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By your loving friend [M-K] 1 ‫باﻷصفر حفظ‬ ‫باﻷحمر مهم‬...

By your loving friend [M-K] 1 ‫باﻷصفر حفظ‬ ‫باﻷحمر مهم‬ ‫اخضر تعليق توضيحي او ملحوظه عامه‬ INDEX L1: introduction - 2 L2: General Epidemiology I - 3 L3: General Epidemiology II - 5 L4: mode of transmission - 7 L5: Immunity - 9 L6: Vaccines & Toxoids - 11 L7: Seroprophylaxis & Chemoprophylaxis - 14 L8: Prevention of infectious diseases - 16 L9: Control measures - 17 L10: Hospital acquired infection - 19 L11: Meningitis - 21 L12,13,14,15,16,17,18 - won’t be summed up L19: Diarrheal & food poisoning - 24 L20,21,22,23,24 - won’t be summed up L25: Diabetes mellitus - 28 L26: Cancer - 32 By your loving friend [M-K] 2 L1: Introduction ‫ي‬/‫المحاضرة اﻷولى مفهاش كﻼم كتير مهم انجز‬ Q1. Types of medicine // compare between preventive and curative medicine Preventive medicine - Prevents disease & promote health - Proactive ‫المثلث ده حفظ‬ - Deals with the whole community Curative medicine - Treats disease - Reactive - Deals with individual cases Q2. Types of health - Physical - Social - Mental - Spiritual Q3. Spectrum of health - Ideal: (Perfect) - Positive:(equilibrium) can adjust to environment - Negative: can NOT adjust to environment - Unapparent disease: appears on test but no symptoms - Apparent disease: there is symptoms - Death Q4. Sings of good health ‫مش مهم بس سيبه اختياطي‬ - Physical health: no diseases - Social health: Can interact with other people in a positive manner and fulfills responsibility - Mental health She has coffee ‫الشفرة‬ - Senstive to others - Has control over emotions - Confident - free from unnecessary tension, anxieties and worries Q5. Disease is classified According to: CoCo PaCa In out ‫الشفرة‬ - Communicability - Course: acute, sub-acute... etc. - Pathological picture: inflammatory, neoplastic … etc. - Cause “etiology” - Involved System - Outcome: fatal or nonfatal By your loving friend [M-K] 3 Q6. What is the difference between disease & illness - Illness is the feeling of sickness disease on the other hand is the diagnosis that may causes the Illness - Patients may present to a doctor with a disease & no illness or vice versa L2: General Epidemiology I Epidemiology: the study of the 3Ds Distribution, Determinants and Dynamics of health related states and the application of this study Q1. Distribution ‫ي كام نقطه سهل كده كده يتجاب باﻹحساس‬/‫احفظ‬ Q2. determinants Means etiology & risk factors of the disease. It includes: agent factors, host factors and environmental factors= (Epidemiological triad) = (ecological triad) Note: Ecology: means the equilibrium that results from the dynamic interaction between host, agent &environmental Q3. Agent factors: Brave People Chase Mighty New Goals Relentlessly ‫الشفرة‬ - Biological agents: bacteria, virus, fungi, parasites & rickettsia. - Physical agents: heat, cold, pressure, radiation, noise. - Chemical agents: as poisons or insecticides. - Mechanical agents: injuries, accidents. - Nutritional agents: deficiency of iron - Genetic agents: as in Down's Syndrome. - Risk factors: no specific causative agents, but a lot of factors may predispose to or associated with the occurrence of diseases. Q4. Host factors (susceptibility): ‫ الشفرة‬SOHA - Sex - Heredity factors - Occupation - Age By your loving friend [M-K] 4 Q5. Environmental factors: 1. Internal environment: These are factors related to tissue or organs e.g. Diabetes. 2. External environment: - Physical environment e.g. air, water, - Chemical environment: dust. Metals, & gases. - Biological environment e.g. animal, insects, microorganism. - Social and cultural environment: cultures, habits, traditions. Q6. Dynamics Note: Mean chain of infection of the disease Factors affecting Sequalae of infection: 1. Agent factors: number (dose) and virulence of organism. 2. Host factors: body resistance (immunity). 3. Environmental factors: affecting occurrence and pattern of spread. Sequel of infection 1.case 2.sub clinical case 3.carrier Q7. Infectious process (chain) (epidemiogical cycle) ‫الترتيب بس هو الي مهم بس سهل‬ I. Infectious agent. II. Reservoir (source of infection). III. Portal of exit. IV. Mode of transmission. V. Portal of entry. VI. Susceptible host. Q8. Reservoir 1. Human reservoir (Cases or carriers) 2. Animal reservoir (Zoonosis) 3. Non-living reservoir (Soil, water, food, etc. …) Q9. Zoonosis: Note: among Non-living reservoir Water is the most dangerous group of diseases which primarily affect animals and can be transmitted to man Examples 1. Monkey: jungle yellow fever. 2. Cattle: brucellosis, bovine T.B, Salmonellosis, Rift Valley Fever. 3. Rodents: plague, leptospirosis, rat bite fever, murine typhus. 4. Dogs: rabies, hydatid disease, leptospirosis. 5. Cats: rabies, dermatophytosis. 6. Poultry: salmonellosis, avian flu. 7. Fish: Heterophyes Heterophyes, Diphyllobothrium latum. By your loving friend [M-K] 5 L3: General Epidemiology II Q1. Importance of carrier 1. Move freely in the community. 2. Clinically healthy 3. Large number 4. Infectivity period may be very long Q2. Types of carriers 1.Incubatory carrier become infective in the last few days of incubation period 2.Convalescent carrier During healing from the disease 3.Contact carrier (High immunity personnel) may infect others by contact 4.Healthy carrier Contacts to polluted environment such as contaminated food,water Q3. Other classifications of carriers 1.the period of infectivity -Transient: for few days (last days of incubation period (I.P.) e.g. cholera -Temporary: for few weeks or few months e.g. viral hepatitis A & B. -permanent (chronic): for years e.g., chronic convalescent carrier of typhoid, hepatitis B and C and incubatory carrier of AIDS. 2.foci of infection - Skin carrier. - Urinary tract carriers. - Gastro-intestinal carriers - Respiratory carriers: in throat, nose, nasopharynx 3.the portal of exit - Respiratory discharge: through coughing, sneezing, spitting. - Fecal carriers in food borne diseases. - Urinary carriers in typhoid and paratyphoid - Vomitus in cholera. - Skin discharge: mucous membrane and skin diseases. - Blood carriers: hepatitis B & C and AIDS. - vertical transmission a. in-utero infection (from mother to fetus) b. Breast milk 4.flow of organism -Regular carriers: organisms always pass during the infectivity period. -Intermittent carriers: sometimes does not pass in the discharge during the infectivity period, e.g. in typhoid. By your loving friend [M-K] 6 Q4. Pattern of spread of infectious diseases Sporadic, 4demic, Outbreak, 2zoo ‫الشفرة‬ Sporadic cases: Infrequent scattered cases not related to each other e.g. Common cold Endemic: A disease constantly present in the community Hyper-endemic: Endemic of high incidence Epidemic: Sudden increase in