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Phase 3a > Public Health and GP > Flashcards

Public Health and GP Flashcards

1
Q

Define incidence

A

The number of new cases in a given time period

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2
Q

Define prevalence

A

The number of existing cases at a given point in time

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3
Q

How is incidence rate calculated?

A

Incidence/Total person-time at risk during that period

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4
Q

What is the ratio of risk of disease in the exposed, to the risk of disease in the unexposed?

A

Relative risk

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5
Q

How is relative risk calculated?

A

Incidence in exposed/incidence in unexposed

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6
Q

What is attributable risk?

A

Rate of disease in the exposed that may be attributed to the exposure

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7
Q

How is attributable risk calculated?

A

Incidence in the exposed minus incidence in the unexposed

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8
Q

What is bias?

A

A systematic error that leads to the distortion of the true underlying association

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9
Q

What are the two types of bias?

A

Selection

Measurement

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10
Q

Give an example of selection bias

A

Systematic error in the allocation of participants to different study groups

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11
Q

Give an example of measurement bias

A

A systematic error in the measurement of the outcome e.g. wrongly calibrated instrument

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12
Q

What is confounding?

A

A factor is associated with the exposure of interest and independently influences the outcome, but does not lie on the causal pathway

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13
Q

Give three of the Bradford Hill criteria required for causality

A

Dose-response
Biological plausibility
Consistency

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14
Q

What is an evaluation of health services?

A

The assessment of whether a service achieves its objectives

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15
Q

What is the Donabedian framework for health service evaluation?

A

Structure, process, outcome

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16
Q

What are Maxwell’s dimensions of quality in assessing healthcare?

A 
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
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17
Q

Give three factors that promote excessive energy intake

A

Shift work
Early developmental factors
Characteristics of food (energy density, portion size etc)

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18
Q

What is malnutrition?

A

Deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients

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19
Q

What are the four types of undernutrition?

A

Stunting (low height for age)
Wasting (low weight for height)
Underweight (low weight for age)
Micronutrient deficiencies

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20
Q

Name some chronic medical conditions that require nutritional support

A

Cystic fibrosis
Eating disorders
Cancer

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21
Q

Give two early influences of feeding behaviour

A

Antenatal maternal diet

Maternal diet if breastfeeding

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22
Q

Give three benefits of breastfeeding

A

Gut protection
Antibodies
Anti infective - bifidus factor

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23
Q

How should parents cope with refusal of food?

A 
Model healthful eating behaviours
Provide a variety of foods
Avoid pressure to eat
Not using food as a reward
Responsive feeding
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24
Q

What is responsive feeding?

A

Recognizing hunger and fullness cues

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25
Q

Define eating disorder

A

Clinically meaningful behavioural or psychological pattern having to do with earing or weight that is associated with distress, disability, or a significantly increased risk of morbidity or mortality

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26
Q

Give three types of disordered eating

A

Strict dieting
Emotional eating
Binge eating

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27
Q

Give three problems of dieting

A

Slows metabolic rate
Weight cycling accelerates weight gain
Risk factor for development of ED

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28
Q

What is restrained eating?

A

The deliberate attempt to inhibit food intake in order to maintain or to lose weight

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29
Q

Give three determinants of health

A

Genes
Lifestyle
Employment
Education

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30
Q

What is the difference between horizontal and vertical equity?

A

Horizontal - equal treatment for equal need

Vertical - unequal treatment for unequal need

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31
Q

What are the domains of public health practice?

A

Health improvement
Health protection
Improving services

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32
Q

Give three risk factors for homelessness

A 
Relationship breakdown
Unemployment
Mental health problems
Domestic violence
Substance abuse
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33
Q

What is the inverse care law?

A

The people that need healthcare the most have the least access to it

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34
Q

What is a health needs assessment?

A

A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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35
Q

What is a health need?

A

The ability to benefit from an intervention

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36
Q

What are the types of health need?

A 
Felt need
Expressed need
Normative need
Comparative need
Health care need
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37
Q

What are the three approaches to a health needs assessment

A

Epidemiological
Comparative
Corporate

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38
Q

What are the sections to Maslow’s Hierachy of Needs (bottom upwards)?

A 
Physiological
Safety
Love/belonging
Esteem
Self-actualization
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39
Q

What are epigenetics?

A

The expression of the genome depends on the environment

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40
Q

What is allostasis?

A

The process of achieving stability through physiological or behavioural change

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41
Q

How is allostasis carried out?

A

Altering that HPA axis hormones

Autonomic nervous system

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42
Q

Epigenetics + allostatic load + environment =

A

Multimorbidity

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43
Q

What is salutogenesis?

