Public health Flashcards
PBH - 1
Which phase of the public health cycle is based on epidemiological analyzes?
A) situation analysis
B) determining the intervention options
C) planning interventions
D) preparing a strategic plan
E) implementation of health promotion programs
ANSWER
A) situation analysis
EXPLANATION
The first phase of the public health cycle (the phase which is repeated regularly during the active cycle) is an epidemiological analysis of the populations’ health status (and the factors influencing it), which is attached to strict professional aspects, and the evaluation of which is called situation analysis. In this phase, it is often necessary to characterize the temporal changes of a given health indicator or a health determinant as well as to determine whether a change took place with respect to a reference value and if it did, to what extent and into which direction
PBH - 3
Whose activity can be related to the establishment of occupational health as a subdiscipline of public health?
A) Max Pettenkofer
B) Bernardino Ramazzini
C) Fodor József
D) Robert Koch
E) Rachel Carlson
ANSWER
B) Bernardino Ramazzini
EXPLANATION
The first professional book related to occupational health, Ramazzini’s work entitled ” De morbis artificum diatribe ” was published in 1700, and it has been considered to be a milestone in establishing the subdisciplines of public health
PBH - 4
When was the eradication of smallpox declared by the WHO?
A) 1967
B) 1979
C) 1993
D) 2003
E) only Europe is smallpox-free
ANSWER
B) 1979
EXPLANATION
In 1979, as a result of the smallpox eradication program organized and managed by the WHO, the organization declared that smallpox had been eradicated on a worldwide level, which served not only the overall acknowledgement of public health activity, but also boosted the development of public health.
PBH - 5
The weight of healthcare in determining the health status in developed countries is approximately:
A) 5-10%
B) 10-15%
C) 15-20%
D) 20-25%
E) 25-50%
ANSWER
B) 10-15%
EXPLANATION
The weight of the different determinants is not equal in ensuring health. Although the contribution of the individual factors is debated (and may indeed differ in different communities), it is generally accepted that the genetic factors and the quality of healthcare determine the state of health in approximately 15-30% and 10-15%, respectively, while the lifestyle factors that are closely related to socio-economic status and education are responsible for the remaining 55-75% in determining health.
PBH - 6
Which screening type implies newborn screening?
A) mandatory screening
B) targeted screening
C) mass screening
D) screening of groups with increased risks
E) diagnostic screening
ANSWER
C) mass screening
EXPLANATION
The term “mass screening” emphasizes that the given screening test covers the entire potentially affected population. Typical examples for mass screening are, for instance, newborn screening (e.g. for phenylketonuria), the screening of the fetus for detecting developmental disorders (e.g. by ultrasound examination, etc.).
PBH - 7
To evaluate the effectiveness of public health programs, the following is essential:
A) the knowledge of mortality
B) the knowledge of morbidity
C) the screening of the population
D) establishing and operating health monitoring systems
E) the exact knowledge of the impact of the interventions
ANSWER
D) establishing and operating health monitoring systems
EXPLANATION
Evaluating the effectiveness of public health programs is not possible without establishing and managing a health monitoring system. Establishing and managing registries (utilizing modern information technology) of communicable and non-communicable diseases (including circulatory, carcinomatosus, digestive, respiratory, neurological, mental and musculoskeletal diseases) as well as registries of accidents are necessary, but not sufficient. This activity should be accompanied by monitoring the factors influencing health status (lifestyle, social, economic and environmental factors).
PBH - 8
Which organization developed the Public Health Code of Ethics describing the valid ethical principles of public health activity?
A) World Health Organization (WHO)
B) American Public Health Association
C) United Nations Organization
D) European Public Health Association
E) An ad hoc committee established by the WHO for this purpose
ANSWER
B) American Public Health Association
EXPLANATION
The American Public Health Association (APHA) defined the Public Health Code of Ethics in 12 points in 2001.
PBH - 9
Which indicator is not part of the vital statistics based on civil registries?
A) fertility
B) migration
C) mortality
D) natality
E) reproduction
ANSWER
B) migration
EXPLANATION
Population dynamics - ongoing population processes - are characterized by vital events and migration over a specified period (usually a one year span). The basic elements of natural population dynamics are natality/birth rate, fertility, mortality and reproduction. Civil registries (vital statistics) are the main information source for vital events/population dynamics
PBH - 11
Which statement is true related to relative risk?
