Tipc: Test 2: Review 2

Front 1

1. Define the "natural history of disease" giving the steps and a brief synopsis of each (5 steps)

Back 1

1. Optimum health
---Treating after optimum health but before pathogenic risk factors are added is called primordial prevention
2. Pathogenic risk factors are added
----This is when the physician has opportunity to intervene with risk factor modification
----Treating after pathogenic risk factors have been added but before any detectable abnormalities is called primary prevention
3. Detectable abnormalities are present --> Treating AT this point is secondary prevention
------ This is when the earliest opportunity to intervene by screening is available
-----. Any treating AFTER the detection of abnormalities is tertiary prevention
4. Next are symptoms of the disease
------ When clinical disease may be diagnosed/ treated
5. Last stage is death.

Front 2

What is primary prevention?

Back 2

2. Treating after pathogenic risk factors have been added but before any detectable abnormalities is called primary prevention

Front 3

what is secondary prevention?

Back 3

treating when detectable abnormalities are present

Front 4

what is tertiary prevention?

Back 4

2. Any treating AFTER the detection of abnormalities is tertiary prevention

Front 5

define prevention

Back 5

Preventing the bad, promoting the good.
1. Excellence in the practice of health promotion requires a holistic approach to health that we as osteopathic physicians are uniquely qualified to do;
2. Health is more than the absence of disease, more than discrete biophysical entities that we can currently measure.

Front 6

1. Define the "natural history of disease" giving the steps and a brief synopsis of each (5 steps)

Back 6

1. Optimum health
---Treating after optimum health but before pathogenic risk factors are added is called primordial prevention
2. Pathogenic risk factors are added
----This is when the physician has opportunity to intervene with risk factor modification
----Treating after pathogenic risk factors have been added but before any detectable abnormalities is called primary prevention
3. Detectable abnormalities are present --> Treating AT this point is secondary prevention
------ This is when the earliest opportunity to intervene by screening is available
-----. Any treating AFTER the detection of abnormalities is tertiary prevention
4. Next are symptoms of the disease
------ When clinical disease may be diagnosed/ treated
5. Last stage is death.

Front 7

excellence in the practice of health promotion require what?

Back 7

a holistic approach to health that we as osteopathic physicians are uniquely qualified to do;

Front 8

What is primary prevention?

Back 8

2. Treating after pathogenic risk factors have been added but before any detectable abnormalities is called primary prevention

Front 9

is health influenced only by biophysical factors? if not, what are some of them?

Back 9

1. Emotional and spiritual life
2. Family dynamics and relationships
3. Work
4. Satisfaction
5. Income
6. Food
7. Security
8. Educational status
9. Personal achievements
10. Social support
11. Self esteem

Front 10

what is secondary prevention?

Back 10

treating when detectable abnormalities are present

Front 11

a. Primordial prevention

Back 11

Preventing risks factors
1. Teach healthy diet
2. Low animal products
3. High fiber
4. Proper vitamins

Front 12

what is tertiary prevention?

Back 12

2. Any treating AFTER the detection of abnormalities is tertiary prevention

Front 13

b. Primary prevention

Back 13

 Prevent disease
1. Risk factors are present but disease can be prevented
2. Determine someone has a diet high in animal fats, low fiber and get them to change

Front 14

define prevention

Back 14

Preventing the bad, promoting the good.
1. Excellence in the practice of health promotion requires a holistic approach to health that we as osteopathic physicians are uniquely qualified to do;
2. Health is more than the absence of disease, more than discrete biophysical entities that we can currently measure.

Front 15

c. Secondary prevention

Back 15

 Detect asymptomatic disease
1. Patient shows no symptoms, but disease could be present
1. Pap smear or other screening tests
2. Detect +hemocult --> Flexible sigmoidoscopy to find benign/pre CA polyps

Front 16

d. Tertiary prevention

Back 16

Prevent worsening of symptomatic disease
1. Treatment such as chemotherapy
2. Remove hyperplastic polyps

Front 17

3. Using the intervention activities for primordial, primary, secondary and tertiary prevention explain how to confront diabetes at each stage.

