GP 2 Flashcards

Question

What is the equation for BP?

Answer 1

BP = CO x TPR

Answer 2

- Preload - Contractility - Vessel hypertrophy - Peripheral constriction

Answer 3

Most often symptomless. - headache - visual changes - dyspnoea - chest pain - sensory of motor deficit

Answer 4

- Lifestyle modification and monitoring (increase exercise, reduce sodium intake, lose weight) Medical treatment thresholds: low CDV risk = 160/100mmHg, high CDV risk = 140/90mmHg - calcium channel blockers, ACEis, ARBs, diuretics, B-blockers

Answer 5

A range of symptoms caused by atherosclerotic obstruction of the lower extremity arteries.

Answer 6

Atherosclerosis

Answer 7

- Smoking - diabetes mellitus - hypertension - hyperlipidaemia - age >40yrs - history of CAD, CVD, sedentary lifestyle, CKD, T2DM

Answer 8

Most often asymptomatic, intermittent claudication, diminished/absent pulse

Answer 9

Ankle-brachial index

Answer 10

Intermittent claudication: RF management Chronic limb ischaemia: revascularization surgery (PCI if small, bypass if larger) Acute limb threatening ischaemia: surgical emergency - revascularization within 4-6 hours other very high amputation risk

Answer 11

Intermittent claudication (least severe) Chronic critical limb ischaemia Acute limb ischaemia

Answer 12

Pulselessness, Pallor, Pain, Persisting cold, Paralysis, Paraesthesia (the more that are present, the more limb threatening)

Answer 13

Renal disease (MC cause) Obesity Pregnancy or pre-eclampsia Endocrine (T2DM, Conn's, Cushing's diseases) Drugs (alcohol, steroids, NSAIDs, oestrogen)

Answer 14

an STI with the parasite trichomonas vaginalis which lives in the urethra of men and women and the vagina

Answer 15

HIV Bacterial vaginosis Cervical cancer Pelvic inflammatory disease Pregnancy-related complications

Answer 16

up to 50% of cases are asymptomatic non-specific symptoms; Vaginal discharge (frothy and yellow-green) Itching Dysuria (painful urination) Dyspareunia (painful sex) Balanitis (inflammation to the glans penis)

Answer 17

strawberry cervix where there are tiny haemorrhages across the surface of the cervix, giving the appearance of a strawberry

Answer 18

charcoal swab with microscopy vaginal pH (>4.5) urethral swab in men

Answer 19

metronidazole

Answer 20

inflammation of the tonsils (typically the palatine tonsils) which can occur due to viral or bacterial infection

Answer 21

group A streptococcus (MC) streptococcus pneumoniae haemophilus influenzae moraxella catarrhalis staphylococcus aureus

Answer 22

sore throat fever >38 pain on swallowing

Answer 23

red, inflamed and enlarged tonsils +/- exudates anterior cervical lymphadenopathy (swollen, tender lymph nodes in the anterior triangle of the neck)

Answer 24

Fever >38 tonsillar exudates absence of cough tendor anterior cervical lymph nodes 3+ score = 40-60 % probability of bacterial tonsillitis and its appropriate to offer antibiotics

Answer 25

viral is self-resolving bacterial - 10 day course of penicillin V with relatively narrow spectrum of activity, effective against strep myogenes

Answer 26

peritonsillar abscess (quinsy) otitis media scarlet fever rheumatic fever post-strep glomerulonephritis post-strep reactive arthritis

Answer 27

a disease caused by infection with borrelia burgdorferi and the body's immune response to this infection

Answer 28

The b.burgdorferi spirochaete bacteria which causes lyme disease is carried by deer ticks which can attach to humans resulting in lyme disease

Answer 29

1. Early/localised Lyme disease - circular, target-like rash which radiates from the site of the tick bite, known as erythema migrans - usually appears within 3-36 days 2. Disseminated Lyme disease - flu-like illness which can include symptoms like joint and muscle pains, headache, fever, tiredness, nausea or vomiting - neurological disorders e.g. meningism, facial nerve palsies, mild encephalitis - occurs days to months later 3. Late manifestations of Lyme disease - arthritis - acrodermatitis chronica atrophicans - late neurological disorders e.g. polyneuropathy, chronic encephalomyelitis, vertigo and psychosis - chronic Lyme disease and 'post-Lyme syndrome' (similar to CFS or fibromyalgia)

Answer 30

It is difficult to make a diagnosis clinically Patients with erythema migrans should be diagnosed and treated for Lyme disease based on clinical assessment without lab testing (at this point there is a high chance that the antibody test will be negative due to the time that it takes for the antibody response to develop) If Lyme disease is suspected in people without erythema migrans, offer an enzyme-linked immunosorbent assay (ELISA) test for Lyme disease IF the ELISA test is positive or equivocal, perform an immunoblot test for Lyme disease

Answer 31

Treat with oral antibiotic for 2-3 weeks: Doxycycline or amoxicillin to treat later complications: High dose IV benzylpenicillin, ceftriaxone

Answer 32

a permanent end to menstruation which is confirmed after a woman has has no periods for 12 months usually occurs around the age of 51

Answer 33

the time around the menopause where the woman may be experiencing vasomotor symptoms and irregular periods this includes the time leading up to the last menstrual period and the 12 months afterwards typically in women older than 45 yrs

Answer 34

menopause before the age of 40 years which results from premature ovarian insufficiency

Answer 35

menopause is caused by a decline in the development of the ovarian follicles which results in reduced oestrogen production oestrogen has a negative feedback effect on the pituitary gland, suppressing the quantity of LH and FSH produced as the level of oestrogen falls in the perimenopausal period, there is an absence of negative feedback on the pituitary gland, and increasing levels of LH and FSH the failing follicular development means that ovulation does not occur, resulting in irregular menstrual cycles without oestrogen, the endometrium does not develop, leading to a lack of menstruation lower levels of oestrogen also cause the perimenopausal symptoms

Answer 36

hot flushes emotional lability or low mood premenstrual syndrome irregular periods joint pains heavier or lighter periods vaginal dryness and atrophy reduce libido

Answer 37

cardiovascular disease and stroke osteoporosis pelvic organ prolapse urinary incontinence

Answer 38

2 years after in women under 50 1 year after in women over 50

Answer 39

vasomotor symptoms are likely to resolve after 2-5 years without any treatment options: - no treatment - HRT (most effective in treating hot flushes/night sweats, mood swings and vaginal/bladder symptoms) - Tibolone (synthetic steroid hormone which acts as continuous combined HRT) - Clonidine - CBT - SSRI antidepressants - Testosterone to treat reduced libido - Vaginal oestrogen cream or tablets to treat dryness and atrophy - Vaginal moisturisers (Sylk, replens, YES)

