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H&S > Year 4 > Flashcards

Year 4 Flashcards

1
Q

What 9 conditions are tested for on the neonatal blood spot?

A

Congenital hypothyroidism, CF, sickle cell disease, PKU, MCADD, MSU, isovaleric acidaemia, glutamic aciduria 1, homocysteineuria, SCID

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2
Q

What blood disorders are tested for at booking?

A

Anaemia, red call alloantibodies, sickle cell, thalassaemia, and HIV, hepatitis and syphillis screen

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3
Q

What newborn hearing tests are carried out?

A

Automated otoacoustic emission (AOAE) and automated auditory brainstem response (AABR) if AOAE is abnormal

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4
Q

What conditions are screen for in the foetal abnormality test?

A

Anencephaly, spina bifida, cleft lip/palate, diaphragmatic hernia, renal agencies, gastrochisiss, exomphalos, cardiac or renal agenesis, Edwards & Patau’s

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5
Q

When its the foetal anomaly screen?

A

18-20+6 weeks

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6
Q

When is the foetal Down’s screen?

A

11-13+6 weeks

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7
Q

What might be tested for in Down’s screen and what are the results?

A

Nuchal translucency (increased), HCG (increased), PAPP-A (decreased), AFP (decreased) unconjugated oestradiol (decreased), inhibit-A (decreased)

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8
Q

What’s included in combined trisomies test?

A

Nuchal translucency, free HCG, PAPP-A, mother’s age

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9
Q

Who can’t have live attenuated vaccines?

A

Anyone who is immunocompromised, e.g. cancer treatment, HIV postive, long term steroids, immunosuppressed, bone marrow transplant in last 6 months

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10
Q

When to postpone a vaccine?

A

Acute illness, pregnancy (unless high risk disease), adverse reaction to previous dose

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11
Q

Examples of live attenuated vaccines?

A

MMR, BCG, chickenpox, nasal influenzae, rotavirus, oral polio, yellow fever, oral typhoid

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12
Q

What vaccines are given at 8 weeks?

A

6 in 1, men B, rotavirus

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13
Q

What vaccines are given at 12 weeks?

A

6 in 1, PCV, rotavirus

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14
Q

what vaccines are given at 16 weeks

A

6 in 1, men B

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15
Q

What vaccines are given at 1 year?

A

2 in 1 (Hib and men C), PCV, MMR, men B

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16
Q

What vaccine is given annually from 2-8 years?

A

Nasal flu vaccine

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17
Q

What vaccine is given at 3 year, 4 months?

A

4 in 1 (dip, tet, pertussis, polio), MMR

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18
Q

What vaccine is given at 13-14 years?

A

HPV

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19
Q

What vaccine is given at 14 years?

A

3 in 1 (dip, tet, polio)

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20
Q

When is the 6 in 1 vaccine given and what is in it?

A
  • 8, 12, and 16 weeks
  • Diphtheria, tetanus, pertussis, polio, HiB, & hep B
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21
Q

When is the 2 in 1 vaccines given and what its in it?

A
  • 1 year
  • Hib and men C
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22
Q

When is the 4 in 1 vaccine given and what is in it?

A
  • 3 years, 4 months
  • Diptheria, tetanus, pertussis, and polio
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23
Q

When is the 3 in 1 vaccine given and what is in it?

A
  • 14 years
  • Diptheria, tetanus, and polio
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24
Q

When is the BCG vaccine given?

A

Offered from birth to high risk babies

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25
Q

Who is most at risk from a burn?

A

Children <5, people >75, and those with diabetic neuropathy

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26
Q

Causes of burns in under 5s?

A

50% happen in kitchen: hot water, chip pan, oven door, kettle, iron, the sun

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27
Q

How to prevent burns?

A
  • Health promotion in schools to teach kids about safety
  • Advice to parents about safety and accident prevention in the home
  • Workplace safety information to employers
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28
Q

How to prevent sunburn?

A
  • Stay out of sun between 11 and 3
  • When in sun wear adequate clothing (e.g. hat, t-shit
  • Wear high factor suncream and reapply every 2 hours
  • Keep close eye on children wearing suncream
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29
Q

How to prevent burns in the kitchen?

