ABPM Board Exam
diabetes prevalence
-2% of world population has diabetes -9.4% of U.S. population has diabetes -22 million DM is 7th leading cause of death DM is leading cause of blindness, renal failure, amputation
4 groups that benefit from statins
1 - clinical athersclerotic CVD (ASCVD) 2 - LDL-C >= 190mg/dl 3 - Diabetes (I or II, age 40-75) 4 - >=7% 10yr ASCVD risk and age 40-75
3 leading causes of cancer deaths (WOMEN)
1 - lung 2 - breast 3 - colorectal
3 leading causes of cancer deaths (MEN)
1 - lung 2 - prostate 3 - colorectal
Survival rate formula
survival rate = 1 - case fatality rate
The Red Book refers to the CDC's...
the CDC's standard resource for pediatric infectious disease
The ECHO pharmacoeconomic model refers to _____?
the economic, clinical, and humanistic outcomes model for pharmacoeconomic evaluation, in which an intervention is viewed as a combination of clinical, economic, and humanistic outcomes
The Pink Book is a resource published by the CDC on...
the epidemiology and prevention of vaccine-preventable illnesses
Direct non-medical cost examples
transportation lodging for family members additional home care disability payments by employer, pension fund, social security
Smoking cessation (USPSTF)
(A recc) screen all adults (incl preg); MD should provide tobacco cessation interventions (X pharm for preg) (B recc) ages 10 - 17*; A, A, R *approx 25% of teens used tobacco in 2009
Alcohol screening recc (USPSTF)
(B recc) screen and counsel adults to reduce alcohol misuse
CVD/Colorectal CA Primary prevention Aspirin recc (USPSTF)
(B-recc) adults 50-59 with 10yr CVD risk >=10% who are not at increased risk for bleeding, have a life expectancy 10+yrs, and willing to take ASA for at least 10yrs (C-recc) adults 60-69
Depression screening recc (USPSTF)
12+ yo (incl preg and postpartum) PHQ2
Symptoms of acute radiation syndrome after whole-body exposure to >2 Gy typically begin ______ - ______ days after exposure.
21-60 days Treatment is based on symptoms. 1 Gy = 100 Rad
Overall cancer mortality (2015)
23% of the population will die from cancer
Obesity Prevalence
40% of adults in US 11% of adolescents at risk
Colorectal cancer screening (USPSTF)
50-75yo (no direct comparison btw screening tests, BEST is whichever one pt agrees to) Best, if pt willing: colonoscopy Q10 yrs OR stool DNA Q3 yrs
Lung cancer screening (USPSTF)
55-79 with 30 pack year Hx who smoked in past 15 yrs low-dose CT EXCLUDE if have significant comorbidity (COPD) b/c can't tolerate curative surgery
The barometric pressure at maximal allowable cabin pressure is _______ mmHg.
564 mmHg
Dental health recc (USPSTF)
6+months old with fluoride defient water fluoride varnish to teeth at age of primary tooth eruption
The CDC recommends that patients who had a pneumococcal vaccine between ages 19 and 64 receive a second vaccination after age ____?
65
Fall prevention recc (USPSTF)
65+ community dwelling @ risk vitD AND exercise or PT risk = hx of falls
The USPSTF recommends that MEN ages _____-____who have any history of smoking should be screened for abdominal aortic aneurysm with an ultrasound.
65-75
In normal individuals, the alveolar partial pressure of oxygen at the maximal allowable cabin pressure is _____ mmHg. The arterial partial pressure of oxygen at the maximal allowable cabin pressure is ______ mmHg.
69 mmHg (alveolar) 60 mmHg (arterial)
The maximum allowable cabin pressure in commercial airlines is ________ feet.
8000 (2439 meters)
What percentage of school-aged children have ever been diagnosed with ADHD?
9%-12% Studies suggest that ADHD is present in most cultures in approximately 9% of children. There is a 2:1 male:female ratio in children and a 1.6:1 ratio in adults
At 8000 feet, the oxygen saturation should be approximately ____ % for a PaO2 of _____ mmHg based on the oxygen saturation curve.
90% 68 mmHg
95% confidence interval calculation
95% CI = mean +/- 2 (SD / square root of #subjects)
Gastrointestinal illnesses account for ______% of visits by passengers to ships' infirmaries
<10% of visits
Vaccine Efficacy formula
= 1 - (incidence vaccinated / incidence unvaccinated) = (Attack rate unvac - Attack rate vac) / Attack rate unvac x 100
TRUE Type II error, also known as beta, is the probability of concluding that treatments do not differ when they actually do.
A Type II error is the probability of concluding that treatments do not differ when they actually do. TRUE or FALSE?
The CDC recommends employing food and water precautions to avoid infectious diseases from contaminated food and water. Which of the following precautions are recommended to avoid traveler's diarrhea (select all that apply) A) Food should be fully cooked food and served hot. B) Avoid salads and unpasteurized milk products, including cheese and yogurt. C) Raw fruits and vegetables need not be avoided. D) Alcohol-based sanitizers are effective against all pathogens. E) Contaminated tap water can cause infection if inadvertently inhaled while showering.
