Miscellaneous Flashcards
(107 cards)
1
Q
Encephalitis Seizures
A
Neurocysticercosis is the most common preventable cause of epilepsy
2
Q
Misc Social innovation
A
Community-engaged process that sees the wisdom of communities and impacts social and health outcomes eg pay-it-forward
3
Q
STI Screening What
A
Importance of condition, high prevalence
4
Q
STI Screening Why
A
Curable, treatable, preventable, effective
5
Q
STI Screening How
A
Tests avaiable, sens/spec, simple, feasible, cost effective
6
Q
STI Screening Who
A
Acceptability
7
Q
STI Screening When
A
Accessibility
8
Q
STI Screening Where
A
At high risk of infection or complications
9
Q
STI Screening Pregnancy
A
CT/NG, TV, TP, HIV, HBV
10
Q
STI POCT Environment
A
Power supply, Space, Security, Temperature/humidity
11
Q
STI POCT Devlice limintations
A
Analytic capacity, maintenance, reliance on technology
12
Q
STI POCT Provider buy-in
A
Impact on workload/services, staffing
13
Q
STI POCT Patients
A
Competing priorities - willingness to wait for results (?true POCT)
14
Q
STI Incidence 2020
A
TP 7.1m GC 82m CT 129m TV 156m
15
Q
STI Prevalence 2020
A
HBV 296m HPV 300m HSV 490m
16
Q
STI High frequency transmitters
A
Sex workers, others with high numbers of sexual partners
17
Q
STI Bridging population
A
male clients of female sex workers (this becomes less relevant if general population has high background risk)
18
Q
STI Partner notification
A
Little evidence of effectiveness in LMIC and potential harm (violence, abuse)
19
Q
STI Male circumcision
A
60% reduction in HIV incidence, 25-45 reduction in GUD, HSV, TV, HPV, little effect GC/CT from voluntary medical male circumcision (VMMC)
20
Q
STI Management
A
Syndromic mx recommended where diagnostic tests arent available - urethral/cervical discharge, vaginal discharge, genital ulcer
21
Q
STI Urethritis cause
A
GC, CT, TV, MG
22
Q
STI Urethritis/cervicitis treatment
A
GC CRO+Azith, CT Doxy or Azith, TV Metro, MG Azith
23
Q
STI Vaginal discharge cause
A
TV, Calb, BV, CT, GC
24
Q
STI Vaginal discharge treatment
A
TV Metro, Calb Clotri pessary, BV Metro
25
STI Genital ulcer cause
HSV, TP, Hducreyi (Chancroid), K granulomatis (Donavanosis), CT LGV
26
STI Genital ulcer treatment
HIV aciclovir, TP Benzathine pen, Hducreyi Azith, Kgranu Azith, CT LGV Azith or Doxy - treatment of GC/CT has wiped out Hd & Kg
27
STI WHO screening recommendation
HIV and Syphilis should both be tested
28
Snakebite Annual mortality
>130,000
29
Snakebite Annual morbidity
400,000 (physical or psychological)
30
Snakebite Recognised as NTD
2016
31
Snakebite Epidemiology
Depends on human-snake interaction (agriculture, building projects, travel, sleeping on ground, intentional handling, nocturnal hunting, mating season), weather, and children
32
Snakebite Viperidae
Viper, adder, moccasins, rattlesnakes > short thick body, distinctive dorsal pattern, long fully erectable fangs which penetrate deep into tissues > shock, coagulopathy etc
33
Snakebite Elapidae
Cobra, krait, mambas, all Oceanian/Aus, and sea snakes > long thin body and tail, uniformly coloured, fast, short permanently erect front fangs > descending flaccid paralysis, bilateral ptosis -> bulbar (+coagulopathy etc)
34
Snakebite Snake venom
Complex - 100 protein/polypeptide toxins including phospholipases, metalloproteases, serine proteases, three-finger toxins (neuro- cyto-toxins) which clip over acetylcholine receptor > paralysis
35
Snakebite Clinical effects
Cytotoxicity (swelling, bruising, necrosis)l Haemo (coagulopathy), Neuro (descending flaccid paralysis), Cardio (arrhythmia, myocardial damage, leak, shock, orthostatic hypotension), Myo (rhabdo, hyperkalaemia), Nephro (AKI)
36
Snakebite Clotting 20min test
Clean dry glass vessel, tip once, positive (no clotting), negative (clotting)
37
Snakebite Prevention
Education, Protect feet, legs and hands, use light and prodding stick, sleep off the ground
38
Snakebite First aid
Remove from danger, reassure, immobilise, remove any potential tourniquets, pressure-pad-immobilisation, transport rapidly in recovery position and admit for 24h
39
Snakebite Pressure pad immobilisation
compress veins and lymphatics in immediate vicinity of bite
40
Snakebite Antivenom
Refined IgG from hyperimmune horse/sheep plasma, scare and expensive to produce, only neutralises venom used in manufacture - cover medically-most-important snakes in geographical region
41
Snakebite Antivenom indications
