Final Exam Flashcards
List 5 factors that may influence an individuals ability to recognize symptoms
- Individual Differences/personality (ex. neurotic)
- Cultural differences (ex. non-expressive)
- Situational factors (ex. medical student disease)
- Stress
- Mood
List 4 factors that many influence an individuals interpretation of their symptoms
- Prior experience (history or prevalence)
- Socio-economic factors
- Expectations
- Seriousness of symptoms
What are the 5 components of an illness representation/schema?
- Identity/label
- Duration
- Consequences
- Causes
- Cure
- The more components you know the better
Contrast acute, chronic, and cyclic illness
Acute is sudden and of short duration
Chronic is long duration
Cyclic has alternating periods of activity
The most common age group to visit a doctor is in your 30’s. True or False
False.
Infants/children use it a lot and adults typically use it the least and then as they become elderly they begin to use it again
Women are more likely to visit a doctor then men. True or False
True.
Better self-reporting skills and also during pregnancy
Minorities are more likely to visit a doctor. True or False
True. But they are less likely to see specialists
Contrast worried well individuals and somaticizers
Worried well individuals have heightened self-care so they exaggerate their symptoms when they occurs
Somatiziers express physical symptoms after emotional insults
When considering illness, what do secondary gains refer to?
Downstream benefits that arise from having an illness:
- Time off/rest
- Removal from responsibility
- Medical vs. psychological symptoms
What time periods is delay behaviour composed of?
Delay behaviour is when a patient lives with one or more potentially serious symptoms without proper care
- Appraisal delay - unsure if symptoms are serious
- Illness delay - symptoms begin to imply an illness
- Behaviour delay - The time b/w illness recognition and treatment
- Medical delay - Time b/w appointment and treatment
What factors increase the probability of delay behaviour?
Age - middle age people delay
Lack of Access - lack of regular physician
Views - Dislike for medical care
History - Are symptoms frequent? Have you had it before?
What factors decrease the probability of delay behaviour?
- Symptoms are highly visible
- There is a high degree of pain
- You have noticed a large degree of change
- Symptoms are incapacitating
What is the difference between treatment delay and provider delay?
Treatment delay occurs after a primary visit. It may occur due to curiosity being satisfied after visit or fear/alarm of diagnosis
Provider delay occurs when treatment is halted due to abnormal patient population or lack of assistance from doctor
What does the term patient consumerism refer to?
People want to be more involved in their treatment and active in the decision making
People care about the delivery of their care and often patients spend a lot of time researching their symptoms
What is CAM and why do patients use it? Who is the most common demographic to use CAM?
Complementary and alternative medicine (CAM) includes: massage therapy, chiropractic care, acupuncture, homeopathy
People use CAM because they don’t have acess to primary physicians, are unhappy with primary care, appointments last long and are vicious
Patients are typically highly educated women with multiple chronic issues
What barriers do people experience to accessing good health care?
Poor communication - physician doesn’t listen
Jargon - physician doesn’t explain in lay terms
Baby talk - physician makes it too simple
Elderpeak - treats elders like infants
Nonperson treatment - Patient is depersonalized
Stereotypes - racism, sexism, cultural stereotypes
How is creative non-adherence different from non-adherence?
Non-adherence is when a patient doesn’t follow prescribed treatment. But creative non-adherence is when they modify/supplement their prescribed treatment
What factors may contribute to non-adherence?
- Poor communication
- Negative satisfaction
- Complex treatment regimen
- Type of treatment (people are typically much more adherent to medical treatment vs. social treatment)
How does a placebo effect work?
- It has indirect physiological responses which can reduce anxiety and lower stress response
It may cause release of endogenous opioids
What factors can increase the placebo effect?
- Patient-Physician relationship/interaction
- Personal characteristics
- The appearance and administration of placebo
What are the two types of pain?
Acute and Chronic
Acute is caused by soft tissue damage, accompanied by infection and inflammation
Chronic is a long-term illness that may have no apparent cause, can trigger other issues, and is difficult to assess
List 3 types of chronic pain
- Chronic benign (ex. lower back pain)
- Recurrent acute pain (ex. migraines)
- Chronic progressive (ex. arthritis)
What factors may influence and individuals pain symptoms?
- Cultural differences - some cultures are more likely to express their pain
- Gender - women are more sensitive
- Coping styles - Catastrophizing heightens pain and resilience and positive emotions lower it
What are common way to measure pain?
- Verbal/self-report: uses personal vocabulary or answers questionnaire
- subjective, descriptive words may be limited, scales may not go in depth enough - Pain behaviour: facial/audible expressions, distortions in posture/gait, negative affect, activity avoidance
What is nociception and how is it transmitted? What are the types of nerve fibres?
