Preventive Medicine 2
Terms
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- using nicotine replacement (gum or patch) increases the smoking cessation success by how much?
- approx. two-fold
- stats of smoking cessation
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1. 20-50 million US smokers attempt to quit
2. 6% long-term success rate - for best success of smoking cessation:
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1. support from weekly counseling session
2. telephone calls from family and other support groups shown to increase success
3. set a precise quit date to begin complete abstinence
4. pts c/ negative affect (depression) have more difficulty quitting - what med helps to increase success of smoking cessation?
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1. bupropion (+/- nicotine replacement) has 12-mon abstinence rate of >30%, 2x better than nictoine replacement alone
2. Chantax--blocks the nicotine receptors in the brain - on average, pts who quit successfully will gain how much wt?
- mean= 5lbs
- what are the interventions for cervical CA screening?
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1. quadavient HPV vaccine for girls age 11-12, before sexually activity begins (against HPV 6, 11, 16, 18)
2. annual pap smear in women >18 yr or sexually active
3. perform less often if >3 consecutive Paps are nl and pt is monogamous - what are the interventions for breast CA screening?
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1. exam and mammogram every 1-2 yr in women 50-69 yr
2. self exams; annual exam and mammogram in women >40 yr - what are the interventions for colorectal CA screening?
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1. hemoccult annually >50 yr (screen earlier c/ positive FHx)
2. Pt >50 yr--do sigmoidoscopy q5yr or colonoscopy q10yr - what are the interventions for prostate CA screening?
- 1. annual digital exam and PSA should be offered to all men >50 yr
- what are the interventions for endometrial CA screening?
- 1. high-risk pts should have biopsy shortly after menopause
- what are the interventions for other CA screening?
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annual physical exam for signs of:
1. thyroid
2. skin
3. oral
4. testicular
5. ovarian - what are the leading causes of death in adolescents (11-24)?
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1. MVA injuries
2. homicide/suicide - what are the health screening concerns for adolescents (11-24)?
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1. BP check
2. Pap smers
3. rubella status
4. durg and STD education
5. safety - how often should you check for hyperlipidemai?
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check cholesterol and lipids in normal popluation approx every 5 yr in:
1. men age 35-65
2. women age 45-65 - what is the abx prophylaxis for endocarditis?
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1. amoxicillin or
2. erythromycin - when should you consider prophylaxis for endocarditis?
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1. prosthetic valves
2. mitral or aortic valvular dz
3. congenital heart dz
4. prior Hx of infectious endocarditis - what are the essentials of diagnosis for infective endocarditis?
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1. preexisting organic heart lesion
2. fever
3. new or changing heart murmur
4. evidence of systemic emboli
5. evidence of vegetation on echocardiography - what are the m/c organisms causing endocarditis?
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1. viridans strep
2. group D strep
3. s. aureus
4. enterococci
5. HACEK
a. H. parainfluenzae
b. Acinobacillus
c. Cardiobacterium hominis
d. Eikenella corrodens
e. K Kingella ingae - what is the adult immunization recommendation for tetanus?
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1. all require primary series
2. periodic boosters q10yr (proven benefit) - what is the adult immunization recommendation for MMR?
- 1. all require vaccination if born after 1956 s/ immunity (proven benefit)
- what is the adult immunization recommendation for hepatitis B?
- 1. recommended for all young adults and increased risk pts (proven benefit)
- what is the adult immunization recommendation for influenza?
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1. give once in immunocompetent pts >65 yr or
2. to any pt c/ increased risk
(probable benefit) - what is the adult immunization recommendation for Hepatitis A?
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only for high-risk pts (e.g. travelers)
(probable benefit) - what is the adult immunization recommendation for varicella?
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1. adults s/ hx of disease or previous vaccination (probable benefit)
2. in HIV pts, avoid live preparations, but MMR should be given if CD4 ct >500
3. in pregnant pts, live vaccinations are not recommended (MMR, OPV--oral polic vaccine, VZV--varicella zoster virus) - how do you tx traveler's diarrhea?
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1. prevent c/ pepto-bismol
2. tx c/ ciprofloxacin and loperamide - what is prophylaxis for malaria?
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1. chloroquine
2. mefloquine (endemic chloroquine-resistant areas) - what is prophylaxis for Hep A?
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1. vaccine requires 4 wk
2. give IVIG for shrot term - where if typhoid endemic?
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India, Pakistan, Peru, Chile, Mexico
*give oral prophylaxis or inject - where is yellow fever endemic?
- South America and Afica
- where is menigococcus endemic and what is prophylaxis?