A) it compares the frequency of exposure among patients to the frequency of exposure among healthy subjects
B) it belongs to the category of difference indicators
C) it is a measure of the incidence observed among the exposed subjects to the incidence of unexposed population
D) all of the statements are true
E) none of the statements is true
ANSWER
C) it is a measure of the incidence observed among the exposed subjects to the incidence of unexposed population
EXPLANATION
Risk indicators are indicators which characterize the relationship between a givendisease and the incidence of an assumed risk factor. Their estimation is based on comparison of the incidences of two (or more) groups from the population, in which the groups’ risk factor’s exposure levels are different. The denominator of the comparison usually is the incidence of the disease among non-exposed population. Risk indicators may be either ratio indicators (relative risk) or difference indicators (attributable risk).Relative Risk (RR) is the incidence ratio among exposed and unexposed persons (RR=events when exposed/events when not exposed).
PBH - 12
Which attributable risk indicator depends on the prevalence of exposure among the population?
A) incidence of exposed
B) attributable risk
C) attributable risk fraction
D) population attributable fraction
E) all of the above
ANSWER
D) population attributable fraction
EXPLANATION
The attributable (AR) risk is the excess risk fraction of the exposured against non-exposured. AR = incidence among exposed - incidence among non-exposed. The attributable risk fraction (ARF) is the reduction in incidence that would be ovbserved in case of the exposition would cease in the entire population (ARF = incidence of the exposed - incidence of the non-exposed / incidence of the exposed). Attibutable risk indicators only indicate the excess risk caused by the risk factor itself and do not rely on prevalence (rate of exposure) of the risk factors in a given population. However, population attributable risk takes into account this feature: Population attributable risk = incidence in the entire population - incidence of non exposured
PBH - 14
Which statement related to odds-ratio is false?
A) it is the probability ratio of exposure among cases and controls
B) if the odds-ratio is exactly 1 then there is no relationship between the risk factors and the disease
C) it can be calculated from contingency tables
D) it can be calculated from case-control studies
ANSWER
A) it is the probability ratio of exposure among cases and controls
EXPLANATION
Calculation of odds ratio (OR) among case and control groups is based on the probability of exposition derived from the 2x2 contingency tables. The odds of exposition in the case group: a/c ; the odds of exposition in the control group: b/d, so the ratio of the two is the odds ratio. The odds ratio is 1 if there is no relationship between the potential risk factor and the disease.
PBH - 15
Which of the following is considered as late neonatal death?
A) death on the 5th day of life
B) death in the 5th week of life
C) death in the 5th month of life
D) all of them
E) none of them
ANSWER
E) none of them
EXPLANATION
During the first year after birth, distinct periods can be distinguished related to infant mortality based on age.These are the following: early infant (neonatal) death: 0-27 days (usually divided into 0-6 days - early neonatal, 7-27 days - late neonatal), late infant (postneonatal) death: 28th day - 1 year (the first birthday does not belong to the infant age).
PBH - 20
Which formula can be used to calculate the excess mortality rate? (expected number of deaths: E, observed number of deaths: O)
A) (O - E) / O × 100
B) (O - E) / E × 100
C) (E - O) / O × 100
D) (E - O) / E × 100
E) none of them are true
ANSWER
B) (O - E) / E × 100
EXPLANATION
The excess mortality rate is the difference between observed and expected number of deaths divided by the number of expected deaths. It can be converted to percentage form using the formula: (O - E )/E x 100; which describes how the percentage of deaths of the given population exceeds that of chosen for comparison base.
