Sem 4 Flashcards

1
Q

5 Requirements for Gender Recognition Act 2004 to change your birth assigned gender.

A
  1. Must be at least 18
  2. Must have a diagnosis of gender dysfunction
  3. Must have lived as that gender for 2 years
  4. Declaration of marital status
  5. Declaration that you live as new gender till death
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2
Q

What would you legally do if an elderly person, requiring institutional care, resists admission?

5 justifications.

A

Consult National Assistance act 1948

allows compulsory removal from homes if:

  • Not Mentally ill (but suffer from grave chronic disease)
  • Old
  • Infirm or physically incapacitated
  • Living in insanitary conditions
  • Not receiving care and attention

REMOVE IN PATIENT’S BEST INTEREST

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3
Q

4 components of getting informed consent.

A
  1. Understand info
  2. Retain info
  3. Weigh up decision
  4. Communicate their decision
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4
Q

What is the goal in decision making?

A
  1. Maximise beneficial health outcomes

2. Minimise undesirable effects from occurring

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5
Q

Components of high quality decision making

A
  1. Correct assessment of clinical situation by healthcare professional
  2. Correct information therapy to communicate situation
  3. Px aware of consequences of treatment & no treatment
  4. Relevant info is required
  5. Info in the form: understood, accurate and unbiased
  6. Numeric risks are communicated in complex info
  7. Px makes decision on accurate info and their values
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6
Q

Demonstrations of Professional Boundaries

A
  1. Doctors must not treat themselves/ family
  2. Confidentiality must be upheld
  3. Whistleblowing to ensure patient safety
  4. Must act with integrity
  5. Personal health must be upheld - GP registration
  6. Probity - must act with beneficence (not own views)
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7
Q

Primary, Secondary and Tertiary intervention

A

Primary- removal of cause of disease - reduces incidence

Secondary- screening for early stage disease - early intervention and treatment to improve prognosis

Tertiary - treatment of established/ late disease - manage consequences of disease

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8
Q

Why is it not always beneficial to perform screening tests?

A

May be costly, harmful or unethical to perform investigation to find out who is at risk of certain diseases.

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9
Q

Define DR (sensitivity)

A

Proportion of individuals affected by the disease that had a positive test result

a/ a+c

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10
Q

Define False positive rate (FPR; 1-specificity)

A

Proportion of people who are unaffected that tested positive on the screening test/

b/ b+d

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11
Q

Define OAPR

A

Odds of being affected given a positive result

a:b

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12
Q

Define TP, TN, FP, FN

A

TP - True positive = positive result + HAS disease
FP - False Positive = positive result + NO disease
TN - True negative = negative result + NO disease
FN - False negative = negative result + HAS disease

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13
Q

Positive Predictive Value (PPV)

A

No. of affected individuals with positive results/ total number of individuals with positive results

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14
Q

Requirements for worthwhile screening programme

A
  • Disorder = well defined medically
  • Prevalence = known and public health importance
  • Natural history = possible to identify early disease from healthy
  • Treatment = effective treatment is available
  • Test = should be simple, safe, easily implemented and acceptable
  • Performance of test= must be known
  • Ethical = test procedures after positive result must be acceptable to both parties
  • Access = all people who could benefit should have access
  • Financial = cost effective
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15
Q

Why have death rates gone down (squaring the rectangle) in the UK?

A
  1. Decreased infant mortality
  2. Improvements in diet
  3. Improvements in sanitation
  4. Improvements in healthcare
  5. Increased standard of living
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16
Q

Define Ageing

A

Process of generalised impairment of function resulting in the loss of adaptive response to stress, and a growing risk of age related disease.

17
Q

Strehler’s concepts of ageing

A

Deleterious - should be eventually harmful to the individual - i.e. blindness

Intrinsic - restricted to changes of endogenous origin

Progressive - all changes continue progressively through time

Universal - identifiable in all members of a species

18
Q

Mutation accumulation and Antagonistic Pleiotropic gene

A

MA = gene not expressed until that species has reproduced and passed that gene on, cannot stop gene being passed on.

