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Phase 2a > Public Health > Flashcards

Public Health Flashcards

1
Q

What are the 7 duties of a doctor?

A
  1. Make the care of your patient your first concern
  2. Keep your professional knowledge and skills up to date
  3. Treat your patient politely and considerately
  4. Respect your patient’s right to confidentiality
  5. Protect and promote the health of patients and the public.
  6. Treat patients as individuals and respect their dignity.
  7. Recognise and work within `the limits of your competence.
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2
Q

What are 4 psychosocial factors that increase CHD risk?

A
  1. Type A personality (hostile, competitive, impatient)
  2. Depression/anxiety
  3. Psychosocial work characteristics -Long work hours (more than 11hrs/day) -High demand, low control
  4. Lack of social support
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3
Q

What can doctors do for those with CHD risk?

A 
Identify depression/anxiety
Ask about occupation
Liaise with social support services
Vascular screening 
Risk reduction through promoting healthier lifestyles 
QRISK2 score
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4
Q

What are the 8 Bradford Hill Criteria?

A
  1. Strength of association
  2. Consistency
  3. Specificity
  4. Temporality
  5. Dose response
  6. Removal
  7. Biological plausibility
  8. Experimental animals
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5
Q

What are the benefits of alcohol consumption?

A
  1. Mildly euphoriant for many
  2. Socialisation
  3. Cardioprotective in low doses
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6
Q

What are the psychosocial effects of excessive alcohol consumption?

A
  1. Interpersonal relationship problems
  2. Criminality/Violence
  3. Problems at work/ Unemployment
  4. Social disintegration (Poverty)
  5. Driving Offences
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7
Q

List 4 withdrawal symptoms

A
  1. Tremulousness
  2. Activation syndrome: Tremulousness, agitation, rapid heart beat, high bp
  3. Seizures
  4. Hallucination
  5. Delirium tremens
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8
Q

What is the UK alcohol limit?

A

14 Units per week (not more than 6 in one session)

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9
Q

How can you work out how many units a drink is?

A

Strength of drink (%ABV)x amount of liquid (ml)/1000

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10
Q

What are some symptoms of fetal alcohol syndrome?

A

Pre + post-natal growth retardation and CNS abnormalities: mental retardation
Irritability, incoordination, hyperactivity
Craniofacial abnormalities
Congenitial defects, increase in incidence of birthmarks and hernias

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11
Q

List some primary preventative methods for alcoholism?

A 
Drinkaware – alcohol labelling 
THINK! – drink driving campaign 
‘Know your limits’ binge drinking campaign
Restriction on alcohol advertising 
Minimum pricing
Legislation – e.g. age limit 
Opening hours 
Glass substitution
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12
Q

What can doctors do for alcoholics?

A

Screening: CAGE and Alcohol Use Disorders Identification Test (AUDIT)
Brief interventions: FRAMES
Motivational interviews
referral to specialist
Help set goals, agree on plan, provide educational materials

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13
Q

What are the four CAGE questions?

A

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever taken a drink first thing in the morning? (Eye- opener)

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14
Q

What are the four risks for alcohol abuse?

A

Role failure
Relationship problems
Run-ins with law
Risk of bodily harm

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15
Q

What are the 6 features of alcohol dependence?

A 
Withdrawal symptoms 
Tolerance 
Keep drinking despite problems 
Cannot keep within drinking limits 
Spend a lot of time drinking/recovering from drinking 
Spend less time on other impt matters
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16
Q

What are the 5 treatments for alcoholism?

A

Naltrexone: competitive antagonist for opioid receptors, rapid detox
Disulfiram: produces sensitivity to alcohol - worst hangover
Acamprosate: stabilises chemical balance
Behavioural therapy
Social support - Alcoholics Anonymous

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17
Q

Why do people smoke?

A 
Fear of weight gain on cessation
Coping with stress 
Socialising
Nicotine addiction
Habit/behavioural
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18
Q

What can doctors do for smokers?

