Tuesday, March 8, 2011
MBBS EXAM QUESTIONS FOR SECOND THIRD AND FINAL YEARS: Community Medicine
MBBS EXAM QUESTIONS FOR SECOND THIRD AND FINAL YEARS: Community Medicine: "COMMUNITY MEDICINE (Ref:Preventive and Social Medicine. K PARK. 19th Ed) Examination Pattern THEORY Written Exam 1 60 Marks Written Ex..."
Wednesday, August 6, 2008
A trip to DXN
After following on a BAKAS field trip to observe “tandas curah” and a 29 year old water pump, we left for another field trip with the Food Quality Control department to the DXN GanoDerma factory in Bukit Wang, about 11km from Jitra.
We arrived at 11.00pm and were ushered into the administrative lobby, we then went to the storage warehouse to meet Mr. Mohd Noor, the Environmental Health Assistant Officer from Food Quality Control Department.
He explained that when(in this case), the factory requests for a Health Certificate, the DHO will send its team to collect samples of the product. Usually 3 samples are collected for each batch of products:
1. The Accredited lab.
2. District Health Office.
3. Factory.
This is done for cross-referencing later on. Among the test done are:
1. pH.
2. Moisture.
3. Total Plate Count(TPC).
4. Heavy Metal( Lead, Mercury, Arsenic)
5. Microorganisms.
The lab results are obtained within 2 weeks and the Health Certificate is produced within a week if all conditions are met, so the entire process is done in 3 weeks. The cost is about RM 80 which is paid by the applicant.
The health certificate is necessary for exporting purposes.
After that we were invited for a ”Plant Tour”, Mr Lim Beng Tuan, the Senior Administrative Executive.
The company’s name is DXN Industries SDN. BHD. Started operations in 1995 as a plantation and was formally registered on the 20 November 1996. This site was opened in 1997. This plant has 730 workers and covers an area of 48 hectares. The company’s other plants are in Indonesia, China, and India.
DXN produces pharmaceutical, food, drinks, and cosmetic products which are exported to 22 countries around the world.
At the start of the tour we were brought to its plantation zone. This is where we first saw the preparation for seeding using sawdust and rice bran. Daily 5000 seeding bags are autoclaved for 2 hours at 125 °C and 11 PSI. It is then cooled down for a day before the spore is inserted in the polybag. The seeding room is kept clean, even unhealthy workers are not allowed in.
The mushrooms are then grown in cabins. There are 124 cabins of which only 4 are opened for tours. Each cabin has 21000 spores. The humidity and temperature are closely monitored. The mushrooms are harvested at about 3 months.
We were then taken to the pharmaceutical production line, where we were told that no photos were to be taken, as these were supposed to be company secrets. We saw how the different products were produced and packaged. At the end of the line we were given 4 sample tablets to try.
We then went to the food and beverage production line, followed by the cosmetic line where we were told about the company getting its “halal” certification by JAKIM.
At the end we were each given some free samples that are yet on the market.
We arrived at 11.00pm and were ushered into the administrative lobby, we then went to the storage warehouse to meet Mr. Mohd Noor, the Environmental Health Assistant Officer from Food Quality Control Department.
He explained that when(in this case), the factory requests for a Health Certificate, the DHO will send its team to collect samples of the product. Usually 3 samples are collected for each batch of products:
1. The Accredited lab.
2. District Health Office.
3. Factory.
This is done for cross-referencing later on. Among the test done are:
1. pH.
2. Moisture.
3. Total Plate Count(TPC).
4. Heavy Metal( Lead, Mercury, Arsenic)
5. Microorganisms.
The lab results are obtained within 2 weeks and the Health Certificate is produced within a week if all conditions are met, so the entire process is done in 3 weeks. The cost is about RM 80 which is paid by the applicant.
The health certificate is necessary for exporting purposes.
After that we were invited for a ”Plant Tour”, Mr Lim Beng Tuan, the Senior Administrative Executive.
The company’s name is DXN Industries SDN. BHD. Started operations in 1995 as a plantation and was formally registered on the 20 November 1996. This site was opened in 1997. This plant has 730 workers and covers an area of 48 hectares. The company’s other plants are in Indonesia, China, and India.
