{"title": "Chapter 1: Health Maintenance and Disease Prevention", "flashcards": [{"q": "What is the recommended screening interval for colorectal cancer in average-risk adults aged 50–74?", "a": "Colonoscopy every 10 years, or faecal immunochemical test (FIT) annually, or CT colonography every 5 years. Screening should begin at 45 in updated USPSTF 2021 guidance. Positive non-colonoscopy tests require follow-up colonoscopy."}, {"q": "Name four modifiable risk factors for type 2 diabetes mellitus.", "a": "Obesity (BMI >30), physical inactivity, unhealthy diet (high refined carbohydrate/saturated fat), smoking, excess alcohol, hypertension, and dyslipidaemia. Weight reduction of 5–7% body weight reduces T2DM incidence by ~58% in high-risk individuals (Diabetes Prevention Programme)."}, {"q": "What vaccines are recommended annually for all adults?", "a": "Seasonal influenza vaccine is recommended annually for all adults. COVID-19 booster as per current public health guidance. Other annual vaccines are not routine; schedule depends on age, comorbidity, and occupational risk."}, {"q": "Define primary, secondary, and tertiary prevention with an example of each.", "a": "Primary: prevent disease before it occurs (e.g. smoking cessation advice, HPV vaccination). Secondary: early detection to halt progression (e.g. mammography, cervical smear). Tertiary: reduce disability in established disease (e.g. cardiac rehabilitation after MI, physiotherapy after stroke)."}, {"q": "What is the recommended blood pressure target for adults with hypertension and established cardiovascular disease?", "a": "<130/80 mmHg per AHA/ACC 2017 and ESC 2018 guidelines for high-risk patients including those with established CVD, CKD, or diabetes. Confirm against current local guidance as targets vary by age and comorbidity."}, {"q": "Which cancer screening test has the strongest evidence for reducing cancer-specific mortality in heavy smokers?", "a": "Low-dose CT chest (LDCT) annual screening in adults aged 50–80 with ≥20 pack-year smoking history who currently smoke or quit within the past 15 years. The NLST and NELSON trials demonstrated significant reduction in lung cancer mortality."}, {"q": "What is the AUDIT-C questionnaire used for?", "a": "The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) is a 3-item validated screening tool for hazardous or harmful alcohol use. Scores ≥3 in women and ≥4 in men indicate positive screening warranting brief intervention or further assessment."}, {"q": "Name three evidence-based interventions for smoking cessation.", "a": "Varenicline (most effective pharmacotherapy, NNT ~5 for abstinence); combination nicotine replacement therapy (NRT patch + short-acting NRT); bupropion SR. Brief behavioural counselling combined with pharmacotherapy is more effective than either alone."}, {"q": "What are the three components of the Ottawa Charter model for health promotion?", "a": "(1) Building healthy public policy; (2) Creating supportive environments; (3) Strengthening community action; (4) Developing personal skills; (5) Reorienting health services. The Ottawa Charter (WHO, 1986) outlines five action areas, not three — a common exam point."}, {"q": "At what age is the shingles (herpes zoster) vaccine recommended in the UK?", "a": "Shingles vaccine (Shingrix — recombinant zoster vaccine, two doses) is recommended from age 70 in the UK immunisation schedule, with a catch-up programme to age 79. It is also offered to severely immunocompromised adults from age 50. Confirm against current JCVI guidance."}], "quiz": [{"q": "Which intervention has the greatest single impact on reducing premature cardiovascular mortality at the population level?", "opts": ["Statin therapy for all", "Blood pressure reduction through lifestyle and pharmacotherapy", "Aspirin prophylaxis", "Annual ECG screening"], "ans": 1, "exp": "Population-wide blood pressure reduction — through salt reduction, lifestyle change, and treatment of hypertension — has the largest attributable effect on cardiovascular mortality reduction. Each 10 mmHg reduction in SBP reduces major CVD events by ~20%."}, {"q": "A 55-year-old woman with a 30 pack-year smoking history asks about lung cancer screening. What is the correct recommendation?", "opts": ["CXR annually", "Low-dose CT annually for 3 years then stop", "Annual low-dose CT if she still smokes or quit within 15 years", "PET-CT biennially"], "ans": 2, "exp": "USPSTF and NICE recommend annual LDCT for high-risk individuals (50–80 years, ≥20 pack-year history, current smoker or quit within 15 years). Screening should continue annually while the person remains in the eligible age and risk group."