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Alternate case 3

See wiki on blackboard

Accessible youth health care

Part i) What is accessible health care? Students should work in 3 groups to develop a list/ table with the following headings (divide these up between the groups)

Suggested cases

  • Definitions and data
    • Accessible health care: 1) Availability of services 2) Adequate standard of services 3) Services available despite financial, organisational, social and cultural factors 4) Acceptibility of services to population
  • Basic demographic factors.
    • 19% of ATSI are 15-19 year
    • 15.5% of Australians 15-24 were born overseas
    • 18% of the total population aged between 12-24
    • 68% young people live in major cities
    • 20% live in inner regional areas, 9% outer regional areas, 2% in remote and very remote
    • 20,000 young people are homeless
    • Gender - less males seek health care, especially mental health services
  • Factors relating to reasons for seeking health care that may affect accessibility
    • Sexual/psychosocial problems, embarrassment, confidentiality
    • Present with musculoskeletal etc when this doesn't align with the DALY statistics
  • Barriers to accessing health care
    • Trust and confidentiality
    • Geographical location
    • Services available in areas where the person lives
    • Desire to seek help for condition
    • Personal concerns, confidentiality and trust
    • Confidentiality
    • Difficulty in disclosing personal health concerns
    • Fears around what health providers might tell parents and teachers
    • Concerns about being seen when accessing a service
    • Young people often feel self-conscious, embarrassed, vulnerable or ashamed that they need help
    • Young people often believe they will be judged negatively by providers
    • Language
    • Ethnicity and cultural barriers
    • Age of person --> when can they take control of their health?
      • Nevertheless, some young people did state that if they knew a provider and had a trusting relationship with them they would be far more willing to access services
    • Lack of knowledge of the existence of services or what they provided
    • (Not as major) Structural issues concerning the operation of services, such as operating hours, inadequate transport, cost and waiting lists
  • Age transition issues for access
    • Young kids go to doctor with parents, and everything is transparent, but then when they're like 16, they may want a confidential appointment without their parents knowing
    • Need to promote independent attainment of Medicare card (atm, age requirement for medicare card is 15)

Design a culturally competent youth mental health service

  • As Amanda’s GP in rural NSW, you are concerned that few young people attend to discuss mental health issues. We are going to explore how, as a GP in Goulburn, rural NSW, you could make your practice more youth- friendly in order to attract teenagers such as Amanda.
  • What is culture?
    • the arts and other manifestations of human intellectual achievement regarded collectively
    • lifestyle, spirituality, ethnicity, morals and values
    • beliefs, ideas
    • people may belong to lots of cultures at once
  • What is cultural competence?
    • competence: the ability to do something successfully or efficiently
    • ability to respect and accommodate for others' cultural features
      • e.g. people in some part of the world are shy discussing sexual issues with the GP
  • Discuss the preparation reading (Section 2: Ch 7) on this as a large group. Confirm the definition and list the key factors needed in a culturally competent GP practice for younger people.
  • How would you design an accessible youth mental health general practice?
    • Discuss this within the three groups formed earlier and design an accessible youth mental health practice. Consider Amanda’s case to help focus your design.
    • Each group take one of the 3 elements below to consider, when you are designing your practice, on top of the question above:
  1. How would the needs of young men differ from the needs of young women?
  2. How might a young person being of a different culture affect these needs and issues?
  3. How might a rural practice have to be designed to cater for its local young people?
    • Reduce embarrassment, anxiety of adolescent
    • Workplace training- e.g. avoid involving parents if adolescent doesn't want it
  • Accessible
  • Affordable
  • Acceptable
  • Appropriate

These questions might help:

  • What do you think Amanda needs from a health care service? (Reflect back to the Plenary and SGS 11 and 12).
  • What would you expect, want or need from a health service for yourself (as or when you were a young person), or for your friends/siblings?
  • In particular, what would assist a young person managing a chronic illness such as depression?
  • How would this differ from what an older person might need?
  • How would the needs of young men differ from the needs of young women?
  • How might a young person being of a different culture affect these needs and issues?
  • How could a health service take into account all the elements of diversity discussed above?

