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Phase 2a > Public Health > Flashcards

Public Health Flashcards

1
Q

What are the 4 four broad categories that can influence an individual’s health?

A
  1. Biological factors e.g. gender, ethnicity
  2. Personal lifestyle e.g. exercise, diet
  3. The physical and social environment e.g. air pollution
  4. Health services
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2
Q

What did the Black Report 1980 confirm?

A

The Black Report confirmed that health inequalities were widening

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3
Q

What did the Acheson report 1988 suggest doing in order to reduce health inequalities?

A
  1. Give high priority to the health of families with children
  2. Reduce income inequalities and improve living conditions
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4
Q

What are the 4 main reasons for why men have higher mortality rates than women?

A
  1. Employment, men are more likely to have a high risk occupation
  2. Risk taking behaviour
  3. Men tend to smoke more than women
  4. Men drink significantly more alcohol than women
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5
Q

What is the disengagement theory?

A

The process by which older people disengage themselves from roles they previously occupied in wider society

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6
Q

What is the theory of the third age?

A

The theory of the third age describes an era after retirement with health, vigour and a positive attitude

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7
Q

Define patient compliance.

A

The extent to which the patient’s behaviour coincides with medical or health advice

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8
Q

Give 3 disadvantages of patient compliance.

A
  1. It is passive, the patient MUST follow the doctor’s orders
  2. It is professionally focused and assumes the doctor knows best
  3. It ignores problems patients have in managing their health
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9
Q

Define patient adherence.

A

The extent to which the patient’s actions match agreed recommendations. It is more patient-centred

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10
Q

What is the difference between patient compliance and adherence?

A

Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive

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11
Q

What are the key principles of adherence?

A
  1. Improve communication
  2. Increase patient involvement
  3. Understand the patient’s perspective
  4. Provide and discuss information
  5. Assess adherence
  6. Review medicines
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12
Q

Describe the necessity-concerns framework.

A

The necessity-concerns framework looks at what influences adherence. Adherence increases when necessity beliefs are high and concerns are low

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13
Q

Give 2 factors that patient centred care encourages.

A
  1. Focus on the patient as a whole person; holistic
  2. Shared control of the consultation, decisions are made by the patient and doctor together
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14
Q

What is concordance?

A

Concordance is the expectation that patients will take part in treatment decisions and have a say in the consultation; it is a negotiation between equals

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15
Q

Give 5 barriers to concordance.

A
  1. The patient may not want to engage in discussions with their doctor
  2. It may lead to worry
  3. Patients may just want the doctor to tell them what to do
  4. Time, resources and organisational constraints
  5. Challenging, patient choice may differ significantly from medical advice
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16
Q

What are the 5 main duties of a doctor?

A
  1. Work in partnership with patients, treat as individuals and respect their dignity
  2. Work with colleagues in a way that best serve patients’ interests
  3. Protect and promote health
  4. Recognise and work within the limits of your competence
  5. Provide a good standard of care
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17
Q

Define mental capacity.

A

The patient’s ability to make a decision about their care

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18
Q

What 4 questions can be asked to assess mental capacity?

A
  1. Does the patient understand?
  2. Can the patient retain the information?
  3. Can they use the information to weigh up options and make a decision?
  4. Can they communicate their decision?
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19
Q

What is Gillick/Fraser competence?

A

If a child is under 16 they can be assessed as being Gillick/Fraser competent; this means they can make decisions about their care without parental involvement

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20
Q

What is the main difference between infection and colonisation?

A

Infection results in harm to the individual whereas there is no harm in colonisation

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21
Q

How can the environment be altered to aid infection control?

A
  1. Design: hospital beds spaced further apart
  2. Ensuring a clean environment
  3. Infectious individuals can be isolated
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22
Q

What can staff do to prevent the transmission of infection?

A
  1. Barrier precautions; gloves and aprons
  2. Isolation
  3. Good hand hygiene
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23
Q

Where might norovirus outbreaks be likely? What can norovirus cause? Will norovirus be killed by alcohol hand gel?

