3.

Primary Health Care services & Family Medicine

3.1. Growth Chart& Nutritional Counseling

Problem 1
1.he is between -2 and - 3 z sores stunted growth
2. he is near between the -1 and -2 z scores near the -2 curve
3. he is stunted and also prone to underweight
4. Nutritional assessment steps
• nutritional history
• general examination
• anthropometric measurements : weight , length and head circumference

Problem 2
1.her height is similar to that of girls of her age
2.Nora`s weight is between 2 -3 z scores above the median . she is overweight ( heavier than
girls in her age)
3. yes she is prone to obesity
4. . Nutritional assessment steps
• nutritional history
• general examination
• anthropometric measurements : weight , height

Problem 3
• A mother is coming to the primary health care unit for vaccination of her 6 months old baby
boy, during checkup you find his weight is 6 kg.
He is normal, his weight lies inside the curve is at the 25th percentile
a. How can you assess his nutritional status?
Check his weight, height and head circumference on the specific growth charts of boys.
Follow him in the next visits to observe the growth. There curve must be rising not flat or
show decline. Check for breastfeeding
 b. The mother is looking forward to start weaning and is asking for your opinion is this
a good timing, and what to give him? Write your advice.
Weaning starts at 6 month so his age is suitable for weaning. She should start gradually.
There are many weaning foods. Home prepared food is better.

Problem 4
• An infant was brought to the health center at the age of 10 months and his weight was 6
kg. Is his weight satisfactory to his age?
• No, he is below the 5th percentile. Failure to thrive.

3.2. EXPANDED PROGRAM of IMMUNIZATION (EPI)

Problem 5
In a primary health care center a mother of one year old baby came to the immunization
room to vaccinate her baby. The nurse brought one vaccine from the freezer and the other
one from the second shelf of the fridge.

a) What are the obligatory vaccines that should be given to the baby at this age?
OPV, MMR
b) Is there any mistake(s) done by the nurse? If yes mention it?
MMR is live attenuated vaccine should be in the first shelf
c) What is the route of administration of these vaccines?
OPV ---- oral, MMR ---- SC injection in right arm

Problem 6

You are the MCH supervisor, preparing the EPI Report; you collect the following data
about 1000 babies born in this year:

Vaccine Number of babies who took the vaccine

BCG 900
Polio 0 900
Polio I 850
Polio II 800
DPT I 850
DPT II 800
 a) Calculate the vaccination coverage of BCG and DPT I?
BCG = 900/1000 = 90%
DPT I = 850/1000 = 85%

b) Calculate the dropout rate for polio and DPT?

Polio = 900-800/900 = 11%
DPT = 850-800/850 = 5.8%

Problem 7
Complete the information in the Table below to calculate the vaccine wastage.

Vaccine Number Number No. of No. of doses Vaccine wastage rate

Stock of vials of doses doses administered
supplied per vial supplied
BCG 15 20 300 56 81.3%
Polio 13 20 260 252 3.1%
DPT 17 10 170 168 1.2%
Measles 6 10 60 59 1.7%

Problem 8

B
What are the vaccines given in sites: A, B
A. Oral polio vaccine
B. MMR vaccine

Problem 9
1. Vaccines for 6 months old baby: oral polio vaccine and pentavalent
2. Oral polio: kept in the freezer compartment
pentavalent: kept in the middle shelf
3. Change in the monitor (same colour or darker than the surrounding area) for oral polio, present
of precipitate for pentavalent
4. Drinking from water bottles

Problem 10
1. MMR vaccine , live attenuated vaccine
2. subcutaneous in the right arm at 12, 18 months

Problem 11
1. Vaccine carrier
2. Used to keep vaccines safe and cool throughout the vaccination sessions

Problem 12
1. Vaccine vial monitor
2. Discarded when the monitor became the same colour or darker than the surrounding area

Problem 13
In the table below there are situations that show that there is a problem in vaccination
program, mention some possible causes for these problems:

• Problems • Possible Causes of these Problems

• Parents do not bring their 1. Health workers have not clearly explained to parents
children for additional what vaccinations are due, when they are due, and why
immunizations they are needed.
2. Health workers do not understand what vaccinations are
due, when they are due, and why they are needed.
3. Barriers discourage parental return, (e.g., hours of clinic
operation, cost, long waits).
4. Health workers have not shown parents respect or
conveyed an interest in the child’s health.
• Children are not immunized 1. Health workers forget to check records or ask about
when coming to the clinic for what vaccines and doses a child/mother has received.
sick visits 2. Health workers do not understand the contraindications
for immunizations or health workers do not understand
that immunizations may be given to mildly ill children.
3. Health workers fail to explain to parents that it is often
acceptable to immunize a mildly ill child.
4. Immunizations are not available on that day.
5. Immunization supplies are not available.
• Health workers cannot 1. Health workers forget to remind parents to bring the
determine what immunizations immunization card.
a child has received 2. Clinic records are not organized so that it is easy to find
a child’s records.
• Children are not receiving all 1. Health workers do not understand what vaccinations are
vaccines that they are eligible due, when they are due, and why they are needed.
to receive during a visit 2. All immunizations are not available or offered at the
clinic on the same day.
3. Supplies of some immunizations are not sufficient.
• Children never come to the 1. The clinic is located too far away.
clinic to begin immunization 2. Clinic hours are not convenient or are not understood by
the community.
3. Outreach activities are too infrequent, or their timing is
not understood by the community.
4. Cultural, financial, racial, gender or other barriers are
preventing use of immunization services.
3.3. Maternal & Child Health Care (MCH)
Problem 1
A 42 years old lady presented to the primary health care with severe labor pains, the attending
nurse in the maternity room took careful history from the lady. Patient history revealed that this
lady has one child 9 years old. On examination; Blood pressure was 130/90 and Random blood
sugar was 185 gm/dl. The patient performed two antenatal care visits and two Ultrasound (U/S)
examinations but no documentation for either visits or U/S were found with the lady. No
immunizations were given to this lady during pregnancy.
a) Do you consider this pregnancy a high risk pregnancy? Give Reasons.
Yes, because she has 42 years old, pre- hypertensive, she performed two antenatal visits only
during this pregnancy, and no immunizations were given to this lady during pregnancy.
b) What is the schedule of antenatal care visits?
Once a month in the first 28 weeks, every two weeks till 36 weeks and every week thereafter
c) What are important investigations and immunizations that should have been done to this
lady during antenatal care visits?
Investigations are CBC, urine analysis, Rh typing, blood grouping.
Immunization tetanus toxoid (1st dose is after 12 weeks, 2nd dose is 4 weeks after and more
than two weeks before term)
Problem 2
Mrs. Farah presented to the antenatal clinic of a maternal & child heath care center with edema
and blood pressure of 150/95 mmHg at gestational age 34 weeks.
1. What is this expected condition?
This expected condition is called pre-eclampsia
1. Is this a risky condition to :
a. Baby: (Yes/No):…………(Explain): ………………………….
b. Mother: (Yes/No):………(Explain)…………………………..
c. Not a risky condition to both
Patient may develop eclampsia called Toxemia of pregnancy and it is one of the major
causes of maternal mortality. Babies are likely to have low birth weight, prematurity and
are prone to mortality
2. What other investigation is requested to Farah?
Lab test for albumin in urine

3. How can you control this condition?

 When pre-eclampsia is detected, the mother is given antihypertensive drugs, sedatives,
bed rest (to relieve the symptoms). Terminate the pregnancy as soon as the baby is
considered able to survive.
Problem 3
Mrs. Nadia a pregnant woman delivered by a dayaa then came to the health care center
complaining of fever 39°c, rigors, rapid pulse and offensive vaginal discharge.
1. What is the possible diagnosis?
Puerperal sepsis
2. Define the possible causes of this condition
Infection by streptococcus hemolyticus group A through unclean hands of the daya, use of
contaminated instruments, articles and fomites during delivery.
3. How could the center prevent additional cases?
Delivery using antiseptic measures in a clean setting Training of Dayaas for safe clean
delivery at home (the 3 Cs)

Problem 4
Mrs Safaa is a diabetic pregnant female at 4 weeks gestation. She went to the antenatal care
clinic at the primary health care center for the first time.

a) What are the expected services should this lady receive?

• Confirmation of pregnancy
• History taking
• General examination
• Local examination
• Ultrasonography
• Lab investigations especially glucose in blood
• Health education especially diet, lifestyle, drugs during pregnancy, diabetes follow
up.
b) When will be the next visit?
After one month

c) Are there special recommendations for this lady?

• To follow up with internal medicine physician concurrently with obstetric physician.
• To follow up her blood glucose at home
• Glycosylated hemoglobin should be done to assure the previous 3 month diabetes
control
• Ultrasonography should be done in each visit to follow the growth of the fetus
3.4.Traveller health

Mr. Ashraf, 60 years old, is going to go to Hajj. He is asthmatic and has

coronary heart disease.

Please answer the following questions:

1- What are the health risks that Mr. Ashraf susceptible for?
• Respiratory infections
- Respiratory tract infections are common during Hajj; (especially, he is
60 years old, asthmatic and has ischemic Heart Disease) such as
pneumonia, tuberculosis, Middle East respiratory syndrome (MERS)
• Communicable diseases
Diarrheal disease is common during Hajj, and travelers should be educated
on usual prevention measures and self-treatment. A pre-travel visit should
include discussions about prevention, oral rehydration strategies, antimotility
agents, and emergency antibiotic use for treatment of traveler’s diarrhea.
• Long standing and walking can lead to fungal or bacterial skin infections.
The use of unclean blades can transmit blood borne pathogens, such as
hepatitis B, C, and HIV.
• Heat exhaustion and heatstroke
They are leading causes of death, particularly when Hajj occurs during the
summer months. Pilgrims should stay hydrated, wear sunscreen, and seek
shade when possible. Umbrellas are frequently used to provide portable sun
protection. Travelers should be counseled on minimizing the risk of heat-
related injuries as well as sun avoidance.
• Trauma
Trauma is a major cause of injury and death during Hajj. Pilgrims may walk
long distances through or near dense traffic, and motor vehicle accidents are
inevitable.
• Asthmatic attacks exacerbation
• Angina up to myocardial infarction

2- Which vaccines should be given for Mr. Ashraf before travel?

All pilgrims should be up-to-date with routine immunizations.

• In addition, hepatitis A and B and typhoid vaccines are recommended.
• Hajj visas cannot be issued without proof of meningococcal vaccination.
All adults and children >2 years of age must have received a single dose of quadri-valent
A/C/Y/W-135 vaccine and must show proof of vaccination on a valid International
Certificate of Vaccination or Prophylaxis. The vaccine is administered >= 10 days before
arriving.
• Seasonal influenza vaccine, including H1N1, is strongly recommended for all pilgrims to
avoid respiratory infections.

3- State the precautions that should be taken by Mr. Ashraf before his travel
:
• Mr. Ashraf should be examined one month before the trip.
• He should take a sufficient supply of medications for his asthma and IHD
during his trip.
• If eyeglasses or contact lenses are worn, an extra pair should be taken.
• Components of the traveler's medical kit should include:
a. Thermometer d. Adhesive tape g. Oral laxative j. Insect repellents
b. Bandages e. Antiseptic h. Antidiarrheal k.Salt tablets in hot
humid c. Gauze f. Antacids
• He should take his personal belongings as tooth brush, scissor,…..

4- What are the precautions that should be taken by Mr. Ashraf during his
travel?
1. Flying: The traveler must be prepared for the effects of Jet Lag due to disturbances in
circadian rhythm. The average traveler requires about one day re-adjusting for every 2 hours
of time change. Motion sickness can be prevented using Dramamine (antihistaminic
anticholinergic).
2. Acclimatization:
▪ Going to high altitudes requires time for acclimatization, and the traveler is advised to
avoid alcohol, tobacco, excessive food and exercise and take rest for days.
▪ Acclimatization to hot and humid weather can be done by exercises in hot weather 2
hours for 2 weeks.
3. Water: in case of doubt that water is contaminated: boil water for 5 minutes or treat by iodine
compounds.
4. Foods and beverages:
▪ If well-cooked hot foods are eaten, most food borne infections can be avoided.
▪ Cold foods and salads are easily contaminated.
▪ Raw fruits should be eaten only when they have unbroken skin.
▪ Smoked, salted or dried meat or fish alone is not effective, but heating these products
at least one hour at 55 C will kill the infective stage of the parasites.
5. Avoid sun stroke or heat exhaustion
6. Traveler’s diarrhea:
▪ Enterotoxigenic E. Coli is the leading cause of travelers' diarrhea
▪ Acute viral infections, caused mainly by rotavirus and campylobacter infections may
cause diarrhea for travelers
▪ The most important factor in treating any diarrhea is the replacement of fluids by
drinking water, tea and carbonated beverages
▪ Electrolyte replacement is also important, and commercial oral rehydration solutions
can be mixed with potable water to prepare a satisfactory replacement fluid
▪ Bananas and oranges are a good source of potassium
▪ The accompanying diet should be bland, with avoidance of alcohol and fats
5- Which advice you can give for Mr. Ashraf after return?
He should consult the public health physician for required investigation and follow up as
he may be in the inculpation period of many diseases.

5. Infection Control

Problem 1
A. What do you think about the following situations? Comment
1. A nurse came to draw a sample of blood from a patient. She already had her gloves on;
she took the sample, recapped the needle with one hand technique and threw it in the
red bag basket. Afterwards she took off her gloves and put on new gloves to see another
patient. (4 mistakes)
a. Gloves should be put on immediately before the activity for which they are indicated.
The nurse did not wear new gloves before handling the patient
b. She did not change gloves (kept her previous gloves)
c. Threw sharps in basket, sharps should be disposed in safety box, no recapping
d. Hand hygiene should be performed in between (Gloves does not replace hand hygiene
and it should be done before and after every procedure).She did not do hand washing
before approaching the next patient.
2. A nurse is giving several patients the same drug; she is using one syringe body with
changing the needle for every patient.
The whole syringe is disposable after use (not only the needle). A new syringe should be
used for each patient. Needles, cannulae and syringes are sterile, single-use items; they
should not be reused for another patient or to access a medication or solution that might be
used for a subsequent patient.
3. A nurse is using a multiple dose drug vial. To make it easy for multiple medication
draws, he left a needle inserted in the vial septum.
Leaving a needle inserted into a vial or a solution represents a direct route for bacteria to
enter the vial.
4. A house officer rubbed his hands with alcohol gel before taking the vital data for ward
patients. After finishing, he used the alcohol rub once more.
He should wear a pair of gloves for every patient with hand rub in-between.

Problem 2
Do you think Gloves do replace hand hygiene?
- Take care that:
Use of petroleum-based hand lotions or creams may adversely affect the integrity of latex
gloves and some alcohol-based hand rubs may interact with residual powder on health-care
workers’ hands

.Problem 3
• Who is most likely to succeed in infection control? (Tick √ or X for the right practice):
Answer: Numbers C, F, H

Problem 4
What are the most commonly missed sites during hand hygiene: (6 sites)
 Areas of hands frequently missed as shown in the diagram
- Finger tips and nails,
- the thumb,
- dorsum of hand(back of hand),
- inbetween the fingers,
- wrist,
- the middle of the palm (front of hand) including the area of the thumb, ….

Problem 5

The hospital administration conducts a meeting with all healthcare workers from all
departments in the hospital to put a new plan to establish an infection control program. As
a physician has a previous knowledge about infection control.

a) What will be your recommendations in establishing this program

(requirements)?

Requirements for establishment of an effective infection control program:

1. Proper hospital design.
2. Setting rules for different activities in the hospital related to:
a. Basic measures for infection control, i.e standard and additional precautions
b. Proper disinfection and sterilization of equipment
c. Hand washing: this is the single most important method for prevention of cross infection.
It must be carried regularly and in the proper way.
d. Isolation of infected person
e. Safe use of sharps
f. Ensuring patient care practices are appropriate to the level of patient risk
3. Developing a programme for supervising the proper use of antimicrobial drugs.
4. Measures for health care workers (HCW):
a. Health Evaluation of HCW before employment and periodically.
b. Wearing personal protective equipment.
c. Immunization against diseases like hepatitis and TB.
d. Periodic training and orientation regarding infection control.
5. Environmental cleaning and safe hospital waste manegement.
6. Conducting an IC surveillance system in the hospital. This system aims to:
a. Identify magnitude of nosocomial infection problem.
b. Measure the rate of infection in specific health service.
c. Early detection of any outbreak for rapid control.
7. Establishment of an Infection Control Committee in the hospital for planning and
implementation of effective infection control program in the hospital. This committee should
include wide representation from relevant personels: e.g. managers, physicians, other health
care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping,
 training services. The committee must report directly to either the administration or the
medical staff to promote programme effectiveness.

b) What are the challenges that will face the infection control program during its
implementation? How to deal?
Staff resistance ----- deal with education and training
Unavailable materials --- mobilizing resources , putting priorties

c) Is establishing infection control program a cost- effective intervention?

Yes --- as it will decrase (complications, length of hospital stay, mortality)

Problem 6

Ebola virus disease (EVD) is a rare, but deadly, disease that wasn't diagnosed in the United
States until 2014. Four cases were confirmed between September and October, including
three healthcare workers who were exposed while caring for EVD patients in the United
States and in the African nation of Guinea. What will you do or recommend as infection
control physician? / What are the precautions will be taken? Choose from below the
suitable sign to be hanged on patients’ room door?

All types of recommendations should be followed (contact, airborne, standard precautions)

(all signs should be hanged).

Problem 7

As a result of a multi-state outbreak of measles that started in December 2014, healthcare

professionals have been advised by the CDC to consider measles when examining patients
who present with fever, malaise, cough, coryza (an upper respiratory infection),
conjunctivitis or maculopapular rash. What will you do or recommend as infection control
physician? / What are the precautions will be taken? Choose from below the suitable sign
to be hanged on patients’ room door?

Airborne and contact precautions signs

 a b

Problem 8
What is the difference between these 2 pictures? Type? When to use?
The first picture --- routine hand washing
• AFTER completing invasive procedures.
• AFTER taking care of particularly susceptible patients,
• AFTER dealing with wounds, whether surgical, traumatic, or associated with an
invasive device.
• AFTER contact with mucous membranes, blood or body fluids, secretions.
• AFTER touching contaminated inanimate sources.
• BEFORE and AFTER contact with patients.
• AFTER using the toilet.
• AFTER removing gloves.
• BEFORE serving meals or drinks.
• BEFORE leaving work

The second picture ---- Antiseptic Hand Wash or Alcohol Based Hand rub

• BEFORE the performance of invasive procedures (e.g., placement of intravascular

catheters, indwelling urinary catheters, or other invasive devices).
• BEFORE dressing wounds.
• BEFORE patient care at high risk of infection.
• BEFORE preparation of intravenous fluids and medication

Problem 9
What are the infection control measures should be applied in this situation?

Standard precautions ----

1. Effective hand washing
2. Use of antiseptic techniques
3. Safe use of sharps
4. Appropriate hospital waste management
 5. Proper disinfection and sterilization

6. Occupational Medicine
Problem 1
1. Diagnosis: posterior polar cataract
Physical exposure: infra-red radiation (from extremely red hot objects)
2. Occupational exposure: chemical exposure in the form of solvents used in cleaning.
One line for management: wearing gloves (personal protective equipment)
3. Occupational exposure: mechanical exposure from carrying heavy objects (lack of
ergonomic)
One complication: musculoskeletal disorder leading to frequent sick leaves.
4. Occupational exposure: chemical in the form of anesthesia gases.
Environmental method: proper ventilation and suction of exhaust gases.
5. Investigation: complete blood counts.
Occupational exposure: chemical from the solvent (petroleum products)
Problem 2
1. Physical: noise, heat, infra red radiation.
Chemical: silica, dyes, lead.
Mechanical: accidents, lack of ergonomics.
Psychosocial: work related stress.
2. Environmental measures: substitution, isolation, segregation, environmental monitoring.
3. Occupational team could be formed of:
- Occupational physician, nurse, technicians … to carry out PEE, PME, HE, writing
records and providing first aid measures.
- Occupational hygienist (engineer) … to undergo periodic measuring of noise levels at the
workplace and obtain air samples for analysis.
- Ergonomics … to advice about how to adapt the work to the capabilities of the worker
and avoid the occurrence of musculoskeletal disorders.

Investigations: chest x-ray, audiogram, ophthalmological examination.

Problem 3
1. Coal workers pneumoconiosis.
2. Personal method: wear personal protective devices as masks.

Problem 4
Rule:
If FEV1 / FVC is more than or equal to 80%, this is a normal or restrictive case.
If it is less than 80% this is an obstructive case.
In both cases we HAVE TO calculate FVC / PVC = if less than 80% there is a restrictive lesion,
either alone or in combination with an obstructive lesion if FEV1 / FVC in step 1 was less than
80%.
1. FEV1 = 3.5, FVC = 4
FEV1 / FVC = 3.5 / 4 = 87.5% … Either normal or restrictive.
FVC / PVC = 4 / 6 = 66.6% … This patient has a restrictive lung lesion, for example,
silicosis, since it is a pottery factory.
2. Chest x-ray … any of silicosis findings, for example, regular nodular opacities in upper lung
zones.
3. Masks.

Problem 5
Ear plugs.
Iron and steel, spinning and weaving, glass.

Problem 6
X-ray burn.
Radiation exposure which is a type of physical occupational exposures

Problem 7
A worker 55 years old in the in the plating of gold jewelry for 20 years develops bone aches
leading to progressive difficulty in walking. The patient gives no history of past trauma,
osteoporosis, diabetes or hypertension. Musculoskeletal and neurological examination was
generally normal, affection of the sense of smell and mild anemia were detected. Urine analysis
was ordered and showed proteinuria and glycosuria.
1. What is the type of metal toxicity in this case? Why?
 …this metal toxicity is caused by exposure to cadmium. This diagnosis is based on the
following points:
a) he is a worker involved in plating of jewlery (cadmium is a known exposure in this
process) for a long work duration (20 years)
b) Presenting complaints of bone aches, kideney affection are known adverse health effects
of cadmium expsoure.
2. What are the main lines of prevention of this occupational exposure?
There are 2 main lines of prevention:
environmental: substitution, isolation, environmental monitoring, ventilation
medical (personal): periodic medical examination, personal protective devices, health
education
3. What can be the instructions you give this worker?
It is recommended to measure cadmium levels in hair and blood to confirm the diagnosis.
Moreover, he is instructed to wear personal protective equipment and referred to a
nephrologist to follow up his condition.

Problem 8
A 55-year-old factory worker consulted his family physician because of ringing in his ears and
depression that began soon after the onset of the tinnitus. He had seldom worn hearing protection
at work, where he had to shout to communicate with co-workers. His physical findings were
normal. His audiogram showed a high-frequency hearing loss. The patient was referred to an
audiologist. A hearing aid was prescribed.

a. Mention the main finding in the above eudiometry that indicates the hearing loss was
mainly due to noise exposure (the acoustic dip)
b. What is the maximum noise exposure intensity that allowed (in dB) to prevent such a
problem
Noise should be less than 85 dB
c. Mention the name of instrument used to measure the noise level in the working place
Sound level meter

d.Mention two occupational setting that should use this device

Glass industry, spinning and weaving industry

Problem 9

A male worker 40 years old was employed as a truck driver for more than 15 years; he sits in
his truck for many long hours every day. Now, he is complaining of low back pain which
interferes with his ability to drive

1-What is the type of occupational exposure that the driver exposed to?
Physical occupational exposure: Whole body vibration

2-Mention two other symptoms/signs the driver might have?

Prostatitis ……….field vision defect

Problem 10
A worker was in his mid-30s when he started to experience pain, numbness and some tingling in
his right hand and wrist with occasional shooting pain going up his arm. The pain was so severe
that it woke him during the night about two nights a week. He had been employed as a repair and
maintenance operative for nine years, carrying out repair work using a pneumatic hand screws,
drills and saws. He had performed the same type of work for up to six hours a day.

1-What do you think the diagnosis of this case?

Physical occupational exposure: Segmental vibration (( Reynaud’s phenomena ))

2-Mention one preventive measure for this problem?

Regular usage of anti-vibration gloves

Problem 11

35years old man has been working in front of the furnace (oven) in iron and steel factory for
almost 15 years. He began to complain of generalized fatigue, blurring of vision, palpitation,
sweating and body cramps. He has one attack of fainting. His supervisor advised him to drink
water as much as he can.

1-What is the occupational hazard the worker exposed to?

Heat and infra-red

2-If an ophthalmologist examined his eye, what he might find?

Posterior polar cataract

3-Was the advice of his supervisor accurate or not in his instructions? explain
His supervisor should have advised him to eat salty meals in addition to drinking water to
compensate for both water and salt loss

Problem 12
A 70 year-old retired man presented to the Emergency Department following a house fire. The
flat below his had caught fire during the night, awakening the patient and his family. Smoke rose
through the floors and windows, and the patient was exposed to significant smoke inhalation.
Following rescue by the fire authorities. The patient was oriented but drowsy and was
expectorating carbonaceous sputum. He was diagnosed as CO poisoning and a proper
management was delivered by the ambulance service, the man’s health condition improved.
1-What is the mechanism of action of CO poisoning?
It is a chemical asphyxiant that binds to hemoglobin forming carboxyhemoglobin which is
incapable to carry oxygen
2-Mention two other chemical asphyxiant gases than CO poising?
Hydrogen sulfide, hydrogen cyanide
3-What is the proper management for this case?
Immediate removal from exposure, oxygen supply

Problem 13

A group of workers exposed to organic solvents.

1-which food item that should be avoided?
Fatty meals
1-which food items should be encouraged?
Antioxidants and vitamins present in fruit and vegetables