Hygien and ecology

Krok 2 Hygiene and Ecology Bases 2019 with Highlights and Explanations

The bellow material is aimed to improve the study and under standing of the Krok 2 Hygiene Bases 2019 with the use of highlights for relevant key works, links to relevant study materials, reference images and explanations to individual questions aimed at making remembrance of questions easier and also understanding of new questions for the upcoming Step 2 exam.

** Refer To Krok 2 Lab values Open table in new tab

 

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1. A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2 %, specific density- 1,040 g/cm3, acidity 21oT, reductase probe – weak positive. What way the product is to be used in? What would you advise?

A. *Sell but inform customers about milk quality

B. Write the product off for animal feeding

C. Utilize technically

D. Sell without limitations

E. Annihilate the product

 

Explanation:

  1. Quality criteria of milk (State standard of Ukraine 3662-97)
Criterion Class standards
Extra First Second
Acidity, Terner degree (oT), not more than 16-17 19 20
Grade by ethanol І І ІІ
Bacterial contamination, thousand/cm3, not more than 300 500 3000
Body cells content, thousand/cm3, not more than 400 600 800
Mass part of dry substances, %, not less than 11.8 11.5 10.6
Solid fat-free residue, %, not less than 8 8 8
Relative mass of milk, g/cm3 1.028-1.033 1.028-1.033 1.028-1.033
Fat content, %, not less than 3.2 3.2 2.5

Comment: The soda, borax (used for hiding the high acidity), starch and flour (to hide the removal of fat) presence is determined for detection of the milk falsification.

 

Milk contains the following proximate principles:

  1. Proteins: 3,5% of total weight, consisting of 3 % Caseinogen, 0,4 % Lact albumen, and 0,1% Lacto-globulin. Milk proteins are of high biological value. Cow’s milk is rich in casein, and human milk in Lactalbumi
  2. Carbohydrates: The carbohydrate in all milks is lactose or milk sugar (4 to 5%). Human milk contains more lactose than cow’s milk
  3. Fats:3,5 to 4 % in the form of glycerides in emulsified form. Milk fat is a good source of vitamins A and D When milk is allowed to stand for sometime, fat rises to the surface as cream. Chemically milk fat consists of myristin, olein, palmitin and stearin.
  4. Vitamins: It contains all the vitamins except vitamin E. In summer, cows, if fed on grass, produce milk containing large amount of vitamins B, C and D. But in winter, amount of vitamins A and D in milk is much reduced.
  5. Mineral Salts: Phosphates and chlorides of calcium, potassium and sodium. It is poor in iron.

 

2. Patient with thyrotoxicosis is in the 2-beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature – 20oC, relative humidity 45%, air movement velocity 0,3 m/s, light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the conditions.

A. *Dis-comfortable micro-climate

B. Non-effective ventilation

C. Poor lighting

D. High level of noise

E. All conditions are OK

 

Explanation:

hyperthyroidism symptoms and signs
  • Excessive sweating.
  • Heat intolerance.
  • Increased bowel movements.
  • Tremor (usually fine shaking)
  • Nervousness, agitation, anxiety.
  • Rapid heart rate, palpitations, irregular heart rate.
  • Weight loss.
  • Fatigue, weakness.

Thyreotoxicosis patient need temperatures at about 16 – 18 degrees Celsius.

Area of 1 bed in the ward = 7m2

Ventilation rate is 2,5/h

Air temperature is 18 – 22 c

Relative humidity is 45%

Air movement velocity is 0,07 – 0.3 m/sec

light coefficient is 1:5  – 1:6

noise level constitutes day = 45 db

noise level constitutes night= 35 db

 

3. 33 y.o. woman works as the secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 200 g of carbohydrates. What pathology can develop from this diet?

 

A. *Obesity

B. Schizophrenia

C. Paradontosis

D. Common cold

E. Uterine fibromyoma

 

Explanation:

Protein : Fat : Carbohydrates = 1 : 2 : 4

 

4. A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field

 

A. *Artesian well water

B. Spring water

C. River water

D. Rain water

E. Water from melted snow

 

Exp:

Artesian well water or Well water are the best option considering the population would use this water too.

 

5. A boy, aged 9, is examined: height- cm (-0,36), weight – 28,2 kg (+0,96), chest circumference- 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the integrated assessment of the child’s physical development?

A. *Harmonious

B. Disharmonious

C. Markedly disharmonious

D. Excessive

E. Below the average

 

Exp:

In normal Harmonious growth the difference in sigma deviation should not be more than 1 sigma.

 

6. Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature – 20o , relative humidity – 45%, air movement velocity – 0,3 m/s, light coefficient – 1/5, noise level – 30 dB. Do hygienic evaluation of the conditions meet the standards?

 

A. *Dis-comfortable micro-climate

B. Non-effective ventilation

C. Poor lighting

D. High level of noise

E. All conditions meet the requirements

 

Exp: See 2

Thyreotoxicosis patient need temperatures at about 16 – 18 degrees Celsius.

 

7. A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjunctiva. The patient’s skin is dry, scales off, folliculitis signs of the face skin are present. What is the cause of this disease?

 

A. *Retinole deficit

B. Thiamine deficit

C. Biotin deficit

D. Folic acid deficit

E. Napthtochynones deficit

 

Exp:

Dark adaptation refers to the ability of the visual system, both rod and cone mechanisms, to recover sensitivity after exposure to light.

Bitot’s spotsBitot’s spots are the buildup of keratin located superficially in the conjunctiva of human´s eyes. They can be oval, triangular or irregular in shape. The spots are a sign of vitamin A deficiency and associated with drying of the cornea

(Retinol Deficiency)

Vitamin A deficiency can result from inadequate intake, fat malabsorption, or liver disorders. Deficiency impairs immunity and hematopoiesis and causes rashes and typical ocular effects (eg, xerophthalmia, night blindness).

 

8. A mine-shaft is situated on the territory of homestead land, it is 20 m away from the house, 10 m – from the toilet and m – from the neighbor’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of probable water pollution?

 

A. *30 m

B. 25 m

C. 20 m

D. 15 m

E. 10 m

 

Exp:

If the well is uphill from the source of pollution 20 m

While if the well is downhill from the source of pollution 50 m

 

9. A boy, aged 9, was examined: height -cm (-0,36), weight – 28,2 kg (+0,96), chest circumference – 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the complex assessment of the child’s physical development?

 

A. *Harmonious

B. Disharmonious

C. Apparently disharmonious

D. Excessive

E. Below the average

 

Exp:

In normal Harmonious growth the difference in sigma deviation should not be more than 1 sigma.

 

10. During the medical examination a port crane operator complained of dizziness, nausea, sense of pressure against tympanic membranes, tremor, dyspnoea, cough. He works aloft, the work is connected with emotional stress. Workers are affected by vibration (general and local), noise, ultrasound, micro-climate that warms in summer and cools in winter. What factor are the worker’s complaints connected with?

 

A. *Infra-sound

B. Noise

C. Vibration

D. Intensity of work

E. Altitude work

 

Explanation:

Infra-sound sound waves with frequencies below the lower limit of human audibility

 

11. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density – 1,04 g/cm3, acidity – 210Т, reductase probe – weak-positive. What way is the product to be used in?

 

A. *Sell but inform customers about milk quality

B. Discard for animal feeding

C. Technical utilization

D. Sell without limitations

E. Do the product away

 

Expiation:

Quality criteria of milk (State standard of Ukraine 3662-97)

Criterion Class standards
Extra First Second
Acidity, Terner degree, not more than 16-17 19 20
Grade by ethanol І І ІІ
Bacterial contamination, thousand/cm3, not more than 300 500 3000
Body cells content, thousand/cm3, not more than 400 600 800
Mass part of dry substances, %, not less than 11.8 11.5 10.6
Solid fat-free residue, %, not less than 8 8 8
Relative mass of milk, g/cm3 1.028-1.033 1.028-1.033 1.028-1.033
Fat content, %, not less than 3.2 3.2 2.5
Comment: The soda, borax (used for hiding the high acidity), starch and flour (to hide the removal of fat) presence is determined for detection of the milk falsification.

