Situational task

At the sanitary examination of the therapeutic department of the hospital it was

established that it is located on the 3nd floor of a 6-storey building and consists of a ward
sections. Internal planning of the corridor is two-sided with orientation of the wards
windows to the south-east and north-west. 3 wards (for 2 and 4 beds) have north-west
orientation. At the time of the examination, 30 patients were hospitalized in the department.
The ventilation of the wards is carried out regularly twice a day, wet cleaning using
disinfectants – 3 time per day. Laboratory and instrumental studies of microclimate
parameters and air environment in a 4-bed room (area 30 m2, height 3,5 m) gave the
following results: air speed in the ward of 0,21 m/s, relative humidity 75 %, CO2
concentration – 0,25 %. The results of temperature measurements are presented in the table.

Place of measurement
Height of Air temperature
measurement Near external Near internal wall In the center of
wall room
0,2 15 17 18
1,5 17 20 19

The temperature of the inner surface of the outer wall is 16°С, the daily temperature
difference is 3.5°С.

Required:
1. Provide a hygienic assessment of the conditions of patients' stay; evaluate the
results of laboratory and instrumental study of microclimate parameters and CO 2 content in
the air of the ward.
2. Establish risk factors for the health of patients and hospital staff.
3. Make a forecast of the effects of the risk factors on health.
4. Develop a scheme of hygienic and preventive measures.
5. List out the devices used for study of microclimate parameters.
 Situational task

When examining the land plot for the construction of a hospital for 200 beds, the
following was discovered: the area of the land plot is 40 000 m2, the shape is rectangular
with a side’s ratio of 2:3 and a long side position in the middle latitudes. Groundwater level
is 1.6 m from the soil surface. The land plot has a convenient connection with the service
area. Relief of the area is plain with a natural slope of 1-6˚. The area is located on the
windward side of the industrial zone, sources of pollution of the environment. The green
area is 45 % of the total land area. The perimeter of the plot is planted with two rows of
trees and a number of bushes of 15 m width. The noise level at 7.00-23.00 is up to 55 dBA,
at 23.00-7.00 is up to 40 dBA.

Required:
1. Give a hygienic assessment of the land plot.
2. Establish risk factors for patient health.
3. Predict the effects of risk factors on patient health.
4. Develop a scheme of planning, preventive and sanitary measures to create optimal
sanitary and hygienic conditions for patients.
5. Describe the methodology for calculating the percentage of landscaping and the
percentage of development.
 Situational task

The water supply of the secondary school of the village of N. is carried out from the
artesian well, the sewer in the village is absent, and there are two waterproof cesspools. The
discharge of the artesian well is 25 m3/h.
It's been discovered that the cesspools are overcrowded. Visually there is pond which
is located next to the school establishment by impurities. The local population is resting
near the pond. Wastes are removed irregularly.
Laboratory study of water samples from an artesian well and pond give the following
results:
Water from Water from
№ Indices of water quality
artesian well pond
1. Turbidity, nephelometric unit of turbidity
1,5 1000
(NUT)
2. Odor at t 20° C, score 1 3
3
3. Ammonia, mg/dm 0,8 4,4
3
4. E.coli, CFU/100 сm abs. 110

Extract from State Standards 2.2.4-400-10: 1. Organoleptic parameters: a) inorganic

components: turbidity 2,6 NUT, odor at t 20°C, points <2; 2. Sanitary toxicological
parameters: a) inorganic ammonium <2,6 mg/dm3, 3. Microbiological parameters: E. coli
(CFU/100 cm3) – absence.

Required:
1. Assess the hygiene situation in the school.
2. Determine water quality indicators that may be a risk factor for public health, using
the excerpt from State Standards 2.2.4-400-10.
3. Make a forecast of the consequences of the possible impact of contaminated water
on the health of the population.
4. Propose measures to prevent the water epidemic of acute intestinal infections
among the population.
5. Check the effectiveness of the measures taken.
 Situational task

A citizen of the city of N. complains about the unacceptable noise that appeared
recently in his home. A citizen lives on the 2nd floor of a 5-storey residential building. On
the first floor, a base of stationery was placed for a long time, which in the last period was
re-profiled into a supermarket for the sale of food products. The re-profile of this facility
was accompanied by its equipment with powerful industrial refrigeration equipment. The
inhabitant complains that especially inadmissible noise is felt at night.
During the survey of a residential apartment, the following noise levels were set: at
8.00 – 68±0,5 dBA, at 13.00 – 75±0,8 dBA, at 17.00 – 74±0,6 dBA, at 23.00 – 68±0,5 dBA
(according to State Building Norms permissible levels of noise in apartment at night should
not exceed 45 dBA, during day – 55 dBA).

Required:
1. Give a hygienic assessment of the situation in a residential apartment.
2. Establish a risk factor for residents of a residential building.
3. Forecasting the effects of risk factors on the health of residents of a residential
building.
4. Identify possible options for carrying out preventive measures.
5. Indicate a list of instruments for instrumental research at the facility.
 Situational task

The project for the construction of a new subway line has arrived for examination. It
is known from the explanatory note of the project that the construction of the new line is
planned to be conducted at a shallow depth (-15 m from the zero cycle), 2/3 of it will be
located in the central part of the densely populated area of the residential zone, where there
are mostly multistory dwelling houses (8-26 floors) the last period of development.
Especially in poor condition there is a plumbing and sewerage network of outdated
buildings.
From the explanatory note to the subway project, it is known that the levels of total
vibration in residential areas will be within:
Average geometric frequencies
City district Indices of octave bands, Hz
2 4 8 16 31,5 63
The central part with a Vibration speed 59 63 57 57 57 57
I relatively high population Vibration
20 20 20 25 27 37
density acceleration
Building area with 5-story Vibration speed 89 83 83 73 73 73
houses of panel type with
II Vibration
a relatively low population 30 30 30 35 40 45
acceleration
density
Vibration speed 79 73 67 67 67 67
Allowable levels Vibration
25 25 25 31 37 43
acceleration

Required:
1. Schedule a sanitary situation that may occur in one area of the city's urban area in
connection with the construction of a new metro line.
2. Identify possible negative factors that can lead to complication of sanitary
conditions of life of residents of one of the districts.
3. Name the nosological forms of diseases, their main manifestations, which can be
caused by unfavorable conditions of people's living.
4. Propose measures aimed at preventing deterioration of the sanitary conditions of
the population.
5. Indicate the device used to determine the levels of vibration in the living space.
 Situational task №___ (part one)

The plant for the production of chemical reagents is located on the outskirts of the
city of S. The main products of the plant are toluene and benzene. Due to the
nonhermeticity of technological equipment, the presence of manual operations in the
production, atmospheric air pollution with toluene and benzene is possible. The plant is
located at a distance of 200 m from the township of the city of K.
During the year, measurements of the toluene and phenol concentrations in the
atmospheric air of the township area of the city of S. were carried out.

№ of Concentration in atmosphere air, mg/m3 at a distance:

measurement toluene phenol
200 m 500 m 200 m 500 m
№1 0,52 0,35 0,19 0,14
№2 0,49 0,32 0,18 0,13
№3 0,33 0,34 0,19 0,14
№4 0,55 0,40 0,17 0,15
№5 0,61 0,39 0,17 0,15
№6 0,63 0,41 0,18 0,14
Note: MAC in ambient air: toluene – 0,6 mg/m , benzene – 0,1 mg m3.
3

Required:
1. Evaluate the location of the plant for the production of chemical reagents in the
residential zone according to hygiene requirements.
2. Point out the risk factors for the health of the population living in the area of the
plant's location.
3. Analyze the effects of the risk factors on the population health.
4. Propose measures for the sanitary protection of the airspace of the territory.
5. List the devices used for air sampling and the rapid analysis of chemical impurities
in the air.
 Situational task

A boy 6 years 2 months is preparing for school. The body length of body is 119 cm,
the body weight is 15 kg, the chest circumference is 54 cm, the subcutaneous fat is 1,4 cm
thick, the number of permanent teeth is 2, the lung volume is 1000 ml, the muscle strength
of the right hand is 6 kg, the left - 5 kg During the year the child was ill with acute
respiratory diseases three times. Has dyskinesia of biliary tract in the stage of stable
remission, myopia of weak degree and caries. Estimation for the Kern-Irasyk test is 8 (3 + 2
+ 3) points, sounds pronunciation is correct. The boy can read and count.

Required:
1. Identify a child's health group.
2. Give a hygienic assessment of the boy's functional readiness for school.
3. Suggest the methods of depth psychophysiological examination of the higher
nervous activity of the child, which can be additionally used for hygienic assessment of the
child's functional readiness for schooling.
4. Develop and justify a set of hygienic and preventive and sanitary measures.
5. Make a comprehensive assessment program for the physical development of the
child.
 Situational task

A woman of 39 years old turned to a pediatrician with a 7 year old child who
complained of abdominal pain, massive multiple vomiting, headache, thirst, dryness and
bitterness in the mouth. Objectively: the child's skin is pale, lips and tongue are dry, lined
with white layers, body temperature is 37,31 ºС. Mother had only one-time vomiting and an
unpleasant sensation in the epigastrium. Mother with child resting at the sea, where they
ate, bought from the sellers on the beach, brewed cakes with vanilla cream. Pastry was very
sweet and fragrant.

Required:
1. Give a hygienic and epidemiological assessment of the situation, pre-set the type of
food poisoning.
2. Determine source of contamination (suspicious product).
3. Identify risk factors and predict the effects of their effects on the individual's
health.
4. Substantiate measures to prevent the onset of foodborne toxoids.
5. Introduce the functional duties of health care providers who first discovered or
suspected food poisoning.
 Situational task

During the annual scheduled medical examination of the 3th year students of the
Medical University, which is held every year, doctor of the student clinic drew attention to
four students: a student N. 19 years old, 174 cm height, 61 kg weight; Student O. 20 years
old, 155 cm height, 85 kg weight; Student K. 21 years old, 167 cm height, 49 kg weight.
Everyone complains of drowsiness in the afternoon, fast fatigability, poor appetite.
Objectively: there is dryness and pallor of the skin, bluish tint of the gums and lips,
bleeding gums. Special study on the resistance of capillaries found that in two of them 25-
27 petechia per 1 cm2 of skin were formed, in the other two - 34-35 petechia per 1 cm2 of
skin. Students live in a hostel and eat fast-cooked pasta, dumplings, sandwiches. Vegetables
and fruits practically do not consume.

Required:
1. Give a hygienic and epidemiological assessment of the situation, pre-determine the
type of hypovitaminosis, given that in the amount of petechia less than 15 -
hypovitaminosis is absent, 15-30 - prehypovitaminosis, more than 30 - hypovitaminosis.
2. Indicate the main causes of hypovitaminosis.
3. Predict the effects of long-term effects on the health of the individual established
hypovitaminosis.
4. Develop a plan of measures for the prevention and treatment of this deficit, to give
recommendations for the correction of the diet.
5. Name additional tests to determine this hypovitaminosis.
 Situational task

60 years old patient is under the supervision of a district doctor. He turned with
complaints of pain in the fingers of the legs and their swelling.
A patient with a hyperstenic constitution, a body weight is 87 kg, a height is 171 cm.
A pulse on the radial artery of the left arm is 75, arterial pressure – 142/76 Hg mm. In the
biochemical analysis of blood elevated levels of total protein and changes in the albumin-
globulin factor were found.
The patient, on the advice of a doctor, has a diary of food. The patient's diet contains:
protein – 125 g, including animal protein – 110 g, fat – 80 g, including vegetable fat – 9 g,
carbohydrates – 200 g, including simple – 190 g (with protein norm – 67 g, including
animal – 37 g, fat – 68 g, including vegetable - 20 g, carbohydrates – 392 g, including
simple – 59 g).
Meat, legumes are prevailing products in nutrition, he consumes a lot of mushrooms.
Frying is often used as a kind of culinary treatment. Fish and fruits are consumed
irregularly. Physical activity is low.

Required:
1. Conduct a hygienic assessment of the actual nutrition of the patient.
2. Establish risk factors for the health of the patient with this nutrition.
3. Predict the effects of the risk factors on the patient's health state in order to
complete the recommendations.
4. Develop and substantiate preventive measures.
 Situational task

In order to optimize the provision of medical care to the residents of the new
residential microdistrict, a decision was taken on the construction of a health care
institution. The area allocated for the development of hospital buildings occupies 19 % of
the land, the greenery area – 60 %, the area of the garden park area – 32 m2 per bed. The
following zones are allocated on the land plot: medical buildings for non-infectious
patients, medical buildings for infectious patients with separated garden and park zones, as
well as an economic zone in which the pathologic-anatomical department is located.
There are 3 separate entrances to the territory of the hospital: to the zone of medical
buildings for non-infectious patients, to the zone of infectious corps and to the economic
zone with a pathologic-anatomical department. The parking facilities are planned at a
distance of 100 m from the ward buildings.

Required:
1. Evaluate the results of the expert hygienic assessment of the hospital.
2. Propose measures to improve the conditions of patients' stay.
3. Indicate the normative document for the design of certain types and types of health
care facilities.
4. Calculate the percentage of construction and the percentage of landscaping of the
land.
 STATE EXAM

Situational task №___ (part two)

The general operating room area is 29 m2. The average air temperature in operating
room is +17°C, the average temperature horizontal variation is +32°C; vertical variation is
+4°С; the radiation temperature (the temperature of the inner surface of the outer wall) -
+15°C, the relative humidity is 45%, the air movement speed is 0,3 m/sec. Heating of the
operating room – radiation, with the arrangement of coolants in the outer walls of the
operating room.

Required:
1. Assess the results of the microclimate survey.
2. To propose preventive measures to improve the microclimatic conditions.
3. Fill in the protocol of measurement of microclimate parameters.

Microclimate parameters
Air
Air Relative Radiant
Premises movement
temperature, humidity, temperature,
speed,
С % С
m/sec
Operating
room

4. Determine the average room temperature.

 Situational task

At the examination of the organized team (garment vocational school) to assess the
nutrition the content of vitamins in a typical daily diet were determined: A – 1.20 ± 0.01
mg, B1 – 1.2 ± 0.2 mg, B2 – 2.5 ± 0.3 mg, B6 – 2.2 ± 0.5 mg, PP – 7 ± 2.5 mg, C – 35 ± 11
mg, with normal content of vitamin A – 1.0 mg, B1 – 1.5-2.5 mg, B2 – 2-3 mg, B6 – 1.5-
3.6 mg, PP – 5-10 mg, C – 70-100 mg.
During the medical examination it was established: girls have average weight with
harmonious physical development, biological age corresponds to calendar, constitutional
type is normosthenic or asthenic, mucous membranes and skin without significant changes.
Often they are ill with acute respiratory viral diseases, after which there are numerous
petechiae in the places of clothes friction (cuffs, belts).
Fatigue is noted and disability is reduced during practical classes.

Required:
1. Evaluate the diet for vitamins content.
2. Specify consequences for the organism at such nutrition.
3. Recommend to diet-nurse to add to the menu-table dishes, which allow to bring the
content of vitamins to the physiological norm.
4. Provide rapid tests to diagnose the presence of this hypovitaminosis