Prevention Flashcards
(152 cards)
1
Q
COPD diagnosis, look at FEV1/FVC. Obstructive lung disease present at less than __% when compared to others
A
70%
2
Q
Tertiary prevention for COPD is to
A
Get patient to stop smoking
3
Q
3rd leading cause of death in the world is:
A
COPD
4
Q
2nd leading cause of death in the world is:
A
Stroke
5
Q
1st leading cause of death in the world is:
A
Ischemic heart disease
6
Q
After quitting smoking, HR normalizes after __ minutes, CO levels normalize after __ hours, risk of MI falls and lung function returns to normal curve after __-__ weeks, risk of CAD is 50% that of a smoker after __ year(s).
A
20 minutes
12 hours
2 - 12 weeks
1 year
7
Q
Symptoms of nicotine withdrawal
A
Depression, insomnia, irritability, anxiety, impaired concentration, appetite changes
8
Q
Smoking cessation can involve behavioral counseling, as well as (4) described alternative therapies:
A
Acupuncture, aversive therapy, financial incentive from employers, hypnosis
9
Q
Five A’s of smoking cessation:
A
Ask (about use every visit) Advise (quitting) Assess (willingness) Assist (in attempt to quit) Arrange (follow up)
10
Q
7 options recognized by USPHS for smoking cessation:
A
Nicotine patch, gum, lozenge, inhaler, nasal spray
Bupropion
Varenicline
11
Q
Action of bupropion
A
Enhances CNS release of dopamine
12
Q
Action of Varenicline
A
Partial agonist of a4-B2 nicotine content acetylcholine receptor
13
Q
Medications to limit disability of COPD
A
Short acting beta agonists (albuterol, lee albuterol)
Anticholinergics (ipratroium)
Long acting beta agonists
Long acting anticholinergics/antimuscarinics (tiotropium)
Corticosteroids
Best: LABA, LAMA, ICS combination
PDE-4 inhibitors
Theophylline
supplemental O2
Pneumococcal and influenza vaccinations
14
Q
Supplemental oxygen improves survival for COPD for patients and is recommended for those with:
A
RA pulse ox less than 88%
PaO2 less than 55mmHg on RA
PaO2 less than 60mmHg with for pulmonary or polycythemia
15
Q
Pulmonary rehab indicated in moderate to severe COPD and benefits may last up to:
A
18 months after rehab
16
Q
Lung Volume Reduction Surgery provided survival advantage for COPD patients with:
A
Upper lobe emphysema and low exercise capacity
Some increased mortality
17
Q
Lung transplant for COPD patients improves FC and should be considered in patients with:
A
Post-bronchodilator FEV1 less than 25% predicted
Resting hypoxemia
Hypercapnia
Pulmonary HTN
18
Q
Diagnosing asthma with bronchodilator, FEV1 improves:
A
More than 15%
19
Q
Diagnosing asthma, methocholine challenge drops FEV1:
A
More than 20%
20
Q
Tertiary prevention for asthma involves:
A
Avoiding triggers and preventing or treating exacerbation a
21
Q
Persistent moderate asthma:
exhibits symptoms _______
Night time awakenings _______
Short acting beta agonist _________
Interferes with normal activity _________
Lung function FEV1 is between __% and __%
A
Daily More than once a week Daily Some limitation 60% and 80%
22
Q
Steps 1 - 6 for intermittent thru persistent asthma treatment:
A
1) SABA PRN
2) low dose inhaled glucocorticoids
3) 2 plus LABA or medium dose
4) medium dose glucocorticoid plus LABA
5) high dose glucocorticoid plus LABA and maybe omalizumab if allergies present
6) high dose glucocorticoid, LABA, oral systemic glucocorticoid.
23
Q
Healthcare practitioners collect data on a single patient, epidemiologists:
A
Collect data on an entire population
24
Q
Classical epidemiology: population oriented. Interested in:
A
Risk factors that can be altered to prevent or delay disease,min jury, and death.
25
Clinical epidemiology: patient oriented. Interested in:
Prevention and care of illness in individual patients at risk for or already have a disease.
