Epidemiological Exercises (1-30)

Epidemiological
Exercises
QUESTIONS 1-30
Shadan Institute of Medical Sciences, Department of SPM
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Horrock’s Test

Finding the bleaching powder demand by Horrocks test
• Horrocks apparatus is devised to find bleaching powder requirement
to disinfect 100 gallon (455 litre) of water.
• Contents of Horrocks apparatus.

1 black cup- 240ml
1 pipette
6 white cups of 200ml each
2 metal spoon- 2gm each
7 stirring rods- 1 for each cup
2 droppers
Indicator: starch- iodine solution*
*Starch- iodine solution: 1.5gm starch is added to 100ml distilled water.

Boiled and cooled. 7.5gm cadmium iodide or potassium iodide is added.
• Procedure:
• With 2gm ( 1 level spoon) of bleaching powder and little water, thin
paste is made in the black cup.
• More water is added to the black cup upto the circular mark, vigorous
stirring is done and allowed to settle. This is ‘stock solution’ or
‘mother solution’.
• All 6 white cups are arranged in order. Water to be tested is filled,

upto a cm below the brim in all 6 cups.
• With pipette stock solution is added to white cups- 1 drop to first cup,
2 drops to second cup, 3 drops to third cup and so on. One drop
represents one part of chlorine in a million part of water.
• Water in all 6 cups is stirred well by using separate glass rod.

• Cups are left undisturbed for half an hour for bleaching
powder action, i.e. liberation of free chlorine.
• Three drops of freshly prepared starch-iodine indicator is

added to all white cups by dropper and stirred again.
• Development of blue colour indicates the presence of free

residual chlorine.
• Note the first cup showing blue colour.
• 5th cup is the first cup showing blue colour, 5 level spoon, i.e.
5 x 2= 10gm of bleaching powder is required to disinfect 100
gallon (455 liter) of water.
• Principle:
• Indicator contains potassium iodide + starch +
NaCl
• Free chlorine reacts with potassium iodide:
iodine is left free which reacts with starch and
gives blue colour.
Step 2: Finding the quantity of bleaching powder
requirement
• 5th cup is the earliest cup showing blue colour in Horrocks
test indicates that 5 level spoon (5 x 2)= 10gm of bleaching
powder is required to disinfect 455 liter of water.
455 liter of water requires- 10gm of bleaching powder

For 45,500 liter- how much bleaching powder is required?
= 10/ 455 x 45500
= 455000/455
= 1000gm ( 1 kg)
1 kg bleaching powder is required to disinfect the tank water.
Epidemiological
Exercises
QUESTIONS 1-30

Question 1

1. A circular well of 10 meter diameter with 15
meter depth of water is to be chlorinated.
Horrock’s test shows blue colour in 3rd cup
onwards.
• Calculate the quantity of bleaching powder
(CaOCl2) required to disinfect the well?
• Explain the procedure of well disinfection?
Step 1: finding the volume of well water
Volume of water in the circular well = π x r 2x h x 1000
Where, π = 22/7 =3.14
r= radius = 5 mt ( half of the diameter )
h= height = 15 mt water column
1000 = volume of water per 1 m3
= π x r2 x h x 1000
= 3.14 x 5 x 5 x 15 x 1000
= 3.14 x 25 x 15 x 1000 = 1,177,500
• Volume of water in the well is = 1,177,500 liter
• Step 2: Finding the amount of bleaching powder requirement
3rd cup is the earliest cup showing blue colour
3rd cup means – 3 level spoon (3 x 2 gm) = 6 gm of bleaching
• 455 liter of water requires – 6 gm of bleaching powder

• For 1177500 liter- how much bleaching powder is required?
= 6/ 455 x 1177500
= 7065000/ 455
= 15,527.5 gm (roughly 15.5 kg)
15 kg 527 gm ( to round up 15.5 kg) of bleaching powder is

required to disinfect the well water.
• Step 3: well disinfection procedure
• Required amount of bleaching powder is mixed with little
water in a bucket ( not more than 100gm at a time) to make
thin paste.
• 3/4th of the same bucket is filled with water, stirred well,
allowed 10 min for sedimentation.
• Supernatant clear chlorine solution is transferred to another
bucket; lime sediment is discarded. Not poured into the well
because sediment increases hardness of water.
• Bucket is lowered into the well below the water level.
• Well water is violently agitated by lowering and drawing
movements for homogenous mixing of chlorine solution in
water.
• This completes chlorination of well.
• Residual chlorine should be tested after half an
hour, by orthotolidine arsenite test. It should be
atleast 0.5 mg/ liter.
• Subsequent to chlorination, well water is used
only after a contact period of 1 hour.
• Wells are best disinfected once in a week at
night.
• During epidemics wells should be disinfected
every day.
Question 2

2. A swimming pool having 100 meter length,
60 meter breadth, with 10 meter depth of
water is to be disinfected.
• Calculate the amount of bleaching powder
required to disinfect the swimming pool.
Horrocks test shows blue colour in 4th cup.
• What measures you advice for swimming
pool sanitation.
Step 1: Finding the volume of water in the swimming
pool
Volume of water in swimming pool= L x b x h x 1000
Where, L = length= 100 mt

b= breadth = 60 mt
h= height = 10 mt
1000 = volume of water per 1 m3
= 100 x 60 x 10 x 1000 = 60,000,000

Volume of water in the swimming pool is 60,000,000
liter.
Step 2: Finding the amount of bleaching powder requirement
• 4th cup is the earliest cup showing blue colour in Horrocks test
indicates that, 4 level spoon ( 4 x 2 ) = 8 gm of bleaching
455 liter of water requires – 8 gm of bleaching powder

For 60,000,000 liter – how much bleaching powder is required?
= 8/ 455 x 60000000
= 480000000/455
= 1,054,945 gm
• 1054 kg 945 gm ( roughly 1055 kg ) bleaching powder is

required to disinfect the swimming pool.
Step 3: Maintaining swimming pool sanitation
• People suffering from skin disease, sore eye, nasal or ear
discharge, upper respiratory, GI infections and any
communicable disease should not be allowed to swim.
• Swimmers are instructed to empty the bladder, bowel and
to take shower bath before entering the pool.
• They should not spit, blow the nose, urinate or defecate in
the pool.
• Surrounding environment of the pool should be maintained
well.
• Pool is cleaned once in 15 days. Water is changed frequently
or best subjected for continuous purification
• Pool water is frequently tested for any contamination.
• 25 sqft area is provided per swimmer.
Question 3

3. During the year 2012, Narsingi primary health centre
covering 30,000 population had collected 4,000
peripheral smears by house to house visit. Another 400
slides were collected in the OPD. Results of the
microscopic examination of these slides are given to
you
Plasmodium vivax positive 41
Plasmodium falciparum positive 9
Total positive 50
• Calculate the possible malarial Indices and suggest
the remedial measures in brief.
Malarial parameters
Annual parasite incidence (API) = confirmed cases in one year x 1000
Population under surveillance
= 50 x 1000
30,000
= 1.6 per thousand population

Annual falciparum incidence(AFI) = number of cases due to falciparum X 1000
Population under surveillance
= 9 X 1000
30000
= 0.3 per 1000 population

