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Phase 3a Medicine > GP/Public Health > Flashcards

GP/Public Health Flashcards

1
Q

Name 5 models for behavioural change:

A
  • Health Belief Model
  • Transtheoretical Model
  • Theory of Planned Behaviour
  • Social Norms Theory
  • Motivational interview
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2
Q

What is the health belief model?

When is it successful?

What is a limitations?

A

Individual believe they are susceptible to the condition
Must believe it is a serious consequence
Taking actions reduce the risk
Benefits of treatment outweigh the cost

  • Successful: vaccinations and adherence to medication
  • Influence of emotion on behaviour is not considered
    Does not differentiate between first time and the repeat.
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3
Q

What is theory of planned behaviour?

What are some limitations:

A

That a person’s intention is the best predictor of behaviour. i.e I intend to give up smoking.

Looks at patient attitude to the behaviour
Perceived social norm to the behaviour
Perceived behavioural control

  • Doesn’t take into account emotion
  • Can an attitude be perceived/controlled?
  • Useful for predicting behaviour.
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4
Q

Transtheoretical Model

A 
-Pre contemplation : no intention on giving up 
Contemplation 
Preparation 
Action 
Maintenance 
Relapse

++ looks at individual stages of readiness and accounts for relapse

    • not all people go through the pattern and doesn’t take into account culture/social etc.
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5
Q

Nudge Theory

A
  • Nudge the environment to the make the best option the easiest choice i.e. have fruit near checkouts.
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6
Q

Motivational interview

A
  • Counselling service approach for initiating behaviour change by resolving ambivalence
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7
Q

What does NICE guidelines say about interventions? They should work in partnership with 4 things:

A
  • Individuals
  • Community
  • Organisations
  • Populations
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8
Q

What are 4 things that determine health?

A
  • Genetics
  • Environment
  • Healthcare
  • Lifestyle
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9
Q

What is Equity?

What is equality?

A

Everyone is inline with fairness and justice. I..e give the smaller person an even bigger stool.
Everyone is treated the same

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10
Q

What is horizontal equity?

What is vertical equity?

A

Equal treatment for equal need

Unequal treatment for unequal need

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11
Q

What determines health equity?

A

Everyone is in line with fairness and justice. Meaning that factors determining this include:

  • Supply of healthcare
  • Access
  • Utilisation
  • Outcomes
  • Health status
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12
Q

What are 3 examples of PH interventions:

A

Individual: patient education
Community: exercise groups
Population: sugar tax

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13
Q

What is epidemiology?

A

The study or frequency, distributions and determinants of disease and health related states in a population to prevent and control disease

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14
Q

What is primary
What is secondary
What is tertiary prevention?

A

Prevention at acquiring a disease
Prevention at progressing a disease
Preventing/slowing down the progress of a disease

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15
Q

What is Sensitivity?

A

The number of people who have been correctly diagnosed as having the disease

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16
Q

What is specificity?

A

The number of people without the disease who have been correctly removed

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17
Q

What is a positive predictive value?

What is a negative predictive value?

A
  • the number of people with a positive result that actually have the disease
  • the number of people with a negative result that don’t have the disease
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18
Q

What is a Gini coefficient?

A

Gini coefficient: a statistical representation of nation’s income distribution
amongs its residents - the lower the coefficient, the greater the equality amongst people. UK has a rather high inequality coefficient compared to Scandinavian countries (Denmark etc)

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19
Q

What are 2 responses to health inequalities?

A

The Black Report (1980)
i Material (environmental causes, might be mediated by behaviour)
i Artefact (an apparent product of how the inequality is measured)
ii Cultural/behavioural (poorer people behave in unhealthy ways)
iii Selection (sick people sink socially and economically)
• The Acheson Report (1998)
i income inequality should be reduced
ii give high priority to the health of families with children

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20
Q

What are contributing factors to health inequalities?

A
  • The more poor you are the more sick you are. Unable to work, unable to access healthcare and pay for things
  • Exercise and Lifestyle factors (good food, no smoking and no alcohol)
  • Psychosocial: stress causing a release of cortisol and increased BP
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21
Q

What are the 3 domains of Public Health?

A
  • Health Protection
  • Health Promotion
  • Health Improvement
  • Addressing wider determinants of health.
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22
Q

What are 5 structural determinants of ill health?

A
  • Maternal health
  • Social Class
  • Gender
  • Race
  • Unemployment/JOb
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23
Q

what is the biomedical model?

A

The idea that you need to treat the body and the soul.!

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24
Q

Confidentiality when can you disclose?

A

You can disclose if:

  • The patient is at risk
  • The public is at risk
  • Under the patient’s wishes
  • Required by the law

YOU must always just give the minimal amount of detail as possible.

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25
Q

Name 3 notifiable disease:

A

Plague
Cholera
Yellow Fever

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26
Q

What are the 3 componments of health behaviour?

A

Health Behaviour: preventing disease
Illness behaviour: going to doctor
Sick role behaviour: aimed at getting better

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27
Q

What are the 4 virtue ethic principles:

A 
Compassion 
Discernment 
Trustworthiness 
Integrity 
Conscientiousness
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28
Q

Utalitarianism vs Kantanism (Deontology)

A

Utilitarianism: act is evaluated solely for consequences. Maximise good and minimise harm.

