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Public Health Flashcards

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1
Q

What are the aims of immunisation

A

To control communicable diseases
Prevent the onset of disease through primary prevention
Interrupt transmission of disease
Alter disease progression or limit consequences through secondary prevention

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2
Q

How are vaccines used in primary prevention

A

Given pre-exposure to antigen to develop immunity
Helps those who are currently healthy to reduce their risk of a specific disease
E.g. childhood schedule, given to older people, travel vaccines, high risk groups, occupational

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3
Q

How do vaccines work

A

They teach the immune system to recognise bacteria and viruses before the person encounters them naturally
This allows the body to effectively fight the pathogens

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4
Q

What is active immunity

A

The person has been exposed to the pathogen in the environment or artificially and produced an immune response

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5
Q

What are antigens

A

Parts of bacteria and viruses, which are recognised by the immune system
Usually proteins or polysaccharides

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6
Q

What are antibodies

A

Proteins which bind to antigens - very specific

When they bind it alerts other immune cells

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7
Q

Describe B cells

A

Mature in bone marrow

Triggered to produce antibodies when they encounter a foreign antigen

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8
Q

Describe T cells

A

Mature in thymus
Exist as CD4 and CD8
Orchestrate response of immune system by binding to other cells and sending out signals

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9
Q

What is passive immunity

A

Transfer of pre-formed antibodies from one person to another

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10
Q

How can passive immunity occur

A

Mother to unborn baby via placenta - lasts up to 1 year

From another person or animal - blood donors, human Ig or specific Ig

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11
Q

What are the advantages of passive immunity via immunoglobulin transfers

A

Rapid action
Can be given post exposure
Can control outbreaks
Used if vaccine is contraindicated

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12
Q

What are the disadvantages of passive immunity via immunoglobulin transfers

A 
Short term protection 
Short time window 
Blood derived 
May trigger hypersensitivity reaction 
expensive
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13
Q

What is the preferred means of immunisation

A

Active immunity through vaccination

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14
Q

List the different types of vaccines

A 
Live virus - attenuated so less effective at causing disease but still triggers immune response
Inactivated: 
Killed organism 
Subunit vaccines 
Conjugate
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15
Q

What are the benefits of inactivated vaccines

A

Safer

Suited to bacterial pathogens

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16
Q

List contraindications to vaccines

A

Confrimed anaphylaxis in response to previous dose
Cannot give live vaccines to immunosuppressed or pregnant patients
Egg allergy - used in production of some vaccines
Severe latex allergy
Acute illness (until resolves)

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17
Q

What is herd immunity

A

Protect unvaccinated individuals, through having sufficiently large proportion of population vaccinated
Those who are vaccinated stop transmission

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18
Q

Which diseases are routinely vaccinated against in the UK

A 
Diphtheria 
Whooping cough 
Tetanus 
Polio 
Hib 
Meningococcal 
Measles 
Mumps 
Rubella 
Flu 
Pneumococcal 
HPV 
Hep B
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19
Q

What are notifiable diseases

A

When there is clinical suspicion or a health risk state associated with this specific disease and the doctors have a legal duty to report it to the health board

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20
Q

How do you notify a health board of a disease

A

In writing within 3 days

Notify ASAP via phone if deemed urgent

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21
Q

What is diphtheria

A

URTI characterized by sore throat, low grade fever
Get a white membrane of tonsils, pharynx etc
Caused by gram + bacterium

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22
Q

For which meningococcal disease serogroups is a vaccine available

A 
A 
C
W
Y135 
B
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23
Q

How are meningococcal diseases spread

A

Spread by person-to-person contact through respiratory droplets of infected people (close contact)
In some people it is part of normal flora

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24
Q

How do the boards decide which vaccines are needed

A

Is there a need for it (epidemiological factors)?
Does it work?
Costs
Acceptability - any safety issues

