Disease Smoking Obesity High BMI (Statin, High Q-risk+ Lithium Warfarin

Vascular HTN>Statin Toxicity Toxicity

dementia)
Plab 2 Revision
Presentation Notes By Ali Munawar
70Y/M-GP 1.45Y/F/GP> 1.335Y/F-GP>F/U 50Y/M-GP- 63Y/M-ED Counselli
Admitted with weight gain. All test Normal, F/U>General Brought by his ng
chest infection. 2.52Y/F/Ortho BMI 28, Check-up daughter as he
K/c of COPD> get OPD> Chronic Cholesterol 6.2, Q- 24H BP was confused
chest infections arthritis L knee> risk 14+Palnning monitering> since morning.
time to time.>On Plan L knee to start on statin. 165/95 -Peeing a lot
sal,Ipra+Dexa arthroplasty. BMI >Drink wine 1G/D Q risk 16 -seems tired.
Now stable> talk 37> Consultant >Eating BMI 28 -Diagnosed
to him regarding want <35. Use to out>Mainly fish with bipolar
smoking cessation. go for walk and chips. mood disorder>
Smoke30/D/30Y>d +exercise > not >Don`t like taking lithium
on’t want to stop. now due to exercising. But for months.
arthritis. walk with husband
Presenting 53Y/M-Cardio 1.Fat since 2.45Y/F-GP. -Businessman > 1.Access the
Complaint: Angina>Schedule childhood> All Has psoriasis using not time for confusion state
fro angioplasty in a family is big. ointment exercise, eat Since when?
what do you
month. High Always hungry and BMI 32 outside,
mean by
Cholesterol+ eat a lot> Fast Worried about stressful job,
confused?
Smoker> Reluctant food, Don`t like vascular dementia smoking 2.Exclude
to stop. running. BMI 40 bcz of older sister 26/D/18Y, Drink dementia by
40/D/20Y.>Tried Wt 100kg, Go to diagnosis. Drink 5- 2G wine/D asking: has he
to stop but failed. Gym but stop bcz 6D/W, Smokes been forgetful
people laughing, 15/D, Eat Junk recently?
Period stopped at food Does he struggle
35>Ovarian failure to find words?
Getting lost in
familiar places ?
Rule out Heart A, HF -Hypothyroidism Hypothyroidism Hypothyroidism DDs for confusion
COPD -Period-PCOS PCOS-Period Dementia UTI:
exacerbation. -OSA + HA Depression Complications Diabetes:
Dementia (2nd Q) of High BP Stroke:
Head injury :
(Headache, sob, Any recent falls ?
Chest pain)
Risk Factor -Commonest 1.Family history of 1.Familial obesity 1.Familial MMA: when
cause of COPD is obesity. 2.Steroid obesity lithium is
smoking.+ 2.Steroids 3.Diet and 2.Steroid mentioned ask
about
Progression of 3.Excessive eating exercise 3.Diet and
Why prescribed?
COPD> Respiratory 4.Depression and 3.Depression and exercise
Since when?
Failure Hypothyroidism hypothyroidism 3.Depression Taking as
2.Most Imp risk and prescribed?
factor for HA is hypothyroidism Going Follow up
smoking>Surgery appointments?
can be post-pone/ Dose change
can lead to recently?
another HA. Other side effects
of lithium
toxicity: Nausea
& vomiting?
Heart racing?

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 Plab 2 Revision Notes By Ali Munawar

