Miscellaneous/Public Health Flashcards
1
Q
Which cells is COX1 found in?
A
All cells
2
Q
What is the major product of COX1 in platelets?
A
Thromboxane A2
3
Q
Which cells is COX2 expressed in?
A
Inflammatory cells
4
Q
What is the major product of COX2?
A
Prostacyclins
5
Q
What is the role of prostacyclins?
A
Involved in inflammation (vasodilation and inhibition of platelet aggregation)
6
Q
Give four processes that COX1 is involved in.
A
- Normal function of GI tract (protective mucosa)
- Normal function of renal tract
- Platelet function
- Macrophage differentiation
7
Q
Name the substrate for cyclooxygenase enzymes.
A
Arachidonic acid
8
Q
Name a class of drug which are COX inhibitors.
A
NSAIDs (and aspirin)
9
Q
Give two examples of hormones having permissive effects.
A
- Thyroid hormone increases receptors for epinephrine
- Cortisol has a permissive effect for glucagon
10
Q
What is released in the short term stress response?
A
Epinephrine
Norepinephrine
11
Q
What is released in the long term stress response?
A
Mineralocorticoids
Glucocorticoids
12
Q
What structures show up with high intensity on a T1 weighted MRI scan?
A
Fat
13
Q
Which structures show up with high intensity in a T2 weighted MRI scan?
A
Structures with high water content
14
Q
What is a pheochromocytoma?
A
A neuroendocrine tumour of the adrenal medulla.
15
Q
How is paracetamol usually conjugated for excretion?
A
Glucuronidation
Sulfation
16
Q
How much paracetamol is normally converted to toxic NAPQI when it is metabolised?
A
10%
17
Q
How is NAPQI usually metabolised for excretion?
A
By glutathione
18
Q
Give two hormones or groups of hormones cleaved from POMC.
A
- ACTH
- Melanocyte Stimulating Hormones
19
Q
What are the four quadrants, in relation to ethics?
A
- Medical indications
- Patient preferences
- Quality of life
- Contextual features
20
Q
What are conscientious objections?
A
Moral claims that are based on an individual’s core ethical beliefs.
Opposition and refusal by a healthcare professional to provide certain treatments, because the individual believes that helping to provide those treatments would violate personal core ethical beliefs.
21
Q
What are the four pillars in regards to ethics?
A
- Autonomy
- Beneficence
- Nonmaleficence
- Justice
22
Q
What are the four things to consider when faced with an ethical dilemma, according to Seedhouse’s Ethical Grid?
A
- Ethical principles
- Ethical behaviour (duties of a doctor)
- Ethical consequences (wider nature of outcome)
- Real life constraints
23
Q
Give four categories of risk factor for a condition.
A
- Clinical
- Lifestyle
- Unmodifiable
- Psychsocial
24
Q
What is meant by ‘population attributable risk’?
A
The proportion of the incidence of a disease in the exposed and unexposed population that is due to the exposure.
25
Define ‘psychosocial factors’.
Factors influencing psychological responses to the social environment and pathophysiological changes.
26
What are four psychosocial risk factors for IHD?
- Coronary prone behaviour pattern
- Depression and anxiety
- Psychosocial work characteristics
- Social support
27
Give three characteristics of type A behaviour which can increase risk of IHD.
- Competitive
- Hostile
- Impatient
28
Briefly describe the type D personality profile, which may increase risk of CHD.
More psychologically distressed individuals.
29
Give three psychosocial work characteristics which increase risk of CHD.
- High demand
- Low control
- Long hours
30
Give two social support risk factors for CHD.
- Loneliness
| - Social isolation
31
Give two reasons why good social relationships can lower risk of CHD.
- Helps coping with life events
| - Motivation to engage in healthy behaviours
32
Briefly describe deontology.
Based on the belief that we owe a duty of care to each other, and ignores the consequences.
Concerned with whether the action itself is right or wrong.
33
Describe Immanuel Kant’s formula of Universal Law.
Before acting, consider: could I live in a world where everyone acted this way?
34
Describe Immanuel Kant’s Formula of Humanity.
People are always to be treated as ends in themselves, never as means to an end.
35
Describe consequentialism.
Consequences are what matters, the means are unimportant.
36
Briefly describe utilitarianism.
A branch of consequentialism whereby the best action is the one that will b positive for most people.
37
Describe virtue ethics.
The character of a person is central and a person of good character will act in the right way.
38
What are virtues?
| Give four examples
Virtues are characteristics that promote human flourishing.
- Compassion
- Patience
- Kindness
- Fidelity
39
What are three principles in the GMC duty of candour?
If something goes wrong:
- Put matters right (if possible)
- Offer an apology
- Explain what has happened and short/long term effects
40
What is whistle-blowing?
Raising concerns about a person, practise, or organisation.
41
Give the five Cs of ethics in practice.
- Candour
- Consent
- Capacity
- Confidentiality
- Communication
42
Give five problems that may arise in teamwork.
- Lack of teamwork
- Lack of leadership
- Lack of effort
- Lack of communication
- Lack of challenge
43
Give six components of teamwork.
- Communication
- Leadership/followership
- Authority gradient
- Situational awareness
- Declaring an emergency
- Training together
44
What is endothelin?
