50. Immigrant issues (4%)

Question 1

Dans le cadre de l’examen médical périodique des nouveaux immigrants,

a) Évaluez l’état de la vaccination (il est possible qu’il ne soit pas à jour).
b) Offrez les vaccins nécessaires.

Question 2

Lorsque confronté à une barrière linguistique, efforcez-vous d’obtenir l’anamnèse à l’aide d’un interprète médical tout en reconnaissant les limites de tous les interprètes.

Nommez des limites

Answer 2

• mentalités différentes
• connaissances médicales sommaires
• quelque chose à cacher

Question 3

Dans la continuité des soins offerts aux immigrants (particulièrement à ceux qui semblent s’adapter difficilement, recherchez quoi ? (3)

Answer 3

• Recherchez une dépression (parce qu’ils sont à risque élevé et vivent fréquemment l’isolement).
• Recherchez des ATCD de violence ou de torture.
• Évaluez la disponibilité des réseaux de soutien (p.ex., famille, organismes communautaires).

Question 4

Chez les immigrants qui consultent pour une nouvelle affection ou une affection qui se poursuit, tenez compte dans votre diagnostic différentiel quoi?

Answer 4

des maladies infectieuses acquises avant l’immigration
* malaria
* maladie parasitaire
* tuberculose

Question 5

Dans la continuité des soins offerts à tous les immigrants, informez-vous de l’utilisation de pratique et/ou de médicaments non conventionnels ou le recours à des praticiens particuliers.

Nommez des examples (5)

Answer 5

• produits « naturels »
• plantes médicinales
• guérisseurs spirituels
• médications provenant de divers pays
• moxibustion

Question 6

Describe : Mandatory Immigration Medical Examination (before arriving to Canada) (4)

Answer 6

• Complete physical examination (including vision/hearing screen)
• > 5yo - Urinalysis for protein, glucose (think diabetes), blood (think shistosomiasis). If abnormal, urine microscopy
• >11yo - CXR r/o TB
• >15yo or risk factor (eg. known infected mother, unprotected sex) = HIV testing, Syphilis

Question 7

Describe Hep B screening

Answer 7

• Africa, Asia, Eastern Europe and parts of South America
• Vaccinate susceptible, refer chronic infection for treatment (and consider screen HCC as indicated)

Question 8

Describe Hep C screening

Answer 8

• Specifically subSaharan Africa [10%]; eastern Europe, especially Uzbekistan and Tajikistan [27%]; Egypt [25%–50%]; Vietnam [10%]; and Pakistan [5-35%]) and exposure to contaminated blood, usually as nosocomial transmission through unscreened blood products, surgery or receipt of intramuscular injections)
• If positive, vaccinate Hep A/B, limit alcohol and refer for treatment

Question 9

Describe TB PPD skin test screening

Answer 9

• Sub-Saharan Africa, Asia, and Central and South America, and some in Eastern Europe
• CXR to rule out active disease

Question 10

Describe HIV screening

Answer 10

• Sub-Saharan Africa, Caribbean, Thailand
• Post-test counselling and refer to HIV treatment program

Question 11

Describe Intestinal parasites screening

Answer 11

• Intestinal parasites if from endemic area, compatible sign/symptoms of infection (asthma) or evidence of peripheral eosinophilia
• Sérologie Strongyloides (à considérer chez les immigrants d’Asie du Sud-Est et d’Afrique).
• Sérologie schistosomiase (Africa)

Question 12

Describe tx : Strongyloides

Answer 12

ivermectin (or albendazole)

Question 13

Describe tx : Schistosomiase

Answer 13

praziquantel

Question 14

Describe DM2 screening

Answer 14

> 35yo South Asian, Latin American and African

Question 15

Describe iron-deficiency anemia screening

Answer 15

with hemoglobin for women of reproductive age, and children 1-4yo

Question 16

Name contents of The First Medical Visit in Canada

Answer 16

• Medical Interpreter (consider CanTalk - telephone interpreter)
• Document findings (scars)
• Medication review, including alternative/herbal remedies
• Infection : Consider malaria, TB, hepatitis, HIV, parasitic disease in differential
• Chronic disease
• Mental Health : Depression, PTSD, Trauma, Culture/tradition/religion/gender roles
• Women’s health : Contraception, cervical cancer screening, HPV vaccine
• Vaccination

Question 17

If positive for sickle cell or thalassemia, consider what vaccination ? (3)

Answer 17

• pneumococcal
• H influenzaee
• meningococcal

Question 18

Vaccination should only be considered valid when?

Answer 18

if there is written documentation of administration of vaccine at ages and intervals comparable with the Canadian immunization schedule.

Question 19

What if there’s no documentation of vaccination? Do we do serology to assess antibody titres?

Answer 19

NON
should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors.”

Question 20

Name worries regarding interpreters who are not professionally trained

Answer 20

• insèrent leurs propres opinions modifient la question posée pour obtenir la réponse souhaitée du patient
• préoccupations en matière de confidentialité et de discrimination
• conflit d’intérêt

Question 21

All immigrants, especially those who you may perceive to not be coping well to a significant change in their lives, should be screened for …

Answer 21

depression

Question 22

Describe presentation : Active TB

Answer 22

• Cough >2-3 weeks in duration
• Lymphadenopathy
• B symptoms

Question 23

Where can we find tuberculosis?

Answer 23

Africa, Asia (not including Saudi Arabia, Oman, Qatar, and
Jordan)
South America.
The only exceptions to this rule are Poland, Portugal, and Mexico (PPM).

Question 24

Describe dx : Tuberculos

Answer 24

Suspicion clinique
Both of :
* RXP AVEC
* 3 prélèvements d’expectorations à au moins 1 heure d’intervalle

Question 25

Describe rpevelance : **Schistosomiase**

Answer 25

* Africa * Middle East * Carribbean * Brazil Venezuela, * Large portions of East and Southeast Asia.

Question 26

Describe presentation Schistosomiase : ACUTE

Answer 26

* Sudden onset fever * Fatigue * Malaise * Myalgia * Urticarial rash * Abdominal pain * Eosinophilia * Hepatosplenomegaly

Question 27

Describe presentation Schistosomiase : CHRONIC

Answer 27

* Intermittent abdominal pain * Chronic diarrhea * Rectal bleeding * Consequences of hepatosplenic disease including but not limited to pulmonary hypertension, hepatomegaly, splenomegaly

Question 28

Describe dx : Schistosomiase

Answer 28

* test ELISA sérologique * Culture selle à la recherche oeufs et parasites * des tests dermatologiques

Question 29

Describe prelevance : Malaria

Answer 29

Africa, Asia (not including Saudi Arabia, Oman, Qatar, and Jordan), and South America. The only exceptions to this rule are Poland, Portugal, and Mexico (PPM).

Question 30

Describe UNCOMPLICATED presentation : Malaria

Answer 30

* **Cyclical fever and chills** * Tachycardia * Tachypnea * N/V * Abdominal pain * Splenomegaly * Jaundice * Diarrhea * Arthralgias and Myalgias

Question 31

Describe COMPLICATED presentation : Malaria

Answer 31

* ALC * Seizures * Anemia with intravascular hemolysis * Hypoglycemia * ARDS * Coagulopathy * Metabolic Acidosis * Circulatory Collapse * Renal compromise * Hepatopathy or failure

Question 32

Describe dx : Malaria

Answer 32

* Initial dx : frottis sanguin épais et mince pour malaria * Gold standard : PCR