CMAN 380 Final Exam Actual Questions and Answers Verified 100%

CMAN 380 Final Exam Actual Questions and Answers Verified 100% Definition of "Screening" The process of using clinical tests and/or examinations to identify patients who require additional health-related interventions What is the goal of screening Detect early Who do you screen? individuals who are at risk (ASYMPTOMATIC) for a certain condition Is screening primary, secondary, or tertiary? Secondary prevention What are screening test recommendations based on? Guidelines that come from research from the U.S Preventive Service Task Force What is the purpose of a diagnostic test? Establish the absence of presence of a disease (have it or not) Diagnostic test are also called? confirmatory test Is a screening diagnostic? NOT considered diagnostic test -screen a subset of the population who may be at risk -recommendations based on data Does the US Preventive Services Task (USPSTF) fall under the HHS? YES What is the USPSTF screening recommendations? -Based on the clinical research and evidence-based preventive care -Recommendations are based of the grading of the research evidence Grade of "A" high certainty of benefit to test Grade of "I" no net benefit or potential harms outweigh the benefit To measure the quality of a test its important to identify? Sensitivity and Specificity What do you look at when selecting screening tests? the test is valid and reliable Validity is the screen distinguishing correctly: 1. Sensitivity 2. Specificity Reliability consistency of test results over time & between examiners Sensitivity -Identifies correctly those WITH disease -truly DO have the disease -positive test result High sensitivity screening test detects most of the patients with the disease Specificity -Identifies correctly those W/O disease -true negatives False negative test result that indicates a person does not have a disease or condition when the person (actually) does have the illness False positive the patient does NOT have the disease, BUT the test is positive. Sensitivity is prioritized when? 1. Disease is serious (want to identify as many true cases) 2. Treatment is effective and available (want to identify and treat as quickly as possible) 3. High risk of infectivity if individuals are not treated (want to minimize harm to others) 4. Subsequent test (next option) is cheap and low-risk Specificity is often prioritized when? 1. Treatment is unpalatable (only want to treat those we are confident have the disease and would benefit from the treatment) 2. Subsequent test is expensive and risky A rapid flu screen has a sensitivity (50-70%). The result came back, and it is negative. How would you explain the results to the patient and what would you recommend? "it is likely you have the flu" -the other 30-50% will be a false negative Achilles InSight test has a sensitivity of 90% and a specificity of 32%. How would you interpret these results? 90% chance of having impaired bone density Lead is? soft blue-gray metal What is the most common source of lead poisoning in children? lead based paint and lead contaminated dust in older buildings Where does lead present in? -paint (homes built before 1978), leaded gasoline, recycling operations, ongoing or historic mining and smelting, commercial operations and, lead contaminated consumer products (candy, toys, pottery, jewelry...etc.) Most lead come from? lead paint chips. they become part of the dust and soil in and around homes Lead-based paint hazards occur in? families living in low income housing with children under the age of 6 years Main exposure of lead? oral -children most at risk due to hand mouth behaviors 2nd and 3rd hand smoke? contributes to increase BLLs in children/adults -3rd hand- surface residue Occupational Lead Exposure (inhaled & ingested) -battery manufacturing -automobile brake repair -companies that work with lead solder -bridge maintenance and repair -construction, renovation, rehabilitation -pottery/ceramic -radiator repair -rubber products, plastics industries -steel welding/cutting operations Para-occupational exposure to lead (secondary exposure) workers bring home lead contaminated on their skin, hair, clothes, shoes, tools I PREPARE Screening The I PREPARE environmental exposure history mnemonic is a quick reference tool created for primary care providers to assess lead exposure risk. (Investigate, Present work/protective clothing at home, residence, environment/water & soil/industries, past work, activities/hobbies, resources/referrals, educate) Who should be screened for lead? -ALL children who live in Chicago (6 months through 6 years) -Children eligible for Medicaid (due to poverty status) What children should have a blood lead test? -with any Yes or don't know response -living in high risk ZIP code -all Medicaid children (prior to 12 months and 24 months) How does lead exposure lead to health problems? -affects brain and CNS to cause coma, convulsions and even death. -Children who have severe lead poisoning can have mental retardation and behavioral disorders. -Even low-level lead exposures in developing babies have been found to affect behavior and intelligence -can lead to anemia, weakness, kidney and brain damage -miscarriage, stillbirths, infertility Who is most effected by lead? Children -shows signs of severe lead toxicity at lower levels than adults -effects on its neurologic system How is lead exposure measured? blood lead testing What therapy is prescribed for a child of BLL of 45 or greater? Chelation therapy When does the CDC recommend blood level intervention? 