Communicable Disease Questions III
Communicable Disease Questions III
Situation 13. Leprosy is an ancient disease and is a leading cause of permanent physical disability among the communicable diseases. It is a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes and mucosa of the upper respiratory tract.
61. Assessment is done upon seeing a patient with leprosy. The following are early signs and symptoms, except:
1. Appearance of a skin patch
2. Loss of sensation on skin lesion
3. Inability to close eyelids
4. Hair growth over the lesion
5. Painful nerves
6. Loss of eyebrow
7. Ulcers that do not heal
8. Sinking of the nose bridge
a. 3, 5 and 7 c. 3, 6 and 8
b. 2, 5 and 8 d. 2, 6 and 7
62. A person can get leprosy through the following except:
1. Inhalation of the infectious organism through a broken skin
2. Repeated skin to skin contact with untreated individual
3. Inhalation of the infectious organism from the nasal discharges of an untreated individual
4. Contact with articles soiled with discharges from lesions of leprosy patient
a. 1 only c. 4 only
b. 1 and 3 d. 3 and 4
63. Philip is a 55 year-old resident who is affected by leprosy and is on schedule for Multidrug Therapy. Which daily treatment is usually prescribed by a physician for lepromatous and borderline type in 28 days?
a. Dapsone 10 mg and Rifampicin 600 mg
b. Clofazimine 50 mg and Rifampicin 50 mg
c. Rifampicin 150 mg and Dapsone 50 mg
d. Clofazimine 50 mg and Dapsone 100 mg
64. Only in rare instances is there really a need to use laboratory and other investigations to confirm a diagnosis. However, when a clinical diagnosis is doubtful. This optional procedure is done to prevent misclassification and wrong treatment.
a. Direct Sputum Smear Microscopy (DSSM)
b. Slit Skin Smear (SSS) examination
c. Mass Blood Smear (MBS) collection
d. Purified Purine Derivative (PPD) test
65. Preventive aspect of care is a priority consideration. Which of the following vaccine is also preventive measure?
a. BCG c. Gammaglobulin
b. DPT d. ATS
Situation 14. Nurse Lorie is taking care of Anne, 15 months old, who is admitted to the hospital with Rubeola. She has conjunctivitis, coryza, cough, rashes and temperature of 38ºC.
66. Which of the following statements is true of Rubeola?
1. It is caused by a filterable virus
2. The prodrome period lasts for about 2 weeks
3. The rashes doesn't end in a branny desquamation
4. It is an acute highly communicable infection
5. The rash usually begins behind the ears and neck
6. The cause of death is usually from complications
7. Serum antibodies appear on the third day of the incubation period
8. A morbilliform rash appears on the 3rd or 4th day
a. 1, 2, 3, 5 and 6 c. 2, 3, 4, 5 and 7
b. 3, 4, 5, 7 and 8 d. 1, 4, 5, 6 and 8
67. Nurse Lorie knows that the incubation period of Rubeola is:
a. 10 days from exposure to appearance of fever and about 14 days until rash appears
b. 2-3 weeks, commonly 13 to 17 days
c. 12 to 26 days, usually 18 days
d. Varies from 3 days to 1 month or more, falling between 7-14days in high proportion of cases
68. Anne's immunity from her mother lasted only 6 months. She was brought by her mother because of spots in her buccal mucosa. What do you call these spots?
a. Pseudomembrane c. Koplik spots
b. Rose spots d. Forscheimer's spots
69. The characteristic signs of measles are which of the following group?
a. Skin eruptions which are abundant on covered areas of the body than on the exposed areas
b. Rashes which spread from the face to the trunk and limbs, conjunctivitis, high fever and tiny white spots in the mucosa inside the cheek
c. Vomiting, headache, fine petechial and morbilliform rashes and epistaxis
d. Severe backache and rashes which are more abundant on extremities than on the trunk
70. A nursing intervention that is important in caring for Anne would include the following, except:
a. Administer as prescribed antipyretics to reduce fever
b. Ensuring that the room is well lighted
c. Wearing face mask when administering nursing care to the child
d. Increase fluid intake of the child by drinking water frequently
Situation 15. Vangie is a 15 year-old child who is spending Christmas Vacation in Pangasinan. A week before the vacation ends, she developed fever, diarrhea and rose spots on her abdomen.