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25
What is the under 5 mortality rate
Probability of a child born in a specific year or period dying before reaching the age of 5 (per 1000 live births)
26
What is the infant mortality rate
Probability of a child born in a specific year or period dying before reaching the age of 1 (per 1000 live births)
27
What are the top 5 causes of under 5 mortality globally
``` Preterm birth complications Pneumonia Intrapartum-related complications - obstructed labour/asphyxia Diarrhoea Neonatal sepsis ```
28
What are the top 5 causes of under 5 mortality in Africa
``` Diarrhoea Pneumonia Malaria Preterm birth complications Intrapartum-related complications ```
29
what percentage of child deaths are linked to malnutrition
45%
30
What is considered the most dangerous period of a child's life
The first 24 hours | Many babies die in this window
31
What simple measures can be used to decrease neonatal death
Proper antenatal care: tetanus vaccine and treatment of maternal infection (HIV, syphilis) Steroids for pre-term labour Skilled birth attendant Clean delivery, warm baby and able to resuscitate
32
How do you prevent neonates dying of syphilis that they got from mum
Give a single dose of penicillin to mum when she is pregnant
33
Why do you give steroid in pre-term births
Helps the lungs develop sufficiently
34
What are the risk factors for developing pneumonia in kids
Malnutrition Over-crowding Indoor air pollution Parental smoking
35
How can you prevent pneumonia in kids
Vaccinations Breastfeeding then complimentary nutrition Good hygiene
36
How do you prevent diarrhoea in kids
Safe drinking water, good hygiene and sanitation Breastfeeding and good nutrition Vaccination - rotavirus
37
What is the major cause of diarrhoea in kids
Contaminated water and food sources
38
How do you treat diarrhoea in kids
Oral rehydration solution (ORS) | Zinc supplements
39
How do the majority of children get HIV
Mother to child transmission | Can occur in pregnancy, during birth or through breastfeeding
40
How do you prevent kids getting HIV
Maternal lifelong antiretroviral treatment Screen for and treat other STDs, especially herpes Infant prophylaxis for 6 weeks
41
How does HIV present in kids
``` Recurrent or severe childhood illnesses or oral candidiasis Failure to thrive or grow Fever Lymphadenopathy Hepatosplenomegaly PJP, Kaposi sarcoma, TB ```
42
How do you treat HIV in kids
Highly active antiretroviral therapy (HAART) | 2 NRTI's and NNRTI or protease inhibitor
43
What are the risk factors for kids developing TB
HIV Malnutrition Household contact
44
How does TB present in kids
Chronic cough or fever lasting more than 2 weeks Night sweats weight loss Lymphadenopathy
45
How can you prevent TB
BCG vaccine | pre and post exposure isoniazid
46
What causes malaria
Plasmodium parasite from female anopheles mosquito | Different parasites cause different severities
47
How does malaria present
Fever Pallor Non-specific malaise Very variable
48
How do you treat malaria
Artemisinin-based combination therapy (ACT) for 3 days | Severe malaria treat with IM or IV artesunate until can tolerate oral
49
How do you prevent malaria
Long-lasting insecticidal nets (LLINs) | Pilot projects for malaria vaccine
50
What causes malnutrition
Lack of access Poor feeding practices Infection
51
What is kwashiorkor
oedema and rounded belly due to lack of protein in the diet | Sign of malnutrition
52
What is marasmus
Extreme skinniness seen in malnourished children
53
How do you treat malnutrition
``` Need to be careful not to overload Treat first for hypoglycaemia, hypothermia and dehydration Balance electrolytes Treat any underlying infection Give micronutrients Initiate feeding and catch-up feeding Sensory stimulation ```
54
What is the definition of health inequalities
Differences in health status or in the distribution of health determinants between different population groups Often those in more deprived groups have poorer health
55
What factors determine health inequalities
Unmodifiable: age, sex and genetics | Modifiable - living and working conditions, water and sanitation, access to services, education, food access
56
What are the most common causes of death in young men in the UK
``` Suicide Drugs and alcohol Accidents Violence More common in deprived areas ```
57
List some fundamental causes of health inequality
``` Global economic forces Political priority Social values Unequal distribution of wealth and power Poverty and discrimination NEEDS TO BE UNDONE ```
58
List some environmental influences on health inequality
