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Public Health > Public Health 2a > Flashcards

Public Health 2a Flashcards

1
Q

define compliance

A

the extent to which the patient’s behavious (taking meds, following diet/lifestyle changes) coincides with medical/health advice

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2
Q

what is a “paternalistic relationship” in health care?

A

idea that patient must follow doctors orders - doctor knows best. doesn’t look at patient’s issues with a treatment.

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3
Q

what is the adherence model of communication?

A

focus on adherence not compliance. acknowledge patient’s beliefs. health professional as expert conveying knowledge. AIM FOR PATIENT-CENTRED APPROACH.

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4
Q

give some examples of unintentional reasons for non-adherence (practical barriers)

A

misunderstood instructions. can’t pay. forgets. problems using treatment. (capacity/resource issues).

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5
Q

give some examples of intentional reasons for non adherence (motivational barriers)

A

patients’ beliefs about their health/treatments personal preferences (perceptual barriers)

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6
Q

what is the necessity concerns framework? how does it impact adherence?

A

key beliefs of patient divided into:
1. necessity beliefs - perceived personal need for treatment
2. concerns - about adverse effects.
adherence needs increased necessity beliefs, decreased concerns

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7
Q

what does the patient-centred care philosophy encourage?

A

focus on patient as a whole with preferences situated in a social context. share control of consultation and decisions about interventions/management

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8
Q

what are the impacts of good doctor-patient communication?

A
  1. better health outcomes
  2. higher compliance to therapeutic regimens in patients
  3. higher patient and clinician satisfaction
  4. decrease in malpractice risk
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9
Q

explain the principle of concordance in the context of patient-centred care

A

the idea that the consultation should be a negotiation between equals. respect for patient’s agenda. patient takes part in treatment decisions.

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10
Q

give some examples of barriers to concordance

A

Patients - may not want to engage in discussion, may worry patient more, may want doctors to make the choice.
health professionals - communication skills, time/resources, challenging to take patient choice against evidence.

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11
Q

what are the key steps to improving patient adherence?

A
  1. improved communication 2. increase patient involvement 3. understand patient perspective 4. provide info 5. assess adherence 6. review medicines
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12
Q

define substance use

A

ingestion of a substance affecting the CNS which leads to behavioural and psychological changes

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13
Q

name some types of substances and their effects

A

opiates - euphoria, pain killers
depressants - sedation, relaxation, slow down thinking/acting
stimulants - increase activity, elevate mood
hallucinogens - alter sensory perception and thinking patterns, loss of sense of reality

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14
Q

name some risk factors for substance abuse

A

family: family history, family conflict
community: availability of drugs, community norms favour drug use, community disorganization, transitions
school: academic failure, low school commitment
individual/peer: smoking/alcohol, sensation seeking and risk taking, rebelliousness, alienation, friends who use drugs, ?genetic vulnerability

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15
Q

what are some protective factors for substance abuse?

A

reverse of risk - e.g. family attachment, academic achievement. opportunities for positive involvement - recognition/reward for this

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16
Q

define addiction

A

physical and pyschological dependence

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17
Q

define physical dependence

A

body needs more and more of a drug for same effect - tolerance. withdrawal symptoms (depends on substance)

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18
Q

define psychological dependence

A

feeling life is impossible without drug. feelings of fear, pain, shame, guilt, loneliness without drug

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19
Q

what are the 4 tiers of UK drug addiction treatment?

A
  1. non-specialist services (primary care, ED) - info, advice, referral
  2. open-access services - outreach, harm reduction/needle exchange
  3. specialist community-based drug assessment/treatment - pyschosocial services, prescribing (e.g. methadone)
  4. specialist residential/inpatient services - detoxification and rehab
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20
Q

Name some risk factors for coronary heart disease

A

current smoking, diabetes, hypertension, central adiposity, lower socioeconomic status

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21
Q

name some proposed protective factors for CHD

A

fruit/veg intake, exercise, moderate alcohol consumption

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22
Q

explain the terms “population attributable fraction” (PAF) / “population attributable risk” (PAR)

A

proportion of the incidence of disease in the exposed and non-exposed population that is due to exposure.
i.e. calculating how much of the disease is due to exposure to each risk (e.g. how much CHD is due to smoking).
It is the disease incidence in the population that would be eliminated if the exposure were eliminated.