71. Based on Vangie's clinical findings, Nurse Ulysses will suspect Vangie to have contacted which infection?
a. Dysentery c. Cholera
b. Amoebiasis d. Typhoid fever
72. Vangie's condition is caused by a:
a. Virus c. Helminth
b. Bacteria d. Protozoa
73. Nurse Ulysses provided the family with health education to prevent transmission of infection as the disease can be transmitted to family members through the following, except:
a. Flies
b. Contaminated food and water
c. Airborne transmission
d. Direct contact
74. The characteristic signs of the said condition in #71 are which of the following?
1. Intermittent fever
2. Continued fever
3. Loss of appetite
4. Slow pulse
5. Rose spots on trunk and abdomen
6. Diarrhea
7. Rice watery stool
8. Bloody stool
a. 2, 3, 4, 5 and 6 c. 1, 3, 4, 5 and 7
b. 1, 3, 4, 5 and 6 d. 2, 3, 4, 5 and 8
75. As a preventive control measure for the said condition in #71, which of the following must be discussed in the health education program for the pubic?
1. Sanitary disposal of human feces and maintenance of fly proof latrine
2. Proper food handling and preparation
3. Removal of stagnant water in empty water drums and flower pots
4. Use of repellants and insecticides
a. 1 and 4 c. 3 and 4
b. 2 and 3 d. 1 and 2
Situation 16. According to a nationwide survey on soil-transmitted helminthiasis (STH) among children aged 12-71 months old done by the DOH, UP and UNICEF in 2003, it showed a cumulative prevalence rate of 66 percent. Studies have shown that STH infected children are prone to acquire other infections. There is a need to sustain mass deworming for 3 consecutive years to immediately control intestinal parasitism and other parasites among these infected children at the critical time of their growth and development.
76. Antihelminthic drugs used include:
a. Albendazole and Mebendazole
b. Metronidazole and Albendazole
c. Cotrimoxazole and Metronidazole
d. All of the above
77. It is a parasitic disease that has similar manifestation with Pulmonary Tuberculosis. What is it?
a. Trichuriasis c. Ascariasis
b. Filariasis d. Paragonimiasis
78. The treatment of choice for the condition in #77 is:
a. Bithionol c. Praziquantel
b. Ethambutol d. Metronidazole
79. The three major causes of intestinal parasitic infections in the Philippines are the following, except:
a. Trichuriasis c. Ancylostomiasis
b. Taeniasis d. Ascariasis
80. This parasite enters the intestinal mucosa and could be spread through autoinfection. This is typically exemplify by:
a. hookworm c. whipworm
b. tapeworm d. pinworm
Situation 17. Lord Voldemort complained of dizziness, vomiting, headache and numbness of the face especially around the mouth after 45 minutes of eating shellfish. He was rushed to the hospital and was diagnosed with Paralytic Shellfish Poisoning (PCP) or Red Tide Poisoning.
81. In addition to the above mentioned signs and symptoms manifested by Lord Voldemort, he may also manifest the following:
a. Blurred vision and rapid rise in the blood pressure
b. Seizures, bradycardia, hematemesis and chest pain
c. Tachycardia, dysphagia, paresthesia and ataxia
d. Floating sensation, hypertension, bradycardia and abdominal pain
82. Which of the following statement is not true about red tide poisoning?
a. The toxin is totally destroyed upon cooking
b. Symptoms occur within minutes or several hours after ingestion of poisonous shellfish
c. It is caused by a plankton
d. Symptoms include tingling sensation and paresthesia
83. Nurse Bellatrix is giving health education to the family of Lord Voldemort regarding Red Tide Poisoning. Lord Voldemort asked the nurse, “Does cooking the shellfish make it safe to eat?” Nurse Bellatrix's best response is:
a. “Yes, as long as you cook the shellfish properly at a boiling point.”
b. “No, the poisons are not destroyed by cooking.”
c. “Yes, the toxins are easily destroyed by heat.”
d. “No, the toxins are destroyed by freezing.”
