Preventive Medicine Fall 2023 Final Exam Study Guide PDF

Preventive Medicine Fall Term 2023 Final Exam Study Guide *This study guide is to help direct your studies for the Final Exam, and may not be all-inclusive of what you should know for the exam or for clinical practice. 1. Fall prevention in elderly a. Regular exercise (Tai Chi) b. Review medications...

Preventive Medicine Fall Term 2023 Final Exam Study Guide *This study guide is to help direct your studies for the Final Exam, and may not be all-inclusive of what you should know for the exam or for clinical practice. 1. Fall prevention in elderly a. Regular exercise (Tai Chi) b. Review medications (dizziness, drowsiness, orthostasis, etc.) c. Eye exam d. Reduce tripping hazards in the home e. Referral to OT/PT to do home assessment f. Fracture Risk Reduction (esp. postmenopausal women; men >70 yo) g. Adequate calcium/vitamin D h. Weight bearing exercise i. Screening for osteoporosis 2. Intrinsic and extrinsic risk factors for falls in the elderly a. Intrinsic - within the individual Normal aging changes (i.e., vision, balance and gait, psychological) i. Marker of frailty and mobility impairment in the elderly ii. Diseases (acute and chronic) iii. Change in mental status iv. Medications b. Extrinsic – external to the individual i. Physical environment (i.e. lighting, stairs, rugs, pets, etc.) ii. Assistive devices (lack of; or using incorrectly) iii. Footwear 3. Least and most effective contraceptive methods EFFECTIVENESS OF FAMILY PLANNING METHODS* 6-12 pregnancies per 100 women in a year REVERSIBLE Less than 1 pregnancy per 100 women in a year Once in place, little or nothing to do or remember. REVERSIBLE MOST EFFECTIVE Implant Intrauterine Device (IUD) 0.2% LNG 0.05% 0.8% Copper T Get repeat injections on time. Take a pill each day. Injectable Pill SUN MON TUES WED THUR FRI 6% 1 2 PERMANENT STERILIZATION *The percentages indicate the number out of every 100 women who experienced an unintended pregnancy within the first year of typical use of each contraceptive method. After procedure, little or nothing to do or remember. Use another method for first 3 months (Hysteroscopic, Vasectomy). Female (Abdominal, Laparoscopic, and Hysteroscopic) Male (Vasectomy) 0.15% 0.5% Keep in place, change on time. Patch Use correctly every time you have sex. Ring Diaphragm SAT 9% 9% 9% 12% 3 4 Use correctly every time you have sex. Male Condom LEAST EFFECTIVE Sponge Withdrawal 12% REVERSIBLE 18 or more pregnancies per 100 women in a year Female Condom 18% Nulliparous Women 22% 21% 24% Parous Women Condoms should always be used to reduce the risk of sexually transmitted infections. Fertility Awareness- Based Methods Spermicide 28% JANUARY Abstain or use condoms on fertile days. 1 2 3 4 5 8 9 10 11 12 15 16 17 18 19 22 23 24 25 26 29 30 31 1 2 6 7 13 14 20 21 27 28 3 4 24% Other Methods of Contraception: (1) Lactational Amenorrhea Method (LAM): is a highly effective, temporary method of contraception; and (2) Emergency Contraception: emergency contraceptive pills or a copper IUD after unprotected intercourse substantially reduces risk of pregnancy. CS248124 Adapted from World Health Organization (WHO) Department of Reproductive Health and Research, Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP). Knowledge for health project. Family planning: a global handbook for providers (2011 update). Baltimore, MD; Geneva, Switzerland: CCP and WHO; 2011; and Trussell J. Contraceptive failure in the United States. Contraception 2011;83:397–404. 4. Most prevalent STI in US a. HPV is the most common STI. b. Most reported Chlamydia c. Highest in age <24 5. Most important risk factor for domestic violence (slides 10-16) A combination of individual, relational, community, and societal factors contribute to the risk of becoming an IPV victim or perpetrator. Some risk factors for IPV victimization and perpetration are the same, while others are associated with one another. i. Childhood physical or sexual victimization is a risk factor for both IPV perpetrator and victim. • • • • • • • • • • • • • History of physical or emotional abuse in childhood* Heavy alcohol and drug use Low self-esteem Low education or income Young age Aggressive or delinquent behavior as a youth Depression and suicide attempts Anger and hostility Lack of nonviolent social problem-solving skills Antisocial personality traits and conduct problems Poor behavioral control and impulsiveness Traits associated with borderline personality disorder History of being physically abusive, violent, or aggressive • • • • • • • • • • • • • • • Having few friends and being isolated from other people Economic stress (e.g., unemployment) Emotional dependence and insecurity Belief in strict