IMED4211 Systems 2

Written Examination 1 2017

Population Health Science/LEAPS Weeks 1 - 15

This document summarises the teaching in the unit Weeks 1 15 and clarifies what is included or not
included in the final Written Examination.

The examination questions will be a mixture of multiple choice questions and short answer questions that
are connected to clinical scenarios in the tutorials and CEL.

I understand there is a lot of material in various disciplines that has been covered and only a small portion
can be asked in what we have been allocated. I have provided guidance with the recognition that the
content here can also help across disciplines/sessions. Good luck in the exam. Kind regards, Helena Iredell

General Points
If you are asked to list then you can give a simple list
Outline you might need to give a bit more than a simple list a one sentence description for example
Discuss a list will not be sufficient you need to list the point and then give 2-3 sentences that explains
the point. You cannot get full marks for a simple list when the question asks you to discuss.

Gastroenterology System
Weeks 1 - 6
Week 1
GIT: Upper Abdominal
This was our first tutorial for the semester. The focus was on upper abdominal conditions helicobacter
pylori infection and biliary (gallbladder) disease. You should focus on the usual aspects of a disease risk
factors, signs and symptoms, etc. Helicobacter pylori is a low prevalence disease in Australia which
means that there are some groups in the population at higher risk but overall is not a significant issue.
However, developing countries have a high prevalence it is disease of lower socio-economic
circumstances.

Gall bladder disease has a number of aspects to consider. Of course risk factors, and signs and symptoms
are important and then consider the likely pathway to managing/treating the person.

Be able to compare and contrast the two upper abdominal conditions.

Week 2
GIT: Colorectal Cancer & Screening
This tutorial looked at colorectal cancer and screening. The basics of screening were covered in year 1 and
so this tutorial was to look specifically at colorectal cancer. It is important to understand the risk factors
that place people at higher risk of colorectal cancer including the 2 main genetic diseases (FAP & HNPCC).
The national screening program was pilot tested prior to its introduction and the immunochemical FOBT
screening test provided a more accurate screening test this is important to a screening program an
accurate test. I want you to know the different screening pathways for colorectal cancer increasing age
and family history are the most important risk factors so if there is a family history of colorectal cancer it
is import to understand the age of occurrence (because if it occurs when they are relatively young then this
changes when you start screening) in the family member as well as the type of relatives affected this then
dictates the screening pathway for your patient and you dont want to get this wrong.

There was an ethical perspective here and in particular ties with testing for familial bowel cancer. Be able
to talk about some ethical dilemmas do people want to know or not.

Week 3
GIT: Hepatitis
This tutorial looked at Hepatitis A, B, and C. Dont forget we looked at the global as well as Australian
perspective. The tables in the slides are a good way to learn each and this came from the ABC of Hepatitis
reference. Basically have a good overview of each type of hepatitis including the global perspective and be
able to compare and contrast the three types.

Dont forget the latest development in treatment the latest medication regime is very costly due to the
price set by the pharmaceutical company (cheap to produce) and we have just added to our PBS and it has
cost us $1billion in four months. It has a 95% cure rate and will if enough people can access it change the
face of the hepatitis C. Should the pharmaceutical company be charging so much?

Week 4
GIT: Alcohol & Violence
This tutorial had two parts alcohol and violence and domestic violence. Some of the tutorial was to
expose you to the conversation surrounding these issues not for you to them memorise all of the tutorial.
However, do think about the harm to health from alcohol, the risk factors, features that indicate that there
is an issue, and an overview of the population level and individual levels approaches to alcohol
prevention/control.

Week 5
GIT: Under-Nutrition
The tutorial looked at the issue on the global stage (with a focus on micronutrients, the SDGs connected to
nutrition, children and the six global targets) and a brief look at older people (because in Australia older
people are one of the most vulnerable to under nutrition). Those 6 targets are really important and I would
be able to talk about 3 SDGs connected to nutrition other than end hunger.

Week 6
Simulated Patients:
This session provided you with an opportunity to revise upper abdominal conditions, colorectal cancer,
and alcohol/hepatitis. There was no new material. The patient scenarios are up for you to view. In this
exam I personally will not give you investigation results to interpret (I understand people were a bit
worried). However, I cannot speak for others.
Examples of Exam Questions
Describe the main diagnostic methods for Helicobacter pylori infection
Outline the main risk factors for gallstones
List the main signs and symptoms indicating gallstone disease.
Hepatitis (could be about A B or C) discuss the risk factors and the prevention strategies that are
effective against this type of hepatitis
The level of alcohol and substance use in young people has recently received significant media
attention. Briefly describe 2 examples of harm minimisation alcohol strategies used in Australia.
Briefly describe the pathogenesis of colorectal cancer, include in your discussion the natural history of
the disease and why it is a suitable disease for screening.
If a person has a family history of FAP, what is the most appropriate screening pathway for that
person?
Genetic testing/screening and genetic information is different to other health information. Ethical
issues can arise from the ability to detect faulty genes that run in families. Outline 2 ethical issues that
can arise from genetic testing/screening.
Endocrine/Renal System
Weeks 6 10

Week 7
Endocrine: Thyroid Disorders
There is no room in this exam to ask about ANOVA so it will be left for now. Otherwise I think it is
straightforward in regards to thyroid disorders. Hopefully the revision with simulated patients also helped
you to differentiate between the two thyroid diseases.

Week 8
Endocrine: Type 2 Diabetes
The tutorial focused on Type 2 Diabetes. We looked at the disease itself but also the Global and Australian
burden of type 2 diabetes. Globally and in Australia this is one disease that is increasing in prevalence.
Therefore you should pay attention to understanding the size/burden of type 2 diabetes. Otherwise, you
should understand the disease itself including the risk factors for the development of type 2 diabetes, the
risk assessment tool (AUSDRISK) used to screen for increased risk for type 2 diabetes (as many people go
undiagnosed), the nature of each diagnostic tool and the criteria for the diagnosis of diabetes.
Management is complex but understanding that a number of health professional would be involved
important.

