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Phase 2A Medicine > Public Health > Flashcards

Public Health Flashcards

1
Q

Give 5 questions used to screen for an occupational health disorder.

A

a. What type of work do you do?
b. Do you think your health problems might be related to your work?
c. Are your symptoms different at work and at home?
d. Are you exposed to chemicals, dust, metals, noise or repetitive work? Have you been in the past?
e. Are any of your co-workers experiencing similar symptoms?

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2
Q

What are the benefits of work?

A
  1. lower mortality
  2. pay/income
  3. feelings of accomplishment, better self-esteem and better mental health
  4. social relationships
  5. structure to life
  6. improved fitness
  7. reduced state benefits
  8. most patients do not need to be 100% fit before returning to work
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3
Q

What kind of hazards can people be exposed to at work?

A
  • noise
  • repetitive work
  • dust
  • fumes
  • chemicals
  • other allergens like flour, pollen, mushroom
  • metals
  • blades and machinery
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4
Q

When is an illness due to work?

A
  • symptoms improve away from work or on holiday
  • characteristic distribution of rash eg contact dermatitis
  • sensorineural deafness with characteristic pattern on audiogram caused by noise
  • a cluster of cases in a workplace
  • exposure to hazard can be linked to disease
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5
Q

What is the Bradford Hill criteria?

A

It is a group of 9 principles that can be used to establish epidemiological evidence of a causal relationship between a presumed cause and an observed effect. Eg. Cigarette smoking and lung cancer.

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6
Q

State 5 principles of the Bradford Hill criteria.

A
  1. Strength of association
  2. Consistency in association
  3. Specificity
  4. Temporal relationship
  5. Coherence of evidence
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7
Q

Give 3 examples of high risk activities for musculoskeletal problems.

A
  • heavy manual handling (>20kg)
  • lifting above shoulder height
  • fast repetitive work; poor posture; poor grip
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8
Q

Name two work-related causes of carpal tunnel syndrome.

A
  1. extremes of flexion-extension of wrist (painters, meat processors)
  2. hand-transmitted vibration
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9
Q

What is hand-arm vibration syndrome and what causes it?

A

A cause of secondary Raynaud’s phenomenon. Caused by excessive exposure to hand-transmitted vibration like chain saws, angle grinders, jack hammers and drills.

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10
Q

How does a person with hand-arm vibration syndrome present?

A

vascular component- blanching

neural component- tingling, numbness and loss of dexterity

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11
Q

Give 2 examples of musculoskeletal disorders caused by forceful and repetitive hand movements.

A

carpal tunnel syndrome
tenosynovitis
epicondylitis (especially tennis and golf players)

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12
Q

What is repetitive strain disorder and how does one overcome it?

A

It is used to describe non-specific pain in the hand.

It can be managed with rest breaks, job rotation, reduced force and ergonomically neutral working positions.

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13
Q

Which tendon is usually affected by rotator cuff problems?

A

supraspinatus tendon

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14
Q

What type of jobs have a high risk of leading to rotator cuff problems?

A

Jobs which involve heavy manual handling, lifting above shoulder height and throwing.

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15
Q

What is thoracic outlet syndrome?

A

Pain or tingling down the arm or blanching of fingers related to the posture of the arm, caused by compression of the trunks of the brachial plexus or subclavian artery under the clavicle due to anatomical abnormalities in the neck.

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16
Q

How would you manage osteoarthritis of the hip?

A
  • weight loss, NSAIDs, paracetamol, arthroplasty
  • stick in hand contralateral to affected hip or knee
  • shoe inserts to correct abnormal biomechanical loading
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17
Q

What conditions are associated with osteoarthritis of the knee?

A

obesity, trauma and meniscectomy (surgical removal of a torn meniscus)

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18
Q

What measures can you take to help a patient get back to work?

A
  • talk about returning to work
  • discuss any barriers
  • provide a fit-note
  • phased return, restricted duties, workplace modifications
  • help regain lost confidence
  • enquire if the employer has an occupational health service you can contact with the patient’s consent
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19
Q

Name two findings you would expect to see on an MRI of someone with mechanical back pain.

A

disc degeneration and bulging discs

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20
Q

What advice would you give a patient with mechanical back pain?

A

Avoid prolonged inactivity and maintain normal activities within limits of back pain

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21
Q

What factors is mechanical back pain associated with?

A

heavy manual handling, stooping and twisting whilst lifting, exposure to whole body vibration, psychosocial distress, smoking and dissatisfaction with work

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22
Q

Give examples of neurological infections that can be prevented using vaccines.

