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Gp Lectures Flashcards

1
Q

What is allostasis?

A

Stability through change - systems react rapidly to environmental stressors

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2
Q

What is allostatic load

A

Long term overtaxation of physiological systems leads to impaired health - stress

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3
Q

E.g. Of allostasis and allostatic load of CV system

A

Allostasis - maintain erect posture, and enable physical exertion
A Load - over activation -> hypertension, stroke, MI

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4
Q

Natural history of self limiting conditions that DO NOT need Abx

A 
Otitis media - 4 days 
Acute sore throat/pharyngitis - 1 week 
Common cold - 10 days 
Acute rhinosinusitits - 2-3weeks 
Acute cough - 3 weeks
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5
Q

When should ABx in otitis media

A

Bilateral <2yr

Or if otorrhoea

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6
Q

When abx in sore throat?

A

With 3 or more of:

Exudate, fever, tender cervical lymphadenopathy, a sense of cough

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7
Q

Other examples of when to give ABX

A

Systemically unwell
High risk co-morbidity (immunosuppressive, prem bab)
Old with recent hospital admission / diabetes /Ccf/ glucocorticoid use
Complications - pneumonia, mastoiditis, abscess

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8
Q 
Common Abx for 
Otitis media?
Sinusitis?
Tonsilitis?
LRTI?
Uti?
A 
Amoxicillin 500mg tds 5 days
Amoxicillin 500mg tds 5 days / doxycycline 5 days 
Penicillin 10 days 
Amoxicillin 5 days 
Trimethoprim / nitrofurantoin 3 days
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9
Q

Vascular response to wound

A

Vasoconstriction
Clotting when blood exposed to air
Blood and serous fluid clean wound
Vasodilation and permeability in vessels adjacent
Fibrin mesh temporality closes wound -> turns into scab

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10
Q

Signs of inflammation

A 
Heat - calor 
Swelling - Tumor 
Erythema - rub or 
Pain - dole 
Loss of function
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11
Q

Egs of inflammatory mediators released by platelets trapped in fibrin mesh

A

PDGF, Prostaglandins, histamine

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12
Q

What locally causes vasodilation by wound?

A

Histamine

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13
Q

When does vasodilation peak after injury

A

20 mins - don’t confuse with infection

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14
Q

Role of neutrophils and macrophages

A

N- release free radicals and pro teases - bactericidal

M - invest dead tissue, release cytokines that recruit lymphocytes and fibroblasts

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15
Q

Lymphocyte role

A

Enter wound after 72hr and secrete chemotactic factors for fibroblasts

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16
Q

Primary secondary tertiary intention?

A

1- little tissue loss - wound edges can be directly apposed -> linear scar
2 - wound edges not apposed - eg ulcer / skin loss ->granulation and broader scar
3 - Would purposely left open - later surgically closed eg graft / suture

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17
Q

General barriers to healing?

Local barriers?

A

Elderly, diabetes, malnutrition, malignancy, immunosuppressive

Infection, oedema, vascular insufficiency, prev radiotherapy

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18
Q

5 stages of grief

A 
Denial 
Anger
Bargaining 
Depression 
Acceptance

Not always in order and not everyone experiences them all

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19
Q

What is an adjustment disorder

A

Emotional or behavioural reaction which is maladaptive

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20
Q

When do adjustment disorders often develop

A

Recovery taking too long (>6/12 usually have acceptance)
The coping mechanisms are extreme or harmful
Continuing impact on relationships / social functioning
Self harm

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21
Q

Types of domestic abuse

A 
Psychological
Physical 
Sexual 
Financial 
Emotional
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22
Q

3 ways domestic abuse can impact on health

A

Trauma
Somatic problems due to living with abuse (headaches, gi, chronic pain, LBW, premature babie)
Psychological (PTSD, self harm, substance misuse, depression, anxiety…)

