Public Health Flashcards
(80 cards)
1
Q
When is somebody deemed unable to make a decision? (4)
A
A person is unable to make a decision if they cannot:
1. Understand information about the decision to be made.
2. Retain the information in their mind.
3. Use/Weigh information as part of decision making
4. Communicate their decision.
Applies for young people aged 16-17 also.
2
Q
Give some examples of screening tests provided on the NHS?
A
Newborn hearing screening Breast Screening Bowel Screening Cervical Screening Sickle Cell and Thalassaemia Screening
3
Q
Give an example of when you may ethically have to disrespect a culture.
A
FGM
4
Q
What are the Millennium Development Goals? (8)
A
- Eradicate Extreme Poverty and Hunger
- Achieve Universal Primary Education
- Promote Gender Equality and Empower Women
- Reduce Child Mortality
- Improve Maternal Health
- Combat HIV/AIDS, Malaria and Other Diseases
- Ensure Environmental Sustainability
- Develop a Global Partnership for Development
5
Q
What are the risk factors for addiction?
A
Family HIstory Low Academic Achievement Availability of Drugs Community Norms Transitional Life Risk-Seeking Individuals Rebelliousness Friends Use Drugs Trauma
6
Q
What are a doctors obligations? (4)
A
- Duty to Patient
- Accountable to Employer and Regulator
- Responsible for each other, the profession and public health
- Moral Obligation
7
Q
Which factors can affect somebodies recovery from dependence? (6)
A
- The drug that they use
- The pattern/level of drug use
- Their support preferences
- What they have tried before
- Their mental/physical health
- Other issues such as housing and employment
8
Q
What are the principles of screening? (10)
A
- Condition should be an important problem
- There should be an acceptable treatment
- There should be a recognised early stage
- Facilities for diagnosis/treatment are available.
- There should be a suitable test
- The test should be acceptable to the population
- The natural history of the disease should be known
- Case finding should be a continuous process
- Early treatment should make a difference to prognosis.
- Cost of case finding should be economical
9
Q
What are the 5 principles of mental capacity?
A
- A person must be assumed to have capacity unless it is established they do not.
- A person must not be treated as unable to make a decision until all practicable steps to help him to do so have been taken without success.
- Must not be treated as unable to make a decision because of a previous unwise decision
- Acts done under the Mental Capacity Act myst ve made in patients best interest.
- Can things be done in a way that is less restrictive to an individuals freedom?
10
Q
What are some of the symptoms of alcohol withdrawal? (5)
A
Tremulousness - The "Shakes" Activation Syndrome Seizures Hallucinations Delirium Tremens
11
Q
What are some of the symptoms of fetal alcohol syndrome?
A
Pre and post natal growth retardation
CNS abnormalities: mental retardation, irritability, incoordination, hyperactivity
Craniofacial Abnormalities, congenital defects - increase in incidence of birthmarks and hernias
12
Q
What is the doctrine of dual effect?
A
- Nature of Act is itself good
- Agent intends the good effect and not the bad either as a means to the good or as an end itself
- Good Effect outweights the bad to justify causing the bad effect and the agent exercises due diligence to minimise the harm
13
Q
What are the duties of a doctor? (8)
A
- Make the care of the patient your first concern
- Keep your professional knowledhe and skills up to date
- Treat your patient politely and considerately
- Respect your patients right to confidentiality
- Listen to patients and respond to their concerns and preferences.
- Never discriminate unfairly against patients or colleagues.
- Work with colleagues in the ways that best serve patients’ interests.
- Treat patients as individuals and respect their interest. Some duties conflict.
14
Q
What are the four types of drugs that can cause hospital admission, how do they work and give examples?
A
Opiates: Heroin - Euphoria and Pain Relief
Depressants: Alcohol, Valium - Sedation, Relaxation, Slow down thinking and acting
Stimulants: Caffeine, Nicotine, Cocaine - Increase Alertness and activity
Hallucinogens: Ecstacy, Ketamine, Magic Mushrooms: Alter sensory perception, lose sense of reality
15
Q
How is a person who lacks capacity defined?
A
A person who lacks capacity to make a particular decision/take action for themselves at the time a decision needs to be made.
