General Practice and Public Health Flashcards
1
Q
What are the 5 level’s of Maslow’s hierarchy of needs?
A
- Physiological needs.
- Safety needs.
- Love and belonging.
- Esteem.
- Self-actualisation.
2
Q
What is epigenetics?
A
The study of how genes interact with the environment. Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
3
Q
What is allostasis?
A
The process of achieving stability, or homeostasis, through physiological or behavioural change.
4
Q
What is allostatic load?
A
The wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress. The price we pay for allostasis.
5
Q
Define domestic abuse.
A
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
6
Q
Give 3 examples of domestic abuse.
A
- Emotional abuse.
- Physical abuse.
- Financial abuse.
- Sexual abuse.
- Psychological abuse.
7
Q
How can domestic abuse impact on health?
A
- Traumatic injuries following assault e.g. fractures, miscarriage.
- Somatic problems or chronic illness e.g. chronic pain, headaches.
- Psychological problems e.g. PTSD, depression, anxiety.
8
Q
Give 3 potential indications of domestic abuse.
A
- Unwitnessed by anyone else.
- Repeat attendances to GP or A+E.
- Delay in seeking help.
- Multiple minor injuries.
9
Q
What assessment tool can be used to determine someones risk of domestic abuse?
A
The DASH assessment.
10
Q
What action would you take if someone was at high risk of domestic abuse?
A
Refer to MARAC or IDVAS.
11
Q
What is Public Health?
A
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society.
12
Q
Define epidemiology.
A
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
13
Q
Define incidence.
A
The rate at which new diseases occur in a population in a certain time period.
14
Q
Define prevalence.
A
The proportion of a population found to have a disease at a point in time.
15
Q
What is person-time a measure of?
A
Person-time is a measure of risk. It is the sum of each individual’s time at risk ie. the length of time they were followed up in the study. It is the denominator in incidence rate calculations.
16
Q
What value is used as the denominator in incidence rate calculations?
A
Person-time.
17
Q
What is relative risk?
A
The risk in one category relative to another, for example, the ratio of risk of disease in the exposed to the risk in the unexposed. It tells us about the strength of association between a risk factor and a disease.
18
Q
What calculation can be used to work out relative risk?
A
Incidence in exposed ÷ incidence in unexposed.
19
Q
Define attributable risk.
A
The rate of disease in the exposed that may be attributed to the exposure. It tells us about the size of effect in absoloute terms.
20
Q
How can you calculate attributable risk?
A
Incidence in the exposed - incidence in the unexposed.
21
Q
What is NNT?
A
Number needed to treat is the number of patients that need to be treated in order to have an impact on one person.
22
Q
How can you calculate NNT?
A
1 / absoloute risk reduction.
23
Q
Define bias.
A
A systematic deviations from the true estimation of the association between exposure and outcome.
24
Q
Name 2 forms of bias.
A
- Selection bias.
2. Information bias.
25
What is selection bias?
The people who choose to participate in screening programmes may be different from those who don't. Proper randomisation is not achieved.
26
What is information bias?
Information or measurement bias can be due to observer, participant or instrument error.
27
What is length-time bias?
Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.
28
What is lead-time bias?
Screening identifies diseases earlier and so gives the impression that survival is prolonged but in reality survival time is unchanged.
29
Define confounding.
Confounders are associated with exposure and outcome but are not on the causal path from exposure to disease.
Confounders may affect the validity of a study.
30
What is the Bradford Hill criteria for causation?
1. Consistency.
2. Biological plausibility.
3. Temporality - cause before disease.
4. Dose response.
5. Reversibility.
6. Strength of association.
31
Name 3 types of study design.
1. Ecological.
2. Cross-sectional.
3. Case-control.
4. Cohort.
5. RCT.
32
Which type of study uses routinely collected population level date to show trends and to generate hypotheses?
An ecological study.
33
Which type of study looks at the population at a point in time?
A cross-sectional or prevalence study.
34
Which type of study compares people with a disease to those without a disease for age, sex, habits, class etc?
A case-control study. These are retrospective.
35
Which type of study follows a population over time to see if they're exposed to the agent in question and if they develop the disease?
A cohort or incidence study. These are prospective.
36
What is a RCT?
Where a population is randomised to either an interventional or a control group. Often these are blind or double-blind trials.
37
Which type of study is also known as an incidence study?
A cohort study - follows a population over time to see if they're exposed to the agent in question and if they develop the disease.
38
Which type of study is also known as a prevalence study?
A cross-sectional study. It looks at the population at point in time.
39
Define primary prevention.
Preventing a disease/condition from occurring in the first place. Eliminating RF's that contribute to the disease.
40
Give an example of a primary prevention method.
Immunisations.
41
Define secondary prevention.
Detecting a disease as soon as possible in order to alter its course and to improve health outcomes.
42
Give an example of secondary prevention.
Screening e.g. cervical smears.
43
Define tertiary prevention.
Trying to slow down disease progression, avoiding complications and helping people to manage their illness effectively.
44
Give an example of tertiary prevention.
Diabetes management - diet advice, exercise programmes, self-monitoring, annual foot checks etc.
45
What is the population approach to prevention? Give an example.
Preventative measures delivered on a population wide basis e.g. dietary salt reduction.
46
What is the high risk approach to prevention? Give an example.
Identifying individuals above a chosen cut-off and treating them. E.g. treating those with high cholesterol to avoid heart disease.
47
Describe the prevention paradox.
A preventative measure that brings much benefit to the population often offers little to each participating individual.
48
Define screening.
Identifying seemingly healthy individuals who may be at increased risk of disease.
49
Give 4 different types of screening.
1. Population based.
2. Opportunistic.
3. Screening for communicable diseases.
4. Pre-employment and occupational.
50
What is the Wilson and Jungner criteria for screening?
