GP Flashcards
(236 cards)
1
Q
What is gender identity
A
A sense of one’s own gender. Typically aligned with the sex assigned to them at birth.
2
Q
What is transgender
A
A wide range of identities: transsexual, cross-gender, people who identify as a third gender and people with atypical gender appearances. A trans woman identifies as a woman but was born classified as a man and vice versa.
Some transgender people take hormones to align their body with their gender identity.
3
Q
What is cisgender
A
Someone who’s gender identity is aligned with their sex at birth (no changes).
4
Q
Define ‘intersex’
A
People born with physical or biological characteristics that do not fit the typical definition of male or female.
(Includes sexual anatomy, reproductive organs, hormonal and chromosomal patterns).
5
Q
What is sexual orientation
A
The person’s physical, romantic and/or emotional attraction towards another person.
Heterosexuals are attracted to the opposite sex, Homosexuals are attracted to the same sex, Bisexual’s are attracted to people of both sexes.
6
Q
What are the 4 GMC core duties of a doctor
A
Knowledge skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining trust
7
Q
Duties of a doctor: what comes under ‘knowledge skills and performance’?
A
Provide good standard of practice and care
Keep knowledge up to date
Recognise and work within the limits of your competence
8
Q
Duties of a doctor: what comes under ‘safety and quality’?
A
Take prompt action if patient safety, dignity or comfort is compromised
Protect and promote health in patients and the public
9
Q
Duties of a doctor: what comes under ‘communication, partnership and teamwork’?
A
Treat patients as individuals and respect their dignity, and treat them politely and considerately.
Respect their confidentiality
Work in partnership with patients
Listen to and respond to their concerns
Give them the information they want in a way they can understand
Support patients in caring for themselves
Work with colleagues in the best interests of patients
10
Q
Duties of a doctor: what comes under ‘maintaining trust’?
A
Be honest and open and act with integrity
Never discriminate
Never abuse patient’s trust in you or the public’s trust in the profession
You must always be able to justify your decisions and actions
11
Q
What is primary care?
A
Managing illness and clinical relationships over time.
Role includes: Preventing illness, promoting health, managing clinical uncertainty.
Involves shared decision making with patients.
12
Q
What are the 5 levels to Maslow’s hierarchy?
A
Physiological - breathing, food, water, sex, sleep
Safety - security of body, employment, family, health, morality
Love/belonging - friendship, family, sexual intimacy
Esteem - self-confidence, achievement, respect of and by others
Self-actualisation - creativity, spontaneity, problem solving, acceptance of facts, lack of prejudice
13
Q
What is it when the expression of a genome depends on the environment?
A
Epigenetics
- lived experience affects human biology and contribute to health and disease.
14
Q
What is allostasis?
A
stability through change
- our physiological systems are adapted to react rapidly to environmental stressors.
15
Q
What is allostatic load?
A
Long-term overtaxation of our physiological systems leading to impaired health
- The price we pay for allostasis
16
Q
Give an example of allostasis and allostatic load on an organ system:
A
Cardiovascular System
Allostasis: works to maintain our erect posture, and enable physical exertion
Allostatic load:
Over-activation leads to hypertension, stroke MI
Metabolic Systems
Allostasis: Activating and maintaining energy reserves, including energy supply to the brain
Allostatic Load: obesity, diabetes, atherosclerosis
Immune System
Allostasis: Response to pathogens,
Tumour surveillance
Allostatic load: Inflammatory and auto-immune disorders
Central Nervous System
Allostasis: Learning, memory, neuroendocrine and autonomic regulation
Allostatic Load: Neuronal atrophy, death of nerve cells, impairment of memory and executive function
17
Q
What does salutogenesis mean?
A
Favourable physiological changes which promote health and healing
18
Q
What are the dangers of overprescribing antibiotics?
A
- unnecessary side effects
- medicalise self living conditions
- antibiotic resistance
19
Q
Respiratory tract infections.
What are the self limiting conditions to not to prescribe antibiotics for?
A
- Otitis media
- Acute sore throat/pharyngitis/tonsillitis
- Common cold
- Rhinosinusitis
- Acute cough/bronchitis
(natural history of self limiting infections above: 1 4 days 2 1 week 3 10 days 4 2 1/2 weeks 5 3 weeks
20
Q
Respiratory tract infections.
When to prescribe antibiotics in self limiting conditions?
A
Otitis media - bilateral OM under 2 years old; with otorrhoea
Acute sore throat with 3 or more cantor criteria: exudate, fever, tender cervical lymphadenopathy, absence of cough
Systemically unwell / high risk (e.g. co morbidities, ex prem-baby, immunosuppression)
Age >65 and 2 or more, or >80 and 1 or more: hospital admission within the last year, diabetes, congestive cardiac failure, current glucocorticoid use
Complications: pneumonia, mastoiditis, peritonsillar abscess.cellulitis
21
Q
Respiratory infections. Which antibiotics for: 1. Otitis media 2. Sinusitis 3. Tonsillitis 4 LRTI 5 UTI
A
- Amoxicillin
- Amoxicillin, or doxycycline
- Penicillin
- Amoxicillin
- Trimethoprim or nitrofurantoin
22
Q
What are the 4 stages of wound healing?
A
Vascular response
Inflammatory response
Proliferation
Maturation
23
Q
In would healing, the vascular response occurs to which layer of the skin? What processes does this set off?
A
Wounds penetrate to the dermis.
Vasoconstriction occurs immediately to reduce blood loss. (5-10 mins)
Clotting process is initiated by exposure to air.
A fibrin mesh or clot forms causing temporary closure of the wound - this is replaced by a scab when it dries out.
Blood and serous fluid cleanse the wound of surface contaminants.
24
Q
In wound healing, the inflammatory response is defined by what 5 things?
A
Calor - Heat Tumor - localised swelling Rubor - erythema/redness Dolor - pain Functiono laesa - some loss of function
25
In wound healing, what happens during the inflammatory response? When does it peak and how long does it last?
Platelets trapped in the fibrin mesh release inflammatory mediators (prostaglandin/ histamine) -> vasodilation.
Neutrophils and macrophages are recruited into the wound by growth factors.
Neutrophils release free radicals and proteases and are bactericidal.
Macrophages ingest dead tissue and release cytokines that recruit lymphocytes and fibroblasts.
Lymphocytes enter the wound after 72 hours and secrete chemotactic factors for fibroblasts
Vasodilation peaks 20mins after injury.
This phase can last up to seven days in a clean wound.
26
During which phase is slough formation common? + what is slough?
Slough is the accumulation of dead cellular debris and is common in the inflammatory phase.
Can prevent a wound from healing properly.
27
In wound healing, what happens in the proliferative stage? And when does this stage start?
