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Phase 2a > Public Health > Flashcards

Public Health Flashcards

1
Q

Define epidemiology

A

The study of distribution and determinants of health-related states or events in specified populations, and application of this study to control health problems

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2
Q

Define clinical epidemiology

A

Uses information about distribution and determinants in a clinical setting, especially in diagnosis

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3
Q

What are DALYs on a graph

A

Disability adjusted life years

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4
Q

Why do doctors seek consent to medical treatments

A

Legal
Ethical

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5
Q

What must consent be

A

Voluntary
Informed
Made by someone with capacity

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6
Q

What should informed consent be (5)

A

Honest discussion
Full details of intervention
Risks - significant risks
Benefits
Alternatives and their risk/benefits

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7
Q

Define the mental health capacity act 2005

A

A person must be presumed to have capacity unless its established that he lacks capacity

An act done or a decision made, under this act for or on behalf of a person who lacks capacity must be done, or made in his best interests

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8
Q

Name 4 causes of reduced capacity

A

Learning disability
Dementia
Mental illness
Impaired consciousness

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9
Q

What happens if someone does not have capacity

A

Is there a lasting power of attorney or advance directive?

A healthcare professional can act in the patient’s best interest

Always involve the patient as much as possible in the decision

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10
Q

Who can make a medical decision for someone else

A

No one can give consent on behalf of another adult - unless lasting of Attorney

Independent mental capacity advocate - be appointed if no family/friend to advise and support patient

Doctor in charge of case usually makes the decision

Judge/court of protection

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11
Q

When would a judge/court of protection make a decision for someone else

A

If very serious or complex decision

Conflict between health care team and patient views/representatives

Examples
- sterilisation
- donation of organs or regenerative tissue e.g. bone marrow
- withdrawal of nutrition and hydration from a person who’s in a permeant vegetive state or minimally conscious state

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12
Q

Describe DOL safeguards

A

Mental capacity act

Extra safeguard needed if the restrictions and restraint used will deprive a person of their liberty

Person has someone appointed with legal powers to represent them

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13
Q

What are the domains of liberty

A

Movement
Eating and drinking
Washing and appearance
Living environment
Family and social life
Privacy
Healthcare

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14
Q

What are the 5 points of making a best interest decision

A
  1. Whether the patient could have capacity and when that might occur
  2. The patient’s past and present wishes and feelings
  3. Patient’s beliefs and values that would be likely to influence any decision
  4. Other factors he might consider to decide
  5. Consultation about 2-4 with anyone named as needing to be consulted, carers, persons interested in his welfare, donees of a lasting power of attorney
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15
Q

If in an emergency and someone is notable to give consent what happens

A

Give treatment - strong presumption that life sustaining treatment is best interest

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16
Q

What is primary prevention of stroke

A

Smoking, alcohol, diet and physical activity

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17
Q

What is secondary prevention of stroke

A

Screening for risk factors

Risk of hypertension is 75%

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18
Q

What is tertiary prevention of a stroke

A

Stroke units, rehabilitation

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19
Q

Define Gillick competence

A

As a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed

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20
Q

How is dementia looked as as part of dementia

A

Awareness raising and opportunistic screening for memory loss

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21
Q

Can under the age of 16 refuse treatment

A

Parents cannot refuse treatment

Young person can refuse if competent

Involve MDT - often helpful to take legal advice

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22
Q

Define Race

A

Differentiates groups of people biologically on the basis of supposed differences in their genetic make-up

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23
Q

Define ethnicity (ethnic minority)

A

Refers to ‘real collectives, with common and distinctive forms of thinking and behaviour, of language, custom, religion and so on: not just modes of oppression but modes of being.

