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phase 3a mine > GP > Flashcards

GP Flashcards

1
Q

equality vs equity (vertical vs horizontal)

A

equality = equal treatment

equity = fair treatment

horizontal equity = equal tx for equal need
- eg 2 similar pts with pneumonia get same tx

vertical = inequal tx for inequal need
- eg pneumonia treated dif to cough
- eg poorer area should have greater expenditure due to greater health need

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2
Q

3 domains of public health

A

improvement
(social improvement e.g. inequalities, lifestyle)

protection
(infectious diseases and enviromental hazards e.g. radiation, covid outbreaks, emergency response)

care
(safe high quality services e.g. clinical effectiveness, equity, audits)

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3
Q

health behaviour
illness behaviour
sick role behaviour

definition and example

A

health behaviour = prevent disease
- eat healthy

illness behaviour = seek remedy
- go to doctor

sick role behaviour = getting well
- rest
-take medication

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4
Q

risk perception -4

A
  1. Lack of personal experience with problem
  2. Belief that preventable by personal action
  3. Belief that if not happened by now, it’s not likely to
  4. Belief that problem infrequent
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5
Q

prevention paradox

A

preventing population incidence of X disease involves individuals risk only being reduced slightly (see notebook if this doesnt make sense)

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6
Q

antihypertensive steps

A

first line = ACEi/ARB (always this if T2DM) or CCB (if over 55 or A-C)

second line = add the other or thiazide-like diuretic

third line = all 3

fourht line = add beta blocker

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7
Q

initial HTN investigations

A

BP (in clinic and ambulatory)
ECG (HF or arrhythmia may cause HTN, or HTN may cause cardiomegaly)
DM inv
U/Es, LFTs, FBC
retinopathy / limbs for ulcers

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8
Q

what to assess for whether to give antibiotics (e.g. for throat)

A

feverPAIN (each worth 1 point)
- fever in last 24h
- < 3d since symptom onset (attended rapidly)
- inflammation of throat- severe tonsil inflam
- no cough or coryza
- purulent tonsils

likelihood of strep throat - 3/4 maybe give abx (maybe delayed), 5, probs give

centor criteria = similar, doesnt include how rapidly they attended, but does include swollen lymph nodes, and age (younger = more likely strep throat)

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9
Q

dermatolgical conditions abx tx

A

local - topical fusidic acid
everywhere - oral flucoxacillin (clarith if pen allergy)

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10
Q

ear infection

symptoms
abx tx

A

external (itchy pain, discharge, tympanic membrane intact and shiny, ?hearing) - flucoxacillin - drops best (oral if cellulitis)

media (tympanic membrance dulll or broken, ENT symptoms, maybe discharge leaking out, hearing/balance affected if severe)- amoxiccilin oral (/clarith if cant have amox cos of pen allergy)

– mastoiditis (tender/boggy) only present in otitis media

interna - labrinthitis - balance/vertigo and hearing ?n/v

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11
Q

bacterial tonsilitis tx

A

pen v - Phenoxymethylpenicillin
ben pen - benzylpenicilin

(usually viral, use feverPAIN and clinical judgment)

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12
Q

when to admit tonsilitis

A

cant swallow water
cant breath as well
quinsy (needs draining and abx)

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13
Q

red flags for ENT cancer

A

bloody cough
voice change
neck lumps
mouth/throat swelling
difficulty swallowing / breathing
smoking
PMH/FH
cant open jaw/ turn head

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14
Q

red flags for brain tumour

A

early morning headache
worsening headache (as time goes on)
neurological/ behavioural change
FH brain cancer

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15
Q

DVT provoked / unprovoked

A

provoked - pregnancy, recent surgery, recent immobilisation, clotting issue (NB- not AF , that is more arterial)

if unprovoked, suspect cancer …. so consider doing
- Ca (bone)
- LFTs
- breast cancer exam
- CT head
- X ray chest
- PSA (prostate)

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16
Q

AAA presentation

A

syncope
drop in BP
tearing pain, radiates to back

this is rupture^, mostly cant feel pre-rupture, maybe pulsating is aneurysm is large

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17
Q

UTI tx

A

first line = nitrofurantoin / trimeth (bad for preg)

amox/clarith

uncomplicated = 3d
5d if old
7-14days if complicated

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18
Q

UTI un/complicated

A

uncomplicated = unfebrile, not immunocompromised, non-pregnant female

complicated = fever, immunocomp, preg, male, catheters, stones, kidney involvement, ureter obstruction

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19
Q

what hba1c aim for

A

48, (e.g. just on metformin
54 if on several / hypoglycaemic med (e.g. sulphonylurea)

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20
Q

PPI monitoring

A

hypocalcaemia (osteopenia)
hyponatraemia
can mask gastric cancer - early satiety, weight loss, pain?