Begins at 2-3days after the wound, can last up to 4 weeks.
Fibroblasts secrete collagen and glycosaminoglycans.
New connective tissue (collagen) fills the wound.
Granulation (angiogenesis, epithelialisation and contraction of wound size occur.
28
In wound healing, what happens during maturation?
Starts when collagen production stops (usually 20 days after injury).
Wound strength progresses.
29
What can happen if wound healing does not occur properly?
Can develop into a chronic wound, or formation of a keloid scar.
30
In wound healing, what are primary, secondary and tertiary intentions?
P = only if little or no tissue loss, wound edges apposed - in surgical wounds closed with sutures -> linear scar.
S= wound edges not apposed (e.g. ulcer) -> wound allowed to granulate -> broader scar.
(epithelialisation occurs from edges of wound/or from base)
T= wound purposely left open - with an infection/foreign body, initially cleaned and derided -> later surgically closed by suture/skin graft.
31
What are the main barriers to wound healing? General and local factors.
```
General:
Elderly
Diabetes - microvascular disease, neuropathy, raised glucose
Malnutrition
Malignancy
Renal/hepatic failure
Drugs
Immunosuppressive disease
Vitamin deficiency
```
```
Local factors:
Site
Infection
Oedema
Vascular insufficiency
Previous radiotherapy
```
32
What are the 5 stages of Grief?
Denial - defence mechanism, refusing to accept facts
Anger - with themselves/others
Bargaining - seek compromise (e.g. 'can we still be friends' when facing a breakup)
Depression - sadness, regret, fear, uncertainty
Acceptance - some emotional detachment and objectivity
33
When experiencing grief, some people have an adjustment disorder. What does this mean?
A MALADAPTIVE emotional or behavioural reaction to an identifiable stressful event / change. Not a healthy, expected response.
May develop when:
- the recovery is taking too long (>6 months and no acceptance)
- extreme/harmful coping mechanisms
- continuing life impact (can't attend school/work)
- self harm/suicidal thoughts
- persistent anxiety/depression
34
Define domestic abuse
Any incident or pattern of incidents of controlling, or coercive, threatening behaviour, violence or abuse between those of aged 16 or over who are/have been intimate partners/family members.
Can encompass:
physical; psychological; sexual; financial; emotional abuse.
35
How does domestic abuse impact on a person's health? Give three ways with example conditions for each.
1. Traumatic injuries following assault
- fractures, miscarriage, bruises
2. Somatic problems/chronic illness consequent of living with abuse
- headache, GI problems, premature delivery
3. Psychological or psychosocial problems secondary to abuse
- PTSD, attempted suicide, substance misuse, depression, anxiety, eating disorders
36
What is the best indicator of domestic violence in someone presenting with non-accidental?
Trauma 'unwitnessed by anyone else'.
Repeat attendance, delay in seeking help, multiple minor injuries not requiring medical treatment.
37
What to do in a suspected case of domestic abuse?
Standard/medium risk - give contact details for domestic abuse services.
High risk - refer to MARAC (multi-agency risk assessment conference).
-> links up to date info about victim's needs and risks directly to provision of services and appropriate responses for services involved.
38
When can you break confidentiality in domestic abuse cases?
In a high risk case if consent cannot be/isn't given
39
What is the difference between incidence and prevalence?
Incidence = new cases, denominator (disease free people at start of study), time
Prevalence = existing cases, point in time
40
What does disease epidemiology look at?
Time, place, and person: age, gender, class, ethnicity
41
What is person-time and when is it used?
A measure of time at risk (time from entry to study to 1 disease onset, 2 loss to follow-up or 3 end of study.
Used to calculate incidence rates.
Useful when participants are involved in the study for varying lengths of time.
42
Define absolute risk
Odds of it taking place. Actual numbers involved - has units (e.g. 50/10000 deaths in a population)
43
Define relative risk
One category relative to another - no units (e.g. x% more likely to develop disease because of FH (comparative to no FH) )
Tells you about the relationship between a risk factor and the disease.
44
Define attributable risk
A type of absolute risk.
Rate of disease in the exposed that may be attributed to the exposure.
(incidence in exposed - incidence in non exposed).
Gives size of effect - ideal for establishing public health outcome.
Relative risk here would be the ratio between the two: incidence in exposed divided by incidence in unexposed.
45
Calculate attributable risk and relative risk:
Incidence of Disease A in smokers, 1/1000 person-years Incidence of Disease A in non-smokers, 0.05/1000 person-years
Incidence of Disease B in smokers, 8/1000 person-years Incidence of Disease B in non-smokers, 4/1000 person-years
Why is the attributable risk smaller for Disease A compared with Disease B even though the relative risk is much larger?
Disease A
Attributable = 1 - 0.05 = 0.95/1000 person-years
Relative = 1 / 0.05 = 20
Disease B
Attributable = 4/1000 person-years
Relative risk = 2
A smaller and R larger -> Disease B is more common.
46
What is number needed to treat?
The number of people you need to treat to prevent one bad outcome.
47
What is bias?
A systematic deviation from the true estimation of the association between exposure and outcome.
-> distortion of true underlying association
48
What are the two main groups of bias?
Selection bias - systematic error in selection of study participants, and allocation of participants to different study groups
Information (measurement( bias - systematic error in measurement or classification of exposure and outcome.
49
What are sources of information bias?
Observer (observer bias)
Participant (recall bias)
Instrument (wrongly calibrated)
50
Define confounding
Where a factor is associated with the exposure of interest and independently influences the outcome but does not lie on the causal pathway.
51
When assessing causality, what factors are important to consider?
1) Strength of association - magnitude of relative risk
2) Dose response - higher exposure, higher risk of disease
3) Consistency - similar results in other studies using different designs
4) Temporality - does exposure priced outcome?
5) Reversibility - removal of exposure reduces risk
6) Biological plausibility - biological mechanisms explaining the link
52
If an association is not causal, what could it be?
Bias, Chance, Confounding, Reverse causality
53
Epidemiological study design - what is a cohort study?
Population -> people without disease -> exposed/not exposed -> exposed either have the disease or not, and not exposed either have the disease or not.
Direction of enquiry equals time course of study.
54
Epidemiological study design - what is a case control study?
Look at cases of patients already diagnosed, and see if they were exposed or not. Additionally look at controls without the disease, and see if they were exposed or not.
Direction of enquiry is the reverse of the time course of study (looking back).
55
Epidemiological study design - what is a randomised control trial?
Population -> selected defined by criteria -> potential participants invited to participate -> randomised into treatment groups and control
56
What is the most robust interventional study design?
Randomised control trial
57
Epidemiological study design - what is a cross-sectional study?
