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Preventive Medicine Exam 1 Question
and Answers
What is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities, and individuals? - Answer -public health Public health is also known as, the approach to ______ that is concerned with the community as a ______ - Answer -medicine, whole Name several notable medical achievements made possible through public health efforts: - Answer --vaccination -improved motor vehicle safety -decline of deaths from CAD and strokes -safer and healthier food -healthier moms, babies, family planning -fluoridation of drinking water -recognition of tobacco as a health hazard What are the variables that determine one's health? - Answer - Biology Behaviors Social Environment Physical Environment Government Policies and Interventions Access to Quality Healthcare What are the leading causes of death in the US? - Answer -heart disease cancer COPD/asthma
unintended injury stroke Alzheimer's diabetes mellitus influenza/pneumonia kidney disease suicide Different populations have different disparities. Women live ______ than men. ______ people live longer than others. Non- hispanic blacks die the _______. - Answer -longer, Hispanic, youngest T/F: Life expectancy in the US is less than 49 other countries - Answer -true What focuses on the health of individuals, communities, and defined populations. It's goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death? - Answer -preventive medicine Challenges faced in providing the best preventive care to our patients arises from patients are ______ and we do not have the time to ______ them always. There is no reimbursement for most ______ done. Patients can't afford _______ measures. We don't train well in preventive med. Lack of ______ from clinicians, hard to stay on top of recommendations. Lack a system that provides _______ when they are due - Answer -misinformed, inform, counseling, preventive, interest, providers Healthy people 2010 have objectives for improving what? - Answer -health
Name interrelationship factors of the epidemiological triad: -host -agent -environment - Answer --host: genetics, immunity, age, sex, race -agent: viral, bacterial, poison, smoke, trauma, nutrition -environment: biological, social, physical, nutritional What is determined by the combination of the rate of new diagnoses, the incident rate and the likelihood of death following the diagnosis (characterized the rapidity of deaths from the disease)? - Answer -mortality rate What is characterized by disease incidence or prevalence? - Answer -morbidity rate Within morbidity rate define each: ______: frequency of new disease over time, measures the rate of change, expresses risk ______: frequency of existing disease at a specific time, useful to quantify disease burden, duration measured is important - Answer -incidence prevalence What are alterable risk factors? Fixed risk factors? - Answer -Alterable - physical activity, diet, screening, etc Fixed - age, ethnicity, nationality, family history What type of prevention occurs before onset? - Answer -primary prevention What type of prevention is used to identify or treat risk factors or pre-clinical disease? - Answer -secondary prevention
What type of prevention is used to treat disease to prevent progression or complications? - Answer -tertiary prevention What are examples of primary, secondary, and tertiary prevention? - Answer -primary - counseling about diet, exercise, smoking cessation, injury prevention, immunizations secondary - blood lipids, mammogram, BP check tertiary - DVT prophylaxis, insulin therapy The natural history of disease progression has two different phases. _______: before any sx arise to treat _______: when sx of a disease arise - Answer -pre-clinical clinical For natural history of disease progression, _______ based studies have found progress of specific illnesses by noting _______events. Follow from ______ to _______ in order to find info of epidemiology. This helps design prevention ______ and evaluating treatment _______. - Answer -population, critical, exposure, resolution, protocol, efficacy T/F: To know the history of disease progression, watch the population to follow the disease in order to learn how to treat disease best - Answer -true What is the monitoring of health in a population over time & the detection of health-related events in a population? - Answer - medical surveillance
-_______ ________ ______: monitors global health by global health observatory - Answer -United Nations World Health Organization At the NATIONAL level, surveillance systems include: -US Census: demographics to analyze ______, _______, and ________ data -Centers for ______ _______ and Prevention -National Center for ______ _______ - Answer -social, economic, geographical Disease Control Health Statistics CDC has... National Hospital Care Survey: latest trends affecting _________ organizations, factors that _______ use of health care resources, quality of health care & _______ in health care services provided
- creates a benchmark for individual facilities to be _______ up to.
