Public health Flashcards

Question

PBH - 37 The most influencing social factor related to suicide behavior is the following: A) inability to loan repayment B) residential segregation C) existential uncertainty caused by economic crisis D) entrepreneurial lifestyle E) unemployment

Answer 1

ANSWER E) unemployment EXPLANATION The most important social factor related to suicide behavior was unemployment according to a survey conducted in Hungary in 1995. Nearly 40% of the unemployed have suicidal thoughts and over 7% of them commit a suicide attempt which requires medical intervention (within the entrepreneurial group the corresponding numbers are 13.4% and 1.2%, respectively). The rate of repeated suicide attempts was highest among the unemployed, too.

Answer 2

ANSWER B) Preventing the onset of a disease in individuals with increased risk genotype mainly by abolishing harmful environmental exposures EXPLANATION Detection of genetic predisposition can not be considered as a primary preventive intervention because the risk factor can not be excluded. It can not be considered as secondary preventive intervention either because it is not intended to help early detection of the disease but to detect the susceptibility. Detection of genetic predisposition of chronic non-communicable diseases is called phenotype prevention (as suggested and determined by Juengst in 1995) which falls between primary and secondary prevention. Phenotypic prevention’s main aim is to prevent the disease’s onset among endangered genotype individuals (high risk groups).

Answer 3

ANSWER A) among Ashkenazi Jewish communities EXPLANATION Susceptibility to various neoplastic diseases at population level is reflected in the different incidence rates that could be seen among different communities (geographically determined, based on ethnicity, etc For example, high incidence rate of breast cancer can be seen among Ashkenazi Jewish communities related to various mutations of the BRCA1 gene.

Answer 4

ANSWER C) ten times increased risk EXPLANATION The carcinogenic role of smoking is generally accepted based on the meta-analysis of epidemiological investigations. The relative risk of regular smokers for lung cancer is ten times higher compared to non smokers.

Answer 5

ANSWER B) to reduce cardiovascular premature mortality EXPLANATION The North Karelia Project was implemented by the Finnish Government in the early 1970s which main aim was to reduce the mortality rate of cardiovascular diseases. The project mainly focused on healthy eating and the reduction of smoking rate which resulted in a reduction of cancer-related mortality. Premature cardiovascular mortality decreased by 60%, and premature cancer-related mortality decreased by 40% within 25 years after implementing the Project.

Answer 6

ANSWER E) the existence of diabetes is unknown by both the patient and the doctor, so diabetes can be detected by a screening test only EXPLANATION A study related to the observation of hidden diabetes was conducted among patients aged 55-64 based on the GPMSSP. According to the study, the prevalence of hidden diabetes is quite high, because every third or fourth diabetic patient was detected only by screening tests and not by the doctor or the patient.

Answer 7

ANSWER D) elevated HDL-C value EXPLANATION The main components of metabolic syndrome are the hypertension, increased fasting blood glucose level, elevated triglyceride value and visceral obesity based on both the ATPIII and the IDF guidelines. Only decreased HDL-C level is considered to be abnormal.

Answer 8

ANSWER A) is more than two times higher EXPLANATION The relative risk of premature mortality related to respiratory diseases has been more than two times higher among both genders since 2005 in Hungary compared to EU15’s mortality. (for men, 2.8, for women 2.3 in 2007)

Answer 9

ANSWER D) mortality rates decreased significantly for both gender EXPLANATION A decreasing trend was observed in recent decades related to suicide mortality. Mortality of men aged 25-64 in 2008 was nearly 50% lower than in 1980, while mortality of women decreased by one third. Highest suicide rate can be seen in Northern Great Plain and Southern Great Plain.

Answer 10

ANSWER B) is limited EXPLANATION The application of knowledge related to genetic / genomic science in public health is still limited. The obstacles hindering utilization are as follows. i) Genetic epidemiological studies were rarely conducted in potentially affected populations. ii) The applied methods are usually cost-intensive. iii) Preventive interventions are available only in a small minority of the identified risk conditions and the acceptance of these interventions for the individuals is also questionable. iv) Human resources are not granted either for genetic-based screening in the field of public health or for dissemination of goals and results. v) . The legal background for the regulation of genomic researches is restricted.

Answer 11

ANSWER D) Taenia solium EXPLANATION Strongyloides stercoralis, Trichuris trichiura and Ascaris lumbricoides are geohelminths, while Taenia solium is not. Infection with Taenia solium and Taenia saginata occur through the consumption of inadequately cooked, semi-cooked or raw meat. The intermediate hosts for Taenia solium are swine and for Taenia saginata are cattles. The eggs could enter the body of the animals orally with infected human feces or with infected fodder They can get everywhere in the body via blood circulation, but they usually settle in the mucles. (cystycercus).

Answer 12

ANSWER C) both EXPLANATION Newborns of HbsAg positive mothers should receive both active and passive immunization against hepatitis B. Protective antigen of HBV is HbsAg. HBs antibody provides protection against it. HBV can not be produced without hosting human body (in vitro). The protective antigen was produced by plasmapheresis from the plasma of healthy carriers in the past. Nowadays, it is produced using standard genetic engineering techniques, the virus's HbsAg-encoding S gene has been implanted into Saccharomyces cerevisiae and can be produced under large-scale circumstances. Component of human origin is not present in the vaccine. Protective antibodies are produced from sera with high titers for passive immunization. Newborns should be given hyperimmun γ globulin within 12 hours as well as the iniation of active immunization should start. The latter must be followed by revaccination at month 1 and and 6.

Answer 13

ANSWER D) salmonellosis EXPLANATION Prevention of salmonellosis is not related to vaccination but it is a hygienic task. This task includes health monitoring of animals which are going to be processed that is the veterinarian’s job. Regulations of production, storage and transport of food are food hygiene tasks. Providing drinking water, proper sewage treatment and disposal, fly and pest control belong to environmental and community health. Personal hygiene is also quite important related to preventive services. Strict observance of hygienic rules is important during food preparation, storage, transportation and catering to prevent salmonellosis.

Answer 14

ANSWER C) vaccination against smallpox EXPLANATION Vaccination against mumps, rubella and tetanus belong to mandatory vaccination according to the vaccination schedule which are received in the form of combined vaccines. Vaccination against smallpox was mandatory up to 1980 (eradication of smallpox).

Answer 15

ANSWER E) 72 hours EXPLANATION Food samples should be kept for 72 hours. Detecting the source of food-related infections and poisonings can be done by the investigation of food samples. Kitchens providing public catering - over 29 servings per day - have to store a 100g food sample of each meal in a clean, microbiologically and chemically acceptable container or packing bag and in a refrigerator for 72 hours. Contents, date of sampling and the name of the person performing the sampling must be attached to the sample. If bacteria was found in the patients’ feces and the bacteria’s antigenic structure could be found in the food sample, as well as the infection was proved by laboratory tests, then the infection developed because of the food consumption. If the symptoms of the suspected food consumers are similar and their latency time is almost the same then the relationship between food consumption and the bacteria is proved epidemiologically.

Answer 16

ANSWER C) chemical sterilization EXPLANATION Liquids (formaldehyde) and gas (ethylene oxide) are used for chemical sterilization of heat-sensitive materials to destroy microorganisms. Their application allows lowering the sterilization temperature.but both compounds are known to have carcinogenic effects. During dry heat sterilization dry air with temperature between 160 and 200 oC circulates in a sealed space in which microorganisms will be inactivated, then destroyed due to high temperature. Autoclaves operate with saturated, pressurized water vapor. The microorganisms are destroyed by the heat energy released from the vapor condensed on the surface of the deposited materials. During plasma steriliztaion, the sterilization will be done in the hydrogen peroxide plasma which will split into water and oxygen

Answer 17

ANSWER A) UV light EXPLANATION γ-radiation, ethylene oxide and autoclaving procedures are used for sterilization, while UV light is used in operating rooms, medical office waiting rooms and laboratories when the staff is not present. Timindimers are produced in the DNA of microorganisms during UV radiation, which penetration is weak so it can only be used for sterilizating surfaces and for disinfecting the indoor air.

Answer 18

ANSWER B) the subregional public health institute competent at the regional location of the infection

Answer 19

ANSWER B) typhus abdominalis EXPLANATION Highly infectious diseases, e.g. typhus abdominalis, cholera, poliomyelitis, lyssa, pestis, etc. have to be reported immediately by phone or by e-mail to the competent county public health service and to the National Public Health and Medical Office Service, National Center for Epidemiology.

Answer 20

ANSWER C) both of them EXPLANATION Limiting and separating the movement of the infectious source (infected patient) can prevent the infectious pathogens from spreading. Separation could be done in an inpatient hospital unit’s quarantine room especially when it is indicated by the patient’s health status, too.

Answer 21

ANSWER A) dysenteria EXPLANATION Epidemiological surveillance is used on persons who could be potential infectious sources due to their direct contact with the infected patient. Its’ duration is equal to the maximum latency of the infectious disease. The duration of the epidemiological surveillance is 7 days for dysenteria, for campylobacteriosis 5 days, 21 days for typhus abdominalis and 30 days for hepatitis A infection.

Answer 22

ANSWER C) laboratory test is not obligatory EXPLANATION Poliomyelitis anterior acute disease is a reportable disease, which must be reported by telephone and fax to the National Public Health and Medical Officer Service and the National Center of Epidemiology. Laboratory tests are mandatory. Feces sample, irrigation fluid, 1-2 liquor samples and native blood must be sent to the Virology Department of National Public Health and Medical Officer Service which must be followed by the resending of new blood samples after 3 weeks for laboratory retests.

Answer 23

ANSWER E) For the correct diagnosis blood sample should be sent to the regional laboratory before treatment EXPLANATION Salmonellosis is a reportable disease. If the infection has been transmitted by food, apart from the usual custom notification, the onset and the suspicion of infection must be urgently reported (by telephone, fax) to the relevant sub-regional public health institute, as well as in written form by filling the "food contamination, food poisoning notification" sheet. The disease is considered as group poisioning if the number of patients is between 5-30, if more than 30 are affected, then poisoning refers to a mass poisoning. In the latter case, the regional public health institution reports to the National Public Health and Medical Officer Service which informs the Medical Office Service and the National institute of Pharmacy and Nutrition. Patients are prohibited to work with food and beverages as well as in childcare facilities until the emission of pathogens is ceased. Laboratory tests of the feces are mandatory for diagnostic purposes while release examinations have to be carry out for those whose occupation is related to a child community of 0-3 years old, or work in a "dangerous position" or give breast milk.

Answer 24

ANSWER A) disease without clinical symptoms EXPLANATION Inapparent infection occurs when the number of pathogens entering the organism is low or the microbe's pathogenicity is low. The immune system of the body can quickly overcome the infection, so it won’t generate any clinical symptom.

Answer 25

ANSWER B) Salmonellosis EXPLANATION The difference between the diseases with similar clinical symptoms is in their latency period. In a staphylococcal foodborne disease, the incubation period is usually between 2 to 6 hours, while 6 to 48 hours for salmonellosis and 12 to 36 hours for botulism. The latency period of Yersiniosis is 3-7 days. The incubation period is usually 7 to 10 days in trichinellosis.

Answer 26

ANSWER B) Tularemia EXPLANATION Swine is not infectious source of the Tularemia; its reservoirs could be certain rodents (mice, rats), cats, sheep, etc. Reservoirs as well as infectious source of Brucellosis (Brucella suis), listeriosis, Taenia (Taenia solium) and trichinellosis are the swine.

