PopMed MUST MEMORIZE FACTS Flashcards
1
Q
a. Provide a formula that can quantitate the burden of disease in a population.
A
- 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*
1
Q
b. List three health conditions which are most responsible for the YLL in developed countries
A
- Cardiovascular disease*
- Cancer*
- Injury*
- Chronic respiratory conditions*
2
Q
c. List three conditions or situations which contribute most significantly to the DALYs in developing countries (ie: associated with a high attributable fraction)
A
- Malnutrition*
- Unsafe sex*
- Poor water sanitation*
- Poor hygiene*
3
Q
d. Provide a definition for prevalence
A
The number of cases within a population at a particular time
4
Q
e. Provide a definition for incidence
A
The number of new cases per set time period (often per year)
5
Q
a. List four broad categories of causes of health inequality.
A
- Risk factors*
- Environmental*
- Biological*
- Behavioural*
6
Q
b. Identify a primary prevention strategy which may be employed to reduce health inequity
A
Reduce social inequality
7
Q
c. Identify a secondary prevention strategy which may be employed to reduce health inequity.
A
Target disease prevention to the disadvantaged population
8
Q
d. Identify a tertiary prevention strategy which may be employed to reduce health inequity
A
Target health care services for disadvantaged sick people
9
Q
a. Which level of government provides the greatest level of funding for healthcare
A
- Federal (46%)*
- Private (32%)*
- States (22%)*
10
Q
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)
A
- Immunisation*
- Education of the population regarding hygiene, etc*
- Needle and syringe exchange programs*
- Surveillance and contact tracing*
- Infection control*
11
Q
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.
A
- Notifiable disease database*
- Lab specimens*
- Deaths records*
- Patient data collections*
- Sentinels*
- Surveys*
12
Q
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.
A
Strength of association (size of odds ratio)
Dose response
Timing (exposure
Consistency of results with other studies
Plausible
13
Q
a. What is an appropriate tertiary management strategy for tuberculosis
A
DOTS Directly Observed Therapy Shortcourse (sputum microscopy, guaranteed supply of drugs, directly observed therapy to ensure compliance)
14
Q
b. List at least three effects TB may have on society.
A
- 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*
15
Q
c. How does society respond to TB in terms of attempting to minimize its impact on society List at least two responses.
A
- 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*
16
Q
d. List at least three factors which may limit a migrants access to quality health care
A
- 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)*
17
Q
a. Identify three risk factors which may contribute to the higher incidence of low birth weight babies in the ATSI population
A
- Drug and alcohol use during pregnancy*
- Poor maternal nutrition*
- Poor antenatal care/support* ½ Effect duration of pregnancy
- SES disadvantage*
- Illness during pregnancy*
18
Q
b. What is the most common reason for hospitalization in the ATSI population
A
Dialysis
19
Q
a. What are the three most common anatomical sites fractured in the elderly population
A
- Wrist*
- Vertebrae*
- Hip*
20
Q
b. List at least three strategies which may be employed as a primary preventative method for hip fractures.
A
- VitD monitoring and supplements*
- Ca monitoring and supplements*
- Regular weight bearing exercise*
- Provision of hip protectors*
- Reduction in obesity*
21
Q
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.)
A
- 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*
22
Q
a. Identify one strategy which has been shown through a RCT to reduce the number of fractures resulting from children falling from play equipment.
A
- Increased depth of bark*
- NB: Engineer visits and support to implement playground safety guidelines reduces observable playground hazards*
23
Q
a. What are three factors which may contribute to the abnormal stress or abnormal cartilage leading to the development of osteoarthritis
A
- Stress: Trauma, Dysplasia, Obesity, Malalignment, Muscle weakness, loss of proprioception*
- Cartilage: Ageing, inflammation, metabolic changes, endocrine factors*
24
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*
25
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*
26
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*
27
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*
28
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%*
29
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*
30
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*
31
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*
32
b. List the three most common causes of viral acute respiratory tract infections.
