OSPE

1. As a Medical officer in-charge of infection Control committee you are

visiting the ICU to supervise Biomedical waste disposal, while making
rounds you are meeting a busy Intern disposing the waste in wrong bags.
a) How will you guide him/her to dispose the biomedical waste in
appropriate bags (5marks)

S.NO Nature of waste Color of bag 1 mark each

1 Dressings contaminated with Yellow
blood
2 Urine bag Red
3 Metallic implants Cardboard box
with blue
marking
4 Scalpel White puncture
proof container
5 Gloves Red

b) Enlist any two technologies of disposal of health care waste? (0.5 x

2=1 mark)
Incineration, chemical disinfection, wet & dry thermal treatment,
microwave irradiation, land disposal and inertization.
c) what do you mean by screw feed technology? (1mark)
Non burn, dry thermal disinfection, suitable to treat infectious waste
and sharp not useful for cytotoxic & radioactive waste.
d) Identify the following symbols. (0.5 x 2=1 mark)
 BIOHAZARD CYTOTOXIC HAZARD
e) When was the Bio Medical Waste Management in India enforced?
Mention the Ministry under which the act was implemented (2x1=2 marks)
1998(1 mark)/ Ministry of Environment and Forest, Government of
India.(1 mark)

2. A 24year old female visits your clinic with symptoms of difficulty and
pain during micturition, lower abdominal pain and foul smelling vaginal
discharge. On probing ,history reveals that her husband has extra marital
contact and history of scrotal swelling for the past few weeks. On
examination ulcers were seen over the genital areas of the woman.
a) what will be your probable diagnosis based on the nature of ulcer? (4
marks)
S.NO If the nature of ulcer is Probable 1 mark each
diagnosis
1 Multiple & painful Herpes Simplex
2 Painless with shotty lymph Syphilis
node
Painless with inguinal lymph Granuloma
nodes inguinale and
LGV
4 Single/painful and painful Chancroid
bubo

b) Name the clinic under NACO which deals with RTI/STD infections? (1
mark)
Suraksha Clinic
c) Enlist any four sexually transmitted diseases? (0.25 x 4 = 1 mark)
 AIDS, Syphilis, LGV, Gonorrhea, Chancroid, Donovanosis
d) what is the color code for kit 2 and mention the symptom it is used for?
(0.5 x 2 = 1 mark)
Green/Vaginitis
e) If Grams stain of vaginal smear reveals clue cells, what will be your
probable diagnosis? (1 mark)
Bacterial vaginosis
f) Enlist any four infectious causes for scrotal swelling (non RTIs) in male
other than sexually transmitted diseases? (0.5 x 4 = 2 marks)
Tuberculosis, Filariasis, Coliforms, Pseudomonas, Mumps

3. A 31year old construction worker, Ravi went to a nearby primary health

center with complaints of fever and cough with expectoration for 15 days.
He is the bread winner of a family of 5 comprising of his wife and three
children aged 10 years, 8 years and 4 years respectively.

a) How many sputum samples should be collected and how? (2 marks)

2 Samples should be collected.
Day1: Sample 1: On the spot under supervision. A sputum container
is given to the patient to take home for an early morning sample the following
morning.
Day 2: Sample 2: Patient brings an early morning sample
b) If Mantoux test was done for the children of Mr. Ravi, Explain the
procedure and specify the threshold of positivity induration. What is two-
step testing. (1+1 +0.5 = 2.5 marks)
Inject 1 TU of PPD in 0.1 ml intra dermally on the flexor surface of
left forearm with a tuberculin syringe, with the needle bevel facing upward. A
pale wheal 6 to 10 mm diameter is produced. The test is read after 48 to 96
hours but 72 hourrs is ideal. Threshold is >or= 10 mm for children <4 years and
15 mm or above for adults.
c) Identify who needs chemoprophylaxis in this household and state the
regimen. (1mark)
4year old child.(0.5 mark) Isoniazid 10 mg/kg for 6 months(0.5 mark)
d) Sputum smear report came as 1+ for this patient. Give your inference.
Also interpret what does 2+ and 3+ mean (2 marks).

1+: 10 to 99 AFB per 100 oil immersion fields

2+: 1-10 AFB per 100 oil immersion fields
3+: >10 AFB per 100 oil immersion fields

e) If the patient weighed 52 kg specify the FDC (Fixed Dose

Combination) for intensive phase (1 mark)
Isoniazid, Rifampicin, Pyrazinamide, Ethambutol (75/150/400/275)

f) Specify the time frames for clinical follow up and long term follow up
for this patient (1.5 marks)
Clinical follow up: monthly intervals
Long term follow up: At end of 6,12,18 and 24 months

