Week 1 - complete Flashcards
1
Q
Sign vs symptom?
A
Sign: what the physician identifies on PEx
Symptom: What the patient perceives
2
Q
What are the 4 types of clinical presentations?
A
- Undifferentiated
- Single typical
- Multisystem
- Preventative care/health promotion
3
Q
Give an example of each type of clinical presentation
A
- Undifferentiated: fatigue, malaise
- Single typical: abdominal pain, diarrhea, knee swelling
- Multisystem: fever, cough
- Preventative care/health promotion: cancer, pap smear, blood screening
4
Q
What are the steps in the diagnostic pathway?
A
- assess stability (vitals [ABC])
- History
- Physical exam
- Investigations
5
Q
What are the main vitals to assess?
A
ABCs: airway, breathing, circulation
AKA blood pressure, HR, resp rate, temperature. O2 saturation can be extra
6
Q
What is the framework used to develop a DDx?
A
Vitamin C&D
7
Q
What does Vitamin C&D stand for?
A
Vascular
Infection/inflammation
Traumatic/toxic
Autoimmune/acquired/allergic
Metabolic/mental health
Iatrogenic
Neoplastic
Congenital
Degenerative
8
Q
What is the framework for picking which investigations to use?
A
Choosing wisely
9
Q
How do you choose which investigations to conduct?
A
Based on potential DDX based on patient history and physical exam
10
Q
What are some aspects of choosing wisely?
A
Choose least invasive, high yield tests that will actually change patient management
Avoid unnecessary rule-out testing or tests for the learning experience
11
Q
What is pre-test probability?
A
The probability that your patient actually has the illness you’re testing for
12
Q
What is the post-predictive value of a test?
A
Positive predictive value is the probability that subjects with a positive screening test truly have the disease.
13
Q
What are the 5 types of investigations to choose from?
A
- Biochemistry
- Microbiology
- Hematology
- Pathology
- Imaging
14
Q
Describe biochemistry Ix
A
Function and metabolic tests and markers
15
Q
Describe microbiology Ix
A
Infection workup
16
Q
Describe hematology Ix
A
blood cells and elements, clotting parameters
17
Q
Describe pathology Ix
A
autopsy, surgical pathology (tissue), cytopathology
18
Q
Describe imaging Ix
A
Xray, CT, MRI, ultrasound, PET
19
Q
What is important when doing Ix? Why?
A
Ensuring proper sample collection to ensure specimen viability
20
Q
How many types of biopsies are there?
A
4
21
Q
What are the 4 types of biopsies?
A
- Fine needle aspiration
- Needle core
- Punch
- Incisional and excisional
22
Q
When do you use fine needle aspiration?
A
For palpable or deep lesions
23
Q
When do you use needle core biopsies?
A
For deeper lesions, specific sites
24
Q
When do you use punch biopsies?
A
For shallow samples, skin lesions only
25
When do you use incisional and excisional biopsies?
Incisional: for diagnosis
Excisional: for diagnosis AND treatment
26
In the case of fatigue, what might be a main vs an associated symptom?
Main symptom = fatigue
Associated symptoms = breathlessness, malaise, confusion
27
What is the first thing to do when determining the clinical presentation type?
See if it is life threatening (check vitals)
28
What is the key feature?
The key in understanding a case. Its not necessarily the symptom or what the patient is saying they're there for.
For instance, rapid symptom onset could be the key feature of a case
29
What are 2 types of physical exam?
General and focused
30
Describe general vs focused PEx
general: whole body
Focused: prioritize areas that are relevant to the patient's symptoms
31
What are social determinants of health?
Non-medical and non-biological influencers that affect health and health outcomes
32
What are examples of social determinants of health?
Race, employment status, education, lifestyle activities, social life
33
What can social determinants of health do to health issues? Give examples
Predispose, (e.g. genetics, medical Hx)
precipitate, (e.g. substance use, grief, stress)
perpetuate, or be (e.g. substance use, continuing mental or physical illness, abuse)
protective of health issues (e.g. healthy habits, support system, etc.)
34
What happens to disease as areas develop economically?
There is an increase in life expectancy and shift in the disease patterns of a population and causes of morbidity nad mortality
35
What are the levels of economic development/disease shift also known as?
Epidemiologic transition
36
What are the 4 stages of epidemiologic transition?
1. Pestilence/famine
2. Receding pandemics
3. Degenerative and man-made diseases
4. Delayed degenerative diseases
37
Describe pestilence/famine stage of epidemiologic transition
Most diseases are based in malnutrition/infectious diseases. Very short life expectancy, low incidence of CVD.
Countries include sub-saharan africa
38
Describe receding pandemics stage of epidemiologic transition
improved nutrition and public health measures lead to improved life expectancy (~50y) and reduction in infectious diseases. People life long enough to experience chronic diseases. 15-35% of deaths from CVD.
Eg.south asia, parts of latin america & caribbean
39
Describe degenerative and man-made diseases of epidemiologic transition
Increased alcohol and tobacco usage and fat and caloric intake results in deaths from chronic disease overtaking those from infectious disease.
Longer life expectancy (60) but also greater proportion of deaths from CVD (>50%)
E.g. europe and central asia, latin america, middle east, north africa, urban India
40
Describe delayed degenerative disease stage of epidemiologic transition
CVD and cancer are leading cause of deaths. Increase in aging-related diseases like Alzheimer's
Life expectancy >70; CVD death <50%.
