Community Written
Community Written
Community Written
COMMUNITY WRITTEN
CHAPTER 3:
1-Define carrier and mention its types, with examples. (Feb 15, May 16, Jan +
May 17 Aug 16)
A carrier is an apparently healthy individual (without showing manifestations of disease
i.e. without an apparent disease) who is infected and harbors pathogenic organisms as
a foci of infection in different parts of their body. The organism finds exit through body
fluids/excreta and can spread infection
TYPES:
- Incubatory carrier, ex: rubella, influenza, typhoid, cholera, poliomyelitis, AIDS, HBV
- Convalescent carriers, ex: typhoid, cholera, poliomyelitis, HBV
- Contact Carrier, ex: typhoid for 2 wks, cholera, poliomyelitis
- Healthy Carrier, ex: typhoid for 2 wks, poliomyelitis, HBV
4- Define chemoprophylaxis and state its limitations & give examples. Mar +
May2 16
-Chemoprophylaxis: Antimicrobial drugs administered for specific prevention of certain
infectious diseases. It is given to prevent the development of disease, or carrier state, either
Pre or Post exposure
-Limitations of Chemoprophylaxis:
Adverse effects of given drugs
Reactions and toxicity
Costly if given on a wide scale
Development of drug resistant strains of organisms
Provide temporary protection protection
-Drugs Commonly Used for Chemoprophylaxis:
Penicillin (long acting) to prevent rheumatic fever.
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The tetravalent vaccine is given 0.5ml S.C, it gives 85% type specific protection and it can be
repeated every 3 years according to the circumstances
Indications:
- preteens and teens
- high risk adults who are potentially exposed to infection
- pilgrims are given one does before leaving
Complications: mostly no serious problems but some may have sore arm, fever, muscle
aches, rash
Contraindications: person who had a severe allergy to any vaccine component
NB: polysaccharide vaccines are used during a response to outbreaks and protein based
vaccines has been recently developed and used in some local countries
2- chemoprophylaxis: Rifampicin 600mg twice daily for 2 days and half the dose for children
for close contacts especially during outbreaks and epidemics
- indiacted for immediate protection in epidemics to high risk and confined groups
- side effects may occur in 5-10%
- it is contraindicated in reduced kidney functions, psychological and neuro diseases
10-Definitions:
Endemic Spread: A disease constantly present in the community, due to maintenance of
infection by existing ecological factors (host, agent and environment) Spread of infection
shows: Sporadic cases that appear here and there, unrelated and Carriers of infection in
some diseases.
Epidemic spread: Increased number of cases significantly more than the usual pattern of
spread of the disease. An epidemic is characterized by the fact that all the cases are
interrelated i.e., have certain features in common regarding. Time i.e. All cases appear
within a certain period and Place: All cases are reported within the same community or area
Outbreak Spread: An outbreak is a localized epidemic that involves a confined group or
closed community, as camp, school, nursery, institute, or hospital. Outbreak shows the
characteristic features of epidemic
Pandemic Spread: an epidemic of a particular infectious disease that spreads in between
countries, and simultaneously involves some countries of the world.
Enzootic Spread: It is endemic spread of infectious diseases in animals, with the potential
risk of transmission to man, e.g., Tuberculosis and brucellosis in cattle
Epizootic Spread: It is epidemic spread of infectious diseases in animals, with the potential
risk of transmission to man e.g., Rift Valley fever, and foot and mouth disease in cattle
11-International measures
-To prevent transmission of certain infectious diseases from one country to another,
quarantine measures were previously used for cholera, yellow fever and plague (small pox
was included before eradication).
-The WHO recent legal instructions for international measures, - The International Health
Regulations (IHR) 2005 - included other infections that can cause serious public health
impact and spread rapidly internationally e.g., poliomyelitis due to wild type poliovirus,
human influenza caused by a new subtype and severe acute respiratory syndrome (SARS).
-The purpose of IHR is to prevent, protect against, control, and provide a public health
response to the international spread of disease in ways that are appropriate with and
restricted to public health risks, and which avoid unnecessary interference with
international traffic and trade.
International measures are applied for: International travelers, Imported animals: e.g.,
Monkey, for yellow fever. Imported goods: Raw wool hides (skin) and hair: quarantined for
anthrax, where imported goods must be associated with "authorized disinfection certificate
Ex: Poliomyelitis and measles are in the way 1-Variola (smallpox): the WHO has declared
to be eliminated, and then eradicated in worldwide eradication of disease in 1978.
