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Phase 2a Public Health Flashcards

1
Q

What is the key finding of The Black Report 1980?

A

widening of health inequalities (esp in mortality)

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2
Q

4 explanations to the findings in The Black Report 1980?

A

Material - environmental factors
Artefact - problems with how inequality is measured
Cultural/Behavioural - deprivation assoc with unhealthy behaviours
Selection - ill people “sink” socially/economically

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3
Q

What is the key finding of Acheson Report 1988?

A

Reduction in mortality but health inequality remain

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4
Q

Give 3 recommendation given in Acheson Report 1988 regarding PH policies addressing health inequality?

A
  1. Evaluate all policies likely to impact on health inequality
  2. Prioritise families with children
  3. Gov should reduce income inequality and improve living conditions in poor households
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5
Q

What is the key finding in the Whitehall Study?

A

Inequality in health and mortality between different employment grades and demands

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6
Q

What are the 3 theories of causation behind health inequality?

A
  1. Psychosocial (e.g. stress)
  2. Materialist (e.g. residential area)
  3. Life-course (combined)
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7
Q

How may doctors reduce health inequality?

A
  1. Changing perspectives
  2. Changing systems
  3. Changing education
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8
Q

What is patient compliance?

A

The extent to which patients’ behaviour (e.g. medications, lifestyle changes) coincides with medical advice

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9
Q

What are 2 key features differentiating adherence from compliance?

A
  1. Acknowledging patient’s beliefs

2. Enhanced patient knowledge/satisfaction

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10
Q

2 ways you can classify reasons for non-adherence? Give an example of each

A
  1. Capacity and resource (can’t understand instructions, can’t pay)
  2. Perceptual (beliefs about treatments/their health)
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11
Q

What 2 approaches does patient-centred care encourage?

A
  1. Patient as a whole person who has individual preferences

2. Shared control of the consultation and decision making

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12
Q

What is concordance?

A

The philosophy of considering patients as equals with respect to their agenda

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13
Q

Give 8 HIV prevention strategies

A
  1. HIV testing
  2. HAART
  3. Sex education
  4. use of condoms
  5. clean needles
  6. circumcision
  7. Pre-exposure prophylaxis
  8. Post-exposure prophylaxis
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14
Q

2 ways to test for HIV?

A
  1. p24 antigen in blood sample

2. Saliva serology

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15
Q

Identify 5 groups at increased risk of HIV?

A
  1. Homosexual/bisexual men
  2. IVDU
  3. Sex workers
  4. Migrant workers (truck drivers, soldiers)
  5. Heterosexual men/women
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16
Q

What is palliative care?

A

Care aimed to improve QoL in those with life-threatening illness by giving symptomatic treatment, spiritual and psychosocial support from diagnosis to end of life

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17
Q

4 ways unemployment can have negative impact on health?

A
  1. increased risk of mental illness
  2. increased risk of poor health
  3. Social exclusion
  4. Loss of fitness and wellbeing
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18
Q

Give some examples of primary, secondary and tertiary prevention of occupational health problems?

A

Primary - monitor risk
Secondary - early diagnosis, task modification
Tertiary - rehab

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19
Q

Influenza A viruses are classified by which 2 surface antigens?

A
  1. Haemagglutinin

2. Neuroaminidases

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20
Q

Define antigenic drift

A

Minor antigenic variation causing seasonal epidemics

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21
Q

Define antigenic shift

A

Major antigenic variation, assoc with pandemics

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22
Q

Define outbreaks, epidemics and pandemics

A 
Outbreak = 2+ linked cases
Epidemics = numerous cases confined to a region/country
Pandemic = epidemics that cross international borders
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23
Q

What actions are taken in the containment phase of managing early stages of a pandemic?

A
  1. Diagnose with swab
  2. Treatment of cases
  3. Contact tracing
  4. Large scale prophylaxis
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24
Q

What actions are taken in the treatment phase of managing early stages of a pandemic?