Back 17

a. Primordial: Teach healthy diet
b. Primary: Treatment of obesity
c. Secondary: Checking glucose
d. Tertiary:Treatment to prevent end organ complications

Front 18

4. Describe the role of the Osteopathic Physician in health promotion and disease prevention.

Back 18

a. “Within man’s body there is a capacity for health. If this capacity is recognized and normalized, disease can be both prevented and treated” – AT STILL
b. The whole picture (the Osteopathic view of prevention)
c. The individual  Prevent disease by modifying risk factors, behavioral habits, lifestyle, teach correct way of lifting.
d. The family  Modifying lifestyle of the family makes modification of individuals lifestyle possible.
1. Can’t expect one person to eat differently from the rest or to exercise while the rest are watching TV.
e. The community  The best way to reach the most.
1. To promote change develop a therapeutic relationship.
2. Elicit patient experience with open ended questions
f. Use reflective listening
g. Emphathize
h. Educate

Front 19

1. The body is a unit and structure and function are interdependent is an osteopathic tenet, how does this relate to prevention?

Back 19

1. Shows that harming one part of the body can affect other parts.
2. The patient should prevent harming the body in every way possible, and this should be encouraged by the physician.

Front 20

2. The body has the ability to heal itself is an osteopathic tenet, how does this relate to prevention?

Back 20

1. If the person eliminates risk factors, the body may be able to rid itself of the effects of those risk factors.
1. For example, if a patient quits smoking, the cilia in his throat may regain function.

Front 21

6. Give examples of how Osteopathic Manipulative Medicine is a form of primordial care

Back 21

a. Primordial --> Preventing risk factors --> Teach a mother methods to keep Eustachian tube open and to minimize somatic dysfunction in the area

Front 22

Give examples of how Osteopathic Manipulative Medicine is a form of primary care

Back 22

b. Primary --> Prevent disease --> Treat somatic findings in hope of preventing otitis media
1. E.g. Cervicals and cranial

Front 23

Give examples of how Osteopathic Manipulative Medicine is a form of secondary care

Back 23

c. Secondary prevention --> Treat asymptomatic disease --> i.e. Short leg

Front 24

Give examples of how Osteopathic Manipulative Medicine is a form of Tertiary prevention

Back 24

d. Tertiary prevention --> Prevent worsening of symptomatic disease --> Treat somatic complaints

Front 25

7. Identify the leading causes of death and the factors contributing to premature death in WV and the U.S.

Back 25

a. In both WV and the US the leading cause of death is heart disease.
1. A sedentary lifestyle, bad diet, and smoking contribute to this disease.
b. Cancer is also high on the list
1. Smoking contributes to this disease

Front 26

top 5 factors leading to premature death in WV?

Back 26

1. Heart Disease (obesity, smoking, high BP)
2. Cancer
3. COPD
4. Unintentional death
5. CVD

Front 27

top 5 factors leading to premature death in US?

Back 27

1. Heart Disease
2. Cancer
3. CVD
4. COPD
5. Unintentional death

Front 28

discuss some of the disease percentages in WV as compared to the rest of US

Back 28

1. WV has higher rate of:
1. Heart disease  32.2%
2. Cancer  34%
3. Stroke  25.6%
4. COPD  56.3%
5. Unintentional Death  83.3%
6. Diabetes  31.2%
7. Renal  42%
8. Alzheimer’s disease  2%

Front 29

what 3 things is WV leading in with respect to disease in the US

f. WV is ranked #1 in the US for:?

