Formative (3) 2019 Version

Question 1

List some factors to consider before setting up a screening programme for any disease

Answer 1

• Test detects condition at a pre clinical stage
• Disease is an important public health problem
• Test is available for the condition
• Natural history of the disease is well understood
• Sensitive, specific and safe
• Reasonable cost of test
• Are facilities for diagnosis and treatment available?
• Does the overall cost-benefit analysis make it worthwhile?
• Is the test acceptable to the public and professionals involved?

Question 2

Contrast case control studies and cohort studies

Answer 2

CC: 2 groups of people are compared - one group who have the disease (cases) and one group who don’t (controls). Data are 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.

CS: 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.

Question 3

Name 6 possible sources of epidemiological data which may provide information on eg ischaemic heart disease

Answer 3

• Mortality data
• Hospital activity stats
• GP morbidity/disease registers
• Population census data
• Social security stats
• NHS expenditure data

Question 4

What questions might you ask in a history to determine if a disease is linked to occupation

Answer 4

• Do symptoms improve when off work/on holiday
• Does the job require PPE and is it used?
• Do any other work colleagues have similar symptoms?
• Does the job involve exposure to irritants eg chemicals, dust, flour, radiation?
• Any other hobbies or activities that may be a likely cause?

Question 5

List 5 examples of psychological and/or social issues which might present in a patient struggling at work

Answer 5

• Anxiety regarding travel or job security
• Depression if away from family a lot
• Stress due to shift pattern
• Pressure to maintain their standard of living
• Abuse of drugs or alcohol

Question 6

List 10 potential difficulties which may arise in any consultation as a result of cultural differences

Answer 6

• Lack of knowledge about NHS
• Fear and distrust
• Racism
• Stereotyping
• Language barriers or presence of third party in room
• Examination taboos
• Differences in perceptions and expectations
• Gender differences between dr and patient
• Bias
• Religious beliefs

Question 7

What factors might cause population pyramids to show an increasing or decreasing trend?

Answer 7

• Premature mortality or life expectancy
• Birth/fertility rates
• Migration
• Availability of contraception
• Improvements in housing or sanitation
• Improved safety and reduction of injury

Question 8

List 3 issues faced by healthcare services due to an increasing elderly population

Answer 8

• Increased prevalence of long term conditions
• Increased numbers of geriatricians required
• Increased wards or healthcare facilities required

Question 9

List 3 social issues caused due to an increasing elderly population

Answer 9

• Increasing dependence on families and carers
• Demand for home carers and nursing home places
• Change in housing demands

Question 10

List 5 ways in which a carer role might affect an individual

Answer 10

• Poor mental health
• May have to give up work
• Financial implications
• Less time for hobbies
• Adaptations to housing

Question 11

List 5 ways in which problems faced by a carer might be alleviated

Answer 11

• Sitter services or home carers
• Day care centre
• Home deliveries for food etc
• Benefits
• Medication review
• Psychological support eg counselling
• Respite care

Question 12

List 5 factors that may contribute to tiredness OTHER than physical illness

Answer 12

• Poor diet
• Inadequate sleep
• Excess screen time
• Lack of or too much exercise
• Bullying
• Mental illness
• Relationship or academic difficulties

Question 13

How many minutes of exercise/day should teenagers be getting and how many hours of sleep?

Answer 13

• 60mins exercise

- 8-10hrs sleep

Question 14

List 6 points to consider when breaking bad news to a patient

Answer 14

• LISTEN to the patient and their carers
• Set the scene
• Find out what patient already understands and how much they want to know
• Avoid jargon
• Review and summarise
• Allow opportunities for questions
• Agree follow up and support

Question 15

List examples of emotional reactions to bad news

Answer 15

-Shock: news unexpected
-Anger: feels it is their fault, or dr’s
-Denial: fail to acknowledge reality of the situation
-Relief: glad to finally know what is wrong
Sadness: low mood especially if been ill for a long time
Fear: worried about pain, dying, family left behind
-Distress: unable to cope
-Guilt: no longer able to provide for family

Question 16

Give 5 examples to suggest a patient can receive palliative care

Answer 16

• Not expected to be alive in next 6-12mths
• Spending more than 50% of the day in bed or on a chair
• Breathless at rest or on minimal exertion
• On long term therapy, eg oxygen
• Many hospital admissions in last 6mths

Question 17

List 5 points relating to the proactive care resulting from anticipatory care planning

Answer 17

• Preferred place of care noticed and organised
• Care plan and medication issued for home
• End of life pathway used
• Dies in preferred place
• Regular assessment of symptoms carried out and care customised to patient and carer needs

Question 18

Definition of sustainability

Answer 18

The ability to be able to continue over a period of time

Question 19

List 4 positive factors that might contribute to a sustainable medical career

Answer 19

• Work life balance
• Autonomy
• Job satisfaction
• Team working, good relationship with colleagues
• Manageable workload
• Ability to develop other outside interests
• Flexibility of role