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IPAP > MPH Block 1 Review > Flashcards

MPH Block 1 Review Flashcards

1
Q

Define Herd Immunity

A

Indirect protection from infectious disease for those that are not immune

Only applies to contagious diseases

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2
Q

Define Herd Immunity Threshold

A

When a disease is no longer persistent in a population due to a critical proportion of the population is already immune

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3
Q

Define Basic Reproduction Number

A

Average number of new cases caused in a susceptible, well mixed population

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4
Q

What are examples of microbes that are transmitted through Direct Contact and Droplet transmission

A

Contact- Herpes, Syphilis, Hookworm

Droplet: travel short distance, less than 1meter but are not suspended in the air- Pertussis, Meningococcal, Mumps

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5
Q

What are microbes that are passed through Indirect Vehicle and Vector (mechanical/biological) transmission from reservoir to host?

A

Vehicle Borne= Food, Water, Fomites: Salmonella, HCV, MRSA

Vector Borne-
Mechanical- Shigellosis/Bacillary dysentery, Plague
Biological- Malaria, Dengue

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6
Q

What are examples of microbes that are passed through airborne transmission?

A

TB

Measles

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7
Q

What types of PTs are screened for gonorrhea and chlamydia?

A 
ASx 
Abstinence
Monogamy
Barrier methods
Alternative methods
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8
Q

HPV screening is recommended to start at what age but can be done as young as ?

A

11-12

9

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9
Q

What age of PTs can have catch up HPV vaccines?

A

Both genders ages 13-26 who have been previously vaccinated or have not completed the series

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10
Q

Can PTs 27-45y/o receive HPV vaccine?

What is NOT considered a contraindication?

A

Yes, if it’s a shared clinical decision

Hx of HPV, abnormal PAP, or genital warts

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11
Q

How old can non-immune compromised PTs receive the HPV vaccine?

A

2 doses prior to 15th birthday

On or after 15th birday- 3 doses

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12
Q

What is the STANDARD schedule for receiving pneumococcal vaccines?

A

PCV13 @ 2, 4, 6, 12-15 months

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13
Q

PTs with chronic conditions such as DM, heart Dz or lung Dz should get what form of the pneumococcal vaccine?

A

PPSV 23

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14
Q

Immune compromised PTs w/ HIV, asplenia, chronic renal failure nephrotic syndrome get what form of the pneumococcal vaccine?

A 
PCV13 
8wks  
PPSV23  
5yrs later
PPSV23
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15
Q

What form of the pneumococcal vaccine can pregnant women receive?

A

PPSV 23

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16
Q

What schedule of pneumococcal vaccines should PTs with CSF leak or cochlear implants follow?

A

PCV13
8 wks later
PPSV23

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17
Q

Define VAERS

A

Unified national system to collect, manage and evaluate reports of possible adverse events that occur after the administration of a US licensed vaccination

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18
Q

What vaccine products are given first or at what timeline?

A

Live vaccine- 2 wks before Ab
Ab/Ig- wait 3+mon then give vaccine (except yellow fever and zoster)
PPD- give live vaccine when PPD is read
Live vaccine- wait 4-6wks to apply PPD

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19
Q

What is the administration interval for combo vaccines?

A

2 inactivated, Inactivated and Live, Oral and Injectable live vaccines- no interval
Two life injected vaccines- 4wks (except yellow fever, can be given <4wks after measles)

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20
Q

What are 3 additives found in vaccines?

A

Adjuvant
Preservatives
Residual materials

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21
Q

Define Adjuvant and 3 examples

A

Substance, primarily Alum, used to enhance vaccines and reduces number of active components and doses needed due to enhancement

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22
Q

What are 3 examples of Adjuvant used in vaccines

A

Shingris
Heplisav
FLUAD- squalene based oil-water emulsion

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23
Q

What are the functions of preservatives in vaccines?

A

Maintain potency and sterility of multi-doses

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24
Q

What are 3 examples of preservatives found in vaccines?

A

Thimerosal
Formaldehyde
MSG
Phenoxyethanol

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25
Q

What is the function of residual materials in vaccines?

What are 3 examples

A

Used to grow virus/bacteria contained in vaccine

ABX, egg protein, gelatin

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26
Q

What are the 3 types of prevention?

A

1- Prevent onset of illness before dz process
2- leads to early Dx and rapid Tx
3*- Reduces morbidity/mortality from existing Dz (most of what occurs in medical treatment)

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27
Q

What is the gold standard of testing a respirator?

