Important points for CHN Paper mcqs 2022

1. In case the nurse did not tell the truth to patient about the patient’s condition what ethical principle
did the nurse violated?

A. Veracity

2. If the patient decides not to undergo another medical procedure which ethical principle will you
observe?

d. Autonomy

3. the nurse noted that a 20-year old wife and mother, has several bruises at various stages of healing.
She tells the nurse that she fell down. Failure to report your findings is an example of

D. negligence

4. The patient is for Blood transfusion and a Jehovas witness.

C. Autonomy

5. Injected the medication without permission

B. Battery

6. Group of students, research project about effect of hot and cold application to febrile pt. WITHOUT
informing patient properly. What is violated

D. Respect for person

7. Patient refuses to undergo surgery, the nurse and doctor repects the decision.

A. Autonomy
8. when a person charged with a crime under state statutes flees the state and sending the person back
to his country.

C. Extradition

9. Gives antibiotic to toddler without parents’ consent

Answer: assault (choices ay a. malpractice b. negligence c. assault d. libel)

10. Violence against women and childre

Answer: RA 9262

11. Total Development and Protection of Children Act by establishing DAY CARE CENTER in every
barangay

Answer: 6972

12. LAW ON REPORTING OF COMMUNICABLE DISEASES.

RA: 3573

13. Nursing scope of practice is on what section of RA 9173

ANSWER: Section 28.

14. Written and distributed defamatory act

Answer: LIBEL

15. orally stated defamatory words

Answer: SLANDER
16. IVT and foremost, patient did not want to go

Answer: respect decision

17. Profuse vaginal bleeding, exception to the rule

Answer: epikia

18. Dressing up properly,not exposing unnecessary parts answer: inviolability of life

19. Reach hospital alive,truthful answer

Answer: veracity

20. Do good to them

Answer: beneficence

21. 48 hours failure to report

Answer: breach of duty

22. Guilty, administrative case

Answer: suspension, revocation

23. Will not happen again

Answer: beneficence

24. Whatever decision, primary ethical decision

Answer: respect autonomy

25. Decide to keep the baby and not abort,ethical principle answer: beneficence

26. Life will change regardless of her decision

Answer: non maleficence

27. Patient advocate,nurse must do the following,except answer: only client social status and religious
affiliation

28. Decision, Ethical principle of

Answer: autonomy

29. Patient failed to sign a consent

Answer: Emergency

30. Real abunition of the baby,what ethical principle does she violate

Answer: veracity

31. Used of antibacterial

Answer: autonomy

32. She has to do good to all patient

Answer: beneficence
33. A fundamental ethical principle that seeks to prevent harm and exploitation of, to maximize benefits
for, study participants is:

B. Beneficence

34. The principle of beneficence include all the following, EXCEPT

Answer: The right to self-determination

35. Obtaining informed consent is the responsibility of

A. The physician

😍✅Primary Health Care and CHN

1. PHC is – essential health care made universally Accessible

2. Alma Ata USSR 1st PHC international conference is at- RUSSIA

3. Implementation of PHC is declared by – WHO

4. 1st Asian country who adopts and implement PHC is – Philippines

5. The legal basis of PHC in the Philippines- L.O.I # 949

✅Public health surveillance is - the ongoing / continuous systematic collection, analysis, and
interpretation of data, closely integrated with the timely dissemination of these data to those
responsible for preventing and controlling disease and injury

Public health surveillance is the cornerstone of public health practice

📌Active surveillance: a system employing staff members to regularly contact heath care providers or
the population to seek information about health conditions.

📌Passive surveillance: a system by which a health jurisdiction receives reports submitted from
hospitals, clinics, public health units, or other sources.

🎉DISASTER is_______ : A disaster is an occurrence disrupting the normal conditions of existence and
causing a level of suffering that exceeds the capacity of adjustment of the affected community.

A flash flood is a sudden local flood characterized by a great volume of water and a short duration. It
occurs within minutes or hours of heavy rainfall

✅PDCA cycle is PLAN DO CHECK ACT

• MDG target- reduction of maternal mortality by 80/100,000 live births (mdg5)

• 2/3- reduction of child mortality rate (mdg4)

• Mdg 5- TARGET 2015

• SDG 3– HEALTH and WELL being Centered ( disease focus : HIV/AIDS , Malaria)

• SDG 6 – SANITATION centered

2030 Agenda for Sustainable Development. “Transforming our world”

17 goals target year is 2030

• Goal 3: Good Health and Well-being (health centered)

• Goal 6: Clean Water and Sanitation(sanitation centered)

• Goal 11: Sustainable Cities and Communities

Agenda 21 - To Reduce population in the cities

✅VIT C prevents SCURVY(increase intake of fruits)

✅ Solutions like alcohol must be must be placed in the BACK of the Public health Bag

📌4P's is Pantawid Pamilyang Pilipino Program

💦Purpose: cash grants, social assistance, break intergenerational poverty

Cash grants :

300.00 per child up to 3 children a month for education

500.00 per household per month for 5 years for nutrition and health

• Vitamin A for postpartum – 200,00 IU one dose

• Vitamin A for pregnant– 10,00 IU 2x a week starts at 4 months

• Vitamin A for Children 12 months and above – 200,00 IU dose every 6 months

• Tuberculosis / PTB- a highly infectious chronic disease that usually affects the lungs.

Causative Agent: Mycobacterium Tuberculosis (acid fast bacteria)

• Robert Koch- German physician and scientist, presented his discovery of Mycobacterium tuberculosis

• Case finding – Direct Sputum Smear Microscopy and X-ray examination of TB symptomatics who are
negative after 2 or more sputum exams

• Sputum smear and culture or DSSM - confirms the diagnosis

• Tuberculin test (Mantoux test- detects the presence of antibodies

(Results read within 48-72 hours from skin testing, posistive if within duration of 10mm or more.

• DOTS- declared in 1996

• Inhale or deep breath then cough up 3-5ml sputum proper way to collect

• Hemoptysis is contraindication of sputum collection

• 3x in a month – collection of sputum for case finding

• Bcg – do not give to immunosuppressed baby- with leukemia and hiv

• Leprosy

• RA 4073- Liberization and Treatment of Leprosy (February as Leprosy Month)

• Hansen's disease - BACTERIA

• SSS – slit skin smear is the diagnostic test

• Multi-Drug-Therapy (MDT)

• LEPROMATOUS TYPE is the most disfiguring type of LEPROSY

1 week of MDT or multi drug therapy patient is not communicable already

CHOLERA

• In August of 1854 Soho, a suburb of London, was hit hard by a terrible outbreak of cholera.

• John Snow to be the pioneer of public health research in a field known as father of MODERN
EPIDEMIOLOGY in part because of his work in tracing the source of a cholera outbreak in Soho, London,
in 1854

• Cholera is an acute diarrhoeal infection caused by the bacterium Vibrio cholera

• Humans are the only relevant reservoir,

• VERY common in RAINY SEASON

• Rice watery stool – sign of cholera

BUBONIC PLAQUE – BLACK DEATH

• Describe the definition of the Black Death- A widespread epidemic of the Bubonic Plague the occurred
in the 14th century, killing millions of people “DARK AGE of EUROPE”.

• What type of flea carried the Disease?- The oriental rat flea
• What was the most common strain of the Black Death?- The Bubonic Plague

• In what season were the fleas most active?- Summer

HElminths

• Helminths - most common is ascariasis , hookworm ,trichuris (whipworm)

Taeniasis is not common in philippines

• Beef tapeworm - Taenia saginata- ingestion of undercooked beef

• Ancylostomiasis/Hookworm – causes anemia - penetration of skin - walking barefooted

• Pinworms/ enterobiasis .- best way to diagnose this infection is through a tape test

• PARAGONIMUS WESTERMANI (Paragonimiasis) is a lung fluke cause by ingestion of raw crustaceans

like crabs and lobsters which is SOMETIMES MISTAKENLY DIAGNOSED AS PTB

Hepatitis

• Hepatitis A , E or Infectious Hepatitis: oral-fecal route

• Hepatitis B or Serum Hepatitis: blood-borne, oral-oral, sex

• Hepatitis C: blood-borne,

• Red tide poisoning/Paralytic shellfish poisoning- first aid Drinking pure coconut milk

Rabies/ Lysa

• People are usually infected following a deep bite or scratch from an animal with rabies, and
transmission to humans by rabid DOGS accounts for 99% of cases.

