CPS First Nations Flashcards
Which of the following is false of scabies?
a) transmitted by skin to skin contact or from bed linens
b) incubation period is 6 weeks
c) can be a “marker disease for immunocompromised patients
d) more prevalence in overcrowded and/or less developed communities
b) false ->is 3 weeks, but reinfestation can occur much faster
the rest are true
caused by a mite that is transmitted from person to person, burrow, lays eggs which cause itching, can cause secondary infection
skin to skin is the most likely way, likely doesn’t survive long off of skin, more parasites equal more transmission
the mites, and ova lead to burrowing and itching
highly contagious, risk for health care workers
Scabies are typically found in all but which of the following locations in infants and young children?
a) scalp
b) hands and feet
c) skin folds
d) face
d)
the others are areas found in children
adult - web spaces between fingers, skin folds, genitalia (men) and breasts (women)
children - often atypically distributed generally, can get missed, scalp (infants), hands/feet and skin folds
often mistaken for impetigo and eczema, but treatment for these doesn’t help
diagnoses is by skin scraping
Which of the following is not true of why scabies is prevalent in aboriginal populations?
a) poor compliance with treatment
b) lack of running water
c) high elderly population
d) crowding in houses and community centres
c) in fact the opposite, high paediatric populations, failure to eradicate scabies from bed linens etc.
also failure to recognize an infestation
reduced access to medical care
lack of running water increases the chance of secondary skin infection
infestations every 15-30 years,
Which of the following is true of scabies treatment?
a) the first line treatment is one dose of 5% permethrin cream
b) treating symptomatic cases decreases the prevalence in a community
c) 1% permethrin (aka Nix) can be used to treat scabies
d) permethrin can be used for children of all ages
a) true - equally effective as Lindane (which is more neurotoxic). permethrin has low toxicity and excellent results
- should be washed off after 8-14 hours
- wash off in 8-9 hours in children
Which of the following treatments is the best for a 1.5 month old with scabies?
a) 5% permethrin
b) Lindane
c) precipitated sulphur (7%)
d) 1% permethrin
c) is the best alternative
for very young infants and pregnant/lactating women, prepared by pharmacist, 3 consecutive days x 24 hours each time
the others
a) 5% permethrin - not for very young infants, acts on sodium channel and leads to paralysis and death of the parasite, no recommended in pregnancy (has been used in 23 day old and pregnant women)
b) Lindane- in general alternative when 5% permethrin not available, however, should be cautious when prescribing to infants or lactating/pregnant women. wash off after 6 hours in infants, 6-8 hours in children, 8-12 hours in adults. only reapply in 1 week if live mites appear
d) for head lice, not the same thing
change clothing and linen every day until you can treat everybody (Julie notes)
in bags, usually don’t live more than 4 days in bag
don’t go to school until treated
Which of the following is not part of treatment of scabies?
a) treat patient, family and contacts
b) apply treatment to whole body after a bath/shower and after drying
c) treat all areas including face and scalp
d) tell patients that persistent of itching means that the mites are still alive
d) itching can persist even after mites are dead due to reaction to material still in the skin
the rest are part of it
- can find mites in places that don’t show signs (i.e. face), need to apply to whole body, especially in very young
also wash bed linens and clothes next to skin in hot water (60 c); if no hot water, put in plastic bag away from family for 5-7 days (cannot survive more than 4 days away from skin),
persistent symptoms most likely due to inadequate application of treatment and inadequate treatment of contact cases
treat all household members at same time, may not have symptoms fro 2-3 weeks
daycare the day after treatment is okay
if we treat a kid with scabies may need prophylaxis (do a treatment) Julie
future - ivermectin not approved in Canada for this use, no clear advantages over topical therapy, single oral dose, helps to control epidemics, doesn’t cross BBB easily
Which of the following are not common challenges with researching Aboriginal populations?
a) easy to identify populations
b) difficulty implementing the community based participatory research (CBPR) method
c) grouping on and off reserve populations together
d) not examining the needs of each subgroup proportionate to their share of the population
a) actually hard to identifity which population you are studying
the rest are true
misrepresentation/stigmatization also challenge
may need to approach elders first ensure the research benefits the children protect anonymity translation may be needed ensure the people know their rights
Which of the following is not part of the CBPR approach of research?
a) ownership
b) prevention of access to information
c) control
d) possession of data
b) opposite should have access
ownership - first nations community owns the information
control by community of research and community infromation/processes
possession of data by the community
should be used for all aboriginal research, developed by the First Nations Longitudinal health survey
governments should prioritize research based on CBPR research to help reduce health disparities
Which of the following has not been linked to vitamin D deficiency?
a) diabetes
b) congenital heart disease
c) tuberculosis
d) asthma
e) dental caries
b) answer
Vitamin D deficiency has been linked to osteoporosis asthma, autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and inflammatory bowel diseases, diabetes, disturbed muscle function, resistance to tuberculosis, cancer
fetal life - linked to severity of asthma, type 1 diabetes and bone density linked to low vitamin D levels in fetal life, dental caries may be linked to low fetal vitamin D levels
Which of the following is not an equivalent amount of vitamin D?
