Surgeons Knot

Skin suture simple

Skin_Suture_mattress

Scalpel_holding_and_cutting

Scalpel Blade Handling

One Handed Surgical Knot

Needle Holding Position

Mesentric Vessel ligation

Knot_deeply_placed

Inspirational Quotes

Instrument_Tie

Instrument Clamp

Holding Forceps

Airway Management Non-Surgical

Airway Management Surgical

Mandatory Skills to be learnt by Medical Graduates

1. Blood Pressure Measurement
2. Blood Sampling
3. Injections
4. Aseptic measures
5. Venous cut down
6. Foley's catheterization
7. Sutures and Knots
8. Basic Life Support & ASLT
9. Lumber Puncture
10. Venous Cannulation
11. POP & Bandages
12. FNAC
13. Episiotomy
14. Normal and Instrumental delivery
15. Breech delivery
16. Tracheotomy
17. Endotracheal intubation
18. True Cut Biopsy

Remember Me, I Will Remember You (By: Jinan Bastaki)

How to Achieve Tranquility of the Heart

“Unquestionably, by the remembrance of Allah hearts are assured.” (Qur’an, 13:28)

In the last article in this section, we wrap up the things we have to do in our journey to gain tranquility of the heart with the remembrance of Allah.

When we try to figure out why we are so often bothered,  why we feel disturbed internally, or why we feel sad – we need to go back to our hearts. The Prophet ﷺ (may the peace and blessings of Allah be upon him) said: “Do not talk too much without remembering and mentioning Allah, for too much talk without mentioning Allah hardens the heart, and the person farthest from Allah is the one with a hard heart.” (Tirmidhi)

SubhanAllah (glory to Allah) – our heart hardens when we do not remember Allah. The heart’s nourishment is the remembrance of Allah, and when we fail to remember Him, it is no wonder that we feel down for no apparent reason. Ibn al-Qayyim stated, “In the heart there is hardness which can only be softened by remembrance of Allah. So the slave must treat the hardness of his heart with the remembrance of Allah.” For those of us who feel that Islam itself has become heavy upon us, look at the answer the Prophet ﷺ gave to a man who said, ‘O Messenger of Allah, the laws of Islam seem to be a lot for me (to remember), so tell me something that I should stick to.’ He ﷺ replied, ‘Let your tongue never cease to be moist with the remembrance of Allah’. (Tirmidhi)

And what is the effect of this remembrance? It acts as a polish for the hearts from its rust, and causes us to be remembered by Allah the Most High. Allah tells us in this amazing hadith qudsi:

“I am to my servant as he expects of Me, I am with him when he remembers Me. If he remembers Me in his heart, I remember him to Myself, and if he remembers me in an assembly, I mention him in an assembly better than his…” (Bukhari and Muslim)

So what exactly is remembrance?

Remembrance of Allah includes specified dhikr (such as saying subhan’Allah, la ilaha ila Allah, etc.), but it is also anything you do related to Allah or mentioning Allah. Anything that you do with Allah in mind – whether it is thinking well of Him, giving charity with the specific intention of doing it for His sake, making du’a’ (supplication) and so on is within the realm of dhikr.

Ways of dhikr

Let’s get more specific. What are the things we can do that are included in dhikr?

Intention

Like we said in the article on earning Allah’s love, we need to immerse ourselves in good works. That said, when we do good, we must always try to be conscious of the fact that we are doing it for Allah. Talk to Allah as you are doing the good deed, ask Him to accept it from you, and to enable you to do more good. Add intentions – such as doing it for Allah, following the sunnah (tradition of the Propeht ﷺ), helping fellow Muslims and people – the more you remember Allah, the more He will remember you. And inevitably you will feel that in your life.

Remember, when we do good, we need to do good with the heart. We probably do certain things anyway – such as giving charity here and there, making du`a’ and so on. But we do them without heart, without any feeling or emotion that this is for Allah. We need to do these things knowing that in them is a cure for what is in our hearts, and that when we feel down, we go to these things – whether it is helping out others or pleading with Allah in our sujood (prostration).

