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HYMS phase II H&S > Block 44 > Flashcards

Block 44 Flashcards

1
Q

Give 5 social implications of a diagnosis of epilepsy..

A

1) Depression (often co-morbid)
2) Reduction in social participation (if photosensitive epilepsy)
3) Stigma
4) Pregnancy and breast feeding risks (teratogenic medications)
5) Driving (DVLA)
6) Employment restrictions

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2
Q

What is the DVLA guidance regarding epileptic seizures and driving?

A

A patient must be free of seizures for 12 months before being allowed to drive.

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3
Q

Name 3 age-related factors which can contribute towards immobility.

A

1) Less efficient walking patterns.
2) Deterioration in vision (acuity and light/dark adaptation)
3) Impaired CV reflexes (postural/ post-prandial hypotension)
4) Decreased cerebral blood flow
5) Decreased renal and lung function

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4
Q

Name 4 physical illness factors which can contribute towards immobility.

A

1) HF (fatigue, oedema, breathlessness, dizziness)
2) CVD (postural hypotension)
3) Respiratory disease (COPD/ ILD, LRTI)
4) GI/ nutrition (tea and toast diet, poor swallow, decreased gut motility, constipation)
5) Locomotor/ neuro (abnormal gait, PD, peripheral neuropathy, painful joints)
6) Visual (cataracts, glaucoma, age-related macular degeneration)
7) Others (leg ulcers, polypharmacy, chiropody)

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5
Q

Name 3 psychological illness factors which can contribute towards immobility.

A

1) Isolation/ bereavement/ anxiety (depression is at 20% for those in hospital >65)
2) Learned helplessness (relinquish decision making responsibility and grow more dependent on help at home).
3) Dementia (up to 40% of the hospital population have significant impairment.

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6
Q

Name 3 environmental factors which can contribute towards immobility.

A

1) Isolation
2) Housing conditions (adaptations may be needed)
3) Difficulty in social mobility (not easy to go and meet new people so stay at home in comfort)
4) Accessibility of public buildings (some places may not be suitable for those with walking aids or wheelchairs)
5) Lack of community support

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7
Q

1) Name a scoring system used to assess functional independence (often used for stroke patients).
2) How do you interpret this scoring system?

A

1) The Barthel index of ADLs.
2) A higher score indicates a greater likelihood of a patient being able to live at home with a degree of independence following discharge from hospital.

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8
Q

What is the Unified Parkinson’s disease rating scale used for?

A

Used to follow the longitudinal course of Parkinson’s disease.

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9
Q

Give the 6 categories in the Unified Parkinson’s disease rating scale.

A

1) Mood and behavioural evaluation.
2) Self-evaluation of ADLs
3) Motor evaluation
4) Complications of therapy
5) Hoehn and Yahr staging of PD severity
6) Schwab and England ADL scale

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10
Q

What are the 4 major themes set out under the ‘National service framework for older people’?

A

1) Respecting the individual
2) Intermediate care
3) Providing evidence-based specialist care
4) Promote an active, healthy lifestyle.

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11
Q

Name and describe the 2 standards set out under the ‘Respecting the individual’ theme of the National service framework for older people.

A

Standard 1 - rooting out of age discrimination - provision of NHS and local services is based on clinical need alone and not on age.

Standard 2 - person centred care - all patients are treated as individuals who take an active and involved role in their care.

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12
Q

Name and describe the 1 standard set out under the ‘Intermediate care’ theme of the National service framework for older people.

A

Standard 3 - Immediate care - elderly people will have access to a new layer of care between primary and specialist servcies (at home or in designated care settings).

**This is designed to decrease unnecessary hospital admissions increase independence and increase early discharge rates.

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13
Q

Name and describe the 4 standards set out under the ‘Providing evidence-based specialist care’ theme for older people.

A

Standard 4 - general hospital care - to be delivered by specialist staff with an appropriate skillset to meet their needs.

Standard 5 - NHS takes action to prevent strokes and people who have a stroke are to be treated by a specialist stroke service.

Standard 6 - falls - NHS to work with council to take action to decrease falls.

Standard 7 - MH - access to integrated MH services provided by the NHS and councils.

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14
Q

Name and describe the 1 standard set out under the ‘Promote an active, healthy life’ theme in the National service framework for older people.

A

Standard 8: promotion of health and an active lifestyle via a co-ordinated programme of action led by the NHS in partnership with local councils.