Answer 40

a viral infection which is spread by respiratory droplets and usually resolves without treatment after around a week

Answer 41

initial period of flu-like symptoms followed by painful parotid swelling which is associated with: fever muscle aches lethargy reduced appetite headache dry mouth

Answer 42

pancreatitis orchitis meningitis or encephalitis sensorineural hearing loss

Answer 43

diagnosis can be confirmed using PCR saliva testing antibody testing of blood or saliva can also be used to confirm diagnosis NOTIFIABLE DISEASE self-limiting condition so management is supportive with rest, fluids and analgesia

Answer 44

an RNA virus which has 3 variants: A, B and C which affect humans Type A has different H and N subtypes and examples of the strains are H1N1 which caused the spanish flu pandemic

Answer 45

fever lethargy and fatigue anorexia muscle and joint aches headache dry cough sore throat coryzal symptoms

Answer 46

flu tends to have an abrupt onset, whereas common cold is more gradual fever is a typical feature of the flu but rare with a common cold people with flu are wiped out with muscle aches and lethargy which is uncommon with a cold

Answer 47

POC swab tests which detect viral antigens Viral nasal or throat swabs for PCR testing

Answer 48

usually self-resolving with supportive care measures (rest and fluid intake) for people at risk of complications: oral oseltamivir inhaled zanamivir

Answer 49

Otitis media, sinusitis and bronchitis Viral pneumonia Secondary bacteria pneumonia Worsening chronic health conditions, such as COPD and heart failure Febrile convulsions (young children) Encephalitis

Answer 50

a condition caused by infection with Epstein Barr virus (EBV) commonly known as the kissing disease or mono

Answer 51

fever sore throat fatigue lymphadenopathy tonsillar enlargement splenomegaly and in rare cases splenic rupture

Answer 52

Test for heterophile antibodies (multipurpose antibodies produced in response to but not specific to EBV antigens), almost 100% specific for IM but only 70-80% sensitive - Monospot test - introduces pt's blood to horse's RBCs - Paul-Bunnell test - like the monospot but uses sheep RBCs Can also test for specific EBV antibodies which target viral capsid antigen: - IgM antibody rises early and suggests acute infection - IgG persists after the condition and suggests immunity

Answer 53

usually self-limiting and lasts around 2-3 months fatigue can last for several months once infection is cleared avoid alcohol and sports (risk of splenic rupture)

Answer 54

splenic rupture glomerulonephritis haemolytic anaemia thrombocytopenia chronic fatigue

Answer 55

dysuria suprapubic pain or discomfort frequency urgency incontinence haematuria cloudy or foul-smelling urine confusion (in old/frail patients)

Answer 56

fever loin or back pain nausea or vomiting may also have: systemic illness loss of appetite haematuria renal angle tenderness on examination

Answer 57

Escherichia coli (gram-negative, anaerobic, rod-shaped bacteria) Klebsiella pneumoniae (gram-negative, anaerobic, rod-shaped) enterococcus pseudomonas aeruginosa staph saprophyticus

Answer 58

Nitrites - suggestive of bacteria in the urine as they break down nitrates to nitrites Leukocytes - significant rise can indicate infection or other cause of inflammation Nitrites are a better indication of infection than leukocuytes If both are present or nitrites are present the patient should be treated as a UTI but not if only leukocytes are present

Answer 59

- seriously ill or septicaemia - poor urine flow - abdominal or bladder mass - raised creatinine - failure to respond to suitable antibiotics within 48 hours - infection with atypical (non-E. coli) organisms.

Answer 60

nitrofurantoin trimethoprim

Answer 61

referral to hospital is required if there are features of sepsis cefalexin, co-amox, trimethoprim or ciprofloxacin antibiotics

Answer 62

nitrofurantoin (avoid in the 3rd trimester due to risk of neonatal haemolysis) amoxicillin (only after sensitivities are known) cefalexin (typical choice) trimethoprim should be avoided due to folate antagonistic properties

Answer 63

Urticaria is hives i.e. small itchy lumps that appear on the skin. They may be associated with angioedema (swelling of the deeper layers of the skin, caused by a build-up of fluid.) and flushing of the skin Urticaria are caused by the release of histamine and other pro-inflammatory chemicals by mast cells in the skin. Most common form is spontaneous urticaria which can be acute (<6 weeks) or chronic (>6 weeks)

Answer 64

distended superficial veins which measure >3mm in diameter usually affecting the legs

Answer 65

when the valves in veins become incompetent they can't carry out their function of preventing blood being drawn downwards by gravity and pooling in the veins the deep and superficial veins are connected by vessels called the perforating veins which allow blood to flow from the superficial veins to the deep veins when the valves are incompetent in these perforators, blood flows from the deep veins back into the superficial veins and overloads them this leads to dilatation and engorgement of the superficial veins, forming varicose veins

Answer 66

blood pools in the distal veins and pressure builds up causing the veins to leak small amounts of blood into the tissues nearby the haemoglobin in this leaked blood breaks down to haemosiderin which is deposited around the shins in the legs giving them a brown discolouration pooling of blood in the distal tissues results in inflammation and the skin becoming dry and inflamed --> venous eczema the skin and soft tissues become fibrotic and tight, causing the lower legs to become narrow and hard, referred to as lipdermatosclerosis

Answer 67

increasing age family history female pregnancy obesity prolonged standing deep vein thrombosis

Answer 68

heavy or dragging sensation in the legs aching itching burning oedema muscle cramps restless legs

Answer 69

tap test (apply pressure at the SFJ and tap the distal varicose vein --> thrill?) cough test (apply pressure to the SFJ while patient coughs --> thrill?) trendelenburg's test - lift affected leg to drain the veins then apply a tourniquet to thigh and get the patient to stand - the tourniquet should prevent the varicose veins from reappearing if it is placed distally to the incompetent valve, reassess at different levels to identify the location of the incompetent valves perthes test

Answer 70

weight loss staying physically active keeping the leg elevated when possible to help drainage compression stockings surgical options: endothermal ablation (catheter insertion and radiofrequency ablation) sclerotherapy (irritant foam injection to close the vein) stripping (veins are ligated and pulled out of the leg)

Answer 71

the vagus nerve receives a strong stimulus e.g. an emotional event, painful sensation or change in temperature and stimulates the parasympathetic nervous system parasympathetic activation counteracts the sympathetic nervous system which keeps the smooth muscle in blood vessels constricted as the blood vessels delivering blood to the brain relax, the blood pressure in the cerebral circulation drops, leading to hypoperfusion of the brain tissue this causes the patient to lose consciousness and 'faint'

