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Year 3 > Block 32 H&S > Flashcards

Block 32 H&S Flashcards

1
Q

RF for UGIB?

A
  • NSAIDs
  • AC
  • alcohol abuse
  • chronic liver or kidney diease
  • age
  • prev PUD or H pylori infection
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2
Q

Role of the GP in prevention of an UGIB?

A
  • Lifestyle advice on alcohol consumption
  • management of liver and kidney disease
  • patient education on NSAIDs - reducing use
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3
Q

effects of a stoma on body image?

A
  • altered body image due to the alteration to physical appearance
  • due to treatment, change or loss of bowel function as well as rstrictions to lifestyle and daily activities
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4
Q

changes in physical appearance can affect a patient’s?

A
  • Change in physical appearance may affect patients’ self-esteem and make them feel less attractive, leading to feelings of insecurity, lack of confidence and loss of control.
  • This in turn can be a threat to existing relationships and/or friendships.
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5
Q

when someone falls ill, they are more likely to become aware of?

A
  • When someone falls ill he/she is more likely to become aware of the body and its loss of function.
  • If illness also involves an alteration in body image, there is an increased likelihood that psychological disturbances will occur
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6
Q

people with stomas who are experiencing problems are more likely to withdraw from?

A
  • People with stomas who are experiencing problems are more likely to withdraw from social interactions as they feel more vulnerable - withdrawing may be used to safeguard against potential negative interactions with others
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7
Q

stomas can cause fear of?

A
  • fear of unexpected loss of faeces and consequent odour reslts in patients curtailing physical and sexual activities as a means of avoiding shame and embarassment
  • fear of being found out
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8
Q

Gluten is found in?

A
  • Gluten is found in wheat, barley, rye, and triticale
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9
Q

rationale for a gluten free diet?

A
  • essential for managing celiac disease
  • in celiac disease, gluten triggers the IS which causes damage to the lining of the small intestine -> overtime prevents absorption of nutrients from food
  • wheat allergy
  • gluten ataxia
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10
Q

foods to avoid for a gluten free diet?

A
  • Wheat
  • Barley
  • Rye
  • Triticale — a cross between wheat and rye
  • Oats, in some cases
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11
Q

eating gluten free at home and in restaurants?

A
  • storing gluten free and gluten containing foods in separate places
  • using separate toasters to avoid cross contamination
  • read menus ahead of time to make sure gluten free options are available
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12
Q

What sort of psychological difficulties does a change in physical appearance cause to a
patient?

A
  • body image
  • stress - from trying to conceal the changes and fear of being ‘found out’
  • anxiety about relationships with others and negative evaluations about physical attractiveness
  • avoidance of social situations to ‘conceal’ changes
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13
Q

body image =

A

a person’s thoughts, feelings and perception of the aesthetics or sexual attractiveness of their own body.

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14
Q

Acceptable elimination behaviour is acquired at an early age. How may a patient process a voluntary loss of excretory behaviour?

A
  • may cause them to feel vastly different from their peers - feelings of rejection and socal isolation
  • loss of control
  • self stigma - may internalize a public stigma
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15
Q

sexual dysfunction in women following surgery which leads to the creation of a stoma?

A
  • The most common sexual dysfunction reported by women with stomas is dyspareunia (painful intercourse)
  • Pelvic surgery also results in the drying of the vagina’s natural lubrication
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16
Q

sexual dysfunction in men following stoma surgery?

A
  • For male stoma patients, surgery may result in damage to the nerves that control ejaculation and erection, and cause altered sexual function.
  • Sexual dysfunction may also take the form of retrograde ejaculation - bladder neck doesn’t close properly so semen enters the bladder instead of exiting via the urethra or dry orgasms
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17
Q

Which three related components according to Price (1990) are required to make up a
satisfactory body image?

A
  • body reality
  • body ideal
  • body presentation
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18
Q

Price’s body image model?

A
  • these 3 exist in a state of balance which together make up a satisfactory body image that humans strive to maintain
  • Therefore it may be presumed that alterations to body reality, for example, as a result of surgery or disease, will lead to tension between body reality and body ideal.
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19
Q

price’s body image model - people may attempt to reduce this tension by?

A

altering the body presentation to compensate for deficiency in body reality

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20
Q

Sight mneumonic for managing potentially infectious diarrhoea?

A

S Suspect that a case may be infective where there is no clear alternative cause for diarrhoea.

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21
Q

sIght mnemonic

A

I Isolate the patient and consult the infection team (IPT) while determining the cause of the
diarrhoea.

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22
Q

siGht?

A

G Gloves and aprons must be used for all contacts with the patient and the environment.

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23
Q

sigHt?

A

H Hand washing with soap and water should be carried out before and after each contact with

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24
Q

sighT?

A

T Test the stool for toxin (Clostridium difficile) or viral studies for Norovirus, by sending a specimen immediately.

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25
Q

Infective diarrhoea - samples?

A
  • stool specimen
  • Clinical details aid the laboratory staff in forming a diagnosis. It is vital to include details of recent antibiotics or if suspecting a viral outbreak.
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26
Q

ppts with unexpected diarhoea and vomiting should be…

A

isolated with dedicated en-suite bathroom facilities and a clinical hand wash basin.

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27
Q

C diff infection

ppts who are at high risk

A
  • recent broad spectrum antibiotics,
  • previous CDI infection,
  • recent exposure to CDI must take priority for a single room.
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28
Q

What conditions may warrant a closure of the ward - infective diarrhoea?

A
  • Ward closure may be necessary if the numbers of affected patients exceeds isolation or cohortingfacilities or if the client group is unable to comply with isolation.
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29
Q

What are some needs of a patient which must be considered before moving them to another ward/department?

A
  • need to have their hygeine needs met
  • have clean clothing
  • are transferred to a bed with clean linin
  • trolley should be decontanimated after use
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30
Q

Discuss the measures that should be employed for effective hand hygiene in the case of an outbreak.

A
  • hands need to be washed with soap and water at the start and end of clinical duties, when hands are visibly soiled or potentially contaminated, following removal of gloves, before and after any clinical interaction with patients and upon leaving an isolation room or cohort area.
  • alcohol gel must not be used to decontaminate hands when caring for patients w D +/- V
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31
Q

disease prevention - hugs?

A

Techniques like direct incentives, such as vouchers in return for healthy behaviour

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32
Q

disese prevention - shoves?

A

while the tougher measures that restrict choice, like restricting takeaways from schools,

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33
Q

disease prevention - smacks?

A

Bans, such as the restriction on smoking in public places,

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34
Q

disease prevention - individual?

A
  • smoking cessation
  • promoting weight loss - healthy eating e.g. producing guides like the eat well guide
  • increasing exercise e.g. cough to 5K
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35
Q

disease prevention - population?

A
  • laws preventing tobacco use - e.g. age restrictions and banning indoor smoking
  • campaigns to increase physical activity
  • improve diet - e.g. rules on what can be served for school dinners
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36
Q

MDT members?

A
  • surgeons
  • clinicians
  • nurses
  • diagnosticians
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37
Q

cancer MDT?

A
  • each week the MDT meets to discuss individual patients cases and make treatment recommendations
  • they review test results and make treatment reommendations based on the best evidence available
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38
Q

MDT is considered the ? for cancer management?

A
  • MDT working is considered the gold standard for cancer patient management bringing continuity of care and reducing variation in access to treatment
  • this improves outcomes for patients
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39
Q

emotional impacts of a cancer diagnosis?

A
  • anger
  • despair
  • fear
  • hopelessness
  • anxiety, depression
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40
Q

psychological impacts of a cancer diagnosis?

A
  • stress
  • body image
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41
Q

social impact of a cancer diagnosis?

A
  • impact on family, relationships, work and school - financial issues from lack of work
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42
Q

spiritual impacts of a cancer diagnosis?

A
  • meaning of life
  • suffering
  • pain
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43
Q

impacts of cancer treatment on the patient?

A
  • physically weak after treatment and tired - impact on relationships
  • dependency on others
  • anxiety about the treatment itself and anticipated side effects
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44
Q

cancer treatment - anxiety and stress about?

A

possible cancer reoccurance

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45
Q

cancer treatment - physical exhaustion from?

A

attending hospital appointments

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46
Q

socio-cultural influence in response to diagnosis and treatment?

A
  • culture impacts whether people even seek help in the first place, which types of help they seek
  • and how much stigma is attached to the condition
  • culture also impacts which treatments are deemed acceptable - for example a Muslim patient may refuse treatments such as heparin
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47
Q

Zolas help seeking model?

A
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48
Q

Zola found that?

A
  • Zola found that people’s responses to symptoms were contingent upon their cultural values / beliefs concerning heath
  • Accordingly, the decision to seek professional medical help was either promoted or delayed by social factors
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49
Q

what are Zolas triggers?

A
  1. inter-personal crisis
  2. perceived interference with work activities
  3. perceived interference with social/ lesiure activities
  4. sanctioning by others who insist help be sought
  5. symptoms perisst beyond the time limit set by the person
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50
Q

modifiable risk factors for breast cancer?

A
  • alcohol
  • obesity
  • contraceptive pill
  • HRT
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51
Q

non-modifiable RF for BC?

A
  • Age
  • Ionising radiation
  • dense breast tissue
  • diabetes
  • FHx and BRCA mutations
  • benign breast disease
  • early menarche (before 12)
  • late menopause (after 55)
  • high testosterone or IGF-1 levels
  • ethnicity: white
  • previous cancer
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52
Q

Top 5 most common cancers?

A
  • breast
  • prostate
  • lung
  • bowel
  • melanoma
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53
Q

incidence =

A

number of new cases of the disease in a defined population over a defined period of time

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54
Q

incidence equation?

A

number of new cases/ number of disease free people

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55
Q

prevalence =

A

the proportion of people with a disease at any point (point prevalence) or period (period prevalence) in time

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56
Q

what does prevalence measure?

A

measures burden of disease in a population and can be used to compare disease burden between populations

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57
Q

cancers with the highest mortality:

A
  • lung
  • bowel
  • breast
  • prostate
    -pancreatic
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58
Q

BC trend globally?

A
  • over the last decase the rates have increasedin females and remained stable in men
  • rates projected to rise - could be upto 70,000 new cases in the UK every year
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59
Q

5 year survival of breast cancer?

A

85%

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60
Q

percentage of breast cancer occur in men?

A

1%

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61
Q

screening is defined as?

A
  • systemic application of a test to identify indviduals at sufficient risk of a specific disorder to warrant further investigation of direct pretentive action, amongst people who haven’t sought medical attention on account of symptoms of that disorder
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62
Q

primary prevention =

A

stops the exposure in the first place

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63
Q

secondary prevention is between?

A
  • secondary prevention: between onset of disease and onset of symptoms, can we detect the onset and do something about it
  • non clinically apparent disease is found
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64
Q

when is tertiary prevention?

A
  • tertiary prevention: between symptoms and cure/control/disability/death - can we impact the outcomes
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65
Q

there are 4 criteria for a screening programme to be valid: epidemiology?

A

the condition you are testing fro must be severe and its epidemiology and pathophys must be fully understood

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66
Q

screening programme - criteria - detectable?

A

there needs to be a detectable evdience between association of risk and disease

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67
Q

SP criteria - ? period?

A

latent period before onset of symptom s

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68
Q

SP criteria - primary prevention?

A

cost effective primary prevention should have been implemented

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69
Q

SP - test?

A
  • the test must be simple, safe, precise and acceptable to perform
  • needs to gave an agreed diagnostic value and policy on further managemebnt
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70
Q

SP - treatment for the condition must be?

A
  • effective and more beneficial if given earlier
  • must be a treatable condition
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71
Q

SP - evidence?

A
  • programme needs to have evidence from RCT trials that it works in reducing morbidity and mortality
  • benefit should outweight any physical or psychological harm from the test
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72
Q

SP - needs to be a balance between?

A

opportunity cost and health care spending

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73
Q

when do the different types of prevention occur?

A
  • primary in the pre-clinical phase
  • tertiarty prevention in the clinical phase
  • secondary prevention in between
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74
Q

female pregnancy screening?

A
  • NHS fetal anomaly screening programme (FASP) - sonograms
  • NHS infectious diseases in pregnancy screening (IDPS) programme - group B strep, HIV
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75
Q

NHS SCT screening at?

A

8-10 weeks

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76
Q

cervical screening?

A
  • 25 to 64 yrs
  • looks for HPV and damaged cells onset - pap smear
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77
Q

NHS Breast screening programme?

A

aged 50-70

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78
Q

male screening programme?

A
  • NHS abdominal aortic aneurysm (AAA) programme (age 65)
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79
Q

Newborn screening programmes?

A
  • NHS newborn and infant physical examination (NIPE) screening programme
  • NHS newborn blood spot (NBS) screening programme
  • NHS newborn hearing screening programme (NHSP) - getting babies to turn their head towards the sound
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80
Q

diabetic eye screening?

A
  • NHS diabetic eye screening (DES) programme (age 12 but only for people with diabetes)
  • impacts of diabetes on the eyes
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81
Q

bowel cancer screening?

A
  • 56 yrs - 74 yrs
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82
Q

Point of screening?

A
  • Screening gives the potential for early treatment and better outcomes
  • In some cases, screening can prevent the onset of disease through preventative treatment (e.g. removal of abnormal cells
  • People may not have any symptoms (asymptomatic)
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83
Q

the condition being screened for has to be?

A
  • Significant health problem
  • The condition needs to understood with a detectable risk factor
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84
Q

criteria for screening - test?

A

should be a simple, safe, precise and validated screening test

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85
Q

sensitivity?

A
  • Proportion of individuals with condition that test positive
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86
Q

specificity?

A
  • Proportion of individuals without condition that test negative
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87
Q

PPV?

A
  • Proportion of individuals with a positive test that actually have disease
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88
Q

NPV?

A
  • Proportion of individuals with a negative test that actually do not have disease
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89
Q

Positive LR?

A
  • How much more likely is a positive test from someone with the condition compared without the condition?
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90
Q

Negative LR?

A
  • How much more likely is a negative test from someone without the condition compared with the condition?
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91
Q

screening criteria - treatment?

A
  • There should be an effective treatment with evidence of early treatment leading to better outcomes
  • have to be able to do something after a positive result
  • must be evidence that intervening early is beneficial
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92
Q

screening criteria - programme?

A
  • acceptable to the public - good uptake required
  • The benefit from the programme should outweigh the harm
  • The opportunity cost of the programme should be economically balanced in relation to health care spending
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93
Q

screening criteria - must be a plan for?

A
  • There must be a plan for quality assurance and adequate staffing and facilities
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94
Q

what is lead time bias?

A
  • Earlier diagnosis – transient increase in incidence
  • w/o screening, the person seeks help when there are clinical mainfestations
  • w screening, earlier diagnosis can make it appear that there’s a longer survival rate but no actual improvement - lead time bias
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95
Q

lead time bias simply extends?

A
  • the time between diagnosis and death (if the death is from an unrelated cause)
  • Artificial improvement in ‘survival’
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96
Q

what is length time bias?