Back 29

1. Heart attacks
2. Angina
3. Stroke

Front 30

8. What are the top three ACTUAL causes contributing to death? (such as leading to lung cancer etc.)

Back 30

a. Tobacco
b. Exercise
c. Alcohol

Front 31

9. Is AIDS deaths substantial in WV?

Back 31

a. Yes, if you look at the 35-44 yr old age group --> Responsible for 1.9% of all male deaths

Front 32

10. List and give three examples of behavioral risk factors.

Back 32

a. Physical inactivity
1. WV is ranked #11
b. Seatbelt Non-Use
c. Hypertension
d. Obesity
e. Smoking
f. Diabetes
g. Binge Drinking
h. Smokeless Tobacco
i. Drinking and Driving

Front 33

11. Where does WV rank in obesity in the country? What % of WV is considered overweight or obese?

Back 33

a. WV is ranked 3rd in the country for obesity
b. About 65% of the WV population is overweight or obese

Front 34

12. Where does WV rank in prevalence/incidence for hypertension, diabetes, smoking, smokeless tobacco, obesity and seatbelt non-use? Why is this data significant?

Back 34

a. Hypertension  #1
b. Diabetes  #2
c. Smoking  #3
d. Smokeless tobacco  #2
e. Obesity  #3
f. Seatbelt non-use  #20
1. Due to seatbelt law enforcement
g. This shows why the rate of heart disease, cancer, stroke, COPD, and D.M. is higher in WV when the prevalence of tobacco use, hypertension, obesity, and sedentary life style is so high
h. The importance of prevention and educating our patients about their risks and assisting and supporting them in attempts at changing lifestyle is so important.
i. This can be done individually in the office or on a group or community level.

Front 35

13. Describe how lifestyle changes can lead to improved health.

Back 35

a. A person’s lifestyle is the single greatest determinant of a person’s health
1. Up to 50% of what occurs to us may be reversible with the correct lifestyle
b. Ceasing to smoke or drink leads to improved health.
c. So does exercising and eating right.

Front 36

14. List some examples of cost effectiveness of prevention. (3)

Back 36

a. 1$ in outpatient diabetes education saves 2-3$ in hospitalization costs
b. Cervical cancer screening in the low income elderly saves $1,600/person
c. 1$ on school tobacco, drug, alcohol & sex education saves $14 in health care costs

Front 37

15. List your own risk factors for the leading causes of death for your age group and discuss how they can be reduced

Back 37

stop being so sweet. you might spontaneously combust

Front 38

1. What are serological studies?

Back 38

a. IgG to offending antigen
b. Aka ‘serum precipitins’
c. “HP Panel” – call the lab to make sure they look for what you are worried about

Front 39

2. Differentiate between intrinsic and extrinsic dermatitis

Back 39

a. Intrinsic dermatitis
i. ---Atopic dermatitis
ii. ---Childhood history, involves flexor surfaces
b. Extrinsic dermatitis
i. ------Contact dermatitis

Front 40

what is irritant contact dermatitis?

Back 40

i. Contact with noxious substances
ii. Mechanism is non-specific mechanical/chemical action on epidermis
iii. Presentation depends on rapidity of injury and potency of agent
iv. Acute reaction
1. Vesico-bullous eruption with secondary weeping, crusting and ulceration
2. Well-demarcated borders
3. Short lag-time between exposure and development of condition
4. Generally many workers affected

Front 41

what is Allergic contact dermatitis

Back 41

i. Type IV delayed immune reaction
ii. Acquired dermatitis requiring prior exposure to become allergic
iii. Clinical presentation similar to ICD
1. Erythema,vesicles, bullae, blisters, weeping
2. Little to distinguish from ICD
3. May extend beyond the site of direct contact

Front 42

what is urticaria?

Back 42

i. Type I immediate immune reaction to certain substances (contact urticaria)
ii. May also be caused by other agents through non-immune mechanisms
iii. Localized wheal-and-flare reaction
iv. Skin burning, itching, erythema; minutes to 24 hours after contact
v. Systemic symptoms: respiratory sx and anaphylaxis

Front 43

how do you do a work up of urticaria?

