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Phase 2a Medicine > Public Health > Flashcards

Public Health Flashcards

1
Q

What proportion of medicines for chronic conditions are not taken as prescribed?

A

30-50%

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2
Q

What is compliance?

A

Assumes doctor knows best, patient passive

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3
Q

What is adherence?

A

Acknowledges important of patient’s beliefs

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4
Q

What is needed to support adherence?

A

Patient-centred approach

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5
Q

Give 5 examples of non-adherence

A
  1. Not taking prescribed medication
  2. Taking bigger/smaller doses than prescribed
  3. Taking medication more/less often than prescribed
  4. Stopping medication without finishing course
  5. Modifying treatment to accommodate other activities
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6
Q

What are the practical barriers for non-adherence?

A
  1. Difficulty understanding instructions
  2. Problems using treatment
  3. Inability to pay
  4. Forgetting
  5. Capacity and resource
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7
Q

What are the motivational barriers for non-adherence?

A
  1. Pt. beliefs about their health/condition
  2. Beliefs about treatment
  3. Personal preferences
  4. Perceptual barriers
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8
Q

What are the 2 beliefs influencing pt. evaluation of prescribed medications?

A
  1. Necessity

2. Concerns

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9
Q

What are necessity beliefs?

A

Perceptions of personal need for treatment

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10
Q

What are concern beliefs?

A

Concerns about a range of potential adverse consequences

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11
Q

What does patient-centred care encourage?

A
  1. Focus in consultation on pt. as a whole person who has individual references situated in a social context
  2. Shared control of consultation, decisions about interventions or management of health problems with pt.
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12
Q

What are the impacts of good doctor-patient communication?

A
  1. Better health outcome
  2. Higher adherence to therapeutic regimens
  3. Higher pt. and clinician satisfaction
  4. Decrease in malpractice risk
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13
Q

What is concordance?

A

Notion that work of prescriber and patient in consultation is a negotiation between equals

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14
Q

What is the aim of concordance?

A

Therapeutic alliance between prescriber and patient

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15
Q

What are the strengths of concordance?

A
  1. Respect for patient’s agenda

2. Open relationship

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16
Q

What are the patient barriers to concordance?

A
  1. Do patients want to engage in discussion with their HCP?
  2. Might worry some patients
  3. Patients may want to be told what to do
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17
Q

What are the HCP barriers to concordance?

A
  1. Relevant communication skills
  2. Time/ resources/ organisational constraints
  3. Challenging
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18
Q

What are the key principles of adherence?

A
  1. Improve communication
  2. Increase patient involvement
  3. Understand patient’s perspective
  4. Provide information
  5. Assess adherence
  6. Review medications
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19
Q

What are the ethical considerations for adherence?

A
  1. Mental capacity
  2. Public health threat
  3. Child welfare
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20
Q

What does the Public Health Act provide a basis for?

A

To detain and isolate an infectious individual in category 4 or 5 disease

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21
Q

How many healthcare associated infections (HCAIs) are there in England per year?

A

300,000

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22
Q

How much do HCAIs cost the NHS per annum?

A

£1bn

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23
Q

What does Health Act 2006 determine?

A

Infection control is every health care workers responsibility

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24
Q

How are infections prevented and controlled?

A
  1. Identify risks
  2. Develop strategies to reduce risks
  3. Ensure staff are aware of risks and what to do
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25
Q

Give 3 infection control policies

A
  1. Single use items
  2. Outbreak Control plan
  3. Antibiotic review policy
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26
Q

What is infection?

A

Affect with a disease-causing organism, requires harm to be done

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27
Q

What is colonisation?

A

Presence of bacterial cells of humans but without harm

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28
Q

What are the 4 principles of infection prevention and control?

A
  1. Identification of risks
  2. Routes and modes of transmission
  3. Virulence of organisms
  4. Remediable factors
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29
Q

What are the routes of transmission?

A
  1. Patient
  2. Environment
  3. Staff
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30
Q

How can patient A be identified?

A
  1. Risk factors
  2. Screening
  3. Clinical diagnosis
  4. Lab diagnosis
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31
Q

What are carbapenemase producing enterobacteriaceae (CPE)?

A

Colonisers of large bowel, skin below waist and moist sites

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32
Q

What doe CPEs often cause?

A

UTIs and intra-abdominal infections

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33
Q

What beta-lactam antibiotics are used for Gram -ve resistant bacterias?

A

Carbapenems

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34
Q

Where are CPEs often found?

A

Countries with unregulated use of antibiotics

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35
Q

What can be done to stop the route of transmission?

A
  1. Isolation

2. Ward design

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36
Q

What is the lead cause of gastroenteritis?

A

Norovirus

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37
Q

Why is norovirus so infective?