Descriptive = prevalence - people with disease/population studied
Analytical = table of people with disease/not against if they were exposed to the agent or not
58
Epidemiological study design - what is an ecological study?
Geographical - prevalence of disease plotted against exposure level
Time trends - prevalence of disease against time
59
What type of study design is this:
Investigators find a high level of correlation between levels of socioeconomic deprivation and cardiovascular mortality across electoral wards in the UK
Ecological
60
What type of study design is this:
Researchers set out to examine the association between alcohol consumption and stroke. They identify all new patients admitted with stroke and compare their alcohol consumption with patients admitted for elective surgery
Case control
61
What type of study design is this:
General practitioners set up a study to estimate the prevalence of depression within their registered population. They decide to start with a random sample of adults aged 45-74 years.
Cross-sectional
62
Give a few types of epidemiological study design
```
A. Cohort study
B. Case-control study
C. Case series
D. Case report
E. Meta-analysis
F. Randomised controlled trial
G. Cross-sectional study
H. Ecological study
I. Systematic review
J. Migration study
K. Intervention study
```
63
What are different types of epidemiological measurement?
```
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
F. Person-years
G. Prevalence
H. Absolute risk reduction
I. Relative risk
J. Number needed to treat
```
64
What is an odds ratio?
Odds of exposure in cases/odds of exposure in controls.
65
What type of epidemiological measurement is this:
In a randomised controlled trial, the time at risk was determined from entry to the study to various end points.
```
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
F. Person-years
G. Prevalence
H. Absolute risk reduction
I. Relative risk
J. Number needed to treat
```
Person-years
66
What type of epidemiological measurement is this:
For patients with meningococcal meningitis, the risk of dying has been estimated to vary from 5-10%.
```
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
F. Person-years
G. Prevalence
H. Absolute risk reduction
I. Relative risk
J. Number needed to treat
```
Case-fatality rate
67
What type of epidemiological measurement is this:
In a case-control study of recent alcohol consumption and road traffic accidents, the measure of association was substantially greater than 1 and indicates that there is a positive association between exposure and outcome.
```
A. Attributable risk
B. Case-fatality rate
C. Cumulative incidence
D. Incidence rate
E. Odds ratio
F. Person-years
G. Prevalence
H. Absolute risk reduction
I. Relative risk
J. Number needed to treat
```
Odds ratio
68
```
Different types of association and causation:
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality
F. Dose-response
G. Strength of association
H. Reversibility
I. Biological plausibility
J. Consistency
```
Which is this:
Researchers set out to examine the hypothesis that stress causes hypertension using hypertensive and normotensive individuals in a case- control study. The study design is however criticised because of concerns regarding the temporal sequence of events.
Reverse causality
69
```
Different types of association and causation:
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality
F. Dose-response
G. Strength of association
H. Reversibility
I. Biological plausibility
J. Consistency
```
Which is this:
A study reports an association between coffee consumption and cancer. However, subsequent studies find that there is a clear association between smoking and coffee consumption.
Confounding
70
```
Different types of association and causation:
A. Bias
B. Chance
C. Confounding
D. Specificity
E. Reverse causality
F. Dose-response
G. Strength of association
H. Reversibility
I. Biological plausibility
J. Consistency
```
Which is this:
An association between postmenopausal oestrogen use and endometrial cancer was reported in some studies. However, it was subsequently argued that this might be due to increased diagnostic attention received by women with uterine bleeding after oestrogen exposure.
Bias
71
Prevention is classified into primary, secondary and tertiary prevention. Explain the difference between the three categories, giving examples of each.
Primary = no disease - prevent it occurring
e.g. immunisation
Secondary = Pre-clinical disease - reduce impact of disease that is already present (e.g. treat as soon as possible/slow down progression)
e.g. screening programme
Tertiary = clinical disease - soften impact of disease with lasting effects/chronic disease - improving their ability to function
e.g. stroke rehabilitation programmes
72
What is the population approach to disease prevention?
A preventative measure delivered on a population wide basis - seeks to shift risk factor distribution curve.
e.g. dietary salt reduction through legislation and general public dietary advice -> shifts BP curve to left
73
What is the high risk approach to disease prevention?
Identify individuals above a chosen cut off and treat them.
e.g. screening people for high BP and treating them.
74
What is this phenomena known as:
A preventative measure that brings benefit to the population often offers little to each participating individual
Prevention paradox
75
What is screening
A process which sorts out apparently well people who probably have a disease (or susceptibility/precursors to a disease) from those who probably do not.
76
What is a screening test not/
Not diagnostic
77
Give two examples of screening types
1) Population based screening programmes
2) Opportunistic screening
3) Screening for communicable disease
4) Pre-employment and occupational medicals
5) Commercially provided screening
78
What are the 4 main criteria for screening and what do they entail?
1) The condition
- important health problem
- latent/preclinical phase
- natural history known
2) The screening test
- is it suitable (sensitive, specific, inexpensive)
- acceptable
3) The treatment
- effective
- agreed policy of whom to treat
4) Organisation and cost
- facilities
- cost and benefit
- ongoing process
79
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening test
True positive/all disease (true positive result+ false negative result)
remember by -> being sensitive = a positive
80
What is specificity?
The proportion of people without the disease who are correctly excluded by the test
True negative /all absent disease (false positive result + true negatives result)
81
What is positive predictive value?
The proportion of people with a positive test result who actually have the disease
True positive/ all positives tests (true positive result + false positive result)
82
What is negative predictive value?
The proportion of people with a negative test result who do not have the disease
True negative/ all negative test results (false negative result and true negative result)
83
Which screening results are dependent on underlying prevalence?
Predictive values or sensitivity and specificity
Predictive values
84
What type of bias is this - lead time or length time?
Disease starts, Pt A diagnosed after screening, earlier than pt B who is diagnosed when symptoms develop, both die at the same time.
A seems to have longer time after diagnosis until death.
Lead time
85
What type of bias is this - lead time or length time?
- Cancers may be slowly or rapidly progressive
- less aggressive cancers are more likely to be detected by screening rounds
- a comparison of survival in screen-detected patients with non screen-detected patients may be biased due to a tendency to compare more aggressive with less aggressive cancers.
Length time
86
Name a few determinants of health
```
Genes
Environment
Lifestyle
Health care
Social and community networks
- education, work, living conditions, housing, sanitation
```
87
What is the difference between inequality and inequity?
Equality is concerned with equal share
| Equity is about what is fair and just
88
Explain the difference between horizontal and vertical equity in relation to healthcare?
Horizontal = equal treatment for equal need
(e.g individuals with pneumonia (with everything else being equal) should be treated equally)
Vertical = unequal treatment for unequal need
(e.g. areas with poorer health may need higher expenditure on health services, individuals with a cold vs pneumonia need unequal treatment)
89
How would you examine health equity?
