Population health and ethics Flashcards
(36 cards)
Age of consent to medical procudere?
- 16+ for medical purposes
- if <16yo:
– minimental (mmc): >25 points
– mm 18-25: order second assessment (pschyatrist or other) -> able or not
You can perform a Gillick’s test. It is about 3 major domains:
home independece, finnancial independence and decision making abillity
! There’s no bottom line for age for mature minor
In case of adult inable to consent. Who decides?
Try to find advanced care directive
If not available, find a decision maker. In order of priority:
1. Legal guardian (Attorney or someone that has written power to do decisions);
2. Partner
3. First degree relatives: parents, siblings, children
4. Primary carers - a nurse, if in nursing home staff; a principal of school, a teacher
5. The doctor after aplying for guardianship (through phone in emergencies or submit a form and send to guardianship tribunal).
When to disclosure information?
If the patient represent harm to himself or others.
In cases of suspicion of child abuse or neglect
What’s Conspiracy of silence? Is it allowed?
Either the patient asks you to give relative misleading information and vice-versa.
It is prohibited
About interdisciplanary problems with healthworkers. What to do?
If a doctor is envolved and there’s a breach that you clearly saw/witnessed: report to AHPRA or MBA
If other professional, report to the head of the concerned department
Genetic testing for Huntington’s disease - indication?
Predictive genetic testing for Huntington disease only for people aged 18 years or older who have at least one blood relative with definite diagnosis of HD.
If competent minor (16-18): not perform the test, only genetic counselling.
General screening tests routine:
DM, Colon cancer, cholesterol,
Every patient should have FOBT at least every two years after the age of 50. Consider sigmoidoscopy every 5 years from the age of 50 for those with moderate family history (2nd degree)
All adults aged 45 and over should have 5 yearly checks of serum cholesterol for the screening of hypercholesterolemia.
Fasting blood glucose should be done every 3 years in all patients above 40 years of age.
Every 3 years FROM 30 YEARS should be considered in following high-risk groups:
All people with a history of the previous cardiovascular event including acute myocardial infarction and stroke.
2-All the women with a history of gestational diabetes mellitus.
3-Women with polycystic ovary syndrome.
4-Those on antipsychotic drugs.
5-Those with impaired glucose tolerance test.
6- BMI > 30;
7- family history of DM 2
Annually if prediabetes or Aboriginal from 18y on
Screening - AAA and Brain aneurysm
BA - if history or family history of Polycystic kidneys disease
AAA - US from 50 if positive family history
What are the characteristics of fourth nerve palsy and its impact on vision?
Fourth cranial nerve (CN IV) palsy:
Binocular vertical diplopia 👓
Subjective tilting of objects (torsional diplopia)
Affected eye often extorted due to superior oblique muscle involvement (intorsion) 🔄
Challenges with down-gaze vision, like navigating stairs. 🏞️
Describe sixth cranial nerve (CN VI) palsy and its clinical findings.
CN VI palsy:
Isolated weakness of abduction of the affected eye 👀
Horizontal binocular diplopia 🎯
Examination findings:
Esotropia (inward deviation)
Worsened with gaze towards the affected lateral rectus muscle
Limited abduction on the affected side
Predisposing factor: Poorly controlled diabetes 🩺🍭
What is the age of majority in Australia, and when can a minor consent to medical treatment? (Gillick competent rule)
Age of majority in Australia: 18 years 🇦🇺
A child over 16 years can consent to medical treatment.
Gillick competence rule allows minors under 16 years (but not younger than 13 years) to consent if they:
Live independently from parents (emancipated minor) 🏡
Demonstrate sufficient understanding to grasp proposed treatment, risks, and benefits 🤔
If these criteria are met, minors can consent to treatment without parental or guardian involvement.
How should minors be approached for medical consent?
Approach a minor as a consenting adult if:
Age is 13 or older 🧒🔞
Living independently from parents 🏡
Demonstrates full understanding of the situation, treatment options, risks, and benefits 🧠💡
What are the legal obligations when a mature minor discloses sexual assault?
