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Gp Lectures Flashcards

1
Q

What is allostasis?

A

Stability through change - systems react rapidly to environmental stressors

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2
Q

What is allostatic load

A

Long term overtaxation of physiological systems leads to impaired health - stress

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3
Q

E.g. Of allostasis and allostatic load of CV system

A

Allostasis - maintain erect posture, and enable physical exertion
A Load - over activation -> hypertension, stroke, MI

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4
Q

Natural history of self limiting conditions that DO NOT need Abx

A 
Otitis media - 4 days 
Acute sore throat/pharyngitis - 1 week 
Common cold - 10 days 
Acute rhinosinusitits - 2-3weeks 
Acute cough - 3 weeks
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5
Q

When should ABx in otitis media

A

Bilateral <2yr

Or if otorrhoea

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6
Q

When abx in sore throat?

A

With 3 or more of:

Exudate, fever, tender cervical lymphadenopathy, a sense of cough

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7
Q

Other examples of when to give ABX

A

Systemically unwell
High risk co-morbidity (immunosuppressive, prem bab)
Old with recent hospital admission / diabetes /Ccf/ glucocorticoid use
Complications - pneumonia, mastoiditis, abscess

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8
Q 
Common Abx for 
Otitis media?
Sinusitis?
Tonsilitis?
LRTI?
Uti?
A 
Amoxicillin 500mg tds 5 days
Amoxicillin 500mg tds 5 days / doxycycline 5 days 
Penicillin 10 days 
Amoxicillin 5 days 
Trimethoprim / nitrofurantoin 3 days
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9
Q

Vascular response to wound

A

Vasoconstriction
Clotting when blood exposed to air
Blood and serous fluid clean wound
Vasodilation and permeability in vessels adjacent
Fibrin mesh temporality closes wound -> turns into scab

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10
Q

Signs of inflammation

A 
Heat - calor 
Swelling - Tumor 
Erythema - rub or 
Pain - dole 
Loss of function
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11
Q

Egs of inflammatory mediators released by platelets trapped in fibrin mesh

A

PDGF, Prostaglandins, histamine

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12
Q

What locally causes vasodilation by wound?

A

Histamine

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13
Q

When does vasodilation peak after injury

A

20 mins - don’t confuse with infection

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14
Q

Role of neutrophils and macrophages

A

N- release free radicals and pro teases - bactericidal

M - invest dead tissue, release cytokines that recruit lymphocytes and fibroblasts

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15
Q

Lymphocyte role

A

Enter wound after 72hr and secrete chemotactic factors for fibroblasts

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16
Q

Primary secondary tertiary intention?

A

1- little tissue loss - wound edges can be directly apposed -> linear scar
2 - wound edges not apposed - eg ulcer / skin loss ->granulation and broader scar
3 - Would purposely left open - later surgically closed eg graft / suture

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17
Q

General barriers to healing?

Local barriers?

A

Elderly, diabetes, malnutrition, malignancy, immunosuppressive

Infection, oedema, vascular insufficiency, prev radiotherapy

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18
Q

5 stages of grief

A 
Denial 
Anger
Bargaining 
Depression 
Acceptance

Not always in order and not everyone experiences them all

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19
Q

What is an adjustment disorder

A

Emotional or behavioural reaction which is maladaptive

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20
Q

When do adjustment disorders often develop

A

Recovery taking too long (>6/12 usually have acceptance)
The coping mechanisms are extreme or harmful
Continuing impact on relationships / social functioning
Self harm

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21
Q

Types of domestic abuse

A 
Psychological
Physical 
Sexual 
Financial 
Emotional
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22
Q

3 ways domestic abuse can impact on health

A

Trauma
Somatic problems due to living with abuse (headaches, gi, chronic pain, LBW, premature babie)
Psychological (PTSD, self harm, substance misuse, depression, anxiety…)

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23
Q

What to consider safeguarding in domestic abuse

A

If there is child abuse / child witnessing

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24
Q

Tool to assess risk in domestic abuse

A

DASH

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25
Q

What to do in standard / medium risk domestic abuse

A

Give contact for domestic abuse services

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26
Q

What to do in high risk domestic abuse

A

Refer for MARAC / IDVAS

You can break confidentiality

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27
Q

What is MARAC

A

Multi agency risk assessment conference

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28
Q

Egs of models / theories of behaviour change

A 
Health belief model 
Health belief model 
Theory of planned behaviour 
Stages of change / trans theoretical model 
Social norms
Motivational interviewing 
Nudging 
Social marketing
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29
Q

When do people change in the health belief model ?

