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Questão 1
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About syphilis, evaluate the following statements, assigning T when you consider the answer TRUE and F when you consider it FALSE. Then choose the correct option.
( ) In recent decades, the occurrence of syphilis has increased throughout Brazil. 
( ) The treatment and follow-up of partnerships is a point that needs to be approached with a great deal of attention and care. 
( ) Social factors do not significantly change the dynamics of STIs, including syphilis.
( ) There are no groups that are more vulnerable to getting an STI.
Escolha uma opção:
a. TTFF
b. TFTT
c. TTFT
d. FFTT
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(T) In recent decades, the occurrence of syphilis has increased throughout Brazil. FEEDBACK – True. The lack of prevention and barriers concerning adequate treatment are factors that have contributed to the increase in the occurrence of syphilis throughout Brazil.  
(T) The treatment and follow-up of partnerships is a point that needs to be approached with a great deal of attention and care. FEEDBACK – True. The treatment and follow-up of partnerships need to be approached with great attention and care since the cure of partnerships is important for breaking the chain of transmission of syphilis.  
(F) Social factors do not significantly change the dynamics of STIs, including syphilis. FEEDBACK – False. Social factors modify the dynamics of STIs, including syphilis, with an increase in infection in the most vulnerable populations, such as, for example, among black/brown-skinned women, adolescents, those poorly educated, and men who have sex with young men.  
(F) There are no groups that are more vulnerable to getting an STI. FEEDBACK – False. Although all sexually active people can get STIs, there are groups with a greater social vulnerability that deserve attention, such as people with black or brown skin color, poorly educated, adolescents, as well as sex workers, men who have sex with men, drug users, etc.
A resposta correta é: TTFF
Questão 2
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Read the following statements about STIs and then choose the alternative with the correct statements:
I. Social determinants are factors that interfere in the incidence of STI cases, including syphilis in pregnancy and, consequently, congenital syphilis;
II. The stigma associated with STIs interferes with the proper follow-up of infected people and their partner(s), contributing to the persistence of high rates of congenital syphilis in Brazil.
III. Lack of knowledge, stigma about sexually transmitted infections, and fear of getting sick are some barriers to accessing health services that present themselves as an obstacle to reducing STIs, especially congenital syphilis.
IV. Maternal age, education, and skin color are individual characteristics that do not increase the risk of STIs, including syphilis in pregnancy.
The assertions are true:
Escolha uma opção:
a. I and II.
b. I, II, and III.
c. II, III, and IV.
d. II and IV.
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I. Social determinants are factors that interfere in the incidence of STI cases, including syphilis in pregnancy and, consequently, congenital syphilis; FEEDBACK – True. Social determinants such as housing, income, education, nutrition, among others, interfere in the incidence of STIs, including syphilis in pregnancy and congenital syphilis.
II. The stigma associated with STIs interferes with the proper follow-up of infected people and their partner(s), contributing to the persistence of high rates of congenital syphilis in Brazil. FEEDBACK – True. The stigma associated with STIs interferes with adequate monitoring of partnerships since it distances such people from health services and contributes to the persistence of the STI scenario, including syphilis, in Brazil.
III. Lack of knowledge, stigma about sexually transmitted infections, and fear of getting sick are some barriers to accessing health services that present themselves as an obstacle to reducing STIs, especially congenital syphilis. FEEDBACK – True. To reduce STIs, access to health care facilities is fundamental because it is the treatment of people with STIs and their partners that will reduce such issues. Yet fear of getting sick and lack of knowledge are barriers to access health services.
IV. Maternal age, education, and skin color are individual characteristics that do not increase the risk of STIs, including syphilis in pregnancy. FEEDBACK – False. The risk of STIs, including syphilis in pregnancy, is increased in young women and adolescents, poorly educated women, and women with brown and black skin color. Such characteristics are social determinants associated with vulnerabilities that hinder access to prenatal care and adequate care.
A resposta correta é: I, II, and III.
Questão 3
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Regarding combination prevention, choose the correct answer:
Escolha uma opção:
a. It entails interventions in the biomedical, behavioral, and structural fields.
CORRECT. Combination prevention is a strategy that aims to meet the needs of the individual by offering different prevention strategies in order to consider their moment of life (understanding that needs are dynamic and vary throughout one person's life) and the context in which they are embedded.
b. All interventions need to be used simultaneously.
c. It presents a hierarchy of strategies.
d. It does not depend on the efforts of the three spheres of government.
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A resposta correta é: It entails interventions in the biomedical, behavioral, and structural fields.
Questão 4
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About HIV/AIDS and viral hepatitis, we can affirm that:
Escolha uma opção:
a. With the provision of multiple prevention strategies, there is no significant influence of socioeconomic or cultural factors on the transmission of the virus.
b. Hepatitis B and C share similar transmission mechanisms to HIV and syphilis. Therefore these diseases, along with other sexually transmitted infections (STIs), should be addressed together.
