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Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. Three categories of prevention: primary, secondary and tertiary.
Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur.
Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.
Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.
In this case, the patient already has anemic syndrome with suspected chronic intoxication. Now, the aim is to prevent further exposure by changing his job. Primary prevention would have involved not working with the Xylene solvent in the first place.
All other options listed are geared towards treating the condition, however, the question is concerned about preventing further anemic complications which is to completely prevent exposure to the Xylene solvent.
In this case, A Triage system is to be followed. Triage is a procedure followed in a medical emergency. It involves the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors
These individuals should be allocated into categories such as: Minor, Deceased, Immediate and delayed. Those in the immediate category require instant medical assistance. Lastly, all 50 victims should be evacuated from the site of explosion.
Agglomeration plants are factories that work mainly with Iron ore materials together with other products, refining them into finished goods. This patient has an accumulation of iron dust in his system as a result of long term exposure over the years. Pneumoconiosis is a restrictive lung disease caused by the inhalation of dust leading to fibrosis. Depending on the type of dust inhaled, different types exist. They include; Siderosis (iron ore), byssinosis (cotton), anthracosis (coal), Asbestosis (asbestos), silicosis (silica dust).
Eczema (dermatitis ) is a chronic inflammatory disease of the skin characterized by the presence of red, itchy, dry scaly rashes. Occupational or professional eczema (dermatitis) is gotten from contact with certain chemicals in the course of working (in this case due to contact with the chemicals in paint ).
Allergic dermatitis is a form of contact dermatitis that results from immune reactions towards certain irritants. This term can be used if it’s unrelated to the patient’s work.
Delta-aminolevulinic acid dehydratase is an enzyme necessary for the synthesis of heme. In lead poisoning, this enzyme is inhibited leading to anemia and an increased delta aminolevulinic acid content in urine. N/B a high reticulocyte number means an increase in RBC production ( new cells) and is observed in cases such as bleeding, high altitude or anemia. The above patient presents with signs of asthenic vegetative syndrome coupled with the above stated reasons confirming a case of lead poisoning.
Presence of dark-yellow pigmentation of the tooth enamel, diffuse osteoporosis of bone apparatus, ossification of ligaments and joints are specific symptoms that indicate Fluorosis. This is a condition that occurs as a result of excessive intake of fluorine.
The right to extend a medical certificate (in this case a sick list) of invalidity alongside with the medical treatment by the doctor is granted by:
• Chief medical officer (assistant of the chief medical officer on expertise of ability for work);
• Manager of department;
• Medical-consulting commission also known as medical expertise committee
The medical-consulting commission (MCC) is formed in case the doctors staff is above 15 doctors.
Generally, persons at high risk for developing TB disease fall into two categories:
Persons who have been recently infected with TB bacteria
Persons with medical conditions that weaken the immune system
Persons in the second group include individuals with the following diseases; HIV infection (the virus that causes AIDS), Substance abuse, Silicosis, Diabetes mellitus, Severe kidney disease, Low body weight, Organ transplants, Head and neck cancer, Medical treatments such as corticosteroids or organ transplant, Specialized treatment for rheumatoid arthritis or Crohn’s disease
Pneumoconiosis is a restrictive lung disease caused by the inhalation of dust leading to fibrosis. Depending on the type of dust inhaled, different types exist. They include; Siderosis (iron ore), byssinosis (cotton), anthracosis (coal), Asbestosis (asbestos), silicosis (silica dust).the maximum permissible concentration of coal is 10 mg/m3, this patient is in an area where the coal content is 450 mg/m3. Accumulation of coal dust in the lungs will lead to anthracosis.
The extensive statistical indicator is used to determine a structure of a disease ( in this case, how many percent of the total diseased fall under cardiovascular cases) i.e., it shows, what part from the general number of all diseases is made with this or that disease which enters into total.
The intensive parameter characterizes frequency or distribution. It shows how frequently the given phenomenon occurs in the given environment.
These factory workers are obesed, with BMI (quetelet index) - 26-30. In relation to diet, carbohydrate and fatty food groups play a large role in obesity; therefore in terms of diet food materials that contain large contents of these groups should be controlled. This includes bakery products such as flour, wheat etc.
Coliphages are microbial indicators specified in the Ground Water Rule (GWR) that can be used to monitor for potential fecal contamination of drinking water. Number of bacteria of group of an intestinal rod (coli-index) in 1000 ml of water - no more than 3.Common microbial number in one ml of water - no more than 100.
The Spearman's Rank Correlation Coefficient is used to discover the strength of a link between two sets of data. This example looks at the strength of the link between the effect of air emissions from a metallurgical plant on obstructive bronchitis morbidity.
Correlation is a bivariate analysis that measures the strength of association between two variables and the direction of the relationship. In terms of the strength of relationship, the value of the correlation coefficient varies between +1 and -1. A value of ± 1 indicates a perfect degree of association between the two variables. As the correlation coefficient value goes towards 0, the relationship between the two variables will be weaker. A correlation coefficient of zero indicates that no relationship exists between the variables. The direction of the relationship is indicated by the sign of the coefficient; a + sign indicates a positive/direct relationship and a – sign indicates a negative relationship.
