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FCP Flashcards

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1
Q

Public Health Definition

A

Art of Preventing Disease
Prolonging Life
Promoting Health

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2
Q

4 Aspects of Public Health Approach

A

Surveillance
Risk Factor Identification
Intervention Evaluation
Implementation

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3
Q

What are the 10 Public Health Essential Services?

A 
Monitor Health of Community
Diagnose
Educate
Mobilize Partnerships
Develop Policies
Enforce Laws
Link People to HS
Competent Workforce
Evaluate Quality of HS
Research
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4
Q

Determinants of Health of Population

A

Social Characteristics
Genes / Biology
Health Behaviors
Medical Care

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5
Q

Community Diagnosis

A

Identification / Quantification of Health Problems in Community

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6
Q

Clinical vs Community Diagnosis

A

Clinical (History / Exam / Test / Diagnosis)

Community (Talk / Records / Survey / C. Diagnosis)

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7
Q

Aim of Community Diagnosis

A

Prevention & Promotion

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8
Q

What is Occupational Health

A

Promotion + Maintenance of Physical / Mental / Social Well Being of Workers

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9
Q

What are the 4 Objectives of Occupational Health

A

Maintenance + Promotion of Workers Health
Prevent Diseases
Protect Workers
Safe Workplace Environment

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10
Q

Difference Between Occupational Disease & Work Related Disease?

A

Occupational - Cause Specific (Silica in Factory)

Work Related - Multifactorial (Work Stress)

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11
Q

Hazard

A

Ability of Agent to cause damage to biologic material

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12
Q

Exposure

A

contact to hazard that allows effective transmission

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13
Q

Risk

A

Probability that adverse effects will occur

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14
Q

Workplace Assessment (3)

A

Workplace Risk Evaluation
Risk Communication
Risk Management

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15
Q

How is Workplace Risk Evaluation carried out? (4 Steps)

A

Hazard Identification
Hazard Evaluation
Exposure Assessment
Risk Characterization

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16
Q

Risk Communication

A

Using Info Gathered this is the follow where the responsible personnel makes informed and independent decisions about Health / Safety Risks

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17
Q

When risk communication is conducted prior to exposure this is called?

A

Primary Prevention

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18
Q

Risk Management

A

Employer / Employee / Medical Consultant manage risk

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19
Q

What are the 4 options in Risk Management?

A

Exposure Reduction / Elimination
(PPE not primary mode this is the most desirable)
Temporary Job Transfer
(High risk and reduction / elimination not possible)
Disability Leave
(Exposure wont be reduced & transfer not possible)
Remove Individual from Work
(Last Desirable)

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20
Q

What are the 6 environmental (Engineering) measures taken ?

A 
Substitution
Isolation (Other workers not affected)
Segregation (Away from workplace)
Ventilation
Environmental Monitoring
Ergonomics
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21
Q

What are the 3 medical / personal measures taken?

A

Pre Employment Medical Examination
Periodic Medical Examination
Biologic Monitoring

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22
Q

What is the aim of Pre Employment Examination (PEE) ?

A

Baseline Medical Data (Medicolegal)

Identify Highly Susceptible Individuals and advise regarding suitability of work and his health

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23
Q

What is the aim of Periodic Medical Examination (PME) (4 Aims) ?

A

Early Disease Detection (Better Treatment / Prognosis)
Early Removal of Susceptible Individuals (Prevention)
Early Detection of Hazardous Jobs
(To apply Engineering / Control Measures)
Evaluation of Previous Prevention / Control

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24
Q

What does Periodic Medical Examination include?

A

Questionnaire
Screening tests
Periodic Audiometry
Periodic CXR / Ventilatory Function