A 
They believe:
they are susceptible 
There is serious consequences 
action reduces susceptibility 
Benefits of action outweigh costs
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30
Q

What factors influence HBM

A

Demographic - SES, gender, age..

Psychological - personality, peer group …

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31
Q

Cirque of HBM

A

Other factors influence - eg self efficacy
Does not consider the influence of emotions on behaviour
Does not differentiate between first time and repeat behaviour

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32
Q

Cues to action help HBM, E.g. Of an internal and external cue ?

A

Internal - feeling unwell

External - reminder letters

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33
Q

What is the most important factor for addressing behaviour change in patients?

A

Perceived barriers

34
Q

Biggest predictor of behaviour in TPB

A

Intentions

35
Q

What 3 things determine a persons intention in TPB

A

Attitude to the behaviour
The perceived pressure to undertake the behaviour - Social norm
Perceived ability to perform behaviour - perceived behavioural control

36
Q

Ways to help people act on their intentions

A

Perceived control - They CAN do it
Anticipated regret - how do you feel after behaviour
Predatory actions - break into small steps
Implementation intentions - eg when make tea, take meds

37
Q

Critique of TPB

A

Lack of temporal element
Doesn’t take into account emotions
Doesn’t explain habitual behaviour
Relies of self reported behaviour

38
Q

Stages of transtheoretical model

A

Pre-contemplation, contemplation, preparation, action, Maintenance

39
Q

Advantages of stages of chance

A

Accounts for relapse
Temporal element
Accounts individual stages of readiness (Tailored interventions)

40
Q

Critique of stages of change

A

Not everyone goes through all the stages
Change might be a continuum rather than discreet
Doesn’t take into account - values, habits, culture, social and economic factors

41
Q

There are 3 main behaviours related to health. What are they and EG?

A

Health behaviour - prevent disease - eating healthy
Illness behaviour - seek remedy - visit doctor
Sick role behaviour - aimed at getting well - taking prescribed medication

42
Q

Identify 3 transition points where interventions are likely to be more effective

A

Leaving school, entering workforce, becoming a parent, becoming unemployed, bereavement

43
Q

Planning cycle in health needs assessment ?

A

Needs assessment -> planning -> implementation -> evaluation -> repeat

44
Q

3 parts of health needs assessment

A

Need - ability to benefit from intervention
Demand - what people ask for
Supply - what is provided

45
Q

3 approaches fro health needs framework

A

Epidemiological
Comparative
Corporate

46
Q

Aspects of epidemiological approach to health needs

A 
Define problem 
Size of problem - prevalence 
Services available - prevention, treatment, care 
Evidence base - effectiveness 
Models of care - quality / outcomes 
Existing services
47
Q

Problems with epidemiological approach

A

Data availability
Variable data quality
Evidence base inadequate
Doesn’t consider felt needs of people afffected

48
Q

What is the comparative approach to health needs

A

Compares services between subgroups E.g. Spatial / age

49
Q

Issues with comparative approach

A

Data availability
Data quality
Difficulty finding a comparable population

50
Q

Issues with corporate approach to health needs assessment

A

Hard to distinguish demand from need
Groups may have vested interest
Influenced by politics
Dominant personalities -> influence

51
Q

Alcohol recommended limits

A

Men 21 units/week

women 14 units/week

52
Q

Pregnant women alcohol intake

A

none in first trimester then no more than 2 units per week

53
Q

Factors that influence drinking levels

A

Social - occupation, availability, advertising, peer group
Family - religion, tradition, culture
Personality, genetics, health

54
Q

Why are women drinking more

A

Socially acceptable, more disposable income, marketing target women

55
Q

Risk factors for problem drinking

A 
Drinking within family
Childhood problem behaviours
early use of nicotine and drugs 
poor coping responses to life events 
depression as a cause not a result of drinking
56
Q

Alcohol intake per day -> liver damage?

