Healthcare Abroad & Family Travel Flashcards
(117 cards)
1
Q
what are 3 types of policies for travel insurance?
A
travel insurance
travel health insurance
medical evacuation insurance
2
Q
what does travel insurance protect?
A
financial investment in a trip - lost baggage, trip cancellation (eg. due to illness)
-might not cover medical expenses abroad
3
Q
what does travel health insurance and medical evacuation insurance cover?
A
short-term supplemental policies, cover health care costs incurred while abroad.
4
Q
what are the main reasons for coverage refusal from traveling health insurance?
A
preexisting illness
poor documentation of expenses incurred
5
Q
what are the chances of purchasing a counterfeit drugs in specific regions in Africa, Latin America, and Asia?
A
<30%
6
Q
a …. product bears the unauthorized representatino of a registered trademark on a product identical or similar to one for which the trademark is registered
A
counterfeit
7
Q
a …. product falsely represents the product’s idenitity, source, or both.
A
falsified
8
Q
a … product fails to meet national specifications cited in an accepted pharmacopeia or in the manufacturer’s approved dossier
A
substandard
9
Q
a … product has undergone chemical or physical changes due to incorrect storage conditions
A
degraded
10
Q
what is the most common complication among medical tourists?
A
infection
-bloodborne infection: hep B, hep C, HIV
-bloodstream infection
-donor-derived infections
-would infections
-AB-resistant infections: CRE-carbapenem-resistant Enterobacterales, fungal (Candida auris) pathogens
11
Q
air travel and surgery independently increase the risk of …?
A
blood clots (deep vein thrombosis and pulmonary emboli)
12
Q
medical tourist should not fly for how many days after chest or abdominal surgery?
laser treatments or cosmetic procedures to the face, eyelids or nose?
A
10 days
7-10 days
13
Q
what is the pressure of commercial aircraft cabin?
A
6000-8000 feet above sea level
14
Q
what are accrediting organizations which maintain listings of accredited facilities outside of the US?
A
-the joint commission international
-accreditation association for ambulatory health care
15
Q
At admission, if patients had an overnight stay in a health care facility outside the US within 6 months, what should be screened for?
A
CRE (carbapenem resistance enterobacterales)
16
Q
what should be the part of pretravel assessment for pregnant traveler?
A
visit with an obstetric health care provider
17
Q
when should pregnant people seek urgen medical attention during travel?
A
-contractions or premature labor
-symptoms of deep vein thrombosis (unusual leg swelling and pain in the calf or thigh)
-pulmonary embolism (unusual shortness of breath)
-dehydration, diarrhea, vomiting
-severe pelvic or abdominal pain
-symptoms of preeclampsia (eg. severe headaches, nausea and vomiting, unusual swelling, vision changes)
-prelabor rupture of the membranes
-vaginal bleeding
18
Q
what are the absolute contraindications to travel during pregnancy?
A
-abruptio placentae
-active labor
-incompetent cervix
-premature labor
-premature rupture of membranes
-suspected ectopic pregnancy
-threatened abortion / vaginal bleeding
-toxemia, past or present
19
Q
what is relative contraindications to travel during pregnancy?
A
Abnormal presentation
Fetal growth restriction
History of infertility
History of miscarriage or ectopic pregnancy
Maternal age <15 or >35 years
Multiple gestation
Placenta previa or other placental abnormality
20
Q
what is safe OTC antihistamine for pregnant people?
A
dimenhydrinate, meclizine
21
Q
what is the caution for aspirin and anti-inflammatory agents in pregnancy?
A
ASA - increse the incidence of abruption
Other anti-infl - can cause premature closure of the ductus arteriosus
22
Q
is Hep A and Hep B vaccine safe in pregnancy?
A
safety has not been determined for A; limited data of safety for B;
ACIP recommends vaccinating if at risk
23
Q
is live-virus vaccine safe in pregnancy?
A
most live vaccines are contraindicated - MMR, live typhoid, varicella
yellow fever is the exception - pregnancy is precaution - if travel is unavoidable, and the risk for exposure outweighs the vaccination risk, it is appropriate to vaccinate –> need serologic testing after vaccination
24
Q
when the person got yellow fever vaccine while pregnant, is additional dose necessary before they are at risk for YF virus exposure?
