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Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #1: Biomedicine as a cultural system
1. Biomedicine can be regarded as a cultural system BECAUSE
A. It is only used by specific cultural groups in Western society
B. Its scientific knowledge base is based on hypotheticodeductive reasoning, and is
capable of being disproven
C. It incorporates a set of transmissible knowledges that frame the worldview of
believers
D. It is used more frequently in Western society than ayurvedic medicine
E. Many biomedical practitioners incorporate in their practices activities which are
not evidence-based.
2. Crazy Little Thing Called Love. Are Ben Lee and Paul Coelho diseased?
Ben Lee’s song Catch My Disease (2008 – those of you who don’t remember it can look
it up on YouTube) is about his own feeling of overwhelming goodwill.
In one of his 29 books Paul Coelho writes “Love is a disease no one wants to get rid of.
Those who catch it never try to get better, and those who suffer do not wish to be cured."
(The Zahir, 2005)
Using the definition of disease and illness that we use in this lecture, does either of these
gentlemen really have a disease? Does either of them have an illness? Why or why not?
[NB: This question does not ask you to express your opinion on the music of Ben Lee or
the writing of Paul Coelho]
3. What are the foundational disciplines of biomedicine and why?
4. “The doctor said I must have had breast cancer for two years, but I just kept on with
my career because I felt fine” [Kylie Minogue]. Assume that in the two years before
diagnosis, Kylie had been in France for one month, and then travelled to the US which
had a higher incidence of breast cancer for six months. She then lived in the UK for
seventeen months. Assume also she has carried the gene which predisposed her to breast
cancer since her birth in Australia. In what country did she become ill?
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #2: Hidden values in biomedicine
(More than one answer may be correct)
1. Cogito ergo sum (“I think therefore I am”) means:
A. When we use our powers of reason, we can understand others better
B. Our ability to reason enables us to recognise that there are dual perspectives on
everything
C. Our ability for rational thought sets us apart from animals
D. Our ability to think rationally limits our ability to see things as they truly are
E. Our ability to reason is the basis of our selfhood.
2. The implications of the Cartesian cogito for medicine are that
A. The emotions are not integral elements determining who we are
B. What people say they feel is as trustworthy and valid as what the doctor can
deduce from examination and interrogation
C. Brain-dead people are not fully human
D. The mind and the brain are similar concepts
E. Bodily experience (of the patient) is secondary to cognitive understanding (by the
doctor or the patient)
3. Psychosomatic medicine was an attempt to integrate the experience of the body into
the how illnesses and physical disabilities are caused and/or maintained by psychological
dynamics. It was intended to recognize the integration of the patient’s experience of
illness into the ways in which the illness or disease became expressed.
This category of illness failed in its quest to find equal space within medicine for the
lived experience and organic dysfunction because:
A. Patients saw themselves as not having a valid illness if they were told it had a
non-organic component
B. Doctors did not see that their role extended to managing illnesses that may not
have an organic component
C. Attempts to manage psychosomatic illness continue to use attempts to impose
rational thought upon the experience of the body, thus reasserting the primacy of
rationality over suffering.
D. Alternative therapists have taken over dealing with psychosomatic illnesses.
E. Psychosomatic explanations for illness behaviour are outdated with advances in
neurobiology.
4. Who said what?
I suppose the body to be just a statue or a machine made of earth.
[On humans] "Oh, there's a brain all right. It's just that the brain is made out of meat! …Yes,
thinking meat! Conscious meat! Loving meat. Dreaming meat. The meat is the whole deal!"
Test Yourself – QUESTIONS
SFM
Christine Phillips
We exist as material beings in a material world, all of whose phenomena are the
consequences of material relations among material entities.
One of these is by Descartes, one is Richard Lewontin, the evolutionary biologist, and
one is an alien describing humans1.
The first is a Cartesian perspective (note how the “I” who supposes is separate from the
body). The second and the third are materialist perspectives.
What is the relevance of materialism in medicine? When (if ever) might a dualist
perspective be useful?
