Public Health Flashcards
1
Q
What are the 4 four broad categories that can influence an individual’s health?
A
- Biological factors e.g. gender, ethnicity.
- Personal lifestyle e.g. exercise, diet.
- The physical and social environment e.g. air pollution.
- Health services.
2
Q
What did the Black Report 1980 confirm?
A
The Black Report confirmed that health inequalities were widening.
3
Q
What is the Whitehall study of British civil servants?
A
Information was collected on risk factors from civil servants; inequalities were seen between different employment grades. Nearly an institution would show this same pattern.
4
Q
What did the Acheson report 1988 suggest doing in order to reduce health inequalities?
A
- Give high priority to the health of families with children.
- Reduce income inequalities and improve living conditions.
5
Q
Why do women tend to suffer more illness than men?
A
- Biological, women’s role in reproduction can cause ill health.
- Ageing, women live longer and so are more prone to old age associated ill health.
- Material, women are still seen as ‘carers’, these commitments have implications for paid employment.
6
Q
What are the 4 main reasons for why men have higher mortality rates than women?
A
- Employment, men are more likely to have a high risk occupation.
- Risk taking behaviour.
- Men tend to smoke more than women.
- Men drink significantly more alcohol than women.
7
Q
What is the disengagement theory?
A
The process by which older people disengage themselves from roles they previously occupied in wider society.
8
Q
What is the theory of the third age?
A
The theory of the third age describes an era after retirement with health, vigour and a positive attitude.
9
Q
Describe the association between social class and life expectancy.
A
The higher the socio-economic classification the higher the life expectancy at birth.
10
Q
Describe the association between social class and smoking.
A
A greater percentage of people smoke in the lower socio-economic classes.
11
Q
Describe the association between mortality and unemployment.
A
Mortality is greater in the unemployed.
12
Q
What are the difficulties with the conceptualisation of ethnicity in health research?
A
- It is influenced by historical, social and political context.
- Notions of ethnicity can become fixed and lead to erroneous stereotyping.
- Experience of racism is strongly associated with poor health.
13
Q
Define patient compliance.
A
The extent to which the patient’s behaviour coincides with medical or health advice.
14
Q
Give 3 disadvantages of patient compliance?
A
- It is passive, the patient MUST follow the doctor’s orders.
- It is professionally focused and assumes the doctor knows best.
- It ignores problems patients have in managing their health.
15
Q
Define patient adherence.
A
The extent to which the patient’s actions match agreed recommendations. It is more patient centred.
16
Q
What is the difference between patient compliance and adherence?
A
Patient adherence is more patient centred, it empowers patients and considers them as equals in care. Patient compliance is often viewed as uncaring, condescending and passive.
17
Q
What are the key principles of adherence?
A
- Improve communication.
- Increase patient involvement.
- Understand the patient’s perspective.
- Provide and discuss information.
- Assess adherence.
- Review medicines.
18
Q
Describe the necessity-concerns framework.
A
The necessity-concerns framework looks at what influences adherence. Adherence increases when necessity beliefs are high and concerns are low.
19
Q
Give 2 factors that patient centred care encourages?
A
- Focus on the patient as a whole person; holistic.
2. Shared control of the consultation, decisions are made by the patient and doctor together.
20
Q
What is concordance?
A
Concordance is the expectation that patients will take part in treatment decisions and have a say in the consultation; it is a negotiation between equals.
21
Q
Give 5 barriers to concordance.
A
- The patient may not want to engage in discussions with their doctor.
- It may lead to worry.
- Patients may just want the doctor to tell them what to do.
- Time, resources and organisational constraints.
- Challenging, patient choice may differ significantly from medical advice.
22
Q
Give 4 advantages of doctor-patient communication.
A
- Better health outcomes.
- Higher compliance to therapeutic regimens.
- Higher patient and clinician satisfaction.
- Decrease in malpractice risk.
23
Q
What are the 5 main duties of a doctor?
A
- Work in partnership with patients, treat as individuals and respect their dignity.
- Work with colleagues in a way that best serve patients’ interests.
- Protect and promote health.
- Recognise and work within the limits of your competence.
- Provide a good standard of care.
24
Q
Define mental capacity.
A
The patient’s ability to make a decision about their care.
25
What 4 questions can be asked to assess mental capacity?
1. Does the patient understand?
2. Can the patient retain the information?
3. Can they use the information to weigh up options and make a decision?
4. Can they communicate their decision?
26
What is Gillick/Fraser competence?
If a child is under 16 they can be assessed as being Gillick/Fraser competent; this means they can make decisions about their care without parental involvement.
27
What is the main difference between infection and colonisation?
Infection results in harm to the individual whereas there is no harm in colonisation.
28
How can the environment be altered to aid infection control?
1. Design: hospital beds spaced further apart.
2. Ensuring a clean environment.
3. Infectious individuals can be isolated.
29
What can staff do to prevent the transmission of infection?
1. Barrier precautions; gloves and aprons.
2. Isolation.
3. Good hand hygiene!
30
What does MRSA stand for?
Methicillin resistant staphylococcus aureus.
31
Where might norovirus outbreaks be likely?
Schools, cruise ships, restaurants, hospitals.
32
What can norovirus cause?
Gastroenteritis; diarrhoea and vomiting.
33
Will norovirus be killed by alcohol hand gel?
No! Norovirus is resistant to conventional cleaning and is only killed by soap and water.
34
Why is c.difficile hard to destroy?
It is acquired in spore form and so is hard to eradicate.
35
Will c.diff be killed by alcohol hand gel?
No! C.diff is resistant to conventional cleaning and is only killed by soap and water.
36
Name 2 microorganisms that are not killed by alcohol hand gel?
Norovirus and C.diff.
37
What are endogenous infections?
Infection of a patient by their own flora. It is important to be aware of this when treating hospitalised patients.
38
How can endogenous infections be prevented?
- Good nutrition and hydration.
- Antisepsis.
- Control the underlying disease.