Answer 72

wounds or breaks in the skin which occur due to the pooling of blood and waste products in the kin secondary to venous insufficiency

Answer 73

occur in the gaiter area (between the top of the foot and bottom of the calf muscle) are associated with chronic venous changes, e.g. hyperpigmentation, venous eczema and lipodermatosclerosis occur after a minor injury to the leg are larger and more superficial than arterial ulcers have irregular, gently sloping borders high chance of bleeding pain relieved by elevation and worse on lowering the leg

Answer 74

wound care (cleaning, debridement, dressing) compression therapy antibiotics for infection analgesia for pain

Answer 75

the narrowing of arteries supplying the limbs and peripheries, reducing blood flow to these areas

Answer 76

a symptom of ischaemia in a limb, occurring during exertion and relieved by rest typically a crampy, achy pain in the calf, thigh or buttock muscles associated with muscle fatigue when walking beyond a certain intensity

Answer 77

Pain Pallor Pulseless Paralysis Paraesthesia Perishing cold

Answer 78

occlusion in the distal aorta or proximal common iliac artery which presents with a clinical triad of: - thigh/buttock claudication - absent femoral pulses - male impotence

Answer 79

skin pallor cyanosis dependent rubor (deep red colour when the limb is lower than the rest of the body) muscle wasting hair loss ulcers poor wound healing gangrene

Answer 80

with patient lying supine, lift their legs to 45 degree angle and hold them for 1-2 mins, looking for pallor then gt the patient to sit up with their legs hanging over the edge of the bed in PAD the legs, rather than turning pink, will go initially blue and then dark red (rubor)

Answer 81

Ankle-brachial pressure index (ABPI) Duplex USS Angiography

Answer 82

the ratio of systolic blood pressure in the ankle compared with the systolic blood pressure in the arm 0.9-1.3 is normal 0.6 – 0.9 indicates mild peripheral arterial disease 0.3 – 0.6 indicates moderate to severe peripheral arterial disease Less than 0.3 indicates severe disease to critical ischaemic

Answer 83

lifestyle changes exercise training (programme of regularly walking to the point of near-maximal claudication and pain, then resting and repeating) atorvastatin, clopidogrel, naftidrofuryl oxalate (peripheral vasodilator) endovascular angioplasty and stenting, endarterectomy, bypass surgery

Answer 84

the end-stage of PAD, where there is an inadequate supply of blood to a limb to allow it to function normally at rest medical emergency requiring urgent referral to the vascular team urgent revascularisation is needed via: Endovascular angioplasty and stenting Endarterectomy Bypass surgery Amputation of the limb if it is not possible to restore the blood supply

Answer 85

refers to a rapid onset of ischaemia in a limb, typically due to a thrombus management options: Endovascular thrombolysis or thrombectomy surgical thrombectomy endarterectomy bypass surgery amputation of the limb if impossible to restore the blood supply

Answer 86

Non-modifiable - older age - family history - male Modifiable - smoking - alcohol consumption - poor diet - low exercise/sedentary lifestyle - obesity - poor sleep - stress

Answer 87

inflammation of the paranasal sinuses in the face (sinusitis) combined with inflammation of the nasal cavity (rhinitis) can be acute (<12 wks) or chronic (>12 wks)

Answer 88

infection allergies obstruction of drainage e.g. foreign body, trauma or polyps smoking

Answer 89

nasal congestion nasal discharge facial pain or headache facial pressure facial swelling over the affected areas loss of smell

Answer 90

Patients with systemic infection or sepsis require admission to hospital for emergency management. NICE recommend not offering antibiotics to patients with symptoms for up to 10 days. Most cases are caused by a viral infection and resolve within 2-3 weeks. NICE recommend for patients with symptoms that are not improving after 10 days, the options of: High dose steroid nasal spray for 14 days (e.g., mometasone 200 mcg twice daily) A delayed antibiotic prescription, used if worsening or not improving within 7 days (phenoxymethylpenicillin first-line)

Answer 91

eruptive widespread rashes originally there were 6 viral exanthema which have now been renamed: First disease: Measles Second disease: Scarlet Fever Third disease: Rubella (AKA German Measles) Fourth disease: Dukes’ Disease Fifth disease: Parvovirus B19 Sixth disease: Roseola Infantum

Answer 92

non-cancerous viral skin growths which affect the squamous epithelium and usually occur on the hands and feet but can also affect the genitals or face they are caused by the human papillomavirus

Answer 93

salicyclic acid, or cryotherapy

Answer 94

also known as ringworm/tinea infections, they are fungal infections caused by dermatophytes - a group of fungi which invade and grow in dead keratin they tend to grow outwards on skin, producing a ring-like pattern which gave them the name ringworm classified according to site: scalp - tinea capitis feet - tinea pedis nail - onychomycosis groin - tinea cruris body - tinea corporis

Answer 95

itchy rash which is erythematous, scaly and well-demarcated tinea capitis - hair loss in a demarcated region plus itching dryness and scalp erythema tinea pedis (athlete's foot) - white or red, flaky, cracked, itchy patches between the toes onychomycosis - thickened, discoloured and deformed nails

Answer 96

usually clinical supported by good response to antifungal meds antifungal creams e.g. clotrimazole and miconazole antifungal shampoo eg. ketoconazole antifungal oral meds e.g. fluconazole, griseofulvin and itraconazole

Answer 97

an inflammatory process of the skin that occurs in response to contact with exogenous substances and involves pruritic and erythematous patches

Answer 98

Allergic contact dermatitis - a type IV delayed hypersensitivity reaction. It occurs after sensitisation and subsequent re-exposure to an allergen. Irritant contact dermatitis - an inflammatory response that occurs after damage to the skin, usually by chemicals. This is not an allergy and can occur in any individual significantly exposed to an irritant. This may be acute or chronic/cumulative.