4. Kumari, a 42 years old house maid reported to the medical officer with
complaints of pain in the right elbow, weakness in right hand and a
persisting bend in the little finger, of two months duration. On
examination, the medical officer found thickened & tender right ulnar
nerve, sensory impairment on ulnar side of right hand and clawing of right
little finger. Apart from these signs, there were two big hypo pigmented
patches with four satellite lesions on right arm all of which had reduced
sensations.
a) Write the diagnosis for Mrs. Kumari and substantiate your diagnosis
(0.5 + 0.5 = 1mark)
Multi bacillary leprosy. Reasons: About 6 hypopigmented skin lesions
with impaired sensation; Involvement of peripheral nerve viz., ulnar nerve
resulting in ulnar claw hand
b) Identify the above test done on Mrs.Kumari. Explain the procedure and
interpretation of the same. (1+2 = 3 marks)
VMT (Voluntary Muscle Testing) for Facial Nerve:
Ask the patient to close her eyes and keep them lightly closed as if in
sleep.
If there is no gap, ask her to close the eye tightly and try to pull the lower
lid down and see whether the patient is able to keep her eyes closed against
resistance.
Grading of muscle strength:
S (Strong) = Able to keep her eyes closed against resistance
P (Paralysed) = A gap visible between the upper and lower eye lids
W (Weak)= Not able to keep her eyes closed
c)While on treatment, Kumari suddenly developed fever, joint pains and
red, tender sub cutaneous nodules. Identify the condition and outline the
management regimen. (1+2 = 3marks)
Lepra reaction (type 2 ENL)
d)Identify the above clinical examination procedure. Explain the steps
involved (0.5+ 2.5 = 3marks)
Palpation of ulnar nerve.
Steps involved:
1.Position of patient: Both patient & examiner facing each other.
2. Site: In the groove above and behind medial epicondyle of the elbow.
3.To examine right ulnar nerve, ask the patient to flex the elbow joint
slightly.
4.Hold the right wrist with your left hand. With the right hand feel for the
medial epicondyle. Pass behind the elbow and feel the ulnar nerve in the
groove.
5.Gently palpate with pulp of 2 fingers (index & middle) and feel across
the nerve, watching facial expression for signs of tenderness. Look for nodules
if any.
6.Trace the nerve proximally as far as to ascertain the length of the
swelling.

5. Mrs. Vanmathy, 63year old female presented with polyphagia, fatigue

and blurred vision. She is a retired bank manager and is staying at home
most of the time. Despite losing weight, her current BMI is 33. She
mentioned that she had to wake up frequently during the night to urinate
during the past 3 weeks. She has a family history of diabetes. The general
practitioner ordered for the following investigations and the results were as
follows: Hb – 11 gm%, Blood urea – 25 mg/dl, blood creatinine – 2.2 mg/dl,
Random blood glucose - 240 mg/dl
 a. What is the most likely diagnosis? What is the main underlying
cause of her disease? (0.5 + 0.5 = 1 mark)
Diabetes mellitus type 2 with complications. B cell dysfunction and
Insulin resistance
b. What are the factors which predisposed her to such a condition?
(0.25 x 4 =1 mark)
Modifiable risk factors
-Obesity.
-Sedentary life style.
Non modifiable risk factors
- Aging
- Family history
c. What is the WHO recommended diagnostic criteria for the above
condition? (2 marks)
a) Fasting venous plasma glucose - >126 mg/dl
b) 2hour post load venous plasma glucose- > 200 mg/dl
c) Random plasma glucose > 200 mg/dl
d) HbA1c 6.5%
d. Name two complications associated with her disease? (1mark)
- Retinopathy
- Neuropathy
- Nephropathy
-Diabetic ulcer
e. What will you advice Mrs.Vanmathi to control the progression of the
disease? (1mark)
Maintenance of normal body weight through Lifestyle modification by
 a) Adoption of healthy nutritional habits - The nutritional habits include an
adequate protein intake, a high intake of dietary fiber and avoidance of
sweet foods and
b) Physical exercise.
f. What do you recommend for this patient who has developed the
disease? (1mark)
(a) to maintain blood glucose levels as close within the normal limits and
(b) to maintain ideal body weight.
g. If you want to check her glycemic control over the previous 2-3
months, what is the proper test? (1mark)
- Measurement of Glycosylated hemoglobin (HbA1C)
h. Name the health programme focusing this disease. (1mark)
National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS)
i. Who are subjected to screening for this disease under the Programme?
(1mark)
All men and women > 30 years and all pregnant women of all age.