APgene = Gene has an early effect - kept - has an adverse effect later on = contributes to ageing.

19
Q

Disposable Soma Theory of Ageing

A
  • views organism as machine that transfers free energy for several options: food, foraging, maintaining, reproducing, defence.
  • amount of energy given for each group is species dependent as they prioritise different factors.
20
Q

Cellular level theories of ageing

A

Hayflick phenomenon = each cell undergoes a set no. of divisions. Younger cells undergo more divisions.

Cross link formation = fewer collagen cross links formed in older cells.

Heat Shock protein = HSP produced at times of cell stress. Fewer in elderly = harder to cope with stressful demands leading to ageing.

21
Q

Genetic theories of ageing

A

GERONTOGENE, LONGEVITY ASSURANCE GENES = Gerontogenes contributes to ageing faster. LAGs make the individual live longer

TELOMERES = at end of chromosomes = responsible for cell division = shorten after each division = finite no. of divisions (TUMOURS can suppress this function.)

22
Q

Genomic Stability Theories of ageing

A

Error catastrophe = errors leading to abnormal proteins important for cellular processes can accumulate and result in ageing

Free radicals = FRs from cellular reactions can damage DNA

Mitochondrial theory = mitochondrial damage from O2 radicals can lead to ageing.

23
Q

Psychology of ageing

A

Bio-psycho-social approach = ageing brain determines any psychological changes occurring in ageing. Usually shown by a decline in intellect and ability to perform fast acting movements

Bernice Neugarten model = events in life require degree of adjustment, the more predictable the easier it is.

Socioemotional selectivity theory = knowing how long you have left shifts priorities from knowledge to life satisfaction

Theory of third age = period of time where one can live their life how they want and follow their own projects

Erikson’s theory = learning from experience = choices in psychosocial crisis’ in life determine our later life traits.
- in adulthood traits = being someone, having someone, helping someone and taking responsibility

24
Q

Elder Abuse

A
  • Criminal act to neglect elder who lacks capacity
  • Abuse = violation of a humans personal/ civil rights
  • Vulnerable person = 18+ who needs care for a disability/age/illness OR someone unable to care for themselves.
  • Types = physical, sexual, verbal (discriminatory) psychological, financial, neglect, institutional.

signs = bruising, change in character, unexplained injuries, social withdrawal.

25
Q

Mental capacity act 2005 principles

A

Everyone has the right to make their own decisions and we must all respect that and allow them to maintain that right even if we disagree/ seems eccentric.

must act in persons best interest and be the least restrictive intervention.

2 stage test to determine decision making ability

  • do they have an impairment of their mind?
  • does it affect their decision making ability?
26
Q

Safeguarding in work?

A

individuals who are deemed to be of a significant risk are placed on a vetting/barring list which will regulate their activity options.

i.e. paedophiles cannot work in schools.

27
Q

Cognitive development- Piaget

A
  • thinking is basic and becomes more advanced with age
  • Sensorimotor- relationship between self and objects
  • Pre-operational - thinks egocentric, can describe by single feature, conservation of numbers
  • Concrete operational- conservation of mass and weight, can classify objects by many features, can think logically about events
  • Formal operational- think logically about abstract ideas and can form hypotheses. Philosophical approach.
28
Q

Morality (levels 1, 2 & 3)

all with thought of ‘should the man steal drugs to help his sick wife?’

A

1 = pre-conventional = s1 punishment and obedience orientation, s2 = reward orientation + acts in own interests.

2 = conventional = s3 good boy/girl theory = conforms for approval and not disappointing others. s4 authority orientation = upholds laws to avoid guilt of not doing duty

3 = post conventional = s5 social contract orientation - relatives values. s6 - ethical principle orientation- actions guided by own ethical principles.