A

Use test

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28
Q

Significance of OSHA, CFR, EO 12196, and DODI 6055

A

OSHA 1970- Primary federal law governing OccHealth

29 CFR 1910 1960- labor laws governing work environment

ExOrder 12196 1980- required OSHA compliance, military exempted (noise on battlefield)

DODI 6055.5-M- minimum standards for medical surveillance/work place exposure health risks and hearing conservation

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29
Q

Define Communicable Period

A

Period of time during which infectious agents may be transferred from person/animal to susceptible host

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30
Q

Define Incubation

A

Time interval between infections and initial onset of clinical illness/Sxs and when a person can transmit the infection w/out showing and signs of the Dz

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31
Q

Define Latency Period

A

Time from infection to infectiousness, shorter than the incubation period

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32
Q

When is a member placed on into the hearing conservation program?

A

> 85dB
8hr TWA
140dB peak
STS of 10dB avg from 2k, 3k and 4k in either ear

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33
Q

What are the reproductive workplace hazards?

A

Blood- HIV and hepatitis
Airborne- Rubella, V-Zoster
Physical hazards not specified by OSHA- Vibration ranges of 5-10hz
Exposure to lead, ethylene oxide, waste anesthetic gases, mercury

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34
Q

What is the criteria for a reproductive protection deferral

A

Job description indicates exposure to teratogenic, fetotoxic or reproductive toxic substance AND worker indicates attempts to conceive OR
Female currently pregnant/breast feeding

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35
Q

What is the key to treatment for diarrhea diseases during a disaster?

A

PO fluids that are glucose/Na ratio equivalent

Total osmolality between 200-310 mOsm/L

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36
Q

What are the 3 vaccination immunity types?

A

Active- Abs in response to exposure/vaccine and leads to memory

Passive- Abs transferred from mother to baby as immune globulins, no memory.

Herd- no Abs, no memory but those around have the Abs and prevent Dz from growing/passing

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37
Q

Criteria for Mild Traveler’s Diarrhea and how is it Tx

A

Tolerable, no distressing and doesn’t interfere w/ planned activities
Use Loperamide or Bismuth Subsalicylates

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38
Q

Criteria for Moderate Traveler’s Diarrhea and how is it Tx

A

Distressing or interferes w/ planned activity
May use Loperamide alone or
Adjuvant w/ AB and +/- ABX

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39
Q

Criteria for Severe Traveler’s Diarrhea and how is it treated?

A

Incapacitating or prevents planned activities

May use Loperamide as adjuvant to ABX and should use ABX

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40
Q

Acute Traveler’s Diarrhea is treated how?

When is microbiological testing recommended?

A

Empirically

Severe or persistent Sx or those who fail empiric therapy

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41
Q

When is multiplex molecular diagnostics preferred?

All dysentery is considered ?

A

PTs with persistent or chronic Sxs

Severe

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42
Q

Characteristics of using Azithromycin

A

1g or 500mg PO- if Sx don’t resolve in 24hrs, continue daily dosing x 3 days
Use empirically as 1st line in SE Asia/India to cover fluoroquinolone resistant Campylobacter or areas if Campylobacter/resistant ETEC are suspected
Preferred regiment for dysentery or febrile dysentery

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43
Q

Characteristics of Rifaximin

A

Do not use if suspected Campylobacter, Salmonella, Shigella or other causes of invasive diarrhea are present

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44
Q

How are vector borne disease prevented?

A

PPM- sometime only effective protection and ALWAYS first line of defense
Vector control- impractical, logistics, time
Prophylaxis/Vaccines

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45
Q

What protective measures are taken for bug protection?

A 
Full protection require each layer
ACU permethrin
DEET/picardian repellent on skin
Wearing of uniform
Sleep in permethrin netting
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46
Q

Permethrin treated netting doesn’t stop what bug that carries what disease?

A

Sand fly- causes leishmaniasis

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47
Q

Function of DEET

A

N,N-diethyl-meta-toluamide
Repels biting bugs such as mosquitoes, ticks, chiggers, fleas and flies
Applied before face paint
Apply sunscreen then DEET

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48
Q

Characteristics of permethium

A

Insecticide in pyrethroid family
Odorless/non-irritating
Prevents mosquito bites through fabric by killing/repelling insects that contact fabric

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49
Q

What is the MOA of permethium

A

Inhibits Na channels causing bugs to spaz/paralysis to death

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50
Q

What are the benefits of STI screening?

A

Female- reduce risk of PID/infertility
Male- reduce risk of reinfecting partners or overall transmission
Lower long term sequals

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51
Q

What are the 5 Ps of conducting a sexual Hx?