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24
Q

Define culture

A

Shared beliefs and values

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25
Q

Define racism

A

Conduct or words or practices which disadvantage or advantage people because of their colour, culture or ethnic origin

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26
Q

Describe smoking and Parkinson’s

A

Current smokers have up to 60% lower risk of both symptomatic disease and death

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27
Q

Define stereotypes

A

Generalised assumptions about, or representations of a social group

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28
Q

Describe women from ethnic minority groups have:

A

Poorer access to maternal care

Clinicans are more likely to ignore the concerns of women from minority groups

Experience racial discrimination in society

Have lower health literacy

Experience structural racism in countries where public policies and institutional practices reinforce racial inequality

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29
Q

Define survival analysis

A

Model the time taken for an event to occur and one or more variables that may be associated with that amount of time

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30
Q

Why would you use survival analysis rather than linear or logistic regression

A

Time to event data tend to be skewed

Censoring

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31
Q

Survival analysis - define survival probability

A

Probability an individual survives from the time origin to a specified future time

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32
Q

Survival analysis - define hazard

A

Probability an individual under observation at a specified time has an event at that time

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33
Q

Survival analysis - describe the key terminology

A

Hazard relates to the incident event rate

Survival to the cumulative non-occurrence of the event

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34
Q

Describe the hazard ratio in survival analysis

A

Ratio of two hazards

HR = 1 = no difference in survival

HR < 1 lower event hazard/increased survival in numerator

HR > 1 higher event hazard/decreased survival in numerator

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35
Q

Define the precautionary principle

A

Approach to risk management that emphasis caution, pausing and review before leaping into new innovations that may prove disastrous e.g. vaping

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36
Q

Describe the cox proportional hazard model

A

Allows comparison hazards between groups - measure the effect size is hazard ratio

Allows prediction survival probabilities

‘Semi-parametric’ as no distribution is assumed for survival times

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37
Q

Describe the BODE Index PH model to predict the 4 year survival in COPD patients

A

Predictors include:

FEV1 precent predicted

6-minute walk test

mMRC dyspnea (SOB) scale

BMI

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38
Q

How are survival curves presented

A

Kaplan-Meier plots

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39
Q

Describe clostridium difficle prevention

A

Produce spores highly resistant to chemicals (spores)

Alcohol hand rubs will not destroy spores

Hand washing with soap and water!!!

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40
Q

Describe SIGHT as a prevention of c. diff

A

Suspect C diff as a cause of diarrhoea

Isolate the case

Gloves and aprons must be worn

Hand washing with soap and water

Test stool for toxin

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41
Q

What is the second leading cause of death among children under 5 globally

A

Diarrhoea

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42
Q

What is the WHO-UNICEF 2004 prevention package of diarrhoea

A
  1. Rotavirus and measles vaccination
  2. Promote early and exclusive breastfeeding + vitamin A supplementation
  3. Promote hand washing with soap
  4. Improved water supply quantity and quality, including treatment and safe storage of household water
  5. Community-wide sanitation promotion
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43
Q

Describe the WHO-UNICEF 2004 Diarrhoea treatment package

A
  1. Fluid replacement to prevent dehydration
  2. Zinc treatment
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44
Q

Define primary prevention

A

Aim to prevent the 1st occurrence of the disease

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45
Q

Define secondary prevention

A

Aim to prevent recurrence of the disease

Aim = detect and treat early = minimise consequences.

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46
Q

Define tertiary prevention

A

Aims to soften the impact of disease on its lasting effects

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47
Q

Name the domains of public health

A

Health promotion/involvement

Health protection

Improving health services

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48
Q

Describe the role of health promotion/involvement

A

Inequalities, education, housing, employment, family/community, lifestyles, surveillance and monitoring of specific diseases and risk factors

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49
Q

Describe the role of health protection

A

Infectious diseases, chemicals and poisons, radiation, emergency response, environmental health hazards

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50
Q

Describe the role of improving health services

A

Clinical effectiveness, efficiency, service planning, audit and evaluation, clinical governance, equity

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51
Q

Describe the public health response

A

Surveillance - what is the problem?

Risk factor identification - what is the cause?

Intervention and evaluation - what works?

Implementation - how do you do it?

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52
Q

What is medicine optimisation

A

Looks at the value which medicines deliver, make sure they are clinically-effective and cost-effective.

Ensure people get the right choice of medicines, at the right time and are engaged in the process by their clinical team.

