PMCH Flashcards Preview

CanQB > PMCH > Flashcards

Flashcards in PMCH Deck (152):
1

Age most vulnerable to lead poisoning

< 6 mo

2

Organisms resistant to chlorine in water?

Cryptosporidium
Giardia
HAV
Entamoeba histolytica

3

Pneumon-Vaccine for elderly

At 65 Yr => q5yr

4

Abuse in elderly
M:F
Perpetrator
MC form
Least common form

F>M

90% adult children of elderly (alcoholic / abusers)

Neglect

Sexual

5

Spouse abuse elderly husband indicate?

Hx of violence in relationship

6

Latex allergy cross-reaction (food)

Latex-fruit syndrome

Avocado
Banana
Kiwi
Chestnut

7

MC nutritional def worldwide

Fe

8

95% CI + OR doesn't > 1?

Significant association

9

Rx for spinal mets?

No Rx increases survival

Best Rx = dexamethasone for Sx + bone pain

10

Prognostic signs of spinal mets
Bad + good

Bad = loss of sphincter tone (irreversible)

Good = ambulation

11

Features of dexamethasone compared to other steroids

1. Least mineralocorticoid activity

2. Least to associated w/ cognitive Sx

3. Least to ass w/ infection

12

HA1c of 6% = FPG?
HA1c of 7% =

Eqn

6% = 7.0

7% = 8.5%

Eqn => FPG = 1.59 x A1c - 2.59

13

Chloroquine in preg

C
Given if plan to travel to high risk

14

RR equation

RR = (A/a+b)/(c/c+d)

15

What's relative risk

Prob of event to occur in exposed group vs non exposed

16

Is HepA vaccine imp for immigrants from developing world

No
It's prevalent, chances are they've had it and immune to it.

17

Outbreak of Ecoli 0157H7 ass w/

Ground beef

18

Best way to remove ticks

Manually by blunt forceps

19

Responsibilities of public health physician

Prevent STD

Prevent dental prob

Infectious disease surveillance

Health promotion activities

20

Effect of b-carotene supplement

Inc risk of lung cancer

21

MCC of travelers diarrhea

Enterotoxigenic E.coli

22

enterotoxigenic Ecoli mechanism of action

Colonization factors

Heat liable enterotoxin

23

For future, to make effective vaccine against ETEC diarrhea it should contain

Colonization factors CS1-6

LT toxoid

24

Larva migrans transmission

Contact with soil contaminated with the cat and dog faeces

25

Rx of dyspnea + terminal illness (Ca)

Opiates esp Morphine

26

Exercise to burn fat frequency

At least 30 min 5d/wk

27

Why fat burning fat exercise must > 30 min

Glycogen burning fuels body for 20 min

Fat fuels it after that

28

Exercise for cardiovascular + fitness

20 min daily

Or

10 daily

29

T/F: walking (land/water) + biking = exercise for 10-20 min

T

30

West Neil virus

What is it?
Transmission?
Sx?
Risk population?

- Human neuropathogen

- Mosquito infected from birds

- mostly flu like
Rarely Neuro Sx: encephalitis, meningitis, paralysis

- elderly at risk

- Rx supportive

31

Number needed to Rx

Importance?
Eqn?

Assess benefit of Rx

NNT = 1/ARR

32

What explains population growth in developing countries

Decreased mortality rates

33

Hospice care services

Short term hospitalization


Sx Rx of terminal illness


Physical/occupational/speech Rx


Dietary counseling

34

T/F: curative Rx is covered by hospice care

F

35

Terminally ill + oral secretions Rx

(Gurgling/rattling)