the number of cases more than expected Pandemic: Epidemic of a particular infectious disease involving more than one country Outbreak: Epidemic occurs in a confined group or closed community Enzootic: endemic among animals Epizootic: epidemic among animals Q5. Incubation period (IP) Q6 IP of quarantinable diseases is very important to be known: 1. Cholera 5 days 2. Plague 6 days 3. Yellow fever 6 days 4. Avian flu 7 days By your loving friend [M-K] 7 L4: Mode of transmission Q1. Mods of infections 1. Droplet (Air–borne) infection 2. Food–borne infection 3. Contact infection& STDs 4. Arthropod-borne infection 5. Occasional modes of transmission Q2. Droplet (Air–borne) infection Direct droplet: from the source to susceptible by direct contact. Indirect method: ✓Air borne droplet nuclei or dust. ✓Contaminated articles & fomites. ✓Milk: e.g. in case of diphtheria Example of droplet infections: ✓Bacterial: T.B., meningitis ✓Viral: chicken pox, influenza Predisposing factors of droplet infection: * Overcrowding * Bad ventilation * Bad health habits Q3. Food–borne infection Direct (fecal-oral) transmission (hand to mouth) Indirect (ingestion of contaminated food) through: Vehicle transmission Vector transmission. Use of human fertilizer Contaminated dust. Predisposing factors: ✓ Poor sanitation ✓ Lack of supervision of food places and food handlers. ✓ Bad health habits Q4. Contact infection& STDs Organisms or parasites invade skin or mucous membrane Intact as in cases of Bilharziasis and syphilis. Injured as in cases of tetanus and gas gangrene. By your loving friend [M-K] 8 Q5. Arthropod-borne infection (vector–borne diseases) Mechanical transmission: the insect has NO role in multiplication or development of the organism. Biological transmission: the insect has role in multiplication and development of the organism to become infective. Insects of medical importance ‫مش مهمين اوي افتكر كام واحد وخﻼص‬ House flies: mechanical transmission of food borne diseases and eye infection. Mosquitoes: Anopheles in malaria Culex in filariasis, rift valley fever. Aedes aegypti in yellow fever. Tsetse flies (glossina): in trypanosomiass. Sand flies in leishmaniasis. Fleas in plague, murine typhus. Hard ticks in Q-fever, spotted fever. Soft ticks in tick borne relapsing fever. Mites (sarcopties scabi) in scabies. Q6. Occasional modes of transmission Injection (parenteral) infection 1. Blood transmitted - blood transfusion -contaminated syringes or needles e.g. hepatitis B & C, AIDS, syphilis, CMV 2. Pyogenic infections By contaminated syringes & needles e.g. staph. injection Vertical transmission 1. In-utero-infection: either before formation of placenta or transplacental e.g. hepatitis B & C, AIDS, syphilis, CMV. 2. Peri-natal infection: during labour through birth canal e.g. ophthalmia neo-natrum, herpes simplex. 3. Lactation (breast feedings): HBV, HCV, AIDS, CMV By your loving friend [M-K] 9 L5: Immunity Q1. Innate Immunity ‫ي عن ايه‬/‫ي من عندك محدش يحفظ اعرف بس انت بتتكلم‬/‫عبي و حط‬ A- Natural barriers of infection: 1. Skin: surface/ sweat. 2. Eye: Blinking reflex & tears prevent infection 3. Respiratory system: sneezing & coughing reflexes, 4. G.I.T: - Saliva & bacterial flora - Gastric acidity - Intestinal flora of colon 5. Vagina: Acidity & lactobacilli B- Inner body defense: ▪ Plasma contains lysozyme, bacterial lysis ▪ Phagocytosis: polymorphnuclear leucocytes (PNLS) & macrophages Q2. Acquired Immunity ‫افهم متحفظش‬ Natural ‫يعني من مصدر طبيعي‬ Artificial ‫معمول في المعمل‬ Passive ‫يعني اﻻجسام المضادة جاهز‬ Active ‫يعني الجهاز المناعي بيكتشف و يكون اﻻجسام المضادة بنفسه‬ ‫ يعني اجسام مضادة جاهزة جيه من مصدر طبيعي "لبن اﻻم" و هكذا مع الباقي‬passive natural ‫فا لو قلت‬ Types of acquired Immunity - Passive natural  breast milk - Active natural  Illness and recoverly - Passive artificial  Harvested antibodies from another person or animal - Active artificial  Vaccine Q3.Passive natural acquired Immunity A) Trans-placental materno-foetal immunity (in the last weeks of pregnancy): - IgG can cross the placenta - 6-9 months immunity - No maternal acquired immunity for pertussis (IgM) or T.B (cell mediated immunity). B) Colostrum & breast milk which contains - IgA - Lysozymes & macrophages By your loving friend [M-K] 10 Q4. Active natural acquired immunity A) Subclinical infection: Repeated attacks stimulate the formation of immunity. With NO symptoms NOTE: No sub-clinical infection for measles gonorrhea, variola & varicella. B) Clinical infection: infection leads to different degrees of immunity: - Absolute immunity as in yellow fever. - Solid or long lasting immunity e.g. measles, mumps, chicken pox. - Mild or short lived immunity e.g. influenza. - Latent (persistence of dormant focus) infection leads to infection immunity (premunition) e.g. T.B. ‫ عادي بس مش بيخف ﻻكن مش ممكن يتعدي تاني‬TB‫ هو بيحصل مناعه ضد ال‬:‫الي مفهمش اخر واحده‬ ‫بعدها لو خف بمضاد حيوي‬ Note: after active immunization of immune system, the response is either by antibodies (humoral immunity) or sensitized lymphocytes (cell mediated immunity). Q5. Passive artificially induced immunity (serophylaxis) ‫ بالتفاصيل‬7 ‫موجود في محاضره رقم‬ Q6 Active artificially induced immunity 6 ‫نفس الكﻼم في محاضره رقم‬ Q7. Herd immunity Definition: Resistance of a group to the spread of infection among them - Occurs when a high percentage of the community is immune to a disease Q8. Herd immunity threshold - Definition: the percentage of Immunized cases to prevent more spread of a specific disease - it can be gained through active artificial or active natural immunity - Note its different from disease to another based on the degree of spread of that disease Its degree depends on: – Frequency of new introductions of infection. – Degree of mixing between populations. – Transmissibility of disease. – Duration of infectiousness (period of infectivity) - For example, in measles. It's estimated to be 94% Note: If herd immunity has been established and maintained in a population for a sufficient time, the disease is inevitably eliminated If elimination is achieved worldwide and the number of cases is permanently reduced to zero, then a disease can be declared eradicated such as small box By your loving friend [M-K] 11 L6: Vaccines & Toxoids ‫المحاضره دي مهمه جدا متفوتش كلمه‬ Q1. Types of Vaccines - Live: Small pox vaccine prepared from cowpox virus - Live attenuated - Killed or inactivated - Subunit, recombinant, polysaccharide, and conjugate - mRNA - Viral vector - Toxoid - Mixed or combined Q2. Live attenuated vaccines: ▪ potent than killed vaccines. ▪ only one dose except for polio (sabin). ▪ Should not be given to pregnant women or persons with immunodeficiency disease. ▪ Examples: MMR, Sabin (OPV), BCG (T.B), yellow fever vaccine, Otten (plague). Q3. Killed or inactivated vaccines: ▪ Killed by heat or chemicals. ▪ Require primary series of 2-3 doses and sometimes booster dose. ▪ Given usually by intramuscular or subcutaneous injection. ▪ Examples : Pertussis vaccine, Salk (polio), TAB (typhoid.) Q4. Compare between live and killed vaccine By your loving friend [M-K] 12 Q5. Subunit, recombinant, polysaccharide, and conjugate vaccines - specific pieces of the germ (like its protein, sugar, or capsid) that can give a strong immune response - may need a booster shot - Examples Hib (Haemophilus influenzae type b) HPV (Human papillomavirus) Whooping cough (part of the DTaP combined vaccine) Pneumococcal disease Hepatitis B Meningococcal disease Shingles Q6. mRNA vaccines - harmless piece of the target pathogen - advantages - shorter manufacturing time - no risk of causing disease Example: COVID-19 Q7. Viral vector vaccines - a piece of the target pathogen inserted into a different virus (e.g. adenovirus) as a driving mechanism  drives it into human cell  production of harmless protein  immunization against that protein - Examples - Ebola vaccine - Zika vaccine - flu vaccine - HIV vaccine - COVID-19 vaccines Q8. Toxoid vaccines - gives immune response against the toxin of the disease instead of the disease itself - Examples: - Diphtheria - Tetanus Q9. Mixed or combined vaccines – Quadruple vaccine: Salk + Diphtheria +Pertussis + Tetanus. – DPT: Diphtheria + Pertussis + Tetanus. – DT: Diphtheria + Tetanus. – MMR: Measles + Mumps + Rubella Q10. Route of administration of vaccines & toxoids S.C or IM most immunizations. ID (intradermal): BCG (T.B). Orally: Sabin (polio) oral drops, oral BCG Intranasal vaccine for influenza By your loving friend [M-K] 13 Q11. System of active immunization 1- Primary dose: Single dose only: e.g. MMR, BCG, yellow fever vaccines. Multiple doses: e.g. DPT, OPV, HBV, TAB, Koll’s vaccines. 2- Booster dose: given after suitable period of time to individual or group at risk to maintain satisfactory level of immunity Q12. Protective period of active immunization Months e.g. cholera vaccine: for 6 months. 2 years e.g. e.g. DPT, TT. 3-5 years TAB (typhoid) 5 years e.g. BCG vaccine. 10 years e.g. yellow fever vaccine. Solid (lifelong) immunity e.g. MMR. Q13. Effectiveness of active immunization (protective value) 1. Absolute protective: yellow fever. 2. Almost absolute (solid): 99% e.g. MMR, small pox vaccine, toxoid of diphtheria & tetanus, HBV (96%). 3. Protective: 80- 90 % e.g. BCG, pertussis, polio. 4. Protective: 40-60% e.g. TAB, cholera vaccine. Note: some vaccine gives local immunity - Sabin vaccine  small intestine - Influenza intranasal vaccine  nasal mucosa Q14. Factors determining the effectiveness of active immunization 1- Vaccine or toxoid given: Protective value of the vaccine Cold chain: It is a system of vaccine storage and transport (at low temperature) during its journey from manufacture to consumer (equipment: freezer, vaccine carrying flask, ice packs). “Cost efficacy” 2- Process of immunization: Primary & booster immunization. Doses, spacing, route of administration. 3- Vaccination coverage: The percent of at-risk individuals or groups that are actively immunized against particular disease by vaccine or toxoid. it should be at least 80 % (Satisfactory). By your loving friend [M-K] 14 Q15. Complications of vaccines General reaction: (FHMAN) fever, headache, malaise, anorexia, Nasua Local reaction: pain, swelling, redness, tenderness, abscess. General infection: due to contaminated syringes e.g. HCV, HBV, HIV. Specific hazards: - BCG if given S.C or IM. - Rabies vaccine especially nerve tissue vaccine. - Pertussis vaccine causes encephalopathy. Q16. Infectious diseases in which active immunization is the only (main) preventive measure - Rabies. - Variola (chicken pox). - Poliomyelitis. - Measles. - Mumps. - Rubella. - Diphtheria. - Tetanus. Q17. diseases where protective role of active immunization is not reliable? - Typhoid fever: clean environment & clean habits are basic preventive measures. - Cholera: clean environment and chemoprophylaxis are basic preventive measures. L7: Seroprophylaxis & Chemo prophylaxis Q1. Compare between (NHI) and (SHI) Normal human immunoglobulins (NHI) - Prepared from large pool of plasma of volunteers in endemic area. - Used in prevention of measles, polio, rubella, virus A hepatitis - Used for: Sero- prevention if given on early exposure. Sero- attenuation on late exposure e.g. measles, HBV Specific human immunoglobulins (SHI) - Prepared from plasma of actively immunized donors or convalescent carriers of specific infections. - Used in prevention of viral disease as HBV, varicella zoster infection and rabies. NOTE: animal Anti-toxins sera can be given as Sero-prophylaxis or serotherapy in Diphtheria, tetanus and gas gangrene. By your loving friend [M-K] 15 Q2. Compare between animal and human Seroprophylaxis Human Advantages: 1-Used in small doses 2-Gives immediate immunity for 30-50 days 3-Safe (does not lead to serum sickness or anaphylactic reactions). Disadvantages: 1-Relatively expensive 2-Not constantly available. Animal Advantages: 1- Cheap 2- Available Disadvantages: 1-Given in large doses 2-Give short term protection (1-2 weeks) due to lack of sensitization of memory cells. 3-Severe hypersensitivity reaction (serum sickness) Q3. Chemoprophylaxis ‫بديل كميائي للنوع اﻷول مفشي فرق كبير‬ Examples: - antibiotics - antimalarial - antituberculosis - antileprotic Note: given just before exposure or immediately after exposure to infection no late exposure (Sero- attenuation) Q4. Indications of chemoprophylaxis a) When vaccination is contraindicated b) For risk groups vaccinated after the start of epidemic until active immunity develops. c) Unimmunized person providing care to risk groups d) Immuno-deficient persons Q5. Disadvantages of Chemoprophylaxis 1. Temporary protection 2. poor Cost-Efficiency 3. Cannot be applied on large-scale as a mass preventive measure 4. Drug toxicity & resistance with prolonged use. 5. Drug allergy as in case of penicillin. 6. Suppresses the immune response as it kills the antigen and intestinal flora. By your loving friend [M-K] 16 Q6. diseases for which there is effective Chemoprophylaxis - Rheumatic fever - Cholera - Tuberculosis - Pertussis - Wound infection - Ophthalmia neonatorum - Epidemic diarrhea of newborn - Malaria - Meningococcal meningitis - Influenza type A NOTE: Chemoprophylaxis in RH, meningitis, and TB will be available in details in each respectful lecture RH in L13. Meningitis in L11. TB in L14. L8: Prevention of infectious diseases Q1. Primary prevention -measures for healthy individual to prevent the occurrence of disease - General measures 1-Community development 2-Sanitation of the environment 3-Health education 4-Health promotion - Specific measures. 