PH2A Flashcards
(56 cards)
1
Q
Duties of a doctor
A
- Care - first priority
- Knowledge - up to date
- Consideration - for patient
- Confidentiality - respected
- PubliC health - promotion
- Competence - work within limits
2
Q
What is 1 unit of alcohol?
A
10ml (8g) pure alcohol
1/2 beer, small wine, shot
___
%ABV (multiplier) x amount liquid (ml) /10
3
Q
Consequences fetal alcohol syndrome
A
Growth retardation
CNS abnormalities; mental retardation
Craniofacial abnormalities; birthmarks, hernias, congenital defects
4
Q
CAGE & Alcohol use disorder identification test (AUDIT)
A
CAGE:
- Felt need to Cut down on drinking?
- Have people felt Annoyed by your drinking?
- Have you ever felt Guilty?
- Ever had a drink first in the morning? (Eye-Opener)
5
Q
Alcohol withdrawal symptoms
“TASHD”
A
Tremors
Agitation; rapid HR, high BP
Seizures
Hallucinations
Delirium
6
Q
FRAMES; intervention for risky behaviour
A
Feedback
Responsibility - stress personal responsibility
Advice - cut down
Menu - of alternate strategies
Empathetic - style of q’s
Self feeling - feeling able to cope by themselves
7
Q
Pharmacological treatment for alcoholism
A
Naltrexone - opioid antagonist (rapid detox)
Disulfram - sensitive to alcohol (worse hangover)
Acamprosate - stabilise chem
8
Q
Breast screening
A
50-70
Every 3 yrs
9
Q
Bowel cancer screening
A
60+
Every 2 yrs
Faecal occult
10
Q
Cervical screening
A
25-50: Every 3 yrs
50-64: Every 5 yrs
11
Q
AAA Screening
A
>65
12
Q
Sensitivity
A
SNNOUT
Sensitivty - rule negatives OUT
“how well test picks up those with disease”
13
Q
Specificity
A
SPIN
Specificity - rule positives in
14
Q
What are the stages of stopping smoking?
A
- Precontemplation
- Contemplation
- Preparation - taking steps to prepare
- Action
- Maintenance
- Relapse
15
Q
Methods to improve or maintain nutrition
A
- Oral nutrition - fortified food
- Enteral - deliver complete feed directly into gut
- Parenteral - IV nutrition
16
Q
BMI categories
BMI = weight (kg)/ height (m2)
A
18-24.9: normal
25-30: overweight
30+: obese
17
Q
How does the malnutrition universal assessment tool work?
A
- BMI
18-24.9 = 0; 25-30 = 1; 30+ = 2
- Weight loss as % body mass
<5% = 0; 5-10% = 1; 10+% = 2
- Illness
If no food intake for >5 days = 2
Add scores: 0=low 1=med 2+=high
18
Q
Anorexia nervosa
A
- Dread of being fat
- Refusal to be >85% of normal body weight
- BMI<17.5
- Behaviours; self-starvation, excessive exercise, self-absorption
N.B. Anorexia > Bulimia (harder to treat)
19
Q
Bulimia nervosa
A
- Repeat boughts of over-eating
- Purging/Excessive exercise
20
Q
Treatment of anorexia nervosa
A
-
Stabilisation of eating, self-monitoring, weekly
weighting (not self-weighting) - Initial focus on enhancing motivation
- Behaviour change: weight re-gain is essential
-
Cognitive restructuring: testing dysfunctional attitudes
on weight pain, loss of control, etc - Relapse prevention
21
Q
Treatment of bulimia nervosa
A
- Education
- Stabilise eating patterns
- Strategies to manage urges to binge or purge
- Systematic introduction of avoided foods
- Reduction of body-checking
- Modification of beliefs
22
Q
Moral theories
A
Frameworks used to justify actions in situations
23
Q
Consequentialism
A
judging the outcomes or consequences of a decision
24
Q
Utilitarian
A
Utilitarian: An act is evaluated solely in terms of its
- *consequences.** The choice that yields the most benefits to the most people
(i. e. man will be brain dead without treatment but his organs can be used for transplant. The utilitarian would not treat and transplant organs)
25
Deontology
Moral decisions based on duties and the rights of others
(i.e. patient brain dead without transplant. deontologist would save the mans life as it is morally right)
26
Virtue ethics (agent based, character ethics)
Focus on the **_character of the agent_** rather than an action that may deviate from their normal behaviour
27
What diseases are screened for in the newborn blood spot test?
sca, congenital hypothyroidism, cf ![]() ![]() ![]()
28
What is the difference between errors and neglect?
Error: Unintended outcome
Neglect: Falling below acceptable care standards
29
What are the 5 focal virtues for health professionals?
Specifically for health professionals, compassion, discernment, trustworthiness, integrity and conscientiousness are seen as being the five focal virtues
30
What are the 4 principles?
Benefcence, non-maleficence, autonomy, justice
31
QRISK2
32
How can action of daily living be assessed?
