Public Health Revision Flashcards
(211 cards)
1
Q
What is the definition of compliance?
A
The extents to which the patients behaviours coincides with medical or health advice
2
Q
Name 2 negatives with the definition of compliance?
A
- Doesn’t look at reasons why the patient may not be compliant
- Implies that the patient must follow the doctors orders
3
Q
What is the definition of patient adherence?
A
Acknowledges the patients beliefs yet still regards the health professional as the expert
4
Q
Give 2 examples of unintentional non-adherence?
A
Inability to pay, forgetting, difficulty understanding instructions, problems using treatment
5
Q
Give 2 examples of intentional non-adherence?
A
Personal beliefs, beliefs about their treatment, beliefs about their health
6
Q
What are the principles behind concordance?
A
Work of the prescriber and the patient is a negotiation between equals and an aim for a therapeutic alliance between them. Ensures patient is an active participant in decision making
7
Q
Suggest 3 barriers to concordance?
A
- Patients may not want to engage in discussion with doctor
- Challenging with patient choice vs evidence
- Time/resources and organisational constraints
- May cause the patient to worry more
8
Q
Name 4 of the steps you would take for shared decision making?
A
- Convey that professionals may not have set opinion
- Outline options and consequences of no treatment
- Allow them to express ideas/concerns
- Check they’re happy with shared decision making
- Provide information in correct format
9
Q
Name 3 principles of infection prevention/control?
A
- Identification of risks
- Routes and mode of transmission
- Virulence of organisms e.g. likelihood of developing infection and consequences of the infection
- Remediable factors
10
Q
What is the single most effective method to prevent cross infection?
A
Hand washing
11
Q
Name 5 occasions when you would wash your hands in a clinical setting?
A
- Before and after handling patients
- Before and after handling food
- Before and after an aseptic procedure
- After handling any item that is soiled
- After using the toilet
- After removing proactive clothing, including gloves
12
Q
Name 3 situations in which you would use alcohol gel to clean your hands as oppose to washing them?
A
- Following hand washing, prior to a ward based procedure
- Between tasks when hands are clean
- Following hand washing, when caring for a patient with better precautions
13
Q
What is an endogenous infection?
A
Infection of a patient by their own flora
14
Q
Name 3 methods to prevent endogenous hospital acquired infections?
A
- Reduce antibiotic pressure as much as clinically possible
- Remove lines and catheters as soon as possible
- Control underlying disease
- Antisepsis
- Good nutrition/hydration
15
Q
What is the definition of prevalence?
A
The proportion of the population who have that disease in a point in time. Eg 15% of UK population have asthma
16
Q
What is the definition of incidence?
A
The rate at which new cases of a disease occur within a population occur during a specific time period. e.g. Number per 10,000 per year
17
Q
What is the definition of mortality?
A
Incidence of death from a disease
18
Q
What is the relationship (equation) between incidence and prevalence?
A
Prevalence = Incidence x Average Duration
19
Q
What is an ecological study?
A
An observational study, in which data is analysed on a population level and not individual. Studies the relationship but not the cause
20
Q
What is a cohort study?
A
Cohort of samples exposed to known risk factor and followed up in a sample of unexposed controls
21
Q
What is a cross-sectional study?
A
Measures prevalence of health outcome/disease in a population, at one point in time, on an individual level
22
Q
What is a case-control study?
A
Identify people with disease and identify past exposure to aeitiological factors and compare to control
23
Q
What is Bradford-Hill criteria?
A
Epidemiological evidence of whether there is a causal relationship between a presumed cause and an observed effect.
24
Q
There are 9 criteria included in Bradford-Hill, name 5 of them?
A
- Strength of relationship
- Consistency
- Specificity
- Temporal sequence (exposure precedes outcome)
- Dose response (increase exposure leads to increase risk)
- Experimental evidence
- Biological Plausibility
- Coherence (compatible with existing theory and knowledge)
- Analogy
25
Name 3 types of healthcare professional that provide palliative care?