84. The mother of Lord Voldemort asked Nurse Bellatrix, “Which sea foods can transmit red tide poisoning to human?” The nurse response included the following sea foods, except:
a. crab meat c. clams and mussels
b. oysters and scallops d. sea cucumber
85. Management of Red Tide Poisoning includes:
a. Do not induce vomiting
b. Giving of medications
c. Give coconut milk and sodium bicarbonate
d. The toxin is totally destroyed upon cooking
Situation 18. Severus was admitted with manifestation of jaundice accompanied by pruritus and urticaria. The patient was diagnosed with Hepatitis A.
86. Hepatitis A is also known by the following names, except:
a. Infectious hepatitis c. Epidemic hepatitis
b. Catarrhal jaundice d. Inoculation hepatitis
87. Severus asked the nurse, “Why don't you give me some medication to help me get rid of this problem?” Nurse Neville's best response would be:
a. “Sedatives can be given to help you relax.”
b. “We can give you immune serum globulin.”
c. “There are no specific drugs used to treat hepatitis.”
d. “Vitamin supplements are frequently helpful and hasten recovery.”
88. Nurse Neville has instructed Severus about the type of diet should be eaten. The lunch selection that would indicate the client's understanding and compliance with the dietary principles taught is:
a. Turkey salad, French fries and sherbet
b. Salad, sliced chicken sandwich and gelatin dessert
c. Cheeseburger, taco chips and chocolate pudding
d. Cottage cheese, peanut butter sandwich and milk shake
89. The cooked food most likely to remain contaminated by the virus that causes Hepatitis A is which of the following?
a. Canned tuna c. Fried tuna belly
b. Broiled shrimp d. Steamed lobster
90. Which of the following signs and symptoms occur in a patient with Hepatitis A?
1. Loss of appetite
2. Enlargement of the lymph nodes
3. Tachycardia
4. Jaundice
5. Bradycardia
6. Urticaria
7. Clay-colored stools
a. 1, 2, 4, 6 and 7 c. All except 5
b. 2, 3, 4, and 6 d. All of the above
Situation 19. During the rainy season, several areas in Davao City becomes flooded with water. Leptospirosis is one infection that is common during this time of year.
91. Leptospirosis is also known with the following names, except:
a. Mud fever and Flood fever
b. Weil's disease and Trench fever
c. Catarrhal jaundice and Ragpicker disease
d. Spiroketal jaundice and Japanese Seven Days Fever
92. Dobby, who is suspected of having Leptospirosis, should have his urine be tested for the presence of the microorganism:
a. During the febrile period
b. During the first week of the illness
c. During the first six months after contracting the infection
d. After the 10th day of illness
93. Leptospirosis can be transmitted through:
a. Open skin contact c. Droplets
b. Airborne d. Sexually transmitted
94. Albus asked if it is possible to be infected while swimming in public pools or rivers. Nurse Hermione replied that:
a. “This is not possible as long as you have no open wounds while swimming in public pools.”
b. “Infection with leptospirosis is possible with recreational swimming in water contaminated with urine of human and animals having the infection.”
c. “You can protect yourself by applying 70% alcohol before swimming
d. “There is no danger during day time because leptospires die when exposed to sunlight.
95. Management and treatment of Leptospirosis is symptomatic but a drug medication is prescribed at 200 mg orally once a week for prevention. What is the drug of choice?
a. Chloramphenicol c. Zidovudine
b. Doxycycline d. Streptomycin
Situation 20. Rabies remains a public health problem in the Philippines. Approximately 300 to 600 Filipinos die of rabies every year. The Philippines has one of the highest prevalence rates of rabies in the whole world.
