IMP Flashcards
What was one of the earliest precursors of Western Medicine?
Egyptian Medicine
When was Imhotep discovered?
2,600 BC
What was the earliest dental practitioner called?
Hesy - Re
When was it disapproved that dental decay was caused by dental worms?
In the 1700s
Who is regarded as the Father of Medicine?
Hippocrates
Who preformed surgeries in the Middle Ages (European Medicine)?
The Clergy (priests) and also Barbers
Who discovered blood circulation?
William Harvey in 1628
Who discovered a vaccination against smallpox in 1796?
Edward Jenner
True or False? Joseph Lister developed antiseptic surgery?
TRUE!
Who discovered a vaccination against anthrax and rabies?
Louis Pasteur
True or False? Penicillin was discovered by John Fredrick in 1886?
FALSE!! It was discovered by Alexander Flemming in 1928
What is isolation?
Isolation separates people who are sick with a contagious disease from people who are not sick.
What is quarantine?
Quarantine separates, and restricts the movement of, people who were exposed to an infectious disease to see if they become sick
What do the demographics when assessing a medical patient include?
Name
Age
Address
Marital status
Religion
Occupation
What do medical history consist of?
Chronic Illnesses
Medical Admissions
Admissions to the ICU
GP visits
What is the shape of the airway in a paediatric patient?
Funnel shaped
What is the shape of the airway in a adult patient?
Cylindrical
What is the most common cause of upper airway obstruction?
Tongue
What is the most commonly inhaled food in Children?
Peanuts
What is the use of oropharyngeal airway devices?
They keep the tongue from falling back and blocking the upper airway
Which type of patients are oropharyngeal airway devices used in?
Are only used in unresponsive patients without a gag reflex
Which type of patients are nasopharyngeal airway devices used in?
Use in semiconscious or intoxicated patients who need an airway assistance
How are oropharyngeal devices sizing measured?
From the corner of the patient’s mouth to the angle of the jaw
How are Nasopharyngeal devices sizing measured?
Measure length from tip of patient’s nose to the earlobe
True or False? Oropharyngeal devices require the use of a water-soluble lubricant.
FALSE!! Nasopharyngeal devices do that
What does CPR stand for?
Cardio-pulmonary resuscitation
What is the ratio of cycles for CPR?
30:2 (30 compressions to 2 breaths)
What is the depth of compression in adults?
At least 2 inches (5cm)
What is the depth of compression in infants?
1/3 depth, 4 cm
What are the three aspects when checking for cardiac arrest?
Responsiveness
Breathing
Pulse rate
What organs do your upper airway include?
Nose, mouth, larynx, pharynx
What organs do your lower airway include?
Trachea, bronchi, bronchioles, alveoli
How is the epiglottis described in that of a paediatric patient?
Floppy
What is normal O2 stats ?
> 95%
What is normal Partial pressure rates(PaO2 )
> 70 mmHg
What is the pulse rate of a patient in the range of Birth to 4 weeks
80-180 bpm
What is the pulse rate from ages 4 weeks to a year?
80-160 bpm
What is bradycardia?
HEART RATE BELOW 60 bpm
What is tachycardia?
HEART RATE OVER 100 bpm
What is level of consciousness tested by?
AVPU scale(alert, verbal, pain, unresponsive) and the Glasgow Coma scale (3-15)
What are the three states for a patient and their vital signs?
Normal State ,Compensation State , De - compensation State
What is the normal respiratory rate?
12 – 20 breaths/min
What is the normal specific gravity for urine?
1.016- 1.022
What is phantom pain ?
This is pain felt in a body part that is no longer there.
Normal blood sugar levels are?
3.5 - 5.5 mmol/L
Who is a psychotic patient?
Psychotic – not in touch with reality (hallucinations /delusions)
Who is the non-psychotic patient?
Patient in touch with reality eg: anxiety disorders, mood disorders
What is self efficacy?
This is when people are afraid to try things that may make them look awkward, inept, incompetent or that may lead to outright failure.
What are facilitators to communication?
Physician’s attentive attitude
Unhurried manner
Maintenance of eye-contact
Comfortable , private setting
Who observed that listening is the key element to establishing the three R’s rapport, respect, and relationship.
Ritter and Wilson
What are bad perceptions of the physician by the public?
Rich
Greedy
Ill mannered/thoughtless
Always late, never apologizes
Impatient
Arrogant
Think they are better than everyone else
Uneducated
Consumed by their own smoke
“Jesus Christ” complex
What are good perceptions of the physician?