1. The condition being screened for should be an important health problem.
2. The natural history of the condition should be understood.
3. There should be a detectable early stage.
4. There should be a treatment available.
5. Facilities for diagnosis and treatment need to be available.
6. There should be a suitable test.
7. The test should be acceptable to the population.
8. There should be an agreed policy on whom to treat.
9. The costs of screening must be balanced against benefits.
10. Screening should be a continuous process, not just a one off.
51
Define sensitivity.
The proportion of people with the disease who are correctly identified (a/a+c).
52
Define specificity.
The proportion of people without the disease who are correctly excluded by the screening test; how well a test detects those without a disease (d/b+d).
53
Define PPV.
The proportion of people with a positive test result who actually have the disease (a/a+b).
54
Define NPV.
The proportion of people with a negative test result who do not have the disease (d/c+d).
55
What are the 4 main determinants of health?
1. Lifestyle.
2. Access to healthcare.
3. Genes.
4. Environment.
56
# Define the following:
a) Equity.
| b) Equality.
a) Equity - what is fair and just.
| b) Equality - equal shares.
57
Define horizontal equity.
Equal treatment for equal need.
58
Define vertical equity.
Unequal treatment for unequal need e.g. someone with a common cold would need a different treatment to someone with pneumonia.
59
Give 2 factors that can affect equity.
1. Spatial factors - geographical.
| 2. Social factors - age, gender, class, ethnicity.
60
What are the 3 domains of public health?
1. Health promotion.
2. Health protection.
3. Improving health services.
61
Domains of public health: give examples of health promotion.
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
62
Domains of public health: give examples of health protection.
Putting measures in place to control infectious diseases.
63
Domains of public health: what are the aims of health service improvements?
To ensure that there is delivery of organised, safe and high quality services.
64
What is health psychology?
Health psychology emphasizes the role psychological factors in the cause, progression and consequences of health and illness. It aims to put theory into practice by promoting healthy behaviors and preventing illness.
65
Give 3 types of health behaviour.
1. Health behaviour.
2. Illness behaviour.
3. Sick role behaviour.
66
Define health behaviour.
Health behaviour is aimed at preventing disease e.g. eating healthily.
67
Define illness behaviour.
Illness behaviour is aimed at seeking remedy e.g. going to the Dr's.
68
Define sick role behaviour.
Sick role behaviour is activity aimed at getting better e.g. taking medications.
69
What are health damaging behaviours?
Health damaging behaviours are often related to mortality e.g. smoking, alcohol, high risk sexual behaviours.
70
What are health promoting behaviours?
Behaviours that seek and maintain health e.g. exercise, eating healthily, having vaccines.
71
What is a meta-analysis?
A statistical technique where you pool all the results of the available evidence and look at effect.
72
Define compliance.
The extent to which a patients behavior coincides with medical advice. It is professionally focused and assumes that the doctor knows best.
73
Give 3 factors that can effect compliance.
1. Side effects of medications.
2. Patient perception of risk.
3. If the patient is asymptomatic.
4. Socioeconomic status.
74
Give 3 examples of population level interventions.
1. PH campaigns e.g. Change4Life, Movember.
2. Screening e.g. cervical smear.
3. Immunisations e.g. MMR.
75
What is unrealistic optimism?
Unrealistic optimism is when individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility.
76
Give 3 factors that contribute to unrealistic optimism e.g. factors that can influence someones perception of risk.
1. Lack of personal experience with a problem.
2. Belief that it may be preventable by personal action.
3. Belief that if not happened now, its not likely to.
4. Belief that the problem is infrequent.
5. Other reasons: health beliefs, situational rationality, cultural variability, socioeconomic factors, stress, age.
77
Why is it important to understand a patient's perception of risk?
A patient's perception of risk can impact on medication adherence and keeping appointments etc.
78
Briefly describe the NICE guidance on behaviour change.
1. Plan interventions.
2. Assess social context.
3. Educate and train.
4. Look at individual level and community level interventions.
5. Evaluate effectiveness and assess cost effectiveness.
79
What is the single greatest cause of illness and premature death in the UK?
Smoking.
80
What 3 diseases are smoking related deaths normally due to?
1. Cancers.
2. COPD.
3. CHD.
81
When does smoking prevalence peak?
In the mid 20's.
82
What is the role of NCSCT?
NCSCT supports the delivery of effective evidence-based tobacco control programmes and smoking cessation interventions provided by local services.
83
What is 'Health Needs Assessment'?
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
84
Health Needs Assessment: define need.
The ability to benefit from an intervention.
85
Health Needs Assessment: briefly describe the planning cycle.
Needs assessment -> planning -> implementation -> evaluation -> needs assessment etc...
86
What is felt need?
Individual perceptions of variation from normal health.
87
What is expressed need?
When an individual seeks help to overcome variation in normal health.
88
What is normative need?
When a professional defines interventions that are appropriate for expressed need.
89
What is comparative need?
Comparison between severity, range of interventions and cost.
90
Health needs assessment: define demand.
What people ask for.
91
Health needs assessment: define supply.
What is provided.
92
Describe the difference between health need and health care need.
Health need: need for health.
Health care need: need for health care. It is more specific and looks at someone's ability to benefit from health care.
93
Name 3 different types of health needs assessment.
1. Epidemiological.
2. Comparative.
3. Corporate.
94
Give 3 negative points for epidemiological health needs assessments.
1. Required date may not be available.
2. Variable data quality.
3. Ignores felt needs.
95
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
96
Give 3 negative points for comparative health needs assessments.
1. Required date may not be available.
2. Variable data quality.
3. It is hard to find comparable populations.
97
Who might be involved with corporate health needs assessment?
1. Politicians.
2. Press.
3. Providers.
4. Professionals.
5. Patients.
98
Give 3 negative points for corporate health needs assessments.
