KEY TO PICTURE TEST ON COMMUNITY MEDICINE 4TH OCTOBER 2022

SLIDE 1.

A. Components of Primary Health Care

 Maternal and Child Health, including Family Planning
 Immunization against major communicable diseases
 Nutrition: Promotion of food supply and proper nutrition (N)
 Education on prevailing health problems and methods of controlling
them (E)
 Prevention and control of locally endemic diseases (P)
 Environmental sanitation: Adequate supply of water and basic
sanitation (E)
 Treatment of common diseases and injuries (T)
 Provision of essential drugs (ED)
B. Pillars or Principles of Primary Health Care
 Community participation
 Intersectoral collaboration
 Appropriate technology
 Equitable distribution
 Self-reliance
C. Two declarations associated with Primary Health Care since inception
 Alma Ata Declaration in 1978
 Astana Declaration in 2018
SLIDE 2

A. Vaccine carrier
B. Cold chain equipment: Refrigerators, Cold boxes, Foam pads, Ice packs,
Vaccine carrier
C. Vaccines that can be stored at 00C to 80C in the refrigerator include: BCG,
OPV, Measles, DPT and Hepatitis B
SLIDE 3

A. Blood Pressure measurement

B. Common screening tests include
  Pap smear for cervical cancer
 Fasting blood sugar for diabetes
 Fasting blood cholesterol for heart disease
 Blood pressure measurement for hypertension
 Mammography for breast cancer
 PSA test for prostate cancer
 Fecal occult blood for colon cancer and Ocular pressure for glaucoma
 PKU test for Phenylketonuria in newborns and TSH for hypothyroid and
hyperthyroid
C. THE PRINCIPLES OF SCREENING/CRITERIA FOR SCREENING DISEASE
INCLUDE:
 The disease should be an important health problem
 The should be an effective treatment available for the disease
 Facilities for diagnosis and treatment should be available
 Natural history of the condition, including development from latent
to declared disease, should be adequately understood
 The test should be acceptable to the population
 There should be an agreed policy on who to treat
 Good evidence that early detection and treatment reduces morbidity
and mortality
 The expected benefits of early detection should exceed the risks and
costs
SLIDE 4.

A. Cross sectional study

B. Prevalence study or Snap shot study
C. Advantages of Cross sectional study include
 Fast and inexpensive
 Can target a larger sample size and No loss to follow up
 Useful for conditions that have long duration [Chronic diseases]
 Useful for health care planning and investigating trends of disease
over time
  It can be used to monitor and calculate prevalence of diseases in
people with risk factor and people free of risk factor[ such as
arthritis, blood pressure]
 It can be used to monitor changes in repeated surveys [are policy
level interventions working]
 It can be used to generate hypotheses about causes
 Useful when routine data are not available

D. Disadvantages of Cross sectional study include

 Cannot determine whether exposure preceded disease
 Cannot determine causal relationship
 Not suitable for conditions that have short duration
 Not suitable for assessing the natural history of disease
SLIDE 5.

A. Point source epidemic

B. Examples of point source epidemic (Single exposure epidemic) include:
 Bhopal gas tragedy in India
 Minamata disease in Japan
 Food poisoning
 Cholera, Measles, Chicken pox
C. Two other types of epidemic include: Continuous Common Source
epidemics (multiple or repeated exposure epidemic) and Propagated
epidemic
D. Uses of Epidemic curve include:
 It shows magnitude of the epidemic
 It indicates pattern of epidemic spread
 It indicates the period of exposure to disease
 It indicates outlier[cases that stand apart from the overall pattern of
epidemic spread
  It can be used to differentiate the type of epidemic that occurred
[common source-point and continuous or propagated epidemic]
 It can be used to indicate the causative organism involved in the
epidemic
 It can be used to estimate the exposure time and the incubation
period
 It can be used to evaluate the impact of interventions taken
E. Aims of an epidemic (Outbreak) investigations include:
 To identify the cause, populations at risk of a disease and modes of
transmission
 To prevent further disease transmission and similar occurrences in
future
 To Provide information that can be used to control the outbreak
 To evaluate the effectiveness of infection control
 To learn more about a disease
 To share knowledge and findings with other health professionals by
documenting the outbreak investigations in reports or journals
 To implement prevent measures
SLIDE 6