PBH - 21
Which formula is used to calculate relative excess mortality rate (REMR)? (expected number of deaths: E; observed number of deaths: O)
A) (O - E)/ O × 100
B) (O - E) / E × 100
C) (E - O) / O × 100
D) (E - O) / E × 100
E) none of them
ANSWER
A) (O - E)/ O × 100
EXPLANATION
The relative excess mortality rate and the excess mortality rate differ in their denominator only. The denominator of the relative excess death rate is the observed number of deaths instead of expected number of deaths. REMR=(O-E)/O ×100
PBH - 24
Standardized mortality ratio (SMR) can be calculated by indirect standardization using the following formula:
A) SMR = (observed number of deaths - expected number of deaths) × 100
B) SMR = (observed number of deaths - expected number of deaths) /observed number of deaths× 100
C) SMR = (observed number of deaths - expected number of deaths) / expected number of deaths × 100
D) SMR = observed number of deaths - expected number of deaths
E) none of them
ANSWER
E) none of them
EXPLANATION
Standardized mortality ratio (SMR, usually expressed as percentage) related to the given population calculated by indirect standardization is the ratio of the observed number of deaths and the expected number of deaths..(SMR = observed number of deaths/ expected number of deaths× 100)
PBH - 25
The true statement on mortality of Hungarian men’s aged 45-64 between 1991 and 1995 was:
A) higher than in 1981-1985
B) higher than in 2001-2005
C) higher than in 1920-1921
D) all of them
E) none of them
ANSWER
D) all of them
EXPLANATION
Analyzing the premature mortality of the Hungarian population stratified by age, we can point to the fact that the mortality of men aged 45-64 between 1991 and 1995 was worse compared to 1920-21. By 2006 this parameter decreased below the value observed in 1930-31.
PBH - 26
The ICD-10 classification…
A) has been valid since the 18th century.
B) uses an alphanumeric code system.
C) varies country by country.
D) the individual classes show overlaps.
E) quantifies mortality data.
ANSWER
B) uses an alphanumeric code system.
EXPLANATION
ICD-10 classifies diseases into standardized classes based on international criteria which were implemented in Hungary on January 1, 1996. The aim of the standardized unification is to ensure that the morbidity and mortality data derived from different sources and for different diseases be comparable. It uses an alphanumeric code system.
PBH - 27
Mortality burden of malignant tumors in Hungary:
A) is the most important related to premature adult mortality
B) takes the second place after cardiovascular diseases among premature adult deaths
C) is the most important related to old age mortality
D) has grown in the last decade
E) is not remarkabla in premature mortality among women
ANSWER
A) is the most important related to premature adult mortality
EXPLANATION
The mortality burden of malignant tumors is the most notable related to premature mortality (especially among women) and the second in total mortality (population age 0 to X) in Hungary. Cardiovascular diseases are the leading cause of death in old age mortality. The mortality of malignant tumors has decreased over the last decade
PBH - 29
The prevalence of hypertension among men aged 65-74 in Hungary is approximately:
A) 13-20%
B) 26-40%
C) 40-58%
D) 48-72%
E) 79-90%
ANSWER
D) 48-72%
EXPLANATION
The prevalence of hypertension among men aged 35-44 is 13-20% and 26-40% among men aged 45-54. It was 40-58% among men aged 55-64 and 48-72% among men aged 65-74 based on the data derived from General Practitioners Morbidity Sentinel Station Program (GPMSSP).
PBH - 30
The amount of the physiological daily sodium chloride requirement is approximately:
A) 1-2 g
B) 3-4 g
C) 5-6 g
D) 7-8 g
E) 9-10 g
ANSWER
A) 1-2 g
EXPLANATION
The physiological sodium chloride intake requirement is no more than 1-2 g per day which is exceeded even if we skip adding extra salt to our food. The WHO recommends that the daily salt intake should be kept below 5 g.
PBH - 32
Which is the most vulnerable population group related to osteoporosis?
A) children and adolescents
B) elderly women and men
C) workers exposed to permanent vibration exposure
D) women at postmenopausal period
E) athletes with increased physical activity
ANSWER
D) women at postmenopausal period
EXPLANATION
Decrease in bone mass is observed as the age progresses in both men and women, but the most significant decrease in bone mass can be seen among postmenopausal women. Osteoporosis is strongly related to the decrease of estrogen production
PBH - 34
Which individuals (related to their gender and family status) exhibit more complicated manifestation of reactive depression?
A) married men
B) divorced men
C) married women
D) divorced women
E) promiscuous individuals regardless of their gender
ANSWER
C) married women
EXPLANATION
Depression of married women is more severe than that of women who are not married based on the findings of cross-sectional studies.The opposite relationship has been observed in men, for example, married men are less likely to have depression and even if the depression has developed it shows milder symptoms.