1. Difficult to distinguish need from demand.
2. Groups may have vested interests.
3. May be influenced by political agendas.
99
Give one health related example of something that you consider is demanded but not needed or supplied.
Cosmetic surgery.
100
Smoking cessation: give 3 symptoms of withdrawal.
1. Difficulty concentrating.
2. Increased appetite.
3. Irritability.
101
Define cardiac failure.
A complex clinical syndrome of signs/symptoms that suggest the efficiency of the heart as a pump is impaired. The heart is unable to deliver blood at a rate that meets the metabolic demands of the body.
102
What are the 3 main types of cardiac failure and what causes them?
1. LVSD - often due to IHD.
2. RVSD - often secondary to LVSD.
3. Diastolic HF.
103
Briefly explain the pathophysiology of cardiac failure.
When the heart fails, compensatory mechanisms attempt to maintain CO. As HF progresses, these mechanisms are exhausted and become pathophysiological.
1. Sympathetic activation.
2. RAAS activation.
3. Natriuretic peptide release.
4. Ventricular hypertrophy.
104
What are the 3 cardinal symptoms of cardiac failure?
1. SOB.
2. Fatigue.
3. Peripheral oedema.
Also:
4. PND.
5. Orthopnoea.
105
Give 3 signs of cardiac failure.
1. Tachycardia.
2. Raised JVP.
3. Displaced apex beat.
4. Added heart sounds.
106
What investigations may you want to do to determine whether someone has cardiac failure?
1. BNP levels.
2. CXR.
3. Echo.
4. ECG.
107
Briefly describe the NYHA classification for cardiac failure.
1. Class 1: no limitation, asymptomatic.
2. Class 2: slight limitation, mild HF.
3. Class 3: marked limitation, moderate HF.
4. Class 4: inability to carry out physical activity without discomfort, severe HF.
108
Describe the management of HF.
1. Lifestyle modification.
2. Main pharmacological benefits are from vasodilator therapy not LV stimulants:
- 1st line: ACEi, beta blockers.
- 2nd line: aldosterone antagonists, ARB.
- Diuretics can help with symptom relief.
- Nitrates and NEP inhibitors can be used too.
3. Surgery: valve replacement and LV remodelling.
109
What must you monitor in a patient taking ACEi e.g. Ramipril?
You must monitor kidney function e.g. U&E's and eGFR.
110
What should you monitor in a patient taking beta blockers e.g. metoprolol?
HR and BP.
111
Give an example of an aldosterone antagonist.
Spironolactone.
112
Give an example of an ARB.
Candesartan.
113
What lifestyle modifications would you suggest for someone with HTN?
- Reduce salt intake.
- Weight loss.
- Reduce alcohol.
- Smoking cessation.
114
Name 3 ACEi that can be used in the treatment of HTN.
1. Ramipril.
2. Enalapril.
3. Perindopril.
115
Give 3 potential side effects of ACEi.
1. Hypotension.
2. AKI.
3. Hyperkalaemia.
Also cough, rash and anaphylactoid due to increased kinin.
116
Name 3 ARB that can be used in the treatment of HTN.
1. Candesartan.
2. Valsartan.
3. Losartan.
117
Name 3 beta blockers that can be used in the treatment of HTN.
1. Atenolol.
2. Propranolol.
3. Bisoprolol.
118
Give 3 potential side effects of beta blockers.
1. Fatigue.
2. Headache.
3. Bradycardia.
4. Hypotension.
5. Erectile dysfunction.
6. Cold peripheries.
119
Name 3 CCB that can be used in the treatment of HTN.
1. Dihydropyridines e.g. amlodipine and felodipine.
2. Diltiazem.
3. Verapamil.
120
What channels do CCB act on?
L-type Ca2+ channels.
121
Name a diuretic that can be used in the treatment of HTN.
Thiazide-like diuretics e.g. Indapamide.
122
What is polypharmacy?
When someone is taking ≥ 5 drugs.
123
Give 3 potential problems associated with polypharmacy.
1. Drug interactions.
2. Can affect compliance and lead to decreased patient satisfaction.
3. Pill burden.
124
What is the prognosis of cardiac failure?
5-year mortality = 75%.
125
Give examples of primary prevention methods for cardiac failure.
1. Healthy lifestyle.
2. Reducing alcohol intake.
3. Smoking cessation.
4. QRISK.
5. Statins.
6. Correct aggravating factors e.g. AF, HTN, diabetes.
126
What is QRISK?
It calculates someones risk of a CV event in the next 10 years.
127
If someone had a QRISK score >10 what would you advise?
You would advise them to start taking statins and to modify their lifestyle.
128
Give examples of secondary prevention methods for cardiac failure.
1. Regularly checking BP.
| 2. Regularly checking blood cholesterol.
129
Give examples of tertiary prevention methods for cardiac failure.
1. Exercise based cardiac rehabilitation.
2. Revascularisation procedures e.g. PCI, CABG.
3. Implantable defibrillators.
130
What is erectile dysfunction?
The inability to attain and maintain an erection sufficient for satisfactory sexual performance.
131
Give 3 RF's for erectile dysfunction.
1. Lifestyle factors e.g. obesity, smoking, alcohol.
2. Hypercholesterolaemia.
3. Hypertension.
4. Diabetes mellitus.
132
Give 5 potential causes of erectile dysfunction.
1. Neuro: brain injury/spinal cord disease.
2. CV disease: atherosclerosis, HTN.
3. Psychogenic: psychosexual disorders, depression, anxiety.
4. Endocrine: thyroid disease.
5. Medications: beta blockers, diuretics, anti-depressants.
133
ED: What points in a history are suggestive of a psychogenic cause?
1. Sudden onset.
2. Early collapse.
3. Problematic relationship.
134
ED: What points in a history are suggestive of an organic cause?
