Preventive And Social Medicine - homeopathy360
MCQ'S

Preventive And Social Medicine

Q.1. The most common cause of maternal mortality in India is? (Bihar/AYUSH/MO/QP/2014):
a) Haemorrhage
b) Anaemia
c) Abortion
d) Sepsis
Answer: (a)

Note Out of above given variables (a) Haemorrhage – is suggested
Ref: Park and Park –Pg-414,18th Ed

Review of variables
a) Haemorrhage
Sample Registration System Survey 2001-2003 – Haemorrhage is cause of Maternal mortality-38%
Annual report 2001 to 2002 of the Ministry of H&FW, GOI-Maternal mortality due to Hemorrhage is-29%
b) Anaemia

Annual report 2001 to 2002 of the Ministry of H&FW, GOI-Maternal mortality due to Anaemia is-19%
c) Abortion

Sample Registration System Survey 2001-2003 – Abortion is cause of Maternal Mortality-8%
Annual report 2001 to 2002 of the Ministry of H&FW, GOI-Maternal mortality due to Abortion is-09%
d) Sepsis

Sample Registration System Survey 2001-2003 – Sepsis is cause of Maternal Mortality-11%
Annual report 2001 to 2002 of the Ministry of H&FW, GOI-Maternal mortality due to Sepsis is-16%


Q2. In maize eating population niacin deficiency is due to (Bihar/AYUSH/MO/QP/2014):
a) High tryptophan
b) High isoleucine
c) High leucine
d) High phenylalanine
Answer: (c)

Note Out of the variables given above (c) High leucine –is suggested for-Maize eating population develop niacin deficiency.

Review of variables
a) High tryptophan
Tryptophan, an essential amino acid that the body converts into niacin. Maize, it is a poor source of tryptophan, as well as niacin. Ref: http://en.wikipedia.org/wiki/Pellagra
b) High isoleucine

Isoleucine is an essential amino acid. Foods that have high amounts of isoleucine include eggs, soy protein, seaweed, turkey, chicken, lamb, cheese, and fish. Ref: http://en.wikipedia.org/wiki/Isoleucine
c) High leucine

Leucine is an essential amino acid. High leucine content in common maize. Excess leucine, as it inhibits quinolinate phosphoribosyltransferase (QPRT) and inhibits the formation of Niacin or Nicotinic acid to Nicotinamide mononucleotide (NMN) causing pellagra, whose main symptoms are “the four D’s”: diarrhoea, dermatitis, dementia and death. Ref: http://en.wikipedia.org/wiki/Leucine
d) High phenylalanine

Phenylalanine is an essential amino acid, found naturally in the breast milk of mammals. It is reputed for analgesic and antidepressant effects.
Ref: http://en.wikipedia.org/wiki/Phenylalanine


Q3. All are true about classical dengue fever except:
a) Case fatality is low
b) Break bone fever
c) Leg raising test positive
d) Self-limiting disease
Answer: (c)

Note Out of the above variables (c) Leg raising test positive-is suggested – not true for classical dengue fever.
Stem: Dengue fever

Recall
Dengue fever is an acute Flavivirus infection caused by one of four antigenically distinct serotypes, which determine the severity of the infection. It is transmitted to humans by the bite of an infected Aedes aegypti mosquito and occurs in tropic and sub-tropic regions. The disease usually produces a triad of symptoms: fever; rash; and severe head, back, and muscle pain. Manifestations of dengue usually occur in two phases, separated by a day of remission. In the first phase the patient experiences fever, extreme weakness, headache, sore throat, muscle pains, and oedema of the hands and feet. The second phase is marked by a return of fever and by a bright-red scarlatiniform rash. The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients fully recover. Occasionally shock and haemorrhage occur, leading to fatality. Dengue is a self-limited illness, although recovery may require several weeks. Treatment is symptomatic. Also called Aden fever, bouquet fever, break-bone fever, dandy fever, dengue, solar fever.
Ref: http://medical-dictionary.thefreedictionary.com/dengue+fever

Review of variables
a) Case fatality is low
The fatality rate is 1–5%, and less than 1% with adequate treatment. Ref: http://en.wikipedia.org/wiki/Dengue_fever#Epidemiology
Mortality rate of less than 1%. When treated, dengue hemorrhagic fever has a mortality rate of 2-5%, but when left untreated, the mortality rate is as high as 50%. Ref: http://emedicine.medscape.com/article/215840-overview
b) Break bone fever