 

12. An anesthesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 21oc, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?

 

A. *Air pollution with anesthetic

B. Improper occupational microclimate

C. High level of noise

D. Mental overfatigue

E. Compelled working pose

 

Explanation:

Area of 1 bed in the ward = 7m2

Ventilation rate is 2,5/h

Air temperature is 18 – 22 c

Relative humidity is 45%

Air movement velocity is 0,07 – 0.3 m/sec

light coefficient is 1:5  – 1:6

noise level constitutes day = 45 db

noise level constitutes night= 35 db

 

13. A 56 y.o. patient has worked at the aluminium plant over 20 years. Within 3 last years he has got loosening of teeth, bone and joint pains, piercing pains in heart region, vomiting. The provisional diagnosis is:

 

A. *Fluorine intoxication

B. Mercury intoxication

C. Lead intoxication

D. Phosphorus intoxication

E. Manganese intoxication

 

14. The patient 25 y.o. was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?

 

A. *Botulism

B. Yersiniosis

C. Leptospirosis

D. Salmonellosis,

E. Gastrointestinal form Lambliasis

 

15.Medical examination of a man revealed “geographic tongue“. This micro-symptom is the evidence of the following vitamin deficiency:

 

A. *Vitamins of B group

B. Vitamin A

C. Vitamin C

D. Vitamin D

E. Vitamin P P

 

Explanation:

Geographic TongueGeographic tongue (also known as benign migratory glossitis) is an inflammatory disorder that usually appears on the top and sides of the tongue. Typically, affected tongues have a bald, red area of varying sizes that is surrounded, at least in part, by an irregular white border

 

16. The major repair of a hospital included renewal of color design of hospital premises because it is of great psychological and aesthetical importance; and so the walls of patient wards will be painted under consideration of:

 

A. *Windows orientation

B. Hospital profile

C. Diseases of patients who will be staying in these wards

D. Wall reflection coefficient

E. Creation of cozy atmosphere

 

Explanation:

Windows orientation affects the color case of light coming from the window

 

17. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density – 1,04 g/cm3, acidity – 210Т, reductase probe – weak-positive. What way is the product to be used in?

 

A. *Sell but inform customers about milk quality

B. Discard for animal feeding

C. Technical utilization

D. Sell without limitations

E. Do the product away

 

18.  A 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, mydriatic pupils, difficult diglutition, bradycardia, constipation. What is the diagnosis?

 

A. *Botulism

B. Yersiniosis

C. Leptospirosis

D. Salmonellosis, gastrointestinal form

E. Lambliasis

 

19. Study of actual diet of an adult revealed the following: proteins make up 16% of energy value of daily ration, fats – 25%, carbohydrates – 59%. Evaluate compliance of protein, fat and carbohydrate share in the energy value of daily ration with the recommended shares of these nutrients?

 

A. *Carbohydrate share is insufficient, there is excess of proteins

B. Fat share is insufficient

C. Carbohydrate share is insufficicent

D. Carbohydrate share is excessive

E. Nutrient content complies with the recommended shares of energy value

 

Explanation:

Protein : Fat : Carbohydrates = 1 : 2 : 4

 

20. During inspection of sanitary conditions of studying at a technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

 

A. *Natural light coefficient

B. Light coefficient

C. Depth of study room

D. Time of the room insolation

E. Presence of mixed (superolateral) light

 

21. Preventive examination of an 11 year old boy helped to determine his habitus type. It was established that the child’s shoulders were deviated and brought forward, with forward flexion of head, the thorax was flattened, abdomen was convex. The child’s backbone had signs of deepened cervical and lumbar curvatures. What habitus is it?

 

A. *Kyphosis

B. Lordosis

C. Round-shouldered

D. Corrected

E. Normal

 

Explanation: 

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis

 

22. The student has the following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?

A. *Krotov’s apparatus

B. Ebert’s counter

C. Geiger’s counter

D. Mischuk’s device

E. Ebert’s device

 

Explanation:

Geiger counter is an instrument used for detecting and measuring ionizing radiation. Also known as a Geiger–Mueller counter (or Geiger–Müller counter), it is widely used in applications such as radiation dosimetry, radiological protection, experimental physics, and the nuclear industry.

Aspiration method. It  is based on a shock action of an air jet about a surface of a medium. Krotov’s apparatus is used for this purpose. It give us the possibility to let pass 50 –100 L of air with a speed of 25 L per minute through clinoid chink in the special glass above the open dish MPA.

 

23. Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?

 

A. *160-200 l

B. 10-15 l

C. 50-100 l

D. 300-400 l

E. 500 l

 

24. A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

 

A. *Vibration disease

B. Caisson disease

C. Noise disease

D. Overwork symptoms

E. Hypovitaminosis of B1

 

Explanation:

Hand-arm vibration syndrome: A disorder resulting from prolonged exposure to vibration, specifically to the hands and forearms while using vibrating tools. Symptoms include numbness, tingling, and loss of nerve sensitivity. The pain, tingling, and numbness in the arms, wrists and hands may interfere with sleep.

 

25. As a result of prophylactic medical examination a 35 year old woman was diagnosed with alimentary and constitutive obesity of the III degree. It is known from her anamnesis that the patient doesn’t observe rules of rational nutrition: she often overeats, the last food intake is usually 10-15 minutes before going to bed, prefers fattening and rich in carbohydrates food. What is the main alimentary risk factor of obesity development?

 

A. *Energetic unprofitableness of nutrition

B. Excess of carbohydrates

C. Excess of fats

D. Lack of cellulose

E. Violation of dietary pattern

 

26. The amount of ultraviolet radiation dose was measured in minutes. What device was applied for measurement of the biodose?

 

A. *Gorbachev’s biodosimeter

B. UV-meter

C. Actinometer

D. Radiometer

E. Catathermometer

 

27. An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?

 

A. *Tinned food

B. Potatoes

C. Pasteurized milk

D. Boiled meat

E.Cabbage

 

28. It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?

 

A. *Bathroom unit

B. Manipulation room

C. Doctor’s consulting room

D. Patient’s examination room

E. Nursing room

 

29. In order to study impact of micro-climate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:

 

A. Thermograph

B. Alcohol thermometer

C. Mercury thermometer

D. August’s psychrometer

E. *Assmann psychrometer

 

Explanation:

Aspiration psychrometers determine the air temperature and humidity of the ambient air. They consist of two thermometers, each inside a double tube for minimizing radiative heating both by the direct sun and longwave radiation exchange between thermometer and surrounding tube.

Thermograph

  • An instrument that produces a trace or image representing a record of the varying temperature or infrared radiation over an area or during a period of time.
  • Medical instrument that uses an infrared camera to reveal temperature variations on the surface of the body. medical instrument – instrument used in the practice of medicine.
  • thermograph – a thermometer that records temperature variations on a graph as a function of time.

 

30. A plot of land with total area of 2,0 hectare was intended for building of a hospital. The maximal capacity of the hospital will be:

 

A. *100 beds

B. 200 beds

C. 400 beds

D. 800 beds

E. Over 1000 beds

 

31. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m 3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as “pure”?

 

A. *Up to 4500

B. Up to 2500

C. Up to 3500

D. Up to 5500

E. Up to 7500

 

Explanation:

Total visible Count (TVC) is used for detrmination of total microbial contamination.

TVC is the nmber of microbes in 1 ml of water, 1 g of soil or 1m3 air.

Airborne microorganisms Normal level (CFU/m3) Contamination level (CFU/m3)
Mesophilic bacteria Clean air: < 4500 (winter)

Clean air: < 1500 (winter)

Inpure air > 7000 (winter)

Inpure air > 2500 (summer)

Alpha Hemolytic streptococci

Beta Hemolytic streptococci

Clean air: < 36 (winter)

Clean air: < 16 (summer)

Inpure air > 124 (winter)

Inpure air > 36 (summer)

Yeast

Molds

Clean air: < 550 Medium infestation: 550-770

Maximum infestation > 770

Source of values

 

32. A patient who has been consuming refined foodstuffs for a long time complains about headache, fatiguability, depression, insomnia, irritability. Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles, during walking the patient lands onto his heel first, then on the external edge of foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes of myocardium. There are also gastrointestinal disorders. What is the most likely diagnosis?

