Public Health Flashcards

1
Q

Hospital autopsy

A
  • Less than 10% in the UK - Requires medical certificate of cause of death (MCCD) - Used for audit, teaching, research and governance
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2
Q

Medico-legal autopsy

A
  • > 90% in the UK - Coronial autopsy - death is not due to unlawful action - Forensic autopsy - unlawful (eg: murder)
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3
Q

What percentage of deaths are referred to the coroner?

A
  • About 40% - But they only choose to investigate about 10%
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4
Q

Deaths referred to coroner

A

Presumed natural - Presumed iatrogenic - Presumed unnatural

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5
Q

Presumed natural death

A
  • Not seen by a doctor in the last 14 days - Unknown cause
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6
Q

Presumed iatrogenic death

A

Peri/postoperative deaths - Anaesthetic deaths - Abortions - Complications of therapy

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7
Q

Presumed unnatural death

A

Accidents - Industrial death - Suicide - Unlawful killing - Neglect - Custody deaths

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8
Q

Who carries out an autopsy?

A

A doctor (pathologist)

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9
Q

Who can refer to autopsy

A

Doctors - Registrar of BDM (statuatory duty to refer) - Relatives - Police - Anatomical pathology technicians

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10
Q

What 4 questions do coronial autopsies aim to answer?

A

Who was the deceased? - When did they die? - Where did they die? - How did they come About their death?

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11
Q

Steps of autopsy

A

External examination - Evisceration - Internal examination

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12
Q

Autopsy external examination

A

Identification: formal identifiers, gender, age, body habitus, jewellery, body modifications, clothing - Disease and treatment - Injuries

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13
Q

Autopsy evisceration

A

Y-shaped incision - Open all body cavities - Examine all organs in situ - Remove thoracic and abdominal organs - Remove brain

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14
Q

Autopsy internal examination

A

Heart and great vessels - Lungs trachea, bronchi - Liver, gallbladder, pancreas - Spleen, thymus and lymph nodes - Genitourinaty tract - Endocrine organs - CNS

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15
Q

How many healthcare associated infections are in England every year? And how many deaths are due to healthcare associated infections

A
  • About 300,000 (9% of patients) - 20,000 deaths
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16
Q

The Health Act 2006 on infection control

A

Infection control is every health care workers responsibility - the possibility of health care related infections should be considered in all aspects of patient management

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17
Q

What percentage of healthcare workers are estimated to get infected at work?

A

75%

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18
Q

Bacteria to consider in infection control

A

MRSA - C.difficile - Multi-drug resistant gram negatives - Glycopeptide resistant enterococci - Group a strep - Mycobacterium tuberculosis

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19
Q

Viruses to consider in infection control

A
  • Influenza - Norovirus - SARS-CoV-2 - HIV - Hep B + C - Varicella Zoster Virus - Viral haemorrhagic fevers
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20
Q

Other things to consider in infection control

A

Candida auris (a fungus) - Creutzfeldt-Jakob Disease

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21
Q

How do we prevent and control infections?

A
  • Identify risks (both patients/staff and the environment) - Ensure staff are aware of the risks and what to do - Develop strategies to reduce risks - Policy development - Audit
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22
Q

Ways to identify risk of infectous disease

A

Look at risk factors (eg: going abroad to a particular country) - Screening - Clinical diagnosis - Lab diagnosis

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23
Q

Why is diabetes a public health issue?

A

Mortality - Disability - Co-morbidity - Reduced quality of life - Preventable but increasing in prevelance

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24
Q

How can we reduce the impact of T2DM?

A

Identify those at risk - Prevention - Diagnose earlier - Effective management and supporting self-management

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25
Q

Lifestyle and environmental factors that increase risk of diabetes?

A

Sedentary job and leisure activities - Diet high in calories, low in fruits, vegetables, pulses and wholegrains - Obesogenic environment

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26
Q

Obesogenic environment

A

Physical: TV remotes, lifts, car culture - Economic: Cheap TV, expensive fruit and veg - Sociocultural environment: Safety fears, family eating patterns

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27
Q

Mechanisms that maintain being overweight

A
  • Physical/physiological - more weight = more difficult to exercise (arthritis, stress incontinence) and dieting -> metabolic response - Psychological - low self-esteem and guilt, comfort eating - Socioeconomic - reduced opportunities employment, relationships, social mobility
28
Q

What do effective interventions for prevention of diabetes require?

A

Sustained increase in Physical activity - Sustained change in Diet - Sustained weight loss

29
Q

NICE guidance for prevention of T2DM

A

Prioritise interventions for pre-diabetics - Use metformin if BMI>35 + HbA1c increasing - Focus on ethnic minorities and socioeconomically deprived communities at increased risk

30
Q

How to diagnose diabetes earlier

A

Raise awareness of the Disease and possible symptoms in the community and amongst healthcare professionals - Use Clinical records to Identify those at risk and/or Use blood tests to screen before symptoms develop

31
Q

Aspects to consider when supporting self-care for diabetes

A

self-monitoring - Diet - exercise - Drugs - Education - Peer support

32
Q

BMI thresholds

A

<18.5 underweight 18.5 - 24.9 normal 25.0 - 29.9 overweight 30.0 - 39.9 obese >40 morbidly obese

33
Q

What can obesity lead to?

