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Y2 I&P > Preventative Medicine > Flashcards

Preventative Medicine Flashcards

1
Q

What is meant by sensitivity in medical testing?

A

Sensitivity measures how often a test correctly generates a positive result for people who have the condition that’s being tested for

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2
Q

What would it mean if a test was described as being “highly sensitive”?

A

It will flag almost everyone who has the disease and not generate many false negative results

e.g. a test with 90% sensitivity will correctly return a positive result for 90% of people who have the disease

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3
Q

What is meant by specificity?

A

Specificity measures a test’s ability to correctly generate a negative result for people who don’t have the condition that’s being tested for

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4
Q

What would it mean if a test was described as being “high specificity”?

A

It will correctly rule out almost everyone who doesn’t have the disease and wont generate many false positive results

e.g. A test with 90% specificity will correctly return a negative result for 90% of people who don’t have the disease

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5
Q

What is the relationship between sensitivity and specificity?

A

Sensitivity and specificity exist in a state of balance

increased sensitivity (the ability to correctly identify people who have the disease) usually comes at the expense of reduced specificity (more false positives)

and vice versa

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6
Q

What is meant by a “good test”?

A

One that has both high sensitivity and high specificity

the value of a test depends on the situation

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7
Q

What is the difference between screening and diagnosis?

A

Screening:

  • finding early, non-symptomatic cases of disease in the general population

Diagnosis

  • trying to find out exactly what is wrong in people who are already complaining of symptoms
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8
Q

What is meant by positive predictive value (PPV)?

A

A statistic that encompasses sensitivity, specificity and how common the condition is in the population being tested

it describes the chances of a patient actually having a condition that they have tested positive for

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9
Q

In what ways has the health of the UK population changed over the last 150 years?

A
  • Changes in life expectancy
  • changes in disability free life expectancy
  • lower infant mortality rates
  • eradication / reduction in infectious diseases
  • changes in disease prevalence
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10
Q

What are the key reasons for the changes in the health of the UK population over the last 150 years?

A
  • Improved social infrastructure - sanitation, housing, welfare and education
  • NHS being free at the point of use
  • immunisation programmes
  • antibiotics
  • development of medical treatments
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11
Q

What is the definition of life expectancy?

A

The average number of years a newborn baby can expect to live if the mortality rates at the time of their birth apply throughout their life

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12
Q

What is much of the reduction in mortality over the last 100 years due to?

A

Immunisation and the introduction of antibiotics and other medical treatments

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13
Q

What is meant by primordial prevention?

A

Action to prevent the development of disease risk factors

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14
Q

What is meant by primary prevention?

A

Action to modify existing risk factors to prevent development of disease in healthy people

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15
Q

What is meant by secondary prevention?

A

Actions to detect disease early to minimise the emergence of symptoms and/or complications

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16
Q

What is meant by tertiary prevention?

A

Actions to improve quality of life and reduce symptoms in established disease

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17
Q

What are examples of primordial prevention?

A
  • Change in social and environmental conditions in which risk factors are observed to develop
  • identifying and taking action at early life stage to prevent later development of risk factors

E.g. changing culture by discouraging smoking in those who have never smoked

these are whole population approaches as they are aiming to change the environment

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18
Q

What are examples of primary prevention?

A
  • Altering risky behaviours - discouraging unhealthy behaviours and encouraging healthy behaviours
  • banning substances known to be associated with disease
  • protecting from pathogenic disease e.g. immunisation
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19
Q

What are examples of secondary prevention?

A
  • Screening for asymptomiatic disease
  • prophylactic treatment to prevent recurrence
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20
Q

What are examples of tertiary prevention?

A
  • Reducing the impact of long-term conditions
  • minimising impairment
    e. g. Cardiac/stroke rehabilitation, peer support groups like dementia cafes
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21
Q

What are the risk factors for heart attack?

A
  • Age
  • family history
  • smoking
  • high blood pressure
  • high blood cholesterol or triglyceride levels
  • obesity
  • diabetes
  • sedentary lifestyle
  • stress
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22
Q

What are the modifiable risk factors for heart attack?

A
  • Smoking
  • high blood pressure
  • high blood cholesterol or triglyceride levels
  • obesity
  • diabetes
  • sedentary lifestyle
  • stress
23
Q

Why is it important to consider where evidence has come from?

A

The profile of risk factors may be different in different populations

24
Q

What does this graph of distribution of blood pressure within a population show about the risk factors for MI?

A

There are individuals with high blood pressure but also populations with high blood pressure

individuals with higher blood pressure have a higher risk of MI

but individuals with lower blood pressure may still experience MI

25
Q

How does disease arise from this population?

A

A large number of people at small risk may give risk to more cases of disease than a small number of people at high risk

26
Q

What does the population mean predict?

A

The population mean predicts the prevalence of cases

e.g. Gambling, alcohol, education

27
Q

what is the difference between causes of population incidence and individual people?

A

Causes of population incidence and individual cases are NOT the same

28
Q

What is meant by the high risk approach to prevention?

A
  • Identifying and acting at the “top end” of the population distribution
  • involves screening or case finding
  • target preventative measures to the individuals at most risk
  • risk-benefit balance is individually assessed
29
Q

What are the benefits of the high risk approach to prevention?

A

As it is targeted, you can make the approach applicable to those who are being targeted

it can be cheaper

30
Q

What is meant by the population approach to prevention?