96. Dolores Umbridge, while on her way home from work, was bitten by a stray dog. Nurse Sirius asked Dolores what she did immediately after the incident. Dolores's response indicates correct understanding of first aid measure when she says that:
a. I went to the hospital and reported the incident
b. I ran after the dog and had bitten it too
c. I washed my wound immediately with soap and water
d. I went to the drug store and bought 500 mg antibiotics
97. Nurse Sirius interviewed Dolores and her mother at the Emergency Room to take the history before seeing a doctor. The nurse told Dolores's mother not to kill the dog because the dog will be:
a. Injected with a vaccine
b. Confined at a veterinary clinic
c. Observed for 14 days
d. Treated with antibiotics against rabies
98. It is the objective of the Department of Health (DOH) to reduce the incidence of Human Rabies from 7 per million to 1 per million population by:
a. 201 b. 2015 c. 2020 d. 2025
99. Considering that rabies is one of the most acutely fatal infections which causes the death of approximately 300 to 600 Filipinos annually, voluntary pre-exposure prophylaxis among people who are at risk is highly recommended. These people include:
a. Barangay tanod officials patrolling the streets at night, side walk vendors, veterinarians and animal handlers
b. All people living within an area where there are dogs that roam their neighborhood
c. Pet owners, animal handlers, health personnel working in anti-rabies units and children below 15 years old
d. Pregnant women, side walk vendors, pet owners, veterinarians and infants
100. What is the most common caused of death in patients with Rabies?
a. Seizures c. Hemorrhage
b. Respiratory Paralysis d. Hydrophobia
Communicable Disease Answers III
61. Answer: C
Rationale: The following are late signs and symptoms of Leprosy: (3) Inability to close eyelids (lagophthalmos), clawaing of the fingers and toes, contractures, (6) loss of eyebrow (madarosis), enlargement of the breast in males (gynecomastia), chronic ulcers and (8) sinking of the nose bridge.
62. Answer: A Rationale: The mode of transmission of leprosy are the following: Airborne (inhalation of droplet/spray from coughing and sneezing of untreated leprosy patient) and Prolonged skin-to-skin contact.
63. Answer: D Rationale: Multidrug Therapy is the method of treatment for leprosy. The daily treatment prescribed for a Multibacillary (lepromatous and borderline) type in 28 days is Clofazimine 50 mg and Dapsone 100 mg.
64. Answer: B Rationale: Slit Skin Smear (SSS) examination is an optional procedure done only when a clinical diagnosis is doubtful. This prevent misclassification and wrong treatment. Options A and D is used for diagnosing Tuberculosis. Option C is used in Malaria.
65. Answer: A Rationale: Bacille Calmette-Guérin (BCG) vaccine is used as preventive measure for Tuberculosis. It can also prevent the occurrence of Leprosy since the two disease both came from the Mycobacterium family.
66. Answer: D Rationale: Rubeola or Measles is caused by a filterable virus (1). It is an acute highly communicable infection (4) characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days of coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day (8) affecting the face - usually beginning behind the ears and neck (5), body and extremities ending in branny desquamation. Death is due to complication (6) such as secondary pneumonia, usually in children under 2 years old
67. Answer: A Rationale: The incubation period of Rubeola is 10 days from exposure to appearance of fever and about 14 days until rash appears. Option B is for Chicken pox. Option C is for Mumps. Option D is for Tetanus.
68. Answer: C Rationale: Koplik spots are tiny grayish to whitish spots found in the buccal mucosa of a client with Rubeola. Option A is the pathognomonic sign of Diphtheria. Option B is found in clients with Typhoid fever. Option D is found in clients with Rubella
69. Answer: B Rationale: The characteristic signs of measles are which of the following: Rashes which spread from the face to the trunk and limbs ending in branny desquamation, conjunctivitis (Stimson's sign), high fever and tiny white spots in the mucosa inside the cheek
70. Answer: B Rationale: Clients with Rubeola has conjunctivitis (Stimson's sign), as a result an important nursing intervention is to protect the eyes of the client from glare of strong light as they are apt to be inflamed. Place the client in a dim-lighted room, not well lighted.
