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Flashcards in CPS First Nations Deck (47)
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1

Which of the following is false of scabies?
a) transmitted by skin to skin contact or from bed linens
b) incubation period is 6 weeks
c) can be a "marker disease for immunocompromised patients
d) more prevalence in overcrowded and/or less developed communities

b) false ->is 3 weeks, but reinfestation can occur much faster

the rest are true
caused by a mite that is transmitted from person to person, burrow, lays eggs which cause itching, can cause secondary infection

skin to skin is the most likely way, likely doesn't survive long off of skin, more parasites equal more transmission
the mites, and ova lead to burrowing and itching
highly contagious, risk for health care workers

2

Scabies are typically found in all but which of the following locations in infants and young children?
a) scalp
b) hands and feet
c) skin folds
d) face

d)

the others are areas found in children

adult - web spaces between fingers, skin folds, genitalia (men) and breasts (women)
children - often atypically distributed generally, can get missed, scalp (infants), hands/feet and skin folds
often mistaken for impetigo and eczema, but treatment for these doesn't help

diagnoses is by skin scraping

3

Which of the following is not true of why scabies is prevalent in aboriginal populations?
a) poor compliance with treatment
b) lack of running water
c) high elderly population
d) crowding in houses and community centres

c) in fact the opposite, high paediatric populations, failure to eradicate scabies from bed linens etc.

also failure to recognize an infestation
reduced access to medical care

lack of running water increases the chance of secondary skin infection
infestations every 15-30 years,

4

Which of the following is true of scabies treatment?
a) the first line treatment is one dose of 5% permethrin cream
b) treating symptomatic cases decreases the prevalence in a community
c) 1% permethrin (aka Nix) can be used to treat scabies
d) permethrin can be used for children of all ages

a) true - equally effective as Lindane (which is more neurotoxic). permethrin has low toxicity and excellent results
- should be washed off after 8-14 hours
- wash off in 8-9 hours in children

5

Which of the following treatments is the best for a 1.5 month old with scabies?
a) 5% permethrin
b) Lindane
c) precipitated sulphur (7%)
d) 1% permethrin

c) is the best alternative
for very young infants and pregnant/lactating women, prepared by pharmacist, 3 consecutive days x 24 hours each time

the others
a) 5% permethrin - not for very young infants, acts on sodium channel and leads to paralysis and death of the parasite, no recommended in pregnancy (has been used in 23 day old and pregnant women)
b) Lindane- in general alternative when 5% permethrin not available, however, should be cautious when prescribing to infants or lactating/pregnant women. wash off after 6 hours in infants, 6-8 hours in children, 8-12 hours in adults. only reapply in 1 week if live mites appear
d) for head lice, not the same thing

change clothing and linen every day until you can treat everybody (Julie notes)
in bags, usually don't live more than 4 days in bag
don't go to school until treated

6

Which of the following is not part of treatment of scabies?
a) treat patient, family and contacts
b) apply treatment to whole body after a bath/shower and after drying
c) treat all areas including face and scalp
d) tell patients that persistent of itching means that the mites are still alive

d) itching can persist even after mites are dead due to reaction to material still in the skin
the rest are part of it
- can find mites in places that don't show signs (i.e. face), need to apply to whole body, especially in very young
also wash bed linens and clothes next to skin in hot water (60 c); if no hot water, put in plastic bag away from family for 5-7 days (cannot survive more than 4 days away from skin),

persistent symptoms most likely due to inadequate application of treatment and inadequate treatment of contact cases
treat all household members at same time, may not have symptoms fro 2-3 weeks
daycare the day after treatment is okay
if we treat a kid with scabies may need prophylaxis (do a treatment) Julie

future - ivermectin not approved in Canada for this use, no clear advantages over topical therapy, single oral dose, helps to control epidemics, doesn't cross BBB easily

7

Which of the following are not common challenges with researching Aboriginal populations?
a) easy to identify populations
b) difficulty implementing the community based participatory research (CBPR) method
c) grouping on and off reserve populations together
d) not examining the needs of each subgroup proportionate to their share of the population

a) actually hard to identifity which population you are studying

the rest are true

misrepresentation/stigmatization also challenge

may need to approach elders first
ensure the research benefits the children
protect anonymity
translation may be needed
ensure the people know their rights