NB: PPI needed with NSAIDs (due to gastro irritation)

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21
Q

how to assess capacity

A

Must be able to do ALL:
Do they understand the given information
Can they retain it
Can they weigh up decision
Can they communicate the decision

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22
Q

key principles of mental capacity act

A

Presume capacity

Support individuals to make own decisions
- Involve them even if they lack capacity

Unwise decisions
- Decisions you do not agree with do not mean they lack capacity

Best interests

Least restrictive option
Interfere with rights/ wishes least

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23
Q

confusion screen (bloods) and other inv

A

FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia, electrolyte imbalances)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency - Anaemia; b12 def affects cerebellum)
Glucose (e.g. hypoglycaemia/hyperglycaemia), and HbA1C

Urine sample - UTI
Blood cultures (e.g. sepsis)
ECG
Chest X ray
CT head - stroke, abscess
Sudden onset - perhaps delerium
Memory test

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24
Q

dementia in learning disability compared to normal intelligence

A

less social, talkative, withdrawn,
personality changes - irritable
more seizures
quicker progression

‘typical’ - memory loss, inhibition, reliance on others (judgement, decisions) - would not appear as much with learning disability

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25
Q

Neurofibrillary tangles is associated with

A

alzheimers

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26
Q

Amyloid aggregations after Congo stain

A

non-specific and is present in Parkinson’s disease, Alzheimer’s disease and Huntington’s disease.

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27
Q

Cerebral blood vessel damage is associated with

A

vascular dementia, and other cerebrovascular conditions.

28
Q

Abnormal collection of alpha-synuclein in neuronal cytoplasms is associated with

A

lewy body dementia

also lewy bodies in basal ganglia

29
Q

pseudo dementia

A

depression that appears as dementia

so slowed down that present as cognitively impaired, amnesia, concentration, neglect

30
Q

prostate cancer inv

A

Stool test (rule out other things) - FIT test (not diagnostic, just screening)

Colonoscopy/sigmoidoscopy with biopsy
CT if rejected

DRE

31
Q

tiredness Inv

A

TFTs
sleep
bone profile - hypoCa/hypoPhos
mood
(iron def) anaemia
testosterone
change in diet/exercise/work/social ..
DM

32
Q

NSAIDS e.g.

A

naproxofen (stronger)
s - celecoxib
asprin
ibuprofen
diclofenac (stronger)

+ miloxical

nOT paractemol

33
Q

analgesia ladder

A
  1. NSAIDs (+ adjuvants)
    - paracetemol
  2. weak opiod (+ adjuvants, +1 )
    - e.g. tramadol, codeine, co-codamol, hydrocodone
  3. strong opioid (+adjuvants, +1)
    - e.g. morphine, fentanyl, oxycodone
34
Q

glandular fever test

tx

A

high lymphocytes
high monocytes
monospot blood test (antibody)

rest, hydrate, steroids if v big tonsils

35
Q

breastmilk has what

A

digestive enzymes
anti-infective factors - wbc, antibodies, viral frragments, tranfer factors (distinguish foreign from native matieral)
gut protection

36
Q

palpitations / racing heart

  • DD
  • inv
A

caffeine, alcohol, drugs
AF/flutter
heart block /MI/ HF
electrolyte imbalance
anaemia
sepsis
anxiety / panic attack
withdrawal
hyperthyroidism
dehydration
poor sleep

exam (AF, HF, hyperthy, sepsis)
bloods (electrolytes, sepsis, hyperthy, anaemia)
ECG (AF, HF, MI, HB)

37
Q

test for
- lactose intolerance
- fructose intolerance
- SIBO small intenstine bacterial overgrowth
- H pylori

A

breath test for each!

38
Q

PSA

screens for?
issue =

A

prostate ca

raised in lots
- BPH/BPE
- prostatitis
- DRE (wait 1w to do PSA)
- sex / ejac (wait 48h)
- vigourous exercise / cylcling (wait 48h)
- UTI (do urine dip before referral)
- age

some prostate cancer asymp/ not problematic - and tests/ tx is invasive / SE so not necessarily worth it

39
Q

DRE findings

A

BPE- big and smooth
Ca - big / craggy
prostatis - ?Tender

40
Q

shingles tx

A

if immunocomp OR <3d presentation –> antiviral (acyclovir)
(immunocomp if large pain/rash, rash not truncal)

> 3d presentation –> paracaetemol
- lots of pain –> gabapentin/ amitryp

41
Q

chostrochondritis

=?
tx

A

cartilidge inflam
mechanical cause

pain killer gel
rest

42
Q

abdo pain better post vom

A

food pois

43
Q

3 concerns of public health

A

health inequalities
wider determinents of health
prevention

44
Q

4 sociological perspectives of ‘need’

