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Phase 3a > Community + Public Health > Flashcards

Community + Public Health Flashcards

1
Q

What is the definition of Public Health?

A

The science and art of preventing disease, prolonging life, and promoting health through organised efforts of society

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2
Q

What are the 4 tiers of social determinants of health?

A
  1. Non-modifiable individual factors
  2. Individual lifestyle factors
  3. Social and community networks
  4. General socioeconomic, cultural and environmental conditions
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3
Q

Give the non-modifiable individual factors within the social determinants of health model

A
  1. Age
  2. Sex
  3. Ethnicity
  4. Genes
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4
Q

Give some factors within the general socioeconomic, cultural and environmental conditions under the social determinants of health model

A 
Working conditions - employment
Living conditions - housing
Education
Healthcare services
Water and sanitation
Agriculture and food production
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5
Q

What is the difference between equality and equity?

A

Equality - giving everyone equal shares

Equity - giving what is fair and just dependent upon individual needs

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6
Q

What is horizontal and vertical equity?

A

Horizontal equity = equal treatment for equal need

Vertical equity = unequal treatment for unequal need

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7
Q

What are 4 factors to measure when looking at health equity?

A 
Supply of healthcare
Access to healthcare
Utilisation of healthcare
Healthcare outcomes
Health status
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8
Q

What are the 3 domains of public health practice?

A

Health Improvement
Health Protection
Improving Services

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9
Q

What is primary prevention?

A

Aims to prevent a disease from occcurring - reduce or eliminate exposures that increase risk of a disease

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10
Q

What is secondary prevention?

A

Aims to detect early disease and slow it down or halt progress of disease to maximise the chance of complete recovery

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11
Q

What is tertiary prevention?

A

Aims to reduce the complications of severity of disease that has already been diagnosed and is symptomatic

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12
Q

What is the prevention paradox?

A

A larger number at small risk of disease may contribute more cases than a small number of people individually at a greater risk
OR
A preventive measure which brings much benefit to the population often offers little to each participating individual

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13
Q

What are 2 prevention approaches?

A

HIgh risk approach - targets high risk individuals to reduce risk (tends to favour affluent)
Population approach - targets all individuals aiming to reduce risk for every individual

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14
Q

What is health psychology?

A

Emphasising the role that psychological factors have in progress and consequences of disease - promote healthy life choices and prevent disease

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15
Q

What is a health behaviour?

A

Behaviour aimed at preventing disease (eg eating healthy)

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16
Q

What is an illness behaviour?

A

A behaviour aimed at seeking remedy (eg going to doctor)

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17
Q

What is sick role behaviour?

A

A behaviour aimed at getting well (eg taking medications)

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18
Q

What proportion of cancer cases are preventable due to modifiable risk factors?

A

1/3

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19
Q

What are 3 levels of health intervention?

A

Individual
Local community
Population

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20
Q

What is unrealistic optimism?

A

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

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21
Q

What health behaviour has the largest impact on illness and premature death in the UK? What are the common diseases related to this behaviour?

A

Smoking!

COPD, cancer, cardiovascular disease

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22
Q

What are the 3As in aiding smoking cessation?

A

Ask
Advise
Assist

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23
Q

Give the stages in the Needs Assessment cycle

A

Needs Assessment
Planning
Implementation
Evaluation

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24
Q

What are the 3 factors to assess in a needs assessment?

A

Need - ability to benefit from intervention
Demand - what people ask for
Supply - what is provided

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25
Q

What is a health needs assessment?

A

Systematic approach for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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26
Q

What is the difference between health need and health care need?

A

Health need - much more general, morbidity, mortality, sociodemographics
Health care need - much more specific, ability to benefit from healthcare

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27
Q

What may a health needs assessment be carried out about?

A

Population/sub-group
Condition
Intervention

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28
Q

What is felt need?

A

Individual perceptions of variation from normal health

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29
Q

What is expressed need?

A

Individual seeks help to overcome variation from normal health

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30
Q

What is normative need?

A

Professional defines intervention appropriate for expressed need

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31
Q

What is comparative need?

A

Comparison between severity, range of interventions and cost

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32
Q

What are 3 approaches to a health needs assessment?

A

Epidemiological Approach
Comparative Approach
Corporate Approach

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33
Q

What is a comparative approach for health needs assessment?

A

Comparing the services received by one population with those received by others - spatial and social

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34
Q

What is a corporate approach for health needs assessment?

A

Focus on actors involved in services

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35
Q

What is the health belief model?

A

Individuals will change their behaviour if they:

  1. Believe they are susceptible to disease
  2. Believe that it has serious consequences
  3. Believe that taking action reduces susceptibility
  4. Believe that benefits of taking action outweight the costs
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36
Q

What is the theory of planned behaviour?

A

Proposes that best indicator of behaviour is intention to carry it out

  • attitude to behaviour
  • perceived social pressure - subjective norm
  • perceived behavioural control
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37
Q

What factors need to be considered in bridging gap between intention and behaviour?

A 
Perceived control
Anticipated regret
Preparatory actions
Implementation intentions
Relevance to self
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38
Q

What are the 5 stages of the transtheoretical model?

A 
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
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39
Q

What is motivational interviewing?

A

Counselling approach for initiating behaviour change by resolving ambivalence

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40
Q

What is nudge theory?

A

Nudge the environment to make the best option the easiest e.g. opt-out schemes, reducing fast food restaurants

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41
Q

What is a succinct definition of evaluation?

A

Assessing to what extent a service achieves its objectives

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42
Q

Give Donbedian’s 3 components core to evaluation of health services

A

Structure
Process (including outputs)
Outcomes

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43
Q

What are Maxwell’s Dimensions of Quality?

A 
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
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44
Q

What is malnutrition?

A

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients

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45
Q

Give some examples of early influence on food behaviour

A

Maternal diet and preferences
Role of breastfeeding, age of introduction to solid food
Parenting practices

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46
Q

Give some examples of Non-Organic Feeding Disorders (NOFEDs)

A

Common in children under 6 yrs old
Food aversion, food refusal, food selectivity, failure to advance to age-appropriate foods, negative mealtime interactions

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47
Q

What are the 3 distinct eating disorders and the 4th separate category?

A

Anorexia nervosa
Bulimia nervosa
Binge Eating Disorder
Other Specified Feeding or Eating Disorder (OFSED)

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48
Q

What is multimorbidity?

A

Simultaneous presence of (3) or more chronic conditions in the same subject

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49
Q

What are the 3 types of opioid receptor in the body?