gender roles (e.g., male dominance and aggression in relationships) Desire for power and control in relationships Hostility towards women Attitudes accepting or justifying violence and aggression Relationship conflicts including jealousy, possessiveness, tension, divorce, or separations Dominance and control of the relationship by one partner over the other Families experiencing economic stress Unhealthy family relationships and interactions Association with antisocial and aggressive peers Parents with less than a high-school education Witnessing violence between parents as a child Unhealthy family relationships 6. Recommended interval for Tetanus-diptheria immunization a. minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination Adolescents age 11–12 years: 1 dose Tdap Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36. Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine. Catch-up vaccination: Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years Persons age 7–18 years not fully vaccinated * with DTaP: 1 dose Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td or Tdap. Tdap administered at age 7–10 years: - Children age 7–9 years who receive Tdap should receive the routine Tdap dose at age 11–12 years. - Children age 10 years who receive Tdap do not need the routine Tdap dose at age 11–12 years. DTaP inadvertently administered on or after age 7 years: - Children age 7–9 years: DTaP may count as part of catch-up series. Administer routine Tdap dose at age 11–12 years. - Children age 10–18 years: Count dose of DTaP as the adolescent Tdap booster 7. Key principle in STI prevention and control a. Abstinence b. Condoms c. Fewer partners – one partner d. Get vaccinated – HPV e. Get tested – many STIs do not have symptoms • Education and counseling of patients at risk • Identify asymptomatically infected patients • Effective diagnosis, treatment and counseling of infected persons • Evaluation, treatment, and counseling of sex partners • Pre-exposure vaccination (HPV) of patients at risk 8. How should a health care provider provide patient education regarding vaccination • Listen carefully and respectfully. • Attempt to understand the parent’s concerns and correct any misperceptions/misinformation. • Refer parents to one of several reputable and evidence-based websites: • http://www.immunize.org/talking-about-vaccines/responding-to-parents.asp • Be flexible – may need to modify schedule. • Explore the possibility that cost is a reason. • Revisit the discussion at each subsequent visit. • Good documentation of the discussion of the benefits of immunization and risks associated with remaining unimmunized; parents sign waiver. 9. • • • • • • • • • • • • Know what immunizations are required for childhood (but don’t need to know schedule) Hep B Rotavirus – 2 doses Diphtheria, tetanus, acellular pertussis, Hemophilus influenzae type b Pneumococcal conjugate Inactivated poliovirus Influenzas Measles, mumps, rubella Varicella Hep A Tetanus, diphtheria, acellular pertussis HPV Meningococcal • Meningococcal B • Pneumococcal polysaccharide • Dengue 10. Know age recommendation for HPV • • HPV vaccination routinely recommended at age 11–12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated 2- or 3-dose series depending on age at initial vaccination: 11. Leading risk factor for suicide in adolescents (from the CDC website) Individual Risk Factors These personal factors contribute to risk: Previous suicide attempt • History of depression and other mental illnesses • Serious illness such as chronic pain • Criminal/legal problems • Job/financial problems or loss • Impulsive or aggressive tendencies • Substance use • Current or prior history of adverse childhood experiences • Sense of hopelessness • Violence victimization and/or perpetration Relationship Risk Factors • These harmful or hurtful experiences within relationships contribute to risk: Bullying • Family/loved one’s history of suicide • Loss of relationships • High conflict or violent relationships • Social isolation Community Risk Factors • These challenging issues within a person’s community contribute to risk: • • • Lack of access to healthcare Suicide cluster in the community Stress of acculturation Community violence • Historical trauma • Discrimination Societal Risk Factors • These cultural and environmental factors within the larger society contribute to risk: • • • Stigma associated with help-seeking and mental illness Easy access to lethal means of suicide among people at risk Unsafe media portrayals of suicide 12. Know components of HEEADSSS mnemonic • Home: Who lives at home? How are things at home? How do you get along with everyone? • Education: Tell me about school? What grade are you in? What is your