A

Nicotine replacement therapy: patches, gum, nasal spray
Ask (are you a smoker)
Advise (smoking is bad)
Assist (refer to NHS Stop Smoking service)

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19
Q

What are the stages of change for stopping smoking?

A

Precontemplation: smoker, not thinking about quitting
Contemplation: smoker, thinking about quitting but not ready yet
Preparation: smoker, thinking about quitting and taking steps to prepare for quitting
Action: ex-smoker, quit for <6months
Maintenance: non-smoker, quit for >6 months
Relapse

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20
Q

What are the 5 components of stress?

A 
Behavioral=Alcohol, poor sleep
Cognitive= Poor concentration
Physiological= Headaches
Emotional= Mood swings, irritable
Biochemical= Endorphin levels altered
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21
Q

What are the Wilson-Junger criteria?

A
  1. Condition should be an important problem
  2. There should be an acceptable treatment
  3. There should be a recognised early stage
  4. Facilities for diagnosis/treatment are available
  5. There should be a suitable test
  6. The test should be acceptable to the population
  7. The natural history of the disease should be known
  8. Case finding should be a continuous process
  9. Early treatment should make a difference to prognosis
  10. Cost of case finding should be economical
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22
Q

What is sensitivity?

A

Measure of how well a test picks up those with the disease

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23
Q

What is specificity?

A

Measure of how well a test recognises those without the disease

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24
Q

What is prevalence?

A

A measure of how common a disease or condition is in a defined population at a particular point in time

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25
Q

What is screened for in pregnancy?

A

Sickle cell and thalassaemia, infectious diseases, Downs syndrome, patau’s syndrome, Edwards’ syndrome, physical conditions

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26
Q

What is screened for in newborns?

A

Newborn hearing
Physical examinations for eyes, hearts, hips and testes
Newborn blood spot for sickle cell etc

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27
Q

When does cervical screening start?

A

Age 25

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28
Q

When does breast screening start?

A

Age 50

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29
Q

What is addiction?

A

Physical and psychological dependence

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30
Q

What are the diagnostic criteria for addiction?

A

Acute intoxication, harmful use, dependence

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31
Q

What is the tier 1 UK drug treatment?

A

Non-specialist, generic-substitution treatment: wean patient off drug

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32
Q

What is tier 2 UK drug treatment?

A

Open-access services

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33
Q

What is tier 3 UK drug treatment?

A

Specialist community-based drug services

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34
Q

What is tier 4 UK drug treatment?

A

Specialist inpatient services- detoxification

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35
Q

What is malnutrition?

A

State of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body function and clinical outcome

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36
Q

What are the consequences of malnutrition?

A
  1. Loss of muscle tissue and strength
  2. Reduced immune response/ increased infection
  3. Poor wound healing
  4. Loss of mucosal integrity
  5. Psychological decline
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37
Q

What are the seven steps to end malnutrition in hospitals?

A
  1. Hospital staff must listen to older people
  2. All ward staff must become food aware
  3. Hospital staff must follow their own proffesional codes
  4. Older people must be assessed on admission and at regular intervals
  5. Introduce protected mealtimes
  6. Implement a red tray system and ensure that it works
  7. Use volunteers where appropriate
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38
Q

List 5 methods to improve or maintain nutritional intake

A
  1. Oral nutrition support
  2. Enteral tube feeding
  3. Parenteral nutrition
  4. Nutritional screening to identify malnourished patients
  5. Nutritional assessment for malnourished patients
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39
Q

How do you calculate BMI?

A

Weight (kg)/ Height^2 (m)

40
Q

What should patients be asked to measure malnutrition?

A

Have you unintentionally lost weight recently?
Have you been eating less than normal?
What is your normal weight?
How tall are you?

41
Q

List 3 eating disorders

A

Anorexia nervosa, bulimia nervosa, binge-eating

42
Q

What are some symptoms of anorexia nervosa?

A 
Dread of fatness
Self starvation
Refusal to maintain or achieve 85% normal body weight
Dietary restriction
Excessive exercise
Induced vomitting
Appetite suppressants 
Social withdrawal 
BMI <17.5 
Metabolic change
43
Q

What are some symptoms of bulimia nervosa?

