1. Who Should Be Screened for DM type 2?

According to USPSTF
U.S. Preventive Services Task Force8 Screen all adults 40 to 70 years of age who are overweight or
obese (grade B) Consider screening earlier in patients with higher risk (i.e., one of the following):
family history of diabetes; members of certain racial and ethnic groups (i.e., blacks, American Indians
or Alaska Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders);
personal history of gestational diabetes or polycystic ovary syndrome
2. What is the difference between efficacy efficiency and effectiveness
Effective – Adequate to accomplish a purpose; producing the intended or expected result.
Efficient – Performing or functioning in the best possible manner with the least waste of time and effort.
The difference between effectiveness and efficiency can be summed up shortly, sweetly and succinctly – Being effective is
about doing the right things, while being efficient is about doing things right.
Efficacy describes the technical relationship between the technology and its effects (whether it actually works)
3. What are the different levels of care? And what types of services are provided at each level
 Primary Health Care
Primary, secondary and tertiary health care activates
 Secondary Health Care
Primary, secondary and tertiary health care activates
 Tertiary Health Care
Primary, secondary and tertiary health care activates
4. What do Spectrum of disease and the Iceberg Phenomenon refer to?
The spectrum of disease refers to the range of manifestations and severities of illness associated with a given diseases,
illnesses, or injury. For example, HIV infection has broad clinical spectrum, from inapparent to severe and fulminating. 
The iceberg phenomenon describes a situation in which a large percentage of a problem is subclinical, unreported, or
otherwise hidden from view. Thus, only the "tip of the iceberg" is apparent to the epidemiologist. Uncovering disease that
might otherwise be below "sea-level" by screening and early detection often allows for better disease control. Consider:
 For every successful suicide attempt there are many more unsuccessful attempts and a still larger number of people
with depressive illness that might be severe enough to have them wish to end their lives. With appropriate
treatment, depressives with suicidal tendencies would be less likely to have suicidal ideation and be less likely to
attempt suicide.
 Reported cases of AIDS represents only the tip of HIV infections. With proper anti-retroviral therapy, clinical illness
may delayed and transmission averted.
 Serious dog bite injuries often go undetected. For each fatal dog bite there are about 670 dog bite hospitalizations,
16,000 emergency department visits, 21,000 medical visits to other clinics, and 187,000 non-treated bites (Weiss et
al., 1998; Figure 2.7). With effective recognition, animal control programs can be put into place to prevent dog bite
injuries.
5. What does natural history of disease refer to?
Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of
treatment. For example, untreated infection with HIV causes a spectrum of clinical problems beginning at the time of
seroconversion (primary HIV) and terminating with AIDS and usually death.
Many, if not most, diseases have a characteristic natural history, although the time frame and specific manifestations of
disease may vary from individual to individual and are influenced by preventive and therapeutic measures.
The process begins with the appropriate exposure to or accumulation of factors sufficient for the disease process to begin in
a susceptible host. For an infectious disease, the exposure is a microorganism. For cancer, the exposure may be a factor that
initiates the process, such as asbestos fibers or components in tobacco smoke (for lung cancer), or one that promotes the
process, such as estrogen (for endometrial cancer).
After the disease process has been triggered, pathological changes then occur without the individual being aware of them.
This stage of subclinical disease, extending from the time of exposure to onset of disease symptoms, is usually called
the incubation period for infectious diseases, and the latency period for chronic diseases. During this stage, disease is said
to be asymptomatic (no symptoms) or inapparent. This period may be as brief as seconds for hypersensitivity and toxic
reactions to as long as decades for certain chronic diseases. Even for a single disease, the characteristic incubation period
has a range.
Although disease is not apparent during the incubation period, some pathologic changes may be detectable with laboratory,
radiographic, or other screening methods. Most screening programs attempt to identify the disease process during this
phase of its natural history, since intervention at this early stage is likely to be more effective than treatment given after the
disease has progressed and become symptomatic.
The onset of symptoms marks the transition from subclinical to clinical disease. Most diagnoses are made during the stage of
clinical disease. In some people, however, the disease process may never progress to clinically apparent illness. In others, the
disease process may result in illness that ranges from mild to severe or fatal. This range is called the spectrum of disease.
Ultimately, the disease process ends either in recovery, disability or death.
For an infectious agent, infectivity refers to the proportion of exposed persons who become infected. Pathogenicity refers
to the proportion of infected individuals who develop clinically apparent disease.  Virulence refers to the proportion of
clinically apparent cases that are severe or fatal.
6. What is surveillance system and its components?
Ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a