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23
Q

What to consider safeguarding in domestic abuse

A

If there is child abuse / child witnessing

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24
Q

Tool to assess risk in domestic abuse

A

DASH

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25
What to do in standard / medium risk domestic abuse
Give contact for domestic abuse services
26
What to do in high risk domestic abuse
Refer for MARAC / IDVAS | You can break confidentiality
27
What is MARAC
Multi agency risk assessment conference
28
Egs of models / theories of behaviour change
``` Health belief model Health belief model Theory of planned behaviour Stages of change / trans theoretical model Social norms Motivational interviewing Nudging Social marketing ```
29
When do people change in the health belief model ?
``` They believe: they are susceptible There is serious consequences action reduces susceptibility Benefits of action outweigh costs ```
30
What factors influence HBM
Demographic - SES, gender, age.. | Psychological - personality, peer group ...
31
Cirque of HBM
Other factors influence - eg self efficacy Does not consider the influence of emotions on behaviour Does not differentiate between first time and repeat behaviour
32
Cues to action help HBM, E.g. Of an internal and external cue ?
Internal - feeling unwell | External - reminder letters
33
What is the most important factor for addressing behaviour change in patients?
Perceived barriers
34
Biggest predictor of behaviour in TPB
Intentions
35
What 3 things determine a persons intention in TPB
Attitude to the behaviour The perceived pressure to undertake the behaviour - Social norm Perceived ability to perform behaviour - perceived behavioural control
36
Ways to help people act on their intentions
Perceived control - They CAN do it Anticipated regret - how do you feel after behaviour Predatory actions - break into small steps Implementation intentions - eg when make tea, take meds
37
Critique of TPB
Lack of temporal element Doesn't take into account emotions Doesn't explain habitual behaviour Relies of self reported behaviour
38
Stages of transtheoretical model
Pre-contemplation, contemplation, preparation, action, Maintenance
39
Advantages of stages of chance
Accounts for relapse Temporal element Accounts individual stages of readiness (Tailored interventions)
40
Critique of stages of change
Not everyone goes through all the stages Change might be a continuum rather than discreet Doesn't take into account - values, habits, culture, social and economic factors
41
There are 3 main behaviours related to health. What are they and EG?
Health behaviour - prevent disease - eating healthy Illness behaviour - seek remedy - visit doctor Sick role behaviour - aimed at getting well - taking prescribed medication
42
Identify 3 transition points where interventions are likely to be more effective
Leaving school, entering workforce, becoming a parent, becoming unemployed, bereavement
43
Planning cycle in health needs assessment ?
Needs assessment -> planning -> implementation -> evaluation -> repeat
44
3 parts of health needs assessment
Need - ability to benefit from intervention Demand - what people ask for Supply - what is provided
45
3 approaches fro health needs framework
Epidemiological Comparative Corporate
46
Aspects of epidemiological approach to health needs
``` Define problem Size of problem - prevalence Services available - prevention, treatment, care Evidence base - effectiveness Models of care - quality / outcomes Existing services ```
47
Problems with epidemiological approach
Data availability Variable data quality Evidence base inadequate Doesn't consider felt needs of people afffected
48
What is the comparative approach to health needs
Compares services between subgroups E.g. Spatial / age
49
Issues with comparative approach
Data availability Data quality Difficulty finding a comparable population
50
Issues with corporate approach to health needs assessment
Hard to distinguish demand from need Groups may have vested interest Influenced by politics Dominant personalities -> influence
51
Alcohol recommended limits
Men 21 units/week | women 14 units/week
52
Pregnant women alcohol intake
none in first trimester then no more than 2 units per week
53
Factors that influence drinking levels
Social - occupation, availability, advertising, peer group Family - religion, tradition, culture Personality, genetics, health
54
Why are women drinking more
Socially acceptable, more disposable income, marketing target women
55
Risk factors for problem drinking
``` Drinking within family Childhood problem behaviours early use of nicotine and drugs poor coping responses to life events depression as a cause not a result of drinking ```
56
Alcohol intake per day -> liver damage?
Min 30g | Usually around 160g
57
Alcohol and liver problems ? Which are reversible ?
50% heavy have fatty liver - reversible | 13-30% develop cirrhosis
58
Why does heavy alcohol intake increase risk of heart disease?
Hyperlipidaemia Hypertension Can precipitate arrhythmia (usually AF)
59
Alcohol and cancer types?
25-50% of head and neck cancers due to alcohol Liver, stomach, Colon, rectum, pancreas Breast
60
Risks with alcohol consumption in pregnancy
Risk of miscarriage / LBW | Foetal alcohol syndrome
61
Signs of fetal alcohol syndrome
Small underweight babies, slack muscle tone Mental retardation, behaviour and speech problems Facial abnormalities Cardiac, renal and ocular abnormalities
62
Facial abnormalities in foetal alcohol syndrome?
Microcephalic, hypoplastic jaw Thin upper lip, smooth philtrum, upturned nose Short Palpebral fissure (upper eyelid fold)
63
What general support for alcohol in primary care?
``` Vitamin supplementation Assess risk of - IHD -Osteoperosis Screening questions Structured advice (Potential harm, benefits of stopping, obstacles to change, goals) ```
64
Examples of alcohol screening questionnaire
CAGE / AUDIT
65
Medication for relapse prevention?
Disufiram (antabuse) | Acamprosate, GABA blocker
66
Criteria for alcohol dependence syndrome
3 in a 12 month period Tolerance increase in for same effect Physiological withdrawal Difficulty controlling amount and termination of use Neglect social / other areas of life Increasing time spent obtaining and using alcohol Continued use despite negative physical and psychological effects
67
What causes wernicke encephalopathy
Bit b1 deficiency - often after withdrawal of alcohol
68
Triad of Sx in wenicke
Acute mental confusion Ataxia Opthalmoplegia (paralysis of muscles around eye)
69
Is Wernickes chronic? Treatment? What can it lead to?
Reversible IV / oral vit b1 (thiamine vitamin b1) Korsakoff's
70
What can be given in hospital setting to booze patients
Pabrinex (b1)
71
Main Sx of Korsakoffs ? Others?
Memory loss - esp short term | Loss of spontaneity, initiative and confabulation
72
How is korsakoffs diagnosed
CT scanning
73
What is delirium Tremens? Sx? Treatment?
3-5day toxic confusional state follows withdrawal of alcohol with long Hx of use Clouding of consciousness, confusion, seizures, hallucinations Marked tremor Supportive fluids / benzodiazepines prevent fitting
74
Why are 'nudging' and financial incentives rarely used in behaviour change?
Nudging - ethical issues | Financial insensitive - ineffective (people care more about what they have to lose)
75
Societal risk behaviour is usually over or underestimated by people?
Over estimated
76
Main idea in social norms ?
Find out the real social norm and disseminate
77
Critique of social norms
What if the norm is an unhealthy behaviour
78
What are the three parts of the framework for health service evaluation?
Structure - what it there Eg number of ICU beds Process - what is done Eg number of patients seen Outcome - health Eg Mortality, morbidity, QOL, patient satisfaction
79
Issues with using health outcomes in evaluation
Cause and effect hard to establish (esp if other factors) Lag time may be long Large sample sizes needed Data availability / quality
80
What are the dimensions of quality (maxwell's dimensions)
3 Es and 3 As Effectiveness, efficiency, equity Acceptability, accessibility, appropriateness

GP (6 decks)

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