8

Which of the following is not part of the CBPR approach of research?
a)ownership
b) prevention of access to information
c) control
d) possession of data

b) opposite should have access

ownership - first nations community owns the information
control by community of research and community infromation/processes
possession of data by the community
should be used for all aboriginal research, developed by the First Nations Longitudinal health survey
governments should prioritize research based on CBPR research to help reduce health disparities

9

Which of the following has not been linked to vitamin D deficiency?
a) diabetes
b) congenital heart disease
c) tuberculosis
d) asthma
e) dental caries

b) answer

Vitamin D deficiency has been linked to osteoporosis asthma, autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and inflammatory bowel diseases, diabetes, disturbed muscle function, resistance to tuberculosis, cancer
fetal life - linked to severity of asthma, type 1 diabetes and bone density linked to low vitamin D levels in fetal life, dental caries may be linked to low fetal vitamin D levels

10

Which of the following is not an equivalent amount of vitamin D?
a) 400 IU
b) 10 micrograms (ug)
c) 26 nmol
d) 50 mg

d) is not equivalent 1IU = 0.025 ug = or 65 pico mol

11

Which is the best measurement of vitamin D levels?
a)vitamin D2
b) vitamin D3
c) 25 OH D
d) 1, 25 OH D

c) optimal 25 OH D is the level where PTH production is minimized and the resorption of calcium from bone is minimized and the absorption of calcium from the gut is stable(see my chart i drew). and to make sure not so much that you get hypercalcemia and its complications


12

Which of the following vitamin D levels is sufficient?
a) 8 ng/ml
b) 50 nmol/L
c) 20 nmol/L
d) 100 nmol/L

d) is the answer

deficient is 225 nmol/L
potentially toxic is >200 ng/ml or >500 nmol/L

aim is to have enough vitamin D to absorb calcium from the gut and to minimize PTH secretion so you don't have breakdown of bone or hypercalcemia and calcium deposition in tissues

vitamin D deficiency is associated with lower Ca absorption from the but and hypocalcemia




13

Which of the following does not influence vitamin D absorption?
a) BMI
b) latitude and sun exposure
c) altitude
d) ethnicity

c)

not altitude, latitude affects amount of vitamin D
one study, Edmonton Alberta, vitamin D3 production in skin almost non existent
worse in Arctice
new research, vitamin D3 inversely related to BMI
ethnicity - Aboriginal women have lower vitamin D levels that others, even with same intake of vitamin D; more risk of bit D deficient rickets in First Nations, Inuit and Middle Eastern
minimal exposure in infants - no sun exposure <1 year old and also use sunscreens

14

Which of the following is not associated with maternal vitamin D deficiency during pregnancy?
a) hypercalcemia
b) dental malformation
c) smaller size
d) rickets

a) false - associated with hypocalcemia and rickets, not hypercalcemia

supplements - Health Canada recommend 200 IU/day for women during pregnancy, most have 400 IU/day of vitamin D3
D3 (animal) D2 (plant -less effective)

15

Which of the following is not an appropriate level of supplementation for the case?
a) healthy breastfed newborn - 400 IU daily
b) breastfeeding mother not supplementing infant - up to 2000 IU
c) baby in Nunavut - 800 IU
d) premature infant - 800 IU

d) premature should be 200-400 IU, should get supplement of at least 200/day since even if the milk has enough vitamin D they don't eat enough to get enough vitamin D


the rest are true
north of 55th parallel - (i.e. Edmonton) between October and April should have 800 IU/day
40th-55th parallel if other risk factors also
should consider giving 2000 IU to breastfeeding and lactating women, to prevent deficiency, especially during winter months; vitamin D deficiency in breastfeeding mothers is common since people don't take enough of them
there have been concerns raised about getting hypercalcemia malignant during pregnancy with supplementation but it hasn't happened
studies now show that we might need more, more research is needed
foods that have vitamin D- infant formula, dairy, soy beverages and rice are fortified with 400 IU/L, traditional native foods have vitamin D also but don't eat enough to prevent deficiency
amount of vitamin D needed might increase with age ; one study showed that needed 1200 IU/day for 12 kg toddler




