Year 2 Tutorial 2 Long Term Conditions

Question 1

Why have chronic illnesses become increasingly prevalent

Answer 1

Due to ageing population resulting in a huge burden on the health care systems

Question 2

Examples of chronic illness

Answer 2

Osteoarthritis, ischaemic heart disease, respiratory disease

Question 3

Effects of chronic illness

Answer 3

Constraints of family life
Failure to re-establish functional capacity to work
Unremitting physical discomfort

Question 4

Incidence

Answer 4

Number of new cases per year

Question 5

Prevalence

Answer 5

Number of existing cases

Question 6

Pathophysiology

Answer 6

pathological basis of underlying disease process. May incl. causation if known and pathological course e.g. atherosclerosis – sub-intimal deposition of atheroma in arteries -> blood vessel narrowing. Occurs prior to clinical events so present in absence of clinically detectable disease

Question 7

Clinical disease

Answer 7

Pathophysiological process resulting in a specific clinical consequence

Question 8

Illness episode

Answer 8

Time between illness onset and offset

Question 9

Response

Answer 9

Pattern of decrease in symptoms and or signs indiciting decrease in the severity of the underlying pathological process

Question 10

Recovery

Answer 10

sustained period of health following illness episode when clinical features no longer present or insufficient to warrant further investigation or change in treatment

Question 11

Remission

Answer 11

period following episode of illness to warrant use of “recovery”; signs and symptoms have lessened in insufficiency and remain insufficient to warrant further investigation or treatment

Question 12

Relapse

Answer 12

reinstatement in clinical features following episode of illness. Not necessary to have entered remission to relapse (can occur during response period)

Question 13

Recurrence

Answer 13

• reinstatement of new episode of illness following abatement of clinical features of sufficient duration to warrant term “recovery”

Question 14

Body and structure impairment

Answer 14

Disturbance to body structures, organ or system function which presents at birth or arises from disease or injury; equates to presence of clinical disease

Question 15

Activity limitation

Answer 15

restriction or lack of ability to perform activity in a manner or within range considered normal e.g. atherosclerosis pt paralysis down one side due to stroke has activity limitation due to impairment

Question 16

Participation restriction

Answer 16

social construct depending on meanings and values; social disadvantage for individual resulting from activity limitation or impairment that limits or prevents role normal for that individual eg pt who has stroke who used to do manual labor

Question 17

WHO definition of health

Answer 17

Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity

Question 18

Aetiology of Chronic Disease

Answer 18

• Long term complex interaction of factors

* May be genetic and/or environmental factors or may be neither

Question 19

Vulnerability

Answer 19

individual’s capacity to resist disease, repair damage and restore physiological homeostasis. This is important in the extremes of age

Question 20

Individual impact of chronic disease

Answer 20

Denial, self-pity, apathy, isolation

Question 21

Family impact of chronic disease

Answer 21

o Financial
o Social
o Other family members may become ill as a result

Question 22

Treatment of chronic disease

Answer 22

• Aimed at disease or effect of disease. Need to recognize chronic nature of disease and come to terms with it.
• Often difficult as both pt and dr must admit failure in diagnosis or cure w/ payoff of better management

Question 23

Stress

Answer 23

o Real or perceived demands of situation outweigh actual or perceived physical, psychological and social factors
o Signs may be cognitive, social, emotional or physical. Usually anxiety and depression when illness related

Question 24

Different coping mechanisms

Answer 24

♣ Problem-solving – direct action, decision-making or planning
♣ Support seeking – social support, comfort and help seeking
♣ Escape avoidance – disengagement, denial and wishful thinking
♣ Distraction – finding alternative activities to do
♣ Cognitive restructuring – positive thinking and accommodation

Question 25

Emotion-focused coping strategy

Answer 25

modifying response to problem (palliative, avoidant or defensive coping). Less constructive e.g. being ill

Question 26

Problem-focused coping strategy

Answer 26

action to change or address stressor (problem solving or approach coping). More constructive e.g. help seeking, taking action

Question 27

Personality

Answer 27

o Fundamental behavioral and social characteristics of a person. o Innate but interacts w/ environmental factors and genetic factors may predispose an individual to interact with or respond to his or her environment in a certain way.

