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FRCS Part 1 > Ch85 Outcome assessment > Flashcards

Ch85 Outcome assessment Flashcards

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1
Q

What is the Karnofsky performance scale?

A

A functional grading scale for cancer. 100 = normal 70 = cares for self but cannot work 40 = disabled requiring special care 0 = dead *the cut off for active oncological treatment is 70!

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2
Q

What is the Glasgow outcome scale?

A

5 - full recovery 4 - moderate disability (disabled but independent) 3 - Severe disability (still concious) 2 - PVS 1 - Dead

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3
Q

What is the modified rankin scale used for?

A

Post-stroke recovery 0 = no symptoms 1 = symptoms but no disability 2 = disability but independent 3 = requiring some help 4 = unable to walk without assistance 5 = Bedridden 6 = Dead

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4
Q

What is the ASIA score?

A

A - Complete injury B - Sensory intact no motor C - Sensory intact and motor <3/5 on average below the injury level D - Sensory intact and motor >3/5 on average below the injury level E - No deficit

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5
Q

What is cerebellar cognitive affective syndrome?

A

Where cerebellar injury causes: Impaired executive function Personality change Language production impairment

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6
Q

What cognitive impairment is least likely to improve with VP shunt in NPH?

A

Frontal lobe executive function

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7
Q

What proportion of patients have cognitive decline at 12 months post WBRT?

A

40%. Decline increases with a higher dose of WBRT.

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8
Q

What is the best marker of long term functional outcome, return to employment and cognitive impairment after TBI?

A

Duration of post-traumatic amnesia i.e. time after the injury until the return of orientation and memory of events

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9
Q

What should be considered in a SCI patient that becomes very hypertensive?

A

Autonomic dysreflexia!

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10
Q

What are the immediate non-pharmacological treatment for autonomic dysreflexia?

A

Put the patient in a more upright position (lowering the BP through orthostatic manoeuvres) Attend to bowel and bladder care routines

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11
Q

What are the pharmacological treatments for autonomic dysreflexia?

A
  1. Nitrogylcerine 2% paste applied to skin about the SCI. Causes vasodilation and reduction in BP. 2. Nifedipine Ca channel blocker causing vasodilation 3. Prazosin alpha-1 anti-adrenergic causing vasodilation. 4. Botulinum toxin to the bladder if the dysreflexia is associated with detrusor hyperactivity.
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12
Q

What is the pathological mechanism behind autonomic dysreflexia?

A

Preganglionic sympathetic neurons stimulate the adrenal medulla and cause adrenaline release. These neurons are inhibited by descending neurons from the hypothalamus in the intermediolateral column. A lesion above T6 removes the descending inhibition. Bladder and colon afferents relay into the preganglionic sympathetic neurons (via interneurons) and the lack of inhibition causes a reflex adrenergic storm. There is also hypersensitivity to adrenergic stimulation. This causes severe hypertension.

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13
Q

What is sensitivity?

A

The proportion of disease + patients that are test +

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14
Q

What is specificity?

A

The proportion of disease - patients that are test -

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15
Q

What is the NPV?

A

The probability of being negative if the test result is - i.e. the true negatives divided by the total number of test negatives

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16
Q

What is the PPV?

A

The probability of being positive if the test result is + i.e. the true positives divided by the total number of test positives

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17
Q

When is a Chi squared test performed?

A

Association between two categorical variables e.g. 2 different treatments and an outcome variable (%mortality)

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18
Q

How does PPV change with the prevalence of disease?

A

A test with a 90% sensitivity and 90% specificity has a poorer PPV if the disease is less common.

If prevalance is 20% PPV = 69%; If prevalence is 5% then PPV is 32%

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19
Q

What is standard deviation?

A

The square root of the variance i.e. how much the values spread around the mean

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20
Q

What is the equation for NNT?

A

1/absolute risk reduction (expressed as decimal i.e. 20% = 0.2)

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21
Q

What is the power of a study?

A

The probability of correctly rejecting the null hypothesis (1-beta i.e preventing a type 2 error)

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22
Q

What are the phases of trials?

A

Phase 1 - test safety

Phase 2 - test efficacy and test safety in a larger group

Phase 3 - Confirm efficacy

Phase 4 - Post market safety surveillance

Phase 5 - new indication for drug (repeat phases 2 and 3 for the new indication)

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23
Q

What non-parametric test is for unpaired and paired data?

A

Mann Whitney U (unpaired) and Wilcoxon signed-rank (paired) tests

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24
Q

What is the non-parametric test for comparing more than one group?

A

Kruskal-Wallis test (non-parametric version of ANOVA!)