PBH - 35
The most common causes of premature deaths related to fatal accidents are:
A) vehicle traffic accidents
B) falls
C) poisoning
D) burns
E) injuries related to firearms
ANSWER
A) vehicle traffic accidents
EXPLANATION
Approximately 40% of accidents causing deaths under 65 were caused by vehicle traffic accidents - especially motor vehicle accidents (men: 33.7%, women: 33.0%) - and every sixth death was caused by accidental falls in 2008. Above the age of 65 years, however, the weight of the two accidental death causes changes: accidental fall is the cause in approx.. two-thirds (59%) of accidental deaths in elderly men. The corresponding number among elderly women is 70.5%.
PBH - 36
Which of the two regions have the most increased risk of suicide-related deaths in Hungary?
A) Northern Great Plain and Southern Great Plain
B) Northern Great Plain and Northern Hungary
C) Southern Great Plain and Northern Hungary
D) Central Hungary and Northern Hungary
E) Central Hungary and Northern Great Plain
ANSWER
A) Northern Great Plain and Southern Great Plain
EXPLANATION
Traditional differencies can be seen related to suicide- mortality inside Hungary. In the Southern and Northern Great Plain the suicide related mortality of men aged 25-64 significantly (p<0.001; by 34% at lest) exceeded the Hungarian average suicide related mortality in the 1990s and 2000srespectively.
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
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.
PBH - 38
What does “phenotype prevention” mean?
A) Interrupting pregnancy (in the case of parental consent) to prevent giving birth to genetically impaired fetuses
B) Preventing the onset of a disease in individuals with increased risk genotype mainly by abolishing harmful environmental exposures
C) genetic counseling for couples with increased genotype risk who want to have children
D) gene therapy interventions among individuals to correct defective genes among individuals with increased genotype risk
E) estimation of population frequency of susceptible alleles related to diseases
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).
PBH - 40
Breast cancer’s incidence is mainly based on various mutations in the BRCA1 gene:
A) among Ashkenazi Jewish communities
B) among Hungarian female population
C) among Australian native population
D) in the background of breast cancer in elderly population
E) in the background of post-operative recidivation
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.
PBH - 41
Relative risk of lung cancer among smokers compared to non-smokers is approximately:
A) two times increased risk
B) five times increased risk
C) ten times increased risk
D) hundred times increased risk
E) 90% higher
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.
PBH - 44
The main aim of the North Karelia Project was:
A) to reduce cancer-related premature mortality
B) to reduce cardiovascular premature mortality
C) to reduce the mortality of mental illnesses
D) to improve the care of hypertensive patients
E) the early detection of cardiovascular diseases
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.
PBH - 45
What does “hidden diabetes” mean?
A) no clinical symptoms are present due to treatment
B) not the primary disease but the complications of the primary disease cause the symptoms
C) the symptoms of the disease are masked by the characteristic symptoms of an other disease
D) only the hypertension accompanying diabetes is treated while the diabetes itself remains untreated
E) the existence of diabetes is unknown by both the patient and the doctor, so diabetes can be detected by a screening test only
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.
PBH - 47
Which is not a component of metabolic syndrome?
A) hypertension
B) increased fasting blood glucose level
C) elevated triglyceride level
D) elevated HDL-C value
E) visceral obesity
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.
PBH - 51
The relative risk of premature mortality related to respiratory diseases) in Hungary compared to EU15 average
A) is more than two times higher
B) is more than three times higher
C) is more than four times higher
D) does not differ significantly ()
E) is 20% lower
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)
PBH - 52
Suicide mortality was characterized by the following over the past three decades in Hungary:
A) it has drastically increased
B) a temporary declining trend was followed by stagnation since the Millennium
C) more women are affected than men
D) mortality rates decreased significantly for both gender
E) the highest suicide mortality for both gender was observed in the Northern Hungary Region
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.
PBH - 53
Utilization of the findings of genomic research in public health:
A) is free of charge and widely available
B) is limited
C) genetic screening can only be used after payment
D) a complete lack of legislation is missing to ensure their implementation
E) screening tests which could prove genetic predisposition to cancer are unreliable
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.
PBH - 54
Which one of the following is not a geohelmint?
A) Strongyloides stercoralis
B) Trichuris trichiura
C) Ascaris lumbricoides
D) Taenia solium
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).
PBH - 55
What vaccine should be given to newborns of HbsAg-positive mothers?
A) passive immunization against hepatitis B
B) active immunization against hepatitis B
C) both
D) none of them
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.
