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the WHO define 3 categories under which disability can be described - list these 3 categories and give a brief explanation of each

1. body structure and function impairment - is defined as abnormalities of structure, organ or system function (organ level)

2. activity limitation - is defined as a changed functional performance and activity by the individual

3. Participation restrictions - defined as the disadvantage experienced by the individual as a result of the impairments and disabilities (interaction at social and environmental level)


give 4 examples of how the definitions of disability could apply to the average child who has cerebral palsy and learning difficulties.

1. damage to motor area of brain
2. damage to cognitive area of the brain
3. limited mobility
4. learning difficulty
5. exclusion/difficulty participating in certain activities (riding a bike and certain sports)


in general, what might be the effect of a disabled child on their parents, siblings, peers and teachers? give 2 examples under each heading


1. over-protection of disabled child
2. increased risk of child abuse
3. marital problems


1. resentment for how much time parents spend with other sibling
2. may have to develop a carer role


1. friend may be stigmatised along with the disabled child

2. may need to adapt to activities to include the other friend


1. may have a lack of training and understanding of the disability
2. lack of willingness to integrate in mainstream activities


Name 6 other recognised causes of disability worldwide

1. communicable disease
2. non-communicable disease
3. alcohol
4. tobacco
5. mental illness
6. malnutrition
7. drugs abuse
8. iatrogenic drugs
9. obesity


list 4 medical factors which may influence the uptake of medical care for any patient

1. duration
2. visible disease
3. new symptoms
4. increasing severity
5. psychological impact of symptoms.


list 6 non-medical factors which may influence the uptake of medical care for any patient

1. crisis (relationship difficulty, loss of job)
2. peer pressure (wife/friend sent me)
3. patients beliefs
4. patient expectations
5. social class
6. culture
7. economic implications
8. age
9. gender
10. access
11. media


briefly describe the inductive reasoning model and its benefits

1. can be used for patients with vague/unexpected symptoms

2. can be used in inexperienced doctors

3. involves systematic and comprehensive history and examination

4. often involves investigations - blood tests and scan

5. evidence is then assessed to find an explanation for symptoms


give a brief description of how hypothetico-deductive reasoning may be used in a patient presenting with chest pain

1. doctors experiences generates a differential diagnosis from presenting symptoms

2. specific questions are used to establish diagnosis, giving consideration to conditions requiring urgent medical attention such as an MI

3. examination and investigation are used as appropriate to help establish diagnosis


give a brief description of how pattern recognition may be used in a patient with chicken pox

1. doctors previous experience will allow them to recognise the natural history of disease and pattern/types of spots

2. this allows the doctor to draw a conclusion from the pattern and reach a certain or near certain diagnosis of chickenpox


using your knowledge of the WHO definition of health, list 3 aspects of health that may be affected by cardiac failure and give an example of the possible effects on health under these categories


1. reduced mobility
2. requirement for medication


1. anxiety that illness may become worse
2. depression secondary to long term condition


1. reduction in working hours
2. loss of earnings if time off work


list 5 example in differences of care provided by a patient's GP and their secondary care doctors?

1. GP is responsible for care for much longer - secondary care is only involved once cardiac symptoms developed

2. GP is responsible for all of his medical care, not just his cardiac illness. secondary team will only deal with specific illness (breadth vs depth)

3. secondary care doctors have easier access to investigations than GPs

4. risk and uncertainty relating to patient health is more likely to be accepted by GP than secondary care doctors - GP is more likely to use time, try empirical treatment

5. quality of Doctor/patient relationship to be improved by continuity of care in general practice, although patient with long term conditions will also have a good quality relationship with secondary care

6. Opportunistic health care and health promotion more likely to occur in General Practice

7. multiple short appointments in GP vs longer less frequent appointments in secondary care

8. GP will act as a gatekeeper to secondary care. secondary care doctors rarely employ a gatekeeper role.


list 2 advantages and three disadvantages of house calls for the patient


1. convenience (no travelling)
2. social contact
3. may be able to let GP see difficulties they have in home environment


1.invasion of privacy
2. some will feel defined to clean
3. lack of ability to see doctor of choice
4. lack of defined time for visit
5. not every examination can be performed at home, so may be delay in diagnosis


list 10 members of the healthcare team who may be involved with a patient's care in their home and give a short description of each of their roles in their house

1. GP - day2day medical support

2. district nurse - dressings

3. home carer - practical tasks

4. pharmacist - advice on medication

5. social worker/care manager - advice on benefits

6. occupational therapist - adaptation of living environment to maximise independence

7. Physiotherapist - continue to improve mobility and stability

8. dietician - advice on improving appetite

9. GMED/NHS24 - out of hours care for unexpected deterioration

10. community psychiatric nurse - assessment and management of low mood

11. parkinson's nurse specialist - specialist advice to patient and family/friends - assist in the support groups