Deontology: loks into the kind of person acting. Are they of good character and virtue?

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29
Q

Give 3 duties of a doctor?

A

To protect and promote health of patients and public
Provide a good standard of care
Work within competence
Treat patients as individuals and respect dignity

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30
Q

Give a few ADLS

A 
Getting out of bed or a chair
Washing 
Dressing 
Going to the toliet 
Eating
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31
Q

Give a few IADLs

A 
Can use a telephone 
Can go shopping 
Can manage money 
Can transfer 
Can groom 
Can bathe 
Can dress
Can be continent
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32
Q

Give 5 physical changes that happen when you get older?

A 
Loose joint flexibility 
Skin is more flexible 
Balance and Ear problems 
Cataracts
Cognitive Impairment. 
Increased suspectibility to infection
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33
Q

What are the 4 awareness contexts of dying?

A

Closed awareness: none
Suspicion awareness: one has suspicion of other
Mutual pretence: both know but don’t tell each other
Open awareness: both acknowledge to each other death is coming

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34
Q

Why is a hospice death good?

A

Open awareness
MDT
emotion and relationships: modelled on family
Holistic care

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35
Q

What is domestic abuse?

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality

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36
Q

What types of domestic abuse are there?

A 
psychological
physical
sexual
financial
emotional
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37
Q

What three ways does domestic abuse impact health?

A
  1. traumatic injuries following an assault
  2. somatic problems or chronic illness consequent on living with abuse
  3. psychological or psychosocial problems secondary to the abuse
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38
Q

What affect does domestic abuse have on children?

A

affects children’s physical and psychological health & well-being; and has long term impacts on self esteem, education, relationships, stress responses.

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39
Q

What are the risk levels in domestic abuse? Give a description of each:

A

STANDARD – current evidence does NOT indicate likelihood of causing serious harm

MEDIUM – there are identifiable indicators of risk of serious harm. Offender has potential to cause serious harm but unlikely unless change in circumstances

HIGH – there are identifiable indicators of imminent risk of serious harm. Dynamic – could happen at any time and impact would be serious

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40
Q

What tool can help assess risk?

A

DASH Tool

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41
Q

How can doctors help people suffering from domestic abuse?

A
  • Display helpline posters
  • Focus on the patient’s safety
  • As direct questions
  • Acknowledge that the behaviour is not ok
  • Be part of their process of recognising and escaping abuse
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42
Q

As a doctor if someone is at high risk of injury from domestic abuse:

Medium risk of domestic abuse:

A

MARAC referral

Contact details for domestic abuse services

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43
Q

What is MARAC?

A

A single meeting that connects information about the victim’s needs and the risk directly. Has inputs from each health service

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44
Q

What is the domestic homicide review?

A

Anyone over the age of 16 who’s death is treated as being as the result of domestic abuse

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45
Q

What are 4 determinants of health:

A

Genes
Environment
Lifestyle
Health care

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46
Q

What is the difference between equality and equity?

A

Equality: all about equal shares

Equity: is all about what is fair and just

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47
Q

What is horizontal equity?

What is vertical equity?

A

This is equal treatment for equal need

This is unequal treatment for unequal need. i.e common cold vs pneumonia need unequal treatment

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48
Q

Examples of health equity:

A

Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal health

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49
Q

What factors affect the dimensions of health equity?

A
  • Geographical

- Social (age, gender and class)

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50
Q

How can we improve health equity?

A

Improve resource allocation: health service, education and housing

Look into wider determinents of health: diet, smoking and SE

Through looking at Supply, Access and Utilisation of health care we can improve health care status

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51
Q

What are the 3 domains of public health?

A 
Health improvement (look at education, employment and lifestyle) 
Health protection (infectious disease, radiation and emergency response)
Improving Services(efficacy, service planning and auditing)
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52
Q

What is:
Primary Prevention
Secondary Prevention
Tertiary Prevention

A

Primary Prevention: Preventing yourself from getting disease: exercise, reduced smoking and alcohol and better diet

Secondary Prevention:try to detect a disease early and prevent it from getting any worse.

tertiary: to prevent the complications of a disease (i.e. stroke)

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53
Q

What is the difference between population and high risk prevention?

A

Population approach to prevention: this happens on a population wide scale and seeks to shift the RF distribution curve to the right… for example salt or sugar tax.

High Risk Prevention: identify individuals above a certain cut off and treat those (i.e. statin and BP use)

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54
Q

What is the prevention paradox?

A

The idea that a preventative measure brings much benefit to the population but little benefit to the individual (a good example is seat belts)

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55
Q

What is the definition of screening?

A

A process by which you want to sort out those apparently with the disease to those who don’t have them.

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56
Q

What are a few types of screening: name 4

A

Population-based screening programmes
Opportunistic screening
Screening for communicable diseases
Pre-employment and occupational medicals

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57
Q

What does Wilson’s Jungner criteria say?

A

The condition
Important health problem
Latent / preclinical phase
Natural history known

The screening test
Suitable (sensitive, specific,
inexpensive)
Acceptable

The treatment
Effective
Agreed policy on whom to
treat

The organisation and costs
Facilities
Costs and benefits
Ongoing process

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58
Q

What is sensitivity:

A

the proportion of people with the disease who are
correctly identified by the screening test
a / a+c

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59
Q

WHat is specificity?

