PPH
Define 'primary prevention' and provide 2 general examples of some strategies
Answer: Health promotion and prevention of disease in healthy people.
For example:
Universal immunisation, health workforce immunisation, screen blood and sperm, injection safety, patient developed educational materials
List 2 principles in assessing capacity for consent
Any of the SCIF elements
Specific
Competent
Informed
Freely given
List an intra-renal cause of AKI?
Answers:
Acute glomerular nephritis, acute tubular necrosis (50% of ACF causes), acute interstitial nephritis, vascular - vasculitis, atherosclerosis
Name two branches of the left coronary artery
Left anterior descending and left circumflex artery
What are endospores?
Dormant, non-reproductive structures produced by certain bacteria. Are extremely resistant to destruction (e.g., by heat, UV, chemical damage).
Answers:
- Temporal relationships unclear
- Subject to recall bias
- Response rate (if low)
- Not good for hypothesis testing
- May not detect rapidly fatal conditions
List 2 reasons why using a family member as a translator could be detrimental
• Possibility of misdiagnosis and/or mistreatment due to inaccurate information
• No knowledge of translating medical terms
• Harmful emotional consequences, especially when children are used
• Family may cloud the patient’s responses with their own interpretation of the situation
List two mechanisms of action of the oral contraceptive pill?
Answers:
Hypothalamus suppression of ovary leading to anovulation
Altered tubal motility
Less receptive endothelium − hostile cervical mucus
At which vertebral level do the following branches of the abdominal aorta arise? What part of the embryological 'gut' do each supply?
Celiac trunk - SMA - IMA
Celiac Trunk = T12 = foregut
SMA = L1 = midgut
IMA = L3 = hindgut
List two methods that are widely used to reduce the spread and effects of microbial infections?
Answers:
1. Vaccinations (most effective)
2. Antimicrobial chemotherapy (i.e. antibiotics)
3. Pasteurisation: using gentle heat to reduce organisms in food
Name 3 sources of subjective stress in doctors
Any of:
Intensity of demand on doctors, conflicting demands and time pressure
Gravity, emotional intensity and responsibility entailed in the job
Insufficient resources provided in the public sector
Medicolegal threat and unreasonable expectations and demands of patients
After-hours and on-call work
Interference with family life
Name 3 ways the doctor-patient relationship improves end-of-life care for a patient
- Better quality of life
- Higher satisfaction with treatment
- Higher rates of treatment adherence
- Lower rates of malpractice litigation
- Greater illness acceptance
- Lower risk of patient suicidal ideation
- Lower likelihood of receiving care in the ICU during the patient's last week of life
- A positive relationship can extend into bereavement
What sensory pathways are the spinothalamic and dorsal column tracts responsible for? Where do each decussate?
The dorsal column pathway is involved with touch and proprioception and decussates in the medulla
The spinothalamic pathway is involved with pain and temperature and decussates in the spinal cord
Explain what constitutes the layers of the rectus sheath - above and below the arcuate line?
Above:
Anterior wall: Aponeurosis of EO and IO
Posterior wall: Aponeurosis of IO, TA and transversalis fascia
Below:
Anterior wall: Aponeurosis of EO and IO and TA
Posterior wall: Transversalis fascia only
Define the following:
α-haemolytic
β-haemolytic
γ-haemolytic
α-haemolytic: Colonies partially lyse erythrocytes in blood agar, tinging them green
β-haemolytic: Colonies fully lyse erythrocytes in blood agar, forming a clear zone
γ-haemolytic: Non-haemolytic, or an absence of haemolysis in blood agar
List 2 factors under each criteria for an effective screening program:
Condition:
Test:
Treatment:
Program:
Condition: Serious, well-defined, epidemiology well known, history of progression well known, recognisable early symptom
Test: Reasonably quick/easy, cheap, safe, accurate, culturally appropriate
Treatment: Follow-up treatment available and accessible, adequate facilities for follow up tests/referrals if screening tests are positive, data on program must be easily collectable
Program: Benefit outweigh harms, equity of access, cost-effective
Explain what is meant by ‘material risk’ in the context of informed decision-making
Objective Test: In the circumstances, a reasonable person in the patient’s position, if warned of the risks, would be likely to attach significance to it
Subjective Test: The medical practitioner/s is, or should reasonably be, aware that the particular patient, if warned of the risk, would be likely to attach significance to it
As a clinician - explain how a "Tet Spell" manifests and walk through the underlying physiology of how you can reverse it?
1. Decrease in systemic vascular resistance or increase in pulmonary vascular resistance (exertion)
2. Worsening of RVOTO
3. Increase in R to L shunt
4. Squatting kinks the femoral artery
5. Increased systemic vascular resistance
6. Decreased R to L shunt
7. Increased blood flow to pulmonary circulation
8. Decreased hypoxaemia
Explain how a cancer of the prostate could metastatically invade other organs?
The prostatic venous plexus facilitates metastatic invasion of prostate cancer into the lumbar vertebrae. This is due to drainage into the vertebral venous plexus.
Name 3 types of urine samples that a clinician can collect and an infection they can detect?
1. First pass urine: STI (affect urethra)
2. Mid-stream urine: UTI (less contamination from skin flora and external genitalia)
3. Full void early morning: TB (may be present in kidneys and urinary tract)
4. Catheterisation: Pseudomonas aeruginosa (obtained directly from bladder)
5. Suprapubic aspiration: UTI (most sterile method - when contamination is a concern e.g. infants)
List the four main groups which are most vulnerable to hospital adverse events and explain why
The young: Medication errors, infections, delayed diagnosis (symptoms different and/or overlooked)
The elderly: Falls, polypharmacy, mismanagement post-op (recovery)
NESB patients: Miscommunication, misunderstandings, delayed treatment
Patients with mental impairment or illness: Medication errors, involuntary physical or pharmacological restraints, inadequate monitoring
Patients who cannot advocate for themselves have lower patient safety and higher rates of adverse events
What are some general legal principles which protect patients in Australia
NSW Medical board: Has responsibility to protect the health and safety of the people of NSW
Code of Professional Conduct: General principles that complement the requirements of the law
The Supreme Court of NSW: Can review decisions of the Medical Board
Explain the mechanism of iron transport in the body?
1. Iron ingested as Fe2+
2. In stomach, reduced pH leads Fe2+ to oxidise to Fe3+
3. Enters duodenum
4. Fe3+ reduced by brush boarder enzyme and Vitamin C to Fe2+
5. Transported via divalent metal transporter
6. Enters enterocyte where there's two fates - remain in cytosol as ferritin and sloughed off or;
7. Enter blood via ferroportin 1 and converted to Fe3+ by hephaestin
8. Binds to transferrin to be transported in the blood
What layers would be pierced in a renal biopsy to reach the kidney
1. Skin
2. Subcutaneous fat
3. Thoracolumbar fascia
4. Lat dorsi
5. Quadratus lumborum
6. Paranephric fat
7. Renal fascia
8. Perinephric fat
8. Renal capsule
Explain how strongyloides stercoralis (roundworm) hyperinfection occurs?
List two conditions/scenarios in which hyperinfection could occur?
Name two treatments?
Before you groan - this was a question on the 2023 Micro UTS exam!
Hyperinfection Mechanism:
Occurs when larvae undergo accelerated autoinfection, leading to increased parasite load within the body
Conditions for Hyperinfection:
Mainly relate to immune system issues
Treatments: