Urine

Question 1

What increases prevalence of incontinence?

Answer 1

Middle age
70+ age

Question 2

what is incontinence?

Answer 2

Involuntary enuresis, can be stress, urge, overflow, neurological

Question 3

RF for incontinence?

Answer 3

F (X2)
Multiparity
Increased age
abdo surgery
BPH
Spinal trauma

Question 4

What is urge incontinence?

Answer 4

Overactive
Nocturnal Sx
Key in door

Question 5

what is stress incontinence?

Answer 5

Valsalva is the trigger

Question 6

What is overflow incontinence?

Answer 6

Post retention in BPH + Prostate Ca (cannot empty bladder properly = absent urge = leaks unexpectedly)

Question 7

what is a cause of neurological incontinence?

Answer 7

Cauda equina

Question 8

How is incontinence Diagnosed?

Answer 8

Bladder diary
Urine dip
Urodynamic studies
MRI Spine?
CT Cytogram?

Question 9

Tx for urge incontinence?

Answer 9

1. Bladder retrain
2. Oxybutynin

Question 10

Tx for stress incontinence?

Answer 10

1. Kiegel
2. Duloxetine

Question 11

Tx for neurological incontinence?

Answer 11

Permanent catheter

Question 12

What is retention?
what are the 2 categories?

Answer 12

Acute (painful >600ml) or
Chronic (less painful, discomfort, ~1000 - 1500ml)

Question 13

What causes retention?

Answer 13

BPH
Prostate Ca
Anticholinergics
fecal impaction

Question 14

Dx of retention?

Answer 14

PR exam (r/o faeces)
Urodynamic studies (CT abdo?)

Question 15

Tx of retention?

Answer 15

Analgesia
acutely catheterise

Question 16

Complications of retention?

Answer 16

Hydronephrosis
Pyelonephritis
AKI

Question 17

What is palliation?

Answer 17

care for Px that has less than 3 months to live

Question 18

what are the aims of palliation?

Answer 18

Max QOL
Set affairs in order (Will, LPA)
Maximise spiritual outcome (imam, priest)
Improve family coping

Question 19

What medications can be given for in palliation:
Pain?
Secretion?

Answer 19

Morphine
Hyoscine butyl bromide, Glycopyrronium bromide

Question 20

What medications can be given for in palliation:
N+V?
Dyspnoea?
Agitation?

Answer 20

Metoclopramide (also co-danthramer for constipation)

Midazolam, O2

Haloperidol

Question 21

If a palliative Px can’t take meds PO, how would it be given?

Answer 21

Consider syringe driver mixed with 0.9% saline

Question 22

What is hypothermia?

Answer 22

core body temp <35c with rectal temp

Question 23

Sx of hypothermia?

Answer 23

Shivering
Piloerection
Autonomic change (tachy, htn initially then Brady + hypo)

Question 24

Dx of hypothermia?

Answer 24

Temperature
ECG (Osborn J wave - extra QRS deflection/VF/tachy)

Question 25

Tx of hypothermia?

Answer 25

External rewarming ABCDE

Question 26

what is hyperthermia?

Answer 26

Core body temp >40c with CNS dysfunction 'heat stroke'

Question 27

what are some causes hyperthermia in older and younger Px?

Answer 27

older = increased heat Young = increased exertion

Question 28

Sx of hyperthermia?

Answer 28

Altered mental state Hot flushed skin Hypotensive

Question 29

Dx of hyperthermia?

Answer 29

temperature ECG BP

Question 30

Tx of hyperthermia?

Answer 30

ABCDE IV fluid + cooling

Question 31

Complications of hyperthermia?

Answer 31

DIC Rhabdomyolysis (to AKI)

Question 32

What are nocturnal cramps? who gets them? Tx?

Answer 32

Exclusively geriatric Px with night leg cramps, abnormal posturing and posterior calf tightening Quinine (+ more exercise)

Question 33

what are the SE of quinine?

Answer 33

ECG QRS prolongation, hypotension, metabolic acidosis, tinnitus

Question 34

What does advanced care planning allow for?

Answer 34

Px to put into place care plans In future should they lack capacity

Question 35

What documents does advanced care planning consider?

Answer 35

Lasting power of attorney Advance statements Advance directives RESPECT forms DNA CPR form

Question 36

is an advance statement legally binding?

Answer 36

no

Question 37

what are RESPECT forms used for and are they legally binding?

Answer 37

Recommended summary plan for emergency care + Tx Not legally binding, reviewed + changed regularly

Question 38

What is a DNA CPR used for and is it legally binding?

Answer 38

Legally binding IDEA, will not do CPR if heart stops but will try to save + prolong life (because risks > benefits of resus)

Question 39

in care packages, what 4 things does the NHS provide free?

Answer 39

home adaptations Allowances Help after discharge from hospital NHS continuing healthcare

Question 40

what home adaptations can be installed?

Answer 40

handrails walking frame ramps for wheelchair

Question 41

what allowances can be given in care packages?

Answer 41

PIP Attendance allowance

Question 42

what help can be provided after discharge?

Answer 42

Paid carer (dressing, cooking, cleaning, toilet)

Question 43

what care is given in NHS continuing healthcare?

Answer 43

fully Pais for disabled/severe illness Px care palliative cases usually