PUBLIC HEALTH Flashcards
1
Q
What types of death are referred to the coroner for an autopsy?
A
natural -cause not known -not seen doctor in last 14 days iatrogenic -peri/post operative -anaesthetic -abortion -complications of therapy unnatural -unlawful -suicide -accidents -custody death -neglect
2
Q
what is the role of the autopsy
A
- who was the deceased
- how did they come about their death
- where did they die
- when did they die
3
Q
what are the stages of an autopsy
A
- history
- external exam
- identify
- injuries
- disease - eviseration
- internal exam
- reconstruction
4
Q
define patient compliance
A
the extent to which the patients behaviour coincides with medical or health advice
5
Q
why is adherence different from compliance
A
it acknowledges the importance of patient beliefs, it is more a patient centred model as apposed to the doctor knows best
6
Q
give examples of non adherence
A
- not taking prescribed medication
- taking bigger/smaller doses
- taking more/less often
- not finishing the course
- modifying treatment to accommodate other activities
- continuing with behaviours against medical advice
7
Q
describe unintentional and intentional reasons for non adherence
A
unintentional practical barriers -difficulty understanding instructions -problems using treatment -inability to pay -forgetting
intentional motivational barriers -patients belief's about their health -beliefs about treatment -personal preference
8
Q
what is meant by necessity belief concerns
A
patients have perceptions of personal need for treatment and concerns about a range of potential adverse consequences
adherence = increasing necessity belief and decreasing concerns
9
Q
what is patient centred care
A
a philosophy of care that encourages
- focus in the consultation on the patient as a whole patient who has individual preferences situated in a social context
- shared control of the consultation, decisions about interventions or management of health problems with the patient
10
Q
what are the positive impacts of good doctor patient communication
A
- better health outcomes
- higher compliance to therapeutic regimens
- higher patient and clinician satisfaction
- decrease in malpractice risk
11
Q
what is meant by concordance
A
the consultation is a negotiation between equals and has respect for the patients agenda
12
Q
what are the barriers to concordance
A
- time/resources
- communication skills
- challenging
- sometimes patients just want doctor to tell them what to do
- may worry patient more
- do patients want to engage in discussion with their doctor
13
Q
what are the duties of a doctor
A
- treat patients as individuals and respect their dignity
- protect and promote the health of patients and the public
- provide good standard of practice and care
- recognise and work within the limits of your competence
- work with colleagues in ways that best serve patients interests
14
Q
what ethical considerations must be taken into account when discussing care with a patient
A
- mental capacity
- decision detrimental to patient wellbeing
- potential threat to health of others
- children
15
Q
what is the cost to the NHS per year from health care associated infections ?
A
1 billion pounds
16
Q
what did the health act 2006 state about HCAI’s
A
infection control is every health care workers responsibility, not just the infection controls team, the possibility of health care related infections should be considered in all aspects of patient management, prosecution possible under health and safety law.
17
Q
what is the difference between colonisation and infection
A
Infections cause harm to the host
18
Q
what are the two routes of transmutation of infection from patient to patient and how can this risk be reduced?
A
- environment - design, cleaning, isolation
2. staff - barrier precautions, isolation, handwashing, PPE (personal protective equipment)
19
Q
what are CPE’s?
A
carbapenemase producing enterobacteriaceae
- coliforms
- colonisation of large bowel and moist sites
- produce carbapenems which are beta lactic antibiotics
- carbapenemases hydrolyse carbapenems and other beta lactase effectively conferring resistance to the entire class
20
Q
what is an endogenous infection? and how can they be prevented
A
an infection of a patient by their own flora
- good nutrition and hydration
- antisepsis
- control underlying diseases
- remove lines and catheters as soon as clinically possible
- reduce antibiotic pressure as much as clinically possible
21
Q
what are the main agents found in the work place that cause OLD
A
Vapour, gases, dusts, fume
22
Q
give an example of an OLD that is present within minutes
A
Asthma, infection e.g silicotuberculosis, direct injury
23
Q
define occupational asthma
A
90% -asthma induced by sensitisation (allergy) to an agent inhaled at work
10% - asthma induced by massive accidental irritant exposure at work (direct airway injury)
24
Q
what % of adult onset asthma is occupational
A
9-15%
1500 - 3000
25
what are the 3 main causes of occupational asthma
isocyanades - hardeners
flour
cleaning products
26
what is extrinsic allergic alveolitis/ hypersensitivity pneumonitis most commonly caused by
microorganisms, animals, vegetation, chemicals
27
what can asbestos cause to the respiratory system
pleural plaques, diffuse pleural thickening and asbestosis (pulmonary fibrosis)
28
what is a mesothelioma
- lung encased by tumour
| - rapidly progressive and usually incurable pleural cancer
29
how can we prevent OLD
- elimination e.g asbestos
- substitution e.g latex to nitrile
- engineering controls
- worker education
- RPE (masks and respirators)
- reduce exposure
- detect early
30
define incidence
the rate at which new diseases occur in a population during a specified time period
31
define prevalence
proportion of a population that have the disease at a point in time
32
what is the formula for prevalence
incidence x duration of disease
33
define mortality
the incidence of death from a disease
34
```
put in order from least useful to most useful and describe:
cohort study
intervention study
ecological study
case control
cross sectional study
```
-ecological study : uses population level data and studies relationships not cause
-cross sectional study:
looks at prevalence at a moment in time, relationship not cause
- case control : looks at people with a disease and those without (retrospective)
- cohort study: follows a group of people over a period of time (incidence study)
- intervention study : compares those with and without intervention
35
what is the estimate for number of COPD cases in UK and how many are diagnosed?