PBH - 56
There is no active vaccination commercially available in Hungary against the following disease:
A) hepatitis B
B) influenza
C) typhus abdominalis
D) salmonellosis
E) yellow fewer
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.
PBH - 58
Which one of the following in not included in age-related mandatory vaccination in Hungary?
A) vaccination against mumps
B) vaccination against rubella
C) vaccination against smallpox
D) vaccination against tetanus
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).
PBH - 59
How long must the food samples be stored in kitchens providing public catering services?
A) 6 hours
B) 12 hours
C) 24 hours
D) 48 hours
E) 72 hours
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.
PBH - 61
In which sterilization method are carcinogenic compounds used?
A) dry heat sterilization
B) autoclaving
C) chemical sterilization
D) plasma sterilization
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
PBH - 62
Which of the following procedures is not used for sterilization?
A) UV light
B) γ-radiation
C) ethylene oxide
D) autoclaving
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.
PBH - 63
Infectious and suspected of being infectious patients detected in primary care should be reported to?
A) the local institution of inpatient care
B) the subregional public health institute competent at the regional location of the infection
C) the subregional public health institute competenet at the infected patients’residence
D) the National Public Health and Medical Office Service, National Center for Epidemiology
ANSWER
B) the subregional public health institute competent at the regional location of the infection
PBH - 64
Which of the following infections should be reported urgently?
A) dysenteria
B) typhus abdominalis
C) campylobacteriosis
D) amoebiasis
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.
PBH - 65
For which infection must be the patient quarantined at an inpatient hospital unit?
A) typhus abdominalis
B) cholera
C) both of them
D) none of them
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.
PBH - 67
In which diseases should the persons in close contact with the infected patient undergo a 7-day epidemiological surveillance?
A) dysenteria
B) campylobacteriosis
C) typhus abdominalis
D) Hepatitis A
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.
PBH - 68
Which statement related to poliomyelitis is not true?
A) Reportable disease
B) must be reported by telephone, by fax
C) laboratory test is not obligatory
D) Feces sample, irrigation fluid, liquor and blood samples must be sent to the Virology Department of National Public Health and Medical Officer Service
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.
PBH - 69
Which statement related to salmonellosis is not true?
A) It is a reportable disease
B) It must be reported on via a “food contamination, food poisoing notification” sheet
C) The regional public health institute should be notified by telephone
D) Laboratory tests are mandatory
E) For the correct diagnosis blood sample should be sent to the regional laboratory before treatment
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.
PBH - 70
What is an inapparent infection?
A) disease without clinical symptoms
B) an infection with mild symptoms that can only be detected during an epidemic
C) all infections that are cured without any harm/lesions
D) any infection that does not generate laboratory changes/alterations
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.
PBH - 72
What is the most likely disease in the case of “food poisoning” when the symptoms appear in a 6-48 hours period after the consumption of homemade ham and mayonnaise French salad, and the symptoms are: abdominal pain, diarrhoea, vomiting, fever?
A) Staphylococcal food poisoning
B) Salmonellosis
C) Botulism
D) Yersiniosis
E) Trichinellosis
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.
PBH - 74
In which disease is not the swine the infectious source? (Which disease is not spread by the swine?)
A) Brucellosis
B) Tularemia
C) Listeriosis
D) Taeniasis
E) Trichinellosis
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.
PBH - 75
If a person has received a complete immunization within 5 years against lyssa, what is the applicable active immunization protocol in the case of a suspected new infection?
A) vaccination on days 0, 7 and 21 (2-1-1 doses)
B) vaccination on days 0, 7 and 21 (1-1-1 doses)
C) vaccinaton on days 0, 3 and 7 (2-1-1 doses)
D) vaccination on days 0, 3 and 7 (1-1-1 doses)
E) vaccination on days 0 and 3 (1-1 dose)
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.
PBH - 76
In which case is the hospital placement of the patient mandatory?
A) Anthrax
B) Leptospirosis
C) Listeriosis
D) Tularemia
E) Q fever
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.
PBH - 77
Which animal (s) is/are the infectious source (s) of Choriomeningitis lymphocytica?
A) ruminants
B) swine
C) dog
D) rodents
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.
Lymphocytic choriomeningitis, or LCM, is a rodent-borne viral infectious disease caused by lymphocytic choriomeningitis virus (LCMV), a member of the family Arenaviridae, that was initially isolated in 1933. The primary host of LCMV is the common house mouse, Mus musculus.
