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DTM&H 2024 > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Encephalitis Seizures

A

Neurocysticercosis is the most common preventable cause of epilepsy

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2
Q

Misc Social innovation

A

Community-engaged process that sees the wisdom of communities and impacts social and health outcomes eg pay-it-forward

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3
Q

STI Screening What

A

Importance of condition, high prevalence

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4
Q

STI Screening Why

A

Curable, treatable, preventable, effective

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5
Q

STI Screening How

A

Tests avaiable, sens/spec, simple, feasible, cost effective

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6
Q

STI Screening Who

A

Acceptability

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7
Q

STI Screening When

A

Accessibility

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8
Q

STI Screening Where

A

At high risk of infection or complications

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9
Q

STI Screening Pregnancy

A

CT/NG, TV, TP, HIV, HBV

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10
Q

STI POCT Environment

A

Power supply, Space, Security, Temperature/humidity

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11
Q

STI POCT Devlice limintations

A

Analytic capacity, maintenance, reliance on technology

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12
Q

STI POCT Provider buy-in

A

Impact on workload/services, staffing

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13
Q

STI POCT Patients

A

Competing priorities - willingness to wait for results (?true POCT)

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14
Q

STI Incidence 2020

A

TP 7.1m GC 82m CT 129m TV 156m

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15
Q

STI Prevalence 2020

A

HBV 296m HPV 300m HSV 490m

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16
Q

STI High frequency transmitters

A

Sex workers, others with high numbers of sexual partners

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17
Q

STI Bridging population

A

male clients of female sex workers (this becomes less relevant if general population has high background risk)

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18
Q

STI Partner notification

A

Little evidence of effectiveness in LMIC and potential harm (violence, abuse)

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19
Q

STI Male circumcision

A

60% reduction in HIV incidence, 25-45 reduction in GUD, HSV, TV, HPV, little effect GC/CT from voluntary medical male circumcision (VMMC)

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20
Q

STI Management

A

Syndromic mx recommended where diagnostic tests arent available - urethral/cervical discharge, vaginal discharge, genital ulcer

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21
Q

STI Urethritis cause

A

GC, CT, TV, MG

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22
Q

STI Urethritis/cervicitis treatment

A

GC CRO+Azith, CT Doxy or Azith, TV Metro, MG Azith

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23
Q

STI Vaginal discharge cause

A

TV, Calb, BV, CT, GC

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24
Q

STI Vaginal discharge treatment

A

TV Metro, Calb Clotri pessary, BV Metro

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25
Q

STI Genital ulcer cause

A

HSV, TP, Hducreyi (Chancroid), K granulomatis (Donavanosis), CT LGV

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26
Q

STI Genital ulcer treatment

A

HIV aciclovir, TP Benzathine pen, Hducreyi Azith, Kgranu Azith, CT LGV Azith or Doxy - treatment of GC/CT has wiped out Hd & Kg

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27
Q

STI WHO screening recommendation

A

HIV and Syphilis should both be tested

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28
Q

Snakebite Annual mortality

A

> 130,000

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29
Q

Snakebite Annual morbidity

A

400,000 (physical or psychological)

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30
Q

Snakebite Recognised as NTD

A

2016

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31
Q

Snakebite Epidemiology

A

Depends on human-snake interaction (agriculture, building projects, travel, sleeping on ground, intentional handling, nocturnal hunting, mating season), weather, and children

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32
Q

Snakebite Viperidae

A

Viper, adder, moccasins, rattlesnakes > short thick body, distinctive dorsal pattern, long fully erectable fangs which penetrate deep into tissues > shock, coagulopathy etc

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33
Q

Snakebite Elapidae

A

Cobra, krait, mambas, all Oceanian/Aus, and sea snakes > long thin body and tail, uniformly coloured, fast, short permanently erect front fangs > descending flaccid paralysis, bilateral ptosis -> bulbar (+coagulopathy etc)

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34
Q

Snakebite Snake venom

A

Complex - 100 protein/polypeptide toxins including phospholipases, metalloproteases, serine proteases, three-finger toxins (neuro- cyto-toxins) which clip over acetylcholine receptor > paralysis

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35
Q

Snakebite Clinical effects

A

Cytotoxicity (swelling, bruising, necrosis)l Haemo (coagulopathy), Neuro (descending flaccid paralysis), Cardio (arrhythmia, myocardial damage, leak, shock, orthostatic hypotension), Myo (rhabdo, hyperkalaemia), Nephro (AKI)

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36
Q

Snakebite Clotting 20min test

A

Clean dry glass vessel, tip once, positive (no clotting), negative (clotting)

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37
Q

Snakebite Prevention

A

Education, Protect feet, legs and hands, use light and prodding stick, sleep off the ground

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38
Q

Snakebite First aid

A

Remove from danger, reassure, immobilise, remove any potential tourniquets, pressure-pad-immobilisation, transport rapidly in recovery position and admit for 24h