A
  • Keep young children out of the kitchen unless supervised
  • Use back hobs
  • Keep hot things out of reach of children
  • Teach older children how to use kettle and oven safely
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30
Q

How to prevent fires?

A
  • Fit smoke alarms in every room and regularly test
  • Avoid open fires (or use fireguard)
  • Keep doors closed at night to prevent spread
  • Store matches away from children
  • Teach older children to use matches safely
  • Have fire blanket ready in kitchen
  • Don’t smoke inside
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31
Q

What is most common cause of death in children?

A

Accidents

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32
Q

Most common accidents in babies?

A

Dropped, burned, scalded

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33
Q

Most common accidents in toddlers?

A

Falls, burns, scalded, accidental poisoning

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34
Q

Most common accidents in older children?

A

Falls from heigh, RTAs

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35
Q

Personal effects of back pain?

A
  • Constant discomfort
  • Loss of income
  • Loss of independence
  • Depression due to social isolation
  • Feeling of guilt
  • Medication side effects
  • Relationship issues
  • Decreased social/leisure activity
  • Inability to care for family
  • Decreased libido
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36
Q

Societal issues of back pain

A
  • 3rd most common cause of sick leave
  • 80% of people will experience back pain
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37
Q

Iatrogenic causes of back pain?

A
  • Lack of encouragement to return to work
  • Medical mismanagement
  • Inappropriate drugs or surgery
  • Lack of reassurance from doctor
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38
Q

Iatrogenic causes of back pain?

A
  • Lack of encouragement to return to work
  • Medical mismanagement
  • Inappropriate drugs or surgery
  • Lack of reassurance from doctor
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39
Q

Services to help with returning to work after back pain?

A

Physio, OT, employment advisors, exercise prescriptions, osteopathy/chiropractors/acupuncture

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40
Q

Physical effects of falls in the elderly?

A
  • Fractured hip
  • Head/eye injury
  • Forearm injury/wrist fracture
  • back/spinal injury
  • Long lie
  • Loss of ability to do ADLs
  • Death
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41
Q

Effects of a long lie?

A
  • Pressure sores
  • Hypothermia
  • Infection from wounds or aspiration
  • Dehydration
  • Rhabdomyolysis and AKI
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42
Q

Psychological effects of a fall?

A
  • Loss of confidence
  • Immobility
  • Isolation
  • Depression
  • Increased independence
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43
Q

Methods to prevent falls?

A
  • Regular cleaning of glasses
  • Home safety assessment and modifications
  • Home-based strength and balance programmes
  • Walking aids
  • Nurse supervision in care home
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44
Q

Medical risks for fall?

A
  • Arthritis
  • Postural hypotension
  • Gait abnormality
  • Parkinson’s
  • Muscle weakness
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45
Q

Environmental risks of fall?

A
  • Poor lighting
  • Loose rugs/carpets
  • New environment
  • Cluttered areas
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46
Q

Pharmaceutical risks of fall?

A
  • Polypharmacy
  • Antihypertensives
  • Sedatives
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47
Q

Sensory/cognitive causes of fall?

A
  • Dementia
  • Poor eyesight
  • diabetic neuropathy
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48
Q

System (care home) risks of fall?

A
  • Poor staff education
  • Poor staff:patient ratio
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49
Q

8 key principles of NSF-elderly?

A
  • Age discrimination
  • Patient centred care
  • Intermediate care
  • Hospital care
  • Strokes
  • Falls
  • Mental health
  • Health promotion
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50
Q

Technology appraisal process:

A
  • Topic selection
  • Data submission
  • Data review
  • Call for contributions
  • fund
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51
Q

Cost effectiveness measured using?

A
  • Incremental cost effectiveness ratio
  • ICER=(cost A - cost B)/(QALYs B - QALYs A)
52
Q

HIV transmission can be:

A
  • Intentional (deliberately meaning to give HIV)
  • Reckless (not deliberate, but careless; fails to inform partner)
  • Accidental (unaware of having HIV/condom failure)
53
Q

Can you inform someone partner they have HIV?