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15
Q

1) If a patient is thought to need help with personal care, what should be carried out?
2) Name 2 grants that can be applied for to help with home rehabilitation.

A

1) A care needs assessment normally arranged by GP or OT.

2) ‘Disabled facilities grant’ and grants provided by the ‘Independence at home’ charity.

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16
Q

After a care needs assessment, what help can patients receive from the local council?

A

If equipment is needed, the council will provide this for free.

If minor home adaptations are needed (

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17
Q

After a care needs assessment, what might a patient have to pay for themselves?

A

Small household aids such as kettle tippers or tin openers.

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18
Q

1) What is the disabled living foundation?

2) What is RICA?

A

1) A charity providing free, impartial advice on home adaptation and mobility products.
2) An independent organisation that carries our consumer research for older and disabled people.

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19
Q

1) When is the risk of contracting meningococcal disease highest?
2) Who normally arranges prophylaxis or vaccination for close contacts of a patient with meningococcal disease?

A

1) In the 7 days before onset of symptoms in index case.

2) Secondary care.

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20
Q

State who is considered to be a close contact requiring prophylaxis with regards to a patient who has meningococcal disease.

A

1) Prolonged close contact in a household during the 7 days before onset of illness.
2) People who have had transient close contact if they have been directly exposed to large particle droplets/ secretions from respiratory tract of index case.

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21
Q

When should antibiotic prophylaxis be started for close contacts after a confirmed diagnosis of an index case of meningococcal disease?

A

As soon as possible after index case diagnosis (ideally within 24 hours).

**Prophylaxis generally considered regardless of close contact meningococcal vaccination status.

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22
Q

Describe the hearing milestones for the following ages:

1) Birth
2) 4 months
3) 7 months
4) 9 months
5) 12 months

A

1) Startles and blinks at sudden noise (i.e. door slam)
2) Quietens or smiles to the sound of voice, even if person not visible. May turn head towards sound.
3) Turns immediately to voice.
4) Listens attentively, babbles.
5) Responds to own name and familiar words.

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23
Q

1) What hearing test is done in a newborn?

2) If the initial hearing screening test done in a newborn is abnormal, what test is done?

A

1) Otoacoustic emission test

2) Auditory brainstem response test

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24
Q

1) Why is there no screening programme for dementia?

2) Active memory assessment should be carried out in those who are at risk, which includes which groups of people?

A

1) Because dementia does not fulfil the criteria of a condition suitable for screening.
2) >75, high vascular risk, Parkinson’s disease, learning disabilities.

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25
Q

What hearing screening tests can be done at the following ages:

1) 6-9 months
2) 18 months - 2.5 years
3) >2.5 years
4) >3 years

A

1) Distraction test
2) Recognition of familiar objects
3) Performance testing or speech discrimination testing
4) Pure tone audiometry (done at school in most areas of the UK)

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26
Q

Name and describe 3 ways to prevent deafness.

A

1) Strengthen maternal and child healthcare programmes (incl. immunisation)
2) Train HCPs in hearing care
3) Regulate and monitor use of ototoxic medications and environmental noise
4) Implement infant and school based hearing screening
5) Make hearing devices and communication therapies accessible.
6) Raise awareness to promote hearing care and reduce stigma.

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27
Q

Describe 3 ways that sensorineural deafness can be prevented.

A

1) Vaccination of children (measles, meningitis, rubella, mumps) AND of women of childbearing age against rubella.
2) Screening for syphilis and other infections in pregnancy
3) Avoidance of ototoxic drugs (monitor dosing if prescription essential)
4) Decrease noise exposure in occupational and recreational settings by using correct PPE

28
Q

Why is early detection of conductive hearing loss or impairment important?

A

Because this will allow earlier medical or surgical intervention, preventing speech and language delays in young children.

29
Q

Give 3 consequences of falls and fractures (individual, social, economical).

A

1) Cost NHS £2.3 billion a year
2) Pain
3) Loss of confidence and independence
4) Hip # has 20-30% mortality
5) Immobility can cause DVT/ pneumonia

30
Q

1) When treating an elderly patient, what should you routinely ask them with regards to falls?
2) What does NICE recommend in order to risk assess a patient for falls?

A

1) Routinely ask elderly people whether or not they have fallen in the last year.
2) NICE recommends a multifactorial risk assessment.

31
Q

List 3 areas asked about/ assessed in the NICE recommended multifactorial risk assessment for falls.