A 
Partners
Practices
Protection from STDs
Past Hx of STDs
Prevention of pregnancy
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52
Q

What is the difference in disease prevalence from 1900s to 2010?
Where is the biggest decrease seen?

A

1910- TB and Pneumonia/Influenza
2010- CA and heart dz
Biggest decrease in infectious disease deaths

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53
Q

Altitude Sickness Sxs are caused by ?

A

Mild/Moderate hypoxia occurring above 8000ft

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54
Q

What are the less severe, more common Sxs seen in travelers w/ acute mountain sickness?

A

HA, fatigue, loss of appetite, nausea, insomnia

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55
Q

What are the two severe forms of Mountain Sickness?

A

High altitude pulmonary edema

High altitude cerebral adema

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56
Q

What meds can be used as prophylaxis for Mtn Sickness?

How is Mtn Sickness treated?

A

Acetazolamide 250mg BID starting 24hrs prior to ascent and continued for 48hrs at highest altitude

Tx= Acetazolamide 250mg BID

Numbness, tingling in extremeties, inc urination

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57
Q

What are the prophylaxis recommendations for PTs with and without Hx of Mtn Sickness/

A

Hx- considered for 8-9K ft and recommended if +9Kft

AHx- considered 9-11k ft and recommended for +11.5K ft

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58
Q

Suspected or confirmed cases of ? are considered medical emergencies

A

Malaria, especially P Faliciparum

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59
Q

When are malaria exposure risks the highest?

A

Dusk, dawn and night

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60
Q

What are the two stages of malaria?

A

Blood- clinical manifestations of Dz

Liver- hypnozoites, dormant stage (Vivax, Ovale)

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61
Q

When are kids 6-11mon and +12mon that are traveling OCONUS given vaccines?

A 
6-11mon= 1 MMR followed by 2 doses after 1st birthday
\+12mon= 2 doses separated by +28 days
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62
Q

When can suppressive meds be used for malaria?

A

Only effective at killing parasites in erythrocytic/blood stage
Provides relief of S/Sxs

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63
Q

What is the regime for taking Doxy for malaria?

A

Take 1-2 days prior to travel
Daily while in area
For 4wks post travel to kill parasites

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64
Q

What is the benefits of taking Tafenoquine for malaria?

What is the screening and dosing requirement?

A

Prevents parasite development in liver and active against blood and dormant liver stage parasites
Reqs G6PD screening
PART dosing 300mg x 1

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65
Q

What medication is most effective at preventing P Vivax?

What is the screening and dosing requirement?

A

Primaquine
Active against dormant liver stage
G6PD screening
PART dosing 52/5mg qday x 14

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66
Q

What is the risk of taking Malarone for malaria?

A

Doesn’t kill dormant liver stage

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67
Q

What are the four infectious sources of mortality consistently associated with humanitarian emergencies?

A

Diarrhea
ARI
Vectore-borne- malaria
Measles

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68
Q

In all suspected and confirmed cases of measles, treatment involves ?

A

Vitamin A- immediately up Dx and the next day

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69
Q

What is measles’ Ro and HIT?

What is pertussis’ Ro and HIT?

A

12-18, 92-95%

12-17, 92-94%

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70
Q

Who is considered high priority for getting a measles vaccination?

A

Refugees

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71
Q

How is Salmonella Typhoidal transmitted?

A

Fecal/urine contamination of food/water

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72
Q

How often is typhoid vaccine given?

A

Vi Capsular Polysaccharide given >2wks prior to travel and booster q2yrs

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73
Q

What is the PO typhoid vaccine schedule?

A

Live attenuated vaccine
4 capusles taken q other day >1wk prior to travel
Must be kept refrigerated, take with cool liquid 1hr prior to meal or 2hrs post meal
Booster q5yrs

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74
Q

What are the common characteristics of pre-formed toxin ingestion?

A 
N/V
Watery diarrhea
6hrs post-ingestion
Resolves in 24hrs 
From improper processing, storage, handling of food
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75
Q

Characteristics of Clostridium Perfringens

A

One of the most common causes of food poisoning in US
Cooking kills cells, not spores
Causes diarrhea, cramps but NO fever or vomit and isn’t passed from person to person

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76
Q

Characteristics of Bacillus Cereus

A

Emetic from food cooked for insufficient time/temps to kill spores then improperly refrigerated
Causes N/V 1-5hrs post consumption

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77
Q

What bug carries Dengue?

A

Aedes mosquito- daytime mosquito (Aedes aegypti, Albopictus)

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78
Q

What protective measures are available for Dengue?