A

Poliomyelitis, tetanus, measles, H. influenzae, meningococcus, tuberculosis

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23
Q

Define epidemiology.

A

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

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24
Q

What is clinical epidemiology?

A

Using information about distribution and determinants of health-related states or events in a clinical setting, especially in diagnosis.

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25
Q

How is a case defined?

A

Based on clinical, laboratory/imaging and pathological findings.

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26
Q

Give examples of common neurological disorders that are of public health importance.

A

Migraine headache, stroke, dementia, epilepsy, Parkinson’s disease, multiple sclerosis and cerebral palsy.

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27
Q

What are the risk factors for migraine?

A

age and sex (female)
sex hormones (oral contraceptive)
family history
education, income and socio-economic status

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28
Q

What are the risk factors for stroke?

A 
increasing age
sex (male)
hypertension (main one)
smoking
alcohol consumption 
cardiac disease
diabetes mellitus and lipids
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29
Q

What is the current policy on the prevention of dementia?

A

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

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30
Q

What factors contribute to the aetiology of epilepsy?

A 
genetic factors
febrile seizures
head injuries
bacterial/parasitic infections
viral meningo-encephalitides
toxic agents
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31
Q

What is the prevalence of Parkinson’s disease?

A

1 in 200 over 70 yrs

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32
Q

What is the mean survival for someone with Parkinson’s Disease?

A

10 - 15 yrs

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33
Q

Is smoking a risk factor for Parkinson’s?

A

No, it is notably less common in smokers.

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34
Q

What is the most common age of onset for multiple sclerosis?

A

20-35 yrs

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35
Q

The prevalence of which neurological condition is directly proportional to the distance from the equator?

A

Multiple sclerosis

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36
Q

Give 2 risk factors for cerebral palsy.

A

anoxia

low birth weight

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37
Q

What is the average age of onset for Creutzfeldt-Jakob Disease?

A

55 to 75 years

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38
Q

What is Creutzfeldt-Jakob disease?

A

It is a neurodegenerative disorder- a rapidly progressive dementia with abnormal EEG, cerebellar signs and myoclonus.

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39
Q

What is the peak age of incidence of variant CJD?

A

27 years

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40
Q

What are the known risk factors of variant CJD?

A

age (26 yrs)
residence in the UK between 1970 and 1990
methionine homozygosity at codon 129 of the prion protein gene

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41
Q

What is the difference between compliance and adherence?

A

Compliance is older terminology that assumes that the doctor knows best and hence the patient plays a passive role in their healthcare.
Adherence acknowledges the importance of patient beliefs and follows a more patient-centred approach.

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42
Q

Give examples of non-adherence.

A
  1. Not taking prescribed medication.
  2. Taking bigger/smaller doses than those prescribed.
  3. Taking medication more or less often than prescribed.
  4. Stopping the medicine without finishing the course
  5. Modifying treatment to accommodate other activities
  6. Continuing with behaviours against medical advice (smoking, drinking alcohol)
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43
Q

What are the two types of reasons for non-adherence?

A

Unintentional - practical barriers

Intentional - motivational barriers

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44
Q

Give examples of intentional reasons for non-adherence.

A

patient’s beliefs about their health/condition
patient’s beliefs about their treatment
personal preference

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45
Q

Give examples of unintentional reasons for non-adherence.

A

difficulty understanding instructions
problems using treatment
inability to pay
forgetting

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46
Q

Give 3 ways non-adherence following organ transplants can be reduced.

A

better patient selection
more education
simplified medical regimens

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47
Q

What are the two types of key beliefs that influence a patient’s evaluation of prescribed medication?

A

Necessity beliefs- perceptions of personal need for treatment
Concerns about a range of potential adverse consequences

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48
Q

Describe patient-centred care.

A

It is a philosophy of care that encourages focus in the consultation on the patient as a whole person who has individual preferences situated in a social context.

It also encourages shared control of the consultation, decisions about interventions or management of health problems with the patient.

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49
Q

Give 4 impacts of good doctor-patient communication.

A
  1. Better health outcomes
  2. High adherence to therapeutic regimens in patients.
  3. Higher patient and clinician satisfaction.
  4. Decrease in malpractice risk.
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50
Q

What is concordance?

A

Concordance is based on the notion that the work of the prescriber and the patient is a negotiation between equals and that there is a respect for the patient’s agenda. So the aim is therefore a therapeutic alliance between them.

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51
Q

List the steps for sharing decision making with the patient.

