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101 Cards in this Set
- Front
- Back
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primary prevention for CVD?
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lifestyle modification
- regular exercise - dietary modification: low salt, high-fibre, and low-saturated-fats diet - smoking cesssation |
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secondary prevention for CVD?
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stop smoking
hypertension: drugs dyslipidaemia: statins, reduce fat diabetes/ poor glycaemic control excercise overweight or obese- lose weight microalbuminuria elevated CRP strong family history male gender |
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what is assessed in a 45-49 year old health check
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smoking
nutrition alcohol physical activity depression osteoporosis body weight blood pressure skin cancer lipids diabetes cervical cancer |
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what is the point of 45-49yr old health check?
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it targets people who at risk for developing chronic disease
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hypercholesterolaemia:
1.environmental causes 2. genetic causes 3. secondary causes |
1. environmental: diet, obesity
2. genetic: LDL-R gene mutation 3. secondary: hypothyroidism, cholestatic liver disease, drugs |
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secondary causes of hypercholesterolaemia
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hypothyroidism
cholestatic liver disease drugs |
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Who should be screening for hypercholesterolaemia?
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all adults >20 years (repeated every 5 years)
all children with hx of premature CHD |
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which is more reliable, plasma or serum for measuring cholesterol?
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both about the same, but plasma is about 3% higher.
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what does illness do acutely to the lipid profiles?
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increases TG
decreases cholesterol |
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target levels:
TC LDL HDL TG |
TC: <4
LDL: <2.5 HDL: >1 TG: <2 |
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High cholesterol levels:
TC LDL HDL TG |
TC: >6.2
LDL: >4.1 HDL: <1.3 TG: >2.2 |
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Define absolute risk
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numerical probability of an event occurring within a specified period expressed as a percentage
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CVD risk assessment:% and frequency of review?
low: moderate: high: |
low: <10%, review every 2 years
mod: 10-15%, review 6-12 months high: >15%, review according to the clinical context |
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non drug treatment of hypercholesteraemia
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- hypertension control
- dietary reduction of total and saturated fat - weight loss - aerobic exercise - the addition of plant sterol - stop smoking |
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nicotinic acid
- use - MOA - adverse effects |
use: mostly TG
MOA: inhibits hepatic TG production and VLDL secretion adverse effects: flushing, palpations, GI disturbance |
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bile acid sequestration
- use - MOA - adverse effects - drug iteractions |
- use: more for high cholesterol, not TG
- MOA: anion exchange resins sequesters ile acids in the intestines- stops reabsorption! - adverse effects: GI: diarrheoa mostly - drug interactions: fat soluble vitamins, digoxin and awrfarin |
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ezetimibe
-use - MOA - adverse effects |
-use: high cholesterol, not TG
- MOA: inhibits absorption of choelsterol from duodenum by blocking NPC1L1 at brush border - adverse effects: diarrhoea, abdo pain, headache- well tolerated normally! |
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fibric acid derivatives
- use - MOA - adverse effects |
- use: mostly used for TG
- MOA: agonise PPARalpha, which increases the transcription of genes for lipoprotein lipase, apoA1, and apoA5. - adverse effects: myositis, rhabdomyolisis, myoglobinuria and cute renal failure |
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statins
- use - MOA - adverse effects |
- use: first line therapy for LDL reduction
- MOA: HMG-CoA reductase inhibitor- increase LDL-R and decreased LDL production - adverse effects: myalgia, GI disturbances, raised concentration of liver enzymes -interactions: raise digoxin levels, potentiated warfarin |
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Strong statins
Weak statin |
strong: atorvastatin, rosuvastatin
weak: fluvastatin |
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starting statins: how do you monitor?
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monitor LFTS
1-3 months x 1 6 monthly x 2 |
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mixed hyperlipidaemia: drug treatment?
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statins + fish oil
statin + fibrate |
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hypercholesteraemia: drug treatment?
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Statin
if necessary + - ezetimibe -resin |
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define major depression
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a depressed mood that lasts at least 2 weeks
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prevalence of depression in australia?
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1 million adults
100, 000 young people 1/6 will experience in their life time |
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internalising risk factors for depression?