5 micrograms per deciliter of lead in blood for children. Why are children at high risk for lead? -nervous system is developing -hand-to-mouth activity (short stature, PICA) -absorb more lead than adults -poor diet (low in Vit C, Calcium, Iron, and Zinc) -BBB is immature or "leaky" (vulnerable to drugs or toxins) What are some measures to protect a family from lead poisoning? 1.Wash hands and toys. ... 2.Clean dusty surfaces. ... 3.Remove shoes before entering the house. ... 4.Run cold water. ... 5.Prevent children from playing in contaminated soil. .. 6.Eat a healthy diet. 7.Keep your home well-maintained. BLLs in Refugee Children -2x as likely as U.S children to have ^BLLs -poverty link Risk Factors for Elevated BLLs among Refugees -living in older homes - presence of lead hazards -cultural practices and traditional medicines -lack of awareness about the dangers of lead -compromised nutritional status Who is at risk for elevated BLLs among children younger age and Asian origin What are the physiological effects of lead? -can affect every organ system -CNS!! -Renal, Hematological, Endocrine, GI, Reproductive Neurological Effects of lead include... -Difficulties with executive functions (flexible, self-control) -Problems with thinking (cognition) -Difficulties with fine motor control -Abnormal social behavior Lead levels and incarcerations puts them at risk for health issues and decision making (effects executive function) Effects of Severe Lead Exposure in Children -(BLL) 70-80 µg/dL or greater in children -Encephalopathy & signs: -Ataxia -Coma -Convulsions -Irritability -Stuper -Death Effects of severe lead exposed adult workers with BLLS ranging from 40-120 µg/dL Depression/mood changes Extremely Lead Exposure in Adults*at extremely high BLLS (460 µg/dl) Lead encephalopathy -dullness, irritability, loss of memory, muscular tremor, poor attention span (see it in teeth) Chronically Exposure (usually work exposure): forearm extensor weakness "wrist drop" Physiological effects across the lifespan? Low hemoglobin, low Vit D, chronic constipation, sudden onset HTN, reproductive High levels of lead exposure in adults -impaired renal function (kidney disease is late sign) -Fanconi Syndrome Latent effects of childhood lead exposure -Chronic advanced renal disease -Reduction in renal function in adulthood Lead effects of pregnancy Lead stores in the bones effects neurological system and DNA, renal function decreases, increase BP, reduced fetal growth, lower birth weight, delayed puberty IPV physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse -gain control! What is the cycle of violence? The cycle of violence looks at the repetitive nature of perpetrator's actions that hinder a victim's ability to leave an abusive relationship. ... It describes the phases an abusive relationship moves through in the lead up to a violent event and its follow-up. Steps of cycle of violence 1. Tension-walking on eggshells, guilt 2. Violence 3. Honeymoon-things feel stable Violence within the family 1. Intergenerational transmission 2. Community Culture/family dynamics 3.Abuse and violence exposure is a major risk factor for repeating behavior! What is Intergenerational transmission? Exposure to violence in families of origin (parent-child or parent-parent) related to parent-child abuse & partner abuse What is Community Culture/Family Dynamics? Climate of tolerating violence in family; "a family matter" where others do not intervene -people don't know the business of family situations What is the most common cause of injury for women? Battering What is physical violence? hitting, kicking, or using another type of physical force. What is sexual violence? force a partner to take part in a sex act, sexual touching, or a non-physical sexual event (e.g., sexting) when partner does not/cannot consent. What is stalking? repeated, unwanted attention and contact by a partner that causes fear or concern for one's own safety or the safety of someone close to the victim. What is psychological aggression? verbal and non-verbal communication with the intent to harm another person mentally or emotionally and/or to exert control over another person. Who's most impacted by IPV? -women -younger -ones that been raped before -vulnerable characteristics ACE Study demonstrated an association of adverse childhood experiences (ACEs) with health and social problems across the lifespan. Heath impacts of IPV, SV, stalking? -PTSD -asthma, diabetes, IBS -frequent headaches, chronic pain, sleep difficulty, activity limitations, poor physical health, poor mental health Opportunities for prevention and action 1. services for survivors (prevent recurrence) 2. promote health, respectful relationships 3. hold perpetrators responsible 4. implement strong data systems 1st step in preventing violence 1. understand the Who, what, where, when, and how 2. analyze data