A
  1. define the problem and consider all views
  2. outline options and consequences
  3. provide information in preferred format
  4. check patient’s understanding
  5. ICE
  6. check acceptance
  7. review
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52
Q

What barriers to concordance do patients face?

A

They may not want to engage in discussion with their doctor as that can make them more worried and they would rather be told what to do.

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53
Q

Name 3 barriers to concordance faced by health professionals.

A
  1. relevant communication skills
  2. time/resources/organisational constraints
  3. challenging- patient choice vs evidence
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54
Q

What is adherence?

A

Adherence is the extent to which the patient’s actions match agreed recommendations.

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55
Q

What are the key principles in ensuring adherence?

A
  1. improve communication
  2. increase patient involvement
  3. understand the patient’s perspective
  4. provide information
  5. assess adherence
  6. review medicines
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56
Q

What ethical considerations must you take into account when discussing patient adherence?

A
  1. Mental capacity (Mental capacity act 2005- dementia, severe learning disability, head injury, mental health condition)
  2. Decision that may be detrimental to a patient’s well-being
  3. Public health threat (Public Health Act 2010- provides a legal basis to detain and isolate an infectious individual)
  4. When the patient is a child- Gillick competency and parent involvement
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57
Q

What is obesity?

A

Abnormal or excessive accumulation of fat that may impair health

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58
Q

Name some of the health implications of obesity.

A 
Heart disease
sleep apnoea
stroke
anxiety and depression
type 2 diabetes
osteoarthritis 
asthma
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59
Q

Name 4 factors that lead to issues with excess weight.

A
  1. accessibility to healthy food
  2. availability
  3. affordability
  4. acceptability
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60
Q

Name the 4 tiers of the UK obesity care pathway and give examples of commissioned services for each.

A

Tier 1: universal prevention- environmental health promotion
Tier 2: lifestyle intervention- multicomponent weight management
Tier 3: specialist services- multidisciplinary intervention
Tier 4: surgery- bariatric surgery

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61
Q

Give examples of national action taken towards reducing obesity.

A
  1. the sugar tax
  2. mandate calorie and nutritional labelling
  3. review physical activities in schools
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62
Q

Why is diabetes a public health issue?

A
  1. increasing prevalence
  2. large inequalities
  3. Lack of effective global, national and local policy
  • mortality, co-morbidity, disability, reduced quality of life
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63
Q

What are the stages of primary, secondary and tertiary prevention of diabetes?

A

primary- prevent diabetes
secondary- earlier diagnosis of diabetes
tertiary- effective management and supporting self-management

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64
Q

What lifestyle factors increase the risk of diabetes?

A
  1. sedentary lifestyle
  2. high calorie diet, low in fruit and veg
  3. obesogenic environment
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65
Q

What contributes to an obesogenic environment?

A
  1. physical environment- remotes control, lifts
  2. economic environment- expensive fruit and veg
  3. sociocultural environment- safety fears, family eating pattern
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66
Q

What are the risk factors for type 2 diabetes?

A 
age, ethnicity, family history
hypertension, vascular disease
weight, BMI, waist circumference 
history of gestational diabetes
impaired glucose tolerance, impaired fasting glucose
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67
Q

What are the currently available screening tests for impaired glucose tolerance and impaired fasting glucose?

A 
HbA1c 
random capillary blood glucose
random venous blood glucose
fasting venous blood glucose
oral glucose tolerance test
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68
Q

What is the oral glucose tolerance test?

A

Medical test for diabetes/insulin resistance in which venous blood glucose measured 2 hours after oral glucose load

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69
Q

What 3 interventions are required in the prevention of diabetes?

A
  1. sustained increased physical activity
  2. sustained change in diet
  3. sustained weight loss
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70
Q

Describe 3 approaches in diagnosing diabetes earlier.

A
  1. raising awareness of the disease and symptoms in the community
  2. raising awareness of the disease and symptoms in health professionals
  3. using clinical records to identify those at risk and/or using blood tests to screen before symptoms develop
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71
Q

How is NHS England promoting diabetes prevention?

A

Healthier You: the NHS Diabetes Prevention Programme

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72
Q

What does self-care for diabetes involve?

A 
self-monitoring
diet
exercise
drugs
education
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73
Q

What are the 4 steps in the prevention of diabetes?

A
  1. identify those at risk
  2. early prevention in those at risk
  3. diagnosing diabetes earlier
  4. effective management and self-supporting management
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74
Q

What is substance misuse

A

The harmful use of any substance for non-medical purposes or effect.

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75
Q

Which s the most commonly misused drug worldwide?

A

Cannabis

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76
Q

What are the different types of drugs that are misused?

