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Radiation
Associations (next slide)
Time course
Exacerbating/Relieving factors
Severity
5. As you find out more about the patient, use increasingly closed
questions to clarify facts and details e.g. when did you first
notice the pain in your arm?
6. Explore the patients ideas, concerns and expectations (example
questions below)
7. Summarize to the patient and check for completeness
Infections
Pollen
Exercise
Cigarette smoking
Allergies to dust mites and animal hair
Treatment is usually with inhalers. A typical person with asthma
may take:
a preventer inhaler (brown) every day (to prevent symptoms
developing)
- Taken every day to prevent symptoms from developing.
The drug commonly used in preventer inhalers is a steroid
- Steroids work by reducing the inflammation in the airways.
When the inflammation has gone, the airways are much less
likely to become narrow and cause symptoms
- It takes 7-14 days for the steroid in a preventer inhaler to
build up its effect so effects are not seen immediately.
Therefore it is important to take it every day to prevent
symptoms from coming back.
- a reliever inhaler (blue) as and when required (if symptoms flare
up)
- This makes the airways open wider, and symptoms usually
quickly ease
- Only to be taken when required.
Correct technique for using the inhalers is very important. In some
people, symptoms persist simply because they do not use their
inhaler properly, and the drug from the inhaler does not get into the
airways properly.
Hypertension
High blood pressure is a risk factor that can increase your chance
of developing heart disease, a stroke, and other serious conditions.
As a rule, the higher the blood pressure, the greater the risk.
Treatment includes a change in lifestyle risk factors where these
can be improved - losing weight if you are overweight, regular
Medication
Contemplate drug treatment
High BP persistent even with adherence to non-drug measures
Systolic sustained > 160 and/or diastolic >100
Systolic sustained > 140 and/or diastolic >90 AND known CVD, diabetes, target organ damage (i.e. renal
impairment) or an estimated CVD risk of .20% over the next 10 years using risk charts
Diabetes Type 1
Type 1 diabetes is the type of diabetes that typically develops in children and young adults. In type 1 diabetes
the body stops making insulin and the blood glucose level goes very high. Treatment to control the blood
glucose level is with insulin injections and a healthy diet. Other treatments aim to reduce the risk of
complications and include reducing blood pressure if it is high, and to lead a healthy lifestyle.
What is diabetes?
Diabetes mellitus (just called diabetes from now on) occurs when the level of glucose (sugar) in the blood
becomes higher than normal. There are two main types of diabetes. These are called type 1 diabetes and type
2 diabetes.
After we eat, various foods are broken down into sugars in the gut.
The main sugar is called glucose. This is absorbed through the gut
wall into the bloodstream. Glucose is like a fuel which is used by
the cells in the body for energy. To remain healthy, your blood
glucose level should not go too high or too low.
So, when your blood glucose begins to rise (after eating), the level
of a hormone called insulin should also rise. Insulin acts on the
cells of your body and makes them take glucose into the cells from
the bloodstream.
Diabetes develops if you do not make enough insulin, or if the
insulin that you do make does not work properly on the body's
cells.
In most cases, type 1 diabetes is thought to be an autoimmune
disease. The immune system normally makes antibodies to attack
bacteria, viruses, and other germs. In autoimmune diseases the
immune system makes antibodies against part or parts of the body.
If you have type 1 diabetes you make antibodies that attach to the
beta cells in the pancreas. These are thought to destroy the cells
that make insulin
The symptoms that usually occur when you first develop type 1
diabetes are:
Long-term complications
If the blood glucose level is higher than normal, over a long period of time, it can have a damaging effect on
the blood vessels. Even a mildly raised glucose level which does not cause any symptoms in the short-term
can affect the blood vessels in the long-term.
It is likely you will need to monitor your glucose levels by using a monitor at home. If you check your blood
glucose level, ideally you should aim to keep the level between 4 and 7 mmol/L before meals, and less than 9
mmol/L two hours after meals.
It may be best to measure your blood glucose level at the following times:
Another blood test is called HbA1c. This test measures a part of the red blood cells. Glucose in the blood
attaches to part of the red blood cells. This part can be measured and gives a good indication of your blood
glucose control over the last 1-3 months. This test is usually done regularly by your doctor or nurse. A level of
HbA1c of 7% or less is usually the target to aim for.