High income countries
41
Describe incidence of CVD during epidemiologic transition
CVD increases as country affluence increases BUT at a certain point in high income countries, incidence dips a bit because other age-related diseases (Cancer, dementia) become more prevalent.
42
What are the 3 levels of social determinants of health?
Proximal, intermediate, and distal context
43
What are examples of proximal context?
Elements in home, work, social life
44
What are examples of intermediate context?
health care systems, education systems
45
What are examples of distal context?
culture, community, society
46
Describe proximal, intermediate, and distal SDH for indigenous individuals
Proximal: health behaviours, education, food insecurity
Intermediate: community infrastructure, cultural continuity
Distal: colonialism, racism, self-determination
47
How many levels of disease prevention are there?
4
48
What are the 4 levels of disease prevention?
1. health promotion
2. primary prevention
3. secondary prevention
4. tertiary prevention
49
Describe health promotion level of disease prevention
Preventing disease risk factors, lower average population risk. For the entire populaton
50
Describe primary prevention level of disease prevention
manage risk factors. For members of population with one or more risk factors. Goal is to prevent the development of disease
51
Describe secondary prevention level of disease prevention
For those with limited disease. Goal is to prevent disease progression or recurrence
52
Describe tertiary prevention level of disease prevention
For those with symptomatic/advanced disease. Goal is to reduce complications of disease and disability
53
What are risk factors?
characteristics or behaviours that increase the chance of diseae
54
What are risk conditions? Examples?
Chronic conditions that contribute to the risk of disease
E.g. prediabetes, obesity
55
What is multimorbidity?
co-existence of 2+ chronic conditions
56
What are the 4 approaches to disease prevention and control?
1. individual-centered
2. public health/population-based
3. high-risk strategy
4. population strategy
57
Describe individual-centered approach to disease prevention and control
Asks why a patient got a disease, focuses on the cause of cases
58
Describe public health/population based approach to disease prevention and control
Looks at causes of disease incidence. Asks whether disease can be prevented. E.g. vaccinations
59
Describe high-risk strategy approach to disease prevention and control
identify high-risk susceptible individuals and offer individual protection. May reduce mortality
e.g. screening for cancer
60
Describe population strategy approach to disease prevention and control
control determinants of incidence and reduce population risk factors. is the traditional public health approach to disease prevention. Mass environmental control methods/alter behaviours
61
What is a drawback of the population strategy for disease control?
Prevention paradox: prevention that brings large benefits to a community offers little individual benefit: e.g., HT prevention by reducing salt intake. Lots of people need to make change, but few actually benefit
62
What are the 4 types of physician/patient relationship?
1. Paternalistic
2. Deliberative
3. Interpretive
4. Informative
63
Describe the 4 types of physician/patient relationship
Paternalistic: guardian-type. Prevents patient well-being regardless of Pt preferences
Deliberative: friend/teacher-type. Persuade patient then implement Pt's selected intervention
Interpretive: counselor/advisor type. Interpret patient values then implement Pt's selected intervention
Informative: competent technical expert type. Providing relevant factual information and implementing patient’s selected intervention
64
What are ADL vs IADL
Activities of daily living VS instrumental activities of daily living
ADL: feeding, dressing, bathing, walking
IADL: improve QOL. Cooking, cleaning, laundry
65
Which physician/patient relationship models are the most/least concerned with patient autonomy?
Paternalistic: least concerned
Informative: most
66
What are some relevant ethical theories?
Deontology/Kantianism –
• Utilitarianism –
• Principlism/pluralistic theory –
• Casuistry –
• Narrative ethics –
• Feminist/communitarian ethics –
• Pragmatism –
• Virtue ethics
67
Describe deontology/kantism
Deontology/Kantianism – based on pure reason and duty; never treat others merely as a means to an end
68
Describe utilitarianism
• Utilitarianism – maximize utility and minimize bad
69
Describe principlism/pluralistic theory
• Principlism/pluralistic theory – autonomy, beneficence, non-maleficence, justice
70
Describe casuistry
• Casuistry – bottom-up reasoning; inferring from similar past cases
71
Describe narrative ethics
• Narrative ethics – reflection and drawing broader lessons; personal identity and storytelling; highly contextual/subjective
72
Describe feminist/communitarian ethics
• Feminist/communitarian ethics – critical of mainstream bioethics that neglect women’s issues/perspectives
73
Describe pragmatism
• Pragmatism – looks for a 3rd “outside the box” solution
74
Describe virtue ethics
focused on character of the individual; pursue eudaemonia; balance character traits between vices
75
What is cultural destructiveness
forced assimilation, subjugation, rights and privileges for dominant groups only
76
What is cultural incapacity
racism, maintain stereotypes, unfair hiring practices
77
What is cultural blindness
differences ignored, treat everyone the same, only meet needs of dominant groups
78
What is cultural pre-competence
expose cultural issues, are committed, assess needs of organization/individuals
79
What is cultural competence
recognize individual/cultural differences, seek advice from diverse groups, interact effectively
80
What is cultural proficiency
implement changes to improve services based upon cultural needs
81
What is cultural safety
fostering an environment that is spiritually, socially, and emotionally safe
82
What is cultural humility
Cultural humility: recognition that our own perspective is not the only and not necessarily the “correct” perspective