1- Immunization: vaccines and Seroprophylaxis 2- Chemoprophylaxis: based on the pathogen 3- International measures Q2. Community development 1-Increase the per capita income. 2-Promotion of educational and cultural levels. 3-Promotion of health services Q3. Sanitation of the environment - Town and village planning - food sanitation - Air - water supply - sanitary waste disposal - insect and rodent control Q4. Health education This is to educate the public about the prevailing infectious diseases, mode of transmission and methods of prevention and control. Q5. Health promotion - Good nutrition - Healthy lifestyle. - Personal hygiene By your loving friend [M-K] 17 Q6. international preventive measures - Imported goods Used clothes → sterilized Raw wool, hides & hair → disinfection certificate for anthrax. Cargo ships: De-ratting certificate, valid for 6 months (fumigation with HCN or H2S). - International travelers Valid vaccination certificate is required for; Cholera: replaced by chemoprophylaxis Yellow fever: for travelers in between endemic and receptive areas. Certificate is valid after 10 days and for 10 years. - Imported animals Monkey: quarantine measures to prevent yellow fever. Cattle: for rift valley fever (RVF). Dogs & cats: for rabies L9: Control measures Q1. Aims of secondary prevention (control measures) To reduce The incidence of disease The duration of disease and consequently the risk of transmission The effects of infection, including both the physical and psychosocial complications The financial burden to the community Q2. Control of cases - Isolation of cases 1) as quarantinable disease isolation either in a fever hospital or a special place (sea/airport) 2) includes severe endemic diseases e.g diphtheria, meningitis, typhoid isolation is preferable to be in a hospital or at home on sanitary conditions. Disinfection of cases 1) Concurrent disinfection of: infective discharge of the patients (excreta, sputum, urine, skin lesion) any contaminated articles, fomites, instruments Excreta and sputum are collected in a closed container and treated immediately by phenol then disposed. 2) Terminal disinfection: By your loving friend [M-K] 18 Applied after termination of illness state either after cure, transfer to hospital or death. Done to the place and everything in the isolation room by liquid disinfection, soap and water, airing, sunning of the room, boiling articles and fomites or steam or incineration Release of cases After clinical cure as in measles. Laboratory cure with repeated negative cultures in diseases with convalescent carriers as (diphtheria, cholera, typhoid). In some diseases release occurs after 1-2 days of specific proper antibiotics as in meningitis and streptococci Q3. Control of carriers Human carrier control Recognize the carriers by bacteriologic diagnosis during pre-employement examination Examination of contacts Trace the source of infection Treatment of carriers Periodic laboratory investigation after release Health education Animal reservoir control Control of Cattles and sheeps by sanitary environment, veterinary care, immunization, milk and meat sanitation. Eradication of stray dogs, cats and rodents. Quarantine measures for imported animal. Protective clothes for those who are working with animal. Q4. Control of contacts - Enlistment - Investigation of contacts - Specific protection - Surveillance - Segregation - Isolation of contacts - Health education and release Q5. Specific protection of contacts booster dose of vaccine is given as diphtheria and tetanus toxoids. Primary vaccination if early exposure as in small pox where immunity occurs after 8 days before the I.P ends(14 days). Immunoglobulin in case of exposure to viral disease as in measles. Chemoprophylaxis as in case of contacts of meningococcal meningitis & cholera. By your loving friend [M-K] 19 Q6. Community Control Applied primary Prevention: Control of Environment Health Education Specific Prevention Community control Measures (2ry prevention) - Case finding - Epidemiologic investigation - Drastic control measures e.g. closing schools and public places. Q7. Control of Environment Control of vehicles and vectors (insects, rodents, water etc. …) Adequate ventilation and spacing of confined places, in respiratory infection Super chlorination of water supply, and disposal of wastes in food-borne infection L10: Hospital acquired infection (Nosocomial) Q1. Nosocomial infection - Within the hospital - Patient - hospital environment - hospital personnel - case - carrier - third person (explained in Q5) - out side the hospital - visitors - outside environment Q2. General hospital infections ‫التفاصيل الناقصة موجوده في محاضرات قدام‬ 1- Staph. Aureus The commonest organism of hospital acquired infection 2- Strept. hemolyticus 3- Hepatitis viruses 4- Tetanus spores 5- Other organisms - endogenous or autoinfection with commensals as E. coli, Strept-Viridians, Pneumococci, and Streptococcus faecalis Q3. Maternity Hospital Staph-aureus and strept-hemolyticus: are the most common agents. Anaerobic streptococci of vagina: commensals, endogenous infection. E. coli: commensals usually autoinfection. Clostridia of tetanus and gas gangrene. By your loving friend [M-K] 20 Q4. Premature/ LBW Units Infection is a major problem and may cause: ❑ acute respiratory infection ❑ neonatal diarrhea ❑ skin infection Q5. hospital cross-infection Personnel going in-between wards of different infectious diseases may transmit infection from one ward to the other through third-person. Undiagnosed cases may be admitted to the ward of suspected disease. More than one infectious disease may be admitted to one ward. NOTE: Professional infection: is when medical care providers may be exposed to varied health hazards according to nature of work: as influenza, viral hepatitis, pulmonary tuberculosis, syphilis, AIDS and others. Q6. Prevention of hospital acquired infection ‫عكس أي حاجه اتقالت فوق‬ 1- Sanitation of environment - incineration of hospital's disposals - Disinfection of air - Sanitary surrounding area 2- Medical care providers - Proper healthy behavior and clean habits. - Free of infection: pre-employment and periodic examination. - When an infectious case is suspected: she or he should be segregated until proven other wise 3- Sterilization and asepsis: strictly followed throughout all processes 4- Chemoprophylaxis 5- Administrative requirements: supervision of personnel, control of hospital visits. 