Formative Flashcards
Break down of marks
End of life care / Inequality / Sustainability, Resilience and Occupational Health - 40 marks
Childrens’ health and Health Promotion / Realistic Medicine - 35 marks
Y1 and Y2 lectures and tutorials (selection of material) - 25 marks
Your first patient of the day is a 45 year old lady who has recently been diagnosed with metastatic ovarian cancer. She is struggling to understand why this was not identified sooner and asks whether there is any screening programme for ovarian cancer.
Wilson (and Jungner), 1968, stated that before setting up a screening programme for any disease, several factors need to be taken into consideration. List ten of them.
- The illness should be important
- The natural history of the illness should be understood
- There should be a pre-symptomatic stage of the illness
- The test should be easy
- The test should be acceptable
- The test should be cost-effective
- The test should be sensitive and specific
- The treatment should be acceptable
- The treatment should be cost effective
- The treatment would be more effective if started early
When Public Health physicians are studying population health to aid health care planning, numerous sources of epidemiological data may be utilised. List six possible sources of epidemiological data which may provide information on ovarian cancer.
Mortality data
Cancer Statistics
Hospital activity statistics
General Practice morbidity/disease registers
ISD information
NHS expenditure data
Social security information/benefits data
Any other reasonable source of data suggested would be given credit
Your next 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 six questions you could ask Vladimir which would help you decide whether occupational contact dermatitis is the likely diagnosis.
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?
Does the company enforce PPE use?
Do other work colleagues have similar symptoms?
Has he any hobbies/pets/other activities which may be a likely cause?
Does he use hand cream or other topical agents he may be allergic to?
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 his family are happy in Aberdeen and have adjusted well to life in the UK Vladimir feels that there has been deterioration in his mental health over the last few months. GMC guidance states that mild-to-moderate mental health conditions are common with a prevalence of 15-25% in the general population at any one time.
List five examples of common mild-to-moderate mental health conditions occurring in the general population.
Depression Generalised anxiety disorder Panic disorder Social anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder
Vladimir and his family live in one of the most deprived areas of your practice. There is a strong link between deprivation and health inequalities. Improving access to healthcare is one way of tackling health inequality
List five other ways the government or local councils could consider to try and reduce health inequality.
Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
Evaluate and refine integration of health and social care
Government policies and legislation e.g. smoking ban
Time to invest in the more vulnerable patient groups
Reduction in poverty
Social inclusion policies
Improved employment opportunities for all
Ensuring equal access to education in all areas
Improved housing in deprived areas
Your next patient is 24 year old Samara. She is thinking about stopping smoking. On discussion you find out that she has been smoking 15 cigarettes daily for the last 7 years but is keen to stop partly due to the cost and partly due to the potential health effects which have come to her attention as her father has recently been diagnosed with COPD. She has tried, unsuccessfully, to stop smoking in the past. Many of her colleagues smoke when together socially and do not seem concerned about it.
Where is Samara in the “Cycle of Change”?
Contemplation
Suggest two ways in which you might help Samara move to the next stage in the cycle?
Affirm her beliefs in the potential risks of smoking
Outline what help is available to help her stop
Define empowerment?
The generation of power in those individuals and groups which previously considered themselves to be unable to neither control situations nor act on the basis of their choices.
List two possible benefits for Samara in this situation if she feels more empowered?
Improved ability to make her own choice, going against the choices of those around her
Improved coping strategies when her colleagues are smoking to avoid smoking herself but still enable to her to socialise with them
An improved awareness of her own capacity to weigh up the benefits and risks of smoking to allow her to make a positive choice and act on that choice
ulation pyramids for Scotland. Between 1951 and 2031 and answer the question below.
Give six possible reasons for the trends shown in the population pyramids.
Decrease in premature mortality/increased life expectancy
Decrease in birth/fertility rates
Migration
Greater availability of contraception
Improvements in housing
Improvements in sanitation
Baby boom-post war recovery years followed by greater sexual “freedom”
Health education programmes e.g. smoking, exercise, diet
Improved safety and reduction of injury
List three social issues that may result from the trends shown in the pyramids.
Increasing dependence on families and/or carers who are also ageing
Demand for home carers and nursing home places likely to increase
Increasing emphasis on social activities for elderly within communities
Role of elderly as grandparents and carers of grandchildren likely to change
Housing demands are likely to change as more elderly people live alone
One of your elderly patients is 82 year old Jean Smith. Jean has several co-morbidities and is on multiple medications. She lives with her daughter.
Amongst her multiple pathologies, Jean has osteoarthritis, ischaemic heart disease, type 2 diabetes and severe renal disease. Her health is rapidly deteriorating.
Several members of the health and social care team are involved in Jean’s care. List five team members other than the GP who have a different role in Jean’s care and give a brief description of their role.
- District nurse and/or practice nurse = E.g. pressure areas, bloods, BP monitoring
- Home carer = Practical tasks e.g. bathing, dressing
- Pharmacist = advice on medication, dossett box
- Care Manager = assessment and organisation of care
- OT = adaptating living environment to maximise independence e.g. stair lift, hoist, shower modification
- Physiotherapist = maintain any remaining mobility, walking aids
- GMED/NHS 24 = out of hours care if unexpected problems
- Nurse practitioner = initial assessment during house call if change in health, GP supported prescribing
- Dietician = advice on diet to minimise further deterioration in renal function
- Practice staff e.g. receptionist = passing on concerns/first point of contact
- Physician’s assistant = GP supported medical assessment and care
- Paramedic Practitioner = acute assessment
- Social worker = benefits, contact with agencies
- Link Practitioners = signposting to third sector agencies
Your final patient of morning surgery is 13 year old Jim who is brought by his mother Anne. Jim’s school teachers have flagged up concerns about him recently appearing sleepy in class. Anne is concerned that he may have developed thyroid problems, as she was diagnosed with an underactive thyroid four years ago.
List five factors, other than physical illness, that may be contributing to Jim’s tiredness.
Poor diet
Inadequate sleep
Excess screen time
Lack of exercise/too much exercise
Academic difficulties
Home/relationship difficulties
Bullying
Social isolation
Mental illness
After taking a thorough history, you discover that Jim was recently given an iPad for his birthday and takes it to bed with him in the evenings. Anne is unsure how long he spends on it before going to sleep. He has also been picked for the local football team and has been training three nights per week and on Saturday mornings. Jim comments that they are having less opportunity to sit down as a family to eat together in the evening.
How many minutes of exercise should Jim be getting per day as suggested by NHS guidelines?
60 minutes