A 
Opiates
Depressants
Stimulants
Cannabinoids
Hallucinogens 
Anaesthetics
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77
Q

What effects do opiates have?

A

Euphoria, analgesia

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78
Q

What effects do depressants have?

A

sedation, anxiolytic

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79
Q

What effects do stimulants have?

A

Increase alertness, alter mood

80
Q

What effects do cannabinoids have?

A

Relaxation, mild euphoria

81
Q

What effects do hallucinogens have?

A

altered sensory perception, thinking

82
Q

What effects do anaesthetics have?

A

Anaesthesia, sedative

83
Q

Give examples of opiates.

A

Heroin, codeine, tramadol

84
Q

Give examples of depressants.

A

alcohol, benzodiazepines

85
Q

Give examples of stimulants.

A

amphetamines, cocaine, crack, caffeine, ecstasy/MDMA

86
Q

Give examples of cannabinoids.

A

Cannabis

87
Q

Give examples of hallucinogens.

A

LSD, magic mushrooms

88
Q

Give examples of anaesthetics.

A

Ketamine, GHB, nitrous oxides

89
Q

What are the effects of drug misuse?

A 
mortality
morbidity- physical and psychological
social- crime, violence, acceptability
economic- productivity, tax
personal- identity, stigma, relationships
90
Q

What is addiction?

A

Severe substance use disorder involving the compulsive use of a substance despite harmful consequences.

91
Q

What is dependence?

A

Psychological and/or physical need that develops relating to substances.

92
Q

What are the 3 stages of addiction?

A

acute intoxication
harmful use
dependence

93
Q

Name 5 features of the dependence syndrome/substance misuse as listed in ICD10/DSM-5.

A

persistent use despite harmful consequences
tolerance
progressive neglect of pleasures/interests
withdrawal symptoms after stopping
consistently failed efforts to control use

94
Q

Give examples of preventative factors for substance misuse.

A 
self-control
parental monitoring & support
positive relationships
neighbourhood resources
academic achievement
school anti-drug policies
95
Q

Give examples of risk factors for substance misuse.

A 
aggressive childhood behaviour
lack of parental support
community deprivation/poverty
drug experimentation 
poor social skills
availability of drugs at school
96
Q

What local services can help people with substance misuse?

A 
GPs
harm reduction services like needle exchange
open access services
structured psychosocial interventions
prescribing services
detox (community or inpatient)
access to residential rehab
recovery support/mutual aid
97
Q

What are the recommended weekly guidelines for alcohol consumption?

A

14 units per week for men and women spread over 3 days or more

98
Q

What is a standard drink unit? What does it depend on?

A

A UK unit is 8 grams or 10 ml of pure alcohol.

It depends on the drink, how much there is and how strong it is.

99
Q

How does one calculate the number of units in a drink?

A

strength of drink (%) x amount of liquid in ml /1000

100
Q

What is the volume of the following in ml?

one pint
small glass of wine
bottle of wine

A

568 ml
125 ml
750 ml

101
Q

Drinking how many units of alcohol is a sign of dependency?

A

35 units per week

102
Q

What is the alcohol harm paradox?

A

Low socio-economic status groups consume lesser alcohol than higher SES groups but experience greater alcohol-related harm.

103
Q

When does drinking become too much?

A
  1. causes or elevates the risk of alcohol-related problems

2. complicates the management of other health problems

104
Q

What are the acute effects of excessive alcohol intake?

A 
accidents and injury
coma and death from resp depression
aspiration pneumonia
oesophagitis/gastritis
Mallory-Weiss syndrome
cardiac arrhythmias
cerebrovascular accidents
neurapraxia due to compression
hypoglycaemia
105
Q

What are the chronic effects of excessive alcohol intake?

A 
pancreatitis
hepatitis
liver cirrhosis
CNS toxicity- dementia, Wernicke-Korsakoff syndrome
Hypertension
Cardiomyopathy
Peripheral neuropathy
106
Q

What are the different ways in which alcohol withdrawal can manifest?

A 
Tremulousness
Activation syndrome- tremulousness, tachycardia, agitation, high BP
seizures
hallucinations
delirium tremens- medical emergency
107
Q

What are the clinical features of foetal alcohol syndrome?

A

pre- and post-natal growth retardation
CNS abnormalities- mental retardation, hyperactivity, irritability, incoordination
craniofacial abnormalities
increased birthmarks and hernias

108
Q

Name some of the craniofacial abnormalities in foetal alcohol syndrome.