Supply of health care, Access to health care, Utilisation of services, Health care outcomes, Health status, Resource allocation
Wider determinants of health (smoking, socioeconomic environment)
90
In health care systems, how is equity usually defined?
Equal access for equal need
91
What are the three domains of Public Health?
Health improvement, health protection and improving services
92
What is the domain health improvement concerned with?
Social intervention aimed at preventing disease, promoting health and reducing inequalities.
e.g. housing, education, employment, lifestyle, family/community
93
What is the domain health protection concerned with?
Measures to control infectious disease risk and environmental hazards.
e.g. infectious disease, chemicals and poisons, radiation, environmental hazards, emergency response
94
What is the domain improving services (health care) concerned with?
Organisation and delivery of safe, high quality services for prevention, treatment and care.
e.g. clinical effectiveness, efficiency, service planning, audit and evaluation, clinical governance, equity
95
Explain the difference between public health interventions delivered at the population (ecological), community and individual levels, using one example for each to illustrate your answer.
Ecological (population)
A preventative measure delivered on a population wide basis, enabling people to exert control over determinants of health - seeks to shift risk factor distribution curve.
e.g. vaccinations, wearing of seatbelt's...
Community
The community is defined geographically and is where the intervention is implemented. Designed to change behaviour by changing the environment around them
e.g. mass media to convey message of healthy eating, price regulations locally, putting fruit and veg near the cashiers not chocolate
Individual
Care responsive to individuals needs - Encourage individuals who are at a high risk of developing a disease to do something about it
e.g. smoking cessation, take medication
96
What is the importance of health psychology?
Emphasises the role of psychological factors in the cause, progression and consequences of health and illness.
97
What are the three main categories of health behaviours?
Health behaviour - aimed to PREVENT disease (eating healthily)
Illness behaviour - aimed to SEEK REMEDY (going to the doctor)
Sick role behaviour - aimed at GETTING WELL (taking medication, rest)
98
Give an example of a health damaging behaviour and health promoting behaviour.
Damaging: smoking, alcohol and substance abuse, risky sexual behaviour, sun exposure, driving without a seatbelt
Promoting: exercise, healthy eating, attending health checks, medication compliance, vaccinations
99
What factors influence a patient's compliance with their medication?
```
Patient's idea about the risk of disease
Side-effects of medication
Asymptomatic/secondary prevention
Forgetting to take it
Social gradient - lifestyle, stress
```
-> to overcome these, discuss how the benefits outweigh the risks they perceive
100
How does a primary care intervention aimed at reducing alcohol combustion among individuals impact on an individual's behaviour, the local community and a population level?
Individual = level of alcohol consumption, incidence of domestic violence, health outcome
Community = local alcohol sales, alcohol related crimes/accidents
Population = national alcohol sales and consumption, demographic patterns of liver cirrhosis
101
Why do we engage in damaging health behaviours?
Individuals continue to practice health-damaging behaviour due to inaccurate perceptions of risk and susceptibility.
Can include: cultural variability, age, stress, situational rationality, socioeconomic factors
102
What are perceptions of risk influenced by? What does this impact on?
Lack of personal experience with the problem
Belief that it's not preventable by personal action
Belief that it's not happened by now so it isn't going to
Belief that the problem is infrequent
Impacts on medication adherence, attendance of appointments.
103
NICE guidance on behaviour change includes what?
READ short version before exams.
```
1 Planning interventions
2 Assessing the social context
3 Education and training
4 Individual level intervention
5 Community level intervention
6 Population level intervention
7 Evaluating effectiveness
8 Assessing cost effectiveness
```
104
What should an individual level intervention help people to do?
- Understand the CONSEQUENCES of their health related behaviours, for themselves and others
- Feel positive about the BENEFITS of health enhancing behaviours
- Plan the changes as easy steps over time
- Recognise how their SOCIAL CONTEXTS AND RELATIONSHIPS affect their behaviour
All this helps the patient take responsibility and give them ideas on what to do if progress fails - should never give up (coping strategies).
105
What is the greatest single cause of illness and premature death in the UK?
Cigarette smoking
106
Smoking related deaths are due to what three main illnesses?
Cancer, COPD, heart disease
about half of all smokers die from smoking related disease
107
True or false, tobacco has been linked to poverty and unemployment
True
108
What is the single biggest cause of inequality in death rates between the rich and poor
Smoking
109
According to the Health Belief model, individuals will change if they believe what 4 things?
1) They are susceptible to the disease
2) That it has serious consequences
3) Taking action reduces susceptibility
4) Benefits outweigh the costs
110
What is a criticism of the health belief model of behaviour change?
Alternative factors can predict health behaviour (outcome expectancy - when a person believes they'll be healthier as a result of their behaviour; self efficacy - belief in their ability to carry out the preventative behaviour)
Does not consider emotional influence on behaviour (and is a cognitive model)
Doesn't differentiate between first time and repeat behaviour
Cue's to action are missing (e.g.smoking cessation advice from GP can make a patient stop smoking).
111
What are advantages with the health belief model?
Successful for a range of behaviours (breast self-exam, vaccinations, adherence to medication, cancer screening)
Perceived barriers are the most important factor in addressing behaviour change in patients
112
The Theory of Planned Behaviour proposes that what? is the best predictor of behaviour?
Intention
113
In the theory of planned behaviour, what is someone's intention determined by?
A person's attitude to the behaviour
Subjective norm - perceived social pressure to undertake the behaviour
Perceived behavioural control - appraisal of their ability to perform the behaviour
114
Theory of planned behaviour example: What are the intentions here:
1) I do not think smoking is a good thing
2) Most people who are important to me want me to give up smoking
3) I believe I have the ability to give up smoking
4) I intend to give up smoking
1) Attitude
2) Subjective norm
3) Perceived behavioural control
4) Behavioural intention
115
In the theory of planned behaviour, what helps people act on their intentions?
```
Perceived control
Anticipated regret
Preparatory actions
Implementation intentions
Relevance to self
```
116
What are the criticisms of the theory of planned behaviour model?
- Lack of direction of causality
- Lack of temporal element
- It is a rational choice model - doesn't take into account emotions that might disrupt the rational.
- Habits and routines bypass cognitive deliberation
- Assumes that attitudes and subjective norms can be measured\- Relies on self-reported behaviour
117
Which of the models of behavioural change is a rational choice model?
Theory of planned behaviour
118
In the transtheoretical model, what are the 5 stages of behavioural change?
```
Pre-contemplation
Contemplation
Preparation
Action
Maintenance or relapse
```
e.g. not ready yet -> thinking about it -> getting ready -> doing it -> sticking with it
119
What are the advantages to the transtheoretical model?