A, B, and E. Contaminated food and water can transmit a variety of infectious diseases to travelers, including shigellosis, E. coli infection, bacillary dysentery, cryptosporidiosis, hepatitis A, norovirus, and typhoid fever. They can also be a source of infection for cholera and diseases caused by parasites. Many of these diseases are transmitted by the fecal-oral route, including swallowing and inhaling aerosols or droplets. Travelers should select food carefully and avoid raw or undercooked meat, fish, and shellfish. If the sanitation and hygiene are inadequate in a region, travelers should avoid salads, uncooked vegetables, and unpasteurized milk, milk products, and fruit juices. In these areas, travelers should only eat food that is fully cooked and served hot or fruit that has been washed in clean water and peeled by the person who is eating it. Raw fruits and vegetables should be avoided unless peeled, and eggs should be thoroughly cooked. Travelers should thoroughly wash their hands with soap and water before eating and after using the bathroom, changing diapers, or after coming into direct contact with preschool-aged children, animals, or feces. Alcohol-based sanitizers should be used when soap and water are not available, but they are not effective against norovirus and cryptosporidium. C. FALSE: Raw fruits and vegetables should be avoided. If eaten, they should be peeled by the person who will consume them. D. FALSE: Alcohol-based sanitizers are not effective against norovirus or cryptosporidium. All alcohol-based sanitizers should contain >60% alcohol.
Which of the following OTC medications can be used for motion sickness (select all that apply)? A) Dimenhydrinate B) Promethazine C) Diphenhydramine D) Meclizine E) Scopolamine
A, C, and D. TRUE: Dimenhydrinate is Dramamine. Meclizine is Bonine. These are anticholinergic agents that are sold over the counter to prevent motion sickness. They should be taken before travel. Cyclizine (Marezine) is another OTC anticholinergic agent used to treat motion sickness. Diphenhydramine (Benadryl) is a first-generation antihistamine that can be useful for treating nausea and prevention of motion sickness. Patients should be informed that these agents are sedating and should not use them while consuming alcohol or taking other central nervous system depressants. They also should not drive or operate heavy machinery when taking these agents. B. FALSE: Promethazine is only available by prescription. E. FALSE: Scopolamine is only available by prescription.
What is the quantification of the course of toxicant absorption, distribution, biotransformation, and excretion? A) Toxicokinetics B) Toxicodynamics C) Bioavailability D) Biological half-life
A. Toxicodynamics refers to the effects of toxicants and their metabolites on body systems. Half-life is the time it takes for a toxicant to lose half of its activity. Bioavailability is a subcategory of absorption.
Which model is a prospective, hospital-based system designed to standardize units of hospital activity in order to link prices? A) Medicare Severity-Diagnosis Related Groups B) International Statistical Classification of Diseases and Related Health Problems C) Resource-Based Relative Value Scale D) Ambulatory Payment Classifications
A. TRUE: Diagnosis-related groups (DRGs) were designed to describe all types of patient care in an acute care hospital. The classification of groups allows hospitals to manage costs and allows payors, such as Medicare, to bind reimbursements to DRGs.
Which of the following is incorrect with regards to screening for sexually transmitted diseases (STDs)? A) All patients being evaluated for STDs should be offered counseling and testing for HIV. B) Asymptomatic women with risk factors for STDs should be screened for gonococcal or chlamydial infections. C) HIV-infected patients should be screened annually for N. gonorrhoeae. D) Pregnant women should be screened for Chlamydia trachomatis. E) All sexually active women and pregnant women need to be screened for herpes infections.
ANSWER: E. E. This is the incorrect (false) statement: The US Preventive Services Task Force (USPSTF) recommends against routine serologic screening for herpes simplex virus (HSV) in asymptomatic pregnant women and in asymptomatic adolescents and adults. According to the 2010 CDC treatment guidelines for STDs, all patients being evaluated for STDs should be offered HIV testing. All women with risk factors for STDs should be screened for a gonococcal or chlamydial infection annually. Hepatitis B screening should be offered to men who have sex with men (MSM), patients with a history of multiple sex partners, or those who abuse intravenous drugs. It is recommended that sexually active MSM undergo annual testing for N. gonorrhoeae, Chlamydia trachomatis, HIV, and syphilis. Pregnant women should be screened for Chlamydia trachomatis, HIV, hepatitis B, and syphilis infections. Patients with HIV should be screened annually for N. gonorrhoeae, Chlamydia trachomatis, syphilis, hepatitis B, and hepatitis C. Local and state public health departments should be kept informed of chancroid, Chlamydia trachomatis, N. gonorrhoeae, acute hepatitis B and C, HIV, and syphilis.
