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NHS Hot Topics Flashcards

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USMLE® Step 1 flashcards
1
Q

What is euthanasia and what are the 2 types?

A
  • Ending a patient’s life who is suffering from an incurable and/or painful disease
  • Active: Acting person deliberately intervenes to end a life, e.g. injecting substances
  • Passive: Causing death by withholding or withdrawing treatment
  • Can be voluntary or involuntary
  • Illegal in the UK
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2
Q

What is assisted suicide?

A

Physician intentionally gives a patient the means to take the lethal medication themselves

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3
Q

What are some arguments in support of euthanasia?

A
  • Some illnesses cause intolerable suffering, to end their lives would be the compassionate thing to do
  • Provides autonomy to the patient - one of 4 pillars of medical ethics
  • Public increasingly supports assisted dying
  • By current UK law patients who want to end their lives must travel abroad to do so
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4
Q

What are some arguments against euthanasia?

A
  • Conflicts with principle of non-maleficence
  • Legislation could be used to justify assisted dying in vulnerable groups, e.g. those with disabilities and mental illnesses
  • Potential negative consequences of legislation (premature ending of lives) outweigh small number of people this would benefit
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5
Q

What are current problems with the ambulance service?

A
  • Ambulance wait times are longer than guidelines
  • Due to shortage of paramedics, crowded EDs, high demand
  • Government has allocated more money and given NHS workers a pay rise
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6
Q

What is consultant led elective care and what are some current problems with it?

A
  • Non-emergency medical care that is planned in advance and led by a consultant
  • High number of people on waiting lists
  • Very long waits for treatment compared to pre-pandemic
  • ‘Hidden backlog’ of people who would normally present for treatment but chose not to or had referrals cancelled
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7
Q

What are the current problems with A&E waiting times?

A
  • Significantly longer than the target, causing delays
  • Results in an increase in ambulance response times
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8
Q

What are current problems with care in the NHS?

A
  • High level of vacancy and more positions
  • Led to decreased level of support and increased number of unpaid carers
  • Due to low pay and regulations that make it impossible for someone from EU to gain work in the UK in the care sector
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9
Q

What are the current problems with the number of doctors and dentists in the NHS?

A
  • Low number of GPs and unavailable dentists
  • Leads to more ED admissions
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10
Q

Why have A&E waiting times increased?

A
  • Fewer hospital beds
  • Ageing population
  • Unnecessary A&E attendances
  • Staffing shortages
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11
Q

What strategies might reduce strain on A&E departments?

A
  • Assemble GPs, A&E staff, urgent care teams, pharmacists to create new emergency and urgent care hubs
  • Investing more in primary care
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12
Q

How do GLP-1 agonists like Ozempic work?

A
  • Activate GLP-1 receptor in pancreas
  • Slow gastric emptying and rate of digestion, inhibits release of glucagon, stimulates insulin production
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13
Q

Explain the dual use of Ozempic.

A
  • Intended to be used in adults with type 2 diabetes to reduce hyperglycaemia
  • A common side effect is weight loss, but the drug has not been approved for this purpose.
  • However, body may get used to the drug and establish a new normal, causing weight to plateau.
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14
Q

What are some ethical issues with the use of Ozempic as a weight loss drug?

A
  • Increased consumer demand has led to shortage of supply for type 2 diabetics
  • Usage has large implications: weight regain, lifelong implementation
  • Uncertain as to its efficacy over a long period of time
  • Decrease in access has raised counterfeit concerns, especially for pharmacies
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15
Q

What are some reasons behind the increased pressure on Primary Care services?

A
  • Increasing demand due to rising life expectancies and an ageing population
  • Recruitment issues
  • Unnecessary appointments
  • Closing practices
  • Low public satisfaction
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16
Q

What are some recent solutions in Primary Care to reduce strain on GP practices?

A
  • Medical schools trying to correct misconceptions about GP and encourage more students to consider it
  • International recruitment (short-term)
  • ‘golden hello’ scheme which pays newly qualified GPs when they start careers in struggling geographical areas
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17
Q

What is organ donation?

A
  • Act of giving an organ to someone who is in need of a transplant
  • Certain organs (e.g. kidney) can be donated while alive, but most come from people who have died.
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18
Q

What are some challenges with organ donation?