1. Consultants in palliative medicine
2. Clinical nurse specialists
3. Hospice nurses
4. Specialist social workers
26
Name 3 principles of palliative care in the elderly?
1. Promoting quality of life
2. Promoting dignity and autonomy
3. Placing importance on controlling symptoms and avoiding use of medical investigations and aggressive treatment
27
What is the classification of mild COPD?
Mild airflow restriction, FEV1 50-70% predicted
28
What is the classification of moderate COPD?
Moderate airflow restriction and symptom progression, FEV1 30-50% of predicted
29
What is the classification of severe COPD?
Severe airflow obstruction, reduced quality of life, exacerbations life threatening and FEV1 <30% of predicted
30
Name 4 of the key issues in palliative care for patients with COPD?
1. Unpredictable illness trajectory
2. Difficulties with prognostication
3. Poor patient understanding of COPD. Patients unable to make decision regarding the care they would like to receive at the end of life
4. Limited access to specialist palliative care and funding
31
Name 4 occupational diseases?
Asbestotis, silicosis, mesothelioma, tenosynovitis
32
Which study design is best suited to calculating attributable risk?
Cohort studies, where individuals are grouped based on exposure status and followed over a period of time
33
Give 4 reasons for a geographical variation of COPD?
1. Socio-economic differences, historic industry eg steel work, developing work - use of biomass fuel, passive smoking, housing and nutrition
34
Name 5 of the 10 components of Marmot's good work?
1. Prevents social isolation
2. Work/life balance
3. Fair employment
4. Individual control (make decisions)
5. Reintegrates sick/disabled where possible
6. Prevents social isolation
7. Share information
8. Promote health and wellbeing
9. Precariousness (safe)
10. Provide opportunities
35
Give an example of primary prevention in occupational diseases?
Monitor the risk of occupation, control any hazards
36
Give an example of secondary prevention in occupational diseases?
Screening and early detection of risks
| Task modification
37
Give an example of tertiary prevention in occupational diseases?
Rehabilitation and support
38
What is the definition of disability?
A physical or mental impairment, which has substantial long term effects on a persons ability to carry out a normal activity
39
What is antigenic drift?
Minor antigenic variation such as changes in the influenza surface receptors. Results in epidemics
40
What is antigenic shift?
Gene reassortment and major antigenic variation which is different to that of the preceding strain. This results in pandemics.
41
What is the definition of reproductive number?
Average number of secondary conditions arising from a primary case. It is a crucial quantity for identifying the intensity of interventions required to control an epidemic
42
Name 4 methods of infection control to stop influenza spreading?
1. Wash hands
2. Reduce social contact
3. Segregation of patients with influenza on wards
4. Environmental cleaning
43
Suggest 4 population wide interventions to prevent influenza spread during a pandemic/epidemic?
1. Travle restrictions
2. Screening for disease at all UK ports
3. School and mass public gathering events cancelled
4. Voluntary home isolation of cases and quarantine of contacts in known cases
44
What is the inverse care law?
The availability of good medical care, tends to vary inversely with the need for it in the population served
45
What is the definition of psychosocial factors?
Factors influencing psychological responses to the social environment and pathophysiological changes
46
What are the 3 personality traits in the Freiman and Rosenam classification?
Competitive, hostile and impatient
47
What personality type is associated with CHD?
Type A
48
How do you assess a type A personality?
1. Questionnaires
2. Self report
3. Jenkins and Bortner
4. Structured clinical interview
49
Name 4 psychosocial factors which affect the development of CHD?
1. Type A personality
2. Depression/anxiety
3. Work characteristics e.g. high demanding job
4. Social Support
50
Name 3 methods to assess depression?
1. Speilberg's state anxiety inventory
2. General health questionnaire
3. Beck's depression inventory
4. MMPI
51
Which study identified the relationship between working hours/demands and CHD?
Whitehall Studies
52
Give two benefits to health of social support?
