I.

NERVOUS SYSTEM
 Tetanus
Lock jaw
Clostridium Tetani
3 days to 30 days
not directly transmitted from
person to person
direct inoculation or indirect
contamination through break in
the skin, tooth decay and
umbilical cord cutting (tetanus
neonatorum)
negative immunity
Trismus
Risus sardonicus Opisthotonus
Rigidity of the abdomen and
extremities
Meningitis
meningococcal meningitis
epidemic cerebrospinal
meningitis, cerebrospinal
fever
Neisseria meningitides
 Hemophilus influenzae
 Diploccocus pneumonia
(pneumoccocus)
 Meningoccocus
2 to 10 days
meningococcal – until bacteria are
not present in nose and throat
discharge hemophilus – even
without nasal discharge
direct contact including
respiratory droplets and
discharges from throat and nose
of infected persons
(nasopharyngeal secretions
negative immunity
Signs of meningeal irritation
 Brudzinski sign.
 Kernig’s sign
 Opisthotonus
 Nuchal rigidity
Encephalitis
brain fever
a. Mosquito-borne encephalitis
 Causative agent: Arbovirus
(arthropod-borne virus)
 Flavivirus family: West Nile
virus, St. Louis Encephalitis
 Togavirus family: Japanese
B, Australian X, Equine
Encephalitis
 Bunyavirus: La Crosse
viruses
 Mode of transmission: bite of an
infective mosquito
 Incubation period: varies
according to the viral disease
b. Viral encephalitis -
 Causative agent: virus
depends on the type of
disease present before
complication
 Mode of transmission –
direct contact through
droplet
 Incubation period – depends
on the pre-disease state, but
usually 5 to 15 days
c. Amoebic meningoencephalitis
 Causative agent
 Naeglena fowleri
 Acanthamoeba
 Mode of transmission: water
infected by N. fowleri which
enters nasal passages and
Acanthamoeba through skin
penetration.
 Incubation period: 3 – 7
days
d. Toxic encephalitis – resulted from
lead and mercurial poisoning.
can lead to permanent immunity
Signs of meningeal irritation
Increase ICP
Decorticate (toward center) and
decerebrate (extension)
Child : high-pitched cry, bulging of
Poliomyelitis
infantile paralysis,
heine-medin disease
polioviruses (Legio-debilitans)
picornavirus family
• Brunhilde (I)
• Lansing (II)
• Leon (III)
7 to 14 days
Infectious during the first few
days and after onset of
symptoms when the virus is
present in the throat and feces
direct contact including
respiratory droplets and
discharges from throat and
nose of infected persons
(nasopharyngeal secretions)
and ingestion of fecally
contaminated milk, food and
material
Brunhilde causes permanent
immunity and Lansing/Leon
causes temporary immunity
Stage 1 – Invasive or Abortive
Stage Stage 2 – Pre-paralytic
Stage
 Hoyne sign)
 Poker’s sign
Rabies
hydrophobia,
lyssa, la rage
Rhabdovirus
10 days to 10 year for man
3 to 8 weeks for rabid animals
dogs and cats can transmit the
virus from 3 to 10 days before
the onset of symptoms and
throughout the course of the
disease
Transmitted through the bite of
rabid animal or through infected
saliva in a break in the skin.
offers active immunity
Rabid Animal
• Dumb form.
• Furious form.
Man
• Invasive stage
II. RESPIRATORY SYSTEM
Diptheria Pertussis Tuberculosis Influenza
Pseudoembrane Whooping cough Koch, phthsis, PTB Flu
Corynebacterium diptheriae Bordotella Pertussis Mycobacterium tuberculosis Influenza virus A (most severe)
Klebs Loeffler bacillus Hemophilus influenza Mycobacterium africanum Influenza virus B (less extensive)
Bordet-Gengou bacillus Mycobaterium bovis Influenza virus C

2 to 5 days
Variable until virulent bacilli has disappeared from
secretions and lesions, usually 2 weeks and seldom
more than 4 weeks. 2 to 4 weeks (untreated
individuals) and 1 to 2 weeks (treated individuals)
7 to 10 days but not exceeding 21 days. less than one month. It may persist for 1 to 5 days (average of 2 days)
lifetime as a latent infection.
In early catarrhal stage, paroxysmal cough As long as the tubercle bacilli is being Probably limited to 3 days from
confirms provisional clinical diagnosis 7 discharged through the sputum clinical onset.
days after exposure to 3 weeks after onset
of typical paroxysms.

Spread by droplet infection or contact with direct spread through respiratory and Airborne droplet through droplet infection, by direct
nasopharyngeal secretions and with utensils or salivary contacts. Crowding and close Direct invasion through mucus contact to infected fomites, and by
personal belongings of an infected individual association with patients facilitate spread membrane or breaks in the skin airborne spread inside a crowded and
Bovine tuberculosis enclosed areas.
provides temporary immunity contracting the disease offers long-lasting contracting the disease doesn’t provides unknown duration of
immunity provide total immunity immunity but due to ability of the
virus to mutate, new strains provides
improbable immunity
• Antigenic shift
• Antigenic drift
Psedumembrane • Invasive stage (catarrhal stage) According to extent • Headache, fever and muscle pain
• Nasal type • Spasmodic stage – 4 to 12 weeks • Minimal • Dry cough worsens over a few
• Pharyngeal type (uncommon yet very  Whooping cough • Moderately advanced days and acute symptoms go
dangerous) • Convalescence stage • Far advanced away within a week
• Laryngeal type (most serious type) According to manifestations • Continuous lingering hacking
• Wound type • Active cough, fatigue and generalized
• Mucous membrane type • Inactive weakness
According to DOH • Chilly sensation, backaches and
• Category I limb pain
• Category II
• Category III
• Category IV

 Cough for two weeks or more

 Afternoon fever
 Chest or back pain not
 referable to any musculo-
skeletal disorders
 Hemoptysis
 Significant weight loss
 Sweating, fatigue, body
malaise and shortness of
breath