A

T2DM - Hypertension - Coronary artery Disease - Stroke - Osteoarthritis - Obstructive sleep apnoea - Carcinoma: breast, endometrium, prostate, colon Especially abdominal (visceral) rather than subcutaneous fat

34
Q

Hypothalamus role in appetite regulation

A

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35
Q

Top 5 obesity interventions in terms of cost effectiveness for years of life saved

A

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36
Q

What is medicines optimisation?

A

Looks at the value which medicines deliver to make sure they are clinically-Effective and cost-Effective - Ensures people get the right choice of medicines at the right time and are engaged in the process by their Clinical team

37
Q

Goal of medicines optimisation for patients

A

Improve outcomes - Take meds correctly - Avoid taking unnecessary medicines - Improve medicines Safety - Reduce wastage of medicines

38
Q

Examples of non-adherance

A

Not taking meds - taking bigger/smaller doses than prescribed - taking meds more/Less often than prescribed - Stopping meds without finishing the course - Modifying treatment to accommodate other activties (work, social) - Continuing with behaviours against medical advice

39
Q

Unintentional reasons for non-adherance

A

Practical barriers - Difficulty understanding instructions - Problem using treatment - Inability to pay - Forgetting

40
Q

Intentional reasons for non-adherance

A

Intentional barriers - Patients’ beliefs about their health/condition - Beliefs about treatment - Personal preferences

41
Q

Necessity-concerns framework

A

Necessity beliefs - Perceptions of personal need for treatment (increase for adherence) Concerns - about a range of potential adverse consequences (decrease for adherence)

42
Q

Impacts of good doctor patient communication

A

Better health outcomes - Higher adherance to therapeutic regimens - Higher patient and clinician satisfaction - Decrease in malpractice risk

43
Q

2 key things a doctor is required to do

A

Certification of death - Notification of infectuous diseases

44
Q

What is a reproduction number in the context of infections?

A

If one person is infected, how many people they will infect

45
Q

What is the only bacteria that alcohol handgel can’t kill?

A

C.difficile

46
Q

What is a UK unit of alcohol?

A

8g/10ml of pure alcohol To work out: Strength of drink (%ABV) x amount of liquid (L)

47
Q

UK drinking guidelines

A
  • No more than 14 units per week (men and women) - Spread drinking over 3+ days
48
Q

Low risk drinking to dependency

A

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49
Q

Alcohol specific deaths

A
  • mc: alcoholic liver disease (78%) - Mental and behavioural disorders due to alcohol use - External causes + other
50
Q

Fetal acohol spectrum disorder (FASD)

A

pre and post-natal growth retardation - CNS abnormalities including learning disabilities, irritability, incoordination, hyperactivity - Craniofacial abnormalities

51
Q

Psychosocial effects of excessive alcohol consumption

A

Interpersonal relationships - Problems at work - Criminality - social disintegration and poverty - Driving incidents/offences

52
Q

NICE recommendations for alcohol policy

A

Price - make alcohol Less affordable - Availability - licensing and import allowances - Marketing

53
Q

NICE recommendations for alcohol in medical practice

A

licensing - Screening and brief interventions - supporting children and young people - Referral

54
Q

Who to screen for alcohol

A

Routine examination - before prescribing meds - Emergency department - Pregnant or trying to conceive - Likely to drink heavily (smokers, middle aged adults) - Have health Problems that might be alcohol induced - Chronic illness Not responding to treatment

55
Q

Alcohol screening tools

A

Clinical interview - just ask - FAST - FAST alcohol Screening test - AUDIT - alcohol Use disorders Identification test - CAGE questions

56
Q

Psychosocial treatments for alcohol dependence

A

CBT - social support, one to one or Group, eg: alcoholics anonymous

57
Q

Opiates - examples, classes and effects

A

Examples - Heroin (A) - Codeine (B) - Tramadol (B) Effects - Euphoria - Analgesia

58
Q

Depressants - examples, classes and effects

A

Examples - Alcohol - Benzodiazepines (C) - Gabapentinoids? (C) Effects - Sedation - Anxiolytic

59
Q

Stimulants - examples, classes and effects

A

Examples - Amphetamines (B) - Khat (C) - Cocaine (A) - Crack (A) - Caffeine - Ecstasy/MDMA (A) Effects - Increase alertness - Alter mood

60
Q

Cannabinoids - examples, classes and effects

A

Cannabis - most commonly used worldwide Effects: Relaxation, mild euphoria

61
Q

Hallucinogens - examples, classes and effects

A

Examples - LSD (A) - Magic mushrooms (A) Effects - Altered sensory perceptions and thinking

62
Q

Anaesthetics - examples, classes and effects

A

Examples - Ketamine (B) - GHB (C) - Nitrous oxide Effects - Anaesthesia - Sedative

63
Q

Effects of drug misuse

A

Mortality - morbidity - social - Economic - Personal

64
Q

Preventative risk factors of drug misuse

A

self control - Parental monitoring and support - Positive relationships - Neighbourhood resources - Academic achievement - School anti-drug policies

65
Q

Risk factors for drug misuse

A

Aggressive childhood behaviour - Lack of Parental support - community deprivation/poverty - drug experimentation - Poor social skills - Availability of Drugs at School

66
Q

Definition of good musculoskeletal health

A

Healthy/Disease free muscles, joints and bones - Abilitiy to carry out Physical activities/functionsboth effectively and symptom free

67
Q

Physical activity advice in clinical consultations

A

Recognised as important but often Not prioritised over medical management elements - Multiple common barriers for implementation of behaviour change interventions - Evidence from randomised trials that brief interventions may be Effective and cost-Effective at least in short term