PMCH Flashcards
Age most vulnerable to lead poisoning
< 6 mo
Organisms resistant to chlorine in water?
Cryptosporidium
Giardia
HAV
Entamoeba histolytica
Pneumon-Vaccine for elderly
At 65 Yr => q5yr
Abuse in elderly M:F Perpetrator MC form Least common form
F>M
90% adult children of elderly (alcoholic / abusers)
Neglect
Sexual
Spouse abuse elderly husband indicate?
Hx of violence in relationship
Latex allergy cross-reaction (food)
Latex-fruit syndrome
Avocado
Banana
Kiwi
Chestnut
MC nutritional def worldwide
Fe
95% CI + OR doesn’t > 1?
Significant association
Rx for spinal mets?
No Rx increases survival
Best Rx = dexamethasone for Sx + bone pain
Prognostic signs of spinal mets
Bad + good
Bad = loss of sphincter tone (irreversible)
Good = ambulation
Features of dexamethasone compared to other steroids
- Least mineralocorticoid activity
- Least to associated w/ cognitive Sx
- Least to ass w/ infection
HA1c of 6% = FPG?
HA1c of 7% =
Eqn
6% = 7.0
7% = 8.5%
Eqn => FPG = 1.59 x A1c - 2.59
Chloroquine in preg
C
Given if plan to travel to high risk
RR equation
RR = (A/a+b)/(c/c+d)
What’s relative risk
Prob of event to occur in exposed group vs non exposed
Is HepA vaccine imp for immigrants from developing world
No
It’s prevalent, chances are they’ve had it and immune to it.
Outbreak of Ecoli 0157H7 ass w/
Ground beef
Best way to remove ticks
Manually by blunt forceps
Responsibilities of public health physician
Prevent STD
Prevent dental prob
Infectious disease surveillance
Health promotion activities
Effect of b-carotene supplement
Inc risk of lung cancer
MCC of travelers diarrhea
Enterotoxigenic E.coli
enterotoxigenic Ecoli mechanism of action
Colonization factors
Heat liable enterotoxin
For future, to make effective vaccine against ETEC diarrhea it should contain
Colonization factors CS1-6
LT toxoid
Larva migrans transmission
Contact with soil contaminated with the cat and dog faeces
Rx of dyspnea + terminal illness (Ca)
Opiates esp Morphine
Exercise to burn fat frequency
At least 30 min 5d/wk
Why fat burning fat exercise must > 30 min
Glycogen burning fuels body for 20 min
Fat fuels it after that
Exercise for cardiovascular + fitness
20 min daily
Or
10 daily
T/F: walking (land/water) + biking = exercise for 10-20 min
T
West Neil virus
What is it?
Transmission?
Sx?
Risk population?
- Human neuropathogen
- Mosquito infected from birds
- mostly flu like
Rarely Neuro Sx: encephalitis, meningitis, paralysis - elderly at risk
- Rx supportive
Number needed to Rx
Importance?
Eqn?
Assess benefit of Rx
NNT = 1/ARR
What explains population growth in developing countries
Decreased mortality rates
Hospice care services
Short term hospitalization
Sx Rx of terminal illness
Physical/occupational/speech Rx
Dietary counseling
T/F: curative Rx is covered by hospice care
F
Terminally ill + oral secretions Rx
Gurgling/rattling
Anticholinergic
Scopolamine
Hyoscyamine
Glycopyrrolate
Atropine
MC hospital error ass w/ SE of drug occurs when
Ordering
Early detection of cervical cancer by Pap smear survival
90% survival rate
WHO def of health
State of complete physical mental and social well-being
T/F: transdermal absorption of medication decreases with age
T
2/2 increase ratio of fat to lean body weight
T/F: NSAID’s should be avoided in liver cirrhosis
T
NSAIDs in preg
Safe
Should be avoided in last 6wk to prevent inhibition of PG synthesis
Sympathomimetic SE in elderly
High BP
High ocular pressure
Worsen urinary retention
Interact w/ BB, methyl dopa, TCA, MAOi
Ex of sympathomemtic
Pseudoephrine
Phenylephrine
How to make medical decision for incapable pt
- Follow advanced directive (oral or written)
- No directives = health care proxy
- No proxy = family
- No family or family can’t agree = ethics committee
What elderly does form heat stroke
Living alone Can't care for self CVD or resp disease Mental illness (schizophrenia) \+/- alcohol, Hx of heat stroke
In terminal illness:
Preparatory grief vs depression
Grief =
normal self image
Sx wax + wane
Worry abt separation from family
Depression =
Poor self esteem
Suicidal ideas
Rx of depression in terminally ill patient
Expected to live few weeks: stimulants methylphenidate
Live longer:
SSRIs
Chemical exposure associated with leukemia and aplastic anemia and multiple myeloma
Benzene
Arsenic exposure is associated with
Skin cancer
Best hearing arrange for sounds
400 to 5000 Hz
Frequency range for audible sound
20 to 20,000 Hz
Who should be screened for HCV
- Blood transfusion prior to 1992
- Needle stick with HCV
- Mucosal exposure to HCV
- Children born to HCV+ mom
Prevent cholera?
Boiling drinking water
Chlorinate drinking water
Cook vegetables + fish thoroughly
When to screen for CRC at 40 and q5 Yrs?
1st degree relative w/ CRC or adenomatous polyps at < 60
> 2 of 1st degree relative with CRC or adenomatous polyps at any age
When to screen for CRC at 40 and q5 Yrs?
1st degree relative w/ CRC or adenomatous polyps at < 60
> 2 of 1st degree relative with CRC or adenomatous polyps at any age
F patient FU w/ male doc
Frequent visits
Normal exam + no complaints.
What to suspect?
Reaction?
Inappropriate relationship
Reaction:
Pointing your awareness of inappropriate patient-doctor relationship and willingness to help
When does palliative care start?
When Dx diagnosed, count through cure or death.
T/F: unit of care in palliative Rx comprises pt and his family as defined by surrogate.
T
Who receives palliative care?
Pt of all ages w/ chronic illness or injury that impairs daily functioning or reduce life expectancy
Having ER contraception readily available results in
Shorter time b/w sex + medication use (15 HR sooner)