health-related event for use in public health action to reduce morbidity and mortality and to
improve health.
Source of data
 Mortality reports  Health surveys
 Vital statistics  High risk groups
 Medical examiner data  General population
 Morbidity reports  Surveillance systems of disease
 Notifiable disease reports indicators
 Laboratory data  Animal populations
 Hospital data  Environmental data
 Outpatient health care data  Drug/biologic utilization
 Specific registries  Student and employee data
Methods of data collection
Passive surveillance: (provider-initiated) Active surveillance: (health-department-initiated)
Targets of surveillance
 Communicable diseases
 NCD
 Risk health behaviors (drug use, risky six, risk factors for chronic diseases
 Injury
 Environmental risks
 Occupational exposure.
 Health care services (Hosp operations, diagnostic tests, prescriptions).
Analyze the data by person, place and time.
 Person includes variables such as age, sex, and race, as well as risk factors such as childcare or
food handler status.
 Place geographical distribution.
 Time is usually represented as date of onset of illness, grouped by day, week, month or year
7. What are the types of transmission based precaution?
Transmission-Based Precautions
Transmission-Based Precautions are designed to supplement standard precautions in patients/residents with
documented or suspected infection/colonization of highly transmissible or epidemiologically important
pathogens. The three categories of Transmission-Based Precautions include:
  Contact Precautions
 Droplet Precautions
 Airborne Precautions
For diseases that have multiple routes of transmission (e.g., Severe Acute Respiratory Syndrome (SARS)), more
than one Transmission-Based Precautions category may be used. When used either singularly or in combination,
they are always used in addition to Standard Precautions.
TRANSMISSION-BASED PRECAUTIONS CATEGORIES
Contact Precautions are designed to reduce the risk of transmission of microorganisms by direct or indirect
contact. Direct contact transmission involves the physical transfer of microorganisms to a susceptible host from
an infected or colonized person. Indirect contact transmission involves contact of a susceptible host with a
contaminated intermediate object. Examples of Diseases: gastrointestinal infections (including diarrhea of
unknown origin), wound and skin infections (e.g. impetigo) and colonization with multidrug-resistant bacteria
(e.g. methicillin-resistant Staphylococcus aureus (MRSA)).
 Special Factors:
o Private room or rooms with a patient/resident who has a similar diagnosis.
o Patient/resident should stay in room except for medically necessary procedures or therapies.
o Gloves for any contact with patient/resident or touching anything in the room.
o Gown if it is likely that clothing will be in contact with any patient/resident or any surfaces in the
patient/resident care environment.
o Mask and eye protection if splashing or splattering of any contaminated substance is likely.
o Patient/resident care items such as blood pressure cuff, stethoscopes or thermometer should be
“dedicated” (used only for that patient/resident and disinfected or discarded after the
patient/resident is discharged).
Droplet Precautions are designed to reduce the risk of droplet transmission of infectious agents. Infectious
droplets are released when the infected person sneezes or coughs and the large droplet spray may spread as far
as three feet. Examples of Diseases: Influenza, meningococcal meningitis, mumps, rubella, diphtheria,
pneumonic plague, pertussis and infections caused by multidrug resistant Streptococcus pneumonia.
 Special Factors:
o Private room or rooms with a patient/resident who has a similar diagnosis.
o Patient/resident should stay in their room except for medically necessary procedures; a mask should
be worn when out of the room.
o A regular/surgical mask should be used for any potential exposure within three feet of the
patient/resident.
o Gloves and gowns are required when delivering patient/resident care in droplet precautions.
o Patient/resident care items such as blood pressure cuff, etc. should be dedicated to that
patient/resident.
o Patient/resident should be taught to cover their nose and mouth with tissues when coughing or
sneezing and to discard tissues into a bag.
Airborne Precautions are designed to reduce the risk or eliminate the airborne transmission of infectious
agents. The infectious particles are so small that they can remain suspended in the air for long periods of time
and are carried on air currents. Examples of Diseases: varicella (chickenpox), tuberculosis, measles.
 Special Factors:
o Private room with special ventilation; door must be kept closed.
o The patient/resident should stay in his or her room except for essential reasons; a special mask
should be worn when out of the room.
o Respirators are worn by personnel if the patient/resident has or is suspected of having an airborne
illness. In general, students are not usually fitted for respirators.
o Respirators are worn for chickenpox or measles only if the employee entering has not had the
disease or has not been immunized.
o Gloves: Worn when in contact with respiratory secretions.
o Patient/resident care items such as blood pressure cuffs, etc. should be dedicated and disinfected or
discarded after the patient/resident is discharged.
 o Patient/resident should be taught to cover their nose and mouth with tissues when coughing or
sneezing and to discard tissues in a bag.
8. What are the elements of Evidence based practice?
Evidence based practice (EBP) is 'the integration of best research evidence with clinical expertise and patient
values' [1]  which when applied by practitioners will ultimately lead to improved patient outcome.  

