Preventive eli:MCQs in Preventive and Social Medicine Singh and Sharma ELSEVIER A division of Reed Elsevier india Private Limited Mosby, Saunders, Churchill Livingstone, Butlerworth Heinemann and Hanley & Belfus are the Health Science imprints of Elsevier, © 2008 Elsevier Reprint 2009 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic, or mechanical, incluuding photocopying, recordi or any information stored and retrieval system, without prior written permission of the publisher. ISBN: 978-81-312-1291-2 Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The authors, editors, contributors and the gublishers have, as far as it is possible, taken care to insure that the information given in this text is accurate and uptodate. However, readers are stongly advised to confirm that the information, especially with regard to drug dose/usage, complies with current legislation and standard of practice, Published by Elsevier, a division of Reed Elsevier India Private Limited, Logix Park, First Floor, A44 & A-5, Sector 16, NOIDA-201301, U.P. (INDIA) Printed and bound at Rajkamal Electric Press B-35/9, G.7. Kamal Road, Delhi- 110 033.Contents Foreword vii Preface xi Acknowledgements xiii LE . EP : lici 2. Concepts of Health and Disease 7 3. Epidemiology: Principles and Practice 18 4. Screening for Disease 70 5. Epidemiology of Communicable Diseases and Related National Health Programmes ris 6. Epidemiology of Non-communicable Diseases and Related National Health Programmes 163 7. Demography and Family Planning 180 8. Maternal and Child Health, and Geriatric Health 192 9. Nutrition and Health 214 10. Social Environment and Health 242 11. Physical and Biological Environment and Health 253 12. Occupational Environment and Health 288 13. Mental Health, Genetics and Health 298xvi 14. 15. 16. 17. 18. Contents Health Information System and Biostatistics Information, Education and Communication for Health Health Planning and Management, Disaster Management Health Care Delivery International Health and Voluntary Health Agencies References 305 328 334 347 356 363Chapter I Evolution of Preventive Medicine 1. Who is the author of this famous quotation, “Since both in importance and in time, health precedes disease, so we ought te consider first how health may be preserved, and then how one may best cure disease”. (a) Galen (b) Hippocrates {c) Atreya (d) Avicenna Answer (a) Galen (130-205 A.D.) the celebrated Roman physician was clearly ahead of his time. He believed that disease is due to three factors: predisposing, exciting and environmental. 2. Fatalistic theory of disease in ancient medicine conceptualized health or disease as: (a) Effect of spirits and demons (b) Reward or punishment based on good or evil deedsZz MCQs in Preventive and Social Medicine {c) Imbalance in elements of nature (d) Magic Answer (b) Fatalistic theory propounded that individuals suffered from disease due to bad deeds and if the entire tribe indulged in sinful practices, it fell prey to plagues and pestilences, It replaced the demonistic theory practiced by ‘witch doctors’ that believed in disease to be due to demons and spirits. Thus ‘witch doctors” were replaced by ‘priest physicians’ advocating appeasement of gods for relief from suffering. . The concept of ‘Ayurveda’ Is detalfed In: (a) Yajurveda (b) Rigveda ({c) Samaveda (d) Atharvaveda Answer (d) Ayurveda is elaborated in the Atharvaveda. It is primarily concerned with maintenance of health rather than treatment of sickness. ‘Swasthasya Swastha Rakshitam’, i.e. keep the well healthy. The concept of health in Ayurvedic medicine is a state of balance between: (a) Four primary humors (b) Three primary humors (c) Five natural elements (d) None of the above Answer (b) Ayurveda conceptualizes disease as being due to imbalance between three humors (tridosha) namely Vata (wind), Pitta (bile) and Kapha (phlegm or mucous), whereas the hypothesis in Greek medicine was based on four humors, i.e. blood, phiegm, black bile and yellow bile.Evolution of Preventive Medicine 3 5. The system of medicine currently not recognized by the Government of India is: (a) Ayurveda/Siddha (b) Homeopathy (c) Acupuncture (d) Unani Answer (c) Acupuncture and acupressure are well known therapeutic modalities of Chinese origin. As yet these are not recognized as separate entities of disease management in India. 6. Who among the following introduced the concept of relationship of environment with human health? (a) Avicenna (b) Charaka (c) Hippocrates (d) Paracelsus Answer {c) Hippocrates, conventionally considered as the Father of Modern Medicine, introduced the concept of human health being closely related to environment. He authored a treatise titled, “Airs, ‘Waters and Places”. 7. Who propounded the germ theory of disease? (a) Leeuwenhoek {b} Robert Koch {c) Ambroise Parre (d} Louis Pasteur Answer (d) Louis Pasteur (1822-1895) demonstrated the presence of bacteria in the air, thereby disproving the theory of ‘spontaneous generation’ of disease. The theory was strengthened subsequently by discovery of a series of microbes in quick succession, i.e.4 MCQs in Preventive and Social Medicine Anthrax bacillus in 1877, Gonococcus in 1847, Typhoid bacillus and Preumococcus in 1880, Tubercle bacillus in 1882, Cholera vibrio in 1883 and so on. 8. The pioneer in concept of specific protection with immunization was: (a) Early Chinese physicians (b) Edward Jenner ic) James Lind (d) Louis Pasteur Answer (a) The Chinese were early pioneers of immunization. They practiced variolation to prevent smallpox. Similar practice is also known to be prevalent in the early Ayurveda period, which was quoted by Edward Jenner to the Royal Society to get approval for his proposed smallpox vaccine. . Which military surgeon successfully evolved the Principle of preventing non-communicable disease with specific diet therapy? {a} Major Walter Reed (b} James Lind (c) Major Ronald Ross (d) Bruce Answer (b) James Lind (1716-1794), the British naval surgeon, based on his observations on sailors living on stored/preserved rations onboard ships successfully brought down the prevalence of scurvy among them by mandatory issuance of one fresh lime per day to each sailor. British sailors thence became known as ‘Limeys’. Major Walter Reed is associated with discovery of yellow fever transmission with Aedes, Major Ronald Ross with transmission of malaria by mosquito, and Bruce with African sleeping sickness transmission by Tse Tse fly.Evolution of Preventive Medicine = 5 10. The earliest public health law was promulgated in: (a) England (b) USA (c) USSR (d) Spain Answer (a) Following a series of epidemics related to poor living and working conditions in Europe, a comprehensive report by William Chadwick titled, “The sanitary condition of the labouring population” was submitted to UK Government. This was followed by the “Great Sanitary Awakening” which lead to the enactment of “The Public Health Act of 1848” in England thereby initiating the concept that "The state has a direct responsibility of the health of the people”. 11. Who introduced the concept of social medicine? (a) Rene Sand (b) Neumann (c) Jules Guerin (d) A Grotjahn Answer (c} Jules Guerin in 1848 introduced the term ‘social medicine’. Although pioneers such as Neumann (1847), Virchow (1848) had propounded that medicine was a social science, the idea could not gain ground. Alfred Grotjahn in 1911 related social factors to actiology of disease and called it ‘Social Pathology’. Rene Sand in 1912 founded the Belgian Social Medicine Association. 12. Where was compulsory sickness insurance introduced? (a) New Zealand (b) Germany (c) USA (d) England6 MCQs in Preventive and Social Medicine Answer (b) Germany was the pioneer in bringing about social control of medicine and lead the way by introducing compulsory sickness insurance in 1883. Other countries followed suit, e.g. England in 1911, France in 1928 and so on. An excellent social and health insurance exists in India also in the form of Employees State Insurance (ESI) enacted in 1948.Chapter 2 Concepts of Health and Disease 1. Which of the following dimensions is not included in the WHO definition of health? (a) Physical well being (b) Occupational well being {c) Mental well being (d) Social well being Answer (b) WHO in the preamble to its constitution defines health as ‘Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity’. In recent years, it has been amplified to include spiritual well being and ability to lead a socially and economically productive life. 2. Physical quality of life index (PQLI) includes the following parameters: (a) IMR {infant mortality rate), per capita calorie intake and life expectancy (b) IMR, life expectancy at 1 year and fiteracyMCQs in Preventive and Social Medicine (c) IMR, MMR (maternal mortality rate) and life expectancy (d) IMR, life expectancy at birth and literacy Answer (b) In a scale of 0-100, the PQLI is an average of three indicators, i.e. infant mortality rate, life expectancy at 1 year and literacy. It is notable that PQLI does not take GNP into consideration, e.g. oil rich countries of the Middle East have high per capita income but low PQLI and Kerala state in India has low per capita income but high PQLI. The Human Development Index (HDI) Is a composite of alt the following components except: (a) Life expectancy at birth (b) Adult literacy rate and mean years of schooling (c) GDP per capita in US dollars (d) Life expectancy at 1 year Answer (d) HDI values range between 0 and 1, and reflect the progress a country has made towards maximum possible value of one. It also allows comparisons with other countries. As per UNDP's (United Nations Development Programme) Human Development Report for 2006, India with an HDI of 0.611, is ranked at 126 out of 177 countries. A good indicator of the availability, utilization and effectiveness of health care services in a country Is: {a) Maternal mortality rate ({b) Hospital bed occupancy rate {c}) Infant mortality rate {d) Disability adjusted life years (DALYs} Answer (c} IMR is considered a sensitive index of health services as it reflects maternal care, perinatal care, child-rearing practices, nutritional practices and socio-economic conditions in which7. Concepts of Health and Disease 9 people live as well as availability, effectiveness and utilization of health care services, The following indices are used for measuring disability except: (a) Sullivan's index {b) HALE (health adjusted life expectancy) (c) PQLI (physical quality of life index) (d) DALYs (disability adjusted life years) Answer (c} PQLI includes infant mortality rate, literacy and life expectancy at 1 year whereas other indicators are directly related to measurement of disability. Suliivan’s index is: {a) Expectation of life free of disability {b) Expectation of life at birth {c) Expectation of life at 1 year of age (d) Average life expectancy Answer fa) Sullivan’s index is calculated by subtracting from the life expectancy the probable duration of bed disability and inability to perform major activities as calculated by data from cross sectional populational surveys. “Years of life lost to premature death and years lived with disability adjusted for the severity of the disability’ is known as: (a) HALE (b) DALYs {c) Sullivan's index (d) HD! Answer (b) DALYs is the measure of the burden of the disease in a population and the effectiveness of the interventions,10 10 MCQs in Preventive and Social Medicine . An ideal health indicator should be: (a) Sensitive (b) Specific (c) Relevant ({d} All of the above Answer (d) A bealth indicator in order to have scientific respectability should be valid, reliable, sensitive, specific, feasible and relevant. . Scales used for assessing socio-economic status of populations are the following except: (a) Modified Udai Pareek scale (b) Modified Kuppuswamy scale (c) Likert scale (d) BG Prasad scale Answer (c) Likert scale is not related to assessment of socio-economic status (SES) and is designed to render scoring criteria for responses during population based studies. BG Prasad scale takes into consideration mainly the total income of the household, Modified Kuppuswamy scale takes into consideration education, occupation and income, whereas Modified Udai Pareek scale takes into consideration in addition to all of the above, household assets, land holding, caste, etc. ‘The systematic study of the means by which biomedical and other relevant knowledge is brought to bear on the health of individuals and communities under a given set of conditions’ is the definition given to: {a} Biomedical research (b) Health systems research (c) Inter-sectoral research (d) Operations research11. 