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INMED Public Health
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73
Medical
Graduate
06/21/2013
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Term
The implications of international public health can be profound in all of the following arenas EXCEPT which ONE?

 

A Medical tourism
B Foreign policy
C Economic development
D Philanthropy
E Global security
Definition
The correct answer is A 

Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly growing practice of traveling across international borders to obtain healthcare services. Such individually oriented practices do not make a significant impact on the health of entire populations. Alternatively, global health and international public health are closely tied to foreign policy, philanthropic efforts, economic development and global security.
Term
Describe the characteristics or background of forgotten people who exist alongside affluent people in wealthier nations. Enter your response in the field below.
 Definition
Forgotten people exist alongside affluent people in every wealthier nation. These individuals and families are often minorities, immigrants, economically disadvantaged and less educated. The H'Mong people in North America, for example, suffer health disparities far out of proportion to other North Americans.
Term
Each of the following is among the most commonly utilized measures of physical health of a population, EXCEPT which ONE?

 

A National per capita expenditure for healthcare
B Mortality rate for children under age 5 years
C Infant mortality rate
D Maternal mortality rate
E Life expectancy at birth
Definition
The correct answer is D 

Three of the most commonly utilized measures of physical health are life expectancy at birth, mortality rate for children under age 5 years, and the national per capita expenditure for healthcare. Maternal death rate, or maternal mortality rate, measures deaths of women during or shortly after pregnancy, and is normally reported as a percentage. Maternal death rate is not among the most commonly used health indicators.
Term
Describe what is meant by Disability-adjusted Life Years (DALYs) lost. What are the two components measured? Enter your response in the field below.
 Definition
The correct answer is:

The Disability-adjusted Life Years (DALYs) lost is a measure that combines Year of Life Lost (YLL) due to premature death and Years Lived with Disability (YLD) based on severity and duration of nonfatal outcomes. One DALY lost equals one year of healthy life lost.
Term
Progress in health status during the 1900s is best attributed to all of the following factors EXCEPT which ONE?

 

A General advances in education
B Antibiotic development
C Improved nutrition
D Control of infectious diseases
E More protective housing
Definition
The correct answer is B 

The 1900s witnessed marked advances in medical interventions, including the introduction of antibiotics about the time of WWII. However, most credit for improvements in health is attributed to progress in nutrition and measures to control infectious diseases - advancements closely connected with economic growth, general education and improvements in housing.
Term
Describe the transition in health challenges that is occurring in many developing nations. Enter your response in the field below.
 Definition
The correct answer is:

Much progress has occurred in the control of infectious diseases throughout the world. However, the HIV/AIDS epidemic, and its often-accompanying tuberculosis, have returned attention to the role and importance of infectious diseases. Widespread economic growth in developing nations has also been accompanied by a steady increase in coronary heart disease and various forms of cancers-diseases most common in wealthier nations.
Term
The WHO defines health as a state of complete physical, emotional and social wellbeing, not just the absence of disease.2 What is the usefulness of such a definition? Enter your response in the field below.
 Definition
The correct answer is:

This definition of health emphasizes that economic conditions, education, agriculture, housing, transportation, family stability and political systems all have a profound effect upon physical health. Involvement of broad social institutions is often essential in both prevention and management of health problems.
Term
Each of the following is a component in calculating the Human Development Index (HDI) for a given nation EXCEPT which ONE?

 

A Gross domestic product (GDP)
B Life expectancy
C Education attainment
D Adult literacy
E Political freedom
Definition
The correct answer is E 

The HDI, the standard most commonly used by United Nations agencies, is based upon three measures: gross domestic product (GDP), adult literacy plus education attainment, and life expectancy. Infant mortality rate is a commonly used measure in assessing physical health status, but is not a part of the HDI equation.
Term
Describe the relationship between HDI, life expectancy, malaria and tuberculosis. Enter your response in the field below.
Definition
The correct answer is:

Both malaria and tuberculosis are most endemic in nations with the lowest HDI and lowest life expectancy.
Term
Poverty generally includes all the following elements EXCEPT which ONE:

 

A Geographic location of country
B Insufficient income
C Insufficient food and nutrition
D Inadequate water and sanitation
Definition
The correct answer is A 

Geographic location is not necessarily associated with economic status. While the world's poorest nations are generally located in the southern hemisphere and closer to the equator, there exist some remarkable exceptions, such as Singapore and the United Arab Emirates.
Term
Economic development and physical health are closely connected. Economic growth enhances the general health of a population through improvements in all of the following, EXCEPT which ONE?

 

A Incentives for increased childbearing
B Nutrition
C Water and sanitation
D Medical services
Definition
The correct answer is A 

Incentives for reduced childbearing are highly correlated with increases in women's health and increases in economic growth. Greater educational and career opportunities that accompany economic growth provide women appealing alternatives to childbearing.
Term
Which of the following statements regarding the Millennium Development Goals is MOST true?

 

A Aims to achieve universal secondary education
B Set goals to be achieved by 2020
C Establishes universal standards for each country to meet
D Includes goals to ensure environmental sustainability
Definition
The correct answer is D 

Millennium Development Goal 7 is to ensure environmental sustainability, especially with reference to forests, land, water and fisheries. Particular MDGs are to be tailored by each country to suit its particular needs, with the deadline of 2015. They include the objective to achieve universal primary education.
Term
The Millennium Development Goals were established to improve world health and living standards and to serve as uniform targets to these ends. Which of the following is NOT one of the MDGs?

 

A Eradicate extreme poverty and hunger
B Promote gender equality and the role of women
C Increase partnerships to trade, aid and research
D Redirection of health resources from vaccine-preventable diseases and towards HIV and malaria control
Definition
The correct answer is D 

The efforts to combat HIV/AIDS and malaria must take place in the context of other health needs. Some 2.1 million children still die each year from vaccine-preventable diseases (polio, measles, diphtheria, pertussis, tetanus, and tuberculosis), though the total numbers have declined precipitously since EPI was initiated in 1974. Roughly 350,000 infants are born each day worldwide, therefore adequate immunization remains a high priority.
Term
All of the following statements are true regarding the health and general education EXCEPT which ONE?

