全科医学主观题.docx

全科医学主观题.docx

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全科医学主观题

全科医学主观题

1.Whatarethepatient’sexperienceofillness?

1）Patientsbecomeverymuchawareofthebodyandthelimitationsitimposes.Theyhavetothinkofactivitiesthatwerebeforecarriedoutbelowthelevelofawareness.

2）Chronicdiseaseespeciallyifitringssuccessivelossesofindependenceandcontrol,oftenengendersprofoundsensationsofgrief.Withgriefareassociatedthefeelingsofsadnessandanger,guiltandremorse.Iftheillnesscarriesstigmalikeepilepsy,cancerorAIDS,thenthefeelingsofrejectionmaybeaddedtogrief.

3）Whenthepatientfeelsresponsibleforhisowndisease,theangerturnedinwards.

4）Fearandangerareeverpresentinillness,eveninminorillness.Fearsaremanyandvaried,rationalandirrational.

5）Illnessmayimpairthefacultyofreason.Patientmaybecomeirrationalandevensuperstitious.

6）Thethreatstoselfthatbringsdisruption,lossofautonomy,lossofcontrolandlossofconfidence,makesthesickpersonvulnerable.

7）Thenaturalrhythmsofthebodylikeeating.sleeping,working,restingaredisturbed.

8）Severaldisabilitiesleadtodecreaseinspaceandincreaseintime.

9）Inmentalillness,thethreattoselfisterrifying.Theexperienceofdementia,depression,schizophrenia,oranxietymayproducethemostintensesuffering.

10）However,peopledotriumphovertheirdisabilities.Thebodyhasremarkablepowersofcompensationandadaptation.

11）Thesituationisdifferentforthosewhoarebornwithadisability.Inthese,thedisabledbodyisthelivedbody,fromtheverybeginning.Sothebodywithdisease,ratherthanbeingalien,becomesself.

Theexperienceofillnessalsovarieswiththecoursetheillnesstakes,asuddenorgradualonset,aone-timedisabilitylikestrokeorinjury,whichthenremainsstatic,aprogressivelydownhillcourse,oraprocessofremissionandrelapse.

2.PewHealthProfessionsCommission（PHFC）

CreatedbyThePewCharitableTrustsin1989,thePewHealthProfessionsCommissionhasdevelopedrecommendationsforchangeinhealthprofessionseducationandadvocatedthedevelopmentofpolicieswhichrespondtothenation'shealthcareworkforceneeds.

3.Describetheroleofafamilyphysician

Thefamilyphysicianisamanagerofresources.Asgeneralistsandfirst-contactphysicians,theyhavecontroloflargeresourcesandareable,withincertainlimits,tocontroladmissiontohospital,useofinvestigations,prescrip¬tionoftreatment,andreferraltospecialists.

Inallpartsoftheworld,resourcesarelimited—sometimesseverelylimited.Itis,therefore,familyphysicians’responsibilitytomanagetheseresourcesforthebenefitoftheirpatientsandforthecommunityasawhole.Becausetheinterestsofanindividualpatientmayconflictwiththoseofthecommunityasawhole,thiscanraiseethicalissues.

4.Shaman

Theshamanisapersonsetapartinhissocietyasamanifestationofthesacred,apersonwho,byunusualmeans,has“experiencedthesacredwithgreaterintensitythantherestofthecommunity”（Eliade,1964）.

5.Whatarethethreesensitiveandspecificquestionnairesareavailableinalcoholism?

thetwenty-five-orthirteen-itemversionsoftheMichiganAlcoholismScreeningTest（MAST）,thefour-itemCAGEquestionnaire,andthe10-itemAlcoholUseDisorderIdentificationTest（AUDIT）developedbytheWorldHealthOrganiza¬tion.

6.Symptoms

Symptomsarethepatient’sdescriptionofwhatheorsheperceivestobeabnormalsensations.Bydefinition,theyaresubjectiveandnotopentoverifica¬tionbyempiricalmethods.Thereisnoobjectivetestbywhichwecanverifythatapatientisactuallyfeelingapain.

Symptomsareaformofcommunication—thewayinwhichapatientconveysfeelingsofillness,distress,ordiscomfort.Symptomsaretheinformationonwhichwebaseourunderstandingofthepatient’sproblem.

7.Whatarethethreescreeningmeasuresareavailableinglaucoma?

Threescreeningmeasuresareavail¬able:

1）Tonometry.Thisisofdoubtfulvalueasacase-findingmethod.Manypeoplewithincreasedpressuredonotgoontodevelopocularpathology.Moreover,upto35percentofpeoplewithoculardamagehaveanormalpressureonasinglereading[CTF（C）].

2）Visualfieldtesting:

Thisisbothsensitiveandspecific.TheHumphreyVisualFieldAnalyzeris90percentsensitiveand91percentspecific.Theprocedure,however,isslowandtheequipmentcostly,twofactorsthatmakethemethodimpracticableformostfamilypractices[CTF（C）].

3）Ophthalmoscopy.Whenperformedbytrainedobservers,thisisbothsensitiveandspecific.However,familyphysiciansrequiretrainingandexperiencetodevelopthisdegreeofskill.

Forfamilyphysicianswholackthenecessaryskillorequipment,thewisestcourseistoreferelderlypatientsforperiodicscreeningtoanophthalmologistoroptometrist.

