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Tropical Medicine > Public health/Disaster/Immigrant > Flashcards

Public health/Disaster/Immigrant Flashcards

1
Q

% death under age 5 YO due to perinatal

A

40%

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2
Q

3 causes of eosinophilic meningitis

A

Angiostrongylus cantonensis

Gnathostoma spinigergum

T. solium (neurocysticercosis)

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3
Q

Ackee fruit

A

in West Africa and Carribean, unripenned fruit leads to hypogycemia

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4
Q

acute diarrhea leading to bacteremia

A

shig, salmonella, campy

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5
Q

Adoptee growth failure- 2 types

A

< 18 mo- nutritional, rickets > 18 mo- stunting, delayed puberty

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6
Q

Aeromonas assoc with

A

reptile and leeches

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7
Q

annual deaths related to cook stove exposure

A

4 million

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8
Q

as poverty improves, birth rates go ?

A

down

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9
Q

asylum seekers- torture, PTSD

A

torture 45% PTSD 65%

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10
Q

B1- name, deficiency, source

A

thiamine Wernicke (encephalopathy), beriberi (neuropathy, hiigh output failure) infantile beriberi in SE Asia due to BF on restricted diet of milled grains unprocessed grains

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11
Q

B12- name, deficiency, source

A

cyanocobalamine cheliosis, glossitis, anemia, cord degeneration meat and dairy

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12
Q

B2- name, deficiency, source

A

riboflavin cheliosis, magenta tongue, seb derm, poor Fe absorption all foods

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13
Q

B3- name, deficiency, source

A

niacin pellagra- 3D- (photo)dermatitis, diarrhea, dementia hyperpigmentation meat, fruit, veg assoc with maize diet (low tryptophan niacin precurser)

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14
Q

B6- name, deficiency, source

A

pyridoxine neuropathy (esp INH, cycloserine, PZA) meat, fruit, veg

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15
Q

Bantu siderosis

A

South Africa beer brewed in iron pots

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16
Q

BCG reduces pediatric CNS TB by

A

80%

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17
Q

BCG side effect

A

risk of LAD, avoid vaccine in same arm for 3 months

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18
Q

Betel nut

A

chewed by 15% of world stimulant assoc with head and neck CA

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19
Q

Burn fluid replacement (Parkland)

A

LR 4 mL/kg/%burn- ½ over 8 h then rest over 16 h

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20
Q

Cancers by region

A

SE Asia: Lung >breast >liver East Africa: Kaposi’s sarcoma >cervix >lung US: Breast >prostate >lung

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21
Q

Capnocytophaga

A

gram neg rod assoc with dog/cat bites

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22
Q

causes of genital ulcer (5)

A

HSV, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale

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23
Q

CDC Quaratine substations

A

20 across US isolate sick, quarantine exposed

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24
Q

cervical cancer deaths

A

275K/yr- 85% in developing

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25
Q

Chest tube level depending upon purpose

A

T2-3 for pneumothorax T 5-7 for effusion

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26
Q

Chronic diarrhea (> 14 d) causes- bacteria (5), protozoa (5), worms (1), viral (5)

A

Bacteria: EAEC, EPEC, Shigella, Yersinia, Campylobacter

Protozoa: Crypotosporidium, Cyclospora, Isospora, Microsporidium, E.histolytica

Worms: Strongyloides

Viral: adeno, noro, CMV, roto, HIV

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27
Q

Class A immigrant restrictions

A

active TB Untreated syphilis, chancroid, GC, granuloma inguinale, lymphogranuloma venerum Untreated Hansen’s dz Drug/mental with harmful behavior

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28
Q

common definition of migrant and temporary worker

A

change of country for > 12 mo temporary worker is migrant who traveled > 24 h

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29
Q

Congenital syphilis Sx

A

rhinits, rash, HSM, LAD, bones, CNS, deaf, keratitis, anemia, low PLT frontal bossing, saddle nose, peg teeth

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30
Q

Contraindications to lumbar puncture (3)

A

Papilledema Focal neuro signs Too unstable to position

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31
Q

COPD highest in? related to?

