4 Spotters Ex Case-1

SPOTTERS
1. MEDICAL ENTOMOLOGY
Points to be written:
 Draw suitable diagrams
 Identification with two points
 Classification
 Habitat
 Diseases transmitted
 Prevention & Control
 National Programme
ANOPHELES EGG: ANOPHELES LARVA
ANOPHELES PUPA ANOPHELES ADULT RESTING POSITION

ANOPHELES ADULT MALE: MOUTH PARTS ANOPHELES ADULT FEMALE: MOUTH PARTS
AEDES EGG: AEDES LARVA

AEDES PUPA AEDES ADULT RESTING POSITION
AEDES ADULT MALE: MOUTH PARTS AEDES ADULT FEMALE: MOUTH PARTS
CULEX EGG: CULEX LARVA
CULEX PUPA CULEX ADULT RESTING POSITION

CULEX ADULT MALE: MOUTH PARTS CULEX ADULT FEMALE: MOUTH PARTS
SANDFLY HOUSEFLY: MAGGOTS

RAT FLEA BED BUG
HARD TICK SOFT TICK

HEAD LOUSE (MALE) HEAD LOUSE (FEMALE)
CYCLOPS MALE CYCLOPS FEMALE

ITCH MITE MICROFILARIA
PLASMODIUM VIVAX: SCHIZONTS PLASMODIUM VIVAX GAMETOCYTES

PLASMODIUM FALCIFARUM : SCHIZONTS PLASMODIUM FALCIPARUM GAMETOCYTES
2. ANTISEPTICS AND DISINFECTANTS
POINTS TO BE WRITTEN:
 Identification
 Nature
 Action
 Uses & dose

PHENOL CRESOL BLACK
SAVLON DETTOL
BLEACHING POWDER CHLORINE TABLETS
SOAP ALUM
LIME POVIDONE IODINE
SURGICAL SPRIT
3. INSTRUMENTS
 Identification
 Description
 Uses
SALTERS SPRING BALANCE INFANT WEIGHING SCALE
INFANTOMETER STADIOMETER
HARPENDEN’S SKIN CALIPER HORROCK’S APPARATUS
CHLOROSCOPE LACTOMETER
HYDROMETER WET &DRY BULB THERMOMETER
VACCINE CARRIER WITH ICE PACKS DAY CARRIER WITH ICE PACKS
4. INSECTICIDES
POINTS TO BE WRITTEN
 Identification
 Nature
 Action
 Uses
PYRETHRUM 2% (BOTANICALINSECTICIDE) DELTAMETHRIN 2.5% (SYNTHETIC PYRETHROID)
DIELDRIN (ORGANO CHLORINE COMPOUND) HEXA CHLORO CYCLOHEXANE (HCH)

MALATHION (ORGANOPHOSPHATE COMPOUND) ABATE / TEMEPHOS (ORGANOPHOSPHATE COMPOUND)
PROPOXUR 20% (OMS-33) CARBAMATE PARIS GREEN (COPPER ACETOARSENITE)

N. DIETHYL BENZAMIDE N. DIMETHYL PHTHALATE
(ODOMOS) MOSQUITO REPELLENT (DMP) MOSQUITO REPELLENT
BENZYL BENZOATE
BARIUM CARBONATE (RODENTICIDE) ZINC PHOSPHIDE (RODENTICIDE)
5. MODELS
 Identification
 Description
 Uses
SLOW SAND FILTER RAPID SAND FILTER
SANITARY WELL TUBE WELL

STEP WELL DOMESTIC WATER FILTER
(BERKEFIELD FILTER)
SEPTIC TANK BORE HOLE LATRINE

RCA LATRINE WATER TRAP/ SEAL
SOAKAGE PIT
6. NUTRITION
 Identification
 Predominant functions
 Nutrients
 RDA
 Public health importance: storing, processing, cooking/

preparation, deficiency, etc.
RAW RICE PARBOILED RICE
BROWN RICE WHEAT

BAJRA MAIZE
RAGI BENGAL GRAM

BLACK GRAM RED GRAM
GREEN GRAM SOYABEAN

GREEN LEAFY VEGETABLE POTATO
CARROT ORANGE
PAPAYA PINEAPPLE
APPLE MANGO
BANANA VEGETABLE COOKING OIL
VANASPATHI BUTTER
GHEE EGG
MILK FISH
SUGAR JAGGERY
GROUNDNUTS
7. MCH & FAMILY WELFARE
 Type of contraceptive
 Mechanism of action
 Eligible candidates
 Advantages
 Side effects
 Contraindications
 Failure rate
CONDOM MALE CONDOM FEMALE
MALA D MALA N
COMBINED ORAL PILL EMERGENCY PILL
COPPER-T MINI PILL

 Identification,
 Description,
 Public Health Importance
DISPOSABLE DELIVERY KIT DISPOSABLE MENSTRUAL HYGIENE KIT

MCH CARD GROWTH CHART
Points to be written for the spotters overleaf:
 Action,
 Indication,
 Dose,
 National Program
ALBENDAZOLE- TABLET ORS PACKET
ZINC TABLETS IRON AND FOLIC ACID- SMALL(TABLETS)

IRON AND FOLIC ACID- LARGE (TABLETS) IRON AND FOLIC ACID- WEEKLY IRON &
FOLIC ACID SUPPLEMENTATION (WIFS)
IODIZED SALT VITAMIN A SOLUTION

8. VACCINES
 Type of vaccine
 Schedule
 Dose, Route, Site of administration
 Adverse effects / reactions if any
 Contraindications
 Storage temperature at Primary Health Centre level
 Diluents to be used if any
 Important Precautions if any

DPT TT
HEPATITIS B MEASLES
MMR BCG
OPV TYPHOID
PENTAVALENT (DPT, HIB, HEPB) QUADRIVALENT (DPT, HiB)
JAPANESE ENCEPHALITIS VACCINE ANTI RABIES VACCINE

INJECTABLE POLIO VACCINE ROTAVIRUS VACCINE
AUTODISPOSABLE SYRINGE VACCINE VIAL MONITOR

9. DRUGS / MISCELLANEOUS
Point to be written:
 Identification
 Action
 Indication
 Doses
 National Programme if any

CHLOROQUINE TABLETS DEC TABLETS
MDT LEPROSY KIT- PB (ADULT) MDT LEPROSY KIT- PB (CHILD)

MDT LEPROSY KIT- MB (ADULT) MDT LEPROSY KIT-MB (CHILD)
MDT TB CATEGORY I MDT TB CATEGORY II

MDT TB PAEDIATRIC KIT COTRIMOXAZOLE SYRUP / TAB
LEPROSY- PAUCIBACILLARY CASE
(PHOTO)
Point to be written:
 Identification
 Description
 Public Health Importance
LEPROSY – MULTIBACILLARY CASE LEPROSY SELF CARE KIT

(PHOTO)
10. STATISTICAL DIAGRAMS
 Draw the following & describe the Concept & Importance.

1. The following are the health problems reported by 175 call center workers: Headache 43,
fatigue 34, eye problem 20, back pain 55, sleep disturbance 18, none 5.
Depict the same in the form of a simple table, pie chart and a simple bar diagram. Write
the importance & the general principles to be considered while constructing each of these
diagrams.
SIMPLE TABLE:
PIE CHART
SIMPLE BAR DIAGRAM
2. Following are the Infant Mortality Rates per 1000 live births according to NFHS 1,2 and 3.
Depict the same as a multiple bar diagram. Write the concept & importance of a multiple
bar diagram
Urban Rural Total

NFHS 1 56 85 79
NFHS 2 47 73 68
NFHS 3 42 62 57
MULTIPLE BAR DIAGRAM

3. Comment on the diagram given below. Write the type, concept and importance of the given
diagram
4. At rest pulse rates for 25 athletes are as follows: 63, 64, 66, 67, 68, 66, 64, 74, 77, 67, 64,
65, 77, 78, 70, 68, 79, 80, 75, 72, 69, 62, 78, 77, 71.
a. Construct a relative frequency distribution for this data using class interval 60-65, 66-70, 71-
75 and 76-80.
b. Construct a histogram & a frequency polygon for this data using the frequency distribution
given above.
5. Represent the following data with a suitable diagram. Write its concept & importance.
SRS 1983 1993 2003 2005 2006 2007 2008 2010

IMR 77 64 59 57 56 54 52 49
6. AGE PYRAMID (draw from textbook & write your comments)

7. Comment on the picture given below. Write its concept & importance
. - represents the
cases of water
borne diseases
X – represents the
water source
8. Comment on the picture given below. Write its concept & importance
9. Following are the length & weight of 10 group of fishes. Draw a scatter diagram &
comment.
Length of fish in cm 13.9 15.7 15.8 17.5 18.1 19.9 22.0 23.8 24.5 26.0
Weight in gram 50 59 64 73 78 81 87 89 92 98
10.PROPAGATED EPIDEMIC CURVE (draw from textbook & comment)
11. POINT SOURCE EPIDEMIC CURVE (draw from textbook & comment)
12. Following are the marks obtained by 120 students. Draw a Distribution curve & write its
features
Marks Marks Marks Marks

Roll no (100) Roll no (100) Roll no (100) Roll no (100)
1 10 31 87 61 82 91 90
2 50 32 82 62 97 92 95
3 84 33 79 63 95 93 72
4 71 34 94 64 94 94 82
5 76 35 87 65 85 95 87
6 83 36 58 66 82 96 59
7 47 37 76 67 92 97 92
8 36 38 95 68 87 98 90
9 66 39 76 69 79 99 95
10 79 40 88 70 95 100 85
11 84 41 84 71 92 101 92
12 94 42 71 72 90 102 90
13 68 43 89 73 85 103 100
14 87 44 92 74 85 104 87
15 76 45 82 75 33 105 90
16 84 46 89 76 97 106 88
17 87 47 87 77 95 107 85
18 95 48 82 78 92 108 90
19 74 49 87 79 92 109 93
20 89 50 79 80 82 110 98
21 58 51 84 81 87 111 80
22 76 52 84 82 77 112 76
23 87 53 82 83 92 113 88
24 87 54 82 84 64 114 70
25 85 55 92 85 55 115 65
26 82 56 90 86 85 116 80
27 66 57 90 87 69 117 100
28 89 58 95 88 77 118 93
29 89 59 92 89 90 119 68
30 84 60 82 90 67 120 98
PROBLEM
SOLVING
EXERCISES
NUTRITIONAL EXERCISES
1. Following is the details of weight in Kg of age in completed years of 4 children.