DXN produces pharmaceutical, food, drinks, and cosmetic products which are exported to 22 countries around the world.
At the start of the tour we were brought to its plantation zone. This is where we first saw the preparation for seeding using sawdust and rice bran. Daily 5000 seeding bags are autoclaved for 2 hours at 125 °C and 11 PSI. It is then cooled down for a day before the spore is inserted in the polybag. The seeding room is kept clean, even unhealthy workers are not allowed in.
The mushrooms are then grown in cabins. There are 124 cabins of which only 4 are opened for tours. Each cabin has 21000 spores. The humidity and temperature are closely monitored. The mushrooms are harvested at about 3 months.
We were then taken to the pharmaceutical production line, where we were told that no photos were to be taken, as these were supposed to be company secrets. We saw how the different products were produced and packaged. At the end of the line we were given 4 sample tablets to try.
We then went to the food and beverage production line, followed by the cosmetic line where we were told about the company getting its “halal” certification by JAKIM.
At the end we were each given some free samples that are yet on the market.
PIC 1: at the autoclave
PIC 2: caffeine products
PIC 3: tablets given to us
PIC 4: production line
PIC 5: with Mr Lim
PIC 6: Tandas curah
PIC 7: Water pump
PIC 8: Culture cabin
PIC 9: Autoclave
JITRA: HIV/AIDS UNIT
There HIV/AIDS unit is handled by only one person that is PPKP Mr.Osman bin Ali. He also analyses the data in Kubang Pasu district and the analysis is presented and discussed in epidemiology meeting..
OBJECTIVE
1) To give comprehensive medical treatment to the target group:-
a) Any high risk cases ( referred or voluntary )
b) Mother who conceive
c) Family members or any individual who takes care of HIV/AIDS patients.
2) To give medical information and support to those who in need.
ROLES AND RESPONSIBILITY AT DISTRICT LEVEL
The programmes in district level is lead by the district officer and helped by family medicine specialist, medical and health officer, assistant of environmental officer (PPKP) and the sisters and staff nurses.
Plan, implement and monitor programmes at district level.
Identification of problems and give feedback about PPHIV programme at district level.
Collect and insert registered cases from health clinic through on line at district level.
Plan and implement PPHIV activities at district level.
Receive all notifiable cases and confirm the contact cases.
HIGH RISK CASES
Drug addicts, who share the needles, having sex partner who have HIV, involve in unsafe sex, from mother who had HIV to the child and sexually transmitted illness (STI) patients are known as high risk cases.
The high risk cases will be counseled:
Pre test
- Given to those who wants to do the HIV screening
Post test
- Test results must be informed as fast as possible.
Home visit by PPKP for 3 reasons:
a) Contact Tracing
b) To give health education to the patient and also to the family members regarding nursing at home
c) To detect defaulters
FORM HIV/AIDS97 is a 3 in 1 form where we record information about HIV,AIDS and death of patient.
To register a patient as a case we need 2 positive results.
Sample verification or 2nd blood test must be obtained 1 week after 1st reactive ELISA test or just after informed by Lab which did the test.
Most cases are obtained from mothers who come for antenatal check-up and drug addicts.
NSP (National Strategy Plan) where by the MOH collaborates with other agencies or NGOs like AADK(Agency Anti-Dadah Kebangsaan,Schools,PLKN,Police) to provide talk and seminars related to HIV/AIDS.
In Kubang Pasu there is 2 PPHIV(Program Pengurusan HIV) that is in K.K Changloon and K.K Kepala Batas. All patients with HIV will be referred to PPHIV and all their contacts will be traced (Contact tracing).PPHIV does counseling,treatment and also lab test such as viral load and CD4.
After been diagnosed with HIV, their spouse and also their children < 6 years old should be informed and screened for HIV.
For year 2008 till 31 July, there has been 8 cases of HIV/AIDS been registered after 2 positive results.
The data from the forms are transferred to registration book and then into computer.
