R&E 1: Block A

Question 1

Determinant of health

Answer 1

The range of social, economic and environmental factors which determine the health status of individuals or populations.

Question 2

The continuum of strategies for health

Answer 2

Downstream
* Diagnosis, treatment & rehabilitation
* Primary, secondary, tertiary, quaternary prevention
* Health promotion (Ottawa Charter)
* Action on social determinants of health
Upstream

Question 3

Primary prevention

Answer 3

Decreases incidence
Timing: before person gets the disease

Question 4

Secondary prevention

Answer 4

Decreases prevalence
Timing: detect disease early to cure or slow down the progression with greater success than if diagnosed clinically

Question 5

Tertiary prevention

Answer 5

Decreases impact
Timing: person has symptomatic disease (goal = care for those with disease)

Question 6

What are the 5 action areas for health promotion in the Ottawa Charter

Answer 6

1. Build healthy public policy
2. Create supportive environments
3. Strengthen community actions
4. Develop personal skills
5. Reorient health services

Question 7

3 actions on social determinants of health

Answer 7

1. Intersectoral action
2. Whole of government
3. Health in all policies

Question 8

How many immigrants in Canada? What cities?

Answer 8

More than 6M
Most live in Toronto, Montreal, Vancouver

Question 9

Considerations for migrants/refugees from China

Answer 9

Hepatitis B virus (high prevalence in this country)

Question 10

Considerations for migrants/refugees from Egypt

Answer 10

Hepatitis C virus (high prevalence in this country)

Question 11

Considerations for migrants: infectious diseases

Answer 11

• viral hepatitis (B or C)
• vaccine preventable diseases
• tuberculosis
• malaria
• intestinal parasites
• HIV
• syphilis
• other STDs

Question 12

Considerations for migrants: non-infectious diseases

Answer 12

• Chronic health issues
• Diabetes
• Malignancies
• Iron deficiency anemia
• Dental issue
• Vision issues

Question 13

Considerations for migrants: psychological & other

Answer 13

• depression (may be under-reported)
• stress
• barriers to access health care

Question 14

In refugees particularly, there is an increased risk of … carcinoma

Answer 14

hepatocellular

Question 15

Migrants are NOT a homogeneous group. An individual’s profile risk depends on …(3)

Answer 15

• country of origin
• socio-economic factors
• whether they have live in an urban or rural setting

Question 16

CIC Medical exam

Answer 16

Pre-screening, done in country of origin prior to arrival.
Goal: identify potential danger to public health or security & identify/prevent excessive burden on the social or health care system in Canada.

Question 17

CIC medical exam includes… (6)

Answer 17

• history to rule out costly chronic diseases
• physical exam
• chest x-ray (>11yrs)
• VDRL for syphilis (>15yrs)
• Urinalysis (>5yrs)
• HIV

Question 18

CIC medical exam does not include… (3)

Answer 18

• vaccination status is not asked about
• hepatits testing
• latent TB testing (CXR only tests active TB; no PPD for latent TB)

Question 19

Multidisciplinary approach to the recognition, diagnosis, treatment, prevention, and control of diseases, injuries and other adverse health conditions resulting from hazardous exposures in workplace

Answer 19

Occupational health

Question 20

Occupational health hazards

Answer 20

• chemical
• biological (infectious agents)
• physical (noises, vibration, radiation, extreme temp.)
• biomechanical (repetition, forceful exertion, awkward positions, duration, frequency)
• psychological/organizational (cognitive, emotional, temporal; demands)

Question 21

Occupational health & work exposure is an important determinant of…

Answer 21

health inequalities

Question 22

There is a strong relationship between socioeconomic status and…

Answer 22

health

Question 23

Common occupational disorders

Answer 23

• musculoskeletal disorders
• accidental injuries/fatalities
• mental health disorders
• contact dermatitis
• hearing loss
• respiratory disorders
• cardiovascular diseases
• cancer
• infectious diseases
• reproductive hazards (e.g. breastfeeding)
  ETC

Question 24

In general, on virtually every measure of health status, Aboriginal peoples fare …

Answer 24

much worse than an average Canadian

Question 25

Important health discrepancies in Aboriginal nations

Answer 25

* obesity * type II diabetes * injuries * tuberculosis * suicide * hypertension * iron deficiency (children) * dental caries (children)

Question 26

The prevalence of diabetes among First Nation adults is ... compared to the general Canadian population

Answer 26

4 times greater

Question 27

... First Nation adults aged 50-69 have diabetes

Answer 27

1/3

Question 28

Who has a higher prevalence of diabetes in First Nation communities? a) Females b) Males

Answer 28

a) Females

Question 29

Main health issues of people experiencing homelessness

Answer 29

* alcoholism (22%) * drug addiction (78%) * mental health problems

Question 30

In terms of mental health issues: 61% of homeless people have... 13% have... 10% have...

