I~-~~~~~~~-~partmentof Community Medicine

University of Baghdad

Al Kindy College of Medicine

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l ~Exam Instructions

-- Two hour mid-year exam, from 9:00 t011:00 am Tuesday January 21, 2013

-- This exam including 5 pages (from 1 to 5), not including this page.

-- Writing on the back of this page is forbidden.

-- Please read carefully each question, it guides you to correct answer.

-- Neatness and organization are important; they help us to evaluate your answers.

-- Only blue and black pens are allowed in writing the answers.

-- Simple calculators can be used for this exam.

. Good luck!

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University of Baghdad

Al Kindy College of Medicine

of Community Medicine

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r ~Exam Instructions

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-- Two hour mid-year exam, from 9:00 t011:00 am Tuesday January 21, 2013

-- 'rhis exam including 5 pages (from 1 to 5), not including this page.

-- Writing on the back of this page is forbidden.

-- Please read carefully each question, it guides you to correct answer.

-- Neatness and organization are important; they help us to evaluate your answers.

-- Only blue and black pens are allowed in writing the answers.

-- Simple calculators can be used for this exam.

. Good luck!

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Ql : answer ONLY TOW of the following: (Answer should be on the back paper 2) (10 marks) A) : What are the likely outcomes following exposure to open TB (show answer in a digram)? _(5 marks)

No Infection (70-90%)

Infection (10-30% )

Dorn"lant TB (90%)

no TB disease not infectious to

Active TB (10%) -ill

- - likely to die i-f - unt..eated

- well

othe..s - infectiou~

V" Activation of infection ~~-~;:- /~"::>-...................._~---- -" ,/"-----_~ts in disease __-:~~~-

B) List the post natal care services at the primary health care level. (5 marks)

The period starts one hour after delivery and continuous for six weeks after delivery, two medical examinations must be

performed during this period, the first examination is carried out within two weeks and the second 4 - 6 weeks after

delivery, to check:

- history

- physical examination: including vital signs, systemic examination ,Uterus position and size, cervix and perineum,

blood pressure.

- investigation :Repeat Hb and general urine exam.

- Promote breast-feeding.

- must teach pelvic floor exercise.

C): defines two of the following: Serial interval. Infectious period. Incubation period. Latent periods.

• Serial interval: (the gap in time between the onset of the primary and the secondary cases) the interval between receipt of infection and maximal infectivity of the host (also called generation time).

• Infectious (communicable) period: length of time a person can transmit disease (sheds the infectious agent).

• Incubation period: time from exposure to development of disease. In other words, the time interval between invasion by an infectious agent and the appearance of the first sign or symptom of the disease in question.

• Latent period: the period between exposure and the onset of infectiousness (this may be shorter or longer than the incubation period).

02) A screening test for bladder cancer is based on the staining properties of exfoliated cells in the urine. The test is known

to have a sensitivity of 80% and a specificity of 96%. We use this test in 100,000 symptom-free individuals from a

population in which the prevalence of preclinical bladder cancer is 0.005. (10 marks)

a) How many people will test positive by this test?-----4380-----------------­b) How many negative test results will be found?---------95620--------------------­c) Of all positive test results, what proportion will be false positives?-------90.87%-------------­d) Of all the negative test results, what proportion were false negatives?----10.46%------------­e) Of all disease individuals, how many people will be positive by this test?-----400--------­

Q1) For each of the following statements, ENCIRCLE the most appropriate answer: (60 marks)

1- All are true about attack rate EXCETP:

a) It is type of prevalence rate T b) Expressed as percentage

c) Used when population is exposed to risk factor for a limited period of time

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d) Reflects extent of epidemic e) It is measure of risk

2- Which of the following is a good index for the severity of an acute disease:

a) Cause specific mortality rate b) Case fatality rate T

c) Standardized mortality ratio d) Five year survival e) Period prevalence.

3- Denominator of crude mortality rate is a) 1000 live birth b) Mid-year population T c) Total number of deaths

d) Total number of cases e) Person years of observation

4- In stable status of disease: a) Incidence = Prevalence X Duration b) Incidence = Prevalence + Duration

c) Prevalence = Incidence X Duration T d) Prevalence = Incidence + Duration

e) Prevalence = Incidence / Duration

5- Which of the following is an example of secondary prevention? a) Yellow fever vaccination b) Wearing a seat belt c) Fluoridation of public drinking water

d) Pap- smears for cervical CA detection T e) community education program on weight loss

6- The best measure to estimate the rapidity with which new cases of asthma develop among school age children is: a) Prevalence b) Incidence T c) Case fatality d) Crude death rate e) Median survival

7- A researcher stated that careful examinations show that 50% out of 100 patients with CA lung have evidence of previous tuberculosis and conclude that tuberculosis is the causative agent of Ca Lung. Possible reasons for disagreeing with the conclusion include all of the following EXCEPT

a) Confounding factors b) Selection bias c) Disease prevalence

d) Chance e) Lead time bias T

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16- Select one of the following statements which you believe to be true about clinical trial. a) a-A double-blind trial avoids assessment bias. (T) b) Randomization ensures that there is no observer bias. c) Randomization implies that there is random selection of the subjects from the

population. d) All clinical trials are randomized and controlled. e) When the statistical analysis is performed, the odds ratio is the measure of association.

17- Regarding Tetanus all are true EXCEPT:

a) is an acute,often fatal,disease caused by an exotoxin produced by the bacterium Clostridiumtetani.

b) prevented by immunization with tetanus toxoid. c) It is characterized by generalized rigidity and convulsive spasms of skeletal muscles.The

muscle stiffness usually involves the jaw (lockjaw)and neck and then becomes generalized. d) Highly contagious disease. T

e) Herd immunity does not protect the individual

18- Regarding Rubella all are false EXCEPT:

a) Report to local health authority: in countries where rubella eradication is a goal, all cases of rubella and CRS should be reported. T

b) WHO not recommend use of vaccine in all countries where control or elimination of CRS is considered a public health priority.

c) Vaccination of Women of Childbearing Age with rubclla vaccine is safe even if she is pregnant or likely to become so in next 4 weeks.

d) Contact isolation is indicated for children with proven or suspected congenital rubella until they are one month of age,

e) Acute onset of generalized maculopapular rash, and high temperature and arthralgia or arthritis, lymphadenopathy, or conjunctivitis caused by bacterial infection.

19- The objectives of ARl Control Programme include all below except:

a) Identify the few serious cases of ARI b) Reduce the high mOltality from ARI in children under 5 years of age c) Treat sever cases at PRC centers without the use of antibiotics. T d) Follow the standard case management for ARl. e) Treat the mild cases at home without the use of antibiotics.

20-Regarding polio all are true except:

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a) intervention trial b) case control study T c) retrospective cohort d) ecologic study e) none of the above.

15- Researchers conduct screening tests on a group of injection drug abusers to detect Hepatitis

C. It is known that the prevalence of Hepatitis C in this group is 30%. Researchers then use

the same screening test to detect Hepatitis C in a group of college students who are known to

have a 1% prevalence of Hepatitis C. Select the best answer.

a) The specificity of the Hepatitis C screening test will be the same in both groups.

b) The specificity of the Hepatitis C screening test will be higher in the group of college

students vs. the group of injection drug abusers.

c) The sensitivity of the Hepatitis C screening test will be lower in the group of college

students vs. the group of injection drug abusers.

d) The predictive value positive will be higher in the group of college students vs. the group

of injection drug abusers. T

e) The predictive value positive will be higher in the group which has more people tested for

Hepatitis C.

16- Select one of the following statements which you believe to be true about clinical trial.

a) a-A double-blind trial avoids assessment bias. (T) b) Randomization ensures that there is no observer bias. c) Randomization implies that there is random selection of the subjects from the

population. d) All clinical trials are randomized and controlled.

e) When the statistical analysis is performed, the odds ratio is the measure of association.

17- Regarding Tetanus all are true EXCEPT:

a) is an acute,often fatal,disease caused by an exotoxin produced by the bacterium Clostridiumtetani.

a) intervention trial b) case control study T c) retrospective cohort d) ecologic study e) none of the above.

