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127 Cards in this Set
- Front
- Back
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Top 6 causes of Daly's in Australia?
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CVS
Cancer Mental Nervous system Injury |
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How is Australian health care costs divided amonst public and private?
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Federal = 46%
Private = 32 % State = 22% |
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What is a formula that can quantitate burden of disease in a population?
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DALY = YLL + YLD
YLL = no. deaths x std life expectancy at age of premature death YLD = no. incidence cases x no. years with disability x disability weight |
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Definition of prevalence?
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No. of cases within a population at a given time
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Definition of incidence?
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No. new cases per set time period
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List four broad categories of causes of health inequality?
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Risk Factors
Environmental Biological Behavioural |
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What is a primary prevention strategy which may be employed to reduce health inequity?
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Reduce social inequality
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Tertiary prevention strategy to reduce inequity?
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Target health care services for disadvantaged sick people.
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3 strategies to reduce a communicable disease?
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Immunisation
Education (hygiene etc) Needle and syringe exchanges Surveillance and contact tracing Infection control |
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How could you assess the prevalence of a particular disease in a population e.g. TB?
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Notifiable disease database
Lab specimens Death record Patient data collections Sentinels Surveys |
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Oysters have been associated with a Hep outbreak. List 3 things you would look for to establish it as causation?
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Strength of association (size of odds ratio)
Dose response Timing (exposure before illness) Consistency of results with other studies Plausibility |
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What is an appropriate tertiary management strategy for tuberculosis?
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DOTS - Directly Observed Therapy Shortcourse
(Sputum microscopy, guaranteed supply of drugs, directly observed therapy to ensure compliance) |
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3 effects of TB on society
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Loss of worker
Threat of serious infection Need to screen at risk Costs Discrimination Impact on institutions local economical effect |
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How does society respond to minimise TB's impact?
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Making TB notifiable
Screening migrants Making invextigations free Treating infectious people Providing preventative therapy if exposed Providing chest clinics all across NSW |
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What may limit a migrant's access to quality health care?
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Language
Cost Low SES Discrimination Unfamiliarity with system Fear/mistrust Lack of transport Cultural differences |
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3 risk factors which may contribute to higher incidence of low birth weight babies in the ATSI population?
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Drug and alcohol misuse during pregancy
poor maternal nutrition poor antenatal care/support SES disadvantage Illness during pregnancy |
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What is the most common reason for hospitalisation in the ATSI population?
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Dialysis
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3 most common anatomical sites fractured in the elderly?
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Wrist
vertebrae Hip |
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3 primary prevention strategies to prevent hip fractures.
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Calcium and Vitamin D monitoring and supplements
Regular weight bearing exercise Provision of hip protectors Reduction in obesity |
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3 strategies to prevent falling listed by the National Fall prevention for Older People Initiative
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Provision of walking aids
Risk factor screening by MDT Muscle strengthening and balance training Home hazard assessment and modification Withdrawal of psychotropic meds Cardiac pacing for fallers with orthostatic Hypotens. Thai Chi group intervention |
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1 strategy shown by RCT to reduce no. fractures resulting from children falling from play equipment?
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Increased depth of bark
(engineer visits Support to implement playground safety guidelines reduces observable playground hazards) |
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3 contributors to abnormal stresses or abnormal cartilage leading to development of osteoarthritis?
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Stress: Trauma, dysplasia, obesity, malalignment, muscle weakness, loss of proprioception
Cartilage: Aging, inflammation, metabolic changes, endocrine factors |
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4 strategies considered treatment options for osteoarthritis?
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OARSI guidelines:
Weight reduction Exercise Gait modification Others: Braces, innersoles, footwear NSAIDS at lowest effect dose Intra-articular hyaluronan Glucosamine + chondroitin supplements Avocado and soybean TENS capsaicin cream |
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Two features of acute alcohol intoxication which may cause it to be associated with road accidents/suicides/drowning/trauma.
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Disinhibition
impaired judgement slowed response time incoordination |
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Identify 3 things from the Asthma 3+ visit plan.
