1
Q
What is Stage 1 HTN?
A
Clinical BP 140/90 to 159/99
OR
ABPM 135/85 to 149/94
2
Q
What is Stage 2 HTN
A
Clinical BP 160/100 to 180/120
OR
ABPM >150/95
3
Q
What is Sage 3/Severe HTN
A
Clinical systolic >180 or clinical diastolic >120
4
Q
How should a HBPM be conducted correctly?
A
For each blood pressure recording, 2 consecutive measurements taken 1 min apart with person seated AND blood pressure recorded twice daily ideally in morning and evening AND blood pressure recording continues for at least 4 days (Ideally 7 days)
5
Q
What are the 2 types of HTN?
A
- Essential HTN = unknown cause (95%)
2. Secondary HTN = known cause (5%)
6
Q
What can secondary HTN be caused by?
A
- Renal –> GN, PCKD, renovascular (atheromatous due to smoking or PVD in older)
- Endocrine –> Conns, Cushing’s, Phaeochromocytoma, Actomeglay
- Coarctation of aorta
- pregnancy
- Steroids
- Pill
7
Q
Name 4 risk factors for HTN
A
- Obesity
- Increasing age
- Lack of exercise
- Family History of HTN or CAD
- Metabolic Syndorme –> DM
- Black ancestry
- Increase alcohol intake
8
Q
Name 3 symptoms of HTN
A
- Usually asymptomatic
- Headaches
- Visual changes –> decreased acuity, floaters
- Dyspnoea
- Chest pain
- Nose bleeds or subconjunctival haemorrhages
9
Q
Name 5 first line investigations
A
- Lipids
- Urinalysis
- FBC –> Hb
- U&Es
- LFTs
- TSH
- HbA1c
- ABPM/HBPM
- QRISK score
- ECG
10
Q
What is the QRISK score?
A
Risk of having a cardiovascular event within the next 10 years
11
Q
What is involved in calculating someone’s QRISK?
A
o Age o Sex o Ethnicity o Smoking status o Diabetes status o Angina/heart attack in 1st degree relative <60 o CKD stage 3, 4 or 5 o AF o Blood pressure treatment o Migraine o Rheumatoid arthritis o SLE o Severe mental illness o Atypical antipsychotic medication o Corticosteroids o Erectile dysfunction o Cholesterol:HDL ratio o Systolic BP and a standard deviation of it o BMI
12
Q
What are the outcomes of QRISK scores?
A
<10% = low risk 10-15% = moderate risk (start statin and modify lifestyle) >20% = high risk
13
Q
What lifestyle modifications would you suggest for someone with HTN?
A
- Reduce salt and fat intake
- Weight loss
- Reduce alcohol consumption
- Smoking cessation
- Increase exercise
14
Q
What is the target BP for adults with HTN <80 years old?
A
<140/90
15
Q
What is the target BP for adults with HTN >80 years old?
A
<150/90
16
Q
What is the target BP for adults with HTN who have Diabetes?
A
<135/85
<130/80 if nephropathy or retinopathy
17
Q
What is the pharmacological treatment of those aged <55 and not black who have HTN?
A
- ACEi or ARB
- CCB
- thiazide like diuretic
- Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
18
Q
What is the pharmacological treatment of those aged >55 or black who have HTN?
A
- CCB
- ACEi or ARB
- thiazide like diuretic
- Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
19
Q
What is the pharmacological treatment of those with diabetes who have HTN?
A
- ACEi or ARB
- CCB
- thiazide like diuretic
- Spirolactone (K+ < 4.5) or Alpha or Beta Blocker (K+ >4.5)
20
Q
Name 3 ACEi that can be used in the treatment of HTN
A
- Ramipril
- Enalapril
- Perindopril
21
Q
Give 3 potential side effects of ACEi
A
- Cough (+ rash) –> due to increased kinin
- Hypotension –> dizziness
- AKI
- Arrhythmias due to Hyperkalaemia
- Erectile dysfunction
22
Q
How do ACEi work?
A
Suppressing ACE which prevents angiotensin I converting to angiotensin II which decreases pressure in heart and therefore workload of heart
Increase Bradykinin levels which causes vasodilation
23
Q
What must you monitor in a patients taking ACEi?
A
Serum Na+ and K+, BP and renal function (U&Es and eGFR)
24
Q
Name 3 ARBs that can be used in the treatment of HTN
A
- Candesartan
- Valsartan
- Losartan
25
Name 3 possible side effects of ARBs
1. Postural hypotension
2. Headache
3. Diarrhoea
4. Renal impairment
26
Name 3 CCBs that can be used to treat HTN and what channels do they act on?
1. Amlodipine
2. Felodipine
3. Verapamil
4. Nifedipine
5. Diltizem
Act of L-type Ca2+ channels
27
Give 3 potential side effects of CCBs
1. Headache
2. Oedema
3. Dizziness and drowsiness
4. ED
28
Name 2 thiazide diuretics that could be used to treat HTN
1. Bendroflumethiazide
| 2. Indapamide
29
Give 3 possible side effects of thiazide diuretics
1. ED
2. Electrolyte disturbances
3. Hyperuricaemia --> gout
30
What is the mechanism of action of thiazide like diuretics?
Inhibits the sodium chloride transporter at the distal portion of the ascending limb and the first part of the distal tubule
This increases water clearance and the excretion of sodium and chloride through the renal tubular epithelium
31
Name 3 beta blockers that can be used in the treatment of HTN
1. Atenolol
2. Propranolol
3. Bisoprolol
32
Give 3 potential side effects of beta blockers
1. Fatigue
2. Headache
3. Bradycardia
4. Hypotension
5. ED
6. Cold peripheries
7. Bronchospasm
33
What is the mechanism of action of beta blockers?
Block the release of adrenaline and noradenaline --> slowing heart rate and reducing force of the heart
34
What should you monitor in a patient taking beta blockers?
Heart rate and BP
35
Define Cardiac Failure
A complex clinical syndrome of signs/symptoms that suggest the efficiency of the heart as a pump is impaired. The heart is unable to deliver blood at a rate that meets the metabolic demands of the body
36
What are the 3 main types of cardiac failure and what causes them?
1. LVSD - often due to IHD
2. RVSD - often secondary to LVSD
3. Diastolic HF
37
What is the ejection fraction?
Compares the amount of blood in the heart and amount of blood pumped out
- The percentage helps describer how well the heart is pumping blood to the body
38
What is considered heart failure with reduced ejection fraction?