Corpse management
1) Notification received via telephone or verbally
2) Record into the record book
3) Patient record is checked in the communicable disease record book
4) Appropriate tools for corpse bathing (cleansing) procedure is prepared like rubber glove, mask and apron.
5) Visit the patients house and identify the person in charge of bathing the corpse.
6) Proper area for bathing the corpse has to designated.Proper disposal of bathing water has to be done that is into the drain or a hole that has been dug.
7) The dead person’s clothes has to be soaked in Clorox for 30 minutes before washed.
8) Explain to the person in charge the correct procedure to bath the corpse and ensure that’s they practice universal precautions.
9) Monitor the bathing procedure at all time
10) The corpse will be wrapped in 3 layers-
- first layer-white cloth
- second layer –plastic
-third layer – white cloth
Purpose is to eradicate microorganism
11)The equipments are soaked in Clorox for 30 minutes before washed and the floor is mopped with Clorox solution.
HARM REDUCTION
Sharing needles while injecting drugs cause 70% of reported HIV infection (2004)
The risk of practicing “unsafe sex” causes 20% of reported HIV infection (2004)
As a response to the 6th. Millennium Development Goal adopted during the Millennium Summit in 2000.
It is the fight against HIV/AIDS that remained to be achieved !
It is about making dangerous behavior less dangerous--It is less dangerous to inject drug with one’s own clean needle as opposed to sharing contaminated needle, and;
About improving Quality of Life--By providing the various supports to IDUs living with HIV/AIDS
And about saving lives--By not being infected or infecting others with HIV
Needle Exchange Program (NEP) is only one of many more harm reduction activities
NEP’s major role is to serve as a driving force towards a wide range of Harm Reduction related activities;
-Information, education and communication on risk reduction
-HIV Testing & counseling…. Condom use !!
-DST services, Half-way house…..
-T.B & STD screening and treatment,
-ARV treatment and;
-Psycho-social and moral care & support.
The Principles;
-First; to help the uninfected IDUs stay that way;
-Second; to help infected IDUs stay healthy, and;
-Third; to help infected IDUs initiate and sustain behaviors that will keep preventing HIV transmission to others.
OBJECTIVE
1) To give comprehensive medical treatment to the target group:-
a) Any high risk cases ( referred or voluntary )
b) Mother who conceive
c) Family members or any individual who takes care of HIV/AIDS patients.
2) To give medical information and support to those who in need.
ROLES AND RESPONSIBILITY AT DISTRICT LEVEL
The programmes in district level is lead by the district officer and helped by family medicine specialist, medical and health officer, assistant of environmental officer (PPKP) and the sisters and staff nurses.
Plan, implement and monitor programmes at district level.
Identification of problems and give feedback about PPHIV programme at district level.
Collect and insert registered cases from health clinic through on line at district level.
Plan and implement PPHIV activities at district level.
Receive all notifiable cases and confirm the contact cases.
HIGH RISK CASES
Drug addicts, who share the needles, having sex partner who have HIV, involve in unsafe sex, from mother who had HIV to the child and sexually transmitted illness (STI) patients are known as high risk cases.
The high risk cases will be counseled:
Pre test
- Given to those who wants to do the HIV screening
Post test
- Test results must be informed as fast as possible.
Home visit by PPKP for 3 reasons:
a) Contact Tracing
b) To give health education to the patient and also to the family members regarding nursing at home
c) To detect defaulters
FORM HIV/AIDS97 is a 3 in 1 form where we record information about HIV,AIDS and death of patient.
To register a patient as a case we need 2 positive results.
Sample verification or 2nd blood test must be obtained 1 week after 1st reactive ELISA test or just after informed by Lab which did the test.
Most cases are obtained from mothers who come for antenatal check-up and drug addicts.
NSP (National Strategy Plan) where by the MOH collaborates with other agencies or NGOs like AADK(Agency Anti-Dadah Kebangsaan,Schools,PLKN,Police) to provide talk and seminars related to HIV/AIDS.
In Kubang Pasu there is 2 PPHIV(Program Pengurusan HIV) that is in K.K Changloon and K.K Kepala Batas. All patients with HIV will be referred to PPHIV and all their contacts will be traced (Contact tracing).PPHIV does counseling,treatment and also lab test such as viral load and CD4.
