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PAS GLS week 1 answers...

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Week 1 Guided Learning Session PAS This exercise involves the use of the RACGP Red Book “Guidelines for preventive activities in General Practice” as a reference. You are on a General Practice placement and your GP supervisor asks you to see the following patients and decide on appropriate preventive interventions.

Case 1: Nora Jones Nora Jones is a 23 year old woman who currently takes the Pill, smokes 15 cigarettes per day and has 4 glasses of wine 3 times a week. She requests a checkup because she wants to conceive in the next year. Nora hasn’t been for a full check-up for over two years. She is very anxious about having an abnormal baby as her sister has a child with spina bifida. Nora also tells you that her mother had breast cancer in her 50s. She is not aware of any other cancers in her family. Questions: 1: Identify the recommended preventive actions using the preventive activities over the lifecycle chart- adults. See chart- Need to know 2: What is the main reason for Nora’s visit today and what care should you provide? Preventive activities before pregnancy; Should include- reproductive plans (number, spacing and timing of children), reproductive history; medical history; medication use; substance use; genetic and family history; physical examination (including pap test and breast examination if indicated and due; BMI; BP) 3: What do you advise about her alcohol & cigarette consumption? Should avoid consuming Alcohol & Tobacco – both harmful to foetus 4: What advice would you give Nora regarding her concerns about spina bifida? Take folate supplements from at least 1 month before pregnancy and continue for the first trimester: Average risk = 0.5mg/d; High Risk = 5mg/d (PHx/FHx neural tube defect, diabetes, anticonvulsant medication.) Nora is high risk due to her family history. 5: What infections should she avoid and why? TORCH infections; Listeriosis; Why- increase risk of miscarriage and birth defects 6: What do you advise her about maintaining a healthy environment? Frequent handwashing; avoid eating raw/undercooked meat, unpasteuised milk products, pate, soft cheeses, pre-packaged salads, deli meats, chilled/smoked seafood; fish containing high levels of mercury; wash all fruit and vegetables before eating; avoid cat litter and garden soil 7: Nora requests a test for breast cancer. What is your response? P65: Nora has one first degree relative (mother) who has been diagnosed with breast cancer at 50 years or older so she is at average risk. She should be advised to be aware of how her breasts normally look and feel and promptly report any new or unusual changes to her GP. Unusual changes include lump, nipple changes, nipple discharge, and change in skin colour or pain in the breast. She should have a mammogram every 2 years from 50-69yrs

Case 2: Arthur Doyle Arthur Doyle is 55 years old & presents for a medical examination for life insurance. He appears slightly overweight, but otherwise healthy. On further enquiry he is a smoker (1pkt/d), drinks 3-4 standard drinks most days, takes no medication and has a family history of prostate cancer (father died at age 60 years). Questions: 1: Identify the recommended preventive actions using the preventive activities over the lifecycle chart- adults.

2: What are the general areas of concern regarding Arthur’s health? Prevention of chronic disease; prevention of vascular disease; cancer screening 3: Is briefly encouraging him to stop smoking worthwhile or is it a waste of time? Support your answer with the level and strength of evidence. Yes, offering smoking cessation advice is effective. (II,A)

4: You measure Arthurs’ BMI as 29 and his waist circumference as 100cm. What would you advise Arthur to aim for in order to reduce his risk to “average”? How would you assist him to achieve this? Waist circumference for males should be...