Acknowledges individual's stages of readiness (tailored interventions)
Accounts for relapse
Temporal element
120
What are the criticisms of the transtheoretical model?
Not all people move through every stage, some move backwards, or miss out stages completely
Change might operate on a continuum rather than discrete stages
Doesn't consider values, habits, culture, social or economic factors
121
What does the transtheoretical model of behaviour change examine?
The process of change, rather than factors that determine behaviour
122
What does a motivational interview aim to do in behaviour change?
A counselling approach for initiating behaviour change by resolving ambivalence
123
How does the 'nudge' theory aim to lead to behavioural change?
'Nudge' the environment to make the best option the easiest (e.g. opt-out schemes, placing fruit next to check-outs)
124
What factors influence a person's health behaviour?
```
Personality traits
Assessment of risk perception
Impact of past behaviour/habits
Social environment
Predictors of maintenance on health behaviour
```
125
What is a health needs assessment?
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.
126
What is health need, demand and supply?
Need - ability to benefit from an intervention
Demand - what people ask for
Supply - what is provided
127
What is the difference between health need and health care need?
Health need - more general need for health, measured in mortality, morbidity, socio-demographic measures
Health care need - specific need for health care, and ability to benefit from this care - depends on the potential for prevention, treatment and care services to remedy health problems.
128
What can a health needs assessment be carried out on?
A population (GP practice population)
A condition (COPD)
An intervention (coronary angioplasty)
129
In the sociological perspective to health care need, there are 4 defined needs, what are they?
Felt need (perceived need)
Expressed need (expressed by action, i.e. visiting a doctor
Normative need (by experts)
Comparative need (comparing one group to another)
130
In health needs, what type of need is: an individual perception of variation from normal health
Felt need
131
In health needs, what type of need is: individual seeks help to overcome variation in normal health (demand)
Expressed need
132
In health needs, what type of need is: professional defines intervention appropriate for expressed need
Normative need
133
In health needs, what type of need is: comparison between severity, range of interventions and cost
Comparative need
134
In the health needs assessment, how does the Epidemiological approach assess the problem?
1) Define problem
2) Size = incidence/prevalence
3) Services available = prevention/treatment
4) Evidence base = cost+effectiveness
5) Models of care = quality outcome measures
6) Existing services = unmet needs, unused services
7) Recommendations
135
What are the limitations of the Epidemiological approach to a health needs assessment?
Required data may not be available
Variable data quality
Evidence base may be inadequate
Does not consider felt need
136
In the health needs assessment, how does the Comparative approach assess the problem?
Compares the services received by a population (spatially/socially).
May examine:
- Health status
- Service provision
- Service utilisation
- Health outcomes (mortality, morbidity, QOL, patient satisfaction)
137
What are the limitations of the Comparative approach to a health needs assessment?
May not show what the appropriate level (e.g. of service provision) should be
Data may not be available
Data may not be good quality
Difficulties in finding a comparable population
138
In the health needs assessment, how does the Corporate approach assess the problem?
Corporate view = commissioners + providers + professional + patients + press + politicians + opinion leaders
139
What are the limitations of the Corporate approach to a health needs assessment?
May be difficult to distinguish need from demand
Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence
140
Give one health related example of something that you consider is demanded but not needed or supplied, clearly explaining the reasoning for your example.
Antibiotics - usually demanded by the patient (say for a viral URTI), not needed, and not supplied because it is not beneficial.
141
All of the following are examples of supply-induced demand except:
A) Variation in referral rates to secondary care among general practitioners
B) Variation in consultation rates in primary care
C) Variation in hospital length of stay for patients with similarly severe conditions
D) Variation in admissions due to multiple injuries due to road traffic accidents
E) None of the above
Answer D – variations in admissions due to multiple injuries due to road traffic accidents.
Rates of admission for severe and life threatening conditions tend not to be influenced by supply.
The other options are classic examples of supply-induced demand as availability of health facilities influences their utilisation.
142
In which part of the need, demand and supply Venn diagram does a patient’s request for antibiotics for mild upper respiratory infection fall?
```
A) Needed, demanded and supplied
B) Not needed but demanded and supplied
C) Needed, demanded and not supplied
D) Demanded but not needed or supplied
E) None of the above
```
Answer D – demanded but not needed and not supplied. Antibiotics are not beneficial; they may be demanded by the patient but are not normally provided.
143
```
Patients calling the general practice to see the doctor is a form of:
A) Normative need
B) Comparative need
C) Expressed need
D) Felt need
E) None of the above
```
Answer C – expressed need. The need is expressed by seeking help.
Normative need is defined by experts. An example would be patients attending an annual health check in response to recommendations by their doctor.
Comparative need compares one group with another, for example in different geographical locations.
Felt need is not correct in this example as need is not only ‘felt’ but also stated.
144
Give an example of where a service is demanded and supplied but not needed.
Tonsillectomy in children with one or two episodes of throat infection; this service may be demanded by patients and supplied by the health service. However, evidence shows that it is of limited clinical benefit in the majority of children. Hence it is not needed.
145
What does a health needs assessment try to achieve?
To describe health problems in a population and differences within and between different groups in order to determine health priorities and unmet need.
It should identify where people are able to benefit either from health care or from wider social and environmental changes and balance any potential change against clinical, ethical and economic considerations: that is, what can be done, what should be done and what can be afforded.
146
List the five objectives of a health needs assessment.
Plan health services
Gather health intelligence
Achieve equity
Target resources efficiently Involve stakeholders.
147
In the homeless, how does the average life expectancy compare to national average?
Roughly half
| 47yrs male, 43yrs female
148
What is the main cause of homelessness and what causes it?
Relationship breakdown
```
Caused by:
mental illness
domestic abuse
disputes with parent
bereavement
```
- more than half of homeless say they have no family ties
149
Give three examples of health problems faced by the homeless.
Infectious disease - including TB and hepatitis
Poor condition of feet and teeth
Respiratory infections
Injuries following violence/rape
Sexual health - smears, contraception, STIs
Serious mental disorders - schizophrenia, personality disorders, depression
Poor nutrition
Addictions/substance misuse
150
What are the general needs of a child?
```
Emotional security and stability
Safety
School
Immunisations
Play, pals, toys
```
151
What are the main barriers to healthcare in the homeless?
Access - due to opening times, appointment locations, perceived/actual discrimination
Lack of integration of primary care with other services (like housing, social services, criminal justice)
Other priorities - more immediate survival issues
May not know where to find help
152
What are the barriers to health care in the gypsy/traveller communities?
Reluctance of GPs to register travellers, and to visit sites.
Poor reading and writing skills, many are illiterate
Communication difficulties
Too few permanent sites
Mistrust of professionals
Lack of choice
153
What is the difference between an asylum seeker and a refugee?