A
  • Schools, cruise ships, restaurants, hospitals
  • Gastroenteritis; diarrhoea and vomiting
  • No - norovirus is resistant to conventional cleaning and is only killed by soap and water
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24
Q

Why is c.difficile hard to destroy? Will c.diff be killed by alcohol hand gel?

A
  • It is acquired in spore form and so is hard to eradicate
  • No - c.diff is resistant to conventional cleaning and is only killed by soap and water
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25
Q

What are endogenous infections?

A

Infection of a patient by their own flora. It is important to be aware of this when treating hospitalised patients

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26
Q

How can endogenous infections be prevented?

A
  • Good nutrition and hydration
  • Antisepsis
  • Control the underlying disease
  • Remove lines and catheters
  • Reduce antibiotic pressure e.g. short courses
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27
Q

Define epidemiology.

A

The study of how often diseases occur in different groups of people and why

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28
Q

What is epidemiological data used for?

A

Seeing trends in diseases and planning future preventative strategies

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29
Q

Define incidence.

A

The rate at which new cases occur in a population during a specified time period

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30
Q

Work out the incidence of new lung cancer cases:
- UK population: 61.4 million.

  • New lung cancer cases per year: 39,000.
A

(39,000/61,400,000) X 100,000 = 63.5 per 100,000 per year.

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31
Q

Define prevalence.

A

The proportion of a population that have the disease at a point in time (normally given as a percentage)

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32
Q

Define mortality.

A

The incidence of death from a disease

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33
Q

Describe an ecological study. Give an advantage and a disadvantage of an ecological study.

A
  • Ecological studies use population level data, e.g. mortality rates
  • Advantage: cheap and easy to perform as it uses readily available data
  • Disadvantage: bias is possible due to variation in diagnostic criteria
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34
Q

Describe a cross-sectional study. Give an advantage and a disadvantage of a cross-sectional study.

A
  • Looks at the population at a point in time
  • Advantage: quick and cheap. Rapid insight into current events in a community
  • Disadvantage: prone to bias, no time reference, could be reporting medical oddities
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35
Q

Describe a case-control study. Give an advantage and a disadvantage of a case-control study.

A
  • Looks at people with a disease (case) and compares with a control (matched). Retrospective
  • Advantage: results can be obtained quickly due to being retrospective - cheap
  • Disadvantage: unreliable if individuals have bad memories. Cannot calculate incidence
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36
Q

Describe a cohort study. Give an advantage and a disadvantage of a cohort study.

A
  • Follows a group of people over time; prospective. Incidence study
  • Advantage: incidence can be determined, reduced chance of bias
  • Disadvantage: expensive, takes a long time and uses large populations. Difficulty with follow up
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37
Q

Describe a RCT. Give an advantage and a disadvantage of a RCT.

A
  • An intervention is given and compared to a control group
  • Advantages: confounders are equally balanced, less bias.
  • Disadvantages: expensive, volunteer bias, ethical difficulties in withholding treatment from controls
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38
Q

What is the obesogenic environment?

A

An environment that encourages people to eat unhealthily and not do enough exercise

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39
Q

Give 3 physical characteristics of the obesogenic environment.

A
  1. Increased car culture
  2. Lifts/escalators
  3. TV remote controls
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40
Q

Give an economic characteristic of the obesogenic environment.

A

Healthy options tend to be more expensive

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41
Q

Give a socio-cultural characteristic of the obesogenic environment.

A

Eating out and indulging has become a very social thing to do

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42
Q

Define NNT.

A

The number of patients that need to be treated in order to have an impact on one person

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43
Q

Give 3 mechanisms that lead to people being unable to lose weight.

A
  1. Physical: more weight = more difficult to exercise
  2. Psychological: low self esteem = comfort eating
  3. Socioeconomic: reduced opportunities and employment
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44
Q

Define primary prevention.

A

Preventing a disease/condition from occurring in the first place. Eliminate exposures/risk factors that contribute to the disease

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45
Q

Define secondary prevention.

A

Detecting a disease as soon as possible in order to alter its course and to improve health outcomes. SCREENING!

