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H+S > Block 10 > Flashcards

Block 10 Flashcards

1
Q

What is sensitivity?

A

Measures proportion of positives that are correctly identified (true positives)

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2
Q

What is specificity?

A

Measures proportion of negatives that are correctly identified (true negatives)

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3
Q

Uses of a Diagnostic Test

A
  1. Diagnosis
  2. Monitoring
  3. Screening
  4. Prognosis
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4
Q

What is a diagnostic test?

A

Any medical test that aids diagnosis/ detection of disease

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5
Q

What is positive predictive value?

A

The probability that subjects with a positive screening test truly have the disease

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6
Q

What is a negative predictive value?

A

The probability that subjects with a negative screening test truly do not have the disease

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7
Q

What is the likelihood ratio?

A

Likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the target disorder

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8
Q

What is screening?

A

Systematic application of a test to identify individuals at risk of a specific disease, to warrant further investigation/ prevention, amongst people who have not sought medical attention on account of symptoms of that disorder

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9
Q

Purpose of screening

A
  1. If primary prevention is limited
  2. If opportunity for treatment is limited
  3. Gives potential for early diagnosis and so more effective treatment
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10
Q

Diseases that are commonly screened for

A
  1. Cancer - colorectal/ breast/ cervical
  2. PPD Test - TB
  3. Prenatal test - foetal abnormality
  4. Newborn bloodspot test - PKU/ cystic fibrosis etc.
  5. Ophthalmamoscopy or digital photography and image grading - diabetic retinopathy
  6. Ultrasound scan - abdominal aortic aneurysm
  7. Screening for metabolic syndrome
  8. Screening for potential hearing loss in newborns
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11
Q

Limitations of screening

A
  1. Cost + resources (many do not have disease)
  2. Adverse effects of screening - radiation exposure, stress
  3. False positive = stress
  4. Unnecesary investigation and treatment of false positives
  5. Stress caused by prolonged knowledge of illness without improvement in outcome
  6. False security by false negatives
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12
Q

What needs to be evaluated when deciding what to screen for?

A
  1. Condition - epidemiology
  2. Test - effective?
  3. Treatment - evidence based?
  4. Programme - RCT evidence of reduction in mortality
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13
Q

What is sojourn time?

A

Duration of a disease before clinical symptoms become apparent, but during which it is detectable by a screening test

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14
Q

What is length bias?

A

Overestimation of survival duration among screening-detected cases by the relative excess of slowly progressing cases

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15
Q

What is lead time bias?

A

Overestimation of survival duration among screen-detected cases (relative to those detected by signs and symptoms) when survival is measured from diagnosis

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16
Q

What is over diagnosis bias?

A

Overestimation of survival duration among screen-detected cases caused by inclusion of pseudodisease (subclinical disease that would not become overt before the patient dies of other causes)

17
Q

What is a PSA test?

A

Detects Prostate specific antigen (PSA) - protein produced by cells of the prostate gland

18
Q

When is PSA elevated?

A

Prostate cancer, BPH, Prostasis, UTI

19
Q

Advantages of PSA screening

A
  1. Help detect asymptomatic tumours
  2. Estimate prostate size and stage
  3. Helps predict response to treatment
  4. Used to monitor men at increased risk
20
Q

Disadvantages of PSA screening?

A
  1. Early detection does not reduce death by cancer
  2. Overdiagnosis = over treatment
  3. May give false positive
  4. May give false negative
21
Q

Impact of incontinence on patient

A
  1. Distress
  2. Embarrassment
  3. Inconvenience
  4. Threat to self-esteem
  5. Loss of personal control
  6. Desire for normalisation
  7. Loss of sexual interest
  8. Difficulty sleeping
22
Q

Impact of chronic dialysis

A
  1. Regular hospital admissions
  2. Restriction of leisure time
  3. May have to give up job
  4. Increased dependence on dialysis
  5. Uncertainess about future
  6. Fatigue
  7. Limitation of liquids + food
  8. Disrupts family and friend relationships
  9. Depression
  10. Low self-esteem
23
Q

4 sources used when making a clinical decision

A

Patient preference
Available resources
Research evidence
Clinical expertise

24
Q

What is opportunity cost?

A

Amount of money that is alienated by choosing to use it for one project rather than another

25
Q

What is distributive justice?

A

How we distribute resources that are finite in a fair way

26
Q

How can you decide how to distribute healthcare?

A
  1. QALY calculation
  2. Waiting list
  3. Likelihood of complying with treatment
  4. Lifestyle choices of patient
  5. Ability to pay
27
Q

What is confidentiality?

A

Pledge of agreement to not divulge or disclose information about patients to others

28
Q

Why is confidentiality important?

A
  1. Improves trust
  2. Respects autonomy
  3. Prevents patient harm
  4. Virtuous
  5. Human rights act
  6. GMC requirement
29
Q

When can confidentiality be breached?

A

Law
Consent by patient
Public best interest

30
Q

Laws that oblige doctors to disclose information

A
  1. Public health act 1984
  2. Road traffic act 1988
  3. Prevention of terrorism act 1989

H+S (2 decks)

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