Nose and throat culture Clinical manifestations – assessment Direct Sputum Smear Microscopy – Nasopharyngeal secretion analysis
Shick’s test Nasopharyngeal swab (Bordet-Gengou test) Chest X-ray
Maloney’s test Increase WBC and lymphocyte count Mantoux test
Purified protein derivative
WHO – 10- 14 mm (+)
DOH – 8 to 10 mm (+)
1. Administer medications, as ordered. 1. Administer medications, as ordered. 1. Medications: HRZES 1. Administer medications, as
a. Equine diphtheria anti-toxin a. Penicillin • Fixed dose combination (FDC) ordered.
b. Penicillin / erythromycin 2. Avoid abdominal hernia by using • Single drug formulation (SDF) a. Amantidine (Symmetrel) /
c. Mild analgesia – control pain abdominal binders Rimantidine (Flumadine) –
2. Maintain patency of airway. 3. Symptomatic / supportive care 2. Chemoprophylaxis: Isoniazid and Zanamivir (Reenza) and
a. RES-P-RA-2-R-Y Vitamin B6 for 6 months to 1 year. Oseltamivir (Tamiflu)
b. Tracheostomy set at bed side 2. Symptomatic / supportive care
3. Throat irrigation and clearing 3. RES-P-RA-2-R (General
4. Symptomatic / supportive care management)
4. Symptomatic / supportive care
• DPT immunization – 3 doses, given @ 6 weeks, IM @ thigh with one month interval BCG immunization – given at or Respiratory secretion isolation.
• Avoid contact with nasopharyngeal secretions. No kissing. anytime after birth, 1 dose ID, .05 ml
Secretions should be disposed and if possible, burn it. at right deltoid region
Cover nose and mouth when sneezing
and coughing
Respiratory isolation

III. GASTROINTESTINAL
Dysentery
Typhoid Fever Cholera (Violent)
(enteric fever) Bacillary Amebic
cholera, el tor, washerwoman’s
(shigellosis, blood flux aamebiasis
disease
Salmonella typhosa Shflesneri, Vibrio cholera (classical) Entamoeba histolytica
Shboy-dii, Vibrio el tor (both with serotypes ogawa
Sn-connei, and inaba)
Sh-dysenteriae,
variable; average 2 weeks, usually 1 to 3 1 days, usually less than 4 years old few hours to 5 days, average of 3 days usually 2 to 4 weeks
weeks
 as long as typhoid bacilli are present in
the excreta
Ingestion of contaminated water and food
due to infected urine and feces (feco-oral
route). Flies serves as the vector
During acute infection and until
microorganism is absent from feces
Ingestion of contaminated water, milk and
food due to infected urine and feces (feco-
oral route). Flies also serve as a vector
carrier
7 to 14 days after onset, occasionally 2-3
months
Ingestion of contaminated water, milk and
food due to infected urine and feces (feco-
oral route). Flies also serve as a vector
carrier. El tor can exists in water for an
extended period of time
during the period of cyst passing which
may occur for years
Ingestion of contaminated water and food
containing the cyst form (feco-oral route).
It can also be contracted through sexual
means

gives no permanent immunity gives no permanent immunity frank clinical attack may offer temporary Negative immunity. Reinfection is possible
immunity, which may give protection for
several years
Prodromal stage • Chills and fever • Invasive stage • Abdominal pain
Fastidial • Nausea and vomiting • Collapse stage • Vomiting
• Rose spot in the abdomen • Tenesmus – painful straining  Profuse watery stool (rice • Chills
 Ladder-like fever • Stool with pus and blood watery stool) • Bloody or mucopurulent diarrhea
 Spleenomegaly  Signs and symtomps of • Can lead to brain amebiasis, liver
 Typhoid psychosis dehydration – Washerwoman’s amebiasis and lung amebiasis
 Carphologia sign
 Subsultus tendinum • Reaction stage
Defervescence
Lysis/convalescence
Blood culture Rectal swab Rectal swab Stool exam – trophozoites or cysts present
Fecalysis and Urinalysis Stool exam Stool exam in fresh stool
Increase WBC Serologic test Vomitus exam Sigmoidoscopy
1. Administer medications, as ordered. 1. Administer medications, as 1. Administer medications, as ordered - 1. Administer medications, as ordered –
a. Chloramphenicol, Ampicillin ordered. Tetracycline Metronidazole (Flagyl)
2. Administer IVF to treat dehydration and a. Sulfamethoxazole 2. D-I-A-R-E-O (general management for 2. D-I-A-R-E-O (general management for
diarrhea b. Trimetoprim diarrhea) diarrhea)
3. D-I-A-R-E-O (general management for c. Severe cases: Ampicillin, 3. Symptomatic / supportive care 3. Symptomatic / supportive care
diarrhea) Tetracycline, Cotrimoxazole 4. Continue breastfeeding for infants. 4. Prevent severe dehydration leading to
4. Symptomatic / supportive care 2. D-I-A-R-E-O (general management 5. Prevent severe dehydration leading to shock
5. Prevent possible complications (e.g. for diarrhea) shock
perforation, hemorrhage, peritonitis) 3. Symptomatic / supportive care
4. Prevent possible complications
(e.g. severe dehydration
• B-A-H-A-W (general management for food handling)
• CDT immunization (IM deltoid area) provides 6 months immunity
• Exclude infected individuals in preparing and handling food.
• Environmental sanitation
• Four R’s of Proper Food handling
• Avoid sexual practices that may permit feco-oral contamination

Hepatitis A (infectious hepatitis) Hepatitis B (serum hepatitis) Hepatitis C (non-A / non-B)

Epidemic hepatitis Homologous serum jaundice Post-transfusion hepatitis
 Epidemic jaundice
Australia antigen hepatitis
Catarrhal jaundice
HB
HA
Picornavirus, HAV Hepadnavirus, HBV Flavivirus, HCV
Feco-oral Blood, semen Blood, possibly semen
3-5 weeks 10-15 weeks 6 to 7 weeks
Gamma globulin (Grammar), inactivated
Recombinant vaccine, immunoglobulin No vaccine
vaccine
Blood screening for blood donation.
Sanitary food handling (control and screening) Use of disposable equipment especially syringe and needles.
Frequent hand washing Avoid sexual contact for those infected.
Avoid street foods. No sharing of personal items which may cause break in the skin. (e.g. razor)
Avoid use of needles that are contaminated especially during ear piercing, acupuncture and tattoing