An inverse correlation, also known as negative correlation, is a contrary relationship between two variables such that when the value of one variable is high then the value of the other variable is probably low.
The value of the correlation coefficient ‘r’ can range from 0.0, indicating no relationship between the two variables, to positive or negative 1.0, indicating a strong linear relationship between the two variables.
Value of r
No linear relationship between the two variables
Strong positive linear relationship; as X increases in value, Y increases in value also; or as X decreases in value, Y decreases also.
Strong inverse linear relationship; as X increases in value, Y decreases in value; or as X decreases in value, Y increases in value.
Therefore, a value of +0.79 is very close to +1.0 and that will give us a strong positive/direct relationship.
0-7% – the seed may not need to be treated with a registered seed treatment.
8-14% – the seed should be treated with a registered seed treatment.
> 14% – the seed should not be planted.
Many household appliances produce electromagnetic fields for example, television, microwave oven, radios etc. The effects of electromagnetic waves on health are vast. Immune, neurological, endocrine systems are majorly affected.
Perinatal mortality refers to the number of stillbirths and deaths in the first week of life (early neonatal mortality).
The infant mortality rate is defined as the number of deaths of children under one year of age.
The natural lighting norms for different premises
The type of premises
The daylight factor (DF)
The lighting coefficient (LC)
The angle of incidence (a)
The aperture angle (g)
The depth coefficient of premises
not less than
1:4 – 1:5
1:5 – 1:6
1: – 1:8
1:2 – 1:3
Vitamin preparations such as vitamin D helps against radiation; Vitamin E acts as an antioxidant which destroys free radicals (reactive oxygen species).
The extensive statistical indicator is used to determine a structure of a disease ( in this case, how many percent ( the proportion) of the total diseased fall under cardiovascular cases) i.e., it shows, what part from the general number of all diseases is made with this or that disease which enters into total.
The intensive parameter characterizes frequency or distribution. It shows how frequently the given phenomenon occurs in the given environment. Examples of Intensive parameters include morbidity rate, mortality rate, lethality rate etc.
From anamnesis, it is stated that the patient has worked for a very long time in an environment in which the noise level exceeds the maximum allowable concentration. The complaints presented on preventive examination are as a result of prolonged exposure to noise over a long period of time.
Asthenovegetative syndrome: weakness, severe fatigue, poor performance and mood, anxiety, depressive mood, hypochondria.
Neurasthenia: a condition that is characterized especially by physical and mental exhaustion usually with accompanying symptoms (such as headache and irritability), is of unknown cause but is often associated with depression or emotional stress, and is sometimes considered similar to or identical with chronic fatigue syndrome.
Boric acid Medical uses include;
antiseptic in burns, cuts and dressing.
Vaginal douche in bacterial vaginosis and candidiasis.
Prevention of athlete’s foot, otitis externa.
Forensic pathologists are essentially required to estimate the time since death (TSD) to assist in death investigation. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, livor mortis, and algor mortis.
Rigor mortis is the post-mortem stiffening of muscles, caused by the depletion of adenosine triphosphate (ATP) from the muscles, which is necessary for the breakdown of actin-myosin filaments in the muscle fibers.
Fully developed rigor mortis is an easily identifiable and reliable indicator that death has occurred. The time of onset is variable but it is usually considered to appear between 1 and 6 hours after death. Smaller muscles over the face – around the eyes, around the mouth (masticatory muscles), etc. are the muscles where rigor mortis first appears, followed by rigor mortis of the muscles in the hands and upper limbs and finally appears in the large muscles of the lower limbs. Rigor mortis appears approximately 2 hours after death in the muscles of the face, progresses to the limbs over the next few hours, completing between 6 to 8 hours after death.
From anamnesis, this patient has been exposed to Ethylated gasoline for the nature of his Job. Tetraethyl Lead is a lead compound found in Ethylated gasoline. On chronic exposure, individuals present with memory loss, neurological problems, insomnia, psychosis, tremors etc.
Patients with organophosphate poisoning usually present with Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms.
Toxicodermatosis is a disease of the skin caused by a poison or by an allergen. The causative agents may be such chemical substances as antibiotics, sulfanilamides, and bromine, iodine, arsenic, and mercury compounds, or such food products as berries, cheese, or fish. As described in this scenario, the rash appeared after visiting a restaurant. Toxicoderma can also occur as a metabolic disorder or an occupational disease.
The causative agent enters the body through the respiratory organs or the digestive tract, during injections, or by direct contact with the skin. The primary manifestation of toxicoderma is a rash, which is generally symmetrical; it can take the form of inflamed or hemorrhagic maculae, papule, or vesicles (blisters). In severe cases, widespread areas of the skin are affected (erythroderma) and the patient manifests fever, cardiovascular disorders, or symptoms of anaphylactic shock.
With the removal of the allergen the symptoms of toxicoderma rapidly disappear, although relapses (usually severe) may occur with subsequent repeated exposure to the causative agent. Treatment consists in avoiding contact with the suspected allergen or toxic agent, as well as in the use of desensitizing agents and of expectant treatment.
