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Medicine > Health & Society > Flashcards

Health & Society Flashcards

1
Q

What is operational duty?

A

where authorities knew/ought to have known of a real and immediate risk to life of an individual and they failed to take measures to avoid that risk

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2
Q

Is consent needed for post-mortems?

A

yes - storage and use of a body requires consent

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3
Q

When can a coroner override consent?

A

When they deem it necessary for investigations so they can override consent of next of kin to examine body

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4
Q

What is the purpose of an inquest?

A

find out who deceased person was, how, where, when they died

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5
Q

When should hospital deaths be reported to the coroner?

A

question of negligence/misadventure, died before provisional diagnosis was made, died as a result of admin of anaesthetic

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6
Q

When is consent not needed?

A

implied, necessity (best interests), emergency (prevent crime or serious harm)

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7
Q

What is the court of protection?

A

office of supreme court - deals with financial and legal affairs of people not their care

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8
Q

Which attorney deals with medical affairs?

A

enduring power of attorney

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9
Q

What are torts?

A

wrongs for which a person is liable in civil law as opposed to criminal law e.g. negligence

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10
Q

How long are people banned from driving when suffering from schizophrenia?

A

6 months after an acute episode requiring hospital admission

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11
Q

How long must AMPH have seen patient in order to order a section 2?

A

within 14 days

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12
Q

How does alcohol effect glutamate?

A

opposes its effects contributing to amnesia and other cerebral depressant effects

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13
Q

Whats the commonest cause of macrocytic anaemia?

A

alcohol

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14
Q

What blood test can detect if someone has been drinking more than 7 units a day for a week?

A

CDT (carbohydrate deficient transferrin)

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15
Q

Who can apply for a section 2-4?

A

AMPH

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16
Q

What does the DoLS provide?

A

safeguards for the patient e.g. right to appeal, appointing a represenative, access to advocacy

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17
Q

How long does a section 17 CTO last?

A

6 months

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18
Q

How long can you not drive for if you suffer from alcohol abuse/dependence?

A

until minimum of 6 months or 1 year free of alcohol problems

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19
Q

What is the role of liason psychiatry?

A

work in general hospital - provide psychiatric opinions for people attending hospital with physical health problems with/without pre-existing mental health issues

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20
Q

What are common referrals for liason psychiatry?

A

assessment following self harm, managing delirium, distinguishing symptoms of depression from physical health disorders

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21
Q

What factors are associated with risk of violence with mental health disorders?

A

Hx of violence, other antisocial behaviour, relationship, employment issues, substance use, major mental disorder, personality disorder, traumatic experience, violent attitudes, treatment or supervision response, insight, violent ideation, instability, living situation and personal support

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22
Q

Who does the MHA apply to?

A

registered medical practitioners, approved clinicians, managers and stafff, approved mental health professionals, local authorities, police, ambulance, commissioners of health services

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23
Q

If patient is in a care home under what act is care & treatment provided under?

A

MCA - MHA cannot be used in care homes

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24
Q

At what age does DoLS apply?

A

over 18

MCA - over 16

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25
Q

What’s the assessment process when using MHA sectioning?

A

AMPH or patient’s nearest relative makes an application
Application is supported by 2 doctors (1 section 12 approved)
Identify and liase with services which offer alternatives to admission

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26
Q

When can a AMPH make an application under the MHA?

A

if they’ve interviewed patient, satisfied detention criteria are met, detention is the most appropriate way of providing care and medical treatment the patient needs

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27
Q

Can MHA be used on children?

A

yes - detain for assessment/treatment but Gillicks and MCA apply in terms of consent to be admitted

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28
Q

If child refuses conset in MHA, can guardian consent?

A

No

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29
Q

When is DoLS given by supervisory body?

A

if 6 of the following criteria are met:
over 18, have a mental disorder, lack capacity, in their best interests, proportionate, person has made no valid/advance decisions to refuse

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30
Q

How does children detainment in MHA differ in application?

A

one of the 2 medical practitioners approving detainment should be a CAMHS professional

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31
Q

Who requests DoLS?

A

managing authority (hospital or care home)

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32
Q

When can we treat physical conditions under the MHA?

A

to alleviate/prevent worsening of symptoms or a manifestation of mental disorders or where treatment is part of treatment for mental disorder e.g. eating disorders

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33
Q

Who hands out DoLS?

A

local authority

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34
Q

What do we use to detain patient who only needs physical treatment?

A

DoLS

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35
Q

If patient has a physical condition unrelated to mental disorder can they be treated under MHA?

A

No - must be MCA

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36
Q

What treatment does sectioning apply to?

A

mental health only

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37
Q

What are the 3 main compulsory orders of sectioning in MHA?

