Written

Question 1

what’s the definition of health?

Answer 1

health is a state of complete physical mental and social well-being, and not merely the absence of disease infirmity.

Question 2

What are the dimensions of health?

Answer 2

Physical health, which implies that all body systems are properly functioning in harmony with physiological norms, and there’s no evidence of disease

Mental health, which is the well-being in which an individual realizes his own potential can cope with normal stresses can work productively to contribute to the community

Social ability of a person to live in react in harmony and adjust within social network and participate to the social system

Spiritual health refers to personal integrity, principles, and ethics

Question 3

What is quality of life?

Answer 3

It is an assessment of how an individual’s well-being may be affected overtime by disease, disability, or disorder

Question 4

What’s the spectrum of health?

Answer 4

Ideal health: State of complete physical mental and social well-being, and not merely the absence of a disease infirmity

Positive health: implies continuing adjustment (dynamic interaction) between the individual and the surrounding

Negative or marginal health state of equilibrium where a person looks healthy, but has no ability to adjust himself to the surrounding

An-apparent disease: not recognized by individual, but discovered by examination or screening Apparent disease: the individual is aware that she suffering from an illness

Death is the end of the health spectrum

Question 5

What is health promotion?

Answer 5

It is the process of enabling people to increase control over and improve their health by seeking to influence lifestyle, health services and Environmental inventions not only focusing on individual behavior.

Question 6

What is determinant of health?

Answer 6

On country and national level: -
* The social economic standard determined by the education occupation, cross development product, which reflects the average income, per capita, and real terms example the purchasing power, another words, the community is determined by the prevalence of illiteracy unemployment and poverty
* Urbanization and industrialization
* Cultural and social attitudes
* Environmental pollution and sanitation
* The availability and quality of health services

Family level: -
* The social economic standard of both parents or family
* Housing condition inside and surrounding environment
* crowding index

On individual level: -
* Age sex genetic predisposition
* Nutritional general health
* Lifestyle stresses, physical activities, habits, like smoking and type of work

Question 7

What are the factors affecting the occurrence of disease?

Answer 7

Host Factors: -
* Heredity and genetic factors several diseases, have a genetic origin like Down syndrome
* Age population is more prone to acute and infectious diseases while old population is more prone to chronic diseases and give examples
* For sex females are more prone to diseases than males and vice versa due to different physiological factors and give example
* Health status the general health and nutritional status determines the ability to resist the disease for example a healthy individual response to tuberculate infection by forming a focus. A poor health status will proceed to a manifest disease.
* Previous immunologic experience having past infections, give you the ability to resist, and some even produce a lifelong immunity
* Physiological state pregnancy lactation, and growing children are more susceptible
* Lifestyle, beliefs, and activities, as well as habits like smoking
* Socio-economic status is affected by education occupation, and economic conditions

Environment Factors:-
* The physical environment which includes physical and chemical surroundings, including air, land, gravity, and temperature
* The biological environment which includes animal and plants as well as microorganisms, biological environment, provides human beings with essentials for life, but also pathological organisms that produce disease
* The social and cultural environments which is created by human relations and behaviours which might differ from one country to another or subcultures in the same country

Causative agent: -
* biological agents that cause communicable diseases, such as bacteria and viruses and fungi
* Nutritional deficiencies and excess nutrients, iron deficiency, and obesity
* Chemical agents like poison insecticides, as well as some drugs
* Physical has excessive heat or cold or radiation
* Mechanical Agents causing injuries or accident

Question 8

What is a risk factor?

Answer 8

Factors that make an individual community family, more prone to specific disease due to the presence of a certain factor (maybe know or unknown), but it’s not the direct causative agent The risk factor is related to the host or their self-specific environment.

Question 9

What are the levels of prevention?

Answer 9

1. Primordial prevention: which is prevention of risk factors through individual and mass education
2. Primary prevention: which is the prevention of development to the disease entirely,
   ➢ non-specific group of interventions aiming at improving the level of health as health education, environmental sanitation, nutrition, care healthy lifestyle
   ➢ Specific prevention referring to different types of interventions to a specific disease condition:
   * Immunization, active and passive
   * Chemo prophylaxis
   * Nutritional supplementation to prevent specific deficiencies
3. Secondary prevention is prevention of complication development, progression, and recurrence through early detection of the disease periodic examination for at risk groups and screening tests example cervical cancer adding to this prompt appropriate treatment to achieve cure like this election of antibiotics and the period of treatment and streptococcal pharyngitis to prevent traumatic fever
4. Tertiary Prevention which is rehabilitation applied to disabled individuals to improve their abilities
   * Might be medical rehabilitation to achieve possible physical ability
   * Social vocational rehabilitation, which includes education and training for suitable job to help earn their own living
   * Psychological rehabilitation to cope with disability, as well as to the family so they can deal with the handicapped and for the environment to welcome him

Question 10

Levels of curative care?

Answer 10

• Primary curative care which is ambulatory care provided by the family physician
• Secondary curative care which is ambulatory care provided by specialist
• Tertiary care refers to hospitalization
• Quater curative care refers to highly specialized services

Question 11

Levels of practice?

Answer 11

On individual level: -
* The case approaches with the presenting condition only (least type of care)
* The total person approach denotes that the person is assessed for it’s for the medical psychological and social aspects to reach proper diagnosis, appropriate line of treatment

Family level: -
* Practice considers the whole family as one unit for care
* It requires a will integrated team of family, physicians, capable of providing quality healthcare to all members with the family
* Also requires family health file and proper record system

The community level: -
* The health services provided to the community should be appropriate to address. The health needs a particular community to promote health and well-being to prevent and control priority, health problems, and treat any disease conditions.

Question 12

Comprehensive healthcare?

Answer 12

Bio-psycho-social preventive and curative care at the level of the individual family and community.

It adopts holistic approach to the health of the individual as a member in the family within the context of the community.

Question 13

comparison between clinical medicine and community medicine?

Question 14

Mention five sustainable development goals?

Answer 14

• No poverty
• Zero Hunger
• Good Health and well-being
• Quality education
• Gender equality

Question 15

Three terms are used to describe an infectious disease according to the various outcomes that may all occur after exposure to its causative agent?

Answer 15

• Infectivity refers to the proportion of exposed persons will become infected
• Pathogenicity refers to the proportion of infected persons who develop clinical disease
• Virulence refers to the proportion of persons with clinical disease will become severely ill or die

Question 16

What is meant by herd immunity?

Answer 16

The resistance of a group of people or a community to an attack by a disease to which a large proportion of the members of the group are immune

If large percentage of the population is immune. The entire population is likely to be protected not just those who are immune.

Question 17

What are the factors affecting incubation Period?

Answer 17

A. Dose And route of infection: for example, a higher dose of salmonella is associated with faster symptoms and shorter incubation. Period.

B. Biological factors of the infected host: some people are more susceptible to faster, disease, progression and complications because of their age genetics or the competence of their immune system. Incubation period of aids tends to be longer in eight HIV infected individuals who are young.

C. Pharmacologic factors: for example, the incubation period of aids will substantially lengthen by the use of effective anti-retroviral therapy

Question 18

What are the elements of chain of infection?

Answer 18

• Reservoir of infection
• Portal of exit
• Motive transmission
• Portal of entry
• Susceptible host

Question 19

Define carrier and the types of carriers?

Answer 19

A carrier is an apparently healthy individual who is infected and harbours pathogenic organisms as a focus of an infection in different part of their body where the organism finds a portal of exit to spread the infection

Types of carriers: -
* Incubatory carrier to transmit the disease during the incubation period.

• Convalescent carrier transmitting the disease during the convalescent period (after recovery of symptoms)
• Contact carrier: contact might be infected if came in contact with an infected person
• Healthy carrier like the inhabitants of endemic areas of infectious diseases usually the infections are eliminated spontaneously in two weeks except for HHBV one year (If asked human reservoir infection, just add cases, individuals with symptomatic illness showing disease manifestation)

Question 20

What is the animal reservoir?

Answer 20

Infectious diseases that are transmitted under normal conditions from animal to humans are called zoonoses where humans are usually an incidental host.

Ex: anthrax from sheep and rabies from dogs

Question 21

Enumerate modes of transmission?

Answer 21

• Droplet infection including direct as measles and indirect droplet as Meningococcal meningitis
• Foodborne infections as HAV
• Arthropod infections as malaria
• Contact infections as tetanus
• Parentally transmitted infections as HBV
• Vertical infections as TORCH infections

Question 22

Compare between direct and indirect droplet infection?

