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Health and Society Year 4 > MSK/Neurology > Flashcards

MSK/Neurology Flashcards

1
Q

6 factors of the National Service Framework for long term conditions (2005)

A
  • person centered
  • early recognition (prompt diagnosis and treatment)
  • early specialist rehab
  • community rehab
  • palliative care
  • supporting family and carers
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2
Q

Services available for people with neurological conditions

A

NHS: GP, geriatrics, physio, speech/language, specialist clinics
Charities
Private sector
Social services: housing, transport, education, respite care, residential nursing home
Financal/employment services e.g. jobcentre

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3
Q

Prevalence of neurological conditions (from most common to least)

A

essential tremor > epilepsy > Parkinsons Disease > Multiple Sclerosis > dystonia > muscular dystrophy > Huntingtons Disease > Motor Neurone Disease

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4
Q

2 ADL that people with neurological conditions suffer from

A

Everyday tasks

Functional activities e.g. getting up from chair, stairs, bath

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5
Q

International Classification of Disabilities and Handicaps

A

Impairment
Disability
Handicap

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6
Q

Define impairment and give an example

A

Impairment: Disturbance affecting function (psych/physiological)
e.g. amputated leg/muscle pain

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7
Q

Define disability and give an exmaple

A

Disability: Restriction of normal activity from impairment e.g. walking

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8
Q

Define handicap and give an example

A

Handicap: Disadvantage that restricts their role that is normal for that individual
e.g. handicap

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9
Q

Medical and biopsychosocial issues with management of a patient

A

Traditional: problem is for healthcare, patient is passive recipient, relief of pain will cure disability
Biopsychosocial: combined effort between patient and healthcare, management must relieve pain and prevent disability.

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10
Q

Define the Disability Discrimination Act 1995

A

Rights to people with a disability

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11
Q

Define the equality act 2010

A

Physical/mental impairment that has a sustained and long-term effect on your ability to do normal daily activities

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12
Q

Legal requirement for a meningitis infection

A

Notifiable disease

Communicable disease control before microbiological confirmation

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13
Q

Who is responsible to ensure policies are in place and implemented

A

Consultant for communicable disease control (CCDC)

Consultant in public health medicine (CPHM)

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14
Q

What policies are in place for infectious diseases

A
  • referred early to hospital
  • cases investigated properly
  • give prophylaxis to contacts
  • info to schools, NHS
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15
Q

First line medication for meningitis

A

Benzylpenicillin IM at GP whilst awaiting transfer unless allergy

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16
Q

What is the prophylaxis for meningitis

A

Give to those in prolonged close contact in a household setting 7 days before illness or those who had transient close contact at time of admission

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17
Q

What medication do you use for prophylaxis?

A

RIFAMPICIN, ciprofloxacin and ceftriaxone

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18
Q

What immunisations are given for meningitis

A

Men ACWY before uni
MenC

Offer vaccine to close contacts of person affected

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19
Q

4 risk factors for stroke

A

HTN, DM, AF, smoking

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20
Q

Score for AF stroke risk

A

CHADSVASC

congestive heart failure, HTN, age > 65, DM, previous stroke, vascular disease, sex category (1). If you have 9/9 risk is 10-27%

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21
Q

Investigation for stroke

A

CT head

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22
Q

Management of stroke

A

Thrombolysis: Alteplase within 4.5h
Aspirin: 300mg within 24 hrs or after 24 hrs if treated with alteplase