Asylum seeker = a person who has made an application for refugee status
Refugee = a person granted asylum and refugee status. Usually means leave to remain for 5 years then reapply.
154
What is humanitarian protection?
Where a person has failed to demonstrate claim for asylum but faces serious threat to life if returned to own country (e.g. gay). Usually 3 years then reapply.
155
What are the barriers to health care for asylum seekers?
Lack of knowledge of where to get help
Lack of understanding of how NHS works
Language/culture/communication
Hyper-mobility - constantly moving from one place to another
Health is not a priority
156
List 5 previous experiences in an asylum seekers life.
```
separation from family
hostility
racism
poverty
poor housing
unemployment
deprivation of human rights
taken hostage
forced eviction
political repression
massacres
torture
abuse/sexual assault/rape
forced conscription
```
157
What are common physical health problems in asylum seekers?
```
Illnesses specific to country of origin
War injuries
Injuries from travelling
Malnutrition
Torture and sexual abuse
Infestatios and debilitation
Communicable/blood borne diseases
Untreated chronic disease
Congenital problems
```
158
What are common mental health conditions in asylum seekers?
```
PTSD
Depression
Sleep disturbance
Psychosis
- inclusive of flashbacks and hallucinations...
Self harm
```
159
What are the emotional needs of the elderly population?
```
Security
Attention
Intimacy
Part of a wider community
Autonomy and control
Privacy
Competence
Achievement
Meaning and purpose
```
160
What are the physical consequences of loneliness?
Earlier death
Take more risks
Harder to self regulate
Health risk - e.g. increased smoking
161
How do you recognise loneliness?
```
Body language, appearance, TALKATIVE, CLINGING
Denial, boredom
Lives alone
Male 50+
Bereavement
Mobility
Sensory impairment
Regular times away from the house?
Close family nearby?
QUALITY not quantity of social contact
```
162
Who is the 'hidden crisis' category in loneliness?
Male 50+
RF: widowers, poor health, low income, few qualification, living in rented housing
163
What is the definition of social exclusion?
The dynamic process of being shut out from any of the social, economic, or cultural systems which determine the social integration of a person in society.
164
Give an example of an initiative to prevent loneliness in the elderly
AgeUK
Dementia friends
Men in sheds
Silverline
165
What is the main framework for evaluation of health care services?
Evaluation = assessment of whether a service achieves its objectives. - must include numerical denominator eg /1000
Framework: Donabedian's:
STRUCTURE - What is there e.g. number of ICU beds
PROCESS - What is done? - includes output e.g. number of patients seen in a&e -
OUTCOME - mortality, morbidity, QOL, patient satisfaction
Also classified using 5 Ds: death, disease, disability, discomfort, dissatisfaction
166
Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations.
Explain why it may be difficult to attribute a health outcome to the service provided.
(What are the issues with health outcomes?)
Link between health service and outcome may be difficult to establish, e.g confounding factors, severity, case-mix
Time between service provision and outcome may be very long
Large sample sizes may be needed for statistically significant results
Data may not be available
Issues with data quality - consider CART: completeness, accuracy, relevance, timeliness
167
How is the quality of health care assessed using Maxwell's 6 dimensions?
3Es &3As:
Effectiveness
- does it produce the desired effect?
Efficiency
- is output maximised for given input?
Equity
- are the patients treated fairly
Acceptability
- of the service provided
Accessibility
- is it provided? geographical access, cost for patients, waiting times...
Appropriateness
- is the right treatment being given to the right people at the right time? ?overuse/underuse/misuse
168
Give examples of qualitative methods of evaluation of health care services.
Observation
Interviews
Focus groups
Review of documents
169
Give examples of quantitative methods of evaluation of health care services.
Routinely collected data - e.g. hospital admissions
Review of records - medical/admin
Surveys
170
What factors contribute to the promotion of excessive energy intake?
```
Genetics
Employment (shift work)
Early developmental factors
TV viewing/adverts
Characteristics of food (energy density, portion size...)
Reduced physical activity
Sleep
Environmental cues
Psychological factors
```
171
Define malnutrition
Malnutrition refers to the deficiencies, excesses or imbalances in a persons intake of energy and/or nutrients.
Covers both undernutrition and over weight.
Undernutrition = includes stunting, wasting, underweight, micronutrient deficiencies (lack of important vitamins and minerals
Over weight = obesity, diet related noncommunicable diseases (heart disease, stroke, diabetes, cancer)
172
What are some chronic medical conditions requiring nutritional support?
```
Cancer
Cystic fibrosis
Coeliac disease
Inflammatory bowel disease
Diabetes - T1 & T2
Failure to thrive
Eating disorders
Overweight, obesity
management of sarcopenic obesity in the elderly
```
173
Give some examples of early influences on eating behaviour
Maternal diet - taste preference development (as amniotic fluid is influenced by diet)
Role of breastfeeding - taste preference and bodyweight regulation
Parental practices
Age of introduction to solid foods and types of food exposed to when weaning and beyond
174
What are the 3 main components of breast milk?
Colostrum
- protein - 3 days after birth
Foremilk
- beginning of feed - watery
Hindmilk
- end of feed >energy dens
175
What is the difference between an eating disorder, and disordered eating?
Eating disorder =
clinically meaningful behavioural/psychological pattern to do with eating or weight, associated with distress, disability or with increased morbidity
Disordered eating = restraint, strict dieting, emotional eating, binge-eating, weight concerns - inappropriate compensatory behaviour that doesn't warrant a diagnosis
176
What are the 3 distinct eating disorder illnesses?
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
177
What are the problems with dieting?
Risk of developing eating disorder
Dieting results in loss of lean body mass not just fat
Dieting slows metabolic rate and energy expenditure
Chronic dieting can disrupt normal appetite responses, leading to increased sensations of hunger
Long-term weight loss is challenging
Weight cycling (repeat diet-relapse) can lead to accelerated weight gain (overshoot)
178
Why is dieting difficult for some patients?
Those susceptible to obesity appear:
- unresponsive to internal satiety signals (when over consuming) and cues of hunger (when dieting)
- vulnerable to external cues (availability of palatable food)
179
Explain the externality theory of obesity. Give a problem with this theory.
Normal weight individuals respond to internal homeostatic cues.
Overweight individuals eat according to:
- external cues
- no compensation after preload
- time of day
- sensory food cues
Problem: too general, not all best are external and not all lean are internal
180
Using the dietary restraint theory (boundary model), explain why dieting may lead to overeating.
Normal eater:
Food consumption regulated by biological process to keep food intake within a set range
Hunger keeps food intake above a specific minimum, and satiety keeps it below a maximum. These levels are determined by body weight, and is regulated by social environmental and psychological factors.