• most common transmission is by infected SALIVA of rabid animal

ACTIVE IMMUNIZATION –

PCEC (Purified Chick Embryo Vaccine), RABIPUR and the new cheap drug VEROWELL

Passive vaccine is ERIG and HRIG

ERIG or EQUINE RABIES is derived from HORSE serum

Rubeola (measles)

• Viral infection

• RNA virus of the genus Morbillivirus within the family Paramyxoviridae

HUMAN is the only reservoir

Nasal and Throat secretions can be the transmission

• Communicable just 4 days before rash appears

• Pre-Eruptive Stage:

• fever, coughing, sneezing, and running of nose and redness of eyes.

• Koplik spots—bluish-gray specks or “grains of sand” on a red base—develop on the buccal mucosa

Diptheria-

Diphtheria is an infectious disease caused by the bacteriumCorynebacterium diphtheria, which primarily

infects the throat and upper airways, and produces a toxin affecting other organs.

Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae.

Signs and symptoms usually start 2 – 5 days after exposure and range from mild to severe.

sore throat and fever.

In severe cases, the bacteria produces a poison (toxin) that causes a thick grey or white patch at the
back of throat (PSEUDOMEMBRANE)

This can block the airway making it hard to breathe or swallow and also create a barking cough. The
neck may swell in part due to enlarged lymph nodes.

The poison may also get into the blood stream causing complications that may include inflammation and
damage of the heart muscle, inflammation of nerves, kidney problems, and bleeding problems due to
low blood platelets. The damaged heart muscles may result in an abnormal heart rate and inflammation
of the nerves may result in paralysis.

How is diphtheria spread?

Diphtheria spreads easily between people by direct contact or through the air though respiratory
droplets, like from coughing or sneezing. It may also be spread by contaminated clothing and objects.

How is diphtheria diagnosed?

1. Schick test, method for determining SUSCEPTIBILITY to diphtheria

2. Moloney test is - a test to detect a high degree of SENSITIVITY to diphtheria toxoid

Zika virus

• a virus transmitted by Aedes mosquitoes.

Key facts

• Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes, which bite during
the day.

• Symptoms are generally mild and include fever, rash, conjunctivitis, muscle and joint pain, malaise or
headache. Symptoms typically last for 2–7 days. Most people with Zika virus infection do not develop
symptoms.

• Zika virus infection during pregnancy can cause infants to be born with microcephaly and other
congenital malformations, known as congenital Zika syndrome. Infection with Zika virus is also
associated with other complications of pregnancy including preterm birth and miscarriage.

• An increased risk of neurologic complications is associated with Zika virus infection in adults and
children, including Guillain-Barré syndrome, neuropathy and myelitis.

Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947 in RHESUS monkeys.
It was later identified in humans in 1952 in Uganda and the United Republic of Tanzania.
The first recorded outbreak of Zika virus disease was reported from the Island of Yap (Federated States
of Micronesia) in 2007. This was followed by a large outbreak of Zika virus infection in French Polynesia
in 2013 and other countries and territories in the Pacific. In March 2015, Brazil reported a large outbreak
of rash illness, soon identified as Zika virus infection, and in July 2015, found to be associated with
Guillain-Barré syndrome.

In October 2015, Brazil reported an association between Zika virus infection and microcephaly.

Signs and symptoms

The incubation period (the time from exposure to symptoms) of Zika virus disease is estimated to be 3–
14 days.

The majority of people infected with Zika virus do not develop symptoms.

Symptoms are generally mild including fever, rash, conjunctivitis, muscle and joint pain, malaise, and
headache, and usually last for 2–7 days.

Complications of Zika virus disease

 Microcephaly and other congenital abnormalities

 pregnancy complications such as fetal loss, stillbirth, and preterm birth.

 Zika virus infection is also a trigger of Guillain-Barré syndrome, neuropathy and myelitis, particularly in
adults and older children.

Transmission

Zika virus is primarily transmitted by the bite of an infected mosquito from the Aedes genus, mainly
Aedes aegypti, in tropical and subtropical regions.

Zika virus is also transmitted from mother to fetus during pregnancy, through sexual contact,
transfusion of blood and blood products, and organ transplantation.

Diagnosis
Pcr- polymerase chain reaction test

Treatment

no treatment available

• Community Diagnosis:

o Descriptive research

o Profile general picture of comm., a direct health indicator

o Process by which the people in the conn & H team assess the comm. H problems & needs as bases for
H programs devt.

o A learning process for the comm. to identify their own H problems & needs

o A profile that deposits the H problems & potentials of the comm.

• 2 Types of Community Dx

• Comprehensive- provides the general health profile of the comm.

• Specific or problem oriented- yields a comprehensive profile of a particular H problem.

• Method of Survey: tool is Questionnaire

• Census (100%) : Most ideal, enumeratx of data conducted 6 mos.

• Sample Survey : Most practical study representative of a comm. Size matters in terms of validity

• Interview method

• Instrument- interview guide/ schedule

 Records review • Instrument: checklist

 Ocular inspection/ observation • Instrument: checklist

 Participant observation

• Finalize sampling design & methods

 Probability: Equal chances- random- ( simple, stratified, cluster)

 Non- probability: Everyone will not have equal chances

• STATISTICS - A science- collection, organization, analysis, interpretation of numerical data.
Biostatistics: refers to the application of statistical method to the life science like biology, medicine.

• Demography: Study of pop size, composition & spatial distribution as affected by births, deaths &
migration.

• Phenomenon of Variation - Tendency of a measurable character to change from 1 individual or 1

setting to another or from 1 instant of time to another within the same individual or setting

• Types of Data:

• Constant- value remains the same from person to person, time to time, place to place Ex. Minutes/
hour, speed

• Variable- Ex. Temperature Qualitative- categories are simply used to label to distinguish & group to
another, rather than a basis for saying that 1 group is greater, higher than the other. Ex. Sex, Religion,
Color

• Quantitative- numerical • Can be measured • Discrete- whole number or integral values • Continuous-
fractions, decimals, can attain any decimal

• Common Epidemiologic Studies:

• Retrospective (Past)

• Cross- Sectional (Present)

• Prospective Cohort (future)

• *Independent variable (Cause) - The one to be manipulated ( symbol is “y”)

• *Dependent (Effect) - Will always be the interest of the researcher ( symbol is “X”)

• Leptospirosis – Vector is Rat

Causative Agent: - bacteria--- Leptospira interrogans

• Sign/Symptoms: High fever, Chills, Vomiting, Red/ orange eyes, Diarrhea, Severe headache, muscle
aches, may include jaundice (yellow skin and eyes), abdominal pain

• Treatment: PET - Penicillins G, Erythromycin, Tetracycline

• Doxycycline as prophylactic drug

DENGUE
• Dengue - mosquito-borne infection

• Vector is female aedes aegypti mosquito, day biting, low flying, satagnant clear water,stripes black
white body.

• Agent is a Virus.. dengue virus 1,2,3,4

- female aedes aegypti in stagnant water

treatment is supportive therapy.

 Intravenous fluids

 A platelet transfusion

• DENGUE DIAGNOSIS:

- Tourniquet test (capillary fragility test or Rumpel Leads Test), a presumptive test which is positive in
the presence of more than 20 petechiae within an inch square, after 5 minutes of test

• DENGUE ns1 – ANTIGEN CAPTURE - CONFIRMATORY

• TOURNIQUET TEST - (BP Cuff):

• RA 9482 or “The Rabies Act of 2007”, rabies control ordinances shall be strictly implemented.

• 99 % of cases is from DOG BITE

• Saliva of infected animals is the reservoir

• *Head (NERVOUS SYSTEM)- most affected part and most fatal or dangerous site for dog bite

• EQUINE rabies vaccine is derived from HORSE

• HRIG is from human serum Rabies vaccine is an artificial active

• given on days 0, 3, 7, 14, 30, and 90,

• avoid gluteal area

• Rabies vaccine should be administered in the deltoid muscle

• In both pre-exposure and post-exposure immunization, the full 1.0 mL dose should be given 9
intramuscularly
EBOLA

• Ebola: Mapping the outbreak

From the section of WEST Africa

• Primary source = fruit bats or flying foxes , old world bats

• Other sources:

o Chimpanzees

o Gorillas

o fruit bats

o monkeys

o antelope

o porcupines

o symptomatic humans

• Ebola largest outbreak in West Africa was first reported in March 2014,

• Virus is named after the ebola river

• There are 5 strains of EBOLA virus

• EBOZ or ebola ZAIRRE strain is the most deadliest strain

• RESTV or EBOR (ebola reston) species, found in Philippines and the People's Republic of China, have
been found to infect humans but they do not cause illness or death

• ***antibody-capture enzyme-linked immunosorbent assay (ELISA)

HERBAL MEDS

• Niog Niogan (Quisqualis Indica) • Anti-helminthic every 6 months 2 hours p supper

• No to less than 4 y/o

• Tsaang Gubat (Carmona Retusa) • Diarrhea

• Ampalaya (Momordica Charantia) • DM Type 2- obesity

• Sambong as anti urolithiasis

• Akapulko for fungal parasites

Anthrax

• (Splenic fever, Siberian ulcer, Charbon, Milzbrand)

• Bacillus anthracis.

