GP/Public Health Flashcards
Name 5 models for behavioural change:
- Health Belief Model
- Transtheoretical Model
- Theory of Planned Behaviour
- Social Norms Theory
- Motivational interview
What is the health belief model?
When is it successful?
What is a limitations?
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.
What is theory of planned behaviour?
What are some limitations:
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.
Transtheoretical Model
-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.
Nudge Theory
- Nudge the environment to the make the best option the easiest choice i.e. have fruit near checkouts.
Motivational interview
- Counselling service approach for initiating behaviour change by resolving ambivalence
What does NICE guidelines say about interventions? They should work in partnership with 4 things:
- Individuals
- Community
- Organisations
- Populations
What are 4 things that determine health?
- Genetics
- Environment
- Healthcare
- Lifestyle
What is Equity?
What is equality?
Everyone is inline with fairness and justice. I..e give the smaller person an even bigger stool.
Everyone is treated the same
What is horizontal equity?
What is vertical equity?
Equal treatment for equal need
Unequal treatment for unequal need
What determines health equity?
Everyone is in line with fairness and justice. Meaning that factors determining this include:
- Supply of healthcare
- Access
- Utilisation
- Outcomes
- Health status
What are 3 examples of PH interventions:
Individual: patient education
Community: exercise groups
Population: sugar tax
What is epidemiology?
The study or frequency, distributions and determinants of disease and health related states in a population to prevent and control disease
What is primary
What is secondary
What is tertiary prevention?
Prevention at acquiring a disease
Prevention at progressing a disease
Preventing/slowing down the progress of a disease
What is Sensitivity?
The number of people who have been correctly diagnosed as having the disease
What is specificity?
The number of people without the disease who have been correctly removed
What is a positive predictive value?
What is a negative predictive value?
- 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
What is a Gini coefficient?
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)
What are 2 responses to health inequalities?
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
What are contributing factors to health inequalities?
- 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
What are the 3 domains of Public Health?
- Health Protection
- Health Promotion
- Health Improvement
- Addressing wider determinants of health.
What are 5 structural determinants of ill health?
- Maternal health
- Social Class
- Gender
- Race
- Unemployment/JOb
what is the biomedical model?
The idea that you need to treat the body and the soul.!
Confidentiality when can you disclose?
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.
Name 3 notifiable disease:
Plague
Cholera
Yellow Fever
What are the 3 componments of health behaviour?
Health Behaviour: preventing disease
Illness behaviour: going to doctor
Sick role behaviour: aimed at getting better
What are the 4 virtue ethic principles:
Compassion Discernment Trustworthiness Integrity Conscientiousness
Utalitarianism vs Kantanism (Deontology)
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?
Give 3 duties of a doctor?
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
Give a few ADLS
Getting out of bed or a chair Washing Dressing Going to the toliet Eating
Give a few IADLs
Can use a telephone Can go shopping Can manage money Can transfer Can groom Can bathe Can dress Can be continent
Give 5 physical changes that happen when you get older?
Loose joint flexibility Skin is more flexible Balance and Ear problems Cataracts Cognitive Impairment. Increased suspectibility to infection
What are the 4 awareness contexts of dying?
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
Why is a hospice death good?
Open awareness
MDT
emotion and relationships: modelled on family
Holistic care
What is domestic abuse?
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
What types of domestic abuse are there?
psychological physical sexual financial emotional
What three ways does domestic abuse impact health?
- traumatic injuries following an assault
- somatic problems or chronic illness consequent on living with abuse
- psychological or psychosocial problems secondary to the abuse
What affect does domestic abuse have on children?
affects children’s physical and psychological health & well-being; and has long term impacts on self esteem, education, relationships, stress responses.
What are the risk levels in domestic abuse? Give a description of each:
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
What tool can help assess risk?
DASH Tool
How can doctors help people suffering from domestic abuse?
- 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
As a doctor if someone is at high risk of injury from domestic abuse:
Medium risk of domestic abuse:
MARAC referral
Contact details for domestic abuse services
What is MARAC?
A single meeting that connects information about the victim’s needs and the risk directly. Has inputs from each health service
What is the domestic homicide review?
Anyone over the age of 16 who’s death is treated as being as the result of domestic abuse
What are 4 determinants of health:
Genes
Environment
Lifestyle
Health care
What is the difference between equality and equity?
Equality: all about equal shares
Equity: is all about what is fair and just
What is horizontal equity?
What is vertical equity?
This is equal treatment for equal need
This is unequal treatment for unequal need. i.e common cold vs pneumonia need unequal treatment
Examples of health equity:
Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal health
What factors affect the dimensions of health equity?