A 
Repeated bouts of overeating
Preoccupation with body weight 
Purging
Fasting 
Excessive exercise
44
Q

What are the 4 psychological principles of eating disorders?

A
  1. Judge self worth exclusively in terms of shape, weight and their control
  2. Control of eating and shape is socially reinforced
  3. Individual vulnerability plus challenges of adolescence can start the disorder
  4. Thinness= competence, attractiveness, control
45
Q

What are the treatments of anorexia?

A
  1. Stabilisation of eating, self-monitoring, weekly weighting
  2. Initial focus on enhancing motivation
  3. Behavioral change
  4. Cognitive reconstruction
  5. Relapse prevention
46
Q

What are the treatments of bulimia?

A
  1. Education
  2. Stabilise eating patterns
  3. Strategies to manage urges to binge or purge
  4. Systematic introduction of avoided foods
  5. Problem-solving
  6. Reduction of body-checking
  7. Modification of beliefs
47
Q

Generally is anorexia or bulimia easier to treat?

A

Bulimia

48
Q

What is the definition of health?

A

State of complete physical, mental and social well-being and not merely the absence of disease or infirmity

49
Q

What are ethics?

A

A system of moral principles and branch of philosophy which defines what is good for individuals and society

50
Q

Name 5 branches of ethics?

A 
Consequentialism
Utilitarian
Deontology
Virtue Ethics
Morality
51
Q

What is consequentialism?

A

Concerned with the outcomes or consequences of behaviour; form the basis for any valid moral judgement

52
Q

What is utilitarian ethics?

A

An act is evaluated solely in terms of its consequences, produce the greatest possible balance of value over disvalue, maximising well-being and minimize suffering

53
Q

What is deontology?

A

A duty to follow natural laws and rights; rightness or wrongness from the character of the act itself rather than the outcomes, features of the act themselves determine worthiness e

54
Q

What is virtue ethics?

A

Focus in on the character of the agent, integrates reason and emotion; deemphasizes rules, consequences and particular acts -contrast with consequentialisation

55
Q

What is morality?

A

Concern about the distinction between good and evil or right and wrong

56
Q

What are the five focal virtues?

A 
Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness
57
Q

What are the four principles?

A
  1. Autonomy
  2. Beneficence
  3. Non-maleficence
  4. Justice
58
Q

What is distrubive justice?

A

Fair distribution of scarce resources

59
Q

What is right based justice?

A

Respect for people’s rights

60
Q

What is legal justice?

A

Respect for the law

61
Q

What is an autonomous action?

A
  1. Intentional
  2. Done with understanding
  3. Done without controlling influences that determine an individual’s actions
62
Q

Where are some areas where ethics conflict with law?

A

Euthanasia, suicide, abortion, assault etc

63
Q

What are the millennium development goals?

A
  1. Eradicate Extreme Poverty & Hunger
  2. Achieve Universal Primary Education
  3. Promote Gender Equality & Empower Women
  4. Reduce Child Mortality
  5. Improve Maternal Health
  6. Combat HIV/AIDS, Malaria and Other Diseases
  7. Ensure Environmental Sustainability
  8. Develop a Global Partnership for Development
64
Q

What are some recommendations to reduce inequality?

A
  1. Improve daily living conditions
  2. Tackle the inequitable distribution of power, money and resources
  3. Measure and understand the problem and assess the results of action
65
Q

What are 4 ways of functionally assessing older people?

A
  1. ADL
  2. IADL
  3. Barthel ADL index
  4. MMSE
66
Q

What is an R number?

A

The average number of secondary cases generated by a primary case

67
Q

What is the disability paradox?

A

People with profound disability report a high quality of life as expectations adjust to current conditions

68
Q

What public health interventions can prevent influenza?

A
  1. High washing
  2. Respiratory hygiene “Catch it, Bin it, Kill it”
  3. Reduce social contact
69
Q

What wide interventions can prevent influenza?