1. Gradual onset.
2. Normal ejaculation.
3. Normal libido.
4. RF's present.
135
What investigations might you do to determine the cause of someone's erectile dysfunction?
1. Fasting glucose.
2. HbA1c.
3. Lipid profile.
4. FSH/LH/Prolactin.
136
Briefly describe the management of ED.
1. Treat RF's.
2. Refer for counselling.
3. Phosphodiesterase inhibitors e.g. Tadalafil.
4. Vacuum devices.
5. Injections.
6. Penile prosthesis.
137
Name a phosphodiesterase inhibitor and briefly describe how they work.
Tadalafil.
They increase the blood flow to the corpus cavernosum
138
Give 3 potential side effects of phosphodiesterase inhibitors.
1. Headaches.
2. Flushing.
3. Indigestion.
4. Priapism.
5. Impaired vision.
139
Give 3 potential causes of homelessness.
Relationship breakdown due to:
1. Mental illness.
2. Domestic abuse.
3. Dispute with parents.
4. Bereavement.
140
Give 3 groups of people who are more vulnerable to homelessness.
1. Substance misusers.
2. Failed asylum seekers.
3. People who are/have been in care.
4. Ex-service men and women.
5. LGBTQ+.
141
What health problems do homeless adults face?
1. Infectious disease inc. TB and hepatitis.
2. Dental problems.
3. Respiratory problems.
4. Injuries following violence/rape.
5. Sexual health problems.
6. Serious mental illness - schizophrenia, depression.
7. Malnutrition.
142
What barriers to care do homeless people face?
1. Difficulty accessing health care.
2. Lack of integration between primary care services and other agencies.
3. People may not priorities health when there are other more immediate health problems.
4. May not know where to find help.
5. Communication difficulties.
143
Define refugee.
A person granted asylum and refugee status in the UK. They have the rights of a UK citizen.
144
Define asylum seeker.
A person applying for refugee status. They are entitled to £35 a week, housing and NHS care.
145
What barriers to care do asylum seekers and refugees face?
1. Language/cultural/communication problems.
2. Money/other priorities.
3. Different perceptions of care.
4. Racism, prejudice, discrimination, stigma.
5. May not understand how the NHS works.
146
What health problems do refugees and asylum seekers face?
1. Injuries from war/travelling.
2. No previous health surveillance/immunisations.
3. Malnutrition.
4. Injuries from torture and sexual abuse.
5. Blood borne and infectious disease.
6. Untreated chronic disease.
7. PTSD, depression, psychosis.
147
Define social exclusion.
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
148
Give 3 causes of loneliness.
1. Poor health, sensory impairment.
2. Poverty.
3. Housing issues.
4. Fear of crime.
5. Lack of transport.
6. Discrimination.
149
Give 3 signs of loneliness.
1. Talkative, clinging.
2. Lives alone.
3. Recent bereavement or transition.
4. Mobility problems or sensory impairment.
150
Give 3 national initiatives to combat loneliness.
1. Age UK.
2. Silverline.
3. Dementia Friends.
151
Give 3 Sheffield initiatives to combat loneliness.
1. Age Better.
2. Active Sheffield.
3. Darnall Dementia Care.
152
What is the Health Belief Model (Becker 1974)?
Individuals will change if they:
- Believe that they are susceptible to the condition in question.
- Believe that is has serious consequences.
- Believe that taking action reduces susceptibility.
- Believe that the benefits of taking action outweigh the costs.
153
What are the 4 key aspects to the health belief model?
1. Perceived susceptibility.
2. Perceived severity.
3. Perceived benefits.
4. Perceived barriers - most important factor for addressing behaviour change!
154
'Cues to action' are another important aspect of the health belief model. What is meant by this?
- Internal cues e.g. worsening pain or breathlessness may trigger someone to want to change their behaviour.
- External cues e.g. reminder letters or phone calls from GP.
155
Give 3 disadvantages of the health belief model.
1. Health beliefs may be affected by alternative factors e.g. outcome expectancy and self efficacy.
2. The model does not consider the influence of emotions on behaviour.
3. Cues to action are often missing in research.
4. It does not differentiate between first time and repeat behaviours.
156
The Theory of Planned Behaviour proposes that the best predictor of behaviour is intention. What are the 3 predictors of intention?
1. A persons attitudes to behaviour.
2. Subjective norm: the perceived social pressure to undertake the behaviour.
3. Perceived behavioural control: a person's appraisal of their ability to perform the behaviour.
157
Theory of Planned Behaviour: Only 50% of intentions transfer to behaviours. How can we bridge this gap?
1. Perceived control.
2. Anticipated regret.
3. Preparatory actions.
4. Implementation intentions!
5. Relevance to self.
158
Give 3 disadvantages to the Theory of Planned Behaviour.
1. Lack of temporal element and lack of direction or causality.
2. The model doesn't taken into account emotions.
3. The model doesn't explain how attitudes, intentions and perceived behavioural control interact.
4. Relies on self-reported behaviour.
5. Good for predicting intentions but not as successful for actual behaviours.
159
Describe the transtheoretical model.
1. Pre-contemplation - no intention of stopping smoking.
2. Contemplation - thinking about giving up.
3. Preparation - getting ready to quit in near future.
4. Action - engaged in giving up.
5. Maintenance - steady no smoker, state of change reached.
Relapse?
160
Give 3 advantages and 3 disadvantages of the transtheoretical model.
Advantages:
1. Acknowledges individual stages.
2. Accounts for relapse.
3. Temporal element.
Disadvantages:
1. Not all people move through every stage.
2. Change might operate on a continuum, not discreet stages.
3. Doesn't take into account habits, culture, social and economic factors.
161
Give 3 external factors that are important when thinking about behaviour change.
