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Phase 3A Quiz > GP & Pub Health > Flashcards

GP & Pub Health Flashcards

1
Q

Name 5 common anxiety disorders

A 
Generalised anxiety disorder (GAD)
Social anxiety disorder
Panic disorder
Post-traumatic stress disorder (PTSD)
Obsessive-compulsive disorder (OCD)
Phobias
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2
Q

What is a self-limiting disease?

A

A disease process that resolves spontaneously with or without specific treatment.

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3
Q

What is public health?

How is it done?

A

Science and Art of:

  • Preventing disease,
  • Prolonging life and promoting health

(Done through)
organised effort and informed choices of society, organisations, individuals and public & private communities

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4
Q

What is screening?

A

Process of identifying apparently healthy, asymptomatic people who may be at increased risk of a disease or condition.

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5
Q

What are important stages to make screening possible?

A

Identifying the eligible population.
Informing individuals and offering screening examination.
Facilitating uptake.
Undertaking screen examination.
Diagnosis and intervention for individuals who screen positive.

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6
Q

Primary investigations for gynaecomastia?

A

LFTs
70% of our total testosterone is bound to a protein called sex hormone-binding-globulin (SHBG). SHBG is produced in our livers and plays an important role in regulating the amount of free testosterone in our bodies.

TSH
Gynaecomastia is caused by hormonal changes resulting from liver problems or testicular lumps. You may need to have an ultrasound scan of the breast, and occasionally a biopsy.

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7
Q

Zopiclone

Drug Class?
Indication?

A

Benzodiazepiene

Sleeping pill that treat bad insomnia.
Reduces day time anxiety;

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8
Q

Define Learning Difficulty?

[PSYCH]

A

Specific difficulties in certain aspects of learning. Learning difficulty doesn’t affect general intelligence.

e.g dyslexia

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9
Q

Define Oppositional defiant disorder?

DSM-V Criteria

[PSYCH]

A

Angry/Irritable mood, argumentative defiant behaviour lasting at least 6M.

Behaviour associated with distress of the individual or others in their immediate social context.

Impairs significantly on social, educational or occupational functioning.

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10
Q

What medication to help with sleep can be given in patients with learning difficulties?

A

Melatonin

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11
Q

Define learning disability?

A

Functional impairment that is apparent before 18yo

IQ 70

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12
Q

Causes of learning disability?

A 
Genetic 
Downs syndrome 
Fragile X syndrome 
Phenylketonuria 
Neurofibromatosis 
Tuberous sclerosis

Perinatal
Intraventricular haemorrhage
Brain hypoxia

Prenatal 
Pre-eclampsia
Congenital hypothyroidism 
TORCHinfections
hydrocephalus 
Fetal alcohol syndrome

Postnatal
Poverty
Neglect/abuse
Head injury

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13
Q

Important history areas in someone with suspected learning difficulties?

A

Obstetric complications,
Neurodevelopmental delays,
Behavioural disturbances,
Past medical history, family history, and social history.

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14
Q

What is ADHD?

[DSM V Criteria]

A

persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Symptoms evident in 2 or more settings.
Symptoms present for 6M+
Symptoms present before 12 yo

Tx - Ritalin (Methyphenidate)

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15
Q

What is Autism?

[DSM V Criteria]

A

Persistent difficulties with social communication and social interaction as well as restricted and repetitive patterns of behaviour, activity or interests.

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16
Q

Define Cohort Study?

A

Longitudinal study in similar groups but with different risk factors/treatments.

Follows up over time.

Associated with Relative Risk Calculation (RR) for risk factors

RR = Risk of diseased (exposed) / Risk of disease (unexposed)

RR >1 = Increased risk
RR<1 = Lower risk
RR =1 = Same

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17
Q

ADVANTAGES AND DISADVANTAGES OF Cohort Study?

A

Advantages
– Can follow up rare exposure
– Allows to identify risk factors
– Data on confounders collected prospectively

Disadvantages
– Large sample size required
– Impractical for rare diseases
– Expensive
– People drop out
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18
Q

Define RCT?

