Health in Humanitarian Crises — MCQs
What is the primary purpose of the World Health Organization's International Health Regulations?
In an accident case, after the arrival of medical team, all should be done in early management except;
Which of the following vaccines is not typically given in disaster situations?
As per the Sustainable Development Goals, what is the target for Maternal Mortality Ratio (MMR)?
A 50-year-old female with a 50 kg body weight suffered burns after a pressure cooker blast, involving 45% of her total body surface area. How much fluid should be given in the first 8 hours?
Ambulatory patients after a disaster are categorized into what color of triage?
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
What is the most common extra-intestinal complication of Shigellosis?
Mobile Medical Units (MMUs) under government health programs can operate through different models. Which of the following statements about MMU operations are correct? 1. MMUs are run by the government 2. MMUs are run by external agencies with medical supplies given by the government 3. MMUs are run by the government and medical supplies are also given by the government 4. MMUs are run by external agencies and medical supplies are also given by the external agency
What is the death rate among cholera-affected individuals in a population of 5000, where 50 people are affected by cholera, and 10 of these individuals have died?
Health in Humanitarian Crises Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary purpose of the World Health Organization's International Health Regulations?
- A. To establish global health standards
- B. To coordinate international health responses
- C. To prevent the spread of diseases across borders (Correct Answer)
- D. To provide financial aid to countries in need
Explanation: ***To prevent the spread of diseases across borders*** - The **International Health Regulations (IHR)** are a legally binding international instrument designed to help countries work together to prevent and respond to **acute public health risks** that have the potential to spread globally. - Their core purpose is to prevent, protect against, control, and provide a public health response to the **international spread of disease** in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. *To establish global health standards* - While the IHR contribute to global health safety, their primary focus is on **risk management and response** rather than setting broad global health standards. - Other WHO initiatives and agreements are more specifically dedicated to establishing **global norms and standards** for health systems and services. *To coordinate international health responses* - The IHR provide a framework for coordination, but their fundamental purpose is to enable countries to **detect, assess, notify, and respond** to public health events of international concern. - Coordination is a means to achieve the goal of preventing international spread, rather than the primary goal itself. *To provide financial aid to countries in need* - The IHR do not involve the direct provision of **financial aid**; their scope is limited to public health measures and reporting. - Financial assistance for health initiatives typically falls under the purview of other **international development organizations** or specific funding mechanisms.
Question 2: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 3: Which of the following vaccines is not typically given in disaster situations?
- A. Influenza (Correct Answer)
- B. Measles
- C. Cholera
- D. Tetanus
Explanation: ***Influenza*** - **Influenza vaccination** is generally **NOT a priority** in acute disaster response and emergency vaccination campaigns. - While influenza can spread in crowded conditions, routine disaster response protocols focus on **immediately life-threatening and epidemic-prone diseases** rather than seasonal respiratory infections. - Influenza vaccination requires **cold chain maintenance** and repeated doses, making it logistically challenging in emergency settings. - WHO and SPHERE guidelines do not list influenza among priority vaccines for disaster situations unless there is a specific ongoing outbreak. *Cholera* - **Oral cholera vaccine (OCV)** is increasingly recommended by WHO for disaster settings with **high cholera risk**, particularly in areas with poor water and sanitation. - Modern OCVs (like Shanchol and Euvichol) have improved **cost-effectiveness** and logistics, making them viable for mass campaigns. - Used in conjunction with **WASH interventions** (water, sanitation, hygiene) for comprehensive cholera control. *Measles* - **Measles vaccination** is the **highest priority** vaccine in disaster response, particularly for children aged 6 months to 15 years. - Its **extreme contagiousness** (R0 = 12-18) and high mortality in malnourished populations make it critical. - WHO recommends measles vaccination within the **first days** of a disaster response in displacement settings. *Tetanus* - **Tetanus toxoid** (often as Td or DT) is essential in disasters involving injuries, floods, earthquakes, or debris. - Protects against **_Clostridium tetani_** infection from contaminated wounds. - Part of standard **wound management protocols** in emergency medical care.
Question 4: As per the Sustainable Development Goals, what is the target for Maternal Mortality Ratio (MMR)?
- A. < 70 per 100,000 live births (Correct Answer)
- B. < 100 per 100,000 live births
- C. < 7 per 1,000 live births
- D. < 10 per 1,000 live births
Explanation: ***< 70 per 100,000 live births*** - **Sustainable Development Goal (SDG) 3.1** specifically targets reducing the global maternal mortality ratio to less than **70 per 100,000 live births** by 2030. - This target aims to address the significant disparities in maternal mortality rates observed across different regions and countries. *< 100 per 100,000 live births* - While this represents an improvement over current global averages, it is **not the specific target set by SDG 3.1** for maternal mortality. - The SDGs establish a more ambitious threshold to ensure greater progress in maternal health outcomes. *< 7 per 1,000 live births* - This value is equivalent to **700 per 100,000 live births**, which is significantly higher than the SDG target and represents a **much higher maternal mortality rate**. - This option reflects a misunderstanding of the scale and denominator used for maternal mortality ratios in the SDGs. *< 10 per 1,000 live births* - This value is equivalent to **1,000 per 100,000 live births**, which is also **significantly higher than the SDG target**. - This option shows a similar misconception regarding the magnitude and proper reporting of maternal mortality ratios.
Question 5: A 50-year-old female with a 50 kg body weight suffered burns after a pressure cooker blast, involving 45% of her total body surface area. How much fluid should be given in the first 8 hours?