A

Specificity – the proportion of people without the disease who are
correctly excluded by the screening test
d / b+d

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60
Q

What is a PPV?

A

– the proportion of people with a positive test
result who actually have the disease
a / a+b

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61
Q

What is a NPV?

A

– the proportion of people with a negative
test result who do not have the disease
d / c+d

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62
Q

What is lead time bias?

A

The idea that even with screening and knowing they have cancer earlier their life expectancy is the same

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63
Q

What is length time bias?

A

Normally the context of cancer. Those who have gone through screening seem to have an extended life expectancy but it would actually be the same.

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64
Q

Epidemiological study designs:

What is a cohort study?

A

You get a population of people without a disease and with time you see who has been exposed to certain things and not. See what proportion of each group get ill.

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65
Q

Epidemiological study designs: Case Control

A

This is a retrospect case study

Looks at those with the disease and those without the disease and see if they were exposed to anything in the past

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66
Q

Epidemiological study designs: RCT

A

You have two groups of people one group get the drug the other group doesn’t

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67
Q

Epidemiological study designs: Cross sectional study:

A

You have a population of people and you see out of that population of people surveyed how many have the disease

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68
Q

Epidemiological study designs: Ecological study

A

Looks at populations of areas and the exposure levels

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69
Q

What is an odds ratio?

A

Odds of exposure in drug population
Divided by
Odds of exposure in control population

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70
Q

What is health psychology?

A

emphasises the role of
psychological factors in the cause, progression
and consequences of health and illness

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71
Q

What are the 3 main health behaviours?

A

Health Behaviour
Illness Behaviour
Sick role Behaviour

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72
Q

What is health behaviour ?

A

A behaviour aimed at preventing disease

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73
Q

What is illness behaviour?

A

A behaviour aimed at seeking remedy?

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74
Q

What is sick role behaviour?

A

ANy activity aimed at getting well again

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75
Q

Name 5 causes of cancer that can be changed:

A 
Alcohol 
Smoking 
Exercise 
Diet 
Sun exposure
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76
Q

What health behaviour can be introduced at a population level?

A

Health promotion: enables people to exert control over their determinants of health
And thus improve their health

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77
Q

What health behaviour can be introduced at an individual level?

A

Have a patient centered approach.

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78
Q

Give 5 examples of Health Promotion Public Health campaigns:

A 
Couch to 5K 
Stoptober 
Movember 
Changer for life 
5 a day campaign 
Cervical Smear 
Vaccinations
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79
Q

What does the theory of unrealistic optimism tell you?

A

Individuals continue the practice of health damaging behaviour due to inaccurate perceptions of risk and susceptibility.

Most of the reasons for low compliance in patients is due to them underestimating risk.

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80
Q

How does NICE suggest to make behaviour changes?

A
  1. Planning interventions
  2. Assessing the social context
  3. Education and training
  4. Individual-level interventions
  5. Community-level interventions
  6. Population-level interventions
  7. Evaluating effectiveness
  8. Assessing cost-effectiveness
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81
Q

Who are at increased risk of smoking?

A

Men
Single people
Lower SE background

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82
Q

What has the highest chance of success with smoking cessation?

A

Individual behavioural support plus medication

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83
Q

What do you need to consider when doing a health needs assessment?

A

Supply
Demand
Need

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84
Q

To make a health needs assessment what 3 things need to be carried out in the QU?

A

The population

The condition

The intervention

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85
Q

What is Bradshaw’s perception of need:

A

Felt need - individual perceptions of variation from normal health
Expressed need - individual seeks help to
overcome variation in normal health
(demand)
Normative need - professional defines intervention appropriate for the expressed
need
Comparative need - comparison between severity, range of interventions and cost

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86
Q

What is a comparative approach?

What does it look into?

A 
Compares the services received by a
population (or subgroup) with others
 Spatial
 Social (age, gender, class, ethnicity)
 May examine:
 Health status
 Service provision
 Service utilisation
 Health outcomes
 (mortality, morbidity, quality of life, patient satisfaction)
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87
Q

If you use epidemiological approach to look into health needs assessment. What 4 things may you want to consider?

A 
Required data may not be available
 Variable data quality
 Evidence base may be inadequate
 Does not consider felt needs of people
affected
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88
Q

Benefits of using social media as a doctor:

A
  • To build professional networks
    • Peer support
    • To share knowledge and experiences
    • To build career and reputation
      To learn from others mistakes and best practice
89
Q

What is a refugee

A
  • An adult or child owning to a well founded fear of being persecuted for reasons of race, religion, nationality, membership, social group or political opinion is outside of the country.
    They have been granted asylum and refugee status. Usually means leave to remain for 5 years then reapply
90
Q

What is an asylum seeker?

What are they entitled to?

A
  • Someone who has submitted an application to be recognised as a refugee and is waiting for their claim to be decided by the home office

Granted £35 per week
Entitled housing and NHS care. They are not allowed to work or have any other benefits

91
Q

What is indefinite leave to remain?