* Respiratory syncytial virus*
* Influenza*
* Parainfluenza*
* Adenoviruses*
33
c. Identify two important bacterial causes of acute respiratory infections.
* Streptococcus pneumonia*
* Haemophilus influenzae*
34
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)*
35
b. Identify an indication for using fresh frozen plasma.
*Control bleeding due to coagulation factor deficiency (liver disease, warfarin OD)*
36
c. Identify an indication for using cryoprecipitated plasma.
*Control bleeding due to hypofibrinaemia (congenital, acquired DIC)*
37
d. What can be some adverse consequences for an individual receiving blood products
* Infection (eg: Staphylococcus)*
* Transfusion Associated Acute Lung Injury (TRALI)*
* ABO incompatibility*
38
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
39
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
40
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*
41
b. Identify two modifiable behaviours which contribute to the development of heart failure.
* Smoking*
* Physical inactivity*
* Poor diet*
42
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*
43
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*
44
b. What two broad choices of a valve type may be offered to patients
* Mechanical*
* Bioprostheses (Xenograft, Homograft, Autograft)*
45
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*
46
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*
47
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)*
48
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*
49
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*
50
c. What are three primary prevention strategies for hypertension
* Maintaining healthy weight*
* Reducing dietary salt intake*
* Undertaking regular exercise*
51
d. Identify one secondary prevention strategy for hypertension.
*Screening (and then early treatment)*
52
a. List at least three causes for a non-traumatic spinal cord injury.
* spinal stenosis*
* disc herniation*
* rheumatoid arthritis*
* vascular*
* inflammatory (infection or non-infectious (MS, transverse myelitis))*
* Tumour*
53
b. With regards to traumatic spinal cord injuries, the mechanism of injury can predict the resultant injury. What type of movement would you expect to have caused a unilateral dislocation
*flexion with rotation injury*
54
c. List two consequences of a spinal cord injury on an indivudual
* Loss of bowel and bladder function*
* Loss of movement*
* Loss of sensation*
* Fertility and sexuality effected*
* Psychosocial impact*
* Inadequate respiratory function*
* Suffer from autonomic dysreflexia*
55
d. Autonomic dysreflexia may be one complication suffered by a patient with a spinal cord injury. List three potential triggers for this condition.
* Full bladder*
* Full rectum*
* Unnoticed wound infected below level of lesion (eg: pressure sore, fracture, in-grown toe-nail, burn)*
* Bladder infection*
* Epididymo-orchitis*
* Intra-abdominal cuase*
56
e. 50 80% of patients with a SCI will develop a pressure ulcer. Identify at least three risk factors for skin breakdown.
* Loss of sensation on pressure region (level of lesion)*
* Lack of carer support to move patient*
* Co-morbidities: moisture from bladder or bowel incontinence; infectious*
* Postural deformities*
* Poor equipment* *½ unrelieved pressure*
* Psychosocial distress (depression, poorly managed frustration)*
* Cognitive impairment (eg: coexistent TBI)*
* Smoking*
* Alteration to vascular supply*
* Aging*
* Scar tissue or altered tissue viability*
57
f. What causes of death are most significantly increased in the SCI population
* Septicaemia (172.3 x)*
* Pneumonia and influenza (32.5 x)*
* Diseases of the urinary system (22.8 x)*
58
g. Identify two secondary prevention strategies for SCI.
* Careful retrieval from traumatic situation*
* Early decompression*
59
h. Identify two tertiary prevention strategies for SCI.
* Rehabilitation programs*
* Self education and management*
* Catheterisation*
* Equipment provision (eg: wheelchairs)*
* Accommodation and housing accommodation*
* Support organizations (eg: ParaQuad)*
60
a. The outcome for individuals who suffer from stroke may be described by the rule of thirds. What are these three outcomes for stroke sufferers
* die*
* recover*
* persistent disability*
61
b. The pneumonic FAST has been used as an educational tool to allow the general population to readily recognise a stroke. What does FAST stand for
* Facial asymmetry*
* Arm weakness*
* Speech disturbance*
* Time to act fast!*
62
c. Evidence suggests that a multidisciplinary team in a discrete stroke ward provides the best outcome for patients who have suffered a stroke. What kind of management strategies may this team employ
* Early mobilization/physiotherapy*
* Monitoring nutrition; assisted feeding; screen for swallowing difficulties*
* Monitoring and maintaining BP, BSL*
* Assessing for psychological distress*
* Maintain hydration*
63
d. What pharmacological methods may be used as secondary prevention of a stroke
* Anticoagulants*
* Statins*
* Anti-hypertensives*
64
a. Identify at least three risk factors for Multiple sclerosis.
* Female*
* Scandinavian or Finnish descent*
* Latitudinal location (closer to the poles)*
* Low sun exposure during childhood*
* Family hx/genetics (presence of HLA-DRB1\*1501)*
65
a. Identify two risk factors for Alzheimers disease.
* Increasing age*
* Family hx of dementia or AD*
* Causative genetics: amyloid protein precursor (APP), presenillin-1 (PS-1), presenillin-2 (PS-2)*
* Promote early onset genetics: APOE4 allele*
* Trisomy 21 (Downs Syndrome)*
* Low level of education*
66
b. What impact does Alzheimers disease have on people, other than the patient themselves
* Carer burden*
* High emotional stress*
* Loss of work hours*
* Significant amount of time dedicated to patient, thus restricting social activities and opportunity for exercise*
* Physically demanding activities required (eg: bathing, feeding)*
67
c. The Living with Memory Loss program supports recently diagnosed patients and their carers. What objectives does this program have
* Decreased isolation and depression*
* Highlight need for future planning*
* Make aware of support groups available*
* Assist education of carers with coping strategies*
* Help understand dementia*
68
a. Identify a prevention strategy suitable for a population approach to reducing lung cancer.
* Ban tobacco advertising*
* ie: everyone in population effected by intervention, regardless of level of risk*
69
b. Identify a prevention strategy suitable for an individual approach to reducing lung cancer.
* Clinicians target anti-smoking messages to known smokers*
* ie: screen and then target intervention to those at high risk*
70
a. Identify three factors which may increase a communitys perception of a situation to be risky.
* event is sudden/acute, rather than chronic*
* exposure to risk factor is coerced, rather than voluntary*
* agent is industrial, rather than natural*
* agent is exotic, rather than familiar*
* true hazard unknown*
* unfair exposure*
* sources untrustworthy*
* process unresponsive*
71
b. Despite the commonly held belief that patients with psychiatric illness are prone to violence, ~15% of all homicides committed in Australia are carried out by subjects suffering from mental illness. Saying that however, at any point in time 10 15% of the population is suffering from a mental illness. Identify three symptomatic predictors for a significant risk of violent behaviour.
* Past hx of violence*
* Persecutory delusions*
* Agitation and anxiety about their own safety*
* Command hallucinations*
72
a. What type of service sees the majority of serious mental disorders (including schizophrenia, bipolar disorder, and some affective/anxiety/substance abuse disorders)
*Public mental health services*
73
b. What type of service sees the majority of any mental disorder (ie: of any severity)
*General practitioners*
74
c. Identify two mental health disorders which may be considered having a high prevalence with a lower individual risk or behavioural disturbance to society.
* Depression*
* anxiety*
* Substance abuse disorder*
* Personality disorder*
75
d. What is an approximate prevalence of any mental health disorder in Australia
*1 in 5 people½*
76
e. Mental disorders only accounted for 8% of the total health system costs in 2000/1 despite depression and dementia being the top ranked conditions contributing to YLDs. Identify two possible reasons for spending so little on mental health.
* Stigma* *½ discrimination*
* Ignorance of disorders and effective treatments*
* Diversity of mental health disorders too difficult to implement a system to treat*
* Providers and infrastructure lacking*
77
a. List three causal risk factors for uterine/endometrial cancer.
* Late menopause*
* Nulliparity*
* Prolonged unopposed oestrogen exposure*
* Obesity*
* Polycystic ovarian disease*
* Other cancer*
* Familial cancer syndromes*
78
b. List two casual risk factors for uterine/endometrial cancer.
* Hypertension*
* Diabetes mellitus*
79
c. List three factors associated with a decreased risk of uterine cancer
* OCP*
* Alcohol*
* Progestogens*
80
a. List three factors which may contribute to a patients non-compliance with their diabetes management.
* lack of understanding of management requirements*
* lack of appreciation of the seriousness of the condition*
* funding not available to financially support management*
* emotionally draining*
* not prioritizing management to fit in with everyday life*
* unwilling to accept Dx of diabetes*
81
a. What non-pharmacological strategies could you employ to further reduce her BSL
* Regular exercise*
* Diet low in GI*
* Weight loss*
82
b. What should you investigate (through hx, examination or investigations) to assess her risks for diabetic complications
* Cardiac: CV exam, LDL, HDL, TG, waist:hip ratio, BMI, smoking hx, level of exercise, family hx of CVD, BP*
* Nephropathy: GFR, urine dipstick, creatinine, urine albumin*
* Neuropathy: neuro exam, foot exam, ulcers, pain on walking*
* Retinopathy: fundoscopy, blurred vision*
* Diabetes control: HbA1c, BSL readings, polyuria, thirst, hypo events*
83
a. What factors may cause a couples chance of falling pregnant to fall
* Increasing maternal age* *½ poorer quality of eggs*
* Endometriosis*
* Abnormal uterine architecture*
* Blocked uterine tubes*
* PCOS*
* Low sperm count*
* Poor quality sperm (motility, morphology, etc)*
* STI*
* Smoking, high BMI*
84
b. Identify some management options for a couple suffering from infertility.
* IVF*
* ICSI*
* Use of donated sperm/eggs*
* Adoption*
85
c. What sort of outcomes would departments and/or committees be interested in collecting to establish evidence for the success and safety of infertility treatments
* Number of live births*
* Rate of congenital malformations in IVF conceived babies*
* Number of multiple pregnancies*
* Health risks associated with IVF for the mother*
86
d. One cause of infertility is if the woman suffers from anovulation. What may be the cause of her anovulation
* PCOS*
* Primary ovarian failure Turners syndrome*
* Hyperprolactinaemia*
* Hypothalamic disturbances (anxiety, stress, anorexia)*
87
e. What may be the cause of a woman having tubal disease
* PID*
* Development of adhesions following a previous surgery*
* Hydrosalpinx (blind ended uterine tube)*
* Congenital abnormalities*
88
a. Identify three strategies which may be employed to prevent weight gain.
* Reduce portion sizes*
* Reduce intake of high energy dense food*
* Reduce level of food prepared outside the home*
* Regular physical activity*
* Reduce time spent doing sedentary behaviours*
* Increase incidental activity*
* Increase participation in active recreation*
* Increase use of active transport*
89
b. List some strategies which may be considered to prevent obesity at a population level.
* Make outside environment inviting (eg: grassy areas for exercise)*
* Make health foods (eg: fruit, veggies) cheaper*
* Design*
* Reduce advertising for junk foods*
* Reduce portion sizes across the food industry*
90
a. List two screening tests currently available in Australia.
* PSA + DRE* *½ prostate cancer*
* Pap smears* *½ cervical cancer*
* Mammograms* *½ breast cancer*
* FOB test* *½ colorectal cancer*
91
a. What are the two most likely outcomes for a patient with CKD.
* Premature death due to CVD*
* Progressive kidney disease requiring dialysis or transplantation*
92
b. Identify at least two problems associated with a kidney transplant.
* Major operation* *½ increased stress + risks*
* Lifelong immunosuppression required* *½ decreased immune surveillance*
* Regular clinic visits required*
93
c. Which mode of treatment is cheaper: Hospital haemodialysis or kidney transplant
* Kidney transplant ($80 000 + $10 000/yr) vs Hospital HD ($100 000)*
* NB: Home HD ~$55 000*
94
a. Identify at least two potentially treatable or preventable causes of CRF.
