GI and Surgery

Question 1

Effect of stomas on image

Answer 1

anxiety, depression, QOL and ADL change, relationship

Shock, denial, acknowledgement and resolution

Question 2

Define food poisoning

Answer 2

Gastroenteritis with an infectious cause

Question 3

Who needs special precautions with food poisoning

Answer 3

Pregnant women
Young children/elderly
Immunosuppressed (or people close to them)
Work in food prep

Question 4

What does the food act 1990 define

Answer 4

Defines food and enforcement authorities and their responsibilities

You cannot sell food unit for consumption or display food with a false label

Question 5

What does section 11 of the public health control of diseases act state

Answer 5

You must notify local authority of any food poisoning

Question 6

Rapid onset (less than 12 hrs) food poisoning organisms

Answer 6

Staph aureus: cooked food that is then contaminated –> toxin
Bacillus cereus: after eating cooked rice

Question 7

Intermediate onset (12-48 hrs) food poisoning organisms

Answer 7

Norovirus: most common, RNA virus spread in close environments
Clostridium: normal flora, slow cooling/unrefrigerated food
E.coli: from milk/meat (cattle) –> watery diarrhoea and HUS
Shigella: contaminated food, watery + bloody diarrhoea

Question 8

Late onset (days) food poisoning organisms

Answer 8

Campylobacter: common, undercooked/raw poultry, unpasteurised milk, bloody diarrhoea
Salmonella: eggs, poultry or water infected with faeces, late summer (typhoid)
Cryptosporidium: foreign travel, swimming pool or camping (severe if immunosupressed)
Legionella: Water (AC), cough, fever, D+V

Question 9

Dealing with community outbreak of food poisoning

Answer 9

Identify and isolate source and treat individual

Question 10

Dealing with infective diarrhoea in hospital

Answer 10

Rapid isolation and identification
Monitor protocols
Communication
Suspend admissions and visitors

Question 11

Purpose of an MDT

Answer 11

Recommend treatment plans, collect information and refer

Question 12

Risk factors for liver disease

Answer 12

Alcohol
Hep B/C
Genetics (haemachromatosis, A1AT, Wilsons)
Budd-Chiari
Autoimmune
Drugs (methotrexate, amiodarone, paracetamol, steroid, statin)

Question 13

Hepatitis Vaccinations

Answer 13

Hep A: vaccinate if high risk, occupational risk, long term damage
Hep B+C

Question 14

Transmission of Hep B and C

Answer 14

Needles, tattoo, sex

Question 15

Define the term screening

Answer 15

The application of a test to identify individuals at sufficient risk of a disorder to warrant investigation or direct preventative action amongst persons who have not sought medical attention to account for the symptoms

Question 16

2 key features of screening

Answer 16

Cost effective

Improve outcomes

Question 17

How can you assess cost effectiveness

Answer 17

Number of years saved (cost-effectiveness analysis)

Question 18

5 key points of the condition in screening

Answer 18

Condition: important, prevalent and progression understood, latent period/early symptomatic stage

Question 19

5 key points of the test in screening

Answer 19

Simple, safe, precise, acceptable, agreed procedure with the positive results

Question 20

Key point about the treatment in screening

Answer 20

Evidence that the treatment is more effective if given earlier

Question 21

Key point about the programme in screening

Answer 21

Evidence it is effective in outcomes and outway costs/harms

Question 22

4 dangers of screening

Answer 22

False positives/negatives, costs, side effects of test and treatment, public perception

Question 23

Most common cancer ein the UK

Answer 23

Breast

Question 24

7 RF for breast cancer

Answer 24

Low socio-economic status, family history, white, alcohol, ionising radiation, increased oestrogen exposure

Question 25

Explain the standard breast screening programme

Answer 25

Invited between 50 and 70 and screened every 3 years

Question 26

3 outliers for breast screening

Answer 26

47-73 in some parts of the country
Over 70 can still have it but need to ask

Moderate risk (FHx): yearly from 40-60
High risk (BRACA): yearly MRI/mammogram from 30-60

Question 27

3 benefits to breast screening

Answer 27

Early identification means increased cure rate
Reduce deaths
Detects 90% of cancers

Question 28

3 negatives to breast cancer screening

Answer 28

False positives and negatives give unnecessary anxiety/reassurance
Overdiagnosis/treatment - find cancer that would never have caused disease
Side effects of treatment - radiation can cause breast cancer

Question 29

Explain bowel cancer screening

Answer 29

Male and Female over 55 offered one off flexible sigmoidoscopy test to look for polyps
60-74 offered FOB every 2 years (over 75 can ask)

Question 30

Explain cervical screening

Answer 30

Women aged 25-49 every 3 years

Women aged 50-64 every 5 years

Question 31

Other screening tests

Answer 31

Diabetic retinopathy
Chlamydia
Downs syndrome
Foetal abnormalities
Newborn hearing
Newborn bloodspot

Question 32

Explain the organisation of breast screening services

Answer 32

GP refer to triple assessment

1. clinical examination
2. ultrasound below 35, mammography and ultrasound above 35
3. histology/cytology

Question 33

Psychosocial impact of breast cancer diagnosis

Answer 33

Worry about the future (death, treatment)
Worry about responsibility, time off work
Reactions of family and society

Question 34

Delayed presentation in breast cancer

Answer 34

Less likely to delay

Socioeconomic status, time off work, financial costs
Influenced by family
Worry about the diagnosis