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Medicine Year 2 5 > Public health > Flashcards

Public health Flashcards

1
Q

Define mental health

A

A state of well being in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community

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2
Q

What is the inverse care law?

A

The availability of good medical care tends to vary inversely with the need for it in the population served

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3
Q

Give 4 categories of health influences

A
  • ) Biological
  • ) Personal lifestyle
  • ) Health services
  • ) Physical and social environment
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4
Q

What 2 things did the Black report 1980 confirm?

A
  • ) Social class health inequalities in overall mortality

- ) Health inequalities are widening

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5
Q

Give 4 mechanisms to explain the Black report 1980

A
  • ) Artefact
  • ) Social selection
  • ) Behaviour
  • ) Material circumstances
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6
Q

What did the Acheson report 1988 find?

A

Mortality has decreased in the last 50 years but inequalities remained or widened

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7
Q

Give the 3 recommendations from the Acheson report 1988

A
  • ) Evaluate all policies likely to affect health in terms of the impact on inequality
  • ) Prioritise health of families with children
  • ) Government should reduce income inequalities and improve living conditions in poor households
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8
Q

Give the 3 domains of the theories of causation

A
  • ) Lifecourse
  • ) Psychosocial
  • ) Materialist
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9
Q

Describe the life course theory of causation

A

Critical periods have a greater impact in the life course (e.g. measles in pregnancy), hazards and their impacts accumulate (e.g. hard blue-collar work) - interactions and pathways

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10
Q

Describe the psychosocial theory of causation

A

Social inequality may affect how people feel, which in turn can affect body chemistry - focuses on individual

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11
Q

Describe the materialist theory of causation

A

Poverty exposes people to more health hazards, disadvantaged people are more likely to live in areas exposed to harm (e.g. damp and pollution)

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12
Q

Give 2 ways in which doctors can help minimise health inequality

A
  • ) Change perspectives
  • ) Change systems
  • ) Education
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13
Q

Give 3 things consent must be

A
  • ) Voluntary
  • ) Informed
  • ) Made by someone with capacity
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14
Q

What must you tell someone to get consent?

A

What, how, risks, benefits, alternatives

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15
Q

What 4 things may a patient not be able to do that leads to a decision not being made?

A
  • ) Understand relavent information
  • ) Retain it
  • ) Use information to make a decision
  • ) Communicate decision
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16
Q

What 4 things must we take into account when acting in the best interests of a patient?

A
  • ) Whether patient may soon regain capacity
  • ) Patient’s past and present wishes
  • ) Patient’s beliefs and values
  • ) Consultation with anyone available
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17
Q

Give 4 types of risk factor for CHD, and an example of each

A
  • ) Unmodifiable (age, sex, ethnicity, genetics)
  • ) Lifestyle (smoking, diet, physical inactivity)
  • ) Clinical (HTN, lipids, DM)
  • ) Psychosocial (behavioural trait, depression/anxiety, work, social support)
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18
Q

What gives a 67% higher chance of an MI?

A

> 11hr work days

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19
Q

Who did the Whitehall study 1 look at?

A

Male British civil servants over a 10 year period

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20
Q

What did the Whitehall study 1 find?

A

Men in the lowest grade had higher mortality than men in the highest grade, 3x mortality rate from all causes

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21
Q

Who did the Whitehall study 2 look at?

A

10,000 civil servents

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22
Q

What did the Whitehall study 2 find?

A

Employment grade was strongly associated with work control and demands

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23
Q

Give 3 things doctors can do to reduce psychosocial influences on CHD

A
  • ) Observe/explore behaviour patterns
  • ) Identify signs of depression/anxiety
  • ) Ask questions from assessment tools
  • ) Ask patients about job/occupation
  • ) Ask about available support
  • ) Liase with relevant services
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24
Q

What is an absolutist explanation?

A

It’s about poverty, absolute measures of socioeconomic deprivation

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25
Q

What is a relativist explanation?

A

It’s about relative differences, larger relative difference means poorer outcomes for the worse off

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26
Q

Give 4 ways we verify death

A
  • ) No heart sounds/carotid pulse for 1 minute
  • ) No breath sounds/respiratory effort for 1 minute
  • ) No response to painful stimuli
  • ) Pupils fixed and dilated
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27
Q

What % of people die in hospital?

A

60%

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28
Q

What is the maximum number of units you should drink in a week?

A

14

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29
Q

Give 2 ways to make drinking 14 units a week better

A
  • ) Spread them evenly over 3+ days

- ) Have several alcohol free days each week

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30
Q

What is substance misuse? (3)

A
  • ) Results in failure to fulfil role obligations (school, work, home)
  • ) May be physical hazardous (driving, machinery)
  • ) Continued misuse despite persistent or recurrent social or interpersonal problems
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31
Q

How do we calculate the number of units in a drink?

