Download University of Jaffna MBBS 2018 October Community and Family Medicine Question Paper

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UNIVERSITY OF JAFFNA, SRI LANKA

SECOND EXAMINATION FOR MEDICAL DEGREES — OCTOBER 2018

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COMMUNITY & FAMILY MEDICINE

Date: 08.11 2018

Time: 3 hours

ANSWER ALL THE SIX QUESTIONS

Answer each question in a separate answer book.

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1. A recent household survey conducted by Department of Community and Family Medicine in Nallur MOH area revealed that there are more than 40 patients suffering from stroke and cerebral palsy. Family members of the patients are the key care givers. Consider yourself as a Family Physician at the University Family Health Centre.

   1. List five (5) common health problems the patients would encounter. (20 marks)
   2. List five (5) common health problems the care givers would encounter.(20 marks)
   3. Briefly discuss a comprehensive care program for the patients and care givers. (60 marks)

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2. Health in adolescence is the result of the interactions of factors influencing the perinatal, natal and early childhood health and social determinants. Specific biological and social role changes during puberty that are influenced.

   1. List the common health related issues among the adolescents. (15 marks)
   2. List Five (5) socially disadvantages groups of adolescents who experiences common health issues listed in 2.1. (20 marks)
   3. Name three (3) services available for adolescents to address these issues in Sri Lanka. (15 marks)
   4. Briefly describe how life skills training for adolescents will help to overcome the above mentioned health issues. (50 marks)

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3. Despite the favourable health indices of Sri Lanka, occupational health services in the areas of surveillance and health interventions face significant challenges. There is a need to identify priority areas that require attention in occupational health and safety services of Sri Lanka.

   1. Define the term surveillance. (10 marks)
   2. List five (5) occupation related health problems that can occur in a grinding mill worker. (10 marks)
   3. Name five (5) different stakeholders involving in the practice of occupation health and safety of a garment factory. (10 marks)

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   4. List five (5) challenges in implementing the occupational health surveillance in Sri Lanka. (30 marks)
   5. Briefly describe the role of a primary care doctor in prevention of occupation related injuries in the area. (40 marks)

4. According to the Family Health Bureau, in 2016, the maternal mortality ratio (MMR) was 33.8 deaths per 100,000 live births in Sri Lanka. The maternal mortality for Kilinochchi District in the years 2014, 2015, and 2016 are given below.

   Table 1: Maternal mortality in Kilinochchi District (2014-2016)

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   Year	No. of maternal deaths	MMR (deaths per 100,000 live births)
   2014	0	0
   2015	2	81.7
   2016	1	40.8

   1. Define the term "maternal death". (10 marks)
   2. List four data sources the Family Health Bureau may have used to estimate MMR in Kilinochchi District. (20 marks)
   3. Critically analyse the increase in MMR in Kilinochchi District. (30 marks)
   4. Discuss the social determinants of MMR. (40 marks)

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5. Use of urinary catheters conveys a substantial risk of urinary tract infection (UTI). A group of physicians believe that use of one type of urinary catheter is more likely to encourage infection than use of other types in an intensive care setting. They planned a study to review medical records over a 5 year period for all users of urinary catheters in an ICU presented in Table 2.

   Table 2: Distribution of number of patients and new UTI's by type of catheter

   Types of catheter	Number of patients	Number of new UTI's
   Suspected type of catheter	1000	200
   All other catheters	5000	100

   Noting the increased frequency of new UTI's when the suspect catheter type is used, they regard their hypothesis as confirmed. To reduce nosocomial UTI's, they recommend discontinuing use of that type of catheter in the ICU.

   1. Define the following terms.

      1. Hypothesis (10 marks)

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      2. Risk (10 marks)
   2. Mention the study design applied in the study. (10 marks)
   3. Explain the reasons for your answer in 5.2. (20 marks)

   4. From these data:

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      1. Calculate the risk for UTI associated with the suspect catheter compare to all other catheters. (10 marks)
      2. The rate of new UTI's which are specifically due to the choice of the suspect catheter, above the rate conferred by use of another catheter type. (20 marks)
   5. Briefly discuss the correctness of the recommendation. (20 marks)

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6. Write short notes on

   1. Consultation in Family Medicine (25 marks)
   2. Elimination of Tuberculosis (25 marks)
   3. Electronic Medical Record (EMR) (25 marks)
   4. Prevention of Dengue (25 marks)

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