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25
What is Biological Monitoring?
Part of Periodic Medical Examination | Measuring Elements / Metabolites in biological fluids
26
Aim of PPE
Prevent penetration of uncontrolled hazardous exposure
27
Organized and Systematic way of finding answers to questions
Research
28
Types of Health Research
Quantitative (Numerical) Qualitative (Non Numerical) Mixed Methods
29
PICO Approach
Population Intervention Comparisons Outcomes
30
4 Ws Format
Who What Where When
31
Different types of epidemiological studies?
Descriptive (No Comparison) | Analytical (Comparison)
32
Types of Descriptive studies
Case Report Case Series Ecological Studies
33
Types of Analytical Studies
Observational (Cohort / Case Control / Cross Sectional) Interventional (Clinical Trial / Community Trial)
34
Case Report
Clinical Phenomenon in Single Patient
35
Case Series
More than one patient with similar problems
36
Limitations of Case Report / Case Series
External Validity | Confounding
37
Ecological Studies
Average Exposure - Frequency of Disease in Populations
38
Ecological Fallacy
Conclusions on individuals based on analyses of group data (high income is associated with high mortality from cancer at the individual level. In fact at individual level we may observe the reverse: mortality from malignancy is lower with high income)
39
Cross Sectional
Exposure and Disease at one Point (snapshot)
40
Cohort
Exposure + Look Forwards to outcome (Prospective)
41
Case Control
Identify disease status then look backwards to exposure (restrospective
42
Which study is known as prevalence study?
Cross Section
43
Advantages of Cross Section
Simple Cheap Quick Gives Prevalence
44
Disadvantages of Cross Section
Not for Rare / Short Duration Diseases May result in wrong conclusion No Solid Evidence
45
Types of Cohort Studies
Prospective Retrospective Reconstructive
46
Relative Risk
Incidence in Exposed / Incidence in unexposed
47
Attributable Risk
Incidence in Exposed - Incidence in Unexposed
48
Relative Risk Interpretation
=1 Risk Same >1 Increased Risk (Exposed) <1 Decreased Risk (Exposed)
49
Confounding
Measure of association or effect between exposure and outcome is distorted by the presence of another variable.
50
How to Deal with Confounding Factors (Design Stage)
Restriction (Admission of those free from confounder) Randomization (Distribute the confounders equally) Matching (Distribution of confounders in different groups)
51
How to deal with confounding (Analysis Stage)
Stratification (Analyzing at different levels) | Modeling (Using regression techniques)
52
Advantage of Cohort Studies
Incidence Rate Calculation Estimates of RR / AR No Recall Bias Suitable for Rare Exposure
53
Disadvantages of Cohort
``` Large Number of People Long time Not for rare diseases / low incidence Loss to follow up Expensive Loss of staff People behavior changes Ethical Problems ```
54
Which type of study is Cohort Study
Observational | Analytical
55
Disease caused by transmission of pathogenic agent to host
Communicable Disease
56
Progression of disease in absence of treatment
Natural History
57
Spectrum of Disease
Manifestations present in each infected individual
58
Epidemiological triad
Agent Host Environment
59
Infectivity Ratio
Number Infected / Number Exposed
60
Basic Reproduction Number RO
Number of secondary infections that result from primary infection in SUSCEPTIBLE population (R is number in both susceptible and unsusceptable)
61
Interpret R0 Number
Example R0 for Measles is 15 | Each new case of measles 15 new secondary cases
62
What is the R0 Number in an epidemic?
Must be >1
63
Effective Reproductive Number (R)
Average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible hosts.
64
Effective Reproductive Number (R) Interpretation
>1 - Number of cases will increase =1 - Endemic <1 - Decline in number of cases
65
Pathogenicity
Extent to which clinically manifest disease is produced in infected population
66
Pathogenicity Ratio
Number developing clinical illness / Number infected
67
Virulence
Extent to which severe disease is produced in population | Virulence - Very Severe
68
Virulence Ratio
Number with severe disease / Number with disease
69
Infective dose of infectious agent
Number of organisms needed to cause infection
70
Resevior
Place where infectious agent can live and multiply
71
Preclinical disease
Disease not clinically apparent but destined to progress to one
72
Sub-Clinical
Not clinically apparent and not destined to become apparent
73
Latent Infection
No active multiplication
74
Modes of Transmission
Direct (Same Place) Indirect (Vehicle / Vector) Airborne (Droplet / Dust)
75
Vertical modes of transmission
In Utero (Pregnancy) Perinatal (During Delivery) Breast Feeding
76
Incubation Period
Time between invasion and first sign / symptom
77
Period of Communicability
time where agent may be transferred from person to person
78
Ability of agent to cause clinical manifestations
Antigenicity
79
An individual who is neither immune or infected
Susceptible individual
80
Permanent reduction of Disease worldwide to zero with no agent detected in environment
Eradication
81
Reduction of infection / disease to zero with agent present
Elimination
82
Eradication vs Elimination
Eradication - Agent isn't in environment | Elimination - Agent present in environment
83
Examples of Eliminated diseases