- Remove lines and catheters.
- Reduce antibiotic pressure e.g. short courses.
39
Define epidemiology.
The study of how often diseases occur in different groups of people and why.
40
What is epidemiological data used for?
Seeing trends in diseases and planning future preventative strategies.
41
Define incidence.
The rate at which new cases occur in a population during a specified time period.
42
Work out the incidence of new lung cancer cases:
- UK population: 61.4 million.
- New lung cancer cases per year: 39,000.
(39,000/61,400,000) X 100,000 = 63.5 per 100,000 per year.
43
Define prevalence.
The proportion of a population that have the disease at a point in time. (Normally given as a percentage).
44
What kind of diseases can prevalence be found for?
Prevalence can only be found for stable conditions, it is unsuitable for acute disorders.
45
Write an equation that links incidence and prevalence.
Prevalence = incidence X average duration.
46
Define mortality.
The incidence of death from a disease.
47
Work out the mortality from lung cancer cases:
- UK population: 61.4 million.
- Lung cancer deaths in 2009: 34,509.
(34,509/61,400,000) X 100,000 = 56.6 per 100,000 per year.
48
Do epidemiological studies look for cause?
No! They look for relationship not cause.
49
What types of study are most useful for epidemiology?
Ecological and cross-sectional.
50
Describe an ecological study.
Ecological studies use population level data e.g. mortality rates.
51
Give an advantage and a disadvantage of an ecological study.
- Cheap and easy to perform as it uses readily available data.
- Bias is possible due to variation in diagnostic criteria.
52
Give an advantage and a disadvantage of a cross-sectional study.
- Quick and cheap. Rapid insight into current events in a community.
- Prone to bias, no time reference, could be reporting medical oddities.
53
Describe a cross-sectional study.
Looks at the population at a point in time - prevalence study!
54
Describe a case-control study.
Looks at people with a disease (case) and compares with a control (matched). Retrospective.
55
Give an advantage and a disadvantage of a case-control study.
- Results can be obtained quickly due to being retrospective - cheap.
- Unreliable if individuals have bad memories. Cannot calculate incidence.
56
Describe a cohort study.
Follows a group of people over time; prospective. Incidence study.
57
Give an advantage and a disadvantage of a cohort study.
- Incidence can be determined, reduced chance of bias.
| - Expensive, takes a long time and uses large populations. Difficulty with follow up.
58
Describe a RCT.
An intervention is given and compared to a control group.
59
Give an advantage and a disadvantage of a RCT.
- Confounders are equally balanced, less bias.
| - Expensive, volunteer bias, ethical difficulties in withholding treatment from controls.
60
What type of study might also be known as a prevalence study?
Cross-sectional study; looks at the population at a point in time.
61
What type of study might also be known as an incidence study?
Cohort study; follows a group of people over time, prospective.
62
What type of study is retrospective?
Case control.
63
What type of study is prospective?
Cohort study.
64
Why is it difficult to determine the prevalence of COPD?
There are a lot of undiagnosed cases.
65
What can cause COPD?
Smoking is the main cause! Occupation, genetics and environmental factors can also lead to COPD.
66
Give 3 reasons why there is geographical variation for the risk of developing COPD.
1. Socio-economic differences: housing and nutrition.
2. Historic industry e.g. steel work and coal mining.
3. Developing world e.g. more pollution.
67
What are the 4 key problems in managing COPD.
1. Unpredictable illness trajectory.
2. Prognosis is hard to determine due to the unpredictable illness trajectory and is often poor if it is determined.
3. Bad patient understanding leads to anxiety and confusion.
4. Limited access to specialist palliative care.
68
What is the WHO definition of palliative care?
Palliative care improves the quality of life of patients and families who face life threatening illness. It provides pain and symptom relief and spiritual and psychological support from diagnosis to the end of life and bereavement.
69
Define specialist palliative care.
Palliative care provided by health professionals who specialise in palliative care and work within a multi-disciplinary specialist care team.
70
Who can provide specialist palliative care.
- Consultants in palliative medicine.
- Clinical nurse specialists e.g. Macmillan nurses.
- Social workers.
- Chaplains.
- Physiotherapists.
- Dieticians.
71
Define generalist palliative care.
Health professionals who have not received accredited levels of training in palliative care and so are not deemed 'specialists', but who routinely provide health care for patients at the end of their lives.
72
Who can provide generalist palliative care.
- GP's.
- Hospital doctors.
- Nurses and district nurses.
- Nursing home staff.
73
What are the 4 building blocks of palliative care?
1. Holistic.
2. Individualised.
3. Patient and family centred.
4. Multidisciplinary approach.
74
What does palliative care aim to do?
1. Promote quality of life.
2. Promote dignity and autonomy.
3. Control disease symptoms.
75
What might multiple co-morbidities result in?
1. A greater need for care.
2. Increased psychological distress.
3. Increased social isolation.
76
Palliative care for COPD patients is notoriously bad. Why is this?
1. Lack of funding.
2. Most palliative care teams are cancer focused.
3. Differing patient need: COPD v cancer.
4. Unpredictable illness trajectory in COPD.
5. Lack of patient understanding.
77
Ethics: what are the 4 principles?
1. Autonomy - respect the patient's choices.
2. Beneficence - do good.
3. Non-maleficence - do no harm.
4. Justice.
78
Ethics: what is deontology?
Features of the act determines worthiness. Deontology teaches that acts are right or wrong, people have a duty to act accordingly. Do unto others as you would be done by.
79
Ethics: categorical imperatives are a type of deontology. What are categorical imperatives?
A rule that is true in all circumstances. You should act in such a way that you would be willing for it to become universal law that everyone follows in the same situations.
80
What are the challenges of deontology?
1. Consequences aren't looked at.
| 2. Duties can conflict.
81
What are virtue ethics?
Virtue ethics focus on the character of the person acting, are they integrating reason and emotion? An act is only virtuous if the person has the right mind set. Virtues are acquired.
82
What are the five focal virtues?