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genetics
neuroticism low self-esteem early-onset anxiety disorder past hx of major depression |
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externalising risk factors for depression?
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substance misuse
conduct disorder |
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adversity risk factors for depression?
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trauma during childhood
stressful life events in past year parental loss low parental warmth history of divorce marital problems low social support low education |
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what is the questionaire commonly used to screen for depression
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K10 form
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what constitutes a high K10 score?
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30-50
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GP mental health treatment plan"
what can be claimed? |
12 session individual therapy
+ 6 in exceptional circumstances 12 session group therapy |
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who can provide the sessions under a GP mental health treatment plan?
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psychologist
appropriately trained doctor social worker occupational therapist |
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non drug options for depression treatment?
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CBT
interpersonal therapy excercise family therapy psychodynamic psychotherapy |
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cancer biomarkers:
CEA CA19.9 Alpha FP Alpha FP/BetahCG CA15.3 CA125 |
CEA: colon ca
CA19.9: pancreatic ca Alpha FP: hepatocellular ca Alpha FP/BetahCG: germ cell tumours/ testicular ca CA15.3: breast ca CA125: ovarian ca |
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3 most common cancers in aus
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prostate, bowel, breast
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3 most common causes of cancer death in aus
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lung
bowel protate |
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primary prevention of cancer: strategies
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H. pylori eradication
Smoking cessation Exercise Sunscreen PHV vaccine |
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is screening primary or secondary prevention?
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secondary
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papsmear recommended schedule
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Recommends pap tests every 2 years for women aged 18-69 years who have ever had sex
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bowel cancer affects?
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Affects 1 in 20 Australians
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high risk criteria for skin cancer?
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Fair, light eyes/hair, burns, freckles
Multiple atypical naevi Hx of melanoma or FHx in ≥1 1st degree relative PHx NMSC (60% grow another in 3yrs) Immunosuppressed (>40years age) |
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how often should you screen high risk patients for skin cancer?
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Every 3-12mnths
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if a pt chooses to be tests for prostate cancer, which test do you do?
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both PSA and DRE should be performed
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should all men be screened for prostate cancer?
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“Patients should make their own decisions about being tested for prostate cancer after being fully informed of potential benefits, risks and uncertainties”
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what is the most common arthritis in aus? prevalence?
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OA
7.8% |
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OA non-modifiable risk factors?
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• Age: mean onset 45yrs (80% of 65yr olds have OA on x-ray, 25-30% asymptomatic)
• Ethnicity: - Knee OA is prevalent in all racial groups - Hand, hip and generalised OA are more common in Caucasians • Women> men (61.% of OA patients are women) • Family history • Congenital/ developmental defects |
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what % of 65yr olds have evidence of OA on xray?
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80%
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what is the biggest modifiable risk factor for OA?
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obesity: 2.4x more
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clinical signs of OA
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• Pain
• Restricted joint movement • Palpable (sometimes audible) coarse crepitus • Bony swelling around joint margins • Deformity w/out instability • Joint line or periarticular tenderness • Muscle weakness, wasting • Mild synovitis |
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signs of hand OA
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charactersitic swelling of 1st carpometacarpal joint
erosive interphalangeal arthritis heberden's and bouchard's nodes |
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pathological changes in OA
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1. focal cartilage loss (degradation, chondrocytes, fibrillation)
2. bone changes: remodelling (subchondral cysts, osteophytes) 3. synovium changes: hyperplasia, osteochondrial bodies within synovium, thickened outer capsule) 4. muscle changes |
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xray changes of OA
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1. joint space narrowing
2. subchondral sclerosis 3. subchondral cysts 4. new bone formation |
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non drug mgt of OA
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Weight loss
Education Exercise: progressive resistance strength training joint protection and energy conservation Diet: - food right in omega-3 fats - avocado/soybean massage |
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does acupuncture help pain control OA?
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nope- failed the cochrane review process
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when is local analgesia first line therapy in OA?
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small joint OS, hands, wrist
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when is paracetamol first line therapy in OA?
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hip, knee OA
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what NSAIDs should be used in OA mgt?
