Communicable Disease Answers III

61. Answer: C

Rationale: The following are late signs and symptoms of Leprosy: (3) Inability to close eyelids (lagophthalmos), clawaing of the fingers and toes, contractures, (6) loss of eyebrow (madarosis), enlargement of the breast in males (gynecomastia), chronic ulcers and (8) sinking of the nose bridge.

62. Answer: A Rationale: The mode of transmission of leprosy are the following: Airborne (inhalation of droplet/spray from coughing and sneezing of untreated leprosy patient) and Prolonged skin-to-skin contact.

63. Answer: D Rationale: Multidrug Therapy is the method of treatment for leprosy. The daily treatment prescribed for a Multibacillary (lepromatous and borderline) type in 28 days is Clofazimine 50 mg and Dapsone 100 mg.

64. Answer: B Rationale: Slit Skin Smear (SSS) examination is an optional procedure done only when a clinical diagnosis is doubtful. This prevent misclassification and wrong treatment. Options A and D is used for diagnosing Tuberculosis. Option C is used in Malaria.

65. Answer: A Rationale: Bacille Calmette-Guérin (BCG) vaccine is used as preventive measure for Tuberculosis. It can also prevent the occurrence of Leprosy since the two disease both came from the Mycobacterium family.

66. Answer: D Rationale: Rubeola or Measles is caused by a filterable virus (1). It is an acute highly communicable infection (4) characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days of coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day (8) affecting the face - usually beginning behind the ears and neck (5), body and extremities ending in branny desquamation. Death is due to complication (6) such as secondary pneumonia, usually in children under 2 years old

67. Answer: A Rationale: The incubation period of Rubeola is 10 days from exposure to appearance of fever and about 14 days until rash appears. Option B is for Chicken pox. Option C is for Mumps. Option D is for Tetanus.

68. Answer: C Rationale: Koplik spots are tiny grayish to whitish spots found in the buccal mucosa of a client with Rubeola. Option A is the pathognomonic sign of Diphtheria. Option B is found in clients with Typhoid fever. Option D is found in clients with Rubella

69. Answer: B Rationale: The characteristic signs of measles are which of the following: Rashes which spread from the face to the trunk and limbs ending in branny desquamation, conjunctivitis (Stimson's sign), high fever and tiny white spots in the mucosa inside the cheek

70. Answer: B Rationale: Clients with Rubeola has conjunctivitis (Stimson's sign), as a result an important nursing intervention is to protect the eyes of the client from glare of strong light as they are apt to be inflamed. Place the client in a dim-lighted room, not well lighted.

71. Answer: D Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and abdomen and diarrhea.

72. Answer: B Rationale: Typhoid fever is caused by Salmonella typhosa or typhoid bacillus, which is a bacteria.

73. Answer: C Rationale: Typhoid fever can be transmitted through the following mode of transmission: direct or indirect contact with patient or carrier; contaminated food and water with flies as vectors; and improper food handling. It is not transmitted via airborne.

74. Answer: A Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and abdomen and diarrhea. (7) Rice watery stools are seen in patients with Cholera.

75. Answer: D

Rationale: Preventive control measures include sanitary disposal of human feces and maintenance of fly proof latrine and proper food handling and preparation.

76. Answer: A Rationale: Antihelminthic drugs used in treating parasitic infections include: Albendazole and Mebendazole (Vermox) that inhibits glucose and other nutrient uptake of helminth; Pyrantel embonate (Antiminth) that paralyzes intestinal tract of worm; and Thiabendazole (Mintezol) that interferes with parasitic metabolism. Metronidazole (Flagyl) is an anti-protozoan drug (options B and C). Cotrimoxazole (Bactrim) is an antibiotics (option C).

77. Answer: D Rationale: Commonly patients with Paragonimiasis are misdiagnosed to have Pulmonary Tuberculosis (PTB) and are treated as Tuberculosis patients. In fact, a study by Belizario et.al revealed that 56% of his subjects were non-responsive to multi-drug therapy for PTB but were positive for Paragonimiasis.

78. Answer: C Rationale: The treatment of choice for Paragonimiasis is Praziquantel (Biltrizide) 25 mg/kg body weight three times daily for three days. It is suitable for treatment of adults and children over four years of age, higher dose is needed for ectopic paragonimiasis. Bithionol (BITIN) is only an alternative drug for paragonimiasis (option A). Ethambutol (option B) is one of the multi-drug therapy for PTB. Metronidazole (option D) is an anti-protozoan drug.

79. Answer: B Rationale: The three major causes of intestinal parasitic infections in the Philippines are the following: (A) Trichuriasis or Whipworm (Trichuris trichiura); (C) Ancylostomiasis or Hookworm (Ancylostoma duodenale and Necator americanus); and (D) Ascariasis (Ascaris lumbricoides).

80. Answer: D Rationale: Pinworms (enterobiasis), which is caused by the parasite Enterobius vermicularis, is the most common helminthic infestation among children. It enters the intestinal mucosa and could be spread through autoinfection (when the child places fingers, used in scratching the anal part and containing the pinworm eggs, into the mouth). It is noted that pinworms caused severe itching as they lay their eggs.

