GP Flashcards
1
Q
Describe the physiology of wound healing
A
- Vascular response (vasoconstriction, clotting)
- Inflammation
- Proliferation
- Maturation
2
Q
Name three inflammatory mediators
A
- Histamine
- Prostaglandin
- PDGF
3
Q
Role of histamine in inflammatory response
A
Causes vasodilation in adjacent vessels to re-direct flow of blood
4
Q
How long after injury does vasodilation peak
A
20 minutes after
5
Q
Describe the inflammatory response
A
- Neutrophils and macrophages recruited into the wound by growth factors
- Release free radicals / macrophages ingest dead tissues
6
Q
How long after inflammatory process do lymphocytes enter the area
A
72 hours
7
Q
What part of the healing process is slough seen
A
Inflammatory response
8
Q
Describe the proliferative stage
A
- 2-3 days after inflammatory stage
Fibroblasts secrete collagen and glycosaminoglycans
Collagen fills up the wound
Summary: granulation, epithelialisation and contraction
9
Q
How long in the process does maturation take place
A
20 days later
10
Q
What is primary intention suturing
A
- ONLY ACHIEVED if no tissue loss
WOUNDS NEED TO BE CLOSE TO EACH OTHER
Has a linear scar
11
Q
What is secondary intention suturing
A
- Ulcer, traumatic skin loss
- Wound is allowed to granulate
- Epithelialisation occurs from follicle hair remnants of base wound
12
Q
What is tertiary intention
A
- Wound is purposely kept open by cause
- Initially cleaned, derided and observed
- Later, surgically closed
13
Q
Barriers to healing
A
- Elderly
- Diabetes
- Malnutrition
- Malignancy
- Site
- Infection
- Oedema
- Vascular insufficiency
14
Q
Treatment for otitis media
A
- Amoxicillin
15
Q
Treatment for sinusitis
A
- Amoxicillin
16
Q
Treatment for tonsilitis
A
- Penicillin
17
Q
Treatment for LRTI
A
Amoxicillin
18
Q
Treatment for UTI
A
Trimethoprim
Nitrofurantoin
19
Q
What are the risk levels for domestic abuse
A
STANDARD - current evidence does not indicate likelihood of serious harm
MEDIUM - Identifiable indications of serious harm risks - potential?
HIGH - Identifiable indicators of IMMINENT risk of harm
20
Q
What TOOL is used for domestic abuse risk assessment
A
DASH
21
Q
How can we lower risk of domestic abuse
A
- HEALTH RECORDS
- Ask direct questions
- Give information
- Non-judgemental
22
Q
How are high risk DA patients managed
A
Refer to MARAC
23
Q
What is MARAC
A
meetings that provide up to date information and provision of services
24
Q
Define incidence
A
- Number of new cases in a population
25
Define prevalcence
Number of existing cases in a population
26
What is person-time
1. Measure of time at risk used to calculate incidence rate
27
Formula for incidence rate
No of persons who have become cases in a period of time/ total person-time at risk during that period
28
Define absolute risk
1. Gives feel for actual number involved (50 deaths/1000 population)
29
Define relative risk
Risk in one category relative to another
30
Define attributable risk
Rate of disease in exposure that may be attributed to exposure
31
Define relative risk
Ratio of risk of disease in the exposed to the risk in unexposed
32
Name two types of bias
1. Selection
| 2. Information
33
Define confounding
1. Situation where a factor is associated with exposure of interest and independently influences the outcome
34
What is the criteria for causality
1. Strength of association
2. Dose-response
3. Consistency
4. Temporality
5. Reversibility
6. Biological plausibility
35
What is an ecological study
observational study defined by the level at which data are analysed, namely at the population or group level, rather than individual level.
36
What is a case control study
A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls)
37
What is a meta analysis
Study of combining multiple studies in an effort to increase estimate size
38
What is reverse causation
One factor can cause the outcomes and those outcomes are causing the factor (like a loop) - temporal sequence issues
39
What is a cohort study
1. PROSPECTIVE
People without disease are exposed and not = see who gets the disease
40
What is a case-control study
RETROSPECTIVE and PROSPECTIVE
| Looking at people with (case) and without the disease (control) and seeing who are exposed and not exposed to risk
41
What is a prevention paradox
Preventative measures bring benefit to population but not to each participating individual (e.g. carseat idea)
42
Define screening
Process which sorts out apparently well people who PROBABLY don't have the disease from those who PROBABLY do
43
Define sensitivity
Proportion of people correctly identified by test
44
Define specificity
Proportion of people correctly excluded by test
45
Define PPV
Proportion of people who actually have the disease (hint, NPV is opposite)
46
Define lead time bias
Early diagnosis falsely makes it look like people are surviving longer
47
Define length time bias
Overestimation of survival duration due to excess cases lowly progression
48
Define horizontal equity
Equal treatment for equal need (those with pneumonia should get equal treatment)
49
Define vertical equity
Unequal treatment for unequal need ( those with cold vs pneumonia need unequal treatment)
50
Dimensions of health equity
Age
Gender
Class Ethnicity
51
4 determinants of health
Diet
Smoking
Helathseeking behaviour
Socioeconomic
52
Three domains of public health
1. Health imprvoement
2. Helath protection
3. Improving services
53
Equity vs equality
What is fair and just vs concerned with equal shares
54
Describe public measures at each level
1. Individual: patient centred (care responsive to individual need)
2. C`community: local Alcohol sales boost, A and e events
3. Population: health promotion e.g. 5 a day, movember
Screening: MMR
55
Define health psychology
emphasises the role of psychological factors in the cause, progression and consequences of health and illness
Aims to put theory into practice
56
Name three health behaviours
1. Helath (bevhioure to prevent disease
2. illness (behaviour to seek remedy)
3. Sick role (behaviour at getting well)
57
Four factors that influence perception of risk
1. Lack of personal experience
2. Belief that preventable by personal action
3. Belief that if not happened now, won't happen
4. Belief its a rare problem
58
4 things we can do for behavioural change
1. Individual level intervention
2. community
3. Population
4. Evaluating cost effectiveness
59
Define need, demand and supply
Need - ability to benefit from an intervention
Demand - what people ask for
Supply - what is provided
60
Define health needs assessment
Systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
61
Health need vs health care need
1. Need for health vs need for health care
62
```
Define the following:
Felt need
Expressed need
Normative need
Comparative need
```
Felt - individual perceptions of variation from normal health
Expressed: individual seeks help to overcome variation in normal health (demand)
Normative: professional defines intervention appropriate for the expressed need
Comparative: comparison between severity, range of interventions and cost
63
What is a comparative approach
Compares the services received by a population (or subgroup) with others
64
Cons of comparative approach
Data may not be available
Data may be of variable quality
May be difficult to find a comparable population
65
Cons of a corporate approach
Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence
66
Give one health related example of something that you consider is demanded but not needed or supplied, clearly explaining the reasoning for your example.