A
  • Screening more likely to identify slower developing cases as opposed to acutely presenting cases - espec w diseases that have a long pre-clinical period
  • less likely to find a disease w an acute onset - tends to be more aggressive tumours
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97
Q

length time bias reflects the fact that the sample of people being screened are ?

A
  • sample of ppl in the screening programme who are pre-destined to live longer due to slower growing tumour
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98
Q

quality assurance?

A
  • If screening is to do more good than harm then QA is essential
  • Best to build in QA before a screening programme begins otherwise it could lead to harmful practice
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99
Q

overdiagnosis from screening?

A
  • Screen-detected cancers are either:
  • Non-growing
  • Growing very slowly
  • Cancers not expected to cause medical problems in lifetime
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100
Q

inequalities from screening?

A
  • Highest risk people are least likely to access screening (Inverse Care Law) - selection bias
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101
Q

People less likely to engage with screening?

A
  • Low socio-economic status/living in deprivation
  • Ethnic minority groups/migrants
  • Transgender
  • Disabilities
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102
Q

Barriers to screening?

A
  • fear, psychological
  • cultural barriers - stigma
  • putting things off
  • language barriers
  • don’t have any symptoms
  • misconceptions - only men get bowel cancer
  • diff of doing test
  • lack of awareness
  • psychological
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103
Q

overdiagnosis -

A
  • diagnosis of “disease” that will never cause symptoms or death during a patient’s lifetime
  • side effect of screening for early forms of disease
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104
Q

PPV equation

A

True positive/ All test positives

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105
Q

NPV =

A

True negative / all test negatives

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106
Q

What increases with prevalence?

A

PPV

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107
Q

what decreases when prevalence increases?

A
  • NPV decreases with increasing prevalence
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108
Q

decreasing prevalence causes?

A
  • PPV decreases as there will now be more false positives for every true positive
  • NPV increases - more true negatives for every false negatuve
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109
Q

which figures are independent of prevalence?

A

specificity and sensitivity

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110
Q

sensitive is the % that …

A

Sensitivityis the percentage of true positives (e.g. 90% sensitivity = 90% of people whohavethe target disease will test positive).

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111
Q

SNOUT?

A

A sensitive test helps rule out a disease when the test is negative. Highly SeNsitive = SNOUT = rule out.

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112
Q

Specifity is the %?

A

Specificityis the percentage of true negatives (e.g. 90% specificity = 90% of people whodo not havethe target disease will test negative).

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113
Q

SPIN?

A

Aspecifictesthelpsrule a disease inwhenpositive. HighlySPecific =SPIN = rule in.

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114
Q

NHS BSP invites all women from the ages?

A
  • The NHS Breast Screening Programme invites all women from the age of 50 to 70 registered with a GP for screening every 3 years
  • after 70, women can still be screened every 3 years but won’t be automatically invited
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115
Q

NHS BSP - women with increased risk can be screened before?

A

50

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116
Q

breast screening is also offered to?

A

trans men and some non-binary people

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117
Q

Describe the factors that are associated with delayed presentation of breast symptoms in primary care.

A
  • lack of knowledge surrounding breast symptoms
  • embarassement and shyness
  • nature of the lump - painless
  • fear - partner abandomnent, cancer treatment
  • denial
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118
Q

Which women are invited to breast cancer screening?

A

women aged 50 upto their 71st birthday

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119
Q

What happens at the breast screening session?

A
  • mamogram taken of the breast
  • X ray machine will then be tiled to one side and the process will be repeated on the side of the breast
  • other breast X rayed in the same way
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120
Q

what is the triple assessment?

A
  • physical examination
  • scanning - mammogram or ultrasound
  • if necessary a biopsy
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121
Q

mammogram vs US?

A
  • Mammogram: X ray of the breasts. Over 35
  • under 35: US
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122
Q

Why do under 35s need an US?

A
  • bc younger women have denser breasts meaning a mammogram is not as effective at detecting cancer
  • US may also be used if needed to decide whether a lump is solid or requires liquid
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123
Q
  • of sceeening - false negative?
A
  • false negative -> false reassurance
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124
Q
  • of screening - false positive?
A
  • false positive -> unecessarily worried and may have tests or treatments that they don’t need
  • overtreatment -> strain on NHS
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125
Q
  • of screening -health risks?
A
  • health risks e.g. exposure to radiation
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126
Q
  • of screening - abn result?
A
  • an abnormal result can result in a treatment, while the abnormality would have disappeared spontaneously or never resulted in complaints.
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127
Q

primary prevention?

A
  • purpose of primary prevention is to prevent a disease from ever occurring.
  • Thus, its target population is healthy individuals.
  • e.g. immunizations
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128
Q

secondary prevention =

A
  • emphasises early disease detection
  • target is healthy-appearing individuals with subclinical forms of disease
  • e.g. screening
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129
Q

tertiary prevention targets both ?

A
  • Tertiary prevention targets both the clinical and outcome stages of a disease.
  • It is implemented in symptomatic patients and aims to reduce the severity of the disease as well as any associated sequela
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130
Q

secondary vs teritary prevention ?

A
  • While secondary prevention seeks to prevent the onset of illness, tertiary prevention aims to reduce the effects of the disease once established in an individual.
  • Forms of tertiary prevention are commonly rehabilitation efforts.
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131
Q

FHx in BC risk?

A
  • Having a mother, sister or daughter(first degree relative) diagnosed with breast cancer approximately doubles the risk of breast cancer.
  • This risk is higher when more close relatives have breast cancer, or if a relative developed breast cancerunder the age of50.
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132
Q

prevention in those at high risk of BC?

A
  • prophylactic mastectomy
  • medications - taken once a day for 5yrs
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133
Q

mastectomy?

A
  • surgery to remove the breasts
  • removes as much breast tissue as possible
  • breast reconstruction is possible during the procedure or after or breast prostheses can be used
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134
Q

alternative to mastectomy?

A
  • nipple sparing masectomy is the alternative - nipple-sparing mastectomy, where the whole mammary gland is removed, but the skin of the breast is preserved
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135
Q

medicines used to prevent BC - tamoxifen?

A

for women who either have or have not been through the menopause

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136
Q

meds used to prevent BC - anastrazole?

A

for women who have been through the menopause

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137
Q

meds to prevent BC - raloxidene?

A

for women who have been through the menopause

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138
Q

What are the genes identified in breast cancer risk?

A
  • BRCA 1
  • BRCA 2
  • ATM
  • PALB2
  • TP53
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139
Q

If a patient has the BRAC1 gene, what is the chance they will develop breast cancer?

A

defect in the BRCA1 gene causes a 65% risk

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140
Q

definition of screening?

A

Screening is the process of identifying apparently healthy people who may have an increased chance of a disease or condition.

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141
Q

Wilson criteria of a screening programme - the condition?

A
  • common or severe disease - is an important health problem
  • has a latent stage that can be detected
  • long pre-clinical duration
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142
Q

Wilson criteria for screening - the test?

A
  • simple, safe, precise and validated
  • isn’t harmful or is an acceptable ;eve; of harm - e.g. benefits > harms
  • agreed pathway following positive test
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143
Q

willson criteria for screening - cut off

A

Distribution of test values well known & suitable cut of

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144
Q

wilson criteria for screening - treatment?

A
  • intervention is effective and leads to better outcomes
  • cost effectie
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145
Q

when the screening cut off is too high?

A
  • all the people you identify are more likely to have disease, but you will inevitably miss some (low false negative rate
  • i.e. LOW SENSITIVITY but HIGH
    SPECIFICITY)
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145
Q

screening - programme?

A
  • RCT evidence showing programme effective in reducing morbidity
  • benefit > harm
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145
Q

When the screening cut off is too low?