Ejection fraction <40%
39
Briefly explain the pathophysiology of cardiac failure
When the heart fails, compensatory mechanisms attempt to maintain CO. AS HF progresses, these mechanisms are exhausted and become pathophysiological
1. Sympathetic activation
2. RAAS activation
3. Natriuretic peptide release
4. Ventricular hypertrophy
40
Give 5 risk factors for developing heart failure
1. History of MI and Coronary Artery Disease
2. DM
3. Dyslipidaemia (increased LDL)
4. Old age
5. Male sex
HTN
6. Valvular heart disease
7. Obesity
8. Sedentary lifestyle
41
Name 3 causes of Heart failure
1. Pump failure --> Heart muscle disease (IHD), restricted filling (constrictive pericarditis), anti-arrhythmic drugs
2. Excessive preload --> mitral regurgitation or fluid overload
3. Chronic excessive after load --> aortic stenosis, HTN
42
What are the 3 cardinal symptoms of cardiac failure?
1. SOB
2. Fatigue
3. Peripheral oedema
Also
4. PND
5. Orthopnoea
43
Give 3 signs of cardiac failure
1. Tachycardia
2. Raised JVP
3. Displaced apex beat
4. Added heart sounds (S3, gallop rhythm)
44
What investigations may you want to do to determine whether someone has cardiac failure?
1. BNP levels
2. CXR
3. Echo
4. ECG
45
What is pro BNP?
```
Inactive peptide (hormone) that is released when the walls of the heart are stretched or there is pressure overload on the heart
- Acts on the kidneys to cause fluid and sodium loss in the urine
```
46
How is pro BNP measured?
```
<400pg/ml = normal, HF less likely
>400 = Echo in 6 weeks
>2000 = Echo within 2 weeks
```
47
Why may someone have a increased proBNP?
1. >70 years old
2. Left ventricular hyeprtrophy
3. Isachamia
4. Tachycardia
5. Renal dysfunction (eGFR <60)
6. COPD
7. DM
8. Cirrhosis of liver
48
Why may someone have a decreased proBNP?
1. Obesity
2. African Caribbean heritage
3. Drugs --> diuretics, BB, ACEi/ARB, MRA
49
What is eGFR?
Estimated glomerular filtration rate = measure of how well your kidneys are working as a filter
- Low GFR = kidneys filtering less
50
What are the stages of CKD?
```
Stage 1 = >90 ml/min
Stage 2 (mild) = 60-89 ml/min
Stage 3a (mild-moderate) = 45-59 ml/min
Stage 3b (moderate-severe) = 30-44 ml/min
Stage 4 (severe) = 15-29 ml/min
Stage 5 (kidney failure) = <15 ml/min
```
51
What might you see on a CXR of someone with cardiac failure?
```
ABCDE
A --> Bat wing alveolar oedema
B --> Kerley B lines
C --> Cardiomegaly
D --> Dilated prominent upper lobe vessels
E --> PLeural effusions
```
52
Why is an ECHO done in someone with suspected heart failure?
It will show whether there is preserved or reduced ejection fraction
53
Briefly describer the NYHA classification for cardiac failure?
Class 1 = no limitation, asymptomatic
Class 2 = slight limitation, mild HF
Class 3 = marked limitation, moderate HF
Class 4 = inability to carry out physical activity without discomfort, severe HF
54
Describe the management of HF
1. Lifestyle modification
2. Main pharmacological benefits are from vasodilator therapy not LV stimulants
- 1st line = ACEi, BB
- 2nd line = 3. ARB, Mineralocorticoid Receptor Antagonist (MRA/aldosterone antagonists),
- Diuretics for symptom relief
- Nitrates and NEP inhibitors can be used too
3. Surgery --> valve replacement and LV remodelling
55
How would heart failure with reduced ejection fraction be treated pharmacologically?
ACEi, BB, ARB, Spirolactone, diuretics
56
How would heart failure with preserved ejection fraction be treated pharmacologically?
Diuretics
57
What is the mechanism of action of a loop diuretic?
Reversibly inhibit the Na+/2Cl-/K+ co-transporter in the thick ascending Loop of Henle where one third of sodium is reabsorbed
58
Name 2 loop diuretics
1. Furosemide
| 2. Bumetanide
59
What is the mechanism of action of a MRA?
MRA = Aldosterone antagonist
Act at the cortical collecting duct to reduce the absorption of sodium and water and increase the excretion of Hydrogen and potassium
60
Give an example of an aldosterone antagonist
Spirolactone
61
What must you monitor in a patients taking MRAs?
Serum Na+ and K+, BP and renal function (U&Es and eGFR)
62
What is the prognosis of cardiac failure?
5 year mortality = 75%
63
Give examples of primary prevention methods for cardiac failure?
1. Healthy lifestyle
2. Reducing alcohol intake
3. Smoking cessation
4. QRISK
5. Statins
6. Correct aggravating factors --> e.g. AF, HTN, DM
64
Give examples of secondary prevention methods for cardiac failure
1. Regularly checking BP
| 2. Regularly checking blood cholesterol
65
Give examples of tertiary prevention methods for cardiac failure
1. Exercise based cardiac rehabilitation
2. Revascularisation procedures --> PCI, CABG
3. Implantable defibrillators
66
What is the NICE traffic light system used for in paediatrics?
It is clinical risk score designed to assist with the assessment and management of febrile children under 5 years old
67
What are the 5 main categories that are assessed the NICE traffic light system?
1. Colour - skin, tongue, lips
2. Activity - response, smile, crying etc.
3. Respiratory
4. Circulation and hydration
5. Other - temperature, rigours, swelling, rash, neck stiffness, seizures etc.
68
How would you manage a child with a green score on the NICE traffic light risk assessment?
You would manage them at home + safety net
Encourage regular fluids, observe for dehydration, monitor for rash, and regularly review the child. Tell the parents to contact a medical professional if parental concern increases
69
How would you manage a child with a amber score on the NICE traffic light risk assessment?
You could refer the child to a paediatric or specialist for further investigation or manage them at home and safety net
70
How would you manage a child with a red score on the NICE traffic light risk assessment?
Urgent referral to a hospital for specialist assessment
71
What is the FeverPAIN Criteria?
Used to determine if a tonsillitis illness is viral or bacterial and whether antibiotics should be prescribed
72
What is assessed in the FeverPAIN Criteria?
- Fever (during past 24hrs)
- Purulence (pus on tonsils)
- Attended rapidly (within 3 days after symptom onset)
- Severely inflamed tonsils
- No cough or coryza (inflammation fo mucus membranes in the nose)
Each scores 1 point = higher score suggests more severe symptoms and likely bacterial (strep)
73
How would you manage a child with a score of 0-1 on the FeverPAIN criteria?