Annual blood examination rate (ABER) = number of slides examined X 100
Population Under surveillance
= 4400 X 100
30000
= 14.6 %

Slide positivity rate (SPR) = number of slides positive for malaria X 100
Number of slides examined
= 50 X 100
4400
= 1.13%
Slide falciparum rate (SFR) = number of slides positive for P.falciparum X 100
Number of slides examined
= 9 X 100
4400
= 0.20%

• Control Measures
• Narsingi PHC can be classified as area with API less than 2

• According to modified plan of operation (MPO) measures
required are:
• Focal spraying in and around P. falciparum detected house.
• Active and passive surveillance (once in 15 days)
• Mass blood survey of people living around patients’ home
• Treatment: Prompt treatment is given to all detected cases.
• Follow up: After completion of radical treatment, monthly
blood examination should be carried out for 12 months
• Epidemiological investigation: All positive cases are to be
investigated.
Question 4

4. In the year 2011, API of a tribal district was
3/1000. Falciparum malaria cases had been
reported with 10 deaths. How will you strengthen
the surveillance and containment of malaria in
that area?
• Early diagnosis & radical treatment
• Case based surveillance & rapid response
• Integrated vector management
 Indoor residual spraying
 Long lasting insecticidal nets / insecticide treated bed nets
 Larval source management
• Epidemic preparedness and early response

• Monitoring & evaluation
• Advocacy, coordination & partnerships
• Behaviour change communication and community
mobilization.
• Programme planning and management.
Usually malaria surveillance is done by:
• Active case finding
• Passive case finding
• Rapid fever survey
• Mass fever survey
Active case finding:
• Carried out by multipurpose health workers working under PHC.
• Every fortnight periodicity of house to house visits.
• Fortnight visits are done to catch most of secondary cases.
• Search for all fever cases.
• If cases have fever – collect blood films (thick and thin on same slide)
• If cases are positive for malaria, radical treatment is provided.
Passive surveillance :
• All the fever cases attending hospitals are screened for malaria and treated
accordingly.
• Medical officer with the help of PHC staff should carry out mapping of
private clinics, under guidance of district malaria officer.
• Various malaria clinics are to be established in all health institutions in high
risk areas.
• MPHW male should contact all fever treatment dispensaries for drug
replacement (fortnightly)
Rapid fever survey:
• House to house visits are undertaken and all
fever cases screened by blood smears.
• Blood smears are to be examined at earliest in
the temporary field lab at village level
Mass survey:
• Carried out for entire population in suspected
epidemic zone.
• As it is high risk area with API> 2 –
1. Vector control :
 Indoor residual spraying
 Use of chemical larvicides like Abate in potable water
 Aerosol spray during day time
 Marathon fogging during outbreaks
 Biologically by – larvivorous fish in ornamental tanks and fountains
 Personal protective measures – bed nets, mosquito repellants
2. Increase community participation

3. Environmental management by source reduction.
4. Entomological assessment – to carryout susceptibility tests and
suggest required insecticide
5. Health Education
Question 5

5. A routine clinical survey for filariasis was carried out in a
community health centre, serving 1 lakh population; data
collected is as follows:
Night blood smears collected 30000

Persons showing only mf positive 300
Persons showing signs of filariasis 80
Persons showing both mf positive and signs 10
• Calculate the possible filarial indices. And suggest the

control measures.
• Sample size: For routine filarial survey, sample size
recommended is 5 to 7%. In this survey, 30% sample is examined
hence the sample is adequate and acceptable.
• Calculation of filarial indices
Microfilarial rate (mf) = number showing mf positivity X 100

Number of persons (slides) examined
= 300 X 100
30000
= 1%
Filarial disease rate = number showing filarial disease symptoms X 100
Number of persons examined
= 80 X 100
30000
= 0.26%

Filarial endemicity rate = signs + number of mf positives + Both X 100
number of persons examined
= 80+300+10 X 100
30000
= 390 X 100
30000
= 1.3%
Control Measures
• Against the Parasite
• Mass chemotherapy
• Given to all in endemic area
• Given only for cases and carriers in low endemic area
• Drug – Diethylcarbamazine (DEC) (Hetrazan)
• Dose – 6 mg/kg/day divided doses after meal
• Duration – 6 day in a week for 2 week, i.e. 12 days
• Total dose: 72 mg/kg
Medicated salt
• Common salt medicated with 1- 4 gm of DEC/kg
Recent schedule
• DEC
• Or Ivermectin
• Or combination of both
• Plus, Albendazole as a supplement
• Vector control
• Antilarval Measure:
• Chemical: Application of selected insecticides once in a week
on all breeding places
• Mosquitoes larvicidal oil (MLO)
• Fenthion 1 ppm
• Organophosphorus – Temephos, fenthion
• Anti -adult measures

• Pyrethrum space spray/Insecticidal spray in and around
• Open underground sewage system
• Neighborhood at human dwelling.
• Environmental measures: source reduction

• Integrated vector control
• Personal prophylaxis
• Other measures
 Maintenance of local hygiene of affected organ (leg)
 Primary health care approach
• Periodic night blood examination
• Blood examination: by taking capillary blood by deep
finger prick between 8.30 pm to 12 mid night.
• Health education: dynamic health education, campaign
is organized to motivate the people, to co-operate in
anti- filarial activities and to take complete treatment.
• Surveillance
Question 6

6. In an antenatal clinic of tertiary care
hospital, a primi aged 21 year was found HIV
positive. Her husband works as a truck driver,
and is repeatedly falling ill for the past few
months. What measures do you suggest?
• Referring the woman to integrated counselling and testing
center (ICTC) where following help is given
• At counselling center, Post-test counselling is done which:

 Prepares the woman psychologically to understand the situation
 Enables her to take appropriate decisions regarding continuing
pregnancy.
 Changing the risk behavior
 Taking treatment to reduce the risk of transmission to child
 Encouraging her to tell her spouse
 Advising her to attend follow up counselling.
 Advise for CD4 count and lab services
 Advising about availability of treatment and supportive services
for people living with HIV/AIDS (PL – WHA)
• Prevention of parent to child transmission (PPTCT) of
HIV/AIDS
 Initiation of lifelong ART medications (tenofovir, lamivudine and

efavirenz) irrespective of CD4 cell count.
 Need of institutional delivery should be explained
 ARV prophylaxis to infants from birth to six months.
 Provision of care for associated infections. (STD, TB etc)
 Provision of nutrition, counselling, and psychosocial support.
 Counselling and support for initiation and continuation of breast
feeding.
 Integrating follow up of HIV exposed infants into routine health
care including immunisation.
 Initiation of cotrimoxazole prophylactic therapy and Early Infant
Diagnosis using HIV- DNA PCR at 6 weeks.
• Advice to Husband
• Attend integrated counselling and testing centers

• Undergo pre-test and post – test counselling
• Safe sex practices
• Usage of condoms
• Undergo testing and treatment for STD’s, RTI, TB if present
• Behaviour change communication.
• If test is positive
• CD4 count is done
• Advise to take treatment at ART center
• Good nutrition and exercises
• Healthy life style
• Early health seeking behavior even for minor illnesses
• If test is negative
• Undergoing test again after window period
Question 7

7. A PHC catering 40,000 population has given
the data about tuberculosis from January 2016
to December 2016
•Calculate Incidence and Prevalence of

infection
•Calculate Incidence and Prevalence of disease
Particulars Tuberculin Positive Sputum Positive
Old Cases 12230 106

New cases 610 34
Total 12840 140
• Incidence = total no. of new cases /
population under surveillance * 1000
• Prevalence = total no. of old & new cases /

population under surveillance *100
• Incidence of Infection = total no of new cases who
are tuberculin positive / population under
surveillance *1000
= 610/40000 *1000
• Prevalence of infection = total no of new and old

cases who are tuberculin positive / population
under surveillance *100
= 12230 + 610 /40000 *100
• Incidence of Disease = total no of new cases who are
Sputum positive / population under surveillance
*1000
= 34 / 40000 *1000
• Prevalence of Disease = total no of new and old cases

who are sputum positive / population under
surveillance *100
= 106+34 /40000 *100
= 140 /40000 *100
Question 8

8. In a study, out of 60 hypertensives 30 were
using OCP. Among 70 non hypertensives, 25
were using oral contraceptives.
• Draw a 2*2 contingency table.