Economy and work Learning Services Needs to prevent inequality in these areas
59
What are the potential outcomes of adverse childhood experiences
Impairment of social, emotional and cognitive skills Adoption of risky behaviour Lower life expectancy
60
List examples of adverse childhood experience
Abuse - physical, sexual & emotional Neglect - physical and emotional Mental illness, substance abuse and violence in the house Incarcerated relative Divorce
61
What are indicators of risk for inequalities in childhood and poor health
``` Family breakdown Lack of family rituals Poor domestic and financial management Neglect Lack of discipline and routine Violence and abuse ```
62
What are the symptoms of deprivation/adverse childhood experience
``` Anti-social behaviour Isolated / withdrawn Behavioural issues Emotional issues Child assuming role of carer ```
63
What is the definition of obesity
Abnormal or excessive fat accumulation that may impair health - WHO Result of long term positive energy imbalance
64
What is the adult BMI range for overweight
25-30
65
What is the adult BMI range for obese
>30
66
Can you use normal fixed BMI measurements for children
NO Healthy BMI changes with age Growth spurts mean height change is not always matched with proportionate weight gain
67
How do you plot BMI in children (over 2 y/o)
Plot the BMI against age on the centile chart | Need to use the one appropriate for gender
68
What are the clinical thresholds for overweight and obesity in children
> or equal to 91st centile is overweight | > or equal to 98th centile is obese (clinically)
69
How do you plot BMI in an under 2 y/o
use BMI conversion chart to provide an approximate BMI centile Usually measure length rather than height in this age group
70
Can waist circumference be used in children to diagnose obesity or health risk
NO
71
Children from deprived areas have a higher prevalence of obesity - true or false
TRUE
72
List risk factors for obesity by the age of 3
``` Parental overweight Black ethnicity Greater birthweight Smoking during pregnancy Lone motherhood Pre-pregnancy overweight Maternal employment ≥21 hrs/week Solid foods before 4 months ```
73
Is breastfeeding protective against obesity
YES | If breastfed for at least 4 months
74
What genetic conditions can cause obesity in childhood
Prader-Willi Syndrome | Bardet-Biedl Syndrome
75
Describe the symptoms of Prader-Willi syndrome
At birth they are floppy, have weak or absent sucking Childhood: always hungry and looking for food (hyperphagia), reduced energy requirement - prone to obesity Low muscle tone, learning difficulty, hypogonadism and short stature
76
Describe the symptoms of Bardet-Biedl Syndrome
Hyperphagia - always hungry Low activity Make them prone to obesity Also have visual impairments, renal abnormalities, polydactyly, learning difficulties and hypogonadism
77
What are the negative consequences of being overweight or obese in childhood
Poorer health in childhood and adulthood Low self-esteem Higher risk of bullying Poorer school attendance and achievement Poorer employment prospects
78
How would you assess an obese child
``` BMI - plot on chart Eating habits and activity Social and school Emotional issues Family support Family history ```
79
List common comorbidities of childhood obesity
``` Metabolic syndrome Respiratory problems Hip and knee problems Diabetes CHD Sleep apnoea Hypertension ```
80
At what point would you refer an obese child for paediatric review
If their is serious comorbidity that requires urgent weight loss - intercranial hypertension, sleep apnoea etc Suspected underlying medical cause - e.g. endocrine issue Under 2's who are severely obese
81
How can you help control portion sizes
Smaller plates Cook only what's required Parents serve rather than kids serve themselves Age appropriate servings
82
How much physical activity should a child get per day
Around 60 mins
83
Does increased screen time increase risk of being overweight or obese
YES More than 2 hours per day increases risk Dose dependant
84
Does increased sleep duration increase risk of obesity
NO | Decreases sleep duration is associated with obesity
85
Can you use orlistat in children
Should only be given to >12 if physical or severe psychological comorbidities present In exceptional circumstances such as life threatening comorbidities it may be considered <12
86
Is surgery considered in overweight children
Surgery may be considered in post-pubertal adolescents with | very severe to extreme obesity and severe comorbidities

Child Health (14 decks)

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