Ethics by Dr Cinita Flashcards
Bioethical principles CLINICAL FEATURES
- Patient autonomy, beneficence, justice (give patients their due), nonmalifecence
Physician assisted suicide CLINICAL FEATURES
Illegal in Oz
Nonsexual violations CLINICAL FEATURES
Excessive self-disclosure, special fee arrangements, extending time beyond what was agreed, allow telephone calls between sessions, extra business relationships, socialize with patients, calling each other by first name, treating the pt as a friend
Sexual misconduct CLINICAL FEATURES
Mentioning pastients or doctors sexual practices or orientation if no relevant, ridiculling patient’s sexual preferences, commenting in sex hx if no clinical issue, requesting details of sex preferences, conversations about sexual problems or fantasies
Vaccines in Oz CLINICAL FEATURES
Not compulsory but you can contact court if it’s for kids best interest and parents don’t want them
Communication with indigenous people CLINICAL FEATURES
Ask family member to accompany them to visit, or aboriginal healthcare worker, do not touch pt, esp if opposite sex
Surrogacy CLINICAL FEATURES
You cant tx couple for which the pt will be the surrogate, compensation only for medical expenses, provide the best care regardless of pts keeping the child or not, refer to mental health counseling to the mum to prefer her
Preventive Medicine CLINICAL FEATURES
-1ry: Prevent. Immunisation, quit smoking, promote sun protection in 6-13yo, anti alcohol and smoking 14-19yo
-2ry: Detect early. Screening
-3ry: Reduce Disability. Tx
CV Risk assessment CLINICAL FEATURES
E/2 years from ≥45 (35 in aboriginals). Assess risk for next 5 years
CV Risk assessment TREATMENT
- Low risk (<10%): LSM + lipids e/5y - Mod risk (10-15%): LSM for 6m and if not change tx + lipids e/12m - High risk (>15%): LSM+Tx + Lipids e/12m
AUDRISK CLINICAL FEATURES
E/3 years from ≥40 (18 in aboriginals). Assess risk for next 5 years
Hyperlipidaemia CLINICAL FEATURES
E/5 years from ≥45.
Hyperlipidaemia FIRST INVESTIGATION
Targets in pts w/ CAD
- Cholesterol <5.5
- LDL <4
- TG <2
- HDL >1
Hyperlipidaemia TREATMENT
Statins decrease cholesterol mainly
Fibrates decrease TG mainly
- HyperTG
1. Diet w/ poli-unsaturated fats
2. Fibrates & Omega 3 (fish oil)
Gastric banding:
- BMI>40 or BMI>35 with co- morbidities (DM, OSA, HTN)
Obesity:
1. LSM for 6m
2. Refer to dietician
3. Medication
Case Control Studies
Only retrospective. Case
(Disease) vs Control (Without Disease) and looking for prior exposure or RF.
- Best for outbreaks, rare diseases
Cohort Studies
Retrospective and prospective. To diff from case control, you have to ask what is the study comparing. If it’s people with dx vs non disease it’s case control, if it’s exposed vs non exposed then it’s cohort
- Best for incidence, identification of RFs, causality
P value
<0.05 is statistically significant
Standard Deviation
Sigma is the value +/- of the SD. 1SD 68%, 2SD 95%, 3SD 99%
Confidence Interval
If the CI crosses 1: Non significant
If the CI doesn’t cross 1: Significant
Power
If you increase sample size, you increase power
Reliability
PR: Precision=Reliability. Reproducibility, falling in same spot
Validity
Validity is accuracy. Falling close to the middle
Sensitivity
PID: Positive in disease.
Specificity
NIH: Negative in Health
PPV
Proportion of positive test that are true positive
NPV
Proportion of negative test that are true negative
Laurence Moon Biedl CLINICAL FEATURES
Obesity, short stature, hexadactily, intellectual disability, hypogonadism
Noonan Syndrome (Male’s Turner) CLINICAL FEATURES
AD, down slanting palpebral fissure, widespread eyes, low set ears, ptosis, short stature, Pulm stenosis, webbed neck, FTT, cardiac conduction and rhythm abn
Marfan Syndrome CLINICAL FEATURES
Tall, long extremities, pectus carinatum or excavatum, hypermobile joints, subluxation of lenses, aortic root aneurysms, aortic dissection
Fragile X syndrome CLINICAL FEATURES
X-extra large testes, jaw, ears. Pale blue irises, strabismus, hypotonia, flexible flat feet
Duchenne Muscular Dystrophy CLINICAL FEATURES
Weakness in pelvic muscles and progresses superiorly. Pt can’t walk so uses hands to stand up (Gowen’s sign), which causes hypertrophy of calf muscles (Replacement of fiber for fat). Dilated cardiomyopathy is MCC death so you do an echo.
Duchenne Muscular Dystrophy FIRST INVESTIGATION
Increase CK and aldolase
Duchenne Muscular Dystrophy BEST INVESTIGATION
Genetic testing showing deletion of dystrophin
Klinefelter CLINICAL FEATURES
XXY so extra X makes them look like women: Gynaecomastia, female pubic hair, tall and long extremities with testicular atrophy
Klinefelter FIRST INVESTIGATION
Dysgenesia of seminiferous tubules causes low inhibin B and high FSH
Abnormal leydig cells causes low testosterone, and high
LH and estrogen
Klinefelter BEST INVESTIGATION
Comp: All effects of hyperestrogenism
Huntington’s Dx CLINICAL FEATURES
AD, person needs to be 18yo to know their gene status.
Dementia, chorea, atethosis, agression.
VATER Syndrome CLINICAL FEATURES
Vertebral anomalies, Anal atresia, Absent radius,
Tracheoesophageal fistula, Renal dysfunction