* Diabetic renal disease*
* Hypertensive diseases*
* Rapidly progressive glomerulonephritis*
* Drug-related interstitial nephritis*
* Drug toxicity (cyclosporine, penicillamine)*
* Obstructive uropathy*
* Early onset chronic infection (ATSI population)*
* Early onset vascular disease (ATSI)*
95
b. Identify strategies available to prevent the development of renal failure.
* Detection and control of diabetes*
* Detection and control of hypertension*
* Early detection of clinical RPGN*
* ACEI and ARGs* *½ reno-protective effects beyond BP control*
* Education + change in lifestyle (ATSI)*
* Urinary screening for infection or protein (ATSI)*
96
a. Identify at least three determinants of poor child health.
* Malnutrition*
* Low birth weight*
* Prematurity*
* Chronic illness*
* Unsupported parent* *½ Maternal exhaustion*
* Low income of family*
* Smoking in family*
* Discrimination*
* Social unrest and war*
97
b. Which population groups are the largest contributors to the prevalence of poverty in Australia
* Lone people*
* Couples with children*
* ATSI population (40% of ATSI in lowest income bracket)*
98
c. List at least two strategies which may be employed to protect children from poor health.
* Full term pregnancy*
* No prolonged separation from family*
* Supported family*
* Adequate spacing of children*
* Adequate income*
* Employment*
* Good education*
* Government benefits*
99
d. List two features which are unavailable to a person who is living in relative poverty (rather than absolute poverty).
* Water sanitation*
* Public transport*
* Recreation facilities*
* (rather than food, clothing, shelter)*
100
a. List at least three factors which may contribute to poor compliance in the elderly population
* Poor memory*
* Multiple medications*
* Poor instruction provided*
* Arthritis and child-proof containers*
* Fear of toxicity; distrust*
* Unpleasant side effects*
101
b. Identify two strategies which may be used to improve compliance.
* Webster packs*
* Prescribe least number of medications possible*
* Involve another person in care*
* Simple dosing*
* Clearer medication card*
* Monitoring self medication*
102
c. Beers criteria lists medications that are deemed inappropriate in the elderly. Identify at least two of these listed medications.
* Benzodiazepines*
* NSAIDs*
* TCAs*
* Digoxin*
* Antihistamines*
* Anticholinergics*
* Serotonin*
103
d. Identify why the elderly may be prone to drug problems
* Polypharmacy* *½ drug interactions*
* Age alters pharmacokinetics and pharmacodynamics*
* Being unwell*
* Impaired homeostasis*
104
a. What is the predominant mode of transmission of HepB in developed countries
*IVDU and sexual transmission*
105
b. What is the predominant mode of transmission of HepB in developing countries
*Vertical transmission*
106
c. What prevention strategies does society employ for Hepatitis B
* Vaccination*
* Screening blood donations*
* Universal infection control precautions (eg: for HCWs)*
107
a. List some causes of food-borne diseases in Australia.
* Salmonella*
* Campylobacter*
* Shigella*
* Norovirus*
* Rotavirus*
* Enteroviruses*
* Giardia*
* Cryptosporidium*
* Prions*
108
b. Identify two causes of food to be ingested carrying infectious agents.
* Poor storage*
* Being undercooked*
* Contaminated equipment*
* Poor hygiene*
109
a. List three foods which definitely or probably protect against some cancers.
* Non-starchy vegetables* *½ mouth, pharynx, larynx, oesophagus, stomach*
* Fruits* *½ mouth, pharynx, larynx, oesophagus, lung, stomach*
* Dietary fibre* *½ colorectal cancer*
110
b. List foods which have been identified to cause some cancers.
* Alcohol* *½ mouth, pharynx, larynx, oesophagus, colon, rectum, breast*
* Salt and salty foods* *½ stomach cancer*
* Red meat and processed meats* *½ colon, rectum*
* Aflatoxin* *½ liver*
111
c. Identify what society could do to encourage people to consider their diet as a way to protect their health.
