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FCP Flashcards

1
Q

Public Health Definition

A

Art of Preventing Disease
Prolonging Life
Promoting Health

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2
Q

4 Aspects of Public Health Approach

A

Surveillance
Risk Factor Identification
Intervention Evaluation
Implementation

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3
Q

What are the 10 Public Health Essential Services?

A 
Monitor Health of Community
Diagnose
Educate
Mobilize Partnerships
Develop Policies
Enforce Laws
Link People to HS
Competent Workforce
Evaluate Quality of HS
Research
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4
Q

Determinants of Health of Population

A

Social Characteristics
Genes / Biology
Health Behaviors
Medical Care

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5
Q

Community Diagnosis

A

Identification / Quantification of Health Problems in Community

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6
Q

Clinical vs Community Diagnosis

A

Clinical (History / Exam / Test / Diagnosis)

Community (Talk / Records / Survey / C. Diagnosis)

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7
Q

Aim of Community Diagnosis

A

Prevention & Promotion

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8
Q

What is Occupational Health

A

Promotion + Maintenance of Physical / Mental / Social Well Being of Workers

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9
Q

What are the 4 Objectives of Occupational Health

A

Maintenance + Promotion of Workers Health
Prevent Diseases
Protect Workers
Safe Workplace Environment

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10
Q

Difference Between Occupational Disease & Work Related Disease?

A

Occupational - Cause Specific (Silica in Factory)

Work Related - Multifactorial (Work Stress)

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11
Q

Hazard

A

Ability of Agent to cause damage to biologic material

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12
Q

Exposure

A

contact to hazard that allows effective transmission

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13
Q

Risk

A

Probability that adverse effects will occur

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14
Q

Workplace Assessment (3)

A

Workplace Risk Evaluation
Risk Communication
Risk Management

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15
Q

How is Workplace Risk Evaluation carried out? (4 Steps)

A

Hazard Identification
Hazard Evaluation
Exposure Assessment
Risk Characterization

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16
Q

Risk Communication

A

Using Info Gathered this is the follow where the responsible personnel makes informed and independent decisions about Health / Safety Risks

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17
Q

When risk communication is conducted prior to exposure this is called?

A

Primary Prevention

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18
Q

Risk Management

A

Employer / Employee / Medical Consultant manage risk

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19
Q

What are the 4 options in Risk Management?

A

Exposure Reduction / Elimination
(PPE not primary mode this is the most desirable)
Temporary Job Transfer
(High risk and reduction / elimination not possible)
Disability Leave
(Exposure wont be reduced & transfer not possible)
Remove Individual from Work
(Last Desirable)

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20
Q

What are the 6 environmental (Engineering) measures taken ?

A 
Substitution
Isolation (Other workers not affected)
Segregation (Away from workplace)
Ventilation
Environmental Monitoring
Ergonomics
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21
Q

What are the 3 medical / personal measures taken?

A

Pre Employment Medical Examination
Periodic Medical Examination
Biologic Monitoring

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22
Q

What is the aim of Pre Employment Examination (PEE) ?

A

Baseline Medical Data (Medicolegal)

Identify Highly Susceptible Individuals and advise regarding suitability of work and his health

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23
Q

What is the aim of Periodic Medical Examination (PME) (4 Aims) ?

A

Early Disease Detection (Better Treatment / Prognosis)
Early Removal of Susceptible Individuals (Prevention)
Early Detection of Hazardous Jobs
(To apply Engineering / Control Measures)
Evaluation of Previous Prevention / Control

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24
Q

What does Periodic Medical Examination include?

A

Questionnaire
Screening tests
Periodic Audiometry
Periodic CXR / Ventilatory Function

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25
Q

What is Biological Monitoring?

A

Part of Periodic Medical Examination

Measuring Elements / Metabolites in biological fluids

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26
Q

Aim of PPE

A

Prevent penetration of uncontrolled hazardous exposure

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27
Q

Organized and Systematic way of finding answers to questions

A

Research

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28
Q

Types of Health Research

A

Quantitative (Numerical)
Qualitative (Non Numerical)
Mixed Methods

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29
Q

PICO Approach

A

Population
Intervention
Comparisons
Outcomes

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30
Q

4 Ws Format

A

Who
What
Where
When

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31
Q

Different types of epidemiological studies?

A

Descriptive (No Comparison)

Analytical (Comparison)

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32
Q

Types of Descriptive studies

A

Case Report
Case Series
Ecological Studies

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33
Q

Types of Analytical Studies

A

Observational
(Cohort / Case Control / Cross Sectional)
Interventional
(Clinical Trial / Community Trial)

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34
Q

Case Report

A

Clinical Phenomenon in Single Patient

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35
Q

Case Series

A

More than one patient with similar problems

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36
Q

Limitations of Case Report / Case Series

A

External Validity

Confounding

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37
Q

Ecological Studies

A

Average Exposure - Frequency of Disease in Populations

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38
Q

Ecological Fallacy

A

Conclusions on individuals based on analyses of group data
(high income is
associated with high mortality from cancer at the
individual level. In fact at individual level we may
observe the reverse: mortality from malignancy is
lower with high income)

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39
Q

Cross Sectional

A

Exposure and Disease at one Point (snapshot)

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40
Q

Cohort

A

Exposure + Look Forwards to outcome (Prospective)

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41
Q

Case Control

A

Identify disease status then look backwards to exposure (restrospective

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42
Q

Which study is known as prevalence study?

A

Cross Section

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43
Q

Advantages of Cross Section

A

Simple
Cheap
Quick
Gives Prevalence

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44
Q

Disadvantages of Cross Section

A

Not for Rare / Short Duration Diseases
May result in wrong conclusion
No Solid Evidence

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45
Q

Types of Cohort Studies

A

Prospective
Retrospective
Reconstructive

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46
Q

Relative Risk

A

Incidence in Exposed / Incidence in unexposed

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47
Q

Attributable Risk

A

Incidence in Exposed - Incidence in Unexposed

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48
Q

Relative Risk Interpretation

A

=1 Risk Same
>1 Increased Risk (Exposed)
<1 Decreased Risk (Exposed)

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49
Q

Confounding

A

Measure of association or effect between exposure and outcome is distorted by the presence of another variable.

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50
Q

How to Deal with Confounding Factors (Design Stage)

A

Restriction
(Admission of those free from confounder)
Randomization
(Distribute the confounders equally)
Matching
(Distribution of confounders in different groups)

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51
Q

How to deal with confounding (Analysis Stage)

A

Stratification (Analyzing at different levels)

Modeling (Using regression techniques)

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52
Q

Advantage of Cohort Studies

A

Incidence Rate Calculation
Estimates of RR / AR
No Recall Bias
Suitable for Rare Exposure

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53
Q

Disadvantages of Cohort

A 
Large Number of People
Long time
Not for rare diseases / low incidence
Loss to follow up
Expensive
Loss of staff
People behavior changes
Ethical Problems
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54
Q

Which type of study is Cohort Study

A

Observational

Analytical

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55
Q

Disease caused by transmission of pathogenic agent to host

A

Communicable Disease

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56
Q

Progression of disease in absence of treatment

A

Natural History

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57
Q

Spectrum of Disease

A

Manifestations present in each infected individual

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58
Q

Epidemiological triad

A

Agent
Host
Environment

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59
Q

Infectivity Ratio

A

Number Infected / Number Exposed

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60
Q

Basic Reproduction Number RO

A

Number of secondary infections that result from primary infection in SUSCEPTIBLE population (R is number in both susceptible and unsusceptable)

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61
Q

Interpret R0 Number

A

Example R0 for Measles is 15

Each new case of measles 15 new secondary cases

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62
Q

What is the R0 Number in an epidemic?

A

Must be >1

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63
Q

Effective Reproductive Number (R)

A

Average number of secondary cases per infectious case in a population made up of both
susceptible and non-susceptible hosts.

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64
Q

Effective Reproductive Number (R) Interpretation

A

> 1 - Number of cases will increase
=1 - Endemic
<1 - Decline in number of cases

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65
Q

Pathogenicity

A

Extent to which clinically manifest disease is produced in infected population

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66
Q

Pathogenicity Ratio

A

Number developing clinical illness / Number infected

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67
Q

Virulence

A

Extent to which severe disease is produced in population

Virulence - Very Severe

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68
Q

Virulence Ratio

A

Number with severe disease / Number with disease

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69
Q

Infective dose of infectious agent

A

Number of organisms needed to cause infection

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70
Q

Resevior

A

Place where infectious agent can live and multiply

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71
Q

Preclinical disease

A

Disease not clinically apparent but destined to progress to one

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72
Q

Sub-Clinical

A

Not clinically apparent and not destined to become apparent

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73
Q

Latent Infection

A

No active multiplication

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74
Q

Modes of Transmission

A

Direct (Same Place)
Indirect (Vehicle / Vector)
Airborne (Droplet / Dust)

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75
Q

Vertical modes of transmission

A

In Utero (Pregnancy)
Perinatal (During Delivery)
Breast Feeding

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76
Q

Incubation Period

A

Time between invasion and first sign / symptom

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77
Q

Period of Communicability

A

time where agent may be transferred from person to person

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78
Q

Ability of agent to cause clinical manifestations

A

Antigenicity

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79
Q

An individual who is neither immune or infected

A

Susceptible individual

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80
Q

Permanent reduction of Disease worldwide to zero with no agent detected in environment

A

Eradication

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81
Q

Reduction of infection / disease to zero with agent present

A

Elimination

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82
Q

Eradication vs Elimination

A

Eradication - Agent isn’t in environment

Elimination - Agent present in environment

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83
Q

Examples of Eliminated diseases

A

Measles
Polio
(Aka reduced but agent present)

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84
Q

Example or Eradicated Disease

A

Small Pox

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85
Q

Level of Prevention

A

Primary - Prevention of Disease
Secondary - Early Detection
Tertiary - Prevent Deterioration
(PED)

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86
Q

Primary Prevention

A

Reduce incidence of Disease / Risk Factor

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87
Q

Secondary Prevention

A

Reduce prevalence by shortening duration of infection

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88
Q

Tertiary Prevention

A

Reduce / Eliminate Long Term Impairments

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89
Q

Control Measures of Cases (7)

A 
Case Finding
Notification
Isolation
Disinfection
Treatment
Release
Others (Follow Up)
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90
Q

Control Measures of Contacts (5)

A 
Enlistment
Examination
Stop Exposure
Surveillance Segregation
Specific Protection
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91
Q

Permanent incidence reduction to Zero (Worldwide)

A

Eradication

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92
Q

Reduction to zero (Defined area)

A

Elimination

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93
Q

Reduction to locally accepted level

A

Control

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94
Q

Agent no longer exists in nature or lab

A

Extinction

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95
Q

Virulence

A

Cause Serious Disease

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96
Q

Pathogenicity

A

Cause Disease

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97
Q

Infectiousness

A

Transmission

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98
Q

Infectivity

A

Ability to infect

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99
Q

Control Measures applied to infectious agents

A 
Cleaning
Cooling
Pasteurization
Disinfection
Sterilization
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100
Q

Control Measures applied to host

A 
Vaccination
Prophylaxis
Behavior
Barrier
Improving Host Resistance
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101
Q

Control Measures applied to environment

A

Safe Water Provision
Feces Disposal
Food / Milk Sanitation

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102
Q

Types of Observational Studies

A

Cross Sectional
Cohort
Case - Control
(No Intervention)

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103
Q

Case Control Study

A

Cases identified and compared with individuals without condition of interest (Controls)

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104
Q

When is a Case Control Study Desirable

A

Rare Disease
Dynamic Population
Little Known about RF

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105
Q

Optimum Selection of Controls

A

Multiple Control Groups (Different Sources)
Matching (Similar to cases)
Size (Equal to Case Group)

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106
Q

Types of Bias

A 
Interviewer (Use Objective Method)
Recall
Selection
Measurement
Observer Bias
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107
Q

Odds Ratio

A

Odds of Exposure in Cases / Odds of Exposure in Controls
Or
AD/BC

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108
Q

Advantages of Case Control

A 
Easy
Cheap
Rare Diseases
No Risk
Study of Several Factors
No loss to follow up
No Ethical Problems
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109
Q

Disadvantages of Case Control

A

Bias
Validation of Info
Appropriate Control Selection difficult
Odds Ratio is an estimate of RR with low prevalence diseases only

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110
Q

Which study is more Suitable for Rare Diseases

A

Case Control

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111
Q

How to remove bias in Clinical Trials?