 

A. *Hypovitaminosis B1

B. Hypovitaminosis B2

C. Hypovitaminosis B12

D. Hypovitaminosis B6

E. Hypovitaminosis B15

 

Explanation:

Vitamins Deficiencies,

(i) Lack of vitamin A results in xerophthalmia, Bitot’s spots, night blindness and keratomalacia.

(ii) B Complex: Deficiency of Thiamine leads to beri beri. Niacin deficiency results in pellagra.

Riboflavin deficiency symptoms are angular stomatitis, cheilosis, scrotal dermatitis and   corneal  vascularisation.

Other   B   Complex eficiencies also result in glossitis, cheilosis and angular stomatitis,

(iii) Vitamin C deficiency leads to scurvy, spongy bleeding gums, haemorrhages in skin and other haemorrhages,

(iv) Vitamin D deficiency result in rickets and osteomalacia.

(v) Vitamin K deficiency leads to hypoprothrombinaemia, which further leads to haemorrhages.

 

Thiamine deficiency
is a medical condition of low levels of thiamine (vitamin B1). A severe and chronic form is known as beriberi. Dry beriberi affects the nervous system resulting in numbness of the hands and feet, confusion, trouble moving the legs, and pain.
Other names: Beriberi, vitamin B1 deficiency, t…
Symptoms: : Wet: Fast heart rate, shortness of …
Causes: Not enough thiamine

 

33. A 44-year-old man has been working in Coke industry for 16 years. Dust concentration at his workplace is 5-10 times higher than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?

 

A. *Anthracosis

B. Anthracosilicosis

C. Silicatosis

D. Asbestosis

E. Siderosis

 

Explanation:

Exposures to respirable coal mine dust should be limited to 1 mg/m3 as a time-weighted average concentration for up to a 10 hour day(MPC is 10 mg/m3) during a 40 hour work week;

Anthracosis (anthrac- meaning coal, carbon + -osis meaning condition) is defined in Bioline as, “the asymptomatic, milder type of pneumoconiosis as caused by the accumulation of carbon in the lungs due to repeated exposure to air pollution or inhalation of smoke or coal dust particles”

 

Nasopharyngitis is commonly known as a cold. Doctors use the term nasopharyngitis specifically to refer to swelling of the nasal passages and the back of the throat. Your doctor may also refer to this as an upper respiratory infection or rhinitis. A virus or bacteria can cause nasopharyngitis.

 

Byssinosis is a lung disease caused by prolonged inhalation of textile fibre dust. It is an occupational lung disease that primarily affects workers in cotton processing, hemp or flax industries. Other names for byssinosis include Monday fever, brown lung disease, mill fever or cotton workers’ lung

 

Siderosis is the deposition of excess iron in body tissue. When used without qualification, it usually refers to an environmental disease of the lung, also known more specifically as pulmonary siderosis or Welder’s disease, which is a form of pneumoconiosis.

 

Pulmonary talcosis is a pulmonary disorder caused by talc. It has been related to silicosis resulting from inhalation of talc and silicates. It is also tied to heroin use where talc might be used as an adulterant to increase weight and street value.

 

34. Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a metallic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:

A. *Mercury

B. Lead

C. Manganese

D. Toluol

E. Tetraethyl lead

 

Explanation:

Mercury is used in the production of thermometers

Symptoms

Mercury may affect the nervous system, leading to neurological symptoms such as:

  • nervousness or anxiety
  • irritability or mood changes
  • numbness
  • memory problems
  • depression
  • physical tremors

As the levels of mercury in the body rise, more symptoms will appear. These symptoms may vary depending on a person’s age and exposure levels. Adults with mercury poisoning may experience symptoms such as:

  • muscle weakness
  • metallic taste in the mouth
  • nausea and vomiting
  • lack of motor skills or feeling uncoordinated
  • inability to feel in the hands, face, or other areas
  • changes in vision, hearing, or speech
  • difficulty breathing
  • difficulty walking or standing straight

 

35. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m 3 of air was 7200. What is the permissible number of microorganisms for the air to be characterized as “pure”?

 

A. *Up to 4500

B. Up to 2500

C. Up to 3500

D. Up to 5500

E. Up to 7500

 

Explanation:

See Question 31

 

36.A patient who has been consuming refined foodstuffs for a long time complains about headache, fatiguability, depression, insomnia, irritability. Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles, during walking the patient lands onto his heel first, then on the external edge of foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes of myocardium. There are also gastrointestinal disorders. What is the most likely diagnosis?

 

A. *Hypovitaminosis B1

B. Hypovitaminosis B2

C. Hypovitaminosis B12

D. Hypovitaminosis B6

E. Hypovitaminosis B15

 

Explanation:

See Question 32

 

37.A 44-year-old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times higher than maximum permissi-ble concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?

 

A. *Anthracosis

B. Anthracosilicosis

C. Silicatosis

D. Asbestosis

E. Siderosis

 

Explanation:

See Question 33

 

38. A driver had been fixing a car in a closed garage and afterwards complained about headache, dizziness, nausea, muscle asthenia, sleepiness. Objectively: pulse and respiratory rate elevation, excitement, hypertension, delirium of persecution. What is the most likely diagnosis?

 

A. *Intoxication with carbon oxide

B. Intoxication with ethyl gasoline

C. Posttraumatic encephalopathy

D. Hypertensive crisis

E. Asthenovegetative syndrome

 

Explanation:

Signs and symptoms of carbon monoxide poisoning may include:

  • Dull headache
  • Weakness
  • Dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Confusion
  • Blurred vision
  • Loss of consciousness

 

39. The total area of a ward at the therapeutical department is 28 m2. What is the maximum number of beds that can be exploited in this ward?

A. *4

B. 1

C. 2

D. 3

E. 5

 

Explanation:

Area for one bed in a ward is 7m2

 

40. A heat station working on solid fuel is located in a residential district. On cloudy foggy days in December there was an increase in diseases with upper airway affection and signs of general intoxication. There were also mortal cases among the elderly people. What is the most likely factor that provoked toxic effect?

 

A. *Suspended materials

B. High air humidity

C. Calm

D. Low air temperature

E. Temperature gradient

 

41. Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a metallic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:

 

A. *Mercury

B. Lead

C. Manganese

D. Toluol

E. Tetraethyl lead

 

42. Examination of a 13-year-old boy reveals that his body length is 147 сm (+2), body weight – 38 kg (+1,5), circumference of chest – 72 cm (+0,2). Estimate the harmonicity of the child’s physical development:

 

A. *Disharmonious

B. Harmonious

C. Above the average

D. Sharply disharmonious

E. Supernormal

 

Examination:

In normal Harmonious growth the difference in sigma deviation should not be more than 1 sigma.

Note: The difference in sigma deviation between chest and other params is > +-1 thus Disharmonious.

 

43. Working conditions of a building company worker are characterized by cooling micro-climate effect, silica-containing dust, caustic alkali (quicklime) and noise. What medical expert should be the chief of the commission that periodically examines the workers of the mentioned category?

 

A. *Therapeutist

B. Ophthalmologist

C. Neurologist

D. Dermatologist

E. Otolaryngologist

 

44. After treating a field with pesticides a machine operator presents with great weakness, headache, nausea, vomiting, diarrhea, visual impairment, watery eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle fibrillation of tongue and eyelids are observed. Pupils are narrowed, there is tachycardia, lung auscultation reveals moist small and medium bubbling rales. In blood: changed level of cholinesterase activity. What is the most likely diagnosis?

 

A. *Intoxication with organophosphorous pesticides

B. Intoxication with organochlorine pesticides

C. Intoxication with organomercurial pesticides

D. Intoxication with arsenic-containing pesticides

E. Intoxication with carbamic acid derivatives

 

Explanation:

The effects of organophosphate poisoning on muscarinic receptors are recalled using the mnemonic SLUDGEM (salivation, lacrimation, urination, defecation, gastrointestinal motility, emesis, miosis) An additional mnemonic is MUDDLES: miosis, urination, diarrhea, diaphoresis, lacrimation, excitation, and salivation.

