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Y2 Health & Society > Block 10 > Flashcards

Block 10 Flashcards

1
Q

Sensitivity

A

True positives

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2
Q

Equation for sensitivity

A

TP/TP+FN

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3
Q

Specificity

A

True negatives

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4
Q

Eq for specificity

A

TN/TN+FP

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5
Q

Diagnostic test

A

Any medical test performed to aid the diagnosis or detection of disease

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6
Q

4 uses of diagnostic tests

A

Diagnosis
Monitoring
Screening
prognosis

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7
Q

Importance of sensitivity and specificity in informing diagnosis

A

importance of diagnostic accuracy in testing is directly proportional to the tests potential to cause patient consequences and harm

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8
Q

true positive

A

test indicates disease when there is disease

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9
Q

true negative

A

test indicates no disease when there is no disease

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10
Q

false negative

A

test indicates no disease when there is disease

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11
Q

false positive

A

test indicates disease when there is none

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12
Q

positive predictive value

A

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

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13
Q

negative predictive value

A

probability that subjects with a negative screening test truly dont have the disease

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14
Q

likelyhood ratio

A

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

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15
Q

screening

A

systematic application of a test to identify individuals at sufficient risk of a specific disorder to warrant further investigation or direct preventative action, amongst people who have not sought medical attention on account of any symptoms of that disorder

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16
Q

purpose of screening

A

opportunities for primary prevention and treatment are limited, gives potential for early and more effective treatment

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17
Q

which cancers commonly screened for

A

colorectal, breast, cervical

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18
Q

what does the PPD test screen for

A

Tuberculosis

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19
Q

prenatal blood tests for

A

foetal abnormalities

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20
Q

newborn bloodspot test for

A

sickle cell, CF, congenital hypothyroidism, metabolic disease (PKU, MCADD, etc.)

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21
Q

Opthalmascopy screens for

A

diabetic retinopathy

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22
Q

ultrasound screens for

A

AAA

23
Q

limitations of screening

A

cost/resources - majority don’t need treatment
adverse effects
stress from FP
unnecessary treatment of FP
stress from prolonging illness with no treatment outcomes
false sense of security from FN

24
Q

pros of good screening

A

early detection of the disease can reduce the risk of death or illness for some people

25
Q

cons of screening

A

some people get tests, diagnosis and treatment with no benefit, some people get ill or die despite negative screen

26
Q

areas for evaluation when deciding what should be screened for

A

condition, test, treatment, programme

27
Q

Condition factors

A

important? epidemiology, natural hustory, detectable risk factor, latent period, cost-effective

28
Q

test factors

A

simple, safe, precise, validated cut off agreed, acceptable

29
Q

treatment factors

A

effected EB treatment

30
Q

programme factors

A

RCT evidence of reduction of mortality/morbidity, benefit outweigh harm, opportunity cost, quality assurance

31
Q

sojourn time

A

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

32
Q

short sojourn time

A

rapidly progressing disease, poorer prognosis

33
Q

length bias

A

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

34
Q

consequences of length bias

A

diseases with longer sojourn time easier to detect through screening,
on average people with disease detected through screening have better prognosis than through S&S,
comparing individuals choosing screened to those not gives distorted picture

35
Q

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

36
Q

consequences of lead time bias

A

survival inevitably longer following diagnosis through screening because of the ‘extra’ lead time.
as a result of this the appropriate measure of effectiveness is deaths prevented, not survival

37
Q

overdiagnosis bias

A

overestimation of survival duration among screen-detected cases caused by inclusion of pseudodisease

38
Q

pseudodisease

A

subclinical disease that would not become overt before the patient dies of other causes

39
Q

when does overdiagnosis bias occur

A

when screen-detected cancers are either non-growing or so slow-growing that they would never cause medical problems

40
Q

PSA testing

A

prostate specific antigen - protein produced by cells of the prostate gland

41
Q

PSA elevated in

A

prostate cancer, BPH, prostatis, UTI

42
Q

advantages of PSA screening

A

can help detect tumours with no symptoms, allows estimation of prostate size and stage, helps doctor predict response to treatment, can be used to monitor men at increased risk

43
Q

disadvantages of PSA screening

A

early detection may not reduce chance of dying from prostate cancer, over diagnosis -> overtreatment, may give FP (not specific enough) or FN

44
Q

impacts of incontinence on a patient

A

distress, embarrassment, inconvenience, threat to self esteem, loss of personal control, desire for normalisation, loss of interest in sex, difficulty sleeping

45
Q

impact of chronic dialysis on patients

A

regular hospital admissions, restriction of leisure time, may have to give up job, increased dependance on dialysis, uncertainness about future, fatigue, limitation of liquids and foods, disrupts relationships, depression, lower self esteem

46
Q

4 sources used when making a clinical decision

A 
PARC
patient preferences,
available resources
research evidence
clinical expertise
47
Q

opportunity cost

A

loss of other alternatives when one alternative is chosen, amount of money that is alienated by choosing to use it for one project rather than another

48
Q

distributed justice

A

how we distribute finite resources fairly

49
Q

how to decide ways to distribute healthcare

A

QALY calculation, waiting list, likelihood of complying with treatment, Pt lifestyle choices, ability to pay

50
Q

confidentiality

A

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

51
Q

importance of maintaining confidentiality

A

improves trust between pt and dr, respects autonomy, prevents pt harm, virtuous, human rights act, GMC requirement

52
Q

when can confidentiality be breached

A

statute (law), consent by patient, public best interest

53
Q

laws which oblige doctors to disclose info

A

public health act 1984
road traffic act 1988
prevention of terrorism act 1989

Y2 Health & Society (15 decks)

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