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46
Q

Define tertiary prevention.

A

Trying to slow down the progression of a disease and helping people to manage their illness effectively

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47
Q

Define appetite.

A

A desire to eat food. Appetite is affected by olfactory, gustatory, cognitive and visual stimuli

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48
Q

Define hunger.

A

The need to eat food

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49
Q

Define satiety.

A

A feeling of fullness; the disappearance of appetite after a meal

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50
Q

Define satiation.

A

What brings an eating episode to an end

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51
Q

Give an example of a food that gives quick and short satiety.

A

Highly refined sugar

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52
Q

Give an example of a food that gives prolonged satiety.

A

Protein

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53
Q

Give 7 diseases that are associated with obesity.

A
  1. T2DM
  2. Hypertension
  3. CAD
  4. Stroke
  5. Osteoarthritis
  6. OSA
  7. Infertility
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54
Q

Describe the association between obesity and shift work.

A

Obesity is more prevalent in people who do shift work. Sleeping out of phase affects the metabolic circadian rhythm

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55
Q

Which brain structure is responsible for appetite regulation?

A

Hypothalamus.

  • Lateral hypothalamus: hunger centre
  • Ventromedial: satiety centre
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56
Q

What satiety hormone is expressed in white fat cells?

A

Leptin

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57
Q

What is the function of leptin?

A

It tells the brain not to eat anymore, switches off appetite. Serum levels of leptin increase after a meal and decrease after fasting

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58
Q

How does leptin switch off appetite?

A

Leptin inhibits NPY and AGRP. Leptin activates POMC and CART. Appetite is decreased

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59
Q

What is the role of CCK in satiety?

A

CCK delays gastric emptying and gall bladder contraction - appetite decreases

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60
Q

What is the role of ghrelin in satiety?

A

Ghrelin stimulates NPY and AGRP = increases appetite

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61
Q

What hormone might it be possible to use in the treatment of anorexia?

A

Ghrelin

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62
Q

Define obesity.

A

Having a very high amount of body fat in relation to lean body mass. BMI >30kg/m^2

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63
Q

Describe individual level interventions for managing obesity.

A
  1. Behaviour change: stimulus control, goal setting, slow rate of eating, relapse prevention, social support, hypnotherapy
  2. Community based programmes can provide on going advice and support
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64
Q

Describe wider level interventions for managing obesity.

A
  1. Food supply: reduce energy dense ingredients and improve access to healthy foods
  2. Media campaigns e.g. change4life, 5-a-day
  3. Environment: improve cycle lanes etc.
  4. Sugar tax and subsidise healthy eating
  5. Restrict the sale of certain foods and drinks in schools
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65
Q

What can doctors do to help manage obesity?

A
  1. Educate patients - make every contact count
  2. Signpost to weight management programmes
  3. Prescribe exercise
  4. Refer for surgery
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66
Q

Describe the trans-theoretical model of behavioural change.

A
  1. Pre-contemplation (no intention of giving up smoking)
  2. Contemplation (consider quitting)
  3. Preparation (get ready to quit in near future)
  4. Action (engaged in giving up)
  5. Maintenance (steady non-smoker)
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67
Q

Describe the Health Belief Model (Becker 1974) of behavioural change.

A

The individual needs to believe that there are consequences and that they are susceptible to disease. They need to believe that taking action reduces the risks and that the benefits will outweigh any costs

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68
Q

Give an example of a restrictive surgical treatment for obesity.

A

Gastric banding

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69
Q

Give an example of a malabsorptive surgical treatment for obesity.

A

Jejuno-ileal bypass

70
Q

Define sensitivity.

A

The proportion of patients who have the disease who test positive

71
Q

Define specificity.

A

The proportion of patients who don’t have the disease and test negative

72
Q

Define positive predicted value (PPV).

A

The number of patients who test positive who have the condition

73
Q

Define negative predicted value.

A

The proportion of patients who test negative who don’t have the condition

74
Q

What are the 4 principles?

