Fourth B.H.M.S., Winter - 2020 COMMUNITY MEDICINE

1. White appropriate answers 

a) Spectrum of Disease

b) Mention Four Modes of Direct Transmission

c) Aims and Objectives of Screening

d) Transmission of Hepatitis C

e) Warning Signs of Cancer

f) What is Vision 2020?

g) What is Eligible couples?

h) Name 4 objectives of ANC.

1) Give sources and daily requirement of Vitamin C.

}) Break point of Chlorination.

k) Give any two engineering measures for prevention of Occupational

Diseases.

]) Define Disaster and mention its types.

m) Name 4 Symptoms of Drug Addiction. "

n) What is Pictogram?

0) Define Health Education. 

2. Write short answer 

a) Discuss-Levels of Prevention.

b) Assessment of Obesity.

c) Mention and discuss various methods of Purification of Water on a small

scale.

d) Principles of PHC.

e) Explain in detail about Dependence Producing Drug and its symptoms.

f) Define Screening and add a note on characteristics of Screening Test.

3. Write short answer 

a) Define Epidemiology and add a note on Short Term Fluctuations.

b) Agent, Host, Environment Factors of Dengue.

c) Discuss about Protein energy malnutrition.

d) Functions of Health Communications.

e) UNICEF.

f) Define Health Information and Give sources of Health Information.

LAQ 

4. Long answer question 

a) What is Ergonomics and Explain in detail about Pneumoconiosis.

b) Describe Prevention of Blindness and Explain National Programm for

Control of Blindness.

c) Define family planning and Describe in detail Hormonal Contraceptives.

d) Explain in detail the Role of Homoeopathy in Prevention of Diseases.

Long answer question 

5. Explain in detail Indicators of Health and add a note on Responsibility for Health. 

6. Describe Case Control Study and Cohort Study. 

7. Discuss Natural History of Tuberculosis and give Preventive Measures in Tuberculosis. 

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1. Short Answers 

a) Spectrum of Disease
Range from subclinical → asymptomatic → mild → severe → death.

b) Four Modes of Direct Transmission

1. Person-to-person droplet

2. Fecal–oral

3. Skin contact (touch/contact)

4. Sexual or perinatal

c) Aims & Objectives of Screening

• Detect disease in early stage

• Reduce morbidity/mortality

• Identify high-risk individuals

• Provide timely intervention

d) Transmission of Hepatitis C
Predominantly via blood transfusion, shared needles, unsafe injections; rarely sexual or vertical transmission.

e) Warning Signs of Cancer

• Lump or swelling

• Unexplained weight loss

• Persistent cough or hoarseness

• Changes in bowel/bladder habits

• Non-healing sores

f) Vision 2020

World Health Organization initiative (with IAPB) aiming to eliminate avoidable blindness by 2020 through global partnerships.

g) Eligible Couples
Couples in reproductive age (15–49 years) neither of whom is sterile.

h) Four Objectives of ANC

• Early detection of pregnancy complications

• Nutritional assessments and supplements

• Health education and counseling

• Preparation & birth planning

i) Sources & Daily Requirement of Vitamin C
Sources: Citrus fruits, guava, green chilies. RDA (India): ~40–60 mg/day.

j) Break Point of Chlorination
Point at which all chlorine demand is satisfied and free residual chlorine appears (~0.2–0.5 mg/L).

k) Two Engineering Measures for Occupational Diseases

• Local exhaust ventilation

• Machine guarding/isolation of hazardous equipment

l) Define Disaster & Its Types
A disaster is a sudden event causing widespread losses; types: natural (earthquake, flood), man-made (chemical spill, industrial accident).

m) Four Symptoms of Drug Addiction

• Craving

• Tolerance

• Withdrawal symptoms

• Neglect of activities

n) What is a Pictogram?
Graphic symbol on containers conveying hazard or instructional messages universally.

o) Define Health Education
Process of informing individuals/communities to adopt health-enhancing lifestyle and practices.

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2. Short Answers (Any four out of six, 4 × 5 = 20 marks)

a) Levels of Prevention

1. Primordial: Avoiding risk creation

2. Primary: Prevent disease onset (e.g., vaccination)

3. Secondary: Early disease detection (screening)

4. Tertiary: Reducing complications/disability

5. Quaternary: Preventing medical overuse/harm

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b) Assessment of Obesity

• BMI: ≥25–29.9 overweight; ≥30 obesity

• Waist circumference: ≥90 cm men, ≥80 cm women (Asia)

• Skinfold thickness, Waist–hip ratio, Bioelectrical impedance for body fat

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c) Small-scale Water Purification Methods

• Boiling: Kills pathogens

• Chlorination: Chemical disinfection

• Filtration: Ceramic or household filters

• Solar disinfection (SODIS): UV exposure in PET bottles

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d) Principles of PHC

• Accessibility

• Community participation

• Intersectoral approach

• Appropriate technology

• Equity and universal care

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e) Dependence-Producing Drug & Symptoms
E.g., Opioids: morphine, heroin.
Symptoms: compulsive use, craving, tolerance, withdrawal—e.g. anxiety, nausea, sweating, tachycardia.

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f) Define Screening & Characteristics of a Good Screening Test
Screening: Identifying unrecognized disease in asymptomatic population.
Characteristics: affordable, acceptable, sensitive & specific, predictive value, safe, easy to perform and interpret, cost-effective.

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3. Short Answers (Any four out of six, 4 × 5 = 20 marks)

a) Define Epidemiology + Short-Term Fluctuations
Epidemiology: Study of disease distribution, determinants, and control in populations.
Short-term fluctuations: Quick changes in disease occurrence due to seasonal or epidemic factors (e.g., flu seasons, outbreaks).

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b) Agent, Host, Environment Factors of Dengue

• Agent: Flavivirus

• Vector/Host: Aedes aegypti mosquito

• Environment: Stagnant water, warm climate, urban crowding

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c) Protein-Energy Malnutrition (PEM)
Caused by inadequate protein and calories. Types: Marasmus (calorie deficiency), Kwashiorkor (protein deficiency with edema). Presents with weight loss, stunted growth, edema, anemia, infections susceptibility.

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d) Functions of Health Communication

• Inform and educate public

• Promote healthy behaviors

• Change attitudes and norms

• Encourage uptake of services

• Support policy and advocacy

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e) UNICEF
United Nations Children's Fund – promotes child health, nutrition, education, emergency relief globally.

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f) Health Information & Sources
H.I.: Data about health status, disease trends, interventions.
Sources: Vital registration, HMIS, surveys, research articles, surveillance, health facility reports.

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4. Long Answer Questions 

a) Ergonomics & Pneumoconiosis

• Ergonomics: Science of designing safe, efficient workplace.
  • Involves human-machine interface, posture, repetitive strain injury prevention.

• Pneumoconiosis: Chronic lung disease from inhaled dust in mines/industry.
  • Types: Silicosis, asbestosis, coal worker’s pneumoconiosis.
  • Prevention: Dust control, PPE, ventilation, medical surveillance, health education.

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b) Prevention of Blindness & NPCB

• Preventive Measures:
  • Immunization (measles, vitamin A)
  • Surgical interventions (cataract)
  • Refractive services
  • Community and health worker training

• NPCB: Launched in India in 1976. Objectives: Reduce prevalence, develop infrastructure, integrate eye care, early detection, awareness and research.

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c) Family Planning & Hormonal Contraceptives

• Definition: Planning spacing and number of children through voluntary methods.

• Hormonal Methods:

  1. Combined oral pills (estrogen + progestin)

  2. Progestin-only pills

  3. Injectables (DMPA)

  4. Implants (e.g., levonorgestrel)

  5. Side-effects: weight changes, mood swings, blood pressure monitoring required.

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d) Role of Homoeopathy in Prevention

• Supports immune system dynamically

• Treats subclinical susceptibility

• Useful in epidemic prevention

• Encourages healthy lifestyle

• Suitable for chronic conditions and enhancing quality of life

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5. Long Answer (20 marks)

Indicators of Health & Responsibility for Health

• Indicators: Life expectancy, maternal/infant mortality, morbidity rates, nutritional status, immunization coverage, mental health trends, environmental quality.

• Responsibility:
  • Individual: lifestyle, diet, preventive checks
  • Community: awareness, support networks
  • Health system: infrastructure, policy, accessibility
  • Government: regulations, funding, enforcement

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6. Long Answer (20 marks)

Case-Control vs Cohort Study

Feature	Case–Control	Cohort
Design	Retrospective	Prospective
Subjects	Disease vs disease-free	Exposed vs non-exposed
Timing	Backward from outcome	Forward from exposure
Measure	Odds Ratio	Relative Risk
Cost & Duration	Low cost, quick	Higher cost, longer
Best-used	Rare diseases	Demonstrating causality

Advantages: efficient for rare conditions / stronger causal evidence
Disadvantages: recall bias / expensive and slow

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7. Long Answer (20 marks)

Natural History of Tuberculosis & Preventive Measures

1. Stage of Exposure: Infection via droplet

2. Primary Infection: Ghon focus formation

3. Latent Period: Asymptomatic, potential reactivation

4. Active TB: Pulmonary or extrapulmonary, symptomatic

5. Complications: Cavitation, dissemination, MDR-TB

Prevention:

• BCG vaccination

• Early screening (TST, CXR)

• Isoniazid prophylaxis

• Prompt detection and DOTS treatment

• Infection control (masks, ventilation)

• Community awareness

• Social determinants (nutrition, income, housing)

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