1. Helps coping with life events
| 2. Motivation to engage in healthy behaviours
53
What is the definition of odds ratio (OR)?
Represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure
54
If OR=1 what does that mean?
Exposure doesn't affect likelihood of of outcome
55
If OR >1, what does that mean?
Exposure is associated with higher odds of outcome
56
If OR is <1, what does that mean?
Exposure is associated with lower odds of outcome
57
What is the population attributable fraction?
Diseases incidence in the population that would be eliminated if the exposure was removed. Looks at the contribution to the problem in the population
58
What is the definition of number needed to treat?
The number of people needed to treat over a given time period in order to have an impact on one person
59
What are the 5 steps in the stages of change model?
1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
60
Give 4 examples of UK screening programmes?
1. Breast aged 50-70 every 3 years
2. Bowel - 60-74 every 2 years, using focal occult blood
3. Cervical Cancer - over 25s every 3 years, 20-64 every 5 years
4. Diabetic eye screening
61
Name 5 of the Wilson's screening criteria?
1. Important condition
2. Population for screening identified
3. Cost effective
4. Natural history of disease known
5. Early/latent stage recognisable
6. Suitable test - safe, acceptable to public
7. Effective and acceptable treatment
8. Continuous process
62
What is the definition of sensitivity?
Ability of test to correctly identify those with the disease
63
What is the definition of specificity?
Ability of test to correctly exclude those who don't have the disease
64
Name 4 limitations of screening?
1. False positives
2. Negative results
3. Over-diagnosis of sub-clinical (harmless) cases
4. Harm from screening e.g. radiation exposure in mammography
65
Is D-dimer sensitive, specific, both or neither?
Sensitive (often picks up PE if there is one) but is not very specific as it can be raised for a range of reasons
66
What is the definition of absolute risk?
Risk of developing a disease over a time period
67
What is the definition of relative risk?
Risk of getting disease in exposed group,c compared to an unexposed group
68
What is a never event?
A serious, largely avoidable patient safety event which should not occur if the preventative measures have been implemented
69
What is the theory behind the swiss cheese model?
Each layer represents processes put in place to prevent errors from happening, holes are where the process can fail. When the holes in the cheese line up, an error can occur
70
What is the definition of negligence?
Breach of legal duty of care owed which results in harm to that patient
71
What are the three times you can breach confidentiality?
1. If they are at risk to the public (intend to commit a crime)
2. If they have given consent
3. If it is required by law e.g. notifiable diseases
72
What is the Bolam standard?
Doctor will not be guilty of negligence if he has acted in accordance with a practise accepted by a responsible body of similar medical peers
73
What is Bolithio standard?
Allows the court to look beyond Bolam, Judge is able to rule against it if professional guidance not correct or cannot withstand logistical analysis
74
What is the principle of deontology?
Belief that we owe a duty of care to each other
75
What is a) absolutist and b) relativist explanations?
a) Absolute measures of socioeconomic depression
| b) Larger the differences in society, the poorer the outcomes for the worse off and for all of us
76
Name a flaw in the consequentialism theory?
Some actions are self evidently wrong even if the consequences are good
77
What are the principles behind virtue ethics?
Character of a person is central. A good person will act in the right way
78
Name three negatives in the virtue ethics theory?
1. No guidance of what to do in moral dilemmas
2. No general agreement on what the virtue's are
3. Virtues must be culture specific
79
What is the definition of the clinical truth?
This is contextual, circumstantial and personal. It cannot ignore objective truth and mustn't be related to it either.
80
Name 2 positives of virtue ethics?
1. It centres on the ethics of a person and what it means to be human
2. It includes the whole of a person's life
81
How would an Autonomist go about truth telling?
Insist on telling the whole truth, without embellishment or delay, reduce doctor to information provider
82
Which two principles of medical ethics may require some disclosure in truth telling?
1. Beneficence
| 2. Non-maleficence
83
What is the four quadrants approach to clinical ethics?
1. Medical indications
2. Patient Preferences
3. Quality of life
4. Contextual features
84
What are the 5 C's of ethics in practise?