S.No Name Age in years Weight (Kg)
1 Sunil 3 yrs 11
2 Manas 4 years 11
3 Asha 2.5 years 9
4 Neha 4.5 years 9
1. Estimate the nutritional status and clarify the children according to degree of malnutrition.
2. Mention the necessary interventions.
2. Following are the weight and height of 4 subjects. Calculate the BMI and interpret the results.
S. No Name Age (years) Weight (Kg) Height (cm)
1 Sam 45 85 163
2 John 40 75 153
3 Arun 20 55 168
4 Ravi 17 40 155
3. Diet of a 50 kg pregnant house wife in last trimester consists of following:
 Calories – 1,800 Kcal, Protein - 40 grams, Iron - 20 mg
 What is the calorie deficit in her diet?
 What is the Protein deficit in her diet?
 What is the Iron deficit in her diet?
 Suggest a model menu.
ENVIRONMENT
Malarial & Filarial indices
1. In a Primary Health Centre with a population of 30,000, health workers collected 3,960 peripheral
blood smears by active surveillance and another 400 slides by passive surveillance during the year
2014. The result of the slide examination are as follows:
 Slides positive for Plasmodium vivax – 45
 Slides positive for Plasmodium falciparum – 12
 No of deaths due to malaria – 2
Calculate all the possible malarial indices & comment on your results.
2. In a primary health centre with a population of 30,000, 4000 blood slides were collected and
examined during the year 2014. Of them, 55 slides were positive for P. vivax. 15 slides were positive
for P. falciparum. Calculate the possible malarial parameters and comment on your results.
3. During the year 2014 in Kuthambakkam primary health center covering 30,000 population 4000
peripheral smears were collected by house to house visit. Another 400 smears were collected in the
OPD. Among the 4400 slides examined, 41 were positive for P. vivax and 9 for P. falciparum.
Calculate the possible malarial parameters and comment on your results.
4. In a PHC with a population of 25,000 a routine filarial survey was conducted and a total of 1200
persons were examined during the year 2012 .It was found that 50 of them showed microfilaria in
their peripheral blood while 100 of them showed clinical manifestation alone and another 50 of them
showed both microfilaria in their peripheral blood and clinical manifestation of the disease also.
Calculate the various filarial disease indices and comment.
5. In a PHC with a population of 25,000, a routine filarial survey was conducted and a total of
2000 persons were examined during the year 2012. It was found that 50 of them showed
microfilaria in their peripheral blood while 100 of them showed clinical manifestations.
Another 50 people showed both microfilarias in their peripheral blood and clinical
manifestations also.
a) Calculate the various filarial indices.
b) Comment on the rates observed.
6. A routine clinical survey for filariasis was carried out in a community health centre, serving
1,00,000 population, the data collected is shown below:
a. Night blood smears collected: 30,000
b. Persons showing only microfilaria positive: 300
c. Persons showing mere signs and symptoms of filariasis- 80
d. Persons showing both microfilaria positive and signs and symptoms - 10
Calculate the possible filarial indices and comment on your result.
Disinfection of well
1. A circular well of 10m diameter and 15m depth of water is to be chlorinated. Horrocks test
shows blue color from 3rd cup onwards.
 Calculate the quantity of bleaching powder required to disinfect the well.
 Briefly discuss the steps of chlorination.
If blue colour does not appear in the 6th Horrock’s cup, what will be your next step?
2. A square tank of 8 meter breadth with 10 meter depth of water is to be disinfected.
Horrocks test shows blue color in 6th cup.
 Calculate the quantity of bleaching powder required to disinfect the tank.
 Briefly discuss the steps of chlorination.
 If blue colour does not appear in the 6th Horrock’s cup, what will be your next step?
3. A rectangular well measuring 6 meters in length, 5 meters in breadth with water column of
10 meters height is to be disinfected. Horrock’s cup reveals blue colour from 4th cup
onwards.
a) Find out the amount of bleaching powder required to disinfect the well.
b) Briefly discuss the steps of chlorination.
c) If blue colour does not appear in the 6th Horrock’s cup, what will be your next step?
BIOSTATISTICS
i. Measures of Central Tendency & Dispersion
1. The weights in grams of both kidneys of 50 men aged between 40-49 years are given below.
Calculate the arithmetic mean and standard deviation. Comment on your results.
Class limits 200-219 220-239 240-259 260-279 280-299
Weight of the 209.5 229.5 249.5 269.5 289.5
kidney (g)
Frequencies 5 10 20 8 7
2. Mean respiratory rate (breaths / minute) of 9 subjects were found to be 23, 22, 20, 24, 16, 17,18, 19,
21. Calculate the arithmetic mean and standard deviation and comment.
3. Weight of 9 children in Kg are as follows: 23, 22, 20, 24, 16, 17, 21, 19, 21. Calculate the arithmetic
mean, median, mode, range, standard deviation.
ii. Chi Square (X2) test
1. In a sample containing 800 individuals, a certain drug was administered to 500 subjects to test
the efficacy of the drug against typhoid. Among those who received the test drug 200 subjects
developed typhoid fever while 280 subjects who did not receive any drug developed typhoid
fever. On the basis of this data can it be concluded that this drug is effective in preventing
typhoid. (Chi- square value at 5% level of significance is 3.84).
2. In a study conducted in a community, a total of 145 subjects were enrolled. Among them 105 subjects
were found to have diabetes. It was found that 65 diabetic subjects and 20 non diabetic subjects were
found to have renal failure. Test whether there is any association between diabetes & renal failure.
(Chi- square value at 5% level of significance is 3.84).
3. A sample of 200 patients was classified according to the regularity of medication and the outcome of
the treatment. It was found that 120 subjects were regular in their medications while 80 subjects were
irregular in the intake of their medications. Among the 90 subjects who were cured of the disease, 70
of them were on regular medications. Is there any association between regularity of medication and
the outcome of the treatment? (Chi- square value at 5% level of significance is 3.84).
iii. VITAL STATISTICS
1. A district with a population of 40,000 had recorded the following events during the year 2014.
Calculate all possible rates & comment.
a) No. of Live Births – 1, 200
b) No. of children deaths < 7 days – 48
c) No. of children deaths between 8 – 28 days – 24
d) No. of infant deaths – 120
e) No. of still births – 20
2. Midyear population of a town was 2,10,000. The following events occurred during year 2014.
Total number of live births 5,000
Total number of deaths 2,000
Total number of maternal deaths 22
Total number of infant deaths 300
Calculate the following & give your comment:
a) Crude Birth Rate (CBR)
b) Crude Death Rate (CDR)
c) Maternal Mortality Rate (MMR)
d) Infant Mortality Rate (IMR)
3. The following are the data of Thirumazhisai Primary Health Centre for year 2014
 Mid year population – 70,000
 Total no. of births – 2500
 Total no. of deaths – 1050
 Total no. of infant deaths –300
 Total no. of maternal deaths – 15
Calculate the following: Crude birth rate, Crude death rate, Infant mortality rate, Maternal Mortality
Rate & compare with national rates
4.
A. The 2011 census population of a Municipality was 2,00,000. Following vital events were
recorded in the years as furnished below. Estimate the midyear population of the town for the
year 2015.
Year Births Deaths Immigration Emigration
2011 4050 1820 3500 1100
2012 4100 1880 3200 3500
2013 4200 1910 4300 900
2014 4250 1950 4500 1200
2015 4300 1980 3100 3500
B. Let census population of a town for the years 2001 & 2011 were 20000 and 25000 respectively.
Calculate the midyear estimated population of the town for the year 2017 & Comment.
Solution B:
iv. FERTILITY INDICATORS
1. Following data is available for the year 2015 for a district with a midyear population of 13,00,000:
Age Group(years) No. of women No. of Live Births
15 – 19 36, 300 1, 500
20 – 24 35, 100 8, 900
25 – 29 32, 870 7, 600
30 – 34 25, 310 2, 400
35 – 39 22,520 1, 200
40 – 44 43, 460 1, 110
45 – 49 39, 740 570
2, 35, 300 23, 280
Calculate Crude Birth Rate, Age specific fertility rate, General Fertility Rate and Total Fertility Rate &
comment on your result.
2. The Mid – year population of a district in Tamilnadu during the year 2015 was 13,00,000. The
data relating to the same year of the district is given in the table:
Age Group (years) No. of women No. of Female Births Survival Rate
15 – 19 36, 300 660 0.969
20 – 24 35, 100 3, 916 0.967
25 – 29 32, 870 3, 344 0.963
30 – 34 25, 310 1, 056 0.958
35 – 39 22,520 528 0.952
40 – 44 43, 460 488 0.942
45 – 49 39, 740 250 0.928
2, 35, 300 10, 242
Calculate Gross Reproduction Rate & Net Reproduction Rate and comment on your result.
3. Following are the data relating to a Municipal corporation in the state of Tamilnadu for the year 2014.
Calculate General Fertility Rate & Total Fertility Rate and comment on your results.
Age Group(years) No. of women No. of Live Births
15 – 19 16, 000 400
20 – 24 15, 000 1, 710
25 – 29 14, 000 2, 100
30 – 34 13, 000 1, 430
35 – 39 12, 000 960
40 – 44 11, 000 330
45 – 49 9, 000 36
90, 000 6, 966
GENERAL EPIDEMIOLOGY
i. Measures of disease frequency
1. In a randomly selected primary health center having a population of 35000. There were 6 cases of
leprosy as on 31.12.2015. During the year 2016 , the number of new cases of leprosy detected in that
PHC was 7 and 10 cases were released from the treatment. Calculate the following:
 Incidence rate of leprosy in 2016
 Prevalence rate of leprosy as on 31.12.2016 and comment
2. The following data are available for a community .
 Midyear population for 2013 – 1,17,000
 Population as on 31st December, 2013 – 1,19,000
 Already existing cases of leukemia at the beginning of the year 2013 - 24
 New cases of leukemia during the year 2013 – 99
Calculate the following
 Incidence rate for the year 2013
 Period prevalence rate for the year 2013
 Point prevalence rate as on 31st December 2013
3. There is an outbreak of cholera in a village of 2000 population. 20 cases of cholera have occurred
and 5 deaths were reported.
 Calculate the Attack rate & Case fatality Rate & Comment.
 Mention the preventive measures to be taken.
ii. Case Control study
1. A study was conducted to compare the effect of difference between planned pregnancy and unplanned
pregnancy. It included randomly selected 349 women who delivered or gestated babies/fetuses with
Neural Tube Defects (NTDs) in the last two years and another 349 women who delivered babies
without NTD. There were 280 women who had their pregnancies planned of whom 99 had reported of
NTD.
a. What is the type of study?
b. Name the factor studied & the outcome measured.
c. What type of bias can probably occur in this type of study?
d. Calculate the appropriate measures of association & Comment on your results.
2. During an investigation of an epidemic of acute diarrhoeal disease (ADD), the spatial distribution
of cases was suggestive that the river water supply may be the probable source of the outbreak. The
village was supplied with water from the public well as well as from the river running adjacent to
the village. The information as to the source of water supply collected from families revealed that
40 out of 60 patients had their water supplied from the river running adjacent to the village and 55
of the 120 normal individuals also had their water supply from the river.

c. Calculate the appropriate measures of association & Comment on your results.
d. How will you disinfect water at household level?
4. A study was undertaken in West Bengal to ascertain the impact of high arsenic level in drinking water
on the reproductive outcome. They identified 100 women who gave a history of still births in their
last pregnancy and another 200 women of same age, parity socio-economic class etc., who had live
birth in their last pregnancy. It was found that of the 100 women with still births, 75 had water source
with high arsenic content while 70 of the women with a live birth had water source of high arsenic
content.
c. What is matching? Why is it done?
d. Calculate the appropriate measures of association & Comment on your results.
ii. Cohort study
1. To study the strength of association between heavy work during ante natal period and low birth
weight of baby (<2500g), a cohort of 500 heavy worker ANCs and an equal number of duly matched
control of 500 sedentary-moderate worker ANCs were followed-up till birth. It was found that 200
heavy worker ANCs and 90 sedentary-moderate worker ANCs gave birth to low birth weight babies.
c. Calculate the appropriate measures of association & comment on your results.
d. What is the prevalence of low birth weight babies?
2. A study was conducted among 80,000 subjects to study the association between cardiovascular
disease (CVD) and cigarette smoking. It was found that among the 30,000 heavy smokers 20%
developed cardiovascular diseases later while among the non smokers 5% developed CVDs.
c. Calculate all possible parameters and interpret the results.
3. In a town with population of 2 lakh, the total number of deaths due to lung cancer was found to
be 174 per one lakh persons. It was also found that the lung cancer deaths among heavy smokers
was 448 per one lakh persons while among non smokers it was 20 per one lakh persons. Calculate
the individual relative risk and population attributable risk. Comment on the results.
iii. Screening Test
1. 100 patients suspected of having pulmonary tuberculosis in the community were subjected for a
study. The technician collected and examined single sputum smear from these patients and reported
30 as sputum positive cases. On subsequent culture of all these 100 patients it was found that 35
patients were positive for pulmonary tuberculosis. Later it was found that the technician reported 5
false positive cases.
i. Construct a 2 by 2 table with the given data.

ii. Calculate all the parameters of screening test.
iii. Write your inference.
2. A new screening test for hypertension was administered to 400 persons. Out of which 150 are known
to have the disease. The test was positive in 36 of the persons with the disease, as well as in 50
persons without the disease. Calculate all the parameters of the screening test and comment.
3. Sputum examination for AFB was carried out among 1000 TB suspects in a community with 20%
prevalence of the disease. The sputum was positive for AFB among 160 individuals with the disease
and 40 without the disease. Calculate the various parameters of the screening test & comment.
iv. Vaccine efficacy
1.A study was carried out to assess the effectiveness of a vaccine. There were 200 children vaccinated and
150 children unvaccinated. They were kept under fortnightly surveillance. Subsequently, there was an
outbreak of the disease for which the children had been vaccinated. The disease was reported among 50
vaccinated children and 50 unvaccinated children. Calculate the efficacy of vaccination and comment?
2.An outbreak of measles has occurred in a CHC area during the month of February 2007. There were 7780
children in the vulnerable age group of whom 64 came down with measles. The measles immunization
coverage of the area as assessed by the coverage evaluation survey was 80% .Among the children
vaccinated, 36 got measles. The remaining cases of measles occurred among unvaccinated children.
Calculate the efficacy of measles vaccination?
3. An outbreak of measles occurred in a CHC area. The measles immunization coverage of the area as
assessed by the coverage evaluation survey was 80% of the 9000 eligible children. Of the 300
measles cases reported in the outbreak, 15% gave history of measles immunization. Calculate the
vaccine efficacy rate and comment.
v. Vaccine Requirement
1. In a town with a population of 50000 the Crude Birth Rate is 30 and the Infant mortality rate is 80
for the year 2016. Calculate the annual vaccine requirement of BCG, TT, OPV, DPT, Measles for
the town.
2. In an area with the population of 75,000 the birth rate is 47 per 1000
population and the infant mortality rate is 130 per 1000 live births.
Calculate the following:
 The expected number of pregnant women and infants.