Spend five minutes reading Terry Bisson’s classic short story “They’re made of meat” here
http://www.terrybisson.com/page6/page6.html
1
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #3: Biomedical nosologies in social and cultural context
(More than one answer may be correct)
1. A nosology is a branch of medical science dealing with:
A. The distribution of diseases
B. The classification of diseases
C. The nature and effects of diseases
D. The phenomena that contradict physical laws
E. The treatment of disease
2. Which of the following is a nosology?
A. SLUDGE – Salivation, Lacrimation, Urination, Defecation, Gastrointestinal
Upset, Emesis
B. The lymphatic system
C. WHO Classification of Myeloid Neoplasms
D. The Pharmaceutical Benefits Scheme Schedule
E. Adult Disability Assessment Tool in the Social Security Act 1991
3. Whether or not alcoholism should be classified as a disease was the subject of a great
deal of conjecture in the early twentieth century. McGoldrick (1954) makes the “no”
case: Alcoholism is no more a disease than thieving or lynching. Like these, it is the
product of a distortion in outlook, a way of life bred of ignorance and frustration.” A
century and a half earlier, Trotter made the “yes” case: “In medical language, I consider
drunkenness, strictly speaking, to be a disease, produced by a remote cause in giving
birth to actions and movements in a living body that disorder the functions of health.”2
(a) On what grounds would alcoholism be considered a disease? If so, how should it
be classified?
(b) The Women’s Temperance Union (an organisation that advocated prohibition) was
very active in promoting the view that alcoholism was a disease. Why do you think
this group would take this view?
4. When AIDS was first recognised in the 1980s a dispute broke out about whether this
should be classified primarily as a haematological, immunological or infectious (or
tropical) disease.
(a) Complete the following table by filling in the discipline under which you would
classify AIDS depending on what you used as your classificatory criteria
2
Quotes lifted from The Natural History of Alcoholism Revisited, by G. E. Valliant (Harvard University
Press, 1995) which is a terrific overview.
Test Yourself – QUESTIONS
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CLASSIFICATION BY
Christine Phillips
DISCIPLINE(S)
CLASSIFIED UNDER (eg
gastroenterology,
respiratory medicine)
Aetiology
Symptoms
Clinical distribution of
cases1
Disease mechanisms
1
In the early 1980s, AIDS was said to affect Haitians, heroin addicts, homosexuals and
haemophiliacs. This posed a tricky problem as it could not be classified as a geographic disease
(cf “Asian flu”, or “Lassa fever”). WHO is now quite careful about geographic classifications –
note how SARS (Sudden Acute Respiratory Syndrome was given a name that did not indicate
country of origin, in order not to stigmatise China)
(b) Why did it matter to the medical profession how AIDS was classified?
(c) The first Chairperson of the AIDS Taskforce in Australia in the 1980s was
Professor David Penington. He became the public face of Australia’s pragmatic and
successful campaign to control the spread of HIV-related infection. Apart from his
intrinsic qualities, why was a specialist from this background chosen to be the public
face of the AIDS response?
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #4: Embodiment of sickness and distress
(More than one answer may be correct)
1. Embodiment refers to:
A. The bodily aspects of human subjectivity
B. The political control of bodies through exercising control over citizens’ liberty
C. The arrangement of anatomical organs within the body
D. The physiological function of organs within the body
E. The ability to enter into others’ subjectivity
2. It’s Happy Hour in heaven. Merleau-Ponty and Descartes meet to share a bottle of
Merlot3. Who says what?
“I particularly enjoy this wine because of its provenance; the grape comes from the
vineyards of Orange and the production process was especially fine.”
Nothing. He is too busy feeling the taste sensations from different parts of his palate.
3. Bodily expressions of illness draw on cultural repertoires of distress and the social and
political contexts that shape them. The following are generally considered to be culturebound illnesses (ie they only occur in some cultures). Match the illnesses to the social or
cultural context.
Susto4
Koro5
Running amok6
Going postal
Bulimia
Political and entertainment culture that
popularises violence
Strongly networked society with social
expectation of outbursts
Cultural equation of thinness with beauty
Female-subordinate culture in which
religious healing is commonly practised
Cultural preoccupation with male sexual
performance
Is it correct to term these conditions culture-bound syndromes? Why or why not?