* Education campaigns*
* Food supply policy*
* Price adjustment*
112
a. What type of justice principle is employed if the action aims to provide the best situation for the greatest number of people
*Utalitarianism*
113
b. What type of justice principle is employed if the action aims to focus on the benefit for the individual.
*Libertarianism*
114
c. Identify one strategy which would be of a high priority to employ if the rationing of health care was driven by a utalitarinism type principle.
*Focus on cancer, CVD and respiratory disease as these contribute most significantly to YLL*
115
a. How has the incidence and mortality of lung cancer changed in Australia in the last 25 years for men
*Falling (by 15%)*
116
b. How has the incidence and mortality of lung cancer changed in Australia in the last 25 years for women
*Increasing (by 88%)*
117
a. List three occupational agents classed by the International Agency for Research on Cancer as category 1 lung carcinogens (ie: sufficient evidence in humans)
* Arsenic*
* Chromium and compounds*
* Crystalline silica*
* Mustard gas*
* Nickel and compounds*
* Soots containing polycyclic aromatic hydrocarbons*
* Tobacco smoke*
* Vinylidene chloride*
118
b. Identify at least two industries classified as Category 1 carcinogenic exposures.
* Aluminium production*
* Coal gasification*
* Coke production*
* Iron and steel founding*
119
c. What primary preventative measures could be employed against occupationally induced lung cancer.
* Control exposure at source*
* Use of respiratory protective equipment*
* Bans on carcinogen use*
* Use of alternative materials*
* Giving up smoking*
* Screening in high risk groups*
120
a. What are the six major components of the national screening program
* Improve communication and education for women and health professionals*
* Establish infrastructure for systematic approach to screening*
* Facilitate regular participation of women in screening programmes*
* Improve quality control in smear taking and lab processing*
* Institute fail safe approach for follow up and management*
* Monitor and evaluate the organised approach*
121
a. List at least two risk factors for breast cancer.
* Female sex*
* Increasing age*
* Family hx*
* Parity*
122
b. A 25 year old woman is concerned about her risk for breast cancer due to a strong family history. What management options are available for her
* Breast surveillance MRI, mammogram, ultrasound + clinical examination*
* Genetic screen from living, affected family member and then testing for presence of gene, if found, in concerned patient*
* Prophylactic mastectomy (reduce risk by ~95%)*
* Ovarian surveillance NB: should not rely on CA-125*
* Prophylactic bilateral salpingo-oophorectomy*
123
c. What gene is associated with FAP (Familial adenoma polyposis)
*APC*
124
d. List some potential benefits for those found to carry a mutation which increases their risk of cancer.
* Uncertainty about whether or not they are at risk is removed*
* More accurate estimate of risk can be made*
* Informed of chances of children carrying mutation* *½ assist family planning*
* Advised on surveillance and preventative measures*
125
a. Identify conditions which favour the rapid spread of HIV
* Receptive anal sex*
* Multiple partners*
* Unprotected penetrative sexual intercourse*
* Presence of ulcerative disease*
* Acute infection* *½ high HIV viral load*
* Sex in homosexual population (due to high prevalence)*
126
b. What factors may help reduce the spread of HIV
* Prevent unprotected sexual behaviour*
* Reduce HIV viral load* *½ treat HIV*
* Post exposure prophylaxis*
* Knowledge of HIV status* *½ reduces risky behaviour*
* Perception of risk to self and others (ie: education of travellers)*
* Access to condoms*
* Self esteem* *½ power to negotiate safe sex*
* Avoid sex, drugs and alcohol combination*
* Avoid needle sharing* *½ needle syringe exchange program*
127
a. List four AIDS defining events.
* Opportunistic infections: Pneumocystis carinii, reactivation of toxoplasmosis*
* Specific malignancies: Non Hodgkins lymphoma, Kaposis sarcoma*
* Severe neurological disease: AIDS dementia*
* Metabolic derangement: Wasting syndrome with profound weight loss*
128
b. What is one opportunistic infection which only requires a relatively slight immundepletion to occur
*TB*
129
c. What is one opportunistic infection which requires a more significant immundepletion to occur
*CMV*
