All Past Formatives Flashcards
Define prevalence
The number of people in a population with a specific disease at a single point in time or in a defined period of time
Define incidence
The number of new cases of disease in a population in a specified period of time
List 5 actions the government could take to stem the rise in obesity
- Health education
- Tax (on unhealthy foodstuffs)
- Legislation (ingredients/can labelling)
- Enforcement of that legislation
- Ban on advertising unhealthy food
- Improve exercise/sport facilities
- Funding of NHS treatment
- Subsidise/fund healthy food
List 4 examples of what a GP could do to help individual patients
- act as a role model
- prescribe treatment
- give tailored advise
- refer for specialist treatment
- arrange to see regularly
- provide education of risks/illness
- tackle underlying causes
List 5 health professional who could also be involved in eg obesity management or prevention
- community dietician
- psychologist
- pharmacist
- secondary care eg surgeon
- practice nurse
- health visitor
Explain the difference between statistical and cultural definitions of normality
Statistical normality = based on the normal distribution curve/standard deviation
Cultural normality = base on Norms and values within a certain group (community)
How might changes in cultural perceptions of normality lead to statistical differences (eg in obesity)
The fact that people see more obese people shifts their notion of what is normal = it becomes accept and normal to eat more junk food and take less exercise etc
Being obese becomes normal and is perceives to be related to affluence or attractiveness or health
How might obesity affect an individuals health risk at psychological, physical and social levels
Psychological = reduced self esteem
Physical = difficult to move or keep fit
Social = ostracization by peers
What is meant by the term gatekeeper
A person who controls patients access (via referral) to specialist/secondary care
List 2 advantages of GP’s as gatekeepers
- keep people out of expensive secondary care
- continuity of the doctor-patient relationship
- personal advocacy
- patient does not know where to go/allows appropriate referral/effective use of resources
List 2 disadvantages of GP’s as gatekeepers
- patients have less choice in secondary care
- seeing a GP may increase the time it takes to receive the needed treatment
- dependent on individual GP knowledge, attitudes, skill and practice organisation
- puts stress on a good doctor-patient relationship
Give possible physical side effects of a stressful/long hour job (eg working on an oil rig)
- too tired to do long shifts
- Potential hazards eg dangers of working/transportation on/to the oil rig
- adjustment of day/bight shift patterns
- potential improved physical health if made use of facilities eg offshore
- partner may be tired of ‘single-parent’ role when patient is working
Give the possible psychological side effects of a stressful/long hours job eg on the oil rigs
- anxiety and stress eg family separation or uncertain on return home
- possible depression due to repeated period of isolation
- anxiety and stress about helicopter journeys
Give the possible social side effects of a stressful/long hours job eg on the oil rigs
- relation difficulties due to the nature of job
Able to spend additional time with family and friends when onshore - discipline problems in children due to absent father figure
- substance misuse due to nature of the job
- well paid employment allows the family to afford a good lifestyle
List 4 categories of hazard
- mechanical
- physical
- chemical
- biological
- psychological/stress
Give 2 possible side effects of a partner losing their job on the patient
- exhaustion due to working extra hours to maintain family finance
- worry/stress about the entire family’s future
- anger for being made redundant
- enjoyment of increased time to spend with husband
Give 2 possible effects being made redundant may have On a patient
- feelings of worthlessness
- guilt of no longer supporting the family
- Depression
- Anxiety about finding another job
- Anger at employers
- Enjoyment of more time with family
How would you deal with a patient asking you about their spouse’s health
- MUST maintain the spouse’s confidentiality
- ask patient why they are concerned
- consider the need to maintain trust
- consider GMC guidelines
List 4 ethical principles derived from deontology and utilitarianism
- beneficence
- non-maleficence
- justice
- autonomy
Define culture
Systems of shared ideas, systems of concepts, rules and meanings that underlie and are expressed in the ways that human beings live
Define ethnicity
Cultural practises and outloook that characterise and distinguish a certain group of people
Characteristics identifying an ethnic group may include
- common language
- common customs and beliefs
- tradition
Define race
A group of people linked by biological/genetic factors
List 4 possible difficulties which may arise in a consultation as a result of cultural differences
- language barriers
- religious beliefs
- racism
- stereotyping
- examination taboos
- Lack of knowledge about health issues