A
  1. Travel restritions
  2. Restrictions of mass public gatherings
  3. Schools closure
  4. Voluntary home isolation of cases
  5. Voluntary quarantine of contacts of known cases
  6. Screening of people entering UK ports
70
Q

What are the phases of managing infectious threat?

A
  1. Infection of new threat
  2. Containment phase- Reduce spread, isolate cases
  3. Management phase- manage cases, reduce severity, protect those most vulnerable
71
Q

How is clostridium difficile identified?

A 
S- Suspect C diff as a cause of diarrhoea
I- Isolate the case
G- Gloves and aprons must be worn
H- Hand washing
T- Test stool for toxin
72
Q

How is clostridium difficile treated?

A

Metronidazole/ Vancomycin

73
Q

How is diarrhoea controlled?

A 
Handwashing with soap 
Ensure availability of safe drinking water 
Safe disposal of human waste 
Breastfeeding of infants &amp; young children 
Safe handling and processing of food 
Control of flies/vectors 
Case management including exclusion 
Vaccination
74
Q

What are the at risk groups for diarrhoea?

A

A- Persons of doubtful personal hygiene or with unsatisfactory hygiene facilities
B- Children who attend pre-school or nursery
C- People whos work involves preparing or serving unwrapped/uncooked food
D- HCW/ Social care staff working with vulnerable people

75
Q

What is epidemiology prevalence?

A

The proportion of a population that have the disease at a point in time

76
Q

How do you calculate prevalence?

A

Incidence x avg. duration

77
Q

What is an ecological study?

A

Population based data rather than individual data

78
Q

What is a case-control study?

A

Looks at people with a disease and compares with a control

79
Q

What is a cohort study?

A

Incidence study, follow a group of people over a period in time

80
Q

What is an intervention study?

A

Do something and compare to none intervention

81
Q

What is confounding?

A

When the effect of an intervention is distorted because of the association with other factor that influences the outcome

82
Q

What is bias?

A

Systemic disposition of certain trial designs to produce results consistently better or worse than other trial designs

83
Q

Name some pandemics

A

Cholera, Spanish flu, SARS, Covid19

84
Q

What is the RAAMbo method for critical appraisal?

A

R – Representative?
A – Allocated or Adjusted?
A – Accounted for?
Mbo –Measurement blind or objective?

85
Q

Describe the chain of infection

A 
Reservoir
Portal of exit 
Mode of transmission
Portal of entry
Susceptible host 
Pathogen
86
Q

Describe the increase in infection group

A 
Sporadic
Cluster
Outbreak
Epidemic
Pandemic
Endemic
87
Q

Name some public health countermeasures in pandemics

A 
Hygiene
Social distancing
Isolation
PPE
Treatment as prevention
Chemoprophylaxis
Vaccination
88
Q

What are the three groups of causes for gender differences in health?

A

Biological, social roles, structural factors

89
Q

List three reasons as to why men may have a lower life expectancy

A
  • Risk behaviours
  • Reluctance to seek help when ill
  • More dangerous employment conditions
90
Q

What is adherence?

A

The patient-centred approach to encourage patients to work with healthcare professionals to get the best possible outcome.

91
Q

Give some examples of non adherence

A
  • Not taking prescribed medication
  • Taken more or less than prescribe
  • Stopping taking medication before finishing the course
  • Continuing with behaviours against medical advise
92
Q

List some unintentional reasons for non adherence

A

Difficulty understanding instructions
Problems using treatment
Inability to pay
Forgetting

93
Q

List some intentional reasons for non adherence

A

Patients belief about their health/ conditions
Beliefs about treatments
Personal preferences

94
Q

What are necessity beliefs?

A

Perceptions of personal need for treatment

95
Q

List some notifiable diseases

A
  • Covid-19
  • Measles, mumps, rubella
  • Malaria
  • Leprosy
  • Food poisoning
  • Meningitis
  • Acute infectious hepatitis
96
Q

What is is a notifiable disease

A

Diseases notifiable to local authority proper officers under the Health Protection

Phase 2a (31 decks)

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