Hyperhidrosis (hi-pur-hi-DROE-sis) is abnormally excessive sweating that’s not necessarily related to heat or exercise. You may sweat so much that it soaks through your clothes or drips off your hands. Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment.

Early manifestations of poisoning by some organochlorine pesticides, particularly DDT, are often sensory disturbances: hyperesthesia and paresthesias of the face and extremities. Headache, dizziness, nausea, vomiting, incoordination, tremor and mental confusion are also reported.

organomercurial: an organic compound or a pharmaceutical preparation containing mercury.

Arsenic, a toxic element, is widely distributed in the environment. Accumulated evidence shows that long-term exposure to arsenic is associated with cancers of the skin, lung, bladder, liver and kidney. … Arsenicbased pesticides are the best examples of agricultural applications of arsenic.

 

45. Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of hygienic norms?

 

A. *Indirect light fittings

B. Direct light fittings

C. Semi-reflected light fittings

D. Ambient light fittings

E. Combined light fittings

 

46. A student analyzes noise level of cold-pressing process. What device should be applied for this hygienic study?

 

A. *Noise and vibration analyzer

B. Noise analyzer

C. Sound tester

D. Actinometer

E. Pyranometer

 

47. Environmental pollution is prevented by mechanical separation of nontoxic solid domestic waste. Specify the method which can be used for mechanical utilization of these wastes:

 

A. *Compressing of wastes into building blocks

B. Hydrolysis

C. Burning as power-plant fuel

D. Burial of wastes

E. Waste neutralization in biothermal boxes

 

48. It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate the level of daylight illumination?

 

A. *Illuminometer

B. Anemometer

C. Katathermometer

D. Actinometer

E. Psychrometer

 

Explanation:

Illuminometer: a photometer for measuring illumination usually by the brightness of an illuminated surface.

Anemometer: an instrument for measuring the speed of the wind, or of any current of gas.

Katathermometer: (plural kata thermometers) (measuring instrument) A device consisting principally of an alcohol thermometer, used to measure air cooling power and, indirectly, small wind speeds in circulating air, by measuring the time taken for the temperature of the bulb of alcohol to make a specified drop (100° to 95°F).

Actinometer: an instrument for measuring the intensity of radiation, especially ultraviolet radiation.

Psychrometer: a hygrometer consisting of wet-bulb and dry-bulb thermometers, the difference in the two thermometer readings being used to determine atmospheric humidity.

 

49. While assessing the health status of graduates of a secondary school, the doctor found one of them to have grade 3 tonsillar hypertrophy, chronic rhinitis and vegetative-vascular dystonia. The organism functionality is reduced. This student belongs to the following health group:

A. *III

B. II

C. I

D. IV

E. V

 

Examination:

Assessment of health state is the most important role of a physician, who works with children and adolescents. It’s main importance lies in the fact, that the formation of physical and psychological human health, organism’s resistance to influence of unfavorable environmental factors and social conditions takes place in childhood.

The following criteria of complex assessment of the children and adolescents health state are used nowadays in everyday practice of sanitary doctors, doctors of general education establishments, pediatricians, general practitioners and family doctors:

     Presence or absence of chronic diseases during examination;

     Functional state of main systems of organism;

     Level of organism resistance to unfavorable influence of environmental factors;

     Current level of nervous and psychological, and physical development, its harmonicity.

According to listed above criteria, allocation scheme of children and adolescents by health groups was elaborated. There are health groups:

First health group includes healthy children and adolescents with harmonious development and development level of organism functional systems corresponding to the age.

Second health group includes healthy children and adolescents who have functional and some morphological deviations, low resistance to acute and chronic diseases, they are ill frequently during long period of time.

Third health group includes children and adolescents suffering from chronic diseases in compensation stage, with normal functional resources of organism.

Fourth health group includes children and adolescents suffering from chronic diseases in sub-compensation stage with lowered functional resources of organism.

Fifth health group includes children and adolescents suffering from chronic diseases in decompensation stage with significantly lowered functional resources of organism.

 

50. A military unit stopped for 3-day’s rest in an inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field conditions:

 

A. *Artesian well water

B. Spring water

C. River water

D. Rain water

E. Melt snow water

 

Explanation:

See question 4

 

51.  At the radiological unit of a hospital gamma-devices of radiotherapy of “Agat” type and other closed sources of ionizing radiation are used for treatment of malignant neoplasms. What measures are to be taken to protect personnel during working with radioactive sources of such type?

 

A. *Reduction of working time and screening of the source

B. Capsulation of devices and organization of room ventilation

C. Screening of the source and the use of means of individual protection of respiration organs

D. The increase of distance to the source and individual hygiene compliance

E. Systematical cleansing of surfaces from the radioactive contamination and shortening of working time

 

52. A 36-year-old female patient complains of bruises on the body, gingival hemorrhage, general weakness. A month ago she had a severe domestic poisoning with some pesticide (the patient can not remember the name). She has a 7-year record of working in contact with petroleum products, particularly benzene. In blood: RBCs – 3, 2 · 1012/l, WBC’ – 2, 7 · 109/l, thrombocytes – 70 · 109/l. What is the most likely pathology

 

A. *Benzene intoxication

B. Organophosphorus pesticide intoxication

C. Organochlorine pesticide Intoxication

D. Mercury-containing pesticide intoxi-cation

E. Chronic fatigue Syndrome

 

Explanation:

Immediate signs and symptoms of exposure to benzene

  • People who breathe in high levels of benzene may develop the following signs and symptoms within minutes to several hours:
    • Drowsiness
    • Dizziness
    • Rapid or irregular heartbeat
    • Headaches
    • Tremors
    • Confusion
    • Unconsciousness
    • Death (at very high levels)
  • Eating foods or drinking beverages containing high levels of benzene can cause the following symptoms within minutes to several hours:
    • Vomiting
    • Irritation of the stomach
    • Dizziness
    • Sleepiness
    • Convulsions
    • Rapid or irregular heartbeat
    • Death (at very high levels)

 

53. Among the inhabitants of a workmen’s settlement located near an industrial plant the cases of nervous and endocrine system diseases as well as renal diseases became more frequent. Blood analyses revealed a decrease in sulfhydryl groups. These pathologies might have been caused by the following substance released into the environment:

 

A. *Mercury

B. Cadmium

C. Boron

D. Chromium

E. Lead

 

54. It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate the level of daylight illumination?

 

A. *Illuminometer

B. Anemometer

C. Katathermometer

D. Actinometer

E. Psychrometer

 

Explanation:

See 48

 

55. During the medical examination at school the schoolchildren had to undergo plantography. After the analysis of footprints platypodia was found in 30% of pupils. What is the percentage of the flatfoot isthmus?

A. *65%

B. 30%

C. 50%

D. 55%

E. 45%

 

Explanation:

Platypodia. It is one of the most frequent foot deformations in infants. The term platypodia denotes deformity of all foot’s arches. Flattening of the longitudinal foot arch is known as longitudinal platypodia, while flattening of the transverse arch is called transverse platypodia.

 

56. Production areas of a greenhouse complex have the following micro-climate parameters: air temperature – 42oC , humidity – 98%, air velocity – 0,05 mps, temperature of enclosing surfaces – 15oC . Characterize the micro-climate of production areas:

 

A. *Overheated

B. Comfortable

C. Cooling

D. Uncomfortable

E. Satisfactory

 

57. Sanitary-veterinary examination of a cow carcass revealed measles contamination (2-3 measles per 10 cm2). What tactics should be chosen in respect of this meat consumption?

 

A. *The whole carcass should be technically disposed

B. Meat can be sold without any restricti-ons

C. The carcass should be used for the production of canned meat

D. Meat should be disinfected by boiling

E. Meat should be disinfected by freezing

 

58. During coal extraction in a mine the concentration of coal dust in the working area is 450 mg/m3 (MPC is 10 mg/m3). What occupational respiratory disease may develop in miners?