A

Min 30g

Usually around 160g

57
Q

Alcohol and liver problems ? Which are reversible ?

A

50% heavy have fatty liver - reversible

13-30% develop cirrhosis

58
Q

Why does heavy alcohol intake increase risk of heart disease?

A

Hyperlipidaemia
Hypertension
Can precipitate arrhythmia (usually AF)

59
Q

Alcohol and cancer types?

A

25-50% of head and neck cancers due to alcohol
Liver, stomach, Colon, rectum, pancreas
Breast

60
Q

Risks with alcohol consumption in pregnancy

A

Risk of miscarriage / LBW

Foetal alcohol syndrome

61
Q

Signs of fetal alcohol syndrome

A

Small underweight babies, slack muscle tone
Mental retardation, behaviour and speech problems
Facial abnormalities
Cardiac, renal and ocular abnormalities

62
Q

Facial abnormalities in foetal alcohol syndrome?

A

Microcephalic, hypoplastic jaw
Thin upper lip, smooth philtrum, upturned nose
Short Palpebral fissure (upper eyelid fold)

63
Q

What general support for alcohol in primary care?

A 
Vitamin supplementation 
Assess risk of - IHD
-Osteoperosis
Screening questions
Structured advice (Potential harm, benefits of stopping, obstacles to change, goals)
64
Q

Examples of alcohol screening questionnaire

A

CAGE / AUDIT

65
Q

Medication for relapse prevention?

A

Disufiram (antabuse)

Acamprosate, GABA blocker

66
Q

Criteria for alcohol dependence syndrome

A

3 in a 12 month period
Tolerance increase in for same effect
Physiological withdrawal
Difficulty controlling amount and termination of use
Neglect social / other areas of life
Increasing time spent obtaining and using alcohol
Continued use despite negative physical and psychological effects

67
Q

What causes wernicke encephalopathy

A

Bit b1 deficiency - often after withdrawal of alcohol

68
Q

Triad of Sx in wenicke

A

Acute mental confusion
Ataxia
Opthalmoplegia (paralysis of muscles around eye)

69
Q

Is Wernickes chronic? Treatment? What can it lead to?

A

Reversible
IV / oral vit b1 (thiamine vitamin b1)
Korsakoff’s

70
Q

What can be given in hospital setting to booze patients

A

Pabrinex (b1)

71
Q

Main Sx of Korsakoffs ? Others?

A

Memory loss - esp short term

Loss of spontaneity, initiative and confabulation

72
Q

How is korsakoffs diagnosed

A

CT scanning

73
Q

What is delirium Tremens? Sx? Treatment?

A

3-5day toxic confusional state follows withdrawal of alcohol with long Hx of use
Clouding of consciousness, confusion, seizures, hallucinations
Marked tremor
Supportive fluids / benzodiazepines prevent fitting

74
Q

Why are ‘nudging’ and financial incentives rarely used in behaviour change?

A

Nudging - ethical issues

Financial insensitive - ineffective (people care more about what they have to lose)

75
Q

Societal risk behaviour is usually over or underestimated by people?

A

Over estimated

76
Q

Main idea in social norms ?

A

Find out the real social norm and disseminate

77
Q

Critique of social norms

A

What if the norm is an unhealthy behaviour

78
Q

What are the three parts of the framework for health service evaluation?

A

Structure - what it there Eg number of ICU beds
Process - what is done Eg number of patients seen
Outcome - health Eg Mortality, morbidity, QOL, patient satisfaction

79
Q

Issues with using health outcomes in evaluation

A

Cause and effect hard to establish (esp if other factors)
Lag time may be long
Large sample sizes needed
Data availability / quality

80
Q

What are the dimensions of quality (maxwell’s dimensions)

A

3 Es and 3 As
Effectiveness, efficiency, equity
Acceptability, accessibility, appropriateness

GP (6 decks)

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