Answer 22

Direct droplet infection both reservoir and host are found together in the same place within 6 feet (1.8 meters) and the host is infected through direct inhalation of the spray (fine droplets) of reservoir. Kissing is a potential method of direct infection.

➢ Predisposing Factors include crowded areas with ill ventilation as camps

Indirect infection reservoir host do not come together and infection is transmitted by droplet nuclei, which are minute residues of spray droplets after evaporation of water, it measure <=5 µm in diameter making them easily suspended and carried by air current for longer period of time.

Question 23

How organisms that find exit from cases and carriers reach food?

Answer 23

• Handling by contaminated hands of food handlers
• Mechanical transmission by houseflies and cock cockroaches
• Using polluted water for drinking washing dishes
• Human excrete contaminated dust (uncovered food)
• Fertilization of vegetables with fresh human manure (parasitic infestation)

Question 24

Types of vector-borne infections?

Answer 24

A. Mechanical transmission, for example, houseflies and cougar roaches that mechanically carry ex critter and discharge and body surface and GIT

B. Biological transmission through blood, sucking insect as mosquitoes they play rolling transmission from a reservoir to a host as well as pathogen cycle events as reproduction occur within a biological vector

Question 25

What are the infections transmitted by blood?

Answer 25

Blood transmitted infections: - * Viral hepatitis (B, C and potentially A) * Syphilis, AIDS and malaria Usually occurring through blood contaminated, syringes and needles and blood transfusion without safety precautions Pyogenic Infections: - usually Staphylococcal When using contaminated syringes and needles

Question 26

Mention three ways of vertical infection?

Answer 26

* In-utero infection: which is transmission from pregnant mother, either in the first trimester before placental formation; example, congenital rubella syndrome or after the formation of placenta ;example, syphilis * perinatal infection, where the infant inquires the infection through infected breast canal * Breast-feeding: some viral infections pass in milk as CMV and HIV

Question 27

Endemic spread is

Answer 27

a disease constantly present in the community due to maintenance of infection by existent ecological factor spread of infection, usually shows sporadic unrelated cases or carriers of infection

Question 28

Epidemic spread

Answer 28

increased number of cases significantly more than the usual pattern of spread of the disease the cases are interrelated, either appearing in the same place or within the same time period

Question 29

Outbreak spread:

Answer 29

it’s a localized epidemic that involves a confined group as camps or schools. Examples are infecting diarrheal disease as during food poisoning or respiratory infections as influenza.

Question 30

Pandemic spread

Answer 30

it’s an epidemic of a particular infectious disease that spreads between countries simultaneously involving them Spanish flu and COVID-19

Question 31

Enzootic and epizootic spread

Answer 31

are endemic (ex,TB in cattle) and epidemic spread(ex, rift valley fever in cattle) of infectious diseases in animals, respectively, with potential risk of transmission to humans

Question 32

What are the Applications of active immunization?

Answer 32

Pre-exposure usually or post exposure occasionally: - Exposure active immunization is applied for children within the first two years of life as the compulsory vaccines in Egypt. It can also be applied for school children, international travellers, elderly, and mother before conception. Post exposure, active immunization: - Three viral diseases where vaccination is protective in shorter time than incubation Period (rabies variola and measles) Two taxemic disease: diphtheria and tetanus for those actively immunized for a booster is given after exposure to induce rapid protective response

Question 33

Limitations of chemo prophylaxis and common examples?

Answer 33

Can be pre or post exposure: - * Adverse effects of given drugs * Reactions and toxic * Costly of given on a wide scale * Drug resistant strains of organisms may develop * Provides temporary protection Commonly used: - * Penicillin for rheumatic fever * Tetracycline for cholera * Isoniazid for TB * Rifampicin to prevent meningococcal infection

Question 34

Surveillance

Answer 34

In the majority of infectious diseases, contacts are put under supervision every day for the incubation period of the disease for case finding however, they can perform their activities as going to school or work

Question 35

Segregation

Answer 35

contacts are excluded from school or work but not isolated usually practiced in diseases that have contact carriers as enterica or highly infectious disease as measles

Question 36

Isolation:

Answer 36

Contacts of the following diseases are isolated since they’re serious and expose others to infection: * Pneumonic anthrax * Pneumonic plague

Question 37

Compare between elimination and eradication of a disease?

Answer 37

Question 38

What is public health/ syndromic /clinical surveillance?

Answer 38

It is the ongoing collection and an analysis of health related data about a clinical syndrome that has a significant impact on population to timely detect or anticipate disease outbreak among populations, which is followed by making decisions and taking public health, actions and term of planning, implementation and evaluation of prevention and control measures

Question 39

Types of surveillance?

Answer 39

Passive surveillance: which refers to data generated by reporting sources without solicitation or intervention by the concerned, health authorities these data provide basic information necessary for studying infectious disease, pattern in a specific area Active surveillance: is a collection of data for a relatively limited period of time by regular outreach Usually done when a new disease is discovered for appears and a new geographic area or a new mode of transmission is being investigated or disease is targeted for eradication or elimination Special studies: Cross-sectional or cohort studies are often used to define incidents or determine prevalence of selected diseases and a population usually used for diseases with asymptomatic presentation has hepatitis c virus

Question 40

What is the case definition and give examples?

Answer 40

It’s a set of diagnostic criteria that must be fulfilled to be regarded as a case of a particular disease , can be based on clinical criteria, laboratory, criteria, or both. * Suspect case: a patient who suspected on clinical basis for reporting purposes * Probable Case: A patient to classified probable on clinical basis plus either epidemiologic or laboratory basis for reporting purposes * Epidemiologically linked case: the patient has contact with one or more individuals with either had the disease or have been exposed to a source infection as an event leading to a foodborne disease outbreak * Laboratory confirmed case: a patient was confirmed by one or more labors are methods listed in the case definition * Confirmed case: a patient who is classified usually on laboratory basis as confirmed for reporting purposes

Question 41

What are the reasons of outbreak occurring?

Answer 41

1. changing the agent itself like an increase in the amount or the virulence of an agent Where it’s introduction into a new setting 2. The host becomes less immune or may have risk factors that renders them more susceptible 3. Environment, favourable for interaction between host agent, for essence enhancing mode of transmission

Question 42

Enumerate Steps of an outbreak investigation?

Answer 42

* Prepare the fieldwork * Establish the existence of an outbreak * Verify diagnose * Define and identify the case * Perform descriptive epidemiology (in terms of time place and person) * Developed hypothesis * Evaluate hypothesis * Refine hypothesis and carry out additional studies * Implement control and prevention measures * Communicate findings * Initiate or maintain surveillance

Question 43

Why is verifying the diagnosis in an outbreak? Importance?

Answer 43

* To ensure the problem has been properly diagnosed by reviewing the clinical and laboratory findings * Many investigators, find it useful to visit one or more patients with the disease * To rule out laboratory errors * Summarize the clinical features using frequency distributions * To see if the clinical features are consistent with the diagnose

Question 44

What is global public health security?

Answer 44

The activities required both proactive and reactive to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries through existence of strong and resilient public health systems that are put in place to prevent detect and respond to infectious disease threats wherever they occur in the world ➢ These risks include emergence of new infectious diseases ➢ Rise of drug resistance ➢ Potential for accidental release of dangerous pathogens ➢ Increased globalization of travel and trade enabling spread

Question 45

Reservoir of healthcare associated infections?

Answer 45

Within healthcare facility reservoir: - Patient (case): may infect himself or others Healthcare providers: may act as a reservoir either a case or a carrier or a third person role where infection is carried in contaminated, hands, cloth or footwear Unknown reservoir: patient infected through insanitary healthcare facility environment ex: improperly sterilized Lenin Outside healthcare facility reservoir: - Visitors or companions: playing the reservoir role either a case or a carrier or they may play non- reservoir rule through food they carry to the patient or unkink contaminated hands Unknown reservoir: infection may be indirectly, carried by vehicles and vectors of insanitary surrounding environment as flies and cockroaches

Question 46

What are the forms of HAI?

Answer 46

Common community infections can also occur in healthcare facilities as influenza and diarrhea. Particular infections that vary according to the scope of services provided by the health facilities for example as pseudomonas aeruginosa in CF chambers and MRSA strain of staphylococcus infections.

Question 47

what are the measures of Prevention of HAIs?

Answer 47

* Effective infection control committee: setting policies and regulation and monitoring the performance of prevention and control of hospital infections * Measure for healthcare providers: periodic examination and segregation of suspected, protection by active immunization, chemoprophylaxis or Sero-prophylaxis * Manage occupational exposures infection and educate about the standard precautions * Surveillance of HAI for early case finding * Sanitary environment within the healthcare facility and the surrounding areas * Strict sterilization and sepsis * Chemoprophylaxis for all patients * Administrative regulations to ensure adherence to infection control, rules, and control of hospital visits

Question 48

What are the five items of standard precautions

Answer 48

Hand hygiene: the most important Use of PPI (gloves, gowns) Safe injection practices Safe handling of potenitally conteminated equipment Respiratory hygenie/ cough ediqutte

Question 49

Measures for healthcare providers and HAI?

Answer 49

* If the healthcare provider is infection-free: do pre-employment/periodic examination and if infection is suspected segregate until proven free of infection * Protect them by active immunization, chemoprophylaxis and Sero-prophylaxis * Education on standard precautions (the minimum infection prevention practice) that is applied to all patients regardless of suspected or confirmed infection status in any setting where healthcare is delivered to protect HCP as well as prevent HCP from spreading infections among patients * Manage occupational exposures to infection

Question 50

Epidemic meningitis (Meningococcal meningitis) causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 50

Causative Agent: The bacterium Neisseria meningitides (also termed meningococcus), is a fragile organism that has selective affinity to the meninges of the CNS. Usually Group A (epidemics) Reservoir: Humans, 5-10% are carriers in throat, if it reaches 20%--> threat of outbreak Mode of transmission: exits through nasopharyngeal discharge; direct droplet inf or indirect droplet inf Prevention: sanitation, health education and promotion. Conjugate vaccines (monovalent and tetravalent). Chemoprophylaxis; Rifampicin

Question 51

What are the advantages of conjugate vaccines over the polysaccharide vaccines

Answer 51

Their ability to elicit cell mediated immunity Confer longer lasting immunity Reduction in nasopharyngeal carriage and hence interruption of transmission Effectiveness in protecting young children

Question 52

Pulmonary TB causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 52

► M. tuberculosis (from human): responsible for 98% of pulmonary T.B, ► M. bovis (from cattle), and ► M. avian Reservoir: Humans, occasionally cattle and birds. Open active case of TB (sputum positive). Subclinical infection. No carriers. MOT: Respiratory discharge, due to direct droplet inf, indirect droplet inf, in utero infection (rare) Prevention: general, BCG vaccine that is live attenuated given once in life time (compulsory at birth without -ve tuberculin test), protects against serious forms of TB disease (limits multiplication not spread), not effective in adults Segregate vaccinated person from exposure of inf for 3 months Chemoprophylaxis; INH for 6-12 months

Question 53

Measles (Rubeola) causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 53

Causative agent: Measles virus; a highly infectious, fragile virus. Reservoir: Humans - Cases: in the form of clinical disease only. No carriers or subclinical infections. MOT: Respiratory discharges; rash not infectious. Direct droplet (main), Indirect droplet (including third person role; droplet is carried on contaminated hands or clothes). In utero. Enters through mucous membranes of mouth, nose and eyes or hematological in infected mother through umbilical cord Clinical disease give life long immunity while vaccine gives lasting immunity. MMR trivalent vaccine which is compulsory and also for pre-marital and married females before pregnancy. Passive immunization: Seroprophylaxis (Normal Human Immunoglobulin (NHIG) injection). Due to the dominance of the active immunization program, the need for immunoglobulin is usually restricted for those who are not legible to be actively immunized

Question 54

Measles used to be a serious fatal childhood illness. However, mortalities now have been declined due to

Answer 54

1- Effective measles vaccine that is estimated to prevent 1 million deaths every year, 2- Age shift towards an older age group, 3- Compulsory nutritional supplementation with Vitamin A, for the young children, 4- Wide spread use of antibiotics and rehydration techniques, 5- Efforts of the Integrated management of childhood Illness program (IMCI).

Question 55

Rubella (German measles) causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 55

Causative agent: rubella virus; a highly infectious virus. Reservoir: Humans: Cases - in the form of clinical disease (typical or atypical cases), Incubatory carriers and subclinical infections, Infants with chronic rubella syndrome (CRS). MOT: Pharyngeal discharges of cases, subclinical infections, and carriers. Infants with CRS shed large number of viruses in their pharyngeal discharges and urine. Rash is not infectious. Direct droplet, indirect droplet and in utero Prevention: General, active immunization by monovalent live attenuated rubella vaccine or by trivalent MMR. Seroprophylaxis; is given after exposure on early pregnancy. Isolation for 7 days from onset of rash, surveillance for max IP to those who and the disease. Protection for susceptible constants

Question 56

Influenza causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 56

Causative agent: Mainly human species of influenza virus, a highly infectious virus. Three types of influenza viruses are recognized: A, Band C, with no cross immunity. Among these three types, type A most virulent Reservoir: humans, occasionally swine and birds. Incubatory carrier exits before symptoms, subclinical inf. MOT: Direct droplet and indirect droplet inf. Entry through mucous membranes Inactivated vaccine from 4 strains of flu virus, given annually for high risk group. Chemoprophylaxis (Oseltamivir), in epidemic high risk contacts 1- Notification to the local health authorities and to WHO under International Health Regulations. 2- Isolation for 7 days at·home or at hospital for severe complicated cases. 3- Treatment is symptomatic. 4- Release:7 days from the onset of illness and good general condition.

Question 57

Public health mitigation measures that helped in the control and eventual end of COVID- 19 pandemic included;

Answer 57

■ Travel restrictions, lockdowns, business restrictions and closures, workplace hazard controls, ■ Emphasis on wearing a mask especially in crowded places, and emphasis on one meter as minimum physical distancing, besides the regular general preventive measures of droplet infections. ■ Quarantining those who have been exposed or are infected, ■ Contact tracing of the infected, ■ Testing systems, ■ The COVID-19 vaccines have been approved and widely distributed m various countries since December 2020.

Question 58

Typhoid and Paratyphoid (Enteric Fevers) causative organism, reservoir, mode of transmission, prevention and control (including vaccines)

Answer 58

Causative agent: * Typhoid: Salmonella typhi (typhoid bacillus), with a big number of serotypes. * Paratyphoid: There are three serotypes of Salmonella paratyphi A, B and C. Can remain in environment like water, ice, milk and milk products for weeks, destroyed by heat and disinfection. Reservoir: Humans, cases and carriers. No animal: * Incubatory carrier: Organisms are found in faeces in the last days of incubation period. * Convalescent carrier: About 10% of convalescents become carriers, either temporary for some weeks or months, or chronic (2-5% of convalescents). * Contact carrier and healthy carrier: for about two weeks. * Healthy carrier: for about two weeks. MOT: Ingestion of contaminated food and water. Direct hand to mouth infection females are liable to be faecal carriers five times more than males due to cholecystitis. Prevention: general, Typhoid conjugate vaccine, unconjugated Vi polysaccharide, live attenuated Ty21a vaccines. Carriers shouldn't handle foods, surveillance for two weeks and segregation from work until -ve 3 consecutive cultures over course of several days. Cirpofloxacin for 28 days for chronic carriers

Question 59

Cholera causative agent, reservoir, MOT, prevention

Answer 59

Causative agent: Two biotypes of Vibrio cholera; Classical and El Tor. Classical bio type is more virulent, but El Tor biotype is more resistant than the classical vibrio. Reservoir: Humans only. Cases include unapparent, subclinical or clinical type. Carriers include incubatory, contact and convalescent type. MOT: Stool and vomit. Prevention: General with special emphasis on implementation of adapted long term sustainable WASH solution to ensure safe of use water, sanitation and good hygiene. Oral cholera vaccines (WC-rBS or WC). Used in areas of hot spots and in humanitarian crises and outbreaks. Chemoprophylaxis; tetracycline Release after 3 -ve successive stool specimens

Question 60

Poliomyelitis causative agent, reservoir, prevention and control

Answer 60

Causative agent: Poliovirus ( enterovirus) has three antigenically distinct types (Type 1, Type 2, and Type 3) - giving no cross immunity Reservoir: human; cases and carriers (all types) incubatory, convalescent, contact and healthy. MOT: Pharynx exit and stool. Droplet and faecal oral. Prevention: Exposure to inf causes life long lasting immunity. Infectiousness last for 6-8 wks. General methods. Sabin-bivalent oral polio vaccine and Salk polio vaccine (trivalent) .No seroprophylaxis. Control: always suspect polio in any case of acute flaccid paralysis, notify local health office and who, isolation at home or in hospital, proper disinfection of respiratory discharges and stool. Measures taken for contacts. Examine and put for two wks. Booster dose of vaccine if needed

