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FOURTH YEAR EXAMS

CONTENTS
OPHTHALMOLOGY
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116 1
Cairo University Fourth year exam
Faculty of Medicine Time allowed 2 hrs
18/6/2008

OPHTHALMOLOGY
1- Describe gross and minute anatomy of the cornea; illustrate your answer with
diagram (10 marks).
2- Compare between hordeolum extemum (stye) and hordeolum internum (cha-
lazion) (10 marks).
3- Discuss medical treatment of dendritic ulcer (10 marks)
4- Enumerate local and systemic causes of complicated cataract (10 marks)
5- Give an account on the effects of blunt trauma on the iris and lens.
(10 marks)

OPHTHALMOLOGY 6- Define glaucoma. How would you classify glaucoma?.


7- Compare in table form between papillitis and papilloedema
(10 marks)
(10 marks)
8- A mother took her 3-months old infant to the ophthalmologist because he
could not face the light and was frequently rubbing his eyes. She also no-
ticed that his eyes look big and hazy (10 marks)
a. What is the most likely diagnosis?
b- How would you proceed to confirm your diagnosis?
c- How is such a condition managed?
9- A 70 - years old hypertensive man came to the emergency room complaining
of sudden complete painless loss vision. On examination his vision was no
PL, the pupil was dilated and fixed. The intraocular pressure was within nor-
mal in both eyes. (20 marks)
a- What is your diagnosis?
b- What is the fundus picture of such a condition?
c- What is your differential diagnosis of this fundus picture?
d- How would you manage in the emergency room?

2 3
10- MCQs 25 questions, one mark for each question 6. Symptoms of retinal tears include
Total 25 marks
a. Flashes of light
1. Angular blepharitis is caused by
b. Ocular pain
a. Phrhirus pubis
c. Headache referred to temporal area
b. Morax Aenfeld diplobacilli
d. Transient attack of loss of vision
c. Staphilococci
7. Fundus examination of an eye with retinitis pigmentosa may show
d. Pneumococci
a. Bone copruscle-like pigmentation
2. Lagophthalmos may be due to the following except :
b. Marked congestion of retinal blood vessels
a. Paralytic ectropion
c. Hyperaemia of the optic nerve head
b. Colomba of the lid
d. Cotton wool exudates
c. Proptosis
8. entropion means
d. Enophthalmos
a. Rolling out of the lid margin
3. Mucopurulent conjunctivitis is caused by all of the following except :
b. Rolling in of the lid margin
a. Koch-Week's bacillus
c. Drooping of the upper lid
b. Streptococci
d. an accessory row of lashes
c. Pneumococci
9. All of the following are complications of a perforated corneal ulcer except :
d. Herpes simplex
a. Leucoma adherent
4. The main symptom of central rentinal artery occlusion is
b. Descematocele
a. Sudden painless complete loss of visioin.
c. subluxation of the lens
b. Photopsia followed by loss of vision
d. Corneal fistula
c. Nasal field defect
10. Spring catarrh usually presents with
d. Temporal field defect
a. Itching
5. Diabetic retionapathy is primarily related to
b. Ropy discharge
a. The duration of diabetes mellitus
c. Lid papillae
b. Acute rise of blood sugar level
d. All of the above
c. Presence of glucose in urine
d. Presence of ketone bodies in urine

4 5
11. Treatment options for pterygium encroaching on the pupillary area in-
b. elevated intraocular pressure
clude the following except :
c. Cupping of the optic nerve head
a. Simple excision
d. All of the above
b. Excision with bare sclera
17. Regarding strabsimus in childhood
c. Excision with grafting
a. Cycloplegic refraction is required in all patients
d. Leave alone
b. fundus examination is not considered routine in all patients
12. One of the following is not a cause of complicated cataract?
c. Amblyopia never occurs
a. Glaucoma
d. All of the above
b. Diabetes mellitus
18. Unilateral proptosis may be seen in all of the following except :
c. Iridocyclitis
a. Cavernous sinus thrombosis
d. Hypermetropia
b. Oribital lumors
13. Medical treatment of POAG
c. Retrobulbar hemorrtage following tramua
a. Is usually tried before resorting to surgical treatment
d. Hyphema
b. Compliance is the main problem
19. As regards Horner's syndrome, all are true except :
c. Can have serious systemic side effects
a. Ptosis
d. All of the above
b. Mydriasis
14. Which of the following is not a type of cataract surgery:
c. Enophthalmos
a. Phacoemulsification
d. Anhydrosis
b. Cryo-extraction
20. commotio retinae is due to
c. Trabeculectomy
a. Blunt trauma to the eye
d. Lensectomy
b. Penetrating trauma
15. Which of the following is a sign of aphakia
c. Sympathetic ophthalmia
a. Jet-black pupil
d. Congenital glaucoma
b. Deep anterior chamber
21. A corneal scar in which the iris is incacerated is called :
c. Tremulous iris
a. Leucoma
d. All of the above
b. Leucoma adherent
16. In a patient with open angle galucoma we may find
c. Macula
a. Visual field changes
d. Nebula

6 7
22. The state of refractin of the eye in which with accommodation complete- Cairo University Fourth year exam August 2008
ly relaxed parallel rays come to a focus in front of the retina is called : Faculty of Medicine Time allowed 2 hrs
Total allocated marks 150
a. Emmetropia
b. amertropia Ophthalmology
c. Myopia 1- Draw and label a section of the upper eyelid (10 marks)
d. Hypermatropia 2- Differentiate between ciliary and conjunctival injection (10 marks)
23. Significant difference in the refractive error between the two eyes is 3- Mention the complications of perforated corneal ulcers (10 marks)
4- Enumerate types of blepharitis (10 marks)
called :
5- Discuss the clinical picture and management of ophthalmia neonatorum
a. Asthenopia
(10 marks)
b. Ametropia
6- Management of acute angle closure glaucoma (20 marks)
c. Anisometropia 7- What are the morphological types of congenital and developmental cata-
d. Anisekonia ract? (10 marks)
24. Myopia can be corrected by : 8- Etiology of central retinal artery occlusion (10 marks)
9- Differentiate in table form between papillitis and papilloedema (20 marks)
a. concave lenses
10- A male patient presented to the ophthalmology clinic complaining of uni-
b. Convex lenses lateral blurring of vision in the right eye associated with neuralgic pain.
c. Cylindrical lenses Anterior segment examination showed ciliary injection, mild corneal haze,
normal depth of the anterior chamber and a normal intraocular pressure.
d. Spheroyclindrical lenses
The pupil was miotic and the iris pattern was less clear than the other eye.
25. Hypermtropia can be corrected by : (20 marks).
a/ Concarve lenses a- What is your diagnosis?
b. Conver lenses b- What signs would you look for in the cornea and anterior chamber to con-
firm your diagnosis?
c. Cylindrical lenses
c- What is the primary treatment?
d. Spherocylindrical lenses d- Mention 3 possible complications for this condition if the treatment is de-
layed.
11- A young myopic male patient received blunt trauma to the right eye since
one month. He complained of recent drop of vision and a field defect pre-
ceded by photopisa and musca (20 marks)
a- What is your diagnosis?
b- Describe the fundus picture you may find

8 9
Cairo University Fourth year exam August 2008 MCQs 25 questions, one mark for each question Choose
Faculty of Medicine Time allowed 2 hrs one correct answer
1. Iridocyclitis
a- Is inflammation of the iris and ciliary body
Ophthalmology b- Is inflammation of the iris
1- Draw and label a section of the upper eyelid (10 marks) c- Is inflammation of the ciliary body
2- Differentiate between ciliary and conjunctival injection (10 marks) d- None of the above
3- Mention the complications of perforated corneal ulcers (10 marks)
4- Management of acute angle closure glaucoma (10 marks) 2- Exogenous uveitis is caused by except
5- What are the morphological types of congenital and developmental cata- a- External injury to the iris
ract?
b- During surgery
(10 marks)
c- Due to endogenous toxins
6- Etiology of central retinal artery occlusion (10 marks)
d- All of the above
7- Definition and mamagement of anisometropia (10 marks)
8- A young myopic male patient received blunt trauma to the right eye since
3- Corticosteroids in Iridocyclitis, the following are true except:
one month. He complained of recent drop of vision and a field defect pre-
ceded by photopisa and musca (10 marks) a- Decrease release of inflammatory mediators
a- What is your diagnosis? b- Decrease vascular permeability
b- Describe the fundus picture you may find c- Increase vascular permeability
9- A male patient presented to the ophthalmology clinic complaining of uni- d- Inhibit fibroblastic activity
lateral blurring of vision in the right eye associated with neuralgic pain.
Anterior segment examination showed ciliary injection, mild corneal haze, 4- Side effects of systemic steroids includes:
normal depth of the anterior chamber and a normal intraocular pressure. a- Salt and water retention
The pupil was miotic and the iris pattern was less clear than the other eye. b- Peptic ulcer
(20 marks) c- Psychological disturbance
a- What is your diagnosis? d- All of the above
b- What signs would you look for in the cornea and anterior chamber to con-
firm your diagnosis?
5- In endophthalmitis the following are true except:
c- What is the primary treatment?
a- There is no pain
d- Mention 3 possible complications for this condition if the treatment is de- b- Increase hyperemia
layed.
c- Lid edema
10- MCQs: 25 questions, one mark for each total 25 marks
d- Hypopyon

10 11
6- In treatment of corneal ulcers, the following are true except: 11- Pain of corneal ulcers may be absent in:
a- Use cycloplegics a- Neuroparalytic keratitis
b- Use pilocaprpine b- Bacterial keratitis
c- Use antibiotics c- Traumatic ulcers
d- Patch the eye d- Acanthameba keratitis

7- Which of the following is not a feature of Horner's syndrome: 12- The main symptom of central retinal artery occlusion is
a- Miosis a- Sudden painless complaete loss of vision
b- Ptosis b- Severe pain
c- Mydriasis c- Discharge
d- Anhydrosis d- Red eye

8- Which of the following is not indicated in the treatment of Iridocyclitis. 13- The following can be seen in the fundus as a sign of central retinal ar-
a- Steroid eye drops tery occlusion
b- Pilocarpine eye drops a- Swelling of the optic nerve head
c- Anti-inflammatory drugs b- A horse-shoe retinal tear
d- Dark glasses c- Cherry red spot at the fovea
d- Bone corpuscle like pigmentation of the retina
9- A patient with acute angle closure glaucoma may show all of the follow-
ing except: 14- Neovascular Glaucoma is a complication of except:
a- Red eye a- Proliferative diabetic retinopathy
b- deep anterior chamber b- Central retinal artery occlusion
c- Dilated pupil c- Retinitis pigmentosa
d- Corneal edema d- Ischaemic central retinal vein occlusion

10- The corneal sensation is dervied from: 15- Diabetic retinopathy is primarily related to
a- The optic nerve a- The duration of diabetes mellitus
b- The oculomotor nerve b- Acute rise of blood sugar level
c- The trigeminal nerve c- Presence of glucose in urine
d- The facial nerve. d- Presence of ketone bodies in urine

12 13
16- The type of retinal detachment that is caused by proliferative diabetic
21- In acute congestive angle glaucoma
retinopathy is
a- Prodromal attacks may precede an acute attack
a- Primary rhegmatogenous retinal detachment
b- Do not try medical treatment
b- Exudative retinal detachment
c- Cycloplegics are the main line of treatment
c- Tractional retinal detachment
d- None of the above
d- None of the above

22- The state of refraction of the eye in which with accommodation com-
17- All of the following can be caused by rhegmatogenous retinal detach-
pletely relaxed parallel rays come to a focus on the retina is called:
ment except:
a- Emmetropia
a- Field defect
b- Ametropia
b- Marked diminution of vision
c- Anisometropia
c- Low intraocular pressure
d- Asthenopia
d- Sudden increase of myopia

23- Simple astigmatism can be corrected by:


18- Fundus examination of an eye with retinitis pigmentosa may show
a- Concave lenses
a- Bone corpuscle-like pigmentation
b- Convex lenses
b- Marked congestion of retinal blood vessels
c- Cylinderical lenses
c- Hyperaemia of the optic nerve head
d- Spherocylinderical lenses
d- Cotton wool exudates

24- Recession of the near point with age beyond the comfortable working
19- Field defects in glaucoma distance is called:
a- Are best detected by perimetry a- Ametropia
b- Arcuate scotomas are the hallmark of glaucomatous disease b- Prebyopia
c- A nasal step can be seen c- Anisometropia
d- All of the above d- Hypermetropia

20- Anti-glaucoma medications include all of the following except 25- Surgical treatment of primary open angle glaucoma is
a- Beta-blockers a- Indicated in non-compliant patients
b- Topical CAl b- Progression of visual field defects
c- Acetazolamide c- Failure medical treatment to control the IOP
d- Antibiotics d- All of the above

14 15
CAIRO UNIVERSITY FOURTH YEAR EXAM 8/6/2009 CAIRO UNIVERSITY FOURTH YEAR EXAM 8/6/2009
FACULTY OF MEDICINE Time allowed 2 hrs FACULTY OF MEDICINE Time allowed 2 hrs
Total allocated marks 150 Total allocated marks 150

OPHTHALMOLOGY.b UE OPHTHALMOLOGY Yb UE
Examination includes :
All questions are to be attempted : - Nine short easy questions (each 10 marks)
1. Give an account on the gross and microscopic anatomy of the - One problem solving question (15 marks)
- MCQs (20 marks
cornea.
2. Definition and types of entropion. All questions are to be attempted :
3. Definition, clinical picture and complications of acute dacryo- 1. Give an account on the gross and microscopic anatomy of the cornea.
2. Definition and types of entropion.
cystitis.
3. Definition, clinical picture and complications of acute dacryocystitis.
4. Definition and clinical picture of spring catarrh. 4. Definition and clinical picture of spring catarrh.
5. Clinical picture and treatment of dendritic corneal ulcer. 5. Clinical picture and treatment of dendritic corneal ulcer.
6. Treatment of acute angle closure glaucoma.
6. Treatment of acute angle closure glaucoma. 7. Definition, etiology and clinical picture of soft cataract.
7. Morphological types of congenital cataract. 8. Complications of acute iridocyclitis.
9. Differentiate between papilledema and papillitis.
8. Complications of acute iridocyclitis.
Problem Solving :
9. Differentiate between papilledema and papillitis. A mother brought her 10 year old son complaining of bilateral redness, se-
vere lid edema and a yellowish conjunctival discharge two days ago. On exam-
10. Effects of blunt ocular trauma on the vitreous and retina.
ination there were bilateral palpable preauricular lymph nodes and his temper-
ature was 38 degrees.
1. What is the provisional diagnosis? What is the commonest organism re-
sponsible for this condition? (5 marks)
2. Mention the most serious ocular complication of this condition.
(3 marks)
3. Plan the lines of treatment in this case? And what options you may add
for the possible complication? (7 marks)

16 17
CAIRO UNIVERSITY FOURTH YEAR EXAM 8/6/2009 6. complications of contact lens wear include all of the following except
FACULTY OF MEDICINE
a) Giant papillary conjunctivitis
b) Acanthamoeba keratitis
OPHTHALMOLOGY c) Trauma to the surface of the eye
MCQs 20 Questions, one mark for each question. Choose one correct an- d) Retinal detachment.
swer : 7. What is the mechanism of glaucoma following central retinal vein oc-
1. Estimation of intraocular pressure can be performed by all of the fol- clusion (100 day glaucoma)
lowing techniques except a) Blood in the trabecular meshwork
a) Applanation tonometry b) Rise in IOP following rise in systemic blood pressure
b) Schoitz Tonometry c) New vessel formation in the angle
c) Tonopen d) Angle recession
d) Topgraphy 8. In acute angle closure glaucoma all of the following are correct ex-
2. Ptosis can occur in the following clinical situations cept
a) Following blunt trauma to the eyelid a) Patients always present with decreased visual acuity.
b) As a congenital condition b) Intraocular pressure is elevated
c) In myasthenia gravis c) Patients never give a history of previous attacks
d) All of the above d) Surgery may be indicated after control of intraocular pressure
3. A 2 year old child with bilateral ptosis and lid movement while eat- 9. Steroids typically induce what kind of catarct?
ing. This is a case of a) Nuclear sclerotic
a) Congenital ptosis with Jaw-winking phenomenon b) Posterior polar
b) Acquired ptosis c) Posterior subcapsular
c) Congenital ptosis with 6th nerve palsy d) Cortical
d) None of the above
10. Leucocoria is commonly seen in cases of
4. Nasolacrimal duct obstruction commonly presents with
a) Congenital cataract
a) Dry eye
b) Reitnoblastoma
b) Eiphora
c) Retinopathy of prematurity
c) Blepharitis
d) All of the above
d) None of the above
11. One of the major criteria associated with Behcet's disease is
5. In keratoconus
a) Hair loss
a) Munson sign is seen
b) Painful oral ulcers
b) Corneal opacity may be seen
c) Anemia
c) Corneal topogrpahy is diagnostic
d) None of the above
d) All of the above

18 19
12. Retinal findings of non-proliferative diabetic retinopathy include all 18. Complications of hyphema include the following except:
of the following except a) Secondary glaucoma
a) Blot hemorrhages b) Corneal blood staining
b) Hard exudates c) Iridocyclitis.
c) Venous beading d) Mucopurulent discharge
d) new vessels at the disc 19. Causes of cherry red spot include the following except :
13. With complete relaxation of accommodation, a myopic eye focuses
a) Central retinal artery occlusion
images :
b) Commotio retinae.
a) In front of the lens
c) Retinitis pigmentosa.
b) In front of the retina
d) Amaurotic family idiocy
c) Behind the retina
20. The first line of management of a chemical injury may be any of the
d) Behind the cornea
following except :
14. Hypermetropia
a) Wash with water immediately
a) Can be corrected by accommodation especially in children
b) Wash with an antidote.
b) Is usually corrected by convex lenses
c) Systemic steroids.
c) Can be corrected by contact lenses
d) Wash with water and refer to a specialist.
d) All of the above
15. Astigmatism
a) Is usually corrected by cylindrical lenses
b) Irregular type is corrected by hard contact lenses
c) Is frequently seen in keratoconus
d) All of the above
16. The best line of treatment of congenital glaucoma is
a) Pilocarpine eye drops
b) Beta blocker eye drops
c) Peripheral iridectomy
d) Goniotomy
17. Glaucoma inversus is caused by
a) Anterior dislocation of the lens.
b) Posterior dislocation of the lens.
c) Central retinal vein occlusion
d) Central retinal artery occlusion

20 21
CAIRO UNIVERSITY Fourth Year exam 24/8/2009 b) Ocular motility. 13. The anterior chamber becomes shallow
FACULTY OF MEDICINE c) the retinal blood vessels in one of the following stages of senile cat-
d) The angle of the anterior chamber. aract
5. Types of elpharitis include all of the fol- a) Immature stage.
lowing except b) Intumescent stage.
OPHTHALMOLOGY a) Congenital blepharitis. c) Mature stage.
Yb UE b) Squamous blepharitis d) Hypermature stage.
Examination Includes : c) Parasitic blepharitis. 14. One of the following causes of a red
- Section A : 9 short essay questions (10 marks each) d) Ulcerative blepharitis. eye is not accompanied by pain and drop of
- Section B : 1 problem solving question (15 marks) 6. Ptosis can occur as a result of injury of vision
- Section C : 20 MCQs (20 marks) a) The facial nerve a) Subconjunctival hemorrihage
Total Allowed Marks (125 marks) b) The oculomotor nerve. b) Corneal ulcer.
Section A : c) The abducent nerve. c) Acute iridocyclitis.
All questions are to be attempted : d) The grigemnial nerve d) Acute congetive glaucoma.
1. Give an account on the gross and microscopic anatomy of the conjunctiva. 7. All of the following are causes of a dry 15. Endophthalmitis may be due to any of
2. define lagophthalmos. Mention its etiology, clinical picture and treatment. eye except the following except
3. Give an account on chronic dacrocystitis (definition, etiology, clinical picture and com- a) Congenital absence of the lacrimal a) Intraocular operations.
plications). gland. b) Penetrating injuries to the globe.
4. What are the complications of a perforated corneal ulcer? b) Inflammation of the lacrimal gland. c) Blood born infections.
5. Mention the medical treatment of acute iridiocyclitis. c) Nasolacrimal duct obstruction. d) Anisometropia.
6. Enumerate the drugs used in the medical treatment of primary open angle glaucoma. d) Conjunctival scarring. 16. A cherry red spot at the macula cna be
7. Mention the local causes of complicated cataract. 8. Giant papillae of the conjunctivitis. due to any of the following except
8. Give an account on the types and clinical picture of central retinal vein occlusion. b) Vernal conjunctivitis. a) Central retinal artery emblism.
9. Mention the effects of an intra-ocular foreign body. c) Diphtheritic conunctivitis. b) Commotio-retinae caused by trauma.
Section B : d) Viral conjunctivatis c) Quinine toxicity.
A 50 years old hyperopic female started to complain of intermittent attacks of blurred vi- 9. Signs of a corneal ulcer include all of the d) Retinitis pigmentosa.
sion in her right eye. The attacks occurred particularly at night and lasted for 1-2 hours. following except 17. In proliferative diabetic retinopathy ne-
the attack was accompanied by mild temporal headache and colored haloes surrounding a) Ciliary injection. ovessels grow on any of the following in-
lamps. The attacks ended when she entered well illuminated areas or went to sleep. b Loss of corneal luster. tra-ocular structures except
1. What is the most probable cause of her complaint? (3 marks) c) Deep anterior chamber. a) The lens
2. What would be the clinical picture of a full blown attack? (5 marks) d) Aqueous flare and cells. b) The iris.
3. How is the full blown attack managed? (5 marks) 10. Visual field changes in primary open c) The retina
4. Does this patient need anything to be done to her other (normal) eye? (2 marks) angle glaucoma include all of the following d) The optic disc.
Section C : Choose only one answer for each question: except 18. Physicological causes of miosis include
1. The outer fibrous coat of the eye ball is a) Paracentral scotoma. all of the following except:
a) The cornea and sclera. b) Arcuate sctoma. a) Light reflex.
b) The tarsus. c) Nasal step. b) Excitement
c) The medial and lateral palpebral ligaments. d) Homonymous hemianopa c) Accommodation reflex.
d) Tenon's capsule. 11. Non-elective topical beta-blockers are d) Sleep.
2. The refractive media of eye include the following, except contraindicated in 19. One of the following drugs does not
a) The cornea. a) Bronehial asthma. cause mydriasis.
b) Aqueous humor. b) Decompensated heart failure. a) Atropine
c) The lens. c) Bundle branch block. b) Morphine.
d) The retina d) All of the above c) Homatropine
3. Photophobia is 12. Filtration surgery in glaucoma creates a d) Phenylephrine
a) Seeing flashes of light. channel for the exit of aqueous from the 20. Myopia accompanying senile nuclear
b) Seeing no light at all. anterior chamber to cataract is a form of
c) Inability to open the eyes on facing light. a) posterior chamber. a) Axial myopia.
d) Seeing colored haloes. b) Vitreous cavity. b) Curvature myopial
4. Gonioscopy is a technique used to examine c) Subconjunctival space c) Index myopia
a) the eye lashes. d) Subretinal space d) Congenital myopia.

22 23
Cairo University June Exam., 2008
Faculty of Medicine Time allowed: 2 Hours.
12/6/2008 4th Year Exam.

EAR, NOSE AND THROAT


1- A male patient aged 37 years is presenting with acute rhinosinusitis. His na-
sal mucosa is oedematous and congested. He is going to fly with the air-
plane on the next day.
a) What problem do you expect him to have during flight? And in which part
of the flight it will occur? (3 marks)
b) What do you advise him in order to avoid this problem? (5 marks)
c) Describe the symptoms and signs of the problem. (5 marks)
d) How to treat this condition if it occurs? (5 marks)

2- A female aged 42 years came with a history of trauma to the head. She had
watery nasal discharge from the right side of the nose following the trauma.
a) What is the most suspected condition? (3 marks)

E.N.T b) What other symptoms do you ask her about?


c) What do you advise her to do to avoid complications?
d) How to mange this condition?
(4 marks)
(5 marks)
(4 marks)

3- A female teacher agecd 36 years came with hoarseness of voice. The condi-
tion started 2 months ago with stationary course. She tried medical treat-
ment but it was not helpful.
a) What is the most probable diagnosis? (2 marks)
b) Describe the lesion (4 marks)
c) How to treat this condition? (3 marks)
d) What is the differential diagnosis of this case? (6 marks)

4- Mention different types of foreign bodies in the ear. How to treat each?
(7 marks)
5- Causes, clinical picture, investigations and treatment of oromaxillary fistu-
la? (7 marks)
6- Causes, clinical picture, investigations and treatment of cancer oesophagus?
(6 marks)
7- MCQ (30 marks)

24 25
Cairo University August exam, 28/8/2008) MCQ
Faculty of Medicine Time allowed: 2 hour
Total marks: 100 4th year exam. Ear, Nose & Throat (August 2008)
1) Stapes footplate covers
a- round window
Ear, Nose & Throat b- oval window
1) A 3 year old child developed upper respiratory infection, followed by in- c- sinus tympani
spiratory stridor 2 days later. d- pyramid
a- What is the most common diagnosis? (2 marks)
b- Why is it more dangerous in children? (2 marks) 2) Treatment of a small dry traumatic rupture of tympanic membrane is
c- Enumerate other causes of stridor in children (4 marks) a- antibiotic ear drops
d- How would you manage this child? (5 marks) b- myringoplasty
2) A 64 year old male patient presented with a swelling in his neck of 2 c- ear pack
months duration. There were no other head and neck symptoms. Examina- d- protection of ear against water
tion revealed a solitary hard 3 cm swelling in the upper cervical chain on
the right side of the neck. Further examination revealed no other abnor- 3) Hosarsness is the earliest symptom of carcinoma of
mality. a- glottis
a- What is the probable diagnosis? (2 marks) b- subglottis
b- Enumerate silent areas of the neck (6 marks)
c- supraglottis
c- How would you investigate this case? (5 marks)
d- pyriform fossa
3) A 33 year old female suffered an attack of acute follicular tonsillitis for 2
4) Regarding multiple papillomatosis of the larynx all are true EXCEPT
days. The pain in her throat started now to localize unilaterally on the left
side with earache in the left ear. She has difficulty in opening her mouth. a- caused by human papilloma virus
a- What is the possible diagnosis? (2 marks) b- recurrent
b- Why is the pain felt in the ear? (2 marks) c- premalignant
c- What other symptoms and signs do you expect to find in this case? d- laser excision is the best treatment
(3 marks)
d- What are the further complications that may occur later? (3 marks) 5) Which of the following is false about nasopharyngeal cancer?
e- How do you treat this case? (4 marks)
a- causes unilateral secretory otitis media
4) Aetiology and types of cholesteatoma (10 marks) b- treatment of choice is radiotherapy
5) Corrosive oesophagitis (10 marks) c- metastasises to cervical lymph nodes
6) Atrophic rhinitis (10 marks) d- most common nerve involved is the facial nerve
7) MCQ (30 marks)

26 27
6) All are true in malignant otitis externa (skull base osteomyelitis) EXCEPT 11) Aetiology of Bell's palsy includes all EXCEPT
a- is seen in diabetics a- autoimmune
b- spreads to skull base b- cholesteatoma
c- more often affects elderly patients c- viral infection
d- causative organism is streptococcus pyogenes d- nerve ischaemia due to cold air drafts

12) Unilateral purulent nasal discharge in a 3 year old child is most likely
7) Clinical picture of nasopharyngeal angiofibroma include the following due to
ECEPT
a- foreign body
a- occurs exclusively in males b- allergy
b- epistaxis and nasal obstruction are common c- angiofibroma
c- radiotherapy is the treatment of choice d- sinusitis
d- arises from the sphenopalatine foramen
13) The most common laryngeal site of tuberculosis is
8) The following are cranial complications of chronic suppurative otitis media a- true vocal cords
EXCEPT b- subglottis
a- labyrinthitis c- interarytenoid
b- petrositis d- epiglottis
c- mastoiditis
14) Which muscle abducts the vocal cords?
d- extradural abscess
a- posterior cricoarytenoid
9) Gradinigo's syndrome is characterized by the following EXCEPT b- lateral cricoarytenoid
a- profuse ear discharge c- cricothyroid
b- facial pain d- thyroarytenoid
c- facial nerve paralysis 15) Tonsillectomy should be considered for the following EXCEPT
d- diplopia a- asymptomatic tonsillar hyperplasia
10) Most common cause of bilateral conductive deafness in a child is b- quinsy
a- otosclerosis c- obstructive sleep apnea
b- secretory otitis media d- 4-5 episodes of tonsillitis per year
c- congenital cholesteatoma
d- adhesive otitis media

28 29
Cairo University August exam, 28/8/2008) Cairo University 24/6/2009
Faculty of Medicine Time allowed: 1 hour Faculty of Medicine June Exam, 2009
Total marks: 80 4th year exam Time allowed: 2 Hours

Final Exam., Ear Nose & Throat


Ear, Nose & Throat Fourth Year
1- A child 34 month old presented to the reception room with difficult noisy
(old system) breathing. The condition started 12 hours before coming to hospital. It was mild
at first, but it was progressive in course. He did not receive any treatment be-
1) A 3 year old child developed upper respiratory infection, followed by inspir fore.
atory stridor 2 days later. a) What are the possible lesions that may cause this condition? Mention the
a- What is the most common diagnosis? (2 marks) common at first then the les common. (6 Marks)
b) Explain the cause of obstruction in each. (4 Marks)
b- Why is it more dangerous in children? (6 marks) c) How to treat each lesion? (5 Marks)
c- Enumerate other causes of stridor in children (6 marks) 2- A 34 year old female complained of deviation of her face to the right side
with inability to close her left eye. The condition started the day before and it
d- How would you manage this child? was of a sudden onset. She suffered from disturbance of hearing and taste on the
2) Aetiology and types of cholesteatoma (10 marks) left side.
a) What was the form of disturbance in hearing? Explain the cause. How to test
3) Corrosive oesophagitis (10 marks) for? (3 Marks)
4) Atrophic rhinitis (10 marks) b) What was the form of disturbance in taste? Explain the cause. How to test
for? (3 Marks)
5) MCQ (30 marks) c) What was the expected cause if the ear was normal on examination? And
what is the aetiology in this condition? (3 Marks_
d) What was the most expected cause if the ear is discharging? Describe the dis-
charge in this condition. (4 Marks)
e) How to know the level of the lesion? (4 Marks)
f) How to follow up the case? (4 Marks)
g) Mention the broad lines of treatment. (4 Marks)
3- Stages and treatment of rhinoscleroma. (10 Marks)
4- Complications of tonsillectomy operation. (10 Marks)
5. Types, clinical picture, investigations and treatment of foreign body in the oe-
sophagus. (10 Marks)
6- M.C.Q. (30 Marks)
1. The most common route for infection to reach the middle ear is through:
a. Traumatic perforation of the tympanic membrane.
b. The Eustachian tube.
c. Blood stream.
d. Retograde infection from meningitis.
2. Supplied by the trigeminal nerve :
a. Medial pterygoid muscle.