AR formula (Attributable Risk)
AR = (event of interest / subjects) - (event in controls / control subjects) AR = incidence in exposed - incidence in unexposed
AR% formula (Attributable Risk Percent)
AR% = (risk exposed - risk unexposed) / risk exposed x 100
Brucellosis is a zoonotic infection transmitted by contact with fluid from infected animals or from food products derived from these animals. These animals include ___________?
Animals primarily include cattle, sheep, pigs, and goats.
Alcohol-based sanitizers are effective against norovirus or cryptosporidium. TRUE or FALSE?
FALSE Alcohol-based sanitizers are not effective against norovirus or cryptosporidium. All alcohol-based sanitizers should contain >60% alcohol.
HTN initial meds (JNC VIII)
Blacks; Ca++ channel blocker or thiazide diuretic CKD; ACE inhibitor or ACE receptor blocker Everyone else; ACE inhibitor, ACE receptor blocker, Ca++ channel blocker or thiazide diuretic
Oral calcium or aluminum phosphate can block absorption of thallium-201. TRUE or FALSE?
FALSE Oral calcium or aluminum phosphate solutions can block the absorption of strontium.
Data analysis for a clinical trial leads to the conclusion that there is no difference between 2 drugs for muscle spasm. In reality, 1 drug is superior to the other. Which of the following describes this conclusion? A) Type I error B) Type II error C) Correct decision D) Error of omission
B. Type II error, also known as beta, is the probability of concluding that treatments do not differ when they actually do.
In which circumstance is a test for cure recommended after treatment of an uncomplicated gonorrhea infection? A) If the patient is a male who has sex with men B) If treatment was with a cefixime-based regimen C) If infection was asymptomatic at the time of diagnosis D) If the initial diagnosis was made without culture
B. Uncomplicated gonorrhea infections treated with a ceftriaxone-containing combination regimen do not require a test of cure if the patient has no further symptoms. However, a test of cure should be performed if an alternate treatment regimen is used. Men who have sex with men have a higher prevalence of resistant infection.
How long after leaving an endemic area should a traveler continue to take chloroquine for malaria prophylaxis? A) 3 days B) 1 week C) 4 weeks D) 8 weeks
C. Chloroquine prophylaxis should begin 1 week prior to exposure and end 4 weeks following exposure. Mefloquine and doxycycline are also continued for 4 weeks after exposure. Atovaquone-proguanil and primaquine only need to be continued for 1 week following exposure.
When designing a study to investigate the effects of gender and geographic location on weight, which of the following measurement scales describes the variables of weight and gender, respectively? A) Ratio, ordinal B) Nominal, interval C) Ratio, nominal D) Ordinal, nominal
C. Ratio, nominal. Explanation: Weight is measured on a ratio scale, which has a zero point, allows ranking, and contains equal intervals. Gender is measured on a nominal scale, which places people or things into categories that are mutually exclusive but not ordered. The other choices are wrong becase: (A) Gender is a nominal or categorical variable. (B) The orders are reversed. An interval variable is a measurement where the difference between 2 values has meaning, but there is no absolute zero. A ratio scale is a type of interval scale. (D) In ordinal variables, the order is important, but the interval differences between values are not equal. Ordinal scales give no information about the difference in quantity between variables.
Researchers are designing a randomized trial and would like to estimate the sample size that will be needed. What information is needed in order to make this calculation? A) Loss to follow-up rate B) Treatment compliance rate C) Level of statistical significance D) Disease prevalence in population
C. Sample size calculation requires a level of statistical significance (alpha), desired power (1 - beta), the difference in response rates to be detected, the estimated response rate in 1 of the groups, and identifying whether the test is 1-sided or 2-sided.
A researcher visits the classrooms in an elementary school and records the number of students present in each room. Her resulting data is of what type? A) Continuous B) Dichotomous C) Discrete D) Binary
C. Numbers of students are a discrete variable because the values are integers. The data are not continuous, as fractions of students cannot be counted. If there were only 2 possible results in each classroom, the data would be binary or dichotomous.
The creation of the Federal Emergency Management Agency (FEMA) in 1979 led to the institutionalization of emergency management. Current paradigms are constructed around 4 stages of emergency management. Which of the following is part of the 4 stages of emergency management? A) Pre-impact B) Surveillance C) Mitigation D) Post-impact E) Prodrome
C. TRUE: The 4 stages of emergency management include mitigation, preparedness, response, and recovery. Mitigation refers to the prevention of future emergencies or minimizing their effects. Preparedness refers to plans or preparations made to handle an emergency, including evacuation plans and stocking food and water. Response indicates a safe action in an emergency, including actions taken to save lives and prevent further property damage. These activities take place during the emergency. Recovery refers to actions taken to return to a safe or normal situation after an emergency and includes obtaining financial assistance.