A

Randomization

Blinding

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112
Q

Levels of Blinding

A

Individual
Investigator
Analyst

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113
Q

Key Elements of Clinical Trial

A 
Selection
Randomization
Blinding
Data Collection
Statistical Issues
Ethical Considerations
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114
Q

Inert compound given to subjects in clinical trial

A

Placebo

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115
Q

Types of RCT endpoints

A

Primary (ex. Cured 3+ Months)
Surrogate
Composite (Death / Attack)
Safety

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116
Q

Rules to stop trial

A

Severe Side Effects

Benefit becomes undeniable

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117
Q

Statistical Issues that can arise

A

Sample Size

Analysis

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118
Q

Intent to treat Analysis

A

All participants enrolled in trial (Completed the trial or not)

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119
Q

Per Protocol Analysis

A

Only who completed trial

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120
Q

Number Needed to Treat Formula

A

1 / (Incidence control - Incidence Treated)
or
1 / Absolute Risk Reduction

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121
Q

Efficacy Formula

A

(Incidence placebo - Incidence Treatment) / Incidence Placebo

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122
Q

Inactivated Toxins

A

Diphtheria and Tetanus

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123
Q

Inactivated Complex Antigens

A

Whole-cell pertussis

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124
Q

Purified Antigen

A

Acellular Pertussis

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125
Q

Recombinant Antigens

A

Hepatitis B Recombinant Vaccine

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126
Q

Live Attenuated

A

Measles

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127
Q

Under Which Condition does WHO grant certification of elimination?

A

Interruption of Transmission lasted at least 3 consecutive years

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128
Q

Transmission of disease no longer active in certain area

A

Elimination

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129
Q

Which diseases have been eradicated ?

A

Smallpox

Rinderpest

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130
Q

Causative Agent of Tetanus

A

Clostridium Tetani

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131
Q

Tetanus is which type of Bacteria

A

Anaerobic
Motile
Gram +

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132
Q

Main Reservoir of Tetanus

A

Soil

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133
Q

Names of Tetanus Toxins

A

Tetanospasmin

Tetanolysin

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134
Q

Which neurotoxin causes clinical manifestations of Tetanus

A

Tetanospasmin

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135
Q

When does tetanus produce toxins

A

Low Oxygen Levels

Spore - Germinates - Active Vegetative State - Multiplies - Produces Toxin

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136
Q

Mode of Transmission of Tetanus

A

Percutaneous (Must pass skin barrier)

No Wound - No Tetanus

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137
Q

Lethal dose of tetanus

A

0.1 Mg for 70 Kg Man

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138
Q

Incubation Period of Tetanus

A

3 - 21 Days

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139
Q

Types of Tetanus

A 
Traumatic
Puerperal
Otogenic
Idiopathic
Neonatorum
Cephalic
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140
Q

What can prevent tetanus

A

Immunization

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141
Q

When is the combined tetanus diptheria pertussis vaccine offered?

A

Months 2 / 4 / 6

Booster ( 18th Month / 5 Years / 10 Years / 16 Years)

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142
Q

When is the monovalent vaccine offered?

A

0 / 2 / 12 Months

Booster after 5 then every 10

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143
Q

When is TdaP given to adults

A

Every 10 Years

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144
Q

How long does the tetanus Ig produce protective antibody levels for?

A

4-6 Weeks Atleast

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145
Q

Tetanus Vaccination in Children

A

Months 2 / 4 / 6 / 18 (Booster)
4th Year Primary
After 10 Years 3rd Dose

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146
Q

Tetanus prevention in Pregnancy (Not Previously Immunized)

A

First Dose - 6th Month
Second Dose - After 1 Month until 2 Weeks Before Delivery
Third Dose - After 6-12 Months or Next Pregnancy
Fourth/Fifth - After one Year

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147
Q

Tetanus Prevention in Pregnancy (Immunized)

A

Two Doses - After First Trimester till 2 Weeks Before Delivery
Third Dose - After 6/12 Months or Next Pregnancy

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148
Q

Tetanus vaccine in adults (Immunized)

A

Booster every 10 Years

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149
Q

Tetanus Vaccine in soldiers / farmers / gardeners

A

Two doses one month apart

Third Dose after 6 - 12 Months

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150
Q

Tetanus Case Management

A 
Medical Emergency - Hospitalization
Patent Airway
TIG Immediately
 Wound Care 
Antibiotics
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151
Q

Does tetanus disease give immunity?

A

No

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152
Q

Tetanus contacts management

A

Nothing

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153
Q

Which type of Virus is Rabies

A

Non-segmented
Negative Stranded
RNA
(Rhaboviridae Family)

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154
Q

Rabies transmission

A

Direct Contact

Through Mucus Membranes

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155
Q

Most effective strategy for preventing Rabies

A

Vaccinating Dogs

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156
Q

Types of Rabies Vaccines

A

Human Diploid Cell Vaccine
Rabies Vaccine Adsorbed
(5*1ml Doses deltoid region)

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157
Q

Mechanism of Action in Rabies

A

Multiplication in Nervous tissue

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158
Q

Polio Incubation Period

A

14 Days

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159
Q

Polio Mode of Transmission

A

Direct Droplet

Faeco-Oral Infection

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160
Q

Types of Polio

A

Non-Paralytic

Paralytic

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161
Q

Non Paralytic Polio

A

Stiff / Pain Neck
2-10 Days
Rapid Recovery

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162
Q

Paralytic

A

Paralysis in 4 days

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163
Q

IPV Vaccination

A

2 / 4 / 6 /18 Months

4-6 Years

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164
Q

OPV Vaccination

A

2 / 4 / 6 / 9 / 12 / 18 Months

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165
Q

Which polio vaccine Builds mucosal immunity?

A

OPV (Oral)

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166
Q

FINER Acronym Research

A 
Feasible
Interesting
Novel (New Findings)
Ethical
Relevant
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167
Q

PICO

A

Population
Intervention
Comparison (Type of Control)
Outcome

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168
Q

Emerging Infectious Disease

A

Newly discovered infectious agent

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169
Q

Re-emerging Infectious Disease

A

Previously controlled but risen again to be a problem

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170
Q

What are factors affecting emerging / reemerging diseases

A 
Ecological Changes
Human Demographics
International Travel
Microbial Adaptation
Breakdown 
Intent to Harm
War
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171
Q

How do ecological changes affect emerging / remerging diseases?

A

Global warming increases temperature

Increase in waterborne / vector transmission

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172
Q

Epidemic

A

Disease that affects large number of People within community / population / region

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173
Q

Pandemic

A

Epidemic that spread over multiple countries or continents

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174
Q

Endemic

A

Constant presence in a specific location

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175
Q

How many phases is the WHO Pandemic Alert system?

A

6 Phases

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176
Q

Phase 1 WHO PS

A

Virus in animals

No infections in humans

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177
Q

Phase 2 WHO PS

A

Animal Virus

Caused Infection in humans

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178
Q

Phase 3 WHO PS

A

Clusters of disease in humans

No Outbreaks

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179
Q

Phase 4 WHO PS

A

Spreading from person to person

Outbreaks at community level

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180
Q

Phase 5 WHO PS

A

More than one country

Same Region

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181
Q

Phase 6

A

More than one country

Different region

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182
Q

Phases Recap

A 
1 - No infection
2- Human Infection
3 - Cluster of infection
4 - Community Outbreak
5 - More than one country
6 - Country in a different region
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183
Q

Types of Epidemic Curves

A

Point Source
Continuous
Propagated

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184
Q

Point Source Outbreak

A

Common contaminated source

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185
Q

Describe the point source epidemic curve?

A

Rapid increase with slower decline

All Cases one incubation period

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186
Q

Describe the continuous common source curve

A

Rise to a peak then falls

Not in a single incubation period

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187
Q

Example of Common Source

A

Cholera

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188
Q

Example of Point Source

A

Hepatitis A

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189
Q

Example of Point Source

A

Hepatitis A

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190
Q

Propagated epidemic example

A

Measles

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191
Q

Propagated curve description

A

Series of successively large peaks

One Incubation period apart

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192
Q

Measures to prevent emerging infectious disease

A

Surveillance
Applied Research
Infrastructure / Training
Prevention / Control

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193
Q

Nuremberg Code

A

Informed consent is essential

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194
Q

Declaration of Helsinki

A

Protocol should be submitted for ethical review

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195
Q

Ethical Requirements of Research

A 
Validity
Social Value
Community Partnership
Favorable Risk/Benefit
Fair Subject
Informed Consent
Independent Review
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196
Q

Levels of IRB Review

A

Full Board - More than minimal Risk
Expedited - Minimal Risk
Exempt - Observational Only

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197
Q

What determines IRB Level

A

Nature of Protocol
Level of Potential Risk
Subject Population

198
Q

Define Research Misconduct

A

Fabrication
Falsification
Plagiarism

199
Q

Define Fabrication

A

Making up data

200
Q

Define Falsification

A

Manipulating data

201
Q

Define Plagiarism

A

Appropriation of another persons idea

202
Q

What is the research ethics committee

A

Review and approve the initiation of research

Protection of Human Rights

203
Q

What are the basic vaccinations

A

BCG
DPT
OPV
Measles or MMR

204
Q

How many doses of hepatitis are recommended

205
Q

Strategies of Vaccine Delivery

A

Fixed Immunization Posts
Outreach Immunization
National Immunization Days
Supplementary Immunization Activities

206
Q

What damages a vaccine?

A 
Expiry Date
Heat / Sunlight
Freezing
Reconstituted vaccine after 6 hours
Disinfectants
207
Q

Examples of Live Attenuated Vaccines

A

BCG
Measles
MMR

208
Q

What could damage live attenuated vaccines

A

Heat / Sunlight

209
Q

What damages toxoid / killed vaccines

A

Freezing

DPT / Pentavalent

210
Q

What damages reconstituted vaccines

A

Using after 6 Hours (Recommended Period)

MMR / Measles / BCG

211
Q

Which vaccines are not damaged by freezing?

A

OPV
MMR
BCG
Hib

212
Q

Which vaccines are damaged by freezing

A 
DTwp
Pentavalent
Hib
T / DT
Hep B
213
Q

Cold Chain

A

System for storing / transporting vaccines at recommended temperature

214
Q

Vaccines Refrigerator Rules

A 
Old vaccines to be used first
No food / drink
No vaccines in the door
No vaccines in the freezer (Except Polio)
Keep vaccines between 2-8
215
Q

Optimum temperature of vaccines

A

Between 2 & 8

216
Q

Which vaccines are kept in dark ampoules to protect from light

A

BCG

Measles

217
Q

How to check potency of vaccine

A

Vaccine Vial Monitor

Shake Test

218
Q

Vaccine Vial Monitor

A

If square lighter than the surrounding circle its good for utilization
Darker - Dont Utilize

