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87 Cards in this Set

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Healthy people proposed objective 2020: overview (2)
1. increase the proportion of people who receive appropriate evidence-based clinical preventative services
2. increase the proportion of practicing primary care providers
Healthy people proposed objective 2020:
adolescent health (2)
1. increase % of adolescent tested for HIV
2. increase % of adolescents who receive a wellness check up
Healthy people proposed objective 2020:
arthritis, osteoporosis and chronic back conditions (3)
1. reduce the mean level of joint pain in adults with doctor-diagnosed arthritis
2. increase the number of adult with arthritis who receive provider counseling
3. reduce the proportion of adults with osteoporosis
Healthy people proposed objective 2020:
Blood disorders and blood safety (3)
1. reduce the amount of adults who develop venous thromboembollism during hospitalization
2. reduce the amount of adults who develop venous thromboembollism
3. increase the proportion of people with blood disorders who receive the appropriate vaccinations
Healthy people proposed objective 2020:
Cancer (4)
1. decrease the incidence of invasive colorectal cancer
2. decrease the incidence of invasive uterine cervical cancer
3. decrease the incidence of late stage disease breast cancer
4. increase the proportion of men who discuss PSA test to screen for prostate cancer
Healthy people proposed objective 2020:
chronic kidney disease (2)
1. increase the amount of persons with chronic kidney disease and diabetes who receive ACE inhibitors and ARBs (angiotensin receptor blocker)
2. increase the percentage of people with CKD who know they have impaired renal function
State the criteria for the ranking of countries by the WHO, and name the ranking for the U.S.
1. rankings are based on: equity of distribution, utilization of existing health resources, preventable deaths
2. US: 37th of 191 countries in overall health system; 72nd on level of health
Discuss what health promotion/disease prevention factors a PA can influence to effect better patient outcomes.
- PAs can educate and counsel the patient on lifestyle changes and to obtain appropiate screenings so that diseases are prevented or caught early
-they cannot influence age, sex or heredity
List, define, and give examples of the three types of disease prevention.
1. primary prevention: remove of modify risk factors of the disease, preventing the disease from occuring in the first place
ex: vaccinations, exercise, no tobacco use
2. secondary prevention: detects a condition in its early stages and tries to reverse the disease or prevent progression
ex: pap smear, mammograms
3. tertiary: treatment of existing disease to prevent complications
ex: PT after a stroke, treatment of diabetes mellitus
What does the USPSTF stand for?
- USPSTF= United States Preventative Services Task Force.
Describe the function of the USPSTF, and how PAs should use their recommendations and ratings.
-they are a panel of experts on primary care and prevention who review available evidence and develop recommendations for clinical preventative services
- use their recommendations on a case by case basis. there are a lot of contradictory statements
List the top 10 causes of death in the U.S.
1. heart disease
2. cancer
3. Lower Respiratory diseases
4. Stroke
5. accidents (MVA, poisoning, falls)
6. Alzheimer's
7. Diabetes
8. Kidney diseases
9. Influenza and pneumonia
10. Suicide
Describe the costs of preventive health care
1. underutilization of preventative health measures: screening for colorectal cancer, choldhood immunization and smoking cessation
2. overutilization of preventative health: CAD testing in asymptomatic patients
3. pressure to do screenings to increase revenue without analyzing harm to patients
List the five preventive services which could save 100,000 lives each year by 90% participation.
1. adults who take aspirin daily to prevent heart disease
2. smokers who are advised to quit and are offer medication or other assistance
3. adults, age 50+, who are advised to screen for colorectal cancer
4. adults, age 50+, who are vaccinated for influenza yearly
5. women, age 40+, who are screened for breast cancer every 2 years.
List the suggestions for practice: "strongly recommended"; what letter is it?
-daily aspirin use for the prevention of CV events with men 40+, women 50+
-"A"
List the suggestions for practice: "no recommendation"
-recommend against ECG and Exercise treadmill test to screen for presence of severe coronary artery stenosis or to predict CHD in adults with low risk for CHD events
-"D"
define prevelence rate
number of cases of target condition
-population at risk for developing a target condition at a given time
define incidence rate
number of new cases of target condition/ population at risk for developing a target condition over a given time period
define absolute risk
incidence of target condition in a population with the risk factor
define relative risk
absolute risk of disease among person with the risk factor/ absolute risk of disk in persons without the risk factor
define attributable risk
amount of risk that can be attributable to a risk factor
