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RW Gastroenterology > Public Health/Nutrition > Flashcards

Public Health/Nutrition Flashcards

1
Q

What is a Faecal Occult Blood (FOB) test looking for?

A

Small amounts of ‘hidden’ blood in stool

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2
Q

What is population screening?

A

No particular reason to assume that anyone has any early signs, just test across population
• E.g. bowel screening at 50

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3
Q

What is opportunistic screening?

A

Test when there may be an increased risk E.g. at early life – Down’s Syndrome or if family member has had cancer

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4
Q

What is the reliability of a test?

A

Repeatability of test and interpretation (basically consistency)

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5
Q

What is the validity of a test?

A

Is it measuring what we think it is?

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6
Q

What is the sensitivity of a test?

A

Proportion of those who have the disease who are correctly identified by a positive test

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7
Q

What is the specificity of a test?

A

Proportion of those who do not have the disease who are correctly identified by a negative test

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8
Q

Positive predictive value

A

Proportion of those who test positive who actually have the disease

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9
Q

Negative predictive value

A

Proportion of those who test negative who actually do not have the disease

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10
Q

Prevalence

A

Number of cases in the population now

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11
Q

Incidence

A

How often it occurs (e.g. 1 in 100)

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12
Q

Recall time

A

Amount of time between screenings - Has to match disease progression

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13
Q

Uptake

A

Number taking part in voluntary programme

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14
Q

Yield

A

Number of previously undiagnosed cases picked up by a screening test or programme

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15
Q

What are Wilson & Jangler’s 7 Criteria for Screening Programmes?

A

1) Condition must be common/serious/both
2) Condition must have well defined latent period - know when to intervene
3) Suitable test available that is specific/sensitive/accessible
4) Must be effective treatment available
5) Doing the test must have benefits
- Early detection must improve prognosis and be better than watching and waiting
6) Test must not be harmful physically or psychologically
7) Must be cost effecting and justified

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16
Q

What are the 6 stages of change?

A

1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Long term maintenance

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17
Q

What are the 5 A’s of behaviour change?

A

Ask (permission to discuss), Asses (habit motivation), Advise, (benefits), Agree (set goals) and Assist (feedback etc)

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18
Q

Malnutrition

A

A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form, function and clinical outcome.

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19
Q

How can disease cause malnutrition?

A
  • Decreased intake
  • Impaired digestion and/or absorption
  • Increased nutritional requirements
  • Increased nutrient losses
  • Psychological effects
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20
Q

Which tool is used to measure malnutrition and what factors does it use?

A

Malnutrition Universal Screening Tool (MUST).

It uses BMI, weight loss score and acute disease effect score (likelihood of not being able to eat etc)

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21
Q

In which people would you give nutritional support?

A
  • BMI 10% within the last 3–6 months
  • BMI 5% within the last 3–6 months
  • Have eaten or are likely to eat little or nothing for more than 5 days or longer
  • Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism
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22
Q

Enteral Tube Feeding (ETF)

A

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum, e.g. nasogastric tube/jejunum or percutaneous endoscopic gastrostomy (PEG)

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23
Q

True or False: If the GI tract can be used at all or at any point, it should

A

True

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24
Q

What are the indications of enteral feeding?

A
  • Unconscious patients
  • Neuromuscular swallowing disorder
  • Upper GI obstruction
  • GI dysfunction
  • Increased nutritional requirements
25
Q

Parenteral nutriton

A

The administration of nutrient solutions via a central or peripheral vein

26
Q

What are the indications for parenteral nutrition?

A
  • inadequate or unsafe oral and/or enteral nutritional intake
  • a non-functional, inaccessible or perforated (leaking) gastrointestinal tract
27
Q

Refeeding syndrome

A

Potentially fatal shifts in fluids and electrolytes (e.g. hypokalaemia) and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition. Occurs as the body has adjusted to reduced levels

28
Q

Malabsorption

A

Imperfect mucosal absorption of food material by the small intestine.

29
Q

What are the 3 main underlying causes of malabsorption?

A

Defective luminal digestion, mucosal disease and tructural disorders

30
Q

What are the symptoms of coeliac disease?

A

Spectrum asymptomatic to nutritional deficiencies, Weight loss, Diarrhea, Excess flatus, Abdominal discomfort

31
Q

What is the pathophysiology of coeliac disease?

A

Intestinal antigen-presenting cells in people expressing HLA-DQ2 or HLA-DQ8, bind with dietary gluten peptides in their antigen-binding grooves, activating specific mucosal T lymphocyte cytokines and cause mucosal damage.