Atopic dermatitis is a chronic condition that requires symptom management. It’s characterized by an itchy, red rash that usually appears at joints in your body, such as knees or elbows, and even around the neck. This condition occurs in flare-ups or bouts, meaning that it gets worse and improves in irregular cycles.
Many doctors use the terms “atopic dermatitis” and “eczema” interchangeably. They are both generic terms for “inflammation of the skin.” Eczema usually starts in early infancy, but also affects a substantial number of adults. It is commonly associated with elevated levels of immunoglobulin E (IgE) and a series of allergic diseases—including food allergy, asthma, and allergic rhinitis.
Contact Dermatitis occurs when your skin has a reaction to something it’s come in contact with. This can include bleach, soap, poison ivy, certain metals, or other irritants. The rash is typically red and may itch or burn.
Hemosorbtion: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, or other adsorbents (e.g., various resins, albumin-conjugated agarose).
Hemodialysis: A medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, also referred to as an "artificial kidney."
Hemodialysis is used to treat both acute (temporary) and chronic (permanent) kidney failure.
Plasmapheresis (PP) is the removal of whole blood from the patient, its separation by machine into component parts, and then the return of certain of those components to the patient. Indications include Gulliane-barre syndrome, good pasture syndrome, chronic demyelinating disorders , Thrombotic thrombocytopenic purpura etc.
Convection refers to the transfers of heat via the movement of fluids and gases. Note that relative humidity also has a direct effect on convective heat transfer. Higher humidity will raise the amount for convective heat transfer coefficient and subsequently the rate of heat transfer increases.
Conduction involves the direct transfer of heat from one molecule to another.
Radiation. Radiation involves the transfer of heat through the air or a vacuum. Heat from the sun is carried by radiation. The human body radiates heat in all directions. The ability to dissipate body heat by radiation depends on the temperature of the environment. Environmental temperature must be less than that of the body for heat loss to occur.
Employees are entitled to emergency time off (sick leave) to care for a dependant.
A dependant includes:
someone else who depends on you for their care.
Your employer may ask for evidence that you are entitled to parental leave. A birth certificate will usually do the trick and you’re entitled to return to the same job after taking parental leave.
Due to the presence of bladder worms (parasitic worms) in the meat, the meat should not be consumed. It should be technically (properly) disposed of.
Forensic pathologists are essentially required to estimate the time since death (TSD) to assist in death investigation. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, algor mortis and livor mortis.
Rigor mortis is the post-mortem stiffening of muscles, caused by the depletion of adenosine triphosphate (ATP) from the muscles.
Hypothermia is a severe condition in which the body temperature drops to an abnormally low level. It occurs when the body is unable to produce enough heat to counter the heat that it is losing. Under healthy conditions, the body maintains a relatively stable temperature of around 98.6˚F or 37˚C.
The following techniques can help treat hypothermia:
Passive external rewarming: This uses the individual’s heat-generating ability. It involves removing their cold, wet clothing, ideally replacing it with adequately insulated, dry clothing, and moving them to a warm environment.
Active external rewarming: This involves applying warming devices, such as hot-water bottles or warmed forced air, externally to truncal areas of the body. For example, the individual could hold a hot-water bottle under each arm.
Active core rewarming: This uses warmed, intravenous fluids to irrigate body cavities, including the thorax, peritoneum, stomach, and bladder. Other options include getting the individual to inhale warm, humidified air, or applying extracorporeal rewarming by using a heart-lung machine.
Do not give a person alcohol if they have signs of hypothermia, and avoid giving any drinks to an unconscious person.
Considering the critical condition of this patient, active core warming by using warmed intravenous fluids which gets into the system immediately and will bring the most desired result at the shortest time possible is by far the best treatment recommendation.
The term coniosis refers to a group of diseases ( conditions) caused by the inhalation of dust ( of different forms). For Example Anthracosis ( pneumoconiosis) also called coal miners lung occurs as a result of inhalation of coal or carbon. Silicosis ( grinder’s disease) - inhalation of crystalline silica dust. Siderosis- Iron inhalation. Berylliosis- Beryllium, Byssinosis - cotton etc. These mineral dusts when inhaled over time accumulate and deposit in the lung tissues forming infiltrates and fibrotic changes.
This patient presents with a condition known as Pneumosiderosis ( welder’s lung) a chronic condition caused by long term inhalation of iron dust; this condition is usually seen in welders.
A regressive type of population is one in which the percentage of older individuals is higher than that of the early aged (younger). In the Progressive type, the younger ones are more in the population. Notice that in this analysis, the percentage of persons aged 50 and above is greater than the percentage of the individuals aged 0-14.
Prasad Syndrome is a condition characterised by geophagia ( the habit of eating soil, clay etc), hypogonadism, growth retardation and zinc deficiency. Bitot spots are keratin fragments found/deposited on the conjunctiva; they are usually found due to Vitamin A deficiency. Zinc deficiency may also be involved with the pathogenesis of secondary vitamin A deficiency. Inadequate zinc can depress the hepatic synthesis of retinol-binding protein (RBP), which is required for mobilization of retinol from the liver. In addition, zinc may play a role in the conversion of beta-carotene to retinol via the enzyme 15-15 dioxygenase.