A

admission for treatment, treatment orders, admission and transfer of patients concerned with criminal acts

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38
Q

What is the T2 form?

A

record of patient consenting to treatment for mental disorder when they have capacity

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39
Q

What is the criteria for a section 2?

A

person is suffering from a mental disorder warranting detention for assessment & treatment
needs to be detained in interests of their own health & safety or to protect others

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40
Q

What is the criteria for a section 3?

A

person is suffering from a mental disorder warranting treatment needed to detain patient for this treatment
health & safety of patient and others
appropriate medical treatment is avaliable

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41
Q

When must applicant have seen patient for a section 4?

A

within last 24hrs and only need 1 section 12 approved doctor alongside an AMPH

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42
Q

When is a section 4 used?

A

immediate and significant risk of mental/physical harm to patient or others
serious harm to property or need for use of restrictive interventions

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43
Q

How long does a section 4 last?

A

24hrs from time doctor examined patient for application or time from application made whichever is earlier and then 72hrs

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44
Q

Can patient be treated under section 4?

A

not without consent unless or until second doctor comes

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45
Q

Which setting does holding powers apply to?

A

hospital inpatients - excluding A&E as they haven’t been admitted

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46
Q

Can patient be treated under a section 5?

A

not without consent and cannot be transferred it’s for assessment only

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47
Q

What does guardian have power to do?

A

require patient to live at a place chosen by them

attend places specified for treatment, occupation, training or education and ensure doctor & social worker can see them

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48
Q

What is section 7?

A

guardianship application - guardian given authority to supervise patient in community

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49
Q

What is section 17?

A

right to leave hospital whilst detained for a short period by the responsible clinician only

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50
Q

What patients are exempt from section 17?

A

section 35/36 criminal patients

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51
Q

Where does a transplanted kidney go?

A

iliac fossa with external iliac artery and vein supplying it

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52
Q

What’s the role of the independent assessor in kidney transplantation?

A

interviews donor and recipient separately & together to ensure donors aren’t forced, no reward has been sought or offered so donor has informed decision capacity and must prove their identity and relationship

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53
Q

What are the 2 sources of kidney transplants?

A

deceased - heart beating (brain death but kidneys are still perfused) or non-heart beating (kidneys are more ischaemic)
living - related and unrelated

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54
Q

What are the offences under the Human Tissue Act?

A

removing, storing and using human tissue without consent, trafficking human tissue for transplantation

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55
Q

What does the Human Tissue Act regulate?

A

removal, storage and use of human tissue and take minimal needed to preserve organs

56
Q

What are alternatives to blood transfusion?

A

volume expanders, growth factors, intraop salvage, autologous blood donation, synthetic blood subs

57
Q

What are the steps to a safe blood transfusion service?

A

national policy for blood services, centrally coordinated structured and organised blood services
screening for transfusion associated infections and rational use of blood

58
Q

How are the UK blood donation services organised?

A

4 national services:
NHS blood and transplant providing blood services and tissue and organs
Scottish, Northern Ireland and Wales blood services

59
Q

What are the 3 goals of the NHS Diabetes Prevention programme?

A

achieve healthy weight, dietary recommendations and physical activity recommendations

60
Q

Whose eligible for the diabetes prevention programme?

A

18+

HbA1c 42-47 or fasting glucose 5.5-6.9

61
Q

What is the aim of the NHS diabetes prevention programme?

A

reduce incdience of T2DM, incidence of complications of T2DM & reduce inequalities associated with incidence of diabetes in the long-term

62
Q

What are advantages of vertical sleeve gastrectomy?

A

good weight loss, fewer dietary deficiencies, hunger producing hormones are reduced and no foreign body used

63
Q

What are advantages of adjustable gastric bands?

A

inserted laparascopically, fewer dietary deficiencies, less weight loss, adjustable, relatively easy surgical procedure

64
Q

What’s the advantage of % body fat?

A

more reliable for athletes, elderly etc. takes fat free mass into consideration

65
Q

What are the disadvantages of BMI?

A

doesn’t account for muscle, fat free mass, cut off doesn’t distinguish between genders or ethnicity

66
Q

What are advantages of waist circumference?

A

good correlation with metabolic syndrome, direct anatomical measure reflecting dysfunction of adipocytes, easy and low cost

67
Q

What are advantages of BMI?

A

good correlation with metabolic disease, easy and low cost, adequate for epidemiology and population studies

68
Q

What barriers to physical activity did men report compared to women?

A

work commitments, women was lack of leisure time

69
Q

Which region of England has the highest obesity prevalence?

A

North East

70
Q

What opportunities should workplaces provide for obesity prevention?