81. Answer: Rationale: The signs and symptoms of Red Tide Poisoning includes: numbness of the face especially around the mouth; vomiting; dizziness; headache; tingling sensation, paresthesia and eventual paralysis of hands and feet; Floating sensation and weakness; rapid pulse (tachycardia); difficulty of speech (ataxia); difficulty of swallowing (dysphagia); and total muscle paralysis with respiratory arrest and death occur in severe cases.

82. Answer: A Rationale: Paralytic Shellfish Poisoning (PCP) or Red Tide Poisoning is a syndrome of characteristic symptoms predominantly neurologic which occur within minutes or several hours after ingestion of poisonous shellfish (option B). It is caused by a single celled organism called dinoflagellates, which is commonly referred to as plankton (option C). One of its symptoms include tingling sensation or paresthesia (option D). Toxins in red tide is not totally destroyed upon cooking.

83. Answer: B Rationale: Toxins in red tide is not totally destroyed upon cooking hence consumers must be educated to avoid bi-valve mollusks like tahong, talaba, halaan, kabiya, abaniko (sun and moon shell or Asian scallop) when the red tide warning has been issued by the proper authorities.

84. Answer: D Rationale: Bi-valve mollusks such as oysters, clams, mussels, sun and moon shell or Asian scallop as well as crabs are avoided when the red tide warning has been issued by the proper authorities. There's no reported cases of red tide poisoning when eating sea cucumber.

85. Answer: C Rationale: Management of Red Tide Poisoning includes the following: induce vomiting; no definite medication indicated; drinking pure coconut milk, which weakens the toxic effect of red tide, and sodium bicarbonate solution (25 grams in ½ glass of water) may be taken. Drinking coconut milk and sodium bicarbonate solution is advised during the early stages of poisoning only. If given during the late stag, they may make the condition of the patient worse; Shellfish affected by red tide must not be cooked with vinegar as the toxin of Pyromidium increases (15 time greater) when mixed with acid; and do not eat even cooked shellfish because toxins of red tide are not totally destroyed upon cooking.

86. Answer: D

Rationale: The other names of Hepatitis A are the following: Infectious hepatitis; Catarrhal jaundice; and Epidemic hepatitis. In option D, Inoculation hepatitis is the other name for Hepatitis B.

87. Answer: C Rationale: There are no specific drugs for the treatment of Hepatitis A. There is, however, a prophylaxis, which is an IM injection of gamma globulin.

88. Answer: B Rationale: The dietary requirement for a client with Hepatitis A is a low fat diet but high in sugar. Options A, C and D are incorrect because all or part of its choices are high in fats. Low fat diet include only lean meats, fish and poultry. The allowed vegetable oils may be used in preparing meats, fish and poultry; used in salad dressings; or in baked products.

89. Answer: D Rationale: Hepatitis A virus can be killed by cooking the food to boiling point, steaming the food will not kill the virus.

90. Answer: A

Rationale: Hepatitis A has the following signs and symptoms: influenza-like such as headache; malaise and easy fatigability; loss of appetite or anorexia (1); abdominal discomfort/pain; nausea and vomiting; fever; enlargement of the lymph node or lymphadenopathy (2); jaundice (4) accompanied by pruritus and urticaria (6); and bilirubinemia with clay-colored stools (7).

91. Answer: C

Rationale: Leptospirosis is also known with the following names: Mud fever and Flood fever (option A); Weil's disease and Trench fever (option B); and Spiroketal jaundice and Japanese Seven Days Fever (option D). In option C, Catarrhal jaundice is the other name for Hepatitis A while Ragpicker disease is the other name for Anthrax.

92. Answer: D

Rationale: Leptospirosis can be diagnosed by its clinical manifestations, culture of the organism, examination of blood and CSF during the first week of illness and urine after the 10th day.

93. Answer: A

Rationale: Leptospirosis can be transmitted through contact of the skin, especially open wounds with water, moist soil or vegetation contaminated with urine of infected host.

94. Answer: B

Rationale: Infection with leptospirosis is possible with recreational swimming in water contaminated with urine of human and animals having the infection.

95. Answer: B

Rationale: Doxycycline is the drug of choice for Leptospirosis. It is prescribed at 200 mg orally once a week for prevention

96. Answer: C

Rationale: The wound must be immediately and thoroughly washed with soap and water. Antiseptics such as povidone iodine or alcohol may be applied.

97. Answer: C

Rationale: Patients should consult a veterinarian or trained personnel to observe the pet for 14 days for signs of rabies.

98. Answer: A

Rationale: The general objective of the Department of Health (DOH) is to reduce the incidence of Human Rabies from 7 per million to 1 per million population by 2010 and eliminate human rabies by 2015.

99. Answer: C

Rationale: People who are at high risk of acquiring rabies includes the following: Pet owners; animal handlers; health personnel working in anti-rabies units; and children below 15 years old.

100. Answer: B

Rationale: Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis.