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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%
e). 45%
d). 40%
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 sick well total Ate 2 beans Didn’t 10 ate beans
7
9
10
20
Didn’t eat hamburger Attack sick Well total rate 3 18 21 0
0
Attack rate
0
a-) How can you find out the infective food item (s) using the attack rates? • 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 Food item Falafel Kofta Righla Mataziz Jarish Fish Rice
People who ate food ill Not ill
total
18 21 5 23 45 16 21
28 37 50 37 60 23 37
10 16 45 14 15 7 16
Attack rate % 64 57 10 62 75 70 57
People who didn’t eat that food ill Not ill Total 28 25 43 23 2 30 25
19 13 11 14 38 22 13
47 38 54 37 40 52 38
Attack rate % 60 66 80 62 5 58 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 egg salad Didn’t ate egg salad
Ate tuna 75 200
Didn’t eat tuna 100 50
Ate tuna 50 80
Didn’t eat tuna 75 15
Table 2. Ate egg salad Didn’t ate egg salad
a- What is the sore throat attack rate in persons who ate tuna and egg salad • 50/75…. • 70/200 • 60/135 • 60/275 • 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). • Tuna only • Egg salad only • Neither tuna nor egg salad • Both tuna and egg salad • Can’t 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 • The curative services. • Curative and promotive • Preventive services. 4. In the previous problem, infection could be terminated by controlling: • The agent • The agent and the host • The host and environment • The agent and the environment • 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˚c , 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. ( )
6. A female suspected to be leprotic.( ) 7. A 50 years old female had a history of open heart surgery. Complained of dyspnea, palpitation retrosternal pain and weakness. ( ) 8. A child (underweight), with biharziasis. ( ) 2- Write down if the referred cases would be sent to a 2nd care level or a 3rd care level, as follows: Number ( ) is referred to ----- care level.
e). 45%
2-The secondary attack rate is: a). 25% b). 30% c). 35%
e). 45%
d). 40%
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 sick well total Ate 2 beans Didn’t 10 ate beans
7
9
10
20
Didn’t eat hamburger Attack sick Well total rate 3 18 21 0
0
Attack rate
0
a-) How can you find out the infective food item (s) using the attack rates? • 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 Food item Falafel Kofta Righla Mataziz Jarish Fish Rice
People who ate food ill Not ill
total
18 21 5 23 45 16 21
28 37 50 37 60 23 37
10 16 45 14 15 7 16
Attack rate % 64 57 10 62 75 70 57
People who didn’t eat that food ill Not ill Total 28 25 43 23 2 30 25
19 13 11 14 38 22 13
47 38 54 37 40 52 38
Attack rate % 60 66 80 62 5 58 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 egg salad Didn’t ate egg salad
Ate tuna 75 200
Didn’t eat tuna 100 50
Ate tuna 50 80
Didn’t eat tuna 75 15
Table 2. Ate egg salad Didn’t ate egg salad
a- What is the sore throat attack rate in persons who ate tuna and egg salad • 50/75…. • 70/200 • 60/135 • 60/275 • 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). • Tuna only • Egg salad only • Neither tuna nor egg salad • Both tuna and egg salad • Can’t 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 • The curative services. • Curative and promotive • Preventive services. 4. In the previous problem, infection could be terminated by controlling: • The agent • The agent and the host • The host and environment • The agent and the environment • 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˚c , 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. ( )
6. A female suspected to be leprotic.( ) 7. A 50 years old female had a history of open heart surgery. Complained of dyspnea, palpitation retrosternal pain and weakness. ( ) 8. A child (underweight), with biharziasis. ( ) 2- Write down if the referred cases would be sent to a 2nd care level or a 3rd care level, as follows: Number ( ) is referred to ----- care level.