219
Q

How to perform shake test

A

Shake and observe sedimentation

220
Q

What indicates vaccine is good for use on shake test

A

Immediately after shaking - Smooth / Cloudy

30 Mins after - Clearing up wo/sediment

221
Q

What indicates vaccine should not be used shake test

A

Immediately after - Granular Particles

30 Mins after - Thick Sediment

222
Q

Indicators for EPI evaluation

A

Vaccination Coverage
Program Drop Out
Vaccine Wastage

223
Q

Proportion of population at risk of disease who received vaccination

A

Vaccination Coverage Rate

224
Q

Vaccination Coverage Rate Equation

A

Number of people vaccinated / target

Times 100

225
Q

What does a high vaccination coverage rater indicate

A

Access of population to HS

226
Q

Program dropout rate equation

A

first dose - second dose / first dose

times 100

227
Q

What does a program drop out rate less than 10 indicate

A

High level of healthcare performance

Good utilization by population

228
Q

It is the proportion of vaccine doses supplied but not administered

A

Vaccine Wastage Rate

229
Q

Vaccine Wastage Rate Equation

A

Dose Supplied - Doses Admin / Doses Supplied

times 100

230
Q

Relationship between three indicators

A

High Coverage
Low Drop out
Low Wastage

231
Q

What is done after positive screening test

A

Diagnostic test

232
Q

Use of Screening Programs

A

Case Detection
Control of Diseases
Research Purposes

233
Q

Types of Screening Programs

A

Mass Screening

Selective Screening

234
Q

Criteria for effective screening program

A 
Disease
Test
Diagnosis
Treatment
Risk / Benefit
235
Q

Assessment of Screening Test Performance

A

Sensitivity
Specificity
PPV
NPV

236
Q

Define Validity

A

Describes Performance of screening test relative to gold standard

237
Q

True Positive / TP + FN

A

Sensitivity

238
Q

True Negative / TN + FP

A

Specificity

239
Q

Validity Formula

A

True Positive + True Negative / Grand Total

Identified Correctly / Total

240
Q

PPV

A

True Positive / All Positive

241
Q

NPV

A

True Negative / All Negative

242
Q

How likely is the disease present of someone tests positive

243
Q

How likely is the disease absent if the person tests negative

244
Q

What factors does the PPV depend on

A

Prevalence
Specificity
Sensitivity

245
Q

Relation between PPV and Prevalence

A

As Prevalence increases PPV Increases

246
Q

Which Marker is used to minimize false negatives

A

High Sensitivity

Rule Out

247
Q

Which marker is used to minimize false positive

A

High Specificity

Rule In

248
Q

Which variables are fixed

A

Sensitivity

Specificity

249
Q

Which variables change

250
Q

Effect of Prevalence on Predictive Value

A

PPV - Directly Proportional

NPV - Inversely Proportional

251
Q

Reliability

A

Test gives same results when repeated

252
Q

Screening Test Reliability

A

Intrasubject - Variation within individual
Intraobserver - Variation in reading by same reader
Interobserver - Variation between those reading

253
Q

Campaign Steps

A 
Training of teams
Raising awareness
Performing Tests
Screening tests done
Referral of detected cases
Follow Up
254
Q

Heat Balance Equation

A

Metabolism + Radiation + Conduction + Evaporation

255
Q

How is heat lost?

A

Evaporation
Radiation
Conduction

256
Q

Disorders that can result from heat

A 
Heat Stroke
Heat Exhaustion
Heat Cramps
Heat Syncope
Skin Disorders
257
Q

Which drugs can increase risk of heat disorders

A 
Sympathomimetics
Anticholinergic
Decrease inn Cardiac Contractility/OP
Volume depletion
Beta Blockers
Lithium
258
Q

Define Heat Stroke

A

Medical Emergency caused by thermal regulatory failure of sudden onset
Manifested by cerebral dysfunction + altered mental status

259
Q

Types of Heat Stroke

A

Classic - Heat Exposure

Exertional - With Effort (Pilgrim)

260
Q

Heat Stroke Cardinal Signs (3)

A

Core temp - 41
CNS Manifestation
Red Hot Skin

261
Q

Heat Stroke Treatment

A

Core Temp Reduction
Evaporative Cooling
Chlorpromazine - Control Shivering

262
Q

Which drug is used to control shivering

A

Chlorpromazine

263
Q

Prevention of Heat Stroke

A

Cool Drinking Water
Shaded Areas
AC
Limiting Exposure

264
Q

What is acclimatization

A

Controlled exposure to heated environments

265
Q

Define Heat Exhaustion

A

Strenuous Work
Prolonged Exposure
Insufficient Salt / Water Intake

266
Q

Difference between Heat Stroke and Heat Exhaustion in temperature

A 
Heat Exhaustion (38-41)
Heat Stroke - 41
267
Q

Heat Exhaustion treatment

A

Shaded Area
Hydration
Isotonic Glucose
24+ Hours Rest

268
Q

Differences between heat stroke / exhaustion

A

Exhaustion - Sweating / Weak Pulse / Cold Skin

Stroke - No Sweat / Rapid Pulse / Hot Skin

269
Q

Heat Cramp

A

Replacement of Sweat with water only
Hyponatremia
Muscular Contractions / Spasm

270
Q

Heat Cramp TRT

A

Water
Relax
Salt

271
Q

Heat Syncope

A

Sudden Unconsciousness

272
Q

Heat Rash

A

Miliaria

Obstruction of sweat duct

273
Q

What produces nitrogen gas bubbles in body

A

Moving from high pressure to low pressure quickly

274
Q

Types of Decompression Sickness

A

Type 1 - Mild Form
Type 2 - Fat Embolism
Type 3 - Delayed Osteonecrosis

275
Q

DCS Type 1 Features

A

Joint Pain

Skin Rash

276
Q

DCS Type 2 Features

A

Spinal Cord / Brain Disorders
Pulmonary Chokes
Arterial Gas Embolism
(Fat Embolism + Poor Prognosis)

277
Q

DCS Treatment

A

Recompression with gradual decompression in hyperbaric chambers

278
Q

Types of Radiation

A

Ionizing

Non-Ionizing

279
Q

Types of Ionizing Radiation

A

Alpha
Betta
Gamma
Xray

280
Q

Types of Non-Ionizing

A

UV
Infrared
Microwave

281
Q

Acute Radiation Syndrome

A

BM Syndrome
GI Syndrome
CV / CNS Syndrome

282
Q

Chronic Radiation Dermatitis

A

Atrophic Skin with telangiectasia
Loss of gland / hair
Reduced Sweating

283
Q

Prevention / Control of Radiation

A

Isolation using Lead
Segregation
Ventilation (Dust could be source of radiation)
Monitoring Devices

284
Q

Conjunctivitis + Corneal ulcers

A

Welders Flash

285
Q

Health effect of Whole Body Vibration

A 
GIT
Decrease VA
Labyrinthine Disorders
MSK Disorders
Skin Lesions
286
Q

Types of Vibration

A

Whole Body

Segmental (HAVS)

287
Q

Hand Arm Vibration Syndrome Clinical Picture

A

Tingling
Color Changes
Decrease Manual Dexterity

288
Q

Diagnosis of Noise Induced Hearing Loss

A

Prolonged exposure to >85 db

289
Q

Control of Noise

A 
Replace Saws with Laser cutting
Segregation of Machines
Isolation of machine
Proper Maintenance 
Monitoring Noise Level
290
Q

Electricity Prevention Measures

A

Electricity Resistant Gloves / Shoes

Non Conductive Clothing

291
Q

Types of Occupational Lung Diseases

A

Pneumoconiosis
Extrinsic Allergic Alveolitis
Byssinosis
Occupational Asthma

292
Q

Types of Pneumoconiosis

A

Silicosis
Asbestosis
Coal Worker P

293
Q

Define Pneumoconiosis

A

Group of Chronic Lung diseases caused by long term exposure to respirable particles