A potent vasoconstrictor.
45
Which receptor does angiotensin II bind to?
AT1
46
What are kinins?
Groups of substances which are formed in a tissue in response to injury.
47
What is the term for when the aqueous/vitreous humours of the eye are infected with fungus?
Fungal endopthalmitis
48
What is a tort?
A civil wrong other than breach of contract or trust.
49
Give the three elements of the law of Tort relating to medical practice.
- Negligence
- Battery
- Breach of confidence
50
What charge is brought upon a medical professional if they do not obtain consent?
Battery
51
Which law of Tort is breached is a medical professional breaks confidentiality?
Breach of confidence
52
Give three criteria essential in an act of negligence.
1. There was a duty of care
2. The duty of care was breached
3. This resulted in harm
53
Give three ‘types’ of consent.
- Implied
- Oral
- Written
54
Define ‘duty of care’.
An obligation on one party to take care to prevent harm being suffered by another.
55
Define ‘standard of care’.
The level at which an ordinarily skilled person with the same training and experience would practice under the same circumstances.
56
What does the validity of consent depend on?
The adequacy of the explanation given before the decision was made.
57
What does the Mental Health Act 1983 (amended in 2007) say?
Doctors are able to admit a person for assessment/treatment of a mental disorder without consent if the person is incompetent.
58
What are the three criteria for proper consent?
- Patient has capacity
- Patient was informed
- Voluntarily given
59
What are the four criteria for a person having capacity?
- Patient understands the information
- Patient retains information long enough to make decision
- Patient can weight up options
- Patient can communicate their decision
60
At what age is someone classed as a minor?
Under 18.
61
At what age are people presumed to be competent to give consent?
16
62
What is Gillick Competence?
Determining a person under the age of 16 capable of consenting to medical decisions.
63
What is the hierarchy of decision making for an incompetent patient according to the mental capacity act 2005?
1. Advance decision
2. Lasting power of attorney
3. Court
4. Court appointed lasting power of attorney
5. Doctors
64
What is the Bolam test?
Comparing the actions of one doctor to other doctors to determine if standard of care has been breached.
65
What is orthopnoea?
Shortness of breath when lying flat
66
What is paroxysmal nocturnal dyspnoea?
Attacks of severe shortness of breath and coughing that occur at night.
67
What is pulsus alternans?
Alternating strong and weak pulses
68
Where is alkaline phosphatase found most?
- Liver and bones
69
What is pulsus tardus?
Slow-rising pulse
70
What is pulsus parvus?
Weak pulse
71
What is meant by ‘wide pulse pressure’?
Big gap between systolic and diastolic pressures.
72
What is Rheumatic fever?
Inflammatory disease that develops after strep throat.
| A complication is that it can damage the heart valves.
73
What is meant by ESR on a blood test?
Erythrocyte sedimentation rate
| ESR is raised in inflammation.
74
When is plasma viscosity raised?
In the presence of fibrinogen or antibodies, so in inflammation.
75
Why are steroids commonly used in chemotherapy?
To either help with the treatment or to reduce side effects of chemotherapy.
76
What is meant by ‘remission’ in cancer treatment?
Undetectable levels of cancer in the body.
However it is not possible to detect very small levels of cancer so there may still be cancer present, hence the term ‘remission’ is used, instead of cure.
77
What is the difference between leukaemia and lymphoma.
They are both cancer of white blood cells, however in leukaemia is when the cancer is present in the blood and in lymphoma it is present in lymph nodes and other tissues.
78
Why does leukaemia often result in hepatosplenomegaly?
Due to organ infiltration of the proliferating cells.
79
Why does bleeding, infection, and anaemia occur in leukaemia?
Due to infiltration of the bone marrow. This prevents production of platelets, neutrophils, and erythrocytes.
80
Give nine side effects of chemotherapy.
- Nausea/vomiting
- Altered bowel habit
- Reduced fertility
- Loss of appetite
- Fatigue
- Allergic reactions
- Cytopenias
- Bystander organ damage
- Hair loss
81
Give three causes of new medical problems in a patient with cancer.
- Original disease
- Complication of disease/treatment
- Completely what new/separate pathology
82
Describe stage 0 of the WHO performance status.
Asymptomatic - activities without restriction
83
Describe stage 1 of the WHO performance status.
Symptomatic but completely ambulatory - restricted strenuous activity but able to carry out work of a light nature.
84
Describe stage 2 of the WHO performance status.
Symptomatic, <50% in bed during the day - ambulatory and capable of all self care but unable to carry out any work activities.
85
Describe stage 3 of the WHO performance status.
Symptomatic, >50% in bed, but not bedbound. Limited self-care, confined to bed or chair 50% or more of waking hours.
86
Describe stage 4 of the WHO performance status.
Bedbound. Cannot carry out any self-care. Totally confined to bed or chair.
87
Describe stage 5 of the WHO performance status.
Death
88
Give 6 late effects of cancer treatments.
- Infertility
- Cardiomyopathy
- Lung damage
- Peripheral neuropathy
- Second cancers
- Psychological issues
89
Give four causes of DIC.
- Malignancy
- Sepsis
- Trauma
- Obstetric events
90
How does ferritin act as an acute phase protein?
