全科医学主观题.docx

1、全科医学主观题全科医学主观题1. What are the patients experience of illness? 1)Patients become very much aware of the body and the limitations it imposes. They have to think of activities that were before carried out below the level of awareness.2)Chronic disease especially if it rings successive losses of indepen

2、dence and control, often engenders profound sensations of grief. With grief are associated the feelings of sadness and anger, guilt and remorse. If the illness carries stigma like epilepsy, cancer or AIDS, then the feelings of rejection may be added to grief.3)When the patient feels responsible for

3、his own disease, the anger turned inwards.4)Fear and anger are ever present in illness, even in minor illness. Fears are many and varied, rational and irrational.5)Illness may impair the faculty of reason. Patient may become irrational and even superstitious.6)The threats to self that brings disrupt

4、ion, loss of autonomy, loss of control and loss of confidence , makes the sick person vulnerable.7)The natural rhythms of the body like eating. sleeping, working, resting are disturbed.8)Several disabilities lead to decrease in space and increase in time.9)In mental illness, the threat to self is te

5、rrifying. The experience of dementia, depression, schizophrenia, or anxiety may produce the most intense suffering.10)However, people do triumph over their disabilities. The body has remarkable powers of compensation and adaptation.11)The situation is different for those who are born with a disabili

6、ty. In these, the disabled body is the lived body, from the very beginning. So the body with disease , rather than being alien , becomes self.The experience of illness also varies with the course the illness takes, a sudden or gradual onset, a one-time disability like stroke or injury, which then re

7、mains static, a progressively downhill course, or a process of remission and relapse.2. Pew Health Professions Commission (PHFC)Created by The Pew Charitable Trusts in 1989, the Pew Health Professions Commission has developed recommendations for change in health professions education and advocated t

8、he development of policies which respond to the nations health care workforce needs.3. Describe the role of a family physicianThe family physician is a manager of resources. As generalists and first-contact physicians, they have control of large resources and are able, within certain limits, to cont

9、rol admission to hospital, use of investigations, prescription of treatment, and referral to specialists. In all parts of the world, resources are limitedsometimes severely limited. It is, therefore, family physicians responsibility to manage these resources for the benefit of their patients and for

10、 the community as a whole. Because the interests of an individual patient may conflict with those of the community as a whole, this can raise ethical issues.4. Shaman The shaman is a person set apart in his society as a manifestation of the sacred, a person who, by unusual means, has “experienced th

11、e sacred with greater intensity than the rest of the community” (Eliade, 1964).5. What are the three sensitive and specific questionnaires are available in alcoholism ? the twenty-five- or thirteen-item versions of the Michigan Alcoholism Screening Test (MAST), the four-item CAGE questionnaire, and

12、the 10-item Alcohol Use Disorder Identification Test (AUDIT) developed by the World Health Organization.6. SymptomsSymptoms are the patients description of what he or she perceives to be abnormal sensations. By definition, they are subjective and not open to verification by empirical methods. There

13、is no objective test by which we can verify that a patient is actually feeling a pain.Symptoms are a form of communicationthe way in which a patient conveys feelings of illness, distress, or discomfort. Symptoms are the information on which we base our understanding of the patients problem.7. What a

14、re the three screening measures are available in glaucoma? Three screening measures are available:1)Tonometry. This is of doubtful value as a case-finding method. Many people with increased pressure do not go on to develop ocular pathology. Moreover, up to 35 percent of people with ocular damage hav

15、e a normal pressure on a single reading CTF(C).2)Visual field testing: This is both sensitive and specific. The Humphrey Visual Field Analyzer is 90 percent sensitive and 91 percent specific. The procedure, however, is slow and the equipment costly, two factors that make the method impracticable for

16、 most family practices CTF(C).3)Ophthalmoscopy. When performed by trained observers, this is both sensitive and specific. However, family physicians require training and experience to develop this degree of skill.For family physicians who lack the necessary skill or equipment, the wisest course is t