A

MOR, KOR, DOR

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50
Q

Where are opioid receptors in the body

A 
Central nervous system, less in peripheral
Vas Deferens
Knee joint
GI tract
Heart
Immune system
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51
Q

What is the major effect of opioid receptors in the nervous system?

A

Pre-synaptic action inhibiting neurotransmitter release

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52
Q

What are the side effects of opioids?

A 
GI tract - constipation K, M
Respiratory depression - sleep apnoea
(CVS risks - if used for arthritis)
CNS - dizziness, sedation, falls, fractures
MSK - increased falls risk/fracture risk
Endo - decreased pituitary hormones - hypogonadism, fertility problems, menstruation
Immune - decreases
Addiction and misuse
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53
Q

Give some non-pharmacological interventions for managing chronic pain

A

Physical - yoga, pilates, stretch, exercise, weight loss
Psychological - counselling, CBT, mindfulness, relaxation, meditation
Complementary - massaging, reflexology
Occupational - work-based review

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54
Q

Give some non-opioid analgesics

A

Paracetamol
NSAIDs
Cox-2 inhibitors

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55
Q

Give some examples of adjuvant analgesics

A

Anti-convulsants
Anti-depressants
Lidocaine patches

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56
Q

Give 6 signs of abuse or dependency on opioids

A
  1. Use of pain medications other than for pain treatment
  2. Impaired control/compulsive use of medication
  3. Continued use of medication despite harm
  4. Craving or escalation of medication use
  5. Selling/altering/stealing medications/prescriptions
  6. Reluctance to try non-pharmacological interventions
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57
Q

What individual and lifestyle factors are associated with increased risk of opioid dependency?

A

Younger, cohabiting but not married, unemployed, non-White, poor physical health, internet pharmacy

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58
Q

What are the 3 core principles of the NHS?

A
  1. meets needs of everyone
  2. free at the point of delivery
  3. based on clinical need, not ability to pay
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59
Q

What is the inverse care law?

A

The principle that the availability of good medical or social care tends to vary inversely with the need of the population served

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60
Q

Give Maslow’s Hierarchy of Needs in order from the bottom of the pyramid to the top

A

Physiological - breathing, food, water, sleep
Safety - security of body, materials, family
Love/Belonging - friends, family, sex
Esteem - self-esteem, confidence, achievements
Self-Actualisation - morality, creativity, problem solving

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61
Q

Give some barriers to healthcare for homeless people

A

Lack of access - difficulty registering at GP, appointment procedures, perceived/actual discrimination
Lack of integration with other agencies - housing, criminal justice, voluntary
Other needs - immediate survival outweighs health

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62
Q

What are some health inequalities faced by the traveller/gypsy community?

A 
Overall poorer physical health
Higher child mortality rate
Worse mental health
Pregnancy complications
Bronchitis and asthma
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63
Q

What are some barriers to healthcare for gypsy/traveller community?

A

Registering for GP services - no permanent address
Perceived/actual discrimination
Reluctance to seek treatment until becomes severe
Low income
Low education
Cultural health beliefs - gender, stoicism, mental health stigma

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64
Q

What are some health inequalities faced by the LGBTQ+ community?

A

Depression
Suicide and self-harm
Drugs and addiction problems
STIs (especially HIV)

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65
Q

What is minority stress theory?

A

Poorer health outcomes stem from negative social climate they can experience

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66
Q

What is life course theory?

A

Accumulation of advantages and disadvantages over time

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67
Q

What is intersectionality?

A

Multiple identities contribute to a person’s sense of self and how these different aspects are themselves potentially subject to forms of discrimination and marginalisation

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68
Q

What are the barriers to healthcare for the LGBTQ+ community?

A

Stigma/prejudice
Fear of disclosing LGBTQ+ status
Previous negative experiences

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69
Q

What is an asylum seeker?

A

A person that has applied for refugee status

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70
Q

What is a refugee?

A

A person granted asylum and refugee status. Usually allows remain for 5 years and then reapply

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71
Q

What is indefinite leave to remain?

A

Person granted full refugee status and given permanent residence in the UK

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72
Q

What are asylum seekers entitled to?

A

£37.75 per week
Housing
Free NHS care
(if child, social services key worker and school)

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73
Q

What are asylum seekers not allowed to do?

A

Not allowed to work

Not entitled to any other form of benefit

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74
Q

What are refugees allowed to do/entitled to?

A

5 years leave of remain in UK
Right to work and claim benefits
Can apply for family union
Can apply for a travel document

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75
Q

How can a refugee get British Citizenship?

A

After 5 years refugee status can apply for Indefinite Leave to Remain (ILR)
After 1 year ILR, can apply for British Citizenship

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76
Q

What happens to failed asylum seekers?

A

Not entitled to money, NHS care, housing
Reliant on charities
Can appeal decision
May be detained in immigrant removal centre

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77
Q

Give some barriers to healthcare for asylum seekers/refugees

A 
Lack of knowledge of access
Language barriers
Discrimination, lack of understanding of culture
Transport to appointments
Frequent dispersal by Home Office
Not homogeneous group
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78
Q

Give some red flags of human trafficking

A

TRAFFICKING
Timid/terrified, Registered with GP/nursery/school (not), Accompanied by controlling person, Foreign language, Frequently moving location, Inconsistent history, Control passport/bank (not), Keep alert, Evidence of injuries left untreated, DNA appointments

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79
Q

What action do you take if imminent threat suspected for trafficked individual?

A

Call police

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80
Q

What action do you take if victim of trafficking appears or claims to be under 18?

A

Follow child safeguarding procedures

Report to NSPCC

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81
Q

What action do you take for trafficking victim if no imminent threat but consents to help?

A

Inform safeguarding

Organise NRM interview with first responder (Salvation Army, Modern Slavery helpline, Police Anti-Slavery unit)

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82
Q

What action do you take if trafficking victim has no imminent threat and does not consent to help?

A

Give information leaflet on modern slavery

Contact number if safe to do so

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83
Q

What is the definition of health?

A

State of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity

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84
Q

Give 2 famous reports in response to health inequalities

A 
Black Report (1980)
Acheson Report (1998)
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85
Q

Give 3 theories of health inequalities

A

Psychosocial - stress means body can’t meet its own demands
Neo-material - hierarchial society means little investment in public goods
Life-course - combination psychosocial and neo-material, with greater affects at critical points in life and accumulation over life

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86
Q

How is social class quantified?

A

Registrar General’s Model (occupation-based)

NS-SEC model

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87
Q

What is incidence?

