Foundations of Primary Care

Question 1

Aspects of healthy lifestyle

Answer 1

Sexual health, diet, exercise, alcohol, smoking, illicit drug use

Question 2

Advantages of position of GP

Answer 2

Aware of current and past medical history. Aware of social circumstances. Broad range of knowledge. Trusted health professional who has long term relationship with patient. Responsible for holistic care. GP is accessible to patients.

Question 3

Types of question

Answer 3

Open question. Direct question. Leading question. Closed question. Reflective question.

Question 4

Motivators to change behaviour

Answer 4

Believe change is possible in all situations, advantages of changing outweighs advantages of not changing, change is socially acceptable, anticipation of positive response from friends/family . New behaviour consilient with self-image.

Question 5

WHO definition of health

Answer 5

State of complete mental, physical, and social wellbeing and not merely the absence of disease and infirmity.

Question 6

Lay beliefs on health

Answer 6

Social class, gender, age and culture

Question 7

Government control of health

Answer 7

Funding of health service, vaccination programmes, legislation, public transport policies, exercise facilities, increasing tax on unhealthy foods/subsidising health options , health education, control of advertising, health and safety laws, housing improvements

Question 8

Cultural competence

Answer 8

Ongoing capacity of healthcare systems, organisations and professionals to provide diverse patient populations high quality care that if safe, patient and family centred, evidence based and equitable.

Question 9

Difficulties between cultures

Answer 9

Language barrier, different expectations, presence of third party (translator/family member), racism or prejudice, different beliefs regarding health, religious beliefs, lack of knowledge of NHS, fear and distrust, examinations taboos, gender difference between Dr and patient, patient not entitled to NHS care

Question 10

Routes of exposure to hazards

Answer 10

physical contact, inhalation, blood, sexual contact, ingestion

Question 11

Categories of hazard

Answer 11

Chemical, physical, mechanical, psychological, biological

Question 12

Safety netting

Answer 12

Explain expected course of illness/recovery, explain symptoms that indicate deterioration, explain where to go/who to contact if patient deteriorates

Question 13

Ways in which risk can be minimised in a consultation

Answer 13

Summarising and verbally checking reason for attendance is clear.
Handing over to patients and bringing consultation to a close, insuring all issues have been covered.
Deal with housekeeping of recovery and reflection (record keeping, referral if necessary and reflecting before seeing next patient)

Question 14

Definition of gatekeeper

Answer 14

Controls access of patients to secondary care in the NHS

Question 15

Advantages of GPs as gatekeepers

Answer 15

Identifies patient in need pf specialist care.
Increases likelihood patient sees correct specialist.
Patient may not know which specialist they require to see.
Saves resources as only patients who require specialist care receive it.
Patient not exposed to radiation/procedures needlessly.
GP acts as coordinator of care.
Opportunity for GP to provide patient education.

Question 16

Percentage of illnesses occurring in the community that are referred on to secondary care.

Answer 16

3%

Question 17

Health and social care team members

Answer 17

Pharmacist - minor illness advice and medication advice.
Physiotherapist - helps with patient recovery and mobilisation of patients.
Practice nurse - blood tests
Dietician - assessment of nutrition and advice on weight gain/loss
Counsellor - assess and manage mood
Practice nurse - assessment and advice on long term conditions, blood tests and vaccinations
Occupational therapist - assess for aids to assist daily living
Midwife - follow up first 10 days after birth and advice on feeding
Health visitor - early child care advice until school age and immunisations

Question 18

Ethical principles

Answer 18

Autonomy - patient control of their own care
Justice - all resources available for everyone
Benefice - help the patient
Non-malefeince - do not harm the patient

Question 19

Ethical issues surrounding health

Answer 19

Beliefs, religious beliefs, thoughts on your capacity

Question 20

Psychological issues surrounding health

Answer 20

Anxiety about a treatment, anxiety about consequences of a health issue, stress/anxiety about level of support from family

Question 21

Social issues surrounding health

Answer 21

Does support network exist, effects on social life, ability to find a job

Question 22

Styles of doctor patient relationship

Answer 22

Mutual participation, Authoritarian or paternalistic, Guidance/co-opaeration

Question 23

Mutual participation style relationship

Answer 23

Patient has greater role in care so feels greater sense of personal autonomy.
Patient has greater responsibility for the their own health through sharing info and decision making.
Patient is more satisfied with consultation where they have been fully informed.
Patient may be more complaint with advice/treatment.

