MEDPRIME REVIEW CENTER BAGUIO CITY

Review Questions for Discussion on Preventive Medicine

Dr. Jose Ronielo Juangco, MD, MPH, FPSVI
UERMMMCI College of Medicine Assistant Professor
Dr. Miguel Noche

Dr. Edgardo Fernando

Dr. Eleanor Almoro

Dr. Maria Graciela Gonzaga

Dr. Clarita Maano

Dr. Eleanor Galvez

Chairman
PEDIATRICIAN
UST
Interim Member
OB GYNE
Our Lady of Lourdes Hospital
Medical City
OB GYNE
Saint Lukes College of
Medicine
INTERNAL MEDICINE
Professor and Dean
UST
DERMATOLOGIST
UP-PGH
DEAN
PLM

Board members divide the 12 subjects

Each submits 1000 questions per subject
Sometimes members ask medical schools to submit questions
(leakage)
Computer randomly picks 100 questions per subject
Members of the board incarcerated in a room inside PRC building
during the exam guarded by the NBI
Physicians Licensure Examination
Deadline: August 22, 2016
September 10, 11, 17 and 18 Baguio, Manila, Cebu and Davao
February 15, 2016 March 6, 7, 13 and 14
EPIDEMIOLOGY
- Epidemiologic basics
- Natural history of Disease
- Outbreak Response
- Levels of Prevention
Broad Categories of Epidemiology
A. Descriptive Epidemiology
- Study of the amount/ frequency and distribution of
disease, etc. in populations
B. Analytic Epidemiology
- Study of determinants or etiology of disease and
related conditions
1. This is the branch of medicine that deals with the study of
causes, distribution, and control of diseases in populations:
C. EPIDEMIOLOGY
2. What does Epidemiology study?
D. THE DISTRIBUTION AND DETERMINANTS OF FREQUENCY OF
DISEASE IN HUMAN POPULATION
3. The London Cholera epidemic of 1848 was traced to the Broad
street pump by
JOHN SNOW
JOHN GRAUNT

WILLIAM FARR

HIPPOCRATES

Father of Epidemiology
Cholera Epidemic in London
Bills of Mortality reason
why we are signing the death
certificates, Top 10 cases of
mortality
Father of modern vital
statistics
International Classification of
diseases (author of ICD-1)
First Epidemiologist

BRADFORD HILL

Described diseases from a

rational point of view
Causal analysis
Smoking and lung cancer

4. The epidemiologic triad shows the interaction of

C. ENVIRONMENT, AGENT, and HOST
Ecological triad
Agent Host Environment (Vector in the middle)
Homeostatic Balance
* At equilibrium Healthy individual
* Agent becomes more pathogenic The disease will be more
virulent
* If the host becomes more susceptible Disease will also ensue
- Immunocompromised host increased susceptibility
* Environmental changes that affects agent and host will bring
brought about other diseases
- Rainy season Dengue Fever is more prevalent
- Brings down immune system of host
5. The natural history of a disease process commences with
A. INTERACTION OF THE HOST AND DISEASE AGENT
FACTORS WITH THE ENVIRONMENT
Factors affecting Disease Causation
A. Predisposing factors Age, Sex, and previous illness
B. Enabling factors Low income, poor nutrition, bad housing,
inadequate medical care
C. Precipitating factors Exposure to a specific disease agent or
noxious agent
D. Reinforcing factors Repeated exposure, unduly hard work
AGENT
- Any element substance, or force whether living or non-living,
the presence or absence of which can initiate or perpetuate a
disease process
- Characteristics
- Inherent
- Directly related to man
1. Infectivity Ability to gain access
2. Pathogenicity Ability to set up a specific
reaction, local
or general, clinical or subclinical
3. Virulence Severity of reaction produced
measured in
terms of mortality
4. Antigenecity Ability to stimulate the host to
produce
antibodies
* Agent with high infectivity and pathogenicity
but low
antigenicity will cause a relatively high
disease prevalence
in the community
* Agent with high infectivity but low
pathogenicity usually
produce a mild or sub clinical
symptom and carrier
- Related to environment
Types of Agents
Biological
Chemical
Physical
Helminths
Foods
Heat
Protozoans
Poisons
Light/ Radiation
Fungi
Drugs
Noise
Bacteria
Allergens
Vibration
Rickettsia
Objects
Viral
Prion
Tropism
- The agent preference to attack and stay in special location in
the host
- Cholera: Digestive tract
- Staphylococcus: Mostly in the skin
- Herpes Zoster: Nervous system
- Poliomyelitis: Anterior-horn cells of the Spinal cord
Host Factors

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1.
2.
3.
4.
5.