• most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, antelopes)

• B anthracis spores can remain viable in soil for many years.

• Raw or poorly cooked contaminated meat is a source of infection for zoo carnivores and omnivores;
anthrax resulting from contaminated meat consumption has been reported in pigs, dogs, cats, mink,
wild carnivores, and people

• diagnostic tests include bacterial culture, PCR tests, and fluorescent antibody stains to demonstrate
the agent in blood films or tissues

• Treatment

• Oxytetracycline given daily in divided doses also is effective.

• Ciprofloxacin,Amoxicillin, Gentamicin, ,Erythromycin Doxycycline, Streptomycin,

• Middle East respiratory syndrome coronavirus (MERS-CoV)

- CAMEL FLU or SARS of MIDDLE EAST

• a viral respiratory disease caused by a novel coronavirus (MERS‐CoV) that was first identified in Saudi
Arabia in 2012.

• 1st case - april 2012

2nd case - sept. 2012

• 1st Outbreak

- SAUDI ARABIAN PENINSULA

• MERS COV IS A CLADES "B" VIRUS

• Republic of South Korea is the largest outbreak outside of the Middle East year 2015
• camels - major reservoir host for MERS-CoV and an animal source of MERS infection in humans

• Highest Risk : IMMUNOSUPRESSION (CANCER)

• Symptoms- Mild-severe respiratory illness

Gastrointestinal symptoms

• Complications-pneumonia, kidney failure

• Signs and symptoms

A- airway problems

B- breathing difficulty

C- cough and colds

D- diarrhea

E- elevated temperature

• Treatment: No specific treatment

• No vaccine or specific treatment is currently available.

• avoid contact with camels, drinking raw camel milk or camel urine, or eating meat that has not been
properly cooked.

• Avoid contact to camel droplets

• Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the
trash.

• Avoid touching your eyes, nose and mouth with unwashed hands.

• Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.

I. ENVIRONMENTAL HEALTH

• Health- is a state of complete physical, mental and social well-being and not merely the absence of
disease (WHO)

• Public health- refers to all organized measures to prevent disease, promote health, and prolong life
among the population as a whole
• Environmental health- is the discipline that focuses on the interrelationships between people and their
environment, promotes human health and well-being, and fosters a safe and healthful environment

Ecological study

• Observational study which focuses on groups rather than individuals

Cross Sectional Studies

• A type of prevalence study in which the distribution of a disease (or other health-related outcome) and
exposure are determined at one particular time and studies more than one disease at once

Case control study

• Subjects who participate in the study are defined on the basis of the presence or absence of disease
(or other outcome of interest). Exposure is then determined retrospectively, meaning the exposure
occurred in the past, by interviewing subjects or reviewing medical and occupational records.

Cohort study

• Classifies subjects according to their exposure to a factor of interest and then observes the subjects
over time to document the occurrence of new cases.

• Demography- the study of human population

• Hippocrates- father of medicine

emphasised role of env as influence of health

• Bernardo Ramazzini

- founded field of occupational medicine

books highlighted hazardous chemicals, dusts and metals in workplace

• what type of data does environmental epi use- observational data

• most common methodology for study design- case-control and cohort

• two classes of epidemiology studies

- descriptive- depiction of occurance of disease in pops according to classification

analytic- examines casual hypotheses between exposures and health conditions

• measure of lethality of disease

CFR%= number of deaths due to disease/number of cases of disease x 100 during a time period

• John Snow- linked cholera to contaminated water

used natural experiment and spacial analysis

• Sr. Percival Pott- first to describe environmental cause of cancer

chimney sweep and scrotal cancer

• Black death – bubonic Plague- Yersinia- bacteria

transmitted by flea on rat

• lyme disease- borrelia

deer ticks spread

• rocky moutain spotted fever - ricketssia

📌SOLID WASTE MANAGEMENT

Black - Non-infectious dry waste

Green - Non-infectious wet waste (kitchen, dietary etc.)

Yellow -- Infectious and Pathological waste

Yellow with black band ---Chemical waste including those w/ heavy metals

🔥Orange--- Radioactive waste

💥Red---- Sharps and pressurized containers