A

(%ABV x volume in ml)/1000

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32
Q

What is dependence?

A

A state in which an organism functional normally only in the presence of a drug, manifests as a physical disturbance when the drug is withdrawn

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33
Q

What is tolerance?

A

A state in which an organism no longer responds to a drug, and a higher dose is required to achieve the same effect

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34
Q

What are the 2 actions of alcohol in the body?

A
  • ) Potentiates GABA (inhibitor NT)

- ) Inhibitis glutamate (excitatory NT)

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35
Q

Where is alcohol well absorbed in the body?

A

Small intestine

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36
Q

What is the half life of alcohol?

A

6-30 hours

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37
Q

Give 2 properties of alcohol in the body

A
  • ) Highly lipophilic

- ) Highly protein bound

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38
Q

What metabolises alcohol?

A

Liver

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39
Q

Can alcohol cross the BBB?

A

Yes

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40
Q

How is alcohol eliminated?

A

Excreted in urine mainly in form of its metabolites, as conjugates (glucuronide/sulphate)

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41
Q

What is Wernicke’s encephalopathy?

A

Caused by a severe deficiency of thiamine, common in severely dependent drinkers

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42
Q

How do we treat Wernicke’s encephalopathy?

A

Pabrinex, VB, thiamine

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43
Q

How do we treat alcohol withdrawal?

A

Benzodiazepines

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44
Q

What is the STI/HIV transmission equation?

A 
R = BCD
R - reproductive rate
B - infectivity rate
C - partners over time
D - duration of infection
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45
Q

What is the infectivity rate of STI/HIV altered by?

A

Condom use, type of sex, microbe characteristics of organism

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46
Q

What is the duration of infection of STI/HIV altered by?

A

Reduced by easy access to services

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47
Q

What is primary prevention?

A

Reducing risk, prevention

48
Q

What is secondary prevention?

A

Detecting, treating

49
Q

What is tertiary prevention?

A

Reducing morbidity/mortality

50
Q

Give 2 primary preventions for STIs

A

Awareness campaigns, vaccinations, key cash condom poster, pre/post exposure prophylaxis

51
Q

Give 2 secondary preventions for STIs

A

Easy access to tests/treatment, partner notification, targeted screening

52
Q

Give 2 tertiary preventions for STIs

A

Antiretrovirals for HIV, prophylactic ABX for PCP, acyclovir for genital herpes

53
Q

Give 3 things partner tracing does

A
  • ) Breaks the chain of transmission
  • ) Prevents re-infection of index patient
  • ) Prevents complications of untreated infection
54
Q

Why do people carry out FGM?

A
  • ) Seen as being ‘pure’

- ) Unable to marry without it

55
Q

Give 2 complications of FGM

A
  • ) Bleeding
  • ) Infection
  • ) Pain
  • ) Death
  • ) LUTS
  • ) Period problems
  • ) Anxiety
  • ) PTSD
  • ) Withdrawal
56
Q

Give 3 infectious conditions that new migrants may present to their GP with

A
  • ) Hepatitis
  • ) TB
  • ) Malaria
  • ) HIV
  • ) Parasitic infections
57
Q

Give 2 mental health problems that war refugees may suffer from after immigration

A
  • ) PTSD
  • ) Depression
  • ) Suicidal thoughts
  • ) Anxiety
  • ) Chronic pain, fatigue, dizziness, headache
58
Q

Give 2 reasons we should be careful using family members as interpreters

A
  • ) Agenda/bias
  • ) Not confidential
  • ) Poor English
  • ) May limit translation
59
Q

What is the typical history of occupational asthma?

A

Asthma improves on weekends/holidays

60
Q

How can we diagnose occupational asthma?

A

Peak flow diary

61
Q

Give 2 bits of advice for hand dermatitis prevention

A
  • ) Avoid allergen/irritants
  • ) Gloves
  • ) Skincare 0 cream and soaps
62
Q

What studies are best suited to calculating attributable risk?

A

Cohort

63
Q

Give 3 teamwork problems

A
  • ) Lack of teamwork
  • ) Lack of leadership
  • ) Lack of effort
  • ) Lack of communication
  • ) Lack of challenge
64
Q

What is SBARR communication?

A 
Situation
Background
Assessment
Recommendation
Response/review
65
Q

What are the most commonly misused drugs?

A

Cannabis, ecstasy, new psychoactive substances

66
Q

Give 4 types of substance, an example, and their effects

A
  • ) Opiates - heroin, morphine - pain relief, euphoria
  • ) Depressants - alcohol - sedation, relaxation
  • ) Stimulants - caffeine, nicotine, cocaine - increased alertness, activity, mood
  • ) Hallucinogens - ecstasy, ket, mushrooms - alter sensory perception and thinking
67
Q

Give 3 risk factors in drug abuse

A
  • ) Quantity and frequency of use
  • ) Knowledge of what they’re using
  • ) Poly drug use
  • ) Propensity for risky behaviour
  • ) Co-existing problems
68
Q

Give 2 risks of NPAs

A
  • ) Overdose and temporary psychotic states
  • ) Unpredictable behaviour
  • ) Sudden pyrexia, tachycardia, coma
  • ) Hallucination and vomiting
  • ) Aggression and violence
  • ) Intense comedown
69
Q

Give 4 models of thinking for substance misuse

A
  • ) Disease - addiction is a chronic recurring/genetic illness
  • ) Behavioural - bad habit, would be punishment and rewards for non-using
  • ) Volitional - failure of will, act to increase self-efficacy self -esteem, education on consequences
  • ) Socio-cultural - target poverty, social exclusion, housing and mental health problems
70
Q

Give 3 family risk factors for substance misuse

A
  • ) FHx
  • ) Family management problems
  • ) Family conflict/abuse
  • ) Being in care
71
Q

Give 3 school/community risk factors for substance misuse

A
  • ) Low academic attainment and commitment
  • ) Availability of drugs
  • ) Community norms
  • ) Community disorganisation
  • ) Transitions/mobility
  • ) Low neighbourhood attachment
72
Q

Give 3 individual risk factors for substance misuse

A
  • ) Risk taking
  • ) Rebelliousness
  • ) Friends who use
  • ) Experience of trauma
73
Q

What is physical dependence?

A

Body adapts to presence of substance over time and needs more for the same effect (tolerance), stopping leads to withdrawal symptoms

74
Q

Give an alcohol withdrawal symptom

A
  • ) Tremors
  • ) Stomach cramps
  • ) Tachycardia
  • ) HTN
  • ) Hallucinations
  • ) Seizures
  • ) Delirium
75
Q

What is psychological dependence?

A

Feeling that life is impossible/challenges cannot be face without drug, emotional effects

76
Q

Give 4 points of the national drug strategy 2017

A
  • ) Reduce demand
  • ) Restrict supply
  • ) Building recovery in communities
  • ) Family/community involvement
  • ) Payment by results
  • ) Abstinece focused with emphasis on recovery and peer support
77
Q

Give 3 local previsions for drug control

A
  • ) GPs
  • ) Harm reduction services
  • ) Open access service
  • ) Structured psychosocial interventions
  • ) Prescribing services
  • ) Detox
  • ) Access to rehab
  • ) Recovery support
78
Q

What is one unit of alcohol defined as?

A

10ml pure alcohol (one shot, half pint, small glass of wine)

79
Q

What is the alcohol harm paradox?

A

Low socioeconomic groups drink less alcohol than high socioeconomic groups, but experience more alcohol related harm

80
Q

What does foetal alcohol syndrome cause?

A
  • ) Pre and post-natal growth retardation
  • ) CNS abnormalities
  • ) Craniofacial abnormalities
  • ) Defects of eyes, ears, mouth, CVS, GUT, skeleton
81
Q

Give 2 chronic effects of alcohol excess

A
  • ) Dementia
  • ) Cerebellar degeneration
  • ) Fatty liver
  • ) Cirrhosis
  • ) Liver cancer
  • ) HTN, CHD
82
Q

Give 3 psychosocial effects of excessive alcohol consumption

A
  • ) Violence, rape, depression, anxiety
  • ) Problems at work
  • ) Criminality
  • ) Social disintegration/povery
  • ) Driving incidents/offences
83
Q

Give a primary prevention for alcohol excess

A
  • ) Known your limits campaign
  • ) Drinkaware labelling
  • ) THINK! drunk driving campaign
  • ) Restriction on alcohol advertising
  • ) TV ads
  • ) Minimum pricing
84
Q

Give a secondary prevention for alcohol excess

A
  • ) Routinely asking, screening questions

- ) FAST, AUDIT, CAGE

85
Q

Give 3 examples of notifiable diseases

A
  • ) Acute meningitis
  • ) Acute infectious hepatitis
  • ) Anthrax
  • ) Acute encephalitits
  • ) Cholera
  • ) Legionnaires
  • ) Malaria
  • ) Measles
  • ) SARS
  • ) Smallpox
  • ) TB
86
Q

Why do we notify about diseases?

