EXAMPLE EXAM 2 Flashcards
1) You are the youngest partner in a busy 5-partner practise within a suburb of Aberdeen; one of your patients is James Collie, a 35y old construction worker in the oil industry. He works offshore on a regular 2 weeks onshore and 2 weeks offshore basis. He is married to Sandra, a 36 year old part-time office worker, they live in their own bungalow in a pleasant suburb of Aberdeen, having moved there for a council house in the centre of Aberdeen 10 years ago; they have 2 children (12 / 9 yrs old) and are settled in their lifestyle.
1a) Under each of the headings, physical, psychological, social; give 2 examples of the possible effects James’ job may have on his and his family’s health (6 marks):
● physical:
○ James might be too tired to do long shifts
○ dangers of working on an oil rig
○ dangers of transportation to the oil rig
○ adjustment to day / night shift patterns
○ potential for obesity due to abundance of food in canteen
○ potential for improved physical health in James if he makes use of healthy eating options & facilities offshore
○ Sandra might be tired of the ‘single-parent’ role when James
● psychological:
○ anxiety & stress in James and Sandra due to dangerous working environment / separation from family
○ both James and Sandra might be anxious about the security of his employment in the current economic climate
○ anxiety & stress about uncertain return home (weather delay)
○ anxiety & stress about helicopter journeys
○ possible depression in either due to repeated periods of isolation
○ anxiety & stress in children due to separation / father’s job
● social:
○ relation difficulties due to nature of James’ job
○ able to spend additional time with family and friends during onshore periods
○ discipline problems in children due to ‘absent’ father figure
○ substance misuse due to stressful nature of job
○ well paid employment allows family to afford good lifestyle, decent car, to go on holiday
○ no smoking / alcohol when offshore
○ James may binge drink when onshore
1b) The offshore oil industry is widely recognised as being hazardous working environment; list 4 categories of hazard (4 marks):
● mechanical ● physical ● chemical ● biological ● psychological / stress
2) Unfortunately, the company employing James restructures its workforce and James is made redundant;
2a) Give 2 possible effects this might have on Sandra’s health (2 marks):
● exhaustion due to working extra hours to maintain family finances
● worry / stress about the entire family’s future
● anger that the husband has been made redundant
● stress at husband being at home all the time = change of friendly dynamics
● enjoyment of increased time to spend with husband
● positive future outlook with possibility of husband gaining more family-friendly employment
2b) Give 2 possible effects this may have on James’ health (different answers to part 2a) (2 marks):
● feelings of worthlessness
● guilt that he is no longer supporting his family
● anxiety about finding another job / retiring
● depression
● anger at his employer’s
● positive outlook for new future employment
● enjoyment of more time with family
● substance misuse as coping mechanism
2c) Sandra attends to see you for a routine appointment and asks you about her husband’s health; state how you would with her enquiry (2 marks)
● maintain James’ confidentiality (MUST be mentioned as 1 mark)
● consider need to maintain James’ trust
● consider GCM guidelines
● acknowledge Sandra’s concern
● ask Sondra why she is concerned
2d) Ethical principles are an important guide to medical practise; list the 4 ethical principles derived from deontology and utilitarianism (4 marks):
● beneficence (do good)
● non-maleficence (do no harm)
● justice
● autonomy
3) The local population within the suburb in which you work is gradually changing; many of the new patients registering with your practise are from different cultures:
3a) define each of the following 3 terms (6 marks):
CULTURE
ETHNICITY
RACE
● culture (either of the 2)
○ complex whole which includes knowledge / beliefs / art / morals / law / customs (Tyler 1874)
○ systems of shared ideas, systems of concepts, rules and meanings that underlie and are expressed in the ways that human beings live (Keesing 1981)
● ethnicity
○ cultural practises and outlooks that characterise and distinguish a certain group of people; characteristics identifying an ethnic group may include a common language, common customs and beliefs and tradition; term preferred over ‘race’
● race
○ a group of people linked by biological / genetic factors
3b) You are consulting one morning and a 33 year old from Romania, Marta Docea, arrives in your surgery. She has only been in the UK for 2 weeks and this is the 1st contact you have with her. List 4 potential difficulties which may arise in the ensuing consultation as a result of cultural differences (4 marks):
● lack of knowledge about health issues ● fear / distrust ● racism ● bias / ethnocentrism ● stereotyping ● ritualistic behaviour ● language barriers ● 3rd part presence (family members etc) ● differences in perceptions / expectations ● examination taboos ● gender difference between doctor / patient ● religious beliefs ● difficulties using language line
4) Your next patient that morning is Jenny Shand, a 15 year old schoolgirl who has a chest infection. You discover that she smokes 12 cigarettes per day. After dealing with her chest infection and discussing her smoking, you use the reminder of the consultation to enquire about other aspects of her social health.