Answer 30

61% have a psychological diagnosis 13% have a psychotic diagnosis 10% have a bipolar diagnosis

Question 31

Notifiable diseases/maladies a declaration obligatoire (MADO) in Quebec. Maladies a surveillance extreme (7)

Answer 31

Should be reported IMMEDIATELY and URGENTLY by telephone or fax simultaneously to the National Director of Public Health and the Director of Public Health in your area followed by a written confirmation within 48 hours. 1. Botulism 2. Cholera 3. Hemorrhagic fever (ebola, crimee-congo, marburg, lassa) 4. Anthrax 5. Plague 6. Smallpox 7 . Yellow fever

Question 32

Maladies, infections et intoxications a declaration obligatoire

Answer 32

Should be reported within 48 hours to the public health director in your area. Most common example: tuberculosis

Question 33

Information that should be reported

Answer 33

Name of disease Patients information (detailed) *In this case the physician is obliged to divulge the patient's information to the public health officials, NOT keep it anonymous*

Question 34

What is a "maladie a traitement obligatoire"?

Answer 34

A disease that is mandatory to treat because it poses a public health risk (e.g. TB).

Question 35

The ratio of the probability of an event (e.g. developing a disease or getting injured) occurring in an exposed group vs non-exposed group. Name Math formula

Answer 35

Rate ratio Incidence rate in exposed/Incidence rate in unexposed

Question 36

The ratio of the hazard rates corresponding to the conditions described by two levels of an explanatory variable To compare the rate of an event (like death, disease recurrence, or recovery) happening in one group versus another over time.

Answer 36

Hazard ratio Time to event in exposed/time to event in unexposed

Question 37

Explain the meaning of... HR=1 HR>1 HR<1

Answer 37

HR = 1: The event rates are the same in both groups. HR > 1: The event happens more often in the group being studied (higher risk). HR < 1: The event happens less often in the group being studied (lower risk).

Question 38

If a new drug has an HR of 0.75 compared to standard treatment, it means the new drug reduces the event rate by...

Answer 38

25%

Question 39

The ratio of the risk of an event in two groups

Question 40

Duchenne muscular dystrophy is a ....

Answer 40

X-linked recessive disorder

Question 41

What are the 3 risks of cancer screening?

Answer 41

Over-diagnosis Over-treatment False positives

Question 42

What is the main harm of cancer therapy/drugs?

Answer 42

Toxicity

Question 43

The therapeutic index for cancer drugs is...

Answer 43

very low (we use drugs with unacceptable levels of toxicity)

Question 44

The extent to which patients follow treatment

Answer 44

compliance

Question 45

What is a major reason for therapeutic failure, esp. in long-term treatment?

Answer 45

non-compliance

Question 46

Which is more common? a) missed doses of a drug b) too many doses of a drug

Answer 46

a) missed doses

Question 47

Which is more important? a) number of drugs a person must take b) number of times a day doses must be remembered

Answer 47

b) number of times a day doses must be remembered

Question 48

What can improve compliance?

Answer 48

Reducing the number of dosing occasions

Question 49

What disease is one of the worst for compliance-related issues?

Answer 49

Diabetes

Question 50

What is the therapeutic index?

Answer 50

Therapeutic ratio, i.e. comparison of the amount causing toxicity to the amount causing therapeutic effect

Question 51

Formula for therapeutic index

Answer 51

TI=LD50/ED50

Question 52

Increased TI means...

Answer 52

increased margin of safety

Question 53

What is the LD50

Answer 53

Lethal dose 50 (dose that causes death in 50% of patients)

Question 54

What is the ED50

Answer 54

Effective dose 50 (dose that has a therapeutic effect in 50% of patients)

Question 55

Sources of inter-patient variability in drug responses

Answer 55

- age - gender - specific physiological states (pregnancy) - concurrent drugs - concurrent diseases - adverse or allergic reactions to drugs - pharmacogenetic phenotype (polymorphisms) - pharmacokinetics - pharmacodynamics

Question 56

Potency of a drug

Answer 56

Amount of drug needed to produce a specific effect (Recognition/affinity for the drug)

Question 57

Efficacy of a drug

Answer 57

Maximum effect a drug can produce, regardless of the dose. It measures how well a drug activates its target receptor or produces a therapeutic response once bound.

Question 58

Risk of recurrence in the same couple of an autosomal recessive disease

Answer 58

1/4

Question 59

Risk of recurrence in the same couple of an autosomal dominant disease

Answer 59

1/2

Question 60

Risk of a sibling of an affected individual

Answer 60

2/3

Question 61

Risk of a sibling of a carrier

Answer 61

1/2

Question 62

X-linked inheritance (3 mai characteristics)

Answer 62

- more males than females affected in the pedigree - never transmitted from father to son - all daughters of affected males will be carriers