A

Similar participants are randomly assigned to an intervention or control group to study effect of intervention

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19
Q

ADVANTAGES AND DISADVANTAGES OF RCT?

A

Advantages
– Low risk of bias and confounding
– Comparative

Disadvantages
– High group out rate
– Ethical issues (i.e. not giving an intervention to someone who could possibly benefit)
– Time consuming and expesnive

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20
Q

Define Cross-sectional study? (Prevalence Study)

A

Observational study collecting data from a population and a specific point in time

A snapshot of a group. Provide health information for a particular period

e.g. Questionnaires, Health surveys

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21
Q

Advantages and Disadvantages of Cross-sectional study?

A

Advantages
– Large sample size
– Provides data on prevalence of risk factors and disease outcomes
– Quick to carry out (Cheap and easy)
– Repeated studies show changes over time. Used to assess health needs

Disadvantages
– Risk of reverse causality

– which came first? (Due to being collected at a certain point in time can’t tell that a particular exposure caused the disease)

– Less likely to include those who recover quickly or short recovery

– Not useful for rare outcomes

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22
Q

Define Case-Control?

GOOD EXAMPLES FOR USE

A

Observational study looking at cause of a disease.

Compares similar participants with disease and controls without – Looks retrospectively for exposure/cause

Associated with Odds Ratio (OR)
e.g. for a particular risk factor -i.e. foods in an outbreak investigation

OR = Odds of being exposed [case group/disease] / Odds of being exposed [control group/unaffected]

OR >1 - Associated w/disesase
OR <1 - Protective
OR = 1 - No association

EXAMPLES - Rare events (Motor vehicle accidents, seatbelts

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23
Q

Advantages and Disadvantages of Case-Control study?

A

Advantages
– Quick
– Good for uncommon diseases (RARE)

Disadvantages
– Difficult finding appropriately matched controls (Hard for rare exposures)
– Prone to selection and information bias
– People may not be able recall exposure accurately

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24
Q

How do you calculate Attributable risk?

A

AR = Incidence in exposed - Incidence in unexposed

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25
Q

How to calculate number needed to treat (NNT)?

A

NNT = 1/ AR

Q- How many do you need to treat to prevent Case
A - For every X people treated, 1 case will be prevented

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26
Q

3 Domains of public health?

A

Health improvement - Improving services (Societal interventions aimed at preventing disease, promoting health and reducing inequalities

Health protection - Measures to control infectious disease risks and environmental hazards

Health care - Delivery of safe, high quality services for prevention, treatment and care

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27
Q

Difference between equity and equality?

A

Equity - Giving everyone what they need to be successful

Equality - Treating everyone the same

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28
Q

Explain Horizonal Equity vs Vertical equity?

A

Horizontal - Equal treatment for equal need.
Same treatment to people in an identical situation
e.g people with pneumonia should be treated equally (all other things being equal)

Vertical - Unequal treatment for unequal need

e. g. Areas with poorer health may need higher expenditure on health services.
e. g. redistributing income within society. Higher incomes should pay more tax

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29
Q

Stages of Health Needs Assessment?

[Planning cycle for health services]

A
  1. Needs assessment - Epidemiological, comparative, corporate
  2. Planning
  3. Implementation
  4. Evaluation
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30
Q

3 Approaches to Health needs assessment?

A
  1. Epidimeological approach
  2. Comparative approach
  3. Corporate approach
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31
Q

What is the Wilson-Junger criteria for screening?

Mnemonic - IATROGENIC

A 
I  - Important Disease
A - Acceptable treatment (Effective) 
T - Treatment and diagnostic facilities available
R - Recognisable at early stage of symptoms
O - Opinions on who to treat agreed
G - Guaranteed safety e.g. low radiation
E - Examination acceptable by patient
N - Natural history of disease known 
I - Inexpensive test
C - Continuous screening
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32
Q

Screening Schedule?

a. Breast Cancer
b. Cervical Cancer

A

a. 50-71, Repeated every 3 years, Mammogram to spot for cancer
b. 25-64, Repeated every 3 years (till 49), Every 5yrs (till 64), Search for HPV (+ve = Cytology test for abnormal cells, 12months follow up on -ve findings)

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33
Q

Names some inequalities that exist in healthcare?