17、o refer elderly patients for periodic screening to an ophthalmologist or optometrist.8. Anxiety expressionAnxiety is not expressed in words, it may be expressed in bodily waysfacial expression, gestures, heart rate and so on. An observant physician may recognize the emotion from these signs. The anx

18、iety results in a visit to the doctor.9. “Exit problem” or “door knob comment” The one that is not mentioned until the patient is getting up to leave, sometimes introduced by the words “By the way, Doctor.” The exit problem is usually the main reason for the patients visit. If the context is a visit

19、 for another problem, mention of the most sensitive problem is likely to be left to the last. This has been called the “exit problem” or “door knob comment”.10. DogmatizationThis is defined as the process by which emotions are transduced to bodily symptoms, for which medical aid is sought. In its or

20、iginal formulation, somatization was related to the psychoanalytic concept conversion: the transduction of a psychological conflict into bodily symptoms.The term somatization is unfortunate in that it suggests that the process is abnormal and that the patient is the agent of the transduction.11. ICE

21、SInstitute for Clinical Evaluative Studies12. What are the main Categories of Alternative Medicine?1)Ancient medical traditions such as Chinese medicine: a complete paradigm, theory, and range of therapeutic practices.2)Shamanistic healing in traditional societies that retain their links with the pa

22、st. Although using herbal medicines, the shaman is distinguished by an initiation that is believed to confer power over the spirit world. The healing process often involves altered states of consciousness and includes members of the patients family and community.3)Folk medicine: lore handed down thr

23、ough generations, often about medical properties of plants. Some modern drugs and practices had their origins in folklorefor example, smallpox vaccination, quinine, digitalis, ergotamine, and colchicine.4)Alternative paradigms and practices with recent roots in Western societies: homeopathy, osteopa

24、thy, chiropractic, anthroposophic medicine, naturopathy.5)Nutritional therapies, ranging from herbal medicines to dietary regimes.6)Body therapies, including many kinds of massage.7)Spiritual healing, either within the mainstream religions or by individuals claiming to have special powers.8)Individu

25、al therapies either borrowed from other traditions or developed autonomously: acupuncture, biofeedback, hypnotherapy, meditation, and imaging.13. What advise should the physician give the patients on the use of herbal products?1)If you are going to take herbs, see a practitioner formally trained in

26、botanical medicine.2)Buy herbal remedies from trusted and reliable sources. Avoid herbs in which the purity and quality are suspicious, especially imported herbs.3)Most herbs, like drugs, should be avoided during pregnancy and lactation and should not be given to small children.4)Consider drug/herb

27、interactions.5)Start with low dosages and beware of the dosages: two pills from the same bottle may have completely different strengths.6)To avoid possible chronic effects, do not use herbal remedies for long periods.7)If you are unwell, discontinue use immediately and seek medical advice.14. What d

28、o we mean by the term descriptive research Descriptive research, also known as statistical research, describes data and characteristics about the population or phenomenon being studied. The methods involved range from the survey which describes the status quo(current state of affairs), the correlati

29、on study which investigates the relationship between variables, to developmental studies which seek to determine changes over time.15. What are the necessary conditions for continuing self-education? 1)There should be some standard against which to measure frm ones performance.2)One must have the ca

30、pacity for accepting criticism3)Make changes in methods of practice if necessary4)Information on ones method of practice and outcome should be available in practice records.5)Should be able to review all cases of condition being studied6)The information should not be available but also accessible.16

31、. What are the cues to context? Cues to ContextThe following cues should alert the physician to the possibility that he or she should be working in the personal and interpersonal rather than the clinical-pathological context:1)Frequent attendances with minor illnesses.2)Frequent attendance with the

32、same symptoms or with multiple complaints.3)Attendances with a symptom that has been present for a long time.4)Attendance with a chronic disease that does not appear to have changed.5)Incongruity between the patients distress and thecomparatively minor nature of the symptoms.6)Failure to recover in the expected time from an illness, injury, or operation. 7)Failure of reassurance to satisfy the patient for more than a short period.8)Frequent visits by a parent with a child with minor problems (the child as a pr