A 
Epicanthic folds
microcephaly
short palpebral fissure 
smooth philtrum 
upturned nose
hypoplastic jaw
109
Q

Name some of the psychosocial effects of excessive alcohol consumption.

A 
interpersonal relationships- rape, violence, anxiety
problems at work
criminality
social disintegration- poverty
driving incidences/offences
110
Q

Give 3 policy recommendations for preventing harmful drinking.

A

Price- make it less affordable
Availability- licencing and import allowances
Marketing- limit exposure esp kids and young people

111
Q

Give 5 practice recommendations for preventing harmful drinking.

A 
resources for screening and brief interventions
supporting children and young adults
brief advice for adults
screening for adults
referral to specialist services
112
Q

Give 2 examples of primary prevention for harmful drinking.

A

health promotion: DrinkAware alcohol labelling, know your limits binge drinking campaign
Minimum unit pricing

113
Q

What does secondary prevention of harmful drinking involve?

A

screening and intervention

  • ask routinely about alcohol consumption
  • think of it in relation to lifestyle change (violence etc)
  • feed back whether or not it is a problem
114
Q

What questions and tools can you use to screen harmful drinking?

A

clinical interview
FAST- fast alcohol screening test
AUDIT- alcohol use disorders identification tests
CAGE questions

115
Q

What is the difference between at risk, alcohol abuse and alcohol dependence?

A

at risk drinking: hazardous- a pattern of drinking which brings about the risk of physical or psychological harm

Alcohol abuse (harmful drinking): a pattern of drinking which is likely to cause physical or psychological harm

Alcohol dependence: substance dependence is defined as a set of behaviours, cognitive and psychological responses that can develop after repeated substance use.

116
Q

How do you assess a person’s level of severity of harmful drinking?

A 
Determine, whether in the past 12 months, your patient's drinking has repeatedly caused or contributed to...
role failure
risk of bodily harm
run-is with the law
relationship trouble
117
Q

Give examples of pharmacological treatments used to manage alcohol dependence.

A

Acamprosate calcium
Dsulfiram
Nalmefene
Naltrexone

118
Q

Give examples of psychosocial treatments used to manage alcohol dependence.

A

therapy- cognitive and behavioural

social support like alcoholics anonymous

119
Q

What are the 4 questions in the CAGE questionnaire related to?

A

Cut down
Annoyed
Guilty
Eye-opener (drink first thing in the morning)

120
Q

What is the FRAMES summary of motivational interviewing?

A 
Feedback
Responsibility (for change)
Advice (on cutting down)
Menu (of alternative strategies)
Empathetic style
Self-efficacy
121
Q

Which tool can be used to help classify diarrhoea?

A

Bristol Stool Chart

122
Q

What are the non-infective causes of diarrhoea?

A

neoplasm, inflammation, irritable bowel, anatomical, chemical, radiation, hormonal

123
Q

What can cause diarrhoea through direct transmission?

A

STIs, scabies

124
Q

What can cause diarrhoea through faeco-oral transmission?

A

viral gastroenteritis

125
Q

What can cause diarrhoea through vector-borne transmission?

A

malaria, dengue

126
Q

What can cause diarrhoea through vehicle-borne transmission?

A

viral GE, Hep B

127
Q

What is an airborne cause of diarrhoea?

A

TB, legionella

128
Q

27 year old student just returned from backpacking holiday around South Asia. Presents with frequent bouts of diarrhoea, flatulence, nausea and abdominal discomfort.
What is the most likely causative organism?

A

Vibrio cholerae - gram negative

129
Q

2 year old child presents with loose stools for 2 days. Miserable. Loss of appetite but drinking ok. No fever. Attends nursery and playgroup. Recently been to a petting zoo.
What is the most likely causative organism?

A

Escherichia coli - gram negative bacilli

130
Q

87 year old resident of a care home presents with confusion, altered consciousness, dehydration and a history of diarrhoea.
What is the most likely causative organism?

A

Norovirus

131
Q

36 year old man presents with bouts of low volume bloody stools. He works in a take-away.
What is the most likely causative organism?

A

Shigella

132
Q

84 year old patient at the Northern General Hospital presents with diarrhoea. She is recovering from a surgical operation a few days ago.
What is the most likely causative organism?

A

Clostridium difficile

- associated with antibiotic use causing related diarrhoea and colitis

133
Q

How do you manage a C diff infection?

A 
SIGHT
Suspect infection
Isolate patient
Gloves and apron to be worn
Hand wash with soap and water
Test for the toxin

control antibiotic usage
standard infection control procedure
Surveillance and case finding
Treat with metronidazole and vancomycin

134
Q

What does the WHO prevention package for diarrhoea involve?