A

Number of new cases per unit time - expressed as % or per 100 000

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88
Q

What is prevalence?

A

Number of existing cases at a given point in time

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89
Q

What is sociology?

A

Study of social relations and processes

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90
Q

What is the medicalisation hypothesis?

A

Doctors tend to see everything medically when could be due to non-medical or social forces

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91
Q

What is sustainability?

A

Being able to meet the needs of today without compromising the ability of future generations to meet the needs of tomorrow

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92
Q

What is a true positive?

A

Test positive and have disease

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93
Q

What is a false positive?

A

Test positive but don’t have disease

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94
Q

What is a true negative?

A

Test negative and don’t have disease

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95
Q

What is a false negative?

A

Test negative but have the disease

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96
Q

What is sensitivity?

A

The proportion of people who have the disease and test positive

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97
Q

What is specificity?

A

The proportion of people without the disease who are correctly excluded by the test (test negative)

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98
Q

How would you calculate sensitivity?

A

True positives/no. people who were screened and have disease

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99
Q

How would you calculate specificity?

A

True negatives/no. people screened without disease

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100
Q

What is the positive predictive value?

A

The proportion of people with a positive result who have the disease
Number true positives/total number positives

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101
Q

What is the negative predictive value?

A

The proportion of people with a negative result who do not have the disease
Number of true negatives/total number negatives

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102
Q

What is selection bias?

A

The people who choose to participate may be different to those who do not

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103
Q

What is lead time bias?

A

Screening identifies disease earlier, giving impression that it lengthens survival but survival time may be unchanged

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104
Q

What is length-time bias?

A

Diseases with longer period of presentation are more likely to be picked up by screening than shorter, more aggressive diseases. Longer, less aggressive diseases likely to have better survival than shorter ones, giving impression screening improves survival rates.

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105
Q

What is satiation?

A

what brings an eating episode to an end

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106
Q

What is satiety?

A

Inter-meal period

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107
Q

What are the stages of the satiety cascade?

A

Sensory, cognitive, post-ingestive, post-absorptive

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108
Q

What are the 4 main STIs?

A

Chlamydia
Gonorrhoea
Syphilis
Trichomoniasis

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109
Q

What are the different phases of a pandemic?

A

Phase 1-3 = animal infections, a few humans
Phase 4 = sustained human-human transmission
Phase 5-6 = widespread human infection

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110
Q

What is the exact measurement of a unit of alcohol?

A

10ml OR 8g of ethanol

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111
Q

How do you calculate number of units in alcohol?

A

(%alcohol x amount of liquid in ml) / 1000

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112
Q

What are the questions of the CAGE questionnaire?

A

Do you ever feel like Cutting down alcohol?
Do you ever get Annoyed when people tell you to cut down?
Do you ever feel Guilty about how much you drink?
Do you ever use alcohol as an Eye-opener?

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113
Q

What is compliance vs adherence vs concordance?

A

Compliance - patient follows doctor’s orders
Adherence - acknowledges patient’s beliefs
Concordance - doctor and patient are equal

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114
Q

What is the problem with healthy life expectancy trajectories?

A

Healthy life expectancy is not increasing as fast as life expectancy so more people living with morbidities

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115
Q

What is polypharmacy?

A

Use of 4 or more medications by a patient, or administration of more medications than is clinically indicated

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116
Q

What is opportunity cost?

A

The sacrifice in terms of the benefits forgone by not allocating resources to the next best activity

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117
Q

What is cost-effective analysis?

A

Incremental cost per life year gained

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118
Q

What is cost-utility analysis?

A

Incremental cost per quality-adjusted life year gained

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119
Q

What is cost-benefit analysis?

A

Outcomes measured in monetary units - net monetary benefit

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120
Q

What is a top-down deductive ethical argument?

A

Using an ethical theory and consistently applying it to each problem

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121
Q

What is a bottom-up deductive ethical argument?

A

Using past cases to create guides for practice

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122
Q

What criteria allows disclosure of confidentiality?

A

Required by law
Patient consent
Public interest

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123
Q

What are the principles when breaching confidentiality?

A

Anonymous if practicable/possible
Patient consent if possible
Kept to a necessary minimum

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124
Q

What is virtue ethics?

A

Based upon character of person, integrating reason and mind - if intentions and state of mind are right then action can be virtuous

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125
Q

Give 3 types of human error and what they are

A

Error of omission - correct action delayed/not done
Error of comission - incorrect action taken
Error of negligence - action/omissions taken did not meet standards required

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126
Q

What is a skill-based error?

A

When performing a well-learned/routine action but error occurs e.g. distraction, little attention, memory lapse

127
Q

What is a Rule/Knowledge-based error?

A

Incorrect plan or course of action taken due to lack of experience/awareness/knowledge

128
Q

What is distress?

A

Negative stress that is damaging or harmful

129
Q

What is eustress?

A

Positive stress that is beneficial and motivating

130
Q

What does FEADE for evidence-based medicine stand for?

A 
Focused questions
Evidence base
Appraisal
Decision
Evaluation
131
Q

What does PICO for focused questions stand for?

A

Population
Intervention
Comparator
Outcome

132
Q

What is hierarchy 1a and 1b in the hierarchy of evidence?

A 
1a = systematic review or meta-analysis of RCTs
1b = at least one RCT
133
Q

What is hierarchy 2a and 2b in the hierarchy of evidence?

A 
2a = at least one controlled trial without randomisation
2b = at least one other type of quasi-experimental study
134
Q

What is validity?

A

How close to the truth something is

135
Q

What is reliability?

A

How consistent the results are (repeatability/reproducibility)

136
Q

What is applicability?

A

How relevant a study is to clinical medicine

137
Q

What are the different study designs falling under observational studies?

A 
- no intervention, show association but no causation
Case reports
Ecological
Cross-sectional
Case-control
Cohort
138
Q

Give features of ecological studies

A

Descriptive observational study

Uses routinely collected data to observe trends in data to generate hypotheses

139
Q

Give features of cross-sectional studies

A

Descriptive and analytical observational study
Divides population into those with disease/without disease at a defined time to find associations at THAT POINT IN TIME - generates hypotheses

140
Q

Give features of case-control studies

A

Analytical observational study
Divides into those with disease and without disease
RETROSPECTIVE - looks at previous exposures
Only shows association, not cause

141
Q

Give features of cohort studies

A

Analytical observational study
Starts with population without disease and follows up over time = PROSPECTIVE
Identifies association between exposures and disease over time - more able to show causation than retrospective

142
Q

What is a randomised controlled trial?

