Formative Examination Flashcards
Wilson and Jungner (1968) stated that before setting up a screening programme for any disease several factors need to be taken into consideration. List 10 of them (10)/14
Will the test detect the condition at an early pre-clinical stage?
Is the disease an important public health problem?
Is the natural history of the disease adequately understood?
Is a test available for the condition?
Is the test sensitive (low false negatives)?
Is the test specific (low false positives)?
Is the test safe?
Is the test acceptable to the public and professionals involved?
Is the cost of the test reasonable?
Does the overall cost-benefit analysis make it worthwhile?
Are facilities for diagnosis and treatment available?
Is treatment for the condition being screened for of proven effectiveness?
Is treatment for the condition being screened for safe?
Is treatment for the condition being screened for acceptable to public and professionals?
Several different types of study are encountered in epidemiological research. Give brief descriptions of both case control and cohort studies (4)
Case-Control Studies: two groups of people are compared: a group of individuals who have the disease of interest are identified (cases), and a group of individuals who do not have the disease (controls). Data is then gathered on each individual to determine whether or not he or she has been exposed to the suspected aetiological factor(s) and whether or not a conclusion can be drawn that the suspected aetiological agent is a likely cause of the disease in question.
Cohort Studies: baseline data on exposure are collected from a group of people who do not have the disease under study.
The group is then followed through time until a sufficient number have developed the disease to allow analysis.
When studying population health to aid healthcare planning, numerous sources of epidemiological data may be utilised List 6 possible sources of epidemiological at a which may provide information on ischaemic heart disease? (6)/6
Mortality data
Hospital activity statistics
General practice morbidity/disease registers
Health and household surveys/population census data
Social security statistics
NHS expenditure data
Your first patient in morning surgery is 45 year old Vladimir Melyanets, who moved to the UK from Russia 18 months ago and works on an offshore oil platform. He presents with dermatitis affecting his hands and lower arms and tells you that he thinks it is work related.
List five points in Vladimir’s history which would help you decide whether occupational contact dermatitis is the likely diagnosis. (5)/9
Does he work with chemical irritants?
How much exposure does he have to those irritants (intensity/duration)?
Do his symptoms improve when not at work?
Is personal protective equipment (PPE) used?
Does the patient comply with PPE use?
Does the company enforce PPE use?
Do other work colleagues have similar symptoms?
Has he any hobbies/pets/other activities which may be a likely cause?
Does he used hand cream or other topical agents he is likely to be allergic to?
You provide Vladimir with a prescription and advice and ask him to return for review one month later. By this time, his dermatitis is much better, but he has some other issues he wishes to discuss with you. Although he, his wife and his young daughters are happy in Aberdeen and have adjusted well to life in the UK Vladimir complains that he feels anxious and has difficulty sleeping. As a GP you are aware that offshore oil industry workers may suffer a variety of psychological and/or social issues.
List five examples of psychological and/or social issues which may be affecting Vladimir. (5)/8
Anxiety about travel
Depression perhaps secondary to loneliness/being away from family
Stress due to shift patterns
Pressure to maintain standard of living
Difficulty adjusting back into family life when onshore
Abuse of drugs or alcohol
‘Misses’ Russian culture/ethnic isolation
Anxiety about job security
What is the stages of change model? Be able to apply them to a scenario
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
List ten potential difficulties that may arise from cultural differences in any consultation? (10)/13
Lack of knowledge about some health issues/NHS Fear and distrust Racism Bias and ethnocentrism Stereotyping Ritualistic behaviour Language barriers Presence of third party Difference in perceptions and expectations Gender differences between doctor and patient Religious beliefs Difficulties using language line
Look at the two population pyramids for Scotland between 1951 and 2031. What two differences in population demographics are apparent from these pyramids? (2)/3
Increasing elderly population
Fewer young people
‘Baby boom’ bulge may be noted in 2031 pyramid
Give 2 possible reasons for the trends shown in the population pyramids? (2)/9
Decrease in premature mortality/increased life expectancy Decrease in birth/fertility rates Migration Greater availability of contraception Improvements in housing Improvements in sanitation Baby boom post-war recovery years followed by greater 'sexual 'freedom' Health education programmes Improved safety and reduction of injury
List three issues this will present to health care services and three social issues relating to the trends shown in the pyramids. (3/3)/4/
Health services:
- Increased numbers of geriatricians and allied health professionals required
- Increased wards and healthcare facilities for elderly health care
- Increased prevalence long term conditions such as diabetes, CVD, renal disease
- Need for specific health promotion campaigns aimed at the elderly
Social:
- Increasing dependancy on families and/or carers who are ageing
- Demand for home carers and nursing home places likely to increase
- Increasing emphasis on social activities for elderly within communities
- Role of elderly as grandparents and carers of grandchildren likely to change
- Housing demands are likely to change as more elderly people live alone
Later in your morning surgery, you see Kathy Roberts. She is 50 years old and cares for her 82 year old mother, Jean Smith. Jean has several co-morbidities and is on multiple medications. She lives with Kathy and her family.
