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Result: PSM (HEALTH PROGRAMME/DEMOGRAPHY/OBS &

PAEDIATRICS MEDICINE) 50Q MODEL TEST (15/07/2011) Date: 2011-07-16

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Question ID: 1 Question: All are true regarding supplementary nutrition provided by ICDS scheme except Options: (1 ) For Children below 1 yr 200 calorie and 8 - 10 gm of protein given (2 v) 1 - 6 years - 500 cal & 15 gms protein (3) Pregnant women and nursing mother -- 500 cal & 25 gms protein (4 ) Given for 300 days in a year Integrated Child Development Service : Started in the year 1975 (Ministry & Social Welfare) & HRD Beneficiaries : a) Pregnant women b) Nursing mother c) Women 15 45 yrs d) Children < 3 yrs e) Children 3 6 yrs f) Adolescence Supplementary nutrition : 300 days a year < 1yr 200 cal & 8 - 10 gms protein 1 6 yrs 300 cal & 15 gms protein Pregnant/nursing mother 500 cal & 25 gms protein ............................................................................................................. Question ID: 2 Question: The incidence of Low birth weight infants if the cut off value is < 2kg instead of 2.5 kg woul be Options: (1 ) 26% (2 ) 10% (3 v) 5.5% (4 ) 7.5% LBW (Low Birth Weight) LBW Birth weight < 2500 g

 2 types a) Preterm -- Before 37th week of gestation b) Small for date Birth weight below 10th percentile for gestational age LBW 26/1000 presently ( Goal < 10/1000 live births ) Wt < 10th percentile of gestational age --- IUGR or SFD Causes : a) Maternal Placental b) Foetal High IMR and PMR ............................................................................................................. Question ID: 3 Question: Managerial tool for improving the MCH care is Options: (1 ) Service approach (2 ) Cafeteria approach (3 ) Welfare approach (4 v) Risk approach Handling of tools and Techniques to achieve a desired goal : Evaluation : Process by which one knows how far objective have been achieved Organisation : Frame work of an institute Risk Approach : a) Managerial tool b) In antenatal care to identify the high risk mother c) Arrange for skilled care d) Improves efficiency and effectiveness of MCH services Personnel involved : a) ANM b) MPW c) PHC doctor ............................................................................................................. Question ID: 4 Question: All are essential components of Under five care except Options: (1 ) Family planning (2 ) Female literacy (3 ) Food supplementation (4 v) Food fortification Under Five Mortality rate : = (No. of deaths in children < 5yrs of age in a year x 1000)/ No. of live births in the same year Child Mortality rate : In INDIA 85/1000 live birth (2004) Best single indicator of social development (UNICEF) Child survival rate = (1000 under 5 mortality rate)/10 Leading cause of Under five Mortality rate in developing country is ARI

 Timing of Under Five death : a) Day 1 20% b) Day 3 25% c) Day 7 37% d) Day 28 50% e) 1 yr 75% f) 5 yrs - 100% GOBI-FFF: Campaign promoted by UNICEF To promote child health Closely linked to Under 5 Clinic G Growth monitoring O Oral rehydration B Breast feeding I Immunization F Family planning F Female literacy F Food supplementation ............................................................................................................. Question ID: 5 Question: The reduction in one of these indicators truly reflects good quality maternal and child care Options: (1 ) Infant Mortality (2 ) Neonatal Mortality (3 v) Perinatal Mortality (4 ) Under 5 mortality Perinatal Mortality rate : PMR = (Late fetal Death + Early Neonatal death(< 1 wk) X 1000 )/ Total live births same year Causes : a) Perinatal b) Intranatal c) Post natal IMR : Yard stick of OBS and Pediatric care India PMR 33/1000 live births (2003) ............................................................................................................. Question ID: 6 Question: Child death rate reflects the mortality in which of these age group Options: (1 ) 0 - 5 yrs (2 v) 1 - 4 yrs (3 ) 0 - 6 yrs (4 ) 3 - 6 yrs Child Death rate : CDR = (number of death in children aged 1 4 yrs age group in a yr X 1000)/ Total children aged 1 4 yrs