4a) List 2 other aspects of Jenny’s social health which you may want to discuss in the consultation (2 marks):
● sexual health ● alcohol ● illicit drugs ● exercise ● diet-eating patterns ● family influence (parental smoking for e.g) ● peer pressure to smoke
4b) It is known that the prevalence of smoking varies according to social class. Social class is a form of social stratification. The most common occupational classification currently in use, and used in Britain since the 1911 Census has 6 social classes. List these 6 social classes (6 marks):
● professional ● managerial & technical ● skilled non-manual ● skilled manual ● partly skilled ● unskilled
4c) Give an explanation as to how culture may influence smoking behaviour in different social classes (2 marks):
● lower social classes see larger numbers of people around them smoking and are more likely to accept it as normal behaviour
● those around them are also more likely to accept the start of another individual smoking as normal behaviour (no stigma attached)
5) Your next patient that day is 57 year old Mark Yule. He has moved to the area to live with his brother, having previously lived in an area of high deprivation in Glasgow. Mark, who is significantly overweight, has been persuaded to come to the surgery by his brother to seek help with weight reduction. Look at the following 2 graphs from the 2008 Scottish Health Survey (separate sheet).
5a) What general trends do the 2 graphs show in relation to deprivation (2 marks):
● those who live in the areas of greatest deprivation have greater rates of obesity than their less deprived counterparts
● those who live in the areas of greatest deprivation eat less fruit and vegetables than their less deprived counterparts
● some students may comment that trends are similar for gender in relation to social class and affluence
GENERALLY (IMAGINE GRAPH)
5b) Give 2 possible reasons for the trend in graph 1 (2 marks):
● early life experience ● education ● cooking facilities / ability ● cost of healthy food ● cultural expectations ● access to good quality food provision ● carry-out culture ● unhealthy budgeting choices (e.g cigarettes, convenience foods over healthy foods) ● some students may note that the 'blip' in quintile 1 males relates to executive lifestyle / 'business lunch culture'
5c) Obesity is a health issue currently being targeted by the government and health professionals. List 3 primary care health professionals who may have a place in tackling obesity and give an example of what they might do (6 marks; 1 for member and 1 for role):
● dietician = individual dietary advice
● pharmacist = general advice; OTC anti-obesity medication; weight management programmes
● health visitor = health education; advice on healthy diet
● GP = advice; prescription of weight reducing drugs
● practise nurse = weight clinics; general dietary advice
● midwife = encourage breast feeding; early dietary advice
6) The next patient you see that day is Alan McCann, an Aberdeen taxi driver. During the consultation, he tells you that he is feeling very stressed at work as one of his colleagues was recently stabbed and robbed by a drunken passenger. His stress is being made worse by current difficulties in his marriage. Various models have been described to explain individuals’ experience of, and response to, stress.
6a) One of the 3 models of stress is described as part of the community course case study is the engineering model. List the other 2 models (2 marks):
● medico-physiological model
● psychological or transactional model