Bradshaw’s need

A

Felt need – individual perceptions of variation from normal health (cant walk as far)

Expressed need – individual seeks help to overcome variation in normal health (demand) (go to doctor)

Normative need – professional defines intervention appropriate for the expressed need (Get a vaccine, go to rehab, take this medication)

Comparative need - comparison between severity, range of interventions and cost

45
Q

sensitivity
=?
calculation

A

The proportion of people with the disease who are correctly identified by the screening test

True positive / (true positive + false negative)

46
Q

specificity
=?
calculation

A

The proportion of people without the disease that are correctly excluded by the screening test

True negative / (true negative + false positive)

47
Q

postive predicted value
=?
calculation

A

The proportion of people with a positive test result who actually have the disease

True positive / (true positive + false positive)

48
Q

negative predicted value
=?
calculation

A

The proportion of people with a negative test result who do not have the disease

True negative / (true negative + false negative)

This is lower if the prevalence is higher

49
Q

incidence and prevalence

A

incidence: The number of new cases of a disease in a population (e.g. per 100,000) in a given time frame (e.g. per year)

prevalence: The total number of people with a condition per 100,000 per year
Number of existing cases/population/point in time

50
Q

lead time bias =?

A

When screening identifies an outcome earlier than it would otherwise have been identified

This results in an apparent increase in survival time, even if screening has no effect on outcome

51
Q

odds ratio
=?
calculation

A

The odds of an event is the ratio of the probability of an occurrence compared to the probability of a non-occurrence

Odds = probability/ (1 – probability)

52
Q

health belief model

A
  1. percieved susceptibility
  2. perceived severity
  3. percieved benefits
  4. perceived barriers

SSBB

–> likelihood of action (influenced by demographic ….)

53
Q

theory of planned behaviours

A

best predictor of change is INTENTION

(attitude, subjective norm (from others), percieved behaciour control (over the factors)

54
Q

implementation intenetion

A

if X, then Y
like putting medication near kettle

55
Q

stages of models/ transtheoretical

A

precontemplation
contemplation
preparatory
action
maintenance (6m)

56
Q

social norms (behaviour change)

A

peer influences and common behaviours/ attitudes influence individual behaviour

57
Q

nudge theory

A

changing the environment - choice architecture - can change likelihood of behaviours

e.g. where food is in the supermarket

58
Q

Bradford Hill Criteria for Causation (6)

A

DR BC ST

  • dose-response
  • reversability (take away exposure –> reduced likelihood)
  • biological plausability
  • consistency
  • strength (of association)
  • temporality - exposure before outcome
59
Q

lead time

length time

A

Lead time – early identification doesn’t alter outcomes but appears to increase survival e.g. patients know they have the disease for longer

Length time – disease that progresses more slowly is more likely to be picked up by screening (i.e. symptom free and around for longer), which makes it appear that screening prolongs life (– like less aggressive cancers more likely to be found by screening, so these ones have longer survival , regardless of screening)

60
Q

health needs assessment (4)

what are the approaches (3)

evaluation
- Donabedian
- Maxwell

A

ASSESSMENT
- needs assessment
- planning
- implementation
- evaluation

(cycle)

APPROACHES
- Epidemiological, (top down)
- comparative, (X group is more healthy than Y)
- corporate (takes views of patients, companies… )

EVALUATION

Donabedian
- Structure – What there is
- Process – What is done
- Outcome

Maxwell (3xe, 3xa)
- access
- acceptability
- appropriate
- equity
- efficient
- effective

Brought together in wrights matrix (table)

61
Q

relative risk calculation

A

exposed group risk/incidence divided by non-exposed group risk/incidence

62
Q

NNT/ attributable risk equaition

A

NNT = 1/attributable risk

(attributable risk = absolute risk difference : risk of cancer in smokers minus risk of cancer in nonsmokers)

63
Q

types of error

outcomes

A

 Sloth (lazy) - inadequate documentation

 System error – Inadequate built in safeguards, lack of surgical equipment due to failure of rota for someone to check stock

 Lack of skill – not having appropriate training – Unable to do ABG

 Fixation – focus on one diagnosis only e.g. patients comes in with photophobia, you
decide it is meningitis and it turns out to be a SAH

 Bravado – working beyond competency, deciding to treat complex patient alone
without requesting senior opinion

 Playing the odds – deciding it is a common disease and then it turns out to be a rare one

 Poor team working – communication breakdown

either. –> ‘adverse event’ or ‘near miss’

64
Q

PDSA model

A

plan
do
study
act

(cycle)
for quality improvement

65
Q

association can be due to (5)

A

Bias

Confounding factors

Chance

Reverse Causality

True association

66
Q

3 buckets model error

A

self
context
task

phase 3a mine (16 decks)

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