Communicable disease

Scenario.1: 42 yrs old man comes to you with continuous fever and cough with expectoration for
3weeks. Investigations were suggestive of TB .His weight is 35kg.

Questions:
Under the national program for Tuberculosis

1. Define Presumptive Tuberculosis? (2mark)

Answer: It refers to a patient who presents with symptoms or signs suggestive of [Link] it is
known as a TB suspect
2. What are all the investigations prescribed for diagnosis of TB? (2mark)
Answer: Sputum examination, Chest x-ray, CBNAAT
3. What are the drugs and it’s Dosage in a single tablet during intensive phase as FDC? (2mark)
Answer: Isoniazid-75 mg, Rifampicin-150 mg, Pyrazinamide- 400 mg and Ethambutol-275
mg
4. Write one side effect of each drug used in FDC? (2mark)
Answer: Isoniazid-Gastric irritation, peripheral neuropathy
Rifampicin-Red color urine, Gastritis
Pyrazinamide- hepatotoxicity, hyperuricaemia
Ethambutol- retro bulbar neuritis
5. Mention the treatment schedule for this case? (2mark)
Answer:
Type of TB case Treatment regimen in IP Treatment regimen in CP
regimen
New and previously treated cases 2 HRZE 4 HRE
H and R sensitive/unknown 75/150/400/275 75/150/275
35 kg 3 3

Scenario.2: 35 yrs old man comes to you with foot drop on right side and weakness on the other side.
There were 6 hypo pigmented patches in back side of the body

Questions:
1. What is your provisional diagnosis? (2 mark)
Answer:Multibacillary Leprosy with Grade 2 feet deformity
2. What is the clinical classification used for control this disease? (2 mark)

Answer:

Characteristics Pauci-bacillary (PB) Multi-bacillary (MB)

Skin lesions 1-5 6 and above

Peripheral nerve No nerve/only one nerve >1 nerve involvement

involvement

Skin smear Negative at all sites Positive at any site

3. Treatment regimen to this case? (2 mark)

Answer:
MDT-MB -Duration 12 months
- Rifampicin 600 mg once a month under supervision for 12 months
Dapsone 100 mg daily self administered for 12 months
 Clofazimine 300 mg once a month under supervision for 12 months
Clofazimine 50mg daily self administered for 12 months
4. Name and two objectives of the National programme associated with disease? (3 mark)
Answer:

i)National leprosy eradication programme (NLEP)

ii) Objectives
a) To reduce Prevalence rate less than 1/10,000 population at sub national and district level.
b) To reduce Grade II disability % < 1 among new cases at National level
c) To reduce Grade II disability cases < 1 case per million population at National level.
d) Zero disabilities among new Child cases.
e) Zero stigma and discrimination against persons affected by leprosy

5. Name of the mascot associated with the programme? (1 mark)

Answer:
Sapna is a concept (mascot) designed and developed using a common girl living in community, who will
help spread awareness in the community.

Scenario.3:30 yrs old man, a truck driver comes to you with urethral discharge for the past one week.
History of sexual contact with Commercial Sex Workers is present.

Questions:

1. What is Suraksha clinic? (2 mark)

Answer:
Suraksha Clinic is a chain of STI/RTI Clinics. These clinics started in the year 1992 and was established
by National AIDS Control Organization for the better health services and for the prevention of HIV/AIDS in
India
2. What is the treatment for this case? (2 mark)
Answer:
Tab Azithromycin 1G single dose and [Link] 400mg single dose orally
3. How many color codes kits are available in syndromic approach? (2 mark)
Answer:
7 color codes
Grey,Green,White,Blue,Red,Yellow,Black
4. What is the color code kit for this case scenario? (1 mark)
Answer:
Grey color
5. Name three Sexually transmitted disease (STDs)? (3 marks)
Answer:
AIDS, Gonorhoea,Syphilis,Genital warts, Genital Herpes

Scenario 4:
Sreedhar aged 25 years has come to the PHC with history of fever with chills and rigors for the past 3
days. Blood examination was positive for Plasmodium vivax.
Questions:

1. What is your Diagnosis? (2 mark)

Answer:
Uncomplicated Malaria
2. How will you diagnosis this disease? (2 mark)
Answer:
i)Microscopy-Peripheral blood examination
ii) Rapid diagnostic test
3. How will you treat this patient? (3 mark)
Answer:
Chloroquine - Day 1 – 4 tablets
Day 2 – 4 tablets
Day 3 – 2 tablets
Each chloroquine tablet contains 150 mg of chloroquine base.
Primaquine – 15 mg daily that is 6 tablets (each 2.5 mg base) daily for 14 days

4. Name of the National Programme associated with this disease and Name any two diseases included in
this
Programme (2 mark)
Answer:
i) National vector borne disease control programme (NVBDCP)
ii) Malaria,Filaria,Dengue,Chickengunya,Filariasis,Kala-azar

5. Specify the day in a year celebrated for this disease? (1 mark)

Answer:
April 25th

Scenario 5:
You are the medical officer of a PHC. A woman has delivered a child in the PHC two days back.
Questions:

1. Specify the immunization schedule for infant’s upto 1 year in India. (5 marks)
Answer:

Birth BCG,OPV-0 dose, Hepatitis B birth dose

6 Weeks OPV-1, Pentavalent-1, Rotavirus Vaccine -1, fIPV-
1, PCV -1
10 weeks OPV-2, Pentavalent-2, Rota virus vaccine-2
14 weeks OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2
9-12 months Measles & Rubella (MR)-1, JE-1 , PCV Booster

2. What is the minimum desirable time interval between two doses of any vaccine? (1 mark)
Answer:
Four weeks
3. List the vaccines does not come under open vial policy? (1 mark)
Answer:
BCG, Measles, JE Vaccine
4. What are freeze sensitive vaccines? (2 mark)
Answer:
Hepatitis B, DPT, DT, TT
5. Name the test to check whether a vaccine has been exposed to freezing temperature? (1 mark)
Answer:
Shake test

Scenario 6:

Questions:

1. What is your diagnosis? (1 mark)

Answer:
Tetanus Neonatorum
2. What are all the Measures to prevent this condition? (2 mark)
Answer:

1. Clean hands
2. Clean delivery surface
3. Clean cord care
4. Clean blade for cutting cord
5. Clean cord tie and no application on cord stump

3. What are all the types of tetanus? (2 mark)

Answer:
1. Generalized tetanus
2. Localized tetanus
3. Cephalic tetanus
4. Neonatal tetanus

4. What vaccine should be given to pregnant mother to prevent tetanus and when it should be
given? (2 mark)
Answer:
Td (In pregnant women, administer at least 2 doses before delivery: the 1st dose as soon as
possible during pregnancy and the 2nd dose at least 4 weeks after the 1st and at least 2 weeks before due
date).

5. What is the recommendation for prevention of tetanus in a wounded patient? (3 mark)

Answer:
Scenario 7:

Questions:

1. What is your diagnosis and what causes it? (2 mark)

Answer:
Bitot’s spots caused due to Vitamin-A deficiency

2. What are all the ocular manifestations of this disease in order? (2 mark)
Answer:
  Night blindness (XN)
 Conjunctival xerosis (X1A)
 Bitot's spots (X1B)
 Corneal xerosis (X2)
 Corneal ulcer covering less than 1/3 of the cornea (X3A)
 Corneal ulcer covering at least 1/3 of the cornea, defined as keratomalacia (X3B)
 Corneal scarring (XS)

3. Which vaccine-preventable disease is associated with this condition? (2 mark)

Answer:
Measles

4. How will you treat this condition? (2 mark)

Answer:
Vitamin A supplementation of
50,000 IU- <6 months of age,
100,000 IU- 6-12 months of age, and
200,000 IU - > 12 months of age daily for 2 days followed by an additional dose after 2 weeks.

5. What are all the measures to prevent this condition? (2 mark)

Answer:
One dose of Vitamin A supplementation for every 6 months
100,000 IU- 6-12 months of age, and
200,000 IU - > 12 months of age upto 5 years.
 Non Communicable Diseases

Scenario 8: A 45 year old male comes to the OPD with complaints of giddiness and head ache. On
history taking you find out that he is a salesman and comes home drunk every night, sleeps only for 5
hours. On examination his overweight, systolic blood pressure is 144 mmHg and diastolic Blood pressure
is 90 mm Hg.

Questions:
1. List any four modifiable risk factors for hypertension. (2 marks)
Answer:
Obesity, High Salt intake, Saturated fat, Decreased dietary fiber intake, Alcohol, Decreased physical
activity, Environmental stress, Lower socio economic status, Other factors like Oral contraception, noise,
vibration, temperature, humidity

2. What is DASH eating plan? Expand the same. (2 marks)

Answer:
To consume a diet rich in fruits, vegetables and low fat dairy products with a reduced content of saturated
fat and total fat. DASH is Dietary Approach to Stop Hypertension.

3. What is tracking of blood pressure? (2 marks)

Answer: If blood pressure levels of individuals were followed up over a period of years from early
childhood into adult life, then those whose were high in the distribution would probably continue in the
same “track” as adults. The low BP tend to remain low and high levels tend to become higher as
individuals grow older.

4. Name the types of hypertension. (2 marks)

Answer:
1. Primary (Essential) - Cause is not known
2. Secondary – Cause is known- Chronic glomerulonephritis, Chronic pyelonephritis, tumors of the
adrenal glands, congenital narrowing of the aorta, toxemias of pregnancy.

5. Mention any four approach for Hypertension used in Population strategy. (2 marks)
Answer:
a) Nutrition like moderate fat intake, avoiding alcohol, Energy intake restriction appropriate to body needs.
B) Weight reduction c) Behavioral changes d) Health education e) Self care
Scenario 9:.A 35 year old male comes to your health center his annual blood reports. His fasting blood
sugar level is 115 mg/dl and his post prandial sugar is 135mg/dl. He is a project manager in an IT firm
and has a sedentary job. On examination he is obese.

Questions:

1. Interpret his blood sugar values and give your diagnosis. (2 marks)
Answer:
Fasting blood sugar between 101-126mg/dl or post prandial blood sugar between 141-200mg/dl or both is
considered as prediabetes.

2. What is self care in Type II Diabetes? (2 marks)

Answer:
Adherence to diet and drug regimens, examination of his own urine and where possible blood glucose
monitoring, self administration of insulin, abstinence from alcohol, maintenance of optimum weight,
attending periodic checkups, recognition of symptoms associated with glycosuria and hypoglycemia, etc

3. What is primordial prevention in Diabetes mellitus? (2 marks)

Answer:
Prevention of the emergence of risk factors – Like maintenance of normal body weight through adoption
of healthy nutritional habits and physical exercise. Nutrition habits include an adequate protein intake, a
high intake of dietary fibers and avoidance of sweet foods.

4. List any four “high risk groups” for screening in Type II Diabetes? (2 marks)
Answer:
a) Those in the age group of 40 and over b) Those with family history of diabetes c) the obese d) woman
who have had a baby weighing more than 4.5 kg ( or 3.5 kg in constitutionally small populations) e)
women who show excess weight gain during pregnancy f) patients with premature atherosclerosis.

5. List any four modifiable risk factors for Diabetes mellitus. (2 marks)
Answer:
a) Sedentary lifestyle b) High Saturated fat c) Decreased dietary fiber intake d) Malnutrition e) Alcohol f)
Viral infections g) Chemical agents h) stress
Scenario 10:.A 34 year married woman with 2 children comes to the Urban health center with complaints
of white discharge?

Questions:

1. What are the screening tests available for screening cancer cervix? (2 marks)

Answer:

a) Pap smear test b) Visual inspection with 5 percent acetic acid (VIA) c) VIA with Magnification (VIAM)
d) Visual inspection post application of Lugol’s Iodine (VILI)

2. How will you interpret the VIA screening test? (2 marks)

Answer:

After application of freshly prepared 5 percent acetic acid solution, detection of well-defined opaque
acetowhite lesions close to the squamo-columnar junction, well defined circum-orificial acetowhite lesion
or dense acetowhitening of ulceroproliferative growth on the cervix constitute positive VIA or VIAM.

3. From what age should cervical cancer screening be done? (2 marks)

Answer:

As per the American college of Obstetricians and gynecologist (ACOG) latest guidelines, all women
should have a pap smear test at the beginning of sexually activity and then every 3 years thereafter. A
periodic pelvic examination is also recommended.

4. What are the two types of Cancer registry? (2 marks)

Answer:

a) Hospital based registries b) Population based registries

5. Mention the four uses of Population based registries. (2 marks)

Answer:

a) Incidence rate of cancer b) Tool for initiating epidemiological enquiries into causes of cancer c)
Surveillance of time trends d) Planning and evaluation of operational activities in all main areas of cancer
control
Scenario 11: Pistia plant

Questions:

[Link] the vector with reason which breeds in the given image? (2 marks)

Answer:

Mansonia mosquitoes are big, black or brown with speckling on their wings and legs.

2. Mention the vector’s breeding places. (2 marks)

Answer:

In ponds and lakes containing certain aquatic plants, especially the floating types like Pistia stratiotes and
water hyacinth.

3. List the common Indian species of this vector. (2 marks)

Answer:

[Link], [Link], [Link] and [Link]

4. What are the diseases transmitted by this vector? (2 marks)

Answer: Malayan ( Brugian ) filariasis, Chikungunya fever

5. How can this vector be controlled? (2 marks)

Answer:

By the removal or destruction of the aquatic host plants by herbicides.

Scenario 12: Tyre shed

Questions:

1. Identify the vector with reason which breeds in the given image? (2 marks)

Answer:

Aedes mosquito easily distinguished by white stripes on a black body. Because of the striped or banded
character of their legs, they are referred to as “ Tiger mosquitoes”

2. List the important species of this vector. (2 marks)

Answer:

Aedes aegypti, Aedes vittatus, Aedes albopictus.

3. What are the diseases transmitted by this vector? (2 marks)

Answer:

Yellow fever (not in India), Dengue, Dengue hemorrhagic fever, Chikungunya fever, Chickungunya
hemorrhagic fever, Rift valley fever, Filaria ( not in India)

4. Mention its breeding places. (2 marks)

Answer:

Artificial accumulations of water in and around human dwellings, such as water found in discarded tins,
broken bottles, fire buckets, flower pots, coconut shells, earthen pots, tree holes and the like.

5. Name and define the index relating to the vector to be kept zero at all ports? (2 marks)

Answer:

Aedes aegypti index is defined as the “ratio, expressed as percentage, between the number of houses in
a limited well defined area on the premises of which actual breeding of Aedes aegypti are found, and the
total number of houses examined in that area”.
 Epidemiology

Scenario 13:

You are a district epidemiologist given the task of investigating a suspected outbreak of SARS. You have
plotted a graph with the available data.

Questions:

1. What does the curve indicate? (2 marks)

Answer:
Single exposure or point source epidemic

2. What are the characteristics of the curve? (2 marks)

Answer:
 The epidemic curve rises and falls rapidly with no secondary waves
 The epidemic tends to be explosive
 There is clustering of cases within a narrow interval of time
 All cases develop within one incubation period of the disease

3. Define median incubation period. (2 marks)

Answer: It is the time required for 50% of the cases to occur following the exposure.

4. Define epidemic? (2 marks)

Answer:
The occurrence in a community or region of cases of an illness or other health related events clearly in
excess of normal expectancy.

5. Classify types of epidemics? (2 marks)

Answer:
a. Common source epidemics
i. Single exposure or point source
ii. Continuous or multiple exposure epidemics
b. Propagated epidemics
i. Person to person
ii. Arthropod vector
iii. Animal reservoir
c. Slow (modern) epidemics
Scenario 14:

You are a district epidemiologist given the task of investigating a suspected outbreak due to drinking
water contamination in a well. You have plotted a graph with the available data.

Questions:

1. What type of a curve is this? (2 marks)

Answer:
Continuous or multiple exposure epidemic

2. What are the characteristics of the curve? (2 marks)

Answer:
The epidemic tends to be explosive
The epidemic curve rises and plateau’s
The curve does not taper
3. What is the next step? (2 marks)
Answer:
Collect water samples for microbial analysis
Calculate attack rate
4. Define epidemic? (2 marks)
Answer:
The occurrence in a community or region of cases of an illness or other health related events clearly in
excess of normal expectancy.

5. Classify types of epidemics? (2 marks)

Answer:
a. Common source epidemics
i. Single exposure or point source
ii. Continuous or multiple exposure epidemics
b. Propagated epidemics
i. Person to person
 ii. Arthropod vector
iii. Animal reservoir
c. Slow (modern) epidemics
Scenario 15:
You are a district epidemiologist given the task of investigating why a large number of Hepatitis A cases
have occurred this year. You have plotted a graph with the available data.

Questions:

1. What type of a curve is this? (2 marks)

Answer:
Propagated epidemic (person to person transmission)

2. What are the characteristics of the curve? (2 marks)

Answer:
 The curve rises gradually
 Tails off over a long period of time
 Multiple peaks
 Cases in one peak may be sources for cases in a subsequent peak

3. What are the indicators that you need to calculate? (2 marks)

Answer:
 Attack rate
 Secondary attack rate

4. When is it more likely to occur? (2 marks)

Answer:
 Where a large number of susceptible are aggregated
 Where there is a regular supply of new susceptible individuals (eg. Birth, migrants)
lowering the herd immunity

5. What are the factors that influence the speed of transmission? (2 marks)
Answer:
 Herd immunity
 Opportunities for contact
 Secondary attack rate