A 
Language, Cultural and Religious issues
Deprivation 
Homelessness
Unemployment 
Physical needs 
Psychological needs
Victims of torture
Family
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34
Q

Benefits and Disadvantages of Breast Ca screening?

A

Benefits

  • Earlier diagnosis
  • Improved prognosis and lower mortality
  • Less radical and invasive treatment needed
  • Reassurance for those with negative results

Disadvantages

  • Low Radiation
  • Over diagnosis of minor abnormalities
  • Earlier knowledge of disease and overtreatment of those with unchanged prognosis
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35
Q

What the Gillick Comptency?

A
  1. Girl under 16 will understand advice
  2. Cannot persuade to tell parents
  3. Likely to continue having sexual intercourse with/without tx
  4. Physical/mental health will suffer unless she receives contraceptive advice.
  5. Best interests require contraception without parental consent.
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36
Q

Sexual activity at what age is a criminal offence and immediate referral needed?

A

Under 13

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37
Q

How do you assess Mental Capacity.

What principles do you have?

A
  1. Understand relevant information
  2. Retain information
  3. Weigh up information
  4. Communicates views, wishes and feelings
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38
Q

What is normative need ?

A

A Professional defines intervention appropriate for the expressed need

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39
Q

What is comparative need?

A

Comparison between severity, range of interventions and cost

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40
Q

What approaches need to be considered for a Health needs assessment?

A

Epidemiological - Defines the problem and size using primary data.

Comparative - Compares services received by a population with others

Corporate - Ask the local population and health professionals what needs are? [Via focus groups]

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41
Q

Problems with Epidemiological approach?

A

Doesn’t consider felt needs of people affected
Data may not be available to compare
Data may be of variable quality

42
Q

Problems with Comparative approach?

A

Difficult to find comparable population
Data may not be available to compare
Data may be of variable quality

43
Q

Problems with Corporate approach?

A

Influenced by political agendas / groups with vested interests /Dominant figures

Difficult to distinguish need from demand

44
Q

Define Health needs assessment?

Areas a health needs assessment may be carried out for?

A

Systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

Condition
Population/sub-group
Intervention

45
Q

Define Screening?

A

Process which sorts out apparently well people who probably have a disease from those who probably do not.

Not intended to be diagnostic - FURTHER TEST MUST BE RUN

Prevalance = Incidence X duration

46
Q

Define Sensitivity?

A

Proportion of people WITH THE DISEASE who are CORRECTLY IDENTIFIED by screening

a/a+c

% correctly identified with the disease

47
Q

Define Specificity?

A

Proportion of people WITHOUT THE DISEASE who are CORRECTLY EXCLUDED by the screening test

d/ b+d

% correctly excluded as disease free

48
Q

Define PPV?

A

Proportion of people with a POSITIVE test result who ACTUALLY HAVE THE DISEASE

a/ a+b

49
Q

Define NPV?

A

Proportion of people with a NEGATIVE test result who DONT HAVE THE DISEASE

d/ c+d

50
Q

Why can PPV be so varied in value?

A

Value is dependent on underlying prevalence of a condition.

51
Q

Define Lead-time bias?

Hint: leaD

Things to consider when evaluating a screening study

A

Overestimation of survival duration due to earlier detection by screening than clinical presentation.

Due to early detection

52
Q

Define Length-time bias?

Hint:lenGth (LONG)

Things to consider when evaluating a screening study.

A

Overestimation of survival duration due to the relative excess of cases detected that are slowly progressing.

Due to slow cases being detected more often simply because they are slowly progressing. [Greater presymptomatic phase = Greater Duration of detection = Greater prevalence]

53
Q

Define prevention paradox?