 

A As average years of education increase in a community, so does the rate of all cause mortality.
B Increased general education is positively associated with increased economic productivity.
C Frequently ill children attend school less, have lower school performance, and have lower economic achievements later in life.
D Greater educational opportunities for women foster improved nutrition and improved access to medical care.
Definition
The correct answer is A 

As average years of education increase, the rate of all cause mortality decreases in a linear fashion. Multiple mechanisms explain this phenomenon. Greater educational opportunities for women, for example, foster increased personal wealth, improved nutrition, reduced childbearing, and improved access to medical care, which contribute significantly to the overall health of women.
Term
Each of the following are leading risk factors for DALYs lost in low-income nations EXCEPT which ONE?

 

A Unsafe drinking water, sanitation and hygiene
B Underweight
C Hyperlipidemia
D Unsafe sex
E Vitamin A deficiency
Definition
The correct answer is C 

Hyperlipidemia, or hypercholesterolemia, is a risk factor for coronary artery disease, but accounts for a relatively small number of DALYs lost in comparison to DALYs lost in association with being underweight, unsafe sex, unsafe drinking water and vitamin A deficiency.
Term
Conventional methods for identifying causes of death specify that about 70 percent of childhood mortality is due to which one of the following:

 

A Respiratory diseases
B Malnutrition
C Injuries
D None of the above
Definition
The correct answer is D 

Conventional methods of quantifying causes of death indicate that about 70 percent of all childhood deaths (ages 0 years to 4 years) worldwide are due to infectious diseases, primarily vaccine-preventable diseases, diarrheal illness, acute respiratory infection and malaria.
Term
Which ONE of the following statements regarding breastfeeding is TRUE?

 

A Breastfeeding alone does not provide adequate nutrition for a 1-month-old infant.
B Transitional foods can be introduced by 2 to 3 years of age.
C Breastfeeding provides little protection against diarrheal diseases.
D Breastfeeding significantly improves an infant's odds of surviving the first 2 to 3 months of life.
Definition
The correct answer is D 

Breastfeeding significantly improves an infant's odds of surviving the first 2 to 3 months of life. The WHO Collaborative Study Team documented that breastfed infants experienced a 75 percent to 80 percent lower risk of death compared to non-breastfed infants.
Term
All of the following are risks associated with short interval between births EXCEPT which ONE?

 

A Low birth weight
B Herd immunity from vaccinated siblings
C Inadequate maternal recovery time (maternal depletion syndrome)
D Early termination of breastfeeding
E Increased exposure to infection from children of similar ages
Definition
The correct answer is B 

Herd immunity refers to the relative protection provided to unvaccinated individuals by being surrounded by those who are vaccinated, and hence less likely to transmit infectious agents.
Term
Pregnancy is a major health risk. Some 98 percent of all pregnancy-related deaths worldwide occur in developing countries. Which one of the following is NOT a major cause of maternal deaths in these nations?

 

A Eclampsia
B Obstructed labor
C Deep venous thrombosis
D Hemorrhage
E Peripartum sepsis
Definition
The correct answer is C 

Deep venous thrombosis is not a common lethal obstetrical complication in developing nations or in wealthier nations. The major causes of maternal deaths in approximate order of importance are: hemorrhage, peripartum sepsis, abortion, eclampsia and obstructed labor/ruptured uterus.
Term
The Expanded Program on Immunization (EPI) was launched to facilitate vaccination of children against common vaccine-preventable diseases. EPI in most developing nations includes vaccination against which ONE of the following diseases?

 

A Pertussis
B Malaria
C Pneumococcus
D Influenza
E Hepatitis A
Definition
The correct answer is A 

Today, EPI routinely provides vaccination against hepatitis B, polio, measles, diphtheria, pertussis, tetanus and TB (with Bacille Calmette-Guérin [BCG] vaccine). Vaccination for women of childbearing age with tetanus toxoid (TT) is included to prevent neonatal tetanus in newborns. Also added are yellow fever vaccine and Haemophilus influenzae meningitis (Hib) conjugate vaccine in countries at high risk for these diseases.

Hepatitis A virus (HAV) causes an acute self-limited disease, rarely leads to death, and confers lifelong immunity. Because of these facts, vaccination against HAV is not currently a high priority.

Influenza and pneumococcus vaccines are relatively more expensive, and they are tailored against organisms common in wealthier nations rather than those in developing ones. Therefore, influenza and pneumococcus vaccination is not currently a part of EPI. An effective vaccine against malaria has yet to be developed, though intensive efforts are underway.
Term
With regard to injuries in developing nations, which ONE of the following statements is TRUE?

 

A Resource allocation to reducing injuries continues to be on par with that to reduce infectious diseases.
B The leading cause of injury deaths worldwide is motor vehicle-related trauma.
C The majority of the world's motor vehicle-related injuries occur in industrialized nations.
D Intentional injuries (violence, homicide, war, suicide) are a much more significant cause of morbidity and mortality than are unintentional injuries (falls, burns, drowning, poisoning).
E Latin America has the highest rate of injury deaths in the world.
Definition
The correct answer is B 

The leading causes of injury deaths worldwide include motor vehicle accidents (20 percent), suicide (15 percent), homicide (11 percent), drowning (10 percent), war (10 percent) and other causes (18 percent). In most regions of the world, unintentional injuries are a much more significant cause of morbidity and mortality than are intentional ones. Sub-Saharan Africa has the world's highest rate of injury deaths. Seventy percent of the world's motor vehicle-related injuries occur in developing nations. One important reason the number of deaths from injuries has not declined is because the response to high rates of injury in developing nations has been minute in comparison to efforts to reduce infectious diseases. 
Term
In 2008, some 31 million adults and 2.1 million children worldwide were living with HIV infection. Which ONE of the following statements about HIV prevention is TRUE?

 

A In the absence of antiretroviral drug treatment, HIV infection carries a 47 percent fatality rate.
B Barrier contraceptives are nearly 100 percent effective in reducing risk of acquiring HIV infection.
C Treatment against other STIs has no influence on the risk of acquiring HIV.
D Peripartum prophylaxis of HIV-infected pregnant women significantly decreases the risk of mother-to-infant transmission.
E Orphans of AIDS victims are at no increased risk for developing HIV infection themselves.
Definition
The correct answer is D 

The risk of mother-to-infant transmission of HIV can be reduced from up to 40 percent to as low as 2 percent through peripartum prophylaxis with antiretroviral medications and alternatives to breastfeeding. HIV infection carries a 100 percent fatality rate in the absence of antiretroviral medication treatment. Due to manufacturing imperfections, even properly applied barrier contraceptives cannot guarantee protection. Presence of other STIs increases an individual's risk of acquiring HIV infection. AIDS orphans are at higher risk for poverty, exploitation and acquiring HIV themselves.
Term
A comprehensive approach to preventing mother-to-child transmission (MTCT) of HIV should ideally include all of the following EXCEPT which one?

 

A Establishment of centers specifically to care for HIV-infected mothers
B HIV testing
C Contraception
D Antiretroviral therapy (ART)
E Provision of management for sexually transmitted diseases
Definition
The correct answer is A 

Establishment of centers to care for HIV-infected mothers has been largely ineffective. Fear over discrimination inhibits many pregnant women from taking advantage of centers identified in this way. Low-resource communities also frequently lack the other components needed to prevent MTCT, including contraception, HIV testing, ART and breastfeeding alternatives. Surveys conducted in 2005 found that only 9 percent of pregnant women in poorer nations were offered any sort of MTCT prevention.
Term
Regarding management of acute lower respiratory tract infections (LRTI) which ONE of the following statements is TRUE?

 

A Most deaths from LRTI occur in elderly persons.
B Treatment with an oral antibiotic must be initiated only after obtaining bacteriological cultures.
C H. influenzae and pneumoccal vaccines are routinely administered.
D Treatment against LRTI should be based on observations regarding a cough, fever, respiratory rate and chest retractions.
E Upper respiratory tract infections cause severe health consequences.
Definition
The correct answer is D 

Medical care providers of all levels, particularly community health workers, must be trained to appropriately diagnose and immediately treat LRTI based on observations regarding a cough, fever, respiratory rate and chest retractions. Delay should never be made for further testing. Deaths from LRTI are most common among children age 1 to 4 years. H. influenzae and pneumoccal vaccines are not routinely administered in low-resource nations.
Term
The greatest concentration of death from malaria is among African children younger than 5 years old. Which of the following is NOT a mechanism by which malaria control is being pursued today?

 

A Indoor residual spraying with insecticides
B Ongoing research into development of an effective malaria vaccine
C Personal measures, such as the use of repellents and protective clothing
D Detection and treatment of clinical cases of malaria
E Large-scale drug chemoprophylaxis during rainy seasons
Definition
The correct answer is E 

Drug resistance and environmental concerns make large-scale chemoprophylaxis against malaria ill-advised. Today's chloroquine medication resistance is due in part to large-scale chemoprophylaxis with this drug. Malaria case detection and treatment is essential to prevent transmission to others. Malaria prevention should also be pursued through personal measures, including the use of repellents, insecticide-impregnated bed nets and indoor insecticide sprays, as well as sealing homes from mosquitoes and reducing outdoor standing water.
Term
Which ONE of the following statements regarding chronic diseases is TRUE?

 

A Providing continuity of care for chronic disease management is essential for successful treatment.
B The prevalence of cigarette smoking worldwide is on the decline, especially in poorer nations.
C Diabetes mellitus is usually diagnosed very early in the disease process.
D Hypertension is generally difficult to manage for lower-level practitioners.
E Adoption of the "modern" lifestyle has brought with it a reduction in atherosclerotic diseases.
Definition
The correct answer is A 

The chief challenge to managing chronic diseases is often continuity of care, for most persons must be monitored and treated for the duration of their lives. Cigarette smoking remains on the rise in most developing nations. Most persons with diabetes are not diagnosed until later in their disease, after at least moderate symptoms develop. Most persons with hypertension can be easily diagnosed and successfully treated, and all at relatively low cost. Adoption of a "modern" lifestyle has brought with it smoking, fast food, increased meat and dairy consumption, and sedentary jobs - all of which contribute to development of atherosclerotic diseases.
Term
Bacille Calmette-Guérin (BCG) vaccine is commonly administered for prevention of tuberculosis (TB). ALL of the following statements regarding BCG vaccine are true, EXCEPT which one?

 

A The effectiveness of BCG vaccine against pulmonary tuberculosis in children is about 95 percent.
B BCG vaccine is administered in many countries with a high prevalence of TB and is an integral part of EPI.
C BCG vaccine is quite effective in decreasing disseminated tuberculosis infections (such as tuberculous meningitis) in infants and children.
D BCG vaccine should not be administered to infants who are at low risk for TB.
E BCG vaccination usually causes a false-positive skin test for TB.
Definition
The correct answer is A 

Immunization with BCG at birth continues to be a standard part of EPI in developing countries and it appears to be quite effective at decreasing the risk of disseminated TB infections, such as tuberculous meningitis, in infants and children. However, BCG vaccine is only about 50 percent to 60 percent effective against pulmonary tuberculosis in children. Therefore, BCG immunization at birth probably results in only a modest decrease in disease by adulthood and little impact on TB in any given community. Furthermore, BCG vaccination causes the recipient to become tuberculin skin test positive, which may impede early diagnosis of clinical TB.
Term
True or False: Disasters are truly exceptional events.

 

True
False
Definition
The correct answer is False 
Term
The first thing that should be done when responding to a disaster is:

 

A Gather and organize supplies
B Organize a response team
C Complete a needs assessment
D Send food, clothes, and medicine to the affected area
Definition
The correct answer is C 

A needs assessment allows responders to rapidly survey the disaster situation, provide data describing the magnitude and extent of the disaster, and includes notify the relief community so that appropriate, efficient, and effective interventions can be established. 
Term
True or False: Any kind of aid and relief is useful after a disaster event.

 

True
False
Definition
The correct answer is False 

Hasty and ill-considered relief initiatives tend to create chaos. Only certain types of assistance, goods, and services will be required. Donation of unusable materials or manpower consumes resources of organizations and accommodation that could be more profitably be used to reduce the toll of the disaste
Term
Convergence can occur after a disaster by which of the following:

 

A Volunteers
B Media
C First responders
D All of the above
Definition
The correct answer is D 

Anyone at the scene who is not directly involved in the response activities on-site is contributing to convergence. Volunteers and first responders who are not being utilized should check-in at the onsite or offsite command post to be assigned a duty or dismissed. Volunteers and first responders should not initiate activities that have not been coordinated with the entity that is in charge. This command structure is established in the Incident Command System
Term
During the disaster response phase, who is usually the initial first responders?

 

A The federal government
B Other disaster victims
C The local government
D The local hospital
Definition
The correct answer is B 

The perception that non-injured or "walking injured" disaster victims burst into chaos post disaster event is inaccurate. History demonstrates that disaster victims are the initial responders who come to the aid of their neighbors and community. These are volunteer disaster victims with very limited to no previous training in disaster response. Studies have shown that half an hour after an earthquake, over 75% of disaster survivors and victims are already involved in some highly effective response activities that outside workers will generally disrupt 
Term
True or False: Individuals should be encouraged to respond to disasters, even if not through an organization or government entity.

 

True
False
Definition
The correct answer is False 

Hasty and ill-considered relief initiatives tend to create chaos. Donation of unusable materials or manpower consumes resources of organizations and accommodations that could be more profitably used to reduce the toll of the disaster by well equipped and organized organizations and government entities
Term
Medical disaster response efforts should include which of the following?

 

A Triage of disaster victims
B Providing continuity of care for disaster victims with chronic illnesses
C Providing medical care for displaced peoples
D All of the above
Definition

The correct answer is D 

Medical disaster response efforts include:

  • Triaging victims to determine who should receive priority care (Ciottone, 2006, p. 283).
  • Providing continuity of care. Disaster victims may have lost prescriptions or need medical care for pre-existing conditions. These additional demands can quickly tax an already devastated health system and have drastic health affects on disaster victims (Kessler, 2007, p. 1225-1230).
  • Caring for displaced people, who usually leave their homes in a hurry with limited resources. Many times they lack food security, clean water, clothes, and medicines. Providing assessments, public health interventions, medical care, and continual assessments is essential for their well-being.
Term
Which of the following are the main phases of medical emergencies during a disaster?

 

A Impact
B Local response
C Additional assistance
D All of the above
Definition

The correct answer is D 

The three main phases in medical emergencies during disasters are:

  • Impact. Disaster events are equal opportunistic -- medical facilities and personnel are not excluded from potential damage. The impact may also damage communications, transportation mechanisms, and infrastructure.

  • Local response. The initiation of medical services in the disaster zone is by local medical resources and personnel. Medical services are limited and local resources may be overwhelmed. Saving disaster victims is concentrated in the first 24 hours after impact.

  • Additional assistance. Additional medical personnel and resources come from other localities, regions, or organizations. Field hospitals are a good example of medical assistance. Usually, field hospitals are used to assist in providing routine medical care, while trauma and disaster-related injuries are treated at local medical facilities (Alexander, 2002, p.191).
Term
Which statement about triage during a disaster is most accurate?

 

A Most triaged injuries end up being fatalities
B Triage is based on severity of injuries
C Triage is based on the benefits a patient would receive from immediate or short-term treatment
D Triage is based on rationing of medical care when the demand for care is less than the supply available
Definition
Triage during a disaster event or mass casualty event should always be based on what benefits a patient would receive from immediate or short-term treatment. Furthermore, triage will be based on rationing of medical care when the demand for care is greater than the supply 
Term
True or False: Unburied dead bodies constitute a health hazard.

 

True
False
Definition
The correct answer is False 

Not even advanced decomposition causes a significant health hazard. Hasty burial demoralizes survivors and upsets arrangements for death certification, funeral rites, and, where needed, autopsy 
Term
True or False: The goal of the recovery phase in disaster medicine management is to restore or improve the health status of a population to the level that existed prior to the disaster event.

 

True
False
Definition
The correct answer is True 

In disaster medicine management, the recovery phase is a process of restoring or improving the health status of a population to reduce vulnerability and build resilience with in the community, which reduces the risk of future disaster events
Term
The recovery phase includes which of the following?

 

A Hazard-vulnerability assessment
B Mitigation
C Preparedness
D All of the above
Definition
The correct answer is D 

Disasters tend to repeat themselves, forming a disaster cycle. Disaster medicine management phases of mitigation, preparedness, response, and recovery are constantly overlapping each other, especially in the recovery phase. Since the recovery phase is the longest, it is essential that mitigation and its activities (such as Hazard-Vulnerability Assessment) and preparedness activities continue to take place. During the recovery phase, mitigation and preparedness phases may occur at the same time 
Term
A community's resilience is composed of:

 

A Absorbing capacity
B Buffering capacity
C Response and recovery from the damage sustained during a disaster event
D All of the above
Definition
The correct answer is D 

Resilience is composed of the absorbing capacity, the buffering capacity, and the response to the event and recovery from the damage sustained
Term
Which of the following is true about recovery?

 

A It is a short-term effort
B It is a long-term effort based on reducing vulnerability
C Healthcare professionals should not be involved in recovery efforts
D All recovery efforts are expensive
Definition
The correct answer is B 

Recovery efforts are based on reducing vulnerability in a community to reduce the population's risk exposure to future disaster events. This requires a long-term approach based on community development and sustainability. However, recovery efforts need not be expensive to be successful. Simple interventions, such as teaching hygiene practices or how to properly clean food, may help in building resilience in many poorer communities 
Term
Which ONE of the following is NOT a belief and behavior pattern of people in traditional cultures?

 

A The value of activity is less important than the value of identity.
B Humans are subjugated by nature. They are controlled by fate.
C Social interactions are often authoritarian.
D Human nature is basically good. People can be trusted.
E People are oriented toward the past and bound by tradition.
Definition
The correct answer is D 

Traditional cultures generally hold that human nature is basically evil. People cannot be trusted. Human circumstances are largely controlled by fate. Tradition takes precedence over reason. Social power is maintained by elders rather than by individuals. In light of these views, it is understandable that conflict often results when people from traditional cultures interact with people from scientific cultures.
Term
All of the following are characteristics of North American culture, and of many other industrialized nations, EXCEPT which ONE?

 

A The nuclear family
B Romantic love
C Individualism
D Distrust of authority
E Belief that human circumstances are largely controlled by fate
Definition
The correct answer is E 

Regarding the relationship of humans to the natural world, Americans tend to believe that humans are the master of nature, can control their circumstances, and are not bound by fate. Concerning individualism, Americans consider competition, assertiveness, education and self-improvement as valuable attributes. Closely connected with individualism is the temptation to view parents, elders, political figures and other authorities with a degree of wariness. Americans are enthralled with the passions surrounding youthfulness, physical appearance, affection and courtship-a fact that causes considerable tension with traditional cultures. In contrast with the extended family living arrangement enjoyed by many cultures, American families usually express their individuality living apart from one another.
Term
Four components are necessary for developing cross-cultural competency. Which ONE of the following is NOT a component of building cross-cultural relationships?

 

A Become aware of one's personal biases.
B Recognize that some attitude of cultural superiority is unavoidable.
C Apply the process of observing, understanding and adjusting to unfamiliar situations.
D Prioritize relationships above projects.
E Treat everyone with respect.
Definition
The correct answer is B 

Unfortunately, attitudes of cultural superiority are part of human nature. People who overcome these instinctive attitudes and who approach others with deference are at great advantage in building cross-cultural bridges. Therefore, all people must be treated with respect. Much of the ineffectiveness and suspicion associated with cross-cultural interaction can be diffused by developing genuine attitudes of regard and patience towards others. This is particularly important for Americans, who are often stereotyped as acting superior, overbearing and impatient.
Term
Successful verbal communication is extremely important to effective interaction with people of a new culture. Which ONE of the following is NOT a correct observation regarding verbal communication?

 

A Attempts to learn and speak a language communicate significant respect for people of that culture.
B Slang, idioms, jargon and colloquialisms are frequently misunderstood.
C A common language shared by culturally diverse people does not necessarily ensure successful communication.
D Contractions or abbreviations should be employed since these will assist the listener in becoming more fluent in the language.
E Speaking quickly increases the risk of being misunderstood.
Definition
The correct answer is D 

Contractions or abbreviations are frequently misinterpreted and should be eliminated. For successful verbal communication in a common language, speak slowly and clearly, use short sentences and phrases, define words or ideas that may be unfamiliar, and be certain that any illustrations used are culturally understandable. 
Term
Communication through an interpreter presents unique obstacles. EACH of the following guidelines should be followed when speaking through an interpreter, with EXCEPTION of which ONE?

 

A Children and family members should not be used for interpretation.
B Humor is a universal language and is understood across cultures.
C Allow adequate time for interpretation.
D First-person speech is preferred.
E Periodically affirm that the listener understands.
Definition
The correct answer is B 

Humor rarely translates effectively from one language and culture to another, so it should be avoided. Similarly, not all gestures have the same meaning from one culture to the next, and seemingly innocent gestures can cause great offense. Speaking through an interpreter greatly slows the exchange of ideas, so adequate time must be allowed.
Term
Learning a new language is achievable for most people who are sufficiently motivated and placed in a setting where a language must be used daily to get by. Which ONE of the following is an INCORRECT observation regarding language learning?

 

A Attempts to learn and speak the host language communicate significant respect for the host culture.
B Even learning just a few words and phrases can prove very useful.
C A common language shared by two culturally diverse individuals does not necessarily ensure successful communication.
D Unsuccessful language acquisition in a high school setting is a poor predictor of the ability to learn a language in a host country.
E Ability to communicate in the host language does not predictably lessen the experience of culture shock.
Definition
The correct answer is E 

One of the significant advantages of learning the host language is the sense of well-being that results. For people who know a local language, culture shock and adaptation to a new culture is usually briefer and less challenging. They generally excel more rapidly in their professional roles. Language learning also carries a symbolic importance: it communicates to those in the host country that expatriates value them and take their new roles seriously.
Term
Examples of culture influencing health include ALL of the following EXCEPT which ONE?

 

A Belief in supernatural powers may result in reliance on spiritual healing rituals in addition to or instead of modern medicine.
B People may view life in terms of their own self-determination and therefore may be less motivated to take action against illness.
C People of traditional cultures often believe that healthcare providers have a higher status and therefore should make the decisions.
D Cultural norms may dictate what symptoms are appropriate to reveal and how they are described.
E Some peoples hold that the mention of illness will cause that illness.
Definition
The correct answer is B 

Many Asians, among other cultures, perceive life in fatalistic terms. Life appears to be controlled by external forces, gods or fate. Such people may be less motivated to take action against illness. Orientations towards individualism and self-determination may be foreign concepts, while humility, gentility and conformity are more highly regarded.
Term
Which ONE of the following is an expected outcome of providing culturally competent healthcare?

 

A Reduced diagnostic errors, because providers are more likely to collect accurate patient information.
B Improved patient compliance, because providers expect all patients to follow their instruction.
C More successful patient education, because providers have confidence that their patients understand English.
D Improved patient compliance, because providers insist that patients are followed by their case workers.
E Increased patient access to care, because fewer providers have the necessary cross-cultural skills.
Definition
The correct answer is A 

Provision of culturally competent healthcare holds promise for improving health through reduced diagnostic errors, because providers compile accurate patient information.
Term
People involved with international service normally experience culture shock. Symptoms typical of culture shock include all of the following, except which one?

 

A Withdrawal from people, especially host nationals
B Enhanced work performance
C Depression
D Compulsive cleanliness
E Bitterness
Definition
The correct answer is B 

Poor work performance is a manifestation of newly arrived expatriates' emotional vulnerability and their lack of familiarity with the new work environment. Inability to perform well is a major source of stress because most expatriates arrive with high expectations for professional accomplishment.
Term
Culture shock and adjustment progresses though predictable stages. Which ONE of the following statements about these stages is FALSE?

 

A "Going native" is the ultimate cultural adjustment and indicates that expatriates have fully integrated themselves within the new culture.
B Irritation and hostility is the stage in which differences between cultures become striking and expatriates are frequently tempted to return home.
C Gradual adjustment is the stage in which expatriates feel symptoms of culture shock abating and their ability to function improving.
D The stage of adaptation and biculturalism is marked by increasing comfort and functionality in the host culture. Upon leaving the new culture and reentering the home culture, expatriates miss the new culture.
E Initial euphoria refers to the strikingly positive fascination that newly arrived expatriates have with the host culture.
Definition
The correct answer is A 

Expatriates generally require several months to progress through the stages of culture shock. An unusual variation is the expatriate who chooses to reject the home country entirely, "goes native," and fully embraces the lifestyle of the new culture. This usually occurs within a few months of arrival - long before the expatriate has had an adequate opportunity to appreciate the nuances of the new culture. Expatriates who "go native" are usually rejected both by people of their home culture (who don't understand why they would reject it) and by those of the new culture (who don't understand why they find it so attractive).
Term
Living by the rules of a new culture is essential for success in that environment. Which ONE of the following is NOT a principle of cultural adaptation?

 

A Few patterns of behavior in new cultures are actually immoral or reprehensible. They are simply different.
B Tension is created when people behave contrary to expectations. However, expatriates are generally excused from following cultural norms because of their unfamiliarity with the culture.
C Adjustment begins with becoming aware of behavioral differences, reflecting on their causes, and observing how to alter one's own behavior.
D To successfully adapt to and function within a new culture, expatriates must observe, understand and adjust to the behavior of nationals.
E People within a particular culture generally expect that everyone will understand and abide by their beliefs and values.
Definition
The correct answer is B 

Tension is created when people, including expatriates, behave contrary to cultural expectations. Exceptions may be made for tourists, who would not be anticipated to understand cultural nuances. But expatriates living in a culture for any length of time are expected to quickly learn acceptable behavior. If they do not adopt this behavior, tension is created. This tension usually prompts both expatriates and nationals to withdraw from contact with one another.
Term
Adaptation to new cultures is easier for some individuals than for others. The traits and skills of such successful individuals include which ONE of the following?

 

A Dependence upon others
B Intolerance for ambiguity
C Low tolerance for failure
D Ability to draw humorous interpretations of stressful events
E High goal orientation
Definition
The correct answer is D 

The ability to find humor is an invaluable personality asset. Embarrassing, frustrating and disappointing events are intimate parts of the cross-cultural experience. Humorous interpretation of these events is quite therapeutic. People from industrialized nations tend to be highly goal-oriented and to have unrealistically high expectations. Expatriates who are less goal-oriented tend to relax their expectations and take more advantage of opportunities for cultural adjustment. Closely connected with low goal orientation is the healthy ability to tolerate ambiguity and the high number of failures and setbacks associated with international living. Individuals who have a strong sense of self and less dependency upon others tend to tolerate these stresses more successfully.
Term
Reentry shock is a common experience among persons returning home from a significant cross-cultural journey. Which ONE of the following is NOT a feature of reentry shock?

 

A Expatriates who have been living among relatively low-income people often feel a sense of injustice at the disparity.
B Friends and family back home frequently admire returning expatriates and are anxious to learn about their experience.
C The pace of life in developing countries often seems unhurried in comparison to that of the home culture and requires significant adjustment.
D Expatriates find their values regarding family and spiritual life are greatly influenced by their international experience.
E Expatriates report that their attitudes toward racism, patriotism and international relations are profoundly changed.
Definition
The correct answer is B 

Spending time away from one's home and experiencing a new cross-cultural home can create social and psychological distance that can be overcome upon reentry. Relationship disconnection is one of the greatest of these distances. Friends and family back home frequently do not recognize the significance of the expatriate's experience. They may not remember that he or she had left home at all. They typically are only interested in hearing about the cross-cultural experience for a moment or two. Otherwise, they respond with disinterest or misunderstanding. This causes expatriates to feel isolated from friends and family, who may come across as being provincial, close-minded or even jealous.
Term
Integration of the cross-cultural experience into one's personal worldview is the main task of cultural reentry. The entire reentry process is aided by adhering to certain guidelines. Which ONE of the following is NOT a guideline for reentry?

 

A Expect to be misunderstood and unappreciated.
B Reenter one's former lifestyle and responsibilities as rapidly as possible.
C Receive a formal debriefing with a person who is skilled and experienced at reentry.
D Remain in regular contact with significant friends and family back home while you are away.
E Get closure by saying goodbye and resolving any tensions with nationals before leaving the host country.
Definition
The correct answer is B 

While quickly reentering one's former lifestyle and responsibilities may appear wise, expatriates generally are advised to avoid making any significant immediate commitments. The physical fatigue of travel, compounded by the emotional fatigue of readjustment, can take a predictable toll. Compensating through regular, prolonged sleep and planned leisure will ease the initial process of reentry.
Term
Leadership today demands more than technical proficiency. Which ONE of the following is the most essential attribute of a leader?

 

A Being a well-known public figure
B Serving as a credible and exemplary role model
C Knowledge of applicable government regulations
D History of working one's way up through an organization
E The ability to create a budget and raise funds
Definition
The correct answer is B 

Credibility is vital to successful leadership. It can be aided through academic credentialing and a good track record, but no qualification contributes to a leader's credibility as much as being an exemplary role model. Leaders who demonstrate innovation, punctuality, work ethic and responsibility are far more likely to inspire these attributes among their followers. Other skills, such as budgeting and personnel management, can usually be successfully acquired or delegated.
Term
Providing healthcare services does not necessarily enhance overall health. It is difficult to keep the goal of health in view for ALL of the following reasons, EXCEPT which one?

 

A The impact of health interventions is not easily measured.
B Health status is not easily measured.
C Care for people who are critically ill is usually perceived as more intriguing and valuable than is disease prevention or health promotion.
D Curative care specialists, such as surgeons, are usually more revered than are those in public health or primary care.
E Saving lives through the eradication of diseases, such as smallpox, provides an exemplary model of effective health intervention.
Definition
The correct answer is E 

Eradication of disease, such as smallpox, has saved hundreds of thousands of lives and helps to focus attention on protecting people's health rather than on disease management, including smallpox treatment. Disappointingly, health promotion efforts are often difficult to measure, whereas curative services rendered are relatively easy to quantify.
Term
Which ONE of the following statements best describes a health system?

 

A Public health services, such as vaccination, food safety and sanitation
B A network or organization that leads to improvement in health for a population
C Mobile specialty services, such as optometric or prenatal care
D Opening a medical office and providing whatever care people expect
E A business plan aimed at generating income from persons that can best afford to pay for care
Definition
The correct answer is B 

A wide variety of interventions will promote health. But not as many interventions are appropriate or efficient for a given community, especially one with limited resources. This is where the careful creation of health systems comes into play. A health system is the combination of resources, organization, financing, management and community participation that culminates in improvement in health for that population. Unfortunately, most profit- or service-oriented health initiatives do not focus on the overall goal of improved health.
Term
Several types of organizations provide leadership for health systems, including ALL but which ONE of the following?

 

A Government agencies
B Private, and usually fee-for-service, healthcare providers
C The Pasteur Institute
D Non-governmental organizations (NGOs)
E Health insurance plans that cater to enrolled individuals
Definition
The correct answer is C 

The Pasteur Institute is one of the world's leading research facilities for infectious diseases. While its discoveries have important bearing on healthcare in general, the Pasteur Institute does not guide a particular health system per se. In most low-income nations, small numbers of people are enrolled in health insurance plans or receive occupational health services. For-profit health services exist, but they are normally only accessible to the relatively wealthy. The bulk of healthcare is provided by NGOs, government health services and traditional medicine practitioners.
Term
Each of the following is a component in calculating the Human Development Index (HDI) for a given nation EXCEPT which ONE?

 

A Gross domestic product (GDP)
B Life expectancy
C Infant mortality rate
D Adult literacy
E Adult education attainment
Definition
The correct answer is C 

Human Development Index, the standard most commonly used by United Nations agencies, is based upon three measures: gross domestic product (GDP), adult literacy plus education attainment, and life expectancy. Infant mortality rate is a commonly used measure in assessing physical health status, but is not a part of the HDI equation.
Term
All of the following statements are true regarding health and general education EXCEPT which one?

 

A As average years of education increase in a community so does the rate of all-cause mortality.
B Increased general education is positively associated with increased economic productivity.
C Frequently ill children attend school less, have lower school performance, and have lower economic achievements later in life.
D Greater educational opportunities for women foster improved nutrition and improved access to medical care.
Definition
The correct answer is A 

As average years of education increase the rate of all-cause mortalitydecreases in a linear fashion. Multiple mechanisms explain this phenomenon. Greater educational opportunities for women, for example, foster increased personal wealth, improved nutrition, reduced childbearing, and improved access to medical care, which contributes significantly to the overall health of women.
Term
Which ONE of the following is NOT an intervention against the leading causes of DALYs lost due to disease or injury in low-income nations?

 

A Mammography for breast cancer detection
B Malaria prevention and treatment
C Recognition and treatment of depression
D Improved driving behavior and protective equipment
E Recognition and management of lower respiratory tract infections
Definition
The correct answer is A 

Relatively speaking, breast cancer is an infrequent cause of DALYs lost in poorer nations. What's more, mammography is a resource-intensive service that is seldom available or sustainable in low-income communities.
Term
All of the following statements are true regarding players in international health EXCEPT which one?

 

A The United Nations (UN) was initially established at the end of World War II "to save succeeding generations from the scourge of disease."
B Pharmaceutical companies have made particularly effective contributions toward control of onchocerciasis and trachoma.
C Research and educational facilities occupy an essential role in international health.
D In the decades since WHO was formed, health organizations have shifted from a more vertical orientation to a more horizontal orientation in terms of influence.
E The UN Food and Agricultural Organization (FAO) and UN World Food Program play a role in international health.
Definition
The correct answer is A 

The UN is composed of several agencies that participate in international health - most notably the World Health Organization (WHO). However, the UN itself was established in the aftermath of World War II "to save succeeding generations from the scourge of war."
Term
Vaccine-preventable diseases have declined dramatically since the Expanded Program on Immunization (EPI) was initiated. Which ONE of the following statements about EPI is MOST correct?

 

A EPI is successful because it is easily understood, easily implemented, inexpensive and causes immediate benefit.
B EPI has been used by governments to test the effects of biological warfare agents.
C EPI is most effective as a separate service from well-child care and prenatal care.
D EPI's vaccines include pneumococcus and influenza.
E EPI makes use of a single-dose, combination vaccine administered just once during the first year of life.
Definition
The correct answer is A 

WHO epidemiologist HR Henderson observed that success "has been possible because the program is easily understood, inexpensive and easy in implement, and because it brings immediate, highly visible benefits. It is good public health and good politics." EPI does not routinely include vaccines against pneumococcus and influenza. A single-dose combination vaccine administered once during the first year of life would greatly simplify vaccination procedures. However, such a vaccine is not yet available. EPI is most effective in promoting overall health when it is combined with other well-child care and prenatal services.
Term
The 1978 WHO conference in Alma Ata, Kazakhstan, highlighted the importance of primary health care (PHC). Of the following statements about PHC, which ONE is most true?

 

A PHC is meant to largely replace hospital-based services.
B PHC is mainly carried out by nurses.
C PHC is envisioned as a top-down, central government-sponsored health initiative.
D Components of PHC include nutrition promotion, safe water and provision of essential drugs.
E PHC today remains a movement largely separated from other health services.
Definition
The correct answer is D 

Nutrition promotion, safe water and provision of essential drugs are components of most PHC efforts. PHC was originally envisioned as a community-based, community-led health initiative founded on the concept of self-reliance and empowerment. While PHC is considered more cost-effective than hospital-based services, it is not intended to replace them. In developing nations, PHC is most commonly carried out by community health workers, who generally undergo 6 to 24 months of formal training. PHC today is more commonly an integrated package of essential health services provided by governments and NGOs, rather than a community-led health initiative.
Term
The number of medical care providers in developing nations is quite low relative to wealthier nations. In response, many developing nations rely upon community health workers (CHWs) in an effort to provide basic medical care to all persons. CHWs are typically expected to perform all of the following skills, EXCEPT which one?

 

A Treatment of common diseases
B Midwifery
C Pursuit of higher medical training
D Nutrition counseling
E Vaccination and well-child care
Definition
The correct answer is C 

The standard skill set for CHWs includes providing vaccination, well-child care, midwifery, communicable disease control, nutrition counseling, injury prevention, sanitation and water protection, and treatment of common diseases. Experience has proven that it is important to select CHW training candidates carefully, with preference for individuals who are most likely to remain and serve their communities over the long term. Those who have a higher degree of education and/or fewer social ties tend to lose interest in providing basic medical care to their communities.
Term
Improved management of childhood illnesses, as well as aspects of nutrition, immunization, contraception and maternal health, are all part of Integrated Management of Childhood Illness (IMCI). Which ONE of the following is NOT a principle of the IMCI disease management protocols?

 

A Designed for use by community health workers
B Use of a very small number of medications
C Reliance upon symptoms and signs only
D Integration of early detection, treatment and prevention of disease
E Radiological confirmation of suspected pneumonia
Definition
The correct answer is E 

IMCI is designed for use by community health workers who have minimal formal training, thus making it more accessible to disadvantaged communities. The protocols are based upon symptoms and signs only. They do not rely upon diagnostic tests, such as radiological services, which are frequently unavailable, unreliable or prohibitively expensive. Management protocols are designed to make use of basic, widely available medications that are inexpensive yet effective and have relatively few adverse effects.
Term
Complex humanitarian emergencies (CHEs) are becoming increasingly common. Which ONE of the following observations about CHEs is MOST correct?

 

A Disaster preparedness and disaster management are disciplines well within the scope of standard medical education and medical practice.
B Child mortality associated with military conflict is usually due to preventable pneumonia, diarrhea, malaria and neonatal tetanus, rather than to trauma or assault.
C CHEs usually involve the shortage of just one resource, such as housing, food or medical care.
D In the past one hundred years, the proportion of non-combatant deaths associated with military conflict has shown no appreciable increase.
E While sites of CHEs are hazardous for local residents, aid workers are generally protected from risks.
Definition
The correct answer is B 

Conducting reliable research in the CHE setting is extremely challenging. A study in Somalia conducted during the political chaos of 1987 to 1989 documented that child mortality jumped from a baseline of 21 percent to a staggering 41 percent. Very few deaths were directly attributable to assault. Rather, in the wake of social upheaval, they were caused by preventable pneumonia, diarrhea, malaria and neonatal tetanus.
Term
Which ONE of the following statements regarding the Millennium Development Goals is MOST true?

 

A Aims to achieve universal secondary education
B Set goals to be achieved by 2020
C Establishes universal standards for each country to meet
D Includes goals to ensure environmental sustainability
E Does not significantly address the role of women
Definition
The correct answer is D 

Millennium Development Goal 7 is to ensure environmental sustainability, especially with reference to forests, land, water and fisheries. Particular MDGs are to be tailored by each country to suit its particular needs, with the deadline of 2015. They include objectives to achieve universal primaryeducation and to increase gender equality and the role of women.
Term
The classic problem-solving process is the best model for leading a health system. Which ONE of the following steps is NOT part of the problem-solving process?

 

A Assess available resources
B Assure that plans are carried through
C Plan the most appropriate interventions
D Assure reimbursement for services rendered
E Assess health problems and risk factors
Definition
The correct answer is D 

Not all services rendered necessarily need be reimbursed, as funding may be provided from a variety of sources. Leading a health system follows the classic problem-solving process and incorporates three essential steps: Assess the community's needs and resources, plan the most appropriate interventions, and assure that the interventions are carried out. These steps are ideally repeated in a cyclical fashion for the life of the system.
Term
Health leaders should select health interventions based upon a thorough assessment of a community's health problems and resources. Which of the following is NOT one of the four levels at which health interventions can occur?

 

A Primary medical care interventions
B Investigational interventions
C Disease- and problem-specific interventions
D Secondary and tertiary medical care
E Population-oriented interventions
Definition
The correct answer is B 

Population-oriented interventions are most effectively applied to groups of people simultaneously. Disease- and problem-specific interventions include efforts to treat particular diseases (such as filariasis leading to blindness) or reduce particular risk factors (including vitamin A supplementation to prevent blindness). Primary, secondary and tertiary medical care interventions are services offered to individuals one by one. Clinical research significantly contributes to the knowledge base that guides effective interventions, though investigational interventions per se are not health interventions since they are usually undertaken chiefly to answer research questions.
Term
The World Bank proposed that all governments of developing nations make available to their citizens a set of essential health services. Each of the following is among the recommended public health (population-oriented) services, except which one?

 

A Information on nutrition and family planning
B Safe drinking water
C Cancer screening
D Vector control
E Tobacco and alcohol control
Definition
The correct answer is C 

Cancer screening is a clinical service for individuals, not a public health service. Cancer screening is not commonly provided in developing nations due to limited resources and the more pressing burden of disease caused by infectious diseases, trauma and reproductive health concerns.
Term
Which ONE of the following statements about communication for health is TRUE?

 

A Message such as "Boil the water" and "Don't take drugs" inherently take into account motivations behind the unhealthy behaviors.
B Maslow's Hierarchy of Needs provides a theoretical basis for one-way messages.
C One step to developing an effective communications program is working with consultants to develop and test messages.
D Media campaigns and social marketing strategies are generally less cost-effective than one-on-one healthcare services.
E When applied to health communications, Maslow's Hierarchy of Needs can help communicators understand the community's felt needs so that messages are positioned to that level.
Definition
The correct answer is E 

When applied to health communications, Maslow's Hierarchy of Needs can help communicators understand the felt needs of individuals and communities so that messages are positioned to that level. For example, if people are concerned about a contagious diarrheal illness, then a message of "Boil your water and wash your hands to stay well" may be most effective. But for youths who sense a higher aspiration to become leaders in their community, communication about "stepping up" and taking action that benefits the entire community will be especially powerful.
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