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HYMS phase II H&S > Overlapping year 2 H&S > Flashcards

Overlapping year 2 H&S Flashcards

1
Q

What is food poisoning?

A

Gastroenteritis, usually with diarrhoea and vomiting which has an infectious cause.

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2
Q

Name the 3 different types of food poisoning, and give examples of each.

A
  1. Microbial infection - Salmonella, Norovirus, Aspergillus, Cryptosporidium (protozoan).
  2. Toxins - Clostridium Perfringens, S. Aureus, Clostridium Botulinum.
  3. Chemicals - Heavy metals, pesticides, herbicides.
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3
Q
  1. What does incubation period mean?
  2. Why is the incubation period useful?
  3. Why must you use PPE when coming into contact with somebody with an infectious disease?
A
  1. The time from eating to the time of symptom onset.
  2. Can help to inform which organism might be causative.
  3. Because you might then become a vector for that disease.
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4
Q
  1. What type of bacteria is Salmonella?
  2. How is Salmonella transmitted?
  3. What are the 2 diseases that can be caused by Salmonella?
  4. What is the incubation period of Salmonella?
A
  1. Gram negative enteric bacteria.
  2. Faeco-oral transmission.
  3. Enteric fever and enterocolitis
  4. 12-72 hours.
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5
Q
  1. Describe enteric fever.

2. What is the reservoir method of Salmonella?

A
  1. Caused by Salmonella Typhi/ paratyphi. It is septicaemia that can lead to a high fever that lasts for weeks, with a mortality of 15% if untreated.
  2. Eggs
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6
Q
  1. What type of bacteria is S. aureus?
  2. How does S. Aureus get spread?
  3. Why is S. aureus not affected by reheating food?
  4. What is the incubation period of S. Aureus?
A
  1. Gram positive cocci.
  2. When previously cooked food gets contaminated with somebody’s skin/ nasal flora.
  3. Because it is heat stable and acid stable.
  4. 2 - 4 hours
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7
Q
  1. What type of organism is Cryptosporidium?
  2. What are the 2 reservoirs for Cryptosporodium?
  3. What is contraction of cryptosporidium associated with?
  4. What are the modes of transmission for cryptosporidium?
A
  1. Protozoa.
  2. GIT of man and animals/ water contaminated with faeces.
  3. Foreign travel.
  4. Animal to human, person to person and recreational exposure (swimming and camping).
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8
Q
  1. What type of virus is the norovirus?
  2. Why can Norovirus occur at any age?
  3. Where are outbreaks of Norovirus common in?
  4. What is the reservoir for Norovirus?
A
  1. Small, round, structured, RNA virus.
  2. Because immunity is not long lasting.
  3. Semi-closed environments (hospitals, schools, care homes, cruise ships).
  4. Man (24 hours D&V)
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9
Q
  1. What is clostridium perfringens associated with?
  2. How toes clostridium perfringens multiply?
  3. What does consumption of large numbers of vegetative cells cause?
  4. What can Clostridium Perfringens also cause?
A
  1. Slow cooling and un-refrigerated storage.
  2. Spores germinate to vegetative cells (generation time of 10-12 minutes). C. Perfringens enterotoxin is then produced after ingestion.
  3. Gastroenteritis.
  4. Gas Gangrene
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10
Q
  1. What is the reservoir for Campylobacter?

2. Give 3 ways that campylobacter can be transmitted.

A
  1. Birds (particularly poultry) and animals, cattle and domestic pets.
  2. Raw or under cooked meat
    Unpasteurised milk/ bird pecked milk on doorsteps.
    Untreated water
    Domestic pets with diarrhoea
    Person to person if personal hygiene is poor
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11
Q
  1. What form of E. Coli is very dangerous?
  2. Name the 5 types of E. Coli and state what they cause.
  3. Where does enterohaemorrhagic E. Coli colonise?
  4. What does enterotoxigenic E. Coli produce?
A
  1. Enterohaemorrhagic
  2. Enteropathogenic (Infantile diarrhoea)
    Enteroaggregative and Enterotoxigenic (Traveller’s diarrhoea)
    Enteroinvasive (Bacillary dysentry common in developing countries)
    Enterohaemorrhagic (causes HUS)
  3. The small intestine.
  4. A heat labile toxin
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12
Q
  1. What is the reservoir for E. Coli O157?