Insulin
To stay well and healthy you will need insulin injections for the rest of your life. Your doctor or diabetes nurse
will give a lot of advice and instruction on how and when to take the insulin. Insulin is not absorbed in the gut
so it needs to be injected rather than taken as tablets. There are various types of insulin. The type or types of
insulin advised will be tailored to your needs.
Most people take 2-4 injections of insulin each day. The type and
amount of insulin you need may also vary each day, depending on
what you eat and the amount of exercise you do.
Insulin pumps
Insulin pump therapy continually infuses insulin into the subcutaneous tissue (the layer of tissue just beneath
the skin). Insulin pumps work by delivering a varied dose of fast-acting insulin continually throughout the day
and night, at a rate that is pre-set according to your needs.
Healthy diet
You should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables.
However, you will need to know how to balance the right amount of insulin for the amount of food that you
eat. Therefore, you will normally be referred to a dietician for detailed advice.
Type 2 Diabetes
Type 2 diabetes occurs mainly in people aged over 40. The 'firstline' treatment is diet, weight control and physical activity. If the
blood glucose level remains high despite these measures, then
tablets to reduce the blood glucose level are usually advised.
Insulin injections are needed in some cases. Other treatments
Long-term complications
If your blood glucose level is higher than normal over a long period of time, it can gradually damage your
blood vessels. This can occur even if the glucose level is not very high above the normal level. This may lead
to some of the following complications (often years after you first develop diabetes):
Complications of treatment
Hypoglycaemia (which is often called a 'hypo') occurs when the level of glucose becomes too low, usually
under 4 mmol/L. People with diabetes who take insulin and/or certain diabetes tablets are at risk of having a
hypo. A hypo may occur if you have too much diabetes medication, have delayed or missed a meal or snack,
Insulin injections
Insulin is needed in some cases if the above treatments do not work well enough. You cannot take insulin by
mouth, as it is destroyed by the digestive juices in the gut. Insulin may be given in addition to taking tablets.
You are less likely to develop complications of diabetes if you reduce any other 'risk factors'. These are briefly
mentioned below :
Angina/ MI
Parkinsons
Stroke
For example, if you lose the blood supply from a main carotid
artery, then a large area of your brain is affected, which can cause
severe symptoms, or death. In contrast, if a small branch artery is
affected, then only a small area of brain is damaged which may
cause relatively minor symptoms. There are two main types of
stroke - ischaemic and haemorrhagic.
Ischaemic stroke - caused by a blood clot
Ischaemic means a reduced blood and oxygen supply to a part of
the body. It is usually caused by blood clot in an artery, which
blocks the flow of blood. This occurs in about 7 in 10 cases.
The blood clot often forms within the artery itself. This
commonly occurs over a patch of fatty material called
atheroma. Atheroma is often called furring or hardening of the
arteries.
Weakness and twisting of one side of the face. This may cause
you to drool saliva.
Dizziness or unsteadiness.
Headache.
Confusion.
Treatment:
Course of 4 drugs for 2 months RIPE
Followed by 2 drugs for 4 months - RI
Sensory Awareness
patients
For this station, you are required to communicate with and guide a
patient with visual impairment. For this, the guidance given in
Exercises
However well you may have carried out exercises in training
situations, it is important to practice as frequently as possible. Try
to role play with friends and colleagues when situations permit.
This will make you easier when doing it for real.
Access to healthcare
Before surgery
Outbreaks
Necessary when HCPs hands have been contaminated with blood or bodily fluids, before and after
immunocompromised patient visits and before and after surgical procedures
Sterilisation is necessary at the start of the day, before and after a patient procedure
Introduction
Introduce self and gain consent
Wash hands
Check patients name, D.O.B. and occupation
Explain
Explain procedure
Check patient understanding of hypertension
Inform them that procedure may cause some discomfort
Ask them to stop you at any time if uncomfortable
Confirm
Ensure patient has:
o rested for >15 mins
o not smoked or had any caffeine prior to the procedure
o pregnant hypertension can occur (usually mild)
Procedure
1. Select appropriate cuff size for patient
2. Check that the cuff is fully deflated and attached correctly
with the marker over the brachial artery
3. Clean stethoscope
4. Position patient with arm supported and extended at the level
of the heart
5. Ensure legs are uncrossed and the patient is sitting up, watch
removed
6. Palpate brachial pulse and place cuff around arm with the
arterial marker over the brachial artery
7. No talking and relax
Classification
SBP DBP
Pre HT
Mild
Moderate
Severe
80 - 89
90 - 99
100 - 110
>110
Subcutaneous Injection
Others : 45
12.Dispose of sharps in sharps bin, and non-sharp waste in
orange clinical waste bin
13.Ensure patient is comfortable questions/concerns
Tell patient to notify healthcare team if experiencing any
side effects, such as dizziness and fever)
14.Clean hands with alcohol gel
15.Record drug administration on drug chart
16.Any questions?
