Preventive and
Social Medicine (PSM)
LEVEL OF PREVENTION
 Primordial: Prevention of occurrence or emer-
gence of risk factor (BEST)
 Primary: Prevention of disease in presence of risk
factors or disease agent.
It is achieved by Health promotion, Specific pro-
tection
 Secondary: Early diagnosis and treatment of a dis-
ease (SCREENING)
 Tertiary: Prevention of disability
— Management of the complications
CONCEPT OF HEALTH AND DISEASE
 HDI: Life Expectancy (LE) at birth, income, knowl-
edge – Mean year of schooling, expected year of
schooling.
 PQLI: LE at 1 year, literacy rate, IMR
 Life expectancy – Only positive mortality indica-
tor.
 DALY (disability adjusted life years) – Best indica-
tor of BURDEN OF DISEASE.
 HALE (Health adjusted life expectancy) – Best in-
dicator of disability.
 EPIDEMIOLOGICAL THEORY – BY JOHN SNOW
 Epidemiological triad – agent host environment
 Epidemiological tetrad – agent host environment
time.
 Elimination – prevention of the occurrence of new
cases  by breaking the chain of transmission
 Eradication-complete removal of causative agent
from environment
 CFR-Severity/killing power/case fatality rate
 Secondary attack rate: Communicability, infectiv-
ity of a disease
 Ice burg phenomenon-Submerged Subclinical
cases, Carrier, Latent case, Undiagnosed cases.
Surrounding water – healthy population
Water line – demarcation between apparent
and unapparent cases
TIP – clinical cases
 Death certificate MOST IMPORTANT LINE IS ----Ic
 Surveillance:
1. Active surveillance – malaria, Filariasis,
leishmaniasis, leprosy, Tuberculosis
2. Passive surveillance – non-communicable
diseases, cancers
3. Sentinel surveillance – mainly for STD
— Identifying the missing cases
— Supplement notified cases
8.1
 MIST ALL IN ONE FOR FMGE

 Temperature is +2 to +8°C
VACCINES
 Dial thermometer is used to record temperature
National Immunization Schedule of ILR
Birth OPV (0 dose), BCG, Hep. B (birth
 At PHC, all vaccines are stored in ILR ONLY. The
dose) deep freezer is used to prepare ice packs only

6 weeks DPT1, OPV1, Hep. B1, HIB1, RVV1, Temperature for Long-term Storage
IPVf1, PCV1
 < 0°C – OPV, measles
10 weeks DPT2, OPV2, Hep. B2, HIB2, RVV2  +2 to +8°C – BCG, DPT, hepatitis B, IPV, Diluents,
14 weeks DPT3, OPV3, Hep. B3, HIB3, RVV3, IPV, JE, Pneumococcal, Rotavirus, HIB
IPVf2, PCV2
Vaccine Vial Monitor (VVM)
9 months Measles1/MMR1/MR1 and Vit. A,
 Used to access Exposer of vaccines to higher tem-
JE1, PCV-B
perature
16-24 months DPT B1, OPV B1 (boosters),  Grade 1 and 2 – we can use it
PSM

MEASLE2/MMR2/MR2, JE2
5 years DPT BOOSTER2
10 years Td
16 years Td
Pregnant Mother – Td1, 2 or Td Booster
 Vaccines C/I in pregnant women: All live vaccine
 Vaccine in adolescence – influenza, chicken pox,
hepatitis B, cervical cancer, rubella.
 Active and passive vaccination simultaneously –
tetanus, diphtheria, rabies, hepatitis B (not in
measle).
 Vaccines which can be give in pregnant women if
benefit>risk: Yellow fever, Hep. A, Jap. Encephali-
tis, Rabies, DPT, OPV.
 For prevention of yellow fever a single vaccina-
tion with 17D non-pathogenic strain of virus gives
protection for life long, effective 10 days after vac-
cination.
Storage of Vaccines
 Temperature is +2 to +8°C
 Reverse cold chain – transfer of stool sample of
suspected polio cases to laboratory.
 Instrument used to store the vaccines is ILR (Ice
lined refrigerator) heart of cold chain.
 Grade 3 and 4 – discard the vaccine
Shake Test
Check freeze damage of vaccine
Open vial policy
 The open returned vial can be used within 28 days
is – DPT, TT, Td, Hep B, PENTAVALENT, PNEUMO-
COCCAL, IPV, OPV
Diluents of Vaccine
 Normal saline – BCG, YF, HIB, DENGA VAXIA
 Distilled water – Measle, MMR
 Reconstituted vaccines should be used within 4
hours if stored at +2 to +8°C
Route of Administration
 Nasal – live influenza vaccines
 Oral – OPV, typhoid, cholera, rotavirus
 Intradermal – BCG, Rabies, IPV
 Subcutaneous – MMR, MEASLE, JE, YF
 Intramuscular – DPT, TT, hepatitis B, IPV, killed in-
fluenza, typhoid
Types of Vaccine
 Live vaccine only – BCG, measle, mumps, rubella,
rotavirus, varicella.