Enterobiasis Ascariasis Strongyloidiasis Trichuriasis Ancylostomiasis Taeniasis

Pinworm
Oxyuris vermicularis
Mouth
Adults and ova
Fomites, autoinfection,
Vomitus, soil contamination
fecal contamination
Anal itching (nocturnal ani), Abdominal pain, live worms
restlessness, irritability,
nervousness, poor sleep
Hemorrhage, Eczema and
Anal infection
Roundworm Threadworm Whipworm Hookworm Tapeworm
Diphyllobothrium latum
Necator americanus & (fish)
Ascaris lumbricoides Strongyloides stercoralis Trichuris trichuria
Ancylostoma duodonale Taenia saginata (beef)
Taenia solium (pork)
Mouth Skin penetration Mouth Skin penetration Mouth
Adults and ova Larva Ova Adults and ova Ova and worm segments
Fecal, soil contamination Insufficiently cooked meat
Skin rash at site of
penetration, cough, Anemia, weakness, fatigue,
Abdominal pain, bloody Few or no symptoms,
vomited or passed in the abdominal pains, physical and mental
stool, weight loss sometimes anemia
stool intermittent diarrhea, retardation in children
weight loss
Lung, appendix, bile duct, Obstruction of biliary duct
Dehydration Rectal prolapsed Vitamin B12 deficiency
liver involvement Stunted growth
Stool Exam, Scotch tape method, Direct fecal smear, Kato and Kato Katz techniques
Use of sanitary toilet.
Keeping fingernails short.
Use of foot wear.
Boil water for 2 to 3 minutes and wash fruits and vegetables thoroughly.
Dispose infected stool properly and carefully.
Meticulous cleansing of skin especially in anal region, hands and nails.
Administer drugs – anti-helmintic drugs (albendazole, mebendazole), Piperazine citrate, Pyrantel pamoate

IV. INTEGUMENTARY
Measles German Measles Chicken Pox Herpes Zoster Leprosy
rubeola, , little red disease, hard rubella, roseola, varicella shingles, zona hansen’s disease, hansenosis,
measles, seven-day measles, rothein, three-day measles leprae, leoniliasis
 nine-day measles
Morbili virus of the Paramyxovirus
family
10-12 days
4 days before and 5 days
after
transmitted through droplet
infection and direct contact with
nasopharyngeal secretions of
infected persons
contracting the disease provides
natural active immunity (lifetime)
Pre-eruptive stage
 High fever
 Conjunctivitis (Stimson’s
sign)
 Koplik’s
Eruptive stage
 Deep red maculo-papular
eruptions (begins at the
hairline, behind the ears,
back of the neck) –
cephalocaudal in
appearance (3rd day)
 Rash turns from red to
brown (in 2 to 3 days)
Post-eruptive stage -
desquamation
• disappear
Rubella virus or Togavirus
14-21 days
One week before and 4 days
after appearance of rashes
transmitted through droplet
infection and direct contact with
nasopharyngeal secretions of
infected persons, indirectly through
fomites
contracting the disease provides
natural active immunity (lifetime)
but can be latent
Pre-eruptive stage
 Low grade fever
 Forscheimer’s spot –
fine red spot on the soft
palate
 Eruptive stage
 Pink-red
maculopapular rashes,
relatively smaller than
measles’ rash (appears on
face first then going to the
trunk and extremities
(cephalocaudal)
 borderline
 Post-eruptive stage
 Post-eruptive stage -
flaking
Varicella zoster virus (VZV)
2 to 3 weeks
Not more than one day
before and more than 6
days after appearance of
the first crop
Direct contact or droplet
spread, indirect through
fomites soiled by discharges
of infected individual.
lifetime immunity
Pre-eruptive stage
 Low grade fever
 Headache
 Body malaise
EruEruptive stage
 Macular-
papular-vesiculo-
pustular rashes
(appearing first in
the trunk or any
covered part of the
body – unifocular)
Rashes start to crust and
reactivated Varicella-Zoster Mycobacterium leprae
virus (VZV)
7-14 days 5 ½ months to 8 years
One day before and 5-6 3 months, if one week of
days after appearance of treatment, client is non-infectious
lesions
airborne – inhalation of droplet/spray
from coughing and sneezing of
untreated leprosy patient; prolonged
skin to skin contact
temporary immunity
 Neuralgic, burning • Lepromatous type
pain experienced along • Tuberculoid type
the cluster of skin • Indeterminate type
vesicles, along courses of • Borderline type
peripheral sensory nerves
(usually unilateral and According to presence of lesions:
found in the trunk, thorax  Single-lesion paucibacillary
and face)  Paucibacillary
 Fever and malaise  Multibacillary
 According to WHO and MDT
 Paucibacillary – tuberculoid and
indeterminate
 Multibacillary – lepromatous and
According to DOH
Early signs:
 Change in skin color – either
reddish or whitish
 Loss of sensation on the skin
lesion
 Anhydrosis
 Thickened and painful nerves
 Muscle weakness or paralysis of
extremities
 Nasal obstruction or bleeding
 Conjunctivitis