Question 28

Resilience

Answer 28

o Positive capacity to cope with change, stress and adversity. o Adapt successfully to challenges. – bounce back to previous normal state or use exposure to adversity to grow stronger. Requires positive childhood experience -> self-confidence

Question 29

Illness behaviour

Answer 29

o Positive e.g. attending rehabilitation classes or negative e.g. addiction to analgesia o Based on social learning in childhood via reinforcement (adopt sick role as a child) or modelling (parents had high levels of illness behavior)

Question 30

Stress in relation to health

Answer 30

Prevents people from making rational health care decisions. Stress hormone release can exacerbate physical symptoms.

Question 31

Symptom Perception

Answer 31

o xisting conditions – may think psychological symptoms physical (e.g. hyperventilation from anxiety in asthma pt -> inhaler overuse) o Need to recognize psychological factors o Pain – unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage o Emotions can modulate sensory signals coming from site of pain

Question 32

Psychological impact of disease

Answer 32

Chronic illness can cause anxiety and depression

Question 33

Illness

Answer 33

o What pt experiences when unwell; how interpret and define symptoms and response to actions they take to them. o Can vary between cultures e.g. in Western world pain during Labour is symptom whereas expected and accepted in other cultures. o Often people only seek help when symptoms interfere with work or daily life

Question 34

Disease

Answer 34

o More objective – what dr sees and interprets and what actions they suggest

Question 35

Medical model of disability

Answer 35

• Disability intrinsic to individual and direct consequence of underlying disease • Reduction can only be achieved via amelioration of underlying pathology Medical intervention means to restore “normality”

Question 36

Social Model of disability

Answer 36

• Socio-cultural focus, disability placed outside individual • People not per se limited by medical condition but by behavior of others towards them and environmental conditions • Underpins legislation to remove barriers Reduces limitations e.g. wheelchair access, hearing aid loop systems etc

Question 37

GMC good medical practice on disability

Answer 37

doctors must not unfairly discriminate against patients by allowing their personal views to adversely affect their professional relationship with patients or the treatment they provide or arrange. This includes disability as well as many other factors. You should challenge colleagues who do not comply with this guidance and be aware of own attitudes and prejudices of disability and address this by finding out about common disabilities

Question 38

Disability discrimination Act

Answer 38

person with disabilities is one with physical, sensory or mental impairment which has a substantial, adverse and long term (>12 months) effect on ‘normal’ day to day activities. Updated in 2010 when equality act became law.

Question 39

Equality Act 2010

Answer 39

disability is one of the characteristics protected under this legislation as well as age, race and sexual orientation. A person has a disability if they have a mental or physical impairment that has a continuing effect on their ability to perform day to day activities.

Question 40

Psychological Model of Disability

Answer 40

• Describes how activities performed by someone with a health condition underpinned by same psychological processes of nondisabled person. • Includes motivation, mood disorders and self-efficacy. Also upbringing, resilience, coping and self-motivation Also lived experience of disability including self image, social and economic marginalization, uncertainty about wellbeing and feelings

Question 41

Pattern Recognition

Answer 41

• car bumper damaged in car park, on return can probably work out what has happened

Question 42

Hypothetico-deductive Reasoning

Answer 42

o Initial hypothesizes – 4 or 5 – determine preliminary level of Hx taking, examination and investigation – must correlate with potential seriousness of diagnosis: DECIDE IF MINOR AND SELF LIMITING or LIKELY TO REQUIRE ACTIVE THERAPY. E.g. not pt’s or NHS best interest to determine exact aetiology of simple viral sore throat

Question 43

Inductive Reasoning

Answer 43

* How we learn medicine and what we fall back on * Takes quite a lot to use hypothetico-deductive model safely and effectively. To begin with in most cases have no idea what’s wrong so must use comprehensive inductive model * Best way of learning about clinical method as gives lots of practice of various skills involved

Question 44

Problem solving method most commonly used by GP's

Answer 44

* Humans are more variable than cars, have a mind of our own and can’t be disassembled or repaired therefore GPs use hypothetico-deductive reasoning more than other specialties, although makes use of all three problem solving methods * Due to large nos of people whose PCs are undifferentiated demands so need way of short-cutting intricacies of inductive method by cutting out lines of enquiry and examination that are most likely unproductive