3
Thanks to Tim Lovell (ANUMS Yr 2011) for suggesting this problem as a memory aid
Susto = an illness attributed to a frightening event that causes the soul to leave the body, leading to
symptoms of unhappiness and sickness (Latin America)
5
Koro = period of intense anxiety associated with belief that penis is retreating into body and will cause
death (Malay word, found in many regions of SE Asia) – occasionally occurs in epidemics of panic, eg in
Singapore in 1967
6
Running amok = a dissociative episode characterized by a period of brooding followed by an outburst of
violent, aggressive, or homicidal behavior directed at people and objects. The episode tends to be
precipitated by a perceived insult or slight and seems to be prevalent only among males.(Malay)
4
Test Yourself – QUESTIONS
SFM
Christine Phillips
4. “At home, no one can hear you scream.” Post-natal depression has been described as a
Western culture-bound syndrome. If so, what cultural repertoires of distress does it draw
on, and how does post-natal depression reflect its social and political and context?
5. Pediatric plumbism is endemic in some indigenous communities, but is rare in nonindigenous communities. Although plumbism is not an idiom of distress (rather, an oldfashioned term for an overload condition), the behaviour that led to it has arisen in a
particular social, cultural and political context. Identifying these contextual layers is
important for a nuanced public health approach to this youth epidemic.
(a) What is plumbism?7
(b) How do the subjective feelings of someone with plumbism reflect their social,
political and/or cultural context?
(c) If you were a public health professional, where would you invest your intervention
dollars to have maximal impact?
7
Google it if you don’t know.
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #5: The therapeutic process
1. Match the type of doctor-patient relationship to the presenting clinical condition. Give
your reasons for choosing the one that you chose (NB: more than one type of relationship
may be appropriate for each case – just explain your reasons for this case).
(a) A patient, aged 72, comes to you with a problem of escalating anxiety. He has pages
of Internet print-outs on different drugs and wants to discuss with you in detail the
right medication. When he was in Serbia he was given a really excellent medication
and he would like to have this prescribed here. It sounds like a high dose valium
equivalent. His English isn’t very good.
(b) A 15 year old girl presents to request going on the pill. Her girlfriends have been
talking about it and she wants the one that will stop her having acne. Her acne is
mild. She isn’t sexually active.
(c) A 37 year old woman presents for a health screen at the behest of her work. The
only thing of note is that she is very obese (BMI 39). She says that she tries to “be
good”, but she is always hungry and can’t stop herself.
(d) A 28 year old forklift driver is brought in by his workmate after he had a funny turn
at work. He can’t remember what happened, but is now feeling well if a little tired,
and is keen to get back to work. His workmate’s description of the funny turn is that
he suddenly slumped over his desk and both his arms and legs began to twitch
uncontrollably. This occurred shortly after a phone call from his mother.
2. What is the practitioner-patient relationship which tends to be used by alternative
practitioners?
A. Consumerist
B. Parentalist
C. Partnership
D. Interpretivist
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #6: Suffering and social inequality 1
1.The epidemiologic triad consists of host, agent and environment. Categorise the
elements in the second column according to the component of the epidemiologic triad
that they represent
Host
Agent
Environment
Hospital cooling towers
Legionella pneumonia
SARS
The Hulk
Mycelia family
Asthmatic children
2. The Malthusian argument is
A. that population increases arithmetically while the capacity to support it increases
geometrically
B. that infectious disease should die out with improvements in health technology
C. that ageing humans exceed the capacity of health systems to look after them
D. that reductions in fertility are associated with increases in lifespan
E. that plagues and pestilences are nature’s way of rebalancing population growth
3. McKeown’s hypothesis is
A. that decreases in infant mortality are attributable to changes in the incidence of
infectious disease
B. that improvements in nutrition have led to reductions in the incidence of infections
C. that population increases arithmetically with the increase in the carrying capacity of
the land
D. that decreases in fertility are associated with a population shift from high rates of high
infection to one of high rates of chronic disease
E. an underestimation of the impact of medical technology on reductions in the incidence
of infections
4. “Flesh-eating bacteria savages young girl in hospital”: Daily Telegraph headline. The
following are all explanations for this phenomenon. Complete the table listing the
element of the epidemiologic triad invoked and the type of health response that would be
prioritised for each explanation (example in the first row).
Test Yourself – QUESTIONS
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Explanation
The young girl was
undernourished, and
therefore prone to serious
infection
The bacteria is unusually
virulent and can attack
anyone
Hospital has poor capacity
to control the spread of this
bacteria
The bacteria has been
allowed to become resistant
to multiple antibiotics
because of high rates of
antibiotic use in the
community
Christine Phillips
Which element of the
epidemiologic triad (host,
agent, environment) is
invoked in this
explanation?
Host
What is the health system
response triggered by this
explanation?
Review reasons the girl was
undernourished and
promote better intake
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #7: Suffering and social inequality 2: AIDS and other catastrophes
(More than one answer may be correct)
1. In 2005, Goulburn had been in a severe drought for three years and its dams were at
8% capacity. From the perspective of Amartya Sen, why did the citizens of Goulburn not
suffer famine? List four reasons.
2. In an evolving pandemic, there is often a process of locating the cause of infection
elsewhere. Name the virus that caused the following illnesses, and who or what was
being stigmatised as either originating the infection or being the major risk group.
Name for illness
Virus/Bacteria
Who is being stigmatised
and why?
The English disease
Spanish flu
Yellow fever
Gay related immune
deficiency syndrome
The French disease
[STUDENTS: these details are for understanding only and are not examinable]
3. The HIV pandemic is the central pandemic of the modern era. Australia is often held
up as an example of a country which responded rapidly and effectively to the pandemic.
In broad terms, outline the elements of this successful strategy.
4. In 1996 there was a syphilis outbreak among among the schoolchildren of Rockdale
County in Georgia in the USA. This generated a great deal of concern and publicity in
the US, as they were in their early teens, and had wealthy parents. There was a well
known documentary on this presenting the outbreak as essentially due to parental neglect,
and boredom in a particularly boring part of Georgia. Other explanations may have been:
A.Particularly virulent syphilis infection spread through non-sexual means
B. Reduced capacity among girls to advocate for themselves in sexual situations
C. Rockdale county had a strong Christian community that advocated abstinence
D. Rockdale county public health services failed to perform adequate contact tracing in
the early days of the outbreak.
E. Rockdale county had few youth-friendly health services
F. Penicillin injections (standard treatment for syphilis) are very painful.
G. Some of the children had a genetic predisposition to being super-spreaders of syphilis.
For each of the above, label the reason as host/agent/environment. If you’re unsure, have
a guess and give a rationale. Where would you, as a public health physician, throw your
Test Yourself – QUESTIONS
SFM
Christine Phillips
energies to reduce the syphilis epidemic? Or would you decide just to wait it out, and if
so why?
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #8: The Placebo Effect
(More than one answer may be correct)
1. You have timetravelled to Medieval England. Timetravelling always gives you a
headache, but fortunately you are taken to the village healer, Mad Meg, who treats you
with a concoction of tree bark and bugs. You have never had this treatment and Mad
Meg strikes you as very odd. An hour later you do notice that your headache has
improved quite a bit. List possible explanations for the improvement.
2. Improvements in motor performance in patients with Parkinson’s after sham
implanation of dopaminergic neurones into the brain represent
A. A placebo effect, in that the patient expected to get better and did
B. A placebo effect, in that the patient had been conditioned by their own dopaminergic
neurons
C. A nocebo effect, in that the patient was likely to be disappointed that he had not had
the correct surgery
D. A nocebo effect, in that patients who did have real implantation of dopaminergic
neurones were more likely to be contaminated with prions
E. An opportunity to sue the hospital for failing to provide real medical treatment.
3. “Prayer works in mysterious ways”. From a medical perspective, what are these
mysterious ways?
4. A 36 year old woman discovers she has breast cancer. She has a biopsy and oestrogen
receptors and has a poorly-differentiated tumour, which has a poor outcome. She begins
treatment with radiotherapy and oestrogen-blockers. She is offered genetic testing for
herself, her sisters and her daughters to see if they carry the BRCA-1 gene, making them
more susceptible to breast cancer. List the occasions in this clinical history where a
nocebo effect may occur, explaining your answer.
