Family Influences on Health and Disease

Chapter 1 Family Influences on Health and Disease




Clinical Case Problem 1: A Calculated Risk


A 40-year-old African American man comes to your office for the first time requesting a health maintenance visit. He is married and the father of two young children. He works as an accountant. His firm has just offered a new health insurance plan, which pays for a health maintenance examination. He is concerned about his risk for diabetes.



Select the best answer to the following questions




1. Regarding his risk, you would ask him about which of the following?


a. diet history

b. exercise type and frequency

c. smoking history

d. family history

e. alcohol intake

f. all of the above

g. none of the above

2. You discover that his mother and two aunts developed diabetes in their 40s. His mother is still alive at 65 and uses insulin daily. One aunt died in her 50s and the other at the age of 75 years of a stroke. Which of the following is true about family and risk?


a. family is one of the major influences on disease incidence and prevalence

b. family risk is not modifiable

c. family risk need not be ascertained because there is nothing you can do about it

d. family disease susceptibility is absolutely transmittable

e. family risk is not ascertainable by current methods of genetic screening


Clinical Case Problem 2: All in the Family


Two 75-year-old patients are hospitalized after both had a stroke resulting in a left-sided hemiparesis. The size and location of the thrombotic events in these patients are almost identical, as is the initial degree of impairment. Treatment received is also the same. One patient lives alone and has a sibling living in a distant state. The other patient is part of an extended family with many social supports, including grandchildren who visit her often while she is in the hospital.



3. What outcomes would you predict for these patients on the basis of their family social circumstances?


a. identical outcomes are likely given the identical lesions and initial impairments

b. it is impossible to predict outcomes

c. the patient with more family supports is likely to have a better outcome

d. the patient with fewer family supports is at lesser risk of acute mortality

e. outcomes achieved are independent of any family social factors


Clinical Case Problem 3: Risks of Omission and Commission


A 28-year-old woman presents to your office for the first time for prenatal care. She is 14 weeks into her first pregnancy. She is HIV positive but stopped antiretroviral agents because she had heard that taking medication during pregnancy could harm the baby. She has a half-pack per day smoking habit that she has been unable to stop despite many attempts at quitting. She drinks at least a glass of wine with dinner each night. She works in sales at a local food bar. She asks you what she can do to give her child a better chance in life than she had.



4. At this time, it is most appropriate to advise her of which of the following?


a. perinatal transmission of the HIV virus poses the child’s greatest risk

b. smoking is by far the most hazardous factor in her prenatal history

c. alcohol consumption during pregnancy is a major risk factor for fetal alcohol syndrome

d. she must restart antiretroviral medications immediately or risk certain death

e. none of the above


Clinical Case Problem 4: Unwanted Advice


A 25-year-old mother presents for the first time with her 2-week-old infant, her first child. Hovering in the background are the two grandmothers. The mother is visibly concerned that the baby is “only” at the same weight as he was at birth. One grandmother chimes in that she knew breast-feeding was a bad idea, and the other insists that it is time to introduce cereal to the baby’s diet. They start arguing among themselves until you escort everyone but the mother and the infant from the examination room.



5. In addition to giving the mother accurate advice about breast-feeding and nutrition, which of the following is an appropriate intervention at this time?


a. refocus the attention of the grandmothers to some other facet of the family experience

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Family Influences on Health and Disease

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