FOPC Y3 Formative

Question 1

What are 10 criteria of Wilson and Jungers criteria for setting up a screening programme?

Answer 1

Will the test detect the condition at an early pre-clinical stage?

Is the disease an important public health problem?

Is the natural history of the disease adequately understood?

Is a test available for the condition?

Is the test sensitive (low false negatives)?

Is the test specific (low false positives)?

Is the test safe?

Is the cost of the test reasonable?

Does the overall cost-benefit analysis make it worthwhile e.g. number of tests required to save one life?

Is treatment for the condition being screened for safe?

Question 2

What is the definition of case control studies and cohort studies?

Answer 2

Case control studies - two groups of people are compared: a group of individuals who have the disease of interest are identified (cases), and a group of individuals who do not have the disease (controls).

Data are then gathered on each individual to determine whether or not he or she has been exposed to the suspected aetiological factor(s) and whether or not a conclusion can be drawn that the suspected aetiological agent is a likely cause of the disease in question.

Cohort studies - baseline data on exposure are collected from a group of people who do not have the disease under study.

The group is then followed through time until a sufficient number have developed the disease to allow analysis.

Question 3

Name 6 sources of epidemiological data?

Answer 3

Mortality data

Hospital activity statistics

General Practice morbidity / disease registers

Health and household surveys / population census data

Social security statistics

NHS expenditure data

Question 4

Your first patient in morning surgery is 45 year old Vladimir Melyanets, who moved to the UK from Russia 18 months ago and works on an offshore oil platform. He presents with dermatitis affecting his hands and lower arms and tells you that he thinks it is work related.

List five points in Vladimir’s history which would help you decide whether occupational contact dermatitis is the likely diagnosis.

Answer 4

Does he work with chemical irritants?

How much exposure does he have to these irritants (intensity/duration)?

Do his symptoms improve when not at work e.g. onshore, holiday?

Is personal protective equipment (PPE) used?

Does the patient comply with PPE use?

Question 5

You provide Vladimir with a prescription and advice and ask him to return for review one month later. By this time, his dermatitis is much better, but he has some other issues he wishes to discuss with you. Although he, his wife and his young daughters are happy in Aberdeen and have adjusted well to life in the UK Vladimir complains that he feels anxious and has difficulty sleeping. As a GP you are aware that offshore oil industry workers may suffer a variety of psychological and/or social issues.

List five examples of psychological and/or social issues which may be affecting Vladimir.

Answer 5

Anxiety r.e. travel

Depression, perhaps secondary to loneliness/away from family

Stress due to shift pattern

Pressure to maintain standard of living

Difficulty adjusting back into family life when onshore

Abuse of drugs or alcohol

Question 6

List ten potential difficulties which may arise in ANY consultation as a result of cultural differences.

Answer 6

Lack of knowledge about NHS

Fear and distrust

Racism

Stereotyping

Ritualistic behaviour

Language barriers

Presence of third party e.g. family member/translator in the room

Differences in perceptions and expectations

Examination taboos

Religious beliefs

Question 7

What are 2 possible reasons for the rise in the elderly population and the drop in population of younger people?

Answer 7

Increased life expectancy

Decreased birth rates

Ease of access to contraception

Healthier lifestyles, e.g. less smoking, less alcohol

Improvements in housing

Question 8

List 3 issues relating to health care services and 3 issues relating to social issues in relation to the ageing population

Answer 8

Health services:

• Increased number of geriatricians required
• Increased requirement for ward facilities for the elderly
• Increased prevelance of long-term health conditions e.g. COPD

Social Issues:

• Increasing dependence on families
• Increasing demand for care homes
• Increased for community to adapt for elderly people, e.g. activities for elderly, access for elderly into shops etc.

Question 9

List 5 ways being a carer for a family member might affect you?

Answer 9

Poor mental health e.g. stress, anxiety, depression, emotional demands

May have to give up work/work fewer hours

Financial implications e.g. due to impact on work, extra expense of caring for her mother

Lack of privacy for Kathy and her family

Restriction on social activities/social isolation

Question 10

List 5 things that someone acting as a carer could do to improve their situation

Answer 10

Home carers to assist with care

Day care centre

Respite centre

Additional help from other family members

Carers allowance

Psychological support

Question 11

List 5 health care team members (other than the GP) that could assist someone with the following health conditions and state the way in which they could this patient:

Jean has osteoarthritis, ischaemic heart disease, type 2 diabetes and severe renal disease

Answer 11

District nurse - take bloods, BP monitoring, blood glucose monitoring

Pharmacist - help Jean with her medication

OT - Adapt living environment to make living with OA easier

Physiotherapist - Help her maintain mobility

GP Receptionist - Booking appointments, passing on concerns etc.

Question 12

List 5 factors, other than physical illness, that may contribute to a teenager being tired at school?

Answer 12

Poor diet

Lack of sleep

Excessive screen time

Not enough exercise

Difficulties at home

Bullying

Question 13

How many minutes of activity should a child be getting per day?

Answer 13

60 minutes

Question 14

How much sleep should teenagers be getting per night?

Answer 14

8-10

Question 15

List 6 points you should consider when breaking bad news to someone?

Answer 15

Set the scene - make sure no interuptions

Find out what the patient already knows

Find out how much the patient wants to know

Give them the information in a way they can understand and avoid using jargon

Give the patient a chance to ask some questions

Make a plan for follow up and support

Question 16

List some typical emotional reactions people have to receiving bad news and how they manifest

Answer 16

Shock - patient may be silent or tearful

Denial - patient doesn’t believe the diagnosis to be true and fails to acknowledge their results

Anger - angry with themselves for earlier poor choices, e.g. smoking

Question 17

List 5 aspects of the following history which would indicate the patient is a good candidate to receive supportive and palliative care

Following surgery, you go on a house call to a poorly patient who has just registered with the practice, following discharge from hospital. Michael Findlay is a 63 year old with severe chronic obstructive pulmonary disease (COPD), who has moved in to his 59 year old sister’s home to facilitate her involvement with his care. Michael took early retirement from his job as a welder due to his COPD. Although he has now stopped smoking, he was a heavy smoker for most of his adult life. He is severely restricted in his activities of daily living due to his COPD. He is breathless on minimal exertion, FEV1<30%, spends most of the morning in bed, sits in his chair most of the afternoon and retires to bed exhausted in the early evening. He receives long-term oxygen therapy. Michael has now had three admissions to hospital with infective exacerbations of COPD in the last six months

Answer 17

Breathless on minimal exertion

FEV1 < 30%

Spends more than 50% of day in bed or chair

Long term O2 therapy

3 hospital admissions within last 6 months

Question 18

List 5 points relating to proactive care as a result of putting an anticipatory care plan in place?

Answer 18

Preferred place of care noted and organised

Care plan and medication issued for home

Dies in preferred place

End of life pathway used

Patient and carer needs assessed by specialists

Question 19

What is the definition of sustainability?

Answer 19

(The Ability to be) Able to continue over a period of time.

Question 20

List four positive factors that might contribute to a sustainable medical career.

Answer 20

Work life balance

Maintaining hobbies

Manageable workload

Good relationship with colleagues

Job satisfaction