In iron deficiency, iron deficiency anemia will be observed (brittle nails, soreness in the tongue, weakness, pale skin etc). Copper deficiency is seen in Menkes disease.
Occupational/ professional Rehabilitation involves specialized healthcare dedicated to improving, maintaining and restoring the physical strength, cognition and mobility with maximum results. It helps an individual to recover from addictions, injuries and disorders.
Social rehabilitation — a set of activities aimed at rehabilitation and improving the functional capability of people and their inclusion in the society.
Psychological rehabilitation focuses on restoring one’s mental status.
Writer’s cramp is a specific form of focal dystonia that affects the fingers, hand, or forearm. Focal dystonia of the hands is a neurological movement disorder.
Cortical agraphia is a neurological disorder in which an individual loses the ability to communicate either through writing or he/she forgets how to spell.
Facial (nerve) palsy is a neurological condition in which function of the facial nerve (cranial nerve VII) is partially or completely lost. Key findings include; Sensory disturbances : Painful sensation around or behind the ear, Impairment of taste in the anterior tongue , Hyperacusis; dropping of the mouth, dry mouth, Bell's phenomenon: a physiologic, reflexive movement of the eye (upward and outward) that occurs when the eyelid is actively closed, Lagophthalmos: The patient cannot fully close the eyes (due to paralysis of the orbicularis oculi muscle). Decreased lacrimation.
In neuropathy of the trigeminal nerve ( trigeminal neuralgia), the individual will feel excruciating pain at the slightest pressure applied on the face e.g. while brushing the teeth, yawning etc.
In neuropathy of the oculomotor nerve, the individual will experience diplopia and strabismus.
According to levels of specialization, types of medical care include: Emergency, Primary, Secondary, Tertiary, palliative, medical rehabilitation and dentistry.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. One major aspect of primary health care is preventive medicine - these include vaccination, teaching on methods for good living etc.
Secondary medical care: When your primary care provider refers you to a specialist, you are then in secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise eg cardiologist, endocrinologist etc
Tertiary Medical Care: Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise.
In Somatoform Autonomic dysfunction, the symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory, and urogenital systems. Clinical and instrumental examination revealed no organic alterations in any system therefore indicating a somatoform autonomic dysfunction.
Organic brain syndrome is defined as a state of diffuse cerebral dysfunction associated with a disturbance in consciousness, cognition, mood, affect, and behavior in the absence of drugs, infection, or a metabolic cause
Notice that the carboxyhemoglobin level is 55% (very high) - this indicates poisoning by carbon monoxide; the level of ethanol found in his blood is too little to cause poisoning or be the major reason behind his death.
Cohort study refers to a cross section of interval through time; Whereas the cohort study is concerned with frequency of disease in exposed and non-exposed individuals, the case-control study is concerned with the frequency and amount of exposure in subjects with a specific disease (cases) and people without the disease (controls).
In cohort study - both groups will have Ischemic Heart Disease, then you consider a risk factor that might have led to the Ischemic Heart Disease. In this question, you are studying overweight and normal weight in those with Ischemic Heart Disease and the study shows that overweight men developed ischemic heart disease more often.
In case control - you will compare those with Ischemic heart disease (Cases) and those without Ischemic Heart Disease (Control).
Methemoglobinemia is an unusual and potentially fatal condition in which hemoglobin is oxidized to methemoglobin and loses its ability to bind and transport oxygen. The most common cause of methemoglobinemia is the ingestion or inhalation of oxidizing agents such as nitrates or nitrites. Signs include dizziness, headaches, cyanosis, dyspnea , tachycardia etc. Treatment of this condition involves the use of methylene blue and vitamin C; other substances that can cause this state (methemoglobinemia) include dapsone and benzocaine.
Lead poisoning is characterised by lead lines on the gingiva (burton lines), encephalopathy, erythrocyte basophilic stippling, abdominal colic, sideroblastic anemia and wrist or foot drop. Dimercaprol ( chelating agent) is used in treatment.
Telemedicine is the exchange of medical information from one location to another using electronic communication, which improves patient health status. It involves remote diagnosis and treatment of patients by means of telecommunications technology.
Aminolevulinic acid and coproporphyrin are amino acids necessary for the synthesis of Heme. The excretion of these constituents in urine indicates either an inherited or secondary Porphyria. One of the most frequent causes of the secondary form of this disease is Lead poisoning. An increased degradation of porphyrin will lead to a decrease in Hemoglobin synthesis. Also note that the patient experiences Asthenovegetative syndrome ( physical and nervous fatigue), pain in the hepatic area and stomach; these are classical signs of Lead poisoning.
Carbon monoxide poisoning will be characterised by headache, lethargy, dizziness, loss of consciousness etc.
This risk of getting Trichinellosis is very high if this meat is consumed; this piece should be technically disposed.
Dispersion is the separation or distribution of a given substance over a particular area. Dust is easily carried by and spread around by air.
Solubility refers to the ability of a given substance (the solute) to dissolve in another substance (the solvent).