Turning to Him

“Whoever comes to me walking, I go to him at speed.” (Bukhari)

It is impossible for you to return to Allah and He rejects you. Look at all these ahadeeth on those who return to Him:

” Allah is happier when a servant of His repents to Him than a man who was on his camel in a waterless desert and the camel escaped from him with his food and water. When he has lost hope of finding it, he retired to a tree and lied down under its shade. As he was there, the camel suddenly appeared in front of him. He took hold of its halter and said in his state of excessive joy: ‘O my Lord You are my servant and I am Your Lord.’ He uttered this erroneous statement as a result of his being overjoyed.” (Muslim)

Allah says in a beautiful hadith qudsi:

“O son of Adam, so long as you call upon Me and ask of Me, I shall forgive you for what you have done, and I shall not mind. O son of Adam, were your sins to reach the clouds of the sky and were you then to ask forgiveness of Me, I would forgive you. O son of Adam, were you to come to Me with sins nearly as great as the earth and were you then to face Me, ascribing no partner to Me, I would bring you forgiveness nearly as great as its.” (Tirmidhi)

Finally Allah says:

“Remember Allah during times of ease and He will remember you during times of difficulty” (Tirmidhi)

Thanking Him

“And [remember] when your Lord proclaimed, ‘If you are grateful, I will surely increase you [in favor]…” (Qur’an, 14:7)

Thanking is recognizing and appreciating. The more you thank, the more you will see. The more you see how Allah has blessed you, you see His presence in your life and this in itself should create a certain soothing of the heart. By thanking Allah, you are recognizing He is al-Wahhab (the Giver of gifts), ar-Razzaq (the Sustainer), al-Wadud (the Most Loving) and insha’Allah (God willingly) you will be able to recognize how He manifests His attributes and Names in your life.

Take the time out every evening to thank Allah for the blessings in your day – not only will you be overwhelmed because you will never be able to enumerate them, but you will truly recognize Allah’s presence in your life.

Daily Wird

“And remember your Lord much and exalt [Him with praise] in the evening and the morning.” (Qur’an, 3:41)

We know that the Prophet ﷺ always remembered Allah – this is why we have du’a’ and adhkar for almost everything we do: from entering into the restroom to what to say when someone compliments us. The Prophet ﷺ also had specific remembrances that he said every morning and every evening (they can be found here). Each of these words and phrases are precious – not only do they polish your heart and cleanse them of their disturbances, but the Prophet ﷺ would say them for protection, and that in itself should give us peace of mind and heart. Yaqeen is so important – if the Prophet ﷺ has told us that saying certain words will have an effect – we should have no doubt.

We should take the time to understand these words, so that they truly enter our hearts.

May Allah make us of people “who remember Allah while standing or sitting or [lying] on their sides and give thought to the creation of the heavens and the earth, [saying], “Our Lord, You did not create this aimlessly; exalted are You [above such a thing]; then protect us from the punishment of the Fire.” (Qur’an, 3:191)

Take Back Your Heart (By: Yasmin Mogahed)

 No one likes to fall. And few people would ever choose to drown. But in struggling through the ocean of this life, sometimes it’s so hard not to let the world in. Sometimes the ocean does enter us. The dunya does seep into our hearts.

And like the water that breaks the boat, when dunya enters, it shatters our heart.  It shatters the boat. Recently, I was reminded of what a broken boat looks like, of what happens when you let everything in. I was reminded because I saw someone, just like me, fall in love too much with this life and seek to be filled by the creation. So the ocean of dunya shattered her boat, as it had shattered mine, and she fell out into the water.  But she stayed down too long, and didn’t know how to come back up or what to hold on to.

So she drowned.

If you allow dunya to own your heart, like the ocean that owns the boat, it will take over. You will sink down to the depths of the sea. You will touch the ocean floor. And you will feel as though you were at your lowest point. Entrapped by your sins and the love of this life, you will feel broken. Surrounded by darkness. That’s the amazing thing about the floor of the ocean. No light reaches it.

But, this dark place is not the end. Remember that the darkness of night precedes the dawn. And as long as your heart still beats, this is not the death of it. You don’t have to die here. Sometimes, the ocean floor is only a stop on the journey. And it is when you are at this lowest point, that you are faced with a choice. You can stay there at the bottom, until you drown. Or you can gather pearls and rise back up—stronger from the swim, and richer from the jewels.

If you seek Him, God can raise you up, and replace the darkness of the ocean, with the light of His sun. He can transform what was once your greatest weakness into your greatest strength, and a means of growth, purification and redemption. Know that transformation sometimes begins with a fall. So never curse the fall. The ground is where humility lives. Take it. Learn it. Breathe it in. And then come back stronger, humbler and more aware of your need for Him. Come back having seen your own nothingness and His greatness. Know that if you have seen that Reality, you have seen much. For the one who is truly deceived is the one who sees his own self—but not Him.  Deprived is the one who has never witnessed his own desperate need for God.  Reliant on his own means, he forgets that the means, his own soul, and everything else in existence are His creation.

Seek God to bring you back up, for when He does, He will rebuild your ship. The heart that you thought was forever damaged will be mended. What was shattered will be whole again. Know that only He can do this. Seek Him.

And when He saves you, beg forgiveness for the fall, feel remorse over it—but not despair.  As Ibn ul Qayyim (RA) has said: “Satan rejoiced when Adam (peace be upon him) came out of Paradise, but he did not know that when a diver sinks into the sea, he collects pearls and then rises again.”

There is a powerful and amazing thing about tawbah (repentance) and turning back to Allah (swt). We are told that it is a polish for the heart. What’s amazing about a polish is that it doesn’t just clean. It makes the object that is polished even shiner than it was before it got dirty. If you come back to God, seek His forgiveness, and refocus your life and heart on Him, you have the potential to be even richer than if you’d never fallen at all. Sometimes falling and coming back up gives you wisdom and humility that you may never otherwise have had. Ibn ul Qayyim (RA) writes:

One of the Salaf [Pious Predecessors] said: “Indeed a servant commits a sin by which he enters Paradise; and another does a good deed by which he enters the Fire.” It was asked: How is that? So he replied: “The one who committed the sin, constantly thinks about it; which causes him to fear it, regret it, weep over it and feel ashamed in front of his Lord—the Most High—due to it. He stands before Allah, broken-hearted and with his head lowered in humility. So this sin is more beneficial to him than doing many acts of obedience, since it caused him to have humility and humbleness—which leads to the servant’s happiness and success—to the extent that this sin becomes the cause for him entering Paradise. As for the doer of good, then he does not consider this good a favor from his Lord upon him. Rather, he becomes arrogant and amazed with himself, saying: I have achieved such and such, and such and such. So this further increases him in self-adulation, pride and arrogance—such that this becomes the cause for his destruction.”

Allah (swt) reminds us in the Qur’an to never lose hope. He says: “Say, ‘O My servants who have transgressed against their souls [by sinning], despair not of the mercy of Allah. Indeed, Allah forgives all sins. Indeed, it is He who is the Forgiving, the Merciful,’” (39:53).

And so, this is a call to all those who have become enslaved by the tyranny of the self, imprisoned in the dungeon of the nafs (self) and desires.  It is a call to all those who have entered the ocean of dunya, who have sunk into its depths, and become trapped by its crushing waves. Rise up. Rise up to the air, to the Real world above the prison of the ocean. Rise up to your freedom. Rise up and come back to life. Leave the death of your soul behind you. Your heart can still live and be stronger and purer than it ever was. Does not the polish of tawbah remake the heart even more beautiful than it was? Remove the veil you have sewn with your sins. Remove the veil between you and Life, between you and Freedom, between you and Light—between you and God.  Remove the veil and rise up. Come back to yourself. Come back to where you began. Come back Home. Know that when all the other doors have shut in your face, there is One that is always open. Always. Seek it. Seek Him and He will guide you through the waves of the cruel ocean, into the mercy of the sun.