(difference between absolute risks)
Sensitivity of screening test
the amount of people with the disease who test positive
A/(A +C)
Specificity
proportion of people who do not have the disease who test negative
D/(D +B)
positive predictive value
the amount of people who test positive who have the disease
A/(A +B)
negative predictive value
amount of people who test negative who do not have the disease
D/ (C+D)
Screening test sensitivity and predictive value
HIGH sensitivity
HIGH neg. predictive value
HIGH false positive
Diagnostic test sensitivity and predictive value
HIGH sensitivity
HIGH specificity
HIGH accuracy
Does prevalence affect positive predictive value, negative predictive value, sensitivity or specificity
prevalence only affects PPV and NPV
-positive predictive value is low if prevalence is low.
5 ecological levels of influence
1. intrapersonal factors (patient characteristics that influence behavior)
2. interpersonal factors: (friends, family who influence the patient's behavior)
3. institutional factors (UTMB bans smoking)
4. community factors (no smoking allowed in bars
5. public policy (can't buy cigarettes under the age of 18)
5 stages of change in the trans-theoretical model
1. pre-contemplation (unaware of problem)
2. contemplation (think about change in the near future)
3. decision/determination (making a plan to change)
4. action (implementation of specific action plans)
5. maintenance (continuing desirable actions)
6 stages of the health belief model
1. perceived susceptibility (ones opinion of chance of getting condition)
2. perceived severity (ones opinion of how serious a condition is)
3. perceived benefits (ones opinion of how effective an advised action will be)
4. perceived barriers (ones opinion of the tangible or psychological effects of the advised action)
5. cues to action (strategies to activate readiness
6. self-efficacy (confidence in ones ability to take action)
6 concepts of social cognitive theory
1. recipricol determinism (behavior changes results from interaction between person and environment)
2. behavior capability (knowledge and skills to influence behavior)
3. expectations (beliefs about likely results of action)
4. self-efficacy (confidence in ability to take action)
5. observational learning (beliefs based on observing others like self and seeing results)
6. reinforcement (responses to a persons behavior that influence recurrence)
Define nosocomial infection
-hospital acquired infection
-infection that is neither present nor incubated at the time of hospitalization
-bacterial infections incubate for 48 hours
define community acquired infections
-all infections that do not meet the criteria for hospital acquired infections
top four most hospital acquired infections
1. UTI (catheters) [37%]
2. Surgical Site (wound) infection [17%]
3. Pneumonia [16%]
4. Bacteremia [11%].
Identify the most important preventive measure for hospital-acquired infections.
1. hand hygiene
-wash hands before and after contact with patients.
Discuss the USPSTF recommendation for screening and behavioral counseling interventions to reduce alcohol misuse by adolescents and adults in the primary care setting.
-The Alcohol Use Disorders Identification Test (AUDIT)
-CAGE questionnaire
Name the most commonly abuse prescription drug in the US
Opiods, CNS depressants and stimulants
Discuss the most commonly used illicit drugs in the U.S.
1. alcohol
2. cannabis (marijuana, hashish)
3. stimulants (nicotine, caffeine, cocaine)
4. opiates (heroin, morphine, oxycontin)
5. sedative hypnotics (barbituates)
6. hallucinogens (LSD)
7. inhalants (nitrous oxide)
define drug misuse
o Taking more drug than prescribed
o Taking medications with alcohol
o Excess use of psychoactive meds
o Using old medications to self treat current problems
o Discontinuing medications AMA
define drug abuse
o Maladaptive pattern of drug use leading to clinical impairment
o Misuse of illicit or licit drugs for recreation or self treatment
list the consequences of tobacco use
•Death
•Increased Health Risks
•Cardiovascular Disease (Coronary Heart Disease)
•Respiratory Disease (Emphysema, Bronchitis, Chronic Airway Obstruction)
•Cancer
•Other Health Effects
Describe the “5 R’s” intervention to enhance motivation to quit tobacco use
1. relevance (patients disease status or risk)
2. risks (asthma, COPD, shortness of breath etc)
3. rewards (longer life span, healthier, save money)
4. roadblocks (withdrawal, weight gain, depression)
5. repetition (repeated everytime a patient comes in)
6 stages of the change cycle
1. precontemplation
2. contemplation
3. determination/planning
4. action
5. maintenance
6. relapse/recycle
Describe the harm reduction approach's 3 central beliefs
1. excessive behaviors occur along a continuum of risk ranging from minimal to extreme
2. changing addictive behavior is a step-wise process; complete abstinence being the final step
3. sobriety isn't for everyone
describe the harm reduction approach objectives
1. to mitigate potential dangers and health risks
2. reduce harm associated with the behavior
Identify examples of readiness scaling questions.
1. “You gave yourself a score of X. Why are you at X and not [a lower number]?”