- 3.7mil
| - 900000
36
give an example of a genetic risk factor for COPD
alpha 1 antitrypsin deficiency
37
what is the incidence of lung cancer in the UK
40000 new cases per year
38
what % of all deaths in the UK is from lung cancer
7%
39
define palliative care
palliative care improves the quality of life of patients and families who face life threatening illness, by proving pain and symptom relief, spiritual and psychosocial supper from diagnosis to the end of life and bereavement
40
who is generalist palliative care provided by
- GP's, hospital doctors and nurses
- district nurses, community matrons
- nursing home staff, social workers
- COPD nurses
41
give four defining features of palliative care
- holistic
- individualised
- patient and family are clients
- multidisciplinary approach
42
what fraction of over 75's have a self reported chronic illness
2/3
43
why are the care needs of older people different to that of most young people
- multiple comorbidities
- greater risk of impairment from treatment complications
- increased psychological distress
- increased social isolation and economic hardship
44
how is COPD classified by severity
- mild - FEV1 50-70% of predicted
- moderate - FEV1 30%-50% of predicted
- severe - FEV1 <30%
45
In what % of COPD cases is smoking the predominant cause
80%
46
what are some key issues involved with COPD
- unpredictable illness trajectory
- difficulties with prognostication
- poor patient understanding
- limited access to specialist palliative care
47
what % of deaths are non cancer deaths and what % of patients receiving inpatient palliative care have cancer?
- 75%
| - 90%
48
what is meant by epidemiological transition
from communicable diseases being the main cause of mortality to non communicable diseases
49
define psychosocial risk factors
factors influencing psychosocial responses to the social environment and pathophysiological changes
50
what is a coronary prone behaviour pattern and why are these people more likely to get CHD? how can this be prevented?
Type A behaviour people, 70% of people in a study had this behaviour, they are more likely to be stressed and less relaxed which leads to CHD.
cognitive behaviour therapy - reconstruct how they think , behavioural therapy -reduce work demand- relax , emotional therapy - learning to relax in times of anxiety or anger.
reduce verbal and physical aggression
51
how can depression be measured
- MMPI
- beck depression inventory
- general health questionnaire
- Spielberger's
- patient health questionnaire PHQ-9
- generalised anxiety disorder assessment - GAD-7
52
how can psychosocial work characteristics attribute to CHD
- High demand/low control
- lack of social support
-long working hours
increases stress levels
53
what are the psychosocial risk factors of CHD
1. coronary prone behaviour pattern
2. depression and anxiety
3. psychosocial work characteristics
4. social support
54
how can lack of social support cause CHD
Less able to cope with life events , less motivation to engage in healthy behaviours
55
who does occupational health involve?
- individual workers
- groups of people
- surrounding population
- clients/customers
56
which occupational diseases are discussed in the 1974 health and safety work act (don't need all)
asbestosis, silicosis, coal miners pneumonocosis, occupational dermatitis, deafness, tenosynovitis, mesothelioma
57
which occupational diseases are most prevalent today
- occupational stress
- work related msk disorders
- occupational lung disease
- cancer
- noise induced hearing loss
- hand arm vibration
58
what is the difference between hazard and risk
```
hazard = potentially harmful
risk = probability of harm
```
59
what are the five types of work hazard
- mechanical
- physical
- biological
- psychosocial
- chemical
60
what 10 key components make a good job that is healthy to the employee
- individual control
- opportunities
- precariousness
- work demands
- fair employment
- work life balance
- prevents social isolation, discrimination or violence
- reintegrates sick and disabled
- shares info
61
what may raise suspicion that a disease has an occupational aetiology
an illness that fails to respond to standard treatment, doesn't fit typical demographic profile or is of unknown cause
62
why is long term wordlessness a risk to health
- mental illness
- 3x risk poor health
- loss of fitness and wellbeing
- social exclusion
- trapped on benefits till retirement
63
why are there inequalities in occupational health
- some jobs promote illness more than others
| - both physical and other risks
64
define disability
a physical or mental impairment which has a substantial long term adverse effect on a persons ability to carry out normal activities
65
what reasonable adjustments should employers make to a disabled person's job?
- alter their working hours
- allowing absence for medical treatment
- giving additional training
- getting special equipment or modifying existing equipment
- changing instructions or reference manuals
- changing an open plan working policy to accommodate someone with an anxiety condition or autism
- providing additional supervision or support
- making adjustments to premises.
66
what are the three levels of prevention of a disease
primary - monitor risks, control hazards, promotion
secondary - screening, early detection
tertiary - rehabilitation and support
67
list the Bradford Hills criteria for causal association
1. strength of association
2. biological plausibility
3. dose-response relationship
4. consistency of findings
5. lack of temporal ambiguity
6. coherence of evidence
7. specificity of association
68
what problems can be associated with flu and health care staff
- unwilling to work /anxiety
- child care
- risk to family
- antivirals
- redeployment of staff
- sharing of staff
69
what are the three key ethical analysis frameworks used in medicine
- Seedhouse ethical grid
- BMA flowchart
- four quadrants framework
70
what are the four centre aspects of Seedhouse's ethical grid
- respect persons equally
- respect autonomy
- serve needs first
- create autonomy
71
describe the four quadrants approach to ethics
- medical indications (beneficence and nonmaleficence) - clinical encounters include a review of diagnosis and treatment options
- quality of life (beneficence and nonmaleficence) the objective of all clinical encounters is to improve or address quality of life patient
- patient preferences (respect for autonomy) - clinical encounters occur because the patient presents with a complaint therefore the patient values are integral to the encounter
- contextual features (loyalty and fairness) - clinical encounters occur in a wider context beyond physician and patient, to include family, law, hospital policy, insurance companies etc.
72
what is the meaning of connectivity and interdependence in ethics
behaviour of one individual may affect others or wider systems
73
what is coevolution
adaption or changes by one organism alters other organisms (doctor and patient coevolve)
74
define mental health
a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community
75
what is the inverse care law
the availability of good medical care tends to vary inversely with the need for it in the population served
76
define health inequality
differences in health status or in the distribution of the health determinants between different population groups
77
in medicine, what is meant by a vulnerable patient
one that has an inability to cope with a hostile environment
78
what is meant by social exclusion
inability of an individual or community to participate effectively in economic, social, political and cultural life
79
why are there ethnic differences in health
- genetic factors
- individual behaviour
- material/structural
- migration and racism
- inequalities in access to health care
- artefact
80
what is the most common genetic disease in the UK
Sudden cardiac death (SCD)
81
what are the two forms of deontology
kantianism
| virtue ethics
82
describe the principles of kantianism (deontology)
| how may someone with a deontological belief approach truth telling?
