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    D1-RT1 TEXT HYPERKALAEMIA

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    38 views19 pages

    D1-RT1 Text Hyperkalaemia

    Uploaded by

    Alwin Bright

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 19
    Hyperkalaemia: Texts Hyperkalaemia is a potently le-threatoning condition. Reduced renal excretion, ‘excessive intake, or leakage of potassium rom the intacellr space can allause thes ‘coniton. Apert rom acute and chronic renal alu, hypoaldesteronism, anc massive ‘issue breakdown are typical condtons aang to hyperkalaemi. Symptoms ae non specific and predominantly related to muscular or carta dystuncton. Handing of potassium inthe nephron depends on passive and active mecrerisms, Excretion mainly occurs in the conical cllecting duct. should De noted, rowever, ‘hat reabsorption and secretion of potassium occur simstaneously, and tht many ‘meduiators are important, such as dt, adrenal sorlds, and ackt-base balance. Renal nsufcency - acute or chronic - coud aso Sead Yo eduoed GFR with bw urine flow and decreased renal excretion of potassium. Medications may also interfere wih unary potassium excration, Potassiu sping duretics are cinicaly relevant, Non-steridal antitarnmatory drags. (tuprofen, naproxen) cen cause a decease in GFR leading to hyperkalaemia, Comtaned teatmont ‘wth spionojactone and ACE inhibitors, especialy in patents with renal imparmant or heart failure, must be monitored very carefully, Diagnosis Hipertalaemia is not usualy associated with symptoms. Patents could sometimes ‘complain of nausea, paraesthesia, paptatons, or musole pain. But moderate to severe !hyperkatoria can resin uneven cardiac hth, which canbe fatal. Bectrocardograpty (ECG) monitoring is mandatory in pallens wil serum potassium > 5 mmol Besides assessment of cardiac function, Kidneys, and urinary tract 3 wl as hycration status, detaled laboratory examination is necessary, especealy# the undorhing cause unkown, Figure + gives a diagnostic algorithm basedt on GFR and akiosteronelevek. 10 Faotitioun hyporkalaomia Hofovar een oieknnsoundinan asymptomatic paint with ro apparent cause, fatto hyperaesni hut bo consiorac This rts kon loakage of poten roe he tac quire chain orator bet sure, ts esas, eweation (HM peta cee nition cx nolvadex posiam in ‘0 a 0 Van enh. sexy pri, solu nani ean 8GGUF cing MU oa cw, cen ee ies nr wth Hcy oe ornare yn er non vote an spay cite oth eh tis prooees. ‘Gorretion tastes rvs uncut ox vay x a dan again. 1" Management of Hyperkalaemia ‘Step 1: Evaluate patient for potential toxicities and initiate ECG monitoring 1. 1 pation has savere hyporkalaemia or shows EO changes, transfer to intensive caro uit (ICL) immectaty. 2, Ca-Gluconate 10% can be used in patients with cardiac symptoms to staiize ‘membrane potential and postivay influence bradycardia and EOG changes Cinical ‘@zamination and echocariograpty should be carried aut to lock for perkarat cfusion, ‘Stop 2: Kdentity and immediately eliminate sources of potassium intake Stop oral oF parenteral potassium supelements an all age that might cass or sagravate hyperkalaeria, “4. Input of aticians might be needed to identity potagiumich foods. ‘Stop 8 Increase potassium shift from extra o intracellular space '5, Dextrose andor insuln infusion. An effect can often be seen immediate but response remains unpredictable. Hypog\yoasmia being the main se-floct 6. Sodium bicarbonate given to patients who are acidic. Arisa in pH can aggravate rypocalcaemia ‘Step 4: Increase potassium excretion 7. Loop aluretics inhibit the inward transport of potassium. Treatment with oop recs may be of value even I the paint has only residual ena ction. 8. lonexchango resins keep potassium from being resorbed, Moce effective if given rally. Enemas should be tained atleast 30-60 min 1 Renal placement therapy isthe ultimate measure in severe hyperkalaemi, but Haomodaiyes provides substantialy higher potassium clearance. Catal i tents wil rarely tolerate Haemodiass, END OF PART A THIS TEXT BOOKLET WILL BE COLLECTED Tr @ET pcre UBT ‘Sample Test 1 READING SUB-TEST - QUESTION PAPER: PART A ‘CANDIDATE NUMBER: LAST NAME: FIRST NAME: OTHER NAMES: PROFESSION: VENUE: ‘TEST DATE: CANDIDATE SIGNATURE: ‘| TIME: 15 MINUTES. (tee 'B0 NOT open this Question Paper orth Text Booklet unt you tlt 0. White your answers on th pacts provided chs Question Pape. ‘Ono mark wi be grant for a caect nse ‘Attend Fhe 15 mites hr is Question Paper nd the Text Booklet. 