After been diagnosed with HIV, their spouse and also their children < 6 years old should be informed and screened for HIV.
For year 2008 till 31 July, there has been 8 cases of HIV/AIDS been registered after 2 positive results.
The data from the forms are transferred to registration book and then into computer.
Corpse management
1) Notification received via telephone or verbally
2) Record into the record book
3) Patient record is checked in the communicable disease record book
4) Appropriate tools for corpse bathing (cleansing) procedure is prepared like rubber glove, mask and apron.
5) Visit the patients house and identify the person in charge of bathing the corpse.
6) Proper area for bathing the corpse has to designated.Proper disposal of bathing water has to be done that is into the drain or a hole that has been dug.
7) The dead person’s clothes has to be soaked in Clorox for 30 minutes before washed.
8) Explain to the person in charge the correct procedure to bath the corpse and ensure that’s they practice universal precautions.
9) Monitor the bathing procedure at all time
10) The corpse will be wrapped in 3 layers-
- first layer-white cloth
- second layer –plastic
-third layer – white cloth
Purpose is to eradicate microorganism
11)The equipments are soaked in Clorox for 30 minutes before washed and the floor is mopped with Clorox solution.
HARM REDUCTION
Sharing needles while injecting drugs cause 70% of reported HIV infection (2004)
The risk of practicing “unsafe sex” causes 20% of reported HIV infection (2004)
As a response to the 6th. Millennium Development Goal adopted during the Millennium Summit in 2000.
It is the fight against HIV/AIDS that remained to be achieved !
It is about making dangerous behavior less dangerous--It is less dangerous to inject drug with one’s own clean needle as opposed to sharing contaminated needle, and;
About improving Quality of Life--By providing the various supports to IDUs living with HIV/AIDS
And about saving lives--By not being infected or infecting others with HIV
Needle Exchange Program (NEP) is only one of many more harm reduction activities
NEP’s major role is to serve as a driving force towards a wide range of Harm Reduction related activities;
-Information, education and communication on risk reduction
-HIV Testing & counseling…. Condom use !!
-DST services, Half-way house…..
-T.B & STD screening and treatment,
-ARV treatment and;
-Psycho-social and moral care & support.
The Principles;
-First; to help the uninfected IDUs stay that way;
-Second; to help infected IDUs stay healthy, and;
-Third; to help infected IDUs initiate and sustain behaviors that will keep preventing HIV transmission to others.
Tuesday, August 5, 2008
JITRA: Preview of tommorow
We found a 29 year old water pump, went on toilet-hunting adventure, visited a factory....were given a full tour and received RM 250 worth of free stuff..wait for it tommorow...
DAY 6 : JITRA
CDC NOTIFICATION PROCESS
PROCESS OF NOTIFIATION(SUMMARY)
1. Disease is suspected.
2. Notification form by Medical Officers but Telephone notification is done for certain diseases immediately.
3. Completed form will be sent through (hand,post, online and fax)
4. Records are updated.
5. Investigations are done
PIC 1: An icelined cooler for vaccination storage.
- ORGANIZATION CHART
Pegawai kesihatan Daerah 1
Dr Nor Azian Bt AbdulWahab
Pegawai Kesihatan Daerah 2
Dr Azilan Abdullah
Ketua Unit PPKP Kanan
En Hussain B. Yusoff
PPKP Unit CDC
Pn Nor Diana Bt Nanyan
PPKP Unit CDC (HIV/AIDS & TIBI)
En Osman B.Ali
RESPONSIBILITIES OF CDC UNIT
1) Record all the communicable diseases in daily, weekly, monthly, and yearly basis.
2) Prepare reports on daily,weekly, 3 months, 6 months and yearly basis regarding communicable diseases as being instructed from time to time.
3) Conduct immediate investigations for any notified diseases to identify the source of the disease and control its spread.
4) Carry out ‘Disinfection’ and ‘Disinfestation’ procedures.
5) Analyse all the investigated cases besides recommending proper preventive and control measures to District Health Officer.