1. Discernment.
2. Conscientiousness.
3. Trustworthiness.
4. Integrity.
5. Compassion.
(TICCD)
83
Focal virtues: define discernent.
The ability to judge well.
84
Focal virtues: define conscientiousness.
Being thorough, careful and vigilant.
85
Focal virtues: define trustworthiness.
The ability to be relied on and trusted.
86
Focal virtues: define integrity.
Being honest and having good moral principles.
87
Focal virtues: define compassion.
Showing concern for others.
88
What are the challenges of virtue ethics?
Virtue ethics don't focus on consequences. They are culture specific and too broad for practical application. It's not always clear how to solve a moral dilemma using virtue ethics.
89
What are utilitarian ethics (consequentialism)?
An act is evaluated solely in terms of its consequences. Maximise good and minimise harm.
90
What are the challenges of utilitarian ethics (consequentialism)?
Treats minorities unfairly to promote the happiness of a majority.
91
Name 2 approaches to ethical analysis.
1. Seedhouse's ethical grid.
| 2. The four quadrants approach.
92
Seedhouse's ethical grid: describe the inner layer.
The inner layer asks the question of whether the intervention is going to create autonomy, respect autonomy and treat all equally?
93
Seedhouse's ethical grid: describe the second layer.
Duties and motives. Is the intervention consistent with moral duties; keeping promises, telling the truth, minimising harm and maximising benefit?
94
Seedhouse's ethical grid: describe the third layer.
Consequentialist layer. Is the intervention going to provide the greatest benefit for the greatest number? Who will benefit, society, individuals, a group?
95
Seedhouse's ethical grid: describe the outer layer.
Is the intervention likely to be affected by external considerations e.g. risks, law, use of resources.
96
What are the advantages of Seedhouse's ethical grid?
It provides structure and function for analysing ethical problems. It is based on moral theory.
97
What are the headings which make up the four quadrants approach to clinical ethical analysis?
1. Medical indications.
2. Patient preferences: respect for autonomy.
3. Quality of life.
4. Contextual features.
98
Ethical analysis: define connectivity and interdependence.
The behaviour of one individual may affect others.
99
Ethical analysis: define co-evolution.
Adaptation of one organism alters other organisms; the doctor and patient co-evolve.
100
Ethical analysis: define the far from equilibrium.
Being pushed away from equilibrium is essential for survival and flourishing. Pushing yourself away from your comfort zone.
101
Ethical analysis: define conscientious objections.
Moral claims that are based on an individual's core ethical beliefs e.g. when a doctor refuses to provide certain treatments because they believe it would violate their personal beliefs. It is important to balance conscientious objections with professional obligations - respect patient autonomy.
102
Until what week of pregnancy can an abortion be carried out?
Abortions can generally only be carried out up to 24 weeks of pregnancy. In exceptional circumstances an abortion can take place after 24 weeks e.g. if there's a risk to life or there are problems with the baby's development.
103
Could any pregnant lady request an abortion?
No. You need a medical reason to request a termination e.g. physical or mental risk to the mother.
104
What is the WHO definition of mental health.
A state of mental wellbeing in which a person realises their own abilities, can cope with normal life stressors, can work productively and fruitfully and are able to contribute to their community.
105
What can affect mental health?
Mental health can depend upon life experiences and life context. Gender, race, religion, social class etc. can all influence mental health.
106
Name 5 mental health conditions.
1. Stress.
2. Depression.
3. OCD, PTSD.
4. Schizophrenia.
5. Eating disorders e.g. anorexia, bulimia.
6. Substance misuse e.g. alcohol, illegal drugs.
107
Give 5 reasons why students are so vulnerable to mental health issues?
1. Academic stress.
2. Financial concerns.
3. Alcohol, drugs.
4. Peer pressure.
5. Unrealistic expectations.
108
Name 3 things that doctors suffer from more than the general population.
1. Increased suicide rates.
2. Increased marital dysfunction and divorce.
3. Increased drug and alcohol problems.
109
Give 5 factors that can contribute to work related stress.
1. Insufficient resources.
2. Excessive workloads.
3. Poor management.
4. Complaints and litigations.
5. Dealing with patient suffering.
110
Give 4 symptoms of burnout.
1. Diminished personal contact.
2. Work avoidance.
3. Increased minor illness.
4. Feelings of failure.
111
What personality traits are susceptible to psychological illness?
1. Perfectionism.
2. High self criticism.
3. Low flexibility.
4. High discipline.
5. High empathy.
112
Describe Malan's 'helping profession syndrome'.
People in helping professions compulsively give to others what they would like to have for themselves. They have an unconscious identification with the patient role, unmet emotional needs.
113
Give 5 trigger factors for conflict and assault in the workplace.
1. Waiting times.
2. Well being/state of mind.
3. Medication, side effects.
4. Frustration.
5. Drug/alcohol abuse/withdrawal.
114
What is the best way to prevent conflict?
Good communication and good body language.
115
Give 3 barriers to good communication.
1. Language barriers.
2. Deafness/blindness.
3. Medical jargon.
116
Describe the 'LOVERS' communication model.
L - listen, learn what the problem is.
O - observe, look at their body language.
V - verify, check you understand.
E - empathise.
R - reassure, tell them you want to help.
S - seek an agreeable compromise.
117
Define population attributable fraction (PAF).
The proportional reduction in population disease that would occur if exposure to a risk factor was reduced.
118
What is the principal factor behind social inequality?
Smoking!
119
What is the obesogenic environment?
An environment that encourages people to eat unhealthily and not do enough exercise.
120
Give 3 physical characteristics of the obesogenic environment.
1. Increased car culture.
2. Lifts/escalators.
3. TV remote controls.
121
Give an economic characteristic of the obesogenic environment.
Healthy options tend to be more expensive.
122
Give a socio-cultural characteristic of the obesogenic environment.
Eating out and indulging has become a very social thing to do.
123
Define NNT.
The number of patients that need to be treated in order to have an impact on one person.
