Case 6 - Multiple Sclerosis Flashcards
1
Q
- Which section of the MCA 2005 refers to lasting powers of attorney?
- What 2 decisions can a person confer authority on another for?
- How old must a person be to confer an LPA?
- What must a person have before they can confer a LPA?
A
- Section 9
- Financial matters, and their personal welfare
- 18 years old
- Capacity
2
Q
- How old must a person be to make an advanced decision?
- What must the patient do in order for an AD to be valid?
- Does a withdrawal of an AD need to be in writing?
- What can nullify an advanced decision?
- What are the 3 things that can invalidate an AD?
- What must an AD in relation to life sustaining treatment have? (2)
- What are the barriers to advanced care planning? (5)
A
- 18 yrs old
- Must specify the treatment they are refusing
- No
- A lasting power of attorney
- Treatment not being specified, Any specified circumstances are absent, or if there are reasonable grounds to believe patient didnt anticipate something
- In writing and witnessed, patient must make clear that it is to apply in that situation
- Lack of skills, difficult conversations, resources, logistics, inequality in terms of access
3
Q
- What is an advanced statement?
- What is its effect?
- Is it legally binding?
A
- Statement setting down preferences etc regarding future care
- Provides guidance to those making decisions about the patient (Best interests)
- No, only advisory
4
Q
- Do patients with capacity have the right to refuse treatment?
- Is there a right to demand treatment?
- Which case demonstrates this?
A
- Yes
- No
- R v Burke
5
Q
- What does the double effect doctrine say?
- What does s2 of the suicide act 1961 say?
- What does s1 say?
- What was the result of R v Purdy & Pretty v UK?
A
- Doctors who administer medication to relieve a patients pain and suffering, but which could cause their death are legally protected
- It is an offence to aid and abet the suicide of another person
- Suicide is legal, no crime is committed
- DPP set out factors which would lead to prosecution of a person aiding another to commit suicide. Doctors will very likely always be charged. There is no right to die in the UK
6
Q
- What is the aim of end of life care?
- What is palliative care?
A
- To allow a person to live as well as possible and die with dignity
- Making a patient as confortable as possible with psychological, social and spiritual support for them
7
Q
- What are the 2 aspects of the health belief model?
- What are the 2 key beliefs of threat perception?
- What are the 2 key beleifs of behavioural evaluation?
A
- Threat perception and behavioural evaluation
- susceptibility to illness or health problems & anticipated severity of the illness
- beliefs about the benefits of a recommended health behaviour & concerning the costs of or barriers to enacting that behaviour
8
Q
- What is stress?
- What is a stressor?
- What are the physiological symptoms of stress? (4)
- What is activated when a situation is deemed stressful?
- What is the short term response by the body? what pathway?
- What is the long term response? what pathway?
A
- Physiological response when we encounter a threat we feel we dont have the resources to deal with
- Stimulus that causes stress
- Increased HR, BR, decrease in digestive activity, and liver releases glucose for energy
- Hypothalamus
- Fight or flight response - Sympathomedullary pathway
- Hypothalamic pituitary adrenal pathway
9
Q
- In the HPA axis what is activated first?
- What does this then stimulate?
- What hormone is secreted?
- What is the purpose of it?
- What does it also do which can be detrimental?
A
- Hypothalamus
- Pituitary gland
- Adenocorticotropic hormone (ACTH)
- Enables body to maintain steady supply of glucose to cope with the stressor
- Suppresses the immune system
10
Q
- In the SAM pathway, what is activated first?
- What does it then activate?
- What does this secrete?
- What is the physiological response? (2)
- What happens when the threat is over?
A
- Hypothalamus
- Adrenal medulla
- Adrenaline
- Leads to arousal of SNS and reduces activity of PNS (Decrease in digestion etc)
- When threat is over, the PNS takes over and balances the body again
11
Q
- What are the 2 types of coping responses?
- What is emotion focused coping?
- When is this useful?
- Is it useful?
- Who is more likely to use this method of coping? (Men or women)
- What is problem focused coping?
- Is it useful?
A
- Emotion focused coping & Problem focused coping
- Aim is to reduce negative emotional responses associated with stress
- When the source of the stress is outside the persons control
- No, Doesnt provide long term solution, just delays the persons problem
- Women
- Targets the cause of the stress, such as using social support or problem solving
- Yes as it deals with the root cause of the stress, but only works if the stressor is within their control
12
Q
- How are neurons classified?
Identify the different types of neurons:
- Unipolar
- Bipolar
- Multipolar
- Pseudo-unipolar
A
- Based on the number of axons and dendrites that extend from the soma
13
Q
- What are the other types of glial cells? (4)
- What is the difference between an oligodendrocyte, and a Schwann cell?
- What is the function of Astrocyctes?
- What is the function of myelin sheaths?
- What is the function of microglia?
- What is the function of epedymal cells?
A
- Astrocytes, Oligodendrocytes, Microglia, Ependymal cells
- Oligodendrocytes - CNS and can myelinate more than 1 axon, Schwann cells - PNS
- They influence the growth and retraction of neurons, and regulate the chemical content of the brain (BBB)
- They insulate axons, speed up nerve impulses
- Phagocytes which remove debris in the brain
- Line the ventricles, direct cell migration during development
14
Q
- What is the lipid that makes up the myelin sheath?
- What are the 3 glycoproteins that make up the myelin sheath?
A
- Galactocerebroside
- MBP, MOG, and MAG
15
Q
- What is Multiple sclerosis?
- What are the 4 possible causes of MS?
- What is the condition called when it is in the peripheral nervous system?
- Which nerve is most often affected in MS? What is this called?
A
- De-myelinating disease
- Immune mediated destruction of myelin, Leukoencephalopathy (Infection), Inherited disorders which affect synthesis of myelin, and Leukodystrophies
- Gullian Barre syndrome
- CN II, Optic Neuritis
16
Q
- What causes MS lesions?
- What is the cause of the neurological deficits?
A
- Auto-immune response directed against components of myelin sheath
- Loss of saltatory conduction, slower conduction which can lead to inefficiency or conduction block