Egypt No cases are reported since then.
2-Rabies: some developed countries have
eradicated the disease in pet animals (dogs
and cats).
13- Enumerate steps of outbreak investigation * all chapter is imp*
1- Prepare the field work
2- Establish the existence of an outbreak
3- Verify the diagnosis
4- Define and identify the case
5- Perform descriptive epidemiology (in terms of time, place and person)
6- Develop Hypotheses
7- Evaluate hypotheses
8- Refine hypotheses and carry out additional studies
9- Implement control and prevention measures
10- Communicate findings
11- Initiate or maintain surveillance
18- Mention the reservoir of infection, MOT, and preventive measures for
HIV infection. May 17
Reservoir: humans: cases and carriers. Human cases and chronic incubatory carriers lasting
up to 10 years or more
Modes of transmission:
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19- Mention MOT and specific prevention of Hepatitis B. May2 16, Jan + Mar
+ May 17, May 19
1. Per-cutaneous (IV, IM, SC, intradermal) and per-mucosal exposure to infective body
fluids: e.g., infected syringes, needles etc.
2. Infected unscreened blood transfusion.
3. Organ transplantation: when donors are not accurately investigated.
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21- What are the specific preventive measures for rabies in human? Feb 15
p.125
CHAPTER 6
1- Mention 5/4 principles of management. Aug 16 Jan 20
1- Management by objectives
2- learning from experience
3- division of labor
4- convergence of work
5- substitution and proper use of resources
6- delegation
7- setting priorities
Safety
Timeliness
CHAPTER 10
1- Define maternal mortality and mention its causes. Jul 15, May + Aug 16,
Nov 17, Jul 20
It is the death of a women while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of pregnancy, from any cause related to or aggrevated
by the pregnancy or its management but not from accidental or incidental causes.
Causes:
a-Direct obstetric causes: (80%)
Hemorrhage: Bleeding in early pregnancy, antepartum & postpartum (1st cause in
Egypt)
Pregnancy induced hypertension (2nd)
Genital Sepsis (puerperal and post abortive)
Unsafe abortion
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Obstructed labor
Other: thromboembolism, postpartum collapse: hypovolemic shock, neurogenic
shock, septic Shock, amniotic fluid embolism
b- Indirect causes: these are from diseases which exist before or during pregnancy and are
aggrevated by physiological changes of pregnancy ex: heart disease (rheumatic 1st in Egypt),
anemia (2nd), Diabetes.
7- State the objectives of antenatal care (ANC) and mention five of its
components. Mar 16
Health promotions of expected mothers
Prevention of complications and hazards during pregnancy
Early detection and proper management of morbidity
Health education of the mother about health care of the baby
Components of ANC:
Registration and record keeping
Periodic examination, including lab tests
Health education
Nutrition care
Immunization
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11- Define the at-risk approach in maternal health program and illustrate
using 4 examples of factors detected from history. Mar 17
It is a method by which we ensure that everyone is receiving a standard level of care and
that more care is given to those at risk according to the type of risk
Factors:
age less than 18 or more than 40
first or 5th or more pregnancy
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CHAPTER 5:
1- Mention six reasons of the increasing prevalence of NCDs. Mar 16, May 18,
Mar 19
(1) The demographic transition: The decrease in mortality and fertility resulted in increase
in life expectancy with subsequent increase in the proportion of the elderly populations.
(2) The epidemiologic transition: There is shift from mortality from communicable diseases
(due to the use immunizations and antibiotics etc.) to mortality from NCDs which have
chronic nature.
(3) Nutrition Transition: There is a shift in the pattern of nutrition to a diet high in total fat,
sugar and other refined carbohydrates and low in polyunsaturated fatty acids and fibers.
Such pattern resulted in increasing the prevalence of obesity and subsequent NCDs.
(4) The multi-factorial nature of the risk factors for the non-communicable diseases: •
Unlike communicable disease, it is difficult to identify the specific cause-effect relationship
in NCDs. • The multiplicity of the risk factors associated with a specific NCD limits the
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opportunities to have specific intervention for prevention and control. • The risk factors are
related to genetic, environment, culture and behavior, which represent a challenging issue
to public health programs.
(5) Migration of population across different cultures: The individuals who migrate from
low-risk culture (e.g. rural areas) to high-risk culture (e.g. urban areas) follow the life-style of
the new culture and demonstrate increased risk for NCDs.