13-18% likelihood of isolating streptococcus --> NO antibiotics
74
How would you manage a child with a score of 2-3 on the FeverPAIN criteria?
34-40% likelihood of isolating streptococcus --> Delayed prescription of Abx if not better
75
How would you manage a child with a score of 4-5 on the FeverPAIN criteria?
62-65% likelihood of isolating streptococcus --> give Antibiotics
76
What is safety netting?
1. Verbal and/or written advice about warning signs/symptoms with a plan of action should these be noticed
2. Arrange follow-up at a specific time and place
3. Liaising with other health care professionals to ensure direct access should the child require it
Advice needs to be clear and easy to follow
77
Give 3 signs of dehydration in children
1. Sunken fontanelle
2. Dry mouth
3. Sunken eyes
4. Absence of tears
5. Poor overall appearance
78
Give 3 common causes of pyrexia in children
1. URTI
2. Tonsilitis
3. Otitis media
4. UTI
5. Pneumonia
6. Measles
79
Give 3 less common causes of pyrexia in children
1. Meningitis
2. Septicaemia
3. Epiglottitis
4. Malignancy
5. Kawasaki Disease
6. TB
80
Name 3 notifiable disease that you may see in paediatrics
1. Meningitis
2. Diphtheria
3. Measles
4. Mumps
5. Meningococcal septicaemia
6. Rubella
7. Smallpox
8. Scarlet fever
9. Tetanus
10. Whooping cough
81
What vaccinations should a child have at 8 weeks?
1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilius influenza (HibB), Hep B (6 in 1)
2. Men B
3. Rotavirus
82
What vaccinations should a child have at 12 weeks?
1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilus influenza (HibB), Hep B = 6 in 1
2. PCV
3. Rotavirus
83
What vaccinations should a child have at 16 weeks?
1. Diphtheria, tetanus, pertussis (DTaP), Polio (IPV), Haemophilus influenza (Hib), Hep B = 6 in 1
2. Men B
84
What vaccinations should a child have at 1 year?
1. Haemophilus influenza (HibB)
2. Men B and C
3. Pneumococcal (PCV)
4. MMR
85
What vaccinations should a child have at 2-6 years?
Influenza vaccine
86
What vaccinations should a child have at 3 years 4 months?
1. Diphtheria, tetanus, pertussis (DTaP)
2. Polio (IPV)
3. MMR
87
What vaccinations should a child have at 12-13 years old?
HPV
88
What vaccinations should a child have at 14 years?
1. Diphtheria
2. Tetanus
3. Polio (IPV)
4. Men ACWY (up to age 25)
89
Name 3 groups of people who are less likely to have vaccines?
1. Homeless
2. Refugees/asylum seekers
3. Children in care
90
Define intellectual disability
Term used when there are limits to a person's ability to learn at an expected level and function in daily life
91
Define Dementia
Chronic decline in memory
| Affects memory and is typically caused by anatomic changes in the brain, has slow onset and is generally irreversible
92
Name 4 risk factors for developing dementia
1. Increasing age
2. Cognitive impairments
3. Learning disabilities
4. Family History
5. Downs syndrome
6. CVD risk factors --> DM, smoking, hypercholesterolaemia, HTN
7. Parkinson's
8. Alcohol Abuse
93
What are the 3 main aspects of dementia?
1. Cognitive impairment
2. Behavioural and psychological symptoms
3. Difficulties with ADLs
94
Give 3 common presenting symptoms of dementia
1. Short term memory loss - amnesia
2. Communication problems - aphasia
3. Difficulty with daily tasks - apraxia
4. Anxious
5. Agnosia - difficulty recognising faces and places
95
Give 4 types of dementia
1. Alzheimers
2. Vascular dementia
3. Lewy bodies
4. Fronto-temporal
96
Give 2 histological signs of Alzheimers
1. Plagues of B-amyloid aggregation
| 2. Neuronal reduction
97
Give the main features of Alzheimers
1. Early episodic memory impairment
| 2. Gradual deterioration
98
Describe the treatment for Alzheimer's
Anticholinesterase inhibitors
- Donepezil
- Rivastigmine
99
What symptoms might you see in someone with vascular dementia?
- Gait and attention problems
- Personality changes
- Focal neurological signs
- More sudden onset than AD
100
With what type of dementia would you associate TIA's?
Vascular dementia
| - Also associated with HTN
101
What symptoms might you see in someone with Lewy body Dementia?
- Repeated falls
- Transient LOC
- Autonomic dysfunction
- Hallucinations
102
What disease is often associated Lewy body dementia?
Parkinson's Disease
103
What symptoms might you see in someone with Fronts-temporal dementia?
- Personality change
- Behavioural disturbances
- Memory and perception may be relatively preserved
104
Which disease is fronto-temporal dementia often associated with?
MND
105
Name 3 dementia screening tools that can be used in primary care
1. 6-CIT (out of 28, >8 = significant, higher = worse)
2. MMSE (out of 30, <18 = some form of cognitive impairment, lower = worse)
3. GP-COG
106
What investigations might you do in a 'confusion screen'?
1. Vital signs
2. Bloods
- FBC --> infection, anaemia, malignancy
- U&E --> hypo/hyper Na+
- LFT --> liver failure with encephalopathy
- Coagulation/INR --> intracranial bleeding
- TFTs --> hypo/hyper thyroidism
- Calcium --> hyper/hypo Ca
- B12/folate/haematinics --> deficiency
- Glucose/HbA1c --> hypo/hyperglcyaemia
- Blood cultures
- Inflammatory markers
- Drug levels --> toxicity of digoxin, lithium or alcohol
3. Urine tests = MCS MSU
4. Sputum culture
5. CXR --> rule out pneumonia
107
What are specialist investigations you may do if you suspect someone has dementia?
1. MRI/CT head --> rule out intracranial pathology
2. ECG --> arrhythmias
3. EEG --> if evidence of any seizures
4. LP --> if meningism
5. Check anticholinergic burden
108
Give 4 differential diagnoses for dementia
1. Normal age related memory changes
2. Delirium
3. Mild cognitive impairment
4. Depression
5. Normal pressure hydrocephalus
6. Sensory deficits
109
Describe the management of dementia
1. Refer for formal diagnosis
2. Open and sensitive discussion with patient and family
3. Encourage use of memory aids --> notebooks, medication dispensers
4. Dementia drugs
5. Refer to services --> admiral nurses and charities
110
Where would you refer someone who you suspect has dementia?