Answer 99

skin redness vesicles or papules over the affected area crusting and scaling of skin itching of an affected area fissures hyperpigmentation pain or burning sensation from an affected area

Answer 100

identify and avoid the irritant protect skin with protective equipment and creams more severe or chronic forms can benefit from topical corticosteroid cream

Answer 101

a virus causing cold sores and genital herpes which can become latent after initial infection in the associated sensory nerve ganglia 2 main strains, HSV-1 (most associated with cold sores) and HSV-2 (typically causes genital herpes) it is spread through direct contact with affected mucous membranes or viral shedding in mucous secretions

Answer 102

often contracted initially in childhood (before 5 years) and remains dormant in the trigeminal nerve ganglion and reactivates as cold sores, particularly in times of stress genital herpes caused by HSV-1 is usually contracted through oro-genital sex, where the virus spreads from a person with an oral infection to the person that develops a genital infection `

Answer 103

can be asymptomatic ulcers or blistering lesions neuropathic type pain flu-like symptoms dysuria inguinal lymphadenopathy

Answer 104

aciclovir + supportive measures e.g. analgesia, fluids, loose clothing

Answer 105

inflammation of the hair follicles of the skin which can occur for a variety of reasons can be acute or chronic

Answer 106

sycosis barbae - chronic folliculitis in the beard area of the face where the skin is painful and crusted with burning and itching on shaving, numerous pustules develop in the hair follicles hot tub folliculitis - caused by pseudomonas aeruginosa gram-negative folliculitis - can occur after acne has been treated with long-term antibiotics pseudo-folliculitis - razor bumps caused by inflammation from shaving and ingrown hairs

Answer 107

diabetes (mc) hypertension

Answer 108

hypertension fluid overload uraemic sallow: yellow or pale brown colour of skin uraemic frost: urea crystals can deposit in the skin pallor evidence of underlying cause

Answer 109

pruritis loss of appetite nausea oedema muscle cramps

Answer 110

- estimated GFR - can be checked with U+E bloods, 2 tests required 3 months apart - proteinuria, checked using a urine albumin:creatinine ration - haematuria - checked using a urine dipstick - renal USS

Answer 111

G1: eGFR>90 G2: eGFR: 60-89 G3a: eGFR: 45-59 G3b: eGFR: 30-44 G4: eGFR: 15-29 G5: eGFR<15 known as end-stage renal failure

Answer 112

Based off the albumin:creatinine ratio: A1: <3 A2: 3-30 A3: >30

Answer 113

Slowing the progression of the disease Optimise diabetic control Optimise hypertensive control Treat glomerulonephritis Reducing the risk of complications Exercise, maintain a healthy weight and stop smoking Special dietary advice about phosphate, sodium, potassium and water intake Offer atorvastatin 20mg for primary prevention of cardiovascular disease

Answer 114

Renal bone disease Anaemia Cardiovascular- hypertension, hypercholesterolemia , heart failure due to fluid overload and anaemia

Answer 115

Any tachycardia which arises from the atrium or AV junction Atrial fibrillation Atrial flutter AV nodal re-entry tachycardia (AVNRT) (MC) AV reciprocating tachycardia (AVRT)

Answer 116

It is irregular ORGANSIED atrial firing, around 250 - 300BPM (conduction pathway typically from around opening of tricuspid valve) Often associated with AF Atrial HR = 300 BPM Ventricular rate = 150/100/75 BPM (due to AV node conducting every 2nd/3rd/4th beat “flutter beat” , so see at least 2 P waves for every QRS complex - but QRS complexes will be regular ECG - see flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1

Answer 117

- Idiopathic (30%) - Coronary heart disease - Thyrotoxicosis - COPD - Pericarditis - Acute excess alcohol intoxication

Answer 118

It is caused by the electrical signal re-entering/ re-circulating back into the atrium, due to an extra electrical pathway It goes round and round, without interruption, so Atrial contraction is at 300bpm The signal makes its way into the ventricles every second lap due to the long refractory period to the AV node, causing 150 bpm ventricular contraction. Can be sudden and brief in episodes, or on going

Answer 119

ECG: regular sawtooth-like atrial flutter waves (F waves) with P-wave after P-wave

Answer 120

- Treat the reversible underlying condition (e.g. hypertension or thyrotoxicosis) - Rate/rhythm control with beta blockers or cardioversion (use of electric shock to put heart back into rhythm) - Radiofrequency ablation of the re-entrant rhythm (Uses heat generated by radio waves to destroy tissue) - Anticoagulation based on CHA2DS2VASc score

Answer 121

Most common type of SVT - AV nodal re-entry tachycardia (AVNRT) Twice as common in women than men The electrical conduction of the atrium re enters back through the AV node, Due to the presence of a “ring” of conducting pathways in the AV node, of which the “limbs” have different conduction times and refractory periods This allows a re-entry circuit and an impulse to produce a circus movement tachycardia

Answer 122

Presentation Regular rapid palpitations – abrupt onset and sudden termination Neck pulsation – JV pulsations Polyuria – due to release of ANP in response to increased atrial pressure during tachycardia Chest pain and SOB Symptoms Palpitations Dizziness Dyspnoea Central chest pain Syncope

Answer 123

The eletrical signals goes back in the atria via an accessory pathway. The best known type of this is Wolff-Parkinson-White Syndrome, there is an accessory pathway (bundle of kent) between atria and ventricles

Answer 124

P waves are either not visible, or are seen immediately before or after the QRS complex (short PR interval) QRS complex is a normal shape because the ventricles are activated in the normal way (down bundle of His)

Answer 125

The early depolarisation of part of the ventricle leads: - shortened PR interval - slurred start to the QRS (delta wave) - QRS is narrow Patients are also prone to atrial and occasionally ventricular fibrillation

Answer 126

Breath-holding Carotid massage - massage the carotid on one side gently with two fingers. Valsalva manoeuvre - Pt blows hard into resistance

Answer 127

If manoeuvres unsuccessful, IV adenosine Causes a complete heart block for a fraction of a second Effective at terminating AVNRT and AVRT

Answer 128

Atrial fibrillation is where the contraction of the atria is uncoordinated, rapid and irregular. This is due to disorganised electrical activity that overrides the normal, organised activity from the sinoatrial node. This disorganised electrical activity in the atria also leads to irregular conduction of electrical impulses to the ventricles.

Answer 129

- Irregularly irregular ventricular contractions - Tachycardia - Heart failure due to poor filling of the ventricles during diastole - Risk of stroke

Answer 130

PE/COPD IHD, Heart failure Rheumatic heart disease, Valve abnormalities Alcohol intake Thyroid issues - Hyperthyroidism Sleep Apnoea Electrolyte disturbances - Hyper/Hypo Kalaemia, Hypo magnesia PIRATE

Answer 131

- Irregular irregular pulse - Hypotension: red flag; suggest haemodynamic instability - Evidence of heart failure: red flag; such as pulmonary oedema - Palpitations - Dyspnoea - Chest pain: red flag - Syncope: red flag Can also be asymptomatic!

