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78 Cards in this Set
- Front
- Back
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what are the 4 xray signs of OA
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1. joint space narrowing
2. subchondral sclerosis 3. subchondral cysts 4. New bone formation (osteophytes) |
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what are the modifiable RF in OA
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trauma
obesity repetitive stress |
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what was the health cost of arthritis in 2007 in australia?
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$4.2billion
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what are the clinical signs of OA?
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morning stiffness
pain after movemet palpable course crepitus body swellings around joint margin muscle weakness, wasting mild synovitis |
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what are the investigations ordered for OA?
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Xray
bloods: rule out other arthritis FBC, ESR and CRP Rheumatic factor and anti-CCP |
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what is the pharmacological management of OA?
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1. local analgesics e.g., capsaicin, methylsalicylate cream or topical NSAIDs - first line
2. paracetamol 3. NSAIDs: use COX-2 4. Opiates: tramadol is preferred |
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describe the focal cartilage loss pathophys in OA?
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-enzymatic degradation (aggrecan and collagen)
-Chondrocytes: increase production of matrix components -increases the water concetration in cartilage --> disrupts the retaining scaffolding of type II collagen -fibrilation: fissuring of the cartilage surface occur |
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what are the bony changes in OA
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Remodelling:
- Subchondral cysts: small areas of osteonecrosis caused bu increased pressure in bone - osteophytes: new fibrocartilage at the joint margin which undergoes ossification - Eburnation: after severe cartilage loss the two surfaces of bone wear on each other |
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what are the medicare numbers for OA tretment
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GPMP - item 721: preparation of a GP mgmt plan (annullly)
TCAs - item 723: coordination of tean care arrangements MBS item 10950-10970: a maximum of five allied health servises per caleder year |
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what arre the synovium changes associated with OA?
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- hyperplasia
- osteochondria bodies commonly occur within synovium - outer capsule also thicken and contracs to retain stability of the joint. |
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diagnosis of diabetes reuires what blood tests?
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fasting BSL > 7
random BSL > 11 (HbA1c > 6.5%) <-- not diagnostic though |
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what is impaired glucose tolerance
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pre-diabetes. with a fasting BSL of 5.6-6.9, indicated to do an oral glucose tolerance test
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when are pharmacological interventions indicated in diabetics?
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HbA1c >7%
or, unsatisfactory glycaemic control, which persists 2-3 months after a trial of lifestyle interventions, if pateint symptoms are significant OR ther BGL is very high (20mmol/L or greater) |
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what are the non-pharmalogical treatments for diabetes
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BP control, lipid control, lifestyle changes (physical activity, nutrition and diet, limit alcohol intake), smoking cessation
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what pharmalogical agents are available for diabets?
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insulin sensitisers (metformin, glitazones)
Insulin secretogogues (sulphonylureas, glitinides) Acrabose Incretinenhancers and mimetics insulin |
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when is a basal-bolus insulin regiment indicated
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with HbA1c high on metformin and basal insulin or 3 non-unsulun agents
Or, with a fasting BSL >16.6 or random BSL >19.4 |
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what ar teh three macrovascular complications of diabetes
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coronoary artery disesae
peripheral artery disease cerebrovascular disease |
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what are the three microvascular complications of diabetes
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nephropathy
retinopathy neuropathy |
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how do you assess a diabetic foot
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Inspection: skin (infection, loss of hair ulcers, fat atrophy), between toes, joints and shoes
Palpation: ft atrophy, perihperal pulses, temperature, capillary refill |
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how d you manage foot care in Diabtics
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Prevention: referral to podiatrist, regular reviews (6m), careful footwear selection, daily inspection of feed, avoid high risk behaviours (walking arefoot), tight glycaemic control
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what is chronic kidney disease? how does diabetse impact CKD?
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defined as a GFR < 60ml/min for 3 or more months
rates are 3x higher in diabetics |
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how do you assess kidney function?
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Albumin excretion rate:
- Micro 30-300mg/24hours - Macro >300mg/24 hours Albumin:creatinine ratio - Micro 2.5-25mg/mmol - Macro > 25mg/mmol |
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How do you treat micro and macroalbuminaemia?
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Micro: glycaemic control, reduce PB, consdier ACEi/ARB
Macro: Glycaemic control, reduce PB, ACEi/ARB, monitor protein excretion, screen for UTIs, refer to specialist |
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what is diabets a major indipendent risk factor for
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CVD, bindness, renal failure and lower limb amputation
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what is involved in the mental state exam?
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Genera; - appearence, behaviour
Mood and affect Speech - rate, quality, appropraiteness Throught for and content Cognition - MMSE Insight and judgement |
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What is the lifetime and spot prevalence of psychiatric disporders in Australia
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40% lifetime prevalence
20% spot prevalence 4th leading cause of global burden of disease 3rd cause of DALYs |
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risk factors for depression?