16
Q
What is the Navajo belief?
A
Belief that to discuss bad information is to make it happen.
17
Q
What are the four principles?
A
Autonomy, Beneficience, Non-maleficience, Justice
18
Q
What are some of the physical symptoms of withdrawal?
A
Runny Nose
Stomach Cramps
Muscle Aches
19
Q
What should be done when C Dificile is suspected?
A
SIGHT Suspect C Diff as cause of diarrhoea Isolate the Case Gloves and Aprons must be worn Hand washing with soap and water Test Stool for Toxin -Control Antibiotic Usage and Treat with Metronidazole/Vancomycin
20
Q
What is the national drug strategy? (7)
A
- Reduce Demand
- Restrict Supply
- Build Recovery In Communities (i.e. AA)
- Public Health England supports local councils to provide provision specific to local need (though funding has decreased)
- Family/Community Involvement
- Payment by Results
- Abstinence focussed
21
Q
What Psychosocial Factors increase the risk of CHD? (4)
A
Type A Personality
Depression/Anxiety
Psychosocial Work Characteristics (Long working hours, more than 11 a day - high demand, low control)
Lack of Social Support
22
Q
How is somebodys capacity tested? (2)
A
- Does this person have impairment of/disturbance in functioning of their mind or brain.
- Does impairment/disturbance mean person is unable to make specific decisions when they need to.
23
Q
How have Public Health England intervened in National Strategy for reducing alcohol abuse?
A
THINK! Campaign
Minimum Pricing - 50p per unit
Secondary Prevention - GP’s ask regularly about alcohol use
24
Q
What constitutes one unit of pure alcohol? Give examples
A
8g or 10ml of pure alcohol
Half a pint of beer
Small glass of wine
Single measure of spirits
25
Discuss 4 Theories of Medical Ethics.
Utilitarian/Consequentialism: An act is evaluated solely in terms of its consequences, produce the greatest possible balance of value over disvalue, maximising well being and minimizing suffering
Deontology: Duty to follow natural laws and rights; rightness or wrongness from the character of the act itself rather than the outcomes, features of the act themselves determine worthiness. I.E. Doctors have to respect everyone.
Virtue Ethics: Focus in on the character of the agent, integrates reason and emotion; deemphasizes rules, consequences and particularacts
Morality: Concern about the distinction between good and evil or right and wrong.
26
What are some of the chronic effects of long term alcohol use? (3)
```
Pancreatitis
CNS Toxicity (Dementia)
Liver Damage (Fatty change, hepatitis, cirrhosis)
```
27
What are the four types of new psychoactive substances, give examples?
Synthetic Cannabinoids: Spice, Black Mamba
Stimulant Type Drugs: Benzo Fury, Mephadrone
Downers/Tranquilisers: Pyrazolam
Hallucinogens: mimic LSD - Bromo, Drogonfly
28
How are Alcohol Abuse (4) and Alcohol Dependence (6) differentiated?
Alcohol Abuse - 1 or more of the following:
- Role Failure
- Risk in Bodily Harm
- Run-Ins with the Law
- Relationship Toruble
Alcohol Dependence - 3 or more of the following
- Tolerance
- Signs of Withdrawal
- Not Been Able to Stick to Limits
- Spent A Lot of Time Drinking
- Less Time Spent on Other Matters
- Kept Drinking Despite Problems
29
How is BMI Calculated and what values are what?
```
Weight (kg) / Height (m)2
<16 Severely Underwight
16-17 Moderately Underweight
17-18.5 Mildly Underweight
25-30 Moderately Obese
40+ Severely Obese
```
30
What is the duty of candour?
Being open, honest and transparent. Spontaneously disclosing error of uncertainty.
If patient has undergone harm:
- Put Things Right
- Apologise
- Say how things will change in both short and long terms
31
What are the key reported harms associated with new psychoactive substances?
```
Overdose, temporary psychotic states
Attendance at A and E
Sudden Increase in Body Temperature, Heart rate increases leading to coma
Hallucination and vomiting
Confusion, Aggression and Violence
Suicidal Thoughts
```
32
How does Naltrexone work?