12. Concepts of Health and Disease 11 Answer (b) Health systems research deals with all aspects of management of health services including prioritization of health problems, planning, management, logistics and delivery of health care services as well as cost benefit and cost effectiveness of health care systems and biomedical research. Sickness is a state of: (a) Social dysfunction (b) Subjective state of a person feeling unwell (c) Impaired physiological function (d) Impaired psychological function Answer (a) Susser’s terminology suggests that sickness is a state of social dysfunction, ic. a role an individual assumes when ill; illness is a subjective state of a person who feels that he is not well whereas disease is a physiological/psychological dysfunction. Disease causation is best explained by: (a) Theory of one-to-one relationship between causal agent and disease (b) Supernatural theory of disease (c} Empirical theory of disease causation (d) Multi-factorial theory of disease causation Answer (d) Germ theory of disease. i.e. one-to-one relationship between causal agents (microbes) and disease held ground throughout the 19" and early part of the 20" century. It demolished supernatural theory of disease. The modern concept of disease causation is “Web of Causation” suggested by Macmahon and Pugg. It largely dwells on the multi-factorial causation as well as the well-known ‘epidemiological triad of disease’ being the result of interplay of agent, host and environmental factors.12 13. 14, 15. MCQs in Preventive and Secial Medicine ‘Course of a disease process without any intervention’ is the definition of: fa) Spectrum of disease (b) Epidemiology of disease {c) Natural history of disease {d) Iceberg phenomenon Answer (c) Each disease has its own unique natural history in individuals which is not necessarily same in all the individuals, On the other hand, spectrum of disease and iceberg phenomenon are related to behaviour of the disease in the community. In the natural history of disease, the ‘pathogenesis phase’ is deemed to start upon: (a) Entry of the disease agent in the human host (b) Interaction between agent, host and environ- mental factors (c) Appearance of signs and symptoms (d) Appearance of complications Answer (a) ‘Cusiomarily, natural history of disease is described to have two phases, i.e. prepathogenesis and pathogenesis. Prepathogenesis phase is interaction between agent, host and environment, the agent yet to gain entry into the human body. All other states listed above are related to period of pathogenesis. This understanding of natural history in relation to cach disease is the key to plan interventions. The term ‘disease contra!’ employs all of the following except: (a) Reducing the complications (b) Reducing the risk of further transmission (c) Reducing the incidence of disease (d) Reducing the prevalence of the diseaseConcepts of Health and Disease 13 Answer (d) In disease control, the agent continues to persist in the community though below the critical level where it ceases to be a public health problem. A state of equilibrium is established between the disease agent, host and environment so that new eases cease to occur. Most contro! activities focus on primary or secondary prevention or both. As opposed to this, the term ‘eradication’ is used to describe termination of all transmission of infection by extermination of the infectious agent (‘tear out by roots’). The term eradication is generally reserved to describe cessation of infection and disease from the entire world. As compared to eradication, the term ‘disease elimination’ is used to describe interruption of transmission of disease generally from a region, e.g. elimination of measles, polio, guinea worm, etc. Regional elimination is considered an important precursor of eradication, 16. Morbidity in a community can best be estimated by: (a) Active surveillance (b) Sentinel surveillance (c) Passive surveillance (d) Monitoring Answer (a) Active surveillance implies activities designed to aggressively look for cases of a disease in the community. It thus reveals true pattern of morbidity, whereas in passive surveillance only those cases get counted which report to the health facility with specific symptoms of that disease. Thus many cases will go unrecorded. Sentinel surveillance on the other hand, is the best way to find out hidden cases. In this, all patients reporting to a health facility (sentinel faciliry) get checked for a particular disease even if they have reported for ather morbidities. 17. Sentinel surveillance is employed to: (a) Establish natural history of disease (b) Detect the total number of cases of a disease in a community14 18. 19, MCQs in Preventive and Social Medicine (c) Detect the missing/hidden cases in a community (d) Plan intervention Answer (c) Which level of prevention is applicable for implementation in a population without any risk factors? (a) Primordial prevention (b) Primary prevention (c) Secondary prevention (d) Teniary prevention Answer (a) Although there is no strict delineation between primordial and primary prevention yet primordial prevention can be considered as primary prevention in its purest sense. It is a series of actions applied to entire communities or populations designed to prevent occurrence of diseases whose risk factors have not yet appeared in the communities, e.g. discouraging children from adopting unhealthy lifestyles like smoking, junk foods, sedentary lifestyle, etc., with the long term aim of preventing obesity, hypertension, coronary heart disease, etc. It is achieved through individual as well as mass health education, As opposed to this, primary prevention is designed to prevent the onset of disease prior to its occurrence with risk factors already existing, e.g. diet supplements for pregnant or lactating mothers, healthful housing, ete. Which of the following is not primary prevention? (a) Pulse polio immunization (b) Vitamin A supplementation (c) Breast self-examination for tumour (d)_ Isoniazid (INH) to a baby breastfed by a sputum positive tubercular mother Answer {(c) Breast self-examination is a classical example of action taken for early diagnosis and treatment, hence it is secondary16 23. 24, MCQs in Preventive and Social Medicine Concept of ‘Hospice’ Is related to: (a) Euthanasia for terminally ill patients (b) Family health advisory service (c) An association running orphanages for abandoned children (d) Special group of people helping the old and terminally ill patients Answer (d) ‘Hospice’ is derived from French word ‘Hospitium-Hospes’. Essentially this concept revolves around providing an ashram- like organization designed to care for the terminally ill. Tt is an approach which focuses on the patient and family rather than the disease, and comfort and pain relief rather than on treating illness or prolonging life. Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being Is called: (a) Impairment (b) Handicap (c) Disability (d) Disease Answer (c) ‘Disability’ is the consequence of an impairment whereby the affected person may be unable to carry out certain activities commensurate with his/her age, sex, etc. ‘Impairment’ is defined as any loss or abnormality of psychological, physiological or anatomical structure or function. On the other hand, a ‘handicap’ is the disadvantage a person suffers so that he/she is not able to. discharge his/her due role in the society. ‘Disease’ refers to any departure from a healthy condition in an organism. Choose the correct sequence in order of occurrence. (a) Disease Disabilityimpairment—Handicap (b) Disease—impairment—>Handicap— DisabilityConcepts of Health and Disease 17 {c) Handicap—DiseaseImpairment— Disability (d) Diseaseimpairment— Disability Handicap Answer id) In the order of occurrence the process is initiated by disease which leads to impairment, which, if not handled properly, leads to disability. Handicap results as a consequence of disability. The above terms can be explained as follows: Accident of soldier (disease)-+Amputation of foot (impairment) — Inability to walk (disability) -+Unemployment as a soldier (handicap). Which of the following is incorrect in relation to International Classification of Diseases (ICD)? (a} It is the standard for international comparisons of morbidity and mortality (b) It is revised once in 10 years (c) The 10* revision of ICD took place in 1995 (d}_ The 10" revision consists of 21 major chapters Answer (c) The 10* revision of ICD came into effect in January 1993.Chapter 3 Epidemiology: Principles and Practice 1. Epidemiology is: (a) Branch of medical science which treats epidemics (b) Science of the mass phenomenon of infectious diseases (c) Study of disease, any disease, as a mass phenomenon (d) Study of distribution and determinants of disease frequency in masses (e) All of the above Answer (e) Epidemiology has been variously described by different authors Tanging from Hippocrates to the present day. However, comprehensive definition of the science of epidemiology has been rendered by John M. Last in 1988 as, “the study of the distribution and determinants of the health related states or events in specified populations and the application of this study to the contro! of health problems”. It is no longer restricted to communicable diseases but encompasses all health related20 MCQs in Preventive and Social Medicine and includes a single examination of a cross section of the entire or representative sample of a population at a single point in lime. The results can usually be extrapolated to the whole population. Cross sectional studics are more useful for chronic diseases like hypertension, diabetes mellitus, etc. Such studies contribute neither towards establishing natural history of a disease nor its causal association. Prevalence of a disease depends upon the following: (a) Incidence (b) Duration (c) Both of the above (d) None of the above Answer (c) In a stable situation: (a) Prevalence = Incidence x Duration (b) Incidence = Prevalence x Duration (c) Prevalence = Incidence + Duration (d) Incidence = Prevalence + Duration Answer (a) Prevalence (P) of a disease depends upon two factors: the incidence (T) and duration (D) of illness. Assuming that in a population, incidence and duration are stable; the prevalence will be a product of incidence and duration (P =I x D). Using the Same equation, incidence and duration can also be determined as: I = PD D = PA Tt should be noted that the longer the duration, the higher will be the prevalence rate, e.g. in tuberculosis where new cases continue to occur in the background of old cases continuing to exist for a long time virtually adding to the prevalence rate. Conversely, the term ‘prevalence’ is not used in the case of one- time events such as food poisoning, accidents, etc.Epidemiology: Principles and Practice 21 7. If a drug prevents mortality but does not affect cure, then which of the following will be true: (a) Incidence will decrease (b) Incidence will increase (c) Prevalence will decrease (d) Prevalence will increase Answer id} To understand the above situation, the example of anti-retroviral therapy (ART) in case of AIDS can be considered, wherein ART prolongs the life but does not cure AIDS, hence the prevalence of AIDS continues to increase. 