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TIPC Test 1

WVSOM -- Topics in Primary care Test 1

What is primary care? A generalist that provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsiblity for providing the patient's care
What are some specialties that lay claim to primary care? family practice, IM, peds, OB/GYN
are neurosurgeons primary care specialists? They may have first contact care of the undifferentiated patient, may be responsible for continuing responsibility for coordination of the patient's care but they are not generalists.
What is a discipline? A Subject that is taught. Like family medicine, internal medicine, biochemistry, pathology
What is a specialty? a particular occupation or branch of learning
What is a specialist? one who devotes themselves to a special occupation or branch of learning.
Who is a specialist that works in internal medicine? internist
What is family practice? medical specialty based on the discipline of family medicine. (always a test question on this )
What is a generalist? a specialist that practices a broad range of their discipline.
What is a subspecialist specialist under the discipline of a specialty. An example is orthopedic surgeons
What is internal medicine? Mostly sees patients over 75 y/o.medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases.
Pediatrician Mostly sees patients to age 17. focus on the physical, emotional, and social health of infants, children, adolescents and young adults from birth to 21 years.
What is family medicine? family medicine is a discipline of Osteopathic medicine dealing with all aspects of care of the entire family from birth to death.
at what age does closeness with a patient help in management? closeness when a patient is young aids in management as the patient ages.
What are the levels of continuity of care? informational, longitudinal, and interpersonal
What is informational continuity of care? informaion is readily available to any health care provider caring for the patient. EX: the VA
What is longitudinal continuity of care? each patient has a medical home where a group of providers assume responsibility for the patient. EX: At the clinic
Wha tis interpersonal continutiy of care in addition to being longitudinal also receive most of care from same provider.
What is chronic care presenting symptoms can appropriately be given the degree of attention by being familiar with the patient's past history and personality
what is cost effective care? need to order less labs, less likely to over or under react to presenting symptoms and results in fewer unnecessary surgeries and hospitalizations
What is comprehensive care? manages the majority of the patient's problems
What is effective use of interpersonal skills closeness when a patient is young aids in management as the patient ages. Can address any topic, know what is and isn't important to the patient.
What is scope of responsibility? (12) continuity of care, chronic care, cost effective care, comprehensive care, preventive care, effective use of interpersonal skills, maintain confidentiality, preventive care, accessibility maintain diagnostic skills, coordinator of care, community, family
How is the primary care doc a coordinator of car? patients access to health care, overall care, care among providers, tie multiple finding and treatments into a single plan. Organizes tests, plans, etc.
What is COPC? community oriented primary care. evaluate the health problems of the community because they contribute to the poor health of your patient. An example is access to care due to poor transportation and smoking
What is the patient centered medical home model provides for ready access to care with comprehensive services and should referral be required than coordination of that referral maintaining continuity of care.
What are the 7 parts to the patient centered medical home model? Continuity of care services, health information technology, practice management, quality adn safety, access to care adn information, care management, and practice0based care team.
What is the scope of primary care? the osteopathic family physician must take into account the basic principles of osteopathy, prevention and screening, coordination of care, continuity of service and family and community dynamics
what are career opportunities for PC physicians? Clincal practice, education, research, community service, administration and journalism
Where are teh majority of patient visits? office
How many patients are needed in a community for a physician? 1500 patients per physcian. 2/3rds are seen each year.
How many people who seek care tha report health care symptoms seek a primary care physician? more than half. only 8 will be hospitalized
What specialty receives the most office visits? family practice (22%)
What are the career opportunities in clinical practice? solo, group, military, public health, ER, academics, occupational medicine
What is outcome based networking? a doctor follows research he has done in his own clinic as to what works for their patients. You do outcome research but to get enough numbers you do so with multiple clinics
What specialty are most physicians? sub-specialists
What is the physician supply like in the united states? shortage of 35,000 generalist and a surplus of 115,000 subspecialists
What is the result of physician shortages? lengthening of waiting times for patients.