1. C-A-T-I (general management
for pruritus)
2. Symptomatic / supportive care
3. Prevent complications (e.g.
otitis media,
bronchopneumonia, bronchitis
Anti-measles vaccine – given to
child after nine months, (0.5 cc,
SQ, deltoid muscle)
Respiratory secretion isolation
V. VECTOR-BORNE DISEASES
Dengue
H-fever, Breakbone fever
Dengue virus types 1, 2, 3 & 4 and
Chikungunya
Physical assessment
1. C-A-T-I (general
management for pruritus)
2. Symptomatic /
supportive care
3. Prevent complications
(e.g. otitis media,
bronchopneumonia,
bronchitis
Respiratory secretion isolation
Avoid German measles during
pregnancy (first trimester
Malaria
ague,
king of tropical diseases
P. falciparum
• Most common in the
Philippines, around 70% of
1. Administer medications as
ordered.
a. Penicillin
b. Alkalinizing agents
c. Acyclovir – Immunosin
d. 1 % Hydrocortisone
lotion
2. C-A-T-I (general management
for pruritus)
3. Symptomatic / supportive
care
4. Prevent complications (e.g.
pneumonia, impetigo,
encephalitis)
Respiratory secretion isolation
Filariasis
human lymphatic filariasis,
elephantiasis
Wuchureria bancrofti,
Brugia malayi and Brugia
timori
 Ulcers that doesn’t heal
Late signs
 Madarosis
 Lagophthalmos
 Clawing of fingers and toes
 Contractures
 Sinking of the nose bridge
 Gynecomastia
 Chronic ulcers
Slit skin smear
Lepromin reaction test
1. Administer drugs as 1. Administer medications as
ordered. ordered.
a. Analgesics Multidrug therapy – Rifampicin,
b. Corticosteroids Dapsone, Clofazimine
c. Antiviral 2. Symptomatic / supportive care
(Acyclovir) 3. Provide emotional and
2. C-A-T-I (general psychological support
management for pruritus)
3. Symptomatic / supportive
care
a. Promote bed rest
b. Isolate client
BCG immunization
Avoid skin contact if still untreated.
Leptospirosis Schistosomiasis
wei’ls disease, mud fever, trench
fever, flood fever, spiroketal
jaundice, Japanese seven days fever, bilhariasis,
hemorrhagic jaundice, canicola snail fever
fever, swineherd’s disease,
icterohemorrhagic spirochetosis
Leptospira interrogans Schistosoma mansoni (endemic
Leptospira icterohemorrhagiae (most in the Philippines)
virulent) causing Weil’s disease. S. haematobium
 cases 51: japonicum
• Causes severe/complicated
malaria and death if not
treated promptly and
appropriately
• Resistance to antimalarial
drugs in the country is
widespread but low grade
• 12 days
P. vivax
• Comprised around 30% of
cases
• Very rarely causes severe
disease
• Sensitive to antimalarial
drugs; resistance suspected
in some countries (New
Guinea, Indonesia)
• Relapse is common if not
treated adequately with
anti-relapse drug
• 13 to 17 days
P. malariae
• Very rare; less than 1% of
cases in the country
• Infection is usually not
severe but may last up to 50
years if not treated
• Drug resistance has not yet
been documented
• 13 to 16 days
P. ovale
• Not found in the Philippines;
present in some Africa
countries
• Relapse may occur if not
treated adequately with
anti-relapse drug;
• Drug resistance has not yet
been
• 28 to 30 days
uncertain, probably 6 days to 1 starts from the entry of the ranges from 7 to 19 days, with starts from the entry of the
week infective larvae to the average of 10 days infective larvae to the
development of clinical development of clinical

unknown, presumed to be on the 1st
week of illness – when virus is still
present in the blood
manifestations, usually it manifestations, usually it ranges
ranges from 8 to 16 months from 8 to 16 months
Unknown, presumed to be on the 1st
week of illness – when virus is still
present in the blood As long as microorganism is present in water

Aedes Agypti (biological Anopheles flavistoris – breeds on Aedes poecilus, usually Through contact of the skin, Fresh water contaminated by
transmitter) slow-flowing, partly shaded water found in abaca stalks especially open wounds with water, Schistosoma eggs when infected
Aedes albopictus (biological and bites at night. moist soil or vegetation people urinate or defecate in the
transmitter) contaminated with urine of infected water.
Culex fatigans. Aedes Aegypti Anopheles litoralis - vector in host. Vector includes wild rat Oncomelania quadrasi, a tiny
coastal areas snail serves as an intermediate
Low flying mosquito that bites at Anopheles maculatus host
the lower extremities before sunrise Anopheles mangyanus
and sunset and usually breeds on a Anopheles balabacensis
clear, stagnant water.

o immunity is contracted because no immunity is contracted No known immunity Immunity is contracted, but possible no immunity is contracted
there are four different strains of infection reoccurrence is observed if
dengue other serovars caused the infection.

Grade 1 – Febrile stage (first 4 Cold stage Asymptomatic stage Leptospiremic phase • Liver damage
days) • Presence of chills mostly 10 to • No clinical signs and • Fever, headache • Malnutrition
• Herman’s sign 15 minutes symptoms • Nausea and vomiting • Weakness
• Petechiae may be present Hot stage Acute stage • Cough, chest pain • Accumulation of fluid in the
Grade 2 – Hemorrhagic stage (4th to • Fever, headache • Lymphadenitis • Myalgia abdominal cavity (ascites)
7th days) • Diarrhea, nausea and vomiting • Lymphangitis • Conjuctivitis, jaundice • Inflammation of the skin and
• Melena • Nose bleeding • Male genitalia – • Hematemesis, hematuria, itching
• Hematochezia • Last for 4 to 6 hours funiculitis, epidydimits, hepatomegaly
• Epistaxis Diaphoretic stage or orhitis (redness, Immune phase
Grade 3 – Circulatory failure / Toxic • Sweating painful, tender scrotum)
stage • Generalized body malaise Chronic stage
Grade 4 – Hypovolemic shock • Decreased pulse rate, • Hydrocoele
temperature and respiratory • Lymphedema
rate • Elephantiasis
Others
• Anemia
• Hepatomegaly
• Splenomegaly

