Department of Family and Community Medicine. Mid-term exam (December 2014).

G2

Name:-…………………………………………………No…………………………

Time: one hour. (Total mark 30)

Section I (One mark for each):

1- One of the following is a live attenuated vaccine:

a) Pneumococcal vaccine.
b) Meningococcal vaccine.
c) Human papilloma virus vaccine.
d) Rotavirus vaccine.
e) Salk vaccine.

2- Two different toxoids present in the following vaccine:

a)OPV. b)MMR. c)IPV. d)BCG. e)HEXA.

3- About the freeze watch, the following is wrong statement:

a) It is a freeze indicator.
b) Has a small vial of red liquid attached to a white card.
c) The vial breaks if the temperature drops below 0° C for more than one hour.
d) It is packed with vaccines that are sensitive to freezing temperatures.
e) OPV need to be monitored with freeze watch more than DPT.

4- In the current Libyan EPI, a fully immunized child at 9 months has:

a) 1 BCG, 3 DPT, 3 OPV,1 MMR, 3 Hep B vaccine.
b) 2 BCG, 1 Measles vaccine, 3 DPT, 3 OPV.
c) 1 BCG, 3 DPT, 3 OPV, 1 Measles.
d) 1 BCG, 3 DPT, 3 OPV, 1 Measles, 3 Hep B vaccine.
e) 1BCG, 2OPV, 4HBV, 3IPV, 3DTaP, 3Hib, 3Rota, 2PCV, 1meningococcal.

5- About the protective value of BCG, the following is not true:

a) Because of it`s protective value during childhood, it is given to all newborns
at birth.
b) Duration of protection is between 15 and 20 years.
c) It is effective against the most severe forms of TB (TB meningitis in children).
d) It is less effective in preventing respiratory disease (more common in adults).
e) BCG gives lifelong prevention against all types of tuberculosis.

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 6- Regarding sputum examination for TB diagnosis, all the following is true
except:
a) Early morning sputum spacemen is best for direct microscopic examination.
b) False positive result can be due to contamination of the slide by environmental
mycobacteria or presence of various acid fast particles.
c) False negative may be because of inadequate sample or sputum stored for too
long time before examination.
d) Sputum culture carried out for every patient to know the drug sensitivity.
e) All the above are true statements.

7- Unsafe injection can led to:

a) HIV infection.
b) HBV infection.
c) Bacterial infection.
d) Injection site abscess.
e) All of the above.

8- Which hand hygiene antiseptic agent is the fastest and most effective?
a) Quaternary ammonium compounds.
b) Iodine compounds.
c) Chlorhexidine (2% and 4% aqueous).
d) Alcohols (60%–95%).
e) Hexachlorophene (3%).

9- Daily morning inspection of school children is carried out by:

a) Doctors.
b) Doctors & nurses.
c) Students themselves.
d) Class teacher.
e) Principal of the school. (‫)ﺍاﻟﻤﺪﻳﯾﺮ‬

10- Positive Emotional Environment in school includes the following:

a) Warm learning environments.
b) Nonthreatening learning environments.
c) Teachers with good social behavior.
d) Emotionally stable teacher.
e) All of the above.

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 11- The following describe a good Physical School Environment, except one
statement:
a) The school must be located at a far distance from busy places.
b) Nursery should be single storied.
c) Percapita space for students in the class room should not be less than 10 sq. ft.
d) Furniture should be  suit the age group of students.
e) Every 3 children can share  one desk.

12- Doctors who find themselves changing position constantly, give feeling of:
a) Rejection to the patient.
b) Empathy with the patient.
c) Acceptance to the patient.
d) Interest in the patient`s story.
e) None of the above.

13- Nodding your head while the patient telling you his story, indicates:
a) Attentive listening to his story.
b) No interest in his story.
c) Non respect to the patient.
d) Effective reassurance for the patient.
e) None of the above.

14- Central (abdominal) obesity can be diagnosed by:

a)WHR b)BMI c)Weight
d)Height e)Hip circumference.

15- In the following picture, which one is a correct method for measuring waist
circumference?
a) Both are correct because both are stand with
their arms hanging naturally by their sides.
b) Number 2 because the tape is above the level of
umbilicus.
c) Number 1 because he Relax and breathe out
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normally & the tape at the level of umbilicus.
d) Number 2 because he holds his breath.
e) Number 2 because he pulls in his tummy on purpose.‫ﺳﺤﺐ ﺑﻄﻨﻪﮫ ﻋﻦ ﻗﺼﺪ‬

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 16- When you greet the patient with warm smile and friendly
handshake, you will:
a) Create uncomfortable atmosphere.
b) Appear to be more dominating.
c) Appear to be more impatient.
d) Appear more interested in the patient’s story.
e) Express a negative feeling toward the patient.