A

Experimental/Intervention Study
Randomised into groups - one given intervention, one in control and outcomes measured
Randomisation allows confounding factors to be equally distributed to reduce confounding biases

143
Q

What is a quasi-experimental study?

A

Intervention study but without randomisation of groups

144
Q

What is a systematic review?

A

Clearly formulated question that uses symptomatic and explicit methods to identify, select and critically appraise relevant research, to collect and analyse data from the studies included

145
Q

What is a meta-analysis?

A

Statistical methods to analyse and summarise the results of included studies

146
Q

How do you calculate absolute risk?

A

Incidence/population

147
Q

How do you calculate relative risk?

A

Risk in exposed group / risk in non-exposed group

148
Q

What signifies no increased risk for between exposure and non-exposure groups regarding relative risk?

A

Null value for relative risk
RR = 1
Confidence interval includes 1

149
Q

What is absolute risk difference?

A

AR in exposed group - AR in non-exposed group

150
Q

What is the number needed to treat?

A

The number of people you would need to treat in order to cure one person/prevent one bad outcome
NNT = 1/ARR (absolute risk reduction)

151
Q

What is the number needed to harm?

A

The number of individuals exposed to harm needed for one person to develop disease
NNH = 1/ARD (absolute risk difference)

152
Q

How do you calculate odds?

A

Probability / (1 - probability)

AR / (1-AR)

153
Q

How do you calculate odds ratio?

A

Odds of exposed group (P/1-P exposed)
divided by
Odds of non-exposed group (P/1-P non-exposed)

154
Q

What studies cannot use relative risk and should use odds ratio instead?

A

Case-control studies

155
Q

When might OR be used over RR in cross-sectional or cohort studies?

A

If independent or dependent variable are not clear

156
Q

What might mean that association between variables is not causality?

A
  1. Confounding factors
  2. Reverse Causality
  3. Bias
  4. Chance
157
Q

What screening questionnaires are there for alcohol misuse?

A
  1. CAGE
  2. AUDIT (Alcohol Use Disorders Identification Test)
  3. FAST
158
Q

What is the max AUDIT score and what score is the cut off for hazardous or harmful drinking?

A

Total score = 40
Cut off = 8 or more
Score of 3 or more should involve more detailed assessment of drinking

159
Q

What is FAST and what is the total max score and cut off scores?

A

Subset of AUDIT for emergency settings
Total max score = 16
Score of 3 or more is FAST positive for harmful drinking
If FAST positive, complete the full AUDIT questionnaire

160
Q

Describe briefly how Disulfiram helps reduce alcohol intake

A

Makes patient feel nauseous upon drinking alcohol

161
Q

How many units constitutes binge drinking in men and in women?

A

8 units or more in single session = men

6 units or more in single session = women

162
Q

If a patient presents to GP with a blood pressure of 140/90 or more, what should you do?

A

Repeat, if different, repeat again. Record lower of last 2 measures as blood pressure
If between 140/90-180/120 - ABPM or HBPM if not tolerated

163
Q

How do you calculate blood pressure from ABPM?

A

Should be 2 readings per hour during waking hours

Take average of at least 14 measurements during patient’s waking hours

164
Q

When would you do same-day specialist referral for hypertension?

A

If BP over 180/120
AND
Retinal haemorrhages or papilloedema
New onset confusion, chest pain, heart failure signs, AKI

165
Q

How would you manage a patient with 180/120 BP or more with no signs requiring same day referral?

A

Do investigations for target organ damage
Consider starting anti-hypertensives immediately
If no target organ damage, repeat BP within 7 days

166
Q

What are the limits for Stage 1 hypertension?

A

140/90-159/99 in clinic
AND
ABPM or HBPM 135/85-149/94

167
Q

What are the limits for Stage 2 hypertension?

A

160/100 - 180/120 in clinic
AND
ABPM or HBPM > 150/95

168
Q

What counts as Stage 3 or severe hypertension?

A

> 180 systolic or >120 diastolic

169
Q

What investigations do you do to check for target organ damage for hypertension?

A 
Urinalysis - haematuria, Albumin:creatinine ratio
U+E
HbA1c
Fundoscopy
ECG
170
Q

How would you assess cardiovascular risk for someone with hypertension?

A

Lipid profile

QRISK score

171
Q

What lifestyle advice would you give for someone with hypertension?

A 
Smoking cessation
Alcohol limitation
Reduce caffeine
Healthier diet and more exercise
Limit dietary sodium
172
Q

How would you manage someone presenting with hypertension under 40 years old?

A

Refer for specialist assessment to assess possible secondary causes of hypertension

173
Q

What investigations might you do to diagnose heart failure?

A

ECG (LVH), cardiac examination, blood tests (BNP and NBP)
If BNP<100ng/L or NBP<300ng/L EXCLUDE HF
If raised BNP, do transthoracic Doppler Echo to detect cardiac abnormalities

174
Q

Why is BNP released in heart failure?

A

Released by ventricles when cardiomyocytes are overworked - increases sodium excretion to increase water loss

175
Q

What treatment might you give in acute heart failure?

A

Reversible or need transplantation?
LMWH
IV diuretic therapy, monitor renal function + heart rate, + U+Es, blood pressure
Ventilation + oxygen
Consider ultrafiltration, beta blocker, ACE-I, ARB, aldosterone antagonist
Follow up 2 wks later, consider valvular surgery

176
Q

What investigations might you do to rule out other differentials or secondary causes of chronic heart failure?

A 
ECG
CXR
FBC, LFTs, U+Es, TFTs, lipid, HbA1c
Peakflow/spirometry
Urinalysis
Measure NT-proBNP. If >2000, need specialist assessment and echo within 2 wks
If 400-2000, need echo in 6 weeks
177
Q

How would you manage a patient with chronic heart failure and reduced ejection fraction?

A

Medication review
Loop diuretic - furosemide, bumetanide
ACE-I and Beta Blocker (start separately). Add MRA if not managed, hydrazaline nitrate + digoxin. Titrate up slowly and monitor BP and renal function
Consider anti-platelets, statins, lifestyle advice, mental health support, Exercise-based group rehabilitation, cardiac rehabilitation
Offer annual influenza vaccine + GTN spray
Surgery - cardioverter debrillator, cardiac resyncrhonisation therapy, bypass operation, transplant
Palliative care

178
Q

How would you monitor a patient with chronic heart failure?