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25
What are the parametric tests?
t-test (2 groups unpaired) Paired t-test (2 groups paired) ANOVA (more than 2 groups unpaired) Repeated measures ANOVA (more than 2 groups paired)
26
What are the non-parametric tests?
Mann-Whitney U (2 groups unpaired) Wilcoxon signed rank (2 groups paired) Kruskall Wallis (more than 2 groups unpaired) Friedman test (more than 2 groups paired)
27
What are type 1 and type 2 errors?
Type 1 is rejecting the null hypothesis falsely i.e. finding a difference when one does not exist (5%) Type 2 is accepting a null hypothesis falsely i.e. not finding a difference when one does exist (20%)
28
What is a COX regression model?
Investigates the relationship between an event (e.g. death) and possible variables providing an estimate of the effect of each variable
29
What test is used to compare two groups using Kaplan-Meier estimates?
Log-rank test (would be cox-proportional hazards regression if more than two groups!)
30
31
What is the odds ratio?
Odds of an event happening in one group divided by odds happening in another group
32
What is the hazard ratio?
Ratio of a hazard in one group divided by hazard in another group i.e. HR 2 means there is a double risk
33
What are the levels of evidence?
1 - RCTs (1a = meta-analysis, 1b - individual study) 2 - Cohort studies 3 - Case-control 4 - Case series 5 - Expert opinion
34
What legislation allows treatment to be given to over 16s that lack capacity?
The Mental Capacity Act (2005)
35
What is the process of assent?
Where a child that lacks the capacity to consent is aware of the procedure, has some understanding and is willing to undergo the treatment. This is different for Gillick competence where a child \>13 years can consent for themselves if they are deemed mature enough.
36
What is parens patriae?
Where a parent refuses to give consent on the behalf of a child and a high court takes on the consenting responsibility for the child.
37
What is autonomy?
The ability to make independent decisions
38
What are the 4 principles of biomedical ethics?
1. Autonomy (independence) 2. Beneficence (doing the right thing) 3. Non-maleficence (not causing harm) 4. Justice (equality)
39
What are the driving rules around seizures (Group 1)?
After a first seizure, the patient must stop driving and inform the DVLA. Patients cannot drive unless they have been seizure-free for more than one year Allowed to drive if seizures only in sleep for \>12 months Allowed to drive if seizures do not impair consciousness Isolated seizure after being seizure-free for 5 years - 6 months off driving if neurologist thinks another seizure is unlikely Provoked seizures are assessed on an individual basis
40
What are the driving rules around seizures (Group 2)?
Regain group 1 license, be seizure-free and off medication for 10 years!
41
What are the driving rules during drug withdrawal?
Stop driving during the withdrawal and for 6 months after
42
What legislation covers emergency treatment in a child that the parents refuse?
Family reform act 1969
43
What legislation covers advanced directives?
Mental capacity act (2005) Advanced directive rules: Age \>18 years Clearly specify treatments you wish to refuse Explain the circumstances in which you refuse them Signed by you and a witness if refusing life-sustaining treatments Free of coercion Not withdrawn/contradicted decision
44
What are Frasier guidelines?
The guidelines outlining the criteria which must be met for doctors to provide contraceptive advice and treatment to under 16s without parent consent
45
What are the 3 statutory bodies with responsibility for child protection?
Police Social services NSPCC
46
Can Gillick competent children refuse treatment?
NO! Under the age of 18 years the ability to refuse treatment can be overturned by persons with parental responsibility or by a court order
47
What is section 8 of the family reform act?
In an emergency act in the child's best interest provided the treatment is limited to that emergency treatment. Parents cannot make decisions that may permanently harm or otherwise impair the healthy development of a child. If the child suffers as a result the parents may be criminally liable.
48
What is the age of consent for medical treatment?
Consent for treatment from 16 years (but they cannot refuse treatment until 18 years)
49
If a Gillick competent 16-year-old Jehovah's witness refuses a life-saving transfusion what do you do?
If parents agree then transfuse If parent disagree then involve the courts but the young person must not be allowed to die from a lack of blood!
50
What legislation covers detainment for treatment for a mental health problem?
Mental health act (2007) Section 2 = Admission for assessment and initiation of treatment (28 days) Section 3 = Admission for treatment (6 months) Section 4 = Emergency admission (72 hours) Section 5(2) = doctor can stop an inpatient leaving hospital (72 hours) Section 5(4) = nurse can stop an inpatient leaving hospital (6 hours) Section 135 = police can enter premises or return someone to hospital Section 136 = police can take a person with a mental disorder to a place of safety
51
What legislation covers the preservation of a body after death until consent for organ donation is established?
Human tissue act 204 Relatives cannot legally veto consent to organ donation
52
When can you break patient confidentiality?
Terrorism Criminal act Risk to others Notifiable disease
53
What is Tarasoff decision?
Where confidentiality must be breached if a patient threatens to harm another person.
54
What are emancipated minors?
If \<18 years and: Married Serving in the military Self-supporting are Parents themselves
55
What is the categorical imperative?
Described by Emmanuel Kant as: 1. Always act in the same way for everyone 2. People should be treated as valuable in themselves
56
What is the difference between Non-voluntary and Involuntary euthanasia?
NON-voluntary is intentionaly killing to benefit a patient without the patient consenting INvoluntary is when it is against the patients wishes
57
What is Aristotelian justice?
Receipt of benefits according to their merit
58
What is libertarianism?
Liberty to keep and exchange property. Fully own themselves.
59
What is Deontology?
Duty based ethics based on the rightness or wrongness of an action not the consequence.
60
What is principalism?
Ethics based on the 4 main principles of beneficence, non-maleficence, justice and autonomy
61
What is virtuism?
Action that would be taken by a virtuous person

FRCS Part 1 (85 decks)

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