A. WHO
B. 1948
C. 7th April
D. Health for all
E. Functions of WHO include:
 Disease surveillance and monitoring
 Health Education
 Making Health Policies for adoption by Member states
 Regulations of health services provided by Member states
 Funding health projects in developing countries
 Linking developing and developed countries in matters of health
 Health promotion
SLIDE 7

A. Internal Displaced Persons

B. Causes of IDP: Political violence, Religious violence, Communal clashes,
Boko haram, Natural disasters, Riots, Pre and Post-Election violence
C. Physical hazards: Heat stroke, Heat exhaustion
Biological hazards: Insect bite, Diarrhoeal diseases, Pneumonia
Social hazards: Sexual abuse, Drug abuse, Child labour
Psychological hazards: Depression, Anxiety, PTSD
D. NEMA, RED CROSS etc
SLIDE 8

A. Monkey Pox Rash

B. On 23th July, 2022
C. Means of transmission:
 Close contact with an animal or person infected with the virus
 Direct contact with an infected animal’s blood, bodily fluids or sores
 Contact with contaminated materials like clothing, bedding, and
other linens used by a person who is infected
 Contact with sores, respiratory droplets or oral fluids of an infected
person via cuddling, kissing or sex
D. Preventive measures:
 Avoid contact with infected animals
 Avoid contact with infected persons
 Avoid contact with bedding and other materials contaminated with
the virus
 Wash your hands frequently with soap and water
 Clean and disinfect frequently touched surfaces
 Practice safe sex, including the use of condoms
 Use personal protective equipment when caring for people infected
with the virus
E. Incubation period: 5-21 days
SLIDE 9

A. An elderly couple
B. 65 years and above
C. 1st October each year
D. Arthritis, Diabetes, Dementia, Heart diseases, Cancer etc.
E. Physical exercise, Health eating habits, Medical check up
SLIDE 10

A. Street Children
B. Causes: Poverty, Political unrest, Domestic violence, Armed conflict, Desire
for independence, Deaths of parents or caretaker, Disasters, Sexual abuse,
Physical abuse, Substance abuse, Mental health problems
C. Problems faced by street children include: Heat stroke, Heat exhaustion,
Malaria, Pneumonia, Depression, Anxiety, PSTD, Exploitation, Neglect, Drug
abuse, Child labour, Sexual abuse
D. Solution: Orphanages, Juvenile homes, Correctional institutions
SLIDE 11

A. A girl drinking water

B. (a) Water borne diseases e.g Cholera, Typhoid, Poliomyelitis
(b) Water based diseases e.g Schistosomiasis, Guninea worm
(c) Water washed disease e.g Scabies, Conjunctivitis, Trachoma
(d) Water related diseases e.g Malaria, Filariasis, Yellow fever
(e) Water chemical diseases e.g endemic goiter, fluorosis
SLIDE 12

A. Road construction workers

B. Physical hazards: Heat stroke, Heat exhaustion
Biological hazards: Insect bite, Diarrhoeal diseases, Pneumonia
Chemical hazards: Dusts (organic and inorganic), Diesel exhaust fumes,
Gases (CO, HCN, Methane, Nitrogen)
Psychological hazards: Depression, Anxiety, PTSD
 C. Hierarchy of controls used in the prevention or control of occupational
hazards include: Elimination, Substitution, Engineering measures,
Administrative controls, Personal Protective Equipment[PPE]
SLIDE 13

A. Open dumping of refuse

B. Sanitary methods of refuse disposal include: Sanitary landfill, Incineration,
Composting, Sea berging
C. Malaria, Cholera, Diarrhoeal diseases, Tyhoid, Tetanus
D. 5th June
SLIDE 14