- features of the act themselves determine worthiness
- following natural laws and rights
- duty ethics
- they may tell the whole truth in a way that is not particularly helpful
83
describe the principles of consequentialism/utilitarianism
- an act is evaluated sole in terms of its consequences
| - maximising good and minimising harm
84
describe the principles of virtue ethics
- focus is on the kind of person who is acting
- are they acting with good intentions
- integration of reason and emotion
- however any list of virtues may be different in different cultures and it does not provide clear judgement of what to do in a moral dilemma
85
what are the five focal virtues
```
compassion
discernment
truth worthiness
integrity
conscientiousness
```
86
what are the four principles of medical ethics + define
1. autonomy - the obligation to respect the decision of our patients
2. benevolence - providing benefits, balancing the benefits against risk
3. non maleficence - do no harm
4. justice - fairness in the distribution of benefits and risks
87
what is whistle blowing and why should we do it
- raising concerns about a person, practice or organisation
| - GMC duty of a doctor to make care of your patients first concern
88
what is team work
work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole
89
what are the problems that may arise when working as a team
- lack of teamwork - lack of working together to achieve a common goal
- lack of leadership -nobody in charge or nobody following designated leader
- lack of effort
- lack of communication
- lack of challenge - groupthink
90
what are the 6 components of teamwork
1. communication - clear purpose, agreed priorities, clear roles and responsibilities, decision making, conflict resolution, structured communication, clear record of events (SBARR situation, background, assessment, request/recommendation)
2. leadership - authority, credibility, drivers
3. authority gradient
4. situational awareness
5. declaring an emergency
6. training together -simulation
91
list belbin's team roles
- plant (creative)
- resource investigator
- coordinator
- shaper
- monitor evaluator
- teamworker
- implementer
- completor
- specialist
92
what is the epidemiological transition that has happened within the last 100 years
transition from communicable diseases being most prevalent to non communicable diseases
93
what is the population attributable risk (PAF)
the proportion of the incidence of a disease in the exposed and non-exposed population that is due to the exposure
- the incidence that would be eliminated if the exposure were also eliminated
94
what percentage of the difference in male mortality between high and low socioeconomic groups is due to smoking
59%
95
what factors attribute to an obesogenic environment
- biology
- individual psychology
- individual activity
- activity environment
- food consumption
- food production
- societal influences
96
define number needed to treat
the number of patients that need to be treated over a given time period in order to have an impact on one person
97
define psychosocial risk factors
factors influencing psychological responses to the social environment and pathophysiological changes
98
what are the four main psychosocial risk factors for IHD
1. coronary prone behaviour pattern
2. depression and anxiety
3. psychosocial work characteristics
4. social support
99
describe " coronary prone behaviour pattern '
- type A behaviour
- aggression, anger, hostility
- due to stress related illness more likely to get CHD
100
name four ways depression can be measured
- MMPI
- Beck depression inventory
- general health questionnaire
- spielbergers
101
what characteristics of a job may cause risk of MI
High demand/ low control
102
why can lack of social support increase risk of heart disease
- quantity and quality of social relationships
- help cope with life events
- motivation to engage in healthy behaviours
103
what is positive predictive value
the probability that subjects with a positive screening truly have the disease
104
what is negative predictive value
the probability that subjects with a negative screening test don't have the disease
105
describe sensitivity and specificity
sensitivity - the ability of a test to correctly identify those with the disease
specificity - the ability of the test to correctly identify those without the disease
106
what must consent be?
- voluntary
- informed
- made by someone with capacity
107
what do you need to tell people about their treatment
- what
- how
- risks
- benefits
- alternatives and their risks/benefits
- answer questions
108
what does the mental capacity act say about capacity
- a person must be presumed to have capacity unless it is established that he lacks capacity
- an act done or a decision made under this act or on behalf of a person who lacks capacity must be done with his best interests
109
when is someone unable to make a decision about their treatment/lacks capacity
1. cannot understand relevant information
2. cannot retain the information
3. cannot use the information or weigh it to make a decision
4. cannot communicate the decision
110
if someone is incompetent of making a decision how do you treat them
1. check whether there is someone who can make a decision on their behalf
2. or a healthcare professional can act in connection with the patients care and treatment if it is in the patients best interests
111
what must be considered when thinking about what is the patients best interests
1. whether the patient could have capacity and when that might occur
2. the patients past and present wishes and feelings
3. patients beliefs and values that would be likely to influence any decision
4. other factors he might consider to decide
5. consultation about 2-4 with anyone named as needing to be consulted, carers, people interested in his welfare, donees of a lasting power of attorney
112
what is Gillick/fraser competence
- capacity rules for children under 16
- does the child understand the consequences of the decision, including the social and emotional implications
- if yes then they can consent to treatment
- if no then parents consent in their best interests
113
what is meant by a patient that is "approaching the end of life"
- likely to die within the next twelve months
- advanced, progressive, incurable conditions
- general frailty and comorbidities
- existing conditions if they are at risk of dying from a sudden acute crisis
- life threatening acute conditions caused by sudden catastrophic events
114
what is advance care planning
discussion with patents and their families about their wishes and thoughts for the future, allowing them to live and die in the place of their choosing
115
what matters most to patients in end of life care
- symptom management
- choice and control
- dignity
- quality of life
- preparation - for patient and family, ensure meds available, explore preferred place of care
- carers support
- coordination and continuity
116
how is a death verified by examination
- no heart sounds or carotid pulse for one minute
- no breath sounds or respiratory effort for one minute
- no response to painful stimuli
- pupils fixed and dilated
117
what formal bereavement support is available
- counselling
- referral to GP
- specialist bereavement psychology support
118
what is anorexia nervosa
restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health (BMI < 17.5)
- intense fear of gaining weight or becoming at
- disturbance in the way in which ones body weight or shape is experienced
119
what are the subtypes of anorexia
restricting
| binge eating/purging subtype
120
what is bulimia nervosa
- recurrent episodes of binge eating characterised by both of the following:
- eating in discrete amount of time large amounts
- sense of lack of control over eating during an episode
- recurrent inappropriate compensatory behaviour in order to prevent weight gain (purging)
121
what are binge eating episodes
- eating much ore rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much one is eating
- feeling disgusted with oneself, depressed or very guilty afterwards.