Answer 27

ANSWER E) vaccination on days 0 and 3 (1-1 dose) EXPLANATION If the exposed person has received a complete vaccination sequence within 5 years, in the case of a new infection his (her) immunity is sufficient to receive a partial vaccination series only for active immunization. This scheme is described in answser E. Answer A corresponds to the full immunization for those who have not been vaccinated or who have been vaccinated for more than 5 years. Answers B, C and D are incorrect, there are no vaccinatiol protocols like these.

Answer 28

ANSWER A) Anthrax EXPLANATION In order to provide an adequate treatment -adequate antibiotic therapy- for the severe, occasionally lethal disease (pulmonary anthrax), the patient should be taken to the hospital as soon as possible.

Answer 29

ANSWER D) rodents EXPLANATION LCM virus reservoirs could be rodents (domestic and field mice, hamsters, guinea pigs, etc.) as well as other animals (e.g. some monkey species) not mentioned here. Humans can be infected due to the consumption of food contaminated with urine and / or feces of these animals or due to inhaling dust containing the pathogens.

Answer 30

ANSWER E) tuberculosis EXPLANATION The new cases of tuberculosis have risen in the age group over 40 year in Hungary. The morbidity of scarlet fever among the 3-5 year-olds is the highest; Diphtheria has occurred only in the form of imported cases in the recent decades; Pertussis is a disease of infants who have not received active immunization yet; Infection of H. influenzae in children under 5 years has been reported sporadically.

Answer 31

ANSWER B) scarlatina EXPLANATION Due to the fact that the cause of scarlet fever (Streptococcus pyogenes) occurs in 5-10% of the population in general and in 20-30% of the population during an epidemic, the possibility of an infection is not restricted only to the patient, but may happen from others, too. Consequently, chemoprophylaxis of the contacts has no significant preventive effects and does not need to be used. In other diseases, as circulating bacteria are limited in the population, the chemoprophylaxis of the contacts - by blocking the development of the infection originating from the patient- is effectively preventive and should be used.

Answer 32

ANSWER D) 7-10 days EXPLANATION The amount of virus required for infectivity is presented in the excretion of the infected person 7-10 days before the onset of symptoms, so those being in contact may be infected with an asymptomatic person

Answer 33

ANSWER E) Toxoplasmosis EXPLANATION Due to transplacental infection in pregnant women carrying toxoplasma gondi the fetus is prone to severe teratogenic changes which could affect the central nervous system. The pathogens of the other listed diseases do not pass the placenta, so they have no teratogenic effect.

Answer 34

ANSWER A) 29-30 years EXPLANATION The epidemiological feature of vCJD is that it occurs in young adults with an average age of approximately 30 years. This is one of the major differences between the new variant and the classic CJD; the latter one mainly affects the elderly generations.

Answer 35

ANSWER B) 2% EXPLANATION A 1% reduction in ozone concentration, which plays an essential role in the uptake of harmful ultraviolet rays, increases the incidence of skin cancer by 2%. (As a result of this change, cataract incidence increases by 0.5%, too.)

Answer 36

ANSWER B) mercury EXPLANATION People with hyperthyroidism should not be exposed to mercury. Non-serious thyroid gland disease does not exclude the employability with/of other heavy metals.

Answer 37

ANSWER D) chlorinated hydrocarbon EXPLANATION Among the listed pesticides, chlorinated hydrocarbons (eg DDT) are persistent in surface waters, they decompose only over a long time. Compounds of the other four groups are decomposed in an aqueous environment in a short time. Organic phosphate esters are hydrolyzed in the presence of a water molecule, which results in the losing of their toxic effect.

Answer 38

ANSWER D) spasm of the respiratory muscles EXPLANATION The spasms of the respiratory muscles is a nicotine-like symptom due to organic phosphates, while bradycardia, bronchospasm, increased sweating and needle pupil are muscarinic alterations.

Answer 39

ANSWER A) toluene EXPLANATION Toluene has a teratogenic effect on humans; due to this special feauture, pregnant women are not allowed to be employed in case of toluene exposure.

Answer 40

ANSWER E) dinitro-o-cresol EXPLANATION High doses of dinitro-o-cresol may cause severe acute symptoms - tachycardia, respiratory disorders, spasms, lung oedema, accompanied by high fever above 40 ° C. Fever caused by acute dinitro-o-cresol intoxication cannot be cured with drugs effectively, but direct cooling of the patient (eg cold water bath) can reduce body temperature.

Answer 41

ANSWER A) heart attack EXPLANATION Based on epidemiological findings, out of the five diseases listed here only the positive relationship between myocardial infarct and the low level of magnesium in the drinking water is considered proven. (low magnesium consumption it increases the heart attack incidence)

Answer 42

ANSWER D) The smallest amount of substance that may have toxic effects EXPLANATION The minimum toxic dose (DT) is the smallest amount of a substance that already causes toxic effects, regardless of whether these effects reflect the general toxicity or are symptoms characteristic of the substance

Answer 43

ANSWER C) xylene EXPLANATION In the case of work related to xylene exposure - in addition to pregnant women, breastfeeding mothers, adolescents, alcoholics, people with hemopoietic and renal disease - dermatological patients are not allowed to be employed.

Answer 44

ANSWER B) tri-ortho-cresyl phosphate EXPLANATION In the case of acute tri-ortho-cresyl phosphate intoxication after 2-4 weeks of the first symptoms (vomiting, diarrhea) paralysis of the lower limbs may occur that is usually reversible. The other compounds will not cause acute damage to the nerves of the lower limbs.

Answer 45

ANSWER D) 40 mg / l EXPLANATION 40 mg / l is the limit for the nitrate concentration in drinking water, above which the water is prohibited for babies to drink or to their food to be preapered with.

Answer 46

ANSWER E) phenol EXPLANATION Due to their lipophilic characteristic the first four substances can be excreted into the breast milk, so the breastfed child can be exposed to them. Phenol is hydrophilic, therefore it does not appear in the breast milk.

Answer 47

ANSWER E) 2-3 years EXPLANATION The resistance of geohelminths’ eggs is significantly greater than the resistance of not geohelminth worms’ eggs, thus they survive 2-3 years in the soil.

Answer 48

ANSWER A) benzene EXPLANATION Determining the level of benzene exposure could be done by measuring the urine concentrations of one of its metabolites, muconic acid. Another possibility is the measurement of the dissolved product of benzene, the urinary phenol. In the case of toluene exposure, urinary hippuric acid or orthocresol concentrations can be measured, and the ortho hippuric acid content can be determined for xylene. The level of exposure to ethylene glycol and propyl alcohol can not be characterized by urinary metabolic measurement.

Answer 49

ANSWER A) 0.5 mg / l

Answer 50

ANSWER D) arsenic EXPLANATION Acrocyanosis is developed due to chronic arsenic exposure, its clinical manifestation is the "Blackfoot Disease", which is a lower limb circulatory disorder.

Answer 51

ANSWER E) UV radiation EXPLANATION Physical (pelletization, moisture, temperature), physicochemical (absorption, precipitation) and biological (degradative organisms, biological membrane) factors participate in the biological activity of the soil. As the UV radiation does not penetrate the soil, thus it does not participate in the geocycling processes.

Answer 52

ANSWER D) methanol EXPLANATION The process of toxic detoxification, namely a metabolism where the the degradation products are more toxic than the original molecule, is only observed related to methanol. Formaldehyde and formic acid, formed from methyl alcohol, can cause more severe symptoms (eg blindness) than the methanol itself. For the other four compounds (toluene, freon, carbon tetrachloride, benzene) the degradation products are less toxic than the original molecule.

Answer 53

ANSWER B) 8-10 g EXPLANATION Consumption of 8 to 10 g of methyl alcohol causes irreversible blindness due to its direct effect on the optic nerve.

Answer 54

ANSWER C) sulfur dioxide EXPLANATION Sulfur dioxide is not involved in the effects of Los Angeles-type smog because it has no oxidative effect. However, all other compounds have such effect and, therefore, they actively participate in the induction of the symptoms of oxidative-type smog.

Answer 55

ANSWER B) 20 mSv / year EXPLANATION Occupational exposure level should be regulated so that the effective annual dose should not o-exceed 20 mSv (averaged over five consecutive years).

Answer 56

ANSWER A) vinyl chloride EXPLANATION Vinyl chloride is a colorless, sweet smelling gas which causes exposition during the manufacturing and processing of PVC. Disorders of the nervous system, Raynaud's syndrome, thrombocytopenia, fibrotic liver damage, pulmonary fibrosis, acro-osteolysis, and sclerodermoid lesions have been reported among workers exposed to long (about 15 years) exposition of moderate doses of Vinly chloride.

Answer 57

ANSWER C) vinyl chloride EXPLANATION During the manufacturing and processing of PVC, the vinyl chloride which is a colorless, sweet smelling gas could be exposed to workers. High doses of chronic or long term exposition may cause liver hemangiosarcoma.

Answer 58

ANSWER C) toxogonin EXPLANATION Carbamates are insecticides classified as toxic or highly toxic compounds based on their per os LD50 values. These organic phosphates are cholinesterase inhibitors, but their effect is reversible and lasts for short time so the enzyme reactivation occurs spontaneously. In case of acute poisoning, administration of reactivators (toxogonin) is prohibited (its intake will worsening the symptoms);otherwise the treatment is the same as described for organic phosphates.

Answer 59

ANSWER C) When the worker's red blood cell AChE activity has decreased by more than 50% compared to own baseline activity. EXPLANATION If the individual’s red blood cell cholinesterase activity is less than 50% compared to its own basic activity, then the person must be (permanently) removed from the position and this is also recommended when the enzyme activitiy decreased by 25% .

Answer 60

ANSWER C) infrared radiation EXPLANATION Infrared radiation spans between the visible and the radiofrequency range of the electromagnetic spectrum. Besides the sunlight it is produced by processes and activities that use the thermal energy of infrared radiation.These activities include heating and dewatering processes, welding, glass manufacturing, drying and burning of coatings for public goods. Waves with wavelengths shorter than 2000 nm can damage the cornea, iris and lens.

Answer 61

ANSWER C) iron and steel production EXPLANATION High cancer-risk industries are those industrial areas, where most of the people employed are exposed to one or more carcinogenic materials and within this population of workers the incidence of tumorous diseases exceeds the expected incidence of cancer in the general population.

Answer 62

ANSWER B) lung cancers EXPLANATION Inhalation of the hexavalent form of chromium could cause cancers, e.g. bronchial and nasopharyngeal cancers (which should be monitored periodically).

Answer 63

ANSWER B) various combinations of air temperature, humidity, and air movement which elicit the same heat sensation EXPLANATION Effective temperature is based on the relative humidity of the air as well as on the airflow rate, while the corrected effective temperature takes into account the heat radiation also. The effective temperature can be determined by a nomogram.

Answer 64

ANSWER C) 4000 Hz EXPLANATION An early hearing loss can only be detected by audiometrical investigations - initially in the range of 4000 to 8000 Hz. In Hungary a hearing loss at 4000 Hz that reaches/exceeds 30 dB (zajcsipke) has to be reported as increased exposition case.

Answer 65

ANSWER C) nickel EXPLANATION Nickel is used in electroplating and steel alloys, in batteries (Ni-Cd and Ni-hybrid) and as a chemical catalyst. Many goods are made of nickel-containing metals. Contact with the skin often causes contact dermatitis, eczema or asthma.

Answer 66

ANSWER D) the level of the sound pressure. EXPLANATION During the measurement of sound pressure the hearing thereshold is taken as a reference and the pressure of the various sounds is compared to this value. The result is the logarithmic decibel scale that gives the sound pressure level.