Antibiotics for a viral infection
67
What is a corporate approach
Politicians, press and providers conduct studies into epidemiology issues
68
Cons of an epidemiological approach
Required data may not be available
Variable data quality
Evidence base may be inadequate
69
Define 4 aspects of epidemiological approach
1. Size of issue
2. Services available
3. Evidence base
4. Models of care
70
How is blood pressure measured
1. Measure BP in both arms
- If the difference in readings between arm is more than 15mmHg repeat the measurements.
2. If the difference between arms remains more than 15mmHg on the second measurement, measure subsequent blood pressures in the arm with higher reading
3. If BP measured in the clinic is 140/90 mmHg or higher, take a second measurement during the consultation.
4. Record three measurements
71
What should be done if the BP is 140/90mmHg or higher
Take second measurementt
72
Name two types of ways we monitor blood pressure
ABPM
| HBPM
73
How is ABPM done
2 measurements per hour during waking time
74
How is HBPM done
2 consecutive measurements at least 1 minute apart with person seated
75
Diagnosis of hypertension
140/90mmHg
76
How often is BP measured in diabetics
Annually: give lifestyle advice
77
What tests do we offer to people diagnosed with hypertension (CV risk assessment)
1. Proteinuria
2. HbA1c
3. Hypertensive retinopathy - fundoscopy
4. 12 lead ECG
78
Lifestyle advice for HTN
1. Discourage coffee and caffeine
2. Lower sodium intake
3. Smoking cessation
79
Treatment pathway for hypertension
1. ACE/ARB if black or over 65
2. ACE + C
3. ACE + C + D
4. ACE + C + D + ALPHA BLOCKER (doxazocin)
80
Essential vs secondary hypertension
1. Essential has no identifiable cause, secondary is caused by other diseases e.g. CKD
81
How is hypertension treatment monitored
1. Clinic BP
2. Advise to self monitor BP
3. Consider HBPM, ABPM
82
What is stage 1 hypertension
1. 140/90 to 150/99
83
What is stage 2 HTN
1. 160/100 to 180/120
84
What is stage 3 HTN
1. 180mmHg or higher
85
Systolic vs diastolic heart failure
1. When the heart ventricles can't pump enough during systole vs when the heart ventricles do not fill up with enough blood during diastole
86
What is CO
HR x SV
87
What is the Ejection Fraction
How much of the total volume in the ventricles is ejected into the carotid artery. Usually 50-70
88
Pathophysiology of systolic HF
1. Decreased contractility of LV causes decreased CO
Decreased EF
2. Happens due to ischaemia caused by MI
3. OR Dilated CARDIOMYOPATHY where ventricles dilate and weaken
89
What is the EVD (End Diastolic pressure volume)
1. The volume of blood that returns from the pulmonary artery into the LV and combines with the leftover blood that wasn't ejected
This increases in systolic HF
90
What is diastolic HF
1. Contractility is fine but less blood returns to ventricles
2. EDP is higher as LV is not compliant enough
91
Effect of EF in diastolic HF
Normal, this is because less blood is returning to the heart but the ventricle is pushing out the same proportion of blood
92
What causes diastolic HF
1. Ventricular hypertrophy - becomes thicker and less compliant
93
Main cause of RHF
1. LHF or cor pulmonale
94
Symptoms of LHF
1. Congestion of Lung vessels
2. Pulmonary oedema, sob
3. Haemoptysis
4. Dyspnoea
5. Orthopnoea as there is more venous return from the lower body back into the heart
6. Paroxysmal nocturnal dyspnoea (wakes people up at night)
7. Crackles on auscultations
BECAUSE there is decreased CO, less blood flow to organs causing fatigue
2. Less blood to kidneys causes RAAS so fluid retention to compensate - this then fails
Leads to pitting oedema
3. Low CO also activates sympathetic nervous system which increases contractility temporarily
EXTRA SOUND on auscultation: S3 gallop (S3 are overly compliant)
95
What is S4
Ventricles stiff, when blood hits the wall as atria contract harder to overcome LV non compliance)
96
Causes of RHF
1. Chronic lung disease, emphysema
97
Symptoms of RHF
1. Congestion in veins (JUGULAR VENOUS DISTENTION), venous congestion in liver causing congestive hepatomegaly (u can see nutmeg liver on inspection as fluid has leaked into hepatocytes) = cardiac cirrhosis
2. Pitting oedema
98
How is HF diagnosed
1. NT-proBNP (raised = poor prognosis)
2. Transthoracic Echocradigram
3. Cardiac MRI/transoesophageal echo if image is poor
4. ECG/urinalysis/blood tests
99
What would be seen on an ECG
1. LV hypertrophy
100
Role of BNP
1. Reduce Ventricular preload and acts on kidneys to increase Na excretion
101
Treatment of HF with reduced EF
1. ACE/ARB and beta blocker (monitor Na, K+ and renal functions)
IF symptoms do not go, Mineralocorticoid receptor antagonist
Ivabradine/valsartan/hydralazine+nitrates for NYHA Class II to IV or combine with standard therapy
