I2M Written Exam Qs

Question 1

2021 paper A -1 a) List, from most to least common, the 3 principal types of skin cancer and specify their cellular origin (3 marks)

Answer 1

• basal cell carcinoma > basal stem cells within the epidermis
• squamous cell carcinoma> keratinocytes within the stratified squamous layer of epidermis
• melanoma > melanocytes within the epidermis

Question 2

1b) Describe the general function of the genes listed below in health and then give an example of this type of gene mutated in cancer (3 marks).
1. Proto-oncogenes
2. Tumour suppressor genes
3. DNA repair enzymes

Answer 2

proto-oncogenes (gain of function) – normally promote cellular growth, mutation causes uncontrolled growth signalling which stimulates cancer development
e.g. Ras, Myc, B-RAF

(loss of function)
tumour suppressor genes – normally inhibit excessive growth but can become dysfunctional due to mutation, allowing for proliferation
e.g. p53, Rb

DNA repair enzymes – proteins which normally function to correct errors/damage in DNA, mutation in these causes dysfunction allowing for further mutations to accumulate
e.g. BRCA1/2, MSH

Question 3

1c) Describe the social determinants that are specific to Indigenous health and give 3 resultant impacts (5 marks)

Answer 3

history, culture & racism > intergenerational trauma & poverty > higher levels of mental and physical health issues & dysfunction

employment & hours worked > lower levels of employment , and more likely working in areas with low remuneration and lacking career progression

income > low income leads to high levels of chronic stress > physical and mental effects

level of schooling > negative impact on health literacy & self efficacy, lower engagement with preventative health services, increased adverse health behaviours, employment and household income

housing > insecure, unsafe, overcrowded, unclean, mould-ridden, a lack of working utilities, all have negative impact on mental and physical health

Incarceration > gross over representation in the prison pop.> indig 3% of pop. and 30% of prison pop. > Removes adults from a community > loss of collective influence & role modelling > neg. Impact on youth via social instability and inc foster care use, & neg impact on elderly family members (inc chronic stress) if they take over care of children. Also creates a criminal record > neg impact on employment, income, education etc.

Question 4

1d) Describe 5 ways in which healthcare professional can work towards creating cultural safety (5 marks)

Answer 4

1. Reflect on your own practice > Self-Reflection is defined as giving serious thought to one’s own character and action. It is about self-awareness, being aware of how our own beliefs and values, families and community influence how we interact with others. Peer review, feedback from colleagues and clients, debrief, one on one supervision.
2. Minimise the power differentials between yourself and your patients > Balancing the power relationships between yourself and the pt. Working alongside them or with them. It can involve negotiating and change to provide a service that doesn’t alienate the pt from the organisation. Is it possible for the pt to make the decisions? If not, why?
3. Engage in conversation with the pt > Building relationships, talking, listening & engaging. “Both Ways Learning”. Local contacts with Indigenous knowledge. Fostering relationships with Indigenous workers, acknowledge them. Cultural mentors.
4. Undertake a process of decolonisation > Learning and acknowledging the role that colonisation and history has impacted on Indigenous people and their lives. Learn the history of the community, people & families. Learn about your own personal history and how it has affected your lives. Learn the history of the system that you work in and the impact it has had on the pts.
5. Treat people with respect of their cultural or individual differences. Do not demean, diminish or disempower others through your actions. recognise and acknowledge diversity between cultures.

Question 5

1e) The new National Agreement on Closing the Gap came into effect in July 2020. What is different about this agreement compared to previous Closing the Gap? (2 marks)

Answer 5

In 2020 CTG, there is a greater focus on partnership between governments and Aboriginal and Torres Strait Islander people, communities, elders, and advocates. The 2020 CTG outlines a new path where Aboriginal and Torres Strait Islander people share ownership to improve life outcomes for current and future generations, and closes off on an era of reporting against government-set targets. At the centre of this new way of working is local action, with a determination to achieve change in clear and tangible ways.