A
yes
25
if pregnant lady is exposed to measles, what should be done?
measles immune globulin (IG) within 6 days of exposure
26
if pregnant lady is exposed to varicella, what should be done?
IG given within 10 days
27
if couple came to be vaccinated with live vaccine, how long do they have to wait if wife plans to become pregnant?
4 weeks or more
28
is quadrivalent meningococcal vaccine ok in pregnancy and lactating?
yes
29
how can malaria in pregnancy be characterized by?
-heavy parasitemia, severe anemia, profound hypoglycemia, complication by cerebral malaria and acute respiratory distress syndrome
-placental sequestration of parasites might result in fetal loss due to abruption, premature labor, or miscarriage
-low birth weight, and rare congenital malaria is possible
30
what is the drug of choice for pregnant travelers against malaria?
chloroquine - if destination is chloroquine-sensitive
mefloquine - if chloroquine-resistant
31
which malaria treatment is contraindicated or not recommended during pregnancy and why?
doxycycline - contraindicated b/c teratogenic effects after 4th month of pregnancy
primaquine - infant cannot be tested for G6P dehydrogenase deficiency (risk for hemolytic anemia)
Atovaquone-proguanil not recommended - lack of data
32
what should pregnant lady pack in her travel health kits in addition?
antacids, antiemetic drugs, graduated compression stockings, hemorrhoid cream, vaginitis/yeast infection meds, prenatal vitamins, Rx meds
blood pressure monitor if travel will limit acceess to a health center
33
pregnant people should not consume water purified by ..... because of potential effects on the fetal thyroid
iodine-containing compounds
34
which hepatitis infections are concern for pregnant people?
Hep A - placental abruption and premature delivery
Hep E - severe disease and could result in a case-fatality rate of 15-30%; if acquired during the third trimester associated with fetal complications and fetal death
35
what is listeriosis and how this is a risk at pregnancy?
foodborne illness caused by bacteria Listeria monocytogenes - found in nature, in soil, groundwater, rotting vegetation and animal feces.
can cross the placenta and cause spontaneous abortion, stillbirth, or congenital or neonatal infection
36
what do you need to advise them about listeriosis and toxoplasmosis during pregnancy?
do not eat unpasteurized cheese and uncooked or undercooked meat products!
37
do you need to treat parasitic infections (helminths) during pregnancy?
no - can wait till pregnancy is over
38
do you need to treat protozoan intestinal infections (e.g. Cryptosporidium, Entamoeba histolytica, Giardia) during pregnancy? why?
yes - cause acute gastroenteritis, severe dehydration, chronic malabsorption --> fetal growth restriction
E. histolytica can cause invasive disease, including amebic liver abscess and colitis.
39
what do you tell pregnant lady to prevent schistosomiasis?
don't bath, swim, or wade in freshwater lakes, rivers, streams that can harbor the parasitic worms (schistosomes) that cause schistosomiasis.
40
what can you prescribe for traveller's diarrhea if pregnant?
azithromycin or 3rd-gen cephalosporin
(no bismuth subsalicylate, no fluoroquinolones)
41
how is zika virus transmitted?
-bite of an infected Aedes mosquito (Ae. aegypti and Ae. albopictus)
-sexually
42
what are the symptoms of zika?
can be asymptomatic or mild
-acute onset of conjunctivitis, fever, joint pain, rash
43
what birth defects does Zika cause in pregnancy?
brain, eye, neurodevelopmental abnormalities
44
why is air quality more healthy problems during pregnancy?
ciliary clearance is slower
mucus more abundant
45
what do you guide pregnant lady about high elevation travel ?
don't sleep at elevations >12,000 ft (3600m)
46
when you are pregnancy, upto when/what week the airlines allow you to fly?
what about cruise ship travel?