 Vaccine requirements for the TT, BCG, OPV, DPT and measles
CLINICO SOCIAL CASE
REVIEW
CLINICO SOCIAL CASE REVIEW
Objective:
To study the given case in the light of the family and the physical & biological
environment of the case. The attempt is to judge the factors which may have precipitated the
case/ disease.
Suggested steps for History Taking, Examination, Presentation & Discussion of the given
case.
History Taking
1. Details of Patient
Name, age, sex, education, occupation, income, marital status, address.
2. Chief Complaints with duration
3. Personal history
Food habits / smoking / alcohol / sleeping
4. Past history
H/O similar complaints/ any other history
5. Treatment history
6. Family history
Type of family, per capita income, Socio economic status, Immunization status
7. Any vital events during the previous one year period
8. Eligible couples if any and the contraceptive method followed
9. Housing and environment
Type, No. of rooms, ventilation, lighting / overcrowding if any, water supply, sullage
disposal, solid waste disposal, latrine facilities, pet animals, rodents, fly/ mosquito nuisance
Case Examination
10. General Examination: Finding
Pulse, B.P, Height, Weight, Temperature, Anemic Status, Edema, Vitamin deficiencies
11. Systemic examination findings
Case Presentation
12. Investigations required for the management of the case
13. A. Brief summary of the findings.
B. Provisional diagnosis
14. A. What is the stage of the disease at the time of presentation of this case?
What are the factors responsible for this stage of disease?
What levels of prevention have failed in this case? Why?
B. Assessment of KAP towards this disease.
15. What steps will you advocate and what health education measures and advice you will
give to prevent the recurrence of this case or to prevent the further spread of the
disease among others in the family/ community?
Individual : Treatment compliance, follow-up, Advice

Family : Screening, Advice on food etc, Care of patient, Prophylaxis if any.
Community : Identification of more cases, prevention and control, Health education
measures
Case Discussion
16. Discuss the following measures wherever applicable Diet, Personal hygiene, Follow-up,
Rehabilitation
17. Natural history of the disease and levels of prevention in this case.
18. Concerned National Programme

Objectives, Strategies, Services / Activities, etc.
INSTRUCTIONS
 For each commonly presenting clinic social case discussion a model case sheet is given for
guidance.
 Go through the given case sheet carefully.
 Follow the given steps and collect all particular relevant for the case under examination and
write your own detailed case sheet for presentation & discussion by using the empty sheets
given.
 Repeat the exercises for two such cases in each morbidity.

V. CLINICO SOCIAL CASES
1. FEVER CASE PROFORMA
1. GENERAL INFORMATION:
a. Name b.Age c. Sex
d. Address e. Occupation
2. PRESENTING COMPLAINTS:
3. HISTORY OF PRESENT ILLNESS :

FEVER: Onset , Duration , Type, Grade, Diurnal variation, Associated with
Other complaints:
4. PAST HISTORY
 Previous hospitalization
 Exanthematous fever
 H /O exposure to a known case of TB – in the family or working palce
5. PERSONAL HISTORY
 Type of diet veg / non veg
 Bowel and bladder habits normal or not
 Smoking yes/ no
 Alcoholism yes / no
 Betal chewing yes / no
6. FAMILY HISTORY:
 Relevant family history
 Type of family nuclear / joint / 3rd generation
 Total no of members
Name Age Relationship Education Occupation Income Health
status
Total income
Per capita Income/month = Total income of the family = Rs…………….

Total no of family members
According to modified Kuppusamy scale the family belongs to ………………
7. DIET HISTORY:
Energy Proteins
Name Morning Afternoon Evening Night
( K Cal) (gms)
Energy requirement Energy intake Energy deficit
Protein intake Protein deficit

Protein requirement
8. ENVIRONMENTAL HISTORY
 Type of house: pucca / kutcha
 Overcrowding present or not:
 Toilet: present/ absent Type: sanitary / non sanitary Disposal: septic tank/
sewerage system/ open drain/ others
 Ventilation: satisfactory / not satisfactory
 Lighting: satisfactory / not satisfactory
 Kitchen: separate/not Fuel for cooking:……….. Exhaust for smoke:…present /
absent
 Source of drinking water……………Storage……………Disinfection method
followed………………
 Waste water disposal (sullage) -- soakage pit yes / no
 Presence of rodents/cockroaches/mosquito,fly breeding/pet animals
9. GENERAL EXAMINATION
Consciousness orientation Built Nourishment
Anemia/ Cyanosis/ Icterus/ Clubbing/ Pedal edema/ Generalized Lymphadenopathy
10. ANTHROPOMETRY
Height
Weight
BMI
(if under 5 case measure Mid arm circumference, head & chest circumference)
11. VITALS
o Pulse rate
o Respiratory rate
o BP
o Temp
12. SYSTEMIC EXAMINATION:
EXAMINATION OF THE ABDOMEN: organomegaly --present /absent
EXAMINATION OF THE RESPIRATORY SYSYTEM : breath sound --vesicular / bronchial

Added sound --present /absent
EXAMINATION OF THE CARDIO VASCULAR SYSYTEM : heart sound S1 ,S2
Murmur-
EXAMINATION OF THE CNS - normal
SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS…………………
PROVISIONAL DIAGNOSIS………………………………………………………..
DIFFERENTIAL DIAGNOSIS……………………………………………….
TREATMENT……………………………………………………..
ADVICE & CARE ……………………………………………..
INTERVENTION TO THE FAMILY -- Look for similar case in the family and treat them /
diet / prophylaxis if any
INTERVENTION TO THE COMMUNITY --Look for similar case in the community and treat,
Immunization / Vit A supplementation for children, Vector control measures (malaria or
filariasis), Water and food sanitation (typhoid), Health education
NATIONAL PROGRAM …objective / strategies…………………………………….
HOW WILL YOU CONFIRM THE DIAGNOSIS
MALARIA - intermittent, high grade fever associated with chills and rigor, By peripheral blood
smear
FILARIASIS – fever with lymph node enlargement, By peripheral blood smear
DENGUE – continuous, high grade fever associated with chills and rigor
Rash , Spontaneous bleeding, h/o of mosquito bite
TYPHOID
 Continuous, step ladder pattern fever
 Diarrhea, constipation, abdominal pain ,rose spots
 According to the duration of fever will do the investigation
1 week blood test
st
2nd week Widal test

3rd week stool test
4th week urine test
UTI – high grade fever, Burning micturition
HEPATITIS – fever with jaundice
LEPTOSPIROSIS - fever with jaundice, myalgia, retro orbital pain, water contamination,
barefoot walking, occupation
TUBERCULOSIS – low grade fever, cough with sputum, loss of appetite, exposure with known
case of TB
2. TUBERCULOSIS CASE
1. Socio-demographic history
Name: Age: Sex:
Address: Occupation:
 Presenting complaints

3. H/O Presenting complaints:

Cough with expectoration-amount/color/consistency-mucoid/odour/blood stained
Fever-evening rise of temperature –low grade
Night sweats
Loss of weight
Loss of appetite
Breathlessness-grading
Chest pain-pleurisy-site/duration/nature-pricking in pleurisy/mode of onset/continuous or
intermittent/radiating or not/aggravating & relieving factor
Hemoptysis-frank blood/ duration/episode
H/o wheeze
H/o cardiac symptoms-syncope/palpitation/pedal edema
H/o renal symptoms – oliguria
H/o abdominal symptoms-distension
H/o right hypochondriac pain
4.Past H/O
H/O of contact with open case of TB
Similar complaints in the past
H/O treatment for TB in the past-details
H/O exanthematous fever
H/O recurrent LRI
H/O – DM/HT/Asthma/Epilepsy
5.Treatment H/O
Any treatment for cough or fever
H/O TB in the past- treatment taken/duration/reason for discontinuation/where diagnosed &
treated- failure or relapse.
6.Family H/O
No. of family members
Type of family
H/O similar complaints in family members
H/O contact
Any under 5 children (vaccination status, if patient is sputum +ve, Screening done? prophylaxis
given ?
Details of family:
Name of Relationship Income
S.N Marital
family Age Sex to head of Education Occupation per
o status
members family month
Type of family: Nuclear/ Joint/ Extended nuclear

Per capita Income/ month = total income of the family = Rs…………….
7.Contact H/O
Contact with open TB case in the past
8. Occupational H/O
Silicosis- construction workers/mining/quarrying/silica industry
Overcrowding- beedi workers
Health care providers
9. Personal H/O
1. Diet: Veg/ Non- Veg/ Mixed
2. Smoking: no. of cigarettes per day X no. of years = pack yrs.
3. Passive smoking:
4. Tobacco chewing / Alcohol intake – duration/ frequency/quantity
5. Bowel and Bladder Habits:
Nearby Health Facility:
Immunization status of the family members: BCG vaccination
10. Diet History:
Energy Proteins
( K Cal) (gms)

Protein requirement
11. Environmental history:

absent
12. General Examination:
Conscious/ Comfortable/ Oriented/ Built/ Nourishment/ Fever/ Anemia/ Jaundice/ Cyanosis/

Clubbing/ Thyroid/ Pedal edema/ Generalized lymphadenopathy
External markers for TB – phylecten/ iritis/skin-lupus vulgaris/erythema nodosum
13.Vital Signs: Pulse: _______Temperature:_________ RR: __________ BP: ___________
14.Anthropometric Measurements: Height: _____Weight:_____ BMI: Wt (kg) / Ht (m2)
15.Systemic examination
Respiratory system
Inspection:
Chest shape, symmetry : shape normal/bilateral symmetry
Chest movements : movement equal on both sides
Position of trachea : appears to be in the midline
Apical impulse : not seen
Intercostal recession :
Bony deformities : kyphosis/ scoliosis/pots spine/pectus excavatum/pectus
Carinatum/pigeon chest
Breathing type : thoraco abd-female/abd thoracic-male/thoracic-pregnant
Use of accessory muscles : abdominal/neck/alar nasi
Drooping of shoulders : fibrosis
Scar & sinuses : any procedure/sinuses
Supraclavicular-infraclavicular hallowing : cavity/ fibrosis
Palpation:
Confirm the inspection findings
Position of trachea confirmed
Apical impulse : felt in the 5th left intercostal space, lateral to the midclavicular line.
Chest movements : anterior/posterior/apical-equal.
Chest expansion : Upper lobe - male at nipple level/female below breast.
Lower lobe – xipisternum.
Tactile fremitus : silent
Vocal fremitus : (1, 1... and feel)-inc. in consolidation/dec. in fibrosis/pleural effusion.
Percussion: Areas of dullness: supraclavicular/infra clavicular/ mammary/ infra mammary/

axillary/ infra axillary/ supra scapular/ inter scapular/ infra scapular.
Auscultation: Breath sounds: Vesicular-normal/harsh- whether diminished or not.
Bronchial-tubular-high pitched/cavernous – low pitched.
Any added sounds : Crepitation-type/time/high or low pitched : Rhonchi / Plural rub
Vocal resonance : (1, 1, 1, use stethoscope)
CVS:
ABDOMEN:
CNS:
16. SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS (Medical,
Economic, Social, Environmental problems for the patient and the family)
17. PROVISIONAL DIAGNOSIS:
Anatomical : Rt. /Lt. sided; Lobes involved (usually apical)
Pathological : Fibrosis/ Fibro cavity/ Pleural effusion/ Bronchiectasis
Aetiological : Probably of tuberculosis origin
18. INVESTIGATIONS:
Sputum AFB//Chest X-ray/ Sputum C&S/ CBC/ HIV-ELISA (TB-HIV coordination)
19. TREATMENT……………………………………………………..
20. ADVICE & CARE ……………………………………………..
21.INTERVENTION TO THE FAMILY -- Look for similar case in the family and treat them /
diet / prophylaxis if any
22. INTERVENTION TO THE COMMUNITY --Look for similar case in the community and
treat them
23. NATIONAL PROGRAM …objective / strategies…………………………………….
24. HOW WILL YOU CONFIRM THE DIAGNOSIS
Discussion: I
1. Agent, Host and Environmental factors involved in this case.
2. Probable source of infection ( in case of communicable diseases)
3. What are the levels of prevention that are failed and why?
- Individual level (Attitude of the patient)
- Family level (Attitude of the family)
- Community level (Attitude of the community)
Discussion: II
1. Management of this case (Treatment and Prevention of Recurrence).
2. Measures to be taken to protect other family members?
3. Measures to be taken to protect other individuals in the community?
3. LEPROSY
Name: Age/ sex:
Education: Occupation: Income:
Marital status:
History of present illness
Chief complain ( in Onset ( sudden/ Duration Progress
chronological order) Gradual)
Skin lesion
Loss of sensation
Glove and stocking
anesthesia
Ulcer
Deformity
Others
Treatment before admission : Yes / No
If Yes, nature of treatment (in brief) :
Previous hospitalization / complications for same illness:
Age at onset :
Duration between onset and diagnosis :
Duration between the onset and start of the treatment:
Epidemiological information
Any similar case in the family: Yes / NO
Any contact with similar case: Yes / NO
Any other relevant information:
Family history of leprosy
General Examination
Built : Anemia:
Height : clubbing:
Weight : Cyanosis:
Nourishment : Jaundice
Temperature : Lymphadeopathy:
Pulse : Edema:
Blood Pressure :
Respiration :
Examination of Leprosy Features
Examination for leprosy is done in a good daylight, from top to bottom, both front and back with
minimal clothing for the evidence of features of leprosy.
Skin Lesions
Number : One / two to five / Numerous
Distribution : symmetrical / Asymmetrical
Situation : Localized / Generalized
Appearance : Macule / Plaque
Size : Small / Big / Variable
Shape : Irregular / Circular – oval
Color : Erythematous / Hypopigmented
Surface : Shiny / Dry, rough
Margins : III defined / well demarcated, Raised
Feel : Soft / Firm
Sweating : Present / Impaired / Absent
Hair : Present / Sparse / Lost
Infiltration : Present / Absent
Sensation : Impaired / Lost
Sensation Lost : Light touch / Pressure / Heat / Cold
Face
Leonic facies : Loss of eyebrows :
Loss of eyelashes: Weakness of eyelids—ptosis
Lagophthalmos : Corneal anesthesia
Corneal ulcer : Nasal discharge :
Depression of nose : Nasal perforation :
Ear thickening :
Elongated lobules :
Nodules :
Hand
Wasting of muscles : Weakness :
Claw hand : Wrist drop :
Absorption of digits : Thumb contraction :
Ulcers :
Feet
Wasting of muscles : Weakness :
Plantar ulcer : Foot drop :
Inversion : Absorption of toes :
Collapse of foot : Swollen foot :
Intercurrent Infection
Examination of Nerve
Nerve Thickening Tenderness Consistency