Anticholinergic

Scopolamine
Hyoscyamine
Glycopyrrolate
Atropine

36

MC hospital error ass w/ SE of drug occurs when

Ordering

37

Early detection of cervical cancer by Pap smear survival

90% survival rate

38

WHO def of health

State of complete physical mental and social well-being

39

T/F: transdermal absorption of medication decreases with age

T

2/2 increase ratio of fat to lean body weight

40

T/F: NSAID's should be avoided in liver cirrhosis

T

41

NSAIDs in preg

Safe

Should be avoided in last 6wk to prevent inhibition of PG synthesis

42

Sympathomimetic SE in elderly

High BP
High ocular pressure
Worsen urinary retention

Interact w/ BB, methyl dopa, TCA, MAOi

43

Ex of sympathomemtic

Pseudoephrine
Phenylephrine

44

How to make medical decision for incapable pt

1. Follow advanced directive (oral or written)

2. No directives = health care proxy

3. No proxy = family

4. No family or family can't agree = ethics committee

45

What elderly does form heat stroke

Living alone
Can't care for self
CVD or resp disease
Mental illness (schizophrenia)
+/- alcohol, Hx of heat stroke

46

In terminal illness:
Preparatory grief vs depression

Grief =
normal self image
Sx wax + wane
Worry abt separation from family


Depression =
Poor self esteem
Suicidal ideas

47

Rx of depression in terminally ill patient

Expected to live few weeks: stimulants methylphenidate


Live longer:
SSRIs

48

Chemical exposure associated with leukemia and aplastic anemia and multiple myeloma

Benzene

49

Arsenic exposure is associated with

Skin cancer

50

Best hearing arrange for sounds

400 to 5000 Hz

51

Frequency range for audible sound

20 to 20,000 Hz

52

Who should be screened for HCV

1. Blood transfusion prior to 1992

2. Needle stick with HCV

3. Mucosal exposure to HCV

4. Children born to HCV+ mom

53

Prevent cholera?

Boiling drinking water

Chlorinate drinking water

Cook vegetables + fish thoroughly

54

When to screen for CRC at 40 and q5 Yrs?

1st degree relative w/ CRC or adenomatous polyps at < 60


> 2 of 1st degree relative with CRC or adenomatous polyps at any age

55

When to screen for CRC at 40 and q5 Yrs?

1st degree relative w/ CRC or adenomatous polyps at < 60


> 2 of 1st degree relative with CRC or adenomatous polyps at any age

56

F patient FU w/ male doc
Frequent visits
Normal exam + no complaints.

What to suspect?
Reaction?

Inappropriate relationship


Reaction:
Pointing your awareness of inappropriate patient-doctor relationship and willingness to help

57

When does palliative care start?

When Dx diagnosed, count through cure or death.

58

T/F: unit of care in palliative Rx comprises pt and his family as defined by surrogate.

T

59

Who receives palliative care?

Pt of all ages w/ chronic illness or injury that impairs daily functioning or reduce life expectancy

60

Having ER contraception readily available results in

Shorter time b/w sex + medication use (15 HR sooner)

61

Rx of travelers diarrhea

ETEC

Rx
Mild = loperamide + diphenoxylate
Safe in kids < 2 yr

Sever =
Adults > cipro
Kids > azithromycin

62

Who shouldn't receive intranasal vaccine

- Kids < 2yrs
- Adults > 60
- Egg allergy
- long term ASA
- chronic disease (COPD, asthma, CHF, CKD...) except HTN
- immune suppression
- preggos

63

Who should be screened for HCV?

IV drug users

64

What's attack rate

#ppl sick / ppl

Attack rate = kids w/ Dz / all kids

65

T/F: negative HBsAg + high LFT = r/o sclerosis of liver

T

66

MC resp Dz from occupational exposure

Asthma

Exposure to gas

67

T/F: early detection of ovarian cancer by CA-125 doesn't improve mortality

T

68

Only DM decreases cardiovascular risks

Metformin

69

What led improvement in life expectancy of Canadians?

Lower infants death rates
By:
Vaccinations
Surgical Rx of congenital heart disease

70

Hyperplastic polyps on colonoscopy mean?

Hyperplastic polyps
Normal
Repeat at 10 yrs


1-2 small adenomas
Low risk
FU 5-10yrs


>3 adenomas or big adenomas (>1cm$
Remove
Rep 3 yr


Sessile adenomas
Remove
Rep 2-6 mo

71

To qualify for federal contributions, insurance plan must guarantee?

1. Province to province coverage

2. Universal coverage

3. Nonprofit basis

4. Benefits all necessary hospital care + physician service.

72

What are not required for federal assures insurance plan

Out of hospital drugs

Dental care

Prosthesis

73

What's varenicline?
Major SE?