124
What did Friedman and Rosenman (1959) describe?
Coronary prone behaviour; competitive, hostile, impatient, type A behaviour.
125
What tool can be used to assess type A behaviour?
MMPI.
126
Give three psychosocial factors that could increase someone's risk of MI.
1. Depression/anxiety.
2. High demand and low control at work, working more than 11 hours a day.
3. Loneliness and social isolation.
127
What can doctors do to help combat psychosocial factors that can increase the risk of patient mortality?
1. Identify signs of depression/anxiety.
2. Ask patients about their occupation.
3. Ask patients about support networks.
4. Liaise with relevant services e.g. social care and occupational health.
128
Give 3 things that consent must be.
1. Voluntary.
2. Informed.
3. Made by someone with capacity.
129
What must you tell someone about their treatment in order for them to make an informed decision?
1. What is the treatment.
2. How you're going to do it.
3. Risks.
4. Benefits.
5. Alternative options and their risks/benefits.
130
What is section 2 of the mental capacity act?
A patient is unable to make a decision for himself in relation to the matter because of an impairment or disturbance in the functioning of the mind or brain.
131
Section 2 of the mental capacity act: what can cause an impairment or disturbance in the functioning of the mind or brain?
- Schizophrenia.
| - Needle phobia.
132
What is section 3 of the mental capacity act?
A person is unable to make a decision for themselves if they cannot:
1. Understand the relevant information.
2. Retain the information.
3. Weigh up the information.
4. Communicate their decision.
133
What 4 questions can be asked to determines whether a patient has capacity?
1. Does the patient understand the relevant information?
2. Can they retain the information?
3. Can they weigh up the information?
4. Can they communicate their decision?
134
What are the two main options for treating a patient deemed incompetent?
1. Can someone make decisions on their behalf e.g. lasting powers of attorney.
2. A healthcare professional can make decisions if it in the patient's best interests.
135
What 4 things need to be considered when deciding what's in the patients best interests?
1. Will the patient have capacity in the future? If so when?
2. Consider the patient's past and present wishes/feelings.
3. Consider the patient's beliefs and values that would influence a decision.
4. Consult with anyone who needs to be consulted e.g. lasting power of attorney, carers etc.
136
What is Gillick competence?
It can be used to determine whether children under 16 have competence to make decisions about their care. It asks whether the child understands the consequences of their decision.
137
Give 5 features of delirium.
1. Acute onset.
2. Impaired attention.
3. Decreased consciousness.
4. Usually reversible.
5. Often accompanied by physical illness.
6. Hospital acquired.
138
Give 5 features of dementia.
1. Chronic illness.
2. Progressive, slow.
3. Attention preserved.
4. Consciousness preserved.
5. Usually irreversible.
6. Usually without physical problems.
7. Community acquired.
139
Give 5 causes of delirium.
1. UTI's.
2. Side effects of opiates.
3. Alcohol withdrawal.
4. Hypoglycaemia.
5. Hypoxia.
140
How can delirium be managed in a hospital environment?
1. Adapt the ward environment to keep patients orientated and safe.
2. Identify underlying causes.
3. Lorazepam can be used but only if absolutely necessary.
141
Name 4 types of dementia.
1. Alzheimers.
2. Vascular.
3. Lewy body.
4. Fronto-temporal dementia.
142
Give 5 risks of falls in the elderly.
1. Weakness.
2. Poor vision.
3. Dizziness.
4. Home hazards.
5. Loss of coordination.
6. Delirium.
7. Loss of mobility aids.
143
Give 4 consequences of falls in the elderly.
1. Fracture.
2. Head injury.
3. Fear/anxiety.
4. Loss of independence.
144
What is anorexia nervosa?
A restriction of energy intake relative to requirements -> low body weight. The person has an intense fear of gaining weight.
145
What BMI indicates that someone might be suffering from anorexia nervosa?
BMI < 17.5.
146
Name 2 sub-types of anorexia nervosa.
1. Restricting.
| 2. Binge-eating and purging.
147
Give the 2 characteristic features of bulimia nervosa.
1. Recurrent episodes of binge eating: eating large amounts of food in discrete periods of time and having a lack of control over eating.
2. Inappropriate compensatory behaviour to prevent weight gain - purging.
148
What is binge eating?
Eating large amounts of food in discrete periods of time and having a lack of control over eating. There is no purging or compensatory behaviour.
149
Give 5 characteristics of binge eating episodes.
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling hungry.
4. Eating alone because of feeling embarrassed.
5. Feeling depressed or guilty afterwards.
150
Describe the Core model (Slade, 1982).
The Core model describes the factors that contribute to the onset of eating disorders. It says that onset is due to a combination of low self esteem and perfectionism leading to a need for control. This is a trigger for using food as a means of self-control.
151
What do the NICE guidelines say is the first line treatment for bulimia nervosa and binge eating?
CBT.
152
What do the NICE guidelines say is the first line treatment for anorexia nervosa?
- Family therapy in younger patients.
| - CBT.
153
Name 2 opiates and describe their effects.
- Heroin and morphine.
| - They create a sense of euphoria, and provide pain relief. They are also depressants.
154
What are the effects of alcohol?
Alcohol is a depressant, its effects are sedation, relaxation and slowing down thinking/acting.
155
Name 3 stimulants and describe their effects.
- Caffeine, nicotine and cocaine.
| - Increase alertness and activity. Elevate mood.
156
Name 2 hallucinogens and describe their effects.
- Ecstasy and ketamine.
| - Alter sensory perception and thinking patterns, loss of sense of reality.
157
Give 5 different societal opinions to substance misuse.
1. Addiction is a disease.
2. Genetics influence addictive tendencies.
3. Punishments should be greater for those who use drugs.
4. Addiction is due to up bringing and a lack of moral values.
5. Poverty, social exclusion and mental health should be targeted to help deal with addiction.
158
Give 5 risk factors for substance misuse.