6. Mr. Thomas, 54year old taxi driver came to hypertension OP with

repeatedly high readings on his brother’s home BP machine. He had no
other symptoms. He smokes 5 cigarettes/ day for 10 years. He is an
occasional, social drinker. He said his father has high BP and high
cholesterol. Upon physical examination, his blood pressure (BP) is 138/87
mm Hg; weight is 72 kg, and his body mass index (BMI) is 28 kg/m2. No
edema or murmur is noted.
a. What stage of hypertension will Mr.Thomas be classified and why?
(0.5 + 0.5 =1mark)
Primary (essential) Hypertension.
Hypertension is classified as “essential” when the causes are generally
unknown.
 b. Mention the common errors while recording of blood pressure.
(1mark)
(a) Observer errors. e.g: hearing acuity, interpretation of Korotkoff
sounds.
(b) Instrumental errors: e.g., leaking valve, cuffs that do not encircle the
arm and
(c) Subject errors: e.g., the circumstances of examination like physical
environment, the position of the subject, external stimuli such as fear, anxiety
etc.
c. What are the risk factors for hypertension in this patient? (0.25 x 4 = 1
mark)
Non modifiable :
- Age
- Family history
Modifiable :
- Obesity
-Alcohol intake
-Physical inactivity
-Stressful lifestyle
d. What are the approaches recommended by WHO for the primary
prevention of hypertension? (1mark)
(a) Population strategy
(b) High-risk strategy
e. What are the non-pharmacotherapeutic interventions you would give to
to Mr.Thomas ? Any 2 (0.5 x 2 = 1 mark)
(a) NUTRITION – i) reduction of salt intake (less than 5 g per day)
(ii) moderate fat intake and (iii) avoidance of a high alcohol intake.
(b) Maintenance of body weight at a BMI below 25.
(c) EXERCISE PROMOTION
 (d) Reduction of stress and smoking, modification of personal life-style,
yoga and transcendental meditation.
(e) HEALTH EDUCATION on all risk factors and related health
behavior and
(f) SELF-CARE
f. What dietary advice will you give to Mr.Thomas to control the blood
pressure levels ? (1mark)
DASH diet - Dietary Approaches To Stop Hypertension- A diet rich in
fruits, vegetables and low-fat dairy products with a reduced content of saturated
fat and total fat
g. What advice on physical activity do you recommend to Mr.Thomas?
(1mark)
Engage in regular aerobic physical activity such as brisk walking at
least 30 minutes per day on most days of the week.
h. What is the need for routine screening of hypertension? Who should be
screened for hypertension? (1mark)
High blood pressure rarely causes symptoms until organ damage has
already occurred and our aim should be to control it before this happens. So
opportunistic screening of all people above 30 years of age is recommended.
i.What is “Tracking” of blood pressure? (1mark)
If blood pressure levels of individuals were followed up over a period
of years from early childhood into adult life, then those individuals whose
pressures were initially high in the distribution, would probably continue in the
same “track” as adults. Low blood pressure levels tend to remain low, and high
levels tend to become higher as individuals grow older. This phenomenon of
persistence of blood pressure is “tracking”. This helps to identify children and
adolescents “at risk” of developing hypertension at a future date.
j. Name the health programme focusing this disease. Name the schemes
recently integrated with this Programme? (1mark)
- National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS)
- AYUSH, RBSK and RNTCP are recently integrated with NPCDCS.
7.15-year-old, Raju while walking on his way back from school, tried to
empty his leftover lunch in a dustbin on the road. He did not notice a stray
dog there, which tried to grab the lunchbox from his hand. He left the box
there and ran away. At home, he noticed 2 scratches (1 cm each) on his arm
without bleeding.

a. What infection is Raju likely to incur?(0.5 marks).

Rabies
b. What is the source of infection of this case (0.5 marks)
• Saliva of rabid animal
c. What is the name of the pathognomic lesion in this disease (1 Mark)
• Negri bodies (intracytoplasmic inclusion bodies)
d. 1) How will you assess and categorize the wound of Raju and
why?(3marks).
Category I Touching, feeding, licking on
intact skin
Category II Nibbling of uncovered skin, minor
abrasion/scratches without
bleeding
Category III Single/multiple transdermal bites
/scratches /licks on broken skin.
Contamination of mucous
membrane with saliva from licks

2) Which category does Raju fall under?

Cat II (0.5 marks)

e. How should Raju’s wound be managed? (1 mark)

• Cleansing with soap and water under running tap for 15 mins,
chemical treatment with alcohol, or povidone iodine, antibiotics
and anti-tetanus if needed
f. Describe the Essen’s regimen. (2 marks)
 • 5 doses, intramuscular, in deltoid or anterolateral part of thigh, 1ml
(0.5 marks)
• 0 3 7 14 28 days (1mark)
g. Enlist 4 vulnerable population for Preexposure prophylaxis (1 mark)

Laboratory staff handling the infected material, clinicians and individuals

attending the human rabies cases, Veterinarians, animal handlers and dog
catchers, hunters, Travelers from rabies-free area to rabies endemic areas

h. If a pregnant woman has a dog bite, can she receive the vaccine? (0.5
mark)
Yes.

