Public Health Flashcards
(288 cards)
1
Q
What proportion of medicines for chronic conditions are not taken as prescribed?
A
30-50%
2
Q
What is compliance?
A
Assumes doctor knows best, patient passive
3
Q
What is adherence?
A
Acknowledges important of patient’s beliefs
4
Q
What is needed to support adherence?
A
Patient-centred approach
5
Q
Give 5 examples of non-adherence
A
- Not taking prescribed medication
- Taking bigger/smaller doses than prescribed
- Taking medication more/less often than prescribed
- Stopping medication without finishing course
- Modifying treatment to accommodate other activities
6
Q
What are the practical barriers for non-adherence?
A
- Difficulty understanding instructions
- Problems using treatment
- Inability to pay
- Forgetting
- Capacity and resource
7
Q
What are the motivational barriers for non-adherence?
A
- Pt. beliefs about their health/condition
- Beliefs about treatment
- Personal preferences
- Perceptual barriers
8
Q
What are the 2 beliefs influencing pt. evaluation of prescribed medications?
A
- Necessity
2. Concerns
9
Q
What are necessity beliefs?
A
Perceptions of personal need for treatment
10
Q
What are concern beliefs?
A
Concerns about a range of potential adverse consequences
11
Q
What does patient-centred care encourage?
A
- Focus in consultation on pt. as a whole person who has individual references situated in a social context
- Shared control of consultation, decisions about interventions or management of health problems with pt.
12
Q
What are the impacts of good doctor-patient communication?
A
- Better health outcome
- Higher adherence to therapeutic regimens
- Higher pt. and clinician satisfaction
- Decrease in malpractice risk
13
Q
What is concordance?
A
Notion that work of prescriber and patient in consultation is a negotiation between equals
14
Q
What is the aim of concordance?
A
Therapeutic alliance between prescriber and patient
15
Q
What are the strengths of concordance?
A
- Respect for patient’s agenda
2. Open relationship
16
Q
What are the patient barriers to concordance?
A
- Do patients want to engage in discussion with their HCP?
- Might worry some patients
- Patients may want to be told what to do
17
Q
What are the HCP barriers to concordance?
A
- Relevant communication skills
- Time/ resources/ organisational constraints
- Challenging
18
Q
What are the key principles of adherence?
A
- Improve communication
- Increase patient involvement
- Understand patient’s perspective
- Provide information
- Assess adherence
- Review medications
19
Q
What are the ethical considerations for adherence?
A
- Mental capacity
- Public health threat
- Child welfare
20
Q
What does the Public Health Act provide a basis for?
A
To detain and isolate an infectious individual in category 4 or 5 disease
21
Q
How many healthcare associated infections (HCAIs) are there in England per year?
A
300,000
22
Q
How much do HCAIs cost the NHS per annum?
A
£1bn
23
Q
What does Health Act 2006 determine?
A
Infection control is every health care workers responsibility
24
Q
How are infections prevented and controlled?
A
- Identify risks
- Develop strategies to reduce risks
- Ensure staff are aware of risks and what to do
25
Give 3 infection control policies
1. Single use items
2. Outbreak Control plan
3. Antibiotic review policy
26
What is infection?
Affect with a disease-causing organism, requires harm to be done
27
What is colonisation?
Presence of bacterial cells of humans but without harm
28
What are the 4 principles of infection prevention and control?
1. Identification of risks
2. Routes and modes of transmission
3. Virulence of organisms
4. Remediable factors
29
What are the routes of transmission?
1. Patient
2. Environment
3. Staff
30
How can patient A be identified?
1. Risk factors
2. Screening
3. Clinical diagnosis
4. Lab diagnosis
31
What are carbapenemase producing enterobacteriaceae (CPE)?
Colonisers of large bowel, skin below waist and moist sites
32
What doe CPEs often cause?
UTIs and intra-abdominal infections
33
What beta-lactam antibiotics are used for Gram -ve resistant bacterias?
Carbapenems
34
Where are CPEs often found?
Countries with unregulated use of antibiotics
35
What can be done to stop the route of transmission?
1. Isolation
| 2. Ward design
36
What is the lead cause of gastroenteritis?
Norovirus
37
Why is norovirus so infective?
1. Low infecting dose
2. Short lived immunity
3. Able to persist in environment for a long time
4. Resistant to conventional cleaning
38
What is the most effective method of preventing cross infection?
Hand hygiene
39
What is an endogenous infection?
Infection of a patient by their own flora rather than being acquired from others
40
Name 5 groups of people most at risk of HIV
1. MSM
2. PWID
3. Commercial sex workers
4. Heterosexual women
5. Truck drivers
41
What are the stages of epidemic?
1. Nascent
2. Concentrated
3. Generalised
42
What is seen in nascent epidemics?
<5% prevalence in all risk groups
43
What is seen in concentrated epidemics?
>5% prevalence in one or more risk groups
44
What is seen in generalised epidemics?
>5% prevalence in general population
45
50% of all new HIV infections occur in which age group?
15-24 year olds
46
What proportion of HIV infections occur in sub-Saharan Africa?
2/3
47
What are the behavioural changes seen in combatting HIV?
1. Education
2. Condom use
3. Needle exchange
48
What is a problem for condom use and consensual sex in HIV infections?
Gender inequality
49
Why does circumcision reduce HIV infection?
1. Keratinisation of the inner aspect of the remaining foreskin
2. Langerhans cells are removed
3. Reduced occurrence of ulcers
4. Reduced abrasions or inflammation of foreskin
50
What can be done to reduce HIV transmission in PWID?
1. Needle and syringe programmes
2. Drug dependence treatment
3. Close compulsory drug detention and rehab centres
51
What is the risk of MTCT of HIV if untreated?
35%
52
What can be done to reduce MTCT of HIV?
1. Comprehensive antenatal HIV screening
2. Anepartum zidovudine (AZT)
3. Oral nevirapine for infant
4. HAART for mother
5. Lifelong antiretroviral treatment for mother
53
What are the goals of HIV testing?
1. Provide high quality service for identifying HIV
2. HIV treatment, care and support
3. Prevent transmission
54
Why is diabetes a public health issue?
1. Mortality
2. Disability
3. Co-morbidity
4. Reduced QOL
55
Why is T2DM a public health issue?
It is preventable but increasing in prevalence, lacks policies and has major inequalities in its patients
56
How many people in England have diabetes?
3.8m
57
How many people in England have undiagnosed diabetes?
940k
58
What % of diabetes cases are type 2?
90%
59
How can T2DM impact be reduced?
1. Identify people at risk
2. Preventing diabetes
3. Diagnosing diabetes earlier
4. Effective management and supporting self-management
60
What environmental factors increase risk of diabetes?
1. Sedentary job
2. Sedentary leisure activities
3. Diet high in calorie dense foods
4. Obesogenic environment
61
What does an obesogenic environment consistent?
1. Physical environment e.g. car culture
2. Economic environment e.g. cheap TV watching
3. Sociocultural environment e.g. family eating habits
62
What physical factors maintain overweight?
More weight is harder to exercise, dieting
63
What psychological factors maintain overweight?
Low self-esteem and guilt, comfort eating
64
What socioeconomic factors maintain overweight?
Reduced opportunities, employment, relationships, social mobility
65
What DM screening tests are currently available?
1. HbA1c
2. Random capillary blood glucose
3. Random venous blood glucose
4. Fasting venous blood glucose
5. Oral glucose tolerance test
66
What interventions are required for DM at primary level?
1. Sustained increase in physical activity
2. Sustained change in diet
3. Sustained weight loss
67
What secondary approaches are there for DM?
1. Raise awareness of diabetes and possible symptoms in community
2. Raise awareness of DM in HCPs
3. Use clinical records to identify those at risk and/or using blood tests to screen before symptoms develop
68
What measures are in place for supporting-self care of DM?
1. Self-monitoring
2. Diet
3. Exercise
4. Drugs
5. Education
6. Peer support
69
What is overweight?
Abnormal or excessive fat accumulation that presents a risk to health
70
How many adults in England are OW or obese?
64%
71
What socioeconomic factors contribute to OW?
1. Poverty
2. Ethnicity (Black African)
3. Disability
4. Lack of qualifications
5. Severe mental illness
72
What % of children in England are OW/obese?
34%
73
What is the reduction in life expectancy as a result of obesity?
3 years
74
Give 3 costs of obesity
1. Less likely to be in employment
2. Increased risk of hospitalisation
3. £6.1bn cost to NHS
75
Give 4 consequences of childhood obesity
1. Stigma
2. School absence
3. Poor physical health
4. Risk into adulthood
76
What factors contribute to energy expenditure?
1. Level of accessibility of healthy food
2. Level of acceptability of healthy food
3. Level of availability of healthy food
4. Level of affordability of healthy food
77
What 5 feedback loops are involved in obesity?
1. Health loops
2. Governance loops
3. Business loops
4. Supply and demand loops
5. Ecological loops
78
What are the 4 tiers of individual level interventions for obesity?
1. Universal prevention
2. Lifestyle intervention
3. Specialist services
4. Surgery
79
Give 6 national actions to combat childhood obesity
1. Calorie labelling on food products
2. Sugar tax
3. Strengthen government buying standards for food
4. Watershed for HFSS product adverts
5. Physical activity in schools
6. Ban price promotions of HFSS
80
Give 3 local actions to combat obesity
1. Exclusion zones
2. Sport and leisure
3. Upkeep of open spaces
81
What are the 4 quadrants of clinical ethics?
1. Medical indications
2. Patient preferences
3. QOL
4. Contextual features
82
What is connectivity and interdependence?
Behaviour of one individual may affect others or wider system
83
What is co-evolution?
Adaptation or changes by one organism alters other organisms
84
What is far from equilibrium?
Pushing yourself away from the comfort zone
85
What is the main driving factor for BME health inequalities?
Poorer socioeconomic position
86
What are the reasons for FGM?
1. Control over women's sexuality
2. Hygiene
3. Gender based factors/ increase femininity
4. Cultural identity
5. Religion
87
Give 5 immediate consequences of FGM
1. Severe pain
2. Shock
3. Difficulty passing urine
4. Infection
5. Bleeding
88
Give 5 long term consequences of FGM
1. Chronic pain
2. Chronic pelvic infections
3. Excessive scar formation
4. Decreased sexual enjoyment
5. PTSD
89
Give 3 complication risks of FGM
1. Infertility
2. Urinary and menstrual problems
3. Painful intercourse
90
Give 2 advantages of family interpreters
1. Cheap
| 2. Accessible
91
Give 2 disadvantages of family interpreters
1. Not confidential
| 2. Limit what is interpreted
92
Give 4 issues around multi-morbidity in pt. from diverse culture
1. Different vocabulary
2. Symptom descriptions differ
3. Undiagnosed disease
4. Unmedicated disease
93
Give 3 unmodifiable risk factors for CHD
1. FHx
2. Age
3. Male
94
Give 3 modifiable risk factors for CHD
1. Smoking
2. Diet
3. Sedentary lifestyle
95
Give 3 clinical risk factors for CHD
1. Diabetes
2. HT
3. Lipids
96
Give 3 psychosocial risk factors for CHD
1. Depression
2. Work
3. Social support
97
What are psychosocial factors?
Factors influencing psychological
responses to the social environment and
pathophysiological changes
98
What behaviour pattern is associated with CHD?
Competitive, hostile, impatient
99
What are 3 behaviours which can reduce CHD risk?
1. Emotional: Relax in response to signs of anxiety
2. Behavioural: Reduce work demands
3. Cognitive: Change way of thinking to less pressured
100
What hostility behaviours are associated with CHD?
1. Feelings of anger
2. Annoyance and resentment
3. Verbal or physical aggression
101
What antecedents do depression and anxiety share?
Social deprivation and health inequalities
102
Which mental health conditions are associated with CHD?
Anxiety and depression
103
What type of job is associated with MI?
High demand, low control
104
Give 3 jobs which are high demand, low control
1. Junior doctor
2. Ambulance distributor
3. Call centre
105
What social factors are a risk for CHD and stroke?
Loneliness and self-isolation
106
How can influences on an individual's health be categorised?
1. Biological factors
2. Personal lifestyle
3. Physical and social environment
4. Health services
107
What did the Black Report 1980 show?
Social class health inequalities in overall mortality and health inequalities are widening
108
What are the 4 possible mechanisms to explain widening socioeconomic health inequalities?
1. Artefact
2. Social Selection
3. Behaviour
4. Material circumstances
109
What did the Acheson Report recommend?
1. Evaluate all policies likely to affect health in terms of their impact on inequalities
2. Priority to health of families with children
3. Government to reduce income inequalities and improve living conditions in poor households
110
What are the theories of causation?
1. Neo-materialist
2. Psychosocial
3. Life course
111
What is the life course theory of causation?
1. Critical periods have greater impact at certain points in life course, primarily childhood
2. Accumulation - hazards and their impacts add up
3. Interactions and pathways
112
What are examples of critical periods?
Measles in pregnancy
113
What are examples of accumulation?
Hard blue collar work leads to injuries, reduced work opportunities, more injuries
114
What are examples of interactions and pathways?
Sexual abuse in childhood > poor partner choices, increased likelihood of violence exposure, increased chance of alcohol abuse
115
What are the categories of psychosocial pathways of causation?
1. Low social status
2. Lack of friends
3. Stress in early life
116
What is materialist pathway of causation?
Poverty exposes people to health hazards. Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing
117
What did the Black Report class as the most important causation to explain health inequalities?
Materialist
118
How can doctors close the gap in health inequalities?
1. Changing perspectives
2. Changing systems
3. Changing education
119
What is substance misuse?
Harmful use of any substance for non-medical purposes or effect
120
What are the types of drug substance and an example of each?
1. Opiates, heroin
2. Depressants, alcohol
3. Stimulants, MDMA
4. Cannabinoids, cannabis
5. Hallucinogens, LSD
6. Anaesthetic, ketamine
121
How are new psychoactive substances designed?
Mimic other substances of abuse but less predictable effects
122
What are the most commonly used substances of abuse?
1. Cannabis
2. Cocaine
3. MDMA
123
What is licit drug misuse?
Dependence and addiction to prescription and pharmacy medications
124
What are the harms associated with substance misuse?
1. Mortality
2. Morbidity
3. Social e.g. crime
4. Economic e.g. tax
5. Personal e.g. stigma
125
What is the most problematic drug of abuse?
Alcohol
126
What are the main theories for fixing substance misuse?
1. Disease model
2. Moral model
3. Sociocultural model
4. Volitional model
5. Behavioural model
127
What does disease model use?
1. Substitution medications
| 2. Gene therapy
128
What does the moral model use?
1. Parenting classes
| 2. Religious education
129
What does the sociocultural model use?
Targets health inequality
130
What does the volitional model use?
Raises self-efficacy
131
What does the behavioural model use?
Law and criminal justice to deter through fines and prison
132
What is addiction?
Compulsive use of a substance despite harmful consequences, involving structural and biochemical changes to parts of brain linked to reward, self-control and stress
133
What is dependence?
A need that develops relating to substances and other things
134
What is psychological dependence?
Feeling that life is impossible without drug
135
What are the emotional effects if withdrawal from drug occurs?
1. Fear
2. Pain
3. Shame
4. Guilt
5. Loneliness
136
What is physical dependence?
Body needs more and more of a drug for same effect (tolerance)
137
What are withdrawal symptoms?
1. Runny nose
2. Stomach cramps
3. Muscle aches
4. Hallucinations
138
What is medical ethics?
1. Critical evaluation of assumptions and arguments
| 2. Inquiry into normal and values
139
What are the basis of medical ethics?
1. Deontology
2. Consequentialism
3. Virtue
140
What is deontology?
Based on belief we owe a duty of care to each other
141
What is the problem with deontology?
Ignores consequences
142
What is consequentialism?
Consequences are what matters, means to get there are important
143
What are virtue ethics?
Character of the person is central; good character will necessarily act in right way
144
What are the pros to virtue ethics?
1. Centres ethics on whole person
| 2. Includes whole of a person's life
145
What are the cons of virtue ethics?