Ionization refers to any process by which electrically neutral atoms or molecules are converted to electrically charged atoms or molecules (ions).
Lead inhibits ferrochelatase and ALA dehydratase which leads to a decrease in Heme synthesis and increased RBC protoporphyrin. Lead also inhibits rRNA degradation which results in RBC’s retaining aggregates of rRNA (seen as basophilic stippling). Symptoms of lead poisoning include; Lead lines on gingiva (Burton lines) and on metaphysis of bones ( on x-ray), Encephalopathy and erythrocyte basophilic stippling, Abdominal colic and sideroblastic anemia, wrist and foot Drop. A chelating agent such as Dimercaprol is used as a first line of treatment.
The signs and symptoms of riboflavin (vitamin B2) deficiency typically include sore throat with redness and swelling of the mouth and throat mucosa, cheilosis and angular stomatitis (cracking of the lips and corners of the mouth), glossitis, seborrheic dermatitis or pseudo-syphilis, and a decreased red blood cell count with normal cell size and hemoglobin content (normochromic normocytic anemia).
Thiamine (Vit B1) deficiency is known as Beri-beri, deficiency of ascorbic acid will lead to scurvy, easy bruising and bleeding are seen in such patients.
Calciferol (Vit D): Rickets in Children; Osteomalacia in Adults
Ascorbic Acid (Vit C): Scurvy - bleeding gums, easy bruising
Retinol (Vit A): Night blindness
From anamnesis, we observe that this patient works in a very hot/steaming environment; the signs shown by this patient i.e. a red dry skin and a temperature of 39℃ indicates the effect of heat on the patient.
Heat stroke is a form of hyperthermia in which the body temperature is elevated dramatically. The cause of heat stroke is an elevation in body temperature, often accompanied by dehydration.
The most common symptoms of CO (carbon monoxide) poisoning are headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion on the background of inhalation of fumes from cars, generators etc.
Acute food poisoning will often present with vomiting, nausea and diarrhea.
Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. Sometimes called celiac sprue or gluten-sensitive enteropathy. When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.
Celiac disease can develop at any age after people start eating foods or medicines that contain gluten.
Oats contain avenin, which is a protein similar to gluten. Research has shown that most people with coeliac disease can tolerate gluten free oats with no problems. The issue is that sometimes oats are produced in the same place as wheat, barley and rye, and then become contaminated with these other grains.
Primary prevention of a disease is aimed at preventing the onset (start of a disease) i.e., the disease is yet to occur so we aim at preventing it from happening via optimization of lifestyle and living conditions etc.
Secondary prevention is aimed at preventing the progress of a disease (early diagnosis and treatment) i.e., the patient already has the disease, so we are more concerned on stopping it from progressing and preventing its complications.
Frostbite is an injury of the skin and underlying tissues that occur due to exposure to cold ( low temperature). There are 4 degrees of frostbite:
I Degree: lasts for about 5-7 days; after warming, paleness changes to hyperemia (redness). Edema of tissues progresses for about 2 days and then it decreases to 6-7 days when shelling (peeling) of epidermis appears. Tactile and pain sensitiveness (sensation) are preserved but sometimes with disorders. Pain in injured areas could be severe, itching also could be.
II Degree: characterised by the spreading of edema, appearance of bullaes. The bottom of the opened bullaes are covered with fibrin. Cyanotic skin and difficulty of movement of phalanges. Necrosis of keratic and granular layers. N/B growth layer of the skin is not lost and regeneration appears after 2 weeks. Scars are not formed.
III Degree: Necrosis of all skin layers or even fatty tissue appears. Inflammation develops: firstly aseptic and then on 5th- 7th day purulent . Bullas contain blood . Decrease of tactile and temperature sensation. Edema of tissues spreads on the proximal areas. Firstly skin has cyanotic color then dark brown and black crusts are formed.
IV Degree: Necrosis of all skin, fat tissue and even bones and joints. Results in amputation of the affected area.
Dental caries is a bacterial disease that begins with demineralization of the outermost dental enamel and progresses, if not halted, can lead to loss of tooth substance and infection of the dental pulp. Fluoride acts in several ways to prevent caries. The principal action is thought to be that fluoride in dental plaque inhibits the initial demineralization of enamel, and then promotes remineralization of early lesions. Fluorine is gotten from drinking water and food materials. Adequate amount of fluorine in water should be from 0.7-1.5
The patient who is currently expressing signs of excess carbon monoxide exposure (unconscious state, discoloration of skin of the hands and face, ECG changes indicating high levels of hypoxia) has normal hemoglobin concentration and color index but a high amount of carboxyhemoglobin ( 2-3% norm). Recall that hemoglobin binds to oxygen forming oxyhemoglobin; in this form, oxygen is transported to various parts of the body. In the presence of Carbon (CO₂ or CO), oxygen is preferentially discharged since carbon has a higher affinity for hemoglobin; carbon then binds to hemoglobin (in this case carbon monoxide forming carboxyhemoglobin) thereby reducing the oxygen carrying capacity of hemoglobin. Hypoxia (reduced oxygen supply) to the brain will lead to a hypoxic coma.