Test Yourself – QUESTIONS
SFM
Christine Phillips
LECTURE #9: The location of death
(More than one answer may be correct)
1. With regard to the location of death in modern medicine, which of the following is
true?
A. We define death as the cessation of the heartbeat
B. Accounts of out-of-body experiences before death support the argument that the soul
may lie in the brain.
C. Bodies that do not putrefy are technically not considered dead.
D. The Cartesian cogito supports the notion of death being defined through cessation of
brain function.
E. Life support technologies reinforce the notion that death is located in the brain.
2. At the end of the Edgar Allen Poe’s The Fall of the House of Usher, the last surviving
member of the family, Roderick, reminisces Gothically about his dead sister Madeleine:
“We have put her living in the tomb! Said I not that my senses were acute? I now tell you
that I heard her first feeble movements in the hollow coffin.”
Had Roderick been more prudent, what could he have done to ensure that Madeleine
wasn’t buried alive?
3. Japan, in contrast to most nations with developed medical systems, took many decades
to embrace transplant surgery. List four reasons for this.
4. Define the elements of a good death for you. Do they reflect your own personal
experience, or do they draw on cultural notions of the good death? How does
biomedicine define the good death, and are there differences within biomedicine about
what constitutes a good death?
Test Yourself – QUESTIONS
SFM
Christine Phillips
CLINICAL SKILLS SESSION #1: Multicultural Health
(More than one answer may be correct)
1. Which of the following is/are correct in relation to the explanatory model of illness?
A. Explanatory models of illness are of particular use for people from immigrant
backgrounds
B. The elements of the explanatory model incorporate questions about the nature of
illness and the person’s interpretation of them
C. The evidence-based perspective that asthma should be treated with relievers (β2
agonists) and preventers (eg steroids) is an explanatory model of illness
D. The belief that epilepsy may result from a curse is an explanatory model of illness
E. To explore an explanatory model of illness it is best to know something of the
culture of the person expressing the belief.
2. In relation to Australia’s migrant population, which of the following is/are correct?
A. Australia has the world’s second highest per-capita population of Holocaust
survivors outside Israel.
B. Australia and the US are the OECD’s most diverse multicultural societies.
C. One in three Australians was born overseas or has a parent born overseas.
D. The largest influx of migrants into Australia occurred after the Vietnam war with
asylum-seekers arriving by sea.
E. People born in New Zealand currently constitute the highest population of
residents born overseas in Australia
3. When are the times in health care or life events, when it might be particularly
important to consider a patient’s particular explanatory model?
4. What is gratuitous concurrence?
A. The cultural process of agreeing to a yes/no question even when the true answer
would be no.
B. A politeness convention observed in some cultures
C. The cultural process of needing to have agreement from more than one person
when making a decision of consequence
D. A cultural strategy for reaching a community-based consensus
E. A gratitude convention whereby more than one person thanks the healthcare
provider at once.
5.
5. You suspect that gratuitous concurrence is a factor in the responses by the patient to
the clinical consultation. What strategies might you use?
Test Yourself – QUESTIONS
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Christine Phillips
CLINICAL SKILLS SESSION #2: Social Disadvantage
(More than one answer may be correct)
1. Define:
A. Absolute poverty
B. Relative poverty
C. Transitional poverty
D. Elective poverty
E. Intergenerational poverty
2. Which of the above have/has the largest impact(s) in relation to health care?
3. Which of the following would be considered an attribute of someone with poor health
literacy?
A. Inability to calculate a half dose (eg can’t work out that half a tablet = number of
milligrams of a dose)
B. Inability to describe the chambers of the heart.
C. Inability to read at a Grade 6 level.
D. Inability to understand the difference between different cadres of health
professionals (eg nurses and nurse practitioners)
E. Inability to describe how and why one should take prescribed medication.
4. Explain the elements that you would explore when taking a social disadvantage
snapshot and why they are relevant to health care delivery.