Nocieception is the system that carries signals of damage and pain to the brain
Nerve fibres transmit pain signals to the cell bodies in the dorsal root ganglia in the dorsal horn of the spinal cord. Which is then sent for processing in the brine
A-delta fibre is a small, myelinated fibre that transmits first and sharp pain (opens pain gate)
C-fibres are unmyelinated and transmit secondary dull or aching pain (opens pain gate)
A-beta fibres are large myelinated fibres that transmit info about vibration and position (closes pain gate)
What is the gate-control theory?
The gate control theory is a theory of pain that proposes that psychological factors contribute to pain
The neural pain can can open/close to module pain signals (A-delta and C-fibres open; A-beta close)
Also Argeș that physical, emotional, and cognitive factors can open and close the gate
What is the body-self neurmatrix?
The body-self neuromatrix is a theory of pain posits there is a network of neurons that extends throughout areas of the brain to create the felt representation of a unified physical self
Each pain experience causes a neurosignature which is what gives rise to pain rather than the sensory inputs
Thus, during phantom limb the inputs do not stop the networks from generating neurosignatures related to missing body parts
How does the body endogenously manage pain?
Produces endogenous opioids:
- Beta-endorphins: peptides that project to limbic system
- Proenkephalin: peptides found in the endocrine and CNS
- Prodynophins: peptides in the gut, pituitary, and brain
Acute stress (SIA) and physical activity reduces sensitivity to pain
What are pain management techniques?
Traditional techniques: pharmacological, surgical, and sensory techniques
Psychology techniques: biofeedback, relaxation, hypnosis, acupuncture, distraction
What does the neurotic triad refer to?
- Hypochondria
- Hysteria,
- Depression
- People who have chronic pain show elevated scores in the neurotic triad
What 4 factors may increase susceptibility to chronic illness?
- Genetics
- Environment
- Lifestyle
- Previous injury or prolonged strain
What demographic profiles are more likely to suffer from chronic illness?
- women
- elderly
- Low SES
- certain sub-populations (ex. aboriginals or italians)
What are the components to quality of life?
- physical functioning
- psychological status
- social functioning
- disease or treatment-relates symptomology
Poor QoL is related to the degree in which normal life activities have been compromised
What factors may contribute to ones evaluation of QoL?
- Characteristics of the illness: acute vs. symptoms free phase
- Acute changes in symptoms: flare-ups
- Age-related changes over time: elderly vs. 35yrs old
- Culture: May impact how people experience common illness
List 4 reasons why it is important to study QoL
- documentation/history
2 Identify trends between illness and QoL factors - Compare effectiveness/impact between treatments
- Inform decision and policy makers
What are the 3 emotional bases (phases) of chronic illness?
- Denial - may interfere with treatment
- Anxiety/fear - elevated self-vigilance may hamper treatment
- Depression - increases with severity, hard to treat and increases risk of suicide
What 4 ‘șelf’ factors contribute to your self-concept?
- Physical self: positive body image increase SE
- Achieving self: job/hobbies increase SE
- Social self: positive social interaction increase SE
- Private self: decreases as dependence on others increases
What copying style is associated with less psychological distress during chronic illness?
Active coping
What are the 5 goals of physical rehab?
- Use your body as much as possible
- Sense change in the environment
- Learn new physical management skills
- Learns a necessary treatment regimen
- Learn how to control energy
What is benefit finding during chronic illness? Provide examples
Benefit finding is the acknowledgement of positive effects during chronic illness.
Ex. Re-evaluation of priorities, strengthening of relationships, realization of ones abilities, positive lifestyle changes
List 6 psychological interventions for chronic illness
- Individual therapy (medical vs. psychotherapy)
- Brief psychotherapeutic interventions
- Patient education
- Relaxation, stress management, exercise
- Social support interventions (support groups)
- Familiar support - increases adherence
What is the most common cause of infancy or childhood death?
Sudden infant death syndrome (SIDS)
___ is the average lifespan in Canada
81 years
What does premature death refer to?
- Death before 79
- Death before emotionally/financially/socially prepared
- Sudden death
What factors do people consider a ‘good death’?
- Death is free from avoidable suffering for all involved parties
- Pts are able to make decisions in their care for pain and symptom management (ex. living will)
- death is quick
- Time to prepare for death (ex. write a will)
What factors typically cause someone to request euthanasia?
When they are:
- experiencing distress or fatigue
- in pain or suffering
- a burden to their families
What criteria must you meet to qualify for MAID in Canada?