Vitamin C is needed for the regulation of collagen synthesis (it stabilizes collagen mRNA, thereby increasing collagen synthesis). In its absence, collagen synthesis is unstable leading to reduced wound healing and strength of tissues; symptoms include frequent gingival and petechial hemorrhages as seen in the patient. Vitamin C deficiency is known as Scurvy.
In Vit A deficiency, the patient will experience impaired vision especially at night; this is because Vit A is a precursor of rhodopsin- the photo pigment found in rods (responsible for black and white vision).
Vit B1 deficiency leads to Beri Beri
Aminolevulinic acid and coproporphyrin are amino acids necessary for the synthesis of Heme. The excretion of these constituents in urine indicates either an inherited or secondary Porphyria. One of the most frequent causes of the secondary form of this disease is Lead poisoning. An increased degradation of porphyrin will lead to a decrease in Hemoglobin synthesis. Also note that the patient experiences Asthenovegetative syndrome (physical and nervous fatigue), pain in the hepatic area and stomach; these are classical signs of Lead poisoning.
The T-test is a statistical, hypothetical test used to compare the mean (average) of two related variables. For example comparing the mean of the experimental group to that of the controlled group. It lets you know how significant the differences are.
The Z-test also compares the means of two populations although it relies on the Variance ( the square root of the mean deviation).
Temporary disability refers to a disability that occurs for a short time period. The medical and preventive treatment facilities are responsible for the assessment and care of such individuals.
The right of prolongation a medical certificate of invalidity alongside with the medical treatment by the doctor is granted by:
Keshan’s disease is an endemic cardiomyopathy caused by a dietary deficiency of selenium and can be triggered by a mutated strain of the Coxsackie virus; the disease is characterised by heart failure and pulmonary edema and increases the chances of having cancer, hypertension and cardiovascular related issues. It is corrected by administering Selenium supplements.
The questionnaire passed across is a way of getting vital information. Anamnesis refers to the collection of previous/ existing information.
Pneumoconiosis is a restrictive lung disease caused by the inhalation of dust leading to fibrosis. Depending on the type of dust inhaled, different types exist. They include; Siderosis (iron ore), byssinosis (cotton), anthracosis (coal), Asbestosis (asbestos), silicosis (silica dust) etc.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. Primary healthcare is the first contact a person has with the health system when they have a health problem.
Tertiary Medical Care: Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise.
At this level, you will find procedures such as coronary artery bypass surgery, renal or hemodialysis, and some plastic surgeries or neurosurgeries.
Primary medical care: involves care given by nurses, midwives, general physicians, family doctors, in polyclinics etc. Primary healthcare is the first contact a person has with the health system when they have a health problem. For example, Immunizations/Vaccinations, health education on benefits of exercise, healthy diet etc., are some of the responsibilities of a primary health care system.
Eczema (dermatitis ) is a chronic inflammatory disease of the skin characterized by the presence of red, itchy, dry scaly rashes. Occupational eczema (dermatitis) is gotten from contact with certain chemicals in the course of working. The patient in question is a milker ( a person who extracts milk from cows) and most likely gets dermatitis as a result of contact with these animals or certain chemicals.
N/B Scabies is caused by a mite Sarcoptes scabiei; pemphigus is an autoimmune disease (antibodies against desmoglein), sores and blisters are seen in the mouth and genitals.
Note that the man works in a closed garage and carbon monoxide is the type of gas released from the engines of these vehicles. Accumulation of these gases is poisonous for health and leads to the expressed symptoms.
The patient presents with weak dropping hands and a weakened carporadial reflex; this sign is often seen in individuals poisoned by lead (wrist and foot drop). Other major signs are ’ Lead lines’ on gingiva/gums (Burton's line), abdominal colic, encephalopathy and sideroblastic anemia.
Guillain-Barre syndrome is an autoimmune condition that destroys schwann cells via inflammation and demyelination of nerve fibres. It occurs as a result of molecular mimicry and triggered by infections, stress etc. major signs include Bilateral facial paralysis and respiratory failure.
Shingles is gotten from varicella zoster virus infection.
An inactivated influenza vaccine is reliably used as a form of prophylaxis from the influenza infection; optimal terms for vaccination are October-November. Influenza vaccination is indicated in children with: chronic bronchopulmonary diseases, cardiovascular diseases, hemolytic anemias, diabetes mellitus, chronic kidney and liver diseases, HIV infection etc. Note that the flu vaccine is safe during pregnancy. The inactivated Influenza vaccine can be given to pregnant women at any trimester.
A minimum interval is the shortest time between two doses in a vaccination series. The Hepatitis B vaccination is given in a three dose series; First dose at birth, second Between 1-2 months and the third dose is given between the 6th-15th month. Examples of the hepatitis B vaccines are Engerix-B and Recombivax HB; the minimum interval between the first and second doses is 4 weeks.
An adult taking the Hepatitis B vaccine will take 3 doses one month apart. For example, as an adult, if you take the first dose 1st March, next dose will be 1st April and the last dose will be 1st May.