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23
Q

describe the absolutist explanations for socioeconomic health differences vs relativist explanations

A 
absolutist = it's about poverty, absolute measures of socioeconomic deprivation predict health status.
relativist = it's about the relative differences - larger the relative differences in society the poorer the outcomes for the poor (and for all of us!)
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24
Q

define psychosocial factors

A

factors influencing psychological responses to the social environment and pathophysiological changes

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25
Q

what is “coronary prone behaviour”?

A

competitive; hostile; impatient; type A behaviour

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26
Q

how are CHD and depression/anxiety linked?

A

each increase the other. possibly linked by precursors (e.g. social deprivation)

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27
Q

what is the impact of depression/anxiety on CHD prognosis?

A

3.4x more likely to die

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28
Q

how does a patient’s work impact their risk of MI/CHD?

A

high demand job / low levels of control in job (“job strain”) increases risk.
working hours - 11+ per day = 67% more likely to have an MI.
WHITEHALL STUDIES

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29
Q

How does social support influence CHD?

A

quantity and quality of social relationships - related to morbidity and mortality.
help patient to cope with life events, motivation to engage in healthy behaviours.

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30
Q

how can doctors help modify psychosocial influences on CHD?

A

observe behaviour patterns; identify signs of depression; use assessment tools (questionnaires); ask about occupation (incl. working hrs); ask about emotional support

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31
Q

What four possible mechanisms were set out by the Black Report to explain widening socio-economic health inequalities?

A
  1. artefact
  2. social selection
  3. behaviour
  4. material circumstances
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32
Q

Suggest some reasons women tend to suffer more illness during their lives

A

biological - women’s role in reproduction can cause ill health (e.g. post-partum depression - women are a lot more likely to get depressed throughout life time).
Ageing - live longer, more prone to ill health associated with old age.
Material - women seen as carer, implications on paid employment = poverty = ill health.

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33
Q

Suggest some social factors explaining higher mortality rates in men

A

employment - occupations involving direct risk to life (machinery, weather, environmental hazards) are male dominated.
risk taking behaviour - men are socialised towards more extreme sports (motor bikes, rock climbing) higher risk of road traffic injury.
smoking - more men smoke than women (this is narrowing).
alcohol - men drink significantly more than women in all age groups.

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34
Q

What 6 areas are included in the HSE management standards?

A

Demands - workload, work patterns, work environment.
Control - how much say the person has in the way they do their work.
Support - encouragement, sponsorship etc from organisation, colleagues etc.
Relationships - promoting positive working, avoiding conflict.
Role - do they understand their role within the organisation?
Change - how is organisational change managed and communicated.

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35
Q

define incidence

A

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

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36
Q

define prevalence

A

the proportion of a population that have the disease at a point in time

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37
Q

what is the main cause of COPD?

A

smoking

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38
Q

List some recognised causes/occupations of occupational COPD (15% of COPD burden)

A

coal dust, silica, cotton, grain, cadmium, isocyanates.

foundry work, joiners, construction workers, welders.

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39
Q

Give some reasons for the geographical variation seen in COPD (much more prevalent in the north)

A

Socioeconomic differences/deprivation - housing and nutrition.
Historic industry - ship building, steel work and coal mining.
Developing world - use of biomass fuel for indoor cooking, increasing smoking prevalence.

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40
Q

How many different genera of influenza virus are there? which are the main human pathogens?

A

3: influenza A, B and C.

A and B are the main human pathogens.

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41
Q

name the 2 key surface antigens described on influenza A viruses, and their actions

A

Haemagglutinin (15 subtypes) - virus binding and entry to cells.
Neuraminidase (9 subtypes) - cuts newly formed virus loose from infected cells.

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42
Q

describe the difference between antigenic drift and antigenic shift

A

antigenic DRIFT = minor antigenic variation, causes SEASONAL epidemics.
antigenic SHIFT = gene re-assortment and major antigenic variation, may be associated with PANDEMICS.

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43
Q

describe the types of disease shown by infection with each of influenza A, B and C.

A

A: infects many species. causes the severe and extensive outbreaks and pandemics.
B: prone to mutation (like A), but tends to cause sporadic outbreaks (e.g. schools, care homes, barracks) that are less severe. more often seen in children.
C: minor disease - mild symptoms/asymptomatic.

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44
Q

describe influenza transmission

A

mainly via aerosols generated by coughs and sneezes.

also possible via hand-to-hand contact, other personal contact or fomites.

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45
Q

list some factors that increase the mortality risk in a person infected with influenza

A

chronic cardiac/pulmonary diseases; old age; chronic metabolic diseases; chronic renal disease; immunosuppression.

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46
Q

define the difference between outbreaks, epidemics and pandemics.

