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Medicine Year 1 > Red SAPs > Flashcards

Red SAPs Flashcards

(75 cards)

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1
Q

Describe the structure of the calgary-cambridge framework

A

initiating the session –> gathering information –> physical examination –> explanation and planning –> closing the session
building a rapport occurs throughout

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2
Q

What are the categories of the GMC’s ethical guidance?

A

good medical practice
confidentiality
maintaining professionalism
children and young people (including protecting at-risk children)
prescribing
decision making and consent
care at the end of life (including assisted dying)
leadership and management
candour and raising concerns
cosmetic interventions
research

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3
Q

Deontological ethics

A

intensions matter. actions are good or bad according to a clear set of rules. do our duty for no other reason than because it is the right thing to do

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4
Q

Utilitarian ethics

A

greatest amount of happiness for the greatest number of people. branch of consequentialism

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5
Q

Virtue ethics

A

action is only right if it is an action that a virtuous person would carry out in the same circumstances

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6
Q

Ethics of care

A

some emotions can be reasonable or morally appropriate in guiding good actions or decisions

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7
Q

What assumptions may underpin ethical debates?

A

man is a rational being and man is free - may not apply in a healthcare setting

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8
Q

Context of GMC’s fitness to practice?

A

comes under professionalism and must be followed - breaches can lead to hearings

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9
Q

Factors that influence fitness to practice

A

criminal convictions
drug or alcohol misuse
aggressiveness, violence, or threatening behaviour
persistent inappropriate attitude or behaviour
cheating or plagiarising
dishonesty or fraud
unprofessional behaviour or attitudes
health concerns or management of these concerns

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10
Q

List the GMC duties of a doctor

A

make care of patient your first concern
provide a good standard of practice and care
take prompt action if safety is being compromised
protect and promote health of patients and public
treat patients as individuals
work in partnership with patients
work with colleagues
be honest
act with integrity
don’t discriminate
don’t abuse trust in profession

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11
Q

Significance of radio-radial delay

A

subclavian artery stenosis, aortic dissection, aortic coarctation

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12
Q

Significance of radio-femoral delay

A

aortic coarctation distal to the left subclavian artery

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13
Q

Significance of arterial bruit

A

stenosis at or proximal to the site of auscultation

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14
Q

Volume of distribution calculation

A

Dose/concentration (C0 - initial plasma concentration)

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15
Q

Loading dose calculation

A

Vd * desired steady state concentration

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16
Q

ECG changes in ischaemic heart disease

A

all waves present but ST depression below baseline

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17
Q

Structure for writing clinical questions

A

PICO:
patient - who? demographic?
intervention - e.g. drug
comparison - vs a placebo
outcome - what is the desired effect?

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18
Q

What are the four sections of critical appraisal and why is it relevant?

A

does the study address a clearly focused question?
did the study use valid methods?
are the valid results of the study important?
are the valid important results applicable to my patient or population?
if the answer of any of these is no then the study does not need to be read

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19
Q

Randomised control trial

A

randomly assigned to either intervention or control. followed over time to see if there is a difference in outcome. determines causation

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20
Q

Cohort study

A

groups followed over time to see any developments in a particular condition. association, not causation. mostly prospective.

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21
Q

Case control study

A

group of cases with condition are identified and matched demographically with a control group. past exposure is then worked out to determine if there is association with outcome