Knowledgeable, competent
Skillful, responsible
Courteous, caring
A confidante, trustworthy
Some one to look up to, and respect – role model
Influential/ with authority Kindly / concerned / committed
What are personal disadvantages of being a doctor?
Sleep deprivation
Lost free weekends and holidays
Lost time with family and friends – breakdown in relationships.
Poor eating habits!!!
Little exercise
Emotional investment – stress when a patient dies or doesn’t do very well
Potential for burnout/ mental health issues
Debt – student’s loan, mortgage, rent etc. – is the solution more paid duty hours, higher fees?
What are professional disadvantages of being a doctor( Constraints)?
➢High cost of Health Care, Shortage of staff ( especially nurses),
➢Inadequate facilities and working conditions.
➢Long Hours
What are professional disadvantages of being a doctor( Public demands and expectations)?
More,better,affordable services
Increased litigation
Disenchantment with Doctors
What are advantages of being a doctor?
P- Power/Control
P- Profile
A- Authority
I-Income
I-Influence
R- Respect
C- Continual learning (is this really an advantage lol)
What is PEP?
Post- Exposure Prophylaxis - Measures employed and medications administered (medical response) when someone has been exposed to a bloodborne pathogen.
What are the different routes of Occupational exposure?
1.Percutaneous injury (e.g. needlestick or injury with a sharp object)
2. Contact of mucous membrane with blood, tissue or body fluids
3. Non intact skin (including chapped, abraded skin) with blood, tissue or other body fluids.
What are the most common blood-borne pathogens?
Hep B
Hep C
HIV
HTLV-1(Human T-lymphotropic virus 1)
Which pathogen has the most risk of transmission after a single percutaneous injury?
HBV (2 - 40%)
What is the most common exposure risk of HIV(not in hospital setting)?
Vertical transmission- 24 in 100 ( from mother to child)
What is the first thing a health care professional should do when exposed?
Wash area with SOAP and WATER!
True or False? For HCV and HIV, exposure via a hollow needle or bloody device is of higher risk than exposure to injection needle.
TRUE!!
What is the suggested drug treatment for health care professionals who have been exposed to a HIV positive patient?
TDF- Tenofovir Disoproxil Fumarate
3TC- Lamivudine
DTG -Dolutegravi (Tivicay)
ABC- Abacavir (Ziagen)
What are high risks occupational exposure routes of HIV?
- Percutaneous
- Hollow bore needle
- Deep penetration
- Visible blood
What are low risk of Occupational exposure routes of HIV?
- Mucous membrane
- Solid needle
- Superficial injury
What are the 6 A’s that should be taken into consideration when interviewing the psychiatric patient?
- Appropriate questioning style
- Always show respect
- Appropriate opening and closing
- Attempt to establish rapport early
- Achieve and demonstrate empathy
- Active listening
What type of questions should be asked when conducting an interview with the psychiatric patient?
Open and close ended questions
True or False? Team work improves the morale of individuals.
TRUE!!!
What are the qualities of a good Team member?
- Reliability
- Constructive communication
- Good listener
- Willingness to share information, knowledge and experience.
- Cooperates with other team members, and devotes time, energy and skills to help get tasks accomplished, and to help/ support others
- Effective change management:
- Shows respect for others and receives their opinions with an open mind.
What are some common misconceptions about teams?
- There is no need for leadership in teams
- Team members need to make own contributions in all decisions
- It is not possible for some groups to function as teams
- Making teamwork a mantra in an organization will bring
out effective team working - It is easier to carry out traditional management than team management
What does a Multidisciplinary team consist of?
A multidisciplinary care team is a team composed of diverse healthcare professionals such as doctors, nurses, dietitians, administrators who pool together their expertise and skills to manage their patients in a coordinated way.
What are benefits of Multidisciplinary teams?
*Enhanced quality of care
*Improved patient outcomes
*Streamlined workflows
*Efficient time management
*Improved patient satisfaction
True or False? In multidisciplinary care teams may consist of members from the same organization or from different organizations. The team members independently treat the same patient but focus on the specific issues in which they have their expertise.
TRUE!!!
What is Interdisciplinary Teams?
There is interdependent collaboration – collaboration built on the notion that team members need each other to succeed and to achieve team’s objectives – positive interdependence.
True or False? There is a stronger team cohesiveness in Interdisciplinary teams than multidisciplinary care teams.