30 31
b. Buccinator muscle. b. The orbit. Cairo University 8/9/2009
c. Stapedius muscle. c. The cavernous sinus. Faculty of Medicine Sept. Exam, 2009
d. Cricothyroid muscle. d. The sphenoid sinus Time allowed: 2 Hours
3. Antrochoanal polyp arises from the 10. A cause of unilateral nasal ob-
: struction : EAR NOSE & THROAT
a. Sphenoid sinus. a. Allergic rhinitis. FOURTH YEAR
b. Ethomoid sinus. b. Rhinoscleroma. Answer the following questions :
c. Frontal sinus. c. Cancer maxilla. 1. A 7 year old male child came to the outpatient clinic complaining of diminu-
d. Maxillary sinus. d. Common cold.
4. Not used in the treatment of the 11. Vertigo without deafness is tion of hearing in both ears for 2 months. He had nasal obstruction preceding
acute stage of corrosive poisoning: present in : this condition. On examination, both tympanic membranes were intact but re-
a. Emollients. a. Labyrinthitis. trated and slightly congested.
b. Antibiotics. b. Meniere's disease.
A. What are the tuning fork tests you are going to do?
c. Stomach wash. c. Otosclerosis.
d. Analgesics. d. Vestibular neuronoitis. What is the significance of each?
5. Causes early stridor before hoarse- 12. Laryngeal paipilloma of adults is B. What are the investigations do you advise? What is the significance of each?
ness of voice : : (3 marks)
a. Glottic carcinoma. a. Multiple.
C. What is your diagnosis and differential diagnosis if present ? (2 marks)
b. Epiglottic carcinoma. b. Premalignant.
c. Supergaottic carcinoma. c. Cures spontaneously. D. How to treat this case ? (6 marks)
d. Subglottic carcinoma. 13. Rhinolalia aperta occurs in cases 2. A 3 year old female child presented with purulent offensive discharge from
6. Highly arched palate is found in of : the right side of the nose for the last 2 days.
cases of: a. Cleft palate.
A. What is the diagnosis? (2 marks)
a. Nasopharyngeal fibroma. b. Redundant palate.
b. Nasopharyngeal carcinoma. c. Adenoids. B. How to treat? (4 marks)
c. Adenoids. d. Allergic nasal polypi. C. What are the compliations if the case is wrongly managed and how to man-
d. Allergic nasal polypi. 14. Referred otalgia occurs in cases age? (6 marks)
7. Cacosmia is a characteristic symp- of :
tom in cases of : a. Traumatic perforation of the tym- 3. A 60 year old man presented with hoarseness of voice for the last 45 days. He
a. Acute sinusitis. panic membrane. used to smoke 30 cigarettes per day for the last 30 years. The condition persist-
b. Sinusitis of dental origin. b. Temporor-mandibular arthritis. ed in spite of medical treatment.
c. Atrophic rhinitis. c. Myringitis. A. What is the most probable diagnosis? (2 marks)
d. Rhinoscleroma. d. Secretory otitis media.
8. Mastoid abscess is treated by : 15. Sneezing is a common symptom B. What is the differential diagnosis ? (6 marks)
a. Simple incision. in : C. How to investigage ? (8 marks)
b. Cortical mastoidectomy. a. Sinusitis. 4. Causes, symptoms, signs and treatment of Oro-mixallary fistula. (8 marks)
c. Radical mastoidectomy. b. Fracture nasal bones. 5. Cause, symptoms, investigations and treatment of achalasia of the cardia.
d. Tympanoplasty. c. Allergic rhinitis.
9. Furunculosis of the nose is danger- d. Cerebrosopinal rhinorrhoea. (8 marks)
ous because infection may spread to : 6. What is tinnitus? What are the types of tinnitus? (8 marks)
a. The nasal cartilage. 7. M.C.Q.s. (30 marks)

32 33
Cairo University Date: 24/6/2008
Faculty of Medicine Time allowed: 3 hours

M.B.B. Ch. EXAMINATION IN FORENSIC


MEDICINE AND CLINICAL TOXICOLOGY
I- Forensic Medicine

I- Short Accounts: (10 points)


1- Enumerate factors affecting the appearance of inlet wound/s in firearm in-
juries. (3 points)
2- Describe the post-mortem picture due to death from strangulation.
(4 points)
3- Describe the hydrostatic "floatation" test of lungs in infanticide cases.
(3 points)

FORENSIC&TOXICOLOGY II- Problem-solving Questions: (20 points)


Case number 1: (10 points)
A young 18 years old male was found dead in his room with an incised wound
in the neck. Huge amounts of blood-stains were seen on a mirror and on
the ventral aspect of his clothes. A razor was seen nearby the body.
1- Do you think that this case was homicidal, suicidal or accidental? And
why? (1.5 points)
2- How could you confirm your suspicion through examination of the wound?
(3 points)
3- Enumerate the causes of death from cut throat? (1.25 points)
4- Describe the post-mortem findings which could you see in that case?
(2 points)
5- How could you estimate the age of that male? (1 points)
6- What was the medico-legal importance of the age of 18 years for males?
(1.25 points)

Case number 2: (10 points)


A young 21 years old girl with a history of psychiatric disorders was admitted

34 35
to a hospital showing severe extensive skin burns involving the face,
chest, abdominal wall, arms and thigh. Two old scars were seen at the ven- 4- Soft tissue lacerations show characteristically:
tral aspect of her left wrist. She died within 6 hours after being admitted. a- Skin trauma over areas of internal tears
1- Do you think that this case was homicidal, suicidal or accidental? And b- "Tissue bridges" between opposing sides of skin
Why? (1.75 points)
c- A wound pattern indicating the shage of the injuring object.
2- How could you confirm the ante-mortem nature of such burns?
d- Both "B" and "C"
(2.25 points)
e- Sharp edges.
3- Enumerate the possible causes of death in that case? (1.5 points)
4- Describe the post-mortem findings which could you see in such case? 5- Post-mortem hypostasis "lividity":
(2 points) A- Is confined mainly to the skin
5- How could you estimate the age of that girl? (1.5 points) b- Is more marked in the internal organs than in the skin
6- What was the medico-legal importance of the age of 21 years? (1 point) c- May simulate pneumonia in the lungs
d- Is more pronounced in leukaemics.
III- Multiple Choice Questions: (10 points)
e- Is more pronounced in anaemics.
For each of the following multiple choice questions, select the most appro-
priate answer: (0.5 point for each question)
6- On performing a post-mortem examination, the body of a cadaver was
1- The type of hymen inconsistent with virginity is: pale. There were faint hypostasis and empty and, collapsed big veins
A- Annular. B- Fimbriate. C- Septate. and heart. No injuries or pathological lesions were found. The cause
D- Carunculae myrtiformes. E- Cribriform. of death is:
a- Haemorrhage
2- In case of a blow on the head and a subsequent fall producing over- b- Vagal shock
crossing fractures: c- sympathetic shock
a- The fracture lines of the fall are arrested by those produced by the blow. d- Amniotic fluid embolism
b- The fracture lines of the blow are arrested by the fracture lines of the fall e- Asphyxia.
c- The fractures of the fall are more extensive.
d- The fractures of the blow are more extensive. 7- Cadaveric spasm:
e- It is impossible to prove which occurred first. a- May be found in drowning
b- May be simulated artificially after death
c- May appear if excitement, terror or severe pain precedes death
3- The second most common fatal complication of criminal abortion is: d- Both "A" and "C" are correct
a- Infection. e- Is nothing else but a medical myth.
b- Haemorrhage
c- Venous air embolism 8- Lochia disappears usually within ........................ days after delivery:
d- Systemic poisoning by abortifacient a- 5 b- 10 c- 15 d- 20 e- 30
e- Neurogenic shock

36 37
14- The determination if small fragments of bones are human or not may
9- Post-mortem mummification changes may: be based on the:
a- Resemble adipocere in obese individuals a- Anatomical features
b- Result in god preservation of external appearance despite internal decay b- Microscopic structure of cartilage
c- Occur spontaneously due to hydrolysis of body fats c- Microscopic structure of bone
d- Require hot and dry environment d- Precipitin test
e- Both "B" and "C" are correct. e- Resistance to incineration

10- A solution of iodine, potassium iodide and distilled water is used for 15- The most common inflammatory complication of head injury is:
the preliminary diagnosis of: a- Leptomeningitis
a- Semen b- Brain abscess
b- Blood c- Encephalitis
c- Pregnancy d- Subdural empyema
d- Carboxy-haemoglobin e- Epidural empyema
e- Met-haemoglobin
16- All of the following but ONE are true about the relationship between
11- All but ONE of the following are true concerning informed consent: a physician and his patient:
a- The consent is invalid if the act consented to is unlawful a- It is extremely confidential.
b- Operations on the wife require the informed consent of her husband b- Betrayal of a patient's confidence may be grounds for revocation of the
c- If a person is over 21 years old, his or her consent should be obtained physician's license.
d- Free treatments do not cancel the obligation of obtained informed consent c- Revelation of professional information without the consent of the patient is
e- The consent implies an understanding of the risks involved. sufficient reason for awarding damages.
d- It is privileged communication under common law.
12- Blood group testing in contested paternity cases may be useful in the e- The patient's authorization for disclosure of medical information by his
following cases: physician can not be partial or limited.
a- Denial of paternity of a child born out of wedlock
b- Suspicion that two newborns have been interchanged in a hospital 17- If the head of the humerus of a found skeleton is separated from the
c- denial of paternity in lawful wedlock by husband shaft, the age of the individual is likely to be:
d- "A", "B" and "C" are correct a- Below 20 years
e- Positive proof of paternity in rape cases b- 20-30 years
c- 30 - 40 years
13- To diagnose stoppage of respiration, you should auscultate best the: d- 40-50 years
a- Larynx e- Above 50 years
b- Lung bases
c- Lung apex 18- Cutis anserina or "goose skin" is:
d- All chest a- Due to post-mortem rigidity of short muscle fibres in the skin
e- Precordium b- A relatively good indicator that death occurred in a cold environment
c- Strictly a post-mortem, non-diagnostic occurrence
d- Both "A" and "C" are correct
e- A relatively good indicator of drowning

38 39
19- A dead body of an adult male was found with stiffness in all the mus- 10- In case of medical certificates for age estimation, a ............................ and
cles, but the face was flaccid. The post-mortem period in hours is ...................... should be obtained to avoid impersonation.
about:
a- 10 b- 14 c- 24 d- 36 e-48 V- () or (x): (10 points)
Indicate whether the following statements are true or false and give rea-
sons:
20- Determination of blood-stains can be done by using:
(2 points for each statement)
a- Precipitin test
b- Phenolphthalein test 1- The posterior fontanelle closes at 3 months after birth, while the anterior
c- Lysis test fontanelle starts closure at 9 months nd closes at 12 months.
d- Microscopy 2- After death, the nervous tissue succumbs within 15-30 seconds, the mus-
e- Both "B" and "D" are correct cles can contract to direct electrical stimulation for up to 1 hour, and sper-
matozoa remain viable in the epididymis for a number of hours.
IV- Complete: (10 points) 3- The edge of cut wounds is absolutely regular and cleanly-cut, while that of
Complete the following statements: (1 point for each statement) contused wounds is absolutely irregular and lacerated.
4- Sepsis of skull fractures takes about 2 weeks to develop in the from of bone
1- After death, the amino acid content in the cerebrospinal fluid rises to defects involving only the outer layer of skull.
.............. mg/dl within 10 hours, while non-protein nitrogen concentration 5- Heat cramps are due to the effect of heat on the head leading to gradual pe-
rises to ................ mg/dl within 24 hours. ripheral vascular collapse. They are treated by ice-cold foments and ice-
2- Fissured fractures of the skull are completely united in............., while in cold enema.
case of non-union, the edges become smooth in ................ leading to bone
ebernation or ivory formation. II- Clinical Toxicology
3- According to Dupuytre's classification of dry burns, the most painful and I- Short Accounts: (10 points)
shocky degree is ............... because ................ 1- Enumerate the methods of induction and contra-indications of emesis "in-
duction of vomiting" (3 points)
4- Investigations of incompatible blood transfusion include
2- describe the treatment of acute digitalis toxicity. (3 points)
........................,.......................,.................and ........................................... . 3- Describe the clinical picture of acute organophosphate poisoning. (4 points)
5- External sure signs of drowning include ......................... and
............................ II-Problem-solving questions: (7.5 ponts)
6- Medico-legal conditions in which a female is examined for signs of virgini- A 25 years old female with a history of epilepsy was admitted to hospital after
ty are ..................,................... and .............................. ingestion of 20 tablets of her drug therapy. On examination, she was comat-
osed, pulse rate was 90/minute, Blood Pressure was 65/50 mm/Hg, respiration
7- Biological tests of pregnancy became positive ....................... after the first was slow, deep and sterturous, temperature was 36.3C and pupils were dilated
missing period, and remained positive for .................. after delivery or and reactive.
abortion. 1- What is your provisional diagnosis? (1.5 points)
8- Delayed causes of death from criminal abortion include 2- How could you confirm your diagnosis? (3 points)
...................,..................... and........................ . 3- What are the proper lines of teratment of that case? (3 points)
9- In child abuse, the value of Roentgenographic examination is not only as
........................, but also in ...........................

40 41
III- Multiple Choice Questions: (10 points) 6- The mechanism/s of carbon monoxide poisoning include/s:
For each of the following multiple choice questions, select the most ap- a- Formation of carboxy-myoglobin
propriate answer: (0.5 point for each question) b- Formation of carboxy-haemoglobin
c- Shift of oxy-haemoglobin dissociation curve to the right
1- The first effect of kerosene on the respiratory tract is: d- Inhibition of cytochrome oxidase
a- Acute pulmonary oedema e- Both "B" and "D" are correct
b- Acute bronchopneumonia
c- Oedema of glottis 7- Weat acids as antidotes for corrosive alkalis are better avoided because
d- Chemical peneumonitis of:
e- Spasm of bronchioles a- Carbon dioxide evolution
b- Production of heat
2- Lead colic is due to: c- Induction of acidosis
a- Continuous constipation d- Induction of vomiting
b- Direct affection of smooth muscles e- Increase of absorption
c- Stimulation of sensory nerves
d- Stimulation of vagus 8- Acute toxicity by iron, in a child who ingested a big amount of ferrous
e- Cramps of abdominal wall muscles sulphate tablets, can be rapidly diagnosed by:
a- Chemical detection
3- All of the following, but ONE, delay or reduce gastrointestinal absorp- b- Clinical picture of gastro-enteritis
tion of toxic substances: c- X-ray on the stomach
a- Ingestion of activated charcoal d- Nervous manifestations
b- Ingestion of evaporated milk e- Black stools
c- Ingestion of water
d- Gastric lavage 9- All but ONE of the following are present in cases of chronic alcoholism:
e- Saline laxatives a- Parkinsonism
b- Amnesia
4- Clinical symptomatology in belladonna poisoning does not include: c- Mental deterioration
a- Hallucinations d- Hallucinosis
b- Hypothermia and pallor e- Peripheral neuritis
c- Dysphagia
d- Mydriasis 10- The presence of cyan-met-haemoglobin in a patient after cyanide poi-
e- Oral and mucosal dryness soning indicates:
a- Severe toxicity
5- Autopsy findings in phosphorus poisoning do not include: b- Dangerous anoxia
a- Jaundice c- Starting haemolysis
b- Interadermal and internal haemorrhages d- Need for blood transfusion
c- Gastro-intestinal haemorrhagic ulcerations e- successful treatment
d- Centri-lobular fatty chagne of the liver
e- Fatty degeneration of the myocardium

42 43
11- The fatal dose of hyoscyamine in relation to hyoscine is: c- Muscarine
a- Half d- Pilocarpine
b- Equal e- Atropine
c- Two times
d- Three times 17- A child was poisoned by Dichloro-diphenyl-trichloroethane "DDT"
e- Four times should be given parenterally the following drug as an emergency treat-
ment:
a- Diazepam
12- Amphetamines in a big dose produce convulsions due to stimulation b- Calcium disodium edetate
of:
c- Atropine sulphate
a- Cerebral cortex
d- Pralidoxime
b- Spinal cord
e- Dimercaprol
c- Brain stem
d- Myo-neuronal junction
18- The rapid intravenous administration of pentothal sodium may pro-
e- Anterior horn cells duce:
a- Vomiting
13- The aim of treatment in cases of acute methanol poisoning is to: b- Anuria
a- Oxidize it to formaldehyde c- Haemolysis
b- Form acetic acid d- Hypotension and shock
c- Prevent its oxidation e- Pulmonary oedema
d- Form formic acid
e- Reduce it to carbon dioxide 19- The best treatment of convulsions due to acute oxalic acid poisoning is
the I.V. injection of:
14- Food poisoning is rapidly diagnosed by: a- Diazepam
a- History taking b- Magnesium sulphate
b- Clinical picture c- Morphine sulphate
c- Stool culture d- Pentothal sodium
d- Chemical analysis e- Calcium gluconate
e- Serum electrlytes
20- Metabolic acidosis is the most important feature of poisoning by the
15- The withdrawal manifestations in an addict are due to: following acid:
a- Psychological dependence a- Oxalic
b- Physical dependence b- Acetic
c- Tolerance c- Acetyl salicylic
d- Detrimental effects d- Hydrochloric
e- Overdosage e- Hydrocyanic

16- The best physiological antidote in cases of acute poisoning by tricyclic


anti-depressants is:
a- Prostigmine
b- Physostigmine

44 45
IV- Complete : (5 points)
Complete the following statements: (1 point for each statement) Cairo University-Faculty of Medicine
Department of Forensic Medicine & Toxicology
1- Dimercapto-propanol "2-3 Dimercaprol" or British Anti-Lewisite "BAL"
1/9/2008) Time allowed: 2 hrs.
has a limited value in treatment of lead poisoning because ............., while
it is contraindicated in treatment of iron toxicity because ....................
FINAL EXAM.
2- Morphine is formerly used as a pre-anaesthetic because it relieves pain, de-
creases anxiety and lessens struggle in induction period but it is not used
Fourth Year MB.Bch.
ALL QUESTIONS HAVE TO BE ANSWERED:
nowadays because it causes ..................,...................,....................... and
FORENSIC MEDICINE:
........................
1- A 16 years- old male was involved in a quarrel. He was admitted to hospital
3- Ethyl alcohol leads to initial sensation of warmth due to increased cutane- with headache and vomiting. On examination, he was confused with scalp
ous blood flow, followed by decreased body temperature due to injury in the right tempro-parietal region. Few hours later, he passed into
........................,.............................. and................................... coma with unequal pupil size and the heart rate was 55 beats/minute.
4- In acute paractamol poisoning, the specific antidote is ........................, and a) What is your diagnosis? What is the proper management of such case? (3
is given in a loading dose of .................., then 70 mg/Kg/4 hours for 17-18 marks)
doses for a total of 72 hours. It is ineffective after ................. hours. b) How can you diagnose the side of brain lesion? (2 marks)
5- Perforation of the nasal septum in chronic cocaine poisoning is due to c) What are the possible sequelae of such case? (3 marks)
................ and....................... d) How can you verify that the age of the victim is 16 years? (2 marks)
V- () or (x): (7.5 points)
II. Give reason(s) for the following: (4 marks each)
Indicate whether the following statements are true or false and give rea-
sons: a) The inlet wound of the bullet may show irregularity.
(1.5 points for each statement) b- Hyoid bone examination is of medicolegal importance.
c- Blood grouping is considered as a good negative test in paternity testing.
1- Stomach wash is contra-indicated in cases of acute poisoning by carbolic
acid "phenol".
2- The fatal dose of corrosive sublimate is 250-500 mg, while that of corro- IV- Choose the best single answer: (one mark each)
sive NaOH is 1 gm. 1- At autopsy, drowning is ascertained by finding:
3- Bleeding tendency in salicylate toxicity is due to bone marrow depression. a- Washer - woman hands.
4- In cases of acute poisoning by phenothiazines, the extra-pyramidal signs b- Deep blue hypostasis in head & neck.
are treated by diazepam in a dose of 10 mg. c- Sand or weeds in the bronchioles.
5- In gradual withdrawal and substitution treatment of chronic opiate poison- d- All of the above.
ing, every 1 mg of methadone can substitute 2 mg morphine or 4 mg heroin.
2- A physician registration may be erased from the medical syndicate in
the following conditions EXCEPT:
a- He/she stopped paying the annual subscription
b- He/she is convicted of malpractice

46 47
c- He/she is involved in commercial jobs 8- After death, the blood remains fluid till the lapse of the following
d- He/she reached the age of pension hours:
a- 2 b- 3 c- 5 d- 8
3- A burn is very dangerous if affecting:
a- The back 9- If both parents have (O) blood group, the children's blood group (s)
b- The upper limb may be:
c- 1/3 of body surface area a- Group A b- Group B c- Group AB d- Group O
d- Full skin thickness.
10- If the femur length is 40 cm. then, the height according to Pearson's
formula is:
4- A dead body was found with a rope mark around the neck, the case
was diagnosed as hanging as examination revealed: a- 120 cm b- 160 cm c- 150 cm d- 140 cm
a- General external and internal signs of asphyxia
b- The rope mark was high up in the neck & oblique 11- Cut wounds characterized by the following EXCEPT:
c- The face was congested a- Regular and clearly cut edges
d- The eyes were prominent with dilated pupils. b- Free external bleeding
c- Tissue bridges
5- Which of the following reach to permanent infirmity? d- Minimal tissue destruction
a- Loss of blind eye
b- Loss of permanent tooth 12- Subendocardil hemorrhages occur mostly in cases of death due to:
c- Rupture of hydronephrous kidney a- Air embolism
d- Removal of splenomegaly b- Hemorrhage
c- Crush syndrome
6- A heavy blunt instrument with wide striking surface area and big mo- d- Drowning
mentum produce:
a- Depressed localized fracture 13- An adult was brought to hospital with 16 shots embedded under the
b- Fissure fracture skin of the cheek, shoulder, chest and right foot. The distance of firing
in meters is:
c- Depressed comminuted fracture
a- 4 b- 8 c- 20 d- 50
d- Cut Fracture

14- Heat hyperpyrexia (stroke) is due to:


7- Suicidal cut throat by right handed person are likely to be:
a- Excessive loss of sodium chloride
a- Begins higher on the right side of the neck
b- Effect of heat on cardiac muscle
b- Deeper on the right side and shallow on the left
c- Depletion of ATP stores in skeletal muscles
c- Accompanied by tentative wounds (hesitation marks) on the left side
d- Effect of heat on the head
d- All of the above

48 49
15- Typical injuries in cases of child abuse include the following EX- III- Give reason(s) for the following: (2 marks each)
CEPT: a) Forced alkaline diuresis is done in acute salicylate poisoning
a- Bruises: multiple and of different ages
b- Subdural hemorrhage b) Red asphyxia is a feature of cyanide poisoning
c- Laceration and stab wounds c) Blood picture may help in diagnosis of chronic lead poisoning
d- Fractures: multiple and repetitive
IV- Choose the best single answer: (one mark each)
V- Fill in the blank spaces: (2 marks each)
1) In treatment of chronic opiates poisoning, gradual withdrawal and sub-
1- Types of fingerprints include:
a) ......................................... stitution is done by all the following druges EXCEPT:
b) ......................................... a) Codeine b) Methadone
2- External signs of live-birth include: c) Naltrexone d) Hyoscine
a) .........................................
b) .........................................
2) In a case of suicide by a drug, the victim shows dystonic reactions, tachy-
3- Examination of passive sodomist revealed: cardia, dry skin & fever, the poison is:
a) .........................................
b) ......................................... a) Phenobarbitone b) Tryptizol
c) Largactil d) Lithium
4- Signs of old delivery include:
a) ......................................... 3) Match the metal poison with its specific local antidote:
b) .........................................
a) Arsenic ( ) Na HCO3 1%
b) Mercury ( ) Fresh Fe OH3
CLINICAL TOXICOLOGY: c) Lead ( ) Sod. formaldhyde sulphoxylate
I- A farmer had repeated vomiting, abdominal colic and diarrhea after ta- d) Iron ( ) Mg SO4
kin his lunch which contains some farm vegetables. The examination re-
vealed constricted pupils, muscular twitches, pulse was 60/minute, Bl.Pr. 4) Contra - indications of renal diuresis include all the following EXCEPT:
was 90/70 mm Hg., with sweating and cripitations all over the chest.
a) Shock b) When the poison is excreted via the kidney
a) What is your provisional diagnosis and differential diagnosis? (4 marks)
c) Heart failure d) Pulmonary edema
b) What is the action of the suspected poison? (3 marks)
c) What is the proper treatment of such case? (3 marks)
5) The pure antagonist of opinum is:
a) Naloxone b) Levallorphan
II- Give an account on the following: (3 marks each)
c) Nalorphine d) codien
a) Oral chelators
b) Management of oxalic acid poisoning
c) treatment of acute methyl alcohol poisoning

50 51
6) Coagulative necrosis occurs in case of poisoning by: 13) Dry secretions, delirium and dilated pupils are produced by:
a) NH4OH b) Phenol a) Datura leaves b) Aconite root
c) Oxalic acid d) Potash c) Jalap root d) Opium

7) In acute methanol poisoning, haemodialysis is indicated in all the follow- 14- Flumazenil (Anexate) is a specific antidote for:
a) Benzodiazepine b) Phenobarbitone
ing EXCEPT:
c) Imipramine d) Chlorpromazine
a) Plasma concentration is >500 mg/1.
b) Significant metabolic acidosis 15- In acute iron poisoning, stage - III is characterized by all the follow-
c) Hypoglycaemia ing EXCEPT:
d) Presence of mental symptoms a) Persistent bloody diarrhea b) Cyanosis
c) Metabolic acidosis d) Fever
8) Workers in the manufacture of cartridge percussion caps may suffer
from:
a) Static tremors
b) Encephalopathy and blue line on gums
c) Neurosis and kinetic tremors
d) Alopecia and periopheral neuritis

9) Ethanol decreases body temperature due to all the following EXCEPT:


a) Depression of heat-regulating centre
b) Depression of vaso-motor centre
c) Cotaneous vaso-constriction
d) Increased heat loss

10) Dilated fixed glistening pupils occur in case of poisoning with:


a) Carbon monoxide b) Barbiturates
c) Cyanides d) Atropine

11) Miosis, vomiting, diarrhea and bradycardia denote poisoning by:


a) Tartar emetic b) Parathione
c) Opuim d) Phenol

12) The specific antidote for acute paracetamol poisoning is:


a) N-acetyl cysteine b) Atropine
c) Narcan d) Oximes

52 53
CAIRO UNIVERSITY FOURTH YEAR EXAM 20/6/2009
FACULTY OF MEDICINE B. CLINICAL TOXICOLOGY :
Total marks=70
Time allowed: 2.5 hr I. A female aged 16 years was brought to Kasr Al Aini Poison Control
Center after attempting suicide by a drug. On examination, the pa-
Department of Foresnic Medicine & Clinical Toxicology tient was confused with history of repeated vomiting with an attack of
hematemesis, tempereature was 38C, BP. was 100/80 mmHg, pulse
ALL QUESTIONS HAVE TO BE ANSWERED: was 105/min., Resp. Rate was 32/min. Investigations revealed that; pH
7.21, HCO3 14 ml Eq/L., prolonged prothrombin & bleeding time and
A) FORENSIC MEDICINE: on X-ray, gastric concertion were noted.
I. An 18 years old farmer was shot to death in his field. Two suspects were ar- 1) What is the acid-bae disturbance in this case? (1 mark)
rested, one of them had a Ghaffir gun and the other had a revolver. On ex- 2) What is your provisional diagnosis? Why? (2 marks)
amination, hypotasis was patchy and the intraocular pressure was zero.
3) Enumerate two other poisons that induce the same acid base disturbance?
There was a central hole surrounded by smaller holes covering an area of 4 (2 marks)
cm in diameter in the procordium and there were no exit wounds. 4) What is the proper treatment of such case? (3 marks)
a) How could you estimate the age of the victim? (2 marks) II. Give an account on the following : (4 marks each)
b) Mention the time passed since death the present case ? (2 marks) 1) Volatile sniffing.
c) Whi is the assailant? How could you prove that his weapon was the causal 2) Lines of treatment of Viperidae snake bite.
object? (4 marks) 3) Two post-toxicity neuromuscular syndromes that complicate poison expo-
d) Mention the distance of firing in this case? What investigation should be sure.
done and what is its value? (4 marks) III. State True or False and give your Rationale : (2 marks each)
II. Give an account on the following : (4 marks each) 1) Acute arsenical poisoning should be differentiated from cholera.
a) Presistent vegetative state (PVS). 2) Ethanol toxicity is more serious than methanol toxicity.
3) Stomach wash is contraindicated in treatment of phenol poisoning.
b) Intracerebral hemorrhage.
4) Circulatory collapse is one of the causes of death due to cocaine overdose.
c) Heat hyperprexia.
5) Tricylic antidepressant overdose is best eliminated by dialysis.
d) Two methods of execution (death sentence) and post mortem picture of one
of them?
III. State True or False and give your Rationale: (3 marks each)
a) A stab to the right ventricle is more serious than that to the left one.
b) Doctors are absolutely prohibited from revealing their patient's confidential
medical informations.
c) Heat splits cannot be differentiated from ante mortem lacerations.
d) Criminal abortion may lead to death.

54 55
CAIRO UNIVERSITY FOURTH YEAR EXAM 20/6/2009
FACULTY OF MEDICINE 6. On the 4th day following a blunt trauma to the eye, you can find .......
Total marks=30
Time allowed: 30 min subconjunctival hemorrhage:
a) Red
FINAL FOURTH YEAR EXAM. (Old system) b) Blue
Choose the best single answer : (one mark each and 2 for matching) c) Green
1. A dead body with suspected poisoning had red brown-colored hyposta- d) Yellow
sis. This was suggestive of poisoning with : 7. Single inlet with multiple exits can be found in all, except :
a) Nitrates. a) Shattered bone.
b) Carbon monoxide.
b) Tangential firing.
c) Cyanides.
c) Near firing of a non rifled weapon.
d) Barbiturates.
d) damdamized bullet.
2. ............. is not a mechanism of death :
8. Postmortem lividity is unlikely to develop in case of:
a) Arrhythmias.
a) Drowning in a well.
b) Hemorrhage.
b) Drowning in a fst flowing river.
c) Septicemia.
c) Postmortem submerison.
d) Stab abdomen.
3. The most fatal head injury in boxing is : d) Drowning in chlorinated swimming pool.
a) Epidural hemorrhage. 9. The medicolegal applications of blood grouping include the following
except :
b) Subdural hemorrhage.
d) Contre-coup intracerebral hemorrhage. a) Identification of seminal stains in rape crimes.
4. All are caauses of post traumatic acute renal failure except : b) Identification of saliva of the assailant present in crime scene.
a) DIC c) Identification in cases of disputed paternity as a good + ve test.
b) Crush syndrome d) None of the above.
c) Venous air embolism. 10. Identification of a fired cartridge can be accomplished by examina-
d) Excessive use of vasopressor agents. tion of the following:
5. Hyoid bone fracture is common after : a) Rifling marks
a) 10-20 years. b) Depression on the rim by the extractor hook.
b) 20-30 years. c) Depression marks on the primer.
c) 30-40 years d) Both 9a) and (c) are correct.
d) After 40 years. e) Both (b) and (c) are correct.

56 57
11. Medicolegal importance of planktons (diatoms) includes the following(s): b) Deeply seated dilated anal orifice.
a) Diagnosis of drowning. c) Funnel shaped anal canal.
b) Differentiation between antemortem and postmortem submersion. d) Hyperreflexra of anal sphincter.
c) Denote the type of water in which drowning has occurred. 17. Action of malpractice may be raised in the following conditions ex-
d) All of the above. cept:
12. Postmorem caloricity is seen in: a) Renal failure de to incompatible blood tansfuison.
a) Strychnine poisoning. b) Leaving a towel in the abdomen without complications.
b) Lead poisoning. c) Fracture vertebrae secondary to electro convulsive therapy.
c) Mercury poisoning. d) None of the above.
d) Phosphorus poisoning. 18. The cause of death in dry drowning is :
13. With 20 permanent teeth and 4 temporary teeth, the age is likely to a) Head trama.
have been : b) RVI (reflex vagal inhibition)
a) 9 years. c) Severe laryngeal spasm.
b) 10 years. d) Bronchopneumonia & abscess.
c) 11 years. 19. A dead body was found with a rope mark around the neck, the case
d) 12 years. was diagnosed as hanging as examination revealed :
14. In suicidal cut throat by a Rt. Handed victim the wound is character- a) General external and internal signs of asphyxia.
ized by : b) The rope mark was high up in the neck & oblique.
a) Deep at the right side and tailing to the left. c) The face was congested.
b) Deept at the left side and tailing to the right. d) The eyes were prominent with dilated pupils.
c) Above the larynx. 20. Match the after birth sign with its appropriate timing :
d) Both (a) and (d). 1) Actual obliteration of ductus arteriosus. a) 6 hours.
e) Both (b) and (c). 2) Fall of umbilical stump. b) One day
15. The commonest complication after crush injury is : 3) Umbilical vessels changed into fibrous cord. c) One week
a) Sympathetic shock 4) Formation of umbilicius. d) 2 weeks
b) Renal failure e) 4 weeks
c) Gas gangrene f) 6 weeks
d) Any of the above 21. In a patient with eye opening to pain, no motor and verbal response
e) None of the above the GCS score is:
16. A habitual sodomist is daignosed by the following except : a) 3
a) Feminine gait, speech & dress. b) 4

58 59
c) 5 c) Doses are tapered over a period of 4 hours.
d) 6 d) All of the above
22. Opium withdrawal syndrome : e) Both (a0 and (c) are correct.
a) Its onset varies from 12-24 hours. 28. Match the drug with its most appropriate action :
b) Symptoms include : piloerection, yawning and diarrhea. 1) Buspirone (Buspar) a) local anaesthetic.
c) Could be treated by clonidine and naloxone. 2) Fluoxetine (Prozac) b) Neuroleptic.
d) All of the above. 3) Clorpromazine c) Anti arrhythmic.
23. Following ingestion of a toxic dose of acetaminophen, hepatocelullar 4) Marcaine d) Antidepressant.
toxicity begins in : e) Caridotonic.
a) Stage I f) Sedative-hypnotic
b) Stage II
c) Stage III
d) Stage IV
24. Digitalis glycosides produce their toxic action by inhibiting:
a) Monoamine oxidase.
b) Carbonic anhydrase
c) Na-K-ATPase.
d) Choline esterase.
25. calomel is :
a) More toxic than corrosive sublimate.
b) Mercuric chloride.
c) The cause of pink disease.
d) All of the above
26. Botulinum toxin :
a) Blocks synthesis of acetylcholine.
b) Affects axonal conduction.
c) Is destroyed by heating at 100C for 10 min..
d) Is produced by Clostridium Botulinum type C&D.
27. Disulfirm (Antabuse) :
a) Blocks enzymatic oxidation of alcohol.
b) Starts 48 hours after last ingestion.