A
  1. Autonomy - respect the patient’s choices
  2. Beneficence - do good
  3. Non-maleficence - do no harm
  4. Justice
75
Q

What is deontology?

A

Features of the act determines worthiness. Deontology teaches that acts are right or wrong, people have a duty to act accordingly

76
Q

Categorical imperatives are a type of deontology. What is a categorical imperative?

A

A rule that is true in all circumstances

77
Q

What are the challenges of deontology?

A
  1. Consequences aren’t looked at
  2. Duties can conflict
78
Q

What are virtue ethics?

A

Virtue ethics focuses on the character of the person acting

79
Q

What are the five focal virtues?

A
  1. Trustworthiness
  2. Integrity
  3. Compassion
  4. Conscientiousness
  5. Discernment
    (TICCD)
80
Q

What are the challenges of virtue ethics?

A

Virtue ethics don’t focus on consequences. They are culture specific and too broad for practical application. It’s not always clear how to solve a moral dilemma using virtue ethics

81
Q

What are utilitarian ethics (consequentialism)?

A

An act is evaluated solely in terms of its consequences. Maximise good and minimise harm

82
Q

What are the challenges of utilitarian ethics (consequentialism)?

A

Treats minorities unfairly to promote the happiness of a majority

83
Q

Name 2 approaches to ethical analysis.

A
  1. Seedhouse’s ethical grid
  2. The four quadrants approach
84
Q

Seedhouse’s ethical grid: describe the inner layer.

A

The inner layer asks the question of whether the intervention is going to create autonomy, respect autonomy and treat all equally?

85
Q

Seedhouse’s ethical grid: describe the second layer.

A

Duties and motives. Is the intervention consistent with moral duties; keeping promises, telling the truth, minimising harm and maximising benefit?

86
Q

Seedhouse’s ethical grid: describe the third layer.

A

Consequentialist layer. Is the intervention going to provide the greatest benefit for the greatest number? Who will benefit: society, individuals, a group?

87
Q

Seedhouse’s ethical grid: describe the outer layer.

A

Is the intervention likely to be affected by external considerations e.g. risks, law, use of resources?

88
Q

What are the advantages of Seedhouse’s ethical grid?

A

It provides structure and function for analysing ethical problems. It is based on moral theory

89
Q

What are the headings which make up the four quadrants approach to clinical ethical analysis?

A
  1. Medical indications
  2. Patient preferences: respect for autonomy
  3. Quality of life
  4. Contextual features
90
Q

Until what week of pregnancy can an abortion be carried out?

A

Abortions can generally only be carried out up to 24 weeks of pregnancy. In exceptional circumstances an abortion can take place after 24 weeks, e.g. if there’s a risk to life or there are problems with the baby’s development

91
Q

Could any pregnant lady request an abortion?

A

No. You need a medical reason to request a termination e.g. physical or mental risk to the mother

92
Q

Name 2 opiates and describe their effects.

A
  • Heroin and morphine
  • They create a sense of euphoria, and provide pain relief. They are also depressants
93
Q

What are the effects of alcohol?

A

Alcohol is a depressant. Its effects are sedation, relaxation and slowing down thinking/acting

94
Q

Name 3 stimulants and describe their effects.

A
  • Caffeine, nicotine and cocaine
  • Increase alertness and activity. Elevate mood
95
Q

Name 2 hallucinogens and describe their effects.

A
  • Ecstasy and ketamine
  • Alter sensory perception and thinking patterns, loss of sense of reality
96
Q

Give 7 risk factors for substance misuse.

A
  1. Family history of substance misuse
  2. Family management problems e.g. poor parenting
  3. Family conflict e.g. domestic abuse
  4. Low academic attainment at school
  5. Availability of drugs in the community
  6. Peer pressure
  7. Experience of trauma e.g. abuse, loss, poor parenting
97
Q

Write an equation that can be used to work out the number of units in a drink.

A

Strength of the drink (% abv) x amount of drink (ml) / 1000

98
Q

Give 4 psychosocial effects of excessive alcohol.