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23
Q

How long do you continue aspirin for after a stroke

A

2 weeks

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24
Q

What secondary prevention medication do you start after 2 weeks

A

Clopidogrel 75mg

Atorvastatin 20-80mg

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25
7 modifiable risk factors for stroke
lipid modification, BP, physical activity, smoking cessation, nutrition, reduce alcohol, control comborbidities
26
Investigations for stroke risk factors
``` ECG ECHO FBC Lipid profile Carotid doppler (stenosis) BP (target 130/80) ```
27
Driving after a stroke
No driving for one month Can continue after if recovery DVLA informed if residual neuro deficit
28
What is the prevention paradox
Majority of deaths come from those with low risk factors and minority come from those with high risk factors Population measures have a large benefit to community, low perceived benefit to individual Targeting high risk groups has a large benefit to individual and small effect on population rate
29
Legal aspects of driving in epileptics
Isolated seizure: group 1: ban for 6m; group 2: ban for 5y Repeat seizures: group 1 need to be free of seizures for 1y, if with-drawing AED then wait 6m; group 2 need to be free for last 10y. Doctors are able to tell DVLA if you continue to drive but it is the patient’s responsibility.
30
Can you join the armed forced if you had epilepsy as a child
No
31
What does the equality act 2010 state about epilepsy
Reasonable adjustments should be made
32
Percentage of over 65's who will have a fall
30% (half of these will have recurrent falls)
33
Percentage of over 90s who will have a fall
55%
34
Percentage of falls which cause a serious injury (and examples)
10% | Fractures, head injury
35
3 psychiatric causes of falling
Fear of falling, social restriction, depression
36
Consequences of falls for carers
Time and anxiety
37
What do QALY show about falls
showed if we could reduce fear of falling may be more benefit than actually treating fractures
38
9 risk factors for hip fracture
age, female, low body weight, smoking, ethnicity, muscle weakness, loss of balance, low bone density, steroids
39
Time until treatment for hip fracture
Within 26 hours
40
2 methods to prevent fractures
prevent with fall prevention, bone protection (Vit D/calcium, bisphosphonates, HRT)
41
5 multifactorial methods to reduce fall risk
target medications, postural hypotension, environmental hazards, gait training, exercise
42
6 people in the falls MDT
Pharmacist, OT, podiatry, GP, physio, nurses
43
Explain 3 types of accommodation for the elderly
Sheltered accommodation w warden control: live in own flat but communal areas, maybe pull cords with responder system Residential homes: staffed by carers but not nurses, not suitable for complex behaviour or mobility issues Nursing homes: nurses and carers: dependent and higher care needs.
44
What should you consider when assessing the elderly for discharge (6)
``` Joint ROM and strength Ability to perform tasks Stairs Toileting Kitchen Cognition ```
45
What are SMART targets used for
Goal setting ``` Specific Measurable Achievable Realistic Timely ```
46
5 interventions for the elderly
strength exercises, mobility work, balance rehab, wheelchair, assessment of home
47
5 discharge options
Home support e.g. package of care from social services Inpatient rehab: try to return a person to their previous level of function Residential home: may be temp (allow respite for carer) or permanent Nursing home: temporary/ permanent. Palliative care: last 6w of life can fast track them there. Discharge to hospice for symptom control or end of life care.
48
2 types of referrals made to social services
NOA notification of assessment (previously section 2s) to request social worker to be allocated. NOD notification of discharge 0 section 5: must be done within 72h of submission of the NOA. Tells social services that patient is both medically and therapy fit for discharge that day and social services input is the only factor delaying.
49
Define capacity
Understand, retain and communicate information | Understand potential risks
50
Can people make unwise decisions
Yes, if they have capacity
51
What happens if a patient lacks capacity and has no next of kin
IMCA (independent mental capacity advocate) needed
52
3 types of care plans
Urgent care plan (crisis) Advanced care plan End of life care plan
53
8 risk factors for substance misuse in the elderly
``` physical mental health long term prescription (painkillers, hypnotics, anti-anxiety) bereavement retirement boredom loneliness homelessness depression ```
54
3 symptoms of substance misuse in the elderly
Memory problems Changes in sleep habits Mood changes
55
What 2 things do nice assess the evidence base for
Clinical and cost-effectiveness
56
What type of appraisals should CCGs have
Technology appraisals to fund the technology
57
Process of technology appraisals
1. Topic selection: consultation with industry, NHS and patient groups, DOH 2. Data submission: all trial data according to NICE 3. Data review: NICE appraisal committee allocates data to academic center for cost-effectiveness 4. Call for contributions: stakeholders 5. Fund: CCG may fund if service is required.
58
Define 'yellow flags' for back pain
Potentially psychosocial pathologies that may prolong recover/outcome
59
Give 6 examples of yellow flags for back pain
- belief that pain/ activity are harmful - abnormal sickness behavior (extended rest) - low/negative mood - work environment (low support/ dissatisfaction) - social problems - seeking treatment that are excessive
60
3 examples of complementary therapy for MSK pain
Osteopathy, Acupuncture, Chiropractic
61
4 advantages of complementary therapy
Patient choice Growing evidence base Cost effective Less invasive
62
3 disadvantages of complementary therapy for back pain
Regulatory issues Lack of evidence Inertia (resistance to change)
63
# Define osteopathy - regulation | - use
Tough physical manipulation, stretching and massage Statutory self-regulation Good for back pain and sports injuries
64
# Define Chiropractor - regulation - use - benefit
Diagnose, treat and prevent MSK - manual treatments for back, neck and shoulder Statutory self-regulation Lower back pain and OA Small benefit after 1 year
65
Define acupuncture | - What do nice recommend it for
Release neurohumoral and endorphins | - headache and migraines
66
Regulation of herbal homeopathy
Self regulated | Accredited with professional standards authority
67
Define the effectiveness gap
A clinical area where treatments are not satisfactory or successful due to a lack of efficacy/acceptability/side effects/compliance e.g. back pain
68
MDT for inflammatory arthritis (11)
GP, Consultant rheumatologist, Rheumatology nurse specialist, Physio, OT, Pharmacist, Radiographer, Social worker, Dietician, Psychologist, Orthopaedic Surgeon

Health and Society Year 4 (9 decks)

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