60 61
Cairo University-Faculty of Medicine sult in hemolytic reaction.
Department of Forensic Medicine & Clinical Toxicology B. Clinical Toxicology:
3/9/2009 Total marks=70 Time allowed: 2.5 hr I. A young girl was admitted to the Poisoning Control Center after she has in-
gested 50 tablets prescribed for her mother's cardiac condition. The girl had
FINAL EXAM
repeated vomiting with abdominal pain. On examination she was uncon-
Fourth Year MB.Bch.
scious but responding to pain, pulse was 60/min., BP 90/60 mm. And the
All questions have to be answered : respiratory rate was 12/min. ECG showed A-V block and serum K+ was 6
A) Forensic Medicine : mEq/L.
I. A 23 years old female was found dead in a clinic. On examination the body 1) What is the electrolyte disturbance in this case? Mention the mechanism
was pale and small fetus was found beside the deceased whose length was 16 (2 marks)
cm. at autopsy, the length of uterus was 6 inches. The obstetrician claimed that 2) What is your provisional diagnosis and the investigations needed to verify
this was a case of therapeutic abortion that has been complicated to death. your diagnosis? State her coma stage? (3 marks)
a) Have could you estimate the age of the victim? (2 marks) 3) What is the proper treatment of such case? (3 marks)
b) Is that fetus belongs to the victim? Why? (2 marks) II. Give an account on the following :
c) What are the possible causes of death in this case? (3 marks) 1) Skin lesions in chronic arsenical poisoning and cardiovasclar manifestations
d) What are the investigations requested by the medical examiner for this case? of chronic lead poisoning.
(2 marks) 2) Cyanide Kit.
e) Is there any medicolegal responsibility on the obstetrician? Why? 3) Two conditions in toxicology practice where specific antidotes should not
(3 marks) be given as a line of treatment.
II. Give an account on the following : III. State True or False and give your Rationale :
a) How can skull fractures denote the site of the assailant? (2 marks each)
b) Degrees and extent of burn. 1) Incision and drainage should be used in treating cases of snake bite.
c) Fabricated (self inflicted) wounds. 2) Ca gluconate is life saving measure in treatment of oxalic acid toxicity.
d) Traumatic asphyxia. 3) Hypertension is one of clinical presentation in phenobarbital toxicity.
III. State True or False and give your rationale : 4) Syrup of ipecac is indicated in phenothiazine toxicity.
(3 marks each) 5) Disulfiram is an antidote in treatment of alcohol dependence.
a) Postmortem eye examination can help to determine time passed since death.
b) Disseminated intravascular coagulation (DIC) may complicate traumatic inju-
ries.
c) Action of malpractice can be raised even n non complicated cases.
d) Incompatible blood transfusion regarding M, N or D agglutinogens may re-

62 63
Cairo Univeristy 8 June / 2008
Faculty of Medicine 4th Year: Final Exam
Public Health Dep Time allowed: 3 hours

(Total: 150 marks)


Public Health & Community medicine
A) Answer the following Questions: (Total = 90 marks)
1. From the Epidemiological point compare between:
a) Measles & Rubella (German measles) (10 marks)
b) Staphylococcal and Salmonella fond poising (10 marks)
In the following points:
Causative agent
Source (Reservoir)
Exit
Mode of Transmission

COMMUNITY Clinical Picture

2. Following your visit to a rural area, respond to the following


(20 marks)
a) What are the expected Health Problems in the village (rural area).
b) What are the services that should be provided by the Health office
c) What are the compulsory vaccines needed to be given for their infants
and young children (18 month) (Age-Dose-Route-Nature)
d) What is the content of H.E messages given to their pregnant mothers at
the Health Unit during the antenatal care visits?

3. Define: (10 marks)


a) Case Fatality rate
b) Neonate Mortality rate
c) General Fertility rate
d) Lethal outcome
e) Growth monitoring

64 65
4. What are the functions, protective role, and impact of deficiency or
10- An attack of infectious disease is always followed by absolute or solid
excess of:
immunity.
a) Dietary Fibers (5 marks)
11- Second attacks are recorded for all infectious diseases except yellow
b) Recommending Vitamin D, C, Calcium, and Iron to pregnant mother.
fever.
(10 marks)
12- Passive immunization can be induced by preparations ready - formed
antibodies, from human or animal source.
5. Mention: (25 marks)
a) Diet could be protective or a risk factor for coronary heart disease, give 13- Zoonoses are limited to reservoir role of animals only.
examples. 14- An endemic disease is characterized by sporadic non - related cases all
b) Types and sources of indoor air pollution the year round.
c) Types of Hospital waste 15- An endemic disease may assume an epidemic waves when favourable
d) The Criteria of a good table circumstances are available.
e) Types of Questions used for interview advantage and disadvantage.
16- Rats are exposed to epizootics of salmonellosis and plague.
17- Antimicrobials can be used for prevention of some infectious diseases.
B) MCQ (In the answer paper, write the question number and one
answer (total = 60 marks) 18- Chemoprophylaxis is commonly used for prevention of enterica.
19- Carriers of infection can be readily controlled.
I Put (T) in case of true and (F) in case of false (half mark each)
20- All infectious cases can be isolated at home.
(Total = 30 marks)
21- Both contacts and the community will benefit of control measures for
1- All the common intestinal infections have a carrier state contacts of infectious cases.
2- Milk can possibly transmit diseases of droplet infection. 22- Control of contacts of infectous diseases is needed for household con-
3- "Contact infection," means invasion of the skin or mucous membranes tacts only.
by a pathogenic organism or parasite. 23- Infectious diseases associated with toxemia can be diagnosed by blood
4- Percutaneous infection may be followed by systemic manifestations. culture.

5- Intact healthy skin is a natural barrier of all forms of infection. 24- Blood film is usually used for diagnosis of parasitic rather than infec-
tious diseases.
6- Cell-mediated immunity is associated with formation of antibodies.
25- Pneumonic plague is only secondary to the septicemia.
7- Immunity develops from humoral immune response only.
26- Vaccination is the basic preventive measure of plague.
8- Natural passive immunity is acquired mainly from breast feeding.
27- All contacts of plague should be isolated.
9- Exposure to infection is only source of actively acquired natural immu-
nity. 28- The reliable preventive measure of yellow fever is vaccination.

66 67
29- Egypt is a yellow fever receptive area. 47- We can calculate incidence rate from cohort and cross sectional stud-
ies.
30- Tetanus neonatorum is form of congenital infection.
48- Cohort studies are useful for examining rare exposures
31- Immunization of man against rabies is only post-exposure.
49- Protein and energy deficiency among scholl children could result in re-
32- Exposure to noise is the only casual factor of impaired hearing of in-
tarded growth and wasting.
dustrial workers.
50- "Tobacco-free schools" is an example of school policies for smoking
33- Pneumoconiosis are not necessarily always pathological, where some
prevention
forms are benign.
51- School children are susceptible to vitamin B2 deficiency which is asso-
34- Byssinosis is a form of Pneumoconiosis caused by inhalation of cotton
ciated with low intake of high biological value protein.
dust.
52- Rheumatic heart is the commonest heart disease, which affect the
35- Inhalation of dust in industry is generally more hazardous by the inor-
school children
ganic than the organic forms.
53- Dental caries among school children could be due to lack of teeth hy-
36- The birth rate of the developing countries is usually lower than that of
giene, excess sweet consumption and florine deficiency
the developed.
54- Antismoking policies should be applied to teachers, students and
37- The rate of natural increase of population in Egypt is around 1.9%.
school workers
38- Prevalence rate is usually used as morbidity index of chronic disease.
55- Both heatstroke and sun stroke are dangerous because they affect the
39- Birth injury is a leading cause of infant mortality. heat regulating center
40- In Observational studies the researcher measure things as they are and 56- Cigarette smoking increases the complications of pneumoconiosis
collects data with no attempt to change conditions.
57- Pneumoconiosis is a rapid process and manifestations start after 10
41- In analytical studies the researcher measure things as they are and col- days of exposure
lects data with no attempt to change conditions.
58- Glassblowers are at risk for heat cataract
42- When we want to establish a relation between the disease and risk fac-
59- Examples of the occupational inhalation of inorganic dust are silica
tors, we use observational analytical studies.
and bagasses.
43- When you want to evaluate a drug or method of treatment, we use co-
60- Hearing loss due to chronic exposure to noise is reversible once the
hort study.
workers are excluded from noisy work environment.
44- Cross sectional studies are very quick and inexpensive
45- The number of controls should at least three or four times as much as
the cases.
46- Data and information collected for both cases and controls are not the
same.

68 69
II Match the Sets of questions using each word or state- 7. Chemoprophylaxis can play a role in the prevention of:
ment once only: a) Poliomyelitis b) Malaria c) Schistosoma
d) All e) None
(Each half mark total = 20 marks)
1. Carriers are an important source of infection in the following dis-
8. In utero infection is common with the following infections:
eases:
a) HIV b) Syphilis c) Tuberculosis
a) Cholera b) Tuberculosis c) Plague
d) a & b e) All
d) a & b e) All

9- International measures are taken to prevent the transmission of:


2. Blood transfusion is a potential source of infection in the following
diseases: a) Tuberculosis b) Cholera c) Plague
a) Syphilis b) HIV/AIDS c) Malaria d) All e) b & c
d) a & b e) All
10. Milk can play a role in the transmission of:
3. Survey studies could be carried as one step in the control of the fol- a) Diarrhea b) Tuberculosis
lowing diseases: c) Streptococcal infection d) a & b) e) All
a) Malaria b) Schistosoma b) Tuberculosis
d) a & b e) All 11. To start treating and preventing newly occurring disease (emerg-
ing disease) we need to study the.
4. The main approach for poliomyelitis eradication in Egypt depends a) The diseased person age, sex, occupation.
on: b) The place of cases, whether rural or urban, the governorate
a) Environmental sanitation b) Mass vaccination c) Health education c) The time of disease occurrence in relation to season.
d) a & b e) All d) All of the above.

5. The following are important causative agents in hospital infection: 12. Some unusual health related situation you need to know more
a) Staph aureus b) Virus B hepatitis c) Tuberculosis about it to be able to correct it.
d) a & b e) All a) Study objectives
b) Study problem
6. Seroprophylaxis is one the preventive measures for the following c) Study question
diseases: d) Study goal
a) Cholera b) Tuberculosis c) Gonorrhea
d) Streptococcal infection e) None

70 71
13. Examples of experimental (Interventional) studies are: 19. Sensitivity of screening test is
a) Prevalence surveys (The proportion of Bilharzia among villagers) a) The ability of the test to detect cases of the disease
b) Coverage surveys (The proportion of vaccinated children) b) The ability of the test to give negative results among controls
c) Both of the above
c) The correct identification of cases among test positive individuals
d) Non of the above
d) The correct exclusion of not diseased among test negative individuals.

14. Examples of observational studies are:


20. Positive predictivity of screening test is
a) Prevalence surveys (The proportion of Bilharzia among villagers)
b) Coverage surveys (The proportion of vaccinated children) a) The ability of the test to detect cases of the disease
c) Both of the abov b) the ability of the test to give negative results among controls
d) Non of the above c) The correct identification of cases among test positive individuals.
d) The correct exclusion of not diseased among test negative individuals.
15. Examples of observational studies are:
a) Study the effect of new treatment 21. The following are true about epidemiologic transition-Except one
b) Study the effect of new treatment a) Shift of morbidity pattern from communicable to non-communicable
c) Both of the above diseases
d) Non of the above b) The increase in the number of females suffering from non-
communicable diseases
16. All of the following is true about case control study except one: c) Shift of mortality causes from communicable to non-communicable dis-
a) An analytical epidemiologic study design eases
b) The number of controls should be at least equal to the number of cases d) There is increase in child mortality rates
c) Useful for examining rare exposures
d) Optimar for study of rare diseases
22. Screening programs could reduce the incidence of the diseases be-
cause of the ability of detection of the following-except one
17. Group of people who share common character or characters for a) Pre-hypertension cases, by blood pressure measurement
example the year of birth
b) Pre-diabetics by measuring the plasma glucose level
a) Control b) Community c) Cohort d) Cases
c) Early cases of cancer liver by serum testing for alpha fetoprotein
d) At risk cases for CHD by testing for the BMI
18. Criteria of good screening tests:
a) It should be simple and easy to conduct
23. Due to the demographic transition in the developing countries the
b) Not time consuming, not invasive, not painful
disease pattern is characterized by the following-except one.
c) Relatively cheap to be tested in mass screening in survey studies
a) Increase in the proportion of elderly with associated high prevalence of
d) All of the above.
non-communicable diseases

72 73
b) Increase in the proportion of youth with early exposure to risk factors c) Viral infections is a direct cause of bronchial asthma
c) Still having large proportion of children with high incidence of commu- d) Malnutrition, environmental factors, and smoking are risk factors for
nicable diseases. cancer
d) The large proportion of the elderly are males exposure to environmental
risk factors. 28. The following are examples of the relations between nutrition and
non-communicable diseases-exceptione.
24. The major risky behavior among 40 years old cigarette smokers is a) High dietary protein is a risk factor for CHD
select one b) Vitamins A, C, and E are protective against cancer
a) Use of low-grade tobacco c) Low potassium intake result in sodium retention in the cells and hyper-
b) Use cigarettes and not pipe or cigars tension.
c) Starting smoking during childhood d) Complex carbohydrates are protective against CHD
d) Deep smoke inhalation
29. The following are true about the epidemiology of diabetes mellitus
25. In Egypt, there is a well-established system for periodic examina- - except one
tion of the following population categories - except one. a) Obesity and sedentary life are the major risk factors in type2 diabetes
a) Pregnant women b) Diabetes is increasing in the developing countries
b) School children c) Type 2 diabetes is less common than type I diabetes
c) Industrial workers d) The genetic risk for type I diabetes increases with diabetic father
d) Elderly people
30. Inuries and accidents are increasing due to the following factors-
26. The following are true about the at risk groups for CHD - except except one
one. a) Heavy traffics
a) Young adults 20-30 years of age could be at risk due to smoking b) Mechanization of agriculture
b) Women before menopause are more susceptible than after menopause c) Increasing manual work and decreasing industrialization
c) Type A personality d) Application of advanced technology including atomic stations
d) Physical inactivity
31. In a nutritional assessment study using the food-record technique,
27. The following are examples of the multi-factorial nature of the analysis of data showed the low intake of iron, vitamin, C, folic acid
non-communicable diseases except one. and copper. The expected health problems of the studied group could
be - select one.
a) Obesity, sedentary life, genetics are risk factors for type 2 diabetes
a) Risk of nervous tissue disorders
b) Sodium sensitivity, obesity, smoking, stress are risk factors for hyper-
tension b) Risk of anemia

74 75
c) Risk of CHD
d) Risk of susceptibility to infection 37. The following are true about the relation between Iron and Vit-
main A-except one
32. The following are the indicators used for assessment of the nutri- a) Vitamin A influences the release of iron from the storage sites
tional status at the national level - Except one b) Vitamin A rich diet from animal sources is also rich in iron
a) Average daily per capita intake from the different food items c) Vitamin A supplementation is recommended during pregnancy improve
b) Average life expectancy at birth iron status
c) Percent of under - five children having stunted growth d) Green leafy vegetables are rich in iron and vitamin A.
d) Under five children mortality rate
38. The following are public health policies to improve nutrition status
33. The following are the risk factors for osteoporosis-except one of the community except one.
a) Menopause b) Lack of physical activities a) lodization of common salt
c) Low intake wheat bran d) late puberty among males b) Fortification of wheat flour with folic acid
c) Fluoridation drinking water
34. The following are the conditions where protein intake should in- d) Fortification of skimmed milk with vitamin A.
crease-except one
a) Pregnant women b) Growth and development of children 39. The following are the hazards of increase consumption of trans fat-
c) Adult males due to hard work d) Lactating women ty acids (TFA) - except one.
a) Decrease LDL cholesterol
35. In a nutritional assessment study using the food-record technique, b) Negative effect on growth and development of the neonates
analysis of data showed the low intake of vitamins E, Bl, B12 and B6. c) Reduce HDL cholesterol
The expected health problems to the studied group could be - select
d) Negative effect on the functions of the brain and eyes
one.
a) Bones and teeth disorders
b) Different types of anemia 40. The following are true about dietary calcium - except one
c) Nervous system disorders a) Calcium absorption is enhanced by increasing fatty acids in the diet
d) High risk of coronary heart diseases b) calcium is needed for formation and maintenance of bone
c) Manifestations of calcium deficiency could be due to low vitamin D in-
36. The following are true about vitamin C-Except one take
a) Help in folic acid metabolism d) Milk and its products are the major sources of calcium.
b) Help in wound healing
c) Help in prevention of cancer
d) Help in prevention of infections (anti-infection vitamin.)