29
Q

Social development of attachment

A

Lorenz = imprinting = innate requirement to acquire specific info during time of critical care (geese follow mum)

Harlow = hard mum vs soft mum =monkey metal mum w/food worse than cloth mum w/o - need intimate care

Bowlby = affectionate bond formed by maternal reinforcement = need to provide secure base, be available and responsive, intervene, encourage exploration from base.
- individual needs care but not all needs met or won’t develop well (mummy boy). needs to find balance

30
Q

Social construction of Gender

basis.

A
  • biological sex = genitalia of individual
  • Gender = social and cultural perceptions associated with sex differences, constructed as masculine and feminine. (MALE SO YOU’RE MASCULINE) = flawed
  • gendering practices = clothing of child, treatment of child differs for genders; once verbal they identify as part of that gender group. Parenting roles = differ for mum or dad. Work roles differ by gender.
31
Q

Social construction of gender - why is gendering done from birth with virtually everyone?

A
  • major determinant of division of labour- alternative is basing jobs on peoples skills and talents
  • gendered social practices are responsible for shaping men and women’s bodies. i.e. choice of sports.
  • converts average differences into absolute differences
  • social construction of masculine and feminine conceptions embodied in practices are fuelled by individuals. (girl doing sport too late, not as developed = seen as weaker_
  • studies showed men having higher risk of CHD was due to gender not biology - lifestyle influences.
32
Q

Psychosexual development

A

normal = occurs in first 3 months of foetal development

sex = gonads you have

gender identity = early awareness of belonging to one of the 2 human being categories
- shaped by actions of parents and environment (e.g. clothes and toys) by 2-3 are aware of their identity + can communicate it.

gender role = outward manifestations of their personality reflecting their gender identity (masculinity or femininity)

33
Q

Atypical sexual development

A

Gender identity disorder = being feels more comfortable as the other gender (transgender)

Transvestite Fetish = likes dressing as other gender , no confusion of gender.

Genital abnormalities

  • micropenis- doesn’t affect gender identity perception
  • botched circumcision
  • ambiguous genitalia
  • eunuch transvestites + castrated males as male prostitutes (have no sexual drive)
34
Q

Sexual orientation

A
Heterosexual = 
first sexual experience
-males = 13
-females = 14
sex = 17

Homosexual

  • boys = 20% in childhood show it, 3% in adulthood show
  • girls = 10% of pre-adolescents show it, 2% of adults exhibit lesbianism

excessive masturbation is a sign of neglect or sexual abuse

35
Q

Communication in people with disabilities:

Autism

Prelingual deafness

Visual impairment

A

Autism & Aspergers

  • Apparent use of language for non communication
  • Perseveration (repetition of own utterances)
  • Reversal of pronouns
  • Failures of theory of mind- unable to imagine what is in someone else’s mind

PL deafness- severe hearing problem for 2+ years

  • Poor literacy
  • Very partial, sporadic acquisition of surrounding vocab and grammar
  • limited ability to gain info from lip reading
  • poor articulation

visual

  • some young blind show pronoun reversal
  • vocab is limited by touch ability of object, person thats described. i.e. can only describe what they feel.
36
Q

Communication in people with disabilities:

Cerebral palsy

Acquired hearing impairment

Cerebrovascular event

A

CP

  • eye contact disruption. limits facial expression
  • willingness to engage in comms = disrupted by resp defects
  • pronunciation is affected

Acq hearing
- lip reading also difficult

Cerebrovascular event

  • acquired dysphagia
  • comprehension problems may mask as schizophrenia/ dementia
37
Q

Communication in people with disabilities:

Acquired movement disorders

Dementia/ cognitive deterioration

A

AMD

  • disrupted eye contact and limits on communication with facial expression
  • pronunciation is affected moderately.

Dementia/ CD

  • Adults with Down’s may lose ability to comprehend speech before other things
  • General symptom of Alzheimer’s is anomia- trouble remembering words = distressing to patient at early stage

Diagnostic overshadowing and inability to convey symptoms often leaves it too late for treatment to improve quality of life.