Measles Polio (Aka reduced but agent present)
84
Example or Eradicated Disease
Small Pox
85
Level of Prevention
Primary - Prevention of Disease Secondary - Early Detection Tertiary - Prevent Deterioration (PED)
86
Primary Prevention
Reduce incidence of Disease / Risk Factor
87
Secondary Prevention
Reduce prevalence by shortening duration of infection
88
Tertiary Prevention
Reduce / Eliminate Long Term Impairments
89
Control Measures of Cases (7)
``` Case Finding Notification Isolation Disinfection Treatment Release Others (Follow Up) ```
90
Control Measures of Contacts (5)
``` Enlistment Examination Stop Exposure Surveillance Segregation Specific Protection ```
91
Permanent incidence reduction to Zero (Worldwide)
Eradication
92
Reduction to zero (Defined area)
Elimination
93
Reduction to locally accepted level
Control
94
Agent no longer exists in nature or lab
Extinction
95
Virulence
Cause Serious Disease
96
Pathogenicity
Cause Disease
97
Infectiousness
Transmission
98
Infectivity
Ability to infect
99
Control Measures applied to infectious agents
``` Cleaning Cooling Pasteurization Disinfection Sterilization ```
100
Control Measures applied to host
``` Vaccination Prophylaxis Behavior Barrier Improving Host Resistance ```
101
Control Measures applied to environment
Safe Water Provision Feces Disposal Food / Milk Sanitation
102
Types of Observational Studies
Cross Sectional Cohort Case - Control (No Intervention)
103
Case Control Study
Cases identified and compared with individuals without condition of interest (Controls)
104
When is a Case Control Study Desirable
Rare Disease Dynamic Population Little Known about RF
105
Optimum Selection of Controls
Multiple Control Groups (Different Sources) Matching (Similar to cases) Size (Equal to Case Group)
106
Types of Bias
``` Interviewer (Use Objective Method) Recall Selection Measurement Observer Bias ```
107
Odds Ratio
Odds of Exposure in Cases / Odds of Exposure in Controls Or AD/BC
108
Advantages of Case Control
``` Easy Cheap Rare Diseases No Risk Study of Several Factors No loss to follow up No Ethical Problems ```
109
Disadvantages of Case Control
Bias Validation of Info Appropriate Control Selection difficult Odds Ratio is an estimate of RR with low prevalence diseases only
110
Which study is more Suitable for Rare Diseases
Case Control
111
How to remove bias in Clinical Trials?
Randomization | Blinding
112
Levels of Blinding
Individual Investigator Analyst
113
Key Elements of Clinical Trial
``` Selection Randomization Blinding Data Collection Statistical Issues Ethical Considerations ```
114
Inert compound given to subjects in clinical trial
Placebo
115
Types of RCT endpoints
Primary (ex. Cured 3+ Months) Surrogate Composite (Death / Attack) Safety
116
Rules to stop trial
Severe Side Effects | Benefit becomes undeniable
117
Statistical Issues that can arise
Sample Size | Analysis
118
Intent to treat Analysis
All participants enrolled in trial (Completed the trial or not)
119
Per Protocol Analysis
Only who completed trial
120
Number Needed to Treat Formula
1 / (Incidence control - Incidence Treated) or 1 / Absolute Risk Reduction
121
Efficacy Formula
(Incidence placebo - Incidence Treatment) / Incidence Placebo
122
Inactivated Toxins
Diphtheria and Tetanus
123
Inactivated Complex Antigens
Whole-cell pertussis
124
Purified Antigen
Acellular Pertussis
125
Recombinant Antigens
Hepatitis B Recombinant Vaccine
126
Live Attenuated
Measles
127
Under Which Condition does WHO grant certification of elimination?
Interruption of Transmission lasted at least 3 consecutive years
128
Transmission of disease no longer active in certain area
Elimination
129
Which diseases have been eradicated ?
Smallpox | Rinderpest
130
Causative Agent of Tetanus
Clostridium Tetani
131
Tetanus is which type of Bacteria
Anaerobic Motile Gram +
132
Main Reservoir of Tetanus
Soil
133
Names of Tetanus Toxins
Tetanospasmin | Tetanolysin
134
Which neurotoxin causes clinical manifestations of Tetanus
Tetanospasmin
135
When does tetanus produce toxins
Low Oxygen Levels | Spore - Germinates - Active Vegetative State - Multiplies - Produces Toxin
136
Mode of Transmission of Tetanus
Percutaneous (Must pass skin barrier) | No Wound - No Tetanus
137
Lethal dose of tetanus
0.1 Mg for 70 Kg Man
138
Incubation Period of Tetanus
3 - 21 Days
139
Types of Tetanus
``` Traumatic Puerperal Otogenic Idiopathic Neonatorum Cephalic ```
140
What can prevent tetanus
Immunization
141
When is the combined tetanus diptheria pertussis vaccine offered?
Months 2 / 4 / 6 | Booster ( 18th Month / 5 Years / 10 Years / 16 Years)
142
When is the monovalent vaccine offered?
0 / 2 / 12 Months | Booster after 5 then every 10
143
When is TdaP given to adults
Every 10 Years
144
How long does the tetanus Ig produce protective antibody levels for?
4-6 Weeks Atleast
145
Tetanus Vaccination in Children
Months 2 / 4 / 6 / 18 (Booster) 4th Year Primary After 10 Years 3rd Dose
146
Tetanus prevention in Pregnancy (Not Previously Immunized)
First Dose - 6th Month Second Dose - After 1 Month until 2 Weeks Before Delivery Third Dose - After 6-12 Months or Next Pregnancy Fourth/Fifth - After one Year
147
Tetanus Prevention in Pregnancy (Immunized)
Two Doses - After First Trimester till 2 Weeks Before Delivery Third Dose - After 6/12 Months or Next Pregnancy
148
Tetanus vaccine in adults (Immunized)
Booster every 10 Years
149