Competetive antagonist for opioid receptors, rapid detox
33
What is substance use disorder? (11)
2/3 Mild, 4/5 Moderate, 6+ Severe
- Consume more than originally planned
- Worrying about Stopping/ Constantly failed efforts to control
- Spending a large amount of time using/obtaining substance
- Use Results in failure to fulfill major role obligations
- Craving
- Continued Use despite health problems caused by it
- Continued Use despite Relationship effects
- Repeated Use in Dangerous Situations (eg Driving)
- Giving Up/ Reducing Activities
- Building Up a tolerance
- Withdrawal Effects After Stopping
34
Describe some of the various viewpoints for why people struggle with addiction (4)?
Denise Bee Veers Sideways
Disease Model: Chronic Recurrent Illness/genetic disorder
Behavioural Model: Bad Habit
Volitional Model: Failure of Will
Socio-cultural Model: A symptom of social problems
35
What is the difference between Aleatory and Epistemic uncertainty?
Aleatory: I can't know any more
Epistemic: I don't know any more
36
How many units is the recommended maximum to drink before driving?
1.7 Units
37
What pharmacological interventions may be considered for treatment of addiction/dependance? (4)
Acamprosate Calcium (Campral)
Disulfiram (Antabuse)
Nalmefene
Naltrexane
38
Describe Physical and Psychological Dependence.
Physical: The body adapts to presence of the substance and over time needs more and more for the same effect
Psychological: Feeling that life is impossible/challenges cannot be faced without the drug. Emotional Reactions: fear, pain, shame, guilt, loneliness
39
Who provides help with drug/alcohol abuse?
```
GPs
Harm Reduction Services (Needle Exchange)
Open Access Service
Structured Psychosocial Interventions
Prescribing Services
Detoxification
Access to Rehab
```
40
What is the difference between sensitvity and specificity?
Sensitvity: Measure of how well a test picks up those with the disease?
Specificity: Measure of how well a test recognises those without the disease
41
If you need to whistle blow, how should you go about it (3 steps)?
Raise Internally
Give a deadline for response/action
Discuss/Take Advice
42
How would you practice motivational interviewing in order to help somebody stop drinking? (6)
FRAMES
Feedback about risk of personal harm or impairment
Stress personal Responsibility for making change
Advice to cut down, or if necessary stop drinking
provide a Menu of alternative strategies for changing patterns
Empathetic Interviewing Style
Self-Efficacy: Intuitive Style which leaves patient enhanced in feeling able to cope with goals they have agreed
43
What are the stages of change associated with quitting smoking?
1. Precontemplation: Smoker, not thinking about quitting
2. Contemplation: Smoker, thinking about quitting but not ready yet
3. Preparation: Smoker, thinking about quitting and taking steps to prepare for quitting
4. Action: Ex-Smoker, quit for <6 months
5. Maintenance: Non-smoker, quit for more than 6 months
6. Relapse: Quit smoking then had a lapse (1 cigarette) that led to smoking being resumed.
44
What are some of the acute effects of alcohol? (7)
```
Accidents and Injury
Aspiration Pneumonia
Mallory Weiss Tear
Pancreatitis
Cardiac Arrhythmias
Cerebrovascular Accidents
Hypoglycaemia
```
45
How are units of alcohol calculated and what is the advised limit per week ?
Strength of drink (% ABV) x Amount of liquid in ml /1000
No more than 14 units a week, spread over 3 days or more
46
What is dependence syndrome? (6)
Experienced 3/6 or more in the past 12 months:
- Strong Desire/Compulsion to use
- Difficulties in controlling substance taking behaviour
- Physiological Withdrawal State when reduced use
- Tolerance (Need more for same effect)
- Progressive Neglect for pleasure/interests, increased time spent using.
- Persistent use despite evidence of harmful consequences
47
Name two questionnaires that doctors can use to screen for Alcoholics?
CAGE and AUDIT
48
How can doctors test how severe somebodies addiction is?
Severity of Dependence Questionnaire (SADQ)
| Score: 31 severe, 16-30 moderate <16 mild
49
Why do people smoke? (5)
```
Fear of weight gain on cessation
Coping with stress
Socialising
Nicotine addiction
Habit/behavioural
```
50
What can doctors do for smokers?
