Block 4

Question 1

Define ‘ethnicity’ and explain how it is different to ‘race’

Answer 1

Ethnicity is socially determined and can be linked
with countries of origin and residence, religion,
social networks etc, whereas race is biological and
genetic

Question 2

Why is ethnicity important in medicine?

Answer 2

Prevalence of disease,
response/perception/effectiveness of treatment
all vary with different ethnicities. For example,
sickle cell disease is more prevalent in some
ethnic groups

Affects management such as carrier screening
etc

Question 3

When is sickle cell disease screened for?

Answer 3

A universal blood spot neonatal screening for

sickle cell disease is carried out

Question 4

Describe what a ‘cross sectional study’ is

Answer 4

A type of descriptive study that involves the
analysis of data collected from a population at one
specific point in time

Question 5

What is a randomised controlled trial?

Answer 5

A rigorous study design in which participants are
randomly assigned either a placebo or the chosen
intervention that is being tested. The participants
are then followed up.

Question 6

disdvantages of a randomised controlled trial?

Answer 6

Disadvantages = ethics of placebo, expensive and time

consuming

Question 7

Advantages of a randomised controlled trial?

Answer 7

Advantages = can determine causality, randomised

allocation reduces confounding variables,

Question 8

What is the difference between a cohort study and a case control study?

Answer 8

Cohort = start with participants with the same
exposure and compare the outcomes

Case control = start with participants with the
same outcomes and compare the exposures

Question 9

Define ‘bias’ ?

Answer 9

Systematic error in measurement

Question 10

State 5 reasons why patient confidentiality is important

Answer 10

It is central to establishing trust

Makes patients more likely to disclose personal
information that may be relevant to their care

Helps ensure that info is not disclosed to those
who may use it to harm the patient

Respects patient autonomy

It is a legal requirement and a professional
obligation

Question 11

In which situations can information be disclosed without breaching confidentiality?

Answer 11

When imparting information about a patient to
those involved in the care and treatment of the
patient (healthcare team) – This is known as
implied consent

However if a patient is reluctant for some personal
information not to be shared within the
healthcare team, it must be justified to break this
confidentiality

Question 12

In which situations can you breach confidentiality?

Answer 12

If demanded by court/stature

If it is necessary to prevent serious harm to
other people

If the patient lacks capacity (or is a child) and
disclosure is in the patient’s best interest

If it is necessary to prevent serious harm to a
competent adult patient and it is not practicable
to seek consent to disclosure (e.g. STI
disclosure to partner)

Question 13

Define ‘risk’

Answer 13

The probability that an event will occur during a

specific time

Question 14

What is the difference between ‘absolute risk’ and

‘relative risk’?

Answer 14

Absolute = the risk of getting an outcome in a
period of time

Relative = the difference between the probability
of an exposed group getting an outcome and the
probability of an unexposed group getting an
outcome – aka Risk Ratio

Question 15

What are the top 5 demands for blood donation?

Answer 15

General surgery (23%)

General medicine (15%)

Cardiothoracic surgery (13%)

Orthopaedics (11%)

Blood diseases (9%)

Question 16

How is the blood donation system funded?

Answer 16

By the taxpayers

Question 17

At what time of year are blood supplies lowest?

Answer 17

December and January

Question 18

Which blood types are in lowest supply

typically?

Answer 18

O positive and negative

Question 19

Titmuss (1970) argued an ethical case against the
purchase and sale of blood. State 4 ethical points
he made.

Answer 19

It would repress altruism

It would erode the ‘sense of community’

It would sanction ‘profits’ in hospitals and
clinics, subjecting medicine to market place
rules

It would increase the blood supply from the
poor, unskilled and unemployed,
redistributing blood from the poor to the rich.

Commercialization may increase infection risks

Question 20

Cooper and Culyer argued a case for the purchase

and sale of blood. State 2 points that they made.

Answer 20

Supply can be increased by removing obstacles
to donors

Offering financial rewards either by direct
payment or exemption from payment in the
future can also increase supply

Question 21

Which are the top 4 organs in demand?

Answer 21

Kidneys

Livers

Heart/Lung or Heart and lung

Corneas

Question 22

If a kidney transplant is not available, patients
must mechanically maintain their kidneys either
through dialysis at home or at hospital.

What are the advantages of a transplant over
mechanical maintenance?

Answer 22

Quality of life is much superior in those with
transplants in comparison to those on dialysis

More cost effective: transplant = £17,000 // dialysis =
£35,000 per year + £5000 for each subsequent year on
immunosuppressive drugs

Question 23

How can the government/NHS increase the

supply of used body parts?