294
Q

Pneumoconiosis pattern in pulmonary function test

A

Restricitve

295
Q

Xray of Silicosis

A

Nodular Opacity

Hilar LN Calcification (Egg - Shell)

296
Q

Which industries are at risk of Asbestosis

A

Car Brakes
Clothes
Cement / Ceiling /Roof

297
Q

Positive Findings in Asbestosis

A

Fine Crepitations at base of lung due to fibrosis

298
Q

Types of CWP

A

Simple (Small opacities)
Progressive Massive (Large Opacities)
Caplan (Nodular Opacity + RA)

299
Q

Extrinsic Allergic Alveolitis (HP)

A

HS reaction following exposure to dust

300
Q

Three dimensions of Burnout Syndrome

A

Emotional Exhaustion
Depersonalization Detachment
Sense of Incompetence

301
Q

Exposure to Lead

A

Inhalation of fumes

Ingestion of Dust

302
Q

Shyness + Anxiety + Memory Loss + Emotional Lability

303
Q

What causes Erethism

A

Mercury Exposure

304
Q

Minamata Disease

A

poisoning with neurological symptoms and caused by the daily consump- tion of large quantities of fish and shellfish that were heavily contaminated with the toxic chemical generated in chemical factories and then discharged into the sea.

305
Q

What are the lung manifestations of Cadmium

A

Bronchitis

Focal Emphysema

306
Q

What are the kidney manifestations of Cadmium

A

Fanconi

Osteomalacia (Itai Itai Disease)

307
Q

Itai Itai Disease

A

Renal Tubular Dysfunction + Osteomalacia

308
Q

What does the steel / leather industry carry a risk of ?

309
Q

Health effects of Chromium

A 
Lung Cancer
Chrome Holes (Ulcers)
310
Q

Risks of Plane Industry

311
Q

Risks of Aluminum

A

Dementia + Alzheimers

312
Q

Chemical Asphyxiants in Petroleum Industry

A

Hydrogen Disulfide

313
Q

Chemical Asphyxiants in Electroplating

A

Hydrogen Cyanide

314
Q

Which chemical asphyxiants inhibit cytochrome oxidase and block oxygen utilization?

A

Hydrogen Disulfide

Hydrogen Cyanide

315
Q

Which gas is released in incomplete combustion?

A

Carbon Monoxide

316
Q

Treatment of Asphyxiant Gases and Upper Airway Irritants

A

Remove Exposure
Oxygen Supply
CPR

317
Q

Treatment of lower airway irritant gases

A

Remove from exposure
Oxygen
CPR
Corticosteroids

318
Q

Upper airway irritants

A

Chlorine

Ammonia

319
Q

Lower airway irritant gases

A

Nitrogen Oxides

320
Q

Chronic Effects of Solvents

A

Presenile Dementia

321
Q

Blood Effects of Benzene

A

Aplastic Anemia - Precursor to leukemia

322
Q

Types of Pesticides

A

Organophosphate
Organochlorine
Carbamate

323
Q

Health effects of Organophosphate / Carbamates

A

Inhibits Acetylcholinesterase Activity

324
Q

Disease Characterized by RTD and Severe Osteomalacia

325
Q

Name Measures of central tendency

A

Mean
Mode
Median

326
Q

Measures of Dispersion

A

Range
Variance
Standard Deviation
Coefficient of Variation

327
Q

How to calculate coefficient of variation

A

SD/Mean *100

328
Q

Qualitative data graphs

329
Q

Quantitative Data Graphs

A

Histogram

Scatter Plot

330
Q

Define Census

A

Enumeration of population recording all people in every residence at a specific time

331
Q

When is the census done?

A

Every 10 Years

332
Q

Defacto Census

A

Counting people where ever they are

333
Q

De Jure Census

A

Counting people at their residence

334
Q

Advantages of De Jure

A

Reflects actual distribution

Counts according to residence

335
Q

Advantages of De Facto

A

Easy

Avoids Problems

336
Q

Who carries out census in egypt?

337
Q

Which Census method is used in Egypt?

338
Q

What is the point of Census

A 
Information about characteristics
Basic Data for Statistical Indicators
Census + Fertility + Mortality
Expected Population Change
Planning
339
Q

Methods of estimating Population

A

Natural Increase
Arithmetic
Graphic
Geometric

340
Q

Natural Increase Method

A

Difference between live births and deaths

341
Q

Arithmetic Method

A

Dividing the difference between two consecutive censuses

342
Q

Graphic Method

A

Plotted on a graph and straight line connected to future

343
Q

Geometric Method

A

Specific Formula

344
Q

Which method is the most accurate method?

345
Q

Ways of measuring population change

A

Rate of Natural Increase

Growth Rate

346
Q

Rate of Natural Increase Equation

A

Birth - Death / 10

347
Q

Growth Rate Equation

A

(Birth - Death) + (Immigration - Emigration)

348
Q

What is demographic transition

A

Long term trend of declining birth and death rates resulting in the change of age distribution

349
Q

Stages of Demographic Transition

A 
Stage 1 - High Stationary
Stage 2 - Early Expanding
Stage 3 - Late Expanding
Stage 4 - Low Stationary
Stage 5 - New Declining
350
Q

Stage 1

A

High Birth Rate
High Death Rate
Very Low Rate of Natural Increase

351
Q

Stage 2 (Early Expanding)

A

Birth Rate High
Drop in Death Rate
Population Increases

352
Q

Stage 3 (Late Expanding)

A

Decline in Birth Rate
Decline in Death Rate
Population Stable
(Children not a necessity)

353
Q

Stage 4 (Low Stationary)

A

Birth Rate low
Death Rate Low
Population Stable
RNI approaches 0

354
Q

Stage 5 (New Contracting Declining)

A

Death Rate > Birth Rate
Population Shrinking
0 Growth

355
Q

Examples of Stage 5 Countries

A

Germany
Japan
(0 Growth)

356
Q

Examples of Stage 4 Countries

A 
UK
Denmark
Sweden
Australia
(RNI Approaching 0)
357
Q

Examples of Stage 2

A

South Asia
Africa
(Population Increases)