A

India and Asia Biofuels (poverty more associated with COPD than smoking)

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32
Q

CPR ratio- infants, children

A

3:1, 15:2

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33
Q

Deaths under 5 in 2014; % neonatal

A

> 6 million 44%

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34
Q

deep sedation- ketamine- age, SE, NPO

A

down to 3 mos may have nystagmus or jerking NPO- 8 h solid, 6 h formula, 4 h breast, 3 h clear

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35
Q

dehydration causes what % deaths < 5 YO

A

15%

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36
Q

Dhaka solution compared to Ringers

A

more K, bicarb, chloride. Also has glucose

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37
Q

Diarrhea related to GBS

A

campy

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38
Q

Diarrhea related to HUS

A

shig, EHEC

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39
Q

Diarrhea related to reactive arthritis

A

campy, salmonella, shigella

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40
Q

Eclampsia management

A

BB- labetalol Vasodilator- hydralazine, methyldopa Magnesium sulfate- IV or IM

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41
Q

Eikinella

A

gram neg rod infecting 15% of human bites

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42
Q

exceptions from overseas immunization requirement

A

adoptees < 10 YO, refugees; otherwise imigrants get exam and immunization before entry

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43
Q

Excess fluoride

A

Fluorosis if high in drinking water (Rift Valley, Punjab); teeth color, rigid joints

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44
Q

Famine defined (3)

A

acute malnutrition > 30 % death rate > 2/d per 10,000 Death > 2 adults or 4 children per day per 10,000

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45
Q

Female circumcision types

A

1- clitoral hood +/- clitoris 2- clitoris +/- labia minora 3- infibulation- remove most with partial closing 4- unclassified/other

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46
Q

folate- deficiency, source

A

tube defects, IUGR, anemia fruits and veg

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47
Q

food requirements (cal)

A

2100 kcal/person/d

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48
Q

Genital warts- common cause, prevalence, Tx

A

HPV 6 and 11 (most) almost 50% sexually active are positive (most subclinical)

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49
Q

halothane

A

CHF, malignant hyperthermia

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50
Q

HBV serotypes and special

A

A B- more resistant to lamivodine C- more HCC, more resistant to interferon

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51
Q

HBV- #infected, #deaths/yr

A

2 billion > 500K due to cirrhosis and HCC

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52
Q

HBV- causes what percent HCC, relation to cirrhosis

A

80% HCC (30% without cirrhosis)

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53
Q

HBV- main mode of transmission

A

perinatal

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54
Q

Health effects of immigrating to US

A

more DM and CVD with poorer outcome less CA deaths (less gastric in Japanese BUT more breast in Asians)

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55
Q

Hindmilk

A

higher in calories and fat

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56
Q

how many immigrants in world

A

> 200 million (3% of world) live outside country of origin

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57
Q

how many lack clean water? basic sanitation

A

1 billion 2.5 billion

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58
Q

how much does hand washing reduce diarrhea by

A

45%

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59
Q

How often does oral rehydration work

A

96%

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60
Q

HPV- high risk strains, vaccine coverage

A

high- 16, 18, 31, 33 Gardasil- 6, 11, 16, 18 Cerbarix- 16, 18

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61
Q

IASC- emergecy categories

A

InterAgency Standing Committee #3 is highest

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62
Q

IGRA/Quantiferon- how, specificty

A

mix serum with antigen and test interferon release Not cross react with BCG, but does other myobacteria

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63
Q

Immigrant cancer screening improves with (3)

A

Duration of residence Hx of previous cancer screenings More primary care visits ER vists use of interpreter

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64
Q

Important vitamins to give with diarrhea

A

zinc, vit A, folate

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65
Q

Incidence

A

new cases over time

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66
Q

Indian childhood cirrhosis

A

1-3 YO high mortality ? due copper intake

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67
Q

infectious agent related to adult T-cell leukemia

A

HTLV-1

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68
Q

infectious agent related to cervical CA

A

HPV

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69
Q

infectious agent related to gastric CA/MALT

A

H. pylori

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70
Q

infectious agent related to HCC

A

Hep B 80% > C

71
Q

infectious agent related to Kaposi’s sarcoma

72
Q

infectious agent related to MALT lymphoma conunctiva

A

Chlamydia trachomatis

73
Q

infectious agent related to nasopharyngeal CA

74
Q

infectious agent related to NHL

75
Q

infectious agent related to SCC of bladder

A

Schistosomiasis hematobium

76
Q

infectious agents related to cholangiocarcinoma

A

clonorchis, opistorchis

77
Q

infectious endocarditis

A

50% on normal valves

78
Q

International accelerated vaccine schedule

A

B- BCG, OPV

6, 10 and 14 wks- DTP, OPV, Hib, Prev, Roto

9 mo- MMR, YF

79
Q

Interosseous sites

A

anteromedial prox tibia, 80 degrees aawy from joint peds: medial malleolus, distal femur, humerus, iliac crest, sternum adult: sternum and distal malleolus

80
Q

Iodine deficiency

A

Cretinism, goiter, hypothyroid; Low levels in soil (Nepal, Bolivia, Bangledesh); single dose good for 1-2 years

81
Q

iodine- highest need, deficiency Sx

A

infant, teen, pregnant/lactating decreased IQ, cretinism, goiter

82
Q

iron deficiency- numbers deficiency and anemia; other vitamins involved

A

4.5 billion iron deficient, 2 billion anemic worldwide 50% kids in sub-Saharan Africa anemic vit C, vit A and riboflavin

83
Q

iron replacement can increase risk of (4)

A

malaria, TB, yersinia and brucellosis delay supplementation in early malnutrition Tx to reduce sepsis risk

84
Q

IV rates

A

Standard set- 20 drops/cc Blood giving- 15 drops/cc (cc/h divided by 4 = drop/min) Microdrip- 60 drops/cc (cc/h = drop/min)

85
Q

Konzo

A

cyanide in improperly prepared cassava -> tropical myelopathy (spastic paraparesis)

86
Q

Kwashiorkor

A

Edema with low protein diet Hair changes, dermatitis Apathetic, lethargic, poor appetite

87
Q

Latent TB outcome, numbers

A

5% active within 2 yrs, 5% later 2 billion in world

88
Q

latrine requirements during disaster

A

Latrine 1/100 emergency; 1/20 after

89
Q

Leptin

A

Hormone related to energy production Deficiency leads to cardiac dysfunction and T-cell modulation problem

90
Q

Malaria and pregnancy

91
Q

male circumcision reduces HIV transmission to men by

92
Q

Marasmus

A

Body wasting may be distended abd (weak muscles, bacterial overgrowth irritable, hungry

93
Q

Mass drug Tx in pregnant, NO (3), OK (4)

A

ALB, MED, IVM

PZQ, DEC, pyrantel, nitazoxaminde

94
Q

Maternal death- numbers, causes

A

> 500,000 (1/16 in Africa) Bleeding 25%, Infection 15%, Unsafe abortion 13%, Eclampsia 12%, Obstructed labor 8%

95
Q

Medical resettlement

A

Medical need- life threatening or irreversible loss of function Adequate Tx not available in country of asylum NOT include: terminal, stable disabilities, HIV, treatable chronic illness

96
Q

Medications with G6PD def issues

A

Primaquine, Dapsone, sulfa, Nitrofurantoin, Naldixic acid

97
Q

methanol intox

A

anion gap metabolic acidosis

98
Q

Migrant qualities

A

more male younger (Except Europe) less educated (Except Europe, Asia, Africa) poorer (Except Europe, Asia)

99
Q

moderate sedation

A

benzo + narcotic

100
Q

Mollarett

A

recurrent HSV meningitis

101
Q

Most common cause of immunodeficiency in the world

A

malnutrition

102
Q

most common cause to pericardial effusion in Africa and Asia

103
Q

most common types torture

A

envirnmental, beating (esp feet- falanga), suspension, women rape

104
Q

MUAC

A

mid upper arm circumference for 6 mo to 5 yrs > 125 mm nl, < 115 mm SAM

105
Q

MVA deaths

A

1.2 million/yr; more in lower income despite fewer vehicles

106
Q

negative predictive value

A

true neg/total neg

107
Q

neonatal jaundice and ceftriaxone

A

Avoid as may displace bilirubin from albumin, increasing bili.

108
Q

Neonatal jaundice- impact, signs Tx

A

9% of neonatal deaths in Africa Leading cause of deafness and cerebral palsy Encephalopathy-blank facies and sunset eyes Arched neck. Scissoring arms and feet Tx: phototherapy, exchange transfusion

109
Q

Neonatal resuscitation

A

1 min- clear airway and stim Bag mask: 40-60/min; 1,2,3,breathe 30 sec, HR< 100, resume

110
Q

Neonatal STD conjunctivitis (2) agent, incubation, Tx

A

GC 2-5 d, IM ceftriaxone chlamydia 5-12 d, PO erythro or bactrim

111
Q

Noma

A

oral/skin destruction related to malnutrition and infection

112
Q

NTD- world (STH-1, LOST), US (5T)

A

STH (ascaris, whip, hook- not strongy), LF, oncho, schisto, trachoma

toxocaria, toxoplas, trich, T. cruzi, T. solium

113
Q

number adopted in past 15 yrs

114
Q

Number of refugees/asylees; number of IDP

A

Refugees/asylum seekers 17 million Internally displaced person (IDP) 24 million Total 43 million displaced

115
Q

number torture survivors in US

116
Q

obstetric fustula- main cause, Sx (4)

A

Fistulas Foot drop due to pelvic nerve injury Chronic urine exposure- stones and maceration social stigma

117
Q

OFDA

A

OFDA- office of foreign disaster aid from US includes: DART- Disaster Assistance Response Team RMT- Response Management team in DC

118
Q

Office of Refugee Affairs

A

covers medical for 1st 90 d

119
Q

organophosphate ingestion- Sx, Tx

A

SLUDGE- salivation, lacrimation, urination, diarrhea, GI cramp, emesis (sweat, drool), Brady, hypotension, miosis, bronchoconstriction, pulm edema Atropine, pralidoxime (reactivate AChE)

120
Q

ORS vs ReOsMal

A

Osmo 311 ORS, 245 ReSoMal ReSoMal- less Na (not needed) but more K and glucose

121
Q

OSSN in African HIV

A

ocular surface squamous neoplasia

122
Q

paraquat OD- no no

A

O2- increases radicals

123
Q

Pediatric CPAP

A

nasal cannula with O2 on one side and other with tube in cup of water other side (pressure)- deeper higher pressure (ave 5 cm)

124
Q

Pediatric fluid bolus use

A

clear tachy, hypotensive shock 20 mL/kg, reassess and repeat IN malnourished: 15mL/ kg IV over 1h( Ringer’s, half-normal saline or half-strength Darrow’s solution each with 5% glucose.

125
Q

Pediatric IV access sites

A

Hands, feet, scalp, ext Jug, Umbilical up to 3 wks

126
Q

pediatric maintenance IVF

A

• 100mL/ kg for the first 10kg • 50mL/ kg for the next 10kg • 25mL/ kg for each subsequent

127
Q

Pediatric malnutrition management

A

days 1-3- hypoglycemia, hypothermia, dehydration (ReSoMol) nutrition: F75 -> F100/RUTF (high energy, low protein 1st) (100 and later 200 kcal/kg/d) Vitamin A (iron later) infection Tx measles vaccine

128
Q

Pesticide poisoning management

A

Resuscitate and stabilize, give oxygen, and obtain history

129
Q

positive predictive value

A

true pos/total pos

130
Q

post-partum fever- cause, Tx

A

UTI, pyelo, septic abortion, amnionitis Tx: amp, gent, flagyl

131
Q

post-partum hemorrhage- def, Tx

A

> 500 mL massage, ergotamine, oxytocin

132
Q

Prevalence HBV for testing immigrants and 1st generation kids

A

> 2%; > 8% of parent home country

133
Q

Prevention of neonatal conjunctivitis

A

TTC topical or 1 silver nitrate

134
Q

Prvelance

A

living cases over time (less deaths)

135
Q

Quarantinable diseases

A

Cholera, Diphtheria Infectious TB Plague, small pox, Yellow fever Viral hemorrhagic fever SARS, Novel flu

136
Q

Rat bite fever agents (2)

A

Streptobacillus moniliformis (US)- gram neg bacilli

Spirillum minus (Asia)- spirochete

137
Q

refugee

A

flees due to fear of persecution

138
Q

Rotovirus causes what % of diarrhea; how effective is vaccine in low resource

139
Q

Rotovirus in kids cause what % of diarrhea and what % deaths

A

60% diarrhea, 40% deaths

140
Q

Sensitivity

A

Sensitivity = test pos/true pos

141
Q

sex trafficking vs labor trafficking

A

more depression, anxiety and PTSD

142
Q

Shigella in kids (2)

A

most common bacterial 15% diarrhea deaths

143
Q

Specificity

A

Specificity = test neg/true neg

144
Q

Surgical care levels

A

1- basic, tyhoid bowel perf 2nd/3rd level hospital- OB fistula, Congenital, cataract, eyelid trachoma