favorite class? • Eating: Any recent changes in weight or appetite? Likes/dislikes about body? Worry about having food to eat? • Activities: Are you in any after school sports or clubs? Youth groups? What do you do for fun? Do you have a best friend? Concerns about online activity? • Drugs & alcohol: Illicit drugs? ETOH? Tobacco? • Sexuality: Men, women, or both? Anal, Oral, Vaginal? Contraception? H/o STI? • Suicide/self-harm: Have you ever been so sad or mad that you thought about hurting yourself or killing your self? • Safety: Has anyone ever touched you sexually in a way you did not want them to? Have you ever been physically abused? Ever been picked on or bullied? Violence in home or school? Access to firearms? 13. #1 cause of death in US/World 1. Cardiovascular Disease 2. Neoplasms 3. Injuries 4. Chronic respiratory disease 5. Diabetes 6. Lower respiratory infections 7. Neurologic diseases The first 4 count for 70% of global mortality or approximately 40 million deaths annually a. half of deaths from cardiovascular disease, and almost a quarter from cancers 14. Which a. b. c. immunization(s) are safe to give during pregnancy Tetanus, diphtheria, and acellular pertussis (Tdap Hep B Influenza d. Hep A e. Meningococcal ACWY 15. Which immunization(s) are contraindicated during pregnancy Influenzas -L Measles, mumps, rubella Varicella HPV 16. Time frame to administer emergency contraception From notes: Recommendations: use within 5 days but are more effective the sooner they are used after the act of intercourse From CDC: within the first 72 h; however, it can still prevent pregnancy beyond the 72 h window and within 120 h 17. Most common age range for STIs 15-24, ½ of STI’s • • • • • Young women’s bodies are biologically more prone to STDs. Some young people do not get the recommended STD tests. Many young people are hesitant to talk openly and honestly with a doctor or nurse about their sex lives. Not having insurance or transportation can make it more difficult for young people to access STD testing. Some young people have more than one sex partner 18. Know “typical” reportable STIs • HIV • Syphilis • Chlamydia • Gonorrhea • Chancroid (Hemophilus ducreyi) • Each year there are an estimated 374 million new infections with 1 of 4 curable STIs: chlamydia, gonorrhea, syphilis and trichomoniasis. 19. Behaviors considered as “risky” for STI transmission a. Unprotected sex (vaginal, oral, or anal) b. Multiple partners (or partner who has multiple partners) c. History of STIs d. Misuse of alcohol or use of recreational drugs e. f. g. h. i. j. Much less likely to use protection IV drug user Sharing needles Age < 25 y/o Sex work (voluntary exchange of sex for compensation e.g. money, drugs, etc.) Ask additional question: anything else I should know? 20. Know barriers to contraception • Lack of education • Language barrier • Geographic location • Social stigma • Unsupportive partners • Unavailability of resources • Cost/insurance coverage • Spiritual/religious beliefs • Institutional • Legislative • Healthcare inequities 21. 5 Ps to STI preventive counseling • 1. Partners • 2. Practices • 3. Protection (from STIs) • 4. Past history (of STIs) • 5. Prevention (of pregnancy) Plus: trauma, violence, sexual satisfaction, sexual health concerns/problems, support for gender id 22. 5 Rs of cultural humility • Reflection- Clinicians will approach every encounter with humility and understanding that there is always something to learn from everyone. • Respect- Clinicians will treat every person with the utmost respect and strive to preserve dignity at all times. • Regard- Clinicians will hold every person in their highest regard, be aware of, and not allow unconscious biases to interfere in any interactions. • Relevance- Clinicians will expect cultural humility to be relevant and apply this practice to every encounter. • Resiliency- Clinicians will embody the practice of cultural humility to enhance personal resiliency and global compassion . 23. Age range for autism screening in pediatrics • • Universal screen at 18 mo and 24 mo Article posted on Canvas 24. Most common vision deficit in childhood found on screening 1) amblyopia and its associated (“amblyogenic”) risk factors, 2) strabismus not associated with amblyopia, and 3) refractive error not associated with amblyopia. Vision: Universal screen at age 3-6 yo, 8 yo, 10 yo, 15yo and 18 yo Hearing: Universal screen at newborn, 4-6 yo, 8 yo and 10 yo 25. List the different types of environmental health hazards. • Air contaminants. • • • • • • • Toxic waste. Radiation. Disease-causing microorganisms and plants. Pesticides. Heavy metals. Chemicals in consumer products. Extreme temperatures and weather events 26. Reasons for concern in advanced