A

Medication reviews
U+Es - especially K+ (digoxin and MRA use)
Fluid status, cardiac rhythm, nutrition, cognition, functional capacity
Recent medication - days-weeks
Stable - every 6 months

179
Q

Which calcium channel blockers are you not allowed to use in heart failure?

A

Non-dihydropyridines - can cause heart block

Can use dihydropyridines e.g. amlodipine

180
Q

What ethnicities might change your hypertension medication? Why?

A

African/Carribbean - have low renin-angiotensin-aldosterone system so ACE-I, ARB and MRAs don’t work as effectively as CCBs

181
Q

Which organ causes the most conflict in management of heart failure and why?

A

Kidneys!
Can be a cause of heart failure, but also damaged by heart failure
Diabetic nephropathy may make more susceptible to damage, but Metformin and poor renal function can lead to lactic acidosis
Diuretics can damage kidneys

182
Q

When might beta blockers be avoided?

A

Asthma! - use cardioselective if have to
Bradycardia
Not tolerated - tired, slow

183
Q

What is the NoTears Tool?

A 
To aid medication reviews
Need/indication
Open questions
Tests
Evidence
Adverse effects
Risk Reduction
Simplification/switches
184
Q

Give another tool used to support medication reviews

A

STOPP-START tool

185
Q

What is the prognosis of heart failure?

A

50% die suddenly

usually 5-10yrs from diagnosis

186
Q

What is the primary prevention for heart failure?

A

Reduce salt, caffeine, alcohol, smoking, cholesterol
5 a day and plenty of fibre
Start statin if QRISK2 score higher than 10%
Low sugar diet
Exercise and weight loss - Orlistat (lipase inhibitor)

187
Q

What is the secondary prevention for heart failure?

A

Excercise - at least 150 mins moderate intensity/wk
Weight loss
Low salt, fat, alcohol, caffeine, sugar
Smoking cessation
5 a day, 2 portions fish/wk, wholegrains
Cardiac rehabilitation programme
ACE-I, BB, statin, aspirin and anti-platelet (dual therapy up to 12 months if post-MI)

188
Q

What is the tertiary prevention of heart failure?

A

Cardiac rehabilitation programme
Diabetes control - hyoglycaemic control
CABG, PCI

189
Q

What are the CXR signs of heart failure?

A 
Cardiomegaly
Kerly B lines
Upper lung venous congestion
Interstitial oedema
Alveolar oedema (bat wings)
Dilated vessels
Pleural effusions
190
Q

How is HBPM done?

A

Measured twice a day. Each measurement consists of 2 measurements at least 1 min apart, seated.
Continues for 4-7 days

191
Q

What is the most common STI in the UK?

What is its incubation period?

A

Chlamydia

7-21 days

192
Q

How does chlamydia present?

A

Many are asymptomatic (50-70%)
Women - cervitis (PCB, IMB, dyspareunia), dysuria
Men - urethritis - discharge, dysuria

193
Q

What are some potential complications of chlamydia?

A

PID, increased ectopic pregnancy risk, infertility, endometritis, reactive arthritis, epididymitis

194
Q

What investigations would you do to test for chlamydia in men and women?

A

Women - NAAT vulvovaginal/cervix swab

Men - first void urine sample

195
Q

How is chlamydia treated?

A

Doxycycline 7 days

2nd line - Azithromycin 3 days

196
Q

What is the commonest bacterial cause of Bacterial Vaginosis? How does this affect vaginal pH?

A

Gardnerella vaginalis
Overgrowth or aerobic lactobacilli - reduced lactic acid production
Vaginal pH >4.5

197
Q

What are the common presenting features of bacterial vaginosis?

A

Fishy smelly discharge
Potential white-grey or green discharge
Thin discharge
No soreness or irritation usually

198
Q

What investigations would give you a diagnosis of bacterial vaginosis?

A

Clue cells on microscopy
Positive whiff test (add KOH, smell fishy)
Raised vaginal pH

199
Q

What treatment do you give for bacterial vaginosis?

A

Metronidazole either stat OR 5-7 days TDS

200
Q

What type of organism causes trichomoniasis?

A

Parasite - Trichomonas Vaginalis

Not STI and raises pH

201
Q

What are the common presenting features of trichomoniasis?

A

Yellow-green frothy discharge
Vulvovaginitis - itching and irritation
Strawberry cervix on examination
Men often asymptomatic or urethritis

202
Q

What investigation would show trichomonas vaginalis?

A

Microscopy - shows mobile trophozoites

203
Q

What treatment do you give for Trichomoniasis?

A

Metronidazole 5-7 days or stat

204
Q

What is another name for thrush?

A

Vaginal candidiasis

205
Q

What are the common presenting features of vaginal candidiasis?

A 
Vulvovaginal itchiness, irritation - dyspareunia, dysuria
Cottage cheese white discharge, non-smelly
Vulval erythema (sometimes)
206
Q

What investigation would you do if unclear whether clinical picture confirms thrush?

A

High vaginal swab

207
Q

How would you treat vaginal candidiasis?

A

Local clotrimazole pessary OR

Oral fluconazole

208
Q

What is the causative organism in gonorrhoea?

A

Gram negative diplococcus - Neisseria gonorrhoea or gonococcus

209
Q

What are the common presenting features of gonorrhoea?

A

Men - urethral discharge, dysuria
Women - Cervicitis - discharge (yellow), dyspareunia
Rectal and pharyngeal infections may occur but can be asymptomatic
Disseminated gonococcal infection - tenosynovitis, polyarthritis, dermatitis (trunk, palms, soles, extremities)

210
Q

What are some potential complications of gonorrhoea?

A

Septic arthritis
Endocarditis
Perihepatitis (Fitz-Hugh-Curtis syndrome)

211
Q

How do you treat gonorrhoea?

A

IM Ceftriaxone

If refuse needles - oral cefixime and azithromycin

212
Q

What are the causative organisms of painful genital sores/ulcers?

A

HSV-1 or HSV-2

Primary infection asymptomatic, but can recur causing painful sores and ulcers

213
Q

How would you treat genital herpes?

A

Oral acyclovir

if cold sores too, topical acyclovir

214
Q

What organism causes syphilis?

A

Treponema Pallidum

215
Q

What are the presenting features of primary syphilis infection?

A

Painless ulcer/chancre at point of sexual contact

Heals after 4-6 weeks, non-tender local lymphadenopathy

216
Q

How does secondadry syphilis present?

A

6-10weeks after primary infection
Rash - trunk, palms, soles
Painless genital warts
OR asymptomatic if in latent phase (still asymptomatic after 2 yrs - not infectious)

217
Q

How does tertiary syphilis present?