There are three fundamental components of evidence based practice.

o Best evidence which is usually found in clinically relevant research that has been conducted using sound
methodology
o Clinical expertise refers to the clinician's cumulated education, experience and clinical skills
o Patient values which are the unique preferences, concerns and expectations each patient brings to a clinical
encounter.
It is the integration of these three components that defines a clinical decision evidence-based.  This integration can
be effectively achieved by carrying out the five following steps of evidence based practice

The 5 Steps
1. Formulate an answerable clinical question
One of the fundamental skills required for EBP is the asking of well-built clinical questions. By formulating an answerable
question you to focus your efforts specifically on what matters. These questions are usually triggered by patient encounters
which generate questions about the diagnosis, therapy, prognosis or etiology.
2. Find the best available evidence
The second step is to find the relevant evidence. This step involves identifying search terms which will be found in your
carefully constructed question from step one; selecting resources in which to perform your search such as PubMed and
Cochrane Library; and formulating an effective search strategy using a combination of MESH terms and limitations of the
results.
3. Appraise the evidence
It is important to be skilled in critical appraisal so that you can further filter out studies that may seem interesting but are
weak. Use a simple critical appraisal method that will answer these questions: What question did the study address? Were
the methods valid? What are the results? How do the results apply to your practice?
4. Implement the evidence
Individual clinical decisions can then be made by combining the best available evidence with your clinical expertise and your
patient’s values. These clinical decisions should then be implemented into your practice which can then be justified as
evidence based.
5. Evaluate the outcome
The final step in the process is to evaluate the effectiveness and efficacy of your decision in direct relation to your patient.
Was the application of the new information effective? Should this new information continue to be applied to practice? How
could any of the 5 processes involved in the clinical decision making process be improved the next time a question is asked?