17.Thank the patient
Resuscitation (HOLOS)
Provide basic life support
Signs of Asphyxia:
Pale skin, blue cyanosed lips
Rapid, difficult, gasping breaths
Losing consciousness
Trying but unable to talk
Procedure:
1. Ask the patient if they are okay. Get them to try to cough
2. 5 backslaps between the scapulas
Procedure:
1.
Keep the patient calm.
2.
Position the patient in an upright position
3.
Assist the patient with their medication, usually their reliever
(blue inhaler)
4.
Advise them to take deep breaths
5.
Call 999, stay with the patient until help arrives
Indirect pressure
- Use when unable to contain bleeding by direct pressure.
- Apply pressure to a pulse point (axillary artery in arm, femoral
artery in leg for 10 mins MAX)
- Then relax. Do NOT use a tourniquet
- For foreign bodies, wrap around without adding direct pressure
- Call 999 if bleeding persists
6.
Total Mark:
Marks
(1)
(1)
(1)
(1)
(2)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
/21
(1)
(1)
Asthma Inhaler
Introduction:
Introduce
yourself to the
patient
Check the
patients
identity
Explain why
you have been
asked to see the
patient
I understand
your doctor has
discussed
asthma and
medication
with you. Have
you used an inhaler beforeshall we go through the
procedure from the beginning? (CONSENT)
Check patients understanding of asthma
Give patient an explanation of asthma if required
Highlight the importance of correct technique
Procedure
1. Check the medication type and the expiry date
2. Shake the inhaler and take the cap off the mouthpiece
3. Sit up straight or stand with chin slightly lifted
4. Hold inhaler between index finger and thumb, place inhaler
upright in front of your mouth
Read at 30 seconds
Read at 40 seconds
Read at 60 seconds
(Normal 4.5-8)
o
Acidic= metabolic activity by diet or DKA
Alkaline
= metabolic alkalosis
Blood can be from renal injury, infection, renal colic or
trauma. Always ask about menstruation if raised in women.
BMI assessment
BMI
< 18.5
18.5 24.9
25 29.9
30 34.9
35 39.9
40.0
Interpretation
Underweight
Normal
Overweight
Obesity I
Obesity II
Morbidly Obese
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Male Female
13.3 16.8
11.5 14.8
4.32 5.66
3.88 4.99
82 98
27 32.6
3.3 - 9.5
3.9 11.1
1.7 - 6.1
1.7 7.5
1.0 3.2
0.2 - 0.6
0.03 0.4
0.02 0.09
information
PICO approach
Problem: condition, patient, population, setting
Intervention: dose, delivery, frequency
Comparison (may not be one)
Outcome: what happens to P? cost effective? Patients
experience?
Find some evidence: Medline clinical enquiries and The
Cochrane Library
To use the clinical queries limit in Medline, click on limits
(underneath the search box) and then Additional limits. Scroll
down until you see the clinical queries limit option, and then select
Therapy (best balance of sensitivity and specificity)
- Observe a short video & answer questions
Students should be able to identify and answer questions on
Ethics
Basic Principles:
- Autonomy
- Beneficence
- Non-maleficence
- Justice
Using a growth chart
Using the data given you will be asked to plot on a growth chart a
childs growth different charts for males and females and also
different charts for weight, height and head circumference. Ensure
you use the correct chart for the data provided
Interpret the results by assessing the childs growth in comparison
with the general population as well as against previous results. If
the growth curve crosses the centiles, growth is slow, which may
indicate failure to thrive (illness, poor nutrition, abuse, but may be
normal if parents are small). If the childs weight/height/etc is
below the 3rd centile or above 97th centile, it warrants
investigation it may be normal (small/big parents) but may also
be due to illness/poor nutrition/abuse.