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Patient self management education
Development of a written asthma mangement plan Practitioner review |
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3 indicators to access success of strategies to manage/prevent asthma.
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Prevalence rate of astma
Rate of asthma related GP visits Average number of sick days due to asthma per year Death rate for asthma Proportion of patients with a written asthma action plan Proportion of schools using asthma education programs |
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3 respiratory conditions heavily associated with occupational exposure.
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Asthma (15-20% attributable fraction)
Lung cancer (10-30% attributable fraction) COPD (12% attributable fraction) |
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3 control strategies to prevent impact of asbestos on health of individuals
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Eliminate exposure
Substitute for a less toxic compound Isolate exposure from work Engineer safety (eg ventilation) Personal protective equipment |
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3 features of a history to ask a 56 year old to assess if their respiratory symptom is related to occupational exposure.
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Activities undertaken at work, likelihood of exposure
Use of protective equipment Timing of symptoms relative to work and holidays If co-workers experienced similar symptoms Exposure to other on-occupational risks Prior exposure to toxins in other occupation |
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Age of peak for URTI?
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2-4 years (8-10 episodes annually, from 8-10 years 4-6 episodes annually)
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3 most common causes of viral acute respiratory tract infections.
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Respiratory syncytial virus
Influenza Parainfluenza Adenovirus |
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2 of the most important bacterial causes of acute respiratory infections.
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Streptococcus Pneumonia
Haemophilus influenzae |
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2 disorders/situations in which a platelet transfusion is indicated
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Thrombocytopaenia (chemotherapy, DIC)
Abnormal platelets (myelodysplastic disorders, congenital platelet dysfunction. |
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1 indication for using fresh frozen plasma.
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Control bleeding due to a coagulation factor deficiency (e.g. liver disease, warfarin overdose)
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1 indication for using cryoprecipitated plasma.
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Control bleeding due to hypofibrinaemia (congenital or acquired/DIC)
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Adverse consequences of receiving blood products?
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Infection
Transfusion Associated Acute Lung Injury (TRALI) ABO incompatability and immune response Volume overload? |
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3 risk factors predisposing to thrombosis
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Stasis (Long flights, Surgical Procedures, bed rest, severe dehydration, Atrial fibrillation)
Hypercoagulability (Factor V Leiden mutation, Oral Contraceptive Pill use, pregnancy, trauma, malignancy/illness, ) Abnormal vessels (atherosclerosis) |
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2 preventative/secondary prevention methods for people at high risk of DVT.
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Compression stockings
Early post-op mobilization Antiplatelet agents (aspirin) Anti-coagulants (warfarin, heparin) |
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3 conditions associated with worsening heart failure.
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Increasing age
Hypertension Diabetes Obesity Cardiomyopathy Valvular disease Obstructive sleep apnoea |
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2 modifiable behaviours which contribute to the development of heart failure.
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Diet high in saturated fats
Lack of Exercise Smoking Drinking excess alcohol |
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2 risk factors for cardiac failure targeted for promotion by society.
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Smoking (quit campaign/national tobacco campaign)
Diet and exercise (diet helpline, 2 and 5, measure up) Alcoholics anonymous |
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2 patient factors which should be considered when deciding on choice of valve in valvular heart disease.
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Age (length of valve life required, metal>tissue)
Activity level/lifestyle Abilty for anticoagulation (unnecessary in tissue) Valve anatomy Coexistent disease |
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2 broad choices of valve replacement types?
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Mechanical (metal)
Bioprosthesis (xenograft, homograft, autograft) |
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3 risk factors which may contribute to the higher incidence of Rheumatic Heart Disease in the ATSI population.
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Access to health care (low SES, rurality)
Cultural attitudes to healthcare Higher incidence of co-morbidities (high BP, high cholesterol, dental caries) Psychosocial stressors (family/friend death, serious injury) |
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3 social determinants of health.
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Employment status
Education level attained Transport available Food available Accommodation available Social support Stress Early life conditions (SES, Rurality, Culture) |
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2 factors for consideration when counselling families about screening for Down Syndrome.
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Specificity and sensitivity of the test
The risks and negative consequences associated with the tests The proposed action following the receipt of a positive result (availability of action, ethical dilemnas) Consequences for other family members (genetics) |
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2 conditions found more in people with hypertension?
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Stroke
Myocardial Infarct Peripheral vascular disease Heart failure Renal failure? |
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2 factors that cause hypertension.
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Obesity and physical activity
Smoking High salt and cholesterol diet Low fruit and vegetable diet Family history |
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3 primary prevention strategies for hypertension.
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Healthy diet (maintain weight, reduce salt)
Exercise Don't smoke |
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1 secondary prevention strategy for hypertension.
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Screening those at risk by taking blood pressure (ie those who visit the GP and are overweight, poor diet etc)
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3 causes for a non traumatic spinal cord injury.
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Spinal stenosis
disc herniation Rheumatoid arthritis Vascular insult Inflammation (MS, transverse myelitis, infection) Tumour Multiple sclerosis Guillian Barre syndrome |
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What type of movement would you expect to have caused a unilateral dislocation in a traumatic spinal cord injury?
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Flexion with rotation injury
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2 physical consequences of a spinal cord injury on an individual.
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Loss of bowel and bladder continence
Autonomic dysreflexia (injury causes high blood pressure with bradycardia) Paralysis Loss of sensation Inadequate respiratory function Fertility issues |
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3 triggers for autonomic dysreflexia.
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Nociceptor stimulation due to wound
Full bladder or rectum Infection |
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3 risk factors which increase the risk of skin breakdown in pressure ulcers.
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Loss of sensation
Lack of carer support to move patient Co-morbities (moisture from incontinence, infected) Postural deformities Poorly designed equipment Pyschosocial distress Cognitive impairment Smoking Alteration to vascular supply Aging Scar tissue or altered tissue viability |
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Causes of death most significantly increased in the Spinal Cord Injury population?
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Septicaemia (~170 x)
Pneumonia and influenza (~30 x) Diseases of the urinary system (~20x) |
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2 secondary prevention strategies for spinal cord injury.
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Careful retrieval from traumatic situation
Early decompression |
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2 tertiary prevention strategies for spinal cord injury.
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Rehabilitation programs
Self education and management Catheterisation Equipment provision Accommodation and housing adjustments Support organisations e.g. ParaQuad |
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What are the three outcomes for stroke sufferers described by the rule of thirds?
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1/3 recover well
1/3 have serious persisting disability 1/3 mortality within a year |
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What does the pneumonic FAST stand for in terms of stroke recognition?
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Facial asymmetry
Arm weakness Speech disturbance Time to act fast! |
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What kind of management strategies may a MDT in a stroke ward employ?
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PT rehabilitation
OT intervention at home ST to improve swallowing/speech Dietition for texture/supplements Maintenance of hydration Monitoring vitals and blood sugar levels |
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Pharmacological methods used a secondary prevention of a stroke?
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Anticoagulants
Antihypertensives Statins Anti-arrhytmic drugs (Atrial fibrillation) |
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3 risk factors for MS.
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Lattitude away from equator
Scandinavian or Finnish descent Low sun exposure in childhood Family hx Genetics (HLA-DR15) Female |
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2 risk factors for Alzheimer's Disease.
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Age
Less education Trisomy 21 Family history Genetics (Presenilin, APP) |
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Impact of Alzheimers disease on patient's friends and family.
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Carer burden
Emotional distress Loss of work hours Time burden reducing social/exercise activities Physically demanding |
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What objectives does the Living with Memory Loss program have?
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Decrease isolation and depression
Highlight need for future planning Make aware of support groups available Assist education of carers with coping strategies Help understand dementia |
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1 prevention strategy suitable for a population approach to reducing lung cancer.
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'Quit' campaign to raise awareness of the risks of smoking and encourage smokers to stop.
Ban on tobacco advertising (ie everyone in population is effected by the intervention, regardless of risk) |
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1 prevention strategy suitable for an individual approach to reducing lung cancer.
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Doctors recommending patient's to stop smoking
(i.e. screen and then target intervention to those at high risk) |
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3 factors which increase community perception of a situation to be risky.
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Serious consequences of situation
Involves a large number of people Consequences are sudden/acute Involuntary/coerced exposure Rare/exotic/unknown exposure Source untrustworthy Exposure to man made as opposed to natural |
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3 symptomatic predictors for a significant risk of violent behaviour.
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Past history of violence
Persecutory delusions Agitation and anxiety about their own safety Command hallucinations |
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What type of health service sees the majority of serious mental disorders?
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Public Mental Health services
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What type of service sees the majority of mental disorders of any severity?
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General practioners
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2 mental health disorders with high prevalence and low individual risk or behavioural disturbance to society.
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Depression
Anxiety Substance Abuse disorder Personality disorder |
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Prevalence of any mental health disorder in Australia?
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1 in 5
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2 reasons for spending only 8% of total health care system costs on depression and dementia, despite being the top ranked conditions according to YLD.
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Stigma and discrimination
Ignorance of disorders and effective treatment Diversity of mental health disorder (difficulty in implementing treating system) Lack of infrastructure from providers |
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3 CAUSAL risk factors for uterine/endometrial cancer.
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Late menopause
Nulliparity Prolonged unopposed oestrogen exposure obesity PCOS other cancer Familial cancer syndromes |
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2 CASUAL risk factors for uterine/endometrial cancer.
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Hypertension
Diabetes mellitus |
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3 factors that decrease uterine cancer risk.
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OCP
Alcohol Progestogens |
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3 factors contributing to non-compliance in diabetes management.
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Lack of understanding of management requirements
lack of appreciation of seriousness of condition inability to fully financially support management Emotionally draining Not prioritizing management to fit in with everyday life Unwilling to accept Dx of diabetes Worry of side effects?? |
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Non-pharmacological strategies to reduce Blood sugar levels?
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Diet (low GI, low fat, highish protein)
Exercise Weight loss |
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What should you investigate to assess risks for diabetic complications in a diabetic patient?
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Microvascular
-eyes through history and fundoscopy -kidney through EUC/urinalysis -PNS through history and neurological examination HBA1c control Macrovascular -Peripheral vascular disease through examination and history -Cardiac function through examination and history -Atherosclerosis risk through lipid tests |
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What factors may cause a couple's chance of falling pregnant to fall?
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Obesity, Age, Smoking
Female: PID, endometriosis, abnormal uterus, blocked uterine tubes, PCOS Male: Low sperm count and quality/mobility/morphology |
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Management options for a couple suffering from infertility.
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Weight loss/lifestyle changes/health improvement
IVF IntraCytoplasmicSpermInjection Use of donated sperm/eggs adoption |
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What outcomes would departments/committees be interested in collecting to establish evidence for the success and safety of IVF?
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Mother postpartum health (risks associated with IVF)
Number of live births Rate of congenital malformations in IVF conceived babies Number of multiple pregnancies |
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What may be the cause of anovulation in a woman?
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PCOS (high androgens)
Primary ovarian failure (e.g.Turner's syndrome) Low weight Endocrinopathy (e.g. hyperprolacinaemia) Hypothalamic disturbances (anxiety, stress, anorexia) |
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Causes for tubal disease in women causing fertility issues.
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Tubal scarring (previous surgery/ectopic, endometriosis, PID)
Hydrosalpinx Congenital abnormalities |
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3 strategies to recommend to an individual to prevent weight gain.
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Portion control
Low GI foods Low fat Less take-away foods Regular exersice REduction in sedentary behaviours Increased incidental activity Increase participation in active recreation Increase use of active transport |
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3 strategies to prevent obesity at a population level.