A
  1. Interpersonal relationships affected, e.g. violence, rape
  2. Problems at work
  3. Criminality
  4. Driving offences
99
Q

Give 5 acute effects of excessive alcohol.

A
  1. Accidents and injury
  2. Pancreatitis
  3. Cardiac arrhythmias
  4. Coma and death from respiratory depression
  5. Gastritis
100
Q

Give 4 chronic effects of excessive alcohol.

A
  1. Liver disease
  2. CNS toxicity, e.g. dementia
  3. Hypertension
  4. CHD
101
Q

Give 4 signs of foetal alcohol syndrome.

A
  1. Pre and post natal growth retardation
  2. Mental retardation
  3. Craniofacial abnormalities
  4. Congenital defects, e.g. eyes, ear and mouth
102
Q

Give 3 methods of screening for alcohol consumption.

A
  1. Clinical interview, e.g. asking about drinking in a patient history
  2. CAGE questions
  3. AUDIT tool
103
Q

What are the 4 questions that make up CAGE?

A
  1. Have you ever felt that you should Cut down?
  2. Have you ever felt Annoyed by people telling you to cut down?
  3. Do you feel Guilty about how much you drink?
  4. Eye opener - ever had a drink first thing in the morning?
104
Q

What are the 3 questions that make up AUDIT?

A
  1. How often do you have a drink containing alcohol?
  2. How many units of alcohol do you drink on a typical day?
  3. How often did you have >6 units on a single occasion in the past year?
105
Q

What questions might you ask to determine whether someone has alcohol dependence?

A

In the past 12 months have you:

  1. Shown tolerance?
  2. Shown signs of withdrawal?
  3. Not been able to stick to drinking limits?
  4. Spent a lot of time drinking?
  5. Kept drinking despite known problems?
106
Q

What kinds of questions are asked in the severity of alcohol dependence questionnaire?

A
  1. Asks about withdrawal symptoms
  2. Frequency of alcohol consumption
  3. Speed of onset of withdrawal symptoms
107
Q

What inhibitory neurotransmitter does alcohol potentiate?

A

GABA

108
Q

What is the preferred drug used in alcohol detoxification?

A

Chlordiazepoxide

109
Q

Name 2 drugs that can prevent alcohol relapse.

A
  1. Acamprosate
  2. Disulfiram
110
Q

Give 3 side effects of disulfiram.

A

Dilsulfiram leads to increased acetaldehyde levels.
Side effects include flushing of skin, SOB, nausea, vomiting, tachycardia

111
Q

Define physical dependence.

A

The body adapts to the presence of the substance and over time needs more and more for the same effect (tolerance). Stopping use leads to symptoms of withdrawal

112
Q

Define psychological dependence.

A

The feeling that life is impossible without the drug, Feelings of fear, pain, shame and guilt if not on the drug

113
Q

Give 5 withdrawal symptoms.

A
  1. Delerium tremens - can be severe/fatal tremors, agitation, confusion
  2. Agitation
  3. High BP
  4. Increased HR
  5. Seizures
114
Q

How would you define binge drinking?

A

Drinking >6 units of alcohol in one go

115
Q

Describe the alcohol harm paradox.

A

Those in lower socio-economic groups consume less alcohol than those in higher socio-economic groups but they experience greater alcohol related harm

116
Q

Give 3 government strategies that prevent harmful drinking.

A
  1. Price - make alcohol less affordable
  2. Availability - limit licensing and import allowances
  3. Marketing - limit exposure especially to young people
117
Q

Name 3 public health campaigns associated with reducing alcohol intake.

A
  1. ‘Know your limits’ - binge drinking campaign
  2. Drinkaware - alcohol labelling
  3. THINK! - drink drive campaign
118
Q

Define at risk drinking. Define alcohol abuse.

A
  • A pattern of drinking which brings about the risk of harm
  • A pattern of drinking which is likely to cause harm
119
Q

Define alcohol dependence.

A

A set of behavioural, cognitive and physiological responses that can develop after repeated substance use

120
Q

What questions might you ask to determine whether someone has alcohol dependence?