Candour. communication, consent, capacity, confidentiality
85
What is a criticism of bolam?
Allows the standard in law to be set subjectively by doctors
86
What are the 5 key underpinning principles of the Mental Capacity Act 2005?
1. Must be presumed to have capacity
2. Maximise decision making capacity
3. Unwise decision- doesn't mean patient doesn't have capacity
4. Decisions must be in best interests of patient
5. Decisions must be the least restrictive alternative
87
To make an advance decision which two pieces of evidence must be required?
1. Signed with a witness present
| 2. Include an express statement
88
Who can consent on behalf of someone lacking capacity?
- Decision taken by physician by governed by Bolam
- Court can make decision on behalf of patients best interests
- Relative not attorney doesn't have right to refuse treatment if its in the patients best interest
- Doctrine of necessity may apply in genuine emergency
89
The Black report 1980 confirmed social inequalities in health, what were the 4 mechanisms suggested as to why health inequalities are widening?
1. Artefact
2. Social selection
3. Behaviour
4. Material circumstances
90
What are three main theories of causation of health inequalities?
1. Life course (e.g. critical periods in life, accumulation of life hazards)
2. Psychosocial
3. Materialist (e.g. poverty exposes people to health hazards)
91
One of the 5 focal virtues is compassion, what are the other 4?
Discernment, trustworthiness, integrity, conceientousness
92
How do you diagnose someone as brain dead?
1. No hart sounds or carotid pulse for 1 minute
2. No breath sounds or repertory effect for 1 minute
3. No response to painful stimuli
4. Pupils are fixed and dilated
93
Name 4 urgent signs you should look out for in a patient with an eating disorder?
1. Muscle weakness
2. Breathing problems
3. Deterioration of consciousness
4. Cardiac signs (low BP, (tacy/bradycardia)
94
What is a notifiable disease?
Legal obligation for any doctor that suspects a case to inform the local authority, often diseases that are vaccine preventable
95
How do we protect community from notifiable diseases?
1. Investigate - eg contact tracing
2. Identify and protect vulnerable individuals e.g. immunisation
3. Exclude high risk persons from high risk settings
4. Educate, inform, raise awareness, health promotion
96
What is active immunity?
Vaccination which stimulates the immune response and memory to a specific antigen which causes disease
97
What is passive immunity?
Protection provided from transfer of antibodies from immune individuals this can either be cross-placental or blood/immunoglobulin transfusion.
Temporary protection.
98
What is the antibiotic prophylaxis for meningitis?
Ciprofloxacin
99
Give 3 of the GMC duties of a doctor?
1. Protect and promote the health of patients
2. Provide good standard of practise and care
3. Recognise and work within limits of competence
4. Work with colleagues in the ways that best serve patients interests
5. Keep professional knowledge up to date
6. Never discriminate
100
Give 4 common risk factors for drug misuse?
Unfinished education, peer pressure, abuse and violence, low neighbourhood attachment
101
What is one UK unit?
8 grams, 10ml
102
How to calculate the number of units?
Strength of drink (%) x amount of liquid in ml
| divided by 1000
103
Name 3 acute effects of excess alcohol intake?
1. Cardiac arrythmia
2. Respiratory depression
3. Mallory-weiss syndrome
4. Aspiration pneumonia
5. Blackouts
104
Name 3 chronic effects of excess alcohol intake?
1. Pancreatitis
2. CNS toxicity
3. Liver damage - cirrhosis
105
Name 3 psychosocial effects of excess alcohol?
1. Problems at work - unemployment
2. Criminality
3. Social disintegration
4. Driving incidents and offences
5. Interpersonal relationships
106
Name 3 symptoms/signs of foetal alcohol syndrome?
Pre and post natal growth retardation, craniofacial abnormalities, CNS abnormalities (mental retardation, incoordination)
107
Name 3 facial abnormalities associated with foetal alcohol syndrome?
up turned nose, microcephaly, thin upper lip
108
List 4 withdrawal symptoms of alcohol dependency?