 

A. *Anthracosis

B. Allergic nasopharyngitis

C. Byssinosis

D. Siderosis

E. Talcosis

 

Explanation:

See Question 33

 

59. During a regular medical examination at a metallurgical plant 20% of workers were found overweight (body weight was 5-14% higher than normal), and had early signs of obesity (grade I-II) with Quetelet index from 26 to 30. What products share must be reduced in the diet of this group of people in the first place in order to normalize their body weight?

 

A. *Bakery products

B. Vegetables

C. Fruit

D. Milk and dairy products

E. Meat and fish products

 

60. In an urban settlement situated on the riverbank an outbreak of hepatitis A was registered. The disease might have water origin. This assumption can be confirmed by growth of the following indicators of water quality:

 

A. *Number of coli-phages

B. Escherichia coli index

C. Oxidability

D. Presence of benign leptospirosis pathogen

E. Index of fecal coli-forms

 

61. A patient complains of frequent, bulky, frothy stools with greenish mucus, cramping pain in the umbilical region, abdominal murmur, body temperature at the rate of 39oC . The patient associates the disease with consumption of soft-boiled eggs. What is the most likely pathogen?

 

A. *Salmonella

B. Yersinia

C. Shigella

D. Enteropathogenic E.Coli

E. Vibrio cholerae El Tor

 

62. A city somatic hospital with 300 beds consists of the main building whi-ch houses the therapeutic and surgical departments. Several separate buildings house the maternity, pediatric and radi-ologic departments that are connected to the main building by underground walkways and above-ground covered skybridges. Specify the building system of the hospital:

 

A. *Central-unit

B. Centralized

C. Decentralized

D. Free

E. Combined

 

63. Sanitary examination of the burns unit for adults revealed that 4-bed wards had an area of 28 m2. What is the minimally required ward area for this department?

 

A. *40 m2

B. 24 m2

C. 28 m2

D. 30 m2

E. 52 m2

 

Explanation:

7m3 for wards

10m3 in burns unit

 

64. In order to reduce weed growth on agricultural land, some herbicides have been used for a long time. In terms of environmental stability these herbicides are rated as stable. Specify the most likely route of their entry into the human body:

 

A. *Soil-plants-humans

B. Soil-microorganisms-humans

C. Soil-animals-humans

D. Soil-protozoa-humans

E. Soil-insects-humans

 

65.6 people live in a modern flat with the total area of 60 m2. There are TV-video equipment, radios, microwave ovens, computer. The residents of the flat complain of bad health, occasional headaches, arrhythmia, conjunctivitis. What is the most likely cause of this condition?

 

A. *Electromagnetic fields

B. Anthropotoxins

C. Carbon dioxide

D. Tetrachlor plumbum

E. Formaldehyde

 

66. A 45-year-old patient complains of fever up to 40oC , general weakness, headache and spasmodic contraction of muscles in the region of a shinwound. The patient got injured five days ago when tilling soil and didn’t seek medical attention. What kind of wound infection can be suspected?

 

A. *Tetanus

B. Anthrax

C. Erysipelas

D. Gram-positive

E. Gram-negative

 

67. Survey radiograph of a 52-year-old worker of an agglomeration plant (28 years of experience, the concentration of metal dust is 22-37 mg/m3) shows mildly pronounced interstitial fibrosis with diffused contrast well-defined small nodular shadows. The patient has no complaints. Pulmonary function is not compromised. What is the provisional diagnosis?

A. *Siderosis

B. Silicosis

C. Anthraco-silicatosis

D. Silicatosis

E. Anthracosis

 

Explanation:

See Question 33

Siderosis is the deposition of excess iron in body tissue. When used without qualification, it usually refers to an environmental disease of the lung, also known more specifically as pulmonary siderosis or Welder’s disease, which is a form of pneumoconiosis.

The average total dust concentration (50 % value) varies in the region of 2.5 mg/m3, the 90 % value is about 16 mg/m3.

Siderosis Symptoms
  • Sensorineural hearing loss– This is the most common symptom associated with superficial siderosis and its absence is rare.
  • Ataxia- The impairment of gait, which is the second most common symptom.
  • Pyramidal signs- Various signs that indicate a condition of the pyramidal tracts.

 

68. Study of natural illumination for a workplace in a secondary school classroom revealed that the angle of sunlight incidence was 25o, window opening angle – 3o , window-to-floor area ratio – 1:4, daylight ratio – 0,5%, depth ratio – 2. What indicators do not meet hygienic standards?

 

A. *Daylight ratio

B. Window opening angle

C. Window-to-floor area ratio

D. Depth ratio

E. Angle of incidence

 

69. Bakers at bread production work in conditions of high temperature and high heat radiation. What is used to increase the body’s resistance to the unfavorable effects of these harmful work environment factors?

 

A. *Vitamin preparations

B. Milk

C. Pectin

D. Therapeutic and preventive diet № 1

E. Therapeutic and preventive diet number № 3

 

70. A 51-year-old female is a weaving factory worker with 15 years of service record. During a regular preventive examination she complained of frequent headaches, poor sleep, tingling in the heart, irritability, rapid fatigability, hearing impairment. For years, the noise level has exceeded the maximum allowable concentration by 10-15 dB. A year ago, the patient underwent a course of treatment for essential hypertension. Specify the most likely diagnosis:

 

A. *Noise disease

B. Essential hypertension

C. Neurasthenia

D. Asthenic-vegetative syndrome

E. Arteriosclerotic encephalopathy

 

71. Some of the population of a city district have uneven teeth color. The individuals have white spots, transverse brown stripes on the incisors. Occurrence of these symptoms is associated with the quality of drinking water from a deep well. Which of the following components of water can be the cause of the disease?

 

A. *F

B. Ca

C. Mg

D. J

E. Fe

 

72. A city somatic hospital with 300 beds has a main building which houses the therapeutic and surgical departments. Several separate buildings house the maternity, pediatric and radiologic departments that are connected to the main building by underground walkways and above-ground covered skybridges. Specify the building system of the hospital:

 

A. *Central-unit

B. Centralized

C. Decentralized

D. Free

E. Combined

 

73. Carpathian region is characterized by permanently high (over 80%) air humidity. In the cold season the population of this region feels very cold at moderately low temperatures. This is due to an increase in the heat transfer by:

 

A. *Convection

B. Emission

C. Evaporation

D. Conduction

E. Radiation

 

Convection is the transfer of heat by the movement of a fluid (liquid or gas) between areas of different temperature. Warm air is less dense than cold air, and so convection currents can form in the presence of a temperature gradient.

An emission is something that’s been released or emitted into the world. Car exhaust, burps, and radio broadcasts are all examples of emissions. Technically, an emission is anything that’s been released out into the open.

Evaporation is the process by which water changes from a liquid to a gas or vapor. Evaporation is the primary pathway that water moves from the liquid state back into the water cycle as atmospheric water vapor.

Conduction occurs when two object at different temperatures are in contact with each other. Heat flows from the warmer to the cooler object until they are both at the same temperature. Conduction is the movement of heat through a substance by the collision of molecules.

 

 

74.A 12-year-old girls has minor functional and morphological abnormalities: 1,0 D myopia, reduced body resistance. The patient has no history of chronic diseases. Over the last year, there were 4 cases of respiratory diseases. The girl belongs to the following health group:

 

A. *II

B. I

C. III

D. IV

E. V

 

Explanation:

See 49

 

75. Evaluation results of sanitary and hygiene conditions in a 4-bed ward were as follows: ward area – 30 m2, height – 3,2 m, temperature – 20oC , humidity – 55%, air velocity – 0,1 m/s, window-to-floor area ratio – 1:5, daylight ratio – 0,6%, concentration of carbon dioxide in the air – 0,1%. Which of the given indicators does not meet hygienic requirements?

 

A. *Daylight ratio

B. Air velocity

C. Window-to-floor area ratio

D. Concentration of carbon dioxide in the air

E. Ward area

 

76. Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as a permissible maximum?

 

A. *0,1%

B. 0,05%

C. 0,15%

D. 0,2%

E. 0,3%

 

Explanation:

Normal levels of coin air is 0.07 to 0.1% for wards, classrooms, etc.