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unemployment, chornic disease, low SES, low education, FHx, single.deivorced, ATSIs, rauma, post-partum women PHx
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what is required for the diagnosis of depression?
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2+ weeks of depressed mood or anhedonia with at least 4 of:
appetite and sleep changes, reduced energy, worthlessness or guilt, difficulty concentrating, recurrent throughts of death |
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what are some non-pharmacological treatment options for depression?
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education, self-management, CBT, interpersona, therapy, short-term psychodynamic therapy
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what are the first line antidepressants?
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SSRIs: citalopram, fluoxetine, fluvoxamine, sertraline, paroxetine
MAOI: meclobemide SNRI: venlafaxine Other: mirtazepine, reboxetine |
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what is the national diseae burden contribution of obesity?
what % of people are obese |
7.5% in 2003
25.4 of males and 23.7% of females in 2007-08 in australia |
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what are some of the causes of secondary obesity?
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Meds (antipsycholtics, antiepressants, antiepileptics, steroids)
PCOS, cushing's syndrome, hypothyroidism, hypothalamic defects, and growth hormone deficiency |
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what are some primary preventative measures for obesity?
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Promoting healthy lifestyle behaviorus such as exercise, nutrition and maintaining a healthy weight
making healthy eating options abailable limiting portion sizes of meals limited ads for unhealthy fooods |
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what are the 5A's stages of change theroy for dealing with obesity
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Ask: risk factors
Assess: level of risk factors, motivation Advice - provide info, a lifestyle prescroption, beif advice and motivational interviewing Assist: meds, support Arrange: referral to special services/consellors/support groups, follow-uo |
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how do you assess obestiy
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BMI of >30 = obese
BMI of > 35 is severely obese waist circumference 80cm for women and 94cm for men |
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what are the non-pharmacological options for obesity treatment?
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lifestyle modification
very low calory diet surgical management |
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what surgical interventions are available for obesity
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for patients BMI >40 or BI >35 + comorbidities
- Gastic banging - Rou-en-Y gastric bypass Sleeve gastrectomy |
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what pharmacologivcal treatments are availabel for obesity?
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Orlistat (Xenical) - inhibits lipase, 2 years, 2-4Kg loss in 1 year, PBS for >35 of >30+
Phentermine (Duromine, Metermine) - appetite suppressant fof hypothalamus, sympathomimetic, 12 weeks max and not PBS listed |
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what are some preventative measures for falls and fall related injuries?
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control risk factors, reassess periodically, eercise, vit D, calcium, education, hip protectors
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what are some risk factors for falls
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living in residential aged care
age, postural control, Hx of falls, hypotension, chornic disease, cognitive impairment, medications, alcohol, type of footwear, environment, poor vision, dementia, incontinence |
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what is a fall?
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an event wihich results in a person coming to rest inadvertantly on the ground or floor or other lower level
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what is involved in the history for a risk assesemnt for falls
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history of activity at time of fall and prodromal symptoms
identify chronic disease complete medication audit check environemnt general functional limitations |
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what is involved in the examination for a risk assessment for falls?
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postural vital signs, visual acuity, hearing, outer extreimties (neuropathy, deformities), POMA (Timetti), Get Up and Go tet and a functional reach test
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what is taken into consideration in the FRAX fracture risk assessment tool?
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age, sex, weight, hieght, previous fracture, parent fracture hip, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol, femoral neck BMD
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what are some risk factors/behaviours for STIs?
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inprotected vaginal/anal/oral sex, sex with strangers or sex workers, multiple sex partners, injecting drug use
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What do you need to know in a sexual history
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symptoms, past STIs, who (number, gender), what (type of encounter, protection), where (overseas?), PMHx, SHx, FHx
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what is involved in a sexual healht examination?
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inspection of anogenital area (Esp foreskin), palpation of ulceration with gloved hand to determine induration and pain, palpation of inguinal lymph nodes
female - PV examination Male - testicular examination |
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describe the approprate tests and samples for specific STI pathogens?
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HSV - swap PCR
Chlamydia + Gonnorrhoea - urine PCR, swab for culture HPV - pap smear HIV, HCV, syphilis - serology |
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what is the management for HSV-1 genetical infections?
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Acyclovir 400mg orally, 8 hourly for 5-10 days
Abstain from sex when symptoms present, use condoms |
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who is the index pateint in regards to contact tracing?
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the first person to come into contact with healthcare workers
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how does GUD affect the sexual transmission of HIV?
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the genital ulceration disrupts the integrity of the mucous memranes and sevres as a portal of entry for HIV. GUD is an independent risk factor for HIV seroconversion
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what is the cancer burden in australia?