Ulnar
Lateral Popliteal
Great auricular
Facial
Trigeminal
Median
Radial
Posterior tibial
Superficial peroneal
Supraorbital
Systemic Examination
RS :
CNS :
CVS :
Abdomen :
Other relevant examination:
Epidemiological Diagnosis
Classification (for the Purpose of Treatment)

Cardinal features SSLPB PB MB
Skin lesion number 1 2-5 >5
Number of nerve involved Nil 1 >2
Skin smear -ve -ve +ve
SSLPB: Single Skin lesion, PB: Pauci bacillary, MB: Multibacillary
In the doubtful condition, patients is classified as MB.
Deformities Grading
Site Grade 0 Grade I Grade II
Hand/ Feet No anesthesia Anesthesia +ve Visible deformity
No visible deformity No visible deformity
Eyes No loss of vision Eye problem present Severe visual
No eye problem Vision not severely Impairment ( < 6/60)
affected
Clinical Diagnosis with Classification / Type
Criteria for Diagnosis

1. Hypopigmented patches
2. Loss of sensation
3. Thickened nerves
4. Presence of M.Leprae
5. Deformity
Medico social discussion

Identification of the Factors Responsible for / influencing the present condition: Agent factors,
host factors, environmental factors & social factors
Levels of Prevention
How could have been
Levels of prevention Which level has failed?
prevented?
Health promotion
Primary
Specific promotion
Secondary Early detection and

prompt treatment
Disability limitation
Tertiary
Rehabilitation
Influence of Medicosocial Factors in Diagnosis, Treatment, and Prevention of the Disease impact
of the Disease on Socioeconomic Status of
Family/ Community/ Nation:
Medicosocial Diagnosis
ADVICE
Patient
Primary
 Adopt good nutrition and healthy lifestyle
 Raising socioeconomic educational level
 Health education
 Avoid alcohol, smoking
 Protection from burns, injuries
 Care during lepra reaction
 Self care; Ulcer, eye, hand, foot
 Hygenic disposal of nasal and wound secretions
 Using microcellular footwear
Secondary
 Take drugs as per schedule/ Go for periodic checkup
Tertiary
 Using the rehabilitation ( Medical, social, surgical, psychological, vocational) facility
Family
 Accept the patient and do not isolate / outcast
 Motivate to take drugs regularly
 Motivate to adopt good nutrition and healthy lifestyle
 Periodic examination of all family members / contacts
Community
 Early detection ofcase by – Contact tracing, mass survey, examination of school children,
slum population
 Efforts to remove the social stigma through IEC
 Creating awareness regarding scientific knowledge of leprosy through IEC
 Providing services through Primary health care (PHC)
4. HYPERTENSION CASE
GENERAL INFORMATION:
b. Name b.Age c. Sex
d. Address e. Occupation
PRESENTING COMPLAINTS:
HISTORY OF PRESENT ILLNESS :
 General fatigue / tiredness
 Sweating
 Giddiness
 Altered consciousness How many days (Duration)
 Headache How it started (Onset)
 Vomiting Progression
 Blurring of vision Associated factors
 Black – outs Aggravating factors
 Chest Pain Relieving factors
 Palpitations
 Breathlessness
 Decreased Urine Output, Swelling of the legs
PAST HISTORY: When was it diagnosed? / Details on current medications

 History of similar episodes in the past
 Known Diabetic Synergetic
 Known Hypertensive Effect of Risk
 History of Coronary artery disease Factors
 Premature / Surgical Menopause
 H/ o CNS Disorder – Hemiplegia / Transient ischemic attack (TIA) / Seizures
 History of Bronchial Asthma – Steroid Therapy raises Blood Pressure
 History of Liver Disorder To avoid certain group of
 History of Kidney Disease anti – hypertensives
 History of Heart Failure hypoglycemic agents
 H / o Endocrine Disorders (Hyperthyroidism, Cushing Syndrome, Pheocytochroma)

 History of Oral Contraceptive Use
 History of Surgeries
 History of Drug Allergy
TREATMENT HISTORY:
Indications, Medications taken, Duration of use & Regimen
 Treatment History should be taken for the diseases mentioned in the past history
PERSONAL HISTORY:
 Type of diet veg / mixed
 Bowel and bladder habits normal or altered (If altered give details)
 Smoking yes/ no
 Betel nut chewing yes / no
FAMILY HISTORY:
 Does any other member in the family suffer from Hypertension?
 Does any other member in the family suffer from any other disease mentioned?
 Type of family nuclear / joint / Third generation
Family composition
status
Total income
Per capita Income/ month = total income of the family = Rs…………….

Diet History:
Energy Proteins
( K Cal) (gms)

Protein requirement
Environmental history:
absent
GENERAL EXAMINATION: Consciousness orientation Built Nourishment
Anemia/ Cyanosis/ Icterus/ Clubbing/ Pedal edema/ Lymphadenopathy
ANTHROPOMETRY
Height
Weight
BMI
VITALS
o Pulse rate
o Respiratory rate
o BP
o Temp
SYSTEMIC EXAMINATION:
 Cardiovascular System – S1 S2 heard, No murmur
 Respiratory System – Breath sound – vesicular / bronchial,
Added sounds – Present / absent
 Abdomen: Scar, Sinus, Organomegaly, Free Fluid, Flanks – Free / Full
 Central Nervous System – No focal neurological deficit,
Reflexes – Present / Absent / Exaggerated
SUMMARY WITH POSITIVE & NEGATIVE FINDINGS
PROVISIONAL DIAGNOSIS:
INVESTIGATIONS:
 Lipid Profile – Total Cholestrol, HDL, LDL, Triglycerides
 Renal Parameters – Blood Urea Nitrogen (BUN), Serum Creatinine
 Throid Function Tests
 Urine Examination (Routine)
 Urine for Microalbuminuria
 X – Ray Chest
 ECG, ECHO
 Fundal Examination
TREATMENT:
 Diet Modifications- DASH diet
 Physical Exercise
 Blood Pressure Control – (Anti – hypertensives – Beta Blockers, Calcium Channel
Blockers, Diuretics, ACE Inhibitors, ARB – Angiotensin Receptor Blockers)
 Lipid Lowering agents
 Cardio – protective drugs (Aspirin)
ADVICE & CARE:
INTERVENTION TO THE FAMILY --Look for similar case in the family and treat them
INTERVENTION TO THE COMMUNITY--Look for similar case in the community and treat
them
NATIONAL PROGRAM:
HOW WILL YOU CONFIRM THE DIAGNOSIS
DISCUSSION:
 What do you understand by Epidemiological Transition?
 Modifiable and Non – modifiable factors for Hypertension
 How do you record Blood Pressure in an individual?
 A patient comes to you and find the BP to be 150 / 100 mmHg. He claims that this first
time his BP has been very high. He denies any stress at the time of measuring his BP.
What advice would you give to him
 Stages of Hypertension / Classify Hypertension according to JNC – 7
 Tracking of Blood Pressure and its importance
 Concept of Rule of Halves and its importance
 What is meant by Prudent Diet?
 What is meant by DASH plan? – It is “Dietary Approaches to Stop Hypertension”
 How frequently should you monitor Blood Pressure?
 What are the tests that should be done to a person diagnosed with Hypertension?
Once in 3 months – Renal Parameters, Blood Sugar, HbA1c (If diagnosed with DM)
Once in a Year – X – Ray Chest/ ECG, ECHO/ Doppler (Peripheral vascular assessment)
 Complications: Hemiplegia, TIA, Hypertensive Encephalopathy, Dissecting Aneurysms,
Retinal haemorrhages, Renal Failure, Myocardial infarction, Angina Pectoris, Heart
Failure, Cardiomyopathy
Levels of Prevention in Hypertension

Primary
 Nutritional Intervention
 Life style Modifications
 Weight Reduction
 Health Education
Secondary
 Early Diagnosis and Treatment
 Optimum Blood Pressure Control
 Maintenance of Optimal Body Weight
 Diet Restriction
 Self Care
 Treatment – Compliance with anti – hypertensive medications
Compliance with medications due to co – morbid illness
Teritary
 Disability Prevention and Rehabilitation
 National Program on Prevention and Control of Non – Communicable Diseases

Components
 Health promotion for general population
 Assessment of prevalence of risk factors
 Disease prevention for the high – risk groups
5. DIABETES MELLITUS CASE
DEMOGRAPHIC DETAILS:
Name:
Age : (determines Type – I DM among children / Type – II DM among adults)
Gender:
Education:
Religion:
Occupation: (sedentary lifestyle – risk factor for DM)
PRESENTING COMPLAINTS:
HISTORY OF PRESENTING ILLNESS:

 General fatigue / tiredness
 Sweating Symptoms suggestive of
 Giddiness HYPERGLYCEMIA
 Vomiting
 Increased thirst
 Dryness of tongue How many days (Duration)
 Increased appetite How it started (Onset)
 Loss of weight Progression
(Mention the baseline weight and duration of weight loss) Associated factors
 Increased frequency in urination Aggravating factors
 Burning micturition (suggestive of UTI) Relieving factors
 Itching & white discharge – external gentialia (canadiasis, trichomonasis)
 Skin infections (impetigo, fungal infections)
Micro vascular Complications
History – Suggestive of Diabetic retinopathy:

 Blurring of vision (Diabetic retinopathy)
 Loss of vision
History – Suggestive of Diabetic neuropathy:

 Weakness in the limbs
Symptoms suggestive of
 Burning sensation in the foot COMPLICATIONS
 Delayed wound healing due to Diabetes
 Non – healing of ulcers
 History of amputations
How many days (Duration)
History – Suggestive of Diabetic nephropathy: How it started (Onset)
Progression
 Swelling of the legs
Associated factors
 Alterations in urine output
Aggravating factors
 Urine examination – Microalbuminuria / proteinuria Relieving factors
 Altered renal parameters
Macro vascular Complications

 Chest pain
(Site, Onset, Character, Radiation, Associated factors, Relieving factors)
 Palpitations
 Giddiness
 Hemiplegia / Transient ischemic attack (TIA)
PAST HISTORY: When was it diagnosed? / Details on current medications

 History of similar episodes in the past
 Known Diabetic Synergetic
 Known Hypertensive Effect of Risk
Factors
 History of Coronary artery disease
 Premature / Surgical Menopause
 History CNS Disorder
Treatment with steroids, raises glycemic
 History of Bronchial Asthma status
 History of Liver Disorder To avoid certain oral
 History of Kidney Disease hypoglycemic agents
 History of Heart Failure
 History of Polycystic Ovarian Syndrome (PCOS) Risk factor to
 History of Gestational Diabetes Mellitus (GDM) develop DM
 History of Impaired Fasting Glucose / Impaired Glucose Tolerance (IGT)
 History of Surgeries
 History of Drug Allergy
TREATMENT HISTORY:
Indications, Medications taken, Duration of use & Regimen (Treatment History should be taken
for the diseases mentioned in the past history)
PERSONAL HISTORY:
 Type of diet : veg / mixed
 Bowel and bladder habits normal or altered (If altered give details)
 Smoking yes/ no
 Betel nut chewing yes / no
FAMILY HISTORY:
 Does any other member in the family suffer from Diabetes Mellitus?
 Does any other member in the family suffer from any other disease mentioned?
 History of delivering big babies (GDM)
 Type of family nuclear / joint / Third generation
status
Total income
Per capita Income/month = total income of the family = Rs…………….