This world cannot break you—unless you give it permission. And it cannot own you unless you hand it the keys – unless you give it your heart.  And so, if you have handed those keys to dunya for a while—take them back. This isn’t the End. You don’t have to die here. Reclaim your heart and place it with its rightful owner:

God.

Mnemonics Pediatric

Croup: symptoms 3 S's:
Stridor
Subglottic swelling
Seal-bark cough

Ataxia-Telangiectasia (AT): common sign AT:
Absent
Thymus

Williams syndrome: features WILLIAMS:
Weight (low at birth, slow to gain)
Iris (stellate iris)
Long philtrum
Large mouth
Increased Ca++
Aortic stenosis (and other stenoses)
Mental retardation
Swelling around eyes (periorbital puffiness)

Russell Silver syndrome: features ABCDEF:
Asymmetric limb (hemihypertrophy)
Bossing (frontal)
Clinodactyly/ Cafe au lait spots
Dwarf (short stature)
Excretion (GU malformation)
Face (triangular face, micrognathia)

Dentition: eruption times of permanent dentition "Mama Is In Pain, Papa Can Make Medicine":
1st Molar: 6 years
1st Incisor: 7 years
2nd Incisor: 8 years
1st Premolar: 9 years
2nd Premolar: 10 years
Canine: 11 years
2nd Molar: 12 years
3rd Molar: 18-25 years

Cyanotic heart diseases: 5 types · Use your five fingers:
1 finger up: Truncus Arteriosus (1 vessel)
2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed)
3 fingers up: Tricuspid Atresia (3=Tri)
4 fingers up: Tetralogy of Fallot (4=Tetra)
5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)

Head circumference with age · Remember 3, 9, and multiples of 5:
Newborn 35 cm
3 mos 40 cm
9 mos 45 cm
3 yrs 50 cm
9 yrs 55 cm

Cyanotic congenital heart diseases 5 T's:
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return

Weights of children with age Newborn 3 kg
6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65 kg

Hemolytic-Uremic Syndrome (HUS): components "Remember to decrease the RATE of IV fluids in these patients":
Renal failure
Anemia (microangiopathic, hemolytic)
Thrombocytopenia
Encephalopathy (TTP)

Cough (chronic): differential When cough in nursery, rock the "CRADLE":
Cystic fibrosis
Rings, slings, and airway things (tracheal rings)/ Respiratory infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Dyskinetic cilia
Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
Edema (heart failure)

Cystic fibrosis: presenting signs CF PANCREAS:
Chronic cough and wheezing
Failure to thrive
Pancreatic insufficiency (symptoms of malabsorption like steatorrhea)
Alkalosis and hypotonic dehydration
Neonatal intestinal obstruction (meconium ileus)/ Nasal polyps
Clubbing of fingers/ Chest radiograph with characteristic changes
Rectal prolapse
Electrolyte elevation in sweat, salty skin
Absence or congenital atresia of vas deferens
Sputum with Staph or Pseudomonas (mucoid)

WAGR syndrome: components WAGR:
Wilm's tumor
Aniridia
Gential abnormalities
Mental Retardation

Haematuria: differential in children ABCDEFGHIJK:
Anatomy (cysts, etc)
Bladder (cystitis)
Cancer (Wilm's tumour)
Drug related (cyclophosphamide)
Exercise induced
Factitious (Munchausen by proxy)
Glomerulonephritis
Haematology (bleeding disorder, sickle cell)
Infection (UTI)
In Jury (trauma)
Kidney stones (hypercalciuria)

Vitamin Toxicity:

Excess vitamin A: Anomalies (teratogenic)
Excess vitamin E: Enterocolitis (necrotizing enterocolitis)
Excess vitamin K: Kernicterus (hemolysis)

Pediatric milestones in development 1 year:
-single words
2 years:
-2 word sentences
-understands 2 step commands
3 years:
-3 word combos
-repeats 3 digits
-rides tricycle
4 years:
-draws square
-counts 4 objects

Breast feeding: contraindicated drugs BREAST:
Bromocriptine/ Benzodiazepines
Radioactive isotopes/ Rizatriptan
Ergotamine/ Ethosuximide
Amiodarone/ Amphetamines
Stimulant laxatives/ Sex hormones
Tetracycline/ Tretinoin

Paediatric history taking · Begin with standard things: patient name, presenting complaint, history of presenting complaint and past medical history.
· Then ask BIFIDA:
Birth details and problems
Immunisations
Feeding
Infection, exposure to
Development, normality of
Allergies
· End by customary review of the rest of the standard things: medications, family history and social history.

