SBA questions Flashcards
The differences in health outcomes between social classes
1) Artefact – the differences in health status that are observed are due to the limitations of measurement.
2) Social selection/mobility - health determines class position not vice versa: the healthy more likely to move up social hierarchy, the unhealthy more likely to move down
3) Behavioural/cultural - Differences in health status arise because of class differences in behaviours that are health damaging or health promoting
4) Materialist/ structuralist – Differences in health status is caused by differences in income, occupation, housing & work environment, economic and social deprivation (i.e. structural factors)
Define rheumatic fever
A systemic post streptococcal inflammatory disease affecting the heart and other sites (joints, brain and skin)
4 clinical manifestation of mitral stenosis
Dyspnoea, fatigue, dizziness, palpitations, oedema, diastolic murmur
The haemodynamic mechanism of mitral stenosis
Dyspnoea usually results from the elevation in left atrial pressure, and pulmonary venous hypertension, which leads to reduced compliance of the lungs and a decrease in vital capacity. Dyspnoea also may be related to an inability to increase the cardiac output with increased metabolic demands
The initial steps after a needle stick injury
1) Ensure patient is safe
2) Immediately encourage bleeding by applying pressure around the wound
3) Wash the area with soap under running water for approximately 5 minutes.
4) Inform the appropriate staff as an accident form will need to be completed and appropriate action taken
The common histopathological type of colonic carcinoma
Adenocarcinoma
The pathophysiological mechanism of diabetes
Net insulin deficiency leads to hyperglycaemia
Why do diabetics pass more urine
Osmotic diuresis (hyperglycaemia)
A test used to determine the sensitivity of microorganisms to antibiotics
1) Disc diffusion method / Kirby-Bauer method
2) Broth dilution method/assay
Name the four principles that feature in principalism
autonomy: self-determination
beneficence: well-being or best interests
non-maleficence: the ‘no harm’ principle
justice: fairness or equity
Three areas of the GMC’s ethical guidance
Consent and shared decision making Confidentiality Leadership and management Research Care at the end of life
Explain with examples the biopsychosocial model
The biopsychosocial model states that a persons health is influenced by social (eg unemployment, social isolation), psychological (eg. stress, traumatic life events) and biological (eg. genetics, blood pressure) factors and that all should be taken into account when treating a patient.
Explain the three stage model of reflection
What- the experience
So what?- reflection
Now what- learning from the experince
Explain the basis of systolic and diastolic blood pressure and the meaning of the values?
Systolic pressure represents the pressure of arterial blood measured in mm of mercury in the brachial artery during cardiac systole, the second is during cardiac diastole
The mechanism in which hypertension damages arteries?
Hypertension causes injury to vessel walls. It also causes endothelial injury and vascular cell proliferation which amplifies the atherosclerotic pathway
List the 4 organs commonly damaged by Hypertension and the mechanism of injury
1) The heart via coronary artery disease.
2) The brain via aneurysms and stroke. It can damage the aorta via aneurysms and dissection.
3) The kidneys via renal artery stenosis.
4) The eyes can be damaged via retinal emboli which are commonly sourced from the carotids
Why does Hypertension cause left ventricular hypertrophy?
Hypertension increases the force required for the heart muscle to eject blood through the aortic valve. Initially there will be an increased left ventricular afterload. This will cause increased levels of multiple hormones and increase contractility. As with any muscle, repeated stimulation of a muscle causes it hypertrophy.
Describe the findings on the fundoscopy that you would expect to find in grade 1-4 hypertensive retinopathy
Grade 1 hypertensive retinopathy shows vascular attenuation only.
Grade 2 hypertensive retinopathy demonstrates vascular attenuation and AV nipping
Grade 3 shows the same as grade 2 plus cotton wool spots and flame haemorrhage
Grade 4 retinopathy shows the same as grade 3 plus optic disc odema, a muscular star and silver wiring
Investigations into left ventricular hypertrophy
ECG changes- left axis deviation, Sokolov-Lyon criteria.
Echocardiogram- direct evidence of left ventricular hypertrophy
Features of chest pain that would suggest it’s cardiac in origin
1) Central or left
2) Crushing in nature
3) Radiating to left arm or jaw
4) Associated with palpitations, sweating and nausea
5) Associated with exercise
4 conditions which result from atheroma
1) Ischaemic heart disease
2) Vascular dementia
3) Aortic aneurysm
4) Renal artery stenosis
Explain the pathological difference between a myocardial infarction where ST elevation is present and when it is not
In ST elevation the myocardial infarction is full thickness infarction of the myocardium.
Describe how an ‘inferior’ myocardial infarction can cause heart block
An inferior myocardial infarction refers to an infarction of the right coronary artery territory. The AV node is usually supplied by the right coronary artery and when infarcted it leads to heart block.
State an advantage of using an MRI scan instead of a CT scan for pregnant woman
MRI does not use ionising radiation like a CT scan so is safer for pregnant woman
Causes of sporadic dilated cardiomyopathy (DCM)
Sporadic DCM: happens in a person with a normal heart in response to an insult
myocarditis: viral, bacterial or parasitic
toxins: chemotherapy, alcohol
autoimmune: rheumatoid, systemic lupus erythematosus
endocrine: thyrotoxicosis
neuromuscular
A complication atherosclerosis may lead to?
Aneurysm- a true aneurysm is a localised permanent dilation of the arteries
What can a urine sample contain in a UTI
Leucocytes, nitrites, protein and sometimes traces of blood
Symptoms of kidney
1) No symptoms at early stage
2) Swollen ankles, feet or hands
3) Dyspnoea
4) Tiredness
5) Haematuria
6) Increased urinary frequency
7) Nausea
8) Pruritis
9) Erectile dysfunction
Why do patients with CKD need to protect their bones)
At risk from renal bone disease. The kidneys are a key organ in the regulation of bone metabolism through regulation of calcium, phosphate and vitamin D. Their bones can get weaker and thinner
The two main treatment options for end stage renal disease
Dialysis or renal transplant are the main treatment options for end stage renal disease. Dialysis is a method of filtering the patient’s blood and removing waste products in the manner that a healthy kidney would. Renal transplant is another good option but there is often a long waiting list awaiting a suitable donor.
Strengths and weaknesses of a cross-sectional study
Looking at one specific population of individuals at a specific moment in time
Strengths- measures prevalence, association between exposure and disease. Quick, low cost
Weakness= Only useful in common illnesses, might miss severely ill, snapshot (misses acute illness)
Causes of Hyperkalaemia
1) Kidney/renal disease
2) Hypoaldosteronism
3) Diabetes
4) ACE inhibitors
How does the UK bowel screening program go against WHO guidline
The screening test is not acceptable to a large proportion of the population who decide not to take part
Modifiable risk factors which increase the risk of bowel cancer
1) Red meat consumption
2) Low fibre diet
3) Obesity
4) Alcohol consumtpion
5) Smoking
Non-modifiable risk factors for bowel cancer
1) Diabetes
2) Inflammatory bowel disease
3) Family history of bowel cancer
4) Bowel adenomas
Causes of macrocytic anaemia
1) Vitamin B12 or folate deficiency
2) Medication
3) Alcohol
4) Liver disease
5) Bone marrow dysfunction
What criteria must a screening test fulfil
1) The disease
2) The screening test- valid, simple and cheap, reliable, safe and acceptable
3) Diagnosis and Treatment
4) The Programme.
