MPH Flashcards
Q
The science and art of preventing disease, prolonging life, and promoting health and efficiency thru organized community effort
What is public health?
study of the distribution and determinants of health-related states or events in specified populations and the applications of this study to the control of health problems
What is epidemiology?
Immunizations Vehicle safety Workplace safety Infectious Dz Control Decrease CAD/CVA Safe/healthy Food Healthier mothers/ babies Family planning Fluoridation of water Tobacco as hazard
What are the top 10 achievements of PH?
heart disease and cancer
What mortality has increased from 1900 to 2010?
accidents, nephropathies, pneumonia, influenza, senility
What mortality has decreased from 1900 to 2010?
diphtheria, TB, GI infections
What mortality has been eradicated from 1900-2010?
Maintain force health, OP performance, readiness
What is the goal of the military PM?
Trauma/sports injury, communicable disease, proactive health, safety
What does the military PM focus on?
PHA, PDHA, PDHRA
What are examples of proactive health in military setting?
Primary prevention
The process of prevention the onset of a disease before the process beings such as immunizations, prophylaxis, environmental, sanitation, PPM is called?
Secondary prevention
The process of prevention that leads to an early diagnosis of a disease to prevent serious problems such as STD screenings is called?
Teritary prevention
The process of prevention that reduced morbidity and mortality from an existing disease which include all treatments is called?
Recommendations for primary and secondary prevention based on evidence strength, benefits and harm balance, WITHOUT cost as an influence
What does the USPSTF provide?
Those WITHOUT signs or symptoms of a disease (primary and secondary)
Who does USPSTF recommendations apply too?
not enough evidence, complete more research or redetermine from a different method
What is the difference between “no evidence of effectiveness” and “ineffective” in a USPSTF recommendation?
LDL >130-190, HDL < 40, diabetes, HTN, smoking (LDL >190 NOT considered)
Who is considered at increased risk for CVD via USPSTF?
Men who have sex with men, those with or living with HIV positive individuals
Who is at increased risk for syphilis via USPSTF?
A- benefit is substantial B- benefit is moderate C- benefit is small D- recommends against servic I- evidence is insufficient
What are the different grades USPSTF can give?
Indirect vector, mechanical
If a fly contaminates food bringing shigella what transmission is this? (also shigellosis, plague, malaria, dengue)
Indirect, vehicle
Staph. poisoning from a single meal is what type of transmission? (also HCV, MRSA from food, water, fomites)
Direct, droplet
The passage in pertussis, meningococcal, or mumps from a cough or sneeze onto a person is what type of transmission?
Indirect, airborne
The passage of TB or measles from coughing into the air is what type of transmission?
Direct, contact
The passes of impetigo, herpes, syphilis, or hookworm from hugging is what type of transmission?
Herd immunity
What is described as a percentage of the population (HIT) who is immune to a contagious disease, will protect those who are not immune by lack of disease?
Incidence rate
The new cases of a disease in a period of an at risk population (risk of getting a disease) is called?
Attack rate
The people who develop a disease over the total population with no time reference is called?
Secondary rate
When a susceptible person is exposed to a diseased individual and develops the disease this is called?
Isolation
The restriction of an ill person with a contagious disease during the communicable period to a hospital as a standard precaution to prevent its transmission is called?
Quarantine
The restriction of a well person who has been exposed to a contagious disease and may be in the incubation period that is rarely used is called?
Disease burden
The gap between current and ideal health status measured by the impact of the health problem and quantified by QUALY/DALY, hospital days, etc. is called?
Health, readiness, OPs, health cost, duty time lost
How is the importance of a condition that is a burden to the US military ranked to determine the priority of resources for primary, secondary,and tertiary prevention?
PM personnel
Who is responsible for the treatment, testing, and certification of major water sources?
Unit sanitation teams
Who is responsible for ensuring the water supplies, storage, and distribution points maintain required chlorine residues 2x/day and when filled?
Prohibiting when necessary, educating to lower the risks, vaccinations (Hep A, Typhoid), knowing threats, prophylaxis
How is the prevention of food and water-borne diseases completed?
1-7 day hospitalization (P. Fal), Anopheles mosquito, Dusk/Dawn
What is the operational impact of Malaria? What are the risks for developing Malaria?
NOT using the same prophylaxis drug for treatment, short-half life daily, long half-life weekly, NOT obtained OCONUS
What are the major considerations associated with the general chemoprophylaxis of Malaria?
Doxycycline, Mefloquine, Chloroquine
What suppressive chemoprophylaxis medications can be used to kill Malaria in the erythrocytic stage?
