14 - Vertical Themes Flashcards
What is the definition of screening?
Trying to find people at risk of a disease that are otherwise healthy
What is the difference between primary, secondary and tertiary prevention and give some examples of screening programmes that are aiming to achieve each?
Primary: cervical smear, antenatal, genetic, Q risk
Secondary:
Tertiary: Diabetic retinopathy screening, diabetic foot
What are the different populations that can be used for screening?
- Mass e.g NIPE
- Selective e.g sickle cell
What are the advantages of screening?
- Reassurance
- Reduce morbidity and mortality
What are the disadvantages of screening?
- False negatives and false positives
- Inverse care law
- Expensive
- Overtreatment
- Lead and length time bias
What conditions does a screening programme need to fulfil to be treatable?
Disease, Test, Treatment, Programme, Implementation
Disease
- Must be serious
- Must be treatable
- Must have known disease progression
- All primary prevention strategies should have been implemented
Test
- Simple and safe
- Should be acceptable to target population
- Clear diagnostic investigation
- Sensitivity and specificity must be known
Treatment
- Should be beneficial to have early treatment
- Must have treatment available
What is sensitivity and how do you work it out?
Low false negatives
True +ve/No with disease
What is specificity and how do you work it out?
Low false positives
True negatives / No without disease
What is positive and negative predictive value?
Higher prevalence higher PPV
When patient with high risk result asks the likelihood of them actually having the disease
What is the difference between lead and length time bias?
Lead: early detection confused with increased survival
Length: screening picks up cancers with long latency period so these naturally have better survival
What are the five national screening programmes?
- Bowel cancer
- Antenatal
- Cervical cancer
- AAA
- Breast cancer
- Diabetic retinopathy and foot disease
How much screening is done antenatally?
How much screening is done neonatally?
What is infant mortality rate?
Why has infant mortality improved overtime?
- Less crowding
- Vaccination
- Sanitation
- Nutrition
Why did neonatal deaths improve in 1990’s?
Back to Sleep programme
What is the biggest risk factor with neonatal deaths?
Low birth weight
How can we prevent perinatal mortality worldwide?
What are some causes of maternal death?
- SUDEP
- Underlying cardiac issues
- VTE
- Mental health
- Post partum haemorraghe
What makes up an FBC?
Have to ask for reticulocytes as an add on
What is included in a basic clotting screen?
Always needs to do platelet count with it so do FBC as well
What questions do you need to ask yourself once you know somebody is anaemic?
- Reticulocyte count
- MCV
- Blood film
What are some causes of DIC?
Sepsis
What are some causes of DIC in pregnancy?
What are some common haematological changes in pregnancy?
- Anaemia
- Macrocytic red cells
- Neutrophilia
- Low B12 measurements (even if not truly deficient) in 20%
- Thrombocytopenia
How is VTE in pregnancy diagnosed and managed?
What are some reasons to give LMWH prophylactically in pregnancy?
What are some causes of thrombocytopenia in pregnancy and how is this managed?
- Monthly FBC until 28 weeks, then fortnightly
- Consider risk of neonatal thrombocytopenia (and consequent bleeding)
- Consider risks of eg foetal blood sampling, instrumental delivery, epidurals!!
What is the likely diagnosis?
How can we tackle poor vaccine uptake in india?
- Political involvement
- NGO involvement
What is the second victim recovery process? (6 steps)
What is mindfulness?
Attention regulation
What is the stress performance curve?
What does utility mean in health economics?
- The effective and efficient use of medical resources (stewardship of resources-see GMC)
- Choosing groups or individuals most likely to benefit
What are some factors involve in utility?
What adjuncts can help you in the A section of the A to E assessment if an airway is not patent and when would you use each of them?
Adequate respiratory effort but obstruction
- Head tilt chin lift
- Guedel (measure from angle of jaw to incisors)
- Nasopharyngeal airway (not in basal skull fracture)
- Jaw thrust
Inadequate respiratory effort
- Bag valve mask
- I-Gel (cardiac arrest)
What is septic shock?
When sepsis leads to prolonged hypotension and raised lactate despite adequate fluid resuscitation and inotropes
What is the ILS algorithm for CPR? (both shockable and non-shockable)
- Ensure safe
- Check pulse and chest for 10 seconds
- Call for help and start chest compressions. Call 2222, adult cardiac arrest
- Get defibrillator pads on
- Airway
- Off the chest whilst analysing
- Off the chest and oxygen away whilst shocking
- Check pulse after each round
What is post resuscitation care?
What are the reversible causes of cardiac arrest?
4 H’s
- Hypoxia
- Hypo/hyperkalaemia
- Hypothermia
- Hypovolemia
4 T’s
- Thrombosis
- Tamponade cardiac
- Toxins
- Pneumothorax
What are the two shockable and two non-shockable rhythms?
PEA and Asystole are non-shockable
What happens to the energy of shock in CPR?
Increases with each shock
What drugs can be used in cardiac arrest and when?