26
Etiology
Cause or origin of a disease or abnormal condition
27
The way a disease progresses in the absence of medical or public health intervention is called
Natural history
28
Name agent, host, and environment for measles
Agent: highly infectious virus
Host: human
Environment: population of unvaccinated people
29
Name agent, host, environment, and vector for malaria
Host: human
Agent: parasite
Environment: General patient population
Vector: anopheles mosquito
30
BEINGS model (major categories of risk factors for disease)
```
Biological and behavioral
Environmental
Immunologic
Nutritional
Genetic
Services, social factors, spiritual factors
```
31
Of the BEINGS model, an immunologic factor can be herd immunity which means
Vaccine diminishes ability to spread disease, leads to reduced disease transmission
32
The framework of examining people not as individuals but as members of communities in a social context is called
Ecological perspective
33
Number of new health related events in a defined population within a specific period of time is known as:
Prevalence
34
Proportion of people who experience the onset of a health related event during a specified time is known as:
Incidence proportion
35
Rate at which new events occur in a population is known as the:
Incidence rate
36
The number of existing cases in the total population at a specific point or period in time is the:
Prevalence
37
The prevalence of disease at a certain point in time is the:
Point prevalence
38
The number of cases that exist during a specific time period is the:
Period prevalence
39
Incidence or prevalence: existing cases that allow us to measure the burden of disease in area
Prevalence
40
Proportion of persons who are unaffected at the beginning of the study period, but who experience a risk event during the study period indicates what for the population?
Risk
41
People at risk at the beginning of the study period constitute the:
Cohort
42
Calculating rate of disease:
Number of events in defined time period/average number of people at risk for event
43
Rate can be used to estimate risk if the following are true about the frequency of event in numerator, proportion of population affected, and time interval:
Frequency: only occurs once in study interval
Proportion: is small
Time interval: is short
44
Calculating positive predictive value (PPV):
Number of true positives/number of all positives
Gives chance of positive test being a true positive.
45
Technical precision has high specificity and high sensitivity, but for a test to be a good one, it must have good:
Clinical precision
46
To calculate true positives:
with true disease x sensitivity
47
To calculate false negatives:
with true disease - true positives
48
To calculate true negatives:
without disease x specificity
49
To calculate false positives:
without disease - true negatives
50
To calculate # with true disease:
Prevalence x n
51
Sensitivity is defined as:
Number of true positives over true positives plus false negatives
52
Specificity is calculated as:
True (-) / false(+) + true(-)
53
SpPin
High specificity, positive test rules in disorder
54
SnNout
High sensitivity, negative rules out disorder
55
Which healthcare workers are at the highest risk for needle sticks?
Nurses, lab workers, non surgical physicians, non clinical lab techs
56
Modes of occupational transmission of HIV
Per cutaneous
Contact of mucous membranes or non intact skin
If visible blood: feces, nasal secretions, saliva, sputum, sweat, tears, urine, vomitus.
57
Chance of transmission from source patient to exposed patient
0. 03% percutaneous
| 0. 09% mucous membrane
58
How long is Post Exposure Prophylaxis for HIV given?
28 days
59
PEP for HIV involves 3 active agents:
Raltegravir (400mg PO BID)
| Truvada (1 PO daily, Tenofovir and emtricitabine)
60
Follow up testing after baseline HIV test:
Baseline CBC and LFTs at baseline/two weeks if initial studies are abnormal
61
Pre-exposure prophylaxis HIV medication recommendation:
Truvada oral daily
62
How often should patients taking Truvada as pre-exposure prophylaxis be tested for HIV? Renal function?
Every 3 months for HIV
| Every 6 months for renal function
63
Latent tuberculosis presents with:
Fever, cough, weight loss, night sweats, hemoptysis, fatigue
64
Testing for active tuberculosis:
CXR, sputum culture, PPD
65
Detection of latent TB:
PPD, negative CXR, no presence of symptoms, not contagious
66
What percentage of patients with latent TB will develop active disease without prophylaxis?