}, {"q": "Which HbA1c level defines prediabetes per WHO 2023 criteria?", "opts": ["≥48 mmol/mol (≥6.5%)", "39–47 mmol/mol (5.7–6.4%)", "<39 mmol/mol", "≥53 mmol/mol"], "ans": 1, "exp": "WHO defines prediabetes as HbA1c 39–47 mmol/mol (5.7–6.4%). Diabetes is diagnosed at HbA1c ≥48 mmol/mol (≥6.5%) on two occasions, or once with symptoms. Confirm against current local guideline thresholds which may differ slightly."}, {"q": "What is the Number Needed to Treat (NNT) concept?", "opts": ["The number of side effects per treatment", "The number of patients who must receive treatment for one to benefit", "The number of doses needed for efficacy", "The number of trials needed for approval"], "ans": 1, "exp": "NNT = 1 / Absolute Risk Reduction. It quantifies clinical benefit: a lower NNT means more efficient treatment. For example, if ARR is 2%, NNT = 50 (50 patients treated for one to benefit). Used alongside Number Needed to Harm (NNH) for benefit-risk assessment."}, {"q": "Which lifestyle intervention most effectively reduces LDL cholesterol without medication?", "opts": ["Aerobic exercise alone", "Mediterranean diet with olive oil and nuts", "Low-fat diet", "Intermittent fasting"], "ans": 1, "exp": "A Mediterranean-style diet rich in olive oil, nuts, fish, fruit, and vegetables is the most evidence-based dietary intervention for LDL reduction and overall cardiovascular risk reduction, as demonstrated in the PREDIMED trial (30% reduction in major CV events)."}, {"q": "Helicobacter pylori eradication is recommended in which preventive context?", "opts": ["Primary prevention of gastric cancer in all patients", "Secondary prevention after peptic ulcer disease and in gastric MALT lymphoma", "Prophylaxis in all NSAID users", "Annual testing in asymptomatic adults"], "ans": 1, "exp": "H. pylori eradication is recommended after peptic ulcer disease, in gastric MALT lymphoma, and in patients with early gastric cancer. It reduces ulcer recurrence by >80% and MALT lymphoma remission occurs in ~75% of localised disease after eradication alone."}, {"q": "What is the recommended interval for cervical smear (HPV-primary) screening in England?", "opts": ["Every year", "Every 3 years (age 25–49) then every 5 years (age 50–64)", "Every 5 years from age 25", "Every 10 years"], "ans": 1, "exp": "England's NHS Cervical Screening Programme (from 2019): HPV primary screening every 3 years for women aged 25–49, then every 5 years from 50 to 64. HPV-positive samples undergo cytology triage. This replaced the previous cytology-first approach."}, {"q": "Which tool is used to estimate 10-year cardiovascular risk in UK primary prevention?", "opts": ["Framingham score", "QRISK3", "GRACE score", "TIMI risk score"], "ans": 1, "exp": "QRISK3 is the validated risk calculator used in UK primary care to estimate 10-year CVD risk, incorporating ethnicity, social deprivation, atrial fibrillation, SLE, SMI, and erectile dysfunction alongside traditional risk factors. A score ≥10% generally prompts statin discussion."}, {"q": "What is the recommended age to start mammographic breast cancer screening in the UK?", "opts": ["40", "47–50", "60", "35"], "ans": 1, "exp": "NHS Breast Screening Programme invites women aged 50–70 (being extended to 47–73) for mammography every 3 years. Women with BRCA1/2 mutations or strong family history are offered earlier, more frequent MRI-based screening from age 25–30."}, {"q": "Which adult immunisation is recommended at age 65 in the UK irrespective of risk factors?", "opts": ["Hepatitis B vaccine", "Pneumococcal polysaccharide vaccine (PPV23)", "BCG", "Typhoid vaccine"], "ans": 1, "exp": "PPV23 (pneumococcal polysaccharide vaccine) is offered to all UK adults at age 65 as part of the routine immunisation schedule, plus those with clinical risk conditions at any age. It provides broad serogroup coverage for invasive pneumococcal disease."}, {"q": "What does 'opportunistic screening' mean in primary care?", "opts": ["Screening only patients who request it", "Using routine consultations for any reason to perform risk-based screening", "Mass population screening programmes", "Screening only symptomatic patients"], "ans": 1, "exp": "Opportunistic screening uses any contact with the health service — regardless of the presenting complaint — to identify risk factors or early disease. Examples: checking BP at a flu vaccine appointment, performing a FAST alcohol screen at a routine review, BMI measurement at any visit."}, {"q": "Which dietary pattern is most strongly associated with reduced dementia risk in observational studies?", "opts": ["Low-fat diet", "MIND diet (Mediterranean-DASH hybrid)", "High-protein diet", "Ketogenic diet"], "ans": 1, "exp": "The MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) emphasises leafy greens, berries, nuts, olive oil, whole grains, fish, poultry, and beans while limiting red meat, butter, and sweets. Observational data suggest up to 53% lower Alzheimer's risk in adherent individuals, though RCT evidence remains limited."