1. No clear guidance in moral dilemmas
2. No agreement on what virtues are
3. Virtues may be relative to culture it is in
146
What are the principles of medical ethics?
1. Autonomy
2. Beneficence
3. Non maleficence
4. Justice
147
What is autonomy?
Right to self-determination
148
What is beneficence?
Medical practice must seek to benefit patients
149
What is non-maleficence?
Avoiding harm
150
What is justice?
Efforts should be directed without reference to our likes or dislikes
151
What ethics are used in practice?
1. Candour
2. Consent
3. Capacity
4. Confidentiality
5. Communication
152
What is candour?
Openness, honesty, transparency
153
When is candour used?
1. Disclosure of error or uncertainty
| 2. Decision influenced by resources
154
What is whistle blowing?
Raising concerns about a person, practice or organisation
155
What is odds ratio?
A measure of association between an exposure and an outcome
156
What does OR represent?
Odds that an outcome will occur given a particular exposure, compared to odds of the outcome occurring in the absence of that exposure
157
What does hazard ratio express?
A similar relativity to OR but based on frequency of events rather than cumulative total outcome
158
What is population attributable fraction (PAF)?
Proportion of incidence of a disease in exposed and non-exposed population that is due to exposure
159
Give 3 risk factors for acute MI
1. Hyperlipidaemia
2. Adverse lipid profile
3. Smoking
160
Which risk factors for IHD have worsened in recent times?
1. Obesity
2. DM
3. Physical inactivity
161
What is number needed to treat (NNT)?
A measurement of the impact of a therapy by estimating no. of pt. that need to be treated over a given time period in order to have an impact on one person
162
How is NNT calculated?
1/absolute risk reduction
163
What is a unit of alcohol?
8g or 10ml or pure alcohol
164
How are units calculated?
(%ABV x amount of liquid in ml)/1000
165
How many units are classed as potentially harmful?
35
166
Which age group is most at risk of drinking alcohol at higher risk of harm?
55-64
167
When does alcohol become a problem?
1. When it causes or elevates risk for alcohol-related problems
2. When it complicates management of other health problems
168
What causes most alcohol-specific deaths?
Alcoholic liver disease
169
What are the symptoms of alcohol withdrawal?
1. Tremors
2. Activation syndrom
3. Seizures
4. Hallucinations
5. Delirium tremens
170
Give 5 abnormalities caused by foetal alcohol syndrome
1. Mental retardation
2. Craniofacial abnormalities
3. GI defects
4. Hyperactivity
5. Incoordination
171
What are the psychosocial effects of excess alcohol consumption?
1. Interpersonal relationships
2. Problems at work
3. Criminality
4. Poverty
5. Driving incidents
172
What are the policy recommendations for alcohol?
1. Make alcohol less affordable
2. Licensing and import allowances
3. Limit exposure in adverts
173
Give 3 primary preventions for alcohol
1. Know your limits campaign
2. THINK drink driving
3. Minimum unit pricing
174
What are secondary preventions for alcohol?
1. Ask about it routinely
2. Use screening tools
3. Think of it to explain symptoms
4. Detect problem drinking
175
What are the alcohol screening tools?
1. Clinical interview
2. Fast alcohol screening test (FAST)
3. Alcohol use disorders identification test (AUDIT)
4. CAGE questions
176
What is at risk drinking?
A pattern of drinking which brings about the risk of physical or psychological harm
177
What is alcohol abuse?
A pattern of drinking which is likely to cause physical or psychological harm
178
What is alcohol dependence?
A set of behavioural, cognitive and physiological responses that can develop after repeated substance abuse
179
What are the main diarrhoeal diseases?
1. Dysentery
2. Typhoid
3. Hepatitis
4. Cholera
180
What are complications of haemolytic rhemelin syndrome?
1. Acute kidney failure
2. Liver failure
3. Anaemia
181
What causes haemolytic rhemelin syndrome?
E. coli
182
What are the symptoms of norovirus?
1. Vomiting
2. Diarrhoea
3. Cramps
4. Headache
5. Fever
183
How long does norovirus last?
1-3 days
184
What bugs cause dysentery?