TRUE!!
In which team, are opportunities for joint visits and assessments and also opportunities for professional development and capacity building of junior team members?
Interdisciplinary Teams
In this model of care, a primary care provider (PCP) managing a patient for a specific condition determines when the patient needs to be seen by a specialist. What is this describing?
Consultative Teamwork
Physicians manage their patients separately even though they work in the same facility describes what team work model?
Parallel Practice
True or False? In parallel practice, There is no co-ordinated or formal sharing/ co- management of patients’ information.
TRUE!!
What are the core clinical competencies required for effective patient interview?
- Knowledge
- Communication skills
- Physical examination
- Problem solving
What is one of the most common approaches used in clinical consultations?
Calgary-Cambridge model
What are the 5 stages of the Calgary-Cambridge model?
▪Preparation and initiation of the session
▪Gathering information
▪Physical examination
▪Explanation and planning
▪Closing the session
What type of question should be used when opening the session with a medical patient?
Open-ended questions
What type of questions should be used when gathering information?
Open-ended questions ,close -ended when necessary
Direct & indirect questions
What are the aspects of taking history of a presenting complaint?
S = Site where the problem is located
O = Onset
C = Character
R = Radiation
A = Associated symptoms
T = Time course
E = Exacerbating/ relieving factors
S = Severity
When taking a medical history , what background information should be assessed?
▪Past medical history
▪Past surgical history
▪Medication history
▪History of Allergy
▪Family history
▪Social history and lifestyle
What is signposting?
A means of indicating to your patient that you want to move from the point being discussed to another point.
What are examples of physical/ environmental barriers to clinical consultation?
▪Room temperature: too hot or cold for the patient
Febrile patients may have chills and find airconditioned rooms too cold
▪Presence of third parties
▪Open windows/ doors (curtains)
▪Sitting arrangement
▪Noises (internal or external)
What are patient-related barriers to clinical consultation?
▪Extremes of age
▪Severity of clinical condition
▪Mental status
▪Substance use
▪Use of the Internet
▪Language barrier
▪Personality issues (aggressive, garrulous)
▪Unrealistic expectation of the clinician
What are clinician -related barriers to clinical consultation?
▪ Experience
- Newly qualified versus well experienced
▪Poor knowledge
▪Too conscious of time
▪Showing little interest in patient’s story’
▪Being judgmental
▪Burn-out
▪Easily distracted (cell phones, tablets)
▪ Mental status (depressed)
▪Substance use
▪ Language barrier
▪Lack of empathy
▪Personality issues (arrogance; controlling behaviour)
What are some examples of risk behaviours?
Problem drinking
Substance use
Smoking
Reckless driving
Overeating
Unprotected sexual intercourse.
What is the first step in behaviour change?
Identifying the behaviour
What is the most important aspects of behaviour change?
The cause or determinants
True or False? In behaviour change, big or sudden changes are more successful than small changes.
FALSE!! Small changes are more successful than big changes.
Fill in the blank. “ ______ is key to motivating behaviour change”
Risk perception
Peer pressure,relationships, role models, innovators are what type of determinants of behaviours?
Interpersonal Factors
What are examples of environmental factors that are determinants of behaviours?
Circumstances that make it easy or difficult to perform the behaviour.
* High prices, reduced access and resources, lack of security, cultural practices and value systems
Legislation or formal/ informal policies that encourage or discourage the behaviour e.g. Lack of: Public health regulations, civil laws and regulations, institutional policies, workplace policies are described as what type of factors that is a determinant of behaviour?
Policy/ Regulation factors
What are examples of Personal factors?
Knowledge, belief, attitude, status, personality.
What are the different types of changes ?
Tuning
Adaptation
Re-orientation
Re-creation
What is tuning?
Making small, incremental changes in response to what is happening
What is adaptation?
Adding new features to old ones
What is re-orientation?
Changing direction
What is re-creation?
change made in response to a crises
Who created the Transactional Analysis?
Michael Berne
Who developed the Six category Intervention Analysis(1975)?
John Heron
What are the six categories that falls under the Six Category intervention analysis?
Prescriptive
Informative
Confronting
Cathartic
Catalytic
Supportive
” take 6 PICCCS “
Which model of consultation has six phases?
Bryne and Long (1976)
In what phase of the Bryne and Long model of consultation does the doctor conduct a physical examination?
Phase III (3)
In what phase of the Byrne and Long model of consultation does the doctor establish a relationship with the patient?
