PMCH Flashcards
End of life pt with bone pain. Tx?
Steroids
Dexamethasone
PPD test is considered + when?
1- >10mm in pts with no known risk factors
2- >10mm in pts with known TB risk factors I.e. immigrants, prisoners, homecare workers
3- >5mm in immunocompromised i.e. HIV, children on chemo, chronic steroid treatment, PLUS household contact with TB pts
Fecal-orally transmitted pathogens:
1- Bacteria: C Diff, Cholera, Shigella
2- Virus: Norwalk, Polio, Hep A, Hep E
3- Parasite: Giardia, Cryptosporidium
when should the 1st dose of rotavirus vaccine be given?
prior to 14 weeks of age
Asymptomatic patients with family Hx of Colorectal Ca should begin colonoscopy at?
age of 50 or 10 yrs younger than the age of their 1st degree relative who had Ca.
screening of 10,000 subjects (160 are +), 8 have the disease.
what is the predictive value of a positive test?
**These 8 survived longer than others suffering from the same type of cancer diagnosed by other means
5%
8/160
Disadv of case control studies:
- possibility of recall bias
- possibility of confounding bias
- no incidence of the disease
- control selection can be difficult
- may be difficult to establish temporality
- record keeping maybe unreliable
- only one outcome can be measured
Tx of Pertussis
Azithromycin OR clarithromycin
note: they aim at reducing transmissibility not other factors
Environmental health jurisdictions:
1- Municipal: waste disposal
2- Provincial:
a- water & air quality
b- regulating industrial emissions
c- toxic waste disposal
3- Federal:
a- designates & regulates toxic substances
b- food regulation
c- pollutants that cross provinces
When are Rotavirus vaccine given?
they are given orally starting 6 weeks of age in a 3 dose schedule at ages 2,4 and 6 months or in 2 doses at 2 and 4 months of age.
Most common resevoir of Hantavirus in Canada?
Deer mouse
T/F: Men have worse outcomes following MI than women.
False
Note: CAD is more common in men than women
Best pharma therapy for reducing craving and smoking cessation
Varenicline
T/F: smoking cessation requires only pharma therapy
False
it requires both pharma & counselling.
T/F: after menopause, incidence of CAD in women increases and can be equal to men
True
T/F: most risk factors for breast Ca are strong risk factors
False
Local sanitation, monitoring of reportable diseases, water and food safety enforcement all fall under the jurisdiction of the:
Public health unit
Relative risk equation?
RR = (A/(A+B))/(C/(C+D))
Note: RR can only be calculated in cohort study
A group of 50 people are exposed to virus A. 9 develop a mild infection, 10 become seriously ill, 3 die.
What is the attack rate of virus A?
22/50
Tx for Organophosphates poisoning:
Pralodoxime within 48h. Give Atropine at the same time.
Adv of case control studies:
- fast and cheap
- can be used in outbreaks
- can be used for diseases that are rare in a population
Define attack rate:
the number of new cases of disease during a specific time period divided by total population at risk during the same time period.
Risk of BRCA1 mutation:
65% risk for breast Ca and 40% risk for Ovarian Ca
T/F: prospective cohort studies provides a stronger evidence of association between health outcomes and exposure to potential risk factors than case control studies.
True
Main reasons for persistent severe pain after a trial of several different opioids?
- failure of functional improvement
- failure to comply with monitoring such as urine drug screen
- failure to comply with pain mgm agreement
- evidence of diversion and abuse
- intolerable side effects
5 criteria of CHA (Canada health act) provincial govs must meet through their public healthcare insurance plans to qualify for federal cash contribution.
1- Universal 2- Portable 3- Accessible 4- Comprehensive 5- Public administration
note: there is 2 specific provisions and 2 conditions.
DTaP (Diphtheria, Tetanus, Acellular Pertussis) + IPV (Inactivated Polio) + Hib vaccine schedule:
- 2 months
- 4 months
- 6 months
- 18 months
(with Hib)
then at 4 y/o
Public health unit oversees:
1- sanitation
2- reportable disease
3- environmental risks
4- enforcing food and water safety
Canadian task force on preventive health care (CTFPH)
1- screen adults 60-74 for CRC via FIT q2yr OR Flexi Sig. q10yr
2- screen adults 50-59 for CRC via FIT q2yr OR Flexi sig. q10yr
3- NOT screening adults younger than 50
4- NOT screening with colonscopy
5- NOT screening men <55 for prostate Ca w/PSA
T/F: Provincial govs are responsible for health insurance either directly or by subsidizing private insurance companies.
False
Prevention tools of Hep A:
- vaccination
- immune globulin
- hygienic practices
T/F: diagnostic tests work well in both men and women
False
it works better in men
Who can LAIV be used for?
Healthy children 2-18 y/o and healthy adults 19-59
Best measure to prevent Hep A in community:
Good hygiene
T/F: Federal gov can withhold cash for social programs in provinces that don’t meet the requirements of the Act.
True
Haemophilus influenza type B containing vaccine is recommended when?
Routine immunization beginning at 2 months
What does Organophosphates inhibit?
AChE. causing increased level of Ach, causing overstimulation of muscarinic and nicotinic receptors
What is the most important indication to taper opioids in non cancer pain?
Persistent sever pain after different opioids.
Pharma therapy for smoking cessation:
1- Varenicline
2- Bupropion
3- Nicotine replacement
50 y/o man has come for annual checkup. no Sx or Hx.
what screening test to do:
Fecal immunochemical test
PPD test is + and IGRA is + but no sign of active infection (no symptoms, no CXR signs)
what is Dx?
LATENT TB
Note:
Isoniazid for 9 months (add pyridoxine i.e. VitB6 to prevent peripheral neuropathy)