A

Dengyvaxia

Supportive care only

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79
Q

Where is Dengue a risk?

Re-exposure increases risk of ?

A

Urban areas

Dengue rheumatic fever

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80
Q

What are the recommendations of USPSTF?

A 
A- recommend, substantial benefit
B- recommend, moderate benefit
C- against 
D- against, mod-high risk
I- insufficient evidence, balance of harm/benefit can't be determined
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81
Q

What is the NMCI methodology for assessing disease risk?

A

Realistic Max rate + Disease endemicity= Potential attack rate in troops

Potential attack rate + typical severity= risk (red, amber, green)

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82
Q

Assessing disease risks of STIs

A 
GC/Ch: women 24 and younger, older @ higher risk
Men- considered class 1, insufficient evidence
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83
Q

How is screening for STIs in men accomplished?

A

Nuclear Chemical Acid Amplification Testing NAAT on urine or urethral swab

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84
Q

How is screening for STIs in women accomplished?

A

NAAT on vaginal swab or endocervical swab

Conjunctival Anne rectal swab are equal or better than other methods

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85
Q

What are the Suppressive and Causal meds used for malaria?

A

Suppressive: Doxy, Mefloquine, Choroquine
Provides clinical cure and relieves Sxs
All suppressive meds are taken with Primaquiine for presumptive antirelapse treatment for Plasmodium sp.

Casual: Tafenoquine, Primaquine, Malarone- only one not requiring G6PD screening and still uses Primaquine for PART

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86
Q

Suppressive malaria meds have what effect compared to causal meds that have ? effect?

A

Suppressive- kills RBC stage

Causal- kills blood and liver stages

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87
Q

Prophylaxis for Traveler’s Diarrhea is not recommended except for in ? type of PTs and ? med is recommended

A

Crohns
UC
Chronic Diarrhea
Rifaximin is DOC

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88
Q

What medication is used against leptospirosis

A

Doxy 200mg, single weekly dose

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89
Q

What two microbes in this block is there no vaccine for?

A

Campylobacter

Leishmaniasis

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90
Q

Define Incidence

A

Number of new Dz cases occurring in a specific time period in a population

Measure of risk, is a ‘rate’ and must have an element of time in denominator

Rate and element of time in denominator
(# new cases/avg population at risk during time)

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91
Q

Define Incidence Density

A

All people not followed for same amount of time

Number of new events per person-time

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92
Q

Define Crude Rate

A

W/out rates

93
Q

Define Specific Rate

A

Homogenous population

94
Q

Define Adjusted Rate

A

Modified calculation to control of variable population characteristics

95
Q

Define Prevalence

A

Proportion of people in population who have certain Dz or over a specific period of time

96
Q

Define Point Prevalence

Define Period Prevalence

A

Prevalence- all cases at a certain POINT of time, a proportion

All cases during a certain PERIOD of time

97
Q

What vaccines are and are not recommended for pregnant women?

A

Recommend:
Inactivated/injected influenza and Tdap between 27-36wks of EVERY pregnancy

Not: Live influenza, MMR, Varicella, Zoster, Anthrax, HPV, typhoid, PCV13

98
Q

Characteristics of Quarantine

A

Individual- healthy
Duration- incubation
Location- home
Action- police power

99
Q

Characteristics of Isolation

A

Individual- sick
Duration- communicable
Location- hospital
Action- common/standard precaution

100
Q

What microbe causes >50% of all food borne illness cases

A

Norovirus

101
Q

How are Salmonella infection acquired?

A

Meat and poultry

Most common source of fatal infections caused by Salmonella and Listeria

102
Q

How are Clostridium Perfringens infections acquired?

A

Dairy and eggs

103
Q

How are Campylobacter infections acquired?

A

Fish and shellfish

Majority of chemical-fish and parasitic

104
Q

What are the top 5 causes of illnesses w/ NO hospitalization/death?

A 
Norovirus
Salmonella
Clostridium
Campylobacter
Staph A
105
Q

What are the top 5 causes of food borne illness hospitalizations?

A 
Salmonella, non-typhoidal
Norovirus
Campylobacter 
Toxoplasmosa Gondii
E Coli STEC O157
106
Q

Stopped on

A

40

107
Q

Define Public Health

A

Science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts- Winslow

Population health perspective

108
Q

Epidemiology is based on what two fundamental assumptions?

A

Dz do not occur by chance

Dz are not distributed randomly among a population

109
Q

What are the objectives of epidemiology?