A 
outbreaks = 2+ cases.
epidemics = more cases in a region/country.
pandemic = epidemics that span international boundaries.
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47
Q

what is palliative care?

A

an approach to care which focuses on comfort and quality of life - focused on living with meticulous symptom control.

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48
Q

what types of suffering does palliative care aim to alleviate?

A

physical suffering - pain/symptoms.
emotional suffering - depression/anxiety/loneliness.
social suffering - isolation, carer’s fatigue, financial worries.
spiritual suffering.

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49
Q

describe the care needs of older patients

A

multiple co-morbidites leading to greater impairment and need for care. poly pharmacy. increased psychological distress, increased social isolation and economic hardship.

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50
Q

what constitutes a “good death”

A

expected, time to say goodbye. control over circumstances. dignity and privacy. symptom control. opportunity to issue advanced directives.

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51
Q

what are the key issues in palliative care of COPD?

A

unpredictable illness trajectory/prognosis. poor patient understanding.

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52
Q

what are the recommended weekly alcohol allowances?

A

14 units a week for men and women, spread drinking over 3+ days.

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53
Q

what is a standard unit of alcohol?

A

10ml of pure alcohol

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54
Q

how do you calculate the number of units?

A

% ABV x vol. in ml

divided by 1000

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55
Q

when does drinking become too much?

A

when it causes or elevates the risk for alcohol-related problems, or complicates the management of other health problems.

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56
Q

list some acute effects of excessive alcohol/ethanol

A

coma and death from respiratory depression; aspiration pneumonia; oesopahgitis/gastritis; mallory-weiss syndrome; pancreatitis; cardiac arrhythmias; cerebrovascular accidents; neuropraxia due to compression; myopathy; hypoglycaemia

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57
Q

list some chronic effects of excess alcohol intake

A

pancreatitis; CNS toxicity (dementia, Wernicke-Korsakoff syndrome, cerebellar degeneration); liver damage (fatty change, hepatitis, cirrhosis, hepatic carcinoma); hypertension; peripheral neuropathy; gastritis; osteoporosis; malabsorption etc etc

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58
Q

describe foetal alcohol syndrome

A

pre and post-natal growth retardation. CNS abnormalities including mental retardation, irritability, incoordination, hyperactivity. Craniofacial abnormalities. Associated abnormalities.

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59
Q

describe the features of alcohol withdrawal

A

“the shakes” - tremors.
activation syndrome - characterized by tremors, agitation, rapid HR, high BP. Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure. Hallucinations.

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60
Q

list some psychosocial effects of excessive alcohol consumption

A

interpersonal relationships (violence, rape, depression or anxiety). problems at work. criminality. social disintegration (poverty). driving offences.

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61
Q

describe some primary prevention campaigns to prevent alcohol abuse

A

‘know your limits’ campaign. drinkaware - alcohol labelling. THINK! drink driving campaign. restricted advertising. minimum pricing.

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62
Q

what must you differentiate between when screening for problem drinking?

A 
At risk drinking (hazardous) - brings about the risk of physical or psychological harm.
Alcohol abuse (harmful drinking) - pattern of drinking which is likely to cause harm.
Alcohol dependence - a set of behavioural, cognitive and physiological responses develop after repeated substance use.
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63
Q

name some alcohol misuse screening tools

A

AUDIT
CAGE
FAST

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64
Q

list the components of the FRAMES summary of motivational interviewing

A

Feedback about the risk of personal harm or impairment.
Stress personal Responsibility for making change.
Advise to cut down or, stop drinking.
Provide a Menu of alternative strategies for changing drinking patterns.
Empathetic interviewing style.
Self efficacy - intuitive style which leaves patient enhanced in feeling able to cope with goals they have agreed.

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65
Q

describe some medical treatments for alcohol dependence

A

disulfiram - producing an acute sensitivity to alcohol.
naltrexone - competitive antagonist for opioid receptors - for rapid detoxification.
acamprosate - stabilize the chemical balance.

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66
Q

give an example of brief interventions to help a patient with alcohol misuse

A

positive reinforcement for lower risk.
motivational interviewing.
higher risk - assess for dependence, MMSE, assess mental health.

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67
Q

what tool would you use to assess someone’s alcohol dependency?