PBH - 78
Which disease incidence has increased in our country (in Hungary) in the age group over 40 years?
A) Scarlet
B) diphtheria
C) pertussis
D) Haemophilus influenzae meningitis
E) tuberculosis
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.
PBH - 79
Which disease does not require that people who are in direct contact with the infected patient be treated with chemoprophylaxis?
A) pertussis
B) scarlatina
C) diphteria
D) meningitis epidemica
E) H. influenzae meningitis
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.
PBH - 81
How many days before the onset of the symptoms can infectivity persist in people infected with Lyssa?
A) 1-2 days
B) 3-4 days
C) 5-6 days
D) 7-10 days
E) 12-15 days
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
PBH - 82
Which disease could cause teratogenic changes in the fetus during pregnancy?
A) Ornithosis
B) Tularemia
C) Leptospirosis
D) Q fever
E) Toxoplasmosis
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.
PBH - 83
The mean age of patients with vCJB is
A) 29-30 years
B) 35-40 years
C) 50-60 years
D) over 60 years
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.
PBH - 85
Reducing ozone concentration by 1% in the stratosphere will increase the incidence of skin cancer by:
A) 1%
B) 2%
C) 3%
D) 4%
E) 5%
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.)
PBH - 86
At which heavy metal exposure are people with hyperthyroidism not allowed to be employed/to work?
A) arsenic
B) mercury
C) lead
D) cadmium
E) chrome
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.
PBH - 87
Which of the following pesticides are persistent in surface waters?
A) organic phosphate esters
B) pyrethroids
C) carbamate
D) chlorinated hydrocarbon
E) dithiocarbamates
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.
PBH - 88
Which is a non-muscarine symptom?
A) Bradycardia
B) bronchospasm
C) increased sweating
D) spasm of the respiratory muscles
E) needle pupil
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.
PBH - 89
Which of the following compounds has a human teratogenic effect?
A) toluene
B) cobalt
C) acrylamide
D) formaldehyde
E) methanol
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.
PBH - 91
Which acute high-dose pesticide poisoning - with other severe symptoms - causes fever above 40° C?
A) carbamate
B) dithiocarbamate
C) phenoxycarboxylic acid derivative
D) Pyrethroid
E) dinitro-o-cresol
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.
PBH - 92
Drinking water containing low level of magnesium will increase the incidence which of the following disease?
A) heart attack
B) cerebral stroke (dash)
C) stomach cancer
D) type 2 diabetes
E) colon cancer
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)
PBH - 93
What does “dose toxica minima” mean?
A) The smallest amount of substance that is still responsible for eliciting the specific effects characteristic of the substance
B) The highest amount of substance to which the organism will not respond with lesions/abnormal alterations
C) Minimum amount of substance to which the body responds with non-typical changes that are not characteristic of the given substance
D) The smallest amount of substance that may have toxic effects
E) The smallest amount of substance to which the body responds with an effect typical of the substance
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
PBH - 94
In which organic solvent exposure are dermatological patients not allowed to work?
A) benzene
B) toluene
C) xylene
D) carbon tetrachloride
E) gasoline
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.
PBH - 95
In the case of acute poisoning which of the substances below can cause - after a few weeks latency - a reversible paralysis of the lower limbs?
A) formaldehyde
B) tri-ortho-cresyl phosphate
C) acrylonitrile
D) acrylamide
E) vinyl chloride
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.
PBH - 97
The nitrate concentration limit of drinking water for infants to drink or their food to be prepared with is:
A) 10 mg / l
B) 20 mg / l
C) 30 mg / l
D) 40 mg / l
E) 50 mg / l
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.
PBH - 99
Which of the following compounds is not excreted into the breast milk?
A) alcohol
B) nicotine
C) dioxin
D) PCB
E) phenol
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.
PBH - 100
The survival time of the geohelminths’ eggs in the soil is:
A) 1-2 months
B) 6-8 months
C) 12-15 months
D) 18-24 months
E) 2-3 years
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.
PBH - 102
Which is the organic solvent of which occupational exposure can be measured by the concentration of urine muconic acid?
A) benzene
B) toluene
C) xylene
D) ethylene glycol
E) Propyl alcohol
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.