71. Answer: D Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and abdomen and diarrhea.
72. Answer: B Rationale: Typhoid fever is caused by Salmonella typhosa or typhoid bacillus, which is a bacteria.
73. Answer: C Rationale: Typhoid fever can be transmitted through the following mode of transmission: direct or indirect contact with patient or carrier; contaminated food and water with flies as vectors; and improper food handling. It is not transmitted via airborne.
74. Answer: A Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and abdomen and diarrhea. (7) Rice watery stools are seen in patients with Cholera.
75. Answer: D
Rationale: Preventive control measures include sanitary disposal of human feces and maintenance of fly proof latrine and proper food handling and preparation.
76. Answer: A Rationale: Antihelminthic drugs used in treating parasitic infections include: Albendazole and Mebendazole (Vermox) that inhibits glucose and other nutrient uptake of helminth; Pyrantel embonate (Antiminth) that paralyzes intestinal tract of worm; and Thiabendazole (Mintezol) that interferes with parasitic metabolism. Metronidazole (Flagyl) is an anti-protozoan drug (options B and C). Cotrimoxazole (Bactrim) is an antibiotics (option C).
77. Answer: D Rationale: Commonly patients with Paragonimiasis are misdiagnosed to have Pulmonary Tuberculosis (PTB) and are treated as Tuberculosis patients. In fact, a study by Belizario et.al revealed that 56% of his subjects were non-responsive to multi-drug therapy for PTB but were positive for Paragonimiasis.
78. Answer: C Rationale: The treatment of choice for Paragonimiasis is Praziquantel (Biltrizide) 25 mg/kg body weight three times daily for three days. It is suitable for treatment of adults and children over four years of age, higher dose is needed for ectopic paragonimiasis. Bithionol (BITIN) is only an alternative drug for paragonimiasis (option A). Ethambutol (option B) is one of the multi-drug therapy for PTB. Metronidazole (option D) is an anti-protozoan drug.
79. Answer: B Rationale: The three major causes of intestinal parasitic infections in the Philippines are the following: (A) Trichuriasis or Whipworm (Trichuris trichiura); (C) Ancylostomiasis or Hookworm (Ancylostoma duodenale and Necator americanus); and (D) Ascariasis (Ascaris lumbricoides).
80. Answer: D Rationale: Pinworms (enterobiasis), which is caused by the parasite Enterobius vermicularis, is the most common helminthic infestation among children. It enters the intestinal mucosa and could be spread through autoinfection (when the child places fingers, used in scratching the anal part and containing the pinworm eggs, into the mouth). It is noted that pinworms caused severe itching as they lay their eggs.
81. Answer: Rationale: The signs and symptoms of Red Tide Poisoning includes: numbness of the face especially around the mouth; vomiting; dizziness; headache; tingling sensation, paresthesia and eventual paralysis of hands and feet; Floating sensation and weakness; rapid pulse (tachycardia); difficulty of speech (ataxia); difficulty of swallowing (dysphagia); and total muscle paralysis with respiratory arrest and death occur in severe cases.
82. Answer: A Rationale: Paralytic Shellfish Poisoning (PCP) or Red Tide Poisoning is a syndrome of characteristic symptoms predominantly neurologic which occur within minutes or several hours after ingestion of poisonous shellfish (option B). It is caused by a single celled organism called dinoflagellates, which is commonly referred to as plankton (option C). One of its symptoms include tingling sensation or paresthesia (option D). Toxins in red tide is not totally destroyed upon cooking.
