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Medicine Year 1 > Red SAPs > Flashcards

Red SAPs Flashcards

1
Q

Describe the structure of the calgary-cambridge framework

A

initiating the session –> gathering information –> physical examination –> explanation and planning –> closing the session
building a rapport occurs throughout

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2
Q

What are the categories of the GMC’s ethical guidance?

A

good medical practice
confidentiality
maintaining professionalism
children and young people (including protecting at-risk children)
prescribing
decision making and consent
care at the end of life (including assisted dying)
leadership and management
candour and raising concerns
cosmetic interventions
research

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3
Q

Deontological ethics

A

intensions matter. actions are good or bad according to a clear set of rules. do our duty for no other reason than because it is the right thing to do

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4
Q

Utilitarian ethics

A

greatest amount of happiness for the greatest number of people. branch of consequentialism

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5
Q

Virtue ethics

A

action is only right if it is an action that a virtuous person would carry out in the same circumstances

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6
Q

Ethics of care

A

some emotions can be reasonable or morally appropriate in guiding good actions or decisions

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7
Q

What assumptions may underpin ethical debates?

A

man is a rational being and man is free - may not apply in a healthcare setting

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8
Q

Context of GMC’s fitness to practice?

A

comes under professionalism and must be followed - breaches can lead to hearings

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9
Q

Factors that influence fitness to practice

A

criminal convictions
drug or alcohol misuse
aggressiveness, violence, or threatening behaviour
persistent inappropriate attitude or behaviour
cheating or plagiarising
dishonesty or fraud
unprofessional behaviour or attitudes
health concerns or management of these concerns

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10
Q

List the GMC duties of a doctor

A

make care of patient your first concern
provide a good standard of practice and care
take prompt action if safety is being compromised
protect and promote health of patients and public
treat patients as individuals
work in partnership with patients
work with colleagues
be honest
act with integrity
don’t discriminate
don’t abuse trust in profession

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11
Q

Significance of radio-radial delay

A

subclavian artery stenosis, aortic dissection, aortic coarctation

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12
Q

Significance of radio-femoral delay

A

aortic coarctation distal to the left subclavian artery

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13
Q

Significance of arterial bruit

A

stenosis at or proximal to the site of auscultation

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14
Q

Volume of distribution calculation

A

Dose/concentration (C0 - initial plasma concentration)

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15
Q

Loading dose calculation

A

Vd * desired steady state concentration

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16
Q

ECG changes in ischaemic heart disease

A

all waves present but ST depression below baseline

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17
Q

Structure for writing clinical questions

A

PICO:
patient - who? demographic?
intervention - e.g. drug
comparison - vs a placebo
outcome - what is the desired effect?

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18
Q

What are the four sections of critical appraisal and why is it relevant?

A

does the study address a clearly focused question?
did the study use valid methods?
are the valid results of the study important?
are the valid important results applicable to my patient or population?
if the answer of any of these is no then the study does not need to be read

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19
Q

Randomised control trial

A

randomly assigned to either intervention or control. followed over time to see if there is a difference in outcome. determines causation

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20
Q

Cohort study

A

groups followed over time to see any developments in a particular condition. association, not causation. mostly prospective.

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21
Q

Case control study

A

group of cases with condition are identified and matched demographically with a control group. past exposure is then worked out to determine if there is association with outcome

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22
Q

Cross-sectional study

A

look at a population at one point in time to determine prevalence

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23
Q

Systematic review

A

overviews of primary literature to determine relevance to question

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24
Q

Meta-analysis

A

systematic review comparing multiple studies on the same topic

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25
Q

Absolute risk

A

risk of a patient developing a disease over a time period

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26
Q

Relative risk

A

compares two groups of patients and their relative risks of developing a condition depending on their contexts e.g. relative risk is increased by 50% if you smoke so non-smoker absolute is 10% and smoker absolute is 15%

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27
Q

Odds ratio

A

odds an outcome will occur if an exposure is present compared to the odds of the outcome without the exposure

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28
Q

Attributable risk

A

measure of the proportion of disease occurrence that can be attributed to a certain exposure

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29
Q

Observational study

A

look at, describe, or compare findings. no interventions performed. examples are case reports or series. good for quick information sharing

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30
Q

Interventional study

A

an intervention must be performed

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31
Q

Internal causes of hyperkalaemia

A

Maisie Called Brad Idiot Egg
insulin deficiency - decreased Na/K ATPase activity
metabolic acidosis
beta blockers and alpha agonists
cell lysis
exercise

32
Q

External causes of hyperkalaemia

A

HARPI
too much intake from IV fluids
hypoaldosteronism
renin inhibitors
AKI
potassium-sparing diuretics

33
Q

Signs and symptoms of hyperkalaemia

A

muscle weakness, flaccid paralysis, cardiac arrest, arrhythmias
ST depression, peaked T, short QT, prolonged PR

34
Q

Internal causes of hypokalaemia

A

excess insulin
metabolic alkalosis
beta agonists and alpha blockers

35
Q

External causes of hypokalaemia

A

low intake
hyperaldosteronism
loop and thiazide diuretics
vomiting
diarrhoea

36
Q

Signs and symptoms of hypokalaemia

A

muscles less responsive, constipation, muscle cramps, flaccid paralysis, muscle weakness, arrhythmias
U wave, prolonged QT

37
Q

What are the categories of causes of AKI?

A

pre-renal (70%), post-renal (10%), and intrinsic renal (15%)

38
Q

Causes of pre-renal AKI

A

reduction of perfusion:
- hypovolaemia
- NSAIDs
- ACEis

39
Q

Causes of post-renal AKI

A

blockage of urinary tract:
- renal cancer
- renal stone
- ureteric injury
- extrinsic compression of ureter

40
Q

Causes of intrinsic renal AKI

A

injury to kidney itself:
-glomerulonephritis
- acute tubular necrosis
- acute interstitial nephritis and vasculitis

41
Q

What is AKI?