Tetanus Vaccine in soldiers / farmers / gardeners
Two doses one month apart | Third Dose after 6 - 12 Months
150
Tetanus Case Management
``` Medical Emergency - Hospitalization Patent Airway TIG Immediately Wound Care Antibiotics ```
151
Does tetanus disease give immunity?
No
152
Tetanus contacts management
Nothing
153
Which type of Virus is Rabies
Non-segmented Negative Stranded RNA (Rhaboviridae Family)
154
Rabies transmission
Direct Contact | Through Mucus Membranes
155
Most effective strategy for preventing Rabies
Vaccinating Dogs
156
Types of Rabies Vaccines
Human Diploid Cell Vaccine Rabies Vaccine Adsorbed (5*1ml Doses deltoid region)
157
Mechanism of Action in Rabies
Multiplication in Nervous tissue
158
Polio Incubation Period
14 Days
159
Polio Mode of Transmission
Direct Droplet | Faeco-Oral Infection
160
Types of Polio
Non-Paralytic | Paralytic
161
Non Paralytic Polio
Stiff / Pain Neck 2-10 Days Rapid Recovery
162
Paralytic
Paralysis in 4 days
163
IPV Vaccination
2 / 4 / 6 /18 Months | 4-6 Years
164
OPV Vaccination
2 / 4 / 6 / 9 / 12 / 18 Months
165
Which polio vaccine Builds mucosal immunity?
OPV (Oral)
166
FINER Acronym Research
``` Feasible Interesting Novel (New Findings) Ethical Relevant ```
167
PICO
Population Intervention Comparison (Type of Control) Outcome
168
Emerging Infectious Disease
Newly discovered infectious agent
169
Re-emerging Infectious Disease
Previously controlled but risen again to be a problem
170
What are factors affecting emerging / reemerging diseases
``` Ecological Changes Human Demographics International Travel Microbial Adaptation Breakdown Intent to Harm War ```
171
How do ecological changes affect emerging / remerging diseases?
Global warming increases temperature | Increase in waterborne / vector transmission
172
Epidemic
Disease that affects large number of People within community / population / region
173
Pandemic
Epidemic that spread over multiple countries or continents
174
Endemic
Constant presence in a specific location
175
How many phases is the WHO Pandemic Alert system?
6 Phases
176
Phase 1 WHO PS
Virus in animals | No infections in humans
177
Phase 2 WHO PS
Animal Virus | Caused Infection in humans
178
Phase 3 WHO PS
Clusters of disease in humans | No Outbreaks
179
Phase 4 WHO PS
Spreading from person to person | Outbreaks at community level
180
Phase 5 WHO PS
More than one country | Same Region
181
Phase 6
More than one country | Different region
182
Phases Recap
``` 1 - No infection 2- Human Infection 3 - Cluster of infection 4 - Community Outbreak 5 - More than one country 6 - Country in a different region ```
183
Types of Epidemic Curves
Point Source Continuous Propagated
184
Point Source Outbreak
Common contaminated source
185
Describe the point source epidemic curve?
Rapid increase with slower decline | All Cases one incubation period
186
Describe the continuous common source curve
Rise to a peak then falls | Not in a single incubation period
187
Example of Common Source
Cholera
188
Example of Point Source
Hepatitis A
189
Example of Point Source
Hepatitis A
190
Propagated epidemic example
Measles
191
Propagated curve description
Series of successively large peaks | One Incubation period apart
192
Measures to prevent emerging infectious disease
Surveillance Applied Research Infrastructure / Training Prevention / Control
193
Nuremberg Code
Informed consent is essential
194
Declaration of Helsinki
Protocol should be submitted for ethical review
195
Ethical Requirements of Research
``` Validity Social Value Community Partnership Favorable Risk/Benefit Fair Subject Informed Consent Independent Review ```
196
Levels of IRB Review
Full Board - More than minimal Risk Expedited - Minimal Risk Exempt - Observational Only
197
What determines IRB Level
Nature of Protocol Level of Potential Risk Subject Population
198
Define Research Misconduct
Fabrication Falsification Plagiarism
199
Define Fabrication
Making up data
200
Define Falsification
Manipulating data
201
Define Plagiarism
Appropriation of another persons idea
202
What is the research ethics committee
Review and approve the initiation of research | Protection of Human Rights
203
What are the basic vaccinations
BCG DPT OPV Measles or MMR
204
How many doses of hepatitis are recommended
3
205
Strategies of Vaccine Delivery
Fixed Immunization Posts Outreach Immunization National Immunization Days Supplementary Immunization Activities
206
What damages a vaccine?
``` Expiry Date Heat / Sunlight Freezing Reconstituted vaccine after 6 hours Disinfectants ```
207
Examples of Live Attenuated Vaccines
BCG Measles MMR
208
What could damage live attenuated vaccines
Heat / Sunlight
209
What damages toxoid / killed vaccines
Freezing | DPT / Pentavalent
210
What damages reconstituted vaccines
Using after 6 Hours (Recommended Period) | MMR / Measles / BCG
211
Which vaccines are not damaged by freezing?
OPV MMR BCG Hib
212
Which vaccines are damaged by freezing
``` DTwp Pentavalent Hib T / DT Hep B ```
213
Cold Chain
System for storing / transporting vaccines at recommended temperature
214
Vaccines Refrigerator Rules
``` Old vaccines to be used first No food / drink No vaccines in the door No vaccines in the freezer (Except Polio) Keep vaccines between 2-8 ```
215
Optimum temperature of vaccines
Between 2 & 8
216
Which vaccines are kept in dark ampoules to protect from light
BCG | Measles
217