Dengue fever is also known as break-bone fever. Ref: http://en.wikipedia.org/wiki/Dengue_fever#Epidemiology
c) Leg raising test positive

Straight leg raise test:
Purpose of test: To test for the presence of a disc herniation.
Test Position: Supine.
Performing the Test: The examiner will passively flex the patient’s hip while maintaining the knee in full extension. A positive test is considered when the patient reports reproduction of pain at 40 degrees of hip flexion or less. The examiner should make note of the degree of hip flexion where the patient reported pain or reproduction of symptoms.
Diagnostic accuracy: Sensitivity: .91, Specificity: .26, +LR: .35,-LR: 1.2 (“The test of Lasegue. Systematic review of the accuracy in diagnosing herniated discs”). Sensitivity: .52, Specificity: .89 (“The sensitivity and specificity of the SLUMP and straight leg raised tests in patients with lumbar disc herniation”). Ref: http://www.thestudentphysicaltherapist.com/straight-leg-raise-test.html
d) Self-limiting disease

Dengue fever is typically a self-limiting disease. Ref: http://emedicine.medscape.com/article/215840-overview


Q4. These tests are used to verify the efficacy of pasteurization of milk EXCEPT (Bihar/AYUSH/ MO/QP/2014):
a) Methylene blue reduction test
b) Phosphatase test
c) Coliform count
d) Standard plate count
Answer: (a)

Note Out of above given variables (a) Methylene blue reduction test – is suggested
Stem: Pasteurization of milk

Recall
Unlike sterilization, pasteurization is not intended to kill all micro-organisms in the food. Instead, it aims to reduce the number of viable pathogens so they are unlikely to cause disease (assuming the pasteurized product is stored as indicated and is consumed before its expiration date). Commercial-scale sterilization of food is not common because it adversely affects the taste and quality of the product. Certain foods, such as dairy products, maybe superheated to ensure pathogenic microbes are destroyed.
Ref: http://en.wikipedia.org/wiki/Pasteurization

Review of variables
a) Methylene blue reduction test
The test is carried out on the milk accepted for pasteurization. It is based on the observation that bacteria growing in milk bring about a decrease in colour imparted to milk. The test thus serves as a confirmation of heavy contamination and compared with direct counts of bacteria, it saves time and money. Ref: Pg-443_16th Ed, Park and Park
b) Phosphatase test

This test is widely used to check the efficiency of pasteurization. The test is based on the fact that raw milk contains an enzyme called phosphatase which is destroyed on heating at a temperature which corresponds closely with the standard time and temperature required for the pasteurization. At 60oC for thirty minutes phosphatase is completely destroyed. Consequently, the test is used to detect inadequate pasteurization or the addition of raw milk. Ref: Pg-443_16th Ed, Park and Park
c) Coliform count

Coliform organisms are usually completely destroyed by pasteurization and therefore their presence in pasteurized milk is an indication either of improper pasteurization or post pasteurization contamination. The standard in most countries is that coliforms should be absent in one ml of milk. Ref: Pg-443_16th Ed, Park and Park
d) Standard plate count

The bacteriological quality of pasteurized milk is determined by the standard plate count. Most countries in the west enforce a limit of 30,000 bacterial counts per ml of pasteurized milk. Ref: Pg-443_16th Ed, Park and Park


Q.5. The most common cancer of adult males in India: (Bihar/AYUSH/MO/QP/2014):
a) Gastric carcinoma
b) Colo-rectal carcinoma
c) Lung cancer
d) Oropharyngeal carcinoma
Answer: (d)

Note The most suitable choice among the above given variables is (d) Oropharyngeal carcinoma
Stem: Most common cancer of adult males in India

Recall
Ref: http://www.apjcpcontrol.org/paper_file/issue_abs/Volume11_No3/633%20Nandagudi%20
Srinivasa%20Murthy.pdf

Review of variables
a) Gastric carcinoma

Gastric cancer is the fifth most common cancer among males and seventh most common cancer among females in India. Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124983/
b) Colo-rectal carcinoma

The age-adjusted incidence rates of CRC in all the Indian cancer registries are very close to the lowest rates in the world Ref: http://www.indianjgastro.com/IJG_pdf/jan2011/Jan_2011_2.pdf Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. Colorectal cancer is generally a disease affecting individuals 50 years of age and older and is much less common in persons under 40 years of age. It is also a very uncommon pediatric malignancy. Ref: http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2013;volume=50;issue=4;spage= 337;epage=340;aulast=Sudarshan
c) Lung cancer

More than 90,000 men and 79,000 women are diagnosed each year with cancer of the lungs and bronchi (the air tubes leading to the lungs). Among men, the incidence of lung cancer has been declining, but it continues to increase among women. The number of lung cancer deaths among women surpasses those from breast cancer. Recent studies indicate that female smokers may be more likely to develop lung cancer than male smokers. Ref:
d) Oropharyngeal carcinoma

Oral cancer is the commonest cancer in India accounting for 50-70% of total cancer mortality. Though    it is more common in males, the rate is increasing in females also. The high proportion of cases among males may be due to the high prevalence of tobacco consumption habits. Over the years, the incidence of oral cancers in the population has increased manifold especially among the younger generation, possibly related to the rising trend of pan and gutkha chewing, smoking and alcohol consumption. Smokeless tobacco use has also been implicated for the etiology of oral pre-cancerous and cancerous lesions. Ref: http://www.waent.org/archives/2010/Vol3-2/20101126-oral-cancer/oral-cancer–manuscript.htm

Extended information
The four most frequent cancers in males in India are Mouth / Oropharynx, Oesophagus, Stomach and Lower respiratory tract (Trachea / Bronchus / Lung).
For women cancers of the cervix, Breast, Mouth / Oropharynx and oesophagus are most frequent.
Ref: Pg-354, 21st Ed, Park and Park.


Q.6. Vitamin B12 is not found in (Bihar/AYUSH/MO/QP/2014) (Bihar/AYUSH/MO/QP/2014):
a) Milk
b) Soyabean
c) Meat
d) Fish
Answer: (b)

Note Out of above given variables (b) Soyabean – is suggested
Stem: Vitamin B12

Recall
Good sources of Vitamin B12 are – Liver, Kidney, Meat, Fish, Eggs, Milk and Cheese.

Note Vitamin B12 is not found in foods of vegetable origin.
Ref: Pg-573-21st Ed, Park and Park
Stem: Vitamin B12: Cobalamin

Recall
Vitamin B12, also known as cobalamin, aids in the building of genetic material, production of normal red blood cells, and maintenance of the nervous system.
Food sources for vitamin B12:
Vitamin B12 can only be found only in foods of animal origin such as meats, liver, kidney, fish, eggs, milk and milk products, oysters, shellfish. Some fortified foods may contain vitamin B12.
The recommended dietary allowance:
RDA for vitamin B12 is 2.4 mcg/day for adult males and females
For those over the age of fifty, the dietary guidelines recommend consuming vitamin B12 in its crystalline form (fortified foods or multivitamin).
Vitamin B12 deficiency:
Vitamin B12 deficiency most commonly affects strict vegetarians (those who eat no animal products), infants of vegan mothers, and the elderly.
Symptoms of deficiency:
These include anaemia, fatigue, neurological disorders, and degeneration of nerves resulting in numbness and tingling.
Ref: http://www.ext.colostate.edu/pubs/foodnut/09312.html


Q.7. Important function of sentinel surveillance is? (Bihar/AYUSH/MO/QP/2014):
a) To plan effective control measures
b) To notify disease
c) To find the total amount of disease in a population
d) To determine the trend of disease in a population
Answer: (c)

Note Out of above given variables (c) To find the total amount of disease in a population – is suggested.
Stem: Function of sentinel surveillance

Recall
No routine notification system can identify all cases of infection or disease. A method for identifying the mission cases and thereby supplementing the notified cases is required. This is known as ‘sentinel surveillance’. The sentinel data is extrapolated to the entire population to estimate the disease prevalence in the total population to estimate the disease prevalence in the total population. The advantages of such a system are that the reporting biases are minimized, and feedback of information to the providers is simplified.
Ref: Pg-37-19th ed Park and Park


Q.8. Active and passive immunity should be given together in all conditions except (Bihar/AYUSH/ MO/QP/2014):
a) Hepatitis B
b) Tetanus
c) Measles
d) Rabies
Answer: (c)

Note Out of the above given variables (c) Measles – is suggested
Stem: ‘When to give active and passive immunity together’

Recall
In some diseases (Tetanus, Diphtheria, and Rabies) passive immunization is often undertaken in conjunction with inactivated vaccine products, to provide both immediate (but temporary) passive immunity and slowly developing active immunity. If the injections are given at the separate sites the immune response to the active agent may or may not be impaired by the immunoglobulins. But according to current recommendations, immunoglobulins should not be given within 3 weeks before, or until two weeks after administration of a live attenuated vaccine. i.e. the antibody response to live attenuated measles vaccine is diminished in persons who receive immunoglobulin concurrently. However, there are exceptions to this rule, as per example, the simultaneous administration of Hepatitis B vaccine and Hepatitis B immunoglobulin.
Ref: Pg-115, 21st Ed, Park and Park


Q.9. During pregnancy this vaccine is contraindicated (Bihar/AYUSH/MO/QP/2014):
a) Diphtheria
b) Tetanus
c) Hepatitis-B
d) Rubella
Answer: (d)

Note Out of above given variables (d) Rubella – is suggested.
Stem: Vaccine contraindicated during pregnancy

Recall
TABLE 1

Immunizations during pregnancy

Considered safe
if otherwise indicated
Contraindicated during pregnancy or safety not established Special recommendations pertain
Tetanus and diphtheria
toxoids (Td)
Hepatitis B
Influenza
Meningococcal Rabies
BCG*
Measles*
Mumps*
Rubella*
Varicella*
Anthrax
Hepatitis A
Japanese encephalitis
Pneumococcal
Polio (IPV)
Typhoid (parenteral and Ty21a*)
Vaccinia*
Yellow fever*
*—Live, attenuated vaccine.
BCG=bacille Calmette-Guérin;
IPV=inactivated poliovirus.
Adapted from Guidelines
for vaccinating pregnant women.
Recommendations of the
Advisory Committee on Immunization Practices (ACIP).
Atlanta, Ga.: Centers for Disease Control and Prevention, 2002.

Ref: http://www.aafp.org/afp/2003/0715/p299.html



Q.10. All of the following are mode of transmission of leprosy except (Bihar/AYUSH/MO/QP/2014):
a) Breast milk
b) Insect bite
c) Transplacental spread
d) Droplet infection
Answer: (c)

Note Out of the above given variables (c) Transplacental spread / route – is suggested
Stem: Leprosy transmission

Recall
Chronic granulomatous communicable disease occurring in tropical and subtropical regions; characterized by inflamed nodules beneath the skin and wasting of body parts; caused by the bacillus Mycobacterium leprae. Transmission:
-Droplet infection
-Contact spread – direct (skin to skin) and indirect (fomites)
-Others (Breast milk, insect vectors, tattooing)

Review of variables
a) Breast milk

Congenital leprosy appears to be rare if it ever genuinely occurs, and transmission through breast milk may be possible. Rare reports of leprosy in infants (including cases confirmed by histology) are mostly from the pre-MDT era including a 3-week old child from Martinique. Leaving aside these unusual infant cases, a relatively high rate of leprosy amongst children is thought to indicate continuing transmission in the community. Ref:
b) Insect bite

Bacilli may also be transmitted by insect vectors, or by tattooing needles. This transmission cannot be ruled out. However, there is no evidence that any of these transmission routes is important in nature. Ref: Pg-291-21st Ed, Park and Park
Also see: http://www.who.int/lep/transmission/en/index5.html
c) Transplacental spread

Leprosy cannot be transmitted from a mother to her unborn baby, and people cannot get leprosy through sexual contact. Ref: http://diseases.emedtv.com/leprosy/how-leprosy-spreads-p2.html
d) Droplet infection

It is widely accepted that the nose is a major portal of exit. Lepromatous cases harbour millions of M. leprae in their nasal mucosa which are discharged when they sneeze or blow the nose.
Ref: Pg-290-21st Ed, Park and Park
Also see: http://www.who.int/lep/transmission/en/index5.html


Q11. The national health policy is based on (Bihar/AYUSH/MO/QP/2014):
a) Comprehensive health care
b) Subsidized healthcare
c) Socialized medicine
d) Equitable distribution of health resources
Answer: (a)

Note Out of above given variables (a) Comprehensive health care – is suggested
Stem: National Health Policy

Recall
National Health Policy formulated by the Ministry of Health and Family Welfare, Govt of India in 1983 (16) which committed the Government and people of India to the achievement of HFA.
The National Health Policy echoes the WHO call for HFA and the Alma-Ata Declaration. It had laid down specific goals in respect to the various health indicators by different dates such as 1990 and 2000 AD.

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