76 77
Cairo University 6 Sept. 2008
III. Join (each one mark) (total = 10 marks) Faculty of Med. 4th year Final Exam
Total Marks 150 Time allowed : 3 hours
Development of preventive medicine and control of infection has greatly
lowered morbidity and mortality:
1. Specific measures a) Clean environment, pesticides Community Medicine Dep.
2. Chemotherapy b) Epidemic, pandemic control
3. Vector control c) Environment, hospitals... A) Answer the following questions : (Total = 90 marks)
4. Sterilization, disinfection d) Vaccines, toxoids, antibiotics 1. State the causative organism, source (reservoir) and mode of trans-
5. International measures e) Low case fatality e.g. meningitis mission for the following diseases :
a. Pulmonary Tuberculosis (10 marks)
b. Brucellosis (10 marks)
Source of statistical data are: a) Outpatient clinics.. c. AIDS HIV (10 marks
6. Census b) No reliable data are available, e.g. chronic
disease 2. What are the health hazards of : (30 marks)
7. Health office
c) Indices of births, deaths, infectious diseases a. Exposure to excessive noise.
8. Hospitals
b. Obesity
9. Medical centers d) Need accurate registration, record-keeping
c. Premature newly born.
10. Field studies e) Demographic & social of population
d. Unsanitary water supply.
e. Deficiency of Iodine in the diet

3. A female delivered in her house in a village X. The newly born started


breast feeding successfully. Within the next days, the child showed
failure of proper suckling and there were signs of spasm in the mus-
cles of the jaw.
a. What is the possible diagnosis and causative organism ? (2 marks)
b. What are the modes of transmission? (3 marks)
c. What are the preventive outlines needed to prevent such disease.
(5 marks)

4. State the characteristic of :


a. Normal distribution curve. (5 marks)
b. Egyptian food balance sheet. (3 marks)
c. Egyptian population pyramid. (3 marks)

78 79
5. Mention the following : circumstances are available.
a. Objective and content of Health education messages for prevention and 16. Rats are exposed to epizootics of salmonellosis and plague.
control of coronary heart disease. (5 marks) 17. Antimicrobials can be used for prevention of some infectious diseases.
b. Maternal risk factors that could be detected during antenatal care. 18. Chemoprophylaxis is commonly used for prevention of enterica.
(4 marks) 19. Carriers of infection can be readily controlled.
20. all infectious cases can be isolated at home.
B) MCQ (In the answer paper, write the question num- 21. Both contacts and the community will benefit of control measures for
ber and one answer : contacts of infectious cases.
(Total = 60 arks) 22. Control of contacts of infectious diseases is needed for house contacts
only.
I. Put (t) in case of true and (f) in case of false 23. Infectious diseases associated with toxemia can be diagnosed by blood
(half mark each) : culture.
(Total = 30 marks) 24. Blood film is usually used for diagnosis of parasitic rather than infec-
1. All the infectious diseases have a carrier state. tious diseases.
2. Milk can possibly transmit diseases of droplet infection. 25. Pneumonic plague is only secondary to the septicemia.
3. "Contact infection", means invasion of the skin or mucous membranes 26. Vaccination is the basic preventive measure of plague.
by a pathogenic organism or parasite.
27. All contacts of plague should be isolated.
4. Percutaneous infection may be followed by systemic manifestations.
28. The reliable preventive measure of yellow fever is vaccination.
5. Intact health skin is a natural barrier of all forms of infection.
29. Egypt is a yellow fever receptive area.
6. Cell-mediated immunity is associated with formation of antibodies.
30. Tetanus neonatorum is a form of congenital infection.
7. Immunity develops from humeral immune response only.
31. Immunization of man against rabies is only post-exposure.
8. Natural passive immunity is acquired mainly from breast-feeding.
32. In observational studies the researcher measure things as they are and
9. Exposure to infection is the only source of actively acquired natural im-
collects data with no attempt to change conditions.
munity.
33. In analytical studies the researcher measure things as they are and col-
10. An attack of infectious disease is always followed by absolute or solid
lects data with no attempt to change conditions.
immunity.
34. When we want to establish a relation between the disease and risk fac-
11. second attacks are recorded for all infectious diseases except yellow fe-
tors, we use observational analytical studies.
ver.
35. When you want to evaluate a drug or method of treatment, we use co-
12. Passive immunization can be induced by preparations ready - formed
hort study.
antibodies, from human or animal source.
36. Cross sectional studies are very quick and inexpensive.
13. Zoonoses are limited to reservoir role of animals only.
37. The number of controls should at least three or four times as much as
14. An endemic disease is characterized by sporadic non-related cases all
the cases.
the year round.
38. Data and information collected for both cases and controls are not the
15. An endemic disease may assume an epidemic waves when favorable
same.

80 81
39. We can calculate incidence rate from cohort and cross sectional studies.
40. Cohort studies are useful for examining rare exposures. II. Match the Sets of questions using each word or state
41. Glassblowers and bakers are at risk for heat cataract. ment once only :
42. In Egypt, farmers are at-risk for cancer urinary bladder and skin malig-
(Each half mark total = 20 marks)
nancy.
43. Egypt food balance sheet indicates that energy intake is less than energy 1. Carriers are an important source of infection in the following disease :
requirements. a) Cholera b) Tuberculosis c) Plague
44. Body mass index and waist circumference cut-off measurements apply d) a & b e) All
differently to males and females.
45. Both TB and coronary heart diseases are social diseases related to low 2. Blood transfusion is a potential source of infection in the following dis-
socioeconomic standards. eases:
46. Wasted children indicate low weight for height compared to WHO ref- a) Syphilis b) HIV/AIDS c) Malaria
erence values. d) a & b e) All
47. Dietary requirements for protein are higher for males than females.
48. High illiteracy rate is associated with high morbidity and high fertility. 3. Survey studies could be carried as one step in the control of the follow-
49. Screening tests are specific disease-oriented, and periodic examination ing diseases :
are individual oriented. a) Malaria b) Schistosoma c) Tuberculosis
50. Survey studies are important community medicine tools for immediate
d) A & b e) All
management of diseased cases.
51. Life expectancy could be calculated from age specific death rates.
4. The main approach for poliomyelitis eradication in Egy pt depends on
52. Health promotion is a short term strategy and disease prevention is a
:
long term strategy for improving the quality of life.
a) Environmental sanitation b) Mass vaccination
53. Interviews with people are necessary to develop the food balance sheet.
c) Health education d) a & b e) All
54. Anthropometric measurements to assess the nutritional status include
weight, height and hemoglobin level.
55. Nutrition transition includes shift from diet poor in polyunsaturated fat- 5. The following are important causative agents in hospital infection:"
ty acids (PUSFA) to diet rich in PUSFA. a) Staph aureus b) Virus B hepatitis c) Tuberculosis
56. Fortification of skimmed milk with vitamin A could reduce the inci- d) a & b e) All
dence of blindness.
57. Nutrients deficient in B vitamins and vitamin E contribute to nervous 6. Seroprophylaxis is one of the preventive measures for the following dis-
system disorders. eases:
58. Vitamin A, C and E as well as selenium are antioxidants. a) Cholera b) Tuberculosis c) Gonorrhea
59. Vitamin B6 is necessary for carbohydrate metabolism.
d) Streptococcal infection e) None
60. Developing countries have constrictive population pyramids profile.

82 83
7. Chemoprophylaxis can play a role in the prevention of : 13. Examples of experimental (Interventional) studies are :
a) Poliomyelitis b) Malaria c) Schistosoma a) Prevalence surveys (The proportion of Bilharzia among villagers)
b) Coverage surveys (The proportion of vaccinated children)
d) All e) None
c) Both of the above.
d) Non of the above.
8. In utero infection is common with the following infections :
a) HIV b) Syphilis c) tuberculosis 14. Examples of observational studies are:
d) a & b e) All a) Prevalence surveys (The proportion of Bilharzia among villagers).
b) Coverage surveys (The proportion of vaccinated children)
9. International measures are taken to prevent the transmission of : c) Both of the above.
a) tuberculosis b) Cholera c) Plague d) Non of the above.
d) All e) b & c
15. Examples of observational studies are:
10. Milk can play a role in the transmission of : a) Studying community vaccination effect on eliminating poliomyelities
a) Diarrhea b0 Tuberculosis b) Study the effect of new treatment.
c) Stretococcal infection d) a & b e) All c) Both of the above.
d) Non of the above.
11. To start treating and preventing newly occurring
disease (emerging disease) we need to study the : 16. All of the following is true about case control study except one:
a) The diseased person age, sex, occupation. a) An analytical epidemiologic study design
b) The place of cases, whether rural or urban, the governorate. b) The number of controls should be at least equal to the number of cases
c) The time of disease occurrence in relation to season. c) Useful for examining rare exposures
d) All of the above. d) Optimal for study of rare diseases

12. Some unusual health related situaiton you need to know more about it 17. Group of people who share common character or characters for ex-
to be able to correct it. ample the year of birth.
a) Study objectives. a) Control
b) Study problem. b) Commuity
c) Study question. c) Cohort
d) Study goal. d) Cases

18. Criteria of good screening tests:


a) It should be simple and easy to conduct.

84 85
b) Not time consuming, not invasive, not painful. 23. The following are true about the at risk groups for CHD-except one
c) relatively cheap to be tested in mass screening in survey studies. a) Young adults 20-30 years of age could be at risk due to smoking
d) All of the above. b) Women before menopause are more susceptible than after menopause
c) Type A personality
19. Sensitivity of screening test is d) Physical inactivity
a) The ability of the test to detect cases of the disease.
b) The ability of the test to give negative results among controls. 24. The following are true about the epidemiology of diabetes mellitus-
c) The correct identification of cases among test positive individuals. except one
d) The correct exclusion of not diseased among test negative individuals. a) Obesity and sedentary life are the major risk factors in type2 diabetes
b) Diabetes is increasing in the developing countries
20. Positive predictivity of screening test is c) Type 2 diabetes is less common than type 1 diabetes
a) The ability of the test to detect cases of the disease. d) The genetic risk for type 1 diabetes increases with diabetic father
b) The ability of the test to give negative results among controls
c) The correct identification of cases among test positive individuals. 25. The following are examples of outcome indicators of PHC programs-
d) The correct exclusion of not diseased among test negative individuals. Except one
a) Percent of the fully immunized children
21. The following are true about epidemiologic transition-Except one b) Neonatal mortality rate
a) Shift of morbidity pattern from communicable to non-communicable dis- c) Contraceptive prevalence rate
eases d) Antenatal care coverage rate
b) The increase in the number of females suffering from non-
communicable diseases 26. The following are the outcome indicators used for evaluation of the ef-
c) Shift of mortality causes from communicable to non-communicable dis- fectiveness of the family planning program-Except one
eases a) Unmet needs for family planning
d) There is increase in child mortality rates b) Total fertility rate
c) Contraceptive failure rate
22. Screening programs could reduce the incidence of the diseases because d) Contraceptive discontinuation rate
of the ability of detection of the following-except one.
a) Pre-hypertension cases, by blood pressure measurement
27. The following are examples of interventions for health promotion of
b) Pre-diabetics by measuring the plasma glucose level the school children-except one.
c) Early cases of cancer liver by serum testing for alpha fetoprotein a) Sanitary school environment
d) At risk cases for CHD by testing for the BMI b) Immunization against TB and diphtheria
c) Health education
d) Nutrition program

86 87
33. It is expected that osteoporosis will be a public health problem in
28. Proper use of antibiotics and chemotherapeutics reduces the risk for Egypt due to the following-Except one.
the following non-communicable diseases-except one
a) Increase in the life expectancy of females
a) Diabetes type 1
b) Increase in the prevalence of diabetes
b) Rheumatic heart diseases
c) Increase in the proportion of menopausal women
c) Cancer bladder
d) Increase in vitamin D efficiency
d) Peptic ulcer
34. The following are the vaccines given to infants - Except one.
29. The following are associations between obesity and non-communicable
a) MMR
diseases-except one.
b) Oral Polio
a) Visceral obesity is a risk for diabetes
c) DPT
b) Obesity increases the blood volume and lead to hypertension
d) BCG
c) Obesity is a risk factor to CHD due to associated dyslipidemia
d) Metabolic syndrome includes having body mass index more than 30Kg/
rn2 35. The following are true about IMCI-Except one
a) Helps in controlling childhood, health problems
30. Acquired deafness is due to the following - except one b) Includes specific prevention of diarrhea and ARI
a) Improper use of streptomycin c) Includes management of children's anemia
b) Trauma d) Includes management of measles cases
c) Rubella infection during pregnancy
d) Exposure to noise in industry 36. The major cause of newborn anemia is-select one
a) Iron deficiency anemia during pregnancy
31. The following are examples of morbidity rates-Except one b) Ante-partum hemorrhage
a) Prevalence of diabetes c) Prematurity
b) Case fatality rate from HIV/AIDS d) Folic acid deficiency during pregnancy
c) Incidence of abortion
d) Prevalence of stunted growth among the US children 37. Congenital health problems could be due to the following nutrient de-
ficiencies-except one.
a) Iodine
32. The following are true about silicosis-except one
b) Iron
a) It is a type of pneumoconiosis
c) Folic acid
b) Silica is an organic dust which results in autoimmune reaction of the
lung d) Zinc
c) It increases susceptibility to pulmonary TB
d) It could lead to heart failure

88 89
38. The following are examples of specific prevention of diseases among CAIRO UNIVERSITY FOURTH YEAR EXAM 15 June 2009
FACULTY OF MEDICINE Time allowed : 3 hours
schoolchildren-except one
a) Vaccination against meningococcal meningitis
b) Revaccination against TB
c) DPT vaccination Public Health & Community Medicine
d) Chemoprophylaxis against meningococcal meningitis in case of epidemics A) Answer the following Questions : (Total = 90)
1. Following a car accident, a person was admitted to emergency room,
39. The characteristics of good health education message are the follow- and received blood transfusion at once with proper management after
ing-except one recovery, he asked his doctor about the health problems, he might de-
a) Action oriented velop following the blood transfusion
b) Addresses a major health problem (20 marks)
c) Believable a) Enumerate these health problems. (2 marks)
d) Contains more than one important topic b) What are the necessary precautions needed to be done for blood before
transfusion. (2 marks)
40. The following are public health interventions to improve the nutrition- c) Give a brief summary for the epidemiology of one of the previous health
al status of the community-except one problems. (10 marks)
a) Iodization of common salt d) Outline the specific preventive measures for that previous health prob-
b) Fortification of wheat flour with folic acid lem. (6 marks)
c) Fluoridation of the drinking water 2. A pregnant mother aged 24 years married since 6 years and had 3 chil-
d) Fortification of the skimmed milk with vitamin A dren, was complaining of headache, oedema in the legs, she attend for
the MCH, the doctor examine her and measured the BP 150/90, Hb
III. Join (each one mark) (total marks = 10) was 9 gm/dl.
(20 marks)
Causes of maternal mortality Situation in Egypt
a) What is the Health education messages needed to increase awareness for
41. Puerperal sepsis a) Direct cause of maternal mortality
that mother?
42. Pregnancy induced hypertension b) First cause of maternal mortality
(5 marks)
43. Rheumatic heart disease c) Preventable cause of maternal mor-
tality b) What are the risk factors behind her hypertension. (4 marks)
d) Indirect cause of maternal mortality c) Could you list the malnutrition problems she might develop and why?
44. Hemorrhage
(4 marks)
d) How can yo proceed to assess her nutritional status (mention two methods).
(4 marks)
Vaccinations Given to:
e) List for the mother the 10 principale for successful breast feeding.
45. Tetanus toxoid a) The couples before marriage
(3 marks)
46. Measles b) Females three months before marriage
3. Define : (10 marks)
47. Rubella c) Infants
a) Rate of natural increase.
48. Hepatitis B d) Mothers in the fifth month of pregnancy
b) Population pyramid
49. BCG e) International travelers to endemic area
50. 17 D Vaccine f) In the first 3 months of life

90 91
c) Perinatal period. B) MCQ (In the answer paper, write the question number and one answer :
d) Epidemic spread. (Total 60 marks)
e) Health care hospital waste. (Put (T) in case of true and (F) in case of false (half mark each)
4. Mention. (25 marks) (Total = 30 marks)
a) Specific prevention for Tetanus. 1. Exposure to noise is the only casual facor of impaired hearing of idustrial
b) Rabies Vaccination workers.
c) Chemical contamination of drinking water. 2. Pneumoconiosis are not necessarily always pathological, where some
d) Charaters of normal distribution curve. forms are bengin.
e) Occupational risks for farmers and agriculture workers. 3. Byssinosis is a form of Pneumoconoisis caused by inhalation of cotton
5. Enumerate the advantage and disadvantage of : (15 marks) dust.
a) Case - Control study. 4. Inhalation of dust in industry is generally more hazardous by the inoor-
b) Diet and Cancer ganic than the organic forms.
c) Types of questions used for interview. 5. The birth rate of the developing countries is usually lower than that of the
devloped.
6. The rate of natural increase of population in Egypt is around 1.9%.
7. Prevalence rate is usually used as morbidity index of chronic disease.
8. Birth injury is a leading cause of infant mortality.
9. In Observational studies the research measure things as they are and col-
lects dat with no attempt to change conditions.
10. In analytical studies the researcher measure things as they are and col-
lects data with no attempt to change conditions.
11. When we want to establish a relation between the disease and risk fac-
tors, we use observational analytical studies.
12. When you want to evaluate a drug or method of treatment, we use cohort
study.
13. Cross sectional studies are very quick and inexpensive.
14. The number of controls should at least three or four times as much the
cases.
15. Data and information collected for both cases and control are not the
same.
16. We can calculate incidence rate from cohort and cross sectional studies.
17. Cohort studies are useful for examining rare exposures.
18. Protein and energy deficiency among school children could result in re-
tarded growth and wasting.
19. "Tobacco-fre schools" is an example of school policies for smoking pre-
vention.

92 93
20. School children are susceptible to vitamin B2 deficiency which is asso- 46. Cholera is pyrexial disease, with high fever.
ciated with low intake of high bilogical value protein. 47. Brucellosis causes acute and chronic disease of man.
21. Rheumatic heart is the commonest heart disease, which affect the 48. Poliovirus has two antigenic types.
schoolchildren. 49. Carriers of virus A hepatitis are incubatory only.
22. Dental caries among schoolchildren could be due to lack of teeth hy- 50. Pneumonic plague is only secondary to the septicaemic.
giene, excess sweet consumption and florine deficiency. 51. Vaccination is the basic preventive measure of plague.
23. Antismoking policies should be applied to teachers, students and school 52. Yellow fever may be a mild self-limited disease.
workers. 53. Dangue is a serious highly fatal disease.
24. Both heatstroke and sun stroke are dangerous because they affect the 54. Tetanus bacillus is a normal inhabitant of the intestine of animals and
heat regulating cener. man.
25. Cigarette smoking increases the complications of pneumoconiosis. 55. Active immunization is the only specific prevention of tetanus.
26. Pneumoconiosis is a rapid process and manifestations start after 10 days 56. Chemoprophylaxis can be applied for prevention of syphilis and gonor-
of exposure. rhoea.
27. Glassbloweres are at risk for ehat cataract. 57. Schistosoma is the only parasite transmitted by contact infection.
28. Examples of the occupational inhalation of inorganic dust are silica and 58. Hand-to-mouth infection is the main mode of spread of ascariasis in chil-
bagasses. dren.
29. Hearing loss due to chronic exposure to noise is reversible once the 59. Malaria is a chronic parasitic disease that gives not acute manifestations.
workers are excluded from noisy work environment. 60. Filariasis is an important form of parasitic zoonosis.
30. Virus of mumps finds exit in saliva only.
31. Cases of herpes zoster may be the reservoir of varicella infection.
32. Chemotherapy of pertussis does not affect period of infectivity.
33. Petussis is always associated with attacks of characteristic paroxysmal
spasmodic coughing.
34. The characteristic rash is the only diagnostic sign of measles.
35. Rubella is a disease of childhood only.
36. Milk cannot be a vehicle of streptococcal infection.
37. Immunity to scarlet fever is antibacterial and antitoxic.
38. The chief source of mentingococcal meningitis is case rather than carri-
er.
39. Influenza infection may possibly be zoonotic.
40. For adults, BCG is given to tuberculin negative healthy individuals.
41. BCG is given by subctuaneous injection.
42. Manifestations of botulism are nervous rather than gastrointestinal.
43. Of Shigellae, the shiga group is the most virulent, being toxigenic.
44. Acute cases of amoebiasis are the main source of infection.
45. Gastric acidity is an effective barrier to cholera infeciton.

94 95
II. Match the sets of questions using each word or statement once only : a) Control
(Each half mark total = 20 marks) b) Community
1. To start treating and preventing newly occurring disease (emerging dis- c) Cohort
ease) we need to study the d) Cases
a) The diseased person age, sex, occupation. 8. Criteria of good screening tests :
b) The place of cases, whether rural or urban, the governorate. a) It should be simple and easy to conduct.
c) The time of disease occurence in relation to season. b) Not time consuming, not invasive, not painful.
d) All of the above. c) Relatively cheap to be tested in mass screening in survey studies.
2. Some unusual health related situation you need to know more about it to d) All of the above.
be able to correct it 9. Sensitivity of screening test is
a) Study objectives. a) The ability of the test to detect cases of the disease.
b) Study problem. b) The ability of the test to give negative results among control.
c) Study question c) The correct identification of cases among test positive individuals.
d) Study goal. d) The correct exclusion of not diseased among test negative individuals.
3. Examples of experimental (Interventional) studies are : 10. Positive predictivity of screening test is
a) Prevalenece surveys (The proportion of Bilharzia among villagers) a) The ability of the test to detect cases of the disease.
b) coverage surveys (The proportion of vaccinated children) b) The ability of the test to give negative results among controls
c) Both of the above. c) The correct identification of cases among test positive individuals.
d) Non of the above. d) The correct exclusion of not diseased among test negative individuals.
4. Examples of observational studies are : 11. The following are true about epidemioloic transition - Ecept one
a) Prevalence surveys (The proportion of Bilarzia among villager) a) Shift of morbidity pattern from communicable to non-communicable
b) Coverage surveys (The proportion of vaccinated children) diseases
c) Both of the above b) The increase in the number of females suffering from non-
d) Non of the above. communicable diseases
5. Examples of observational studies are : c) Shift of mortality causes from communicable to non-communicable
a) Studying community vaccination effect on eliminating poliomyelitis diseases
b) Study the effect of new treatment. d) There is increase in child mortality rates
c) Both of the above 12. Screening programs could reduce the incidence of the diseases because
d) Non of the above. of the ability of detection of the following - except one
6. All of the following is true about case control study except one : a) Pre-hypertension caes, by blood pressure measurement
a) An analytical epidemiologic study design. b) Pre-diabetics by measuring the plasma glucose level
b) The number of controls should be at least equal to the number of cases c) Early cases of cancer liver by serum testing for alpha fetoprotein
c) Useful for examining rare exposures d) At risk cases for CHD by testing for the BMI
d) Optimal for study of rare diseases. 13. Due to the demoraphic transition in the developing countries the disease
7. Group of people who share common character or characters for example pattern is characterized by the following - except one
the year of birth a) Increase in the propotion of elderly with associated high prevalence of
non-communicable diseases

96 97
b) Increase in the proption of youth with early exposure to risk factors b) Help in wound healing
c) Still having large proportion of children with high incidence of com- c) Help in prevention of cancer
municable diseases d) Help in prevention of infections (anti-infection vitamin)
d) The large proportion of the elderly are males exposure to environmen- 21. The following are public health policies to improve nutrition status of
tal risk factors the community - except one
14. The major risky behavior among 40 years old cigarette smokers is select a) lodization of common salt
one b) Fortification of wheat flour with folic acid
a) Use of low-grade tobacco c) Fluoridation drinking water
b) Use cigarettes and not pipe or cigars d) Fortification of skimmed milk with vitamin A
c) Starting smoking during childhood 22. With proper chemotherapy, the case fatality of meningococcal meningi-
d) Deep smoke inhalation tis is :
15. In Egypt, there is a well-established system for periodic examination of a) still high
b) somewhat lowered
the following population categories except one
c) Low
a) Pregnant women
d) Quiet low (below 5%)
b) School children
23. Objects may transmit variola when spoiled by :
c) Industrial workers
a) Respiratory discharges
d) Elderly people
b) Skin eruption c) Saliva d) Excreta e) All f) a & b
16. The following are the risk factors for osteoporosis - except one 24. Type A influenza virus is characterized by :
a) Menopause a) Marked mutation
b) Lack of physical activities b) Causes epidemics and pandemics
c) Low intake wheat bran c) Both
d) Late puberty among males d) Neither
17. The following are the conditions where protein intake should increase - 25. Cases of influenza are not infectious through the following stages, ex-
except one cept :
a) pregnant women a) Incubation period
b) Growth and development of children b) Clinical diseases, few days
c) Adult males due to hard work c) Convalescence
d) Lactating women 26. Human sources of pulmonary tuberculosis are :
18. In a nutritional assessment study using the food-record technique, analy- a) All cases b) Active (open) cases
sis of data showed the low intake of vitamin E, B1, B12 and B6. The ex- c) Carriers d) All e) None
pected health problems to the studied group could be - select one 27. Choose the two basic preventive measures of typhoid:
a) bones and teeth disorders a) Sanitary environment b) Health promotion
b) Different types of anemia c) Specific prevention d) Health behavior
c) Nervous system disorders 28. Infectious food poisoning may be caused by :
d) High risk of coronary heart diseases a) Samonella infection
19. The following are true about vitamin C - Except one b) Staphylococcal intoxication
a) Help in folic acid metabolism c) Botulinum intoxication d) All e) None

98 99
29. Causative agent of botulism is : c) Children immnization coud reduce the neonatal mortality rate
a) Exotoxin b) Neurotoxin c) Entrotoxin d) Proper postnatal care could reduce the neonatal mortality rate
d) Bacillary infection e) a & b 38. The major cause of newborn anemia is - select one
30. Cholera vibrios invade the intestine causing : a) Iron deficiency during pregnancy
a) Loss of fluid and electrolytes b) Toxaemia b) Ante-partum hemorrhage
c) Dysentery d) Bateraemia e) All c) Prematurity
31. El Tor cholera is characterized by : d) Folic acid deficiency during pregnancy
a) Milk diarrhea b) Little vomiting, if any 39. The most cost effective nutrition supplementation during pregnancy is -
c) High fatality d) All e) None select one
32. Brucellosis is prevented in man by the following, except : a) Iron and zinc (in one table) for hemoglobin formation and RNA and
a) Food sanitation b) Prevent airborne infection DNA synthesis
c) Prevent occpational infection b) Iron and calcium (in one tablet) for hemoglobin formation and skeletal
d) Specific prevention e) None development of the fetus
33. Sabin poliovaccine is characterized by : d) Multivitamins and minerals (in one tablet) to prevent any malnutrition
a) Live attenuated b) By mouth c) Highly protective during pregnancy
d) Induces humoral and cellular immunity e) All 40. Congenital malformation could be due to the following nutrient defi-
34. The following infections could negatively affect the outcome of preg- cienes. except one
nancy and they are Sexually transmitted ecept one : a) Iodine
a) HIV b) Iron
b) Syphilis c) Folic acid
c) Toxoplasmosis d) Zinc
d) Genital herpes
35. With the increase of the prevalence of diabetes in Egypt, the following III. Join each one mark (total markts 10)
neonatal health problems are expected to increase - except one
Modes of transmission of some infection diseases :
a) Birth injuries
b) Prematurity 1. Respiratory a) Shigellosis
c) Congenital anomalies 2. Food-borne b) Relapsing fever
d) Small for date 3. Arthropod-borne c) Syphilis
36. The following are true about infant mortality rate (IMR) - except one 4. In-utero d) Staphylococcal diseases
a) It is the number deaths in the first year of life per 1000 live births 5. Contact e) Varicella
b) High IMR is one of the motives of high fertility
Pathogenic organisms find exit in:
c) diarrhea and ARt are the major causes of infant mortality in Egypt.
d) It is one of the evaluation indicators that reflects the outcome of the 6. Respiratory discharges a) Salmonella
hcild care services 7.Vomitus b) Salmonellae, Shigellae
37. The following are true about the neonatal mortality - except one 8. Saliva c) Stap Aureus, TB bacillus
a) Low birth weight is the first major cause of neonatal mortality 9. Faeces d) Cholera vibrios
b) Proper ANC care could reduce the neonatal mortality rate 10. Urine e) Mumps virus

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MCQ (30 marks) b) Cortical mastoidectomy
1. The most common route for infectin to reach the middle ear is through : c) Radical mastoidectomy
a) Traumatic perforation of the typanic membrane. d) Tympanoplasty.
b) The Eustachian tube. 9. Furunculosis of the nose is dangerous because infection may spread to:
c) Blood stream. a) The nasal cartilage.
d) Retrograde infection from meningitis. b) The orbit.
2. Supplied by the trigeminal nerve : c) The cavernous sinus
a) Medial pteyrgoid muscle. d) The sphenoid sinus
b) Buccinator muscle. 10. A cause of unilateral nasal obstruction:
c) Stapeidus muscle. a) Allergic rhinitis.
d) Cricothyroid muscle. b) Rhinoscleroma.
3. Antrochoanal polyp arises from the : c) Cancer maxilla.
a) Sphnoid sinus. d) Common cold.
b) Ethmoid sinus. 11. Vertigo without deafness is present in :
c) Frontal sinus a) Labyrinthitis.
d) Maxillary sinus. b) Meniere's disease.
4. Not used in the treatment of the acute stage of corrosive poisoning : c) Otosclerosis.
a) Emollients. d) Vestibular neuronitis.
b) Antibiotics. 12. Laryngeal papilloma of adults is :
c) Stomach wash. a) Multiple.
d) Analgesics. b) Premalignant.
5. Causes early stridor before oarseness of voice : c) Cures spontancously.
a) Glottic carcinoma. d) Causes early stridor.
b) Epiglottic carcinoma. 13. Rhinolalia aperta occurs in cases of :
c) Supraglottic carcinoma. a) cleft palate.
d) Subglottic carcinoma b) Redundant palate.
6. Highly arched palate is found in cases of: c) Adenoids.
a) Nasopharyngeal fibroma. d) allergic nasal polypi.
b) Nasopharyngeal carcinoma. 14. Referred otalgia occurs in cases of :
c) Adenoids a) Traumatic perforation of the typanic membrane.
d) Allergic nasal polypi. b) Temporo-mandibular arthritis.
7. Cacosmia is a characteristic symptom in cases of : c) Myringitis.
a) Acute sinusitis. d) Secretory otitis media
b) Sinsusitis of dental origin. 15. Sneezing is a common symptom in :
c) Atrophic rhinitis. a) Sinusitis.
d) Rhinoscleroma b) Fracture nasal bones.
8. Mastoid abscess is treated by : c) Allergic rhinitis.
a) Simple incision. d) cerebrospinal rhinorrhoea.

