Public health and PPS

Question 1

Define good musculoskeletal health

Answer 1

Healthy/disease-free muscles, joints, and bones, with the ability to carry out a wide range of physical activities/functions both effectively and symptom free

Question 2

What are the primary, secondary, and tertiary preventions in musculoskeletal health?

Answer 2

Primary prevention = reduce the prevalence of risk factors (physical activity, nutrition through life course)
Secondary prevention = screening (specific conditions e.g. congenital hip dislocation)
Tertiary prevention = management of conditions to reduce impact (e.g. back pain, joint pain, minor injuries)

Question 3

What is the prevalence of MSK conditions in England?

Answer 3

30%

Question 4

What are the modifiable risk factors of MSK conditions?

Answer 4

Vitamin D/calcium deficiency
Obesity
Physical activity
Injury prevention

Question 5

How is physical activity used in MSK health?

Answer 5

Self-directed: needing accessible community facilities (e.g. parks, cycle paths, gyms, swimming pools)
Supervised physical activity: run by fitness professionals (e.g. walking clubs, aqua aerobics, dance clubs)
Structures community rehabilitation programmes: run by physiotherapist more condition specific (e.g. ESCAPE-pain)
Individualised support: covered by sports/exercise medicine and physiotherapy

Question 6

Define frailty

Answer 6

Loss of individual resilience that affects the rate and extent of recovery following an injury, illness, or other physical, emotional, or psychological trauma

Question 7

What things are required for consent?

Answer 7

Consent must be…
- voluntary
- informed
- mad by someone with capacity
You must tell people…
- what
- how
- risk
- benefits
- alternatives

Question 8

Why is informed consent important?

Answer 8

Properly informed consent helps to prevent a negligence claim being brought

Question 9

What things mean that a patient is unable to make a decision?

Answer 9

A patient is unable to make a decision if they cannot…
- understand the relevant information
- retain it
- use or weight it to make a decision
- communicate the decision

Question 10

What should be done if the patient is not capable of making a decision for themselves?

Answer 10

Check whether there is someone who can make a decision on their behalf
Act in the patients best interests, taking into account…
- whether the patient may soon regain capacity
- patient’s past and present wishes
- patients’ beliefs and values
- consultation with anyone applicable

Question 11

What is the recommended level of alcohol to keep the associated harm risks low?

Answer 11

> 14 units per week
Spread evenly over 3+ days
Have several alcohol-free days each week

Question 12

How are the number of units in an alcoholic drink calculated?

Answer 12

(%ABV x volume in ml)/1000

Question 13

What is substance misuse?

Answer 13

Continued misuse of a substances (e.g. alcohol, drugs) despite persistent or recurrent social or interpersonal problems
May be physically hazardous e.g. driving or operating machinery
Results in failure to fulfil role obligations e.g. work, school, home life

Question 14

Define dependence

Answer 14

A state in which an organism functions normally only in the presence of a drug, manifesting as a physical (e.g. stomach cramps, muscle aches) or psychological (e.g. feelings of fear, pain, shame, guilt, loneliness) disturbances when the drug is withdrawn

Question 15

Define tolerance

Answer 15

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

Question 16

What are withdrawal symptoms treated with?

Answer 16

Benzodiazepines (e.g. diazepam)

Question 17

List the types of substances, some examples, and their effects

Answer 17

Opiates e.g. heroin, morphine: euphoria, pain relief
Depressants e.g. alcohol, benzodiazepines: sedation, relaxation, slow down thinking
Stimulants e.g. caffeine, nicotine, cocaine: increased alertness, activity and mood
Hallucinogens e.g. ecstasy, ketamine, mushrooms: alter sensory perception and thinking

Question 18

What are the risk factors for developing substance misuse?

Answer 18

Family:
- family history of substance misuse
- management problems (e.g. poor parenting)
- family conflict/domestic abuse
- being in care
School/community:
- low academic attainment and commitment
- availability of drugs
- community norms favourable to drug use
- community disorganisation
Individual:
- risk taking/rebelliousness
- friends who use drugs
- experience of trauma e.g. abuse, loss, poor parenting

Question 19

What are the local provisions for substance misuse?

Answer 19

GPs
Harm reduction services e.g. needle exchange, advice
Open access service
Structured psychosocial interventions
Prescribing services
Detox
Access to residential rehab
Recovery support

Question 20

Describe the primary and secondary prevention of alcohol misuse

Answer 20

Primary prevention:
- ‘know your limits’ binge drinking campaign
- drinkaware alcohol labelling
- ‘THINK!’ drunk driving campaign
- restriction on alcohol advertising by Ofcom
- TV ad campaigns
- minimum pricing
Secondary prevention:
- exploring alcohol consumption with patients e.g. routinely asking, screening questions, detect problem drinking
- screening tools: FAST, ADUIT, CAGE

Question 21

Describe the primary, secondary, and tertiary prevention of STIs

Answer 21

Primary: (reducing risk)
- awareness campaigns
- vaccination (e.g. HBV, HPV)
- pre/post exposure prophylaxis
Secondary: (find/treat undetected cases early)
- easy access to STI tests/treatments
- partner notification (contact tracing)
- targeted screening (e.g. antenatal screening for HIV and syphilis, national chlamydia screening programme)
Tertiary prevention: (reducing morbidity/mortality)
- antiretrovirals for HIV
- prophylactic antibiotics for PCP
- acyclovir for suppression of genital herpes

Question 22

Describe the population approach to C. diff

Answer 22

SIGHT:
Suspect C. diff as a cause of diarrhoea
Isolate the cause
Gloves and apron
Hand washing
Test stool for toxin

Question 23

List some interventions for obesity

Answer 23

Wider level e.g. change4life, 5-a-day
Environment e.g. more cycle paths, less car parking
Public policy e.g. sugar tax, minimum alcohol pricing

Question 24

Define compliance

Answer 24

The extent to which the patient’s behaviour coincides with medical or health advice

Question 25

What are some disadvantages to the theory of compliance?

Answer 25

It is passive: the patient MUST follow the doctor’s orders
It assumes the doctor knows best
It ignores problems patients have in managing their health

Question 26

Define adherence

Answer 26

The extent to which the patient’s actions match agreed recommendations (more patient centred)

Question 27

What are the key principles of how adherence is achieved?

Answer 27

Improve communication
Increase patient involvement
Understand the patient’s perspective
Provide and discuss information
Review medicines

Question 28

Define concordance

Answer 28

Expectation that patients will take part in treatment decisions and have a say in the
consultation, it is a negotiation between equals

Question 29

What are some barriers to good communication?

Answer 29

Language barriers
Deafness / blindness
Medical jargon

Question 30

What factors may affect a patients compliance/adherence?

Answer 30

Socioeconomic e.g. long distance from treatment setting
Health system e.g. supply of medication
Condition e.g. memory impairment
Therapy e.g. complex treatment regimes
Patient e.g. disbelief / denial of diagnosis

Question 31

In what circumstances can confidentiality be broken?

Answer 31

They are a risk to the public e.g. intend to commit a crime
If they have given consent
If it is required by law e.g. notifiable disease, ordered by a judge

Question 32

What are the 9 protected characteristics listed in the equality act?

Answer 32

Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race (including colour, nationality, ethnic or national origin)
Religion or belief
Sex
Sexual orientation