Smoking-cessation drug

Suicide

74

Why Rx pertussis w/ azithromycin

Decrease infectivity + severity of Sx.


Doesn't change course of illness

75

What's direct observational Rx

Provide medication directly to patient and watch them swallow

76

The benefit of direct observational therapy

As your highest treatment completion rate

77

A freshman heading to college should receive what vaccine

Meningococcal glad to stay in the dome

78

3 situations in which that things are contraindicated

1. Live vaccine for a pregnant

2. Anaphylaxis to a component

3. Immune suppression

79

NNT
2 eqn

NNT= 1/ARR

ARR = (c/c+b) - (a/a+b)
ARR = control event rate - experiment event rate.

80

Vaccine recommended for homosexuals

Hepatitis a vaccine

81

Who is responsible for our local sanitation, water and food safety, monitoring reportable disease, local environmental risk assessment

Public health unit

82

What is the job of the federal government

Regulate toxic substance

regulate food product

set policies for pollutant

83

Provincial government

Maintaining water and Eire quality standards

regulated and industrial

emission and toxic waste disposal

84

Characteristic of occupational hearing loss

Hearing Loss at the high frequency

85

Who should be screen for lung cancer and when

1. Adults
Smoked 30 pack-year
Currently smokers
Exsmoker < 15 yrs


2. Start at 55-75 then yearly for 3 yrs


3. Low dose CT

86

T/F: most women with breast cancer had no identifiable rest factors

T

87

The woman has a 1st° relative with the breast cancer what's her Risk of developing the disease

There is 3 to 4 fold increased risk

88

What do you do with a patient requires oxygen on the planes

Arranged through home airline for oxygen to be available on board + airport 24-48 hr prior to flight

89

Can you patient who requires continuous oxygen to bring their own supply to the airport/flight

No

90

T/F: people with PaO2 <68-70 shouldn't go on plane unless on plane oxygen is arranged

T

91

Daily use of ASA recommend for what age group (M + F)

M: 45-79

F: 55-79

92

When is breach of confidentiality justified (3)

1. Abuse of vulnerable person child or elder

2. Public health risk like in communicable disease

3. Danger to patient or others

93

Eqn of kappa (chance-corrected agreement)

Kappa = (observed agreement - chance agreement) / (1-chance agreement).

94

Viruses transmitted fecorally

Norwalk virus
Hepatitis a + e
Poliovirus

95

Perinatal mortality

Write up a stillbirth and early neonatal deaths

96

Decreased perinatal mortality rates indicates

Improve the quality of health care during pregnancy and delivery

97

Is asbestos removal mandated by the Environmental Protection Agency

No

98

Are asthmatics at increased risk of cancer from asbestos exposure

No

99

MCC of a cute aseptic meningitis

Echovirus
Coxsackievirus

100

In case of airborne bioterrorism use respirator maybe harmful in what conditions

COPD
Asthma
CAS
Anxiety disorders

101

A doctor convicted of narcotic abuse and completed drug Rehabilitation program

Who decides if he can go back to work

provincial medical board

102

Anaesthesiologist convicted of narcotic abuse can he ever go back to work

Not this speciality


I different to speciality that is not anaesthesiology

103

What each of the following herbs ass w/

Ginkgo

Kava

Yohimbine

Ginkgo = intracerebral bleed in pt w/ anticoagulant


Kava = GI side effects + rash


Yohimbine = HTN

104

What animals get you salmonella

Iguana

105

Can physicians be compensated for attending a CME activity

No it's against the law

106

Can monosodium glutamate cause cancer

Nope

Its of Flavor enhancer

107

Can fat cause cancer

Yes CRC

108

Can alcohol cause cancer

Pancreatic cancer

109

How to use the walking cane

Place the cane in the hand opposite to the most affected leg

Movement of the cane tracks the movement of the affected leg

110

Exposure to pesticides causes?