122
what risk factors may contribute to onset of an eating disorder
- genes/temperament
- family interaction
- social pressures
- trauma
123
what complications can be associated with eating disorders
- bone deterioration
- physical damages e.g tears to oesophagus
- muscular weakness
- breathing problems
- deterioration of consciousness
- cardiac signs
124
what sort of therapies are most helpful for eating disorders
- diary keeping and weighing the patient
- CBT/group CBT
- family therapy for adolescent cases of anorexia
- no evidence based mediciations
125
give an example of the following drug types and what they do in the body:
- opiates
- depressants
- stimulants
- hallucinogens
- opiates e.g heroin, morphine - euphoria, pain relief
- depressants e.g alcohol, valium - sedation, relaxation, slow down thinking and acting
- stimulants - e.g caffeine, nicotine - increase alertness and activity, elevate mood
- hallucinogens e.g ecstacy, ketamine - alter sensory perception and thinking patterns, loss of sense of reality
126
what are the main types of NPS
"legal highs/ new psychoactive substances" mimic the effects of other substances but less predictably
- synthetic cannabinoids
- stimulant type drugs - mimic cocaine and ecstasy
- downer - mimic anti anxiety drugs
- hallucinogenics - mimic substances like LSD
127
What are the key reported side effects of NPS's
sort term
- temporary psychotic states and unpredictable behaviours
- sudden increase in body temperature, heart rate, come and risk to internal organs
- hallucination and vomiting
- intense comedown that can cause suicidal feelings
long term
--increase in mental health issues including psychosis, paranoia, anxiety and depression
- dependency
128
what are the models for treatment and prevention of drug addiction
- disease model - addiction is a chronic recurrent illness - treat with medication e.g substitute prescribing
- disease model 2 - a genetic disorder? - explore gene therapies
- behavioural model - a bad habit? - punishments to make behaviour unattractive, reward non using behaviours
- volitional model - a failure of will? increase self efficacy, self esteem, education on consequences
- sociocultural model - a symptom of social problems? target poverty, social exclusion, housing and mental health problems
129
what are the family risk factors that may lead to drug misuse
- family history of drug misuse
- family management problems
- family conflict including domestic abuse
- being in care
130
what are the school and community risk factors that may lead to drug misuse
- low academic attainment and commitment
- availability of drugs
- community norms
- community disorganisation
- transitios/mobility
- low neighbourhood attachment
131
what are the individual and peer risk factors that may lead to drug misuse
- risk taking
- rebelliousness and alienation
- friends who use drugs
- favourable attitudes towards antisocial behaviour
- experience of trauma
132
what is the difference between physical and psychological drug dependance
1. physical - the body adapts to presence of the substance and over time needs more and more for the same effect
2. psychological - feeling that life is impossible/ challenges cannot defaced without the drug
133
what are the features of dependence syndrome
- strong desire to use
- difficulty controlling substance taking behaviour
- physiological withdrawal state when reduce use
- tolerance (More for same effect)
- progressive neglect of pleasures.interests, increased time using
- persistent use despite evidence of harmful consequences
134
what are the features of substance use disorder (give 3)
Consuming more than originally planned
Worrying about stopping/consistently failed efforts to control use Spending a large amount of time using/obtaining substance
Use results in failure to fulfil major role obligations
Craving
Continued use despite health problems caused or worsened by it Continued use despite negative relationship effects
Repeated use in a dangerous situation e.g. driving
Giving up or reducing activities
Building up a tolerance to the alcohol or drug (more for same effect)
Withdrawal symptoms after stopping e.g. anxiety, irritability, fatigue, nausea, hand tremor or seizure in the case of alcohol
135
what are the features of the national drug strategy 2017
- reducing demand
- restricting supply
- building recovery in communities
- support local councils
- abstinence focused with greater emphasis on recovery and support
136
what is community prescribing of drug cessation treatment
- delivered by GP
- substitution treatment to help patient come off drugs gradually
- counselling, advice, community detox, referral to housing, help with criminal justice issues, vaccination
137
what is a standard unit of alcohol
8 grams or 10ml of pure alcohol
138
how do you calculate the number of units in a drink
strength of the drink (%abv) x amount of liquid in millimetres
divided by 1000
139
what is meant by the alcohol harm paradox
individuals in higher socioeconomic status groups are more likely to report drinking excessive amounts of alcohol, and yet those in lower socioeconomic groups are more likely to get alcohol related harm
140
what are the acute effects of excess alcohol (a few)
- accidents and injury
- coma and death from respiratory depression
- aspiration pneumonia
- oesophagitis/gastritis
- mallory weiss Syndrome - gastric tears
- pancreatitis
- cardiac arrthymias
- cerebrovascular accidents
- neurapraxia due to compression
- myopathy
- hypoglycaemia
141
what are the chronic effects of excess alcohol intake
- pancreatitis
-CNS toxicity e.g dementia
- liver damage
- hypertension
-chd
-skin disorders \etc
etc
etc
etc
142
what is the largest mortality condition caused by alcohol
alcoholic liver disease
143
what is foetal alcohol syndrome
- pre and post natal growth retardation
- CNS abnormalities including mental retardation, irritability, incoordination, hyperactivity
- craniofacial abnormalities
- defects of eyes, ears, mouth, CVS, GUT
144
what are the symptoms of alcohol withdrawal
- tremulousness
- activation syndrome: agitation, tachycardia, hypertension
- seizures
- hallucinations
- delirium tremens -is a rapid onset of confusion usually caused by withdrawal from alcohol.