When a mature minor discloses sexual assault, the doctor should:
Inform the minor about mandatory reporting requirements and limitations on doctor-patient confidentiality 🚨🤐
It’s important to remember that no matter how mature or independent a minor may be, they are legally considered children until they reach 18 years of age, and reporting abuse or assault is mandatory. 👶🚫🔒
Note: Different rules apply when a mature child voluntarily engages in sexual relationships. No mandatory reporting is required if the child is 13 years or older in such cases. 🚫🔞
What is the recommended treatment for carefully selected ischemic stroke patients who present within 4.5 hours of symptom onset?
Fibrinolytic (thrombolytic) therapy is the treatment of choice if not contraindicated.
Recombinant tissue plasminogen activator (rTPA) such as alteplase is approved for this purpose in Australia. 🩸
Blood pressure management is crucial before thrombolysis. Lower it to 185/110 mmHg or lower using medications like glyceryl trinitrate and labetalol. 🩺
Thrombolysis should not be initiated if the blood pressure cannot be lowered to this level. ⚠️
Acute lowering of blood pressure is harmful, except in cases of extremely high blood pressure (systolic > 220mmHg, diastolic > 110 mmHg). 🚫🩸
When is endovascular thrombectomy recommended for ischemic stroke, and what are the eligibility criteria?
Endovascular thrombectomy is highly effective within 6 hours of symptom onset when stroke is due to occlusion of a large vessel (e.g., internal carotid artery, proximal middle cerebral artery, basilar artery). 🧲
Eligible patients may overlap with those who receive intravenous alteplase, and both treatments can be used in the same patient.
Endovascular thrombectomy is also appropriate when alteplase is contraindicated (e.g., patient on anticoagulant) or when patients present too late for alteplase (between 4.5 and 6 hours after stroke onset). 🕒
What are the uses of carotid endarterectomy (CEA) and aspirin in the management of ischemic stroke?
CEA is considered for secondary prevention of ischemic stroke and TIA in selected patients. It prevents further ischemic events but doesn’t affect the outcomes of the patient’s current condition. 🚫🩸
Aspirin (300mg initially and 100mg subsequently) is the common medication for initial treatment of ischemic stroke, given as soon as possible (within 48 hours), unless contraindicated in hemorrhagic stroke. If thrombolysis is performed, aspirin should be delayed for 24 hours. 💊🕒
What are the clinical signs and possible causes of common peroneal nerve injury after knee surgery?
Clinical signs include foot drop due to ankle dorsiflexor weakness (deep peroneal nerve) and sensory loss over the outer aspect of the leg (common peroneal nerve and its superficial branch). 👣🚶♂️
Injury commonly occurs during knee surgeries due to nerve compression or trauma. 💥🔪
The nerve wraps around the fibular head and is superficial in this region, making it susceptible to injury. 🦵
What are the key differences between common peroneal nerve injury and other potential nerve injuries in the lower leg?
(Option A) L4 nerve root damage: Weak knee reflex and partially impaired ankle inversion but doesn’t explain the full clinical picture. 🦵👩⚕️
(Option B) L5 nerve root damage: Similar presentation to common peroneal nerve injury but history of knee surgery makes the latter more likely. 🩹👍
(Option D) Tibial nerve damage: Impaired ankle jerk, weak or absent plantar flexion, and weak ankle inversion. Sensory impairment affects different areas. 🤕👣
(Option E) Sciatic trunk damage: Located above the knee, unlikely to be affected by knee surgery. Produces a different clinical picture involving both common peroneal and tibial nerve injuries. 🦵🧐
Weakness of foot dorsiflexion and eversion. Which nerve is most likely to have been damaged?
Common peroneal nerve
What are the common medical conditions and procedures that may lead to reduced driving ability, and what are the recommended non-driving periods for private and commercial drivers in these situations?
In cases of various medical conditions or procedures, it is essential for patients to receive appropriate advice regarding their ability to drive safely. 🚗🩺
Patients themselves are responsible for informing the Road Safety Department about their medical condition, and failing to do so can result in legal consequences. 🚨📋
The table below outlines common medical problems and procedures and the recommended minimum non-driving periods, including advisory periods for private and commercial drivers. ⏳🚗🚚
what are the recommended non-driving periods for private and commercial drivers in these situations?