How to check potency of vaccine
Vaccine Vial Monitor | Shake Test
218
Vaccine Vial Monitor
If square lighter than the surrounding circle its good for utilization Darker - Dont Utilize
219
How to perform shake test
Shake and observe sedimentation
220
What indicates vaccine is good for use on shake test
Immediately after shaking - Smooth / Cloudy | 30 Mins after - Clearing up wo/sediment
221
What indicates vaccine should not be used shake test
Immediately after - Granular Particles | 30 Mins after - Thick Sediment
222
Indicators for EPI evaluation
Vaccination Coverage Program Drop Out Vaccine Wastage
223
Proportion of population at risk of disease who received vaccination
Vaccination Coverage Rate
224
Vaccination Coverage Rate Equation
Number of people vaccinated / target | Times 100
225
What does a high vaccination coverage rater indicate
Access of population to HS
226
Program dropout rate equation
first dose - second dose / first dose | times 100
227
What does a program drop out rate less than 10 indicate
High level of healthcare performance | Good utilization by population
228
It is the proportion of vaccine doses supplied but not administered
Vaccine Wastage Rate
229
Vaccine Wastage Rate Equation
Dose Supplied - Doses Admin / Doses Supplied | times 100
230
Relationship between three indicators
High Coverage Low Drop out Low Wastage
231
What is done after positive screening test
Diagnostic test
232
Use of Screening Programs
Case Detection Control of Diseases Research Purposes
233
Types of Screening Programs
Mass Screening | Selective Screening
234
Criteria for effective screening program
``` Disease Test Diagnosis Treatment Risk / Benefit ```
235
Assessment of Screening Test Performance
Sensitivity Specificity PPV NPV
236
Define Validity
Describes Performance of screening test relative to gold standard
237
True Positive / TP + FN
Sensitivity
238
True Negative / TN + FP
Specificity
239
Validity Formula
True Positive + True Negative / Grand Total | Identified Correctly / Total
240
PPV
True Positive / All Positive
241
NPV
True Negative / All Negative
242
How likely is the disease present of someone tests positive
PPV
243
How likely is the disease absent if the person tests negative
NPV
244
What factors does the PPV depend on
Prevalence Specificity Sensitivity
245
Relation between PPV and Prevalence
As Prevalence increases PPV Increases
246
Which Marker is used to minimize false negatives
High Sensitivity | Rule Out
247
Which marker is used to minimize false positive
High Specificity | Rule In
248
Which variables are fixed
Sensitivity | Specificity
249
Which variables change
NPV | PPV
250
Effect of Prevalence on Predictive Value
PPV - Directly Proportional | NPV - Inversely Proportional
251
Reliability
Test gives same results when repeated
252
Screening Test Reliability
Intrasubject - Variation within individual Intraobserver - Variation in reading by same reader Interobserver - Variation between those reading
253
Campaign Steps
``` Training of teams Raising awareness Performing Tests Screening tests done Referral of detected cases Follow Up ```
254
Heat Balance Equation
Metabolism + Radiation + Conduction + Evaporation
255
How is heat lost?
Evaporation Radiation Conduction
256
Disorders that can result from heat
``` Heat Stroke Heat Exhaustion Heat Cramps Heat Syncope Skin Disorders ```
257
Which drugs can increase risk of heat disorders
``` Sympathomimetics Anticholinergic Decrease inn Cardiac Contractility/OP Volume depletion Beta Blockers Lithium ```
258
Define Heat Stroke
Medical Emergency caused by thermal regulatory failure of sudden onset Manifested by cerebral dysfunction + altered mental status
259
Types of Heat Stroke
Classic - Heat Exposure | Exertional - With Effort (Pilgrim)
260
Heat Stroke Cardinal Signs (3)
Core temp - 41 CNS Manifestation Red Hot Skin
261
Heat Stroke Treatment
Core Temp Reduction Evaporative Cooling Chlorpromazine - Control Shivering
262
Which drug is used to control shivering
Chlorpromazine
263
Prevention of Heat Stroke
Cool Drinking Water Shaded Areas AC Limiting Exposure
264
What is acclimatization
Controlled exposure to heated environments
265
Define Heat Exhaustion
Strenuous Work Prolonged Exposure Insufficient Salt / Water Intake
266
Difference between Heat Stroke and Heat Exhaustion in temperature
``` Heat Exhaustion (38-41) Heat Stroke - 41 ```
267
Heat Exhaustion treatment
Shaded Area Hydration Isotonic Glucose 24+ Hours Rest
268
Differences between heat stroke / exhaustion
Exhaustion - Sweating / Weak Pulse / Cold Skin | Stroke - No Sweat / Rapid Pulse / Hot Skin
269
Heat Cramp
Replacement of Sweat with water only Hyponatremia Muscular Contractions / Spasm
270
Heat Cramp TRT
Water Relax Salt
271
Heat Syncope
Sudden Unconsciousness
272
Heat Rash
Miliaria | Obstruction of sweat duct
273
What produces nitrogen gas bubbles in body
Moving from high pressure to low pressure quickly
274
Types of Decompression Sickness
Type 1 - Mild Form Type 2 - Fat Embolism Type 3 - Delayed Osteonecrosis
275
DCS Type 1 Features
Joint Pain | Skin Rash
276
DCS Type 2 Features
Spinal Cord / Brain Disorders Pulmonary Chokes Arterial Gas Embolism (Fat Embolism + Poor Prognosis)
277
DCS Treatment
Recompression with gradual decompression in hyperbaric chambers
278
Types of Radiation
Ionizing | Non-Ionizing
279
Types of Ionizing Radiation
Alpha Betta Gamma Xray
280
Types of Non-Ionizing
