Public health programs

Women & Reproductive health/ Maternal Morbidity & Mortality 1. Define maternal mortality rate. Mention causes of maternal mortality. State the possible causes of its decline. Definintion: no. of maternal deaths of 100,000 women at age 15-49 years old. Causes: -Direct : Hypertension, eclampsia, puerperal sepsis, obstructed labor, induced abortion. -indirect: Heart disease, anaemia, chronic htn, diabetes. Decline due to: -improvement of the quality of obstetric care. -increassing access to family planning, -education women about seeking medical care.
2. Define perinatal mortality and rate. Mention causes of perinatal mortality Number of still birth and death of neonates (less than 7 days) per 100000 total birth. Causes: Maternal Toxemia of pregnancy +antepartum hge maternal malnutrition maternal diseases Natal long difficult labour asphyxia birth injuries

Postnatal RDS premature, low birth weight infections anomalies

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4. 5.

Discuss briefly five principles that make the women during reproductive period require special care woman in reproductive age constitutes large number of population pregnancy related morbidity and mortality are frequent but preventable pregnancy related deaths will affect socioeconomic development women are special risk group, because of child bearing period, more vulnerable to socioeconomic and environmental factors health problems of mothers and children are interrelated. State maternal health indices Mention predisposing factors which increase the risk occurrence of puerperal sepsis low general resistance low resistance of genital tract unclean delivery practice

Mention why anemia should should be detected and treated during pregnancy and outline role of antenatal care in its prevention 7. Risk Indicators for a pregnant women 8. Enumerate different investigations that should be conducted during premarital care. CXR Blood examination: ABO, Rh, HIV, Hep, VDRL, sugar urine: albuminuria, glycosuria, DM, renal infection stool: parasites
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Lab Investigation in initial visit (antenatal care) Blood : Hb level, ABO, Rh, syphilis urine: albumin, pregnancy test, sugar Lab investigation for pregnant women Biological risk (maternal age, maternal height, maternal weight, paternal age, birth order, interbirth interval) Medical risk (general diseases: CVS, renal, liver, DM, anemia, etc) Obstetrical risk (bad obstetrics history, present condition of malpresentation, twins, hge, eclampsia) social risk (poor, unsanitary home, smoking)

10. Risk factors that might affect pregnancy outcome

11. Biological factors for risk pregnancy 12. Give short account on maternal age as a biological risk factor in pregnancy

young maternal age (<16) increases risk of prematurity IUFD preeclampsia, eclampsia uterine dysfx old age (>35) increases risk of genetic abnormal conception first trimester abortion medical complications: HTN related pregnancy, DM difficult labor maternal and fetal death 13. List immediate preventive measures for newborn during natal care. clear airway aseptic cut of umbilical cord apply silver nitrate or sulfa eye drop 14. Points of health education during postnatal period BF, Family planning avoid puerperial infection care of episiotomy sleep and rest diet psychological changes, exercise 15. Mention health education topics during first trimester pregnancy advise on how to deal with nausea and vomiting, importance of attending center periodically, traveling, clothes, bathing, douche, mood swings, sexual intercourse, breast care

warn about drugs, radiation, diseases eg rubella

16. Preventive measures for puerperal sepsis

during pregnancy correct anemia treat septic focus health education on personal hygiene and abstinence from intercourse late in pregnancy during labor and puerperium prophylactic antibiotics healthcare providers should be trained to diagnose and treat or refer the patient with puerperal sepsis women should be aware of early sign and symptome conduct clean, sterile techniques during delivery. Demography 1. Characteristics of Egyptian Population pyramid Base-wide denoting high birth rate Sides-Minimal slope bulge from 0-4 years inndicating contol of infant and preschool mortality -Slope rapidly after youngest age group due to relatively high age specific mortality rate that Height-short, as the life span is short.Average life expectancy is 72 years (2010) Median age-low due to relatively high birth rate and high mortality rate Dependency state-The productive age group constitutes a smaller proportion compared to the percentage formed primarily by those below 15 years added to those above 60 years Discuss census and its types 1. de facto: counting the individuals wherever they actually are at the time of the census. easier, less expensive and more economic compared to de juro type. 2. de juro: counting individuals at their legal permanent residence regardless whether or not they are present physically at the time of the census. this gives factual figure
2. 3.