Age extremes of age more susceptible to get disease

Sex
Race
Culture
Defense mechanism

11. The term epidemic is defines as

A. AS THE OCCURRENCE OF CASES IN EXCESS OF WHAT IS
NORMALLY EXPECTED IN A COMMUNITY OR REGION
Is spreading through human populations across a large region,
for instance, multiple continents or even worldwide Pandemicity

Environment
1. Climate
2. Geography
3. Biologic Environement
6. Which among the factors below in determining the nature of
the infection of the infection is a measure of the severity of
disease, which can vary from very low to very high?
B. VIRULENCE

Sporadic Some surges of disease but does not surpass previous

number of cases
Endemic sustained moderate to high level of cases in a
community
Epidemic more cases now compared to last year (more than 1
focus for source of infection)
Pandemic nations, continents are already involved
Outbreak Only 1 focus of the source of infection

7. Which among the following is an important source of infection

maybe an infected person who shows no evidence of clinical
disease?
C. CARRIER

12. The following is true regarding the behaviour of diseases in

the community
C. ENDEMIC REFERS TO THE PERSISTENT OCCURRENCE OF
A DISEASE IN A PARTICULAR AT REGULAR INTERVAL

8. Which of the following transmissions occurs through

contaminated materials, such as food, clothes, bedding and
cooking utensils?
B. INDIRECT TRANSMISSION

WHO Pandemic Alert Scale

Phase I to III mostly affected are animals
Phase IV Human to human transmission is seen
Phase V One WHO region is affected by disease
Phase VI Two or more WHO regions are affected by disease
a. This choice is Phase 6 Pandemic alert scale
b. Sporadic should have an irregular pattern
d. Outbreak is the behaviour of disease who has a focal source of
infection

9. An 18 year old male works in a company where lunches are

often catered. One day, the water at the company facility is not
working, but they managed to have lunch anyway. Two weeks
later, he becomes sick. He develops anorexia, nausea, malaise
and jaundice. During the course of the next four weeks, seven
people who shared in the lunch becomes ill with similar
symptoms. After a few weeks, each of the seven people
completely recovers and they replace their caterer. The period
between infection and clinical onset of the disease is termed as?
C. INCUBATION PERIOD
10. Predisposition and susceptibility to a disease is observed at
which stage of a diseases natural history?
A. PREPATHOGENESIS
Incubation Period
- Virulence, dose and portal of entry
- Host and defense mechanisms
- Identify of point source propagated epidemics
- Tracing the course of infection and epidemic
* Importance of Incubation Period
- Tracing the source of infection and contact
- Period of surveillance
- Immunization
- Identification of point source of propagated epidemics
Communicable period
- It is defined as the time during which an infectious agent may
be transferred directly or indirectly from an infected animal to
man, or from an infected person to an animal, including
arthropods
Herd Immunity
- The resistance of a group to invasion and spreading of an
infectious agent based on the resistance to an infection of a high
proportion of individual members of the group
Prodrome
Consists of mild
non-specific signs
and symptoms

Frank Illness
Signs and
symptoms are now
more specific

Chronic stage
Disease is
prolonged

(Generalized body
weakness, fever)

(Icteresia,
hemoptysis,
paroxysmal
nocturnal
dyspnea)

(Development of
anemia due to
CKD secondary to
uncontrolled HPN
and DM)

10 Steps in an Outbreak Investigation

1. Prepare for field work
- When the DOH is called upon due to an outbreak, we ready for
the investigation (2 boxes which contains microscopes,
instruments, etc.)
2. Establish the existence of an outbreak
- Ask the local health officer incidence of the disease of the
same month last year (More cases now than last year =
Outbreak)
3. Verify the diagnosis
- Medical technologists will look at cultures, look at possible
causes like water or soil
4. Define and identify the cases
Confirmed: usually has laboratory verification
Probable: usually has clinical features without lab
verification
Possible: usually has fewer of typical clinical features
5. Describe and orient the data in terms of time, place and
person
- Spot map is done putting in people who are involved to locate
which area is the disease more prevalent
6. Develop hypotheses
7. Evaluate the hypotheses
- Either case control or cohort (more of case control study)
8. Refine hypotheses and carry out additional studies
9. Implementing control and prevention measures
- Only after you have shown or identified the source of the
outbreak will you be allowed to do interventions and control of
the disease
10. Communicate findings
Point epidemic only have one source, sudden rise and sudden
drop