A

Severity of dependence questionnaire (SADQ).
assesses for physical/affective withdrawal symptoms; relief drinking; frequency of alcohol consumption; speed of onset of withdrawal symptoms

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68
Q

describe the process of assisted withdrawal

A

aka detoxification.
alcohol stimulates GABA (major depressive neurotransmitter) - chronic use means these receptors become tolerant of alcohol stimulation.
treatment with chlordiazepoxide (or other benzodiazpine e.g. lorazepam) allows patient to stop alcohol without withdrawal symptoms, and then dose of this medication can be reduced in a controlled, step wise manner.

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69
Q

what is Wernicke’s encephalopathy? how might you treat it?

A

caused by thiamine deficiency. common in severe alcohol dependency. poor diet, low vitamin intake, gastritis causing poor GI absorption.
high demand as alcohol metabolism depends on thiamine.
treat with Pabrinex and ongoing vitB/thiamine.

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70
Q

describe how disulfiram (antabuse) tablets help prevent alcohol relapse.

A

disrupts oxidative metabolism of alcohol, resulting in a build up of acetaldehyde.
this gives them a hangover that’s 10x worse, lasting 20hrs, for MUCH less alcohol.
flushing, tachycardia, SOB, nausea, vomiting.

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71
Q

describe how nalmefine helps prevent alcohol relapse

A

it’s an opioid receptor antagonist. it modifies activity at receptor sites linked to reward mechanisms. effects of alcohol still present, but reduced feeling of reward/pleasure.

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72
Q

give 3 examples of drugs used to prevent alcohol relapse

A

acamprosate
disulfiram
nalmefine

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73
Q

what is anorexia nervosa?

A

restriction of energy intake relative to requirements, leading to a significantly low body weight.
intense fear of gaining weight/becoming fat - even though underweight.
disturbance in how one’s body weight/shape is experienced etc.

74
Q

what are the subtypes of anorexia nervosa?

A

restricting

binge/purging subtype

75
Q

what is bulimia nervosa?

A

recurrent episodes of binge eating characterised by eating large amounts in a discrete time period (e.g. 2h), and sense of lack of control over eating during an episode.
inappropriate compensatory behaviour to prevent weight gain - purging.
undue influence of body shape/weight on self-evaluation.

76
Q

describe the features of a binge-eating episodes

A

eating a large amount of food in a 2h period.
lack of control over eating.
eating much more rapidly than normal. eating until uncomfortably full. eating alone because of feeling embarrassed by how much they’re eating. feeling disgusted/depressed/guilty afterwards - marked distress.

77
Q

what are some “maintaining factors” the causes initially disordered eating to continue?

A

initially - positive reinforcement for weight loss/control.
then, terror at losing control - body image disturbance, emotional instability, family and professionals trying to take control of your body to make you eat etc

78
Q

list some things you would look/test for in assessing a patient with a suspected eating disorder

A

severe food/fluid restriction.

electrolyte imbalance. bone deterioration. physical damage (oesophageal tears, blood in vomit). substance misuse.

79
Q

list some URGENT signs to look for when assessing an eating disorder patient

A

muscular weakness. breathing difficulty. deterioration of consciousness. cardiac signs (tachy/brady, low BP). rapid weight loss (not low weight necessarily!). risky behaviours (e.g. suicidal intent).

80
Q

what is the first choice treatment for eating disorders?

A

cognitive behaviour therapy.

alternatives - guided self-help, psychotherapy, family therapy

81
Q

list some non-infective causes of diarrhoea

A

neoplasm; hormonal; inflammatory; radiation; irritable bowel; chemical; anatomical

82
Q

list the points in the chain of infection

A 
AGENT.
mode of transmission.
portal of entry.
HOST.
person to person spread.
RESERVOIR.
portal of exit.
83
Q

list some types of transmission of infection

A

direct.
faecal-oral route.
vector-bourne.
airborne - respiratory route.

84
Q

list some causative organisms of diarrhoea

A

rotavirus; shigella; E Coli; salmonella typhi; salmonella paratyphi; hepatitis A; hepatits E; vibrio cholerae

85
Q

describe the features of norovirus, and where it typically occurs

A

“winter vomiting” - vomiting, diarrhoea, nausea, cramps, headache, fever, chills.

hospitals, care homes, schools, cruise ships etc.

86
Q

how is C diff spread?

A

faecal-oral route.

spores in environment (highly resistant to chemicals - alcohol hand wash won’t destroy!)

87
Q

what are the components of the WHO diarrhoea prevention package?

A
  1. rotavirus and measles vaccinations.
  2. promote early + exclusive breastfeeding, and vit A supplementation.
  3. promote hand washing with soap
  4. improve water supply quantity and quality.
  5. community-wide sanitation promotion
88
Q

what are the components of the WHO diarrhoea treatment package?

