Red SAPs Flashcards
Describe the structure of the calgary-cambridge framework
initiating the session –> gathering information –> physical examination –> explanation and planning –> closing the session
building a rapport occurs throughout
What are the categories of the GMC’s ethical guidance?
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
Deontological ethics
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
Utilitarian ethics
greatest amount of happiness for the greatest number of people. branch of consequentialism
Virtue ethics
action is only right if it is an action that a virtuous person would carry out in the same circumstances
Ethics of care
some emotions can be reasonable or morally appropriate in guiding good actions or decisions
What assumptions may underpin ethical debates?
man is a rational being and man is free - may not apply in a healthcare setting
Context of GMC’s fitness to practice?
comes under professionalism and must be followed - breaches can lead to hearings
Factors that influence fitness to practice
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
List the GMC duties of a doctor
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
Significance of radio-radial delay
subclavian artery stenosis, aortic dissection, aortic coarctation
Significance of radio-femoral delay
aortic coarctation distal to the left subclavian artery
Significance of arterial bruit
stenosis at or proximal to the site of auscultation
Volume of distribution calculation
Dose/concentration (C0 - initial plasma concentration)
Loading dose calculation
Vd * desired steady state concentration
ECG changes in ischaemic heart disease
all waves present but ST depression below baseline
Structure for writing clinical questions
PICO:
patient - who? demographic?
intervention - e.g. drug
comparison - vs a placebo
outcome - what is the desired effect?
What are the four sections of critical appraisal and why is it relevant?
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
Randomised control trial
randomly assigned to either intervention or control. followed over time to see if there is a difference in outcome. determines causation
Cohort study
groups followed over time to see any developments in a particular condition. association, not causation. mostly prospective.
Case control study
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
Cross-sectional study
look at a population at one point in time to determine prevalence
Systematic review
overviews of primary literature to determine relevance to question
Meta-analysis
systematic review comparing multiple studies on the same topic
Absolute risk
risk of a patient developing a disease over a time period
Relative risk
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%
Odds ratio
odds an outcome will occur if an exposure is present compared to the odds of the outcome without the exposure
Attributable risk
measure of the proportion of disease occurrence that can be attributed to a certain exposure
Observational study
look at, describe, or compare findings. no interventions performed. examples are case reports or series. good for quick information sharing
Interventional study
an intervention must be performed
Internal causes of hyperkalaemia
Maisie Called Brad Idiot Egg
insulin deficiency - decreased Na/K ATPase activity
metabolic acidosis
beta blockers and alpha agonists
cell lysis
exercise
External causes of hyperkalaemia
HARPI
too much intake from IV fluids
hypoaldosteronism
renin inhibitors
AKI
potassium-sparing diuretics
Signs and symptoms of hyperkalaemia
muscle weakness, flaccid paralysis, cardiac arrest, arrhythmias
ST depression, peaked T, short QT, prolonged PR
Internal causes of hypokalaemia
excess insulin
metabolic alkalosis
beta agonists and alpha blockers
External causes of hypokalaemia
low intake
hyperaldosteronism
loop and thiazide diuretics
vomiting
diarrhoea
Signs and symptoms of hypokalaemia
muscles less responsive, constipation, muscle cramps, flaccid paralysis, muscle weakness, arrhythmias
U wave, prolonged QT
What are the categories of causes of AKI?
pre-renal (70%), post-renal (10%), and intrinsic renal (15%)
Causes of pre-renal AKI
reduction of perfusion:
- hypovolaemia
- NSAIDs
- ACEis
Causes of post-renal AKI
blockage of urinary tract:
- renal cancer
- renal stone
- ureteric injury
- extrinsic compression of ureter
Causes of intrinsic renal AKI
injury to kidney itself:
-glomerulonephritis
- acute tubular necrosis
- acute interstitial nephritis and vasculitis
What is AKI?
rapid deterioration in kidney function that happens within a few hours or days
Clinical consequences of AKI
The vowels:
A - acidosis
E - electrolyte imbalance (hyperkalaemia)
I - intoxicants (drug accumulation)
O - oedema, fluid overload
U - uraemia (elevated urea)
Risk factors AKI
over 65
previous AKI
CKD
nephrotoxic drugs
heart failure
liver disease
diabetes mellitus
hypovolaemia
limited fluid intake
Risk factors kidney stones
dehydration
loop diuretics
antacids
male
obese
white
hypertension
Pathophysiology kidney stones
urine becomes supersaturated with solutes that precipitate and form a stone
Types of kidney stone
calcium oxalate - acidic
calcium phosphate - basic
struvite - urine infections
uric acid - high purine diet
Presentation kidney stones
severe unilateral loin to groin abdominal pain
haematuria
pain passing urine
walking to ease the pain
nausea and vomiting
flank tenderness
Complications of kidney stones
failure of stones to pass
AKI
hydronephrosis
infection
recurrence
Where are kidney stones most likely to get stuck?
ureteropelvic junction
pelvic brim/iliac vessels
ureteric orifice
Strengths of health AI
screening/triage support
diagnosis automation
prognosis forecasting
treatment decision support
treatment delivery
telemedicine
robotic surgery
Limitations of health AI
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
Fully supervised AI
inputs and outputs both well-labelled. good for areas we already have experience in
Partly supervised AI
data is labelled but the labels may not be complete - small amounts of labelled in a pool of unlabeled
Unsupervised AI
machine uses algorithms to attempt to recognise patterns from the input data - forms own conclusions
Rule based learning
human derived rules to determine an outcome
Machine learning
machine learns directly from the data rather than from human rules
Deep learning
adding multiple connections to neural network that performs the analysis
What criteria must be met before a screening test is implemented?
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
Stages of the cycle of change
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
Stages of the experiential learning cycle
concrete experience - having the experience
reflective observation - reflecting on the experience
abstract conceptualisation - learning from the experience
active experimentation - putting into place new behaviours
What are the six building blocks of a healthcare system?
service delivery
health workforce
information
medical products, vaccines, and technologies
financing
leadership/governance
Phases of a clinical trial
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
Ethical questions in a clinical trial
voluntary participation
confidentiality
consent
anonymity
potential for harm
True endpoint of a clinical trial
clinically meaningful endpoint that directly measures patients
has it worked? how does the patient feel and function?
Surrogate endpoint of a clinical trial
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
What are the harms of bias in a trial?
over-estimation of effect
wrong conclusions
treatments look better than they are
make ineffective treatments look as if they work
Types of data misrepresentation
fabrication/falsification
improper analysis
poorly drawn graphs
selective reporting
over-interpretation of results
Most common causes of CKD
diabetes mellitus
hypertension
PKD
renal artery stenosis (unilateral kidney)
but most are never identified
What are the three broad types of health system?
Government financed
Privately financed
Mixed
Describe the tax-based health system
example NHS
general government revenues so funds are in competition with other sectors
one pool
Describe the social health insurance model
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
Describe the private health system
can be either out of pocket payments or private insurance
e.g. USA, most lower-income countries
What is the HFEA?
human fertilisation and embryology authority
established as part of the human fertilisation and embryology act
regulate fertility treatment and research using human embryos
What is direct to consumer testing?
genetic tests sold online and in shops
Pros and cons of direct to consumer testing?
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