Phase I
In what phase of the Byrne and Long model of consultation does the doctor discuss treatment / further investigation?
Phase V
What happens in phase VI of the Byrne and Long model of consultation?
The consultation is terminated usually by the doctor.
When was the Scott and Davis model of consultation developed?
1979
Which model has their basis that a patient with a problem comes to a doctor seeing answers to six questions during consultation around 6 questions?
Helman’s ‘Folk Model’ (1981)
” Kristen asked 6 questions”
Which model of consultation suggest that four areas can be systematically explored each time a patient consults?
Scott and Davis
“ Scott and davis are 4 Lifers”
What are the four areas discussed in the Scott and Davis model?
- Management of presenting problems
- Modification of help-seeking behaviours
- Management of continuing problems
- Opportunistic health promotion
Which model of consultation has 7 tasks?
Pendleton, Schofield, Tate and Havelock (1984, 2003)
Which model of consultation was developed by by McWhinney et al?
The Disease-Illness model
What is another name for the disease-illness model?
Patient-centred clinical interviewing
When was the Blaint model developed?
1986
The Neighbour model of consultation developed by Roger Neighbour has 5 checkpoints which include?
Connecting
Summarising
Handing over
Safety net
Housekeeping
” Neighbour !!Come Summarise Harry’s Safety House essay”
When was the Three-function approach developed?
1989
When was the Calgary-Cambridge Approach developed?
1996
Who developed the Bard model of consultation?
Ed Warren
What does Bard stand for?
B- Behaviour
A-Aims
R- Room
D-Dialogue
Which three models of consultation was developed in 2002?
Bard
Narrative- Based Medicine
Comprehensive clinical method
Who developed the Three-Function Model?
Cohen- Cole and Bird
What are the three functions in the Three-function model of consultation?
*Gathering data to understand the patient’s problems
*Developing rapport and responding to patient’s emotion
*Patient education and motivation
Who developed the Calgary-Cambridge Model?
Suzanne Kurtz and Jonathan Silverman
What are the different aspects of the Calgary -Cambridge model?
Initiating the session
Gathering information
Building the relationship
Providing structure
Explanation and planning
Closing the session
What is the procedure done to open the airways if there is no detection of spinal injury?
Head- tilt
Chin- lift
What is the main function of the oropharyngeal airway?
They keep the tongue from falling back and blocking the upper airway
What type of patients are oropharyngeal airways used in?
Patients who are unconscious WITHOUT a gag reflex
In what patients are Nasopharyngeal airways used?
The semiconscious or intoxicated patients who need an airway assistance.
What are some causes of Cardiac arrest?
Dysrhythmias
Coronary Heart Disease
Respiratory arrest
Drowning
Electrocution
Drugs
Allergic Reaction
Where should you check for the central pulse in a unresponsive adult?
Carotid Artery
Where should you check for the central pulse in a unresponsive child?
Brachial artery
What should be the Chest Compression fraction when delivering CPR?
60%
What does AED stand for?
Automated External defibrillator
When does the AED determines a shockable rhythm?
Ventricular fibrillation and Pulseless Ventricular Tachycardia
When does the AED determines a non- shockable rhythm?
Asystole (flat-line) and PEA ( Pulseless electrical activity)
What is the first step to take when administering CPR?
Ensure the scene is SAFE!!
Who are the 6 persons that are involved in a hospital setting when trying to resuscitate a patient?
Group Leader
Medicationist
Timer/ recorder
Compressor
Monitor/Cpr coach/ Defibrillator
Airway manager
What is the recommended compression rate?
100-120/min
If there is just one rescuer present, what is the advised hand placement when giving cpr to a patient less than 1 year old?
2 fingers in the centre of chest just before nipple line
What is the name of the drug recommended to give patients with suspected opioid overdose?
Naloxone
What position is ideal for Airway Management in Child CPR?
Sniffing position
What position is ideal for Airway Management in infant CPR?
Neutral Position
What is the name of the technique that should be used in Patients over 1 year old who are choking?
Abdominal Thrusts
What is the name of the technique that should be used in pregnant or obese patients who are choking?
Chest thrusts
What does your past surgical history include?
Type of surgery/Year
Duration of Hospitalisation
Surgical complications
Anaesthetic complications
What does your drug history include?
Drug name
Dose
Duration
Alternative medications
What does your social history entail?
Marital status
Job
Amount earned
Living standard- number of bedrooms, number of occupants
Garbage collection