Back 43

i. History of exposure and demonstrable urticarial lesions
ii. Timing of symptoms is critical!
iii. Confirmatory testing
iv. Skin scratch/prick testing
v. RAST- specific IgE

Front 44

what is Oil folliculits

Back 44

i. Comedones and inflamed hair follicles (folliculitis)
ii. Direct skin contact with oils or tar:
1. Oil field and refinery workers
2. Engineering industry
3. Diesel mechanics
4. Sheep shearers
5. Road workers

Front 45

how do you treat oil folliculitis?

Back 45

1. Avoid prolonged contact with oils
2. Change protective material regularly
3. Wash with mild soap as needed
4. Other tx measures similar to acne

Front 46

what is Chloracne

Back 46

i. Predominantly open comedones (‘blackheads”)
ii. Slightly different distribution than primary acne (Face/neck/chest)
1. Behind ears
iii. From systemic exposure to PCB’s, dioxins, other chlorinated biphenyls
1. Long half life
iv. Only established human effect

Front 47

a. Elastosis

Back 47

Thinning of skin

Front 48

b. Keratosis

Back 48

Areas of scaly skin

Front 49

please list the 3 types of Skin cancers we are required to know for TIPC

Back 49

i. Non-Melanomatous
1. ----Basal cell carcinoma
2. ----Squamous cell carcinoma
ii. Malignant melanoma

Front 50

what is the most common cancer in US whites?

Back 50

a. Non-Melanomatous

Front 51

what is the main risk factor for non-melanomatous cancer?

Back 51

UV exposure and fair skin

Front 52

please describe Basal cell carcinoma

-common/rare?
-location?
-spread?

Back 52

1. Most common skin cancer
2. 90% on head and neck
3. Nodular/ulcerative lesion
4. Rarely metastasizes but may be locally invasive

Front 53

please describe Squamous cell carcinoma

--where does it occur?
--what does it look like?
--can it spread?

Back 53

1. Occurs in sun exposed skin
2. Actinic keratosis is pre-malignant stage
3. Raised, scaly, erythematous plaque
4. May metastasize

Front 54

please describe malignant melanoma

-common?
spread?
-is UV exposure a risk factor?

Back 54

i. Very rare
ii. Metastasizes rapidly
iii. UV exposure less clearly a risk factor

Front 55

8. Identify the elements of an occupational history

Back 55

a. Exposures at work, worse at work etc.

Front 56

9. Describe the function of an occupational medicine specialist

Back 56

a. Involved in the prevention and management of illness, injury or disability that is related to the workplace

Front 57

10. Define Worker's Compensation and the role of the osteopathic primary care physician in Worker's Compensation

Back 57

i. Workers receive treatment and indemnity benefits
ii. Employers receive protection from lawsuits
iii. TTD  2/3 salary off work
iv. TPD  Partial Wage replacement (Does not exist in WV system)
v. PPD  < 40%  Settlement Permanent partial disability
vi. PTD  > 40%  Never go back to work, get lump sum and pension until 70

Front 58

what is TTD (Temporary Total Disability)

Back 58

means you get benefits while not working

2/3 salary

Front 59

5. Describe the key points regarding obstructive and restrictive lung disease.

Back 59

1. Obstructive: FVC normal unless severe obstruction, FEV1 decreases, FEV1/FVC ratio decreased (used to diagnose)
2. Restrictive: FVC decreased, FEV1 normal or decreased, FEV1 ratio is normal

Front 60

what is TPD

Back 60

Partial Wage replacement (Does not exist in WV system)

Front 61

what is PPD (Permanent partial disability)

Back 61

means you are disabled, just not as bad as the person who has 60% whole person impairment

So LESS THAN 60% damage

Settlement Permanent partial disability

Front 62

What is PTD (Permanently totally disabled)

Back 62

is what you would be in WV if you have a 60% whole person impairment

Never go back to work, get lump sum and pension until 70

Front 63

who funds Worker's compensation?