1. Hallucinations
2. Seizures
3, Activation syndrome
4. Tremors
5. Activation syndrome
109
Name 3 of the primary prevention strategies to reduce alcohol use?
1. THINK - drink driving campaign
2. Drinkaware labels on drinks
3. "Know your limits" binge drinking campaign
110
Name 3 secondary prevention screening tools in alcohol use?
1. FAST - Fast alcohol screening test
2. AUDIT- Alcohol use disorders identification test
3. CAGE
111
What are the 4 questions in CAGE questionnaire?
1. Have you ever felt you should Cut down?
2. Have people Annoyed you by criticising your drinking?
3. Have you ever felt Guilty about your drinking?
4. Have you ever had a drink first thing in the morning (Eye opener)?
112
What is the FRAMES intervention?
Summary of how to interview people with alcohol dependency
113
What does FRAMES stand for?
Feedback, Responsibility, Advice, Menu (of alternative strategies), Empathetic (interview style), Self- efficacy
114
Name 5 control measures to stop spread of diarrhoea (WHO)?
1. Hand washing with soap
2. Safe drinking water
3. Safe disposal of human waste
4. Promote breastfeeding infants and Vit A supplementation
5. Safe handling and processing of good
6. Rotavirus and measles Vaccination
115
In the management of C. Difficile what does SIGHT stand for?
```
Suspect C.diff as cause of diarrhoea
Isolate the case
Gloves and apron worn
Hand washing
Test stool for toxin
```
116
Which work related disorder is diagnosed using Tinels and Phalens Test?
Carpal Tunnel Syndrome
117
What is the clinical presentation of carpal tunnel syndrome?
Pain/tingling/numbness in the median region of the hand
118
Which tendons does tenosynovitis commonly affect?
Abductor pollicis longus and extensor pollicis brevis
119
How do you test for tenosynovitis?
Finklesteins test
120
What is medial epicodylitis also known as?
Golfer's Elbow
121
If someone has weakness of grip, and is diagnosed using Cozen's test, what would you expect the diagnosis to be?
Lateral epicondylitis (tennis elbow)
122
Which work related MSK disorder is a secondary cause of Raynaud's?
Hand-Arm Vibration Syndrome
123
In Gonorrhoea diagnosis, what would you see on microscopy?
Gram negative diplococci with cytoplasm of polymorphs
124
How do you diagnose chlamydia?
NAAT (Nucleic Acid Amplification Tests) - uses PCR
Female - vaginal swab
Male - first void urine
125
Name a complication of gonorrhoea in neonatal transmission?
Ophthalmic neonatorum
126
Name 5 complications of chlamydia?
1. Tubal factor infertility
2. Ectopic pregnancy
3. Pelvic inflammatory disease
4. Atypical pnuemonia
5. Fitz Hugh Curtis syndrome - right upper quadrant pain
6. Reactive arthritis (male)
127
What is the antibiotic treatment for chlamydia?
Azithromycin or doxycycline
128
How do you diagnose syphilis?
Serology - treponema pallidum particle agglutination test
129
What is the treatment for syphilis?
Penecillin injection
130
What is the equation for the HIV/STI transmission model?
R = B x C x D
131
R= BxCxD. R = reproductive rate, what do the other letters stand for?
```
B= Infectivity rate
C= Partners over time
D= Duration of infection
```
132
Name 4 primary prevention strategies in STI control?
1. STI awareness campaign eg sex worth talking about
2. One to one risk reduction
3. Vaccination eg HPV
4. ARV primary prevention
5. Free condoms
133
What are the three methods of contact tracing?
1. Partner referral
2. Provider referral via text, letter etc
3. Conditional or contact referral
134
Name 3 methods of tertiary prevention for STI?
1. Anti-retroviral for HIV
2. Prophylactic antibiotics for PCP
3. Acyclovir for suppression of genital herpes
135
What is secondary prevention of STIs?