2. How can E. Coli O157 be spread?

A
  1. GIT of cattle and other domesticated animals.
  2. Contaminated and under cooked food (beef and beef products and milk), Person to person, contact with infected animals.
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13
Q
  1. Define food poisoning outbreak.
  2. What is a general outbreak?
  3. Give 2 reasons as to why we investigate food poisoning outbreaks.
A
  1. An incident in which 2 or more people, thought to have a common exposure, experience a similar illness of proven infection.
  2. Affects members of >1 household/ institution.
  3. Reduces morbidity and mortality; decreases NHS burden; protects vulnerable groups; can have political implications.
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14
Q
  1. What are the 4 objectives of investigating food poisoning outbreaks?
A
  1. Reduce the number of primary outbreaks, reduce the number of secondary outbreaks, reduce harmful consequences, prevent further outbreaks.
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15
Q
  1. What are the 3 steps in an investigation of a food poisoning outbreak?
A
  1. Preliminary phase, Immediate steps and collecting data/ descriptive epidemiology.
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16
Q

What is involved in:

  1. the preliminary stage of a food outbreak investigation?
  2. The immediate steps in a food outbreak investigation?
  3. Collecting data in a food outbreak investigation?
A
  1. Is there an outbreak?
    Confirming the diagnosis.
    What is the nature and extent of the outbreak?
  2. Who is ill? How many are ill? What is the cause? Is proper care being arranged? What immediate action can be taken?
  3. Time, person, place, number affected, symptoms, common factors, where are they? food histories and storing data.
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17
Q
  1. Why is taking food histories difficult

2. What might be involved in an environmental health investigation?

A
  1. Poor food recall, buffet meals, snacks/ grazing, lying (if on diet).
  2. Environmental health officers visit the food place and inspect premises, take samples, swab equipment, check food procedures are being followed.
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18
Q
  1. What are outbreak outliers?
  2. If these outbreak outliers are not an error, what might they represent?
  3. What are analytical epidemiological studies used for?
A
  1. Cases at the very beginning and very end that may not be related.
  2. Baseline level of illness, outbreak source, case exposed earlier than others, a unrelated cause, a case with a long incubation period.
  3. Used to ID probable causes in absence of lab confirmation.
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19
Q
  1. What type of study would you use for a point source outbreak?
  2. What type of study would you use for a common source outbreak?
A
  1. Cohort.

2. Case control.

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20
Q
  1. Why is food not intrinsically safe?

2. Name 3 food safety concerns.

A
  1. Because it contains certain nutrients ideal for the growth of pathogens and there is a lot of handling and processing involved in food production.
  2. Food borne illnesses, nutritional adequacy, environmental contaminants, naturally occurring contaminants, pesticide residues and food additives.
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21
Q
  1. What does the public health act allow?

2. Give 2 examples of groups of people that might pose an increased risk of spreading GIT infections.

A
  1. Exclusion from work of people that pose an increased risk of spreading GIT infections.
  2. Persons of doubtful personal hygiene or with unsatisfactory toilet hand washing/ children in nursery or preschool groups/ people whose work involves food preparation or handling ready to eat foods, health and social care staff who have contact with highly susceptible persons.
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22
Q
  1. Give the 3 primary objectives that the UK food law is based upon.
  2. What is the main piece of primary food legislation in GB?
A
  1. A high level of protection of human life and health, the protection of consumers interests, fair practices in the food trade.
  2. The food safety act of 1990.
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23
Q
  1. What does the food safety act of 1990 define?

2. Under the food safety act of 1990, what is included by the term ‘food’?

A
  1. Food and the enforcement authorities and their responsibilities.
  2. Drink, articles of no nutritional value which are used for human consumption, chewing gum and similar products, substances used as food ingredients.
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24
Q

Give 3 offences under the food safety act of 1990.

A
  1. sale of food rendered injurious to health, unfit for consumption or is contaminated.
  2. Sale of any food which is not of the quality demanded by the purchaser.
  3. Display of food for sale with a label that falsely describes the food is likely to mislead as to the nature of a substance or the quality.
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25
Q
  1. What does HACCP stand for?
  2. What is HACCP?
  3. Name the 3 requried aspects in the GMP guidelines.
A
  1. Hazard analysis critical control point.
  2. A compulsory procedure in the goods manufacturing practice (GMP) guidelines.
  3. Analysis of potential food hazards, ID of points in operation where hazards could occur, review of these hazards and critical points at periodic intervals.
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26
Q

What are the 3 healthcare objectives and what do they entail?

A
  1. Equity: improving access to care.
  2. Efficiency: doing the right thing at the right time at the least cost.
  3. Control of expenditure: which system performs best?
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27
Q

Name the 2 main healthcare systems.

A

Private insurance (USA) and Public single payer tax financed system (UK).