A

Favourable physiological changes secondary to experiences which promote healing and health

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44
Q

Give five models of behaviour change

A 
Health belief
Theory of planned behaviour
Stages of change
Motivational interviewing
Nudging
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45
Q

What are the characteristics of the health belief model?

A

The individual will change if they believe they are susceptible to the condition, that it has serious consequences, that taking action reduces susceptibility, the benefits of taking action outweigh the costs

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46
Q

What is the unique component of the health belief model?

A

Cues to action

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47
Q

What are the three components of theory of planned behaviour?

A

Attitude to behaviour
Subjective norm
Perceived behavioural control

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48
Q

What are the 5 stages of change?

A 
Pre-contemplation
Contemplation
Decision
Action
Maintenance
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49
Q

What is primary prevention?

A

Prevention of disease when there is no disease present

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50
Q

What is secondary prevention?

A

Prevention of disease when there is subclinical disease present

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51
Q

What are the two approaches to prevention?

A

Population

High-risk

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52
Q

What is screening?

A

A process that sorts apparently well people who probably have a disease, do those who probably do not

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53
Q

What is the criteria for screening tests?

A

Wilson and Jugner

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54
Q

Outline the Wilson and Jugner criteria

A

Condition is important, has a preclinical phase
Test is suitable
Effective treatment
Cost-effective

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55
Q

What is a false positive?

A

Disease is absent but screening test says it is present

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56
Q

What is a false negative?

A

Disease is present but screening test says it is absent

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57
Q

Define specificity

A

The proportion of people without the disease who are correctly excluded by the test

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58
Q

Define sensitivity

A

The proportion of people with the disease who are correctly identified by the test

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59
Q

What is the PPV?

A

The proportion of people with a positive test result who actually have the disease

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60
Q

What is the NPV?

A

The proportion of people with a negative test result who do not have the disease

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61
Q

What are the types of health behaviours?

A 
Health behaviour
Illness behaviour
Sick role behaviour
Health damaging behaviour
Health promoting behaviour
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62
Q

What are three characteristics of addiction?

A

Craving
Tolerance
Compulsive drug seeking behaviour
Physiological withdrawal state

63
Q

What are the aims of treating substance misuse?

A

Reduce harm
Improve health
Stabilise lifestyle
Reduce crime

64
Q

What medications are used for maintenance of an opioid user?

A

Methadone or buprenorphine

65
Q

What is the biopsychosocial approach to health and disease?

A

Integrated approach

Involves biological, psychological, and social factors

66
Q

What is the difference between demand and supply?

A

Demand - what people ask for

Supply - what we actually provide

67
Q

What is expressed need the same as?

A

Demand

68
Q

What is a felt need?

A

Individual perceptions of variation from normal health

69
Q

What is the name of the taxonomy of need?

A

Bradshaw’s

70
Q

Finish the sentence: if there is no need, there should be…

A

No intervention

71
Q

What does a corporate health needs assessment involve?

A

Stakeholders e.g. doctors, patients, funding bodies

-Asking what is needed

72
Q

What does a comparative health needs assessment involve?

A

Compares health needs with similar populations/situations

73
Q

What does an epidemiological approach to a health needs assessment involve?

A

Looks at problems, addresses them based on the extent of the issue

74
Q

What is the difference between the Donabedian and Maxwell evaluation frameworks?

A

Donabedian - structure>process>outcomes

Maxwell - Efficacy, efficiency, equity, access, acceptability, appropriateness

75
Q

What is the black evaluation framework?

A

Efficacy, efficiency, equity, humanity

76
Q

What are the three types of evaluation frameworks?

A

Donabedian
Black
Maxwell

77
Q

What is an ecological study?

A

Study carried out at population level rather than individual level

78
Q

What is a cross-sectional study?

A

Examines distribution and determinants
Data is collected on each participant at a single point in time - snapshot
Measures prevalence

79
Q

What is a case control study?

A

Identifies those with and without the outcome and determines previous exposure to risk factors

80
Q

What is a cohort study?

A

Observational - group of individuals who share a common characteristic, measures incidence
Prospective or retrospective

81
Q

What is the criteria for a randomised controlled trial?

A

Random allocation to intervention or control

Predefined rules for eligibility, endpoints, follow up, analysis plans

82
Q

What are the pros and cons of RCTs?

A

Pro - minimises bias and confounders

Cons - expensive, large drop outs

83
Q

What is the PICO framework that is used for studies and literature searches?

A

Population
Intervention/exposure
Comparison/control
Outcome

84
Q

What are the four types of surveillance of prevalence of diseases?

A

Passive - routine
Sentinel
Active - requires negative reporting
Enhanced

85
Q

What is risk?

A

Total number of new cases in a defined population at risk over a specified time period

86
Q

What is the prevention paradox?