1. Partner notification
2. Targeted screening eg antenatal screening for HIV
3. Easy access to STI/HIV test
136
What is the maximum number of units of alcohol per week for a woman?
14 units
137
Name 5 criteria for a pandemic spread?
1. Ready and sustainable transmission
2. Large pool of susceptible people
3. Capable of causing human illness
4. A novel virus
5. Capable of infecting humans
138
Describe the 5 stages of the chain of infection?
1. Susceptible host
2. Causative microorganism
3. Reservoir - spread originates
4. Portal of entry/exit eg resp tract
5. Mode of transmission
139
Name 4 diarrhoeal diseases? (not organisms causing them)
Dysentry
Typhoid
Cholera
Hepatitis
140
What is the definition of the Gini-co-efficient?
A statistical representation of a nations income distrubutions among its residents. Lower co-efficient = great equality
141
What are the principles of proportionate universalism?
Action must be universal but with a scale and intensity proportional to the disadvantage
142
What are the ethical considerations in concordance?
1. Mental capacity
2. Decisions may be detrimental to a patients wellbeing (non-maleficence)
3. Potential threat to the health of others
143
Name 4 issues why diabetes requires public health intervention?
1. Mortality
2. Disability- blindness, renal failure
3. Co-morbidity
4. Reduced quality of life
144
Give 3 reasons as to why type 2 diabetes is a public health issue?
1. Increasing in prevelance
2. Lack of effective, global, national or local policy
3. Major inequalities in prevalence
145
Give 3 lifestyle and environmental factors that increase risk of diabetes?
1. Sedentary job
2. Diet high in calories, low in fruit and beg
3. Obseogenic environment
146
What is the obseogenic environment?
1. Physical environment eg TV removes
2. Economic environment eg expensive fruit and beg
3. Sociocultural environment eg safety fears
147
Give 3 mechanisms that maintain overweight?
1. Physical - eg more weight, more difficult to exercise --> arthritis
2. Psychological - low self esteem- guilt and comfort eating
3. Socioeconomic - reduced opportunities employment
148
Give 5 known risk factors for type 2 diabetes?
1. Age,sex,ethnicity
2. weight, BMI and waist
3. History of gestational diabetes
4. Hypertension or vascular disease
5. Impaired glucose tolerance or impaired fasting glucose
149
Give 5 screening tests that are currently available for diabetes?
1. Random capillary blood glucose
2. Random venous blood glucose
3. Fasting venous blood glucose
4. Oral glucose tolerance test
5. HbA1c
150
In preventing diabetes what to effective interventions require?
1. Sustained increase in physical activity
2. Sustained change in diet
3. Sustained weight loss
151
In type 2 diabetes, what are the NICE guidelines in preventing diabetes?
Focus on ethnic minorities and socio-economically deprived communities at increased risk
Focus on culturally appropriate interventions
152
Name 3 approaches that would enable earlier diagnosis of diabetes?
1. raising awareness of diabetes and symptoms in community
2. Raising awareness of diabetes and possible symptoms in health professionals
3. Using clinical records to idenitfy those at risk and using blood tests to screen before symptoms develop
153
Give an example of how NHS england is investing in type 2 diabetes prevention?
Healthier you: The NHS diabetes prevention programme
154
Give 6 methods of supporting self care as tertiary prevention in type 2 diabetes?
1. Self- monitoring
2. Diet
3. Exercise
4. Drugs - support taking medication, Metformin
5. Education
6. Peer support
155
What are the 4 overall steps in reducing impact of type 2 diabetes?
Step 1: identifying people at risk of diabetes
Step 2: early prevention in those at risk
Step 3: diagnosing diabetes earlier
Step 4: effective management and supporting self-management
156
In the swiss cheese model of accident prevention, what are the two reasons why holes form?
a) Active failures
| b) Latent conditions - arise during design or building stages of a system
157
Name a pharmacological treatment method for motor neurone disease?
Riluzole
158
Give 4 differential diagnosis of strokes?