• Calculate Exposure rates among Cases and
Controls
• Find the odds ratio and Comment
In a study, out of 60 hypertensives 30 were using OCP. Among
70 non hypertensives, 25 were using oral contraceptives
Hypertensive Non Hypertensives Total
OCP Users 30 (a) 25 (b) 55
Non OCP users 30 (c) 45 (d) 75
Total 60 70 130
Exposure rates among cases (Hypertensives) = a /a+c
= 30/30+30
= 0.5
Exposure rate among controls (Non Hypertensives) = b/

b+d
= 25 /25+45
= 0.35
Odds ratio = ad/bc

= 30*45/30*25
= 1.8
• The odds of OCP users developing hypertension is 1.8
times that of non OCP users
Question 9

9. Out of 482 Smokers 27 developed Stroke
while among 1908 non-smokers, 77 developed
Stroke.
• Draw a 2*2 contingency table.
• Calculate incidence rates among Exposed and
Non exposed
• Find the relative risk and attributable risk and
comment
Out of 482 Smokers 27 developed Stroke while among 1908 non-smokers,
77 developed Stroke.
Stroke Present Stroke Absent Total
Smokers 27 (a) 455 (b) 482
Non Smokers 77 (C) 1831 (d) 1908
Total 104 2286 2390

• Incidence rates among exposed (Smokers) = a /a+b
= 27/27+455
= 50
• Incidence rate among non-exposed (Non Smokers) = c/ c+d

= 77 /77+1831
= 40
• Relative risk = IE /INE

= 50 / 40
= 1.25
• Attributable risk = IE - INE /IE *100

= 50 – 40/50 *100
= 20
• The risk of developing stroke is 1.25 times more among smokers when
compared to non-smokers
• The risk of developing stroke is 20 times greater among smokers when
compared to population in community.
Question 10

10. A new rapid test has been devised for Leshmaniasis. Following
are the results of the rapid test
•Calculate the Sensitivity of the rapid test

•Calculate the Specificity of the rapid test
•Calculate the Positive predictive value of the rapid test
•Calculate the negative predictive value of the test
Disease
Yes No
Positive 148 12
Rapid test
Negative 2 188
150 200
Rapid test Diagnosis Total
results Diseased Not diseased
Positive True positive (a) False positive (b) a+b

148 12 160
Negative False negative (c) True negative (d) c+d
2 188 190
Total a+c b+d
150 200
Sensitivity = a/(a+c) × 100 = 148/150 × 100 = 98.67%

Specificity = d/(b+d) × 100 = 188/200 × 100 = 94%
Positive predictive value = a/(a+b) × 100 = 148/160 × 100 = 92.5%
Negative predictive value = d/(c+d) × 100 = 188/190 × 100 = 98.95%
Question 11

11. In an anganwadi centre, the Mid Arm Circumference
(MAC) screening of 110 under-five children was
conducted. The following data was obtained –
11 cms MAC – 25 children
• How do you classify malnutrition in the Anganwadi

Centre?
• Indicate Nutrition Supplementation and other Services
required.
Malnutrition can be classified based on
• WEIGHT – GOMEZ’S CLASSIFICATION
• WEIGHT FOR HEIGHT- WATERLOW’S CLASSIFICATION
• MID ARM CIRCUMFERENCE- ARNOLD’S CLASSIFICATION
• Arm circumference cannot be used before one year of age.

• >13.5cms- normal/ well nourished
• 12.5- 13.5cms- mild- moderate malnutrition
• <12.5cms- severe malnutrition
• Shakir’s tape can be used for measuring mid arm circumference.
• Shakir’s tape has 3 colors.

• Red- indicates severe malnutrition
• Yellow- mild- moderate malnutrition
• Green- no malnutrition
• In the given data, 41 children are mild to
moderate malnourished.
• They require supplementary feeds at anganwadi
center & each child to get 500 calories & 12-15
grams of protein.
• Iron & folic acid supplementation to be given.
• Deworming should be done if required.
• Vit-A & B complex supplementation.
• Child’s diet must contain protein & energy rich
foods.
• 57 children are severely malnourished.
• They require supplementary feeds at anganwadi
center & each child to get 800 calories &20-25 grams
of protein.
• Iron & folic acid supplementation.
• Deworming should be done if required.
• Vit-A & B complex supplementation.
• Child’s diet must contain protein & energy rich foods.
• Nutritional rehabilitation services.
• Hospital treatment if any co infections are existing.
• Follow up care.
Question 12

12. In a village, an untrained dai conducted
delivery on a primigravida. After 1 week, the
neonate could not take feeds, developed
convulsions and spasm of limbs. Discuss the
health problem and enumerate the preventive
measures.
• This is a case of neonatal tetanus. The child is immediately
admitted to district hospital/referral center for treatment
• Passive and active immunization (Best given within 6 hours of
birth)
• Passive
• Tetanus hyper immunoglobulin (TIG) 250 IU to 500 IU is given by
IM route
• Tetanus anti toxin neutralizes the circulating toxins but not the
toxin already fixed to nerve roots.
• Passive protection is upto 30 days only.
• If human TIG is not available anti tetanus serum (ATS) given
subcutaneously 1500 IU after test dose.
• It gives passive protection for 7 days.
• Active
• Along with human hyper immunoglobulin.
• First dose of 0.5 ml tetanus toxoid is given to
another site.
• 6 weeks later, second dose of tetanus toxoid is
given.
• One year later, third dose is given. Regular
vaccination is continued
• General treatment and supportive measures.
• The child is nursed in a dark & quite room.

• IM injections and handling of child is minimized as it will
provocate spasm
• Maintenance of airway - sucking secretions, oxygen is given, if
necessary.
• Nutrition (Oral feeding is stopped) intravenous / nasogastric tube
feeding is given.
• Fluid, electrolyte and temperature is maintained.
• Control of spasm – Diazepam IV 0.5 to 1 mg/kg every 3 to 4 hour.
• Antibiotic – penicillin
• Tracheostomy, assisted ventilation- if indicated.
• Prevention
• Utilization of health services
• Clean delivery practices – institutional
• Trained attendants
• Providing home delivery kit
• Educating pregnant women about clean delivery
• Clean hands
• Clean blade
• Clean surface
• Clean tie
• Clean cord care
• No application to cord stump
• Tetanus toxoid to pregnant women

• First dose: As early as possible
• Tetanus toxoid two doses to all women of child bearing age at 1 month interval.
Question 13

13. A 25 year old man came to the casualty,
with unclean deep wounds on both the legs
with considerable tissue damage sustained on
the previous day. The person has taken TT
vaccine 12 years back. How do you manage the
case?
• Thorough wound cleaning has to be done for the
wound
• Remove any foreign particles, if present.
• Antibiotic and anti-tetanus treatment to be given.
Penicillin is the drug of choice after test dose.
• Category A – complete course of tetanus toxoid has
been received < 5 years
• Category B – tetanus toxoid received > 5 years – 10
years
• Category C - tetanus toxoid received > 10 years
• Category D – No h/o tetanus vaccination
• Treatment based on categories:
• Category A – complete surgical toilet
• Category B – complete surgical toilet + 1 dose of tetanus
toxoid
• Category C - complete surgical toilet + 1 dose of tetanus
toxoid + human Immunoglobulins
• Category D - complete surgical toilet + 2 doses of tetanus
toxoid + human Immunoglobulins
• Dosage of human immunoglobulin: 250 -500 IU for all

ages
• Vaccine dose: 0.5 ml of tetanus toxoid IM in gluteal region
Question 14

14. A 15 month old child was brought to the
hospital with history of watery loose motions
since the past 3 days. The child had 10 episodes
since morning and is drinking lot of water. On
examination – eyes are sunken, mouth and
tongue are dry and skin is retracting slowly on
pinching.
• What is the status of dehydration?
• Which treatment plan will you select for this
child?
• The child is suffering from some dehydration.
The ideal method recommended is ORS
solution .
• Salts and sugar are provided in dry powder
form in a packet, to be reconstituted when
required. It can be used in any age group,
including newborns.
• After correction of some dehydration, ORS
solution is used to maintain hydration till the
disease is cured.
• The contents of ORS are: sodium chloride – 2.6 gm;
Potassium chloride - 1.5 gm; anhydrous Glucose –
13.5 gm; Trisodium citrate – 2.9 gm;
• One ORS packet is dissolved in 1 litre of clean
drinking water. Once prepared, should not be used
beyond 24 hrs.
• Trisodium citrate makes the product more stable
and helps in better absorption of sodium and water.
• Dosage is 50-100 ml/kg body wt or 75ml x wt
(kg)/4hrs.
• According to the age, <1yr – 500ml ; 1-2yrs -750ml; 2-
4yrs -1000ml; 4-10yrs -1500ml.
• The above doses are for the first 4 hrs, after this, if the
patient wants more or is able to drink more, it can be
given accordingly.
• After 4 hrs, the child is reassessed and if there is
improvement, treatment is shifted to plan A.
• If the dehydration still continues, ORS is continued.
• If there is severe dehydration, treatment is shifted to
plan C that is Intravenous fluid treatment.
• Advise the mother to continue breastfeeding. And if the
child deteriorates, she has to get the child back to the
PHC
Question 15

15. During a school health survey, few cases of
scabies were detected among the boys from
the school hostel. Suggest measures you will
take to manage and prevent further spread.
• Diagnosis of disease is by:-
• Complaints: Itching which is worse at night
• Clinical examination of all inmates for- follicular
lesions and secondary infections at: Hands, wrist,
extensor aspect of elbow, axilla, buttocks, lower
abdomen, feet, ankles, genitals.
• Excluding the other conditions that mimic scabies
(Dermatitis, Erythema)
• Management:
• Confirmation of diagnosis is by microscopic
demonstration of itch mite
• Treatment:
• All residents are treated simultaneously (Blanket treatment).
First, all infected inmates are given a good scrub bath. After
bath, 25 % benzyl benzoate (sarcopticide) is applied all over
the body, below the chin. It is allowed to dry. The application
is repeated again after 12 hours.
• Thorough bath is given 12 hours after the second
application. All under clothes, towels, bedsheets, and linens
should be boiled, washed, sun dried and ironed.
• Permethrin 5% cream is highly effective and safe in the

management of scabies. Treatment consists of a single
application for 8–12 hours, repeated in 1 week.
• Oral ivermectin in a dose of 200 mcg/kg is effective in about
75% of cases with a single dose and 95% of cases with two
doses 2 weeks apart
• Oral ivermectin can be very beneficial in mass treatment to
eradicate infections in institutions or villages
Prevention:
• Taking bath daily, washing the clothes regularly.
• Maintaining personal hygiene.
• Prevention of overcrowding.
• Avoiding sharing of fomites like clothes, bedsheets etc.
• Avoiding contact with scabies person. Prompt early diagnosis
and treatment.
• Health education regarding the cause and prevention of scabies
Question 16

16. In the year 2014, 156 cases of
gastroenteritis occurred in a village, and 5
deaths were reported. The source of drinking
water for the people is an unsanitary well. How
do you investigate the outbreak of epidemic of
GE and what are the containment measures to
be adopted to prevent the recurrence of such
outbreaks?
1.Verification of diagnosis: thorough clinical examination of
a sample of cases. Lab investigations where ever necessary.
2. Confirmation of the existence of epidemic:
• In common source epidemics, the existence of an
epidemic is quite easily recognized. Existence of modern
epidemics is not easily recognized unless comparison is
made with past experience.
3. Defining the population at risk:
• Preparing a spot map of the area containing information
of landmarks, roads and location of dwelling units.
• Counting population to obtain a denominator of
population at risk.
4. Rapid search for all cases and their characteristics:
• Medical survey to identify all the cases who have not sought medical
care and those at risk. Search for more cases every day, usually for
twice the incubation period of the disease since the occurrence of
the last case. Epidemiological case sheet should be prepared with full
details like name, age, sex, occupation, social class, time of onset of
illness, all personal contacts, special events such as parties attended,
food eaten and exposure to common vehicles.
5. Conduct evaluation of ecological factors/environmental assessment:

• Particular reference to water supply, disposal of wastes and places of
eating.
• Vectors, pet animals
• Fairs, festivals and community feasts.
6. Further investigation of population at risk:
• Medical examination, screening tests, examination of suspected food, faeces, or
blood samples, biochemical studies etc.
7. Data analysis:
• The parameters are time, place and person. This implies preparation of:
• Epidemic curve (time distribution)
• Spot map (place distribution)
• Attack rates and case fatality rates (person distribution)
• Identify common event experience as well as the group with the common
experience.
8. Formulation of hypothesis:
• Possible source
• Causative agent
• Possible modes of spread
• Environmental factors.
9. Testing of hypothesis:
• Hypothesis considered and weighed by comparing the attack rates in various
groups for those exposed and not exposed to each suspected factor.
10. Writing the report: information included:

• Background, historical data, methodology of investigations, analysis of data,
control measures, definition of strategies and methodology implementation,
constraints, results, significance of results and cost effectiveness.
Main strategies for the control of an epidemic:

• Attack source:
• Treatment of cases and carriers, isolation of cases, surveillance of suspects,
quarantine, control of animal reservoirs and notification of cases.
• Interrupt transmission:
• Environmental hygiene, personal hygiene, vector control, disinfection and
sterilization and restrict population movements.
• Protect susceptible people:
• Immunization, chemoprophylaxis, personal protection and better nutrition.
Question 17

17. Ramya, 15 months old child, with normal gait is
brought to your health centre by her mother with
the following history: cough – 7days; Difficulty in
breathing since 1 day, fever, no convulsions,
suddenly fell ill on the previous day and not taking
feed.
• O/E - Restless. RR: 66/min. No wheeze or stridor,
• Temp. 39°C. Indrawing of chest wall, Tongue
cyanosed.
• How do you classify, diagnose and manage her
illness?
• According to the history and clinical presentation, child
is found to have pneumonia. Because the child is having
in-drawing of chest wall, difficulty in breathing,
increased respiratory rate, cyanosis and the child is not
taking feeds it can be classified as severe pneumonia .
• At PHC level, first dose of antibiotic should be given and
referred to hospital urgently.
• First dose of antibiotic is Benzyl penicillin
50,000IU/kg/dose IM (OR)
Ampicillin 50 mg/kg/dose IM (OR) Chloramphenicol
25 mg/kg/dose IM.
• If referral is not feasible, same drug should be given 6th
hourly for 48 hours and followed closely.
• If there is improvement in the child’s condition, for next three
days Benzyl penicillin should be changed to Procaine penicillin
50,000IU/kg single dose, ampicillin or chloramphenicol should
be changed to oral doses. If no improvement, change the
antibiotic, ampicillin to chloramphenicol, chloramphenicol to
Cloxacillin 25mg/kg 6thhrly with Gentamycin 2.5mg/kg
8thhrly.
• Symptomatic treatment for fever and wheeze should be given.
• Monitor fluid and food intake.
• Advice mother on home management on discharge, warm
care, continue breastfeeding, clear nose.
• Ask the mother to return if breathing becomes difficult or fast,
child is unable to feed, if child becomes more sick.
Question 18

18. In a boarding school with 200 unprotected
children in the age group of 5 – 15 yrs, there
was an outbreak of Diphtheria, soon after the
school was reopened. Suggest measures to
manage, control and prevent the spread of the
disease to the other inmates in the hostel.
• In diphtheria modes of transmission are droplet
infection, direct contact and through the objects
contaminated by nasopharyngeal secretions.
• In case of outbreak in a boarding school, rapid search
should be done for cases and carriers by doing throat
swab culture for all students and their contacts.
• Isolation of suspected cases and carriers should be
done for atleast 14 days or until proved free of
infection.
• Atleast two swab cultures taken 24 hrs apart should
be negative before terminating isolation
• Treatment: when diphtheria is suspected, diphtheria
antitoxin should be given IM or IV.
• For mild disease, 20,000-40,000 units
• Moderate disease, 40,000-60,000 units
• Late / extensive disease, 80,000-1, 00,000 units
• In addition to antitoxin, every case should be treated
with penicillin or erythromycin for 5 to 6 days.
• Carriers should be treated with 10 day course of oral
erythromycin.
• CONTACTS:
a) where primary immunization or booster dose was given
within previous 2 years, no action needed.
b)where primary course or booster dose given more than 2
years before, only booster dose of diphtheria toxoid given.
c) Non immunized contact should be given prophylactic
penicillin or erythromycin and 1000-2000 units of diphtheria
antitoxin and actively immunized against diphtheria contacts
should be placed under medical surveillance and examined
daily for evidence of diphtheria for atleast a week after
exposure.
• Disinfection of objects and linen used by cases and carriers

should be done properly.
Question 19

19. A 40 year old female primary school teacher
was diagnosed with pulmonary tuberculosis.
Sputum was positive for AFB.
• How do you manage the case?
• What health education is required?
• How do you prevent the infection to contacts?
MANAGEMENT OF THE CASE:
• As the primary school teacher is newly diagnosed as AFB positive, she
should be registered and treated under RNTCP
• According to DOTS treatment schedule, he/she is categorized under
category I
• Drugs used are
• H - Isoniazid -600mg
• R - Rifampicin -450mg
• Z - Pyrizinamide -1500mg
• E - Ethambutol -1200mg
• Treatment is given in 2 phases

• Intensive Phase – 2 months – 2(HRZE)
• Continuation phase – 4 months – 4(HRE)
• Sputum Examination is repeated at the end of intensive phase (i.e, 2
months), then at 4th and 6th month in the continuation phase.
HEALTH EDUCATION:
• To undergo periodic follow up.
• To take drugs regularly and completely.
• To Maintain cough hygiene (cover the mouth with
cloth while coughing)
• To maintain sputum hygiene (avoid indiscriminate
spitting, hygienic disposal of sputum)
• To take balanced diet and avoid smoking.
• PREVENTION OF INFECTION TO CLOSE CONTACTS:
Screening of school children:
• Check for BCG scar, clinical symptoms and suspected child is
subjected for sputum examination, if found positive, should
be treated promptly.
Family members:
• Should be screened for tuberculosis and prompt treatment is
given if found positive.
• INH prophylaxis:
• Is given for children < 6 years who are the close contacts of
tuberculosis patients
• 150 mg is given daily for 6 months.
Question 20

20. A 35 year old anganwadi teacher is having
three hypo pigmented anaesthetic patches on
her right arm. How will you manage this case
and suggest the remedial measures to be
taken?
Patient came with patches on the back and both arms, and there is
loss of sensation in the patches along with thickening of peripheral
nerves.so it is categorized as Multibacillary type of Leprosy.
• WHO has recommended Multidrug therapy for both Multi &

Paucibacillary Leprosy
Multi bacillary Leprosy treatment:

Rifampicin – 600 mg, once monthly, given under supervision
Dapsone – 100 mg daily, self-administered
Clofazamine – 300 mg once monthly supervised;
and 50 mg daily, self- administered.
Where Clofazamine is totally unacceptable owing to the discoloration
of the skin, it’s replaced by 250 to 375 mg Ethionamide or
Protionamide self- administered daily.
• Duration of treatment is 12 months.
• During treatment patient is observed for Lepra reaction

and treated accordingly using prednisolone. Add
Clofazamine in Erythema Nodosum Leprosum or Type II.
Follow up surveillance:
• Once in a year for 5 years after completion of treatment.
• Patient who does not show evidence of relapse (clinical
& bacteriological) during the period of surveillance is
released from treatment.
Health education:
• Patient:
• To take drugs regularly and completely – Compliance.
• Periodic checkups.
• Self-care practices.
• Counselling regarding the concept of etiology.
• Hygienic disposal of nasal secretions.
• To use microcellular rubber foot wear.
• Provide awareness regarding corrective surgeries and
community based rehabilitation.
• Family/Close contacts:
• Accept the patient, do not discriminate.
• Motivate the patient for treatment.
• Periodic examination of contacts.
• Chemo prophylaxis: Dapsone- 4 mg/ kg weight/ week for 3 years.
• Immunoprophylaxis: BCG (as relevant)
• Community:
• Health education about cause, cure and availability of services
• Removal of stigma attached to Leprosy
• Improvement in living standards
• Creating awareness regarding NLEP (National Leprosy Eradication
programme).
Question 21

21. A 15 year old boy was bitten by a stray dog
on his back and right arm, with a lacerated
wound of 2.5 cm * 0.5 cm. What measures are
to be taken?
• As the wound caused by street dog on right leg and thigh it is
categorized as contaminated wound.
• Probable infections transmitted by street dog bite are-

• 1) Rabies
• 2) Tetanus
• 3) Mixed bacterial contamination by saliva and teeth of street
dog.
• Local Treatment
• Wash the wound by soap and running water for at least 10 mins
• Chemical treatment with 0.01% iodine, alcohol, Savlon, Dettol.
• Do not suture the wound in most of the cases
• Inj tetanus toxoid
• Inj rabies immunoglobulin 20 IU/kg body wt., half
dose near the wound, other half in gluteal region.
• Antibiotics for bacterial contamination
• Observe the dog for 10 days
• If not possible then give HDC Rabipur vaccine 1ml

on deltoid region on 0,3,7,14,28 days and booster
on 90th day.
Question 22

22. Five Cases of hepatitis-B were reported
among nursing staff of a private hospital. What
are the various precautions required in the
hospital to eliminate Hepatitis-B?
• Modes of transmission:
• Through infected blood and body fluids
• Mother to child vertical transmission
• IVdrug abuse, contaminated needles and
syringes
• Multiple sexual partners, homosexuals
• Blood transfusions
• Breaking the channels of transmission:
• Sterilization of syringes, needles, catguts and surgical
instruments
• Use of auto disabled syringes and needle cutters.
• Screening of the blood donors for HbsAg
• Proper disposal of all the hospital wastes, especially the needles
and sharps and infected body fluids, blood and body parts.
• Proper disinfection of all the body fluids in the hospital wards,
disinfection of all the soiled linen.
• Screening of all the antenatal mothers, for HbsAg
• All the hospital staff including doctors should follow universal
precautions and wear PPE (personal protection equipment)
accordingly while they are doing any surgeries, deliveries or
procedures.
• Protection of susceptibles and high risk groups:
• High risk groups are surgeons, dentists, nurses, lab technicians and
blood bank workers.
• Pre exposure prophylaxis for high risk groups:
• The schedule is 0, 1 and 6 months.
• Special dosage schedule for post exposure prophylaxis, for
individuals accidentally exposed to needle stick injuries, cuts or
transfusions. For these patients, both active and passive
immunizations are given simultaneously.
• Passive immunization:
• HBIG prepared from immunized persons.
• Dose is 0.05 to 0.07 ml/kg body wt
• Two doses with an interval of 4 weeks, should be given within 24 hrs
of exposure, if possible
Question 23

23. A 45 year old male who is a clerk by
occupation came to the PHC with complaints of
tingling and numbness in limbs and foot ulcer.
Random blood sugar level was 345 mg/dl and BMI
– 31kg/m 2.
• How will you manage this case?
• What is the health advice given to the patient?
• The above mentioned is a case of Diabetes and obesity. The
risk factors in this case are age (> 40 years) and sedentary life
style. Secondary and tertiary level of prevention should be
applied.
• Secondary prevention:
• To maintain blood glucose levels within normal limits
• Diet modifications - proportion of energy dense foods such as
simple carbohydrates and fats should be reduced.
• Oral anti diabetic drugs
• Routine blood sugar level examination
• Routine monitoring of urine for ketones
• Blood pressure measurement
• Visual acuity testing
• The patient has already developed peripheral
neuropathy which has resulted in foot ulcer,
self- care of foot should be advised.
• Regular dressing of ulcer should be done and if
required debridement of ulcer should also be
done.
• The ulcer should be treated with broad
spectrum antibiotics and every effort should
be put to bring blood sugar levels under
control.
• The patient should be advised to take high fiber
diet and avoid refined foods.
• The patient should be advised to lose weight
and maintain ideal weight through regular
physical exercise and dietary changes.
• Abstinence from alcohol should also be advised.
• The patient should be asked to monitor glucose
regularly at home.
Question 24

24. During the year 2016, 227 two wheeler
accidents occurred at a particular junction in a
metropolitan city. Most of the accidents
involved young males in 18 – 25 yrs group.
Discuss the health problem and its preventive
aspects.
• Factors which influence road traffic accidents:
• Place of accidents:
• Road conditions
• Procession /obstruction in road
• Road defects, very narrow roads
• Cyclists , children and animal movements on road
• Excess of traffic, bad illumination
• Curves, lack of speed breakers
• Person met with accident:

• Age , sex
• Defective and delay in decision
• Excess speed, poor driving standards
• Ill-health, defect in vision and hearing
• Risk behavior: fantasy, impulsive, aggressiveness, emotional tensions.
• Poor psychological status
• Lack of sleep, fatigue
• Influence of medicine, drug, alcohol
• Sudden ill health like epilepsy, MI
• TIME OF ACCIDENT:
• Month, week, day, time.
• ENVIRONMENT:
• Fog , rain, natural calamities and sudden damage of roads
• Excess heat or cold
• Vehicle involved in accidents:

• Condition of vehicle
• Safety device ( helmet, seat belt)
• Social factors:
• Trend of license issuing
• Supervision by parents
• Traffic control/signals
• Enforcement of law
• Measurement of the problem:
• Proportion mortality = No. of deaths due to
accident/ total deaths * 100
• Accident rate per 1000 two wheelers =

Number of two wheeler accident / total
number of two wheelers *100
Prevention:
• General measures:
• Accident prevention education
• Improvement of roads
• Application of all road safety measures, improvement of road
conditions
• Proper control of traffic
• Supervision by the elder
• Engineering measure to make safe vehicles
• Survey and research on road accidents
• Notification
• Celebrating awareness campaign like road safety week.
• Medical measures:
• Providing medical care  emergency transport services(108
vehicles)
• Periodic counseling and behavioral modification
• Training medical and paramedical staff in first aid resuscitation and
trauma care.
• Legal measures:
• Licensing regulation
• Limiting the speed
• Separation of fast/slow tracks
• Use of protective device like helmet and seat belt
• Timely inspection of vehicles for road fitness
• Prohibition of driving after alcohol
• Prohibiting animals in road
Question 25

25. Some houses in the city are getting raw milk
from a village milk- vendor.
• How do you confirm the milk is free from
bacteria?
• What are the pathogenic organisms transmitted
through milk?
• How do you prevent milk borne infections?
• What are the differences between pasteurized
and home boiled milk?
• Methylene blue reduction test is done for detection of
micro-organisms present in the milk.
• Methylene blue is added to 10 ml of milk in a test tube,
and it is kept at 37 0C for some time.
• Milk which retains blue colour for the longest period
(>4½ hour) is considered as free from bacteria.
• Pathogenic organisms that transmitted through milk

are:-
• Bovine tuberculosis, Staphylococcal toxin, Brucella
abortus, Salmonellosis, Streptococcal infections, Q fever.
• Prevention of milk borne infections:-
• Registration and regulation of dairy farms and milk
vendors
• Periodic inspection of dairy farms and health of
cattle
• Medical examination of persons working in milk
business
• Enforcement of Food Adulteration Act, 1954.
• Health education to public regarding milk safety.
•Differences between pasteurised and home boiled milk:-
Particulars Pasteurised milk Boiled milk
Method Holder method: 63-66 deg Heated in an open vessel
used C for atleast 30 min and till scum layer forms
quickly cooled to 5 deg C
Or HTST method (High
temperature short time)
Bacteria Destroyed, but lactic acid Completely sterilized, but

forming bacilli are reduced lactic acid bacilli are killed
Protein Partially decomposed Totally coagulates

Nutrient Not much affected Nutrients are reduced,
iodine is completely lost.
Souring Delayed More delayed
Question 26

26. A poor anaemic pregnant woman has come
to your PHC to attend Antenatal clinic. She is
3rd gravid and is in 3rd trimester of pregnancy.
Her weight is 38 kgs. Haemoglobin – 7.5 gm.
• How do you manage the case?
• What are the existing national health
programmes to prevent this problem?
• The pregnant woman is having multiple risk
factors like poverty, anemia, multi gravida,
unregistered at early pregnancy which are
most important and preventable causes of high
maternal mortality and fetal mortality and
morbidity in India.
• Target Hb to be reached in a pregnant woman
should be 11gm%.
• This woman is having 7.5%, which can be
classified as moderate anemia
• Required iron dose (mg) = {2.4 X (target Hb- Actual Hb) X
Pre pregnancy weight (kgs)} + 1000 mg (for replenishment)

= {2.4 X (11-7.5) X38} +1000
= {2.4 X 3.5 X 38} +1000
= 319.2 + 1000
= 1319.2 mg
• each 1 ml of iron sucrose / iron dextran provides 20 mg of

elemental iron
• around 66 ml of iron sucrose is required to correct the
deficit in this women
• 14 (5 ml) ampules of iron sucrose are required.
• Therapeutic doses of 100 more IFA tablets should be given in
addition to 100 tabs of prophylaxis.
• Advise her to take IFA tabs in the night time after meals,
preferably taken with citrus fruits, not to be taken with
calcium tablets, milk etc.
• She should be advised to take iron rich foods like green leafy
vegetables, jaggery etc.
• Poor pregnant woman are given supplementary nutrition in

anganwadi centre like boiled egg, supplementary nutrition
powder under Integrated Child Development Sevices Scheme.
National Programmes for anemia prevention:
• National Iron Plus Initiative
• Weekly Iron Folic Acid Suplementation
• National nutritional anemia prophylaxis
programme
Question 27

27. In a village of 4000 population, all 580
eligible couples are registered. How will you
provide health services to them under RCH
program?
• Organization of RCH services
• Eligible couple: Married woman in reproductive age group (15 -45
years)
• Target couple: Eligible couples having two or more children
Categorize eligible couples & provide family planning services:
Category 1: with 2 or more children (target couples)

• Permanent methods advised
• Women –Tubectomy by mini-lap method, Laparoscope sterilization
• Male – Vasectomy using no scalpel method
Category 2: with one child

• Spacing methods are advised – condom, Cu T, oral pills etc.
Category 3: with no child- Delay child birth by spacing methods if needed.

OBSTETRIC CARE
• Essential obstetric care:
• Monthly antenatal examinations and early identification at risk
pregnancy, referral if necessary
• Minimum 4 ANC visits
• 1st visit- within 12 weeks (as soon as pregnancy is confirmed)
• 2nd visit- b/w 14 and 26 weeks
• 3rd visit- b/w 28 and 34 weeks
• 4th visit- b/w 36 weeks and term
• IFA tablet (100mg elemental iron, 500mcg folic acid) daily for minimum
of 100 days
• TT immunization (2 doses)
• Counselling
• Emergency obstetric care: First referral units and skilled attendance at

birth
POSTNATAL CARE:
• Home visits-(by health worker)
- First 3 days twice per day
- Until umbilical cord falls off-once per day
- Once in a month during first 6 months

- Once in 2 to 3 months till end of 1 year
• Advice - nutrition, exercises, utilization of programmes –

BFHI (Baby Friendly hospital Initiatives), ICDS (Integrated
Child Development Services)
• Health education: Breast feeding, Growth monitoring,
Immunization, Oral rehydration, family planning – birth
spacing
ALL WOMEN:
• PAP smear once in 3 years
• Screening and treatment for STIs
• MTP(Medical termination of Pregnancy)
services
• Counselling regarding genetic, premarital,
marriage and HIV
• Fertility advice for childless women.
CHILD CARE:
• Essential New Born care-Management of Asphyxia, Hypothermia,
Prevention of Infections, and Referral of sick new born.
• Immunization (National immunization schedule)
• Diarrhoeal disease control-ORS, Zinc
• Deworming
• Acute Respiratory disease control
• Prevention of Vit-A deficiency - Vit A is given at 9 months (1 lakh units) &
subsequent doses of 2 lakh units every 6 months upto 5 years of age.
Prevention and control of Anemia-

• 6 months to 5 years – Iron supplements in liquid formulations-20 mg
elemental iron+100mcg folic acid for 100 days in a year
• Children 6-10 years – Iron in dose of 30 mg elemental iron + 250 mcg folic
acid for 100 days a year.
• Children >10 years - iron supplement in adult dose(60mg of elemental
iron + 500mcg folic acid) for 100 days in a year.
Question 28

28. Prescribe balanced Diet for a pregnant
woman who is a labourer and also prepare a
balanced diet chart for the same woman after
delivery during lactation period.
• A balanced diet is defined as one which
contains a variety of foods in such quantities
and proportions that need for energy, amino
acids, vitamins, minerals, fats carbohydrates,
and other nutrients is adequately met for
maintaining health, vitality and general well -
being and also makes a small provision of extra
nutrients to withstand short duration of
leanness.
• CONSTRUCTING A BALANCED DIET-
• First – daily requirement of protein should be met- 10-15% of
dietary energy intake
• Next - fat requirement 15-30%of dietary energy intake
• Carbohydrates rich in natural fiber should constitute remaining
food energy.
• Normal women of 55 kg wt energy intake are-
• SEDENTARY -1900 Kcal
MODERATE-2230KCAL
HEAVY-2850KCAL
• Pregnant women of same weight should get –additional 350kcal
• Lactating women of same weight -0-6 months-should get
additional -600 kcal
• Lactating women 6-12 months-additional energy -520kcal.
• Visible fat around 30g/day
• Calcium-1200mg/day
• Iron-pregnant and lactating women -35mg/day
• Iron in lactating women -21mg/day
• Zinc in pregnancy & lactation -12mg/day
• Healthy eating during pregnant and lactation-

• Should eat 5 times a day
• 3 regular meals
• 2 small meals and snacks
• 5 servings of fresh fruits
• Should take food that contain lean non vegetarian protein mass
• As protein requirement of a normal person -1gm/kg wt/day
• During pregnancy and lactation –require extra 0.3g/day
• And increase demand of protein is during 2nd/3rd trimester.
• Example -poultry lean meat, beans, eggs….etc
• Foods containing more of unsaturated fatty acids along with
saturated fatty acids for development of nervous system of
fetus, and increased source of stored energy.
• Eg-fish, egg, meat…etc
• Should take food containing iron –which helps in coping with
physiological changes in pregnancy, and also responsible for
increasing volume of blood.
• Eg-jaggery.., dry fruits.., papaya…etc.
• Taking foods containing vit B12,folic acid-cereals.., beans..,
berries.., green veggies.., carrots.., cauliflower.., spinach..,
• Consume carbohydrates containing natural fiber along with
plenty of water.
• Eg beans..,broccoli..,cabbage..,carrots..,greenpeas.., spinach…,
fruits – like peachs, Pine apple, Pear, Berries, Apple, dried fruits.
• Consume fruits containing vit A - as vit A is required for
growth of lungs, heart, kidney, eyes, bones, nervous system,
and infections and is also required for fat metabolism.
• Vit A is also required for post-partum repair.
• Eg-carrots.., green veggies.., tomatoes…etc.
• Consume foods containing vit C-as it is required for mental
development and collagen formation.
• Eg-berries, tomatoes, amla, etc.
• Consume foods containing vit D-which is required for
maintain calcium and phosphorous in the body. eg- fish,
cereals, egg yolk
• Calcium required for skeletal development-dairy products,
beans, fish, almonds etc.
Question 29

29. A mandal PHC of 30,000 Population with
CBR 20, IMR 40/1000 live births, has to
implement UIP. As a medical officer, calculate
the vaccine requirement.
• As a medical officer, I would like to calculate:
i. No. of pregnant mothers = total population x CBR

= 30,000 x 20/1000 = 600
ii. No. of infants = total population x birth rate (1- IMR)

= 30,000 x 20/1000 (1-0.04)
=600 x 0.96 =576
iii. Estimation of vaccine requirement = no. of
doses required
• No. of doses required = no. of eligible

candidates x no of doses x wastage factor
• Wastage factor for MEASLES-RUBELLA (MR) &

BCG = 2
• Wastage factor for TT, OPV, IPV, Pentavalent,
HEP-B, DPT = 1.33
• iv. No. of TT doses = 600 x 2 x 1.33 = 1596
• No. of BCG doses = 576 x 1 x 2 = 1152
• No. of OPV doses = 576 x 5 x 1.33 = 3064.32= 3065
• No. of IPV doses = 576 x 2 x 1.33 = 1532.16
• No. of Pentavalent doses = 576 x 3 x 1.33 = 2298.24 = 2299

• No. of Measles-Rubella doses = 576 x 2 x 2 = 2304
• No. of Hep-B doses = 576 x 1 x 1.33 = 766.08 = 767
• No. of DPT doses = 576 x 2 x 1.33 = 1532.16

v. No. of doses in each vial =
IPV = 50 doses
OPV = 20 doses
BCG, TT, Pentavalent, Measles-Rubella (MR),

Hep-B, DPT = 10 doses
vi. No. of vials of TT required = 1596 = 159.6 = 160 vials
10
• No. of vials of BCG required =115.2 = 116 vials
• No. of vials of Hep-B required= 76.6 = 77 vials
• No. of vials of OPV required = 3065 = 153.25 = 154 vials

20
• No. of vials of IPV required = 1532.16 = 30.64 = 31vials
50
• No. of vials of Pentavalent required = 2299 = 230 vials
10
• No. of vials of MR required= 2304 = 230.4 = 231 vials
10
• No. of vials of DPT required = 1532.16 = 153.2 = 154 vials
10
Question 30

30. A vaccine trial was conducted among 6000
children; of these 3000 children received the
vaccine and 3000 received the placebo. After a
specific period of follow up it was found that 400
children developed the disease among the
vaccinated group while 1030 children developed
the disease among the placebo group.
• Calculate the vaccine efficacy.

• Specify the immunization schedule required in
case of under-5 children.
Developed Did not Total
disease develop the
disease
Vaccinated 400 2600 3000
Unvaccinate 1030 1970 3000
d (Placebo)
Total 1430 4570 6000
• Vaccine efficacy = incidence of disease among
unvaccinated – incidence of disease among
vaccinated / incidence of disease among
unvaccinated x 100
• Vaccine efficacy = Iu – Iv / Iu x 100
= c/(c+d) – a/(a+b) X 100
(c/c+d)
= 1030/3000 – 400/3000 X 100
1000/3000
=61.2%
• IMMUNISATION SCHEDULE in the state of Telangana is as follows:
• At birth – BCG & OPV – zero dose

HEP-B – Zero dose
• At 6 weeks- PENTAVALENT – 1
OPV-1
F IPV-1
• At 10 weeks – PENTAVALENT – 2
OPV-2
• At 14 weeks - PENTAVALENT – 3
OPV-3
F IPV-2
• At 9 months- MR-1 along with Vit A
• At 16- 24 months- DPT booster-1
OPV booster
MR-2nd dose
• At 5-6 years - DPT booster-2
VACCINE DOSE ROUTE OF SITE OF
ADMINISTRAT ADMINISTRATION
ION
BCG 0.05 ml (till 1 I.D Left upper arm
month age),
0.1 ml after 1
month
OPV 2 drops Oral Oral

Hep-B 0.5 ml I.M Left Anterio lateral

side of mid - thigh
PENTAVALENT 0.5 ml I.M Left Anterio lateral
side of mid- thigh
f IPV 0.1 ml I.D Right upper arm
MR 0.5 ml S.C Right upper arm
DPT Booster 0.5 ml I.M Left Anterio lateral
side of mid- thigh
END OF
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Epidemiological

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• Contents of Horrocks apparatus.

*Starch- iodine solution: 1.5gm starch is added to 100ml distilled water.

• All 6 white cups are arranged in order. Water to be tested is filled,

• Water in all 6 cups is stirred well by using separate glass rod.

• Three drops of freshly prepared starch-iodine indicator is

• Development of blue colour indicates the presence of free

• Note the first cup showing blue colour.

455 liter of water requires- 10gm of bleaching powder

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• 455 liter of water requires – 6 gm of bleaching powder

15 kg 527 gm ( to round up 15.5 kg) of bleaching powder is

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

Where, L = length= 100 mt

= 100 x 60 x 10 x 1000 = 60,000,000

455 liter of water requires – 8 gm of bleaching powder

• 1054 kg 945 gm ( roughly 1055 kg ) bleaching powder is

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• Narsingi PHC can be classified as area with API less than 2

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• Epidemic preparedness and early response

2. Increase community participation

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

Night blood smears collected 30000

• Calculate the possible filarial indices. And suggest the

• Calculation of filarial indices

Microfilarial rate (mf) = number showing mf positivity X 100

• Anti -adult measures

• Environmental measures: source reduction

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• At counselling center, Post-test counselling is done which:

 Initiation of lifelong ART medications (tenofovir, lamivudine and

• Attend integrated counselling and testing centers

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

•Calculate Incidence and Prevalence of

Particulars Tuberculin Positive Sputum Positive

Old Cases 12230 106

• Prevalence = total no. of old & new cases /

• Prevalence of infection = total no of new and old

• Prevalence of Disease = total no of new and old cases

Shadan Institute of Medical Sciences, Department of SPM

Genezens 2k15: www.genezens.weebly.com

• Draw a 2*2 contingency table.

Hypertensive Non Hypertensives Total

OCP Users 30 (a) 25 (b) 55

Non OCP users 30 (c) 45 (d) 75

Exposure rate among controls (Non Hypertensives) = b/

Odds ratio = ad/bc

Shadan Institute of Medical Sciences, Department of SPM