145
give some policy and practice recommendations for preventing harmful drinking
1. price
2. availability
3. marketing
practice
1. licensing
2. recourses for screening and brief interventions
3. supporting children and young people
4. screening
5. advice for adults
6. referral to specialist treatment
146
whats the primary and secondary prevention of excessive alcohol use
primary - health promotion " know your limits" binge drinking campaign
-drink aware alcohol labelling
-think! drink driving campaign
-restriction on advertising
-minimum pricing
secondary -
-exploring alcohol consumption with patients
- ask about it using screening questions/tools
-detect problem drinking
147
what are the criteria for suffering with alcohol abuse
repeatedly caused one or more in past year:
- role failure
- risk of bodily harm
- run ins with the law
- relationship trouble
148
what are the criteria for suffering with alcohol dependence
in the past 12 months:
- shown tolerance
- shown signs of withdrawal
- not been able to stick to drinking limits
- spent a lot of time drinking
- spent less time on other matters
- kept drinking despite problems
149
what is the CAGE questionnaire for drinking
C - have you ever felt you should Cut down
A - have people Annoyed you by criticising your drinking
G - have you ever felt Guilty about drinking
E - eye opener - have you ever taken a drink first thing in the morning to steady your nerves or get rid of a hangover
150
what are the four tiers of support for substance misuse
1. non substance misuse specific services
2. open access drug/alcohol services
3. specialist community based clinics
4. specialist in patient services
151
what are the NHS guidelines for alcohol consumption amount per week
- not regularly drinking more than 14 units a week
- spread it over three or more days if you do
- if you're trying to reduce the amount you drink its a good idea to have several alcohol free days each week
152
what is AUDIT in alcohol related abuse
a screening evidence based tool - alcohol use disorders identification test
153
what is SADQ in alcohol abuse
severity of dependence questionnaire
- 20 questions
- physical and affective withdrawal symptoms
- relief drinking
- frequency of consumption
- speed of onset of withdrawal symptoms
154
what is "dependence"
a state in which an organism functions normally only in the presence of a drug
155
wha are the interventions for patients who are dependent on alcohol
- community based assisted withdrawal
- in patient based assisted withdrawal
- treatment with benzodiazepines
- preferred choice chlordiazepoxide
156
what happens to the number of calcium channels on neurones in chronic alcohol use
they multiply, causing reduced cl ion flow, electrical impulse in the nerve increases
157
which drug is used for alcoholic relapse presentation
Nalmefine (selnicro) - opioid receptor antagonist
| - modifies activity of at receptor sites link to reward mechanisms
158
what are the seven types of stool listed on the bristol stool chart
type 1 - separate hard lumps, like nuts
type 2 - sausage shaped but lumpy
type 3 - like a sausage but with cracks on the surface
type 4 - like a sausage or snake, smooth and soft
type 5 - soft blobs with clear cut edges
type 6 - fluffy pieces with ragged edges, a mushy stool
type 7 - watery, no solid pieces - entirely liquid
159
what are the package of prevention and treatment measures of diarrhoea (WHO)
prevention
1. rotavirus and measles vaccines
2. promote early and exclusive breastfeeding + vitamin A supplements
3. promote hand washing wish soap
4. improved water supply quality and quantity
5. community wide sanitation promotion
treatment
1. fluid replacement to prevent dehydration
2. zinc treatment
160
list as many notifiable diseases as you can
```
rabies
plague
mumps
yellow fever
whooping cough
rubella
legionnaires disease
cholera
diphtheria
enteric fever
food poisoning
acute meningitis
measles
malaria
leprosy
infectious bloody diarrhoea
small pox
tetanus
tuberculosis
typhus
and many more
```
161
why notify a communicable disease?
- outbreak detection
- early warning
- forecasting
- extent and severity
- risk factors
162
why are some diseases notifiable
- need specific control measures
- vaccine preventable
- nasty diseases
163
what is the difference between primary and secondary vaccine failure
primary - person doesn't develop immunity
| secondary - initially responds but protection wanes over time
164
what is a meningococcal infection and what is it caused by
- meningitis or septicaemia
| - caused by Neisseria meningitidis
165
who is effected by contact tracing of meningitis
- anyone who had close contact with a case in the past 7 days
- that being, kissing, sleeping with, spending the night together or spending an excess of eight hours in the same room
166
what is an incubation period
time between infection being acquired and onset of symptoms
167
what is the prophylaxis for meningococcal disease
- advice
- antibiotic chemoprophylaxis
- immunisation
168
which vaccines does a baby receive at 8 weeks old
- DTaP/IPV/Hib - diphtheria, tetanus, pertussis, polio, influenza type b
- PCV - pneumococcal
- MenB - meningococcal group B
- rotavirus
169
which vaccines does a baby receive at twelve weeks old
- DTaP/IPV/Hib (2)
- Men C
- Rotavirus (2)
170
which vaccines does a baby receive at 16 weeks
- DTaP/IPV/Hib (3)
- Men B (2)
- PCV (2)
171
which vaccines does a baby receive at one year old
- Hib/MenC (4,2)
- PCV (3)
- MMR
- MenB(3)
172
which vaccine do children receive from 2-6 yrs
Flu (annually) (LAIV)
173
what vaccines doe children receive at three years four months
DTaP/IPV (4)
| MMR (2)
174
what vaccine do girls aged 12-13 get
HPV (human papillomavirus) (two doses)
175
what vaccines do teenagers get at 14 years old
- Td/IPV (tetanus, diphtheria and polio) (4,4)
| - MenACWY
176
what vaccines do you get 65+
pneumococcal (PPV)
influenza annually
shingles
177
list some high risk activities for msk disorders
```
heavy manual lifting
lifting above shoulder height
lifting from below knee height
incorrect manual handling technique
forceful movements
fast repetitive work
poor posture
```
178
list some occupational arm/hand problems
- beat elbow
- tennis elbow
- golfers elbow
- hand - arm vibration syndrome
- carpal tunnel syndrome -seamstress finger - hyperextension of distal interphalangeal joint
179
what is carpal tunnel syndrome and when may a patient get it
(median nerve compression) can cause wasting of the thenar eminence
- associated with obesity, short stature, pregnancy, diabetes, hypothyroidism, RA, acromegaly
- forceful repetitive work in which work is in abnormal posture - e.g painting
- prescribed for industrial disablement benefit - benefit given if the patient has developed carpal tunnel from work
180
what is raynaud's phenomenon and what can it be caused by in the work place
vasospasm of the digital arteries in which the patient experiences a triphasic colour change of the fingers
- white - blue - red
- hand arm vibration syndrome can cause secondary raynaud's phenomenon
181
what are the symptoms of hand arm vibration syndrome
- vascular (blancing) and sensori-neural (tingling, numbness and loss of dexterity)
182
which test can identify hypothenar hammer syndrome (occlusion of ulnar artery and superficial palmar arch)
Allens test
183
what is tenosynovitis
Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness.