5-10%
67
Purified Protein Derivative test is interpreted __ hours after administration and interpreted in millimeters.
48 - 72 hours
68
Induration of >5 mm is considered positive in:
HIV positive persons, recent contacts of TB patients, people with fibrotic changes in CXR with prior TB, patients with organ transplants or are immunosuppressed.
69
Induration of >10 mm is considered positive in:
Recent immigrants from countries with high prevalence
Injection drug users
Residents or employees in jails, nursing homes, hospitals, AIDS facilities, homeless shelters
Mycobacteriology lab personnel
70
Induration >15 mm is considered positive in:
Person with no known risk factors
71
Effective treatment for latent TB infection involves:
Isoniazid or isoniazid and rifampin
72
How much heroes the risk increase in HIV patients for latent TB to progress to TB?
7-10% each year
73
Side effects of isoniazid include:
```
Transaminitis (symptomatic in 80-90%, stop if 3x normal or more)
Peripheral neuropathy (0.2% of patients, esp with diabetes, HIV, renal failure, alcoholism)
```
74
Side effects of Rifampin and Rifapentine (RPT):
Asymptomatic hyperbilirubinemia
Pruritus and self limiting rash
Orange bodily fluids
Drug-drug interactions
75
Environmental factors for TB exposure:
Small enclosed spaces, inadequate ventilation, re circulation of infected air, inadequate disinfection, improper procedure for handling specimens.
76
XDR-TB is resistant to:
Isoniazid, rifampicin, fluoroquinolone, at least 1 of 3 second line drugs (amikacin, capreomycin, kanamycin)
77
Relative risk (RR) represents:
Ratio of risk in the treated group to the risk in the control group. Expressed as a percentage (e.g. 0.001 event rate/0.002 control event rate = .5).
78
Relative risk reduction (RRR) represents:
The percent reduction in the risk in the treated group compared to control. Given as percentage. Higher RRR the better the treatment.
RRR = 1 - RR
79
Absolute risk reduction (ARR) or risk difference represents:
The difference in risk rate between the control group and the treated group.
80
Number needed to treat (NNT) represents:
The number of patients that need to be treated to prevent one bad outcome.
NNT = 1/ARR
81
The number of assumptions required to assume a patient will benefit from a given recommendation in DOE vs POEM is: (high/low)
HIGH for DOE
LOW for POEM
82
In EBM, after assessing the patient, one forms a clinical question with PICO:
Patient/population
Intervention or exposure (what is being done or is happening to pt)
Comparisons (what could be done instead of interventions?)
Outcomes (how does intervention affect pt?)
83
Identify the components of PICO in the following:
In an elderly female with newly diagnosed atrial fibrillation, does use of anticoagulant compared to aspirin alone reduce risk of stroke and mortality?
P - elderly female with atrial fib
I - anticoagulant
C - aspirin
O - reduced risk of stroke and mortality?
84
Match the category of clinical question with the type of study:
Therapy, diagnosis, screening, prognosis, causation
Cross sectional study or RCT, RCT, Cohort or case-control study (or case report), Longitudinal survey
Therapy - RCT
Diagnosis and screening - cross sectional or RCT
Prognosis - longitudinal survey
Causation - cohort or case-control study
85
Primary prevention involves the modification of:
Risk factors; proactive
86
Secondary prevention involves the modification of:
The disease to prevent recurrence; reactive
87
Tertiary prevention involves the modification of:
Progression and complications with return to baseline as the goal; rehab
88
Risk factors for cardiovascular disease
```
Cigarette smoking
CAD
HF
DM
HTN
Dyslipidemia
Sedentary lifestyle
```
89
How does cigarette smoking increase risk for CV disease?
Accelerates blood clotting, nicotine is vasoconstrictive, CO levels are increased reducing O2 delivery
90
How does DM affect the CV system?
Increases risk of repeat MI, elevated Hba1c affects heart/kidneys/eyes, CAD equivalent
91
How does HTN increase risk of CV disease? Directly? Indirectly?