An epidemiologist investigates a waterborne disease outbreak associated with recreational water. If the etiological factor is identified, it will most likely fall into which category? A) Bacterium B) Virus C) Parasite D) Chemical
C. TRUE: In a CDC study of 2009-2010, only 60% of waterborne disease outbreaks associated with recreational water had an etiological factor identified. Of those, 55% were caused by Cryptosporidium.
All patients should be decontaminated before any treatment or stabilization after radiation exposure. TRUE or FALSE?
FALSE Patients should be stabilized then decontaminated, beginning with the removal of clothing. After the patient has been stabilized, he or she should be surveyed with alpha and Geiger counters to evaluate radioactivity, which should be documented on an anatomic chart and used to determine the sequence of decontamination of intact skin. Decontamination should begin with debridement of open wounds.
Prussian blue should be administered to patients potentially exposed to radioactive iodine. TRUE or FALSE?
FALSE Supersaturated potassium should be used to treat all patients potentially exposed to radioactive iodine. Prussian blue is administered to prevent recycling of radioactive substances in patients contaminated with substances like cesium-137 or thallium-201.
The use of fans indoors should be encouraged during extreme heat events. TRUE or FALSE?
FALSE The use of fans indoors in the absence of air conditioning should be discouraged during an EHE when the heat index is >99°F because blowing air warmer than body temperature over the skin surface increases heat stress
A 12-month-old child is given the first dose of MMR vaccine and has a high fever and a mild rash for a few days. The provider should call the vaccine adverse effect hotline. TRUE or FALSE?
FALSE There is no need to call the vaccine adverse effect hotline since this is not a serious reaction. However, if a child gets seizures, deafness, or altered consciousness, then the vaccine adverse effect hotline should be called.
Cost-minimization analysis is used to compare 2 products that are equivalent in _______ and ________ to project the ______?
Cost-minimization analysis refers to a method of calculating the cost of drugs to project the least costly drug or therapeutic intervention. It is used to compare 2 products that are equivalent in dose and therapeutic effect.
A county's public health department is currently investigating a recent outbreak of measles in the community. Eight individuals have developed measles since the outbreak began. Which additional factor would be needed in order to calculate an attack rate? A) Number of people vaccinated against measles B) Number of people with previous measles infection C) Number of people exposed to 1 of 8 affected individuals D) Number of people at risk for measles infection
D. Attack rate is defined as the number of people in whom a certain illness develops divided by the total number of people at RISK.
Which of the following changes occurs with exposure to high altitude in air travel? A) Significant reductions in atmospheric pressure begin to occur at 10,000 feet above sea level. B) Increased temperature can contribute to increased physiological consequences of altitude. C) At the same altitude, barometric pressure at the equator is lower than at distances from the equator. D) Barometric pressure is the primary determinant of the partial pressure of oxygen in inspired air. E) FiO2 decreases with altitude
D. Barometric pressure is the primary determinant of the partial pressure of oxygen in inspired air (PiO2). It decreases with altitude but increases in hyperbaric environments at depth. The fraction of oxygen in inspired air does not change with altitude. The relationship between barometric pressure, FiO2, and PiO2 is expressed as PiO2 = FiO2 x barometric pressure. In addition, the PiO2 is reduced by the partial pressure of water vapor that is obtained during transport of air into the lungs (47 mmHg). This relationship is expressed as PiO2 = 0.21 - (barometric pressure - 47 mmHg). A. FALSE: Significant reductions in atmospheric pressure occur beyond a critical height of 2500 meters or 8200 feet in altitude. B. FALSE: Factors that increase the physiological consequences of altitude include decreased temperature and deteriorating weather. C. FALSE: Because of a large mass of cold air above the equator, the barometric pressure at a given altitude is higher at the equator than at distances from the equator. E. FALSE: The FiO2 is the same at all altitudes. The partial pressure of oxygen changes with altered barometric pressure.
A drug was approved for the treatment of depression in adults 2 years ago. Since then, there have been several case reports of neutropenia in patients taking the drug. Researchers are now planning a clinical trial to further evaluate any association between the drug and neutropenia. What is the most appropriate classification for this trial, according to US Food and Drug Administration (FDA) standards? A) Phase I B) Phase II C) Phase III D) Phase IV
D. Phase IV testing is also known as post-marketing surveillance and is used to further monitor and study drugs that have already been approved.