145
Q

TB pericarditis- mort, PPD?, Tx

A

40% mortality

PPD may be neg

Tx- steroids, drain, TB Tx

146
Q

Top 3 causes of death in < 5 YO

A

perinatal, pneumonia, diarrhea

147
Q

Traffickers- gender, conviction

A

1/3 women (more Asia), women more likely to be convicted

148
Q

transverse myelitis/spastic paraparesis etiology- viral, parasite

A

viral, including HTLV-1

parasite- S. mansoni, S. hematobium (vascular)

149
Q

TRIPS

A

Trade Related Aspects of Intellectual Property Rights WTO agreement Differential pricing in different markets

150
Q

TST > 5 mm and > 10 mm

A

> 5 mm: immunosuppressed, recent exposure, CXR changes >10 mm: immigrant, IVDU, chronic medical illness, < 4 YO, institutional living, health care

151
Q

Tx TB in HIV- drug interaction, preferred NNRTI

A

RIF effective but interacts with PI

EFV less effected by RIF than NVP

152
Q

UNHCR

A

UN High Commission for Refugees- legal, food, shelter, medical for refugees

153
Q

US immigrants 3 subtypes

A

1- lawful permanent resident- in process, e.g. adoption, international marriage 2- Authorized employment- H1B visa 3- lawful temporary resident (green card)- refugee, asylee, parolee

154
Q

Vaginitis with high pH

A

BV and trich (vs yeast)

155
Q

Vision problems in world- impaired, blind, causes (7)

A

285 million impaired people, 39 million blind due to cataract, vit A def, congenital, DM, glaucoma, oncho, chlamydia trachomatis

156
Q

Vitamin A and HIV

A

A increases perinatal transmission

157
Q

Vitamin A- deficiency, high, source, effect

A

vision, measles, dry skin, rash perinatal HIV transmission, teratogenic meat, dairy, eggs, fruit and veg (red palm oil) reduce overall mortality by 25% with twice a year dosing

158
Q

Vitamin C deficency Sx

A

Scurvy, joints, dry skin gingivitis, infant bleeding; secondary iron and folate def

159
Q

Vitamin E deficency Sx

A

infant hemolytic anemia, dry skin

160
Q

Vitamin K and infants

A

proph dose to prevent neonatal bleeding

161
Q

water requirements in disaster

A

7.5 L/per/d on emergency; 15-20 L after

162
Q

what percent asymptomatic kids are pos for campylobacter

163
Q

Who are exempt from pre-travel testing (2)

A

refugees, adoptees

164
Q

WHO Essential medicine

A

> 300 meds, region specific Includes TB and HIV Excludes birthcontrol, includes abortifacients if legal

165
Q

Xerophthalmia- number annual deaths, blindness

A

1 million die annually and > 500,000 go blind Night blindness (reversible); Keratinization- Bitot’s spot; corneal lesions; scarring leading to rupture

166
Q

Zinc dosing

A

20 mg/d (10 mg under 6 mo)

167
Q

zinc effect on diarrhea

A

25% reduction, boosts immune system

168
Q

Zinc- sources, deficiency Sx

A

meat, fish, liver

acral dermatitis, immunity, reproductive, neurobehavioral, infant diarrhea, alopecia

Stunting > 2 SD in Africa and Asia

Tx reduces diarrhea 25%

169
Q

Zoonotic restrictions

A

Dogs require rabies proof, some states also cats Illegal- primates (special), African rodents (bush meat), civets, bat, turtles <4 inches (salmonella), terrapins and tortoises Primate parts Tissues, trophies

170
Q

___% world pop in developing countries, use only ___% of resources and have ___% world disease

A

84% in developing 11% resources 93% disease

171
Q

Vitamin D def- Sx

A

rickets, rosary chain ribs

decreased resistance to TB, MAC

lower CD4 counts

172
Q

Conjunctivits can be seen with (6)

A

Measles, Lepto, Zika, Filovirus

Lassa, YF

173
Q

Burkitt’s lymphoma- type, Sx, Tx, geo

A

B-cell non-Hodgekins

rapid painless protosis in boy

vision intact

Tx: intrathecal MTX, steroids and chemo good response

most common childhood cancer in malaria areas

Tropical Medicine (7 decks)

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