Answer 67

ANSWER D) 130 dB EXPLANATION During the measurement of sound pressure the hearing thereshold is taken as a reference and the pressure of the various sounds is compared to this value. The result is the logarithmic decibel scale that gives the sound pressure level.The hearing range spans from 0 dB (this corresponds to the hearing threshold of 20 μPa) to 120-140 dB (this is 2 × 107 μPa). Sound pressure greater than the pain threshold (approx.. 130 dB) causes only pain.

Answer 68

ANSWER E) stalactite EXPLANATION There are two known groups and six types of minerals related to asbestos: serpentine group - chrysotile, amphibole group -, crocidolite, amosite, antofilite, tremolite, actinolite.

Answer 69

ANSWER E) working with silicate EXPLANATION High cancer-risk industries are those industrial areas, where most of the people employed are exposed to one or more carcinogenic materials and within the population of workers the incidence of tumor diseases exceeds the expected incidence that is the incidence of cancer in the general population.

Answer 70

ANSWER E) cyclosporine EXPLANATION Aflatoxin, arsenic, benzene, cyclophosphamide are proven human carcinogens.

Answer 71

ANSWER A) the inhibition of acetylcholinesterase EXPLANATION Carbamates, like organic phosphates, are acetylcholinesterase inhibitors, but their activity is reversible and short acting, so the enzyme reactivation occurs spontaneously.

Answer 72

ANSWER C) chlorinated hydrocarbon EXPLANATION DDT is the most commonly known representative of chlorinated hydrocarbons.

Answer 73

ANSWER C) small wave tremor EXPLANATION Chronic exposure of mercury is most commonly caused by mercury vapor. Symptoms of the peripheral nervous system are dominating in chronic exposure of mercury, the so-called small- wave tremor mercurialis is especially characteristic, which starts in the facial and hand muscles (writing test) but eventually affects the whole body

Answer 74

ANSWER A) microsomal enzymes of the liver EXPLANATION Absorbed PCBs induce changes in steroid metabolism and metabolic processes due to the induction of microsomal enzymes in the liver.

Answer 75

ANSWER B) binaural negative spike at 4000 Hz (30 dB) EXPLANATION An early hearing loss can only be detected by audiometrical investigations - initially in the range of 4000 to 8000 Hz. In Hungary a hearing loss at 4000 Hz that reaches/exceeds 30 dB (recess, negative spike) has to be reported as increased exposition casebut the hearing loss is irreversible in these cases.

Answer 76

ANSWER B) yes, its the highest among infants with the lowest status EXPLANATION The socio-economic situation is a factor that has a significant impact on the health status and on its various indicators, including infant mortality. This factor tends to be more favorable in children with better socioeconomic status in all countries (resulting in smaller infant mortality rate).

Answer 77

ANSWER A) Increased in all social categories, but the increase was the highest among those in the highest category. EXPLANATION The socio-economic situation is a factor that significantly affects health status and its various indicators, including life expectancy.Life expectancy was significantly greater among those in better position compared to those in lower socioeconomical groups in England.

Answer 78

ANSWER C) if the mother ignores alcohol consumption throughout the pregnancy EXPLANATION The best way to prevent fetal alcohol syndrome is to avoid alcohol consumption throughout the pregnancy, as the quantity of alcohol that would not cause harm to the fetus during pregnancy is not known.

Answer 79

ANSWER B) The pysician will dispose the test on the 16th week for the screening of the closure dosorders of the neural tube EXPLANATION According to the decree 33/1992 regarding the prenatal care of pregnants, serum alpha-fetoprotein test is performed during the 16th week of pregnancy. The test is ordered by the physician who is responsible for carrying the prenatal care.

Answer 80

ANSWER A) accidents EXPLANATION Approximately 37% of deaths are caused by accidents among individuals aged 10-18. The number of deaths related to accidents is more then two times bigger among boys compared to girls.

Answer 81

ANSWER C) at the age of 13-15 EXPLANATION According to the 2009/2010 date of the HBSC study (Health Behaviour of School-age Children), the frequency of smoking in 11-year-olds seems low, but it’s increased more than 10 times among 15+ teenagers in European countries.

Answer 82

ANSWER D) marijuana EXPLANATION According to data obtained from the National Drug Collection and Contact Center, the most commonly used illegal drug among adolescents is the marijuana. According to the European Monitoring Center for Drugs and Drug Addiction in Europe and according to the United Nations Office on Drugs and Crime (UNODC) worldwide marijuana is the most commonly used drug among teenagers.

Answer 83

ANSWER D) marijuana EXPLANATION According to data obtained from the National Drug Collection and Contact Center, the most commonly used illegal drug among adolescents is the marijuana. According to the European Monitoring Center for Drugs and Drug Addiction in Europe and according to the United Nations Office on Drugs and Crime (UNODC) worldwide marijuana is the most commonly used drug among teenagers.

Answer 84

ANSWER D) family doctors, home pediatricians, health visitors, school doctors, school dentists EXPLANATION Basic medical care for children between the ages of 0 and 18 includes school health care in Hungary; the control of growth and the screening tests must be performed by family doctors, home pediatricians, school doctors, school dentists, and health visitors.

Answer 85

ANSWER A) circulatory diseases EXPLANATION according to mortality rates, deaths from circulatory diseases are more common among the Hungarian 65 to 74 year-olds compared to individuals over the age of 85 in the EU-15 countries (according to 2009 data: men: 44.5 %, Women: 44.6%).

Answer 86

ANSWER B) in the Northern and Southern Great Plains EXPLANATION The highest suidice rates could be observed among men and women over the age of 65 years in the two regions of the Great Plain.

Answer 87

ANSWER B) high blood pressure EXPLANATION According to data obtained from the Hungarian General Practitioners' Morbidity Sentinel Stations Program (GPMSSP), a very high incidence o high blood pressure (60-70%) can be seen among Hungarians aged 65+.

Answer 88

ANSWER D) birth before the termination of the 37th week during pregnancy EXPLANATION According to an earlier definition of the World Health Organization (WHO), premature birth was defined as the birth before the termination of the 37th pregnancy week or when the birth weight is below 2.500 g. However, the current WHO definition refers to premature birth when the birth take place before the end of the 37th week.

Answer 89

ANSWER B) men over 65 years EXPLANATION The risk of suicide in men over the age of 65 is the highest in Hungary; According to data of 2009, suicide rate was more than two and a half times higher than the EU average of the same age group and more than twice as high as the rate of deaths from suicide among Hungarian men under the age of 65

Answer 90

ANSWER D) Vitamin B12, vitamin D, folic acid EXPLANATION Sufficient intake of calcium and vitamin D in combination with exercise is a key factor in the prevention of osteoporosis and resulting bone fractures. Intake of adequate amounts of vitamin B12 and folic acid is necessary not only to prevent anorexia, but also to prevent the symptoms of neuropathy. The higher concentration of folic acid in plasma correlates with the improved cognitive performance observed among older people

Answer 91

ANSWER D) walking EXPLANATION The recommended exercise should be the walking, which duration and speed can be adjusted to the capacity of the patient and could be increased slightly with time. It wont put a great burden on the joints, it improves the patients’ endurance, no tools are required and can be easily integrated into everyday activities.

Answer 92

ANSWER C) child abuse EXPLANATION The learned helplessness develops through a sustained, prolonged loss of control, it includes the feeling of hopelessness, self-abandonment,and has other consequences, too (eg.decreased immune function, learning deficit.

Answer 93

ANSWER A) nicotine EXPLANATION The cardiovascular complications due to smoking are related to the activity of stimulant nicotine, which acts as an acetylcholine agonist.

Answer 94

ANSWER A) individual behavior is strongly influenced by family and friends EXPLANATION Human communities have a significant concious and non-concious impact on the behavior of their members. Individual behaviours which differ from the expected/acted behaviour of the community are not sustainable and, if maintained, often lead to social isolation. Thus, behaviour having a positive effect on health status can be most efficiently developed at community level by helping communities to increase their health awarness.

Answer 95

ANSWER E) all of them could be applied EXPLANATION Health education’s aim is to increase the individuals' health-related knowledge and skills by creating learning opportunities with adequate methods (individual and group meetings, live and recorded lectures, printed and electronic communication, websites).

Answer 96

ANSWER C) from 18.5 to 24.9 EXPLANATION The body mass index calculation formula is the following: body weight in kilograms has to be divided by the square of height in meters. According to the classification of the World Health Organization, the normal range is between 18.5-24.9. Those with BMI of 20-25 have the lowest risk of premature death. Under 20, the risk is increased in the industrialized countries. It seems that BMI below 20 does not play a causative role in higher mortality, but in this group the proportion of those who lost weight as a result of several diseases is higher. The BMI of Asian populations tends to be lower, consequently here a BMI value between 18.5-20.0 does not indicate an increased risk.

Answer 97

ANSWER C) Vitamin C EXPLANATION The hem-iron absorbtion derived from hemoglobin and myoglobin found in meat is hihgly effective. The absorption of inorganic non-hem iron is considerably worse, and is influenced by nutritional factors. The absorption of non-hem iron is inhibited by phytates, polyphenols and oxalates found in plant foods. High calcium intake also inhibits iron absorption. Vitamin C and fermented foods facilitate iron absorption. The role of vitamin C in iron absorption is so important that it can be considered as the physiological role of this vitamin. Each meal should contain at least 25 mg of Vitamin C, if iron-absorbtion inhibitors are present, even more. There are slight differences in the absorption of hem-iron, but the differences in the absorption of non-hem-iron could be as high as 20 times.. In the case of mixed diet, the absorbtion of the total iron content is approx.. 10%.

Answer 98

ANSWER B) mandatory enrichment of bread flour with folic acid EXPLANATION Folic acid is a general methyl donor involved in the synthesis of nucleic acids and amino acids as an enzyme cofactor. In the absence of folic acid, severe disorders in the homocysteine-methionine metabolism and damage of the cell proliferation occur. Folic acid deficiency during pregnancy cause an increased risk of closure abnormalities of the neural tube as well as fetal growth retardation, resulting in low birth weight. To prevent the consequences of hyperhomocysteinemia, it is recommended to consume folic acid fortified foods for the whole population. In order to reduce neural tube closure disorders in recent years fortification of flour with folic acid is mandatory in 60 countries, regarding the fact that almost half of the pregnancies are not anticipated and, consequently, the folic acid supplementation may start late.

Answer 99

ANSWER A) in America EXPLANATION Iinadequate iodine supplement is the lowest in America (10%) and the highest in Europe (50%) in the general population. Although the effective anti-iodine preventive intervention, iodising the salt was estabilished in the 1920s, in Europe, even today less than half of the households use iodised salt. Despite the efforts of recent decades, the inadequate intake of iodine remains a major public health problem in Europe, althought the severe mental impairment related to iodine deficiency is very rare.

Answer 100

ANSWER B) can induce hyperthyroidism EXPLANATION Too much iodine intake can cause hyperthyroidism; especially in the long-defective areas, it was found that at the beginning of iodine supplementation thyrotoxicosis rarely occured (so-called iodo-Basedow disease) in individuals over 40. Iodine is an essential component of thyroid hormones. In the absence of iodine growth- and developmental disorders, deafness, damage to the nervous system, slowing of mental activity, apathy could develop. Severe iodine deficiency during pregnancy and during early childhood causes developmental disorders and severe psychomotor disoerders. Cretens are characterized by severe mental retardation. Increasing metabolism due to hyperthyroidism can lead to weight loss.