A

Preventative measure which brings much benefit to the population that offered little to each participating individual.

54
Q

When do you communicate notifiable diseases?

A

Any case of a notifiable disease presents - CLINICAL SUSPICION (Don’t have to wait for lab confirmation)

Any other infection/contamination that could risk human health

55
Q

How do you report notifiable diseases?

A

Contact local health protection authority/PHE

Written notification / Telephone if urgent

56
Q

What features of a communicable disease would make it a public health concern?

A 
High mortality 
High morbidity 
Highly contagious 
Expensive to treat 
Effective interventions against it.
57
Q

Define Pandemic?

A

Disease spread across large region - Multiple continents/worldwide

58
Q

Define Epidemic?

A

Rapid spread of disease to large number of people in a given population within a short period of time.

59
Q

Define Endemic?

A

Constant maintained increase in disease occurrences in a geographic area.

60
Q

Define Outbreak?

A

Incident in which two or more people experiencing a similar illness are linked in time or place.

Sudden increase in occurrences

Confirmed: A clinically compatible case that is laboratory confirmed

Suspected: Waiting for the laboratory results to become available for definitive categorisation (Case/ Not a case)

61
Q

Define Cluster?

A

An aggregation of cases of a disease/condition closely grouped in time and place.

Number of cases in the cluster may or may not exceed the expected number.

62
Q

Define Hyper-endemic?

A

Disease that is constantly present at high incidence and/or prevalence rate and affects all age groups equally

63
Q

Define primary prevention?

A

Preventing a disease/condition from occurring in the first place. Eliminate exposures/risk factors that contribute to the disease.

64
Q

Define second prevention?

A

Detecting a disease as soon as possible in order to alter its course and to improve health outcomes. SCREENING!

65
Q

Define tertiary prevention?

A

Trying to slow down the progression of a disease and helping people to manage their illness effectively.

66
Q

Define Prevalence?

A

The proportion of a population that have the disease at a point in time. (Normally given as a percentage).

67
Q

Define Incidence?

A

The rate at which new cases occur in a population during a specified time period.

68
Q

Write an equation that links incidence and prevalence.

A

Prevalence = incidence X average duration.

69
Q

Define Mortality?

A

The incidence of death from a disease.

70
Q

Define Confounding?

A

Situation where a factor is associated with exposure of interest and independently influences the outcome

(but does not lie on the causal pathway)

71
Q

Criteria for confirming causality for a factor?

6 Things.

A
  1. Strength of association - Magnitude of the RR
  2. Dose-response - Higher exposure=Higher risk of disease?
  3. Consistency - Similar results from different study designs.
  4. Temporality - Does exposure precede the outcome? (Must)
  5. Reversibility - Removal of exposure reduces risk of disease.
  6. Biological plausibility - Biological mechanisms explaining the link
72
Q

If a factor isn’t a cause!

What are reasons for association of a factor to an outcome.

A

1 - Chance (Coincidence)
2 - Bias
3 - Confounding
4 - Reverse causality (Cause and effect direction switched)

73
Q

Define Revere Causality?

A

Association between an exposure(factor) and an outcome is not due to direct causality from exposure to outcome

Rather outcome actually results in a change in the defined “exposure”.

e.g. Stress and HTN

74
Q

Define Bias?

A

Systematic error that results in a deviation from the true estimate of the association between exposure and outcome.

75
Q

What are the Main types of bias?

A
  1. Selection bias
    - Error in selection of study participants
    - Allocation of participants to different study groups
  2. Information bias
    Error in measurement/classification of:
    -Exposure
    -Outcome
  3. Confounding
76
Q

Name sources of information bias?

A

Observer Bias
Participant - Recall Bias
Instrument - Wrongly calibrated instrument

77
Q

Define Epidemiology?

A

Study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.

78
Q

Define Attributable risk?

A

Rate of disease in the exposed that may be attributed to the exposure

Tells us about the size of the effect in absolute terms

79
Q

Define Relative risk?