(6) International communication: • International communication, multinational business
and new food technologies have resulted in new life-styles and new food products favoring
the occurrence of NCDs. • Communication through the mass media/satellites/internet,
overseas travel, and international food marketing introduce dietary patterns which
predispose to NCDs. • Adolescents and youth are exposed to modernization in concepts and
behavior. Their exposure to the risks of NCDs early in the life cycle results in the
development of a large cohort with health problems during adulthood and older age.
(7) Environmental changes: The increase in the level of physical and chemical air pollution is
associated with high prevalence of NCDs.
(8) Limited use of scientific progress in management of NCDs: There are rapid and
successful achievements in the science of risk detection, use of medication and technologies
to prevent and control NCDs.
6- Compare risk factors for type I and type II Diabetes. Nov 17, Nov 18
-type 1: inherited genetic disorder that can be triggered by viral inf( mumps, rubella, CMV)
and environmental factors as early cow milk
-type 2: genetics, age, sedentary life, obesity, smoking, stress
7- State risk factors for Cancer. May 16 State environmental risk factors for
cancer. Aug 16
1- biological carcinogens: viral, bacterial, parasitic infections, hormonal and genetic factors
2- chemical carcinogens: food and water contamination and tobacco smoking
3- physical carcinogens: UV rays and ionizing rafiations
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9- Mention the role of diet as a risk and protective factor for cancer. May 17
-low intakes of fruits and vegetables lung cancer (increase fruit and vegetable
consumption)
-High intakes of meat and fat and low intake of fruits, vegetables, fibers, vitamins and
minerals colorectal cancer (stop consumption of meat especially preserved meats can
reduce the risk)
-Poor dietary habits leading to obesity breast cancer( maintain health weight)
10- Discuss 4 risk factors for chronic obstructive pulmonary disease (COPD).
May 21
Genetic and environmental factors and they include:
Air pollution, tobacco smoke and second-hand smoke, indoor and outdoor air pollution,
occupational exposures and socioeconomic factors
12- Describe the role of PHC physicians in prevention and control of NCDs
1. Health education to improve the lifestyle.
2. Nutrition education to prevent nutrition-related diseases.
3. Identify the high-risk groups for NCDs.
4. Early detection of the diseases by conduction of screening tests to the high-risk groups.
5. Referral of the identified cases to specialists.
6. Follow up of referred cases to ensure compliance to treatment & following healthy
behavior.
CHAPTER 9:
1- Explain the purpose for community needs assessment
To promote the health status and to solve relevant problems in a community we should:
Understand the community, know all the people
Identify community needs, the actual and the felt
Plan and implement health programs with full involvement of the community
Services intended to help people will be most effective if:
People identify their problems and know the cause and underlying factors
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3- Short account on/ state principles of 1ry Health Care? Jul 15, May 18
Affordable by people: they can pay for the cost incurred by utilization of the service
Acceptable to people: measured by utilization
Accessible geographical, social, financial
Appropriate to meet the health needs of the population
4- State the 8/6/4 of the essential elements of 1ry health care. May + Nov 17,
May + Nov 18, Nov 20, Mar 21
1- Health education concerning prevailing health problems, their prevention and control.
2- Promotion of food supply and proper nutrition.
3- Basic sanitation and safe water supply.
4- Maternal and child health (MCH), including family planning
5- Immunization
6- Prevention and control of locally endemic diseases address priority health problems
7- Appropriate treatment of common diseases and injuries.
8- essential drug list to cover the local needs according to the disease load in the community
CHAPTER 16:
1- Discuss the (age) dependency ratio. Mar 17
It is the ratio of persons in the dependent ages (<15 and >64) to those at the working age
(16-64). It is usually expressed as the number of persons in the dependent age for every 100
persons in the working age
- It indicates the economic burden that the working proportion of a population must carry,
the higher the ratio the heavier the burden
- It affects health, social pattern, and labor force quality
It states that a population's fertility and mortality will both decline from high to low levels as
a result of economic and social development. The decline in mortality usually precedes the
decline in fertility, resulting in high population growth during the transition period.
Stages of demographic transition:
Stage 1: High birth rate and high death rate = little or no increase in the population (High
potential population).
Stage 2: High birth rate and falling death rate = high growth rate (Transitional population).
Stage 3: Declining birth rate and relatively low death rate = slow population growth
(Balanced population).
Stage 4: Low birth rate and low death rate = very low or no population growth
7- Discuss the latest Egyptian population trends as regards size, change, and
structure
AS Q3