Differentiate between population pyramid between developing and developed communities Developing Developed narrow - low birth rate not sloping - low mortality rate wide and high life expectancy high- d.t low birth rate, low mortality rate, high old dependency low young dependency high old dependency

Base Side Apex Median age Dependency

wide - high birth rate, high young dependcy ratio sloping - high mortality rate narrow and low life expectancy low - d.t high birth rate, high mortality rate, high young dependency High young dependency low old dependency

4.

Define Migration. Mention its type with examples (tajuk ni dr omit, kn?) ye ea? rasanya doc ajar dlm praktikal....masuk gak kot.

5. 6. 7. 8. 9. 10.

Increasing life expectancy and proportion of older people is growing in most of societies, enumerate factors behind this increase. Compare between aging phenomenon in developed and developing communities Mention four fertility indicators. Write formula used for their calculation. Give short account on Crude birth rate Give short account on Age specific Fertility rate Give short account on General Fertility Rate (formula, what does it measure, 2 points of weakness)

Under 5 1. Why nutritional diseases are prevalent in preschool period? -hyperactivity -faulty feeding habits -infectious & parasitic disease 2. Short account on characteristics of preschool period -high mortality -high morbidity -malnutrion -injuries -growth & development 3. Define Post Neonatal Mortality Rate. List 3 main causes of death . post neonatal mortality = no of death aged 28d to 1year X 1000 total no of live birth - no of neonatal death 1. ARI 2. GE & dehydration 3. congenital anomalies & prematurity 4. Define Infant Mortality Rate. List main causes of infant mortalilty and outline the means reducing this rate in Egypt no of death in end of 1year per total no of live birth in same year & locality X 1000 1. ARI 2. GE & dehyration 3. Congenital anomalies & low birth wt means of reducing infant mortality: multi intervention 1. GENERAL MEASURE -improve socioeconomic std & environmental sanitation -education of females 2. SPECIFIC MEASURE a)maternal care: ANC, N, PNC. family planning, maternal nutrition b)infant care: immunization, early dx & mx of ARI & GE, breastfeeding & safe weaning practices, growth monitoring, special care of LBW babies 5. Define (by formula ) a vital rate to measure the mortality of children aged 28 days to one year. What are main causes of mortality. Three main measures to reduce it. post neonatal mortality = no of death aged 28d to 1year X 1000 total no of live birth - no of neonatal death COD 1. ARI 2. GE & dehydration 3. congenital anomalies & prematurity measure to reduce it: 1. GENERAL MEASURE -improve socioeconomic std & environmental sanitation

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-education of females 2. SPECIFIC MEASURE a)maternal care: ANC, N, PNC. family planning, maternal nutrition b)infant care: immunization, early dx & mx of ARI & GE, breastfeeding & safe weaning practices, growth monitoring, special care of LBW babies Compare in a tabular form between neonatal and postnatal mortality rates as regard; formulae used for calculation main causes of mortality and measures aiming to reduce deaths in each Define indicators of health services directed to under five children. a) Neonatal mortality rate. b) Post-neonatal mortality rate. c) Infant mortality rate. d) Child death rate. e) Under-5 mortality rate. Give 8 reasons school age is given special consideration in health Enumerate 6 different means of reducing infant mortality rate. List 5 characteristics for preschool children -high mortality -high morbidity -injury -malnutrition -growth &development Advantages of breastfeeding for the child and mother Mention 6 breastfeeding guidelines -begin ASAP, half an hour after delivery -should be on demand, day & night -exclusive breastfeed for 6m -complementary semisolid food after age 6m -continue breastfeeding till age 2y -avoid use of bottle & pacifier Enumerate different uses of growth chart Define preschool period and mention the reasons for high prevalence of malnutrition among them. Give examples of their malnutrition diseases

EPI Enumerates 4 factors that would damage vaccines defect in cold chain use of antiseptic in BCG expiry date due - due date~ unacceptable temperature freezing of DPT, dt, TT, HBV exposure to sunlight during administration 2. Write down in a table compulsory immunization schedule of infants in Egypt. (Age, disease, type of vaccine, route of administration)
1.