A
  • end up identifying too many people needing unnecessary further
  • investigations (too many false positives i.e. HIGH SENSITIVITY but LOW SPECIFICITY
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146
Q

Advantages of screening?

A
  • better ppt outcomes
  • better survival
  • lees need for radical therapy
  • reassurance for negatve results
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147
Q

Disadvantages of screening?

A
  • Longer morbidity if prognosis is unaltered – over-diagnosis
  • Cost of resources
  • false reassurance for false negatives
  • unnecessary investigations for false positives - over treatment
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148
Q

screening - overdiagnosis?

A

occurs when the screen detects cancers that are either non growing or so slowly growing that they would never cause medical problems

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149
Q

selection w screening?

A
  • Well-educated individuals tend to worry and comply with screening programmes better = individuals often healthier & will therefore have better outcome
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150
Q

why is PSA screening not done?

A
  • high prev of clinically unapparent disease
  • many false positives for PSA
  • Current active monitoring is similar to treating = no benefit to screening
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151
Q

AAA screening?

A
  • all men 65+
  • uses US
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152
Q

Components of antenatal screening?

A
  • foetal abn
  • maternal pre-existing issues
  • maternal obstetric complications
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153
Q

Benefits of antenatal screening?

A
  • gives women more choice abt raising children w Down’s
  • allows time to prepare if wanting to continue w pregnancy
  • reassurance for those who are low risk
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154
Q

risks of antenatal screening?

A
  • . Only a SCREENING TEST hence a negative result does not guarantee child won’t have Down’s i.e. false positives and also false negatives
  • Risk of diagnostic testing
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155
Q

NHS cervical screening invites?

A
  • 25 to 64 yrs olds
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156
Q

CC: 25-59 are invited every ? years

A

3

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157
Q

CC: 50-64 are invited every?

A

5 yrs

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158
Q

who is invited annually for CC?

A

HIV+

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159
Q

exceptions to CC?

A
  • symptoms -> urgent referral
  • virgins -.> low risk HPV
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160
Q

Bowel cancer screening?

A
  • 60-74, men and women
  • FIT test
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161
Q

how often does bowel cancr ecreening occur?

A

every 2 yearss

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162
Q

abn FIT test ->

A

colnscopy

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163
Q

mammogram for breast cancer is done for?

A
  • 50 to 70 yrs olds
  • every 3 yrs
164
Q

who can self refer for breast cancer?

A

> 70

165
Q

deontology?

A

An ethical theory that states it is possible to determine the rightness or wrongness of actions by examining actions themselves without focusing on the consequences

166
Q

consequntialism?

A

an ethical theory that states it is possible to determine the rightness or wrongness of actions by examining its consequence

167
Q

what is consent?

A
  • informed decision of a competent patient
  • freely given
  • one off event and can be withdrawn at any time
168
Q

importance of consent?

A
  • professional and legal requirement under mca
  • Strengthens dr-ppt relationship
  • rspects autonomy
169
Q

consent for u16s?

A
  • parents can refuse or consent
  • if dr disagrees w parents decision -> can take it to court
  • young child/ person can be treated without consent if failure to provide immediate treatment may lead to death or severe injury
170
Q

common vs statute law?

A
  • common law: law that arises from a ruling in a court case
  • statute law - written law
171
Q

how can consent be given?

A
  • written
  • oral
  • NV
172
Q

Principles of MCA?

A
  1. Presumed to have capacity unless proven otherwise
  2. Must take all steps to allow patient to have capacity (e.g. speak in their language, not in jargon, hearing aid, change environment)
  3. Unwise decision does not mean patient does not have capacity
  4. Make decisions for patient in their best interests
173
Q

MCA - the person does not have capacity if they can’t?

A
  • understand info
  • retain info
  • use or weigh up info
  • communicate that decision
174
Q

MCA - acting for the patient?

A
  • must act in their best interest
  • should be minimally restrictive of that perso’s rights
175
Q

lasting power of attorney?

A

this allows the patient to appoint an attorney to act on their behalf if they should lose capacity in the future. There is a formal legal protocol to register an attorney

176
Q

advanced statement of wishes?

A

are about expressing preferences – i.e. written statements of wishes. They are not legally binding but the should be taken into account

177
Q

advanced directives?

A
  • specific decision to refuse treatment (can’t demand treatment
  • Trumps best interests every time as is equal to consent
  • Are beneficial as they extend patient autonomy
178
Q

eurocare cancer study?

A
  • looks at 5 yr survival pf cancer ppts in diffcountries
  • UK had one of the worst survival statistics in europe
179
Q

reasons for the eurocare report?

A
  • UK has an older population
  • patients present later in the UK
  • lower social classes don’t access services
180
Q

based off the eurocare report, the ? was developed

A

calmine hine report

181
Q

What did the calmne hine report 1995 find?

A
  1. Concluded unacceptable variation in quality of treatment between hospitals = services were disjointed & outcomes were poor
  2. So would be better to centralize treatment to improve quality, with primary care at the center of this
  3. should ensure ppts have equal access to care
  4. Public & professionals educated on recognizing early signs
182
Q

CHR - services should be?

A

patient centered

183
Q

CHR - cancer?

A

registration and monitoring of outcomes essential

184
Q

CHR - psychosocial needs?

A

of carers and patient recognised

185
Q

CHR report solutions?

A

formation of NHS cancer plan and formationof cancer networks

186
Q

3 levels of care in a cancer network?

A
  • primary care
  • cancer unit
  • cancer center
187
Q

Cancer networks: primary care?

A

prevention & early diagnosis

188
Q

cancer centers?

A
  • 1 per 250,000
  • treat common cancer and make diagnosis
  • non complex chemo and surg
189
Q

cancer centers?

A
  • 1 per mill
  • treat rare cancers, radiotherapy, complex chemo and surgery
190
Q

every level of the cancer network uses?

A

MDTs which meet weekly to discuss new ppts

191
Q

CHR - reasons for centralising cancer care?

A
  • more cost effective
  • clinicans become expert -> better outcomes
  • better care for specific conditions - more hollistic care from intergrated services
192
Q

Aims of strategic cancer networks?

A
  • reduce incidence of cancer
  • max survival of cancer ppts
  • enhance QoL of cancer ppts and their families
193
Q

what do strategic cancer networks do?

A
  • develop strategic plans for better care
  • implement national policies
  • devliver improvements in care
  • provide resources for audits and research
194
Q

cancer care networks include?

A
  • 12 Strategic Clinical Networks (SCNs)
  • Over not just cancer (include CVD, dementia, less staff)
  • Primary aim = reduce inequalities in the care of cancer
195
Q

national cancer research network was created in response to?

A
  • to the need to improve the infrastructure within the NHS for clinical research in cancer
  • established in 01
196
Q

aim of national cancer research network?

A
  • Aim = improve the speed, quality and integration of research, ultimately resulting in improved patient care
  • Closely matched to cancer networks to improve patient numbers etc.
197
Q

national cancer research institute?

A
  • was created to develop common plans for cancer research and to avoid unnecessary duplication of studies / effort
  • established in 01
198
Q

roles of the national cancer resarch inst?

A
  1. Invest in facilities + resources for research
  2. Maintain cancer research database and analyze new research
  3. Develop research initiatives
  4. Coordinate clinical trials for new drugs
199
Q

cancer reform strategy 2007 - areas for improvement?

A

PET LID

200
Q

Cancer reform strategy - the P?

A

Prevention

201
Q

CRS - E?

A

Early diagnosis -> overcome barriers preventing presentation to GP (including awareness of symptoms), education of GPs & more screening, new referral guidelines, decision aiding tools

202
Q

CRS - T?