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cox-2 inhibitors: celecoxib (Celebrex), meloxicam (Mobic), lumiracoxib (Prexige)
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should tramadol be used in the mgt of OA?
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yes.
Tramadol Benefit: decreases pain intensity, produces symptom relief and improves function Side effect: nausea, vomiting, dizziness, constipation, tiredness, and headache Cochrane review: number needed to treat to harm= 8 Contraindication: alcohol, driving or operating machinery, elderly patients, renal impairment, GI disease, respiratory depression |
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surgical options for mgt of OA?
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1. Osteotomy: reduces intra-osseous pressure, and prolongs the life of misaligned joints and relieves pain.
2. Joint replacement |
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what role does a physiotherapist have in the mgt of OA?
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Physiotherapy: Progressive resistance strength training
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What are the following medicare item numbers for?
GPMP- item 721: TCAs- item 723: MBS items 10950-10970: |
• GPMP- item 721: Preparation of a GP Management Plan (annually)
• TCAs- item 723: Coordination of Team Care Arrangements (annually) • MBS items 10950-10970: a maximum of five (5) allied health services per calendar year |
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safest way to treat depression in the elderly?
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CBT: no increase in falls
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ulcer characteristics:
Herpes simplex virus |
• Multiple vesicular lesions that rupture and become painful, shallow ulcers
• Constitutional symptoms and lymphadenopathy in first-time infections • Commonly non-classical presentations – rash, burning, tingling, redness and irritation |
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ulcer characteristics:
Syphilis (primary) |
Syphilis (primary)
• Single, painless, well-demarcated ulcer (chancre) with a clean base an indurated border • Mild or minimal tender inguinal lymphadenopathy |
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Ulcer characteristics:
Chancroid |
Chancroid
• Non-indurated, painful, slowly progressing border and friable base • Covered with necrotic and often purulent exudate • Tender, suppurative, unilateral lymphadenopathy |
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Ulcer characteristics:
Donovanosis |
Donovanosis
• Persistent, painless, beefy-red papules or ulcers • May be hypertrophic, necrotic or sclerotic • No lymphadenopathy • Subcutaneous granulomas |
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Ulcer characteristics:
Lymphogranuloma venereum |
• Small, shallow, painless, genital or rectal papule or ulcer
• No induration • Unilateral, tender lymphadenopathy • Rectal bleeding, pain or discharge |
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Painless GUD: options?
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Primary syphilis
Donovanosis Lymphogranuloma venereum |
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STI testing: HSV
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PCR or culture of swab
– PCR is up to 70% more sensitive than culture. Site specific testing is preferable to serology |
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STI testing: Syphilis
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Serology or dark field microscopy of chancre – serology is preferred as dark field micro is operator dependant.
Positive VDRL and RPR need to be confirmed with treponemal antigen testing |
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STI testing: Donovanosis
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Microscopy of swab – intracytoplasmic donovan bodies on
Wright stain |
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STI testing: Chancroid
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M/C/S of swab
– gram stain suggestive of H. ducreyi is indicative - H. ducreyi identified on culture is definitive |
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can you start treating a GUD before lab tests come back?
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• Starting treatment immediately before getting the results of lab tests is usually in the patients best interests and beneficial to public health
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immediate treatment of painful suspected herpes?
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• Aciclovir 400mg, TDS, 5 days, or
• Famciclovir 250mg, TDS, 5 days, or • Valaciclovir 500mg, BD, 5 days |
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Treatment: Syphilis (Primary)
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Benzathine penicillin 1.8g, IMI, stat
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Treatment: Chancroid
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Azithromycin 1g, po, stat, or
Ceftriaxone 500mg, IV, stat, or Ciprofloxacin 500mg, po, BD, 3 days |
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who should be screened for DM?
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People with impaired glucose tolerance or impaired fasting glucose
Aboriginal and Torres Strait Islanders aged ≥35yrs Pacific Islanders or people of Indian or Chinese origin, aged ≥35yrs People ≥40yrs who have BMI ≥30 kg/m2 or HT People with clinical CVD: MI, angina, stroke or PVD Women with PCOS who are obese People on antipsychotic drugs |
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what are the steps of the 3-step screening and diagnosis process for DM?