1. Impact of personality traits.
2. Assessment of risk perception.
3. Impact of past behaviour/habit.
4. Social environment.
162
NICE guidance suggests that there are certain transition points in a person life where they are more susceptible to behaviour change. Name 3.
1. Leaving school.
2. Entering workforce.
3. Becoming a parent.
4. Becoming unemployed.
5. Retirement and bereavement.
163
What is the NICE traffic light system used for in paediatrics?
It is a clinical risk score designed to assist with the assessment and management of febrile children under 5 years old.
164
What are the 5 main categories that are assessed in the NICE traffic light system?
1. Colour - skin, tongue, lips.
2. Activity - response, smile, crying etc.
3. Respiratory.
4. Circulation and hydration.
5. Other - temperature, rigors, swelling, rash, neck stiffness, seizures etc.
165
Give 3 common causes of pyrexia in children.
1. URTI.
2. Tonsillitis.
3. Otitis media.
4. UTI.
5. Pneumonia.
6. Measles.
166
Give 3 less common causes of pyrexia in children.
1. Meningitis.
2. Septicaemia.
3. Epiglottitis.
4. Malignancy.
5. Kawasaki disease.
6. TB.
167
How would you manage a child with a green score on the NICE traffic light risk assessment?
You would manage them at home + safety net.
Encourage regular fluids, observe for dehydration, monitor for rash, and regularly review the child. Tell the parents to contact a medical professional if parental concern increases.
168
How would you manage a child with an amber score on the NICE traffic light risk assessment and with no diagnosis?
You could refer the child to a paediatric or specialist for further investigation or manage them at home + safety net.
169
How would you manage a child with a red score on the NICE traffic light risk assessment?
Urgent referral to a hospital for specialist assessment.
170
What is safety netting?
1. Verbal and/or written advice about warning signs/symptoms with a plan of action should these be noticed.
2. Arrange follow-up at a specific time and place.
3. Liaising with other health care professionals to ensure direct access should the child require it.
Advice needs to be clear and easy to follow.
171
Name 3 notifiable diseases that you may see in paediatrics.
1. Meningitis.
2. Diphtheria.
3. Measles.
4. Mumps.
5. Meningococcal septicaemia.
6. Rubella.
7. Smallpox.
8. Scarlet fever.
9. Tetanus.
10. Whooping cough.
172
What vaccinations should a child have at 8 weeks?
1. Dipthera, tetanus, pertussis (DTaP).
2. Polio (IPV).
3. Haemophilus influenza (Hib).
4. Pneumococcal (PCV).
5. Men B.
6. Rotavirus.
DR PIMP.
173
What vaccinations should a child have at 12 weeks?
1. Dipthera, tetanus, pertussis (DTaP).
2. Polio (IPV).
3. Haemophilus influenza (Hib).
4. Men C.
5. Rotavirus
DR PIM.
174
What vaccinations should a child have at 16 weeks?
1. Dipthera, tetanus, pertussis (DTaP).
2. Polio (IPV).
3. Haemophilus influenza (Hib).
4. Pneumococcal (PCV).
5. Men B.
D PIMP.
175
What vaccinations should a child have at 1 year?
1. Haemophilus influenza (Hib).
2. Men B and C.
3. Pneumococcal (PCV).
4. MMR.
176
What vaccinations should a child have at 2-6 years?
Influenza vaccine.
177
What vaccinations should a child have at 3 years 4 months?
1. Dipthera, tetanus, pertussis (DTaP).
2. Polio (IPV).
3. MMR.
178
What vaccinations should a child have at 13-14 years?
HPV (girls).
179
What vaccinations should a child have at 14 years?
1. Tetanus.
2. Diphtheria.
3. Polio.
180
Name 3 groups of people who are less likely to have vaccines.
1. Homeless.
2. Refugees/asylum seekers.
3. Children in care.
181
Give 3 factors that contribute to the promotion of excessive energy intake.
1. Genetics.
2. Employment e.g. shift work.
3. Advertisements.
4. Characteristics of food - energy density, macronutrient composition, portion size.
5. Reduced physical activity.
6. Sleep.
7. Psychological factors.
182
Define malnutrition.
Deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. Malnutrition covers under-nutrition and overweight.
183
Name 3 chronic medical conditions that require nutritional support.
1. Cancer.
2. CF.
3. Coeliac disease.
4. IBD.
5. T1DM and T2DM.
184
Name 2 early influences on feeding behaviour.
1. Human foetuses swallow amniotic fluid.
| 2. Breast feeding.
185
Give 3 advantages of breast feeding on feeding behaviour.
1. More likely to accept novel foods in weaning.
2. Less fussy eaters in childhood.
3. More likely to have a diet rich in fruit and vegetables.
186
Give 3 ways in which parents can tackle fussy eating.
1. Modelling healthy eating behaviours and eating as a family.
2. Provide a variety of food.
3. Avoid pressure to eat.
4. Restriction.
5. Authoritative parenting.
6. Not using food as a reward.
187
Name 3 eating disorders.
1. Anorexia nervosa.
2. Bulimia nervosa.
3. Binge eating disorder.
188
Give 3 examples of disordered eating.
1. Restraint.
2. Strict dieting.
3. Emotional eating.
4. Binge eating.
5. Weight concerns.
189
Give 3 potential problems with dieting.
1. Risk factor for developing eating disorders.
2. Dieting results in a loss of lean body mass, not just fat mass.
3. Dieting slows metabolic rate.
4. Chronic dieting may disrupt normal appetite responses and increases sensations of hunger.
5. Long term weight loss is challenging, people often regain weight.
190
If associations are not causal, what might they be due to?
1. Confounding factors.
2. Chance.
3. Bias.
4. Reverse causation.
191
Describe the aetiology of vaginal discharge.