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39
Q

Snakebite Pressure pad immobilisation

A

compress veins and lymphatics in immediate vicinity of bite

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40
Q

Snakebite Antivenom

A

Refined IgG from hyperimmune horse/sheep plasma, scare and expensive to produce, only neutralises venom used in manufacture - cover medically-most-important snakes in geographical region

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41
Q

Snakebite Antivenom indications

A

Shock, Systemic envenoming - incoagulable blood, neutrotoxicity (ptosis), black urine, rapidly progressive local swelling (bites over digits)

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42
Q

Snakebite Antivenom administration

A

Check species covered, infuse IV 10-60min, same dose for adults & children, prophylactic adrenaline SC may reduce reactions

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43
Q

Snakebite Antivenom reactions

A

IM adrenaline, early pyrogenic and/or anaphylactic reactions, late serum sickness

44
Q

Snakebite Adjunctive care

A

Tetanus, drain abscess & remove necrotic tissue, early rehabilitation. No evidence for other Rx including fasciotomy

45
Q

Arthropod bite Prevention

A

Wear boots, repellants, search clothing & footwear/backpack, sleeping environment etc, sleep under insecticide impregnanted bed net

46
Q

Arthropod bite Scorpion epidemiology

A

> 3250 fatalities, in Mexico, Sth America, Africa, Middle East, India, esp children, prevention is excluding from home and awareness, UV light useful

47
Q

Arthropod bite Scorpion mechanism

A

Ion channel stimulate/block cation Na K Ca channels > parasympathetic (cholinergic) and sympathetic (adrenergic)

48
Q

Arthropod bite Scorpion symptoms

A

Severe local pain, Systemic ‘autonomic’ storm from massive release of acetylcholine and catecholamines -> shock, arrhythmias, erratic eye movements, muscle spasms

49
Q

Arthropod bite Scorpion treatment

A

Lignocaine infiltration, antivenom in some countries, and/or prazocin/vasodilators in ICU

50
Q

Arthropod bite Spiderbite Epidemiology

A

Very few bites, common in Americas, mediterranean, South Africa, Australia

51
Q

Arthropod bite Spiderbite Necrotic arachnidism

A

Brown recluse spiders - local pain, swelling, followed by classic red-white-blue sign, generalised rash, malaise, eventually eschar, necrotic slough, systemic sx 4-10%

52
Q

Arthropod bite Spiderbite Neurotoxic arachnidism

A

Black/brown cosmopolitan spiders & funnel well - local immediat epain, sweating, systemic rapidly evolving headache, NV, priapism, muscle spasms,

53
Q

Arthropod bite Hymenoptera anaphylaxis

A

History, mast cell tryptase, venom-specific IgE (skin or RAST), treat with adrenaline

54
Q

Marine injury Water organisms

A

Salty V vulnificus, Brackish A hydrophila

55
Q

Marine injury Treatment

A

Remove from water to prevent drowning, immerse hot water 45C, box JF wash/shave tentacles with sea water, topical lignocaine, antivenom for seawasp and scorpion fish

56
Q

Marine injury Jelly fish prevention

A

Obey warning, don’t swim alone in tropical seas, protective clothing, stings may hypersensitise with anaphylaxis on reexposure

57
Q

Marine injury Other marine sting prevention

A

Beware of handing fish, avoid touching coral, anenomes, sea snakes etc, beware wading barefoot

58
Q

Marine injury Poisoning

A

Scombroid 1-120min, Puffer 10-180min, Shellfish 30-180min, Ciguatera 1-12h

59
Q

Marine injury Ciguatera

A

1-12h, GI sx plus paraesthesias (esp hot-cold reversed sensation), rash, bradycardia, hypotension, can be confirmed by toxin detection in fish remnant (but not in patients) treat supportive +/- mannitol (controversial), amitriptyline

60
Q

Marine injury Scombroid

A

1-120min immediate perioral tingling, progressing to anaphylactic response, treat with histamine inhibitors +/- adrenaline

61
Q

Marine injury Poisoning prevention

A

Don’t rely on cooking - seafood toxins are heat/acid stable, avoid large fish (>10kg), eat only fresh fish and never eat puffer fish, avoid shellfish in red algae, don’t swallow seafood tha tmakes your lips tingle

62
Q

Global Surgery Epidemiology

A

5bil lack access to surgical care, 18 mil deaths could be avoided, 33mil face catastrophic expense after surgical care, 30% of Global Health Burden require surgery

63
Q

Global Surgery Definition

A

Multidisciplinary field concerning the improved and equitable access to surgical care across international healthcare systems with focus on LMICs

64
Q

Global Surgery Minimum procedures required

A

Laparotomy, C-section, Open fracture management and wound debridement, D&C, closed fracture reduction

65
Q

Global Surgery Burn depth

A

1 superficial 2A sup partial (red, painful, weeping), 2B deep partial (red, painful, dry), 3 full thickness (black/white, no feeling)

66
Q

Global Surgery Burn assess BSA

A

1% BSA is size of child’s hand

67
Q

Global Surgery Burn management

A

Fluid (Modified Parkland), Pain (affects catabolism), Nutrition, Infection control, Tetanus vax