Answer 132

ECG Tests to look for causes of AF: Serum Electrolytes Thyroid Function Tests Cardiac biomarker - eg Troponin Chest x-ray look for heart failure Transthorasic Echo - look for functional heart disease

Answer 133

Emergency electrical synchronised DC cardioversion - Shock: hypotension (systolic blood pressure <90 mm Hg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness - Syncope - Myocardial ischaemia - Heart failure:

Answer 134

Start by controlling either rate of rhythm Rate control: - First line: beta-blocker (e.g. bisoprolol) or a rate-limiting calcium-channel blocker (e.g. verapamil) - Digoxin: may be considered first-line in patients with AF and heart failure OF HAEMODYNAICALLY STABLE, DO RATE CONTROL BEFORE RHYTHM CONTROL

Answer 135

Left atrial ablation - small burns/freezes to scar heart tissue to break up electrical signals that cause irregular heartbeats Electrical DC cardioversion Anticoagulants - DOACS - Apixaban to reduce risk of strokes, or Warafarin if DOACs are CI, (aka in Metal heart valves)

Answer 136

CHADS2VASc score used to calculate stroke risk in AF 0 = no anticoagulation 1 = consider oral anticoagulation or aspirin 2 = Anticoagulants - DOACS - Apixaban to reduce risk of strokes Congestive Heart failure = 1 Hypertension = 1 Age > 75 = 2 Age 65-74 = 1 Diabetes Mellitus = 1 Stroke or TIA = 2 Vascular disease = 1 Female sex = 1

Answer 137

Irregularly irregular F (Fibrillatory) waves No clear P waves Rapid QRS complex absence of [isoelectric] baseline variable ventricular rate

Answer 138

Rhythm control: - either pharmacological or electrical cardioversion - Pharmacological: - anti-arrhythmics - Flecainide or amiodarone: if no evidence of structural/ischaemic heart disease - Amiodarone: if structural/ischaemic heart disease is present - Electrical cardioversion: rapidly shock the heart back into sinus rhythm IF HAEMODYNAICALLY UNSTABLE, DO RHYTHM CONTROL BEFORE RATE CONTROL (aka Cardioveresion)

Answer 139

“ A delta wave is slurring of the upstroke of the QRS complex. Occurs because the action potential from the SA node is able to conduct to the ventricles very quickly through the accessory pathway => QRS occurs immediately after the P wave, making the delta wave.

Answer 140

Abnormal or excessive fat accumulation which poses a risk to health. BMI > 30.

Answer 141

- Type II Diabetes - Hypertension - Coronary artery disease - Stroke - Osteoarthritis - Gout - Obstructive sleep apnoea - Carcinoma (breast, endometrium, colon, prostate)

Answer 142

- Hypothyroidism - Hypercortisolism - Corticosteroid therapy - Diet high in sugar and fats - High alcohol intake

Answer 143

A hormone released by adipocytes which switches off appetite and stimulates the immune system. Leptin levels in the blood increase after eating and decrease after fasting.

Answer 144

A hormone released by endocrine cells of the stomach which stimulates growth hormone release and appetite. Blood levels are high when fasting and fall after eating.

Answer 145

- suppresses hepatic glucose output (decreases glycogenolysis and gluconeogenesis) - increases glucose uptake into muscle and fat - suppresses lipolysis and muscle breakdown

Answer 146

- increases hepatic glucose output (increases glycogenolysis and gluconeogenesis) - reduce peripheral glucose uptake - stimulate peripheral release of gluconeogenic precursors (glycerol, AAs) - increases lipolysis and muscle breakdown

Answer 147

An insulin deficiency disease characterised by loss of beta cells due to autoimmune destruction.

Answer 148

- HLA DR3 and DR4 and islet cell antibodies - Other autoimmune diseases - Environmental infections (e.g. viruses)

Answer 149

A disorder of carbohydrate metabolism characterised by hyperglycaemia.

Answer 150

- Acute hyperglycaemia (leads to diabetic ketoacidosis and hyperosmolar hyperglycaemic state if untreated) - Chronic hyperglycaemia leading to tissue complications - Side effects of treatment - hypoglycaemia

Answer 151

GTT = Glucose tolerance test GTT (75g glucose) fasting > 7mmol/l or 2hr value >11mmol/l (repeated on 2 occasions)

Answer 152

HbA1c = glycated haemoglobin, a form of haemoglobin used to measure the average haemoglobin-associated glucose in blood over the last three months, HbA1c >48mmol/mol (6.5%) is seen in patients with diabetes mellitus

Answer 153

Beta cells express HLA (human leukocyte antigen) which activates a chronic cell mediated immune process leading to chronic 'insulitis' and consequently insulin insufficiency

Answer 154

Young lean pt - polydipsia - nocturia/polyuria - glycosuria - polyphagia (excessive eating) + weight loss - excessive tiredness

Answer 155

Basal Bolus Insulin - basal = longer acting to maintain stable insulin levels throughout day - bolus = faster acting, 30 mins preprandial to give "insulin spike"

Answer 156

genetic link, smoking, obesity, sedentary lifestyle

Answer 157

Peripheral insulin resistance (e.g. malfunctional insulin intracellular activation pathway) leads to decrease GLUT4 receptor expression + minor destruction of pancreatic islets. This results in hyperglycaemia with increased insulin demand from depleted beta cell population.

Answer 158

Obese, hypertensive, older patient - persistant hyperglycaemia - polydypsia - nocturia + polyuria - glycosuria - blurred vision - recurrent infections - tiredness - acanthosis nigiricans (dark pigmentation of skin folds) suggesting insulin resistance

Answer 159

IGT = Impaired Glucose Tolerance IFG = Impaired Fasting Glycaemia Conditions of slightly elevated blood glucose but not high enough to be classed as diabetic so are called prediabetic states

Answer 160

- Lifestyle changes (weight loss, exercise, diet changes) - medications to control BP, blood glucose + lipids - Metformin (1st line) - DPP-IV inhibitors (vildagliptin, sitagliptin) - GLP analogues (exenatide, liraglutide) - SGLT-2 inhibitors (empagliflozin, canagliflozin) - Sulphonylureas (gliclazide, glibenclamide) - Thiazolidinediones (pioglitazone)

Answer 161

- Stimulate insulin release by binding to beta-cell receptors - improve glycaemic control at the expense of significant weight gain *risk of hypoglycaemia

Answer 162

- Bind to the nuclear receptor PPARy and activate genes concerned with glucose uptake and utilisation and lipid metabolism - improve insulin sensitivity - need insulin for therapeutic effect

Answer 163

improves action of insulin in reducing blood glucose

Answer 164

They extend the duration of GLP-1 which is a gut hormone that stimulates insulin release and reduces appetite. GLP-1 analogues extend the duration of GLP-1 action and so lower blood glucose and help to reduce weight and cardiovascular disease.

Answer 165

DPP-IV is an enzyme which destroys incretin, a hormone which helps the body reduce blood glucose. DPP-IV inhibitors stop the destruction of incretin and so help lower blood glucose however the effect is not highly significant and has no effect on CVD or weight.