Tremors?
Any other
medications? (to
exclude
interaction

Relevant History 1.Explore>Admissi 1.Explore Weight 1.Explore DESA Explore HTN, Psychosocial of
on>COPD>Smokin gain. How much? 2.Explore Reason for, Father and
g>DESA>MMA+Psy time? last weight psoriasis+ Steroid Explore risk Daughter:
chosocial. and height? factors. does he live
alone?
1.Explore>Angina> Always like this?
Any one caring
Smoking>Previous 2.Explore diet for him other
attempt to stop> 3.Previous than yourself?
MMA> attempts to lose Is he
Pschosocial. weight. independent with
4.Explore periods. daily activities?
Who else do you
care for? Do you
find it difficult to
care for him? Any
help we can offer
?
No>DM, HITN,
Thyroid problem.
Retired
No smoking or
drinking habit. No
history of
dementia, fever,
infection, stroke,
trauma or fall.
Examination OBs+Chest OBs+ Chest+ OBs+ Chest+ OBs+ Chest+ OBS+GPE
Thyroid exam+ Thyroid exam+ Thyroid exam+ Neurological
BMI BMI BMI Urine Dip examination,
Urine Dip (BMI>30 is Scan>Fundo, MMSE
Scan>Fundo, ECG obesity) ECG
Investigation Blood (Routine, Blood (Routine, Blood (Routine, FBC, RFT, TFT,
LFTS, KFTS, TFTS) LFTS, KFTS, TFTS) LFTS, KFTS, U&E, Lithium
Hormone Level Hormone Level TFTS) blood level,
Lipid Profile Lipid Profile Hormone Level ECG
Lipid Profile
Management Benefits of Quit 1.Familial obesity 1.Explain Q score: Treatment is Confusion is
smoking: > run in families. > yours is 14 and same as high due to lithium
1.Benefits: excessive eating the expected is 10 BMI and toxicity , that’s
1.Reduce damage without burning and you are at cholesterol. when the
to lung>reduce calories. > medical risk of stroke. Same options lithium level in
chest infection condition but in 2. Vascular like diet, the blood
>Reduce your case it’s dementia? It is exercise, statin, increases over
progression of unlikely as it’s reduced blood to Regular GP the
disease>reduce familial the brain causing follow-ups. recommended
Hosp Admission 1.Options: damage and dose we need
Diet destruction of to do further

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 Plab 2 Revision Notes By Ali Munawar

2.Decrese Chances Exercise brain cells. + investigations

of Lung cancer, Medicine Usually due to Antihypertensiv to see why this
IHD and HF. Surgery narrowing of BV e medication happened
3.Good sense of 1.Dietician. in this brain. It is ACEI> s/e 1.Admit the
taste, No bad Supervised weight caused by one big Cough. patient right
breath from loss. stroke or multiple away
mouth. 2.Exercise: mini strokes. 2.Involve senior
2.Options: Gym Instructor> Psoriasis is also +INV
1.Go turkey > Provoke exercise associated with 3.Treatment:
quitting date + training. increased risk of -IV fluids
Nicotine 3.Medication vascular -Recheck
replacement. Orlistat> Prevent dementia, stroke lithium level
2.Nicotine gums, fat absorption and heart every 6-12
lozenges. (Fatty, bulky stool problem hours
3.Bupropion>Redu and abdominal 1.Options -Might need
ce craving >Start discomfort) 1)Diet and heamodialysis if
1-2 W before 4.Surgery. exercise level is too high
quitting. (>35BMI+Other Join local weight 4.Refer to
3.CBT > Stress sig disease like local weight loss psychiatrist for
management Recent DM within group. bipolar
4.Smoking 10Y or BMI>40 2)Medication like reassessment
Cessation groups. If all non-surgical Statin and dose
5.Support Group options failed) (S/E> Muscle adjustment.
to join> Smoke 1.Band around aches, stomach 5.Advice
free. stomach upset and 1)continuous
2.Remove part of drowsiness(take at monitor /
stomach. night), headache) follow up
2.CBT> Mood 2.Risks: appointments
3.Regular GP HTN, 2)no OTC
follow-up Atherosclerosis NSAIDs
4.Advice: (Clot in brain, 3)Maintain
Eat Slowly, Eating heart, lung, leg)> hydration by
with partner, Small Regular GP follow- fluid intake
plate up and tests. 4)Not to stop
lithium
suddenly and
always seek
medical advice
first.
6.Offer support
and career if
needed
Safety Net S/N> Low mood or S/N> Low mood or 1.Deterioration,
generally unwell. generally unwell. neurological
manifestations
2.(other signs
of toxicity)

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