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28
Q
  1. What is the expenditure-income identity model?
  2. What are the 4 types of income for the NHS?
  3. What does the majority of healthcare funding in the UK come from?
  4. What is a type of co-payment in the NHS?
A

A model which details profits as income and costs as wages, payments or expenditure on products.

  1. General taxation, social ‘insurance’, private insurance and user charges/ co payments.
  2. Taxation.
  3. Prescription charges.
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29
Q
  1. Give 2 reasons why there is increasing demand for healthcare.
  2. Give 3 ways that expenditure could be controlled within the NHS.
  3. What are the 4 ways of funding equity?
A
  1. Multi morbidities across all age groups and technological advances.
  2. Reducing the workforce, reducing wages and pensions, increasing productivity (reduce practice variations).
  3. General taxation, social insurance, private insurance and user charges.
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30
Q
  1. What is used to divide the UK NHS budget between countries?
  2. What is technical efficiency?
  3. What is allocative efficiency?
A
  1. The Barnett formula.
  2. Maximising production of goods and services.
  3. Production of the most desired/ worthwhile goods and services at the least cost.
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31
Q

Why do we need efficiency in the NHS?

A
  1. Resources are scarce (opportunity cost)
  2. Inefficiency is unethical as it deprives other people of care from which they would benefit.
  3. Efficiency ensures the maximisation of health gains.
32
Q
  1. Between 1900 and 1930, what was the trend in alcohol consumption and why?
  2. From the 1950’s to now, what has the trend in alcohol consumption been?
  3. Why has the consumption of beer decreased, but of wine increased?
A
  1. Consumption per capita decreased due to the temperance movement, war, US prohibition and UK controls (pub closing times and drink strength).
  2. Dramatic increase in alcohol consumption.
  3. Due to the increased affordability of wine.
33
Q
  1. Give 2 international comparisons in alcohol consumption.
A
  1. Per captia, UK lower than most European countries. Earlier start of alcohol consumption in the UK means that there is an increase in youth binge drinking.
34
Q
  1. What is the impact of alcohol expressed as?

2. Name 3 alcohol related harms to society.

A
  1. Alcohol attributable fractions (AAFs).
  2. Deaths and hospital admissions, crime and disorder (alcohol particularly implicated in violent crimes), workplace (drunkenness and hangover effects on productivity) and family.
35
Q
  1. What are the 2 most effective methods for limiting alcohol consumption?
  2. Name a moderately effective way of limiting alcohol consumption.
  3. Give an ineffective way of attempting to limit alcohol exposure.
A
  1. Increasing price through taxation and minimum price per unit and restricting availability (opening hours, outlet density and age restrictions).
  2. Restriction of youth to advert exposure, licensing and training staff.
  3. Drug and alcohol education and mass media campaigns.
36
Q
  1. Describe 2 efforts made during the labour years to reduce alcohol consumption.
  2. Describe 2 efforts made during the coalition years to attempt to reduce alcohol consumption.
A
  1. Alcohol harm related strategy for England (AHRSE), 2004 and the licensing act (2003).
  2. Minimum unit price, ban of some drinking games in promotions, doubling of fine for sale of alcohol to underage persons, hospital security staff can issue fines for A&E behaviour, alcohol included in NHS health check for adults 40-75.
37
Q
  1. Name 4 interventions which are included in the roles of health care professionals.
  2. What does the direct enhances service do?
  3. Give 3 specialist treatment strategies for people identified as being at risk for over consumption of alcohol.
A
  1. 2004/5 GP survey, ID of people at risk and delivery of brief advice, hospital alcohol health workers, specialist treatment.
  2. Screens all persons 16+ for being at risk.
  3. CBT, couples therapy, motivational interviewing, social behaviour and network therapy (evidence shows this is very effective)
38
Q
  1. Give examples of inputs and outputs in terms of economic evaluation.
  2. Why is health economic evaluation concerned with choices?
  3. What is the aim of economic evaluation in healthcare?
A
  1. Inputs = staff, medications, equipment and premises. Outputs = Improvement in patient health.
  2. Because demands usually outweigh the resources available in healthcare.
  3. To make choices explicit (firm decisions to make rules and guidelines).
39
Q

Overall, what is economic evaluation in healthcare?

A

The comparative analysis of courses of action in terms of both costs and consequences.

40
Q

What are the 4 basic steps of health economic evaluation, and what is the basic meaning?

