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
How many hours of sleep per night is recommended for teenagers to function best?
8-10 hours
During the consultation you take time to discuss the benefits of Jim’s regular exercise
List five benefits of regular exercise/physical activity for children and young people.
Builds confidence and social skills
Develops coordination
Improves concentration and learning
Strengthens muscles and bones
Improves health and fitness
Improves sleep
Aids weight loss/reduces risk excess weight gain
Makes you feel good/improves feeling of general well-being
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.
It does not take you long to realise that it is unlikely that Michael will still be alive in six months or so. You also realise that Michael and his sister are unaware of the severity of his COPD and find yourself in the situation of breaking bad news.
List seven points to consider when breaking bad news to Michael and his sister.
Listen to the patient and their carers
Set the scene
Check whether Michael wants to speak himself or with his sister present
Find out what the patient already understands
Find out how much the patient wants to know
Share the information using a common language/avoid jargon
Review and summarise the information
Allow opportunities for questions
Agree follow up and support
Patients and their carers show a variety of emotional reactions when receiving bad news, some immediately and some over a period of time.
List three examples of typical emotional reactions which may be experienced in this situation and state how they may manifest.
Shock - news is completely unexpected, patient may be tearful and anxious.
Anger - angry with themselves for earlier health related behaviour e.g. smoking or angry with health care professionals for not being able to provide cure.
Denial - patient does not believe it can be true and for a time will fail to acknowledge reality of situation.
Bargaining - “if I change something in my life, perhaps I will get better”.
Relief - patient glad to finally know what is wrong so they can plan for the future.
Sadness/depression - low mood common, especially if patient has been ill for some time or following bad news.
Fear/anxiety - fear of dying, worry about pain, worry about family who are left.
Guilt - not able to provide for family any more, guilt that earlier behaviours may have affected health e.g. lack of exercise, XS alcohol intake.
Distress - patient unable to cope with news and shows acute anxiety, tearfulness.
After spending a considerable time discussing the severity of Michael’s long term condition with him and his sister, you agree that he should have supportive and palliative care and draw up an Anticipatory Care Plan.
Identify five aspects of Michael’s history which indicate he is a suitable patient to receive palliative care.
Not expected to be alive in next 6-12 months.
Breathless at rest/minimal exertion.
FEV1<30%.
Spends more than 50% of day in bed or chair.
Long term O2 therapy.
Three hospital admission with acute exacerbations in last 6 months.
Relying on others for care
During your lunch break one of the reception staff gives you a letter from one of your patients. It is from a patient that you saw last week and you remember it being a complex presentation. On reading the letter you are pleased that they were very happy with the consultation and have written to say thank you.
The Our Voice Citizens’ Panel performed a survey in 2017 asking members of the public what they felt made a good doctor.
What three attributes did this survey show were most important in being a good doctor?
Knowledge / qualifications
Good listener
Friendly / approachable
In the same survey, what were the three most important elements of a good consultation with a doctor found to be?
Feeling listened to / not being rushed
Clear communication
Resolution / diagnosis / outcome
That evening, you attend a meeting of GPs, hospital consultants and Health Board managers. A visiting speaker gives a talk about sustainability in the NHS. The group then discuss ideas about how to make medical careers in the NHS more sustainable.
What is the definition of sustainability?
“(The ability to be) Able to continue over a period of time”
Sustainability is a term that could also be applied to careers in medicine. Resilience is known to contribute to sustaining a career in medicine.
List five different factors that contribute to resilience.
Intellectual interest e.g. job satisfaction, career progression, variability (if wanted), capacity to develop special interest
Self-awareness and self-reflection e.g. recognise and accept personal limits, establish boundaries in doctor-patient relationship, less self-critical, aided by mindfulness based stress reduction
Time management and work life balance e.g. ensuring time for hobbies, leisure, relaxation, self-expression
Continuing professional development
Support including team working/supportive relationships within and out-with medicine
Mentors (help trainees adapt to change and react to stress)