1. Physiological causes e.g. puberty, pregnancy, ovulation.
2. Infection.
3. Foreign bodies.
4. Malignancy.
192
Name 3 organisms that can cause abnormal vaginal discharge.
1. BV.
2. Candida.
3. Trichomoniasis.
193
White discharge with vulval itching/soreness may be a sign of infection with which organism?
Candida.
194
Thin grey/white discharge with an offensive odour may be sign of infection with which organism?
Bacterial vaginosis.
195
Yellow/green frothy discharge with an offensive odour and pruritus and/or dysuria may be a sign of infection with which organism?
Trichomoniasis.
196
Describe the mechanism of action of the COCP.
Negative feedback effect of oestrogen prevents LH surge and so inhibits ovulation. The progesterone inhibits proliferation of the endometrium therefore creating unfavourable conditions for implantation. The thickness of the cervical mucus increases too.
197
Give 3 advantages of combined hormonal contraception.
1. More effective than barrier methods.
2. Periods tend to be lighter and less painful.
3. There is a reduced risk of ovarian, uterine and colon cancer.
198
Give 3 disadvantages of combined hormonal contraception.
1. User dependent.
2. Increased risk of VTE.
3. There is a small increased risk of breast and cervical cancer.
4. Doesn't protect against STI's.
199
Who might combined hormonal contraception be contraindicated in?
1. BMI>35.
2. Smokers aged >35.
3. Those with a family history of VTE.
4. History of migraines with aura.
200
Give 3 examples of progesterone only contraception.
1. POCP e.g. Cerazette.
2. Implant.
3. Injection e.g. Depo-Provera.
201
Give an advantage and a disadvantage of POCP e.g. Cerazette.
Advantages:
1. Can be used when COCP is contraindicated.
2. More effective than barrier methods.
Disadvantages:
1. User dependent.
2. Can produce irregular menstruation.
3. Small increased risk of breast cancer and ovarian cysts.
202
Give an advantage and a disadvantage of the implant.
Advantages:
1. Extremely effective.
2. Can be used in women who are breast feeding.
Disadvantages:
1. Fitting and removal may cause pain.
2. Can break in situ.
203
Give an advantage and a disadvantage of the contraceptive injection.
Advantages:
1. Extremely effective.
2. No known interactions.
3. Can be used in women with BMI >35.
Disadvantages:
1. Not rapidly reversible.
2. Shown to increase body mass.
3. Loss of bone mineral density with long term use.
204
Teenage pregnancy can result in what negative outcomes for both the mother and the child?
1. Poor health.
2. Lower academic achievement.
3. Lower socio-economic status.
4. Lower self esteem.
5. Under achievement at work.
205
Give 3 reasons why teenagers may discontinue using contraception.
1. SE's e.g. acne and weight gain.
2. Mood changes.
3. Fertility concerns.
4. Bleeding patterns.
206
What are the Fraser guidelines?
The following criteria judge the competence of a young person to make decisions about contraception without parental consent:
1. The patient understands the advice given.
2. The patient cannot be persuaded to inform their parents.
3. It is likely that the patient will continue to have sexual intercourse with or without contraception.
4. The patient's physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
5. It is in the best interests of the patient and the doctor to provide contraception advice and treatment without parental consent.
207
When treating substance misuse, what are the treatment aims?
1. Reduce harm to user, friends and family.
2. To improve health.
3. To stabilise lifestyle and reduce illicit drug use.
4. Crime reduction.
5. Reduce risk taking behaviour and blood borne virus transmission.
208
Substance misuse: briefly describe the different methods of treatment.
1. Harm reduction.
2. Detoxification e.g. Lofexidine.
3. Maintenance e.g. Methadone.
4. Relapse prevention e.g. Naltrexone.
5. Psychological interventions.
6. Alternative therapies.
209
Substance misuse: where can people get help in Sheffield?
1. Fitzwiliam centre.
| 2. Non-opiate service on Sidney street.
210
Substance misuse: what are the aims of basic harm reduction?
1. Action to prevent death: not injecting/injecting safely, reduce amount taken.
2. Action to prevent BBV transmission: not sharing needles, safe sex, hep A and B vaccination.
3. Refer to specialist services if needed.
211
How can you prevent blood borne virus (BBV) transmission?
1. Don't share needles.
2. Safe sex.
3. Hepatitis A and B vaccination.
4. Blood borne virus screening.
212
Opioid misuse: name a drug that can be used for detoxification.
1. Buprenorphine.
213
Opioid misuse: in what type of people would maintenance therapy be indicated?
Stabilisation/maintenance is needed for the following:
1. Those who have been addicted for a long time.
2. IVDU.
214
Opioid misuse: name 2 drugs used for maintenance/stabilisation.
1. Methadone.
2. Buprenorphine.
Titrate up from a low starting dose.
215
Give 3 signs of addiction.
1. Cravings.
2. Tolerance.
3. Compulsive drug-seeking behaviour.
4. Physiological withdrawal state.
216
Give 3 physical effects of drug use.
1. Complications of injecting.
2. Overdose.
3. Poor pregnancy outcomes.
4. Blood borne virus transmission.
5. Side effects of opiates/cocaine.
217
Give 3 social effects of drug use.
1. Effects on families and relationships.
2. Imprisonment.
3. Social exclusion.
218
Give 3 psychological effects of drug use.
1. Fear of withdrawal.
2. Craving.
3. Guilt.
219
Describe the mechanism of action of heroin.
Acts at opiate receptors. Addictive because it is high reward for minimal effort.
220
Give 3 effects of heroin.
1. Euphoria.
2. Intense relaxation.
3. Drowsiness.
221
Give 3 adverse effects of heroin.
1. Dependence.
2. Withdrawal.
3. Physical complications.
4. Overdose.
222
Describe the mechanism of action of cocaine.