Answer 23

Replace ‘opt in’ donor cards with ‘opt out’
donor cards

Use transplant coordinators and clinical leads
in hospital to increase supply

Financial incentives (used in the USA) –
However there are debates about ethics and quality
control

Question 24

Name the methods / criteria for rationing

Answer 24

Ability to pay: this method favours the rich and
is accepted in most markets though not usually
in healthcare 􏰅

Need: (but what is need?) Ability to benefit as
measured against cost. Therefore this method
favours those who can benefit the most per unit
cost

Question 25

How can you select who will benefit most from a treatment?

Answer 25

Age Behaviour: smoking, alcohol etc Family circumstances Social class (may also be related to behaviour)

Question 26

What is the definition of confidentiality?

Answer 26

The principle of not divulging or disclosing | information about patients to others

Question 27

Under what circumstances does the GMC allow | you to breach confidentiality?

Answer 27

Demanded by court or statute Disclosure is in the public interests (e.g. necessary to prevent serious harm to other people) The patient lacks capacity (or is a child) and disclosure is in the patient’s best interests Necessary to prevent serious harm to a competent adult patient and it is not practicable to seek consent to disclosure

Question 28

If a patient has a serious communicable disease and still having sex with unaware partner what should you do?

Answer 28

Should tell the patient before you make the disclosure. Try and get them to disclose. If practicable you should not disclose the identity of the patient. Only disclose the necessary information

Question 29

Ratio?

Answer 29

Odds ratio: The ratio of odds of exposure amongst subjects with disease compared to the odds of exposure amongst a control group. It is equal to the cross-product ratio. ``` Odds ratio (OR) = odds in exposed 􏰊 odds in non-exposed􏰃 ```

Question 30

What is a Cross-sectional Study?

Answer 30

A study that examines the relationship between diseases (or other health-related characteristics) and other variables of interest in a particular population at one particular time. Cross-sectional studies may be used to estimate the prevalence of disease, but not the incidence of disease.

Question 31

What is a case-control study?

Answer 31

``` An epidemiological study design where subjects are recruited on the basis of the presence or absence of disease (cases or controls) and exposure is measured retrospectively. ``` In this way it is possible to estimate the risk of disease associated with exposure usually by calculating an odds ratio.

Question 32

What is an occupational cohort study?

Answer 32

The definition of the cohort is based primarily on a common occupational exposure e.g. workers in the nuclear power industry. In this way the risk of disease can be compared with the general population or other occupational groups to determine the occupational risk.

Question 33

What are the 2 key elements of randomised | control trials?

Answer 33

The key elements of randomised controlled trials are: The comparison of a group receiving the treatment (or intervention) under evaluation With: a control group receiving either best practice, or an inactive intervention.

Question 34

What is “allocation concealment” in RTCs

Answer 34

Successful implementation of a randomisation scheme depends on: Making sure that those responsible for recruiting and allocating participants to the trial have no prior knowledge about which intervention they will receive (this is called allocation concealment)

Question 35

What is a double blind trial?

Answer 35

A trial in which neither participants nor study personnel knows what treatment has been received until the 􏰅code is broken􏰆 after the end of the trial. This is achieved by using a placebo. If a double-blind design is not possible then outcome assessment should be done by an investigator blind to the treatment received.

Question 36

What is a Systematic Review

Answer 36

An attempt to systematically review the research evidence on a particular topic: Systematic means a defined methodology that could be repeated by someone else and retrieve the same publications and the same results. The results of the review might be expressed in words 􏰀 or mathematically.

Question 37

What is a Meta-Analysis?

Answer 37

Mathematically combination of the individual results of studies in the review to get a more precise estimate of what is happening.

Question 38

What is a focus group?

Answer 38

An evaluation activity comprising of a semi-structure discussion with a group of people. Focus groups, comprising of stakeholders, are used to inform test-designers on the significance of each topic to be administered within a certification exam.

Question 39

What is a participant observation?

Answer 39

A research method involving direct participation of the researcher in the events being studied. The researcher may either reveal or hide the true reason for involvement.

Question 40

what is a non-participant | observation?

Answer 40

Researchers | do not partake in the activity of the study.

Question 41

‘cross sectional study’ advantages

Answer 41

Advantages = allows researchers to compare many different | variables at one time, quick and easy to conduct

Question 42

‘cross sectional study’ disadvantages

Answer 42

Disadvantages = the study may not represent the population well, difficult to determine a causal relationship between risk factors and outcomes