UV Infrared Microwave
281
Acute Radiation Syndrome
BM Syndrome GI Syndrome CV / CNS Syndrome
282
Chronic Radiation Dermatitis
Atrophic Skin with telangiectasia Loss of gland / hair Reduced Sweating
283
Prevention / Control of Radiation
Isolation using Lead Segregation Ventilation (Dust could be source of radiation) Monitoring Devices
284
Conjunctivitis + Corneal ulcers
Welders Flash
285
Health effect of Whole Body Vibration
``` GIT Decrease VA Labyrinthine Disorders MSK Disorders Skin Lesions ```
286
Types of Vibration
Whole Body | Segmental (HAVS)
287
Hand Arm Vibration Syndrome Clinical Picture
Tingling Color Changes Decrease Manual Dexterity
288
Diagnosis of Noise Induced Hearing Loss
Prolonged exposure to >85 db
289
Control of Noise
``` Replace Saws with Laser cutting Segregation of Machines Isolation of machine Proper Maintenance Monitoring Noise Level ```
290
Electricity Prevention Measures
Electricity Resistant Gloves / Shoes | Non Conductive Clothing
291
Types of Occupational Lung Diseases
Pneumoconiosis Extrinsic Allergic Alveolitis Byssinosis Occupational Asthma
292
Types of Pneumoconiosis
Silicosis Asbestosis Coal Worker P
293
Define Pneumoconiosis
Group of Chronic Lung diseases caused by long term exposure to respirable particles
294
Pneumoconiosis pattern in pulmonary function test
Restricitve
295
Xray of Silicosis
Nodular Opacity | Hilar LN Calcification (Egg - Shell)
296
Which industries are at risk of Asbestosis
Car Brakes Clothes Cement / Ceiling /Roof
297
Positive Findings in Asbestosis
Fine Crepitations at base of lung due to fibrosis
298
Types of CWP
Simple (Small opacities) Progressive Massive (Large Opacities) Caplan (Nodular Opacity + RA)
299
Extrinsic Allergic Alveolitis (HP)
HS reaction following exposure to dust
300
Three dimensions of Burnout Syndrome
Emotional Exhaustion Depersonalization Detachment Sense of Incompetence
301
Exposure to Lead
Inhalation of fumes | Ingestion of Dust
302
Shyness + Anxiety + Memory Loss + Emotional Lability
Erethism
303
What causes Erethism
Mercury Exposure
304
Minamata Disease
poisoning with neurological symptoms and caused by the daily consump- tion of large quantities of fish and shellfish that were heavily contaminated with the toxic chemical generated in chemical factories and then discharged into the sea.
305
What are the lung manifestations of Cadmium
Bronchitis | Focal Emphysema
306
What are the kidney manifestations of Cadmium
Fanconi | Osteomalacia (Itai Itai Disease)
307
Itai Itai Disease
Renal Tubular Dysfunction + Osteomalacia
308
What does the steel / leather industry carry a risk of ?
Chromium
309
Health effects of Chromium
``` Lung Cancer Chrome Holes (Ulcers) ```
310
Risks of Plane Industry
Aluminum
311
Risks of Aluminum
Dementia + Alzheimers
312
Chemical Asphyxiants in Petroleum Industry
Hydrogen Disulfide
313
Chemical Asphyxiants in Electroplating
Hydrogen Cyanide
314
Which chemical asphyxiants inhibit cytochrome oxidase and block oxygen utilization?
Hydrogen Disulfide | Hydrogen Cyanide
315
Which gas is released in incomplete combustion?
Carbon Monoxide
316
Treatment of Asphyxiant Gases and Upper Airway Irritants
Remove Exposure Oxygen Supply CPR
317
Treatment of lower airway irritant gases
Remove from exposure Oxygen CPR Corticosteroids
318
Upper airway irritants
Chlorine | Ammonia
319
Lower airway irritant gases
Nitrogen Oxides
320
Chronic Effects of Solvents
Presenile Dementia
321
Blood Effects of Benzene
Aplastic Anemia - Precursor to leukemia
322
Types of Pesticides
Organophosphate Organochlorine Carbamate
323
Health effects of Organophosphate / Carbamates
Inhibits Acetylcholinesterase Activity
324
Disease Characterized by RTD and Severe Osteomalacia
Itai Itai
325
Name Measures of central tendency
Mean Mode Median
326
Measures of Dispersion
Range Variance Standard Deviation Coefficient of Variation
327
How to calculate coefficient of variation
SD/Mean *100
328
Qualitative data graphs
Pie / Bar
329
Quantitative Data Graphs
Histogram | Scatter Plot
330
Define Census
Enumeration of population recording all people in every residence at a specific time
331
When is the census done?
Every 10 Years
332
Defacto Census
Counting people where ever they are
333
De Jure Census
Counting people at their residence
334
Advantages of De Jure
Reflects actual distribution | Counts according to residence
335
Advantages of De Facto
Easy | Avoids Problems
336
Who carries out census in egypt?
CAPMAS
337
Which Census method is used in Egypt?
De Facto
338
What is the point of Census
``` Information about characteristics Basic Data for Statistical Indicators Census + Fertility + Mortality Expected Population Change Planning ```
339
Methods of estimating Population
Natural Increase Arithmetic Graphic Geometric
340
Natural Increase Method
Difference between live births and deaths
341
Arithmetic Method
Dividing the difference between two consecutive censuses
342
Graphic Method
Plotted on a graph and straight line connected to future
343
Geometric Method
Specific Formula
344
Which method is the most accurate method?
Geometric
345
Ways of measuring population change
Rate of Natural Increase | Growth Rate
346
Rate of Natural Increase Equation
Birth - Death / 10
347
Growth Rate Equation
(Birth - Death) + (Immigration - Emigration)
348
What is demographic transition
Long term trend of declining birth and death rates resulting in the change of age distribution