Hypoglycaemia, migraine, mass lesions, functional hemiparesis, TIA
159
What are the principles behind virtue ethics?
Focus on the person who is acting
160
Give 3 key challenges of an ageing population?
1. Strains on pension
2. Increasing demand for health care
3. Increasing demand for long time care
4. Ageing workforce
161
Give 3 causes of an ageing population?
1. Improvement in sanitation, housing, nutrition
2. Raising life expectancy
3. Substantial falls in fertility
162
Give 4 examples of physical changes in later life?
1. Loss of skin elascitiy and hair colouring
2. Decrease in size and weight
3. Loss of joint flexibility
4. Increased susceptibility to illness
163
What are the 4 identified awareness contexts in glaser and strauss awareness of dying?
1. Closed suspicion
2. Suspicion awareness
3. mutual pretence
4. Open awareness
164
Which two organisms does not kill?
1. Norovirus
| 2. C. difficile
165
Give 3 methods for smoking cessation?
1. Nicotine replacement therapy
2. Non-nicotine pharmacotherapy
3. Transtheoretical Model
166
What are the criteria of the wilson and tangier criteria for screening?
1. It should be an serious health problem
2. Aetiology should be well undestood
3. A detectable early stage
4. Accepted treatment for the disease
5. Facilities for diagnosis and treatment should be available 6. Suitable test should be devised for the early stage
7. Test should be acceptable for the patients
8. Intervals for repeating the test should be determined
9. There should be an agreed policy on whom to treat
10. Cost should be balanced against the benefits
167
Give an example of a study which demonstrated the association between MI and psychosocial work characteristics?
Whitehall Studies
168
What is the treatment for gonorrhoea?
Ceftriaxone IM injection with azithromycin
169
Which neuro disease is associated with HLADR2?
Multiple sclerosis
170
What is Creitzfeldt-Jakob disease?
Neuro-degernative disease, rapidly progressive dementia
171
Give a limitation of passive immunisation?
Antibody mediated - only works if the disease is mediated by the antibody
172
Give two advantages of passive immunisation?
Gives immediate protection and is effective in immune-compromised patients
173
Give two disadvantages of passive immunisation?
Short lived, possible transfer of pathogens, serum sickness or transfer or animal serum
174
Give 3 disadvantages of whole killed vaccines in active immunisation?
Whole pathogens cause reactogenicity, immune responses are not always close to normal response to infection
Organism must be grown to a high titre in vitro
175
Suggest 4 novel approaches to vaccination?
1. Recombinant proteins produced from heat
2. Synthetic peptides
3. Live attenuate vectors
4. DNA vaccines
5. Poly-saccharide-protein conjugates
176
Give 3 advantages of using inactivated toxins in active immunisation?
Lower doses required so lower scale of IV growth
Immune response more closely mimics real infection
route of administration may be favourable
Fewer doses may be required
177
Give 3 disadvantages of using inactivated toxins in active immunisation?
Reversion to virulence
Transmissable
Problems in immunocompromised hosts
178
Which drug may you prescribe in assisted alcohol withdrawal?
Benzodiazepine
179
What are common risk factors for eating disorders?
Genetics, personality, family interaction, social pressures, trauma
180
Give 4 emotional effects of obesity?
Stigma, bullying, low self-esteem, school absence , unemployment
181
Give 4 long term effects of obesity?
High cholesterol, hypertension, pre-diabtes, bone and joint problems, breathing problems, liver disease, sleep apnoea
182
Give 3 public health interventions on an individual level in approach to obesity?
1. Encourage physical exercise, healthy diets,
2. Behaviour change strategies eg goal setting, social support 3. Community based weight management programme,
4. Diet - low calorie diet
183
Give 4 population level interventions to reduce obesity?
1. Increase access to healthy food, altering composition and manufacture of food products
2. Change 4 life and 5-a aday
3. Transport changes - more cycle paths, more green space
4. Public policy - sugar tax and minimum alcohol pricing, subsidise gyms and active transport
184
What is the role of the doctor in managing obesity?