maternal age (AMA)  Pregnancy at age 35 or older  Decreased fertility  HTN more common  Increased risk of gestational diabetes  Increased risk of birth defects  Increased risk of multiple pregnancy  Increased risk of preterm labor  More likely to require C-section 27. Understand aspects of confidentiality for the teen history most states do require parental consent for most medical procedures, there are numerous exceptions allowing for Minor Consent. Here are the typical treatment areas where many states allow Minor Consent to suffice: • STIs • Drug and alcohol use • Mental health care • Blood donation • Pregnancy-related care https://docs.google.com/document/d/19DxgVMqTGwFnoLRMGmB_XLbXA5bDHjVX3GMNzsW2YU/edit 28. Implicit vs. explicit bias regarding social determinants of health Explicit, overtly racist, sexist, and homophobic attitudes often underpin discriminatory actions. Implicit biases, by contrast, are attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside our conscious awareness and can be measured only indirectly. 29. Understand grading system for USPFTF Grade Definition Suggestions for Practice A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service. B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer or provide this service. C The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Offer or provide this service for selected patients depending on individual circumstances. D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service. I Statement The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms. 30. Strongest predictor of being a perpetrator of intimate partner violence – they are the same as becoming a victim to it. 31. SAFE model Stress and Safety: Do you feel safe in your relationship? What happens when you and your partner disagree? Afraid or Abused: Have you or your children ever been physically threatened or abused? Have you ever been forced to have sexual intercourse? Friend or Family Awareness: Are your friends or family aware of what is happening? Would they support and help you? Emergency Escape Plan: Are you in danger now? Would you like to go to a shelter or talk with someone? Do you have a place where you and your children could go in an emergency? 32. Timing for a newborn health screening Occurs while still in the hospital • Development: periods of wakefulness, responsive to parents voice and touch, looks at parents when awake, calmed when picked up, moves in response to visual or auditory acuity • Tests: Obtain newborn screen, hearing screen, give 1st Hepatitis B vaccine before discharge • Some topics include: 1. Family readiness 2. Infant behaviors 3. Feeding 4. Safety 5. Routine baby care 33. Understand concept of Expedited Partner Therapy (EPT)  For STI’s The clinical practice of treating sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions to the patient to take to his/her partner without the health care provider first examining the partner.  Facilitates partner management 34. Screening requirements for lead in children --blood lead reference value (BLRV) to 3.5 micrograms per deciliter (µg/dL) Risk Factors: Live in home built in 1950 or in 1978 that is being renovated, sibling being treated Universal screen at 12 mo and 24 mo for patients with Medicaid or in high prevalence areas Describe the sequelae of high lead levels in children brain and central nervous system can be severely damaged causing coma, convulsions and even death Children who survive severe lead poisoning may be left with permanent intellectual disability and behavioral disorders 35. Discuss the common types of elder abuse. • Physical – kicking, pushing, slapping, burning • Sexual – forced participation in a sexual act when the elder does not or cannot consent. • Psychological/Emotional - inflict anguish, mental pain, fear, or distress on an older adult; humiliation, disrespect; isolation (not letting the elder see friends and/or family). • Neglect - failure to meet basic needs of food, housing, clothing, and medical care. • Abandonment - leaving an elder alone or no longer providing care. • Financial - illegally misusing an elder’s money, property, or assets; scamming. 36. Describe those patients at risk for elder abuse Perpetrator: ▪ High levels of stress, low or ineffective coping resources ▪ Using drugs or alcohol, especially drinking heavily ▪ Lack of social support ▪ High emotional or financial dependence on the elder ▪ Lack of training in taking care of elders ▪ Depression Abuse in the Elderly: -occurs among those 60 and older - Violence occurs FROM caregivers and trusted persons - in institutions like nursing homes / long term care - cases are under reported d/t fear 37. Most common types of poisonings reported 1. 2. 3. 4. 