Mnemonics: Surgery

Post-operative fever causes Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever

Scrotum: scrotum swelling differential THE THEATRES:
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB

Post-operative complications (immediate) "Post-op PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis

Fistulas: conditions preventing closure FETID:
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction

Oedema causes: localised ALIVE:
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)

GI bleeding: causes ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel

Compartment syndrome: signs and symptoms · 5 P's:
Pain
Palor
P ulseless
Paresethesia
Pressure (increased)

Swollen leg: unilateral swelling causes TV BAIL:
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema

Pancreatitis: treatment MACHINES:
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review

Appendicitis: Alvarado's scoring system for diagnosis MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more = appendicitis is confirmed.

Post operative order list check-up FLAVOR:
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx [medications]

Mnemonics: Medicine

Indications of Dialysis: AEIOU
1. Acidosis
2. Electrolyte abnormalities-hyperkalemia
3. Ingestion of substances like barbiturates, salicylates, lithium, methanlo, etc
4. Overload fluid (unresponsive to diuretics)
5. Uremia symptoms (pericarditis, encephalopathy) 

MI: basic management BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size


Murmurs: questions to ask SCRIPT:
Site
Character (eg harsh, soft, blowing)
Radiation
Intensity
Pitch
Timing 


Metabolic acidosis: causes Hi Yield [ID 1873]
KUSSMAL:
Ketoacidosis
Uraemia
Sepsis
Salicylates
Methanol
Alcohol
Lactic acidosis 


Days of appearance of rashes:
Mnemonic: "Very Sick Patients Must Take Double Exercise"
Varicella (chickenpox)- 1st day
Scarlet fever – 2nd day
Pox (smallpox) – 3rd day
Mumps – 4th day
Typhus – 5th day
Dengue – 6th day
Enteric fever (typhoid) – 7th day 

Misc images

Community Medicine OSPE Set 2

Community Medicine OSPE Set 1

Epidemiology MCQs with key Part 2

1.         When a new treatment is developed that delays deaths but does not produce recovery from a chronic disease, which of the following will occur.

a.     Prevalence of the disease will decrease

b.     Incidence of the disease will increase

c.     Prevalence of the disease will increase

d.     Incidence of the disease will decrease

e.     Incidence & prevalence of the disease will decrease

                                                                                                                 

Key:    True:  c

2.         Higher crude annual mortality rate in a developing country as compared to a developed country is mostly due to one of the following reasons:

a. An incorrect record keeping

b.     A younger age distribution

c.     An inaccurate census of the population.

d. More stressful life style

e.     Greater exposure to occupational hazards.

Key     True:  b         

3.         To compare the death rate of India with the death rate of Pakistan, the most          appropriate measure is a comparison between:

a.     Age specific mortality rates

b.     Crude death rates

c.     Maternal mortality rates

d.     Standardized mortality rates

e.     Life expectancy

Key:    True:  d

4.         In an outbreak of cholera in a village of 2,000 population, 20 cases have occurred and 5 died. Case fatality rate is:

a.     1%

b.     .25%

c.     5%

d.     25%

e.     .0025%

Key:    True:  d

5.         If an epidemiologist while investigating an epidemic makes a graph to plot distribution of cases of disease by the time of onset and gets a polymodal          distribution curve. The most likely disease is:

a.     Salmonellosis

b.     Staphylococcal food poisoning

c.     Measles

d.     Typhoid

e.     Hepatitis A

Key:    True:  c

Questions # 6-7.

The results of a study of the incidence of pulmonary tuberculosis in a village in India are given in the table below. All persons in the village are examined during           two surveys made 2 years apart, and the number of new cases was used to determine the incidence rate.

