Explaining management and treatment Flashcards
Why would you eradicate H pylori?
Reduces recurrence of gastric and duodenal ulcers and risk of rebleeding
Regression of MALT lymphomas
How do you explain H pylori eradication?
3 medications, tablets, taken OD for 1 week
2 antibiotics, 1 acid reducing tablet
Options depend on recent abx treatment and allergies
How do you test for H pylori?
C-Urea breath test (oral C-urea, breath samples before and after) only if no abx in last month
CLO test during endoscopy, biopsy sample placed on urea medium, turns red if urea turned to ammonia by H pylori
How to approach pt after blood tranfusion reaction
WIPE
How much do you know about your condition and need for blood?
Current symptoms?
Better since transfusion was stopped?
Prev allergies
ICE
Explain what happened, likely impact and plan
Plan after acute haemolytic transfusion reaction?
Monitor pt obs, urine output
Watch out for haematuria, jaundice, syncope
Double check for clerical error
Don’t throw away tubing or bag
Check expiry date of blood and check for imperfections/clots
Document and send blood back to blood bank
Run saline through cannula used
Blood tests (FBC, U&E, LFTS, group and save)
Furosemide?
Clinical incident form
How should you approach a smoking cessation discussion
Establish timeline and amount smoked Previously quit? How? What happened, cause? Motivation to quit now? Benefits of quitting, negatives of continuing Never too late to quit, benefits still seen even when smoked for many years Advice on how to quit Arrange future follow up
What advice is given to help smoking cessation?
Gradually versus cold turkey
Smoking cessation clinic w/specialist nurse and f/u
Cravings, weight gain, irritability at first
When temptation arises, keep busy, exercise, avoid peer pressure
Enlist support of family and friends
NRT: patches, lozenges, inhaler but SE: nausea, headache, palpitations
Bupropion: reduces seizure threshold but reduces cravings
Decide on date, f/u
Name positives of quitting smoking
Save money
Improve health (reduce risk of lung, throat, mouth cancer, MI, stroke) (breathing improves, reduced cough)
Less stigma
Name negatives of continuing smoking
Increases risk of lung, throat, mouth and stomach cancer, risk of MI and stroke
Expensive
Could get COPD
How do you approach explaining Down’s syndrome?
What do you understand about Down’s syndrome, particular concerns?
Genetic condition, not inherited, no cure
Variable manifestations: Mental impairment, care needed, complex health problems with heart defects, early dementia etc
1/1500 risk if age 20, 1/50 risk age 45
Risk higher if prev pregnancy affected
National screening programme
How would you explain national screening programme for Down’s syndrome?
National screening programme, offered to all pregnant women, can choose to not have it
Identifies those at higher risk
11-14 weeks blood test (AFP, PAPP-A, HCG, oestrogen) and USS (neck fat pad)
If risk >1/200 then offered diagnostic test
CVS (2% risk miscarriage)
Amniocentesis (1% risk)
Counselling & support, option of TOP
How would you explain moderate dyskaryosis result from cervical screening and management steps
Check understanding
Moderate dyskaryosis means abnormal cells seen from smear
Not cancer but can be pre-cancerous so need biopsy for diagnosis
If pre cancer, may need cervical laser/excision
Biopsy happens with specialist doctor or nurse in a clinic, speculum, colposcope to magnify area, special dyes and biopsy
Takes 20mins, may have bleeding/discharge for 5 days after
Can return to work same day, bring dark pants and pad to the appointment
Avoid sex/tampons/pessaries/creams 24hrs prior
Avoid tampons/sex until bleeding stops
Take paracetamol before clinic
Biopsy results within a week
Further management (laser, surgery etc) will be discussed after results are back
Procedure can be associated with preterm birth so inform doctor if becomes pregnant in future
How would you explain rhesus -ve status to a pregnant woman?
Establish what the pt knows about rhesus status and implications in pregnancy
Rhesus status is a way of categorising blood, like ABO, and describes whether the blood has specific chemicals (antibodies) in or not
15% of people are -ve
If the father is -ve then the baby will be negative and nothing needs to be done
If the father is +ve, the baby will be +ve and extra caution needs to be taken
If the baby’s blood and mother’s blood mixes, the mother’s immune system might attack the baby’s blood as foreign
Usually it will not harm the baby but will be dangerous for subsequent pregnancies
Can cause ‘haemolytic disease of the newborn’ and jaundice, extremely ill or stillborn
Risky times are childbirth, trauma, spotting, TOP, amniocentesis
Give treatment to prevent problems, anti-D, 2x in pregnancy (28 & 34 weeks) to stop mother mounting immune response
Blood test (kleihauer) taken after delivery to see if another injection is needed
Ask father’s rhesus status
Ask about previous ectopics/TOPs/miscarriages/spotting in this pregnancy
Injections are safe, rarely mum might be allergic
Not at risk of congenital deformity, don’t need c-section
Anti-D in next pregnancies too
How would you counsel a med student with a needlestick injury?
WIPE
Account of injury, time since event, type of exposure
Which pt, sharps now disposed of?
Hep B vaccines before med school?
Encourage wound to bleed under running water, wash with soap but don’t scrub
Contact occ health
If pt high risk then PEP may be given within 1hr of injury for 28 days, antiretrovirals
Blood test after 3 months for HIV, hep b, hep c
Practice safe sex and don’t donate blood during this time
PEP reduces risk by 80%
Risk of transmission in pt with known HIV is 3/1000
PEP SE: n & v & d, headache, dizziness
Someone should take blood from pt and document in notes
Ask/check pt HIV & hep status
If unknown, risk assess (safe sex, IVDU, country of origin etc)
Risk high, status unknown, ask to test pt
How would you counsel someone about CBT?
WIPE, establish pt diagnosis and prev therapies
Establish what pt knows about CBT
Cognitive behavioural therapy
Talking therapy, 1-to-1 with therapist (psychiatrist, psychotherapist, trained socail worker)
Used for anxiety, OCD, eating disorders etc
Focuses on current problems, encourages problem solving
May have homework each week (reflective)
Usually 6 weekly sessions but variable
Benefits (prevention of relapse, new coping mechanisms, different ways of thinking)
Antidepressants can be continues alongside
Confidential (unless risk to self or others)