358
Q

Age Dependency Ratio Equation

A

Population Under 15 + Over 64 / 15-64

*100

359
Q

Types of Population Pyramid

A

Expansive
Constrictive
Stationary

360
Q

Developing countries - Pyramid

361
Q

Transition Phase Countries Pyramid

A

Constrictive

362
Q

Western European Countries Pyramid

A

Stationary

363
Q

Define Health Education

A

Systematic Planned Application to influence antecedents of behavior

364
Q

Health Education Levels

A

Counseling - One on One
Group Discussion - Group of People
Community - Multiple Level

365
Q

Define Health Literacy

A

Capacity to obtain / interpret / understand basic health information

366
Q

Health Promotion

A 
Promote Social Responsibility
Increase Investments for health
Expand Partnerships for health
Increase Community capacity
Secure an infrastructure
367
Q

Tools of Health Promotion

A 
Mass Media
Social Marketing
Community Mobilization
Health Education
Client Provider Interactions
Policy Communication
368
Q

Six Stages of Social Marketing

A 
Listening (To target)
Planned (Objective Defined)
Structuring
Pretesting (Tested)
Implementing (Put into effect)
Monitoring (Progress Tracked)
369
Q

Effects of Global Warming on Health

A

Increased Temperatures
Extreme Temperatures
Vector Borne Illnesses

370
Q

Effect of Air Quality on Health

A

Increase in CVD & Respiratory Disease

371
Q

Effect of increase in VB Transmission

A

Lyme Disease

372
Q

Effect of increase in flooding

A

Mental Health
Drowning
GI

373
Q

What is the most common health risk associated with drinking water

A

Microbial Contamination

374
Q

Water Acceptability Aspects

A

No Taste & No Odor
No Turbidity
Hardness Varies

375
Q

Which microorganisms can be transmitted by ingestion

A

Cholera

Shigellosis

376
Q

Which mo are transmitted by inhalation

A

Legionnaire

377
Q

Which mo are transmitted by contact

A

Schistosomiases

Leptospirosis

378
Q

How is cholera transmitted

A

feco-oral

Contamination

379
Q

L.Pneumophila

A

Inhalation of aerosols

Shower / Spa / Humidifier

380
Q

How does the leptospiral organism enter the body?

A

Cuts / Abrasions / Mucous Membranes

381
Q

Chlorine pH for effective disinfection

A

Less than 8

382
Q

Methods of disinfection

A

Chlorination
Solar Disinfection
UV Light Radiation

383
Q

How can food be contaminated at production level

A

Untreated Manure - Amoebiasis
Polluted Water
Washing Fruits/Veggies in polluted Canal Water (Fascioliasis)
Animal Food (Taenia)

384
Q

At Manufacture level

385
Q

pH / Temp that is suitable for bacterial growth

A

4.6 - 7.5

5 - 60 Celsius

386
Q

How long does it take for bacteria to double

387
Q

Water activity suitable for growth

388
Q

WHO Five Keys to Safer Food

A 
Keep Clean
Separate Raw / Cooked
Cook Thoroughly
Safe Temp
Safe Water / Raw Material
389
Q

Type of Virus that causes Yellow Fever

A

RNA Virus

Flavivirus Family

390
Q

Yellow Fever Belt

A

15N - 10 S

391
Q

What are the primary reservoir of Yellow Fever?

392
Q

Vaccine used in Yellow Fever

A

17D Vaccine

393
Q

Which type of Vaccine is 17D?

A

Live Attenuated

394
Q

What is given after receiving the Yellow Fever Vaccine?

A

Stamped International Certificate of Vaccination / Prophylaxis

395
Q

Traveling Precautions (Yellow Fever)

A

Vaccine 10 Days before traveling

>10 Quarantine remaining days in country

396
Q

Mode of Transmission of Yellow Fever

A

Aides Mosquito Bite

397
Q

Incubation Period of Yellow Fever

A

3 - 6 Days

398
Q

Dengue Virus Mode Of Transmission

A

Aedes Aegypti Mosquito

399
Q

Define EIP (Dengue)

A

Time from ingesting virus to new host

400
Q

EIP Duration (Dengue)

A

8 - 12 Days

401
Q

When to suspect Dengue

A 
40+ Fever
2 Symptoms (Headache / Pain Behind Eyes/ MSK Pains / NV / Rash / Swollen Glands)
402
Q

Ebola Mode of Transmission

A

Close Contact

403
Q

Incubation Period of Ebola

A

2 - 21 Days

404
Q

Ebola Virus Drugs

A

Inmazeb

Ebanga

405
Q

Ebola Vaccine

406
Q

Ebola Presentation

A

Dry Symptoms

Organ Failure

407
Q

Lymphatic Filiarsis agent

A

Roundworms (Filariodidea)

408
Q

Lymphatic Filariasis worm subtypes

A

Wuchereria Bancrofti (90%)
Brugia Malayi
Brugia Timori

409
Q

Leishmaniasis Forms

A

Visceral Leishmaniasis
Cutaneous Leishmaniasis
Mucocutaneous Leishmaniasis

410
Q

Visceral Leishmaniasis

A 
Kala Azar
Fatal if untreated 
Fever / Weight Loss
Hepatosplenomegaly
Anemia
411
Q

What is the vector in Leishmania

A

Phlebotomine Sandflies

412
Q

Contamination of environment by any agent

A

Air Pollution

413
Q

Major Outdoor Air Pollutants

A

Nitrogen Oxide
Sulphur Dioxide
Ozone
Carbon Monoxide

414
Q

Main source of Nitrogen Oxides

A

Traffic Emissions

Product of combustion

415
Q

Sulphur Dioxide Sources

A

Industry (Petroleum Fuel)

Traffic

416
Q

What is ozone

A

Gas comprised of 3 atoms of oxygen

417
Q

Function of Stratospheric Ozone

A

UV Rays Protection (Shield)

418
Q

What is tropospheric ozone

A

Ground Level Ozone

Harmful Pollutant

419
Q

What creates Tropospheric Ozone?

A

Oxides of Nitrogen
Volatile Organic Compounds
Sunlight

420
Q

PM2.5 / PM10 ?

A

PM2.5 - Particles with a diameter less than 2.5

PM10 - Particles with a diameter less than 10

421
Q

What are the guidelines regarding PM2.5/10?