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53
Q

Name the 5 goals of medicine optimisation

A

Improve their outcomes

Take medicines correctly

Avoid taking unnecessary medicines

Improve medicines safety

Reduce wastage of medicines

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54
Q

What is adherence

A

older term = compliance (assumes doctor knows best)

Acknowledges importance of the patients beliefs

= The extent to which a person’s behaviour - taking medication, following a diet/or executing lifestyle changes - corresponds with agreed recommendations from a health care provider

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55
Q

Name 4 unintentional reasons for non adherence

A

Practical barriers - capacity and resource

Difficulty understanding instructions

Poor dexterity

Inability to pay

Forgetting

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56
Q

Name 3 intentional reasons for non adherence

A

Motivational barriers - perceptual barriers

Patients beliefs about their health/condition

Beliefs about treatments

Personal preferences

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57
Q

Describe the necessity-concerns framework

A

Key beliefs = influencing patients evaluations of prescribed medicines can be grouped into two categories

Necessity beliefs - perceptions of personal need for treatment

Concerns - about a range of potential adverse consequences

Validated questionnaire - beliefs about medicine

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58
Q

Describe the necessity-concerns framework impact on adherence

A

Increase necessity beliefs

Decrease concerns

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59
Q

What are the ethical considerations of adherence

A

Mental capacity

Decision that may be detrimental to a patient’s wellbeing

Potential threat to health of others

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60
Q

Describe the public health act (2010) on ethical considerations of adherence

A

Provides legal basis to detain and isolate infectious individuals

No power to compel treatment.

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61
Q

Describe Gillick competent

A

Child under 16 can give consent to their own treatment if they are believed to have enough intelligence and understanding to fully appreciate what is involved in their treatment

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62
Q

A 50 year old patient found to be at increased risk of cardiovascular disease mentions at a routine GP check-up that they have not been taking the statin prescribed at their last visit. The patient comments that they are “not anti-medication” but “feel fine without it”.

Which of the following seems to be the most pertinent reason for this non adherence?

A

Necessity beliefs about medication

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63
Q

What type of term is sex

A

Biological

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64
Q

What type of term is gender

A

Cultural

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65
Q

What are the 3 different explanations for gender differences in health

A

Biological
Social factors
Structural factors

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66
Q

Describe the structural impact on gender differences in health

A

Power and resources in the home can leave women disadvantaged

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67
Q

Describe meningitis (any cause) and meningococcal septicaemia as a notifiable disease

A

Notify on suspicion

Contact tracing
Chemoprophylaxis
Vaccination
Alerting and informing close contacts and the public

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68
Q

Describe what happens in public health in meningitis

A

Confirmed case - immediate PH action

Probable case - not confirmed by lab, but meningococcal disease is most likely - immediate PH action

Possible cause - no lab and other diagnosis equally likely - no immediate PH action

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69
Q

Who are close contacts of meningitis

A

People living in same household

Anyone who slept overnight in the same household in the previous 7 days

Other household members if case stayed overnight elsewhere in previous 7 days

Intimate kissing contacts in last 7 days

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70
Q

Describe antibiotics given to close contacts of meningitis

A

Antibiotics given to eradicate throat carriage

Single dose ciprofloxacin (recommended everyone)

Alternative - rifampicin

Offered up to 4 weeks after case became ill

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71
Q

What is a meningitis cluster in a school

A

Two probable or confirmed cases of the same type in 4 weeks

Need to define risk group

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72
Q

Where is group B and C meningitis more common

A

Europe and Americas

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73
Q

Where is group A meningitis most common

A

Africa and Asia

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74
Q

Does meningitis have a vaccine

A

Yes

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75
Q

What are the 3 goals of defeating meningitis by 2030

A

Elimination of bacterial meningitis epidemics

Reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%

Reduction of disability and improvement of quality of life after meningitis due to any cause

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76
Q

Describe the immunisation schedule of meningococcal

A

8 weeks - primary (B vaccine)

16 weeks - primary (B vaccine)

One year - Primary (MenC), booster (Hib), booster (MenB)

Around 14 years - primary (menAWY), booster (MenC)

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77
Q

Describe polysaccharide vaccines in meningitis

A

Short term 3-5 years

No immune response in children under 2 years

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78
Q

Describe conjugate vaccines in meningitis

A

Polysaccharide-conjugate vaccines - immunogenic across all ages

Prevents acquisition of carriage

Serogroup specific

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79
Q

Describe the meningitis B vaccine

A

Difficult to produce

Not one size fits all

Given routinely to infants - uncertain effectiveness and high costs

Not used in outbreaks

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80
Q

Name the 5 immunoglobulins

A

G
M
A
D
E

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81
Q

Name the two forms of active immunity

A

Cell-mediated
Antibody mediated

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82
Q

Name the ways in which someone can gain passive immunity

A

Cross-placental transfer of autoantibodies from mother to child (measles, pertussis)

Transfusion of blood or blood products (Hep B)

Temporary

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83
Q

What are the 5 things vaccines are made from

A

Inactivated (killed) - pertussis, inactivated polio

Attenuated live organisms - yellow fever, MMR, polio, BCG

Secreted products - tetanus, diphtheria toxoids

Constituents of cell walls/subunits - Hep B

Recombinant components - experimental

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84
Q

Define primary vaccine failure

A

Person does not develop immunity from vaccine

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85
Q

Define secondary vaccine failure

A

Initially responds but protection wanes over time

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86
Q

Give examples of vaccine preventable diseases

A

Diphtheria
Tetanus
Pertussis - whooping cough
Polio
Haemophilus influenza type B
Meningococcal disease

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87
Q

Describe the role of surveillance

A

Detection of any changes in disease
- outbreak detection
- early warning
- forecasting

Track changes in disease
- extent and severity of disease
- risk factors

88
Q

Name the route of disease transmission

A

Source

Pathway

Receptor

89
Q

What is the obescogenic environement

A

Physical environment - e.g. tv remove, lifts, car culture

Economic environment - e.g. cheap Tv watching. expensive fruit and veg

Sociocultural environment - e.g. safety fears, family eating patterns

90
Q

Describe primary prevention of obesity

A

Before overweight/obesity occurs

Wider determinants breastfeeding and early years, food environment, physical activity advertising, marketing

91
Q

What are the alcohol guidance

A

No more than 14 units per week

Spread over 3 or more days

92
Q

How do you calculate the units of a drink

A

Strength of a drink (%ABV) x amount of liquid (Litres)

93
Q

How many grams is in a UK unit of alcohol

A

8g

94
Q

What is a UK unit of alcohol

A

8 grams or 10ml of pure alcohol

95
Q

Describe the treatment of semaglutide in obesity

A

Prescribed alongside diet, physical activity and behavioural support

BMI of at east 35 and a weight related condition (hypertension, DM)

Only via specialist services

96
Q

Describe the link between trauma and obesity

A

Significant link

Adverse childhood experiences
Socioeconomic factors - disadvantaged areas
Intergenerational impact - trauma in parents
Health inequalities

97
Q

What is the relationship between adverse childhood experiences and obesity

A

Individuals who have experienced trauma, especially during childhood (abuse, neglect or household dysfunction) are more likely to develop obesity later in life.

98
Q

Describe tertiary prevention of obesity

A

After overweight/obesity has occurred

Physical activity, healthy diet, compassionate approach, stigma reduction, mental health support, pharmaceuticals, surgery

99
Q

Describe secondary prevention of obesity

A

During development of overweight/obesity

Healthy diet intervention, physical activity, weight loss support programmes, education, labels

100
Q

Describe primary prevention of obesity

A

Before overweight/obesity occurs

Wider determinants breastfeeding and early years, food environment, physical activity advertising, marketing

101
Q

Describe the sugar drinks industry levy

A

Introduced as an anti-obesity policy 2016 Childhood obesity strategy

Implemented 2018

Tax on sugary drinks

102
Q

What are examples of government policies aimed to reduce obesity

A

Sugar Drinks industry levy (2016)

Restrict volume promotions such as buy one get one free (2025)

Restrict HSFF food locations both online and in stores (2022)

Calorie labelling in large out of home food businesses (2022)

Advertising restrictions on HFSS foods (2025)

103
Q

What is the calculation of BMI

A

Weight (kg) divided by square of height (in metres)

104
Q

Name the 4 research topics for risk factors of CHD

A

Coronary prone behaviour pattern

Depression/anxiety

Psychosocial work characteristics

Social support

105
Q

What did the Whitehall study conclude

A

1 (only men) - men in the lowest grade had a higher CHD mortality rate than men in highest grade