Which of the following patients should be screened for colorectal cancer with a fecal immunochemical test (FIT), according to the United States Preventive Services Task Force (USPSTF)? A) A 45-year-old male with 20 pack-year history of tobacco use B) A 78-year-old male with diabetes C) An 87-year-old male whose father died of colon cancer at age 85 D) A 55-year-old male who had a negative colonoscopy 4 years earlier E) A 56-year-old male who had a negative flexible sigmoidoscopy at age 50
E. The USPSTF recommends screening for colorectal cancer in all individuals after age 50 and continuing until age 75. The median age at diagnosis is 68 years. Colorectal cancer is most frequently diagnosed among adults ages 65-74 years; the median age at death from colorectal cancer is 68 years. There are a variety of screening modalities with recommendations. For patients who choose to be screened with flexible sigmoidoscopy, the USPSTF recommends flexible sigmoidoscopy every 5 years or every 10 years in combination with FIT. Evidence has shown that flexible sigmoidoscopy alone reduces deaths from colorectal cancer and, when combined with FIT, reduces colorectal cancer-specific mortality even more. The USPSTF also recommends aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in average-risk adults. A. FALSE: The USPSTF did not review specific populations at risk, but for most adults, the most important risk factor is older age. The recommendations are for screening starting at age 50. B. FALSE: The USPSTF recommends that the decision to screen for colorectal cancer in adults ages 76-85 years should be made after taking into account the patient's overall health and prior screening history. C. FALSE: The USPSTF does not recommend routine screening in individuals over age 86. In addition, a family history of colorectal cancer at an early age is a risk factor. D. FALSE: Colonoscopy is indicated every 10 years as a screening method.
Cost-benefit analysis compares different interventions and outcomes relative to _____?
Expected benefits minus the total cost of implementation. Cost-benefit analysis is a technique to assist with decision making. In a cost-benefit analysis, expected benefits of an intervention or project are subtracted from the total cost of implementation, measured in monetary units.
Skin cancer screening (USPSTF)
Fair skinned 10-24; counsel to avoid UV radiation NOTE skin ca is THE most common cancer of all
Diagnosis of Diabetes
Fasting blood sugar >125 (2 readings) Random blood sugar > 200 PLUS symptoms of hyperglycemia HgbA1c >=6.5 (diabetes); 5.6-6.4 (prediabetes)
Gonorrhea treatment
Gonorrhea TX: IM Ceftriaxone Cover Chlamydia with: azithromycin : 1 g orally as a single dose doxycycline : 100 mg orally twice daily for 7 days
Which cancer causes the most deaths in the US annually?
Lung cancer (colorectal is #2)
Pregnancy screening @ 1st visit (USPSTF)
HepB surface antigen syphylis (RPR) HIV Rh incompatability
For 12- to 17-year-olds in the United States, what is the ranking of racial/ethnic subgroups from highest to lowest with regards to their 12-month prevalence of alcohol use disorder?
Hispanics > Native Americans and Alaska Natives > Caucasians > African Americans > Asian Americans and Pacific Islanders At any age and in any race/subgroup, men have higher rates of alcohol use disorders than women.
Type I allergic reaction is mediated by...
IgE and is immediate. It can lead to anaphylaxis and angioedema and may cause urticaria. I. Allergic, Anaphylaxis, Atopy II. anti-Body III. immune Complex IV. Delayed
Abdominal Aortic Aneurysm Screening (USPSTF)
MEN 65 - 75 who have EVER smoked (1X screen w ultrasound) 100+cigarettes
Which patients should be screened for an abdominal aortic aneurysm with an ultrasound?
MEN ages 65-75 years who have ever smoked. Selective screening should also be offered for MEN ages 65-75 years who have never smoked.
Mortality formula
Mortality = incidence x case fatality
Should women with dense breasts be routinely screened with MRI and 3D mammogram?
NO
When do you use OR instead of RR? OR = Odds Ratio RR = Relative Risk
OR is only for case-control
Cadmium Exposure Symptoms include...
Osteomalacia and kidney damage are associated with exposure to cadmium.
An infant death at 60 days old would qualify as which type of mortality?
Postneonatal First 28 days of life (neonatal) 29 days through 1 year of life (postneonatal) First 6 weeks after birth (post partum) First 28 days of life, including stillbirths (perinatal)
Power Calculation Formula
Power = 1 - Beta Beta = Type 2 Error
Prevalence formula
Prevalence= incidence x duration / 1 + (incidence x duration) Prevalence = incidence x duration (when prevalence is low)
Relative Risk
RR = [a/(a + b)] / [c/(c + d)] or RR = incidence in exposed / incidence in unexposed RR can be estimated by OR (same formula, but OR uses case control study results)
American Academy of Pediatrics' (AAP's) 2011 lipid management recommendations for children and teenagers include...
Screening should occur as early as 2 years of age with a family history of CVD or hyperlipidemia. Lower LDL cut points are proposed for the initiation of treatment, depending on risk level. All children should be screened for cholesterol at least once between ages 9 and 11. Emphasis is now on overweight status, high TG, and low HDL managed with lifestyle interventions and weight management.
Hydrocarbon pneumonitis is treated ______?
