Public Health

Question 1

Age for mammography

Answer 1

50-69 q1-2yr

Question 2

When do you do fasting lipids for screening?

Answer 2

• men >40
• women postmenopausal or >50
  any age with risk factors
  q1-3 yr

Question 3

When do you do fasting glucose screening?

Answer 3

• > 40yr q3yr or more frequent with RF

Question 4

FOBT screening at what age?

Answer 4

• 50yr q 1-2yr

Question 5

When do you do bone density screening?

Answer 5

• RF osteoporosis
• previous #
• > 65yr
  q3-5yr

Question 6

Calculate infant mortality rate

Answer 6

Infant = #death in children <1yr in certain time period and population / #live births in same period and population

• > neonatal (#deaths kids <28d)
• > perinatal (# deaths in fetuses >28wk GA + infants <7d old)

Question 7

Maternal mortality rate calculation

Answer 7

deaths related to puerperal cause in certain time period and population/ # pregnancies in same time period and population

Question 8

Calculate proportionate mortality ratio

Answer 8

deaths due to particular cause/ total # deaths in same time period and population

Question 9

Crude death rate calculation

Answer 9

= # deaths in population from any cause/ total population win same period

Question 10

Calculate age-specific death rate

Answer 10

= #deaths in age group in certain time period and population/ average or mid-year population of that age group in same time period and population

Question 11

Calculate case fatality rate

Answer 11

= #deaths from illness in certain time period/ #people diagnosed with that illness in that time period

Question 12

Calculate potential years of life lost (PYLL)

Answer 12

= life expectance for population - age at death of individual

Question 13

Calculate PYLL for population

Answer 13

= add all PYLL for members who died/ total # members of population under age of life expectancy

Question 14

Define if test is valid

Answer 14

• does it measure what it claims to?

Question 15

Define reliable test

Answer 15

• can be repeated and the same result obtained?

Question 16

Define predictive value

Answer 16

• probability that a positive test is a true positive case or that a negative test is a true negative case; determined by the sensitivity and specificity and prevalence of the tested condition

Question 17

Define efficacy

Answer 17

• the ability to produce a specific result

Question 18

Define efficient

Answer 18

• is the output useful and worth the input?

Question 19

Define compliance

Answer 19

• did someone do as instructed?

Question 20

Define incidence

Answer 20

• the # new cases that will occur in a certain time period

Question 21

Define prevalence

Answer 21

• the # cases present at a particular time

Question 22

Define good screening test in terms of disease and the test

Answer 22

disease should be

• common (relatively)
• serious morbidity and/or mortality
• treatment available/ prognosis improved with early detection

test should be:

• safe
• cost effective
• specific and sensitive
• reliable and valid

-> screening test not diagnostic

Question 23

Define sensitivity

Answer 23

• if condition is there, the probability the test will pick it up

= disease with positive test/ (disease with positive test + disease but negative test)

Question 24

Define specificity

Answer 24

• if condition is not there, the probability the test result will be negative

= disease not present and negative test/ (disease not present and negative test + disease present and negative test)

Question 25

What is positive predictive value

Answer 25

= disease present with positive test/ (disease present with positive test + disease not present with positive test)

Question 26

What is negative predictive value

Answer 26

= disease not present with negative test/ (disease not present with negative test + disease present with negative test)

Question 27

Are systematic reviews good?

Answer 27

Yes - better than an individual trial of same kind?

Question 28

Type of trial with best evidence?

Answer 28

Randomized control trial when true randomization and allocation concealment present

Question 29

What type of disease prevention when level of action before disease present? Examples?

Answer 29

Primary - education - social marketing - public health policy - Community organizations Conditions prevented - family violence - outbreaks - many chronic medical conditions - accidental death

Question 30

What type of disease prevention is action level in very early stages of disease allowing for effective intervention? Examples?

Answer 30

Secondary - education - social marketing - public health policy conditions prevented - those for which an effective screening test is available

Question 31

What type of disease prevention is level of action when the disease is established, treatment and minimizes suffering? Examples?

Answer 31

Tertiary - education - social marketing - community organizations (support groups) conditions prevented - hopefully morbidity and mortality reduced

Question 32

Common occupational exposures?

Answer 32

- inhalants - skin contact - blood borne - sound - MSK

Question 33

Do you need consent to release information to worker's compensation board?

Answer 33

Yes

Question 34

Define outbreak

Answer 34

- greater than expected number of epidemiologically linked cases of a particular illness (more cases of particular illness for geographic location) - > not just infectious agents

Question 35

What is case definition

Answer 35

- specific criteria (sx, onset) required to label a pt suspicious for or actually infected with the illness in question; can initially be broad but becomes more defined over time

Question 36

Approach to an outbreak

Answer 36

1. Plan of action for cases 2. Identify patient's presenting with symptoms of case presentation 3. Isolation of cases and confirmation through testing 4. Organize a management team 5. Cohort staff to limit further exposures (workers already in contact with cases stay in that role) 6. Hand hygiene, gown and gloves (follow advice for contact precautions) 7. Restrict new admission and transfers of non-cases; limit visitors 8. Exclude symptomatic staff from facility 9. Medical Officer of Health and Management Team decide end of outbreak 10. Outbreak end declaration often based on type of infectious organism and length of time since pt were symptomatic

Question 37

Roles of public health?

Answer 37

- education - immunization/ prophylaxis strategies - advice for health centres - investigation of cause of outbreak (travel, food borne) - investigation of environments involved (restaurants) - communication with public/media

Question 38

Likely exposure with nausea, GI upset, headache, seizures, irritability, Burton line?

Answer 38

Lead - lead blood level - chelation therapy complications - coma, LD

Question 39

Likely exposure with fatigue, headaches, palpitations, SOB, confusion?

Answer 39

CO - CO Hbg level - EKG - Cr - Hyperbaric O2 complications - arrhythmias, MI, ARF, cardiac/resp arrest, cognitive difficulties, muscle necrosis