A
  1. fluid replacement to prevent dehydration

2. zinc treatment

89
Q

list some upper limb and neck conditions that may be work related

A 
shoulder/rotator cuff/bicipital tendinitis.
shoulder capsulitis (frozen shoulder).
cervical spondylosis.
tension neck
lateral/medial epicondylitis.
carpal tunnel
De Quervain's disease of the wrist.
Repetitive strain injury (RSI).
90
Q

what is thoracic outlet syndrome?

A

pinching of the nerves of the thoracic outlet, e.g. those under collar bone, those between scalene muscles, those under the pec minor (pinched when arms lifted above head).

91
Q

how does thoracic outlet syndrome manifest?

A

sensory - pain and tingling.
MSK - wasting of hands.
vascular - +ve Adson’s test.

92
Q

describe the features of frozen shoulder (adhesive capsulitis).

A

F:M = 2:1. unknown cause.
equal restriction of active and passive movements in capsular patterns (external rotation > abduction > internal rotation).

93
Q

what causes medial and lateral epicondylitis / olecranon bursitis?

A

repetitive bending and straightening of elbow.

olecranon bursitis - people that lean on their elbows (students, DSE, miners).

94
Q

describe the features of carpal tunnel syndrome

A

F>M.
pain/tingling/numbness in median occupations with repetitive/forceful wrist movements, adverse wrist postures (DSE - display screen equipment).

95
Q

describe the features of tensoynovitis.

A

local tenderness and swelling of tendon sheath.
pain on resisted movements.
F>M.
manual workers.
For De Quervain’s = wrist - common flexor tendon to thumb sheath. as above + seen in rowers.

96
Q

describe the features of hand-arm vibration syndrome

A

need to be exposed to sufficient vibration.
vascular HAVS - blanching.
sensorineuronal HAVS - pain, numbness, tingling.
MSK HAVS - wasting, dexterity.
usually asymmetrical.

97
Q

describe “simple” (mechanical) back pain

A 
present age 20-55.
lumbosacral region, buttocks and thighs.
mechanical pain.
varies with physical activity and time.
90% recover from acute attack within 6 weeks.
98
Q

describe neurological back pain

A

nerve root pain.
unilateral leg pain worse than low back pain. radiates to foot or toes.
numbness/paraesthesia in same distribution.
motor, sensory, or reflex change.
50% recover from acute attack within 6wks.

99
Q

what are the red flags for possible serious spinal pathology.

A 
onset 55yrs.
violent trauma.
constant, progressive, non-mechanical pain.
thoracic pain.
PMH carcinoma, systemic steroids, drug abuse, HIV.
systemically unwell, weight loss.
widespread neurology.
structural deformity.
100
Q

list some causes of meningitis

A

bacteria - meningococcus, pneumococcus.
viruses - coxsackie virus, echovirus, herpes virus, mumps virus
medications/cancers/SLE

101
Q

what are the symptoms and signs of meningitis?

A

photophobia, stiff neck, fever, altered consciousness, headache, painful joints and muscle aches.
Kernig’s sign - knee.
Brudzinski’s neck sign.

102
Q

what are the additional symptoms of septicaemia caused by meningitis?

A

rash, severe aches and pains, cold hands and feet, rigors, abdominal cramps.

103
Q

what are the symptoms of septicaemia in babies?

A

fever with cold hands and feet. petechial (non-blanching) rash. floppiness, severe sleepiness. rapid/unusual patterns of breathing. skin that is pale, blotchy, or turning blue. shivering. vomiting. refusing to feed. irritability from muscle aches or limb/joint pain.

104
Q

what are the symptoms of meningitis in babies?

A

fever. drowsy and less responsive. difficult to wake. floppy and listless, OR stiff with jerky movements. high-pitched, moaning cry. irritable when picked up. refusing feeds, vomiting. skin that is pale, blotchy or turning blue. bulging fontanelle.

105
Q

describe the spread of Neisseria meningitidis

A

found naturally in throat/nose - only occasionally pathogenic.
transmitted person-to-person by inhaling respiratory secretions from the mouth/throat, or by direct contact (kissing)

106
Q

list some sequelae of meningitis

A

brain abscess, brain damage, seizure disorders, hearing impairment, focal neurological disorders, organ failure, gangrene, auto-amputation, death.

107
Q

how is meningitis managed?

A

immediate benzylpenicillin/cefotaxime/ceftriazone. IV, IM or IO (intraosseous).
supportive care.