A
  1. Treat cases only

2. National flu pandemic service

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25
6 infection control strategies?
1. Hand hygiene / Cough etiquette 2. Personal protective equipments (PPE e.g. gloves, aprons, masks etc) 3. segregation of patients 4. Reduce social contact 5. Flu surgeries 6. Environmental cleaning
26
6 population-wide interventions in an epidemic/pandemic?
1. Travel restrictions 2. Restriction of mass public gatherings 3. School closure 4. Voluntary home isolation of cases 5. Voluntary quarantine of contacts of known cases 6. Screening of people entering UK ports
27
9 rIsk factors of CHD?
1. Hypercholesterolaemia 2. Hypertension 3. Smoking 4. Obesity 5. Diabetes 6. Low socioeconomic status 7. Social isolation 8. Type A behaviour 9. Depression/Anxiety
28
Why does CHD risk in post-menopausal become the same as in male of the same age?
Protective effect of oestrogen is lost post-menopause
29
Give 3 characteristic features of Type A behaviour pattern?
1. Hostile 2. Impatient 3. Competitive
30
3 ways Type A behaviour can be assessed?
1. Jenkins survey 2. Bortner scale 3. Structured clinical interviews
31
What is the key finding in Western Collaborative Study regarding CHD risk?
CHD risk in Type A behaviour pattern doubles that of Type B
32
What is the key finding in Recurrent Coronary Prevention Project?
Reduction in Type A behaviour reduces morbidity/mortality in post-MI patients
33
What the requirements for mental capacity?
1. able to understand the information 2. able to retain the information 3. able to evaluate the information
34
When is it acceptable to breach patient confidentiality?
1. Patient consents 2. Required by law 3. Public interest
35
Define anorexia nervosa
Restriction of energy intake leading to significant low body weight, BMI < 17.5
36
Define bulimia nervosa
Recurrent episodes of binge eating, characterised by sense of lack of control over eating and eating large amounts in discrete period of time, followed by compensatory behaviour to prevent weight gain
37
Binge eating disorders need to assoc with 3 of which 5 features for a diagnosis?
1. eating more rapidly 2. eating until uncomfortably full 3. eating lots when not feeling physically hungry 4. eating alone because of felling embarrassed 5. feeling disgusted, depressed or guilty afterwards
38
Urgent signs to look for in eating disorders?
1. rapid weight loss 2. muscle weakness 3. cardiac signs 4. reduced GCS
39
General treatment for eating disorders?
Cognitive behaviour test
40
Alternative treatment for anorexia nervosa?
MANTRA
41
What is substance use?
Ingestion of a substance affecting the CNS which leads to behavioural & psychological changes
42
3 risk factors of substance use relating to family?
1. +ve FH of substance misuse 2. Family conflict inc. domestic abuse 3. Being in care
43
3 risk factors of substance use relating to school/community?
1. Low academic attainment/commitment 2. Community norms favouring drug use 3. Availability of drugs in community
44
4 risk factors of substance use relating to individual/peers?
1. Peer influence 2. Rebelliousness 3. Tendencies towards anti-social behaviour 4. Traumatic experience e.g. abuse
45
Give 2 examples of depressants
Alcohol, benzodiazepines
46
Give 3 example of stimulants
Caffeine, nicotine, cocaine
47
Give 3 examples of hallucinogens
Ecstasy, ketamine, magic mushroom
48
Define physical substance dependence
Body adapts to presence of substance, needs more for the same effect over time, with physical withdrawal symptoms on cessation
49
Define psychological substance dependence
Feeling that life is impossible without the drug, with emotional effect when not on drug e.g. fear, shame , guilt etc
50
6 features of substance dependence syndrome?
1. Desire to use 2. Difficult controlling use 3. Tolerance 4. Physical withdrawal symptoms 5. Spend more time using 6. use despite evidence of harmful effects
51
4 management strategies for substance dependence?
1. Advice and counselling 2. Detoxification - gradual reduction of dose, relapse prevention 3. Community prescribing - substitution (reduction/replacement) 4. Residential rehabilitation
52
What are the 3 diagnostic code for substance misuse?
1. Acute intoxication - Disturbances in level of consciousness, cognition 2. Pattern of use causing damage to health 3. Strong desire to take drug etc (dependence syndrome)
53
How do you calculate alcohol units?
% ABV x Volume(ml) / 1000
54
What is the weekly limits of alcohol intake for men and women?
< 14 units/week
55
Acute conditions assoc with alcohol?
1. Accidents and injury 2. Respiratory depression 3. Aspiration pneumonia 4. Arrhythmias 5. Mallory-Weiss syndrome 6. Gastritis 7, Acute pancreatitis
56
Chronic conditions assoc with alcohol?
1. Alcoholic liver disease 2. Chronic pancreatitis 3. CNS toxicity 4. HTN 5. CHD 6. Osteoporosis
57
What is foetal alcohol syndrome?
Foetal alcohol syndrome is pre-/post-natal growth retardation due to foetal alcohol exposure
58
3 features of foetal alcohol syndrome?
1. Craniofacial abnormalities (e.g. microcephaly, upturned nose) 2. CNS abnormalities (e.g. mental retardation) 3. other congenital defects
59
2 syndromes that can be caused .by alcohol withdrawal?
1. Delirium tremens - tremors, seizures, hallucination, confusion, photo/phonophobia 2. Activation syndrome - tremulousness, agitation, high HR/BP
60
5 psychosocial effects of excessive alcohol?
1. Interpersonal relationships - violence, depression/anxiety 2. Poverty 3. Work problems 4. Criminality 5. Driving offences
61
5 population approaches to preventing alcohol misuse?
1. Know your limits 2. THINK! (drink driving) 3. Drinkaware 4. Change4life 5. Minimum pricing
