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Musculoskeletal System > Healthy and unhealthy communities > Flashcards

Healthy and unhealthy communities Flashcards

1
Q

What does screening for disease entail?

A

testing people who do not suspect they have health problem (without symptoms)

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2
Q

What is the purpose of screening

A
  • reduces risk of future ill health (earlier detection and treatment)
  • provides information (helps make choices)
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3
Q

What are the 6 NHS screening programmes

A 
○ Cervical cancer 
○ Breast cancer 
○ Abdominal aortic aneurysms 
○ Antenatal and neonatal testing (pregnancy and infant screening)  
○ Diabetic eye disease 
Bowel cancer
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4
Q

Why are there only 6 screening programmes?

A

It can do more harm that good

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5
Q

What are the components of the screening programme?

A
  • register eligible people
  • system invitation and recall
  • screening tests
  • confirmation of diagnosis
  • treatment or other interventions
  • staff training
  • standards and quality assurance
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6
Q

How can screening cause harm?

A
  • can cause over diagnosis
  • can give false positive test (further testing could also lead to more false positives)
  • false negative tests> can give pt a sense of security
  • you might administer unnecessary treatment to a condition that would have never progressed to severe disease
  • costs of screening, further testing and treatment
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7
Q

How can you confirm the accuracy of screening test?

A

By comparing it to gold standard diagnostic tests

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8
Q

Diagnostic tests should be highly specific/sensitive

A

specific

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9
Q

Screening tests should be highly specific/sensitive

A

sensitive

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10
Q

What are the principles of screening?

A

We need to know the natural history of disease > knowing how the disease states progressive

We need to be able to detect risk factors at an early stage

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11
Q

What evidence is available about the effectiveness of screening?

A
  • RCTs (best evidence)
  • CCT (often biased by cofounding)
  • time trends in disease incidence and outcomes (compared to countries or regions without screening)
  • systematic reviews of evidence
  • modelling
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12
Q

Common sources of bias in screening evaluation

A
  • people who take part tend to be healthier than those who do not
  • disease is more likely to be detected in people with longer lasting and slowly types of disease
  • earlier detection makes duration of survival after diagnosis even if treatment is ineffective (therefore in research articles the mortality rates should be used not the survival rates)
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13
Q

Symptoms of malaria

A

Appear after approx 2-4 weeks of the bite:

  • Chills and fever
  • If not treating properly and cause serious conditions > can cause death
  • Abdominal pain
  • TRAVEL HISTORY IS VERY IMPORTANT
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14
Q

Does death of malaria occur more in children or adults

A
  • Children, they are more vulnerable and weaker than adults
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15
Q

Prevention of malaria

A
  • insecticide-treated bednets
  • window nets
  • indoor spraying of homes with insecticide (can be effective for months)
  • antimalarial medicines (e.g sulfadoxine-pyrimethamine)
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16
Q

What is the ideal weather for mosquitos to breed?

A
  • hot temperatures

- especially days after rain

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17
Q

What is the malarian form of fever called?

A 
....... tertian 
either 
1. Malgnant tertian 
2. Benign tertian 
3. Quartan 
4. Ovale tertian
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18
Q

What is the incubation period of malaria?

A

between 6-40 days depending on what species it is.

PLASMODIUM falciparum: 6-14 DAYS

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19
Q

Major complications of malaria

A
  • cerebral malaria
  • anemia
  • jaundice
  • odema
  • shock
  • Splenmegaly
  • hypoglycaemia
  • nephrotic syndrome
  • renal distress/failure
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20
Q

Are male mosquitos infectious?