A. John Snow
B. James Lind
C. William Farr
D. John Graunt
E. Olikoye Ransome Kuti
SLIDE 15

A. False
B. True
C. True
D. True
E. True
SLIDE 16

A. Abattoir
B. Physical hazards: Heat stroke, Heat exhaustion
Biological hazards: Insect bite, Diarrhoeal diseases, Pneumonia
Social hazards: Substance abuse, Drug abuse,
Psychological hazards: Depression, Anxiety, PTSD
Musculosketetal hazards:
Chemical hazards
C. Zoonoses occupationally acquired by butchers: Anthrax, Brucellosis,
Tetanus, Leptospirosis, Newcastle disease, Rabies
 D. Recommendations for occupational safety of butchers: Use of PPE,
legislation, Health Education, Regular washing of hands with soap and
water, proper disposal of animal waste, Environmental sanitation

SLIDE 17

A. Normal Distribution Curve

B. Mean and Standard deviation
C. Properties or Characteristics of a Normal (Gaussian) Distribution include:
 Bell shaped curve
 Symmetric around the mean
 Unimodal
 The mean, median and mode are equal and located at the centre of a
normal distribution
 The shape of the curve depends on the mean and standard deviation
 The area under the curve is equal to 1 [100%]
 The tails are asymptotic I.e. they approach the axis but never touch it
 Insensitive to outliers
 50% of the values lie above [Right] the mean and 50% of the value
lies below [left] the mean
 About 68% of the area under the curve falls within 1 standard
deviation [SD] of the mean
 About 95% of the area under the curve falls within 2 SD of the mean
 About 99.7% of the area under the curve falls within 3 SD of the
mean
D. 95%
SLIDE 18

A. Focus Group Discussion

B. Qualitative methods that can be used to obtain information from a
community for healthcare planning include: Focus group, Observation,
Interviews, Newspaper
 C. Qualitative data can be presented using the following: Bar charts, Pie
Charts, Pictogram, Spot map
D. Quantitative data can be presented using: Histogram, Box plot, Scatter
diagram, Frequency polygon, Frequency curve, line chart, Cumulative
frequency diagram
SLIDE 19

A. Obesity
B. BMI OF 25 TO LESS THAN 30-------- OVERWEIGHT
BMI OF 30 TO LESS THAN 35 ------- CLASS 1 OBESITY
BMI OF 35 TO LESS THAN 40---------CLASS 2 OBESITY
BMI OF 40 OR ABOVE ------------------CLASS 3 OBESITY
C. Causes of Obesity: Physical inactivity, Consumption of high dense energy
food, Genetics, Frequency of eating, Medications-oral contraceptives,
Stress, Anti-depressant, Pregnancy and Hypothyroidism
D. Type 2 DM, Hypertension, Stroke, Heart attack, Breast Cancer, Colon
Cancer, Sleep Apnea, Hypercholesterolemia
SLIDE 20

A. Substance abuse
B. Causes of Substance abuse: Depression, Unemployment, loneliness, Peer
pressure, Neglect
C. Health Education, Policies, Rehabilitation, Legislation
D. 26th June-International Day against Drug Abuse and Illicit Trafficking

SLIDE 21

A. A teacher with school children

B. Components of school health services: Health education, Immunization,
Nutritional services, Maintenance of personal hygiene, physical and
recreational activities, care of the handicapped children
C. Objectives of school health services:
 To prevent diseases in children
 To promote immunization
  To promote Nutrition
 To promote early diagnosis, treatment and follow up of disease
among children
D. Major health problems of school children:
 Malnutrition
 Infectious diseases
 Intestinal parasites
 Dental caries
 Diseases of the skin, eye and ear
SLIDE 22

A. Combined oral contraceptives

B. Estrogen and Progestogen
C. Benefits: Child spacing, Reduces the risk of breast disorders, Reduces iron
deficiency anaemia, Reduces ectopic pregnancy, reduces the risk of ovarian
and endometrial cancers
D. Contraindications:-DM, Untreated Hypertension, Breast cancer, deep vein
thrombosis, stroke, Congestive heart disease
SLIDE 23

A. Woman cooking with firewood

B. Physical hazards: Heat stroke, Heat exhaustion
Biological hazards: Insect bite, Pneumonia
Chemical hazards: Dusts (organic and inorganic), Gases (CO, HCN, Methane,
Nitrogen)
Psychological hazards: Depression, Anxiety,
C. Greenhouse gases: Water vapour, Carbon dioxide, Methane, Nitrous oxide,
Ozone, Chlorofluorocarbons
D. Ways to reduce greenhouse effect: Plant a tree, Legislation on air pollution,
Vehicles use unleaded petrol, Environmental campaign
SLIDE 24