A 
ID etiology and risk factors
Determine Dz extent in community
Study Hx and prognosis of Dz
Evaluate new and existing measures
Provide foundation for policy
110
Q

What are today’s risks for cause of death?

What are today’s lifestyle risk factors?

A

Heart Dz, CA, CVA, COPD

Tobacco/ETOH, Nutrition, Obesity, Inactivity, Exposures

111
Q

What do immunizations do?

A 
Prevent:  ST WISP
Invasion
Destruction of organs
Permanent damage
Over stimulation of imm. system
Weakened state for opportunisitcs
Toxin susceptibility
112
Q

Define Contraindications and the four types

A

Condition that DOES increase the risk of a serious adverse reaction
Four true contraindications:
Anaphylactic, Encephalopathy, Pregnancy, Immunocompromised

113
Q

Define Precautions

A 
Condition that MAY increase the risk for an adverse reaction or affect the vaccines ability to produce immunity
Prior reactions
Illness
Breastfeeding
Hx of Guillain-Barre Syndrome
114
Q

Which vaccines are considered in special circumstances during pregnancy?

A

RHYTHMIST JAP

Rabies Hep A Yellow fever Td Hep B Meningococcal IPV Small pox Typhoid JE Anthrax PPSV 23

115
Q

What are the three types of VAREs?

A

Confined to local injection site
Body reaction
Hypersensitivity

116
Q

S/Sx of a local inflammatory or hypersensitivity reaction

A

Severe pain, Swelling, Induration, Edema that onset within 4-12hrs after vaccine, peaks 12-48hrs after and resolves within a week
Tx w/ acetaminophen/ibuprofen, cool compress, observation

117
Q

What are the S/Sx of a cellulitis reaction from an immunization?

A

Erythema, Pain, Swelling, Warm, Tight glossy skin
Usually has system Sx
Treat w/ ABX and Warm compresses

118
Q

Define SIRVA

A

Shoulder Injury Related to Vaccine Administration
Rapid onset of pain w/ limited RoM
Tx w/ NSAIDs, PT and corticosteroid injections

119
Q

What are the different types of adverse neurological events from vaccines?

A

ADEM
Transverse myelitis
Guillian-Barre- nerves are attacked starting w/ legs to arms
Brachial Plexus Neuritis- severe arm pain w/ upper arm weakness

120
Q

When are febrile seizures likely to happen and they’re more likely to occur if ?

A

Rarely before 6mon/after 3yrs
More likely if:
Already had one, immediate relative has had one, Hx of frequent fevers,

121
Q

Who manages VAERS?

What type of reactions are monitored for?

A

CDC and FDA

Alopecia after Hep B
Thrombocytopenia after measles
Myopericarditis after small pox

122
Q

What vaccine program is a no fault resolution program and provides ACIP childhood schedules?

Which one provides compensation for injuries?

A

NVICP

CICP

123
Q

What is the incubation and communicable periods for measles?

A

Incubation- 14 days for rash

Communicable- 4 days before rash until 4 days after

124
Q

What is the incubation and communicable period for Hep A?

A

Inc- 28-30 days

Comm- latter half of incubation to few days after onset of jaundice

125
Q

What is the incubation and communicable period for smallpox?

A

Inc- 7-17 days

Comm- from onset of Sxs to separation of scabs

126
Q

What are the three parts of the Epidemiological Triad?

Sometimes there’s a fourth part, what is it and what three microbes are transmitted through the fourth component?

A

Susceptible host
Causative agent
Environment

Vector- malaria, dengue, scrub typhus)

127
Q

What are the components of the Host within the epidemiologic traid?

A 
I CAPS
Susceptibility
Prior exposure
Age
Co-infection
Immune response
128
Q

What are the components of the Agent within the epidemiologic traid?

A 
STIRS V
Susceptibility to ABX
Toxicity
Infectivity
Reservoir
Survival out of the body 
Virulence
129
Q

What are the components of the Environment within the epidemiologic triad?

A 
SPPC
Social structure
Population density
Physical structure
Climate
130
Q

Define Primary/Definitive host

A

Organisms that a pathogen reaches maturity and reproduces in

131
Q

Define Secondary/Intermediate host

A

Organism that harbors the sexually immature parasite and is required for completion of the life cycle

132
Q

Define Dead End/Accidental host

A

Organism that doesn’t allow transmission to the definitive host

133
Q

What are two examples of dead end hosts?

