Public health/Disaster/Immigrant Flashcards
1
Q
% death under age 5 YO due to perinatal
A
40%
2
Q
3 causes of eosinophilic meningitis
A
Angiostrongylus cantonensis
Gnathostoma spinigergum
T. solium (neurocysticercosis)
3
Q
Ackee fruit
A
in West Africa and Carribean, unripenned fruit leads to hypogycemia
4
Q
acute diarrhea leading to bacteremia
A
shig, salmonella, campy
5
Q
Adoptee growth failure- 2 types
A
< 18 mo- nutritional, rickets > 18 mo- stunting, delayed puberty
6
Q
Aeromonas assoc with
A
reptile and leeches
7
Q
annual deaths related to cook stove exposure
A
4 million
8
Q
as poverty improves, birth rates go ?
A
down
9
Q
asylum seekers- torture, PTSD
A
torture 45% PTSD 65%
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
11
Q
B12- name, deficiency, source
A
cyanocobalamine cheliosis, glossitis, anemia, cord degeneration meat and dairy
12
Q
B2- name, deficiency, source
A
riboflavin cheliosis, magenta tongue, seb derm, poor Fe absorption all foods
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)
14
Q
B6- name, deficiency, source
A
pyridoxine neuropathy (esp INH, cycloserine, PZA) meat, fruit, veg
15
Q
Bantu siderosis
A
South Africa beer brewed in iron pots
16
Q
BCG reduces pediatric CNS TB by
A
80%
17
Q
BCG side effect
A
risk of LAD, avoid vaccine in same arm for 3 months
18
Q
Betel nut
A
chewed by 15% of world stimulant assoc with head and neck CA
19
Q
Burn fluid replacement (Parkland)
A
LR 4 mL/kg/%burn- ½ over 8 h then rest over 16 h
20
Q
Cancers by region
A
SE Asia: Lung >breast >liver East Africa: Kaposi’s sarcoma >cervix >lung US: Breast >prostate >lung
21
Q
Capnocytophaga
A
gram neg rod assoc with dog/cat bites
22
Q
causes of genital ulcer (5)
A
HSV, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale
23
Q
CDC Quaratine substations
A
20 across US isolate sick, quarantine exposed
24
Q
cervical cancer deaths
A
275K/yr- 85% in developing
25
Chest tube level depending upon purpose
T2-3 for pneumothorax T 5-7 for effusion
26
Chronic diarrhea (\> 14 d) causes- bacteria (5), protozoa (5), worms (1), viral (5)
Bacteria: EAEC, EPEC, Shigella, Yersinia, Campylobacter
Protozoa: Crypotosporidium, Cyclospora, Isospora, Microsporidium, E.histolytica
Worms: Strongyloides
Viral: adeno, noro, CMV, roto, HIV
27
Class A immigrant restrictions
active TB Untreated syphilis, chancroid, GC, granuloma inguinale, lymphogranuloma venerum Untreated Hansen’s dz Drug/mental with harmful behavior
28
common definition of migrant and temporary worker
change of country for \> 12 mo temporary worker is migrant who traveled \> 24 h
29
Congenital syphilis Sx
rhinits, rash, HSM, LAD, bones, CNS, deaf, keratitis, anemia, low PLT frontal bossing, saddle nose, peg teeth
30
Contraindications to lumbar puncture (3)
Papilledema Focal neuro signs Too unstable to position
31
COPD highest in? related to?