36 weeks
24 weeks
47
to help prevent DVT, pregnant travelers should do...
stay hydrated, stretch, walk and perform isometric leg exercises, wear graduated compression stockings
48
which malaria chemoprophylaxis is good to use when breastfeeding?
chloroquine, mefloquine
doxycycline - short-term use is ok
primaquine - if G6PD is good with mom and baby
atovaquone-proguanil - not recommend if baby is <5kg
49
if mom has traveller's diarrhea, is it ok to breastfeed?
yes - TD do not pass into breast milk.
50
what AB for Travellers' diarrhea is ok to use when breastfeeding?
azithromycin
51
is live vaccine ok when breast feeding?
most live and inactivated vaccines do not affect breastfeeding;
but, yellow fever, and smallpox (vaccinia) require special consideration
- preexposure smallpox vaccine is contraindicated in breastfeeding people because of the risk for contact transmission to the breastfed child
52
is YF vaccine when breastfeeding ok?
precaution!
avoid vaccinating but if the mom must travel to a YF endemic area, vaccination should be recommended.
pump and discard milk for 2 or more weeks after vaccination
53
if mom has zika virus, can she still breastfeed?
yes
54
Use of powdered infant formula has been associated with --- infection
Cronobacter infection
55
what is kid's dose of azithromycin for TD?
10mg/kg for 3 days
56
what is fluoroquinolone indicated for kids?
fluoroquinolones be considered for treatment of children with severe infections caused by multidrug-resistant strains of Campylobacter jejuni, Salmonella species, Shigella species, or Vibrio cholerae.
57
what is the risk of using fluoroquinolone in kids?
Fluoroquinolone resistance in gastrointestinal organisms has been reported from some countries, particularly in Asia. In addition, use of fluoroquinolones has been associated with tendinopathies, development of Clostridioides difficile infection, and central nervous system side effects including confusion and hallucinations. Routine use of fluoroquinolones for prophylaxis or empiric treatment for TD among children is not recommended.
58
what is rifaximin indicated for kids 12 and up?
noninvasive strains of E. coli only
59
Children with bloody diarrhea should receive medical attention, because ...
antibiotic treatment of enterohemorrhagic E. coli, a cause of bloody diarrhea, has been associated with increased risk for hemolytic uremic syndrome
60
BSS is not recommended for children aged ...
years
<3 years in general;
<12 years old to treat diarrhea;
61
A Cochrane Collaboration Review of the use of antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents showed some benefits with ...
dimenhydrinate, metoclopramide, or ondansetron.
62
A recent systematic review and network meta-analysis comparing several antiemetics in acute gastroenteritis in children showed that ... was the best intervention to reduce vomiting and prevent hospitalization and the need for intravenous rehydration.
ondansetron (>4 years)
63
loperamide is particularly contraindicated for children aged < 2 years because..
the risks for respiratory depression and serious cardiac events.
64
Antimotility drugs (e.g., the opioid receptor agonists loperamide and diphenoxylate), generally should not be given to children .... years of age with acute diarrhea.
<18 years
65
Diphenoxylate and atropine combination tablets should not be used for children aged ----years, and should be used judiciously in older children because of potential side effects
< 2 years
66
Once prepared, Oral Rehydration Solution should be consumed or discarded within -- hours if held at room temperature, or within -- hours if kept refrigerated.
12, 24
67
In general, children weighing <22 lb (10 kg) who have mild to moderate dehydration should be administered -- of ORS for each diarrheal stool or vomiting episode. Children who weigh ≥22 lb (10 kg) should receive -- of ORS for each diarrheal stool or vomiting episode.
2–4 oz (60–120 mL);
4–8 oz (120–240 mL)
68
which malaria meds have a bitter taste?
Atovaquone-proguanil, chloroquine, and mefloquine
69
Because overdose of antimalarial drugs, particularly --- , can be fatal, store medication in childproof containers and keep out of the reach of infants and children.
chloroquine
70
Most EPA-registered repellents can be used on children aged >2 months, except products containing --or --that specify they should not be used on children aged <3 years. Insect repellents containing DEET, picaridin, IR3535, or 2-undecanone can be used on children without age restriction.
OLE or PMD
71
what is the lowest effective DEET concentrations that seems most prudent for infants and young children, on whom it should be applied sparingly.