Direct: damage to blood vessels
Indirect: increased demand on heart
92
What tests are involved in a complete lipid profile?
```
TC (total cholesterol)
TG (triglycerides)
HDL-C
LDL-C
VLDL-C
```
93
VLDL-C is a precursor to LDL-C, which is a precursor for:
Atherogenesis
94
TC = HDL-C + LDL-C + (TG/5) so as triglycerides go up,
LDL-C goes down
95
Cholesterol guidelines:
LDL >___ mg/dL
If aged 40 to 75 with DM and ___
LDL > 190
70 > LDL > 190
96
What are the metrics for metabolic syndrome diagnosis in terms of abdominal obesity, triglyceride levels, HDL-C levels, blood pressure, and fasting glucose?
Abdominal obesity: waist circumference (>40 inches for men, >35 inches for women)
TG: >150mg/dL
HDL-C: 130/85
Fasting glucose: >100mg/dL
97
Possible etiologies of essential hypertension
Atherosclerosis, fluid retention, changes in renin-angiotensin-aldosterone system
98
Possible etiologies of non-essential hypertension
Renal artery disease, chronic kidney disease, obstructive sleep apnea
99
JNC 8 recommended treatment for treatment of HTN in general population (black, non black)
Non black: thiazides, CCB, ACEI, ARB
| Black: thiazides or CCB
100
JNC 8 recommendations for treatment of hypertension in persons with CKD
ACEI or ARB (never together!)
101
HTN medication that is a good first choice, has been shown to reduce CV disease in RCT. May see negative side effects in elderly (orthostatic hypotension, AKI, electrolyte derangements).
Thiazide
102
HTN medication that seems to be a good choice if CAD, DM, or CHF. It is contraindicated in conduction abnormalities and poses a significant risk if no heart disease is present.
Beta blockers
103
Once people have access to adequate nutrition, clean water, and a safe environment, ___________ becomes the major determining factor of health.
Behavior
104
Behavioral change theory that focuses on the individual's perceptions of the threat posed by a health problem, the benefit of avoiding the threat, and factors influencing the decision to act.
Health belief model
105
Behavioral change theory that focuses on the individual's motivation and readiness to change a problem behavior. (Precontemplation, contemplation, preparation, action, maintenance).
Stages of change model
106
Behavioral change theory that focuses on the individual's attitude toward a behavior, perceptions of norms, and beliefs about the ease or difficulty of changing.
Theory of planned behavior
107
Behavioral change theory that focuses on the individual's seven step journey from lack of awareness to action and maintenance. Similar to stages of change except development is linear and not circular.
Precaution adoption process model
108
Behavioral theory of change that focuses on personal factors, environmental factors, and human behavior that exert influence on each other. People learn not only from their experiences by from observing others.
Social cognitive theory
109
3 main concepts of motivational interviewing
1) ambivalence
2) I learn what I believe as I hear myself talk
3) change motivated by perceived disconnect between present behavior and personal goals/values
110
4 main strategies of motivational interviewing
Empathy
Cognitive dissonance
Roll with resistance
Support self-efficacy
111
When evaluating an obese patient, facial plethora may indicate:
Cushions
112
When evaluating an obese patient, hirsutism may indicate:
Cushiness, PCOS
113
When evaluating an obese patient, peri orbital edema, lateral thinning of eyebrows, and scalloped tongue may indicate:
Hypothyroidism
114
When evaluating an obese patient, erosion of dental enamel may indicate:
Bulimia nervous
115
When evaluating an obese patient, acanthosis nigricans may indicate:
Insulin resistance or diabetes
116
When evaluating an obese patient, a buffalo hump may indicate:
Cushions
117
When evaluating an obese patient, red striae may indicate:
Cushings vs obesity
118
When evaluating an obese patient, acrochordon (skin tags) may indicate:
Insulin resistance or diabetes
119
Body mass index is measured by:
Weight in kg / height^2 in m
120
Over 90% of COPD linked to exposure to
Cigarette smoke
121
Overweight BMI for adults and children respectively is:
25child BMI>95th percentile
122
Obese BMI for adults and children respectively is considered
>30
>95th percentile
123
Four categories of weight related problems:
Metabolic
Degenerative
Neoplasticism
An atomic
124
T2DM, HTN, and elevated blood lipids are categorized as what type of weight related problem?