Answer 101

ANSWER D) frequent consumption of salt-preserved foods EXPLANATION Frequent consumption of salted foods is associated with an increased risk of developing gastric cancer. The significant decrease in the incidence of gastric cancer in recent decades is due to changes seen in the preservation methods (traditional preservation methods was replaced by refrigeration) in the industrialized countries. Frequent consumption of very hot drinks causes an increased risk of developing esophageal cancer. Inadequate intake of dietary fibers and excessive alcohol consumption correlates with the development of colorectal cancer, not with gastric cancer.

Answer 102

ANSWER D) 30% EXPLANATION It has long been assumed that it does not make any particular difference what part of our energy needs is covered by proteins, fats and carbohydrates. Epidemiological studies of recent decades have clearly confirmed not only the importance of individual nutrients but also their correct proportions. According to the WHO recommendations, 15-30% of the energy intake should come from fat consumption. The increase of fat intake is mainly due to the consumption of food from animal origins (meat, milk), which is at the expense of the complex carbohydrate consumption. These so-called high-energy, western-type diets increase the risk of many chronic non-infectious diseases.

Answer 103

ANSWER D) can cause liver cancer EXPLANATION The oldest known mycotoxins are aflatoxins produced by Aspergillus flavus and Aspergillus parasiticus fungi. Aflatoxins are teratogenic, mutagenic and carcinogenic compounds and represent one of the major etiological factors of liver cancer in Africa. Cereals, oilseeds, beans and dried fruits can be infected with aflatoxin-producing molds, most commonly the contamination is affecting peanut, therefore peanuts can only be marketed after aflatoxin control.

Answer 104

ANSWER D) an immune system-mediated pathological response to one (or sometimes multiple) component of food EXPLANATION The food allergy is an abnormal immune response to the food which is often IgE-mediated (Type I hypersensitivity) or delayed cell-mediated reaction (IV type .). Mostly, specific antibodies can be detected in the serum of patients. Food allergy symptoms can not only affect the gastrointestinal tract but could cause skin symptoms, asthma or anaphylactic shock. The prevalence among the adult population is about 2%, while in children its more frequent, approx.. 8%. Lactose sensitivity or intolerance is a non-allergic pathological state, caused by the decreased functioning of the lactase enzyme, due to which the main carbohydrate component of the cow's milk, lactose can not be digested by the patients and this causes the gastrointestinal symtpoms.

Answer 105

ANSWER D) Campylobacteriosis EXPLANATION Campylobacterosis has been the most frequently reported gastrointestinal disease in the EU Member States and in Hungary since 2005. In recent years, the number of reported salmonellosis cases is declining in many countries, including Hungary, although it is still one of the most common causes of gastrointestinal infections, similarly to Campylobacter infections, which involves the most commonly infants (0- 4 years old).

Answer 106

ANSWER D) Toxic mushroom EXPLANATION Hospital admission is required if there is a suspicion of mushroom poisoning. In the other cases hospitalization is required only if the symptoms indicate it.

Answer 107

ANSWER A) To achieve the greatest possible health gain compared to the available resources EXPLANATION The definition of clinical efficacy is to maximize health gain compared to available resources. This can only be achieved through the efficient use of resources and the minimization of complications, but these are the indicators of clinical effectiveness not the definition of clinical effectiveness itself.

Answer 108

ANSWER A) risk group strategy EXPLANATION Population strategy of primary prevention includes preventive interventions for the whole population. There are no target groups here, information or interventions should reach everyone. The principle of the risk factor strategy is to identify individuals or groups with increased risk, and then aim these groups specifically with preventive services. Obviously, this strategy requires risk factor identification in order to select the target group properly

Answer 109

ANSWER C) the gap between GDP’s slow and the health care costs rapid growth EXPLANATION Mortality of chronic noncommunicable diseases did not grow intensively in the most industrialized countries in the second half of the 20th century, even a declining trend was observed related to cardiovascular mortality. The increasing trend in unemployment rate was not so intensive that it could affect the health care system itself. Informatics is not a crucial factor in the healthcare systems, on the contrary, it must adapt to the healthcare system as well as must serve its needs. The true reason was the very rapid growth of health care costs, which the GDP increase could not keep pace with. It was necessary to restructure the healthcare system, besides organizational changes rethinking its content was also necessary.

Answer 110

ANSWER C) quality EXPLANATION Market-oriented systems do not focus on democratic theorems but on the quality of service which comes closest to the mechanisms of the free market. The more restrictive regulation of market mechanisms is characteristic of socially sensitive systems which, however, are unable to provide a high quality level due to their limited resources.

Answer 111

ANSWER C) Canada EXPLANATION Formerly socialist countries have emphasized the accessibility and equality but were unable to sustain the proper quality (due to limited resources). The USA healthcare system was characterized by high quality, but this care was provided for narrower groups only. In Canada, the basic medical care is financed from taxes (a strong economic potential is available for this) and the additional treatments are financed mainly through additional insurances, so the Canadian healthcare system is considered as well organized.

Answer 112

ANSWER B) Politics (state) EXPLANATION Consumers and service providers are the two main participants of common consumer models. Obviusly these two participants are present in the field of health services as well. However, the health care consumer models are complemented with two other participants, namely with the financier (usually the health insurer, as the services are usually not obtained by the consumers directly) and wih the politics. Politics is the expression of state’s will related to healthcare.

Answer 113

ANSWER B) The spectrum of services offered by the service provider facilites EXPLANATION The healthcare provider is generally not interested in the question who is paying for its service. Furthermore, it not interested in the amount of self payment of the customer for receiving adequate service (of course, a too high self payment is not in the interest of the provider as it decreses the requisition of the service). Rather, the provider and the insurer have contrary interest in the spectrum of the services offered. Interest of the service provider is to offer as many types of service as possible (because it sells more and gets more reimbursed), while the insurer prefers a narrower range of the services because it has to pay less for less service.

Answer 114

ANSWER B) 5000 EXPLANATION Approximately 5,000 general practitioners (adult family doctors?) (and about 1,500 children family doctor) work in Hungary. Their number is almost identical to the number of practice districts, as the number of vacant practices in recent years has been around 150-200. In the near future, primary care will be severely challenged by the high rate of retirement of elderly GPs. The situation may be worsened further by the , increasing number of young doctors leaving the country (i.e. by the decrease of refill).

Answer 115

ANSWER A) the number of patients registered at the GP EXPLANATION GP practices are financed by a per capita basis in Hungary, so the financing is based on the number of registered persons. Nevertheless, a degression can be found in financing if the registered patients number exceeds a certain limit.

Answer 116

ANSWER D) Chronic care and treatment of pulmonologic patients EXPLANATION Pulmonary care institutions are dealing manily with providing care for pulmonological patients. The volume of X-ray screening has been decreased as the method is not effective enough for detecting lung cancers, and, on the other hand, the prevalence of TBC does not justify the regalur screening at populational level. On the basis of its experience and infrastructure the pulmonary care network performs complex screening services to enhance prevention and to utilize the capacities, but this is not its main activity area..

Answer 117

ANSWER A) The tasks related to blood provision is managed by the Hungarian Red Cross EXPLANATION The main principles of blood provision are the following in Hungary. The tasks related to blood provision are managed by the Hungarian National Blood Transfusion Service (HNBTS). Hungarian Red Cross participates in the organization of blood donations. Blood donation is voluntary, unlike in some countries where a fee is payed for donatng blood. Human blood and blood products could not be marketed.

Answer 118

ANSWER A) Primary Care EXPLANATION There is a relatively high proportion of physicians working in primary and outpatient care as enterpreneurs, while this proportion is below 10% in inpatient care and is mainly restricted to specific occupations and duties. Proportion of enterpreneurs working in outpatient care is between 50% and 70% (with a higher proportion in the case of dentists), while the majority of primary care physicians (around 85%) are entrepreneurs.

Answer 119

ANSWER B) contribution is in relation to income, care is based on needs; the care is granted for those who are paying the contribuition EXPLANATION In Bismarck’s health insurance system, insured persons pay a contribution (in proportion related to their income) and therefore receive care according to their needs. The system is based on the principles of solidarity (for the insured), because the care does not depended on the amount of contribution paid but the entitlement is granted by the fact of paying contribution). The Beveridge system is characterized by the theorem that health care costs are financed by taxes and care is granted for everyone. In the case of risk insurances, the contribution payment is related to the risk and the services chosen.

Answer 120

ANSWER A) 6-7 minutes EXPLANATION Based on Hungarian statistics, general practitioners serve 8-10 patients per hour in general, i.e. 6-7 minutes fall on one patient.

Answer 121

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Development of organizational framework of healthcare is not a public health objective; since in this field only supporting the planning is a task of the public health to ensure the general availability.

Answer 122

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Development in the field of microbiology, immunology and pharmacology bring forth the qualitative changes (improvements) of “new age”/modern epidemiology. These findings include the identification of pathogens, discoveryof the body's reactions against them and the discovery ofchemotherapeutics (antimicrobial drugs).

Answer 123

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION All components were mentioned in the definition created by Stokes et al., except the absence of polymorphism, which does not exist at individual level.

Answer 124

ANSWER C) answers 2 and 4 are correct EXPLANATION Primary prevention’s aims are to maintain general health, to prevent health loss and diseases. Primary prevention aims at eliminating the potential disease sources (etiological and /or risk factors) completely or partially or forming and increasing the resistance against them. Screening programs for an early detection of the disease are considered as secondary preventive interventions.

Answer 125

ANSWER E) all of the answers are correct EXPLANATION Epidemiology is a scientific field that observs the distribution and changes of those determinants that influence the health-related states or events in a given population in order to use its findings in the field of health promotion, disease prevention, medical care and rehabilitation.

Answer 126

ANSWER E) all of the answers are correct EXPLANATION The study of health related states and determinants is always carried out in a given - well-defined - population. Such a population may be a group of individuals belonging together or merged on the basis of their unique/specific characteristics (eg pupils of a particular grade of a given school, workers or other employees of a particular factory or other the institution, people who have been treated with a certain surgical procedure). Alternatively, a population may be formed by the residents of a given administrative unit (eg the inhabitants of a country/region/county/settlement at a given time or interval.

Answer 127

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION The basic data of structural demography is provided by the census that counts all individuals on the basis of well-defined structural characteristics for a given time. Censuses are usually conducted in every 10 years in developed countries. Investigations of the ongoing changes between two censuses are based on the data obtained from calculations using extra- and interpolational methods. The ongoing changes can also be examined by analysises conducted on representative samples (1-5% of the population; microcensuses). The traces of censuses can be detected in the ancient times. Modern censuses are conducted since the 17th-18th century. The first census was implemented in Hungary due to the will of József the 2nd between 1784 and 1787 while the next census was. only in conducted in 1869. Since then, censuses are usually conducted in every 10 years.

Answer 128

ANSWER E) all of the answers are correct EXPLANATION Ecological studies are a specific type of descriptive epidemiological studies which examine population level connections of characeristics on the basis on aggregated data by evaluating correlation indicators. Consequently, ecological studies are also called correlational studies. The two names emphasize different features of the same method. The term “ecological study” indicates that the examination is based not on individual data but on the average parameters of populations (or their subgroups). The term “correlation study” indicates that the direction and the strength of the correlation is described by correlation coefficients or regression equations. Results of the ecological studies are usually presented on scatter diagrams.