 Modified Kuppusamy for urban
 BG Prasad for rural & urban
Diet History:
Energy Proteins
( K Cal) (gms)

Protein requirement
absent
GENERAL EXAMINATION:
Consciousness orientation Built Nourishment
Anemia/ Cyanosis/ Icterus/ Clubbing/ Pedal edema/ Generalized Lymphadenopathy
VITAL SIGNS:
 Temperature
 Height (cms), Weight (kgs) & BMI = Weight / Height in m2
 Pulse Rate (per minute)
 Blood Pressure (mm Hg)
 Respiratory Rate (per minute)
SYSTEMIC EXAMINATION:
 Cardiovascular System – S1 S2 heard, No murmur
 Respiratory System – Breath sound – vesicular / bronchial, Any Added sounds ?
 Abdomen: Scar, Sinus, Organomegaly, Free Fluid, Flanks – Free / Full
 Central Nervous System – No focal neurological deficit,
Reflexes – Present / Absent / Exaggerated
INVESTIGATIONS:
 OGTT – Oral Glucose Tolerance Test (Only to establish the diagnosis)
 FBS – Fasting Blood Sugar
 PPBS – 2 hr Post – Prandial Blood Sugar To MONITOR the Glycemic status
 HbA1c – Glycosated Hemoglobin
 Lipid Profile – Total Cholestrol, HDL, LDL, Triglycerides
 Renal Parameters – Blood Urea Nitrogen (BUN), Serum Creatinine
 Throid Function Tests
 Urine Examination (Routine)
 Urine for Microalbuminuria
 X – Ray Chest
 ECG, ECHO
 Fundal Examination
 Doppler Study (If suggestive of Peripheral Vascular Disease as a Baseline Test)
SUMMARY WITH POSITIVE & NEGATIVE FINDINGS:

PROVISIONAL DIAGNOSIS:
TREATMENT:
 Diet Modifications
 Physical Exercise
 Oral Hypoglycemic agents
 Insulin
 Blood Pressure Control – (Anti – hypertensives)
 Lipid Lowering agents
 Cardio – protective drugs (Aspirin)
ADVICE & CARE:

 INTERVENTION TO THE FAMILY – Look for similar case in the family and treat
them
 INTERVENTION TO THE COMMUNITY – Look for similar case in the community
and treat them
NATIONAL PROGRAM: - objective / strategies

DISCUSSION:
 Epidemiological Triad for DM
 WHO cut – off values
NORMAL DIABETES
Fasting Blood Sugar 100 mg / dl More than 126 mg / dl
2 hour Post prandial Blood Sugar 140 mg / dl More than 200 mg / dl
 Importance of HbA1c – to find out the glycemic control over the last 3 months as the life
span of RBC is about 120 days
 What are the tests that should be done to monitor the glycemic status?
Thrice in a day Blood Sugar (if the patient is STARTED on Insulin)
Once in Fortnight
Once in 3 months – Blood Sugar, HbA1c, Renal Parameters
Once in a Year – X – Ray Chest
ECG, ECHO
Fundal Examination
Doppler (Peripheral vascular assessment)
 Complications:
Microvascular Complications
 Diabetic Retinopathy, Diabetic Neuropathy, Diabetic Nephropathy
Macrovascular Complications: MI, Angina Pectoris, Cerebro vascular accidents
Systemic Complications: Diabetic Ketoacidosis
 What is hypoglycemic awareness?

 Levels of Prevention in DM
Primary
 Nutritional Intervention
 Life style Modifications
 Weight Reduction
 Health Education
Secondary
 Early Diagnosis and Treatment
 Optimum Blood Glucose Control – FBS, 2 hr PPBS, HbA1c
 Optimum Blood Pressure Control
 Maintenance of Optimal Body Weight,
 Diet Restriction
 Self Care
 Treatment – Compliance with Oral Hypoglycemic Agents / Insulin
Compliance with medications due to co – morbid illness
Teritary
 Disability Prevention and Rehabilitation
 National Program on Prevention and Control of Non – Communicable Diseases

Components
 Health promotion for general population
 Assessment of prevalence of risk factors
 Disease prevention for the high – risk groups
6.ANAEMIA CASE
Socio-demographic history
Name:
Age:
Sex:
Address:
Occupation:
Presenting complaints:
History of presenting complaints

Easy fatiguability – reduced physical capacity for routine work, household work
Tiredness /weakness – general malaise
Breathlessness – dyspnoea on exertion
Frequent headaches
Palpitations
Irritability/lack of concentration, drowsiness
H/o recent bleeding – stools (black tarry stools or fresh blood), vomit (H/o stomach ulcer ?),
external haemorrhoids, menstrual cycles (H/o heavy bleeding during menstrual cycles –
complete menstrual cycle history)
H/o jaundice, fever (malaria), H/o recent hospitalization
H/o hypotension (dizziness), syncopal (fainting) attacks
H/o pale skin – palms, nail beds, face etc
H/o recurrent infections – URI/LRI, ADD etc
H/o any worm infestation (hookworm)
H/o chronic bleeding (colon cancer)
H/o chronic illhealth – TB, COPD, HIV/AIDS etc
H/o intake of certain medication causing anemia (Chemotherapy agents, antiepileptic agents)
H/o abdominal distension ( splenomegaly)
H/o sickle cell anemia, thalassemia etc
H/o contraceptive use (IUD)
H/o any recent loss of weight (how much)
Any H/o Amenorrhoea present, since __ weeks
Present Obstetric history (If pregnant):
Obstetric score: GPLA
Present pregnancy:LMP &EDD
Registered,TT given Y/N, IFA tablets: Y/N when started?
Beneficiary of ICDS:
H/o abdominal pain, bleeding, pedal edema, headache
Past obstetric history: H/o excessive bleeding during delivery, blood transfusions, Iron
injections
Order of pregnancy:
Age at pregnancy:
Outcome: live birth/still birth/ abortion
Delivery at home/hospital type:
Sex & weight of the child at birth:
Age and cause of death:
Menstrual history:
Age at menarche –
Cycle- complete history, duration of bleeding, regularity, history of heavy bleeding,
number of pads changed, H/o passing of clots, irregular cycles – menorrhagia,
metrorrhagia
Marital history:
Age at marriage ____ yrs, Married since _____yrs/ Consanguinous or not/
Contraceptive used:
Past history:
H/o blood transfusions, bleeding – stools, vomit, menstrual cycles
H/o recent surgeries/illness, prolonged medication, jaundice, malaria, external
haemorrhoids, previous hookworm infections, recent delivery
Any history of fainting episodes
Treatment history:
H/o treatment with IFA tablets : Yes/ No
Details of treatment – duration it was advised, number of IFA received, number of IFA
consumed, if not consumed – reasons for the same
Personal history:
Type of diet veg / non veg Bowel and bladder habits normal or not
Family history:
No. of family members/type
H/o similar complaints in family members/siblings/peers
Details of family:
S.N Se Marital
family Age to head of Education Occupation per
o x status
Per capita Income/month = total income of the family = Rs…………….

Diet History:
Energy Proteins
( K Cal) (gms)

Protein requirement
absent
General examination:
Signs of anemia – pallor (pale palm, nail bed), icterus (yellow skin, eyes),
lymphadenopathy (cervical/ generalized), Koilonychia, Clubbing, signs of fatigue,
malaise
Vital signs: Pulse rate: ___ RR: ____Temperature _____BP: ______

Anthropometric measurements: Height: _____Weight: ____ BMI_____
Systemic examination:
CVS: Normal S1 & S2 heard
RS:
Abdomen:
CNS:
SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS
PROVISIONAL DIAGNOSIS: levels of anemia
Treatment :
Treatment with iron and folic acid tablets
Injectable iron forms
Blood transfusion
Treating underlying cause (eg: deworming – hookworm)
Treating excessive bleeding if irregular menstrual cycles
Investigations: Complete blood count : MCH, MCHC, Haematocrit

Peripheral Blood smear : Microscopic, normoscopic, macroscopic anemia
Haemoglobin estimation
Stool : for RBC’s, occult blood etc, eggs of hookworm
Serum ferritin, serum transferrin levels
Folate and vitamin B12 levels
Serum bilirubin (jaundice)
Liver function tests
Kidney function tests (CKD)
Haemoglobin electrophoresis (sickle cell anemia, thalassemia)
Reticulocyte count
Bone marrow biopsy
ADVICE - To the patient:

Diet advice – prudent diet, inclusion of fruits, vegetables, green leafy vegetables, iron rich foods
(explain), treating underlying illness, consuming IFA tablets without fail as advised
DISCUSSION POINTS:
Iron and folic acid supplementation- 100 mg elemental iron and 500 mcg of folic acid-100
tablets for pregnant women with mild to moderate anemia
High risk cases during pregnancy
Anemia grading, treatment
National programme for iron deficiency

Nutrition: Foods (plant & animal origin) rich in iron content, foods inhibiting iron absorption,
foods enhancing iron absorption, factors affecting bioavailability of iron
Balanced diet – prudent dietary goals
Nutritional security in India
Nutrition related health programmes of India
7. ANC CASE
Name of the mother:………………………………………………………………..
Age:………………………………………….
Occupation: a. homemaker b. employed (mention)………………………………
Education:
Religion:
Address:…………………………………………………………………………………………
Socioeconomic status:…………………………………………………………………………...
With H/O ……….months amenorrhoea,
[note: If age ≤ 18 years, ≥ 35 yrs, birth order ≥4, birth interval ≤ 2 yrs - AT RISK pregnancy]
Has come for
- Safe confinement (or)
- Presenting with anten atal problems (or): (in chronological order with duration)
- Other reasons:
[Note: Antenatal problems: nausea, vomiting, fever, giddiness, fatigue (r/o anaemia), edema (tightening
of bangles, ring, pedal edema, puffiness of face, anasarca), headache, blurring of vision, abdominal pain
(r/o gastritis, false labor pain), breathlessness, bleeding/draining P/V, burning micturition,
constipation/diarrhea/dysentery/piles, chest pain, passing worm in stool, palpitation, impaired appetite,
cold intolerance (r/o thyroid disorders), sudden weight gain, others (if relevant)]
2. HISTORY OF PRESENTING ILLNESS : (Elaborate the complaints in detail in chronological

order along with all relevant NEGATIVE history)
3. OBSTETRIC HISTORY:
Present Obstetric history:
Obstetric score: G……..P……..L……..A………
LMP: EDD: Naegele’s formula: (LMP+ 9 months& 7 days)
Registered: Y/N Date of registration/where:………………………
Nearest health facility: No. of antenatal visits:
Immunization: (Yes/No, when?) TT1:……………TT2…………..TT booster:…………..,
IFA tablets: Y/N when started?.....Total tablets received…..Total tablets consumed…..Reason if
not taken……
Beneficiary of ICDS:Y/N
(Note: Elaborate the events/ complaints in the relevant trimesters till date)
I trimester:
Confirmation of pregnancy –where& when?................................................
H/o Vomiting, fatigue
H/o giddiness
H/o fever, burning micturition
H/o abdominal pain, bleeding, pedal edema
H/o drug intake, radiation, contraception, USG
II trimester:
Quickening felt –primi-20 weeks, multi-16 weeks
TT given-2 doses
USG taken/not
Glucose challenge test done/not
IFA tablets given/not
H/o abnormal bleeding, headache, visual disturbances, pedal edema
III trimester:
H/o pedal edema, visual disturbances, bleeding/discharge p/v
Fetal movements
H/o burning micturition
H/o fatigue, false pain
H/o previous pregnancy:
Particulars Pregnancies in chronological order
1st 2nd 3rd 4th
Age at pregnancy
Spontaneous
conception/others
Pregnancy confirmed by
Full term/ pre term
Registered/ not (if yes,

where)
No. of ANC visits
No. of TT doses received &

when
IFA tablets
date & place of delivery
Nature of delivery
Person conducted delivery
Outcome:
abortion/premature/full term
*Complications if any
If death: age, sex, cause of

death
Age, sex & birth weight of

living child
When was breast feeding

initiated after birth
Any prelacteal feeds given?
Was Exclusive breast feeding

followed?
Immunization status: fully
immunized/partially
immunized/ not immunized
*complications: abortion, premature birth, eclampsia, APH, PPH, prolonged labor, retained
placenta, sepsis, still birth, IUD
4. MENSTRUAL HISTORY
o Age at menarche:
o Cycle: regular/ irregular interval:………………………………
o Flow:………………………………. (no.of pads used/day)…………………………
o Passing clots................................... H/o dysmenorrhoea……………………h/o
intermenstrual bleeding........................................h/o post coital bleeding………………..
5. MARITAL & FAMILY PLANNING HISTORY:

 Age at marriage:
 Consanguineous/ Non consanguinous marriage:
 Cohabiting since:
 Age at first child birth:
 Interval between previous & present pregnancy:
 Elaborate if any contraceptive method used & regularity of its use: (before, inbetween &
after pregnancy; current status):
……………………………………………………………………………………………
 Willingness for sterilization if completed family:
………………………………………………..
 If not used any FP method (reasons)
……………………………………………………………..
6. PAST HISTORY
 H/O Exanthematous fever/DM/HT/TB/asthma/epilepsy/jaundice/others
 H/o drug allergy
 H/o Previous surgery/ hospitalization
 H/o any gynaecological problems/ blood transfusion
7. PERSONAL HISTORY
 Sleep: normal/disturbed
 Bowel and bladder habits: regular/irregular
 Physical activity: sedentary/moderate/heavy
 Smoking/alcoholism/betel chewing:
8. FAMILY HISTORY
 Family h/o DM/HT/TB/Asthma/twinning/congenital anomalies etc:
 Does any family member smokes (cigarette/beedi) inside the house: Y/N
 Type of family: Nuclear/joint/Three generation family
 Total no. of family members:

status
Total income
No. of eligible couples:……. Geriatric:………. Under 5……….. Adolescent………..
Per capita income/month = total income of the family = Rs…………….