A
  • treatment being better
  • reduce waiting time - 2WWW
  • improve clinical trials and better training
203
Q

CRS - L?

A
  • living w and beyond cancer
  • partnerships w charities, clinicians and patients to inc support and services for survivors
204
Q

CRS -I?

A

Inequality reduction

205
Q

CRS - D?

A
  • DELIVERING CARE IN THE MOST APPROPIATE SETTING
  • locally for ppt conviience when possible but centralised if this improves qoC
206
Q

Cancer registration?

A
  • conducted by cancer registries which collect and submit data to
  • office of national statistcs
207
Q

what is the benefits of cancer registrtation?

A

Allows comparisons in the incidence of disease & survival in different places and populations groups – and also allows researchers to examine the long term outcome under different treatments or between population groups

208
Q

main functions of cancer registries?

A
  • monitoring trends in incidence and survival between areas and social grs
  • evaluate effectiveness of screening programmes
  • evaluate impact of environmental & social factors on cancer risk
209
Q

psych consequnces of cancer?

A
  • change to physical appearance - mastectomy, hair loss
  • worried abt leaving ppl behind
  • grief
  • uncertainty
  • demands of chemo
210
Q

4 most prevalent cancer?s

A
  • Lung
  • Breast
  • CRC
  • Stomach
  • Prostate
211
Q

Causes of cancer death?

A

Lung > colorectal > breast > prostate

212
Q

3 most common cancers in the UK?

A
  1. Female = breast / Male = prostate
  2. Lung
  3. Bowel
213
Q

Current incidence changes in the UK?

A
  1. Incidence of most increases with age
  2. Bladder currently decreasing due to reduced occupational
    exposure to aniline dyes
  3. Lung decreasing overall (still increasing in women)
  4. Liver increasing due to alcoholism
  5. Melanoma increasing due to holidays abroad
214
Q

Childhood cancers?

A
  • peak incidence 2-5 yrs
  • leukemias most common
  • ALL most common
215
Q

Cancer MDT?

A
  • streamlines and co-ordinates care so that it’s not fragmented over several sites
    -> better outcomes
216
Q

Function of the cancer MDT?

A
  1. Discuss all new diagnosis
  2. Decide on management plan & inform primary care
  3. Develop guidelines
  4. Designate specialist nurse to patient
  5. AudIT
217
Q

NHS Blood & Transplant Service?

A
  • Accountable to DoH
  • Test blood, process & store it & distribute it to every NHS trust
  • manage supply of blood and deliver it to hospitals
  • recruit new donors
218
Q

The Blood Safety and Quality Regulations 2005 is enforced by

A

MHRA

219
Q

what does the blood safety and quality regulations regulate?

A

regulates blood storage and transport

220
Q

Key concepts of blood safety and quality regulations?

A
  1. The transfer of blood must be correctly documented to maintain proof of the cold chain of blood storage
  2. Vein-to-vein traceability must be maintained
  3. Blood must only be transferred in the appropriate clinical scenario
  4. use validated procedures to ensure safety
  5. wastage of blood is minimised
221
Q

acute grief?

A
  • Somatic or bodily distress
  • Preoccupation with image of the deceased
  • Guilt relating to the deceased or circumstances of the death
  • Hostile Reactions
  • Inability to function as one had before the loss
222
Q

worden’s task of mourning?

A
  • Accept the reality of loss
    2. Work through the pain of grief
    3. Adjust to an environment in which the deceased is missing
    4. Emotionally relocate the deceased and move on with life
223
Q

pathological grief?

A
  • Extended grief reaction
  • Mummification – preservation of deceased person’s thing or room and denial
  • Major depressive disorder >2 months after loss
224
Q

fair innings argument?

A
  • reflects the idea that everyone is entitled to some “normal” span of life
    years
  • according to this argument, younger persons have stronger claims to life-saving
    interventions than older persons because they have had fewer opportunities to
    experience life.
  • The implication is that saving one year of life for a young person is valued more than saving one year of life for an older person
225
Q

leventhal’s model of illness rep?

A
  1. Identity of Illness
  2. Timeline of illness
  3. Consequence of illness
  4. Cause of illness
  5. Control of illness
226
Q

MCA cannot be used when…

A

MHA applies and VV

227
Q

immediate risks of surgery?

A
  • Primary Haemorrhage
  • shock
  • low urine putput
228
Q

early risks of surgery?

A
  • pain
  • confusion
  • N&V
  • DVT/ PE
  • pressure sores
229
Q

late risks of surgery?

A
  • bowel obst
  • malignancy reoccurane
  • incsional hernia
  • cosmetic appearance
230
Q

outbreak =

A
  • Incident in which 2+ people, thought to have a common exposure, experience a similar
    illness or proven infection
231
Q

management of an outbreak?

A
  • Notify local food safety authority
  • barrier nursing - PEE
  • isolate ppts
  • limit transport of ppts w infective diarrhoea
  • inc handwashing and be bare below elbows
232
Q

food safety act 1990

A

offenses under act:
1. Sale of food rendered injurious to health, unfit for consumption,
not of quality demanded by purchaser
2. Display of food with label falsely describing food or likely to
mislead as to nature of substance / quality

233
Q

RF for CLD?

A
  • Heavy alcohol consumption
  • Viral Hepatitis A, B, C, D, E
  • Obesity/high fat diet/high cholesterol
  • Genetics
  • Medications e.g. paracetamol OD, steroids
  • Medical conditions: Biliary disease (PBC, PSC) or
  • Vascular disease
234
Q

reducing risk of CLD at an indiv level?

A
  • not engaging in dangerous activities - unsafe sex, IV drug use, sharing needles
  • cut down alcohol
  • up to date w vaccines
235
Q

population level ways or addressing risk factors for CLD?

A
  • education - alc and drugs
  • provide needle banks
  • blister packs for paracetamol
  • screening transfusionf ro hepatitis
236
Q

diabetic retinopathy screening?

A

(pts with DM from 12 years old

237
Q

newborn screening?

A

Physical examination, bloodspot, hearing test

238
Q

prev of BC

A

1 in 7 women will develop breast cancer in the UK

239
Q

BC screening aims?

A
  • detect invasive cancers
  • persuade > 70% to attend
  • reduce mortality from BC by 25% in the screened population
240
Q

benefits to BC screening?

A
  • less deaths
  • more conservative surgery
  • reduced need for chemo
  • reassurance
241
Q
  • of BCC?
A
  • Attendance - lower socioeconomic status are less likely to attend
  • Deemed unacceptable/embarrassing to some people
  • Increased anxiety
  • Time off work/transport costs to ppt
242
Q

breast cancer screening - overtreatment?

A

Treat cancer and pre-cancerous states in women who die early due
to another cause (over-treatment)

243
Q

Coping strategies (cancer diagnosis) -anxious preoccupation?

A
  • worrying abt diseaase
  • physical symptoms seen as signs of new disease
  • seek reassurance thru self referral
244
Q

Coping strategies (cancer diagnosis) - avoidance/ denial?

A

pt denies impact of disease and there are behaviours which minimise impact of disease on pt’s life

245
Q

Coping strategies (cancer diagnosis) -fatalism?

A

pt believes that there is no control that can exerted over the situation, there is an attitude of passive acceptance and active
strategies towards fighting the cancer are absent

246
Q

causes of patient delay in presentation of breast symptoms?

A
  • age
  • lower education ll
  • fear of cancer
  • intial symptoms not recog - not a lump
247
Q

prognosis of BC is worse for those of a lower SES or BAME bc?

A
  • Less likely to attend screening programmes
  • Increase in risky lifestyle choices (smoking, drinking, poor diet, lack of exercise)
  • Information inaccessible (language barrier)
  • Services inaccessible
248
Q

deprivation of liberty safeguards?

A
  • This is an amendment to the Mental Capacity Act 2005 which
    allows restraint and restrictions to be used – but only if they are in
    the persons best interests
  • The safeguards set out a process that hospitals and care homes
    must follow if they believe it is in the person’s best interests to
    deprive a person them of their liberty, in order to provide a
    particular care plan
249
Q

DOLS - safeguards are?

A
  • That the arrangements are in the person’s best
    interest
    2. The person is appointed someone to represent them
    3. The person is given a legal right of appeal over the
    arrangements
    4. The arrangements are reviewed and continue for no
    longer than necessary
250
Q

3 principles of safeguarding children?

A
  1. Protecting child from maltreatment
  2. Preventing impairment of child’s health / development
  3. Ensure child grows up in circumstances consistent with provision of safe & effective care
251
Q

what to do if you suspect a child is in immediate danger?

A

If suspect a child is in immediate danger refer to local authority social care (or police if very urgent)

252
Q

Section 17 of the children’s act 1989?

A
  • = deemed to be in need if, without the provision of services by a
    local authority, a child is:
    1. Unlikely to maintain or achieve satisfactory level of health & development
    2. Their health or development is likely to be significantly impaired
    3. They are disabled
253
Q

safeguarding children - section 44?

A
  • Emergency Protection Order (EPO) can be sent by police, NSPCC & social services:
    1. Requires person to produce child to applicant
    2. Prevention of removal of child from safe place, e.g. hospital, or ensures removal to safe place
    3. Gives parental responsibility of child
    Lasts 8 days extension for 7 days on
254
Q

what is confidentiality?

A

principle of not divulging or disclosing info about patients to others

255
Q

Why should be practice confidentiality?

A
  1. Legal requirement
  2. Autonomy & trust for patient
  3. Prevent harm to patient – non-maleficence
256
Q

when can confidentiality be broken?

A
  • life threatning situations - self harm/ suicide, DVLA
  • demonstrated by court/ parliament
  • disclosure in public interest to prevent harm
  • . Patient lacks capacity & disclosure is in their best intere
257
Q

disclosure after death?

A
  • Usually allowed to disclose to certain parties unless
    patient explicitly requested complete confidentiality
    upon deat
258
Q

Disclosure is in public interest to prevent harm:

A

a. Communicable disease to partner
B. Intention to murder / terrorism prevention
C. DVLA informed Insulin, Epilepsy, TIAs if patient won’t
D. Knife / gun wounds police must be informed
E. Protect children
F. Prevent trafficki

259
Q

summary of breaking confidentiality?

A
  1. Protect children
  2. Protect public – e.g. from acts of terrorism
  3. Required by courts
  4. Prevent or detect a crime
  5. Provide care in life-threatening circumstances
  6. Protect the service provider in life-threatening circumstances
260
Q

right to life?

A
  • The European court has held that the article requires hospitals to take measures to ensure steps are in place to secure an individual’s right to life = mostly relevant with
    regards to suici
261
Q

prohibition of torture?

A
  • Have to justify medical treatment (as side effects / process e.g. ECT) could be classified as torture
  • Relevant to MHA as could give patient cheaper drug with worse side effects (can’t do this), or give drug instead of psychological thera
262
Q

right to liberty and security?

A
  • Everyone has right to freedom cannot be taken away without good reas
263
Q

right to a fair trial?

A
  • Everyone sectioned has the right to a mental health review tribunal hear
264
Q

fertility and LDs?

A
  • someone with a LD may not be able to provide sufficient care, capacity to consent or refuse sex
  • If sterilization or abortion are being considered as a possible option for a person who is considered to lack capacity, and the person has no-one else to support or represent them, an Independent Mental Capacity Advocate (IMCA) must be appointed
265
Q

disability discrimination act?

A
  • Illegal to discriminate against someone applying for a job because of a disability & employers are expected to make reasonable adjustments to their premises to assist disabled user
  • 1995
266
Q
A
267
Q
A
268
Q

non mod athero RF?

A
  • Age (risk increases with advancing age)
  • Sex (M>F)
  • Family history/ genetics / Race
269
Q

Modifiable athero RF?

A
  • Smoking
  • Hyperlipidaemia
  • Hypertension
  • Diabetes
  • Sedentary lifestyle
270
Q

rehab following amputation?

A
  • exercises whilst sitting or lying
  • taught transfer techniques from wheelchair to bed
  • encouraged to move around ASAP using wheelchair
  • physio and OT
  • physio will teach them how to use prosthetic limb
271
Q

mobility aids post amputation?

A
  • OT: for adaptations required to home
  • e.g. wheelchair ramp or stairlift
272
Q

most common cancer in women in the UK?

A

breast

273
Q

RF of breast cancer?

A
  • Age.
  • Family history
  • Duration of oestrogen exposure(Exogenous/Endogenous).
  • Early Menarche/Late Menopause/Late first pregnancy/Breast Feeding
  • HRT-may double relative risk after 10 years use
  • Obesity
  • Alcohol
274
Q

Breast Cancer Screening Programme(NHSBSP)?

A
  • All women aged 50-70 years (
  • On demand after 70
  • Mammography every 3 years (2 Views)
275
Q
  • of breast cancer screening?
A
  • X ray dose may contibribute <1:100000 extra cancers
276
Q

Nottingham prognostic index?

A
  • prognosis if no treatment other than surgery occurs
  • Grade (1-3) + Nodes (1-3) + 0.2x size (cm)
277
Q

TNM staging?

A
278
Q

masectomy indications?

A
  • large tumour
  • multifocal cancer
279
Q

breast screening programme?

A
  • over 50s
  • recalled if abnormalities
  • assessment clinic - history, clinical exam, biopsy and ultrasound
280
Q

triple assessment?

A
  • examination
  • imaging - mammography and/or US
  • sampling - core biopsy or fine needle aspiration cytology
281
Q

presentation of breast cancer?

A
  • lump
  • inverted nipple or dimpling
  • inflammation
  • discharge - usually blood stained
282
Q

others risks of BC?

A
  • Age at menopause and menarche
  • alcohol intake
  • older mothers
  • BRCA 1/2
  • higher oestrogen levels
283
Q

What does screening do?

A
  • 3-yearly
  • 2 view mammography
  • detection of pre symptomatic disease in the well
284
Q

To justify screening we need to satisfy the following conditions:

A

*A common or severe disease
*A recognisable early stage that responds better to treatment
*A non harmful test which is acceptable to the screened population and has an acceptable false positive and false negative rate
*Cost effectiveness

285
Q

benefits of breast screening ?

A
  • less deaths from BC
  • more conservative surgery
  • improved breast awareness
  • reassurance
286
Q

disadvantages of breast screening?

A
  • Increased anxiety
  • Time off work, transport costs
  • Unnecessary recalls and benign biopsies
  • Treatment of cancers and precancerous states in women who die prematurely from other causes.
  • False reassurance
287
Q

aims of BC screening?

A
  • to detect invasive cancers
  • to persuade 70% of invited women to attend
  • to reduce mortality from BC by 25% in the screened population
288
Q

imaging for women under 35?

A

ultrasound

289
Q

imaging for women over 40?

A

mammography

290
Q

imaging for where the breast is dense?

A
  • MRI where the breast is dense or an oncogene is suspected
291
Q

breast screening detects many cases of?

A

DCIS

292
Q

Advantages and disadvantages of breast screening?

A
293
Q

benefits of BC mammography in BC screening?

A
  • promotes early identification of treatable cancers
  • reduces mortality rate
  • increases choice of Tx options
294
Q

risks of mammography?

A
  • some cancers r missed
  • some identified cancers are not curable
  • false positives
  • overdiagnosis may lead to unecessary treatment
295
Q

US in breast screening?

A
  • helpful in women w dense breast tissue which can make it hard to see abn on mammograms
  • can tell the difference between cysts and solid masses
296
Q

what can cause lymphoedema?

A
  • From surgery to LN, radiotherapy or tumour obstruction of LN areas
297
Q

BRCA-1?

A

mutation on chromosome 17 - breast and ovarian cancer

298
Q

BRCA-2?

A

chromosome 13 mutation. More of a risk factor in BC in men

299
Q

BRCA-2 mutation is also associated with which types of cancer?

A

pertioneal, endometrial, fallopian, pancreatic and prostate cancer

300
Q

Who does CD affect more?

A
  • Increased incidence in Caucasians, Jews and slight female preponderance
  • More common in smokers
301
Q

peaks in CD?

A

15-25 and 55-65 years of age

302
Q

RF of CRC?

A
  • Family history
  • Hereditary syndromes - lynch syndrome and FAP
  • Inflammatory bowel disease
  • Ethnicity - white
  • Radiotherapy
  • Obesity
  • Diabetes mellitus
  • Smoking
303
Q

CRC most commonly affects?

A
  • Most commonly affects left side of the colon
  • mets mostly to liver
304
Q

which cancers mets to the lung?

A
  • Rectal cancers are more commonly associated with lung metastasis (prior to liver metastasis) due to direct haematogenous spread via the inferior rectal vein and IVC
305
Q

Summary of CRC mets?

A

left sided -> liver

rectal -> lung

also peritoneum, brain and bone

306
Q

Screening for CRC?

A
  • FIT test
  • 60-74
307
Q

RF for an UGIB?

A
  • NSAIDs
  • Anticoagulants
  • Alcohol abuse
  • Chronic liver disease
  • Chronic kidney disease
  • Advancing age
  • Previous PUD orH. pyloriinfection
308
Q

CRC contributes ? of all cancer cases?

A

13%

309
Q

Order of cancers in terms of prevalence?

A

lung, breast, prostate, CRC

310
Q

CRC incidence and death rates?

A

incidence increasing but death rates falling

311
Q

aetiology of CRC?

A
  • most arise from adenomatous polyps - adenoma carcinoma sequence
312
Q

genetic mutations in CRC?

A

APC, K-ras, DCC, p53

313
Q

Herediary causes of CRC?

A

HNPCC and FAP

314
Q

majority of cases of CRC occur?

A

spontaneously

315
Q

RF for CRC?

A
  • obesity
  • red meat
  • processed meat
  • alc
  • smoking
  • animal fat
  • long standing IBD
316
Q

Protective factors for CRC?

A
  • regular exercise
  • dietary fibre
  • non starchy vegetables
  • calcium, garlic
317
Q

Sites of CRC?

A
  • rectum
  • sigmoid colon
  • right colon
318
Q

Screening for CRC?

A
  • 60-74 yrs
  • FOB testing kit every 2 years
  • positive patients offered a colonoscopy
319
Q

MDT?

A
  • every hosp must have an MDT team for each cancer type
  • meets every week
  • aims to ensure a co-ordinated and consistent approach to diagnosis and treatment of patients
320
Q

Peer review =

A

process by which MDT is assessed according to set of national measures, occurs on an annual basis

321
Q

CRC MDT core members?

A
  • CRC surgeons
  • radiologist
  • histopathologists
  • oncologists
  • specialist nurses
322
Q

Post op surveillance?

A
  • aim is to identify recurrent disease earlier, allowing further curative tx
  • consists of regular serum CEA, and chest abdo pelvis CT
  • patients followed up for 5 years bc it usually recurs within 2-3yrs
323
Q

Mx of infective diarrhoea?

A
  • fluid replacement - oral or IV
  • public health management
324
Q

Ethnic groups which have a higher risk of iBD?

A

Caucasian and jews

325
Q

O-G cancer incidencr?

A
  • incidence is rising faster than any other solid organ maligancy in the uk
326
Q

O-G cancer symptoms?

A
  • IDA - GOJ which typically bleed at a low level
  • weight loss
  • dysphagia
  • dyspepsia
  • mets e.g. RUQ pain
  • aspiration, fistulas etc
  • hoarnessness - LN compression or recurrent LN
327
Q

Dyspepsia?

A
  • indigestion
  • epigastric pain/ discomfort/ burning
  • heartburn or acid reflux
  • bloating or fullness post prandial
  • nausea and or vomiting
328
Q

red flag symptoms for dyspepsia?

A
  • weight loss
  • overt GI bleeding
329
Q

criteria for CRC referral

A
330
Q

GB cancer?

A
  • Upper abd mass consistent w enlarged GB
331
Q

Dyspepsia flowchart

A
332
Q

common causes of dyspepsia?

A
  • functional dyspepsia
  • GORD
  • PUD
  • GALLSTONES
333
Q

referral critera

A
334
Q

Role

MDT?

A
  • Communication between diagnostic, primary, secondary & tertiary care
  • Improve outcomes and compliance with guidelines
  • Enter patients into high quality research projects
  • Holistic approach to patients and their cancer
335
Q

cancer incidence graph

A

breast > prostate > lung > bowel

336
Q

genetics relating to pancreatic cancer?

A
  • BRCA2
  • HNPCC
337
Q

imaging for <40 jaundice?

A

USS - stones, biliary dilatation

338
Q

imaging for > 40 jaundice which is painless?

A

CT r/o malignancy

339
Q

> 40 jaundice w pain?

A

USS

340
Q

gallstones prev?

A

10%

341
Q

gastric cancer incidence?

A
  • more common in men
  • highest indicence in far east
  • > 90% are adenocarcinomas
342
Q

RF for gastric cancer?

A
  • H. Pylori infection (secondary to inducing atrophic gastritis)
  • Excessive intake of salted food
  • Smoking
  • Pernicious anaemia
  • Menetrier’s disease
  • Gastric polyps
343
Q

Decision to treat?

A
  • the date a patient agrees a treatment plan, may not be the day consent is signed
  • Can change if the treatment plan changes and the patient needs to agree the change
344
Q

CRC tumour markers?

A

CEA

345
Q

Prostate cancer tumour marker?

A

PSA

346
Q

CA125 tumour marker?

A

ovarian

347
Q

pancreatic cancer tumour marker?

A

CA19.9

348
Q

hepatocellular cancer tumour marker?

A

AFP -germ cell, ovary/ testis

349
Q

gastric cancer risk factors?

A
  • H. Pylori increases HR to 4.5.
  • Smoked foods.
  • Tobacco, alcohol.
  • Pernicious anaemia, achlorhidria.
  • Blood group A.
350
Q

gender and age inc risk for gastric cancer?

A
  • Male sex.
  • Age 50- 70 yrs.
351
Q

Celiac disease?

A
  • 2x as common in womem
  • intolerance to prolamin proteins - wheat, barley and rye
352
Q

genetics of celiac?

A

HLA-DQ2

353
Q

what inc risk of celiac disease?

A

recurrent rotavirus infections

354
Q

Most common type of liver cancer?

A

HCC

355
Q

which site does pancreatic cancer most commonly affect?

A

head

356
Q

CA19-9?

A

CA19-9: likely cholangiocarcinoma - pancreatic tumour marker

357
Q

AFP?

A

testicular tumours and liver

358
Q

Gastric cancer?

A
  • 90% squamous or adenocarcinoma
  • 5th most common cancer, present late
  • most common pres anemia
359
Q

gastric cancer epidemiology?