Torniquet test / Rumple Lead’s test Malarial Smear Physical examination and Agglutination test Fecal and urinal examination
Hematocrit level Quantitative Buffy Coat history taking CSF analysis
Platelet count Nocturnal Blood Culture and Sensitivity
 examination (NBE)
Immunochromatographic
Test (ICT)
1. Administer medications as 1. Administer medications as 1. Administer 1. Administer medications, as 1. Administer Praziquantel
needed. needed Diethylcarbamazine ordered (Biltricide). Alternative drugs
 Vitamin K – to promote a. Blood Schizonticides - Citrate (DEC) or  Penicillin and other B include
blood clotting. -quines (Choloroquines, 2. Assist in surgical lactam antibiotics  Oxamniquine for S.
 Antipyretics – for fever. No Primaquines, Quinidine therapy  Tetracycline mansoni
aspirin. Sulfate) a. Lymphovenous (Doxycycline)  Metrifonate for
2. Control bleeding b. Antipyretics for fever anastomosis -  Erythromycin in patients haematobium.
3. Avoid shock 2. Symptomatic / supportive care b. Chyluria to allergic to penicillin. 2. Symptomatic / supportive
4. Symptomatic / supportive 3. Symptomatic / 2. Symptomatic / supportive care care
care supportive care a. Measure abdominal
girth

• 4 o’clock habit by DOH
C – hemically treated mosquito
nets
L – arvivorous fishes
E – nvironmental sanitation
A – nti-mosquito soaps
N – ymph tree / eucalyptus tree
• Isolation of the infected person
(sleeping under the mosquito
net)
• Case finding and reporting
• 4 o’clock habit by DOH
C – hemically treated mosquito
nets
L – arvivorous fishes
E – nvironmental sanitation
A – nti-mosquito soaps
N – ymph tree / eucalyptus tree
• Isolation of the infected person
(sleeping under the mosquito
net)
• Mass screening – MBS – Mass
Blood Smear collection
• House spraying (fumigation)
• 0n stream-seeding
• On stream-clearing
• 4 o’clock habit by DOH • Environmental sanitation • Proper waste disposal
C – hemically treated • Eradication of rats • Use of molluscicides
mosquito nets • Use of rubber boots • Apply 70% alcohol after
L – arvivorous fishes exposure to water
E – nvironmental • Use of rubber boots
sanitation • Water can be treated with
A – nti-mosquito soaps iodine or chlorine, standing
N – ymph tree / 48-72 hours before use
eucalyptus tree
• Improve irrigation and
cultural practices
• On stream-clearing

VII. SEXUALLY TRANSMITTED DISEASES

Herpes Simplex Type 1 Herpes Simplex Type 2
Usually last for 7 to 10 days 2-12 days
Acquired by sexual contact
Transmitted by kissing, sharing kitchen utensils or sharing
Can also be spread by touching an unaffected part of the body after touching the herpes
towels
lesion
Commonly affect lips, mouth, nose, chin or cheeks Cause genital sores, affecting buttocks, penis, vagina or cervix
Tiny, clear, fluid-filled blisters Minor rash or itching, painful sores, fever, muscular pain, burning sensation on urination

Gonorrhea Syphilis Chylamydia Trichomoniasis

Strain, Clap, Jack Lues, the Pox, Bad blood, Sy Chylamydia Trich
 Morning drop, Gleet, GC
Neisseria gonorrhea Treponema pallidum Chylamydia tranchomatis Trichomonas vaginalis
2-10 days 10 – 90 days 14-21 days 4 to 20 days
Primary: chancre
Drainage, lymph node
involvement
Secondary: Condyloma lata
Burning sensation, yellowish discharge, Painful and burning sensation especially
Skin rashes, alopecia, fever, Asymptomatic in men
pelvic pain, fever (male) during urination
headache, sore throat, body Burning, pruritus and vaginal discharge for
+ nausea and vomiting , urinary Painful sexual intercourse
malaise female
frequency (female)
Tertiary: Gumma
Cardiovascular changes
Ataxia
Stroke/blindness
Wasserman’s test
Cervical smear
Culture and Sensitivity Microscopic slide of discharge
Urethral smear Culture and Sensitivity
Dark illumination test Culture and Sensitivity
Culture and Sensitivity
Kalm test
Penicillin
Tetracycline Doxycycline Metronidazole – female
Penicillin
Ceftriaxone Azithromycin (pregnant) Tetracycline – male
Amoxicillin
Pelvic inflammatory disease Organ damages Sterility
Sterility Insanity Prematurity and stillbirths Cervical cancer
Eye damage (newborn) Brain damage Blindness (newborn)

VIII. BIOTERRORISM
Small Pox Anthrax SARS (Severe Acquired Respiratory Syndrome)
Variola virus Bacillus Anthracis Human Corona Virus
60 days (inhalation)
12 days 7 to 10 days
1-6 days (cutaneous)
Droplet Inhalation, ingestion and skin lesion Airborne
Inhalation: Fever
Fever Cough, headache, fever, vomiting, chills, dyspnea, syncope Cough
Malaise Cutaneous: Rapid respiration and distress
Headach Maculopapular rash, eschar Dyspnea
Backache Intestinal: Atelectasis
Maculo-papular rashes on face, mouth and Nausea and vomiting, abdominal pain, hematochezia, ascites,
pharynx massive diarrhea

Symptomatic / supportive Supportive/Symptomatic

Autoclaving Ciprofloxacin / Doxycycline Ventilatory
Cremation N95
 REVIEW QUESTIONS
1. It is an illness due to a specific agent transmitted by an agent from a reservoir to a susceptible host
through different modes of transmission:
a. Contagious disease
b. Communicable disease
c. Infectious disease
d. Iatrogenic disease

2. A clinically manifest disease of a man or animal resulting from an infection:

a. Contagious disease
b. Communicable disease
c. Infectious disease
d. Iatrogenic disease

3. Presence of classical sings and symptoms that are highly specific to a certain disease is known as:
a. Tell tall signs
b. Pathognomonic sign
c. Distinctive sign
d. Fastigium sign

4. When will you consider that an infection is acquired in the hospital and called as nosocomial?
a. When infection occurred upon admission
b. When infection is acquired before discharge
c. When infection is validated by the laboratory of the hospital
d. When the patient is within 14 days of hospital stay

5. A infection that is completely manifested by signs and symptoms:

a. Opportunistic infection
b. True infection
c. Communicable infection
d. Contagious infection

6. Which of the following is the main cause of nosocomial infection?

a. Surgical wound infection
b. Sepsis
c. Urinary tract infection
d. Respiratory tract infection