A

If you believe partner issues high risk then tell them, but inform patient you are going to do so

54
Q

Why monitor adverse events?

A
  • They are common
  • They have important consequences
  • 50% are preventable
  • We can learn from them to improve care and safety
55
Q

Who is responsible for handling of adverse events?

A

National Patient Safety Agency

56
Q

Where should you report adverse events?

A

The National Reporting and Learning System

57
Q

How are adverse events handled?

A

Root Cause Analysis

58
Q

Duty of candour in adverse events:

A
  • Explain what has happened and apologise
  • Offer solution
  • Explain long term implications
59
Q

Most common adverse events?

A
  • Prescribing error
  • Communication failure
  • Delay/failure in diagnosis
60
Q

What are never events, and give an example?

A

A serious preventable patient safety incident that should not have occurred if all the correct safety procedures were implemented/followed, e.g. wrong-site surgery

61
Q

What its an adverse event?

A

An unintended event arising from clinical care that causes patient harm

62
Q

Barriers to correcting adverse events

A
  • Failure to take responsibility
  • Lack of communication
  • Focus on immediate event and not root cause
  • Poor/rigid staff attitudes
63
Q

What are types of unintentional adverse event?

A
  • Knowledge based
  • Rule based
  • Skill based
64
Q

What is an example of a knowledge based adverse event?

A

Wrong care plan formulated due to poor knowledge of clinician in that area

65
Q

What is an example of a rule based adverse event?

A

Wrong application of a rule/guideline to the clinical scenario, e.g. applying a paediatric treatment pathway to a 2 year old

66
Q

What is an example of a skill based adverse event?

A
  • Attention/memory lapse
  • Deviation from a good plan
  • These are common
67
Q

What are types of intentional adverse events?

A
  • Routine
  • Situational
  • Reasoned
  • Malicious
68
Q

What is an intentional routine adverse event?

A

The normalisation of bad practice

69
Q

What is a situational intention adverse event?

A
  • Depends on clinical situation/scenario
  • I.e. cutting corners when short staffed or overwhelmed
70
Q

What is a reasoned intentional adverse event?

A

A deliberate deviation from protocol thought to be in best interests at the time

71
Q

What is a malicious intentional adverse event?

A

A deliberate act intended to harm

72
Q

Advantages to releasing performance data?

A
  • Transparency for patients
  • Increases patient confidence
  • Competition could boost performance
  • Focus of improving care
  • Public reassurance on safety of care
73
Q

Disadvantages to releasing performance data?

A
  • May not be representative (e.g. surgeons that do riskier surgeries will look worse)
  • Could result in fewer clinicians carrying out important but risky procedures
  • Manipulation of data (doctors may only want to treat healthier patients so they look better)
  • Case-mix (some areas only receive patients with poor prognoses
74
Q

What 3 aspects of consent are required?

A
  • Informed
  • Voluntary
  • Patient must have capacity
75
Q

How can consent be given?

A
  • Written
  • Verbally
  • Non-verbally
76
Q

When its consent not required?

A
  • Additional procedures
  • Emergency treatment when patient can’t consent (e.g. unconscious)
  • Mental health condition (under MHA 2005)
  • Risk to public health with infectious disease (under Public Health (Control of Disease) Act 1984)
  • Severely ill and living in unhygienic conditions (under National Assistance Act 1948)
77
Q

What explained for consent to be informed?

A
  • Overview of condition/procedure
  • Likely outcome of decision
  • Treatment options, including second opinion
78
Q

Evidence that a person lacks capacity must show both of the following:

A

1) Patient has an impairment or disturbance in function of their mind or brain
2) This impairment or disturbance is significant enough to hinder them making a particular decision at this time

79
Q

Examples of conditions that would reduce patient capacity:

A
  • Schizophrenia
  • Bipolar
  • Dementia
  • Drug intoxication
  • Serious LD
  • Brain damage
  • Delirium
80
Q

To have capacity, patients must be able to:

A

1) Understand information
2) Retain the information
3) Use the information to make a decision
4) Communicate their decision

81
Q

What may and may not be treated without consent if a person lacks capacity and hasn’t made wishes known?