Nicotine Replacement Therapy: patches, gum, nasal spray
```
5 A's
Ask (are you a smoker)
Advise (smoking is bad)
Assess Willingness to Quit
Assist (therapy)
Arrange Follow Up
```
51
What makes a job 'good'? (10)
1. Precariousness - stable, risk of loss : safe
2. Individual Control - part of decision making
3. Work Demands - quality and quantity
4. Fair Employment - earnings and security from employer
6. Prevents social isolation, discrimination and violence
7. Share information - participate in decision making
8. Good work life/balance
9. Reintegrates sick or disabled whenever possible
10. Promotes health and wellbeing - psychological needs.
52
What are the seven steps to ending malnutrition in hospitals?
1. Hospital Staff must listen to older people, their relatives and carers and act on what they say.
2. All ward staff must become 'food aware'.
3. Hospital staff must follow their own professional codes and guidance from other bodies.
4. Older people must be assessed for signs or danger of malnourishment on admission and at regular intervals throughout their stay.
5. Introduce 'protected mealtimes'.
6. Implement a 'red tray' system and ensure that it works in practice
7. Use volunteers where appropriate.
53
Name three methods that can be used to improve or maintain nutritional intake?
1. Oral nutrition support
2. Enteral Tube Feeding
3. Parenteral nutrition (IV)
54
How is Anorexia Nervosa treated? (7)
1. Stabilisation of eating, self-monitoring, weekly weighing
2. Initial focus on enhancing motivation
3. Behaviour change: Weight re-gain is essential.
4. Cognitive restructuring: testing dysfunctional attitudes on weight pain, loss of control etc
5. Relapse prevention
6. Food Diaries
7. Psychological: CBT, Family therapy
55
What are the psychological principles of anorexia nervosa? (4)
1. Judge self worth exclusively in terms of shape, weight and their control.
2. Control of eating and shape is socially re-enforced and apparently more controllable than other aspects of life.
3. Individual vulnerability plus challenges of adolescence can start the disorder.
4. Thinness = competence, attractiveness, control, independence
56
Give 3 reasons why whistleblowing is important?
1. Duty as a doctor
2. Mid Staffordshire Scandal - patients were not cared for
3. Patient and their care is primary concern
57
How is an autonomous action defined? (3)
1. Intentional
2. Done with understanding
3. Done without controlling influences that determine an individuals actions.
58
What are the five focal virtues?
1. Compassion
2. Discernment
3. Trustworthiness
4. Integrity
5. Conscientiousness
59
What are some of the limitations of virtue ethics?
Assesment of virtue is cultural and non specific.
Notion of virtue is too broad for practical application
An emphasis on the moral character f individuals ignores social and communal dimensions.
60
How can the functional daily living of older people be assessed?
1. Activities of Daily Living Scale (KATZ)
2. Instrumental Activities of Daily Living Scale
3. The Barthel ADL Index
4. Mini Mental State Examination
61
Describe the iceberg concept of disease.
The number of cases of disease ascertained is outweighed by those not discovered, assessment of the true burden of disease and need for services is often not easily done.
1. Pre-symptomatic
2. Undiagnosed / Wrongly diagnosed
3. Diagnosed, uncontrolled
4. Diagnosed, controlled
62
What is the public health intervention for influenza?
1. Hand Washing
2. Respiratory Hygeins 'Catch it, bin it, kill it'
Give fluids and zinc to those affected
63
What are the four types of error?
Human error: failure of planned action or sequence
of mental or physical actions to be completed as
intended
Never events: serious, preventable patient safety
incidents that should not occur if available
preventative measures have been implemented.
Intolerable and inexcusable
Latent failure: removed from practitioner and
involving decisions that affect organisational
policies, procedures, allocation of resource
Active failure: involved direct contact with patient
3 types of error:
- omission (delay in action or not taken)
- professional negligence
- commission (wrong action taken)
64
What are the Bolam and Bolithos tests?
Would a group of reasonable doctors do the same?
| Would it be reasonable for them to do so?