8.2
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
 Killed only – hepatitis B, rabies, pertussis.
 Both live & killed – JE, typhoid, polio, cholera,
hepatitis A, plague, influenza
 Toxoid – tetanus, diphtheria
Vitamin A
 Given from 9 months to 5 year
 1st dose: 9 to 12 months
 2nd does: every 6 months till 5 year age
 Total 9 doses
 Does <1 years -1 lac IU/dose
 >1 years -2 lacIU/dose [if baby weight <8 kg – 1 lac
IU/dose
 Total amount of vitamin A =17lac IU
 Given in strength of 1 ml/lac IU
EPIDEMIOLOGY
 Incidence – No. of new cases per 1000, its determined
from “Cohort study”, it is a rate.
 Prevalence – All cases (Old + New) per 100, it’s a
proportion, calculated by cross-sectional study
 Elimination (no new case) – When prevalence < 1/
10,000 population for leprosy in all states.
 Eradication – Not present globally (agent removed
from environment).
 Disease which shows change in occurrence of dis-
ease over a long period of time-Secular trend.
 Influenza pandemic shows cyclic trend.
 Bhopal gas tragedy is an example of point
source epidemic.
No. of infant deaths
 IMR –  1,000. It is a rate.
No. of live birth
No. of maternal
deaths
 MMR – × 100000. It is a ratio.
No. of live births
 Relative Risk (RR) – Incidence among exposed/in-
cidence among non-exposed, ratio.
 Most effective analytical study – Cohort study.
 Cohort study:
— Incidence
— Relative risk
— Attributable risk
— Population attributable risk
 Case control study – Odds Ratio.
 Cross sectional study – Prevalence.
 Ecological study – Group characteristics.
 Confounding – Any factor unequally distributed
in both exposure and outcome, and has an inde-
pendent effect in causation of outcome is a con-
founder.
 (a) Pre-clinical phase – For Laboratory experi-
ments:
PSM
(b) Phase 0 – Micro dosing trial (10-20).
(c) Phase 1 – Healthy human volunteers or those
having lack of treatment option. To evaluate
safety and toxicity (20-100).
(d) Phase 2 – Patients (less number). To evaluate
effectiveness (100-300), maximum drug
failure.
(e) Phase 3 – Patients. To compare with an existing
medication (300-3000).
(f) Phase 4 – Patients. To look for long term side
effect (>3000), longest phase.
 Clinical phase
(i) On healthy person -Phase I
(ii) On patients - II, III, IV
(iii) Longest phase – IV
(iv) Post marketing phase – IV.
(v) Drug launched in market: End of phase III trial.
 Isolation is done Till period of infectivity.
 Randomization is known as ‘Heart of a Trial’ (Most
important step in RCT).
 Randomization – Correct selection bias, known
and unknown confounding.
 Overall social development of a country depends
on – IMR.
 Study of choice for rare ds- case control.
8.3
 MIST ALL IN ONE FOR FMGE
 Nested case control- type of cohort
 Framingham heart study- cohort
 Father of modern epidemiology - John Snow
 Father of public health - Cholera
 BERKESONIAN error- type of selection error
BERKESONIAN ERROR
 Father of EBM: D L Sacket
 Study with attrition : cohort
 Best epidemiological study: Metanalysis.
 Best analytical study: RC > PC.
 How long to continue study : Till twice IP of dis-
ease from appearance of last case.
 Best study for natural disease history: Cohort study.
PSM
SCREENING
 Screening time – Time interval between first pos-
sible diagnosis and final critical diagnosis.
 Lead time – Time interval between first possible
diagnosis and usual time of appearance of a dis-
ease.
 Sensitivity: a/a+c = TP/TP + FN
 Specificity: d/b+d = TN/FP + TN
 PPV: a/a+b = TP/TP + FP
 NPV: d/c+d = TN/FN + TN
 PPV is directly proportional to prevalence of dis-
ease [PPV  Prev. of disease].
 NPV is inversely proportional to prevalence of dis-
1 ues.
ease [NPV  ]
Prev. of disease
 High FP cases in a study signify – high test sensitiv-
ity – low disease prevalence
 Same test applied in different community, more
FP cases:
• Only difference in prevalence of disease.
• Test sensitivity/specificity remains constant.
Predictive value of test (diagnostic power of a test)
depends on:
 Prevalence of disease
8.4
 Test sensitivity
 Test specificity
Most important quality of a screening test is = sen-
sitivity.
Usefulness of screening test depends on: sensi-
tivity.
Test in Series Test in Parallel
• Specificity – Increases Specificity – Decreases
• Sensitivity – Decreases Sensitivity – Increases
• PPV – Increases PPV – Decreases
• NPV – Decreases NPV – Increases
If cutoff shifted to upper side: Specificity increases,
sensitivity decreases.
If cutoff shifted to lower side: Specificity de-
creases, sensitivity increases.
BIOSTATISTICS
 Central tendency – Mean, Median, Mode.
 MC used central tendency – mean.
 Test used to compare non-continuous data in 2 or
more groups variables – Chi-Square test.
 Mean – Sum of all values divided by total no. of
values.
 Median – Middle most value in a distribution ar-
ranged in an ascending or descending order of val-
 Mode – Most frequent occurring value in a distri-
bution (can be more than one value).
 Standard Deviation (SD) – most appropriate mea-
sure of dispersion.
 Normal distribution – Mean = Median = Mode
 Right (Positive) shift – Mean > Median > Mode
 Left (Negative) shift – Mean < Median < Mode
 Histogram – best for continuous quantitative data
 Qualitative Data: Bar diagram, Pie chart, Pictogram,
Spot map.
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
 Quantitative Data: Histogram, Line chart, Fre-
quency curve, Frequency polygon, Scatterd dia-
gram, Cumulative frequency diagram.
 Cluster sampling (30 × 7 cluster): Used for immuni-
zation survey
 Simple random sampling: Sample is drawn in such
a way that each unit has an equal chance of being
drawn in a sample.
 Scattered diagram: correlation coefficient
 Range: Value between two extreme ends
 Standard deviation: Root mean square deviation
(x  x)2
SD =  =
n
1. Mean +/– 1SD – 68% population
Test of Significance
PARAMETRIC (Quantitative)
Mean/SD
1. Student t test : to compare 2 group of data
2. ANOVA test: >2 data
Student t Test
Paired t Test
Compare same group before & after intervention
CONTRACEPTION
 Eligible couple: Couple where the female is 15-49
yrs old
 Target couple: Couple having 2 or more live chil-
dren
 Couple Protection Rate (CPR): (No of EC using any
contraception/Total no of EC) × 100
NRR-1 – CPR >60%
 GATHER approach of counseling (spikes in cancer
prognosis)
 NISHCHAY kit UPT kit [‘NIKSHAY’ (TB)]
2. Mean +/1 2SD – 94-95% population
3. Mean +/– 3SD – 98-99% population
 Type 1 error: Probability of declaring significant
difference when actually it is not present (null
hypothesis true but rejected)
Most Dangerous
 Type 2 error: Probability of declaring no Signifi-
cant difference when actually it is is present (Null
hypothesis false, accepted)
 = max permissible upper limit of type 1 error
(5%)
Significance of p value:
P<5% = <0.05 – Significant study
P<1% = <0.01 – Highly significant
PSM
NON-PARAMETRIC (Qualitative)
%/proportion
1. Sign test (2 paired data)
2. Chi-Square test: >/= 2 unpaired
Unpaired t Test
Compare 2 different groups
 PP IUCD (Post-partum IUCD insertion)-CuT 380A
 CHAYA: Non hormonal oral contraceptive tab
 ANTARA: Injectable hormonal preparation
 KAP gap – Contraception, STD
K – Knowledge
A – Attitude
P – Practice
 MISSION PARIVAR VIKAS – Accelerate use, aware-
ness of family planning services, High TFR district.
 Criteria for sterilization Min 1 child >1 year
 Best contraception for spacing – IUD.
8.5
 MIST ALL IN ONE FOR FMGE
 Best contraception in recently married couple –
OCP
 Best contraception in young adoloscent – Condom.
 Barrier method Advantages – protect against STD
(most imp-condom)
 Efficacy increases by – spermicidal gel (non-
oxynol-9)
IUD
 2nd Generation: Copper containing device, e.g.,
CuT220B, CuT380A, prevent fertilization.
 3rd Generation: Hormone containing (hormone is
always progesterone), e.g., inhibit ovulation, cer-
vical mucus thick, endometrium out of phase.
PSM
 Synthetic progesterone – Levonorgestrel
(MIRENA) (LNG-20). Daily release – 20 mcg.
 Time of insertion best: Post menstrual, Preferred:
Post-partum.
 Shelf life: CuT 380A – 10 yrs, MIRENA (LNG-20) – 7-
10 years.
 C/I: Absolute – H/O ectopic, PID, irregular undiag-
nosed bleeding P/V.
 Complication – Menstrual irregularity (MC), pain
(immediate removal), removal of device by pull-
ing thread.
OCP
 Govt.Recommended-Mala-N.
 POP(minipills)- preffered in lactation
Composition of MALA – N
 (21) Active – Ethinyl Estradiol (0.03 mg/30 mcg)
Levonogestrel (0.15 mg/150 mcg)
 (7) – 60 mg ferrous fumarate (19.5 mg elemental
iron)
MoA : Ovulation inhibition
OCP with cancers: Increased – breast, cervix, hepa-
tocellular
Decreased – Ovary, endometrium
8.6
C/I
 A: Absolute: Family H/O breast Ca, DVT, Cardiovas-
cular disease, Liver disease, Congenital hyperlipi-
demia.
 Side effects DVT, Cancer – Breast, cervical, hepa-
tocellular, CVD, Vaginal candidiasis.
Permanent Methods
 Vasectomy (male) – More cost effective, Addi-
tional 3 months contraception (Barrier).
 Mini laparotomy – Modified pomeroy’s method
(MC), Patient with cardiac and respiratory
disease,just after delivery
 Laparoscopic – Fallop ring (MC)
Essure Implant
 Hysteroscopically inserted
 B/L tubal cornual ends
 MoA: inflammation -fibrosis
 Additional barrier method for 3 months
Emergency Contraceptive
1. IUCD – within 5 days (highest efficacy)
2. LNG tablet (1.5 mg) – within 72 hrs (MC used)
Efficacy
1. Pearl index – 1200 month
2. Life table analysis (best) : monthly analysis
Pearl Index (PI)
Number of accidental pregnancies
PI =  1200
Total months of exposure
DEMOGRAPHY
 DG = Crude birth rate – Crude death rate.
 Total fertility rate (TFR) is average no. of children
a woman in her reproductive life.
 Replacement target level for TFR = 2.1.
 Net Reproduction Rate (NRR) is no. of daughters a
woman would have in her lifetime if she experi-
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
ences prevailing age – specific fertility and mor-
tality rate. Most important demographic vital in-
dicator.
Only demographic fertility indicator which in-
cludes mortality.
 Gross Reproduction Rate (GRR) is no. of daughters
a woman would have in her lifetime if she experi-
ences prevailing age – specific fertility, assuming
no mortality.
 Crude Birth Rate (CBR) is the childbirths per 1000
Mid Year Population.
 Growth Rate (GR) is the change in population over
time and can be quantified as the ‘change in the
number of individuals in a population per unit
time’.
 Sex ratio is defined as no. of females per 1000
males.
 Child sex ratio is defined as number of female chil-
dren 0-6 years age per thousand male children 0-6
years age.
 Literacy Rate: [total no of literate/total popula-
tion >/=7 years] × 100
 Best state for all demographic parameter= Kerala
 Dependency Ratio (DR) = <15 years + >65 years
[non-working population]/15-65 yrs [working
population]
As per 2011 = 54.4
 Adolescent – 10-19 years of age.
 Reproductive age group – 15-49 years.
 Geriatric age (India) – >60 years.
 Census of India comes every 10 years (Decadal).
next due in 2021.
 Census set up and works under Ministry of Home
Affairs.
 SRS – Dual survey, every 6 month
 CRS – Birth and death 21 days, marriage 60 days
 Five stages of demographic cycle:
(i) High Stationary – High CBR and high CDR
(Population stationary)
(ii) Early Expanding – Birth Rate > Death Rate
(Population increasing at fast rate)
(iii) Late Expanding – BR – , DR – (Population
increasing at slow rate) (BR > DR)
(iv) Low Stationary – BR– and DR– (Population
stationary)
(v) Declining Rate, e.g., Japan, UK, Norway
(Population decreasing)
 India is in late expanding stage (IIIrd stage).
 Movement across socioeconomic level is-Social
mobility.
Current Values
 CBR = 19.5; CDR = 6.0
Goal for:
 NRR = 1 (population stabilization)
PSM
 TFR =2.1
Eligible couple register (EGR): Maintained by mul-
tipurpose worker (MPW)-female at subcenter
HEALTHCARE SYSTEM
 Three tier structure:
(a) Primary level – Village level (1000
population).
• Sub center 3000 population in hilly, tribal
and difficult areas.
• 5000 population in other areas.
• 1 sub center/5 villages.
• PHC – 20,000 population in hilly, tribal and
difficult areas.
• 30,000 population in plain areas.
(b) Secondary level – CHC – 80,000 population in
hilly, tribal and difficult areas.
• 1 lakh – 1.2 lakh population in other areas.
(c) Tertiary level – Medical college.
ASHA- 1/1000 (recommendation 2/1000); 10th pass,
23 days training.
1. A part of JSY (Janani Suraksha Yojna) Promotion
of hospital delivery.
8.7
 MIST ALL IN ONE FOR FMGE

2. Home delivery of contraception (Condom, MPW F

OCP, ECP).
3. Active disease surveillance: TB, Leprosy,
Filariasis, Leishmaniasis, Malaria (MPW – M)
4. Home based new born care:
 Home delivery (7) = 1,3,7,14,21,28,42 days
 Hospital vaginal (6) = 3,7,14,21,28,42 days
 Hospital operative (5) = 7,14,21,28,42 days
5. Member of village health sanitation and
nutrition committee (VHSNC)
ASHA:
(i) Part of Gram Panchayat
(ii) Superwise toilet construction
PSM
 MCH care
 Conduction of delivery: Sub center
 Post natal home visit
 Contraception advice
 Test : Hb%, Blood sugar, Urine: A and S
MPW M
1. Treatment of common disease
2. Immunization
3. Chlorination of well water
4. Active malaria surveillance
5. Part of *IMNCI programme
*IMNCI: Integrated management of neonatal and

NOTE: ASHA never conducts delivery childhood illness

6. Mobilization of community to ICDS center of
nutrition day (once/month)
ANGANWADI WORKERS (Heart of ICDS center)
— 1/400-800 population
Beneficiary: 0-6 yrs. (most important), Mothers
(lactating/re-pregnant), Adolescent girls (10-19
yrs.), Reproductive women (15-49 yrs.)
Functions of AWW: Growth monitoring, Immuni-
MEDICAL OFFICER
zation, Mid-day meal, Referral services, Non-for-
mal school education, Health education
Ministry of women and child development
Mid Day Meal Programme
Composition of food: ½ protein; 1/3 calorie
Green: Home based treatment
Yellow: Treatment, follow-up
Pink: Immediate referral
6. Part of IDSP project: Integrated disease surveil-
lance project
7. Sputum collection of suspicious TB cases and trans-
fer to DMC (designated microscopy center)
1. School health check
HA – M/F
2. Randomly visit 10% of houses
 Ophthalmologist – 1/5,00,000
 All specialist – 1/1,00,000

PREVENTION IN OBSTETRICS & PEDIATRICS HEALTHCARE SYSTEM

MMR – No of maternal death/1,00,000 LB
Period included – Antenatal, Natal, Post natal (most dangerous)
Causes of MMR Direct: Hemorrhage (MC), Indirect: Anemia (MC)
Current MMR (India) – 103
Goal (INDIA): to 100 by 2020
SDG 3 (3.1) – <70 (by 2030)
Regular antenatal checkup: Average: 13-14, Minimum : 4, WHO – 8
Post natal visit – Average – 5-6

8.8
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Min : Hospital delivery – 3 : 3, 7, 42 day

Home delivery – 4 : 1, 3, 7, 42 day
U5MR = 0-5 yrs
IMR = 0-1 yrs (28)
NNMR = 0-28 days (0-1 month)
ENNMR = 0-7 days PER 1000 LB
LNNMR = 7-28 days
Post NNMR = 1 month- 1 yr
Peri natal MR = (28 wk pregnant - delivery - 7 days After delivery)
Still birth rate – Number of still born babies/1000 total delivery
Number of still born baby/1000 LB (22)
Breast milk – High lactose, DHA, calcium phosphorus ratio, iron
Low-protein, fat, sodium, calcium, phosphorus, vit K, energy
How long to continue: Exclusive: 6 months, Supplementary: 2 yrs

PSM
MAA: Mother absolute affection
Baby friendly hospital concept (1991): keep baby by side of mother
Breast feed awareness wk: 1st week of Aug

GROWTH MONITORING Weekly – IFA tab

 Most Imp: Wt for age (acute + chronic malnutri-
tion)
Wt for ht (acute malnutrition or wasting)
Ht for age (chronic – stunning)
ICDS GROWTH CHART – Between 1st & 2nd line-
normal
2nd & 3rd line – mild to moderate under nutrition
Below 3rd line – severe under nutritionI
Birth wt: Indicator of chances of survival, devel-
opment of newborn
Average birth wt (INDIA) – 30. kg, LBW – <2.5 kg
(18%)
School Health
Health checkup – dental disease (MC)
Eye checkup: Teacher (1/150)
Vision eye center Every 6 month
Referral if vision < 6/9
Deworming: Albendazole 400 mg
Daily – mid day meal (1/2 protein; 1/3 calorie)
Space – 10 sq feet/child
MINUS type of desk
 PM Surakshit matratva abhiyan (Vande Mataram
Scheme) : 9th of every month free AN checkup by
private doctors:
 PM Matra Vandana Yojna — Rs. 5000 cash incen-
tive in first pregnancy.
 SUMAN: Surakshit Matratva Ashwasan — Zero pre-
ventive obstetric and neonatal mortality
 Kilkari — Mobile app for audio message
 Laqshya: Improvement of labour room service
quality
 Dakshta: Training of health workers for better ob-
stetric and newborn services
 ARMMAN: Advance reduction in mortality in
mother and neonate