A
  • Mental health conditions and related physical issues (e.g. paracetamol overdose) CAN be treated
  • Unrelated physical conditions CAN’T be treated
82
Q

What is an example of an unwise decision that doesn’t necessarily mean a patient lacks capacity?

A

Jehovah’s Witness refusing blood transfusion, so long as they’re aware of consequences

83
Q

Transient conditions that may affect capacity include?

A
  • Shock
  • Intoxication
  • Delirium
  • Panic
    -Extreme fatigue
84
Q

What may be put in place if a person knows their capacity may change?

A
  • An advance directive
85
Q

Important facts about advanced directives?

A
  • Legally binding
  • Can refuse treatment
  • cannot be overruled, unless someone needs to be sectioned under the MHA 2005
86
Q

When can you break confidentiality?

A
  • Protecting children
  • Protecting the public (e.g. act of terror, communicable disease)
  • Required by courts
  • Prevent or detect crime (e.g. Drug Trafficking Act 1986)
  • Provide care in life threatening circumstances
  • Protect service provider in life threatening circumstances
87
Q

Why I confidentiality important?

A
  • Legal requirement
  • Strengthens doctor-patient relationship
  • Reduces fear of health seeking
  • Improves autonomy and trust
  • Do not harm to patient
88
Q

Confidentiality and capacity?

A
  • Patients without capacity can’t be assumed to give or withhold consent
  • Disclosure to relevant parties (e.g. family) its allowed if it will benefit the patient or is in the interest of justice
89
Q

Death and consent?

A

Can disclose information relevant parties unless strictly told not to by patient

90
Q

What is euthanasia?

A

The act of deliberately ending someone’s life to relieve suffering

91
Q

What is assisted suicide?

A

The act of deliberately aiding or encouraging someone to commit suicide

92
Q

Example of assisted suicide?

A

Acquiring strong sedatives for a relative to take to commit suicide

93
Q

Which is legal out of euthanasia and assisted suicide?

A

NEITHER

94
Q

What are the types of euthanasia?

A

Active, passive, voluntary, non-voluntary, involuntary

95
Q

Describe active euthanasia?

A

When someone actively ends the life of another to relieve suffering

96
Q

What is an example of active euthanasia?

A
  • Injecting drugs that will kill a patient
  • Think: Million Dollar Baby
97
Q

Describe passive euthanasia?

A

When a person withholds or withdraws life-prolonging treatment

98
Q

What is an example of passive euthanasia?

A

Removing ventilation

99
Q

Describe voluntary euthanasia?

A

When someone decides they want to die and ask for help

100
Q

Describe non-voluntary euthanasia?

A

When someone can’t give consent for euthanasia, os someone decides for them, often because the patient has previously expressed their wishes to die to them

101
Q

Describe involuntary euthanasia?

A

Euthanasia when someone doesn’t want to die, essentially murder

102
Q

Arguments for euthanasia?

A
  • Ethical: people should have choice (autonomy) to decide how and when they want to die
  • Pragmatic: argues procedures in end of life care are essentially the same a euthanasia
103
Q

Pragmatic arguments for euthanasia?

A
  • Some procedures e.g. DNACPR and palliative sedation are essentially the same as euthanasia (passive and active respectively) so may as well legalise and regulate it
  • This would be acting in patient’s best interests (beneficence)
104
Q

Arguments against euthanasia?

A
  • Religious: people believe only god has the right to end a life
  • Slippery slope: concerns legalising will lead to unwanted side effects
  • Medical ethics: possibly violates non-maleficence
    Alternatives: is a cure just round the corner? Will advances in palliative medicine and mental health make disease bearable?
105
Q

Examples of slippery slope arguments for euthanasia?

A
  • Very ill people may feel pressured to end their own life so they aren’t a burden
  • Research in palliative care may be discouraged
  • Misdiagnosis and prognosis may lead to euthanasia when not required
106
Q

Medical ethics arguments against euthanasia?

A
  • Violates non-maleficence
  • May result in poor attitudes towards terminally ill
  • Loss of patient trust (e.g. “doctor just wants to kill me off)
107
Q

What is an abortion?