1. Memory clinic
| 2. Old age psychiatrist
111
Name 3 services available for dementia sufferers
1. Dementia UK and Dementia Friends
2. Alzheimers society Sheffield
3. Admiral nurses
4. Age UK
5. Memory Clinic
112
Define Delirium
Acute, fluctuating syndrome of disturbed consciousness, attention, cognition and perception
Affects mainly attention and is typically caused by acute illness or drug toxicity and is often reversible = disturbance of consciousness with reduced ability to focus, sustain or shift attention
113
What are the types of delirium?
1. Hyperactive --> marked by increased motor activity, agitations, hallucinations, inappropriate behaviour and vigilance
2. Hypoactive --> marked by lethargy with a decrease in motor activity (poorer prognosis)
114
Give 4 signs of delirium
- Easily distracted
- Less aware of where they are or what time it is (Disorientation)
- Suddenly not be able to do something as well as normal
- Unable to speak clearly or follow a conversation
- Sudden mood swings
- Have hallucinations – seeing or hearing things, often frightening
- Have delusions or become paranoid
115
Name 4 possible causes of delirium
PINCH ME
1. Pain
2. Infection
3. Nutrition
4. Constipation
5. Hydration
6. Medications/metabolic
7. Environment
116
What is the CAM criteria for dementia?
Confusion Assessment Methods Criteria = diagnostic algorithm based on the 4 cardinal symptoms of delirium
- Need to have 1, 2 AND either 3 or 4 present
1. Sudden onset confusion
2. Inattention
3. Disorganised thinking
4. Altered level of consciousness
117
How is delirium treated?
Treat the underlying cause
118
What is mental capacity?
The patients ability to make a decision about their care
119
What are the 5 key principles of the MCA?
1. Person must be assumed to have capacity unless it is established that he lacks capacity
2. A person is not to be treated as unable to make a decision unless all practical steps to help them to do so have been taken without success
3. A person is not to be treated as unable to make a decision merely because it is an unwise decision
4. An act done, or decision made under this act or on behalf of a person who lacks capacity must be done or made in their best interests
5. Before decision is made, regard to whether the purpose for which it is needed can be effectively achieved in a way that is less restrictive to that person’s rights and freedom
120
What 4 questions can be asked to assess mental capacity?
1. Does the patient Understand the information relevant to the decision?
2. Can the patient Retain the information?
3. Can they use the information to Weigh up the options and make a decision?
4. Can they Communicate their decision to you?
121
What is DOLS?
Deprivation of Liberty Safeguards
DOLS are part of the MCA, the safeguards aim to ensure that people in care homes or hospitals who lack capacity are looked after in a way that has their best interests at heart
122
What questions should be asked when determining whether something is in the patients best interests?
1. What are the patient's past/present wishes or feelings relating to the decision?
2. What are the patient's values and beliefs relating to the decision?
3. Are there any other factors that the patient would want to be considered?
4. What are the risks/benefits of each option?
5. Consider other factors e.g. future implications and safety concerns
123
What is an IMCA?
Independent Mental Capacity Advocate = a legal safeguard for people who lack capacity
They represent people when there is no one independent of service --> e.g. no family members/friends
124
What is the ICD-10 criteria for depression?
1. Persistent low mood
2. Loss of interest
3. Fatigue or low energy
125
Give 5 risk factors for depression
1. Female
2. Past history or family history of depression
3. Chronic illness
4. Alcohol/substance misuse
5. Traumatic events --> bereavement, abuse
6. Lack of social support
7. Low socioeconomic status
126
Give 5 physical symptoms of depression
1. Sleep disturbance
2. Unexplained aches/pains
3. Appetite change
4. Loss of libido
5. Changes to menstrual cycle
6. Weight change
7. Slowness or fidgety
127
Give 5 psychological symptoms of depression
1. Continuous low mood
2. Feeling hopeless
3. Tearful
4. Guilty
5. Lacking motivation/interest
6. Anxious
128
Give 3 social symptoms of depression
1. Less productive at work/school
2. Avoiding contact with friends/family
3. Neglecting hobbies and interests
4. Difficult relationships
129
Give 5 differentials for depressions
1. Dementia
2. Hypothyroidism
3. Parkinson's disease
4. Chronic disease
5. Grief
6. Anxiety disorders
7. Bipolar diorders
8. Cancer
130
What investigations might you do in someone with depression and why?
Bloods --> glucose, U&Es, LFT, TFT, Ca, FBC, ESR/CRP
Imaging if there are features suspicious of an intracranial lesion
Done to exclude any organic cause
131
Name a screening tool for depression that can be used in primary care
PHQ-9
| - Higher the score = more severe (out of 27)
132
How would you among mild-moderate depression?
1. Active monitoring
2. Low intensity psychological intervention --> IAPT, CBT
3. Encourage lifestyle changes such as exercise, smoking cessation and healthy diet
133
How would you manage moderate-severe depression?
1. High intensity psychological intervention
| 2. Anti-depressant --> SSRIs, SSNRI, NASSAs, TCA, MAOIs
134
Name 3 Selective Serotonin Reuptake Inhibitors (SSRIs)
1. Fluoxetine
2. Citalopram
3. Sertraline
135
Name a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SSNRI)
Duloxetine
| Venlafaxine
136
Name a Noradrenaline and specific serotogenic antidepressants (NASSAs)
Mirtazapine
137
Name a Tricyclic antidepressant (TCA)
1. Amitriptyline
| 2. Clomipramine
138
Name a Monoamine oxidase inhibitor (MAOI)
1. Tranylcypromine
| 2. Phenelzine
139
Give 5 risk factors for suicide
1. Previous suicide attempt
2. Family history of suicide
3. History of self-harm
4. Feeling hopeless
5. History of substance misuse
6. Relationship problems
7. Access to harmful means --> medications, weapons etc
140
What questions may you ask to assess someones suicide risk?