A
  • Aims to shift the mean of the entire distribution to the left
  • identify important risk factors for the community
  • policy to reduce risk factor irrespective of the individual risk
  • risk-benefit balance for the whole community
31
Q

Complete the table

A
32
Q

What determines the individual and population risk:

in populations where mean plasma cholesterol levels are high, a great many people have raised levels of plasma cholesterol and the rate of CHD tends to be high

A

The individual’s risk is determined by their own cholesterol level

the population level of disease risk is an average of the individual disease risks

you can be an individual with a low risk but part of a population that has a high overall risk of CHD due to cholesterol levels

33
Q

What is meant by herd immunity and how does it affect individuals and populations :

if enough people in a closed community are immune to measles there will be herd immunity such that an individual with no immunity will have low probability of getting measles

A

Herd immunity is a societal level characteristic that is derived from the individual risks but can be considered an emergent property of the society

without immunity (mostly from vaccination) all individuals are at risk of measles if exposed to the pathogen

some individuals cannot be vaccinated so herd immunity protects them

34
Q

What determines individual and population risk:

if enough people in a closed community are immune to measles there will be herd immunity such that an individual with no immunity will have low probability of getting measles

A

Immunisation against MMR benefits the population as a whole

BUT

from an individual point of view, the chance of benefit may be outweighed by perceived certainty of negatives

35
Q

How does the choice of a parent choosing not to vaccinate their child affect other individuals?

A

More parents taking the option not to vaccinate means that an individual child’s risk increases as they are no longer being protected by those who have been immunised (herd immunity)

36
Q

What determines individual and population risk:

populations characterised by high levels of social capital have lower rates of illness than those with low levels of social capital

A

Societal characteristics affect health over and above the characteristics of the individuals who are members of that society

even if you as an individual are at increased risk of poor health, if you are part of a population with good community cohesion then your likelihood of experiencing poor health is less that if you were the same individual in a population with poor community spirit

37
Q

How can the societal effect on health influence a person who is socially isolated?

A

Social isolation is associated with depression

a socially isolated person in a cohesive community has less risk of depression than the same socially isolated person living in a fragmented community with little community cohesion

38
Q

What is the purpose of the Wanless report?

A

It called for a rebalancing of policy away from health care to health

this focuses on reducing the burden of disease and tackling the key lifestyle and environmental risks

39
Q

What is the Walness report predict about 2020 if there wasn’t investment in population health?

A

If there wasn’t investment in population health as opposed to individual sickness, then we would be faced with spiralling healthcare costs, rising levels of obesity and widening inequalities in health

40
Q

What is the purpose of secondary prevention?

What is the main strategy by which this is performed?

A

Actions to detect disease early to minimise the emergence of symptoms and/or complications

the main strategy involves screening for asymptomatic disease

41
Q

What is the definition of screening?

A

Testing of a population for a condition who do not have recognised symptoms

they are symptomless

42
Q

What is the difference between screening and diagnostic tests?

A

A screening test can find out if a person has a high or low risk of the condition

those found to be at high risk of a condition will often be offered a diagnostic test

this gives a more definite “yes” or “no” answer

43
Q

What are the main benefits of screening?

A
  • Can detect problems before symptoms are noticed
  • early treatment can be more effective or less invasive
  • you can make informed decisions about your health
  • screening can reduce risk of developing a condition
  • some deaths can be prevented
44
Q

What is an abdominal aortic aneurysm?

In which group is it more common?

A

An aneurysm is a weakening of an artery wall

AAA is an enlargement of the abdominal aorta

it is most common in men over 65

45
Q

What are the risk factors associated with AAA?

A
  • Smoking
  • high blood pressure
  • diabetes
  • high cholesterol
46
Q

What is involved in the national AAA screening programme?

A

It is a national screening programme introduced to men over 65

it involves a non-invasive ultrasound scan

47
Q

What is the main problem with screening problems?

A

Screening tests are not 100% accurate - they produce false positive and false negative results

identifying a potential health problem can cause anxiety (e.g. small AAA)

screening tests can lead to difficult decisions e.g. fetal anomaly screening

48
Q

What can false positives and false negative results of screening lead to?

A

False positive results:

  • leads to high anxiety, overtreatment and potentially harmful procedures (e.g. surgery)

False negative results:

  • can lead to false reassurance
49
Q

What are the UK Screening Committee criteria?

A
  • The condition should be an important health problem as judged by its frequency and/or severity
  • there should be a simple, safe, precise and validated screening test
  • there should be an effective intervention for patients identified through screening
  • there should be evidence from high quality research that the screening programme is effective in reducing mortality or morbidity
  • the benefit gained by individuals from the screening programme should outweigh any harms
  • the cost of the screening programme should be economically balanced in relation to expenditure on medical care as a whole
  • the complete screening programme is clinically, socially and ethically acceptable to health professionals and the public
50
Q

What are the screening tests for prostate cancer?

How does it impact on mortality?

A

Digital rectal examination

prostate-specific antigen (PSA) level screening - blood test

the PSA test can reduce mortality by 21%

51
Q

Why was it concluded no evidence that a screening programme using PSA would do more good than harm?

A
  • About 75% with positive results do not have cancer (false positive)
  • misses cancer in 15% of cases (false negative)
  • treatments have significant risk
  • cannot differentiate between slow-growing and fast-growing cancer
  • This screening test cannot be justified in low-risk populations*
52
Q

What is the procedure in place for screening for Down’s syndrome?

A

All pregnant women in England are offered screening between 10 and 14 weeks

diagnostic test associated with 0.5% chance of miscarriage

termination of pregnancy is legal for Down’s syndrome up to term

53
Q

What is the policy of informed choice involved in screening?

A

As a person being offered a screening test, I need to understand the benefits and harms of having the test

so that I can decide whether it is right for me to have the test or not

54
Q
A

Y2 I&P (14 decks)

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