Notes

Explain the terms relative risk reduction and absolute risk reduction and why one is preferred to the other.
- Relative risk reduction describes the proportional reduction in disease incidence of those who would have developed the disease.
- Absolute risk reduction describes the proportional reduction in disease incidence for an entire population, hence tends to be significantly less than relative risk reduction.
- The use of relative risk reduction may often exaggerates effectiveness of treatment

Elena is showing delay in her development across a number of domains. List the 4 domains via which developmental delay is usually assessed.
- The 4 major domains of childhood development are gross motor, fine motor and vision, speech and language and social.
- By not being able to walk at the normal age Elena is displaying delay in gross motor function. By not babbling she is showing delay in speech and language. By interacting poorly with her father and being unable to feed herself she is showing delay in the social domain.

The mechanism via which measles causes hearing loss is thought to be due predominantly via direct damage to the organ of corti. Select the statement which best describes the mechanism of action of the organ of corti.
- The organ of corti is responsible for producing the initial neuronal signals involved in hearing, using hairs which stimulate nerves when oscillated.
- The ossicles transduce and amplify sounds from the tympanic membrane to the oval window of the cochlear, where they are further transduced onward to the organ of corti via peri-lymph. After the organ of corti has generated a neuronal impulse this is transmitted via the vestibulocochlear nerve to the cochlear nucleus of the brain where theses impulses are first integrated.

An irritable infant refers to one with a persistent, high pitched, inconsolable cry. The other are all symptoms of viral upper respiratory tract infections. For clarification, miserable refers to a crying but consolable infant. Anorexia refers to a child who is off their food; although in a limited extent this is normal parents and health professionals should be cautious to prevent dehydration.

The light reflex is seen inferior to handle of malleus in the anterior portion of the tympanic membrane. Therefore, when looking in the left ear the, the light reflex should be seen to the left.

Causes of abnormal development are classically split into prenatal, perinatal and postnatal. Prenatal conditions refer to those which occur prior to birth such as chromosomal defects including Down syndrome, metabolic abnormalities, congenital infections and neurocutaneous syndrome such as tuberous sclerosis. Perinatal condition refer to those around the birthing process such as extreme prematurity, birth asphyxia and some other after birth metabolic conditions such as hypoglycaemia and jaundice. Finally, postnatal conditions refer to those such as infection, acquired traumatic or hypoxic brain injury and dietary deficiencies.

Distal determinants of health refers to population level effects which influence health through numerous proximal determinants.
Distal determinants can be divided as follows: socio-economic, such as national income, inequality and infrastructural development; institutional, such as health systems, available technologies and information programmes; cultural, such as female empowerment, religious values and traditional health beliefs; and broader context, such as urbanisation, agricultural development and the ecological setting.
The proximal determinants though which these act are personal behaviours, such as diet; environmental exposures, such as air pollution; nutrition, such as micronutrient deficiencies; injuries, intentional or accidental; and personal illness control, such as sickness care actions.

In order to help combat these equalities the United Kingdom has pledged a proportion of its gross national income to international development. Name the organisation through which this pledge was made.
In 1969, the majority of the 36 members of the Organisation for Economic Co-operation and Development (OECD), including the United Kingdom, pledged 0.7% of their gross national incomes to Official Development Assistance (ODA). This was formally recognised at the United Nations in 1970. The United Kingdom is one of 7 countries to ever achieve this target, which it has done every year since 2013. The average spend between the countries has never risen above 0.4%.

The correct answer is Bizarre, which refers to novel non-dose related reactions such as allergy.
Augmented refers to exaggerated normal pharmacological actions and are dose related.
Continuing reactions persist for a long time, such as osteonecrosis of the jaw with bisphosphonate use.
Delayed reactions refer to reactions which become apparent some time after the onset of the drug, such as leucopoenia with lomustine which can take up to 6 weeks to present.
End of use reactions refer to reactions which occur on the cessation of treatment such as insomnia on the withdrawal of benzodiazepines.

Type A Reactions Type A (augmented) reactions result from an exaggeration of a drug’s
normal pharmacological actions when given at the usual therapeutic dose and are normally
dose-dependent. Examples include respiratory depression with opioids or bleeding with
warfarin. Type A reactions also include those that are not directly related to the desired
pharmacological action of the drug, for example dry mouth



Type B Reactions Type B (bizarre) reactions are novel responses that are not expected from the known pharmacological actions of the drug. These are less common, and so may only be discovered for the first time after a drug has already been made available for general use. Examples include anaphylaxis with penicillin or skin rashes with antibiotics.
Type C Reactions Type C, or ‘continuing’ reactions, persist for a relatively long time. An example is osteonecrosis of the jaw with bisphosphonates.
Type D Reactions Type D, or ‘delayed’ reactions, become apparent some time after the use of a medicine. The timing of these may make them more difficult to detect. An example is leucopoenia, which can occur up to six weeks after a dose of lomustine.
Type E Reactions Type E, or ‘end-of-use’ reactions, are associated with the withdrawal of a medicine. An example is insomnia, anxiety and perceptual disturbances following the withdrawal of benzodiazepines.