A
  1. rotavirus and measles vaccination
  2. promote early and exclusive breastfeeding + vitamin A supplement
  3. Promote handwashing with soap
  4. Improved water supply quantity and quality
  5. Community-wide sanitation and promotion
135
Q

What does the WHO treatment package for diarrhoea involve?

A
  1. fluid replacement to prevent dehydration

2. zinc treatment

136
Q

What are the different groups of people who are at risk of contracting diarrhoea?

A

A- poor hygiene
B- children who attend pre-school or nursery
C- People whose work involves preparing or serving unwrapped/uncooked food
D- HCW/ social care staff working with vulnerable people

137
Q

Give examples of notifiable diseases.

A

rubella, whooping cough, infectious bloody diarrhoea, acute meningitis/encephalitis/poliomyelitis, botulism, cholera, malaria, leprosy, tuberculosis

138
Q

Give examples of notifiable diseases that are vaccine preventable.

A

mumps, measles, whooping cough, diphtheria, rubella, tetanus.

139
Q

What role does surveillance of notifiable diseases play in public health?

A

detection of any changes in disease- outbreak detection, early warning, forecasting.
track changes in disease- extent, severity, risk factors
allows development of interventions targeted at vulnerable groups

140
Q

Give ways in which public health measures provide community-wide protection.

A

Investigate:contact tracing, partner notification, lookback exercises
Identify and protect vulnerable people: chemoprophylaxis, immunisation, isolation
exclude high risk person or setting
educated, inform, raise awareness, health promo
coordinate multi-agency responses

141
Q

What are the 2 forms of passive immunity?

A

cross-placental transfer of antibodies from mother to child - measles, pertussis

via transfusion of blood or blood products including immunoglobulins - hep B

142
Q

What is Human Normal Immunoglobulin?

A

derived from pooled plasma of donors

contains antibodies to infectious agents that are currently prevalent in the general population

143
Q

What are the different types of vaccines made of?

A

inactivated, killed (pertussis, inactivated polio)
attenuated live organisms (yellow fever, MMR, polio, BCG)
secreted products, toxoids (diphtheria, tetanus)
constituents of cell walls (Hep B)
recombinant components (experimental)

144
Q

What is primary vaccine failure?

A

The person does not develop immunity from the vaccine

145
Q

What is secondary vaccine failure?

A

The person initially responds but the vaccine protection wanes over time

146
Q

What are the most common pathogenic serogroups of Neisseria meningitidis?

A

B, C, A, Y, W135

147
Q

What are the sequelae of meningitis?

A

brain abscess/damage, death, focal neurological deficits, hearing impairment, gangrene, auto-amputation, organ failure

148
Q

What is the Glass Test?

A

It is a test for meningitis in which petechial spots do not blanch on pressure.

149
Q

What is the Green Book?

A

Key guidance reference for all immunisations in the UK

150
Q

Name the 3 vaccines offered to the elderly.

A

pneumococcal polysaccharide vaccine
inactivated influenza virus
shingles

151
Q

What are the causative organisms of hospital-acquired infections?

A 
S. aureus
S. pyogenes
vancomycin resistant enterococcus
coag neg staph
C. difficile
norovirus
salmonella
shigella
E. coli
M. tuberculosis
CJD
HIV
Hep b
Hep C
varicella zoster virus
influenza
152
Q

What are the main principles of infection prevention and control?

A
  1. identification of risks
  2. routes and modes of transmission
  3. virulence of organisms (ease of spread, likelihood of causing infection, consequences of infection if it occurs)
  4. remedial factors
153
Q

How do we prevent transmission of hospital-acquired infections?

A 
handwashing
barrier precautions
isolation
ward design
personal protective clothing
154
Q

When to wash hands?

A

before and after handling patient
after handling any soiled item/ bodily fluid exposure
after contact with patient surroundings
after using the toilet
before and after handling food
before and after aseptic procedure
after removing protective clothing including gloves

155
Q

When to use alcohol gel?

A

following handwashing, prior to ward based invasive procedure
following handwashing, when caring for a patient with barrier precautions
between tasks, when hands are visibly clean

156
Q

What is an endogenous HAI and how do you prevent it?

A

infection of a patient by their own flora
prevention:
good nutrition and hydration
antisepsis/skin prep where indicated
control underlying disease- drain pus
remove lines and catheters as soon as clinically possible
reduce antibiotic pressure as much as clinically possible (narrow spectrum, short courses)

157
Q

Who is most at risk of HIV?