A
  • Person has been granted full refugee status and given permanent residence in the UK.
    Eligible for family reunion: one spouse and any child from the marriage under the age of 18
92
Q

What is an unaccompanied child?

A

A child under the age of 18 who has crossed an international border and is applying for asylum in his/her own right

93
Q

What are some barriers to accessing healthcare:

A

language barrier
lack of knowledge of where to go and how the NHS works
They move around a lot
Health isn’t a main priorit y

94
Q

What are the 3 core principles of the nHS

A

Free at the point of access
meets the needs of everyone
Based on clinical need not ability to pay

95
Q

Name a couple of vulnerable groups in society:

A
  • Ex Prisoners
    • Care leavers (those that just leave care)
    • Alcoholics and Drug Addicts
    • Homeless
    • LGBTQ
    • Asylum Seekers
    • Those with learning difficulties
      Those with mental health disorders
96
Q

What is Maslow’s Hierachy of needs:

A

A pyramid of 5 tiers of human needs. Need to satisfy the lower ones like food, warmth, clothing etc
Before progressing to safety, love and esteem.

97
Q

What can loneliness cause? 4 things

A 
Earlier death 
Take more risks 
More cigarette 
Big issue with obesity 
can bring on ill health
98
Q

What is social exclusion:
What are the 5 domains that make it up?

What are causes of social exclusion?

A

The dynamic process of being shut out by the rest of society. They are no longer socially integrated.

The 5 domains:

  1. Material Resources
  2. Civic activities
  3. Basic services
  4. Neigbourhood
  5. Relationships

Reasons to be excluded:

  • Disability
  • Religion
  • Ethnicity
  • Poverty
  • Sexuality
99
Q

What are initiatives to combat loneliness?

A

Age UK and Sliverline

100
Q

What is the definition of homelessness?

A
  • A person who doesn’t have a permanent residence.

- Or feels at threat in their accommodation

101
Q

What risk do the homeless have?

A 
Increased risk of infection like TB 
They are increased risk of suicide 
Being in fights 
Having dental and feet problems 
STIs 
Substance misuse
102
Q

Who help support the homeless?

What are the barriers to healthcare?

A
  • Homeless Assessment and support service

Barriers include:
- Not prioritised
Discrimination
Opening times and appointment booking is hard.

103
Q

What are some problems in the traveller community?

A

More anxiety
More asthma
Teenage pregnancy
Lots of travelling no fixed abode

104
Q

What issues are in the LGBTQ+ community?

A 
Drug and alcohol use 
Mental Health 
Suicide 
STI/HIV 
Self harm

barriers are stigma and prejudice !

105
Q

What are some examples of human trafficking exploitation?

A
  • Sexual exploitation
    • Domestic servitude
    • Forced labour
    • Forced criminality
      Organ harvesting

Forced labour then sexual exploitation are the two most common

106
Q

What are the 4 components of a planning cycle

A 
What is the planning cycle: 
	1. Evaluation: by a RCT, evaluation of a PH intervention or a health economic evaluation. 
	2. Needs Assessment 
	3. Planning 
Implementation
107
Q

What are some of the issues with studying health outcome?

A
  • Link between health services provided and health outcomes may be hard to establish
    • Time lag between services provided and outcome can be too long
    • Large sample sizes may needed to look at statistical significance.
  • Data may not be available
108
Q

Name 6 of Maxwell’s Dimensions of Quality”

A
  • Effectiveness
    • Efficiency
    • Equity
    • Acceptability
    • Accessibility
      Appropriateness
109
Q

4 ways you can classify health outcomes:

A

Mortality e.g. 30 day mortality rate

2) Morbidity e.g. complication rates
3) Quality of life / PROMs
4) Patient satisfaction

110
Q

What are some cons of the social norm theory?

A
  • The impact of personality
  • Assessment of risk
  • Social environment
  • Predictors of maintenance of health
111
Q

What is the definition of malnutrition?

A
  • Deficiencies, Excesses or imbalances in a person’s intake of energy and/or nutrients.
    • Can either be under or over nutrition
112
Q

Where do early influences of food come from?

A
  • Food avoidance can come from parents
    • You need to avoid pressuring.
    • Not use food as a reward
      Need to reduce coercion, persuading and just try and think of interesting ways to encourage children to have food.
113
Q

Where do people develop their taste preference?

A

In utero

114
Q

How does breast feeding reduce the incidence of obesity ?

A
  • Breast milk is pretty low in protein
    Breast feeding reduces the incidence of infant obesity. As compared to formula milk: it is low In protein and has leptin hormone in
115
Q

Explore why dieting for weight loss in unsuccessful for some people:

A
  • Unresponsive to internal cues that signal satiety when overcoming hunger and overconsuming
    • Dietary restraints
    • Vulnerable to external cues that signal availability of palatable food.
      Portion size effect. The larger the portion size you overconsume for. If you ate a smaller portion you would eat it all and a larger portion you would do the same
116
Q

What promotes an increased food intake?