A

PM2.5 - Should not exceed 10

PM10 - Should not exceed 20

422
Q

What creates sulfuric / nitric acid or acid rain?

A

Sulfur / Nitrogen Oxides + Bodies of Water

423
Q

Outdoor air pollutant associated with largest health effects 2.5/10 ?

424
Q

Techniques of Waste Management

A

Recycling
Landfill
Composting
Incineration

425
Q

What is the most prevalent method of solid waste disposal?

A

Sanitary Landfill

426
Q

What is the benefit of Sanitary Landfill?

A

Methane Gas can be recovered for use

427
Q

Large scale area where trash is dumped is called?

A

Open Dumping

428
Q

Disadvantages of Dump

A

Foul Odors
Diseases
Contamination

429
Q

Decomposition of waste into humus

A

Composting

430
Q

Converting waste materials into ash / flue gas / heat

A

Incineration

431
Q

Best way to dispose of hazardous hospital waste?

A

Incineration

432
Q

Sideeffects of incineration

A

Carcinogenic

433
Q

Compostable Items

A

Soiled Paper
Fruit Peels
UCLA Food Containers

434
Q

Landfill Items

A

Plastic Bottles w/liquid
Cans w/liquid
Cups
Tissue

435
Q

Recyclable Items

A

Cartons
Glass Bottles
Coffee Sleeves / Lids
Newspapers

436
Q

Hospital Waste Classification

A 
Infectious
Pathological
Sharp
Chemical
Pharmaceutical
Cytotoxic
Radioactive
General
437
Q

Hospital Color Coding

A 
Red - Blood
White - Dental
Orange - Infectious
Yellow - Highly Infectious
Blue - Medicine
Purple - Chemo Medicine
Black - Normal Waste
438
Q

Injury caused by medical management

A

Adverse Event

439
Q

AE Caused by error

A

Preventable AE

440
Q

Failure of planned action to be completed

441
Q

Error but no AE

442
Q

Overdose discovered but countered with Antidote

A

Mitigation

443
Q

Overdose was prevented

A

Prevention

444
Q

Overdose didnt do anyrhing

445
Q

Slips vs Lapses

A

Slips - Action Observable

Lapse - etc. Forgetting

446
Q

Incident Reporting

A

Collecting and analyzing information about AE

447
Q

Sentinel Event

A

AE where death / serious harm occured

448
Q

Retrospective approach to studying errors and identifying problems

A

Root Cause Analysis

449
Q

Healthcare Associated Infections

A

Infections 48+ Hours after admission

450
Q

Four categories of HAI

A

Catheter
Bloodstream
Surgical
Pneumonia

451
Q

Most Common HAI Pathogens

A

C. Difficile (Leading)

S. Aureus

452
Q

Pathogen responsible for CAUTI

A

C. Difficile

453
Q

Most Common Pathogen CLABSI

454
Q

How to prevent Central Line BSI

A

Avoid Femoral Vein in Adults

455
Q

Most common surgical site infection Pathogen

456
Q

Surgical Site Aseptic Solution

A

Chlorhexidine Gluconate Based

457
Q

Smoke emitted from cigarette between puffs

A

Side Stream Smoke

458
Q

Residual Tobacco Smoke on surfaces

A

Third Hand Smoke

459
Q

DRI Increase Second Trimester

460
Q

DRI Increase Third Trimester

461
Q

Protein increase in pregnancy

462
Q

Zinc Requirements 1-3 + 3-8

A

1-3 - 3mg

3-5 - 8mg

463
Q

Iron Requirements 1-3 + 3-8

A

1-3 - 7mg

3-8 - 10mg

464
Q

Desirable WHR in Men / Women

A

Men - 0.9

Women - 0.8

465
Q

Waist Circumference risky for obesity disease

A

Men - Greater than 102

Women - Greater than 88

466
Q

Skinfold measurements areas

A

Men - Chest / Ab / Thigh

Women - Tricep / Suprailiac / Thigh

467
Q

Public Health Approach

A

Surveillance
Risk Factor Identification
Intervention Evaluation
Implementation

468
Q

Most Effective Intervention to Reduce HIV Transmission

A

Condoms (85 %)

469
Q

Risk of Transmission Needle Stick Injury HIV+

470
Q

Risk of Transmission Receptive Anal

471
Q

Post Exposure Prophylaxis HIV Drugs

A

Truvada + Kaletra

472
Q

Suspect Case

A

Clinical Findings Only

473
Q

Probable Case

A

Clinical Features + Epidemiological Base

No Lab Confirmation

474
Q

Confirmed Case

A

Confirmatory Lab Tests

475
Q

Types of Surveillance

A

Passive
Active
Sentinel
Syndromic

476
Q

Passive Surveillance

A

Using Available Data on Notifiable Diseases
No Active Search
Underreporting likely
Cheap

477
Q

Active Surveillance

A

Specifically Recruited
Case Finding
More Accurate
More time / resources

478
Q

Sentinel Surveillance

A 
High Quality Data Needed
High Probability
Signal Trends / identify Outbreaks
Monitor Burden
Not Effective for Rare Diseases
479
Q

Syndromic Surveillance

A

Preferred for Bioterrorism

480
Q

Alpha Error - Type 1 Error

A

Probability of Rejecting True Null Hypothesis

481
Q

Probability of Beta Error - Type II Error

A

Probability of accepting false null hypothesis

482
Q

Power

A

Probability of rejecting false null hypothesis

483
Q

Quantitative Variable Types

A

Binary
Nominal - Names
Ordinal - Order

484
Q

Quantitative Variable Types

A

Discrete (1/2/3)

Continuous (Decimals Included)

485
Q

Pre Contemplation

A

No intention of taking action in the next six months

486
Q

Contemplation

A

Intends to take action in the next six months

487
Q

Preparation

A

Intends to take action in the next 30 days

488
Q

Action

A

Changed Behavior (< 6 Months)

489
Q

Maintenance

A

Changed behavior 6+ Months

490
Q

Termination

A

0 Temptation to relapse (5+ Years)

491
Q

Universal Health Coverage Requirements (4)

A

Health System
Financing System
Access to Medicine
Health Workers

492
Q

Common models of Health System

A

LICUS (Low Income Under Stress)
Fragmented
Universal

Y5 (6 decks)

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