STUDENT NAME: _______________________________________ STUDENT NUMBER: ____________________________________

THE UNIVERSITY OF QUEENSLAND

MBBS2000

FINAL SUMMATIVE ASSESSMENT, 27 November 2002

PAPER 3 - PART E

Total number of marks = 42.5

You should spend about 40 minutes on Part E

YOU MUST WRITE IN INK. DO NOT WRITE IN PENCIL. YOU MUST PRINT YOUR FULL NAME AND STUDENT NUMBER ON THE FRONT PAGE OF EACH PART OF THE EXAMINATION. ALL questions to be answered. Answers should be confined to the spaces provided. The marks allocated to each question are shown on the examination paper.

Page 1

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PART E Diabetes mellitus is a significant public health concern and it substantially increases the risk of cardiovascular disease. Question 1. (4 marks) List four (4) interventions for which there is evidence of benefit in reducing the risk of cardiovascular disease in people with diabetes. (4 marks)

Q1 Examiner’s use only

Part E (cont) Page 2

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Question 2. (9 marks) Microalbuminuria is a marker of significant renal damage. You recently read an article about a diagnostic study that was conducted to assess the accuracy of a new dipstick test for microalbuminuria (Gilbert et al, 1997).

(a) Fill in the 2 x 2 table below using the data from the study. (2 marks)

RIA +ve RIA -ve Dipstick test + ve

Dipstick test - ve (b) From (a) calculate the sensitivity and specificity of the dipstick test (2 marks) (c) What is the positive and negative predictive value in this group of patients? (2 marks)

In 411 consecutive patients the new test was compared with radioimmunoassay (RIA). Eighty-two patients had a positive test for microalbuminuria by the dipstick test and 57 were confirmed positive by RIA. Of the 61 patients with confirmed microalbuminuria by RIA, 57 had a positive dipstick test. Three hundred and twenty five patients had a negative dipstick test which was confirmed negative by RIA.

Part E (cont) Page 3

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(d) Why is the post-test probability for a positive test lower than both the sensitivity and specificity? (2 marks) (e) How useful do you think this test would be in a clinical practice setting? (1 mark)

Q2(a), (b), (c), (d) &* (e) Examiner’s use only Question 3. (6 marks) You are discussing the use of HRT (hormone replacement therapy) with one of your peri-menopausal patients, Anne. She tells you that her friends have told her about the benefits of Yam Cream for perimenopausal and menopausal symptoms. She asks you for your general advice about the use of complementary medicine treatments for the menopause. Outline the issues you would consider in your response to Anne. (6 marks)

Q3 Examiner’s use only

Part E (cont) Page 4

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Question 4. (6 marks) Your local community centre is developing a guide for health practitioners who provide care for those with terminal illness. The guide aims to help health practitioners better meet the psychosocial needs of clients with terminal illness and their families. You are one of a number of local doctors who have been asked to contribute to the guide. List and discuss three (3) recommendations you would want to see included in the guide. (6 marks)

Q4 Examiner’s use only

Part E (cont) Page 5

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Question 5. (5 marks) You are the doctor in the Brisbane Northside Public Health Unit. You are analysing the notifiable disease reports for January and you note that the number of positive Ross River serology tests has increased. (a) Define the terms incidence and prevalence. (3 marks) (b) Which immunoglobulins would you measure to determine whether it is an incident or prevalent case and why? (2 marks)

Q5(a) & (b) Examiner’s use only

Part E (cont) Page 6

Question 6. (12.5 marks) Compare and contrast the salient features of Ross River Fever, Dengue and Malaria. Use the following table to answer this question.

Ross River Fever Dengue Malaria What is the causative organism for the infection? (1.5 marks)

Which answer best describes the usual annual incidence of infection in Queensland? (a) <100 (b) 100 – 500 (c) 1000 –5000 (1.5 marks)

Are the majority of cases in Queensland due to local transmission? (1.5 marks)

Can secondary transmission of the infection occur in Far North Queensland? (Yes/No) (1.5 marks)

Is the infection notifiable under Public Health Legislation? (Yes/No) (1.5 marks)

List 3 classical symptoms on presentation. (3 marks)

In addition to vector control, what preventive measures are used to stop the spread of the infection? (2 marks)

Q6 Examiner’s use only

END OF PART E