A

Granulomas on skin and bones
Aortic aneurysm
Neurosyphilis (dementia, psychosis, strokes)

218
Q

How would you treat syphilis?

A

Penicillin

219
Q

What are the different causes of painless genital warts?

A

Syphilis - primary or secondary

HPV 6-11 - STI

220
Q

What are the presenting features of HPV 6-11 infection?

A

Painless, fleshy genital warts - may be itchy

221
Q

How would you treat HPV infection?

A

Topical podophyllum or cryotherapy 1st line
2nd line - imiquimod cream
May clear without intervention

222
Q

Give some common presenting features of acute primary HIV infection

A 
2 weeks to 10 months post-exposure
Lethargy, depression
Fever
Rash
Weight loss
223
Q

How long is the clinical latency period of HIV and what features might be present?

A

7-10 years

Asymptomatic, may have enlarged lymph nodes

224
Q

What are the features of early symptomatic HIV? (CD4>200)

A 
Oral/vaginal candida
Shigella >2 episodes/dermatomes
Cervical dysplasia
Peripheral neuropathy
Unexplained fever
Diarrhoea >1 month
225
Q

What might be some features of AIDS (CD4<200)?

A

Candidiasis
TB
Recurrent bacterial pneumonia
Invasive cervical carcinoma, Kaposi sarcoma
Primary CNS lymphoma, non-Hodgkin’s lymphoma
Other opportunistic infections

226
Q

What investigations might you do for HIV?

A

Offer to all suspicious clinical pictures
Offer to ALL pregnant women
Venous blood sample - positive at 4-10wks, repeat 2 weeks later if negative

227
Q

What preventive measures may be taken for HIV?

A

Primary - condoms, reduce partners, needle exchange programmes, sex education, pre-exposure prophylaxis
Secondary - post-exposure prophylaxis, vaginal Tenofivir, screen blood products
Tertiary - Caesarean section, circumcision, bottle feeding

228
Q

What treatment is given to those who test HIV positive?

A

Highly Active Anti-Retroviral Therapy (HAART)

229
Q

What treatment would you give when a mother is HIV positive?

A

Maternal viral load <50 - oral zidovudine to infant
Maternal viral load >50 - triple ART to infant
Breastfeeding - oral nevirapine to infant, encourage bottle feed

230
Q

How does the cap/diaphragm work?

A

Silicone cap placed in vagina prior to sex with spermicide - prevents sperm entering uterus
Keep in for 6 hrs after sex
Needs fitting

231
Q

How does the combined pill work as a contraceptive?

A

Combined synthetic oestrogen and progesterone - prevents ovulation, thins lining of uterus and thickens cervical mucus. Monophasic keeps hormones at constant level throughout cycle = 1st line

232
Q

How should the COCP be taken?

A

Same time every day. Start on day 1 of cycle
Some pills for 21 days, with 7 day break
But some can be taken back-to-back until breakthrough bleed. Then should stop for 4 days

233
Q

What should be done if 1 or 2 COCP doses are missed?

A

Take the last pill you missed, even if it means taking 2 in one day
Carry on the rest of pack as normal
If missed 2 or more doses, risk of pregnancy

234
Q

How should condoms be used?

A

Use or place condoms before penis comes into contact with vagina
Use water-based lubricants
Use during oral sex as well as penetrative sex

235
Q

How does the implant work?

A

Plastic tube inserted under skill of upper arm
Release progestogen - stops ovulation, thickens cervical mucus and thins lining of womb
Replace every 3 years
Fit in first 5 days of cycle. If not, use condoms for first 7 days
Can stop periods or make the irregular, lighter, heavier

236
Q

What are the risks associated with the COCP?

A

SE: breast tenderness, mood swings, nausea, abdo pain, headaches, menstrual irregularities
Risks: breast cancer, cervical cancer, VTE risk, HTN, CVD, liver disease, hemangioma

237
Q

What conditions is the COCP protective against?

A

Menorrhagia - periods usually regular, lighter, less painful
Reduces risk ovarian and endometrial cancers
Reduced risk colorectal cancer
Reduced risk ovarian cysts
Reduced acne in some women
Possible reduction benign breast disease and osteoporosis

238
Q

What are the 2 most common contraceptive injections and how are they used?

A

Depo-Provera - 12 week intervals - IM

Sayana - 13 week intervals - SC (self-administered)

239
Q

What are the risks with the contraceptive injections?

A

Highest dose of hormones out of hormonal contraceptives
Can cause weight gain and thin bones (reduces oestrogen as is progestogen only)
Takes around 1 yr to regain fertility

240
Q

How is the contraceptive patch used?

A

Sticky transdermal patch (Evra) on thigh or stomach
Change every week for 3 weeks, then one week off
Contains oestrogen and progesterone

241
Q

How are female condoms used?

A

Inserted into female vagina before intercourse
No lubricant needed
Can be uncomfortable and noisy

242
Q

How is female sterilisation done?

A

GA operation - clamp or block fallopian tubes with implants

If unsuccessful, remove fallopian tubes with salpingectomy

243
Q

How does the IUD work?

A

T-shaped copper and plastic device inserted into uterus
Can stay 5-10 yrs
Copper alters fluids in womb so sperm can’t survive
Stops fertilised eggs from implanting
Patient should check in place after 1st month and after every period - if threads present

244
Q

What are the risks with the IUD?

A

Perforation
Pelvic infection (should do pelvic exam before inserting to check for local infection/STI) in first 20 days
May be unethical for some as prevents implantation of embryo - abortion?

245
Q

How does the IUS work?

A

T-shaped plastic device inserted into uterus

Releases progestogen

246
Q

What are the risks of the IUS?

A

Risk of perforation
Pelvic infection (should do pelvic exam before inserting to check for local infection/STI) in first 20 days
Rejection
Ectopic pregnancy

247
Q

How should the progesterone-only pill be taken?

A

Every day with no break

AT SAME TIME EVERYDAY - some 3 hr window, some 12 hr window (don’t ovulate with 12hr pills)

248
Q

What are the risks with the mini pill?

A

Increased risk of breast cancer and ovarian cyst formation

249
Q

How does the vaginal ring work?

A

Small plastic ring placed inside vagina
Releases oestrogen and progestegen
Leave in for 21 days, then remove and take 7d off

250
Q

How is male sterilisation done?

A

Vasectomy - vas deferens cut or blocked in LA operation
Use contraception for at least 8wks after operation
Not-reversible on NHS, but can be done privately

251
Q

What are some risks associated with teenage pregnancy?

