As a health officer, you have identified blindness among the elderly in your state as a cause of falls and resultant inability to perform activities of daily living. You try to prevent this by improving access to which of the following?
Answer(s): C
There is a markedly higher frequency of impaired vision of the elderly in nursing homes than in the community. While it is not frequently recorded as a reason for nursing home admission, people with impaired vision experience any other limitations. Cataract is the leading cause of blindness in both communities. Maximizing visual acuity by appropriate refraction obviously improves mobility and ability to function but is not effective if the patient has cataracts.
You participate in the global effort to eradicate poliomyelitis. A poliomyelitis outbreak has been identified in a community in Africa. You advise your outbreak investigation team that they must focus on transmission from which one of the following sources?
Answer(s): D
The poliovirus is excreted in stools and pharyngeal secretions. Transmission occurs mainly by the fecal- oral route, particularly where sanitation and personal hygiene are poor, as in developing countries. The WHO, with the assistance of Rotary International, is progressing toward global eradication. There is no known reservoir for poliovirus except humans. By 2000, the Americas were polio free.
A 20-year-old student asks to have his vaccinations updated. You recommend that he be vaccinated for typhoid fever under which of the following circumstances?
Vaccination against typhoid fever (caused by Salmonella typhi) is less effective than antibiotic treatment, with only 6575% effectiveness. Transmission is via fecal-oral route, with humans as the reservoir. Most cases (62%) are contracted as a result of overseas travel to certain areas of the world where the incidence remains high. It is in such endemic areas that vaccine is still advised. There has been no indication that immunization after earthquakes or other cataclysmic disasters is either necessary or effective.
A 50-year-old slaughterhouse worker complains of intermittent episodes of fever, malaise, weakness, and weight loss over the past several months. Several of his coworkers have experienced flu-like symptoms since last winter.Which of the following statements about his illness is correct?
Human illnesses caused by the various species of Brucella organisms tend to be quite similar. All tend to be chronic, relapsing infections. Reinfection rarely occurs in recovered patients, with immunity to subsequent Brucella infections in 90% of people. Infection is rarely airborne but can be encountered in laboratory and abattoir (slaughterhouse) workers. Personto- person spread is rare. The primary reservoir is in animals. The mode of infection is principally from direct contact with infected animals or by the ingestion of infected unpasteurized milk.
You are asked by a company predominantly employing women to design an educational program to reduce morbidity and mortality due to cardiovascular disease. Which of the following statements should you include in this program to describe women's risk of cardiovascular disease?
Answer(s): E
Researchers have reported significant disparities between men and women in heart disease. An excess risk is documented in Western society through studies such as the Framingham study and studies in Finland. There appears to be relative protection from estrogens among younger women. However, the Women's Health Initiative demonstrated an increase in risk for heart disease in women using exogenous postmenopausal HRT. Cardiac disease is more likely to present as angina in women. Older women carry more cholesterol as high-density lipoprotein (HDL) than low-density lipoprotein (LDL) compared to younger women. The gender difference in vascular disease is less apparent in the aorta, cerebral, and peripheral arteries than in the coronary arteries. In Eastern Europe, cardiovascular disease is increasing rapidly in women, while in the United States, the agespecific increase in cardiovascular disease is greater among women than men.
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