Note that the patient presented the document that confirms he received all the necessary vaccination at the right time (which definitely includes a tetanus vaccine). In this case, the patient should be carefully monitored for the following few days in order to observe if any signs or changes that indicate a tetanus infection occur.
Side effects from MMR vaccines that can occur 7 to 10 days after vaccination include:
fever (can be more than 39.4 °C), lasting two to three days
faint red rash (not infectious)
head cold, runny nose, cough or puffy eyes
drowsiness or tiredness
swelling of salivary glands
localised pain, redness and swelling at the injection site.
2 doses of the MMR vaccine provide the best protection against measles, mumps and rubella. The above listed side effects are expected in a small percentage of the population. Once the first dose is given, if any of the above listed side effects should occur, it is not a contraindication for the second dose as these side effects are expected.
So, it is possible, as the patient in question, only had low grade fever and a macular rash.
This patient had Diphtheria a year ago but currently, his condition is satisfactory. The question wants to know which vaccine was given to him a year ago that helped in managing the disease.
D- Diphtheria; T- Tetanus; P- Pertussis (Whooping cough); aP- acellular pertussis vaccine.
It is recommended that diphtheria, tetanus, and acellular pertussis vaccination be administered across the lifespan. Children younger than 7 years of age receive DTaP or DT, while older children and adults receive Td. Therefore, in this patient who is older than 7 years (26 year old man), he was given a diphtheria and Tetanus Vaccine.
Give infants and children 5 doses of DTaP. Give one dose at each of these ages: 2 months, 4 months, 6 months, 15 through 18 months, and 4 through 6 years.
Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
Give pregnant women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36.
Give adults who have never received Tdap a single dose of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td booster every 10 years.
Rule of “nines” – area of different areas of the body is proportional: anterior surface of the trunk – 18 %, posterior – 18 %, lower limb – 18 %, external genitals – 1 %);
Rule of “palm”. It is used if burns are limited and located on different areas of the body.
According to the rule of palm takes 1 % of the skin surface.
Division of the burns on superficial (I, II, IIIA st.) and deep (IIIB-IV st.)
I stage – hyperemia of the skin
II stage – separation of epidermis with formation of bullas
III A stage – necrosis of superficial layers of the skin with saving of bulbs hair, sweat glands and sebaceous glands.
IIIB stage – necrosis of all the derma
Palmar surface - 1%; Dorsal surface - 1%, that's 2% for one hand and that will be 4% for both hands.
Blisters (bullae) - Stage II
Amongst the listed radioactive substances, an exposure to radioactive iodine will result in the irritation of the nasopharynx, increased tear production, swelling of the neck, loss or a change in taste etc. Note that radioactive iodine is mostly used in the treatment of thyroid cancers and is readily absorbed by the thyroid gland. Majority of the other listed radioactive substances will lead to acute radiation sickness, skin burns etc.
Eczema (dermatitis) is a chronic inflammatory disease of the skin characterized by the presence of red, itchy, dry scaly rashes. Occupational eczema (dermatitis) is gotten from contact with certain chemicals in the course of working (in this case due to contact with formaldehyde). Allergic dermatitis is a form of contact dermatitis that results from immune reactions towards certain irritants.
Note that the question indicates “content of mercury vapors in the air of the working area”. Since the mercury is in vaporized form, the route of entry will be through the respiratory organs.
The symptoms listed in the question stem are classic for Iron deficiency anemia.
A person with insufficient Iron in the blood will experience symptoms such as; fatigue, headaches, temperature sensitivity, heart palpitations, cold hands and feet, pallor of mucous membrane, cracks on the side of the mouth, inflammation of the tongue, brittle nails etc. These patients also experience an Iron deficiency anemia which is characterised by a reduction in hemoglobin level and color index.
The other microelements listed as answer choices are not directly involved with the development of anemia.
An audiometry focuses on measuring the hearing acuity (sharpness), check for variations in pitch, intensity, tones and frequencies. The above patient is diagnosed with occupational deafness (loss of hearing ability due to work hazards), to put up such diagnosis, an audiometry test is to be carried out coupled with assessing hygienic conditions of his workplace.
Primary prevention of a disease is aimed at preventing the onset (start of a disease) i.e., the disease is yet to occur so we aim at preventing it from happening via optimization of lifestyle and living conditions, vaccinations/Immunizations etc.
Secondary prevention is aimed at preventing or slowing the progress of a disease (early diagnosis and treatment) i.e., the patient already has the disease, so we are more concerned on stopping it from progressing and preventing its complications.
This committee should be headed by the local SES (state emergency committee) who are responsible for providing assistance especially in emergency situations to their immediate environment.
Air cleanness estimation according to indexes of bacteriological research in different year periods.
Microorganisms Contents in 1m3 of air.
1500 - 2500
Using the information provided in the question stem:
Blisters (bullae) - Stage II (blisters filled with serous liquid are forming)
Necrosis of superficial layers - Stage IIIA (epidermis of the palms and backs of her hands is exfoliating)
The main risk amongst welders is the inflammation of the cornea and conjunctiva, commonly known as 'arc eye' or 'flash'. This is caused by the irritation of the eyes by the ultraviolet rays produced. Other possible hazards include skin inflammation, cancer.