OR DIGOXIN if this doesnt work
Diuretics, calcium channel blockers, amiodarone, anticoags, vaccinations
102
Lifestyle advice for HF people
1. Lower Na levels, smoking and alcohol,
103
Describe the classification of HF (NYHA)
1. Class I: Patient comfortable with high physical activity, but causes symptoms of HF
2: Comfortable at rest but norma; physical activity causes symptoms
3. Light activity causes fatigue, palpitations and sob
4. Patient shows symptoms at rest
104
Mortality rate of HF
60%
105
Primary, secondary and tertiary prevention of HF
1. Stop disease before it begins (stop smoking, alcohol
2. Early detection and stopping progression
3. Tertiary: PCI, CABG to prevent further deterioration
106
At 8 weeks of age, what immunisations are given
1. DTap
2. IPV
3. Hib
4. HepB
5. PCV
6. MenB
7. Rotavirus
107
At 12 weeks of age, what immunisations are given
1. DTap/IPV/Hib/HepB
| 2. Rotavirus
108
At 16 weeks of age, what immunisations are given
1. DTap/IPV/Hib/HepB
2. Men B
3. PCV
109
At the age of 1, what immunisations are given
1. Hib/MenC
2. PCV
3. Men B
4. MMR
110
At the age of 2 to 10, what immunisations are given
1. LAIV
3 years 4 months old:
Tap, polio, MMR,
111
What immunisation is given from 12 to 13
HPV,
Yr 9: Td/IPV, MAN ACWY
112
Ethical dilemmas concerning vaccination
1. Beneficence, nonmaleficience, etc
113
Name 2 notifiable diseases
MMR, contact PHE
114
Assessment of an unwell child
1. PAT
2. ABCDE
3. Vital signs, history, examination
115
What is the paediatric assessment triangle
1. Appearance: observing state of mind, TICLS
```
Tone
Mental status
Consolability
Look
Speech
```
116
Describe the traffic light system for fevers
```
GREEN:
Normal colour
Responds normally to stimuli
Normal skin and eyes
Moist mucous membranes
```
```
AMBER:
Pallor reported by parent
Not responding to stimulus, wakes only with prolonged stimulation
Nasal flaring
Tachypnoea
Crackles in chest
Oxygen sats less than 95
Tachycardia
Dry mucous membranes
Poor feeding
3-6 months
Fever over 5 days
Temp over 39
Riggers
Swelling of limb
```
```
RED:
1. PALE/BLUE
2. NO responses to stimuli
3. High pitched cry
4. Tachypnoea (>60)
5. Rudecuded skin turgor
6. <3 months
7. Non blanching rash
8. uldging fontanelle
9. Neck stiffness
NEURO SIGNS
```
117
Management of an infant with red features
1. Assess within 2 hours if there is no life-threatening features
2. HOSPITAL ASSESSMENT
118
Management of an infant with amber features
1. Admission if UTI
2. 5 days = kawasaki disease
3. The recommendation to safety net and/or reassess the child is based on the need to check for any clinical deterioration and to assess for new symptoms or signs suggesting an underlying cause for fever
119
Fever pain score
1. Fever in past 24 hours
2. Absence of cough or coryza
3. Symptom onset <3 days
4. Prurulent tonsils
5. Severe tonsil inflammation
120
Safety netting advice for parents with child who has a fever
RED:
Pale
Stiff for prolongs period of time
Lethargic
A AND E
AMBER:
No wet nappies in last 8 months
Dry mouth
Between 1-3 months with a high temperature
GP surgery
GREEN:
Feeds well
Wet nappies
Stay at home self care
121
Cognitive assessments about Dementia
1. AMTS
2. 6-item cognitive impairment test
3. GPCOG
122
Examples of social support for people with dementia
1. Laundry
2. Meals on wheels
3. OT
4. Access to day centres
Needs assessment
123
Name two effects of being a carer
1. Stress
| 2. Anxiety
124
5 principles of MCA
1. Assume capacity if not otherwise
2. Do not treat as incapable of making a decision unless all practicable steps have been tried to help them
3. A person should not be treated as incapable of making a decision because it seems unique
4. Always take decisions for lack of capacity patients in their best interest
5. Before making a decision on their behalf, consider if outcome could be done in a less restrictive way
125
How to test capacity
1. Retain information
2. Use information to weigh up and com etc a conclusion
3. Communicate decision
4. Unerstdand information
126
Anxiety disorder test
GAD-7
127
Depression severity assessment
PHQ-9
128
Risk factors for TB
1. Diabetes mellitus
2. Low body weight
3. Close contact
4. Silicosis
5. HIV
129
Methods to protect against TB
1. Early detection of TB
2. Reducing time to treatment
3. BCG vaccination
130
What other health problems other than TB can people abroad face
1. HIV
2. Enteric fever
3. Malaria
4. FGM
5. Diabetes
6. Smokers
131
What is the FGM act 2003, section 5b
Anyone who reports FGM and under 18, the person has a mandatory duty to report it
132
What people are commonly susceptible to FGM
1. Women from Africa and Middle East
133
What types of FGm are ther
1. Partial removal of clitoris
2. Removal of clitoris and minor
3. this is the narrowing of the vaginal opening through the creation of a covering seal.