Cocaine blocks re-uptake of mood enhancing neurotransmitters at the synapse leading to feelings of intense pleasure.
223
Give 3 effects of cocaine.
1. Confidence.
2. Euphoria.
3. Impulsivity.
4. Alertness.
224
Give 3 adverse effects of cocaine.
1. Anxiety.
2. Hypertension.
3. Arrhythmias.
4. Dysphoria.
5. Depression.
6. Paranoia.
7. Psychosis.
225
How could you treat a heroin (opioid) addiction?
Provide a substitute e.g. methadone.
226
How could you treat a cocaine addiction?
There is no substitute available therefore harm reduction is key e.g. advice on risky behaviour, safe sex, BBV advice, Hep B/C testing.
227
Opioid misuse: how could you prevent relapse?
1. Provide plenty of support.
2. Naltrexone tablets can prevent relapse.
3. Stabilise and offer maintenance therapy.
228
What formula is used to work out how many units of alcohol there are in a drink?
Strength of drink (%ABV) X Volume (ml) / 1000
229
Briefly describe the metabolism of ethanol into water and carbon dioxide.
Ethanol -> ADH -> acetaldehyde -> ALDH -> acetate -> CO2 + H2O
230
Give 5 causal factors for problem drinking.
1. Occupation factors.
2. Availability of alcohol.
3. Advertising.
4. Peer group.
5. Gender.
6. Biological vulnerability.
7. Family.
231
Give 3 reasons why women are drinking increasingly more.
1. Its more socially acceptable.
2. They have a more disposable income.
3. More drinks are targeted at women.
232
Risk Factors: Give 3 social/psychological risk factors associated with problem drinking.
1. Drinking within the family.
2. Behavioural problems in childhood.
3. Early use of alcohol, nicotine or drugs.
4. Poor coping responses to life events.
233
What are the most common causes of death due to alcohol?
1. Accidents and violence.
2. Malignancies.
3. Cerebrovascular disease.
4. CHD.
234
Give 5 alcohol related health problems.
1. Gastrointestinal problems.
2. Liver disease: 50% have fatty liver, 20% go on to have cirrhosis.
3. CV problems: increased risk of hyperlipidaemia, HTN and AF.
4. Neurological problems.
5. Birth defects: low birth weight, FAS.
6. Malignancy.
235
Name 3 cancers that are commonly associated with alcohol.
1. Head and neck.
2. Liver.
3. Pancreatic.
4. Stomach.
5. Colon.
6. Rectum.
7. Breast.
236
Give 3 symptoms of alcoholic hepatitis.
1. Anorexia.
2. Nausea.
3. Abdominal pain.
4. Weight loss.
237
Name 3 public health interventions that help to reduce alcohol abuse.
1. Minimum price per unit and reduce supply.
2. Screening and brief intervention.
3. Drinkaware campaigns.
238
Name 2 alcohol screening tools.
1. CAGE.
| 2. AUDIT.
239
What questions are asked in CAGE?
1. Have you ever thought about cutting down?
2. Have you ever felt annoyed by people telling you to cut down?
3. Have you ever felt guilty about your drinking?
4. Eye opener – have you ever had a drink first thing in the morning?
240
What questions are asked in AUDIT?
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day?
3. How often did you have >6 units on a single occasion in the past year?
241
What disease can result from thiamine deficiency.
Wernicke's encephalopathy.
242
What are the triad of symptoms seen in Wernicke's encephalopathy.
1. Acute confusion.
2. Ataxia.
3. Opthalmoplegia.
243
How do you treat Wernicke's encephalopathy?
IV or IM thiamine - pabrinex.
244
What complication can arise if you fail to treat Wernicke's encephalopathy?
Korsakoff syndrome - non-reversible.
245
What is delirium tremens.
Short lived toxic confused state due to reduced alcohol intake in alcohol dependent individuals.
246
Give 3 symptoms of delirium tremens.
1. Confusion.
2. Seizures.
3. Hallucinations.
4. Tremor.
247
How can you treat delirium tremens?
Detoxification using benzodiazepines e.g., Lorazepam.
248
Name 3 dementia screening tools that can be used in primary care.
1. 6-CIT.
2. MMSE.
3. GP-COG.
249
Where would you refer someone who you suspect has dementia?
1. Memory clinic.
| 2. Old age psychiatrist.
250
Give 3 common presenting symptoms of dementia.
1. Short term memory loss - amnesia.
2. Communication problems - aphasia.
3. Difficulty with daily tasks - apraxia.
4. Anxious.
5. Agnosia - difficulty recognising faces and places.
251
Give 3 causes of dementia.
1. Alzheimer's.
2. Vascular dementia.
3. Lewy bodies.
4. Fronto-temporal.
252
Which disease is fronto-temporal dementia often associated with?
MND.
253
Give 2 histological signs of Alzheimer's disease.
1. Plaques of amyloid.
| 2. Neuronal reduction.
254
Describe the treatment for Alzheimer's.
Anticholinesterase inhibitors e.g. Donepezil and Rivastigmine.
255
With what type of dementia would you associate TIA's?
Vascular dementia.
256
What investigations would you do in someone with dementia and why?
- Bloods - FBC, U+E, ESR, LFT, TFT, glucose, Ca, B12, folate, ferritin.
- MCS MSU.
These investigations are aimed at detecting a treatable cause.
257
Describe the management of dementia.
1. Refer to memory clinic for formal diagnosis.
2. Open and sensitive discussion with patient and family.
3. Encourage the use of memory aids e.g. notebooks, medication dispensers.
4. Dementia drugs e.g. Rivastigmine.
5. Refer to services e.g. Admiral nurses and charities e.g. Alzheimer's society.
258
Name 3 services available for dementia sufferers.