184
what is epicondylitis
- on lateral side - tennis elbow
- on medial side - golfers elbow
- due to repetitive movement of the joint in a specific angle
- causes tenderness, weakness of grip
185
what is repetitive strain disorder
- non specific pain in the hand
- fatigue of the muscles in the hand
- often treated with rest, or ergonomically neutral working postures
186
compare mechanical and neurological back pain
```
mechanical
simple back pain
- presentation between ages 20 - 55
- lumbrosacral region, buttocks and thighs
-pain mechanical in nature
-varies with physical activity and time
-patient well
-prognosis good
-90% recover from acute attack within 6 weeks
```
neurological
nerve root pain
- unilateral leg pain worse than low back pain
-pain generally radiates to foot or toes
- numbness or paraesthesia in same distribution
- nerve irritation signs
- reduced SLR which reproduces leg pain
- motor sensory or reflex change
-limited to one nerve root
-prognosis reasonable
-50 % recover from acute attack within 6 weeks
187
what are the red flags for serious spinal pathology
- age of onset less than 20 or greater than 55
- violent trauma
- constant, progressive, non mechanical pain
- thoracic pain
- PMH carcinoma, systemic steroids, drug abuse, HIV
- systemically unwell, weight loss
- persisting severe restriction of lumbar flexion
- widespread neurology
- structural deformity
- sphincter disturbance
- current or recent infection
- nocturnal pain
- worse pain on being supine
188
define bio mechanics
the measurement of the range, strength, endurance, speed and accuracy of human movements
189
what is the difference between crystalloid and colloid volume expanders
crystalloid
- small molecules which pass through cell membrane
- move from intravascular space extravascular space
colloid
- large molecules which do not pass cell membrane
190
what are the four moral principles and define them
autonomy - the right to make one's own decisions
justice - everyone receives the same standard of care/ fair distribution of good in society
non maleficence - do not harm the patient
beneficence - duty to be of benefit to the patient
191
what is epidemiology
the study of the distribution and determinants of health related states or events in specified populations.
192
what is a migrane
- unilateral pain distribution
- premonitory visual disturbance
- presence of nausea or vomiting
193
what are the risk factors of a migrane
- age and sex
- sex hormones (OC)
- family history
- education, income and socioeconomic status
194
what is the definition of stroke
- rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours or leading to death
195
what are the risk factors of stroke
- age
- sex
- hypertension
- smoking
- alcohol consumption
- cardiac disease
- DM and lipids
196
what is the % attributable risk of stroke
75%
197
what age groups are likely to have epilepsy
- young and old
198
what is the incidence of parkinsons
- increases with age
199
who is parkinsons LESS common in
-smokers
200
which age group is most likely to be diagnosed with MS
- 20 to 35
201
what is cerebral palsy
non progressive brain damage before or during neonatal period
- RF - low birth weight
202
what is Creutzfeldt-Jakob Disease
- neurodegenerative disease, dementia that is rapdily progressive
- 14% gene mutation
203
What is expert medical generalism
provision of health care to all patients with any medical need
204
define culture
shared values and beliefs that interact with an organisations structure and control systems to produce behavioural norms
205
what is a positive safety culture
where staff have a constant and active awareness of the potental for things to go wrong
- open and fair
- encourages people to speak up about mistakes
- shared values and responsibilities
- produces behavioural norms
206
what does the cognitive, psychological and behavioural manifestation of CNS disorders depend on
- the tempo of the underlying disorder
- the brain regions it affects
- the neurotransmitter systems it involves
- individual characteristics such as age, sex and psychosocial background
207
what is transient global amnesia
- abrupt memory loss (retrograde amnesia) and unable to learn new info (ante retrograde) that usually returns to normal within a few hours
- causee is unknown but a migraine like depression of temporal lobe is a favoured possibility
- attacks associated with physical or emotional stress in a significant minority of cases
208
what are somatisation disorders
when physical symptoms are caused by mental or emotional factors
209
what are hypochondrias
fear that minor symptoms may be due to a serious disease
210
what is a conversion disorder
when somatisation causes symptoms which suggest a serious disease of the brain or nerves e.g total loss of vision
211
what is a pain disorder
a person has persistent pain that cannot be attributed to a physical disorder
212
what is the Gini coefficient
a statistical representation of nations income distribution amongst its residents - lower the coefficient the greater the equality among people.