Organophosphate toxicity

111

Path of organophosphate

Rx

Inhibit AChase


Few hours = pralidoxime + atropine

112

Alcohol rub vs hand soap

Alcohol rub is better
- microbiologically more effective
- less irritating
- less time

113

When is hand soap a preferred over alcohol rub

Of the hands are visibly soiled or exposed to spore forming organism

After use of bathroom

114

Which woman should be screened for ovarian cancer

No woman

115

Best screening test for hemochromatosis

Transferrin

116

Why should smokers use nicotine patches

Double chances of quitting

117

How long should the smokers use nicotine patch to give result

8 wks

118

T/F: tapering nicotine patch is better than abrupt D/C

F
Same

119

MCC of blindness in > 65

Macular degeneration

120

Should I help you I want to be screened for hepatitis C

No need

121

Who should be screened for hepatitis C

Persistent abnormal ALT

122

When to Rx influenza even if it's > 48 hrs?

Patient is deteriorating

Rx oseltamivir or zanamivir

123

Contraindication to zanamivir

COPD
Asthma
Resp distress

124

High INR + on warfarin

• 5-9 + no bleeding
Hold warfarin for 48 hrs


• 5-9 + risk of bleeding
Vit K


• 5-9 + bleeding
Vit K
FFP

125

MCC of retinal detachment

Posterior detachment of vitreous

126

Most fatal cancer in Canada

Lung

127

Coagulation profile in vW

High PTT
High BT

128

What's otosclerosis

Normal eardrum + conductive hearing loss

129

Ms affected in otosclerosis

Stapes

130

Rx of rotator cuff tear
RICE or physio

RICE

131

What does low appetite in seasonal affective mean

Endocrine path

132

Recurrent pain + swelling of salivary gland

Sialolithiasis

133

Dextromethorphan + SSRI

It's a cold drug

Cause serotonin syndrome

134

How much vitamin D a post menopausal woman need

800

135

pregnant gets parvovirus b19 happens to her baby

Hydrops

136

Antabiotics for dog bite

Amoxicillin-clave

137

Ginseng

Herb
Should be stopped 7 days pre-op


Causes Hypoglycaemia and interferes with anticoagulant

138

Fiscal policy

Additional taxes on unhealthy behaviors

139

Tetrad of Menier's

Vertigo
Hearing loss
Tinnitus
Aural fullness

140

Risks for claudication

DM
Smoking
HTN
Dyslipidemia

141

T/F: raloxifene helps menopause Sx

F

142

Someone tests + for HBsAg + HBcAg

Repeat test in 8 weeks to see if it progresses to chronic.

Stop all things hurt liver (alcohol)

143

T/F: PPV influenced by prevalence

T

High prevalence = high PPV

144

WPW arrhythmia

ECG
Rx

Delta wave
Wide QRS
Short PR


Its SVT
Procainamide or amiodrone
Sync cardioversion
Ablation

No BB, CCB, adenosine!

145

1st heart block

ECG
Rx

Prolonged PR

No Rx

146

2nd heart block

ECG
Rx

Mobitz 1:
Progressive increase in PR until drop

No Rx stop drug causing it.


Mobitz 2:
Fixed drop (no progressive prolongation)

Pacemaker

147

3rd heart block

No relation b/w p + QRS

Pacemaker

148

Afib
A flutter

ECG
Rx

AFib
Irregular irregular
No P wave

Unstable = sync cardio version
Stable = BB or CCB
Chronic:
Add anticoagulant CHADS2
0-1 = ASA
> 2 = no renal = dabigtran
Or warfarin if renal or prosthetic valve INR 2-3



Flutter:
Saw tooth

< 48 HR => drug version: procainamide, amiodrone
Or electrical version

>48 HR => warfarin then 3-4 wk electrical cardio version.
TEecho to r/o thrombi 1st
Cont warfarin for 4wks

Anticoagulant
Rate (BB, CCB, digoxin)

149

SVT

ECG
Rx

Narrow QRS

1st
Valsalva
Massage

2nd
Rate (BB, CCB, adenosine)
Electrical cardioversion

150

T/F: Nicotine replacement is safe in stable angina

Yes

151

Ethnic group at risk of prostate ca

Black

152

How long after Sx of sore throat can u start Abx to prevent rheumatic fever

9 day