Supportively, depending on the degree of toxicity. Asymptomatic patients should be monitored with pulse oximetry and radiographic evaluation at least 4-6 hours after ingestion or sooner if symptoms occur. Patients with mild to moderate respiratory symptoms should have a chest x-ray and monitoring for 24-48 hours with supplemental oxygen as needed. They should also be NPO initially with maintenance IV fluids. Patients who do not respond to oxygen and beta-2 bronchodilators or with lethargy and coma should be intubated. ECMO or high-frequency ventilation may be beneficial in patients with hydrocarbon pneumonitis and respiratory failure unresponsive to conventional mechanical ventilation. Benzodiazepines are indicated for patients with seizures. DO NOT USE: Antibiotics Corticosteroids Epinephrine (may trigger fatal ventricular dysrhythmia) Isoproterenol
Type IV allergic reaction is mediated by...
T lymphocyte cells. It is delayed and may take 2-3 days to occur. It is a cause of contact dermatitis and is mediated by cells. I. Allergic, Anaphylaxis, Atopy II. anti-Body III. immune Complex IV. Delayed
Specificity formula
TN / (TN + FP) or 1 - Type I Error
Sensitivity formula
TP / (TP + FN) or TP / prev
PPV formula
TP / (TP + FP)
Bartonella henselae is associated with cat scratch disease. TRUE or FALSE?
TRUE
Indicated programs are designed for those who are already experimenting with drugs in order to encourage them to quit and remain abstinent. TRUE or FALSE?
TRUE
PRECEDE/PROCEED is a framework used for health program planning and policy-making, which includes phases of diagnosis, implementation, and evaluation. TRUE or FALSE?
TRUE
Pasteurella is isolated from 75% of cat bite wounds. TRUE or FALSE?
TRUE
Patients who have only been exposed to gamma radiation pose no risk of contamination to medical personnel. TRUE or FALSE?
TRUE
Proportionate mortality is the number of deaths due to a disease in a specified time period divided by the total number of deaths during the time period. TRUE or FALSE?
TRUE
Statistical power refers to the likelihood that a study will detect an effect when there is an effect present. TRUE or FALSE?
TRUE
TRUE or FALSE? Hierarchy of study designs: Descriptive -case report -case series Observational -pre/post -ecological -cross-sectional -case-control -cohort (prospective, retrospective) Experimental -RCT -quasi-experimental (natural experiment) Summary -meta-analysis -decision analysis
TRUE
The construct of reciprocal determinism states that individual behavior and environment influence and are influenced by each other (i.e. a reciprocal interaction). This suggests that a person's actions and function are the results of a dynamic interaction between personal characteristics, behavior, and environment. TRUE or FALSE?
TRUE
You should suspect a cohort effect whenever you see a decline of an event in older age groups TRUE or FALSE
TRUE
Type I error (conclude there is a difference when there is not) refers to the rejection of the null hypothesis when no true difference exists in the population. TRUE or FALSE?
TRUE Also, Alpha refers to the probability of making a type I error.
The Yellow Book is the CDC's Health Information for International Travel. TRUE or FALSE?
TRUE The Yellow Book is the CDC Health Information for International Travel. It is published every 3 years. Although it is written primarily for health professionals, it can be a useful resource for any international traveler wanting to learn about health risks when traveling abroad. It includes advice about epidemiology, pre-travel preparations, treatment of minor travel-related illness, and preventive measures to avoid illness or injury when traveling internationally. It also contains detailed information about infectious diseases related to travel throughout the world and advice for travelers with specific needs. The Pink Book is a resource published by the CDC on the epidemiology and prevention of vaccine-preventable illnesses. The Pink Sheet is a publication of biopharma regulatory, legislative, and business developments. The Orange Book is a list published by the Food and Drug Administration with approved drug products and their generic equivalents. The Red Book refers to both the CDC's standard resource for pediatric infectious disease and to the reference on drug pricing data used primarily in community pharmacies.
Incidents are generally managed at the local level, although a few disasters require federal support. TRUE or FALSE?
TRUE Surrounding communities may be involved in any level of disaster response, particularly level II and level III. Regional efforts typically occur during level II and III disasters. When an incident exceeds or is anticipated to exceed local and state resources, the Federal Government will use the National Response Framework to add support (FEMA) The fire department may be involved in any level of disaster. A local health department is involved in all levels of disaster response.
The PiO2 is greater than the arterial and alveolar pO2 at all altitudes. TRUE or FALSE?
TRUE The PiO2 is greater than the arterial and alveolar pO2 at all altitudes. As a result of anatomical dead space, all inspired oxygen is not involved in gas exchange
Zinc deficiency can result in severe dermatitis. TRUE or FALSE?
TRUE Zinc deficiency can result in severe dermatitis. This has been reported in infants receiving parenteral nutrition during a nationwide injectable zinc shortage.
The US Preventive Services Task Force advises against screening men and nonpregnant women for asymptomatic bacteriuria. TRUE or FALSE?
TRUE The US Preventive Services Task Force advises against screening men and nonpregnant women for asymptomatic bacteriuria; there is adequate evidence to suggest that screening is ineffective in improving clinical outcomes. In older adults with chronic urinary incontinence, ABU can be difficult to differentiate from symptomatic UTI. In such cases, delaying treatment for 1 week while offering supportive treatment such as increased fluid intake is an acceptable therapeutic option. Up to 50% of women with UTI will have symptom relief or show spontaneous improvement in 1 week without antibiotics.