What is occupational health? deals with interface between medicine and owrk
What are the two mirror aspects of occupational health? work related work effects and health-related work effects
What are work related health effects? work place factors that can influence health
What are health-related work effects an example is a firefighter who is a smoker
What is environmental health? impact of the environment on human health
What are examples of environmental health? air pollution, climate change, environment lead, PCB exposure
What is OEM occupational environmental medicine. Public health for the working population
How are occupationally related conditions and non-occupationally related conditions distinguished history of occupational exposure. most are non-specivid and no different than non-occupationally related conditions
What are common occupational conditions? dermatitis, back pain, carpal tunnel
what is an occupational injury? one exposure or multiple in rapid succession
What makes something respirable? < 4 microns and will reach the alveolus
what is more common injuries or disease? injuries
what is an occupational disease? prolonged exposure
What is an example of an occupational injury? splash of strong acid on the hand
What is an example of an occupational disease? getting dilute acid on hands for 1 month leading to irritant dermatitis
What is the role of a PC physician in occupational health? precention of work-related disease/injuries, identifying when a disease or injury is work related, advise on ability of patient to work, and treating work-related medical conditions
What is the role of a doctor in identifying when a disease or injury is work-related? almost all such conditions are not the same as those in the general population, work0related means "more likely than not" and file/manage a workers' compensation claim
What are the common features of the major types of occupational and environmental related healht problems? high prevalence in work age population, largely subjective, multifactorial causation, most episodes settle rapidly, and most people remain at work or return to work quite quickly
What is the connection between work and health? outcomes for a given condition are better the sooner the patient returns to work
What is the single greatest predictor of eventual return to work? time already off work. by 6 months, 90% of people will never return to work.
Who is succeptable to hazard? worker
What is one of the greatest risks to health? long term worklessness
Trauma leads to ____________ and _________. injury;disease
What does long term workless-ness lead to? loss of fitness, 2-3x risk of poor health. Depression, 20% excess deaths. greater risk than many killer diseases
What is the most dangerous job? NOT working!
What does re-employment do for the injured patient? improves physical and general health and well-being. improves mental health and magnitude of improvement comparable to the harmful effects of losing a job
What is dependant of re-employment to be beneficial to recovery? depends on teh quality and security of re-employment
What is the most therapeutic and best for m of rehab? WORK
As physicians we need to mvoe from treating symptoms and ____________. restore function
What is the hierarchy of controls for a hazard? substitution/Elimination; engineering controls; administrative controls; perosnal protective equipment
What is elimination best way to control a hazard is to eliminate it and remove the danger
Waht is subsitution substitute somethign else in its place that would be non-hazardous or less hazardous to workers
What are engineering controls? AUTOMATION; if a hazard cannot be eliminated or a safer substitue, the next best approach is to use engineering controls to keep the hazard from reaching the worker
What are administrative controls changes in workplace policies and procedures such as warning alarms, labeling systems, training, etc
What is Personal protective equipment? use of PPE is a way of controlling hazards by placing ppe directly on the body. it is the least effective method and should be used only while other more effective controls are being developed or installed.
What is toxicology? what a chemical does to the body
What is a poison all things are poison.. .only the does makes a thing NOT a poison
What is a toxin? connotes natural substance with toxic effects
what is a xenobiotic substance foreign to the body
what is toxicology what a chemical does to the body
what is toxicokinetics what the body does to a chemical
What re the old exposure paradigms? heavy industry; food, beverage, medicinal adulterants; intentional
What are new exposure paradigms? Cottage industries adn hobbies; alternative and traditional therapies; cosmetics; imported foodstuffs; intentional; environmental
What areh the main occupational routes of exposure? inhalation and dermal absorption
What are the additional routes of exposure other than inhalation and dermal exposure? oral, absoprtion into GI tract, and liver metabolism
In inhalation exposure when does lung damage occur? if the substance reaches alveolar region, ie. is respirable
What characteristics do dermal agents have? lipid soluble
