General questions

1.What are the types of family ?

Nuclear family
Joint family
Three generation family
2.What is a joint family?
Joint family:It consist of a number of married couples and their children who live together in the
same household All the men are related by blood and the women of the household are their
wives unmarried girls and widows of the family kinsmen .There is a common family pursue to
which all the family income goes and from which all expenditures are met. They share a common
kitchen
3.What is house/ household
House is the physical structure, such as a building or dwelling while household refers to the
people living in the house.

4.What is the criteria to be the “Head of the family”

Head of the family is the one who take the primary decisions and manages the expenditure of
the family
5.Define “Rural area” and “Urban” area, “Slum area”
Urban Area
According to the Census of India 2001, an urban area is the one which fulfils the following
criteria:
a) All statutory places with a municipality, corporation, cantonment board or notified town area
committee, etc. OR
b) A place satisfying the following three criteria simultaneously:
i.A minimum population of 5,000;
ii. At least 75 per cent of male working population engaged in non-agricultural
pursuits; and
iii. A density of population of at least 400 per sq. km. (1,000 per sq. mile)
Rural area
According to the Census of India 2001, all those areas which do not fulfil the criteria for urban
area are
grouped as rural areas
Slum area
According to the Census of India 2001, slum areas broadly constitute:
1. All specified areas in a town or city notified as ‘Slum’ by State/Local Government and UT
Administration under any Act including a ‘Slum Act’.
2. All areas recognized as ‘Slum’ by State/Local Government and UT Administration, Housing and
Slum Boards, which may have not been formally notified as slum under any act;
3. A compact area of a population of at least 300; or about 60-70 households of poorly built
congested tenements, in unhygienic environment usually with inadequate infrastructure and
lacking
in proper sanitary and drinking water facilities.
The UN habitat defines a slum as an area lacking the following facilities:
a. Access to improved water
b. Access to improved sanitation
c. Security of tenure (the right to effective protection by the state against arbitrary, unlawful
eviction)
d. Durability of housing (including living in a non - hazardous location)
e. Sufficient living area (no overcrowding).
6.What are the scales to determine the socioeconomic status
Urban - Modified Kupusamy Scale
Rural - Udai pareek scale
Both - Modified BG Prasad Scale
7.What do you mean by “ below poverty line “ “above poverty line”
Below Poverty Line
They typically have very limited financial resources and may struggle to meet their basic needs,
including food, shelter, and healthcare
Those with the greatest economic challenges receive targeted assistance to improve their living
conditions and access to healthcare
Above Poverty Line
They are generally more financially stable and have fewer economic hardships.
APL individuals may not qualify for certain healthcare subsidies or assistance that are reserved
for BPL individuals and families.
8.When can you call a person “literate?
A person who has total inability to read, write, and comprehend information from a simple
statement of everyday life
9.What is consanguinity? what are the degrees of consanguinity?
consanguinity- Relationship by blood: relationship by descent from the same ancestors
Four degrees of consanguinity have been identified.
1 st degree = Marriage between siblings (Incest)
2 nd degree = Marriage between uncle and niece (girl marrying her mother’s brother)
3 rd degree = Marriage between first cousins (girl marrying her uncle’s son)
4 th degree = Marriage between second cousins or between people with a relationship beyond
second
cousins or a far off relationship all fall under this category.
10.What are the criteria to assess overcrowding ?
· Persons per room
· Per capita floor space- 70-100 sq feet/person
· Gender separation-Male and female (>9 yrs) other than husband and wife living in the same
room
BABY UNDER 12 MONTHS NOT COUNTED, CHILDREN 1-10 YEARS CONSIDERED AS HALF IN CASE
OF MEASUREMENT
11.What is safe water?
Water intended for human consumption should be both safe and wholesome. This has been
defined as water that is-
A. free from pathogenic agents;
B. free from harmful chemical substances;
C. pleasant to the taste, i.e., free from colour and odour; and
D. usable for domestic purposes.
12.What should be the distance between water source and septic tank
It should be atleast 15 feet (50 metres)
13.What is skilled/ semiskilled/ unskilled worker ? give 5 examples for each
Skilled workers (Long training in complicated work): Mason, Carpenter, Mechanic, Car-driver,
Telephone- operator
Semi-skilled workers (Require some training): Factory worker, Workshop labourer, Library
attender, Car-cleaner
Unskilled workers (No/minimal training): Watchman,Peon, Coolie, Domestic servant
14.How do you asses the type of house
Pucca house
The walls and roof made of burnt bricks,stone,cement concrete
Semi pucca house
walls made of pucca materials but the roof is made up of the material other than those used for
pucca house
Kuchcha house
Walls made of mud,bamboo and roof made of straw,grass,reeds
15.What are the public health importance of a kutcha house
Poor Sanitation: Kutcha houses often lack proper sanitation facilities, like toilets and sewage
systems.
Vector-Borne Diseases: The construction of kutcha houses may not provide adequate protection
against disease-carrying vectors such as mosquitoes and rodents
Inadequate Shelter during Natural Disasters: Kutcha houses are vulnerable to damage or
destruction during natural disasters like floods, earthquakes, or storms.
Limited Access to Clean Water: Many kutcha house dwellers may not have access to clean and
safe drinking water
Overcrowding: In some cases, kutcha houses may be overcrowded due to limited space and
resources.
Respiratory Illnesses: Kutcha houses may have inadequate ventilation
16.What are the mosquito breeding sites you know?
In general, the anophelines prefer clean water for breeding; the culicines prefer dirty and
polluted water: the aedes prefer artificial collections of water. The mansonia breed in water
containing certain types of aquatic vegetation
17.Write the breeding places for Aedes, Anopheles and Culex
Aedes- Artificial collection of water
Anopheles- Clean freshwater
Culex- Dirty water
18.What is cross ventilation ?
Cross ventilation:Doors and windows facing eachother
19.What is the ideal age at marriage for boys?
21years
20.What is the ideal age at marriage for girls?
18years
21.Who is “reference male “ reference female “
"Reference man" is aged between 19-39 years and weighs 65 kg with a height of 1.77 metre and
a BMI of 20.75; is free from disease and physically fit for active work. On each working day, he is
engaged in 8 hours of occupation which usually involves moderate activity; while when not at
work he spends 8 hours in bed, 4-6 hours in sitting and moving about, 2 hours in walking and in
active recreation or household duties.
"Reference woman" is aged between 19-39 years, non- pregnant non-lactating (NPNL) and
weighs 55 kg with a height of 1.62 metre and a BMI of 20.95, is free from disease and physically
fit for active work. On each working day she is engaged in 8 hours of occupation, which usually
involves moderate activity, while when not at work she spends 8 hours in bed, 4-6 hours in sitting
and moving about, 2 hours in walking and in active recreation or household duties
22.What are the methods of dietary survey
★Weighment Of Raw Foods
★Weightment Of Cooked Foods
★Oral Questionnaire Method
23.What is intermittent water supply ? what are the disadvantages
In the intermittent system, water is delivered only during fixed hours. The disadvantages of the
intermittent system are : (1) the pipes may be empty during times of emergency (2) people need
to store water in containers which may not be clean always. The safe water is likely to be
rendered unsafe through improper storage (3) when the pipes are empty, there is negative
pressure and by what is known as back-siphoning, bacteria and foul gases may be sucked in
through leaky joints. A number of recorded outbreaks of typhoid and of relapsing fever, among
other diseases, have been traced back to the contamination of water in the intermittent piped
water supplies. Flowing water available 24 hours is therefore desirable, although it may entail
some wastage of water through misuse. The supply of water in most cities in India is intermittent.
A WHO Expert Committee (1965) strongly recommended that intermittent and low pressure
service should be avoided.
AN case questions

1. What is the calorie and protein requirements for pregnant and lactating women?
Pregnant women requires additional calorie of 350kcal daily throughout pregnancy and lactating
woman requires additional calorie of 600kcal daily during first 6 months and 520kcal daily during
the next 6 months.
Pregnant woman requires additional protein of 9.5 gm/day during 2nd trimester, 22 gm/day
during 3rd trimester and lactating woman requires additional protein of 17gm/day during 0-6
months, 13gm/day during 7-12 months.

2. How do you confirm pregnancy?

The simple way to confirm pregnancy in the first trimester is to conduct a urine examination
using a pregnancy test kit. The kit detects pregnancy on the basis of presence of human
chorionic gonadotrophin hormone in the urine.The Government of India has made “Nischay”
pregnancy test kit available across the country.

3.How will you calculate LMP

EDC by LMP is calculated by adding 280 days (40 weeks) to the first day of the last menstrual period.

4.Define Gravidity, Parity, Abortion, Stillbirth, Maternal death

GRAVIDITY: Number of times a woman has been pregnant regardless of whether the pregnancies
were interrupted or resulted in a live birth.
PARITY: Number of pregnancies after 20 weeks of gestation
ABORTION: Termination of a pregnancy by removal or expulsion of an embryo / foetus.
An abortion that occurs without any intervention is known as “Miscarriage” (or)
Expulsion or extraction of products of conception before foetal viability i.e, before 24 weeks of
gestation
STILL BIRTH: A baby which dies after 28 weeks of pregnancy but before or during birth.Every year
2 million still births are reported.
MATERNAL DEATH: Death of a woman who is pregnant or within 42 days of termination of
pregnancy, irrespective of the site or duration of pregnancy,from any cause related to or
aggrevated by the pregnancy or its management.

5.What is the current Maternal mortality rate? What are the common causes of Maternal mortality in
India?

An estimated 295,000 maternal deaths occurred globally in 2017, yielding an overall MMR of 211
(199-243) maternal deaths per 100,000 live births.

MMR is considered to be high if it is 300-499, very high if it is 500-999, and extremely high if it is ≥ 1000
maternal deaths per 100,000 live births.
Causes of Maternal mortality in india

*Hemorrhage – 38%

*Other conditions – 34%

*Sepsis – 11%

*Abortion – 8%

*Obstructed labour – 5%

*Hypertensive disorders- 5%

6.Define antenatal period

Antenatal / prenatal period covers the time from conception until birth.
It includes
a)ovum – 0 to 14 days
b)Embryo – 14days to 9 weeks
c)Foetus – 9th week to birth

7.What are the objectives of antenatal care?

*To promote, protect and maintain the health of mother during pregnancy
*To detect high risk cases and give them special attention
*To forsee the complications and prevent them
*To remove anxiety and dread associated with delivery
*To reduce maternal and infant mortality and morbidity
*To teach the mother elements of child care, nutrition,personal hygiene and environmental
sanitation

8.What is early registration of pregnancy?

Registration of pregnancy within 12 weeks is called early registration of pregnancy.

It facilitates proper planning and allows for adequate care to be provided during pregnancy for both the
mother and the foetus.

Helps to record the date of last menstrual period and calculate the expected date of delivery.

9.Mention the recommended minimum AN visits

A minimum of 4 visits covering the entire period of pregnancy should be the target. The
suggested schedule is

1st visit – within 12 weeks, preferably as soon as the pregnancy is suspected, for registration of
pregnancy and first antenatal check-up.
 2nd visit between 14 and 26 weeks.
3rd visit between 28 and 34 weeks.

4th visit - Between 36 weeks and term.

10.What are the basic investigations to be done in an antenatal woman?

AT SUBCENTRE
*Pregnancy detection test
*Hb examination
*Urine test for the presence of albumin & sugar
*Rapid malaria test
AT PHC/CHC/FRU
*Blood grouping (including Rh factor)
*VDRL/RPR
*HIV testing
*Rapid malaria test(if unavailable at SC)
*Blood sugar testing
*HBs Ag for Hep B infection

11.What is Risk approach? Give examples of high-risk pregnancy?

The central purpose of AN care is to identify high risk cases from a large group of antenatal mothers
and arrange skilled care for them,while continuing to provide appropriate care for all mothers.

These cases are:

*Elderly primi(30 yrs & above)

*short statured primi(140cm & below)

*Malpresentation

*Antepartum hemorrhage, threatened abortion

*Pre-eclampsia & eclampsia

*Anemia

*Previous still births,IU death & manual removal of placenta

*Elderly grand multiparas

*Prolonged pregnancy

*H/o previous caesarean/instrumental delivery

*Pregnancy associated with CVS/kidney/DM/TB/liver disease/malaria/convulsions/HIV/RTI/STI

 *Treatment for infertility

*3 or more spontaneous consecutive abortions

12.How do you screen for high risk in pregnancy? (through history…examination..Investigations)

13.Deworming during pregnancy – is it recommended or not?