A

In the past 12 months have you:

  1. Shown tolerance?
  2. Shown signs of withdrawal?
  3. Not been able to stick to drinking limits?
  4. Spent a lot of time drinking?
  5. Kept drinking despite known problems?
121
Q

Deficiency of what vitamin can lead to Wernicke’s encephalopathy?

A

Vitamin B1

122
Q

What is the difference between linear and logistic regression?

A

In linear regression, the outcome (dependent variable) is continuous. It can have any one of an infinite number of possible values. In logistic regression, the outcome (dependent variable) has only a limited number of possible values

123
Q

A study is done to compare the survival rates of various treatments for prostate cancer within a cohort of 695 patients. 348 patients were managed via Watchful Waiting (WW). Of these, 31 patients died. 347 patients were managed via Radical Prostatectomy (RP). Of these, 16 patients died. What are the odds of death from prostate cancer with WW and RP?

A

WW odds (using populations) = 31 / (348-31) = 0.097….

RP odds (using risks) = (16/347) / (1 - (16/347)) = 0.048….

We can then use these to find the odds ratio which is calculated in the same way as a risk ratio:

The odds ratio of death from prostate cancer with WW compared with RP = (0.097..)/(0.048..) = 2.02

The odds of death from prostate cancer are 102% higher with WW compared to RP

124
Q

Logistic regression analysis is appropriate when:

A. The outcome variable is skewed

B. The outcome is continuous

C. The sample is very small

D. The outcome variable is binary and there are potential confounders to account for in the analysis

A

D

125
Q

The confidence interval of an Odds Ratio will not be symmetric because:

A. Estimates are actually calculated on a square root scale which would be symmetric

B. Odds Ratios must be larger than 1

C. The p-value is not significant

D. Estimates are actually calculated on a log scale which would be symmetric

A

D

126
Q

An Odds Ratio is referred to as ‘crude’ or ‘unadjusted’ if:

A. All confounders are not significant

B. We calculate it by hand

C. They are non-significant

D. Other confounders are not taken into account

A

D

127
Q

A study aims to work out the magnitude of difference in heights between children with and without celiac disease. There are concerns that the children in the sample have different ethnicities, ages and sex.

A. If the mean difference between the children is significant enough, differences in demographics don’t matter

B. Linear regression should be performed (height as outcome) with adjustment for ethnicity, age and sex

C. If the magnitude of mean difference between the children is large, differences in demographics don’t matter

D. Logistic regression should be performed with celiac disease as the outcome with adjustment for ethnicity, age and sex

A

B

128
Q

Look at the estimates for “Exposed to ≥ 3 invasive devices”. Look at estimates of 10.6 to 4.2 in the two columns. Which statement is correct?

A. The change in OR in the adjusted model is so strong that the finding becomes irrelevant

B. The OR estimate of 4.2 is adjusted, so background factors are taken into account, and therefore the strength of association, on this occasion, has diminished from OR=10.6

C. After being put into a multivariable model, the estimate of 4.2 is no longer a significant relationship

D. In both cases, the confidence intervals are too wide that we can’t draw conclusions

A

B

129
Q

Look at the adjusted estimate for “McCabe-Jackson classification” for ‘Rapidly fatal disease’ [OR=8.7 (4.3-17.6)). Which is the correct interpretation:

A. Individuals with Rapidly fatal disease had a 9% increase in the risk of dying compared to participants with a ‘nonfatal disease’ after taking account of other confounders in the model

B. Individuals with Rapidly fatal disease had nearly 9 times the odds of dying compared to participants with a ‘nonfatal disease’

C. Individuals with Rapidly fatal disease had nearly 9 times the odds of dying compared to participants with a ‘nonfatal disease’ after taking account of other confounders in the model

D. Individuals with Rapidly fatal disease had a 9% increase in the risk of dying compared to participants with a ‘nonfatal disease’

A

C

130
Q

Without looking at the p-value column, how can you tell that male sex and digestive system disease have a non-significant association with death?