Answer 129

ANSWER B) answers 1 and 3 are correct EXPLANATION Analytical studies mainly focus on "why" type questions: they examine and test hypothetical relationships, identify the influencing (risk or preventive) factors, measure the role (significance) of the risk factors in the development of the phenomenon (risk). The two basic types of analytical epidemiological studies are the case/control and cohort studies, which primarily aim is to elucidate the etiological background of the diseases (occurring events)

Answer 130

ANSWER D) only 4 is right EXPLANATION Based on the information needs and data sources the following types of surveillance can be defined: 1. Mandatory reporting system (E.g. infectious diseases, occupational diseases).They are needed when the report requires some sort of intervention. Consequently, the content of the report is defined in detail according to the conditions of the intervention. 2. Monitoring based on laboratory results. (E.g.: Monitoring of antibiotic resistance) By regularly evaluating the results of microbiological laboratories, changes can be monitored relatively simply and effectively even at institutional level.3. Disease (group) specific registry (E.g .: tumor register, register of developmental malformations) Tools that register every diesease of a certain population, which use exact definition for the cases, collects detailed informations and often enable follow up of patienst. These tools require relatively large amounts of resources and rarely contain information regarding determinants of health. 4. Voluntary reporting (E.g.: Family doctor monitoring systems in regard to certain illnesses ,prevalency and quality of care; the General Practitioners Sentinal Station Programme operated by the Faculty of Public Health of the University of Debrecen). Ocassionally for operating the monitoring system such information is needed that goes beyond the routine information requirements and which is not required by law and requires additional work and commitment of the data providers.. In these cases it is advisable to generate a longer list from voluntary data providers, from whom a representative survey group can be set up. 5. Surveys (eg: National Health Interview Survey in 2000 and 2003, the European Health Interview Survey, 2009) These can be interview based, where the knowledge related to health, attitude and actions towards health as well as and experiences with the healthcare system and the health status based on self-assessment can be evaluated. It may require more resources, but the final data will be more reliable if this is combined with objective measurements as well. 6, Utilising databases of other information systems. (E.g.: Database of the National Health Insurance Fund, IT databases of healthcare providers.) These systems are primarily not for monitoring morbidity; the data content is generally insufficient for the monitoring, their data quality is often insufficient, its reliability varies from one provider to another, as institutional diagnostic and coding methods vary. We can get misleading results if we use these databases without taking into account these limiting factors. 7. Monitoring Warning Events (eg diagnosis of Mesothelioma) This method can be used in the case of rare diseases that are connected to a risk factor in a very specific way and are automatically linked to a certain intervention..8. Combining custom data from databases (individual IDs can be used to connect different databases. In a pooled database of linked exposure and health data, little effort is required to detect specific connections. It is a very potent method in regard to data utilization, however this possibility is very limited in certain countries due to legisislation. It is also useful to determine the reporting discipline of some registries.) 9. Combined Monitor (Eg .: Northeastern Hungarian Health Observatory) We can create a more complete picture of a disease by evaluating the results of multiple monitors together, for example if combined evaluation of mortality, morbidity and the quality of care data is possible.

Answer 131

ANSWER E) all of the answers are correct EXPLANATION An indicator can be considered as well defined, when it can be easly interpreted, it is connected to intervention possibilites, correlates with other indicators, is timely, can be produced in all study populations, its raw data originate from reliable data sources, does not need too many resources, its calculation is based on standardized methodology, it reflects reality in a valid manner, its values are comparable in different populations, and is related to a real public health issue.

Answer 132

ANSWER E) all 4 answers are correct EXPLANATION For healthcare websites, the following quality criterias can be formulated regarding user protection: 1. Transparency (It is generally expected that the website must contain the exact name, the postal and electronic address of the service provider, the target group of the publication , the aim of the site and a listing of the a participants in the development of the webpage, as well as its supporters.) 2. Authenticity of the data source (The website must display the data that enables user to identify the authors of the site,it must also display the sources of the published information together with the date of publication. If the use of any methods, medicine or devices is recommended by the website, then it must be indicated that the recommendation does not replace the personal advice of professionals. Date of the last update must be also shown on the website.) 3. Responsibility (It must provide options for user feedback, it also has to indicate who will be responsible for answering these user inputs.).

Answer 133

ANSWER C) answers 2 and 4 are correct EXPLANATION The relationship between treatment threshold and benefit: treatment threshold = risk /( benefit + risk) = 1 / [benefit / risk +1]

Answer 134

ANSWER E) all statement are correct EXPLANATION As for men, the average life expectancy at birth calculated on the basis of annual mortality indicators decreased slightly between 1988-1993 - which was a unique phenomenon in Europe. On the contrary, slightly but consequently increasing trend has been observable in case of women since 1980. However, in both genders this indicator is far behind the same indicators of not only the most developed countries, but also of Czechia and Poland, the previous sister states showing similar historical fate. When comparing the Hungarian indicator regarding the average life expectancy to that of the male and female population of Austria (a country that has similar geografical location and - apart from the second half of the 20th century similar history) the lagging behind was showing a constantly increasing trend from 1980 to the millenium and has been stable since that. This lag was 7.9 years in case of men and 5.1 years in case of women in 2008.

Answer 135

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION The tenth, currently valid revision of the ICD was implemented on 1 Jan 1996. The 11th revision of ICD is currently in progress and the expected year of its completion is 2014. The revisions have been supervised by the WHO since 1948. One of the most important elements of revision is to specify better the class boundaries rather than to erase them.

Answer 136

ANSWER C) Answers 2 and 4 are right EXPLANATION Based on National Registry on Cancer data, the following malignancies were the most frequently diagnosed in Hungary in 2009: for men, bronchial and lung cancer (19.5%), cancer of the the lips, the oral cavity and the pharynx (10.5%) , colorectal and anal cancer (10%). In case of women, breast cancer (21.5%), bronchial and lung cancer (12%), colorectal and anal cancer (8%), and cervical cancer (4%). The percentage distribution indicates the order in both sexes.

Answer 137

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Sizes of risk factors among the aetiological factors for men: lifestyle factors 35%, smoking 30%, sunlight 10%, occupational exposure 5%, alcohol 5%.

Answer 138

ANSWER B) answers 1 and 3 are correct EXPLANATION N-nitroso compounds, which are formed in the intestinal tract from nitrites and nitrates, may be involved in the development of esophageal, gastrointestinal, bowel and bladder cancers. Low-fibre diet is a factor that increases the risk of developing colon cancer. Flavonoids and beta-carotene have a protective effect.

Answer 139

ANSWER C) Answers 2 and 4 are right EXPLANATION Breast cancer screening (mammography) is performed biannually for the age group 45-65 in Hungary

Answer 140

ANSWER B) Answers 1 and 3 are correct EXPLANATION The relationship between being overweight/obese and the onset of coronary heart disease was confirmed by the North Karelia project and the Framingham Heart study. The National Cholesterol Education Committee deals with the risk-increasing effects of cholesterol in the aspect of causing coronary heart disease, whereas the name of the most restricted fat intake reducing diet is Pritkin-Ornish.

Answer 141

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Earlier start and more freuqent screening is suggested for individuals whose BMI reaches or exceeds 27 kg/m2, who has straight-line relatives with diabetes, who have offspring(s) with a birth weight over 4 kg, who have have 2.9 mmol or higher triglyceride levels and/or have decreased HDL cholesterol level (0.9 mmol/l or lower). According to the recommendation regular diabetes screening based on assesing fasting glucose is suggested for persons above the age of 45. In case of a normal test result, repetition of the test on a three yearly basis seems to be appropiate

Answer 142

ANSWER A) Answers 1, 2 and 3 are correct EXPLANATION The main risk factors of osteoporosis are: decrease in estrogen production, physical inactivity and smoking. D-hypervitamonis causes bone alterations characterized by increased calcification.

Answer 143

ANSWER E) all of the answers are correct EXPLANATION Diseases of the liver and cirrhosis are responsible for 80% of premature death caused by gastrointestinal disorders in Hungary. Approximately 80% of these diseases has an alcohol-related origin, their high prevalence can be explained by the amount and quality of alcohol consumed (consumption of alcoholic beverages contaminated by aliphatic alcohols and obtained from illegal sources)

Answer 144

ANSWER E) all 4 answers are correct EXPLANATION The strategy of preventing accidental injuries and accidental deaths is basically not a designed public health field. Haddon's technical accident control strategy is consisted of ten, logically coherent strategic steps, which describe safe designing of the vehicles, traffic areas, etc. Literature is using the term injury controll mostly instead of using the term accident prevetnion (eg the safety belt is for accident prevention, but it can also cause injuries)

Answer 145

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION The literature distinguishes five strategic groups of interventions related to suicide prevention. These include all methods except the employmet of persons with mental disorders.

Answer 146

ANSWER B) answers 1 and 3 are correct EXPLANATION IPV is a vaccine containing inactivated polyoviruses which should be given intramuscularly. The administration of the vaccine (containing also other components) takes place in age-related manner according to the vaccination regulation is performed that is effective in Hungary since 1 January 2010. The vaccine contains other components as well. The vaccine containing the components of DTPa (diphtheria, tetanus, acellularis pertussis), IPV (inactivated polyovirus vaccine) and Hib (haemophilus influenzae b) together must be given to childrem of 2, 3, 4 and 18 months afe, while DTpa and IPV vaccination must be given at the age of 6 years (this is the last IPV vaccination).

Answer 147

ANSWER C) answers 2 and 4 are correct EXPLANATION If botulism infection is suspected, samples of food leftovers and blood must be sent to the laboratory. The bacteria and toxins can be detected from food leftovers while the toxin absorbed and entered the circulation can be detected from blood samples. Sending feces samples does not make sense due to the fact that the symptoms are caused by swallowed and absorbed toxins.

Answer 148

ANSWER E) all of the answers are correct EXPLANATION The listed diseases may be transmitted by the faeco-oral route and by body fluids, consequently, continuous and final disinfection is needed in order to prevent the infection from spreading. Final disinfection with more strict regulations has to be carried out in case of cholera infection.

Answer 149

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Unreporting must be done in case of long lasting changes effecting any organ, complications or fatal outcome.

Answer 150

ANSWER D) only 4 is right

Answer 151

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Clearing examinations are needed in the following infections: 1. Salmonellosis. After recovering, a fecal bacteriological control (release) test should be carried out only in persons who attend communities of children of 0 to 3 years, who are receiving care in social or health care institutions and who are working with breast milk or are giving breast milk. These persons are allowed to continue their activity in case of having two normal stool tests on two consecutive days started two days after the clinical recovery. 2. Typhus abdominalis. The patient should be isolated until tests conducted on fecal and urine samples on 3 consecutive days starting 48 hours after the cease of the clinical symptoms and the end of the antibiotic therapy give negative results. If only one of the tests gives positive result then the isolation may be discontinued, but the patient should undergo a clinical observation until the pathogen shedding/carrying is ceased. 3. Cholera. The patient cured from cholera have to be isoleted until bacteriological stool tests on two consecutive days starting 48 hours after clinical recovery and end of the antibiotic therapy give negative result. 4. After the recovery of infection with Yersiniosis no mandatory release tests are required.

Answer 152

ANSWER C) answers 2 and 4 are correct EXPLANATION ETEC = Enterotoxic (or enterotoxigenic) E. coli. Its toxins paralyze the Na + -K + pump in the epithelial cells of the intestinal wall, so the infection cause profuse cholera-like diarrhoea. As with most coliform infections, asymptomatic shedding is also possible. Coli infections may also occur in the form of EPEC (enteropathogenic E. coli, intestinal mucosal degeneration) and EIEC (enteroinvasive E. coli, dysenteria-like symptoms, mainly attacking the colon) in Hungary. Beyond the above forms, enteroadhesive, enterohaemorrhagic and enteroaggregative E. coli groups are also known but these forms appear in Hungary never or on very rare occasions.

Answer 153

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION As specified in various acts, screening tests should be performed in certain jobs in order to detect syphilis, gonorrhea and HIV infection to prevent the transmissions of these diseases.