A

Horses and humans for the West Nile virus, normally between mosquito and birds

134
Q

Define Natural Reservoir

A

Specific environment in which an infectious pathogen naturally lives and reproduces or one that is primarily depended upon for survival

135
Q

A reservoir is usually what main characteristic

A

Living host of certain species without causing dz to reservoir itself

136
Q

Define and list characteristics of a Carrier

A

Organism that is infected with a pathogen w/out showing S/Sxs and can transmit pathogen to others or eventually develop Sxs

137
Q

Define Convalescent Carrier

Where is this method commonly seen?

A

Capable of spreading disease following a period of illness

Viral diseases- hepatitis, polio

138
Q

Define Asymptomatic Carriers

Where is this method commonly seen?

A

Never exhibit S/Sxs of disease but are capable of infecting others

6% of individuals infected w/ Salmonella typhi become chronic ASx carriers

139
Q

Define the type of disease transmission: fly carries shigella from latrine to food?

A

Indirect vector borne mechanical transmission

140
Q

Define the type of disease transmission: staphylococcal poisoning from a single meal?

A

Indirect vehicle borne transmission single exposure

141
Q

Define the type of disease transmission: student in hallway sneezes on you?

A

Direct transmission droplet spread

142
Q

Define the type of disease transmission: cook with poor hand washing contaminates a salad?

A

Indirect vehicle borne transmission probable multiple exposure

143
Q

Define the type of disease transmission: person w/ TB repeatedly coughs during 9hr flight?

A

Airborne transmission

144
Q

Define the type of disease transmission: child with impetigo gives you multiples hugs?

A

Direct transmission person to person

145
Q

Incidence represents the ?

Prevalence represents the ?

A

Risk of getting a Dz

Odds of having it in a population

146
Q

In a steady state situation, what is the prevalence equation?

A

P= incidence x duration of dz

147
Q

High prevalence of a Dz may reflect ?

Low prevalence may reflect ?

A

High- High incidence (risk) or prolonged survival w/out care

Low- low incidence (risk), a rapidly fatal process, or rapid recovery

148
Q

Define Isolation

A

Separation/restricted movement of ILL people who have a contagious disease in order to prevent transmission

149
Q

Define Quarantine

A

Separation/restricted movement of exposed but ASx/WELL people before it is known if they will become ill

Essentially a monitoring need resulting in loss of personal freedom

150
Q

Historically, when has quarantine methods been used?

A 
Public health Action
Executive Order 13295
CYSTS PDF
Cholera Yellow fever Smallpox TB SARS
Plague Diphtheria Fever, hemorrhagic
151
Q

What is the purpose of Hospital Isolation

A

Transmission-based precautions

Established for a specific Dx

152
Q

Who does exclusion from work apply to?

A

Health care
Day care
Food handler
Law enforcement/detainees

153
Q

What is the mission of occupational health?

What two areas does it focus on?

A

Promote health and safety of workplace and community

Focuses on education regarding hazards and surveillance within the occupational environment

154
Q

What is the primary role of occupational health in a military setting?

A

Protect service members and DOD civilians
PrevMed
Public Health

155
Q

What are 4 reasons for Occupational Health

A

Compliance with laws, regulations and executive orders
Maintain healthy work force
Maintain productivity
Decrease organization costs

156
Q

What was NIOSH created under?

A

OSHA 1970

157
Q

When are reference/initial audiograms conducted?

What is the first valid hearing test?

A

Within 30 days of initial exposure to hazardous noises

Reference audiogram, preceded by 14hrs w/out noise exposure

158
Q

Human remains do not pose a threat as communicable disease hazards with what exception?

A

Death from cholera,
Viral hemorrhagic fever
Epidemic typhus (Louse-borne)

159
Q

Disaster associated outbreak population characteristics and the characteristics of sudden displacement

A

Population: size, health and living conditions

Sudden displacement: inadequate water, poor sanitation, lack of access to health services

160
Q

What type of diarrhea outbreak is considered a public health emergency?

A

Cholera

161
Q

What is the goal of diarrhea disease treatment?

What is the main treatment goal?

A

Prevent death from dehydration and circulatory collapse

Re-hydration

162
Q

When are ABX used for diarrhea disease?

A

Moderate/sever cholera
Dysentery- bacillary or amoebic
Giardiasis

163
Q

What is a major respiratory cause of morbidity and mortality in emergency setting

A

Pneumonia

164
Q

Characteristics of Influenza A

A

Primary reservoir in humans and birds but can also infect swine, seals and horses
Seasonal epidemics
Only know cause of pandemics

165
Q

Characteristics of Influenza B

A

Infects humans and swine
Seasonal epidemics
Mostly antigenic drifts

166
Q

Characteristics of Influenza C and D

A

C= mild illness

D- infects cattle

167
Q

What are the H and N parts of Influenza A

A

Hemagglutinin- binds to respiratory cells

Neuraminidase- releases new virions from cells

168
Q

When is flu season in the northern/southern hemisphere?

