Community medicine UG exam key - SBV 2020

Final MBBS Part-1 Degree Examination – January 2020 – Community Medicine
Paper I (Code: 1291) : Section A
Long answer Question
1. Describe the concept of Natural history of disease using suitable illustration. Discuss the concept of
epidemiological triad with suitable examples. (4+6)
Disease results from a complex interaction between man, an agent (or cause of disease) and the
environment. The term natural history of disease is a key concept in epidemiology. The natural history of
disease is best established by cohort studies. What the physician sees in the hospital is just an "episode" in
the natural history of disease. The epidemiologist, by studying the natural history of disease in the
community setting, is in a unique position to fill the gaps in our knowledge about the natural history of
disease. It has two phases: (1 Mark)
A. Period of Pre-pathogenesis: Before the man is involved.
B. Period of Pathogenesis: Recovery, Disability & Death - the course of disease in man.
A. Period of Pre-pathogenesis: (1 Mark)
• This refers to the period preliminary to the onset of disease in man.
• Agent has not yet entered man
• Factors favouring the interaction of dis. agent with the human host do exist in the environment.
o “Man in the midst of disease” Or “Man exposed to risk factors”
• Causative factors of disease are classified as: Agent, host and environment and is referred to
as “Epidemiological triad”.
• Interaction of the triad is required for the initiation of disease- Black area.
B. Period of Pathogenesis: (1 Mark)
• “Begins with entry of dis. agent in the susceptible human host”
• Progresses through IP & later early and late pathogenesis
• Unpredictable hosts reaction to infection. i.e., typical/ atypical, clinical or subclinical, carrier
(diphtheria, Hep B)
• Spectrum of disease- Eg: Leprosy Chronic diseases (CHD, HTN, Cancer) the early pathogenesis
phase is less dramatic. Its referred to as pre-symptomatic phase. (Diagram 1 Mark)

Epidemiological triad: (2 Marks)
This model – agent, host and environment- has been in use for many years. It helped epidemiologists
to focus on different classes of factors, especially with regard to infectious diseases.
a) Agent factors: (1 Mark)
• Biological: viruses, rickettsiae, fungi, bacteria, protozoa and metazoan.
• Nutrient: proteins, fats, carbohydrates, vitamins, minerals and water.
• Physical: excessive heat, cold, humidity, pressure, radiation, electricity and sound.
• Chemical: Endogenous- urea, serum bilirubin, ketones, uric acid and calcium carbonate.
Exogenous - allergans, fumes, metals, dust, gases and insecticides.
• Mechanical: friction, crushing, tearing, sprains and dislocations.
• Absence or insufficiency or excess: Chemical, nutrient, lack of structure, lack of part of structure
and chromosomal factors.
• Social: poverty, smoking, abuse of drugs and alcohol, unhealthy lifestyles, social isolation and
maternal deprivation.
b) Host factors: (1 Mark) Demographic, biological, social and economic and lifestyle factors.
c) Environmental factors: (1 Mark)
• Physical: air, water, soil, housing, climate, heat, light, noise, debris and radiation.
• Biological: virus, other microbial agents, rodents, insects, animals and plants.
• Psychosocial: cultural values, customs, habits, beliefs, attitude, moral, religion and education,
lifestyle, community life, health services and political organization.
Examples: Epidemiological triad for tuberculosis: (1 Mark)
Environment:
Over crowded house
Host:
1. Smoking
2. Person living with HIV
3. K/C/O diabetes
4. Poor immune status
5. Auto immune diseases
6. Children less than 6 years
7. Exposure to patients with tuberculosis
Agent: Mycobacterium
tuberculosis
Mode of transmission:
Sputum of infected
person

Short answer Questions
2. Describe the functions of a family.
They are (Any 4 listed: 2 Marks & any 4 explained: 2 Marks) What about generalised answer?
a) Child rearing
b) Socialization
c) Personality formation
d) Care of dependant adults
e) Stabilization of adult personality
f) Familial susceptibility to disease
a) Child rearing:
The child rearing is undertaken differs enormously from society to society, and from time to time,
depending upon factors such as capital resources , level of knowledge, state of technology and system
of values. It is important to note that patterns of child are (e.g ., feeding , nutrition, hygiene, sleep ,
clothing, discipline, habit training) are passed on from one generation to another. In many societies,
child care is socially determined by tradition. Child care is more permissive in the East starting with
the "on demand" schedule at mother's breast : in the West, child care is more rigid and confined to a
set of rules. When the community health worker seeks to improve the health of the child, he meets
several obstacles. These obstacles are the traditional ways which are supported by appeals to religion
and other sanctions.
b) Socialization:
The second responsibility of the family is to socialize the "stream of new-born barbarians." It refers to
the process whereby individuals develop qualities essential for functioning effectively in the society
in which they live. It is a latent function. By socialization is meant teaching the young the values of
society and transmitting information, culture, beliefs, general codes of conduct, by example and
precept, in order to make them fit for membership in the wider society of which the family is a part.
c) Personality formation:
This is even a more latent function. It is an area in which sociology comes closest to psychology. The
capacity of an individual to withstand stress and strain and the way in which he interacts with other
people is to a large extent determined by his early experience in the family, mainly with the father,
mother and siblings who provide the earliest and most immediate component of the child's external
environment.
d) Care of dependant adults:
• Care of the sick and injured: In all forms of society, adults may become dependent either through
injury, illness or because of basic biological limitation for performing functions normally expected
by adults. However, the family is charged with the responsibility of care of such individuals. The
family is expected to provide the front-line care, particularly the mother. Much depends upon her
understanding of illness and the extent she believes herself capable of providing nursing care.
• Care of women during pregnancy and child birth: The attitude of society to pregnancy and child-
bearing may have an important bearing on the infant deaths, premature and stillbirths, maternal
morbidity and mortality. In many societies today, women are given financial help, maternity leave
facilities , diet and nutritional supplements and decreased responsibilities during pregnancy and
puerperium.