What characteristics of fibers make them reach the alveolar region? the aspect ratio. governed by size
What properites of particles help them to be respirable? aerodyamic properties and size
What are the characteristics of high solubility gases? dissolves in mucus membrane of upper airways; upperairway injury; good warning signs
What is an example of a high solubility gas? sulfur dioxide
What is an example of a low solubility gas? nitric oxide
What are the characteristics of low water solubility gases? penetrates deep into lungs; alveolar injury; delayed, occult lung injury
What happens if mercury is ingested? nothing
what happens if mercury is inhaled? you are exposed
Does the route of exposure target the organ for toxicity? not necessarily
What is an example of a toxin in which the route of exposure does not target the organ exposed? Paraquat; GI route of exposure but lung is target organ
How does oxidation state affect absorption. the more charged a toxin is the less absorbed
What is the difference between aacute bnzene exposure vs chronic benzene exposure? acute: CNS depression; chronic: aplastic anemia leukemia
What is Tier 1 toxicity testing in vitro studies replacing in vivo bioassays where feasible including Ames Test. Range-finding animal bioassays
What is tier 2 toxicity testing? Tier 2 studies inclue lethality studies; LD50 or LC 50
What is tier 3 toxicity testing? subchonic or chronic. Carcinogenesis bioassays
What is LD50 lethal dose 50%
What is LC 50? lethal concentration 50% for inhalation
What are problems with LD50 host differences adn does not account for different toxicity slopes
What is LD01? lethal dose for 1% of the animal population
What is LD100 lethal dose for 100% of the animal test population
What is LDLO? lowest does causing lethality
What is TDLO lowest dose causing toxic effect
How do you approach a patient with sensitivity? do not be dismissive. recognize that worker's expectaiont is zero exposure to potential hazardous chemicals
What container to do you collect specimens in that are being tested for metal? trace-element free tube
When do you order a test? don't order tests unless there is an indication and you know what you are doign
What is the gell and coombs classification Type I, Type II, Type III and type IV
What is type I G and C classificaiotn? immediate hypersensitivity or anaphylaxis. IgE
How do you measure Type I reactions? measure circulating IgE in blood by RAST and ELISA as well as a skin prick test
What is Type II reactions? cytotoxic reaction
What is type III reaction immune complex reaction
what is a type IV reaction? delayed or cell mediated
How long does it take for type IV to see symptoms? 48-72 hours
What symptom is seen in type IV reactions? localized granulomatous inflammation
What are expamples of type IV reactions? allergic dermatitis, PPD, mantoux testing
What are most common hypersensitivity seen? type I and IV
How do occupational illnesses and diseases to types of hypersensitivity reaction relate? because of anatomy, long and skin come into highest contact with occupational exposurs and many diseases are due to hypersensitivity
is there an antibody response to Type IV reactions? NO. Cell mediated!
At what level exposures do sensitized indiviuals react? very low exposures
what needs to be done with workers who react at very low exposures? recurrent episodes may cause irreversible disease progression so complete removal may be necessary, even if levels below legal standards. PPE may not be an acceptable alternative
What is an example of obstructive lung disease? asthma
What is an example of restrictive lung disease? pneumoconioses
What are examples of pneumoconioses? coal workers pneumoconiosis; silicosis adn asbestosis
What is spirometry? measures FVC and FEV1 to gain the measure of the amount and/or speed of air that can be inhaled and exhaled
Why does it take a long time to get FVC in emphysema patients? takes a long time to get the FVC because they can't get the air out
What is the biggest technical error with spirometry? not having the ptaient blow out 6 seconds. FVC will be falsely underestimated
What is methacholine test? bronchial challenge test where the patient breathes in a nebulized drug to provoke narrowing of the airways. Patient is hyperreactive if obstruction is < 8mg/ml
What is FVC? forced vital capacity
what is FEV1? forced expiratory volume in 1 second
What ratio is used to diagnose obstruction? FEV1/FVC
What is plethysmography? measures changes in voluem within an organ or whole body. so all areas of the lung are measured. even where dead space exists and no gas exchange occurs
What kind of problem are pneumoconioses? restriction
what kind of problem is hypersensitivity pneumonitis? restriction
what kind of problem is chest wall problems? restriction
What does restriction cause? reduced lung volumes
What is FVC in restriction? decresaed
What is the FEV1/FVC ration in restriction? normal
What is the FEV1 in restriction? normal or decreased if severe restriction
What kind of problem is asthma? obstructive
What is asthma? variable airflow obstruction in response to certain agents. "twitchy" airways.