108
Q

what investigations would be done in a suspected case of meningitis?

A

bloods - FBC, blood glucose.
blood cultures.
lumbar puncture - CSF sent for MC&S, PCR and biochemistry tests (protein, blood and glucose).
throat/nasal swabs.

109
Q

who should be “notified” if a notifiable disease presents to you?

A

the “proper officer of the local authority”

or, public health england

110
Q

what 3 things must consent be?

A

voluntary. informed. made by someone with capacity.

111
Q

what information should be given to a patient about their treatment to meet the requirements of INFORMED consent?

A

what, how, risks, benefits, alternatives and their risks/benefits

112
Q

what does the Mental Capacity Act state?

A
  1. a person must be presumed to have capacity unless it is established that he doesn’t
  2. any act done or decision made on behalf of a person who lacks capacity must be in their best interests.
113
Q

what 4 things must a person be able to do to be deemed capable of making a decision?

A
  1. understand the relevant information (incl. consequences).
  2. retain this info for long enough to decide.
  3. use or weigh it to make a decision.
  4. communicate the decision.
114
Q

when acting on behalf of a patient without capacity, in their best interest, what must be considered?

A
  1. whether the patient could have capacity + 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 (e.g. carers, family, lasting power of attorney).
115
Q

give some examples of incidents a patient may experience in hospital that put their safety at risk

A

failure/delay to diagnose.
failure/delay in clinical monitoring and management.
looking at wrong patient!
failure to document.

116
Q

give 3 main contributory factors leading to patient safety incidents

A

communication, orientation/training, patient assessment, staffing levels, physical environment, compentency, alarm systems

117
Q

give the 5 elements of a positive safety culture and a brief definition

A

1) open culture - staff able to discuss incidents/issues
2) just culture - staff, patients and carers treated fairly and with empathy when involved with an incident
3) reporting culture - staff aren’t blamed/punished when reporting an incident, reporting process is easy and accessible
4) learning culture - organisation learns safety lessons, communicates them to colleagues and remembers them.
5) informed culture - organisations has learnt from past events and is able to prevent recurrence.

118
Q

define human error

A

failure of a planned action or a sequence of mental/physical actions to be completed as intended.
or, use of a wrong plan to achieve an outcome

119
Q

define “never events”

A

serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented - intolerable and inexcusable

120
Q

give 3 examples of “never events”

A

wrong site surgery, wrong implant, retained object, strong potassium, wrong route of drug administration, overdose of insulin/methotrexate/midazolam, misplaced NG/OG tubes, ABO incompatible blood/organ, non-collapsible shower rails (suicide risk), scalding, falls from windows, entrapment in bed rails

121
Q

define “latent errors”

A

removed from the practitioner, involves decisions affecting organisational policies, procedures, resource allocation etc
e.g. unclear policies, incomplete patient info such as missing allergy

122
Q

define “active errors”

A

due to direct contact with patient e.g. programming an IV pump incorrectly, nurse giving wrong dose of heparin to 6 babies

123
Q

define “organisational system errors”

A

indirect failures involving management, organisational culture, protocols/processes, transfer of knowledge, and external factors, lack of standardisation

124
Q

define “technical errors”

A

indirect failure of facilities or external resources

125
Q

what is SBAR?

A

structured method of communicating - Situation, Background, Assessment, Recommendation

126
Q

what are the 7 rights to ensure safe use of medications?

A

right:

drug, patient, dose, time, route, reason, documentation

127
Q

give some examples of human factors that could lead to error

A

load theory - how much info can a human brain process.
lack of situational awareness.
problems with team dynamics.
communication issues (use SBAR).
stress, fatigue, complacency, distraction, lack of knowledge.

128
Q

what is confirmation bias?

A

tendency to look for confirming evidence to support a diagnosis, rather than look for evidence to refute it

129
Q

what is “anchoring”?

A

tendency to focus on salient features in the patient’s initial presentation too early in the diagnostic process and failing to adjust this initial impression in light of later info

130
Q

list 3 vaccine preventable neurological infections

A

poliomyelitis, tetanus, measles, H influenzae, meningococcus, TB

131
Q

which group of people get the most migraines, in terms of age and gender?

A

females aged 25-50

132
Q

give 3 risk factors for migraines

A

age and sex, sex hormones (oral contraceptive), FHx, education, income and socio-economic status

133
Q

give 3 risk factors for stroke

A

age, male sex, hypertension, smoking, alcohol consumption, cardiac disease, diabetes mellitus and hyperlipidaemia

134
Q

give 3 possible aetiological factors in epilepsy

A

genetic factors, febrile seizures, head injuries, bacterial/parasitic infections, viral meningo-encephalitides, toxic agents

135
Q

which neurological disease is less common in smokers?

