Download University of Jaffna MBBS 2016 December Community and Family Medicine Question Paper

UNIVERSITY OF JAFFNA, SRILANKA SECOND EXAMINATION FOR
MEDICAL DEGREES -- DECEMBER 2016 COMMUNITY & FAMILY
MEDICINE
Date: 18.01.2017

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Time: 3 hours
ANSWER ALL THE SIX QUESTIONS
Answer each question in a separate answer book.
1. You are a medical officer in the Family Health Center, Kondavil. Suba is a 26-year-
old woman who has been referred to you by the local postpartum clinic. Suba, her

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husband and members of his extended family are living in Kondavil. This is the first
time that you have met her. She has had an arranged marriage and the family has
struggled with financial pressures. Her husband is very close to his mother, who
advises him on all issues related to the baby. Her husband says that Suba seems
unhappy and does not want to do anything. She is reluctant to get out of bed or to

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look after the baby, and complains of pain in her stomach constantly. He discloses
that his mother thinks Suba is lazy because she is unwilling to do household chores.

Medical history

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Her husband says Suba did not disclose any past medical history to him, so her
past psychiatric history is unknown.
On examination
An initial physical examination does not reveal anything abnormal.
?

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1.1 Define the following terms
1.1.1 Referral in primary care
(10 marks)
1.1.2 Coordinated care
(10 marks)

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1.2 After receiving the referral from the postpartum clinic, how would you need to tailor
your approach within this consultation?
(30 marks)
1.3 After consultation, you have decided to refer Suba to a mental health team. Describe
the essential components of an ideal referral letter.

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(20 marks)
1.4 Briefly describe the available resources to provide comprehensive care for the patient
(30 marks)
2. Musculoskeletal disorders (MSDs) affect the muscles, nerves, blood vessels, ligaments
and tendons. Workers in many different industries and occupations can be exposed to

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risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing
and pulling heavy loads, working in awkward body postures and performing the same or
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similar tasks repetitively. Exposure to these known risk factors for MSDs increases a

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worker's risk of injury.
2.1. Name five(5)musculoskeletal disorders that could be experienced by
a worker at an
automobile service station
(10 marks)

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2.2. Name the five (5) groups of hazards found in workplaces
(15 marks)
2.3. Define the term ergonomics
(O5marks)
2.4. Briefly describe the important steps in preventing occupational hazards mentioned in

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2.2
(40 marks)
2.5. Briefly describe the role of a primary care physician in managing above mentioned
health issues
(30 marks)

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3. The School Heath Programme in Sri Lanka has the following goals: to ensure that school
children are healthy; to develop their capability to self-promote their own health and
promote the health of family members and the community; and to enable school
children to derive optimal benefit from the educational opportunities provided to them_

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3.1. List at least seven stakeholders who may be involved in achieving these goals
(15 marks)
3.2. Briefly describe the importance of maintaining a healthy environment in schools to
achieve these goals.
(20 marks)

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3.3. Briefly describe the role of an area PHI in maintaining a healthy school environment.
(40 marks)
3.4_ Briefly describe the importance of implementing School Medical Inspection/School
Health Programme in relation to reducing maternal morbidities and mortalities in the
country_ (25 marks)

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4. The table below lists four health expenditure indicators relevant to Sri Lanka and India.
2014
Sri Lanka India
Per capita total health expenditure (in US
127

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75
dollars)
Government expenditure as a % of total
56
30

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health expenditure
Government expenditure on health as a % 6
4
of total government expenditure
Out-of-pocket spending on health as a %

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42
62
of total health expenditure
(Source - World Bank Data 2016; data have been rounded off to the nearest whole number)
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4.1. Define per capita health expenditure
(10 marks)
4.2. On average, how much does the government of Sri Lanka and India spend,
respectively, on health per citizen (in US dollars)?

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(10 marks)
4.3. Which country places greater priority on health? Justify your answer using the data
provided in the table.
(40 marks)
4.4. The government of Sri Lanka allocates less than 5 % of the health budget to the

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preventive sector. Discuss how this policy could influence the prevention and
control of non-communicable diseases in the country. (40 marks)
5. The incidence of overweight and obesity is on the rise among adolescents in urban Sri
Lanka. The Non-Communicable Disease Unit of the Ministry of Health tasks you to carry
out a systematic review of the effectiveness of school-based nutritional interventions for

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the reduction of overweight and obesity among school-going children.
5.1 What is a systematic review?
(20 marks)
5.2 How is a systematic review different from a literature review?
(20 marks)

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5.3 What are the advantages of a systematic review? How would a systematic review
be of use to the Non-Communicable Disease Unit in formulating school-based
nutritional interventions?
(30 marks)
5,4 A systematic review of life-style interventions for child obesity (Ho et al. 2012)

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published in Pediatrics yielded among other findings, changes in BMI depicted in
the figure below:
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A Outcome: Change in M1 (kgini) at the end of active treatment

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Lifestyle intervention
Written education
mean Dffef etre
Mean Differ Brice
Study or Subgroup

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Mean
SO Total Meal'
SD Total Weight ? , Random, 95% C1
TV, fltandoin. 95'. CI
Weigel 21308, 12 mo

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-1.5
I 89
36
2.8
2.33

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30 49.1%
-4.30 1-5.34, -3.251 -R-
Johnston 2007, 6 mo -0.16
1.05
46 0 64

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0.9
25 50.9%
-0.801-1 27, -0.331
Tot 1195% CI)
82

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55 100,0%
-2.52 1-5.95, 0.911
Heterogeneity- Tare= 6.96; Chit= 36.40, elf= 1 (P 4 .00001), r1 = 97%
1
1

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4
Test for overall effect Z. 1.44 (P = 15)
-4 -2
Favors Itfestyle avers wrlIten edu
B Outcome: Change in BM! z scare at the end of active treatment

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Lifestyle intervention
Written education
Mean Difference
Mean Difference
510dyprourild,911

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Mean
S0 Total Mean
Sp_ Total Weight N, F011410111. 95N CI
IV, Random, 95% CI
Weigel 21013D, 12 rno

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- 0.34
0.32
36 0.26 0.37
30
1.9% '-D60-i) 77 -043J

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Fullerton 2007, 6 mo
- 0.13
0.14
52 0.04 0.12
28 207% -0.171-0.23, -0.11)

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Estabrooks 2009, 6 rn0,1vs3# - 0.07
0.01
68 -0.05 0.01
38 37 2% -0.02 1-0.02, -0.02]
Estabrooks 2009, 6 me:In?* - 003

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0.01
64 -0.05 0.01
38 372%
0 02 )0.02, 0 021
Total (95%

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220
134 100.0% -0.061-0.10, -0.021
Heterogeneity Tats= 0 00; Chi 273.61, d1= 3 (p ( .00001); I'= 99%
-0 5 -0.25 0 0.25 0.5 Favors
Teat for overall effect Z= 3.16 (p = 002)

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tirestrie Favors written edu
g 1 vs2 means comparing intervention arm I to arm 2
5.4.1 What is the statistical term used for this representation of data? (10 marks)
5.44,What is your interpretation of the success/failure of the intervention for children
who participated at the end of active treatment?

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(20 marks)
6. Write short notes on
6.1. Life style clinics
(25 marks)
6.2. Palliative care

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(25 marks)
6.3. Electronic Indoor Morbidity Mortality Register (E-IMMR)
(25 marks)
6.4. Prevention of cervical cancer
(25 marks)

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