6- Early case finding: 7- Prevention of hospital cross-infection - Special hospital design to prevent spread of infection in-between wards. - Separate isolation wards for each infectious disease. - Availability of a suitable number of "isolation cubicles" for separate undiagnosed cases. Q7. Precautions for personnel: Must have basic knowledge of infection and how to be prevented. Application of specific protection i.e. active immunization and chemoprophylaxis. Providing facilities of personal cleanliness. Nursing and service personnel: must be responsible for cases of ONE infectious disease only During the daily round of personnel in hospital: it is necessary to use clean gown and shoes. By your loving friend [M-K] 21 L11: Meningitis Definition: Acute infectious disease characterized by inflammation of the brain-meninges and CNS manifestations Q1. Causative organism 1- Purulent (septic meningitis) - Meningococcus: cerebrospinal fever. - Streptococcus. - Staphylococcus. - Other pyogenic bacteria. 2- Aseptic: caused by - Viruses (as enteroviruses: Coxsackie A & B, respiratory transmitted viruses as measles and mumps). - Leptospirae. 3- Granulomatous: Caused by - T.B. - Fungi. - Syphilis Q2. Cerebrospinal fever - Reservoir: (human only) - Cases (rarely Communicable) duo to isolation of cases “unique symptoms” Note: the organism quickly disappears from the nasopharyngeal discharge as soon as starting the treatment - All types of Carriers (the most common source of infection) - Exit: nose and mouth. - Mode of transmission: 1. Direct droplet infection: “direct contact with carriers mostly” 2. Droplet nuclei and articles are rare because the organism dies rapidly outside the body. - Inlet: nose and mouth. - Incubation period: 2-7 days. - Communicability: as long as the meningococci present in the discharge of the nose and mouth. - Sporadic cases all over the year. - some times Out breaks - More common in late winter and early spring. - Predisposing factors: Overcrowding and bad ventilation - Susceptibility: it is general. However, younger ages are more susceptible NOTE: By your loving friend [M-K] 22 Q3. Immunity against Cerebrospinal fever 1. mothers (passive natural immunity) 2. Repeated subclinical infection. “Post infection immunity of unknown duration” 3.Clinical cases. 4.Vaccination Note: second attack is rare, even without vaccination Q4. Clinical picture of Cerebrospinal fever sudden onset of Fever Headache Cattarh Neck rigidity Head retraction +ve Kernig’s sign +ve Brodzinski’s sign Q5. Complications - hydrocephalus - ocular nerve palsy, - optic neuritis, - arthritis - nerve deafness, NOTE: Fatality: decreases from 50% to 5% by specific treatment. Q6. Diagnosis 1. Clinical picture. 2. Laboratory. Blood culture shows meningococi. CSF exam shows Pus cells. Nasopharyngeal swab Q7. Prevention of - General (Q1 L8 ) - good ventilation - Avoidance of overcrowding. - Specific: - Chemoprophylaxis: by rifampicin 600 mg daily for 3 days - Vaccination - Quadrivalent (A-C-Y-W135). - Monovalent A or C - bivalent (C&Y) Q8. A-C-Y-W135 Quadrivalent vaccine - Administration: single subcutaneous injection for > 2 years. - Immunity: post vaccination immunity starts after 10 days and lasts for 3 years. - Timing: a booster dose every 3Y is recommended in case of continuous exposure. By your loving friend [M-K] 23 Q9. Target groups for the A-C-Y-W135 vaccine 1.Military groups. 2. Old diabetics. 3. School children: 4 doses: kindergarten, 1st primary, preparatory, secondary. 4. International travelers to endemic areas. 5. During pilgrimage. 6. During community outbreaks. Note: vaccination is not for general prevention only cases at risk Q10. Control of Cases: Notification. Isolation for 7 days after the start of specific treatment. Treatment: should begin immediately when clinical diagnosis even before culture Penicillin given parenterally is the drug of choice. Ampicillin and chloramphenicol can be used in cases of hypersensitive to penicillin, 3rd generation cephalosporine) Disinfection: concurrent and terminal. Release: after cure and satisfactory general condition (within 24 hrs. of treatment). Q11. Control of contact Enlistment & Surveillance for 10 days. No isolation from school. Chemoprophylaxis: by rifampicin 600 mg twice daily for 2 days to family and school contacts. (Or sulphadiazine twice daily for 2 days or ciprofloxacin 500 mg single oral dose for adults). Q12. Epidemic measures: (during outbreaks) - For closed communities and high-risk groups: Ventilation and spacing. Surveillance, to detect and treat cases. Chemoprophylaxis: by Rifampicin 600 mg once daily for 5 days. Vaccination of high-risk groups. Q9 18 ‫ الي‬12 ‫مش هيبقي في ملخص من محاضره رقم‬ By your loving friend [M-K] 24 L19: Diarrheal Diseases & food poisoning Q1. Classification of diarrheal illness 1. Acute watery diarrhea: loose or watery stools at least three times in 24-hour 2. Invasive diarrhea (dysentery): - Gross blood (by history or inspection) in the stool and accompanied by fever. - It is the result of inflammation of the distal small bowel and colonic mucosa 3. Persistent diarrhea: loose, watery, or bloody stools of ≥14 day Q2. Diarrhea In Egypt 1- High childhood morbidity Each child under 5 years experiences on the average 3 serious bouts of diarrhea/ year. 2- High childhood mortality: Diarrhea accounts for 25-30 % of infant and preschool mortalities. The main cause of death from acute diarrhea is dehydration. 3- Important cause of malnutrition Q3. Infectious diarrhea A- Enteral infection: Bacterial: Salmonella, shigella, E. coli, cholera, campylobacter, Yerssenia and staph. Viral: Rota virus, Enteroviruses (ECHO, Coxsackie's) and adenoviruses. Fungal: Candida albicans. Parasitic: Entameba, Giardia lamblia, Balantidium coli and Bilharzial dysentery. B- Parenteral infections Otitis media. Common cold and influenza. Tonsillitis, pharyngitis and sore throat. Bronchitis, pneumonia and bronchopneumonia. Urinary tract infections Q4. Non. Infectious diarrhea Dietary: food allergy or intolerance (lactose intolerance, cow's milk protein intolerance); Chemical food poisoning. Malabsorption syndromes. (cystic fibrosis, coeliac disease) Endocrinal (hyperthyroidism). Prolonged antibiotic therapy and laxatives. By your loving friend [M-K] 25 Q5. Predisposing factors for diarrhea ✓Season: More in summer (flies). ✓Nutritional state and general condition: bad. ✓Type of feeding (infants): more with artificial feeding. ✓Insanitary environment. ✓Bad personal habits and hygiene. Q6. Complications of diarrhea 1. Dehydration. 2. Electrolyte imbalance. 3. Metabolic acidosis. 4. Malnutrition. 5. Susceptibility to infection. 6. Extraintestinal manifestations like: - Reactive arthritis, Guillian-Barre: campylobacter - Glomerulonephritis, Haemolytic–uraemic syndrome and erythema nodosum: salmonella, campylobacter Q7. Diagnosis of diarrhea 1.Clinical Assessment: Classification of diarrheal illness: The assessment of a child with diarrhea should include a history of the duration, frequency, and character of the stool Assessment of hydration status. Assessment of nutritional status. Assessment of co-morbid conditions. 