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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
Neurofibrillary tangles is associated with
alzheimers
26
Amyloid aggregations after Congo stain
non-specific and is present in Parkinson's disease, Alzheimer's disease and Huntington's disease.
27
Cerebral blood vessel damage is associated with
vascular dementia, and other cerebrovascular conditions.
28
Abnormal collection of alpha-synuclein in neuronal cytoplasms is associated with
lewy body dementia also lewy bodies in basal ganglia
29
pseudo dementia
depression that appears as dementia so slowed down that present as cognitively impaired, amnesia, concentration, neglect
30
prostate cancer inv
Stool test (rule out other things) - FIT test (not diagnostic, just screening) Colonoscopy/sigmoidoscopy with biopsy CT if rejected DRE
31
tiredness Inv
TFTs sleep bone profile - hypoCa/hypoPhos mood (iron def) anaemia testosterone change in diet/exercise/work/social .. DM
32
NSAIDS e.g.
naproxofen (stronger) s - celecoxib asprin ibuprofen diclofenac (stronger) + miloxical nOT paractemol
33
analgesia ladder
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
glandular fever test tx
high lymphocytes high monocytes monospot blood test (antibody) rest, hydrate, steroids if v big tonsils
35
breastmilk has what
digestive enzymes anti-infective factors - wbc, antibodies, viral frragments, tranfer factors (distinguish foreign from native matieral) gut protection
36
palpitations / racing heart - DD - inv
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
test for - lactose intolerance - fructose intolerance - SIBO small intenstine bacterial overgrowth - H pylori
breath test for each!
38
PSA screens for? issue =
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
DRE findings
BPE- big and smooth Ca - big / craggy prostatis - ?Tender
40
shingles tx
if immunocomp OR <3d presentation --> antiviral (acyclovir) (immunocomp if large pain/rash, rash not truncal) >3d presentation --> paracaetemol - lots of pain --> gabapentin/ amitryp
41
chostrochondritis =? tx
cartilidge inflam mechanical cause pain killer gel rest
42
abdo pain better post vom
food pois
43
3 concerns of public health
health inequalities wider determinents of health prevention
44
4 sociological perspectives of 'need' Bradshaw's need
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
sensitivity =? calculation
The proportion of people with the disease who are correctly identified by the screening test True positive / (true positive + false negative)
46
specificity =? calculation
The proportion of people without the disease that are correctly excluded by the screening test True negative / (true negative + false positive)
47
postive predicted value =? calculation
The proportion of people with a positive test result who actually have the disease True positive / (true positive + false positive)
48
negative predicted value =? calculation
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
incidence and prevalence
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
lead time bias =?
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
odds ratio =? calculation
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
health belief model
1. percieved susceptibility 2. perceived severity 3. percieved benefits 4. perceived barriers SSBB --> likelihood of action (influenced by demographic ....)
53
theory of planned behaviours
best predictor of change is INTENTION (attitude, subjective norm (from others), percieved behaciour control (over the factors)
54
implementation intenetion
if X, then Y like putting medication near kettle
55
stages of models/ transtheoretical
precontemplation contemplation preparatory action maintenance (6m)
56
social norms (behaviour change)
peer influences and common behaviours/ attitudes influence individual behaviour
57
nudge theory
changing the environment - choice architecture - can change likelihood of behaviours e.g. where food is in the supermarket
58
Bradford Hill Criteria for Causation (6)
DR BC ST - dose-response - reversability (take away exposure --> reduced likelihood) - biological plausability - consistency - strength (of association) - temporality - exposure before outcome
59
lead time length time
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
health needs assessment (4) what are the approaches (3) evaluation - Donabedian - Maxwell
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
relative risk calculation
exposed group risk/incidence divided by non-exposed group risk/incidence
62
NNT/ attributable risk equaition
NNT = 1/attributable risk (attributable risk = absolute risk difference : risk of cancer in smokers minus risk of cancer in nonsmokers)
63
types of error outcomes
 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
PDSA model
plan do study act (cycle) for quality improvement
65
association can be due to (5)
Bias Confounding factors Chance Reverse Causality True association
66
3 buckets model error
self context task

phase 3a mine (16 decks)

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