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63 Cards in this Set
- Front
- Back
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Test in brainstem dead patients |
CN II CN VIII CN XII CN III Pain at extremities |
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PVS diagnosis |
No awareness of self or environment No response to visual, auditory, tactile or noxious stimulus No language comprehension Sleep/wake cycles maintained 6-12 months |
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What might present as PVS? |
Minimal awareness Locked in GB |
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Classical conditioning |
Neutral stimulus associated with involuntary response by association with previously unconditioned stimulus |
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Stages of conditioning |
Before conditioning - UCS produces UCR Also NS has no effect During - NS associated with UCS = Conditioned stimulus After - New conditioned response produced |
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operant conditioning |
Likelihood of response controlled by consequences REINFORCEMENT |
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Forget long term memory by... |
Interference and decay |
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Causes of memory impairment |
Diffuse brain disease - dementias Focal brain disease - amnesias Physiological disturbances - delirium Psychiatric illness - schizophrenia, depression |
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Working memory |
Which info is ongoing: Programming Initiation Regulation Monitoring |
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Input to pain gate at SC |
Peripheral nerve fibres - pain pressure heat Descending central influences from brain - info about psychological state Large and small fibres- small=bad,large=good |
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VAS |
10cm line Pain severity and treatment effects DOESNT ASSESS QUALITY |
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McGills pain questionnaire |
Examines diff components of the pain experience Sensory Affective Evaluative |
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Pain diaries |
PROS Doctor can understand causes - exacerbating/relieving Detailed daily picture of pain Patients can see changes in pain and impact of their behaviours CONS Permanent record - demoralising Lazy/forgetful patients Inconvenient |
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Doctrine of double effect |
The good and bad effect of an action Compared according to a principle which seeks to justify the action if the bad effect Though foreseen Is outweighed by the good effect |
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Types of euthanasia |
1. Voluntary - competent patient requests 2. Non vol - 3rd party decides for incompetent patient 3. Active - action performed to being about death 4. Passive - action omitted to bring about death |
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How can a doctors intent - dosage of pain meds be proven in court |
Evidence Direct evidence Circumstantial evidence |
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Section 2(1) Suicide Act 1961 |
A person who aids abets counsels or procures the suicide or suicide attempt of another will be liable to imprisonment up to 14 years |
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Factors in favour of prosecution - Assisted suicide |
VICTIM: Child/lack of capacity No consistently expressed death wish Not terminally ill SUSPECT: Not motivated by compassion History of abuse Pressured victim Dr/nuse/paid Public place |
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Factors against prosecution - Assisted suicide |
VICTIM: Clear, settled SUSPECT: Motivated by compassion Tried to dissuade Minor assistance Reluctant Reported to police |
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Article 8 of European Convention on Human Rights |
Right to private life and family |
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Family function |
Facilitates the procreation of children Provides social control and socialisation of children Dictates the social placement of children and adults Physically looks after its members |
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Tansella - 3 ways family becomes to doctors attention |
1. Fail in patient care function 2. Family member has physical or psychological breakdown 3. Non compliance friction between patient, doctor and family |
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Centripetal family - chronic illness |
Tightly bound together Organise family life around illness Ignore illness Cuts down involvement with other people in community Gratification within fam Harmony seen as glue Distrust medical advice autonomy at risk |
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Centrifugal family - chronic illness |
Pulls apart Marital disruption Over attention to ill person Exclude ill person and family returns to normal Gratification outside family May not offer support to patient Distance between members Lack of understanding by family members |
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Carer common effects seen |
Stress Depression Anxiety Back injury Hypertension |
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Human Tissue Act 2004 Part 1 |
Part 1: Consent and organ transplantation Section 2 - Appropriate consent for children LIVE organ donation - Gillick competent or if not -parent gives consent DEAD organ donation - Gillick competent -Advanced declaration, if not - parent gives consent Section 3 - Appropriate consent for adults LIVE - adult gives consent DEAD- Advanced declaration or Nominated person gives consent or Next of kin |
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HTA 2004 Part 2 |
Issues codes of practice Prohibits commercial dealing |
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HTA 2004 Part 3 - Section 43 |
lawful for hospital authorities to take minimum steps to preserve organs of deceased persons whilst the appropriate consent to transplantation is sought |
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Overruling refusal of treatment - justification and ethical problems with this |
Illness interferes with persons normal values Best interests ethical probs: Assumes mental illness - incompetent Protection of others as well as patient doesn’t happen with physical disorders so why mental |
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Mental health act 1983 Compulsory admission 3 routes Admission for assessment S2 |
Must have mental disorder Must be dangerous Nearest blood relative makes application 2 doctors support Lasts 28 days |
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Mental health act 1983 Compulsory admission 3 routes Emergency Assessment S4 |
Have significant mental disorder Dangerous 1 doctor makes application 3 days |
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Mental health act 1983 Compulsory admission 3 routes Admission for treatment S3 |
Nature of mental disorder warrants hospital treatment DangerousMental illness is treatableTreatment includes symptomsNearest relative or social worker makes application6 months |
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Amendments to MHA from 83 to 07 |
Section 1 - Removal of categories of mental disorder Section 4 - Replacement of treatability and care tests with appropriate treatment Chapter 2 : Professional roles Section 23- Patients Nearest Relative - Patient Safeguarding Section 27 Electroconvulsive therapy Section 17 - Supervised community treatment |
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Which section is conscientious objection under? |
Section 4 1(1)b and 1(1)c are exceptions |
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Abortion procedure |
Medical: Mifepristone Prostaglandins Surgical: Suction aspiration - 7 weeks Dilation and evacuation - 15 weeks Feticide using KCL with surgical evacuation under GA - post 24 weeks |
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Maladaptive focus |
Deciding whether something is normal on a large scale |
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Self maladaptation |
Consider yourself to be maladapted Society doesn’t adapt to you Internal process Cant reconcile who you are Cant reach own goals Hard to diagnose |
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Social maladaptation |
Other people consider you to be maladapted External process Society considers you as a maladapting individual easier to diagnose |
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Violation of norms |
Ritual/routine - failure to fulfil role obligations Mores - routines that have moral judgement Law - following is normal |
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Conformity definitions |
Crutchfield 1954 - Yielding to group pressure Myers 1999 - Change in behaviour as a result of real or imagined group pressure Zimbardo 1995 - A tendency for people to adopt the behaviours attitudes and values of a reference group |
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FGM Type 1 |
Excision of prepuce With/without clitoris difficult to do so often head of clitoris also |
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FGM Type 2 |
Excision of part of whole of labia minora or majora usually the clitoris as well Can still see urethra and vagina |
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FGM Type 3 |
Excision of part of whole of the external genitalia with stitching/narrowing of the vaginal opening Urethra and vagina cannot be seen |
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FGM Type 4 |
Unclassified - pricking, incising, piercing, burning |
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Immediate FGM complications |
Pain Infection Fractures Shock |
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FGM obstetric consequences |
Difficult vaginal examinations Difficult catheterisation Difficult scalp electrode placement More c sections |
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Foetal consequences |
Lower Apgar scores More intact resuscitation More neural damage Low birth rate IUGR - more |
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Defibulation |
Only type 3 FGM Pregnancy - 20 weeks is best practice |
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4 quadrants - medical military ethics |
Medical Indications Patient Preferences QoL Contextual features |
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Triage |
Sorting casualties based on complexity of treatment, urgency and resources |
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Salvage medicine |
Reverse of triage Force priority - ensure max force strength Treat lightly wounded first - recycle |
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Relative survival |
a survival measure representative of cancer survival in thetheoretical situation there are no other causes of death - no other co-morbidities |
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Cancer stats |
300,000 new cases 150,000 deaths 2 million survivors 10% of those aged 65 = survivors |
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Phonology |
how sounds are used to make words |
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Phonetics |
How speech sounds are produced Acoustic result of speech articulation |
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Speech sounds |
Phonemes: speech sounds in an ideal world Phonetics: phones and allophone Vowels: slower extrinsic muscles Consonants: faster extrinsic muscles |
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Morphology |
Structure of words Smallest meaningful unit of speech - morphemes |
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Syntax |
rules for putting together a series of words |
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Semantics |
Word and sentence meanings for what is spoken |
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Pragmatics |
Social use of language |
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5 types of speech disorder |
Articulation Voice - airstream Fluency - emotional or cognitive Language - cause found Apraxia - planning of speech |
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Prosody includes |
Pitch Intensity Timing |
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agraphia |
impaired writing ability Acquired brain disease Aphasic or non-aphasic |
