GP 1 Flashcards
(100 cards)
1
Q
What are the 4 main determinants of health?
A
- Lifestyle.
- Access to healthcare.
- Genes.
- Environment
- physical
- social + economic
2
Q
Define the following:
a) Equity
b) Equality
A
a) Equity - what is fair and just.
b) Equality - equal shares.
3
Q
What are the two types of equity?
A
- Horizontal equity: equal treatment for equal need eg. Individuals with pneumonia (with all other things equal) should be treated equally.
- Vertical equity: unequal treatment for unequal need. e.g. someone with a common cold would need a different treatment to someone with pneumonia.
4
Q
Give 2 factors that can affect health equity
A
- Spatial factors - geographical.
2. Social factors - age, gender, class, ethnicity.
5
Q
What are the 3 domains of public health?
A
- Health promotion.
- Health protection.
- Improving health services.
6
Q
Domains of public health: give examples of health promotion.
A
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
7
Q
Domains of public health: give examples of health protection.
A
Putting measures in place to control infectious diseases, radiation, chemical/poison, emergency
8
Q
Domains of public health: what are the aims of health service improvements?
A
To ensure that there is delivery of organised, safe and high quality services.
9
Q
What is health psychology?
A
Emphasises the role of psychological factors in the cause, progression + consequences of health + illness.
> promote healthy behaviours + prevent illness
10
Q
What are the 3 health behaviours?
A
- Health behaviour
- Illness behaviour
- Sick role behaviour
11
Q
What is meant by ‘Health behaviour’?
A
Health behaviour is aimed at preventing disease e.g. eating healthily.
12
Q
Define illness behaviour.
A
Illness behaviour is aimed at seeking remedy e.g. going to the Dr’s.
13
Q
Define sick role behaviour.
A
Sick role behaviour is activity aimed at getting better e.g. taking medications.
14
Q
Give some examples of health damaging / impairing behaviours.
A
- Smoking
- Alcohol + substance abuse
- Sun exposure
- Risky sexual behaviour
- Driving without a seat belt
15
Q
Give some examples of health promoting behaviours.
A
- Exercising
- Healthy eating
- Medicines compliance
- Vaccinations
- Attending health checks
16
Q
Give 3 factors that can effect compliance.
A
- Side effects of medications.
- Patient perception of risk.
- If the patient is asymptomatic.
- Socioeconomic status.
17
Q
Give 3 examples of population level interventions.
A
- PH campaigns e.g. Change4Life, Movember.
- Screening e.g. cervical smear.
- Immunisations e.g. MMR.
18
Q
What is unrealistic optimism?
A
Unrealistic optimism is when individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility.
19
Q
Give 3 factors that contribute to unrealistic optimism e.g. factors that can influence someones perception of risk.
A
- Lack of personal experience with a problem.
- Belief that it may be preventable by personal action.
- Belief that if not happened now, its not likely to.
- Belief that the problem is infrequent.
- Other reasons: health beliefs, situational rationality, cultural variability, socioeconomic factors, stress, age.
20
Q
Briefly describe the NICE guidance on behaviour change.
A
- Plan interventions.
- Assess social context.
- Educate and train.
- Look at individual level and community level interventions.
- Evaluate effectiveness and assess cost effectiveness.
21
Q
What 3 diseases are smoking related deaths normally due to? When does smoking prevalance peak?
A
- Cancers.
- COPD.
- CHD.
- mid 20s
22
Q
What is NCSCT? What’s it’s purpose?
A
National Centre of Smoking Cessation Training
- delivers training + assessment programmes
- provides support services for local + national providers
- conducts research into behavioural support for smoking cessation
- provides stop smoking services with a measure of quality assurance.
23
Q
What is ‘Health Needs Assessment’?
A
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.
24
Q
Health Needs Assessment: define need.
A
The ability to benefit from an intervention.
25
Health Needs Assessment: briefly describe the planning cycle.
Needs assessment -> planning -> implementation -> evaluation
26
What are the 2 ways in which a 'Health Needs Assessment' can be approached?
1. Sociological perspective
| 2. Public Health perspective
27
What 4 factors comprise the Sociological perspective in terms of the Health Needs Assessment?
1. Felt need: individual perceptions of variation from normal health
2. Expressed need: individual seeks help to overcome variation in normal health (demand).
3. Normative need: professional defines intervention appropriate for the expressed need.
4. Comparative need: comparison between severity, range of interventions + cost.
28
Which 3 factors comprise the Public Health Approach to the Health Needs Assessment?
1. Epidemiological
2. Comparative
3. Corporate
29
Give 3 negative points for epidemiological health needs assessments.
1. Required data may not be available.
2. Variable data quality.
3. Ignores felt needs.
30
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
31
Give 3 negative points for comparative health needs assessments.
1. Required data may not be available.
2. Variable data quality.
3. It is hard to find comparable populations.
32
Who might be involved with corporate health needs assessment?
1. Politicians.
2. Press.
3. Providers.
4. Professionals.
5. Patients.
33
Give 3 negative points for corporate health needs assessments.
1. Difficult to distinguish need from demand.
2. Groups may have vested interests.
3. May be influenced by political agendas.
34
Smoking cessation: give 3 symptoms of withdrawal.
1. Difficulty concentrating.
2. Increased appetite.
3. Irritability.
35
Define epidemiology.
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
36
Define domestic abuse.
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
37
Give 5 examples of domestic abuse.
1. Emotional abuse.
2. Physical abuse.
3. Financial abuse.
4. Sexual abuse.
5. Psychological abuse.
38
How can domestic abuse impact on health?
1. Traumatic injuries following assault e.g. fractures, miscarriage.
2. Somatic problems or chronic illness e.g. chronic pain, headaches.
3. Psychological problems e.g. PTSD, depression, anxiety.
39
Give 3 potential indications of domestic abuse.
1. Unwitnessed by anyone else.
2. Repeat attendances to GP or A+E.
3. Delay in seeking help.
4. Multiple minor injuries.
40
What assessment tool can be used to determine someones risk of domestic abuse?
The DASH assessment. 'Domestic Abuse, Stalking, Harassment + 'Honour' based violence'
41
What action would you take if someone was at high risk of domestic abuse?
- standard or medium risk: national helpline, give contact details for domestic abuse hotlines
- high risk: Refer to MARAC (Multi-Agency Risk Assessment Conference) or IDVA (Independent Domestic Violence Advisors)
42
Give 4 Models of Behaviour Change
1. Health Belief Model
2. Theory of planned behaviour
3. Transtheoretical Model
4. Social norms theory
43
What is the Health Belief Model (Becker 1974)?
Individuals will change if they:
- Believe that they are susceptible to the condition in question. (percieved susceptibility)
- Believe that is has serious consequences. (percieved severity)
- Believe that taking action reduces susceptibility. (perceived benefits)
- Believe that the benefits of taking action outweigh the costs. (perceived barriers)
- worked in diabetes mx, breast self-examination, vaccinations
44
Give 3 disadvantages of the health belief model.
1. Health beliefs may be affected by alternative factors e.g. outcome expectancy and self efficacy.
2. The model does not consider the influence of emotions on behaviour.
3. It does not differentiate between first time and repeat behaviours.
45
The Theory of Planned Behaviour proposes that the best predictor of behaviour is intention. What are the 3 predictors of intention?
1. A persons attitudes to the behaviour.
2. Subjective norm: the perceived social pressure to undertake the behaviour.
3. Perceived behavioural control: a person's appraisal of their ability to perform the behaviour.
46
Give 3 disadvantages to the Theory of Planned Behaviour.
1. lack of direction or causality.
2. The model doesn't taken into account emotions which might disrupt 'rational' decision making
3. Habits + routines bypass cognitive deliberation + undermine a key assumption
4. Relies on self-reported behaviour.
5. Useful for predicting people's intentions; not as successful for predicting actual behaviours.
47
Describe the transtheoretical model.
1. Pre-contemplation - no intention of stopping smoking.
2. Contemplation - thinking about giving up.
3. Preparation - getting ready to quit in near future.
4. Action - engaged in giving up.
5. Maintenance - steady no smoker, state of change reached.
6. Relapse?
48
Give 3 advantages of the transtheoretical model / 'Stages of Change' model
- Acknowledges individual stages of readiness (tailored interventions)
- Accounts for relapse
- Temporal element (although arbitrary).
49
3 disadvantages of the transtheoretical model.
1. Not all people move through every stage.
2. Change might operate on a continuum, not discreet stages.
3. Doesn't take into account habits, culture, social and economic factors.
50
NICE guidance suggests that there are certain transition points in a person life where they are more susceptible to behaviour change. Name 3.
1. Leaving school.
2. Entering workforce.
3. Becoming a parent.
4. Becoming unemployed.
5. Retirement and bereavement.
51
Define malnutrition
Deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients. Malnutrition covers under-nutrition and overweight.
52
Name 3 chronic medical conditions that require nutritional support.
1. Cancer.
2. CF.
3. Coeliac disease.
4. IBD.
5. T1DM and T2DM.
53
Name 2 early influences on feeding behaviour.
- Maternal diet + taste preference development
- Breast feeding -> for taste preference + body weight regulation
- Parenting practices
- Age at introduction of solid food
54
Give 3 advantages of breast feeding on feeding behaviour.
1. More likely to accept novel foods in weaning.
2. Less fussy eaters in childhood.
3. More likely to have a diet rich in fruit and vegetables.
55
Give 3 ways in which parents can tackle fussy eating.