A

If something brings about a lot of benefit to the population, then it provides little benefit to each individual

87
Q

From what age is breast cancer screening an option and what are the details?

A

50-70 years
Mammography every 3 years
Triple assessment if positive

88
Q

What is the triple assessment in breast cancer screening?

A

Imaging (USS<40, mammography+USS>40)
Clinical assessment
Biopsy

89
Q

What are the disease screened for in the newborn heel-prick test?

A 
Sickle cell
CF
Congenital hypothyroidism
Maple-syrup disease
PKU
Homocystinuria
90
Q

What is length-time bias in screening?

A

Shorter, more aggressive disease is usually missed as screening happens at regular intervals and is more likely to identify diseases with a prolonged pre-clinical stage

91
Q

Why do negligence and never events happen?

A 
Human error
Misconduct
Judgement failure
Neglect
Poor performance
92
Q

What is a never event?

A

An adverse event that should never happen

93
Q

When does negligence occur?

A

There was a duty of care
This was breached
The patient came to harm
The harm was due to the breach in the duty of care

94
Q

What are the four principles of ethics?

A

Autonomy
Beneficience
Non-maleficience
Justice

95
Q

What are some transition points in stages of change?

A 
Leaving school
Relationship breakdown
Having children
Losing/getting a job
Bereavement
96
Q

What is the difference between equity and equality?

A

Equity - what is fair and just

Equality - equal shares for all

97
Q

What is stage 1 and stage 2 hypertension?

A

Stage 1 - Clinic BP >=140/90 or home BP >= 135/85

Stage 2 - Clinic BP >=160/1– or home/ambulatory BP>=150/95

98
Q

When is hypertension severe?

A

Clinic systolic >=180mmHg OR

Clinic diastolic >=110mmHg

99
Q

When do you treat Stage 1 hypertension?

A

Less than 80 years
Target organ damage
Established renal/CV disease/diabetes/Q-risk over 20%

100
Q

When do you treat Stage 2 hypertension?

A

Drug treatment regardless

101
Q

How much salt should be restricted in hypertensive patients?

A

Less than 6g/day, ideally less than 3g/day

102
Q

What are three other lifestyle changes in hypertension?

A

Reduce caffeine

General - stop smoking, drink less alcohol, exercise etc

103
Q

What is the first line treatment for hypertension in a) a patient less than 55 years, and b) a patient older than 55 years/Afro-Caribbean origin?

A

a) ACE inhibitor

b) Calcium channel blocker

104
Q

What is the second line treatment for hypertension?

A

Combine ACEI and CCB

105
Q

What is an alternative treatment if a patient does not tolerate an ACEI?

A

Angiotensin-receptor blocker

106
Q

What is the third line treatment in hypertension?

A

Add a thiazide diuretic (chlorthalidone or indapamide)

107
Q

What is the fourth step in treating hypertension?

A

Further diuretics: K<4.5mmol/l add spironolactone

K>4.5mmol/l add higher dose thiazide

108
Q

What investigations would you do for “feeling tired all the time?”

A 
FBC, ESR/CRP, WCC, LFT, UE
IgA and TTG
Thyroid function
Random or fasting glucose/HbA1c
PHQ-9
109
Q

What are the differentials for “feeling tired all the time?”

A 
Diabetes
Hypothyroidism
Coeliac disease
Lyme disease
Infectious mononucleosis
Vitamin D deficiency
Chronic hepatitis
Depression
110
Q

What are three dietary advices for type 2 diabetes?

A

High fibre, low glycaemic index source of carbohydrates
Oily fish
Control saturated fats

111
Q

How often is HbA1c checked?

A

6 monthly once stable

112
Q

What is the HbA1c required for a diagnosis of diabetes, and non-diabetic hyperglycaemia?

A

DM: =>48mmol/mol

Hyperglycaemic: 42-47mmol/mol

113
Q

What is the fasting blood glucose level required to diagnose diabetes, and non-diabetic hyperglycaemia?

A

DM: >=7mmol/l
Hyperglycaemia: >= 6.1-6.9

114
Q

What is non-diabetic hyperglycaemia another phrase for?

A

Impaired glucose tolerance

115
Q

Give three complications of uncontrolled type 2 diabetes?

A 
Peripheral arterial disease
Neuropathy
Retinopathy
Ketoacidosis
Nephropathy
116
Q

When should you arrange emergency admission to hospital in a man with chest pain?

A

Chest pain <3 days: emergency

Chest pain >3 days: History, ECG, troponin, then decide

117
Q

What is the prophylactic treatment for angina?

A

Aspirin
Statin
Sublingual glycerol trinitrate
BB/CCB

118
Q

What type of calcium channel blockers can be used in angina?