213
what model is the most powerful predicator of health experience
socio-economic model of health
214
what is the black report (1980)
used to describe reasons for inequalities in health
- material (environmental)
- artefact (an apparent product of how inequality is measured)
- selection (sick people sink socially and economically)
- cultural/behavioural ( poorer people behave in unhealthy ways)
215
what does the acheson report say about health inequality
- income inequality should be reduced
| - give high priority to the health of families with children
216
what is proportionate universalism
- focusing on the disadvantaged only will not help to reduce the inequality
- action must be universal but with a scale and intensity proportional to the disadvantage
- fair distribution of wealth is important
217
describe 3 theories of causation of illness
- psychosocial
stress results in inability to respond effectively to bodies demands, impacts bp, cortisol levels and inflammatory and neuro-endocrine responses
-neomaterial
- more hierarchal societies are less willing to invest into the provision of public goods
poorer people have less material goods, quality of which is generally lower
-life course
a combination of both above
critical periods - possess greater impact at certain points in the life course (childhood)
accumulation - hazards and their impacts add up,
interactions and pathways e.g sexual abuse in childhood leads to poor partner choice in adulthood
218
what are the 4 domains of public health
- health protection
- improving services
- health improvement
- addressing the wider determinants of health
219
what is meta ethics
- exploring fundamental questions - right/wrong
220
what are the five ethical theories
- virtue
- categorical
- imperative
- utilitarianism
- 4 principles
221
list the four ethical arguements
- deductive (one general ethical theory applied to all medical problems)
- inductive (settled medical cases generate theory or guides to medical practice)
- considering what we believe in
- ethical analogies
222
list some ethical fallacies
- authority claims - saying a claim is correct because the authority have said so
- motherhoods - inserting a soft statement to disguise the disputable one
- no true scotsman - modifying the arguement
223
what are the structural determinants of illness
- social class
- poverty
- unemployment
- discrimination
- gender and health
224
what is the biomedical model of health medicine
- mind and body are treated seperately
- body, like a machine, can be repaired
- privileges use of technological interventions
- it neglects social and psychological dimensions of disease
225
when is disclosure of confidential information allowed and what is the criteria for its disclosure
```
allowed if
- required by law (notifiable, ordered by judge)
- patient consents
-public interest (serious communicable disease)
the data must be
-anonymous is practicable
- patients consent (overrule?)
- kept to a necessary minimum
- meets current law (data protection)
```
226
what are the three main notifiable diseases that must be reported to WHO
- cholera
- yellow fever
- plague
227
give five lifestyle factors promoting mortality
- smoking
- obesity
- sedentary life
- excess alcohol
- poor diet
228
what is the difference between health behaviour, illness behaviour and sick role behaviour
- health behaviour - aimed to prevent disease
- illness - aimed to seek remedy ( goes to doctor)
- sick role - aimed at getting well (compliance, resting)
229
what are the two models of behavioural change
- health belief model
| - transtheoretical model
230
describe the health belief model (becker 1974)
- individuals must believe they are susceptible to the condition
- that the condition has serious consequences
- that taking action reduces their risk
- that the benefits of taking action outweigh the costs
231
describe the transtheoretical model
- precontemplation (no intention giving up smoking)
- contemplation
- preparation
- action
- maintenance
- relapse
232
define morality
the concern with the distinction between good and evil or right and wrong
233
what is ethics
a system of moral principles and a branch of philosophy which defines what is good for individuals and society
234
describe utilitarianism/consequentialism
an act is evaluated solely in terms of its consequences - maximising good and minimising harm
- however this cannot respect the rights of indviduals
235
describe kantianism
- features of the act themselves determine worthiness
- following natural laws and rights
- a set of universal moral premises from which the duties are derived (do not lie, do not kill)
- forces humans into an internal conflict between reason and desire
236
describe virtue ethics
focuses on the kind of person acting, are hey expressing good character or not?
integration of reason and emotion
237
what are the five focal virtues
- compassion
- discernment
- trustworthiness
- integrity
- conscientiousness
238
describe the four principles
- autonomy - the ability to make ones own decisions on their health care
- benevolence - providing benefits
- non maleficience - do no harm
- justice - fairness in the distribution of benefits and risks
239
what are the GMC duties of a doctor
- protects and promote the health of patients and the public
- provide good standard of practice and care
- recognise and work within the limits of your competence
- work with colleagues in the ways that best serve patients interests
- treat patients as individuals and respect their dignity
240
what do the katz ADL scale include
- bathing
- dressing
- toilet use
- transferring (in/out of bed or chair)
- urine and bowel contience
- eating
241
what does the IADL scale include (instrumental activities of daily living)
- use of telephone
- travelling by car or public transport
- food or clothes shopping
- meal prep
- housework
- medication use
- management of money
242
what does the barthel ADL index include (10 items to measure daily functioning)
- feeding
- moving wheelchair to bed
- grooming
- transferring to and from toilet
- bathing
- walking on level surface
- going up and downstairs
- dressing
- continence of bowel
- continence of bladder
243
what is the name for using multiple medications
polypharmacy
244
what are the key challenges of an aging population
- strains on pension and social security systems
- increasing demand for health care
- bigger need for trained workforce
- increasing demand for long term care
- pervasive ageism (denying older people the rights and opportunities available for other adults)
245
what are the causes of an aging population
- improvements in sanitation
- life expectancy rising
- decline in premature mortality
- more people reaching old age while fever children born
- higher age of first pregnancy
246
what is intrinsic and extrinsic aging
intrinsic - natural, universal, inevitable
| extrinsic - dependent on external factors
247
why do women live longer than men
20% biological - women are protected from heart disease by hormones
80% environmental - men take more lifestyle risks than women
248
what is meant by medicalisation of death
death is seen as a failure, death as natural part of life has changed
249
describe the four types of awareness during death
- closed awareness - patients are unaware they are going to die
- suspicion awareness - patients do not know for sure but are suspicious and think doctors know
- mutual pretence - medical staff and pts pretend they dont know the pt is dying
- open awareness - the situation in which medical staff and pts admit to the knowledge the pt is going to die