2 - working 11-hours or more a day were 67% more likely to have a heart attack

106
Q

Do anxiety and depression increase the risk of development of CHD

A

Depression is a higher risk factor than anxiety but both are risk factors

Can share similar antecedents with CHD e.g. deprivation

More research is needed

107
Q

Describe ‘hostility’ as a risk factor of CHD

A

Feelings of anger
Annoyance and resentment
Verbal or physical aggression

108
Q

What were the findings from the recurrent coronary prevention project

A

Reduction in type A behaviours reduces morbidity and mortality in post infarction patients

109
Q

Describe the coronary prone behaviour pattern

A

Friedman and Rosenman (1959)

Competitive Hostile Impatient

Type A behaviour

110
Q

What are the psychosocial risk factors for CHD

A

Behaviour pattern
Depression/anxiety
Work
Social support

111
Q

What are the demographic risk factors for CHD

A

Age
Sex
Ethnicity
Gender

112
Q

What are the environmental risk factors for CHD

A

Air pollution
Chemicals

113
Q

What are lifestyle risk factors for CHD

A

Smoking
Diet
Physical inactivity

114
Q

Which of the following is the most appropriate term to describe physical activity as a risk factor for Coronary Heart Disease?

  1. Lifestyle risk factor
  2. Environmental risk factor
  3. Demographic risk factor
  4. Clinical risk factor
  5. Psychosocial risk factor
A

Lifestyle risk factor

115
Q

Which of the following is the most appropriate term to describe diabetes as a risk factor for Coronary Heart Disease?

  1. Lifestyle risk factor
  2. Environmental risk factor
  3. Demographic risk factor
  4. Clinical risk factor
  5. Psychosocial risk factor
A

Clinical risk factor

116
Q

Define psychosocial factors

A

Factor influencing psychological responses to the social environment and pathophysiological changes

117
Q

What are the current screening tests for pre-diabetes/diabetes

A

HbA1c

Random capillary blood glucose

Random venous blood glucose

Fasting venous blood glucose

Oral glucose tolerance test (venous blood glucose 2 hours after oral glucose load)

118
Q

Name the 3 mechanisms that maintain overweight

A

Physical/physiological - more weight = more difficult to exercise (arthritis, stress incontinence) and dieting = metabolic response

Physiological - low self esteem and guilt. comfort eating

Socioeconomic - reduced opportunities employment, relationships, social mobility

119
Q

Describe the runaway weight train in obesity

A

Steep slope = obesogenic environment

Ineffective breaks = knowledge, prejudice, physiology

Accelerators = vicious cycles of mechanical dysfunction, psychological impact, ineffective dieting, low socioeconomic background

120
Q

What is the obesogenic environment

A

Physical environment - e.g. tv remove, lifts, car culture

Economic environment - e.g. cheap Tv watching. expensive fruit and veg

Sociocultural environment - e.g. safety fears, family eating patterns

121
Q

What does prevalence depend on

A

Primary prevention - incidence of the condition

Secondary prevention - % of incident cases diagnosed

Tertiary prevention - survival from diagnosis

122
Q

Name 4 reasons why diabetes is a key health issue

A

Mortality

Disability

Co-morbidity

Reduced quality of life

123
Q

Name the clinical alcohol withdrawal syndromes

A

Tremulousness
Activation syndrome
Seizures
Hallucination
Delirium tremens - can be severe/fatal

124
Q

Describe the activation syndrome in alcohol withdrawal

A

Characterised by tremulousness, agitation, rapid heart beat and hight blood pressure

125
Q

Describe foetal alcohol spectrum disorder

A

Caused by pre-natal exposure to alcohol

Pre/post-nasal growth retardation
CNS abnormalities
Craniofacial abnormalities
Associated abnormalities