4. This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
134
In patients with HTN and at risk of dementia, what should be given as treatment
1. Calcium channel blocker/dihydropyridine
135
What is the effects of multi morbidity
1. Poor medication adherence and adverse drug reaction - polypharmacy
2. Greater susceptibility to failures of care delivery and coordination
3. Complex management regimens
136
Define appropriate polypharmacy
1. Optimisation of medication regimes has the potential to improve quality of life, longevity and minimise the harm from medications
137
Define problematic polypharmacy
1. Interactions from drug combinations and demands of medicine taking are unacceptable to patients
138
Name the three types of opioids
1. MOR, KOR, DOR
139
Side effects of Opioids
1. Withdrawal
2. Tolerance
3. Weight Gain
4. Hyperalgesia
5. Depression
6. Osteoporosis
7. Constipation
140
Signs of opioid abuse and dependency
1. Craving
2. Altering prescriptions
3. Stealing
4. Calls of early refills
5. Reluctance to try nonpharmacologic interventions
141
Risk factors for opioid dependance
1. Young
2. White
3. Smoker
142
What are the four aspects of the health belief model
Will change if:
1. Belief they are susceptible to condition in question
2. Belief it has serious consequences
3. Belief that taking action reduces seceptibility
4. Belief that the benefits of taking action outweigh the cost
143
Cons of the HBM
1. Does not consider emotions on behaviour
| 2. Does not differentiate between first time and recent behaviour
144
What is the theory of planned behaviour
1. proposes best predictor of behaviour is intention
145
What determines intention according to the theory of planned behaviour
1. A person's attitude to the behaviour
2. Subjectie norm (social pressure to do s o)
3. Perceived behavioural control (if they can do it or not)
146
Cons of theory of planned behaviour
1. Lack of causality
2. Does not explain how attitudes, intention and perceived behavioural norms interact
3. Relies of self-reported behaviour
147
Describe the transtehoretical model
```
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
```
148
Pros of transtheoretical model
1. Acknowledges each individual stag e
2. Accounts for relapse
3. Temporary element
149
Cons of transtheoretical model
1. Not all people move through these stages in the same direction
2. Might be continuous and not discrete
150
Name other models of behavioural change
1. Motivational interviewing
| 2. Nudge theory
151
Define evaluation of health services
1. Evaluation is the assessment of wether a service achieves its objectives
152
Framework for health service evaluation
1. Structure (what is there - staff, buildings)
2. Process
3. Outcome
153
Define process
1. What is done (e.g. number of patients seen in a and e)
154
What four factors classify health outcomes
1. Mortality
2. Morbidity
3. QOL
4. Patient satisfaction
155
Issues with health outcomes
1. Time lag between service provided and outcome
| 2. Large SAMPLE SIZEs may e needed to detect statically significant effects
156
Name four of maxwell's dimensions of quality
1. Effectiveness
2. Efficiency
3. Equity
4. Accessibility
5. Appropriateness
6. Acceptability
157
Two examples of qualitative methods of evaluation
1. Interviews
| 2. Focus groups
158
Two examples of quantitative methods
1. Records
| 2. Survey
159
What is the framework for evaluating health services
1. Define what the service is
2. Aims and objectives of service
3. Framework: structure, process and outcome
4. Methodology to be used
5. Results, conclusions and recommendations
160
Define malnutrition
Deficiencies, excess or imbalance in a person's intake of energy or nutrients (undernutrition or overweight)
161
Early influences on feeding behaviour
1. Maternal diet and test preference
| 2. Parenting practices
162
What are the three components of breastmilk
1. Colostrum
2. Foremilk
3. Hindmilk
163
Three basic forms of dieting
1. Restrict the total amount of food eaten
2. Do not eat certainn types of food
3. Avoid eating for long periods of time
164
4 challenges with dieting
1. Risk of eating disorder
2. Loss of lean body mass not just fat
3. Dieting slows metabolic rate and energy expenditure
4. Chronic dieting can disrupt normal appetite responses
165
What is portion size effect
Consumption of large portion sizes of energy dense food facilitates over consumption
166
Why is dieting challenging for some people
1. Unresponsiveness to internal queues to satiety
| 2. Vulnerable to external queues
167
How do we calculate NNT
1/ARR
168
Example of Prevention Paradox
1. Giving everyone who has a 10% risk of having a CVD statins
169
Define disability
Related to anyone with a physical, sensory or mental impairment which seriously affects their daily activities
170
Most common type of eye condition in the UK
1. AGE RELATED MACULAR DEGENERATION
171
What is retinitis pigmentosa
Disease of retina which leads to a GRADUAL reduction in vision
172
What is glaucoma
Effects the optic nerve
173
Four ways we can recognise a visually impaired person
1. Guide dog
2. Dar glasses
3. Reading braille
4. Guiding cane
174
2 ways we can improve communication for the blind
1. LARGE print
2. Braille
3. Speech package
4. CD
175
What are the 3 core principles of the NHS
1. Meets everyone's needs
2. Free at point of delivery
3. Based on clinical need, not pay
176
Causes of homelessness
1. Domestic abuse
2. Poverty
3. Housing affordability
4. Unemployment
177
Barries to access to healthcare by homesless
1. Lack of integration
2. Other priorities
3. May not know where to get help
178
Barries to access to healthcare by GYPSIES
1. Communication problems
2. Frequent movement
3. Poor reading skills
4. Reluctane by GPs to register
179
Health problems faces by LGBTQ
1. Depression
2. Suicide
3. Drugs
4. STIs
180
Barries to healthcare by LGBTW
1. Stigma
2. Discomfort discussing their gay
3. Previous negative experiences
181
Signs and symptoms of Physical and sexual abuse
1. Brusing, cuts and scored
2. Anxiety
3. Depression
4. Aggressiveness
5. PTSD
Sexual Abuse:
1. Fear and anxiety towards sexual activity
2. Suicide risk
3. STis, UTIs
182
Signs and symptoms of Physical and sexual abuse
1. Brusing, cuts and scored
2. Anxiety
3. Depression
4. Aggressiveness
5. PTSD
Sexual Abuse:
1. Fear and anxiety towards sexual activity
2. Suicide risk
3. STis, UTIs
183
Three causes of of communication disorders
1. Stroke
2. MND
3. Cerebral Palsy
184
Four presentations of speech difficulties
1. Dysarthria
2. Apraxia
3. Dysfluent speech
4. Stammer
185
Comprehension difficulties
1. No Spoken/written language at all
2. Word-finding difficulties
3. Trouble with grammar
4. Sounds fine but content isn't right
186
Name a condition in which primary progressive aphasia is seen
Dementia
187
Presentation of pragmatic impairment
1. Atypical body language, eye contact
2. Difficulties with turn taking
3. Atypical intonation, speech rate/voluem
4. Poor awareness of how others are responding
188
Define cultural expertise
Where training focuses on providing information about different groups based on one characteristic
189
Define cultural sensibility
relates to a person's moral, emotional or aesthetic ideas or standards.