 

77. An 8-year-old boy during preventive examination was determined to have changes in his spine curvature in frontal plane: the right shoulder is lowered and flat, scapulae angles are of different height due to the right scapula being shifted down. Waist triangles are pronounced on the both sides; longitudinal muscles of the back form muscle cushion on the left. What type of posture is detected in the child?

 

A. *Scoliotic

B. Kyphotic

C. Lordotic

D. Stooping

E. Corrected

 

78. When examining the parameters of desk natural lighting in a school class it was determi-ned that: light angle is 25o , window angle is 3o , window-to-floor area ratio is 1:4, daylight factor is 0,5%, and window-head-to-room-depth ratio is 2. What parameter does not correspond to hygienic norms?

 

A. *Daylight factor

B. Window angle

C. Window-to-floor area ratio

D. Window-head-to-room-depth ratio

E. Light angle

 

79. Caries morbidity rate is 89% among resi-dents of a community. It is determined that fluorine content in water is 0,1 mg/l. What preventive measures should be taken?

 

A. *Water fluorination

B. Tooth brushing

C. Fluorine inhalations

D. Sealant application

E. Introduce more vegetables to the diet

 

Explanation:

Normal fluorine content in water should be 1 mg/L

 

80. In river-side urban community there was an outbreak of hepatitis type A possibly spread by water. What indexes of river water quality can confirm this theory?

 

A. *Coliphage number

B. Colibacillus index

C. Oxidability

D. Non-icteric leptospirosis agent

E. Fecal coliform bacteria index

 

81. For a long time to eradicate weeds on agricultural lands herbicides retaining in envi-ronment have been used. Point out the most probable way of herbicides reaching human organism from soil:

 

A. *Soil-plants-human

B. Soil-microorganisms-human

C. Soil-animals-human

D. Soil-protozoa-human

E. Soil-insects-human

 

82.Residents of an industrial community situated near a plant suffer from increased morbidity rate caused by nervous and endocrine system conditions and kidney diseases. Blood test: decrease of sulfhydric groups content in blood. The pathologies developed can be caused by environment being polluted by the following:

 

A. *Mercury

B. Cadmium

C. Boron

D. Chromium

E. Lead

 

Explanation:

Sulfhydryl groups are powerful blood antioxidants. In plasma they are mainly present on proteins and in red blood cells (RBC) mainly present as glutathione.

 

83. A tractor driver with the record of service of 24 years has undergone palestesiometry test (Vibration Sensitivity Measurement). Test revealed increased vibration sensitivity threshold at the frequencies of 63-125-259 Hz to 25 dB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold stimulus test is positive, time of hand temperature restoration is 52 minutes. Blanching at pressure symptom is positive and equals 21. Hypesthesia of upper and lower limbs is observed and can be classified as “gloves”and “socks”polyneuritic pattern. Make the provisional diagnosis.

A. *Vibration disease, I stage, caused by combined vibration

B. Vibration disease, I stage, caused by local vibration

C. Vibration disease, II stage, caused by combi-ned vibration

D. Vibration disease, II stage, caused by local vibration

E. Vibration disease, I stage, caused by general vibration

 

84. Survey radiograph of a 52-year-old worker of an agglomeration plant (28 years of experience, the concentration of metal dust is 22-37 mg/m3) shows mildly pronounced interstitial fi-brosis with diffused contrast well-defined small nodular shadows. The patient has no complaints. Pulmonary function is not compromised. What is the provisional diagnosis?

 

A. *Siderosis

B. Silicosis

C. Anthraco-silicatosis

D. Silicatosis

E. Anthracosis

 

Explanation:

See Question 33 & 67

 

85. A 60-year-old man has a diet consisting of unvaried food staples: mostly cereals, potato, pasta; few vegetables and little fats (especially animal fats). During medical examination he complains of deterioration of his twilight vision. This condition can be caused by lack of:

 

A. *Retinol

B. Amino acids

C. Fats

D. Calcium

E. Carbohydrates

 

86. Clinic of a research institute for occupational diseases examined a worker who works at a concentration plant and diagnosed him with chronic dust bronchitis. The case is investigated by a commission including the representatives of: the plant, clinic, local SES, department of Social Insurance Fund, trade union. According to the ”regulation on investigation of” , the commission should be headed by the representative of the following authority:

 

A. *Local SES

B. Plant

C. Social Insurance Fund

D. Trade union

E. Clinic

 

87.Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1 m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as ”pure”?

 

A. *Up to 4500

B. Up to 2500

C. Up to 3500

D. Up to 5500

E. Up to 7500

 

Explanation:

See Question 31

 

88. Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0,1 mg/l. What preventive measures should be taken?

 

A. *Water fluorination

B. Tooth brushing

C. Fluorine inhalations

D. Sealant application

E. Introduce more vegetables to the diet

 

89. Examination of a group of persons living on the same territory revealed the following common symptoms: dark-yellow pigmentation of the tooth enamel, diffuse osteoporosis of bone apparatus, ossification of ligaments and joints, functional disorders of the central nervous system. This condition may be caused by the excessive concentration of the following microelement in food or drinking water:

 

A. *Fluorine

B. Copper

C. Nickel

D. Iodine

E. Cesium

 

Explanation:

Fluorine Toxicity

Excess fluorine can accumulate in teeth and bones, causing fluorosis. Drinking water containing > 10 ppm is a common cause. Permanent teeth that develop during high fluoride intake are most likely to be affected. Exposure must be much greater to affect deciduous teeth.

Excess exposure to fluoride can lead to a bone disease known as skeletal fluorosis. Over many years, this can result in pain and damage to bones and joints. The bones may become hardened and less elastic, increasing the risk of fractures

 

90. In a pre-school educational establishment the menu consists of the following dishes: milk porridge from buckwheat, pasta with minced meat, cucumber salad, kissel (thin berry jelly), rye bread. What dish should be excluded from the menu?

 

A. *Pasta with minced meat

B. Milk porridge from buckwheat

C. Kissel (thin berry jelly)

D. Rye bread

E. Cucumber salad

 

91. During meat testing Trichinella was detected in diaphragm crura in one of the two muscular tissue samples. What tactics should a doctor choose regarding this meat?

 

A. *Technolgical disposal

B. Incineration

C. Boiling under 1,5 atmosphere

D. Preservation in 10% salt solution

E. Freezing under -12oC

 

92. After a lengthy march an army regiment has set camp for 3 days near a settlement. Sanitary-hygienic investigation detected several water sources. Choose the source that would satisfy the demands for potable water the most under the given field conditions:

 

A. *Artesian well

B. Brook

C. River

D. Rain water

E. Melt water

 

93. A planner designs a heating system for a pre-school educational establishment. The highest air temperature should be in the following room:

 

A. *Game room of a nursery group

B. Common room of a preschool group

C. Bedroom of a nursery group

D. Bedroom of a preschool group

E. Gymnasium

 

94. An emergency situation at a chemical plant caused acute occupational intoxication. A doctor who revealed the case of ”acute occupational disease (intoxication)” must notify the following authority:

 

A. *Sanitary and epidemiological station

B. Plant administration

C. Trade union committee of the plant

D. Medical unit of the plant

E. Ministry of Public Health of Ukraine

 

95. The process of open-cut mining requires drilling and blasting operations, rock and ore excavation, transportation of ore to fragmentation and sorting factories and transportation of barren rock to slag-heaps, road building and maintenance, repair works. What factor of production is most important for miner’s health?

 

A. *High content of dust in the air

B. High content of explosion gas

C. Vibration

D. Noise

E. Adverse microclimate

 

96. Survey radiograph of a 52-year-old worker of an agglomeration plant (28 years of experience, the concentration of metal dust is 22-37 mg/m3 ) shows mildly pronounced interstitial fibrosis with diffused contrast well-defined small nodular shadows. The patient has no complaints. Pulmonary function is not compromised. What is the provisional diagnosis?

