全科医学：主观题

1、全科主观题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 independence a

2、nd 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 his ow

3、n 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 disruption

4、, 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 disabi

6、lity. 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

7、remains 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

8、 the 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 co

9、ntrol 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 f

10、or 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

11、the 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, an

12、d 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. Ther

13、e 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

14、 are 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

15、have 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

16、 for 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

17、 is to 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. Th

18、e anxiety 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

19、visit 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 i

20、ts original 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

21、. ICESInstitute 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

22、 the past. 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

23、down through 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

24、, osteopathy, 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 power

25、s.8) Individual 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 formal

26、ly trained in 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) Co

27、nsider drug/herb 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 medic

28、al advice.14. What do 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 aff

29、airs), the correlation 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

30、) One must have the capacity 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 availa

31、ble but also accessible.16. 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) F

32、requent attendance with the 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 sy

33、mptoms.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 presenting symptom of illness in the parent).9) An ad

34、ult patient with an accompanying relative.10) Inability to make sense of the presenting problem 17. “Heart Sink Patients”It is the other name for “The fat envelop syndrome.” It is identified by the feeling they evoke in the doctor. This is due to the unhelpful Consultations with specialists.18. Defi

35、ne difficult patient and classify them.Weston defines a difficult patient as one with whom the physician has trouble forming an effective working relationship. The long term relationships with patients in general practice make this a particular problem for family physicians. As the therapeutic succe

36、ss depends so much on the relationship between doctor and patient , the inability to form a therapeutic relationship is usually a source of much frustration for the doctor. Paradoxically, failure of the relationship does not necessarily lead to its termination, so that dealing with the problem is a

37、continuing struggle.Difficult patients fall into a Number of categories:Patients who have developed a “somatic fixation,” that is, express personal distress in the form of somatic symptoms and refuse to believe that no organic disease is present. These are patients we perceive as working in the wron

38、g context. They seek answers from the medical system and the answers they get are negative: negative tests and failed therapies. These kind of patients end up with unnecessary surgery.Patients who abuse themselves with drugs or alcohol, or who use their diseases in a self -destructive way.Patients w

39、ho become dependent on prescription drugs.Patients who make excessive demands on us by frequent visits, out of- hours calls, pressure for tests, medications, or referrals.Patients who move from doctor to doctor or who go to several doctors for the same problem, perhaps playing one of against the oth

40、er.Seductive patients.Angry patients.Some patients fall into more than one of the above categories.Certain cues may alert the physician to a problem- or a potential problem in his or her relationships with a patient. Some of these patients have been described as cue to a context error.A new patient

41、who comes after leaving another physician and is extravagant in his praise for you, while expressing great hostility towards the former doctor.Frequent visits for problems that never respond to treatment ; persistent complaints of symptoms with repeatedly negative tests and unhelpful consultations w

42、ith specialists. This is called as fat envelop syndrome and these patients are called as heart sink patients.Disagreements over prescription drugs.Cues from our own feelings.What patients fear most about the relationship is what they invite by their behavior. The doctor falls into the trap of respon

43、ding automatically to the behavior rather than to the patients needs. What the patient fears most is the rejection. But his or her behavior, paradoxically, invites rejection, and the doctor, if unreflective, responds accordingly. There is no easy solution to these difficulties. Physicians who can co

44、rrectly identify the problem, however and avoid many pitfalls, may not only save themselves from much frustration, but also in some cases help their patients, if in no other way than protecting them from harm. Here are some guidelines:1) Try to avoid somatic fixation by dealing with it when it first

45、 occurs.2) Be cautious in prescribing narcotics for chonic or recurrent pain.3) Try to protect patients from harm in a medical system that is oriented towards physical pathology; from unnecessary tests, medication or surgery.4) Be alert for counterference reactions in yourself.5) Do not over react i

46、f a patient tests the relationship.6) Be prepared to set limits.7) Involve colleagues in your management plan.8) if conflicyual relationship becomes persistent and pervasive in your practice, seek consultation or supervision.DONOT make things by being a difficult doctor. Sometimes the patient seems

47、to be difficult but , the difficulty is really with the doctor.19. Normal anxiety Normal anxiety-th anxiety that a person naturally feels when faced with the threat of death or disability.20. What is empathy? Empathy is the capacity to enter into another persons experience.for the physician it is th

48、e capacity to sense what it is like to be the patient-to experience illness,disability,depression,and so on.on other occasions it may be the capacity to sense what it is like to be the person caring for the patient.this may seem like an impossible task.21. Iatrogenic fatigue It is kind of fatigue wh

49、ich produced by one of the many drugs22. In the patients who do not receive a specific diagnosis for the cause of fatigue, in these patients fatigue will be related to aspects in their way of life. Please list four of these aspects? 1) Insufficient sleep2) Over work3) Poverty4) Too little exercise23

50、. The first part of the assessment of patients presenting with fatigue includes? 1) Listening to the patients account of the symptoms2) Trying to understand the symptom meaning for the patient 3) Following up any cues to the symptom cause24. If the diagnosis of fatigue is not apparent, then conditio

51、nal probabilities will depend to some extent on: a. Age of patientb. Sex of patientc. Length of historyd. All of the above answers are correct25. Which causes result in the fact that patients with depression rarely complain of feeling depressed? 1) Lack of insight into their condition2) Difficulty i

52、n putting their feelings into words3) Assumptions about what complaints are legitimate in a medical context26. fatigue Defined as an overwhelming sense of exhaustion and decreased capacity for physical and mental work regardless of adequate sleep27. what are the four clusters of tasks for the GP? 1)

53、 Acknowledgement of the multiple symptoms,recognition of the patients suffering and diagnosis.the group would have found it helpful to know more about the process of coming to a diagnosis. 2) More help with symptom control.to be hold each time that “its just cfs” was not enough.if the treatment invo

54、lved lifestylechanges,such as rest,this should actually be prescribed by the doctor to make it acceptable to family and colleagues3) Avoid rigid adherence to the “disease model” and the dualistic distinction between physical and psychological illness.4) Prevention of relapses by encouraging patients

55、 to watch for warning signals.28. Please explain the latter phrase Depression is not easy to identify in a person of widely different culture from the observer? A western physician, for example may find it difficult to know when an Asian or African patient is depressed. However, many family physicia

56、ns have patients from different cultures29. According to the features of the patient-centered clinical method, list the description of the physician who is more likely to recognize depression? 1) Who make more eye contact with patients2) Who is a good listener3) less likely to interrupt patients 4)

57、Who is more likely to explore psychological and social issues30. A family physicians witnessed which kind of sadness? 1) The sadness of disappointment2) The sadness of loss3) The sadness ad despair of overwhelming misfortune4) The sadness of old age and mortality31. Please list the six important pri

58、nciples which should be remembered to successes in the management of chronic headache? 1) The original reason for the headaches is not necessarily the same as the reason that makes them chronic.2) Complete removal of the headaches is not a realistic objective of therapy. Success should be measured by patients ability to function, their assessment of the severity and frequency of the headaches, their use of medication, and the extent to which the pain ceases to dominate thei