CMAN 380 Final Exam Study Guide with complete solution

CMAN 380 Final Exam Study Guide with complete solution goal of epidemiology` to improve health outcomes in a population rate number of events/populations at risk x 100,000 incidence number of new cases of an illness/injury that occurs within a specific time prevalence measures all of the existing cases at a given point in time prospective study establishes a causal association and a temporal relationship, all subjects are free of disease, data is collected over time retrospective study does NOT establish a causal association, investigators go back in time to study a population that was at risk (subjects have already has the illness/injury) confounding factor variable that effects both the exposure and the outcome; must be identifiable to account for what may impact the direct and indirect variables evidenced based research taking findings from studies and implementing them into practice pathogenesis how an infection or disease develops in the body/chain of events leading to the disease tuberculosis transmission droplet nuclei (airborne) latent TB occurs when the tubercle bacilli are in the body but the immune system is keeping them under control active TB develops when the immune system cannot keep tubercle bacilli under control conditions that increase the probability of a person with latent TB to develop active TB - HIV - substance abuse - recent TB infection - prolonged corticosteroid or immunosuppressive therapy - organ transplant - silicosis - diabetes mellitus - severe kidney disease - certain types of cancer - certain intestinal conditions - low body weight the ways in a person infected with HIV can develop TB 1. person with latent TB contracts HIV and in turn develops active TB as a result of a weakened immune system 2. a person with HIV becomes infected with TB and rapidly develops active TB pulmonary TB tubercle bacilli are located in the lungs extrapulmonary TB tubercle bacilli are located in areas of the body that are not the lungs military TB tubercle bacilli is carried to all parts of the body via bloodstream populations more susceptible to extrapulmonary TB - HIV patients - immunosuppressed patients - young children high risk groups for developing TB - foreign born/immigrants - Eastern European, Latin America - low income and homeless - congregate and residential settings i.e. nursing homes, correctional facilities, healthcare facilities, homeless shelters, drug treatment centers TB symptoms - unexplained weight loss - loss of appetite - night sweats - fever - fatigue pulmonary TB symptoms - coughing for /- 3 weeks - hemoptysis - chest pain mantoux tuberculin skin test (TST/PPD) 0.1 ml of 5 tuberculin units are injected between the layers of skin on the forearm, forearm should be examined within 48-72 hours of injection two types of IGRA tests Quantiferon TB Gold In-Tube Test and T-SPOT advantages of IGRA - requires single patient visit - results can be available in 24 hours - does not cause booster phenomenon - less likely to have an incorrect reading of results - BCG vaccination does not affect results disadvantages of IGRA - blood samples must be processed within 8-30 hours - errors in running and interpreting test can decrease accuracy - limited data in its use in certain populations i.e. children 5 years, those recently exposed to TB, immunocompromised patients, serial testing patient populations that should receive IGRA - persons who have received the BCG vaccine - persons from groups that historically have poor rates of return for TST reading DOT therapy continuous visits with HCP to ensure treatment adherence - good for patients that require continuous medication management primary drug resistant TB causes by person to person transmission of person to person transmission of drug resistant organisms secondary drug resistant TB develops during TB treatment - patient was not given appropriate treatment regimen or the patient did not follow treatment regimen as prescribed mono-resistant drug resistant TB resistant to any one TB treatment drug poly-resistant drug resistant TB resistant to at least any 2 Tb treatment drugs (but not both isoniazid (INH) and rifampin RIF) multidrug resistant TB resistant to at least isoniazid (INH) AND rifampin (RIF) estensively drug resistant TB resistant to isoniazid (INH) and rifampin (RIF) plus resistant to a fluoroquinolone adn at least 1 of the 3 injectable second-line drugs the five Ps Partners Practices Protection for STIs Past history of STIs Prevention of pregnancy Viral STIs Herpes Simplex Virus (HSV) and Genital Human Papillomavirus (HPV) Bacterial STIs Syphilis, Gonorrhea, Chlamydia herpes treatment antivirals and daily suppressive therapy S/S of herpes painful fluid filled vesicles - ulcerations - crusting pregnancy implications of herpes c-section if S/S present at delivery (pregnant women do not get regularly screened) S/S of HPV often asymptomatic, genital and anogenital warts can appear treatment of syphilis single IM injection of Benzathing penicillin for primary, secondary, or early latent TB, 3 doses of IM injection Benzathing penicillin for latent or syphilis of unknown duration pregnancy implications of syphilis if untreated and acquired within 4 years of delivery, fetus is at risk for infection and death clinical manifestations of gonorrhea in males