A

Ratio of risk of disease in the exposed to the risk of the unexposed

Tells us about strength of the association between a risk factor and a disease.

80
Q

Define Epigenetics?

A

Expression of genome depends on the environment

81
Q

Define Allostatsis?

A

Stability through change

Physiological systems adapted to react rapidly to environmental stressors

82
Q

Define Allostatic load

A

Price paid for allostasis

Overtaxation of our physiological systems leads to impaired health (STRESS)

83
Q

Define Salutogenesis?

A

Favourable physiological changes secondary to experiences which promote healing and health

84
Q

What are the 3 key concerns of public health?

A

Prevention
Inequalities in health
Wider determinants of health

85
Q

Define felt need?

A

Individual perceptions of variation from normal health.

86
Q

Define expressed need?

A

Individual seeks help to overcome variation in normal health (Demand)

87
Q

What are the two main levels of prevention approach?

A

Population approach - Preventative measures, e.g. dietary salt reduction, sugar tax, legislation

High risk approach - Identify individuals above a chosen cult off and trust - e.g. screening for high BP

88
Q

When does Bowel Cancer Screening start?

What is its frequency?

A

60-74 Years (Both M and F)

Every 2 Years

89
Q

AAA Screening?

Who and When

BONUS MARKS -Repair circumstances?

A

Men at 65 years.

> 5.5 - Repaired [Asymptommatic + Size]
Every 2 months surveillance - 4.5cm to 5.4
2 Years surveillance - 3cm to 4.4cm

AAA Repaired if - Asymptomatic >5.5c or >4cm + growing by more than 1cm within 12m

90
Q

When does Diabetic Eye Screening start?

A

12+

91
Q

Disadvantages with screening

A

Inverse care law - Those most at risk don’t present for screening. increasing the gap between health and unhealthy

False negatives + false reassurance - May lead to more negative risk behaviours

False positives can cause unnecessary worry and stress

92
Q

What type of prevention is screening and why?

A

Secondary

Early detection of disease to provide prompt treatment.
Latent/early stages

93
Q

STREPTOCOCCAL PNEUMONIA

REPORTING YES OR NO?

A

YES

ANY Disease caused by streptococcal pneumonia requires reporting.

94
Q

Define Prior probability?

[BONUS Q]

A

Probability of disease in a patient at a certain point in time, prior to obtaining additional data.

95
Q

Define Odds Ratio?

A

Chance of an event occurring in one population against the chance of it occurring in another population.

OR = Odds of being exposed [case group/disease] / Odds of being exposed [control group/unaffected]

OR >1 - Associated w/disesase
OR <1 - Protective
OR = 1 - No association

e.g. for a particular risk factor -i.e. foods in an outbreak investigation

96
Q

Cervical Screening

AGES AND REPETITION SCHEDULE?

A

25 - 64

25 TO 49 - EVERY 3 YEARS
50+ - EVERY 5 YEARS
65+ - ONLY IF 1 OUT 3 LAST TEST WERE ABNORMAL

97
Q

Breast Screening

AGES AND REPETITION SCHEDULE?

A

50-70 [47-73]

Every 3 years

Earlier screening for those deemed high risk with significant FH for breast cancer

98
Q

Motivation interviewing?

Where is it used?
4 Basis principles used?

4 basic principles
[HINT: RULE]

A

Employed within primary care setting and useful in medication compliance discussions.

Resisting to employ didactic course of action
Understanding the reasons for the change in behaviour
Listening to the patient’s ICE
Empowering the patient to understand they are able to change their behaviour.

99
Q

Key Points of the Fraser Guidelines?

[4 Main points]

A

Young person understands the professional’s advice and cannot be persuaded to inform their parents.

Young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment

Young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer

Young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

100
Q

Health problems associated with FGM?

A

Infection, infertility, sexual dysfunction, severe pain & shock, psychological/social consequences

Phase 3A Quiz (7 decks)

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