8.A 36 years old, Mrs. Kamala, came to OPD with complaints of backpain
and increased vaginal discharge which was watery, sometimes blood
stained. She also complained of bleeding after intercourse. She was advised
to get evaluated for cancer cervix.
a. Mention the Causative agent of cancer cervix. List any 4 risk factors
of cancer cervix (1 mark)
Human papilloma virus. (0.5 marks)
Age – 25-45 years, Genital warts, multiple sexual partners, OCP usage,
low socio economic class (0.5 marks)
b. Name the vaccines available in India for cancer cervix (1 mark)
Gardasil
Cervarix
c. Name the other cancers caused by biological agents (1 mark)
EBV - Burkitt’s lymphoma, Nasopharyngeal carcinoma
Human T cell leukemia virus - T cell leukemia/lymphoma
Cytomegalovirus - Kaposi sarcoma
Hep B & C – hepatocellular carcinoma
Schistosomiasis – bladder carcinoma
d.What is the screening test for this condition ?(1 mark). When is
this test recommended? (1 mark)
 - PAP smear
- All women are advised to have PAP smear at the beginning of sexual
activity and then every 3 years
e.What are the other cost-effective screening methods available for Ca
cervix. Describe how is it done. (2 marks)
Visual inspection using 5 %acetic acid (VIA)
Visual inspection using Lugol’s iodine (VILI)
Freshly prepared 5% acetic acid solution /Lugol’s iodine is applied in
cervix and observed for well- defined opaque well defined acetowhite
lesions
f.Identify the picture. (1 mark)

Acetowhite lesions
g. List the top 5 cancers among women in India (1 mark)
Ca breast, CA cervix, CA colorectum, CA ovary, CA lip
h. Under which programme in Tamil Nadu, screening for Cancer
cervix is done for all adult women (1 mark)
Makkalai thedi maruthuvam
9) In a medical college hostel, students complained to the warden that there
were many inmates falling sick with high grade fever, severe body aches,
fatigue and running nose and severe sore throat. Inmates thought this was
an outbreak of flu and this led to great panic among students and parents.
The warden requested the epidemiologist in the college to investigate this
complaint.
a. What data will the epidemiologist require to establish if this is an
outbreak? (5 marks)
1. Number with verified diagnosis of the cause for URI. This has to be
through clinical examination and laboratory investigation from a sample of
inmates falling sick. Sample can be selected using a simple random
sampling method. (2 marks)
2. Calculate the disease frequency. This is the number of inmates who were
suffering from specified symptoms and signs during the last one week
divided by the average number of inmates present during the week.
(2marks)
3. If the above two data are clearly above the expected frequency, an
outbreak is confirmed (1 mark)
b. Considering that an outbreak of URI has been established in the hostel.
how will you identify the primary case? (1 mark)
Through a detailed travel and contact history taking of all the confirmed
cases of URI in the hostel.
c . How will you analyse the data obtained from the outbreak investigation
in the student’s hostel and interpret the findings? (4 marks)
1. The data has to be analysed with respect to time, place and person of
occurrence of each event of fever with other symptoms and signs of URI.
(1 mark)
2. The data has to be tabulated. Rates and ratios have to be calculated to
indicate source and aetiology. (1 mark)
3. Hypotheses have to be formulated with regards to source and aetiology,
if possible identifying control measures. (1 mark)
4. Formulated hypothesis has to be tested using appropriate statistics. (1
mark)
10. You are a doctor practicing in your own private nursing home. Your
neighbour comes to your house in early morning hours asking you to check
on his father who is not responding to any stimuli. You visit their house and
find that the person has no pulse, no respiration, pupils are fixed and dilated.
a. Are you eligible to declare the death of this person? (1 mark)
yes, because any registered medical practitioner is eligible to declare
death.
b. Are you eligible to certify the death? Give reasons for your answer.
(2 marks)
No, because neither I am the treating physician nor did I witness the
death
c. Which death form can you certify if you had attended the death? (1
mark)
form 4A
d. Considering that the above person named Mr. Kuppusamy son of
Mr. Rajendran aged 66 years residing in P.N.Palayam visited your
nursing home for treatment regarding chronic hypertension and
diabetes mellitus for 7 years. He was diagnosed to have Coronary
Artery Disease a year ago. He was under treatment for 4 days.
Suddenly had an episode of angina and went for cardiogenic shock. He
expired due to cardiopulmonary arrest on 10.2.2023 at 11.25 am.
Write a medical certification for the cause of death. (6 marks)
11.
P1 P2

a. What is your observation on P1 and P2? (2 mark)

P1 - Skin pinch test- Skin goes back very slowly, more than 2 seconds
- Indicates severe dehydration -Fluid deficiency more than 10% of the
body weight
P2 - Sunken eyes
b. Mention and classify the clinical condition that causes these
symptoms? (1 mark)
Acute diarrheal disease with severe dehydration
c. Write down the IMNCI classification of the disease? (2 marks)
Severe dehydration (any 2 of the following signs) – Lethargic or
unconscious, Sunken eyes, Not able to drink or drinking poorly, Skin
pinch goes back very slowly
Some dehydration (any 2 of the following signs) – Restless and
irritable, sunken eyes, thirsty and drinks eagerly, skin pinch goes back
slowly
No dehydration – Not enough signs to classify in above 2 groups
d. What are the risk factors associated with this condition? Any 4. (0.25
x 4 = 1 mark)
Poverty, prematurity, reduced gastric acidity, immune deficiency,
lack of personal and domestic hygiene, incorrect feeding practices.
e. How will you manage this condition? (2 marks)
 SEVERE DEHYDRATION – Intravenous fluids should be started
immediately using Ringer lactate with 5% dextrose. Plain ringer lactate or
Normal saline may be used as alternative but 5% dextrose alone is not
effective. A Total of 100 ml/kg of fluid is given, over 6 hours in children
< 12 months and over 3 hours in children >12 months.