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CAIRO UNIVERSITY FOURTH YEAR EXAM 5. Hazards of hospital waste.
FACULTY OF MEDICINE Total marks=150 6. Vertical infection.
August 29, 2009 Time allowed: 3 Hours 7. Silicosis (definition, etiology, occasions of exposure)
Community Medicine 8. Risk factors in osteoporosis.
A. Answer the following questions : (90 marks) 9. Modes of transmission of staphylococcal versus salmonella food poisoning.
1. A group of soldiers comprised of 2000 members. In 2008, they lived in a 10. Risk and dangerous groups in pulmonary tuberculosis and how they
military camp with dormitories of 1600 m2/total surface area. In late win- should be investigated.
ter and early spring of the same year, lots of them suffered from frequent B. MCQ : (In the answer paper, write the question number and one spe-
attacks of common cold and sore throat. However, 120 of these soldiers be- cific answer)
gan to suffer from fever, headache, vomiting and neck stiffness. Others be- (Total 60 marks) (half mark each)
gan to develop non specific skin rash. Also, a few of them developed CNS Put (T) in case of true or correct statement and (F) in case of incorrect or
manifestations. Meningococcal meningitis was diagnosed, proved and the false statement:
situation was investigated. 1. There is no congenital acquired immunity against tuberculosis and pertus-
1-1. In the previous scenario, mention four risk factors that would be incrimi- sis.
nated in the spread of meningococcal meningitis among these soldiers. (4 2. Pneumoconiosis is a rapid process and manifestations start after 10 days of
marks) exposure.
1-2. Mention other risk factors for developing such problem in confined plac- 3. Malaria could be one of the hospital acquired infections.
es. (4 marks) 4. The vaccinaes received by school children are DT, BCG and meningococcal
1-3. Name the epidemiologic pattern of spread. (4 marks) meningitis vaccine.
1-4. Mention measures to be taken to prevent the spread of this meningococ- 5. A mixture of cereals and pulses could supply all the essential amino acids to
cal meningitis among the unaffected soldiers. (4 marks) the body.
1-5. Mention the necessary epidemic measures that should be taken in this 6. Disabilities could result from severe deficiency in dietary vitamin A and io-
camp. dine.
(4 marks) 7. Exposure of male workers to teratogens could lead to congenital anomalies
1-6. Give some recommendations to avoid such problem to occur again. (4 of the offspring.
marks) 8. Both diabetes type 1 and rheumatic heart are attributed to autoinmmune re-
1-7. Describe other health problems that could be encountered in confined actions.
places as camps, boarding schools, prisons ... etc (6 marks) 9. In Egypt, the incidence of cancer bladder is decreasing due to reduction in
II. Give an account on all the following questions (6 marks each, 60 total) the prevalence of schistosomaiasis mansoni.
1. Ecology of malnutrition. 10. Incidence rate of abortion is one of the age specific mortality rates.
2. Risk factors in hypertension. 11. Newborns have iron stores to supply their requirements for 6 months.
3. Maternal mortality (definition of maternal mortality rate, and causes of 12. Perinatal mortality includes stillbirths and earlyneonatal deaths.
13. The population pyramid of the developing countries has narrow base.
deaths)
14. General fertility rate is usually higher than feucndity rate.
4. Malaria eradication.

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15. Deaths of mothers due to spontaneous abortion are not included in the ma- 32. The following are outcome indicators of the family planning program -
ternal mortality statistics. Except one a) Contraceptive prevalence rate
16. Postnatal care includes informing the mother about birth spacing for one b) Contraceptive failure rate
year. c) General fertility rate
17. Pregnant mothers are considered at risk if the hamoglobin level is 11-12 d) Contraceptive discontinuation rate
gm/dl. 33. The following are of the impact indicators used for evaluation of the effec-
18. Tetanus toxoid immunization starts at the 5th month of pregnancy. tiveness of the maternal care program - Except one :
19. Egypt food balance sheet indicates taht energy intake is higher than ener- a) Incidence of abortion
gy requirements. b) Maternal mortality ratio
20. The health office could provide data to calculate the incidence of cholera c) Infant mortality rate
and typhoid. d) Perinatal mortality rate
21. Wasted children indicate low weight for height compared to WHO refer- 34. Nutritional deficiency diseases among school children include the follow-
ence values. ing - Except one :
22. Low age dependency ratio is one of the Egypt population problems. a) Vitamin A deficiency
23. Human anti-rabies immunoglobulin could be given before and after expo- b) Vitamin B2 deficiency
sure. c) Vitamin D deficiency
24. Prevention of opthalmia neonatorum is included in the premarital care. d) Fluorine deficiency
25. Hospital wastes containing pathogenic material are disposed by incinera- 35. The following are associations between obesity and non-communicable
tion. diseases - Except one :
26. adding 0.6 ppm chlorine to filtered water results in its sterilization. a) visceral obesity is a risk for diabetes
27. Xerophthalmia and cirumorneal vascularisation are manifestation of vita- b) Obesity increases the blood volume and lead to hypertension
min A deficiency. c) Obesity is a risk factor for CHD due to associated dyslipidemia
28. Booster dose maintains immunity and revaccination reforms immunity. d) Metabolic syndrome includes having body mass index more than 30kg/
29. Exotoxins of clostridium botulinum, and clostridium tetani could contami- m2.
nate food. 36. There are specific measures for contacts of the following diseases - Except
30. Each pregnancy requires 6 months of normal diet to replace iron stores one :
that are lost during pregnancy. a) TB
MCQ - select One Response b) Typhoid
31. The intake of dietary fibers is protective against cancer colon due to the c) Meningitis
following - Except one : d) Brucellosis
a) Dilution of bile acids 37. The following diseases could be transmitted by organ transplantation -
b) Hastening the outside passage of ingested carcinogenic agents Except one:
c) Diet rich in fibers is rich in protein content. a) Hepatitis B
d) Diet rich in fibers is poor in fat content. b) Rabies

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c) HIV/AIDS 44. The following are true about IMCI - Except one :
d) Typhoid a) Helps in controlling childhood health problem.
38. The following are health problems related to water - Except one : b) Includes specific prevention of diarrhea and ARI
a) Fluorosis c) Includes management of children's anemia
b) Leptospirosis d) Includes management of measles cases
c) Plague 45. The following are public health interventions to improve the nutitional
d) Endemic Goiter status of the community - Except one :
39. Examples of zoonoses transmitted to man by droplets - Except one : a) Iodization of common salt
a) Avian influenza b) fortification of wheat flour with folic acid
b) Brucellosis c) Fluoridation of the drinking water
c) Encephalitis d) Fortification of the skimmed milk with vitamin A
d) Psittacosis 46. The total fertility rate in Egypt 2005 was - Except one :
40. The following are examples of morbidity rates - Except one : a) 130 children per 1000 women in the reproductive age
a) Prevalence of diabetes b) 3100 children per 1000 married women in the reproductve age
b) Case fatlity rate from HIV/AIDS c) 3.1 children per married woman in the reproductive age
c) Incidence of abortion d) 3.1 children per woman in the reproductive age
d) Prevalance of stunted growth among the U5 children 47. Congenital problems could be due to the following nutrient deficiencies -
41. Cases to be screened for diabetes are the following - Except one : Except one :
a) High serum LDl a) Iodine
b) Hypertension b) Iron
c) High serum HDL c) Folic
d) Abdominal obesity d) Zinc
42. The following are true about interventions for health promotion - Except 48. The following are the compulsory immunization in the first year of life -
one : Except one :
a) Environmental sanitation a) MMR
b) Active immunization b) OPV
c) Healthy lifestyle c) BCG
d) Health education d) DPT
43. The following are true about nutrition to reduce the risk of coronary heart 49. Down's Syndrome could be prevented trough the following program - Ex-
diseases - Except one : cept one :
a) Increase intake of Omega 6 fatty acids (in vegetable oils) a) Antenatal care
b) Increase intake of trans - fatty acids b) Premarital Care
c) Increase intake of Omega 3 fatty acids (fish oil) c) Postnatal care
d) Increase intake of vitamin E d) Child care

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50. The following are true about plague - Except one : a) Early menarche
a) It is zoonoses b) Increase of female life expectancy
b) Quarantinable disease c) Smoking
c) Fleas are the reservoir of infection d) Abuse of corticosteroids
d) The vaccines have short protection period 57. To assess under-five children chronic malnutition, we measure - Select
51. The following infections is associated with locally acting exotoxins - Ex- one :
cept one : a) Weight for height
a) Cholera b) Weight for age
b) Botulism c) Height for age
c) Shigella shiga d) None of the above
d) Staph aureus 58. Communicable diseases form a risk for non-communicable diseases - Ex-
52. The following diseases ahve intestinal carries - Except one : cept one :
a) Cholera a) Streptococcal infection
b) Brucellosis b) Schistosomiasis
c) Poliomyelitis c) Pulmonary tB
d) Typhoid d) Virus B hepatitis
53. The compulsory immunization is against the following droplet infections - 59. Crude birth rate is used for measurement of he following - Except one :
Except one : a) Fertility
a) Diphtheria b) Growth rate
b) Mumps c) Rate of natural increase
c) Rubella d) Age depenency ratio
d) Chicken pox 60. The health office could provide the folloiwng annual indicators - Except
54. Chemoprophylaxis to contacts of cases in - Except one : one :
a) Brucellosis a) Incidence of diabetes
b) Typhoid b) Crude birth rate
c) Tetanus c) Crude death rate
d) Meningitis d) Maternal Mortlity Ratio
55. Poliomyelitis eradication in indicated b the following - Except one : 61. "People feel the importance of primary health care services" indicates - Se-
a) No virus in the sewage samples lect one
b) No virus in the water samples. a) Affordability
c) No reported cases b) Accessibility
d) Sabin vaccination coverage is 100% c) Acceptability
56. The increase in the prevalance of osteoporosis is associated with the fol- d) Availability
lowing - Except one : 62. The following are true about the median in data analysis - Except one :

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a) Ita takes all values into consideration c) Givento tuberculin positive
b) Its value is not affected by the extremes of values d) Immunity against pulmonary and extra-pulmonary TB
c) it is used to compare between groups 69. The potentials for eradication of measles are the following - Except one :
d) It presents value of the observation located in the middle of the arranged a) No carries
data b) High efficacy reservoir
63. Measures of central tendency include the following - Except one : c) No animal reservoir
a) Mid range d) Measles virus has only one antigenic type
b) Mode 70. The following are examples of diseases with subclinical manifeastations -
c) Range Except one :
d) Median a) Measles
64. The following are true abot the normal distribution curve - Except one : b) Diphtheria
a) Bell shaped c) Poliomyelits
b) Mean, mode and median have the same value d) Rubella
c) 95% of the obxervations have values within a range of mean 1SD 71. Pilgrims receive tetrcyline on arival because of the following - Except one :
d) Values distributed symmeterically around the mean a) The required cholera vaccine is ineffective
65. The following are true about the pi chart - Except one : b) Prevent disease in case of infection
a) Use percentages for each category c) Prevent carrier state
b) The total area is 360% d) Cost-effective
c) Each 1% is equivalent 3.6 of the circle 72. Under-five children mortality includes - Select one:
d) Presents data for qualitative variable a) Stillbirth and child deaths
66. The following are true about the histogram - Except one : b) Neonatal and post-neonatal deaths
a) Used for nominal variables c) Infant and child deaths
b) The bars are placed side by side d) Early neonatal deaths and child deaths
c) The total area is 100% III. Cross Match the statements in the two columns
d) The population pyramid is an example of the histogram
67. The following are water related vector - transmissible diseases - Except
one :
a) Malaria Preventive measures Reduce the problem of
b) Yellow fever 73. ( ) Hepatitis B vaccine a) Rheumatic heart disease
c) Filaria 74. ( ) MMR b) Cancer bladder
d) Leshmania 75. ( ) Long acting penicillin c) Cancer liver
68. The following are true about BCG - - Except one : 76. ( ) Prazequantile d) Diabetes
a) It is life attenuated vaccine
b) Revaccination if necessary

112 113
Cross Match Cross Match
Vaccine Immunity Vaccination is the major measure in Reasons
77. ( ) Salk a) Local tissue immunity 97. ( ) Yellow fever a) Difficult to control the contaminated soil
78. BCG b) Short duration immunity 98. ( ) Poliomyelitis b) Difficult to control the animal reservoir
79. ( ) Otten's vaccine c) Cell mediated immunity 99. ( ) Tetanus c) It is the method to reduce source of infection
80. ( ) Sabine d) Humeral immunity 100. ( ) Measles d) Difficult to ensure sanitary environment
Cross Match
IV. Fill in the spaces using statements in the boxes:
Risk factors Health problem
a) Ostemalacia b) Rickets c) Type I osteoporosis d) Type II osteoporosis
81. ( ) Atherosclerosis a) Type 2 Diabetes
82. ( ) Sodium sensitivity b) CHD 101. ( ) ............. affect children 6-24 months old.
102. ( ) ............. is a health problem among elderly males and females.
83. Visceral obesity c) Rheumatic heart 103. ( ) ............. is one a bone problem among high parity women.
84. ( ) Genetic factors d) Essential Hypertension 104. ( ) ............. appears among women in the early years after menopause.

Cross Match a) Vitamin B12 b) Vitamin B6 c) Vitamin B2 d) Vitamin B1

Mutreints' Function Examples of nutrients 105. ( ) ............. is essential for amino acid metabolism.
106. ( ) ............. is essential for carbohydrate metabolism.
85. ( ) Antioxidants a) Vitamins B1, B2 B5 107. ( ) ............. is essential for tissue respiration
86. ( ) Synthesis of new tissues b) Calcium, phosphorus and vitamin D 108. ( ) ............. is essential for nervous tissue metabolism.
87. ( ) Skeletal growth c) Vitamins A, C, E and selenium a) Cross - sectional studies b) Case - control Studies c) Cohort Studies d) Clinical trials
88. ( ) Production of energy d) Folic and vitamin B6
109. ( ) ............. assess the effecitveness of vaccines and drugs
110. ( ) ............. measure incidence of disease among exposed and none exposed
Cross Match 111. ( ) ............. measure prevalence and suggest risk factors
112. ( ) ............. evaluate multiple risk factors for one disease.
Infectious Disease Reservoir / Source of Infection
89. ( ) Meningococcal meningitis a) Cattle a) Hemorrhage b) Eclampsia c) Heart diseases d) Genital sepsis
90. ( ) Whooping cough b) Atypical cases 113. ( ) ............. is one of the indirect causes of maternal mortality.
91. ( ) Tuberculosis c) Clinical cases 114. ( ) ............. is one of the direct causes of maternal mortality.
92. ( ) Measles d) Healthy carries 115. ( ) ............. is the first cause of maternal mortality in Egypt.
116. ( ) ............. is one of the preventable causes of maternal mortality.
Cross Match a) Influenza virus b) Streptococcal pyogens c) Neisseria Meningitides d) Diphtheria
Biological contaminatin of food Example 117. In ....... ( ) .... group A is responsible for epidemic spread.
93. ( ) Improper refirgeration a) Botulism 118. Second attacks of the diseases occurs because ...... ( ) ...... has more
than 130 serotypes.
94. ( ) During production b) Typhoid
119. Due to shift and drift of ..... ( ) .... second attack could occur.
95. ( ) During manufacture c) Fascioliasis 120. The portal of entry in ..... ( ) ... are the nose, mouth, skin and conjuncti-
96. ( ) Food handlers d) Staphylococcal food poisoning va.

114 115