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1

what 3 broad types of skills

1. content skills
2. perceptual skills
3. process skills

2

what are the 3 types of problem solving that a GP may use?

1. inductive reasoning
2. hypothetico-deductive reasoning
3. pattern recognition

3

Name 5 factors that affect a consultation

1. site and environment
2. adequacy of medical records
3. time constraints
4. patient status
5. personal factors

4

what kind of questions can you use to elicit more information?

1. open-ended questions
2. direct questions
3. closed questions
4. leading questions
5. reflected questions

5

what is the word used when body language and verbal language match?

1. congruence

6

what percentage of the population are attending the GP for care at any point in time?

19%

7

are there any issues in having done the majority of undergraduate training in hospital specialties when considering, for example, a child presenting with abdominal pain?

the hospital is just the tip of the iceberg. you will see a narrow spectrum of presentations in hospital and may gain a distorted view of the presentations of illness.

8

what form of problem solving does a GP use to rapidly narrow down the list of likely diagnoses?

hypothetico-deductive reasoning.

9

what is the WHO definition of health?

not merely the absence of disease but also the state of complete physical, mental and social well-being

10

Jim is out walking to the newsagents when he becomes clammy, out of breath and nauseated. He starts to sweat and has a heavy feeling on his chest. He becomes faint, collapses and an ambulance is called. What is the likely diagnosis

Myocardial infarction

11

He is admitted to hospital and treated in CCU. He is discharged 48 hours later on medication. What groups of medication might he now be on

1. antiplatelets
2. anti-anginals
3. anti-hypertensives
4. statins

12

The discharge letter arrives with you 8 days later, and you note that Jim was asked to make an appointment with you. You check and he has not done so. You ask reception to phone him and ask him to come in.
Jim attends and tells you he decided not to start the medication. You endeavour to persuade him to start. What consultation model would be the preferred option when discussing Jim’s new treatment with him?

Mutual participation – Jim is an intelligent person who would likely respond to information about the risks and benefits of the proposed treatment. It would be important to allow him to ask questions and to understand his treatment. This would likely result in improved compliance.

13

factors might put someone at risk of developing a long-term condition?

1. genetics
2. environmental factors

14

Long-term conditions may have far reaching “impacts”. Give three examples of potential “impacts” of a long-term condition.

1. on the individual - negative or positive (denial, self pity and apathy - lack of interest)
2. on the family - financial, emotional - the health of other family members may be affected
3. community/society - isolation of an individual may result - physical adaptations and changes in attitude may be required.


it has been said that the success of a community can be judged on how it looks after its infirm members

15

what 3 categories are used to classify disability?

1. activity limitation
2. body and structure impairment
3. participation restrictions

16

list 5 members of the primary care team and their roles

1. GP - coordinating care and reviewing treatment and medication
2. district nurse - coordinating care at home (wound care, bloods, catheter care etc)
3. occupational therapist (OT) - assessing environment around the patient at home and work and providing aids to promote independence
4. Physiotherapist (PT) - looking to maximise a patient's physical function (mobility, chest care)
5. care management co-ordinating social care package

17

what are the two approaches that health care professional will use to help a patient overcome their limitations?

1. therapeutic - we change the nature of disability (treating the osteoarthritis
2. prosthetic - we change the environment (taxi-card, occupational therapy, rails at home etc

18

list 8 factors that may affect the way a patient will react to their diagnosis

1. nature of the disability
2. information base of the individual - education and access to information
3. personality of the individual
4. coping strategies of the individual
5. role of individual (loss of role/change of role)
6. mood and emotional reaction of the individual
7. reaction of others around them
8. support network of the individual

19

suggest 3 ways in which a diagnosis of multiple sclerosis may affect a patient's life

1. personal
2. social
3. economic

20

describe the different factors which may affect someone's psychological adaptation to their illness

1. age - older people may have a different attitude to illness. young people may also not expect to become ill.
2. how common the illness is therefore dictating someone's support network with friends (others may have understanding of the condition)
3. the speed of onset of the illness may mean that people have less time to adapt psychologically to the idea of being labelled as a 'patient' and being on a number of medications
4.

21

what barriers may there be to someone who wishes to stop smoking?

they use smoking as a coping strategy to manage a lot of other life stresses.

until a person finds other ways of coping then it is likely that they will return to smoking.

there may also be peer pressure from other friends and relatives who smoke and so there is a cultural normality.

22

NAme the 4 aspects of clinical competence

1. knowledge
2. communication skills
3. physical examination
4. problem solving

23

name the 3 different types of interview skills which may be used

1. content
2. perceptual
3. process

24

suggest 4 physical factors which may affect the consultation

1. site and environment
2. adequacy of medical records (need to reassess)
3. time constraints
4. patient status (new or not known)

25

suggest 6 factors which may affect a consultation

1. age
2. sex
3. origin (social and ethnic class)
4. belief (media, people and past experiences)
5. knowledge and skills
6.illness (terminal vs minor)

26

describe the 3 main different types of doctor patient relationship

1. authoritarian/paternalistic
2. guidance/cooperation
3. mutualistic (most desirable)

27

what are the 2 main activities associated with taking a consultation?

1. talking together
2. doctor examining the patient
3. performing procedures

28

suggest the 5 different types of interview techniques

1. open ended question
2. listen and silence (nod and eye contact, facial expression and posture)
3. facilitation (change in posture and facial expression)
4. confrontation ( you looks sad)
5. support and reassurance

29

suggest 5 different types of questioning to elicit more responses

1. open-ended question
2. direct question
3. closed question
4. leading question
5. reflected question

30

suggest the 4 classes of non-verbal communication and give an example of each

1. instinctive - crying and laughing

2. learned - based on culture and family experiences

3. clinical observation - pain, abnormal movement and distress

4. body language - culture, context (pain/vision), congruence, gesture clusters (gestures in context), posture (may be depressed)