A

NO only female mosquitos are infectious

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21
Q

Most common species of mosquitos that cause malaria

A
  • plasmodium falciparum
  • P.vivax
  • P. malarie
  • P. ovale
  • P. knowlesi
22
Q

LIFE CYCLE OF A MOSQUITO BRED

A
  1. SPOROZOITES (early life stage of mosquito) from the saliva are injected into humans bloodstream through bites.
  2. Mosquitos bite humans because they asexually reproduce and need to feed on blood
  3. The SPOROZOITES enter the parenchymal cells of the liver where they turn into SCHIZONTS (after 2 weeks)
  4. These SCHIZONTS rupture into thousands of MEROZOITES
  5. MEROZITES circulate in blood only for a few minutes and then enter RBC
    6.(In P. Vivax and P.Ovale some parasites remain within the liver and remain dormant as HYNOZOITES > causes the relapse)
  6. When in RBC merozites turn into the ring form TROPHOZOITE and SCHIZONT and then the cycle is complete.
  7. In the RBC haemolysis occurs due to the parasites inside the blood.
    THIS CAUSES THE ANEMIA
  8. Some merozoites can initiate the sexual stage with RBC to produce female gametocytes and the cycle starts again
23
Q

Why does fever occur in malaria?

A
  • fever follows a rupture of erythrocytic schizonts > therefore there is periodicity in the fever and characteristic of fever
24
Q

Which type of malaria is the most fatal?

A
  • P. falciparum is most fatal during the first 2 weeks
25
Q

Major complications of P. falciparum malaria

A
  • AFFECTS THE CNS
  • cerebral malaria (causes diminished level of consciousness progressing to coma)
  • can cause serious neurological and psychiatric sequelae
  • could be caused due to the small size of capillaries in the brains that get blocked with the parasites
  • severe anaemia
  • acute renal failure (due to the sensitivity of the capillaries in the kidneys
26
Q

How do you diagnose malaria?

A
  • by the finding parasitized red blood cells in thick and thin blood films
  • lateral flow devices to detect malarial antigens
  • molecular assays to detect malarial DNA or RNA are much more sensitive and are available in reference laboratories
  • antibody testing
  • 3 blood films need to completed (24 and 48hours after)
27
Q

Malaria treatment

A
  • IV artesunate
  • IV quinine
  • Oral artemisin combination therapy
  • Chloroquine
  • Primaquine
28
Q

Key factors determining the travel- related risks

A
  • mode of transport
  • destination
  • season of travel
  • duration of travel
  • standards of accommodation, food hygiene and sanitation
  • underlying health of the traveller
  • behaviour or the traveller/purpose of travel
29
Q

Why is the behaviour of a traveller important?

A

Going outdoors in the evenings in a malaria-endemic areas without taking precautions;

Swimming in Schistosoma infested lakes;

Exposure to insects, rodents, bats and other animals;

Contaminated food/ water is a major risk;

Unprotected sexual intercourse.

30
Q

What are the 3 viruses that cause VIRAL gastroenteritis?

A
  • rotavirus
  • norovirus
  • astrovirus
31
Q

What is viral gastroenteritis?

A

inflammation of the gastrointestinal tract—the stomach and intestine.

Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur.

VERY COMMON IN TRAVELLERS (MILITARY, PASSENGERS OF BROAD CRUISE SHIPS, TOURISTS VISITING RURAL AREAS ETC.

32
Q

What are the 3 viruses that cause BACTERAIL gastroenteritis?

A
  • salmonella
  • Campylobacter jejuni
  • Shigella
  • E.coli
  • Vibrio cholerae
33
Q

How is gastroenteritis diagnosed?

A
  • Clinical evaluation

- Stool testing

34
Q

What is the treatment of gastroenteritis?

A
  • oral or IV rehydration

- antibiotic in select bacterial cases and if bacteraemia is present (bacteria in blood)

35
Q

What type of hepatitis is prevalent in travellers that travel to areas with poor sanitation and lack of access to clean water?

A
  • Hepatitis E

- Hepatitis A

36
Q

How is hepatitis E transmitted?