If Yes, name the drug, dosage, frequency & In which trimester it should be prescribed?

Yes,Albendazole – single dose- 400mg

It should not be prescribed in 1st trimester,preferably prescribed in 2nd trimester

14.What is birth preparedness

Birth preparedness and complication readiness (BP/CR) is a strategy to promote the timely use of skilled
maternal and neonatal care, especially during childbirth, based on the theory that preparing for
childbirth and being ready for complications reduce delay in obtaining care.

15.What are the danger Signs during pregnancy?

*Vaginal bleeding

*Swelling of leg/face

*Reduced/absent fetal movements

*Severe headache

*Increased BP

*Persistent nausea & vomiting,foul smelling vaginal discharge

*Blurring of vision

*Leakage of amniotic fluid without labor

*High fever,severe abdominal cramps

16.How will you advice a pregnant woman with regard to diet

17.Name the Iron rich foods to be advised during pregnancy

Meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called
heme, is more easily absorbed than the iron in vegetables.
18.Who is an ASHA and what are the roles of ASHA?

ASHA – Accredited Social Health Activist

Calculating the expected number of annual pregnancies in the area will help her judge how good
pregnancy is.If the number of pregnancy registered is less than that of estimated,tracking down of
pregnancies with the help of ASHA is done.

ASHA & link workers should visit every house in the area and ensure that all pregnant women are
registered.

Immunization is also tracked.

19.How do you prevent infection at the place of delivery?

Standard infection control in obstetrics measures should be taken before, during and after labour. During
labour, gloves should be worn at all times and it is advisable to wear a gown, a mask and eye protection
during all procedures.

20.What is MCTS? What is MCP card ?

Mother and Child Tracking System (MCTS) is an initiative of Ministry of Health & Family Welfare to
leverage information technology for ensuring delivery of full spectrum of healthcare and immunization
services to pregnant women and children up to 5 years of age.

Mother and Child Protection Card” provides space for recording the family identification and
registration, birth record, pregnancy record, institutional identification, care during pregnancy,
preparation for delivery, registration under Janani Suraksha Yojana, details about immunization
procedures, breast-feeding and introduction of supplementary food, milestones of the baby, birth
spacing and reasons for special care.

21.What is an FRU? What facilities are available at an FRU?

FRU – First Referral Units

*24 hrs delivery services including normal & assisted deliveries

*Emergency obstetric care including caesarean sections and other medical interventions

*Newborn care

*Emergency care of sick children

*Full range of family planning services includes laparoscopic services

22.Name maternity benefit schemes available for pregnant mothers during pregnancy and after
delivery?

Pradhan Mantri Matru Vandana Yojana.

Mathrushree Scheme.
Muthulakshmi Maternity Benefit Scheme.

KCR Kit and Amma Odi Scheme.

Mamta scheme
MALNUTRITION

1.what do you understand by protien gap and food gap?

Recommended daily Protein intake is 60 to 90 gramme while average Indian consumes as less as the
30 gramme this is called protein gap

Food gap differences between the level of nutrients an average person is obtaining a new train levels
identified by research needed for optimal health

2.How do you assess nutritional status of a child?

assessment methods include 1. clinical

one clinical examination 2.anthropometry

3 biochemical evaluation

4 functional assessment

5 assessing dietry intake

6 vital and health statistics

7 ecological study

question 3

Name some age independent anthropometric Measures?

Mid arm circumference

Weight for height

thickness of subcutaneous fat

arm span

Body mass index

body ratios

Ponderal index

Quack stick

Question 4 what is malnutrition infection cycle?

Undernutrition results in decreased immunity inturn causing high risk of disease.This leads to
infectious disease that demands increased energy inturn leading to undernutrition

• question 5 what are the causes of malnutrition?

conditioning influences infectious diseases like diarrhea,intestinal parasites,measles

Food Fads cooking practises child rearing practises

Miscellaneous Men eating first and woman eating poorly

Socioeconomic factors poverty, ignorance,lack of knowledge and education

Qn 6 What are principle features of marasmus?

Inadequate protein intake and energy

Severe cachexia

Wasting in infancy and childhood

No edema

Minimal subcutaneous fat

Severe muscle wasting

Normal serum albumin levels

7.principle features of kwashiorkor?

Inadequate protein intake

Low concentration of essential amino acids

Diet with low protein/energy ratio

Edema

Wasting

Liver enlargement

Hypoalbuminemia

Steatosis

Possible depigmentation of skin and hair

8.What is the difference between wasting and stunting?

Wasting-recent failure to achieve adequate nutrition due to recent diarrhea episodes or other accute
illnesses

Causes-inadequate food intake, incorrect feeding practices,disease , infection

Show marked seasonal pattern

Stunting -failure to achieve expected hieght or length as compared to well nourished children of
same age

Failure to recieve adequate nutrition over a long period of time

Chronic infection, chronic insufficient nutrition intake, frequent poverty

Delayed psychosocial cognitive development

-2SD below median

9.List various classification of pem

Kwashiorkor (protein malnutrition predominant

Marasmus (deficiency in calories)

Marasmic kwashiorkor

10.Differance between devangiri mix and hyderabadi mix?

Devangiri mix contains Bengal gram (rich in protein)

Ragi(rich in iron and calcium)

Jaggery(iron and carbohydrates)

Excellent dietary supplement for children with malnutrition

Hyderabadi mix-developed in NIN Hyderabad

Whole wheat -40g

Bengal gram-60g

Groundnut-10g

Jaggery20g

11.Difference between complementary and supplementary feeding?

Complementary feeding-milk feeding given in addition to breast feeding or replacement food

Foods given in addition to breastfeeding after 6 months for adequate nutrition

Supplementary feeding-provided in place of breastfeeding

Any food given prior to 6 months

Expressed or banked breast milk

12.Nutritional rehabilitation centre?where is it located

Established in health facilities to provide appropriate and facility based management of children with
SAM for all under 5 children

At district hospital and medical College level

Intensive feeding to recover lost weight

Expenditure rs250 per children per day

13.List some community nutrition programmes

Vitamin A proPhylaxis programme

ProPhylaxis against nutritional anaemia

Control of iron deficiency disorders

special nutrition programme

Balwady nutrition programme

ICDS
midday meal programme

midday meal scheme

14. what is S AM child?

S AM child is defined by very low weight for height or length is it score below three SD the medium
WHO child growth standards

Meet arm circumference less than 115 centimetres

Presence of nutritionalPresence of nutritional edoema

Significant risk of death in children under five years

indirect costs of death by increasing CFR in children suffering from common illnesses like diarrhoea
pneumonia

15 list uses of growth chart

growth monitoring

diagnostic tool for high risk children

educational tool

planning and policymaking

tool of action

evaluation

tool of teaching

16 what is road to health?

record chart carried by caregiver that combines esential in formation on growth monitoring alpha
child immunisation Vitamin A supplementations deworming medicine and other illnesses

17 what is the growth chart used in India? what is the cut of for assessing nutritional status of a child

India adopted New WHO child growth standards in February 2009

available for both boys and girls below five years

MCH card records family identification care during pregnancy record preparation for delivery
milestones birth spacing etc

Preparation for delivery milestones birth spacing etc under nutrition - -2 SD S AM - -3 SD

18 what is ICDS? what are the beneficiaries of icds scheme? ICDS started in 1975 in pursuance of
national policy for children

strong nutrition component in the form of supplementary nutrition, Vitamin A profil access and iron
and folic acid distribution

Beneficiaries include preschool children below 6 years call mom adolescent girls 11 to 18 years,
pregnant and lactating mothers
19 what are the health measures to prevent PE M

health promotion

specific protection

early diagnosis and treatment

rehabilitation

20 what are the specific protection measures to prevent PEM

childs diet must contain protein and energy rich foods

Child’s diet must contain protein and energy rich foods milk eggs fresh fruits given if possible

Immunisation

food fortification
Anaemia

1. Anaemia
Anaemia is a condition in which the number of RBC
and consequently their O2 carrying capacity is
insufficient to meet the body’s physiological needs.
Due to Iron deficiency, Vit B12 deficiency and
parasitic infection

2.Aetiology of anaemia
Dietary deficiencies of Vit B12, Iron
Parasitic infections
The commonest causes of anaemia in developing
countries particularly among the most vulnerable
groups(pregnant women, pre school age children) are
dietary deficiency of iron and vit B12.

3.classification of anaemia in pregnancy

Anaemia is the commonest hematological disorder that
may occur in pregnancy. Anaemia is responsible for
20% of maternal deaths in the 3rd world countries

Classification
1. Physiological anaemia of pregnancy
2. Pathological
I. Deficiency anaemia
Iron, folic acid, vit B12, and protein
 II. Hemorrhagic
a. Acute - bleeding early months/APH
b. Chronic – Hookworm infestation, bleeding
piles, etc,.
III. Hereditary
a. Thalassemis
b. Hereditary homolytic anaemia
IV. Bone marrow insufficiency – hypoplasia/aplasia
due to radiation, drugs
V. Anaemia of infection – malaria, TB, kala-azar
VI. Chronic diseases (renal)/neoplasm
VII. Hematological malignancy

4. Causes if anaemia in pregnancy

I. Before pregnancy
➢ Faulty dieatry habit
➢ Faulty absorption mechanism
➢ Iron loss
II. During pregnancy
➢ Increased demand of iron
➢ Diminished intake of iron
➢ Decreased absorption
➢ Pre-pregnant health status
➢ Decreased metabolism

5. When will you start therapeutic Iron

supplementation in pregnancy?
 IFA – Everyday for atleast 100 days of gestation
followed by the same dose for 100 days in
postpartum period

6. In which trimester Iron supplementation should be

started? Why?
➢ Iron supplementation should be started at 2nd
trimester because the iron requirement
increases
➢ To prevent anaemia complicating pregnancy,
immature delivery, increased risk of death
during labour

7. Management
A. Hb – 9-11g/dl
2IFA tablets/day, for 100days
Level of facility: subcentre
Hb levels should be reassessed at monthly
intervals. If on testing Hb-normal, discontinue
the treatment. If it does not rise inspite of
treatment refer the women to next higher
health facility for further management
B. Hb level – 7-9g/dl
Level of facility: PHC/CHC
• Hb between 8-9 g/dl
Oral IFA as for Hb level goes to 9-11g/dl, Hb
testing to be done every month
 • Hb between 7-8g/dl
o Injectable i.m Fe preparation
o i.m iron therapy in divided dose along
with oral folic acid daily
If a women with Hb between 7-8g/dl comes to
PHC/CHC in 3rd trimester of pregnancy, refer to
FRU/MC for further management.
C. Hb<7g/dl
Level of facility: FRU/MC/DH
• Parenteral iron therapy
• Depending on the further response to
treatment, same course of action as
prescribed for Hb level b/w 9-11g/dl

8. Complications of anaemia for mother in pregnancy

➢ Pre eclampsia
➢ Infection
➢ Preterm labour
➢ Heart failure
➢ During labour: uterine inertia, PPH, shock,
cardiac failure

9. Effect on baby
➢ Amount of iron transferred to the fetus is
unaffected even if mother suffers from Iron
deficiency anaemia. So the neonate does not
suffer anaemia at birth.
➢ Increased incidence of low birth weight babies
 ➢ Intrauterine death
➢ Increased perinatal loss

10. Diet diversification

Encouraging the consumption of micronutrients rich
foods – green leafy vegetables, lentils, vitamin C rich
foods(fruits mainly) which may be available but
under utilized by deficiebt population

Food fortification:
Food fortfication. refers to the addition of
micronutrient to processed foods. This can also
lead to relatively rapid improvement n the
micronutrients status of a population and at a very
reasonable cost.

Supplementation:
Highly concentrated vitamins and minerals
produced by pharmaceutical manufacturers in the
form of capsules, tablet/injection and administered
as part of health care or specific nutrition
campaigns.