A 
N= Oct-March
S= Apr-Sept
169
Q

What factors increase and inverse Influenza A ability to transfer?

A

Aerosol- little/no transmission with high humidity

Temps- greater transmission at lower temps

170
Q

Current influenza vaccines are categorized as ? or ?

A

Trivalent- two influenza A and one B

Quadrivalent- two As and two Bs

171
Q

What is the definition of measles outbreak?

A

Three or more confirmed cases linked in time and space

172
Q

What is the target population for measles vaccine during the emergency phase?

A

All kids 6mon-14yrs
Priority= 6mon-5yrs
If immunized between 6-9mon, re-immunize at 9mon

173
Q

What is the target population for measles vaccine during time that there is insufficient vaccines available?

A

Undernourished/sick kids- 6mon-12yrs
All kids 6mon-23mon
Kids 24-59mon

174
Q

What medication is used for chemoprophylaxis for Traveler’s Diarrhea if a PT requests it?

A

Bismuth subsalicylate- 2oz of liquid or,

2 tabs Q4D

175
Q

What travel vaccines are considered for widespread, geographical and duration/activity risks

A

Widespread- Hep A, Typhoid

Geographic- Yellow, Meningococcal, Polio, JEV

Duration/activity- Hep B, Rabies

176
Q

What are the routine childhood vaccines?

A 
MMR
Varicella
DTaP
Polio
HiB
Hep A/B
PCV
Rota
Influena
177
Q

What are the routine vaccines for adolescents/Adults?

A 
Tdap
Meningococcal
HPV
Influenza
Penumococal
Vericella/Zoster
MMR
178
Q

What type of mosquito carries JEV?

What time of the day do they eat?

A

Culex

Evening and night biter

179
Q

What are the sources of medical intelligence?

A

Strategic- NCMI for DoD

Tactical- S2/G2

180
Q

What info IS provided by NCMI

A 
Health risk
Health services
Trends/forecasts
Indications/warnings
Facility database
181
Q

Uses of taking Tafenoquine for malaria prevention

A

Prevents initial parasite development in liver
Acts on blood stage parasites
Active against dormant liver stage
300mg x 1

182
Q

Uses of taking Primaquine for malaria prevention

A

Most effective against P. Vivax
Active against dormant liver stage
No action for blood stage of P Falciparum
52/5mg qday x 14 days

183
Q

Use of Malarone for malaria prevention

A

Does not kill dormant liver stage

Must still use Primaquine for presumptive PART

184
Q

What two meds are the only approved drugs for acting on the dormant hypnozoites in the liver?

A

Primaquine

Tafenoquine

185
Q

What are the ABCDEs of malaria prevention

A 
Awareness
Bite prevention
Chemoprophylaxis
Dx 
Emergency standby treatment
186
Q

What is the primary host of Leptospirosis

A

Brown rats

Humans are dead end hosts

187
Q

What medication is used for preventing Leptospirosis infections in service members?

A

Doxy 200mg 1x/wk= 95% effective prevention

188
Q

When is re-screening peformed after STI treatment?

A

3, 6, 9 and 12 mon

189
Q

What are the stats of Gonorrhea

A

Second most commonly reported communicable disease Second most prevalent STI in US
Men to Women= 4x more common
Men usually ASx

190
Q

What class of ABXs are the last ones recommended and still effective for gonorrhea treatment?

A

Cephalosporins

191
Q

What is the current combo therapy recommended for treating gonorrhea?

A

Ceftriaxone 250mg IM

Azithromycin 1g PO

192
Q

How is Expedited Partner Therapy for gonorrhea treated?

A

Cefixime

Azithromycin

193
Q

Characteristics of Chlamydia

A

Most reported bacterial STD in US
10x more prevalent than gonorrhea
Most costly non-viral transmitted infection

194
Q

What is the screening method for chlamydia?

A

NAAT for men

Vaginal swabs for women

195
Q

What is the recommended chlamydia treatment regiment?

A

Azithromycin 1g PO or

Doxy 100mg PO BID x 7 days

196
Q

What is the alternative treatment recommendation for chlamydia

A

Ezithromycin 500mg Q4D x 7 days

Ofloxacin 300mg BID x 7 days- for pregnancy

197
Q

When is re-testing needed after chlamydia treatment?