India and Asia Biofuels (poverty more associated with COPD than smoking)
32
CPR ratio- infants, children
3:1, 15:2
33
Deaths under 5 in 2014; % neonatal
\> 6 million 44%
34
deep sedation- ketamine- age, SE, NPO
down to 3 mos may have nystagmus or jerking NPO- 8 h solid, 6 h formula, 4 h breast, 3 h clear
35
dehydration causes what % deaths \< 5 YO
15%
36
Dhaka solution compared to Ringers
more K, bicarb, chloride. Also has glucose
37
Diarrhea related to GBS
campy
38
Diarrhea related to HUS
shig, EHEC
39
Diarrhea related to reactive arthritis
campy, salmonella, shigella
40
Eclampsia management
BB- labetalol Vasodilator- hydralazine, methyldopa Magnesium sulfate- IV or IM
41
Eikinella
gram neg rod infecting 15% of human bites
42
exceptions from overseas immunization requirement
adoptees \< 10 YO, refugees; otherwise imigrants get exam and immunization before entry
43
Excess fluoride
Fluorosis if high in drinking water (Rift Valley, Punjab); teeth color, rigid joints
44
Famine defined (3)
acute malnutrition \> 30 % death rate \> 2/d per 10,000 Death \> 2 adults or 4 children per day per 10,000
45
Female circumcision types
1- clitoral hood +/- clitoris 2- clitoris +/- labia minora 3- infibulation- remove most with partial closing 4- unclassified/other
46
folate- deficiency, source
tube defects, IUGR, anemia fruits and veg
47
food requirements (cal)
2100 kcal/person/d
48
Genital warts- common cause, prevalence, Tx
HPV 6 and 11 (most) almost 50% sexually active are positive (most subclinical)
49
halothane
CHF, malignant hyperthermia
50
HBV serotypes and special
A B- more resistant to lamivodine C- more HCC, more resistant to interferon
51
HBV- #infected, #deaths/yr
2 billion \> 500K due to cirrhosis and HCC
52
HBV- causes what percent HCC, relation to cirrhosis
80% HCC (30% without cirrhosis)
53
HBV- main mode of transmission
perinatal
54
Health effects of immigrating to US
more DM and CVD with poorer outcome less CA deaths (less gastric in Japanese BUT more breast in Asians)
55
Hindmilk
higher in calories and fat
56
how many immigrants in world
\> 200 million (3% of world) live outside country of origin
57
how many lack clean water? basic sanitation
1 billion 2.5 billion
58
how much does hand washing reduce diarrhea by
45%
59
How often does oral rehydration work
96%
60
HPV- high risk strains, vaccine coverage
high- 16, 18, 31, 33 Gardasil- 6, 11, 16, 18 Cerbarix- 16, 18
61
IASC- emergecy categories
InterAgency Standing Committee #3 is highest
62
IGRA/Quantiferon- how, specificty
mix serum with antigen and test interferon release Not cross react with BCG, but does other myobacteria
63
Immigrant cancer screening improves with (3)
Duration of residence Hx of previous cancer screenings More primary care visits ER vists use of interpreter
64
Important vitamins to give with diarrhea
zinc, vit A, folate
65
Incidence
new cases over time
66
Indian childhood cirrhosis
1-3 YO high mortality ? due copper intake
67
infectious agent related to adult T-cell leukemia
HTLV-1
68
infectious agent related to cervical CA
HPV
69
infectious agent related to gastric CA/MALT
H. pylori
70
infectious agent related to HCC
Hep B 80% \> C
71
infectious agent related to Kaposi's sarcoma
HHV-8
72
infectious agent related to MALT lymphoma conunctiva
Chlamydia trachomatis
73
infectious agent related to nasopharyngeal CA
EBV
74
infectious agent related to NHL
Hep C
75
infectious agent related to SCC of bladder
Schistosomiasis hematobium
76
infectious agents related to cholangiocarcinoma
clonorchis, opistorchis
77
infectious endocarditis
50% on normal valves
78
International accelerated vaccine schedule
B- BCG, OPV
6, 10 and 14 wks- DTP, OPV, Hib, Prev, Roto
9 mo- MMR, YF
79
Interosseous sites
anteromedial prox tibia, 80 degrees aawy from joint peds: medial malleolus, distal femur, humerus, iliac crest, sternum adult: sternum and distal malleolus
80
Iodine deficiency
Cretinism, goiter, hypothyroid; Low levels in soil (Nepal, Bolivia, Bangledesh); single dose good for 1-2 years
81
iodine- highest need, deficiency Sx
infant, teen, pregnant/lactating decreased IQ, cretinism, goiter
82
iron deficiency- numbers deficiency and anemia; other vitamins involved