Shock, Systemic envenoming - incoagulable blood, neutrotoxicity (ptosis), black urine, rapidly progressive local swelling (bites over digits)
42
Snakebite Antivenom administration
Check species covered, infuse IV 10-60min, same dose for adults & children, prophylactic adrenaline SC may reduce reactions
43
Snakebite Antivenom reactions
IM adrenaline, early pyrogenic and/or anaphylactic reactions, late serum sickness
44
Snakebite Adjunctive care
Tetanus, drain abscess & remove necrotic tissue, early rehabilitation. No evidence for other Rx including fasciotomy
45
Arthropod bite Prevention
Wear boots, repellants, search clothing & footwear/backpack, sleeping environment etc, sleep under insecticide impregnanted bed net
46
Arthropod bite Scorpion epidemiology
>3250 fatalities, in Mexico, Sth America, Africa, Middle East, India, esp children, prevention is excluding from home and awareness, UV light useful
47
Arthropod bite Scorpion mechanism
Ion channel stimulate/block cation Na K Ca channels > parasympathetic (cholinergic) and sympathetic (adrenergic)
48
Arthropod bite Scorpion symptoms
Severe local pain, Systemic 'autonomic' storm from massive release of acetylcholine and catecholamines -> shock, arrhythmias, erratic eye movements, muscle spasms
49
Arthropod bite Scorpion treatment
Lignocaine infiltration, antivenom in some countries, and/or prazocin/vasodilators in ICU
50
Arthropod bite Spiderbite Epidemiology
Very few bites, common in Americas, mediterranean, South Africa, Australia
51
Arthropod bite Spiderbite Necrotic arachnidism
Brown recluse spiders - local pain, swelling, followed by classic red-white-blue sign, generalised rash, malaise, eventually eschar, necrotic slough, systemic sx 4-10%
52
Arthropod bite Spiderbite Neurotoxic arachnidism
Black/brown cosmopolitan spiders & funnel well - local immediat epain, sweating, systemic rapidly evolving headache, NV, priapism, muscle spasms,
53
Arthropod bite Hymenoptera anaphylaxis
History, mast cell tryptase, venom-specific IgE (skin or RAST), treat with adrenaline
54
Marine injury Water organisms
Salty V vulnificus, Brackish A hydrophila
55
Marine injury Treatment
Remove from water to prevent drowning, immerse hot water 45C, box JF wash/shave tentacles with sea water, topical lignocaine, antivenom for seawasp and scorpion fish
56
Marine injury Jelly fish prevention
Obey warning, don't swim alone in tropical seas, protective clothing, stings may hypersensitise with anaphylaxis on reexposure
57
Marine injury Other marine sting prevention
Beware of handing fish, avoid touching coral, anenomes, sea snakes etc, beware wading barefoot
58
Marine injury Poisoning
Scombroid 1-120min, Puffer 10-180min, Shellfish 30-180min, Ciguatera 1-12h
59
Marine injury Ciguatera
1-12h, GI sx plus paraesthesias (esp hot-cold reversed sensation), rash, bradycardia, hypotension, can be confirmed by toxin detection in fish remnant (but not in patients) treat supportive +/- mannitol (controversial), amitriptyline
60
Marine injury Scombroid
1-120min immediate perioral tingling, progressing to anaphylactic response, treat with histamine inhibitors +/- adrenaline
61
Marine injury Poisoning prevention
Don't rely on cooking - seafood toxins are heat/acid stable, avoid large fish (>10kg), eat only fresh fish and never eat puffer fish, avoid shellfish in red algae, don't swallow seafood tha tmakes your lips tingle
62
Global Surgery Epidemiology
5bil lack access to surgical care, 18 mil deaths could be avoided, 33mil face catastrophic expense after surgical care, 30% of Global Health Burden require surgery
63
Global Surgery Definition
Multidisciplinary field concerning the improved and equitable access to surgical care across international healthcare systems with focus on LMICs
64
Global Surgery Minimum procedures required
Laparotomy, C-section, Open fracture management and wound debridement, D&C, closed fracture reduction
65
Global Surgery Burn depth
1 superficial 2A sup partial (red, painful, weeping), 2B deep partial (red, painful, dry), 3 full thickness (black/white, no feeling)
66
Global Surgery Burn assess BSA
1% BSA is size of child's hand
67
Global Surgery Burn management
Fluid (Modified Parkland), Pain (affects catabolism), Nutrition, Infection control, Tetanus vax
68
Global Surgery Aim
Early referral and advice, transport
69
NTD Definition
Disproportionately affects populations living in poverty; and causes important morbidity and mortality – including stigma and discrimination - in such populations, justifying a global response