A
  1. Identify - different inputs and outputs.
  2. Measure - what goes in and out.
  3. Value - apply an economic value.
  4. The costs anf consequences of alternatives.
41
Q
  1. What are NICE recommendations of new and existing treatments within the NHS based upon?
  2. What are 3 types of evaluations that can be done?
A
  1. A review of clinical and economic evidence.

2. Costs AND consequences, only costs, only consequences.

42
Q
  1. What does a cost-effectiveness analysis look at?
  2. What does a cost-utility analysis look at?
  3. What does a cost-benefit analysis look at?
  4. What is the most complete type of analysis?
A
  1. Benefit in natural units (life years)
  2. Benefit in utility values (QALYs)
  3. Benefit in monetary values
  4. Cost-benefit analysis.
43
Q
  1. What are the 2 approaches to conducting economic evaluations in health care?
  2. What is involved in the ‘identify’ step of an economic evaluation?
  3. Name 4 different ‘inputs/ costs’ that would need to be considered in an economic evaluation.
A
  1. Conducting alongside RCT or non-randomised studies OR relying on existing (secondary) data or existing studies.
  2. Draw up a checklist of costs and consequences, including all inputs/ resources that are involved.
  3. Healthcare sector, patients, family and third parties (productivity decreases as patient cannot work).
44
Q
  1. What is the primary outcome of a health economic evaluation?
  2. Name 2 other outcomes that can be measured.
A
  1. The primary outcome is to measure the change in health state.
  2. Changes in physical, social and emotional functioning; changes in resource use; changes in quality of life for the patient.
45
Q
  1. What is a cost minimisation analysis?

2. What can a cost minimisation analysis NOT do?

A
  1. Not a full form of economic evaluation, which assumes that health effects will be equal regardless of the intervention. The least cost option is then simply chosen.
  2. Provide answers where effectiveness is different between competing individuals.
46
Q
  1. What are the effects of a cost-effectiveness analysis measured as?
A
  1. Measured in terms of the most appropriate uni-dimensional natural unit - cost per unit effect. For example, cost per life saved.
47
Q
  1. Where does the data for cost effectiveness analysis come from?
  2. What is the formula for working out an incremental cost-effectiveness ratio?
  3. What does the incremental cost effectiveness ratio mean?
A
  1. Evaluation alongside a RCT or from modelling.
  2. ICER = (mean cost of the intervention - mean cost of the control) / (mean effect of the intervention - mean effect of the control)
  3. Shows how much extra it costs to generate 1 extra unit of health outcome.
48
Q
  1. Name the main decision rule for a cost effectiveness analysis.
  2. What is a problem with cost effectiveness analysis?
A
  1. Reject any alternatives that: are dominated by another alternative or combination of alternatives, have a greater cost with no added benefit or lower benefits with a smaller cost.
  2. It only allows comparison of interventions with the same unit of outcome.
49
Q
  1. Describe a cost utility analysis.
  2. What is 1 QALY?
  3. What does cost utility analysis allow?
  4. What do QALY league tables do?
A
  1. Effects are multi-dimensional and combines life years gained with some judgement of the quality of those life years (QALYs).
  2. 1 year of full life quality.
  3. Enables comparison of interventions that would be measured using different clinical outcomes.
  4. Rank procedures based on marginal cost per QALY.
50
Q
  1. In the UK, what is the monetary range recommended by NICE per year that is deemed to be acceptable?
  2. What is the most comprehensive form of evaluation?
A
  1. £20,000 - £30,000

2. Cost benefit analysis.

51
Q
  1. Describe what is meant by a MACRO level of resource allocation.
  2. Describe what is meant by a MICRO level of resource allocation.
A
  1. Strategic or societal intervention –> the government deciding how much money should be divided.
  2. Clinical level –> male decisions between treating individual patients.
52
Q
  1. State why age SHOULD be relevant to macro level resource allocation decision making.
  2. State 2 reasons why age SHOULD NOT be relevant to macro level resource allocation decision making.
A
  1. Older people have already had a long life, and younger people have not, so fairer for resources to be diverted from old to young.
  2. Burden relates to cost of illness and incapacity in the last years or months of life, not age itself/ Society should treat all members equally with respect and compassion/ Devalues the status of older people/ danger of signalling to society that the old are not as respected as the young/ unequal respect towards the elderly.
53
Q
  1. Why SHOULD resources be allocated to the younger at a micro level?
  2. Why should resources NOT be allocated to the young over the old at a micro level?
A
  1. Because older people are less likely to respond to treatment.
  2. Age alone is not a good predictor of prognosis/ this would create discrimination.
54
Q

What 9 characteristics does the equality act of 2010 offer protection to?