PBH - 103
Limit of nitrite concentration
A) 0.5 mg / l
B) 1 mg / l
C) 2 mg / l
D) 3 mg / l
E) 4 mg / l
ANSWER
A) 0.5 mg / l
PBH - 104
The chronic effect of which of the listed metals causes acrocyanosis?
A) lead
B) mercury
C) cadmium
D) arsenic
E) chromium
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.
PBH - 106
Which factor does not participate in the biological activity of the soil (geocycle)?
A) the filtering effect of soil particles
B) soil temperature
C) absorption
D) biological membrane
E) UV radiation
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.
PBH - 107
Which compounds dissolve in the body during the toxic detoxification process?
A) toluene
B) freon
C) carbon tetrachloride
D) methanol
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.
PBH - 108
What is the minimum dose responsible for causing irreversible blindness in acute methanol intoxication?
A) 1-3 g
B) 8-10 g
C) 20-22 g
D) 25-30 g
E) 40-50g
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.
PBH - 109
Which compound is not involved in the effects caused by the Los Angeles-type smog?
A) aldehydes
B) ozone
C) sulfur dioxide
D) hydrogen peroxide
E) peroxyacetyl nitrate
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.
PBH - 110
The permissible cumulative annual equivalent dose of workers exposed to ionizing radiation is:
A) 5-10 mSv / year
B) 20 mSv / year
C) 50 mSv / year
D) 100 mSv / year
E) 500 mSv / year
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).
PBH - 111
Which monomer causes a sclerodermic change affecting the fingers of chemical plant workers?
A) vinyl chloride
B) acrylamide
C) acrylonitrile
D) vinylbenzene
E) phenylethylene
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.
PBH - 112
High dose chronic or “long-term” exposure of which monomer is responsible for the liver hemangiosarcoma in chemical factory workers ?
A) acrylamide
B) vinylbenzene
C) vinyl chloride
D) phenylethylene
E) acrylonitrile
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.
PBH - 115
It is forbidden to give one of the followings in the case of carbamate intoxication:
A) atropine
B) diazepam
C) toxogonin
D) other parasympathetic compounds
E) too much liquid
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.
PBH - 116
When is it recommended to remove the worker spraying with organich phosphoric acid ester from her/his job?
A) When the worker’s red blood cell AChE activity has decreased by 10% compared to the exposure-free self-activity.
B) When the worker’s plasma AChE activity decreased by 50% compared to its own basic activity.
C) When the worker’s red blood cell AChE activity has decreased by more than 50% compared to own baseline activity.
D) If the worker’s red blood cell AChE activity decreased by 20-50% from own basic activity.
E) Urgent action should be taken even in the case of the smallest decrease of the red blood cell AChE activity
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% .
PBH - 117
What kind of radiation cause the cataracts of smeltery workers?
A) microwave radiation
B) visible light with high brightness
C) infrared radiation
D) stroboscopic effects
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.
PBH - 118
Industry or activity with a high risk of causing cancer is
A) rag-picking
B) pepper (paprika) splitting
C) iron and steel production
D) electrical installation
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.
PBH - 119
Chromium and its compounds can cause:
A) mesothelioma
B) lung cancers
C) myeloma
D) lymphoma
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).
PBH - 120
What is the effective temperature?
A) various combinations of air temperature and humidity which elicit the same heat sensation
B) various combinations of air temperature, humidity, and air movement which elicit the same heat sensation
C) combinations of air temperature and radiation that elicit the same heat sensation
D) combinations of air temperature and air flow that elicit the same heat sensation
E) none of them
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.
PBH - 122
Which is the lowest frequency where a noise-induced permanent increase in the hearing threshold can be detected?
A) 1000 Hz
B) 2000 Hz
C) 4000 Hz
D) 8000 Hz
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.
PBH - 123
Which heavy metals chronic exposure causes allergies and contact eczema?
A) manganese
B) silver
C) nickel
D) iron
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.
PBH - 124
The decibel means
A) the strength of the noise/sound.
B) the sound frequency.
C) the sound pressure.
D) the level of the sound pressure.
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.
PBH - 125
The pain threshold related to sound pressure level is:
A) 70 dB
B) 80 dB
C) 100 dB
D) 130 dB
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.
PBH - 126
Which substance is not asbestos?