A
  1. Low infecting dose
  2. Short lived immunity
  3. Able to persist in environment for a long time
  4. Resistant to conventional cleaning
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38
Q

What is the most effective method of preventing cross infection?

A

Hand hygiene

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39
Q

What is an endogenous infection?

A

Infection of a patient by their own flora rather than being acquired from others

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40
Q

Name 5 groups of people most at risk of HIV

A
  1. MSM
  2. PWID
  3. Commercial sex workers
  4. Heterosexual women
  5. Truck drivers
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41
Q

What are the stages of epidemic?

A
  1. Nascent
  2. Concentrated
  3. Generalised
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42
Q

What is seen in nascent epidemics?

A

<5% prevalence in all risk groups

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43
Q

What is seen in concentrated epidemics?

A

> 5% prevalence in one or more risk groups

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44
Q

What is seen in generalised epidemics?

A

> 5% prevalence in general population

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45
Q

50% of all new HIV infections occur in which age group?

A

15-24 year olds

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46
Q

What proportion of HIV infections occur in sub-Saharan Africa?

A

2/3

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47
Q

What are the behavioural changes seen in combatting HIV?

A
  1. Education
  2. Condom use
  3. Needle exchange
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48
Q

What is a problem for condom use and consensual sex in HIV infections?

A

Gender inequality

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49
Q

Why does circumcision reduce HIV infection?

A
  1. Keratinisation of the inner aspect of the remaining foreskin
  2. Langerhans cells are removed
  3. Reduced occurrence of ulcers
  4. Reduced abrasions or inflammation of foreskin
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50
Q

What can be done to reduce HIV transmission in PWID?

A
  1. Needle and syringe programmes
  2. Drug dependence treatment
  3. Close compulsory drug detention and rehab centres
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51
Q

What is the risk of MTCT of HIV if untreated?

A

35%

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52
Q

What can be done to reduce MTCT of HIV?

A
  1. Comprehensive antenatal HIV screening
  2. Anepartum zidovudine (AZT)
  3. Oral nevirapine for infant
  4. HAART for mother
  5. Lifelong antiretroviral treatment for mother
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53
Q

What are the goals of HIV testing?

A
  1. Provide high quality service for identifying HIV
  2. HIV treatment, care and support
  3. Prevent transmission
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54
Q

Why is diabetes a public health issue?

A
  1. Mortality
  2. Disability
  3. Co-morbidity
  4. Reduced QOL
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55
Q

Why is T2DM a public health issue?

A

It is preventable but increasing in prevalence, lacks policies and has major inequalities in its patients

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56
Q

How many people in England have diabetes?

A

3.8m

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57
Q

How many people in England have undiagnosed diabetes?

A

940k

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58
Q

What % of diabetes cases are type 2?

A

90%

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59
Q

How can T2DM impact be reduced?

A
  1. Identify people at risk
  2. Preventing diabetes
  3. Diagnosing diabetes earlier
  4. Effective management and supporting self-management
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60
Q

What environmental factors increase risk of diabetes?

A
  1. Sedentary job
  2. Sedentary leisure activities
  3. Diet high in calorie dense foods
  4. Obesogenic environment
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61
Q

What does an obesogenic environment consistent?

A
  1. Physical environment e.g. car culture
  2. Economic environment e.g. cheap TV watching
  3. Sociocultural environment e.g. family eating habits
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62
Q

What physical factors maintain overweight?

A

More weight is harder to exercise, dieting

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63
Q

What psychological factors maintain overweight?

A

Low self-esteem and guilt, comfort eating

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64
Q

What socioeconomic factors maintain overweight?

A

Reduced opportunities, employment, relationships, social mobility

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65
Q

What DM screening tests are currently available?

A
  1. HbA1c
  2. Random capillary blood glucose
  3. Random venous blood glucose
  4. Fasting venous blood glucose
  5. Oral glucose tolerance test
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66
Q

What interventions are required for DM at primary level?

A
  1. Sustained increase in physical activity
  2. Sustained change in diet
  3. Sustained weight loss
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67
Q

What secondary approaches are there for DM?

A
  1. Raise awareness of diabetes and possible symptoms in community
  2. Raise awareness of DM in HCPs
  3. Use clinical records to identify those at risk and/or using blood tests to screen before symptoms develop
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68
Q

What measures are in place for supporting-self care of DM?

A
  1. Self-monitoring
  2. Diet
  3. Exercise
  4. Drugs
  5. Education
  6. Peer support
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69
Q

What is overweight?

A

Abnormal or excessive fat accumulation that presents a risk to health

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70
Q

How many adults in England are OW or obese?

A

64%

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71
Q

What socioeconomic factors contribute to OW?