A 
What promotes an increased food intake? 
	- Environmental cues and psychological factors 
	- Genetics 
	- Employment (shift work) 
	- Early Developmental factors (culture and parents)
	- Advertising (TV and adverts)
	- Reduced physical activity 
Lack of sleep
117
Q

What is Disordered Eating:

A
  • Dietary Restrictions: reduce the amount of energy rich food in the diet. Or disinhibition when it comes to food.
    • Night eating
      Weight and shape concern
118
Q

What is a population approach and what is a high risk approach?

A

Population approach: an intervention aimed at the whole population: i..e reduced salt intake in takeaways

High risk: only aimed at those at an increased risk. This is like giving statins.

119
Q

Substance Misuse:

What is an addiction?

A
  • When the person’s life revolves around the drug
  • They are trying to work out when the next time they can have the drug
  • They are having a tolerance for the drug
  • They are having physiological drug withdrawal
120
Q

Substance Misuse: What are some of the effects of drug use?

A

Hallucinations
Psychosis
Increased guilt
Socially: affects jobs, families can lead to homelessness
Physical: tremor, seizures and respiratory depression

121
Q

Substance Misuse: how does heroin work?

A

Opiate receptors

Causes euphoria, miosis and drowsiness

122
Q

Substance Misuse: how does cocaine work?

A

Blocks serotonin and dopamine receptors

Can cause anxiety, panic or adrenaline secretion

123
Q

How do you treat people with a substance misuse problem?

A
  • Harm reduction
    • Detox therapy
    • Maintence: methadone (full agonist) for opioid addicts
    • Relapse: naltrexone
      Psychological interventions
124
Q

Alcohol Misuse: recommended units in males and females.

What is classed as hazardous in males and females

A

14 units in males
14 units in females

Hazardous drinking:

  • Males: 50
  • Females: 35
125
Q

Alcohol Misuse: how many g is one unit of alcohol?

A

8g of alcohol is one unit

126
Q

Alcohol Misuse: give some aetiological causes behind drinking!

A
  • Occupation
    • Availability
    • Advertising
    • Family (religion, tradition and culture)
127
Q

Alcohol Misuse: two screening tools for alcohol

A

AUDIT and CAGE

CAGE: 
Cut Down 
Angry 
Guilty 
Eye Opener
128
Q

Alcohol Misuse: What meds do you use to detox

A

Disulfiram and Acamprosate

129
Q

4 symptoms of foetal alcohol syndrome:

A
  • Microcephaly
    • Thin upper lip
    • Epicanthic folds
    • Upturned nose
130
Q

What is categorised as an alcohol dependence syndrome?

A

Cluster of 3 of the following over a 12 month period:
1. Tolerance increasing amount of alcohol to have the same effect
2. Characteristic physiological withdrawal
3. Difficulty controlling onset, amount or termination of use
4. Neglect of social aspects
5. Spending more time obtaining and using alcohol
Continued use despite negative impacts

131
Q

Most important comorbidity to sight loss

Which group is at an increased risk of sight problems

A

Is Depression

BME group: as increased risk of diabetes, glaucoma and cataracts

132
Q

How do you reduce the risk of eye disease?

A

Stop Smoking
Regular exercise
Good diet: plenty of nutrients
Regular eye tests

133
Q 
What visual disturbance would you get in
Glaucoma 
Macular Degneration 
Retinitis Pigmentosa
Diabetic Retinopathy
A
  • You would get tunnel vision. Associated with age, FH and BME community
  • Damage is caused by the raised eye pressure on the optic nerve

Macular Degeneration: damage to the centre so will get visual loss in the centre of the eye

Retinitis Pigmentosa: everything but particular;y worse at night or colour/central vision

134
Q

WHat are the 4 functions of assistive technology ?

A

Bigger
Brighter
Talkative
Tactile

135
Q

GP ILA: what tests would you want to do on someone that you suspected HTN in? 4 things

A

BP in both arms
24 hour BP monitoring
Lipid, HbA1c, lipid profile and Kidney Function

136
Q

GP ILA: what is
Stage 1
Stage 2
Stage 3 of Hypertension

A

Stage 1: 140/90
Stage 2: 150/100
Stage 3: 160/110

137
Q

GP ILA: When are drugs offered?

What is the flow chart for someone under 55 or over 55?

A

When lifestyle interventions have not worked

OVER 55 years old or BME

  1. Start them on a CCB
  2. ACE or ARB
  3. Thiazide like diuretic

Under 55:

  1. ACE or ARB
  2. CCB
  3. Thiazide like diuretic
138
Q

GP ILA: how do thiazide like diuretics work?

A

They act on the distal tubule and inhibit sodium reabsorption. Helping to relieve oedema. An example is indapamide

139
Q

GP ILA: How do you diagnose Heart Failure:

A

Chest Xray and ECG
ECHO
Bloods for serum natriuretic peptide (BNP)

140
Q

GP ILA: what treatment would you give if they had a preserved ejection fraction?
What treatment would you do if they had a reduced ejection fraction?

A

Preserved ejection fraction: loop diuretic like furosemide

Reduced ejection fraction: ACE + BB if very bad give spironolactone

141
Q

GP ILA: How would kidney disease affect your management of heart disease?
If someone had acute heart failure how would you treat them?
How would you change your management for age, ethnicity?

A

Reduced eGFR. Is a reduced renal clearance meaning that you will have to titrate the level of ACE up slowly.