A

active & continious promotion of healthy choices in restaraunts, hospitality, vending machines, working policies such as active travel, supportive physical environment and recreational opportunities

71
Q

Whose more likely to have a raised waist circumference of the 2 genders?

A

women

72
Q

What’s the obesity prevalence of obesity in England?

A

26% of men and women 16+ are obese

73
Q

When can you continue orlistat therapy beyond 3 months?

A

if they’ve lost 5% of their initial body weight since starting drug

74
Q

When can orilstat be prescribed in obesity?

A

when they have a BMI of 28+ with associated risk factors or BMI 30+

75
Q

What’s important to include in weight management programmes?

A

behaviour change techniques

76
Q

What is important to recognise with patients in obesity?

A

their views - anger, suprise, denial, explore eating patterns and physical activity, what has person previously tried and what they learnt, readiness to adopt changes and confidence in making changes

77
Q

What is the uncertainity principle?

A

giving patient different treatment is acceptable when a doctor doesnt know which treatment is best

78
Q

What happens to patients taking non-insulin diabetes medication when driving?

A

can drive provided no more than 1 episodes of severe hypoglycaemia while awake in last 12 months
practice appropriate monitoring

79
Q

What are signs that someone’s at the end of their life?

A

getting worse, bed bound, extreme tiredness, needing help, little interest in food/drink, difficulty swallowing, sleepy, reduced urine output, new urinary incontinence, delirium, changes in breathing, noisy chest secretions, cold to touch

80
Q

What criteria must be met for patient to drive with insulin treated diabetes?

A

adequate awareness of hypoglycaemia, no more than 1 episode of severe hypoglycaemia while awake in the last 12 months, most recent occured over 3 months ago, practices appropriate glucose monitoring and meets visual standards

81
Q

What are strategies for weight loss in adults?

A

self monitoring of behaviour and progress stimulus control, goal setting, slowing rate of eating, ensuring social support, problem solving assertiveness, cognitive restructuring, reinforcement of changes, relpase prevention

82
Q

What gene has been implicated in obesity and metabolic rate?

A

KSR2

83
Q

What is high risk waist circumference?

A

102cm in men and 88cm in women

84
Q

When should waist circumference be calculated?

A

those with a BMI under 35

85
Q

What is provided on the NHS healthier you programme?

A

1-1 assessment to understand needs, motivations and programme goals, group discussions, physical activity and nutrition guidance

86
Q

Whose eligible for the NHS Healthier you service?

A

18+, registered with GP, have high glucose levels, not pregnant, able to take part in light/moderate physical activity

87
Q

What initial body weight loss target is given to those with T2DM and obesity?

A

5-10%

88
Q

How do we perform education in diabetes?

A

evidence-based specific aims and LOs, supporting patient and their family to develop attitudes, beliefs, knowledge and skills to self-manage, group educations are preferred

89
Q

What MDT services are involved in diabetes management?

A

retinopathy, peripheral neuropathy, gastroparesis, foot care, lower limb PVD, renal disease, non-alcoholic liver disease

90
Q

What’s section 18?

A

patient is absent without leave - have left hospital without permission and must inform family

91
Q

How long does section 17 last?

A

short term no more than 7 days and local agencies must be consulted

92
Q

What points about the process of organ donation need to be told to the patient?

A

risks of donation, nature of surgical procedure, length of stay, potential graft loss, requirements for HTA assessment,

93
Q

What are general consent points for organ donation?

A

donor must be properly informed, info must be given about what will be shared, explained that tests might throw up unexpected findings such as genetic relationships and medical findings

94
Q

What assessment needs to be made prior to an organ donation?

A

independent assessment of donor and recipient

95
Q

What is a paired or pool donation?

A

form of living donation where donor-recipient pairs are involved in an exchange so donor A gives to recipient B and vice versa

96
Q

What is operational duty?

A

where authorities knew or ought to have known of a real and immediate risk to life of an individual and they failed to take measures to avoid that risk

97
Q

Is consent needed for post-mortem?

A

yes - required for storage and use of body but where a coroner deems one necessary for Ix then it is not and can override next of kin’s consent

98
Q

What is the purpose of an inquest?

A

find out who deceased was, how and when and where they died

99
Q

When should hospital death be reported to the coroner?

A

question of negligence/misadventure, died before provisional diagnosis was made, died as a result of admin of anaesthetic

100
Q

When is a death reported to the coroner?

A

doctor didn’t treat person during last illness or see them in the last 28 days of their life, cause of death was sudden, violent, unnatural, murder, industrial disease, death requires Ix

101
Q

What is the role of the coroner?

A

independent judicial officers investigating deaths reported to them

102
Q

What’s the difference between a coroner and a medical examiner?