Back 63

a. Funded by employers
i. Premiums charged on payroll based on:
1. Industry classification - “pooled risk”
2. Claims experience – incentive to improve workplace health & safety

Front 64

define impairment vs. disability

Back 64

Impairment: measurable loss of structure or function
A medical determination

disability: a restriction in activities as a result of an impairment
NOT a medical determination

Front 65

Define occupational health

Back 65

Deals with interface between medicine and work
Two mirrored aspects
Work-related health effects
Health-related work effects

Front 66

define Occupational Injuries and Disease

Back 66

Injuries are much more common than disease
Distinguish by exposure
One exposure, or multiple in rapid succession = injury
Prolonged exposure = disease
Example: Splash strong acid on hands leading to burn is an injury, getting dilute acid on hands for 1 month leading to irritant dermatitis is a disease.

Front 67

define environmental health

Back 67

Impact of the environment on human health
Air, water, food etc.
Follows logically from occupational health
Examples: air pollution, climate change, environmental lead, PCB exposure

Front 68

are occupationally-related conditions specific? are they considerably differnt than non-occupationally related conditions

Back 68

nope

Front 69

what is the single greatest predictor of eventual return to work?

Back 69

time off

by 6 months off, 90% of people will never return to work

Front 70

what is one of the greatest risks to health (this was from the occupational health lecture)

Back 70

long term worklessness

Loss of fitness
2-3X risk of poor health
Depression, 2-3X risk mental illness
20% excess deaths
Greater risk than many “killer diseases”
Greater risk than most dangerous jobs e.g. construction, mining
Trapped on benefits to retirement age
Social exclusion, poverty

Front 71

re-employment will improve general health, but what is one important factor that can alter this

Back 71

That depends on the quality and security of re-employment
There is a persisting risk of poor employment patterns and further unemployment

Front 72

if a patient has some common illness, is it better for them to work or not?

Back 72

For the vast majority of your patients, they are better off working.
There are recognized occupational hazards.

Front 73

describe the hierarchy of controls for a hazard

Back 73

Base of pyramid: personal protective equipment

administrative controls

engineering controls

tip of pyramid: substitution/elimination

Front 74

for a sensitized individual is personal protective equipment an acceptable alternative?

Back 74

no

Front 75

what are the Gell and Coombs classicfications of hypersensitivity rxns?

Back 75

Type I:Immediate hypersensitivity or anaphylaxis
Type II: Cytotoxic reaction
Type III: Immune complex reaction
Type IV: Delayed-type or cell mediated

Front 76

Allergic rhinitis
Allergic conjunctivitis
Asthma
Urticaria
Latex allergy
Anaphylaxis

are examples of?

Back 76

Type I – Immediate Hypersensitivity

Front 77

describe Type IV HS rxns

Back 77

Macrophages process and present antigen to T cells
T cells become activated, secrete cytokines, with further inflammatory cell recruitment to site of antigen
Results in localized granulomatous inflammation
Symptoms usually 48 to 72 hours post exposure

Front 78

Contact allergic dermatitis
PPD, Mantoux testing

are associated with?

Back 78

Type IV – Delayed or Cell-Mediated Immunity

Front 79

Obstruction – Key Points

FVC?
FEV1?
FEV1/FVC ratio

Back 79

FVC normal unless obstruction is severe
FEV1 decreases
FEV1/FVC ratio used to diagnose obstruction
FEV1 used to grade severity of obstruction

Front 80

Restriction – Key Points

FVC?
FEV1?
FEV1/FVC ratio

Back 80

Causes reduced lung volumes
FVC decreased
FEV1 normal or decreased if severe restriction
FEV1/FVC ratio normal

Front 81

what percentage of asthma is related to work?

Back 81

10-15% of all asthma is related to work

Front 82

what is the most common occupational lung disease?

Back 82

asthma

Front 83

describe work-related asthma

Back 83

Pre-existing asthma may be aggravated by work
Asthma may be caused by work
Without latency (irritant exposure)
With latency (sensitization, Type I hypersensitivity or unkown mechanism

Front 84

describe irritant-induced asthma

Back 84

Caused by high-level exposure to irritant gases (chlorine, ammonia, acid mists)
Develop symptoms within 24 hours
Clinically indistinguishable from other types of asthma
Prognosis unclear

Front 85

what is asthma with latency?