190
Negative aspects of cultural knowledge
1. Too many categories to learn
| 2. Risks oversimplification and stereotyping
191
Define Culture
1. Socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life
192
Define Ethnocentrism
1. Tendancy to evaluate other groups according to values and standards of one's own cultural group - especially with conviction that one's own cultural group is superior to other groups
193
4 aspects of iceberg model of culture
1. Gender
2. Age
3. Ethnicity
4. Socioeconomic status
194
What is individual culture
Based on heritage, individual circumstances and dynamic.
195
Define stereotype
Involve generalisations about typical characteristics of members of a group
196
Define prejudice
Attitude towards another person based solely on their membership of a group
197
Define discrimination
Actual positive or negative actions towards the objects of prejudice
198
What is Hofstede's cultural dimensions
1. Effects of society's culture on values of its members
199
Define flexibility
Capacity to adapt, accommodate or modify change
200
Define intellectual integrity
I questioned my bias and assumptions and examined my thinking
201
Duties of a doctor (3)
1. Make sure patient is first concern
2. Take prompt action if you think patient safety is compromised
3. Maintain trust
202
Example of HNA in a population , condition and an intervention
Manor practice population
COPD
Coronary angioplasty
203
What is a cross-sectional study
Analysis of data rom a population at a SPECIFIC POINT in time
204
What type of anaemia is seen in Liver disease
Macrocytic
205
What does raised ALT indicate in liver disease
Chronic liver disease - elevates later on in the disease
206
Signs of liver cirrhosis
```
Jaundice
hepatomegaly
Splenomegaly due to portal hypertension
Spider Naevi
Palmar Erythema
Gynecomastia
Ascites
Caput medusae (distended paraumbilical veins due to portal hypertension)
Asterixis
```
207
What is the first line investigation for non-alcoholic fatty liver disease
Enhanced liver fibrosis test
208
What would a USS of the liver in cirrhosis look like
Nodularity of the liver surface
Ascites
Splenomegaly
209
Treatment of oesophageal varices
caused by portal hypotension
TIPS (Transjugular Intra-Hepatic Portosystemic Shunt)
210
Management of bleeding oesophageal varices
vasopressin analogues (terlipressin) to cause vasoconstriction
Correct with Vit J and plasma
211
What antigen shows active Hep B infection
HBsAg
212
What antigens are a marker of Hep B viral replication and high infectivity
HBeAg
213
What is the marker for a previous Hep B infection
HBcAb
214
What marker implies vaccination to hep B
HBsAb
215
What marker is used to check viral load in Hep B infections
HBV DNA
216
Treatment of autoimmune hepatitis
Oral Prednisolone
217
Symptoms of Haemochromatosis
1. Chronic fatigue
2. joint Pain
3. Pigmentation (slate grey/bronze)
Hair Loss
Erectile Dysfunction
Amenorrhoea
Dementia
218
Diagnosis of haemahcromatosis
Serum ferritin levels
Genetic Testing
219
Complications of haemochromatosis
1. T1DM
2. Liver Cirrhosis
3. Cardiomyopathy
4. Hepatocellular carcinoma
5. Hypothyroidism
6. Chrondrocalcinosis (calcium deposits causing arthritis)
220
Management of haemochromatosis
venesection
221
Signs of Wilson's disease
1. Chronic Hepatitis
2. Dysarthria and Dystonia, Parkinsonism from copper deposition in the basal ganglia
3. Depression
4. Kayser-Fleischer rings
222
Diagnosis of Wilson's
Serum Caeruloplasmin levels
| 24-hour urinary copper assay
223
Management of Wilson's
Penicillamine
224
Where is alpha-1-antitripsin produced
Liver, coded by chromosome 14
225
Signs of alpha-1-antitripsin deficiency
Inhibits Elastase:
Liver: Mutated porteins accumulatie = cirrhosis of the liver -> hepatocellular carcinoma
Lung: Excess protease enzymes -> Bronchiectasis + Emphysema
226
Diagnosis of alpha-1 antitripsin deficiency
Low alpha-1 antitripsin
2. Liver biopsy: acid-Schiff-positive staining globules
3. Genetic testing: A1AT gene
227
Management of alpha 1 antitripsin deficiency
Symptomatic management
Then Organ transplant
228
Signs of Primary biliary sclerosis
1. Fatigue
2. Itching
3. Abdo pain
4. Jaundice
5. Pale Stools
6. Xanthoma (cholesterol deposits in the skin and blood vessels)
229
RF for primary biliary sclerosis
Middle Aged Women
Autoimmune Conditions
Rheumatoid conditions
230
Diagnosis of primary biliary sclerosis
1. Anti-mitochondrial antibodies
| 2. ANA
231
Treatment of primary biliary sclerosis
1. Urseodeoxycholic acid
| 2. Colestyramine (binds to bile acid and prevents absorption, reducing itching
232
RF for primary sclerosing cholangitis
1. Male
2. 30-40
3. UC
4. FH
233
Presentation of primary scleorsing cholangitis
1. Jaundice
2. Chronic RUQ pain
3. Pruritis
4. Fatigue
5. Hepatomegaly
234
Autoantibodies found in primary sclerosing cholangitis
p-ANCA
ANA
Anticardiolipin antibodies
235
Diagnosis for primary sclerosing cholangitis
MRCP
236
Management of primary sclerosing cholanhgitis
Liver Transplant
237
Complication of primary sclerosing cholangitis
Cholangiocarcinoma
238
What isa tumour marker for hepatocellular carcnioma
AFP
239
What is the tumour marker for cholangiocarcinoma
CA19-9
240
Gastric vs duodenal ulcers
Eating makes peptic ulcers worse, while eating makes duodenal ulcers better
241
Management of COPD
First Line: Salbutamol or Ipratropium Bromide
Then: LABA PLUS LAMA if asymptomatic now.