10 NOT renove OET mater Ham he test em 1% NR es =====-=-=-===z.=7 Part A “TIME: 15 MINUTES, + Look atthe four texts A-D, in the separate Text Booklet + For each question, 1-20, ook through the texts, AD, to find the event information. + White your answers on the spaces proved inthis Question Paper. ‘+ Answer at the questions within the 1 minute tie Sr ‘Your answers should be corey spat, Hyperkalaemia: Questions Questions 1-6 For each question, 18, deco which text, B, Cor B the ivan comes fom | ‘You may uso any latter mere than once. | In which text can you fd inermation about | 1. acondtion that does not requte toatmont? 2. a woatiment that could benefit patents with minimal kidney function? {8 the vel of sorum potassium that necessitates an electrocardogran’? 4. factors affecting serum petassium level inthe body? 5 6 6 ‘| mediation that can hap in improving ECG resus? ‘wat coud lead to low GFR? ‘Questions 7-14 ‘Answer each of the questions, 7-14, wth a word or short phrase from one of te texts, Each answer may include words, numbers or bath 7. Why could non-stercidal pan lls lad to hyperkalaeia? 8. What could be the rest of kidney transplantation? 8. Why's EG monitoring of patient with serum potassium greater than 6.5 rmebt mandatory? 10. Wen can lekage of potassium from intraclular space be not determined as one ofthe tigger of hyperkalaeri? 1“ 11. patient presenting with GFF greatr than 15min, cabetic nephropathy ‘nud be associated with what? 12.\What postive influence does sodium bicarbonate have on patent expedoncing nyperkatzmia? 18, Assistance from whom coud be reauiredtin cuting down potassium consumption? +14, Which management methed is recommended for increasing potassium excretion, Ifthe patient sin otherwise good heath? Questions 15-20, Complete each ofthe sentences, 15-20, wih a word or short phrase from ane ofthe tes, Each anewer may include words, numbers or both 416. As a side-effect, sodum bicarbonate can 16. Hyperketaemia prosents wh symptoms that are but related to cardiac dysfunction, 17,____ Is equted for pationts presenting changes in EOS. 18, Use of slcohol causes haemolysis when taksng 18. While the esponse oi might nat be variable, the _ of daxtraseintusion can be memediate. 20, Haomodiysis i not recommended forthe END OF PART A ‘THIS QUESTION PAPER WILL BE COLLECTED 6 T @ET ‘Sample Test 1 Liao UR ESL ease ai a te CANDIDATE NUMBER: LAST NAME: FIRST NAME: OTHER NAMES: PROFESSION: VENUE: TEST DATE: ‘CANDIDATE SIGNATURE: _ TIME: 45 MINUTES Cee BO NOT open this Question Paper unl you ae tld do so. (One mark wil bo granted foreach corect answer ‘newer ALL questions. Mars are NOT decictod for ncoset answers, At the ond of tho test, handin this Question Pape. DO NOT remove OET materia om the test room, Pe Mark your answers on he Question Paper by ing nthe ce sing 228 pene © 7 ry = = Part B inthis par ofthe test, here ere si short extracts relating to the work of health professionals. For questions 1-6, choose the answer (A, B, or C) wich you think fits best secorcing to the text 1. Which of the following is NOT montonedtin the text? ‘A. Some sytinges can contain a mature of two diferent medications, 1. Needles must nove be broken after administering macications, (C. Two syringes ofthe same type cannot have cferent meccatons, ‘Aseptic Technique ‘Asoptis technique must be used win handing syringes and needles. The ‘edt, the tp and hub, the inside of the bar, an the phinger must be kept Steril times. Contaninaton ofthe plunger wl contaminat the solution or ‘meescation as the plunger goos down the bar Al syringes shouldbe labled ith the name ofthe medication Iwo or more syringes ofthe same type but Containing diferent solutions or medications are being used, they must be coary labeled to prevent confusion. Ia naedle Is broken, t must be accounted fora ts enrety. Bonding, shearing, breaking or recapping contaminatod neetlesis stulely pohtbited, 19 2, Wich of the flowing can be understood trom the tent? ‘A. Face masks may be worn only when Instructed bya nurse ola member (ofthe infection corr team B, itis necessary for al hospital tal and visor to folow addtional infection prevention precautions before entering the hospital premises, (©. Weating face mask might not be raquired ata ties, Infection Prevention and Control Each year, an excess of bllon is spent by NHS on hethcare-associated infection. This san infection that was nether prasent nor incubating atthe tne Of contact with the heatthcars facity Al staf havea duty to protec paints ‘rom hain and ensure coleaques, patients