8, If the incidence of a disease in females is 2 times as in males but the prevalence is equal in males and females, what is the inference? (a} Proportional mortality from disease in question more in females (b) Proportional mortality from disease in question less in males (c) Any of the above (d) None of the above Answer (c) In the above situation, as incidence of the disease is 2 times more in females as compared to males but the prevalence is equal, evidently either the mortality in females is more or mortality in males is less or both. 9. Prevalence of a disease: (a) Can only be determined by a cohort study (b) Is the number of new cases in a defined population (c) Describes the balance between incidence, mortality and recovery22 10. 11. MCQs in Preventive and Social Medicine (d) Is the best measure of disease frequency in aetiological studies Answer (c) At the end of year 2000, the population of a tribal district was 2,00,000 and number of cases of tuberculosis were 800. At the end of the year 2001, the population was 2,10,000 and 200 new cases were detected and 12 cases had died. Based on this data, all of the following rates can be calculated except: (a) Prevalence (b) Incidence (c) Proportional mortality (d) Case fatality Answer (c) For calculating proportional mortality (in this case due to tuberculosis) total number of deaths because of ‘all causes’ is essential as a denominator, Prevalence Is: (a) Rate (b) Ratio. (c) Proportion (d) Made Answer (b) Although referred to as a rate, prevalence rate is actually a ratio. It is of two types: point prevalence (number of all current cases of a specified disease existing at a given point of time per hundred estimated population at the same point of time) and period prevalence (number of existing cases of a specified disease during a given period of time interval per hundred estimated mid-interval population at risk).24 14, 15. 16. 17. M(CQs in Preventive and Social Medicine immigration, e.g. measles in the prevaccination era) or due to antigenic variations, ¢.g. influenza. Which of the following show seasonal variation? {a) Viral conjunctivitis (b) Gastroenteritis {c) Measles (d) Meningococcal meningitis fe) All of the above Answer (e) Which ts not the true reason for cyclic trend of a disease? (a) Antigenic variation (b) Buildup of susceptibles (c) Herd immunity variation (d) Environmental conditions Answer (d} Seasonal variation of a disease can be assessed by: (a) Comparing the prevalence of disease (b) Comparing the incidence of disease (c) Calculating the survival rates (d) Calculating the mortality rates Answer (b) All are true regarding point source epidemic except: (a) No secondary waves occur (b) Occurs within a specified period (c) All cases occur abruptly and simultaneously ({d} Children are mast commonly affected Answer (d) In point source epidemic, the exposure to disease agent is brief and simultaneous, all cases occur within a single cubation18. 19. Epidemiology: Principles and Practice 25 period describing a single peak in the epidemic curve. There are no secondary cases. The epidemic tends to be explosive with maximum number of cases clustered around one point of time. All ages are equally likely to be affected, e.g. food poisoning. All are true regarding propagated epidemic except: (a) Progresses slowly (b) No secondary waves occur {c) Person to person transmission occurs {d) Spread depends on herd immunity Answer (b) Propagated epidemics usually occur in case of infectious diseases and are commonly the result of person-to-person transmission so that transmission continues to occur until the number of susceptibles is depleted or no longer exposed. The rapidity of spread depends upon herd immunity, opportunities for exposure and secondary attack rate. Secondary waves are likely to occur. Propagated epidemics may also occur through agency of arthropod vectors or animal reservoirs. ‘Chernobyl’ tragedy is an example of: (a) Point source epidemic (b) Modem epidemic (c) Propagated epidemic (d) Continuous or repeated exposure epidemic Answer (d) Continuous or repeated exposure epidemics are a type of common source epidemics. The common source epidemics are frequently but not always due to exposure to an infectious agent. They can result from contamination of the environment (air, water, soil) by industrial chemicals or pollutants, e.g. Bhopal gas tragedy (air pollution), Minamata disease in Japan (contaminated food chain), Chernobyl tragedy (radiation pollution). As opposed to this, common source (single exposure) epidemics are called point source epidemics, ¢.g. food poisoning.26 =MCQs in Preventive and Social Medicine 20. A disease is called ‘endemic’ when it: (a) Occurs in more than one geographical area (b) Occurs in more than one season (c) Is constantly present at low rates in a specified geographical area (d) Occurs iin a frequency more than expected in a specified geographical area Answer (c) 21. Which of the following is the most useful study design In a hospital setting? (a Cohort (b) Case control (c) Cross sectional (d) Longitudinal Answer (b) The case control studies have three essential features: i. Both exposure and outcome (disease) have occurred before the start of study. ii, The study proceeds backwards from effect to cause. ii, It uses a control group to support or refute an inference, All these conditions are readily met in a hospital setting. Therefore case control studies are readily feasible and cost- effective in a hospital setting, However, quality of hospital records will determine the quality of case control study. 22. All of the following are characteristics of a case control study except: (a) Least risk to subjects (b) Rapid and cost-effective (c) Risk factors can be identified (d)_ Less prone to bias Answer (d)28. Epidemiology: Principles and Practice 29 due to confounding, selection bias, memory or recall bias and interviewer's bias . It is necessary to minimize all types of bias to the maximum extent possible to ensure the scientific validity of a study, In a case control study of smoking and lung cancer, which of the following can be a possible conclusion? (a) Smoking is a cause of lung cancer (b) Lung cancer is commoner in smokers than non- smokers (c) Ifsmoking is stopped, the number of cases of lung cancer will decrease (d) Smoking is associated with lung cancer Answer (d} Since case control studies proceed backward from effect to cause, they mainly indicate statistical association between exposure and occurrence of disease. Statistical association does not imply causation, however, strength of this association can be measured by odds ratio. The ratio between incidence of disease among exposed persons and incidence among non-exposed persons is commonly known as: (a) Odds ratio (b) Relative risk (c) Attributable risk (d} Population attributable risk Answer (b) Relative risk (also known as risk ratio) is an estimate of disease risk associated with an exposure to a risk factor, Case control studies do not provide incidence rates from which relative risk can be calculated directly as these is no denominator or population available, Relative risk, therefore, can be determined exactly only from a cohort study.33. $ Epidemiology: Principles and Practice 31 (c) Cohort study (d) Randomized control trials Answer (c} Incidence of diarrhoea in a community can be calculated by: (a) Case control study (b) Cross sectional study (c) Double blind study (d) Cohort study Answer (d) Incidence rates are best calculated by cohort studies as explained above. All of the following are characteristics of a cohort study except: (a) Reserved for testing precisely formulated hypothesis (b) Suitable for study of rare diseases (c) Can yield information about more than one outcome {d) Involves large number of subjects Answer (b) As cohort studies are population based, rare diseases may or may not be encountered during the progress of a particular cohort. Case control studies can be designed in superspecialty hospitals where admission rates of rare diseases may be high due to referrals. Hence rare diseases are best studied with case control studies. . A study began In 1975 in Bombay (now Mumbai) with @ group of 10,000 adults who were asked about their alcohol consumption. The occurrence of cancer was analysed among the same population for the period 1995-2000. This design of study Is known as:32 36. 37. MCQs in Preventive and Social Medicine (a) Case control study (b) Retrospective cohort study {c) Concurrent cohort study (d) Cross sectional study Answer (c) ‘Cohort studies are Jong term studies entailing follow up of a group of people (cohort) over a period of time. Common types: of cohort studies are: prospective (concurrent) cohort studics, retrospective (historical) cohort studies and a combination of retrospective and prospective cohort studies. Which is the best measure for strength of association between exposure and outcome of interest? (a) Relative risk (b) Attributable risk (c) Population attributable risk (d) Odds ratio Answer (a) Relative risk (RR) is a direct measure of the strength of association between suspected cause and effect, therefore, it becomes important in actiological enquiries. RR = | indicates nil association whereas RR > | suggests positive association between exposure and disease under study, ¢.g. RR = 2 indicates that incidence of disease is 2 times higher in the exposed group as compared to unexposed. In other words, this represents a 100% increase in the risk. It should, however, be noted that risk does not necessarily imply causal association. “Difference of incidence rate of disease among exposed and non-exposed expressed as percentage” is known as: {a} Attributable risk (AR) (b) Risk ratio (RR) (c) Odds ratio (OR)38 Epidemiology: Principles and Practice 33 (d} Population attributable risk (PAR) Answer (a) Attributable risk, also known as risk difference, indicates to what extent the disease under study can be attributed to the exposure. Conversely, we can deduce the amount of disease that might be eliminated if the factor under study could be controlled or eliminated in the study population, Therefore all of the above ean be calculated by the following formulae: Incidence of disease (or death) among exposed— __ Incidence of disease (or death) among non-exposed Incidence of disease (or death) among exposed «100 Incidence of disease (or death) among exposed RR Theidence of disease (or death)among non-exposed OR = ad/be Where, Disease Present absent Exposed a b Non-exposuu c d Incidence rate of disease (or death) in total population — Incidence tate of the disease PAR= __(or death) in non-exposed population 100 incidence rate of disease (or death) in total population Which is the best measure for estimating Impact of health interventions in general population? (a) Relative risk (b) Attributable risk (c) Population attributable risk (d) All of the aboveMCQs in Preventive and Social Medicine Answer (c) Both attributable risk and PAR are good measures for estimating the impact of specific interventions. However, PAR is useful for applying to general population as it provides an estimate of the amount by which the disease could be reduced in that population if suspected factor was eliminated or modified because PAR is dependent on the prevalence of the risk factor. Which of the following is a good measure of the severity of an acute disease? (a) Standardized mortality ratio (b) Cause-specific death rate (c) Case fatality rate (d) Age-specific death rate Answer (c) Case fatality rate (CFR) is actually a ratio of the total number of deaths due to a particular disease to total number of cases due to the same disease expressed as a percentage. The salient features of CFR are: - Itrepresents the killing power of a disease and virulence of an agent. - The time interval is not specified. - Itis used in acute infectious diseases (e.g. dengue, cholera, food poisoning, etc.) but its usefulness in chronic diseases is limited because of long and variable period from onset to death. — CFR may be variable for the same disease in different epidemics because of changes in agent, host, and environmental factors. ‘Number of deaths due to a particular cause (or in a specitic age group) per 100 (or 1000) total deaths’ Is known as: (a) Specific death rate (b) Proportional mortality rate46. Epidemiology: Principles and Practice 37 stable rates of larger (reference or standard) population are applied to the smaller study (e.g. a specific occupational group). It, thus, gives a measure of the likely excess risk of mortality due to that occupation. SMR is calculated with the forniula: Observed deaths SMR = Expected deaths 108 If the ratio has value greater than 100, then that particular occupation will appear to carry a greater mortality risk than that of the whole population. The SMR has the advantage over direct methods of age standardization in that it permits adjustments for age and other factors where age-specific rates are not available. One needs to know only the number of persons in each age group in the study population and the age- specific rates of the national (reference) population. SMR is also useful if the event of interest is occurrence of disease rather than death. . All are true about standardized mortality ratio except: {a} Can be adjusted for age (b) Age-specific death rates are not needed (c) Can be used for events other than death (d) Expressed as rate per year Answer (d} In the international death certificate, which of the following is true? fa) Part | of the certificate deals with the immediate and also the underlying cause (b) Part | of the certificate deals with the immediate cause only {c) Part Il of the certificate deals with the underlying cause {d) Other morbid canditions not related to the cause of death are not included Answer (a)38 =MCQs in Preventive and Social Medicine 47. Verbal autopsy is: (a) Examination of the dead body where post-mortem facilities are not available (b) Ascertaining cause of death by interviewing the relative of the deceased (c) A discussion about lessons learnt after completion of a health camp {d) Inquest report or panchnama Answer (b) Verbal autopsy is an important tool for ascertaining causes of death in population-based studies where medical certification of cause of death is not available, which is commonly the case in developing countries like India. However, to minimize subjectivity, the interviewer must take care to use standardized/ structured questionnaires. 48. As compared to a routine case contro! study, nested case control study avoids problems related to: (a) Confounding bias (b) Need for long follow up (c) Temporal association {d) Randomization Answer (c) A nested case control study draws its cases and controls from a cohort population that has been followed for a period of time. Its salient features are: ~ It is carried out when it is either too costly or not feasible to perform analysis on the entire cohort. = It can utilize the exposure data originally collected before the onset of the disease, thus reducing the risk of recall bias and temporal ambiguity. — It includes cases and controls drawn from the same cohort, thus decreasing the chances of selection bias.51. 52. MCQs in Preventive and Social Medicine These studies are able to provide ‘scientific proof of aetiological factors and also a method of measuring the effectiveness and efficiency of health services’. These, however, have the limitation of cost, ethics and feasibility. All are true for randomized controlled trial (RCT) except: (a) Bias may arise during evaluation (b) The groups should be representative of the population (c) Both study and control group should be comparable (d) Used only for testing new drugs on human or animal subjects Answer (d) RCT is an epidemiological experiment. It forms the basis of the modern concept of ‘evidence-based medicine’. It is used not only for testing new drugs but is an important tool for validating widely used treatment modalities like tonsillectomy, varicose veins stripping. hospitalization of all patients with myocardial infarction and applicability of many preventive and therapeutic procedures. Which of the following is true about double blind study? (a) Participant is not aware about the group allocation and treatment received (b} Neither the participant nor the doctor is aware about the group allocation and treatment received (c) The participant, doctor and investigator are unaware about the group allocation and treatment received (d)_ None of the above Answer (b} Blinding is a useful procedure to minimize bias in randomized controlled studies. Ii is of three types:53. 54, 58. Epidemiology: Principles and Practice 41 i. Ina single blind trial, the participant is not aware whether he belongs to the study or the control group, ii. Ina double blind wial, neither the doctor nor the participant is aware about the group allocation and the treatment received. ti. In the triple blind trial, the participant, the doctor and the personnel analyzing the data are all blind. This is ideal but the commonest used method is double blinding. When the outcome such as death is being measured, blinding is not so essential. The number of patients required in a clinical trial to treat a specific disease Increases as: (a) The incidence of the disease decreases (b) The size of the expected treatment effect increases (c) The drop-out rate increases (d) The significance level increases Answer (c) The purpose of a double blind study is to: (a) Avoid subject bias (b) Avoid observer bias and sampling variation (c) Reduce the effects of sampling variation (d) Avoid subject bias and sampling variation Answer (b) All of the following are characteristics of cross over studies except. (a) All subjects receive the new therapy (b) Not suitable if therapy of interest cures the disease (c) Ideally suitable if disease changes radically during the study (d) Not suitable if therapy of interest is effective only during a certain stage of disease42 MCQs in Preventive and Social Medicine Answer (c) Common study designs of controlled trials are concurrent ‘parallel study’ design and ‘cross over’ type of study design. In the former, comparisons are made between two randomly assigned groups with one group exposed to specific treatment. Patients remain in the study group or control group for the entire duration of the trial. In the cross over type of design, each patient serves as his own control, The patients are randomly assigned to a study group or control group with study group receiving the treatment under trial and control group receiving a placebo. After a period, both groups cross over. Such a design has a number of advantages including assurance that all patients will receive the new therapy at some stage, thus economizing on time and expense, However, these studies have limitations as listed in the question. 56. Which of the following is nof true In a non-randomized trial? (a) Approach is crude (b) The experiment can serve as its own control or can utilize a natural control ({c) Degree of comparability is high (d) Several trials needed before evaluation is considered conclusive Answer (c) Although the experimental studies or randomized control trials are ideal and almost always to be preferred, it is not always possible to use it im human beings due to administrative, ethical or other reasons, e.g. smoking and lung cancer have never been experimented directly on human beings. In such situations non- randomized/non-experimental trials are resorted to, in which case effects of preventive interventions on community basis (community trials of water fluoridation) can be studied. Further, when disease frequency is low and natural history is long (cancer cervix), RCT will be impracticable, as it will require follow up of61. Epidemiology: Principles and Practice 45 {a) Infection (b) Infestation (c) Contamination (d) Pollution Answer {c) Infection implies entry and development or multiplication of an infectious agent in the body of man or animal wherein there is a specific response of the host, e.g. immune response and/or disease. Contamination, on the other hand, does not invoke any response from the host or other inanimate objects like water, milk, table- top, surgical instruments, ete. Therefore presence of Staphylococcus on intact skin means contamination of the skin but causation of abscess by the same Staphylococcus will mean infection of the skin. The term ‘infestation’ is used in relation to the presence of adult or pre-adult stages of arthropods on the surface or other parasites in the gut/other tissues, e.g. ascariasis, filariasis. Pollution implies presence of offensive but not necessarily infectious matter in the environment. Contamination of the body surface does not imply a carrier state. ‘A clinically manifest disease of man or animal resulting from an infection’ is called: (a) Infectious disease (b) Contagious disease (c) latrogenic disease (d) Nosocomial disease Answer (a) Contagious disease is the one which is transmitted through contact, e.g. scabies, sexually transmitted diseases (STDs), trachoma, etc. Communicable disease is an illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to man, man to animal or animal to animal or from environment to man or animal. Infectious disease and communicable disease are both generic terms used interchangeably. The term ‘nosocomial disease” is restricted toMCQs in Preventive and Social Medicine consequence of hospital acquired infection, whereas iatrogenic (physician induced) disease connotates any untoward or adverse consequence of preventive/diagnostic/therapeutic procedure. Endemic disease means that a disease: (a) Exhibits seasonal trend (b)_ Is constantly present in a given population group (c) Occurs clearly in excess of normal expectancy (d) Is prevalent arnong animals Answer {b) Endemic disease may burst into an ‘epidemic’ which is defined as unusual occurrence of a disease or other health related event in a community or region clearly in excess of the expected occurrence. Sometimes the term ‘outbreak’ is also used to describe a localized epidemic to minimize public panic. An epidemic is called a ‘pandemic’ when it occurs over a wide geographic area such as a section of a nation, the entire nation, a continent or the entire world. As opposed to this, the term ‘sporadic’ is used to describe a situation where cases occur irregularly, haphazardly and generally infrequently. These cases are clearly unconnected to each other in time and space, Infection maintained in both man and lower vertebrate animals that can be transmitted in either direction is: (a) Amphixenoses (b) Zooanthroponases (c) Anthropozoonoses (d} Epornithic Answer (a) All of the above are examples of zoonoses which is a generic term defined as ‘an infection or infectious disease transmissible from vertebrate animals to man under natural conditions’, It may be enzootic (like endemic in man) or epizootic (like epidemic in man). An outbreak of disease in a bird population is called epornithic.Epidemiology: Principles and Practice 49 69. Alt of the following are true about sub-clinical cases except: (a) Responsible for immunity in adults to a variety of infections (b) Can be detected only by laboratory tests (c} Host does not shed the infectious agent (d) Play a significant role in maintaining endemicity ichain of infection) in the community. Answer (c) Sub-clinical cases are also referred to as ‘missed’ or ‘abortive’ cases, ‘in-apparent’ or ‘covert’ cases. The disease agent may multiply in the host but does not manifest itself by signs and symptoms. These cases are equally important as sources of infection, hence maintain endemicity in an area by constantly shedding disease agent. On the other hand, some of cases harbour disease agent but do not shed the same in the community. The disease agent lies dormant within the host and may not be detectable in blood, tissues or other secretions. For such a situation, the term ‘latent infection’ is used. 70. Sub-clinical Infection is seen in all except: {a} Hepatitis B {b} Measles (c) Poliomyelitis ({d) Japanese encephalitis Answer (b) 71. Latent Infection is not seen in: {a} Ancylostomiasis (b) Brill Zinser disease (c} Japanese encephalitis (d) Herpes simplex Answer (c)50) =MCQs in Preventive and Social Medicine 72. Which of the following is the essential criterion for 73. 74, defining a ‘carrier state’? (a) Presence of disease agent in the body (b) Absence of recognizable symptoms and signs of the disease (c) Shedding of the disease agent in the discharges or secretions (d) All of the above Answer (d} All of the following conditions describe a ‘carrier state’ except: (a) Person shedding disease agent only during incubation period of a disease (b) Person under treatment for clinical disease (c) Person shedding the disease agent even after treatment (d) Person never having shown any signs and symptoms but shedding the disease agent Answer (b) Person shedding infectious agent during incubation period of disease are called ‘incubatory carriers’, e.g. measles, mumps, diphtheria, etc. Persons who continue to shed infectious agent even after treatment are called ‘convalescent carriers’, e.g. typhoid fever, amoebic dysentery, diphtheria, etc, Persons never having shown any signs and symptoms but shedding the infectious agent are known as ‘healthy carriers’. Such carriers emerge from sub-clinical cases, ¢.g. meningococcal meningitis, poliomyelitis, cholera, etc. An agent with low pathogenicity and high infectivity would result in: (a) Clinical case (b) Carrier75. 76. Epidemiology: Principles and Practice 51 (c) Pandemic (d} Epidemic Answer (b) Epidemiological significance of ‘carriers’ is higher than ‘cases’ because: {a} They infect more people (b) They increase virulence of the agent (c) They are more infectious than cases (d} They cannot be treated Answer (a) Carriers of ‘avirulent organisms’ are known as: (a) Healthy carriers (b} Asymptomatic carriers {c} Pseudo carriers (d) All of the above (e} None of the above Answer (c) All of the following are modes of direct transmission of communicable disease except: {a} Droplet infection (b} Contact with soil ({c} Transplacental (d) Droplet nuclei Answer (d) Droplet nuclei are a type of particles in the range of 1-10 pm. These represent dried residues of droplets and have a tendency to remain air-borne for long periods. Particles in the range of 1-5 um are liable to reach right up to alveoli of the lungs. These are thus indirect modes of transmission (air-borne transmission). Diseases spread by droplet nuclei include tuberculosis, influenza, chickenpox, measles, etc.52 78. 79. MCQs in Preventive and Social Medicine All of the following diseases are transmissible by contact with soil except: (a) Ancylostomiasis (b) Leptospirosis (c) Anthrax (d) Leishmaniasis Answer (d) Leishmaniasis is a vector-borne disease transmitted by the bite of Phiebotomus spp. Vertical transmission refers to a mode of transmission of disease agent by the agency of: (a) Placenta (b) Blood transfusion (c) Breast milk (d) All of the above Answer (a) Vertical transmission is a term exclusively used for transplacental transmission, which is another form of direct transmission, e.g. TORCH agents, human immunodeficiency virus (HTV). Even some of the non-living disease agents can also be transmitted transplacentally, e.g. thalidomide, diethyl stilbestrol, etc. Vertical transmission is seen in ail of the following except: (a) Hepatitis B (b) Measles (c) Cytomegalovirus (d) Coxsackie B virus Answer (b) In biological mode of transmission, which of the following is incorrectly matched? (a) Agent changes in form and number: cyclopropaga- tive8 Epidemiology: Principles and Practice 53 (b) Agent changes from nymph to adult stage: trans- stadial (c) Agent transmitted vertically: transovarial (d) Agent changes in form but not in number: cyclopropagative Answer (d) In cyclopropagative mode of biological transmission, the infectious agent changes both in form and number, e.g. malarial parasite in mosquito. Cyclodevelopmental mode of transmission is seen in: (a) Malaria (b) Filariasis (c) Cholera (d) Plague Answer tb} Cyclopropagative mode of transmission is seen in: (a) Plague bacilli in rat flea (b) Japanese encephalitis {c) Guinea worm embryo in cyclops (d) Malarial parasite in mosquito Answer (d) . The time interval between receipt of infection by a host and maximal Infectivity of that host is: (a) Incubation period (b) Period of communicability (c) Generation time (d) Latent period (e) Serial interval Answer (c} In general, generation time roughly matches the incubation period but these two terms are not synonymous. Incubation perioda4 MCQs in Preventive and Social Medicine {clinical incubation period) is defined as, ‘the time interval between invasion by an infectious agent and appearance of the first sign or symptoms of the disease in question’. The term “median incubation period” is used to define the time required for 50% of the cases to occur following exposure. “Period of communicability’ refers to the time during which an infectious agent may be transferred from infected man or animal to another man or animal directly or indirectly. This period may be shorter than incubation period or prolonged beyond incubation period. ‘Latent period’ is the term used in relation to non-infectious diseases such as cancer, heart diseases, etc. as equivalent of incubation period. The term ‘serial interval’ is applied in relation to outbreaks and describes ‘the gap in time between the onset of primary case and secondary case’. It gives an indication of the incubation period during an outbreak of the disease. “The time between invasion of an infectious agent and detection of evidence of the infectious agent by laboratory means’ is known as: (a) Prepatent period (b) Incubation period (c) Generation time (d) Serial interval Answer (a) Prepatent period is generally shorter than clinical incubation, period, e.g. IgM antibodies may become detectable in many cases before appearance of clinical signs and symptoms. . The importance of secondary attack rate is that it reflects: (a) Fatality (b) Severity {c) Communicability (d) All of the above56 =MCQs in Preventive and Social Medicine 89. All of the following are true statements in relation to herd immunity except: (a) It is affected by occurrence of clinical cases (b) It is not affected by occurrence of sub-clinical cases (c) It is affected by the presence and distribution of alternative animal hosts (d) It refers to group protection beyond that afforded by the protection of immunized individuals Answer (b) Herd immunity implies level of resistance of a community or a group of people (herd) to a particular disease. It depends on three factors: i Occurrence of clinical and sub-clinical infections in the herd ii, Immunization status of the herd Herd structure, which is never constant due to new births, deaths, migrations, etc. and includes presence of hosts of other species like animals, insects as well as environmental and social factors . It may be noted that herd immunity does not protect the individual in case of tetanus. 90. Active Immunity can be acquired by all of the following except: (a) Inoculation with immune serum (b) Inoculation with live or killed vaccine (c} Inoculation with toxoids (d) Exposure to infectious agents Answer (a) Immune serum contains immunoglobulins, which only render passive immunity. 91. Active immunity with sub-clinical infection is seen in: (a) Measles (b) Poliomyelitis93. 94. Epidemiology: Principles and Practice 57 (c) Rubella (d) Chickenpox Answer (b) Nature and extent of primary response to an antigen depends on: (a} Nature and dase of antigen {b) Route of administration (c} Adjuvants (d} Nutritional status of host (e) All of the above Answer (e) Primary response depends on the dose of antigen, to the extent that with a small dose only IgM response may be elicited which is immediate. IgG response peaks in 7-10 days but needs about 50 times the dose of antigen. An important outcome of the primary response is development of ‘immunological memory’ based on B and T lymphocytes. The accelerated secondary response on a subsequent antigenic stimulus (booster) is the result of this immunological memory. All of the following are characteristics of a ‘secondary immune response’ except: {a} Antibody production is more abundant (b) Antibodies have greater capacity to bind with the antigen (c) Response lasts for a shorter period (d) Shorter latent period Answer (c) Which of the following statements is nof true in relation to five vaccines? (a) Produce a long and durable immunity (b} Are more potent than killed vaccines because have the entire major and minor antigenic componentsEpidemiology: Principles and Practice 59 98. After administration of live vaccine, immunoglobulins ‘can be given after: (a) 1 week (b) 2 weeks (c) 8 weeks (d) 12 weeks Answer (b) Immunoglobulins should not be given within 2 weeks of administration of live vaccine as this may jeopardize the immune response to the vaccine. 99. Which class of immunoglobulins is transported across placenta? (a) IgM (b) IigD (c) IgG (d) IBA Answer (c) 100, Which of the following vaccines must be stored in the freezer compartment of the refrigerator? (a) Oral polio {b) Measles (c) Both of the above (d) None of the above Answer {c) All vaccines as a general rule must be stored under the conditions recommended by the manufacturer. Polio and measles are live vaccines which are thermo-labile and should be stored preferably at ~20°C. Vaccines which must never be allowed to freeze but stored in the cold part of the refrigerator (48°C) are typhoid, DPT, DT, TT, BCG and diluents,101. 102. MCQs in Preventive and Social Medicine Cold chain equipment jocated at regional level is: (a) Deep freezer 300 L (b) Deep freezer 140 L (c) Ice lined refrigerator (ILR) 300 L ({d} Walk in cold rooms Answer (d) Walk in cold rooms are meant to store vaccines for 3 months and serve 4--5 districts. Large deep freezers and ILRs are placed at district headquarters. Small deep freezers and [LRs are placed at Primary Health Centres (PHCs), Urban Centres, ete. Ice packs are prepared in deep freezer. Smaller cold chain equipment like cold boxes/vaccine carriers/day canners are used for transportation of vaccines from larger centres or for outreach services. A 3%-year-old child has not received primary immunization. Which of the following is the best vaccination advice to such a child? (a) BCG, DPT1, OPV1, and DPT2, OPV2 after 4 weeks (b) BCG, DT1, OPV1, measles, Vitamin A (c) BCG, DPT1, OPV1, measles, HB1, Vitamin A (d) DT1, DT2 and booster after 1 year. Answer (c) As per Indian Academy of Pediatrics (IAP) guidelines, schedules have been suggested for unimmunized children aged less than 5 years as apart from more than 5 years. The schedules take into consideration possibility of faulty compliance on subsequent dosage. Hence measles/MMR vaccine can be given at the first contact itself along with other vaccines. The suggested schedule for unimmunised child is as under:103. 104. Epidemiology: Principles and Practice 61 Age <5 years >S years First visit BCG OPV, DPT. HB TTT, HB Second visit OPY, DPT, HB TdT. HB (1 month later) Third visit OPV, DPT, HB HB, MMR, Typhoid (1 month later) Measles/MMR, Typhoid 1 year later OPV, DPT Every 3 years Typhoid booster Typhoid booster The Expanded Programme of immunization (EPI) was started in India in 1978. It included all of the following vaccines except: {a} BCG (b) Measles (c) Typhoid (d) DPT Answer (b} The EPI was originally started by WHO in 1974 and was adopted by the Government of India in 1978, It included only BCG, DPT and typhoid for children under 5 years of age. It did not include measles vaccine and OPV was added in 1979, This programme continued up to 1987. EPI was supplanted by Universal Immunization Programme (UIP) in 1985. The Government of India subsequently set up the ‘Technology mission on vaccination and immunization of vulnerable populations, specially children’. The UIP is current ull now and is integral part of Reproductive and Child Health (RCH) Programme since 1997, The immunization activities in India are largely supported by UNICEF. The funding agency for Global Alliance for Vaccine and Immunization (GAVI) is: (a) UNICEF (b) WHO107. 108. 109. Epidemiology: Principles and Practice 63 (d) Sabin strain grown in primary monkey kidney (PMK) cells Answer (a) Ring vaccination is: (a) Given to produce a ring lesion (b) Given around 100 yards of a case detected (c) Given by ring-shaped machine (d) Given around a mile of a case Answer (b) Ring vaccination/immunization is an operational device for creating a virtual isolation of the infected persen with a barrier of immune persons in order to contain the infection locally. This method was successfully used for eradication of smallpox. This method is also being applied in North America in measles control and eradication. Toxic shock syndrome (TSS) is an adverse reaction related to: (a) Any vaccine (b) OPV (c) BCG (d) Measles Answer (dl) TSS is consequent of contamination of measles vaccine with Staphylococeus aureus. tt occurs within 30 minutes to few hours and is characterized by mounting fever, vomiting, diarrhoea and septic shock. It is managed with IV fluids, antimicrobials such as cloxacillin 50-100 mg/kg/24 hour, steroids, antipyretics and Supportive therapy. “Separation for the period of communicability of infected persons or animals from others’ is termed as: (a) Quarantine (b) Segregation112. 113. 114, Epidemiology: Principles and Practice 65 (c) Cholera (d} Meningococcal meningitis Answer (a) “The process, which destroys all microbial fife including spores’ is known as: {a} Disinfection (b) Antisepsis (c} Deodorization (d) Sterilization Answer (d) “‘Antisepsis’ relates to destruction of inhibition of microorganisms. in living tissues, ¢.g. Savion, Dettol, chlorhexidine, etc. ‘Deodorant’ is a substance which suppresses or neutralizes bad odours, c.g. lime, bleaching powder. ‘Detergents’ are surface cleaning agents and act by lowering the surface tension thereby breaking up the fat covering of dirt, e.g. soap. ‘Disinfection’ is the killing of infectious agents outside the body by direct exposure to chemical or physical agents. The term is usually applied to inanimate objects or surfaces, ¢.g. phenol, sunlight, cresol, hypochlorite solution, etc. Chemical disinfectants in small doses or dilutions can also act as antiseptics. Which of the following Is not a complete sterilizing agent? (a) Glutaraldehyde (b} Absolute alcohol (c) Hydrogen peroxide (d) Sodium hypochlorite Answer (b) Absolute alcohol is not effective against spores, hence cannot be termed as complete sterilizing agent. Disinfectant action of sunlight is due to: (a) Ultraviolet rays66 115. 116. 117. 118, MCQs in Preventive and Social Medicine (b) Infrared rays (c}) Heating effect (d} None of the above Answer (a) Glass vessels and syringes are best sterilized by: (a) Hot air oven (b) Gamma irradiation {c) Autoclaving {d) Ethylene dioxide Answer (a) All of the following can be sterilized by autoclaving except: (a) Gloves (b) Plastic material (e) Linen (d) Culture media Answer (b} Choleric stool is best disinfected by: fa) Phenol (b) Formaldehyde (c) Cetrimide (d) Bleaching powder Answer (d) Bleaching powder in a dose of 50 g/L. is used for disinfecting stools. Gamma irradiation is used to sterilize: (a) Linen (b) Surgical instrumentsEpidemiology: Principles and Practice 69 Step 3: Rapid search of all cases and their characteristics. Step 4: Data analysis. Step 5: Formulation of hypotheses. After that, the hypothesis should be tested followed by evaluation of ecological factors, further investigation of population at risk and writing of report.Screening for Disease 71 (c) Require considerable physician time (d) All of the above Answer id) The time interval between diagnosis by early detection and diagnosis by other means is: (a) Serial interval (b) Lead time (c) Time lag (d) Latent period Answer (b) Lead time is the advantage gained by screening. Therefore screening programmes are useful for those conditions where the time lag between the disease onset and final critical point for treatment to be effective is sufficiently long. All of the following are true for a screening test except: {a} Less accurate (b} Forms the basis for treatment (c} Test results are arbitrary (d) Less expensive Answer (b} Screening tests are only arbitrary, less accurate, less expensive and do not form the basis for treatment as a specific ‘diagnostic test’ will need to be performed to confirm the diagnosis suggested by a screening test in order to start a specific treatment. ‘Multiphasic screening’ means: (a} Application of two or more screening tests in combination at one time (b) Application of two or more screening tests in combination at different time (c) Apptication of two or more screening tests in combination at different geographical areasa 10. Screening for Disease 73 yield, simplicity, safety, rapidity, ease of administration and cost effectiveness. All of the above criteria may not be fulfilled by any one screening test. Therefore the choice of the test is largely based on the objective of screening as well as the degree of compromise. ‘Sensitivity’ of a screening test refers to: (a) True negative (b) True positive (c) False negative (d) False positive Answer (b) “Walidity’ (accuracy) of a good screening test is an important attribute, which ensures that the observed values closely agree with the true values. The two components of validity are “sensitivity” and ‘specificity’. Both are expressed as percentages. Sensitivity and specificity together with predictive accuracy are important determinants of a good screening test. Sensitivity refers to the ability of the test to pick up true positive cases from the screened population whereas specificity refers to the ability of the test to pick up true negative cases. Specificity of a test means all except (a) Identifies those without disease (b) Identifies true positives {c) Identifies true negatives (d) An ideal screening test should have 100% specificity Answer (b} Diagnostic power of a screening test is deduced from: (a) Specificity (b) Population attributable risk {c) Sensitivity {d) Predictive value74 11. 12. MCQs in Preventive and Social Medicine Answer (dj Predictive value or predictive accuracy of a screening test depends on sensitivity, specificity and disease prevalence. The higher the disease prevalence in a given population, the more accurate will be the predictive value of a positive screening test. The predictive value of a positive result falls as disease prevalence declines, A test is done in community X and Y; more false positives were found in community X. The inference is: (a) Invalid test {b) Prevalence less in community X (c) Prevalence less in community Y (d) Prevalence more in community X Answer (b} Sensitivity of a screening test can be determined by the following formulae: True negative (a) 100 False positive + True negative ) True positive «100 True positive + False positive tc) True positive 1 True positive + False negative True negative (d) False negative + True negative oe Answer (c)} Formula at (a) measures the specificity; (b) measures the predictive value of a positive test and (d) measures the predictive value of a negative test.76 MCQs in Preventive and Social Medicine (c) Specific (d) Sensitive Answer (b) “Repeatability” (reliability. precision or reproducibility) is also an important attribute of a good screening test. It means that the test must give consistent results when repeated more than, once on the same individual or material under the same conditions, It is influenced by intra-observer variation, inter- observer variation, biological variation and errors due to technical defects of the equipment. 17. What will be the effect on the interpretation of a screening test if the cut off point in the interpretation is raised? (a) Sensitivity and specificity will increase (b) Sensitivity and specificity will decrease (c) Sensitivity decreases but specificity increases (d) Specificity decreases but sensitivity increases Answer {(c}Chapter 5 Epidemiology of Communicable Diseases and Related National Health Programmes RESPIRATORY INFECTIONS 1. nN Eradication of smallpox has been possible due to the following epidemiological facts except: {a} Highly effective vaccine available conferring long tenm protection (b) No Jong term carriers of the virus (c) Easy case detection due to characteristic rash (d) Elimination of animal reservoir {e) International cooperation Answer (d) Animal reservoir of the smallpox virus does not exist. . Global eradication of smallpox was certified by WHO78 MCQs in Preventive and Social Medicine (a) April 1977 (b) May 1979 (ce) May 1980 (d) May 1981 Answer {c) India was certified to be smallpox free in April 1977. The last case in the world occurred in 1977 in Somalia, WHO certified the global eradication of smallpox on 8 May 1980, All of the following are characteristics of the chickenpox rash except: fa) Rash occurs in crops (b) Pleomorphism is present fc) Is centripetal in distribution (d) Scabs are infectious Answer (d) Eruptive stage of chickenpox follows 2—3 days of pre-eruptive or prodromal stage. The rash is typically centripetal and occurs on flexor surfaces. It occurs in crops. Characteristically different stages of the rash are visible at any given time (pleomorphism). Scabs are non-infections and the mode of transmission is through droplet infection. The infectivity of chickenpox lasts for: (a) 3 days after the onset of rash (b) 5 days after the appearance of first crop of vesicles (c) Till the last scab falls (d) Till the fever subsides Answer (b) Period of communicability of chickenpox may be as long as 5 days but it is usually 1-2 days before the onset of rash and extends up to 5 days after the appearance of first crop of vesicles. However, patients with zoster may remain infectious for a week after the appearance of vesiculo-papular lesions.WW 12. 13. Epidemiology of Communicable Diseases 81 (c) All ages are susceptible if not previously infected or immunized (d) Immunity after clinical attack is long lasting Answer (b) Immunity develops 11-12 days after vaccination and is usually of long duration probably for life. One dose of vaccine gives 95% protection. Diagnostic criteria for measles include all of the following except: (a) Severe prodromal symptoms (b) Koplik’s spots (c) Rising IgM antibodies in paired sera (d) Leucocytosis Answer (d) Commonest complication of measles in young children is: (a) Otitis media (b) Pneumonia (c) Glomerulonephritis (d) Subacute sclerosing panencephalitis SSPE} Answer (a) Pneumonia is a complication commonly found im adults. [t is mainly of viral origin; however, secondary bacterial pneumonias with streptococcus/pneumococeus/staphylococcus are also common. SSPE is an extremely rare form of measles encephalitis and occurs many years after measles infection, especially if infection was contracted before 2 years of age. Other complications of measles include glomerulonephritis, gastroenteritis, myocarditis, hepatitis, ete, Measles epidemic can be anticipated when proportion of susceptible children in a community reaches:19. 21. MCQs in Preventive and Social Medicine A large number of rubella infections are sub-clinical. This constitutes one of the major differences between measles and rubella, Infants with congenital rubella shed large quantities of virus in pharyngeal secretions as well as urine and serve as a source of infection to contacts. Post-auricular, occipital and posterior cervical lymphadenopathy is classical presentation in case of: {a} Chickenpox (b) Measles (c) Rubella (d) Mumps Answer (c) . Classical triad of congenital rubella syndrome includes all of the following except: (a) Patent ductus arteriosus (PDA) {b) Hydrocephalus (c}) Cataract (d) Deafness Answer (b) Congenital rubella may include single or combined defects such as deafness, cataract, microphthalmia, congenital glaucoma, microcephaly, meningoencephalitis, mental retardation, PDA, atrial or ventricular septal defects, purpura, hepatosplenomegaly, Jaundice and radiolucent bone disease. Maximum risk of congenital malformations is related to maternal rubella Infection during pregnancy of: (a) Less than 11 weeks (b) 11-16 weeks (c) 17-26 weeks (d) 27-36 weeks Answer (a)22. 23. 24. Epidemiology of Communicable Diseases 85 Which of the following is not true in respect of RA 27/3 live attenuated rubella vaccine? (a) Produces high antibody titres (b) Single dose gives long term immunity (c) Does not prevent sub-clinical infection with wild virus (d) Contraindicated in pregnancy Answer {c) RA 27/3 isa live attenuated human diploid cell vaccine. [t produces an immune response closely similar to natural infection. Seroconversion occurs in more than 95% of recipients when administered in a single-dose of 0.5 ml subcutaneously, Vaccine- induced immunity persists in most vaccinees for 14-16 years and may even be lifelong. Infants under 1 year should not be vaccinated due to possibility of persisting maternal antibodies. Recipient of vaccine should be advised to avoid pregnancy for 3 months. It is also available as a combined mumps, measles and rubella vaccine (MMR). Which of the following statements is nottrue in relation to communicability of mumps? {a} Maximum infectiousness occurs about 48 hours before onset of illness (b) Exposed non-immune persons are infectious from 12-25 days after exposure (c) 30-40% cases are sub-clinical (d) Inapparent infections are not communicable (e) Virus may be found in urine for as long as 14 days after onset of illness Answer (d) Commonest complication of mumps is: (a) Encephalitis {b) PneumoniaHW MCQs in Preventive and Social Medicine (c) Amantadine (d} Zidovudine Answer (c) . Anon-toxigenic strain of Corynebacterium diphtheriae may become toxigenic when exposed to the following bacteriophage: (a) Alpha phage (b) Beta phage (c) Gamma phage (d) Delta phage Answer (b} - The most important source of infection for diphtheria is: (a) Sub-clinical case (b) Clinical case (c) Carrier (d)_ All of the above Answer (c} Carriers are considered the commonest sources of infection. ‘There are approximately 95 carriers for five clinical cases. Carriers may be nasal, throat and cutaneous, out of which nasal carriers are particularly important as sources of infection. The incidence of carriers in a community varies from 0.5 to 1%. Immunization does not prevent carrier state. . The period of infectivity in diphtheria Is: (a) A few days before to 5 days after the appearance of prodromal symptoms (b} 14-28 days from the onset of disease (c) 7-21 days from the onset of disease (d) None of the above Answer (b)Epidemiclogy af Communicable Diseases 89 A case or carrier is considered non-infectious when at least two consecutive cultures, systematically obtained from nose and throat, 24 hours apart, are negative for C. diphtheriae. 33. Shick test is designed to elicit: (a) Hypersensitivity to diphtheria toxin {b) Presence of anti-toxin {c) Immunity status (d) All of the above (e) None of the above Answer (d) Four types of reactions may occur in response to Shick test: i, Negative reaction: when blood serum contains more than 0.03 units of anti-toxin/ml. Indicates that a person is immune to diphtheria. ii, Positive reaction: circumscribed red flush 10-50 mm in diameter within 24—48 hours in the test arm, nil in the control arm. Indicates susceptibility to diphtheria. iii. Pseudo-positive reaction: red flush not clearly circumscribed in both the arms. It is an allergic reaction, interpreted as negative. iv. Combined reaction: pseudo-positive reaction in control arm and true positive reaction in the test arm. Indicates that the person is susceptible but allergic to diphtheria anti-toxin, hence should be vaccinated carefully. Shick test has largely been replaced now by measurement of serum anti-toxin level by hemagglutination test. 34. Duration of isolation of a diphtheria case as a control measure is: (a) Till 2 consecutive nose/throat swabs are negative (b) Till the symptoms subside (c) Till Shick test becomes negative (d) Till antibody titres decrease39. Epidemiology of Communicable Diseases 91 ic) Presence of acellular pertussis component increases its immunogenicity (d) Presence of Haemophilus influenza type B component increases its immunogenicity Answer (d) H. influenza type B is not a component of DPT vaccine. Contraindications of DPT vaccines are all except: (a) Any febrile illness {b) Family history of epilepsy (c) Recent history of infectious disease (d) Children below 2 years of age Answer (d) Which of the following statements is no? true in relation to pertussis: (a) Most infectious during catarrhal stage (hb) Secondary attack rate is 90% (c) Sub-clinical cases are source of infection (d) Infants are susceptible from birth Answer {c) Period of infectivity in case of pertussis extends from early catarrhal stage (1 week after exposure) to 3 weeks after the appearance of paroxysmal stage. Sub-clinical cases and chronic carrier state do not exist. Maternal antibodies do not appear to be effective, hence infants are susceptible from birth. Incubation period of pertussis is: (a) 1-7 days (b) 7-14 days (c) 15-28 days (d) More than 28 days Answer (b)45. Epidemiology of Communicable Diseases 93 (b) The vaccine is not effective in children below 2 years of age (c) Chemopraphylaxis of close contacts of cases is recommended (d) The source of infection is mainly clinical cases Answer (d) The organism is found in the nasopharynx of cases and carriers, Carriers are the most important source of infection. Fomite transmission is insignificant. Number of carriers greatly outnumbers the cases, Period of communicability in meningococcal meningitis is: {a} Till meningococci are no longer present in the nasopharynx (b) 7 days after exposure to 3 weeks after appearance of symptoms (c) A few days before to 5 days after the appearance of symptoms (d) None of the above Answer (a) Meningococci rapidly lose infectiousness within 24 hours of specific antibacterial therapy. Hence cases should be isolated for minimum up to 24 hours after the start of chemotherapy. Which of the following drugs can be used as chemoprophylaxis for protection of contacts of meningococcal meningitis patient? (a) Rifampicin (b) Sulfadiazine (c) Ciprofloxacin (d) All of the above Answer (d)4 47. MCQs in Preventive and Social Medicine Sulfadiazine is the drug of choice provided the organisms in the outbreak are sulfonamide sensitive. In case of sulfonamide resistance or unknown sulfonamide sensitivity, rifampicin can be used. Ceftriaxone single IM dose or ciprofloxacin single oral dose can also be used for adults. . Ina military barrack, soldier X and Y¥ develop infection with group B and group C meningococci, respectively, Which of the following is nota correct action regarding contral of infection? (a) Information, education, communication (IEC) for prevention and control, to all soldiers ib) Chemoprophylaxis to all contacts (c) Vaccine prophylaxis for contacts of soldier X (infected with group B meningococcus) {d) Vaccine prophylaxis for contacts of soldier ¥ (infected with group C meningococcus) Answer (c) No vaccine effective against group B meningococci is currently available. Meningococcal vaccine is not recommended for: {a} Pregnant women (b) Infants (c} Children below 2 years of age (d) All of the above Answer (d) Currently available polysaccharide vaccines exhibit poor immunogenicity in case of infants and children below 2 years of age. Safety in pregnant women is not proved. Which of the following agents commonly causes acute respiratory intection in intants and young children? (a) Mycoplasma pneumoniae (b) Coxiella burnetii53. Epidemiology of Communicable Diseases 97 Children with severe pneumonia (chest indrawing) and very severe disease (see Q. No. 49) should be treated as in-patients with intra-muscular (1/M) benzyl penicillin or ampicillin or chloramphenicol. Such children should be monitored every day, and after 48 hours if the condition improves, benzyl penicillin should be replaced by procaine penicillin. If there is no improvement after 48 hours, consider change of antibiotics. Pneumococcal vaccine is indicated in all except: {a) Diabetes mellitus (b) Renal failure (c) Cystic fibrosis (d) Sickle cell anaemia Answer {c) Mode of transmission of severe acute respiratory syndrome (SARS) includes all of the following except: (a) Droplet nuclei (b) Contact with sewage, faeces of the patient (c) Cockroaches (d}_ Respiratory droplets Answer (a) There is no evidence that SARS is an air-borne disease. It is essentially transmitted by contact with patients, infected material. SARS virus belongs to which family of viruses? (a) Picornaviridae (b) Herpesviridae {c) Coronaviridae (d) Bunyaviridae Answer (c) 56. Which of the following is an Incorrect statement regarding exclusion criteria of SARS?98 =MCQs in Preventive and Social Medicine (a) When an alternative diagnosis can fully explain the illness (b) When no autopsy was carried out on death due to an unexplained acute respiratory illness before 1 November 2002 (c) A person residing in a SARS affected area and presenting with high fever after 1 November 2002 (d)_ All of the above Answer (c} The existing case definition of SARS is as follows: Suspect Case: lL. A person presenting after 1 November 2002 with high fever (>38°C), cough or breathing difficulty and one or more of the following in the previous 10 days: (a) Close contact with suspected/probable case of SARS (b) History of travel to SARS affected area (c) Residing in an affected area 2. A person with unexplained ARI resulting in death after | November 2002 on whom no autopsy has been performed and has been in close contact with a person who is suspect or probable case of SARS and/ or history of travel to an affected area during 10 days prior to the onset of symptoms and/or residing in an affected area. Probable Case: 1. A ‘suspect’ case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome.Epidemiology of Communicable Diseases 99 2 A ‘suspect’ case with autopsy findings consistent with respiratory distress syndrome without an identifiable cause. 57. Causative agent for last pandemic of avian influenza belongs to: {a} Orthomyxoviridae (b) Paramyxoviridae (c} Coronaviridae (d} Picornaviridae Answer (a) Agents for avian influenza are a large group of influenza viruses primarily affecting birds. However, some strains on rare occasions may infect other species like pigs and humans. The strain responsible for the recent pandemic was HSN1, 58. The most appropriate test to assess the prevalence of tuberculosis infection in a community is: (a) Sputum examination (b) Mass miniature radiography (c) Tuberculin test id) Clinical examination Answer (c) The most appropriate test to assess the prevalence of tuberculosis cases in a community is sputum examination, which is the best available practical index to estimate the number of infectious cases or ‘case load’ in. a community. According to WHO ‘control’ of tuberculosis is said to have been achieved when the prevalence of natural infection in the age of group of 0-14 years is: {a) 40% (b) 10%100 61. MCQs in Preventive and Social Medicine (c) 1% (d) 5% Answer (c} All of the following are commonly used epidemiclogical indices in tuberculosis except: (a) Annual infection rate (b) Case rate (c} Incidence of new cases (d) X-ray positivity rate Answer (d) In addition to the above, the other epidemiological indices used in tuberculosis are prevalence of infection, prevalence of drug resistant cases and tuberculosis mortality rate. X-ray chest is not a reliable test for diagnosing tuberculosis, hence no epidemiological significance can be drawn out of data based purely on X-ray examination. Tuberculin test denotes: (a) Patient is resistant to tuberculosis {b} Previous or present sensitivity to tubercle proteins (c) Person is susceptible ta tuberculosis (d) Protective immune status of individual against tuberculosis Answer (b) A positive reaction (reaction of 10 mm or more to | TU PPD) indicates that the person is infected with Mycobacterium mberculosis; but not necessarily active tubercular lesion in case of adults. However, in a child below 2 years a positive test is an indirect evidence of an active tubercular lesion. 62. Which of the following is not a correct statement about the tuberculin test? (a) Itis the only tool available for measuring the pre- valence of tuberculous infection in a community64. 65. Epidemiology of Communicable Diseases 101 (b} induration of more than 10 mm indicates a positive test (c} It is a specific test (d) New cases occur more commonly in patients who are tuberculin reactors Answer {c) . Which of the following is nota bactericidal drug? (a) Rifampicin (b) Isoniazid (c) Streptomycin (d) Ethambutol Answer (d) ‘ Which of the following is the basis for categorization of a patient in Revised National Tuberculosis Control Programme (RNTCP)? (a) Clinical examination (b) Chest X-ray (c} Sputum microscopy (d)} ELISA for tuberculosis Answer (c) Which of the following is mot a true statement in relation to the strategy of RNTCP? {a} Achievement of at least 65% cure rate in newly detected infectious cases (b} Detection of 70% of such cases in the community after achieving 85% cure rate (c} Detection of 70% of such cases in the community before achieving 85% cure rate (d) Involvement of NGOs72. Epidemiclogy of Communicable Diseases 105 (c) 3,5 and 6 months (d) 1, 3. and 5 months Answer (b) The above schedule in case of category I is 3, 5 and 8 months, and in category III is 2 and 6 months. However, if the patient is found to be sputum positive al the end of intensive phase (IP) (2 months in categories I and If, and 3 months in category I), then the intensive phase is extended for one more month in categories | and IJ (declared treatment failure in category [Il and patient re-registered in category I}, Sputum is re-tested at the end of extended IP. So the new schedule will become 3, 5 and 7 months for category |, and 4, 6 and 9 months in category Il. A patient with sputum positive pulmonary tuberculosis is on anti-tuberculosis therapy (ATT) for last 5 months but the patient is still positive for AFB in sputum. This case will be termed as: (a) New case (b) Default case (c) Failure case (d) Relapse case Answer (c) Which of the following Is the correct definition of multi- drug resistant (MDR) tuberculosis? {a} Clinically suspected resistance to rifampicin and isoniazid (b) Laboratory confirmed resistance to rifampicin and isoniazid (c) Clinically suspected resistance to all first line drugs (d} All of the above Answer (b)83. Epidemiology of Communicable Diseases 109 (d) Transporting vaccines to laboratory to check potency Answer (b) The term ‘reverse cold chain’ is conventionally used for transporting stool samples from periphery to the laboratories for virus isolation in the AFP Surveillance Programme. Criteria for declaring an epidemic of polio are all except: (a) Two or more cases (b) All cases caused by the same virus (c) All cases occurring in same locality id) All cases occurring within 8-week period Answer (d) All cases should occur within a 4-week period in addition to the above criteria. An effective step to stop spread of infection during an epidemic of poliomyelitis is: (a) Chlorination of drinking water {b) Isolation of cases (c) Administration of oral polio vaccine (OPV) to all children (d) Administration of IPV to all children Answer (c) As OPV is a live vaccine, the vaccine strain readily infects intestinal epithelial cells conferring local immunity. [t prevents establishment of wild virus in the intestinal mucosa. Further, since the vaccine virus starts getting excreted in the faeces, it exerts a multiplier effect rapidly raising the herd immunity and tends to replace the wild virus from the local environment. Which of the following statement is rof true about IPV: (a) Cannot be given to AIDS patient (b) Given in four doses186 16. 17. 18. MCQs in Preventive and Sacial Medicine As there is no single contraceptive method likely to satisfy the social, aesthetic, cultural and service needs of different individuals and communities, the search for an ‘ideal contraceptive” has been given up. The present approach for family planning programmes is to give a ‘cafeteria choice’, i.e. to offer all methods of contraception from which an individual can make his own choice. Ideally the selection should be supported by accurate information regarding advantages/disadvantages of all methods on offer. The following statements about intrauterine devices (UD) are true except (a) The pregnancy rate of Lippes loop and Cu-T 200 are similar (b) Multiload Cu-375 is a third generation IUD (c) IUD can be used for emergency contraception (d) Levonorgestrel releasing |UD has an effective life of 5 years Answer (b) Multiload Cu-375 is a second generation IUD. Third generation TUDs include hormonal devices such as progesterone containing device (Progestasert) and levonorgestrel (LNG-20/Mirena), The most common side effect of IUD insertion is: {a} Pain (b} Pelvic infection (c) Bleeding (d) Ectopic pregnancy Answer (c} Scope of family planning services Include all of the following except: (a) Screening for cervical cancer (b) Providing services for unmarried mothers (c) Providing adoption services (d) Screening for HIV infectionPreventive and Social Medicine BU e ly be Se eee cn eed enact a am Sete Ur tiem Reider tis = Includes recent questions and solutions of AlIMS, all india and other ac Ula : Features over 800 questions cavering the entire subjects per the sylabi Pennies re * Usefulin quick revision of the full course. Deane i De Ca ee Cait * Style—matches that encountered in enirance UU Peete Ere : Te Est tr ea lc GPI Singh is Professor and Head, Department of Community Medicine, BOIL owe lec cies tee eee ee LS EAE 4 Snow era ee