1. Dementia UK and Dementia Friends.
2. Alzheimer's society Sheffield.
3. Admiral nurses.
4. Age UK.
5. Memory clinic.
259
What 4 questions can be asked to assess mental capacity?
1. Does the patient understand the information?
2. Can the patient retain the information?
3. Can they use the information to weigh up options and make a decision?
4. Can they communicate their decision to you?
260
What is mental capacity?
The patients ability to make a decision about their care.
261
What is DOLS?
Deprivation of Liberty Safeguards.
DOLS are part of the MCA, the safeguards aim to ensure that people in care homes or hospitals who lack capacity are looked after in a way that has their best interests at heart.
262
What questions should be asked when determining whether something is in the patients best interests?
1. What are the patient's past/present wishes or feelings relating to the decision?
2. What are the patient's values and beliefs relating to the decision?
3. Are there any other factors that the patient would want to be considered?
4. What are the risks/benefits of each option?
5. Consider other factors e.g. future implications and safety concerns.
263
What is an IMCA?
Independent Mental Capacity Advocate - a legal safeguard for people who lack capacity. They represent people when there is no one independent of services e.g. no family members/friends.
264
What is the ICD-10 criteria for depression?
1. Persistent sadness or low mood.
2. Loss of interest.
3. Fatigue or low energy.
265
Give 5 risk factors for depression.
1. Female.
2. Past history of depression or family history.
3. Chronic illness.
4. Alcohol/substance abuse.
5. Traumatic events e.g. bereavement.
6. Lack of social support.
7. Low socio-economic status.
266
Give 5 physical symptoms of depression.
1. Sleep disturbance.
2. Unexplained aches/pains.
3. Appetite change.
4. Loss of libido.
5. Changes to menstrual cycle.
6. Weight change.
7. Slowness or fidgety.
267
Give 5 psychological symptoms of depression.
1. Continuous low mood.
2. Feeling hopeless.
3. Tearful.
4. Guilty.
5. Lacking motivation/interest.
6. Anxious.
268
Give 3 social symptoms of depression.
1. Less productive at work/school.
2. Avoiding contact with friends/family.
3. Neglecting hobbies and interests.
4. Difficult relationships.
269
Give 5 differentials for depression.
1. Dementia.
2. Hypothyroidism.
3. Parkinson's Disease.
4. Chronic disease.
5. Cancer.
270
What investigations might you do in someone with depression and why?
Bloods: glucose, U+E's, LFT's, TFT's, Ca, FBC, ESR/CRP.
Imaging if there are features suspicious of an intra-cranial lesion.
These investigations are done to exclude an organic cause.
271
Give 5 risk factors for suicide.
1. Previous suicide attempt.
2. Family history of suicide.
3. History of self harm.
4. Feeling hopeless.
5. History of substance abuse.
6. Relationship problems.
7. Access to harmful means e.g. medications or weapons.
272
What questions may you ask to assess someones suicide risk?
1. Do you ever feel hopeless and that life is not worth living?
2. Do you ever think about taking your own life?
3. Have you made any plans to end your own life?
4. Do you have the means for doing this available to you?
5. What has kept you from acting on these thoughts?
273
Briefly describe section 2 of the mental health act.
Admission for assessment: allows compulsory admission for up to 28 days for assessment.
274
Briefly describe section 3 of the mental health act.
Admission for treatment: allows compulsory admission for up to 6 months for treatment.
275
Briefly describe section 4 of the mental health act.
Emergency admission: compulsory admission for 72 hours.
276
Briefly describe section 135 of the mental health act.
A magistrate can authorise forced entry into a property where it is believed that a person is suffering from a mental health disorder.
277
Briefly describe section 136 of the mental health act.
Used by police to take someone suffering from a mental health disorder from a public place to a place of safety.
278
How would you manage mild-moderate depression?
1. Active monitoring.
2. Low intensity psychological interventions - IAPT, CBT.
3. Encourage lifestyle changes such as exercise, stop smoking, healthy diet.
279
How would you manage moderate-severe depression?
1. High intensity psychological intervention.
| 2. Anti-depressant - SSRI e.g. Fluoxetine or Tricyclic e.g. Amitriptyline.
280
Name 3 SSRI's.
1. Fluoxetine.
2. Citalopram.
3. Sertraline.
281
Name a screening tool for depression that can be used in primary care.
PHQ-9.
282
"Structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “structure”.
Structure looks at what there is - buildings, staff, equipment. E.g. no. of ICU beds per 1000 or no. of vascular surgeons per 1000 or no. of locations screening takes place.
283
When assessing the quality of health services, Maxwell’s classification lists six dimensions. What are they?
1. Effectiveness.
2. Efficiency.
3. Equity.
4. Accessible.
5. Acceptable.
6. Appropriate.
284
Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations. Explain why it may be difficult to attribute a health outcome to the service provided.
1. Other factors may be involved.
2. There may be a time lag between service and outcome.
3. Large sample sizes may be needed.
4. Data may be unavailable or there may be issues with data quality.
285
Give 4 criteria for negligence.
1. Duty of care.
2. Breach in duty of care.
3. Patient harmed.
4. Patient was harmed due to breach in duty of care.
286
What is an NHS never event.
A serious, largely preventable patient safety incident that should never happen if the available preventable measures have been implemented e.g. checklists.
287
Give an example of an NHS never event.
Patient misidentification.
| Misplacement of an NG tube.
288
Clinical errors can be managed using a systems approach and a persons approach. Describe the persons approach.
Errors are due to wayward mental processes e.g. negligence, inattention, distraction. Focuses on unsafe acts of staff on the front-line e.g. nurses, doctors.
289
Clinical errors can be managed using a systems approach and a persons approach. Describe the systems approach.
Adverse events are the product of many causal factors - a whole system is to blame (swiss cheese). Implementation of standardised working and developing error free processes.