7. Which of the following causative agent are able to live in a non-nutritive environment and is easily
transmitted in the hospital?
a. S. aureus
b. P. aeruginosa
c. E. Coli
d. H. influenza

8. The infection brought by normal biota of the body with low degree of virulence but may take
advantage when the body is immunocompromised:
a. Opportunistic infection
b. Nosocomial infection
c. True infection
d. Parasitic infection

9. When a disease can be easily transmitted from one person to another, such infection is:
a. Communicable
b. Infectious
c. Contagious
d. Virulent

10. What is the difference between gonorrhea and influenza when taking into consideration being
infectious and contagious?
a. Gonorrhea is infectious and influenza is contagious
 b. Influenza is infectious and gonorrhea is contagious
c. Both are contagious and infectious
d. Gonorrhea and influenza is not contagious but only infectious

11. Which of the following statements are true?

a. All communicable diseases are infectious and contagious.
b. All contagious diseases are infectious but not all infectious are contagious.
c. Communicable diseases are all contagious but not infectious.
d. Infectious diseases are contagious and also communicable.

12. An organism that is capable of invading and multiplying in the body of the host:
a. Causative agent
b. Reservoir
c. Bacteria
d. Carrier

13. The infecting ability of a microorganism depends on its degree of:

a. Pathogenecity
b. Communicability
c. Teratogenecity
d. Epidemiology

14. Shigella species only requires 10 microorganisms to cause infection while Salmonella must have
1,000 bacteria to initiate disease. This property of microorganism is known as:
a. Viability
b. Toxigenecity
c. Virulence
d. Invasiveness

15. (Refer to number 16) Also, this directly proportional relationship of number and infection refers to
what property of the causative agent?
a. Dose
b. Antigenicity
c. Specificity
d. Mode of action

16. A person whose medical history and symptoms suggest that he may now have or be developing
some communicable disease is known as:
a. Patient
b. Carrier
c. Contact
d. Suspect

17. A special type of toxin found on the cell wall of the gram negative bacteria that causes sepsis
especially when they lyse themselves (suicide bomber):
a. Exotoxin
b. Enterotoxin
c. Endotoxin
d. Epitoxin

18. The type of exotoxin that is released in the GI tract that stimulates the vomiting center of the body
and exhibits its harmful effect by the inflammation of the intestinal tract:
a. Exotoxin
b. Enterotoxin
c. Endotoxin
d. Epitoxin

19. A non cellular microorganism that contains a nucleus of DNA and/or RNA with a surrounding protein
coat and are self-limiting. Also known as the ultimate parasite:
a. Virus
b. Protozoa
c. Amoeba
d. Bacteria
20. Beds in the hospital are arranged in such a way that droplet transmission of microorganism can be
prevented. This is done by:
a. Letting a single bed occupy a single room
b. Arranging the bed not facing the door or window
c. Positioning the bed 1 meter away from each other
d. Placing blinders in each patient, if possible.

21. When an infective microorganism escaping from the reservoir is suspended in the air and is carried
through air current in the form of droplet nuclei, the mode of transmission is:
a. Airborne
b. Droplet
c. Pressurized
d. Fomites

22. Which of the following is considered a fomite?

a. Staphylococcus aureus carrier
b. Urinals
c. Mosquito
d. Hands

23. Which of the following precautions doesn’t require any private room?
a. Reverse isolation
b. Strict isolation
c. Droplet precaution
d. Universal precaution

24. A vector that transmits a microorganism by harboring it to its system and serves as its reservoir:
a. Mechanical vector
b. Biological vector
c. Accidental host
d. Intermediate vector

25. Which of the following will most likely acquire an infectious disease?
a. A 30 year old male who is alcoholic
b. A pregnant mother
c. A healthy sexual worker
d. A patient who is discharged from the hospital

26. The pattern of infection where the pathognomonic signs of a specific disease is present is:
a. Incubation period
b. Prodromal period
c. Invasion/ fastigium period
d. Convalescent period

27. Cholera, tetanus, and typhoid fever occurs intermittently or on and off in different parts of the
country. This is pattern of disease occurrence is known as:
a. Endemic
b. Epidemic
c. Sporadic
d. Pandemic

28. A newly emerged strain of E. Coli that killed hundreds of hamburger eaters in the United States:
a. Sin Nombre Coli
b. E. coli O157:H7
c. Colicollus coli
d. Legionairre’s coli

29. Level of prevention focused on the early sick and aimed to detect diseases at its early state:
a. Primary
b. Secondary
 c. Tertiary
d. Quarternary

30. Which of the following is a primary level of disease prevention:

a. Mass screening
b. Contact tracing
c. Hand washing
d. Prompt treatment

31. Health education is prevents communicable diseases through IEC. Which of the following refers to
the part of IEC that involves behavioral change?
a. Information
b. Education
c. Communication
d. Integration

32. An information learned and caused a change in behavior of the client will only be effective if:
a. Able to apply everyday
b. If shared with other members of the family or even the society
c. If kept and considered as own
d. Written and well documented

33. Which of the following vaccine is introduced intradermally at right deltoid region?
a. BCG
b. DPT
c. Measles
d. Hep B

34. Which of the following vaccine is very sensitive from heat and should be stored at (-15 C to -25C) at
the freezer?
a. Measles
b. DPT
c. BCG
d. Hep B

35. Hep B is given for three doses and the schedule is:
a. At birth, 6 weeks after the 1st dose and 8 weeks after the 2nd dose
b. At six months with interval of 4 weeks in each doses
c. At birth with 4 weeks interval
d. Given together with DPT and OPV

36. What will the nurse do if a child developed convulsion within 24 hours after giving DPT?
a. Give TSB and paracetamol, as ordered.
b. Do not give the second dose of DPT.
c. Give the child DTaP instead.
d. The child must begin with DT only on the second dose because the child reacted negatively
and developed pertussis with the first dose.