126
Q

What age group in men and women have the highest proportion of drinking

A

55-64

127
Q

What are the NICE recommendations of alcohol policy

A

Price - make alcohol less affordable

Availability - licensing and import allowances

Marketing - limit exposure, especially to children and young people

128
Q

What are the NICE recommendations for alcohol practice

A

Licensing

Screening and brief interventions

Supporting children and young people ages 10-15 years

Referral - consider referral for specialist treatment

129
Q

Name 3 ways of alcohol harm prevention

A

Restrict choice - restriction on alcohol advertising, minimum unit pricing

Enable choice - dry January, alcohol-free/low alternatives

Provide information - labelling, drinking guidelines media campaigns

130
Q

What are the benefits of dry January

A

Amongst weekly drinkers
- insulin resistance
- blood pressure
- cancer related growth factors

Reduces drinking at 6 moths follow up
Increased ability to refuse drinks
Improved self rated heath and wellbeing

131
Q

What is alcohol use disorder or alcohol dependence diagnosed on

A

DSM-V criteria

132
Q

What are the screening tools for alcohol

A

FAST - fast alcohol screening test

AUDIT - alcohol use disorders identification test

CAGE questions

133
Q

Name the medical/pharmacological treatment of alcohol dependence

A

Acamprosate (campral)

Disulfiram (antabuse)

Nalmefene (selincro)

Naltrexone

134
Q

Define primary prevention

A

Reduce prevalence of risk factors

135
Q

What form of prevention is screening

A

Secondary

136
Q

Define tertiary prevention

A

Management of conditions to reduce impact

137
Q

What is an online page about MSK health

A

MovingMedicine

1 minute, 5 minute and more minutes conversation

138
Q

What are the main theoretical models that explain substance misuse

A

Disease model - used substitution medicines

Moral model - parenting classes, religious education

Socio-cultural model - target health inequality

Behavioural model - law/criminal justice to deter through fines and prison

Volitional model - raise self-efficacy

Disease model - explore gene therapies

139
Q

What are the 3 diagnostic codes for substance misuse

A

Acute intoxication

Harmful use

Dependence

140
Q

What is used to measure substance misuse

A

ICD-10

Diagnostic and statistical manual of mental disorders (DSM-V)

141
Q

Describe ICD-10: F10-19.2 substance misuse

A

Experienced 3/6 or more in the past 12 months

  1. strong desire or compulsion to use
  2. difficulties controlling substance-taking behaviour
  3. physiological withdrawal state when reduce use
  4. tolerance
  5. progressive neglect of pleasures/interests, increased time spent using
  6. persistent use despite evidence of harmful consequences
142
Q

Describe the diagnostic and statistical manual of mental disorders (DSM-V) - substance use disorder

A

Experienced out of 11 in the past 12 months

2-3 mild

4-5 moderate

6+ severe

143
Q

Describe community prescribing in substance misuse

A

Delivered by GP/specialist services

Goal - stop patient using illicit drugs, enable a more stable life

144
Q

What is tertiary prevention of strokes

A

Stroke units - rehabilitation

84% patients return home following a stroke but few return to work

145
Q

Describe secondary prevention of strokes

A

Screening for risk factors

Attributable risk of hypertension is 75%

146
Q

Describe primary prevention of strokes

A

Smoking, alcohol, diet and physical activity

147
Q

What is current policy of dementia

A

Awareness raising and opportunistic screening for memory loss (part of NHS health checks)

Screening = controversial - due to lack of evidence that benefits outweigh the harms

148
Q

Describe the epidemiology of epilepsy

A

Incidence highest in elderly in children

Prevalence difficult to ascertain if no seizures to to effective treatment

149
Q

Describe the epidemiology of Parkinson’s disease

A

Incidence - increases with age

Prevalence - 1 in 200 over 70 years

Variable progression - mean survival 10-15 years

Risk factors - less common in smokers

150
Q

Describe the epidemiology of multiple sclerosis

A

Onset commonest 20-35 years

Reduced risk associated with fish consumption and living closer to the equator

Increased risk with specific HLA antigens, nutritional deficiencies and exposure to infections (EBV)

151
Q

Describe Creutzfeldt-Jakob Disease

A

Neurogenerative disease (dementia)

Average onset 55-75 years

Rapidly progressive dementia, abnormal ECG, cerebellar signs, myoclonus

Rare

152
Q

Describe Variant Creutzfeldt-Jakob Disease

A

Neurogenerative disease similar to CJD

Peak incidence 27 years - genetic susceptibility (methionine homozygosity at codon 129 of prion protein gene)