Answer 154

ANSWER E) all of the answers are correct EXPLANATION After the virus has entered the central nervous system, it begins to grow intensely and then travels along the efferent nerves to all organs. As a result of this, it will appear in all tissues and - listed - excretions.

Answer 155

ANSWER B) answers 1 and 3 are correct EXPLANATION Active immunization is used against meningitis epidemica, which is mandatory in certain occupations (eg laboratory technicians), otherwise it is recommended, especially for those who are more susceptible. Active immunization is available against pneumococcus meningitis (free of charge for those younger than 2 years old) which is highly recommended for those with increased risk.There is no active immunization against scarlet fever and legionellosis.

Answer 156

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Among the listed pathogens, HPV participates in the development of cervical cancer, HBV and HCV could cause liver cancers; while HAV is not a carcinogenic virus.

Answer 157

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Patients infected with meningitis epidemica or parotis epidemica must be isolated in rooms for infectious diseases. Patients infected with scarlat fever must be isolated at their own home or at rooms for ifectious diseases. The reason behind the isolation is that all three types of diseases are transmitted by humans. Since the transmission of the two forms of Legionellosis from humans to humans does not play a role, the isolation is not necessary in these cases.

Answer 158

ANSWER E) all of the answers are correct EXPLANATION People who were in direct contact with the patient infected with any of the four listed diseases should receive antibiotic prophylaxis.

Answer 159

ANSWER D) only answer 4 is correct EXPLANATION Blocking the hospital admissions in the case of meningitis epidemica is necessary, because the probability of transmission of the pathogen is 50. For this reason, persons entering the area (hospital ward) are exposed to an increased risk of being infected. Moreover, admisson blocking is justified by the high lethatility of the disease which is 70% without antibiotic therapy, 15-20% with antibiotic therapy. For the other three diseases admission blocking is not necessary.

Answer 160

ANSWER E) all of the answers are correct EXPLANATION In all listed diseases cats may be the sources of infection although the frequency may vary. The role of cats is less important in the transmisson of Q fever and tularemia than the role of other animals. Cats belong, however, to the most important sources of Rabies; the most recent lethal Rabies cases were due to cats because of the late diagnosis of the infections The role of the cats in the transmission of toxoplasmosis should be especially emphasized. Toxoplasmosis is a teratogenic infection. Since 10-15% of cats - and not only those living free but also the domestic ones - are constantly infected with Toxoplasma and shed the pathogens with their feces, pregnant women should avoid direct contact with them.

Answer 161

ANSWER E) all of the answers are correct EXPLANATION All waste types listed - radioactive waste, waste containing more than 40% chlorine, those which cause the formation of carcinogenic substances during their burning, which have a heavy metal content of more than a few percent are not permitted to deal with in waste incinerators. These wastes must be preserved/settled in special waste cemeteries.

Answer 162

ANSWER D) only answer 4 is correct EXPLANATION Chronic effects of benzene could cause hematopoietic tumors, leukemia. Vinyl chloride could cause hemangiosarcomas, benzidine could cause bladder cancer, while nitrosamine exposure could cause stomach cancer.

Answer 163

ANSWER C) answers 2 and 4 are correct EXPLANATION High concentrations of phosgene and fluorine could cause irritation in the respiratory tract during their acute toxication and eventually could cause lung oedema. Ethylene as asphyxiant gas at high concentration in the air, could cause hypoxia which could result in suffocation due anoxia. Hydrogen sulfide - although it irritates the airway mucosa - could cause hyperpnoe, spasms, loss of consciousness and eventually coma.

Answer 164

ANSWER E) all 4 answers are correct EXPLANATION All listed plants are able to accumulate cadmium absorbed from the soil, their consuming (smoking, eating) leads to chronic metal exposition. This represents a particular danger, especially when the Cd content level is high in the soil mainly due to industrial activity.

Answer 165

ANSWER E) all 4 answers are correct EXPLANATION All four types of waste listed - such as livestock manure, pesticides that are not used for plant protection, wastes generated by health care activities and household chemical products - are considered as hazardous wastes due to the infectivity and / or toxicological effects.

Answer 166

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION The first three symptoms (bronchospasm, bradycardia, pinpoint pupils) are muscarine-like symptoms, therefore they can be mitigated by atropine, while the fourth symptom, the spasm of the respiratory muscles, as being a nicotinic answer, could not be treated with atropine.

Answer 167

ANSWER B) answers 1 and 3 are correct EXPLANATION Cadmium and chromium have mutagenic effect in humans, while cobalt and lead do not have any mutagenic effect in humans.

Answer 168

ANSWER E) all 4 answers are correct EXPLANATION Employing pregnant women exposed to any metal listed is contraindicated

Answer 169

ANSWER B) answers 1 and 3 are correct EXPLANATION The London-type smog is considered as reducing smog, the following chemical components play roles in its mechanism of action: carbon dioxide, carbon monoxide, sulfur dioxide. Nitrogen oxide and UV radiation are not involved in thise mechanism, these component are the preconditions of the Los Angeles-type oxidative smog.

Answer 170

ANSWER C) answers 2 and 4 are correct EXPLANATION Silicosis has been a well-known and proven predisposition to the development of tuberculosis. Due to the increased load on the heart, the formation of cor pulmonale is also a typical complication of advanced or long term silicosis.

Answer 171

ANSWER C) Answers 2 and 4 are right EXPLANATION The relationship between asbestos exposure and mesothelioma is important because mesothelioma is considered as a rare tumor and almost exclusively develops due to exposure to asbestos. Asbestos can also cause lung cancer, but it is not associated with the development of lymphoma and pancreatic cancer.

Answer 172

ANSWER B) answers 1 and 3 are correct EXPLANATION Chronic benzene exposure damages the hematopoietic system, causes aplastic anemia and reversible pancytopenia. Although the production of different cell types is damaged at different level, all hematopoietic changes may indicate benzene toxication. The most serious complications of chronic benzene exposure are the acute or possibly chronic myeloid leukemia.

Answer 173

ANSWER B) Answers 1 and 3 are correct EXPLANATION The carbamate pesticides inhibit of acetylcholinesterase reversibly, while the organic phosphate esters inhibit the enzyme irreversibly. Therefore, carbamate and thiocarbamate poisoning are generally less severe than poisoning caused by organic phosphate esters, but both are dose-dependent.

Answer 174

ANSWER A) Answers 1, 2 and 3 are correct EXPLANATION PCBs accumulate in the food chain due to their accumulation in animal and human adipose tissue, and are excreted in breast milk. They induce the microsomal enzymes of the liver. The population is mainly exposed to PCBs orally by means of food.

Answer 175

ANSWER B) Answers 1 and 3 are correct EXPLANATION Periodic medical examination of those working under benzene exposure involves biomonitoring based on metabolites that includes measuring the urinary concentrations of phenol and muconic acid.

Answer 176

ANSWER D) only answer 4 is correct EXPLANATION Stochastic effects are those effects the frequency and probability of which increses on elevating the doses, more precisely the dose equivalent value. There is no threshold dose in the case of these effects, and the dose-response curve runs through the origo (zero point). A typical example of the stochastic effects is the carcinogenic effect.

Answer 177

ANSWER C) Answers 2 and 4 are right EXPLANATION Acute acoustic trauma develops due to a single high intensity noise which is not accompanied by significant pressure fluctuation. Therefore, only the inner ear is being damaged and the outer and middle ear will show no abnormal changes. The acoustic damage is perceptual, irreversible, effects the high-frequency sound range as one-sided due to the shielding effect of the head. Mostly it is caused by the firing of firearms.

Answer 178

ANSWER B) answers 1 and 3 are correct EXPLANATION The level of education, like the social status, is an important influencing factor of health status, as it has a positive effect on most indicators describing health status. The positive effects of education on health status are achieved through various mechanisms: higher educated people acquired more (background) knowledge during their studies; by the help of their comprehensive skills they can find and understand better health-related knowledge; because of their wider access to resources, they can reduce their health risks better and, if necessary, have access to health services relatively easier.

Answer 179

ANSWER E) all of the answers are correct EXPLANATION Preterm birth is more than five times higher among women with elementary school qualification than in mothers with a university degree. It is more common among adolescent mothers. Risk factors of preterm birth are the followings: previous artificial abortion, multiple earlier pregnancies, infections, diabetes and hypertension as chronic non-communicable diseases.

Answer 180

ANSWER E) all 4 answers are correct EXPLANATION The incidence of those diseases is high in the elderly, which are not so important as the direct cause of death but severely impair the life quality. The most common sensory changes are the ones effecting the vision (refraction disorders - presbyopia, cataract), hardness of hearing (presbyacusis), and loss of equilibrium (vestibular disorders).

Answer 181

ANSWER B) Answers 1 and 3 are correct EXPLANATION Chemical components of tar are responsible for the carcinogenic effects of smoking, including nitrosamines (eg nitrosonornicotine) and benzpyrene, which have been declared carcinogens based on data obtained from International Agency for Research on Cancer (IARC).

Answer 182

ANSWER E) all 4 answers are correct EXPLANATION Vitamin A is essential for the following functions: vision, intactness of cornea, skin and mucous membranes, reproduction and growth. In the absence of vitamin A hemeralopia, xerophthalmia, keratomalacia, complete blindness as well as skin and mucosal lesions could occur. The immune system is damaged, infections are more common and the outcomes are more severe, growth slows down.

Answer 183

ANSWER B) the correct answers are 1 and 3 EXPLANATION In the absence of vitamin B12 (cobalamin), megaloblastic anemia and severe neuropathy develop. Vitamin B12 can only be synthesized by microorganisms. In humans, cobalamin is absorbed in the lower part of the ileum, with the help of gastric intrinsic factor secreted by the stomach. Atrophic gastritis is common among the elders, which causes vitamin B12 deficiency due to decreased secretion of gastric juice. All food of animal origin (liver, meat, fish, egg, milk and dairy products) contain vitamin B12, but plant foods do not contain vitamin B12, therefore a vegetarian diet, especially the rather rigorous vegan diet posesa risk of vitamin B12 deficiency. Folic acid deficiency does not cause the symptoms of vitamin B12 deficiency, but in the absence of vitamin B12, no formation of biologically active tetrahydrofolic acid occurs.

Answer 184

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION The main factors increasing the risk of obesity are the sedentary lifestyle, the increased consumption of high-energy foods, the increased consumption of fast-food menus and sweetened soft drinks. Regular exercises and a home/school environment supporting healthy alimentation help to maintain optimal body weight. Regular consumption of foods with low glycemic index (legumes, vegetables, whole grains) are considered as protective factor in the aspect of obesity. Especially high prevalence of obesity could be seen among women with poor social status in developed countries.

Answer 185

ANSWER E) all of the answers are correct EXPLANATION According to the World Health Organization, overweight and obesity are the second most important preventable risk factors after smoking. They play an important causal role in the development of hypertension, cardiovascular diseases, cerebral vascular diseases (stroke), type 2 diabetes. It’s a risk factor for many cancers (breast, endometrium, kidney, colorectal carcinoma, pancreas, esophagus).

Answer 186

ANSWER E) all 4 answers are correct EXPLANATION Type 2 diabetes develops through the interaction of genetic and environmental factors. A typical diabetinogenic diet has high energy density, contains high amount of saturated fat and low amounts of dietary fibers. In epidemiological studies strong correlation was found between the increase of body mass index (especially central obesity) and the development of type 2 diabetes. Worldwide, 44% of diabetes risk is attributed to overweight and obesity. Daily intense physical activity or sports activity increases insulin sensitivity and thus reduces the risk of diabetes.