- Answer -healthcare, influence, disparities, measured NHCS guides actions to improve the health of __________. Data enables us to document health ______, identify health _______, monitor trends in health, identify problems, support ________, evaluate the impact of health policies & programs - Answer - Americans, status, disparities, research -National Vital Statistics System (NVSS): ______ & ________ -National Health Interview Survey (NHIS): _______ status, access to _______, immunizations, risk _______, and behaviors -National Health and Nutrition Examination Survey (NHANES): _______ & _______ -National Health Care Surveys: _______ & ____ - Answer -birth/death health, healthcare, factors
health/nutrition organization/providers At the STATE level, surveillance systems include: Behavioral Risk Factor Surveillance System (BRFSS): established by ______; state-based system; collects information on health ______ behaviors, preventive health practices, health care ______ mostly related to chronic disease/______. LARGEST ________ health survey IN THE WORLD! - Answer - CDC risk access injury telephone Know the 18 diseases that you must report by phone within 4 hours: 1 A 1 B 1 C 1 D 1 I 3 M 2 P 2 R 2 S 2 T 2 V - Answer -Anthrax Botulism Cholera Diphtheria Influenza, novel A virus infection
select the most appropriate, timely, and effective treatment? - Answer -clinical trial Clinical trials provide us the information needed to practice what type of medicine? - Answer -evidence-based What is using the best, most up-to-date evidence with clinical expertise, knowledge of diseases, and patient preferences to make health care decisions? - Answer -evidence-based medicine What is the powerful influence of the passions of the mind? - Answer -placebo effect What is a study of studies by combining several studies. Makes a more data driven and more objective? - Answer -meta-analysis What is a publication bias? - Answer -not all studies are published. A single study may be published more than once so make sure two papers were not based on the same evidence, studies published in English may give you limited studies What ratio do we use for a cohort study? - Answer -risk ratio State the risk ratio equation... A. Exposed persons who later dies of disease X B. Unexposed person who later dies of disease X C. Exposed person who do not die of disease X D. Unexposed persons who do not die of disease X - Answer - RR= Rate of death in exposed= A/(A+C)/ B/(B+D) What occurs when the cases and the controls are not representative of the same population and the cases and control are different in a way that makes a difference in the outcome being measured? - Answer -selection bias
What ratio is used in a case-control study? - Answer -odds ratio State the odds ratio equation... A. they have the disease and they were exposed B. they don't have the disease and they were exposed C. they have the disease and were not exposed D. they don't have the disease and were not exposed - Answer - Odds Ratio = Odds of case with exposure (A/C) / odds of control with exposure (B/D) What is estimating the probability of: disease, severity of disease, predicting the course of disease, and patient response to treatment? - Answer -diagnostic test What are the requirements for a perfect test? - Answer --All test results will be one of two values, either X or Y -All individuals without the disease will have one value, X -All individuals with the disease will have a different value, Y _________ = % correctly identified to have the disease true positives/(true positives + false negatives) __________ = % correctly identified to NOT have the disease true negatives/(true negatives + false positives) - Answer - sensitivity specificity So lets say we create a test to identify if a candy bar contains nuts. So we have tested 1000 candy bars, 500 of them contain nuts and 500 of them do not contain nuts. When we tested the 1000 candy bars 450 tested positive and 550 tested negative. So we cut open the candy bars and 50 of them that the test said had
test is specific to detecting nuts only 90% of the time. Another way to look at this is that 10% of the time something else in the candy bar triggered the test to show that it was positive for nuts, so 10% of the time the test was not specific to nuts. - Answer - true negatives, total T/F: The less the SENSITIVITY, the more accurate it is at identifying those w/ the disease - Answer -false, greater the sensitivity T/F: The greater the SPECIFICITY, the more accurate it is at not making a false positive - Answer -true What estimates probability of disease, severity of disease, predicting course of treatment, patient response to treatment? - Answer -diagnostic test What is a type of diagnostic test that identifies individuals with a disease BEFORE the disease is detected by its symptoms? - Answer -screening test What is defined by survival appears to be lengthened (disease was detected in an earlier stage)? - Answer -lead-time bias What is slowly progressive disease discovered by screening? - Answer -length-time bias What is the number of patients who need to be treated/screened to obtain one fewer bad outcome or one more good outcome? - Answer -number needed to treat (NNT) Do we want NNT to be a low or high number? - Answer -low