37. Which of the following is true about Tetanus Toxoid?

a. It is given for mothers for two doses with one month interval with booster doses every next
pregnancy.
b. It is given with 0.05 cc, IM at deltoid region
c. It provides 99% immunity at the third dose
d. Infant is protected from tetanus for 10 years if TT2 is given

38. Environmental sanitation refers to the study of all factors in man’s physical environment which may
exercise or may not exercise deleterious effect on his health and well-being. Which of the following
is not included?
a. Safe and Water Supply
b. Proper Excreta and Waste Disposal
c. Food Sanitation
d. Sexual worker’s occupation sanitation program
39. The four R’s of food sanitation includes all of the following, except:
a. Right Source
b. Right Price
c. Right Storage
d. Right Cooking

40. An adequately cooked food is heated with the temperature of:

a. 10-60 degrees C
b. 70 degrees C
c. 100 degrees C
d. 150 degrees C

41. For right storage, the following is correct except:

a. Foods should not be stored longer than 2 hours
b. Reheat with 60 degrees centrigrade.
c. Food must not be stored with room temperature
d. No rethawing, if possible.

42. Food establishments in the community shall be appraised as to their sanitary conditions. Which of
the following is important for the cook or cook helper to have?
a. Inspection
b. Approval of all food sources
c. Updated health services
d. Compliance to health certificate

43. A patient is removed from the other persons because he is susceptible in acquiring a certain
disease. This kind of isolation is called as:
a. Strict isolation
b. Contact isolation
c. Source isolation
d. Reverse isolation

44. Which of the following is true regarding source isolation?

a. Negative pressure in the room and positive outside
b. Positive pressure in the room and negative outside
c. Equalized pressure from both areas
d. Negative pressure should be maintained inside and out

45. The restriction of activities of well person that has been exposed to a case of communicable
disease to prevent disease transmission during the incubation period but without limitation to
movements:
a. Complete quarantine
b. Source isolation
c. Surveillance
d. Separation

46. A patient with typhoid fever and have several bouts of diarrheal stool prompts a nurse to use what
kind of precaution:
a. Contact
b. Reverse Isolation
c. Drainage precaution
d. Enteric precaution

47. Which of the following statements about source isolation is false?

a. Air entering the room is passed through filters
b. The room is under negative air pressure
c. Source isolation is appropriate for patients with meningitis, whooping cough, or influenza
d. Transmission-based precautions will be necessary
48. Which of the following is not part of the standard precaution
a. Hand washing between patient contacts
b. Placing a patient in a private room having negative air pressure
c. Proper disposal of needles, scalpels and other sharps
d. Wearing gloves, masks, eye protection and gowns when appropriate

49. A patient with suspected tuberculosis has been admitted to the hospital. Which of the following is
not appropriate?
a. Droplet precautions
b. Source isolation
c. Standard precautions
d. Use of a type of N95 respirator by the health care provider

50. Which of the following statements about medical asepsis is false?

a. Disinfection is a medical aseptic technique
b. Hand washing is a medical aseptic technique
c. Medical asepsis is considered a clean technique
d. The goal of medical asepsis is to exclude all microorganisms

51. It is the killing of microorganisms by chemical and physical means. It can be done through dry heat,
moist heat and radiation:
a. Disinfection
b. Sterilization
c. Sanitation
d. Disinfestation

52. You are caring a client in isolation. After nursing care is done what will you remove first after
handling the patient?
a. Mask
b. Gown
c. Gloves
d. Bonnet

53. The process of weakening microorganism through consecutive steps of freezing and dessication.
This process is used for making vaccine:
a. Use of formaldehyde
b. Lyophilization
c. Attenuation
d. Moist heat application

54. The process of rendering surface that has been heavily exposed to infectious pathogen safe to
handle is known as:
a. Disinfection
b. Decontamination
c. Sterilization
d. Anti-septic

55. When a nurse uses alcohol on the client’s skin before an injection, she uses what kind of chemical-
removing-microorganism?
a. Antiseptic
b. Disinfectant
c. Decontaminant
d. Antimicrobial

56. The removal of stains and any contaminants from a kitchen utensils done at home is also known as:
a. Sanitization
b. Sanitation
c. Decontamination
d. Disinfection
57. The client with tuberculosis is expelling large amount of sputum. The nurse, every time the client
coughs, removes the soiled linen and discards the tissues and burns it. This technique is what kind
of disinfection?
a. Terminal
b. Concurrent
c. Longitudinal
d. Post-expulsion

58. The process of filling animal forms through use of gaseous agent.
a. Indoor Residual Spraying (IRS)
b. Disinfestation
c. Sanitation
d. Gaseous Desentisization

59. Medical hand washing can be done for ___ and with elbows ___ :
a. 10 – 15 seconds: down
b. 10 – 15 seconds: up
c. 3 - 5 minutes: down
d. 3 – 5 minutes: up

60. The removal of all harmful microorganisms is also known as:

a. Medical asepsis
b. Surgical asepsis
c. Sterilization
d. Decontamination

61. Clostridium tetani has the following characteristics, except:

a. Drum-stick in appearance and normal inhabitant of intestine
b. Aerobic, spore-forming rod shape bacteria
c. Found in soil fomites and excretion animals and human
d. Produces one of the most potent toxin

62. Incubation period of Clostridium tetani is:

a. 3 to 30 days
b. 3 days to 3 weeks
c. 3 to 9 days
d. 3 to 3 months

63. The incubation period of tetanus among infants is:

a. 3 to 30 days
b. 3 days to 3 weeks
c. 3 to 9 days
d. 3 to 3 months

64. Tetanolysis causes RBC destruction while tetanospasmin causes:

a. Inhibition of impulses that stops muscle contraction
b. Direct control over contraction of muscles
c. Absence of sodium potassium pump that inhibits contraction
d. Stimulation of salivary which produces excessive salivation

65. The initial sign of tetanus is:

a. Trismus
b. Abdominal rigidity
c. Opisthotonus
d. Risus sardonicus

66. The pathognomonic sign of tetanus is:

a. Trismus
b. Abdominal rigidity
c. Opisthotonus
d. Risus sardonicus

67. Which of the following management neutralized the toxins present in the body with tetanus?
a. Anti-tetanus toxin
b. Tetanus immunoglobulin
c. Penicillin
d. Equine anti toxin
68. DPT immunization provides how many years of protection?
a. 2 years
b. 5 years
c. 7 years
d. 10 years