2. Laboratory: Stool examination (smears and culture). Blood examination (Hb%, HCT, PH, Na, K, Ca, HCO3, PCO2). Q8. Detection of the degree of dehydration A child is considered to have: ❖No signs of dehydration : If he has lost less than 5% of his body weight. ❖Mild to moderate dehydration If he has lost 5-10 % of his body weight. ❖Severe dehydration If the weight loss more than 10% of the body weight. By your loving friend [M-K] 26 Q9. Signs observed in the child to detect the degree of dehydration 1- General condition and behavior 4- Eyes 2- Tears on crying 5- Mouth and tongue 3- Thirst 6- Skin pinch Q10 General Prevention for gastroenteritis 1- Sanitation of the environment: - Safe water supply. - Sanitary liquid waste disposal. Fly control. 2- Health education of Mothers Personnel of nurseries Food handlers. 3- Adequate nourishment of infants and young children - Breast feeding - Proper weaning - Supplementation of diet - Nutrition education of mother 4- Prevention and control of systemic infections Q11. Specific vaccination for gastroenteritis ❑ Rotavirus Vaccine: Rotavirus vaccine is administered by putting drops in the child’s mouth. Babies should get 2 or 3 doses of rotavirus vaccine, depending on the brand of vaccine used. The first dose must be administered before 15 weeks of age. The last dose must be administered by 8 months of age. By your loving friend [M-K] 27 Q12. Management of a Child with Diarrhea Fluid therapy Proper feeding during and after diarrhea. Management of associated problems Q13. Treatment class A of dehydration Giving the child more fluids than usual to prevent dehydration Amount of fluid: o The general rule is to give as much as the child wants. o As a guide, after each loose stool give: For children under 2 years: 50-100 ml. For older children: 100-200 ml. Types of fluids: - Food-based fluids: as Soups (drinks made from cooked rice, wheat , cereals, pulse, potatoes, meat or chicken), and yoghurt-like drinks. - Sugar-salt solution (SSS) containing 3 g of salt and 18 g. of sugar per liter of water. - Oral rehydration solution (ORS). - Breast milk. NOTE: Hyperosmolar fluids like very sweet tea,, and sweetened commercial fruit drinks should be avoided because they can cause osmotic diarrhea. Q14. Treatment for class B -Fluid therapy - Oral rehydration solution (ORS) is the treatment of choice. As a general guideline we offer 75 ml/kg of body weight. - If a patient is still thirsty or signs of dehydration are still present, more ORS solution can be given - Assessing the progress of oral rehydration: Check the child from time to time during rehydration and fully reassess him after 4 hours according to table 2 to decide next step. - If there are no signs of dehydration shift to plan A. - If the child still shows signs of mild to moderate (some) dehydration  continue plan B and start feeding. - If the child has been passing frequent large watery stools or if signs of severe dehydration have appeared shift to intravenous fluid therapy (plan C) Q15 Rehydration for class C Severely dehydrated children should be rehydrated immediately by intravenous route, in hospital, to avoid death from hypovolemic shock. L24 ‫ الي‬L20 ‫مفيش من‬ By your loving friend [M-K] 28 L15: Diabetes mellitus Notes: - Diabetes Mellitus is a common group of metabolic disorders - Diabetes mellitus is defined as fasting blood glucose of 126 mg/dL or more - People with pre-diabetes are at increased risk for developing type 2 diabetes, heart disease and stroke - 6% of the world's population has DM Q1. prevalence in 2019 is estimation ‫سؤال مش مهم بس حطه احتياطي‬ Worldwide - higher in urban (10.8%) than rural (7.2%) areas - high-income (10.4%) than low-income countries (4.0%) - One in two (50.1%) people living with diabetes do not know that they have diabetes In Egypt - The International Diabetes Federation (IDF) has identified Egypt as the ninth leading country in the world - around 15.56% among adults between 20 and 79 years of age, with an annual death of 86,478 related to diabetes - n 2013, the IDF estimated that 7.5 million individuals have diabetes and around 2.2 million have prediabetes in Egypt. Q2. Epidemiological Features ‫سؤال مش مهم بس حطه احتياطي‬ - The 40-59 age groups currently has the greatest number 75% of whom live in low- and middle-income countries - by 2030 80% will be found in newly developed or developing countries - Although insulin-dependent diabetes mellitus in 11 to 12 years is low in incidence, their insulin requirements increase - One of the most important epidemiological features of diabetes is that. It is now common in the lower social classes whereas 50 years ago, the slope was the reverse. ‫ناخد بالنا هنا عشان منتلغبطش‬ ‫ في نسبة مرضي السكر الي مفهمش دي يكلمنه اشرحله‬country income ‫ عكس‬social class‫ال‬ voice Q3. Classification and types of DM ‫سؤال مش مهم بس حطه احتياطي‬ 1- Insulin-dependent diabetes mellitus (IDDM) =(Type 1 diabetes) autoimmune disease with destruction of pancreatic (β cell function and severe insulin deficiency 2- Non-insulin-dependent diabetes (NIDDM)= (Type 2 diabetes) By your loving friend [M-K] 29 Q4. Etiology for DM type 1 1. Personal factors: - Inheritance: genetic factors. - Familiar tendency: children of insulin-dependant diabetes parent are more exposed to IDDM risk is more with diabetic father than mother and is greater when both parents are diabetic. - Auto immunity. 2-Environmental factor: Especially viral infection such as coxsackie viruses which may have predisposing, not etiologic role. Onset of Loom: Age of onset 10-13 years but it may occur later and even through rarely in old age. Hence the term “Juvenile” or juvenile-onset diabetes is more used Q5. Type 2 diabetes - Over time, type 2 diabetes can cause serious damage to the body, especially nerves and blood vessels - Type 2 diabetes is often preventable - More than 95% of people with diabetes have type 2 diabetes. Type 2 diabetes was formerly called non-insulin dependent, or adult onset. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children. Q6. Etiology type 2: - Deficient secretion of insulin or peripheral resistance to insulin. - Genetic role. - Obesity. - Aging the elderly is more susceptible. - Age of Onset: Usually middle or old ages but any age may be affected, hence term (maturity onset diabetes) is no more used. Q7. Compare between type one and two DM Type one DM - Body doesn’t make enough insulin - often starts in childhood - caused by autoimmune - symptoms come on quickly - treated with insulin Type 2 DM - doesn’t responds to insuline - more common in middle age - lifestyle and genetic factors - symptoms develop slowly - managed by drugs and life style changes By your loving friend [M-K] 30 Q8. Gestational diabetes - Gestational diabetes is hyperglycemia with blood glucose values above normal but below those diagnostics of diabetes. Gestational diabetes occurs during pregnancy. -Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. - These women and possibly their children are also at increased risk of type 2 diabetes in the future. - Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms. Q9. Symptoms and signs of diabetes type one - frequent urination - blurred vision - recurrent infections - slow wound healing - lack of energy/tiredness - extreme fatigue and Irritability - losing weight unintentionally - hunger - very thirsty Q10. Symptoms and signs of diabetes type two - slow progressed symptoms - Impotency (‫)عجز جنسي‬ - numbness and tingling of the hands/feet - slow wound healing - recurrent blader, gum or skin infections - blurred vision - sometimes asymptomatic Q11. Complication of DM - Neuropathy: Diabetic neuropathy affects the motor and sensory peripheral nerves. - Nephropathy: damage blood vessels in kidneys may  kidneys failure - Retinopathy: damage blood vessels in retina  permanent vision loss - Cardiovascular: Arterial disease due to atherosclerosis and sequel (CHD, coronary thrombosis and myocardial infarction, peripheral gangrene and retinal and cerebral thrombosis (and microangiopathy). - Hypoglycemia, - Digestive disorders, including ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhea and gallstones. - Oral Complications, Periodontal disease, which can lead to tooth loss - Infections: diabetic subjects have a higher risk of some infections, including asymptomatic bacteriuria, lower extremity infections, re-activation tuberculosis, infections in surgical wounds and group B streptococcal infection. - Diabetic foot By your loving friend [M-K] 31 Q12. Screening for diabetes 1. Urine examination test for glucose (2 hours after meal) is commonly used in medical practice for detecting cases of diabetes. not a very reliable test 2. Blood sugar testing the cornerstone of diagnosis of diabetes. random blood sample is considered unsatisfactory for epidemiological use Q12 Targeted groups for DM screening - 40 years old or over - those with family history of diabetes - women who have had a baby weighing more than 4.5 kg - women who show weight gain during pregnancy - patients with premature atherosclerosis. - obese Q13. 1ry preventions of DM DM1 - Vaccines to prevent the immune system from destroying the pancreas cells. - Giving people with a family history of diabetes injected or oral insulin before they develop diabetes. Note: prevention DM1 is still an active area of research, and still experimental Type DM2 (Lifestyle) - change in diet: modest fat intake, and eating sufficient fiber - increasing physical activity getting at least 2½ hours of exercise per week - maintaining a healthy weight, Q14. 2ry preventions  Early Treatment - Diet and physical activity. (prediabetic) - Diet, physical activity & oral hypoglycemic drug. (DM II) - Diet, physical activity & insulin. (DMI &late stage of DM II)  Health education of the case for all about diabetes.  Prevention and control of the cardiovascular factors Q15. 3ry preventions: - The main objective of 3ry prevention is to organize specialized clinics (diabetes clinics) and units to help them adapt with these disabilities and live with them in the best way possible By your loving friend [M-K] 32 L26: Cancer Note: cancer is malignant tumors and neoplasms, they are usually vascular Q1. Types of cancer - Carcinoma most common type of cancer. They are formed by epithelial cells. - Sarcoma Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments). - Leukemia Cancers that begin in the blood-forming tissue of the bone marrow. - Lymphoma Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-fighting white blood cells that are part of the immune system. - Brain and spinal cord cancers The most common type of brain tumor develops from glial cells and is called Glioma Q2. General Signs And Symptoms Of Cancer - Unexplained weight loss (cancer cachexia) loss of 10 pounds or more may be the first sign of cancer. happens most often with cancers of the pancreas, stomach, esophagus, or lung. - Fever It more often happens after cancer has spread from where it started. - Fatigue Extreme tiredness that doesn’t get better with rest. - Pain An early symptom in bone cancers or testicular cancer. - headache that does not go away or get better with treatment may be a symptom of a brain tumor. - Skin changes Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include: Dark skin (hyperpigmentation) Yellowish skin and eyes (jaundice) Reddened skin (erythema) Itching (pruritis) Excessive hair growth Notes: - There is unequal distribution of cancer between developed and developing countries. - Life style may influence the pattern of distribution of cancer. - Chronic infection also affect the distribution of cancer By your loving friend [M-K] 33 Q3. The most common causes of cancer death are cancers of - lung (1.59 million deaths) - liver (745,000 deaths) - stomach (723,000 deaths) - colorectal (694,000 deaths) - breast (521,000 deaths) - esophageal cancer (400,000 deaths). ‫مش مهم تحفظ ارقام بس الترتيب مهم‬ Q4. Cancer incidence rates in Egypt Comments cancers are liver (23.8%) (both sexes) breast (15.4%) (both sexes) ‫ترتيب دول مهم‬ bladder (6.9%) (both sexes) liver (33.6%) and bladder (10.7%) among men breast (32.0%) and liver (13.5%) among women Q5. Risk factors (environmental) “modifiable” ‫اﻷرقام مش ضروري بس اعرفها احتياطي‬ - tobacco (25–30%) - stress ‫عشان الترتيب‬ - diet and obesity (30–35%) - infections (15–20%) - radiation (both ionizing and non-ionizing, up to 10%) - lack of physical activity - environmental pollutants Note: The great majority of cancers (90–95%) are known to be due to environmental factors and lifestyle. The remaining (5–10%) are due to inherited genetics. Q6. Non-modifiable risk factors - genetics - family history - age - gender - race ‫ او ممكن يطلبهم مع بعض في سؤال واحد مقالي فا احفظ‬Q6 ‫ او‬Q5 ‫ي خلي بالك ان ممكن يطلب سؤال‬/‫بص‬ ‫اﻻثنين ضروري دا محل سؤال مقالي ولو طلبهم سوا ﻻزم على اﻷقل نقطتان من كل واحد‬ Notes: - Age is the most important risk factor Most of the cancer cases are diagnosed above 65 years - A high-salt diet is linked to gastric cancer - high fat diets might increase risk of breast, uterus and colon cancer By your loving friend [M-K] 34 Q7. Diet and cancer - Aflatoxin: foods as peanuts and grains have been found to produce liver cancer in fish and other animals. - Nitrosamine and nitroamide: Metabolic end products of some foods are found to be carcinogenic in experimental animals. - Smoking of food: and