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Make healthy foods cheaper
Design healthy foods to be more appealing Reduce junk food advertising Food industry reduction in portion sizes Make outside environments available and attractive for physical activity |
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2 screening tests currently available in Australia.
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Breast - exam+mammograms+U/S
Cervical - pap smear Colorectal - FOB Prostate - PSA + DRE |
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2 most likely outcomes from patient with Chronic Kidney Disease.
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CVD causing premature death
Progression of disease requiring dialysis/transplantation. |
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2 problems with kidney transplant.
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Major operation increased stress and risks
Lifelong immunosuppression required, leading to decreased immune surveillance Regular clinic visits required (Matching HLA types?? Lack of supply, Age of recipients/giver??) |
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Which mode of treatment is cheaper: Hospital haemodialysis or kidney transplant.
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Kidney transplant ($80 000 +$10 000/year)
Hospital Haemodialysis ($100 000) Home Haemodialysis ($55 000) |
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Two potentially treatable/preventable causes of chronic renal failure.
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Diabetic renal disease (high blood glucose levels)
Hypertensive diseases Rapidly progressive glomerulonephropathy Drug related interstitial nephritis Drug toxicity (cisplatin) Obstructive uropathy Early onset chronic infection/vascular disease Hepatorenal syndrome from HCC from Hep B exposure????? |
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Identify at least three determinants of poor child health.
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• Malnutrition
• Low birth weight • Prematurity • Chronic illness • Unsupported parent Maternal exhaustion • Low income of family • Smoking in family • Discrimination • Social unrest and war |
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Which population groups are the largest contributors to the prevalence of poverty in Australia?
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• Lone people
• Couples with children • ATSI population (40% of ATSI in lowest income bracket) |
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List at least two strategies which may be employed to protect children from poor health.
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• Full term pregnancy
• No prolonged separation from family • Supported family • Adequate spacing of children • Adequate income • Employment • Good education • Government benefits |
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List two features which are unavailable to a person who is living in relative poverty (rather than absolute poverty).
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• Water sanitation
• Public transport • Recreation facilities • (rather than food, clothing, shelter) |
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List at least three factors which may contribute to poor compliance in the elderly population?
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• Poor memory
• Multiple medications • Poor instruction provided • Arthritis and child-proof containers • Fear of toxicity; distrust • Unpleasant side effects |
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Identify two strategies which may be used to improve compliance.
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• Webster packs
• Prescribe least number of medications possible • Involve another person in care • Simple dosing • Clearer medication card • Monitoring self medication |
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Beer’s criteria lists medications that are deemed inappropriate in the elderly. Identify at least two of these listed medications.
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• Benzodiazepines
• NSAIDs • TCAs • Digoxin • Antihistamines • Anticholinergics • Serotonin |
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Identify why the elderly may be prone to drug problems
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• Polypharmacy drug interactions
• Age alters pharmacokinetics and pharmacodynamics • Being unwell • Impaired homeostasis |
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What is the predominant mode of transmission of HepB in developed countries?
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• IVDU and sexual transmission
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What is the predominant mode of transmission of HepB in developing countries?
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• Vertical transmission
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What prevention strategies does society employ for Hepatitis B?
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• Vaccination
• Screening blood donations • Universal infection control precautions (eg: for HCW’s) |
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List some causes of food-borne diseases in Australia.
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• Salmonella
• Campylobacter • Shigella • Norovirus • Rotavirus • Enteroviruses • Giardia • Cryptosporidium • Prions |
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Identify two causes of food to be ingested carrying infectious agents.
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• Poor storage
• Being undercooked • Contaminated equipment • Poor hygiene |
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List three foods which definitely or probably protect against some cancers.
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• Non-starchy vegetables mouth, pharynx, larynx, oesophagus, stomach
• Fruits mouth, pharynx, larynx, oesophagus, lung, stomach • Dietary fibre colorectal cancer |
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List foods which have been identified to cause some cancers.