8.9
 MIST ALL IN ONE FOR FMGE

JSY (Janani Suraksha Yojna) (incentive)

RURAL URBAN
Patient ASHA Total Patient ASHA Total
LPS 1400 600 2000 1000 400 1400
HPS 700 600 1300 600 400 1000
JSSK (Janani Shishu Suraksha Karyakram) – mother and infant upto 1 year
RBSK – Beneficiaries – 0-18 yrs
0-6 yrs = ICDS centers
6-18 yrs = school health
RKSK – 10-19 yrs
NSSK- Training of health workers for basic newborn resuscitation 2 days)
PSM

OCCUPATIONAL HEALTH  CONTRIBUTION Employee: 0.75%, Employer:

 Uppermost limit of whole body radiation – 5 rad/
year (5 rem/year ICRP).
 Minimum thickness of Lead apron to provide pro-
tection from radiation – 0.5 mm.
 Dust-Pneumoconiosis (Particle size – 0.5-3 mi-
crons).
 Cotton dust – Byssinosis.
 Sugarcane dust – Bagassosis, prevention by 2%
propionic acid, non notifiable ds
 Grain dust – Farmer’s lung.
 Most common pneumoconiosis – Silicosis (as
known as Grinder’s asthma/Stone Mason’s dis-
ease).
 Cancer caused – Bronchogenic ca (most common).
Mesothelioma (most specific).
 Most common occupational cancer – Skin cancer.
 Lead poisoning – inhalation (MC route), inorganic
lead- peripheral symptoms, organic lead - central
symptoms
 Threshold level (at which symptoms appear) – se-
rum lead conc >70 micrograms/dL.
 Chelating agent – d-Penicillamine, EDTA.
 Factory act- space 500 cu feet/worker, max work-
ing hours-48/wk, age<14 yrs not allowed.
3.25%
Government: state, central – 1:7 [1/8 : 7/8]
 Sick leave: 91 days (3 months): 70% of salary
 Extended sick leave: up to 2 years with 80% of sal-
ary
 Maternity leave: (6 months (26 weeks) with 100%
salary
 ABHIYAN INDRA DHANUSH – Change of bedsheet
in ESI hospital everyday as per – VIBGYOR
ENVIRONMENTAL AND HEALTH
Water
Bacteriological Indicator of Water Quality:
 Coliforms (recent fecal contamination)
• Fecal origin – E. coli, Fecal streptococci
• Non-fecal origin – Klebsiella aerogenes.
 Remote fecal contamination – Clostridium
perfringens.
 Most specific indicator of fecal contamination of
water – E. coli.
 Most common form of chlorine added to water –
Chlorine gas.
 Most potent disinfactant in chlorination – Hy-
pochlorous acid.

8.10
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
 Other agent for chlorinational – Hypochlorite ion.
 Period of contact required – 1 hour.
 Residual chlorine
Normal level – 0.5 mg/L.
In an outbreak or post disaster gastrointestinal
disease – 0.7 mg/L.
Swimming pool – 1 mg/L.
 Measurement of chlorine demand – Horrock’s ap-
paratus.
 Measurement of residual chlorine – Chloroscope.
 Test for demonstration of free residual chlorine in
water–OTA test (better) and OT test.
 During cholera epidemic wells need to disinfected
every 24-48 hours.
 Softening of water recommended when hardness
– >3 mEq (>150 mg/L).
 MC air pollutant – CO.
 Most important indicator of air pollution – SO2.
 Biological indicator of air pollution – Lichens
(Green  Yellow  Brown).
 Kata thermometer-Low air velocity (cooling power
of air)  Air temperature, humidity, air move-
ment.
 Globe thermometer: mean radiant temperature
 Sling psychrometer: humidity
 Anemometer – air veleocity
 Wind wane – direction
 Soiling index – indicator of air pollution
 Level of noise we can hear – 20 to 20,000 Hz.
 Max. level of sound tolerance without damage –
85 db.
 Sudden exposure of sound to 160 db  Rupture
of ear drum.
 Repeated exposure of 100 db can cause perma-
nent hearing loss.
 Sand particle size – 0.2-0.3 mm (slow filter), 0.4-
0.7 mm (rapid filter)
 SCHUMUTZDECK layer – slow filter
 Chlorine demand – amount of chlorine to kill
pathogenic organism
 Environmental (avoid breeding) – best method of
mosquito control
 Paris green dust (stomach poison) – Anopheles
larva
 Temephos: culex, aedes, mansonian
 DDT- synthetic,residual, every 6 month
 Malathion- synthetic, residual every 3 month, ul-
tra low volume spray
 Pyrethrum- natural, non-residual, space spray
 Agreement for green house gases – KYOTO PRO-
TOCOL (2005), PARIS AGREEMENT (2015) GLASGOW
AGREEMENT (2021)
 Sanitary land filling (controlled tipping) – BEST
REFUGE DISPOSAL
 Septic tank (unsewered area) – Anaerobic oxida-
tion
 Sewage treatment plants (sewage system) – Aero-
PSM
bic oxidation
VECTORS/ARTHROPOD
BORNE DISEASES
 Anopheles – Malaria, Filaria (not in India).
 Aedes – Yellow fever, Dengue, Chikungunya, Rift
valley fever, Zika virus disease.
 Culex – Filaria (bancroftian filariasis), Japanese
Encephalitis, West Nile fever.
 Mansonoides – Filaria (brugian filriasis),
Chikungunya.
 Sandfly – Kala Azar, Oriental sore, Sandfly fever,
Oraya fever, Pneumonic (KOSO).
 Tse Tse fly – Sleeping sickness.
 Blackfly – Onchocerciasis (river blindness).
 Soft tick – Q fever (in animals), relapsing fever,
KFD (not in India).
 Hard tick – KFD (in India), Tick typhus, RMSF,
babessiosis
 Trombiculid mite – Scrub typhus, Rickettsial pox.
 Louse – Epidemic typhus, Relapsing fever, Trench
fever, Pediculosis.
 Rat Flea – Bubonic plague, Endemic typhus.
 Reduviid bug – Chaga’s disease.
 Itch Mite – Scabies.
 Cyclops – Guinea worm disease.
8.11
 MIST ALL IN ONE FOR FMGE

NUTRITION FOOD ADULTERATION

Disease Toxin Agent Food Stuff

Lathyrism BOAA (Beta- oxylyl aminoalanine) Lathyrus sativus Yellow pulse
Epidemic dropsy Sanguinarine Argemon seeds Mustard seed
Sensitive Test to detect
contamination : paper
chromatography (0.0001%)
Endemic ascites Pyrolizidine (hepatotoxin)- Crotorella seed Millet
ascites (jhunjhuniya seeds)
Aflotoxicosis Aflatoxin (hepatotoxic)- Aspergillus flavus Grains (high, moisture
hepatic cancer during storage)
Ergotism Ergot alkaloid (clavine)- Claviceps fusiformis Flowering plants
PSM

vasospasm-gangrene

Milk  Cereals are mainly deficient in Lysine and to a

 Pasturisation of milk, Minimum temp. during
Pasteurization – 63°C-65°C (> 30 min.) HOLDER
METHOD
 MOST COMMON METHOD – FLASH method
 Pasteurization is ineffective against
Thermoduric bacteria and bacterial spores..
Test applied before pasteurization: Methylene
Blue Test
Test applied after pasteurization:
1. Phosphatase test (most imp) [phosphatase
should be absent]
2. Coliform count = must be nil
3. Standard plate count <30,000/ml
Protein
 NPU in egg – 96 (100).
 Egg is taken as Reference Protein.
 Pulses are mainly deficient in Methionine and to
a lesser extent Cysteine.
lesser extent Threonine.
 Maize is deficient in Lysine and Tryptophan and
has excess of Leucine.
 Maize is a pellegrogenic diet.
 Protein requirement in adult
— 1 gm/kg/day if NPV is 65
— 0.83 gm/kg/day if NPV is 100.
Fatty Acids
 Deficiency of essential fatty acids – Toad skin
(Phrenoderma).
 Most important essential fatty acid – LINOLEIC ACID
 Richest source of linoleic acid – Saflower oil
 Richest source of linolenic acid – Flexseed oil
 Richest source of unsaturated fatty acid – Coconut
oil
 Richest source of MUFA – Ground nut oil
 Richest source of PUFA – Safflower oil, Sunflower
oil, Corn oil, Mustard oil

8.12
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Balanced Diet
Energy -Protein: 10-15%, Fat: 10-30% (ICMR: 10-20%), Carbohydrates: 60-70%

Caloric requirement [Kcal/day) Male Female

Sedentary 2100 1700
Moderate 2700 2100
Heavy 3500 2700

Extra Caloric Requirements

1. Preg – +350 (In 1st trim: +150)
2. Lactation 0-6 month: +600, >6 month: +520
Summary of RDA for Indians — 2020

PSM
Vitamin
 Strict vegetarian diet can lead to deficiency of – Vit. B12.
 Demyelinating neurological lesion in the spinal cord are associated with Vit. B12 def.
 Most potent antioxidant – Vit. E.
 All vitamins are present in breast milk required by newborn until mother is deficient, except Vit. K.
 B1 deficiency-Wernicke'sencephalopathy, beri beri (Polished rice eaters)
 B3 niacin deficiency-pellagra (maize eaters) – diarrhoea, dementia, dermatitis.
 B9 folic acid – congenital malformations (NTD), megaloblastic anaemia

8.13
 MIST ALL IN ONE FOR FMGE

 Vit. C – scurvy Prophylaxis

 Vit. D – ricket (children), osteomalacia (adult)
 Active form of Vit. D – 1,25 di-hydroxy vit. D Time Iron Folic Acid Frequency
(Calcitriol).
6 months - 5 yrs 20 mg 100 mcg Biweekly
 Vitamin deficiency with INH therapy–Pyridoxine.
6-10 yrs 45 mg 400 mcg
 Vitamin which function like statin–Niacin (in-
crease HDL). 10-19 yrs 60 mg 500 mcg Weekly

Vitamin A 15-49 yrs 60 mg 500 mcg

 Richest source – Halibut liver oil. Pregnancy 60 mg 500 mcg Daily
 Therapeutic dose – 3 doses---Day 1, Day 2, 2-4 Lactation 60 mg 500 mcg
weeks after 2nd dose.
 Vitamin A Deficiency causes – Xerophthalmia
Iodine
(a) 1st symptom – Night blindness
 In iodized salt:
(reversible).
PSM

— Production level  30 ppm.

(b) 1st sign – Conjunctival xerosis (reversible).
 1 LAC IU = 55mg of Retinol Pamitate
 Most important clinical sign for screening: BITOT
spot .
 Most sensitive screening test: Serum retinol level
 Major public health problem-Prevalence of: NB –
>1%, Bitot Spot – >0.5%, Serum retinol (<10 mcg/
ml) – >5%
 Animal source: Halibut oil (richest), Cod liver oil
 Vegetable source: Carrot, papaya
Iron
 Source – Pistachio (Pista) (14 mg of iron/100 gm of
pista), pumpkin seed.
 WHO cutoff off for iron deficiency anemia:
Male: <13 gram/dL
Female:
1. Non-pregnant <12 gram/dL
2. Pregnant <11 gram/dL
 In pregnant female in India (according to ICMR)
Iron deficiency anemia < 10 gm/dL.
 Most sensitive marker for IDA – Serum Ferritin.
 RDA of folic acid in Pregnancy 500 g/day.
 Continue iron tablet for minimum 3 months after
achieving normal Hb%.
— Consumer level  15 ppm.
 Best indicator of:
1. Iodine deficiency in community  Neonatal
hypothyroidism
2. Impact of control procgramme  Urinary
iodine level excretion.
Fluoride
 Optimum level in drinking water – 0.5-0.8 mg/L
 Maximum permissible upper limit – 1.5 mg/L
 Deficiency causes – Dental caries (<0.5 mg/L).
 Excess causes – Fluorosis (>1.5 mg/L).
 Deflouridation of water
 Nalgonda Technique – Lime, Alum, Bleaching pow-
der.
NATIONAL NUTRITION MISSION
(Poshan Abhiyan)
It make INDIA free from mal nutrition by 2022.
 Grain which is richest in Ca concentration: Ragi.
ACRODERMTITIS ENTEROPATHICA:
Defective Zn absorption from intestine
 Selenium: Deficiency: Keshan’s cardiomyopathy

8.14
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
DISEASES
TB
 History of cough for 2 or >2 weeks
 Two sputum samples:
(a) Spot sample
(b) Early morning sample.
 ARI  1% ARI = 50 sputum positive per 1 lakh popu-
lation.
 For a positive sputum smear number of bacili
should be more than 10,000 per ml of sputum.
 IT based software to track patients – NIKSHAY.
 New drug – reduces sputum conversion time
BEDAQUILINE added in RNTCP
Indicated in MDR, XDR cases
 End TB strategy (2016-2035)
Goal – End global tuberculosis epidemic
Global plan target 90:90:90
 DMC (designated microscopy centre)
1 DMC/1 lakh population (50,000 in hilly, tribal
area)
1TU/1.5-2.5 lac (1,00,000 in hilly, tribal area)
 National institute of tuberculosis – Bengaluru.
 National tuberculosis research institute – Chennai.
 CAT I given to:
(i) New case (pulmonary or extra pulmonary).
(ii) 2(HRZE) + 4(HRE).
(iii) Follow up – 2, 4, 6, months
 CAT II given to: DST and decide accordingly.
Malaria
 Caused by protozoal parasite (Plasmodium).
 Vector – Anopheles (breeds in water).
 Thick film – To see presence of malarial parasite
(sensitive).
 Thin film – To see which species of malarial para-
site is involved (specific).
 API (Annual parasite incidence) is number of new
confirmed cases of malaria/1000 population.
 Infant parasite rate – recent malaria transmission
Rx
P. vivax
 Primaquine × 14 days (also as radical Rx) (0.25 mg/
kg × 14 days)
 Chloroquine full course: 25 mg/kg in 3 divided
doses
 P. Falciparum
• In North East States – ACT–AL therapy
(Artemether, lumifantrin)
• In other states – ACT–SP therapy (Artesunate,
sulfadoxine pyremethamine)
• In pregnancy:
Ist trimester– quinine
II/III trimester– ACT-AL/ACT–SP
PSM
 Tab primaquin 0.75 mg/kg single dose (contrain-
dicated in pregnancy).
Kala Azar (Visceral Leishmaniasis)
(i) Vector – Sandfly.
(ii) Lab Dx: Anemia, reversal of albumin:globulin ra-
tio, aldehyde test.
(iii) Confirmatory test: LD bodies.
(iv) Newer rapid Dx test: RK39 dipstick test.
(v) DOC – Lyposomal amphotericin-B (LAMB)
Dengue (Breakbone Fever)
(i) Group B Arbovirus as known as Flavivirus.
(ii) Vector–Aedes Aegypti (breeds in artificial collec-
tion of water).
(iii) Dx: Flu-like symptoms.
(iv) Confirmatory Dx: NS-1 Antigen, by Elisa PCR.
(v) Rx–Coservative.
(vi) Prevention – Avoid artificial water collection.
(vii) CYD–TDV – Vaccine under trial for dengue.
Chikungunya
(i) Agent – Group A Arbovirus.
(ii) Vector – Aedes Aegypti (most common).
(iii) Closely resembles dengue.
8.15
 MIST ALL IN ONE FOR FMGE

Filariasis HIV
(i) Agent:  Two serotypes:
(a) Wuchereria bancrofti • MC in World–HIV-I
(b) Brugia malayi • Some parts of Africa–HIV-II
(ii) Vector – Culex quinquefaciatus (earlier known as
Opportunistic Infections
culex fatigans).
>500: none
(iii) Confirmatory Dx: Demonstration of microfilaria in
peripheral blood (thick smear). 500-200: TB, candidiasis, KAPOSI Sarcoma
200-100: P Jeroveci pneumonia, Cryptococcus men-
(iv) Best test – Membrane filteration test
ingitis, Coccidiomycosis
(iv) Triple drug therapy:
100-50: toxoplasmosis, Cryptosporidiosis
(a) Diethyl carbamazene.
<50: CMV retinitis, MAC
(b) Ivermectin. MOST COMMON OPPORTUNISTIC INFECTION:
(c) Albendazole (400 mg) single dose.  India: TB, Candidiasis
PSM

 World: P Jeroveci Pneumonia

Japanese Encephalitis
ROUTE OF TRANSMISSION
(i) Agent – Group B Arbovirus.
 Sexual – MC (least dangerous), 1:10,000
(ii) Vector
 Parenteral: (most dangerous) Least common
(a) Culex tritaeniorhynchus (MC in India). — Blood transmission = 95%
(b) Culex vishnuii. — Needle prick = 1:300
(iii) Pigs act as amplifier hosts. — Needle sharing = 1:150
(iv) Man-is dead end.  Mother to child: 30%
(v) Commonly used is live vaccine.  Breast feeding: 12-16%
(vi) Cattle, sheep are mosquito attractant.
Schedule of Rabies Vaccine
Polio  Post exposure: Non-vaccinated 0, 3, 7, 14, 28 (I/
(a) Agent – Enterovirus – P1, P2 (eradicated), P3 (eradi- M), 2-2-2-0-2 (I/D).
cated)  Pre exposure: 0, 7, 28 days.
(b) Mode – Feco-oral.  Post exposure in vaccinated one  0, 3 (I/M), 4
site (I/D).
(c) Most virulent strain – P1.
 Human Ig 20 IU/kg, animal – 40 IU/kg
(d) Dx – Stool examination.
 No suture for 24-48 hours.
(e) Residual paralysis assessed after 60 days of attack.
 Rabies can be confirmed early by antigen detec-
(f) Switch day: tion by skin biopsy immunofluorescence.
— 25th April 2016  Negri body (after death): Hippocampus, cerebellum
— Switch from trivalent OPV to bivalent OPV (P2
removed from OPV) COVID 19
— Now OPV is bivalent (P1, P3)  Pandemic stage
(g) AFP surveillance done in children <15 years.  Iceberg Phenomenon = present

8.16
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

 Short term fluctuations – started as point source,  Most satisfactory method of waste disposal, when
now propogative sufficient land area is available-Sanitary land fall-
 IP = 2-14 days ing controlled tipping.
 Quarantine period = 14 days  After how many days of stopping of corticoster-
oids a live vaccine can be given –2 weeks
 SAR = 30-40%
 A patient is undergoing abortion at 7 weeks, IUCD
 CFR = 2-10%
can be put-Immediately after procedure
 Started as SARS COV-2 virus
 Criteria of CD4 count for start of ART treatment –
Route of transmission: No role of CD4 count
 Droplets (MOST COMMON)  Suraksha clinic are for – STI, RTI
 Contact  Least effective contraceptive – Spermicidal gel
 Fomite  Convalescence period of cholera – 2-3 weeks
POC - 1-3 days BEFORE Symptoms TO – 1-3 weeks  All diseases are included under health care sys-
after symptoms tems except-Surgically associated disease
Types of Vaccine:  Chemical used for vector of kala-azar – DDT

 Whole virus – killed – COVAXIN
 Protein Subunit – NOVAVAX
 Viral Vector – Adeno Virus – COVISHIELD, SPUT-
NIK V
 Nucleic Acid – mRNA– MODERNA/BION TECH
Contraindications of Vaccines
1. Hypersensitivity to previous dose during trial
Side effects:
1. Minor side effects at site of injection
2. S/S of viral injection
3. Rare – demyelinating disorders
Disinfectant – 1% sodium hypochlorite
Social distance – 6 feet
MISCELLANEOUS POINTS
 Waist hip ratio for obesity->1.0 in Males; >0.85 in
Females
 First step after disaster – Rescue-first aid
 Risk reduction phase before impact of disaster-
Mitigation-preparedness
 Measle vaccine can be given within how many days
of exposure-3 days.
 In villages sputum for AFB collected and fixed by-
Multi Purpose Workers.
PSM
 Weight gain of female in pregnancy – 9-11 kg
 WHO index for obesity – Quetlet index
 Best indicator of health status of community-IMR
 Innertization for-Prevent mixing of waste with
underground waste
 Quarantine is-Separation of exposed person till
maximum incubation period of ds
 Sodium in ORS as per WHO formula – 75 mmol /L
 Protein in cow milk compared to breast milk-3
times more
 Protein quality is assessed by – Net protein
utilisation
 Sustainable developmental goals given by – United
nations
 UNICEF is concerned with Child health.
 NITI Ayog is National institution for Transforming
India
 Kala-azar can be seen up to maximum altitude of-
600 meter
 ARI (annual rate of infection) is – Tuberculin nega-
tive to tuberculin positive cases
 N-95 respirator is protective for – Aerosol
 A person is diagnosed with HIV and TB simulta-
neously management protocol-First ATT, then af-
ter 2 weeks ART

8.17
 MIST ALL IN ONE FOR FMGE
 Contraceptive contraindicated in DVT – OCP
 In meningococcal endemic area we are giving vac-
cines and chemoprophylaxis to healthy popula-
tions. This is which level of prevention – Primary
specific
 On Republic day, in a health camp, people were
screened for HT & DM. This is which level second-
ary
 Kartar Singh committee gave concept of male/fe-
male multipurpose worker.
 1 DALY is 1 year lost due to disability or premature
death.
 Cervical cancers can be prevented by vaccination
– Cervarix (Bivalent) – HPV 16, 18 (Dose-0, 1, 6
months) Gardasil (Tetravalent)-HPV 6, 11, 16, 18
PSM
(Dose-0, 2, 6 months)
 Expired vaccines are discarded by incineration in
yellow bag.
 Framingham heart study is a prospective cohort
study. It was longest study done to know cardio-
vascular diseases.
 Berksonian bias is a admission rate bias seen in
hospital based studies because of different ad-
mission with different diseases.
 Sullivan index in life free of disability.
 Kuppuswamy scale for socio economic status in
urban area:
26-29 Upper (1)
16-25 Upper middle (II)
11-15 Lower middle (II)
5-10 Upper lower (IV)
3-4 Lower (V)
 Colour kits in suraksha clinic
Kit 1-grey-urethral, anorectal discharge
Kit 2-green-vaginal discharge
Kit 3-white-genital ulcers (non-herpetic)
Kit 4-blue-genital ulcer (non-herpetic allergic to
penicillin)
Kit 5-red-genital ulcer (herpetic)
Kit 6-yellow-lower abdominal pain
Kit 7-black-scrotal swelling/buboos
8.18
 Disease included in NVBDCP-Malaria, filaria, den-
gue, chickenguinya, kala-azar, JE. (not yellow fe-
ver)
 Causative agent of rare disease can be best deter-
mined by case control study.
 Cohort study gives an idea about natural course of
disease.
 Measle vaccine: Live attenuated vaccine, Dose 0.5
ml s/cat right deltoid, Strain-edmostron jagreb
strain, Age at 9 month of age (in epidemic can be
given at 6-9 month of age), It lead to toxic shock
syndrome, Measle vaccine can be given within 3
days of exposure
 Disaster management: Response and rehabilita-
tion (Post-disaster), mitigation (Pre-disaster), Pre-
paredness (Pre-disaster)
 Positive tuberculin test seen after 8-12 week of
BCG vaccination
Incubation period of:
— Cholera – 1-3 day
— Influenza – 18-72 hour
— Diphtheria – 2-6 days.
 Transovarian transmission seen in: Aedes mos-
quito (dengue, chikungunya) and tick, mite.
 Road traffic accidents are common cause of death
in young adolescent.
 Most common subtype of HIV virus HIV1.
 Drugs used in treatment of scabies: 5% permethrin,
Ivermectin, Benzyl benzoate (pregnancy).
 Common cause of blindness in India: 1st-Cataract
(65-70%), 2nd-Refractive errors (18-20%).
 Cut off level of blindness in India and WHO is < 3/
60 in better eye with best possible correction.
 National Programme of Control of Blindness
(NPCB) changed to National Programme for Pre-
vention and Control of Blindness and Visual Im-
pairment.
 Chicken pox is caused by human herpes virus-3.
 Last case of polio was reported from Hawrah (West
Bengal) on Jan 13, 2011.
 Obesity is if: BMI> 30 (India >25), BMI = Weight in
kg/(Height in mt)2
 PREVENTIVE AND SOCIAL MEDICINE (PSM)
 Ujjawala scheme is used for prevention of child
trafficking.
 TB bacilli takes AFB stain due to presence of my-
colic acid.
 Asha kit contain-common medicine, ORS, OCP,
condoms, emergency pills, (not IUCD).
 National programme for control of diabetes, CVD
and stroke are integrated with cancer control.
Programme (NPCDCS).
 Block leprosy awareness programme is carried out
in September to November.
 Age pyramid of India-Broad at base, narrowat
apex.
 Amendment in MTP act in 2002 to include men-
tally ill in place of lunatic.
 Measle contribute to 3% of U5MR in India.
 U5MR child mortality rate = No. of death 0-5 year/
1000 live birth
 Child death rate= No. of death of children in age
group 1-4 year/1000 population children of 1-4 year
 Pediatric iron folic acid tab. are 1/5 of adult dose
 Chromium is associated with glucose metabolism
 Cobalt is associated with iodine metabolism.
 Zn dose in adult-5-10 mg/day.
 Anti oxidants are: Vit. A (beta carotene), Vit. C,
Vit. E (Most Important), Selenium, Lycopene
 Floor space per person:
(a) 500 Cu feet (50-100 sq. feet/person)
 Strength of sewage by Biochemical Oxygen De-
mand (BOD)
 Sharp waste is disposed off in white translucent
bag.
 Disposal of black bag is land filling.
 Disposal of placenta in yellow bag for incinera-
tion.
 Most common heavy metal poisoning in world-
Lead.
 Union Labour Minister is Chairman of ESI.
 Millennium Developmental Goals (MDG) were
adopted by United Nations in 2000.
 SDG (Sustainable Developmental Goal) from 2016-
2030, successor of MDG, 17 goals, goal no. 3 is di-
rectly health related.
 Zonal office of central drugs standard control or-
ganization is at Chennai.
 WHO day-7th April
 WHO notifiable diseases are cholera, plague, yel-
low fever
 Bioterrorism group ‘A’ agent-Botulism, Anthrax,
Tularemia, Small pox, Viral haemorrhagic fever
 Bioterrorism group ‘B’ agent-Q fever – Brucello-
sis, Epidemic typhus.
 SAR- No. of exposed person developing the dis-
ease within range of incubation period *100/Total
no. of exposed/susceptible contacts
PSM
 Osmolarity of low osmolar ORS-245 mmol
 Amount of ORS in mild diarrhoea-75 ml/kg in 4
hrs.
 IV fluid in severe diarrhoea-100 ml/kg in 3-6 hrs.
 Addition of zinc in diarrhoea: <6 months-10 mg/
day for 14 days, >6 months-20 mg/day for 14 days.
 Prevention of neonatal tetanus by
(a) Best method-tetanus toxoid to mother during
pregnancy
(b) Delivery by 5 clean methods.
(c) Tetanus immunoglobulin to newborn after
delivery (if mother unimmunized).
 Vaccine C/I in pregnancy Rubella and all live vac-
cine
 Indicator in HOROCK’S apparatus—Starch iodine
 Immunization NOT done under SCHOOL HEALTH
PROGRAMME
 Asha Never Conduct Delivery.
Delivery conducted by MPW (F) at sub-centre and
by TBA, MPW (F) at home.
 In triage of disaster
RED-surgery within 6 hours
YELLOW-surgery within 6-24 hours
Green-ambulatory patient
Black-dead or morbid patient
8.19
 MIST ALL IN ONE FOR FMGE
 First step in biomedical waste disposal-Segrega-
tion of waste in different color code
 Vaccination in adolescent-Influenza, chickenpox,
rubella, cervical cancer vaccine, Hep. B
 Trend of an event is best represented by Line chart
 Use of SHAKIR’S tape is an example of— Appropri-
ate technology
 Corpulence index of obesity = Actual weight/De-
sire weight
If more than 1.2 (>1.2) abnormal
 According to vision 2020, population coverage
Primary vision centre-1/50,000
Service (secondary) centre-1/5 lac
Tertiary centre-1/5 million
PSM
Centre of excellence-1/50 million
 Preventable cause of blindness-Vitamin A defi-
ciency, Trachoma.
 Biomedical waste mixing with cement
(Inertization)
 Intramuscular injection of 1 ml of-lodized oil pro-
vide protection for 4 years, Oral 2 ml protect for 2
years.
 Amino acid present in breast milk required for
brain development-Cystein and taurine.
 Def of zinc leads to Acrodermatitis enteropathica.
 Impairment-Any loss or abnormality of psychologi-
cal, physiological or anatomical structure of body
part
 Urban malaria scheme:
A. Area included: Population >50,000, Slide posi-
tivity rate> 5%
B. Control of urban malaria by: Prevent mosquito
breeding. Larvicidal fish, Chemical larcividal agent
 Disaster management is controlled by Ministry of
Home Affairs.
 First step after disaster impact-Rescue, first aid.
 Drug of choice for chemoprophylaxis of meningo-
coccal meningitis in a pregnant body-Ceftriaxone.
8.20
 Biomedical waste:
1. Yellow category: Human anatomical waste,
Animal waste, Soiled waste Chemical waste,
Microbial waste, Medicine, Discarded bed,
linen.
2. Red category: Contaminated plastic recyclable
waste.
3. White category: Infectious sharp waste.
4. Blue category: Glass item, Metallic body
implants.
 In school eye checked by school teacher and high
risk cases checked at primary vision centre by para-
medical ophthalmic assistants.
 Most satisfactory method of waste disposed when
sufficient land area available-Sanitary land filling
(controlled tipping).
 A live vaccine can be given after stoppage of corti-
costeroid for minimum 2 weeks.
 IUCD can be inserted just after delivery and abor-
tion.
 Under NACP, ART treatment given to every patient
of HIV positive irrespective of CD4 count.
 Suraksha clinics are for sexually transmitted dis-
eases.
 Pradhan Mantri Ujjwala Yojna for free LPG connec-
tion to BPL family.
 Most important demographic indicator is NRR; NRR
includes mortality also.
 Lepromine test is done to know type of leprosy
(not for diagnosis of leprosy disease).
 Confirmation of rabies in live pet dog by skin bi-
opsy.
 India New Born Action Plan (INAP) – Single digit
Neonatal mortality and still birth rate by 2030.
 KAYAKALP-Award to public health facilities with
high level of cleanliness hygiene and infection
control.
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

RECENT FMGE/MCI QUESTIONS—PREVENTIVE AND SOCIAL MEDICINE (PSM)

(c) Etinyl estradiol (d) EE + LNG
JUNE 2022
Q. 8. Blood bag is disposed off in which category
Q. 1. Relative risk is calculated by which study (a) Yellow (b) Red
(a) Case control (b) Cohort (c) Blue (d) Black
(c) Cross sectional (d) Ecological
Q. 9. 30 year male member of family is presenting
Q. 2. As per NACO, If you are doing counselling and with C/O diarrhoea, knee oedema, ascites. On
screening for TB in a HIV patient in ICTC clinic, investigating it came to know that in grocery
level of prevention is item main consumption is of mustard oil. What
(a) Primary (b) Secondary is probable diagnosis
(c) Primary, secondary (a) Epidemic dropsy (b) Endemic ascites
(d) Tertiary (c) Aflotoxicosis (d) Lathyrism
Q. 3. Vaccine given to baby at birth Q. 10. As per WHO definition, maternal deaths are
(a) BCG, IPV, Hep B (b) BCG, OPV, Hep B (a) Antenatal- 6 weeks post partum

PSM
(c) BCG, OPV, MR (d) DPT, MR, HIB (b) Antenatal- 12 weeks post partum
Q. 4. At what time you can give first dose of Hep B (c) Delivery- 2 weeks post partum
vaccine to a neonate (d) During pregnancy
(a) At birth (b) 6 week Q. 11. People eating Khesari dal for last 1 year in an
(c) 2 month (d) 6 month area. To avoid epidemic of lathyrism all are
Q. 5. In a measle epidemic, measle vaccine is given done except
to a baby at 7 month of age. Next dose of (a) Toxin removal (b) Crop ban
measle vaccine is given at (c) DEC (d) Vit. C
(a) Vaccine at 9 month Q. 12. Trends of events of diarrhoea epidemic hap-
(b) Booster at 9 month pening currently in an area is represented by
(c) Booster at 1½ year (a) Line chart (b) Bar chart
(d) Booster At preschool age (c) Pie chart (d) Spot map
Q. 6. All health care providers are present in village Q. 13. In an European country continuously deaths
except are happening but no new birth is reported,
(a) TBA (b) ASHA so DR > BR. Country is in which phase
(c) AWW (d) ANM (a) High stationary (b) Low stationary
Q. 7. Content present in contraceptive given in im- (c) Decline (d) Late expansion
age Q. 14. Comparison of quality of life between two
countries is done by
(a) HDI (b) HPI
(c) DALY (d) QALY
Q. 15. A person lost both of his hands in a machine,
for that he lost his job and unable to write and
do his machine work. What is type of impair-
ment?
(a) Disability (b) Loss of both hands
(c) Unemployed
(a) LNG (b) Nonoxynol 9 (d) Unable to write and do machine work,

8.21
 MIST ALL IN ONE FOR FMGE

Q. 16. A P1L1 lady reported to clinic 6 weeks post-
partum, who does not want baby for next 3
years, best contraceptive is
(a) OCP
(b) Condom
(c) CuT
(d) Progesterone only pills
Q. 17. Correct statement about population pyramid
(a) Base- fertility
(b) Height increases- low life expectancy
(c) Middle part- M>F
(d) Broad base- more working population
Q. 18. Identify image
PSM
Q. 21. 30 trackers have gone for a camp for 1 week.
Best method of disposal of waste generated
is
(a) Dumping
(b) Burial
(c) Composting
(d) Controlled tipping
Q. 22. On WHO day 4-8 persons sit in front of large
group of audience to talk about topic. Director
of hospital opens the meeting, welcome au-
dience and introduces speakers. He introduces
the topic briefly and invites the speakers to
present their point of view. There is no spe-
cific agenda, no order of speaking, no set
speech. In the end audience is invited to take
part. Identify method

(a) Panel discussion (b) Symposium

(c) Workshop (d) group discussion
Q. 23. A group conducted a mass gathering on hand
wash awareness. Correct sequence of events
are
(a) awareness – interest – adoption –
evaluation
(b) awareness – interest – evaluation –
adoption
(c) evaluation – adoption- awareness –
interest
(d) adoption- awareness – interest –
(a) Population cycle
evaluation
(b) Demographic transition
(c) Demographic model Q. 24. All test are done before blood transfusion ex-
(d) cept
(a) Hep. A (b) Hep. B
Q. 19. Which of following are true for PHC except
(c) HIV 1, 2 (d) Hep. C
(a) Population –30,000
(b) Delivery Q. 25. 2 year baby having height for age status < –
(c) 1st referral 2SD. Baby is having
(d) First contact between doctor and (a) Wasting (b) Stunting
community (c) Mal absorption (d) ____________
Q. 20. All are present at CHC except Q. 26. A baby is coming for regular check up in OPD.
(a) Surgeon His growth chart shows that weight of baby is
(b) 1st referral between 85th-95th percentile. Child status is
(c) Treatment of congenital or genetic (a) Obesity
disease (b) Overweight
(d) Blood storage (c) SAM
(d) BMI needed for interpretation

8.22
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Q. 27. Identify vitamin deficiency in given image Q. 33. If old people die, what will its effect on de-
pendency ratio
(a) Increase (b) Decrease
(c) Same (d) No comment
Q. 34. Patient presented with H/O fever and gastric
upset for 3 days. There is suspicion of typhoid
fever. Which is best test for diagnosis at this
point
(a) WIDAL test (b) Blood culture
(c) Urine culture (d) Stool culture
Q. 35. A person who consumed fast food few hours
(a) Vit. A (b) Thiamine
ago presented with symptoms of food poison-
(c) Niacin (d) Vit. B12
ing. Which organism is responsible?
Q. 28. If wide range of values are present in a com- (a) B ceres (b) E. coli
munity, then central tendency is measured by (c) Clostridium (d) Staphylococcus
(a) Mean (b) Median

PSM
Q. 36. A couple told doctor that they are prone for an
(c) Mode (d) Mean deviation
anencephalic baby and they want to prevent
Q. 29. 2 year baby is reported to sub center with C/O it. Best advise by doctor
fever and cough for 2 days. His respiratory rate (a) Folic acid supplementation
is 38/min and presence of chest indrawing. (b) Vitamin A supplementation
Next step of management is (c) Iron supplementation
(a) Home treatment (d) Injection TT
(b) Pneumonia – clinical treatment Q. 37. Best radically new approach for health educa-
(c) Severe pneumonia – referral tion is
(d) Severe pneumonia – antibiotic and (a) Service approach
referral (b) Health education
Q. 30. Drug used for termination of 8 weeks preg- (c) Manage prevention
nancy (d) Primary health care approach
(a) Mifepristone 200 mg – misoprost Q. 38. A patient presented with dry appearing trian-
(b) Misoprost 200 mcg – mifepristone gular foamy patches on conjunctiva. This con-
(c) Only misoprost dition is:
(d) Only mifepristone (a) Thiamine deficiency
Q. 31. More than 1 doctor signature is needed for (b) Niacin Deficiency
doing MTP (according to latest MTP regula- (c) Vitamin C deficiency
tion 2021) (d) Conjunctival xerosis
(a) Up to 12 week (b) Up to 20 week Q. 39. Optimal time of discharge from hospital after
(c) 12-24 week (d) 20-24 week normal vaginal delivery
(e) 20-26 week (a) 2 days (b) 7 days
Q. 32. Describe relation between disease and social (c) 2 week (d) 4 week
condition Q. 40. For diagnosis of suspected TB, sputum assess-
(a) Social pathology ment is which level of prevention
(b) Social science (a) Primordial (b) Primary
(c) Social structure (c) Secondary (d) Tertiary

8.23
 MIST ALL IN ONE FOR FMGE

Q. 41. A patient presented with H/O chronic alcohol (a) Irregular Vaginal bleed
intake and neurological deficit. It is due to (b) H/O ectopic pregnancy
deficiency of (c) H/O PID (d) Anaemia
(a) B1 (b) B2 Q. 8. Minimal number of antenatal visits as per WHO
(c) B3 (d) B6 (a) 2 (b) 3
(c) 4 (d) 5
DECEMBER 2021 Q. 9. A 25 year old lady coming with complains of
vaginal discharge and lower abdominal pain ,
Q. 1. Number of maternal deaths per 1,00,000 live
colour kit used is
birth is
(a) Red (kit 5) (b) Yellow (kit 6)
(a) Maternal mortality rate
(c) Blue (kit 4) (d) White (kit 3)
(b) Maternal mortality ratio
(c) IMR Q. 10. A worker posted in same village 25-45 yrs, 8th
(d) U5 Mortality rate pass, married/divorce, with good communi-
cation skill. Identify worker
Q. 2. In a population of 10,000; sex ratio is >1000.
(a) ANM
Correct statement is
(b) Accredited social health worker
PSM

(a) Male <500 (b) Male <5000

(c) Anganwadi worker
(c) Female <500 (d) Female <5000
(d) Trained dai
Q. 3. Couple has given birth to their first child. Fam-
Q. 11. Pregnancy kit for follow up at home
ily is entering in which phase
(a) NIKSHAY, TB surveillance
(a) Formation (b) Extension
(b) NISHCHAY
(c) Contraction (d) Dissolution
(c) Nayi pahal (d) Free day
Q. 4. In 14th century there was a disease called
Q. 12. Burden of disease is
plague, for how many days ship and all pas-
(a) DALY (b) SULLIVAN INDEX
sengers were kept under quarantine
(c) HALE (d) QALY
(a) 7 days (b) 14 days
(c) 40 days (d) 60 days Q. 13. If you want to teach how to prepare ORS in
urban slum area, then which method will be
Q. 5. Population covered under +/– 1 SD of mean is
used?
(a) 34% (b) 68.3%
(a) Role play (b) Demonstration
(c) 95% (d) 99%
(c) Group discussion (d) Flash card
Q. 6. After doing dressing of a patient of road side
Q. 14. If you want to explain nutritive value of vari-
accident, cotton swab will be disposed in
ous food items to family members with help
which colour bag
of pictorial chart, it is
(a) Yellow (b) Red
(a) Histogram (b) Bar chart
(c) White (d) Black
(c) Pie chart (d) Pictogram
Q. 7. Absolute contra indication of devise given in
Q. 15. Dose of Vitamin A to < 8 KG BABY of > 12 month
image
age
(a) 50,000 IU (b) 1,00,000 IU
(c) 1,50,000 IU (d) 2,00,000 IU
Q. 16. Most common cause of childhood blindness
(a) Vitamin A deficiency
(b) Refractory error
(c) Glaucoma (d) Cataract

8.24
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Q. 17. A patient returned to Delhi from Assam, on 1st (a) Matching (b) Blinding
day had fever, 2nd day dizziness, 3rd day sei- (c) Randomization (d) Stratification
zures, confirmed as plasmodium falciparum Q. 26. You are medical officer of ESI, treating insured
on blood smear, treatment of choice patients in rural area is under
(a) Chloroquine (b) Quinine
(a) Direct medical benefit
(c) Mefloquine (d) I/V artesunate
(b) Indirect medical benefit
Q. 18. A 40 year patient working in stone cutting fac- (c) Sickness benefit
tory presenting with dry cough, weight loss, (d) Extended sickness benefit
with possibility of TB, is result of which pneu-
moconiosis Q. 27. Lung malignancy is associated with
(a) Silicosis (b) Asbestosis (a) Silicosis (b) Asbestosis
(c) Byssinosis (d) Bagassosis (c) Baggasosis (d) Byssinosis
Q. 19. If you want to check for incidence of deafness Q. 28. Absolute contraindication of breast feed
caused by noise effect in office workers and (a) Galactosemia
factory workers after 1 year, study conducted (b) Mother with CMV Infection
will be (c) Mother with Herpes but not at side of

PSM
(a) Case control (b) Cohort feed
(c) Ecological (d) Cross sectional (d) Mother with Hep. C infection
Q. 20. A maize eater with diarrhoea, dermatitis, Q. 29. A tubercular patient resistant to isoniazid,
memory loss, disease is rifampicin, kanamycin, quinolones. He will be
(a) Pellagra categorized as
(b) Korsakoff psychosis (a) Multi drug resistant
(c) Glossitis (d) Chelosis (b) Mono drug resistant
Q. 21. Maximum number of candidates in group dis- (c) Extensive drug resistant
cussion to avoid over crowding is (d) Extended drug resistant
(a) 3-4 (b) 4-8 Q. 30. Information specially of a biased or mislead-
(c) 6-12 (d) 12-15
ing nature used to promote a political cause
Q. 22. Land area required to fill trench of 2 meter or point of view is
depth with compacted refuse for population (a) Propaganda (b) Health promotion
of 10,000 is
(c) Health education (d) Advocacy
(a) 1 acre (b) 2 acre
(c) 3 acre (d) 4 acre Q. 31. A 2 year old child reported to PHC with com-
plains of fever and breathlessness. On exami-
Q. 23. Re-infection in presence of antibody in blood
nation respiratory rate is 36/min and presence
will flare up symptoms in
of chest indrawing. Management protocol is
(a) Measle (b) Rabies
(c) Dengue (d) Polio (a) Hone management
(b) Antibiotic, follow up
Q. 24. A child presenting with fever, swelling in neck
(c) Immediate referral
and testis, 2 more children in village were hav-
(d) Antibiotic and immediate referral
ing same symptoms, diagnosis is
(a) Measle (b) diphtheria Q. 32. All are true for vasectomy except
(c) Mumps (d) TB involving nodes (a) Immediate sterilization
Q. 25. If you want to reduce selection error in a clini- (b) Permanent method
cal trial conducted among two groups, best (c) Contraceptive result after 3 month
method will be (d) Non scalpel method

8.25
 MIST ALL IN ONE FOR FMGE

(c) GRR (d) NRR

JUNE 2021
Q. 11. A health worker has 2 open vials, one each of
Q. 1. Complication seen with mumps DPT and MR vaccine. What is done next
(a) Pneumonia (a) Discard both (b) Use both
(b) Epididymo-orchitis (c) Discard DPT, USE MR
(c) Otitis media (d) Discard MR, USE DPT
(d) Diarrhoea
Q. 12. Which vaccine follows open vial policy
Q. 2. A 5 year old child presented to clinic with c/o (a) BCG (b) PENTAVALENT
fever, swelling in neck, giving bull neck ap- (c) JE (d) MMR
pearance. Diagnosis is
Q. 13. Which vaccine has seroconversion time less
(a) Measle (b) Diphtheria
than incubation period for that disease
(c) Pertussis (d) Influenza
(a) Flu (b) Measle
Q. 3. Survey of 4 cities A, B, C, D reported total fer- (c) Rubella (d) Mumps
tility rate as 2.1, 2.4, 2.6, 2.8 respectively.
Q. 14. Worker responsible for active malaria surveil-
Which city had achieved desire goal for TFR
lance
(a) 2.1 (b) 2.4
PSM

(a) ASHA (b) MPW

(c) 2.6 (d) 2.8
(c) Anganwadi (d) Health Assistant
Q. 4. Agency funding TB program in India
Q. 15. Lowest center where patient can go for deliv-
(a) WHO (b) UNAID
ery
(c) World Bank (d) Global Fund
(a) CHC/DH (b) PHC/DH
Q. 5. Reproductive health promoting agency in (c) PHC
world is (d) CHC/Medical College
(a) UNDP (b) UNICEF
Q. 16. Disease caused by given mosquito
(c) UNESCO (d) UNFPA
Q. 6. Which agency give support to achieve sustain-
able development goals
(a) WHO (b) UN
(c) UNESCO (d) UNDP
Q. 7. Ortho toludine test used for detection of
(a) Chlorine demand
(b) Free residual chlorine (a) Malaria (b) JE
(c) Combine chlorine (c) Dengue (d) Zika Virus
(d) Free and combined separately
Q. 17. Incineration Process is used for which colour
Q. 8. Low stationary phase is which phase in demo- bag
graphic cycle (a) Yellow (b) Red
(a) Phase 1 (b) Phase 2 (c) White (d) Blue
(c) Phase 3 (d) Phase 4
Q. 18. Which is principle of PHC?
Q. 9. Maximum money under PM JAY YOJNA (a) Unequal distribution
(a) 1 LAC (b) 2 LAC (b) Appropriate technology
(c) 5 LAC (d) Unlimited (c) Money
Q. 10. Total number of children born to a reproduc- (d) Inter country control
tive female is calculated by Q. 19. Most cost effective screening test for cervical
(a) GFR (b) TFR cancer

8.26
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

(a) Pap smear (b) Biopsy Q. 27. Patient presented with liver cancer who is
(c) Lugol iodine/VIA working in grain industry (ground nut) for last
(d) Colposcopy 15 years. Toxin responsible for this condition is
Q. 20. If you want to know about recent malaria trans- (a) BOAA (b) Aflotoxin
mission in area, then preferred indicator is (c) Pyrolizidine (d) Sanguanarine
(a) API (b) ARI Q. 28. Which level is taking care of school health in
(c) Infant parasite rate rural area
(d) Annual blood examination rate (a) Sub center (b) PHC
Q. 21. A pregnant lady has rabid dog bite with minor (c) CHC
scratch, line of action (d) Sub district hospiatals
(a) Clean wound, no vaccine Q. 29. A 30 year old lady presented to OPD with c/o
(b) Clean wound with vaccine pain in lower abdomen with h/o copper t in-
(c) Clean wound with vaccine and sertion 3 years back. On USG investigation it
immunoglobulin was confirmed that copper t is extra uterine
(d) No action needed near ovary. Its removal by
Q. 22. A person reported to ophthalmic OPD with vi- (a) Hysteroscope (b) Laparoscope

PSM
sion of < 3/60 in RT eye and finger movement (c) Colposcope (d) By pulling tread
at 1 meter distance in LT eye. His state of vi- Q. 30. A child presented with H/O diarrhoea for last
sion is 12 hrs. He is severely dehydrated and unable
(a) Severe visual impairment to drink. Fluid management by
(b) Economic blindness (a) ORS (b) I/V Ringer lactate
(c) Social blindness (c) Normal Saline (d) Dextrose saline
(d) Manifest blindness Q. 31. Given condition is due to deficiency of
Q. 23. A card board worker is at a risk of
(a) Bagassosis (b) Byssinosis
(c) Asbestosis
(d) Nasopharyngeal carcinoma
Q. 24. A man travelled to Assam and after returning
back he developed fever, giddiness, altered
sensorium and on investigation confirmed to
be a case of Pl falciparum. Treatment of choice
(a) I/V artemether (b) Doxycycline
(c) Chloroquine
(d) Artesunate, sulfadoxine, pyrimethamine
(a) Only energy (b) Only protein
Q. 25. Food component helps in healing (c) Both protein and energy
(a) Iron (b) Vitamin E (d) Vitamins
(c) Vitamin C (d) Vitamin A
Q. 32. Most common cancer in head and neck regien
Q. 26. A patient from Bihar presented with general- in India
ized bone pain and had excess fluoride intake. (a) Oral cavity (b) Neck
He was diagnosed as fluorosis. Fluorosis of (c) Oro-pharyngeal (d) Naso Pharyngeal
bone is commonly associated with
Q. 33. A 30 year old person is coming from china with
(a) Osteopetrosis (b) Osteosclerosis
suspected covid symptoms. Test for confirma-
(c) Osteoporosis (d) Osteomalacia
tion is

8.28A
 MIST ALL IN ONE FOR FMGE

(a) CBNAAT (b) RT PCR Q. 4. Identify logo:

(c) HIV blood smear (d) ELISA
Q. 34. First step to be done for immunization survey
in an area
(a) List of pregnant mother
(b) Vaccinated children in last year
(c) Census data
(d) Population of area
Q. 35. A case control study was done to know risk
factors of obesity. Two groups formed will be
(a) Patients with and without obesity (a) First AID (b) Red cross
(b) Person with or without online food (c) Suraksha clinic (d) Homeopathy
(c) Person with or without exercise Q. 5. Post marketting trial is after completion of
(d) Perdon with or without smoking which phase of drug trial
Q. 36. Demographic bonus is (a) Phase 1 (b) Phase 2
(a) Population density (c) Phase 3 (d) Phase 4
PSM

(b) Reduction in population in last few years Q. 6. Main worker of active malaria surveillance
due to contraception (a) ASHA (b) Anganwadi
(c) Fertility rate (c) MPW M (d) MPW F
(d) Literacy Q. 7. Demographic indicator which includes mortal-
ity also
(a) GRR (b) TFR
DECEMBER 2020 (c) NRR (d) GFR
Q. 1. ROUTE of insertion of ESSURE implant through Q. 8. A farmer reports to clinic after 8 hrs of unpro-
(a) Laparoscopy (b) Hysteroscopy tected intrercourse, what will be preferred
(c) Vaginoscopy (d) Colposcopy method of contraception
Q. 2. Population coverage of ASHA worker (a) LNG 1.5 mg (b) OCP
(a) 1000 (b) 3000 (c) MIFEPRISTONE (d) IUCD
(c) 5000 (d) 10000 Q. 9. Breast feeding contra indicated in users of
Q. 3. Contra indication of the device given in im- (a) OCP (b) NORPLANT
age: (c) MINIPILL (d) DEPOPROVERA
Q. 10. Minimum thickness of lead apreon
(a) 0.5 mm (b) 0.5 cm
(c) 2.0 mm (d) 2.2 mm
Q. 11. Time interval between first possible diagno-
sis and usual time of appearance of disease
(a) Screening time (b) Lead time
(c) Survival time (d) Latent period
Q. 12. In a population of 5000, reported birth rate is
25/1000 population. Calculate number of total
pregnancy in that area
(a) PID (b) Hypertension (a) 125 (b) 138
(c) Lactation (d) Migrain (c) 112 (d) 69

8.28
 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Q. 13. Zika virus disease is transmitted by which in- Q. 20. Condition seen in deficiency of:
sect
(a) Aedes mosquito
(b) Anophales mosquito
(c) Culex
(d) Sand fly
Q. 14. Niti ayog is replacement of
(a) MCI
(b) NMC
(c) Planning commision
(d) Health commision
Q. 15. While on increasing disease prevalence, which (a) Thiamine (b) Riboflavin
parameter is affected most (c) Niacin (d) Folic Acid
(a) Sensitivity (b) Specificity Q. 21. Micro elements are all except
(c) PPV (d) Descriptive Value (a) Selenium (b) Copper
Q. 16. In a study patients were selected in two groups (c) Zinc (d) Calcium

PSM
of 100 each of different variety of hyperten- Q. 22. All are included under SRS survey except
sion. Their BP was measured before and after (a) IMR (b) MMR
3 months of therapy. Which test is used for (c) Death rate (d) Birth rate
analysis of these two groups after 3 months of
therapy Q. 23. 19 year old boy presented with urethral dis-
charge. Which colour kit will be used
(a) Chi-square test (b) Paired t-test
(a) Grey (b) Green
(c) Unpaired t-test (d) ANOVA test
(c) Yellow (d) BLACK
Q. 17. A worker fall sick and getting 3 month leave
Q. 24. Out of 4000 live births in an area, 40 died be-
with 70% of salary, type of leave
tween 0-7 days, 40 more died between 7-28
(a) Sickness benefit
days, calculate neo natal mortality rate
(b) Extended sickness benefit
(a) 10 (b) 20
(c) Maternity benefit
(c) 30 (d) 40
(d) Enhanced sickness benefit
Q. 25. In central India most common species of ma-
Q. 18. Rabies free state or union territory
laria parasite
(a) Punjab
(a) PL. falciparum (b) Pl. vivex
(b) Sikkim
(c) Pl ovale (d) Pl malariae
(c) Andaman and Nikobar
(d) J&K Q. 26. A lady with swallon leg, giving H/O off and on
rigours:
Q. 19. A health worker is sitting in a vaccination clinic
and throwing waste in one container which
contain cotton, gauze, packed food, needle,
syringe. Suddenly medical officer comes on
round and picks needle with fixed syringe.
Ideal method of disposal
(a) Red bag
(b) White clear bag
(c) White translucent bag
(d) Black bag

8.29
 MIST ALL IN ONE FOR FMGE

(a) Leishmaniasis (b) Filariasis Q. 33. To know effect of alcohol intake and divorce a
(c) Malaria (d) Fungal infection study was designed on patients. Two groups
Q. 27. A child with IQ 55, Mental retardation stage were made of divorce and non divorce indi-
(a) Mild (b) Moderate viduals. Their history of alcohol intake was
(c) Severe (d) Profound taken. Study design is
(a) Case control (b) Cohort
Q. 28. Who package of essential non communicable
(c) Cross sectional
diseases IN NPCDCS
(d) Retrospective cohort
(a) HT, diabetes
(b) HT, diabetes, asthma
(c) Asthma, cancer, DM AUGUST 2020
(d) Cancer, HT, Stoke, DM
Q. 1. Minimum number of Antenatal visits required
Q. 29. Nurse has accidental prick while collecting
are?
blood of a known case of HIV, preferred test
(a) 3 (b) 4
for confirmation of transmission
(c) 5 (d) 6
(a) Blood culture (b) ELISA
(c) P 24 antigen (d) Westen blot Q. 2. A man came for health checkup after his fa-
PSM

ther had a cerebrovascular accident who died

Q. 30. Which agency collect and publishes large scale
last month. He was having the history of hy-
survey continuously regarding vital events,
pertension. Which type of prevention is this?
family planning and morbidity
(a) Primordial (b) Primary
(a) AIIMS (b) SRS
(c) Secondary
(c) National Sample Survey
(d) Specific protection
(d) Central Bureau of Health
Q. 3. Mid-year population is taken on?
Q. 31. Urban heart is
(a) 01 September (b) 01 June
(a) Urban health equity assessment and
(c) 01 April (d) 01 July
response tool
(b) Urban health evaluation assessment and Q. 4. Identify the Statistical diagram shown below
response tool
(c) Urban health equity assessment and
response technique
(d) Urban health evaluation assessment and
response technique
Q. 32. A student presented with c/o abdominal pain
on examination he was having fever and jaun-
dice. Within a week few more students pre-
sented with similar problems. On investiga-
tion medical officer confirmed that all students
were sharing food from common canteen in a
boarding school. Investigation of choice to
confirm diagnosis
(a) IgM for Hepatitis A
(a) Histogram
(b) IgM for Hepatitis B
(b) Bar diagram
(c) IgG for Hepatitis A
(c) Frequency polygon
(d) Ig G for Hepatitis B
(d) Scatter diagram

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 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Q. 5. Identify the logo shown below?
(a) AGMARK
(b) PFA standards
(c) Food Standards and Safety Authority of
India (FSSAI)
(d) Bureau of Indian Standards (BIS)
Q. 6. Regarding the School health service guidelines
recommendations, which of the following
statements is true?
develop disease. Which is the best parameter
of new cases:
(a) Prevalence
(b) Incidence
(c) Cumulative incidence
(d) Secondary attack rate
Q. 11. All of following are Principles of Primary
Health Care Except?
(a) Community participation
(b) In Appropriate facility
(c) Intersectoral coordination
(d) Equitable distribution
Q. 12. In different types of graphs, Secular trend of a
Disease is best represented by;
(a) Line diagram (b) Bar graph
(c) Box and whiskers plot

PSM
(a) Minimum area 5 sq. fl. per student (d) Stem leaf plot
(b) Minus type desk Q. 13. Which of the following depicts Severity/le-
(c) Can allot 60 students per classroom thality of disease?
(d) Light coming from front of the expressed (a) Proportional mortality rate
glass (b) Case specific death rate
Q. 7. Researcher was conducting study in relation (c) Case fatality rate
of Depression associated with history of so- (d) Total deaths due to that disease
cial media usage. One group had social media Q. 14. In a hospital, systematic observation and re-
users with depression and another group had cording of doctors spending time with patients
social media users without depression. Which care and time without patients’ care is calcu-
type of study design is used? lated for future management purposes. The
(a) Cohort study type of management technique used here is?
(b) Case control study (a) Network analysis (b) System analysis
(c) Cross sectional study (c) Work sampling (d) Decision making
(d) Random sampling
Q. 15. Definition of blindness, as per WHO:
Q. 8. Delphi technique used for collective opinion (a) <1/60 in better eye
of: (b) <1/60 in worse eye
(a) Population (b) Group (c) <3/60 in better eye
(c) Community (d) Individual (d) <3/60 in worse eye
Q. 9. A Researcher did study on staff, nurses and Q. 16. An 8-month-old child reported to a PHC with
junior resident doctors doing yoga (Divided runny nose and fever since last 3 days. Rash
into male and female). Yoga shows 25% de- started on face and then covered the trunk
creased risk of infections. Which is the best part of body. What’s the most likely diagno-
test to test the significance of the result? sis?
(a) ANOVA (b) Chi square test (a) Measles (b) Chicken pox
(c) Z test (d) Correlation (c) Mumps (d) Rubella
Q. 10. During influenza pandemic many individual Q. 17. Which of the following is NOT constrained by
infected and recovered. Recovered case again Time or Existing resources?

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(a) Vision (b) Target 32 mildly injured. Color coding in Triage High-
(c) Goal (d) Mission est to Lowest category is
Q. 18. Newborn Health Mission component do not (a) Green-Yellow-Red-Black
include: (b) Yellow-Red-Green-Black
(a) Target of infant mortality to double digit (c) Black-Yellow-Red-Green
by 2030 (d) Red-Yellow-Green-Black
(b) Antenatal care Q. 25. A healthy person gets in contact with an in-
(c) Postnatal visits (d) Care during labor fected case, and they have to separate him
Q. 19. Identify the Contraceptive shown in the Pho- not more than the incubation period of dis-
tograph given below: ease. This is called as;
(a) Absolute quarantine
(b) Isolation
(c) Interruption of transmission
(d) Serial interval
Q. 26. A male underwent Vasectomy and after 3
PSM

months his wife got pregnant. What advice

(a) CuT 7 (b) CuT 220B should have been given to him post-vasec-
(c) CuT 380A (d) NOVA-T tomy?
Q. 20. If you are posted as a medical officer in an (a) Abstinence for 3 months after the
area under NVBDCP, and you will be advised procedure
to spray Malathion for malaria prophylaxis. (b) Usage of Barrier methods for 3 months
What could be the probable decision you will after the procedure
take regarding frequency of Malathion spray? (c) OCPS usage for I month
(a) Once very fortnight (d) Female condom usage for 1 month
(b) Once every 3 months Q. 27. A case of HIV, C/O cough with fever, which test
(c) Twice every 3 months you will perform to diagnose TB
(d) Once every month
(a) Chest X-ray
Q. 21. A country is suspecting a severe disease like (b) Sputum smear examination
yellow fever. What’s the probable time within (c) CB-NAAT (d) Liquid culture
which one should report it to WHO?
Q. 28. In ORS, Sodium is given along with Glucose
(a) 6 hours (b) 12 hours
(c) 24 hours (d) 48 hours for?
(a) Reducing secretions
Q. 22. Least Iron content is present in:
(b) Osmosis
(a) Beans (b) Milk
(c) Spinach (d) Liver (c) Facilitative diffusion
(d) Co-transport
Q. 23. In an operation theatre, the nurse spilled
blood on the floor. What can be used to disin- Q. 29. A factory worker had a history of frequent ex-
fect it? posure to groundnuts. Subsequently he de-
(a) Cresol (b) 70% Ethyl alcohol velops Hepatocellular carcinoma. Most likely
(c) Glutaraldehyde exposure association is?
(d) 1% Sodium hypochlorite (a) Ergot toxin (b) Aflatoxin
Q. 24. In a train accident, there were 74 dead, 64 were (c) Sanguinarine
severely injured, 20 moderately injured and (d) Pyrrolizidine alkaloids

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 PREVENTIVE AND SOCIAL MEDICINE (PSM)

Q. 30. A Medical officer examines workers in mines in different stages and non- uniform. Most
and suspected Silicosis. What should be his probable diagnosis is?
comments? (a) Measle (b) Chicken pox
(a) It is reversible once we remove the cause (c) Rubella (d) Small pox
(b) It takes 6-10 years to develop Q. 35. In crude death rate calculation, denominator
(c) Fibrotic changes in the lungs of the is midyear population this means population
patient can be reversed on:
(d) TB screening should be done at regular (a) 1st Jan. (b) 1st March
intervals (c) 1st July (d) 1st Dec.
Q. 31. A person returning from malaria endemic Q. 36. 6 month old child came to PHC with diarrhoea
country should continue chemoprophylaxis 10-18 times/24 hours, 3-4 vomiting/24 hours;
for how long? child is irritable, but took fluid from mouth
(a) 1 week (b) 15 days management
(c) 4 weeks (d) 4 months (a) Intravenous fluid
Q. 32. An infant is given Buffalo milk. It is superior (b) ORS
because? (c) 4 Hours intravenous fluid and then oral

PSM
(a) High calories and high protein (d) No fluid
(b) Low calories and high protein Q. 37. A 4 month old child with the nasal flaring, in-
(c) High calories and low protein tercostal retraction, RR 56 per minute. what
(d) Low calories and low protein will be diagnosis and next steps
Q. 33. Long term changes/sequelae of a disease are (a) No pneumonia
seen in? (b) Pneumonia
(a) Secular trend of a disease (c) Severe pneumonia, antibiotic, referral
(b) Cyclical trend of a disease
urgently
(c) Disease changing its traits according to
herd immunity in the population (d) Very severe pneumonia and immediate
(d) Disease changing the symptoms as per referral
seasons Q. 38. A case of HIV, CD4 count is < 350 most probably
Q. 34. A 5-year-old child came into OPD with fever, infection can be
rashes on the body. There were rashes on the (a) TB (b) Oral thrush
axilla and flexor surface with various macules, (c) Pneumonia (d) Diarrhoea
papules and vesicles. Rashes and blisters are

ANSWER KEYS
June 2022
1. (b) 2. (c) 3. (b) 4. (a) 5. (a) 6. (d) 7. (b) 8. (a) 9. (a) 10. (a)
11. (c) 12. (a) 13. (c) 14. (a) 15. (b) 16. (c) 17. (a) 18. (b) 19. (c) 20. (c)
21. (b) 22. (a) 23. (b) 24. (a) 25. (b) 26. (b) 27. (c) 28. (b) 29. (d) 30. (a)
31. (d) 32. (a) 33. (b) 34. (b) 35. (a) 36. (a) 37. (d) 38. (d) 39. (a) 40. (c)
41. (a)

December 2021
1. (b) 2. (b) 3. (b) 4. (c) 5. (b) 6. (a) 7. (a) 8. (c) 9. (b) 10. (b)

8.33
 MIST ALL IN ONE FOR FMGE

11. (b) 12. (a) 13. (b) 14. (d) 15. (b) 16. (a) 17. (d) 18. (a) 19. (b) 20. (a)
21. (c) 22. (a) 23. (c) 24. (c) 25. (c) 26. (b) 27. (b) 28. (a) 29. (c) 30. (a)
31. (d) 32. (a)

June 2020
1. (a) 2. (b) 3. (a) 4. (b) 5. (d) 6. (d) 7. (b) 8. (d) 9. (c) 10. (b)
11. (d) 12. (b) 13. (b) 14. (b) 15. (c) 16. (b) 17. (a) 18. (b) 19. (c) 20. (c)
21. (b) 22. (c) 23. (a) 24. (a) 25. (c) 26. (b) 27. (b) 28. (b) 29. (b) 30. (b)
31. (b) 32. (a) 33. (b) 34. (b) 35. (a) 36. (b)

December 2020
1. (b) 2. (a) 3. (a) 4. (c) 5. (c) 6. (c) 7. (c) 8. (a) 9. (a) 10. (a)
11. (b) 12. (b) 13. (a) 14. (c) 15. (c) 16. (c) 17. (a) 18. (c) 19. (c) 20. (c)
21. (d) 22. (b) 23. (a) 24. (b) 25. (b) 26. (b) 27. (a) 28. (d) 29. (c) 30. (c)
31. (a) 32. (a) 33. (a)
PSM

August 2020
1. (b) 2. (c) 3. (d) 4. (a) 5. (d) 6. (b) 7. (b) 8. (b) 9. (b) 10. (c)
11. (b) 12. (a) 13. (c) 14. (c) 15. (c) 16. (a) 17. (c) 18. (a) 19. (c) 20. (b)
21. (c) 22. (b) 23. (d) 24. (d) 25. (a) 26. (b) 27. (c) 28. (d) 29. (b) 30. (d)
31. (c) 32. (a) 33. (a) 34. (b) 35. (c) 36. (b) 37. (c) 38. (a)

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VISUALS — PREVENTIVE AND SOCIAL MEDICINE (PSM)

PSM

8.35
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PSM

8.36
PREVENTIVE AND SOCIAL MEDICINE (PSM)

PSM

8.37
 MIST ALL IN ONE FOR FMGE
PSM

8.38