- Geographical
- Social (age, gender and class)
How can we improve health equity?
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
What are the 3 domains of public health?
Health improvement (look at education, employment and lifestyle) Health protection (infectious disease, radiation and emergency response) Improving Services(efficacy, service planning and auditing)
What is:
Primary Prevention
Secondary Prevention
Tertiary Prevention
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)
What is the difference between population and high risk prevention?
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)
What is the prevention paradox?
The idea that a preventative measure brings much benefit to the population but little benefit to the individual (a good example is seat belts)
What is the definition of screening?
A process by which you want to sort out those apparently with the disease to those who don’t have them.
What are a few types of screening: name 4
Population-based screening programmes
Opportunistic screening
Screening for communicable diseases
Pre-employment and occupational medicals
What does Wilson’s Jungner criteria say?
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
What is sensitivity:
the proportion of people with the disease who are
correctly identified by the screening test
a / a+c
WHat is specificity?
Specificity – the proportion of people without the disease who are
correctly excluded by the screening test
d / b+d
What is a PPV?
– the proportion of people with a positive test
result who actually have the disease
a / a+b
What is a NPV?
– the proportion of people with a negative
test result who do not have the disease
d / c+d
What is lead time bias?
The idea that even with screening and knowing they have cancer earlier their life expectancy is the same
What is length time bias?
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.
Epidemiological study designs:
What is a cohort study?
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.
Epidemiological study designs: Case Control
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
Epidemiological study designs: RCT
You have two groups of people one group get the drug the other group doesn’t
Epidemiological study designs: Cross sectional study:
You have a population of people and you see out of that population of people surveyed how many have the disease
Epidemiological study designs: Ecological study
Looks at populations of areas and the exposure levels
What is an odds ratio?
Odds of exposure in drug population
Divided by
Odds of exposure in control population
What is health psychology?
emphasises the role of
psychological factors in the cause, progression
and consequences of health and illness
What are the 3 main health behaviours?
Health Behaviour
Illness Behaviour
Sick role Behaviour
What is health behaviour ?
A behaviour aimed at preventing disease
What is illness behaviour?
A behaviour aimed at seeking remedy?
What is sick role behaviour?
ANy activity aimed at getting well again
Name 5 causes of cancer that can be changed:
Alcohol Smoking Exercise Diet Sun exposure
What health behaviour can be introduced at a population level?
Health promotion: enables people to exert control over their determinants of health
And thus improve their health
What health behaviour can be introduced at an individual level?
Have a patient centered approach.
Give 5 examples of Health Promotion Public Health campaigns:
Couch to 5K Stoptober Movember Changer for life 5 a day campaign Cervical Smear Vaccinations
What does the theory of unrealistic optimism tell you?
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.
How does NICE suggest to make behaviour changes?
- Planning interventions
- Assessing the social context
- Education and training
- Individual-level interventions
- Community-level interventions
- Population-level interventions
- Evaluating effectiveness
- Assessing cost-effectiveness
Who are at increased risk of smoking?
Men
Single people
Lower SE background
What has the highest chance of success with smoking cessation?
Individual behavioural support plus medication
What do you need to consider when doing a health needs assessment?
Supply
Demand
Need
To make a health needs assessment what 3 things need to be carried out in the QU?
The population
The condition
The intervention
What is Bradshaw’s perception of need:
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
What is a comparative approach?
What does it look into?
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)
If you use epidemiological approach to look into health needs assessment. What 4 things may you want to consider?
Required data may not be available Variable data quality Evidence base may be inadequate Does not consider felt needs of people affected
Benefits of using social media as a doctor:
- To build professional networks
- Peer support
- To share knowledge and experiences
- To build career and reputation
To learn from others mistakes and best practice
What is a refugee
- 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
What is an asylum seeker?
What are they entitled to?
- 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
What is indefinite leave to remain?
- 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
What is an unaccompanied child?
A child under the age of 18 who has crossed an international border and is applying for asylum in his/her own right
What are some barriers to accessing healthcare:
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
What are the 3 core principles of the nHS
Free at the point of access
meets the needs of everyone
Based on clinical need not ability to pay
Name a couple of vulnerable groups in society:
- 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
What is Maslow’s Hierachy of needs:
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.
What can loneliness cause? 4 things
Earlier death Take more risks More cigarette Big issue with obesity can bring on ill health
What is social exclusion:
What are the 5 domains that make it up?
What are causes of social exclusion?
The dynamic process of being shut out by the rest of society. They are no longer socially integrated.
The 5 domains:
- Material Resources
- Civic activities
- Basic services
- Neigbourhood
- Relationships
Reasons to be excluded:
- Disability
- Religion
- Ethnicity
- Poverty
- Sexuality
What are initiatives to combat loneliness?