6) Give vaccination to the affected patients to avoid the spread of the disease.
7) Collect specimens such as blood,stool, vomitus, sputum, food particles and etc. for investigation purposes to detect the disease.
8) Working as a member of Health Team regarding communicable diseases.
9) Prepare and update all the dates, graphs and maps regarding communicable diseases.
10) Analyze all the collected data’s and submit its report to District Health Officer.
11) Identify and detect the patient in order to control the spread of the diseases.
12) File court orders against cases which related to communicable diseases.
13) Conduct epidemiological studies on communicable diseases control and its surveillance control.
14) Educate public regarding preventive and control measures of the communicable disease.
LIST OF NOTIFIABLE COMMUNICABLE DISEASE - Chancroid
- Cholera
- Dengue Fever and Dengue Haemorrhagic Fever
- Diptheria
- Dysentry
- Food Poisoning
- Gonococcal infections
- HIV (all form)
- Leprosy
- Malaria
- Measles
- Plague
- Poliomyelitis
- Rabies
- Relapsing Fever
- Syphilis (all form)
- Tetanus (All form)
- Tuberculosis (all form)
- Typhoid and Paratyphoid Fever
- Typhus and other Rickettsioses
- Viral Encephalitis
- Viral Hepatitis
- Whooping cough
- Yellow Fever.
PROCESS OF NOTIFIATION(SUMMARY)
1. Disease is suspected.
2. Notification form by Medical Officers but Telephone notification is done for certain diseases immediately.
3. Completed form will be sent through (hand,post, online and fax)
4. Records are updated.
5. Investigations are done
PIC 1: An icelined cooler for vaccination storage.
PIC 2: Confusion during the AIMST team visit.
KUALA MUDA, 7.8.08, (FINAL DAY)
Adolescent health (Kesihatan remaja)
According to the definition of WHO (1993), adolescents are categorized under the age group of 10 to 19 years of age.
Objectives
To create awareness among adolescents about the importance of leading a healthy life style.
Prevent bad habits which cause ill health by organizing health promoting activities.
Encourage adolescents for their active involvement in health promoting activities for prevention of bad habit and health promotion purpose.
Guidelines for implementation of adolescent health.
Four categories:
1) Adolescent clinic
2) Standard operating procedure (SOP)
3) Adolescents health screening
4) Guidelines to manage adolescent health
Part I
Adolescent clinic
1.1 Objectives: guidelines for health officers.
1.2 Implemented on year 1998.Revised back on year 2000.
1.3 Definition :
1.3.1 adolescent:10-19 years
1.3.2 adolescent health is under the National adolescent health policy
1.4 clinic concept used in all the clinics
1.4.1 services provided by a health clinic:
1.4.1.1 screening
1.4.1.2 management
1.4.1.3 counseling
1.4.1.4 referrals
1.4.2 optional services
1.4.2.1 physical activity in group
1.4.2.2 family counseling
1.4.2.3 health promotion
1.4.2.4 activity clubs
1.5 -services scope in adolescent clinics
-covers health promotion,prevention,management and referral
The service scopes covers
1.5.1 developmental assessments
1.5.2 diet
1.5.3 mental
1.5.4 sexual and reproductive
1.5.5 high risk attitudes
1.5.6 physical
Part II: SOP (Standard operating procedure)
-Management of adolescent health clinic
Introduction: i) Entry point through JPL
ii)’one stop’ service centers
iii) Daily clinic with centralized counters
Facilities in clinic
Medical registration card 96-pin 1/78
Registration book KKR/Fail KKR
Screening form SKR1 & SKR2
Height and weight scaling machines
BMI charts
Guidelines books
Adolescent health services
SOP book fir medical assistance (part 1 & part 2)
Standard laboratory tools
Checkup rooms and counseling
Human models
Flip charts
Part III
Screening Programmes
3.1-Introduction-To identify attitude or health problems
3.2 SKR forms (screening forms) SKR 1-males, SKR 2 –Females
3.3 implementation of SKR –regular check ups-#times (12, 13 and 17 years)
3.4 methods of health screening-guidelines for male adolescent (m/s 37), female perempuan(m/s 42)
Guidelines for sexual and reproductive system
4.1.1 Amenorrhea
4.1.2 Abdominal pain during menstruation
4.1.3 Abdominal Mass
4.1.4 Menstrual irregularity
4.1.5 Vaginal discharge
Dietary
4.2.1 Underweight problem
4.2.2. Overweight problem
4.2.3 Anemia
Psychological aspect:
4.3.1 Adjustment disorders
4.3.2 Anxiety disorders
4.3.3. Depressive disorders
Attitude problems
4.4.1 Smoking
4.4.2 Gum sniffing
4.4.3 Alcohol
4.4.4 Vandalism
4.4.5 Amphetamine
4.4.6 Acne
4.4.7 Headache
4.4.8 Intentional injury
4.4.9 Non intentional injury
4.4.10 abdominal pain
Part IV
Management of adolescent and flow chart (last page)
Reported by Shanky
According to the definition of WHO (1993), adolescents are categorized under the age group of 10 to 19 years of age.
Objectives
To create awareness among adolescents about the importance of leading a healthy life style.
Prevent bad habits which cause ill health by organizing health promoting activities.
Encourage adolescents for their active involvement in health promoting activities for prevention of bad habit and health promotion purpose.
Guidelines for implementation of adolescent health.
Four categories:
1) Adolescent clinic
2) Standard operating procedure (SOP)
3) Adolescents health screening
4) Guidelines to manage adolescent health
Part I
Adolescent clinic
1.1 Objectives: guidelines for health officers.
1.2 Implemented on year 1998.Revised back on year 2000.
1.3 Definition :
1.3.1 adolescent:10-19 years
1.3.2 adolescent health is under the National adolescent health policy
1.4 clinic concept used in all the clinics
1.4.1 services provided by a health clinic:
1.4.1.1 screening
1.4.1.2 management
1.4.1.3 counseling
1.4.1.4 referrals
1.4.2 optional services
1.4.2.1 physical activity in group
1.4.2.2 family counseling
1.4.2.3 health promotion
1.4.2.4 activity clubs
1.5 -services scope in adolescent clinics
-covers health promotion,prevention,management and referral
The service scopes covers
1.5.1 developmental assessments
1.5.2 diet
1.5.3 mental
1.5.4 sexual and reproductive
1.5.5 high risk attitudes
1.5.6 physical
Part II: SOP (Standard operating procedure)
-Management of adolescent health clinic
Introduction: i) Entry point through JPL
ii)’one stop’ service centers
iii) Daily clinic with centralized counters
Facilities in clinic
Medical registration card 96-pin 1/78
Registration book KKR/Fail KKR
Screening form SKR1 & SKR2
Height and weight scaling machines
BMI charts
Guidelines books
Adolescent health services
SOP book fir medical assistance (part 1 & part 2)
Standard laboratory tools
Checkup rooms and counseling
Human models
Flip charts
Part III
Screening Programmes
3.1-Introduction-To identify attitude or health problems
3.2 SKR forms (screening forms) SKR 1-males, SKR 2 –Females
3.3 implementation of SKR –regular check ups-#times (12, 13 and 17 years)
3.4 methods of health screening-guidelines for male adolescent (m/s 37), female perempuan(m/s 42)
Guidelines for sexual and reproductive system
4.1.1 Amenorrhea
4.1.2 Abdominal pain during menstruation
4.1.3 Abdominal Mass
4.1.4 Menstrual irregularity
4.1.5 Vaginal discharge
Dietary
4.2.1 Underweight problem
4.2.2. Overweight problem
4.2.3 Anemia
Psychological aspect:
4.3.1 Adjustment disorders
4.3.2 Anxiety disorders
4.3.3. Depressive disorders
Attitude problems
4.4.1 Smoking
4.4.2 Gum sniffing
4.4.3 Alcohol
4.4.4 Vandalism
4.4.5 Amphetamine
4.4.6 Acne
4.4.7 Headache
4.4.8 Intentional injury
4.4.9 Non intentional injury
4.4.10 abdominal pain
Part IV
Management of adolescent and flow chart (last page)
Reported by Shanky
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