Public Health (Respiratory)

Question 1

Are the numbers of diagnoses of asthma increasing or decreasing?

Answer 1

Increasing.

Question 2

Are the numbers of hospitalisations with asthma increasing or decreasing?

Answer 2

Decreasing

Question 3

What are the risk factors for asthma?

Answer 3

Family history of atopic disease, co-existence of atopic disease, male (pre-pubertal) or female (childhood to adulthood), bronchiolitis in infancy, parental smoking (including perinatal), low birthweight and/or premature birth.

Question 4

In what sex and where is lung cancer more prevalent?

Answer 4

Males, Scotland in the UK.

Question 5

What socioeconomic correlation is there with lung cancer?

Answer 5

Correlation with deprivation and mortality.

Question 6

What are the sources of information when we assess the burden of morbidity?

Answer 6

Hospital admissions/discharges, bed occupancy, GP contacts.

Question 7

Why when looking at statistics of illnesses does setting matter?

Answer 7

As some conditions are managed more commonly in primary care whereas others are managed in hospitals.

Question 8

What does it mean when we say there is a dose response relationship in smoking and lung cancer?

Answer 8

If you smoke more you will have a greater risk.

Question 9

How can health inequalities be decreased?

Answer 9

Governments making legislative changes.

Question 10

What was the effect of the Irish smoking ban on the respiratory health of bar workers in Dublin pubs?

Answer 10

Statistically significant improvements in pulmonary function tests, significant reduction in self-reported symptoms.

Question 11

Why can we not just ban tobacco?

Answer 11

There is a lot of tax revenue, would add to illicit trade.

Question 12

What is Scotland and England’s most popular quitting aid?

Answer 12

E-cigarettes.

Question 13

What is the clinical presentation of influenza (what are the signs/symptoms)?

Answer 13

Fever (high, abrupt onset), malaise, myalgia (sore muscles), headache, cough, prostration (knocked flat).

Question 14

What is the aetiology (causes)?

Answer 14

Classical flu (A+B), flu-like illnesses (parainfluenza viruses, many other viruses), haemophilus influenzae (bacterium, not primary cause of flu, may be a secondary invader).

Question 15

Describe the surface antigens of the flu virus?

Answer 15

2 different types (hemaghlutin, neuraminidase).

Question 16

How do we name viruses/flu?

Answer 16

Virus type/geographic origin/strain number/year of isolation (virus subtype).

Question 17

What are the 2 complications of flu (both pneumonias)?

Answer 17

Primary influenzal pneumonia (seen most during pandemic years, can be disease of young adults, high mortality). Secondary bacterial pneumonia (more common in elderly, debilitated, pre-existing disease, cause of mortality in all influenza epidemics).

Question 18

Describe the 2 types of therapy for flu.

Answer 18

Symptomatic (bed rest, fluids and paracetamol). Antivirals (oseltamivir, zanamivir, 2% of population were prescribed during 2009 pandemic, prescribed when flu is circulating, risks of complications, use in prophylaxis).

Question 19

What are the differences between epidemics and pandemics?

Answer 19

Epidemics: in winter, seen in association with minor mutations in surface proteins of virus (antigenic drift). Pandemics: rare, unpredictable, influenza A, antigenic shift, animal reservoir/mixing vessel required.

Question 20

Define endemic, epidemic and pandemic.

Answer 20

Endemic: occurs naturally in population. Epidemic: outbreak of an unexpected size (more than one area/country for flu). Pandemic: global distribution of disease.

Question 21

Describe phases 1-6 of a pandemic.

Answer 21

1-3: predominantly animal infections. 4: sustained human-to-human transmission. 5-6: widespread human infection.

Question 22

Describe post peak and post pandemic levels.

Answer 22

Post peak: possibility of recurrent events. Post pandemic: activity at seasonal levels.

Question 23

Give 2 examples of flu pandemics in the past.

Answer 23

2009 swine flu epidemic, 1918 post world war flu epidemic.

Question 24

What are the internal, external and social causes of lung disease?