Question 24

Authoritarian or paternalistic relationship

Answer 24

Dr has all the authority inherent in their status and patient has no autonomy. Patient tries to please Dr and does not actively participate in own treatment.

Question 25

Guidance/co-operation relationship

Answer 25

Dr still exercises much authority and patient is obedient but patient has greater feeling of autonomy and participates more actively in relationship.

Question 26

Communication skills

Answer 26

Content skills, perceptual skills and process skills

Question 27

Content skills

Answer 27

What Drs communicate - substance of questions and responses, info they gather and give and treatment plans

Question 28

Perceptual skills

Answer 28

Drs internal decision making, clinical reasoning, awareness of own biases, attitudes and distractions

Question 29

Process skills

Answer 29

Way that Drs communicate with patients, how they go about discovery history or providing info (verbal and non-verbal skills - way they structure and organise communication)

Question 30

Factors that influence views on behaviour

Answer 30

What is normal for peer/social group

What is shown on TV/social media

Question 31

Hypothetico-deductive reasoning process

Answer 31

Several diagnosis generated from Dr experience based on history
Rare and not immediately concerning diagnosis can be excluded at early state
Rare but serious diseases should be actively excluded
More detailed history and examination to strengthen case for diagnosis/diagnoses
Extend search if no diagnosis identified
Revision of diagnoses required if patient does not follow expected course/pattern of diagnosis
Process is about finding the most likely diagnosis (not necessarily most common)

Question 32

Role of computers in general practice

Answer 32

Store and book appointments 
Store patient records 
Support prescribing 
Electronic management of hospital letters
Electronic management of test results 
Useful in conducting audits 
Chronic disease management and recall 
E-consultations 
Patient leaflets/resources
Public health info 
Identify patients for screening programmes

Question 33

Hazard

Answer 33

Something with potential to cause harm

Question 34

Risk

Answer 34

The likelihood of a hazard occurring

Question 35

Questions to determine if illness is occupational

Answer 35

Does it happen at work?
Does it happen at holidays?
Did it occur before starting to work there?
Is anyone else at work effected?

Question 36

Coping mechanisms for stress

Answer 36

Problem focused - make problem causing stress better/easier

Emotion focused - counselling or stress management (or alcohol and drug misuse - negative)

Question 37

Problems of child health in deprived areas

Answer 37

Lower birth weight
Less likely to benefit from breast feeding
Poorer dental health
Higher rates of obesity and poor nutrition
Higher rates of teenage pregnancy
More likely to take up smoking, alcohol misuse or substance misuse.
Greater risk of admission to hospital
Greater risk of infant mortality
Less likely to get vaccinations

Question 38

Risks to foetal wellbeing

Answer 38

Smoking, illicit drug use, prescription drugs, OTC medication, herbal medication, X-rays, diet (poor nutrition, lack of folic acid), infectious diseases, maternal disease

Question 39

Tilar definition of Culture

Answer 39

A complex whole which includes knowledge, beliefs, art, morals, law, customs etc.

Question 40

Common reasons for children seeing GP

Answer 40

Pyrexia, feeding problems, URTIs/colds, coughs, sore throat, vomiting and/or diarrhoea, abdominal pain, behavioural problems, anxiety

Question 41

Social influences on health

Answer 41

Gender, ethnicity, housing, employment, financial security, health system, environment, social class

Question 42

Non-verbal communication

Answer 42

Listening, use of silence, posture, body language, specific gestures, facial expressions, eye contact, layout of room

Question 43

Disadvantages of GPs as gatekeepers

Answer 43

Patients have less choice in secondary care
Places stress on GP to have wide range of knowledge, Dependant on individual GP knowledge, attitudes and skills.
Increased time to see specialist and receive treatment
Dissatisfied patients may inappropriately present to A&E or private sector

Question 44

No of patients registered with a GP

Answer 44

1200-2000

Question 45

Keesing definition of Culture

Answer 45

Systems of shared ideas, concepts, rules and meanings that underlie and are expressed in the way human beings live.