A

rapid deterioration in kidney function that happens within a few hours or days

42
Q

Clinical consequences of AKI

A

The vowels:
A - acidosis
E - electrolyte imbalance (hyperkalaemia)
I - intoxicants (drug accumulation)
O - oedema, fluid overload
U - uraemia (elevated urea)

43
Q

Risk factors AKI

A

over 65
previous AKI
CKD
nephrotoxic drugs
heart failure
liver disease
diabetes mellitus
hypovolaemia
limited fluid intake

44
Q

Risk factors kidney stones

A

dehydration
loop diuretics
antacids
male
obese
white
hypertension

45
Q

Pathophysiology kidney stones

A

urine becomes supersaturated with solutes that precipitate and form a stone

46
Q

Types of kidney stone

A

calcium oxalate - acidic
calcium phosphate - basic
struvite - urine infections
uric acid - high purine diet

47
Q

Presentation kidney stones

A

severe unilateral loin to groin abdominal pain
haematuria
pain passing urine
walking to ease the pain
nausea and vomiting
flank tenderness

48
Q

Complications of kidney stones

A

failure of stones to pass
AKI
hydronephrosis
infection
recurrence

49
Q

Where are kidney stones most likely to get stuck?

A

ureteropelvic junction
pelvic brim/iliac vessels
ureteric orifice

50
Q

Strengths of health AI

A

screening/triage support
diagnosis automation
prognosis forecasting
treatment decision support
treatment delivery
telemedicine
robotic surgery

51
Q

Limitations of health AI

A

requires large and complex datasets which need a broad skillset to understand so more collaborations between stakeholders
potential to automate and augment clinical decision making
unknown effects on broad scale
disagreements between clinicians and AI

52
Q

Fully supervised AI

A

inputs and outputs both well-labelled. good for areas we already have experience in

53
Q

Partly supervised AI

A

data is labelled but the labels may not be complete - small amounts of labelled in a pool of unlabeled

54
Q

Unsupervised AI

A

machine uses algorithms to attempt to recognise patterns from the input data - forms own conclusions

55
Q

Rule based learning

A

human derived rules to determine an outcome

56
Q

Machine learning

A

machine learns directly from the data rather than from human rules

57
Q

Deep learning

A

adding multiple connections to neural network that performs the analysis

58
Q

What criteria must be met before a screening test is implemented?

A

The disease - should be important health problem, the disease should be understood, association between marker and treatable disease, long time between detectable signs and overt disease
The test - must be valid (sensitive and specific), simple and cheap, safe and acceptable, reliable
Diagnosis and treatment: agreed policy for those that test positive, treatment available, facilities adequate to meet demand for treatment
Programme - evidence that is reduces disease and mortality, acceptable to the public, opportunity cost

59
Q

Stages of the cycle of change

A

pre-contemplation - no intention of changing behaviour
contemplation - aware of problem
preparation - intent on taking action
action - active modification of behaviour
maintenance - sustained changes
relapse - fall back into old patterns of behaviour

60
Q

Stages of the experiential learning cycle

A

concrete experience - having the experience
reflective observation - reflecting on the experience
abstract conceptualisation - learning from the experience
active experimentation - putting into place new behaviours

61
Q

What are the six building blocks of a healthcare system?

A

service delivery
health workforce
information
medical products, vaccines, and technologies
financing
leadership/governance

62
Q

Phases of a clinical trial

A

pre-clinical research
phase 1 - safety and side effects, small group
phase 2 - safety and effectiveness, larger group
phase 3 - safety, effectiveness, and dosage, larger group again
approval phase
phase 4 - made available to public, monitoring phase

63
Q

Ethical questions in a clinical trial

A

voluntary participation
confidentiality
consent
anonymity
potential for harm

64
Q

True endpoint of a clinical trial

A

clinically meaningful endpoint that directly measures patients
has it worked? how does the patient feel and function?

65
Q

Surrogate endpoint of a clinical trial

A

measurement of a specific outcome used in place of another as a predictor to tell if a treatment works. usually occurs before a true endpoint

66
Q

What are the harms of bias in a trial?

A

over-estimation of effect
wrong conclusions
treatments look better than they are
make ineffective treatments look as if they work

67
Q

Types of data misrepresentation

A

fabrication/falsification
improper analysis
poorly drawn graphs
selective reporting
over-interpretation of results

68
Q

Most common causes of CKD

A

diabetes mellitus
hypertension
PKD
renal artery stenosis (unilateral kidney)
but most are never identified

69
Q

What are the three broad types of health system?

A

Government financed
Privately financed
Mixed

70
Q

Describe the tax-based health system

A

example NHS
general government revenues so funds are in competition with other sectors
one pool

71
Q

Describe the social health insurance model

A

also known as the Bismarck model
many pools of sickness funds
labourers are insured by employers in case of illness/injury
e.g. Germany, Kenya

72
Q

Describe the private health system

A

can be either out of pocket payments or private insurance
e.g. USA, most lower-income countries

73
Q

What is the HFEA?

A

human fertilisation and embryology authority
established as part of the human fertilisation and embryology act
regulate fertility treatment and research using human embryos

74
Q

What is direct to consumer testing?

A

genetic tests sold online and in shops

75
Q

Pros and cons of direct to consumer testing?

A

Pros:
- promotes awareness of genetic disease
- may help people to be aware of their health
- results not included in medical record
- often less invasive
Cons:
- Tests don’t cover all diseases
- information may be upsetting
- little regulation on testing companies
- privacy may be compromised

Medicine Year 1 (23 decks)

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