1. Do you ever feel hopeless and that life is not worth living?
2. Do you ever think about taking your own life?
3. Have you made any plans to end your own life?
4. Do you have the means for doing this available to you?
5. What has kept you from acting on these thoughts?
141
Briefly describe section 2 of the mental health act
Admission for assessment --> allows compulsory admission for up to 28 days for assessment
142
Briefly describe section 3 of the mental health act
Admission for treatment --> allows compulsory admission for up to 3 months for treatment
143
Briefly describe section 4 of the mental health act
Emergency admission --> compulsory admission for 72 Hours
144
Briefly describe section 135 of the mental health act
A magistrate can authorise forced entry into a property where it is believed that a person is suffering from a mental health disorder
145
Briefly describe section 136 of the mental health act
Used by police to take someone suffering from a mental health disorder form a public place to a place of safety
146
Give 4 physical signs of anxiety
1. Restless
2. Difficulty falling asleep due to racing thoughts
3. Dizziness
4. GI Disturbance --> Nausea, diarrhoea, constipation
5. Increased HR, BP and sweating
6. Muscle tension
7. Shortness of breath
147
Give 3 psychological symptoms of anxiety
1. Excessive worry
2. Uncontrollable racing thoughts
3. Difficulty concentration due to agitation or racing thoughts
4. Sense of dread and fearing the worst
5. Feeling tense and nervous and unable to relax
6. Rumination = thinking about bad experiences over and over again
148
Name 3 possible causes of anxiety
1. Family history
2. Female
3. Traumatic events
4. Other mental health problems
5. Chronic illness
6. Medications --> antidepressants, corticosteroids, OCP
7. Menopause
149
Name 4 differential diagnosis of anxiety
1. Generalised anxiety
2. Social anxiety
3. Panic disorders
4. Phobias
5. PTSD
6. Obsessive Compulsive disorders
7. Health anxiety
8. Body dysmorphic disorder (BDD)
150
What is generalised anxiety?
Regular or uncontrollable worries about many different things in everyday life
- Subjective experience of nervousness
151
What is social anxiety?
Experience of extreme fear or anxiety triggered by social situation (parties, workplaces, or everyday situations where you have to speak to a different person)
152
What is a panic disorder?
Having regular or frequent panic attacks without clear cause or trigger
153
What are the characteristic features of panic disorders?
- Crescendo of the anxiety usually resulting in an exit from the direction
- Somatic symptoms --> palpitations, sweating, trembling,SOB, chest pain, dizziness
- Secondary fear of dying/losing control
154
What is a phobia?
Extreme fear or anxiety triggered by a particular situation
| - HAve anticipatory features
155
Give 2 examples of phobia
1. Agoraphobia = crowds, public places, leaving home
2. Claustrophobia = small, enclosed spaces
3. Arachnophobia = spiders
4. Social phobia
156
What is PTSD?
Anxiety problems have occurred after going through something you found traumatic, flashbacks and nightmares that feel like you are reliving the fear
157
What are the characteristic features of PTSD?
- Hyperarousal --> persistently heightened perception of current threat
- Avoidance of situation/activities
- Emotional numbing
- Re-experiencing --> flashbacks, nightmares
158
What are obsessive compulsive or related disorders?
Anxiety problems involve repetitive thoughts, behaviours and urges including
- OCD
- Body dysmorphic disorder (BDD)
- Body-focused repetitive behaviour disorders
- Hypochondriasis (health anxiety disorder)
- Hoarding disorder
Typically, repetitive thoughts are intrusive and distressing and the repetitive behaviours are compulsive habitual means or reducing distress which become difficult for the person to control
159
What screening tool for anxiety can be used in primary care?
GAD-7 Questionnaire
| - Out of 21, >5 = mild, >10 = moderate, >15 = severe anxiety
160
Describe the treatment of anxiety
1. Psychoeduction, sleep hygiene, self guided CBT, relaxation techniques
2. CBT
3. Pharmacological treatments
161
What pharmacological treatments can be used for the treatment of anxiety?
- SSRI = sertraline, citalopram
- SNRI = duloxetine
- Pregabalin (if SSRI/SNRI are CI, avoid is history of substance misuse)
- Beta blockers --> propranolol for situational anxiety, more for the physical effects
162
What is the Mental State Examination (MSE)?
Gives you a snapshot of a patient's emotion, thoughts, and behaviour at he time of observation
- Can help identify the presence and severity of mental health conditions and the risk a patient poses to themselves and/or others
163
What is included in a MSE?
1. Appearance and behaviour
2. Speech
3. Mood and Affect
4. Thought
5. Perception
6. Cognition
7. Insight
164
Give 3 physical effects of drug use
1. Complications of injecting
2. Overdose
3. Poor pregnancy outcomes
4. Blood borne virus trasmission
5. Side effects of opiates/cocaine
165
Give 3 social effects of drug use
1. Effects on families and relationships
2. Imprisonment
3. Social exclusion
166
Give 3 psychological effects fo drug use
1. Fear of withdrawal
2. Craving
3. Guilt
167
Give 3 signs of addiction
1. Cravings
2. Tolerance
3. Compulsive drug seeking behaviour
4. Physiological withdrawal state
168
When treating substance misuse, what are the treatment aims?
1. Reduce harm to user, friends and family
2. To improve health
3. To stabilise lifestyle and reduce illicit drug use
4. Crime reduction
5. Reduce risk taking behaviour and blood borne virus transmission
169
Briefly describe the different methods of treatment of substance misuse
1. Harm reduction
2. Detoxification --> Lofexidine, Buprenorphine
3. Maintenance --> Methadone
4. Relapse prevention --> Naltrexone
5. Psychological interventions
6. Alternative therapies
170
What are the aims of basic harm reduction in substance misuse?
1. Action to prevention death --> not injecting/injecting safely, reduce amount taken
2. Action to prevent BBV transmission --> not sharing needles, safe sex, Hep A/B vaccination
3. Refer to specialist services
171
Opioid misuse: in what type of people would maintenance therapy be indicated?
1. Those who have been addicted for a long time
| 2. IVDU
172
How could you prevent relapse in opioid use?
1. Provide plenty of support
2. Naltrexone tablets
3. Stabilise and offer maintenance therapy
173
What is the mechanism of action of heroin?
Acts at opiate receptors
| Addictive because it is high reward for minimal effort
174
Give 3 effects of heroin
1. Euphoria
2. Intense relaxation
3. Drowsiness
175
Give 3 adverse effects of heroin
1. Dependence
2. Withdrawal
3. Physical complications
4. Overdose
176
How could you treat a heroin addiction?
Provide a substitute --> methadone
177
What is the mechanism of action of cocaine?
Blocks re-uptake of mood enhancing neurotransmitters at the synapse leading to feelings of intense pleasure
178
Give 3 effects of cocaine
1. Confidence
2. Euphoria
3. Impulsivity
4. Alertness
179
Give 3 adverse effects of cocaine
1. Anxiety
2. HTN
3. Arrhythmias
4. Dysphoria
5. Depression
6. Paranoia
7. Psychosis
180
How can you treat a cocaine addiction?
No substitute so harm reduction --> advice on risky behaviour, safe sex, BBV advice, HepB/C testing
181
What formula is used to work out how many units of alcohol are in a drink?