a) 400 IU
b) 10 micrograms (ug)
c) 26 nmol
d) 50 mg
d) is not equivalent 1IU = 0.025 ug = or 65 pico mol
Which is the best measurement of vitamin D levels?
a) vitamin D2
b) vitamin D3
c) 25 OH D
d) 1, 25 OH D
c) optimal 25 OH D is the level where PTH production is minimized and the resorption of calcium from bone is minimized and the absorption of calcium from the gut is stable(see my chart i drew). and to make sure not so much that you get hypercalcemia and its complications
Which of the following vitamin D levels is sufficient?
a) 8 ng/ml
b) 50 nmol/L
c) 20 nmol/L
d) 100 nmol/L
d) is the answer
deficient is 225 nmol/L
potentially toxic is >200 ng/ml or >500 nmol/L
aim is to have enough vitamin D to absorb calcium from the gut and to minimize PTH secretion so you don’t have breakdown of bone or hypercalcemia and calcium deposition in tissues
vitamin D deficiency is associated with lower Ca absorption from the but and hypocalcemia
Which of the following does not influence vitamin D absorption?
a) BMI
b) latitude and sun exposure
c) altitude
d) ethnicity
c)
not altitude, latitude affects amount of vitamin D
one study, Edmonton Alberta, vitamin D3 production in skin almost non existent
worse in Arctice
new research, vitamin D3 inversely related to BMI
ethnicity - Aboriginal women have lower vitamin D levels that others, even with same intake of vitamin D; more risk of bit D deficient rickets in First Nations, Inuit and Middle Eastern
minimal exposure in infants - no sun exposure <1 year old and also use sunscreens
Which of the following is not associated with maternal vitamin D deficiency during pregnancy?
a) hypercalcemia
b) dental malformation
c) smaller size
d) rickets
a) false - associated with hypocalcemia and rickets, not hypercalcemia
supplements - Health Canada recommend 200 IU/day for women during pregnancy, most have 400 IU/day of vitamin D3
D3 (animal) D2 (plant -less effective)
Which of the following is not an appropriate level of supplementation for the case?
a) healthy breastfed newborn - 400 IU daily
b) breastfeeding mother not supplementing infant - up to 2000 IU
c) baby in Nunavut - 800 IU
d) premature infant - 800 IU
d) premature should be 200-400 IU, should get supplement of at least 200/day since even if the milk has enough vitamin D they don’t eat enough to get enough vitamin D
the rest are true
north of 55th parallel - (i.e. Edmonton) between October and April should have 800 IU/day
40th-55th parallel if other risk factors also
should consider giving 2000 IU to breastfeeding and lactating women, to prevent deficiency, especially during winter months; vitamin D deficiency in breastfeeding mothers is common since people don’t take enough of them
there have been concerns raised about getting hypercalcemia malignant during pregnancy with supplementation but it hasn’t happened
studies now show that we might need more, more research is needed
foods that have vitamin D- infant formula, dairy, soy beverages and rice are fortified with 400 IU/L, traditional native foods have vitamin D also but don’t eat enough to prevent deficiency
amount of vitamin D needed might increase with age ; one study showed that needed 1200 IU/day for 12 kg toddler
Which of the following is not a risk factor for type 2 diabetes?
a) obesity
b) hypertension
c) ethnicity and genetic markers
d) gestational diabetes
b)
the physical signs of insulin resistance and metabolic syndrome (including acanthuses nigracans, PCOS, HTN, dyslipidemia and steatohepatitis) are not causative of DM2 but are associated with glucose intolerance and early onset DM2
PCOS - 2 main features are hirsutism and irregular menses, despite more obesity in First Nations, PCOS is rare in Aboriginal girls
prevention program: Kawnawake is the example, since it incorporates Mohawk culture i.e. the Sandy Lake Program includes classroom curriculum, family outreach, student activities, and advocacy for changes in the school and store environment. get rid of junk food (including advocacy), exercise, teach about diabetes
Which of the following Aboriginal kids should be screened for type 2 diabetes?
a) 11 year old with BMI >85th percentile and mother with gestational diabetes
b) 8 year old with BMI >85th percentile and dyslipidemia and hypertension
c) 15 year old with BMI
a) should have all 3 of : age >10 year old, BMI>85th percentile and Aboriginal descent, PLUS one of the following : sedentary lifestyle, mother with GDM, 1st or secondary relative with type 2 DM (immediate family member, or aunt, uncle, grandparent) , dyslipidemia, hypertension, acanthosis nigracans, PCOS
lots of people have questioned who should be screened. only high risk individuals should be screened CPS supports opportunistic screening for DM2 in Canada
Which of the following is not an appropriate screening test for diabetes?
a) Fasting blood glucose >7.0 mmol/L
b) Random blood glucose > 11.1mmol/L
c) HgA1C >7.0
d) Oral Glucose Tolerance Test with fasting and 2hr post glucose load test
c) currently no evidence to recommend HgA1C as a screening method