Answer 187

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Excessive alcohol consumption increases the risk of oral, pharyngeal, laryngeal, esophagus, liver, colon, rectum and breast cancer, therefore cutdown of alcohol consumption is recommended. Breastfeeding has a positive effect on the mother as it reduces breast cancer risk and is beneficial to the baby as it reduces the risk of adult obesity and therefore the development of many cancers. The beneficial effect of increased fruit and vegetable consumption is due to the fact that they contain high quantities of dietary fibers, vitamins, minerals and other phytochemicals. The protective effect of milk consumption was observed against the development of colorectal cancer.

Answer 188

ANSWER E) all 4 answers are correct EXPLANATION In case of mushroom poisoning the main components of the first aid are the induction of vomiting and / or performing gastric lavage as soon as possible after the consumption of mushrooms. People suspected of having mushroom poisoning are also advised to be hospitalized even in case of having only mild symptoms because the person who picked the mushrooms could collect other species too, including not only moderately harmful ones with short latency and early symptoms but also lethal ones with longer latency (eg death-cup). If poisoning is suspected, further consumption of the food containing mushroom components must be prohibited, the rest of the food, the kitchen cleaning waste, a portion of the gastric lavage fluid and the vomit, respectively should be sent for laboratory testing. For the prevention of mushroom-induced poisoning the most important task is the examination of the collected mushrooms by a mushroom expert.

Answer 189

ANSWER E) all 4 answers are correct EXPLANATION The PDCA acronym used in quality improvement consists of the initials of the English words plan, do, check, act. It refers to the quality improvement cycle that consists of planning (necessary changes, preparation and planning of interventions), action (implementation of changes), control (impact assessment) and feedback.

Answer 190

ANSWER E) all 4 answers are correct EXPLANATION All 4 areas listed in the question (support for health-oriented decision-making in all public areas, ensuring equal access to health care for all, health protection ad promotion, prevention, detection and treatment of specific health problems) are the main areas of health policies in most countries of the world. It should be noted that the term policy in health policy is used as the way to achieve certain goals.

Answer 191

ANSWER B) answers 1 and 3 are correct EXPLANATION The essence of an insurance system based on solidarity (also called Bismarck's insurance system), is that everyone pays contribution in proportion to their income, and when they are sick, they receive care that meet their needs. The system is therefore not for-profit and basically offers equal possibilities to the contributors, as the benefit does not depend on the amount of the contribution made. At the same time, contributors have no interest in health preserving lifestyle because they have no financial benefits in regard to neither contributions paid nor services used. The system is unable to provide the most up-to-date (and most expensive) care options for all, as this can not be financed by the contributions.

Answer 192

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION Act LXXXIII of 1997 lays down five principles for the regulation of health insurance in Hungary: health services can be used to an extent justified by the health conditions under the law (the service is independent of the amount of the contribution); Cash benefits may be used in proportion to the health insurance contribution (eg sickness benefit); Healthcare services offer the same professional services to all people entitled to healthcare (equal opportunities); the state ensures the fulfillment of the statutory services from the state budget, even if the necessary expenses cannot be covered by the health insurance (state commitment); the authorities carrying out the health insurance tasks inform the insured persons of their rights and obligations and assist in enforcing their claims (right to information). The principle of progressivity does not appear here, it can be found among the principles of the act CLIV (1997) regarding health care.

Answer 193

ANSWER A) answers 1, 2 and 3 are correct EXPLANATION While the first three areas / institutions are the responsibility of the State Secretariat for Healthcare, the Regional Office of WHO is not supervised by them, but they coordinate the cooperation with it.

Answer 194

ANSWER C) 2 and 4 are correct EXPLANATION The European Union has implemented a number of joint action programs in the field of health in the context of closer integration. The EU published a White Paper in 2007 estabilishing the health strategy for 2008-2013. The three main objectives of this publication were: protecting health in the aging Europe, protecting citizens from health threats, supporting dynamic health care systems and supporting new technologies.

Answer 195

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Both statements are correct, and there is a cause-and-effect relationship between them. A large-scale prevention program very often cause significant improvements in the incidence/prevalence of multiple diseases. North Karelia programme could be consideres as an example, because its main aim was to reduce the rate of premature death due to cardivasvular diseases and was launched by the Finnish government in the early 1970s. Since the program - among other things - was aimed at promoting a healthy diet and the reduction of smoking, it has made significant improvements in deaths caused by cancer-related diseases (more than 25 years after the start of the program, premature death resulting from cardiovascular diseases decreased by 60% and premature deaths due to cancer decreased by 40%).

Answer 196

ANSWER E) both are wrong EXPLANATION The first and second statements are both wrong. Breast cancer mortality among Hungarian women exceeded the EU15 average by 14% in 2007. Breast cancer screening was introduced in Hungary in 2001.

Answer 197

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Both parts of the statement are correct, and there is a cause-and-effect relationship between them. Breast cancer and ovarian cancer cases show occasionally familial accumulation that is caused by mutations of the BRCA1 / BRCA2 genes.

Answer 198

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION The potential carcinogenic effect of androgens came up due to an increased incidence of hepatoma (and not prostate cancer) in bodybuilders, but the correlation was not confirmed either in this case.

Answer 199

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both parts of the statement are correct, but there is no cause-and-effect relationship between them. The fact that women in the premenopausal period are less prone to hypertension can be explained by the protective effect of estrogens. The phenomenon that the effect of predisposing genes in women becomes effective later is also due to the estrogens.

Answer 200

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both parts of the statement are correct, but there is no cause-and-effect relationship between them. The increase in the prevalence of obesity in the industrialized countries can be explained by the fact that a positive change in the social status first causes changes in dietary habits and the prevalence of obesity increases due to the spread of high-calory diets.

Answer 201

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The most common causes of deaths are the cardiovascular diseases in Hungary, but it is true that more than 80% of deaths due to gastrointestinal diseases are caused by liver diseases in Hungary.

Answer 202

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION Gastric ulcers develop in about 80% of the cases due to H. pylori infection, but it is estimated that more than half of the world's population (about 65% of the population of Hungary) is infected with this pathogen.

Answer 203

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both parts of the statement are correct, but there is no cause-effect relationship between them. The World Health Organization (WHO) estimates that 25% of the population in developed and developing countries exhibit mental illnesses or behavioral disorders during their lifetime. The most frequent disorders within this disease group are depression, schizophrenia and Alzheimer's disease.

Answer 204

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION The statement is true because vaccines are effective in the prevention of infectious diseases. The reasoning is also correct, but does not explain the statement, rather the relationship is vice versa: Vaccines belong to primary prevention tools (based on the definition of primary prevention) because they reduce the incidence of infectious diseases.

Answer 205

D) The first is wrong, the second is correct in itself EXPLANATION Because the vaccine may have effects on the fetus, pregnant women will only be vaccinated if it is certain that the vaccine will not cause any complications to the fetus, or if there is a serious situation (eg. rabies) so that it is absolutely necessary to vaccinate the mother. During pregnancy, live vaccines are the most dangerous, toxoids or genetically modified vaccines are generally harmless. Do not use inactivated vaccines as they are much more reactive than the toxoid type (although there is a difference between the reactogenicity of each vaccine).

Answer 206

ANSWER A) both are right, they have a causal relationship between them EXPLANATION The prevention of tetanus is achieved by age-related mandatory vaccination. If atetanus infection is suspected (broken, torn, deeply soiled wound, etc.), the victim should be vaccinated in addition to the appropriate surgical care as follows. If they received both primary immunization and revaccination and the last vaccination was received within 5 years, a vaccination is not required; when 5 or more years have passed, tetanus toxoid should be given. ; If 10 years or more have passed since the last revaccination and the wound is heavily torn, contaminated with soil, contains a foreign body or the patient has lost blood, is in shock, a large area ofthe skin is burned, is damaged with nuclear radiation, than both active and passive immunization (toxoid and human tetanus immunoglobulin) is required. B - both are correct, but there is no cause-and-effect relationship between them

Answer 207

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION In case of suspected hepatitis infection, the person should preferably be passively immunized within 24 hours. A specific immunoglobulin-containing vaccine (eg HBIG) should be used, γ-globulin formulas are insufficient because these do not contain enough antibodies to hepatitis B due to the low rate of infection of the population. In general, it should be noted that γ-globulin reflects the overall antibody level of the general population, so it can be effective against diseases (eg, hepatitis A) that infected a significant proportion of the population (this is also possible in asymptomatic form).

Answer 208

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both statements are true, but there is no causal relationship between them. It is noteworthy that Clostridium perfringens produces its toxins in the gastrointestinal tract and not in food.

Answer 209

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION Iodine-based disinfectants are still widely used today, but unlike in earlier years, they contain varoius complex iodine compounds instead of iodine tincture. They are non-irritant but may cause allergic reactions in certain cases.

Answer 210

ANSWER E) both are wrong EXPLANATION Only the most serious, highly infectious diseases must be reported by telephone calls (diseases listed in the regulation). Most infectious diseases that have to be reported do not require immediate actions by the epidemiological authorities which would indicate telephone notification.

Answer 211

ANSWER E) both are wrong EXPLANATION The toxin of Staphylococcus aureus is heat resistant so the disease can not be prevented by boiling foods.

Answer 212

ANSWER A) both are right, they have a causal relationship between them EXPLANATION In the case of sexually transmitted diseases, it is possible that in homosexual / heterosexual relationships, one of the partners has already been infected with several pathogens, thus these can be transmitted simultaneously to the unaffected (healthy) partner. It should be noted that certain pathogens (HBV, HCV, HIV) that belong to the STD group can not only be transmitted sexually (eg common use of needles among drug users). This possibility, however, does not modify the mandatory HIV screening of patients with syphilis and gonorrhea.

Answer 213

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The first part of the sentence is incorrect because, in contrast to the internationally accepted 4-5% level of nosocomial infections, only a 1.5% value of these infections are reported in Hungary. The statement which is described in the second sentence is correct, because monitoring according to professional requirements can actually prevent 30% of such infections.

Answer 214

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Both parts of the sentence are correct, as only 30-40% of HIV-positive pregnant women infect the fetus via the placenta. It should be noted, that the fetus may be infected during delivery and may also be infected with breastmilk containing the virus of the HIV-positive mother. In the case of an HIV-negative fetus both infection forms may be and has to be prevented.

Answer 215

ANSWER E) both are wrong EXPLANATION Both statements are wrong. The varicella virus can actually cause symptoms among pregnant women (eg skin rash, pneumonia), but can also be transferred to the fetus and may cause a congenital varicella syndrome with severe complex developmental disorders.

Answer 216

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both parts of the sentence are correct, but there is no correlation between them. The primary goal of chemical safety is the protection of human health and the environment from the dangers caused by chemicals, and the first phase is categorizing them based on their actual physical, physico-chemical, human- and ecotoxicological properties.

Answer 217

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Both parts of the statement are correct and there is a correlation between them. Global warming could cause heatwaves, and these climatic features, especially the extreme high temperatures are not well tolerated by elderly patients suffering from chronic cardiovascular/respiratory diseases. As a result, the number of deaths is increases, especially among them.

Answer 218

ANSWER E) both are wrong EXPLANATION Both parts of the statement are wrong. For a significant proportion of xenobiotics, the symptoms of acute and chronic intoxications differ (see, for example, benzene) partly because due to a difference in the duration of the exposure (and the level of the exposure) the same xenobiotic could act on different attack points and thus could evoke different mechanisms.