A

1) Falls history
2) Assessment of gait, balance, mobility and muscle weakness
3) Osteoporosis risk
4) Perceived functional ability and fear related to falling
5) Visual impairment
6) Cognitive assessment
7) Neurological examination
8) Urinary incontinence
9) Assessment of home hazards
10) CV examination
11) Meds review

32
Q

Name 3 multifactoial intervention programmes which can be used to reduce falls risk.

A

1) Strength and balance training
2) Home hazard intervention
3) Vision referrals for poor vision
4) Meds review with modification and withdrawal
5) Cardiac pacing if necessary (?carotid sinus hypersensitivity)
6) Vitamin D supplements
7) Safety rails in beds/ showers

33
Q

Name the general interventions that can be used to reduce the risk of falls.

A

1) Decrease any modifiable risk factors

2) General diagnosis of underlying pathology

34
Q

What is the national service framework for long term conditions?

A

A tool for delivery of a government strategy to support people with long term conditions based on best evidence and patient experience.

35
Q

How many quality requirements are there in the national service framework for long term conditions?

A

11.

36
Q

Name the first 6 quality requirements for the national service framework for long term conditions.

A

1) Patient centred care
2) Early recognition, prompt diagnosis and treatment.
3) Emergency and acute treatment - patient to be assessed and treated in a timely manner if neurological emergency
4) Early specialist rehabilitation - receive timely, ongoing and high quality rehab services in and out of hospital
5) Vocational rehab - in order for the patient to help find, regain and remain at work
6) Community rehab - support and increase independence and autonomy.

37
Q

Name the first 5 quality requirements for the national service framework for long term conditions.

A

1) Providing equipment and accommodation - E.G. assistive technology/ equipment to support independent living.
2) Providing personal care and support - health and social care work to support independent living at home.
3) Palliative care - receive comprehensive range of palliation services when in the latter stages of disease
4) Supporting family and carers - access to support that recognises their needs both in their role as a carer and in their own right.
5) Caring for people with neurological conditions in hospital or in other health and social care settings - need to have specific neurological needs met, even when receiving care for other reasons.

38
Q

Overall, what are the 3 main aims of the national service framework for long term conditions?

A

1) Ensure quick access to specialist neurological expertise, as close to home as possible.
2) Support people to live with long term neurological conditions.
3) Improve QoL through provision of services which promote independent living

39
Q

Give 2 examples of support available from community groups for patients with chronic neurological conditions.

A

1) Patient organisations - various organisations/ registries often named after specific conditions (they offer advice, support and raise money for research).
2) The brain Charity - offers emotional support, practical help and social activities for anyone with a neurological condition and their family, friends and carers (coffee mornings, arts and crafts, walking groups, support groups, choir).

40
Q

1) Global patterns of visual loss vary according to what 2 main factors?
2) What percentage of the world’s blind population live in developing countries?
3) What proportion of blindness in developing countries would have been preventable in developed countries?

A

1) Nutrition and economic factors.
2) 90%
3) 80% would not be blind if these countries had proper infrastructure to prevent/ treat blindness.

41
Q

Name the main causes of worldwide avoidable blindness from most common to least.

A

Cataract > Glaucoma > ARMD > Corneal opacity > trachoma > childhood causes (vitamin A deficiency).

42
Q

List 3 causes of blindness in developed countries.

A 
Congenital causes
Cataract
ARMD
Glaucoma
Diabetes
43
Q

State the causes of avoidable blindness in developing countries.

A 
Cataract
Glaucoma
Corneal opacities
Trachoma (chlamydia trachomatis)
Childhood blindness
Onchocerciasis ('river blindness' caused by parasitic worm Onchocerca volvulus)
44
Q

What did the WHO vision: 2020 strategy aim to do?

A

Aimed to eliminate the 6 main causes of avoidable blindness in developing countries by 2020.

45
Q

1) What are optometrists?
2) What do optometrists do?
3) How often are people advised to visit an optometrist/ optician?

A

1) Primary health care specialists trained to examine eyes to detect defects incision, signs of injury and ocular disease.
2) Make assessments, refer to specialists and prescribe spectacle lenses. They also screen for diabetic or hypertensive retinopathy.
3) At least once every 2 years.

46
Q

What 3 areas is the quality of healthcare assessed upon?

A

1) Structure of an organisation
2) Processes
3) Outcomes

47
Q

Give 3 reasons was to why consumer protection is necessary in medicine.

A

1) Weak evidence bases sometimes.
2) Large practice variation
3) Failures to measure success with regards to outcomes.

48
Q

Give 3 types of data that are available to increase patient safety.

A

1) Hospital episode statistics
2) Patient reported outcome measures
3) QALY assessment before and after procedures.

49
Q

1) What is a consumer protection agency at work within the NHS?
2) What does this consumer protection agency do?
3) What is a limitation of this consumer protection agency?

A

1) CQC
2) Regulates quality and financial performance, gives licensing to providers and police service providers through unannounced visits.
3) They review hospital episode statistics, but do not integrate this data with private care data.

50
Q

Aside from the CQC, name 3 other examples of consumer protection agencies.

A

1) DoH
2) NHS England
3) Health protection agency (monitor infection rates)
4) NICE
5) GMC
6) Royal Collages

51
Q

State 3 ways that consumer protection in the NHS could be improved.

A

1) Peer appraisal
2) GMC revalidation
3) Compulsory medical audits
4) GP and consultant contracts (increase transparency in comparative performance with regards to activity, costs, PROMs)
5) Transparency and accountability

52
Q

What are technology appraisals?

A

Recommendations on the use of new and existing medicines and treatments within the NHS in England and Wales.

53
Q

Give 3 examples of areas within medicine in which technology appraisals are carried out on.

A

1) Medicines
2) Medical devices (for example, hearing aids or inhalers)
3) Diagnostic techniques
4) Surgical procedures (e.g. repairing hernias)
5) Health promotion activities (e.g. ways of helping patients with diabetes to manage their condition).

54
Q

State the 9 steps in developing NICE technology appraisals.

A

1) Provisional appraisal topics chosen.
2) Consultees and commentators identified.
3) Scope prepared.
4) Appraisal topic referred.
5) Assessment report prepared.
6) Evaluation report prepare.
7) Appraisal consultation document (ACD) produced.
8) Final appraisal determination (FAD) produced.
9) Guidance issued.

55
Q

What are the conditions under which NICE guidance can be issued after a technology appraisal has been completed?

A

If there are no appeals against the final appraisal determination, or an appeal is not upheld, then the final recommendations are issued as NICE guidance.

56
Q

What criteria are used in order to filter suggestions of provisional appraisal topics when developing NICE technology appraisals?

A

NICE filters the technology appraisal suggestions using the DoH’s selection criteria:

  • Burden of the disease
  • Resource impact
  • Policy importance
  • Inappropriate variation in practice across the country
  • Factors affecting the urgency for guidance
57
Q

State 3 examples of groups of people used as consultees or commentators in NICE technology appraisals.

A

National organisations including:

  • Groups representing patients and carers
  • Bodies representing HCPs
  • Manufacturers
  • Research groups
58
Q

1) Who does NICE work with the develop a scope for a technology appraisal?
2) What happens in order to prepare a scope for a technology appraisal?
3) Who comments on the draft scope?

A

1) The DoH.
2) The scope sets out the questions to be addressed by the appraisal, when considering clinical effectiveness and cost-effectiveness of the technology.
3) Consultees and commentators.

59
Q

What happens when the appraisal topic is referred?

A

The DoH refers the technology appraisal topics to NICE.

60
Q

What are the 2 assessment components in a technology appraisal?

A

1) Systematic review of the relevant evidence available on a technology
2) An economic evaluation of the technology’s cost effectiveness.

61
Q

Who does NICE commission in order to conduct the components in a technology appraisal assessment report?

A

An independent academic centre.

62
Q

What happens in the ‘evaluation report prepared’ section of a technology review?

A

The assessment report and comments on it are drawn together in the evaluation report.

63
Q

Describe the steps that happen when the appraisal consultation document is produced in a technology appraisal.

A

1) Independent appraisal committee considers the evaluation report.
2) Committee hears evidence from nominated clinical experts, patients and carers before making first recommendations in ACD.
3) Consultees and commentators have 4 weeks to comment on ACD.
4) ACD also made available online so HCPs and members of the public can comment on it.

64
Q

Describe what happens when a final appraisal determination is produced in a technology appraisal.

A

Independent appraisal committee considers comments on ACD and then makes its final recommendations.

The FAD is submitted to NICE for approval.

Consultees can appeal against the final recommendations in the FAD.

65
Q

Give 3 groups of people who can recommend and appraisal topic for the NICE technology appraisal.

A

1) DoH
2) National horizon scanning centre (at University of Birmingham)
3) HCPs
4) General public

HYMS phase II H&S (12 decks)

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