A
  1. Poverty
  2. Ethnicity (Black African)
  3. Disability
  4. Lack of qualifications
  5. Severe mental illness
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72
Q

What % of children in England are OW/obese?

A

34%

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73
Q

What is the reduction in life expectancy as a result of obesity?

A

3 years

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74
Q

Give 3 costs of obesity

A
  1. Less likely to be in employment
  2. Increased risk of hospitalisation
  3. £6.1bn cost to NHS
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75
Q

Give 4 consequences of childhood obesity

A
  1. Stigma
  2. School absence
  3. Poor physical health
  4. Risk into adulthood
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76
Q

What factors contribute to energy expenditure?

A
  1. Level of accessibility of healthy food
  2. Level of acceptability of healthy food
  3. Level of availability of healthy food
  4. Level of affordability of healthy food
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77
Q

What 5 feedback loops are involved in obesity?

A
  1. Health loops
  2. Governance loops
  3. Business loops
  4. Supply and demand loops
  5. Ecological loops
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78
Q

What are the 4 tiers of individual level interventions for obesity?

A
  1. Universal prevention
  2. Lifestyle intervention
  3. Specialist services
  4. Surgery
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79
Q

Give 6 national actions to combat childhood obesity

A
  1. Calorie labelling on food products
  2. Sugar tax
  3. Strengthen government buying standards for food
  4. Watershed for HFSS product adverts
  5. Physical activity in schools
  6. Ban price promotions of HFSS
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80
Q

Give 3 local actions to combat obesity

A
  1. Exclusion zones
  2. Sport and leisure
  3. Upkeep of open spaces
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81
Q

What are the 4 quadrants of clinical ethics?

A
  1. Medical indications
  2. Patient preferences
  3. QOL
  4. Contextual features
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82
Q

What is connectivity and interdependence?

A

Behaviour of one individual may affect others or wider system

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83
Q

What is co-evolution?

A

Adaptation or changes by one organism alters other organisms

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84
Q

What is far from equilibrium?

A

Pushing yourself away from the comfort zone

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85
Q

What is the main driving factor for BME health inequalities?

A

Poorer socioeconomic position

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86
Q

What are the reasons for FGM?

A
  1. Control over women’s sexuality
  2. Hygiene
  3. Gender based factors/ increase femininity
  4. Cultural identity
  5. Religion
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87
Q

Give 5 immediate consequences of FGM

A
  1. Severe pain
  2. Shock
  3. Difficulty passing urine
  4. Infection
  5. Bleeding
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88
Q

Give 5 long term consequences of FGM

A
  1. Chronic pain
  2. Chronic pelvic infections
  3. Excessive scar formation
  4. Decreased sexual enjoyment
  5. PTSD
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89
Q

Give 3 complication risks of FGM

A
  1. Infertility
  2. Urinary and menstrual problems
  3. Painful intercourse
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90
Q

Give 2 advantages of family interpreters

A
  1. Cheap

2. Accessible

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91
Q

Give 2 disadvantages of family interpreters

A
  1. Not confidential

2. Limit what is interpreted

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92
Q

Give 4 issues around multi-morbidity in pt. from diverse culture

A
  1. Different vocabulary
  2. Symptom descriptions differ
  3. Undiagnosed disease
  4. Unmedicated disease
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93
Q

Give 3 unmodifiable risk factors for CHD

A
  1. FHx
  2. Age
  3. Male
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94
Q

Give 3 modifiable risk factors for CHD

A
  1. Smoking
  2. Diet
  3. Sedentary lifestyle
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95
Q

Give 3 clinical risk factors for CHD

A
  1. Diabetes
  2. HT
  3. Lipids
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96
Q

Give 3 psychosocial risk factors for CHD

A
  1. Depression
  2. Work
  3. Social support
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97
Q

What are psychosocial factors?

A

Factors influencing psychological
responses to the social environment and
pathophysiological changes

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98
Q

What behaviour pattern is associated with CHD?

A

Competitive, hostile, impatient

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99
Q

What are 3 behaviours which can reduce CHD risk?

A
  1. Emotional: Relax in response to signs of anxiety
  2. Behavioural: Reduce work demands
  3. Cognitive: Change way of thinking to less pressured
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100
Q

What hostility behaviours are associated with CHD?

A
  1. Feelings of anger
  2. Annoyance and resentment
  3. Verbal or physical aggression
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101
Q

What antecedents do depression and anxiety share?

A

Social deprivation and health inequalities

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102
Q

Which mental health conditions are associated with CHD?

A

Anxiety and depression

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103
Q

What type of job is associated with MI?

A

High demand, low control

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104
Q

Give 3 jobs which are high demand, low control

A
  1. Junior doctor
  2. Ambulance distributor
  3. Call centre
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105
Q

What social factors are a risk for CHD and stroke?