70
NTD Epidemiology
Primarily affects populations living in tropical and sub-tropical areas
71
NTD Schistosoma strategy
MDA (praziquantel), sanitation, snail control
72
NTD Onchocerca strategy
MDA (ivermectin), (vector control) - does not kill adult worm, need to treat for long time, and barrier to ivermectin use in loa loa endemic regions -> cerebral inflammation
73
NTD Lymphatic filariasis strategy
MDA (ivermectin, albendazole), vector control - does not kill adult worm, need to treat for long time
74
NTD Trachoma strategy
MDA (azithromycin), water, sanitation, education
75
NTD Yaws strategy
MDA (azithromycin)
76
NTD Soil transmitted helminth strategy
MDA (albendazole)
77
NTD Guinea worm strategy
Safe water, health education
78
NTD HAT strategy
Case finding and treatment (vector control)
79
NTD Visceral leishmaniasis strategy
Case finding and treatment
80
NTD Leprosy strategy
Case finding and treatment
81
NTD Taeniasis/cysticercosis strategy
Sanitation, meat inspection, vaccination of pigs
82
NTD Echinococcosis strategy
Abbatoir control, treatment of dogs, education
83
NTD Foodborne trematodes strategy
Treatment of sheep, health education
84
NTD Chagas disease strategy
Vector control, blood screening
85
NTD Buruli ulcer strategy
Case finding and treatment
86
NTD Rabies strategy
Vaccination of dogs, health education
87
NTD Dengue and Chikungunya strategy
Vector control
88
NTD Mycetoma strategy
Case finding and treatment
89
NTD Scabies strategy
?MDA (ivermectin)
90
NTD Snakebite strategy
?Case finding, education - not yet established
91
NTD Noma strategy
?Case finding and treatment - not established
92
NTD Elimination
Reduction to zero of the incidence of a disease in a defined geographical area. Continued interventions required to prevent re-introduction
93
NTD Eradication
Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent. Intervention measures no longer needed
94
NTD Biological req for elimination/eradication
Intervention effective, Surveillance (good diagnostic), No animal reservoir
95
NTD Social req for elimination/eradication
Recognised as public health importance, technically feasible intervention, political commitment, advocacy plan
96
NTD Negatives of elimination strategies
Lead to underreporting, lack of ongoing surveillance may lead to resurgence
97
DDx Umbilicated skin lesion SE Asia DDx
Virus M contagiosum, CMV, Fungi Crypto, Histo/Tmarneffei, Bacteria TP, TB, Non-infectious trichoepitheliomas, tuberous sclerosis
98
Biomarker Definition
a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathological processes, or pharmacological response to a therapeutic intervention
99
Medicine Quality WHO estimate SF
WHO estimated in 2017 that 10.5% of medicines in LMIC are SF (substandard or falsified)
100
Medicine Quality Substandard
Degraded - leave factory in good quality but degrade due to improper storage (frozen/heated/light exposure etc), substandard - fail to meet quality standards or their specifications or both - result from factory error
101
Medicine Quality Falsified
Medical products that deliberately/fraudulently misrepresent their identity, composition or source
102
Medicine Quality Measures
Medicine Quality Scientific Literature surveyor, early warning systems, 'Globe' monitoring system,
103
Medicine Quality Vaccine incidents
Plague vaccine 1902 contaminated with tetanus, Cutter incident 1955 Salk inactivated polio vaccine - failure of formaldehyde treatment resulting in live polio - many infections and deaths
104
Medicine Quality Monitoring devices
Minilab thin layer chromatography, Rama spectroscopy 'see through bottles', Paper analytica devices 12 lines colorimetry
105
Medicine Quality Diethylene & ethylene glycol
Used instead of propylene glycol -> renal toxins, consider if unexplained children with AKI
106
Medicine Quality Resolution
Functional regulatory authorities and monitoring, greater international political will, timely data sharing, targeted research
107
Medicine Quality Summary
Always consider SF if you encounter AE, therapeutic or diagnostic failure, surprisingly inexpensiv emedical products, typos and packaging defects, report to NMRA and WHOrapidalert. Medicine falsification is world's 3rd oldest profession - not going to go away, key to minimising occurrence and impact, screening devices hold hope, multidisciplinary approach needed with increased research
