GI + SURGERY Flashcards

Question

How should clinicians act to control food poisoning or infective diarrhoea?

Answer 1

Notify local food safety authority (Section 11 of Public Health (Control of disease) Act 1984) Identify cause (person, school, workplace, event, restaurant) Contact tracing Barrier nursing - PPE Isolate pts - Private/side room with dedicated toilet Increase handwashing and ensure bare below the elbows Clean equipment and aseptic technique Prohibit potential reservoirs Limit transport of pts with infective diarrhoea Pt’s room, bed and bedside equipment should be cleaned thoroughly Urine, faeces and soiled linens should be considered potentially infectious and treated as such Warn visitors of risk Dedicated pt care equipment e.g. blood pressure cuffs

Answer 2

A provision in UK law that gives local authorities in England and Wales the power to take action to control the spread of infectious diseases. Under Section 11, if a medical practitioner or any other person has reason to believe that a patient is suffering from an infectious disease that could be a threat to public health, they are required to notify the local authority. The local authority then has the power to take necessary steps to prevent or control the spread of the disease, including isolating patients, closing premises, and disinfecting areas where the disease is suspected to have spread. It gives the power to require information, to order medical examination if someone’s suspected to be infected, the power to take specimens, the power to detain to prevent spread and the power to disinfect anything suspected to be contaminated

Answer 3

C.diff Norovirus Rotavirus E.coli MRSA

Answer 4

Proper hand hygiene Isolation PPE Environmental cleaning Education on signs and symptoms

Answer 5

A UK law that sets out the framework for food safety and hygiene It defines food and the responsibilities of the enforcement authorities Offences: Sale of food rendered injurious to health, unfit for consumption, not of quality demanded by purchaser Display of food with label falsely describing food or likely to mislead as to a nature/quality

Answer 6

Heavy alcohol consumption Viral Hepatitis A, B, C, D, E Obesity/high fat diet/high cholesterol Genetics Medications e.g. paracetamol OD, steroids Medical conditions: Biliary disease (PBC, PSC) or Vascular disease

Answer 7

Not engaging in dangerous activities e.g. unsafe sex, sharing needle, IVDU Lose weight Cut down on alcohol Up to date on vaccines

Answer 8

Education in school, media or by doctors on healthy diets, importance of exercise, dangers of alcohol and drug use Provide needle banks for safe drug use Regulations to improve food safety and reduce exposure to toxins e.g. aflatoxins Screening Free condoms Reducing risk from drugs e.g. better mental health treatment and blister packs for paracetemol Tax and restrictions on alcohol and sugar Vaccinations for healthcare workers and travellers Safe work environment to reduce needle stick injury Careful screening of blood transfusion Better mental health awareness

Answer 9

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

Answer 10

UK National Screening Committee

Answer 11

The condition should be an important health problem There should be an accepted treatment for patients with recognised disease Facilities for diagnosis and treatment should be available There should be a recognisable latent or early symptomatic stage There should be a suitable test/examination The natural history of the condition should be adequately understood There should be an agreed policy on whom to treat as patients It should be cost effective Case-finding should be a continuing process and not a ‘once and for all’ project

Answer 12

Breast cancer - mammogram women 50-70 every 3 years and women >70 at self-referral Cervical cancer - women 25-49 every 3 years and women 50-64 every 5 years Bowel cancer - m+f 60-74 every 2 years after this at self-referral AAA - men one off 65 Diabetic eye screening - annually from the age of 12 Newborn blood spot screening, hearing and physical examination Screening in pregnancy

Answer 13

1 in 7 women! 56,000 new cases each year 11,500 deaths a year 76% survival for 10 or more years Most common cancer in the UK

Answer 14

Better survival and less requirement for radical therapy May require less long-term therapy Reassurance for those with negative results Allows you to make informed decisions about your health Early detection may improve health outcomes Early detection can improve treatment outcomes Allows the pt to take preventative measures Some deaths from AAA, bowel cancer, breast and cervical cancer can be prevented Cost-effective compared to cost of treating diseases or complications

Answer 15

Overdiagnosis - longer morbidity if diagnosis is unaltered Cost of resources False reassurance for false negatives Unnecessary investigation and treatment for false positive - waste fo resources and may have health implications for pt i.e. complications of investigations Unnecessary investigations for borderline pos/neg results False pos and negs Can lead to difficult decisions May cause considerable anxiety

Answer 16

You end up identifying too many people needing unnecessary further investigations High sensitivity but low specificity - false positives

Answer 17

All the people you identify are more likely to have the disease but you will inevitably miss some - low sensitivity but high specificity

Answer 18

When a disease is diagnosed earlier so it appears survival time is longer but in fact it has just been diagnosed for longer

Answer 19

Measure deaths prevented rather than survival

Answer 20

You are more likely to detect a slow growing, more treatable cancer so prognosis will be good i.e. you are more likely to detect disease with a longer sojourn time

Answer 21

Individuals screened not being representative of the population - well-educated individuals tend to worry and comply with screening better but these individuals tend to be healthier and so will have better outcomes

Answer 22

Individual with positive screening test results are more likely to undergo confirmatory testing I..e the individual’s interpretation of the result is affected by their pre-existing beliefs This can lead to an overestimation of the accuracy of the screening test, because the individual is only focusing on the instances where the screening test and the confirmatory test results agree, while ignoring any instances where they do not agree. In reality, the accuracy of a screening test should be evaluated based on its sensitivity and specificity, which are determined through rigorous scientific studies, and not based on individual experiences or perceptions.