List two aspects of social health you would explore in a 15 year old school girl who smokes 12 cigarettes a day
- sexual health
- alcohol
- illicit drugs
- diet-eating patterns
- peer pressure
List the 6 social classes from the 1911 Census
- professional
- managerial and technical
- skilled non-manual
- skilled manual
- partly skilled
- unskilled
Give an explanation as to how culture may influence statistical normality eg smoking behaviour in different social classes
lower social classes see larger numbers of people smoking around them and are more likely to accept it as normal behaviour
Describe the 3 models of stress
- engineering model
- medico-physiological model
- Psychological or transnational model
Describe the engineering model of stress
- stress acts as a stimulus which the individual must resist
- if the stimulus becomes too intense or prolonged the individual breaks
Give two possible coping mechanisms an individual may use when faced with a stressful situation
- problem focused
- emotion focused
- combination of problem/emotion focused
Describe the ‘guidance/co-operation’ style of doctor-patient relationship
- The doctor exerts a degree of authority and the patient is obedient
- the patient does have a little feeling of autonomy and participates to a small degree in the relationship
Name the three style fo doctor-patient relationship
- guidance/co-operation
- authoritarian/paternalistic
- mutual participation
List the 5 types of question that may be used in medical interviewing and describe them
- Open questions = not seeking a specific answer but simply allows/signals the patient to tell their own story
- direct questions = ask about a specific item
- closed questions = can only be answered yes or no or an equivalent
- reflected questions = allows the doctor to avoid answering a direct question from the patient/aids the doctor in exploring the patients own thoughts and perceptions
- leading questions = presumes answer, best avoided
List 5 different ways in which a doctor can facilitate the interview in a non verbal way
- listening
- use of silence
- posture/body language
- specific gestures
- Eye contact
Approximately how many patients are registered on average with each GP in the NHS in the UK?
1200-2000 patients each
Approximately what percentage of illness presenting to primary care are referred on to secondary care?
3%
List 4 aspects of lifestyle you may cover in a consultation with any patient when giving advice to promote a healthier lifestyle
- diet
- exercise
- alcohol
- smoking
- sexual health
List 4 aspects of health which are likely top be worse for children (of all ages) living in the most deprived areas compared to those living in the least deprived areas
- lower birth weight
- less likely to benefit from breastfeeding in infancy
- Poorer dental health
- higher rates of obesity
- more likely to take up smoking
List 6 risks to foetal wellbeing
- smoking
- illicit drugs
- prescription drugs
- X-rays
- diet (poor nutrition)
- infectious diseases (rubella)
- maternal disease (diabetes)
List 4 factors that would make a patient more likely to be motivated to change their behaviour. For each factor give an example relating to a mother giving up alcohol during pregnancy
- state the advantages their change in behaviour would outweigh the disadvantages e.g birth of a healthy baby
- anticipation of a positive response from others e.g mother’s partner/family want the unborn baby to be healthy
- social pressure to change e.g very socially unacceptable to drink when obviously pregnant
- ability to carry out the change in a range of circumstances e.g not drinking at home/parties etc
State the WHO definition of health
A state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity
List 4 factors that influence lay beliefs about health and give an example of how each of these factors may influence lay beliefs about health
Age = elderly concentrate on functional ability, younger people speak of health in terms of physical strength and fitness
Social class = people of low socioeconomic circumstances regard health as functional (ability to take care of others)
Gender = men and women think differently about health, women find concept of health more interesting
Culture = different perceptions of illness/disease, differences in concordance with treatment
List 3 different routes via which someone may be exposed to a hazardous substance
- blood
- sexual contact
- ingestion
- inhalation
List 2 categories of hazard. Give an example of each in relation to work in a chemistry lab
- physical = heat/noise/radiation from equipment
- mechanical = trips/slips
- biological = spread of infection amongst colleagues
- psychological/stress = anxiety regarding job security/relationships with colleagues/deadlines/busy
List 4 common reasons for a child of any age to see their GP or health visitor
- feeding problems
- URTIs
- Rashes
- Sore throat
- Vomiting/diarrhoea
- Abdominal pain
- Behavioural problems
List 4 social influences on health
- gender
- ethnicity
- housing
- employment
- social class
List 2 health and social care team members who work within the community whom you may decide to help with your patients care.