It binds iron to inhibit microbial iron uptake.
91
Define substance misuse.
The harmful use of any substance for non-medical purposes or effect.
92
What effects does misusing opiates cause?
- Euphoria
| - Analgesia
93
What effects does misusing depressants cause?
- Sedation
| - Anxiolytic
94
What effects does misusing stimulants cause?
- Increase alertness
| - Alter mood
95
What effects does misusing cannabinoids cause?
- Relaxation
| - Mild euphoria
96
What effects does misusing hallucinogens cause?
- Altered sensory perceptions
| - Altered thinking
97
What effects does misusing anaesthetics cause?
- Anaesthesia
| - Sedative
98
What are new psychoactive substances?
Previously termed legal highs, they are designed to mimic other substances of abuse but with less predictable effects.
99
Define addiction.
Compulsive use of a substance despite harmful consequences, and often involves structural and biochemical changes to parts of the brain linked to reward, self-control, and stress.
100
What is psychological dependence?
Feeling that life is impossible without the drug.
101
What is physical dependence?
Needing higher doses of a drug for the same effect.
102
Give two recognised disorders related to substance misuse.
- Dependence syndrome
| - Substance use disorder
103
Give 6 protective factors against substance misuse.
- Self control
- Parental monitoring and support
- Positive relationships
- Neighbourhood resources
- Academic achievement
- School anti-drug policies
104
Give six risk factors for substance misuse.
- Aggressive childhood behaviour
- Lack of parental support
- Community deprivation/poverty
- Drug experimentation
- Poor social skills
- Availability of drugs at schools
105
What is the recommended weekly alcohol units for men and women?
No more than 14 units per week.
106
What is a standard drink unit?
8 grams or 10ml of pure alcohol
107
How many units of alcohol are there in a 750ml bottle of wine which is 13.5% by volume?
10
108
How many units of alcohol per week are considered hazardous/harmful?
35 units per week
109
How many units of alcohol in one episode count as binge drinking for men and women?
```
MEN = >8 units
WOMEN = >6 units
```
110
What is the alcohol harm paradox?
Low socioeconomic groups consume less alcohol than higher socioeconomic groups but experience greater alcohol-related harm.
111
Give some acute effects of excessive alcohol intake.
- Accidents/injury
- Coma/death from respiratory depression
- Aspiration pneumonia
- Oesophagitis/gastritis
- Mallory-Weiss syndrome (gastric tears)
- Pancreatitis
- Cardiac arrhythmias
- Cerebrovascular events
- Neurapraxia due to compression
- Myopathy/rhabdomyolysis
- Hypoglycaemia
112
Give some chronic effects of excess alcohol intake.
- Pancreatitis
- CNS toxicity
- Liver damage
- Hypertension
- Peripheral neuropathy
- Oesophagitis
- Cardiomyopathy
- Gastritis
- Cerebrovascular accidents
- Osteoporosis
- Malabsorption
- Coronary heart disorders
- Skin disorders
113
Give five alcohol withdrawal syndromes.
- Tremulousness
- Activation syndrome
- Seizures
- Hallucinations
- Delirium tremens
114
Describe activation syndrome.
Alcohol withdrawal syndrome characterised by tremulousness, agitation, rapid heart beat, and high blood pressure.
115
Give the features of the alcohol withdrawal syndrome delirium tremens.
- Tremors
- Agitation
- Confusion
- Disorientation
- Hallucinations
- Sensitivity to light and sound
- Seizures
*Medical emergency
116
Give four features of foetal alcohol syndrome.
- Pre and post-natal growth retardation
- CNS abnormalities
- Craniofacial abnormalities
- Congenital defects of other body systems
117
Give five psychosocial effects of excessive alcohol consumption.
- Interpersonal relationships
- Problems at work
- Criminality
- Social disintegration
- Driving incidents/offences
118
What is primary prevention of excess alcohol consumption?
Educating people about alcohol consumption.
119
What is secondary prevention of excess alcohol consumption?
Exploring alcohol consumption with patients.
120
Define ‘at risk drinking’.
A pattern of drinking which brings about the risk of physical or psychological harm.
121
Define ‘alcohol abuse’.
A pattern of drinking which is likely to cause physical or psychological harm.
122
Define substance dependence.
A set of behavioural, cognitive, and physiological responses that can develop after repeated substance use.
123
Give four ways of screening patients for alcohol misuse.
- Clinical interview
- FAST (fast alcohol screening test)
- AUDIT (alcohol use disorders identification test)
- CAGE questions
124
What are some steps that Public Heath England can take when they are informed of a notifiable disease?
- Contact tracing/notification
- Chemoprophylaxis to exposed people
- Exclude high risk persons from high risk settings
- Trace the source of infection
125
What is primary vaccine failure?
When the person doesn’t develop immunity from a vaccine.
126
What is secondary vaccine failure?
When a person initially responds to a vaccine but the protection wanes over time.
127
Give three reasons why a disease may be notifiable.
- It’s scary
- It’s nasty
- It’s vaccine preventable
128
Which vaccinations should be given at 8 weeks?
- 6 in 1
- Pneumococcal
- Rotavirus
- Meningitis B
129
Which vaccinations should be given at 12 weeks?