A. The respective confidence intervals include 1

B. It isn’t possible to tell this from the table

C. The OR is close to 1

D. The confidence intervals are quite narrow

A

A

131
Q

What are the 3 main features of the national drug strategy 2010?

A
  1. Reduce demand
  2. Restrict supply
  3. Build recovery in communities
132
Q

What does substance misuse mean?

A

Relates to the harmful use of any substance for non-medical purposes or effect

133
Q

Define addiction.

A

Not having control over doing, taking or using something to the point where it could be harmful to you

134
Q

What are the different BMI classifications?

A
  • Normal weight = 18-25kg/m^2
  • Overweight = 25-29.99kg/m^2
  • Obesity I = 30-34.99kg/m^2
  • Obesity II = 35-39.99kg/m^2
  • Obesity III = >40kg/m^2
135
Q

In a survival analysis diagram, what does censored mean?

A

It means that the person has either:

  • survived until the end of the observational period (most common)
  • left the study midway
  • died before the study started
  • died for a reason unrelated to the study
136
Q

How do we present survival analysis?

A

In a Kaplan-Meier graph

137
Q

What is the basic significance test in survival analysis?

A

Log-rank test

138
Q

How are confounders handled (as log-rank test generally can’t handle confounders)?

A

Cox regression

139
Q

Define mortality. Work out the mortality from lung cancer cases:

  • UK population: 61.4 million.
  • Lung cancer deaths in 2009: 34,509.
A
  • The incidence of death from a disease
  • (34,509/61,400,000) x 100,000 = 56.6 per 100,000 per year.
140
Q

Until what week of pregnancy can an abortion be carried out? Could any pregnant lady request an abortion?

A
  • Abortions can generally only be carried out up to 24 weeks of pregnancy. In exceptional circumstances an abortion can take place after 24 weeks, e.g. if there’s a risk to life or there are problems with the baby’s development
  • No. You need a medical reason to request a termination e.g. physical or mental risk to the mother
141
Q

Describe Malan’s ‘helping profession syndrome’.

A

People in helping professions compulsively give to others what they would like to have for themselves. They have an unconscious identification with the patient role, unmet emotional needs

142
Q

Define population attributable fraction (PAF).

A

The proportional reduction in population disease that would occur if exposure to a risk factor was reduced

143
Q

Describe the Core model (Slade, 1982).

A

The Core model describes the factors that contribute to the onset of eating disorders. It says that onset is due to a combination of low self esteem and perfectionism leading to a need for control. This is a trigger for using food as a means of self-control

144
Q

What is the Bradford Hill criteria? Give 6 of the Bradford Hill criteria that provide evidence for causation.

A
  • A group of minimal conditions necessary to provide adequate evidence of a causal relationship
  1. Strength of association
  2. Consistency of association
  3. Exposure-response relationship
  4. Temporality - cause before disease
  5. Specificity
  6. Coherence of evidence
145
Q

Describe the STI/HIV transmission model (May & Andersen 1987).

A

R = BCD:

R = reproductive rate
B = infectivity rate
C = number of partners
D = duration of infection
146
Q

How does variant Creutzfeldt-Jakob disease (vCJD) differ from CJD?

A

Presents younger: mid-twenties compared to 60’s for CJD

147
Q

Give 3 signs of variant Creutzfeldt-Jakob disease (vCJD).

A
  1. Neuropsychiatric symptoms
  2. Ataxia
  3. Dementia
148
Q

What is the association between variant Creutzfeldt-Jakob disease (vCJD) and BSE?

A

vCJD and BSE are caused by the same prion strain suggesting transmission from BSE infected cattle to the human food chain

149
Q

Define:

a) impairment
b) disability
c) handicap

A

a) Any loss or abnormality of psychological, physiological or anatomical structure or function
b) An inability to perform an activity
c) An inability to fulfill one’s role, e.g. parental, vocational or recreational

150
Q

How does Baclofen work as an anti-spasticity drug?

A

Baclofen is a GABA analogue. It reduces calcium influx and so suppresses release of excitatory neurotransmitters

151
Q

What is somatic symptom disorder (functional symptoms)?