Answer 166

They inhibit the sodium glucose transporters in the renal proximal tubules, blocking the reabsorption of glucose and so increasing glucose excretion and lowering blood glucose levels.

Answer 167

Abnormally low thyroid hormone levels

Answer 168

Absence/dysfunction of thyroid gland

Answer 169

Hashimoto's thyroiditis

Answer 170

Secondary - pituitary disfunction Tertiary - hypothalamic dysfunction

Answer 171

- Hashimoto's thyroiditis - ^(131)I therapy - Thyroidectomy - Postpartum thyroiditis - Thyroiditis - Drugs - Iodine deficiency - Thyroid hormone resistance

Answer 172

- Iodine (inorganic or organic) - Iodide - Iodinated contrast agents - Amiodarone - Lithium - Thionamides - Interferon-a

Answer 173

- Thyroid agenesis - Thyroid ectopia - Thyroid dishormonogenesis - Resistance to thyroid hormone - Isolated TSH deficiency

Answer 174

- Fatigue - Weight gain - cold intolerance - Constipation - Menstrual disturbance - muscle cramps - Slow cerebration (thinking) - Dry, rough skin - Periorbital oedema - Carotenaemia - Oedema

Answer 175

Elevated TSH and usually low free T4 and T3

Answer 176

TSH inappropriately low for reduced free T4/T3 levels

Answer 177

Synthetic Levothyroxine (T4) - in primary dose is titrated until TSH normalises - in secondary T4 is monitored as TSH will remain low

Answer 178

1 - Clinic blood pressure from 140/90 to 159/99 mmHg or average HBPM from 135/85 to 149/95 mmHg 2 - Clinic BP ≥160/100 but <180/120 mmHg and HBPM average ≥150/95 3 - Clinic systolic BP ≥180 mmHg or clinic diastolic BP ≥120 mmHg

Answer 179

bacterial infection fungal infection (aspergillus or candida) eczema seborrhoeic dermatitis contact dermatitis

Answer 180

pseudomonas aeruginosa staphylococcus aureus

Answer 181

ear pain discharge itchiness conductive hearing loss

Answer 182

erythema and swelling of the ear canal tenderness of the ear canal pus or discharge in the ear canal lymphadenopathy in the neck or around the ear

Answer 183

mild - acetic acid (can also be used prophylactically before and after swimming) moderate - topical antibiotic and steroid e.g. neomycin, dexamethasone and acetic acid

Answer 184

severe and potentially life-threatening form of otitis externa where the infection spreads to the bones surrounding the ear and progresses to osteomyelitis of the temporal bone

Answer 185

a chronic autoimmune condition which causes recurrent symptoms of psoriatic skin lesions with a large variety in severity of presentation

Answer 186

dry, flaky, scaly and faintly erythematous skin lesions which appear in raised and rough plaques commonly occur over the extensor surfaces of the elbows and knees and on the scalp

Answer 187

plaque psoriasis - MC form in adults, features thickened erythematous plaques with silver scales guttate psoriasis - commonly occurs in children, small raised papules across the trunk and limbs which can turn into plaques, often triggered by a strep throat pustular psoriasis - rare, severe form of psoriasis where pustules form under areas of erythematous skin, pus is non-infectious, MEDICAL EMERGENCY erythrodermic psoriasis - rare severe form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin, MEDICAL EMERGENCY

Answer 188

auspitz sign - small points of bleeding when plaques are scraped off koebner phenomenon - development of psoriatic lesions to areas of skin affected by trauma residual pigmentation of the skin after the lesions resolve

Answer 189

Topical steroids Topical vitamin D analogues (calcipotriol) Topical dithranol Topical calcineurin inhibitors (tacrolimus) are usually only used in adults Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis

Answer 190

inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix

Answer 191

inflammation of the fallopian tubes

Answer 192

PID is usually associated an STI neisseria gonorrhoea chlamydia trachomatis mycoplasma genitalium less-commonly: gardenerella vaginalis haemophilus influenzae E. coli

Answer 193

Not using barrier contraception Multiple sexual partners Younger age Existing sexually transmitted infections Previous pelvic inflammatory disease Intrauterine device (e.g. copper coil)

Answer 194

Pelvic or lower abdominal pain Abnormal vaginal discharge Abnormal bleeding (intermenstrual or postcoital) Pain during sex (dyspareunia) Fever Dysuria

Answer 195

Pelvic tenderness Cervical motion tenderness (cervical excitation) Inflamed cervix (cervicitis) Purulent discharge

Answer 196

antibiotics depending on local and national guidelines ceftriaxone (gonorrhoea) doxycycline (chlamydia and mycoplasma) metronidazole (gardnerella)

Answer 197

a complication of PID caused by inflammation and infection of the liver capsule (Glisson's capsule) leading to adhesions between the liver and peritoneum

Answer 198

Blood pressure ≥140/90mmHg

Answer 199

DRIED ICE - Disturbance of autoregulation - Renal sodium retention - Insulin resistance/hyperinsulinaemia - Excess sodium intake - Dysregulation of RAAS with elevated plasma renin activity - Increased sympathetic drive - Cell membrane transporter changes - Endothelial dysfunction

Answer 200

- NSAIDs - SNRIs (serotonin and norepinephrine reuptake inhibitors) - Corticosteroids - Oral contraceptives (oestrogen containing) - Stimulants - Anti-anxiety drugs - Anti-TNFs

Answer 201

- age >65yrs - moderate/high alcohol intake - sedentary lifestyle - FH of hypertension of CAD - obesity - metabolic syndrome - diabetes mellitus - black ancestry - hyperuricemia - obstructive sleep apnoea ** Smoking is NOT a risk factor

Answer 202

BP = CO x TPR

Answer 203

- Preload - Contractility - Vessel hypertrophy - Peripheral constriction

Answer 204

Most often symptomless. - headache - visual changes - dyspnoea - chest pain - sensory of motor deficit

Answer 205

Renal disease (MC cause) Obesity Pregnancy or pre-eclampsia Endocrine (T2DM, Conn's, Cushing's diseases) Drugs (alcohol, steroids, NSAIDs, oestrogen)

Answer 206

Result of too much gluconeogenesis so that glucose is converted to ketone bodies which are acidic. Caused by poorly managed T1 DM or from infection/illness

Answer 207

T1DM symptoms +... - Kussmaul breathing (deep laboured breaths to compensate for increased CO2) - Pear drop breath (breath smells fruity due to ketones) - Reduced tissue turgor, hypotension + tachcardia