5. Cosmetics & Personal Care Products (perfume, alcohol, hand sanitizer, talcum powders) Cleaners (colorful pods for dishwasher/laundry, sprays, bottles) Medications (supplements, OTCs, analgesics) Foreign objects (playdough, silica gel, button batteries) “Things in a tube” (topical preparations, mouth numbing cream – oragel, ambesol) 38. strategies to decrease risk of poisoning • Store & lock medicines and household products out of reach and sight of children. • • • • • • • • Store products in original containers, never in food or drink containers. Use child-resistant packages and put tops on tightly. Return household products and medicines to their proper storage place immediately after use. Don’t let children watch adults taking medicine - children like to imitate adults. Always read the label and follow the directions on medicines and products. Call medicines by their proper names. Never call it candy. Begin teaching safety rules to children at an early age. Discard medications per slide 35 in PPT 39. Identify which individuals may be particularly vulnerable to the consequences of “disasters”. children, women and dependent elderly population 40. Indicate the mechanisms by which low community socioeconomic status can affect health during times of disaster.  Low socioeconomic status  High rates of poverty  Unemployment  Low education levels  Low income levels Health affected by means of 2 primary mechanisms:  Limited availability of resources  Psychosocial stress accompanying chronic shortage of resources  looting, chaos, violence, etc. 41. barriers to implementing preventive services which affect the development of a health maintenance schedule. cost, not having a primary care provider, living too far from providers, and lack of awareness about recommended preventive services. Teaching people about the importance of preventive care is key to making sure more people get recommended services. 42. Know the core values of medical ethics • • • Nonmaleficence- (“first, do no harm”) directive that health care professionals should avoid causing harm to patients and minimize the negative effects of treatments. Beneficence- dictum that clinicians are to act for the patients’ good by preventing or treating disease. Respect for autonomy- commitment to accept the choices patients with decisional capacity make about which treatments to undergo, including to reject treatment. The • • • • • addition of this value to medical ethics changed the clinician-patient relationship from a paternalistic one to a more collaborative one. Decisional capacity- ability to make an autonomous choice that clinicians should respect. Confidentiality- duty to prevent the disclosure of patient’s personal information to parties who are not authorized to learn that information. Informed consent- principle that clinicians must elicit patients’ voluntary and informed authorization to test or treat them for illness or injury. This principle also encompasses the responsibility to inform patients of diagnoses, prognoses, and treatment alternatives. Truth telling- value that clinicians should disclose information beyond that required by informed consent that may be relevant to patients (e.g. the number of procedures previously performed.) Justice- Value that all patients with similar medical needs should receive similar medical treatment and should be treated fairly by clinicians. 43. What patients might be considered as “vulnerable” • Children • Elderly • Pregnant women • Poor and homeless • Disabled • Chronically Ill 44. What can you do as a health provider to improve patient health and reduce inequity 1. Learn to think beyond your patient’s clinical/medical history ◦ Each patient has a unique cultural and ethnic identity within the context of their social environment and their personal experiences ◦ Investigate mistrust as a barrier to healthcare ◦ Review relevant literature resources ◦ Elicit your patients' viewpoints, beliefs, concerns ◦ Explore and expose personal and/or institutional racial biases ◦ Self-examination and reflection ◦ Cross-cultural training/educational programming throughout your medical education and career 2. Establish interpersonal trust ◦ Listen attentively to patients and their concerns/fears ◦ Maintain eye contact ◦ Practice and utilize learned clinical skills 1. Summarize encounter frequently 2. Empathize with the patient and their situation 3. Maintain end-goal clarity b. Ask patients to clearly identify what their goals are for the visit c. Focusing on promoting self-advocacy and empowerment d. Support patients with an ultimate goal of independent ownership of their health and healthcare 45. 1-2 questions related to CAM project (these will be relatively easy—no need to memorize everyone’s poster)