A

Not needed if treated w/ Azithromycin or Doxy

Retest if treated w/ Erythromycin

198
Q

Define Food Infection

A

Organisms are present/introduced to foods and multiply in the food/human body until they cause sickness

199
Q

Define Food Intoxication

A

Microbes are present in food and produce a toxin. The toxin causes the illness and not the actual microbe

200
Q

What is an examples of a naturally occurring chemical and introduced chemicals

A

Ciguatera Toxin

Poison, pesticide, leeching from containers

201
Q

What are the majority of food borne illnesses caused by?

What are the majority of fatal infections caused by?

A

Half by produce contaminated w/ Norovirus

Meat and poultry

202
Q

What causes the majority of chemical and parasitic food borne illness?

A

Aquatic animals
Fish= chemical
Parasitic= mollusks

203
Q

What are the top five pathogens contributing to domestically acquired food borne illnesses resulting in death?

A 
Salmonell
Toxoplasma gondii
Listeria
Norovirus
Campylobacter
204
Q

What are the 3 food borne investigation tasks in bold?

A

Detecting possible outbreak
Generating hypotheses about sources
Controlling outbreaks

205
Q

What is one of the reasons we do routine surveillance in food services?

A

Detecting possible outbreaks

206
Q

What is the criteria to verify a food borne illness outbreak?

What is the exception to this criteria?

A

Two or more people from different house holds who eat a common food and is confirmed through lab analysis as the source of the illness

Except- botulism or chemical caused illnesses

207
Q

For food borne illnesses, define diarrhea

A

Loose/water stools three times on 24hrs
Acute= <14 days
Persistent= >14days, < 30days
Chronic= >30days

208
Q

How long does it take for N/V from ingesting preformed toxins to start showing?

A

Within 6hrs

209
Q

Define Scombroid

A

From eating improperly stored/processed fish

Commonly from tuna, mackerel, mahi mahi, or blue fish (fish with high histidine levels)

210
Q

What are the S/Sx of Scombroid?

A

Facial flushing
Burning/peppery taste in mouth
Facial rash/pruritus

211
Q

What are the non-inflammatory viruses?

A

Rotavirus
Norovirus
Adenovirys
Cytomegalovirus

212
Q

What are the non-inflammatory bacterias?

A 
Enterotoxigenic
E Coli
Clostridium Perf.
Staph A
Bacillus Cereus
Vibrio Cholera
213
Q

What are the non-invasive parasites?

A

Giardia intestinalis
Cryptosporidium
Cyclospora

214
Q

How are Bacillus Cereus infections acquired?

A

Meat/veggie foods after cooking and not maintained at temp

215
Q

What are the S/Sxs and time frames of a Bacillus Cereus infection?

A

8-16hr incubation

Watery diarrhea and GI pain

216
Q

How is Norovirus testing conducted for Dx?

A

PCR

217
Q

There are no standardized/validated lab tests for detecting Norovirus in food except for in ?

A

Shellfish

218
Q

What is the Kaplan Criteria

A

Mean illness duration of 12-60hrs
Mean incubation of 24-48hrs
50% w/ vomitting
No bacterial agent ID’d

219
Q

What methods are used for preventing Norovirus infections?

A

Water and Soap= effective
Alcohol sanitizer- not as effective due to lack of lipid envelope
Bleach for surfaces

220
Q

Characteristics of Salmonella, non-typhoidal

A

Leading cause of food borne illnesses, hospitalizations and death
More common in warmer months
Present in poultry

221
Q

What temp and time frame is recommended for killing Salmonella?

A

165*F x 15 min

222
Q

How are PTs determined to be ASx from Salmonella?

A

Two negative stool cultures collected no less than 24hrs apart

223
Q

What is the most common contaminated method of Campylobacter transmission?

A

Unpasteurized milk

224
Q

Capylobacter infections are at highest risk for people traveling to what countries?

A

Africa

S. America

225
Q

What is the only source of the Salmonella bacteria?

How is it transmitted?

A

Human

Fecal/urine contamination of food/water

226
Q

What is a superior form of drying hands?

A

Paper towels

227
Q

What is the danger zone temps for bacteria growth?

A

40-140*F

Especially 90-110*, can double population in 20min

228
Q

What are the recommended temps and storage times for food?

A

Shallow containers
40F or lowers within 2hrs
If outside and temps are >90F, refrigerate within 1hr

229
Q

Define Primary Prevention and it’s main goal

A

Pre-pathogenesis phase
Prior to Dz exposure

Remove cause of disease- imms

IPAP (212 decks)

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