case 2 - health & illness behaviour

Question 1

What is the acronym used for the possible reasons for pathophysiological symptoms?

Answer 1

‘AVINDICATEDPIF’

Question 2

What are the 6 parts/steps in taking a history?

Answer 2

Sequence of events, Symptom analysis, associated symptoms, patient perspective, background medical information, personal and social history

Question 3

What class of drug is codeine?

Answer 3

Opiate

Question 4

What is codeine used as?

Answer 4

An analgesic, decreasing pain perception

Question 5

What is the mechanism of action of codeine?

Answer 5

An agonist of mu-opioid receptors, which are involved in the transmission of pain.

Question 6

What are the key side effects of codeine?

Answer 6

Drowsiness, sedation, respiratory depression, nausea, vomiting, constipation

Question 7

What are the GI side effects of codeine?

Answer 7

Nausea, vomiting, constipation

Question 8

What class of drug is diclofenac?

Answer 8

NSAID - non-steroidal anti-inflammatory drug)

Question 9

What is diclofenac used for?

Answer 9

Reduce pain & inflammation

Question 10

What is the mechanism of action of diclofenac?

Answer 10

Binds to and inhibits COX-1 and COX-2 to block the production of prostaglandin, which is involved in inflammation

Question 11

What are the GI side effects of diclofenac?

Answer 11

Nausea, vomiting, diarrhoea

Question 12

What is the key difference between the action of diclofenac and the action of codeine?

Answer 12

Diclofenac reduces inflammatory pain, while codeine decreases pain perception

Question 13

What are the key personal perspectives of the doctor and patient in the doctor-patient relationship?

Answer 13

knowledge, experiences, ideas, priorities, attitudes, opinions

Question 14

What are some of the societal factors that contribute to health behaviours?

Answer 14

Advertising, accessibility, stigma, cost, education, socioeconomic status, cultural values, religion

Question 15

What are the 4 pillars of medical ethics?

Answer 15

Beneficence, non-maleficence, autonomy, justice

Question 16

What is beneficence?

Answer 16

To act in the best interest of the patient

Question 17

What is non-maleficence?

Answer 17

To do no harm to the patient

Question 18

What is autonomy?

Answer 18

The patient’s right to choose or decline treatment

Question 19

What is justice?

Answer 19

Fairness and equity in the distribution and delivery of treatment

Question 20

What are the 3 parts of the ‘spirit of Motivational Interviewing’?

Answer 20

Collaborative, Honouring autonomy, evocative

Question 21

What are the core principles of Motivational Interviewing?

Answer 21

OARS: Open questions, affirmation, reflective listening, summarising

Question 22

What are the 6 stages of change in Motivational Interviewing?

Answer 22

Pre contemplation, Contemplation, Determination, Action, Maintenance, Recurrence

Question 23

What causes nausea/vomiting in a patient taking morphine?

Answer 23

Morphine, and other opioids, act on chemoreceptors in the CTZ (chemoreceptor trigger zone) in the medulla oblongata. Morphine also inhibits gut motility, causing nausea & vomiting.

Question 24

What is the name for the ‘vomiting centre’ in the medulla oblongata?

Answer 24

CTZ - chemoreceptor trigger zone

Question 25

What causes nausea/vomiting in a patient in cardiogenic shock?

Answer 25

Decreased blood flow to the GI tract slows digestion. The ischemic byproducts of damaged cardiomyocytes can trigger nausea and vomiting also.

Question 26

What causes nausea/vomiting in a patient receiving cytotoxic chemotherapeutic drugs?

Answer 26

Drugs trigger the release of substance P from neurons which acts on NK1 receptors in the brain, triggering vomiting. Cell damage in GI tract can also cause it.

Question 27

What causes nausea/vomiting in a patient who has witnessed a horrifying event?

Answer 27

Adrenaline can decrease gut motility, and the vasovagal response leads to hypotension and nausea

Question 28

What causes nausea/vomiting in a patient who is in her first trimester of pregnancy?

Answer 28

HCG, a hormone produced by the placenta, can trigger nausea. High progesterone can slow gastric motility. Increased sensitivity of CTZ in the brain

Question 29

What are antiemetic drugs?

Answer 29

Medications used to prevent nausea and vomiting symptoms

Question 30

What are the 3 key antiemetic drugs studied?

Answer 30

Metoclopramide, domperidone, cyclizine

Question 31

What is the mechanism of action of metaclopramide?

Answer 31

Antagonises dopamine-2 receptors in the CTZ to decrease sensitivity of nerves between GI tract and CTZ.

Question 32

What is the mechanism of action of domperidone?

Answer 32

Antagonises dopamine-2 and dopamine-3 receptors in the CTZ to decrease the sensitivity of nerves between the GI tract and vomiting centre.

Question 33

What is the mechanism of action of cyclizine?

Answer 33

Antagonises H1 histamine receptors to inhibit nausea and vomiting

Question 34

What is the action of metaclopramide?

Answer 34

anti-emetic

Question 35

What is the action of domperidone?

Answer 35

anti-emetic

Question 36

What is the action of cyclizine?

Answer 36

anti-emetic