1. Activities of daily living scale (**ADL**) - 6 activities graded on level of **dependence**
2. Instrumental activities of daily living (**IDL**) - functional tasks graded on level of **independence**
3. **Barhell** ADL - 10 items measuring **independence**
4. **MMS** examination - orientation, registration, short-term memory
33
What are the 3 features of an autonomous action?
* Intentional
* Done with understanding
* No outside control
34
The disability paradox
"People with a disability often have a **higher QOL** due to **adjusting their expectation**s. Challenged health status leads to **re-evaluation**"
35
PHE interventions for influenza
1. Hand washing
2. "Catch it, bin it, kill it"
3. Self-isolation
36
Influenza; reproduction number
R valve = number of cases as a result of a single case
37
What are the 3 principles of the doctrine of dual effect?
1. Nature of action is good
2. Agent intends good effect
3. Good effect outweights the bad
38
Influenza; widespread interventions
1. **Travel** **restrictions**
2. **Restrictions** of mass public gatherings
3. Schools **closure**
4. Voluntary **home isolation** of cases
5. Voluntary **quarantine of contacts** of known cases
6. **Screening** of people entering UK ports
39
Millenium development goals
Goal 1: Eradicate Extreme **Poverty & Hunger**
Goal 2: Achieve **Universal** **Primary** **Education**
Goal 3: Promote **Gender Equality** & Empower Women
Goal 4: Reduce **Child Mortality**
Goal 5: Improve **Maternal Health**
Goal 6: Combat **HIV/AIDS, Malaria** and Other Diseases
Goal 7: Ensure **Environmental** Sustainability
Goal 8: Develop a **Global Partnership** for Development
40
Phases of managing infectious threat
1. Early **identification** of new threat
2. **Containment** Phase - few cases
-_aim_: reduce spread while learning about disease and
developing treatments/vaccine
-**handwashing**, **isolation** of cases, antivirals for reducing
spread, controlling **ports**, social **restrictions** etc
3. **Management** Phase: many cases, spreading freely in the
community. Control spread
-**vaccinate**, ensure **system able** to provide best treatment, **isolate vulnerable**
41
*C.Diff;* SIGHT
S – Suspect C diff as a cause of diarrhoea
I – Isolate the case
G – Gloves and aprons must be worn
H – Hand washing with soap and water
T – Test stool for toxin
-Control antibiotic usage
-Treat: metronidazole/vancomycin
42
Diarrhoea control measures
1. **Handwashing** with soap
2. Ensure availability of safe **drinking water**
3. Safe **disposal** of human waste
4. Promote **b****reastfeeding** of infants & young children
5. Safe **handling** and processing of food
6. **Control** of flies/**vectors**
7. Self-**isolation**
8. **Vaccination**
43
How are deaths recorded?
1(a) Disease or condition leading directly to death
(b) other disease or condition, if any, leading to 1(a)
(c) other disease or condition, if any, leading to 1(b)
II Other significant conditions contributing to death but not
related to the disease or condition causing it
44
Iceberg concept of disease
1. **Pre-symptomatic**
2. **_Un_**diagnosed/**Wrongly diagnosed**
3. _Diagnosed_, **uncontrolled**
4. _Diagnosed_, **controlled**"The number of cases of disease *quoted* is lower because there are many that have *not been discovered*"
45
PPV/NPV
PPV: Proportion of positive results that are **true positive**
NPV: Proportion of negative results that are true negative
46
Absolute risk
Risk of **developing** a disease (eg: lung cancer) _over a time period_.
_Eg_: risk of lung cancer is 45/ 300 in smokers and 5/700 in non smokers.
47
Relative risk (ratio)
absolute risk of getting a disease (eg: lung cancer) in exposed group (eg: smokers) **compared to** an unexposed group (eg: non-smokers).
It’s a ratio so has **NO UNITS**. Eg: 45/300 divided by 5/700 = 21.4 x the risk of lung cancer in smokers compared to non smokers.
48
Atributable risk/Attributable risk reduction (ARR)
Rate of disease in exposed that may be **attributed to exposure**.
I.e. incidence in exposed minus incidence in unexposed.
Eg: 45/300 – 5/700.
49
Difference between an error of omission & error of commission?
Commission: Doing something
Omission: Not doing something
50
Swiss cheese model
* Each layer of cheese represents a practice meant to prevent errors
* If holes line up, error can occur
51
Latent errors (swiss cheese model)
Early processes that have been put in place to prevent errors from occurring:
i.e. two people not checking a drug chart
52
Under what 3 circumstances can confidentiality be broken?
1. Given consent
2. Risk to the public
3. Required by law (i.e. GMC investigation, notifiable disease)
53
Stages of a pandemic
1. Endemic - high prevalence in one region
2. Epidemic - increase in prevalence above normal for a region
3. Pandemic - several countries
54
What are the 4 questions to determine negligence?
1. There was a duty of care
2. The duty of care was violated
3. Violation caused injury
4. Injury caused loss
55
Bolam; determining negligence
‘A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art…putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.’
56
Bolitho; determining negligence
Ammendment to the bolam test;
"Bolitho narrowed the scope of the test, stating that the court must be satisfied that ***the body of opinion*** relied upon has a logical basis." In other words, the body of opinion must have a good foundation to have based their opionion on