4.5 billion iron deficient, 2 billion anemic worldwide 50% kids in sub-Saharan Africa anemic vit C, vit A and riboflavin
83
iron replacement can increase risk of (4)
malaria, TB, yersinia and brucellosis delay supplementation in early malnutrition Tx to reduce sepsis risk
84
IV rates
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
Konzo
cyanide in improperly prepared cassava -\> tropical myelopathy (spastic paraparesis)
86
Kwashiorkor
Edema with low protein diet Hair changes, dermatitis Apathetic, lethargic, poor appetite
87
Latent TB outcome, numbers
5% active within 2 yrs, 5% later 2 billion in world
88
latrine requirements during disaster
Latrine 1/100 emergency; 1/20 after
89
Leptin
Hormone related to energy production Deficiency leads to cardiac dysfunction and T-cell modulation problem
90
Malaria and pregnancy
prophylax
91
male circumcision reduces HIV transmission to men by
60%
92
Marasmus
Body wasting may be distended abd (weak muscles, bacterial overgrowth irritable, hungry
93
Mass drug Tx in pregnant, NO (3), OK (4)
ALB, MED, IVM
PZQ, DEC, pyrantel, nitazoxaminde
94
Maternal death- numbers, causes
\> 500,000 (1/16 in Africa) Bleeding 25%, Infection 15%, Unsafe abortion 13%, Eclampsia 12%, Obstructed labor 8%
95
Medical resettlement
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
Medications with G6PD def issues
Primaquine, Dapsone, sulfa, Nitrofurantoin, Naldixic acid
97
methanol intox
anion gap metabolic acidosis
98
Migrant qualities
more male younger (Except Europe) less educated (Except Europe, Asia, Africa) poorer (Except Europe, Asia)
99
moderate sedation
benzo + narcotic
100
Mollarett
recurrent HSV meningitis
101
Most common cause of immunodeficiency in the world
malnutrition
102
most common cause to pericardial effusion in Africa and Asia
TB
103
most common types torture
envirnmental, beating (esp feet- falanga), suspension, women rape
104
MUAC
mid upper arm circumference for 6 mo to 5 yrs \> 125 mm nl, \< 115 mm SAM
105
MVA deaths
1.2 million/yr; more in lower income despite fewer vehicles
106
negative predictive value
true neg/total neg
107
neonatal jaundice and ceftriaxone
Avoid as may displace bilirubin from albumin, increasing bili.
108
Neonatal jaundice- impact, signs Tx
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
Neonatal resuscitation
1 min- clear airway and stim Bag mask: 40-60/min; 1,2,3,breathe 30 sec, HR\< 100, resume
110
Neonatal STD conjunctivitis (2) agent, incubation, Tx
GC 2-5 d, IM ceftriaxone chlamydia 5-12 d, PO erythro or bactrim
111
Noma
oral/skin destruction related to malnutrition and infection
112
NTD- world (STH-1, LOST), US (5T)
STH (ascaris, whip, hook- not strongy), LF, oncho, schisto, trachoma
toxocaria, toxoplas, trich, T. cruzi, T. solium
113
number adopted in past 15 yrs
\> 250K
114
Number of refugees/asylees; number of IDP
Refugees/asylum seekers 17 million Internally displaced person (IDP) 24 million Total 43 million displaced
115
number torture survivors in US
500K
116
obstetric fustula- main cause, Sx (4)
Fistulas Foot drop due to pelvic nerve injury Chronic urine exposure- stones and maceration social stigma
117
OFDA
OFDA- office of foreign disaster aid from US includes: DART- Disaster Assistance Response Team RMT- Response Management team in DC
118
Office of Refugee Affairs
covers medical for 1st 90 d
119
organophosphate ingestion- Sx, Tx
SLUDGE- salivation, lacrimation, urination, diarrhea, GI cramp, emesis (sweat, drool), Brady, hypotension, miosis, bronchoconstriction, pulm edema Atropine, pralidoxime (reactivate AChE)
120
ORS vs ReOsMal
Osmo 311 ORS, 245 ReSoMal ReSoMal- less Na (not needed) but more K and glucose
121
OSSN in African HIV
ocular surface squamous neoplasia
122
paraquat OD- no no
O2- increases radicals
123
Pediatric CPAP
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
Pediatric fluid bolus use
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
Pediatric IV access sites
Hands, feet, scalp, ext Jug, Umbilical up to 3 wks
126
pediatric maintenance IVF
• 100mL/ kg for the first 10kg • 50mL/ kg for the next 10kg • 25mL/ kg for each subsequent
127
Pediatric malnutrition management
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
Pesticide poisoning management
Resuscitate and stabilize, give oxygen, and obtain history