A

Parkinson’s

136
Q

at what ages is the onset of multiple sclerosis most common?

A

20-35yrs

137
Q

describe the geographical variation in multiple sclerosis prevalence?

A

prevalence is directly proportional to distance from the equator

138
Q

what is Creutzfeldt-Jakob disease? at what age does it usually begin?

A

rapidly progressive neuro-degenerative disease (dementia).

55-75yrs.

139
Q

what is variant Creutzfeldt-Jakob disease?

A

similar to CJD, first identified by unit set up to monitor CJD due to BSE epidemic.
peak incidence at 27yrs.
genetic susceptibility, age and BSE combine to cause it.

140
Q

list possible complications of chlamydia trachomatis and neisseria gonorrhoeae infection in females

A

PID - tubal factor infertility, ectopic pregnancy, chronic pelvic pain.
neonatal transmission - opthalmia neonatorum, atypical pneumonia

141
Q

list the possible sites of chlamydia/gonorrhoea infection in adults

A

urethra, endocervical canal, rectum, pharynx, conjunctiva

142
Q

how does chlamydia/gonorrhoea present in males?

A

dysuria and urethral discharge.

at least 50% of chlamydia is asymptomatic (10% of gonorrhoea).

143
Q

how does chlamydia/gonorrhoea present in females?

A

non-specific symptoms - discharge, menstrual irregularity, dysuria.
mostly asymptomatic!

144
Q

what test is used to diagnose chlamydia?

A

nucleic acid amplification tests (NAAT)

145
Q

what samples can be used to diagnose chlamydia?

A

male - first void urine

female - endocervical swab, self collected vaginal swab, first void urine.

146
Q

how is chlamydia treated?

A

partner management. full STI panel.

azithromycin/doxycycline.

147
Q

what test is used to diagnose gonorrhoea?

A

MC&S of male urethra/female endocervix smears.
look for gram-ve diploccoci.

NAAT also used.

148
Q

how is gonorrhoea treated?

A

partner notification.
test for other STIs.
RESISTANCE A BIG PROBLEM - continually check for sensitivity.

single dose treatment - ceftriaxone (IM) w/oral azithromycin.

149
Q

what is the key feature of syphilis?

A

genital ulcers!

150
Q

how is syphilis diagnosed?

A

serology

151
Q

how is syphilis treated?

A

injection of penicillin.

follow up and partner notification.

152
Q

why is type 2 diabetes a public health issue?

A

it’s PREVENTABLE and..
increasing in prevalence, affecting younger age groups.
major inequalities in prevalence and outcomes.
lack of effective global/national/local policy that has influenced trends in population, obesity and sedentary lifestyles.

153
Q

how can we reduce the impact of type 2 diabetes?

A

identifying people at risk of diabetes.
preventing diabetes (primary prevention).
diagnosing diabetes earlier (secondary prevention).
effective management and supporting self-management (tertiary prevention).

154
Q

list some lifestyle/environmental risk factors for diabetes

A

sedentary job, sedentary leisure activities.
diet high in calorie dense foods/low in fruit and veg, pulses and wholegrain.

“obesogenic” environment.

155
Q

what is the “obesogenic environment”?

A

physical environment e.g. TV remote controls, lifts, “car culture”.

economic environment e.g. cheap TV watching, expensive fruit and veg.

sociocultural environment e.g. safety fears, family eating patterns.

156
Q

list some mechanisms that maintain being overweight

A

physical/physiological - more weight makes it more difficult to exercise and diet.
psychological - low self-esteem and guilt, comfort eating.
socioeconomic - reduced opportunities, employment, relationships, social mobility.

157
Q

list some risk factors for diabetes that might be recorded in a clinical record

A

age, sex, ethnicity, family history, weight BMI, waist circumference, history of gestational diabetes, hypertension or vascular disease, impaired glucose tolerance/impaired fasting glucose.

158
Q

list the currently available screening tests for pre-diabetes/diabetes (impaired glucose tolerance and impaired fasting glucose)

A

random capillary blood glucose, random venous blood glucose, fasting venous blood glucose, HbA1c, oral glucose tolerance test.

159
Q

what 3 things do effective interventions for preventing diabetes require?