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1. endemic in meningococcal belt (sub-Saharan Africa)
2. ensure all other routine immunizations are up to date (MMR, polio, hepatitis B) - what are the sx of a bee/wasp sting?
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1. local inflammation
2. anaphylactic reaction possible - what is tx of a bee/wasp sting?
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1. scrape out stinger if present
2. wash c/ soap and water
3. airway management, IV fluids, cardiac monitioring for systemic effects - what are drug tx of a bee/wasp sting?
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1. epinephrine (1:1000) 0.3-0.5 mL SQ in adults, 0.01 mL/kg in children. may be given a second time in 10-15 min
2. diphenhydramine 25-50 mg IV/IM
3. methylprednisolone 80-120 mg IV. prenisone taper upon stabilization - what are the sx of a black widow (red hourglass on abdomen)?
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1. sharp pain at site
2. deep burning, aching pain along extremity
3. vomiting
4. HA
5. chest tightness
6. hypertension
7. rigid abd muscles - what are the tx for a black widow?
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1. airway managment, IV fluids, o2 cardiac monitoring for systemic effects
2. anti-venim can be give; skin test prior to admin
3. nitrates for hypertension
4. wound care, tetanus prophylaxis, pain relief - what are the si/sx of brown recluse spider ("brown yellow violin" on thorax)?
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1. pain at site
2. nausea
3. myalgias and arthralgias
4. fever, chills
5. rash, necrosis at bite site - what is tx for brown recluse (brown yellow violin on thorax)?
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1. wound care and ice compresses
2. erythromycin PO
3. plastic surgery consult for significant necrosis - what are the si/sx of a snake bite?
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1. fang puncture marks
2. vomiting, diarrhea
3. restlessness
4. dysphagia
5. m. weakness
6. fasciculations
7. generalized bleeding - what is tx for snake bite?
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1. advanced cardiac life support resuscitation as needed
2. type-specific antivenim
3. tetanus prophylaxis
4. monitor for compartment syndrome of affected extremity - what are si/sx of cat bite?
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1. tender regional lymphadenopathy
2. local edema
3. erythema
4. decreased ROM (tenosynovitis) - what is m/c organism involved in a cat bite?
- Pasteurella
- what is tx for a cat bite?
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1. copious irrigation and wound care
2. augmentin PO, IV abx for immunocompromised pts
3. tetanus prophylaxis
4. close follow-up - what are si/s of dog bite?
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1. local edema and erythema
2. Pasteurella also commonly involved
3. unprovoked bite=worrisome for rabies
4. provoked bite=unlikely rabies - what is tx for dog bite?
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1. copious irrigation and wound care
2. tetanus prophylaxis
3. r/o fractures
4. augmentin PO - what are si/sx of human bite?
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1. treat all knuckle injuries in a fight as a human bite
2. erythema, edema, purulence, pain, fever, and chills
3. aerobic and anaerobic bacteria commonly involved - what is tx for human bite?
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1. copious irrigation
2. tetanus prophylaxis
3. augmentin PO
4. IV abx for severe unresolving infxn or in immunocompromised pts
5. r/o fractures
6. close follow-up - Prospective study is more powerful than a .... study?
- retrospective
- Interventional is more powerful than a ... study?
- observational
- what is a clinical trial?
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1. prospective
2. interventional trial
3. pts are randomized into
4. intervention group and
5. control group - define randomization
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1. blunts the effect of confounding factors
2. blinding both clinician and pt (double-blind) further decreases bias - what is a cohort study?
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1. population is divided by exposure status
2. requires large population (cannot study rare disease)
3. can study mulitple effects by exposure
4. can be prospective or retrospective
5. gives relative risk if prospective - what is a case-control study?
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1. pts divided into those with dz (cases) and those s/ dz (controls)
2. fewer pts are needed (good for rare disease)
3. can study correlation of multiple exposures)
4. gives odds ratio
5. always retrospective - which study type is always retrospective?
- case-control study
- what is the definition of sensitivity?
- probability that test results will be positive in pts c/ dz
- what is the definition of specificity?
- probability that test results will be negative in pts s/ dz
- what is the definition of false-positive?
- pt s/ dz who has a positive test result
- what is the definition of false-negative?
- pt c/ dz who has a negative test result
- what is the definition of PPV?
- positive predictive value=probability pt c/ positive test actually has dz
- what is the definition of NPV?
- negative predicitve value=probability pt c/ negative test actually has no dz
- what is the definition of incidence?
- # of newly reported cases of dz divided by total population