Social Determinants of Health and Melanoma

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Questions and Answers

What percentage of health outcomes is suggested to be accounted for by social determinants of health (SDOH)?

30-55% (correct)

80-90%

10-20%

60-75%

Which of the following is a social determinant of health that can influence health outcomes?

Transportation availability (correct)

Genetic predisposition

Access to healthcare services

Age of the population

How does poverty relate to health outcomes based on the provided content?

Poverty has no effect on health outcomes.

Poverty correlates with poorer health outcomes and higher risk of premature death. (correct)

Poverty improves access to health services.

Poverty is only a minor contributor to health disparities.

What is one noted difference in under-5 mortality rates between regions?

Higher rates in Africa than in Europe Signup and view all the answers

Which of the following factors does not contribute to health inequities as stated in the content?

Genetic characteristics of individuals Signup and view all the answers

What is a recommended non-pharmacologic strategy for managing headaches?

Keeping a headache diary to monitor triggers Signup and view all the answers

Which medication is suggested for a mild migraine attack?

Excedrin Signup and view all the answers

What is the first-line medication for treating tension headaches?

Amitriptyline Signup and view all the answers

What class of drugs is recommended for cluster headache prophylaxis?

Triptans Signup and view all the answers

Which of the following is NOT a dietary trigger for headaches?

Bright lights Signup and view all the answers

For patients suffering from severe migraines, when should triptans be administered?

Immediately at onset of symptoms Signup and view all the answers

Which treatment options are considered for abortive therapy of tension headaches?

NSAIDs and analgesics with caffeine Signup and view all the answers

What is recommended as abortive therapy for cluster headaches?

100% oxygen therapy Signup and view all the answers

What is a warning sign for melanoma when assessing nevi in individuals over 20 years old?

Change in size or color Signup and view all the answers

Which type of melanoma has the worst prognosis due to thickness?

Nodular melanoma Signup and view all the answers

Which of the following is NOT considered a risk factor for developing melanoma?

Frequent use of sunscreen Signup and view all the answers

What characteristic is evaluated using the ABCDE criteria for melanoma?

Evolution of the lesion Signup and view all the answers

What term describes a flat change in skin color, detectable by touch?

Macule Signup and view all the answers

What is considered the most important prognostic indicator in the treatment of melanoma?

Breslow depth of tumor invasion Signup and view all the answers

Which type of skin lesion is characterized as a solid raised lesion that is < 1 cm in diameter?

Papule Signup and view all the answers

Which of the following characteristics is true for a bulla?

It is fluid-filled and measures over 1 cm in diameter Signup and view all the answers

What is a common characteristic of cervicogenic headaches?

Presents as unilateral pain referred from neck structures Signup and view all the answers

Which of the following symptoms is NOT typically associated with migraines?

Tearing and redness of the eye Signup and view all the answers

Which technique is recommended for treating migraines?

Upper thoracic and rib counterstain Signup and view all the answers

What is a common symptom associated with cluster headaches?

Severe pain around one eye Signup and view all the answers

Which treatment may help alleviate headaches caused by organ disease?

Targeted treatment of affected dermatomes Signup and view all the answers

What triggers a migraine headache according to described mechanisms?

Somatic dysfunction of cranial bones Signup and view all the answers

What is a distinguishing feature of cluster headaches compared to migraines?

Accompanied by Horner's syndrome Signup and view all the answers

What underlying condition could express as a bilious headache?

Gallbladder disease Signup and view all the answers

Which element is NOT required for documenting the informed consent discussion?

The patient's medical history Signup and view all the answers

What is a primary obligation of the provider during the informed consent process?

To make it clear that the patient is part of the decision-making process Signup and view all the answers

What does the principle of autonomy primarily emphasize?

The right of patients to make decisions about their own body Signup and view all the answers

Which ethical principle involves treating all persons fairly and ensuring equal distribution of resources?

Justice Signup and view all the answers

Under current laws, what is one area where minors may NOT provide informed consent in most states?

Prenatal care Signup and view all the answers

What is the primary focus of the principle of non-maleficence?

Preventing harm to patients Signup and view all the answers

Which of the following is an ethical principle related to actions producing the greatest balance of happiness?

Utility Signup and view all the answers

What must a provider do in addition to making a recommendation during informed consent?

Provide reasoning for the recommendation Signup and view all the answers

Study Notes

SDOH have a greater influence on health than genetic factors or access to healthcare services.
SDOH account for 30-55% of health outcomes.
Poverty is strongly linked to poorer health outcomes and a higher risk of premature death.
There's an 18-year difference in life expectancy between high- and low-income countries.
The majority of premature deaths from non-communicable diseases occur in low- and middle-income countries.
The under-5 mortality rate is significantly higher in Africa compared to Europe.
Social determinants, including the effects of systemic racism, are major contributors to health inequities within communities of color.
These factors limit access to essential social and economic benefits like housing, education, wealth, and employment, increasing the risk of poor health.