- 6 in 1
| - Rotavirus
130
Which vaccinations should be given at 16 weeks?
- 6 in 1
- Pneumococcal
- Meningitis B
131
Which vaccinations should be given at one year?
- Pneumococcal
- Meningitis B
- Hib/MenC
- MMR
132
Which vaccinations should be given at 3 years, 4 months?
- MMR
| - 4 in 1
133
When are children eligible for the annual flu vaccine?
Between 2 and 8 years of age.
134
At what age is the HPV vaccine given?
12-13 years
135
What does the HPV vaccine protect against?
Cervical cancer
136
At what age should the 3 in 1 vaccine be given?
14 years
137
What does the 3 in 1 vaccine protect against?
- Tetanus
- Diphtheria
- Polio
138
At what age is the MenACWY vaccine given?
14 years/uni students
139
What does the MenACWY vaccine protect against?
Meningococcal A, C, W, and Y
140
What is the alternative name for the pneumococcal vaccine?
PCV
141
What does the 6 in 1 vaccine protect against?
- Diphtheria
- Tetanus
- Whooping cough
- Polio
- Haemophilus influenzae type B (Hib)
- Hepatitis B
142
What does the MMR vaccine protect against?
- Measles
- Mumps
- Rubella
143
What does the Hib/MenC vaccine protect against?
- Meningococcal C
| - Haemophilus influenzae type B
144
What does the 4 in 1 vaccine protect against?
- Diphtheria
- Tetanus
- Whooping cough
- Polio
145
Describe the chain of infection.
- Reservoir
- Portal of exit
- Agent
- Mode of transmission
- Portal of entry
- Host
- Person to person spread
146
Give three general modes of transmission.
- Direct
- Indirect
- Airborne
147
What are the two direct modes of transmission?
- Direct
| - Faeco-oral route
148
What are the two indirect modes of transmission?
- Vector-borne
| - Vehicle-borne
149
By which route do airborne pathogens spread?
Respiratory route
150
Describe the vehicle-borne route of transmission.
Pathogen held on inanimate objects, like clothes.
151
Give 4 explanations from the Black Report for widening socio-economic health inequalities.
- Artefact
- Social selection
- Behaviour
- Material circumstances
152
Give three theories of causation for the socio-economic health inequalities.
- Neo-materialistic
- Psychosocial
- Lifecourse
153
What is a neo-materialistic theory for socio-economic health inequalities?
The theory that physical features cause ill health (eg. Pollution).
154
Describe the psychosocial theory of socio-economic health inequalities.
People from poorer socioeconomic backgrounds have poorer health because of social stresses.
155
Describe the lifecourse theory of socioeconomic health inequalities.
- Certain events in a person’s life (eg. Family death) are harder to overcome because of poor support
- Previous life circumstances lead to poor choices (eg. Abuse and poor sexual partners)
- Poor social circumstances lead to a pathway of poor health (eg. Unemployment, unhealthy foods)
156
What is transudate.
Fluid with a low protein content.
157
What is exudate?
Fluid with a high protein content.
158
What is the serum ascites albumin gradient (SAAG)?
The difference in albumin content between the serum and the ascites fluid.
159
What is implied if the serum ascites albumin gradient is high?
The ascites is caused by transudate.
160
What does it mean if the serum ascites gradient is low?
The ascites is caused by exudate.
161
What is Wernicke’s encephalopathy caused by?
Thiamine deficiency in alcoholics
162
What does the triad consist of which suggests Wernicke’s encephalopathy?
- Confusion
- Cerebellar ataxia
- Nystagmus
163
Where is CRP produced, and what is it a response to?
Produced in the liver in response to IL-6
164
What is infliximab?
TNF-a inhibitor.
165
Give six conditions which can be treated with infliximab.
- Crohn’s disease
- Ulcerative colitis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Plaque psoriasis
166
Give five features of an illness that may suggest that it is due to work.
- Symptoms improve away from work
- Characteristic distribution of rash
- Sensorineural deafness with characteristic pattern on audiogram
- Cluster of cases in a workplace
- Exposure linked to disease and would only occur at work
167
Give six high risk occupational activities for MSK problems.
- Heavy manual handling
- Lifting above shoulder height
- Lifting from below knee height
- Incorrect manual handling technique
- Forceful movements
- Fast repetitive work, poor postures, poor grip
168
Give seven epidemiological principles of causality (Bradford Hill).
- Strength of association
- Consistency in association
- Exposure-response relationship
- Specificity
- Temporal relationship
- Coherence of evidence
- Biologically plausible
169
Define anorexia nervosa.
Reduction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
170
Give four features of anorexia nervosa.
- Intense fear of gaining weight/becoming fat
- Disturbance in the way body weight or shape is experienced
- Undue influence of body weight or shape on self-evaluation
- Denial of the seriousness of current weight
171
Give two subtypes of anorexia nervosa.
- Restricting
| - Binge-eating/purging
172
Give two characteristics of a binge eating episode.
- Eating large amounts of food in a discrete amount of time (2 hours)
- Sense of lack of control over eating during an episode
173
Describe bulimia nervosa.
Recurrent episodes of binge eating and inappropriate compensatory behaviour to prevent weight gain.