How many asthma cases are work related? 10-15%
What is the most common occupational lung disease? asthma
What is irritant-induced asthma caused by high-level exposure to irritant gases; symptoms within 24 hours
What is the two step diagnosis in occupational asthma? diagnose asthma and then determine the relationship to work
How do you determine relationship to work in asthma? peak flow monitoring at work and not at work.
How do you manage occupational asthma? treat as for other types of asthma and if senstiized use strict avoidance of further exposure
How long is the delay to when people get asbestosis? 20-30 year delay
How do you diagnose benign pleural changes in asbestosis? bilateral plaques!!!!!!
What is malignant exposure to asbestos? mesothelioma
what are benign parenchymal cahnges with exposure to asbestos? fibrosis aka asbestosis
What is asbestosis? benign fibrosis in the parenchymal lung
How is asbestosis diagnosed? by X-ray
What are teh symptoms of asbestosis? usually no symptoms and if they do it will be things like malaise
What is seen in biopsyies of patienst with asbestosis? small irregular opacities mostly in lower lung zones. look like bumbells
What kind of effect does smoking and asbestos have together? synergistic effect
What is acute silicosis? results from high level exposure to freshly generated crytalline silica. NOT a fibrotic lung disease. rapidly fatal
Waht is chronic silicosis? small regular opacities in upper lung zones; no pleural changes. Increased risk of TB
What is a B-reader chest radiographs of pneumoconiosis interpreted according to standardized method kown as IL. Must have to get benefits
What do regular opacities in a B-reader indicate? CWP or silicosis
What are irregular opacities in a B-reader indicate? asbestosis
When does a patient get benefits when diagnosed form a b-reader? 0/0 and 0/1 do NOT get benefits. All other diagnoses do.
What is hypersensitivity pneumonitis? type IV and III. due to organic particles (bird protein).
How do you diagnose hypersensitivyt pneumonitis? imaging consistent with diffuse granulomatous fibrosis. IgG to ffending antigen. aka serum precipitins or HP panel. Determine relationship to work/environment
What are the six aims of the health care system in the 21st century? safe, effective, patient-centered, timely, efficient and equitable
What kind of disease are the numberr 1 caue of death and disability in the US? chronic diseases
what percentage of the total population has at least 1 chronic disease? 45%
What are the 10 rules for the health care system? continuous healing relationships; customized according to patient needs and values; source of control; kowledge is shared and information flows freely; evidence based; safety; transperency; needs anticipated; wast is decraed; cooperation with clinicians.
Patients with chronic diseases account for how much of the nation's health care spending? 75%
What accounts for nearlyh 30% of the rise in health care spendign? doubling of obesity
Can teh vast majority of cases of chronic disease be better prevented or managed? yes
How aware are many Americans of the extent tow high chronic disease harms their health? they aren't
Why is the health care system in crisis? quality is less than expected and costs are high adn continuiing to rise. negative correlation between cost and quality. all highly dissatisfied with current status of health care
What is the concept of a medical home? emphasis on management vs. short term treatment; continuous care vs. episodic care; team concept vs. single provider
What are the 8 segments of the health care population as established in the Bridges to health model? health, maternal and infant health; acutely ill; chronic conditions, normal fucntion; stable but serious disability; sorht period of decline before dying; limited reserve and exacerbations;frailty with or with dementia
What are the unique challenges in the care of chronic diseases? increased longevity, therefore, more peopel with crhonic conditions; increased complexity of care
What is the organization of the chronic care model? Community and Health system with productive interactions to have an informed activated patient and a prepared proactive practice team
What are the parts of the community in the chronic care model? resources, policy and self-management support
What is the organization of health care in the chronic care model? decision support;delivery system design; clinical information systems
What are clinical information systems use of registries such as EMR
What is the uses of clinical information systems? provide timely reminders for providers and patients; identify patients requiring proactive care; facilitate individiuatl ptient care planning; share information; monitor performance of team and system
What are teh 5 A's in CCM? assess, advise, arrange, agree and assist
What are the 6 personal action plan? something you want to do; describe; barriers; plans to over come barriers; confidence rating; follow-up plan
What are the principles of the medical home model (7) phersonal physician; physician directed medical practice; whole person orientation; coordination/integration; quality and safety; enhanced access; payment
What is the definition for medical home model? an approach to providing comprehensive primary care for children, youth and adults. Facilitates partnership between patients, their physicians adn families
What is the definition of epidemiology? branch of medical science that deals with incidence, distribution and control of disease in a population.
what is the definition of clincial epidemiology? marriage between quantitative concepts by epidemiologists to study disease in populations and decision-making in the individual case which is the daily fare of clincial medicine
Farr and Snow studied what? Cholory in the borad street pump outbreak.