Question 61

Discuss why the elimination of Polio in Egypt happened

Answer 61

1- Compulsory immunization of infants at the first two years (with 7 doses of oral Polio vaccine). 2- Mass polio immunization campaigns that hold annually (using the old Sabin vaccine that included all three types of virus - t OPV)). They were conducted twice/ year in Egypt for all children from 1 day till 5 years irrespective of immunization status. 3- Surveillance of Acute Flaccid Paralysis (AFP) 4- Environmental surveillance for wild virus in sewage. The wild virus

Question 62

Hepatitis A causative agent, reservoir, MOT, prevention and control

Answer 62

Causative agent: Hepatitis A virus, relatively resistant outside the body. Reservoir: Man: Cases and incubatory carrier Cases: Acute cases. Mild unapparent cases are more common in children and are important reservoirs. No chronic disease, nor persistent infection. Exit: The virus is found in blood and is excreted in faeces. MOT: 1. Feco-oral transmission 2. Parenteral transmission: rarely from blood during viremia. Prevention: active immunization of two doses given to high risk individuals. Seroprophylaxis normal immunoglobulin given before exposure or within a few days. For intimate contacts or houshold mates and travelers to endemic areas and at risk groups. Control: rules of food sanitation

Question 63

Tetanus (lock jaw) causative agent, reservoir, MOT, prevention and control

Answer 63

Causative agent: Clostridium tetani. powerful exotoxins. Reservoir: animals, man and soil Exit: Intestinal excrete of animals and humans MOT: injury at contaminated sight, post operative surgical tetanus, after labor/abortion or neonatal infection of the umbilical stump. Prevention: general, active immunization via monovalent vaccine three doses. to military forces, policemen, camp resident, farmers, agricultural workers, pregnant women at 6 months pregnancy followed by 2nd does after one month at least 2 wks before delivery. 5 full doses give full immunization. Seroprophylaxis and penicillin to prevent local activity of organism. Control: as general

Question 64

Algorithm of tetanus prophylaxis after injury

Answer 64

Question 65

Discuss the causative agent, reservoir, exit and MOT of HIV

Answer 65

HIV Human cases and chronic incubatory carriers lasting for up to 10 yrs Exit: blood, semen, vaginal, CSF, saliva, breast milk, urine and tears MOT: Direct sexual contact, contact of abraded skin or mucous membrane with body secretions, blood transmission thru needles and IV, Vertical transmission,

Question 66

Complications of AIDS

Answer 66

* Bacterial infections: Bacterial pneumonia, Mycobacterium tuberculosis, Salmonellosis. * Viral infections: Cytomegalovirus, Viral hepatitis, Herpes simplex virus, Human Papilloma virus. * Fungal infections: Candidiasis, Cryptococcus meningitis ... * Parasitic infections: Pneumocystis carinii pneumonia, Toxoplasmosis. * Cancers: Kaposi's sarcoma, Non-Hodgkin's lymphoma. * Other complications: Wasting syndrome, neurological complications.

Question 67

Prevention of AIDS

Answer 67

1. Social welfare, health promotion and health education about prevention of illegal sexual relations. Provision of facilities for easy marriage and for recreation as sports. Provision of chance of work to youth in order to earn money. 2. It is also important to use disposable syringes and sharp objects and do not share needles for any purposes. Sanitary precautions during any piercing procedures, dental procedures, surgical operations and haemodialysis must be followed. Usage of personal protective equipments as gloves, masks, gowns or goggles and hand washing should be applied. 3. Avoiding sexual activity with intravenous drug users, persons with multiple sexual partners known or suspected to have AIDs. Usage of condoms consistently and correctly will prevent transmission of HIV. 4. Testing blood donors and blood products: * For being free from HIV. * From donors who have engaged in no HIV risk behaviors and * From donors who have been previously tested negative for HIV antibodies 5. Routine HIV testing and counseling in areas of high prevalence. Routine HIV testing in antenatal clinics and avoidance of pregnancy in HIV seropositive female. 6. Prevention of congenital infection by treatment of mother during pregnancy by highly active antiretroviral therapy (HAART). HIV women should not breast feed their infants. 7. Immunization of HIV infected children with BCG, DPT, measles, MMR, hepatitis B vaccines to guard against infection of the corresponding diseases in highly susceptible immune­ compromised persons.

Question 68

Control of HIV

Answer 68

1. Isolation of HIV infected person is unnecessary and ineffective 2. Specific treatment: ■ HIV can be suppressed by lifelong treatment with combination ART (antiretroviral therapy), consisting of 3 or more ARV (antiretroviral) drugs. ■ ART does not cure HIV infection but controls viral replication within a person's body and allows individual's 'immune system to strengthen and regain the capacity to fight off infections. ■ Treatment also includes drugs for prophylaxis / treatment of opportunistic infections. Contacts to HIV/ AIDS: 1- Listing of the sexual and needle sharing partners. Confidential HIV testing and counseling should be offered to them 2- No isolation or segregation, just follow up is recommended every 3 months by staff from the National AIDS program. 3- No specific protection measures, just highlight on the general measures -(given before)­ through health education to prevention of further exposure( s) to infection.

Question 69

What is the post exposure prophylaxis for HIV

Answer 69

* Post-exposure prophylaxis (PEP) is the use of ARV drugs within 48 hours of exposure to HIV in order to prevent infection. * A three drug ARV regimen is recommended. * PEP is recommended for healthcare workers following needle stick injuries in the workplace.

Question 70

Hepatitis B virus causative agent, reservoir, exit, MOT

Answer 70

Hepatitis B Humans as cases and carriers in incubatory carriers, convalescent carriers and healthy carriers Exit: blood and blood products, saliva, CSF, peritoneal, pericardial and synovial fluid, amniotic fluid, semen and vaginal secretions. MOT: pre-cutaneous and per-mucosal exposure to inf body fluids, infected unscreened blood transfusion, organ transplantation, renal dialysis, sexual contact, perinatal mother to infant transmission.

Question 71

Prevention of Hepatitis B

Answer 71

Prevention of blood-transmitted inf Health education of the public and high risk groups prevention of sexual inf screening for vulnerable groups Active immunization: Hepatitis B vaccine by recombinant DNA which is compulsory for infants four dose at birth. Seroprophylaxis of human specific immunoglobulin for post exposure prophylaxis in case of infants born to HBsAg +ve mother or suspected exposure. Both sero and vaccinatoin: for infants born to inf mother or when individual is infected

Question 72

Hepatitis C virus causative agent, reservoir, MOT and prevention

Answer 72

Hepatitis C virus Human cases and carriers MOT: HCV primarily parenterally, sexual and perinatal mother to infant transmission I-General: same as HBV. 2-Specific: No vaccine is available yet. Prophylactic immunoglobulin is not effective.

Question 73

Control of Hepatitis C

Answer 73

* Case-finding, by serologic testing of suspected cases. * Specific therapy: The goal is to prevent complications of HCV and to eradicate infection. Patients legible for treatment are selected carefully according to the degree of liver fibrosis, coma, liver functions and blood picture. Direct acting antiviral agents (DAAs), which work as HCV protease inhibitors, are currently used as the main treatment regimen.

Question 74

The Ministry of Health Plan of Action for prevention, care and treatment of viral hepatitis includes the following topic areas:

Answer 74

1) Strengthening surveillance of acute and chronic viral hepatitis to: * Monitor trends of disease. * Assess risk factors. * Monitor prevention programs. * Detect outbreaks. 2) Reducing transmission of viral hepatitis through: * Promoting infection control practices in governmental hospitals as well as private healthcare settings. * Establishing governmental commitment to support policies that ensure infection control practices in Egypt. * Reducing occupational transmission of viral hepatitis. * Strengthening monitoring and evaluation programs for ensuring implementation of infection control programs. 3) Improving blood safety through: * Establishing governmental commitment to support policies that ensure the safety and adequacy of national blood supply. * Building a sustainable base of safe blood donors to maintain adequate and safe blood supplies. * Applying the national standards in all activities related to production and testing of blood. 4) Increasing awareness about viral hepatitis through health education. 5) Eliminating transmission of vaccine-preventable viral hepatitis through: * Achieving universal hepatitis B vaccination for populations at high risk for infection or complications. * Ensuring that all newborns receive the hepatitis B birth dose as soon as possible following birth (24 hours). 6) Improving care and treatment to prevent complications through: * Providing safe, effective, and affordable treatment to patients with chronic hepatitis B and C. * Improving care and treatment of patients with advanced forms of liver diseases. * Increasing political commitment to support global pricing for viral hepatitis drugs and to increase access to new drugs in Egypt and worldwide.

Question 75

HCV screening in Egypt is a priority cost effective public health program due to many facts:

Answer 75

* Prevalence of HCV seropositivity was about 10% and the prevalence of HCV RNA positivity was 7% among the 15 - 59 years age groups. Approximately 3.7 million persons had chronic HCV infection in the age group 15-59 as per EDHS-2015 * A significant number of those who are chronically infected will develop cirrhosis or liver cancer. * New HCV infections are usually asymptomatic, few people are diagnosed when the infection is recent. Chronic HCV infection is also often undiagnosed because it remains asymptomatic until decades after jnfection when symptoms develop secondary to serious liver damage "WHO calls HCV as silent enemy". * Currently, antiviral medicines can cure more than 95% of persons with hepatitis C infection, thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment is low.

Question 76

Rabies (Hydrophobia) causative agent, reservoir, exit, MOT

Answer 76

Rabies virus single antigenic type Urban type (canine) dogs, cats Sylvatic type (wild): foxes and wolves, vampire bats Man MOT: Bites/licks, contact with saliva or brain tissue, inhalation of aerosolized rabies virus and bat excreta

Question 77

HIV manifestations early inf, late inf, and late phase of inf

Answer 77

* Fever * Headache * Sore throat * Swollen lymph glands * Rash * Swollen lymph nodes (often one of the first signs of HIV infection) * Diarrhea * Weight loss * Fever * Cough and shortness of breath * Night sweats * Chills or fever higher than 38 ° C * Dry cough and shortness of breath * Chronic diarrhea * Persistent white spots on tongue/mouth * Headaches * Blurred and distorted vision * Weight loss

Question 78

Prevention of rabies

Answer 78

General preventive measures for animal: 1. Destruction of stray dogs. 2. Registration, licensing and vaccination of all pets by in activated or modified live virus vaccines. 3. Avoid handling and feeding of unfamiliar animals. Specific prevention for human: -Active vaccination (pre and post exposure) pre in 3 doses at 0,7,21,28 days. booster if titre falls and given every two years in long occupation exposure -Post exposure: first dose is given as soon as possible after bite then day 3, 7, 14, 28 of the first dose. - Seroprophylaxis (human anti-rabies immunoglobulin): together with vaccine after sever exposure as soon as possible to neutralize virus. Given as soon as possible up to the 7th day.

Question 79

What do you have to do if a dog bites an adult or a child in the street? 4 different problems

Answer 79

You have the risk of 4 main problems: * Pyogenic infections: staph, stept. Infections => (use antibiotics) * The risk of tetanus (see algorithm for contaminated wounds) * The risk of rabies (Give HDCV + RIG if indicated) * Besides: the lacerated wounds & cut nerves and tendons

Question 80

What do you have to do for a rabies bite?

Answer 80

The first thing ( without thinking) is to deal with the wound: ■ Clean the wound with plenty of water+ 20.0% soap solution, 70.0 % alcohol ■ Never suture the wound (except in life threatening conditions or excessive bleeding) If: ■ The animal escaped, or died/ killed and found Negri bodies, or ■ Severe multiple wounds in the head and neck Then, give HRIG and start active immunization immediately and complete the doses You have to ask about the history of previous immunization: ■ If no history: Give full doses. ■ If previously immunized within 2 years: give fewer doses. o HDCV: give only 2 doses, 3 ·days apart. If: low severity wound, and the animal is alive, confined, arrested, or captured Then, start active immunization, and observe the animal for 10 days. ■ If the animal dies, complete the doses. ■ If the animal kept alive, stop the doses. Conditions where RIG is Not given: ■ Minor scratches, abrasions or bruises without bleeding ■ The wound was not contaminated with animal's saliva (e.g., there was a barrier of clothes) ■ If the bitten individual had full post exposure vaccination in the last 5 years. ■ After 10 days or more of the bites with no signs of rabies on the animal

Question 81

Categories of contact and recommended post-exposure prophylaxis.

Answer 81

Question 82

Yellow fever causative agent, reservoir/vector, exit and MOT

Answer 82

Causative agent: The yellow fever virus of the family Flaviviridae. Reservoir and vector of Yellow Fever: In Jungle yellow fever, the main reservoirs in the forest area are nonhuman primates, and forest mosquito (Aedes or Haemagogus species) is the vector. In Urban yellow fever, the reservoir is man and Aedes aegypti mosquito is the vector. Blood of infected individuals and monkeys thru mosquito bites MOT: bite of infective female Aedes aegypti mosquitoes (man-mosquito-man). and bite of several species of genus Aedes or Haemagogus (monkey-mosquito­ man).

Question 83

Prevention of yellow fever

Answer 83

1) General Prevention a. Environmental sanitation: Eradication or control of mosquito vector . Control measures are directed to breeding places and use of insecticides. b. Health education: to the target population in endemic area to follow the methods of protection from mosquito bites ( e.g. protective clothing, bed nets, repellents, etc.) 2) Specific Prevention: Immunization: Active Immunization: 17 D vaccine: * It is the most effective preventive measure for yellow fever. * It gives 99% immunity. Antibodies appear 7-10 days after immunization and persist for life. International health regulation considers that the yellow fever vaccines approved by WHO provide protection against infection starting 10 days following the administration of the vaccine; this protection continues for the lifetime of the person vaccinated. * The vaccine is given to international travelers ( all travelers 2:9 months of age) coming from or going to endemic countries.

Question 84

How is Egypt protected from Yellow Fever?

Answer 84

Yell ow fever is not present in Egypt and is rare in other areas such as eastern Africa despite the wide spread of the vector Aedes aegypti. Cross immunity due to infection by other flavi viruses ( e.g. Dengue, West Nile), provides an "ecological barrier" that prevents the occurrence of yellow fever in these areas.

Question 85

West Nile Fever (WNF) causative organism, reservoir/vector and MOT

Answer 85

West nile virus Birds are the reservoir and Culex pipiens is vector transmitted by blood transfusion, trans-placental and percutaneous routes

Question 86

Elimination of lymphatic filariasis (Bancroftian) in Egypt:

Answer 86

1. Interruption of transmission, and care for those who already .have the disease. To interrupt the transmission, the entire population at risk must be covered by mass drug administration (MDA) for a period long enough to ensure that the level of microfilariae in the blood remains * below that which is necessary to sustain transmission .. The recommended MDA includes a single annual dose of combinations of Diethylcarbamizine citrate (DEC) and Albendazole for 4-6 years. The regular use of DEC­ medicated cooking salt for 1-2 years has also been used in some settings to interrupt the transmission cycle. Mass administration of these drugs has the two-fold purpose of preventing future cases of lymphatic filariasis and control the infection for those people who are already suffering from the disease. Alleviate the suffering of affected people through morbidity management and disability prevention.

Question 87

Malaria causative agent, reservoir & Vector, MOT

Answer 87

Protozoan parasites of genus plasmodium. Four species: Plasmodium vivax, P. falciparum, P. ovale and P. malaria Humans are the only reservoir of human malaria. A case may have several plasmodia species at the same time. Vector is anopheles mosquito. MOT: Bite of infective female anopheles mosquito, direct transmission from one individual to another thru blood or blood products, injection equipment, congenital transmission or in utero infection.

Question 88

Complications of malaria

Answer 88

* Anemia * Splenomegaly * Abortion and fetal infection * Falciparum malaria may be associated with respiratory distress, jaundice, liver failure encephalopathy, pulmonary and cerebral edema, coma and death

Question 89

General preventive measures for malaria

Answer 89

1. Environmental sanitation: * Elimination of the breeding sites of mosquito by filling of swamps, marches and water collections. * Eradication oflarval stages by spraying crude oil and larvicides on water surfaces. * Destruction of adult mosquitoes by using suitable insecticides (liquid aerosol, pyrethrium). * Human protection by: o Using Insecticide-treated bed nets o Screening of windows and doors o Animal barrier between breeding places and human habitation. o Using protective clothes. o Applying repellents to exposed skin between dusk and dawn. o A void going outdoors at dawn when Anophiline mosquitoes commonly bite. 2. Health education of the public, at risk groups and travelers about the mode of transmission, protection from exposure and value of prophylaxis and treatment. 3. Avoid taking blood from any individual giving history of malaria or a history of travel to, or residence in, a malaria endemic area.