129
positive predictive value
true pos/total pos
130
post-partum fever- cause, Tx
UTI, pyelo, septic abortion, amnionitis Tx: amp, gent, flagyl
131
post-partum hemorrhage- def, Tx
\> 500 mL massage, ergotamine, oxytocin
132
Prevalence HBV for testing immigrants and 1st generation kids
\> 2%; \> 8% of parent home country
133
Prevention of neonatal conjunctivitis
TTC topical or 1 silver nitrate
134
Prvelance
living cases over time (less deaths)
135
Quarantinable diseases
Cholera, Diphtheria Infectious TB Plague, small pox, Yellow fever Viral hemorrhagic fever SARS, Novel flu
136
Rat bite fever agents (2)
Streptobacillus moniliformis (US)- gram neg bacilli
Spirillum minus (Asia)- spirochete
137
refugee
flees due to fear of persecution
138
Rotovirus causes what % of diarrhea; how effective is vaccine in low resource
30% 60%
139
Rotovirus in kids cause what % of diarrhea and what % deaths
60% diarrhea, 40% deaths
140
Sensitivity
Sensitivity = test pos/true pos
141
sex trafficking vs labor trafficking
more depression, anxiety and PTSD
142
Shigella in kids (2)
most common bacterial 15% diarrhea deaths
143
Specificity
Specificity = test neg/true neg
144
Surgical care levels
1- basic, tyhoid bowel perf 2nd/3rd level hospital- OB fistula, Congenital, cataract, eyelid trachoma
145
TB pericarditis- mort, PPD?, Tx
40% mortality
PPD may be neg
Tx- steroids, drain, TB Tx
146
Top 3 causes of death in \< 5 YO
perinatal, pneumonia, diarrhea
147
Traffickers- gender, conviction
1/3 women (more Asia), women more likely to be convicted
148
transverse myelitis/spastic paraparesis etiology- viral, parasite
viral, including HTLV-1
parasite- S. mansoni, S. hematobium (vascular)
149
TRIPS
Trade Related Aspects of Intellectual Property Rights WTO agreement Differential pricing in different markets
150
TST \> 5 mm and \> 10 mm
\> 5 mm: immunosuppressed, recent exposure, CXR changes \>10 mm: immigrant, IVDU, chronic medical illness, \< 4 YO, institutional living, health care
151
Tx TB in HIV- drug interaction, preferred NNRTI
RIF effective but interacts with PI
EFV less effected by RIF than NVP
152
UNHCR
UN High Commission for Refugees- legal, food, shelter, medical for refugees
153
US immigrants 3 subtypes
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
Vaginitis with high pH
BV and trich (vs yeast)
155
Vision problems in world- impaired, blind, causes (7)
285 million impaired people, 39 million blind due to cataract, vit A def, congenital, DM, glaucoma, oncho, chlamydia trachomatis
156
Vitamin A and HIV
A increases perinatal transmission
157
Vitamin A- deficiency, high, source, effect
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
Vitamin C deficency Sx
Scurvy, joints, dry skin gingivitis, infant bleeding; secondary iron and folate def
159
Vitamin E deficency Sx
infant hemolytic anemia, dry skin
160
Vitamin K and infants
proph dose to prevent neonatal bleeding
161
water requirements in disaster
7.5 L/per/d on emergency; 15-20 L after
162
what percent asymptomatic kids are pos for campylobacter
25%
163
Who are exempt from pre-travel testing (2)
refugees, adoptees
164
WHO Essential medicine
\> 300 meds, region specific Includes TB and HIV Excludes birthcontrol, includes abortifacients if legal
165
Xerophthalmia- number annual deaths, blindness
1 million die annually and \> 500,000 go blind Night blindness (reversible); Keratinization- Bitot’s spot; corneal lesions; scarring leading to rupture
166
Zinc dosing
20 mg/d (10 mg under 6 mo)
167
zinc effect on diarrhea
25% reduction, boosts immune system
168
Zinc- sources, deficiency Sx
meat, fish, liver
acral dermatitis, immunity, reproductive, neurobehavioral, infant diarrhea, alopecia
Stunting \> 2 SD in Africa and Asia
Tx reduces diarrhea 25%
169
Zoonotic restrictions
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
\_\_\_% world pop in developing countries, use only \_\_\_% of resources and have \_\_\_% world disease
84% in developing 11% resources 93% disease
171
Vitamin D def- Sx
rickets, rosary chain ribs
decreased resistance to TB, MAC
lower CD4 counts
172
Conjunctivits can be seen with (6)
Measles, Lepto, Zika, Filovirus
Lassa, YF
173
Burkitt's lymphoma- type, Sx, Tx, geo
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