- A. 4.5 litres (Correct Answer)
- B. 4 litres
- C. 5 litres
- D. 6 litres
Explanation: ***4.5 litres*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL x body weight (kg) x % TBSA burned**. - For this patient: 4 mL x 50 kg x 45% = 9000 mL. Half of this volume (4500 mL or **4.5 litres**) is given in the first **8 hours**. *4 litres* - This volume would be insufficient for a patient with a 45% TBSA burn and 50 kg body weight according to the **Parkland formula**. - Undersupplying fluid in severe burns can lead to **hypovolemic shock** and organ dysfunction. *5 litres* - This volume is slightly more than the calculated amount for the first 8 hours based on the **Parkland formula**. - Over-resuscitation can lead to complications such as **pulmonary edema** and **abdominal compartment syndrome**. *6 litres* - This volume is significantly higher than the recommended amount for the first 8 hours, indicating **over-resuscitation**. - Excessive fluid administration can worsen burn edema, leading to **compartment syndromes** and potentially impacting organ function negatively.
Question 6: Ambulatory patients after a disaster are categorized into what color of triage?
- A. Red
- B. Yellow
- C. Green (Correct Answer)
- D. Black
Explanation: ***Green*** - **Green tag** is for the walking wounded, meaning those with minor injuries who can move independently and do not require immediate medical attention. - These patients can often assist with **their own care** or aid others, and their treatment can be delayed. *Red* - **Red tag** patients have critical, life-threatening injuries that require immediate intervention to save life or limb. - This category includes conditions like **severe bleeding**, shock, or airway compromise. *Yellow* - **Yellow tag** is assigned to patients with serious injuries that are not immediately life-threatening but require definitive treatment within a few hours. - Examples include **stable fractures**, moderate burns, or significant but controlled bleeding. *Black* - **Black tag** indicates patients who are deceased or have injuries so severe that survival is unlikely even with maximal medical care. - Resources are diverted from these patients to those with a higher chance of survival, to **maximize overall saved lives**.
Question 7: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 8: What is the most common extra-intestinal complication of Shigellosis?
- A. Pneumonia
- B. Meningitis
- C. HUS
- D. Reactive arthritis (Correct Answer)
Explanation: ***Reactive arthritis*** - **Reactive arthritis** is triggered by a prior infection, such as *Shigellosis*, and is the most common extra-intestinal complication, especially in HLA-B27 positive individuals [1]. - It typically presents with a triad of **arthritis**, **urethritis**, and **conjunctivitis**, though not all symptoms may be present [1]. *Pneumonia* - While pneumonia can occur in severely ill patients, it is not a common nor specific extra-intestinal complication directly linked to the pathogenesis of *Shigellosis*. - Respiratory complications are rare in uncomplicated cases of shigellosis. *Meningitis* - **Meningitis** is a rare and severe complication, primarily seen in young children or immunocompromised individuals, and is not the most common extra-intestinal manifestataion. - It suggests systemic spread of the bacteria beyond the gastrointestinal tract, which is uncommon. *HUS* - **Hemolytic Uremic Syndrome (HUS)** is a well-known complication of *E. coli* O157:H7 (Shiga toxin-producing E. coli, STEC), rather than *Shigella* species. - While some *Shigella* strains produce Shiga toxin, HUS is far less common in *Shigellosis* compared to STEC infections.
Question 9: Mobile Medical Units (MMUs) under government health programs can operate through different models. Which of the following statements about MMU operations are correct? 1. MMUs are run by the government 2. MMUs are run by external agencies with medical supplies given by the government 3. MMUs are run by the government and medical supplies are also given by the government 4. MMUs are run by external agencies and medical supplies are also given by the external agency
- A. 1, 2, 3, and 4
- B. 1 and 2
- C. 1, 2, and 3 (Correct Answer)
- D. Only 1
Explanation: ***1, 2, and 3*** - This option correctly identifies the flexible operational models of **Mobile Medical Units (MMUs)** under government health programs. - MMUs can be directly managed by the **government**, managed by **external agencies** with government-provided supplies, or managed by the government with **government-provided supplies**. *1, 2, 3, and 4* - This option incorrectly includes the scenario where MMUs are run by **external agencies** and medical supplies are also provided by the **external agency**. - While external agencies can run MMUs, government health programs typically ensure that essential medical supplies are provided or funded by the **government** to maintain standardization and accessibility. *1 and 2* - This option is incomplete as it misses the model where both the MMU operation and medical supplies are provided by the **government** (statement 3). - Government health programs often have fully integrated models, especially in remote areas. *Only 1* - This option is too restrictive, as it only includes the model where MMUs are run by the **government**. - MMUs often involve partnerships with **external agencies** for operational efficiency or specialized services.
Question 10: What is the death rate among cholera-affected individuals in a population of 5000, where 50 people are affected by cholera, and 10 of these individuals have died?
- A. 10 per 1000
- B. 20 per 100 (Correct Answer)
- C. 1 per 1000
- D. 5 per 1000
Explanation: ***20 per 100*** - The death rate among cholera-affected individuals is also known as the **case fatality rate (CFR)**. - This is calculated as (number of deaths / number of *affected* individuals) × 100 = (10 / 50) × 100 = **20% (or 20 per 100)**. - CFR measures the severity of disease among those who contract it. *1 per 1000* - This would represent a case fatality rate of 0.1%, which is far lower than the actual rate. - This is an incorrect calculation that doesn't match the given data. *5 per 1000* - This would represent a case fatality rate of 0.5%, which is also incorrect. - This calculation does not reflect the proportion of deaths among cholera-affected individuals. *10 per 1000* - This appears to confuse the number of deaths (10) with a rate expression. - The actual **mortality rate** (deaths per total population) would be (10 / 5000) × 1000 = **2 per 1000**, not 10 per 1000. - The question specifically asks for death rate among *affected* individuals (CFR), not the population mortality rate.
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