Age UK and Sliverline
What is the definition of homelessness?
- A person who doesn’t have a permanent residence.
- Or feels at threat in their accommodation
What risk do the homeless have?
Increased risk of infection like TB They are increased risk of suicide Being in fights Having dental and feet problems STIs Substance misuse
Who help support the homeless?
What are the barriers to healthcare?
- Homeless Assessment and support service
Barriers include:
- Not prioritised
Discrimination
Opening times and appointment booking is hard.
What are some problems in the traveller community?
More anxiety
More asthma
Teenage pregnancy
Lots of travelling no fixed abode
What issues are in the LGBTQ+ community?
Drug and alcohol use Mental Health Suicide STI/HIV Self harm
barriers are stigma and prejudice !
What are some examples of human trafficking exploitation?
- Sexual exploitation
- Domestic servitude
- Forced labour
- Forced criminality
Organ harvesting
Forced labour then sexual exploitation are the two most common
What are the 4 components of a planning cycle
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
What are some of the issues with studying health outcome?
- 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
Name 6 of Maxwell’s Dimensions of Quality”
- Effectiveness
- Efficiency
- Equity
- Acceptability
- Accessibility
Appropriateness
4 ways you can classify health outcomes:
Mortality e.g. 30 day mortality rate
2) Morbidity e.g. complication rates
3) Quality of life / PROMs
4) Patient satisfaction
What are some cons of the social norm theory?
- The impact of personality
- Assessment of risk
- Social environment
- Predictors of maintenance of health
What is the definition of malnutrition?
- Deficiencies, Excesses or imbalances in a person’s intake of energy and/or nutrients.
- Can either be under or over nutrition
Where do early influences of food come from?
- 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.
Where do people develop their taste preference?
In utero
How does breast feeding reduce the incidence of obesity ?
- 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
Explore why dieting for weight loss in unsuccessful for some people:
- 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
What promotes an increased food intake?
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
What is Disordered Eating:
- 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
- Night eating
What is a population approach and what is a high risk approach?
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.
Substance Misuse:
What is an addiction?
- 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
Substance Misuse: What are some of the effects of drug use?
Hallucinations
Psychosis
Increased guilt
Socially: affects jobs, families can lead to homelessness
Physical: tremor, seizures and respiratory depression
Substance Misuse: how does heroin work?
Opiate receptors
Causes euphoria, miosis and drowsiness
Substance Misuse: how does cocaine work?
Blocks serotonin and dopamine receptors
Can cause anxiety, panic or adrenaline secretion
How do you treat people with a substance misuse problem?
- Harm reduction
- Detox therapy
- Maintence: methadone (full agonist) for opioid addicts
- Relapse: naltrexone
Psychological interventions
Alcohol Misuse: recommended units in males and females.
What is classed as hazardous in males and females
14 units in males
14 units in females
Hazardous drinking:
- Males: 50
- Females: 35
Alcohol Misuse: how many g is one unit of alcohol?
8g of alcohol is one unit
Alcohol Misuse: give some aetiological causes behind drinking!
- Occupation
- Availability
- Advertising
- Family (religion, tradition and culture)
Alcohol Misuse: two screening tools for alcohol
AUDIT and CAGE
CAGE: Cut Down Angry Guilty Eye Opener
Alcohol Misuse: What meds do you use to detox
Disulfiram and Acamprosate
4 symptoms of foetal alcohol syndrome:
- Microcephaly
- Thin upper lip
- Epicanthic folds
- Upturned nose
What is categorised as an alcohol dependence syndrome?
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
Most important comorbidity to sight loss
Which group is at an increased risk of sight problems
Is Depression
BME group: as increased risk of diabetes, glaucoma and cataracts
How do you reduce the risk of eye disease?
Stop Smoking
Regular exercise
Good diet: plenty of nutrients
Regular eye tests
What visual disturbance would you get in Glaucoma Macular Degneration Retinitis Pigmentosa Diabetic Retinopathy
- 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
WHat are the 4 functions of assistive technology ?
Bigger
Brighter
Talkative
Tactile
GP ILA: what tests would you want to do on someone that you suspected HTN in? 4 things
BP in both arms
24 hour BP monitoring
Lipid, HbA1c, lipid profile and Kidney Function
GP ILA: what is
Stage 1
Stage 2
Stage 3 of Hypertension
Stage 1: 140/90
Stage 2: 150/100
Stage 3: 160/110
GP ILA: When are drugs offered?
What is the flow chart for someone under 55 or over 55?