A
  • Demand is significantly higher than supply:
  • Only small proportion of deaths (e.g. stroke/brain injury) allow for organ donations as most do not leave viable organs for use
  • These deaths are becoming less common
  • Difficult to find a match
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19
Q

What is an opt-in system for organ donation? What are some of the benefits and drawbacks of this?

A
  • Doctors can only use a person’s organs after death if they signed up to a register during their life
  • Argued to be most valid and ethical form of consent
  • Potential donors don’t register or are unaware of the option
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20
Q

What is an opt-out system of organ donation? What are some drawbacks?

A
  • If a person has not registered, they are considered to have no objection to being an organ donor after death (presumed consent)
  • Adopted by England, Wales, Scotland
  • Aim to increase numbers as only those with strong opposing views will bow out
  • ‘Less valid’ as people may be unaware
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21
Q

How does organ donation in England work?

A
  • Soft opt-out system: 18+ are automatically added, and must actively withdraw to opt-out.
  • Families are still consulted before organ donation goes ahead
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22
Q

What is abortion, and how is it done?

A

The medical process of ending a human pregnancy so it doesn’t culminate in the birth of a baby.

  • surgical abortion - operation to remove pregnancy from the womb
  • medical abortion - 2 pills taken, which inhibit progesterone and induce contractions to pass pregnancy
  • recently second pill was legalised to take at home
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23
Q

What are some arguments opposing abortion (pro-life)?

A
  • human life begins at the point of conception
  • child could be adopted rather than taking an innocent life
  • abortion can cause psychological distress for woman
  • all children have great potential, and abortion may kill a child that could be very important to society or the world
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24
Q

What are some arguments supporting abortion (pro-choice)?

A
  • all abortions are carried out early when foetus cannot exist independently outside mothers womb - hence it is not murder
  • in cases of rape or incest, forcing a woman to have the child will be more psychologically damaging than abortion
  • abortion may be necessary to save woman’s life in certain cases
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25
Q

Briefly describe the Jim the Horse Tetanus Scandal.

A
  • Jim was a milk wagon horse who had symptomatic signs of tetanus and was eventually euthanised
  • Used to produce serums containing diphtheria antitoxin:
  • horses inoculated with bacteria, then antitoxin rich serum removed from blood
  • Serum led to death of 13 children, as it was found to be contaminated with tetanus - batch not tested before use
  • mislabelling of samples as free of contamination when actually contaminated
  • later found that Jim was not immunised against tetanus
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26
Q

What were the key factors that led to the Jim the Horse Tetanus scandal, and how can incidents like this be prevented in the future?

A
  • Distribution of antitoxin organised poorly and not tested appropriately + mislabelling of samples
  • Maintain patient safety - establish medical protocols and ensure supervision within the team to ensure safe medical practice. Apply quality assurance measures.
  • Ensure informed consent as patients did not know Jim was not vaccinated against tetanus
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27
Q

What is whistleblowing? What policies are implemented in the NHS to encourage it?

A
  • Raising concerns to an official channel rather than discussing with colleagues
  • NHS England runs ‘freedom to speak up’ policy, offering info and supporting staff to raise concerns.
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28
Q

What are some ethical dilemmas and barriers associated with whistleblowing?

A
  • Challenging as there are risks, such as being fired from job or challenging ability to practice medicine
  • however, ethically correct as it is beneficent and non-maleficent aiming to protect patients
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29
Q

What are some whistleblowing mechanisms within the NHS?

A
  • speaking directly to people involved
  • speaking to supervisor or line manager
  • speaking to an external organisation, e.g. Care Quality Commission or NHS England
30
Q

How would privatisation of the NHS occur?

A
  • Public pay for their own healthcare or through insurance
  • NHS offers contracts to various private sectors, which then carry out individual services
  • Currently services are used to reduce burden on NHS
31
Q

What are some arguments for the privatisation of the NHS?

A
  • AIDS with NHS waiting lists and reduces wait times
  • Reduces patients visiting doctors unless necessary
  • Allows for supplementation of doctors’ income, increases incentive to continue to work in the UK
  • Patients have autonomy to choose to pay for different treatment if they wish
32
Q

What are some arguments against privatisation of the NHS?

A
  • Affects justice, as those with wealth are able to access private care
  • Resources may not be shared equally
  • Private healthcare may be more financially focused than patient-centred
33
Q

What is an ageing population?

A
  • Improved quality of healthcare leads to increased life expectancy
  • More people live to older ages
34
Q

What is ‘bed blocking’?

A

If an elderly person is admitted to A&E after a fall, it can sometimes take days or weeks for them to be discharged.