Summary - Elements for a well-designed accessible health care service for teenagers

Notes from the Exam review quiz

GIT development, biochemistry and physiology

  1. Foregut lies mainly behind which organ?
    • The heart
  2. Into what structure does the midgut open?
    • Yolk sac via vitelline duct.
  3. Where does the hindgut end?
    • Cloacal membrane
  4. The paramesonephric duct differentiates to form which structure?
    • The uterus, oviduct, etc
  5. Bones contributing to the hard palate include:
    • The body of the sphenoid
    • The palatine process of the maxilla (correct answer)
    • Perpendicular plate of ethmoid
    • Vomer
    • None of above
  6. Infants should not be weaned onto cows milk until twelve months of age because:
    • It is too high in fat
    • Bacterial count of cows milk is too high
    • It contains too much protein, sodium and phosphate (correct answer)
    • Calcium content is too low
    • Insufficient energy in cows milk
  7. Which of the following statements is most correct:
    • The stomach is lined by stratified cuboidal epithelium (wrong; simple columnar)
    • The gastric glands contain only parietal cells (wrong; chief, parietal and mucous neck cells reside in the glands)
    • The muscularis externa contains 2 layers of skeletal muscle (wrong; 3 layers of smooth muscle)
    • Mucous neck cells form a secretory sheet of protective mucous (correct answer)
    • It has many chief (zymogenic) cells producing HCl (wrong; they secrete pepsinogen)
  8. What volume of gastric juice is produced per day?
    • 2L/day
  9. Name 3 enzymes that digest protein
    • Trypsin, chymotrypsin, pepsin, peptidases, elastase
  10. Name 3 different types of carbohydrates
    • Monosaccharides, oligosaccharides and polysaccharides
  11. What are the 3 important groups of lipids or fats?
    • Triglycerides, phospholipids and cholesterol esters
  12. What are possible mechanisms for controlling enzyme activity
    • Covalent modification, reversible binding, amount of enzyme present (via control of gene transcription)
  13. What hormone causes milk secretion?
    • Prolactin
  14. What hormone causes milk Ejection
    • Oxytocin
  15. Which is the zymogen that requires activation before it initiates degradation of proteins in the stomach?
    • Pepsinogen
  16. Does the growth spurt in puberty occur earlier in boys or girls?
    • Younger in girls
  17. What is the change in weight in the first year of life?
    • At one year of age, body weight is approximately trebled since birth
  18. What are 2 good sources of iron for babies?
    • Breast milk (the only food source and therefore is adequate for babies 4-6 months)
    • Iron fortified cereals
    • Formulas and haem-sources
  19. What is the Extrusion reflex?
    • Reflex pushing out of tongue when something is put in mouth (losing this is one sign heralding readiness for introducing semi-solids to diet)
  20. Do babies have a reduced ability to taste?
    • No, they have more taste buds (this is why bland foods are given)
  21. What growth parameters are routinely measured to assess whether a child id growing normally?
    • Length or height, head circumference and weight, plotted against age on the appropriate growth charts
    • Serial measurements are required for accurate picture of growth
    • Large deviations from an established percentile line or large differences in perentiles for height, weight and head circumference warrant investigation
  22. What is commonly considered the normal range for growth measurements plotted on growth charts?
    • 3-97% percentile (5-95% percentile is also commonly used)
  23. Which one of the following is most correct regardung infant nutrition?
    • Solid foods should be introduced one at a time commencing at 6 weeks of age
    • Infant formula is preferable to breast milk as it is more consistent in its composition
    • Infant formula is recommended instead of breast milk for infants attending day care
    • The concentration of protein in breast milk is lower than cow's milk (correct answer)
    • The main protein in human breast milk is casein
  24. Which one of the following skills would you expect a normally developing 3 year old to perform?
    • Speak in sentences of 5-6 syllables (correct answer)
    • Ride a 2 wheeler bicycle without training wheels
    • Tie shoelaces
    • Have a vocabulary of about 10 single words
    • Build a tower of 2 blocks only
  25. What are Piaget's stages
    • Sensorimotor
    • Pre-operational
    • Concrete operational
    • Formal operational
  26. Which statement is incorrect regarding Piaget's theory of cognitive development?
    • A one year old infant is likely to have difficulty with object permanence
    • Learning occurs through the process of assimilation and accommodation
    • During a dispute, children aged 4-6 can appreciate other's ideas (correct answer; during pre-operational stage around 2-7 years old they focus mainly on themselves and aren't able to properly consider other people's feelings. they become more sensitive to others when they move on to concrete operational stage)
