4th BHMS Winter - 2022 Community Medicine [SOLVED PAPER]

2. Short Answer Questions (Solve any 4 out of 6): 

a) Function of Anganwadi worker

 b) Preventive approaches for alcoholism and drug dependence 

c) Concept and uses of Screening 

d) Define Intervention. Write note on Rehabilitation e Risk factor and Prevention of CHI)

 e) Principles and Methods of Chlorination 

3. Short answer questions (Solve any 4 out of 6): 14 x S = 201 

a) Health communication by chalk and talk (lecture)

 b) Minimum need Programme  

t.;) i(cp,isif;ition or Vit:i! eVent!;

 ti) *Hie cold Chair' Equipment

 e) • Community nutrition programme Clinical leature!; and prevwfflort oINIcasles 

4. Long Auslver Quesiionl (Solve any 2 out of 4): 12 x 10 = 201

 a) Role oil loineopathy in Community Mcdicine. 91t. 

I) Define Demography. Write about mTp Act 1971 and Factors affecting 011 Fertility.

 c) Classify occupational Diseases and explain Pneumoconiosis. pit 

(I) Natural history, screening and preventive measures for Diabetes mellitus. 

Long Answer Questions (Solve any one from Q. No. 5, 6 and 7): 

 5. Write in detail about case control study and cohort study with its Advantages and disadvantages. 

6. Write in detail about Determinants of health.

 7. Write in details about Early Neonatal care with Neonatal examination and neonatal screening.  

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✅ Q.2 – Short Answer Questions (All 6 Solved)

[6 × 5 = 30 Marks]

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a) Function of Anganwadi Worker

1. Nutritional supplementation to children under 6 and pregnant/lactating women.

2. Preschool education (non-formal) to children aged 3–6 years.

3. Growth monitoring and referral for malnourished children.

4. Assist in immunization, health checkups, and health education.

5. Maintenance of records and support for schemes under Integrated Child Development Services (ICDS).

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b) Preventive Approaches for Alcoholism and Drug Dependence

1. Health education and awareness campaigns.

2. Life skills education in schools.

3. Enforcing legal measures: age limits, taxation, license control.

4. Early detection through screening and counseling.

5. Rehabilitation and community support programs like AA (Alcoholics Anonymous).

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c) Concept and Uses of Screening

• Screening: Process of identifying unrecognized disease in apparently healthy individuals using tests.

• Types:

  • Mass screening

  • Selective screening

  • Multiphasic screening

• Uses:

  • Early detection

  • Control of disease spread

  • Improved prognosis and reduced complications

  • Prioritization of interventions

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d) Define Intervention and Write Note on Rehabilitation

• Intervention: An action or set of actions to prevent or treat illness, improve health, or alter disease course.

Rehabilitation:

• Process of restoring an individual to the highest level of function and independence.

• Includes medical, physical, psychological, and vocational support.

• Types:

  • Physical (post-stroke, amputation)

  • Social (disabled integration)

  • Occupational (training for jobs)

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e) Risk Factors and Prevention of Coronary Heart Disease (CHD)

Risk Factors:

1. Modifiable: Smoking, hypertension, diabetes, obesity, sedentary lifestyle.

2. Non-modifiable: Age, sex, family history.

Prevention:

• Primary: Lifestyle changes, dietary control, physical activity, BP and sugar control.

• Secondary: Medications (statins, antihypertensives), angioplasty.

• Tertiary: Rehabilitation post-MI (cardiac rehab programs).

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f) Principles and Methods of Chlorination

Principles:

1. Must destroy pathogens.

2. Must not be harmful to humans.

3. Should provide residual protection.

Methods:

1. Break-point chlorination – ensures complete disinfection.

2. Super chlorination – used in epidemics.

3. Continuous chlorination – for municipal water supply.

4. Chlorine tablets/liquid – for domestic use.

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✅ Q.3 – Short Answer Questions (All 6 Solved)

[6 × 5 = 30 Marks]

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a) Health Communication by Chalk and Talk (Lecture Method)

• A traditional didactic teaching method.

• Useful for transferring knowledge quickly to large groups.

• Advantages:

  • Cost-effective

  • Simple, can be modified

  • Used in schools, health centers

• Limitations:

  • Passive learning

  • Limited feedback

  • Not suitable for behavior change

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b) Minimum Needs Programme (MNP)

• Launched in 1974–78 (5th Five Year Plan).

• Aimed to provide basic needs and improve living standards.

• Components:

  1. Primary health care

  2. Nutrition

  3. Rural housing

  4. Water supply

  5. Elementary education

  6. Electrification

• Focus on equity and social justice.

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c) Classification of Vital Events

Vital events = important life events tracked for public health:

Event	Classification
Birth	Vital statistics
Death	Medical certification of cause
Marriage	Civil registration
Divorce	Legal documentation
Migration	Census or surveys

Vital statistics are compiled through Census, Civil Registration System, Sample Registration System.

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d) Equipment of Cold Chain

Cold chain = System for storing and transporting vaccines at recommended temperatures.

Key equipment:

1. Ice-lined refrigerator (ILR)

2. Deep freezers

3. Cold boxes

4. Vaccine carriers

5. Ice packs

6. Thermometers & temperature logbooks

Maintains +2°C to +8°C for routine immunization vaccines.

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e) Community Nutrition Programme

• Aim: Prevent and treat malnutrition through community participation.

• Examples:

  • ICDS (Integrated Child Development Services)

  • Mid-Day Meal Scheme

  • Vitamin A Prophylaxis

  • Iron-Folic Acid Supplementation

  • Nutrition education in schools and Anganwadis

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f) Clinical Features and Prevention of Measles

Clinical Features:

1. High fever, Koplik spots, cough, coryza, conjunctivitis

2. Maculopapular rash, spreads from face to limbs

3. Complications: Pneumonia, diarrhea, encephalitis

Prevention:

• Measles-Rubella vaccine (MR) at 9 months and 15 months

• Herd immunity, isolation, outbreak control

• Vitamin A supplementation

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Thank you! Now let's complete the Long Answer Questions (Q.4 to Q.7) from the BHMS Fourth Year Community Medicine (PSM) paper, each answered in MUHS-compliant 10–20 mark format.

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✅ Q.4 – Long Answer Questions (All 4 Solved)

[4 × 10 = 40 Marks]

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🔷 a) Role of Homoeopathy in Community Medicine

1. Holistic approach: Homoeopathy treats patients as a whole, considering physical, mental, and social well-being — aligning with public health principles.

2. Prevention:

   • Preventive medicines like Belladonna in scarlet fever, Bryonia in dengue, and Arsenicum Album in COVID-19 (AYUSH advisory).

   • Nosodes: e.g., Tuberculinum for predisposition to TB.

3. Chronic disease management:

   • Useful in managing asthma, arthritis, skin diseases, lifestyle disorders.

4. Safe, economical:

   • Non-toxic, low cost, ideal for mass health programs.

5. Integration in AYUSH and NHM:

   • Community health centers (CHCs) and primary health centers (PHCs) use homoeopathy.

   • Homoeopathic CHOs and RBSK schemes employ BHMS doctors.

6. School health and maternal care:

   • Nutritional, developmental, behavioral issues in children.

   • Menstrual disorders, anemia in women.

7. Limitations:

   • Limited rapid relief in emergencies.

   • Requires trained practitioners.

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🔷 b) Define Demography, MTP Act 1971 & Fertility Factors

Demography:
Scientific study of human populations, covering size, structure, distribution, and changes due to birth, death, migration.

📌 Indicators:

• Birth rate

• Death rate

• Sex ratio

• Infant Mortality Rate (IMR)

• Total Fertility Rate (TFR)

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MTP Act 1971 (Amended 2021):

• Legalizes abortion under specific conditions:

  • Up to 24 weeks with medical opinion

  • In cases of rape, incest, fetal anomaly

  • Ensures confidentiality and women's rights

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Factors Affecting Fertility:

1. Biological: Age at marriage, infertility

2. Socioeconomic: Education, income, urbanization

3. Cultural: Religion, customs, early marriage

4. Health services: Access to contraception

5. Government policies: Population control programs

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🔷 c) Occupational Diseases & Pneumoconiosis

Definition: Diseases caused due to occupation/environmental exposure.

📌 Classification:

1. By system: Respiratory, skin, musculoskeletal

2. By causative agent:

   • Dust: Pneumoconiosis

   • Chemicals: Lead poisoning

   • Biological: Anthrax

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Pneumoconiosis:

• Lung disease caused by inhalation of inorganic dust.

• Types:

  • Silicosis – from silica dust

  • Asbestosis – asbestos

  • Coal worker’s pneumoconiosis

• Features: Cough, dyspnea, fibrosis

• Prevention: PPE, ventilation, regular screening

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🔷 d) Diabetes Mellitus: Natural History, Screening & Prevention

Natural History:

1. Risk factors (genetics, obesity)

2. Insulin resistance

3. Impaired glucose tolerance

4. Diabetes onset

5. Complications (retinopathy, nephropathy, neuropathy)

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Screening:

• Fasting blood glucose

• HbA1c

• Oral glucose tolerance test (OGTT)

• Target: > 40 years, obese, family history

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Prevention:

1. Primordial: Healthy eating habits in children

2. Primary: Physical activity, weight control

3. Secondary: Early detection, oral hypoglycemics

4. Tertiary: Management of complications

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✅ Q.5 – Case Control & Cohort Study

[20 Marks]

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Aspect	Case-Control Study	Cohort Study
Definition	Compares patients (cases) with controls	Follows exposed and unexposed groups
Direction	Retrospective	Prospective or retrospective
Subjects	Based on outcome	Based on exposure
Time & cost	Less time, less expensive	More time, more cost
Bias risk	Recall bias high	Loss to follow-up risk
Output	Odds Ratio	Relative Risk, Incidence rate
Suitability	Rare diseases	Rare exposures

Example:

• Case-Control: Lung cancer (cases) vs non-cancer (controls), assess smoking.

• Cohort: Smokers vs non-smokers followed for lung cancer occurrence.

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✅ Q.6 – Determinants of Health

[20 Marks]

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A. Biological Determinants

• Genetics

• Age, gender

• Immunity status

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B. Environmental Determinants

• Physical: Water, air, housing

• Biological: Pathogens, vectors

• Social: Culture, customs, hygiene

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C. Behavioral/Lifestyle

• Smoking, alcohol, exercise

• Diet, sleep, stress

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D. Socioeconomic Determinants

• Education, income, occupation

• Family size

• Health services availability

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E. Political & Policy Factors

• Health laws

• Insurance systems

• Government funding

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Importance:

• Health is multi-factorial.

• Understanding determinants is key to effective prevention and health planning.

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✅ Q.7 – Early Neonatal Care, Examination & Screening

[20 Marks]

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A. Early Neonatal Care (0–7 days)

1. Thermal protection – Drying, skin-to-skin contact

2. Cord care – Sterile, no application of substances

3. Breastfeeding – Within 1 hour

4. Eye care – Wipe with sterile gauze

5. Vitamin K – 1 mg IM at birth

6. Immunization – BCG, OPV, Hepatitis B (birth dose)

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B. Neonatal Examination

• Vital signs: RR, HR, temp

• Weight, length, head circumference

• Examine for:

  • Birth injuries

  • Jaundice

  • Anomalies (cleft lip, club foot, etc.)

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C. Neonatal Screening

1. Hypothyroidism

2. Phenylketonuria (PKU)

3. Congenital heart disease

4. Hearing screening (OAE/BERA)

5. Sickle cell, G6PD deficiency

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