Radar charts are also known as spider, polar, web charts or star plots; they are used as a way to visualize multivariate data. They are used to plot one or more groups of values over multiple common variables. They do this by giving an axis for each variable, and these axes are arranged radially around a central point and spaced equally.
A cartogram uses a map to differentiate how a variable is distributed.
Pneumatic hammer disease is also known as white fingers, traumatic vasospastic syndrome, vasospastic disease of the hands or hypothenar hammer syndrome, It occurs in individuals whose occupation requires the use of huge percussion machines such as hammers, drilling equipment and also in sport related activities such as weightlifting, volleyball. This disorder is as a result disturbed blood flow to the affected hand.
Raynaud phenomenon possess similar physical changes but usually occurs due to temperature changes or emotional distortions.
From anamnesis, we can tell this patient has had prior exposure to contents of mercury, this can be confirmed by the presented symptoms which indicate poisoning by mercury. For the management of mercury poisoning, Unithiol should be administered; it is a chelating agent that is used as a remedy for poisonings by heavy metals. Other chelating agent include dimercaprol, d-penicillamine etc.
Atropine sulphate is used as a remedy for organophosphate poisoning, calcium tetacine is used in lead poisoning, amyl nitrite is used for cyanide poisoning.
This meat has been found to be infested by trichinella; if consumed, this individual is likely to get Trichinellosis. In this case, preservation of the meat by salting, boiling or freezing isn't going to salvage the meat. This meat should be properly disposed of to avoid consumption.
The extensive statistical indicator is used to determine a structure of a disease ( in this case, how many percent ( the proportion) of the total diseased fall under cardiovascular cases) ie., it shows, what part from the general number of all diseases is made with this or that disease which enters into total.
Artesian well is a type of well from which water flows under natural pressure without pumping. It is dug or drilled wherever a gently dipping, permeable rock layer (such as sandstone) receives water along its outcrop at a level higher than the level of the surface of the ground at the well site. From the above listed options, the artesian well is the best source of clean water.
The Z-test also compares the means of two populations although it relies on the Variance ( the square root of the mean deviation).
Mining involves the extraction of materials/ minerals from the earth; just like the question states, it involves processes such as drilling, blasting, excavation, sorting etc. Miners are usually exposed to lots of hazards such as earth collapse, dust inhalation, noise, vibrations etc. Of all the above listed hazards, exposure to dust is the most important/frequent hazard to a miners health; depending on the type of dust, this can lead to restrictive lung diseases such as pneumoconiosis, silicosis etc.
Correlation factor/Coefficient is a statistical measure that shows the relationship between two variables; in the case between service records and eosinophil concentration. Most common types include the Pearson’s correlation coefficient and rank coefficient.
Common morbidity rate refers to the proportion or frequency at which a disease occurs in a population; from the report of registered diseases in a particular area, we can calculate the morbidity rate.
Observe that the levels of WBC (Leukocytes), hemoglobin and platelets are very low. This can be traced to the effect of radiation from around his workplace. Working in this environment should be prohibited for this individual because of the health effects.
Kwashiorkor is a disease marked by severe protein malnutrition and bilateral extremity swelling. It usually affects infants and children. It should be differentiated from marasmus which is energy or calorie deficiency. For the correction of kwashiorkor, foods rich in protein should be taken eg, fish, meat, cereals, milk etc.
The physician on duty should issue a medical certificate ( a written statement from a physician or another medically qualified health care provider which attests to the result of a medical examination of a patient) indicating a temporary disability. This medical certificate will assist the patient in obtaining a sick list which is a document given to an individual exempting him/her from workday to an illness or disability.
The right of prolongating a medical certificate of invalidity alongside with the medical treatment by the doctor is granted by:
Biological Effects of radiation are of two types a) 1.Deterministic Effect b) Stochastic Effect. Deterministic effects are also called non-stochastic effects. These effects depend on time of exposure, doses, type of Radiation.it has a threshold of doses below which the effect does not occur, the threshold may vary from person to person. They include acute and chronic graduation sickness. Stochastic effects are those effects which occur when a person receives a high dose of radiation. These effects have an increased probability of occurring with increased dose. The two types include a) somatic stochastic effect eg., somatoform autonomic dysfunction, malignancies etc B) Genetic or hereditary effects.
A thermograph is a visual representation of temperature recordings of an area over a period of time. Thermometers are used to measure instant temperature while a psychrometer is used in measuring relative humidity.
According to the character of influence to the organism there is local, general and combined vibration. During the local vibration the transmission of mechanical oscillations to the body is realized through the arms. Most often this etiologic factor we can see among the face-workers, chasers, drillers. The sources of the general vibration are the vibro platform, the table vibrator, the forming and concrete-laying machines.
The combined vibration is a combination of local and general - as in this case with a tractor driver who will have both localized and generalized vibratory impact.
According to the intensity’s degree of pathologic process symbolically mark out 4 stages of disease:
I – initial (episodic finger numbness with or without tingling - Hypesthesia)
II – moderately expressed (dystrophic disorders);
III – expressed (irreversible organic changes);
IV – generalized