8 Preventive and

Social Medicine

AIIMS NOVEMBER 2017
1. Which of the following OPV vaccine vials is/ are usable
based on the Vaccine Vial Monitor (VVM) colour change?
6. Prevalence of Leprosy in India, as of 31st march 2016 is?
a. 0.66/10000 population b. 0.66/ 1 lakh population
c. 9.7/ 10000 population d. 9.7/ 1 lakh population
7. A randomized control trial comparing efficacy of two drugs
found to have significant difference in activity (p<0.01),
however in reality there was no difference between two

/e
drugs. This is called?
a. Alpha error b. Beta error

,2
c. - Alpha d. 1 - Beta
8. Viral Haemorrhagic fever reported in India is?
a. Crimean Congo Hemorrhagic fever

PSM PLATE 29

sy b. Yellow fever
c. Ebola
Ea
a. Only 1 b. Both 1 and 2 d. Marburg
c. Both 3 and 4 d. 1, 2, and 3 9. Drug of choice for scrub typhus is?
2. A doctor uses a highly sensitive test on a patient and the a. Doxycycline b. Azithromycin
ed

result is positive. What does this mean? c. Ciprofloxacin d. Chloramphenicol

a. Highly likely that patient has the disease
10. A 18 year male comes with pruritus over hand as shown in
b. Highly unlikely that patient has the disease
M

the picture. Causative organism shown in the picture is?

c. If the prevalence is high, then the patient is likely to have
the disease
S

d. If it is a rare disease, then the patient is likely to have the disease

3. Chronic liver disease is classified using Child–Pugh class A
IM

to C, employing the added score from above. Class A= 5–6,

Class B= 7–9 and Class C = 10–15. What is the type of data
in this scoring system?
AI

a. Ordinal b. Qualitative
c. Nominal d. Continuous
4. In a subcenter with a Crude birth rate of 20, what will be the ex-
pected number of Antenatal care (ANC) registrations in a year?
a. 60 b. 80
c. 100 d. 120
5. While testing the health hazards on a group of people after
giving a new drug and or placebo. The following results were
obtained. Based on these results what is the absolute risk
reduction and relative risk reduction in %?
Total subjects People affected
New drug 15230 1600
Placebo 15229 1830
PSM PLATE 27
a. 10% and 0.9% b. 0.1% and 0.9% a. Sarcoptes scabiei b. Pediculus capitis
c. 1% and 10% d. 1% and 9% c. Ixodid Tick d. Xenopsylla cheopis
432 Section I  •  Subject-wise MCQs and Answers with Explanations

11. In mid day meal programme, Supplementary nutrition 17. A new test in black line (below line) has been designed to
provided should cover at least how much of total calorie and diagnose a disease condition. The test is being applied to both
protein? normal and diseased population. The graph of which is given
a. ⅓ calorie, ½ protein below. Which of the following is correct regarding the test?
b. ½ calorie, ⅓ protein
c. ½ calorie,⅔ protein
d. ⅔ calorie, ½ protein

AIIMS MAY 2017

12. A researcher said he has discovered a new drug which is
effective in chronic hypertensives with a P value of <0.10.
Which of the following is true regarding the same?
a. The test is 90% reproducible
b. 90% of test results could have occurred by chance
a. High sensitivity high specificity
c. Not more than 10% of the people benefitted by the drug
b. Low sensitivity low specificity
could be due to chance
c. Low sensitivity high specificity
d. 90% of patients will be benefitted by giving the drug

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d. High sensitivity low specificity
13. Which point in the below natural history of disease marks
18. Which biomedical waste is disposed in the bag shown below?

,2
the onset of symptoms?

sy
Ea
ed

a. A b. B
c. C d. D
M

14. A child with sputum negative and chest X-ray suggestive of

tuberculosis. Next step to do according to revised RNTCP
criteria?
S

PSM PLATE 28
a. NAAT b. Culture
a. Laboratory wastes
IM

c. Line probe assay d. Tuberculin test

b. Human anatomical waste
15. The following are the disease frequencies in a population. c. Sharp waste
AI

Based on the number of cases which of the following is the d. Soiled plastic waste
correct match
19. A study was conducted with the objective to compare the
Disease 1-Usually 40-50 case per week with 48 cases last week
incidence of post partum depression using depression
Disease 2-Usually less than 10 cases in a year with 1 case last
score (Edinburgh depression scale) depression in mother
week
Disease 3-Usually 2-3 cases per week, with 13 cases last week as compared to the sex of the child. One group with female
a. Endemic, epidemic, sporadic babies one with male babies. Which test should be used to
b. Endemic, sporadic, epidemic compare?
c. Sporadic, endemic, epidemic a. Student’s t test
d. Pandemic, endemic, sporadic b. Paired t test
c. Chi-square test
16. A radiation therapist prescribes a new drug combination d. Pearson’s coefficient
of chemotherapy and immunotherapy for metastatic
melanoma. It prolongs the survival. Which of the following 20. Below is the graph of CD4 count in HIV patients. From the
is true in this situation? graph below identify the mean CD 4 count?
a. Incidence reduces and prevalence increases a. Mean will be 300
b. Incidence remains the same and prevalence increases b. Mean more than 350
c. Incidence reduces and prevalence remains the same c. Mean anywhere between 300 to 400
d. Incidence increases and prevalence reduces d. Mean less than 300

AIIMS Nov 2013–May 2011

AIIMS (Nov 2017–May 2014) Questions with Explanations Covered in Volume II (Available Separately)
440 Section I  •  Subject-wise MCQs and Answers with Explanations

ANSWERS WITH EXPLANATIONS

AIIMS NOVEMBER 2017 considered fixed properties of a diagnostic test unaffected by

1. Ans. (b)  Both 1 and 2
Ref: Park 24th ed page 118
See PSM PLATE 29
From the above image only vial 1 and 2 can be used as the inner
squares are lighter than outer squares.
A vaccine vial monitor (VVM) is a label containing a heat
sensitive material which is placed on a vaccine vial to register
cumulative heat exposure over time. The combined effects of
time and temperature cause the inner square of the VVM to
darken, gradually and irreversibly. A direct relationship exists
between the rate of colour change and temperature. The color
the prevalence (Common or rare) of the disease. On the other
hand Predictive value depends on the prevalence of the disease.
Positive predictive value: The PPV of a test is a proportion
that is useful to clinicians since it answers the question: ‘How
likely is it that this patient has the disease given that the test
result is positive? Predictive value” reflects the diagnostic
power of the test. The predictive accuracy depends upon
sensitivity, specificity and disease prevalence. The “predictive
value of a positive test” indicates the probability that a patient
with a positive test result has, in fact, the disease in question.
The more prevalent a disease is 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.

/e
change is irreversible. The VVM indicates the accumulated             True positives
heat to which the vaccine has been subjected Positive predictive value =

,2
             True positives + False positives
2. Ans. (c)  If the prevalence is high, then the patient is likely
to have the disease 3. Ans. (a)  Ordinal
Ref: Park 24th ed page 149
Sensitivity of a screening test is its ability to detect correctly
sy Ref: High Yield Biostatistics 4th ed page 2-3
Child Pugh is an Ordinal scale as there is Rank order with
Ea
those who have the disease. Sensitivity and specificity can be Class A= 5–6, Class B= 7–9 and Class C = 10–15
ed

Statistical scales
Name Comments Examples
M

Categorical scale (For Qualitative data)

Nominal scale No implication of order/ ratio, Data cannot be Hindus, Muslims, Christians
placed in meaningful order (Statistically least
S

preferable)
IM

Ordinal scale Rank ordered. No information about size of 1st, 2nd, 3rd
interval (i.e, not known is the difference between Mild, moderate, severe
the 1st and 2nd rank is the same as between 2nd TNM staging
AI

and 3rd ) Child Pugh Class A= 5–6, Class B= 7–9 and

Class C = 10–15
Dichotomous scale Data fall into 2 groups only Died/ Alive
Metric scale (for quantitative data)
Interval Scale Meaningful Intervals between items Difference between 50°C and 60°C is the
Do not have an absolute zero same as that between 30°C and 40°C
Do not have meaningful ratios But 60°C is not twice as hot as 30°C
because 0°C does not mean complete
absence of heat
Ratio Scale Same as Interval Scale Kelvin Scale
Has an absolute Zero Pulse

4. Ans. (a)  60
Ref: Park 24th ed page 559
The sub-centre is the peripheral outpost of the existing health delivery system in rural areas. They are being established on the basis of
one sub-centre for every 5000 population in general and one for every 3000 population in . hilly, tribal and backward areas.

AIIMS (Nov 2017–May 2014)


Hence Expected No. of Births/ year = CBR X Population / 1000
= 20 × 5000/ 1000 = 100
As some pregnancies may not result in a live birth (i.e.
abortions and stillbirths may occur), the expected number of
live births would be an under-estimation of the total number
of pregnancies. Hence, a correction factor of 10% is required,
i.e. add 10% to the figure obtained above. So, the total number
of expected pregnancies (Z) = Y + 10% of Y = 100 + 10= 110
As a thumb rule, in any given month, approximately half the
number of pregnancies estimated above should be in records.
I.e. ANC registrations should be minimum 110/ 2 = 55 which
is approximately 60
To ensure complete registration, it is essential that the ANM
should know the estimated number of pregnancies to be
registered annually in her area. Calculating the expected
number of annual pregnancies in the area will help her judge
how good her pregnancy registration is and help her judge
whether she has an adequate stock of the supplies required to
PREVENTIVE AND SOCIAL MEDICINE  •  Answers with Explanations 441
c   a 
Absolute risk reduction (ARR) =  − 
 c +d   a +b 
Number needed to treat = 1/ARR
Relative Risk (RR) = (1600/ 15230) / (1830/ 15229) = 0.87 (0.9
Rounded off)
Relative risk reduction (RRR) = 1- Relative Risk = 1- 0.9 =
0.1 or 10%
Absolute Risk Reduction (ARR) = (1830/ 15229) - 1600/
15230 = 0.01 = 1%
6. Ans. (a)  0.66/10000 population
Ref: NLEP Annual Report http://nlep.nic.in/pdf/revised%20
annual%20report%2031st%20March%202015-16.pdf
Recall Bias..................................................
Some recallers think that Annual new case detection rate (ANCDR)

/e
provide routine ANC was asked
If prevalence was asked then 0.66/10000 population

,2
5. Ans. (c)  1% and 10%
If Annual New case detection rate was asked then it is 9.71/
Ref: High Yield Biostatistics 4th ed page 92-93 lakh population or 0.97/10000 population.

sy
Lets first redraw the table During the year 2015-16, Annual New Case Detection Rate
(ANCDR) of 9.71 per 1 lakh population Prevalence Rate (PR)
Total Health Health of 0.66 per 10,000 population
subjects Hazard Hazard
Ea
It has been observed that trend of two important indicators of
Positive Negative National Leprosy Eradication Program, India i.e. Annual New
New drug 15230 (a+b) 1600 (a) 13400 (b) Case Detection Rate (ANCDR) and Prevalence Rate (PR) are
ed

almost static since 2006 – 2007.

Placebo 15229 (c+d) 1830 (c) 13620 (d)
In addition, the percentage of grade II disability amongst new
cases detected has been increased from 3.10% (2010 - 2011) to
 a − c 
M

Relative risk =     4.61% (2014 - 2015), which indicates that the cases are being
 a +b   c +d 
detected late in the community and there may be several cases
Relative risk reduction = 1 – relative risk which are lying undetected or hidden
S
IM
AI

PREVENTIVE AND SOCIAL MEDICINE

442 Section I  •  Subject-wise MCQs and Answers with Explanations

7. Ans. (a) Alpha error

Ref: High Yield Biostatistics 4th ed page 28, 29

Types of error
Type 1 error Type II error
Alpha error Beta error
False negative False positive
Rejecting null hypothesis when its true Accenting null hypothesis when its false
•• There is no real difference however we find a difference •• We fail to observe a difference when in reality there is a
•• An example of this would be if a test shows that a woman is difference
pregnant (H0: she is not) when in reality she is not, or telling •• An example of this would be if a test shows that a woman is
a patient he is sick (H0: he is not), when in fact he is not not pregnant (H0: she is not), when in reality, she is

Tabulated relations between truth/ falseness of the null hypothesis and outcomes
Null hypothesis (H0) is true Null hypothesis (H0) is false

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Reject null hypothesis Type I error Correct outcome
False positive True Positive

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Fail to reject null hypothesis Correct outcome Type II error
True Negative False negative

8. Ans. (a)  Crimean Congo Hemorrhagic fever

Ref: With Text sy
Ea
Agents causing VHFs are distributed worldwide. Although there are 12 viruses that are capable of causing hemorrhagic fevers, only 2 are
consistently seen in India. In the Indian scenario, however, Dengue and Dengue hemorrhagic fever, and Kyasanur Forest Disease (KFD)
infection are seen and are endemic (even hyperendemic). There is also an increasing recent interest in the Ebola virus as the current 2014
ed

epidemic in the African subcontinent may soon spread beyond its boundaries and indeed some cases have already been reported from
outside of the main affected region. (Ref: Update on Tropical Fever page 153 http://www.apiindia.org/pdf/monograph_2015_update_
on_tropical_fever/014_viral_hemorrhagic.pdf)
M

In India the first confirmed case of CCHF was reported during a nosocomial (Infections caught in hospitals) outbreak in Ahmadabad,
Gujarat, in January 2011. (Ref National Health Portal https://www.nhp.gov.in/disease/blood-lymphatic/crimean-congo-haemorrhagic-
S

fever-cchf)
The Crimean-Congo haemorrhagic fever (CCHF) virus causes severe viral haemorrhagic fever outbreaks. CCHF outbreaks have
IM

a case fatality rate of up to 40%. The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human
transmission can occur resulting from close contact with the blood
AI

Viral hemorrhagic fever

Disease Incubation Case-Infection Ratio Case-Fatality Geographic Range
Period, Days Rate, %
Lassa fever 5–16 Mild infections probably 15 West Africa
common
South American HF 7–14 Most infections (more than 15–30 Bolivia, Argentina, Venezuela, and
half) result in disease Brazil
Rift Valley fever 2–5 1:100 50 Sub-Saharan Africa, Madagascar,
Egypt
Crimean Congo HF 3–12 1:5 15–30 Africa, Middle East, Turkey, Balkans,
southern region of former USSR,
western China, Gujarat (India 2011)
HF with renal 9–35 Hantaan, >1:1.25; Puumala, Hantaan, 5–15; Worldwide, depending on rodent
syndrome 1:20 Puumala, <1 reservoir

Contd…

AIIMS (Nov 2017–May 2014)

 PREVENTIVE AND SOCIAL MEDICINE  •  Answers with Explanations 443

Viral hemorrhagic fever

Disease Incubation Case-Infection Ratio Case-Fatality Geographic Range
Period, Days Rate, %
Hantavirus 7–28 Very high 40–50 America
pulmonary
syndrome
Marburg or Ebola 3–16 High 25–90 Sub-Saharan Africa
HF
Yellow fever 3–6 1:2–1:20 20 Africa, South America

Dengue HF/dengue 2–7 Nonimmune, 1:10,000; <1 with Tropics and subtropics worldwide
shock syndrome heterologous immune, 1:100 supportive
treatment
Kyasanur Forest/ 3–8 Variable 0.5–10 Mysore (India)/ western Siberia
Omsk HF

/e
9. Ans. (a)  Doxycycline

,2
Ref: Park 23rd ed page 300, Harrison 19th ed page 152e-3
Tetracycline (Doxycycline) is the drug of choice for the treatment of epidemic louse-borne typhus, murine typhus, scrub typhus, tick
typhus, Rocky Mountain spotted fever, and Mediterranean spotted fever

Typhus group Rickettsia

prowazekii
Epidemic typhus Louse (Human
(louse-borne body louse)
sy Humans Fever, chills,
myalgia, rash (no
Central Africa,
Asia, Central,
Ea
typhus), Brill- eschar), headache North, and
Zinsser disease severe illness if South America
untreated
ed

Rickettsia typhi Murine typhus, Flea Rodents Fever, headache, Tropical and
endemic typhus myalgia, rash (no subtropical
M

(flea-borne eschar); milder areas worldwide

typhus) illness than
epidemic typhus
S

Orientia Scrub typhus Larval Rodents Fever, headache, Asia-Pacific

IM

(formerly trombiculid rash (50% region from

Rickettsia) mites (chigger) have eschar), maritime Russia
tsutsugamushi (True reservoir) lymphadenopathy, and China to
AI

atypical Indonesia and

lymphocytes North Australia
to Afghanistan

10. Ans. (a)  Sarcoptes scabei 11. Ans. (a)  ⅓ calorie, ½ protein
Ref: Rook’s 8th Ed page 38.36, Park 23rd ed page 782 Ref: Park 23rd ed page 661
See PSM PLATE 27 Principles of Mid Day Meal
The image in the question shows four pairs of legs , two anterior •• The meal should be a supplement and not a substitute to the
and two posterior. The legs don’t have claws. There is no siphon home diet
mechanism on the head. The legs aren’t attached to the thorax •• The meal should supply at least 1/3 of the total calories and
alone. Thus it is a case of sarcoptes scabies. 1/2 of the total protein need

PREVENTIVE AND SOCIAL MEDICINE

444 Section I  •  Subject-wise MCQs and Answers with Explanations
•• The cost of the meal should be reasonably low
•• The meal should be such that it can be prepared easily in
schools; no complicated cooking process should be involved
•• As far as possible, locally available foods should be used; this
will reduce the cost of the meal, and
•• The menu should be frequently changed to avoid monotony
AIIMS MAY 2017
12. Ans. (c)  Not more than 10% of the people benefitted by the
drug could be due to chance
Ref: Oxford Handbook of Medical Statistics Page 248
•• This question is based on basic biostatistics.
•• The P (probability) value is used when we wish to see how
likely it is that a hypothesis is true. The hypothesis is usually
that there is no difference between two treatments, known
as the “null hypothesis”.
•• The P value gives the probability of any observed difference
having happened by chance.
•• P = 0.5 means that the probability of the difference having
happened by chance is 0.5 in 1, or 50:50.
•• Similarly, a P value of less than 0.10 means that the
probability of it happening by chance is 10%.
•• Thus, according to our question, the probability that the
Ea
drug affected the chronic hypertensives by chance is less
than 10%. Hence, 90% of the subjects were benefitted by the
drug.
ed
13. Ans. (c)  C
Ref: Park 24th ed page 40, CDC
M
•• Natural history of disease refers to the progression of a
disease process in an individual over time, in the absence
of treatment.
S
•• The process begins with the appropriate exposure to or
IM
accumulation of factors sufficient for the disease process
to begin in a susceptible host. For an infectious disease, the
exposure is a microorganism. For cancer, the exposure may
AI
be a factor that initiates the process, such as asbestos fibers
or components in tobacco smoke (for lung cancer), or one
that promotes the process, such as estrogen (for endometrial
cancer).
•• After the disease process has been triggered, pathological
changes then occur without the individual being aware
of them. This stage of subclinical disease, extending from
the time of exposure to onset of disease symptoms, is
usually called the incubation period for infectious diseases,
and the latency period for chronic diseases. During this
stage, disease is said to be asymptomatic (no symptoms)
or inapparent. This period may be as brief as seconds for
AIIMS (Nov 2017–May 2014)
hypersensitivity and toxic reactions to as long as decades for
certain chronic diseases.
•• Although disease is not apparent during the incubation
period, some pathologic changes may be detectable with
laboratory, radiographic, or other screening methods. Most
screening programs attempt to identify the disease process
during this phase of its natural history, since intervention at
this early stage is likely to be more effective than treatment
given after the disease has progressed and become
symptomatic.
•• The onset of symptoms marks the transition from
subclinical to clinical disease. Most diagnoses are made
during the stage of clinical disease. In some people, however,
the disease process may never progress to clinically apparent
illness. In others, the disease process may result in illness
that ranges from mild to severe or fatal. Ultimately, the
disease process ends either in recovery, disability or death.
•• The term “spectrum of disease” is a graphic representation
/e
of variations in the manifestations of disease.
•• These different manifestations are simply reflections of
,2
individuals’ different states of immunity and receptivity.
Leprosy is an excellent example of the spectral concept of
disease.
sy •• The sequence of events in the spectrum of disease can
be interrupted by early diagnosis and treatment or by
preventive measures which if introduced at a particular
point will prevent or retard the further development of the
disease. The concept of spectrum of disease provides for
inclusion of all cases, both subclinical and clinical, in the
study of disease.
Natural history of disease timeline
14. Ans. (a)  NAAT
Ref: Technical and Operational guidelines for TB control in India
- 2016
Cartridge Based Nucleic Acid Amplification Test (CB NAAT):
The CB NAAT is known as the GeneXpert in most countries
other than India. This is the preferred first diagnostic test in
children and people with TB and HIV co-infection.
 PREVENTIVE AND SOCIAL MEDICINE  •  Answers with Explanations 445

Flow chart: Diagnostic algorithm for pulmonary TB

/e
,2
15. Ans. (b)  Endemic, sporadic, epidemic
sy
Ea
Ref: Park 24th ed page 98
In disease 1: We see a continuous trend. Thus we can call this endemic.
In disease 2: No trend can be seen, it can be sporadic increase.
ed

In disease 3: THere is an abrupt increase in cases, within a week, we can label it epidemic.

Some Important Definitions

M

Term Description Example

Epidemic The “unusual” occurrence in a community or region of disease, specific Cholera, chickenpox.
S

health-related behaviour or other health-related events clearly in excess Modern “slow” epidemics-
of “expected occurrence”. The amount of disease occurring in the past, in Coronary disease
IM

the absence of an epidemic, defines the “expected” frequency.

Endemic It refers to the constant presence of a disease or infectious agent within Common cold
AI

a given geographic area or population group, without importation from

outside; may also refer to the “usual” or expected frequency of the
disease within such area or population group.
Hyper-endemic The disease is constantly present at a high incidence and/or prevalence
rate and affects all age groups equally.
Holo-endemic “Holoendemic” a high level of infection beginning early in life and Malaria
affecting most of the child population, leading to a state of equilibrium
such that the adult population shows evidence of the disease much less
commonly than do the children.
Sporadic The cases occur irregularly, haphazardly from time to time, and generally Polio, tetanus, herpes-zoster and
infrequently. The cases are so few and separated widely in space and time meningococcal meningitis.
that they show little or no connection with each other, nor a recognizable
common source of infection. A sporadic disease may be the starting point
of an epidemic when conditions are favourable for its spread.
Pandemic An epidemic usually affecting a large proportion of the population, Influenza pandemics of 1918 and
occurring over a wide geographic area such as a section of a nation, the 1957, cholera El Tor in 1962 (still
entire nation, a continent or the world. continuing) & acute haemorrhagic
conjunctivitis in 1971 and 1981.

PREVENTIVE AND SOCIAL MEDICINE

446 Section I  •  Subject-wise MCQs and Answers with Explanations

16. Ans. (b)  Incidence remains the same and prevalence increases positive rate) on the horizontal axis. This idea point indicates
the diagnostic test has a sensitivity of 100% and specificity of
Ref: Park 24th ed page 66
100%. It is also called perfect classification. Diagnostic test
with 50% sensitivity and 50% specificity can be visualized on
See table of Risk, Incidence and Prevalence in PSM AIIMS
the diagonal determined by coordinate (0, 0) and coordinates
May 2016
(1, 0). The interpretation of ROC curve is similar to a single
point in the ROC space, the closer the point on the ROC curve
Indirect repeat PSM AIIMS NOV 2015 (Options were in single
to the ideal coordinate, the more accurate the test is. The closer
parameter that is prevalence or incidence decrease or increase)
the points on the ROC curve to the diagonal, the less accurate
The new treatment is not going to affect the number of new
the test is.
cases. That is, treatment has no effect on the disease incidence.
But if we increase survival by new treatment, we ultimately
increase number of people living with disease in the community
and thus we increase prevalence.

17. Ans. (d)  High sensitivity low specificity

Ref: Park 23rd ed page 141, Lange Epidemiology 4th ed ch 6

/e
Note
This question can be solved by application of ROC

,2
curve. Precision and accuracy are not the same as
sensitivity and specificity.

Summary
Lesser the area under overlapping curves greater is the
sy
Ea
sensitivity and lesser is the specificity
ROC Space: shadow area represents better diagnostic classification
Conventional analyses of diagnostic accuracy by using 2 × 2
table consider the sensitivity and the specificity of a diagnostic
ed

test as the primary indices of accuracy since these indices

are considered to be independent of the prior probability
of disease. However, using a single sensitivity and a single
M

specificity as measures of accuracy is problematic since these

measures depend on a diagnostic criterion. ROC analysis
S

has become a popular method for evaluating the accuracy of

medical diagnostic systems. The most desirable property of
IM

ROC analysis is that the accuracy indices derived from this

technique are not distorted by fluctuations caused by the use of
arbitrarily chosen decision criteria or cut-offs.
AI

ROC Curve
The ROC curve is a fundamental tool for diagnostic test
evaluation. In a receiver operating characteristic (ROC) curve
the true positive rate (Sensitivity) is plotted in function of the
false positive rate (100-Specificity). The area under a receiver
operating characteristic (ROC) curve can be used to assess
the performance of a diagnostic test. This curve derives its
name from its first application—measuring the ability of
radar operators to distinguish radar signals from noise. For
the purposes of diagnostic testing, a graph is constructed with
sensitivity (sometimes labeled as the true-positive rate) on the Top: Probability density functions for two distributions showing areas
vertical axis, and 1 – specificity (sometimes labeled as the false- of sensitivity and 1-specifi city. Bottom: Corresponding ROC-curve

AIIMS (Nov 2017–May 2014)

 PREVENTIVE AND SOCIAL MEDICINE  •  Answers with Explanations 447

/e
,2
B sy
Ea
ed
M
S
IM
AI

From the above discussion and particularly from the above 18. Ans. (d)  Soiled plastic waste
graph it is clear that lesser the area under overlapping curves Ref: Park 24th ed page 830
greater is the sensitivity and lesser is the specificity
See PSM PLATE 28 KEY
AUC (Area under curve) classification for diagnostic test
The picture is of Red Colored Biomedical waste container.
AUC Range Classification
19. Ans. (c)  Chi-square test
0.9 < AUC < 1.0 Excellent
Ref: Park 23rd ed page 852
0.8 < AUC < 0.9 Good Incidence of depression will be in nominal form, i.e. depression
0.7 < AUC < 0.8 Worthless present or absent, whatever may be the value of the scale used for
each patient. The other variable is number of male and female
0.6 < AUC < 0.7 Not good
babies. Thus the comparison is best made through Chi square test.

PREVENTIVE AND SOCIAL MEDICINE

448 Section I  •  Subject-wise MCQs and Answers with Explanations

Sample Characteristics Correlation

Level of
1 Sample 2 Sample K sample (i.e., >2)
measurement
Independent Dependent Independent Dependent
Categorical or x or binomial
2
x 2
Macnarmar's x 2
x 2
Cochran's Q
nominal
Rank or ordinal x2 Mann Whitney U Wilcoxon Kruskal Wallis H Friedman's Spearman's rho
Matched Pairs ANOVA
Signed Ranks
Parametric z test or t test t test between t test within 1 way ANOVA 1 way ANOVA Pearson's
(Interval and groups groups between groups (within or
ration) repeated
measure)
Factorial (2 way) ANOVA

20. Ans. (c)  Mean anywhere between 300 to 400 CD4 Count Mid Point Number of Xn

/e
Ref: Oxford Handbook of Medical Statistics page 182 (X) People (n)

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In a normal distribution bell shaped curve without any skew 0 – 100 50 5 250
(if the given histogram is converted to a curve) the mean will
anyway lie at the midpoint, i.e. between 300-400 100 – 200 150 10 1500
Mean CD4 count = Total values/Total population
Total values will be given by: Mid points of histogram X
Height of Histogram column
sy 200 – 300
300 – 400
250
350
25
35
6250
12250
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Mean = x1.n1+x2.n2+……. 400 – 500 450 20 9000
n 1 + n2 + …….
500 – 1600 1050 5 5250
= 34500/100 = 345
ed

Hence, the answer is option (C) Mean anywhere between 300 Total 100 34500
to 400
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AIIMS NOVEMBER 2016

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21. Ans. (a)  There is a positive correlation between two groups

IM

Ref: With text

Note
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1. The figure and case is taken directly from a Study done at St Stephen’s Hospital Tis Hazari, Delhi
“Evaluation of pulse-oximetry oxygen saturation taken through skin protective covering. James J,
Tiwari L, Upadhyay P, Sreenivas V, Bhambhani V, Puliyel JM - BMC Pediatr (2006)
2. This is the graph of Regression analysis not Bland and Altman plot, However since Bland and
Altman plot is often preceeded by a Regression analysis some people confuse it to be a part of
Bland and Altman plot because it is often used as step one of Aggrement measurement

Lets forst know the difference between Correlation and Aggrement.

In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they
agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation
coefficients. The use of correlation is misleading. A high correlation does not necessarily imply that there is good agreement between
the two methods. Correlation studies the relationship between one variable and another, not the differences, and it is not recommended
as a method for assessing the comparability between methods.

AIIMS (Nov 2017–May 2014)

 PREVENTIVE AND SOCIAL MEDICINE

PSM PLATE 1 PSM PLATE 2 KEY

Ionizing Radiation Hazard

The international radiation symbol (also known as trefoil) first
appeared in 1946, at the University of California, Berkeley Radiation
Laboratory. At the time, it was rendered as magenta, and was set on
a blue background. The modern version used in the U.S. is magenta

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against a yellow background, and it is drawn with a central circle of
radius R, an internal radius of 1.5R and an external radius of 5R for
the blades, which are separated from each other by 60°. The trefoil

,2
is black in the international version, which is also acceptable in the
U.S. In general it is used for ionizing radiations like X rays, Gamma

sy
rays etc.
Ea
PSM PLATE 3

PSM PLATE 1 KEY

ed

Biological hazards, also known as biohazards, refer to biological sub-

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stances that pose a threat to the health of living organisms, primarily

that of humans. This can include medical waste or samples of a micro-
organism, virus or toxin (from a biological source) that can affect
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human health. It can also include substances harmful to animals.

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The term and its associated symbol is generally used as a warn-

ing, so that those potentially exposed to the substances will know to
take precautions. The biohazard symbol was developed in 1966 by
AI

Charles Baldwin.

PSM PLATE 2

PSM PLATE 3 KEY

Non Ionizing Radiation Hazard

Non-ionizing (or non-ionising) radiation refers to any type of elec-
tromagnetic radiation that does not carry enough energy per quan-
tum to ionize atoms or molecules. Near ultraviolet, visible light,
infrared, microwave, radio waves, and low-frequency radio frequency
(longwave) are all examples of non-ionizing radiation.
1126 Section II  •  Subject-wise Color Plates

Directorate of National Vector Borne Disease Control Pro-

gramme (NVBDCP) is the central nodal agency for the prevention
PSM PLATE 11
and control of vector borne diseases i.e. Malaria, Dengue, Lymphatic
Filariasis, Kala-azar, Japanese Encephalitis and Chikungunya in
India. It is one of the Technical Departments of Directorate General
of Health Services, Government of India.

PSM PLATE 10

PSM PLATE 11 KEY

/e
National Programme for Control of Blindness was launched in the
year 1976 as a 100% Centrally Sponsored scheme with the goal to

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reduce the prevalence of blindness from 1.4% to 0.3%. As per Survey
in 2001-02, prevalence of blindness is estimated to be 1.1%. Target
for the 10th Plan is to reduce prevalence of blindness to 0.8% by 2007

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prevalence of Blindness is 1% (2006-07 Survey).
Main causes of blindness are as follows: - Cataract (62.6%)
Ea
PSM PLATE 10 KEY Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma
(5.80%), Surgical Complication (1.20%) Posterior Capsular Opacifi-
cation (0.90%) Posterior Segment Disorder (4.70%), Others (4.19%)
RNTCP or the Revised National Tuberculosis Control Program
ed

Estimated National Prevalence of Childhood Blindness /Low Vision

is the state-run tuberculosis control initiative of the Government of is 0.80 per thousand
India. It incorporates the principles of directly observed treatment- The objectives of the programme are:
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shortcourse (DOTS), the global TB control strategy of the World •• To reduce the backlog of blindness through identification and
Health Organization. The program provides, free of cost, quality treatment of blind.
anti-tubercular drugs across the country through the numerous •• To develop Eye Care facilities in every district.
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Primary Health Centres and the growing number of private-sector •• To develop human resources for providing Eye Care Services.
DOTS-providers. •• To improve quality of service delivery.
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‘DOTS: Pura Course, Pakka Ilaaj’ •• To secure participation of Voluntary Organizations in eye care.
The element of ‘Hinglish’ is to bring some freshness into a commu-
AI

nication that has been around for a long time. The visual element in
the old logo has been retained for the new one, as the old logo had PSM PLATE 12
already successfully established a connect with communities.
The DOTS strategy along with the other components of the Stop
TB strategy, implemented under the Revised National Tuberculosis
Control Programme (RNTCP) in India, is a comprehensive package
for TB control.
The DOTS strategy is cost-effective and is today the international
standard for TB control programmes. To date, more than 180 coun-
tries are implementing the DOTS strategy. India has adapted and
tested the DOTS strategy in various parts of the country since 1993,
with excellent results, and by March 2006 nationwide DOTS cover-
age has been achieved.

AIIMS
 PREVENTIVE AND SOCIAL MEDICINE  • Color Plates 1135

PSM PLATE 28

PSM PLATE 28 KEY

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,2
sy
Ea
ed
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S
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Biomedical Waste Categories

Category Waste Category Treatment and Disposal
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Category 1 Human Anatomical Waste (human tissues, organs, body Incineration@/deep burial*
parts)
Category 2 Animal Waste (Animal tissues, organs, body parts Incineration@/deep burial*
carcasses, bleeding parts, fluid, blood and experimental
animals used in research, waste generated by veterinary
hospitals, colleges, discharge from hospitals, animal
houses)
Category 3 Microbiology and biotechnology waste (Wastes from Local autoclaving/micro-waving/incineration@
laboratory cultures, stocks or micro-organisms live or
vaccines, human and animal cell culture used in research
and infectious agents from research and industrial
laboratories, wastes from production of biologicals,
toxins, dishes and devices used for transfer of cultures)
Category 4 Waste sharps (needles, syringes, scalpels, blade, glass, Disinfection (chemical treatment/autoclaving/
etc. that may cause punture and cuts. This includes both microwaving and mutilation/shredding##
used and unused sharps)
Contd…

PREVENTIVE AND SOCIAL MEDICINE

1136 Section II  •  Subject-wise Color Plates

Category 5 Discarded medicines and cytotoxic drugs (Waste Incineration@/destruction and drugs disposal in secured
comprising of outdated, contaminated and discarded landfills
medicines)
Category 6 Soiled waste (items contaminated with blood, and body Incineration@autoclaving/microwaving
fluids including cotton, dressings, soiled plaster casts,
lines, bedding, other material contaminated with blood)
Category 7 Solid waste (Waste generated from disposal items other Disinfection by chemical treatment@@ autoclaving/
than the sharps such a tubings, catheters, intravenous microwaving and mutilation/shredding##
sets etc.)
Category 8 Liquid waste (Waste generated from laboratory and Disinfection by chemical treatment@@ and discharge into
washing, cleaning, housekeeping and disinfecting drains
activities)
Category 9 Incineration ash: Ash from incineration of any Disposal in municipal landfill
bio-medical waste

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Category 10 Chemical waste (Chemicals used in production of Chemical treatment@@ and discharge into drains for
biologicals, chemicals used in production of biologicals, liquids and secured landfill for solids

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chemicals used in disinfection, as insecticides, etc.)
Note:
@
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There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated.
Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.
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@@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that
chemical treatment ensures disinfection.
ed

## Multilation/shredding must be such so as to prevent unauthorised reuse.

Biomedical Waste Disposal

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Colour code Type of Waste Waste disposed Treatment options

container category
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Black bag Plastic bag 5, 9, 10 Noninfectious waste (papers, plastic covers), discarded medicines Disposal in secure
and cytotoxic drugs land fills
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Red bag Plastic bag/ 3, 6, 7 Infected solid disposable wastes other than sharps (gloves, Autoclave,
Disinfected tunings, catheters, iv sets), infected solid wastes contaminated microwave,
container with blood and body fluids (dressing, plaster, linen), chemical treatment
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microbiology/Biotech waste (vaccines, cultures)

Yellow bag Plastic bag 1, 2, 3, 6 Human anatomical waste Incineration
Animal waste, Microbiology/Biotech waste (vaccines, cultures),
Infected solid wastes contaminated with blood and body fluids
(dressing, plaster, linen)
Blue bag Plastic bag/ 4, 7 Solid sharps (needles, syringes, scalpels, blades), infected solid Autoclave,
Puncture disposable wastes other than sharps (gloves, tunings, catheters, microwave,
proof iv sets) chemical treatment,
container destruction and
shredding

AIIMS