20-30%
72
Children are more likely than adults to have contact with soil or sand, and therefore could be exposed to diseases caused by infectious stages of parasites in soil - what are 6 likely infections from soil?
ascariasis, hookworm, cutaneous or visceral larva migrans, strongyloidiasis, and trichuriasis.
73
will Antihistamines and decongestants have been shown to be of benefit?
no
74
The safest place for a child on an airplane is in a government-approved -- system or device.
child safety restraint system
75
what are nonspecific symptoms of high altitude sickness in kids?
loss of appetite or irritability, unexplained fussiness, changes in sleep and activity patterns
76
what is the age indication of acetazolamide for altitude illness? what is the dose if need to use it?
not approved for kids <12 years for altitude illness, but generally sae for use in kids for other indication;
2.5mg/kg every 12 hours
77
what is the leading cause of death in children who travel?
what is the second leading cause of death in young travelers?
vehicle-related injuries;
drowning
78
what factor does exposure to ultraviolet (UV) light is greatest?
Exposure to ultraviolet (UV) light is greatest near the equator, at high elevations, during midday (10 a.m.–4 p.m.), and where light is reflected off water or snow.
79
what are physical UV filters called?
what are they?
inorganic UV filter;
titanium oxide, zinc oxide
80
babies aged < 6 months require extra protection from the sun because ---
their thinner and more sensitive skin
81
If both sunscreen and a DEET-containing insect repellent are used, apply which one first?
can insect repellent diminish the level of UV protection provided by the sunscreen ?
apply the sunscreen first;
diminish the level of UV protection by as much as one-third
82
if your infant is 6-11 months old, which vaccine should the baby get for traveling (earlier than routine vaccine schedule)?
hep A & MMR
83
if your baby is less than 6 months, traveling to where hep A protection is recommended, what dose should IG be given?
0.1ml/kg IM (if travel within 1 month) or
0.2ml/kg IM (if travel more than 1 month) Q2months
84
if immunocompromised or chronic medical conditions, and traveling to high-risk of hep A area in <2 weeks, what should be given?
initial dose hep A vaccine + IG at separate anatomic injection sites
85
what vaccines does hep A IG interact with?
MMR, varicella (not YF) for up to 6 months
86
what is the minimum interval of MMR vaccines?
MMRV vaccines?
28 days;
3 months
87
what is age indication for MMRV vaccine?
12 month to 12 years
88
how old does baby need to be in order to get vaccination for miningococcal quadrivalent conjugate vaccine?
2 months old
89
is Men B recommended for travel to the meningitis belt or other regions of the world?
no - unless an outbreak
90
when do you consider meningococcal B vaccination for infants?
residing in the countries according to the routine infant immunization recommendations
91
when do you recommend Polio vaccine?
if countries have circulating polio during the last 12 months;
92
what age is Tick-born encephalitis vaccine approved?
1 year and older
93
what is the dose of tick-born encephalitis vaccine?
3 doses;
1-15 yrs old - 0, 1-3 months
16 and older - 0, 14 days-3 months
3rd dose 5-12 months after receiving their 2nd dose;
if ongoing exposure, booster 3 years later
94
what is the min age of typhoid vaccine?
2 years old for injection;
6 years old for oral
95
what is the min age for YF vaccine?
9 month old;
6-8 months only if they must travel
96
what are list of infectious disease screening tests recommended by the American Academy of Pediatrics (AAP) for ALL internationally adopted children?
hep A, B, C
HIV 1 & 2
Intestinal pathogens - Ova and parasites, cryptosporidium, giardia duodenalis;
Syphilis;
Tuberculosis
97
what are list of infectious disease screening tests recommended by the American Academy of Pediatrics (AAP) for internationally adopted children with eosinophilia?
lymphatic filariasis;
schistosomiasis;
strongyloidiasis;
Toxocara canis;
98
what level of eosinophil count warrants further evaluation for internationally adopted children?
>450 cells/ml
99
Investigation of eosinophilia (for adopted children) also should include serologic evaluation for -- and -- ; both are found worldwide.