174
Give four compensatory behaviours in bulimia nervosa.
- Vomiting
- Exercise
- Laxatives
- Starvation
175
How often does bulimia nervosa typically occur?
At least once a week for three months.
176
Describe the patient’s weight in bulimia nervosa.
May be normal or overweight.
177
What may be a serious consequence of bulimia nervosa?
Hypokalaemia
178
Give two drivers of a binging episode.
- Starvation
| - Emotion
179
Describe binge eating disorder.
- Recurrent episodes of binge eating (no purging)
180
How often does binge eating disorder typically occur?
At least once a week for three months.
181
Describe the weight changes in binge eating disorder.
Tend to gain weight.
182
Episodes of binge eating disorder are associated with 3 or more of the following...
(5 answers)
- Eating more rapidly
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone due to embarrassment
- Feeling disgusted, depressed, or very guilty afterwards
183
What is the most common eating disorder?
Binge eating disorder.
184
Describe ‘other specified feeding and eating disorders’ (OSFED).
Presents with symptoms of other eating disorders but doesn’t meet full criteria for diagnosis.
185
What percentage of eating disorders do OSFEDs account for?
Almost 50%
186
Name 5 other specified feeding and eating disorders.
- Atypical anorexia nervosa
- Atypical bulimia nervosa
- Binge-eating disorder
- Purging disorder
- Night eating syndrome
187
Describe atypical anorexia nervosa.
Significant weight loss but not underweight.
188
Describe atypical bulimia nervosa.
Low frequency and/or limited duration.
189
Describe atypical binge-eating disorder.
Low frequency and/or limited duration.
190
What is the prevalence of anorexia nervosa in females aged 14-40yrs?
0.5-1%
191
What is the prevalence of bulimia nervosa in females aged 14-40yrs?
1-2%
192
What is the prevalence of atypical eating disorders in females aged 14-40yrs?
3-4%
193
Describe what leads to the onset of an eating disorder, according to the core model.
- Combination of low self-esteem and perfectionism, leading to a need for control
- Uses food as a means of self control
194
Give four potential triggers for an eating disorder.
- Teasing re appearance
- Positive comments about weight loss
- Illness
- New social circle
195
Describe the steps of maintaining an eating disorder.
- Positive reinforcement for weight loss/control enhances overvaluation of eating, shape, and weight as ways of defining oneself
- But then body, family, and professionals all take control
- This enhances overvaluation even more
196
Give four ways that the body attempts to ‘take over’ in an eating disorder.
- Physiological reaction to starvation
- Body image disturbance
- Cognitive rigidity
- Emotional instability (serotonin deprivation)
197
Give five important issues to pick up in a consultation about an eating disorder.
- Severe restriction of food/fluid
- Electrolyte imbalance (hypokalaemia)
- Bone deterioration
- Physical damage (tears to oesophagus, blood in vomit)
- Alcohol/drug intake
198
Give six urgent signs to look out for in a consultation about an eating disorder.
- Muscle weakness
- Problems in breathing
- Deterioration in consciousness
- Cardiac signs (ectopic beats, tachycardia, bradycardia, hypotension)
- Rapid weight loss
- Risky behaviours (suicidal intent, risk to others eg.driving)
199
Describe the therapy used to treat eating disorders.
- Structured therapies (‘doing’ rather than ‘talking’
- Diary keeping and weighing patient
- Therapy involves food
200
What treatment is used for bulimia nervosa and binge eating disorder?
Cognitive behavioural therapy
201
What treatment is used for adolescents with anorexia nervosa?
Family therapy
202
What treatment is given to adults with anorexia nervosa?
Cognitive behavioural therapy
203
What medications can be used to treat eating disorders?
There are no evidence-based medications available.
204
Give the equation used in the STI transmission model (May and Anderson 1987).
R=BCD
R=reproductive rate
B=infectivity rate
C=partners over time
D=duration of infection
205
What is meant by primary prevention of an STI?
Reducing the risk of acquiring an STI
206
What is meant by secondary prevention of an STI?
Finding STIs earlier
207
What is meant by tertiary prevention of an STI?
Reducing morbidity/mortality
208
Give three primary prevention strategies for STIs.
- Awareness campaigns
- One to one risk education discussion
- Vaccination/prophylaxis
209
Give three primary prevention strategies for HIV.
- Post-exposure prophylaxis
- Pre-exposure prophylaxis
- Treatment as prevention
210
What is the ABC of prevention STIs?
```
Avoid exposure (abstinence)
Be faithful
Condom use
```
211
Give three secondary prevention strategies for STIs.
- Easy access to testing and treatment
- Partner notification
- Targeted screening
212
Give three examples of tertiary prevention for STIs.
- Anti-retrovirals for HIV
- Prophylactic antibiotics for pneumocystis
- Acyclovir for suppression of genital herpes
213
Give three reasons why partner notification is important when treating STIs.
- Break the chain of transmission
- Prevent re-infection of the index patient
- Prevent complications of untreated infection
214
If someone presents with an STI, how should partner notification be managed?
Refer to sexual health Sheffield (SHS).
215
Give the three themes in the Models of Care for Alcohol Misusers (MoCAM) policy 2006.