A
  1. men having sex with men
  2. heterosexual women
  3. injecting drug users
  4. commercial sex workers
  5. heterosexual men
  6. truck drivers
  7. migrant workers
158
Q

What are the 3 stages of the HIV/AIDS epidemic?

A
  1. Nascent- prevalence is less than 5% in high risk groups
  2. Concentrated- prevalence greater than 5% in subpopulations of high risk groups but women attending antenatal clinic still less than 5%
  3. generalised- HIV has spread beyond high risk groups, which are now heavily infected.
159
Q

What age group is most affected by HIV worldwide?

A

15-24 yrs

160
Q

Why does circumcision work in preventing HIV transmission?

A

foreskin removal –> keratinisation of inner aspect of remaining foreskin –> reduced ability of HIV to penetrate
inner part of foreskin contains many Langerhans cells that are prime targets for HIV and some of these are removed with the foreskin
ulcers that facilitate HIV transmission occur on the foreskin
foreskin may suffer abrasions or inflammation during sex that could facilitate the passage of HIV

161
Q

What problems do you think might be encountered with the delivery of antiretroviral therapy for HIV to those in developing countries?

A 
awareness
procurement/delivery
clinical services - staff, clinics, testing and monitoring facilities 
cost/choice of drugs
adherence
efficacy
co-morbidities
162
Q

Definition of psychological factors?

A

Factors influencing psychological responses to the social environment and pathophysiological changes. Psychological factors can be:

  • Cognitive
  • Behavioural
  • Emotional
163
Q

What is a coronary prone behaviour pattern?

A

Type A behaviour

  • competitive
  • hostile
  • impatient
164
Q

What is the conclusion of the Recurrent Coronary Prevention project?

A

Reduction in Type A behaviour via education (teach Type B behaviour: relaxed, patient, easy going), and psychological support reduces morbidity and mortality in post infarction patients.

165
Q

What are the main four psychological factors associated with CHD?

A
  • Type A behaviour
  • Depression and Anxiety
  • Psychological work characteristics (long working hours >11hrs; control and demand)
  • Social support (both quantity & quality of social relationships)
166
Q

What can doctors do to recognise and prevent psychological factors associated with CHD?

A
  • Observe/explore behaviour patterns
  • Identify signs of depression/anxiety
  • Ask questions from assessment tools
  • Ask patients about their job/occupation
  • Ask patients about available support (Physical; Emotional)
  • Liaise with relevant services (Social Care; Occupational Health)
167
Q

What are the main risk factors in CHD?

A
  • smoking
  • diabetes
  • psychosocial index (socioeconomic status, social isolation + loneliness)
  • abdominal obesity
  • hypertension
168
Q

What are the main factor that reduce the risk of CHD?

A
  • exercise
  • healthy diet (low salt and fat)
  • weight loss
  • stop smoking
169
Q

What is the best treatment for CHD: policies/programmes or healthcare/treatment?

A

policies/programmes

170
Q

Who should be tested for chlamydia?

A

symptomatic M/F
sexual partners of infected individuals
all sexually active people under 25yrs annually
people under 25 who have been treated for chlamydia in the past 3 months
people with concerns about sexual exposure
more than 2 sexual partners in a year
all women presenting for termination of pregnancy
all presenting at GUM clinic
mothers of infants with chlamydia

171
Q

When tested for cure for an STI, what are the reasons for a positive result?

A

poor adherence to treatment
re-infection from an untreated or new partner
inadequacy of treatment
false positive result

172
Q

What is the duration of the ‘look-back’ period for partner tracing in the UK?

A

4 weeks prior to developing symptoms and all contacts since where a male has urethral symptoms

all contacts in last 6 months of asymptomatic individuals and people with extra-urethral symptoms

173
Q

How are partners notified during contact tracing for an STI?

A

patient or provider referral

SMS, phone call, Internet, home visit
single dose over-the-counter azithromycin in partners of asymptomatic index patient

174
Q

What are the general preventative approaches for an STI?

A

promotion of safer sexual behaviour
encouragement of early healthcare-seeking behaviour
primary care involvement in prevention and sexual healthcare

175
Q

What is the current national chlamydia screening programme strategy?

A
  1. To reduce prevalence and transmission by promoting public awareness
  2. Offering annual, opportunistic screening to sexually active individuals under 25 yrs
  3. Providing easy access to testing and treatment via a wide range of healthcare and non-healthcare (uni, postal home kits) settings
176
Q

Define palliative care

A

“Palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement.”