A
  • Faeces (drinking contaminated water or eating contaminated food)
37
Q

What is the epidemiology of hepatitis E

A
  • <1%
  • more common in pregnant women
  • severity of diseases increases with age
  • vaccines are developed(currently used in china and nepal)
38
Q

What is the incubation period of hepatitis E

A

3-7 weeks

and the attack rate is 1 in 2

39
Q

How can hepatitis E be prevented

A
  • avoiding drinking water of unknown purity
  • eating uncooked shellfish
  • eating uncooked fruit and vegetables not peeled or prepared by traveller
40
Q

Can hepatitis E be transmitted through sexual transmission or person - to person

A

NO

41
Q

Characteristic of Hepatitis A infections

A
  • acute and self limiting (usually resolves itself without any treatment)
  • adults are often asymptomatic
  • nearly 1.5 million cases every year
  • most common viral hepatitis worldwide
42
Q

How many serotypes of hepatitis A exist?

A

Only one, but there are multiple genotypes

43
Q

Prevention of Hep A

A

Good hygiene
Pre-exposure: active immunisation Vaccine (killed whole virus)
-Travellers to intermediate and high risk areas
-individuals at risk due to sexual behaviour, parenteral drug abuse
Vaccine active within 14 days of first dose
Post exposure: Vaccine (within 7 days) and immunoglobulin HNIG (within 14 days of onset of disease in primary case)

44
Q

What are the mosquito associated viral infections?

A
  • Malaria
  • Yellow fever
  • Dengue type 1,2,3,4
  • Japanese encephalitis (infection of the brain)
  • Zika virus (
45
Q

Characteristics of dengue fever

A
  • transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus;
  • symptoms: high fever, severe headache, severe pain behind eyes, joint pain, bone pain, rash and mild bleeding
  • characterized by a fever that lasts from 2 to 7 days
  • when fever declines next symptoms are: vomiting, severe abdominal pain and dispnoea may develop
  • haemorrhage can follow
46
Q

Characteristics of Crimean- Congo haemorrhage fever

A

Causes severe viral haemorrhagic fever outbreaks;

Case fatality rate of 10% to 40%;

Incubation period short (1-3 days);

Fever, myalgia, neck stiffness, backache, headache, eyes, photophobia;

Nausea, vomiting, diarrhoea, abdominal pain, mood swings, confusion;

Bleeding into the skin, mucosa, internal organs;

Liver failure, kidney failure.

47
Q

What is viral haemorrhagic fever and what are the usually symptoms?

GIVE SOME EXAMPLES OF THAT FEVER

A
  • Iit is a multi- system syndrome (multiple organs systems are affects)
  • characterised by the overall vascular system being damaged and the body’s ability to regulate itself is weakened

symptoms are accompanied by bleeding which can be life threatening

examples:
yellow fever, crimean congo haemorrhagic fever, ebola

48
Q

What is tuberculosis?

A
  • serious infectious disease caused by various strains of mycobacteria
  • most common one: mycobacterium tuberculosis
  • airborne droplet transmission
  • latent TB infection carriers are asymptomatic and not infectious
  • about one quarter of the world’s population is infected with mycobacteria
49
Q

Treatment of TB?

A
  • Standard treatment of TB consists of a six-month regimen of four first-line drugs (isoniazid, rifampicin, ethambutol and pyrazinamide);
  • more and more variants of TB are becoming resistant to antibiotics
50
Q

Features of the middle east respiratory syndrome (MERS -CoV)

A

27 countries reported cases of MERS-CoV;
Symptoms include fever, cough and shortness of breath;
Pneumonia is common, but not always present;
Gastrointestinal symptoms, including diarrhoea, have also been
reported;
Dromedary camels are a major reservoir host for MERS-CoV.

51
Q

Features of rabies

A

Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries;

Dogs = main transmission source but could be any mammal

Mainly caused death in africa and asia

Wash wound with soap and water immediately and give post exposure prophylaxis (rabies vaccine and Rabies immunoglobulin medication0

52
Q

Features of monkeypox

A
  • rare zoonotic (when germs are spread between animals and people)
  • usually near tropical rainforests
  • similar to human smallpox diseases (now eradicated)
  • mostly transmitted to people from various wild animals e.g rodents and primates
  • case fatality lies between 1 and 10%
  • no specific treatment or vaccine available although prior smallpox vaccination was highly effective in preventing monkeypox

Musculoskeletal System (14 decks)

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