11. Therapeutic approach through life cycle for

anaemia prevention
6 months - 5 years(60months)
 -ASHAS & ANMS will screen children from 6m -
5yrs of age
-screening through palmar pallor
-routine Hb estimation for child with illness
As per IMNCI(Integrated Management of Neonatal
& Childhood Illness). Guidelines through
opportunistic screening at VHNDS, Immunisation
decision, House-house visits by AHAS for
biweekly IFA supplementation
-sick child coming to health facility

Dose of IFA:
Age of child Dose Frequency
6m-12m(6- 1ml of IFA Once a day
10kg) syrup
1yr-3yrs(10- 1.5ml of IFA Once a day
14kg) syrup
3yr-5yrs(14- 2ml of IFA Once a day
19kg) syrup

12. How to enhance iron content of food at

different ages
Age Fe Fe content Food- Amount of
requirement (Assuming iron required
(mg/day) frequency content green
of gap leafy
meals/day) (mg/day) vegetables
6m-8m 5 1-2mg 3-4 25
9m- 5 2-2.5mg 2.5-3 25
11m
12m- 9 2.5-3.5mg 5.5-6.5 40
23m

13.Health programme
➢ Anemia mukt Bharat strategy
➢ ICDS
➢ Midday meal programme
➢ Under MWCDC (SABLA- for
supplementary nutrition to adolescent )
➢ national iron+ initiative
➢ ministry of women and child
development
➢ supplementation intervention by
ministry of health and family welfare

14.From which age iron supplementation

recommended in India?
from 6 months of age
PIH

1. Classify hypertensive disorders in pregnancy

*Gestational hypertension
*Pre eclampsia
*Eclampsia
*Chronic hypertension
*Pre eclampsia superimposed on chronic hypertension

2.Explain each

PIH : BP >140/90mmHg or more for the 1st time after 20 weeks of pregnancy in a woman without
proteinuria. BP will come to normal within 12 weeks of delivery.

*Pre eclampsia : It is a multisystem disorder of unknown etiology characterized by development of

hypertension to the extent of 140/90mmHg or more with proteinuria after 20th week in a previously
non-proteinuric woman.

*Eclampsia : Pre Eclampsia when complicated with grand mal seizures/ coma is called Eclampsia.

3.Complications of PIH

Maternal complication

During pregnancy – Eclampsia , Intracranial hemorrhage , HELLP syndrome , preterm labor , pulmonary
edema , ARF , proteinuria, DIC

During labour – Eclampsia, PPH

Puerperium – Eclampsia, shock, sepsis

Fetal complications

Intrauterine death, Intrauterine growth retardation, prematurity, Asphyxia

4.Management of PIH

The main aim is to control HTN, assessing the severity, monitoring the maternal and fetal condition and
to prevent the onset of Eclampsia.

GHTN & mild Pre Eclampsia management

BP – 140/90 – 159/109mmHg

*Offer pharmacological treatment if BP >140/90mmHg

*Aim for BP 135/85mmHg or less

*Test for proteinuria, measure full blood count, RFT, LFT

Severe pre Eclampsia & Eclampsia

*Anti hypertensive drugs should be given

*Inj.MgSO4 should be given (1gm/day of calcium in pregnancy after 1st trimester. This reduces the risk
of pre eclampsia by 50%)

*Before 34 weeks – continue surveillance unless there are medication for planned early birth

*34 – 36 weeks – continue surveillance & plan for early birth in case of any indications & give anti
hypertensive drugs

*37 weeks onwards – initiate birth within 24 – 48 hrs

Proper rest, high protein diet & following drugs are recommended

1. Tab. Alpha methyldopa 250mg BD/TDS

2. Nifedipine 10-20mg orally BD/TDS
3. Labetolol 100mg BD
4. In setting of pre eclampsia, prophylactic MgSO4 should be given I.M

5.Danger signs to be told to the patient with respect to PIH

Any imminent symptom of Eclampsia like headache, blurring of vision, epigastric pain, oliguria &
increasing edema, bleeding PV, absent/decreased fetal movements.
 PN case questions
1.Define postpartum period,perinatal and neonatal period.
Postpartum period:
Interval between birth of newborn and return of
reproductive organs their normal non pregnant state.It lasts
for 6 weeks,with some variation among women
Perinatal period:
The period commenced at 28 weeks completed of
gestation ends seven completed days after birth
Neonatal period:
From birth to 28 th day of life(4 weeks after birth)
2.what is prelacteal feed
Prelacteal feeding is the feeding practices in which any
substances other than breast milk given to newborns before
breastfeeding initiation, usually in the first 3 days of life
3.How many post natal visits are recommended?Any when?
Make Visit to all newborns according to specified
schedule up to first 42 days of life.
Six visits in case of institutional delivery on 3rd,
7th,14th,21st 28th and 42nd days after birth and one additional
visit within 24 hours of delivery in case of hom delivery.
4.what do you mean by involution of uterus?
 After the delivery of baby the uterus(Myomaterial
muscle) is well contracted and
Retracted and become at the level of the umbilicus
And after 10-14 days the uterus well become as pelvic organ
5.what is the normal involution pattern of uterus after
delivery?
. Immediately after birth uterus is in the midline
approximately 2cm below the level of the umbilicus,
Size of grapefruit,weights approximately 1000 g
Within 12 hours the fundus may be approximately 1 cm
above the umbilicus.
During next few days the fundus descends 1 to 2 cm
(fingerbreadth) every 24hours
By the sixth postpartum day the fundus is normally
located halfway between the umbilicus and the symphysis
pubis.
A week after birth the uterus once again lies in the
true pelvis.
After the ninth postpartum day the uterus should not
be palpable abdominally.
6.what are the complication in posnatal period?
* Puerperal sepsis -foul smelling
Lothian ,pain, tenderness
* Thrombophlebitis- varicose
 * Seconary haemorrhage- bleeding from vagina
* urinary tract infection,mastitis
7.what are symptoms or signs of puerperal sepsis?
Infection of the genital tract within 3 weeks after
delivery.
Rise in temperature
Rise in pulse rate
Foul smelling Lochia
Pain and tenderness
8.what advice will you give to postnatal mother?
(Danger sign,visits,diet,exercise,IFA tablets,personal
hygiene, breast freeding,family planning,care of the new
born)
*postnatal exercise are necessary to bring the stretched
abdominal and pelvic muscle back to normal
*To relive has from fear
* Routine Hb estimation done during PN visit detect
anemia
* Adequate lactation to infant
* 6 months exclusive breastfeeding given
*Visit:three visit
*Danger sign: fever,mastitis,abdominal pain,bleeding
per vagina
 *IFA tablet:100 mg iron and 500 mcg FA for 100 days
daily
* Family planning:Attempts should be mode to
motivate the mothers for spacing the next birth
Postpartum sterilization is recommended on the 2nd
day after delivery
Six months -IUD and non-hormonal contraceptives
9.when can IUD be inserted in post Partum period?
- During 1st week after delivery
( Risk present due to 1) high expulsion rate
2)perforation
-convenet time 6 -8 week after delivery(Post-
puerparal insertion)
10.what are the extra nutrition required by lactating mother?
Calorie requirement +500 kcal
Protein requirement 70g
11.what are the preferred method of contraceptive after the
birth of a child?
Most preferred method IUD
Followed by injectable contraceptive
IUD timing of insertion:
During 1st weak after delivery
Convent time 6 to8 weeks after delivery
Injectable contraceptive:
Antara – DMPA is widely used during postpartum period
to space pregnancies
S/E:wt gain,irregular bleeding,prolonged infertility
12.What do you understand by APGAR Score?
APGAR score is taken at 1 minute and again at 5 minutes
after birth. It’s require immediate observation of heart rate,
respiration rate,muscle tone,reflex,colour of infants.
Total 10 score
* Perfect 9 or 10
* 4-6 moderate
* 0-3 sever
13.what are the anomalies you will look for in a newborn
bady?
.Hydrocephalus
.Eyes- cataract,colobom
.Ear- dysmorphism,accessory auricles
.mouth and lips-Hare lip,cleft palate
.Limbs and joint- deformities of joints,congenital
dislocation hip

.cvs- VSD,ASD . Male- Hypospadius,undescened

testis
 Female- fused labia,enlarged clitoris
14.what is the first milk called? What is its importance
The first milk is called colostrum- milk secreted during
the initial
3-4 days after delivery
Importance:
. Boosts immunity and contain vit – A,D,E,K
.Prevent allergies and infection
.Reduces inflammation
.Reduce the risk of cancer
.strengthens gut
.Enhance metabolism
15. What is exclusive breast feeding? For how long should
breast feeding be continued?
Under any circumstance breast milk is the ideal food
for the infant. No other food is required by the baby until 6
months after birth
16.what are advantage of breast feeding?
.Safe,clean,hygienic,cheap and available correct
temperature
.it contains macrophage,lymphocytes,secretary IgA
.easily digested and utilized
.bonding b/w mother and infant
 .sucking it helps development of jaws and teeth
.prevent malnutrition and reduce infant mortality
.prevent neonatal hypocalcemia and
hypomagnesemia
.Reduce the mothers risk-PPH,Anemia,
Booster mother's
Immunity,
delayed pregnancy,
Prevent ovarian and
Breast cancer
17.what is good positioning and good attachment?
Good position:
. Baby’s whole body is supported not just neck
or shoulders
. Baby’s head and body are in one line without
any twist in the neck
. Baby’s body turned towards the mother
Baby’s nose is at the level of nipple
Good attachment
. The baby’s mouth is wide open
.Most of the nipple and areolar in the mouth,only
upper areolar visible,
Not the lower one
 .Baby’s chin touch the breast
. Baby’s lower lip is exerted
18. What is rooming in?
Keeping the Baby’s crib by the side of the mother’s
bed is called rooming
19.what is baby friendly hospital initiative?
BFHI has proved highly successful in encouraging
proper infant feeding practices start at birth
The steps are
. Establish ongoing monitoring and data-
management system;
. Ensure that staff have sufficient knowledge,
competence and skills to support breastfeeding;
. Discuss the importance and management of
breastfeeding with pregnant women and their families;
. Facilitate immediate and uninterrupted skin to skin
contact and support mothers to initiate breastfeeding as soon
as possible after birth;
. Support mothers to initiate and maintain
breastfeeding and manage common difficulties;
. Do not provide breastfed newborns any food or
fluids other than breast milk, unless medically indicated;
. Enable mothers and their infants to remain
together and to practice rooming-in 24 hours
 .Support mothers to recognize and respond to their
infant's cues for feeding;
. Counsell mothers on the use and risk of feeding
bottles, teats and pacifiers
. Coordinate discharge so that parents and their
infants have timely access to ongoing
Support and care

20.when should complementary feeding begin?

WHO recommends that infants start receiving

complementary foods at 6 months of age in addition to

breast milk. Initially, they should receive
complementary foods 2-3 times a day between 6-8 months
and increase to 3-4 times daily between 9- 11 months and
12-24 months. Additional nutritious shacks should also be
offered 1-2 times per day for ages 12-24 months as desired

Gradually increase food consistency and variety as the infant

gets older adapting to the infant's requirements and abilities
Infants can eat pureed mashed and semi solid foods
beginning at 6 months By 8 months most infants can also eat
finger foods (snacks that can be eaten by children alone).
By 12 months, most children can eat the same types of foods
as consumed by the rest of the family, while keeping in mind
the need for nutrient-dense foods, including animal-sourced
foods like meat, poultry, fish, eggs and dairy products.

Avoid foods in a form that may cause choking, such as whole

grapes or raw carrots. Avoid giving drinks with low nutrient
value, such as tea, coffee and sugary soft drinks. Limit the
amount of juice offered. to avoid displacing more nutrient-
rich foods.

21.what are tha ideal complementary foods?

Good complementary foods are:

* Rich in energy, protein and micronutrients

(particularly iron. zinc, calcium, vitamin A, vitamin C and
folate)
* Clean and safe
*No pathogens (i.e. no disease-causing bacteria or
other harmful organisms)
*No harmful chemicals or toxins
*No bones or hard bits that may choke a child
*Not too peppery or Salty
 *Easy for the child to eat liked by the child
*Not boiling hot easy to prepare
*locally available and affordable
22.What are the normal birth weight,height and head
circumference of a child?
Normal birth weigh:

1. Birth-weight

The birth-weight should be taken preferably within the

first hour of life, before significant post-natal weight loss has
occurred . The naked baby should be placed on a clean towel
on the scale pan. In home delivery, weight is taken by placing
the baby in a sling bag using a salter weighing scale. The child
is weighed to the nearest 100 g according to the standard
method for weight measurement.
Normal birth weight is 3 kg

Normal height:

2. Length (height)

This need not be taken immediately if the baby's

condition gives rise to any anxiety, but should be recorded
within the first 3 days. Length can be taken most accurately
with a measuring board (infantometer) with a fixed head
piece on which the infant lies supine with its legs fully
extended and the feet flexed at right angles to the lower legs.
Two people are needed to hold the baby correctly.
Normal height at birth 50 cm

Normal head circumferance:

3.Head circumferance
This measurement may change slightly during the first
3 days owing to moulding during labour. It is taken with a
tape measure at the maximum circumference of the head in
the occipito-frontal diameter.
Normal head circumferance at birth 34cm

23. Who is an at -risk infant?

Identification of "at-risk" infants

The number of infants (and children 1-5 years of age) in a

community, or attending a child health clinic, may be so large
that it may not be possible to give sufficient time and
attention to all of them. It is therefore necessary to identify
particularly those "at-risk" and give them special intensive
care, because it is these "at-risk" babies that contribute so
largely to perinatal, neonatal and infant mortality. The basic
criteria for identifying these babies include:

1. birth weight less than 2.5 kg;

2. twins
3. birth order 5 and more;
4. weight below 70 per cent of the expected weight (i.e.,
II and III degrees of malnutrition);
5.failure to gain weight during three successive months;
6. children with PEM, diarrhoea;
7. working mother/one parent.
8.Artificial feeding

24.what is kangaroo mother care and what is its advantage?

Kangaroo mother care:

* skin-to-skin positioning of a baby on the

mother's chest;
* adequate nutrition through breast-feeding;
* ambulatory care a result of earlier as
discharge from hospital; and
 * support for the mother and her family in
caring for the baby
Advantage:
Benefits to Baby:

.Maintains body temperature

.Stabilisation of heart rate

.Increased sleep times

.Improved respiratory rate or breathing pattern

.Increased weight quicker than usual

. Low episodes of crying

. Increase in the success rate of breast feeding

Benefits to Parents:
. Boosting milk production while breastfeeding feeding
 .Improving the bond between parent and newborn

.Boosting confidence in the provision of better care to

the child

25.what is Ushers criteria?

Special emphasis was laid on the clinical criteria

evolved by Usher .The incidence of prematurity in these 1020
cases, according to various criteria was determined
Weight up to 2500G.55.6%,crown- heel length less than
47 cm.52.5%, Crown-rump length less than 32 cm.72.9%
head circumference less than 33cm

26.what are the danger signs in a newborn?

* Excessive wt. loss

*Vomiting

* Diarrhea
 *Hypothermia

*Respiratory distress

* Cyanosis

*Abd. distension

*Bleeding

*Lethargy

*Convulsion
* Yellow palms/ soles

27.what are main causes of infant mortality?

* Causes of infant mortality

. Neonatal mortality (0-4 weeks)

1. Low birth weight and prematurity

2. Birth injury and difficult labour

3. Sepsis

4. Congenital anomalies

5. Haemolytic diseases of newborn

6. Conditions of placenta and cord

7. Diarrhoeal diseases

8. Acute respiratory infections

9. Tetanus

*Post-neonatal mortality (1-12 months)

1. Diarrhoeal diseases

2. Acute respiratory infections

3. Other communicable diseases

4. Malnutrition

5. Congenital anomalies

6. Accidents

28.list some socio-cultural practices that are followed

commonly during postpartum period( harmful practices to
avoid beneficial practices to be encouraged)

. Mothers movements are restricted to house-

confinement period of 40 days assisted in personal care and
receives special nourishing diet

.pregnancy is a state of hotness and following delivery

bring about weakness,so desirable to include milk ghee nuts
and jaggery(cooling and nourishing foods)

29.what is low birth weight? What are the common causes of

LBW?
Low birth weight:
International agreement low birth weight has been defined
as a birth weight of less than 2.5 kg (upto and including 2499
g), the measurement being taken preferably within the first
hour of life, before significant postnatal weight loss has
occurred
Causes of LBW:
.Spontaneous preterm birth- Age at
pregnancy,pregnancy spacing,Multiple pregnancy
Infection, Nutritional,
.provider initiated preterm birth- Medical induction or
cesarean birth

30.what are the vaccines given to a newborn?

.BCG
.Hep B
.opv -0 dose
.OPV – 1,2,3 dose
.Pentavalent-1,2,3 dose
.PCV
.Rota virus
 .IPV
.MR- 1 dose
. JE - 1dose
.vitA

31.what is Essential Newborn care?

Essential newborn care

The primary goal of essential newborn care is to reduce

perinatal and neonatal mortality. The main components are
resuscitation of newborn with asphyxia, prevention of
Hypothermia, prevention of infection, exclusive breast
feeding and referral of sick newborn. The strategies are to
train medical and other health personnel in essential
newborn care, provide basic facilities for care of low birth
weight and sick new borns in FRU and district hospitals etc.

32.what is new born care corner?

Newborn Care Corner (NBCC)

NBCC is a space within the delivery room in any health

facility where immediate care provided
 To all newborns at birth.This area is MANDATORY for all
health facilities where deliveries are
Conducted. About 20,336 NBCCS are operational in the
country.
 ARI case
1. What are the 5 commonest childhood killer diseases?
Keller diseases :
• ARI (Pneumonia)
• ADD (acute diarrhoeal diseases)
• Diphtheria
• Measles
• Pertussis
• SAM(Seveíe Acute Malnutíition)

2. How do you define Acute Respiratory Infection?

Definition : Infection may Interfere with normal breathing ,it can affect upper respiratory system
, which starts from sinus and ends with vocal cord (or) lower respiratory system , which starts at
vocal cord ends at lungs

3. What are the causes of ARI among children (medical & socio-cultural factors)?
Medical:
▪ Low birth weight
▪ Preterm
▪ Malnutrition
▪ No natural immunity
Social :
• Overcrowding
• Pollution
• Siblings in school
• Day care centre
• Climate condition
• Low socio-economic status

4. How do you classify ARI in a child aged 2 months to 5 years?

Classification of ARI : (2months to 5 years)
➢ No pneumonia
➢ Pneumonia
➢ Severe pneumonia
➢ Very severe pneumonia
5. How do you classify ARI in a young infant aged less than 2 months?
Classification of ARI : (less than 2 months)
❖ No pneumonia
❖ Severe pneumonia
❖ Very severe pneumonia

6. How do you assess for fast breathing? What are the respiratory rate cut-offs?
Assess Fast breathing :
➢ Count the respiratory rate of one full minute , using wrist watch, looking at the
abdominal movement ,When the child is clam
➢ The chest and abdomen must be exposed for counting
Respiratory rate cut off :

✓ < 2 months of age < 60 breaths \ minute

✓ 2 months to 12 months < 50 breaths \ minute
✓ 1 year to 5 year < 40 breaths \ minute
~ Child getting older breathing rate decreases

7. How do you assess a child for chest in-drawing?

Lock for check indrawing when child breaths in , the child has indrawing the lower chest wall
goes in , when the child breaths in.
Chest indrawing occurs when the efforts required to breath in , it’s greater than normal .

8. Why is the category of “pneumonia” missing in the classification for a young infant aged less
than 2 months?
The young infant become sick and die very quickly from bacterial infection and are much less
like to develop cough with pneumonia and frequently have nonspecific signs like poor feeding,
fever, low body temperature, mild chest indrawing is normal (because their chest wall are soft)

9. What are the signs of very severe disease?

• Refusal of feeding / Not able to drink
• Convulsions
• Difficult to walk/ abnormally sleepy
• Stridor in clam child
• Severe malnutrition
• Wheezing
10. What is the antibiotic of choice for pneumonia according to the WHO standard case .
Management? State the doses according to age/weight.

Children age 2–59 months with chest indrawing pneumonia should be treated with oral
amoxicillin: at least 40mg/kg/dose twice daily (80mg/kg/day) for five days. Previous guidelines
by WHO for the management of chest indrawing pneumonia in children recommended
parenteral antibiotics for atleast three days.

11. What are the antibiotics of choice for treatment of pneumonia in a child aged less than 2
months?
Gentamicin (7.5 mg/kg IM/IV once a day) should be added for children aged less than two
months, children having very severe disease at the outset or those who fail to respond at 48
hours.

12. What are the various vaccines available to prevent respiratory illnesses among children?
✓ Measles vaccine
✓ HiB vaccine( Pentavalent)
✓ Pneumococcal pneumonia vaccine
i. PPV 23 :
*Children and adults more than 2 years
*IM ,0.5 ml

ii. PCV :
a. PCV 10
b. PCV 23

12. How do you define fever in a child?

Fever :
▪ Axillary temperature > 95°F
▪ Oral temperature > 100 °F
▪ Rectal , Ear temperature > 100.4°F

14. How do you define hypothermia in a child?

Hypothermia :axillary temperature < 95°F

15. How can a mother handle fever in a child at home before approaching health facility?
❖ Light clothing
❖ Good Nutrition
❖ Plenty of fluids
❖ Lukewarm water sponging
❖ Rest
16. What is the recommended dose of Paracetamol in children?

➢ 10 -15 mg\kg body weight

➢ 3 – 4 times a day ( maximum 4 times a day)
➢ Syrup contains 125 mg in 5 ml

17. What are the common differential diagnoses for fever in a Child?
✓ Cough-cold
✓ Pneumonia
✓ Ear infections
✓ Dysentery
✓ Malaria
✓ Dengue
✓ Measles
✓ Scrub typhus
✓ Skin Infections
✓ Viral fever

18. What are the differential diagnoses of fever with rash in children?
▪ Measles
▪ Chicken pox
▪ Rubella
▪ Dengue
▪ Chikungunya
▪ Rheumatic fever
▪ Meningitis
▪ Leptospirosis
▪ Rickettsial diseases
▪ Drug-hypersensitivity

19. According to IMNCI, what are the signs to check for in a young infant (less than 2 Months) to rule
out possible bacterial infection?
• Lethargy
• Unconscious
• convulsions
• fast breathing
• severe chest indrawing
• nasal flaring
• Grunting
• bulging anterior fontanelle
• skin pustules
• umbilicus red or draining pus
• icterus over palms and soles

20. What are the commonest complications of measles?

➢ Pneumonia
➢ Diarrhoea
➢ ear -Infection( ottis media)
➢ Vitamin A deficiency
➢ Malnutrition
➢ Post measles encephalitis

21. Write the National Immunisation schedule

22. What are the leading causes of death among children?

❖ Neonatal condition
❖ Pneumonia
❖ Diarrhoea
❖ Malaria
❖ Malnutrition
❖ Pre-term complications
❖ Birth asphyxia
❖ Congenital anomalies
TB

1. What is the Case definition of Tuberculosis (TB)?

A bacteriologically confirmed TB case is one from whom a biological specimen is positive by

smear microscopy, culture or WRD. All such cases should be notified regardless of whether treatment
has started.

A clinically diagnosed TB case is one who does not fulfil the criteria for bacteriological
confirmation but has been diagnosed with active TB by a clinician or other medical practitioner who has
decided to give the patient a full course of TB treatment. This definition includes cases diagnosed on the
basis of X-ray abnormalities or suggestive histology and extrapulmonary cases without laboratory
confirmation. Clinically diagnosed cases subsequently found to be bacteriologically positive (before or
after starting treatment) should be reclassified as bacteriologically confirmed.

2. What is the difference between prevalence of TB infection and prevalence of TB disease?

Prevalence of TB disease:

>Case rate is the % of population suffering from TB disease (both old & new cases) & sputum is
positive for TB bacilli.

>This reflects the case load in the community. It is estimated to be 0.4% (or 4/1000 population)
in India.

Prevalence of TB infection:

>Tuberculin index is the % of population infected with TB bacilli & show the reaction to
tuberculin test. It is about 30% in our country.

>But the limitation is that most of the people vaccinated with BCG also show positive to the test.

3. What do you understand by new case, relapse, failure and default in the context of
Tuberculosis?

New case:

Patients who’ve never been treated for TB or have taken anti-TB drugs for less than 1 month.

Relapse:

Relapse have been previously treated for TB, were declared cured or treatment completed at
the end of their most recent course of treatment & are now diagnosed with a recurrent episode of TB.

Failure:

Treatment after failure patients are those who’ve been previously treated for TB and whose
treatment failed at the end of their most recent course of treatment

Default:
 Patients not taking anti-TB drugs for 2 months or more, consecutively after starting treatment.