 Period of highest risk in 1 4 yrs age group 2nd yr Leading causes in INDIA : a) ADD b) Resp. infections c) Malnutrition d) Accident e) Injuries India : 5.2 % of total deaths States with high Child Death rates : a) Mp b) Rajasthan c) UP d) Bihar e) Assam f) Haryana ............................................................................................................. Question ID: 7 Question: Best indicator of Social development of a country is Options: (1 ) Child death rate (2) Perinatal mortality rate (3 ) Infant mortality rate (4 v ) Child mortality rate Child Mortality Rate : Under 5 mortality rate Best indicator of social development & well being Leading cause : ARI ............................................................................................................. Question ID: 8 Question: School health committee recommends medical examination every Options: (1 ) year (2 ) Quaterly (3 v) Every 4 yrs (4 ) Every 2 yrs School Health Sevice (1909) School Health Committee -- 1960 Medical examination : a) At Entry b) Every 4 yrs i) Vision testing ( Annually) ii) Height/weight (Quarterly) iii) Dental Check up (Every yr) iv) Per capita space not < 10 sq. ft v) Minus type desk ............................................................................................................. Question ID: 9

Question: The Plus component of IMNCI approach in INDIA is Options: (1 ) Care at birth (2 ) Child care (3 ) Immunization (4 v) Community participation IMNCI : Model of newborn & child care under RCH II 3 complementary elements a) Care at birth b) IMNCI c) Immunization Involvement in IMNCI : a) ANMs b) Medical officers / Nurses/ / LHVs c) Implementation by 2010 d) Indian Adaptation of WHO UNICEF IMCI e) Integrated management of Child hood illness f) Strategy in RCH II Flow chart of action of health worker sick child a) OPD health facility b) Check danger signs c) Assess main symptoms d) Assess nutrition/ immunization status e) Classify conditions / identify treatment f) Actions : Color coded treatment Pink urgent referral, Yellow Treatment OPD Green Home management IMNCI Approach : a) Care at birth b) Newborn and child health c) Immunization d) Health system strengthening e) Community Participation !!! ............................................................................................................. Question ID: 10 Question: WHO treatment schedule for children with symptoms of Vitamin A deficiency is Options: (1 ) 2 lakh IU vitamin A, 4 weeks apart (2 v) 2 lakh units on day 1, 2 lakh units on day 2, 2 lakh units 4 weeks later (3 ) 5 doses of 2 lakh units at 6 months interval (4 ) none of these Vitamin A Prophylaxis RCH II : 5 doses

 9 months - 3 yrs Treatment : a) 2 lakh IU Vitamin A 4 weeks apart (RCH) b) Day 1 --- 2 Lakh unit / Day 2 2 Lakh unit / 2 Lakh Unit 4 weeks apart (WHO) ............................................................................................................. Question ID: 11 Question: The current broad approach under the RCH II programme is Options: (1 ) Target free approach (2 ) CNAA (3 v) CNAMA (4 ) Target approach RCH II approach was CNAA Community Need Assessment Programme (CNAA) Components of Monitoring to be strengthened Male health workers to be included CNAMA : Community Need Assessment and Monitoring Approach Current Broad approach of RCH II ........................................................................................................... Question ID: 12 Question: Under the RCH programme districts are divided on the basis of which of these criteria Options: (1 v) Crude birth rate and Female literacy rate (2 ) Crude Birth rate and NRR (3 ) Age specific Birth rate and Total fertility rate (4 ) Crude birth rate and Infant Mortality rate RCH Programme : 1997 Implementation at District level Inputs not uniform at all districts Based on crude birth rate and Female Literacy rate districts were divided a) Category A 58 districts b) Category B 184 Districts c) Category C 256 Districts ............................................................................................................. Question ID: 13 Question: India is currently experiencing a growth phenomenon which is Options: (1 ) Slow (2 ) Rapid (3 v) Very rapid (4 ) Explosive Growth rate = Birth rate Death rate Ratings and Annual growths are a) Stationary No growth b) Slow Growth -- < 0.5 1.0 c) Moderate Growth 0.5 1.0 d) Rapid Growth 1.0 1.5 e) Very Rapid growth 1.5 2.0 f) Explosive growth -- > 2.0

INDIA: Annual Exponential growth = 1.93% Very rapid growth Population Doubling time = 35 47 yrs Decade Growth rate = 21.34 % Demographic cycle : H High Stationary - BR, DR -- INDIA E Early Expanding BR stable, DR L Late Expanding BR , DR -- China, Singapore L Late Stationary -- BR, DR UK, Denmark, Sweden, Belgium D Declining -- BR, DR Germany, Hungary ............................................................................................................. Question ID: 14 Question: Demographic measure which reflects completed family size is Options: (1 ) NRR (2 ) GRR (3 v) TFR (4) GFR Total Fertility rate : Average number of children a women can have !! Gives approximate magnitude of Completed Family Size Fertility Statistics : Birth rate : a) Simplest indicator of fertility b) Birth rate = (No. of life birth during the year x 1000 )/Mid Yr population c) Unsatisfactory measure d) Total population not exceed to child bearing e) Crude birth rate India 24/1000 (2004) ; 22.22/1000 (2009) General Fertility rate : a) Number of Live Births in an Area during the Year per Mid Yr female population (15 44) in the same area in same year b) Weakness: Not all women in the demonitaor are exposed to risk of Child birth c) India 95.3/1000 (2003) , 93.3 (2006) Age Specific Fertility rate : a) Number of Live births in a year to 1000 women in any specified age group b) More precise measure of fertility c) Sensitive indicators of Family planning achievement NRR a) Total number of Daughters a newborn girl will bear during life time

b) Aged Specific fertility and mortality rates c) Goal i) 1 (2 child norm Presently NRR 1.5) ii) 100% CPR by 2010 GRR a) Average number of girls that would be born to a woman throughout her reproductive span b) GRR in INDIA 1.4 c) Mean age at effective marriage for females 20.1 ............................................................................................................. Question ID: 15 Question: The best indicator of a country's development and overall health status is Options: (1 ) IMR (2 v) Life expectancy (3 ) PQLI (4 ) Dependency ratio Life expectancy : Total life expectancy rate in INDIA - 69.89 (2009 est..) Male 67.46 (2009) Female 72.61 (2009) 3 countries have low life expectancy Nepal, Bangladesh, Myanmar Country with Highest Life expectancy Japan It is one of the Best Indicator of the Overall health status of a population !!!!!! Note !!! ............................................................................................................. Question ID: 16 Question: Annual growth rate to be achieved by INDIA for population stabilization Options: (1 ) 1.6% (2 v) 1.2% (3 ) 1.5% (4 ) 2.0% Growth rate in INDIA : Current Growth rate in India 1.41 (2009) Goal is to achieve annual Growth rate 1.2 This is essential for the population stabilization over the next 50 yrs India Second most populous country 1921 Year of big Divide !! ............................................................................................................. Question ID: 17 Question: Population of Eligible couples still unprotected against conception in India is Options: (1 ) 32% (2 ) 46% (3 v) 54% (4 ) 60% CPR : Indicator ( Prevalence of Contraceptive practice) % of eligible couples protected Goal :

a) CPR > 60% b) NRR > 1 Punjab CPR is 66% (By all Means) Least Assam & Bihar INDIA by all methods CPR 46.2 INDIA by all Sterilization 29% Percentage of unprotected couples 100 46.2 = 54%

............................................................................................................. Question ID: 18 Question: What is the approximate percentage of legal abortion done in INDIA yearly Options: (1 ) 20% (2 ) 30% (3 v) 10% (4 ) 50% Abortion in INDIA : Annual no. of legal abortions : 0.6 million Contribute to only 10% of Abortions done in INDIA MTP act 1971 5 conditions for Abortions : a) Medical b) Eugenic c) Humanitarian d) Socioeconomic e) Failure of Contraception First most common cause followed by Socioeconomic !!! Note !! Written consent from women under 18 yrs Lunatics > 18 yrs < 12 weeks one RMP > 12 weeks to 20 weeks 2 RMP MTP rule altered by 1975 in 3 areaas : a) Approval by board b) Qualification c) Place

............................................................................................................. Question ID: 19 Question: Current child dependency ratio is Options: (1) 62 (2 v ) 56 (3 ) 8 (4 ) 45 Societal Dependency ratio : Proportion above 65 yrs + children < 15 yrs Dependant on 15 64 yrs (Economically productive age group) Ratio of these two age groups is the dependency ratio

 Indias Dependency ratio is 57.49 (2008) (Expected to be 54 by 2010 ) Child Dependency ratio 50 (2008) Old Age Dependency ratio 7.5 (2008) ............................................................................................................. Question ID: 20 Question: All are true highlights of Vandemataram scheme except Options: (1) Scheme for safe mother hood activities (2 ) Involves Public Private partnership (3 v) Can be availed through Primary health centres only (4 ) Takes into account family planning activities Vandemataram Scheme : Involvement of private sector in safe motherhood /Family Planning Free Outpatient services by private Gynecologist Fixed day each month Vandemataram Physician Provided a Kit IFA tablets, OC, Condoms, IUCD Free provision by Govt. ............................................................................................................. Question ID: 21 Question: Juvenile delinquents with more adaptive behaviour belongs to which category Options: (1 ) Neurotic delinquents (2 ) Characterological delinquents (3 v) Sociological delinquents (4 ) None of these Juvenile delinquents : Boy not aged 16yrs and girl not aged 18 yrs Committed an offence Causes : a) Biological b) Social c) Others Types : a) Sociological delinquents (adaptive) b) Characterological (Anti-social) c) Neurotic delinquents Prevention --- Counscelling Child Guidance Clinic : First Chicago(1909) Team work Service provided .............................................................................................................

Question ID: 22 Question: The estimated protein requirement of an infant in the first 6 months is Options: (1 ) 1g/kg (2) 1.5g/kg (3 v) 2g/kg (4 ) 3g/kg Principals of Artificial Feeding : Energy requirement Average of 100 Kcal Protein (First 6 months) 2g/kg body wt End of 1 yr 1.5 g/kg 8 10% calorie from protein Carbohydrate requirement 10g/kg body wt. Infants 6-8 times feed After 4 months undiluted feeds ............................................................................................................. Question ID: 23 Question: Leprosy is considered a public health problem if the prevalance of leprosy is more than (AIPGME) Options: (1 v) 1 per 10,000 (2 ) 2 per 10,000 (3 ) 5 per 10,000 (4 ) 10 per 10,000 The Aim of National Leprosy Eradication Programme is to reduce the case load to 1 or less than 1 per 10,000 population (i.e 0.01%) Prevalence < 1/1000 Contact survey Prevalence 1/1000 or Higher Group survey Prevalance 10 or more /1000 Mass survey ............................................................................................................. Question ID: 24 Question: What is the number of FRU units poer district Options: (1 ) 01 - 03 (2 v) 04 - 06 (3 ) 07 - 09 (4 ) 10 - 12 In each district 6 FRU are being created by Upgrading CHC and PHC The CSSM (Child Survival and Safe Motherhood) Programme is being Implemented through the existing networks of Sub-center, PHC, CHC, and District Hospital CSSM Programme has following components : a) Early Registration of Pregnancy b) Provide minimum 3 antenatal checkups c) Immerse coverage of all preganant women with TT immunization d) Advice on food, Nutrition, and Rest (Not Nutrition supplement) e) Detection of High risk pregnancies and promote referral f) Clean deliveries by trained personal g) Birth Spacing h) Promotion of Institutional delivery In 1992, the Universal Immunization programme was integrated with CSSM Also, ORT and Programmes under MCH was also integrated under CSSM

RCH intervention : For Child survival intervention Immunization, Vitamin A oral rehydration therapy and prevention of Death due to Pneumonia For Safe Motherhood Antenatal Check up, Immunization of tetanus safe delivery, anemia control ............................................................................................................. Question ID: 25 Question: A 46 yr old female presented at eye OPD in a Hospital. Her vision in the Right eye was 6/60, and in the left eye was 3/60. Under the National Programme for control of Blindness, she will be classified as Options: (1 ) Socially blind (2 v) Low vision (3 ) Economically blind (4 ) Normal vision WHO criteria of Blindness : Classification of Visual Impairment : 0. Normal (6/6 6/18) -----------------------------------------------------------Can see 6/18 or Better 1. Visual Impairment (Low Vision) ( < 6/18 6/60) ------------------------Cannot see 6/18 but can see 6/60 2. Severe Visual Impairment ( Economic Blindness) ( < 6/60 3/60)----Cannot see 6/60 but can see 3/60 3. Blindness (Social Blindness) ( < 3/60 1/60) ------------------------------Cannot see 3/60 but can see 1/60 4. Blindness (Legal Blindness) ( < 1/60 LP) -------------------------------- Cannot see 1/60 but can have Light perception 5. Blindness (Complete Blindness) (no LP) ------------------------------------ No Light Perception ............................................................................................................. Question ID: 26 Question: Leprosy eradication programme is best evaluated by Options: (1 ) The ratio of disability as compared to new ones (2 ) The ratio of the multibacillary to the Paucibacillary cases (3 ) Percentage of lepromin positive in the newly detected cases (4 v) Detection of new cases Case finding method : 1. Contact survey : Prevalence < 1/1000 (Technique of choice is house hold contact in this case) 2. Group survey : Prevalence 1/1000 (Technique is skin camps in preschool/school children and people living in slums and military area . If enrolment is < 70% of all children in 6 145 yrs group then this technique is less effective 3. Mass survey : Prevalence 10/1000 (Technique i s House to House visit in Hyperendemic area to cover this population)

............................................................................................................. Question ID: 27 Question: Deficient in weight for Height in a 3 yrs old child indicates Options: (1 v) Acute malnutrition (2 ) Chronic Malnutrition (3 ) Concomitant acute and chronic malnutrition (4 ) Under weight

Remember that most sensitive measure of growth is weight !!

CLASSIFICATION OF MALNUTRITION IN CHILDREN: Mild Malnutrition Percent Ideal Body Weight Percent of Usual Body Weight Albumin (g/dL) Transferrin (mg/dL) Total Lymphocyte Count (per L) 80-90% 90-95% 2.8-3.4 150 - 200 1200 - 2000 Moderate Malnutrition 70-79% 80-89% 2.1-2.7 100 - 149 800 - 1199 Severe Malnutrition < 70% < 80% < 2.1 < 100 < 800

Gomez Classification: The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations. percent of reference weight for age = ((patient weight) / (weight of normal child of same age)) * 100 percent of reference weight for age 90 - 110% 75 - 89% Interpretation normal Grade I: mild malnutrition

60 - 74% < 60%

Grade II: moderate malnutrition Grade III: severe malnutrition

Wellcome Classification: evaluates the child for edema and with the Gomez classification system. Weight for Age (Gomez) 60-80% < 60% With Edema kwashiorkor marasmic-kwashiorkor Without Edema undernutrition marasmus

Waterlow Classification: Chronic malnutrition results in stunting. Malnutrition also affects the child's body proportions eventually resulting in body wastage. percent weight for height = ((weight of patient) / (weight of a normal child of the same height)) * 100percent height for age = ((height of patient) / (height of a normal child of the same age)) * 100 Weight for Height (wasting) Normal Mild Moderate Severe > 90 80 - 90 70 - 80 < 70 Height for Age (stunting) > 95 90 - 95 85 - 90 < 85

Serum Albumin: considered to be the single best nutritional test to predict patient outcome. breakpoint for clinically relevant malnutrition: ranges from 3.0 to 3.5 g/dL Level of Malnutrition normal Albumin g/dL 3.5 - 4.8

mild moderate severe Definitions of malnutrition Classification Gomez Definition

2.8 - 3.4 2.1 - 2.7 < 2.1

Grading Mild (grade 1) 75%90% WFA Moderate (grade 2) 60%74% WFA Severe (grade 3) <60% WFA Mild Moderate Severe Moderate Severe Moderate Severe Mild Moderate Severe 80%90% WFH 70%80% WFH <70% WFH -3%</= z-score < -2 z-score < -3 -3%</= z-score < -2 z-score < -3 <0.31 <0.28 <0.25 BMI for age z-score < -1 BMI for age z-score < -2 BMI for age z-score < -3

Weight below % median WFA z-scores (SD) below median WFH z-scores (SD) below median WFH z-scores (SD) below median HFA MUAC divided by occipitofrontal head circumference

Waterlow

WHO (wasting) WHO (stunting)

Kanawati

Cole

Grade 1 z-scores of BMI for age Grade 2 Grade 3

Abbreviations: BMI, body mass index; HFA, height for age; MUAC, mid-upper arm circumference; SD, standard deviation; WFA, weight for age; WFH, weight for height; WHO, World Health Organization. ............................................................................................................. Question ID: 28 Question: Present IMR in india is Options: (1 ) 54 (2 ) 42 (3 v) 31 (4 ) 48 Present IMR is 30.15/1000 live births (2009 est.) .............................................................................................................

Question ID: 29 Question: Child rights are guaranteed in which article of the constitution (PGI) Options: (1 v) Article 24 (2 ) Article 28 (3 ) Article 35 (4 ) Article 42 Just Learn it !!!! ............................................................................................................. Question ID: 30 Question: If API < 2 then what should be done (PGI) Options: (1 v) Monthly surveillance of patients (2 ) Positive survillance (3 ) Twice yearly DDT (4 ) Radical treatment If API 2 Spraying : a) Regular insecticidal spray with 2 round DDT 1gm/m2 b) DDT refractory then 3 round malathion 2gm/m2 c) Refractory to both then 2 rounds of pyrethroids 0.25 gm/m2 Surveillance : a) Collection and examination of blood smear b) Active and passive surveillance every fortnight Treatment : a) Presumptive and radical Rx Follow up : a) No follow up !!! Entomological Assessment a) Susceptibility test to insecticide If API < 2 Spraying : a) Focal spray b) P. Falciparum case area

Surveillance : a) Active and passive surveillance every fortnight Treatment : a) Radical Rx only !!!! Follow up : a) Blood smear collected on radical treatment and after that monthly follow up for 1 year Epidemiological Assessment a) Epidemiological investigation only malaria +ve cases investigated, Mass surveys

............................................................................................................. Question ID: 31 Question: In a population of 1 lakh, with 4000 live births per annum and under 5 population is 15000 with infant death per annum is 280, so the under 5 mortality rate is Options: (1 ) 40% (2 ) 100% (3 v) 26.5% (4 ) 69% Under 5 mortality rate :UNICEF : considers it as a best single indicator of social development and well-being than GNP per capita! = (number of deaths of children less than 5 years of age in a given year x 1000)/number of

live births in the same year Now the Question: No. of live birth per year = 4000 So, in 5 yrs number should be 4000 x 5 = 20,000 But the number of under 5 children is 15,000 The deficient = 5000 Per year death under 5 child = 5000/5 = 1000 Applying to the formula above = 1000/4000=0.25 x100 % = 25% ............................................................................................................. Question ID: 32 Question: Who are not the beneficiaries of ICDS scheme Options: (1 ) Adolescent females (2 v) School going children (3 ) Pregnant females (4 ) Lactating females ICDS service : Women : 15 45 yrs & older women Preganant women : Immunization against tetanus; Health check up ; Supplement nutrition Nursing mother : Health check up ; supplement nutrition Children : Children (< 3 years) Referral services Children (3 - 6 yrs) Non-formal Education To children Supplementary nutrition; Immunization and Health check up !! ............................................................................................................. Question ID: 33 Question: Mobile eye care are not done at which level (UP) Options: (1 ) Primary care level (2 ) Secondary care (3 ) District hospitals (4 v) None of these Mobile Eye care is done at all these levels : b) Primary care c) Secondary care d) District hospitals Not done at Tertiary level !!!!! Note !!! ............................................................................................................. Question ID: 34 Question: SET centre is set up if prevalence of leprosy is Options: (1 ) Below 0.1% (2 ) Less than 1% (3 ) Above 1% (4 v) Above 5% Just Learn it !!!

............................................................................................................. Question ID: 35 Question: In revised National Tuberculosis control programme the salient features are to achieve Options: (1 ) Cure rate 85% and diagnosis rate 85% (2 v) Cure rate 85% and diagnosis rate 80% (3 ) Cure rate 80% and diagnoisis rate 85% (4 ) Cure rate 80% and diagnosis rate 80% Prevalence of TB infection : 30% Incidence of TB infection (ARI): 1.7% Prevalence of disease 4/1000 cases ARI: Most informative index of Magnitude of problem of TB RNTCP: -- Objective : Cure rate 85% Case finding 70% DOTS Sputum microscopy 2 sputum smears ............................................................................................................. Question ID: 36 Question: A country is certified for Polio eradication, if there is no virologically confirmed diagnosed case of polio for the last Options: (1 ) 1 yr (2 ) 2 yrs (3 v) 3 yrs (4 ) 5 yrs About Polio : Type 1 virus --- causes paralysis MOPv1 is used in many states 94% polio cases in INDIA (Type 1) Pulse Polio Immunization Strategy (1995) VAP: 1 in 1 million vaccines Type 3 Virus has a tendency to mutate Risk of close contact developing VAP 1 case/5 million doses of vaccine

As per National Programme the confirmation of POLIO is based on Wild Virus Isolation ! 1000 subclinical infection amoing children Single case is an outbreak !!!! Note!! Controlled measures initiated within 48 hrs of Notification Confirmation : Wild Type Virus Isolation

 ORI (Outbreak response Immunization) MOP A case of Polio is considered confirmed if : a) Wild Virus isolation b) RP within 60 days c) Patient died d) Lost to follow up Sensitivity of AFP surveillance : Active search for casesw in 0 15 yrs with onset within last 60 days ORI : is indicated in all 0 59 months children (MCQ) Follows AFP case notification Follows stool specimen collection One dose of OPV House to House immunization At least 500 children immunized

............................................................................................................. Question ID: 37 Question: In INDIA census for literacy rate, the lowest cut off age is Options: (1 ) 3 yrs (2 v) 7 yrs (3 ) 5 yrs (4 ) 11 yrs You know this one !!!! . ............................................................................................................. Question ID: 38 Question: Road to health has two reference points, which are Options: (1 ) 30th percentile for boys and 3rd percentile for girls (2 v ) 50th percentile for boys and 3rd percentile for girls (3) 50th percentile for boys and 5th percentile for girls (4 ) 80th percentile for boys and 10th percentile for girls The Growth Chart : The growth or Road to Health chart (designed by David Morley later modified by WHO) It is a visible display of childs physical growth and development. The WHO Growth chart: It has two reference curves : a) Upper reference curve represents the median 50th percentile for boys b) Lower reference curve represents the 3rd percentile for girls c) The Objective in child care is to keep the child above the 3rd percentile Growth Chart Used In India : Present Indias Literacy rate is : 71.7% (2009 est)

 There are 49 different types of growth charts used in India The one recommended by the Government of India has four reference curves a) The Topmost curve corresponds to the 80th percent of the median (50th percentile ) of the WHO reference Standard b) The lower lines : represent 70 percent, 60 percent, 50 percent . c) 80 percent median weight is approximately equivalent to 2 SD below the median d) The purpose of these lines is to indicate the degree of malnutrition The Growth chart recommended by the Govt. of India shows three degrees of malnutrition : Grade I (80 70) Mild malnutrition Grade II (70 60) Moderate malnutrition Grade III ( < 60 ) Severe malnutrition Grade IV (< 50 ) --- Has also been added

NOTE : These charts are all Weight for age chart and does not include the Height as Weight is considered the most sensitive measure of Growth !!! Imp!!!
Uses of growth chart : Growth monitoring Diagnostic tool Planning and Policy making Educational tool Tool for action Evaluation Tool for teaching ............................................................................................................. Question ID: 39 Question: "Child Guidance clinic" is helpful for (JIPMER) Options: (1 v) Bed wetting problems (2 ) Impaired hearing (3 ) Eye Squint (4 ) Cerebral palsy Child Guidance Clinic : Started in Chicago Originally dealt with problems of Juvenile delinquency . Child guidance clinic deals with all children and Adolescents who for one reason or another are not fully satisfied with their environment The objective : is to prevent children become neurotic or psychotics The Psychiatrist is the central figure Core therapy is Posychotherapy in order to restore positive feelings of security to children Child Placement : a) Orphanages b) Foster homes

c) Adoption d) Borstals Boys above 16 yrs who are too difficult in handling Certified schools .Borstals sentence is usually for 3 yrs. There are about 6 Borstals for boys in India and none for girls. e) Remand Homes Here thechild is placed under the care of doctors, psychiatrist . ............................................................................................................. Question ID: 40 Question: As per WHO classification it is a case of severe mental retardation if the IQ is Options: (1 ) 50 - 70 (2 ) 35 - 49 (3 v) 20 -34 (4 ) Below 20

IQ Classifications in Psychiatric Use

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) American Psychiatric Association, 1994 Borderline Intellectual Functioning Mild Mental Retardation Moderate Retardation Severe Mental Retardation Profound Mental Retardation IQ 71-84 IQ 50-70 IQ 35-49 IQ 20-24 IQ below 20

IQ Classifications No Longer in Use

Terman, Lewis M. The Measurement of Intelligence. Houghton Mifflin Company, 1916 An explanation of and complete guide for the use of the Stanford Revision and extension of the Binet-Simon Intelligence Scale 140 and over 120-140 110-120 90-110 80-90 70-80 Below 70 Genius or near genius Very superior intelligence Superior intelligence Normal or average intelligence Dullness Borderline deficiency Definite feeble-mindedness

Mental deficiency used to be divided into the following subclassifications, but these labels began to be abused by the public and are now largely obsolete: Borderline Deficiency (IQ 70-80), Moron (IQ 50-69),Imbecile (IQ 20-49) and Idiot (below 20). Mental deficiency is

now generally called mental retardation.

............................................................................................................. Question ID: 41 Question: The criteria for an infant to be at risk of undernourishment is all except (KCET) Options: (1 ) Birth weight below 70% of expected (2 ) Birth weight of 2.8 kgs and working mother (3 ) Birth weight of 2.5 kg (4 v) Birth order 3 or more Criteria for the Identification of At Risk Infants : Birth weight less than 2.5 kg Twins Birth order 5 or more Artificial feeding Weight below 70 % of the expected weight (i.e II and III degrees of Malnutrition) Failure to gain weight during three successive months Children with PEM , diarrhea Working mother, one parent ............................................................................................................. Question ID: 42 Question: With reference to Heatlthful school environment, which of the following statement is not correct (UPSC) Options: (1 ) In the class room, desks should be minus type (2 v) Per capita space per student should be 6 Sq feet (3 ) Combined window and door area should be 25% of the floor area (4 ) One urinal should be provided for 60 students Healthful School enviromnet : Minimum Requirement : a) 10 acres of land for higher elementary schools b) 5 acres for primary schools c) Additional 1 acre per 100 students d) Exterior walls thickness 10 inch e) One class room should accommodate 40 students f) Per capita space for students should be 10 sq. ft g) Minus type desks h) Height of windows at least 26 from floor i) Window area at least 25% of floor area j) Urinals provided 1 for 60 students and 1 latrine for 100 students ............................................................................................................. Question ID: 43 Question: The number of Abortions performed divided by the number of live births in the same period is known as (ICS) Options: (1 ) Abortion rate (2 ) Abortion incidence (3 ) Abortion prevalence (4 v) Abortion

ratio You know it !!!!! ............................................................................................................. Question ID: 44 Question: Roll back Malaria programme is (JIPMER) Options: (1 ) Encourage the development of more effective and new anti malarial drugs and vaccines (2 ) Encourage the proper and expanded use of insecticide treated mosquito nets (3 ) Training of village health workers and mother on early and appropriate treatment of malaria (4 v) All of the above National Anti-malarial Promgramme : 1999 Enhanced Malaria control Project 1997 World bank Selection criteria a) API > 2 for last 3 yrs b) Pf cases > 30% c) 25% Tribal PHC d) Malarial deaths Insecticide treated bed nets Programme North eastern region of INDIA High stable Malarial cases ; High O.F. Incidence 1999-2000 Synthetic pyrethroid used Deltamethrin (2.5%), Cyfluthrin (5%) 50 mg/m2 dosage Effectivenes : 6 12 months New technology Remote sensing in Vector control Roll Back Malaria : Launched in 1998 WHO, UNICEF, UNDP, World bank To reduce Malaria morbidity and Mortality by 75% by 2015 One of the Millennium development goals. Challenges in Malarial control : Triple insecticide resistance A. Culicifacies DDT, BHC, Malathion Maharashtra , Karnataka, Gujarat (Southern parts) Malarial Indices : ABER a) Indices of Operational efficiency !!!!

b) 0.8% Non transmission season c) 1.2 to 1.8% during Transmission season API Already discussed !! SPR a) Trends help to predict epidemics b) Monthly SPR exceeds by 2 times of SD observed in SPR of preceeding 3 yrs or preceeding 3 months of the same year epidemic build up suspected c) Utilized to study impact of control operations Drug Policy Malaria : Anti malaria drug policy Drafted in the year 1982 National Drug policy on Malaria - 2007 ............................................................................................................. Question ID: 45 Question: Under the National Polio eradication programme, case of Flaccid paralysis is confirmed as polio, under the following circumstances except (MAHE) Options: (1 ) If a case is lost to follow up (2 ) If a case could not be confirmed because the patient dies before that (3 ) If a wild strain of Polio virus is isolated from the stool (4 v) If a patient develops paralysis within 30 days diagnosis of AFP Discussed in Q 36 above !!!! ............................................................................................................. Question ID: 46 Question: The malaria eradication programme of Govt. of INDIA using insecticides aims to reduce the life span of mosquitoes to less than (DPG) Options: (1 ) 1 day (2 ) 3 days (3 v) 6 days (4 ) 15 days Just Learn it !!!!!! ............................................................................................................. Question ID: 47 Question: Which of the following methods can most effectively control the prevalence of Brugia Malayan Filariasis Options: (1 ) BHC spraying at the rate of 2 gm per Sq m surface on all structures in the area (2 ) Application of one kg of Paris Green as 2% dust with soap stone per acre of water surface (3 v) Removal of Pistia and other water Hyacinth group of plants from water colonies (4 ) Daily use of Mosquito repellant nets by all residents Filarial Programme d) Since 1995 . e) Operational component merged with Urban Malarial scheme f) Current strategy MDA for 5 yrs in Highly endemic areas

Treatment of Filaria : g) DEC (6mg/kg body weight orally x 12 days ) h) NFCP DEC + Albendazole i) Elimination by 2015 Mass drug administration strategy: j) DEC tablets a single day every year for 5 yrs k) Age 1 5 ( 100 mg) l) Age 6 15 (200 mg) m) Age 16 above (300 mg) ............................................................................................................. Question ID: 48 Question: If API > 2 then what should not be done Options: (1 ) Regular Insecticide spray with two round DDT 1gm/m2 (2 ) DDT refractory then 3 round malathion 2 gm/m2 (3 ) No Follow up (4 v)Radical treatment only Discussed in Q 30 above !!! ............................................................................................................. Question ID: 49 Question: The inception of RCH Programme in INDIA was in the year Options: (1 ) 1998 (2 ) 1999 (3 v) 1997 (4 ) 1994 Discussed in Q 12 above !!!! RCH Programme has 4 components : 1. Family planning (prevention and management of unwanted pregnancy) 2. CSSM (Include mother care including antenatal checkup, delivery and post natal services. 3. Client Approach of Health care 4. Prevention and management of RTI, STD, and AIDS ............................................................................................................. Question ID: 50 Question: Child abuse is defined as Physical, mental and sexual abuse , negligent treatment of a child under Options: (1 v) 18 yrs of age (2 ) 16 yrs of age (3 ) 12 yrs of age (4 ) 10 yrs of age You know it !!! .............................................................................................................