Strength of drink (%ABV) X Volume (ml) / 1000
182
Describe the metabolism of ethanol into water and carbon dioxide
Ethanol --> ADH --> acetaldehyde --> ALDH --> acetate --> CO2 + H2O
183
What is the recommended alcohol units?
| What is considered problem drinking?
Recommended = 14 units per week, spread over at least 3 days
Problem drinking = prolonged alcohol use above the defined limits
184
What is problem drinking characterised by?
- Craving
- Tolerance
- Continuing to drink despite harmful consequences
- Preoccupation with alcohol
185
Give 5 causal factors for problem drinking
1. Occupation factors
2. Availability of alcohol
3. Advertising
4. Peer group
5. Gender
6. Biological variability
7. Family
186
Give 3 reasons why women are drinking increasingly more
1. It is more socially acceptable
2. They have more disposable income
3. More drinks are targeted at women
187
Define harmful drinking
Pattern of alcohol consumption causing health problems directly related to alcohol
188
Who would you screen for alcohol dependency?
- Relevant physical conditions --> HTN, GI disorders, liver disorders
- Relevant mental health problems --> anxiety, depression, other mood disorders
- Those who have been assaulted
- At risk of self-harm
- Regularly experience accidents or minor trauma
- Who regularly attend GUM clinical or seek emergency contraception?
189
Name 2 alcohol screening tools
1. CAGE
| 2. AUDIT
190
What are the questions asked in CAGE?
1. Have you ever thought about Cutting down?
2. Have you ever felt Annoyed by people telling you to cut down?
3. Have you ever felt Guilty about your drinking?
4. Eye opener – have you ever had a drink first thing in the morning?
191
What questions are asked in AUDIT?
AUDIT-C = first 3 questions of full AUDIT questionnaire
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day?
3. How often do you have >6 units on a single occasion?
>8 = hazardous drinking, >16 - harmful, >20 = possible dependency
192
What are the best markers of alcohol use on blood tests?
GGT and MCV --> both raised
193
Name 3 public health interventions that help to reduce alcohol abuse
1. Minimum price per unit and reduce supply
2. Screening and brief intervention
3. Drinkaware campaigns
194
What are the most common causes of death due to alcohol?
1. Accidents and violence
2. Malignancies
3. Cerebrovascular disease
4. CHD
195
Give 5 alcohol related health problems
1. GI problems
2. Liver disease --> 50% fatty liver, 20% cirrhosis
3. CV problems --> increased risk of hyperlipidaemia, HTN, AF
4. Neurological problems
5. Birth defects --> low birth weight, FAS
6. Malignancy
196
Name 3 cancer that are commonly associated with alcohol
1. Head and neck
2. Liver
3. Pancreatic
4. Stomach
5. Colon
6. Rectum
7. Breast
197
Name 3 symptoms of alcoholic hepatitis
1. Anorexia
2. Nausea
3. Abdominal pain
4. Weight loss
198
Give 3 symptoms of mild alcohol withdrawal
1. HTN
2. Tachycardia
3. Anorexia
4. Anxiety
5. Insomnia
6. Diaphoresis
7. Irritability
8. Headache
9. Fine tremor
199
Give 3 symptoms of moderate alcohol withdrawal
1. Worsening mild symptoms
2. Agitation
3. Coarse tremor
200
What is delirium tremens?
= severe alcohol withdrawal
| Short lived toxic confused state due to reduced alcohol intake in alcohol dependent individuals
201
Name 3 symptoms of delirium tremens
1. Confusion/delirium
2. Seizures = generalised tonic clonic
3. Hallucinations --> auditory, visual or tactile
4. Tremor
5. Hyperthermia subsequent to psychomotor agitation
202
How can you treat delirium tremens?
Detoxification using benzodiazepines --> Lorazepam
203
What disease can result from thiamine deficiency?
Wernicke's encephalopathy
204
What are the triad of symptoms seen in Wernicke's encephalopathy?
1. Acute confusion
2. Ataxia
3. Opthalmoplegia
205
How do you treat Wernicke's encephalopathy?
IV or IM thiamine
206
What complication can arise if you fail to treat Wernicke's encephalopathy?
Korsakoff syndrome = non reversible
207
Alcohol dependancy: What is brief intervention?
Short, evidence-based, structured conversation about alcohol consumption to motivate and support individual considering change in alcohol habits
- Support networks, risk about drinking, advice about reducing drinking
- Emotional issue around drinking an drinking diaries
- Tips for social drinking
208
Alcohol dependancy treatment: When should abstinence be recommended?
- If on antipsychotics, metronidazole or terbinafine
- Have liver or heart disease
- Are pregnancy or becoming pregnant
209
Alcohol dependancy treatment: When should withdrawal medications be give?
- Alcohol dependency of >20 units a day
| - Previously experienced withdrawal symptoms
210
Name 4 possible alcohol withdrawal medications and how they work
1. Acamprosate --> relieves cravings
2. Disulfiram --> make you suffer when drinking
3. Naltrexone --> block opioid receptors in the brain
4. Nalmefene --> opioid system modulator
211
What is the first line treatment for alcohol withdrawals?
Chlordiazepoxide hydrochloride or diazepam
212
Describe the aetiology of vaginal discharge
1. Physiological causes --> puberty, pregnancy, ovulation
2. Infection
3. Foreign bodies
4. Malignancy
213
Name 3 organisms that can cause abnormal vaginal discharge
1. Bacterial vaginosis
2. Candida
3. Trichomoniasis
214
What discharge would you classically get with Trichomoniasis?
Frothy yellow/green offensive smelling discharge
| - can also have itching and dysuria, strawberry cervix
215
What discharge would you classically get with Bacterial vaginosis?
Profuse, thin, whitish/grey, offensive smelling discharge
216
How would you diagnose BV?
Amsels Criteria = need 3/4 of criteria
1. Thing white homogenous discharge
2. Clue cells on microscopy wet mount
3. pH of vaginal fluid >4.5
4. Release of fishy odour on adding alkali
217
What discharge would you classically get with Candida?
Thick, curd like white discharge (cottage cheese)
| Vulval itching/soreness is also associated with thrush
218
Give 4 symptoms/signs of chlamydia
1. Asymptomatic = 60-70%
2. Discharge --> pale, thick
3. Dysuria
4. Irregular bleeding --> PCB, IMB
5. Pelvic pain
6. Cervical motion tenderness
219
Give 4 symptoms of gonorrhoea
1. Asymptomatic (less than chlamydia)
2. Discharge = odourless, purulent, green/yellow
3. Low abdominal pain
4. Irregular bleeding
5. Dysuria
220
How would you treat Trichonomasis?