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19% of total in 2010 (higherst contributor), over 500000 DALYs
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what ares ome primary preventative measure for lung, breast, protste, colorectal, skin and cervical cancer
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Lung - don't smoke
Breast - none Prostate - none colorectal - don't smoke, healthy diet, not overweight Skin - avoid sunburn, be sun smart Cervical - vaccination |
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what are some screening recommendations (Secondary prevention) for lung, breast, prostate, colorectal, skin and cervical cancer?
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lung and prostate: non (PSA?)
breast: mammogram every 2 years from 50-70, younger if high risk colorectal - FOBT at 50, 55 and 65, colonoscopy for abnormalities Skin - regular self check Cervical - pap smear every 2 years for 18-70 or 2 years after sex |
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what are the most common cancers? what the most deadly cancers?
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highest incidence:
prostate > breast > colorectal > melanoma > lung cancer death rates are lung > prostate > breast > colorectal > melanoma |
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what are the common risk factors for lung cancer?
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smoking and occuptinal exposure (asbestos, radons, hydrocarbons, heavy metals)
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what are the common risk factors for skin (non-melanoma) cancer?
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UV radiation, increased number of dysplastic naevi, fair skin, tendency to burn, freckles, light eye colour, light or red hair, previous skin cancer
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what are teh common risk factors for breast cancer?
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increasing age, FHx, genetics (BRCA1 and 2) female hormones, obesity, alcohol
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what are the common risk factors for colorectal cancer?
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age, inerited genetic risk IBD obesity and smoking
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what are the common risk factors for skin (melanoma) cacner
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UV radiation, increased number of dysplastic naevi, depressed immune system, FHx, fair skin, tendancy to burn, freckles, light eye colour, light or red hair, previous skin cancer
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what are the common risk factors for prostate cancer?
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increasing age, FHx, ?diet?, ancenstry (african), high testosterone levels
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what are the common risk facotros for cervical cancer?
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HPV infections
daughter of DES used, smoking |
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what is the estimated cost of arthritis to the economy?
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$23.9 billion
almost 95000 DALYs |
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what investigations would you do for arthritis?
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Xray: erosions in RA, in OA osteophytes, joint space narrowing, subchondral sclerosis, and cysts
CRP, ESR - normal in OA, high in RA RF and anti-CCP antibody - postive in RA (70%) and negative in OA |
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what are the risk factors for RA
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geentics (60%), smokers, female
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what allied health profressionals should be involved in your pteints arthrtis care?
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exercise, pain management, healthy eating, education, dietary, supplements (glucosamine and fis oil for OA)
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what are some pharmacologica treatments for arthritis?
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OA - paracetamol, NSAIDs, corticosteroid injections, opiods,
RA- DMARDs (methotrexate), corticosteroids (prednisolone), NSAIDs, biological agents (etanercept, infliximab, etc.) |
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what support networds avaiable for people living with arthritis?
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arthritis Australia
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What are the risk factors for OA?
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Age, female, genetics, biomedical factors such as obesity, body misalignment, meniscus (cartilage) tears and injury
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what are the common types of surgery for arthritis typesof surgery for arthritis?
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arthrodesis - fusign bones
arthroscopy - key hole scope osteotomy - re-aligning bone resection - removal of bone synovectomy - remove synovium arthroplasty - joint replacement |
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what primary prevention options are there for cardiovascular disease?
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lifestype modification - regular exercise, dietary modification (low salt, high fibre, low sat fat), no smoking
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how do you assess the risk of cardiovascular events occurring?
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with the framingharm-based risk chart of the online calculator.
Low <10% review in 2 years moderate 10-15% review in 6-12 months high >15% reivew now |
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when is cholesterol assessment indicated?
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for all adults over 20, repeated every 5 years if normal
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what are the non-pharmocological treatment options for cholesterol and lipid disorders?
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HTN control, reduce dietary fat, weight loss, exercise, smoking cessation, add plant sterol
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what are some pharmocological management options for cholesterol and lipid disorders?
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nicotinic acid (vit B3)
bile acid sequesterants ezetemibe fibric acid derivative HMG-CoA reductase inhibitors (statins) |
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How do you investigate cholesterol levels? what are normal levels?
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a lipid profile consists of TC, TG LDL, HDL, done fasting
TC < 5.2 LDL < 2.6 HDL > 1.5 TTG < 1.7 |
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what is the 45-49 health check?
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a health check for 45-49 year olds to promote good leath and reduce the burden of disease. Looks at smoking, nutrition, alcohol, exercise, derpression, osteoporosis, weight, BP, skin cancer, lipids, diabetes, and cervical cancer
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what secondary prevention options are there for cardiovascular disease?
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smoking cessation, control HTN/diabetes/dyslipidaemia, exercise, lose weight, reduce alcohol, eat healthily
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