32
Q

What causes lactose malabsorption/intolerance?

A

Deficiency of lactase

33
Q

How do you diagnose lactose intolerance?

A

Confirmed by the lactose breath hydrogen test

34
Q

What are the symptoms of lactose intolerance?

A

History of the induction of diarrhea, abdominal discomfort, and flatulence following the ingestion of dairy products

35
Q

Tropical spure

A

Colonization of the intestine by an infectious agent or alterations in the intestinal bacterial flora induced by the exposure to another environmental agent

36
Q

What are the symptoms of tropical spure?

A

Diarrhoea, steatorrhea, weight loss, nausea, anorexia, anaemia

37
Q

What is the treatment for tropical spure?

A

Tetracycline and folic acid

38
Q

Whipple’s disease

A

Rare, systemic infectious disease caused by the bacterium Tropheryma whipplei.

39
Q

What are the clinical features of malabsorption?

A 
- Easy bruising
• Vitamin C – scurvy/Vitamin K deficiency
-Skin
•Acrodermatits Enteropathica
•impaired zinc uptake 
•Dermatitis Herpetiformis
•May indicate coeliac disease
•Glossitis and angulas stomatitis - Vit B and Iron deficiency
•Spooning of nails
•Iron (thyroid) deficiency
40
Q

How many units are in a bottle of beer?

41
Q

How many units are in a bottle of wine?

42
Q

How many units are in a medium glass of wine?

43
Q

How many units are in a pint of cider?

44
Q

Wernicke-Korsakoff’s syndrome

A

Wernicke encephalopathy and Korsakoff syndrome due to Vit B12 (thiamine) deficiency

45
Q

What is effective about the minimum unit price?

A

It target the lower cost end of alcohol which will affect most heavy drinkers as they are the most cost responsive

46
Q

What are alcohol brief interventions?

A

Focused, structured conversation aimed at making a link in the individuals mind between the behaviour (drinking) and the consequences (

47
Q

What is the FRAMES model for alcohol brief interventions?

A
  • Feedback about personal risk or impairment (recognise patterns)
  • Emphasis on personal Responsibility to change
  • Advice (with permission) to cut down or abstain
  • Menu of options for changing drinking and setting a target
  • Empathic interviewing: listening reflectivity without trying to persuade or confront
  • Self-efficacy: and interviewing style that enhances people’s belief in their ability to change
48
Q

Which tools can you use for alcohol screening?

A

AUDIT (Alcohol Use Disorders Identification test) and FAST (Fast Alcohol Screening Tests)

49
Q

How many mls of pure alcohol are in 1 unit?

50
Q

How do you work out the number of units in a drink?

A

Multiplying the total volume of a drink (in ml) by its ABV and dividing the result by 1,000.

51
Q

What is FODMAPs in the elimination diet for IBS?

A

Group of short chain carbohydrates which are p oorly absorbed leading to fermentation and osmotic changes in the bowel. Fermentable Oligo, Disaccharides, Monosaccharides
And
Polyols saccharides

52
Q

What are dietary recommendations for Crohn’s?

A
  • Regular meals
  • Limit alcohol and caffeine
  • Increase activity levels and relaxation
  • Limit fresh fruit
    -Adjust fibre
    -
53
Q

Globus

A

Sensation of a lump in the throat

54
Q

Functional dysphasia

A

The sensation of solid (or liquid) food ‘sticking’ on the way down the oesophagus. (diagnosis of exclusion, as opposed to the symptom)

55
Q

Malingering and factitious disorder

A

Malingering: Making up or exaggerating symptoms for external gain e.g. getting off work
Factitious: Making up or exaggerating symptoms in order to occupy the ‘sick role’

56
Q

What is the criteria for anorexia nervosa?

A
  • Significant weight loss
  • Weight loss is self-induced
  • Core psychopathology
  • Widespread endocrine abnormality
57
Q

What are the 3 models in health behaviour?

A

Health-belief model, theory of planned behaviour and trans-heretical model

58
Q

Anorexia nervosa

A

A syndrome in which the person maintains a low body weight as a result of a preoccupation with weight, construed as either a fear of fatness or a pursuit of thinness

59
Q

Bullimia Nervosa

A

Characterized by recurrent episodes of binge eating and compensatory behaviour (any one or a combination of vomiting, fasting, or excessive exercise) in order to prevent weight gain

RW Gastroenterology (13 decks)

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