If still asthmatic, give an ICS.
Long term oxygen therapy by Venturi mask
242
Medical Treatment at home for COPD exacerbation
1. Prednisolone
| 2. Regular inhalers
243
Medical treatment for COPD exacerbation in hospital
1. Nebulised salbutamol
2. Hydrocortisone (IV)
3. Antibiotics + Physio
IV Aminophylline as second line
244
CXR signs for lung cancer
1. Hilary enlargement
2. Peripheral opacity (a visible lesion in the lung)
3. UNILATERAL pleural effusion
4. Collapse
245
What are case-control Studies
People who have ALREADY developed the disease are identified with their past exposure and compared with those who do not have the disease or other controls
246
What are cohort studies
Where participants are recruited who share a common characteristic and are followed up over a LONG period of time to measure the impact of a variable (e.g., smoking and lung cancer)
247
What are cross-sectional studies
Studies that are used to look at an association between to variables (no causality).
A single point in time, like a snapshot (so interviewing participants at a single point in time)
Cohort: Prospective
Case-Control: Retrospective
248
What are randomised control trials
Randomly picking participants from the population with shared characteristics that are wanted to be studied.
249
What research is used to establish causality
RCT not a cross-sectional study
250
What can cause selection bias
Non-Response
| Loss to follow up
251
Four types of information bias
1. Measurement (using different equipment to measur outcomes
2. Observer (the researcher knows the participants and subconsciously reports the outcome differently)
3. Recall
4. Reporting
252
What is strength in the Bradford-Hill Criteria
Stronger Association between exposure and outcome
253
What is dose-response in Bradford-Hill's criteria for strengthening causality
Increased risk of outcome with increased exposure
254
Formula for screening
Have Disease + Positive / (Have Disease + Tested Positive and Have Disease + Tested Negative)
255
Formula for Specificty
(Do not have the disease + Negative/ Do not have the disease + Negative and Do not have the disease + Positive)
256
Formula for Positive Predictive Value
True number of people who actually have the disease out of all the people who teste dpositive
257
Formula for negative predictive value
True negatives that didn't have the disease as a proportion of all the people who tested negative
258
What is the NHS criteria for a screening test
Screening should be on-going and not one off
| Costs of screening should be economically balanced to healthcare spending as a whole
259
NHS criteria for mass screening for a condition
1. The condition should be important
2. The epidemiology and history of the condition should be adequately understood with detectable risk factors
3. All cost effective primary prevention should have been implemented as far as possible
4. If carriers are identified, the implications must be understood
260
NHS criteria for testing
1. Simple screening programme should be available
2. Cut off levels for test values must be agreed nationally.
3. Tests should be acceptable to the population
4. There should be an agreed policy for diagnostic investigation following a positive result
261
What is Case-Fatality rate
The % of people who are at risk of dying from a disease
262
What does an Odds Ratio show us
An association between exposure and outcome
If >1 = positiver association
If <1 = negative association
263
Formula for NNT
1/ Absolute Risk Reduction
264
What is NNT
The number of patients needed to treat to prevent one additional bad outcome
265
What is the absolute risk reduction
For example, if in an RCT 20% of the control group received bad outcomes compared to only 12% in the intervention group, the ARR is 8%.
This means iff 100 children were treated, the intervention prevents 8 people from developing bad outcomes
Then NNT is, if 8 children benefit out of 100 people going treatment, 100/8 means for every 12.5 that are treated, one child is saved.
266
What is an observation bias
Where participants are aware they're being examined and change their behaviour as a result
267
What is selection bias
Preferential selection of participants who may not represent the true population that the research question tries to study
268
How to calculate relative risk
The risk of disease in one group / the risk of disease in another group
269
What does an odds ratio show us
The probability that an event will occur in a given exposure compared to the probability that event will happen without the exposure
270
What is distinctive about an ecological study
They look at population statistics as opposed to investigating anything at individual level. No interviewing or case-based issues.
271
How do we differ out relative risk reduction from a relative risk figure
100- relative risk
272
What is attrition bias
Loss of participants, leading to a type of selection bias.
273
What drugs can cause AKI
1. NSAIDs
2. ACEi
3. ARBs
4. CCBs
5. alpha-blockers
6. Beta-blockers
7. Opioids
8. Diuretics
9. Acyclovir
10. Trimethoprim
11. Lithium
274
What does aspirin inhibit
COX-1 only
It MAY inhibit activity of COX-2 by disabling enzymes but not directly.
275
What drug is used to reverse to effect of Heparin
Protamine
276
How does N-Acetylcysteine work?
Replenishes Glutathione stores
277
Which malarial parasite reside in the liver
Plasmodium Vivax/Ovale
278
Signs of p. vivid and ovale
Cyclical fevers ever 48 hours
279
Management of p viva and ovale
Chloroquine for all
Primaquine for any relapses
280
In areas where there is chloroquine resistance, what medication should be given for malaria
Artemisinin-based combination therapy
281
Primary prevention of Cardiovascular Disease
QRISK3 score: Risk of developing CVD in the next 10 years
282
If QRISK is greater than 10%, what should be given
Statins
283
What conditions are absolute indications for CVD
CKD
| T1 DM
284
What is secondary prevention of CVD
AAAA
A- Aspirin (+ Clopidogrel for 12 months)
A - Atoravstatin
A - Atenolol
A - ACEi
285
Side effects of Statins
T2 DM
Creatine Kinase is elevated due to myopathy
Haemorrhagic strokes
286
Management of Angina
1. RAMP
R - Refer to Cardiology
A - Advice
M - Medical Treatment
P - Proceedurol or surgical intervention
287
What is given as immediate symptomatic relief of angina
GTN spray - vasodilator
Take GTN then repeat after 5 minutes.