Strongyloides stercoralis
Toxocara canis
100
For children positive for HBsAg, what do you need to do?
retest 6 months later to determine if they have chronic infection
101
what do you test if adopted children has chronic HBV infection?
hepatitis e antigen
hepatitis B e antibody
HBV viral load
hepatitis D virus antibody
liver function
102
which test is used for children 18 months and older for hep C?
antibody testing (IgG ELISA)
103
which test is used for children younger than 18 months for hep C?
PCR testing
104
if an adopted baby <18 month old has HIV antibodies, what do you need to do?
what screening test is available?
it may be reflecting maternal antibodies rather than infection.
HIV1/HIV2 antigen/antibody combination assay for standard screening, but some experts recommend PCR for any infant aged <6 months on arrival to the US to confim the diagnosis in an infant or child.
If PCR testing is done, 2 negative results from assays administered 1 month apart, at least 1 of which is done after the age of 4 months, are necessary to exclude infection.
some recommend repeating screening for HIV antibodies 6 months after arrival if the initial test results are negative.
105
an adopted kid has persistent growth delay, or has ongoing or recurrent symptoms or unexplained anemia. what tests are needed?
Parasitic
- GI parasites - 3 stool samples early morning 2-3 days apart --> test for ova and parasite detection
- Cryptosporidium or Giardia - combined antigen test
Bacteria
- stool testing for kids with fever and diarrhea, especially acute-onset bloody diarrhea
- non-culture methods commonly used
106
is routine malaria screening recommended for aopted kid?
no - but obtain thick and thin malaria smears immeidately for any kid coming from a malaria-endemic area who presents with fever or who has symptomatic splenomegaly; or kid with asymptomatic but with splenomegaly
107
is screening for Treponema pallidum (Syphilis) recommended for all internationally adopted children?
yes - but treponemal tests remain positive for life in most cases, even after treatment - conduct a full evaluation for disease if positive
108
where is Chagas disease endemic to?
Mexico and throughout countries in Central and South America;
109
if kid is adopted from endemic areas of Trypanosoma cruzi (Chagas) infection, what screening should be done? at what age?
serologic test if kid 9-12 months old;
PCR if <9 months old
110
do you screen all adopted kids for TB? which test is recommended?
yes - TST for children < 2 years
TST or IGRA for 2 and older
if kids vaccinated with BCG, IGRA is more specific than the TST for Mycobacerium tuberculosis infection
retest 3-6 months after negative results
111
which routine vaccines are probably needed for adopted kid from low/mid income countries?
Haemophilus influenzae type b (Hib);
Hep A; HPV; meningococcal, mumps, pneumococcal conjugate, rotavirus, rubella, varicella vaccines
112
if you perform antibody testing to revaccinate an adopted kid, what do you need to consider?
pertussis - Bordetella pertusis antibody titers do not correlate with immune status
hep B - anti-HBs as a correlate of vaccine-induced protection has only been determined for people who have completed an approved vaccination series; but if kid has positive hep B surface antibody and positive hep B core antibody, vaccination is not required, as they are considered immune after natural infection
113
which testing is needed for children >6 months of age to consider revaccination for an adopted kid?
for >12 months?
6 month: diphtheria (IgG), hep B, Hib, tetanus (igG)
12 month: hep A, measles, mumps, rubella, varicella
114
which vaccine do you need to consider for adopted kid without testing?
for children born on or after 2016 April who do not have documentation of receiving IPV according to an approved schedule, administer Polio;
penumococcal 13
115
which noninfectious diseases should be performed in all or in selected adopted kids?
CBC, hemoglobin, eleectrophoresis,
G6PD deficiency screening
serum level thyroid-stimulating hormone,
blood lead level
serum levels of iron, iron-binding capacity, transferrin, ferritin, total vitamin D 25-hydroxy
vision and hearing screening, dental evaluation
neurologic and psychological testin if there is any concern
116
what is the definition of 'service' dog?
trained to do work or perform tasks for the benefit of a person with a disability, including an intellectual, mental, physical, psychiatric, or sensory disability;
DOJ (the Department of Justice) does not recognize emotional support animals as service animals, and airline carriers are not required to recognize emotional support animals as service animals.
117