A) crocidolite
B) Amosite
C) antofilit
D) tremolos
E) stalactite
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.
PBH - 127
Which industrial activity has no risk of causing cancer?
A) aluminum production
B) furniture production
C) shoe making
D) coke production
E) working with silicate
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.
PBH - 128
Which compound is not a proven carcinogen in humans?
A) aflatoxins
B) arsenic
C) benzene
D) cyclophosphamide
E) cyclosporine
ANSWER
E) cyclosporine
EXPLANATION
Aflatoxin, arsenic, benzene, cyclophosphamide are proven human carcinogens.
PBH - 129
The mechanism of action of carbamate pesticides
A) the inhibition of acetylcholinesterase
B) Inhibition of glutathione peroxidase
C) inhibition of C-SH group enzymes
D) inhibition of ATPase
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.
PBH - 130
DDT is:
A) phenolic fungicide
B) carbamate insecticide
C) chlorinated hydrocarbon
D) organic phosphate ester compound
ANSWER
C) chlorinated hydrocarbon
EXPLANATION
DDT is the most commonly known representative of chlorinated hydrocarbons.
PBH - 131
The first symptom of chronic mercury poisoning is:
A) paralysis of radial nerve
B) paralysis of ulnar nerve
C) small wave tremor
D) visual impairment
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
PBH - 132
Polychlorinated biphenyls induce (activate?):
A) microsomal enzymes of the liver
B) glutathione peroxidase
C) superoxide dismutase
D) catalase
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.
PBH - 133
Early hearing loss caused by noise is indicated on the audiogram
A) a monaural recess (30 dB) seen at 8000 Hz
B) binaural negative spike at 4000 Hz (30 dB)
C) bilateral recess formation at any frequency
D) unilateral recess formation at any frequency
E) recess formation only at the 600 Hz (30 dB)
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.
PBH - 135
Is the child (infant?) mortality differerent among the highest and lowest socioeconomic groups, respectively?
A) Yes, its the highest among infants with the highest status
B) yes, its the highest among infants with the lowest status
C) No
D) No general conclusion could be drawn, it varies from country to country.
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).
PBH - 136
What changes could be seen related to the average life expectancy of men over the age of 65 in the different social strata/categories between 1972 and 2001 in England?
A) Increased in all social categories, but the increase was the highest among those in the highest category.
B) Increased in all social categories at similar rates
C) Increased in all social categories, but the change was higher in the lowest category compared to change affecting those in the highest social category
D) Increased in the highest category and decreased in the lowest category
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.
PBH - 138
How can fetal alcohol syndrome be prevented?
A) if the mother ignores alcohol consumption during the first trimester of pregnancy
B) if the mother ignores alcohol consumption during the first two trimesters of pregnancy
C) if the mother ignores alcohol consumption throughout the pregnancy
D) it can not be prevented as is due to genetic predisposition
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.
PBH - 140
Who disposesthe alpha fetoprotein (AFP) test of a pregnant woman, when and for what purpose?
A) The pysician will dispose the test on the 12th week for the screening of the closure dosorders of the neural tube
B) The pysician will dispose the test on the 16th week for the screening of the closure dosorders of the neural tube
C) The health visitor will dispose the test on the 16th week for the screening of the closure dosorders of the neural tube.
D) The health visitor will dispose the test on the 18th week for the screening of the closure dosorders of the neural tube.
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.
PBH - 141
What is the most common cause of deaths among 10-18 year olds?
A) accidents
B) suicides
C) upper respiratory tract infections
D) gastrointestinal infections
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.
PBH - 143
At what age do teenagers start smoking at the highest rate?
A) at the age of 10-11
B) at the age of 11-12
C) at the age of 13-15
D) at the age of 15- 18
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.
PBH - 144
Which illegal drug is consumed the most among adolescents in Hungary?
A) heroin
B) cocaine
C) extasy
D) marijuana
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.
PBH - 145
Basic pediatric care is accomplished by
A) home paediatricians, school doctors
B) home paediatricians, school doctors, school dentists
C) home pediatricians, health visitors, school doctors, school dentists,
D) family doctors, home pediatricians, health visitors, school doctors, school dentists
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.
PBH - 146
Which disease is the leading cause of death among 65-74-year olds in Hungary?
A) circulatory diseases
B) malignant tumors
C) accidents
D) respiratory tract infections
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%).