Age 0-2 w

vaccine OPV BCG

route of administration oral Intradermal

disease polio TB

Type of vacine LAV LAV

2, 4 6 m

OPV DPT HBV

oral IM (AL thigh) IM

polio Diphteria, Whooping cough, tetanus Hep B polio polio measles, mumps, rubella polio measles, mumps, rubella Diphteria, Whooping cough, tetanus

LAV DT toxoid, pertussis killed bacteria recombinant yeast derived Ag LAV LAV LAV LAV LAV DT toxoid, pertussis killed bacteria recombinant yeast derived Ag

9m 12m

OPV OPV MMR OPV MMR DPT

oral oral subcutaneous oral subcutaneous IM

11/2 y- 2y

Short notes on compulsory schedule of vaccination in the first year of life in Egypt Objectives of expanded program on immunization i. to achieve and maintain almost 100% coverage with all EPI vaccines ii. to achieve global eradication of polio and then maintain polio free status iii. to eliminate measles by immunization of targets with 2 doses of measles vaccine iv. to control hepatitis B infection by reducing sero-prevalence of HBsAg to < 1% among children <5 v. to eliminate NT vi. to maintain 0 level of Diphtheria vii. to prevent severe form of TB ( meningitis and military TB) viii. to reduce incidence of whoping cough, mumps and rubella ix. to maintain immunization safety x. to prepare for introduction of new vaccine (HIB vaccine) 5. Discuss cold chain and its components tool for its monitoring
3. 4. 6. Discuss absolute and temporary contraindications of vaccination Absolute Pertussis vaccine within 48hrs, fever spikes to 40.5, not caused by other causes, collapse or shock or persistantly crying for 3hrs. within 3 hrs, convulsion with or without fever

Temporary blood transfusion (1-3 m) pregnancy sever illness, hospitalized immunosuppressive therapy 7. List different compulsory vaccines given to infant in Egypt during the second month of life OPV, DPT, HBV

Mention compulsory immunization schedule during first year of life in Egypt. (Types, mode and time of administration of different vaccines) 12months. MMR - liva attenuated vaccine- 0.5ml - SC on rt arm OPV - OPV live attenuated vaccine - 2drops - oral 9. National Immunization Days. Advantages. Characteristics of an effective NID for polio eradication progam 1. all children age 0-59 months 2. within 1-3day 3. conducted in 2 round (4-6w apart) 4. OPV given in extra doses 5. given in low season polio transmission 6. conducted at least 3y annually. 10. Write the schedule of vaccination of women in reproductive period by tetanus toxoid by WHO. 1st dose: after 3 month 2nd dose: 4 weeks later (at least) 3rd dose: during 6 month or subsequent pregnancy 4 th dose: 1 year later, or subsequent pregnancy 5th dose: 1 year later, or subsequent pregnancy 11. Give short account on Outreach immunization services as one of the strategy for the vaccine delivery. health team should be visting the area that: inaccessible to service hove low vaccination coverage
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limitations expensive cold chain may be disturbes difficult to arrange schedule