Educate patients, behaviour change interventions, prescribe exercise and medications, refer for surgery, signpost to weight loss management programmes
185
Under mental capacity act 2005, when does a patient lack capacity?
If a patient cannot
1. Understand information
2. Weigh up the information
3. Retain the information
4. Communicate the information
186
If a patient lacks capacity what would you do?
1. Check if someone can make a decision on their behalf
2. Check if there is a lasting power of attorney or advance decision
3. Healthcare professionals can act in line with patients best interests
187
Name 4 typical incidents that would jeprodise patient safety?
1. Failure to diagnose
2. Failure to appreciate patient overall condition
3. Failure to delay in clinical monitoring and management
4. Failure to treat right patient and record
188
Name the 4 main types of error?
1. Latent
2. Active
3. Organisational system failure
4. Technical failure
189
What are the 3 types of human error?
1. Error of omission (required action delayed)
2. Errors of commission (wrong action is taken)
3. Errors of negligence
190
What does SBAR stand for?
Situation, background, assessment, recommendation
191
What range of BMI classifies as obese?
30-39.9
192
Give 5 effects of obesity in children?
School absence, high cholesterol, pre-diabtes, bullying/stigmatism, risk of ill-health and premature mortality in adult life, breathing difficulties
193
Between which groups of people is obesity more common?
People from more deprived areas, older age groups, some black and minority ethnic groups, people with disabilities
194
Name 3 barriers to controlling obesity?
1. We like easily available energy
2. Interventions will only impact upon rates of obesity inland term
3. Industry profits from making us fat
195
Name 4 long term effects on positive action on obesity?
1. Reduced health inequalities
2. Great social cohesion
3. Stronger local economy
4. Reduced demand on health and social care services
5. Less discrimination and bullying
6. Improved local environment
196
Give 5 examples of conditions that arise from obesity?
Stroke, MI, type 2 diabetes, hypertension, stroke, osteoarthritis, obstructive sleep apnoea
197
Give 4 reasons as to why we eat?
1. Internal physiological drive to eat
2. Feeling that prompts thought of food and motivates food consumption
3. External psychological drive to eat
4. Sometimes even in the absence of hunger
198
Which hormone switches off appetite?
Leptin
199
What is considered when making a decision in the patents best interest?
1. Could they ever gain capacity
2. Past and present wishes
3. Beliefs and values
4. Factors they would consider
5. Opinions of relevant people
Relatives cannot provide or refuse consent
200
What is Gilleck Competence?
Does a child under 16 understand the consequences of their decision
If they are not Gillick competent they cannot consent
201
What are the 3 principles of informed consent?
1. Given voluntarily
2. Given by an individual who has capacity
3. Given by an individual who has been fully informed on the issue
202
Within how many house do you have to give IV N-acetlcysteine in paracetamol poising?
Within 8 hours
203
What is the definition of addiction?
Physical and physiological dependence
204
What are methods of primary prevention for smoking cessation?
1. Smoking cessation services
2. Nicotine replacement therapy
3. AAA - Ask, Advise, Assist
205
What are the steps to end malnutrition monitoring in hospitals?
1. Introduce protected meal time
2. Implement red tray system
3. use volunteers where appropriate
4. All ward staff must be food aware
5. Hospital staff mist listen to older people
206
What are the wider determinants of health?
Age, sex and heridatory factors, individual lifestyle factors, Social and community networks, living and working conditions
207
What is an error of comission?
The wrong action is taken
208
What is errors of omission?
Required action is delayed
209
What is the difference between occupational disease and work related disease?
Primarily from risk factor associated with work (eg tenosynovitis), whereas work related disease (eg hand arm vibration)
210
What is a hazard?
Something that has the potential to cause har,
211
What questions would you ask in occupational health screening?
1. What work do you do?
2. Are your symptoms better away from work?
3. Do other people in your work have same problems?
4. Have you ever been exposed to ...?