- Screening and assessment
- Four-tiered framework
- Care planning and coordination
216
Give the four tiers of alcohol misuse interventions.
1. Non substance misuse specific services
2. Open access drug/alcohol services
3. Specialist community based clinics
4. Specialist in-patient services
217
Give three aspects of the Government’s Alcohol Strategy (2012).
- Minimum pricing
- Licensing
- The Law
218
Give three pieces of advice from the NHS to keep risk of alcohol-related harm low.
- Don’t drink regularly more than 14 units of alcohol a week
- If drinking 14 units a weeks, spread evenly over three or more days
- If trying to reduce the amount of alcohol you drink, have several alcohol-free days each week
219
What three areas does AUDIT-C focus on?
- Frequency of drinking
- Units of alcohol in a day
- Frequency of binge drinking
220
What AUDIT-C score indicates increasing or higher risk drinking?
5+
221
Give three methods of brief alcohol interventions.
- Behavioural change
- Motivational-enhancement therapy
- Motivational interviewing
222
What total AUDIT score may indicate possible alcohol dependence?
20+
223
Give a way of assessing alcohol withdrawal symptoms and severity of dependance.
SADQ
224
What SADQ score indicates moderate or severe alcohol dependence?
>16
225
What is the recommended treatment for someone who scores over 16 on the SADQ?
Chlordiazepoxide detoxification regime.
226
Is alcohol a stimulant or a depressant?
Depressant
227
Describe how alcohol acts in the CNS.
- Potentiates GABA (inhibitory neurotransmitter)
| - Inhibits glutamate (excitatory neurotransmitter)
228
Give two methods of delivering alcohol dependance interventions.
- Community based assisted withdrawal (clinical risk permitting)
- In-patient based assisted withdrawal
229
Give three reasons why alcohol withdrawal interventions may be carried on an inpatient basis.
- Previous seizures
- Low mood
- Suicide risk
230
What medication can be used to treat alcohol withdrawal, what is the preferred choice?
Benzodiazepines (chlordiazepoxide is preferred)
231
Give three indications for benzodiazepines.
- Symptomatic relief of anxiety
- Muscle spasm
- Symptomatic relief of acute alcohol withdrawal
232
Are benzodiazepines short or long term treatments for alcohol withdrawal?
Short term (shouldn’t be used >4weeks)
233
Describe a typical chlordiazepoxide regime which may be used to treat alcohol withdrawal.
Starts with fairly high doses and then gradually reduces dose.
234
Describe the pharmacokinetic properties of chlordiazepoxide.
- Highly lipophilic and absorbed in small intestine
- Crosses blood brain barrier to get to grey matter
- Metabolised by liver
- Excreted in the urine (long half life)
235
What is the suggested mechanism of action of chlordiazepoxide?
Enhances actions of GABA.
236
Give seven contraindications to chlordiazepoxide.
- Hypersensitivity to benzodiazepines
- Severe pulmonary insufficiency
- Phobic and obsessional states
- Chronic psychosis
- Severe hepatic insufficiency
- Pregnancy
- Myaesthenia gravis
237
Give five withdrawal effects of chlordiazepoxide.
- Headache
- Muscular pain
- Anxiety
- Hallucinations
- Epileptic seizures
238
Give four types of drugs that benzodiazepines may interact with.
- Alcohol
- Centrally acting drugs (antipsychotics, analgesics)
- Anti-epileptic drugs
- Compounds affecting hepatic enzymes
239
Give three special populations that must have a lower dose of benzodiazepines.
- Elderly
- Respiratory impairment
- Organic brain damage
240
Give an alternative benzodiazepine to chlordiazepoxide if the patient has low liver function in alcohol withdrawal.
Lorazepam
241
Give three drugs that may prevent relapse in alcohol withdrawal.
- Acamprosate
- Disulfiram
- Nalmefine
242
How does disulfiram work to prevent relapse in alcohol dependence?
What is a drawback of the drug?
Disrupts the oxidative metabolism of alcohol.
| Results in a build up of acetaldehyde.
243
Give five possible side effects of disulfiram.
- Flushing
- Tachycardia
- SOB
- Nausea
- Vomiting
* Feels like hangover
244
What are he sepsis six?
BLU OAF
- Blood cultures
- Lactate
- Urine cultures
- Oxygen
- Antibiotics
- Fluids
245
What are the symptoms of hyperviscosity syndrome?
- Bleeding
- Headaches
- Visual disturbances
- Weakness
- Confusion
- Drowsiness
- Lethargy
- Chest pain
- Abdominal pain
246
Give four conditions which can cause hyperviscosity syndrome.
- Polycythaemia
- Multiple myeloma
- Leukaemia
- Waldenstom macroglobulinaemia
247
What are the three elements of the atopy triad?
- Eczema
- Asthma
- Hayfever
248
Describe the system approach to error.
Errors are to be expected and adverse events are the product of many causal factors.
This approach encourages pro-active management.
249
Describe an individual approach to errors.
Errors are a result of problematic mental processes (forgetfulness, inattention, distraction, etc) and the person who committed the unsafe act is responsible.
This focuses on a re-active approach to management.
250
Is the ‘Swiss Cheese Model’ of errors an individual or system approach?
System
251
Describe the swiss cheese model of errors.