1. Modelling healthy eating behaviours and eating as a family.
2. Provide a variety of food.
3. Avoid pressure to eat.
4. Restriction.
5. Authoritative parenting.
6. Not using food as a reward
56
Name 3 eating disorders.
1. Anorexia nervosa.
2. Bulimia nervosa.
3. Binge eating disorder.
57
Give 3 examples of disordered eating.
1. Restraint.
2. Strict dieting.
3. Emotional eating.
4. Binge eating.
5. Weight concerns.
58
Give 3 potential problems with dieting.
1. Risk factor for developing eating disorders.
2. Dieting results in a loss of lean body mass, not just fat mass.
3. Dieting slows metabolic rate.
4. Chronic dieting may disrupt normal appetite responses and increases sensations of hunger.
5. Long term weight loss is challenging, people often regain weight.
59
What is defintion of blindness + partial blindness
inability to perform any work for which eyesight is essential.
- <3/60 : Have to be less than 3 meters away from subject that someone with normal vision can see 60 meters away.
- partial blindness: usually 3/60-6/60
60
Most common Causes of visual impairment in elderly and younger patients
elderly: macular degeneration, glaucoma
younger: diabetic retinopathy, uveitis, inherited retinal disease, retinovascular disease
61
Symptoms of Horners syndrome
ptosis, miosis (pupil constriction), anihydrous (loss of sweating)
62
Causes of Horners
```
Central lesions (4 Ss):
S – Stroke
S – Multiple Sclerosis
S – Swelling (tumours)
S – Syringomyelia (cyst in the spinal cord)
```
```
Pre-ganglionic lesions (4 Ts):
T – Tumour (Pancoast’s tumour)
T – Trauma
T – Thyroidectomy
T – Top rib (a cervical rib growing above the first rib above the clavicle)
```
```
Post-ganglionic lesion (4 Cs):
C – Carotid aneurysm
C – Carotid artery dissection
C – Cavernous sinus thrombosis
C – Cluster headache
```
63
3rd nerve palsy
- Ptosis (drooping upper eyelid)
- Dilated non-reactive pupil
- Divergent strabismus (squint) in the affected eye. It causes a “down and out” position of the eye.
64
Causes of red eye
1. Conjunctivitis - painful, discharge, no change in visual acuity
2. Sub-conjunctival haemorrhage - blood under eye. No change to vision or pain
3. Keratitis - inflammation of cornea (herpes viral, bacterial, fungal), painful, reduced visual acuity, watering, photophobia
4. Episcleritis - self-limiting inflammation of episclera (outermost layer of sclera, just underneath conjunctiva. No discharge, not painful, segmental redness (patch)
5. Scleritis - infla. of whole sclera. Severe pain, uni/bi, photophobia, reduced acuity
6. Anterior uveitis/iritis - unilateral, excessive lacrimation, abnormally shaped pupil, pain, reduced acuity, photophobia
65
Causes of congenital hearing loss/deafness
- genetic
- intrauterine infection
- drugs in pregnancy (stepamycin)
- meningitis
- neonatal jaundice
66
Causes of childhood onset deafness
- No earache: bilateral glue ear, impacted wax, hereditary, following meningitis/head injury
- Earache: acute otitis media
67
Causes of adulthood Sensorineural heading loss
Sensorineural
- age-related hearing loss (presbyacusis). Gradual onset.
- noise exposure
- MS, stroke
- can present with tinnitus (ringing)
- infection
- Menieres disease -> episodes of vertigo, nausea, hearing loss. Progressive disease. Can give labrynthine sedatives during attacks.
68
Causes of adulthood conductive heading loss
Conductive
- impacted wax
- foreign body
- ear drum perforation
- glue ear -> non-infective fluid accumulated in middle ear
- otosclerosis -> adhearance of stapes to bone - uni or bi. Surgery.
69
Examination of deafness
- examine ears - canal, wax, foreign body, perforated eardrum
- Weber and Rinne to help distinguish between conductive and sensorineual hearing loss
70
Define refugee.
A person granted asylum and refugee status in the UK. They have the rights of a UK citizen. Usually means leave to remain for 5 years then reapply
71
Define asylum seeker.
A person applying for refugee status. They are entitled to £35 a week, housing and NHS care.
72
Define social exclusion.
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
73
When a refugee is granted 'indefinite leave to remain', what does this mean?
When a person is granted full refugee status + given permanent residence in the UK.
- they have all the rights of a UK citizen.
74
What is the theory behind Maslows hierarchy of needs
a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid.
- Needs lower down in the hierarchy must be satisfied before individuals can attend to needs higher up.
75
What are the 5 factors that comprise Maslow's hierarchy of human needs?