Week 9
Endocrine: UTIs & CKD
Urinary Tract Infections (UTIs) This tutorial focused on women. What are the patient characteristics that
place women at greater risk of uncomplicated or complicated UTIs? Remember that there are the two
classifications of UTIs which then affects the diagnostic process uncomplicated UTIs usually do not require
a urine culture performed as part of the diagnostic process as the patient history and a urine dipstick
testing is sufficient to prescribe treatment you dont want to waste money doing tests that are
unnecessary. You should understand the link between UTIs and diabetes.

Chronic Kidney Disease The first thing to say is that chronic kidney disease, diabetes and cardiovascular
disease is a triad of diseases with the presence of one increasing the likely of the other two. For example
once a person has diabetes (doesnt matter whether it is type 1 or 2) then they should be monitored for the
development of cardiovascular & kidney disease. You should know the thresholds such as the eGFR that
diagnoses and stages chronic kidney disease. I will not be asking for detailed treatment as it is too complex.
My focus is on good recognition the disease, the risk factors, diagnostic criteria and the diseases that are
connected to an increased risk of chronic kidney disease.

Week 10
Simulated Patients - Endocrine
The patient scenarios have been placed on the LMS for you to view. They do make good revision materials
for the various conditions. Please note that they are more complex than you might get for the clinical skills
assessment as there is only 10mins but still a good study aid for this assessment too.

Week 11
Study Break
Examples of Exam Questions
List 4 of the most significant signs and symptoms for hypothyroidism.
List 4 of the most significant signs and symptoms for hyperthyroidism
Be able to compare and contrast the main features of hyperthyroidism and hypothyroidism
Subclinical hypothyroidism who is most affected?
While I focused on type 2 diabetes in the main dont forget type 1 diabetes and diabetic ketoacidosis
there are similarities in presentation but of course some important differences
What are the key risk factors for urinary tract infections?
Why in uncomplicated urinary tract infections is a urine culture is not usually necessary?
What are the key risk factors for chronic kidney disease?
What are the key causes on end stage kidney disease?
Provide a definition of chronic kidney disease. What is the GFR for stage 4?
Reproductive /Life Course System
Weeks 12 - 15

Week 12
Maternal Health
This tutorial focused on the global situation in regards to maternal health. However, do not forget the
Australian context if presented in the tutorial. What are the determinants/reasons for poor maternal
health? What is the current situation? What are the MDG main goals?

Maternal Deaths what are women dying from other than the pre-existing medical conditions? Global
and Australian situation. What are some innovative strategies to try to overcome this important global
issue? What are the 13 Life-saving commodities?

Week 13
Contraception & Unplanned Pregnancy
Do I have to be 18 years or older to make my own health care decisions? Be able to discuss the Mature
Minor Rule/Gillick Competence. We also talked about unplanned pregnancies what the contributing
factors and the suggested solutions to this issue. Does emergency conception lower the unplanned
pregnancy rate?

Week 14
Infertility & Very Pre-mature Babies
In recent times women are delaying childbearing (or not choosing to have children) what are the key
reasons for this? Furthermore some women have difficulties in becoming pregnant what the key reasons
for the infertility? Hoe is infertility defined? I do not need a detailed explanation of the various types of
ART. But we did talk about the ethical issues in relation to infertility and assisted reproduction. This
included:
over-population of the world and creating more children;
the separation of conception and sexuality;
ART and children as commodities and commercialised;
access to ART (includes age, marital status of the mother, sexual preference of the mother; risk of
genetic disease)
Human embryos Fresh and Frozen embryos

This tutorial also looked at very tiny babies those born extremely premature. We focused on the period
termed borderline/greyzone of viability what does this mean and what are some of the ethical dilemmas
in this period of a neonates life?

Week 15
Breast Feeding & Breast Cancer
This tutorial explored the issue of breastfeeding and the difficulties women may face and the strategies
being employed to increase or maintain breast feeding levels what is the percentage of women who
breast feed when leaving hospital and what are the rates over the first 6 months it goes down quite
quickly why is that?

More importantly in this tutorial we explored breast cancer and screening. What are the risk factors? In
particular what is the triple test, why do we do 3 tests, what are they and how well does the triple test
perform? It is well known that there is quite a bit of controversy surrounding breast cancer screening using
mammography what re the main issues being raised does it reduce mortality from breast cancer?
Examples of Exam Questions

The mother of a 15 year old patient rings the medical practice demanding to know if her daughter had
consulted a GP at the practice and the reasons why.
Outline the issues surrounding adolescent competence and informed consent. Under what
circumstances are adolescents (15-16 years) able to consent to their own medical care without the
knowledge of the parents/guardian?

Discuss the ethical dilemmas that are raised in relation to infertility and assisted reproduction
technology.

The term borderline of viability is used to describe extremely premature babies who are born at or before
25 weeks and 6 days. This has also been coined as a grey zone between 23 weeks and 25 weeks and 6
days gestation.
Discuss the ethical dilemmas that are raised in relation to these very small babies.

Discuss the two main reasons for common breastfeeding problems.

If a breast lump is found the next question is to determine the likelihood of cancer. This can be
assessed using the triple test. Outline the components that make up the triple test for the investigation
of breast cancer. Go on to outline the accuracy of the triple test and each of its components (accuracy
= sensitivity, specificity etc).
Discuss the current controversies in screening women for breast cancer using mammography. Is it
effective in preventing mortality?