1. EHEC
2. Shigella
3. Salmonella
185
Where are C. difficile found?
Soil, digestive tract
186
What could cause a C. difficile infection?
Antibiotic that removes protection from pathogens
187
What does C. difficile cause in hospitalised pt.?
1. Antibiotic-associated diarrhoea
2. Antibiotic-associated colitis
3. Pseudomembranous colitis
188
How is C. difficile spread?
1. Faeco-oral route
| 2. Spores in environment
189
What age is most at risk of C. difficile infection?
>65
190
What is the prevention for C. difficile infection?
1. Hand washing with soap and water
| 2. Hydrogen peroxide for cleaning
191
What is the protocol for a C. diff pt.?
SIGHT
1. Suspect C diff as cause of diarrhoea
2. Isolate case
3. Gloves and aprons worn
4. Hand washing with soap and water
5. Test stool for toxin
192
What Abx must be controlled for C. diff prevention?
1. Ampicillin
2. Amoxicillin
3. Cephalosporins
193
What is the Rx for C. diff diarrhoea?
Metronidazole or vancomycin
194
What is the investigation for C diff?
1. Stool sample for toxin
2. Culture to ID strain
3. Tissue samples
195
What bug contributes to 40% of hospital admissions for diarrhoea?
Rotavirus
196
What is the prevention for rotavirus?
1. Vaccine
2. Early and exclusive breastfeeding
3. Handwashing
4. Improve water quantity and quality
5. Community-wide sanitation promotion
197
What is the Rx for rotavirus diarrhoea?
1. Fluid replacement
| 2. Zinc treatment
198
What groups are at risk for diarrhoeal disease?
1. Persons with unsatisfactory hygiene
2. Children in nursery
3. People working with uncooked food
4. HCWs
199
What diseases are notifiable?
1. Diseases that are very lethal/no cure
2. Disease with severe symptoms and long-term consequences
3. Vaccine preventable diseases
4. Diseases that need specific control measures
200
What are the symptoms of scarlet fever?
1. Flushed red sandpaper rash
| 2. Strawberry tongue
201
How is the community protected from notifiable diseases?
1. Investigate e.g. contact tracing
2. Identify vulnerable persons
3. Exclude high risk persons from high risk settings
4. Health promotion
5. Coordinate multi-agency responses
202
What is primary vaccine failure?
Person doesn't develop immunity from vaccine
203
What is secondary vaccine failure?
Initially responds but protection wanes over time
204
What are the most common causes of meningitis in the UK?
Neisseria meningitidis B and C
205
How does meningococcus cause gangrene?
Causes arterial occlusions
206
What is the Rx for meningitis?
1. Cefotaxime or ceftriaxone
| 2. Supportive Rx
207
Why is meningitis notifiable immediately?
Risk of transmission is greatest in first few days
208
What happens when close contacts of meningitis are identified?
1. Warn about symptoms and signs
2. Glass test
3. Contact number
209
What Abx chemoprophylaxis given to in contact with meningitis pt.?
Ciprofloxacin or rifampicin
210
What is the prevalence of MSK conditions in the UK?
30%
211
What are the effective MSK risk management strategies?
1. Vit D/calcium
2. Weight management
3. Physical activity
4. Injury prevention
212
When is developmental dysplasia of hip (DDH) screened for?
Newborn physical examination and 6-8 weeks old
213
Why is DDH not screened in utero?
Most cases resolve without treatment
214
Why is osteoporosis not screened for?
It does not reduce fractures from osteoporosis
215
What is the role of physical activity on primary prevention for MSK?
1. Maintain good MSK health
| 2. Ensure optimum activity levels to maintain strength, balance, cardio fitness
216
What is the role of physical activity on tertiary prevention for MSK?
Manage chronic conditions and improve symptoms/prognosis with fitness
217
What are the condition-specific barriers than make more activity difficult in chronic conditions?
1. Pain, fatigue, anxiety in chronic conditions
2. Joint pain and stiffness
3. Depression
4. Risk/fear of falling
5. Stress incontinence
218
What maternal health preventions are in place for MSK conditions?