Health of Elderly 1. Mention characteristics of illness in elderly 2. What are the goals of preventive health care in the elderly 3. Enumerate personnel and sectors responsible for elderly care 4. Give 6 primary preventive measures applied to the elderly 5. Identify factors affecting the elderly quality of life 6. Mention 8 causes of death among elderly in Egypt 7. Psychosocial factors affecting mental health of the elderly 8. Discuss specific medical features of illness in old age 9. Factors affecting the elderlys quality of life Disabilities 1. Define handicap. Mention their types 2. Differences between crippled and disabled child 3. Discuss risk factors for occupational injuries 4. Give an account on primary preventive measures aiming at preventing the occurance childhood disabilities 5. Enumerate 5 categories of sensory disabilities of children 6. List prenatal causes of childhood disabilities

 chromosomal cause genetic cause rh factor maternal stress environmental causes maternal disease & disorder during pregnancy age of mother 7. Postnatal etiological factors of disability among children injuries childhood disease environmental Occupational health 1. Mention the objectives of preplacement examination 2. Discuss briefly pre employment examination 3. Objectives of periodic medical examination for industrial workers 4. Each employee is subjected to a preplacement examination before joining a new job. Mention the components and objectives of pre placement examination 5. Mention problems of malnutrition among industrial workers 6. Role of industrial physician 7. Factors to be considered in diet planning of industrial workers 8. List consequences of malnutrition among industrial workers 9. Duties of occupational physician 10. Mention how can you reach the diagnoses of occupational diseases 11. Mention medical measures to prevent occupational diseases 12. What are the criteria of diagnosis for occupational diseases 13. Mention 3 health problems of agricultural workers due to their occupation. 14. Risk factor for occupational injuries 15. Discuss factors to be considered in diet planning for industrial workers 16. Write the classification of the different hazards that may be encountered in a work place? Give the name of one disease caused by each of the mentioned hazard 17. Outline prevention and control of noise induced occupational deafness 18. Comment on occurance of communicable diseases related to occupational exposure (3 examples) 19. Define pneumoconiosis and give one example School health programme 1. Give reasons for giving special consideration for school age 2. Explain why school children specially primary ones more liable to communicable disease 3. Why health Education should be done for school children 4. Mention screening test carried out for schoolchildren. Who are responsible to carry them. 5. Objectives of health appraisal in the school 6. Define school health appraisal and mention its purposes 7. Mention safety measures for accident prevention at schools 8. Mention 4 most common communicable disease among primary school children in Egypt and discuss the activities should be taken for their prevention 9. Methods of health education in school. 10. Enumerate measures should be taken fpr prevention communicable disease in school Family planning 1. Define family planning and mention its impact on health (both mother and children)

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Mention 5 activities of family planning clinic Premarital care, including family life education birth control services management of infertility and STD health screening tests ( breast examination,bld pressure, weight measurement, pap smear, pelvic examination) treatment and follow up for any pathological condition related to reproductive organ Mention type of effectiveness of contraceptive method Theoretical effectiveness: effectiveness of method when it is perfectly invariably applied by user Use effectiveness : observed effectiveness of a method and includeds errors by users due to faluty application, omission or discontinuation Program effectiveness : success of a method when recommended to large group.(depend on factor of acceptability) Mention activities of family planning clinic State the types of evaluation in family planning programme Evaluation of need Evaluation of plan Evaluation of performance Evaluation of impact Evaluation of outcome Discuss criteria of choice of contraceptive methods in family planning Safety Effectiveness Acceptability Discuss briefly the impact of family planning on health health a. maternal : prevent HRP, unwanted pregnancy, induced abortion treatment of gynecological problem b. infant : good infant care, good use medical services, avoid hereditary disease, reduce risk of congenital malformation c. family: maintain and improve quality of health of family What are the items that should be covered during counseling women in the family planning clinic regarding the use of certain contraceptives effectiveness of method advantages and disadvantages of method side effect and complication how to use method to increase use of effectiveness STD prevention,safe behaviour, abstinence, condom use when to return : for more supply etc List the main activities of family planning clinic