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• Alcohol mouth, pharynx, larynx, oesophagus, colon, rectum, breast
• Salt and salty foods stomach cancer • Red meat and processed meats colon, rectum • Aflatoxin liver |
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Identify what society could do to encourage people to consider their diet as a way to protect their health.
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• Education campaigns
• Food supply policy • Price adjustment |
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What type of justice principle is employed if the action aims to provide the best situation for the greatest number of people?
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• Utalitarianism
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What type of justice principle is employed if the action aims to focus on the benefit for the individual.
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• Libertarianism
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Identify one strategy which would be of a high priority to employ if the rationing of health care was driven by a utalitarinism type principle.
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• Focus on cancer, CVD and respiratory disease as these contribute most significantly to YLL
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How has the incidence and mortality of lung cancer changed in Australia in the last 25 years for men?
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• Falling (by 15%)
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How has the incidence and mortality of lung cancer changed in Australia in the last 25 years for women?
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• Increasing (by 88%)
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List three occupational agents classed by the International Agency for Research on Cancer as category 1 lung carcinogens (ie: sufficient evidence in humans)
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• Arsenic
• Chromium and compounds • Crystalline silica • Mustard gas • Nickel and compounds • Soots containing polycyclic aromatic hydrocarbons • Tobacco smoke • Vinylidene chloride |
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Identify at least two industries classified as Category 1 carcinogenic exposures.
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• Aluminium production
• Coal gasification • Coke production • Iron and steel founding |
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What primary preventative measures could be employed against occupationally induced lung cancer.
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• Control exposure at source
• Use of respiratory protective equipment • Bans on carcinogen use • Use of alternative materials • Giving up smoking • Screening in high risk groups |
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What are the six major components of the national screening program for cervical cancer?
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• Improve communication and education for women and health professionals
• Establish infrastructure for systematic approach to screening • Facilitate regular participation of women in screening programmes • Improve quality control in smear taking and lab processing • Institute fail safe approach for follow up and management • Monitor and evaluate the organised approach |
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List at least two risk factors for breast cancer.
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• Female sex
• Increasing age • Family hx • Parity |
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A 25 year old woman is concerned about her risk for breast cancer due to a strong family history. What management options are available for her?
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• Breast surveillance – MRI, mammogram, ultrasound + clinical examination
• Genetic screen from living, affected family member and then testing for presence of gene, if found, in concerned patient • Prophylactic mastectomy (reduce risk by ~95%) • Ovarian surveillance – NB: should not rely on CA-125 • Prophylactic bilateral salpingo-oophorectomy |
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What gene is associated with FAP (Familial adenoma polyposis)?
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• APC
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List some potential benefits for those found to carry a mutation which increases their risk of cancer.
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• Uncertainty about whether or not they are at risk is removed
• More accurate estimate of risk can be made • Informed of chances of children carrying mutation assist family planning • Advised on surveillance and preventative measures |
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Identify conditions which favour the rapid spread of HIV
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• Receptive anal sex
• Multiple partners • Unprotected penetrative sexual intercourse • Presence of ulcerative disease • Acute infection high HIV viral load • Sex in homosexual population (due to high prevalence) |
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What factors may help reduce the spread of HIV?
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• Prevent unprotected sexual behaviour
• Reduce HIV viral load treat HIV • Post exposure prophylaxis • Knowledge of HIV status reduces risky behaviour • Perception of risk to self and others (ie: education of travellers) • Access to condoms • Self esteem power to negotiate safe sex • Avoid sex, drugs and alcohol combination • Avoid needle sharing needle syringe exchange program |
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List four AIDS defining events.
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• Opportunistic infections: Pneumocystis carinii, reactivation of toxoplasmosis
• Specific malignancies: Non Hodgkins lymphoma, Kaposi’s sarcoma • Severe neurological disease: AIDS dementia • Metabolic derangement: Wasting syndrome with profound weight loss |
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What is one opportunistic infection which only requires a relatively slight immundepletion to occur?
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TB
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What is one opportunistic infection which requires a more significant immundepletion to occur?
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CMV
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