Primaquine
What medication should be used for presumptive anti relapse treatment for Malaria? (note: also used for P. vivid NOT blood stage P. fal, requires G6PD testing)
Tafenoquine (NOT for use w/ G6PD deficiency)
Which Malaria causal chemoprophylaxis prevents development in the liver, acts on blood stage parasites, and is active against dormant liver stage?
Malarone
Which Malaria causal chemoprophylaxis does NOT kill in the dormant liver stage?
Dengue
Which vector borne disease is associated with the Aedes daytime mosquito in urban areas that when re-exposed causes major risk of hemorrhagic fever?
CDY-TDV (Dengvax)
Which vaccine is protective against previously exposed individuals but increases severity among children w/o previous exposure?
Mites; female to egg (transovarial transmission- human host not required)
Scrub typhus endemic to farmers, 40-60, and July-November is caused by a mite (chigger) via Orientia tsutsugamushi accidentally transmitted into a human from a larva in the bite because their bacterial cycle is maintained by?
Epidemic typhus
What disease is caused by infective lice (louse) that do NOT transmit infection to their progeny, infect via deification on a bite, lifespan of louse IS shortened with infection and is controlled via eradication of human infestation w/ Permethrin?
Maurine (Endemic) typhus
What disease is caused by Rickettsia typhi from a rat flea that is permanently infected w/o a short lifespan, infect via deification, w/ prominent GI sx in children?
doxycycline
What is the prophylaxis for typhus?
avoid animals, vaccine at 0-7-21(or 28) days
What is the PRE-exposure prophylaxis for rabies?
Thorough washing w/ soap/water/viricide (povidone-iodine), Rabies Immune globulin into the wound (NOT vaccinated, immediate) or Rabies vaccine into the deltoid (NEVER in gluteal area, 7-10d, given on 0-3-7-14d in nonvax or 0,3 prior vax)
What is the POST-exposure prophylaxis of rabies?
incubation period
What is the interval between initial infection and first signs and symptoms (need to meet threshold)?
latent period
What is the time from infection to infectious?
When an infected individual can transmit an infection w/o showing signs/sx’s
What is a subclinical infection?
Reduces reinfection in males and overall transmission in males Reduces personal risk of sequelae (PID, infertility)
What is the difference in rationale for screening in males and females for STI’s?
M to F is 4x more efficient, 70% F asymptomatic w/ cervix infection, men symptomatic 7-10d, communicable in untreated cases, resistant strains, antibiotics can end communicability
Why is it important to screen women for gonorrhea?
nucleic acid amplification testing-NAAT on urine (preferred for men- accuracy w/ PT collected specimen) or vaginal swabs (preferred for women)
What is the screening method for gonorrhea AND chlamydia?
Most are asymptomatic, results in scarred tubes, ovaries, lining and increases infertility/ectopic pregnancy
Why is it important to screen for Chlamydia?
6, 11
What are the “low risk” HPV types responsible for anogenital warts?
16*, 18
What are the high risk HPV types responsible for cervical cancer?
6, 11, 16, 18, 31, 33, 45, 52, 58
What HPV types are included in the vaccine?
11-12, can start at 9, 13-21 catch up 22-26 if MSM or IMCP
What is the vaccination schedule for Males for HPV?
11-12, can start at 9, 13-26 catch up in no/incomplete vaccine <15 2 doses >15 3 doses (youth respond better)
What is the vaccination schedule for Females for HPV?
cholera, viral HF, epidemic (louse) typhus
What are the disaster related outbreaks associated with human remains?
inadequate water, poor sanitation, lack of healthcare
What sudden displacements factors seen in disasters tend to lead to outbreaks?
Diarrhea (50%), acute respiratory infection, vector borne (malaria), measles
What are the four infectious sources of mortality in humanitarian emergencies associated with malnutrition?
Cholera
What global pandemic disease is caused by toxigenic serogroup O139, requires NaCl and high inoculation count, and is associated with blood group O and retinol deficiency?
Oral rehydration (200-310 mOsm/L, glucose, Na)
What is the mainstay of treatment for diarrheal diseases?
Acute respiratory infections that lead to pneumonia
What is a major cause of morbidity and mortality usually seen in <5yo children in emergency settings?
Measles
What causes mortality in <5yo children worldwide from respiratory droplets classified by an outbreak of three or more confirmed cases linked in time and space?
Vitamin A
What is the treatment indicated for measles in all levels of causes due to a synergistic effect?
- detect an outbreak (2+) 2. define cases 3. Generate hypothesis 4. Test hypothesis (call PM) 5. find contamination 6. control the outbreak 7. decide when over
What are the food borne investigation tasks?
top 5 pathogens resulting in death
What is the link between non-typhoid salmonella, toxoplasma, listeria, norovirus and campylobacter?