Metabolic
125
Osteoarthritis, atherosclerotic changes, and pulmonary diseases are categorized as what sort of weight related problem?
Degenerative
126
Many forms of cancer including colorectal, breast, prostate, esophageal and ovarian cancers, are considered what category of weight related problems?
Neoplasticism
127
GERD and Obstructive Sleep Apnea are categorized as what type of weight related problem?
An atomic
128
Some contraindications for anti-obesity medications include:
```
Pregnancy or lactation
Unstable cardiac disease
Uncontrolled hypertension
Unstable severe systemic illness
Unstable psychiatric disorder/anorexia
Incompatible drug therapy
Closed angle glaucoma
General anesthesia
```
129
A weight management medication that inhibits pancreatic lipase and is taken orally with each meal containing fat is:
Oralist at
130
A weight management medication that is a specific 5-HT2C serotonin agonist and is given as 10mg orally BID is:
Lorcaserin
131
A weight management medication that is a sympathomimetic anticonvulsant (via GABA receptor modulation, carbonic anhydrase inhibition, glutamate antagonism) given orally in the morning with incremental doses every 14 days is:
Phentermine/ Topiramate ER
132
A weight management medication that is an opioid receptor antagonist and a DOPA/NE re uptake inhibitor and is given orally and daily with increasing doses and frequency each week is:
Naltrexone SR/ Bupriopion SR
133
A weight management medication that is a GLP-1 receptor agonist and is administered subq, increasing dosage at weekly intervals till 3mg/day is reached
Liraglutide 3mg
134
Three weight management medications contraindicated with MAOIs
Lorcaserin, Phentermine, Naltrexone/Bupriopion
135
4 weight management medications contraindicated in pregnancy
Lorcaserin, Phentermine, naltrexone/bupropion
136
Criteria for surgical treatment of obesity:
| BMI related
BMI of 40 or higher
| BMI of 35-39.9 with co morbidity
137
A bariatric surgical procedure that is reversible, safe, results in moderate weight loss
Adjustable gastric band
138
A bariatric surgical procedure that is irreversible, results in moderate to extreme weight loss, and is less safe than adjustable gastric band:
Gastric sleeve
139
A bariatric surgical procedure that is irreversible, results in drastic weight loss, and is least safe is
Gastric bypass
140
A bariatric surgical procedure that is irreversible, results in extreme weight loss, and is least safe:
Biliopamcrestic diversion with duodenal switch
141
In research design,none step above randomized controlled double blind studies in the hierarchy of evidence is
Systematic reviews and meta analysis
142
Cross-sectional surveys, cohort studies, and case-control studies fall under the umbrella of what category of study?
Observational studies
143
Randomized controlled trials and quasi-experimental designs fall under the umbrella of what category of study?
Experimental studies
144
3 categories of energy expenditure:
1) basal metabolic rate (70%)
2)
3)
2) physical activity (25%)
| 3) thermos effect of food (5%)
145
The point where lactic acid rises disproportionately during incremental exercise
Lactate threshold
146
Influence vaccination is indicated in
All adults over 18
Anyone with medical problems
Health care workers
147
Pneumovax contains 23 variants and is indicated in
Adults over 65
Chronic illness
Risk factors
Splenectomy
148
Prevnar (PCV 13) given to all adults over what age and how long must one wait before administering pneumovax?
13 years old, 6 months
149
Who has functional asplenia and should bebgiven pneumovax?
Sickle cell patients, splenic infarcts from sickle cell crises
150
Hepatitis B vaccine seroconversion occurs a few months after the third dose. Those who don't develop seroconversion are called:
Non responders
151
Hepatitis A vaccine is recommended for:
Travelers
| Chronic liver disease
152
How long must one wait to give Td booster after Tdap?
No wait is necessary