Population Attributable Risk (PAR)
The amount of "extra" disease attributable to a particular risk factor in a particular population If the association is causal - this is the amount of disease (theoretically) we could prevent if we removed that particular risk factor from the population If we have interventions that target high risk groups we use RD - high risk strategies If we go for a population based approach - PAR
Cost-utility analysis compares different interventions and outcomes relative to _____?
This type of analysis compares different interventions and outcomes relative to a person's quality of life. Cost-utility analysis is a method recommended by the World Health Organization to determine the allocation of resources by calculation of the cost of quality-adjusted life years (QALYs) and disability-adjust life years (DALYs).
Gestational diabetes screening recc (USPSTF)
after 24 wks 1-hr glucose tolerance test
CVD Primary prevention statin reccs (USPSTF)
age 40 - 75 with 10yr CVD risk >=10% or DM; low, moderate dose statin (high dose if have atherosclerotic CVD) age 75+ or not candidate for high dose statin AND have atherosclerotic CVD, use moderate dose
USPSTF Blood Pressure reccs (JNC VII)
age 60 and up; < 150/90 age under 60; < 140/90 diabetes or CKD; < 140/90
For adults in the United States, what is the ranking of racial/ethnic subgroups from highest to lowest with regards to their 12-month prevalence of alcohol use disorder?
This prevalence changes as adolescents progress into adulthood: Native Americans and Alaska Natives > Caucasians > Hispanics > African Americans > Asian Americans and Pacific Islanders At any age and in any race/subgroup, men have higher rates of alcohol use disorders than women.
Number needed to treat (NNT)
The number of patients who must receive a particular drug or treatment in order for one to benefit. NNT = 1 / Attributable Risk AR = incidence in exposed - incidence in unexposed
Over the course of a month, a physician gives all his patients a cancer screening test that he developed in his clinic's lab. Thirty patients test positive, but when he has the patients undergo the gold standard diagnostic test, only 20 of them actually have cancer. What is the positive predictive value of his screening test?
The positive predictive value is the proportion of patients who test positive who actually have the disease. In this case, 20 out of 30 patients who tested positive have the disease (20/30 = 0.67, or 67%).
Toxoplasma gondii causes infections in _______________ patients and is transmitted through _____________.
Toxoplasma gondii causes infections in immunosuppressed patients, but those who are immunocompetent are usually asymptomatic. It is transmitted through the ingestion of infectious oocysts that may come from cat litter that is contaminated with cat feces.
Which Type of error refers to the failure to reject the null hypothesis when a difference exists?
Type II error. (conclude there is no difference when there is) Explanation: The failure to reject the null hypothesis when a true difference exists in the larger population refers to a type II error. The null hypothesis states that the difference between 2 groups is the result of random chance alone. The alternate hypothesis states that differences within a sample are influenced by a non-random cause. Beta refers to the probability of making a Type II error. Type I error (conclude there is a difference when there is not) refers to the rejection of the null hypothesis when no true difference exists in the population. Confounding refers to errors made as a result of the researcher failing to account for an extraneous variable that directly or inversely correlates with both the dependent and independent variables. Statistical power refers to the likelihood that a study will detect an effect when there is an effect present. It is the probability that a test will reject a false null hypothesis and is inversely related to the probability of making a type II error. Alpha refers to the probability of making a type I error.
Diabetes screening recc (USPSTF) vs (ADA)
USPSTF: 40-70yo who are overweight/obese check for abnormal blood glucose as part of CVD risk assessment ADA: 20+yo with risk factors (BMI>25) 45yo at average risk check fasting blood glucose or HgbA1c
Cervical cancer screening (USPSTF)
Women 21-65 Pap smear Q3 years Women 30-65 Pap smear with HPV Q5 years
Breast cancer screening (USPSTF)
Women 50-74 Mammography Q2 years
Osteoporosis screening recc (USPSTF)
Women 65 and older or younger women with fracture risk (FRAX) NOTE Tx with bisphosphonates
Yellow fever vaccination YF-VAX contraindications include...
Women who are breastfeeding should not receive the vaccine. Patients with hypersensitivity to gelatin, eggs, or chicken products should not receive this vaccine. Patients who are taking Enbrel or Humira should not receive the vaccine. Explanation: YF-VAX is a live viral vaccine. It is given in a single dose 10 days or more before travel, but some individuals may require a booster dose after 10 years. This includes patients who are immunocompromised, pregnant women, and those with increased exposure. This vaccine is contraindicated in patients with hypersensitivity to egg or chick embryo protein or gelatin; infants <9 months; patients with acute or febrile disease; and immunosuppressed patients, including those with HIV infection, leukemia, lymphoma, thymic disease, generalized malignancy, or immunosuppression due to drugs or radiation. It is also contraindicated in breastfeeding women. It should be used with caution in adults older than 60 years of age, according to ACIP guidelines, as there is an increased risk of vaccine-associated neurologic disease. Pregnant women should avoid use unless travel to a high-risk area is unavoidable since they may not produce an adequate immune response to the vaccine.
