Table 2.
Bioterrorism knowledge-based multiple-choice questions
| Questions | n (%) |
|---|---|
| Q1. The deadliest form of anthrax is: | |
| ▪ Inhalation | 783 (76.8) |
| ▪ Cutaneous | 111 (10.9) |
| ▪ Gastrointestinal | 72 (7.1) |
| ▪ Bubonic (swollen lymph nodes) | 53 (5.2) |
| Q2. What is a critical measure in preventing contact transmission of vaccinia virus (the agent used in the currently licensed smallpox vaccine)? | |
| ▪ Thorough hand washing after contact with the vaccination site | 534 (53.3) |
| ▪ Isolation of the vaccinated person | 200 (20.0) |
| ▪ Use of a porous bandage to cover the vaccination site | 99 (9.9) |
| ▪ Application of the vaccine at an anatomic site normally covered by clothing | 94 (9.4) |
| ▪ Antibacterial ointment applied to the vaccination site | 74 (7.4) |
| Q3. “Which of the following diseases has the potential for the person-to-person spread?” | |
| ▪ Smallpox and plague | 526 (51.5) |
| ▪ Anthrax and plague | 414 (40.5) |
| ▪ Plague and botulism | 41 (4.0) |
| ▪ Botulism and brucellosis | 41 (4.0) |
| Q4. Which of the following features help to distinguish the rash of smallpox from that of chickenpox? | |
| ▪ The smallpox rash is centrifugal (the majority of lesions are on the face and extremities), while the rash in chickenpox is central (the majority of lesions lie on the trunk). | 471 (47.2) |
| ▪ The initial smallpox lesions coincide with the onset of fever, while the fever in chickenpox precedes the rash by 2–3 days | 260 (26.1) |
| ▪ Various stages of lesion progression can be found at any one single location on a smallpox patient, while the lesions of chickenpox tend to all occur at the same stage of development. | 191 (19.1) |
| ▪ Lesions rarely occur on the palms and soles in smallpox, while lesions commonly occur on the palms and soles in chickenpox. | 76 (7.6) |
| Q5. The most common early presenting syndrome associated with the majority of high-risk (“Category A”) bioterrorism-associated diseases (i.e., anthrax, botulism, plague, smallpox, tularaemia, and viral haemorrhagic fevers) is: | |
| ▪ Influenza-like illness | 415 (40.8) |
| ▪ Fever and rash | 380 (37.4) |
| ▪ Acute bloody diarrhoea | 179 (17.6) |
| ▪ Acute hepatitis | 42 (4.1) |
| Q6. A pathognomonic chest X-ray finding of advanced inhalation anthrax is: | |
| ▪ Widened mediastinum | 429 (42.6) |
| ▪ Cavitation | 293 (29.1) |
| ▪ Normal chest X-ray despite dyspnoea and tachypnea | 286 (28.4) |
| Q7. Epidemiologic features of a plague outbreak that may indicate an intentional release of the plague organism include: | |
| ▪ Location of infections outside of areas of known enzootic infection | 391 (39.5) |
| ▪ Occurrence in persons with known health risks such as chronic pulmonary disease | 336 (33.9) |
| ▪ Occurrence in areas with prior reported rodent deaths | 263 (26.6) |
| Q8. Which of the following are high biological terrorism threats because of substantial morbidity and mortality, ease of production, efficient dissemination, stability in aerosol, or high infectivity? | |
| ▪ Anthrax, smallpox, botulism, and plague | 331 (32.6) |
| ▪ Anthrax, chickenpox, botulism, and plague | 291 (28.6) |
| ▪ Anthrax, smallpox, chickenpox, and plague | 250 (24.6) |
| ▪ Anthrax, smallpox, mumps, and plague | 144 (14.2) |
| Q9. Smallpox has all of the following clinical features EXCEPT: | |
| ▪ The virus can only be spread through direct or indirect contact with open lesions (e.g., by touching an infected lesion or by contact with infected clothing or bedding). | 307 (30.5) |
| ▪ During the incubation period, the infected person looks and feels healthy and cannot infect others | 279 (27.7) |
| ▪ Infectivity is highest after the fever has begun and during the first 7–10 days following the appearance of the rash. | 287 (28.5) |
| ▪ The incubation period ranges from 7 to 17 days. | 135 (13.4) |
| Q10. Which of the following symptoms is/are not commonly found in inhalation anthrax, and if present, could help to differentiate an upper respiratory tract infection from anthrax? | |
| ▪ Rhinorrhoea and sore throat | 293 (28.7) |
| ▪ Meningeal signs | 389 (38.1) |
| ▪ Dyspnoea | 191 (18.7) |
| ▪ Vomiting | 140 (14.5) |
| Q11. According to KFMC policies, a physician who sees a patient he or she suspects of having anthrax or smallpox must notify the Ministry of Health: | |
| ▪ By phone as soon as the provisional diagnosis is established | 265 (26.2) |
| ▪ By phone as soon as the suspected diagnosis has been laboratory confirmed | 390 (38.5) |
| ▪ By mail, phone, or fax within 72 h | 184 (18.2) |
| ▪ Immediately after receiving written permission from the patient (or his/her legal guardian) | 174 (17.2) |
| Q12. According to KFMC policies, a physician who sees a patient he or she suspects of having anthrax or smallpox must notify the Ministry of Health: | |
| ▪ By phone as soon as the provisional diagnosis is established | 265 (26.2) |
| ▪ By phone as soon as the suspected diagnosis has been laboratory confirmed | 390 (38.5) |
| ▪ By mail, phone, or fax within 72 h | 184 (18.2) |
| ▪ Immediately after receiving written permission from the patient (or his/her legal guardian) | 174 (17.2) |
Because of missing data in responses, items have various denominators
The questions have been ordered from the most to the least correct answers