2.“You gave yourself a score of X. What would have to happen for you to move to [a higher number]?”

want to give people positive thoughts
explain the relationship between motivational interview and the trans theoretical model of change
precontemplation: explore the status quo, introduce ambivalence, do not persuade, listen
contemplation: introduce new possibilities
preparation: encouragement and enthusiasm
action: encouragement, reinforce positive actions
maintenance:
what is the prevalence of intimate partner violence?
-1.5 million women are victimized annually
-20-35% of women experience IPV in their lifetime
-11-20% of teens have experienced severe dating violence
what is the prevalence of intimate partner rape?
-8-14% of women have been raped by their partners
what are the consequences of IPV?
-injuries
-STDs
-pregnancy complications
-irritable bowel syndrome
-hypertension
-headaches
-sleep disorders
-death
-stress
-anxiety
-depression
-substance abuse
relevance of IPV to medicine
-patients are harmed both physically and mentally
-your intervention may be the patients best opportunity to get away
-44% of HMO enrollees have a history of IPV
what is the importance of screening for and timely management of IPV?
violence is a constant stressor of the body
-IPV can lead to death
compare and contrast different contraceptive methods
1. barrier: physical object blocks sperm (condoms)
2. chemical: inactivate the sperm (spermicide)
3. hormonal:inhibit ovulation (the pill, the patch, the ring...)
4. family planning:avoiding intercourse during "fertile days"
5. postcoital contraception: pull out method
6. sterilization: surgical permanent birth control
7.abstinence
Identify examples of patient education regarding the different types of contraceptive methods
- express the failure rates
- when to use back up contraceptives
- inform them of contraindications
advantages, disadvantage, barriers: condoms
advantages:
-no rx needed
-prevents against some STDs
-readily available

disadvantage:
-embarrassing
-non private
-risk of improper placement
-high failure rate

barriers:
-irritation
-allergic reaction
advantages, disadvantage, barriers:: female condoms
advantages:
-no rx needed
-can be placed up to 4 hrs prior
-protects against STDs

disadvantages:
-high failure rate
-embarrassing
-non-private
-risk of improper placement

barrier:
-irritation
-allergic reaction
advantages, disadvantage, barriers: diaphragm
advantages:
-privacy
-goes all the way around the cervix

disadvantages:
-requires prescription
-need to have a doctor visit to be fitted

barriers/contraindications:
-allergic reaction
-needs to be refitted with wt change
-associated with TSS
advantages, disadvantage, barriers: cervical cap
ad:
-remain in place for 48hrs
-privacy

dis:
-requires rx
-needs to be fitted
-needs to be removed and cleaned
-can become dislodged

barriers/contra:
-allergic reaction
-TSS
-inflammation
advantages, disadvantage, barriers: sponge
ad:
-no rx
-can be placed at the time of intercourse
-provides lubrication

dis:
-high failure rate
-messy
advantages, disadvantage, barriers: chemical methods
ad:
-privacy
-no rx
-inserted before intercourse

dis:
-irritation
-high failure rate if used alone
-messy

barrier/contr:
-irritation
-UTI
advantages, disadvantage, barriers: OCP (BC)
ad:
-reversible
-offers other benefits
-can be used continuously
-decreases risk of ovarian and uterine cancer

dis:
-rx needed
-daily schedule important

barri/cont:
-breathrough bleeding
-nausea
-dizziness
-breast tenderness
-HX of CVA, breat cancer, CAD and liver disease
-smoking
advantages, disadvantage, barriers: Nuva ring
ad:
-reversible
-offers other benefits
-placed weekly

dis:
-rx needed
-higher cost

barrier/contra:
-vaginal discharge
-vaginitis
-headache dizziness
-HX of CVA, CAD, breast or liver cancer
-smoking
advantages, disadvantage, barriers: the patch
ad:
-reversible
-other advantages

dis:
-rx needed
-high VTE risk
-potential displacement

barrier/contra:
-VTE
-HX of CAD, CVA, breast or liver cancer
-smoking
advantages, disadvantage, barriers: the shot
ad:
-progesterone only (safe in lactation)
-no daily pill
-other benefits

dis:
-rx needed
-office visit every 3 months
-weight gain
-irregular bleeding
-depression
-bone loss

barrier/contra:
-hx of breast cancer
-osteoporosis
advantages, disadvantage, barriers: implants
ad:
-privacy
-reversible
-progesterone only
-other benefits
-highly effective

dis:
-rx needed
-office visit for placement/removal
-irregular bleeding patterns
-weight gain
-bone loss
-depression

barrier/contra:
-weight gain
-breakthrough bleeding
advantages, disadvantage, barriers: IUD
ad:
-other benefits
-privacy
-low failure rate
-easy to use
-reversible
-only progesterone

dis:
-must be placed/removed in office
-weight gain
-bone loss
-depression

barrier/contra:
-cramping
-bleeding
-must be in a monogamous relationship
-high risk for STD
-acute pelvic infections
advantages, disadvantage, barriers: plan B
ad:
-used in episodes of condom failure
-works up to 72 hrs after intercourse
-no rx

dis:
-will not terminate existing pregnancy

barrier/contra:
-nausea
-vomiting
-fatigue
-headaches
advantages, disadvantage, barriers: fertility awareness based methods (FABM)
ad:
-self knowledge of a women's cycle

dis:
-high failure rate
-can not be used with irregular menstral cycles
-requires time
compare the rate of transmission of gonarrhea between men and women
women will contract it 90% of the time
men- 20%
methods for preventing transmission of STDs (4)
1. abstinence
2. wear protection
3. get tested
4. no sharing needles
Identify the screening and confirmation tests for syphilis, gonorrhea, HIV, chlamydia and HPV.
SYPHILIS:
screening: nontreponemal (RPR, VDRL)
confirmation: treponemal (Darkfield, TPPA, FTA-ABS)

GONORRHEA:
confirmation: Gram-stain smear,Culture, DNA probe

HIV:
confirmation:CD4 count, Viral load, Drug resistance tests

Chlamydia:
DNA probes - Genprobe, Enzyme immunoassay – chlamydiazyme, Ligase chain reaction - urine test, Polymerase chain reaction - urine test

