1. ESA Style Question

2. Mr Godfrey, a 41 year old male presents to his GP with colicky right upper quadrant pain for two weeks. On examination, Mr Godfrey displayed a positive Murphy’s Sign i)What does a positive Murphy’s sign indicate ii)How is Murphy’s sign performed. 4 Max. Mark

3. i)Cholecystitis (1) i)The examiner asks the patient to exhale and places their hand below the right costal margin (1). The patient is then instructed to inhale (1). In a positive Murphy’s sign the patient will stop mid-inhalation due to pain caused by the inflamed gallbladder coming into contact with the examiners hand(1). Max. Mark Mr Godfrey, a 41 year old male presents to his GP with colicky right upper quadrant pain for two weeks. On examination, Mr Godfrey displayed a positive Murphy’s Sign i)What does a positive Murphy’s sign indicate ii)How is Murphy’s sign performed. 4

4. Max. Mark What is the most common cause of cholecystitis? 1

5. Gallbladder stones Max. Mark What is the most common cause of cholecystitis? 1

6. Max. Mark On examination the GP notices scratch marks on the patients arms. Mr Godfrey said he has been feeling particularly itchy over the past few days. Considering the presenting complaint, what is the most likely cause of Mr Godfreys itching? 2

7. Gallstones blocking the common hepatic duct or common bile duct cause post-hepatic jaundice (1). This results in excess bilirubin the blood stream. Bile acids are deposited in the skin resulting in itching (1). Max. Mark On examination the GP notices scratch marks on the patients arms. Mr Godfrey said he has been feeling particularly itchy over the past few days. Considering the presenting complaint, what is the most likely cause of Mr Godfreys itching? 2

9. Mr Godfrey reveals he has been feeling nauseas for the past 24 four hours and has not eaten in over 12 hours. What are the three states that can be achieved in metabolism. For each, define the time period in which that state occurs following ingestion of food. Max. Mark 3

10. Fed state – 0-4 hours after eating Fasted state – 4-12 hours after eating Starved state - 12 hours after eating (1/2 mark each) Max. Mark Mr Godfrey reveals he has been feeling nauseas for the past 24 four hours and has not eaten in over 12 hours. What are the three states that can be achieved in metabolism. For each, define the time period in which that state occurs following ingestion of food. 3

11. Max. Mark 4 Mr Godfrey rarely visits the GP, however, Mrs Godfrey visits regularly to have a general check up. List four reasons for male-related health behaviour

12. Max. Mark 4 Men perceive health as primarily the responsibility of women Men perceive themselves to be less vulnerable or susceptible to illness Men tend to normalize their symptoms and fear wasting the doctor’s time Men are less likely to accept emotional pain as valid Mr Godfrey rarely visits the GP, however, MRs Godfrey visits regularly to have a general check up. List four reasons for male-related health behaviour

13. i)Define gender ii)Define sex 2 Max. Mark

14. 2 Max. Mark i)Gender is the social and cultural meaning assigned to being male or female i)Sex is the biologically determined characteristics between males and females i)Define gender ii)Define sex

15. Ultrasound shows a gallstone blocking the common bile duct. The GP decides to refer Mr Godfrey to a surgeon for ERCP and laparoscopic cholecystectomy to unblock the common bile duct and reduce the risk of further stones. On the day of surgery, Mr Godfrey decides that after speaking to a friend he doesn’t want to have surgery as he is worried about ‘dying on the table’. i)Define the term lay beliefs ii)List three sources of lay beliefs 4 Max. Mark

16. Max. Mark i)Lay beliefs are a persons ‘common-sense’ understanding and knowledge about health and illness. i)Medical or scientific knowledge Personal knowledge and experience Media Folk knowledge Spiritual beliefs Ultrasound shows a gallstone blocking the common bile duct. The GP decides to refer Mr Godfrey to a surgeon for ERCP and laparoscopic cholecystectomy to unblock the common bile duct and reduce the risk of further stones. On the day of surgery, Mr Godfrey decides that after speaking to a friend he doesn’t want to have surgery as he is worried about ‘dying on the table’. i)Define the term lay beliefs ii)List three sources of lay beliefs 4