Primary health care 1. Enumerate functions of PHC 2. List 4 examples of community participation in primary healthcare delivery involved in defining community health problem participate in preparing plan of action with health personnel to solve the problem participate in help financial supply adopting healthy behavior

 proper utilization of health services Rurals health problems in Egypt poverty ( low std living,poor nut) illeteracy (barrier in dissemination of health knowledge) cultural barrier( belief in fate, keep women and child indoor->rickets,dayas) enviroment factor( poor village planing,poor housing, lack water supply and sewage disposal) 4. Functions / elements of the primary health care 5. Give short notes on community participation in the provision of primary health care 6. Enumerate 5 problems related to the delivery of health services in Egypt consumers low utilization of preventive services( FP, child care, maternity care) low utilization of available bed inadequate com participation high morbidity and mortality mothers and child increase rate of illiteracy lack of awareness about health porb unhealthy life style. health care itself limited multi-sectorial approach poor referral system inadequate human resources(physician,nurse, technician) lack non human resouces ( drug, equipment, transport, elcticity)) 7. List health problems in rural Egypt 8. Differentiate between rural health unit and rural health centre 9. List health problem in rural Egypt 10. As a physician working in the Health Office, how do you manage the following settings: 11. Death registration 12. Estimation of age of those having no birth certificate 13. Rural health problems are the result of the interplay of multiple factors 14. What are rural health problems in Egypt 15. Discuss factors behind rural helath problems 16. Discuss smoking cessation intervention provided by primary health care physician to assist the smokers willing to stop 17. Factors behind rural health problems 18. Mention 2 functions of a rural health unit. Enumerate the compulsory immunixation carried out in these units. Medical Management 1. Discuss briefly types of evaluation in medical management
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COMMUNICABLE DISEASES
Healthcare associated infection & infection control programme in healthcare settings 1. Mention the standard precaution (control measures) for hospital acquired infection control program HAND HYGIENE PERSONAL PROTECTIVE EQUIPMENT - gloves - face protection - gowns PROCESSION OF EQUIPMENT,DEVICES & INSTRUMENT Tuberculosis 1. Reasons for administration of at least 3 anti tuberculous drugs for a smear positive pulmonary TB case
a. b. c. 2. single drugs result in the rapid development of resistance and treatment failure The different drugs in the regimen have different modes of action rapid multipliers senstive to INH , slow sentitive to pyrazinamide , persisters sensitive to rifampin

Contact measures for tuberculosis a- enlistment b- health education c-inv contact: tuberculin testing d- BCG vaccination Meningitis 1. List complication of meningococcal meningitis ~ arthritis, otitis media, deafness, blindness Measures for contacts of meningococcal meningitis a- Enlistment b- surveillance for 10days household/other intimate contct for sign illness esp fever to iniate therapy without delay c- chemprophylaxis to all close cntc (rifampicin, sulfadiazine, ciprofloxacin) d-health education
2.

Influenza 1. SARS start to decrease globally. Discuss 5 WHO recommended measures for its prevention Measles 1. List characteristics of measles transmission rendered the diseases more refractory to eradication - measles has very high secondary attack ( highly communicable ),the infectivity of measle is very high.Single exposure may be enough to infect all susceptible. - measle is transmitted mainly by direct contact with infectious droplet or less commonly bt air borne spread.air borne transmission of measles effectively increase the contact rate between the index case n susceptible.Need maximal coverage. - since patient are contagious 4days < RASH > 4days , difficult to identify them.this limit the effectiveness of isolation, and containment activities. 2. Favourable factors that make measles a possible candidate for eradication The virus exist in a single serotype antigenically stable that provide durable immunity Absence of animal reservoir An effective live vaccine available whic is relatively stable n produce durable immunity