Different brain appearance on post-mortem

Linked to beef scandal? Iatrogenic exposure via blood products and surgical instruments. 4 cases related to transfusion

153
Q

What level of prevention are vaccinations

A

Primary prevention

154
Q

What are the symptoms of gonococcal arthiritis

A

Fever, arthiritis, tenosynovitis

Maculopapular - pustular rash

155
Q

Name 5 ethical theories

A

4 principles
Imperative
Virtue
Categorical
Utilitarianism

156
Q

Describe the transtheoretical model of behavioural changes

A

Pre-contemplation - no intension of giving up smoking

Contemplation - consider quitting

Preparation - get ready to quit in the near future

Action - engaged in giving up

Maintenance - steady non-smoker

Relapse?

157
Q

What is the Gini coefficient

A

A statistical representation of nation’s income distributed among it’s residents.

It is most commonly used to measure equity.

158
Q

What is utilitarianism ethics

A

An act is evaluated solely in terms of its consequences

Maximise good and minimise harm

159
Q

What are the main principles of virtue ethics

A

Focuses on the person who is acting - are they expressing good character

Integrates reason and emotion

Virtues are acquired.

An action is virtuous only if the person is acting with genuine intention of doing the right thing

160
Q

What are the principles of ethics?

A

Autonomy - respect the patients decision

Benevolence - provide benefits to the patient

Non-maleficence - do no harm

Justice - ensure fairness in the distribution of treatment

161
Q

What does the GMC stay are the 5 main ‘duties of a doctor’

A

Protect and promote health

Provide a good standard of care

Recognise and work within the limits of your competence

Work with colleagues in a way to best serve your patients

Treat patients as individuals and respect their dignity

162
Q

Name 4 ways to assess the function limitations among older people

A

The Katz ADL scale
IADL
The Barthel ADL Index
MMSE

163
Q

What does the MMSE test for?

A

Orientation, immediate memory.

Short-term memory

Language functioning

164
Q

Glaser and Strauss - what 4 awareness contexts did they identify

A

Closed awareness
Suspicion awareness
Mutual pretence
Open awarness

165
Q

Describe the chain of infection

A

Susceptible host
Causative micro-organism
Reservoir (patients, visitors etc.)
Portal of entry/exit
Transmission

166
Q

How can infection be transmitted

A

Exogenous spread - direct contact (STIs), airborne (TB), vector spread (malaria)

Endogenous spread - self-spread

167
Q

Give 3 types of handwashing

A

Routine handwash
Hygienic hand antisepsis
Surgical hand scrub

168
Q

Describe the physiological effects of nicotine

A

Activation of nicotinic Ach receptors in the brain - causes dopamine release

Dopamine = stimulant

Tolerance increases and cessation will result in withdrawals

169
Q

Which methods can be used in smoking cessation

A

Nicotine replacement therapy - patches, gums, nasal spray

Non-nicotine pharmacotherapy - varenicline, bupropion

Transtheoretical model

170
Q

What are the 3 A’s?

A

Ask - ask the patient about smoking

Advice - advice on smoking cessation methods

Assist - refer to local NHS stop smoking services

171
Q

What is the Bradford Hill Criteria

A

A group of minimal conditions necessary to provide adequate evidence of a causal relationship

172
Q

Define sensitivity

A

The proportion of people with the disease who are connectively identified

True positive / (true positive + false negative)

173
Q

Define specificity

A

The proportion of people without the disease who are correctly excluded by the screening test

How well a test detects those without a disease

True negative / (true negative + false positive)

174
Q

Define positive predictive value (PPV)

A

The proportion of people with a positive test result who actually have the disease

True positive / (true positive + false positive)

175
Q

Define negative predictive value (NPV)

A

The proportion of people who test negative who do not have the disease

True negative / (true negative + false negative)

176
Q

Define prevalence

A

The proportion of people found to have the disease at a point in time

177
Q

Define incidence

A

The rate at which new cases occur in a population in at a point in time

178
Q

What is the calculation for specificity

A

True negative / (true negative + false positive)