> 2 weeks before travel every 2 years 4caps 1 every other day for >1 week prior expo every 5 years
When should ViCPS for typhoidal salmonella be given? Oral vaccine?
3-4 hrs up to 5-6
When is the pre/post workout meal window?
1.2-1.6g of protein/kg/d (25-30g per meal)
What is the recommend protein for weight loss?
manufacturer BEFORE market FDA AFTER market
Who is responsible for safety of supplements?
submit AE through natural medicine watch shared with MTF/commanders and reported to FDA MedWatch
What is OTSG/MEDCOM policy memo 12-028?
the composite of all ongoing or potential enemy actions and environmental conditions that will reduce combat effectiveness through wounding, injuring, causing disease or performance degradation
What is a medical threat?
Risk
What drives Force Health Protection?
Collection, evaluation, analysis, and interpretation of information for strategic/military medical planning/operations to conserve friendly forces and foreign medical capabilities in military and civilian sectors
What is medical intelligence?
Strategic- NCMI, Tactical-S2/G2/J2
What are the sources of medical intelligence?
Approved/Authorized Prophylaxis Recommended Medical Treatment Protocol Medical Policy Medical Doctrine
NCMI provides Health/Hazard Assessments, Health Services Assessments, Trends & Forecasts, Indications/warnings, Facility Database. What does it NOT provide?
NO countermeasures
What are the assumed risks included in the risk estimate?
Realistic max rate + disease endemicity –> Potential attack in troops + severity –> Risk Operational Impact (high, inter., low)
What is the methodology for assessing disease risk?
Hep B, DTaP, HiB (influenza), PCV (pneumococcal), rotavirus, polio
What are the recommended early vaccinations?
Measles (MMR)
What is an important consideration for all OCONUS children 6-11 months (1 dose) and 2 doses after age 1 OR children >12 months w/ 2 doses after 28 days
Travelers diarrhea
What is the most common traveling illness that can be shortened to 1-2 days with self treatment?
Azithromycin
What is the antibiotic used for dysentery, febrile diarrhea, and empirically for SE Asia and India for resistant camplyo/ETEC?
Rifaximin
What antibiotic is the best option but is NOT indicated for compylo/salmonella/shigella?
Bismuth taken 4 times per days, not typically
IF (rarely) chemoprophylaxis is indicated for travel diarrhea what should be used?
PO2 at >8000 ft, at 10000 ft PO2 is 70% of sea value
Why does headache, fatigue, loss if appetite, nausea, and insomnia our at increased altitude?
Acetazolamide Prophylaxis: 125BID 24 hr before to 48hr after highest point Tx: 250mg BID AE: numbness, tingling, urination expected
What are the methods used to control altitude sickness?
4 weeks
What is the spacing between 2 live vaccinations?
Voluntary surveillance system Relies upon non-standardized descriptions of events Under-reporting is a major limitation “Over-reporting” may occur for non-causal associations
What are the limitations of VAERS?
Hospitalization 24 hour loss of duty Auto-inoculation or contact vaccinia Event is on VAERS reportable events table Event is on the NVCIP vaccine injury table Contamination of a vaccine lot is suspected Adverse Event results a permanent Medical Exemption
What vaccine AE require mandatory reporting?
OSHA 1970
What safety regulations apply to military and civilian?
“use test” (PFT used for COPD/Asthma)
What is the gold standard for respiratory testing?
> 85dB for 8 hrs, or 140 dB peak
When is a hearing conservation program indicated annually?
- Lead (inorganic). - Ethylene oxide. - Ionizing radiation. - Waste anesthetic gases. - Mercury (note: evaluation of workplace upon request)
What is known to cause spontaneous abortion?
Check with supervisor to see if restriction is appropriate or defer the worker from the job
IF job description indicates exposure to a teratogenic, fetotoxic or reproductive toxic substance and IF worker indicates current attempts to conceive or Female worker currently pregnant or breastfeeding you should?
number of new cases in a well mixed population
What does the basic reproduction number (R0) represent in herd immunity?
contaminated water
What can leave an entire unit incapable of conducting successful operations?
centrifugal rash (trunk to limbs)
The hallmark of epidemic typhus includes what that occurs several days after fever, severe headache, and malaise?
latent period is shorter than incubation period
Why does subclinical disease occur?
mild may use loperamide/ bismuth moderate may use loperamide may use antibiotic Severe may use loperamide w/ non-dysentery use AB severe dysentery use AB *Multiplex molecular diagnostic for chronic cases
How is travelers diarrhea treated?