16

Which of the following is not a risk factor for type 2 diabetes?
a) obesity
b) hypertension
c) ethnicity and genetic markers
d) gestational diabetes

b)
the physical signs of insulin resistance and metabolic syndrome (including acanthuses nigracans, PCOS, HTN, dyslipidemia and steatohepatitis) are not causative of DM2 but are associated with glucose intolerance and early onset DM2

PCOS - 2 main features are hirsutism and irregular menses, despite more obesity in First Nations, PCOS is rare in Aboriginal girls

prevention program: Kawnawake is the example, since it incorporates Mohawk culture i.e. the Sandy Lake Program includes classroom curriculum, family outreach, student activities, and advocacy for changes in the school and store environment. get rid of junk food (including advocacy), exercise, teach about diabetes

17

Which of the following Aboriginal kids should be screened for type 2 diabetes?
a) 11 year old with BMI >85th percentile and mother with gestational diabetes
b) 8 year old with BMI >85th percentile and dyslipidemia and hypertension
c) 15 year old with BMI

a) should have all 3 of : age >10 year old, BMI>85th percentile and Aboriginal descent, PLUS one of the following : sedentary lifestyle, mother with GDM, 1st or secondary relative with type 2 DM (immediate family member, or aunt, uncle, grandparent) , dyslipidemia, hypertension, acanthosis nigracans, PCOS


lots of people have questioned who should be screened. only high risk individuals should be screened CPS supports opportunistic screening for DM2 in Canada

18

Which of the following is not an appropriate screening test for diabetes?
a) Fasting blood glucose >7.0 mmol/L
b) Random blood glucose > 11.1mmol/L
c) HgA1C >7.0
d) Oral Glucose Tolerance Test with fasting and 2hr post glucose load test

c) currently no evidence to recommend HgA1C as a screening method

19

Which of the following recommendations is not an appropriate way to reduce diabetes in First Nations Children?
a) encourage breastfeeding
b) daily physical activity 60-90 minutes
c) traditional values should be encouraged and safe play areas in communities should be developed
d) passive activities should be limited to 3 hours/day

d) false, should be limited to 1.5-2 hr/day

the rest true - breastfeeding, part of traditional diet, should be encouraged to decrease obesity

20

Which organism is the most common cause of early childhood caries?
a) streptococcus mutans
b) streptococcus pyogenes
c) lactobacilli
d) streptococcus sobrinus

a) is the most common - mutans

lactobacilli and strep sobrinus are common too
pathophys: bacteria, exposure to carbs in the diet (fermentable), and host susceptibility (integrity of tooth enamel)
associated with other infections in First Nations - including resp infections and AOM (although relationships are weak and hard to study)

21

Which of the following is the main consequence of early childhood caries?
a) speech difficulties
b) low self - esteem
c) need for repair under general anaesthesia
d) obesity
e) growth restriction

c) the biggest consequence is the need for repair under general anaesthesia, as well as the economic and travel and social costs of this option; the others are consequences as well but not as severe
has been associated with obesity and growth restriction

also with poor bite and alignment of teeth


also associated with obesity in lower SES kids

22

Which of the following best approximates the prevalence of early childhood caries in indigenous children in Canada?
a) 50%
b) 60%
c) 80%
d) 90%

d) in some communities, prevalence of early childhood caries (Defined as cavities before age 6 of primary teeth) exceeds 90%

other surveys showed 60-68%

23

Which of the following is the greatest risk factor for early childhood caries?
a) household crowding
b) poverty
c) prolonged bottle use
d) environmental smoke

b) poverty is the single greatest risk factor
52% of Canadian First Nations Children live in poverty

the other risk factors include those listed as well as:
family size, poor nutrition (including lots of carbs and sugars, carbs affect the carbs needed for cavities to form as well as affecting tooth enamel development which is affected by nutrition), health behaviours, parenting practices, association with parents oral health status
environmental smoking and maternal smoking status have also been associated

24

What are some ways to reduce cavities in the first nations population?