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* Example is when in a community, the source of water

comes from a
water district and it is contaminated
(continuous exposure)
16. If quarantine is necessary to contain an outbreak/epidemic,
who of the following should be quarantined?
D. SUSPECTS
* Isolate the cases and quarantine the suspects
Isolation separation for the period of communicability of
infected person
Quarantine Restriction of activity during the periods of
communicability of well persons who have been exposed
Propagating epidemic from one source will infect other people
then will infect other people, etc. Will start little, then there will
be slight increase, and as the outbreak continues, people
infected are noted to slightly decrease overtime

17. What is the graphical presentation of data most useful in

locating cases during an epidemic?
A. SPOT MAP
18. What is the first step in an epidemiologic/ outbreak
investigation?
C. DETERMINE EXISTENCE OF THE EPIDEMIC
* Ideally it should be Prepare for Field work

Outliers = cases that stand apart

* Early case may represent:
- A background (unrelated) case
- A source of epidemic (index)
- An early exposure
* Late cases may be:
- Unrelated
- Have long incubation periods
- Indicate later exposure
- Secondary cases
* Time Trends
A. Secular time trends that are longer in nature
(decades)
- Heart diseases, Diabetes Mellitus, Cancer
B. Cyclic time trends where there is a number of
interval between
outbreaks
- Dengue before was noted to have outbreaks
every 3
years
C. Seasonal time trends that are related to the seasons
- Summer more skin diseases
D. Attention phenomenon there is increase in cases
but does not
warrant any investigation
13. What are changes in disease frequency usually
encompassing several decades?
B. SECULAR
14. To establish the existence of an outbreak/ epidemic, which of
the following should be done?
C. COMPARE THE PRESENT INCIDENCE WITH THE NORMAL
EXPECTANCY
15. What is the type of outbreak where exposure is brief and all
cases develop within one incubation period of the disease?
C. POINT SOURCE OUTBREAK
a. common source outbreak with intermittent exposure
* Example is when in a community, the source of water
is from a
nearby waterfalls and at the top of the
waterfall, sometimes there are
people that defecate
polluting the source of water of the community
(intermittent because not always that the people
upstream are
defecating)
b. common source outbreak with continuous exposure
increasing trend with noted plateau

19. What level of prevention aims to avoid the emergence and

establishment of the social, economic and cultural patterns of
living that are known to contribute to an elevated risk of disease?
A. PRIMORDIAL LEVEL OF PREVENTION
- Before the interaction of the agent, host and environment
- Community based prevention
Primary during the interaction of the agent, host and
environment
- Individual based prevention
- Prevent the initiation or onset of disease
Prepathogenesis

Pathogenesis
early
Secondary
- Early diagnosis
- Prompt
treatment

Pathogenesis
late
Tertiary
- Disability
limitation
- Rehabilitation

Primary
- Health
Promotion
- Specific
Protection
Primordial (even before prepathogenesis)
20. Pap Smear is an example of what level of prevention?
C. SECONDARY LEVEL OF PREVENTION

Primary Level of Prevention

1. Health Promotion
- Health education in the fundamental facts of health
and disease
- Good standards of nutrition
- Inculcation of healthy living habits
- Adequate housing recreations
- Improvement and protection water supply systems
- Improvement of environmental sanitation
2. Specific Protection
- Segregation
- Control of means of spread
- Vector control
- Increasing resistance
- Immunization
- Chemoprophylaxis
- Mechanical factors
* Malaria Chemoprophylaxis
Chloroquine and Mefloquine taken once weekly, and safe for
pregnant women
Doxycycline taken daily, tends to be the least expensive antimalarial drug
21. Which level of prevention is aimed at reducing the progress
or complications of established disease and is an important
aspect of therapeutic and rehabilitation medicine?
D. TERTIARY LEVEL OF PREVENTION
22. Which of the following statements regarding herd immunity is
FALSE?

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B. HI causes the prevalence of the organism in the

population to plateau, but it will NEVER decline

d. Herd immunity The disease has a low occurrence among the

native inhabitants and a high occurrence among the migrants

23. Susceptibility of a host to a disease can be best altered or

controlled through:
C. BUILDING IMMUNE SYSTEM AND RESISTANCE TO
AGENTS OF DISEASES

23. What is the reason why death rates are higher for males than
females throughout life?
D. ALL OF THE ABOVE

* Which of the following defines a local place variation of disease

B. THE DISEASE HAS A HIGH OCCURRENCE IN BOTH THE
NATIVE INHABITANTS AND MIGRANTSTO THE PLACE
a. Cultural variation The disease has a high occurrence in the
native inhabitants but not among the immigrants
c. Genetic immunity The disease will continue to have a high
occurrence among the offspring of the native inhabitants who
have migrated out of the area

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