179
Q

What is the calculation for sensitivity

A

True positive / (true positive + false negative)

180
Q

What is the calculation for positive predicted value

A

True positive / (true positive + false positive)

181
Q

What is the calculation for negative predicted value

A

True negative / (true negative + false negative)

182
Q

What is the Wilson and Jungner criteria used for

A

To determine whether a condition should be screened for

183
Q

What are the 10 Wilson and Jungner criteria for screening

A

The condition should be serious health problem

The natural history of the condition should be understood

Early detectable stage

Treatment available

Facilities for detection and treatment

Suitable test

Test acceptable to the population

Should be agreed policy of whom to treat

Cost should be balanced against the benefits

Should be a continous process, not just a one off

184
Q

Describe selection bias in regards to screening

A

Diseases with longer period of presentation are more likely to be detected by screening than ones with shorter time presentations

185
Q

Define lead-time bias

A

Screening identifies a disease earlier and therefore gives the impression that survival is prolonged but survival remains unchanged

186
Q

Give 2 examples of check lists used in the NHS

A

SABR check list - reporting a case

Surgical safety checklist

187
Q

What is SBAR checklist

A

It is used for reporting a case

S - situation
B - background
A - assessment
R - recommendation

188
Q

What is the WHO definition of health

A

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmly

189
Q

What is the WHO definition of mental health

A

Mental health is a state of well-being in which individuals realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.

190
Q

What are the two types of stress

A

Eustress

Distress

191
Q

What is eustress

A

Positive stress

Often beneficial and motivating

192
Q

What is distress

A

Negative stress

Often damaging and harmful

193
Q

What are the 3 stages of general adaptation syndrome (GAS)

A

Alarm
Adaptation
Exhaustion

194
Q

What is the diagnostic criteria for PTSD

A

The person experienced an event or events that involved actual or threatened death or serious injury, or a threat to physical integrity of self or others

The person’s response involved intense fear, helplessness or horror

195
Q

How is BMI calculated

A

Weight (kg) / height m^2 (m)

196
Q

What is the range of normal BMI

A

18.5 - 24.9

197
Q

Describe Prader Willi syndrome

A

Paternal chromosome 15 deletion

The individual will have learning difficulties, growth abnormalities and obsessive eating

198
Q

What genetic conditions are linked to obesity

A

Prader Willi syndrome

Mutations of leptin and melanocortin receptors

Congenital leptin deficiency

199
Q

What is leptin

A

Appetite inhibitor

200
Q

What is meant by indirect controls of meal sizes

A

Metabolic, endocrine, cognitive, social and environmental factors

Can override direct controls

201
Q

What is meant by direct control of meal size

A

All the factors relating to direct contact of food with the GI mucosa receptors

202
Q

Define satiation

A

What brings an eating episode to end

203
Q

Define satiety

A

The inter-meal period

204
Q

What is the satiety cascade

A

Sensory - cognitive - post-ingestive - post absorptive

205
Q

What is the ABC of HIV safety

A

Abstain

Be faithful

Condom use

206
Q

What has the most significant effect on the reduction of TB

A

Improvements of social conditions

207
Q

How can you reduce the incidence rates of a disease

A

Decrease risk factors e.g. primary preventions

208
Q

What can decrease the prevalence

A

Cures and decreasing risk factors

209
Q

What can increase prevalence

A

Screening and identifying new cases

Increased life expectancy

210
Q

What is the equation used to work out how many units of alcohol there are in a drink

A

% ABV x volume of drink (ml) / 1000

211
Q

What is the doctrine of double effect

A

If you administer a drug to relieve pain in doses you know may be fatal, provided your intention is to relieve pain and not to shorten life the administration is ethically okay

212
Q

What are the 5 focal virtues

A

Compassion
Trustworthiness
Discernment
Integrity
Conscientiousness

213
Q

What is the gold standard of evidence based medicine

A

Systematic reviews of RCT

214
Q

What are confounding factors

A

Factors that can effect the validity of a study

They may be responsible for a result seen

215
Q

What is the critical appraisal and why is it important

A

Critical appraisal is about assessing validity, reliability and applicability

Important - means you can provide your patients with the best possible evidence and information

Phase 2a (15 decks)

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