1. (TOP) Self-actualization: desire to become the most that one can be
2. Esteem: respect, self-esteem, status, recognition, freedom
3. Love + belonging: friendship, intimacy, family, sense of connection
4. Safety needs: personal security, employment, resources, health, property
5. (BOTTOM) Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
76
What is epigenetics?
- Behaviors and environment can cause changes that affect the way your genes work -> doesnt affect DNA genetic code but the expression of genes (e.g. dna methylation)
- No individual has the same experience as another
77
What is allostasis?
The process of achieving stability, or homeostasis, through physiological or behavioural change
78
4 groups of people who suffer from health inequalities
- Deprived areas -> smoking, obesity, chronic illness, teenage pregnancy
- Homelessness -> poor physical and mental health, substance abuse
- Unemployed -> increased mortality and morbidity
- Refugee and asylum seekers -> restricted access to services, disease, difficulty expressing health needs, social exclusion
79
NICE diagnosis if HTN
1. First consultation in clinic: >140/90
2. To rule out white coat or temporary stress, exercise:
ABPM - 2 measurements per hour during usual waking hours. (14 min. measurements)
Home BP - morning + evening for 4+ days
= 135/85+
80
What are the parameters for stage 1 HTN?
ABPM / HBPM BP >135/85
81
What are the parameters for stage 2 HTN?
ABPM / HBPM BP > 150/95
82
What are the parameters for Severe HTN?
Systolic > 180
| Diastolic > 110
83
Any patient with Stage 1 HTN plus comorbidities should be treated as Stage 2 HTN.
List some examples of these comorbidities.
End organ damage (ECG, U+Es, Haematuria, Fundoscopy)
- Established CVD
- Diabetes
- Renal pathology
- 10 year CVD risk >10% (according to QRISK-3)
84
How should Stage 1 HTN be managed?
LIFESTYLE MODIFICATIONS!!!
- Smoking cessation
- Exercise
- Improve diet + reduce salt intake
- Reduce alcohol intake, and caffeine
- Engage in relaxation
85
What is the 1st line treatment for Stage 2 HTN in a person under 55 years?
ACEi
| eg. Ramipril, Lisinopril
86
What is the 1st line treatment for Stage 2 HTN in a person over 55 years OR Afro-Caribbean origin?
Calcium Channel Blocker
| eg. Amlodipine, Verapamil
87
What is the 2nd line treatment for Stage 2 HTN if a person is under 55y and already on an ACEi?
Add Calcium Channel Blocker (Amlodipine, Verapamil)
88
What is the 2nd line treatment for Stage 2 HTN if a person is over 55 or of Afro-Caribbean origin and is already on a CCB?
ACEi
eg. Ramipril, Lisinopril OR
ARB eg. losartan if ACEi not tolerated
89
What is the 3rd line treatment for Stage 2 HTN?
| this is the same for under and over 55s and for Afro-Caribbeans
Add a thiazide-like diuretic
90
What is the 4th line treatment for Stage 2 HTN if a pt's Potassium is below 4.5mmol/l?
Spironolactone (potassium sparing)
91
What is the 4th line treatment for Stage 2 HTN if a pt's Potassium is above 4.5mmol/l?
- alpha blocker eg. Doxazosin, Prazosin, Terazosin.
| - beta blocker eg. propanolol.
92
Give 3 potential side effects of ACEi
1. Hypotension.
2. AKI.
3. Hyperkalaemia.
4. Cough, rash and due to increased bradykinin.
5. Erectile dysfunction (all antihyp).
93
Give 3 potential side effects of beta blockers.
1. Fatigue.
2. Headache.
3. Bradycardia.
4. Hypotension.
5. Erectile dysfunction.
6. Cold peripheries.
94
Give 3 potential side effects of CCBs
1. Ankle oedema
2. Flushed
3. Constipation
4. Headache
5. Erectile dysfunction
95
Potential side effects of diuretic (thiazide)
1. Hyponatremia (parti. thiazides) - cerebral oedema/swelling, coma.
2. hypokalaemia (thiazides) - abnormal heart rhythm.
3. Gout - contraindication
4. Hypovalaemia - kidney failure
5. ED
96
Potential side effects of diuretic (spironolactone)
1. hyperkalaemia
2. gynaecomastia
3. ED
97
Contraindications of Acei
1. renal artery stenosis
| 2. Hyperkalaemia
98
For a Qrisk3 of 10% what should put patient on + what is a side effect of this medication
Statins.
| Myalgia
99
What are the secondary causes of HTN
ROPE
- Renal - renal bruit, high creatinine
- Obesity, Obstructive sleep apnoea
- Pregnancy induced/pre-eclampsia
- Endocrine - Conns (high aldosterone, hypokalaemia), hyper/hypothyroid (other symptoms/TSH)
100
Complications of HTN
- MI, HF, Stroke
- PVD
- CKD, dementia, metabolic syndrome, eye damage
