全科医学主观题.docx
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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
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