According to Modified Kuppusamy Scale the family belongs to ………………
9. Diet History: 24 hour recall method
Energy Proteins
( K Cal) (gms)

Protein requirement

 Kitchen: separate/not Fuel for cooking:……….. Exhaust for smoke:…present / absent
Conscious, oriented, built, nourishment, fever, pallor (nail, conjunctiva, tongue), jaundice,
cyanosis, clubbing, thyroid swelling, pedal edema, generalized lymphadenopathy, varicose veins,
oral hygiene, Spine and gait.
Vital signs: Pulse rate: _____ RR: ______Temperature _____BP: _______
Anthropometric measurements: Height: _____Weight: ______ Pre-pregnancy weight ______kg
[note: height ≤ 145 cm or 4’10”- AT RISK; weight: avg 10kg weight gain. If ≥3kg/month suspect
preeclampsia; BP 140/90 sustained & after 20 weeks suggests pre eclampsia]
Breast examination:
Nipples –retracted/fissures
Breast engorgement-
12. OBSTETRIC EXAMINATION:

Examination of abdomen: (to monitor progress of pregnancy, foetal growth, foetal lie, foetal
presentation)
 Inspection – linea nigra (20th week)
striae gravidarum(lower abdomen), scars, umblicus
 Palpation –
Fundal height:
Term uterus corresponds to 32-34 wks, flanks full

Foetal lie: vertical/transverse/oblique
Fundal grip:
Cephalic – well circumscribed hard independently ballotable
Breech – soft, broad, not independently ballotable
Umbilical grip:
Baby back – Smooth uniformly curved back felt on left or right side
Limb buds – opposite side
I pelvic grip:
Head – A hard well circumscribed independently ballotable
Breech- Soft, broad, not independently ballotable
Head – Mobile/unengaged/engaged
II pelvic grip:
Mobile head – can insert fingers
Engaged head – cannot insert fingers
Presentation: Cephalic/breech
 Auscultation: FHS (after 20th week)
[Note: Normal FHS 140beats/min, if ≤ 120 or ≥ 160 indicates foetal distress]
13. SYSTEMIC EXAMINATION:

- RS: vesicular or bronchial breath sounds heard
- CVS: S1, S2 heard or not, any murmer?
- CNS: within normal limits
14. SUMMARY OF YOUR CASE:

Summarize all the IMPORTANT & RELEVANT positive and negative findings of your case
15. PROVISIONAL DIAGNOSIS: GPLA, EDD, booked, immunized, cephalic/breech presentation,

complications (if any)
16. ADVICE –
To the mother:
- Treatment advise
- Diet (one extra meal every day), No alcohol/tobacco
- Additional calorie & protein requirement
- Personal hygiene
- Rest and sleep (8 hours sleep at night, 2hours rest in afternoon & rest as
often, no heavy work), Mental preparation
- TT immunization
- Anaemia prophylaxis: 100g elemental iron & 500 microgram folic acid for
100 days
- Provide disposable delivery kit
- Warning signs pedal edema, absent fetal movement, fits, headache, blurring
of vision, bleeding/discharge p/v etc.
- Give information about nearest FRU, transportation, blood donors
- Institutional delivery
- Contraception
- Follow up
For the baby: Initiation of breast feeding/colostrum/no prelacteal feed/exclusive breast

feeding/on demand feed/ night feeds/ immunization/ICDS/growth monitoring/rooming in/warm
chain, newborn care etc.
17. ADVICE - To the family ( health education on ANC care, child rearing/care, diet, warning signs,
hygiene etc)
18. INTERVENTION IN THE COMMUNITY: screen other ANC cases in the community/ provide
health education/create awareness about services available
19. Levels of prevention:

Identify all adverse factors in mother: (medical, social)
Levels of prevention Which level has How could it have been
failed? prevented?
Primary Health promotion
Specific protection
Secondary Early detection &

treatment
Tertiary Disability limitation
Rehabilitation
20. National Programme: RCH programme (to reduce maternal & child morbidity & mortality),
ICDS.
Note:
 Stages of normal labour:
Stage 1: onset of pain to full cervical dilatation 10 cm (primi 20 hours; multi 5 hours)
Stage 2: dilatation of cervix to delivery of baby (primi 1-2 hrs; multi 1 hr)
Stage 3: delivery of baby to delivery of placenta (10-15min)
 Monitor first stage of labour & maintain a partograph
- Partograph is a graphic representation of progress of labour with reference to
foetal heart, cervical dilatation, descent of head, uterine contraction &
maternal condition.
- It is used to identify signs of obstructed labour, signs of prolonged labour
early so as to give timely medical attention.
8. PNC CASE
GENERAL INFORMATION:
 Mother
Name: Age:
Education: Occupation: Religion:
Address:
 Information of baby:
Name:
Age/sex:
Birth place: home/institutional
Mode of birth:
Date & time of birth:
Birth order:
Birth interval:
Last child birth:
Term: full term/ preterm
CHIEF COMPLAINTS: Elaborate all the present complaints in detail in chronological order
along with all relevant NEGATIVE history)
[Note: Bleeding/ foul smelling discharge P/V, fever, pain & tenderness in abdomen, fatigue,
palpitation, chest pain, Swollen leg, burning micturition, Breast pain / engorgement, Breast
feeding problem, any complaints relating to baby]
HISTORY OF PRESENT DELIVERY:
Antenatal History:
1. Obstetric score: P/L/A LMP:……… EDD:………..
2. Registered: Y/N Date of registration/where
3. No. of antenatal visits:
4. Immunization: TT1:……………TT2…………..TT booster:…………..,
5. IFA tablets: Y/N when started.....Total tablets received…..Total tablets
consumed…..Reason if not taken……
6. Beneficiary of ICDS:Y/N
7. Elaborate on the ANC period: (Note: Elaborate the events/ complaints in the relevant
trimesters)
First trimester (registered, complaints, h/o drug/radiation exposure, FA tablet):
Second trimester (quickening, IFA, TT, any complaints):
Third trimester (warning signs):
Natal history:
1. Date & admission to hospital:
2. Details of referral if any :
3. Mode of transport to hospital:
4. Reason for delay, if any:
5. Person accompanying:
6. Time of rupture of membranes:
7. Date, time, duration of delivery:
8. *Any complication during delivery:
9. Nature of delivery: normal/instrumental/caesarean
10. Mode of delivery: induced/elective/emergency
11. Time of delivery of placenta (if known):
12. If home delivery – conducted by trained dai/doctor/ untrained person; delivery kit used or
not?
[ *note: intranatal problems- no pain-no progress, rupture & leakage of membrane > 24
hours, meconium stained liquor, malpresentation/prolapse of cord/hand, blood loss > 240
ml, late expulsion of placenta, perineal tear, collapse,temperature >35.C]
Postnatal history:
1. Full term/ preterm
2. Outcome of delivery: Normal healthy baby
3. Sex of the baby:
4. Weight at birth:
5. APGAR score (if known) :
6. Baby cried immediately after birth: Y/N
7. Any complication of the newborn: NICU admission
8. Urine and meconium passed
9. Breast feeding initiation:
10. Colostrum given : Y/N
11. Artificial feeding/ prelacteal feeds given: Y/N
12. BCG & “0” dose OPV given: Y/N
13. Any postnatal complications in mother/baby (puerperal sepsis, thrombophlebitis,
secondary hemorrhage, mastitis, UTI, birth injury, congenital anomalies, neonatal
tetanus/jaundice)
PREVIOUS OBSTETRIC HISTORY
Particulars Pregnancies in chronological order
1st 2nd 3rd 4th
Age at pregnancy
Spontaneous
conception/others
Pregnancy confirmed by
Full term/ pre term
Registered/ not (if yes,

where)
No. of ANC visits
No. of TT doses received &

when
IFA tablets
date & place of delivery
Nature of delivery
Person conducted delivery
Outcome:
abortion/premature/full
term
*Complications if any
If death: age, sex, cause of

death
Age, sex & birth weight of

living child
When was breast feeding
initiated after birth
Any prelacteal feeds given?
Was Exclusive breast

feeding followed?
Immunization status: fully

immunized/partially
immunized/ not immunized
*complications: abortion, premature birth, eclampsia, APH, PPH, prolonged labor,

retained placenta, sepsis, still birth, IUD.
MENSTRUAL HISTORY
o Age at menarche
o Cycle: Regular / irregular interval:………………..
o Flow:………………………… no of pads used/day:…………………..
o Passing clots................................... H/o dysmenorrhoea……………………h/o
intermenstrual bleeding........................................h/o post coital
bleeding………………..
MARITAL & FAMILY PLANNING HISTORY:

 Age at marriage:
 Consanguineous/ Non consanguinous marriage:
 Age at first child birth:
 Interval between previous & present pregnancy:
 Elaborate if any contraceptive method used & regularity of its use: (before,
inbetween & after pregnancy; current status):
…………………………………………………………
 Willingness for sterilization if completed family:
……………………………………..
 If not used any FP method (reasons)
……………………………………………………..
PAST HISTORY
 H/o exanthematous fever, DM, HT, TB, asthma, epilepsy, blood transfusion
 H/o previous surgeries/illness, prolonged medication, drug allergy
PERSONAL HISTORY
 Sleep: normal/disturbed
 Bowel and bladder habits: regular/irregular
 Physical activity: sedentary/moderate/heavy
 Smoking/alcoholism/tobacco chewing:
FAMILY HISTORY
 Family h/o DM/HT/TB/Asthma/twinning/congenital anomalies etc:
 Does any family member smokes (cigarette/beedi) inside the house: Y/N
 Type of family: Nuclear/joint/Three generation family
 Total no of members:
status
1
2
3
4
5
6
Total income
No. of eligible couples:……. Geriatric:………. Under 5……….. Adolescent………..
Per capita income/ month = total income of the family = Rs…………….

According to Modified Kuppusamy Scale the family belongs to ………………
DIET HISTORY: 24 hour recall method

Energy Proteins
( K Cal) (gms)

Protein requirement
ENVIRONMENTAL HISTORY:
absent
GENERAL EXAMINATION
Conscious, oriented, built, nourishment, fever, pallor, jaundice, cyanosis, clubbing,

thyroid swelling, oral hygiene, pedal edema, generalized lymphadenopathy, varicose
veins, psychological condition (post partum psychosis)
Vital signs: Pulse rate: _____ RR: ______Temperature _____BP: _______

Anthropometric measurements: Height: _____Weight: ____
Breast examination:
Nipples –retracted/cracks/fissures:
Mass:
Breast engorgement/tenderness/engorged veins:
EXAMINATION OF THE ABDOMEN:

Inspection:
1. Distension
2. Flanks free
3. Umbilicus in midline
4. Linea nigra, straie gravidarum
5. Any scar, sinus, any surgical wound
6. Distended veins
Palpation:
1. Soft
2. Uterus : palpable/not - Firm and contracted well
3. Fundus –level
4. Consistency –firm
5. Suprapubic tenderness
Auscultation: Normal bowel sounds heard: Y/N
EXAMINATION OF PERINEUM:
1. Episiotomy scar/perineal tears: Wound clean and healthy
2. Lochia: Color/ smell/clots/ any undue bleeding PV
[note: lochia: reddish (rubra), pale red (serosa), white (alba)
OTHER SYSTEMS:
RS: vesicular or bronchial breath sounds heard
CVS: S1, S2 heard or not, any murmer?
CNS: within normal limits
IMPRESSION: Normal postnatal mother?
EXAMINATION OF NEW BORN
ANTHROPOMETRY (comment on each)

o Length
o Weight
o HC
o Chest Circumference
VITALS
o Heart rate
o Respiratory rate
o Temperature
o Capillary refill time (Normal < 2 sec)
HEAD TO FOOT EXAMINATION
 Skin : Any rash-vesicular/ bullous lesions/ skin turgor

 Color : Any cyanosis/jaundice
 Anterior & posterior fontanelle
 Palate : cleft lip/palate
 Eye : Cataract, conjunctivitis, sunken
 Ear : Dysmorphism, accessory auricles, pre-auricular pits
 Nose :
 Cardio respiratory activities: Murmurs, central cyanosis, RR>60 /chest retraction on
inspiration
 Neurobehavioral activities:
- Posture- neck retraction, frog like posture, hyperextension/ hyperflexion of all
limbs, asymmetrical posture.
- Look for primitive reflexes ( moro, plantar, palmar, rooting, sucking reflex,
glabellar tap)
- Muscle tone- tendon reflexes, cry, movements.
 Umbilical cord : clean Stump: dry Base: dark Any discharge:
 Abdomen : Signs of distension, abnormal mass, imperforate anus.
 Limbs & joints: Deformities of joints, congenital dislocation of hips ,extra digits
 Spine : Neural tube defects
 External genitalia:
Male : Hypospadiasis, undescended testis, hydrocele, hernia
Female : fused labia, enlarged clitoris
 Signs of prematurity:
 Congenital anomalies/infection/birth injuries:
 Anemia, jaundice, lymphadenopathy?
 Cry, color, activity: normal/abnormal
IMMUNIZATION H/O: BCG, Zero Polio, Zero Hep B, given/not, next dose due
on…………….
DIET History:
When breast feeding was initiated after birth:
Any artificial feeds given (with reason):
Exclusive breast feeding: Y/N Awareness of mother about EBF: Y/N
Breast feeding on demand: Y/N
Night feeds: Y/N No of times given at night:
No. of times passes urine/ feces in a day:
IMPRESSION: Normal neonate