4. What are the modes of transmission of TB?

>Droplet infection

>Sputum positive pulmonary TB patients

>Bovine milk.

5. What are the various environmental factors that favour the transmission of TB?

>Poor quality of life

>Poor housing

>Overcrowding

>Smoking

>Alcohol

>Undernutrition

>Large families

>Population exposure

>Lack of awareness of cause of illness

6. What is the protocol for collection of sputum sample in case of TB?

Day 1 – On the spot sample

Day 2 – Patient brings an early morning sample.

Far parts - 2 samples on day with 1 hour gap.

7. How will you perform Ziehl-Neelson stain?

a) Smear fixation

b)Carbol fuchsin; over direct flame x 5 mins

c) wash with deionized water

d) decolonize with 3% acid-alcohol

e) wash with water

f) counter stain with Loeffler’s methylene blue x 1 mins

g) wash & dry.

8. How will you perform and interpret Mantoux test? What is the use of Mantoux test?
 >1 TU of PPD 0.1mL intradermally on the flexor surface of the left forearm, midway between
elbow & wrist

>Result read after 48-96 hours (72 hours is best)

>Erythema & induration checked

>Greater than 10mm – positive

>Less than 6mm – negative

> No induration – record as 0

>6-9mm doubtful

> +ve reaction: past or present infection by M.tuberculosis

>Only means of estimating prevalence of infection in a population.

9. What is the treatment schedule for TB under DOTS (Directly Observed Treatment, Short Course
Chemotherapy)?

It is taken for 6 months.

4 drugs (INH, rifampicin & pyrazinamide, supplemented by either streptomycin or ethambutol)

for a period of 2 months

Followed by 2 drugs (INH + rifampicin/thioacetone) for 4 months, given daily or intermittently.

10. What are the adverse reactions of drugs used in the treatment of TB?

INH ---> liver damage, peripheral neuropathy

Rifampicin ---> nausea, hepatotoxicity, neurotoxicity

Pyrazinamide ----> hepatotoxicity, hyperuricemia

Ethambutol ---> retrobulbar neuritis.

11. When will you call a TB strain Multi drug resistant and extensively drug resistant?

MDR- resistance to at least isoniazid & rifampicin

XDR- resistance to any fluoroquinolone & at least one of the 3 second-line injectable drugs
(capreomycin, amikacin & kanamycin), in addition to multidrug resistance.

12. Which drugs are used in the treatment of MDR (Multi Drug Resistant) TB?

Ethambutol, rifampicin, pyrazinamide, isoniazid, levofloxacin, ethionamide, clofazimine.

13. What is the dosage and route of administration of BCG vaccine?

0.1mL, Intradermal

14. What is the diluent used to reconstitute BCG vaccine?

 Contains 0.45mg NaCl & water.

15. What are the objectives of the NTEP?

>Achievement of at least 85% cure rate of infectious cases of TB, through DOTS involving
peripheral health functionaries; &

>Augmentation of case finding activities through quality sputum microscopy to detect at least
70% of estimated cases.

16. What are the main strategies under DOTS?

>Political will & administrative commitment.

>Diagnosis by quality assured sputum smear microscopy.

>Adequate supply of quality assured short course chemotherapy drugs.

>Directly observed treatment.

>Systemic monitoring & accountability.

17. How do you diagnose TB in children?

>CBNAAT is the preferred choice (if unavailable smear microscopy should be performed).

>If M.tuberculosis isn’t detected, or specimen isn’t available then chest X-ray & Tuberculin Skin
Test by Mantoux technique using 2 TU of PPD RT 23 should be done.

18. List the targets under the “End TB” strategy.

Reach at least 90% of all people with TB.

Reach at least 90% of the key populations.

Reach at least 90% of treatment success.

19. Why is diagnosis of TB difficult in HIV positive persons?

They’ve high frequency of negative sputum smears.

Tuberculin test relies on patient’s immune system, if it’s damaged the person mayn’t respond
even though the person is infected with TB.

20. What is the prevalence of TB among children in India?

Total new & relapse cases % among children aged 0-14 years is 6-8%.

21. TB is the number one killer of adults among all infectious diseases, in India – True/False

True

22. Annual Risk of Tuberculosis Infection (ARTI)?

0.5-2%
23. If ARTI is 1.0%, what does it indicate? ARTI in India?

It indicates 50 new cases of smear positive pulmonary tuberculosis per year for 10000.

ARTI in India is 1.5%.

24. What is the importance of patient’s address in a TB case?

This helps to differentiate rural & urban areas.

In rural areas TB is more common than in urban areas.

25. What is Pulmonary TB?

PTB refers to any bacteriologically confirmed or clinically diagnosed case of TB involving the lung
parenchyma or the tracheobronchial tree.

Miliary TB is classified as PTB because there are lesions in the lungs. Tuberculous intra-thoracic
lymphadenopathy (mediastinal and/or hilar) or tuberculous pleural effusion, without radiographic
abnormalities in the lungs, constitutes a case of extrapulmonary TB. A patient with both pulmonary and
extrapulmonary TB should be classified as a case of PTB.

26. What is Extrapulmonary TB?

EPTB refers to any bacteriologically confirmed or clinically diagnosed case of TB involving organs
other than the lungs.

27. Name the common sites of Extrapulmonary TB?

Pleura, lymph nodes, abdomen, genitourinary tract, skin, meninges, joints & bones.

28. Most common form of extra-pulmonary TB is ___TB Lymphadenitis___

29. How will u diagnose Extra Pulmonary TB?

>Culturing Mycobacterium from the specimen obtained.

>Body fluid examination

>Nucleic acid amplification

>Immunological tests.

30. Constitutional symptoms like fever, malaise, weight loss, anorexia, etc. may or may not be
present in an Extra Pulmonary TB case? True/False

True

31. Multidrug-resistant tuberculosis (MDR-TB)?

Multidrug resistance: resistance to at least both isoniazid and rifampicin.

32. Why does multidrug resistance occur?

 It occurs because of gene mutation of bacteria, irrelevant use of drugs such as isoniazid &
rifampicin & weaker medical systems.

33. Prevalence of MDR-TB amongst new cases -----------% and amongst retreatments

Cases___________%.

34. Extensively Drug Resistant TB (XDR–TB)?

Extensive drug resistance: resistance to any fluoroquinolone and at least one of three second-
line injectable drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance.

35. What is DOTS plus?

Additional measures including continuous drug resistance surveillance, culture drug

susceptibility testing for TB patients & tailoring of individual drug regimen through the use of first &
second-line drugs.

36. Objectives of National Tuberculosis Elimination Program (NTEP)

>Achievement of at least 85% cure rate of infectious cases of TB, through DOTS involving
peripheral health functionaries; &

>Augmentation of case finding activities through quality sputum microscopy to detect at least
70% of estimated cases.

37. Name the 5 components of DOTS strategy

>Political will & administrative commitment.

>Diagnosis by quality assured sputum smear microscopy.

>Adequate supply of quality assured short course chemotherapy drugs.

>Directly observed treatment.

>Systemic monitoring & accountability.

38. What is End TB strategy?

Reach at least 90% of all people with TB.

Reach at least 90% of the key populations.

Reach at least 90% of treatment success.

39. What is the impact of HIV on TB control programme?

>HIV screening in RNTCP designated microscopy centers

>TB case findings in all ICTC and ART centers

 >Isoniazid prophylaxis

>Priority to women & children.

40. What is the impact of TB infection on HIV?

>HIV weakens the immune system hence

-TB bacilli are able to multiply rapidly causing reactivation of latent infection

-Risk of primary infection

-Risk of recurring infection again.

>Increase TB mortality & morbidity.

>Alters clinical manifestation of TB

>Complicates treatment.

>Discrimination.

41. Most common opportunistic infection amongst HIV-infected individuals?

TB

42. Name the major cause of mortality among patients with HIV?

TB

43. All known HIV-infected TB patients are subjected to ______Co-trimoxazole_______prophylactic

therapy?

44. If a pulmonary TB patient is left untreated, he has the potential to spread infection to ____5-10
_____ persons annually

45. On an average, about __2-3%__ of new adult out-patients in a general clinic (in rural PHC

settings) will be presumptive TB cases and should be referred for sputum examination.

46. On an average, __10%__ of the presumptive TB cases, subjected for sputum examination (SOP)

are found to be smear positive pulmonary tuberculosis

47. The most common symptom of PTB is ____persistent productive cough for more than 2
weeks______

48. Which among these are accompanying symptoms of PTB?

Fever, night sweats, weight loss, Chest pain, hemoptysis, shortness of breath, tiredness and loss of
appetite

All

49. Who are called Pulmonary TB suspects?

 Any persons who present with symptoms & sign of suggestive TB,

persistent productive cough for more than 2 weeks accompanied by other respiratory symptoms
(shortness of breath, chest pain, hemoptysis)

With constitutional symptoms like Fever, night sweats, weight loss, tiredness and loss of
appetite.

A history of contact with a TB patient.

50. How many sputum smears should be examined for diagnosis?

2 sputum smears.

51. How will u advice a patient to collect sputum?

>Deep breath & slowly breathe out

>Deep breath & cough

>Spit sputum into the plastic bottle given

>Early morning sample

52. Sputum samples should be transported and examined not later than __7__days after collection

53. Results of sputum tests should be reported within ___24hours___

54. What is the Role of STS, STLS in TB?

STLS:

>Rechecks all positive slides + 10% negative slides

>1 STLS for 5 microscopy centres.

STS:

>ensure quality of DOTS in the assigned area

>ensure effective case detection

>maintain TB register

>prepare quarterly reports

>maintain a map

>provide training.

55. What is Microbiologically confirmed TB?

A microbiologically confirmed TB case is one from whom a biological specimen is positive by

smear microscopy, culture or WRD (such as Xpert MTB/RIF).

56. What is Clinically confirmed TB?

 A clinically diagnosed TB case is one who does not fulfil the criteria for bacteriological
confirmation but has been diagnosed with active TB by a clinician or other medical practitioner who has
decided to give the patient a full course of TB treatment. This definition includes cases diagnosed on the
basis of X-ray abnormalities or suggestive histology and extrapulmonary cases without laboratory
confirmation.

57. What is Smear conversion?

Smear conversion:

Smear positive to smear negative after TB treatment

No longer infectious.

58. Explain the Diag. algorithm for pulmonary TB

59. Name the Tools for diagnosis of Pulmonary TB in adults

An early and accurate diagnosis of pulmonary TB should be established using chest X-ray,
sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest
computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic
tests can be used for earlier and improved diagnoses, especially in patients with smear-negative
pulmonary TB or clinically diagnosed TB and drug-resistant TB.

60. Describe Ziehl-Neelsen staining procedure

a) Smear fixation

b)Carbol fuchsin; over direct flame x 5 mins

c) wash with deionized water

d) decolonize with 3% acid-alcohol

 e) wash with water

f) counter stain with Loeffler’s methylene blue x 1 mins

g) wash & dry.

61. What are the other staining methods available?

Kinyoun cold acid-fast stain

Auramine rhodamine fluorochrome stain

62. Name the Limitations of the chest x-ray as a diagnostic tool in TB

It isn’t effective in finding consolidation & cavitation.

63. How will u diagnose MDR-TB / XDR TB?

CBNAAT

Line probe assay

64. Case definitions of TB

A bacteriologically confirmed TB case is one from whom a biological specimen is positive by

smear microscopy, culture or WRD. All such cases should be notified regardless of whether treatment
has started.

A clinically diagnosed TB case is one who does not fulfil the criteria for bacteriological
confirmation but has been diagnosed with active TB by a clinician or other medical practitioner who has
decided to give the patient a full course of TB treatment. This definition includes cases diagnosed on the
basis of X-ray abnormalities or suggestive histology and extrapulmonary cases without laboratory
confirmation. Clinically diagnosed cases subsequently found to be bacteriologically positive (before or
after starting treatment) should be reclassified as bacteriologically confirmed.

65. Explain about follow-up sputum examinations in a TB patient?

Sputum examination should be done at the end of intensive phase and end of treatment.

At the end of continuation phase

Long term follow up: 6, 12, 18, 24 months or in the presence of clinical symptoms, sputum,
culture, etc.