Procedure:
1. Identify patients name, D.O.B, sex, age, height and weight
2. Calculate predicted height
3. Parental average + 7 cm (for boys) OR Parental average 7
cm (for girls)
4. Plot predicted height on appropriate chart
5. Identify mid-parental centile
6. Plot predicted and actual heights at current age
7. Compare and report patients current centile
8. Plot patients weight and identify centile
Use the correct chart according to gender
Plot height on corresponding stature line, and weight on
corresponding line
If patient is >97 or <3 percentile, further tests are needed
th
rd
Movement disorders
seizure spreads throughout the temporal lobe impairing consciousness and may be
secondarily generalized to provoke a tonic-clonic seizure. This is the commonest form of
epilepsy
Status epilepticus
o When a seizure does not spontaneously stop but continues or repeats for a period of 30 min or
more the condition is termed status epilepticus and is life threatening.
Parkinsons Disease:
Resting tremors in hands
Bradykinesia/Akinesia difficulty in starting movement, expressionless face, followed by an action tremor
on movement.
Stooped posture, shuffling gait, difficulty in turning,
Ballistic, uncontrolled movements are disease progresses.
Chorea
In Huntingtons Disease
o Rapid, jerky,
o Dance-like-movement in face
o Limbs and trunk
Other causes:
o Drug induced phenytoin, L-Dopa
o Alcohol
Hemiballismus
Violent swinging movement of one side of the body
o usually caused by infarction or haemorrhage
o In the contralateral subthalamic nucleus
Myoclonus Rapid, brief, shock-like muscle jerks
Dystonias
Prolonged spasms of muscle contraction
e.g. spasmodic torticollis (head turned and held to one side or drawn backwards or forwards)
Anatomy
Skeletal
Cartilage
Chondroblasts: secrete ground substance and collagen to form a rigid cell. In situ and formed
chondrocytes
No neurovascular elements
Nutrients by diffusion
Preformed in hyaline cartilage articular surfaces (joints) where rigidity and elasticity required
Bone
Support framework
Movement lever for muscles
Protection skull, thorax
Haemopoiesis (blood cell formation in bone marrow)
Storage of calcium and phosphate (blood calcium must be constant, intake isnt)
Constantly being remodelled
Axial and Appendicular skeleton
Axial: skull, sternum, ribs, vertebral column
Appendicular: scapula, clavicle, limbs, hip bones
Shape
o Sesamoid patella
o Long humerus
o Short wrist, trapezoid
o Flat sternum
o Irregular vertebra
Origin
o Endochondral ossification cartilage
o Intramembranous ossification bones of skull achondral, no cartilage
Terminology
o Head expanded end of epiphysis
o Neck between epiphysis and diaphysis
o Condyle smooth articular rounded process
o Trochlea smooth grooved articular process
o Facet small flat articular surface
o Process - projection/bump
o Ramus - extension at an angle
Attachments to ligaments/tendons
Surface
Examine the Head, Neck, Chest, Back & Limbs to identify &
palpate anatomical structures.
If patient present: introduce yourself, gain consent, explain purpose, wash hands , ask to remove shirt, sorry if
hands are cold.Thank the patient
Head
Chest and neck
o Jugular notch
o Sternocleidomastoid
o Mastoid process
o Thyroid
o Limbs
Tendo calcaneus (Achilles tendon)
Popliteal fossa
Acromioclavicular joint
Malleoli
Femoral condyles/epicondyles
Biceps femoris
Back
o Deltoid
o Latissumus dorsi
o Scapula and its muscles
o Erector spinae
Heart
o Heart sounds
o Apex beat
Lungs
o Fissures
o Pleura
Landmarks
o C7
o T12 (angle of Louis)
o L5 (iliac crest)
o ASIS
o Inguinal ligament
o Mid-Axillary line
Organ
Identify & answer questions on structures within and relating to
organs
Plastic model of the anatomical part which may be labelled with letters and you will be expected to identify
that part. Expected to know a little about the relation of that labelled part to other parts of the anatomy.
Histology