Restrained eater:
Dieters have a larger range between hunger and satiety - it takes them longer to feel hungry, and more food to satisfy them.
Dieters have a self-imposed COGNITIVE DIETARY BOUNDARY (what they think they should eat and how much). If they exceed this boundary, they eat until full (more than normal person) -> leads to overeating and weight gain over time.
181
What are the criticisms of the dietary restraint theory?
Suggests a link between restraint and overeating.
Cannot explain restricting behaviour in anorexics, (avoiding meals, weighing and portioning foods) as this should otherwise result in overeating and weight gain, not severe weight loss.
182
Why are some dieters successful, and others fall into the chronic dieting category?
External cues.
Chronic dieters experience conflict between incompatible goals
- eating enjoyment and weight control ->persuasive food cues in the environment prime the goal of food enjoyment
Successful dieters use food cues as a weight loss motivational goal.
183
What is the worst food cue in the environment?
Large portion sizes
-> portion size effect = increased prevalence of overweight and obesity.
184
What are the physical effects of dependent drug use?
Acute
- complication of injecting (DVT, abscesses, SBE)
- overdose (respiratory depression)
- poor pregnancy outcome
- side effects of opiates (constipation)
Chronic
- blood-borne virus transmission (Hep C 50% in IVDU)
- effects of poverty
- side effects of cocaine (vasoconstriction, local anaesthesia)
185
What are the social effects of dependent drug use?
Effects on families
Driven to criminality (inc. prostitution)
Imprisonment
Social exclusion
186
What are the psychological effects of dependent drug use?
Fear of withdrawal
Craving
Guilt
Depression/anxiety
-> all temporarily alleviated by drug use
187
```
Heroin
Mode of action?
Routes of administration?
Effects?
Adverse effects?
```
Acts on opiate receptors
Administration: smoking/chasing, snorting, oral, IV, submit, IM, rectal
Effects:
euphoria, intense relaxation, miosis (pupil constriction), drowsiness
Adverse effects:
- dependence and withdrawal symptoms
- physical complications: nausea, itching, sweating, constipation
- overdose
188
```
Cocaine
Mode of action?
Routes of administration?
Effects?
Adverse effects?
```
Action:
Blocks reuptake of mood enhancing neurotransmitters (serotonin + dopamine)
Intense pleasurable sensation, reinforcement leads to further use
Administration:
oral, snorting, smoking, IV (coca leaves/coke powder/ crack)
Effects:
Confidence, euphoria, impulsivity, increased energy, decreased need for sleep
-ve: impaired judgement, anxiety, panic
Adverse effects:
Produce anxiety, HT, arrhythmia's
Subsequent 'crash' - dysphoria
Chronic: depression, panic, paranoia, psychosis, damaged nasal septum, CVA (stroke)
189
What are the aims of drug rehabilitation treatment?
Reduce harm to user, family and society
Improve health
Stabilise lifestyle and reduce amount of illicit drug use
Reduce crime
190
For a dependent drug user, what are the modalities of treatment?
Harm reduction (especially non-opiate drug users)
Detoxification (lofexidine, buprenorphine)
- >Maintenance: methadone (full agonist), buprenorphine (partial agonist/antagonist)
- >Relapse prevention (naltrexone)
- >Psychological interventions
Alternative therapies
Referral for allied problems (e.g. Hep C, STDs...)
191
What can you offer a newly presenting drug user?
Health check
Screening for blood-borne viruses and referral for positive results
Contraception/smear
Sexual health advice
Check general immunisation history (against hep A/B?)
Signpost to additional help (counselling, housing, benefits)
Info on local drug services including needle exchange
192
How does a doctor aim to achieve basic harm reduction for drug users under:
- Action to prevent death
- Action to prevent blood borne
+ referral where appropriate
Prevent death
- not injecting/injecting more safely
- reducing amount taken after intervals where tolerance is lost
- not mixing respiratory depressants
- not using drugs alone by themselves
- knowing t call an ambulance if necessary
Prevent infection
- not sharing needles
- safer sex (condoms)
- provision of hep A and B vaccines
- blood borne virus screening inc hep c
Referral
- specialist drug service
- voluntary sector
- infectious disease
193
What treatment is involved in a quick detox in a drug user?
Buprenorphine 1st line
(lofexidine in v young/low levels of addiction)
+symptomatic medication
+support from other agencies
194
What is the profile of a drug user who can quickly detox?
- young
- less addicted
- often not injecting
- lower level of drug use
195
What is the profile of a drug user who needs stabilisation and maintenance?
- opiate user
- longer time using
- usually injecting
196
What treatment is involved in stabilisation and maintenance of a drug user?
Methadone
Buprenorphine is sometimes used
-> titration from low start dose to maintenance dose - will not need heroin
Aims to keep people alive until they are ready to become abstinent
197
What is involved in the treatment of crack cocaine addiction?
```
No substitute available
Harm reduction is key.
- advice on risky behaviour
- safe sex and contraception
- blood borne virus advice
- hep b/c testing
```
Brief intervention
- explain effects
- explain risks
- advise on controlled use
- setting limits
Team work - sexual health/specialist team referrals
198
How is relapse prevention carried out in drug users?
Support is essential - involve other teams/agencies
Naltrexone licensed (LFTs, urinalysis, supervised administration and warnings re concomitant heroin use)
Specialist agency support
- avoid benzodiazepines except v short-term
- contact relapsing needs stabilisation and maintenance
199
Can drug users still have analgesia?
Yes, follow usually analgesic ladder
If opiates indicated give in usual dose and frequency - but may need more due to tolerance, keep maintenance drug medication constant
NB Pt's on buprenorphine may need alternative analgesia - if problematic switch to methadone and use opiates
200
What is the second most important factor after smoking for causing cancer?
Alcohol
201
What are the recommended units of alcohol in a given week?
14 units for both men and women
Pregnant women are advised to abstain in the first trimester, then no more than 2 units per week
202
What is hazardous drinking?
Pattern of alcohol use which increases someone's risk of harm
203
How many units constitutes high risk and increased risk drinking behaviours?
High: 50+units for men, 35+units for women
Increased: 22-50 men, 15-35 women
204
What is a unit of alcohol?
A standard measure of alcohol content of a drink, taking into account the strength (%ABV) and the volume (pint/litre) -> this is 8g of alcohol
205
How do you calculate units of alcohol?
%ABV volume/1000ml
| as %ABV = units in a litre -> so a litre of 12% wine would be 12 units
206
Who metabolises alcohol faster and why? (Men/women)
Men - because women have a higher percentage of body fat -> lower water .
207
What is ethanol metabolised into?
Ethanol -> (ADH (alcohol dehydrogenase)/catalase/cytochrome P450 isoform) ->
>>>
ACETALDEHYDE ->
ALDH (acetaldehyde dehydrogenase)->Acetate -> CO2 +water
208
Give some examples of etiological factors in problem drinking.
