PRACTICE OF MEDICINE Flashcards
The difference between screening and diagnostic testing?
Normal/negative result on screening down no equal disease-free necessarily
What does the term sensitivity mean regarding screening?
how well the test picks up having the disease
What does the term specificity mean regarding screening?
how well the tests detects not having the disease
Sensitivity formula=
(no. of correctly identified diseases/no. of disease cases) x 100
Specificity formula=
(no of normals correctly detected/no of normals in total) x 100
What is positive predictive value and what is it’s formula?
How reliable the test is at showing disease is present
(no of correct positive results/total no of positive results) x 100
What is negative predictive value and what is the formula?
How reliable the test is at showing the disease is not present
(no of correct negative results/total no of negative results) x 100
Advantages of screening? Name 3
- Reduced disease incidence
- Reduced disease mortality
- Overall population benefit
Disadvantages of screening? Name 3
- False reassurance
- Anxiety
- Harm from screening test
- Opportunity costs
Gold standard way of measuring effectiveness?
Randomised Controlled Trial (RCT) obby
What is the formula for measuring coverage?
(screened population/ eligible population) x 100
What is the formula for measuring uptake?
(screened population/invited population) x 100
Challenges with optimising coverage? (why a population in general doesn’t go to screenings?)
- Minority ethnic groups
- Immigrants
- Travellers
- Prisoners
- Students
- Reduced uptake
Challenges with optimising uptake? (why people that are invited to be screened don’t go?)
- Change of address
- Communication
- Health literacy
- Deprivation
- Accessibility
- Vulnerable groups
What are the 4 methods of abortion?
- Medical
- Vacuum aspiration/suction
- Surgical D&E
- Late abortions
How many weeks of gestation are the different methods of abortion specific for?
Medical- up to 13 weeks
Vacuum aspiration/suction- from 7 to 15 weeks
Surgical D&E- 15 weeks onwards
Late abortions- 20 weeks onwards
Active euthanasia, what is it?
X performs an action which itself results in Y’s death
What is passive euthanasia?
X allows Y to die. X withholds life prolonging treatment or withdraws life-prolonging treatment
What is voluntary euthanasia?
Euthanasia when Y competently requests death himself
Non-voluntary euthanasia, what is it?
Euthanasia when Y is not competent to express a preference
Involuntary euthanasia, what is it?
Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit
What is incidence?
Incidence: the rate at which new cases occur in a population during a specific period
What is prevalence?
Prevalence: the proportion of a population that are cases at a point in time
What is period rate?
(Number of people with outcome at a point in time)/ (number of people in group)
x100
What is a case-control study?
Case-control study; the cases (have the outcome) and control (doesn’t have the outcome) are compared.
Observational –> individual –> analytic
What is a cohort study?
Cohort study: prospective (looking into the future) OR retrospective (looking back in time). Follow-up populations relating information on risk factor and health states to the outcome of interest
Observational –> individual –> analytic
What is a randomized control trial?
RCT- individuals are randomly allocated to two groups undergoing two different treatments and effect is followed up.
–>Experimental
What is a case series?
Cases series: a series, often consecutive, of cases with the same disease
Observational –> Individual –> descriptive
What is cross-sectional survey
Cross-sectional survey: study health and disease states in a population/populations at a defined place and time.
Observational –> Individual –> descriptive
What is an ecological study/population case-series?
Ecological studies (population case-series): The unit of study is a population (not an individual). Good for study of signs/symptoms and creating disease definitions and foundations for other studies. Observational --> populations --> descriptive
What are the three main sources of major/minor life events?
Individual, family and society
What systems are impacted by major/minor life events?
Physiological system: sympathetic nervous system, endocrine system, heart rate, breathing, muscles
Psychological aspect: Cognitive functioning (memory, attention) and emotion
Social aspect: Social behavior
What is the main method of assessment of major/minor life events?
Social Re-adjustment Rating Scale
SRRS
Name 3 strengths and weaknesses of the SRRS?
Strengths: Quick and easy to complete Wide range of events Values assigned to events based on broad sampling Weaknesses: Events are vague Causality? Failure to distinguish between desirable/undesirable
What are the two methods for assessing the effects of daily hassles and how do they differ?
Hassles Assessment Scale for Students (HASS): Score allocated to hassle associated with health status. Is a strong predictor of psychological and physical well being
Uplifts Scale: Positive events that brings satisfaction e.g. completing a task. Has little association with health status.
What is the advised limit for men and women’s alcohol consumption?
14 units
How many units are women told not exceed in a day?
No units
How many ml’s of pure alcohol is a unit?
10ml
What is the equation to calculate the number of units in alcohol?
No. of units= No. of litres x %strength
Name 4 of the actions taken by the World Health Assembly to reduce the harmful use of alcohol
- Drink-driving policies and countermeasures
- Pricing policies
- Reducing the negative consequences of drinking and alcohol intoxication
- Availability of alcohol marketing of alcohol beverages
Define coping
Process by which people manage the perceived demands of a situation and the resources available as they appraise a situation
What are the two forms of coping? And how do they differ?
Problem focused: Reduce demands of situation or expand resources to deal with it.
Emotion focused: Focus on controlling emotional response to situation
Emotion focused is used when people feel they can do nothing to change the situation
What are the 4 types of illness coping strategies? (Hint: DARN)
Denial: denies existence of symptom
Accommodation: acknowledges, deals with problem
Resignation- Becomes consumed by illness
Normalising- Interpret symptoms as normal experience
Name 3 examples of coping resources?
Money
Social support
Personality
How does the COPE method assess coping?
Assesses what individuals do and feel when they experience stressful situations in 13 different scales (e.g. active coping, seeking emotional support)
How does social support influence health?
Buffering effect and direct effect
What is the buffering effect? Give examples
A way that social support influences health.
Protects the individual against the negative effects on health when the stressor is strong.
Eg: Enhances resources, enables reappraisal
What is the direct effect? Give examples
A way that social support can influence health
Is beneficial to health and well-being regardless of degree of stress
E.g.: healthier lifestyle, positive outlook
When is social support not beneficial? (4)
When it is not perceived as supportive
When it encourages a damaging lifestyle
When is does not match needs
When is reduces self-esteem
What are the 3 theories for stress?
Stimulus: Environment is the cause of stress, stressors
Response: Individuals reaction to stressors. The psychological and physiological response, responses are known as “strain”
Transaction: Focus is on stress as a process of stressors and strains, with continuous interactions and adjustments.
What is stress?
The perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation.
What is the acute and chronic physiological system response to stress?
Acute: Fight or flight
Chronic: General adaptation syndrome
What are the two responses to stress?
Sympathetic activation HPA activation (Hypothalamic-Pituitary- Adrenocortical)
How does “sympathetic activation” respond to stress?
The sympathetic nervous system is activated and catecholamines (adrenaline and noradrenaline) are produced.
Quick response system
How does HPA activation respond to stress?
Increased levels of corticosteroids (e.g. cortisol)
Raised levels of brain opoids, beta endorphin and enkapthalin
Slower response system
How does stress alter CV reactivity?
The release of corticosteroids and catecholamines promotes atherschlerosis.
Consequently tachycardia and hypertension develop
Name 3 benefits of increasing physical activity
Reduces CHD risk
Anti-depressive
Increases mental health
What are the recommendations for exercise for 19-64yr olds?
30mins x 5 per week at moderate intensity
20 mins x 3 per week at vigorous intensity
What are the exercise recommendations for 64+ yr olds?
Strengthening
Balance + coordination