Answer 24

Internal: genetic and uterine development. External: smoking, exposure to agents. Social: deprivation, cultural norms.

Question 25

Give some examples of occupational lung diseases.

Answer 25

Hypersensitivity pneumonitis (extrinsic allergic alveolitis) e.g farmer's lung, bird breeder's lung, cheese workers lung, mollusc shell hypersensitivity, paprika splitter's lung. 
Pneumoconiosis e.g. asbestosis, silicosis, coal worker's lung, berylliosis.

Question 26

What is the pathological changes in chronic hypersensitivity pneumonitis and what is the treatment focused on?

Answer 26

Extensive fibrosis with honeycombing and air-trapping. Treatment focused on antigen avoidance.

Question 27

What is asbestosis and what is it caused by?

Answer 27

Fibrotic lung disease, cause by inhalation of asbestos fibres.

Question 28

What are the different types of asbestos?

Answer 28

White (safest), brown and blue.

Question 29

Is there a synergystic effect between smoking and asbestos exposure causing lung cancer?

Answer 29

Yes, there is some interaction between the smoking and the asbestos that causes greater cancer rates.

Question 30

What industries are involved in asbestos exposure?

Answer 30

Shipbuilding, mining, heat insulation and building.

Question 31

What are the indoor and outdoor causes of lung disease?

Answer 31

Indoor: asbestos, mould, cooking smoke, passive smoking, nanparticles.
Outdoor: air/traffic pollution.

Question 32

What can mould in housing cause?

Answer 32

Respiratory problems, a lot more childhood asthma.

Question 33

What is the definition of fuel poverty?

Answer 33

Where over 50% of your household budget is spent on heating.

Question 34

What was introduced to decrease the cost of heating on an island and has it been effective?

Answer 34

A subsidy, no.

Question 35

Why is overcrowding greater in Perth and Kinross than in Dundee?

Answer 35

Eastern European immigrants living in caravans for fruit picking.

Question 36

What groups is overcrowding more common in?

Answer 36

Minority ethnic groups, poorer areas.

Question 37

What can help solve the problem of cooking smoke?

Answer 37

Types of cooking stoves.

Question 38

What makes up photochemical smog and where can it be found?

Answer 38

Ozone, nitrogen oxide, nitrogen dioxide, volatile organic compounds (VOCs) all produced from cars.

Question 39

What makes up olden days “London” smog and what event did it affect?

Answer 39

Fly ash, sulphur dioxide, sodium chloride, calcium sulphate particles (all from high sulphur coal).

Question 40

What are the most common hazardous materials in air pollution?

Answer 40

SO2, NOs, particular matter, O3, volatile organic compounds, persistent organic compounds (POPs), benzene, CO, lead and heavy metals.

Question 41

What negative effects can traffic fumes have on people’s health?

Answer 41

Reduced lung growth in adolescence, increased rates of asthma and COPD, increased rates of respiratory symptoms like wheeze/cough/breathlessness.

Question 42

What effects outside the lungs can inhaled substances have?

Answer 42

Low birth weight, appendicitis, stroke, neurological/neurobehavioural outcomes e.g. neurodegenerative disease, cognitive decline, depressions and suicide.

Question 43

What are dioxins and what problems do they cause?

Answer 43

A subset of persistent organic compounds. Associated with reproductive and immunological problems. Bioaccumulates both in people and animal fat.

Question 44

Why is there a cycle of smoking in deprived areas?

Answer 44

There are more cigarette shops.

Question 45

What makes you more likely to live next to hazardous landfills? (environmental justice)

Answer 45

If you are poorer.

Question 46

What are the causes of water scarcity?

Answer 46

Global population increase, growing demand for food, more agriculture needing more water, increased allocation for cities/agriculture/industries, increased tension/conflict/environmental strain.

Question 47

What effect does climate change have on water scarcity?

Answer 47

More frequent droughts, intensified storms and flooding, destroys crops, contaminates freshwater and damages the facilities used to store and carry that water.