```
Occupation
Availability
Advertising
Peer group
Religion, tradition, culture -> family
Genetics, personality, biological vulnerability
Physique, health, gender
```
209
Give a social and psychological factor for problem drinking.
Drinking within the family
Childhood problem behaviour relating to impulse control
Early use of alcohol/nicotine/drugs
Poor coping in response to life events
Depression as a cause not a result of problem drinking
210
What is the relationship between deprivation and alcohol misuse?
Adverse effects of alcohol exacerbated amongst lower socio-economic groups
More likely to experience negative effects directly ad indirectly
Lack of money means less likely to protect themselves against negative health
2-3x more likely to die of causes influenced by alcohol
211
What are the common causes of death due to alcohol?
Accidents and violence
Malignancies
Cerebrovascular disease
Coronary heart disease
212
Is fatty liver reversible on withdrawing alcohol? True/False?
True
213
Is there risk of liver damage with 30g of alcohol per day?
No significant risk at less than 30g of alcohol
Average alcohol intake of men with liver cirrhosis is 160g per day
214
What are the symptoms of alcoholic hepatitis?
Vary: anorexia, nausea, abdominal pain and weight loss
More susceptible to infection
Severe hepatitis is a medical emergency -> ascites, bleeding and encephalopathy
215
Does alcohol intake worsen IHD? True/False - explain your answer.
True and False.
False at moderate intake: It can protect against IHD thought to be due to raised HDL lipids
True at heavy alcohol use: increases risk, hyperlipidaemia, raised blood pressure. Can precipitate arrhythmia's notably AF.
216
What types of cancer can alcohol cause?
Head and neck: mouth, larynx, pharynx, oesophagus cancers
Liver, stomach, colon, rectum, pancreatic cancer
Breast cancer
217
Why is alcohol not recommended in pregnancy?
Alcohol can increase rate of miscarriage and low birth weight babies.
Persistent drinking throughout can cause a spectrum of problems - notably foetal alcohol syndrome.
218
What are the signs/symptoms of foetal alcohol syndrome?
Small, underweight babies, slack muscle tone
Mental retardation, behavioural and speech problems
Characteristic facial appearance: microcephaly, upturned nose, hypoplastic jaw, smooth philtre, thin upper lip, epicanthic folds, short palpebral fissure
Cardiac, renal and ocular abnormalities
219
What is a major risk in excessive alcohol drinking?
Violent crime/domestic violence
Child protection issues
220
What questions in a history do you ask if you are concerned about someone's drinking?
Generally:
How much; what; how long has it been like this; steady/regular/binge; what time of day do you start; where do you drink/who with; any debts; what does your partner/family think about your drinking
221
Give an example of a public health measure in reduced alcohol problems.
Minimum price per unit of alcohol (as in Scotland)
Changing licensing laws in places where cirrhosis is a big problem
222
What other health concerns are considered in an alcoholic other than liver issues?
Osteoporosis risk increased
IHD risk
Consider vitamin supplementation
223
What are the two screening tools for assessing someone's alcohol use?
AUDIT
10 point questionnaire to determine: hazardous drinking (score of 8) or dependence (score of 13 women, 15 for men)
CAGE questionnaire
- ever felt you needed to CUT down on your drinking?
- ANGRY/ANNOYED when someone criticises your drinking?
- ever felt GUILTY about your drinking?
- need an EYE-OPENER in the morning to steady nerves/get rid of a hangover?
224
What constitutes alcohol dependence syndrome?
Tolerance
Difficulty controlling onset, amount/termination of use
Neglect of social and other areas of life
Spending more time using and obtaining alcohol Characteristic physiological withdrawal
Continued use despite negative affects
225
What is the serious disorder to consider in alcohol withdrawal? What are the main symptoms? Treatment?
Wernike's Encephalopathy - cause by vitamin b1 deficiency
Triad: confusion, ataxia, ophthalmoplegia
Treated with IV/IM thiamine vitamin b1 (small risk of anaphylaxis)
Reversible -> not treating can lead to Korsakoff's
(as an f1 write up pt for bag or two of pabrinex (b1))
226
What is the complication of not treating Wernicke's? What are the symptoms and how is this diagnosed
Korsakoff's syndrome: amnestic disorder due to enduring b1 malnutrition
Not reversible
Symptoms: memory loss esp. short-term; loss of spontaneity, initiative, and confabulation
Diagnosed: CT scan
227
What is the toxic confusional state which occurs as a result of reduced alcohol intake in a dependant alcoholic?
Delerium tremens
Symptoms: clouding of consciousness, confusion, seizures; hallucinations in any modality; marked tremor
Treatment:
supportive fluids, benzodiazepine to prevent fitting
Don't forget the pabrinex mentioned for wernicke's - preventative b1.
228
How do you identify someone who is visually impaired?
White walking stick, white symbol cane, guide dog, dark/tinted glasses, being guided, reading braille
...possibly none of the above
229
Most people registered blind have some degree of vision. True/False
True - only 2% of blind people have no sight at all.
230
Give three examples of eye conditions leading to sight loss.
```
Cataracts
Age-related macular degeneration
Glaucoma
Retinitis pigmentosa
Hemianopia
Diabetic retinopathy
```
231
What happens in cataracts?
As we age, the lens in the eye gradually changes and becomes less transparent.
A misty/cloudy lens = cataract
232
What are the two forms of age related macular degeneration and how do they happen?
What is the treatment and how do you reduce risks?
Dry (most common, and wet.
Damage occurs to cells of the macula (central part of the retina) and affects central vision.
AMD causes blurriness, distorted or dim vision (as the macula is part of the eye used in fine detail (reading/writing, driving, cooking, recognising faces, colours ->affects daily life.
Use an amsler grid to test for AMD
Treatment: drug therapy/laser eye treatment
Reduce risk: eye tests, protect from sun, stop smoking, balanced diet
233
What is a glaucoma and how does it occur?
Condition affecting the optic nerve
Damage caused by raised eye pressure, or a weakness in the optic nerve
Peripheral vision is affected and can lead to blindness if left untreated
Risk: increase with age, FH
234
What are the first things to notice in retinitis pigmentosa?
Difficulties with night vision and peripheral vision first.
Later reading, colour and central vision are affected
It is a gradual progressive reduction vision
235
What is hemianopia?
Loses vision in either left half or right half of visual field in both eyes following a stroke/traumatic brain injury.
Homonymous hemianopia = loss of field of view on same side in both eyes
236
What is diabetic retinopathy?
Affects blood vessels supplying the retina - they become weak and damaged -> lack of blood supply -> loss of vision/light sensitivity