35
Q

What is the impact of an ageing population?

A
  • As more people age NHS must treat an increasing number of chronic conditions associated with ageing, e.g. heart disease, type 2 diabetes, arthritis, Alzheimer’s
  • Elderly people also have complex social needs and require additional support with daily activities
  • Increases strain on care homes, social services, hospitals
  • Increased cost of support
  • Bed blocking
36
Q

Explain 2 new variants of COVID-19, their impacts and similarities and differences between them.

A
  • UK variant which has a higher R rate of 0.7, causing cases to triple despite second lockdown
  • Many countries closed borders to UK in response
  • South Africa variant caused travel to the country to be stopped
  • Both share N501Y mutation in the viral gene which lies in receptor-binding domain
  • UK variant has this mutation in the spike protein used to bind to human ACE2 receptor, making it more infectious
37
Q

Describe the lockdowns in response to COVID-19 , their purposes, and differences between them.

A
  • Introduced to protect the NHS and mitigate further viral spread
  • First lockdown aimed to keep people inside as much as possible, except for exercise, shopping etc.
  • Second lockdown allowed schools, colleges, unis to stay open - however, was ineffective
  • Third lockdown made schools colleges, unis close down and cancel public exams
38
Q

Did the first lockdown work? Provide reasons for and against.

A

For:
- Drove infection numbers down, temporarily reduced strain on NHS
- Delays transmission, bought time for drug and vaccine development
Against:
- Caused extra deaths due to suicides and drug overdoses, poor mental health
- Not a long-term solution to reduce strain on NHS
- Future lockdowns still needed

39
Q

Did the UK government handle the COVID-19 pandemic well? Provide arguments for and against.

A

Against:
- Doctors told to wash and reuse PPE if stocks were running low
- Majority of public didn’t trust government to stop spread of pandemic
- Had severe economic impacts on NHS and businesses
For:
- Launch of biggest vaccination programme in the history of the NHS, with mRNA vaccines being used
- Government provided some economic support
- Daily briefings communicated directly to the public

40
Q

What are mRNA vaccines and how do they work?

A
  • Piece of mRNA corresponding to a viral spike protein introduced into cells
  • mRNA is transcribed and translated producing the viral protein
  • Protein is recognised as foreign, and immune response occurs, including production of antibodies
  • When the real pathogen is encountered the body has immunity against it and produces the same antibodies
  • Allows researchers to develop vaccine quickly as virus does not have to be grown
41
Q

Explain the Wakefield and MMR scandal and its impact.

A
  • Paper linking MMR vaccine to autism was published by Wakefield and others
  • Sample size was small and paper had poor experimental design
  • Paper’s claims have been proven false, but MMR vaccine uptake still dropped
  • Childhood vaccine rate has lowered
  • Anti-vaccination groups formed and are prevalent
42
Q

What is the NHS long term plan to tackle vaccine uptake?

A
  • Improved local coordination and support to improve immunisation conversation in low uptake areas
  • MMR check for ages 10 and 11 added with GPs
  • Attempts to ‘catch up’ young adults who missed vaccinations as children
43
Q

How is AI currently being used in medicine?

A
  • Diagnosing disease from medical imaging scans and microscope slide,s e.g. cancer detection at earlier stages
  • Calculating radiotherapy doses based on CT scans and electronic health records
  • Virtual nurses and wearable devices to monitor vitals, etc.
  • Robotic surgery to help with certain operations
44
Q

What are some pros and cons for the use of AI in medicine?

A

Pros:
- Earlier diagnosis - good at recognising patterns, e.g. analysing X-ray images
- Humans are not prone to making mistakes, if AI is trained properly it will be more accurate and reliable
Cons:
- Currently NHS is still very reliant on physical data, so methods of collection and quality of data need to be improved for use of AI
- May pose a threat to privacy and confidentiality due to use of data

45
Q

What are the Francis reports?

A
  • Robert Francis is a Barrister specialising in medical law
  • He led a public enquiry into the poor care at Mid Staffordshire NHS Foundation Trust
  • Many issues which led to appalling treatment and high mortality rates
  • First report cited understaffing as one of the problems
  • Second report looked at setup of health and social care system in England and how it helps/hinders ability to deliver care.
46
Q

What were the consequences of the Francis reports?