68
Q

Global Surgery Aim

A

Early referral and advice, transport

69
Q

NTD Definition

A

Disproportionately affects populations living in poverty; and causes important morbidity and mortality – including stigma and discrimination - in such populations, justifying a global response

70
Q

NTD Epidemiology

A

Primarily affects populations living in tropical and sub-tropical areas

71
Q

NTD Schistosoma strategy

A

MDA (praziquantel), sanitation, snail control

72
Q

NTD Onchocerca strategy

A

MDA (ivermectin), (vector control) - does not kill adult worm, need to treat for long time, and barrier to ivermectin use in loa loa endemic regions -> cerebral inflammation

73
Q

NTD Lymphatic filariasis strategy

A

MDA (ivermectin, albendazole), vector control - does not kill adult worm, need to treat for long time

74
Q

NTD Trachoma strategy

A

MDA (azithromycin), water, sanitation, education

75
Q

NTD Yaws strategy

A

MDA (azithromycin)

76
Q

NTD Soil transmitted helminth strategy

A

MDA (albendazole)

77
Q

NTD Guinea worm strategy

A

Safe water, health education

78
Q

NTD HAT strategy

A

Case finding and treatment (vector control)

79
Q

NTD Visceral leishmaniasis strategy

A

Case finding and treatment

80
Q

NTD Leprosy strategy

A

Case finding and treatment

81
Q

NTD Taeniasis/cysticercosis strategy

A

Sanitation, meat inspection, vaccination of pigs

82
Q

NTD Echinococcosis strategy

A

Abbatoir control, treatment of dogs, education

83
Q

NTD Foodborne trematodes strategy

A

Treatment of sheep, health education

84
Q

NTD Chagas disease strategy

A

Vector control, blood screening

85
Q

NTD Buruli ulcer strategy

A

Case finding and treatment

86
Q

NTD Rabies strategy

A

Vaccination of dogs, health education

87
Q

NTD Dengue and Chikungunya strategy

A

Vector control

88
Q

NTD Mycetoma strategy

A

Case finding and treatment

89
Q

NTD Scabies strategy

A

?MDA (ivermectin)

90
Q

NTD Snakebite strategy

A

?Case finding, education - not yet established

91
Q

NTD Noma strategy

A

?Case finding and treatment - not established

92
Q

NTD Elimination

A

Reduction to zero of the incidence of a disease in a defined geographical area. Continued interventions required to prevent re-introduction

93
Q

NTD Eradication

A

Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent. Intervention measures no longer needed

94
Q

NTD Biological req for elimination/eradication

A

Intervention effective, Surveillance (good diagnostic), No animal reservoir

95
Q

NTD Social req for elimination/eradication

A

Recognised as public health importance, technically feasible intervention, political commitment, advocacy plan

96
Q

NTD Negatives of elimination strategies

A

Lead to underreporting, lack of ongoing surveillance may lead to resurgence

97
Q

DDx Umbilicated skin lesion SE Asia DDx

A

Virus M contagiosum, CMV, Fungi Crypto, Histo/Tmarneffei, Bacteria TP, TB, Non-infectious trichoepitheliomas, tuberous sclerosis

98
Q

Biomarker Definition

A

a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathological processes, or pharmacological response to a therapeutic intervention

99
Q

Medicine Quality WHO estimate SF

A

WHO estimated in 2017 that 10.5% of medicines in LMIC are SF (substandard or falsified)

100
Q

Medicine Quality Substandard

A

Degraded - leave factory in good quality but degrade due to improper storage (frozen/heated/light exposure etc), substandard - fail to meet quality standards or their specifications or both - result from factory error

101
Q

Medicine Quality Falsified

A

Medical products that deliberately/fraudulently misrepresent their identity, composition or source

102
Q

Medicine Quality Measures

A

Medicine Quality Scientific Literature surveyor, early warning systems, ‘Globe’ monitoring system,

103
Q

Medicine Quality Vaccine incidents

A

Plague vaccine 1902 contaminated with tetanus, Cutter incident 1955 Salk inactivated polio vaccine - failure of formaldehyde treatment resulting in live polio - many infections and deaths

104
Q

Medicine Quality Monitoring devices

A

Minilab thin layer chromatography, Rama spectroscopy ‘see through bottles’, Paper analytica devices 12 lines colorimetry

105
Q

Medicine Quality Diethylene & ethylene glycol

A

Used instead of propylene glycol -> renal toxins, consider if unexplained children with AKI

106
Q

Medicine Quality Resolution

A

Functional regulatory authorities and monitoring, greater international political will, timely data sharing, targeted research

107
Q

Medicine Quality Summary

A

Always consider SF if you encounter AE, therapeutic or diagnostic failure, surprisingly inexpensiv emedical products, typos and packaging defects, report to NMRA and WHOrapidalert. Medicine falsification is world’s 3rd oldest profession - not going to go away, key to minimising occurrence and impact, screening devices hold hope, multidisciplinary approach needed with increased research

DTM&H 2024 (32 decks)

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