250
what is a social death
when people die in social and interpersonal terms before their actual death
251
what is death the hospice way
open awareness, compassion, honesty
MDT
Emotion and relationships
holistic care
252
what is the chain of infection
- susceptible host
- causative microorganism
- reservoir
- portal of entry/exit
- mode of transmittion - exogenous (direct/indirect contact, vector, airborne), endogenous (self spread)
253
which two organisms does alcohol gel not kill
norovirus
| clostridium difficile
254
how many deaths per year are due to smoking
100,000
255
what laws were implemented in 2007 regarding smoking
- smoking in public banned + legal min age raised to 18 in uk
256
what methods can be used to stop smoking
- NRT (nicotine replacement therapy) - patches, gums, nasal spray
- non nicotine - varenicline, buproprion
- transtheoretical model
257
what are the millenium development goals for global health
- eradicate extreme poverty and hunger
- achieve universal primary education
- promote gender equality and empower women
- reduce child mortalitiy
- improve maternal health
- combat HIV/AIDS , malaria and other dieseases
- ensure environmental sustainability
- develop a global partnership for development
258
what are the three leading causes of death in children in the developing world
pneumonia
diarrhoea
malaria
259
give some examples of migrants
```
asylum seekers
refugees
trafficked people
migrant workers
family joiners
international students
```
260
what are the nhs goals for treatment of migrants
- equity of access
- reducing gap in health inequalities
- providing services for the vulnerable
- ensuring the services are appropriate and accessible
261
define sustainability
being able to meet the needs of today without compromising the ability of future generations to meet the needs of tomorrow
262
define sensitivity
the proportion of people with the disease who are correctly identified by the screening test
263
define specificity
the proportion of people without the disease who are correctly excluded by the screening test
264
define positive predictive value
the proportion of people with a positive test result who actually have the disease
265
define negative predictive value
the proportion of people with a negative test result who do not have the disease
266
describe the wilson and jungner criteria for screening
condition
- should be a serious health problem
- with a well understood aetiology
- should be a detectable early stage
treatment
- accepted treatment for disease
- facilities for diagnosis and treatment available
- cant be an unmanagable extra clinical work load
test
- suitable test for early stage
- test should be acceptable for the patients
- intervals for repeating the test should be determined
benefits
- there should be an agreed policy on whom to treat
- the cost should be balanced against the benefits
267
define selection bias
people who choose to participate in screening programmes may be different from those who do not
268
lead time bias
screening merely identifies the disease earlier than before and thus gives the impression that survival is prolonged
269
length time bias
disease with longer period of presentation are more likely to be identified by screening than the ones with shorter time of presentation
270
what are the two outcomes of a medical error
- adverse event
| - near miss
271
what are the types of human error
- errors of omission (action not taken/delayed)
- errors of commission (wrong action taken)
- errors of negligence (the actions or omissions due not meet the standard of an ordinary skilled person)
- skill based errors - when performing a routine task little attention given and memory lapses
- rule/knowledge based errors - an incorrect plan or course of action is chosen (No experience)
272
what is a violation
deliberate deviations from practices procedures and standards or rules
273
what are the types of violation
- routine (cutting corners)
- necessary (to get job done)
- optimising (personal gain)
274
what are two approaches to managing errors
- the person approach - individual - errors are the products of wayward mental processes of individual people in the system
- the system approach - organisational - adverse effects are product of many causal factors (swiss cheese
275
define stress
stress occours when the demands made upon an individual are greater than their ability to cope
276
what is eustress
a positive stress which is beneficial and motivating
277
list some types of stressors
acute - noise, danger, injuries, hunger
chronic - health, home, finances, work
internal - physical (inflammation, infection), psychological (attitudes, work, social and cultural pressure)
278
describe the flight or flight response to stress
- an autonomic response to external acute stressors
- elicits a physiological response
hypothalamus: sympathetic system and adrenocorticosteroid system
both adrenal medulla (Ad Nad) and cortex (cortisol) activated
activation of specific organs
- inc RR
- blood flow - increasing up to 400%
- skeletal muscles - tense
- spleen - more RBC discharged
- skin - blood flow directed away to support skeletal muscles and heart
- immune - WBC redistributed
279
what are the three stages of the general adaptation syndrome
- alarm
- adaptation
- exhaustion
280
what are the 5 signs of stress
biochemical - endorphin and cortisol levels altered
physiological - shallow breathing, raised BP, more HCL production
- bahvioural - overeating, anorexia, insomnia, more alcohol or smoking
- cognitive - negative thoughts, no concentration, worse memory, tension headaches
- emotional - mood swings, irritability, aggression, boredom, apathy, tearfulness
281
what are the PTSD diagnostic criteria
- the person experienced an event that involved actual or threatened death or serious injury to physical integrity
- the persons response involved intense fear, helplessness or horror
282
what are the symptoms of PTSD
the event is persistently re-experienced in recollections and dreams
- persistent avoidance of stimuli associated with the event
- persistent symptoms of increase arousal (insomnia, irritability)
283
what are the seven key domains of energy balance
- food environment
- food consumption
- individual activity
- societal influences
- individual psychology
- individual biology
284
what is the difference between satiation and satiety
satiation - what brings an eating period to an end
protein>CHO>dat>alcohol
satiety - inter-meal period
285
what factors promote overeating
```
environmental
-portion size
-distractions
- social facilitation
psychological factors
-stress
-sleep
-dietary restrains
-reward sensitivity
food characteristics factors
- macros
-energy density
-liquids vs solids
```
286
who is most likely to use CAM
```
35-60
women
higher income
higher education
>60% have chronic disease
geographical variation in uk, mostly south and south west
autism spectrum disorders
```
287
what are the NHS big five of CAM
1. acupuncture
2. chiropractic therapy
3. homeopathy
4. herbal medicine
6. osteopathy
288
what is the opportunity cost of an activity
the sacrifice in terms of the benefits forgone from not allowing resources to the next best activity
289
what are the types of economic evaluation (assessing whether benefit is maximised)
- cost effectiveness analysis (outcomes measured in natural units: incremental cost per life year gained)
- cost utility analysis (outcomes measured in quality adjusted life years: incremental cost per QALY gained)
- cost benefit analysis (outcomes are measured in monetary units: net monetary benefit)
