Fourth.B.H.M.S. Winter - 2021 COMMUNITY MEDICINE

2. Short answer Questions 

-a) Elements and principles of Primary Health Care (PHC).

-b): Types and criteria for screening. | |

- ¢) Types and causes of mental illness. |

d) Causes and control of cancer.

_e) Effects of air pollution and it’s preventive measures.

f) Disease eradication. 

3. Short answer questions 

‘a) Census and sample registration system (SRS).

b) Functions of health communication.

c) FAO. |

d) Endemic flurosis and it’s prevention.

e) Prevention of poliomyelitis.

f) Immunization schedule.

4. Long Answer Questions 

- a) Define family planning. Write about Hormonal contraceptives, add note

on MTP Act.

OR

- b) Role of Homeopathy in Community medicine. -

c) Coronary Heart disease (CHD).

OR

d) Explain Pneumoconiosis and add note on ESI Act.

Long Answer Questions (5,6,7) 

5. Classify vitamins, writedeficiency and sources. Add note on Community

nutrition programme. :

6. Write in detail about Early neonatal care. Add note on Breast feeding and

. «Artificial feeding.

- 7, Write about Levels of prevention and Modes of Intervention.

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

[6 × 5 = 30 Marks]

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🔹 a) Elements and Principles of Primary Health Care (PHC)

Elements (8):

1. Health education

2. Nutrition

3. Safe water and sanitation

4. Maternal and child health

5. Immunization

6. Prevention and control of endemic diseases

7. Treatment of common ailments

8. Provision of essential drugs

Principles (4):

1. Equitable distribution

2. Community participation

3. Inter-sectoral coordination

4. Appropriate technology

Source: Park's PSM, Chapter 5

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🔹 b) Types and Criteria for Screening

Types:

1. Mass screening – Whole population

2. Selective screening – High-risk groups

3. Multiphasic screening – Multiple tests at once

Criteria (Wilson & Jungner):

1. Condition should be an important health problem

2. Recognizable early stage

3. Effective treatment available

4. Suitable, acceptable test

5. Cost-effective

6. Continuous process

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🔹 c) Types and Causes of Mental Illness

Types:

• Psychotic (e.g., schizophrenia)

• Neurotic (e.g., anxiety, OCD)

• Affective (e.g., depression)

• Personality disorders

Causes:

1. Genetic predisposition

2. Neurochemical imbalance

3. Chronic stress/trauma

4. Substance abuse

5. Socioeconomic factors

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🔹 d) Causes and Control of Cancer

Causes (modifiable and non-modifiable):

• Tobacco use

• Alcohol

• Radiation

• Viruses (e.g., HPV, EBV)

• Genetics

• Occupational exposure

Control:

1. Health education

2. Anti-tobacco programs

3. Vaccination (e.g., HPV, Hep B)

4. Early screening (e.g., PAP, mammogram)

5. National Cancer Control Programme

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🔹 e) Effects of Air Pollution & Preventive Measures

Effects:

• Respiratory illness (e.g., asthma, COPD)

• Cardiovascular issues

• Cancer

• Eye, throat irritation

• Low productivity, absenteeism

Prevention:

• Reduce vehicular emissions

• Promote public transport

• Industrial regulation

• Afforestation

• Awareness campaigns

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🔹 f) Disease Eradication

Definition:
Permanent reduction of disease incidence to zero globally (e.g., smallpox)

Criteria for Eradication:

1. No animal reservoir

2. Effective vaccine

3. Easily diagnosed

4. Global commitment

Examples:

• Smallpox (eradicated)

• Polio (targeted)

• Guinea worm disease (nearly eradicated)

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

[6 × 5 = 30 Marks]

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🔹 a) Census and Sample Registration System (SRS)

Census:

• Conducted every 10 years (e.g., 2011, next 2021)

• Total population count

SRS:

• Conducted by Registrar General of India

• Continuous demographic data collection

• Provides birth rate, death rate, fertility rate

• Dual recording system: continuous + half-yearly surveys

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🔹 b) Functions of Health Communication

1. Health education

2. Behavior change

3. Community mobilization

4. Encourage utilization of services

5. Counter misinformation

6. Motivation for screening/immunization

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🔹 c) FAO – Food and Agriculture Organization

• UN specialized agency (Founded: 1945)

• Headquarters: Rome

• Works on food security, nutrition, agriculture

• Provides technical support to governments

• Monitors locust invasions, malnutrition, food prices

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🔹 d) Endemic Fluorosis & Its Prevention

Cause:

• High fluoride levels (>1.5 mg/L) in drinking water

Effects:

• Dental fluorosis (mottling)

• Skeletal fluorosis (stiff joints)

Prevention:

• Safe water supply (<1 ppm fluoride)

• Defluoridation (Nalgonda technique)

• Nutrition improvement (calcium, vit C)

• Monitoring & awareness

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🔹 e) Prevention of Poliomyelitis

1. Routine immunization (OPV/IPV)

2. National Immunization Days (Pulse Polio)

3. Surveillance of acute flaccid paralysis

4. Mop-up operations

5. Use of bivalent OPV

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🔹 f) Immunization Schedule (Universal Immunization Programme – India)

Age	Vaccine
At birth	BCG, OPV-0, Hep B-1
6, 10, 14 weeks	Pentavalent, OPV, IPV, Rotavirus, PCV
9–12 mo	Measles-Rubella, JE-1
16–24 mo	DPT booster-1, OPV booster, JE-2
5–6 yrs	DPT booster-2
10, 16 yrs	Td (Tetanus, diphtheria)

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

[2 × 10 = 20 Marks]

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🔷 a) Family Planning – Hormonal Contraceptives & MTP Act

Definition:
Family planning allows individuals/couples to plan and space births, prevent unwanted pregnancies, and maintain reproductive health.

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Hormonal Contraceptives

1. Combined Oral Contraceptives (COCs):

• Contains estrogen + progestin

• e.g., Mala-D, Mala-N

• Taken daily for 21 days + 7-day break

• Prevents ovulation, thickens cervical mucus

2. Progestin-Only Pills (Mini Pills):

• Safer in breastfeeding mothers

• Taken daily, no breaks

3. Injectable Contraceptives:

• e.g., DMPA – given every 3 months

4. Implants:

• Subdermal, long-term (3–5 years)

• e.g., Norplant

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Advantages:

• Highly effective

• Reversible

• Improves menstrual regularity (in COCs)

Disadvantages:

• Needs regular intake

• Nausea, weight gain, mood changes

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Medical Termination of Pregnancy (MTP) Act – 1971

Provisions:

• Legal up to 24 weeks (amended 2021)

• By registered medical practitioner

• Conditions:

  • Risk to mother’s health

  • Fetal abnormalities

  • Rape/incest

  • Contraceptive failure

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🔷 b) Role of Homoeopathy in Community Medicine

1. Preventive aspect

   • Prescribing constitutional remedies to improve immunity

   • Prophylactic use (e.g., Belladonna in scarlet fever, Bryonia in flu epidemics)

2. Curative aspect

   • Acute and chronic disease management

   • Individualized therapy

3. Rehabilitation

   • Useful in post-operative, geriatric, and palliative care

4. National programs

   • AYUSH integration in PHC

   • Homoeopathy dispensaries in rural areas

5. Education & health promotion

   • Awareness of nutrition, hygiene, vaccination

6. Cost-effective

   • Safe, economic, with minimal side effects

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🔷 c) Coronary Heart Disease (CHD)

Definition:
Condition where coronary arteries are narrowed → reduced blood flow to heart.

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Risk Factors:

1. Non-modifiable: age, gender, family history

2. Modifiable: smoking, hypertension, diabetes, hyperlipidemia, obesity, stress, sedentary lifestyle

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Clinical Features:

• Angina

• Breathlessness

• Palpitations

• Fatigue

• Myocardial infarction (in severe cases)

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Prevention:

• Primary: Lifestyle modification, smoking cessation

• Secondary: Aspirin, statins, control of BP, sugar

• Tertiary: Rehabilitation, CABG/angioplasty

Programs:

• NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke)

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🔷 d) Pneumoconiosis & ESI Act

Pneumoconiosis:
Chronic lung disease caused by inhalation of mineral dust (e.g., coal, silica, asbestos)

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Types:

• Silicosis

• Coal worker’s pneumoconiosis

• Asbestosis

Symptoms:

• Chronic cough

• Breathlessness

• Restrictive lung function

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Prevention:

• Dust control in workplace

• Use of PPE (masks)

• Medical surveillance

• Legislative safety (Factory Act)

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Employees’ State Insurance (ESI) Act, 1948
Objectives:

• Social security for workers

Benefits:

• Medical, sickness, maternity, disablement, dependents’, funeral

• Applied to factories with ≥10 employees earning < Rs. 21,000/month

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✅ Q.5 – Classify Vitamins + Community Nutrition Programme

[20 Marks]

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Classification of Vitamins

Type	Examples	Solubility
Fat soluble	A, D, E, K	Stored in body
Water soluble	B-complex (B1, B2, B6, B12), C	Not stored

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Common Deficiencies and Sources

Vitamin	Deficiency Disease	Sources
A	Night blindness	Liver, milk, carrots
D	Rickets, osteomalacia	Sunlight, fish oil
B1	Beriberi	Cereals, pulses
B2	Cheilitis	Eggs, milk
B12	Anemia	Animal products
C	Scurvy	Citrus fruits
K	Bleeding disorders	Leafy vegetables

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Community Nutrition Programmes

1. ICDS (Integrated Child Development Services)

   • Supplementary nutrition for children <6 yrs, lactating mothers

2. Mid-Day Meal Scheme

   • Hot meals in government schools

3. NNAPP (National Nutritional Anaemia Prophylaxis Programme)

   • Iron-folic acid tablets

4. Vit A prophylaxis

   • 9 mega doses till age 5

5. POSHAN Abhiyan

   • Targets malnutrition by convergence of schemes

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✅ Q.6 – Early Neonatal Care + Breast & Artificial Feeding

[20 Marks]

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Early Neonatal Care (0–7 days)

1. Resuscitation at birth

2. Maintain body temperature

   • Kangaroo mother care

3. Cord care

   • Clean, dry, no antiseptic

4. Eye care

   • Wipe with sterile gauze

5. Breastfeeding initiation

   • Within 1 hour

6. Weighing and registration

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Breastfeeding

Benefits to baby:

• Nutritionally ideal

• Antibodies – protects from infection

• Reduces risk of SIDS, obesity

Benefits to mother:

• Uterine involution

• Delays ovulation

• Bonding

Duration:

• Exclusive breastfeeding: 6 months

• Continue with complementary food till 2 years

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Artificial Feeding

Indications:

• HIV positive mother (in high-risk areas)

• Absent/ill mother

Risks:

• Infection

• Malnutrition

• Improper dilution

Precautions:

• Boil water

• Sterilize bottle

• Proper dilution and hygiene

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✅ Q.7 – Levels of Prevention & Modes of Intervention

[20 Marks]

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Levels of Prevention (Leavell & Clark Model)

1. Primordial Prevention

   • Prevent emergence of risk factors

   • e.g., lifestyle education in schools

2. Primary Prevention

   • Health promotion (nutrition, exercise)

   • Specific protection (vaccination)

3. Secondary Prevention

   • Early diagnosis (screening)

   • Prompt treatment to prevent complications

4. Tertiary Prevention

   • Disability limitation

   • Rehabilitation (physical, vocational)

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Modes of Intervention

• Health education

• Environmental modification (clean water, sanitation)

• Nutritional intervention

• Screening programs

• Legislation (anti-smoking, MTP, food safety)

• Immunization

• Surveillance and monitoring

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