You would give them IV diuretics and morphine and O2

You would need to reduce dose and talk to pharamcists

142
Q

What are some of the issues with polypharmamcy?

A

This is when there are more than 5 drugs

Drugs compliance is reduced
Patient will have more SE
More prevalence of Drug Interactions and ADR.

143
Q 
What are 
Primary 
Secondary 
Tertiary 
Support for Coronary Heart Disease?
A

Primary: increased exercise and reduced junk food. Better eating

Secondary: you need to have early detection and start them on medications. Do this with QRISK2

Tertiary: coronary artery bypass and pacemakers

144
Q

ILA 2: What do they trend in immunisation show?

What are come of the RFs for not being vaccinated?

A

We have fallen below our 20% target for full vaccination coverage.

RF: being in care, previously unvaccinated, children not registered at practices, travellers, children of teenage mothers and also abused children

145
Q

Name 5 notifable disease:

Depending on severity i.e. measles need urgent contact. TB can be within 24 hours

A 
Diptheriae 
Chlorea 
Yellow Fever 
meninigitis 
Whooping cough 
Measles 
Rubella
146
Q

What is NICE traffic light system on an unwell child?

Management of each traffic light:

A

Need for each category:

  1. Colour
  2. Activity: Conscious, crying, smiling etc? Are they playing
  3. Respiratory: RR, nasal flaring and oxygen sats
  4. Cardiology: Mucous membranes, perfusion and HR
  5. Other: temperature, rigor, seizure, swollen/red joints

Green: manage at home
Amber: manage at the hospital or home
Red: manage at hospital

147
Q

What investigations would you want to do on a sick child?

A 
Blood Cultures 
MSU 
Stool culture 
Lumbar Puncture 
CXR 
Throat swabs etc if indicated
148
Q

What is safety netting?

A

What GPs do a lot they tell parents to come back if they are concerned. tell them Red flags for when they need to attend a&E etc

149
Q

Who is at an increased risk of sepsis?

A

The young
Immunocompromised
the Old
People undergoing chemo or radiotherapy

150
Q

Give 5 symptoms of sepsis:

A 
Confusion 
High RR 
High HR 
Low BP 
cyanotic  
Low Temp
151
Q

What is the Fever pain Score? What does the score tell you?

A

Works out the chance that a patient has an infection that is caused by a strep infection: Need 4 symptoms for ABX!

  • Absence of Cough or cold
  • Duration less than 3 days
  • Fever in past 24 hours

Examination:

  1. Do they have white pus on tonsils
  2. Inflammed tonsils
  3. Do they have lymphadenopathy

A score of 2 or more is associated with a strep throat: give amoxicillin 1st line.

152
Q

GP 3: give some RF for teenage pregnancy:

A
  1. Leaving school early
  2. Being in foster care
  3. Low SE background
  4. Drug and Alcohol Misuse
  5. Unprotected sex
  6. Children from teenage mothers
153
Q

What are the implications of teenage pregnancy?

A
  • Low BW
  • Increased infant mortality and morbidity
  • Increased risk of maternal MH conditions
  • Increased reliance on Benefits
154
Q

What is Gilick Compentency?

A

This is the idea if seeing if children under the age of 16 are competent enough to make there own decision without their parent’s choice. If not it relies on the parents

155
Q

What are the Fraser Guidelines:

A

The Fraser Guidelines are to ensure that all women have the capacity to make decisions about their sexual health and contraception. This is reliant on:

  1. The girl understands the role and implication of contraception
  2. The girl can not be persuaded to tell her parents
  3. They would carry on with sex anyway
  4. Without the contraception there would be disasterous MH/physical issues
  5. It is in the girl’s best interest
156
Q

Describe the legality of age and sexual activity for under 13
14-16
and 16-18

A

13 and under is always illegal they just can’t consent for sexual activity. It will always be a crime
14-16: limited capacity. case by case basis
16: legal age for sex.
16-18: got capacity: but porn and images are still illegal

157
Q

Types of Contraception: Name 5

A
  • COCP
  • Mini pill: progesterone only
  • Condoms
  • IUD
  • IUCD
  • Female sterilisation and Male
158
Q

What cancers does COCP protect against?

Who can use the mini-pill who may have otherwise struggled?

A
  • Endometrial, Ovarian and colorectal
    Increased cancer risk for breast and cervical.

Mini pill can be used in those over the age of 55 and those who are obese.

159
Q

How does the depop injection work?

A

It works by stopping ovulating by supressing LH and FSH.
Makes the endometrium and cervical mucosa unstable

CONS: increased weight gain, decreased BMD and ireegular prolonged bleeding

160
Q

How does the copper coil work for emergency contraception?

A

It effects the ova and sperm from joining. It is an inflammatory effect and this is not a good environment for sperm.

161
Q

What test do you do for anxiety?

A

GAD-7

162
Q

What test do you do for depression?

A

PHQ-9

163
Q

Give some symptoms of anxiety?

A
  • Worry
  • Fear that something bad is going to happen
  • De personalisation and De realisation
  • Low Mood
  • Restless/Fidgeity
  • Palpitations, Sweatiness, Hyperventilation, dry mouth, headache and stomach pain
164
Q

RF for anxiety:

A 
Female Sex 
FH 
Personality
Life events 
Co morbid situation
165
Q

What is a panic disorder?

A

Sudden onset of anxiety. Not precipitated by anything in particular. Normally need 4 symptoms such as: SOB, headache, palpitations,d izziness and fear of dying

166
Q

RF for depression and suicide?

A
  • male
  • Recent life events
  • isolation
  • physical health conditions
  • previous MH in the past
  • FH
  • Drug and alcohol abuse
167
Q

Give me the components of a suicide risk assessment:

SAD PERSONS

A

S ex
A ge less than 20 or above 44
D epression

Previous suicide attempt 
Ethanol abuse 
Rational thinking loss
Social support lacking 
Organised suicide plan 
No spouse 
Sickness of presence of a chronic disease
168
Q

How do antidepressants work:

  1. SSRI: give an example
  2. SNRI: give an example
  3. TCA: give an example

At an increased risk of suicide see the patient every week. Not increased: review after two week

A

SSRI: fluoxetine work by allowing there not to be reuptake of serotonin in the brain. So there is a bigger exposure to it
SNRI: duloxetine: these work by preventing the uptake of noradrenaline and serotonin. Help with neuropathic pain but can cause fatigue, headache and suicidal thoughts
TCA: amitriptyline. Worse effects than SSRIs. They can be sedating and have cardiogenic toxic effects

169
Q

What does the PHQ-9 tool screen for: what are some of the questions?

A 
Depression:
Feeling worthless 
low mood 
problems sleeping
Lack of interest in things
170
Q

What does GAD-7 tool screen for?

A

Anxiety

During the past two weeks have you ever experienced several days/ half of the days or never

171
Q

What substance abuse screening tool is used for pregnant ladies:

A

TWEAK

and 4Ps pre natal

172
Q

What are two screening tools for substance misuse?

A

DAST
COWS
SOWS: last two are for opiate withdrawal

173
Q

What is classed as an acute cough

what is classed as a chronic cough

A

Acute is less than 3 weeks

Chronic is more than 8 weeks

174
Q

What are 3 causes of an acute cough?

What are 3 causes of a chronic cough?

A

URTI, cardiac failure, croup, bronchiolitis

Chronic rhinitis, sinusitis, asthma and GORD

175
Q

In children with a chronic cough more than 4 weeks what could be the likely causes:

A
  1. Congenital defects
  2. Foreign body aspiration
  3. Asthma, Cystic Fibrosis and URTI
176
Q

What is a cough?

A

Forceful expulsion of air from the lung to help clear secretions, foreign bodies and irritants from the airway

This can be voluntary or a reflex to irritants/triggers

177
Q

Describe the process that triggers a cough?

A

irritation of the cough reflex
leads to closure of the epiglottis and vocal cords
Contracture of the diaphragm muscles and surrounding muscles leads to a massive increase in diaphragmatic pressure and a sudden opening of the vocal cords and forceful expulsion of air out of the lungs.

178
Q

Causes of a productive cough:

A

Bronchiectasis
TB
Lung Cancer
Cystic Fibrosis

179
Q

What is some RF for TB?

A 
Living in an area of TB prevalence
Being around someone with TB
Being malnourished and low body weight 
History of TB in the past 
Living in crowded areas 
Haemotological/Kidney or Vitamin D deficency
180
Q

How can you protect your practice population against TB?

A

immunise anyone from a high risk country or may have risk factors
contact trace anyone TB patients have been in contact with
Make people more vigilent of the signs

181
Q

Treatment for TB:

A 
RIPE 
Rifampicin 
Isoniazid 
Pyrazinamide 
Ethambutol

All 4 for 2 months
Only Rifampicin and isoniazid for 4 months

182
Q

What is the treatment for latent TB?

A

You need to give 3 months of Rifampicin and Isoniazid

An additional 3 months of Isoniazid

183
Q

List a few problems that patients with poor English cause for clinicans?

A

Need of a translator: is it a direct
The patient may not feel comfortable talking to a patient
The patient may feel put off going to the GP as has low english.
Will they understand a complex management plan
Will they have compliance with medicine

184
Q

Name 5 types of error?

A 
Sloth 
Communication Breakdown 
Poor Team Working 
Mis-triage 
Lack of Skill 
Fixation and loss of perspective 
Ignorance 
System error
185
Q

What does the theory of proportionate universalism say?

A

It says that we can not purely focus on the disadvantaged in society we need to
- take action universally and allow the fair distribution of wealth

186
Q

What are the 3 theories of causation to health inequalities?

A

Psychosocial: stress results in an inability to deal with body demands

Neo-Material: more hierarchical societies are less willing to invest in public goods. The poorer people have less material goods

Life course: critical periods and poor things that happen during them and an accumulation of hazards and bad experiences in life

187
Q

What are the 4 domains of public health

A

Health improvement
Health Prevention
Health promotion
And addressing the wider determinants of health

188
Q

What is the ethical argument of:

  • Deductive
  • Inductive
A
  • Deductive is when you use one general ethical theory for all medical problems
  • Inductive: is when you use settled medical cases to influence theories
189
Q

What are some structural determinants of illness:

A 
Maternal Health 
Gender
Ethnicity 
Occupation/Un-employed 
Social Class
190
Q

What 4 things does the health belief model say?

