Public health 6 experience

Public health final ✔ and 8th semester ✔ as of yesterday. I don’t remember as much as I would like to, but I do remember at least some of the questions they had.

We were like 20 something students having the exam at 8 yesterday, so I was expecting to have to wait for a while to get called. I wasn’t completely ready at 8 sharp, still cleaning the desk and getting dressed. But then I get a call on Teams.

I answer, being greeted by Prof. Csaba Varga and a co-examiner. They ask me to show ID, and to give them a quick look at the room. Then, they ask me if I’m ready. Prof. Varga draws the first topic from the “A” envelope:

21. Ecological studies. Immigrant studies

This was the same topic where I’d done poorly on my A-chance, so I laugh as I draw it again. I did read up on it after the A-chance, so I thought I would have a good grasp on it now. The examiner asks whether I would like a question to get started, but I tell him that I’m fine.

  • Me: Ecological studies are also called correlational studies. They’re analytical and observational studies.
  • Examiner: They are?
  • M: Yes
  • E: *Visibly disagreeing with what I’ve said*

Good start. From his response I could tell that he disagreed that they’re analytical studies. I don’t remember how we got there, but eventually he asks me:

  • E: So with an ecological study, do you already have a hypothesis or do you construct a new one?
  • Me, changing my answer: You construct a new one
  • E: Yes.
  • E: What kind of data can you use for an ecological study?
  • M: You use mortality, incidence, prevalence, etc. You use populational data like this instead of data on individual cases.
  • E: Okay, what else?
  • M: *Can’t think of anything else
  • E: Could you give me an example of an ecological study?
  • M: Okay, I remember in the lecture there was an example where they looked at how the incidence of suicide was different between different religions in old Germany, or something.
  • E: Mhm. So if we made an ecological study where we compared the amount of salt purchased and the incidence of hypertension in a population, what would be the problem with this?
  • Me, after some thinking: Well areas with higher socioeconomic status would purchase more salt, so that could be a cofounding factor?
  • E: Hmm, could be.
  • M: I can’t think of anything else
  • E: So, not all salt bought is consumed. For example, salt is used on icy roads, etc. So it doesn’t correlate perfectly to salt intake. However, it would be a good estimate. Okay, tell me about immigrant studies
  • M: So immigrant studies compare the incidence and prevalence of disease between immigrants to a country and the host population of that country, to evaluate the effect of genetic factors and environmental factors.
  • E: Could you give me an example?
  • M: So in the lecture there was a study where they compared the incidence of gastric cancer between Japanese immigrants into the US and the native population of the US. After 2 generations the incidence of gastric cancer of the Japanese immigrants increased to reach the incidence of the native population.
  • Examiner, visibly disagreeing: Was the cancer rate higher or lower in the Japanese immigrants?
  • Me, correcting myself: It was higher
  • E: And after how many generations was the incidence equalized
  • M: After 2 or 3, I think.
  • E: After 2, yes.

There was more back-and-forth to get to the correct answers than I made it seem here. I can’t remember any other questions he asked here. Before moving on to the next topic, he asked the co-examiner whether he had any questions, which he didn’t. The professor says “This was good”, which surprised me, actually.

He reaches into the “B” envelope, holds it up to the camera, and draws another topic out.

55. Prevention of infectious diseases: vaccination, chemoprophylaxis

I was so glad I didn’t get a topic about bacteria or parasites in ph4, because my micro knowledge really sucks.

  • Examiner: What’s the difference between vaccination and chemoprophylaxis?
  • Me, after taking a few moments to think: Well, vaccination is something you give to everyone, while chemoprophylaxis is something you give to someone you expect to be exposed to the pathogen if they’re already exposed
  • E: Are all vaccines given to everyone?
  • Me, realizing my mistake: No, there are travel vaccines and stuff like that..

In the end I couldn’t find a good explanation. I guess I should’ve mentioned that vaccines cause prevention for much longer, or something.

  • E: How would you prevent malaria, for example?
  • M: Well I believe there is a recent vaccine against it, but chemoprophylaxis would be more important.
  • E: Who gets the chemoprophylaxis?
  • M: Everyone who are expected to be exposed. Travellers, for example.
  • E: So the whole native population of endemic areas should take chemoprophylaxis?
  • Me, realising my mistake: No, of course not..
  • E: What would be better preventative measures for the native population?
  • M: Well there are insect nets, insect repellants, etc.
  • E: What else?
  • I can’t think of anything
  • E: Killing the mosquitoes for example.

