Public health

Question 1

Adherence vs compliance

Answer 1

Adherence preferred terminology rather than compliance
Adherence acknowledges the importance of patient beliefs
Adherence is much more patient centered

Question 2

Non-adherence examples

Answer 2

Antibiotics - stopping the medicine without finishing the course
Dementia (forgetfulness)
Skipping physiotherapy
Modifying treatment to accommodate work/social life
Continuing with behaviours against medical advice (diet, smoking, alcohol)

Question 3

Reasons for non-adherence

Answer 3

Unintentional (capacity and resource) - difficulty understanding instructions, inability to pay, forgetting
Intentional (perceptual) - Patients beliefs about their health/condition, personal preferences (Jehovahs witnesses)

Question 4

Necessity-Concerns framework

Answer 4

Necessity beliefs - perceptions of personal need for treatment
Concerns - potential adverse effects
Increased adherence = increased necessity beliefs, decreased concerns

Question 5

Patient centredness

Answer 5

Shared control of consultation, decisions about interventions or management of health problems with the patient
Patient as a whole person

Question 6

Concordance

Answer 6

Process of being patient centered

Negotiation between equals

Question 7

Barriers to concordance

Answer 7

The patient may simply want the doctor to tell them what to do, where medical decisions were complex or based on complicated info (stats)

Question 8

Ethical considerations

Answer 8

Mental capacity (dementia, severe learning disability, brain injury, mental health condition)
Potential threat to health of others
When patient is a child - 3rd party (parents)

Question 9

Public health act

Answer 9

Provides a basis to detain and isolate an infectious individual

Question 10

RF types

Answer 10

Unmodifiable risk factors - Age, sex, gender, ethnicity
Lifestyle risk factors - Smoking, diet, physical activity level
Clinical risk factors - Hptn, diabetes, lipids
Psychosocial risk factors - Work/occupation, anxiety/depression

Question 11

Coronary prone behaviour pattern

Answer 11

Type A behaviour - Competitive, hostile, impatient

Question 12

Assessing behaviour

Answer 12

Questionnaires - MMPI
Self report
Structured clinical interviews - Speech, answer content, psychomotor responses, non-verbal

Question 13

Cardiology counseling

Answer 13

Fewer cardiac events occur as a result of this educational approach

Question 14

Anger and hostility

Answer 14

Key RF
Verbal or physical aggression
Annoyance
Feelings of anger

Question 15

Type A behaviour modification

Answer 15

Educational and psychological

Question 16

Depression/anxiety and CHD - Measurement tools

Answer 16

MMPI -
BDI - Beck depression inventory
GHQ - General health questionnaire

Question 17

Psychosocial work characteristics

Answer 17

High demand/Low control = Raised MI risk

Question 18

Whitehall studies

Answer 18

Lower work grade = Greater CHD mortality rate

Question 19

Working hours and CHD

Answer 19

Working more than 11 hours a day increases heart attack risk by 67% than those working the standard 7-8hrs

Question 20

Social support

Answer 20

Loneliness and social isolation are RFs for CHD and stroke

Question 21

What can doctors do

Answer 21

Observe behaviour patterns
Identify signs of anxiety/depression
Use assessment tools
Ask about occupation

Question 22

Hepatitis B

Answer 22

Common in Roma Slovak community

Question 23

Inverse care law

Answer 23

Availbaility of good medical care tends to vary inversely with the need for it in the population served

Question 24

Socioeconomic position and circumstance

Answer 24

Income
Class (ownership of assets)
Status (hierarchy/prestige)

Question 25

CHD risk

Answer 25

Higher risk in south asian people

Question 26

Cancer rates lower in

Answer 26

BME ethnic minority groups

Question 27

Risk factors for VitD deficiency

Answer 27

Reduced sunlight exposure | Pigmented skin

Question 28

VitD deficiency - Symptoms

Answer 28

Bone pains/fractures Muscle weakness Dental deformities Rickets (in children) - Bowed legs (bent), big and bumpy joints

Question 29

Female genital mutilation

Answer 29

More common in BME minority groups

Question 30

BME

Answer 30

Black minority ethnic group | Non-white descent

Question 31

Stroke risk

Answer 31

F>M

Question 32

IHD risk

Answer 32

M>F

Question 33

Rose hypothesis

Answer 33

A large number of people at a small risk may give rise to more cases of disease than the small number who are at high risk

Question 34

Social inequality - Principal RF in mortality

Answer 34

Smoking

Question 35

How to protect communities against infectious disease (notifiable)

Answer 35

Investigation - Contact tracing, partner notification | Identify and protect vulnerable persons - Chemoprophylaxis, immunisation, isolation

Question 36

Meningococcal infection

Answer 36

Vaccine preventable disease Infection presents as meningitis or septicaemia Caused by neisseria meningitidis Transmitted from person to person by inhaling respiratory secretions from mouth/throat or direct contact (kissing) Majority of infections occur in children with a small secondary peak in young adults Seasonal peak in winter

Question 37

Meningococcal infection - Complications

Answer 37

``` Brain damage/abscess Seizures Hearing impairment Gangrene+autoamputations Death - more deaths due to septicaemia than meningitis ```

Question 38

Gangrene pathopshyiology in meningococcaemia

Answer 38

Infection causes arterial occlusions leading to gangrene of extremities and auto-amputations

Question 39

Meningococcal infection - Treatment

Answer 39

Antibiotic therapy - Cefotaxime/ceftriaxone | Supportive - fluids

Question 40

Meningitis - Prophylaxis

Answer 40

Antibiotic chemoprophylaxis - Ciprofloxacin or rifampicin Vaccination (depends on serogroup) Glass test - Petechial spots do not blanch on pressure

Question 41

Meningitis - Routine childhood immunisations

Answer 41

MenB MenC MenACWY (year 9 school)

Question 42

Travel vaccination

Answer 42

MenA/C/ACWY especially for Hajj/umrah

Question 43

Diseases/problems associated with ageing

Answer 43

``` Osteoporosis, falls and fractures Osteoarthritis Dementia, delirium, cognitive impairment Parkinson's Stroke Macular degeneration Cataracts AF Hptn Angina ```

Question 44

Polypharmacy

Answer 44

5 or more meds

Question 45

Erythema ab igne and Onychogryphosis

Answer 45

Erythema ab igne - rashy legs can indicate hypothyroidism (cold) due to excessive exposure to heat from fireplaces etc Onychogryphosis - Outgrowing toenails