• Care of the aged and handicapped : The increased number of such people have created new
problems in terms of long term care and specialist facilities. Without the support of the family, no
amount of medical care can succeed. In India, the joint family provides for such support.
e) Stabilization of adult personality:
The family is like a "shock absorber" to the stress and strains of life. The family provides an
opportunity, both for adults and children, for release of tension so that the individual can attain mental
equilibrium and strive to maintain a stable relationship with other people. The stress of modern living
has increased the importance of mental illness as a public health problem. Alcoholism and narcotic
addiction are also a reflection of this trend. Thus the family has an important function in the
stabilization of the personality of both adults and children, and in meeting their emotional needs.
f) Familial susceptibility to disease:
The members of a family share a pool of genes and a common environment and together, these decide
their susceptibility to disease The family is often the playground also for such communicable diseases.
3. List the principles of health education.
Health education is the translation of what is known about health, into desirable individual and
community behaviour patterns by means of an educational process.
Principles of health education are: (Listed any 8 – 4 Marks)
1. Credibility
2. Interest
3. Participation
4. Motivation
5. Comprehension
6. Reinforcement
7. Learning by doing
8. Known to unknown
9. Setting an example
10. Good human relations
11. Feedback
12. Leaders
4. Describe the measures of central tendency.
The word "average" implies a value in the distribution, around which the other values are distributed.
It gives a mental picture of the central value. There are several kinds of averages, of which the commonly
used are : - (1) The Arithmetic Mean, (2) Median, and (3) The Mode. (Listed all 3 – 2 marks)
The Mean (Explained all the three – 2 Marks )
• The arithmetic mean is widely used in statistical calculation. It is sometimes simply called Mean. To
obtain the mean, the individual observations are first added together, and then divided by the number
of observations.
• The operation of adding together is called 'summation' and is denoted by the sign Σ or S. The individual
observation is denoted by the sign η and the mean is denoted by the sign x (called "X bar").
• The advantages of the mean are that it is easy to calculate and understand.
• The disadvantages are that sometimes it may be unduly influenced by abnormal values in the
distribution.
The Median: The median is an average of a different kind, which does not depend upon the total and
number of items. To obtain the median, the data is first arranged in an ascending or descending order of
magnitude, and then the value of the middle observation is located, which is called the median.
The Mode: The mode is the commonly occurring value in a distribution of data. It is the most frequent
item or the most "fashionable" value in a series of observations. The advantages of mode are that it is easy
to understand, and is not affected by the extreme items. The disadvantages are that the exact location is

often uncertain and is often not clearly defined. Therefore, mode is not often used in biological or medical
statistics.
Very Short answer Questions
5. Describe briefly the types of families. (List any 2 – 1 Mark and given a brief description – 1 Mark)
• Nuclear family / elementary family – Consists of married couple & their dependent children
occupying same dwelling space.
• Joint family/ extended family – Consists of number of married couples, property is common,
authority – senior male member
• Three generation family – representatives of three generations related to each other by direct descent
living together.
6. Enlist the stages of demographic cycle (All 5 stages – 2 Marks, any 3 – 1 Mark, any 4 – 1.5 Marks)
a) First stage – Highly stationary stage
b) Second stage – Early expanding stage
c) Third stage – Late expanding stage
d) Fourth stage – Low stationary stage
e) Fifth stage – Declining stage
7. Illustrate the Iceberg phenomenon (Any one is enough – description / illustration – both can be
given 2 marks)
According to this concept, disease in a
community may be compared with an
iceberg . The floating tip of the iceberg
represents what the physician sees in the
community, i.e. clinical cases. The vast
submerged portion of the iceberg
represents the hidden mass of disease, i.e. ,
latent, inapparent, pre-symptomatic and
undiagnosed cases and carriers in the
community. The "waterline" represents the
demarcation between apparent and
inapparent disease. In some diseases (e.g.,
hypertension, diabetes, anaemia,
malnutrition, mental illness) the unknown morbidity (i.e. the submerged portion of the iceberg) far exceeds
the known morbidity. The hidden part of the iceberg thus constitutes an important, undiagnosed reservoir
of infection or disease in the community, and its detection and control is a challenge to modern techniques
in preventive medicine.
8. Define the term Demographic transition.

Paper I (Code: 1291) : Section B
9. Define screening. Describe the types of screening and list the criteria for screening. (2+4+4)
Screening is defined as the search for unrecognized disease or defect by means of rapidly applied tests,
examinations or other procedures in apparently healthy individuals. (2 Marks)
Types of screening (1 Mark)
Three types of screening have been described:
a) Mass screening
b) High-risk or selective screening
c) Multiphasic screening.
Mass screening (1 Mark)
Mass screening simply means the screening of a whole population or a sub-group, as for example,
all adults. It is offered to all, irrespective of the particular risk individual may run of contracting the
disease in question (e.g., tuberculosis). Mass screening for disease received enthusiastic support in the
past. However, when a number of mass screening procedures were subjected to critical review, there
appeared to be little justification for their use in any instances. Indiscriminate mass screening, therefore,
is not a useful preventive measure unless it is backed up by suitable treatment that will reduce the duration
of illness or alter its final outcome.
High-risk or selective screening (1 Mark)
• Screening will be most productive if applied selectively to high-risk groups, the groups defined on
the basis of epidemiological research.
• For example, since cancer. Cervix tends to occur relatively less often in the upper social groups,
screening for cancer cervix in the lower social groups could increase the yield of new cases. One
population sub-group where certain diseases (e .g. , diabetes, hypertension, breast cancer) tend to be
aggregated in the family. By screening the other members of the family (and close relatives), the
physician can detect additional cases.
• Epidemiologists have extended the concept of screening for disease to screening for "risk
factors”, as these factors apparently antedate the development of actual disease.
• For example, elevated serum cholesterol is associated with a high risk of developing coronary heart
disease. Risk factors, particularly those of a patho-physiological nature such as serum cholesterol and
blood pressure are amenable to effective interventions.
• In this way, preventive measures can be applied before the disease occurs.
Multiphasic screening (1 Mark)
• It has been defined as the application of two or more screening tests in combination to a large
number of people at one time than to carry out separate screening tests for single diseases.
• The procedure may also include a health questionnaire, clinical examination and Arrange of
measurements and investigations (e.g., chemical and haematological tests on blood and urine
specimens, lung function assessment, audiometry and measurement of visual acuity) - all of which can
be performed rapidly with the appropriate staffing organization and equipment.
Criteria for screening (4 Marks – all)
The disease to be screened should fulfil the following criteria before it is considered suitable for
screening:
i. The condition sought should be an important health problem (in general, prevalence should be high);

ii. There should be a recognizable latent or early asymptomatic stage;
iii. The natural history of the condition, including development from latent to declared disease, should be
adequately understood (so that we can know at what stage the process ceases to be reversible);
iv. There is a test that can detect the disease prior to the onset of signs and symptoms;
v. Facilities should be available for confirmation of the diagnosis;
vi. There is an effective treatment;
vii. There should be an agreed-on policy concerning whom to treat as patients (e.g., lower ranges of blood
pressure; border-line diabetes) ;
viii. There is good evidence that early detection and treatment reduces morbidity and mortality;
ix. The expected benefits (e.g., the number of lives saved) of early detection exceed the risks and costs.
10. State the uses of Epidemiology (Listed all 7 – 4 Marks, each use – 0.5 Mark)
1) To study historically the rise and fall of disease in the population
2) Community diagnosis
3) Planning and evaluation
4) Evaluation of individual's risks and chances
5) Syndrome identification
6) Completing the natural history of disease
7) Searching for causes and risk factors
11. Briefly describe the effects of radiation.
Biological effects of radiation are divided into two categories. (1 Marks)
• The first category consists of exposure to high doses of radiation over a short period of time
producing acute or short term effects .
• The second category represents exposure to low doses of radiation over an extended period of time
producing chronic or long-term effect. High doses tend to kill cells, causing organ damage. This in
inturn may cause whole body response often called "Acute Radiation Syndrome".
The effects of ionizing radiation can be somatic or genetic as shown below :
A. Somatic (1 Mark)
Immediate
(1) Radiation sickness
(2) Acute radiation syndrome
Delayed :
(1) Leukaemia
(2) Carcinogenesis
(3) Foetal developmental abnormalities
(4) Shortening of life
B. Genetic (1 Mark)
I. Chromosome mutations
II. Point mutations
The biological response of high dose of radiation is as follows
• < 5 rad : No immediate observable effects
• 5 rad to 50 rad : Slight blood changes may be detected by medical evaluations
• 50 rad to 150 rad : Slight blood changes will be noted and symptoms of nausea, fatigue, vomiting
etc. likely
• 150 rad to 1,100 rad : Severe blood changes will be noted and symptoms appear immediately.
Approximately 2 weeks later, some of those exposed may die. At about 300-500 rad, up to one half of
the people exposed will die within 60 days without intensive medical attention. Death is due to

destruction of the blood forming organs. Without white blood cells, infection is likely. At the lower
end of the dose range, isolation, antibiotics, and transfusions may provide the bone marrow time to
generate new blood cells and full recovery is possible. At the upper end of the dose range, a bone
marrow transplant may be required to produce new blood cells.
• 1,100 rad to 2,000 rad : The probability of death increases to 100% within one to two weeks. The
initial symptoms appear immediately. A few days later, things get very bad, very quickly since
the gastrointestinal system is destroyed. Once the GI system ceases to function, nothing can be
done, and medical care is for comfort only.
• 2,000 rad: Death is a certainity. At doses above 5,000 rad, the central nervous system (brain and
muscles) can no longer control the body functions, including breathing and blood circulation.
Everything happens very quickly. Nothing can be done, and medical care is for comfort only. As
noted, there is nothing that can be done if the dose is high enough to destroy the gastrointestinal
or central nervous system. That is why bone marrow transplants don't always work.
C. Genetic effects: (1 Mark)
While somatic effects are recognizable within the life span of the irradiated person, genetic effects
would be manifest in the more or less remote offspring. Genetic effects result from injury to
chromosomes chromosome mutations and point mutations. Chromosome mutation is associated with
sterility. Point mutation affects the genes.
12. State the various ocular manifestations of vitamin A deficiency. (Listed All 5 – 2 marks, explained
all 5 – 2 Marks)
a) Night blindness: Lack of vitamin A, first causes night blindness or inability to see in dim light. The
mother herself can detect this condition when her child cannot see in late evenings or find her in a
darkened room. Night blindness is due to impairment in dark adaptation. Unless vitamin A intake is
increased, the condition may get worse, especially when children also suffer from diarrhoea and other
infections.
b) Conjunctival xerosis: This is the first clinical sign of vitamin A deficiency. The conjunctiva becomes
dry and non-wettable. Instead of looking smooth and shiny, it appears muddy and wrinkled. It has been
well described as "emerging like sand banks at receding tide" when the child ceases to cry.
c) Bitot's spots: Bitot's spots are triangular, pearly-white or yellowish, foamy spots on the bulbar
conjunctiva on either side of the cornea. They are frequently bilateral. Bitot's spots in young children
usually indicate vitamin A deficiency. In older individuals, these spots are often inactive sequelae of
earlier disease.
d) Corneal xerosis: This stage is particularly serious. The cornea appears dull, dry and non-wettable and
eventually opaque. It does not have a moist appearance. In more severe deficiency. There may be
corneal ulceration. The ulcer may heal leaving a corneal scar which can affect vision.
e) Keratomalacia: Keratomalacia or liquefaction of the cornea is a grave medical emergency. The
cornea (a part or the whole) may become soft and may burst open. The process is a rapid one. If the
eye collapses, vision is lost.
13. Define breakpoint chlorination.
• The addition of chlorine to ammonia in water produces chloramines which do not have the same
efficiency as free chlorine.

• If the chlorine dose in the water is increased, a reduction in the residual chlorine occurs, due to the
destruction of chloramine by the added chlorine. The end products do not represent any residual
chlorine.
• This fall in residual chlorine will continue with further increase in chlorine dose and after a stage, the
residual chlorine begins to increase in proportion to the added dose of chlorine.
• This point at which the residual chlorine appears and when all combined chlorines have been
completely destroyed is the breakpoint and corresponding dosage is the breakpoint dosage.
14. List any four major public health nutritional problems in India. (Each 1 – 0.5 Mark)
A. Vitamin A prophylaxis programme
B. Prophylaxis against nutritional anaemia
C. Iodine deficiency disorders control
programme
D. Special nutrition programme
E. Balwadi nutrition programme
F. !CDS programme
G. Mid-day meal programme (School lunch
programme)
H. Mid-day meal scheme (National
programme of Nutritional support to
primary education).
15. State the significance of blocked flea.
• The bacilli multiply enormously in the gut of the rat flea and may block the proventriculus so that no
food can pass through. Such a flea is called a "blocked flea".
• A blocked flea eventually faces starvation and death because it is unable to obtain a blood meal.
• It makes frantic efforts to bite and suck blood over and It over again; and in so doing, it inoculates
(regurgitates) plague bacilli into the bite wound each time it bites.
• A blocked flea , therefore, becomes an efficient transmitter of plague. A partially blocked flea is
more dangerous than a completely blocked flea because it can live longer.
• Infected fleas may live up to an year, and certain species survive in the burrow micro-climate for as
long as 4 years
16. State two disease transmitted by Culex mosquito. (Each 1 – 1 Mark)
• Japanese encephalitis
• Bancroftian Filariasis
• West Nile fever
• Viral Arthritis (Epidemic / Polyarthritis)

Paper II (Code: 1301) : Section A
Long answer Questions
1. Describe the epidemiology of Road Traffic Accidents (RTA) and add a note on preventive measures
of RTA?
Epidemiology (2 Marks)
During the year 2015, a total of 1.77 lakh traffic accidents deaths were reported in the country. The rate
of death per 1000 vehicles has decreased from 1.6 in 2007 to 1.2 in 2011. The rate of accidental deaths per
1000 vehicles was highest in Bihar and Sikkim at 1.6, followed by West Bengal at 1.5. 24.9 per cent of
victims of road traffic accidents were occupants of two wheelers. Maximum number (73,001) of accidents
occurred between 6 PM and 9 PM time period.
Risk Factors (2 Marks)
• Speed - An increase in average speed is directly related both to the likelihood of a crash occurring and
to the severity of the consequences of the crash.
• Drink-driving - Drinking and driving increases both the risk of a crash and the likelihood that death or
serious injury will result. The risk of being involved in a crash increases significantly above a blood
alcohol concentration (BAC) of 0.04 g/dl.
• Motorcycle helmets - Wearing a motorcycle helmet correctly can reduce the risk of death by almost
40% and the risk of severe injury by over 70%.
• Seat-belts and child restraints - Wearing car seat-belt reduces the risk of fatality among front-seat
passengers by 40-50% and of rear-seat passengers by between 25-75%.
• Distracted driving.
Human and Environmental Factors (2 Marks)
• Medical conditions include sudden illness, heart attack and impaired vision and fatigue.
• Psycho-social factors - Lack of experience, risk-taking, impulsiveness, defective judgment, delay in
decisions, aggressiveness, poor perception, family dysfunction
• Lack of body protection measures that are helmets and safety belts.
• Relating to road-defective, narrow roads, defective lay-out of cross-roads and speed-breakers, poor
lighting, lack of familiarity relating to vehicle, excessive speed, old and poorly maintained large
number of 2 or 3 wheelers, overloaded buses, low driving standards and bad weather, inadequate
enforcement of existing laws.
Preventive Measures of RTA (4 Marks)
1. Data collection - There should be a basic reporting system of all accidents. The national data should
be supplemented by special surveys and in-depth studies. These studies will bring out the risk factors,
the circumstances and chain of events leading up to the accident. These details are rarely provided by
the basic reporting system.
2. Safety education - There is a widespread belief that accidents are inevitable; this fatalistic attitude must
be curbed. Safety education must begin with school children. The drivers need to be trained in proper
maintenance of vehicles and safe driving.
3. Promotion of safety measures
• Seat belts: The use of seat belts reduces the number of fatalities and non-fatal injuries by
approximately 50 per cent each.
• Safety helmets: They reduce the risk of head injury by 30 per cent on an average and that of
fatalities by 40 percent.
• Children: Another safe type measure is to ensure that children remain seated when they are in a
vehicle. They should be prohibited to take the front seats of cars.

• Others: These comprise use of door locks, proper vehicle design, use of laminated high penetration
resistance windscreen glass, etc.
• Alcohol and other drugs - Alcohol impairs driving ability and increases the risk of an accident as
well as the severity of its consequences.
• Elimination of causative factors - The factors which tend to cause accidents must be sought out
and eliminated, e.g., improvement of roads, imposition of speed limits and marking of danger
points.
• Enforcement of laws - Legislation embodies codified set of rules. These are enforced by the State
to prevent accidents.
• Rehabilitation services - Rehabilitation consists of a number of elements which each injured person
should benefit from. These are medical rehabilitation, social rehabilitation and occupational
rehabilitation.
• Accident research - The future of accident prevention is in research. Such research will be
concerned with gathering precise information about the extent, type and other characteristics of
accidents, correlating accident experience with personal attributes.
2. Describe the Laboratory diagnosis of pulmonary tuberculosis. (Any 4 methods – 4 marks)
a. Sputum examination: Sputum smear examination by direct microscopy is now considered the method
of choice. Commonly Ziehl-Neelsen acid-fast staining is followed. The reliability, cheapness and ease
of direct microscopic examination have made it number one case finding method all over the world.
Collection of sputum samples - A pulmonary tuberculosis suspect should submit two sputum samples
for microscopy. The chances of finding TB bacilli are greater with two samples than with one sample.
Slide reporting - The number of bacilli seen in a smear reflects disease severity and patient infectivity.
Therefore, it is important to record the number of bacilli seen on each smear.
Number of bacilli Result reported
No AFB per 100 oil immersion fields 0
1-9 AFB per 100 oil immersion fields scanty (or number AFB seen)
10-99 AFB per 100 oil immersion fields + (1 +)
1-10 AFB per oil immersion field ++ (2+)
> 10 AFB per oil immersion field +++ (3+)
b. Radiography - Chest X-rays are useful for the diagnosis of smear negative pulmonary TB and TB in
children. It is not routinely indicated in smear-positive cases.
c. Sputum culture - Isolation of mycobacteria from clinical samples by culture still represents the
corner-stone on which definitive diagnosis of tuberculosis and other mycobacterium.
• BACTEC MGIT 960 system (Becton Dickinson), MB/BaCTsystem and the ESP II culture system.
• Radiometric BACTEC 460 TB method - This technique is specific for mycobacterial growth,
wherein C labeled palmitic acid in 7H12 medium is used.
• MGIT 960 mycobacteria detection system - It is an automated system for the growth and detection
of mycobacteria with a capacity to incubate and continuously monitor 960 mycobacteria growth
indicator tube (MGIT) every 60 minutes for increase in fluorescence.
d. Genotypic methods: Polymerase chain reaction - The PCR allows sequences of DNA present in only
a few copies of mycobacteria to be amplified in vitro such that the amount of amplified DNA can be

visualized and identified. The most common target used in the PCR is IS6110. The following are some
of the methods used for identification of M. tuberculosis and non-tuberculous mycobacteria (NTM).
• Transcription mediated amplification (TMA) and nucleic acid amplification test.
• Cartridge based nucleic acid amplification test
• GeneXpert MTBIR IF
e. Phenotypic method - FAST Plaque TB
f. Tuberculin test – Mantoux test - The Mantoux test is carried out by injecting 1 TU of PPD in 0.1 ml
intradermally on the flexor surface of the left forearm, mid-way between elbow and wrist. The injection
should be made with a tuberculin syringe, with the needle bevel facing upward. The result of the test
is read after 48- 96 hours but 72 hours (3rd day) is the ideal. Those less than 6 mm are considered
"negative". Those between 6 and 9 mm are considered "doubtful", i.e. , the reaction may be due to M.
tuberculosis or atypical mycobacteria. If there is no induration, the result should be recorded as 'O'.
3. Describe two anti- rabies vaccine regimens.
Intramuscular administration of vaccine for post-exposure prophylaxis (2 Marks)
The post-exposure vaccination schedule is based on injecting 1 ml or 0.5 ml (the volume depends on the
type of vaccine) into the deltoid muscle (or anterolateral thigh in children aged <2 years) of patients. The
recommended regimen consists of either a 5- dose or a 4-dose schedule:
a. Essen regimen: the 5-dose regimen prescribes 1 dose on each of days 0, 3, 7, 14, and 28.
b. Zoreb regimen: the 4-dose abbreviated multisite regimen prescribes 2 doses on day 0 (1 in each of
the 2 deltoid or thigh sites) followed by 1 dose on each of days 7 and 21.
Intradermal administration for post-exposure prophylaxis (2 Marks)
The 2-site regimen prescribes injection of 0.1 ml at 2 sites (deltoid or thigh) on days 0, 3, 7 and 28.
4. Define pneumoconiosis. List four conditions that fall under the term pneumoconiosis.
Dust within the size range of 0.5 to 3 micron, is a health hazard producing, after a variable period of
exposure, a lung disease known as pneumoconiosis, which may gradually cripple a man by reducing his
working capacity due to lung fibrosis and other complications. (2 Marks)
List of conditions under pneumoconiosis (Listing any 4 – 2 Marks)
a. Silicosis
b. Anthracosis
c. Byssinosis
d. Bagassosis
e. Asbestosis
f. Farmer’s lung
5. State the composition of reduced osmolarity ORS. (Names – each 0.5 Mark)
Reduced osmolarity ORS
g/l
Sodium chloride 2.6
Glucose, anhydrous 13.5
Potassium chloride 1.5
Trisodium citrate, dehydrate 2.9
Total 20.5
mmol / l
Sodium 75
Chloride 65
Glucose, anhydrous 75
Potassium 20
Citrate 10
Total osmolarity 245

6. State the reactions seen in lepromin test
Two types of positive reactions have been described: (Listing 2 – 2 marks)
(a) Early reaction: The early reaction is also known as Fernandez reaction.
An inflammatory response develops within 24 to 48 hours and this tends to disappear after 3 to 4
days. It is evidenced by redness and induration at the site of inoculation. If the diameter of the red
area is more than 10 mm at the end of 48 hours, the test is considered positive.
(b) Late reaction: This is the classical Mitsuda reaction.
The reaction develops late, becomes apparent in 7- 10 days following the injection and reaching its
maximum in 3 or 4 weeks. The test is read at 21 days. At the end of 21 days, if there is a nodule
more than 5 mm in diameter at the site of inoculation, the reaction is said to be positive.
7. List the warning signs of poor mental health. (Any 4 – 2 Marks)
• Always worrying
• Unable to concentrate because of
unrecognized reasons
• Continually unhappy without justified
cause
• Lose temper easily and often
• Regular insomnia
• Wide fluctuations in moods
• Continually dislike to be with people
• Upset if the routine of life is disturbed
• Aches and pains for which no doctor can
find a physical cause.
8. Mention two key aspects of school health services. (Any 2 – 2 Marks)
• Health appraisal of school children and
school personnel.
• Remedial measures and follow-up.
• Prevention of communicable diseases.
• Healthful school environment.
• Nutritional services.
• First-aid and emergency care.
• Mental health.
• Dental health.
• Eye health.
• Health education.
• Education of handicapped children

Paper II (Code: 1301) : Section B
9. Define primary health care. Describe in detail the principles of primary health care with examples.
(3+7).
A new approach to health care came into existence in 1978, following an international conference at
Alma-Ata (USSR). This is known as “Primary Health Care”. It has all the hallmarks of a PHC delivery,
first proposed by the Bhore Committee in 1946. The Alma-Ata conference defined PHC as: “Primary
health care is essential health care made universally accessible to individuals and acceptable to them,
through their full participation and at a cost the community and country can afford”. (2 Marks)
The concept has been accepted by all countries as the key to the attainment of “Health for All” by 2000
AD. It has also been accepted as an integral part of the country’s health system.
The Principles of Primary Health Care are: (Listed all 4 – 1 Mark and explained all 4 – 4 Marks)
A. Equitable distribution: (1 Marks for explanation, 1 mark for Eg.)
• First key principle in PHC strategy is equity or equitable distribution of health services.
• Health services must be shared equally by all people irrespective of their ability to pay, and all (both
rich or poor, urban or rural) must have access to health services.
• At present, health services are mainly concentrated in the major towns and cities resulting in inequality
of care to the people in rural areas.
• The worst hit are the needy and vulnerable groups of the population in rural areas and urban slums.
This has been termed as social injustice.
• The failure to reach the majority of the people is usually due to inaccessibility.
• PHC aims to redress this imbalance by shifting the centre of gravity of the health care system from
cities (where three-quarters of the health budgetis spent) to the rural areas (where three-quarters of the
people live), bring these services as near people’s home as possible.
B. Community participation: (1 Marks for explanation, 1 mark for Eg.)
• Notwithstanding the overall responsibility of the central and state governments, the involvement of
individuals, families, and communities in promotion of their own health and welfare, is an essential
ingredient of PHC.
• Countries are now conscious of the fact that universal coverage by primary health care cannot achieved
without the involvement of the local community.
• There must be a continuing effort to secure meaningful involvement of the community in the planning,
implementation and maintenance of health services, besides maximum reliance on local resources such
as manpower, money and materials.
• In short, primary health care must be built on the principle of community participation.
• One approach tried in India is the use of village health guides and trained dais. It is now considered
that ASHA and Anganwadi workers are an essential feature of PHC in India.
• They have been greatly influenced by experience in China where community participation in the form
of bare-foot doctors took place on an unprecedented scale.
C. Intersectoral coordination: (1 Marks for explanation, 1 mark for Eg.)
• There is an increasing realization of the fact that the components of PHC cannot be provided by the
health sector alone.
• The Declaration of Alma-Ata states that “PHC involves in addition to the health sector. All related
sectors and aspects of national and community development, in particular agriculture, animal
husbandry, food, industry, education, housing, public works, communication and other sectors”.

• An important element of intersectoral approach is planning – planning with others sectors to avoid
unnecessary duplication of activities.
D. Appropriate technology: (1 Marks for explanation, 1 mark for Eg.)
• It is defined as “the technology that is scientifically sound, adaptable to those who apply it and those
for whom it is used, and that can be maintained by the people themselves in keeping with the principle
of self-reliance with the resources the community and country can afford”.
• The term appropriate is emphasized because in some countries, large, luxurious hospitals that are
totally inappropriate to the local needs, are built, which absorb a major part of the national health
budget, effectively blocking any improvement in general health services.
Short answer Question
10. Describe planning cycle with suitable example (Drawn the cycle or listed all the steps – 2 Marks, Eg:
2 Marks).
Planning is the broad foundation on
which much of the management is based.
Planning may be defined as a process of
analysing a system, or defining a problem,
assessing the extent to which the problem
exists as a need formulating goals and
objectives to alleviate or ameliorate those
identified needs, examining and choosing
from among alternative interventions
strategies, initiating the necessary action for
its implementation and monitoring the system
to ensure proper implementation of the plan
and evaluating the results of intervention in
the light of stated objectives.
1. Analysis of the health situation
2. Establishment of objectives and goals
3. Assessment of resources
4. Fixing priorities
5. Write-up of formulated plan
6. Programming and implementation
7. Monitoring
8. Evaluation
11. Describe the components of essential obstetric care.
RCH- Phase I: (any 2 points – 2 Marks)
• Early registration of pregnancy within (12- 16 weeks).

• Provision of minimum three antenatal check up by ANM or medical officer to monitor progress of
pregnancy and to detect any risk/ complications so that appropriate care including referral could be
taken in time.
• Provision of safe delivery at home or in an institution.
• Provision of three postnatal check-up to monitor the postnatal recovery and to detect complications.
RCH- Phase II: (2 Points – 2 Marks)
• Institutional delivery
• Skilled attendance at delivery.
12. State two advantages and two disadvantages of oral contraceptive pills. (Each point 1 Mark)
Advantages:
• The single most significant benefit of the pill is its almost 100 per cent effectiveness in preventing
pregnancy and thereby removing anxiety about the risk of unplanned pregnancy.
• Gives protection against benign breast disorders including fibrocystic disease and fibroadenoma,
ovarian cysts, iron- deficiency anaemia, pelvic inflammatory disease. ectopic pregnancy and ovarian
cancer.
• The pill should be used primarily for spacing pregnancies in younger women.
Disadvantages:
• Increases risk of cardiovascular problems - myocardial infarction, cerebral thrombosis and venous
thrombosis
• Carcinogenesis : Cervical cancer
• Metabolic Effects: elevation of blood pressure, the alteration in serum lipids with a particular effect
on decreasing high-density lipoproteins, blood clotting and the ability to modify carbohydrate
metabolism with the resultant elevations of blood glucose and plasma insulin.
• Other problems: hepatocellular adenoma, gall bladder disease, adversely affect the quantity and
constituents of breast milk, Subsequent fertility, Ectopic pregnancies
• Must be taken at the same time every day and no protection against STDs.
• Side-effects: Breast tenderness, Weight gain, Headache and migraine and Bleeding disturbances.
Very Short answer Question
13. List the components of APGAR score. (Listed any 3 – 1 Mark, any 4 – 1.5 Mark, 5 – 2 Marks)
• Heart rate
• Respiratory effort
• Muscle tone
• Reflex response
• Colour
Apgar score is taken at 1 minute and 5 minutes after birth. Each sign is given a score of 0, 1 or 2. It
provides immediate estimate of the physical condition of the baby. A perfect score should be 9 or 10. 0
to 3 – Baby is severely depressed. 4 to 6 – Baby is moderately depressed. Score below 5 needs prompt
action.
14. Define PEARL index:
Pearl index is defined as “the number of Failures per 100 woman-years of exposure (HWY)”.
Method used to measure contraceptive efficacy.
This rate is given by the formula: 𝐅𝐚𝐢𝐥𝐮𝐫𝐞 𝐫𝐚𝐭𝐞 𝐩𝐞𝐫 𝐇𝐖𝐘 =
𝐓𝐨𝐭𝐚𝐥 𝐚𝐜𝐜𝐢𝐝𝐞𝐧𝐭𝐚𝐥 𝐩𝐫𝐞𝐠𝐧𝐚𝐧𝐜𝐢𝐞𝐬
𝐓𝐨𝐭𝐚𝐥 𝐦𝐨𝐧𝐭𝐡𝐬 𝐨𝐟 𝐞𝐱𝐩𝐨𝐬𝐮𝐫𝐞
× 𝟏𝟐𝟎𝟎
In applying the above formula, the total accidental pregnancies shown in the numerator must include every
known conception, whatever its outcome, whether this had terminated as live births, still-births or

abortions or had not yet terminated. The factor 1200 is the number of months in 100 years. The total
months of exposure in the denominator is obtained by deducting from the period under review of 10
months for a full-term pregnancy, and 4 months for an abortion.
15. Define the concept of triage in disaster management
Triage is the only approach that can provide maximum benefits to the greatest number of injured in a major
disaster situation. The principle of “First come, first treated”, is not followed in mass emergencies. Triage
consists of rapidly classifying the injured on the basis of the severity of their injuries and likelihood
of their survival with prompt medical intervention. (1 Mark)
It uses the internationally accepted four colour code system (1 Mark)
• Red – Indicates high priority
• Yellow – Medium priority
• Green – Ambulatory patients
• Black – Indicates dead / moribund
patients.
16. List the maternity benefits under ESI act.
• The benefit is payable in cash to an insured women for confinement/ miscarriage or sickness arising
out of pregnancy/ confinement or premature birth of child or miscarriage.
• For confinement, the duration of benefit is 26 weeks, for miscarriage 6 weeks and for sickness
arising out of confinement etc. 30 days.
• The benefit is allowed at about full wages.
• The rate of confinement expenses has been increased from Rs.2,500 to Rs.5,000 per confinement.

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