A

When a person feels extreme anxiety about physical symptoms that are medically unexplained. This anxiety interferes with daily life

152
Q

What are the 3 main types of somatic symptom disorder?

A
  1. Pain in different locations
  2. Functional disturbance of an organ system
  3. Complaints of fatigue/exhaustion
153
Q

Describe the criteria for diagnosis of somatic symptom disorder.

A

A - >1 somatic symptom that is distressing and disrupts daily life
B - Excessive thoughts, feelings and behaviours related to these symptoms
C - Chronicity - > 6 months

154
Q

Give 2 diseases that are examples of somatic symptom disorder.

A

IBS and fibromyalgia

155
Q

What is the management for somatic symptom disorder?

A

Sleep, exercise and CBT

156
Q

Describe the Health Belief Model (Becker 1974) of behavioural change.

A

The individual needs to believe that there are consequences and that they are susceptible to disease. They need to believe that taking action reduces the risks and that the benefits will outweigh any costs

157
Q

How can depression and anxiety be evaluated?

A
  1. GAD-7 - anxiety
  2. PHQ-9 - depression
158
Q

Give an example of an SSRI. Give an example of a tricyclic antidepressant.

A
  • Citalopram
  • Amitriptyline
159
Q

What is asked on the PHQ-9 questionnaire?

A
  1. Little interest or pleasure in doing things?
  2. Feeling down?
  3. Trouble sleeping?
  4. Feeling tired?
  5. Poor appetite or over-eating?
  6. Feeling bad about yourself?
  7. Trouble concentrating?
  8. Moving or speaking slowly?
    9 Suicidal or self-harm thoughts?
160
Q

Give 5 risk factors for breast cancer.

A
  1. Previous cancer
  2. Increasing age
  3. Family history
  4. Uninterrupted oestrogen exposure
  5. OCP/HRT
161
Q

When is breast cancer screening offered to women?

A

A mammogram is offered every 3 years between the ages of 50-70

162
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

163
Q

What investigations might you do in someone to confirm a diagnosis of breast cancer?

A
  1. Clinical examination
  2. Biopsy
  3. Mammogram
164
Q

What inherited gene mutations can increase the risk of someone developing breast cancer?

A

BRCA1 and BRCA2. p53 gene mutations too

165
Q

Name 5 causes of benign breast lumps.

A
  1. Lipoma
  2. Fat necrosis
  3. Fibroadenoma - firm, smooth, mobile, painless
  4. Breast cysts and abscesses
  5. Duct ectasia
166
Q

Describe the management for breast cancer.

A
  1. Wide local excision - removal of tumour
  2. Mastectomy +/- reconstruction
  3. Radiotherapy
  4. Chemotherapy
  5. Hormone therapy – reduced oestrogen activity in oestrogen receptor positive disease, e.g. tamoxifen
167
Q

If a breast cancer is oestrogen receptor is this associated with a better or worse prognosis?

A

A better prognosis as hormone therapy can be used

168
Q

If a breast cancer expresses the oncogene HER2 is this associated with a better or worse prognosis?

A

Over-expression of HER2 is associated with aggressive disease and poorer prognosis. Give Herceptin (trastuzumab) and chemotherapy

169
Q

What can you use to treat breast cancers that express the oncogene HER2?

A

Herceptin (trastuzumab) and chemotherapy

170
Q

What are the features of a successful vaccination programme?

A
  • A suitable vaccine must be economically available in sufficient quanitites to immunise all the vulnerable population
  • Means of producing, storing and transporting the vaccine must available
  • There must be few side-effects, if any, from vaccination. Unpleasant side-effects may discourage individuals in the popuation from being vaccinated
  • There must be means of administering the vaccine properly at the appropriate time. This involves training staff with appropriate skills at different centres throughout the population
  • Must be possible to vaccinate the vast majority (all, if possible) of the vulnerable population. This is best done at one time so that, for a certain period, there are no individuals in the population with disease and the transmission of the pathogen is interrupted. This is known as herd immunity
  • As few doses as possible

Phase 2a (13 decks)

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