CORRECT. Sexual transmission of hepatitis C is infrequent, but because of its possibility of occurrence, it is recommended that it be addressed along with hepatitis B, HIV, syphilis, and the other STIs, considering the biological aspects and the social context in which they are embedded.
c. Vaccination against hepatitis B is not part of the combined prevention of HIV/AIDS because its indication is not directed at vulnerable populations.
d. Because they are similar regarding transmission, the key populations for diagnosing HIV/AIDS and hepatitis B and C are also the same.
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A resposta correta é: Hepatitis B and C share similar transmission mechanisms to HIV and syphilis. Therefore these diseases, along with other sexually transmitted infections (STIs), should be addressed together.
Questão 5
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Choose the best option:
Carlos is 28 years old and lives on the outskirts of a big city with his wife Karla, 26, who is pregnant and found out, during prenatal care, she is HIV-positive. Carlos is unemployed and has been taking odd jobs to support his family. A month ago, Carlos started to feel very fatigued and weakened, his clothes were loose, and he coughed a lot; he could not take any work anymore. While taking the family to lunch at the public restaurant, Carlos found Reference Center for Social Assistance in the region. He then went there to seek out help. When he arrived at CRAS, he presented an episode of much coughing, and the social worker suspected that it could be tuberculosis, so she advised him to:
Escolha uma opção:
a. Go to the nearest hospital emergency room or Urgent Care Centers, given the severity of the situation.
b. For a few more days, observewhether the symptoms would disappear and seek health care only if they did not improve since social isolation must be maintained.
c. Seek care at the nearest Primary Health Care Center.
Correct. PHC centers should be prioritized for conducting TB diagnosis, treatment, and contact investigation.
d. Return home and wait for the visit of the community health agent, who would direct them to the most appropriate services.
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A resposta correta é: Seek care at the nearest Primary Health Care Center.
Questão 6
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Upon receiving health care, Carlos was diagnosed with tuberculosis, and Karla was diagnosed with latent TB infection. Carlos has started treatment and follow-up at a health center near his home. Karla will be given preventive treatment for TB at the location she has been followed up for HIV. Carlos will have to go to the health center every day to take his medications (Directly Observed Therapy). But then he complains that he cannot afford daily transportation and cannot work. Yet his children could not get a place at the school, where they had lunch every day. What could the PHC center health team do?
Escolha uma opção:
a. Propose that the HIV Specialized Care Service (SAE) – where Karla has been followed up – also monitors Carlos; this way, both can attend the same health service, reducing transportation costs.
b. Organize with CRAS, together with HIV Specialized Care Services, a care plan that considers social benefits and family support so that both can take treatment according to the recommended place and regularity.
Correct. As the care organizer, the Primary Health Center should articulate intra-, inter-, and multi-sectorally with SUS and SUAS services to develop a coordinated care plan based on the care line, aiming at better conditions for the confrontation and control of diseases.
c. Contact the social assistance service of the region to identify possible social benefits and subsidies, but only for Carlos since Karla is undergoing treatment at the specialized service.
d. Dispense a large amount of medication so that Carlos can treat himself at home (self-administered) and does not need to attend the health center daily.
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A resposta correta é: Organize with CRAS, together with HIV Specialized Care Services, a care plan that considers social benefits and family support so that both can take treatment according to the recommended place and regularity.
Questão 7
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Regarding the physical disabilities due to Hansen's disease, choose the correct answer:
Escolha uma opção:
a. People affected by Hansen's disease with grade 1 disability have visible deformities such as claw hands and lagophthalmos, which can be corrected surgically.
b. Although the physical disabilities due to Hansen's disease are frequent, its treatment requires specialized equipment, which is not available in the SUS Health Care Network.
c. Mycobacterium leprae directly affects the muscles, bones, and joints of the hands and feet and may cause permanent destruction of these structures, with irreversible disabilities.
d. Physical disabilities can set in quickly by inflammation of the nerves during reaction states but usually set in slowly and reflect a late diagnosis of the disease.
Correct. Hansen's bacillus multiplies slowly, causing progressive neurological impairment. For this reason, the symptoms are initially discrete, causing some patients to delay seeking health care, which eases the onset of physical disabilities.
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A resposta correta é: Physical disabilities can set in quickly by inflammation of the nerves during reaction states but usually set in slowly and reflect a late diagnosis of the disease.
Questão 8
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Choose the alternative that correctly describes the main reasons for people affected by Hansen's disease to be off work:
Escolha uma opção:
a. People with multibacillary Hansen's disease need to avoid contact with others at the beginning of treatment until the bacilli are killed, and transmission is interrupted.
b. People affected by Hanses's disease in the paucibacillary forms present extensive involvement of several peripheral nerves, which generates diffuse pain and permanent work disability.
c. People affected by Hanses's disease with decreased sensation in the hands should avoid any manual activity, requiring permanent absence from work.
d. Inflammation of the peripheral nerves (peripheral neuritis) is treated with corticoids and immobilization of the affected limb and may temporarily compromise work activity.
Correct. Corticosteroids are potent anti-inflammatory drugs that can prevent neurological damage during acute neuritis. In addition, immobilization decreases friction and pain on the affected nerve.
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A resposta correta é: Inflammation of the peripheral nerves (peripheral neuritis) is treated with corticoids and immobilization of the affected limb and may temporarily compromise work activity.
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