Answer 23

Capacity - high demand for it so long wait times and delays Shortage of trained personnel e.g. radiographers Barriers to access such as low socioeconomic groups or ethnic minorities False positives Overdiagnosis

Answer 24

Screening uptake Cancer detection rates False positive rates Interval cancer rates Treatment outcomes Patient and staff satirisation

Answer 25

Quality indications: Compliance with national standards and guidelines Timeliness Safe Effectiveness Patient experience

Answer 26

Physical changes - pain, fatigue, scars, stoma Psychological changes - anxiety, depression, social isolation, fear of recurrence Social changes - capabilities, family, future plans, realtionship strain, financial burden, work issues Spiritual changes Existential changes i.e seeking meaning of life in the face of death

Answer 27

Cultural beliefs - in some cultures cancer may be stigmatised which can lead to feelings of shame and guilt. On other cultures cancer may be viewed as a punishment leading to feelings of despair of hopelessness Socioeconomic - income, education - may have limited access to healthcare resources and support services which can impact their ability to cope with the emotional and financial burden of cancer Gender and age - women with breast cancer may exprence body image issues and feel stigmatises, older adults may experience unique challenges e.g. mobility issues or cognitive decline that can impact their ability to manage their cancer treatment

Answer 28

a study found that individuals from more deprived areas in England were more likely to experience delays in the diagnosis of lung and colorectal cancer. The study also found that individuals from ethnic minority groups were more likely to experience delays in the diagnosis of lung cancer. 2018 in the British Journal of General Practice

Answer 29

Individual level: - lack of knowledge about symptoms and importance of early detection - fear and anxiety about diagnosis and treatment - cultural and language barriers prevention people from seeking help - beliefs in cancer and its causes which cna impact a pt decision to seek care Social determinants of health: - lower income groups more likely to present with advanced cancer due to barriers of healthcare access, transport or childcare - individuals from certain ethnic minorities are more likely to present with advanced cancer due to systemic racism, lack of access to healthcare, cultural or language barriers - geirgraphy - people living in rural or remote areas are less likely to have access to screening programmes and treatment Others: - lack of trust in healthcare system - stigma surrounding cancer - fear of cancer diagnosis or treatmet

Answer 30

Few unresolved concerns Good social support Active coping - seeking support, engaging in positive thinking etc Personality traits - optimistic, resilient, strong sense of self-efficacy Knowledge and understanding so they feel empowered to make informed decisions Good relationships with staff Satisfaction with information Spirituality and religious beliefs as a source of strength

Answer 31

This coping style involves taking active steps to address the problem or stressor causing the distress. Examples may include seeking information, making decisions, and taking action to manage the cancer.

Answer 32

This coping style involves managing the emotional response to the stressor rather than trying to change the stressor itself. Examples may include seeking support from family or friends, practicing relaxation techniques, and engaging in activities that provide a sense of comfort.

Answer 33

This coping style involves avoiding or denying the stressor or problem. Examples may include avoiding conversations about the cancer, denying the severity of the illness, or engaging in activities to distract from the stressor.

Answer 34

This coping style involves finding meaning and purpose in the cancer experience. Examples may include finding ways to give back to others, developing a new appreciation for life, or finding spiritual or religious meaning in the experience.

Answer 35

When pt believes the events are predetermined and that their actions have little to no effect on the outcome e.g. cancer is inevitable and there is nothing that can be done to treat or prevent it This can lead to a sense of hopelessness and may discourage individuals from seeking medical care or engaging in preventative behaviours

Answer 36

Younger patient Atypical symptoms Misdiagnosis Inadequate examination Inappropriate tests Failing to follow-up negative/inconclusive tests

Answer 37

BRCA1 and BRCA2

Answer 38

Genetic testing in 1st degree family members Consider mastectomy and oophorectomy Advice (lifestyle, contraception, HRT) Mammogram and breast MRI every year starting at age 25 Education on symptoms and signs of cancer (e.g. breast checking)

Answer 39

12-48 hours

Answer 40

48-72 hours

Answer 41

Campylobacter

Answer 42

Shigella Vibrio cholera Enterotoxigenic E.coli (Due to poor sanitation)