Preventive Medicine Paper Model Answers

One of the big 3: TB, malaria, HIV will be on there

Only 70% is infectious disease– 30% will be NCDs, refugee camps

  • WHO and CDC guidelines are where many of the examiners turn for their questions

Preventive Medicine Paper

1. GIS Question:

  • What is the role in public health?
    • GIS is computer aided database managemnt and mapping
    • GIS adds dimension of demographic analysis to IT linking data to map
    • Determining geographic distribution
    • Analysing spatial and temporal trends
    • Mapping populations at risk
    • Stratifying risk factors
    • Assessing resource allocation
    • Planning and targeting interventions
    • Monitoring diseases and interventions over time
  • Guinea worm
    • Maps drawn showing regional occurrence
    • Unsafe groundwater sources
    • Filters
    • Temephos – biodegradable larvacide
    • Systematically track all villages
    • Identify infected and reinfected
    • Detect target resoures
    • Monitor process towards eradication
    • Still in Southern Sudan and Chad
    • Community based surveillance – look for painful blister relieved by dipping in water

2. Polio eradication what is required (10 marks) and what are the obstacles (10 marks)?

  • Required
    • Surveillance of AFP with virology stool samples
    • Routine vaccination
    • Catch-up vaccinations/ mass vaccinations
    • Targeted mop-up campaigns
    • Other causes AFP: Guillan-barre, WNV, novel eneterovirus
  • Obstacles
    • Political will
    • Sanitation
    • Vaccine refusal
    • Increased costs as cases reduced
    • Violence against owkers
    • Vaccine-associated polio strains
    • Transition from IPV to OPV
    • Financing
    • Vaccine Supply
    • Trouble countries: India, Syria, Pakistan, Nigeria, South Sudan
    • Infrastructure
    • Cultural/religious beliefs

3. NCDs.  Using either Type 2 DM or epilepsy describe how you would organize delievery of care to a rural community in central Africa (20 marks)

  • Diagnosis
    • Diagnose with fasting or glucose challenge
    • Establish system to diagnose problem
  • Treatment
    • Essential medicine list, ensure no stockouts
    • Move care to Primary Health Centre
    • Set targets
    • Use simple regimens of cheap, effective drugs
    • Nurse-led clinical algorithms
  • Follow-up
    • Encourage and check compliance
  • Access to Care
  • Education
    • Educate patients and carers
    • Educate health care staff

4. HIV. Why is HAART important to take on time (5 marks)? In setting of Africa, describe strategies to ensure compliance (15 marks)?

  • Take all drugs on time to ensure ideal drug level.  Sub-optimal drug levels may provide pressure to select for resistant strains/mutations.  HIV has a rapid mutation rate and is highly prone to developing resistance so having 3 drugs at active levels at all times is critically important.
  • Strategies
    • Avoid stockouts
    • Treatment buddies (relatives)
    • Educate patients
    • Educate health care workers
    • Mobile phones/SMS
    • Simplified regimens
    • DOTs if needed
    • Adeherence counselling
    • Standardized adherence measures
    • Free drugs
    • Recall systems to prevent loss to follow up
    • Expert patients

5. HPV: Should you accept a donation of Cervarix or Garasil for three years

  • Vaccine basics
    • Highly effective
    • Expensive
  • Cost
  • Sustainability
  • Are there other health/social interventions to be given alongside?
  • Studies needed for acceptability, proportion of disease from 16/18
  • How do you market? Cancer prevention or STIs
  • Outside of typical vaccine target ages, how to be done?

6. Discuss 4 key messages that you would put into an information leaflet for men considering being circumcised (20 marks)?

  • Interventions: condoms, syndromic management, ART, cirucmcision
  • Shown repeatedly to prevent men acquiring HIV by almost half
  • Will not protect you from other means of infection
  • Keep using condoms
  • Don’t have sex for 6 weeks until wound is healed because it increases chance until then

7. 6 critical public health measures for diarrhoeal prevention

  • Clean water
  • Nutritional supplementation: vitamin A, zinc
  • Rotavirus immunization
  • Exclusive breastfeeding
  • Wat/san
  • Hand hygiene
  • Hygienic nutritious weaning foods (not just rice)
  • ? Anti-helminthic
  • Main causes (GEMS Trial): Rotavirus, Cryptosporidium, Shigella, Enterotoxigenic E. Coli

Trachoma

  • Wat/san
  • Latrines
  • Access to safe water

 

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