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1. Initial risk assessment using a risk assessment tool
2. Measurement of fasting plasma glucose 3. Oral glucose tolerance test (OGTT) if fasting plasma glucose result equivocal |
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what are the treatment goals in DM?
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Management Goals
1. Relieve acute symptoms 2. Optimise control of glycaemia and other risk factors for complications 3. Treat existing complications 4. Maintain other preventive activities |
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Assessing pt with diabetes: exam features?
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• BMI/waist circumference
• CVS • Eyes • Feet • Peripheral nerves • Urinalysis |
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Assessing pt with diabetes: investigations?
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• Renal function
• Lipids • HbA1c • ± ECG |
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Metformin
Action: SE: CI: |
Metformin
Action: reduces hepatic glucose output and insulin resistance SE: anorexia, N/V/D, abdo cramps, flatulence, lactic acidosis CI: eGFR <30ml/min (use with caution if eGFR of 30–45ml/min) |
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Sulphonylureas
Action: SE: |
Sulphonylureas
Action: increases insulin secretion SE: weight gain, hypoglycaemia, anorexia, N/V, skin rashes |
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Acarbose
Action: SE: |
Acarbose
Action: inhibits digestion of carbohydrates, slowing the rate of glucose delivery into circulation SE: flatulence, abdo discomfort, diarrhoea |
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Glitazone
Action: SE: CI: |
Glitazone
Action: reduces insulin resistance SE: increased subcut fat/fluid, anaemia, fracture risk CI: IHD, CCF |
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GLP-1 (glucagon-like peptide) therapies
Action: SE: |
GLP-1 (glucagon-like peptide) therapies
Action: enhances insulin secretion, inhibits glucagon secretion, increases satiety and decreases gastro-emptying SE: N/V, headaches, upper respiratory tract symptoms |
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recommended starting schedule for insulin?
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1. Single, daily dose (10 units) of intermediate or long acting insulin added to oral hypoglycaemic
2. Change doses in increments of 10–20% (2–4 units) at intervals of 2–4 days |
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what % of australians are overweight?
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61% Australians overweight or obese
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secondary causes of obesity?
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True genetic obesity (e.g. Prader Willi)
CNS e.g. hypothalamic tumour Endocrine e.g. Cushings, hypothyroidism Medications e.g. atypical antipsychotics Psychiatric e.g. binge eating disorder |
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Obesity ↑ Risk certain cancers: which ones?
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endometrial and breast, colon
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what are the 5 A's of assessing obesity?
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1. assess
2. advice 3. agree 4. assist 5. arrange |
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what is a reasonable agreement for goal of weight loss?
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Set a weight loss goal 10% below baseline weight
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medications that may cause weight gian
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anticonvulsants
lithium antipsychotics antidepressants sulfonylureas any hypertensives corticosteroids |
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how much should an obese patient be excercising?
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Exercise: at least 30 minutes on most days at moderate intensity
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Drug options for weight loss: when to be considered, what are the options?
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o Consider if BMI >27, significant comorbidity and/or consistent failure to lose weight with a well-supervised lifestyle program
o Orlistat: lipase inhibitor o Phentermine: appetite suppressant. Only safe for short term use (up to 12 weeks) |
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Surgical options for weight loss?
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Indications: usually when BMI >40 or >35 with comorbidity like diabetes or sleep apnoea
o Roux-en Y gastric bypass o Adjustable gastric band (“lap band”) o Sleeve gastrectomy |
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Phertermine: use, contraindications
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weight loss, it is an appetite suppressant
CI:unstable hypertension or cardiovascular disease Caution use: anxiety and other psychiatric conditions. |
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what % over 65 fall per year?
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30%
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risk factors for falls in the elderly?
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old
polypharmacy sensory deficits male white increased BMI poor general health insufficient sleep use of walking aid alcohol history of stroke |
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factors to address in falls risk assessment?
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1. hx of falls
2. medications 3. gait, blalance, mobility, muscle strength 4. visual acuity 5. neurological impairment 6. heart rate/ arrhythmias 7. postural hypotension 8. feet and footwear |
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should you give someone with a falls risk vit d?
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yes
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