69. Tetanus toxoid for mothers are given, except:

a. Two doses at the 2nd trimester
b. With one month interval
c. At thigh region , IM, 0.5 cc
d. Booster dose in every other pregnancy

70. Prevention of tetanus neonatorum among infants is best achieved through:

a. Adequate and effective maternal and child health
b. Provision of adequate medicine to tetanus infected child
c. Proper wound care
d. Frequent hand washing among health care providers especially during child birth

71. Wounds with patients with suspected tetanus infection is best cleaned by:
a. Soap and water
b. 3% hydrogen peroxide
c. Iodophor
d. Cydex

72. Which of the following facts about meningitis is not true:

a. 2/3 of humans are asymptomatic carrier
b. It is caused by gram negative sphere bacteria
c. Can be caused by other bacteria other than Neisseria meningitides
d. Non-infectious after one week of treatment

73. The following strains of N. meningitides do not have vaccines?

a. A
b. Y
c. C
d. B

74. Which of the following causative agents of meningitis which is common among children?
a. Hemophilus influenza
b. Streptococcus pneumonia
c. Meningococcus
d. E. coli

75. The drug of choice for this meningitis causative agent is Penicillin:
a. Hemophilus influenza
b. Streptococcus pneumonia
c. Meningococcus
d. Clostridium tetani

76. Meningoccocemia is a result of the systemic profileration of the microorganism in the body
characterized by except:
a. Petechial rash
b. Hypotension
c. DIC
d. Convulsion

77. Meningitis is the characterized by flexion of the hip and knee while in supine position, when neck is
flexed. This is known as:
a. Kernig’s sign
b. Brudzinski’s sign
c. Opisthotonus
d. Nuchal rigidity

78. Chemoprophylaxis for meningitis includes which of the following pharmacological intervention for 2
days and 2 dose and is contraindicated for pregnant mothers and taking contraceptives:
a. Rifampicin
b. Penicillin
c. Ceftriaxone
d. Penicilin

79. The drug of choice for Meningitis is:

 a. Rifampicin
b. Penicillin
c. Ceftriaxone
d. Penicilin

80. The following management decreases tendency of increased intra-cranial pressure, except:
a. Avoid valsalva maneuver
b. Administer anti-diuretics
c. Lessen environmental stimuli
d. Elevate head part

81. Which of the following causes of encephalitis is brought by a mosquito?

a. Japanese B encephalitis
b. Amoebic meningoencephalitis
c. Toxic encephalitis
d. Spongiform encephalopathy

82. West nile virus, St. Louis Encephalitis are mosquito-related encephalitis and is caused by:
a. Flavivuris
b. Togavirus
c. Bunyavirus
d. Paramyxovirus

83. It is a kind of encephalitis that resulted from complication of communicable disease of viral origin
due to ascending infection:
a. Secondary encephalitis
b. Amoebic encephalitis
c. Toxic encephalitis
d. Mosquito-borne encephalitis

84. La crosse virus is very potent to patients who are:

a. Under 15 years old
b. Elderly
c. Pregnant
d. Male

85. The only mosquito borne encephalitis that have vaccine made from inactivated brain of mouse,
given for three doses of I cc:
a. Australian X Encephalitis
b. Equine Encephalitis
c. Japanese B encephalitis
d. St. Louise encephalitis

86. Mad cow disease is a kind of encephalitis and medically called as:
a. Kuru
b. Creudzfeldt Jakob Disease
c. Scrapie
d. Bovine spongiform encephalitis

87. Amoebic encephalitis is brought by a microorganism from waters containing organic waste and
enters body through nasal passages, olfactory nerve reaching the CNS. What is this amoeba?
a. N. fowleri
b. Acanthamoeba
c. Plasmodium ovale
d. T. brucei

88. Increase ICP among infants is manifested primarily by all of the following, in exception of:
a. High-pitched cry
b. Bulging of fontanels
c. Decrease pulse rate
d. Projectile vomiting

89. The following are the diagnostic procedures for encephalitis, except:
a. EEG
b. Blood culture
c. Nose and throat swab
d. Lumbar puncture

90. Which of the following intervention can be a preventive measure against encephalitis?
 a. Avoid nasopharyngeal secretions from infected individuals with toxic encephalitis
b. CLEAN program of DOH
c. Influenza virus vaccine
d. Proper food handling

91. The following are included in the CLEAN program of DOH:

a. Stream seeding
b. Zooprohylaxis
c. Stream clearing
d. IRS

92. Drug of choice for encephalitis is:

a. Penicillin
b. Ciprofloxacin
c. Variable
d. Penicillin

93. In 1955, Jonas Salk introduced this vaccine to prevent poliomyelitis caused by Sabin’s vaccine?
a. OPV
b. IPV
c. OPT
d. OPM

94. Which of the following strain of Legio-debilitans causes permanent immunity?

a. Brunhilde
b. Lansing
c. Leon
d. Paquita

95. Stage of poliomyelitis where no evident involvement of CNS noted?

a. Invasive
b. Pre-paralytic
c. Paralytic
d. Poliotic

96. Pathognomonic sign of poliomyelitis includes all of the following, except:

a. Hoyne’s sign
b. Poker’s sign
c. Photophobia
d. Paralysis

97. How many days will it take to have an irreversible paralysis among client with Poliomyelitis?
a. 30 days
b. 60 days
c. 90 days
d. 100 days

98. Which kind of paralysis that affects the cranial nerves and respiratory muscles?
a. Spinal
b. Bulbar
c. Bulbo-spinal
d. Laundry’s paralysis

99. Diagnostic procedure for poliomyelitis includes all of the following, except:
a. Muscle Grading Scale
b. Electroencephalogram
c. Lumbar puncture
d. Stool exam

100. Priority nursing diagnosis for clients with poliomyelitis is:

a. Impaired gas exchange
b. Impaired Physical Mobility
c. Self Care deficit
d. Ineffective airway clearance