Answer 219

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The first part of the statement is false because the dimension of the emission is not mg / m3, but g / h or kg / year. The second part is correct because the particles released could travel from their emission point to various distances, sometimes hundreds of kilometers away.

Answer 220

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Both parts of the statement are correct, but there is no connection between them. Alkylated organic mercury compounds are actually more stable and more lipophilic; because due to their latter property they can be enriched in the food chain. The elemental mercury or its inorganic compounds are converted by biotransformation, especially in aquatic environment, into methyl or dimethylmercury.

Answer 221

ANSWER E) both are wrong EXPLANATION Both parts of the statement are wrong. Neither a human toxic metabolite of pyrethroid nor symptoms associated with chronic pyrethroid exposure are known.

Answer 222

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Both parts of the statement are correct and there is a relationshp between them. Women could not be exposed to teratogenic effects, especially in the early stages of pregnancy, so they should be taken off the given work after the pregnancy is confirmed

Answer 223

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The first part of the statement is incorrect, as children less than 5 years old are the most prone to the Sick Building Syndrome. The second part is correct because the increased concentration and accumulation of indoor chemical pollutants play a role in the development of the syndrome.

Answer 224

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION The first part of the statement is correct, as lipophilic PCBs are indeed cumulative in animal and human adipose tissue and are excreted in breast milk. The second part is wrong, because the dioxins are not PCBs, but PCDDs and PCDFs, and are not related to the electrical and paint industries, they are pesticides and cause chronic human processes as contaminants.

Answer 225

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION The first half of the sentence is correct because the composition of karstic waters is generally suitable for human consumption. The second part is false, as the pollutants from the environment are not filtered from the water by geological conditions, thus the natural purification of the karstic water does not happen.

Answer 226

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Acute acute trauma develops from a single high-intensity sound of more than 125 dB when the high-intensity sound is not associated with significant air pressure changes. Therefore, only the inner ear (mainly the hair cells) is damaged, the examination of the outer and middle ear does not indicate pathological changes.

Answer 227

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION Acoustic blast trauma induced hearing loss is caused by a single-wave, high-intensity sound effect and a change in the air pressure at the same time. Mostly it is caused by an explosion, but rarely occurs as a sports injury (water polo players, handballers, boxers).

Answer 228

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION The MC value of carcinogenic substances is also referred to as "tolerable" value. This emphasizes that, to the best of our knowledge, carcinogenic chemicals do not have a safe threshold concentration or a threshold dose.

Answer 229

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION The prevention of occupational diseases is carried out by primary prevention that means the possible elimination or at least attenuation of the risk factors. Even the most organized secondary prevention (screening) has no impact on the incidence of the disease, but recognizes the disease at an early stage when amore effective early treatment could be carried out if needed.

Answer 230

ANSWER E) both are wrong EXPLANATION Diseases that largely correlate with occupations are called occupational diseases. On the other hand, he work environment and its characteristics, effects originating from the work process and its circumstances together with other risk factors can play a role in the development, progression and outcome of complex, multi-causal diseases. These multiple pathophysiological disorders are more common among certain group of workers than among the population in general or among other worker group. These diseases are distinguished from the occupational diseases, they are called work- related diseases.

Answer 231

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION The effective temperature takes into account the air temperature, relative air humidity and the speed of the airflow rate. The effective temperature can be determined with the help of a nomogram.

Answer 232

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION Particular change in the heat balance is called acclimatization. The essence of acclimatization is that the heat loss becomes more effective (primarily the perspiration increases), while both the core temperature (after an initial temporary increase) and the heart rate decreases during the same physical activity. Acclimatization is usually completed within 2 weeks, and the acclimatized status ceases in approximately the same amount of time.

Answer 233

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Those effects are called deterministic which develop above a certain dose (so-called threshold dose) at everybody. The threshold dose is relatively high, it is ususal that when the dose is increased, the effects become more severe and finally fatal. Acute local radiation injury: exposure of isolated skin to ionizing radiation (3-10 Gy) causes erythema, hair loss, dry exfoliation and moist exfoliation.

Answer 234

ANSWER A) both are right, they have a causal relationship between them EXPLANATION The United Nations Charter on the Rights of Children sets the ages limit of childhood between 0 and 18 years Accordingly, children are entitled for paediatrician care if available, until the age of 18 years.

Answer 235

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION The prevalence of skeletal system fray disorders (osteoarthritis, osteoporosis, spinal hernia) is high in people older than 65 years and significantly affects mobility, leading to various consequences. According to Hungarian data obtained from the 2009 European Health Interview Survey, two-thirds of people older than 65-years live their lifes with disabilities and 58% of them are unable hardly able to travel 500 meters away on a plain ground without any aids/support.

Answer 236

ANSWER B) both are correct, but there is no cause-and-effect relationship between them EXPLANATION Regular exercise reduces the risk of loosing muscle strength and by exercising the abdominal muscles exerts external pressure on the abdominal organs which aids bowel movement. Accoring to a current summary of the Cochrane Reviews, aerobics-type exercise improves cognitive performance in people over the age of 55. However, the mechanism behind this effect is not known yet.

Answer 237

ANSWER A) both are right, they have a causal relationship between them EXPLANATION A proven and effective way to prevent influenza and pneumonia is the vaccination. There is an increased risk of developing complications for people over the age of 65 years in both cases, which also increases the risk of death. One vaccinaton is enough against pneumococcal pneumonia, while influenza vaccination is recommended to be repeated yearly.

Answer 238

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The worsening of social status (position) is a very serious chronic stress condition leading to severe depression, impaired health status and an increased risk of early death in men according to the results of the „Hungarostudy” follow-up study.

Answer 239

ANSWER A) both are right, they have a causal relationship between them EXPLANATION The fluoridation of drinking water in certain countries is based on the consideration that sufficient fluoride intake prevents tooth decay. The fluoridation of drinking water requires a political decision that can be made at local or national level, as technical changes are required by the water supplier. The fluoride content of the drinking water should be monitored continously to ensure that the fluoride content reaches the optimal level of 0.7 mg / L, but does not reach the maximum acceptable level of 4 mg / L, because that leads to an increased frequency of fluorosis.

Answer 240

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The first statement is not true, the second is correct in itself. Low iodine content in drinking water could be seen in Hungary and surveys conducted in Hungary found that among school aged children the prevalence of goitre is 11% (4-23%). Based on urine iodine levels Hungary is considered as a country with a mild iodine deficiency. Iodised salt can be successfully used to prevent iodine deficiency. This programme was introduced in Europe in the 1920s, in developing countries in the 1990s. The aim is that at least 90% of households use iodised salt.

Answer 241

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION The first statement is not true, the second is correct in itself. Vitamin D is considered as an important nutrient only when the ultraviolet sun rays entering the skin do not cause 7-dehydro cholesterol to produce enough vitamin D3. In urbanized environment of economically developed countries, infants, very young children and the elderly with some sort if impair in movement are at risk of lacking of vitamin D. In normal clothing, 15 to 30 minutes a day is usually enough to produce enough vitamin D in the skin due to UV irradiation. Professionals suggest vitamin D supplementation for infants and toddlers under age 3, since in their case the development and bone growth period is very intense and breast milk does not contain the adequate amount of vitamin D needed.

Answer 242

ANSWER E) both are wrong EXPLANATION Vegetarianism is generally considered as a healthy diet - except for its extreme forms. Fruits, vegetables, legumes, whole grains, nuts and vegetable oils have a protective effect against cardiovascular and cancer diseases. Although most plant proteins are not complete, i.e. their amino acid composition does not meet the essential amino acid needs of humans, by a suitable combination of foods that the various incomplete protein sources complete each other (eg, combination of corn and beans can ensure an acceptable amino acid supply).

Answer 243

ANSWER A) both are right, they have a causal relationship between them EXPLANATION Among the nutritional risk factors of osteoporosis, inadequate calcium intake is one of the most important influencing factors. It is a fact that the incidence of hip fracture is significantly higher in developed than in developing countries, although in developed countries the calcium consumption is much higher. This is the so-called "Calcium paradox" caused by the fact that high protein consumption increases renal calcium loss. There is also a relationship between sodium and calcium that is excreted in the urine: if the diet contains less sodium, then less calcium is eliminated from the body.

Answer 244

ANSWER A) both are right, they have a causal relationship between them EXPLANATION In addition to eating saturated fat, other dietary and lifestyle factors also have a significant impact on cardiovascular risk. Substitution of saturated fats in foods with carbohydrates, especially with refined cereal foods (foods with a high glycemic index), has been found to increase risk. However, replacing the saturated fats with unsaturated fats reduced the risk, this effect was probably supported by the higher consumption of plant foods ensuring higher intake of dietary fibers and micronutrients. In physically inactive and overweight populations, refined carbohydrates are likely to cause greater metabolic harm than saturated fatty acids. Therefore, dietary recommendations for the prevention of cardiovascular disease should be more focused on the consumption of whole grains, vegetables, fruits, legumes and on decreasing salt intake. If intake of saturated fats is reduced, it should be emphasized that the same (repleaced) percentage of energy intake has to be covered with unsaturated fatty acids and carbohydrates having low glycemic index.

Answer 245

ANSWER E) both are wrong EXPLANATION Food safety is not only the responsibility of the food industry participants. The quality and safety of food is influenced by every single participant in the food chain (manufacturers/producers, processors, suppliers, food manufacturers, consumers). Consumers are also responsible for ensuring food safety at home.

Answer 246

ANSWER A) both are right, they have a causal relationship between them EXPLANATION In 1995, the dental care support system was redesigned and since this time a variety of treatments for adult dental care, including dental preservation treatments, are offered in return for a fee. Since then, the number of people subjected to dental treatment has declined sharply, and many patients have had their teeth pulled out rather than opting for a chargeable conservation treatment. Recently, since 2000, he tooth conserving treatments were offered as charge-free treatments again.

Answer 247

ANSWER E) both are wrong EXPLANATION One of the main reasons of the reconstruction of healthcare systems is the considerable increase in health expenditures, which could not be covered by the amount of GDP available for the health care. Structural changes obviously affect primarily the most expensive services of the healthcare system. Accordingly, a significant reduction in inpatient care has happened in Hungary, as this is the most expensive element of the healthcare system. This process was necessarily linked to a strengthening of primary and outpatient care and the widest possible use of treatments that shortened the duration of hospital treatment (eg one-day surgery).

Answer 248

ANSWER D) The first is wrong, the second is correct in itself EXPLANATION One of the conditions for equal opportunities is accessibility. In simplified manner accessibility means that a healthcare facility, hospital or emergency center is located nearby (within a certain distance or within a certain accessibility time), where the necessary care is available and can be used within a reasonable time. Equal opportunities mean more, it involves many factors that together ensure that people with the same health status actually have the same access to the necessary care. For example, the poor should not be limited by the fee of treatment to be paid in order to receive a proper treatment, or the family doctor should have an equal chance of sending people with the same illness to inpatient care. Equal opportunities also include patient's information, because equal opportunities can only be achieved if patients have the same opportunity to recognize the need for treatment and to consult a doctor. Equal opportunities are therefore an extremely broad, cross-sectoral category defined by political, economic and other factors.

Answer 249

ANSWER C) the first is correct in itself, the second is wrong EXPLANATION Equal opportunities in practice can not be guaranteed even in the richest countries, as there are always treatments (eg high technology, extremely high quality) that are expensive and can not be funded for the whole population. These costs may be is covered by supplementary insurance, while the richest part of the society receives the desired treatments under private care. Healthcare providers are keen to provide high-quality services, as this generate higher profits for them. Therefore, they are also interested in providing these services to as many people as possible.