    • The time a child spends in each of Piaget's stages of development varies from individual to individual
    • The sequence by which a child experiences each of Piaget's stages ocf development is the same across individuals
  27. Which of the following structure of the ear is derived from the endoderm?:
    • Tympanic cavity (correct answer)
    • External Auditory Meatus
    • Tympanic membrane (moore & persaud: primordium of tympanic membrane (TM) is the 1st pharyngeal membrane which forms external surface of TM. TM is derived from 3 sources: ectoderm of 1st pharyngeal groove + endoderm of tubotympanic recess [a derivative from the 1st pouch] + mesenchyme of 1st and 2nd arches. so TM = 1st membrane along with its intervening layer of mesenchyme)
  28. Which of the following statements about hearing development is most correct?:
    • The external ear is formed mainly from a series of hillocks on the maxillary and mandibular components of the first pharyngeal arch (wrong; external ear is derived from 6 surface auricular hillocks: three on pharyngeal arch 1 and the other three on arch 2.)
    • The otic sensory placode gives rise to the majority of inner ear structures (correct answer)
    • The middle ear bones form from the otocyst (wrong; otocyst AKA otic vesicle will form the inner ear; it is formed by invagination of otic placodes)
    • The tympanic membrane is formed from the second pharyngeal cleftectoderm
    • The cavity of the membranous labyrinth communicates directly with the Eustachian tube
  29. What are the types of Hearing loss?
    • Conductive, neurosensory and mixed
  30. What is Conductive hearing loss?
    • Hearing loss caused by blockage or other damage that interrupts the passage of sound through the middle or outer ear
  31. What is Sensorineural hearing loss?
    • Loss due to damage or malfunction of inner ear, cochlear (auditory) nerve or (rarely) the brain itself
  32. Why are children more prone to ear infections than adults?
    • More commonly affected by colds and blocked eustachian tubes (ET) because ET is smaller, more horizontal and so mucus build up is harder to drain. ET is also softer so it blocks more easily, kids are not good at blowing noses.
  33. Which of the following statements about acute otitis media is incorrect?
    • It is most frequently caused by Streptococcus pneumoniae
    • Antibiotics must be prescribed as this is a serious infection in children (correct answer)
    • Gram staining of fluid from the middle ear may show gram +ve cocci
    • Haemophilus influenzae may also cause otitis media
    • It is a common condition in children
  34. How is Rotavirus infection spread?
    • Fecal-oral
  35. With respect to the synthesis and secretion of thyroid hormones from the thyroid gland, which one of the following statements is incorrect?
    • Iodide is transported into the follicular cells by the sodium/iodide co-transporter
    • Thyroid-stimulating hormone (TSH) acts to increase the endocytosis of colloid by the follicular cells
    • The synthesis of thyroglobulin is inhibited by TSH (correct answer)
    • Thyroid peroxidase is responsible for the conjugation of adjacent iodinated tyrosyl residues in thyroglobulin
    • Iodide is oxidised to iodine by thyroid peroxidase
  36. In the practical class on thyroid gland physiology, data were provided forma a group of rats that had been treated with thyroxine for 4 days. Which of the following statements most accurately describes the outcome of this treatment? Compared with the control (untreated) group, thyroxine-treated rats had.
    • A larger average follicular cell height and smaller follicular diameter, due to inhibition of endocytosis
    • A larger average follicular diameter, due to an increase in iodide uptake
    • A smaller average follicular cell height and larger average follicular diameter, due to a decrease in TSH release (correct answer)
    • Increased synthesis of thyroglobulin, resulting in larger average follicular diameter
    • A larger average follicular cell height and a smaller average follicular cell diameter, due to inhibition of the enzyme thyroid peroxidase
  37. Cholesterol is considered important in cell maintainance and growth BECAUSE it is a critical component of cell membranes. True or false?
    • True (Both assertion and reason are correct and reason correctly explains assertion)
  38. Cranial end of paramesonephric duct opens into the:
    • Urogenital sinus
    • Vaginal canal
    • Allantois
    • Urethra
    • Peritoneal cavity (correct answer)
  39. Failure of the urethral folds to fuse during embryonic development would generate:
    • Epispadias
    • Extrophy of the bladder
    • Horseshoe kidney
    • Hypospadias (correct answer)
    • Multiple ureters
  40. Regarding the anatomical movement of the developing gonads:
    • In females, the ovaries undergo cranial and lateral shifts
    • In males, the testes move in 2 phases (correct answer)
    • In females, the ovary attaches to the uterine infundibulum
    • In males, the testes move by shortening of the gubernaculum (correct answer)
  41. Which one of the following statements is the most correct about the hypothalamic-pituitary-gonadal axis during development?
    • During childhood, the ovaries and testes are quiescent (correct? karen gibson's notes: yes. ganong: quiescent until they are activated by gonadotropins from pituitary to bring about final maturation of reproductive system)
    • The hypothalamus doesn't contain GnRH until puberty is reached (wrong; it still contains GnRH but GnRH release is prevented during childhood, therefore low levels of gonadotropins in prepuberty)
    • When GnRH secretion begins at puberty, it initially occurs during the day (wrong; pulsative release of GnRH first occurs at night during sleep; with maturation, occur throughout the day)
    • Removal of the ovaries in childhood causes LH and FSH to increase to high levels (wrong; karen gibson: removal of gonads doesn’t cause massive elevation of LH/FSH)
  42. What is thelarche?
    • Breast development
  43. What is menarche?
    • Onset of menstruation
  44. How are the actions of thyroid hormones generated in target cells?
    • By altering the expression of specific genes (eg. gluconeogenic and respiratory enzymes, myosin heavy chain, b-adrenergic receptors)
  45. During pregnancy, prolactin levels are very high but there is very little milk secretion. Why?
    • High levels of oestrogen and progesterone prevent milk secretion
  46. When is colostrum produced?
    • 1-5 days postpartum
  47. When do human male plasma testosterone levels peak?
    • By the end of puberty
  48. Name the hormones released from posterior pituitary.
    • Oxytocin and ADH
  49. Name 4 hormones released by the anterior pituitary.
    • TSH, LH, FSH, GH, prolactin, ACTH
  50. Which of the following statements is most correct? In the adenohypophysis (pars distalis):
    • There are only acidophils and basophils (wrong; chromophobes too)
    • Acidophils produce FSH and LH (wrong; GH and prolactin)
    • Basophils produces GH and prolactin (wrong; FSH, LH, MSH, TSH, ACTH)
    • Chromophobes are "stem cells" which can develop into chromophils (correct answer)
    • The arterial supply is only from the superior hypophyseal artery (adenohypophysis is not directly supplied by these arteries but receives its blood supply from a system of portal veins: after entering hypophyseal stalk, the 2 superior hypophysial arteries divide into capillary loops [primary plexus of hypophyseal portal system]. blood from the plexus drains into 1 or 2 portal vessels [hypophysial portal veins] which carry it to the adenohypophysis. there the vessels divide again to form a secondary capillary network [secondary plexus] surrounding glandular cells.)
  51. An infant born with type 1 congenital adrenal hyperplasia (CAH) which accounts for over 95% of diagnosed cases of CAH has:
    • 11 beta hydroxylase deficiency (cameron has this deficiency [Type2 CAH] which is less common than type 1)
    • 21 beta hydroxylase deficiency (correct answer)
    • 17 beta hydrosteroid deficiency
    • 17 alpha hydroxylase deficiency
    • Pregnenolone deficiency
  52. Name 3 symptoms of depression in adolescents.
    • Drug and alcohol abuse
    • Decreased/increased appetite and consumption of food (hypo/hyper-phagia)
    • Eating disorders
    • Insomnia/disturbed sleep
    • Hyposomnia (needing less sleep)
    • "Can't get out of bed" (hypersomnia)
    • Anhedonia (inability to experience pleasure)
    • Social withdrawal
    • Decreased motivation
    • Self-harm
    • Depressed mood
    • Fatigue
    • Irritability/anger
  53. Discussing relapse after a person has recovered from depression can lead to premature relapse. True or False?
    • False. Knowledge of early warning signs that herald a relapse can help a person take corrective action.
  54. Suicide attempts are attention seeking behavious that should be ignored as paying attention to an attempt is likely to reinforce the behaviour. True or False?
    • False. Any suicidal thoughts or attempts warrant careful evaluation of the individuals situation as well as their mental state to determine need for treatment and degree of risk of further attempts.
  55. What are the DSM-IV and ICD-10 Guidelines used for?
    • Diagnosis of psychiatric disorders. Both of these are classification systems that are used in mental health care.
    • DSM-IV is the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association.
    • ICD-10 is the 10th revision of the International Classification of Diseases produced by the WHO. Chapter V is on 'mental and behavioural disorders.'
  56. Depression is a homogeneous disorder. True or False?
    • False. Depressive illness comes in a number of different subtypes i.e. it is heterogeneous