WHO

177
Q

Define “specialist” palliative care

A

Palliative care provided by health professionals who specialise in palliative care and work within a multi-disciplinary specialist care team

178
Q

Define “generalist” palliative care

A

Health professionals who have not received accredited levels of training in palliative care provision and thus are not deemed ‘specialists’, but who routinely provide health care for patients at the end of their lives

179
Q

What are the inequalities that older people suffer in palliative care compared to younger people?

A
  • less likely to be admitted to a hospice
  • less likely to die in their place of preference
  • less likely to receive proper preventative planning
  • more likely to experience repeated hospital admissions
  • less likely to be involved in discussions concerning options available to them at the end of life (advanced care planning)
180
Q

Why are COPD patients less likely to receive palliative care compared to Lung Cancer patients?

A

Palliative care was developed around a cancer model.

Most people who receive specialist palliative care still have a diagnosis of cancer.

181
Q

What are the barriers towards delivering palliative care for COPD patients?

A
  • Uncertainty about prognosis because illness trajectory is so unpredictable
  • Poor communication with patient
  • Poor patient understanding combined with lack of communication regarding death leads to anxiety and confusion regarding the condition and its implications
  • Families and carers often unprepared for death, can seem ‘sudden’
  • lack of specialist palliative care for COPD
182
Q

What are the characteristics of an eating disorder?

A
  • set of beliefs about importance of weight & size as an index of personal worth
  • lead to stereotyped behaviours to manipulate food intake & energy expenditure
  • disrupt normal physiology; predictable & profound effects on health & functioning
  • problems maintaining positive self-image, perfectionism, seeking control & ‘ideal’ body, difficulties to early attachment, once established, powerfully addictive
183
Q

What is anorexia nervosa?

A

Restriction of energy intake relative to requirements leading to a significantly low body weight (BMI <17.5), characterised by:

fear of gaining weight, self starvation, refusal to maintain or achieve 85% normal body weight, dietary restriction, excessive exercise, induced vomiting, laxatives, appetite suppressants,

184
Q

What is bulimia nervosa?

A

Repeated episodes of overeating (bingeing) and compensatory behaviour (purging), fasting, or excessive exercise, undue influence of shape & weight on self-evaluation

185
Q

What are the psychological principles of eating disorders?

A

Onset factors: low self-esteem and perfectionism

Maintaining factors: initial positive outcome and sense of control; then fear of loss of control

186
Q

What is the treatment for eating disorders?

A

Cognitive Behavioural Treatment (CBT) with positive reinforcement from carers/family

Difficulty in treatment: Anorexia > Bulimia
-People with anorexia are less likely to want treatment and are unlikely to persevere with efforts to change
leading to higher mortality rate

187
Q

Define screening.

A

a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.

188
Q

What is the Wilson Jungner criteria?

A

A set of criteria used to assess the viability, effectiveness and appropriateness of a screening programme.

189
Q

What does the Wilson Jungner criteria include?

A

Knowledge of the disease- important disease with recognisable early symptomatic phase and adequately understood natural history
Knowledge of the test- suitable test that is acceptable to the population
Treatment for the disease
Cost considerations

190
Q

What screening programmes are currently running in the UK?

A 
Abdominal aortic aneurysm
bowel cancer
breast
cervical
diabetic eye
foetal anomaly
infectious diseases in pregnancy
newborn and infant physical exam
newborn hearing
sickle cell disease and thalassaemia
191
Q

Give 3 primary prevention strategies for STI

A

STI awareness campaign
One to one risk reduction discussions
Vaccination (Hep B and HPV)

192
Q

Give 3 anti-retroviral primary prevention strategies for STI

A

Post-exposure prophylaxis
Pre-exposure prophylaxis
Treatment as prevention

193
Q

Give 3 secondary prevention strategies for STI

A

Easy access to STI / HIV tests / treatment
Partner Notification (Contact tracing)
Targeted screening

194
Q

Give 3 tertiary prevention strategies for STI

A

Anti-retrovirals for HIV
Prophylactic antibiotics for PCP
Acyclovir for suppression of genital herpes

195
Q

Why is it important to trace a partner in STI?

A

Break the chain of transmission
Prevent re-infection of the index patient
Prevent complications of untreated infection

196
Q

What is the difference between outbreak, epidemic and pandemic influenza?

A

Outbreak: 2 or more linked cases
Epidemic: cases confined to a region/country
Pandemic: cases cross international boundaries

197
Q

What are the most important pandemics of influenza?

A

Spanish flu 1918-1919 (H1N1): avian source
Avian flu 2005-2008 (H5N1)
Swine flu 2009 (H1N1)

Phase 2A Medicine (16 decks)

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