Ischaemic heart disease:
Acute myocardial infarction: 2 weeks (private) or 4 weeks (commercial)
Percutaneous coronary intervention (e.g., angioplasty): 2 days (private) or 4 weeks (commercial)
Coronary artery bypass graft: 4 weeks (private) or 3 months (commercial)
Disorders of the rate, rhythm, and conduction:
Cardiac arrest: 6 months (private and commercial)
Implantable cardioverter defibrillator (ICD): 6 months (private), after cardiac arrest (commercial)
Generator change of an ICD: 2 weeks (private)
ICD therapy associated with symptoms of haemodynamic compromise: 4 weeks (private)
Cardiac pacemaker insertion:
2 weeks (private)
4 weeks (commercial)
Vascular disease:
Aneurysm repair: 4 weeks (private) or 3 months (commercial)
Valvular repair: 4 weeks (private) or 3 months (commercial)
Other cardiovascular conditions:
Deep vein thrombosis: 2 weeks (private and commercial)
Pulmonary embolism: 6 weeks (private and commercial)
Heart/lung transplant: 6 weeks (private) or 3 months (commercial)
Syncope (due to cardiovascular event): 4 weeks (private) or 3 months (commercial)
Epilepsy:
First seizure OR isolated seizure: 6 months (private) or 5 years (commercial)
Recently diagnosed with epilepsy: 12 months (private) or 10 years (commercial)
Chronic epilepsy + uncontrolled seizure in the past: 12 months after the last seizure (if on treatment) (private) or 10 years (commercial)
Seizure only in sleep OR treated with surgery: 12 months after the last seizure (private) or 10 years (commercial)
Reducing the dose of one or more antiepileptic drugs: 3 months after dose reduction (if no other seizure occurs) (private)
Seizure in a person whose epilepsy was previously well controlled: 4 weeks if a provocative cause can be identified or 3 months if a provocative cause cannot be identified (private and commercial)
Vertigo:
Benign paroxysmal positional vertigo: 3 months (private) or 6 months (commercial)
Meniere’s disease: Conditional license if there are alarming symptoms to alert the driver of the attack (private and commercial)
Stroke / intracranial hemorrhage:
Intracranial surgery: 6 months (private) or 12 months (commercial)
Stroke (ischemic or hemorrhagic): 4 weeks (private) or 3 months (commercial), conditional licensing depends on residual defects
TIA: 2 weeks (private) or 4 weeks (commercial)
Subarachnoid hemorrhage: 3 months (private) or 6 months (commercial)
Visual acuity / visual fields:
Visual acuity: No driving license if acuity in the better eye or with both eyes together is worse than 6/12 (private) or no driving license if acuity in the better eye is worse than 6/9 (commercial)
What are the recommended non-driving periods for patients after a stroke or transient ischaemic attack (TIA), and what assessments are necessary before they can resume driving?
Patients who have experienced a stroke or transient ischaemic attack (TIA) are generally considered unfit to drive until certain criteria are met. 🚗🩺
After a stroke:
Private vehicle drivers should not drive for at least 4 weeks.
Commercial vehicle drivers should not drive for at least 3 months.
These non-driving periods apply even if the patient has no detectable neurological deficit.
Before resuming driving, patients must undergo an assessment to evaluate for residual impairments that could impact their ability to drive safely. 🚦📋
Particular concerns include sensory and/or visual inattention (neglect) and hemianopia. 🚫👁️
Patients with significant neurological, cognitive, or perceptual impairments (especially inattention) should be referred for a driving assessment supervised by an occupational therapist.
Patients with hemianopia should be referred for assessment by an ophthalmologist.
After a TIA:
Private drivers are advised not to drive for 2 weeks.
Commercial drivers are advised not to drive for 4 weeks.
When is the MMR vaccine typically administered in infants, and why?
MMR-containing vaccines are usually not recommended for infants under 12 months due to the presence of maternal antibodies to measles, which can interfere with immunization. ⏰👶
Evidence suggests that giving the first MMR dose at 11 months (but before 12 months) can provide sufficient immunity. 💉👶👍
Rubella infection offers lifelong immunity in immunocompetent individuals, but not against measles and mumps. 🩺🔒
Can family members or friends be used as interpreters for patients with language barriers?
in general, using family, friends, or non-accredited individuals as interpreters is discouraged. 🚫❌
Such practices may raise legal and ethical concerns about the validity of consent obtained. 🧾⚖️
Exceptions can be made when the medical issue is minor and the patient explicitly wishes to use a close friend or family member as an interpreter. 🤝💬