288
When in angina treatment, should a patient call for an ambulance
If there is still pain 5 mins after the second dose of GTN
289
Long term symptomatic relief of Angina
1. Betablockers
2. CCB
Others include nitrates and ivabradine
All vasodilators
290
Secondary prevention of Angina
AAAA
Aspirin
Atorvastatin
Atenolol
ACEi
291
Where is a PCI scar seen
Brachial artery and femoral artery scars
292
Where are CABG scars seen
Midline sternotomy
| Great Saphenous Veins
293
What supplies the right ventricle and atrium
Right coronary artery
294
What supplies the left atrium
Circumflex artery
295
What supplies the left ventricle and septu,m
LAD
296
What supplies the inferior left ventricle and posterior septal area
Right coronary artery
297
What coronary artery condition is primarily associated with left bundle branch block
New onset = STEMI
298
What distinguishes angina from MI
Troponin levels are normal
299
What can be done within 12 hours of acute STEMi onset
1. PCI
| 2. Thrombolysis (sletplase or streptokinase)
300
Acute NSTEMI treatment
BATMAN
```
B - Beta blockers
A - Aspirin 300mg stat
T - Ticagrelor (or clopidogrel if higher bleed risk)
M - Morphine
A - Anticoagulant: Fondaparinux
N - Nitrates
```
301
What is the GRACE score
Assess 6 month risk of death or repeat MI after PCI
302
Complications of MI
```
DREAD
D - Death
R - Rupture of septum
E - Edema
A - Arrhythmia and Aneurysm
D - Dressler's Syndrome
```
303
What is Dressler's syndrome
Immune response causing pericarditis: Pleuritic chest pain and a pericardial rub
Needs NSAIDs
304
Secondary prevention of an MI
1. Aspirin 75mg
2. Clopidogrel 12 months
3. Atorvastatin
4. ACEi
5. Atenolol
6. Aldosterone antagonist
305
Management of supra ventricular tachycardias
Adenosine (can't be given in COPD, HF, Heart Block)
Instead give beta blockers, calcium channel blockers or amiodarone
306
When should a GP refer a patient to a specialist for chronic HF
> 2,000 ng/litre
307
What vaccinations does someone with Chronic HF need
Yearly flu and pneumococcal vaccine
308
First line treatment of Chronic HF
ABAL
ACEi
Beta Blockers
Aldosterone antagonist (3rd line)
Loop Diuretics
309
What does HIV treatment consist of
2 NRTIs + one of any other HAART medication classes
310
Name some HAART medication classes
1. Protease Inhibitors
2. Integrase Inhibitors
3. Nucleoside Reverse Transcriptase Inhibitors
4. Non-Nucleoside Reverse Transcriptase Inhibitors
5. Entry Inhibitors
311
What consists of Post Exposure Prophylaxes
Truvada and Raltegravir
This is cART
312
Signs of disseminated TB on an X-Ray
Millet Seeds uniformly distributed across the chest
313
Side Effect of Pyrazinamide
Hyperuricaemia
314
Side effect of Ethambutol
Colour Blindness and reduced visual acuity
315
Side effect of isoniazid
Peripheral Neuropathy
316
What antibiotic prevents folic acid metabolism
Trimethoprim
317
What can be given to treat MRSA
Teicoplanin or Vancomycin
318
Absolute Risk Reduction vs Relative Risk Reduction
Absolute: Risk (control) - Risk (experimental)
Relative: 1 - [Risk (Experimental Group) / Risk (Control Group)]
319
What is intention to treat analysis
Avoids the effects of drop outs in an experiment
320
What is a time interval bias
Termination of a trial at a tie when its results support a desired outcome
321
What is a type I error
False Positive: Incorrect rejection of the null hypothesis when it is true
322
What is a type II error
Failure to reject the null hypothesis when it is false
323
What is a confidence interval
A range of values where there is a certain level of confidence that the value parameters lie within
324
What HbA1c level is diabetes diagnosed at
>48 mmol/mol
325
What Random Glucose is Diabetes diagnosed at
>11 mmol/mol
326
What Fasting Glucose is diabetes diagnosed at
>7 mmol/mol
327
What is the target Hb1ac for diabetes
48 mmol/mol on metformin or 53mmol/mol if they're on multiple medications
328
How long should antibiotics be given for men , pregnant women and catheter-related UTIs (complex)
7 Days of trimethoprim or nitrofurantoin
329
When is nitrofurantoin contraindicated
eGFR < 45
330
Why should nitrofurantoin be avoided in the third trimester of pregnancies
There is a risk of neonatal haemolytic
331
Why should trimethoprim be avoided in the first trimester for pregnancy
Folate antagonist
332
First line treatment for rate control in AF
Beta lockers
Second: CCB/Digoxin
333
What is the first line pharmacological cardio version tactics used for AF
1. Flecanide
334
At what chadsvasc score are anticoagulants recommended for
>1
335
First line treatment of AV node blocks
Atropine
336
Complication of a third degree heart block
Asystole
337
Diagnostic for HF
ECHO
338
What gene causes PCKD
Autosomal dominant: Chromosome 16
339
What does autosomal recessive PKCD present with during pregnancy
Oligohydramnios
340
Management of PCKD
Tolvaptan
341
What is TWOC
This is a trial without catheterisation. We check if the bladder output is good and they do not need a replacement
342
How long do people with catheters need to be on antibiotics for in UTIs
7 Days
343
Main cause of epididymo-orchitis
E.coli
344
Signs of mumps
Testicular swelling (sparing of the epididymis) and parotid gland swelling
345
First line treatment of epididymo-orchitis
Ofloxacin
346
Four risk factors of bladder cancer
1. Older Age
2. Aromatic amines in dye and rubber
3. Smoking
4. Schistosomiasis
347
Most common type of bladder cancer
Transitional cell carcnioma
348