These steps may be more memorable if remembered as : 1. Ask 2. Acquire 3. Appraise 4. Apply 5. Audit (Assess)
9. Describe the hierarchy of evidence
What is "the best available evidence"?  The hierarchy of evidence is a core principal of Evidence-Based Practice (EBP) and
attempts to address this question.  The evidence higherarchy allows you to take a top-down approach to locating the best
evidence whereby you first search for a recent well-conducted systematic review and if that is not available, then move
down to the next level of evidence to answer your question.
EBP hierarchies rank study types based on the rigour (strength and precision) of their research methods.  Different
hierarchies exist for different question types, and even experts may disagree on the exact rank of information in the
evidence hierarchies.  The following image represents the hierarchy of evidence provided by the National Health and
Medical Research Council (NHMRC). 1
Most experts agree that the higher up the hierarchy the study design is positioned, the more rigorous the methodology and
hence the more likely it is that the study design can minimise the effect of bias on the results of the study.  In most evidence
hierachies current, well designed systematic reviews and meta-analyses are at the top of the pyramid, and expert opinion
and anecdotal experience are at the bottom
10. Define screening
 A strategy used in a population to identify the possible presence of an undiagnosed disease in
apparently healthy individuals (without signs or symptoms). 
 Types of screening
 Mass screening
 aims to screen the whole population (or subset);
 Targeted screening (risky groups)
 groups with specific exposures, e.g. workers in lead battery factories
 Case-finding or opportunistic screening
 Aimed at patients who consult a health practitioner for some other purpose.
 Multiple or multiphasic screening
 uses several screening tests at the same time

 Appropriate Diseases for screening

 Important Health Problem
 High Prevalence
 Natural History understood
 Long latent period
 Early detection improves prognosis
 Available and meaningful treatment

 Appropriate screening test

 Feasibility: Quick, easy, safe, Acceptable, Affordable, Cost effective
 Reliability (repeatability, precision)
 Validity (Sensitivity, Specificity)
  Yield (performance): Predictive values of the test.
 Effectiveness
o Bias : There are three possible sources of bias when evaluating a screening program
that may result in a false picture of its efficacy:
 Self selection bias
 Lead time
 Length bias
11. Define the cold chain
The 'cold chain' is a system of storing and transporting vaccines at recommended temperatures
from the point of manufacture to the point of use. That is, the role of the cold chain is to maintain
the potency of vaccines. There is also a concept called 'reverse cold chain', which is a system of
storing and transporting samples at recommended temperatures from the point of collection to
the laboratory.
Essential elements:
 Personnel to manage vaccine distribution
 Equipment for vaccine storage & transport
 Maintenance of equipment
 Monitoring
12. What are the Risk Factors for Developing HTN
I. Modifiable risk factors
 Overweight or obese
 Sedentary lifestyle (lack of physical activity)
 Tobacco usage
 Unhealthy diet (high in sodium)
 Excessive alcohol usage
 Stress
 Sleep apnea
 Diabetes

II. Non Modifiable

 Age
 Race
 Family History
13. What are the 5 moments of Hand hygiene?
 14. Enumerate the 10 steps of outbreak investigation
o Identify investigation team and resources
o Establish existence of an outbreak
o Verify the diagnosis
o Construct case definition
o Find cases systematically and develop line listing
o Perform descriptive epidemiology/develop hypotheses
o Evaluate hypotheses/perform additional studies as necessary
o Implement control measures
o Communicate findings
o Maintain surveillance
15. What is the definition of impairment, disability, and handicap?
Impairment – any loss or abnormality of psychological, physiological or anatomical structure or
function.
Disability – any restriction or lack of ability to perform an activity in the manner or within the range
considered normal for a human being.
Handicap – the result when an individual with impairment cannot fulfill a normal life role.
16. What are the 10 steps of successful steps to promote breastfeeding at hospitals?
Cite some elements of the baby friendly hospital?
o Have a written breastfeeding policy that is routinely communicated to all health care staff.
o Train all health care staff in skills necessary to implement this policy.
o Inform all pregnant women about the benefits and management of breastfeeding.
o Help mothers initiate breastfeeding within half an hour of birth.
o Show mothers how to breastfeed, and how to maintain lactation even if they should be
separated from their infants.
o Give newborn infants no food or drink other than breast milk, unless medically indicated.
o Practise rooming-in - that is, allow mothers and infants to remain together - 24 hours a day.
o Encourage breastfeeding on demand.
o Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
o Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.