1. Family history of substance misuse.
2. Family management problems e.g. poor parenting.
3. Family conflict e.g. domestic abuse.
4. Low academic attainment at school.
5. Availability of drugs in the community.
6. Peer pressure.
7. Experience of trauma e.g. abuse, loss, poor parenting.
159
Give 3 ways to prevent substance misuse.
1. Good family attachment.
2. Academic achievement.
3. Opportunities to develop self confidence, self worth and resilience.
160
Define physical dependence.
The body adapts to the presence of the substance and over time needs more and more for the same effect (tolerance). Stopping use leads to symptoms of withdrawal.
161
Give 4 withdrawal symptoms.
1. Tremulousness.
2. Agitation.
3. High BP.
4. Increased HR.
5. Seizures.
162
Define psychological dependence.
The feeling that life is impossible without the drug, Feelings of fear, pain, shame and guilt if not on the drug.
163
What are the 3 main features of the national drug strategy 2010?
1. Reduce demand.
2. Restrict supply.
3. Build recovery in communities.
164
What is the maximum units of alcohol that men and women can consume within a week?
14.
| Spread over the week, not all in one go.
165
Write an equation that can be used to work out the number of units in a drink.
Strength of the drink (% abv) X amount of drink (ml) divided by 1000.
166
How would you define binge drinking?
Drinking > 6 units of alcohol in one go.
167
Describe the alcohol harm paradox.
Those in lower socio-economic groups consume less alcohol than those in higher socio-economic groups but they experience greater alcohol related harm.
168
Give 3 acute effects of excessive alcohol.
1. Accidents and injury.
2. Pancreatitis.
3. Cardiac arrhythmias.
4. Coma and death from respiratory depression.
5. Gastritis.
169
Give 3 chronic effects of excessive alcohol.
1. LIVER disease!
2. CNS toxicity e.g. dementia.
3. Hypertension.
4. CHD.
170
Give 4 psychosocial effects of excessive alcohol.
1. Interpersonal relationships affected e.g. violence, rape.
2. Problems at work.
3. Criminality.
4. Driving offences.
171
Give 4 signs of foetal alcohol syndrome.
1. Pre and post natal growth retardation.
2. Mental retardation.
3. Craniofacial abnormalities.
4. Congenital defects e.g. eyes, ear and mouth.
172
Give 3 government strategies that prevent harmful drinking.
1. Price - make alcohol less affordable.
2. Availability - limit licensing and import allowances.
3. Marketing - limit exposure especially to young people.
173
Name 3 public health campaigns associated with reducing alcohol intake.
1. 'Know your limits' - binge drinking campaign.
2. Drinkaware - alcohol labelling.
3. THINK! - drink drive campaign.
174
Give 3 methods of screening for alcohol consumption.
1. Clinical interview e.g. asking about drinking in a patient history.
2. CAGE questions.
3. AUDIT tool.
175
What are the 4 questions that make up CAGE?
1. Have you ever felt that you should cut down?
2. Have you ever felt annoyed by people telling you to cut down?
3. Do you feel guilty about how much you drink?
4. Eye opener - ever had a drink first thing in the morning?
176
What are the 3 questions that make up AUDIT?
1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day?
3. How often did you have >6 units on a single occasion in the past year?
177
Define at risk drinking.
A pattern of drinking which brings about the risk of harm.
178
Define alcohol abuse.
A pattern of drinking which is likely to cause harm.
179
Define alcohol dependence.
A set of behavioural, cognitive and physiological responses that can develop after repeated substance use.
180
What questions might you ask to determine whether someone has alcohol dependence?
In the past 12 months have you:
1. Shown tolerance?
2. Shown signs of withdrawal?
3. Not been able to stick to drinking limits?
4. Spent a lot of time drinking?
5. Kept drinking despite known problems?
181
What kinds of questions are asked in the severity of alcohol dependence questionnaire?
1. Asks about withdrawal symptoms.
2. Relief drinking?
3. Frequency of alcohol consumption.
4. Speed of onset of withdrawal symptoms.
182
What inhibitory neurotransmitter does alcohol potentiate?
GABA.
183
What is the preferred drug used in alcohol detoxification?
Chlordiazepoxide.
184
Name 2 drugs that can prevent alcohol relapse.
1. Acamprosate.
| 2. Disulfiram.
185
Give 3 side effects of disulfiram.
Dilsulfiram leads to increased acetaldehyde levels.
| Side effects include flushing of skin, SOB, nausea, vomiting, tachycardia.
186
Deficiency of what vitamin can lead to Wernicke's encephalopathy?
Vitamin B1 - thiamine.
187
What is good transition between paediatric and adult health services?
Young person centred, multi-faceted, active process that attends to the medical, psychological and educational needs of adolescents with chronic conditions as they move from child to adult-centred care.
188
Young people with chronic ill health are more likely to engage in health risk behaviour. What is the potential consequence of this?
Health risk behaviour is associated with non-adherence to medical therapy and so these young people could become very poorly.
189
Give 4 benefits of good transition between paediatric and adult health services.
1. Improved follow up.
2. Patient satisfaction.
3. Improved disease control.
4. Improved documentation.
190
Give 5 benefits of work.
1. Reduced mortality.
2. Earning an income.
3. Feelings of accomplishment.
4. Life structure.
5. Fitness.
191
Give 3 ways of telling if an illness is due to work.
1. Symptoms improve when away from work.
2. Characteristic rash distribution e.g. contact dermatitis.
3. Cluster of cases in a work place.
192
What is the Bradford Hill criteria?
A group of minimal conditions necessary to provide adequate evidence of a causal relationship.
193
Give 6 of the Bradford Hill criteria that provide evidence for causation.
1. Strength of association.
2. Consistency of association.
3. Exposure-response relationship.
4. Temporality - cause before disease.
5. Specificity.
6. Coherence of evidence.
194
Give 3 examples of work related MSK disorders.
1. Carpal tunnel syndrome.
2. HAVS.
3. Tenosynovitis.
4. Rotator cuff problems.
195
Who might be at risk of carpal tunnel syndrome?