HPV:
History, Visual exam, DNA testing, Pap smears,Cervicography
Identify the incidence, prevalence and mortality rate of lung cancer
-incidence increases with increasing age
-prevalence: slightly more common in men than women
-mortality: 60% of lung cancer patients succumb to the disease within one year of diagnosis, and nearly 75% of patients die during the two years following diagnosis.
describe small cell lung cancer
-10-15% lung cancer
- almost always occurs in smokers
- males > females
- located near the brochii
- very aggressive
- tx: chemo and radiation
describe non-small cell lung cancer
- 85% of lung cancers
-males> females
-AA > caucasian
-3 subtypes:
1. adenocarcinoma
2. large-cell undifferentiated carcinoma
3. squamous cell carcinoma
identify risk factors for lung cancer
1. tobacco smoke
2. occupational exposures
3. environmental exposures
4. marijuana
5. radiation to the chest
6. diseases
7. personal or family history
8. diet
effects of direct smoke
tobacco smoke is responsible for 80-90% of all lung cancers
-increase risk of lung cancer
-smoking makes you more susceptible to environmental factors
-rate of recurrence of lung cancer is 3% higher in smokers
describe effects of second hand smoke
-increases the risk for lung cancer
-linked to sinus, cervical, bladder and breast cancer
- known to cause upper respiratory infections in children
List the available treatment options/interventions used to facilitate smoking cessation
1. Medication- Bupropion (Zyban/Wellbutrin), Venlafaxine (Effexor), Varenicline tartrate (Chantix)
2. Nicotine replacement therapy (NRT)- (such as nicotine gum, inhalers, lozenges, nasal sprays, and patches)
3. counseling
-community based therapies
Discuss approaches to screening for lung cancer and their limitations
1. cytology, chest xray: detects disease but does not detect early stages and does not reduce mortality

2. traditional CT: used to distinguish size of lesions; more sensitive than CXR; lots of radiation; can't see small tumors

3. low dose spiral CT: highly sensitive; quick so less radiation; better images than CXR, worse than CT

4. Enhanced sputum cytology analysis: can locate malignant masses in small airways; can't detect peripheral airways

5. autoflorescent bronchoscopy: detects tumors in bronchi; finer visual distinctions; requires bronchoscope
Assess the costs and benefits of screening for asymptomatic lung cancer
BENEFITS: Lung cancer is best treated when detected early

COSTS: less expensive tests can not diagnose early stages
Describe the common symptoms of lung cancer related to local effects of the disease
Unremitting, chronic cough
Hemoptysis or rust-colored sputum
Unexplained weight loss
Progressive anorexia/ loss of appetite
Persistent fever
Dyspnea
New onset wheezing
Recurrent pulmonary infections
Hoarse vocal quality
Pleurisy
Unilateral shoulder pain
Horner’s syndrome - compression of sympathetic chain by lung tumor → ipsilateral ptosis, miosis, anhidrosis of affected side of face
Virchow’s node - enlarged left supraclavicular node
Bone pain
Neurologic changes
Jaundice or icterus
discuss the use of primary, secondary and tertiary prevention in lung cancer
primary: smoking is responsible for 80-90% of lung cancer. primary prevention would be to lower the exposure to smoke

secondary: targets asymptomatic people. figure out who is at risk and encourage then not to smoke. health education policies

tertiary: treatment and support of patients who are symptomatic
mortality rate vs survival rate in screening tests
mortality rate is unbiased and is a good measurement of the effectiveness of a screening test. survival rate is subject to bias. it depends on when the disease is actually detected and there is no evidence that screening vs unscreening is better.
compare lead-time bias, length-time bias and overdiagnosed bias in survival rates
lead-time bias:patients were screened at the same time but one developed symptoms first and had a longer survival time, even though both lived to the same age

length-time bias: tumors grow at different rates. aggressive tumors show symptoms much earlier

overdiagnosed bias: mortality rate is equal in both those that were screened and those that weren't screened
Describe the ten essential public health services.
1. monitor health status to identify and solve community health problems

2. diagnose and investigate health hazards in the community
-communicable disease reporting

3. inform, educate and empower people about health issues

4. mobilize community partnerships and action to identify and solve health problems

5. develop policies and plans that support individual and community health efforts

6. enforce laws and regulations that protect health and ensure safety

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable

8. Assure competent public and personal health care workforce

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.
State when you report a patient with a disease to a health department? Know the General Rule of Thumb.
REPORT THE PATIENT with a disease if any of the following are true:
-If we have a vaccine for the disease
- You haven’t heard about the disease in a while
- Disease is very contagious!