 

A. *Siderosis

B. Silicosis

C. Anthraco-silicatosis

D. Silicatosis

E. Anthracosis

 

Explanation:

See Question 33 & 67

 

97. During medical examination of a group of children less than 4 years carried out by a pediatric team in one of the African countries a set of similar pathological signs was detected in some of the children. The signs are as follows: growth inhibition, mental changes, muscle atrophy, swellings and changes in hair and skin pigmentation. These children were diagnosed with kwashiorkor. What food products should be added to the diet to treat this disorder?

 

A. *Fish, vegetables, cereals

B. Milk, meat, vegetables

C. Vegetables, fruit

D. Cereals, fruit, berries

E. Poultry, fruit, berries

 

Explanation:

Bananas, fruit juice, meat, eggs, vegetables, and cereals are gradually added to give a diet throughout most of the recovery period containing 5 to 7 g of protein and 130 to 150 cal.

 

98. What juice is recommended to be included in a complex drug and diet therapy for patients suffering from gastric or duodenal ulcer and high acidity of gastric juice to speed up ulcer healing?

 

A. *Potato, potato-carrot

B. Apple, apple-birch

C. Pumpkin

D. Cabbage, cabbage-carrot

E. Celery, parsley

 

99. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1 m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as “pure”?

A. *Up to 4500

B. Up to 2500

C. Up to 3500

D. Up to 5500

E. Up to 7500

 

Explanation:

See Question 31

 

100. When examining the parameters of desk natural lighting in a school class it was determined that: light angle is 25o, window angle is 3o, window-to floor area ratio is 1:4, daylight factor is 0,5%, and window-head-to-room-depth ratio is 2. What parameter does not correspond to hygienic norms?

 

A. *Daylight factor

B. Window angle

C. Window-to-floor area ratio

D. Window-head-to-room-depth ratio

E. Light angle

 

101. A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an in- patient hospital unit. He was diagnosed with progressing somatoform autonomic dysfunction. This disease relates to the following group of ionizing radiation effects:

 

A. *Somato-stochastic

B. Somatic

C. Genetic

D. Hormesis

E. Heterosis

 

Explanation:

Somatic stochastic effects. These are late effects which occur at random with no dose threshold. All stochastic effects are late but not all late effects are stochastic. The probability of their occurrence increases with increase in the absorbed dose but not their severity.

Vegetative symptoms are disturbances of a person’s functions necessary to maintain life (vegetative functions). Vegetative symptoms in a patient with typical depression include: Weight loss and anorexia (loss of appetite) Insomnia. Fatigue and low energy.

 

BIOLOGIC EFFECTS OF IONIZING RADIATION

Determined

  1. Somatic
    •  acute radiation disease
    •  chronic radiation disease
    •  radiation combustion
    •  alopecia – ray cataract
    •  clinical registered disorders of hemopoiesis
    •  temporary or constant sterility
  2. Stochastic
    Somato-stochastic Genetic
    • cancerogenic effect
    • teratogenic effect
    • genetic mutation
    • chromosomal aberration

 

 

102. Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0,1 mg/l. What preventive measures should be taken?

 

A. *Water fluorination

B. Tooth brushing

C. Fluorine inhalations

D. Sealant application

E. Introduce more vegetables to the diet

 

103. Establishments participating in medical examinations include: medical and preventive treatment facility, hygiene and preventive treatment facility, sociomedical expert committees, Ministry of Defence medical committees, Ministry of Domestic Affairs medical committees, forensic medicine agency, etc. Specify what service deals with sociomedica assessment of temporary disability:

 

A. *Medical and preventive treatment facility

B. Hygiene and preventive treatment facility

C. Sociomedical expert committees

D. Ministry of Defence medical committees

E. Ministry of Domestic Affairs medical committees

 

104. For a long time to eradicate weeds on agricultural lands herbicides retaining in environment have been used. Point out the most probable way of herbicides reaching human organism from soil:

 

A. *Soil-plants-human

B. Soil-microorganisms-human

C. Soil-animals-human

D. Soil-protozoa-human

E. Soil-insects-human

 

105. Residents of an industrial community situated near a plant suffer from increased morbidity rate caused by nervous and endocrine system conditions and kidney diseases.Blood test: decrease of sulfhydric groups content in blood. The pathologies developed can be caused by environment being polluted by the following:

 

A. *Mercury

B. Cadmium

C. Boron

D. Chromium

E. Lead

 

Explanation:

See 82

 

106. A tractor driver with the record of service of 24 years has undergone palestesiometry test (Vibration Sensitivity Measurement).Test revealed increased vibration sensitivity threshold at the frequencies of 63-125-259 Hz to 25 DB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold stimulus test is positive, time of hand temeperature restoration is 52 minutes. Blanching at pressure symptom is positive and equals 21. Hypersthesia of upper and lower limbs is observed and can be classified as “gloves” and “socks” polyneuritic pattern. Make the provisional diagnosis.

A. *Vibration disease, I stage, caused by combined vibration

B. Vibration disease, I stage, caused by local vibration

C. Vibration disease, II stage, caused by combined vibration

D. Vibration disease, II stage, caused by local vibration

E. Vibration disease, I stage, caused by general vibration

 

107.  ?During regular check-up the doctor examines a young woman, a student, with height of 162 cm and weight of 59 kg. She complains that in the evening she becomes unable to see clearly the objects around her. Objectively her skin is dry, presents with hyperkeratosis. Her daily ration has the following vitamin content: vitamin A – 0.5 mg, vitamin B1 – 2.0 mg, vitamin B2 – 2.5 mg, vitamin B6 – 2 mg, vitamin C – 70 mg. Make the diagnosis:

 

A. B2 – hypovitaminosis

B. B6 – hypovitaminosis

C. C – hypovitaminosis

D. *A – hypovitaminosis

E. B1 – hypovitaminosis

 

Explanation:

See 32

FDA vitamins and minerals chart

The amount of vitamin A adults aged 19 to 64 need is: 0.7mg a day for men. 0.6mg a day for women.

Recommended daily allowance (RDA) of thiamin (Vitamin B1) taken by mouth is 1.2 mg for males and 1.1 mg for females over the age of 18 years. Pregnant or breastfeeding women of any age should consume 1.4 mg each day.

Among children and teens, the average daily riboflavin (Vitamin B2) intake from foods is 1.8 mg for ages 2–5 years, 1.9 mg for ages 6–11, and 2.1 mg for ages 12–19 [19]. In adults, the average daily riboflavin intake from foods is 2.5 mg in men and 1.8 mg in women.

The average vitamin B6 intake is about 1.5 mg/day in women and 2 mg/day in men [1]. However, 11% of vitamin B6 supplement users and 24% of people in the United States who do not take supplements containing vitamin B6 have low plasma PLP concentrations (less than 20 nmol/L)

The amount of vitamin C you need each day depends on your age. Average daily recommended amounts for different ages are listed below in milligrams (mg).

Life Stage Recommended Amount
Birth to 6 months 40 mg
Infants 7–12 months 50 mg
Children 1–3 years 15 mg
Children 4–8 years 25 mg
Children 9–13 years 45 mg
Teens 14–18 years (boys) 75 mg
Teens 14–18 years (girls) 65 mg
Adults (men) 90 mg
Adults (women) 75 mg
Pregnant teens 80 mg
Pregnant women 85 mg
Breastfeeding teens 115 mg
Breastfeeding women 120 mg

 

108. A population of a small town often presents with registered cases of juvenile cardiomyopathy, atherosclerosis, hypertension, endocrinopathy, chronic dermatitis and arthralgiasigns of Keshan disease. What is the mostly likely cause of this pathology?

 

A. Excessive zinc in the environment

B. Strontium deficiency in the environment

C. *Selenium deficiency in the environment

D. Excessive iron in the environment

E. Excessive manganese in the environment

 

Explanation:

Selenium: An essential mineral that is a component of an antioxidant enzyme, glutathione reductase, that is key in tissue respiration. Food sources of selenium include seafoods; some meats, such as kidney and liver; and some grains and seeds. … Deficiency of selenium causes Keshan disease.