A. Leopard skin on the anterior lower leg

 B. Onchocerca volvulus, transmitted to humans by the bite of an infected
blackfly (simulium spp)
C. Fast flowing rivers and stream
D. Blindness, Onchonodules, Onchodermatitis, Onchoadenitis
SLIDE 25

A. Eggs of Ancylostoma duodenale

B. Complications associated with Hookworm: Dermatitis, Itching, Pneumonia,
Iron deficiency anaemia, abdominal pain, epigastric pain, diarrhea, vomiting
C. Preventive measures: Sanitary disposal of human faeces, wearing of shoes
and gloves, treating infected persons, Health education
D. Soil transmitted helminthes include; Hookworm, Ascaris, Trichuris Trichuria
SLIDE 26

A. People swimming in the river

B. Schistosomiasis
C. Clinical presentation of Schistosomiasis: Dysuria, Frequency of micturition,
lower abdominal pain, urinary stones, painless haematuria,
hydronephrosis, bladder cancer (complication)
D. Preventive measures: Proper disposal of human faeces, avoid swimming or
bathing in infected water, treatment of infected population, health
education, eradication of snails as well as their eggs via molluscicides
SLIDE 27

A. Pulmonary Function Test

B. Spirometry
C. Lung capacities and Volumes measure using this technique include: Forced
vital capacity, Total lung capacity, Forced expiratory volume, Inspiratory
vital capacity
D. Indications for the use of spirometry include: To diagnose or manage
asthma, To diagnose chronic obstructive pulmonary disease, To diagnose
restrictive lung disease (such as interstitial pulmonary fibrosis), To diagnose
emphysema and Cystic fibrosis, To conduct pre-operative risk assessment
 before anaesthesia or cardiothoracic surgery and To diagnose vocal cord
dysfunction
SLIDE 28

A. Genexpert machine
B. For rapid TB diagnosis and to identify resistance to rifampicin
C. Resistance to Isoniazid and Rifampicin
D. 24th March
SLIDE 29

A. Snellen’s chart
B. Measles
C. Vitamin A deficiency
D. Causes of vision impairment: Cataract, Corneal opacity, Diabetic
retinopathy, glaucoma, age related macular degeneration, uncorrected
refractive errors (myopia, hyperopic)
E. 14th October
SLIDE 30

A. Components or Elements of Reproductive Health (RH)

 Family Planning
 Safe Motherhood
 Child Health: Survival strategies, Growth and Development
 Adolescent Reproductive Health
 Female Genital Mutilation, Gender inequality & Gender based
violence [Elimination of harmful practices]
 Health Education: on human sexuality, RH
 Problems of Elderly women [Menopause and Andropause]
 Malignancies of the Reproductive Tract [Detection and Mgt]
 Prevention and Management of complications of unsafe abortion
 Prevention and Management of STIs, HIV/AIDS, & RTIs
 Prevention and Treatment of Infertility
 Fertility Regulation and Men’s participation in RH/Family planning
B. Reproductive Rights of women include:
  Right to a responsible, safe and satisfied sex life
 Right to reproduce and freedom to decide when to have children
 Right to decide whether to have children and when to have them
 Right to get access to quality healthcare services during pregnancy
and childbirth
 Right to be informed about advantages, possible risks and side
effects of contraceptives
 Right to equality and to be free from all forms of discrimination
 Right to safe pregnancy and childbirth
 Right to be free from sexual violence and assault
C. Indicators for monitoring Reproductive Health include:
 Antenatal care coverage
 Adolescent birth rate
 Contraceptive prevalence rate: % of women of reproductive age [15-
49] who are using [ or whose partner is using] a contraceptive
method at a particular point in time
 Unmet need for family planning
 Maternal mortality ratio
 Perinatal mortality rate
 Percentage of births attended by skilled health personnel[excluding
trained and untrained traditional birth attendants]
 Availability of Basic and Comprehensive Essential Obstetric Care
D. 8th March