Question 90

Specific measures of malaria

Answer 90

* Chloroquine phosphate, (500 mg for average adult orally once a week). Prophylaxis should begin 1-2 weeks before travel, during stay and must be continued for 4 weeks after leaving endemic areas. * In areas with chloroquine-resistant P. falciparum, Mefloquine is recommended (250 mg orally once a week) for adults. Prophylaxis should begin 1-2 weeks before travel, during stay and 4 weeks after leaving the endemic area. no vaccine for malaria

Question 91

Role of the public health physicians regarding environmental health issues?

Answer 91

* Recognition of the environmental problems in the area he/she serves * Identifying the agencies responsible for implementing preventative and corrective actions to deal with the environmental hazards followed by monitoring these actions * Participating in the environmental health, education activities to the public

Question 92

Enumerate the environmental issues facing our planet?

Answer 92

1. Climate changing global warming 2. Air pollution 3. Ocean acidification 4. Acid Rain 5. Water pollution, and freshwater scarcity 6. Solid waste crisis 7. Desertification 8. Deforestation 9. Loss of biodiversity diversity 10. Energy shortage

Question 93

Define water scarcity?

Answer 93

Question 94

mention Sources of outdoor air pollution?

Answer 94

1. Transportation is the major source of pollution through exhausts of automobile that releases carbon monoxide, hydrocarbons and lead compounds 2. Combustion fossil fuels as coal in power stations, releasing large amount of carbon dioxide and acidic oxide of sulphur & nitrogen 3. Industrial manufacturing processes that give off Dust & fumes 4. Agriculture activities, and the use of pesticides and fertilizers 5. Forest fires 6. Active volcanoes with the release of sulphur oxide 7. Decomposition of organic matters; for example, dead animals release methane and ammonia

Question 95

General impacts of outdoor air pollution?

Answer 95

Health impacts 1. Immediate and short term: - * Headache, anxiety, breathing problems, eye and nose irritation 2. Long-term: - * cancers, respiratory, cardiac, and reproductive disabilities 3. Premature death Effect on properties Building deterioration by corrosion of metals and degradation of limestone monuments Environmental impacts * Global warming, stratosphere ozone depletion and acid drains * Food security and agriculture impacted due to damage of vegetables and crops * Water resources shows low quantity and quality * Aquatic life shows reduced diversity and death of coral reefs * Reduced biological diversity due to species, death and susceptibility to illness

Question 96

What are the measures to mitigate the impact of outdoor air pollution?

Answer 96

* citizens and public authorities should participate in implementation of strategic plan to reduce pollution * Emphasis should involve transportation, industries, and households * Highlighting pollution prevention so pollutants will not be released at all; example, by changing the design of engines * Prevention of pollutants from entering the environment by setting up new filtering technology * Highlighting tax incentives for pollution rather than fines and penalties * Setting legislative standards for energy efficiency * Expansion afforestation * Saving convenient public transportation facilities * More research into green energy resources * Distributing solar energy to developing countries to replace firewood

Question 97

Given an account on global challenge of an adequate water, quality and quantity?

Answer 97

Question 98

Outline healthcare waste management in hospitals?

Answer 98

1) Sorting and packaging by type; example, infectious or pharmaceutical into color-coded containers at the place it was generated; in addition to adding a label and a symbol to ease distinguishing between different wastes and avoid directing them to different waste stream 2) Collecting and transport through the facility with precautions (not to spill out the contents) 3) Interim storage where containers are stored before being disposed, the room should be adequately ventilated and free of insects, cats and rodents * Storage time is 24 to 72 hours according to weather temperature 4) Treatment of the waste to reduce hazards and costs of disposal; example, incineration and sterilization 5) Final disposal of the treated waste in a sanitary landfill

Question 99

What’s the most important differences between communicable and non-communicable disease?

Answer 99

* Most infectious diseases are communicable, which means they can be transmitted from one person to the other, either directly, for example influenza via droplet infection or indirectly like malaria via mosquito bites * The risk of getting a disease increases with the number of people who have the disease in the population, for example a child having influenza in a class will transmit it to his classmates while risk of a child getting diabetes, is not directly dependent on his friend having diabetes * Some infectious diseases as measles give long-lasting immunity against Re-infection

Question 100

Give reasons of the increasing prevalence of NCDs?

Answer 100

1. The demographic transition The decreasing mortality and fertility increase life expectancy with subsequent increasing in elderly population, aging is associated with NCDs 2. The epidemiologic transition Shift mortality due to communicable disease to non-communicable disease as a result of immunization and antibiotics 3. Nutrition transition Shift in the pattern of nutrition, for example, a diet, high and fats and sugars and low in fibre and polyunsaturated fatty acids will increase prevalence of obesity and subsequently NCDs 4. Multifactorial nature of factors Factors are related to genetic environmental, cultural and behavioural aspects, which limits the opportunities to having a specific intervention for prevention and control 5. Migration of population across different culture: new lifestyle of the new culture increases the risk of NCDs 6. International communication Youth are exposed to modernization and concepts and behaviour through mass media and Internet for example by the introduction of dietary patterns that predispose to NCDs 7. Environmental changes: air pollution is associated with high prevalence of NCDs 8. Limited use of scientific progress and management of NCDs

Question 101

Who is at risk of NCD?

Answer 101

Modifiable behavioural risk factors (4): - * Unhealthy diet * tobacco use * Physical activity * Harmful use of alcohol Nonmodifiable risk factors * Age – sex – genetics – ethnicity - personality type Metabolic factors (4 key changes) * Raised blood pressure * Overweight/obesity * Hyperglycaemia * Hyper lipidaemia

Question 102

Definition of quaternary prevention?

Answer 102

It’s the set of health activities to avoid the consequences of unnecessary or excessive intervention of the healthcare system for example, avoid unnecessary use of antibiotics with the subsequent increase of bacterial resistance

Question 103

Outline the role of the public health, physician in prevention and control of NCDs?

Answer 103

* Health education * Nutrition education * Identifying high-risk groups * Early detection by screening tests * Referral of the identified cases to specialists * Follow up referrals to ensure compliance to treatment and behavioural changes

Question 104

Mention three causes of cancer ?

Answer 104

1. Biological carcinogens (bacterial, viral parasitic infections, hormonal, and genetic factors) 2. Chemical carcinogens as tobacco smoking, which is the main cause of cancer. 3. Physical carcinogens as UV and ionizing radiation.

Question 105

Define noncommunicable diseases surveillance and mention its goals?

Answer 105

Ongoing systematic collection and analysis of data to provide appropriate information regarding a country’s NCD burden by tracking the population at risk and estimating mortality, morbidity, risk factors and determinants of NCDs and their trends overtime. * Establishing the baseline data for the four main NCDs and the risk factors to ensure their Burden magnitude can be estimated. * Monitoring trends and collecting consistent data across countries to determine the geographical distribution * Generating hypothesis and stimulating research to enable comparisons overtime * Contributing to planning and prevention of NCD pandemics before their occurrence, by predicting future caseloads and faults in health practice

Question 106

Outline framework for national NCD surveillance?

Answer 106

Pillar 1: monitoring exposures (risk factor surveillance) Monitoring risk factors is the main stay of national NCD surveillance in most countries either behaviour as physical inactivity or metabolic as raised blood pressure or social as educational level Pillar 2: monitoring outcomes An accurate measure of adult mortality is one of the most informative ways to measure the extent of the NCD pandemic and to effectively plan and target control programs Pillar 3: assess health system, capacity and response This assessment requires reviewing the status of NCD: relevant policies, strategies, action, plans and programs, as well as the existence of partnerships and collaborations related to NCD prevention and control

Question 107

What are the principles of management?

Answer 107

* Management by objectives in order to get things done effectively * Learning from experience * Division of labour as management needs teamwork * Conversion of work: coordinate the activities with team members to achieve objectives * Substitution and proper use of resources by optimizing the use of available resources to maximize benefits * Delegation Someone with authority gives another person the authority to take responsibility for a specific activity when needed * Setting priorities to start with the most important objective

Question 108

What are the management functions?

Answer 108

* planning function * implementation functions * evaluation functions

Question 109

Enumerate steps of planning ?

Answer 109

* Situation analysis * Problem identification and priority setting * Objective setting * Selection of alternative solution/interventions * Planning for Resources * Planning for monitoring and evaluation * Planning for sustainability

Question 110

What is taking it into consideration in order to prioritize a problem?

Answer 110

1. The magnitude of the problem 2. Seriousness of the problem which has four main components: - * Urgency * Severity * Economic coast * Impact on others 3. Effective productivity and other socioeconomic implications 4. Availability of cheap feasible technologies for prevention and control

Question 111

Define and enumerate strategic planning?