 no chronic carrier state 3. Mode of transmission of measles - Droplet spread - Direct contact with nasal or throat secretion of infected persons. - Less commonly,spread by air borne or indrect contact with articled freshly soiled by secretion of nose n throat. German measles Measures for contact of german measles 1) PREGNANT CONTACT: -identification n put under surveillance for the I/P ( not less 2w) -Lab investigation: If she has IgM / rising IgG = give immunoglobulin or abortion is dOne 2) CHILDREN CONTACT: -put under surveillance -no active or passive immunity ; immunization is indicated 1. Mention 3 points of differences between German measles nad hepatitis B transmission from mother to her baby
2. Complication of german measles RARE: Encephalitis, thrombocytopenic purpura, neuritis JOINT INVOLVEMENT: arhtralgia, arhtritis CONGENITAL RUBELLA : COmmon TRIAD ( Microcephaly , PDA, Cataract ) ( from above to downword ) a) CNS : Microcephaly n MR b) EYES : cataract, glaucoma, retinopathy n microphtalmia c) EAR : Deafness d) HEART : PDA, VSD, PS, Coarcitaion aorta e) OTHERS: Bone lesion, splenomegaly, hepatitis, thrombocytopenia purpura. Cholera 1. State why cholera vaccine is not highly recommended in prevention of cholera 2. Mode of transmission in cholera common vehicle : ingestion cont food & H2o vector : flies direct or indirect contact w excreta 3. Enumerate preventive measures for cholera H2O : protect,putrify,chlorine FOOD : safe food handling, sanitary supervision food service in public, limit shellfish marketing EXCRETA : sanitary disposal EDUCATION : spcfc hygenic practise FLIES : control VACCINE : oral 4. Why oral cholera vaccines are more preferred than old vaccine better immunity , last 2 yr less SE easy admin indicated 2 be used by travelers

Polio

Compare in a table between Salk and Sabin vaccines of poliomyelitis (advantage/disadvantage) 2. Define eradication and elimination. Discuss the criteria that make polio suitable for eradication. 3. Enumerate mode of transmission for poliomyelitis 4. Measures applied during epidemic of poliomyelitis DISEASE NOTIFICATION MASS VACCINATION POSTPONE ELECTIVE NOSE AND THROAT SURGERY START CONTROL MEASURES IMMEDIATELY IDENTIFY ROUTE OF INTRODUCTION ACTIVE SURVEILANCE OF AFP CASES V. hepatitis 1. Compare in table between carrier state of Hep B, Hep A, and typhoid as regards place, chronological stage, and duration of carriage. 2. Discuss measures to prevent Viral Hepatitis B (HBV) HBV: a- vaccination b- preventive meassure in blood banks: - test blood for HBsAg - reject - paid donor in emergency only - limit administration - maintain surveillance (post transfusion hepatitis) c- use disposable / properly sterilized syringes, needles or other equipments d- discourage tattooing / enforce aseptic practices e- precaution for health care personnels d- maternal screening
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Measures for contacts of hepatitis A 1) enlistment 2) surveillance for the incubation period (observation only, no need for isolation) 3) health education 4) passive immunity; IG 0.02 ml/kg IM in deltoid, given before exposure / within 2 weeks after exposure and to persons in contact with a case / traveling into endemic area 5) active immunization; HA vaccine (given asap after exposure till 2 weeks afterward) 6) inx of source of infection n missed cases.
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Give short notes on hepatitis A vaccine (type,dose, administration, and indication) type: formalin inactivated virus A, stored in temp 2-8 C, should not be frozen dose: IM injection 2 doses; 6-12 months appart, 2-18 y 0.5 ml adult >18 y 1.0 ml indications: population at risk 1. persons traveling or working in high endemic area 2. children > 2 y living in comm. with high rate of HAV infection 3. persons with clotting factor disorder 4. person with chronic liver disease 5. person who receive IG during outbreak 6. food handlers Preventive measures for Hep A and Hep B