Back 85

Allergic or presumed to be allergic
Causes: latex, large molecules (animal dander, detergent enzymes, flour proteins), isocyanates, wood dust

Front 86

2 ways to diagnosis asthma?

Back 86

Spirometry
Methacholine challenge

Front 87

what 2 things does asbestos cause?

Back 87

Pleural changes
Benign (Plaques, thickening, effusions)
Malignant (mesothelioma)
Parenchymal changes
“Benign” (fibrosis) = asbestosis
Malignant (lung cancer)

Front 88

describe the pleural changes due to asbestos

Back 88

Benign (Plaques, thickening, effusions)
Malignant (mesothelioma)

Front 89

describe the parenchymal changes due to asbestos

Back 89

“Benign” (fibrosis) = asbestosis
Malignant (lung cancer)

Front 90

describe the relationship of cigarette smoking and plueral/parenchymal changes seen in asbestos

Back 90

pleural: no relationship

parenchymal: Cigarette smoking contributes
For lung cancer, cigarette smoking and asbestos have a synergistic (multiplicative) effect.

Front 91

if you see small opacities in lung with pleural changes what are you seeing? with no pleural change?

Back 91

with change: asbestos
without: CWP, chronic silicosis

Front 92

what is CWP

Back 92

Small regular opacities in upper lung zones
No pleural changes

Front 93

Acute silicosis

Back 93

Results from high level exposure to freshly generated crystalline silica
Not a fibrotic lung disease
Rapidly fatal
Minimum of 700 workers died during digging of tunnel at Gauley Bridge in late 1920’s.

Front 94

Chronic silicosis

Back 94

Small regular opacities in upper lung zones
May also have larger opacities
No pleural changes
Increased risk of TB

Front 95

Hypersensitivity pneumonitis (HP)

Back 95

Elements of both type III and IV hypersensitivity
Granulomatous disease
Follows a spectrum from acute self-limited flu-like illness to chronic fibrotic lung disease

Front 96

Hypersensitivity Pneumonitis

Back 96

Like, asthma prompt recognition and removal from exposure critical
Treatment is supportive
Often under recognized
Think of it when patients have recurrent ‘flu’

Front 97

90% of all work-related dermatoses are what kind?

Back 97

Occupational Contact Dermatitis

Front 98

are there more irritant or allergic Occupational Contact Dermatitis?

Back 98

70-80% irritant; 20-30% allergic

Front 99

Irritant Contact Dermatitis

Back 99

Contact with noxious substances
Mechanism is non-specific mechanical/chemical action on epidermis
Presentation depends on rapidity of injury and potency of agent

Front 100

if you see Vesico-bullous eruption with secondary weeping, crusting and ulceration
Well-demarcated borders
Short lag-time between exposure and development of condition
Generally many workers affected

what are you thinking?

Back 100

Acute Irritant Contact Dermatitis

Front 101

allergic contact dermatitis is what type of HS rxn?

Back 101

Type IV delayed immune reaction
Acquired dermatitis requiring prior exposure to become allergic
Clinical presentation similar to ICD

Front 102

what are the principles behind workers comp?

Back 102

No fault system
Workers receive treatment and indemnity benefits
Employers receive protection from lawsuits
How does WC differ from tort law?

Front 103

describe how workers comp work, what are the conditions?

Back 103

State law requires that claims be filed for conditions
… which, with a reasonable degree of medical certainty, arose:
in the course of AND
as a result of performing normal job duties.
When in doubt, give benefit to the worker

Front 104

biggest work-related cause of disability is ?

Back 104

low back pain

Front 105

What is Public Health?

Back 105

Not a single product or service provided by one type of health professional in one place
Trans and multi disciplinary
The web of relationships between many different people and organizations about a wide variety of topics
“What we, as a society, collectively do to assure the conditions in which people can be healthy” (IOM)