1. Smoking cessation
2. Diet
3. Vit D
219
What child health preventions are in place for MSK conditions?
1. Physical activity
| 2. Diet
220
What adult health preventions are in place for MSK conditions?
1. Injury prevention
2. Workplace health
3. Healthy weight/ weight loss
221
What healthy ageing preventions are in place for MSK conditions?
1. Dietary protein, calcium
2. Vit D
3. Strength and balance exercises
222
Which STIs are MSM more at risk of?
1. Syphilis
| 2. Gonorrhoea
223
What is the STI transmission model?
RBCD
1. Reproductive rate
2. Infectivity rate
3. Partners over time
4. Duration of infection
224
Give 3 individual factors which affect sexual health
1. Mental health
2. Self-esteem
3. Dysfunction
225
Give 3 social relationships factors which affect sexual health
1. Family
2. Upbringing
3. Peers
226
Give 3 emotional factors which affect sexual health
1. Experience of different emotions
2. Ability to handle difficult emotions
3. Response to others
227
Give 3 external or political factors which affect sexual health
1. Law
3. Media
3. Religion
228
Give 3 social group factors which affect sexual health
1. Class
2. Gender
3. Sexual orientation
229
Give 3 service factors which affect sexual health
1. Access to contraception
2. STI & HIV services
3. Counselling
230
What is the primary prevention for sexual health?
Reducing risk of acquiring STI
231
What is the secondary prevention for sexual health?
Case finding
232
What is the tertiary prevention for sexual health?
Reducing morbidity and mortality
233
Give 3 primary prevention strategy for STIs
1. STI awareness campaigns
2. Vaccination - HPV, Hep B
3. PrEP and PEP
234
What are the methods for HIV prevention?
1. Condom use
2. Regular testing
3. Early access to treatment
4. Challenging stigmas
235
What are the secondary prevention strategies for STIs?
1. Easy access to tests and Rx
2. Partner notification
3. Targeted screening e.g. antenatal
236
What are the tertiary preventions for STIs?
1. Anti-retrovirals for HIV
2. Prophylactic Abx for PCP
3. Acyclovir for suppression of genital herpes
237
What is partner notification?
A public health activity that aims to control infection by identifying key individuals and sexual networks, warn the unsuspecting and attempt to break the chain of infection
238
How are partners traced?
1. Pt. referral
2. Provider referral
3. Conditional or contract referral
4. Emphasis on pt. choice and confidentiality
239
Name 5 disease associated with ageing
1. Dementia
2. Osteoporosis
3. Stroke
4. Parkinson's
5. OA
240
What is polypharmacy?
When a pt. is on >5 drugs
241
What is palliative care?
Palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement
242
What are the key issues in COPD?
1. Unpredictable illness trajectory
2. Difficulties with prognostication
3. Poor pt. understanding
4. Limited access to specialist palliative care
243
What are the main trajectories of decline at end of life?
1. Cancer
2. Organ failure
3. Physical and cognitive frailty
244
What is substance misuse?
Recurrent substance use resulting in
1. Failure to fulfil major obligations e.g. work
2. Situations which it is physically hazardous e.g. driving
3. Despite persistent social or interpersonal problems e.g. debt
245
How are units of alcohol measured?
ABV x vol (ml)/1000
246
What extended brief interventions can be used for alcoholics?
1. Behavioural change
2. Motivational-enhancement therapy
3. Motivational interviewing
247
What is used to measure severity of alcohol dependence?
Severity of Dependence Questionnaire (SADQ)
248
What is indicated for a person scored 16+ on SADQ?
Chlordiazepoxide detoxification
249
What is dependence?
A state in which an organism functions normally only in presence of a drug
250
What is tolerance?
A state in which an organism no longer responds to a drug
251
What are the Rx for people with alcohol dependence?
1. Community based assisted withdrawal
2. Inpatient based assisted withdrawal
3. Rx with benzodiazepines
4. Preferred choice chlordiazepoxide
252
What is the result of stopping alcohol in alcoholics?