Melanoma

Melanoma arises from pigment-producing cells, often nevi (moles).
Warning signs include new moles or existing moles changing in size, color, symmetry, or pigmentation in patients over 20 years old.
Lesions may also bleed, itch, ulcerate, or cause pain.
Types of melanoma include superficial spreading, nodular, and lentigo maligna.
Risk factors include fair skin, red/blonde hair, inability to tan easily, freckles, increased childhood sun exposure, multiple blistering sunburns, increased number of moles, family history of melanoma, personal history of melanoma, immunosuppression, and older age.
Melanoma is diagnosed and treated using excisional biopsy.

Prognostic Indicator for Melanoma

The most significant prognostic factor in treating melanoma is the Breslow depth of tumor invasion (thickness).

Primary and Secondary Skin Lesions

Primary skin lesion: Uncomplicated lesion representing the initial pathological change, unaffected by secondary alterations.
Secondary skin lesion: A lesion that has undergone changes due to disease progression, scratching, or infection of the primary lesion.
Macule: Flat, colored change in the skin, not detectable by touch.
Papule: Solid, raised lesion with distinct borders, less than 1 cm in diameter.
Plaque: Solid, raised, flat-topped lesion greater than 1 cm in diameter.
Nodule: Raised, solid lesion located in the epidermis, dermis, or subcutaneous tissue.
Tumor: Solid mass in the skin or subcutaneous tissue, larger than a nodule.
Vesicle: Raised lesion less than 1 cm in diameter filled with clear fluid.
Bulla: Circumscribed, fluid-filled lesion greater than 1 cm in diameter.

Acute Treatment of Primary Headaches

Non-pharmacologic:
- Headache diary: Track headache frequency, severity, treatment, and relief to identify triggers and stressors.
- Stress reduction: Meditation, prayer, relaxation techniques, regular exercise, and adequate sleep.
Pharmacotherapy:
- Migraines:
  - Mild attacks: Excedrin (aspirin, caffeine, acetaminophen).
  - Severe attacks: Triptans (e.g., sumatriptan Imitrex) at symptom onset, ergotamine compounds, lidocaine nasal spray, antiemetics.
  - Prophylaxis: Trigger avoidance, NSAIDs, beta-blockers, calcium channel blockers, SSRIs, TCAs, anticonvulsants.
- Tension:
  - First-line: Amitriptyline (TCA) and short-term muscle relaxants for pain extending into the shoulder or trapezius muscles.
  - Abortive therapy: NSAIDs and analgesics with caffeine.
- Cluster:
  - Abortive: 100% oxygen.
  - Prophylaxis: Valproate, ergotamine, triptans.

Cervicogenic Headache

Unilateral pain starting in the neck, referred from bony structures or soft tissues, often associated with decreased cervical range of motion.
Similar associated symptoms and treatments as tension headaches.

Migraine Headache

Unilateral, throbbing headache that worsens with activity, associated with nausea/vomiting, photophobia, phonophobia, and potential aura.
Contributing factors: Upper thoracic spine dysfunction, cranial dysfunction (trigeminal nerve compression), upper cervical somatic dysfunction, myofascial strain patterns, sacral and coccygeal tension, and rib dysfunction.
Treatment: Upper thoracic and rib counterstain, myofascial release, cranial techniques, occipital condyle decompression, OA decompression, parietal lift.

Cluster Headache

Severe unilateral pain around the eye, accompanied by tearing, redness, stuffy/runny nose, and potential ipsilateral Horner's syndrome.
Similar contributing factors to migraines, especially C1-C2 dysfunction and cranial dysfunction affecting the trigeminovascular complex.

Headaches Secondary to Organ Disease

Example: Bilious headache from gallbladder disease.
Sympathetic afferents to T6-9 increase muscle tone, leading to type II dysfunction (T8 frequently SRRR) and increased muscle tension cephalad to the suboccipital area.
Treatment of these regions can improve both the underlying organic disease and subsequent symptoms.

Involves assessing the patient's understanding, providing a recommendation, and documenting the process.
Documentation should include:
- Nature of the procedure.
- Risks and benefits of the procedure.
- Reasonable alternatives.
- Risks and benefits of alternatives.
- Assessment of the patient's understanding of all elements.
Providers have an ethical responsibility to ensure patients are actively involved in decision-making and avoid making them feel pressured.

Legal Rights of Minors regarding Sexual Health

All jurisdictions have laws allowing minors of a specific age to give informed consent for STD diagnosis and treatment.
Most states allow minors to give informed consent for contraceptive services, but restrictions on age or specific types of contraception may apply in some states.
Laws vary by state regarding access to prenatal care, medical care for a minor’s child, abortion services, and adoption.

Ethical Principles in Healthcare

Autonomy: Patient's right to control their body, make decisions regarding their care, and have their preferences respected.
Beneficence: Actions taken to promote the well-being of others and act in the patient's best interests.
Non-maleficence: Do no harm.
Fidelity: Honesty, integrity, and faithfulness to the patient.
Justice: Fair and equitable treatment of all individuals, including equal distribution of resources.
Utility: Actions are considered right if they maximize happiness and benefit the greatest number of people.

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Description

Explore the crucial influence of social determinants of health (SDOH) on overall health outcomes and their connection to diseases like melanoma. Understand how factors such as income, race, and access to resources impact health inequities, as well as learn about the characteristics and warning signs of melanoma. This quiz provides insights into health challenges faced globally.