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MS1 FOM > Week 1 - complete > Flashcards

Week 1 - complete Flashcards

1
Q

Sign vs symptom?

A

Sign: what the physician identifies on PEx
Symptom: What the patient perceives

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2
Q

What are the 4 types of clinical presentations?

A
  1. Undifferentiated
  2. Single typical
  3. Multisystem
  4. Preventative care/health promotion
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3
Q

Give an example of each type of clinical presentation

A
  1. Undifferentiated: fatigue, malaise
  2. Single typical: abdominal pain, diarrhea, knee swelling
  3. Multisystem: fever, cough
  4. Preventative care/health promotion: cancer, pap smear, blood screening
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4
Q

What are the steps in the diagnostic pathway?

A
  1. assess stability (vitals [ABC])
  2. History
  3. Physical exam
  4. Investigations
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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

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6
Q

What is the framework used to develop a DDx?

A

Vitamin C&D

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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

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8
Q

What is the framework for picking which investigations to use?

A

Choosing wisely

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9
Q

How do you choose which investigations to conduct?

A

Based on potential DDX based on patient history and physical exam

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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

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11
Q

What is pre-test probability?

A

The probability that your patient actually has the illness you’re testing for

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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.

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13
Q

What are the 5 types of investigations to choose from?

A
  1. Biochemistry
  2. Microbiology
  3. Hematology
  4. Pathology
  5. Imaging
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14
Q

Describe biochemistry Ix

A

Function and metabolic tests and markers

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15
Q

Describe microbiology Ix

A

Infection workup

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16
Q

Describe hematology Ix

A

blood cells and elements, clotting parameters

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17
Q

Describe pathology Ix

A

autopsy, surgical pathology (tissue), cytopathology

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18
Q

Describe imaging Ix

A

Xray, CT, MRI, ultrasound, PET

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19
Q

What is important when doing Ix? Why?

A

Ensuring proper sample collection to ensure specimen viability

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20
Q

How many types of biopsies are there?

A

4

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21
Q

What are the 4 types of biopsies?

A
  1. Fine needle aspiration
  2. Needle core
  3. Punch
  4. Incisional and excisional
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22
Q

When do you use fine needle aspiration?

A

For palpable or deep lesions

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23
Q

When do you use needle core biopsies?

A

For deeper lesions, specific sites

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24
Q

When do you use punch biopsies?

A

For shallow samples, skin lesions only

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25
Q

When do you use incisional and excisional biopsies?

A

Incisional: for diagnosis
Excisional: for diagnosis AND treatment

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26
Q

In the case of fatigue, what might be a main vs an associated symptom?

A

Main symptom = fatigue
Associated symptoms = breathlessness, malaise, confusion

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27
Q

What is the first thing to do when determining the clinical presentation type?

A

See if it is life threatening (check vitals)

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28
Q

What is the key feature?

A

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

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29
Q

What are 2 types of physical exam?

A

General and focused

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30
Q

Describe general vs focused PEx

A

general: whole body
Focused: prioritize areas that are relevant to the patient’s symptoms

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31
Q

What are social determinants of health?

A

Non-medical and non-biological influencers that affect health and health outcomes

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32
Q

What are examples of social determinants of health?

A

Race, employment status, education, lifestyle activities, social life

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33
Q

What can social determinants of health do to health issues? Give examples

A

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
Q

What happens to disease as areas develop economically?

A

There is an increase in life expectancy and shift in the disease patterns of a population and causes of morbidity nad mortality

35
Q

What are the levels of economic development/disease shift also known as?

A

Epidemiologic transition

36
Q

What are the 4 stages of epidemiologic transition?

A
  1. Pestilence/famine
  2. Receding pandemics
  3. Degenerative and man-made diseases
  4. Delayed degenerative diseases
37
Q

Describe pestilence/famine stage of epidemiologic transition

A

Most diseases are based in malnutrition/infectious diseases. Very short life expectancy, low incidence of CVD.
Countries include sub-saharan africa

38
Q

Describe receding pandemics stage of epidemiologic transition

A

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
Q

Describe degenerative and man-made diseases of epidemiologic transition

A

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
Q

Describe delayed degenerative disease stage of epidemiologic transition

A

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
Q

Describe incidence of CVD during epidemiologic transition

A

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
Q

What are the 3 levels of social determinants of health?

A

Proximal, intermediate, and distal context

43
Q

What are examples of proximal context?

A

Elements in home, work, social life

44
Q

What are examples of intermediate context?

A

health care systems, education systems

45
Q

What are examples of distal context?

A

culture, community, society

46
Q

Describe proximal, intermediate, and distal SDH for indigenous individuals

A

Proximal: health behaviours, education, food insecurity
Intermediate: community infrastructure, cultural continuity
Distal: colonialism, racism, self-determination

47
Q

How many levels of disease prevention are there?

A

4

48
Q

What are the 4 levels of disease prevention?

A
  1. health promotion
  2. primary prevention
  3. secondary prevention
  4. tertiary prevention
49
Q

Describe health promotion level of disease prevention

A

Preventing disease risk factors, lower average population risk. For the entire populaton

50
Q

Describe primary prevention level of disease prevention

A

manage risk factors. For members of population with one or more risk factors. Goal is to prevent the development of disease

51
Q

Describe secondary prevention level of disease prevention

A

For those with limited disease. Goal is to prevent disease progression or recurrence

52
Q

Describe tertiary prevention level of disease prevention

A

For those with symptomatic/advanced disease. Goal is to reduce complications of disease and disability

53
Q

What are risk factors?

A

characteristics or behaviours that increase the chance of diseae

54
Q

What are risk conditions? Examples?

A

Chronic conditions that contribute to the risk of disease
E.g. prediabetes, obesity

55
Q

What is multimorbidity?

A

co-existence of 2+ chronic conditions

56
Q

What are the 4 approaches to disease prevention and control?

A
  1. individual-centered
  2. public health/population-based
  3. high-risk strategy
  4. population strategy
57
Q

Describe individual-centered approach to disease prevention and control

A

Asks why a patient got a disease, focuses on the cause of cases

58
Q

Describe public health/population based approach to disease prevention and control

A

Looks at causes of disease incidence. Asks whether disease can be prevented. E.g. vaccinations

59
Q

Describe high-risk strategy approach to disease prevention and control

A

identify high-risk susceptible individuals and offer individual protection. May reduce mortality

e.g. screening for cancer

60
Q

Describe population strategy approach to disease prevention and control

A

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
Q

What is a drawback of the population strategy for disease control?

A

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
Q

What are the 4 types of physician/patient relationship?

A
  1. Paternalistic
  2. Deliberative
  3. Interpretive
  4. Informative
63
Q

Describe the 4 types of physician/patient relationship

A

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
Q

What are ADL vs IADL

A

Activities of daily living VS instrumental activities of daily living

ADL: feeding, dressing, bathing, walking
IADL: improve QOL. Cooking, cleaning, laundry

65
Q

Which physician/patient relationship models are the most/least concerned with patient autonomy?

A

Paternalistic: least concerned
Informative: most

66
Q

What are some relevant ethical theories?

A

Deontology/Kantianism –
• Utilitarianism –
• Principlism/pluralistic theory –
• Casuistry –
• Narrative ethics –
• Feminist/communitarian ethics –
• Pragmatism –
• Virtue ethics

67
Q

Describe deontology/kantism

A

Deontology/Kantianism – based on pure reason and duty; never treat others merely as a means to an end

68
Q

Describe utilitarianism

A

• Utilitarianism – maximize utility and minimize bad

69
Q

Describe principlism/pluralistic theory

A

• Principlism/pluralistic theory – autonomy, beneficence, non-maleficence, justice

70
Q

Describe casuistry

A

• Casuistry – bottom-up reasoning; inferring from similar past cases

71
Q

Describe narrative ethics

A

• Narrative ethics – reflection and drawing broader lessons; personal identity and storytelling; highly contextual/subjective

72
Q

Describe feminist/communitarian ethics

A

• Feminist/communitarian ethics – critical of mainstream bioethics that neglect women’s issues/perspectives

73
Q

Describe pragmatism

A

• Pragmatism – looks for a 3rd “outside the box” solution

74
Q

Describe virtue ethics

A

focused on character of the individual; pursue eudaemonia; balance character traits between vices

75
Q

What is cultural destructiveness

A

forced assimilation, subjugation, rights and privileges for dominant groups only

76
Q

What is cultural incapacity

A

racism, maintain stereotypes, unfair hiring practices

77
Q

What is cultural blindness

A

differences ignored, treat everyone the same, only meet needs of dominant groups

78
Q

What is cultural pre-competence

A

expose cultural issues, are committed, assess needs of organization/individuals

79
Q

What is cultural competence

A

recognize individual/cultural differences, seek advice from diverse groups, interact effectively

80
Q

What is cultural proficiency

A

implement changes to improve services based upon cultural needs

81
Q

What is cultural safety

A

fostering an environment that is spiritually, socially, and emotionally safe

82
Q

What is cultural humility

A

Cultural humility: recognition that our own perspective is not the only and not necessarily the “correct” perspective

MS1 FOM (5 decks)

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