66. True/False

a.Tuberculosis should be suspected among children presenting symptoms of prolonged / unexplained

fever and / or cough for more than 2 weeks, with no weight gain or history of failure to thrive. T/F

True
b.In Children, Cough may not be the predominant and constant symptom unlike in an adult. T/F

True

c.Children presenting neurological symptoms like irritability, refusal of feeds/failure to thrive, headache,
vomiting or altered sensorium and convulsions, may be suspected to have TB meningitis T/F

True

67. If you suspect a False-positive smear result, what could be the possible reasons?

A false-positive result means that the sputum smear result is positive even though the patient
does not really have sputum smear-positive PTB. This may arise because of the following:

-red stain retained by scratches on the slide;

-accidental transfer of AFBs from a positive slide to a negative one;

-contamination of the slide or smear by environmental mycobacteria;

-presence of various particles that are acid-fast (e.g., food particles, precipitates, other
microorganisms).

68. Explain the Regimen for Drug-Sensitive TB (DSTB) cases (Duration of Rx, Drugs used in IP, CP)

Treatment is given in two phases:

Intensive phase consists of 8 weeks (56 doses) of isoniazid (H), rifampicin (R), pyrazinamide (Z) &
ethambutol (E) given under direct observation in daily doses as per weight band categories.

Continuous phase consists of 16 weeks (112 doses) of H, R & E in daily dosages. The CP may be
extended by 12-24 weeks in certain phase forms of TB like CNS TB, skeletal TB, disseminated TB etc.
Based on clinical decision of the treating physician on case to case basis. Extensions beyond 12 weeks
should only be on the recommendation of specialists.

69. What is the Role of intensive phase in TB treatment?

To rapidly kill the bacilli, bring about sputum conversion & afford fast symptomatic relief.

70. What is the Role of continuation phase in TB treatment?

To eliminate the remaining bacilli so that relapse doesn’t occur.

71. Number of doses in IP___56____, doses in CP_____112______[drug sensitive TB]

72. What are the Advantages of daily TB regimen?

Standardized treatment means that all patients in a defined group receive the same treatment
regimen. Standard regimens have the following advantages over individualized prescription of drugs:

errors in prescription – and thus the risk of development of drug resistance – are reduced;
 estimating drug needs, purchasing, distribution and monitoring are facilitated;

staff training is facilitated;

costs are reduced;

maintaining a regular drug supply when patients move from one area to another is made easier;

outcome evaluation is convenient, and results are comparable.

73. What do you mean by Fixed Dose Combination?

FDCs refer to product containing 2 or more active ingredients in fixed doses, used for a
particular indication (s)

74. How TB drugs are provided in daily regimen?

Under the new daily drug regimen, TB patients will be given fixed dose combinations (FDCs) -
three or four drugs in specific dosages in a single pill - on a daily basis. The drugs will also be
administered in a more scientific manner, according to the patient’s weight. The biggest advantage for
the patient under the new regimen will be reduced pill burden, as instead of seven tablets, patients
need consume only 2 or 3 tablets, according to their weight band.
75. Among these persons, who can be a DOTS provider or who can provide TB drugs to patients?

ASHA

76. A schoolteacher/ shopkeeper/ Anganwadi worker/ NGO volunteer/ priest/ASHA

77. What will be your advice while initiating TB Treatment to a patient?

Follow Medical Advice: Emphasize the importance of adhering to the treatment plan prescribed
by their healthcare provider. Taking the medication exactly as directed is essential for curing TB and
preventing drug resistance.

Take Medications Consistently: TB treatment often involves multiple medications, which must be taken
consistently every day. Encourage the patient to establish a routine and take their medication at the
same time each day to help with consistency.

Understand the Medications: Explain the purpose of each medication, potential side effects, and how to
manage them. Encourage the patient to ask questions and clarify any concerns about the drugs.

Report Side Effects: Instruct the patient to report any side effects or adverse reactions to their
healthcare provider immediately. Some side effects can be managed, and healthcare providers may
adjust the treatment if needed.

Complete the Full Course: Stress the importance of completing the entire course of treatment, even if
the patient starts feeling better before the treatment period is over. Stopping treatment prematurely
can lead to treatment failure and drug-resistant TB.

Avoid Alcohol and Drug Interactions: Advise the patient to avoid alcohol and inform their healthcare
provider about any other medications or supplements they are taking to prevent potential drug
interactions.

Maintain a Healthy Diet: Encourage a balanced diet to support the patient's immune system and overall
health. Nutritious meals can help the body fight TB.
Rest and Hydration: Adequate rest and hydration are important for recovery. Recommend getting plenty
of sleep and drinking enough fluids.

Practice Good Respiratory Hygiene: Encourage the patient to cover their mouth and nose when
coughing or sneezing, and to dispose of tissues in a closed bin. This helps prevent the spread of TB to
others.

Isolate When Necessary: If the patient is contagious, such as in the case of active pulmonary TB, advise
them on proper infection control measures, including isolation as needed, to protect household
members and close contacts.

Regular Follow-Up: Stress the importance of attending all scheduled follow-up appointments with their
healthcare provider. These visits are essential for monitoring treatment progress and adjusting the
regimen if necessary.

Support and Counseling: Remind the patient that TB treatment can be challenging, and it's normal to
have concerns or emotional reactions. Encourage them to seek support from healthcare providers or
support groups if needed.

Notify Close Contacts: If not already done by healthcare authorities, advise the patient to inform their
close contacts so they can be screened for TB if necessary. Early detection and treatment of TB in close
contacts are essential for preventing further transmission.

Prevent Transmission: Educate the patient on preventing the spread of TB by maintaining good hygiene,
covering their mouth and nose when coughing or sneezing, and using tissues.

78. What are the sputum disposal techniques you will advise for patients?

1. Use Tissues or Disposable Cups:

When you need to collect sputum, use disposable tissues or cups provided by your healthcare provider.
These should be labeled and used for this purpose only.

2. Cover Your Mouth and Nose:

When coughing up sputum, cover your mouth and nose with a tissue or the disposable cup provided to
catch the sputum.

3. Do Not Spit Into Open Air:

Never spit sputum into open air, as this can release infectious droplets into the environment. Always use
a tissue or cup.

4. Securely Seal the Container:

After collecting the sputum, securely seal the container. If you're using a disposable cup, ensure it's
properly closed with a lid.

5. Wash Hands Thoroughly:

After handling sputum or any materials contaminated with sputum, wash your hands thoroughly with
soap and water for at least 20 seconds.

6. Dispose of Properly:

Follow your healthcare provider's instructions for proper disposal. Typically, this involves double bagging
the sealed container in plastic bags to prevent leakage and contamination. Dispose of these bags in
designated waste bins for infectious materials.

7. Clean and Disinfect:

If you've used any surfaces or objects during the sputum collection process, such as tables or
countertops, clean and disinfect them promptly with an appropriate disinfectant.

8. Maintain Respiratory Hygiene:

Continue to practice good respiratory hygiene by covering your mouth and nose with a tissue or your
elbow when coughing or sneezing. Dispose of tissues in a closed bin.

79. If a patient does not take medication as scheduled in IP or CP, what should be done?

Patients in IP/CP who miss doses: All missed doses during IP must be completed prior to
switching the patient to CP. Similarly, all missed doses during CP must be administered prior to ending
treatment.

Patients who interrupt treatment for less than one month during IP: When the patient returns to
resume treatment, IP will be continued. However, the duration of treatment will be extended to
complete IP. The follow-up cultures will be done as per the schedule.

Patients who interrupt treatment for less than one month during CP: When the patient returns to
resume treatment, the CP will be continued however, the duration of treatment will be extended to
complete CP. The follow-up cultures will be done as per the schedule.

Patients who are "lost to follow-up" (interrupt treatment continuously for one month or more)
and return back for treatment: Such patients will be given an outcome of "lost to follow-up". The patient
would be subjected to repeat CBNMT & FL-SL LPA and LC as per the d diagnostic algorithm to restart
with appropriate DST guided regimen with or without newer drug for a fresh episode of treatment.

80. If the TB patient is a chronic smoker, how will it affect his treatment?

Smoking significantly increases the likelihood of poor tuberculosis treatment outcomes.

It also increases the risk of relapse after successful TB treatment.

81. If the TB patient is an alcoholic, how will it affect his treatment?

Chronic alcohol abuse weakens the immune system, making it less effective in fighting off
infections, including TB. This can make it more challenging for the body to control and eliminate TB
bacteria, potentially leading to more severe and prolonged TB disease.
 Alcoholism can lead to poor adherence to TB medication regimens. Alcohol can impair judgment
and memory, leading to forgetfulness or neglecting to take prescribed medications regularly. Missing
doses or not completing the full course of treatment can result in treatment failure and the
development of drug-resistant TB strains.

Alcohol can interact with certain TB medications, potentially affecting their absorption,
metabolism, or side effects. This can complicate the management of TB and may require adjustments to
medication regimens.

82. If a smear positive pulm.TB patient has a 4 yr. old child at home, what will you do for the child?

Child Evaluation for TB Infection or Disease:

The child should undergo a thorough medical evaluation by a healthcare provider to determine if they
have any signs or symptoms of TB infection or disease. This evaluation may include a physical
examination, a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA) blood test, and
possibly a chest X-ray.

The evaluation aims to determine if the child has TB infection or active TB disease.

TB Preventive Therapy (TPT) for the Child (if indicated):

If the child tests positive for TB infection but does not have active TB disease, they may be eligible for TB
preventive therapy (TPT) to reduce the risk of developing active TB in the future. The specific TPT
regimen and duration should be determined by a healthcare provider based on local guidelines and the
child's age and weight.

Infection Control Measures at Home:

Ensure that the adult TB patient is educated about and follows proper infection control measures at
home. This includes practicing good respiratory hygiene (covering mouth and nose when coughing or
sneezing), proper ventilation in the living space, and maintaining a safe distance from the child,
especially during periods of coughing.

Use of Masks:

In households with a confirmed TB patient, it may be advisable for both the adult and child to wear
masks, especially when they are in close contact, to reduce the risk of transmission. However, masks
should not be relied upon as the sole preventive measure, and other precautions should be followed.

Hygiene and Handwashing:

Emphasize the importance of proper hand hygiene. Both the adult TB patient and the child should wash
their hands frequently with soap and water, especially after any contact with respiratory secretions or
surfaces that may be contaminated.

Nutritional Support:

Ensure that the child receives proper nutrition and maintains a healthy lifestyle to support their immune
system.
Psychological Support:

Consider providing psychological support to both the adult TB patient and the child, as living with a TB
diagnosis can be emotionally challenging for the entire family.

Monitor the Child's Health:

Continue to monitor the child's health closely, even if they test negative for TB infection initially. TB can
take time to develop, and regular check-ups may be necessary.

Vaccinations:

Ensure the child is up to date with their childhood vaccinations, including the Bacillus Calmette-Guérin
(BCG) vaccine, which is given to protect against severe forms of TB in children.

83. If a TB patient comes to you with gastrointestinal (vomiting or epigastric discomfort) symptoms
after treatment initiation, how will you treat?

84. If a TB patient presents to you with Tingling/burning/numbness in the hands and feet

after treatment initiation, which drug could be responsible for this and how will you treat?

The drug responsible for this is isoniazid, treat with pyridoxine.

85. If a TB patient presents to you with impaired vision after treatment initiation, which drug could
be responsible for this and how will you treat?

The drug responsible for this is ethambutol.

Stop ethambutol.

86. If a TB patient presents to you with Ringing in the ears/Loss of hearing/Dizziness and loss of

balance after treatment initiation, which drug could be responsible for this and how will you treat?

The drug responsible for this is streptomycin, stop & replace with ethambutol.

87. If a patient develops jaundice during treatment, how will you proceed?

Stop pyrazinamide first, if jaundice resolves continue with HRE, if persistent stop rifampicin & if
jaundice resolves continue with HE.

88. Name the drug absolutely contraindicated during entire pregnancy.

Streptomycin

89. Is there any provisions for providing money to TB patients?

Yes.

90. What is NIKSHAY?

NIKSHAY – eradication of TB
 Functional components are:

- Master management

- User details

- TB Patient registration and details of diagnosis. DOT provider, HIV status, follow-up, contact
tracing, outcomes.

- Details of solid and liquid culture and DST, LPA, CBNAAT details.

- DR-TB patient registration with details.

- Referral and transfer of patients.

- Private health facility registration and TB notification.

- Mobile application for TB notification.