65
What are the priorities in end of life care? (5)
1. Possibility recognised and communicated
2. Sensitive communication
3. Decision making is shared.
4. Families needs met.
5. Individual Plan of Care
66
When can death be verified? (4)
1. No Heart sounds or carotid pulse for one minute.
2. No respiratory effort or breath for one minute
3. Fixed and dilated pupils.
4. No response to pain stimuli.
67
Describe Gillicks and Fraser competency.
Gillicks: Childs capacity to consent (16-17 years old)
Fraser: Childs capacity to consent to contraceptive or sexual health advice (14-16 years)
Children under the age of 13 cannot consent to any sexual activity and thus if acted or suggested, the case is reported.
68
What are the Fraser Guidelines (5)?
Need to be met for abortion under 16 without parental consent.
1. Girl Understands Advice
2. Can't persuade her to inform parents via doctor or herself.
3. Likely to continue having sexual intercourse with or without contraceptives.
4. Mental and Physical Health will suffer if not provided sexual health advice or contraception.
5. Best Interests.
69
Describe the law in the UK for Doctors with regard to abortion. (5 points)
GP fills out HSA1 form for abortion with patient. This requires 2 doctors signatures and one of the five reasons to be satisfied.
A. Risk to Mums Life is Too High
B. Permanent Injury to Mum
C. Greater Risk to patient continuing pregnancy versus risk associated with pregnancy.
D. Existing Kids and family at risk.
E. Risk to child of being handicapped.
70
Give a reason that a patient may not be compliant.
Unintentional patient beliefs about their condition of treatment and personal preferences.
71
What are the four main aims of the Marmot Report?
Sustainable Local Communities
Active Transport
Sustainable Food production
Zero Carbon Houses
72
What is the Marmot Report?
Health Inequalities Review. Social Determinants determine health inequality. People in the most deprived areas die 7 years earlier. Huge gap between rich and poor. This will result in monumental cost.
73
Describe Maslow's Hierarchy of Needs.
Lowest Level: Physiological - Breathing, food, water, sleep, homeostasis, sex, excretion
Next up is Safety: Security of Body, of employment, of resources, of morality, of the family, of health, of property
Love and Belonging: Friendship, family, sexual intimacy
Esteem: Self-esteem, Confidence, Achievement, Respect of Others, Respect By Others
Self-Actualization: Morality, Creativity, Spontaneity, Problem Solving, Lack of Prejudice, Acceptance of facts
74
How can HIV transmission be prevented? (9)
1. Circumcision of Males
2. Pre exposure prophylaxis and post exposure prophylaxis
3. STI Control
4. Screen Blood Products (Transfusions)
5. Vaccinations
6. Microbicidal Gels (Vaginal)
7. Needle Exchange Programmes.
8. Education and Behavioural Change - condoms, reduce partner changes, reduce traumatic sex
9. Partner Notification
75
What are some of the reasons why FGM may occur? When should you suspect?
1. Control womens sexuality
2. Cultural Identity
3. Gender based factors (womanhood)
4. Religion
5. Hygeine
If child returns from a holiday late, spends more time in the toilet and withdrawn
76
What are the nine Belbin Team Roles?
```
Plant - Creative
Resource investigator - Opportunist
Coordinator - Mature
Shaper - Drive and Courage
Monitor Evaluator - Strategic
Teamworker - coorperative, perceptive
Implementer - Disciplined, reliable
Completer - Conscientious, Anxious
Specialist - Single Minded
```
77
What is the four quadrants approach to treatment and ethics?
Is There a medical indication - beneficence or non maleficence?
What is the patients preference?
Quality of Life - Beneficence and Non Maleficence
Contextual Features - Loyal and Fair to patient and families.
78
What is the STI/HIV Transmission Model?
```
R = BCD
R = Reproduction Rate: Rate Organism Reproduces
```
B = Infectivity Rate: Chance of Infection per potential Exposure
C = partners over time: Number of opportunities for transmission
D = Duration of Infection
79
Why are notifiable disease notifiable?
- To Prevent Outbreaks
| - To control possible epidemics
80
Give four reasons that a patient with pneumonia might have persistant symptoms despite correct antibiotics?
Pleural effusion
Empyema
Respiratory failure
Septicaemia