Category of Household at First survey	Number of Persons	Number of New cases
With culture positive case	500	10
Without culture positive case	10,000	10

6.         What is the incidence of new cases per 1000 person years in households that had a culture positive case during the first survey?

a.     0.02

b.     0.01

c.     1.0

d.     10

e.     20

Key:    True:  d

                        10 new cases                           = 10 cases/1000 persons years

                        500 persons x 2 years

7.         What is the incidence of new cases per 1000 person years in households that did not have a culture positive case during the first survey?

a.     0.001

b.     0.1

c.     0.5

d.     1.0

e.     5.0

Key:    True:  c

                        10 new cases                           = 0.5 cases/1000 persons years

                        10,000 persons x 2 years

8.         In a population of 1000, measles coverage is 60%, one child goes out of station and comes back with measles from whom 20 more children get measles. Secondary attack rate of measles is:

a.     0.65%

b.     5%

c.     6%

d.     6.5%

e.     7%

Key:    True:  b

Ø Total No. of children=1000

Ø No. of immunized =600

Ø No. of un-immunized=400

Ø Primary case=1

Ø Secondary attack rate=20/(400-1)=20/399 X100= 5%

9.         A village has total of 100 under-five children. The coverage with measles vaccine in this age group is 60%. Following the occurrence of a measles case in a child after a visit outside, twenty- six children developed measles. The secondary attack rate of measles is:

a.     25%

b.     40%

c.     50%

d.     65%

e.     66%

Key:    True:  e

Ø Total No. of children=100

Ø No. of immunized =60

Ø No. of un-immunized=40

Ø Primary case=1

Ø Secondary attack rate=26/(40-1)=26/39 X100= 66%

10.       Public Policies in Pakistan aim at avoiding the underlying reasons for the development of environmental and atmospheric concentration of SO₂ to protect the health of people. It’s an example of

a.     Primordial

b.     Primary

c.     Secondary

d.     Rehabilitation

e.     screening

Key:    True:  a

11.       The number of deaths due to diarrhea, total cases of measles, total number of accidents and the total number of drug addicts were to be reported by a researcher. The best title given to all of this data would be:

a.     Mortality data

b.     Morbidity data

c.     Case fatality rate

d.     Addiction rate

e.     Health related data

Key:    True:  e

12.       Japanese have a higher rate of stomach cancer and a low rate for colon carcinoma than the U.S. However third generation descendents of Japanese immigrants to U.S have rates of stomach & colon cancer like that of U.S. This particular characteristic supports effects of:

a.     Environment

b.     Genetics

c.     Mutation

d.     Accidents

e.     Misinterpretation

Key:    True:  a

13.       Influenza pandemic occurs after every 7 – 10 years. This kind of disease distribution in time is known as:

a.     Secular trend

b.     Short time fluctuation

c.     Cyclical trend

d.     Seasonal trend

e.     Endemicity

Key:    True:  c         

14.       If the age incidences curve of leukemia shows two peaks it is suggestive of            bimodality. Bimodality usually signifies:

a.     Non homogeneity

b.     Cluster sampling

c.     Large number of observations

d.     Accuracy

e.     Short duration of disease

Key:    True:  a

15.       The health statistics department revealed that the sale of anti-Asthma drugs was more in those countries where Asthma deaths were more. This association may prove wrong when the individual based study designs are conducted. This association is an example of:

a.     Ecological fallacy

b.     Berkesonian bias

c.     Indirect association

d.     Temporal association

e.     Specific association

Key:    True:  a

16.       A researcher wanted to study the time sequence to prove the concept of causativity, which design of study should be preferred by the researcher:

a.     Longitudinal

b.     Cross-sectional

c.     Case report

d.     Case series report

e.     Quasi experimental

Key:    True:  a

17.       An expert in the field of public health is required to estimate the magnitude of a health problem. Which rate would he calculate for this?

