PPD 1
What is explicit vs implicit consent?
Explicit: written or oral --> needed for anesthesia, invasive procedures, blood transfusions or experimental treatments
Implied: patient indicates willingness to undergo procedure e.g. rolling up sleeve for venipuncture
List the 4 elements of consent
1. Specific
2. Capacitiy/Competent
3. Informed
4. Voluntary
Give 2 advantages and disadvantages of a cross sectional study
Advantages: Quick and easy. Can generate hypothesis. Gives info for health planning
Disadvantages: Temporal relationships unclear, Subject to bias, Response rate (if low), Not good for hypothesis testing, may not detect rapidly fatal condition
Give 2 advantages and disadvantages of a randomised control trial study
Advantages: "gold standard" for evaluating an invention. Investigator can control the whole study
Disadvantages: Truly randomising subjects may be impossible/unethical, Time consuming and expensive, Limited generalizability, Can only study known factors
Term for vomiting blood
Vomiting blood (hematemesis)
4 ways to deal with stress as a medical student/doctor?
• Having a general practitioner
• Be aware of the risks of self-diagnosis & self-treatment
• Recognise the impact of fatigue on your own health & ability to care for patient
• Have supportive work colleagues, appreciative superiors, effective infrastructure
• Maintain interests outside medicine
• Doctor’s Health Advisory Service there to assist you
• Know when to give up practice
What are 3 implications for physician impairment caused by stress?
For doctor --> become strained, which takes the form of burnout (physical & emotional exhaustion)
For patient --> increased clinical errors, potentially fatal implications
For community --> less doctors in the area: drastic effects in rural & remote areas
Differentiate between incidence and prevalance
Incidence refers to the number of new cases of a disease reported in a given population, over a given period of time.
.
Prevalence is the number of cases of an illness in a population at a set point in time.
What is capacity and list 3 things that could impact one's capacity?
It is the patient’s ability to understand the relevant information and to appreciate the consequences of the decision. May not have capacity if affected by alcohol/drugs, mental illness, intellectual impairment
4 clinical signs of hepatitis
Jaundice – Yellowing of the skin and sclera due to elevated bilirubin.
Hepatomegaly
Tenderness in the right upper quadrant (RUQ)
Dark urine
List 4 instances of exceptions to obtaining consent
1. Emergency treatment: unless reason to believe the patient would refuse treatment if capable
2. Treatment ordered by court
3. Procedures authorized by statute )Compulsory blood, drug and alcohol estimate on the request of a police officer)
4. Involuntary admission of psychiatric patients
When can confidentiality be breached?
1. When the patient has given their consent
2. When it is required by the law
3. If there is danger to the patient or to others
The Bradford Hill criteria include nine viewpoints by which to evaluate human epidemiologic evidence to determine if causation can be deduced: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy.
What is a confounding variable?
factor that is associated with both the exposure and the outcome
Criteria for a confounding factor:
• It is a risk factor for a disease in patients who are not exposed
• It is associated with exposure in the source population
• It is not an intermediate between the exposure and outcome ie. Not on the same causal pathway
• The effect of the exposure is different in patients with confounder present vs absent
5 clinical signs/symptoms of down syndrome
1. Congenital heart defects
2. Intellectual disability
3. hypotonia in newborn babies
4. single palmar crease
5. epicanthic folds
What is the Duty of Care?
A registered medical practitioner has an obligation (0.5) to adhere to a standard of reasonable care to patients (0.5) in the confines of a patient-doctor relationship (0.5). Duty of care is both an ethical and a legal concept. (0.5)
Define patient autonomy
Patient autonomy is the right (0.5) of competent patient (0.5) to make informed decisions (0.5) about their own medical care (0.5).
Define Relative Risk + formula
Ratio of probability of an event occurring in an exposed group to the probability of the event occurring in an
unexposed group. RR = Risk of disease in the "exposed" population / Risk of disease in the "unexposed" population
Define Odds ratio + formula
Quantifies how strongly the presence or absence of property A is associated with the presence or absence of property B
OR: Odds of exposure in "CASES" (disease present) / Odds of exposure in "CONTROLS" (disease absent
3 signs of hypoglycemia
Sweating
Tachycardia
Altered level of consciousness (e.g. confusion, drowsiness, or even loss of consciousness)
What term does "Failure to obtain consent" refer to?
It refers to battery
What term does this refer to: "Failure to inform the patient of risks"?
It refers to negligence
Rank these in order of best to worst
Case Reports/case series
Animal research
Randomised Control Trial
Case Control Studies
Meta analysis
Cohort Studies
Systematic review
Meta analys
Systematic revie
Randomised Control Trial
Cohort Studies
Case Control Studies
Case Reports/case series
Animal research
Interpret this graph
Refer to answers for graphs
3 signs of DKA
Kussmaul breathing – deep, labored breathing due to metabolic acidosis
Dehydration – dry mucous membranes, hypotension, tachycardia
Fruity (acetone) breath odor – due to ketone body production