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Problems

# Problems

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03/18/2014

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Problem in investigation of an epidemic

1-In a classroom of 25 students (15 males and 10 females ), 5 males
develop hepatitis A over a 2 weeks period. During the next 6 weeks, an
additional 3 males and 2 females develop the infection.

1- The attack rate of hepatitis A in this classroom is :
a). 25%
b). 30%
c). 35%
d). 40%
e). 45%
2-The secondary attack rate is:
a). 25%
b). 30%
c). 35%
d). 40%
e). 45%

3-The source of this outbreak is most likely:
a). Common-source outbreak.
b). Continuing common source outbreak.
c). Person-to-person transmission.
d). Common-source outbreak with secondary person-to-person
transmission.
e). Continuing common source outbreak with person-to-person
transmission.

2- A group of fifty children were in a trip to Alexandria, ( 21) of them
ate sandwiches of beans, (20 )of them ate hamburger sandwiches and 9
ate both types. After a time; (15) children had acute vomiting and
diarrhea., 3 of them ate beans and the other 10 ate hamburger and 2 ate
both types.
The following table will guide you.

Ate hamburger
Didn\u2019t eat hamburger
sick
well
total
Attack
rate
sick
Well
total
Attack
rate
Ate
beans
2
7
9
3
18
21

Didn\u2019t
ate
beans

10
10
20
0
0
0
\u2022
a-) How can you find out the infective food item (s) using the
attack rates?
\u2022
In this outbreak, what is the first step do you recommend as an

epidemiologist:
a). Use the specific antibiotics.
b). Try to find out the diagnosis clinically and laboratory.

c). Find the source of infection.
d). Reach the suspected food to destroy it.
3- Deduce the suspected food item in a food born outbreak, by calculating
the attack rates on the table below
People who ate food

People who didn\u2019t eat that food
Food
item

ill
Not ill
total
Attack
rate %
ill
Not ill
Total
Attack
rate %
Falafel
18
10
28
64
28
19
47
60
Kofta
21
16
37
57
25
13
38
66
Righla
5
45
50
10
43
11
54
80
Mataziz
23
14
37
62
23
14
37
62
Jarish
45
15
60
75
2
38
40
5
Fish
16
7
23
70
30
22
52
58
Rice
21
16
37
57
25
13
38
66

4- The 1st table shows the total number of persons who ate each of two
specified food items that were possibly infective with group A
streptococci .
The 2nd table shows the number of sick persons (with acute sore throat)
who ate each of the various specified combinations of the food items.

Table 1.
Ate tuna
Didn\u2019t eat tuna
75
100
200
50
Table 2.
Ate tuna
Didn\u2019t eat tuna
50
75
80
15
a- What is the sore throat attack rate in persons who ate tuna and egg salad
\u2022
50/75\u2026.
\u2022
70/200
\u2022
60/135
\u2022
60/275
\u2022
none of the above

b- According to the results shown in the preceding tables, Which of the following
food items (or combination of food items) is (are) most likely to be infective
item(s).

\u2022
Tuna only
\u2022
\u2022
\u2022
\u2022
Can\u2019t be calculated from data given
Problems in P.H.C

Q1)
In a rural health unit, a pregnant female came in labour, she was bleeding, her pulse
rate was 55/min and blood pressure was 90/60 Hg. What do you recommend as a
primary care physician?

1. Fix a canula with intravenous fluids and try to deliver the lady in the health

unit.
2. Refer her immediately in the ambulance to the nearest hospital.
3. Fix a canula and refer her immediately in the ambulance with a proper report

about her case including any data or investigations { as RH or ABO blood
group}from her record kept in the unit.
4. Try to deliver the lady with the assistance of the midwife.

Q3)
In an urban health center, There was a notification about 2 personnel in a family
complained of symptoms and signs suspected to be of cholera.

1. Which sector (or service) in the center is responsible for controlling this
epidemic?
2. Who are responsible for the control measures { name the job of the persons
in charge}.?
3. The previous personnel are responsible for
\u2022
The curative services.
\u2022
Curative and promotive
\u2022
Preventive services.
4. In the previous problem, infection could be terminated by controlling:
\u2022
The agent
\u2022
The agent and the host
\u2022
The host and environment
\u2022
The agent and the environment
\u2022
The agent, the host and the environment

Q4)
In the rural health unit one day the physician faced the following situations. Write
down, which cases can be managed at the unit and which must be referred to
specialists.

Write either:
a) at the unit
or
b) at the center
1. A two years child with a fever 39\u02dac , rhinitis and a sore throat. ( )
2. A 9 months infant with fever, cough, tachypnea > 50 times /minute, difficult
breathing and chest indrawing. ( )
3. A 1.5 year child with severe diarrhea and vomiting, drowsy with very dry
skin.( )
4. A pregnant lady who was healthy during the antenatal care and seemed to be
in normal labour. ( )
5. An adult male complained of itching at night. ( )