62
3 screening tools for alcohol misuse?
1. FAST 2. CAGE 3. AUDIT
63
Some criteria for being alcohol dependent?
1. Tolerance 2. Withdrawal 3. Not being able to stick with drinking limits 4. Spend more time drinking
64
Define substance misuse
Physically hazardous, recurrent use of substance that results in failure to fulfil obligations, despite persistent social or interpersonal consequences
65
Define substance dependence
A state where normal function is only possible in presence of the substance
66
1st line pharmacological treatment for physical alcohol withdrawal symptoms? Briefly describe its mechanism of action
Chlordiazeopoxide (Benzodiazepines). Enhances actions of GABA (inhibitory neurotransmitter)
67
4 contraindications of benzodiazepines?
1. Myasthenia gravis 2. Pregnancy 3. Respiratory impairment 4. Psychosis
68
3 important drug interactions of benzodiazepines?
1. Alcohol 2. Antipsychotics 3. Anticonvulsants
69
Some side effects on benzodiazepines?
1. Respiratory depression 2. Impaired liver function 3. Amnesia 4. Drowsiness 5. Ataxia
70
2nd line pharmacological treatment for physical alcohol withdrawal symptoms?
Lorazepam
71
What is Wernicke's encephalopathy?
Deficiency of thiamine as alcohol exhausts thiamine store by using it as a co-enzyme in its metabolism
72
Triad of clinical features in Wernicke's encephalopathy?
1. Ataxia 2. Confusion 3. Nystagmus/Ophthalmopelgia
73
What can be a consequence of untreated Wernicke's encephalopathy?
Korsakoff's syndrome - chronic and irreversible memory impairment
74
Acute management of Wernicke's encephalopathy?
IV Thiamine/vitamin B
75
Name 3 drugs used to prevent alcohol misuse relapse?
1. Acamprosate 2. Disulfiram SE = tachycardia/-pnoea, N/V 3. Nalmefine
76
Describe thoracic outlet syndrome
Pain/tingling/wasting of hands due to compression of brachial plexus and subclavian artery/vein
77
Describe medial epicondylitis
Pain against resisted flexion of the wrist where there is repetitive bending and straightening of elbow (aka Golfer's elbow)
78
Describe lateral epicondylitis
Pain against resisted extension of the wrist where there is repetitive bending and straightening of elbow (aka Golfer's elbow)
79
Describe tenosynovitis
Local tenderness and swelling of tendon in the wrist causing pain and crepitus
80
Describe DeQuevain's tenosynovitis
Local tenderness and swelling in tendon sheaths of extensor pollicis brevis and abductor pollicis longus
81
Describe Hand-Arm vibration syndrome
ASYMMETRICAL blanching, sensory deficit and motor deficit in fingers
82
Describe trigger finger
Restricted movements of finger due Inflammation and hypertrophy of retinacular sheath
83
Describe Dupuytren's contracture
Permanent flexion of fingers due to collagen deposition in palmar fascia
84
Describe mechanical back pain
Pain in lumbosacral region, buttocks, thighs that is mechanical in nature and varies with activity and time
85
Describe the STI/HIV transmission model
R = BCD ``` R = Reproductive rate - rate of organism reproduction B = infective rate - chance of transmission per potential exposure C = partners over time D = duration of infection ```
86
3 strategies of STI primary prevention?
1. "Sex. Worth talking about" campaign 2. Vaccination 3. Pre-/post-exposure prophylaxis
87
3 strategies of STI secondary prevention?
1. Easy access to testing/treatment 2. Contact tracing 3. Screening programmes
88
3 strategies of STI tertiary prevention?
1. HAART for HIV 2. Co-trimoxazole for PCP 3. Acyclovir for herpes
89
Definition of obesity?
= BMI > 30
90
4 impacts obesity can have on the individual?
1. Increased risk of major illnesses (DM/HTN/OA/IHD etc) 2. Social stigmatisation 3. Emotional/behavioural (low self-esteem, social withdrawal etc) 4. Need for community/social care
91
5 factors behind the obesongenic environment with some examples of how obesity can be attributed to them?
1. Food consumption - cheap access to unhealthy foods 2. Physical activity environment - access to sport facilities, transport, sedentary employment etc 3. Biological - genetics, regulation of appetite 4. Individual psychology - stress, indulgence 5. Social psychology - passive entertainment, lack of recognition of obesity as an illness
92
4 interventions available on individual level?
1. Physical activity 2. Diet 3. Behaviour change strategies
93
4 interventions available on society level? (+ examples)
1. Media campaign 2. Food production - increase availability of healthy foods 3. Physical activity environment - more green space/sports facilities 4. Public policy - increase prices on obesogenic factors e.g. sugar tax, legislations
94
4 actions a doctor can take when tackling obesity?
1. Recognise obesity early 2. Educate patients 3. Offer brief interventions e.g. behaviour change, prescribe exercise 4. Signpost to weight management programmes
95
4 reasons why T2DM is a public health issue?
1. Major chronic assoc with mortality, co-morbidity and reduced QoL 2. Prevalence on the increase in populations 3. Lack of policies of all scale to reduce risk from obesity 4. Major inequality in prevalence and outcome
96
3 strategies in primary prevention of DM?
Sustained physical activity, diet change and weight loss
97
3 ways you can achieve earlier diagnosis of DM?
1. Raise awareness of DM and assoc symptoms in community and between healthcare professionals 2. Identify those at risk from clinical records 3. Screening tests
98
What is the programme aimed at halting DM progression?
Healthier You: The NHS Diabetes Prevention Programme
99
What is the aim of tertiary prevention of DM?
Achieve effective management and support self-management

Public Health (2 decks)

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