List five ways in which her role as a carer might affect Kathy. (5)/8
Worsen mental health
May have to give up work or work less hours
Financial implications
Lack of privacy for Kathy and her family
Restriction on social activities/social isolation
Less time for hobbies
Adaptation to Kathy’s house
Positively may gain satisfaction from her role
Suggest five ways in which problems Kathy may experience in her role as a carer could be alleviated (5)/11
Sitter services Home carers to assist with her mother's personal care Elderly frozen food deliveries Day care centre Respite care Benefits Psychological support Disabled badge scheme Physiotherapy/OT assessment and support Medication review Additional help from other family members/friends/neighbours
Amongst her multiple pathologies, Jean has osteoarthritis, ischaemic heart disease, type 2 diabetes and severe renal disease. Her health is rapidly deteriorating.
Several members of the multi-professional team are involved in Jean’s care. List five team members other than the GP and give a brief description of their role in relation to Jean’s care. (10)/24
District nurse/practice nurse - pressure areas, bloods, BP monitoring
Home carer - practical tasks (bating/dressing)
Pharmacist - advice on medication, dossett boxes
Social worker - Benefits, contact with agencies
Occupational therapist - Adaptation to living environment to maximise independence (stair lift/hoist/shower modification)
Physiotherapist - Maintain any remaining mobility, walking aids
GMED/NHS 24 - Out of hours care if unexpected problems
Nurse practitioner - Initial assessment during house call if change in health, GP-supported prescribing
Dietician - Advice on diet to minimise deterioration in renal function
Practice staff - Passing on concerns/first point of contact
Physician’s assistant - GP-supported medical assessment and care
Following surgery, you go on a house call to a poorly patient who has just registered with the practice, following discharge from hospital. Michael Findlay is a 63 year old with severe chronic obstructive pulmonary disease (COPD), who has moved in to his 59 year old sister’s home to facilitate her involvement with his care. Michael took early retirement from his job as a welder due to his COPD. Although he has now stopped smoking, he was a heavy smoker for most of his adult life. He is severely restricted in his activities of daily living due to his COPD. He is breathless on minimal exertion, FEV1<30%, spends most of the morning in bed, sits in his chair most of the afternoon and retires to bed exhausted in the early evening. He receives long-term oxygen therapy. Michael has now had three admissions to hospital with infective exacerbations of COPD in the last six months.
It does not take you long to realise that it is unlikely that Michael will still be alive in six months or so. You also realise that Michael and his sister are unaware of the severity of his COPD and find yourself in the situation of breaking bad news.
List six points to consider when breaking bad news to Michael and his sister. (6)/9
Listen to the patient and their carers
Set the scene
Check whether Michael wants to speak himself or with his sister present
Find out what the patient already understands
Find out how much the patient wants to know
Share the information using common language/avoid jargon
Review and summarise the information
Allow opportunities for questions
Agree follow-up and support
Patients and their carers show a variety of emotional reactions when receiving bad news, some immediately and some over a period of time.
List two examples of typical emotional reactions which may be experienced in this situation and state how they may manifest. (4)/18
Shock - news is completely unexpected. Patient may be tearful and anxious
Anger - angry with themselves for earlier health related behaviour
Denial - Patient does not believe it can be true and for a time will fail to acknowledge reality of situation
Bargaining - ‘If I change something in my life, perhaps I get better’
Relief - Patient glad to finally know what is wrong so that they can plan for the future
Sadness/Depression - Low mood common, especially if the patient has been ill for some time or following the bad news
Fear/Anxiety - Fear of dying, worrying about pain, worry about family who are left
Guilt - Not able to provide for family anymore, guilt that earlier behaviours may have affected health
Distress - Patient unable to cope with the news and shows acute anxiety