A

Outbreak detection, early warning, forecasting

87
Q

What are the 2 types of vaccine failure?

A

Primary - no immunity developed from vaccine

Secondary - initially responds but protection wanes over time

88
Q

Give 2 reasons DM is a public health issue

A
  • ) Mortality
  • ) Disability
  • ) Co-morbidity
  • ) Reduced QOL
89
Q

Give 3 risk factors for DM

A
  • ) Sedentary job
  • ) Obesogenic environment (physical, economic and sociocultural)
  • ) Diet high in calories, low in veg
90
Q

Give 2 factors that maintain obesity

A
  • ) Physical - more weight, more difficult to exercise
  • ) Psychological - low self-esteem, comfort eating
  • ) Socioeconomic - reduced opportunities
91
Q

Give a primary prevention of DM

A
  • ) Sustained increase in physical activity
  • ) Sustained change in diet
  • ) Sustained weight loss
92
Q

How do we achieve early DM diagnoses?

A
  • ) Raising awareness in community and health professionals

- ) Identify those at risk

93
Q

Give 3 factors affecting patient compliance

A
  • ) Socioeconomic (distance)
  • ) Health system (medication)
  • ) Condition (memory)
  • ) Therapy (complex)
  • ) Patient (denial)
94
Q

What is an endemic?

A

Disease permanently present within a population in a geographic area

95
Q

What is an epidemic?

A

An increase in the prevalence of a disease above the number usually observed in the population in a particular area

96
Q

What is a pandemic?

A

Endemic in several countries

97
Q

What does antigenic drift cause?

A

Seasonal epidemics

98
Q

What does antigenic shift cause?

A

Pandemics

99
Q

Give 3 conditions when confidentiality can be broken

A
  • ) Risk to public
  • ) Have given consent
  • ) Required by law
100
Q

What is anorexia nervosa?

A

Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, developmental trajectory and physical health

101
Q

What is bulimia nervosa?

A

Recurrent episodes of binge eating characterised by eating in a discrete amount of time large amounts of food, and a sense of lack of control over eating during an episode, with recurrent inappropriate compensatory behaviour to prevent weight gain

102
Q

How do we distinguish binge eating disorder from bulimia nervosa?

A

No purging or compensatory behaviours

103
Q

What does OSFED stand for?

A

Other specified feeding and eating disorders

104
Q

Give 3 diseases of OSFED

A
  • ) Atypical anorexia nervosa
  • ) Bulimia nervosa/binge eating disorder of low freqeuncy/limited duration
  • ) Purging disorder
  • ) Night eating syndrome
105
Q

Give 2 risk factors for developing eating disorders

A
  • ) Genes
  • ) Temperament
  • ) Family interaction
  • ) Social pressure
  • ) Trauma
106
Q

Give the maintaining factors of an eating disorder

A
  • ) Positive reinforcement for weight loss initially

- ) Then terror at losing control

107
Q

How do we treat eating disorders?

A

CBT, family therapy, specialist support

108
Q

What is the 2nd leading cause of death amongst children under 5 globally?

A

Diarrhoea

109
Q

What does SIGHT mean with C. diff?

A
  • ) Suspect C. diff as a cause of diarrhoea
  • ) Isolate cause
  • ) Gloves and apron
  • ) Hand washing
  • ) Test stool for toxin
110
Q

Give 2 emotional side effects of obesity

A
  • ) Stigma
  • ) Bullying
  • ) Low self esteem
  • ) School absence
  • ) Unemployment
111
Q

Give 3 physical effects of obesity

A
  • ) High cholesterol and BP
  • ) Pre-diabetes
  • ) Bone and joint problems
  • ) Breathing problems
  • ) Risk of premature mortality
  • ) RF for heart disease, stroke, cancer, liver disease, infertility, depression, sleep apnoea, asthma, DM
112
Q

Give 2 interventions for obesity

A
  • ) Wider level - change4life, 5 a day
  • ) Environment - more cycle paths, less car parking
  • ) Public policy - sugar tax, minimum alcohol pricing
113
Q

What are the 2 groups of beliefs influencing patients evaluation of prescribed drugs?

A
  • ) Necessity

- ) Concerns

114
Q

What is human error?

A

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

115
Q

What is the swiss cheese model of patient safety?

A

Each slice is a level of defence, the holes are latent conditions/poor design/poor management conditions - if many holes line up, it gives a patient safety incident

116
Q

Give an example of a patient safety defence

A
  • ) Pre-op checklist
  • ) Checking drugs before adminstration
  • ) Marking surgical site before operation

Medicine Year 2 5 (17 decks)

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