A painter/decorator due to the forceful and repetitive nature of their work with abnormal wrist postures.
196
Who might be at risk of HAVS?
People who use chain saws, grinders, drills etc.
197
Who might be at risk of rotator cuff problems?
People in jobs that involve lifting above the shoulder.
198
Describe the epidemiology of chlamydia.
- Peak in 15-25 y/o.
| - Women > men.
199
What can cause chlamydia?
Chlamydia trachomatis.
| Gram negative
200
Give 2 symptoms of chlamydia/gonorrhoea infection in men.
1. Dysuria.
| 2. Urethral discharge.
201
Give a potential complication of chlamydia infection in men.
Epididymo-orchitis.
202
What is the primary site for chlamydial infection in men?
The urethra -> urethritis.
203
What is the primary site for chlamydial infection in women?
The cervix.
204
Give 3 symptoms of chlamydia/gonorrhoea infection in women.
1. Discharge.
2. Menstrual irregularity.
3. Dysuria.
Over 70% are asymptomatic!
205
Give 4 potential complications of chlamydia/gonorrhoea infection in women.
1. Pelvic inflammatory disease.
2. Ectopic pregnancy.
3. Infertility.
4. Neonatal transmission: opthalmia neonatorum.
206
What investigation might you do to see if someone is infected with chlamydia?
Nucleic acid amplification tests (NAAT).
- Females: self vaginal swab.
- Males: first void urine.
207
Describe the treatment for chlamydia.
1. Partner notification.
2. Test for other STI's.
3. Azithromyocin or doxycycline.
208
Describe the epidemiology of gonorrhoea.
- Peak age group: 25-30 y/o.
| - Men > women.
209
What can cause gonorrhoea?
Neisseria gonorrhoeae.
Gram -ve diplococci.
210
Describe the treatment for gonorrhoea.
1. Partner notification.
2. Test for other STI's.
3. Ceftriaxone IM with azithromyocin.
(Antibiotic resistance is a problem).
211
What investigation might you do to see if someone is infected with gonorrhoea?
1. Gram staining of male urethral discharge or female endo-cervical swab.
2. NAAT.
212
Management of STI's: give 3 benefits of partner notification.
1. Prevents re-infection.
2. Prevents complications in asymptomatic contacts.
3. Breaks the chain of infection.
213
What can cause syphilis?
Treponema pallidum.
214
Describe the epidemiology of syphilis.
- Men > women.
| - High risk in MSM.
215
Why are MSM at high risk of syphilis?
Syphilis is highly transmissible through oral sex.
216
What is the main symptom of syphilis?
Primary chancre (non-tender ulcer) on the genital skin, nipples and mouth.
Any genital ulcer is syphilis until proved otherwise.
217
What investigation might you do to see if someone is infected with syphilis?
Serology.
218
What is the treatment for syphilis?
Penicillin (IM).
| Follow up and partner notification is essential.
219
Describe the STI/HIV transmission model (May & Andersen 1987).
R = BCD.
```
R = reproductive rate.
B = infectivity rate.
C = number of partners.
D = duration of infection.
```
220
What is primary prevention of STI's? Give examples.
Primary prevention aims to reduce the risk of acquiring an STI in the first place.
- Awareness campaigns - reduce risk behaviour.
- Vaccination for hep B and HPV.
- One to one risk reduction discussions.
221
What is secondary prevention of STI's? Give examples.
Secondary prevention is case finding.
- Partner notification.
- Easy access to STI/HIV tests and treatment.
- Targeted screening e.g. national chlamydia screening programme.
222
What is tertiary prevention of STI's? Give examples.
Tertiary prevention focuses on reducing morbidity/mortality.
- Anti-retrovirals for HIV.
- Acyclovir for suppressing herpes.
223
Define sensitivity.
The proportion of people with the disease who are correctly identified (a/a+c).
224
Define specificity.
The proportion of people without the disease who are correctly excluded (d/b+d).
How well the test detects those without the disease.
225
Name 3 vaccine preventable CNS infections.
1. Tetanus.
2. Measles.
3. H.influenzae.
4. TB.
226
Give 2 risk factors for cerebral palsy.
1. Anoxia.
| 2. Low birth weight.
227
What is cerebral palsy?
Movement disorders that appear in early childhood due to brain damage before or during the neo-natal period.
228
How does variant Creutzfeldt-Jakob disease (vCJD) differ from CJD?
Presents younger: mid-twenties compared to 60's for CJD.
229
Give 3 signs of variant Creutzfeldt-Jakob disease (vCJD)?
1. Neuropsychiatric symptoms.
2. Ataxia.
3. Dementia.
230
What is the association between variant Creutzfeldt-Jakob disease (vCJD) and BSE?
vCJD and BSE are caused by the same prion strain suggesting transmission from BSE infected cattle to the human food chain.
231
What are controlled drugs?
Drugs which are ‘dangerous or otherwise harmful’ and have the potential for abuse or misuse.
232
Give 3 examples of controlled drugs that are used in general practice.
1. Codeine.
2. Tramadol.
3. Diazepam.
233
Define addiction.
Not having control over doing, taking or using something to the point where it could be harmful to you.
234
Define impairment.
Any loss or abnormality of psychological, physiological or anatomical structure or function.
235
Define disability.
An inability to perform an activity.
236
Define handicap.
An inability to fulfill one's role e.g. parental, vocational or recreational.
237
What is neurological rehabilitation?
Restoration of the individual to the highest feasible functional level within the constraints of impairments and within the context of cultural milieu.
238
Name 5 people who are involved in neurological rehabilitation.
1. Occupational therapists.
2. Physiotherapists.
3. Speech and language therapists.
4. Nurses.
5. Psychologists.
6. Social workers.
239
Define spasticity.
Disordered sensorimotor control resulting from an UMN lesion presenting as involuntary activation of muscles.
240
Describe the non-pharmacological management of spasticity.