17- Fatma is a new nurse working with you in the polyclinic, she showed to you
the vial of OPV with the following VVM view, she is asking what to do?
Which answer you will choose?
a) If the expiry date has not been passed, you can give it to the child.
b) If this is the only vial you have, give it to the child.
c) If the whole stock is the same, you can use it.
d) Don`t use the vaccine and inform your supervisor.
e) Don`t worry about this discoloration, you can use it.

18- In the emergency room, you notice that the nurse gave IM injection (an
analgesic) to the first patient (half content of the syringe), then she change
the needle, and give the remaining drug to the next patient, what you will tell
her?
a) Nothing, as changing the needle prevents any contamination.
b) It is a good idea, this will save the amount of drug used.
c) Don`t use the same syringe for more than one patient.
d) This is an incorrect practice,  because it will expose the patient to many
pathogen transmission.
e) Both c & d

19- In the clinic, you ask the nurse to weight the patient, the following picture
shows her way to weight the patient, what will be your comment?
a) It is the right way for measurement, reading is correct.
b) The reading will be accepted, but next time must be more
accurate.
c) It is accepted way to measure the weight, but the patient must
repeat it at home same day.
d) Repeat the measurement without heavy cloths and shoes.
e) Repeat the measurement after removing the shoes, and the reading
will be correct.

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 20- During your work in the observation room, a new doctor asked you what to
do before he go to examine the next patient as he noticed that his hands are
contaminated with blood after removing the gloves, what will be your
answer?
a) Rinse your hands with an alcohol-based antiseptic, followed by soap and
water.
b) Wash your hands with soap and water only.
c) Wipe your hands vigorously with an antiseptic-saturated towel.
d) Your hands must be soaked in an alcohol-based solution for two minutes.
e) Initially wash your hands with soap and water then use an alcohol- based
hand rub.

Section II: Cross match (0.5 mark for each)

Choose the correct answer from the left column, and put its number in front of
suitable term in right column:
1- Domestic waste. ( 8 ) Discard.
2- Verbal communication. ( 5 ) Mask.
3- Nail spooning. ( 9 ) length not height.  
4- Diagnostic for pulmonary TB ( 7 )  Red bags  
5- Airborne disease. ( 2 ) history taking.  
6- Nonverbal communication. ( 1 )  Green bags  
7- Infectious waste. ( 4 ) AFB  
8- Frozen Hep B vaccine. ( 10 ) ILR  
9- Less than 2 years old. ( 6 )  Facial expressions  
10- Cold chain equipment. ( 3 ) Iron deficiency.  

Section III (One mark for each)

1) Mention the tools of case finding in tuberculosis.

1- Sputum examination.
2- Mass Miniature Radiography MMR(chest X ray).
3- Tuberculin test.

2) Mention the indications of use for Disposable Non-sterile gloves.

1) When starting intravenous (I.V.) lines or performing phlebotomy.
2) When changing dressings or handling soiled dressings.
3) When cleaning or handling soiled equipment, instruments, or other items that may
be contaminated with blood, urine, feces, or drainage.
4) When handling specimens and their containers.
5) When suctioning the respiratory tract of a patient or performing oral care in which
fingers need to be placed inside the patient’s mouth.

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 3) From the cold chain golden rules, mention only four.

1) Refrigerator placed in the coolest place of the health centers away from
sunlight.
2) Distance from the wall (10-15 cm).
3) Source of energy.
4) Refrigerator condition rust, leaking.
5) Temperature recording.
6) Vaccine packing in shelves (air circulation)
7) First in first out/ expiry dates.
8) Avoid frequent opening.
9) At the end of the day opened vials should be discarded.

4) Write a short note on the psychological reactions of the patients who were
told a bad news.

1- First phase: period of early reaction within few days (deny the facts).
2- Second phase: period of distress/ after 1-2 weeks (phase of anxiety,
depression, insomnia, appetite loss and loss of concentration).
3- Third phase: period of adaptation after 2 weeks – 1 month (sometimes 2
months), when the patient adapts the new situation.

5) Mention the direct and indirect methods of nutritional assessment.

Direct methods:
a. Anthropometry.
b. Biochemical & laboratory evaluation.
c. Clinical examination.
d. Dietary intake assessment.

Indirect methods:

a. Assessment of ecological factors including crop production.

b. Assessment of Economic factors e.g. per capita income, population
density & social habits.
c. Vital health statistics particularly infant and under 5 mortality rates, rate of
LBW, and life expectancy.

Good luck for all

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