Public Health & Medical Ethics

Question 1

What is Gillick/Fraser competence?

Answer 1

If a child is under 16 they can be assessed as being Gillick/Fraser competent; this means they can make decisions about their care without parental involvement.

Question 2

Name 2 microorganisms that are not killed by alcohol hand gel?

Answer 2

C.diff
Norovirus

Question 3

Define prevalence.

Answer 3

The proportion of a population that have the disease at a point in time. (Normally given as a percentage).

Or incidence x average duration

Question 4

What are the 4 key problems in managing COPD.

Answer 4

Unpredictable illness trajectory.
Prognosis is hard to determine due to the unpredictable illness trajectory and is often poor if it is determined.
Bad patient understanding leads to anxiety and confusion.
Limited access to specialist palliative care.

Question 5

4 building blocks of palliative care

Answer 5

Holistic.
Individualised.
Patient and family centred.
Multidisciplinary approach.

Question 6

Aims of palliative care

Answer 6

Promote quality of life.
Promote dignity and autonomy.
Control disease symptoms.

Question 7

Why is palliative care not great in COPD?

Answer 7

Lack of funding for programs.
Most palliative care teams are cancer focused.
Unpredictable illness trajectory in COPD.
Lack of patient understanding.

Question 8

What are the focal virtues in biomedical virtue ethics?

Answer 8

Discernment.
Conscientiousness.
Trustworthiness.
Integrity.
Compassion.

Question 9

Until what week of pregnancy can an abortion be carried out?

Answer 9

24 weeks of pregnancy

Question 10

Describe Malan’s ‘helping profession syndrome’.

Answer 10

People in helping professions compulsively give to others what they would like to have for themselves. They have an unconscious identification with the patient role, unmet emotional needs.

Question 11

Describe the ‘LOVERS’ communication model.

Answer 11

L - listen, learn what the problem is.
O - observe, look at their body language.
V - verify, check you understand.
E - empathise.
R - reassure, tell them you want to help.
S - seek an agreeable compromise.

Question 12

Population attributable fraction (PAF).

Answer 12

The proportional reduction in population disease that would occur if exposure to a risk factor was reduced.

Question 13

Define Number Needed to Treat (NNT)

Answer 13

The number of patients that need to be treated in order to have an impact on one person - can measure therapeutic effectiveness.

Question 14

Give 3 things that consent must be.

Answer 14

Voluntary.
Informed.
Made by someone with capacit

Question 15

What is section 2 of the mental capacity act?

Answer 15

A patient is unable to make a decision for himself in relation to the matter because of an impairment or disturbance in the functioning of the mind or brain.

Question 16

What is section 3 of the mental capacity act?

Answer 16

A person cannot make decisions for themselves if they are unable to understand the information given, weigh its benefits and communicate their decision.

Question 17

How to treat patients who do not have capacity to make decisions?

Answer 17

Can someone make decisions on their behalf e.g. lasting powers of attorney.
A healthcare professional can make decisions if it in the patient’s best interests.

Question 18

What is anorexia nervosa?

Answer 18

A mental health disorder where a person is scared of gaining weight and so eats extremely less

Question 19

2 mechanisms/types of anorexia nervosa

Answer 19

1. Restricting.
2. Binge-eating and then vomiting - bulimia nervosa.

Question 20

What is the Core model for eating disorders?

Answer 20

States that the factors contributing to eating disorders is a combination of low self esteem and perfectionism, where a need for control is expressed through controlling food intake.

Question 21

First line treatment for bulimia and anorexia nervosa?

Answer 21

CBT

Question 22

3 stimulants examples + effects

Answer 22

Caffiene, nicotine, cocaine - elevate mood and increase alertness.

Question 23

3 hallucinogens examples + side effects

Answer 23

Ketamine + LSD

Question 24

Define tolerance

Answer 24

When your body becomes used to the substance and needs a greater amount for the same effect.

Question 25

Define dependance

Answer 25

The feeling of needing to take a substance to remain functioning at a normal capacity and that not taking it can lead to adverse psychological and physical effects.

Question 26

Define binge drinking

Answer 26

> 6 units of alcohol in one sititng.

Question 27

What is the alcohol harm paradox

Answer 27

Those in lower socio-economic groups consume less alcohol than those in higher socio-economic groups but they experience greater alcohol related harm.

Question 28

Signs of foetal alcohol syndrome

Answer 28

Growth retardation
Reduced weight gain
Cognitive impairment
Craniofacial deformities

Question 29

Methods to screen for alcohol usage

Answer 29

Asking about drug history
CAGE questionnaire.
AUDIT tool.

Question 30

Components of CAGE questionairre

Answer 30

Have you ever felt that you should cut down?
Have you ever felt annoyed by people telling you to cut down?
Do you feel guilty about how much you drink?
Eye opener - ever had a drink first thing in the morning?

Question 31

Components of AUDIT tool

Answer 31

Frequency - How often do you have a drink containing alcohol?

Amount - How many units of alcohol do you drink on a typical day?

Bing drinking - How often did you have >6 units on a single occasion in the past year?

Question 32

How does alcohol affect neurotransmission?

Answer 32

Enhances GABA production

Question 33

Drug for initiating alcohol withdrawal

Answer 33

Benzodiazepines such as chlordiazepoxide.

Question 34

Drugs for maintaing remisssion after alcohol withdrawal

Answer 34

Naltrexone, acamprosate.

Question 35

WHat is the bradford hill critera?

Answer 35

Assess the epidemiological evidence of a causal relationship between a presumed cause and observed outcome.

Strength of association.
Consistency of association.
Exposure-response relationship.
Temporality - cause before disease.
Specificity.
Coherence of evidence.

Question 36

Examples of work related MSK disorders.

Answer 36

Carpal tunnel syndrome - painters
HAVS (hand arm vibration syndrome) - drills
Tenosynovitis - desk jobs due to typing
Rotator cuff problems - warehouse e.g lifting above shoulder.

Question 37

primary site for chlamydial infection in women and men?

Answer 37

Women: Cervix

Men: Urethra

Question 38

Complications of chlamydia in women

Answer 38

Pelvic inflammatory disease.
Infertility.
Neonatal transmission: opthalmia neonatorum.
Ectopic pregnancy.

Question 39

How is a NAAT performed for chlamydia in men and women?

Answer 39

Men: First void urine

Women: Self-vaginal swab

Question 40

STI/HIV transmission model (May & Andersen 1987).

Answer 40

Reproductive rate = infectivity rate x number of partners x duration of infection

Question 41

Define sensitivity.

Answer 41

Proportion of people with a disease who are correctly screened to have the diseaes.

Question 42

Define specificity

Answer 42

Proportion of people without the disease who are correctly screened not to have the disease.

Question 43

Define disability

Answer 43

An inability to perform an activity.

Question 44

Withdrawal symptoms

Answer 44

Tremulousness.
Agitation.
High BP.
Increased HR.
Seizures.

Question 45

Trans-theoretical model of change.

Answer 45

Pre-contemplation (no intention of giving up smoking).
Contemplation (consider quitting).
Preparation (get ready to quit in near future).
Action (engaged in giving up).
Maintenance (steady non-smoker).
Relapse?