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22
Q

Cross-sectional study

A

look at a population at one point in time to determine prevalence

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23
Q

Systematic review

A

overviews of primary literature to determine relevance to question

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24
Q

Meta-analysis

A

systematic review comparing multiple studies on the same topic

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25
Absolute risk
risk of a patient developing a disease over a time period
26
Relative risk
compares two groups of patients and their relative risks of developing a condition depending on their contexts e.g. relative risk is increased by 50% if you smoke so non-smoker absolute is 10% and smoker absolute is 15%
27
Odds ratio
odds an outcome will occur if an exposure is present compared to the odds of the outcome without the exposure
28
Attributable risk
measure of the proportion of disease occurrence that can be attributed to a certain exposure
29
Observational study
look at, describe, or compare findings. no interventions performed. examples are case reports or series. good for quick information sharing
30
Interventional study
an intervention must be performed
31
Internal causes of hyperkalaemia
Maisie Called Brad Idiot Egg insulin deficiency - decreased Na/K ATPase activity metabolic acidosis beta blockers and alpha agonists cell lysis exercise
32
External causes of hyperkalaemia
HARPI too much intake from IV fluids hypoaldosteronism renin inhibitors AKI potassium-sparing diuretics
33
Signs and symptoms of hyperkalaemia
muscle weakness, flaccid paralysis, cardiac arrest, arrhythmias ST depression, peaked T, short QT, prolonged PR
34
Internal causes of hypokalaemia
excess insulin metabolic alkalosis beta agonists and alpha blockers
35
External causes of hypokalaemia
low intake hyperaldosteronism loop and thiazide diuretics vomiting diarrhoea
36
Signs and symptoms of hypokalaemia
muscles less responsive, constipation, muscle cramps, flaccid paralysis, muscle weakness, arrhythmias U wave, prolonged QT
37
What are the categories of causes of AKI?
pre-renal (70%), post-renal (10%), and intrinsic renal (15%)
38
Causes of pre-renal AKI
reduction of perfusion: - hypovolaemia - NSAIDs - ACEis
39
Causes of post-renal AKI
blockage of urinary tract: - renal cancer - renal stone - ureteric injury - extrinsic compression of ureter
40
Causes of intrinsic renal AKI
injury to kidney itself: -glomerulonephritis - acute tubular necrosis - acute interstitial nephritis and vasculitis
41
What is AKI?
rapid deterioration in kidney function that happens within a few hours or days
42
Clinical consequences of AKI
The vowels: A - acidosis E - electrolyte imbalance (hyperkalaemia) I - intoxicants (drug accumulation) O - oedema, fluid overload U - uraemia (elevated urea)
43
Risk factors AKI
over 65 previous AKI CKD nephrotoxic drugs heart failure liver disease diabetes mellitus hypovolaemia limited fluid intake
44
Risk factors kidney stones
dehydration loop diuretics antacids male obese white hypertension
45
Pathophysiology kidney stones
urine becomes supersaturated with solutes that precipitate and form a stone
46
Types of kidney stone
calcium oxalate - acidic calcium phosphate - basic struvite - urine infections uric acid - high purine diet
47
Presentation kidney stones
severe unilateral loin to groin abdominal pain haematuria pain passing urine walking to ease the pain nausea and vomiting flank tenderness
48
Complications of kidney stones
failure of stones to pass AKI hydronephrosis infection recurrence
49
Where are kidney stones most likely to get stuck?
ureteropelvic junction pelvic brim/iliac vessels ureteric orifice
50
Strengths of health AI
screening/triage support diagnosis automation prognosis forecasting treatment decision support treatment delivery telemedicine robotic surgery
51
Limitations of health AI
requires large and complex datasets which need a broad skillset to understand so more collaborations between stakeholders potential to automate and augment clinical decision making unknown effects on broad scale disagreements between clinicians and AI
52
Fully supervised AI
inputs and outputs both well-labelled. good for areas we already have experience in
53
Partly supervised AI
data is labelled but the labels may not be complete - small amounts of labelled in a pool of unlabeled
54
Unsupervised AI
machine uses algorithms to attempt to recognise patterns from the input data - forms own conclusions
55
Rule based learning
human derived rules to determine an outcome
56
Machine learning
machine learns directly from the data rather than from human rules
57
Deep learning
adding multiple connections to neural network that performs the analysis
58
What criteria must be met before a screening test is implemented?
The disease - should be important health problem, the disease should be understood, association between marker and treatable disease, long time between detectable signs and overt disease The test - must be valid (sensitive and specific), simple and cheap, safe and acceptable, reliable Diagnosis and treatment: agreed policy for those that test positive, treatment available, facilities adequate to meet demand for treatment Programme - evidence that is reduces disease and mortality, acceptable to the public, opportunity cost
59
Stages of the cycle of change
pre-contemplation - no intention of changing behaviour contemplation - aware of problem preparation - intent on taking action action - active modification of behaviour maintenance - sustained changes relapse - fall back into old patterns of behaviour
60
Stages of the experiential learning cycle
concrete experience - having the experience reflective observation - reflecting on the experience abstract conceptualisation - learning from the experience active experimentation - putting into place new behaviours
61
What are the six building blocks of a healthcare system?
service delivery health workforce information medical products, vaccines, and technologies financing leadership/governance
62
Phases of a clinical trial
pre-clinical research phase 1 - safety and side effects, small group phase 2 - safety and effectiveness, larger group phase 3 - safety, effectiveness, and dosage, larger group again approval phase phase 4 - made available to public, monitoring phase
63
Ethical questions in a clinical trial
voluntary participation confidentiality consent anonymity potential for harm
64
True endpoint of a clinical trial
clinically meaningful endpoint that directly measures patients has it worked? how does the patient feel and function?
65
Surrogate endpoint of a clinical trial
measurement of a specific outcome used in place of another as a predictor to tell if a treatment works. usually occurs before a true endpoint
66
What are the harms of bias in a trial?
over-estimation of effect wrong conclusions treatments look better than they are make ineffective treatments look as if they work
67
Types of data misrepresentation
fabrication/falsification improper analysis poorly drawn graphs selective reporting over-interpretation of results
68
Most common causes of CKD
diabetes mellitus hypertension PKD renal artery stenosis (unilateral kidney) but most are never identified
69
What are the three broad types of health system?
Government financed Privately financed Mixed
70
Describe the tax-based health system
example NHS general government revenues so funds are in competition with other sectors one pool
71
Describe the social health insurance model
also known as the Bismarck model many pools of sickness funds labourers are insured by employers in case of illness/injury e.g. Germany, Kenya
72
Describe the private health system
can be either out of pocket payments or private insurance e.g. USA, most lower-income countries
73
What is the HFEA?
human fertilisation and embryology authority established as part of the human fertilisation and embryology act regulate fertility treatment and research using human embryos
74
What is direct to consumer testing?
genetic tests sold online and in shops
75
Pros and cons of direct to consumer testing?
Pros: - promotes awareness of genetic disease - may help people to be aware of their health - results not included in medical record - often less invasive Cons: - Tests don't cover all diseases - information may be upsetting - little regulation on testing companies - privacy may be compromised

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