1. prenatal - encourage dental care for pregnant women and anticipatory guidance about oral health for their babies
2. fluoride varnish for all babies who are first nations, should assess all children to see if they can get sealants (health canada doesn't recommend supplemental topical fluoride for first nations, rather they emphasize the other things)
3. think about how much fluoride is in the water
4. brush teeth with fluoridated toothpaste (grain size for infant, pea sized for older)


the rest true
- varnish application - on RCT showed reduced cavities by 18%
in US four or more treatments between age 9-24 months is the best practice to reduce cavities
most Canadian inuit children fall into high risk category for dental caries, and <10% have access to fluoridated water sources

cariogenic bacteria can be transmitted vertically**

25

Which of the following is not an effective and recommended method to reduce early childhood caries in Canadian Indigenous children?
a) use of sealants in both permanent and primary teeth
b) oral health visits during well child visits starting at age 6
c) promote supervised use of fluoridated toothpaste 2 x /day once teeth have erupted, using smear for infant and pea sized for children
d) use of fluoride varnish treatments at primary care visits

b) false - should start doing screening and referring to dentist as needed as soon as possible; in terms of formal dental assessment, dentist association wants a dental examination 6 months after 1st tooth or by 12 month of age, also, evidence that should provide anticipatory guidance and supervision starting even prenatally; Statement says should have access to dental professional by age 12 months

the rest are true
a) use of sealants in both teeth, in high risk children (such as First Nations Children)

dentist association wants a dental examination 6 months after 1st tooth or by 12 month of age

also, should try to get more fluoridated water to indigenous communities

26

Which of the following is false of community acquired MRSA?
a) more susceptible to beta-lactam drugs compared to health care associated MRSA
b) associated primarily with skin and soft tissue infections
c) produced specific virulence factors that lead to tissue necrosis
d) a recent study showed that many cases occurred in marginalized individuals, there are different strains in different geographic areas

a) false - overall is more susceptible to antimicrobials, compared to HCA MRSA, OTHER than beta - lactam drugs (LESS susceptible to these)

types most associated with community associated infections in Canada include CMRSA 10 and CMRSA 7

Community Acquired MRSA - refers to MRSA acquired in the community in a person and without the risk factors associated with HCA MRSA

27

Which of the following is not a risk factor for community acquired MRSA?
a)overcrowding
b) reduced exposure to antibiotics
c) poor hygiene
d) frequent skin to skin contact

b) the opposite - increased exposure to antibiotics have been associated with CA MRSA

the others have been associated, as well as trouble cleaning personal items, participation in activities that lead to abraded skin surfaces

28

Which of the following is not a recommended method to reduce the burden of MRSA in Indigenous communities?
a) encourage influenzae vaccination
b) promote hand hygiene starting with young children
c) keep wounds covered
d) reduce microbial carriage during outbreak of CA-MRSA

d) NOT recommended:
1. to determine carriage rate among asymptomatic contacts
2. not recommended to reduce carriage for routine management of CA-MRSA, including during endemic infection or with outbreak; **little/inconsistent evidence that reducing carriage of CA-MRSA reduces recurrence of CA-MRSA (only in dry well defined areas, where you have already tried to do hygiene, with low prevalence and and in patients with recurrent infections)

- unsure what the best method of reducing carriage is - for example, oral rifampin can lead to increased resistant TB, lots of communities have high levels of muciprocin resistance already
- current studies in way to determine the usefulness of diluted bleach bathes

a) true - since risk of severe MRSA pneumonia after influenza
d) true - if can't keep covered then exclude from child care and contact sports until wound drainage stops/is healed

also clean surfaces in the home and keep things as clean as possible
the others are cleanliness, as well as education regarding hand washing, and educating professionals about resistance patterns, etc.


appropriate management of infections (there is a separate statement on this in the ID section)
abscess - I and D
furuncles, scratches, impetigo - wet warm compresses, washing with warm soap and water, consider topical antibiotics and based on local resistance patterns consider oral antibiotics
seek medical attention if the lesion doesn't improve after 48 hours of Abx

29

Which of the following necessitates contacting public health?
a) all cases of CA-MRSA
b) 2 or more cases of CA-MRSA in the same individual over 6 month period
c) outbreak at a daycare
d) all of the above

c) any outbreak in a closed community - i.e. daycare or sports team

b) tricky - DO need to contact for recurrent infection, but this is defined as 3 or more cases in the same person over 6 month period

don't need to contact for all cases

30

How much of the Canadian population smokes?
a) 10%
b) 15%
c) 20%
d) 35%

c) 20% of the population smoked in 2004, decreased from 35%in mid 1980s
aboriginals still have increased rates of smoking - 3x that of non aboriginal Canadians (decreasing but still high)