PopMed MUST MEMORIZE FACTS Flashcards
a. Provide a formula that can quantitate the burden of disease in a population.
- DALY = YLL + YLD where,*
- YLL = number of deaths x standard life expectancy at age of premature death*
- YLD = number of incidence cases x number of years lived with disability x disability weight*
b. List three health conditions which are most responsible for the YLL in developed countries
- Cardiovascular disease*
- Cancer*
- Injury*
- Chronic respiratory conditions*
c. List three conditions or situations which contribute most significantly to the DALYs in developing countries (ie: associated with a high attributable fraction)
- Malnutrition*
- Unsafe sex*
- Poor water sanitation*
- Poor hygiene*
d. Provide a definition for prevalence
The number of cases within a population at a particular time
e. Provide a definition for incidence
The number of new cases per set time period (often per year)
a. List four broad categories of causes of health inequality.
- Risk factors*
- Environmental*
- Biological*
- Behavioural*
b. Identify a primary prevention strategy which may be employed to reduce health inequity
Reduce social inequality
c. Identify a secondary prevention strategy which may be employed to reduce health inequity.
Target disease prevention to the disadvantaged population
d. Identify a tertiary prevention strategy which may be employed to reduce health inequity
Target health care services for disadvantaged sick people
a. Which level of government provides the greatest level of funding for healthcare
- Federal (46%)*
- Private (32%)*
- States (22%)*
a. List at least three strategies you could employ to reduce communicable diseases in general. (ie: These could be applied to TB, HepB, HIV, etc)
- Immunisation*
- Education of the population regarding hygiene, etc*
- Needle and syringe exchange programs*
- Surveillance and contact tracing*
- Infection control*
b. List at least two sources of data you could use to assess the prevalence of a particular disease, such as TB or HepA, in a population.
- Notifiable disease database*
- Lab specimens*
- Deaths records*
- Patient data collections*
- Sentinels*
- Surveys*
c. An outbreak of HepA has been suggested to be associated with a batch of infected oysters. List atleast 3 things you would look for to clearly establish a causation, rather than just an association.
Strength of association (size of odds ratio)
Dose response
Timing (exposure
Consistency of results with other studies
Plausible
a. What is an appropriate tertiary management strategy for tuberculosis
DOTS Directly Observed Therapy Shortcourse (sputum microscopy, guaranteed supply of drugs, directly observed therapy to ensure compliance)
b. List at least three effects TB may have on society.
- Loss of a worker*
- Threat of serious infection*
- Need to screen migrants, HCW, others*
- Costs (treatment, screening, FU)*
- Discrimination*
- Impact on institutions*
- Local economical effect*
c. How does society respond to TB in terms of attempting to minimize its impact on society List at least two responses.
- TB is a notifiable disease*
- TB screening performed on migrants*
- Investigations and treatment is free*
- Treat infectious people*
- Provide preventative therapy if exposed*
- Chest clinics located across NSW*
d. List at least three factors which may limit a migrants access to quality health care
- Language barrier*
- Cost and low SES*
- Discrimination*
- Unfamiliarity with system*
- Fear (of deportation)/mistrust*
- Lack of transport*
- Cultural differences not suitable for receiving health care (eg: female patient vs male doctor)*
a. Identify three risk factors which may contribute to the higher incidence of low birth weight babies in the ATSI population
- Drug and alcohol use during pregnancy*
- Poor maternal nutrition*
- Poor antenatal care/support* ½ Effect duration of pregnancy
- SES disadvantage*
- Illness during pregnancy*
b. What is the most common reason for hospitalization in the ATSI population
Dialysis
a. What are the three most common anatomical sites fractured in the elderly population
- Wrist*
- Vertebrae*
- Hip*
b. List at least three strategies which may be employed as a primary preventative method for hip fractures.
- VitD monitoring and supplements*
- Ca monitoring and supplements*
- Regular weight bearing exercise*
- Provision of hip protectors*
- Reduction in obesity*
c. List at least three strategies which may be employed to prevent falling by the National Fall Prevention for Older People Initiative (established 1999/2000 by the Federal Gov.)
- Provision of walking aids*
- Risk factor screening by multidisciplinary team*
- Muscle strengthening and balance retraining*
- Home hazard assessment and modification*
- Withdrawal of psychotropic medication*
- Cardiac pacing for fallers with carotid sinus hypersensitivity*
- Thai Chi group intervention*
a. Identify one strategy which has been shown through a RCT to reduce the number of fractures resulting from children falling from play equipment.
- Increased depth of bark*
- NB: Engineer visits and support to implement playground safety guidelines reduces observable playground hazards*
a. What are three factors which may contribute to the abnormal stress or abnormal cartilage leading to the development of osteoarthritis
- Stress: Trauma, Dysplasia, Obesity, Malalignment, Muscle weakness, loss of proprioception*
- Cartilage: Ageing, inflammation, metabolic changes, endocrine factors*
b. List at least four strategies which may be considered treatment options for osteoarthritis.
- Weight reduction*
- Exercise (lower limb strengthening + range of motion exercises)*
- Gait modifications*
- Braces, innersoles, footwear*
- NSAIDs at lowest effective dose, but long term use should be avoided*
- Intra-articular hyaluronan*
- Glucosamine + chondroitin dietary supplements*
- Avocado/soybean*
- TENS (Trans cutaneous electro nerve stimulation)*
- Capsaicin cream (Zostrix)*
- NB: all of the above have varying degrees of evidence, top 3-4 are in the OARSI (2009) guidelines*
a. Identify at least two features of acute alcohol intoxication which may cause it to be associated with the problems listed above.
- Disinhibition*
- Impaired judgement*
- Slowed response time*
- Incoordination*
a. The Asthma 3+ Visit Plan was developed by the National Asthma Council in an effort to improve the management of asthma. Identify the three things this plan includes.
- Patient self management education*
- Development of a written asthma management plan*
- Practitioner review*
b. List three indicators which may be used in order to assess the success of strategies employed to better prevent and manage asthma.
- Prevalence rate of asthma*
- Rate of asthma related GP visits*
- Average number of sick days due to asthma per year*
- Death rate for asthma*
- Proportion of patients with a written Asthma Action Plan*
- Proportion of schools, etc using asthma education programs*
a. List at least three respiratory conditions which have an attributable fraction of 10% with regards to occupational exposure.
- Asthma: 15 20%*
- Lung cancer: 10 30%*
- COPD: 12%*
b. What control strategies have been employed to prevent the impact of Asbestos on the health of individuals List at least three.
- Eliminate exposure*
- Substitute for a less toxic compound*
- Isolate exposure from work (eg: spray both, enclosed lab)*
- Engineer safety (eg: ventilation)*
- Personal protective equipment*
c. You wish to assess if a 56 year olds presentation with respiratory symptoms is related to occupational exposure. Identify three features in the history you would ask.
- Activities undertaken at work and likelihood of exposure*
- Use of protective equipment*
- Timing of symptoms relative to work and holidays*
- If co-workers experience similar symptoms*
- Exposure to other non-occupational risk factors (eg: smoking)*
- Prior exposure to toxins in other occupation*
a. During which age range is the incidence of upper respiratory tract infections at its peak
- 2 4 years old (8 to 10 episodes annually)*
- vs average adult levels of 4 to 6 per year reached by 8 to 10 yrs old*
b. List the three most common causes of viral acute respiratory tract infections.
- Respiratory syncytial virus*
- Influenza*
- Parainfluenza*
- Adenoviruses*
c. Identify two important bacterial causes of acute respiratory infections.
- Streptococcus pneumonia*
- Haemophilus influenzae*
a. List at least two disorders/situations in which a platelet transfusion is indicated.