349
Stages of Demographic Transition
``` Stage 1 - High Stationary Stage 2 - Early Expanding Stage 3 - Late Expanding Stage 4 - Low Stationary Stage 5 - New Declining ```
350
Stage 1
High Birth Rate High Death Rate Very Low Rate of Natural Increase
351
Stage 2 (Early Expanding)
Birth Rate High Drop in Death Rate Population Increases
352
Stage 3 (Late Expanding)
Decline in Birth Rate Decline in Death Rate Population Stable (Children not a necessity)
353
Stage 4 (Low Stationary)
Birth Rate low Death Rate Low Population Stable RNI approaches 0
354
Stage 5 (New Contracting Declining)
Death Rate > Birth Rate Population Shrinking 0 Growth
355
Examples of Stage 5 Countries
Germany Japan (0 Growth)
356
Examples of Stage 4 Countries
``` UK Denmark Sweden Australia (RNI Approaching 0) ```
357
Examples of Stage 2
South Asia Africa (Population Increases)
358
Age Dependency Ratio Equation
Population Under 15 + Over 64 / 15-64 | *100
359
Types of Population Pyramid
Expansive Constrictive Stationary
360
Developing countries - Pyramid
Expansive
361
Transition Phase Countries Pyramid
Constrictive
362
Western European Countries Pyramid
Stationary
363
Define Health Education
Systematic Planned Application to influence antecedents of behavior
364
Health Education Levels
Counseling - One on One Group Discussion - Group of People Community - Multiple Level
365
Define Health Literacy
Capacity to obtain / interpret / understand basic health information
366
Health Promotion
``` Promote Social Responsibility Increase Investments for health Expand Partnerships for health Increase Community capacity Secure an infrastructure ```
367
Tools of Health Promotion
``` Mass Media Social Marketing Community Mobilization Health Education Client Provider Interactions Policy Communication ```
368
Six Stages of Social Marketing
``` Listening (To target) Planned (Objective Defined) Structuring Pretesting (Tested) Implementing (Put into effect) Monitoring (Progress Tracked) ```
369
Effects of Global Warming on Health
Increased Temperatures Extreme Temperatures Vector Borne Illnesses
370
Effect of Air Quality on Health
Increase in CVD & Respiratory Disease
371
Effect of increase in VB Transmission
Lyme Disease
372
Effect of increase in flooding
Mental Health Drowning GI
373
What is the most common health risk associated with drinking water
Microbial Contamination
374
Water Acceptability Aspects
No Taste & No Odor No Turbidity Hardness Varies
375
Which microorganisms can be transmitted by ingestion
Cholera | Shigellosis
376
Which mo are transmitted by inhalation
Legionnaire
377
Which mo are transmitted by contact
Schistosomiases | Leptospirosis
378
How is cholera transmitted
feco-oral | Contamination
379
L.Pneumophila
Inhalation of aerosols | Shower / Spa / Humidifier
380
How does the leptospiral organism enter the body?
Cuts / Abrasions / Mucous Membranes
381
Chlorine pH for effective disinfection
Less than 8
382
Methods of disinfection
Chlorination Solar Disinfection UV Light Radiation
383
How can food be contaminated at production level
Untreated Manure - Amoebiasis Polluted Water Washing Fruits/Veggies in polluted Canal Water (Fascioliasis) Animal Food (Taenia)
384
At Manufacture level
Botulism
385
pH / Temp that is suitable for bacterial growth
4.6 - 7.5 | 5 - 60 Celsius
386
How long does it take for bacteria to double
20 Mins
387
Water activity suitable for growth
0.85+
388
WHO Five Keys to Safer Food
``` Keep Clean Separate Raw / Cooked Cook Thoroughly Safe Temp Safe Water / Raw Material ```
389
Type of Virus that causes Yellow Fever
RNA Virus | Flavivirus Family
390
Yellow Fever Belt
15N - 10 S
391
What are the primary reservoir of Yellow Fever?
Monkeys
392
Vaccine used in Yellow Fever
17D Vaccine
393
Which type of Vaccine is 17D?
Live Attenuated
394
What is given after receiving the Yellow Fever Vaccine?
Stamped International Certificate of Vaccination / Prophylaxis
395
Traveling Precautions (Yellow Fever)
Vaccine 10 Days before traveling | >10 Quarantine remaining days in country
396
Mode of Transmission of Yellow Fever
Aides Mosquito Bite
397
Incubation Period of Yellow Fever
3 - 6 Days
398
Dengue Virus Mode Of Transmission
Aedes Aegypti Mosquito
399
Define EIP (Dengue)
Time from ingesting virus to new host
400
EIP Duration (Dengue)
8 - 12 Days
401
When to suspect Dengue
``` 40+ Fever 2 Symptoms (Headache / Pain Behind Eyes/ MSK Pains / NV / Rash / Swollen Glands) ```
402
Ebola Mode of Transmission
Close Contact
403
Incubation Period of Ebola
2 - 21 Days
404
Ebola Virus Drugs
Inmazeb | Ebanga
405
Ebola Vaccine
Ervebo
406
Ebola Presentation
Dry Symptoms | Organ Failure
407
Lymphatic Filiarsis agent
Roundworms (Filariodidea)
408
Lymphatic Filariasis worm subtypes
Wuchereria Bancrofti (90%) Brugia Malayi Brugia Timori
409
Leishmaniasis Forms
Visceral Leishmaniasis Cutaneous Leishmaniasis Mucocutaneous Leishmaniasis
410
Visceral Leishmaniasis
``` Kala Azar Fatal if untreated Fever / Weight Loss Hepatosplenomegaly Anemia ```
411
What is the vector in Leishmania
Phlebotomine Sandflies
412
Contamination of environment by any agent
Air Pollution
413
Major Outdoor Air Pollutants
Nitrogen Oxide Sulphur Dioxide Ozone Carbon Monoxide
414
Main source of Nitrogen Oxides
Traffic Emissions | Product of combustion
415
Sulphur Dioxide Sources
Industry (Petroleum Fuel) | Traffic
416
What is ozone
Gas comprised of 3 atoms of oxygen