1. Number of Ca channels multiple
2. Chloride ion flow reduced
3. Electrical impulse in nerve increases
4. Excitability of nerve enhanced
253
Give 3 contraindications of chlordiazepoxide
1. Pregnancy
2. Severe pulmonary insufficiency
3. Chronic psychosis
254
What are the withdrawal effects of alcohol?
1. Headache
2. Muscular pain
3. Anxiety
4. Hallucinations
5. Epileptic seizures
255
What is the cause of Wernicke's encephalopathy?
Deficiency of thiamine
256
What is the Rx of Wernicke's encephalopathy?
1. Pabrinex
2. Vit B
3. Thiamine
257
What is used to prevent relapse in alcoholics?
1. Acamprosate
2. Disulfiram
3. Nalmefine
258
What law of tort is important in medicine?
1. Negligence
2. Battery (consent)
3. Breach of confidence
259
What is negligence?
A duty of care existed which was breached resulting in harm
260
When can confidentiality be disclosed?
1. Info likely to cause serious harm to mental or physical health of pt.
2. Info likely to cause serious harm to mental or physical health of another person
3. Info is about another individual
261
What are the risk factors for migraine?
1. 25-50
2. Female
3. Sex hormones (OCP)
4. FHx
262
What are the risk factors for stroke?
1. Male
2. Age
3. BME
4. Smoking
5. Alcohol
6. CVD
263
What is the aetiology of epilepsy?
1. Genetic factors
2. Febrile seizures
3. Head injuries
4. Bacterial/parasitic infections
5. Viral meningo-encephalitis
6. Toxic agents
264
What is the triad of symptoms in PD?
1. Tremor
2. Rigidity
3. Akinesia
265
What are the risk factors for cerebral palsy?
1. Anoxia
| 2. Low birth weight
266
What is the usual age of onset for Creutzfeldt-Jakob disease (CJD)?
55-75
267
What are the signs of CJD?
1. Rapidly progressive dementia
2. Abnormal EEG
3. Cerebellar signs
4. Myoclonus
268
What are the risk factors for variant CJD?
1. Age (26)
2. Residence in UK
3. Methionine homozygosity at codon 129
269
What MH conditions commonly affect medics?
1. Insomnia
2. Depression
3. PTSD
4. Anxiety
270
What are the barriers to seeking help for MH?
1. Fear of looking weak
2. Competition between peers
3. Doctors seen as infallible
4. Stigma
271
What is the philosophy of palliative care?
1. Holistic approach
2. Individualised
3. Patient and care involved
4. MDT approach
272
What are the key PH issues in COPD?
1. Unpredictable illness trajectory
2. Difficulties with prognostication
3. Poor pt. understanding
4. Limited access to specialist palliative care
273
What is the result of poor understanding of COPD?
1. Anxiety/confusion
2. Unable to make advanced care planning
3. Families unprepared for death
274
What are the common work-related ill health?
1. Occupational stress
2. MSK disorders
3. Lung disease
4. Cancer
5. Noise-induced hearing loss
275
What study design is best suited to calculating attributable risk?
Cohort studies
276
Give an example of an acute occupational disease
Slipped disc
277
Give an example of a cumulative occupational disease
Asthma
278
Give an example of a progressive occupational disease
Radiation poisoning
279
Give an example of a occupational disease with latencies
Asbestosis
280
What is hazard?
Potentially harmful
281
What is risk?
Probability of harm
282
How can work hazards be classified?
1. Mechanical
2. Physical
3. Chemical
4. Biological
5. Psychosocial
283
When should an occupational aetiology of a disease be considered?
When an illness fails to respond to standard Rx, doesn't fit the typical demographic profile or is of unknown cause
284
What are the screening questions for occupational disease?
1. Type of work?
2. Do you think health problems are related to work?
3. Symptom differences between work and home?
4. Exposures at work?
5. Co-worker symptoms?
285
What is a disability?
A physical or mental impairment, which has a substantial long term adverse effect on a person's ability to carry out normal activities
286
What are the primary preventions for OH?
1. Monitor risk
2. Control hazards
3. Promotion
287
What are the secondary preventions for OH?
1. Screening
2. Early detection
3. Task modification
288
What are the tertiary preventions for OH?
1. Rehabilitation
| 2. Support