- Bleeding due to thrombocytopaenia (chemotherapy, DIC)*
- Bleeding due to functionally abnormal platelets (myelodysplastic disorders, congenital platelet dysfunction)*
b. Identify an indication for using fresh frozen plasma.
Control bleeding due to coagulation factor deficiency (liver disease, warfarin OD)
c. Identify an indication for using cryoprecipitated plasma.
Control bleeding due to hypofibrinaemia (congenital, acquired DIC)
d. What can be some adverse consequences for an individual receiving blood products
- Infection (eg: Staphylococcus)*
- Transfusion Associated Acute Lung Injury (TRALI)*
- ABO incompatibility*
a. Identify at least three risk factors predisposing to thrombosis.
Stasis/alterations in venous flow (long flight, bed rest, obesity, polycythaemia, severe dehydration)
Hypercoaguable state (pregnancy)
Family hx/genetics (Factor V Leiden deficiency)
OCP platelets or coagulation factors increased
Release of pro-coagulant material into circulation (malignancy metastatic adenocarcinoma, crush injury)
Previous DVT
b. List at least two preventative methods which may be employed for individuals at an abnormally high risk of thrombosis (ie: secondary prevention).
Wearing compression stockings
Early post-op mobilization
Anti-platelet agents
Heparin
a. There are many conditions associated with causing or worsening heart failure. List at least three of these conditions.
- Increasing age*
- Hypertension esp. China and Hong Kong*
- Diabetes*
- Obesity*
- Cardiomyopathy*
- Valvular disease (eg: Rheumatic HD) esp. Sub-Saharan Africa*
- Obstructive Sleep Apnoea*
b. Identify two modifiable behaviours which contribute to the development of heart failure.
- Smoking*
- Physical inactivity*
- Poor diet*
c. Society has responded to the problem of cardiac failure through the introduction of a number of health promotions. Identify at least two risk factors which have been targeted.
- Measure up obesity*
- Go for 2 and 5 diet*
- Target alcohol consumption*
- National tobacco campaign*
a. Identify at least two patient factors which should be considered when deciding on the choice of valve.
- Age length of valve life required (metal tissue)*
- Patient preference and lifestyle (reoperation may be required if tissue; consider remote residence)*
- Able to be anti-coagulated (not required for tissue replacement)*
- Availability of prosthesis (homograft from cadaver rare)*
- Valve anatomy*
- Coexistent disease*
b. What two broad choices of a valve type may be offered to patients
- Mechanical*
- Bioprostheses (Xenograft, Homograft, Autograft)*
a. List at least three risk factors which may contribute to the higher incidence of Rheumatic heart disease.
- Poor access to public dental and medical care*
- Psychosocial stressors family or friend death, serious injury*
- Higher incidence of dental caries*
- Low education, low income*
- High BP, High cholesterol*
b. It has been demonstrated that it is not only the delivery of health care which impacts upon the health of a population. List at least three social determinants of health.
- Employment status*
- Education level attained*
- Transport available*
- Food available (fresh vs fast food)*
- Accommodation available*
- Social support*
- Stress*
- Early life conditions*
a. Identify at least two factors which need to be considered when counseling families regarding their decision to have screening for Down Syndrome.
- The specificity and sensitivity of the test*
- The risks and negative consequences associated with the tests*
- The proposed action following the receipt of a positive result ( availability of treatment, ethical dilemmas)*
- The consequences for other family members (ie: genetics wise)*
a. List two conditions which an individual is at a higher risk of suffering from if they have hypertension.
- Stroke*
- Myocardial infarct*
- Peripheral vascular disease*
- Heart failure*
b. Identify two factors which are thought to cause hypertension.
- Family hx*
- High salt intake*
- High cholesterol*
- Obesity and physical inactivity*
- Diet low in fruit and vegetable and high saturated fat*
c. What are three primary prevention strategies for hypertension
- Maintaining healthy weight*
- Reducing dietary salt intake*
- Undertaking regular exercise*
d. Identify one secondary prevention strategy for hypertension.
Screening (and then early treatment)