When lifestyle interventions have not worked
OVER 55 years old or BME
- Start them on a CCB
- ACE or ARB
- Thiazide like diuretic
Under 55:
- ACE or ARB
- CCB
- Thiazide like diuretic
GP ILA: how do thiazide like diuretics work?
They act on the distal tubule and inhibit sodium reabsorption. Helping to relieve oedema. An example is indapamide
GP ILA: How do you diagnose Heart Failure:
Chest Xray and ECG
ECHO
Bloods for serum natriuretic peptide (BNP)
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?
Preserved ejection fraction: loop diuretic like furosemide
Reduced ejection fraction: ACE + BB if very bad give spironolactone
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?
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
What are some of the issues with polypharmamcy?
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.
What are Primary Secondary Tertiary Support for Coronary Heart Disease?
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
ILA 2: What do they trend in immunisation show?
What are come of the RFs for not being vaccinated?
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
Name 5 notifable disease:
Depending on severity i.e. measles need urgent contact. TB can be within 24 hours
Diptheriae Chlorea Yellow Fever meninigitis Whooping cough Measles Rubella
What is NICE traffic light system on an unwell child?
Management of each traffic light:
Need for each category:
- Colour
- Activity: Conscious, crying, smiling etc? Are they playing
- Respiratory: RR, nasal flaring and oxygen sats
- Cardiology: Mucous membranes, perfusion and HR
- Other: temperature, rigor, seizure, swollen/red joints
Green: manage at home
Amber: manage at the hospital or home
Red: manage at hospital
What investigations would you want to do on a sick child?
Blood Cultures MSU Stool culture Lumbar Puncture CXR Throat swabs etc if indicated
What is safety netting?
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
Who is at an increased risk of sepsis?
The young
Immunocompromised
the Old
People undergoing chemo or radiotherapy
Give 5 symptoms of sepsis:
Confusion High RR High HR Low BP cyanotic Low Temp
What is the Fever pain Score? What does the score tell you?
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:
- Do they have white pus on tonsils
- Inflammed tonsils
- Do they have lymphadenopathy
A score of 2 or more is associated with a strep throat: give amoxicillin 1st line.
GP 3: give some RF for teenage pregnancy:
- Leaving school early
- Being in foster care
- Low SE background
- Drug and Alcohol Misuse
- Unprotected sex
- Children from teenage mothers
What are the implications of teenage pregnancy?
- Low BW
- Increased infant mortality and morbidity
- Increased risk of maternal MH conditions
- Increased reliance on Benefits
What is Gilick Compentency?
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
What are the Fraser Guidelines:
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:
- The girl understands the role and implication of contraception
- The girl can not be persuaded to tell her parents
- They would carry on with sex anyway
- Without the contraception there would be disasterous MH/physical issues
- It is in the girl’s best interest
Describe the legality of age and sexual activity for under 13
14-16
and 16-18
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
Types of Contraception: Name 5
- COCP
- Mini pill: progesterone only
- Condoms
- IUD
- IUCD
- Female sterilisation and Male
What cancers does COCP protect against?
Who can use the mini-pill who may have otherwise struggled?
- 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.
How does the depop injection work?
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
How does the copper coil work for emergency contraception?
It effects the ova and sperm from joining. It is an inflammatory effect and this is not a good environment for sperm.
What test do you do for anxiety?
GAD-7
What test do you do for depression?
PHQ-9
Give some symptoms of anxiety?
- 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
RF for anxiety:
Female Sex FH Personality Life events Co morbid situation
What is a panic disorder?
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
RF for depression and suicide?
- male
- Recent life events
- isolation
- physical health conditions
- previous MH in the past
- FH
- Drug and alcohol abuse
Give me the components of a suicide risk assessment:
SAD PERSONS
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
How do antidepressants work:
- SSRI: give an example
- SNRI: give an example
- TCA: give an example
At an increased risk of suicide see the patient every week. Not increased: review after two week
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
What does the PHQ-9 tool screen for: what are some of the questions?
Depression: Feeling worthless low mood problems sleeping Lack of interest in things
What does GAD-7 tool screen for?
Anxiety
During the past two weeks have you ever experienced several days/ half of the days or never
What substance abuse screening tool is used for pregnant ladies:
TWEAK
and 4Ps pre natal
What are two screening tools for substance misuse?
DAST
COWS
SOWS: last two are for opiate withdrawal
What is classed as an acute cough
what is classed as a chronic cough
Acute is less than 3 weeks
Chronic is more than 8 weeks
What are 3 causes of an acute cough?
What are 3 causes of a chronic cough?