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HAV: 1) health education; personal hygene, food sanitation 2) apply measures in day care center 3) environment sanitation 4) vaccination (high risk) 5) travelers should given HA vac 6) use disposable / properly sterilized syringes, needles or other equipments HBV: AS ABOVE* Enteric fever 1. Enteric carriers (classification, detection and management) 2. Measures done for contact enteric fever Food poisoning 1. Enumerate steps should be followed to investigate an outbreak of food poisoning 2. Preventive measures done for Salmonella food poisoning 3. Sources of infection in Salmonella 4. Classification of food poisoning Tetanus 1. Outline measures done for prevention of Neonatal Tetanus active immunization w tetanus toxoid i. immunization for women in reproductive period - 5 doses TT health education license midviwes&dayas 2. Preventive measures of tetanus in an injured agricultural worker 3. Problem: In a health facility located in rural community, two cases of Tetanus Neonatrum were diagnosed among 80 babies dlivered there over 2 month period. Case A had its onset on fifth day after birth. Case B had its onset on ninth day after birth. One of these two cases died, the other recovered. Why it is more likely that Tetanus Neonatrum occurs in rural disease? In your opinion, which of the two cases is the one that died? Why? Name and calculate an epidemiological rate to describe the situation With the absence of a vaccination program for pregnant females against Tetanus, who do you expect to be at higher risk of Tetanus Neonatorum, newborns of young or old mothers? Give reasons State the preventive measures to be done at the health facility level Anthrax 1. Discuss control measures for anthrax Rabies 1. How to manage different situations of post exposure prophylaxis done for a person bitten by a dog 2. At the emergency room, a boy aged 12 years old, came with lacerated wound in his leg giving history of a street dog bite, discuss measures to be done for this boy. 3. Measures done for a person bitten by a dog 4. Mode of transmission of rabies 5. Post exposure prohylaxis in rabies 6. Reservoir, mode of transmission and pre exposure prophylaxis of rabies STD 1. What are measures used to prevent AIDS in our community 2. Mention modes of transmission of HIV 3. Give reasons incidence of STDS cannot be accurately determined. Vector borne diseases Plague

Discuss International measures against plague Discuss control measures done for plague List 4 difference between bubonic and pneumonic plague Mode of transmission of bubonic plague Yellow fever 1. Compare in a table between Yellow fever and Rift Valle fever as regards; reservoir of infection, mode of transmission, and vaccination 2. International measures for Yellow fever in infectable zone (receptive zone) Malaria 1. Discuss the indices used to determine the prevalence of malaria in an area and enumerate malaria vaccines 2. Discuss phases of malaria eradication program 3. Enlist 4 factors that leads to resurgence of malaria
1. 2. 3. 4.

Non Communicable Disease

CHD
1. 2. 3.

Profile of person at risk of IHD Discuss primary prevention for CHD Discuss briefly the personal risk factor for CHD

Cancer Define relation between infection disease and etiology of cancer Comment on the secular trend of cancer Reasons for steady increase of morbidity and mortality from cancer Give reasons why secular trend of cancer shows a steady increase Diabetes 1. Enlist 4 high risk groups for development of diabetes
1. 2. 3. 4.

Problem
1)Mrs X is a 23 years old poor woman, who lives in a small village out of Alexandria City. She has been married for 5 years and has 3 children. Her last pregnancy ended with antepartum hemorrhage and still birth. Currently she is pregnant in her second trimester. For the past 3 weeks, she has suffered excessive tiredness, dizziness, fainting, palpitation, pale skin and shortness of breath. Physical examination revealed insufficient weight gain and smaller uterine siza for gestational age. The routine blood test showe a hemoglobin level of 6gm% and a low hematocrit value

a. What is the most likely diagnosis of this condition b. What could be the predisposing factors for this problem as revealed from this particular case study c. Explain how rural residence could be related to her problem d. What are the expected maternal fetal/newborn complications of this condition? e. What preventive measures (including specific nutritional education messages) are recommended for pregnant women to prevent occurrence of this condition f. How the doctor can manage or treat this case 2)State measures should be done for a breast fed baby in the following situation Active TB mother Positive hepatitis B mother 3)Comment on occurance of communicable disease related to occupational exposure (3 examples) 4)Define passive immunity. Diseases use of artificial passive immunizing agent in revention and treatment of diseases. (give examples) 5)Diarrhea disease are a leading case of morbidity and mortality among children in developing countries. Discuss how to prevent diarrhea disease among our children. 6)Mention common infection disease in school and basic measure for their prevention and control.