SUMMARY OF CASE: Summarize all the IMPORTANT & RELEVANT positive and
negative findings.
DIAGNOSIS
MANAGEMENT:
ADVICE TO MOTHER:
a. Treatment advise if any
b. Care of episiotomy/Caesarean sutures
a. Diet
b. IFA tablets atleast for 6 months
c. Plenty of fluids
d. Adequate rest
c. Breast feeding-Exclusive breast feeding has to be continued upto 6 months. Frequency of
breast feeding should be more than 8 times during day hours and atleast 3 times during
night hours.
d. Mother should wash her hands before and after food preparation and feeding-before and
after cleaning the baby with soap and water
e. Abstinence for 6 weeks
f. Contraceptive advice – IUCD is best for spacing
g. Pelvic floor muscle exercises- exercise for strengthening the pelvic floor & abdominal
muscles.
h. Baby care- breast feeding on demand, umbilical cord care, immunization, growth
monitoring once a month (weight/length), rooming in, warm chain, ICDS
ADVICE - To the family (health education on mother care, child rearing/care, diet,
hygiene etc)
INTERVENTION IN THE COMMUNITY: screen other PNC cases in the community/

provide health education/create awareness about services available.
Levels of prevention:
Identify all adverse factors in mother & baby: (medical, social)
Levels of prevention Which level has How could it have been
failed? prevented?
Primary Health promotion
Specific protection
Secondary Early detection &

treatment
Tertiary Disability limitation
Rehabilitation
National Programme: RCH programme (to reduce maternal & child morbidity &
mortality), JSY, JSSK, ICDS etc.
9. PROTEIN ENERGY MALNUTRITION CASE

1. Socio – demographic history
Name:
Age:
Sex: Male / Female
Address:
Occupation:
Head of the family:
Informant:
Reliability of the informant: Good/fair/not reliable
2. Presenting complaints:
3. History of presenting illness:

Diarrhoea: Duration : ____days
Frequency/day:
Foul smelling
Consistency : Watery-cholera, rotavirus, E.coli/mucus & blood-dysentry

(shigella, amoebic, salmonella)/pea soup-typhoid
Colour : yellowish/green
H/o passing blood
H/o abdominal pain
H/o passing worms
Decreased urine output: Yes / No
Any history of persistent loose stools ( for >14 days)
Fever: Onset : Acute/chronic
Duration : _____ days
Type : Intermittent- continuous/step ladder type
Grade : high /low
Diurnal variation : morning/evening
Associated with : chills/rigor/myalgia
Vomiting: Duration : ___days
Non projectile/projectile-raised ICT, meningitis
Sudden onset
Colour, Content: undigested food/blood & mucus/bile
Frequency of vomiting
Frothy/ non frothy
H/o abdominal distension / H/o abdominal pain
H/o decreased urine output
Cough: Duration : ____days
Productive : scanty/copious//dry
Colour : white-TB/yellow-asthma/green-pseudomonas/blood
stained/rusty-pneumonia/black-aspergillus/red-klebsiella
Smell : Foul
Aggravated-lying down/relieving factors:
Diurnal variation : Day/Night
Micturition: Burning/frequency (crying during passing urine)
H/o bottle feeding at early age
H/o Refusal of feeds, decreased appetite
H/o muscle cramps
H/o Wheeze
H/o weight loss
Dull/lethargy
4. Past history:
H/o Exanthematous fever- post measles- vitA deficiency-corneal ulcer,
pneumonia, diarrhea/chicken pox/rubella
H/o Contact with TB- failure to thrive
H/o Recurrent URI-tonsillitis /adenoids
H/o ear discharge -ASOM
H/o Jaundice-leptospirosis/hepatitis
H/o Hospitalization/surgery
H/o Visual dimunition
H/o Mouth ulcers
H/o bleeding tendencies
Any previous H/o admission due to malnutrition
5. Treatment history: For previous admissions for ADD, URI, LRI , Malnutrition related illness
6. Personal History
 Type of diet veg / non veg/ mixed
7. Family history:
H/o consanguineous marriage, H/o twin pregnancies in family, Bad obstetric history in
the mother – ectopic pregnancies, abortions, still births, APH/ PPH, LBW in siblings, obstructed
labour etc
Details of family:
Marital
S.No family Age Sex to head of Education Occupation per
status
Per capita Income = total income of the family = Rs…………….

According to modified Kuppusamy scale the family belongs to …………
8. Antenatal history:
Registered / TT 2 doses/IFA /No. of AN visits
H/o Fever with rash
H/o Exposure to ionizing radiation
H/o PIH,GDM
H/o Weight gain
9. Natal history:
Birth order:
Term/preterm : any LBW history
Type of delivery: Normal / caesarean
Place of delivery: institutional/home
10. Postnatal history:
Baby cried immediately after birth
Birth weight:
Breast feeding initiation/colostrums given/prelacteal feeds
Birth related problems- congenital anomalies/hospitalization
H/o jaundice
H/o umbilical sepsis
H/o respiratory distress
H/o seizures
H/o hospitalization-reason
11. Developmental history:
Gross, fine, language, social milestones were attained normally for age.
12. Immunization history: Immunization card-present/absent
Fully immunized / Partially immunized / Un immunized
Vaccine Age
Birth 6 weeks 10 weeks 14 weeks 9-12 months
Primary vaccination
BCG X
Oral polio X X X X
DPT X X X
Hemophillus Influenzae type B X X X
Hepatitis B* X X X
Measles first dose X
Booster Doses
DPT + Oral polio + Measles second
16 to 24 months
dose
DT 5 years
Tetanus toxoid (TT) At 10 years and again at 16 years
Vitamin A 9, 18, 24, 30, 36 , 42, 48, 54, 60 months
Pregnant women
Tetanus toxoid (PW): 1st dose As early as possible during pregnancy (first contact)
2 dose
nd
1 month after 1st dose
Booster If previously vaccinated, within 3 years
14. Dietary history:

Prelacteal feeds
Breast feeding initiation
Duration of exclusive breast feeding
When started on complementary feeds/what?
Whether sending the child to ICDS :
Supplementary feeding taken from ICDS – Yes/No
Growth chart maintained at the ICDS centre or elsewhere : Yes /No
Monthly monitoring of weight done: Yes / No
24 hour recall method
Energy Proteins
( K Cal) (gms)

Protein requirement

absent
16. Nearby Health Facility: Present where? distance? Facilities available? regular utilization
present or absent
17. General examination:
Conscious, Comfortable, Oriented, Built, Nourishment, Fever, Anemia (pallor), Jaundice
(icterus), Cyanosis, Clubbing, Thyroid enlargement, edema (Pedal edema, facial edema),
Generalized lymphadenopathy.
Any toxic look
Any congenital anomalies
Head to foot examination:
General appearance : Normal built/thin built/sickly
Hair : Normal/lack of luster, easily pulled out/flag sign
Face : Diffuse depigmentation/moon face
Eyes : Conjunctiva-bitot spots/cornea-dryness/opaque
Lips : Angular stomatitis/cheilosis
Tongue : Pale/fissured/geographic
Teeth : Mottled enamel/caries
Gums : Bleeding
Glands : Thyroid/parotid enlargement
Skin : Dry/scaly/pellagra/ diffuse pigmentation/ flaky paint dermatosis
Nails : Koilonychia
 Edema in dependent parts: lower legs and in face
 Rachitic changes: Knock knees/bow legs/ epiphyseal enlargement/ beading of the ribs/
pigeon chest
 Internal changes : Hepatomegaly/ psychomotor change/ mental confusion/ sensory loss/
muscle wasting/ motor weakness/ loss of position sense/ loss of vibration sense/ loss of
ankle & knee jerks/ calf tenderness/ cardiac enlargement/ tachycardia
 Mental changes : quiet apathetic/ irritable/moaning
 Muscle wasting – fat retained or not, skin fold thickness.
18. Vital Signs: Pulse: Temperature: RR:
19. Anthropometric Measurements: Height: _______Weight:_________

20. Nutritional Assessment: -
IAP Degree of malnutrition (based on weight for age)
Length/height________________ (Mclaren/ Waterlow classification)
Mid arm circumference (1 – 5 years): __________
Head circumference (<1 year): ____________
Chest circumference (<1 year))___________
21. Systemic Examination:

RS :Stridor-present/absent
Chest indrawing-present/absent
Auscultation- Wheeze associated lower respiratory infections (WALRI)
CVS : Physiological murmurs
CNS : irritable/ apathetic
Abdomen : Organomegaly, distension, tenderness
Examination of External Genitalia:

22. Assessment of Dehydration: Thirst /eyes/tongue/skin turgor
23. SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS
24. PROVISIONAL DIAGNOSIS: Protein energy malnutrition with grading and immunization
status of the child
25. Treatment: Treatment of associated infections and illness– treatment of URI/ LRI, typhoid,
malaria etc , illness like – pellagra, celiac sprue etc
Correction of malnutrition – immediate, short term and long term
Treat primary complex if present
Treat worm infestations
Correct anemia if present
Growth monitoring
Supplementary feeding
26. INVESTIGATIONS:
Stool : Macroscopic, colour, consistency, blood, mucus, worms, parasites.
Microscopic : pus cells, RBC, cyst & eggs, trophozoites
(Ascariasis/Ancyclostomiasis/Giardiasis/Amoebiasis/Strongyloides)
(Dark field microscopy for Vibrio Cholerae)
stool culture if required
Urine examination: colour, albumin, sugar
Electrolytes: sodium, potassium, bicarbonates in blood
Blood smear : Malaria parasite/ Filaria Blood : TC, DC, Hb%
Other investigations: serum albumin, urinary urea per gm creatinine, hydroxyproline/creatinine
ratio, plasma/amino acid ratio
USG whole abdomen
27.Advice to the patient/family:
Prevention:
 Agent, Host and Environmental factors involved in this case.
 Probable source of infection ( in case of communicable diseases), probable cause
if illness
 What are the levels of prevention that are failed and why?
Discussion points:
 Management of this case (Treatment)
 Nutritional status assessment
 Grading of PEM, classifications of PEM (Gomez’ , Waterlow’ IAP )
 Clinical signs of PEM
 ICDS programme , Mid Day meal programme
 Growth chart monitoring
 Micronutrients and macronutrients, nutritional foods, sattu maavu
 Rehabilitation of severe PEM cases – nutritional rehabilitation services
 Prevention of recurrent infections in malnourished under 5 children
 Assessment of dehydration, treatment of dehydration
 Diet surveys
 MCH & NRHM – measures at pregnant and lactating mothers to prevent LBW
and malnutrition
 Different scales used in weight and height measurement
 Low cost Weaning foods
 Health education on balanced diet, correct feeding practices – inclusion of fruits
and vegetables, home garden
 Home economics, microfinancing, self help groups
 Nutritional surveillance
 Deworming
 Vitamin A prophylaxis, measles vaccination and National immunization schedule
10. ACUTE DIARRHOEAL DISEASE CASE
1. Socio-demographic history
Name:
Age:
Sex: Male / Female
Address:
Occupation:
Head of the family:
Informant:
Reliability of the informant: Good/fair/not reliable
2.Presenting complaints:
3.History of presenting illness:
Diarrhoea: Duration : ____days
Frequency/day:
Foul smelling: yes / no
Consistency : Watery-cholera, rotavirus, E.coli/mucus & blood-dysentry

(shigella, amoebic, salmonella)/pea soup-typhoid
:Was stools semisolid in consistency?
Colour : yellowish/green
H/o passing blood
H/o abdominal pain
H/o passing worms
Decreased urine output: Yes / No
Any history of persistent loose stools ( for >14 days)
Fever: Onset : Acute/chronic
Duration : _____ days
Type : Intermittent- continuous/step ladder type
Grade : high /low
Diurnal variation : morning/evening
Associated with : chills/rigor/myalgia
Vomiting: Duration : ___days
Non projectile/projectile-raised ICT, meningitis
Whether sudden in onset
Colour, Content: undigested food/blood & mucus/bile
Frequency of vomiting
Frothy/ non frothy
H/o abdominal distension / H/o abdominal pain
H/o decreased urine output
H/o any respiratory tract infection
H/o Refusal of feeds
Dull/lethargic
H/o muscle cramps
H/o cough
H/o acute weight loss
H/o bottle feeding at an early age
4.Past history:
H/o Exanthematous fever- post measles- Vitamin A deficiency-corneal ulcer,
pneumonia, acute or persistent diarrhoea/chicken pox/rubella
H/o Contact with TB- failure to thrive
H/o Recurrent URI-tonsillitis/adenoids
H/o ear discharge - ASOM
H/o Jaundice-lepto/hepatitis
H/o Hospitalization/surgery
H/o Visual dimunition
H/o Mouth ulcers
H/o bleeding tendencies
Any H/o admission due to malnutrition - PEM
5. Treatment history: Details of any relevant treatment history in the past
6. Personal History
 Type of diet veg / non veg
6. Antenatal history:
Registered / TT 2 doses/IFA /No. of AN visits
H/o Fever with rash
H/o Exposure to ionizing radiation
H/o PIH,GDM
H/o Weight gain
7. Natal history:
Birth order:
Term/preterm
Type of delivery: normal/caesarean
Place of delivery: institutional/home
Baby cried immediately after birth
Birth weight:
Breast feeding initiation/colostrums given?/ any prelacteal feeds?
Birth related problems- congenital anomalies/hospitalization
8. Postnatal history:
H/o jaundice
H/o umbilical sepsis
H/o respiratory distress
H/o seizures
H/o hospitalization-reason
9. Developmental history:
Gross, fine, language, social milestones were attained normally for age.
Fully immunized / partially immunized / unimmunized
Vaccine Age
Primary vaccination
BCG X
Oral polio X X X X
DPT X X X
Hepatitis B* X X X
Booster Doses
16 to 24 months
dose
DT 5 years
Vitamin A 9, 18, 24, 30, 36 , 42, 48, 54, 60 months
Pregnant women
2nd dose 1 month after 1st dose
11. Family history:

Any H/o consanguineous marriage
Details of family:
S.N Marital
o status
Per capita Income = total income of the family = Rs…………….

Prelacteal feeds
Whether sending the child to ICDS – whether active beneficiary of ICDS ?
Energy Proteins
( K Cal) (gms)

Protein requirement

absent
14. Nearby Health Facility: Present where ? distance? Facilities available? regular utilization
present or absent?
15. GENERAL EXAMINATION:

(icterus), Cyanosis, clubbing, Thyroid, edema/Pedal edema, Generalized
lymphadenopathy
Any toxic look in the child? Alert or restless? Drowsy or comatose? Cold extremities?
Any congenital anomalies

Shape of the head : normal
Anterior fontanelle : normal or sunken
Eyes : sunken, conjunctiva dry
Nose : flaring of alar nasi, normal breathing present?
Mouth: dry lips, tongue dry
Chest : chest indrawing present or normal chest wall movements
Abdomen : normal bowel sounds heard, any distension
Skin turgor : on pinching does it go back slowly? (>2 seconds)
Thrist : increased?
Edema in dependent parts:
Urine flow : normal or decreased
Any signs of PEM present: flag sign, rachitic changes, mottled teeth etc
Vital Signs: Pulse: Temperature: RR:
16.Anthropometric Measurements: Height: _______Weight:_________

17.Nutritional Assessment:
Height for age ________________ (Mclaren/ Waterlow classification)
18.SYSTEMIC EXAMINATION:
RS :Stridor-present/absent, Chest indrawing-present/absent
Auscultation- Wheeze associated lower respiratory infections (WALRI)
CVS :
CNS :
Abdomen : Organomegaly, distension, bowel sounds , tenderness present? Region of
tenderness?
Examination of External Genitalia:
19. SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS
20. PROVISIONAL DIAGNOSIS: Degree of dehydration with immunization status and
nutritional status
1. Acute diarrhea without dehydration
2. Acute diarrhea with some dehydration
3. Acute diarrhea with severe dehydration
4. Persistent diarrhea
5. Dysentery
6. Cholera
21. INVESTIGATIONS:
Stool: Macroscopic, colour, consistency, blood, mucus, worms, parasites.
Microscopic: pus cells, RBC, cyst & eggs, trophozoites
(Ascariasis/Ancyclostomiasis/Giardiasis/Amoebiasis/Strongyloides)
(Dark field microscopy for Vibrio cholerae)
stool culture if required
Urine examination: colour, albumin, sugar
Electrolytes: sodium, potassium, bicarbonates in blood
Blood smear : Malaria parasite/ Filaria
Blood : TC, DC, Hb%
Other investigations:
22. Treatment: Appropriate clinical management (oral rehydration therapy, IV fluids) continue
appropriate feeding, stop bottle feeding.
23. Advice to the patient/family:
1. Warn about danger signs
2. Follow up visit
3. Home available fluids
4. Breast feeding continuation
5. Hand hygiene- Hand washing after defecation
6. Food items to be kept covered, utensils properly washed
7. Personal hygiene – nails etc
8. To immunize the child as per schedule
9. To give child Vitamin A solution as per schedule
23. Prevention:
4. Agent, Host and Environmental factors involved in this case.
5. Probable source of infection ( V. Cholerae, Salmonella, Shigella, Enterotoxigenic
E.Coli, Campylobacter jejuni etc )
6. What are the levels of prevention that are failed and why?
Discussion points :
(a) Child nutrition – prevention and treatment of malnutrition (Kwasiorkar, Marasmus, Pellagra
etc)
(b) Sanitation – provision and usage of sanitary toilets (clean functioning f toilet)
(c) Filtration of drinking water – chlorination etc
(d) Health education regarding open air defecation and its adverse effects, personal hygiene
(hand washing), hand hygiene, domestic hygiene, provision of safe drinking water,
indiscriminate defecation practices of young children
(e) Immunization status of the child – national immunization schedule, immunization against
measles, dosage and schedule of measles vaccine, rotavirus vaccine, Vitamin A
(e) Fly control – fly breeding sites, disposal of human excreta and fly breeding association,
fly control measures
(f) Diarrhoeal disease control program in India ( This programme is part of NRHM ) – national
oral rehydration therapy programme, clinical case management of diarrhea for children under 5
years of age, continued feeding, home available fluids. MCH programme
(g) ORS & its composition, treatment with IV fluids (Ringer’s lactate solution) – treatment plans
for rehydration therapy and maintenance therapy
(h) Zinc supplementation
(i) Levels of dehydration – assessment of dehydration (mild & severe)
(j) Chemotherapy for ADD
(k) Role of primary health care in prevention of diarrhoeal diseases.
11. ARI CASE (UNDER 5)
Name Age Sex
Address
Informant Reliability
2. PRESENTING COMPLAINTS:
Fever ,running nose, cough, sore throat, difficulty in breathing ,ear problem
3. HISTORY OF PRESENT ILLNESS :
FEVER:
 Onset
 Duration
 Type
 Grade
 Diurnal variation
 Associated with
COUGH: continuous / intermittent
with sputum / without sputum
Other complaints:
4. PAST HISTORY
 H/o Previous hospitalization
 H/o Exanthematous fever
 H/o wheeze, difficulty in breathing
 H/o recurrent vomiting
 H/o passing worms in motion
 H/o recurrent URI
 H/o ear discharge
 H/o jaundice
 H/o Contact with TB
 H/o mouth ulcers
 H /o Nasal flaring ( when the nose widens as the child breaths in)
 H/o similar illness in sibling/peers
5. ANTENATAL HISTORY ( for child < 1 yr)

 Registered yes /no
 Immunization: TT1 TT 2 TT
booster
 No. of antenatal visit 3 or more
 H/o IFA tablets intake 100/ 200/ more
 H/o fever with rash yes / no
 Beneficiary of ICDS : yes / no
 H/o exposure to ionizing radiation yes / no
 History suggestive of Pregnancy Induced Hypertension/Gestational Diabetes
Mellitus
6. NATAL HISTORY( for child < 1 yr)
 Birth order Gravida …./para…../living……./abortion……
 Term / preterm
 Nature of delivery : normal /instrumental / caesarean
 Institutional / home delivery
 If home delivery ---conducted by trained dai / doctor / untrained person ; delivery
kit used or not
7. POSTNATAL HISTORY
 Weight at birth
 Baby cried immediately after birth yes /no
 Any complication of the new born :NICU/Temperature/diarrhoea
 Exclusive breast feeding
 Colostrum given yes/no
 Artificial feeding / Prelacteal feeds given yes/no
 Any h/o any infection
Fully immunized / partially immunized / unimmunized

Vaccine Age
Primary vaccination
BCG X
Oral polio X X X X
DPT X X X
Hepatitis B* X X X
Booster Doses
16 to 24 months
dose
DT 5 years
Vitamin A 9, 18, 24, 30, 36 , 42, 48, 54, 60 months
Pregnant women
2nd dose 1 month after 1st dose
9. Family history:
No. of family members/ Type of family

Any H/o consanguineous marriage
Details of family:
S.N Marital
o status

Per capita Income / month = total income of the family = Rs…………….
Prelacteal feeds
Whether sending the child to ICDS – whether active beneficiary of ICDS ?
Morni Energy Proteins
Name Afternoon Evening Night
ng ( K Cal) (gms)

Protein requirement
absent

(icterus), Cyanosis, clubbing, Thyroid, edema/Pedal edema, Generalized
lymphadenopathy. Any toxic look in the child? Alert or restless? Drowsy or comatose?
Cold extremities? Any congenital anomalies
Shape of the head : normal
Anterior fontanelle : normal or sunken
Eyes : sunken, conjunctiva dry
Nose : flaring of alar nasi, normal breathing present?
Mouth: dry lips, tongue dry
Chest : chest indrawing present or normal chest wall movements
Abdomen : normal bowel sounds heard, any distension
Skin turgor : on pinching does it go back slowly? (>2 seconds)
Thrist : increased?
Edema in dependent parts:
Urine flow: normal or decreased
Any signs of PEM present: flag sign, rachitic changes, mottled teeth etc
Vital Signs: Pulse: Temperature: RR:
Nutritional Assessment:
Length/height________________ (Mclaren/ Waterlow classification)
13. SYSTEMIC EXAMINATION

 EXAMINATION OF THE RESPIRATORY SYSYTEM
 Stridor - present / absent
 Chest Indrawing - present / absent
 Auscultation - : breath sound --vesicular / bronchial
Rhonchi present / absent
 EXAMINATION OF THE ABDOMEN; Organomegaly present /absent
 EXAMINATION OF THE CARDIO VASCULAR SYSYTEM : S1 ,S2 heard

No murmur
 EXAMINATION OF THE CNS - normal
 SUMMARY WITH POSITIVE AS WELL AS NEGATIVE

FINDINGS…………………
 PROVISIONAL DIAGNOSIS -- ARI / Pneumonia / Severe Pneumonia / No Pneumonia /

severe disease
 TREATMENT - according to national program guidelines (standard case management)
 ADVICE & CARE
 INTERVENTION TO THE FAMILY - Look for similar case in the family and treat
them (sibling in the family)
 INTERVENTION TO THE COMMUNITY --Look for similar case in the community

and treat them
Immunization / vit A supplementation for children
Health education
 NATIONAL PROGRAM ……objective / strategies………………………………….
 HOW WILL YOU CONFIRM THE DIAGNOSIS

No Pneumonia Pneumonia Severe Very severe disease
( cough and cold) pneumonia
Signs No chest No chest Chest Not able to drink

indrawing indrawing indrawing+ Convulsions
No fast breathing Fast breathing + Cyanosis + Abnormally sleepy
(<50 -2months to Nasal flaring + Stridor
12 months) Severe malnutrition
(<40 -12months
to 5 years)

4 Spotters Ex Case-1

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SPOTTERS

 Draw suitable diagrams

 Identification with two points

 Prevention & Control

ANOPHELES PUPA ANOPHELES ADULT RESTING POSITION

AEDES EGG: AEDES LARVA

CULEX PUPA CULEX ADULT RESTING POSITION

SANDFLY HOUSEFLY: MAGGOTS

HARD TICK SOFT TICK

CYCLOPS MALE CYCLOPS FEMALE

PLASMODIUM VIVAX: SCHIZONTS PLASMODIUM VIVAX GAMETOCYTES

 Uses & dose

DIELDRIN (ORGANO CHLORINE COMPOUND) HEXA CHLORO CYCLOHEXANE (HCH)

PROPOXUR 20% (OMS-33) CARBAMATE PARIS GREEN (COPPER ACETOARSENITE)

SANITARY WELL TUBE WELL

SEPTIC TANK BORE HOLE LATRINE

 Public health importance: storing, processing, cooking/

BROWN RICE WHEAT

RAGI BENGAL GRAM

GREEN GRAM SOYABEAN

COPPER-T MINI PILL

 Public Health Importance

DISPOSABLE DELIVERY KIT DISPOSABLE MENSTRUAL HYGIENE KIT

Points to be written for the spotters overleaf:

ZINC TABLETS IRON AND FOLIC ACID- SMALL(TABLETS)

IODIZED SALT VITAMIN A SOLUTION

 Dose, Route, Site of administration

 Adverse effects / reactions if any

 Storage temperature at Primary Health Centre level

 Diluents to be used if any

 Important Precautions if any

JAPANESE ENCEPHALITIS VACCINE ANTI RABIES VACCINE

AUTODISPOSABLE SYRINGE VACCINE VIAL MONITOR

 National Programme if any

MDT LEPROSY KIT- PB (ADULT) MDT LEPROSY KIT- PB (CHILD)

MDT TB CATEGORY I MDT TB CATEGORY II

 Public Health Importance

LEPROSY – MULTIBACILLARY CASE LEPROSY SELF CARE KIT

 Draw the following & describe the Concept & Importance.

Urban Rural Total

MULTIPLE BAR DIAGRAM

SRS 1983 1993 2003 2005 2006 2007 2008 2010

6. AGE PYRAMID (draw from textbook & write your comments)

Marks Marks Marks Marks

1. Following is the details of weight in Kg of age in completed years of 4 children.

a. What is the type of study?

i. Construct a 2 by 2 table with the given data.

 The expected number of pregnant women and infants.

Individual : Treatment compliance, follow-up, Advice

18. Concerned National Programme

 Go through the given case sheet carefully.

 Repeat the exercises for two such cases in each morbidity.

1. FEVER CASE PROFORMA

3. HISTORY OF PRESENT ILLNESS :

Per capita Income/month = Total income of the family = Rs…………….

According to modified Kuppusamy scale the family belongs to ………………

Protein intake Protein deficit

12. SYSTEMIC EXAMINATION:

EXAMINATION OF THE ABDOMEN: organomegaly --present /absent

EXAMINATION OF THE RESPIRATORY SYSYTEM : breath sound --vesicular / bronchial

SUMMARY WITH POSITIVE AS WELL AS NEGATIVE FINDINGS…………………

ADVICE & CARE ……………………………………………..

NATIONAL PROGRAM …objective / strategies…………………………………….

13.Vital Signs: Pulse: ___Temperature:_ RR: BP: _____

14.Anthropometric Measurements: Height: _Weight:_ BMI: Wt (kg) / Ht (m2)

Vital signs: Pulse rate: _ RR: Temperature _BP: ____