Physiotherapy e.g. special seating, moving and handling, stretching.
241
Describe the pharmacological management of spasticity.
Anti-spasticity drugs e.g. Baclofen and Tizanidine.
242
How does Baclofen work as an anti-spasticity drug?
Baclofen is a GABA analogue. It reduces calcium influx and so suppresses release of excitatory neurotransmitters.
243
Describe the 'step care approach' to spasticity.
1. Neurophysiotherapist.
2. Drugs e.g. baclofen, dantrolene and tizanidine.
3. Botulinum toxin.
4. Baclofen pump.
244
Describe the management for those patients with gait problems.
1. Identify the cause.
2. Physiotherapy.
3. Falls education.
4. Walking aids.
5. Drugs e.g. botulinum toxin.
245
What are the three clinical features of spasticity?
1. Increased tone.
2. Clonus.
3. Spasm.
246
What is somatic symptom disorder (functional symptoms)?
When a person feels extreme anxiety about physical symptoms that are medically unexplained. This anxiety interferes with daily life.
247
What are the 3 main types of somatic symptom disorder?
1. Pain in different locations.
2. Functional disturbance of an organ system.
3. Complaints of fatigue/exhaustion.
248
Describe the criteria for diagnosis of somatic symptom disorder.
A - >1 somatic symptom that is distressing and disrupts daily life.
B - Excessive thoughts, feelings and behaviours related to these symptoms.
C - Chronicity - > 6 months.
249
Give 2 diseases that are examples of somatic symptom disorder.
IBS and fibromyalgia.
250
What is the management for somatic symptom disorder?
Sleep, exercise, CBT.
251
What is an NHS health check?
Secondary prevention. It is used to detect early signs of disease and to control risk factors.
252
Give 3 risk factors for developing type 2 diabetes.
1. Sedentary job, lack of exercise.
2. Obesity.
3. Family history.
4. History of gestational diabetes.
5. Hypertension.
6. IGT and IFG.
253
What is an obesogenic environment?
An environment that encourages people to eat unhealthily and not do enough exercise.
254
Give 3 physical characteristics of an obesogenic environment.
1. TV remote controls.
2. Car culture.
3. Lifts.
255
Give an economic characteristic of an obesogenic environment.
Expensive fruit and vegetables.
256
Give a socio-cultural characteristic of an obesogenic environment.
Family eating patterns.
257
Give 3 mechanisms that lead to people being unable to lose weight.
1. Physical: more weight = more difficult to exercise.
2. Psychological: low self esteem = comfort eating.
3. Socioeconomic: reduced opportunities and employment.
258
Define primary prevention.
Preventing a disease/condition from occurring in the first place. Eliminate exposures/risk factors that contribute to the disease.
259
Define secondary prevention.
Detecting a disease as soon as possible in order to alter its course and to improve health outcomes. SCREENING!
260
Define tertiary prevention.
Trying to slow down the progression of a disease and helping people to manage their illness effectively.
261
Describe the tertiary prevention of diabetes.
1. Self monitoring.
2. Diet - healthy eating.
3. Exercise.
4. Education.
5. Peer support.
262
Define appetite.
A desire to eat food.
Appetite is affected by olfactory, gustatory, cognitive and visual stimuli.
263
Define hunger.
The need to eat food.
264
Define anorexia.
A lack of appetite.
265
Define satiety.
A feeling of fullness; the disappearance of appetite after a meal.
266
Define satiation.
What brings an eating episode to an end.
267
Describe the satiety cascade.
- Sensory.
- Cognitive.
- Post ingestive.
- Post absorptive.
268
Give an example of a food that gives quick and short satiety.
Highly refined sugar.
269
Give an example of a food that gives prolonged satiety.
Protein.
270
Give 5 diseases that are associated with obesity.
1. T2DM.
2. Hypertension.
3. CAD.
4. Stroke.
5. Osteoarthritis.
6. OSA.
7. Infertility.
271
Describe the association between obesity and shift work.
Obesity is more prevalent in people who do shift work.
Sleeping out of phase affects the metabolic circadian rhythm.
272
Which brain structure is responsible for appetite regulation?
Hypothalamus.
- Lateral hypothalamus: hunger centre.
- Ventromedial: satiety centre.
273
What satiety hormone is expressed in white fat cells?
Leptin.
274
What is the function of leptin?
It tells the brain not to eat anymore, switches off appetite.
Serum levels of leptin increase after a meal and decrease after fasting.
275
How does leptin switch off appetite?
Leptin inhibits NPY and AGRP.
Leptin activates POMC and CART.
Appetite is decreased.
276
What might happen if someone was deficient in leptin?
They might become obese. This was seen in the ob/ob mice that were leptin deficient.
277
What is the role of CCK in satiety?
CCK delays gastric emptying and gall bladder contraction - appetite decreases.
278
What is the role of Ghrelin in satiety?
Ghrelin stimulates NPY and AGRP = increases appetite.
279
What hormone might it be possible to use in the treatment of anorexia?
Ghrelin.
280
Define obesity.
Having a very high amount of body fat in relation to lean body mass. BMI >30kg/m2.
281
Give 3 group's of people in whom obesity is common.
1. Lower SE groups.
2. Older people.
3. People with disabilities.
282
Give 5 potential consequences of obesity in children.
1. Stigmatisation.
2. Bullying.
3. Low self esteem.
4. School absence.
5. High cholesterol and BP.
6. Bone and joint problems.
7. Increased risk of being overweight as an adult.
283
Give 5 potential consequences of obesity in adults.
1. Less likely to be employed.
2. Discrimination and stigma.
3. Risk of hospitalisation.
4. Reduced life expectancy.
5. Depression and psychiatric problems.
284
What are the 7 key domains for energy balance?
1. Food production.
2. Food consumption.
3. Individual activity.
4. Societal influences.
5. Individual biology.
6. Individual psychology.
7. Activity environment.
285
Describe individual level interventions for managing obesity.