15- Researchers conduct screening tests on a group of injection drug abusers to detect Hepatitis

C. It is known that the prevalence of Hepatitis C in this group is 30%. Researchers then use the same screening test to detect Hepatitis C in a group of college students who are known to have a 1% prevalence of Hepatitis C. Select the best answer.

a) The specificity of the Hepatitis C screening test will be the same in both groups.

b) The specificity of the Hepatitis C screening test will be higher in the group of college students vs. the group of injection drug abusers.

c) The sensitivity of the Hepatitis C screening test will be lower in the group of college students vs. the group of injection drug abusers.

d) The predictive value positive will be higher in the group of college students vs. the group of injection drug abusers. T

e) The predictive value positive will be higher in the group which has more people tested for

Hepatitis C.

16- Select one of the following statements which you believe to be true about clinical trial.

a) a-A double-blind trial avoids assessment bias. (T) b) Randomization ensures that there is no observer bias. c) Randomization implies that there is random selection of the subjects from the

population. d) All clinical trials are randomized and controlled.

e) When the statistical analysis is performed, the odds ratio is the measure of association.

17- Regarding Tetanus all are true EXCEPT:

a) is an acute,often fatal,disease caused by an exotoxin produced by the bacterium Clostridiumtetani.

b) prevented by immunization with tetanus toxoid. c) It is characterized by generalized rigidity and convulsive spasms of skeletal muscles.The

muscle stiffness usually involves the jaw (lockjaw)and neck and then becomes

generalized. d) Highly contagious disease. T

e) Herd immunity does not protect the individual

18- Regarding Rubella all are false EXCEPT:

a) Report to local health authority: in countries where rubella eradication is a goal, all cases

of rubella and CRS should be reported. T b) WHO not recommend use of vaccine in all countries where control or elimination of CRS

is considered a public health priority. c) Vaccination of Women of Childbearing Age with rubella vaccine is safe even if she is

pregnant or likely to become so in next 4 weeks. d) Contact isolation is indicated for children with proven or suspected congenital rubella

until they are one month of age, e) Acute onset of generalized maculopapular rash, and high temperature and arthralgia or

arthritis, lymphadenopathy, or conjunctivitis caused by bacterial infection.

19- The objectives of ARI Control Programme include all below except:

a) Identify the few serious cases of ARI b) Reduce the high mortality from ARI in children under 5 years of age

c) Treat sever cases at PHC centers without the use of antibiotics. T d) Follow the standard case management for ARI. e) Treat the mild cases at home without the use of antibiotics.

20-Regarding polio all are true except:

a) Occurrence of a single case of poliomyelitis due to wild poliovirus must be recognized as a public health emergency.

b) Oral Polio Vaccine :Contains 3 serotypes of vaccine virus, Shed in stool for up to 6 weeks following vaccination, >95% immune after 3 doses, Immunity probably lifelong

c) Man is the only reservoir of infection of poliomyelitis

d) Modes of transmission:Oral-oral infection: direct droplet infection ,Faeco-oral infection e) Inactivated Polio Vaccine: used in Iraq for immunization against polio. T

21- Regarding Pertussis (whooping cough) infection all are false EXCEPT:

a) The bacterium Bordetella pertussis Fastidious gram-negative bacteria( is the primary

whooping cough cause. T

b) The infection follows a distinct seasonal pattern.

c) Pertussis can occur only at younger age group only.

d) If untreated, a person can transmit pertussis from onset of symptoms to 3 months after

the onset of coughing episodes. The period of communicability is reduced to 10 days

after treatment with antibiotics. e) vaccination and natural infection with pertussis guarantees lifelong protective immunity

against pertussis.

22- Regarding Diphtheria all are true except:

a) A disease of colder months in temperate zones primarily involving non immunized or under immunized children below 15 years of age.

b) Preventing diphtheria depends almost completely on immunizing children with the diphtheria/tetanus/pertussis (DTP) .

c) Reservoir is human carriers, Transmission RespiratOly, Skin and fomites. d) Incubation period 5-10 days. T e) It mainly affects the mucous membrane of the upper respiratory tract (nose,tonsils,

pharynx, larynx) skin, or may involve any mucous membrane( conjunctiva, vagina, or ear).