- SMS alerts to patients on registration.

- SMS alerts to programme officers.

91. What is NIKSHAY Poshan Yojana?

Financial incentive of Rs.500 /month for each notified TB patient.

Incentive for the complete duration of anti-TB treatment to the patient.

Incentive given via direct benefit transfer.

92. What is 99DOTS?

99 DOTS is a new scheme for providing free anti-TB medicines. The medicines are placed in a
special envelope which when peeled reveals a toll-free phone number. Each time the patient takes the
medicine, he or she has to dial the phone number found inside the medicine envelope.

93. Explain the Patient support systems available for TB patients in Govt?

>Nutrition support direct benefit transfer

>Link with other socio welfare schemes

>Psychological support

>Economic assistance in kind.

94. When is World TB day celebrated?

March 24, every year.

 LEPROSY
1.what is the WHO working definition of a case of leprosy?
A case of leprosy is a person with 1 or more of the following
features and who is yet to complete a full course of treatment
i) hypopigmented or reddish skin lesion with definite loss of
sensation
ii)involvement of peripheral nerves
iii) skin smear +ve for acid fast bacilli
2.What is the cardinal features of leprosy?
a)hypopigmented patches
b)partial /total loss of cutaneous sensation in the Affected area
c)thickened nerves
d)presence of acid fast bacilli in the skin / nasal smear
3.what are the modes of transmission of leprosy?
1.Droplet infection -aerosols
2.Direct contact -person to person
3.Indirect contact -famines or soil

4.what are the environmental factors that favours the transmission

of leprosy?
i)overcrowding
ii)lack of ventilation
iii)presence of infectious cases in environment
Dried nasal secretions -9 days
Moist soil -46days
5.How will you classify leprosy?
Ridley Joplin classification
Tuberculoid Leprosy
Borderline tuberculoid
Borderline borderline
Borderline lepromatous
Lepromatous leprosy
6. How will you classify leprosy for treatment purpose?
PAUCIBACILLARY MULTI BACILLARY

1-5 lesions more than or equal to 6 lesions

no or one nerve involved > I nerve involved

Skin Smear -ve at all sites +ve at any one site

7. what are the nerves commonly involved in Hansen's disease ?
Ulnar, Radial,Median, facial, Common peroneal, Posterior tibial

8. How will you do a slit skin smear (explain the steps clearly) ?
1. Clean skin with spirit & let dry
2. Skinfold is nipped between thump and forefinger of examiner
3. Knife held vertical to apex of skinfold
4. 5mm incision made at depth about 2mm
5. Blood is wiped off with cotton wool swab
6. Rotate knife blade 90° transversely
7. knife point used to scrape first one side than other Side 2 to 3
times to obtain tissue pulp from the dermis
8. material transferred to glass slide and spread over an area of
8 mm diameter
9. How will you do voluntary muscle testing in leprosy?
Check range of movements
( Whether decreased/ Increased or absent )
Movement normal then do test for resistance(N/reduced/absent)
Grading - strong, weak/paralysed .
[Power, Tone, Reflex,Bulk]
10. what is the importance of bacteriological and morphological
index in leprosy?
Bacteriological index:
both living & dead bacilli identified
Used to monitor the benefit of treatment.
Morphological index: → Only live bacilli (Solid )
→ Asses patients response to treatment &
asses presence of drug resistance
12. What are the deformities you can expect in Hansen's disease?
Face -> leonine facies,Madarosis,, Saddle nose, Perforated
nose, corneal opacities, mask face
Hand → Wrist drop, claw hand, thumb web contracture,
Swollen hand
Feet → foot drop, Plantar ulcer, clawing of toes.
13. what is the treatment of Paucibacillary and multibacillary
leprosy under NLEP?
For Paucibacillary [6 month]
ADULT CHILD

Rifampicin 600 mg once a month 450 mg once a month

Dapsone 100 mg daily 50 mg daily

Multibacillary -> 12 months
ADULT CHILD (10-14)

Rifampicin 600 mg once a month 450 mg once a month

Dapsone 100 mg daily 50 mg daily

Clofazimine 300 mg once a month 150 mg once a month

50 mg daily 50 mg every other
day

14. What are the types of lepra reaction?

Type I: reversal reaction
Type 2: Erythema Nodosum Leprosum
15. For how long and how often should treated case of leprosy be
followed up ?
Pauci→atleast once a year x 2 yrs
Multi → atleast once a year x 5yrs
16. What is the difference between reversal reaction and ENL?
Type 1 Type 2

Delayed hypersensitivity Ag ab rxn

Both PB and MB seen in MB (BL&LL)

New lesions appear Red painful tender subcutaneous nodules

Neuritis seen Not as severe as in Type 1

Other organs not affected Eyes testis kidney affected

General symptom nor common Fever joints pain red eyes with watering

Lagophthalmos and corneal anesthesia Iritis /iridocyclitis

17. What is the status of leprosy in India (Eliminated/ Eradicated)
⇒ELIMINATED
HIV
1) What is the prevalence of HIV in India?
24 lakh for the year 2021
Adult (15+) 23.3 lakh
Women (15+) 10.5 lakh
Children less than 15 years 0.7 lakh
Young people 15 to 24 year 1.7 lakh
2) How do you classify the States in India based on HIV Prevalence?
States can be divided into low burden and high burden states
At national level established adult HIV prevalence is highest in North eastern region
states followed by Southern states . There is significant regional disparity among states
with higher averages as in Mizoram , Nagaland and Manipur.

3) What are the modes of spread of HIV? HIV

(a) Sexual transmission AIDS is first and foremost a sexually transmitted disease. Any
vaginal, anal or oral sex can spread AIDS. Every single act of unprotected intercourse
with an HIV-infected person exposes the uninfected partner to the risk of infection.
As for HIV-infected people, they are more infectious to others in the very early stages,
before antibody production i.e. during the "window period", and when the infection is
well advanced, because levels of virus in the blood at that time is higher than at other
times.

(b) Blood contact AIDS is also transmitted by contaminated blood transfusion of whole
blood cells. platelets and factors VIII and IX derived from human plasma.
As a result, needle-sharing by drug users is a major cause of AIDS in many countries,
both developed and developing, and in some it is the predominant cause. Any skin
piercing (including injections. ear-piercing, tattooing, accupuncture or scarification) can
transmit the virus, if the instruments used have not been sterilized and have previously
been used on an infected person.
 (c) Maternal foetal transmission through placenta or during delivery or by breast
feeding.Risk of transmission 20 to 25 %
4) What are the 4 broad categories of clinical manifestations of HIV?

The clinical features of HIV infection have been classified into four broad categories
I. Initial infection with the virus and development of antibodies
II. Asymptomatic carrier state
III. AIDS-related complex (ARC)
IV. AIDS.

5) What is ‘window period’ in HIV? What is the importance of window period ?

HIV antibodies usually take between 2 to 12 weeks to appear in the blood-stream, though
they have been known to take longer. The period before antibodies are produced is the
"window period" during which, although the person is particularly infectious because of
the high concentration of virus in the blood, he will test negative on the standard antibody
blood test.
6) What is AIDS related complex?
A person with ARC has illnesses caused by damage to the immune system, but without
the opportunistic infections and cancers associated with AIDS, they may exhibit one or
more of the following clinical signs; unexplained diarrhoea lasting longer than a month,
fatigue, malaise, loss of more than 10 per cent body weight, fever, night sweats, or other
milder opportunistic infections such as oral thrush, generalized lymphadenopathy or
enlarged spleen. Patients from high-risk groups who have two or more of these
manifestations (typically including generalised lymphadenopathy), and who have a
decreased number of T - helper lymphocytes are considered to have AIDS-related
complex . Some patients with AIDS-related complex, subsequently develop AIDS.
7) Most common opportunistic infections associated with HIV?
Tb
Kaposi sarcoma
Oropharyngeal candidiasis
Cytomegalovirus retinitis
 Pneumocytosis carinii pneumonia
Toxoplasma encephalitis
Hairy leukoplakia
Cryptococcal meningitis
Herpes zoster or shingles
Severe prurigo or pruritic dermatitis
Skin infections

8) What is the link between HIV and TB?

An alarming factor in the AIDS epidemic is the increasing link between HIV infection
and tuberculosis. In countries where tuberculosis is endemic, many people are infected in
childhood. When the immune system breaks down, as in HIV infection, tuberculosis
becomes active and the person becomes contagious to others. Studies in Rwanda, the
USA, Zaire and Zambia found that HIV-positive individuals were 30-50 times more
likely to develop active tuberculosis than HIV- negative people.
9) What is the WHO case definition for AIDS surveillance?
For the purposes of AIDS surveillance an adult or adolescent ( > 12 years of age) is
considered to have AIDS if at least 2 of the following major signs are present in
combination with at least 1 of the minor signs listed below, and if these signs are not
known to be due to a condition unrelated to HIV infection.
Major signs
• weight loss > 10% of body weight
• chronic diarrhoea for more than 1 month
• prolonged fever for more than 1 month (intermittent or constant).
Minor signs
• persistent cough for more than 1 month•·
• generalized pruritic dermatitis
• history of herpes zoster
• oropharyngeal candidiasis
• chronic progressive or disseminated herpes simplex infection
• generalized lymphadenopathy.
 The presence of either generalized Kaposi sarcoma or cryptococcal meningitis is
sufficient for the diagnosis of AIDS for surveillance purposes.
10) What are the screening tests available for HIV?
ELISA(sensitive test to detect antibodies)
Western blot(confirmatory test highly specific)
11) At what CD4 count level should antiretroviral treatment be initiated?
<350cells / microL
12) Classify the drugs used for antiretroviral therapy, giving one example for each.
NRTIs – lamivudine,zidovudine
NNRTIs- efavirenz,nevirapine
NTRTIs- tenofovir
Protease inhibitors- indinavir, ritonavir
Entry or fusion inhibitors- enfuvirtide

13) What are the levels of prevention in HIV?

(a)Until a vaccine or cure for AIDS is found, the only means at present available is health
education to enable people to make life-saving choices. One should also avoid the use of
shared razors and toothbrushes. Intravenous drug users should be informed that the
sharing of needles and syringes involves special risk. Women suffering from AIDS or
who are at high risk of infection should avoid becoming pregnant, since infection can be
transmitted to the unborn or newborn. Educational material and guidelines for prevention
should be made available.
(b} COMBINATION HIV PREVENTION Combination prevention programmes use a
mix of biomedical, behavioural and structural interventions to meet the current HIV
prevention needs of particular individuals and communities so as to have the greatest
possible impact on reducing new infections.
(c)Prevention of blood borne hiv transmissions
People in high-risk groups should be urged to refrain from donating blood, body organs,
sperm or other tissues. All blood should be screened for HIV 1 & HIV 2 before
transfusion
 14) Which are the high risk groups for HIV transmission?
Male homosexuals and bisexuals, heterosexual partners (including prostitutes),
intravenous drug abusers, transfusion recipients of blood and blood products,
haemophiliacs and clients of STD.
15) What are the functions of ICTC?
The main functions of an ICTC are:
Conducting HIV diagnostic tests.
Providing basic information on the modes of HIV transmission, and promoting
behavioural change to reduce vulnerability.
Link people with other HIV prevention, care and treatment services.

16) How can we prevent mother to child transmission of HIV?

Transmission of HIV from mother to child can be prevented almost entirely by anti-
retroviral drug prophylaxis, elective caesarian section before onset of labour and rupture
of membranes, and by refraining from breast-feeding. However, in economically poor
countries, elective caesarean section is not a safe option. A substantial efficacy of triple
combination of drugs has been shown in industrialized countries, where the rate of
transmission is now below 2 per cent in the absence of breast feeding.
17)What is post exposure prophylaxis? For whom is it recommended?
Post-exposure prophylaxis should be offered, and initiated as early as possible, to all
individuals with exposure that has the potential for HIV transmission, and ideally within 72 hours.
Health care personals who have occupational exposure to blood ,tissue or body fluids that may
contain HIV.
Raltegravir 40 mg twice daily and Tenofovir 300mg once daily * 4 weeks
Dolutegravir 50 mg OD and Tenofovir 300 mg OD *4 weeks

18)What are the different strategies for control of HIV/AIDS under the National AIDS
Control program?
The national strategy has the following components : establishment of surveillance
centres to cover the whole country; identification of high-risk group and their screening;
issuing specific guidelines for management of detected cases and their follow-up;
 formulating guidelines for blood bank, blood product manufacturers, blood donors and
dialysis units; information, education, and communication activities by involving mass
media and research for reduction of personal and social impact of the disease; control of
sexually transmitted diseases; and condom programme
19)What are the different types of surveillance for HIV/ AIDS under the National AIDS
control program?
The types of surveillance are : (a) HIV Sentinel Surveillance,
(b) HIV Sero-Surveillance,
(c) AIDS Case Surveillance,
(d) STD Surveillance,
(e) Behavioural Surveillance, and
(f) Integration with surveillance of other diseases like tuberculosis etc
20)What is bridging population?
It comprises people, who through close proximity to high risk groups are at risk of
contracting hiv. NACO also categorizes truck drivers as a bridge population because of
unprotected sex with high risk groups which increases risk of transmitting hiv into
general population.