A

Loneliness and self-isolation

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106
Q

How can influences on an individual’s health be categorised?

A
  1. Biological factors
  2. Personal lifestyle
  3. Physical and social environment
  4. Health services
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107
Q

What did the Black Report 1980 show?

A

Social class health inequalities in overall mortality and health inequalities are widening

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108
Q

What are the 4 possible mechanisms to explain widening socioeconomic health inequalities?

A
  1. Artefact
  2. Social Selection
  3. Behaviour
  4. Material circumstances
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109
Q

What did the Acheson Report recommend?

A
  1. Evaluate all policies likely to affect health in terms of their impact on inequalities
  2. Priority to health of families with children
  3. Government to reduce income inequalities and improve living conditions in poor households
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110
Q

What are the theories of causation?

A
  1. Neo-materialist
  2. Psychosocial
  3. Life course
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111
Q

What is the life course theory of causation?

A
  1. Critical periods have greater impact at certain points in life course, primarily childhood
  2. Accumulation - hazards and their impacts add up
  3. Interactions and pathways
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112
Q

What are examples of critical periods?

A

Measles in pregnancy

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113
Q

What are examples of accumulation?

A

Hard blue collar work leads to injuries, reduced work opportunities, more injuries

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114
Q

What are examples of interactions and pathways?

A

Sexual abuse in childhood > poor partner choices, increased likelihood of violence exposure, increased chance of alcohol abuse

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115
Q

What are the categories of psychosocial pathways of causation?

A
  1. Low social status
  2. Lack of friends
  3. Stress in early life
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116
Q

What is materialist pathway of causation?

A

Poverty exposes people to health hazards. Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing

117
Q

What did the Black Report class as the most important causation to explain health inequalities?

A

Materialist

118
Q

How can doctors close the gap in health inequalities?

A
  1. Changing perspectives
  2. Changing systems
  3. Changing education
119
Q

What is substance misuse?

A

Harmful use of any substance for non-medical purposes or effect

120
Q

What are the types of drug substance and an example of each?

A
  1. Opiates, heroin
  2. Depressants, alcohol
  3. Stimulants, MDMA
  4. Cannabinoids, cannabis
  5. Hallucinogens, LSD
  6. Anaesthetic, ketamine
121
Q

How are new psychoactive substances designed?

A

Mimic other substances of abuse but less predictable effects

122
Q

What are the most commonly used substances of abuse?

A
  1. Cannabis
  2. Cocaine
  3. MDMA
123
Q

What is licit drug misuse?

A

Dependence and addiction to prescription and pharmacy medications

124
Q

What are the harms associated with substance misuse?

A
  1. Mortality
  2. Morbidity
  3. Social e.g. crime
  4. Economic e.g. tax
  5. Personal e.g. stigma
125
Q

What is the most problematic drug of abuse?

126
Q

What are the main theories for fixing substance misuse?

A
  1. Disease model
  2. Moral model
  3. Sociocultural model
  4. Volitional model
  5. Behavioural model
127
Q

What does disease model use?

A
  1. Substitution medications

2. Gene therapy

128
Q

What does the moral model use?

A
  1. Parenting classes

2. Religious education

129
Q

What does the sociocultural model use?

A

Targets health inequality

130
Q

What does the volitional model use?

A

Raises self-efficacy

131
Q

What does the behavioural model use?

A

Law and criminal justice to deter through fines and prison

132
Q

What is addiction?

A

Compulsive use of a substance despite harmful consequences, involving structural and biochemical changes to parts of brain linked to reward, self-control and stress

133
Q

What is dependence?

A

A need that develops relating to substances and other things

134
Q

What is psychological dependence?

A

Feeling that life is impossible without drug

135
Q

What are the emotional effects if withdrawal from drug occurs?

A
  1. Fear
  2. Pain
  3. Shame
  4. Guilt
  5. Loneliness
136
Q

What is physical dependence?

A

Body needs more and more of a drug for same effect (tolerance)

137
Q

What are withdrawal symptoms?

A
  1. Runny nose
  2. Stomach cramps
  3. Muscle aches
  4. Hallucinations
138
Q

What is medical ethics?

A
  1. Critical evaluation of assumptions and arguments

2. Inquiry into normal and values

139
Q

What are the basis of medical ethics?

A
  1. Deontology
  2. Consequentialism
  3. Virtue
140
Q

What is deontology?

A

Based on belief we owe a duty of care to each other

141
Q

What is the problem with deontology?

A

Ignores consequences

142
Q

What is consequentialism?

A

Consequences are what matters, means to get there are important

143
Q

What are virtue ethics?

A

Character of the person is central; good character will necessarily act in right way

144
Q

What are the pros to virtue ethics?