A

More likely to leave education

Increased risk still birth, low birth weight, poor breastfeeding, poor maternal mental health

252
Q

What is Gillick competency?

A

Allows children under the age of 16 to consent to healthcare interventions if they are deemed to have capacity. Based upon maturity, understanding and assessment of situation.

253
Q

What is the purpose of the Fraser Guidelines?

A

Allows children under 16 to consent to sexual health interventions if certain criteria are met

254
Q

What are the criteria under the Fraser Guidelines?

A
  1. Patient can understand advice + what’s involved
  2. Patient cannot be persuaded to inform parents or agree for doctor to inform parents
  3. Patient will continue to have sexual intercourse with or without contraception
  4. Patient’s mental or physical health may suffer if not given contraceptive advice/treatment
  5. Patient’s best interests involve giving contraceptive advice/treatment without parental consent
255
Q

What are the guidelines on age of sexual consent in England and Wales?

A
  1. Illegal to have sex with anyone under age 16
  2. Will not prosecute teenagers under 16 where both mutually agree and are of similar age
  3. Illegal for someone over 18 to have sex with someone under age of 18 if person is in a position of trust
  4. People under 12 cannot legally give consent to any sexual activity
256
Q

Give some cognitive assessment that might be done to screen for dementia in primary care. Can these rule out dementia?

A 
AMTS
6-CIT
GPCOG or Mini-Cog
MOCA
Can't rule out dementia if normal!
257
Q

What questionnaires can you do to screen for dementia with carers/informants?

A

Informant Questionnaire on Cognitive Decline in the Elderly (IQCDE)
Functional Activities Questionnaire (FAQ)

258
Q

What investigations might you do as a confusion screen?

A 
FBC -  Hb, WCC
LFTs
B12, thymine
TFTs
HbA1c
U+Es
Calcium
Urinalysis - (but often have asymptomatic bacturia)
CT head - CJD, bleeds, tumours
259
Q

Where would you refer if suspect dementia and organic causes of confusion been excluded in a patient?

A

Memory Clinic or Community Old Age Psychiatry
If rapid decline in cognition - Neurology (CJD)
If suspect AD, test verbal episodic memory

260
Q

What medications should you avoid or take caution with in LBD?

A

Anti-cholinergics - dampen effects of Achesterase inhibitors (rivastigmine) - worsen cognition
Dopamine agonists - increase hallucinations (but may improve PD symptoms)

261
Q

What might you see on hisopathology of Alzheimer’s Disease?

A

Neurofibrillary tangles
Senile plaques
Neuronal loss

262
Q

What is PRIME-MD?

A

Aka PHQ-2 (screening tool for depression)

  1. Little interest or pleasure in doing things?
  2. Feeling down, depressed or hopeless in last month)
263
Q

What is the screening tool for dependent alcohol users?

A

Severity of Alcohol Dependence Questionnaire

264
Q

What is the cut off score on the SADQ for chlordiazepoxide detoxification regime?

A

16 or over

265
Q

What are the classes of score for the SADQ?

A

<16 = mild physical dependency
16-30 = moderate dependency
31 or over = severe dependency

266
Q

In depression when would you refer to specialist services?

A

If urgent risk to self or others

If combined antidepressants and CBT are not working (tried 2 SSRIs, SNRI…)

267
Q

What are the risk factors for TB?

A

Close contact with TB, travel to TB-endemic country, homesless people, IVDUs, HIV positive, crowded living conditions, poor sanitation, diabetes, immunosuppressants, severe kidney disease, low body weight, silicosis, head and neck cancer

268
Q

Describe the course of TB transmission and infection

A

Mycobacterium tuberculosis, respiratory droplet spread
Initial infection clears quickly
Bacteria can become dormant - latent phase
Or progress to active TB instead or after latent phase over following weeks or months

269
Q

What is the standard treatment for people with active TB?

A

2 months: Rifampicin, Ethambutol Hydrochloride, Pyrazinamide, Isoniazid
then 4 months: Rifampicin and Isoniazid if no CNS
If CNS - do 10 months continuation instead of 4

270
Q

What is the main health concern with the medications given for active TB treatment?

A

ALL hepatotoxic - check liver function

271
Q

How should contacts of someone with TB be managed?

A

Quantiferon testing (or Mantoux in children)
If under 65, consider BCG vaccination
Treat for latent TB?

272
Q

How would you treat latent TB?

A

3 months isoniazid and rifampicin (preferred liver problems)

OR 6 months isoniazid

273
Q

How would you diagnose active lung TB?

A

Chest XR

3 sputum samples 8-24hrs apart, at least one early morning sample

274
Q

Give the common presentation of gout

A

Acute, red, hot swollen joint (often at metatarsophalangeal joint of big toe)

275
Q

What is the pathophysiology of gout?

A

Deposition of monosodium urate crystals in and near joints, associated with raised plasma urate

276
Q

What are some triggers of gout?

A 
Trauma
Surgery
Starvation
Infection
Diuretics
277
Q

What are some potential long-term consequences of gout?

A

Tophi

Renal disease - stones, interstitial nephritis

278
Q

What are some differentials for gout?

A 
SEPTIC ARTHRITIS - exclude!
Reactive arthritis
Haemarthrosis
Calcium pyrophosphate desposition
Palindromic RA
279
Q

What are some risk factors for gout?

A

Elderly, impaired renal function, HTN, metabolic syndrome, diuretics, anti-hypertensives, aspirin
Dietary (alcohol, sweeteners, red meat, seafood)
Genetic disorders
Tumour-lysis syndrome
Cytotoxics
Warfarin

280
Q

What should you screen for in someone with gout?

A

Chronic kidney disease
HTN
Dyslipidaemia
Diabetes

281
Q

What investigations would you do for gout?

A

Polarised light microscopy of synovial fluid
- Negatively birefringent needle crystals
Possible raised serum urate

282
Q

What is the treatment of acute gout?

A

High dose NSAID (Diclofenac)
OR
Colchicine
Steroids may also be used, rest and elevate joint, ice packs and bed cages can be effective

283
Q

What prophylactic treatment might you give for gout?

A

If >1 attack in a year, tophi/renal stones - ALLOPURINOL (may trigger attack so cover with NSAID up to 6wks or colchicine up to 6 mnths)
Febuxostat if allopurinol contraindicated

284
Q

What crystals form pseudogout? How do thsee appear on polarised light microscopy?