What is the number of patients who need to be treated/screened for one bad outcome to occur? - Answer -number needed to harm (NNH) Do we want NNH to be low or high? - Answer -high Herd Immunity: the resistance to the spread of a _______ disease within a _______ that results if a high proportion of individuals are ______ to the disease; chains of infection are likely to be disrupted when _______ numbers of a population are immune or less susceptible to the disease; un-vaccinated individuals are _______ protected by vaccinated individuals; people who are unable to receive vaccine (young or contraindication, get protection through the ______) - Answer -contagious, population, immune, large, indirectly, herd What is the ability of the human body to tolerate the presence of material indigenous to the body & to eliminate foreign material? - Answer -immunity What is the protection by products produced by an animal or human & is transferred to another human, usually by injection - protection wanes? - Answer -passive immunity When do babies get antibodies across the placenta? - Answer - last 1-2 months of pregnancy if born full term Post-exposure prophylaxis is a ______ treatment to an individual who has been exposed to the ______ - Answer -preventive, pathogen T/F:
complications: myocarditis, neuritis, and death immunization: DTap or Tdap - 5 doses The role of Tdap in pregnant women is to _______ the maternal antibody response and passive antibody ______/______ in the newbown - Answer -maximize, transfer/levels For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: Haemophilus influenza type b - Answer -pathogen: haemophilus influenzae transmission: colonizes in nasopharynx, can be asymptomatic S/S: pneumonia, meningitis, epiglottitis, cellulitis complications: hearing loss or other neurologic problems, case fatality is 2-5% schedule: Hib Vaccine: 3-4 dose series depending on the brand, Pentacel: 4 does series at 2,4,6,12-15 months For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: Hepatitis A - Answer -pathogen: hepatitis A virus (HAV) transmission: fecal oral transmission S/S: fever, malaise, anorexia, N, ab pain, dark urine/jaundice
risk: case fatality is 0.3% but worse with people older than 40 schedule: HepA, two doses given 6-18 months apart, at 12- months of age For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: Hepatitis B - Answer -Pathogen: hepatitis B virus (HAB) transmission: blood borne S/S: pain in liver/ab, dark urine, fever risk: can live on surface for up to seven days HepB vaccine: Birth, 2, 4, ad 6 months- 6 month only given if combo drug at birth For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: Measles - Answer -pathogen: paramyxovirus transmission: direct contact with droplets and airborne spread, primary site of infection: respiratory epithelium S/S: fever, rash, cough, corya, conjunctivitis, Koplik spots complications: OM, pneumonia, encephalitis, death
bad if happens during first trimester? - Answer -congenital rubella syndrome For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: Varicella - Answer -pathogen: varicella zoster virus S/S: mild prodrome for 1-2 days then rash complications: 2 degree infection of the skin, pneumonia, CNS manifestations, reye syndrome, death, maternal varicella 5 days before to 2 days after delivery MMR, MMRV see above - 2 dose series For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: pneumoccoccal disease - Answer -Pathogen: Streptococcus pneumonia S/S: Pneumonia, cough, rusty sputum, tachypea, tachycardia, SOB Complications: Bacteria Meningitis Vaccine Schedule: 2,4,6 month, 12-15 months, booster before school Who gets which vaccine for pneumococcal disease?
_______ (conjugated): 4 doses at 2, 4, 6, 12-15 months. Give boosters prior to school. ________: given to children if at high risk (congenital heart disease, severe asthma, DM, immune compromised). Adults >_____: give PCV13 if never received, give PPSV23 1 year later. Adults ___-____ w/ risk: give PCV13 then PPSV23, additional PPSV23 5 years later & again at age 65. - Answer -PCV PPSV 65 19- For each of the following illnesses you should know the pathogen, mode of transmission, S/S of disease, risk of complications and the immunization schedule: poliomyelitis - Answer -pathogen: poliovirus Transmission: by mouth, herd immunity through poop S/S: fever, headache, sore throat, nausea, 3 days of nothing, paralysis Complications: Spinal polio, paralysis, death Immunizations: 2, 4, 6-18, 4-6 years Oral Polio Vaccine (OPV) - discontinued in US d/t vaccination associated ______ polio. _____ virus that can revert back to