- Eligible for government-funded insurance
- 18+
- Suffering from a grievous and irremediable condition
- Request is made voluntary and not due to external pressure
- Consent after being informed of all the available means to manage pain and symptoms
What is considered a grievous and irremediable condition?
- Have a serious and incurable illness/disease/disability
- Be in an advanced sate or irreversible decline
- Endure physical and psychological suffering that is intolerable
- Natural death is in the foreseeable future
What are Kubler-Ross’s 5 stages of dying?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What are the two alternative options to hospitals for terminally ill patients?
- Hospice care - dying in a nice facility
- Home care setting- dying at home
What are the 4 major chronic disorders? What do these disorders have in common?
- Heart disease
- Stroke
- Hypertension
- Diabetes
There all involve the circulatory and/or metabolic system, may be co-morbid, have modifiable risk factors, and are non-communicable disease
What causes heart disease?
Atherosclerosis - narrowing of coronary ratios which increases blood pressure and lowers oxygen supply to the heart
Temporary shortages cause angina pectoris and severe deprecation causes myocardial infarction
Physiologically what is a good way to tell if someone has coronary heart disease?
People with CHD have high levels of proinflammatory cytokine IL-6 and C-reactive protein (CRP) in blood stream
IL-6 causes atherosclerotic plaques
What factors put you at risk for higher CRP levels?
- weight/obesity
- low physical activity
- high blood pressure
- diabetes
- cigarette smoking
- high serum cholesterol
What is metabolic syndrome?
Metabolic syndrome is when an individual has 3 or more of the following:
- obesity centred around waist
- high blood pressure
- low levels of HDL
- difficulty metabolizing blood sugars (pre-diabetic)
- high levels of triglycerides
List 4 ways cardiovascular reactivity contributes to coronary heart disease
- damages endothelial cells
- facilitates the deposit of lipids
- increases inflammation
- develops atherosclerotic lesions
Anger can cause a heart attack. True or False
True.
Acute stress can cause angina or heart attack
What are 4 reasons people eat too much?
- Increased serving size
- Increased food access
- Social context
- Stress
Why does coronary heart disease increase after menopause?
- Estrogen levels diminish sympathetic n.s arousal
- weight gain
- increased blood pressure
- increased LDL
______ hostility is highly correlated with coronary heart disease
cynical
*response to stress is heightened and lasts longer in hostile individuals
Why does stress impact cardiovascular reactivity?
Stress can lead to vasorestriction of the heart and increase blood pressure
This produces atherosclerotic lesions and plaque formations
What are 3 reasons individuals delay going into treatment for heart disease?
- Denial of episode
- Interpret symptoms as mld
- Use self-treatment
- individuals also delay if they have seen a doctor in the past about the reason or they have a daytime attack
What is the initial treatment when first diagnosed with coronary heart disease?
- Coronary artery bypass graft (CABG)
- hospitalization with heart monitoring
- assessment of mood (depression, anxiety, etc.)
- home-care with rehabilitation
What are the goals of cardiac rehab?
- Lifestyle modification
- Produce relief from symptoms and reduce severity/progression
- promote psychological and social adjustment
- restore self-efficacy
What are the pharmacotherapy options for heart disease?
- antiplatelet agents: aspirin
- Beta-adrengeric blocking agents
- Statins: target LDL (i.e. lipitor)
Why is it important manage stress and depression when an individual has heart disease?
Stress can trigger and contribute to heart disease
Depression can impact response to CHD treatment and decrease QoL and perceived health
What is cardiac invalidism?
Cardiac invalidism is when a pt or souse sees their abilities as lower then they actually are
- social support significantly improves recovery
What is hypertension ?
Hypertension is high blood pressure that:
- occurs when supply of blood through vessels is high
- puts pressure on arterial walls
- occurs in response to peripheral resistance to blood flow in small arteries of the body
How is blood pressure measured?
Systolic: measure of force generated from contraction of heart (output)
over
diastolic: pressure in the arteries when the heart is relaxed (input)
What levels of blood pressure indicate mild, moderate, and severe hypertension?
Mild: systolic pressure between 140-159
Moderate: systolic pressure between 160-179
Severe: systolic pressure above 180
List 5 typical treatment interventions for hypertension
- low-sodium diet
- weight loss / exercise
- diuretics: reduce blood volume via extortion of Na+
- Beta-adrenergic blockers: decrease cardiac output
- CBT
What are 3 issues with hypertension diagnosis?
- many individuals are unaware they have hypertension
- hypertension is symptom-less free early on
- high rates of non-adherence to therapy
Contrast the two types of strokes
Ischemic stroke: blood clot stops blood supply to a localized area of the brain
Hemorrhagic stroke: hemorrhage/blood leaks into brain tissue
What are the 5 warning signs of a stroke?
- muscle weakness
- trouble speaking
- vision problems
- headache
- dizziness
What are potential consequences of a stroke?
- motor deficits
- cognitive impariments
- emotional problems
*71% of survivors require assistance with daily life
What is diabetes?
Diabetes is a chronic condition whether individuals secrete insufficient insulin or are resistant to insulin
Insulin is used to breakdown glucose and is used as energy. When there is insufficient insulin glucose does not enter the cells builds up in the bloodstream
What is the difference between type I and type II diabetes?
Type I develops early in life and is when someone secretes insufficient insulin. They are insulin dependent
Type II develops later in life and they have an insulin resistance that relates to obesity and diet.
What is the deadly quartet?
- Diabetes
- Interabdominal body fat
- Hypertension
- Elevated lipids
What are the health implications for individuals with diabetes?
- Thickening of arteries
- Shorter life expectancy
- Depression
- Sexual dysfunction
What is natural immunity?
Natural immunity is the bodies defence against a variety of pathogens
Granulocytes (includes neutrophils and macrophages) congregate and the site of injury to release toxic substances
Macrophages lead to inflammation, fever, and promote wound healing
What do Natural Killer (NK) cells do?
NK cells:
- recognize viral infections or cancer cells
- lyse cells by release toxic factors
- are important in signalling potential malignancies
- limit early phases of viral infections
What is specific immunity?
Specific immunity is a more specific but slower process that develops due to prior experience
Lymphocytes have ver speicifc receptors for one antigen that once activated divide to create a proliferative response
Compare humoral and cell-mediated immunity
In humoral immunity B lymphocytes prevents viral infections by recognizing phagocytes, neutralizing toxins, and providing protection against bacteria
In cell-mediated immunity T lymphocytes activate a cytotoxic (TC) response to specific antigens
Helper T cels enhance the functioning of TC cells, B cells, and macrophages (most important)
Which 2 ways can immune functioning be assessed?
- Blood examination: counts # of T, B and NK cells
2. Functioning assessment: examines activation, proliferation, transformation, and cytotoxicity of cells
What are 1 signs that an individuals immune system is not working well?
- They produce antibodies to a latent/inactive virus
2. They have an immune response to a vaccine
How does stress impact immunocompetence?
Anticipitatory stress:
- Decreases # of TH (helper cells)
Short term stress:
- Activates fight-or-flight response
- Increases NK cells, and granular lymphocytes
- Leads to down regulation of specific immunity
- Can increase pro inflammatory cytokine activity
Long-term stress:
- Causes down regulation of cellular and humoral immunity
- Can impact other co-morbid issues
- Increases susceptibility
What factors contribute to AIDS?
AIDS: Acquired immune deficiency syndrome
- high rates of sex
- low condom use
- high rates of gonorrhoea
- non-sterile techniques
What is the mechanism of HIV?
- Attacks helper T cells
- Attacks macrophages of the immune system
- Transmits between cell-containing bodily fluids
What are symptoms of AIDS?
Early symptoms:
- swollen glands
- mild-like flu symptoms
May be followed by asymptomatic period
Progressive symptoms:
- chronic diarrhea
- Wasting
- Skeletal pain
- Blindness
- CNS impairment
What therapy is used for AIDS?
Incurable
Highly active antiretroviral therapy (HAART):
- combination of antiretroviral meds
- must be taken religiously
- Treatments may be complex/distrubtive
- Depression can cause non-adherence
Who is at highest risk for AIDS?
- homosexual IV drug users
- adolescents (50% of new cases)
Why is teaching sexual negotiation skills important?
Teaching adolescents to negotiate safe sex and use of sterile techniques can prevent HIV
What is the mechanism of cancer?
- A mutation inactives tumor supressor gene
- Causes cells to rapidly proliferate
- Drains body of essential resources
Why is depression linked to cancer?
It elevates endocrine response (increased cortisol and NE)
It puts you at a higher risk and can lower the efficacy of NK cells
What is arthritis? What are the different types?
Arthritis is a chronic progressive disease marked by inflammation of a joint
Types include: Rheumatoid arthritis, osteoarthritis, gout, lupus, ankylosing spondylitis (spine)
What is RA?
RA is when the immune system target the thin membrane surrounding the joints of the hands, feet, wrists, knees, ankles, and neck
It leads to inflammation, stiffness, pain, affects lifestyle, and is comorbid with other health conditions
What is osteoarthritis?
Most common form of arthritis that results when the membrane is degraded and bone on bone occurs