Answer 208

Ketones >3mmol/l Random plasma glucoe >11.1mmol/l pH<7.3 or <15mmol HCO3-

Answer 209

- in an emergency ABCDE - 1st line always fluid (dehydration is most likely cause of death) - then insulin (+ glucose and postassium)

Answer 210

FPG >/= 6mmol/l 2hr OGTT 7.8-11mmol/l

Answer 211

FPG 6.1-6.9mmol/L 2hr OGTT <7.8mmol/l

Answer 212

- cerebral oedema - adult respiratory distress syndrome - thromboembolism - aspiration pneumonia (drowsy/comatose patients) - death

Answer 213

An autoimmune disease which causes the immune system to attack the thyroid gland resulting in permanent hypothyroidism

Answer 214

- goitre - tiredness - weight gain - muscle weakness

Answer 215

insulin decreases potassium levels in the blood by redistributing K+ into the cells via increased Na/K pump activity causing low serum K+ levels --> hypokalaemia low levels of K+ can cause arrhythmia, weakness (as the heart and muscles can struggle to contract)

Answer 216

inflammation of the glans penis sometimes extends to the underside of the foreskin which is known as balanoposthitis

Answer 217

gentle saline washes and ensuring washing under the foreskin 1% hydrocortisone if caused by candidiasis, treat with topical clotrimazole for 2 weeks oral flucloxacillin for bacterial balanitis circumcision can help in cases of lichen sclerosus associated balanitis lichen sclerosus and plasma cell balanitis of Zoon are managed with high potency topical steroids like clobetasol dermatitis and circinate balanitis are managed with mild potency topical corticosteroids e.g. hydrocortisone

Answer 218

candidiasis - white non-urethral discharge dermatitis (contact or allergic) - clear non-urethral discharge dermatitis (eczema or psoriasis) bacterial (most commonly staph spp.) - yellow non-urethral discharge lichen planus - Wickam's striae and violaceous papules lichen sclerosus (rare) plasma cell balanitis of Zoon (rare) circinate balanitis (can be associated with reactive arthritis)

Answer 219

a tropical STD caused by haemophilus ducreyi which presents with painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement the ulcers typically have a sharply defined, ragged, undermined border

Answer 220

macrolide antibiotics - azithromycin, ceftriaxone or erythromycin aminoglycosides e.g. gentamycin second line

Answer 221

STI caused by chlamydia trachomatis serotypes L1, L2 and L3

Answer 222

men who have sex with men HIV historically seen more in the tropics

Answer 223

1: small painless pustule which later forms an ulcer 2: painful inguinal lymphadenopathy which can form fistulating buboes 3: proctocolitis (inflammation of the rectum and colon)

Answer 224

doxycycline

Answer 225

also known as condylomata accuminata small, slightly pigmented fleshy protuberances which may bleed or itch caused by the many varieties of the human papillomavirus HOV, especially types 6 & 11

Answer 226

1st line: topical podophyllum or cryotherapy 2nd line: imiquimod cream often resistant to treatment

Answer 227

- Sexual - Vertical (in the womb, breast-feeding) - Blood or bodily fluids

Answer 228

- Clinician indicated diagnostic testing - Routine screening in high prevalence locations - Antenatal screening - Screening in high risk groups - Patient initiated requests for testing

Answer 229

With any recurrent, severe or unexplained medical condition HIV should be considered. Common examples: - multi-dermatomal shingles - unexplained lymphadenopathy - unexplained weight loss or diarrhoea, night sweats, pyrexia - oral/oesophageal candidasis or hairy leukoplakia - flu-like illness, rash, meningitis - unexplained blood dyscrasias (disorders)

Answer 230

500-1200 cells/mm3

Answer 231

Human Immunodeficiency virus, a lentivirus which uses reverse transcriptase to replicate. (retrovirus) Decimates the CD4 cell population over time causing immunodeficiency and viral load increases over time.

Answer 232

<50 copies/mL

Answer 233

Kaposi's sarcoma (disease in which cancer cells are found throughout the GI tract and presents with purple patches on the skin) Pneumocystis jivorecii pneumonia (PCP) Cytomegalovirus infection Candidiasis (oesophageal or bronchial) Lymphomas Tuberculosis

Answer 234

antiretroviral therapy medications e.g. protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, entry inhibitors usual starting regime = 2 NRTIs (e.g. tenofovir plus emtricitabine) plus a third agent e.g. bictegravir aim of treatment is to achieve a normal CD4 count and undetectable viral load

Answer 235

prophylactic co-trimoxazole (for PCP) close monitoring for cardiovascular risk factors due to increased risk yearly cervical smears due to increased risk of HPV and cervical cancer vaccinations condom use to prevent spread

Answer 236

under 50 copies --> normal vaginal birth over 50 copies --> consider pre-labour c-section over 400 copies --> pre-labour c-section recommended unknown viral load or >1000 copies --> IV zidovudine infusion during labour

Answer 237

PEP is a combination of ART therapy: emtricitabine/tenofovir and raltegravir for 28 days PrEP: emtricitabine/tenofovir

Answer 238

pediculosis pubis is caused by Phthirus pubis, an obligate, blood-sucking ectoparasite found on pubic and perianal hairs and transmitted through sexual contact or occasionally contact with infected towels, clothing or bedding

Answer 239

genital itching, usually worse at night small blue macules or red papules may be seen at feeding sites rust-coloured flecks of the lice's faecal material may be seen on skin and underwear

Answer 240

insecticides such as permethrin or malathion decontamination of clothing and bedding and avoidance of close bodily contact until treatment is completed

Answer 241

the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance it is a symptom and not a disease

Answer 242

gradual symptoms onset lack of tumescence (swelling) normal libido

Answer 243

sudden symptoms onset decreased libido good quality spontaneous or self-stimulated erections major life events problems or changes in a relationship previous psychological problems history of premature ejaculation

Answer 244

increasing age cardiovascular disease risk factors e.g. obesity, diabetes mellitus, dyslipidaemia, metabolic syndrome, hypertension, smoking alcohol use drugs - SSRIs, beta-blockers

Answer 245

free testosterone (measured in the morning between 9-11am) - low or borderline it should be repeated with FSH, LH and prolactin and if any are abnormal referral to endo is indicated

Answer 246

Treat the cause Lifestyle changes - stop smoking, lose weight, reduce alcohol consumption

Answer 247

phosphodiesterase inhibitors e.g. sildenafil improve relaxation of smooth muscle vacuum erection devices prostaglandins are used as second line drug therapy penile prosthesis

Answer 248

selective serotonin reuptake inhibitor (SSRI) Sertraline, Paroxetine and fluoxetine topical anesthetic to reduce penile sensitivity, eg. lidocaine-prilocaine cream (5%) applied 20-30 minutes before sexual activity behavioural techniques - . ‘Stop-start’ techniques, thicker condoms taking breaks during sex Couples therapy advice