A
  1. Centres ethics on whole person

2. Includes whole of a person’s life

145
Q

What are the cons of virtue ethics?

A
  1. No clear guidance in moral dilemmas
  2. No agreement on what virtues are
  3. Virtues may be relative to culture it is in
146
Q

What are the principles of medical ethics?

A
  1. Autonomy
  2. Beneficence
  3. Non maleficence
  4. Justice
147
Q

What is autonomy?

A

Right to self-determination

148
Q

What is beneficence?

A

Medical practice must seek to benefit patients

149
Q

What is non-maleficence?

A

Avoiding harm

150
Q

What is justice?

A

Efforts should be directed without reference to our likes or dislikes

151
Q

What ethics are used in practice?

A
  1. Candour
  2. Consent
  3. Capacity
  4. Confidentiality
  5. Communication
152
Q

What is candour?

A

Openness, honesty, transparency

153
Q

When is candour used?

A
  1. Disclosure of error or uncertainty

2. Decision influenced by resources

154
Q

What is whistle blowing?

A

Raising concerns about a person, practice or organisation

155
Q

What is odds ratio?

A

A measure of association between an exposure and an outcome

156
Q

What does OR represent?

A

Odds that an outcome will occur given a particular exposure, compared to odds of the outcome occurring in the absence of that exposure

157
Q

What does hazard ratio express?

A

A similar relativity to OR but based on frequency of events rather than cumulative total outcome

158
Q

What is population attributable fraction (PAF)?

A

Proportion of incidence of a disease in exposed and non-exposed population that is due to exposure

159
Q

Give 3 risk factors for acute MI

A
  1. Hyperlipidaemia
  2. Adverse lipid profile
  3. Smoking
160
Q

Which risk factors for IHD have worsened in recent times?

A
  1. Obesity
  2. DM
  3. Physical inactivity
161
Q

What is number needed to treat (NNT)?

A

A measurement of the impact of a therapy by estimating no. of pt. that need to be treated over a given time period in order to have an impact on one person

162
Q

How is NNT calculated?

A

1/absolute risk reduction

163
Q

What is a unit of alcohol?

A

8g or 10ml or pure alcohol

164
Q

How are units calculated?

A

(%ABV x amount of liquid in ml)/1000

165
Q

How many units are classed as potentially harmful?

166
Q

Which age group is most at risk of drinking alcohol at higher risk of harm?

167
Q

When does alcohol become a problem?

A
  1. When it causes or elevates risk for alcohol-related problems
  2. When it complicates management of other health problems
168
Q

What causes most alcohol-specific deaths?

A

Alcoholic liver disease

169
Q

What are the symptoms of alcohol withdrawal?

A
  1. Tremors
  2. Activation syndrom
  3. Seizures
  4. Hallucinations
  5. Delirium tremens
170
Q

Give 5 abnormalities caused by foetal alcohol syndrome

A
  1. Mental retardation
  2. Craniofacial abnormalities
  3. GI defects
  4. Hyperactivity
  5. Incoordination
171
Q

What are the psychosocial effects of excess alcohol consumption?

A
  1. Interpersonal relationships
  2. Problems at work
  3. Criminality
  4. Poverty
  5. Driving incidents
172
Q

What are the policy recommendations for alcohol?

A
  1. Make alcohol less affordable
  2. Licensing and import allowances
  3. Limit exposure in adverts
173
Q

Give 3 primary preventions for alcohol

A
  1. Know your limits campaign
  2. THINK drink driving
  3. Minimum unit pricing
174
Q

What are secondary preventions for alcohol?

A
  1. Ask about it routinely
  2. Use screening tools
  3. Think of it to explain symptoms
  4. Detect problem drinking
175
Q

What are the alcohol screening tools?

A
  1. Clinical interview
  2. Fast alcohol screening test (FAST)
  3. Alcohol use disorders identification test (AUDIT)
  4. CAGE questions
176
Q

What is at risk drinking?

A

A pattern of drinking which brings about the risk of physical or psychological harm

177
Q

What is alcohol abuse?

A

A pattern of drinking which is likely to cause physical or psychological harm

178
Q

What is alcohol dependence?

A

A set of behavioural, cognitive and physiological responses that can develop after repeated substance abuse

179
Q

What are the main diarrhoeal diseases?

A
  1. Dysentery
  2. Typhoid
  3. Hepatitis
  4. Cholera
180
Q

What are complications of haemolytic rhemelin syndrome?

A
  1. Acute kidney failure
  2. Liver failure
  3. Anaemia
181
Q

What causes haemolytic rhemelin syndrome?

182
Q

What are the symptoms of norovirus?

A
  1. Vomiting
  2. Diarrhoea
  3. Cramps
  4. Headache
  5. Fever
183
Q

How long does norovirus last?