- Adrenaline 1mg 1 in 10000 (100 micrograms/mL) after 3rd shock then every other cycle
- Amiodarone 300mg after 3rd shock, given over 3 minutes
What are the two biggest factors that are proven to have good outcomes in CPR?
- Chest compressions
- Defibrillation
What age do children get CT head for suspected NAI?
<1 or any neurology
How can you diagnose tines capitis?
- Hair plucking
- Skin scrapings
Often clinical diagnosis though!
Treat with oral terbinafine
What can be the source of tines capitis?
PETS - treat pets
What is a complication of eczema herpeticum?
- Secondary bacterial infection
- Herpetic keratitis
What is the difference between erysipelas and cellulitis?
Erysipelas has sharp border, cellulitis is not clear cut
Erysipelas just S.Pyogenes, Cellulitis can be S.Aureus too
Erysipelas usually only on shins and face
How do you treat erysipelas?
Flucloxacillin, Rest and Elevate legs, Dressings
How can you tell this is chickenpox?
Varying stages of rash
Usually starts on trunk then goes out to limbs
If someone has tines cruris where else should you examine?
Toenails!
If they have this they need systemic treatment
What are some differentials?
- Tinea cruris
- Intetrigo
- Psoriasis
- Contact dermatitis
What is autoimmune encephalitis associated with?
Teratomas
What are the antibiotics for neonatal sepsis and neonatal meningitis?
Sepsis: Benzylpenicillin, Gentamicin
Meningitis: Gentamicin, Cefotaxime, Amoxicillin
Who can get involved in an ASD diagnosis?
- CAHMS
- SALT
- OT
- Educational psychologist
What are some comorbidities with ASD and some poor prognostic factors?
Co-morbidities
- Fragile X
- Anxiety
- Tuberous Sclerosus
- ADHD
- Visual and hearing impairments
Poor prognosis
- No speech by 5 years
- IQ<50
What are some questions to ask when a child presents with chronic constipation?
- Meconium in first 48 hours?
- PR bleeding?
- Any incontinence?
- Any psychosocial changes?
- Triggers?
What are some signs of abuse in the elderly?
- Pressure sores
- Unkempt
- Cachexia
- Not wanting to be left alone with certain family members
- Depressed
- Being aggressive for no reason
- Becoming quiet and withdrawn
What are some risks for abuse of the elderly?
- Carer relies on victim e.g home, emotional
- Memory problems
- Social isolation
- Being dependent on carer
- Poor relationship with carer
REFER TO SOCIAL SERVICES OR DEPARTMENTAL SAFEGUARDING LEAD
What are some causes of falls in diabetic patients?
- Polypharmacy
- Alcohol
- Peripheral neuropathy
- Postural hypotension
What should you do after a patient on an Apixiban has a head injury and what is the mechanism of action of Apixaban?
Xa Inhibitor
- Stop anticoagulant
- Contact near surgeons
- Contact haematologists about referral
- Monitor GCS with neurological obs
What are the hallucinations in Schnider’s first rank symptoms?
3rd person auditory
What is essential for diagnosis of anorexia?
- Have to have vomiting, laxatives, diuretics or excessive exercise
What are some psychological therapies for anorexic patients?
- MANTRA
- CBT-ED
- SSCM
What is the pathophysiology of PD and what are some examples of dopamine agonists?
Degeneration of dopaminergic neurones in the nigrostriatal pathway so less dopamine in the basal ganglia
Examples: Rotigotine, Bromocriptine, Cabergoline, Apomorphine
What could hallucinations in PD be due to?
- Dementia
- Delirium
What are the issues with giving levodopa?
- Progression of PD
- SEs
- Freexzing on/off
How would you describe this audiogram?
Bilateral low-frequency conductive hearing loss
How does an adenoidectomy work for OME?
Removes the source of infection
What advice should you give a patient with BPPV?
- Do not drive whilst symptomatic
- Hydrate
- Rest
- Avoid sudden change in head movement
What swab should you do for a patient with PV vaginal discharge that is odorous?
HIGH VAGINAL OR ENDOCERVICAL
Only vulvovaginal when not symptomatic
Why is azithromycin and ceftriaxone given for N.Gonorrhoeae?
Has developed resistance but resistance to both is unlikely
What are some poor prognostic factors for breast cancer?
- Large primary tumour
- Low grade/Poor differentiation
- Axillary lymph node spread
- Oestrogen receptor negative
- HER2 positive
- BRCA½ positive
- African/american
- <35 years at diagnosis
What are some red flags for an upper GI endoscopy?
- Dysphagia
- Persistent vomiting
- Haematemesis
- Melaena
- Abdominal mass
- Odynophagia
- Exertional epigastric pain
What are some atopic conditions apart from the classical triad?
- Urticaria
- Conjunctivitis
What does lichenification look like and what does it mean?
Appearance: Skin thickening, hyperpigmentation, pseudo-papule, ill-defined, plaques
Means: it is chronic and not the first time they have had eczema
What are the side effects of topical steroids?
- Excess hair growth
- Telengectasia
- Striae
- Perioral dermatitis