a.     Incidence

b.     Prevalence

c.     Case fatality

d.     Proportionate mortality

e.     Cause specific mortality

Key:    True:  b

18.       When the number of educated females is expressed as a percentage of total            females present in a village. It is known as:

a.     Proportion

b.     Rate

c.     Ratio

d.     Frequency

e.     Cumulative frequency

Key:    True:  a

19.       The trend in mortality from tuberculosis in England showed a steady fall in years 1855 – 1965 but thereafter a gradual rise in the incidence of this disease was reported. This type of time trend or fluctuation in disease occurrence is termed as:

a.     Epidemic trend

b.     Cyclical trend

c.     Seasonal trend

d.     Secular trend

e.     Pandemic trend

Key:    True:  d

20.       The incidence of pollen allergy at Faisalabad is 10 cases per thousand populations. The mean duration of illness is 3 months from February to April. The prevalence of pollen allergy at Faisalabad is:

a.     10

b.     20

c.     30

d.     40

e.     50

Key:    True:  c

21.       If the number of deaths from tuberculosis is expressed in relation to the total mid year population, it is:

a.     Case fatality rate

b.     Age specific death rate

c.     Proportionate mortality rate

d.     Crude death rate

e.     Cause specific death rate

Key:    True:  e         

22.       Bhopal gas tragedy is an example of:

a.     Slow epidemic

b.     Continuous epidemic

c.     Point source epidemic

d.     Propagated epidemic

e.     An accident which did not warrant an emergency

Key:    True:  c

23.       The estimate of the average number of additional years a person could expect to live if the age specific death rates for a given year prevail for the rest of his life, is best expressed by:

a.     Survival index

b.     Probability of dying

c.     Life expectancy

d.     Crude death rate

e.     Age specific death rate

Key:    True:  c

24.       In a universe comprising of 1500 children less than 5 years of age, 75 children with severe malnutrition were found. If 75 new cases of severe malnutrition were registered over a period of one year, the incidence rate for severe malnutrition during the same year is:

a.     50 / 1000

b.     53 / 1000

c.     55 / 1000

d.     60 / 1000

e.     63 / 1000

Key:    True:  b

25.       Every year during the winter season the hospital admissions are more for pneumonia cases. This year also about 358 children with pneumonia were admitted in the Pediatric department of POF Hospital between the months of Jan – Mar 2007. This increased frequency of respiratory infections during winter          months is an example of:

a.     Epidemic trend

b.     Cyclical trend

c.     Seasonal trend

d.     Secular trend

e.     Pandemic trend

Key:    True:  c

26.       A 40 years old man of 75 kg came to a physician for his routine checkup. His         serum   cholesterol was found to be 230 mg/dL and he was diagnosed as      hypertensive.   The risk factor of this particular condition is classified as:

a.     Physical

b.     Chemical

c.     Biological

d.     Nutritive

e.     Mechanical

Key:    True:  b

27.       Acute hemorrhagic conjunctivitis affected a large proportion of population over a wide geographic area in 1971 and 1981. This spread of disease is:

a.     Epidemic

b.     Sporadic

c.     Pandemic

d.     Endemic

e.     Opportunistic

Key:    True:  c

28.       A patient came in emergency with signs of dehydration and severe diarrhea. An Intra venous infusion was given to correct electrolytes and fluid levels. He was discharged after 2 days. About 2 months later the patient came back with signs of jaundice and Hepatitis B surface antigen was positive. He did not give history of any event which could have lead to this disease. This hepatitis infection may be labeled as:

a.     Sub clinical

b.     Idiopathic

c.     Opportunistic

d.     Cross infection

e.     Iatrogenic

Key:    True:  e

29.       In a village of population 10,000, 250 cases of Hepatitis B were reported in the month of July. The point prevalence of Hepatitis B per thousand populations is:

a.     20

b.     25

c.     30

d.     50

e.     100

Key:    True:  b

30.       A woman brings her child to the hospital for mongolism. The possible agent of the disease that comes in your mind is?

a.     Bacteria

b.     Virus

c.     Nutritional factor

d.     Hormonal factor

e.     Chromosomal factor

Key:    True:  e