A

Calcium pyrophosphate

Positively birefringent rhomboid crystals, also soft tissue calcium deposits on XR

285
Q

How would you treat pseudogout?

A

Acute: aspiration, intra-articular steroids
NSAIDs (+PPI), colchicine may prevent acute attacks
Chronic: Methotrexate and hydroxychloroquine may be considered

286
Q

In LFTs, what enzymes are:

a) hepatocellular?
b) biliary?
c) pancreatic?

A

a) AST + ALT
b) ALP + GGT
c) amylase + lipase

287
Q

What does raised AST but normal ALT indicate and why?

A 
Problem elsewhere (not liver) - think MUSCLE, check CK
AST produced by bone, muscle, heart, brain, RBC, not just liver, whereas ALT is specific to liver
288
Q

What does a raised ALP but normal GGT suggest?

A

Not biliary problem, think elsewhere e.g. BONE

ALP produced bone, kidney, GIT, placenta, but GGT is specific to biliary + ALCOHOL use

289
Q

What does a raised amylase but normal lipase suggest?

A

Not pancreatic cause, as amylase produced in saliva too, whereas lipase only produced in pancreas

290
Q

What are the classic AST and ALT proportions in:

a) liver disease?
b) alcoholic fatty liver disease?

A

a) ALT>AST

b) AST>ALT

291
Q

What should you monitor when starting ACE-I?

A

Renal function and electrolytes
Be aware of rises in K (if over 5.5, need ECG, but acceptable up to 5.5 with ACE-I)
Creatinine - allowed up to 30% increase from baseline after starting ACE-I
If either of these is too much, switch to amlodipine

292
Q

What ECG changes might you see in hyperkalaemia?

A

Tall tented T waves
Prolonged PR
Wide QRS complexes
Small or absent p waves

293
Q

What vaccines are within the 6-in-1 vaccine?

A 
Diphtheria
Tetanus
Polio
Whooping cough
Hib
Hep B
294
Q

What routine vaccines are given to children at 2 months?

A

6-in-1 vaccine
Rotavirus
MenB

295
Q

What routine vaccines are given at 3 months?

A

6-in-1 (2nd)
Rotavirus (2nd)
Pneumococcal

296
Q

What routine vaccines are given at 4 months?

A

6-in-1

Booster MenB

297
Q

What routine vaccinations are given at 12-13 months?

A

MMR
combined MenC and Hib
Pneumococcal
MenB

298
Q

What routine vaccinations are given at 3-4 years?

A

4-in-1: Tetanus, Diphtheria, Polio, Whooping cough

MMR (2nd)

299
Q

What routine vaccines are given at 13-14 yrs?

A

Booster Diphtheria, tetanus and polio (3 in 1)
Men ACWY
HPV girls (now boys too?)

300
Q

Which children can get annual flu vaccinations?

A

2-3yrs
All primary school and year 7 children
2-17yrs with long-term health conditions

301
Q

How should you report a notifiable disease?

A

Report to “proper officer” at local council or local Health Protection Team
Urgent - Ring within 24 hrs, then written notification form within 3 days
Routine - written notification form within 3 days
Do immediately after diagnosis, do not await confirmation

302
Q

How would you manage a child with RED life-threatening features?

A

Call 999, ambulance

303
Q

How would you manage a child with RED non-life-threatening symptoms?

A

Arrange urgent face-to-face assessment (if on telephone). Consider hospital admission immediately

304
Q

How would you manage a child with AMBER symptoms?

A

Arrange face-to-face assessment
Admit to hospital if: suspected UTI, no obvious site of infection, longer than expected for self-limiting, parental anxiety/not coping
Manage at home otherwise
- SAFETY NETTING
- follow-up appointment
- liaise with other healthcare providers inicluding out-of-hours so child has direct access if needed later

305
Q

How would you manage a child with GREEN symptoms?

A

Urinalysis if no other site found for fever
Child can be managed at home with anti-pyretics and fluids - only prescribe Abx if bacterial infection
Safety netting and provide Fevers in Children leaflet
Explain that anti-pyretics do not stop recurrent febrile seizures

306
Q

How would you advise parents to use anti-pyretics and fluids?

A
  • Don’t use paracetamol and ibuprofen simultaneously
  • Can use one or alternate between them if one is ineffective
  • Don’t give ibuprofen if child hypovolaemic - risk of renal impairment
    Keep child hydrated where possible - encourage fluids
307
Q

What tool might you use if a child presents with GREEN symptoms and a sore throat?

A

FeverPAIN score
Scores 1-5
Lower score means less likely to be streptococcal
Higher score may mean streptococcal and give antibiotics e.g. amoxicillin

308
Q

What does the FeverPAIN score stand for?

A 
Fever (during previous 24hrs)
Purulence
Attend rapidly (within 3 days onset)
Inflamed (severe) tonsils
No cough or coryza
309
Q

What are the symptom categories of the NICE traffic light guidelines?

A 
Colour
Activity
Respiratory
Circulation and Hydration
Other
310
Q

What are colour symptoms for green, amber and red in traffic light guidelines?

A

Green - normal colour
Amber - pallor reported by parent/career
Red - Pale/mottled/ashen/blue

311
Q

What are the activity symptoms for green, amber and red in traffic light guidelines?

A

Green - responds normally to cues, content/smiling, stays awake, strong normal cry or not crying
Amber - not responding normally to social cues, not smiling, wakes only with prolonged stimulation, decreased activity
Red - no response to cues, appears ill, does not wake or does not stay awake if roused, weak high-pitched continuous cry

312
Q

What are the respiratory symptoms for green, amber, red in traffic light guidelines?

A

Green - no respiratory symptoms
Amber - nasal flaring, RR>50 6-12mnths, >40 over 12 mnths, O2 sats <95%, crackles
Red - Grunting, RR>60, moderate/severe chest recession/indrawing

313
Q

What are the circulation/hydration symptoms for green, amber and red in traffic light guideliens?

A

Green - normal eyes, skin, moist mucous membranes
Amber - HR>160 under 1yr, >150 <2yrs, >140 2-5yrs, CRT 3s or more, dry mucous membranes, poor feeding, reduced urine output
Red - reduced skin turgor

314
Q

What are the “other” symptoms for green, amber and red in traffic light guidelines?

A

Green - none of the amber/red symptoms
Amber - age 3-6mnths fever>39, fever>5days, rigors, swelling limb/joint, non-weight bearing limb, not using extremity
Red - age<3mnths temp>38, non-blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurological signs, focal seizures

Phase 3a (8 decks)

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