Waht is miasma? bad air
What are the key concepts to epidemiology and biostatistics? (7) casual reasoning; understanding how death/disease are measured; evaluating tests; recognizing study design; familiarity with common statistical tests and when they re used; interpretaion and applications
What is public health? art and science of community health, concerned with statistics, epidemiology, hygiene and the prevention and eradication of epidemic diseases
What are the 3 parts to the public health model? 1. study health status in populations to identify risk factors; 2. design and implement
Describe the epidemiological triad The vector is the middle and connects to the host, agent and environment.
What kind of physicians practice preventative medicine? ALL physicians
What is evidence based medicine aims to apply evidence gained from the scientific method to certain parts of meidcal practice.
What does EBM require? clincal knowledge to formulate right question; knowing how to access the evidence; good foundation in epidemiology to interpret results
What are teh challenges of the medical literature information overload; financial motives; accuracy; changes over time
How do you formulate a clinical question? patient or problem; intervention; comparison/intervention; outcome
What is the cochrane collaboration? bibliogrpahic database of controlled trials form systematic search of journals and other sources published or underway
what is MEDLINE? National library of medicine's online database containing over 18 million citations in the health sciences
What is PubMed web-based retrieval system to search MEDLINE
What is accuracy? how close the measurement is to the true value
what is reliablity consistency on repeat measurements
What is precision? relates to teh limit of the detection of the test
what is validity whether the test measures what it is supposed to measure
Waht is screenign? identifies individuals; secondary prevention
What is surveillance identifies populations; primary prevention
What is A in the 2x2 true postiives
What is B in teh 2x2 False negatives
Waht is C in the 2x2? true negatives
Waht is D in the 2x2 false negatives
What is equation for sensitivity? a/a+c
What is equation for specificity d/b+d
what is the equation for PPV a/a+b
What is the equation for NPV? d/c+d
How do you determine a cutoff point? need to pick a number to split people into normal and abnormal. you will try to isolate sensitivity or specificity.
What is the most important property of the screening test when making a cut off value? maximizing sensitivity; worst thing is a false negative
What is the most important part of a diagnostic test when making a cut off point? compromise between false negative adn positive. diagnostic tests, treatment is potentially hazardous so a false positive is as bad as a false negative
What is ROC? receiver operator characteristics; systematic method to determine best single cutoff value when test yields continuous results
What is the best spot for a cutpoint in an ROC curve plot? upper left
What is the y axis for the ROC? senstiivity
What is the x axis for the roc? 1-specificity
What woudl be teh pefect test in ROC curve? 100% sensitive with 0% false positive (upper left hand corner)
As prevalence of disease goes up what else goes up? PPV
What is the equation for prevalence? number of existing cases/population
What is frequency expression of how often something happens
What is incidence measures the number of new cases of a disease that occur during a specified period of time in a population at risk!
what is incidence density? aka incidence rate. each person contributes to person-years of observation for the length of timethey were followed
What is point prevalence? Old + new cases/population
What is case mortality rate? # dying/ #with disease
What is Proportinate mortality rate? death from illness / deaths of all illnesses
what is cause fatality rate? deaths form cause(cancer) / total midyear population
what is crude mortality rate? number of deaths / midyear population
what is age-specific mortality rate deaths of people in age group / total mid year population of those ages
What is case-fatality rate? # deaths due to disease / # of cases of the disease
Infant mortality ratio? # deathos of infants / total live births
Maternal mortality ratio # maternal deaths / total live births
What is proportionate mortality ratio? # of deaths from specific cause / total deaths
What is the immediate cause of death? final disease
What is mechanism of death? how death occurred, NOT a disease or injury
What is attributed to cause of death? always list the last one
what will lead to a decreased prevalence? deaths and cures
what will increase prevalance incidence and longer lifespan
Created by: Todd Jamrose Todd Jamrose