Diagnosis of Bladder cancers
Cystoscopy with biopsy
349
Treatment of bladder cancer
1. Transurethral resection of bladder tumour
Intravesical chemotherapy
350
Features of multiple myeloma
CRAB
C - Hypercalcaemia
R - Renal Failure
A - Normocytic anaemia
B - Bone Pain
351
How do we test for Myeloma
B - Bence-Jones Protein
L - Serum free light chain assay
I - Serum IgG
P - Serum Protein Electrophoresis
352
What kind of skull is seen on an X-Ray for Myeloma
Raindrop skull (lytic lesions that look like raindrops)
353
How do we manage a tension pneumothorax
Insert a large bore cannula into the second intercostal space of the midclavicular line
354
Main hospital cause of pneumonia
Pseudomonas Aerguinosa
355
Advantages of Cohort STudies
Can follow up groups with rare exposures
Good for multiple outcome analysis
Less risk of selection and recall bias
356
Disadvantages of cohort studies
Takes a while
Loss for follow up
Needs large sample size
357
Advantages of case-control
1. Good for rare outcomes
2. Quicker than cohort or interventional studies
3. Inexpensive
358
Disadvantages of case-control studies
1. Difficult to find controls to match with cases
2. Prone to selection and information bias
3. Data may not be reliable due to patient memory
359
Disadvantages of cross-sectional
Risk of reverse causality
360
What does a relative risk number show
```
1 = no difference between groups
>1 = the intervention increases risk
```
<1 = The intervention decreases risk
361
Mode of action of cocaine
1. Enhances neurotransmitter synapse (serotonin and dopamine)
362
Define Altruism
The moral value of an individual's action depends solely on the impact on other individuals
363
Define egoism
Self interest of an action is the sole foundation of the morality of the action
364
Define Utilitarianism
Promotes actions that maximises happiness and well being for the majority of the population
365
Define deontological
The morality of an action should be based on whether then action itself is right or wrong
366
Define consequentialist
The consequence of the action is the ultimate basis of whether what we did is morally right
367
Define virtue ethics
Focuses on character traits
Emphasises the mind, character and sense of honesty
368
Dimensions of Healthcare Equity
Spatial - Geographical
Social - AGe, Gender, Class, Socioeconomic and ethnicity
369
What is the Wilson and Jugner Screening Criteria
The condition must:
Be important
Have a latent/preclinical phase
Known aetiology
The screening test must:
Be suitable
Be Acceptable
The treatment must:
Be Effective
Have an agreed policy on who to treat
The organisation and cost:
Facilities must be available
Costs and Benefits measured
Be an ongoing process
370
Second line treatment for rheumatoid arthritis
Dual therapy using two DMARDs
371
What should be prescribed alongside methotrexate in RA
Folic acid, to be taken on a different day to the methotrexate
372
What RA drug can cause pulmonary fibrosis
Methotrexate
373
Signs of psoriatic arthritis
Onycholysis
Dactylitis
Enthesitis
Conjunctivitis + Anterior Uveitis
374
X-Ray changes seen in psoriatic arthritis
1. Periostitis
2. Osteolysis
3. Dactylitis
4. Pencil-in-cup appearance
375
What is arthritis Mutilans
Destruction of the bones around the joints in the digits. Th skin then folds as the digit shortens, giving a 'telescopic finger' appearance
376
Management of Psoriatic Arthritis
1. NSAIDs for pain
2. DMARDs (Methotrexate)
3. Anti-TNF medications (Etanercept)
Ustekinumab LAST LINE
377
What key joints are affected in ankylosing spondylitis
Fusion of sacroiliac joints
| Stiffness in vertebral joints -> Bamboo spine
378
Presentation of ankylosing spondylitis
1. Lower back pain and stiffness
2. Sacroiliac pain in the buttock
Worst at rest and better on movement
379
Extraarticular presentation of AS
1. Chest pain (cost vertebral and costosternal tenderness)
2. Enthesitis
3. Dactylitis
4. Anaemia
5. Anterior Uveitis
6. Aortitis
7. Heart Block
8. Pulmonary Fibrosis
380
What test is done to check for AS
Schober's test
Find L5 vertebrae and draw a line 10 cm above and 5 cm below and ask to bend over.
381
What specific structure is found in AS on XRay
Syndesmophytes
382
Management of AS
1. NSAIDs
2. Steroids
3. Etanercept (TNF-alpha inhibitors)
383
What is a key investigation for polymyositis and dermatomyositis
Serum Creatine Kinase measurements
384
Signs of Dermatomyositis
1. Gottron Lesions on knuckles
2. Photosensitive erythematous rash
3. Purple rash on the face and eyelids
4. Periorbital oedema
5. Subcutaneous calcinosis
385
Management of polymyositis
Corticosteroids
386
What range INR is used for APL
2-3
387
What medication is given for APL
Long term warfarin or LMWH in pregnant women PLUS aspirin
388
Definitive diagnosis of a Pulmonary Embolism
V/Q mismatch or CT Angiography
389
Initial Management of a Pulmonary Embolism
LMWH Heparin
Then switch to Warfarin or Doacs for 3 months
390
In what testicular tumour is AFP raised
Teratomas
391
In what testicular cancer is Beta hCG raised
BOTH teratomas and Seminomas
392
What testicular cancer has the better prognosis
Seminomas
393
What is Conn's syndrome
Primary Hyperaldosteronism
394
Investigations for suspected Conn's/Hyperaldosteronism
Renin/Aldosterone ratio:
High Aldosterone + Low Renin = Primary Hyperaldosteronism
High Aldosterone + High Renin = Secondary
395
The effects of hyperaldosteronism
Hypernatraemia
Hypokalaemia
Alkalosis
396
Management of Conn's Syndrome
Eplerenone