A

Monotherapy - rate limiting one such as verapamil or diltiazem
Combo with BB - long acting dihydropyridine e.g. nifedipine

119
Q

What drug should beta-blockers not be prescribed with and why?

A

Verapamil

Risk of complete heart block

120
Q

What medications are second line in the treatment of angina?

A

Ivabradine

Nicorandil

121
Q

In treatment of Atrial Fibrillation, what factors favour rate control?

A

Older than 65

History of ischaemic heart disease

122
Q

In treatment of Atrial Fibrillation, what factors favour rhythm control?

A

Younger than 65
Symptomatic
First presentation
Congestive heart failure

123
Q

Name three rate-control agents used in AF

A

Beta-blocker
Calcium channel blocker
Digoxin if heart failure

124
Q

Name three rhythm control agents used in AF

A

Sotalol
Amiodarone
Flecainide

125
Q

What is the CHADSVASC score?

A

Calculates risk of stroke in atrial fibrillation

126
Q

What post-bronchodilator spirometry findings are likely in COPD?

A

FEV1/FVC<70

127
Q

What are the X-Ray findings in COPD?

A

Hyperinflation
Bullae
Flat hemidiaphragm

128
Q

What are the symptoms of COPD?

A

Productive chronic cough
Dyspnoea
Wheeze
Afebrile

129
Q

What are pink puffers?

A

Typically emphysema-predominant

Older and thing, not cyanosed, severe dyspnoea, quiet chest

130
Q

What is emphysema?

A

Permanent enlargement and destruction of airspaces distal to the terminal bronchiole

131
Q

What are blue bloaters?

A

Typically chronic bronchitis patients
Overweight and cyanotic
Cough and wheeze, peripheral oedema

132
Q

What is the treatment of an acute exacerbation of COPD?

A

Increase frequency of bronchodilator use, consider giving via a nebuliser
Prednisolone 7-14d

133
Q

What should oral antibiotics be given in COPD?

A

Purulent sputum

Clinical signs of pneumonia

134
Q

What is the most common case of an infective exacerbation of COPD?

A

Haemophilus influenzae

135
Q

Which drugs should you be careful of in AKI/CKD?

A 
Diuretics
ACEI
ARBs
Metformin
NSAIDs
136
Q

What are the causes of anaemia in renal failure?

A

Reduced EPO
Reduced iron absorption
Reduced red cell survival
Reduces erythropoiesis due to toxic effects of uraemia on bone marrow

137
Q

What are three causes of acute heart failure?

A

Acute coronary syndrome
Hypertensive crisis
Acute arrhythmia
Valvular disease

138
Q

When is BNP raised?

A

> 100mg/litre

139
Q

What causes BNP to rise?

A

Heart failure
Any cause of left ventricular dysfunction
Reduced excretion in CKD

140
Q

What is the name of the classification system for heart failure?

A

New York Heart Association

141
Q

What test would you do for someone wanting to stop drugs?

A

Urine drugs screen

142
Q

What blood test would you do in alcoholics?

A

MCV

Gamma GT

143
Q

What are the symptoms of hypothyroidism?

A 
Fatigue
Feeling cold
Poor memory and concentration
Constipation
Weight gain and poor appetite
Shortness of breath
Hoarse voice
Poor hearing
Carpal tunnel
144
Q

What are the signs of hypothyroidism?

A 
Dry skin
Cool peripheries
Hair loss
Bradycardia
Delayed relaxation of tendon reflexes
Oedema
Pleural effusion/ascites
145
Q

What are the components of the health transaction?

A

Persons health needs and demands
Providers services that are supplied
How is it paid for

146
Q

What is the main differentiation between different types of healthcare system?

A

How it is paid for

147
Q

Name five barriers to accessing healthcare.

A 
Costs
Geography
Risk perception
Physical barriers
Awareness/education
148
Q

What are the components of health economics?

A

Opportunity cost
Economic efficiency
Equity
Economic evaluation

149
Q

What is meant by opportunity cost?

A

Sacrifice e.g. benefits lost from not allocating resources to the next best activity

150
Q

What is meant by economic efficiency?

A

Resources allocated to maximise benefit

151
Q

What is an economic evaluation?

A

Comparative study of the costs and benefits of healthcare interventions

152
Q

What is a QALY?

A

Quality adjusted life year
Measures disease burden - quality and quantity of life gained after an intervention
1 QALY = 1 year of perfect health

153
Q

What is incremental analysis in cost-effectiveness?

A

Analysing by comparison

154
Q

What is the incremental cost analysis ratio?

A

Cost intervention A-Cost intervention B
/
Benefit intervention A-Benefit intervention B

Phase 3a (18 decks)

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