417
Function of Stratospheric Ozone
UV Rays Protection (Shield)
418
What is tropospheric ozone
Ground Level Ozone | Harmful Pollutant
419
What creates Tropospheric Ozone?
Oxides of Nitrogen Volatile Organic Compounds Sunlight
420
PM2.5 / PM10 ?
PM2.5 - Particles with a diameter less than 2.5 | PM10 - Particles with a diameter less than 10
421
What are the guidelines regarding PM2.5/10?
PM2.5 - Should not exceed 10 | PM10 - Should not exceed 20
422
What creates sulfuric / nitric acid or acid rain?
Sulfur / Nitrogen Oxides + Bodies of Water
423
Outdoor air pollutant associated with largest health effects 2.5/10 ?
PM2.5
424
Techniques of Waste Management
Recycling Landfill Composting Incineration
425
What is the most prevalent method of solid waste disposal?
Sanitary Landfill
426
What is the benefit of Sanitary Landfill?
Methane Gas can be recovered for use
427
Large scale area where trash is dumped is called?
Open Dumping
428
Disadvantages of Dump
Foul Odors Diseases Contamination
429
Decomposition of waste into humus
Composting
430
Converting waste materials into ash / flue gas / heat
Incineration
431
Best way to dispose of hazardous hospital waste?
Incineration
432
Sideeffects of incineration
Carcinogenic
433
Compostable Items
Soiled Paper Fruit Peels UCLA Food Containers
434
Landfill Items
Plastic Bottles w/liquid Cans w/liquid Cups Tissue
435
Recyclable Items
Cartons Glass Bottles Coffee Sleeves / Lids Newspapers
436
Hospital Waste Classification
``` Infectious Pathological Sharp Chemical Pharmaceutical Cytotoxic Radioactive General ```
437
Hospital Color Coding
``` Red - Blood White - Dental Orange - Infectious Yellow - Highly Infectious Blue - Medicine Purple - Chemo Medicine Black - Normal Waste ```
438
Injury caused by medical management
Adverse Event
439
AE Caused by error
Preventable AE
440
Failure of planned action to be completed
ERROR
441
Error but no AE
Near Miss
442
Overdose discovered but countered with Antidote
Mitigation
443
Overdose was prevented
Prevention
444
Overdose didnt do anyrhing
Chance
445
Slips vs Lapses
Slips - Action Observable | Lapse - etc. Forgetting
446
Incident Reporting
Collecting and analyzing information about AE
447
Sentinel Event
AE where death / serious harm occured
448
Retrospective approach to studying errors and identifying problems
Root Cause Analysis
449
Healthcare Associated Infections
Infections 48+ Hours after admission
450
Four categories of HAI
Catheter Bloodstream Surgical Pneumonia
451
Most Common HAI Pathogens
C. Difficile (Leading) | S. Aureus
452
Pathogen responsible for CAUTI
C. Difficile
453
Most Common Pathogen CLABSI
S. Aureus
454
How to prevent Central Line BSI
Avoid Femoral Vein in Adults
455
Most common surgical site infection Pathogen
S. Aureus
456
Surgical Site Aseptic Solution
Chlorhexidine Gluconate Based
457
Smoke emitted from cigarette between puffs
Side Stream Smoke
458
Residual Tobacco Smoke on surfaces
Third Hand Smoke
459
DRI Increase Second Trimester
(2)340
460
DRI Increase Third Trimester
(3)450
461
Protein increase in pregnancy
25
462
Zinc Requirements 1-3 + 3-8
1-3 - 3mg | 3-5 - 8mg
463
Iron Requirements 1-3 + 3-8
1-3 - 7mg | 3-8 - 10mg
464
Desirable WHR in Men / Women
Men - 0.9 | Women - 0.8
465
Waist Circumference risky for obesity disease
Men - Greater than 102 | Women - Greater than 88
466
Skinfold measurements areas
Men - Chest / Ab / Thigh | Women - Tricep / Suprailiac / Thigh
467
Public Health Approach
Surveillance Risk Factor Identification Intervention Evaluation Implementation
468
Most Effective Intervention to Reduce HIV Transmission
Condoms (85 %)
469
Risk of Transmission Needle Stick Injury HIV+
3/1000
470
Risk of Transmission Receptive Anal
1/1112
471
Post Exposure Prophylaxis HIV Drugs
Truvada + Kaletra
472
Suspect Case
Clinical Findings Only
473
Probable Case
Clinical Features + Epidemiological Base | No Lab Confirmation
474
Confirmed Case
Confirmatory Lab Tests
475
Types of Surveillance
Passive Active Sentinel Syndromic
476
Passive Surveillance
Using Available Data on Notifiable Diseases No Active Search Underreporting likely Cheap
477
Active Surveillance
Specifically Recruited Case Finding More Accurate More time / resources
478
Sentinel Surveillance
``` High Quality Data Needed High Probability Signal Trends / identify Outbreaks Monitor Burden Not Effective for Rare Diseases ```
479
Syndromic Surveillance
Preferred for Bioterrorism
480
Alpha Error - Type 1 Error
Probability of Rejecting True Null Hypothesis
481
Probability of Beta Error - Type II Error
Probability of accepting false null hypothesis
482
Power
Probability of rejecting false null hypothesis
483
Quantitative Variable Types
Binary Nominal - Names Ordinal - Order
484
Quantitative Variable Types
Discrete (1/2/3) | Continuous (Decimals Included)
485
Pre Contemplation
No intention of taking action in the next six months
486
Contemplation
Intends to take action in the next six months
487
Preparation
Intends to take action in the next 30 days
488
Action
Changed Behavior (< 6 Months)
489
Maintenance
Changed behavior 6+ Months
490
Termination
0 Temptation to relapse (5+ Years)
491
Universal Health Coverage Requirements (4)
Health System Financing System Access to Medicine Health Workers
492
Common models of Health System
LICUS (Low Income Under Stress) Fragmented Universal

Y5 (6 decks)

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