The main symptom of Keshan disease is myocardial necrosis, leading to weakening of the heart. Selenium deficiency also contributes to Kashin-Beck disease. Kashin-Beck disease results in atrophy, degeneration, and necrosis of cartilage tissue in the joints.
Symptoms: Fatigue; Goitre; Hypothyroidism

 

109. 40 – 50 minutes after the completion of repair works conducted in closed garage, with car engine running, the repair workers developed severe headache in temporal area, nausea, tinnitus, vertigo, etc. These symptoms are characteristic of acute poisoning with:

 

A. Aldehydes

B. Fluoride

C. Hydrogen sulfide

D. Organochloride

E. *Carbon monoxide

 

Explanation:

See Question 38

 

110. An excavator operator with 20 years of work experience at the opencast ore mine undergoes regular medical examination. He presents with signs of pneumoconiosis. What type of pneumoconiosis is the most likely in this case?

A. *Anthracosis

B. Silicatosis

C. Silicosis

D. Siderosis

E. Asbestosis

 

Explanation:

See Question 33

 

111. A group of 5 had been resting in a forest, they were drinking alcohol and eating canned mushrooms and cured fish. The next day two of them were hospitalized with disturbed vision, swallowing and respiration; the third one presented with acute general weakness and dry mouth. The remaining two were healthy. A tick was detected on the skin of one of the healthy group members. What is the most likely diagnosis?

 

A. *Botulism

B. Tick- borne encephalitis

C. Lyme borreliosis

D. Mushroom poisoning

E. Alcohol poisoning

 

Explanation:

Signs and symptoms of food-borne botulism include:
  • Difficulty swallowing or speaking.
  • Dry mouth.
  • Facial weakness on both sides of the face.
  • Blurred or double vision.
  • Drooping eyelids.
  • Trouble breathing.
  • Nausea, vomiting and abdominal cramps.
  • Paralysis.

 

112. A man working in a casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp pains in the stomach, constipations, pain in the hepatic area. In urine: aminolevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:

 

A. Carbon monoxide

B. *Lead and lead salts

C. Nitric oxide

D. Zinc

E. Tin

 

Explanation:

The following are symptoms of lead poisoning in adults:
  • abdominal pain is usually the first sign if a high dose of lead is ingested.
  • raised blood pressure.
  • joint and muscle pain.
  • constipation.
  • anemia.
  • tingling, pain, and numbness in the extremities.
  • memory loss and decline in mental functions.
  • headache.

 

113. Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0.1 mg/L. What preventive measures should be taken?

 

A. Tooth brushing

B. Fluorine inhalations

C. Sealant application

D. *Water fluorination

E. Introduce more vegetables to the diet

 

Explanation:

Normal fluorine content in water should be 1 mg/L

 

114. During assessment of work conditions at the factory manufacturing mercury thermometers, the content of mercury vapors in the air of the working area is revealed to exceed the maximum concentration limit. Specify the main pathway of human body exposure to mercury:

 

A. Intact skin

B. *Respiratory organs

C. Gastrointestinal tract

D. Damaged skin

E. Mucous tunics

 

115.Human body receives from the atmosphere a number of chemicals. What type of action results in the combined effect that is less than the sum of isolated effects of these chemicals on the body?

 

A. Synergistic action

B. Complex action

C. Isolated action

D. *Antagonism

E. Potentiation

 

116.A 38-year old woman works in the processing, she dries flax. She came to the hospital complaining of difficult breathing, constricting sensation in her chest, and cough attacks. These signs appear on the first day of her working week and gradually diminish on the following days. What respiratory disease is likely in this case?

A. *Byssinosis

B. Asthmatic bronchitis

C. Bronchial asthma

D. Allergic rhinopharyngitis

E. Silicosis

 

Explanation:

Carboconiosis is pneumoconiosis caused by inhalation of dust consisting of carbonaceous dust, as anthracite cole, coke, graphite, soot

Berylliosis, or chronic beryllium disease (CBD), is a chronic allergic-type lung response and chronic lung disease caused by exposure to beryllium and its compounds, a form of beryllium poisoning.

Pneumoconiosis is the general term for a class of interstitial lung diseases where inhalation of dust has caused interstitial fibrosis.

Byssinosis, is an occupational lung disease caused by exposure to cotton dust in inadequately ventilated working environments.

Siderosis is the deposition of excess iron in body tissue. When used without qualification, it usually refers to an environmental disease of the lung, also known more specifically as pulmonary siderosis or Welder’s disease, which is a form of pneumoconiosis.

 

117.A 9-month-old infant presents with delayed tooth eruption and fontanel closure, weakness, and excessive sweating. What type of hypovitaminosis is the most likely in this child?

A. Hypovitaminosis A

B. Hypovitaminosis B1

C. Hypovitaminosis B6

D. *Hypovitaminosis D

E. Hypovitaminosis C

 

Explanation:

See Q 32

 

118. During medical examination of high and middle school students, the doctors were accessing correlation between biological and calendar age of the school student based on the following criteria: height growth rate per year, ossification of the carpal bones, the number of permanent teeth. What additional development criterion should be accessed at this age?

 

A. Vital capacity of lungs

B. Hand strength

C. Chest circumference

D. Body mass

E. *Development of secondary sex characteristics

 

119. A 43- year old man, a coal face worker with 15 year long record of work complains of cough, thoracic pain and dyspnea. The cough is mild, usually dry, occurs mostly in the morning. The pain is localized in the interscapular region and aggravates during a deep intake of breath. Dyspnea occurs during physical exertion. Vesicular respiration in the lungs is weakened. Heart sounds are rhythmic, heart rate is 86/min. Blood pressure is 135/80mmHg. The abdomen is soft and painless. X-ray shows micro-nodular pulmonary fibrosis. Make the provisional diagnosis:

 

A. Berylliosis

B. Metal pneumoconiosis

C. *Carboconiosis

D. Byssinosis

E. Siderosis

 

Explanation:

Carboconiosis is pneumoconiosis caused by inhalation of dust consisting of carbonaceous dust, as anthracite cole, coke, graphite, soot

Berylliosis, or chronic beryllium disease (CBD), is a chronic allergic-type lung response and chronic lung disease caused by exposure to beryllium and its compounds, a form of beryllium poisoning.

Pneumoconiosis is the general term for a class of interstitial lung diseases where inhalation of dust has caused interstitial fibrosis.

Byssinosis, is an occupational lung disease caused by exposure to cotton dust in inadequately ventilated working environments.

Siderosis is the deposition of excess iron in body tissue. When used without qualification, it usually refers to an environmental disease of the lung, also known more specifically as pulmonary siderosis or Welder’s disease, which is a form of pneumoconiosis.

 

120.  In April during the medical examination of various population groups, 27% of individuals presented with low working ability and rapid fatigability. The following symptoms were observed in the affected individuals- swollen friable gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied by skin dryness. This symptoms most likely result from the following pathology-

A. Polyhypovitaminosis

B. Parodontosis

C. *C hypovitaminosis

D. B1 hypovitaminosis

E. A hypovitaminosis

 

Explanation:

see Question 32

121. During regular medical examination a lyceum student presents with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red, with single vertical cracks covered with brown red scalps . These clinical signs are most likely caused by insufficient content of the following in the diet-

 

A. Ascorbic acid

B. *Riboflavin

C. Retinol

D. Thiamine

E. Thiamine

 

Explanation:

Lyceum is a category of educational institution defined within the education system of many countries, mainly in Europe. The definition varies among countries; usually it is a type of secondary school.

Cheilitis is inflammation of the lips. This inflammation may include the perioral skin (the skin around the mouth), the vermilion border, or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.
Symptoms: Desquamation

Riboflavin – Vit B2, Ascorbic acid – Vit C, Retinol – Vit A, Thiamine – Vit B1

Riboflavin deficiency usually occurs with other B vitamin deficiencies. Symptoms and signs include sore throat, lesions of the lips and mucosa of the mouth, glossitis, conjunctivitis, seborrheic dermatitis, and normochromic-normocytic anemia.

 

122. Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust induced disease. What is the main physical property of dust aerosols?

 

A. Ionization

B. Electric charge

C. Solubility

D. Magnetization

E. *Dispersion

 

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