Answer 111

A 3 to 5 years plan that would go into several steps to reach a goal that the organization wants to achieve in the future – it include the following :- * Setting or updating organization vision and mission * Organization situation analysis: strengths, weaknesses, opportunities, and threats challenges (SWOT/SWOC) * Problems solving * Identifying the problem * Prioritize the problem * Establish goals and objectives * Select solutions * Continue with the following steps * Put an action plan * Implement monitor evaluate * Update your plan

Question 112

What are the components of implementation function?

Answer 112

* Organizing and staffing * Directing and leadership * Coordination of work and teambuilding * Recording and reporting * Monitoring and supervision

Question 113

What are the characteristics of an effective leader?

Answer 113

* A leader must attain the art of influencing people, so they will strive willingly toward the achievement of a group goal. * He needs to be mentally able, intelligent, decisive, got a superior judgment and fluency of speech * Personality factors like responsibility, positive attitude and having a vision * Must have skills in communication, problem-solving, creative thinking, negotiation, teambuilding, and risk management

Question 114

Compare between a manager and a leader?

Answer 114

Question 115

Give an account on the types of indicators?

Answer 115

Input indicators: - Measures the resources of the organization; for example, measuring the number of health units per 100,000 population (done by MOHP). Process indicators: - Measures the efficiency and quality of implementation and how work is done: for example, percentage of public health facilities that fulfil quality standards. Output indicators: - Measures the efficiency and workload of health facilities and management of resources to increase utilization; Example, average number of ANC visits per mother Outcome indicators: measures the effectiveness of the organization in achieving its strategic objectives; Example, number of two-year-old children who are fully immunized. Impact indicators measures the effectiveness of health program and achieving its goal influenced by socioeconomic and cultural characteristic of the community; example, maternal mortality rate

Question 116

mention four of the principles of the health sector reform in Egypt?

Answer 116

* Equity * Efficiency * Sustainability * quality

Question 117

Define patient safety and mention its goals?

Answer 117

risk reduction of unnecessary harm that could be associated with healthcare to the minimum Goals * Identify patient correctly using at least two patient identifiers before administering medication or taking blood samples * Improve effective communication among healthcare team by using readback confirmation technique and by avoiding the use of similar abbreviations or symbols * Improve safety of using medication by enlisting the look-alike/sound alike and labelling medication * Eliminate wrong side, wrong patient and wrong procedure surgery by preoperative verification of the process via available documents and surgical site before anaesthesia * Reduce the risk of healthcare acquired infections by following infection control guidelines * Reduce the risk of patient harm, resulting from falls by implementing and evaluating a fall reduction program

Question 118

What are the components of health system?

Answer 118

* Service delivery * Health workforce * Health information system * Medical products, vaccines, and technologies * Health system financing * Leadership and governance

Question 119

What are the levels of health system in Egypt?

Answer 119

The central level: - MOHP headquarters are located in Cairo. Their main functions are policy formulation, national strategies, planning, supervision, evaluation, international and bilateral agreements Health directorates: - One in each of the 27 Gates, their main function is implementing national policies, planning, supervision and evaluation Health districts: - 255 of them. They are the link between health directorate and health service delivery points Healthcare providers at primary secondary and tertiary levels of care: -

Question 120

Services covered by NUHIS?

Answer 120

* Family physician * Specialist and consultant concerning dentistry * Home health services * Treatment and hospitalization Surgeries * Treatment abroad * Medical imaging laboratory, and other investigations * Rehab services and restorative devices

Question 121

Causes of maternal morbidity?

Answer 121

Maternal nutrition: - * iron or folic acid deficiency anemia * Wasting due to protein deficiency * Osteomalacia due to Calcium deficiency Complication of pregnancy and faulty management of delivery: - * Hemorrhage * Preeclampsia * Injury and infection of genital tract Aggravation of pre-pregnancy diseases: as diabetes, cardiac renal diseases

Question 122

Causes of maternal mortality?

Answer 122

Direct obstetric causes: - 1. Hemorrhage: bleeding an early pregnancy, antepartum and postpartum (1st cause) 2. Pregnancy induced hypertension (2nd cause) 3. Genital sepsis 4. Unsafe abortion 5. Obstructed labour 6. Amniotic Fluid embolism, hypervolemic/neurogenic and septic shock Indirect causes of mortality or diseases: which existed before or occured during pregnancy and is aggravated by physiological changes associated with pregnancy; example, rheumatic disease ranking 1 followed by anemia

Question 123

What are factors contributing to maternal mortality?

Answer 123

* Young age of marriage and short spacing between births * Nutrition as anemia * Economic status * Medical problems as diabetes * In adequate maternity healthcare

Question 124

What’s the difference between lethal and sub lethal pregnancy wastage?

Answer 124

Lethal denotes abortion and stillbirth Sub-Lethal denotes congenital malformations

Question 125

Given account on the measures used to reduce maternal mortality and improve the outcome of pregnancy?

Answer 125

* Improve utilization of maternal health services * Community development * Adequate Antenatal care * Routine screening and treatment of diseases * Proper training of the medical staff

Question 126

Outline the premarital care package?

Answer 126

Premarital care is caring for a female from birth to marriage with an objective of promoting health of the future parents and prevention of health hazards in order to have a healthy future. Component: - * Personal history of partners * Family, history of diabetes and genetic diseases * Genetic counselling for hereditary * Complete medical examination for case finding * Immunization MMR and DPT * Health education and social care * Investigations including blood tests for STDs

Question 127

Mention 9 components of ANC?

Answer 127

* Registration and recordkeeping * Periodic visits in clinical examination * Health education * Nutrition, education * Tetanus toxoid immunization * Risk detection and management * Referral if needed * Home visiting * Social care

Question 128

Principles of good natal care?

Answer 128

Having the objective to protect the health of the mother and her baby during delivery, as well as having a timely access to emergency care whenever needed. Components: - * Clean delivery with aseptic techniques * Avoid unnecessary vaginal examinations * Early detection and referral in case of prolonged or obstructed labour * Proper resuscitation of the new born and sterile dressing for umbilicus * Eye drops as chemoprophylaxis to prevent ophthalmia neonatorum

Question 129

Outline the postnatal care package?

Answer 129

Objectives: - * Care for both mother and the newborn * Prevention of complication as purple substance and bleeding * Rapid restoration of mother’s health * Family planning services discussion * Encouragement of breast-feeding * Emotional support to avoid postpartum blues Components: - * Medical care, including general, abdominal, and local examination * Nutritional care * Health education

Question 130

Outline the interpregnancy care package?

Answer 130

Objectives: - * To decrease infants and maternal mortality and morbidity * To prevent unwanted, pregnancies and decrease nutrition among infants and young children Components: - * Medical care through periodic examination to check any morbidity changes * Nutritional care: restore, nutritional status * Health education about family planning * Social care

Question 131

Components of comprehensive reproductive health?

Answer 131

Effort includes: - 1. Safe motherhood 2. Sexual health, education 3. STD prevention 4. Family planning 5. Infertility prevention 6. Abortion complications management 7. Managing reproductive health disorders

Question 132

What are the contributing factors related to the under-five health problems?

Answer 132

Socioeconomic factors * Availability and accessibility of quality healthcare * Food sufficiency * Clean water supply Family factors * Housing condition * Family size * Culture, habits and lifestyle Child factors * Gender inequality, put females at high risk * Birth order: the higher the order the more the risk * Child spacing

Question 133

Predisposing factors for preterm?

Answer 133

* Idiopathic * Pre-induction of labour * Premature rupture of membranes * Maternal cause as uterine abnormalities and diabetes * Fatal causes as twins and congenital anomalies

Question 134

Causes of congenital abnormalities?

Answer 134

Genetic factors: - * gene mutations and chromosomal aberrations are the most common causes Adverse intrauterine environment: - * Infections causing congenital anomalies as TORCH infections * Live vaccines similar to infections * Drugs containing teratogenic chemicals * Exposure to radiation * Maternal smoking (passive or active) or malnutrition (iodine deficiency causes cretinism)

Question 135

Prevention of congenital abnormalities?

Answer 135

* Genetic counselling which allows early detection * Premarital care, which includes immunization and health education to avoid all risk factors as smoking, teratogenic drugs and radiation * Antenatal care Should emphasize the health education messages mentioned above, early detection of infection and therapeutic abortion if indicated * Secondary prevention through early detection after birth with proper management * Rehabilitation of congenitally disabled children

Question 136

Components of healthcare for children?

Answer 136

* Registration * Periodic examination involving clinical laboratory examinations as well as Growth development monitoring * Health education * Nutrition care * Immunization * Management to sick children * Out-reach program

Question 137

Enumerate health education messages in maternal and child health care?

Answer 137

* The importance of well-Baby care and timing for visits * Promotion and techniques of breast-feeding * Feeding of the lactating mother * Birth Spacing * Immunization schedule * Essentials of baby care * Stimulating activities for development of the child and importance of toys * Weaning * Diarrhea and oral rehydration therapy * Management of acute respiratory infections * Accident prevention

Question 138

Discuss direct and indirect interventions in nutrition care?

Answer 138

Direct intervention components: - * Nutrition assessment by growth, monitoring and education on breast-feeding and weaning practices * Nutrition supplementation including vitamin A given routinely at the 9th and 18th months for the child and for the mother postpartum * vitamin D at 2nd month to the mother * iron supplements at 7th month to the mother * Apply corrective measures for malnutrition and referral of severe cases Indirect interventions * health education * immunization * birth spacing * parasitic and infectious disease control

Question 139

Tetanus toxoid schedule

Answer 139

Question 140

What are the health problems of school children?

Answer 140

* Malnutrition problems as Iron deficiency anemia, PEM, obesity, vitamins and fluorine deficiency with dental caries * Psychological problems as depression and suicide * Tobacco and drug use * Parasitic diseases * Infectious diseases especially droplet in crowded schools * Non-infectious diseases as diabetes * Injuries, especially sports accidents * Teenage sexual relations carries hazards of early pregnancy and STDs

Question 141

Mention 4 specific problems of adolescence?

Answer 141

1. Use of alcohol, cigarettes, and other drugs 2. Initiating sexual relationships at early ages, putting themselves at high risk of unintended pregnancies and STDs 3. Psychological, physical and sexual violence 4. Wide range of adjustment and mental health problems

Question 142

What are the objectives of SHP (school healthcare program)

Answer 142

Promotion and primary prevention through: * Measures for school children as nutrition care, immunization at school entry, health education, physical, social, mental health promotion, guidance and counselling * Measures for the environment by having a school surrounding free of pollution and a school building well-ventilated with classrooms that are not crowded with proper illumination * Desks and seats must be suitable in size * School must follow a sanitation policy with white playground stuff with crowding * Measures for school staff * School and community partnership Secondary prevention through control of health problems by pre-entry and periodic examination, screening for early detection and proper management through curative services Tertiary prevention = Rehabilitation of disabled students

Question 143

What are the reasons for population aging?

Answer 143

Epidemiologic transition (decreasing mortality rate): - * In developed countries that decline is attributed to general improvement in socioeconomic conditions, nutrition, and prevention and control of diseases. * Advancement in medical care. * In developing countries, the success of infant and child health programs (growth monitoring and immunization etc) are responsible for the decline. * Reduction in the infant and child mortality resulted in increased average life expectancy and subsequently increase in elderly population . Demographic transition (decline in fertility): - * Urbanization * Industrialization * Development programs directed to women * Family planning programs

Question 144

Outline common health problems of the elderly?

Answer 144

Old people are more prone to: * Chronic diseases like diabetes, chronic heart disease, hypertension, cancer, and stroke * Disorders of vision and hearing and taste * Osteoporosis type II * Lowered Immunity * Injuries leading to fracture * Nutritional disorders, obesity, wasting , iron and vitamin deficiency ex= A, B2 ,C Mental health problems: - * depression * Dementia, most commonly Alzheimer’s disease * low Resilience to life stresses Social health problem: - * Social stresses that arise from retirement, loneliness, death of spouse/friends and associated disability

Question 145

What is the population census and its value?

Answer 145

Census is the enumeration of all persons in different parts of the country at the specific time as well as collecting demographic and social economic data of the population ( age, sex, religion, education, occupation, etc) using a special questionnaire form by a trained enumerator, usually every 10 years. Value of census: - * Provides information about the characteristic features of population. * Provides basic data required for calculation of statistical indicators; example, vital rates * The census data along fertility and mortality indicators are used in making population projection (expected population changes) which is essential for planning the future needs of a population as education, jobs, etc

Question 146

What are the three components of a population change? And three ways to measure it?

Answer 146

* Births * Deaths * migration Measured by rate of natural increase, growth rate, doubling time of population growth

Question 147

Outline the stages of demographic transition?

Answer 147

* Stage one: high birth rate and high death rate = little or no increase in the population (high potential population) * Stage two: high birth rate and falling death rate = high growth rate (transitional population) * Stage three: declining birth rate and relatively low death rate = slow population growth (balanced population) * Stage four: low birth rate and low death rate = very low or no population growth

Question 148

Characteristics of the population pyramid?

Answer 148

* The base width: presents the proportion of the young age group * The top width: presents the proportion of the old age group * The height: presents duration of life expectancy * The symmetry: presents the similarity/differences in proportion of males and females in the different age group * The shape of the sides: maybe smooth with depressions (emmigration out the country) or with bulging (immigration or baby boom)

Question 149

Discuss different Profiles of the different population pyramids?

Answer 149

The age-sex composition may show: - * expensive population: large number of people in the younger ages (developing countries) * Constrictive population: smaller number of people in the younger ages (transitional phase from high to low birth rates) * Stationary population: has roughly equal number of people in all age ranges and of gradually at older ages; example, developed countries

Question 150

What is age-dependency ratio and what does it indicate?

Answer 150

It’s the ratio of person in the dependent age (<15 and >64) to those at the working age (15- 64) usually expressed as the number of dependent persons for every 100-working person. It indicates the economic burden that the working portion of the population must carry, the higher the ratio, the heavier the dependency. Burden is one of the factors that affect health, social pattern and labour for quality

Question 151

What are the three main dimensions of Egyptian problems?

Answer 151

* Rapid population growth: Egypt population ranks 15th in the world. * Improper population distribution where 97% of Egyptians are concentrated in about 4% of the total of 1 million km² * Improper population characteristics as high illiteracy rate, high level of unemployment, high age dependency ratio, and minor role of women in the development programs.

Question 152

What are the objectives of the national population policy?

Answer 152

* Decreasing rate of population growth * Achieving better population geographic distribution * Promoting the population characteristics

Question 153

What are the strategies to achieve the objectives of the national population policy?

Answer 153

The national socioeconomic development programs as a long-term policy; examples, education and economic development Family planning program is a short-term policy that aim at slowing down population growth so that the country can allocated resources towards development programs rather than service programs Strategy is focusing on FIVE parameters: family planning, youth, health, woman empowerment, and communication/awareness

Question 154

Enlist to the factors affecting fertility?

Answer 154

* Age and sex structure of the population: the higher the proportion of young women in reproductive age the higher the fertility rates * Fecundity: it is the physiological capacity of couples to reproduce * Marriage rate * Age at marriage for girls: the younger, the higher the rates * Economic status: the higher, the lower the rates * Education: better education is associated with low fertility rates * Woman status: the better the woman status in the community with good access to education, work and health services the lower the fertility * Family planning method use: the availability and accessibility to them is associated with high contraception and subsequently low fertility rates * Presence of motives for high fertility; example, stable marriage, religious or personal motive

Question 155

Mention some motives for high fertility ?

Answer 155

* Health: high infant/child mortality motivates the family to have more children * Economically children support the family by being employed at young age * Family welfare where they believe large families are empowered and sons continue the family name * Stable marriages as many children help prevent divorce and infidelity * Religious motive * Personal motive: manliness in high fertility * Dislike of contraception * National welfare: stronger nation when having high population

Question 156

What are the objectives of the family planning program?

Answer 156

* Increase the contraceptive prevalence rate through increasing availability and accessibility of family planning services and methods . * Increase the demand for family planning services through information, education and communication programs. * Follow up services to decrease discontinuation rates for contraception * Decreased contraceptive method failure rate * Reduce the unmet needs for family plan

Question 157

Who are the priority groups for family planning programs?

Answer 157

1. Teenage pregnancy as it’s too early and may lead to spontaneous abortion or prematurity. 2. Late pregnancy above 35 years of age as it increases risk of down syndrome. 3. Short spacing negatively influence, proper breast-feeding and process of rebuilding maternal nutritional stores. 4. Multi-parity (5 or more) predisposes to hypertension, diabetes, renal diseases, and genital prolapse.

Question 158

What are the impact indicators of family planning program?

Answer 158

* Crude birth rate * General fertility rate * Fecundity rate * Age specific fertility rate * Total fertility rate * Other indicators as maternal morbidity, maternal mortality

Question 159

What are the outcome indicators of family planning program?

Answer 159

* Contraceptive prevalence rate * Contraceptive discontinuation rate * Contraceptive failure rate * The unmet needs for family planning