There are many protective factors in place to avoid errors, but all of these protective factors have ‘holes’.
Some holes are in the form of active (human) failures, and some are in the form of latent conditions related to the system/organisation.
Adverse events occur when the active failures and latent conditions line up to allow hazards to occur.
252
Define culture.
Shared values and beliefs that interact with an organisation’s structure and control systems to produce behavioural norms.
253
Describe what is meant by a ‘positive safety culture’ in healthcare.
Where staff have a constant and active awareness of the potential for things to go wrong.
254
Give five elements of the safety culture in healthcare.
- Open
- Just
- Reporting
- Learning
- Informed
255
Define epidemiology.
The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.
256
What is clinical epidemiology?
Using information about distribution and determinants in a clinical setting, especially in diagnosis.
257
Give the steps in the process of how epidemiology can be used to help to improve diagnosis of certain conditions.
- Case definition and ascertainment
- Incidence, prevalence, trends
- Risk factors
- Scope for earlier diagnosis and prevention
258
Give four drawbacks of using very broad spectrum antibiotics (nuclear missile).
- Expensive
- Adverse effects
- Harder to give
- Promotes resistance
259
Give four advantages of using more focussed empirical antibiotics (sniper).
- Narrower adverse effects profile
- More tolerable
- Saves other choices
- Cheaper
260
Give five risk factors for depression.
- Female gender
- Past history of depression
- Significant physical illness
- Other mental health problems
- Psychosocial problems
261
Are males or females more at risk of committing suicide?
Males
262
Give three broad categories of depression symptoms.
- Psychological
- Physical
- Social
263
Give two core symptoms of depression.
- Persistent sadness or low mood nearly every day
| - Loss of interest or pleasure in most activities
264
Describe some other symptoms of depression.
- Fatigue or loss of energy
- Worthlessness (feeling of)
- Excessive or inappropriate guilt
- Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts
- Diminished ability to think/concentrate, or increased indecision
- Psychomotor agitation or retardation
- Insomnia/hypersomnia
- Changes in appetite and/or weight loss
265
How long should symptoms of depression have been present for?
At least 2 weeks
266
Give five medications that may increase the risk of depression.
- Beta blockers
- CCB
- Antipsychotics
- Antiepileptics
- Oral contraceptives
267
Name a self-report questionnaire which can help to assess the severity of depression.
Patient health questionnaire (PHQ-9)
268
What percentage of people with a chronic illness are likely to develop depression?
20%
269
Give five general measures in the management of depression.
- Manage comorbidities
- Manage safeguarding issues
- Assess and mitigate suicide risk
- Appropriate monitoring and follow up
- Advice on sleep hygeine
270
Give four non-pharmacological management methods of mild-moderate depression.
- Consider watchful waiting
- Guided self-help based on CBT principles
- Group physical activity sessions
- Counselling or short-term psychodynamic psychotherapy
271
Give four indications for anti-depressants in mild-moderate depression.
- Mild depression persists after other interventions
- Mild depression complicates care of other health problems
- Patient has a history of moderate/severe depression
- Symptoms persist for >2yrs
272
What is the standard treatment for moderate-severe depression.
Antidepressant medication combined with high intensity psychological treatment (CBT or interpersonal therapy (IPT).
273
Give a last-resort treatment that may be used for very severe depression.
Electroconvulsive therapy
274
What is the first-line antidepressant?
Selective serotonin reuptake inhibitors (SSRIs)
275
Give five classes of antidepressants.
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-noradrenaline reuptake inhibitors (SNRIs)
- Noradrenaline and specific serotonergic antidepressants (NASSAs)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
276
Why are SSRIs the first line antidepressants?
- Fewer side effects
| - Less serious overdose
277
Give four examples of selective serotonin reuptake inhibitors.
- Fluoxetine
- Citalopram
- Paroxatine
- Sertraline
278
Give two examples of serotonin-noradrenaline reuptake inhibitors.
- Duloxetine
| - Venlafaxine
279
Give an example of a noradrenaline and specific serotonergic antidepressant.
Mirtazapine
280
Give two reasons why tricyclic antidepressants are not first-line.
- More serious overdose
| - Cause more unpleasant side effects
281
Give five examples of tricyclic antidepressants.
- Amitriptyline
- Clomipramine
- Imipramine
- Lofepramine
- Nortriptyline
282
Why are monoamine oxidase inhibitors rarely used for depression?
They can cause serious side effects.
283
Give three examples of monoamine oxidase inhibitors used to treat depression.
- Tranylcypromine
- Phenylzine
- Isocarboxazid
284
Name a questionnaire that helps to assess the severity of anxiety.
GAD-7
285
What is palliative care?
Palliative care improves the quality of life of patients and families who face life-threatening illnesses, by providing pain and symptoms relief, spiritual, and psychosocial support from diagnosis to the end of life and bereavement.
286
Who provides specialist palliative care?
Health professionals who specialise in palliative care
287
Who mainly receives specialist palliative care?
Patients with advanced cancer
288
Who provides generalist palliative care?
Health professionals who have not received accredited levels of training in palliative care.
289
Who mainly receives generalist palliative care?
Older people (who may not have malignant disease)
290
Give four aspects of the philosophy of palliative care.
- Holistic/humanistic
- Individualised
- Families included (families are patients too)
- Multidisciplinary
291
Give three problems with the healthcare of older patients.
- More co-morbidities
- Higher risk of adverse effects of treatment
- Social isolation
292
Do older patients or younger patients generally have more access to palliative care?
Younger patients (eg. With cancer)
293
Give four key issues in COPD which make it hard to get good palliative care.
- Unpredictable trajectory of disease
- Difficult to make a prognosis
- Poor patient understanding of condition
- Limited access to specialist palliative care
294
In general, do patients with COPD or lung cancer report worse activities of daily living?
COPD
295
Is depression more prevalent in patients with COPD or lung cancer?
COPD
296
Are patients with COPD or lung cancer more likely to get visits from district nurses?
Lung cancer
297
Are patients with COPD or lung cancer more likely to know that they might die?
Lung cancer
298
Is there more specialist palliative care in COPD or Lung cancer?
Lung cancer
299
Are COPD or lung cancer patients more likely to be admitted to intensive care?
COPD
300
What access should patients with COPD have to palliative care?
They should have full access to palliative care
301
The care that most COPD patients get at the end of life is provided by who?
Generalist palliative care providers
302
Give four issues which result in more specialist palliative care being given to cancer patients over COPD patients.
- Specialist palliative care funded by cancer charities
- Expertise of specialist palliative care teams have a cancer focus
- Differing patient needs between COPD and cancer
- Stigma around smoking
303
What is occupational medicine?
Branch of medicine concerned with interaction between work and health.
304
Give four people/groups of people who benefit from occupational medicine.
- Individual workers
- Groups of workers
- Workplace effects on surrounding population (eg. Emissions)
- Employers’ customers/clients
305
Give seven examples of occupational diseases.
- Asbestosis
- Silicosis
- Coal miners’ pneumoconiosis
- Occupational dermatitis
- Occupational deafness
- Tenosynovitis
- Mesothelioma
306
Give the six most common work-related ill health conditions in Great Britain, in order of decreasing prevalence.
- Stress/depression/anxiety
- Musculoskeletal disorders
- Lung disease
- Cancer
- Noise-induced hearing loss
- Hand-arm vibration
307
Give four examples of occupational lung diseases causing death, in decreasing order of prevalence.
- Chronic obstructive pulmonary disease (COPD)
- Non-asbestos related lung cancer
- Mesothelioma
- Asbestos-related lung cancer
308
Give three methods of establishing the extent of work-related ill-health.
- Case counts
- Self-reports
- Attributable or aetiological fractions (assess fraction of cases that are attributable to work)
309
Give four sources of occupational illness data.
- Labour force survey
- Death certificate
- Disablement benefit
- Surveillance schemes (health and occupation reporting network, mesothelioma register)
310
What study design is best suited to calculating attributable risk?
Cohort studies
311
Give four time patterns of occupational disease.
- Acute
- Cumulative
- Progressive (disease progresses after exposure ceases)
- Diseases with latencies
312
What is the difference between hazard and risk?
```
Hazard = potentially harmful
Risk = probability that the hazard will cause harm
```
313
Give five classifications of work hazards based on the broad mechanism that they use to cause disease.
- Mechanical
- Physical
- Chemical
- Biological
- Psychosocial
314
Give three aspects of a disease that should raise suspicion of an occupational aetiology?
- Fails to respond to standard treatment
- Does not fit the typical demographic profile
- Is of unknown cause
315
What are the ten key components that Marmot highlighted which contribute to chances of work having a positive effect?
- Precariousness
- Individual control
- Work demands
- Fair employment
- Opportunities
- Prevents social isolation/discrimination/violence
- Sharing information
- Work/life balance
- Reintegrates sick/disabled
- Promotes health and wellbeing
316
Give five general topics of screening questions used to determine whether an illness has an occupational aetiology.
- Type of work?
- Patient’s opinion?
- Symptoms different at work/home?
- Exposures at work or in past?
- Co-workers with similar symptoms?
317
What is the GP’s role in occupational health?
Sickness certificate
318
Give five dangers of long-term worklessness.
- Risk of mental illness
- Risk of poor health
- Loss of fitness and well-being
- Social exclusion and poverty
- Trapped on benefits to retirement
319
According to the Equality Act 2010, what is a disability?
A physical or mental impairment, which has a substantial long-term adverse effect on a person’s ability to carry out normal activities.
320
Give eight reasonable adjustments that employers should make to accommodate people with disabilities in the workplace.
- Altered working hours
- Allowing absences for medial treatment
- Additional training
- Special equipment/modifying equipment
- Changing instructions/reference manuals
- Changing open plan working policy (anxiety/autism)
- Additional supervision or support
- Adjustments to premises
321
Define ‘mental health’.
A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
322
Define ‘health’.
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
323
Give the five elements of Maslow’s hierarchy of needs.
- Self-actualisation
- Esteem
- Love/belonging
- Safety
- Physiological
324
Describe the two stages on either side of the ‘window of tolerance’.
- Hyperarousal (sympathetic)
| - Hypoarousal (parasympathetic)
325
Give the ABC of self care.
- Awareness
- Balance
- Communication