184
Q

What bugs cause dysentery?

A
  1. EHEC
  2. Shigella
  3. Salmonella
185
Q

Where are C. difficile found?

A

Soil, digestive tract

186
Q

What could cause a C. difficile infection?

A

Antibiotic that removes protection from pathogens

187
Q

What does C. difficile cause in hospitalised pt.?

A
  1. Antibiotic-associated diarrhoea
  2. Antibiotic-associated colitis
  3. Pseudomembranous colitis
188
Q

How is C. difficile spread?

A
  1. Faeco-oral route

2. Spores in environment

189
Q

What age is most at risk of C. difficile infection?

190
Q

What is the prevention for C. difficile infection?

A
  1. Hand washing with soap and water

2. Hydrogen peroxide for cleaning

191
Q

What is the protocol for a C. diff pt.?

A

SIGHT

  1. Suspect C diff as cause of diarrhoea
  2. Isolate case
  3. Gloves and aprons worn
  4. Hand washing with soap and water
  5. Test stool for toxin
192
Q

What Abx must be controlled for C. diff prevention?

A
  1. Ampicillin
  2. Amoxicillin
  3. Cephalosporins
193
Q

What is the Rx for C. diff diarrhoea?

A

Metronidazole or vancomycin

194
Q

What is the investigation for C diff?

A
  1. Stool sample for toxin
  2. Culture to ID strain
  3. Tissue samples
195
Q

What bug contributes to 40% of hospital admissions for diarrhoea?

196
Q

What is the prevention for rotavirus?

A
  1. Vaccine
  2. Early and exclusive breastfeeding
  3. Handwashing
  4. Improve water quantity and quality
  5. Community-wide sanitation promotion
197
Q

What is the Rx for rotavirus diarrhoea?

A
  1. Fluid replacement

2. Zinc treatment

198
Q

What groups are at risk for diarrhoeal disease?

A
  1. Persons with unsatisfactory hygiene
  2. Children in nursery
  3. People working with uncooked food
  4. HCWs
199
Q

What diseases are notifiable?

A
  1. Diseases that are very lethal/no cure
  2. Disease with severe symptoms and long-term consequences
  3. Vaccine preventable diseases
  4. Diseases that need specific control measures
200
Q

What are the symptoms of scarlet fever?

A
  1. Flushed red sandpaper rash

2. Strawberry tongue

201
Q

How is the community protected from notifiable diseases?

A
  1. Investigate e.g. contact tracing
  2. Identify vulnerable persons
  3. Exclude high risk persons from high risk settings
  4. Health promotion
  5. Coordinate multi-agency responses
202
Q

What is primary vaccine failure?

A

Person doesn’t develop immunity from vaccine

203
Q

What is secondary vaccine failure?

A

Initially responds but protection wanes over time

204
Q

What are the most common causes of meningitis in the UK?

A

Neisseria meningitidis B and C

205
Q

How does meningococcus cause gangrene?

A

Causes arterial occlusions

206
Q

What is the Rx for meningitis?

A
  1. Cefotaxime or ceftriaxone

2. Supportive Rx

207
Q

Why is meningitis notifiable immediately?

A

Risk of transmission is greatest in first few days

208
Q

What happens when close contacts of meningitis are identified?

A
  1. Warn about symptoms and signs
  2. Glass test
  3. Contact number
209
Q

What Abx chemoprophylaxis given to in contact with meningitis pt.?

A

Ciprofloxacin or rifampicin

210
Q

What is the prevalence of MSK conditions in the UK?

211
Q

What are the effective MSK risk management strategies?

A
  1. Vit D/calcium
  2. Weight management
  3. Physical activity
  4. Injury prevention
212
Q

When is developmental dysplasia of hip (DDH) screened for?

A

Newborn physical examination and 6-8 weeks old

213
Q

Why is DDH not screened in utero?

A

Most cases resolve without treatment

214
Q

Why is osteoporosis not screened for?

A

It does not reduce fractures from osteoporosis

215
Q

What is the role of physical activity on primary prevention for MSK?

A
  1. Maintain good MSK health

2. Ensure optimum activity levels to maintain strength, balance, cardio fitness

216
Q

What is the role of physical activity on tertiary prevention for MSK?

A

Manage chronic conditions and improve symptoms/prognosis with fitness

217
Q

What are the condition-specific barriers than make more activity difficult in chronic conditions?

A
  1. Pain, fatigue, anxiety in chronic conditions
  2. Joint pain and stiffness
  3. Depression
  4. Risk/fear of falling
  5. Stress incontinence
218
Q

What maternal health preventions are in place for MSK conditions?

A
  1. Smoking cessation
  2. Diet
  3. Vit D
219
Q

What child health preventions are in place for MSK conditions?

A
  1. Physical activity

2. Diet

220
Q

What adult health preventions are in place for MSK conditions?

A
  1. Injury prevention
  2. Workplace health
  3. Healthy weight/ weight loss
221
Q

What healthy ageing preventions are in place for MSK conditions?

A
  1. Dietary protein, calcium
  2. Vit D
  3. Strength and balance exercises
222
Q

Which STIs are MSM more at risk of?

A
  1. Syphilis

2. Gonorrhoea

223
Q

What is the STI transmission model?

A

RBCD

  1. Reproductive rate
  2. Infectivity rate
  3. Partners over time
  4. Duration of infection
224
Q

Give 3 individual factors which affect sexual health

A
  1. Mental health
  2. Self-esteem
  3. Dysfunction
225
Q

Give 3 social relationships factors which affect sexual health

A
  1. Family
  2. Upbringing
  3. Peers
226
Q

Give 3 emotional factors which affect sexual health

A
  1. Experience of different emotions
  2. Ability to handle difficult emotions
  3. Response to others
227
Q

Give 3 external or political factors which affect sexual health

A
  1. Law
  2. Media
  3. Religion
228
Q

Give 3 social group factors which affect sexual health

A
  1. Class
  2. Gender
  3. Sexual orientation
229
Q

Give 3 service factors which affect sexual health

A
  1. Access to contraception
  2. STI & HIV services
  3. Counselling
230
Q

What is the primary prevention for sexual health?

A

Reducing risk of acquiring STI

231
Q

What is the secondary prevention for sexual health?

A

Case finding

232
Q

What is the tertiary prevention for sexual health?

A

Reducing morbidity and mortality

233
Q

Give 3 primary prevention strategy for STIs

A
  1. STI awareness campaigns
  2. Vaccination - HPV, Hep B
  3. PrEP and PEP
234
Q

What are the methods for HIV prevention?

A
  1. Condom use
  2. Regular testing
  3. Early access to treatment
  4. Challenging stigmas
235
Q

What are the secondary prevention strategies for STIs?

A
  1. Easy access to tests and Rx
  2. Partner notification
  3. Targeted screening e.g. antenatal
236
Q

What are the tertiary preventions for STIs?

A
  1. Anti-retrovirals for HIV
  2. Prophylactic Abx for PCP
  3. Acyclovir for suppression of genital herpes
237
Q

What is partner notification?

A

A public health activity that aims to control infection by identifying key individuals and sexual networks, warn the unsuspecting and attempt to break the chain of infection

238
Q

How are partners traced?

A
  1. Pt. referral
  2. Provider referral
  3. Conditional or contract referral
  4. Emphasis on pt. choice and confidentiality
239
Q

Name 5 disease associated with ageing

A
  1. Dementia
  2. Osteoporosis
  3. Stroke
  4. Parkinson’s
  5. OA
240
Q

What is polypharmacy?

A

When a pt. is on >5 drugs

241
Q

What is 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

242
Q

What are the key issues in COPD?

A
  1. Unpredictable illness trajectory
  2. Difficulties with prognostication
  3. Poor pt. understanding
  4. Limited access to specialist palliative care
243
Q

What are the main trajectories of decline at end of life?

A
  1. Cancer
  2. Organ failure
  3. Physical and cognitive frailty
244
Q

What is substance misuse?

A

Recurrent substance use resulting in

  1. Failure to fulfil major obligations e.g. work
  2. Situations which it is physically hazardous e.g. driving
  3. Despite persistent social or interpersonal problems e.g. debt
245
Q

How are units of alcohol measured?

A

ABV x vol (ml)/1000

246
Q

What extended brief interventions can be used for alcoholics?

A
  1. Behavioural change
  2. Motivational-enhancement therapy
  3. Motivational interviewing
247
Q

What is used to measure severity of alcohol dependence?

A

Severity of Dependence Questionnaire (SADQ)

248
Q

What is indicated for a person scored 16+ on SADQ?

A

Chlordiazepoxide detoxification

249
Q

What is dependence?

A

A state in which an organism functions normally only in presence of a drug

250
Q

What is tolerance?

A

A state in which an organism no longer responds to a drug

251
Q

What are the Rx for people with alcohol dependence?

A
  1. Community based assisted withdrawal
  2. Inpatient based assisted withdrawal
  3. Rx with benzodiazepines
  4. Preferred choice chlordiazepoxide
252
Q

What is the result of stopping alcohol in alcoholics?

A
  1. Number of Ca channels multiple
  2. Chloride ion flow reduced
  3. Electrical impulse in nerve increases
  4. Excitability of nerve enhanced
253
Q

Give 3 contraindications of chlordiazepoxide

A
  1. Pregnancy
  2. Severe pulmonary insufficiency
  3. Chronic psychosis
254
Q

What are the withdrawal effects of alcohol?