Give an example for each in the case of a patient with cystic fibrosis
- physiotherapist = to help clear chest secretions
- dietician - nutritional assessment and advise on improving appetite/weight gain
- counsellor - assessment and management of low mood
- occupational therapist = assess for aids to assist daily living
Explain beneficence
Care maximised ie doing what is best for the patient
Explain non-Maleficence
Ensuring you do no harm to the patient eg perform appropriate investigations before treatment
Explain autonomy
A patients rights not to take advised treatment even if fully informed of the benefits
List two ethical issues regarding abortion
- regions/beliefs regarding termination
- thoughts regarding bringing a child into the world that you do not feel able to care for
List 2 psychological issues of abortion
- anxiety about being pregnant
- anxiety about going through termination
- anxiety/stress about level of support from family
Give 2 social issues of abortion
- support network
- social life will dramatically change after having a baby
- ability to find a job/work
List the 5 core concepts associated with he social cognitive theory
- observational learning/modelling
- outcome expectations
- self efficacy
- self-regulation
- goal setting
Give 3 examples of environmental factors which may influence an individuals behaviour
- culture
- social support
- location
- income
- time
Give three examples of behavioural factors which may influences an individuals behaviour
- activity/exercise
- intrinsic motivation
- goal setting
Give 3 examples of personal factors which may influence an individuals behaviour
- knowledge/information
- self-efficacy scale ie belief in ability to change
- behavioural capability
What factors might increase the chance of someone changing their behaviour
- they think the advantages of change out weight the disadvantages
- social pressure to change
- they perceive the new behaviour to be consistent with self-image
- they anticipate a positive response from others to their behaviour change
- they believe they are able to carry it the new behaviour in a range of circumstances
State 3 benefits of adopting the mutual participation style of doctor/patient relationship
- greater participation by the patient means they have a feeling or relatively greater personal autonomy
- the patient adopts great responsibility for their own health through sharing of information and decision making
- may increase compliance with advice/concordance with treatment
Describe the authoritarian or paternalistic doctor/patient relationship
The physician uses all of the authority inherent in his/her status and the patient has no autonomy.
Patient tries hard to please the doctor and does not actively participate in their own treatment
Give a brief description of the 3 broad types of skills that are need for successful medical interviewing
- content skills = what doctors communicate ie the substance of their questions and responses, the information they gather and give
- perceptual skills = what they are thinking and feeling ie their internal decision making, clinical reasoning and awareness of their own biases, attitudes and distractions
- process skills = how they do it ie the way the doctors communicate with patients, how they go about discovering the history or providing information, verbal/nonverbal, structure
List 5 actions that the government might take to promote health in the population as a whole
- legislation/policies on smoking/alcohol
- improvements in housing
- provision of health education
- health and safety laws
- traffic/transport legislation/polices
What does a statistically normal distribution curve look like?
Curve starts low then gets high in the middle then goes low again = like a hill in the middle
Describe the steps of the hypothetico-deductive reasoning process
- is about likely diagnoses
- use of past experience ie have you seen similar cases before and what were they
- form a hypothesis
- deduce predictions from hypothesis
- Order tests investigations etc
What might safety netting advice include?
- Advise the patient of the expected course of the illness/recovery
- Advise of symptoms indicating deterioration
- Advise who to contact if patient deteriorates
List 3 ways in which neighbour suggests risk can be minimised
- Summaries and verbally check that reasons for attendance are clear
- hand over and bring he consultation to a close ie hand over to the patient at the end to ensure all issues have been covered
- deal with the housekeeping of recovery and reflection eg record keeping, referral if necessary pausing to reflect before next patient
Give 5 examples of the use of computers in patient care within general practice
- store appointments
- book appointments
- assist in consultations
- electronic management of hospital letters/test results
- e-consultations
- public health information
- support prescribing
Define hazard
Something with the potential to cause harm
Define risk
The likelihood of farm occurring
State 3 coping mechanisms
- Problem focused eg enlist help of family and friends
- emotion focused eg seek counselling/stress management
- combined problem and emotion focused
State 5 factors that makes a GP the most appropriate profession to guide a patient about their current worries
- aware of current and past ,education history
- aware of patients social circumstances
- has knowledge of a broad range of illnesses and health conditions
- trusted health professional with perhaps lifelong rapport with patient
- likely to be near patients home so is accessible
What is cultural competence?
The understanding of diverse attitudes, beliefs, behaviours, practices and communication patterns attributable to a variety of factors
What does cultural competence eliminate in the primary care setting?
- eliminates misunderstandings in diagnosis or in treatment planning that may arise from differences in language or culture
- improve patient adherences with treatments
- eliminate health care disparities
Explain the methods used to overcome language barriers
- a wide variety of language interpreters are available through language line services
- use phone interpreters
- use on site interpreters
- family members or translators