and vistors take infection prevention seriously tis necessary to apply standard precautlons of infection atl tines, ‘ational precautions may be required in certain creumstance, and these wil be advised by a nursa in charge ora member of the infection contol team. For [oe certain condtions may rogue a face mask to be worn 20 E/FENS EE i 8, The emalis reminding stat ‘A. that thw have been breaches of coisidance inthe recent times, Bi, the need for care while transiting confident information. how to use the tiple chack method of using the fax machine. ‘To: All Stat ‘Subject: Faxing Confidential Information Please note the following: Tako safety measures betore faxing confidential nfotion, A fax cover sheat shoud contain inetruction tha the faxed materials to be given only tothe ramed recipient. Consant Is neoded from the cllant to fax information. Check. thatthe fax number is correct, chock the number onthe dspay ofthe machine ater caling, and check a thir tima before pressing the "send" button. Flow up with the agency receiving tho faxto assure that the private records are received and placed in a sure locaton as 900n as the fax has been sont. a 4. The passage supports the statement that ‘A. Patients and medical personne should use the same language 8. Some words may be interpreted dferenty by non-medical people C. Patients should be explained about anginas and migraines. (Clear Communication "Mecical personnal reso Immersed in jrgon that it becomes part of ther daly ‘speech. The patent may not understand the werds or may have accent idea of ter mesning. Technical words such as myocardial infarcton are in cious "eed of avoidance or explanation. Consider also terms such as exacorbat, hronic, eam, and sputum — these may soem cious in meaning to you but "otto the pation. You may think that some terms such as angina an migraine ‘are so wel: known that they dont need explanation, but these are very often misinterpreted 5, The passage suggests which ofthe folowing? A. Older people prefer physical examination, 53. Symptoms in older people re not always typical CC. Physical examinations the way to gain adcltional history. Physical Examination Many indvicuats pecoie a comprehensive physical examination to be an intrusive event that is best zvoidad i possible, However, for older peopl, in \whom the typica” presentations of ness may be subtisor unusual, thorough Physical examination is a comerstone of aasessment. The value ofa thorough Physical examination can be underestmated by heaithcare professional, but ‘may be highly regarded as a therapeutic bene by patients Taking to the pationt during the examination is aso a method of reassurance, while potently gaining additional history and most ofa, ehgenderng rut, The key massage is ‘he luo ofa comprehen, oleic and unnshed examination. 6, Before ispensing medicine, nurses ‘A. must contact the pharmacist 8. are expected take writen permission trom the doctor ©. must have had adstional raining Role of the Pharmacist The pharmacist i legaly responsible forthe supeiy and dstbution of rags in accordance with the law, However, n some oa89s, nurses who have had ‘acitiona traning may dispense madicnes, this in ite with the hospita Polcy ancl withthe writen inst mecial ravitoner Tae roe ‘of pharmacist also includes that of being @ ascurce person for medicine 'nformation, and they are responsite for chocking that ery newly proscribed "meric wit not interact dangerously wh, or null, ary existing mediation 2 Ad : Intio part ofthe test, there are two texts about ifort aspects othoalthcae. For questions 7-22, cioase the answer (A,B, C oD) wich you think fis best aocorcng to the text Part ¢ ‘Text 1: Myopia More and more cilcten today need eye tests and glasses. The wort has been gripped by an |, enpxecedented rie in myopia aloo known as short-sghtodnss. Sy years ago, 10-20% of ‘the population was short-sighted. Today, upto 60% of teenagers and young aduits are. By some estimates, one-third ofthe works population — 2.5 lion people — could be afiecte by shor-sightedness by the end of this decade, We seem to behaving a myopia epidemic “Two condtin Is moe than an inconvenience. Glasses, contact lenses and surgery can hep tocorect it but they do not acess the underlying defect: a sight elongated eyebal, which means thatthe lens focuses ght rom far objects slighty in font ofthe retina, rather than docty on it. In severe cases, his condtion increases the risk of retinal detachment, cataracts, claucoma and even bindhass. Bacause the eye grove throughout chidhood, myopia ganeraly develops in school-age chien and adolescents. About one-fith of Lniversity-aged pooele in East Asia now have ths extreme form of myopia, and half of ther : are expected to develop ieversble vision loss. This threat nas promptod risen esearch to ty to understand the causes of the disor ‘Asa rut olddeas that myopia isthe domain of tha bookish chil ae boing thrown out ard ‘a naw notion has come un: that spending too fang indoors is plang caren at rk, For ‘many yours, the consonus was thal mwopia was lrgaly down to gonos. But it was cbvious that gones could not bo the whale story (One ofthe clearest signs came from a study of poople inthe northern tip of Alas whose este was changing, Of adults who hac grown up in scated communities, only 2 of 131, hac myopic eyes. But more than half oftheir chien and grandchildren had tha conden, Genetic changes happen too siowyto explain this rapid change — or the soaring rats in ‘myopia that have since boon documented al over the world, The only expanalion was thal an feaveormenta affoct has caused the diference, ‘There was one obvious cup: book work. Tha modém rise in myopia mimored a tend for tilda in many counties to spend more tee engaged in reacng, tucking or — more reconty ~ luad to computer and smartphone soreens. This is particularly the case in East ‘Asian counties, whore the high value placed on educational performance is dking cher to spend longer in school and on their studio. Researchers have coneitenily documented a song association between measures of {education and the peevalance of myopia Inthe 1900s, for example, they found thet teenage boys in saa who attended schools where they spent thelr days stuching had! much highor Fates of myopia than did students who spent less tine at their books. On biological level, it seemed pause that sustained close work coud ltr gtowah ofthe eyeball asi res to ‘2ocommodate the incoming ight and focus close-up images squaray onthe rena, ‘Atractive though th iden ws iid rot ole up. the early 2000s, when researchers j ‘stated to look al specie tohaours, such as Books fad por week ox hours Sper eadng OF Using a computer, none seemed tobe a mje contrbutor to myopia sk. But anode factor ‘id. A 2007 survey tacked more than 500 alght- and nine-yeacols in Galoria who stared ‘ou with healty vision. The tear examined how the chicken spant thir days. Ato fv years, ‘nmin fe ofthe children had developed! myopia, and the ony ervrcrmenta factor that was ‘Stongly associated wit sk was time spent outdoors. A year ater another study tacking ‘more than 4,000 chidron at Sydney primary and secondary schools for tvee years, found ‘that chicken who spent less time outsie were at gratar rk of developing myopia ‘Animal experiments support the idea that ight is protective, Researchers frst demenstrated thisin chicks, a common lab modal fr studying vision. By ting chicks with goggles that ater the scion and contrast of incoming images, 1 poseibe to indice the development ‘of myopia while raising the brs under controled conditions in which ony ight ftensy ‘changed. High lurination leks — comparable to those encountered outside — dowed the development of expermentaly induced myopia in chicks by about 60% compared with ‘ermal indoor ighting condone. Resaarchers eleswfnere have found smiar protective effets in toe shrews and rhesus monkeys But what explains how bright ght coud prevent myopia? The leading hypothesis that ght stimulates the release of dopamine nthe rtina, and this neuroransrater in tum bck the slongaton ofthe eye dung development. Retinal dapemine which is produced dung the day tls the eye to switch rom night-time vision to daytime sion, Under indoor lating, the cycle is csrupted and the system starts to got abit noisy and the development of he eye becomes treguar Text 1: Questions 7-14 7. Inthe fist paragraph, statistics are presented to |A. explain the main reason for worry ®. reinforce the view that mpopia i an epic C. question the qualty ofthe variables. . describe the changes inthe causes. 8. What according to the second paragraph isthe problem with surgery? A. Surgery doss not restore vision, BB. Contact lenses ae better than surgery. (©. The focus is not onthe primary cause, D. ttleads to rovers vision los. 9. ‘The phrase ‘This Threat’ in the third paragraph refers to A. aise in research into the causes of the sora Ban extreme form of myoria C. development of ireversibie vision loss, : D. children being thrown out. 26

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