other processes used in preparation of food may result in the production of carcinogen. - Various food additives: such as dye and trace elements found in high concentration may be of etiologic importance in human carcinogenesis. - frequent consumption of meat may result in a higher risk of cancer colon vegetables may decrease the risk. - Nutritional deficiencies: may play an etiologic role. These deficiencies are directly or indirectly influencing enzymes, which may produce carcinogenic substances. Q8. Chemicals - Tobacco smoking: It contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons. It is a major cause of cancer of the lung, larynx, mouth, esophagus, bladder, kidney, throat, stomach and pancreas. - Alcohol: increase the risk of cancer of the mouth, throat, esophagus, larynx, liver, and breast. may produce liver cirrhosis, which is pre-cancerous Note: The risk of cancer is much higher for those who drink alcohol and also use tobacco Q9. Infectious Agents oncovirus human papillomavirus (cervical carcinoma) Epstein–Barr virus (lymphomas) Kaposi's sarcoma herpesvirus HHV8 (primary effusion lymphomas) hep-B & hep-C (hepatocellular carcinoma) human T-cell leukemia virus-1 (T-cell leukemias and lymphomas). Bacterial infection: Helicobacter pylori (gastric carcinoma). Parasitic infections: Schistosoma haematobium (squamous cell carcinoma of the bladder) Q10. Radiation Ionizing radiation  cell damage  cancer (leukemia and thyroid, breast, lung, and stomach cancers). Non ionizing radiation (UV radiation)  melanoma, squamous and basal cell carcinoma By your loving friend [M-K] 35 Q11. Physical agents Arsenic  Lung and skin cancers Asbestos  Lung and mesothelioma (cancer of the serous membrane surrounding the lungs) benzene  leukemia Note: It requires years of exposure to develop cancer Q12. Hormones: - examples. taking combined menopausal hormone therapy (estrogen plus progestin) can increase a woman’s risk of breast cancer. - Menopausal hormone therapy with estrogen alone increases the risk of endometrial cancer. Q13. Genetics: - 5-10% of all cancer. - mutations in BRCA1 and BRCA2 genes are associated with hereditary breast and ovarian cancer syndrome. - mutation of the APC gene (Familial adenomatous polyposis): leads to early onset of colon carcinoma. Q14. Breast cancer - begins in - cells of the lobules: (milk producing gland) - ducts - stromal tissue (less common) - Mostly found in women, but men can get breast cancer too. - most common cancer in women worldwide. - 38.8% of malignancy in Egypt Q15. Risk factors for Breast cancer. ‫يجي مقالي بس سعتها تحط العنوين اﻷساسية بس‬ Being a female ‫اﻷرقام تيجي اختر‬ Age: uncommon below 35, more common in 35 to 50. Family history. Genetic: BRCA1 or BRCA2 are at higher risk. Hormonal factors: early menarche before 12, late menopause after 55 increase the risk, also hormone replacement therapy (HRT). Obesity Parity: the older a woman is when she has her first full-term pregnancy, the higher risk of breast cancer. Excessive radiation Oral contraceptive Alcohol. By your loving friend [M-K] 36 Q16. Clinical picture of Colorectal cancer May include ‫مقالي‬ - blood in the stool - weight loss - change in bowel movements - feeling tired all the time Note: The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate, while in Egypt, it ranged from 0.4% to 14%. Q17. Polyp in the colon or rectum - Adenomatous polyps (adenomas): Pre-cancerous - dysplasia: Pre-cancerous Found in Crohn’s disease, ulcerative colitis - Hyperplastic polyps and inflammatory polyps: Not pre-cancerous Q18. Types of colorectal cancer ‫مقالي‬+mcq Adenocarcinomas (More than 95%) start in mucus synthetizing cells of the colon and rectum. Carcinoid tumors start hormone-producing cells in the intestine Gastrointestinal stromal tumors (GISTs): start from cells in the wall of the colon called the interstitial cells of Cajal. Lymphomas Sarcomas. Q19. Risk factors of Colorectal cancer Age Radiation therapy Obesity. sedentary lifestyle Family history of CRC Diabetes Polyps: (Q17 ) Smoking increases the risk 2-3 folds. Diet: high in fat and calories and low in fiber, vegetables, fruits Inflammatory bowel disease: Crohn’s disease, or ulcerative colitis. Genetic syndromes: familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (Lynch syndrome). Q20. Lung cancer Carcinoma of the lung are classified into two broad groups: 1. Small cell lung cancer (SCLC). 2. Non-small cell lung cancer (NSCLC). (More common 85-90%) Q21. Risk factors for lung cancer Smoking. Second hand smoke. Radon: the second leading cause of lung cancer. Other substance: asbestos, arsenic, diesel exhaust, and some forms of silica and chromium. Personal (reoccurrence) or Family History of Lung Cancer. Radiation Therapy to the Chest By your loving friend [M-K] 37 Q22. Primary Prevention of cancer risk factors ‫اعكس أي حاجه اتقالت في ال‬ - avoiding the risk factors Q5 ‫ إجابة‬+ avoid ‫خلي بالك من النقطه دي بالذات ممكن تيجي سؤال لوحدها أجابتها هتبقي كلمة‬ - Health education - Vaccination: HBV for prevention of hepatocellular carcinoma HPV vaccine will decrease cervical cancer - Chemoprophylaxis Q23. Types of cancer are more common in people who are overweight or obese breast cancer, bowel cancer, esophageal, gastric cardia cancer, pancreatic cancer, kidney cancer, liver, probably - gallbladder, ovarian and aggressive prostate cancers Q24. Health education to prevent the occurrence of Cancers (primary prevention) - Increasing the public's awareness of cancer - Programs for changing risk behaviors - Programs for learning self-examination skills Q25. Chemoprophylaxis – Tamoxifen (Nolvadex) reduces the risk of developing breast cancer, and raloxifene (Evista), which lowers the risk of developing breast cancer in women with menopause – Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) – Testosterone inhibitor – Multivitamens Q26. Secondary Prevention of cancer 1- Lung cancer The U.S. Preventive Services Task Force recommends yearly lung cancer screening with LDCT (low-dose computed tomography) for people who Have a history of heavy smoking Smoke now or have quit within the past 15 years Are between 55 and 80 years old. 2 - Brest Cancer: Mammography is recommended for women 40 years old and above every 3 years and self-examination is recommended every month, during the first week after menstrual cycle. 3- Colorectal cancer: Tests that can find both colorectal polyps and cancer 1. Flexible sigmoidoscopy 3. Double-contrast barium enema 2. Colonoscopy By your loving friend [M-K] 38 Tests that mainly find colorectal cancer 1. Guaiac-based fecal occult blood test 2. Fecal immunochemical test Q27. Tertiary prevention of cancer habitation after occurrence of complications reduce suffering Help the patient to adapt to his life