URTI, cardiac failure, croup, bronchiolitis
Chronic rhinitis, sinusitis, asthma and GORD
In children with a chronic cough more than 4 weeks what could be the likely causes:
- Congenital defects
- Foreign body aspiration
- Asthma, Cystic Fibrosis and URTI
What is a cough?
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
Describe the process that triggers a cough?
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.
Causes of a productive cough:
Bronchiectasis
TB
Lung Cancer
Cystic Fibrosis
What is some RF for TB?
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
How can you protect your practice population against TB?
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
Treatment for TB:
RIPE Rifampicin Isoniazid Pyrazinamide Ethambutol
All 4 for 2 months
Only Rifampicin and isoniazid for 4 months
What is the treatment for latent TB?
You need to give 3 months of Rifampicin and Isoniazid
An additional 3 months of Isoniazid
List a few problems that patients with poor English cause for clinicans?
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
Name 5 types of error?
Sloth Communication Breakdown Poor Team Working Mis-triage Lack of Skill Fixation and loss of perspective Ignorance System error
What does the theory of proportionate universalism say?
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
What are the 3 theories of causation to health inequalities?
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
What are the 4 domains of public health
Health improvement
Health Prevention
Health promotion
And addressing the wider determinants of health
What is the ethical argument of:
- Deductive
- Inductive
- Deductive is when you use one general ethical theory for all medical problems
- Inductive: is when you use settled medical cases to influence theories
What are some structural determinants of illness:
Maternal Health Gender Ethnicity Occupation/Un-employed Social Class
What 4 things does the health belief model say?
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
What are the 6 stages of the trans theoretical model ?
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
What are the 5 duties of a doctor?
- To work with colleagues in a way that best serves patient’s interests
- To promote healthy lifestyle choices
- Provide a good standard of care
- Work within limits of competency
- Respect patient autonomy
What is extrinsic ageing?
This is when the external factors you have exposed yourself to have caused your ageing. I.e smoking, alcohol and UV exposure
What is a social death?
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
What are the 5 stages of chain of infection?
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 ‘/
What two organisms does alcoholic gel not kill?
It doesn’t kill
- Norovirus
- C Diff
What is the physiological process that leads to smoking?
It activates the nicotinic ACh
This releases a release of dopamine
This gives the sense of pleasure
Causes addiction
What are some public health changes that have been done to reduce smoking incidence?
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
What are 3 smoking cessation techniques:
Nicotine Replacement Therapy: patches, gum and nasal spray
Non-nicotinic pharmacotherapy:
- Champix
- Bupropion
What is the 3 As approach
Who is it used for?
Ask
Advise
Assist
It is used in smoking cessation
Name 5 millennium development goals
Reduce infant mortality Improve maternal health Reduced HIV/AIDS and malaria Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality
What is the Bradford hill criteria?
Give some components of it?
This is a criteria that determines causation
- Biological plausibility
- Temporality
- Strength
- Consistency
- Specificity
- Coherence
- Analogy
What is incidence
The number of new cases in a specified time period
What are the 3 main types of error?
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
What are violations?
Give a few examples
This is a deliberate deviation from the practice, procedure and standard
Types include
Routine
Necessary
Optimising
How do we reduce error
Need to make individual changes
Population changes
What are some obstaticles to team work?
Organisational
Location
Management
What makes up a good team?
Identified team leader Sole purpose Shared knowledge and experience Good team Size Good team dynamic
What are some examples of
- Acute stress
- Chronic stress
- Acute stress: this is when you have noise, danger, infection and hunger
- Chronic: is when you have people, job, health, family, financial issues
What are some biological responses to stress?
Reduced sleep Lungs: rapid breathing Blood flow: increased up to 400% Tense muscles Mouth: drier Immune Response: impaired
What are the 3 components of the general adaptation syndrome:
Alarm: threat/stressor is identified
Adaption: defensive countermeasures
Exhaustion: biodynamic begins to run out of defence
What are the 5 signs of stress?
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
What are 5 components contributing to obesity?
Over eating High energy dense foods Shift work Advertising Low exercise Replacing water with sugary drinks Longer hours and more commuting
What are the seven key domains of energy balance?
Food environment Food consumption Individual activity Activity of environment Society influence Individual psychology Individual biology
What is the satiety cascade?
Sensory
Cognitive
Post ingestive
Post absorption
Give 5 alternative therapies
Aromatherapy Osteopathy Chiropathy Homeopathy Herbal Medicine Acupuncture
What are 3 causes of a Heart Failure
Heart attack Cardiomyopathy Anaemia AF Thyroid Arrhythmia
What is 4th line treatment for reduced ejection fraction
ACE
BB
Then Spirolactone
Then 4th is Ivabradine!