A

The person must believe they are susceptible to the disease
The person must believe the disease has severe consequences
They must believe that taking actions reduces risks
And that the benefits of the action outweigh the cost

191
Q

What are the 6 stages of the trans theoretical model ?

A

Pre contemplation: no intention in giving up smoking
Contemplation: considering quitting
Preparation: getting ready to quit in the future
Action: engaged in giving up
Maintenance: keeping it up
Relapse: smoking again

192
Q

What are the 5 duties of a doctor?

A
  1. To work with colleagues in a way that best serves patient’s interests
  2. To promote healthy lifestyle choices
  3. Provide a good standard of care
  4. Work within limits of competency
  5. Respect patient autonomy
193
Q

What is extrinsic ageing?

A

This is when the external factors you have exposed yourself to have caused your ageing. I.e smoking, alcohol and UV exposure

194
Q

What is a social death?

A

This is the idea that a person dies in social and interpersonal terms before their actual biological death: this is a lonely in personal death

195
Q

What are the 5 stages of chain of infection?

A

Susceptible host

Causative micro-organism

Reservoir : i.e staff, patients and family

Portal of entry/exit

Mode of transmission (exogenous multiple people spread) or endogenous which is spread via the same person ‘/

196
Q

What two organisms does alcoholic gel not kill?

A

It doesn’t kill

  • Norovirus
  • C Diff
197
Q

What is the physiological process that leads to smoking?

A

It activates the nicotinic ACh
This releases a release of dopamine

This gives the sense of pleasure
Causes addiction

198
Q

What are some public health changes that have been done to reduce smoking incidence?

A

Ban of sale of tobacco under 16s

1965: ban of advertising
2007: smoking in public is banned
2015: smoking in a car with children was banned

199
Q

What are 3 smoking cessation techniques:

A

Nicotine Replacement Therapy: patches, gum and nasal spray

Non-nicotinic pharmacotherapy:

  • Champix
  • Bupropion
200
Q

What is the 3 As approach

Who is it used for?

A

Ask
Advise
Assist

It is used in smoking cessation

201
Q

Name 5 millennium development goals

A 
Reduce infant mortality 
Improve maternal health 
Reduced HIV/AIDS and malaria 
Eradicate extreme poverty and hunger 
Achieve universal primary education 
Promote gender equality
202
Q

What is the Bradford hill criteria?

Give some components of it?

A

This is a criteria that determines causation

  • Biological plausibility
  • Temporality
  • Strength
  • Consistency
  • Specificity
  • Coherence
  • Analogy
203
Q

What is incidence

A

The number of new cases in a specified time period

204
Q

What are the 3 main types of error?

A

Error of omission: required action is missed
Error of commission: wrong action is taken
Error of negligence: error does not meet the standard that person requires

205
Q

What are violations?

Give a few examples

A

This is a deliberate deviation from the practice, procedure and standard

Types include
Routine
Necessary
Optimising

206
Q

How do we reduce error

A

Need to make individual changes

Population changes

207
Q

What are some obstaticles to team work?

A

Organisational
Location
Management

208
Q

What makes up a good team?

A 
Identified team leader
Sole purpose 
Shared knowledge and experience 
Good team Size 
Good team dynamic
209
Q

What are some examples of

  • Acute stress
  • Chronic stress
A
  • Acute stress: this is when you have noise, danger, infection and hunger
  • Chronic: is when you have people, job, health, family, financial issues
210
Q

What are some biological responses to stress?

A 
Reduced sleep 
Lungs: rapid breathing 
Blood flow: increased up to 400% 
Tense muscles 
Mouth: drier 
Immune Response: impaired
211
Q

What are the 3 components of the general adaptation syndrome:

A

Alarm: threat/stressor is identified
Adaption: defensive countermeasures
Exhaustion: biodynamic begins to run out of defence

212
Q

What are the 5 signs of stress?

A

Biochemical: endorphin and cortisol release

Physiological: shallow breathing and raised BP

Behavioural: over eating anorexia and insomnia

Cognitive: negative thoughts, no concentration and worse memory

Emotional: mood swings, irritability and aggression

213
Q

What are 5 components contributing to obesity?

A 
Over eating 
High energy dense foods 
Shift work
Advertising 
Low exercise 
Replacing water with sugary drinks 
Longer hours and more commuting
214
Q

What are the seven key domains of energy balance?

A 
Food environment 
Food consumption 
Individual activity 
Activity of environment 
Society influence 
Individual psychology 
Individual biology
215
Q

What is the satiety cascade?

A

Sensory
Cognitive
Post ingestive
Post absorption

216
Q

Give 5 alternative therapies

A 
Aromatherapy 
Osteopathy 
Chiropathy 
Homeopathy 
Herbal Medicine 
Acupuncture
217
Q

What are 3 causes of a Heart Failure

A 
Heart attack 
Cardiomyopathy 
Anaemia 
AF 
Thyroid 
Arrhythmia
218
Q

What is 4th line treatment for reduced ejection fraction

A

ACE
BB
Then Spirolactone

Then 4th is Ivabradine!

Phase 3a Medicine (9 decks)

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