A

An elective procedure to end a pregnancy

108
Q

What 2 acts are relevant to abortion in the UK?

A
  • Abortion Act 1967
  • Human Fertilisation and Embryo Act 1990
109
Q

When its an abortion legal until?

A

-24 weeks
- Reduced from 28 to 24 weeks under Human Fertilisation and Embryo Act 1990

110
Q

When might an abortion be carried out after 24 weeks?

A
  • Necessary to save mother’s life
  • Necessary to prevent severe permanent injury to the physical or mental health of the mother
  • Substantial risk of severe permanent mental or physical disability that would result in the child being handicapped
111
Q

How many doctors must sign for an abortion after 24 weeks?

A

2

112
Q

Does a patient under 16 need tell her parents about having an abortion?

A
  • Not if 2 doctors agree it is in her best interests and she understands the procedure
  • But doctors should try to convince child to tell parents or an adult
113
Q

Arguments for abortion?

A
  • A woman has the right to choose what happens to her body, including pregnancy (autonomy)
  • Banning abortions will cause women to use illegal and dangerous abortionists (beneficence)
  • Woman shouldn’t have to bear the emotional stress of carrying a child by rape (Justice)
  • Vast majority of abortions occur when foetus is in such an immature state it isn’t alive/wouldn’t survive outside the uterus (non-maleficence)
114
Q

Arguments against abortions?

A
  • All forms of life, however immature, have a right to life (Justice)
  • Abortion is the deliberate ending of another life, similar to murder (non- maleficence)
  • Abortions can have complications later in life (e.g. ectopics) (non-maleficence)
115
Q

What outlines research ethics principles for human experimentation?

A

The Nuremberg Code

116
Q

What are 3 research ethics principles?

A
  • Voluntary consent is required from all patients
  • Experiment should yield results that are beneficial to society that can’t be gained by other means
  • Based on animal experimentation and should be knowledge of natural history of disease
  • Must avoid all unnecessary physical or mental suffering
  • Should not be performed if intervention is believed to be harmful
  • Risk should not exceed humanitarian importance
  • Preparations and facilities should be in place to protect subjects from injury, disability or death
  • Should be conducted by qualified people
  • Subjects can leave whenever they wish
  • Those in charge should be prepared end the experiment if harm to subjects becomes likely
117
Q

When should you break confidentiality regarding young people asking for sex related treatment (e.g. contraception, abortion)?

A
  • If under 13 always inform relevant authorities (this is statutory rape)
  • If fear of coercion or exploitation (e.g. much older partner, patient is secretive)
118
Q

Dr responses to MUS diagnosis?

A
  • Sceptisism
  • Pressure on Dr (can’t provide cure etc)
  • Assume patient is seeking cure
  • Easier to give in to give treatment
  • Difficult communication/explanation with patient
119
Q

Patient responses to MUS?

A
  • Unnecessary tests/radiation exposure
  • Patient seeking exculpation and explanation, not necessarily a cure
  • Want to feel listened to
  • Not disregarded
120
Q

Measures of QoC?

A
  • Donebedian model
  • PROM forms
  • Public performance data (e.g. mortality rate)
  • Audits
  • Complaints
121
Q

What is primary prevention?

A
  • Occurs before a disease has developed
  • Aims to prevent onset of disease
122
Q

What is an example of primary prevention?

A
  • Tackling modifiable risk factors
  • E.g. smoking cessation to prevent onset of CVD
123
Q

What its secondary prevention?

A
  • Occurs after disease has developed
  • Preventing disease progression or any adverse effects of disease
124
Q

What is an example of secondary prevention?

A
  • Medications to prevent adverse secondary outcomes of a disease
  • E.g. statins to prevent MI in CVD
125
Q

What is tertiary prevention?

A
  • Occurs after an adverse event
  • Aims to limit impact that adverse event has on life
126
Q

What is an example of tertiary prevention?

A
  • Treatment to prevent deterioration following adverse events or further adverse events
  • E.g. CABG following MI

H&S (5 decks)

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