Should someone with CVD and history of MI or stoke take aspirin?
YES
HPV vaccine recommendations (USPSTF)
all females and males 11-12 (@ 0, 2, 6 mos) Women and MSM men up to age 26 Men up to 21 in not previously immunized
Hearing loss screening (USPSTF)
all infants should be screened early detection improves language outcomes
Group B Strep (GBS) screening recc (USPSTF)
all women at 35-37 wks gestation for rectal/vaginal GBS
The Orange Book is a list published by the Food and Drug Administration on...
approved drug products and their generic equivalents
Infectivity
ability of a biological agent to enter and grow in the host (establish an infection)
immunogencity
ability of pathogen to elicit an immune response (cellular, local, or systemic)
Infectiousness
ability to be transmitted to other hosts
Pathogenicity
ability to cause disease (produce clinical illness)
Virulence
ability to produce SEVERE clinical illness, including death
Type III reaction is due to...
accumulated immune complexes (antigen and antibody). This is seen in systemic lupus erythematosus, rheumatoid arthritis, farmer's lung, and serum sickness. I. Allergic, Anaphylaxis, Atopy II. anti-Body III. immune Complex IV. Delayed
Type II allergic reaction is mediated by...
by antibodies. This is seen in myasthenia gravis and Goodpasture's syndrome. I. Allergic, Anaphylaxis, Atopy II. anti-Body III. immune Complex IV. Delayed
intimate partner violence (IPV) screening recc (USPSTF)
screen all women of childbearing age no recommended interval
Folic acid chemoprophylaxis
daily MVI with folic acid for all women planning or capable of pregnancy 0.4mg through 1st trimester 4.0mg through 1st trimester if hx of preg with neural tube defect
Indirect costs examples
days lost from work reduced productivity of a patient or caregiver
neonatal death rate
deaths in the first 28 days / number of live births
Economic outcome measures: examples (outcomes research)
direct medical costs direct non-medicala costs indirect costs resource utilization length of stay
Direct medical cost examples
drugs labs hospitalization nursing staff cost health care professional fees
Beryllium Exposure Symptoms include...
dyspnea, cough, fatigue, weight loss, night sweats, fever, lung cancer, COPD It is a chronic obstructive lung disorder. Lung cancer is also associated with occupational exposure to beryllium. Chronic beryllium disease is a granulomatous lung disease caused by the inhalation of beryllium in previously sensitized workers. Foundry Workers Furnace Tenders Machine Operators Machinists Metal Fabricators Welders Dental Technicians Secondary smelting and refining (recycling electronic and computer parts, metals) Abrasive Blasters (slags)
Efficacy describes an intervention used in a _____________ situation or ____________ setting. Effectiveness describes an agent when used in a _______________ setting.
experimental situation or laboratory setting (efficacy) "real-life" setting (effectiveness)
Fetal death (stillbirth) rate is determined by dividing total number of fetal deaths for the period by total number of?
fetal deaths plus live births
Aspirin chemooprevention of preeclampsia
low dose (81mg) aspirin after 12 wks gestation in women at high risk for preeclampsia risk = hx of preecl., multiple fetus, chronic HTN, diabetes, renal dz, autoimmune dz
Protection from radiation exposure can be accomplished by minimizing _________, maximizing _________, and using ________.
minimizing the time of exposure maximizing the distance from the source using a shield
Clinical outcome measures: examples (outcomes research)
morbidity mortality
Pregnancy general counseling (USPSTF)
nutrition breastfeeding tobacco alcholol sexual behavior lap/shoulder belt infant safety seat
Child vision recc (USPSTF)
once between 3-5yo to detect amblyopia or risk factors 2-4% of kids have amblyopia treatment with patching, cycloplegics, glasses improves visual outcomes
Cost-effective analysis measures costs per ______?
outcome achieved
Criteria air pollutants include (6 of them)...
ozone carbon monoxide sulfur oxides nitrogen oxides particulate matter lead
Intangible costs examples
pain psychological harms
Humanistic outcome measures: examples (outcomes research)
perceived outcomes (quality of life, functional status, return to work) patient satisfaction (healthcare providers incl physicians, hospitals...)
Formula for discounting
present value = amount of money / (1 + r) to the t r = discount rate (ie 5%) t = time (ie years)
Vitamin D Supplementation and Screening
reccommend vitD supplemetation to prevent FALLS in adults 65+ 600IU women =<70 800 IU women >70 do not screen vitD deficiency if asymptomatic
Obestiy screening recc (USPSTF)
screen all people 6+yo refer to intensive comprehensive behavioral intervention