A

1 - sustained increase in physical activity.
2 - sustained change in diet.
3 - sustained weight loss.

160
Q

what are the 3 approaches to help diagnose diabetes earlier?

A

raising awareness of diabetes and possible symptoms in the community.
raising awareness of diabetes and possible symptoms in health professionals.
using clinical records to identify those at risk and using blood tests to screen before symptoms develop.

161
Q

what is the current practice for screening for type 2 diabetes?

A

screen as part of CHD primary and secondary prevention.
screen at hypertension management reviews.
may screen other risk groups.

162
Q

give examples of supporting self-care for diabetes

A

self-monitoring - useful for some if on insulin.
diet - support changes in eating patterns.
exercise - support for increasing physical activity.
drugs - support for taking medication.
education - professionals/expert patients.
peer support - health champions/health trainers.

163
Q

what is the formula from the STI/HIV transmission model?

A 
R = reproductive rate.
R = BCD
B = infectivity rate
C = partners over time
D = duration of infection
164
Q

give some examples of primary prevention strategies for STIs

A

STI awareness campaigns to reduce personal risk behaviour - Keys, Cash, Condom.
one to one risk reduction discussion.
vaccination (hep B, HPV).
pre and post exposure prophylaxis.

165
Q

give examples of secondary prevention strategies for STIs

A

easy access to STI/HIV tests/treatment.
partner notification (contact tracing).
targeted screening.

166
Q

what are the targeted screening programmes in place for STIs?

A

antenatal screening for HIV and syphilis.
national chlamydia screening programme.
HIV home-testing - ‘it starts with me’ Terrence Higgins Trust.

167
Q

give examples of tertiary prevention strategies for STIs

A

anti-retrovirals for HIV.
prophylactic antibiotics for PCP.
acyclovir for suppression of genital herpes.

168
Q

why do we do partner tracing?

A

break the chain of transmission.
prevent re-infection of the index patient.
prevent complications of untreated infection.

169
Q

how is partner tracing carried out?

A

patient referral.
provider referral - via phone, text, letter etc.
conditional or contract referral.

170
Q

what are the challenges of partner notification?

A

hard to reach client group - IVDUs, phoneless/homeless/floor sleepers, social exclusion/criminal activities, chaotic lifestyle/health care low priority.
how do you find their contact details?
how do you trace/notify contacts?
how do you make testing accessible?

171
Q

list 3 diseases obesity puts you at risk of

A 
type II diabetes
hypertension
coronary artery disease
stroke
osteoarthritis
obstructive sleep apnoea
carcinoma (breast, endometrium, prostate, colon).
172
Q

why do we eat?

A

internal physiological drive to eat.
feeling that prompts thought of food and motivates food consumption.
external psychological drive to eat.
sometimes even in the absence of hunger (e.g. buffet)

173
Q

what is the function of leptin?

A

expressed in white fat, binds to leptin receptors in hypothalamus.
“switches off” appetite.

174
Q

what is the function of peptide YY?

A

secreted by neuroendocrine cells in ileum, pancreas and colon in response to food.
inhibits gastric motility, reduces appetite

175
Q

what is the function of cholecystokinin?

A

receptors in pyloric sphincter - delays gastric emptying, gall bladder contraction, insulin release.
satiety - via vagus.

176
Q

what is the function of ghrelin?

A

expressed in stomach.

stimulates GH release and appetite.

177
Q

in what groups of people is obesity more common?

A

people from more deprived areas, older age groups, some black and minority ethnic groups, people with disabilities.

178
Q

what are the general principles of pubic health interventions for obesity?

A

make it easier to do healthy things, make it harder to do unhealthy things.
life-course approach.
not “one size fits all”.
prevention better than treatment.

179
Q

give some examples of individual level interventions for obesity

A

encourage/prescribe exercise.
diet - healthy diet. caution on very low kcal diets.
behaviour change strategies - self-monitoring of behaviour and progress, goal setting, relaxation, social support.
commercial/community-based weight management programmes

180
Q

give examples of wider-level interventions for obesity

A

food supply - alter composition/manufacture. increase access/availability of healthy food.

society - media campaigns (change4life), change “social norms”.

environment - transport infrastructure, urban design - cycle lanes etc.

reshape public policy - subsidise prices, sugar tax, minimum unit pricing, legislation.

181
Q

what can doctors do to help combat obesity?

A

educate patients, offer brief interventions, signpost to weight management programmes, prescribe exercise, prescribe medications, refer for surgery, lobby for policy/legislative changes.

Public Health (12 decks)

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