A
  • GMC monitored progress made towards goals, which included staffing levels, training and regulation of healthcare assistants and registered nurses
  • Government provided actions to improve patient care - increasing openness, changes to regulation
  • NICE was asked to create guidelines on staffing capacity
47
Q

Explain what happened in the Bawa-Garba case.

A
  • 6-year old Jack Adcock was feeling unwell and was admitted to a local paediatric ward.
  • He had Down’s syndrome and a known heart condition requiring long-term medication
  • He was seen and assessed by Dr Bawa-Garba, an ST6
  • Jack’s condition deteriorated that day and he passed away
  • Dr Bawa-Garba was taken to high court and found guilty of manslaughter
48
Q

What were some mistakes made in Jack’s treatment in the Bawa-Garba case?

A
  • A chest X-ray that showed infection was not seen early enough due to poor teamwork
  • Antibiotics were prescribed late
  • Blood test revealed high CRP but was reported very late due to failings of computer system
  • Insufficient communication with family - heart medication was stopped but not documented
  • Temporarily mistaken for a DNACPR patient during a cardiac arrest
49
Q

Explain the Shropshire Maternity Scandal.

A
  • At the Royal Shrewsbury and Princess Royal Hospital an inquiry took place, with its findings leaked to the press as a report.
  • It investigated the deaths and injuries of babies at these hospitals, examining over 1800 cases.
  • It showed that many babies and mothers had died or sustained severe damage unnecessarily due to unchecked clinical malpractice.
  • Many other errors were made in the treatment of patients, e.g. calling babies ‘it’ and leaving babies’ bodies to decompose for weeks post-mortem.
50
Q

What were the consequences of the Shropshire Maternity Scandal?

A
  • Trust was ordered to repay £1 million that was given by NHS for good maternity care.
  • Maternity services rated inadequate by CQC (Care Quality Commission) and special measures placed, including weekly status reports.
  • Ongoing criminal investigation
  • Poor doctor-patient trust and negligence of doctors’ moral duties
51
Q

What is causing antibiotic resistance?

A
  • Livestock is dosed with antibiotics, so eating meat and dairy contributes
  • Large proportion of antibiotic prescriptions are inappropriate/unnecessary
  • Lack of education, e.g. patients believing they will help with viruses
  • Patients not completing a course of treatment
52
Q

What are some solutions for antibiotic resistance?

A
  • GPs encouraged to prescribe more sparingly
  • Clinical commissioning groups have reduced number of prescriptions and use of broad-spectrum antibiotics
  • Measures to reduce infections contracted from surgery
  • Public health England pushes education of infection-preventing public hygiene, e.g. handwashing
53
Q

What new developments are happening to combat antibiotic resistance?

A
  • A push for new drugs - incentivising pharmaceutical companies to research and develop drugs by paying them based on how valuable the drugs are, not how many are sold
  • New therapies such as combination therapy (2 or more drugs to increase effectiveness of both) and phage therapy (using viruses called bacteriophages)
  • Boosting research by committing further funds
54
Q

Explain the problem with access to mental health services, and how this is being controlled.

A
  • Patients struggle to get a bed in a mental health hospital close to their home
  • NHS launched a pilot scheme for patients in A&E with mental health issues
  • Rollout of specialist mental health services across England.
55
Q

What mental health support improvements have been made for NHS staff?

A
  • National support service for critical care staff (who are most vulnerable to severe trauma)
  • Nationwide outreach and assessment services
  • Well-being and psychological training
56
Q

What are some of the inequalities faced by BAME staff?

A
  • Unequal representation amongst board members
  • Recruitment problems: white applicants likelier to be appointed than BAME applicants
  • Less likely to be supported (and enter a formal disciplinary process)
  • Likelier discrimination
57
Q

What is the NHS doing to address BAME inequalities faced by staff?

A
  • NHS people plan has action points to increase BAME representation across the workforce
  • Striving to engage further with staff and staff networks so BAME staff can be heard
58
Q

What inequalities are faced by BAME patients?

A
  • Death during childbirth - BAME women more likely than white women to die in childbirth
  • Detrimental health outcomes
59
Q

What is the sugar tax and was it effective as a public health measure?

A
  • Drinks with 5-8g of sugar pay 18p per litre
  • Drinks with >8g of sugar pay 24p per litre
  • Has been successful - manufacturers have adapted and reformulated carbonated drinks
  • Most drinks now are below 5g of sugar per litre
  • Household purchasing of soft drinks remained the same, but amount of sugar has reduced
60
Q

What public health measures are being taken to combat childhood obesity?