8.Anxietyexpression

Anxietyisnotexpressedinwords,itmaybeexpressedinbodilyways—facialexpression,gestures,heartrateandsoon.Anobservantphysicianmayrecognizetheemotionfromthesesigns.Theanxietyresultsinavisittothedoctor.

9.“Exitproblem”or“doorknobcomment”

Theonethatisnotmentioneduntilthepatientisgettinguptoleave,sometimesintroducedbythewords“Bytheway,Doctor.”Theexitproblemisusuallythemainreasonforthepatient’svisit.Ifthecontextisavisitforanotherproblem,mentionofthemostsensitiveproblemislikelytobelefttothelast.Thishasbeencalledthe“exitproblem”or“doorknobcomment”.

10.Dogmatization

Thisisdefinedastheprocessbywhichemotionsaretransducedtobodilysymp¬toms,forwhichmedicalaidissought.Initsoriginalformulation,somatizationwasrelatedtothepsychoanalyticconceptconversion:

thetransductionofapsy¬chologicalconflictintobodilysymptoms.

Thetermsomatizationisunfortunateinthatitsuggeststhattheprocessisabnormalandthatthepatientistheagentofthetransduction.

11.ICES

InstituteforClinicalEvaluativeStudies

12.WhatarethemainCategoriesofAlternativeMedicine?

1）AncientmedicaltraditionssuchasChinesemedicine:

acompleteparadigm,theory,andrangeoftherapeuticpractices.

2）Shamanistichealingintraditionalsocietiesthatretaintheirlinkswiththepast.Althoughusingherbalmedicines,theshamanisdistinguishedbyaninitiationthatisbelievedtoconferpoweroverthespiritworld.Thehealingprocessofteninvolvesalteredstatesofconsciousnessandincludesmembersofthepatient’sfamilyandcommunity.

3）Folkmedicine:

lorehandeddownthroughgenerations,oftenaboutmedicalpropertiesofplants.Somemoderndrugsandpracticeshadtheiroriginsinfolklore—forexample,smallpoxvaccination,quinine,digitalis,ergotamine,andcolchicine.

4）AlternativeparadigmsandpracticeswithrecentrootsinWesternsocieties:

homeopathy,osteopathy,chiropractic,anthroposophicmedicine,naturopathy.

5）Nutritionaltherapies,rangingfromherbalmedicinestodietaryregimes.

6）Bodytherapies,includingmanykindsofmassage.

7）Spiritualhealing,eitherwithinthemainstreamreligionsorbyindividualsclaimingtohavespecialpowers.

8）Individualtherapieseitherborrowedfromothertraditionsordevelopedautonomously:

acupuncture,biofeedback,hypnotherapy,meditation,andimaging.

13.Whatadviseshouldthephysiciangivethepatientsontheuseofherbalproducts?

1）Ifyouaregoingtotakeherbs,seeapractitionerformallytrainedinbotanicalmedicine.

2）Buyherbalremediesfromtrustedandreliablesources.Avoidherbsinwhichthepurityandqualityaresuspicious,especiallyimportedherbs.

3）Mostherbs,likedrugs,shouldbeavoidedduringpregnancyandlactationandshouldnotbegiventosmallchildren.

4）Considerdrug/herbinteractions.

5）Startwithlowdosagesandbewareofthedosages:

twopillsfromthesamebottlemayhavecompletelydifferentstrengths.

6）Toavoidpossiblechroniceffects,donotuseherbalremediesforlongperiods.

7）Ifyouareunwell,discontinueuseimmediatelyandseekmedicaladvice.

14.Whatdowemeanbytheterm‘descriptiveresearch’

Descriptiveresearch,alsoknownasstatisticalresearch,describesdataandcharacteristicsaboutthepopulationorphenomenonbeingstudied.Themethodsinvolvedrangefromthesurveywhichdescribesthestatusquo（currentstateofaffairs）,thecorrelationstudywhichinvestigatestherelationshipbetweenvariables,todevelopmentalstudieswhichseektodeterminechangesovertime.

15.Whatarethenecessaryconditionsforcontinuingself-education?

1）Thereshouldbesomestandardagainstwhichtomeasurefrmone’sperformance.

2）Onemusthavethecapacityforacceptingcriticism

3）Makechangesinmethodsofpracticeifnecessary

4）Informationonone’smethodofpracticeandoutcomeshouldbeavailableinpracticerecords.

5）Shouldbeabletoreviewallcasesofconditionbeingstudied

6）Theinformationshouldnotbeavailablebutalsoaccessible.

16.Whatarethecuestocontext?

CuestoContext

Thefollowingcuesshouldalertthephysiciantothepossibilitythatheorsheshouldbeworkinginthepersonalandinterpersonalratherthantheclinical-pathologicalcontext:

1）Frequentattendanceswithminorillnesses.

2）Frequentattendancewiththesamesymptomsorwithmultiplecomplaints.

3）Attendanceswithasymptomthathasbeenpresentforalongtime.

4）Attendancewithachronicdiseasethatdoesnotappeartohavechanged.

5）Incongruitybetweenthepatient’sdistressandthecomparativelyminornatureofthesymptoms.

6）Failuretorecoverintheexpectedtimefromanillness,injury,oroperation.

7）Failureofreassurancetosatisfythepatientformorethanashortperiod.

8）Frequentvisitsbyaparentwithachildwithminorproblems（thechildasapr