Download University of Jaffna MBBS 2015 October Community and Family Medicine Question Paper

UNIVERSITY OF JAFFNA, SRILANKA

SECOND EXAMINATION FOR MEDICAL DEGREES PART II [2nd] October 2015

COMMUNITY & FAMILY MEDICINE

Date: 28.10.2015 Time: 3 hours

ANSWER ALL THE SIX QUESTIONS

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Answer each question in separate answer book

1. A 75 year old woman with Type 2 diabetes for ten year duration and living alone presented at your clinic with bilateral lower limb swelling and numbness.

   1. Briefly describe the importance of the multi disciplinary team in the care of this patient. (30 marks)
   2. List the possible members for the multi disciplinary team to provide the care for this patient. (20 marks)
   3. As family physician, how will you efficiently make use of the team to provide comprehensive care of this patient. (30 marks)

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   4. On what basis you will decide whether you could care at home or admit to an institution. (20 marks)

2. Please read the article abstract and answer the question given below.

   Journal of Clinical and Experimental hypertension. 2014 Jan: 36(7): 484-91.

   The prevalence, predictors and associations of hypertension in Sri Lanka: a cross-sectional population based national survey

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   Prasad K, Priyanga R, Ranil J, Godwin R, Rezvi Sheriff MH, David RM,

   We studied the community prevalence, patterns and predictors of hypertension in a large sub – population of South Asian adults with a view of identifying differential risk factors. Data were collected between year 2005 2006 and 5000 adults were invited for the study. The sample size was 4485, and about 39.5 % were males. Mean systolic and diastolic blood pressure were 127.1° 19.8 mmHg and 75.4 ± 11.3 mmHg, respectively. Urban adults had a significantly higher prevalence of hypertension than rural adults. In the binary logistic- regression analysis, male gender (OR: 1.2), increasing age, Sri Lankan Moor ethnicity (OR: 1.6), physical inactivity (OR: 1.7), presence of diabetes (OR2.2) and central obesity (OR: 2.3) all were significantly associated with hypertension. In conclusion, nearly one third of the Sri Lankan adult population is hypertensive. Hence, public health initiatives should encourage healthier lifestyles with emphasis on preventing obesity and increasing physical activity.

   1. Define the terms in bold. (20 marks)
   2. Briefly comment on the finding of the study. (25 marks)
   3. Correlate the study outcome with the current programmes by Ministry of Health. (25 marks)

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   4. If you are a practicing family physician, how you will incorporate this information in your practice. (30 marks)

3. "If the fertility rate had not declined as it did, Sri Lanka would have faced serious social and economic problems. It would have been difficult to provide free education and health services and other social welfare services to the mass of the population" (Abeyakoon; Economic Review; 37 (3/4 ) ; 2011),

   1. Name three fertility related measures used to describe changes in population. (15 marks)
   2. List 3 possible serious social problems Sri Lanka can face if the expected fertility rates are not achieved. (15 marks)

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   3. Briefly describe the need of well organized home for elders to address these issues. (20 marks)
   4. Increasing lin-met-need of family planning is one of the reasons for this increasing fertility rate. List 5 reasons for increasing un-met- need of family planning in Sri Lanka. (20 marks)
   5. Describe as a public health manager how you will address one of the above mentioned reasons. (30 marks)

4. After the recent war, people are being resettled in their former villages abandoned for several years and in new areas.

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   1. List the Health, social, environmental problems the resettled population is expected to face. (20 marks)
   2. Discuss the reasons for the development of these problems and how these could be solved. (50 marks)
   3. If you are appointed as a Medical officer of Health to look after this area, what immediate action will you take? (30 marks)

5. In Sri Lanka, the public and the private sectors provide health care through the allopathic system and through the Ayurvedic and other systems of Medicine. The organized delivery for provision of health services is implemented mainly through the allopathic (western) system. The state sector health services function under a cabinet minister. With the introduction of the 13th amendment to the constitution in 1987 which led to the establishment of Provincial Councils, a major reform was undertaken leading to the devolution of the organization for providing health care, to the Provincial Councils. Public health sector is directly controlled by provincial health system. Epidemiological surveillance and disease prevention is an integral function of the public health service in Sri Lanka.

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   1. Describe the structure of the Provincial health system in Sri Lanka. (30 marks)
   2. Define the term disease surveillance. (10 marks)
   3. List 4 activities carried out for disease surveillance in Public health sector. (20 marks)
   4. Briefly describe strength, weakness, opportunities and threats for the effective community based communicable disease surveillance. (40 marks)

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6. Write short notes on

   1. Medical ethics.
   2. Randomised control trials.
   3. Effective communication.
   4. Comment on this graph.

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