23- All below is true conserning the Comprehensive care meanings excepts:

a) it cares for all age groups;

b) it includes promotive and preventive care;

c) It deals only with the physical problems. T

d) it includes curative, rehabilitative and palliative care;

e) it cares for both gender;

24- concerning diarrhea all below are true except:

a) Despite it cause high mortality rate it is a preventable disease

b) Plan A treatment aims to prevent dehydration from occurring. c) Plane A include Teaching the mother How to prepare and give ORS d) Plane A Usually applied at the PHC centers. T e) Plane A include Teaching the mother the Signs of dehydration.

25- Regarding children under5 years of age all are true except:

a} They are the major victims of diarrhea.

b) Frequent attacks of diarrhea lead to growth failure.

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c) All cases of diarrhea should be treated at hospitals. T

d) Malnutrition predisposes children to disease, which often result in worse nutritional status.

e) Reduced food intake during diarrhea attack contributes to growth failure.

26- Regarding Prevention of ARI,:

a) Health education. b) Good ANC. c) Continued breastfeeding and proper nutrition.

d) Increase the amount of food after recovering. e) All of the above. T

27- Breast feeding considered as protective factor for the nursing mother regarding the

followings except:

a) carcinoma of ovary, b) osteoporosis. c) postpartum heamorrhage.

d) carcinoma of colon. T e) Breast cancer.

28- Regarding the contraindication for breast feeding all the followings are true except:

a) Breast milk jaundice

b) Puerperal psychosis

c) Pulmonary tuberculosis of the lactating mother. T

d) Inborn error of metabolism like phenylketonurea. e) Cleft palate.

29- After weaning all the listed below dietary instructions are right except:

a) Yellow vegetables will introduced like carrots, potatoes, green vegetables are then added.

b) supplementations of vitamin A and D are recommended.

c) Iron supplementation is important in premature infant

d) After age of 4 months animal protein should be added like white meat. T

e) Gradual introduction of soft food like fruit juices, rice water

30- A 6 month -old infant is brought for a well child visit. The growth chart shows the child's

growth has slowed when compared to growth curve expected for his age. The most

appropriate action is:

a) to increase feeding amounts

b) to reassure the family that this is a common finding and that no further workup is necessary

c) to order laboratory tests ,including a complete blood count, serum gloucose and serum

electrolytes. T

d) To consult social services.

e) Consider it as norma I.

Q2) On 30 September, 7 out of 100 students who attended certain class reported sore throat. All of them continued to be

ill on 1 October, but recovered within 3 days. On 1st October, 10 new students had sore throat, On 10 October, 10

students had sore throat, and till 31 sl October, 30 different students had sore throat and 8 of them were absent due to

illness. Calculate per 1000:

(10 marks)

a- Point prevalence on 10ctober_-----­ _____ 170 per 1000

b- Point prevalence on 10 October: _ 100 per 1000

c- Period prevalence froml-l0 October: ________270 per 1000

d- Period prevalence froml-30 October: ___________________ .570 per 1000

c- Incidence rate for October: _ ______ 50/100-7 Xl000 =537 per 1000

Q4): Answer ONLY TWO of the following:

A) give five points explain how you can write a good referral letter? (5 marks) Write a good referral letter:

1. Brief and to the point

2. Include relevant history, physical examination and test results so that they are available when the patient arrives(

lab results, X-rays, ultrasound, CT scan results)

3. Describe any treatment that have already been tried and their effectiveness.

4. Give your opinion, ask specific questions or identify the problems that the (consultant or referral) physician is to

address or answer.

5. Phone directly for urgent conditions and early appointments.

6. Provide feedback to the consultant about the patient progress.

B) From primary health care point of view,what are the simple important measures that have the power to prevent

illness and save life? (5marks)

Proper hand washing with soap, Safe sanitary facilities, Clean water storage, Treatment when necessary,

Ventilation of living area, Road safety, Adequate nutrition,

C) Enumerate the Strategies of PHC: 1- Development of basic health infrastructure. (Safe water supply, basic sanitation).

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2-Development of human resources for health, preparation of health workers, health visitors, & traditional birth

attendance (TBA).

3- Incorporation of traditional medical system & encouragement of its positive aspect 4-Health promotion & disease

prevention:

5-Equity in distribution of health services in urban &rural areas with relevance of the programs to the community

health problems

6-Community participation:

7- Ensure inter-sectoral cooperation

8-Referal system Competent

Good luck .

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