A
  1. Headache
  2. Muscular pain
  3. Anxiety
  4. Hallucinations
  5. Epileptic seizures
255
Q

What is the cause of Wernicke’s encephalopathy?

A

Deficiency of thiamine

256
Q

What is the Rx of Wernicke’s encephalopathy?

A
  1. Pabrinex
  2. Vit B
  3. Thiamine
257
Q

What is used to prevent relapse in alcoholics?

A
  1. Acamprosate
  2. Disulfiram
  3. Nalmefine
258
Q

What law of tort is important in medicine?

A
  1. Negligence
  2. Battery (consent)
  3. Breach of confidence
259
Q

What is negligence?

A

A duty of care existed which was breached resulting in harm

260
Q

When can confidentiality be disclosed?

A
  1. Info likely to cause serious harm to mental or physical health of pt.
  2. Info likely to cause serious harm to mental or physical health of another person
  3. Info is about another individual
261
Q

What are the risk factors for migraine?

A
  1. 25-50
  2. Female
  3. Sex hormones (OCP)
  4. FHx
262
Q

What are the risk factors for stroke?

A
  1. Male
  2. Age
  3. BME
  4. Smoking
  5. Alcohol
  6. CVD
263
Q

What is the aetiology of epilepsy?

A
  1. Genetic factors
  2. Febrile seizures
  3. Head injuries
  4. Bacterial/parasitic infections
  5. Viral meningo-encephalitis
  6. Toxic agents
264
Q

What is the triad of symptoms in PD?

A
  1. Tremor
  2. Rigidity
  3. Akinesia
265
Q

What are the risk factors for cerebral palsy?

A
  1. Anoxia

2. Low birth weight

266
Q

What is the usual age of onset for Creutzfeldt-Jakob disease (CJD)?

267
Q

What are the signs of CJD?

A
  1. Rapidly progressive dementia
  2. Abnormal EEG
  3. Cerebellar signs
  4. Myoclonus
268
Q

What are the risk factors for variant CJD?

A
  1. Age (26)
  2. Residence in UK
  3. Methionine homozygosity at codon 129
269
Q

What MH conditions commonly affect medics?

A
  1. Insomnia
  2. Depression
  3. PTSD
  4. Anxiety
270
Q

What are the barriers to seeking help for MH?

A
  1. Fear of looking weak
  2. Competition between peers
  3. Doctors seen as infallible
  4. Stigma
271
Q

What is the philosophy of palliative care?

A
  1. Holistic approach
  2. Individualised
  3. Patient and care involved
  4. MDT approach
272
Q

What are the key PH issues in COPD?

A
  1. Unpredictable illness trajectory
  2. Difficulties with prognostication
  3. Poor pt. understanding
  4. Limited access to specialist palliative care
273
Q

What is the result of poor understanding of COPD?

A
  1. Anxiety/confusion
  2. Unable to make advanced care planning
  3. Families unprepared for death
274
Q

What are the common work-related ill health?

A
  1. Occupational stress
  2. MSK disorders
  3. Lung disease
  4. Cancer
  5. Noise-induced hearing loss
275
Q

What study design is best suited to calculating attributable risk?

A

Cohort studies

276
Q

Give an example of an acute occupational disease

A

Slipped disc

277
Q

Give an example of a cumulative occupational disease

278
Q

Give an example of a progressive occupational disease

A

Radiation poisoning

279
Q

Give an example of a occupational disease with latencies

A

Asbestosis

280
Q

What is hazard?

A

Potentially harmful

281
Q

What is risk?

A

Probability of harm

282
Q

How can work hazards be classified?

A
  1. Mechanical
  2. Physical
  3. Chemical
  4. Biological
  5. Psychosocial
283
Q

When should an occupational aetiology of a disease be considered?

A

When an illness fails to respond to standard Rx, doesn’t fit the typical demographic profile or is of unknown cause

284
Q

What are the screening questions for occupational disease?

A
  1. Type of work?
  2. Do you think health problems are related to work?
  3. Symptom differences between work and home?
  4. Exposures at work?
  5. Co-worker symptoms?
285
Q

What is a disability?

A

A physical or mental impairment, which has a substantial long term adverse effect on a person’s ability to carry out normal activities

286
Q

What are the primary preventions for OH?

A
  1. Monitor risk
  2. Control hazards
  3. Promotion
287
Q

What are the secondary preventions for OH?

A
  1. Screening
  2. Early detection
  3. Task modification
288
Q

What are the tertiary preventions for OH?

A
  1. Rehabilitation

2. Support

Phase 2a Medicine (15 decks)

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