}, {"q": "A 65-year-old man has a BMI of 32, BP 145/90, fasting glucose 6.4 mmol/L. Which single intervention has the greatest impact on his overall risk?", "opts": ["Start metformin", "Weight loss of 5–10% body weight through diet and exercise", "Start antihypertensive alone", "Start statin alone"], "ans": 1, "exp": "Weight loss of 5–10% reduces BP, improves insulin sensitivity, lowers triglycerides, and raises HDL. In prediabetic obese patients, lifestyle intervention is superior to metformin alone for diabetes prevention (DPP trial: 58% vs 31% risk reduction). It addresses the metabolic root cause."}, {"q": "What is absolute risk reduction (ARR)?", "opts": ["Risk in treatment group divided by risk in control group", "Risk in control group minus risk in treatment group", "1 minus relative risk", "Odds ratio minus 1"], "ans": 1, "exp": "ARR = Control Event Rate − Treatment Event Rate. For example, if 8% of untreated and 4% of treated patients have a MI, ARR = 4%. Relative risk reduction = ARR/CER = 50%. NNT = 1/ARR = 25. Understanding ARR prevents overestimation of benefit from relative risk alone."}, {"q": "Which medication is recommended for chemoprophylaxis against malaria in West Africa?", "opts": ["Chloroquine", "Atovaquone-proguanil (Malarone) or mefloquine or doxycycline", "Primaquine", "Azithromycin"], "ans": 1, "exp": "Chloroquine-resistant Plasmodium falciparum is widespread in West Africa. Atovaquone-proguanil, mefloquine, or doxycycline are recommended. Choice depends on tolerability, contraindications, and travel duration. Confirm current PHE/CDC guidance as resistance patterns change."}, {"q": "What is the primary mechanism by which statins reduce cardiovascular risk?", "opts": ["Reducing blood pressure", "Inhibiting HMG-CoA reductase reducing LDL cholesterol and plaque inflammation", "Reducing platelet aggregation", "Improving endothelial function through ACE inhibition"], "ans": 1, "exp": "Statins competitively inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. This reduces hepatic cholesterol, upregulates LDL receptors, and lowers circulating LDL-C. They also have pleiotropic anti-inflammatory and plaque-stabilising effects independent of lipid lowering."}, {"q": "What defines 'healthy ageing' according to the WHO?", "opts": ["Absence of all chronic disease after age 65", "The process of developing and maintaining functional ability that enables wellbeing in older age", "Living past age 85", "Having a BMI below 25 after age 70"], "ans": 1, "exp": "WHO defines healthy ageing as the process of developing and maintaining the functional ability that enables wellbeing in older age, encompassing physical, cognitive, and social dimensions. It emphasises function and quality of life rather than absence of disease."}, {"q": "Aspirin for primary prevention of CVD: what does current evidence recommend?", "opts": ["Routine aspirin for all adults >50", "Aspirin not recommended for primary prevention due to bleeding risk outweighing benefit", "Aspirin for all diabetic adults", "Aspirin for all adults with LDL >3 mmol/L"], "ans": 1, "exp": "ASPREE, ASCEND, and ARRIVE trials showed that aspirin for primary CVD prevention is not recommended in general adults due to increased GI and intracranial bleeding risk that equals or exceeds cardiovascular benefit. Aspirin remains indicated for secondary prevention after established CVD."}, {"q": "Which behaviour change model describes stages from pre-contemplation through to maintenance?", "opts": ["Health Belief Model", "Transtheoretical Model (Stages of Change)", "Social Cognitive Theory", "COM-B model"], "ans": 1, "exp": "The Transtheoretical Model (Prochaska and DiClemente) describes behaviour change through stages: pre-contemplation contemplation preparation action maintenance. It underpins motivational interviewing and is widely used in smoking cessation, weight management, and alcohol reduction programmes."}, {"q": "What is a 'brief intervention' in the context of alcohol misuse?", "opts": ["Prescribing chlordiazepoxide for withdrawal", "A structured, time-limited conversation (5–20 minutes) using motivational techniques to reduce hazardous drinking", "Admission to a detoxification unit", "Naltrexone prescribing"], "ans": 1, "exp": "Brief interventions (BIs) for alcohol are evidence-based structured conversations (5–20 min) using FRAMES principles (Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy). They are effective in primary care for hazardous/harmful drinkers identified by AUDIT screening, reducing consumption by ~25%."}]}