A
  1. Age
  2. Race
  3. Sex
  4. Gender reassignment status
  5. Disability
  6. Religion or belief
  7. Sexual orientation
  8. MAariage and civil partnership status
  9. Pregnancy and maternity
55
Q
  1. What is direct age discrimination?

2. What is indirect age discrimination?

A
  1. When a direct difference in treatment based on age cannot be justified. So, when people are treated in a less favourable manner because they are older.
  2. When a seemingly neutral provision, measure or practice has harmful repercussions on a person ( E.G. a universal early discharge policy would affect the elderly more as they take longer to recover).
56
Q
  1. What do QALY based asessment involve?
  2. What does a beneficial health care activity generate?
  3. What does it mean if the cost per QALY is as low as it can be?
A
  1. Assigning a utility value (between 0 and 1) to a state of health and then multiplying that value by the number of years expected to be lived in that state.
  2. A positive amount of QALYs
  3. That the health care is efficient.
57
Q
  1. What is a high priority health care activity?

2. What is a low priority health care activity?

A
  1. One in which cost per QALY is low.

2. One where the cost per QALY is high.

58
Q
  1. Give reasons FOR QALY based assessment.
  2. Give reasons AGAINST QALY based assessment.
  3. Why might QALYs be considered as being unjust?
A
  1. Addresses the primary purpose of healthcare (maximising welfare)/ motivated at the individual patient level/ useable in practice (already used widely by NICE).
  2. Difficulties relating to measurement - how do you define quality of life?/ Are QALYs unjust?
  3. Double jeopardy objection (multiple morbidities = even lower QALY)/ does end of lfie care lose out?/ Favours life years over individual lives.
59
Q
  1. What is covert discrimination?
A
  1. Hidden or subtle discrimination (harder to identify).
60
Q

As a doctor, what should you do if you suspect a case of food poisoning which could be linked to an outbreak?

A

1) Notify the responsible consultant.
2) Notifiers the local food safety authority.
3) Manage it appropriately.

61
Q

Describe 4 features of managing hospital outbreaks.

A

1) Infections decrease with hand washing and use of alcohol gel, being bare below the elbows, clean equipment, use of aseptic techniques, general ward hygiene and prohibition of general reservoirs (cooked food/ flowers).
2) Barrier nursing with PPE use (gloves and gowns).
3) Use of side rooms as quarantine bays.
4) Restriction of ward access/ visiting times (or close to visitors/ new admissions).
5) Lift new cases after 72 hours symptom free.

62
Q

What is the difference between a point source outbreak and a common source outbreak?

A

A point source outbreak is the same as a common source outbreak aside from the fact that a point source outbreak the exposure period is relatively brief and so all cases occur within one incubation period.

63
Q

What vaccinations should children receive at 8 weeks old?

A

1st 5 in 1 vaccine
1st pneumococcal vaccine
1st rotavirus vaccine
1st Men B vaccine

64
Q

What does the 5 in 1 vaccine include?

A 
diphtheria
tetanus
pertussis
polio
Hib
65
Q

What vaccinations should children receive at 12 weeks old?

A

2nd 5 in 1 vaccine

2nd rotavirus vaccine

66
Q

What vaccinations should children receive at 16 weeks old?

A

3rd 5 in 1 vaccine
2nd pneumococcal vaccine
2nd men B vaccine

67
Q

What vaccinations should children receive at 12-13 months old?

A

Hib and Men C
1st MMR
Booster pneumococcal
Booster Men B

68
Q

What vaccinations should children receive at 2-6 years?

A

Annual children’s four vaccine

69
Q

What vaccinations should children receive at 3 years and 4 months?

A

Booster 4 in 1 (diphtheria, tetanus, pertussis, polio)

2nd MMR

70
Q

What vaccinations should children receive at 12-13 years old?

A

HPV (females)

71
Q

What vaccinations should children receive at 13 - 18 years old?

A

Booster for diphtheria, tetanus and polio.

Men ACWY

72
Q

What is economic evaluation?

A

The comparative analysis of courses of action in terms of both costs and consequences.

73
Q

What outcome measures are used in the following types of economic evaluation?

1) Cost-effectiveness
2) Cost-utility
3) Cost-benefit

A

1) Life-years
2) QALYs
3) Monetary values

74
Q

What is the most complete type of economic evaluation?

A

Cost-benefit

75
Q

Name the 2 ways that economic evaluations can be conducted.

A

1) Alongside RCTs or other studies with primary data (quite expensive)
2) Through reliance on existing secondary data or existing studies (cheaper and quicker).

HYMS phase II H&S (12 decks)

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