1. Behaviour change: stimulus control, goal setting, slow rate of eating, relapse prevention, social support, hypnotherapy.
2. Community based programmes can provide on going advice and support.
286
Describe wider level interventions for managing obesity.
1. Food supply: reduce energy dense ingredients and improve access to healthy foods.
2. Media campaigns e.g. change4life, 5-a-day.
3. Environment: improve cycle lanes etc.
4. Sugar tax and subsidise healthy eating.
5. Restrict the sale of certain foods and drinks in schools.
287
What can doctor's do to help manage obesity?
1. Educate patients - make every contact count.
2. Signpost to weight management programmes.
3. Prescribe exercise.
4. Refer for surgery.
288
Describe the trans-theoretical model of behavioural change.
1. Pre-contemplation (no intention of giving up smoking).
2. Contemplation (consider quitting).
3. Preparation (get ready to quit in near future).
4. Action (engaged in giving up).
5. Maintenance (steady non-smoker).
6. Relapse?
289
Describe the Health Belief Model (Becker 1974) of behavioural change.
The individual needs to believe that there are consequences and that they are susceptible to disease. They need to believe that taking action reduces the risks and that the benefits will outweigh any costs.
290
Give 5 indications for the surgical treatment of obesity.
1. BMI > 40.
2. BMI > 35 and co-morbid.
3. Minimum 5 year's obesity.
4. Failure of conservative treatment.
5. No alcoholism or psychiatric illness.
6. > 18 y/o.
291
Give an example of a restrictive surgical treatment for obesity.
Gastric banding.
292
Give an example of a malabsorptive surgical treatment for obesity.
Jejuno-ileal bypass.
293
Give 5 risk factors for depression.
1. Female.
2. Past history of depression.
3. Chronic illness.
4. Alcohol/substance abuse.
5. Traumatic/stressful events.
6. Lack of social support/isolation.
7. Lower socio-economic status.
294
Give 5 psychological symptoms of depression.
1. Continuous low mood.
2. Feeling hopeless/helpless.
3. Tearful.
4. Guilt ridden.
5. Lacking motivation/interest in daily activities.
6. Anxious/worried.
295
Give 5 physical symptoms of depression.
1. Appetite change.
2. Weight loss/gain.
3. Unexplained aches/pains.
4. Changes in menstrual cycle.
5. Disturbed sleep.
296
Give 4 social symptoms of depression.
1. Less productive at work/school.
2. Avoiding contact with friends and family.
3. Neglecting hobbies or interests.
4. Difficult relationships.
297
How can depression and anxiety be evaluated?
1. GAD-7 - anxiety.
| 2. PHQ-9 - depression.
298
Describe the management for depression.
1. Exercise and diet.
2. CBT.
3. SSRI's and tricyclics.
4. Electroconvulsive therapy.
299
Give an example of an SSRI.
1. Citalopram.
| 2. Sertraline.
300
Give an example of a tri-cyclic anti-depressant.
Amitriptyline.
301
What is asked on the PHQ-9 questionnaire?
1. Little interest or pleasure in doing things?
2. Feeling down?
3. Trouble sleeping?
4. Feeling tired?
5. Poor appetite or over-eating?
6. Feeling bad about yourself?
7. Trouble concentrating?
8. Moving or speaking slowly?
9 Suicidal or self-harm thoughts?
302
What are the 5 signs of stress?
1. Biochemical.
2. Physiological.
3. Behavioural.
4. Cognitive.
5. Emotional.
303
5 signs of stress: what changes occur in the biochemical stage?
Endorphin and cortisol levels are altered.
304
5 signs of stress: what changes occur in the behavioural stage?
Over-eating, anorexia, insomnia, more alcohol or smoking or drug use.
305
5 signs of stress: what changes occur in the cognitive stage?
Negative thoughts, no concentration, worse memory, tension headaches.
306
5 signs of stress: what changes occur in the physiological stage?
Shallowing breathing, raised BP, more HCl produced.
307
5 signs of stress: what changes occur in the emotional stage?
Mood swings, irritability, aggression, boredom, apathy (lack of interest), tearfulness.
308
Define median survival.
The time at the end of which 50% of index cases are still alive.
309
Define 5-year survival rate.
The proportion of diagnosed patients still living five years after diagnosis of the disease.
310
Give 5 risk factors for breast cancer.
1. Female sex.
2. Increasing age.
3. Family history.
4. Uninterrupted oestrogen exposure.
5. OCP/HRT.
6. Obesity.
7. Previous radiation to chest.
9. Previous cancer.
311
When is breast cancer screening offered to women?
A mammogram is offered every 3 years between the ages of 50-70.
312
What is the most common type of breast cancer?
Invasive ductal carcinoma.
313
What investigations might you do in someone to confirm a diagnosis of breast cancer?
1. Clinical examination.
2. Biopsy.
3. Mammogram.
314
What inherited gene mutations can increase the risk of someone developing breast cancer?
BRCA1 and BRCA2.
p53 gene mutations too.
315
Name 5 causes of benign breast lumps.
1. Lipoma.
2. Fat necrosis.
3. Fibroadenoma - firm, smooth, mobile, painless.
4. Breast cysts and abscesses.
5. Duct ectasia.
316
Describe the management for breast cancer.
1. Wide local excision – removal of tumour.
2. Mastectomy +/- reconstruction.
3. Radiotherapy.
4. Chemotherapy.
5. Hormone therapy – reduced oestrogen activity in oestrogen receptor positive disease e.g. tamoxifen.
317
If a breast cancer is oestrogen receptor is this associated with a better or worse prognosis?
A better prognosis as hormone therapy can be used.
318
If a breast cancer expresses the oncogene HER2 is this associated with a better or worse prognosis?
Over-expression of HER2 is associated with aggressive disease and poorer prognosis. Give Herceptin (trastuzumab) and chemotherapy.
319
What can you use to treat breast cancers that express the oncogene HER2?
Herceptin (trastuzumab) and chemotherapy.
