Formative past papers 1

Question 1

Prevalence and Incidence

Answer 1

●prevalence = the number of people in population with a specific disease at a single point in time or in a defined period of time

●incidence = the number of new cases of disease in a population in a specified period of time

Question 2

List actions the government could take to stem the rise in obesity:

Answer 2

● health education (diet / exercise)

● tax unhealthy foods e.g fat tax

● ban advertising unhealthy food

● improve exercise facilities

● subsidise healthy food

● funding of NHS treatment for obesity e.g bariatric surgery

● legislation: proper labelling/ ingredients

Question 3

List examples of what the GP could do to help individual patients with weight loss:

Answer 3

● role modelling

● tailored advice on specific diet / exercises

● education about obesity risks

● referral to dietician

● prescribing weight loss medication

● treat diseases that contribute to obesity

● tackle underlying causes e.g depression

Question 4

List 5 other health professionals who could also be involved in obesity management or prevention

Answer 4

● community dietician

● psychologist

● pharmacist

● bariatric surgeon

● practise/school nurse

● health visitor

● midwife

Question 5

Explain the difference between statistical and cultural definitions of normality

Answer 5

● statistical normality = based on normal distribution curve / standard deviation

● cultural normality = based on norms and values within a certain group (community)

Question 6

How might obesity affect an individual’s health at a psychological, physical and social level?

Answer 6

● psychological = reduced self-esteem

● physical = difficult to move or keep fit

● social = ostracization by peers

Question 7

GP gatekeeper meaning

Answer 7

○ controls patients’ access (via referral) to specialists

Question 8

Advantages of GPs as gatekeepers

Answer 8

• keep people out of expensive secondary care
• continuity of the doctor-patient relationship
• patient does not know which speciality to go
• referral to appropriate department so apporopriate use of resources
• limits exposure to certain investigations e.g. X-ray

personal advocacy

Question 9

Disadvantages of GPs as gatekeepers

Answer 9

• patients have less choice in secondary care
• stress on GP to know everything about every disease
• dependent on individual GP knowledge, attitudes, skill, practice organisation
• puts stress on a good doctor-patient relationship
• seeing GP increases time it takes to receive treatment

Question 10

Possible physical health effects from a job

Answer 10

○ Too tired to do long shifts

○ dangers of working on an X (oil rig)

○ dangers of transportation to X (oil rig)

○ adjustment to day / night shift patterns

○ potential for obesity due to abundance of food (in canteen)

○ spouse may feel stress from having to look after kids alone

○ potential for improved physical health in him if he makes use of healthy eating options & facilities offshore

Question 11

Possible psychological health effects from a job

Answer 11

○ anxiety & stress due to dangerous working environment

○ anxious about security of his employment

○ anxiety & stress about uncertain return home e.g weather delay

○ possible depression in either due to repeated periods of isolation

○ anxiety & stress in children due to separation

Question 12

Possible social health effects from a job

Answer 12

Positives

○ well paid employment, good lifestyle, decent car, to go on holiday

○ no smoking / alcohol (when offshore)

○ able to spend additional time with family and friends when off (during offshore period)

Negatives

​○ relationship difficulties due to nature of job

○ may binge drink (when onshore)

○ discipline problems in children due to ‘absent’ father figure

○ substance misuse due to stressful nature of job

Question 13

5 categories of hazard

Answer 13

● mechanical

● physical

● chemical

● biological

● psychological

Question 14

How would you deal with a patient asking about the health status of a relative

Answer 14

● maintain X’ confidentiality (MUST - 1 mark)

● consider need to maintain X’ trust

● consider GMC guidelines

● acknowledge their concern and ask them why she is concerned

Question 15

4 ethical priniciples

Answer 15

● beneficence (do good): maximise care

● non-maleficence (do no harm): minimising risk of harm

● justice: recieve care that everyone in their position would be entitled to

● autonomy:a patient’s right not to take proposed treatment even if fully informed of benefits

Question 16

culture def (2 answers)

Answer 16

• systems of shared ideas, concepts, rules and meanings that underlie and are expressed in the ways that human beings live
• complex whole which includes knowledge / beliefs / art / morals / law / customs

Question 17

ethnicity def

Answer 17

• cultural practises and outlooks that characterise and distinguish a certain group of people;
• e.g common language/customs and beliefs / tradition
• term preferred over ‘race’

Question 18

Race

Answer 18

a group of people linked by biological / genetic factors

Question 19

Potential difficulties when interviewing patients with cultural differences

Answer 19

● lack of knowledge about health issues

● fear / distrust

● racism or bias

● language barriers

● 3rd party presence (e.g family members )

● differences in perceptions / expectations

● examination taboos

● gender difference between doctor / patient

● religious beliefs

● they may not be entitled to NHS care

Question 20

6 social classes

Answer 20

● professional

● managerial & technical

● skilled non-manual

● skilled manual

● partly skilled

● unskilled

Question 21

How may culture influence smoking behaviour in different social classes

Answer 21

● 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)

Question 22

Primary care proffesional to tackle obesity and give role

Answer 22

● dietician = individual dietary advice

● pharmacist = OTC anti-obesity medication or weight management programmes

● health visitor = health education; advice on healthy diet

● GP = prescription of weight reducing drugs

● practise nurse = weight clinics

● midwife = encourage breast feeding; early dietary advice

Question 23

3 models of stres

Answer 23

• Engineering model
• Medico-physiological model
• Psychological model

Question 24

Engineering model

Answer 24

● stress acts as a stimulus which the individual must resist

● if the stimulus becomes too intense or prolonged, the individual breaks

Question 25

Possible coping mechanism for stress

Answer 25

● problem focused

● emotion focused

● combination of problem / emotion focused

Question 26

Guidance/co-operation relationship

Answer 26

● doctor exerts authority and patient is obedient

● patient has a little feeling of autonomy and participates to a small degree in relationship

Question 27

3 types of doctor-patient relationship

Answer 27

● authoritarian / paternalistic

● mutual participation

● guidance co-operation

Question 28

5 types of questions used in medical interviewing

Answer 28

● open questions = not seeking any particular answer , allows patient to tell their story

● direct questions = asks about a specific item

● closed questions = can only be answered by yes or no or an equivalent

● reflected questions = allows doctor to avoid answering a direct question from the patient

● leading questions = presumes answer

Question 29

Nonverbal ways doctors can facilliate the interview

Answer 29

● listening

● use of silence

● posture/ body language

● specific gestures

● facial expressions

● eye contact

● layout of room (not talking across desk)

Question 30

Approximately how many patients are registered on average with each GP in the NHS in the UK

Answer 30

1200-2000 patients each

Question 31

% of people reffered on to secondary care from primary care

Answer 31

● 3% (accept 2-5%)