Metronidazole 2g single oral dose
OR
Metronidazole 400-500mg BD for 5-7 days
221
How would you treat BV?
Metronidazole 2g single oral dose
OR
Metronidazole 400-500mg BD for 5-7 days
222
How would you treat candida?
Clotrimazole 500mg pessary +/- topical clotrimazole cream
OR
Fluconazole single dose (CI in pregnancy)
223
How would you treat chlamydia?
Azithromycin single dose OR doxycycline BD for 7 days
| Pregnant = erythromycin bd 10-14 days
224
How would you treat gonorrhoea?
IM ceftriaxone 1g --> if sensitivities are not known
- Ceftriaxone IM stat + Azithromycin stat
Oral ciprofloxacin 500mg --> if sensitivities are known
225
Give 3 possible symptoms of herpes
1. Painful blisters
2. Vaginal/urethral discharge
3. Local oedema
4. Tingling/neuropathic pain in genital are, lower back, buttocks or legs
226
Give 3 risk factors of someone having a STI if they present with abnormal vaginal discharge
1. Multiple partners
2. Not using contraception
3. Under 25
4. Previous STI
5. New partner
227
What STIs can be screened for using a blood test?
1. HIV
| 2. Syphilis
228
How are chlamydia and gonorrhoea screened for>
NAAT
In women = vulvo-vaginal or endocervical swab
In men = first catch urine
229
When is the best time to get tested for STIs?
* Gonorrhoea = 2-30 days after exposure
* Trichomoniasis = 5-28 days after exposure
* Chlamydia = 1-3 weeks after exposure
* Syphilis = 10 days – 3 months after exposure
* Herpes = 2 weeks – 3 months after exposure
* Hepatitis B = 3 weeks – 2 months after exposure
* HIV = 4 weeks - 3 months after exposure
* Hepatitis C = anytime up to 6 months after exposure
230
Describe the mechanism of action of the COCP
Negative feedback effect of oestrogen prevents LH surge and so inhibits ovulation
The progesterone inhibits proliferation of the endometrium therefore creating unfavourable conditions for implantation
The thickness of the cervical mucus increases too
231
Give 3 advantages of combined hormonal contraception
1. More effective that barrier methods
2. Periods tend to be lighter and less painful
3. Reduce risk of ovarian, uterus and colon cancer
232
Give 3 disadvantages of combined hormonal contraception
1. User dependent
2. Increased risk of VTE
3. Small increased risk of breast and cervical cancer
4. Doesn't protect against STIs
5. Headaches
6. Mood swings
233
Who might combined hormonal contraception be contraindicated in?
- BMI >35
- Smokers aged >35
- Family history of VTE
- History of migraines with aura
234
What is used to provide guidance on what method of contraception women should be on?
UKMEC = Determines what methods of contraception are safe to use --> screening and contraindications
4 categories --> category 4 = complete contraindication
235
Give 3 examples of progesterone only contraception
1. Progesterone only Pill (POP)
2. Implant
3. Injection = Depo-Provera
236
What is the mechanism of action of the progesterone only pill (POP)?
Thickens cervical mucus thereby preventing sperm penetration, delays ovum transport, inhibits ovulation, and provides an endometrium hostile to implantation
237
Give an example, an advantage and a disadvantage of the POP
```
Cerazette
Advantages
1. Can be used if COCP is CI
2. More effective than barrier methods
Disadvantages
1. User deppend
2. Irregular periods
3. Doesn't protect against STIs
```
238
Give an advantage and disadvantage of the contraceptive implant
Advantages
1. Extremely effective and lasts 3 years
2. Safe during breast feedings
Disadvantages
1. Irregular periods/bleeding
2. Fitting and removal can cause pain
3. Doesn't protect against STIs
239
Give an advantage and disadvantage of the contraceptive injection
```
Advantages
1. Extremely effective and lasts 3 months
2. No known interactions
3. Can be use din women with BMI >35
Disadvantages
1. Irregular periods/bleeding
2. Osteoporosis risk with long term use
3. Doesn't protect against STIs
4. Weight gain
```
240
What is the mechanism of action of the levonorgestrel IUS (minera coil)?
Acts mainly via its progestognenic effect on the endometrium, which prevents implantation of the fertilised ovum
Changes in cervical mucus also inhibit the penetration of sperm into the uterus
241
Give an advantage and disadvantage of the Minera Coil
```
Advantages
1. Extremely effective and lasts 3-5 years
2. Periods are usually lighter
3. Safe to use when breastfeeding
Disadvantages
1. Irregular periods
2. Headaches, acne, breast tenderness
3. Doesn't protect against STIs
```
242
What is the mechanism of action of the Copper IUD?
Inhibits fertilisation by its toxic effect on sperm and ova
| If fertilisation does occur, the Cu-IUD has an anti-implantation effect
243
Give an advantage and disadvantage of the Copper IUD
Advantages
1. Extremely effective and lasts 5-10 years
2. No hormonal side effects
3. Can be used as emergency contrception
Disadvantages
1. Periods may become heavier or more painful
2. Perforation of uterus
3. Doesn't protect against STIs
244
Teenage pregnancy can result in what negative outcomes for both mother and child?
1. Poor health
2. Lower academic achievement
3. Lower socioeconomic status
4. Lower self esteem
5. Under achievement at work
245
Give 3 reasons why teenagers may discontinue contraception
1. Side effects --> acne, weight gain etc
2. Mood changes
3. Fertility concerns
4. Bleeding patterns
246
What are the Fraser Guidelines?
The following criteria judge the competence of a young person to make decisions about contraception without parental consent
1. The patient understands the advice given
2. The patient cannot be persuaded to inform their parents
3. It is likely that the patient will continue to have sexual intercourse with or without contraception
4. The patient's physical or mental health may suffer as a result of withholding contraceptive advice or treatment
5. It is in the best interests of the patient and the doctor to provide contraception advice and treatment without parental consent
247
What is Gillick Competence?
Children under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed
- Decision by decision basis
For a young person under the age of 16 to be competent, she/he should have
- Ability to understand that there is a choice and that choices have consequences
- Ability to weigh information and arrive at a decision
- A willingness to make a choice
- An understanding of the nature and purpose of the proposed intervention
- An understanding of the proposed interventions risks and side effects
- An understanding of the alternatives to the proposed intervention and the risks attached to them
- Freedom from undue pressure
248
Give 3 advantages of a friend or family member acting as an interpreter
1. Readily available --> useful in emergency
2. Trusted by patient
3. Provides vital clinical information
4. Provides accurate cultural context
249
Give 3 disadvantages of a friend or family member acting as an interpreter
1. Threat to confidentiality and safeguarding concerns
2. Could dissuade patient from disclosing information
3. Poor grasp of medical terminology
4. Embarrassing or emotionally distressing
5. Difficult to check accuracy of interpretation
250
Give 3 advantages of a using a professional interpreter
1. Non judgemental and confidential
2. Degree of assurance
3. Neutral and passive
4. Cultural context
251
Give 3 red flag symptoms of a cough
1. Haemoptysis
2. Hoarseness
3. Peripheral oedema with weight Gian
4. Prominent dyspnoea
5. Smokers
6. Systemic symptoms
7. Swallowing difficulties
252
Give 4 possible symptoms of TB
1. Cough >3 weeks, usually productive and can contain blood
2. Dyspnoea - gradually increasing
3. Night sweats
4. Fatigue
5. Fever
6. Weight loss
253
What investigations would you do for latent TB?
1. Mantoux test
| 2. Interferon Gamma Release Assay (if active TB excluded and +ve Mantoux)
254
What induration on a Mantoux test gives a positive result for TB?
>5mm
255
Who should have a Mantoux test?
- Those who are 18-65 years old who are close contacts of a person with pulmonary or laryngeal TB
- Immunocompromised adults
- New entrants from high incidence countries
- Healthcare worker who have not had BCG or are a new entrant from a high incidence country
- Children under 18
256
How is latent TB diagnosed?
Positive Mantoux test AND positive IGRA
257
What investigations are done for suspected active TB?
- TB culture samples --> 3 resp smaples, 1 early morning
- CXR
- NAAT
- Bloods
258
What stain is used for TB microscopy?
Ziehl Neelsen stain for acid fast bacilli
259
What stain is used for TB cultures?
Lowenstein Jensen media
260
What is the treatment for latent TB?
Isoniazid for 6 months
AND
Rifampicin for 3 months
261
What is the treatment for active TB?
Rifampicin and Isoniazid for 6 months
Pyrazinamide and Ethambutol for 2 months
(All are hepatotoxic drugs)
262
Give a side effect of Rifampicin
Red/orange discolouration of secretions --> urine, tears
263
Give a side effect of Isoniazid
Peripheral neuropathy
| - Prescribed with pyridoxine (B6) to reduce this risk
264
Give a side effect of Pyrazinamide
Hyperuricaemia --> gout
265
Give a side effect of Ethambutol
Colour blinding
| Reduced visual acuity
266
What other management considerations need to be thought of when dealing with someone with TB?
1. Contact Tracing
- Screen close contacts
2. Notify Public health
3. Test for other infectious diseases
267
When should PHE be notified of a TB case?
Within 3 working days of making or suspecting the diagnosis
| Within 24 hours if immediate public health action will be needed
268
Give 3 potential causes of homelessness
Relationship breakdown due to
1. Mental illness
2. Domestic abuse
3. Dispute with parents
4. Bereavement
269
Give 3 groups of people who are more vulnerable to homelessness
1. Substance misusers
2. Failed asylum seekers
3. People who are/have been in care
4. Ex-service men and women
5. LGBTQ+
270
What health problems do homeless adults face?
1. Infectious disease --> TB, hepatitis
2. Dental problems
3. Respiratory problems
4. Injuries following violence/rape
5. Sexual health problems
6. Serious mental illness - schizophrenia, depression
7. Malnutrition
271
What barriers to care do homeless people face?
1. Difficulty accessing health care
2. Lack of integration between primary care services and other agencies
3. People may not prioritise health when there are other more immediate health problems
4. May not know where to find help
5. Communication difficulties
272
Define refugee
A person granted asylum and refugee status in the UK
- They have the rights of a UK citizen
- After 5 years of refugee status --> can apply for Indefinite Leave to Remain (ILR) and after a year of ILR can apply for British citizenship
273
Define asylum seeker
A person applying fo refugee status
| They are entitled to £35 a week, housing and NHS care
274
What barriers to care do asylum seekers and refugees face?
1. Language/cultural/communication problems
2. Money/other priorities
3. Different perceptions of care
4. Racism, prejudice, discrimination, stigma
5. May not understand how the NHS works
6. Lack of knowledge about where to get help
275
What health problems do refugees and asylum seekers face?
1. Injuries from war/travelling
2. No previous health surveillance/immunisations
3. Malnutrition
4. Injuries from torture and sexual abuse
5. Blood borne and infectious disease
6. Untreated chronic disease
7. PTSD, depression, psychosis
276
Define social exclusion
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society
277
Give 3 causes of loneliness
1. Poor health, sensory impairment
2. Poverty
3. Housing issues
4. Fear of crime
5. Lack of transport
6. Discrimination
278
Give 3 signs of loneliness
1. Talkative, clinging
2. Lives alone
3. Recent bereavement or transition
4. Mobility problems or sensory impairment
279
Give 3 national initiative to combat loneliness
1. Age UK
2. Silverline
3. Dementia Friends
280
Give 3 Sheffield initiatives to combat loneliness
1. Age Better
2. Active Sheffield
3. Darnall Dementia Care
281
What is erectile dysfunction?
The inability to attain and maintain an erection sufficient for satisfactory sexual performance
282
Give 3 risk factors for erectile dysfunction
1. Lifestyle factors --> obesity, smoking, alcohol
2. Hypercholesterolaemia
3. HTN
4. DM
283
Give 5 potential causes of erectile dysfunction
1. Neuro --> brain injury/spinal cord disease
2. CV disease --> atherosclerosis, HTN
3. Psychogenic --> psychosexual disorders, depression, anxiety
4. Endocrine --> thyroid disease
5. Medications --> BB, diuretics, antidepressants
284
ED: what points in a history are suggestive of a psychogenic cause?
1. Sudden onset
2. Early collapse
3. Problematic relationship
285
ED: what points in a history are suggestive of a organic cause?
1. Gradual onset
2. Normal ejaculation
3. Normal libido
4. RFs present
286
What investigations might you do to determine the cause of someones erectile dysfunction?
1. Fasting glucose
2. HbA1c
3. Lipid profile
4. FSH/LH/Prolactin
287
Briefly describe the management of ED
1. Treat RF's
2. Refer for counselling
3. Phosphodiesterase inhibitors e.g. Tadalafil
4. Vacuum devices
5. Injections
6. Penile prosthesis
288
Name a phosphodiesterase inhibitor and describe how they work
Tadalafil, Viagra
| Increase the blood flow to the corpus cavernous
289
Give 3 potential side effects of phosphodiesterase inhibitors
1. Headaches
2. Flushing
3. Indigestion
4. Priapism
5. Impaired vision
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