1. Mrs Jones is 43 and presents to her GP with stomach pain. When describing the pain she points to her RUQ and says it “comes and goes”. aWhat other questions would you want to ask her about the pain? Max Mark 3

2. aWhat other questions would you want to ask her about the pain? Clinical Skills!! - SQITAS 1.Can you describe how the pain feels? E.g. stabbing, dull, achy etc. 2.If you had to rate the pain from 1-10 (10 being the worst pain imaginable) what would you give it? 3.How long have you had the pain? 4.Does anything make it better? 5.Does anything make it worse? 6.Have you noticed any other symptoms in relation to the pain Max Mark 3

3. bDue to your excellent history taking skills you have discovered that the pain is worse on eating fatty foods. The GP suspects gallstones. What are the risk factors for this? Max. Mark 3

4. Max. Mark 4 bDue to your excellent history taking skills you have discovered that the pain is worse on eating fatty foods. The GP suspects gallstones. What are the risk factors for this? GI: Most memorable are: Female Forty Fat Fertile Fair Max. Mark 3

5. cMrs Jones is overweight. What potential psychosocial factors have been suggested for people being overweight in low SES? Max. Mark 3

6. cMrs Jones is overweight. What potential psychosocial factors have been suggested for people being overweight in low SES? HiC: Affordability of food Availability of food Personal preference within the household Lack of motivation Lack of education – not a good one to pick Max. Mark 3

7. dWhich diagnostic technique for gallstones can also be used as a treatment? Name one risk associated with this. Max. Mark 2

8. dWhich diagnostic technique for gallstones can also be used as a treatment? Name one risk associated with this. GI: Endoscopic Retrograde Cholangiopancreatography (ERCP) Risk: acute pancreatitis Max. Mark 2

9. eAfter recurrent episodes of gallstones the doctors suggest removing her gall bladder. Calot’s triangle must be avoided during surgery. What are the boundaries and why is it avoided? Max. Mark 4

10. eAfter recurrent episodes of gallstones the doctors suggest removing her gall bladder. Calot’s triangle must be avoided during surgery. What are the boundaries and why is it avoided? GI: Contains the cystic artery Medially: common hepatic duct Inferiorly: Cystic duct Superiorly: Inferior edge of liver Max. Mark 4

11. fAfter surgery Mrs Jones is recommended to reduce her dietary intake of fat. What are the six essential nutrients? Max. Mark 5

12. fAfter surgery Mrs Jones is recommended to reduce her dietary intake of fat. What are the six essential nutrients? Molecules: Essential: Water Calories (fat and carbs) Essential amino acids Essential fatty acids Vitamins Minerals Max. Mark 5