Obviously..

  • E: What types of vaccines do we have?
  • M: There are live attenuated vaccines, where the pathogen is modified to be less pathogenic, or where they use bacteria which are similar to the bacteria, like using mycobacterium tuberculosis bovis in the BCG vaccine
  • E: It’s “mico”-bacterium. Not “maicoh”-bacterium.

Okay

  • Me: Okay, micobacterium tuberculosis.
  • E: Wait, go back. There is another classification of vaccines.
  • Me, pretending to think but actually knowing I don’t know the answer: …
  • E: Active and passive

Isn’t it active and passive _immunization_, and vaccination is a type of active immunization?

  • M: Okay, so passive is when you give IV antibodies.
  • E: Okay. What is anatoxin?
  • Me, after taking a few moment to think: I don’t know.
  • E: What kind of vaccine do we have against diphtheria?
  • M: It’s a toxoid vaccine.
  • E: Yes, that’s the same

I’ve never heard the term “anatoxin”..

  • Me: Okay, so toxoid vaccines are used when the disease is caused by a toxin rather than the pathogen itself. The toxin is inactivated so that it’s no longer pathogenic. These vaccines don’t have to be refridgerated, which is a plus. They don’t give herd immunity, though.
  • E: What were the biggest epidemics in the middle ages?
  • M: Well there’s the black death, at least
  • E: And what’s the scientific name of it?
  • M: The bubonic plague. Caused by yersinia pestis.
  • E: Yes. And what was the other major epidemic?
  • M: I don’t know.
  • E: It was water-borne
  • Me, guessing: Cholera?
  • E: Yes.
  • E: What was the first country or empire to use vaccination?
  • M: Are you thinking about Edward Jenner and the smallpox vaccine?
  • E: No, there was someone much earlier than that.
  • M: I have no idea
  • E: It was the Chinese empire

I learned a lot today

  • E: Do you have any questions, co-examiner?
  • Co-examiner: Yes, I have one question. Which STD can be prevented by a vaccine?
  • Me: Well I’ve noticed that not all sources count it as an STD, but it has to be HPV.
  • Co: Yes, but now that you mention it, why do you think it’s not always regarded as an STD?
  • M: I don’t really know. (Doesn’t HPV only transmit sexually?)
  • Co: It has to do with the mode of transmission, but it’s okay. You answered my original question.
  • E: Okay, let’s move on to the last question.

He holds up envelope “C” and pulls out the last topic.

86. Epidemiology and prevention of breast cancer

I begin by saying that it’s more common in women, to we all laugh. I talked about the risks of age, obesity, high oestrogen exposure, BRCA, screening, etc.

  • E: How is the socioeconomic status related to breast cancer risk
  • M: High socioeconomic status increases the risk.
  • E: Yes. Why?
  • M: Well high socioeconocomic status is related to obesity and low physical activity
  • E: Yes but that’s not really it. Think about carreer women who have children late or no children, or who choose to not breastfeed. But you already talked about that, so it’s okay.
  • E: You said we use mammography in older women, but what can we use in younger women?
  • M: We can use clinical breast exam and self-examination
  • E: Okay but what else. Which modality
  • Me, guessing: Ultrasound?
  • E: Yes. Why do we use ultrasound instead of mammography?
  • M: Well maybe because tumours in young women are different than tumours in older women?
  • E: It’s related to the tissue structure, yes, something like that. Co-examiner, do you have any questions?
  • Co: No, no questions.
  • E: Okay. Then please leave the call, then we will discuss your grade and call you up again in a few minutes.

They called me up after a few minutes, told me I had gotten a 4, and that was it.

Final words

I was done at 08:32, so it took around half an hour. He always showed the paper slips with the topic name, which is nice. He often didn’t give a reaction to my answers, which is annoying, because you don’t know whether you said something wrong or not. I was given multiple chances and hints when answering his questions, though, and he didn’t stress me at all during the exam.

So that’s all for fourth year for me (except derma..). The feeling of relief hasn’t reached me yet, but maybe it soon will.

Thank you to everyone’s best wishes, and especially thank you to those who joined me in the virtual library <3

I have some plans for greek this summer, but I won’t reveal them until later. I will return with some statistics at the end of the exam period, as is tradition by now.

Good luck to those who still have exams left, and to those who are already finished: congratulations!

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