A
  1. Local council trials - 5 local councils were allocated money every year to test and redefine ideas to address these issues, e.g. working with local mosques to give places to exercise, working with restaurants to introduce healthier options
  2. More opportunities to exercise - more money allocated to training PE teachers, and enabling schools to open facilities during holidays and at weekends
61
Q

What is the fat tax? What are some of the supporting and opposing arguments for it?

A
  • Theoretical tax placed on foods that are high in fat, salt or sugar
    Supporting:
  • leads to health problems like type 2 diabetes, heart disease
  • Could reduce consumption, encouraging healthier eating
  • money spent on these conditions is better spent elsewhere
    Against:
  • many people are obese because of medical or mental health issues
  • Price manipulation is seen as a form of control -> denying autonomy
  • Affects those on a low income the most
62
Q

What is PrEP?

A
  • Pre-Exposure Prophylaxis
  • Drug taken by HIV -ve people before sexual contact, usually with HIV positive partner
  • Not needed if other person is taking medication and has undetectable viral load
  • Can be taken regularly (1 per day) or just before and after sex
  • Available only from sexual health clinics
63
Q

What are the advantages and disadvantages of PrEP?

A

Advantages:
- Effective at helping HIV negative people maintain their -ve status
- Freely available in Scotland, wales an England
Disadvantages:
- Can have serious side effects
- Real world adherence to instructions is not perfect - is not as effective as in theory
- may promote drug-resistant HIV
- may lead to more STIs due to misconceptions that it protects against these

64
Q

What Brexit claims swayed the public opinion to leave the EU, related to the NHS?

A
  • EU would free up £350 million per week for NHS
  • This turned out to be an incorrect claim, but people accepted it and some voted to leave
  • Government promised an increase to NHS budget (from extra money from leaving EU)
  • But it is expected that costs associated with leaving will outweigh those being saved
65
Q

What was the impact of Brexit on the NHS?

A
  • Staffing crisis with many nurses and midwives from EU countries leaving NHS (although some from other countries came)
  • Number of european workers is expected to fall due to harsher immigration laws and decreasing UK salaries
  • Decrease in funding for scientific research
  • Border disruptions and delays make stockpiling medicines difficult (used up during covid)
66
Q

What is the junior (resident) doctor contract and what were the proposed changes to the old one (+ what happened as a result)?

A
  • Contract of employment for all NHS junior doctors
  • Government tried to update it, but junior doctors felt this endangered patient safety and was unfair to them
  • New changes increased basic salary, but reduced supplements for on-call shifts (so effective pay reduced)
  • Contract may increase stress, tiredness and burnout among peers, causing patient care to suffer
  • Thus junior doctors striked, not showing up to work
  • This caused it to then be reviewed
67
Q

Why are junior (resident) doctors striking in the UK?

A
  • Salaries have remained static and have not increased with inflation
  • They are demanding full pay restoration - 35% increase
68
Q

What are the positive and negative impacts of the BMA junior doctor strikes?

A

Positive:
- Increase in salary means doctors are less stressed and overwhelmed - better patient care
- improved working conditions reduce emotional and physical pressure on medical professionals
Negative:
- Fewer doctors present in A&E
- Cancellation of clinic appts and theatre lists
- Fewer doctors on the wards
- Deterioration of patient-doctor relationship

69
Q

What are the ethical arguments for and against the BMA junior doctor strikes?

A

For:
- Doctors are still humans and should not work in poor working conditions
- Will improve quality of their lives, making them better clinicians
- While negligent, industrial action must be impactful to be effective
- Prevents UK doctors from leaving the NHS to go abroad, which would accelerate the understaffing crisis
Against:
- Doctors should follow non-maleficence
- Affects doctor-patient relationship and public perception of the profession
- Has cost the NHS a lot of money
- Puts pressure on other members of multidisciplinary team

70
Q

What is the Medical Licensing Assessment (MLA)?

A
  • A pass/fail exam sat at the end of university coming into effect in 2024/25 onwards
  • 2 parts: Applied knowledge test, and clinical and professional skills assessment
  • Passing allows you to apply for foundation training
71
Q

What are the four pillars of medical ethics?

A

Beneficence - Doing good
Non-maleficence - To do no harm
Autonomy - Giving the patient freedom to choose, where they are able
Justice - Ensuring fairness

Medical Interview Prep (2 decks)

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