A
  • M:F 2:1
360
Q
A
361
Q

RF for viral hepatitis?

A
  • travel
  • transfusions
  • sexual contacts
  • occupation
  • body piercing
362
Q

exposure to hepatic toxins?

A
  • mushrooms
  • organic solvents
  • phosphorous contained in fireworks
363
Q

complications from ALF?

A
  • sepsis due to marked immune dysfunction and progressive multi organ failure - AKI, metabolic disturbance, haemorrhage (GI bleeding) and cerebral dysfunction
  • cerebral dysfunction e.g. seizures, irreversible brain injury, cerebral dysfunction is commonly the result of raised intercranial pressure
364
Q

Why are ppl at risk of high output cardiac failure with ALF?

A

due to slow vascular resistance

365
Q

Reducing

Alcohol misuse?

A
  • alcohol licensing laws
  • taxation
  • alcohol control zones
  • driving legistation
  • gov funded education campagins e.g. ‘know your limits’
366
Q

tobacco misuse?

A
  • tobacco licensing laws
  • taxation
  • smoking in public places bans
  • advertising bans
  • smoking cessation services
367
Q

illicit substance law?

A
  • misuse of drugs act 2010
368
Q

Risk minimisation w ilicit substances?

A
  • risk minimisation: needle exchange services, maintenance Tx to prevent wider public health problems associated w substance misuse (BBV spread, crime, impact on children)
369
Q

service for illicit substances?

A
  • gov funded internet and phone advice services (FRANK)
370
Q

Drugs

proactive public health policies?

A
  • Proactive policies attempt to reduce substance misuse related harm prior to initiation, for example by classifying new substancesas they are developed and therefore attempting to limit supply to the market.
371
Q

reactive policies?

A
  • Reactive policies aim to respondquickly to epidemics in substance misuse.
372
Q

e.g. reactive policy

A
  • For example, as new substances or diseases emerge educational campaigns respond to provide early advice to limit potential harms andappropriate interventions have been initiated (e.g. needle exchange services).
373
Q

watery diarrhoea in GE?

A
  • due to predominant small bowel involvement.
  • Causes a large volume watery diarrhoea with features of abdominal cramping/bloating and weight loss.
374
Q

Bloody (inflammatory diarrhoea)?

A
  • due to predominant large bowel involvement.
  • Causes frequent, smaller-volume bloody or mucoid diarrhoea that is associated with fever and severe abdominal pain.
375
Q

Typical causes of watery diarrhoea:

A
  • Clostridioides (formally Clostridium) difficile
  • Clostridium perfringens
  • Enterotoxigenic Escherichia coli (ETEC)
376
Q

typical causes od bloody diarrhoea?

A
  • non typhoidal salmonellosis
  • campylobacter
  • shigella
  • EHEC
377
Q

Parasites?

A
  • Parasitic gastroenteritis is commonly associated with foreign travel.
  • Giardia spp. is the most commonly identified pathogen in prolonged travellers’ diarrhoea.
378
Q

rotavirus?

A
  • most common cause of GE in children
  • oral vaccine in the child immunisation programme
379
Q

rotavirus GE?

A
  • Commonly causes a watery diarrhoeal illness with vomiting.
  • Vomiting often settles within 1-3 days and diarrhoea within 7 days.
380
Q

Norovirus?

A
  • most common cause of GE
  • common in winter months
  • full recovery usually within 2 days
381
Q

campylobacter?

A
  • undercooked poultry and other contaminated food/water
  • C. jejuni is the most commonly implicated species and causes either a watery or bloody diarrhoeal illness 2-5 days after exposure.
382
Q

Campylobacter gastroenteritis has been linked to the development of…

A

several autoimmune conditions following an acute episode (e.g. reactive arthritis, Guillain-Barré syndrome).

383
Q

bacilus cereus - vomiting illness?

A
  • vomiting illness after reheating starchy foods - 1-5hrs of ingestion and resolution within 6-24 hrs
384
Q

bac cereus - diarrhoeal illness?

A

Ingestion of contaminated food with the diarrhoeal enterotoxin leads to a watery diarrhoeal illness 8-16 hours following ingestion with quick resolution (i.e. < 24 hours).

385
Q

bacilus vs staphlycoccus?

A
  • Staphylococcus aureus can also produce an enterotoxin that contaminates food and leads to a rapid-onset gastroenteritis illness.
  • the vomiting with S. aureus enterotoxin is usually accompanied with diarrhoea.
386
Q

salmonella transmission?

A
  • ingestion of contaminated food such as undercooked poultry (most commonly red and white meat, raw eggs and diary products).
387
Q

Salmonella GE?

A
  • typical watery diarrhoeal illness, but can be bloody, with associated abdominal pain, fever and vomiting.
  • The illness typically starts within 3 days of exposure and resolves within a week.
388
Q

Shigella?

A
  • classic cause of dysentery in young children
  • bloody/mucoid diarrhoea associated with fever and abdominal pain
389
Q

when is shigella most common?

A

most common in late summer and spread by direct human-to-human transmission because the bacteria only colonises humans and some nonhuman primates.

390
Q

shigella GE?

A

illness usually begins 1-3 days following exposure and resolves within 7 days.

391
Q

Enterohaemorrhagic E. coli ?

A
  • Classically causes a bloody diarrhoeal illness
  • the UK, E. coli O157 is the most common serotype of EHEC that commonly infects children < 5 years old.
392
Q

EHEC transmission?

A
  • most commonly transmitted by contaminated food (e.g. meat, salad, water) - also seen from direct human-to-human spread, which can be due to contact with infected animals (e.g. petting zoos).
393
Q

EHEC infection?

A

Infection may be asymptomatic or cause a diarrhoeal illness (classically dysentery-type illness), which begins within 3-4 days of exposure and resolves within 10 days

394
Q

EHEC 0157?

A

can cause haemolytic uraemic syndrome (HUS) in up to 20% of infected children and accounts for 90% of cases of HUS in children

395
Q

HUS symptoms?

A
  • microangiopathic haemolytic anaemia,
  • thrombocytopaenia and
  • acute kidney injury
396
Q

ETEC?

A

Commonly associated with a watery diarrhoeal illness in travellers or resource-limited countries.

397
Q

Entamoeba?

A
  • travellers
  • mainly asymptomatic
  • presentation ranges from mild diarrhoeal illness to severe dysentery.
398
Q

Giardia?

A
  • commonly implicated in Travellers’ diarrhoea.
  • watery diarrhoea
399
Q

Ecoli TP?

A
  • Common amongst travellers
  • Watery stools
  • Abdominal cramps and nausea
400
Q

Giardiasis TP?

A
  • Prolonged,
  • non-bloody diarrhoea
401
Q

shigella TP?

A
  • Bloody diarrhoea
  • Vomiting and abdominal pain
402
Q

Staph aureus TP?

A
  • Severe vomiting
  • Short incubation period
403
Q

Campylobacter GE?

A
  • A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
  • May mimic appendicitis
  • Complications include Guillain-Barre syndrome
404
Q

bac cereus TP?

A

2 types of illnesses:

  • vomiting within 6 hours, stereotypically due to rice
  • diarrhoeal illness occurring after 6 hours
405
Q

Amoebiasis TP?

A
  • Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
406
Q

1 to 6 hr incubation period?

A

Staphylococcus aureus, Bacillus cereus - vomiting subtype, the diarrhoeal illness has an incubation period of 6-14 hours

407
Q

12 - 48 hrs incubation period?

A

Salmonella, Escherichia coli

408
Q

48-72 incubation period?

A

Shigella, Campylobacter

409
Q

> 7 days?

A

Giardiasis, Amoebiasis

Year 3 (45 decks)

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