AGE 30 ml/kg 70 ml/kg

<12 months 1 hr 5 hrs
>12 months 30 min 2 and half
hrs

f. What are all the warning signs for this condition? (1 mark)
DANGER SIGNS = continuing diarrhea beyond 3 days, increased
volume / frequency of stools, repeated vomiting, increasing thirst, refusal
to feed, fever or blood in stools.
g. Which vaccine is being given under National Immunization Schedule
to prevent this disease in children? (1 mark)
Rota virus & vit A

12.
 a. What disease do these pictures indicate? (1 mark)
Rheumatic Heart disease
b. What are the causes of this disease? (1 mark)
Group A beta hemolytic streptococci, Coxsackie B 4
c. What are the risk factors for this condition? (0.25 x 4 = 1 mark)
Poverty, overcrowding, poor housing, low level of awareness,
School children aged 5-15 years, Slum dwellers, those living in barracks.
d. What is the diagnostic criteria of this disease? (2 +2 = 4 marks)

Major manifestation Minor manifestation

Carditis • Clinical – Fever,

Polyarthralgia
Polyarthritis
• Laboratory- elevated
Chorea
Acute phase reactants /
Erythema marginatum ESR /Leucocyte count
Subcutaneous nodules

Diagnostic Criteria
categories
Primary episode of Two major (or) one major and two minor
RF manifestation + evidence of preceding
streptococcal infection
 Recurrent attack of Two major or one major and two minor
RF in a patient manifestation + evidence of a preceding
without established group A streptococcal infection
RHD
Recurrent attack of Two minor + evidence of a preceding group
RF in patient with A streptococcal infection
established RHD

e. Elaborate the primary and secondary preventive measures of this

condition? (1.5 + 1.5 = 3 marks)
Primary prevention- To prevent the attack of RF - Single IM injection
of 1.2Million units of Benzathine penicillin for adults and 6,00,000 units for
children then Oral Penicillin G for 10 days.
Secondary prevention - Prevention of recurrences of RF -IM injection
must be continued for atleast 5 years or until the child reaches 18 yrs. For the
patients with carditis, the treatment should be continued for 10 yrs after last
attack or at least until 25 yrs of age. More severe valvular disease or post
valvular surgery cases require lifelong treatment.
Improving living conditions, breaking poverty-disease-poverty cycle,
better housing.

13.
 a. Identify the disease condition from the above picture. (1mark)
Scabies
b. Identify its causative organism. (1mark)
Itch mite: Sarcoptes scabiei or Acarus scabiei
c. What is the mode of spread for this disease? (1mark)
Close contact and contaminated clothes
d. Enlist any four signs and symptoms of this disease? (0.5 x 4 =2marks)
The main diagnostic features are
a. Itching which is worse at night
b. Follicular lesions at the affected site
c. Secondary infection leads to crusted papules and pustules
d. Other members of the household are also affected
e. Confirmed by searching for the parasite in the skin debris under the
microscope
e. Name the stages in the life history of the organism (1mark)
Four stages – egg, larva, nymph and adult
f. What is the drug of choice, mention its recommended strength?
(1mark)
25 percent Benzyl Benzoate
g. How is this drug applied? (2marks)
 After giving thorough scrub bath, the drug should be applied with a paint
brush or shaving brush to every inch of the body below the chin, including the
soles of the feet. The application should be repeated after 12 hours and further
12 hours later a bath is given and all clothes and beddings should be washed.
h. What type of mass treatment is done in case of this disease? (1mark)
Blanket treatment

14. Baby Ramu, aged 18 months has been coming to the health centre
regularly since birth for health check-ups. The following table gives his
weight in kg for his corresponding age at that time.
Age
0 3 6 9 12 15 18
(months)
Weight
2.6 5.4 6.8 6.8 7 7.2 7.4
(kg)

a. Plot the weight of the baby against his weight in the chart given
(2marks)
 b. Write your inference from the graph plotted (1mark)
Child has severe acute malnutrition
c. What is the name of this chart? (1mark)
Growth chart or Road to health chart
d. Who developed this chart? (1mark)
David Morley
f. Mention any four uses of this chart? (0.25 x 4 = 1mark)
i. Growth monitoring
ii. Diagnostic tool
iii. Planning and policy making
iv. Educational tool
v. Tool for action
vi. Evaluation
vii. Tool for teaching
f. Define Severe Acute Malnutrition (SAM) (2marks)
 Severe acute malnutrition is defined by very low weight-for-
height/length (Z- score below -3 SD of the median WHO child growth
standards), or a mid-upper arm circumference < 115 mm, or by the presence of
nutritional oedema. Severe Acute Malnutrition is both a medical and social
disorder.
g. Where are SAM children managed? (1mark)
Nutritional Rehabilitation Centers
h. What does flattening of this curve mean? (1mark)
Flattening or falling of the child’s weight curve signals growth
failure, which is the earliest sign of protein-energy malnutrition.

15) Mrs. Rani (wife of Mr.Mani), age 26 years, was admitted at 11:00 am
on 2 Jan 2023 with the complaint of labour pains since 4:00 am. Her
membranes ruptured at 9:00 am.
Plot the following findings on the partograph:
At 11:00 am:
• The cervix is dilated 4 cm.
• The Fetal head was at -5 station.
• She had 3 contractions in 10 minutes, each lasting less than 20 seconds.
• The FHR is 140 per minute.
• The membranes have ruptured and the amniotic fluid is clear.
• Her BP is 100/70 mmHg.
• Her temperature is 37°C.
• Her pulse is 80 per minute.

Time FHR Contractions Pulse Amniotic

Fluid
11.30 130/min 3/10 each 35 seconds 88/min Clear
am
12.00 136/min 3/10 each 40 seconds 90/min Clear
pm
12.30 140/min 3/10 each 40 seconds 88/min Clear
pm
 1.00 130/min 3/10 each 40 seconds 90/min Clear
pm
1.30 120/min 3/10 each 45 seconds 96/min Clear
pm
2.00 118/min 3/10 each 45 seconds 96/min Clear
pm
2.30 112/min 3/10 each 45 seconds 98/min Meconium
pm Stained

At 3:00 pm
• The cervix is dilated 6 cm.
• The Fetal head was at -3 station.
• She had 4 contractions in 10 minutes, each lasting 45 seconds.
• The FHR is 100 per minute.
• The amniotic fluid is meconium-stained.
• Her BP is 120/80 mmHg.
• Her temperature is 37.8°C.
• Her pulse is 100 per minute.

a. Plot the above details in a Partograph (3 marks)

b. What is your inference and what action will you take? (1 mark)
Fetal distress/Non progression of labor
 Action: Immediate referral to tertiary care center/ Cemonc center for
cesarian section.
c.Mention two uses of partograph (1 mark)
Graphical representation of labor
Indicator of maternal and fetal well being
d. When will you start plotting a partograph (1 mark)
When cervical dilatation is 4 cm
e. How frequently should you plot the vital indicators? (1 mark)
Every 30 minutes
- Fetal heart rate
- Pulse rate
- Contractions
- Liquor
Every 4 hours
- Blood pressure
- Cervical dilatation
- Fetal station
f. What are the indicators of good progress of labour in partograph? (1
mark)
- Cervical dilatation 1cm/hr
- Descent of head adequate
- Increase in number and duration of contraction
g. What are the indicators of fetal well-being in partograph? (1 mark)
- Fetal heart rate within normal limits
- No moulding
- Normal liquor
h. What are the indicators for immediate referral? (1 mark)
- No descent of head
- Cervical dilatation less than 1cm/hr and plot crosses below the alert
line
- No change in force of contraction
- Fetal distress like tachycardia, bradycardia, meconium stained liquor

16) In a village of 3000 population with 650 houses , for past one week there
were about 50 cases of mild fever with watery diarrhea were reported
from the village. The previous day also about 12 cases were reported with
the same symptoms. As a medical officer you have instructed the health
inspector to check the presence of residual chlorine using chloroscope of
water sample of that village.

a.What are the steps to check the presence of residual chlorine using
chloroscope (1 x 5= 5 mark)
1. Fill the test tube with water to be tested upto the 1 mark
mouth
2. Shake the ortho toluidine solution. Add 2 drops of 1 mark
OT solution to the test tube and shake well
3. Look for the appearance of color 1 mark
4. Place it in the chloroscope and match it with color 1 mark
intensity and note the value
5. What is the inference made 1 mark

b. Enlist any four waterborne diseases (0.25 x 4 = 1mark)

- Enteric, Salmonella
- Cholera
- Viral
- Bacillary dysentery
- Amoebiasis
c. What are the main disinfecting components in chlorinated water? (1
mark)
HOCl – Hypochlorous acid, Hypochlorous ions
d. What is superchlorination? When it is used? (0.5 x 2 = 1 mark)
- Chlorine is applied beyond break point usually over 4 ppm.
- It is used in swimming pools, outbreaks, festivals.
e. What is the minimum level of chlorine that should be present at the
last pipeline of that village(1mark)
0.5 ppm
f. In that village there is a overhead tank with a capacity of 25,000 liters.
Horrock’s apparatus test shows blue colour from 3rd cup onwards. How
much amount of bleaching powder is needed for normal chlorination
(1mark)
Capacity = 25,000 litres
Horrock’s apparatus – 3rd cup
(i.e.) 6 gm is needed to disinfect 455 litres of water.
 So for 25,000 litres, = 6 x 25,000
455
= 329.67 (330 grams)
- 330 grams is needed to disinfect 25,000 liters capacity of the tank for
normal chlorination.

17) In a family of five members, a child of 7yrs developed fever which was
sudden in onset with chills, high grade, intense headache, retro- orbital
pain associated with photophobia and also complaints of abdominal pain.
His father had similar illness and history of travel before 2 weeks and
recovered from the same. On torniquet test the child was found to be
positive and pathophysiological changes like rising hematocrit value and
moderate to marked thrombocytopenia.
a. What is the probable diagnosis of the above explained condition? (1
mark)
Classical dengue fever
b. How will you interpret torniquet test? (1 mark)
A positive test is 10 or more petechiae for 1 sq.inch
c. What is the extrinsic and intrinsic Incubation period of the above
condition? (0.5 x 2= 1mark)
Extrinsic incubation period – 8 to 10 days
Intrinsic incubation period – 5 to 7 days
d. What is the programme related to this condition? (1 mark)
NVBDCP – National Vector Borne Disease Control Programme
e. What are the vector causing the above infection? (0.5 x2 =1 mark)
1. Aedes aegypti 2. Aedes albopictus
f. What is the flight distance of the vector involved in the disease? (1
mark)
Upto 400 metres
g. What are the other diseases caused by this vector? (0. 5 x 2= 1 mark)
- Chikungunya
- Yellow fever
- Zika
- Filariasis
- Rift valley fever
 h. Enlist any four investigations that will favor the diagnosis of the
above condition (0.25 x 4= 1mark)
- Platelet count
- Hematocrit
- Positive tourniquet test
- Hemorrhagic manifestation
- Acute onset of fever of 2 to 7 days duration
i. Enlist any four laboratory test to diagnosis the above condition (0.25 x
4= 1mark)
- NS1 Ag Rapid Test
- RT PCR
- Virus isolation
- IgG ELISA
- IgM ELISA
- Neutralization test
j. Comment about the usefulness of Paris Green to control the above
vector? Mention any other vector for which it can be used? (0.5 x 2= 1
mark)
Paris green has no effect on the above vector but useful against
Anopheles (surface feeder).

18) Mathuri, 3 years old, child is brought to under 5 clinic by her mother
with c/o loose stools for past three days. She did not have vomiting or fever.
The mother had stopped giving water or any food because of loose stools.
Now she feels that the baby is sleepy and not interested in surrounding
since morning.
How will you proceed with clinical history, examination, advice the mother
regarding feeding and preventive measures pertaining to this condition?
(5marks)

Greet the mother and make her sit and develop a rapport.
a. Ask for duration, frequency, consistency and presence of 1mark
any blood in stools.
Look for general condition (Lethargy/Restlessness), sunken
b. eyes. Offer water to baby and look whether she drinks 1mark
 eagerly or unable to drink. Pinch the skin to find out how
slowly it goes back. (normal/>2 seconds)

Assess for no/some/severe dehydration

c. 1mark

Counsel the mother that during diarrhoeal episodes, if the

d. baby drinks water, do not stop oral feeds. Continue with 1mark
usual diet of cereals, vegetables and other foods.
Advice the mother regarding preventive measures such as
e. handwashing, use of clean drinking water, maintain clean 1mark
latrine, proper disposal of stools of child and immunisation.
Verify if the mother has understood the transformed
knowledge and thank her.

f. According to IMNCI, what will be your diagnosis and mention

clinical signs pertaining to your diagnosis? (1mark)
Acute diarrhoeal disease.
Clinical Signs – sunken eyes, restless and irritable /lethargic or
unconscious, thirsty and drinks eagerly / not able to drink, skin pinch goes back
very slowly.
g. How will you manage the severe form of this disease? (1mark)
SEVERE DEHYDRATION – Intravenous fluids should be started
immediately using Ringer lactate with 5% dextrose. Plain ringer lactate or
Normal saline may be used as alternative as 5% dextrose alone is not effective.
A total of 100 ml/kg of fluid is given, over 6 hours in children < 12 months and
over 3 hours in children >12 months
h. How will you calculate the amount of ORS required in first 4 hours,
if the age of the baby is not known? (1mark)
The patient’s age should only be used if weight is not known. The
approximate amount of ORS required in ml. may be calculated by multiplying
the patient’s weight (expressed in kg) by 75.
i. What are the vaccines given to prevent this disease and mention its
dose, site and route of administration? (1mark)
Rotavirus vaccine – 3 doses given at 6th,10th,14th weeks, oral ,3 drops.
Measles – 2 doses given at 9 completed months-12 months and 16-24
months,0.5 ml, sub- cutaneous, right upper arm.
 j. What is the prophylactic drug given to reduce the severity of the
disease and mention its dose? (1mark)
Zinc supplements are given for 10 – 14 days to lower the incidence of
diarrhoea.
WHO and UNICEF recommend daily 10 mg of zinc for Infants under 6
months of age and 20 mg for children older than 6 months for 10 – 14 days.
When zinc supplement is given during an episode of acute
diarrhoea, it reduces the frequency, duration and severity of diarrheal
episodes.

19) A 32 years old Mrs. Vijaya with obstetric score of G3P1L1A1 came
with complaints of easy fatiguability, breathlessness on exertion at 28
weeks of gestation. O/E, Mother was pale, On Auscultation, chest was clear.
Hb – 6 g/dl.
a. What is the cutoff value of Hb for anemia in pregnancy and classify?
(1 +1 = 2 marks)
11 gm/dl
Mild anemia – 9 t o 10.9 gm/dl
Moderate anemia – 7 to 8.9 gm/dl
Severe anemia – less than 7 gm/dl
b. Enlist any 4 complications due to anemia in pregnancy? (1mark)
 c. Name any 2 food sources of haem-iron and non-haem iron? (1mark)
Haem-iron = liver, meat, poultry, fish.
Non-haem iron = cereals, green leafy vegetables, legumes, nuts,
jaggery, dried fruits.
d. Name any 4 causes of anemia in pregnancy? (1mark)
Nutritional /Iron deficiency, hookworm infestation, pre-pregnancy poor
nutrition, multiparity, antepartum haemorrhage, postpartum haemorrhage,
recurrent abortions, hemoglobinopathies like thalassemia, sickle cell anaemia.
e. Under which category of anemia does this patient belong to ?How
will you manage this patient ?(1 + 1 = 2 marks)
• Severe anemia
• As the patient is in 28 weeks of gestation with Hb 6 gm%, she must be
advised for blood transfusion.

g. What is the dose of IFA tablet and how long is it given during
pregnancy under Anemia Mukt Bharat Programme? (1mark)
Anaemia Mukth Bharath: 60 mg elemental iron and 500 μg of folic acid
every day for at least 180 days starting after the first trimester plus same dose
for 180 days postpartum
g.What advice will you give before prescribing prophylactic iron and
folic acid tablet to this patient?(1 mark )
• Preferably take the tablets during night time
• Avoid consuming iron and folic acid tablets along with milk, tea, coffee
as they may interfere with iron absorption
• Consume the tablet after meals to avoid gastric discomfort and nausea.
• Calcium tablets should not be taken at the same time, as calcium inhibits
with iron absorption
• Patients may pass black stools after consuming tablets.

h. Mention any 4 indications for parenteral iron therapy. (1mark)

1. No response to oral iron therapy after 2-4 weeks of treatment.
2. Inability to tolerate oral therapy due to gastrointestinal side effects
3. Malabsorption disorder (prior gastric bypass surgery)
4. Severe iron deficiency anaemia
20. With the arrival of monsoon season, The Health Inspector reported an
increase in fever cases for the past one week from a particular village.
Domestic breeding checkers have also detected mosquito breeding in more
than 70% of the houses in that particular village last week. The following
pictures were taken in and around the village.

[PICTURE A] [PICTURE B]

[PICTURE C]

a) Identify the picture [ A] and write the Public Health Importance of

the picture[A] (0.5 x 2 = 1 mark)
It is Pistia water plant associated with Mansonoides mosquito –
Vector for Brugia malayi filarisis.
This source may enhance the breeding of Mansonoides mosquito which
will spread Filariasis in that area
b) Identify the picture [B] and write the Public Health Importance of
the picture[B] (0.5 x 2 = 1 mark)
 It is a Coconut shell – breeding source of Aedes mosquitoes
This source may enhance the breeding of Aedes mosquitoes which will spread
Dengue and Chikungunya in that area.
c) List out the various vector control strategies for this village. (2
marks)
1.Environmental control -Source reduction
2.chemical control -Chemical larviciding, chemical adulticiding(fogging)
3.Biological control – Gambusia fish
4.Personal/community protection – insecticide treated nets
5.Modern methods – genetic control, chemosterilants, sex attractants

d) What do you mean by Integrated vector control?(2 marks)

It is defined as the rational decision making process for the optimal use of
resources for vector control and includes 5 elements
1.evidence based decision making
2.integrated approach
3.capacity building
4.intra and inter sectoral collaboration
5.advocacy,social mobilisation and legislation

The need to overcome challenges experienced with conventional single

intervention approaches to vector control as well as recent oppurtunities
for promoting multi sectoral approaches to human health

e) Define any two indices used to monitor Aedes aegypti infection

levels.? ( 2 marks)
House Index = Percentage of houses infested with larva or pupae
Container index = Percentage of water holding containers infested with
larva or pupae
Breteau index = Number of positive containers per 100 houses inspected
Pupa index = Number of pupae per 100 houses inspected
f) Identify the larval species in PICTURE [C] and why (1 + 1 = 2
mark)
Anopheles larva
Floats horizontally in water
Have no siphon tube at the tip of its abdomen.
Palmate hairs present on abdominal segments.