A

coroner - doesnt need medical background, confirms death, notifies next of kin, identifies body, handles personal belongings, maintains death records but doesnt do autopsies
Medical examiner - performs Ix medical autopsies, toxicological and pathological tests

103
Q

What is the role of the Human Tissue Act?

A

license and inspect organisations that remove, store and use human tissue for research, medical treatment, post mortem, education and training to ensure organ and stem cell donations don’t involve reward or coercion

104
Q

When does a coroner have a duty to Ix a death?

A

deceased died a violent or unnatural death cause of death is unknown, deceased died whilst in custody

105
Q

What medical conditions are referred to a coroner?

A

acute alcoholism, acute dehydration, asphyxia, barotrauma, birth asyphyxia, birth injury, compressed air, fibrosing alveolitis, Diver’s palsy, Haartmanns procedure, haemothorax, heart attacj, hyperthermia, injury, malnutrition, medical techniques, radiation colitis, refusal to eat, stent, subdural haematoma, toxic anaemia

106
Q

What are the 4 matters that must be determined at inquest?

A

Who person was, where, when and how they died

107
Q

What are examples of modes of death?

A

cardiac arrest, coma, exhaustion, renal failure, respiratory arrest, syncope

108
Q

Which depression or OCD would we use higher doses of SSRIs?

A

OCD but need therapy also

109
Q

How does OCD in early schizophrenia differ from OCD?

A

they have no insight and no idea that they’re their own thoughts

110
Q

How does incidence of OCD change with pregnancy?

A

increases

111
Q

Who doesn’t follow the human tissue act?

A

police

112
Q

When is a jury involved in an inquest?

A

violent member of police, accident, poisoning, discretion

113
Q

What is section 1(1) of the coroner’s and justice act?

A

triggering of an investigation into cause of death

114
Q

Who can be coroners?

A

only barristers and solicitors

115
Q

Who should be informed if death was due to/contributed by employment?

A

coroner

116
Q

What is the lowest age limit for old age as a cause of death?

A

80

117
Q

Where does histology of tumours need to go on death certification?

A

part 1 along with whether primary/secondary and the site

118
Q

Who can sign a form 5 for cremation?

A

senior doctor of at least 5 years

119
Q

What does the proportional mortality ratio measure?

A

proportion of deaths occuring from a given cause for a particular occupation relative to proportion of deaths from that cause in the whole population

120
Q

Which diseases have a high proportional mortality ratio?

A

MS, leukaemia, aplastic anaemia, Parkinson’s and bicycle accidents

121
Q

What is the main kind of fatal accident for workers?

A

falls from a height followed by being struck by a moving vehicle

122
Q

What is section 1 (7) of the coroner’s and justice act?

A

empowers coroner to conduct preliminary inquries to see whether duty to Ix is triggered

123
Q

What are the core functions of the medical examiners?

A

ensure cases are appropriately referred to coroner ASAP, ensure content of MCCD is as accurate as possible, ensure clinical governance concerns are passed onto relevant body

124
Q

What are features of death on examination?

A

absence of central pulse, absence of heart sounds, asystole on continious ECG, absence of pulsatile flow, absence of contractile activity on ECHO and railroading eyes

125
Q

When do we refer deaths to coroner?

A

cause of death unknown
deceased not seen by certifying doctor within 14 days before or after death, violent, unnatural or suspicious death, accident, neglect, self-neglect, industrial disease, related to abortion, following surgery or anaesthesia, suicide, following detention in police custody/prison

126
Q

How do we document joint causes of death?

A

entered on same line

127
Q

What should be the cause of death at 1a on certificate?

A

proximate cause

128
Q

What does part 2 of death certification show?

A

any significant disease that contributed to death but didn’t directly cause it

129
Q

What does part 1 of death certification show?

A

immediate cause of death and any underlying cause or causes

130
Q

What are the types of death certification?

A

medical certificate cause of death - MCCD
neonatal death certificate - within first 28 days of life
certificate of stillbirth - issued from mother after 24 weeks

131
Q

Who must register patient death?

A

registered medical practitioners, attended deceased during last illness and must state known cause of death to best of knowledge and belief

132
Q

What is form 5 of death certification?

A

need for confirmatory medical certificate for cremation

133
Q

What is the purpose of death certification?

A

enables registration of death, permits disposal of body, public health and stats roles, research into planning of healthcare

134
Q

What measures of health status are important to patients with CVD?

A

overall survival, major cardiac surgery complications, angina, dyspnoea, depression, functional status, health related quality of life, reinfarction, stroke, HF, need for revascularisation

135
Q

What are the 5 principles of high reliability organisations?

A

interest in failure, reluctance to simplify, sensitivity to operations, commitment to longevity and resilience, respect for expertise

Medicine (29 decks)

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