Answer 249

infection - especially, trichomonas, vaginal candidiasis vaginal atrophy - postmenopausal shrinkage; infrequent intercourse psychological - vaginismus, fear, ignorance, previous painful intercourse poor sexual stimulation pelvic inflammatory disease endometriosis

Answer 250

Management typically focuses on treating underlying causes where appropriate A penetration desensitisation programme is useful in dyspareunia and vaginismus Fenton’s procedure - increase the dimensions of the introitus intramuscular injection of botulinum toxin Psychological therapy may be useful in some patients. if psychosexual problems persist refer her to a psychosexual therapist

Answer 251

semen passes into the bladder rather than the urethra - complication of TURP or bladder neck incision may also occur as a result of spinal injury or DM the patient can usually achieve an orgasm but there is no ejaculate or the volume of the ejaculate is decreased urine may be cloudy after having sex

Answer 252

vaginismus is usually apparent at vaginal examination - severe spasm of the vaginal muscles and adduction of the thighs Common causes: - fear of intercourse - local pain - past history of rape, abuse or severe emotional trauma - defence mechanism against growing up

Answer 253

progressive relaxation to manage anxiety densensitisation - vaginal trainers and encouraging the woman to examine herself physiotherapy hypnotherapy topical lidocaine applied within the vagina antidepressants

Answer 254

1 - Clinic blood pressure from 140/90 to 159/99 mmHg or average HBPM from 135/85 to 149/95 mmHg 2 - Clinic BP ≥160/100 but <180/120 mmHg and HBPM average ≥150/95 3 - Clinic systolic BP ≥180 mmHg or clinic diastolic BP ≥120 mmHg

Answer 255

Health behaviour = behaviour aimed at preventing disease e.g. eating healthily Illness behaviour = behaviour aimed at seeking remedy e.g. going to the doctor Sick role behaviour = any activity aimed at getting well e.g. taking prescribed medications, resting

Answer 256

environment (physical, social and economic) genes lifestyle healthcare access

Answer 257

equity = recognises each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome equality = each individual or group of people is given the same resources or opportunities regardless of circumstance

Answer 258

Flat government subsidy for travel to work of £5 per day Some people's travel costs more than others e.g. £7 - £5 = £2 to pay £14 - £5 = £9 to pay

Answer 259

Horizontal equity is equal treatment for equal need e.g. all individuals with pneumonia (assuming all other things equal) should be treated equally Vertical equity is unequal treatment for unequal need e.g. individuals with common cold vs pneumonia need unequal treatment

Answer 260

Health improvement = societal interventions aimed at preventing disease, promoting health and reducing inequalities Health protection = measures to control infectious disease risks and environmental hazards Health care = organisation and delivery of safe, high quality services for prevention, treatment, and care

Answer 261

Ecological (population) level e.g. clean air act Community level e.g. creating playground for local community Individual level e.g. childhood immunisations

Answer 262

Primordial prevention is action to prevent risk developing in healthy people who are currently not at risk e.g. laws/health promotion put in place to discourage and prevent substance misuse Quaternary prevention is action to prevent over treatment of patients with a condition or disease e.g. empowering individuals to seek own outcome and avoid over-treatment and medication dependence

Answer 263

Secondary is focussed on early detection of illness and either curing or preventing progression/ long-term effects e.g. mammograms to detect breast cancer early Tertiary is centred on preventing worse outcomes or complications of a condition or disease e.g. reducing or controlling the symptoms and morbidity of established cancer or the morbidity caused by cancer therapy.

Answer 264

Preventing development of a health problem when risk exists e.g. targeted education, health promotion against recreational substance misuse

Answer 265

Needs assessment Planning Implementation Evaluation

Answer 266

Self-actualisation (achieving one's full potential, including creative activities) Esteem needs (prestige and feeling of accomplishment) Belongingness and love needs (intimate relationships, friends) Safety needs (security, safety) Physiological needs (food, water, warmth, rest)

Answer 267

Felt (individual perceptions of variation from normal health) Expressed (individual seeks help to overcome variation in normal health (demand)) Normative (professional defines intervention appropriate for the expressed need) Comparative (comparison between severity, range of interventions and cost)

Answer 268

epidemiological corporate comparative

Answer 269

Dementia and Alzheimer's disease Ischaemic heart disease Chronic lower respiratory diseases Cerebrovascular diseases Malignant neoplasm of trachea, bronchus and lung

Answer 270

1. Lack of personal experience with the problem 2. Belief that the problem is preventable by personal action 3. Belief that if the problem has not happened by now, it's not likely to 4. Belief that problem is infrequent

Answer 271

individuals will change if they: - Believe they are susceptible to the condition in question (e.g. heart disease) - Believe that it has serious consequences - Believe that taking action reduces susceptibility - Believe that the benefits of taking action outweigh the costs

Answer 272

- A person's ATTITUDE to the behaviour e.g. I don't think smoking is a good thing - The perceived social pressure to undertake the behaviour, or SUBJECTIVE NORM e.g. important people in my life want me to give up smoking - A persons appraisal of their ability to perform the behaviour, or their PERCEIVED BEHAVIOURAL CONTROL e.g. I believe I have the ability to give up smoking

Answer 273

Lack of a temporal element and direction or causality Doesn't take into account emotions such as fear, threat, positive affect Doesn't explain how attitudes, intentions and perceived behavioural control interact

Answer 274

Pre-contemplation (not ready yet) Contemplation (thinking about it) Preparation (getting ready) Action (doing it) Maintenance (sticking with it) [Relapse]

Answer 275

not all people move through every stage or in that order change might operate on a continuum rather than in discrete stages doesn't take into account values, habits, emotions, culture, social and economic factors people often change their behaviour in the absence of planning/intentions can change over a very short time period

Answer 276

a counselling approach for initiating behaviour change by resolving ambivalence clinical impact shown in problem drinkers

Answer 277

"nudge' the environment to make the best option the easiest e.g. opt out schemes such as pensions, fruit next to checkouts weak evidence to support efficacy of nudging in improving population health

Answer 278

deficiencies , excess or imbalances in a person's intake of energy and/or nutrients. Includes undernutrition and weight excess, obesity and diet-related non-communicable disease like heart disease, stroke, diabetes,

Answer 279

Cancer Cystic fibrosis Coeliac disease Inflammatory bowel diseases Types 1 and 2 Diabetes Mellitus Faltering growth Eating disorders Overweight, obesity Management of sarcopenic obesity in elderly patients

Answer 280

Availability Access Utilisation Stability

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