83. Answer: B Rationale: Toxins in red tide is not totally destroyed upon cooking hence consumers must be educated to avoid bi-valve mollusks like tahong, talaba, halaan, kabiya, abaniko (sun and moon shell or Asian scallop) when the red tide warning has been issued by the proper authorities.
84. Answer: D Rationale: Bi-valve mollusks such as oysters, clams, mussels, sun and moon shell or Asian scallop as well as crabs are avoided when the red tide warning has been issued by the proper authorities. There's no reported cases of red tide poisoning when eating sea cucumber.
85. Answer: C Rationale: Management of Red Tide Poisoning includes the following: induce vomiting; no definite medication indicated; drinking pure coconut milk, which weakens the toxic effect of red tide, and sodium bicarbonate solution (25 grams in ½ glass of water) may be taken. Drinking coconut milk and sodium bicarbonate solution is advised during the early stages of poisoning only. If given during the late stag, they may make the condition of the patient worse; Shellfish affected by red tide must not be cooked with vinegar as the toxin of Pyromidium increases (15 time greater) when mixed with acid; and do not eat even cooked shellfish because toxins of red tide are not totally destroyed upon cooking.
86. Answer: D
Rationale: The other names of Hepatitis A are the following: Infectious hepatitis; Catarrhal jaundice; and Epidemic hepatitis. In option D, Inoculation hepatitis is the other name for Hepatitis B.
87. Answer: C Rationale: There are no specific drugs for the treatment of Hepatitis A. There is, however, a prophylaxis, which is an IM injection of gamma globulin.
88. Answer: B Rationale: The dietary requirement for a client with Hepatitis A is a low fat diet but high in sugar. Options A, C and D are incorrect because all or part of its choices are high in fats. Low fat diet include only lean meats, fish and poultry. The allowed vegetable oils may be used in preparing meats, fish and poultry; used in salad dressings; or in baked products.
89. Answer: D Rationale: Hepatitis A virus can be killed by cooking the food to boiling point, steaming the food will not kill the virus.
90. Answer: A
Rationale: Hepatitis A has the following signs and symptoms: influenza-like such as headache; malaise and easy fatigability; loss of appetite or anorexia (1); abdominal discomfort/pain; nausea and vomiting; fever; enlargement of the lymph node or lymphadenopathy (2); jaundice (4) accompanied by pruritus and urticaria (6); and bilirubinemia with clay-colored stools (7).
91. Answer: C
Rationale: Leptospirosis is also known with the following names: Mud fever and Flood fever (option A); Weil's disease and Trench fever (option B); and Spiroketal jaundice and Japanese Seven Days Fever (option D). In option C, Catarrhal jaundice is the other name for Hepatitis A while Ragpicker disease is the other name for Anthrax.
92. Answer: D
Rationale: Leptospirosis can be diagnosed by its clinical manifestations, culture of the organism, examination of blood and CSF during the first week of illness and urine after the 10th day.
93. Answer: A
Rationale: Leptospirosis can be transmitted through contact of the skin, especially open wounds with water, moist soil or vegetation contaminated with urine of infected host.
94. Answer: B
Rationale: Infection with leptospirosis is possible with recreational swimming in water contaminated with urine of human and animals having the infection.
95. Answer: B
Rationale: Doxycycline is the drug of choice for Leptospirosis. It is prescribed at 200 mg orally once a week for prevention
96. Answer: C
Rationale: The wound must be immediately and thoroughly washed with soap and water. Antiseptics such as povidone iodine or alcohol may be applied.
97. Answer: C
Rationale: Patients should consult a veterinarian or trained personnel to observe the pet for 14 days for signs of rabies.
98. Answer: A
Rationale: The general objective of the Department of Health (DOH) is to reduce the incidence of Human Rabies from 7 per million to 1 per million population by 2010 and eliminate human rabies by 2015.
99. Answer: C
Rationale: People who are at high risk of acquiring rabies includes the following: Pet owners; animal handlers; health personnel working in anti-rabies units; and children below 15 years old.
100. Answer: B
Rationale: Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis.
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