21)What are the criteria used by NACO for classification of states in India?
Based on sentinel surveillance data, the HIV prevalence in adult population can be broadly
classified into three groups of States/UTs in the country.
Group I High Prevalence States : includes states of Maharashtra, Tamil Nadu, Karnataka, Andhra
Pradesh, Manipur and Nagaland where the HIV infection has crossed 5 per cent mark in high-risk
group and 1 % or more in antenatal women.
Group II Moderate Prevalence States : includes states of Gujarat, Goa and Puducherry where HIV
infection has crossed 5% or more among high risk groups but the infection is below 1 % in
antenatal women.
Group Ill Low Prevalence States : includes remaining states where the HIV infection in any of the
high risk groups is still less than 5% and is less than 1 % among antenatal women.
1.What is diabetes mellitus?

The term diabetes describe a group of metabolic disorders characterized and identified by the
presence of HYPERGLYCEMIA in the absence of treatment

2.What is the classification of diabetes mellitus?

Type 1 diabetes mellitus

Type 2 diabetes mellitus

Gestational diabetes mellitus

3. What is impaired glucose tolerance?

Impaired glucose tolerance describes a state intermediate –“at risk“ group between diabetes
mellitus and normality. It can only be defined by the oral glucose tolerance test

4.What is impaired fasting glucose?

Impaired fasting glucose is a type of pre diabetic state in which a person’s blood sugar levels
during fasting are consistently above the normal range, but below the diagnostic cut-off for a formal
diagnosis of diabetes mellitus. That is between 110 to 125 mg/dl

5.What is syndrome X?

It has been proposed that insulin resistance predisposes to hyperglycemia, which result in
HYPERINSULINAEMIA and this excessive insulin level then contributes to high level triglycerides and
increased sodium retention by renal tubles thus inducing hypertension. High level of insulin can
stimulate endothelia proliferation to initiate atherosclerosis

6.What are the screening tests used for diabetes mellitus?

Urine examination

Blood sugar testing

7.What is HbA1C? What is the use of it?

Hemoglobin reacts with glucose non enzymatically and form a derivative known as Glycated
hemoglobin (HbA1c). It reveals the mean blood glucose over the past two to three months . Elevated
HbA1c indicates poor control of diabetes mellitus. The risk of retinopathy and other complications of DM
are increased with elevated HbA1c levels . Normal HbA1c is <5.5%

8.What are the complications of diabetes mellitus?

Macrovascular complications

Atherosclerosis

Myocardial infraction

Gangrene of lower extremity

Cerebrovascular accident

Renal vascular insufficiency

Microvascular complications

Diabetic nephropathy

Diabetic neuropathy

Diabetic retinopathy

9.What are the common oral hypoglycaemic agents?

Sulphonylureas: Glyburide, Glipizide

Biguanide: metformin

Meglitinide analogue : Repaglinide

Thiazolidinediones: Pioglitazone

DPP4 inhibitor: sitagliptin

SGLT2 inhibitors: Dapagliflozin, canagliflozin

10.What are the host factors that lead to diabetes mellitus?

Age

Genetic factor

Genetic marker : HLA-B8 and B15

Immune mechanism

Obesity
 Maternal diabetes

11. What are the environmental factors that lead to diabetes mellitus?

Sedentary lifestyle

Diet: high saturated fat diet

Dietary fibre: reduces the risk

Malnutrition: result in failure of beta cells

Alcohol

Viral infection: rubella ,mums and human coxsackie virus B4

Chemical agent: Toxic to beta cells (eg. Alloxan , streptozotocin)

Stress

Other : occupation, marital status, religion , economic status , education

12. What is primordial prevention? Whether it is applicable to diabetes mellitus?

Prevention of emergence of risk factors in countries in which they have not yet appeared.

- maintenance of body weight

- adoption of healthy nutritional habits

- physical exercise

It is applicable to Diabetes mellitus

13. What is primary prevention? Whether it is applicable to diabetes mellitus ?

Two strategies for primary prevention have been suggested

1. Population strategy

2. High risk strategy

14. What is secondary prevention? Whether it is applicable to Diabetes mellitus?

Aims :

- to maintain blood glucose levels as close within the normal limits as is practicable
 - to maintain ideal body weight

15. Which are the high risk groups for screening diabetes mellitus?

1. Those in age group 40 and over

2. Those with a family history of diabetes

3. The obese

4. Women who have had a baby weighing more than 4.5 kg

5. Women who show excess weight gain during pregnancy

6. Patients with premature atherosclerosis

16. Why insulin is used as a treatment for diabetes mellitus ?

In type 1 diabetes mellitus, there is a deficiency of insulin. So, insulin is the preferred drug.

In type 2 diabetes mellitus, there is insulin resistance. So, we prefer hypoglycemic agents.
But, in resistant cases, insulin is also used with other hypoglycemic agents.

17. What are the treatment available for gestational Diabetes mellitus?

The ADA first line of treatment for GDM is insulin. The therapy with insulin has been
considered the standard therapy for gestational diabetes management when adequate glucose levels are
unachievable with diet and exercise.

18. Why foot care is important in diabetes mellitus?

Feet should be examined for any defective blood circulation ( Doppler ultrasound probes are
advised ), loss of sensation and the health of skin. Foot care is advised to prevent any injuries which may
lead to diabetic foot.

19. List one side effect for oral hypoglycemic drug.

Metformin – Nausea vomiting diarrhoea, vitamin b12 deficiency

 Sulphonylureas – hypoglycemic

Meglitinide – weight gain

Thiazolidinediones – nausea vomiting Anemia edema weight gain

20. What is glycemic index? Give examples.

Glycemic index of a food is defined by the are under the two hour blood glucose response
curve (AUC) following the ingestion of a fixed portion of test carbohydrate (usually 50g) as a proportion
of the AUC of the standard (either glucose or white bread).

Low glycemic index – 55 or less – most fruits and vegetables ( except potatoes, watermelon and sweet
corn), whole grains, past foods, beans, lentils

Medium glycemic index – 56 to 69 – sucrose, basmati rice, brown rice

High glycemic index – 70 or more – corn flakes, baked potato, white bread, candy bar, syrupy foods

21. Name few foods that should be eaten or avoided in a diabetic

Adequate protein intake – meat, cereals, pulses, fish

High intake of dietary Fibre – vegetables, fruits, green leafy vegetables

Avoidance of sweet foods – sweets, cakes, biscuits

HYPERTENSION
1 . What is the value of blood pressure to be called hypertension?
Systolic blood pressure ≥140 mm of Hg
Diastolic blood pressure ≥90-99mm of Hg.

2 . What is the classification of hypertension?what is JNC?

Category Systolic (mm of Hg) Diastolic (mm of Hg)
Optimal <120 <80
Normal <130 < 85
High normal 130-139 85-89
Grade 1 hypertension 140-159 90-99
Grade 2 hypertension >160 >100
Hypertensive crisis ≥180 >110
Isolated systolic HT ≥140 <90
 JNC - Joint national committee on detection , evaluation, treatment
of high blood pressure

3 . Difference between JNC 7and JNC 8?

JNC 7
Definition - defined both hypertension and prehypertension
Treatment goals – separate treatment goals defined for uncomplicated
hypertension and for patient with co-morbid condition
JNC 8
definition – defined only hypertension, prehypertension is not given
Treatment goals – similar treatment goals defined for all hypertension
patients except when evidence review support different goals for a particular
subpopulation
 4.what are the complications of hypertension?
* Heart – left ventricular hypertrophy,angina/previous myocardial
infarction and heart failure
* Brain – stroke or transient ischemic attack, dementia
* Chronic kidney disease
* Peripheral arterial disease, aneurysms
* Retinopathy
* cognitive changes

5. What is Essential hypertension?

* Hypertension is classified as ‘Essential’ when the cause are
Generally unknown .It is also known as primary hypertension
* Essential hypertension is most prevalent form of hypertension
Accounting for 90 percent of all cases of hypertension
6.what is secondary hypertension and give examples?
* Hypertension is classified as ‘‘secondary ’’ when some other
disease process or abnormality is involved in its causation.
* prominent among these are disease of kidney (chronic glomerulo-
nephritis and chronic pyelonephritis), tumours of adrenal glands,
congenital narrowing of the aorta and toxemias of pregnancy.
* Account for 10 percent of the cases of hypertension .

7. Explain rule of halves

Hypertension is an ‘‘iceberg’’disease
About half of the hypertensive subjects in the general population
of most developed countries were aware of the conditions,only
about ½ of those aware of the problem were being treated and
only ½ of those treated were considered adequately treated .
8.Explain the tracking of blood pressure
* If the blood pressure levels of individuals were followed up over a
Period of years from early childhood into adult life,then those
Individuals whose pressures were initially high in the distribution
Would probably continue in the same ‘‘tract’’as adults.
* In other words ,low blood pressure levels tend to remain low,and
high levels tend to become higher as individuals grow older
* This knowledge can be applied in identifying children and
Adolescents ‘‘at risk’’of developing hypertension at future date

9.What are the non-modifiable risk factors in hypertension?

* Age
* Sex
* Genetic factors
*Ethnicity
10. What are the modifiable risk factors?
* Obesity
* Salt intake
* Saturated fat
* Dietary fibre – inversely related to risk of CHD and HT
* Alcohol
* Heart rate
* Physical activity
* Environmental stress
* Socio- Economic status

11.What is primordial prevention? Whether it is applicable to hypertension?

* Intervention done to prevent the emergence of risk factor
* It is applicable to hypertension
12 .what is primary prevention? Whether it is applicable to
hypertension?
Primary prevention is defined as ‘‘all measures to reduce the Incidence of
disease in a population by reducing the risk of onset’’.
A) POPULATION STRATEGY
I) nutrition: reduction of salt intake (<5 g per day), moderate fat
intake , avoidance of high alcohol intake , restriction of energy
intake appropriate to body needs.
ii) Weight reduction
iii) Exercise promotion
iv) Behavioural changes – reduction of stress .
v) Health education
vi) Self care
B) HIGH –RISK STRATEGY
The aim of this approach is ‘‘to prevent the attainment of levels of blood
Pressure at which the institution of treatment would be considered ’’.
13.What is secondary prevention? Whether it is applicable to
hypertension?
The goal of secondary prevention is to detect and control high blood
Pressure in affected individuals.
A) EARLY CASE DETECTION:
The only effective method of diagnosis of hypertension is to screen the
population. Screening should not be initiated if health resources for
treatment and follow up are not adequate.
B) TREATMENT:
The aim of the treatment should be to obtain a blood pressure below
140/90 mmHg and ideally a blood pressure of 120/80 mmHg
C) PATIENT COMPLIANCE:
The extent to which patient behaviour ( in terms of taking medicines,
following diets or executing other lifestyle changes) coincides with Clinical
prescription.
 14.What is non pharmacological approach for hypertension
. * Weight reduction - maintain BHI 18.5-24.9
* Adopt DASH eating plan – consume a diet rich in fruits, vegetables
and low - fat dairy products with a reduced content of saturated
fat and total fat .
* Dietary sodium reduction – reduce dietary intake to no more than
100 mEq/d
* Physical activity – engage regular aerobic physical activity such as
Brisk walking atleast 30 minutes.
* Moderation of alcohol consumption – not more than 2 drinks / day

15.What are the common drugs available for the treatment of hypertension?
ARBs – losartan ,Telmisartan .
ACE inhibitors – Enalapril , lisinopril.
Calcium channel blockers – amiodipine.
Diuretics – hydrochlorothiazide
Beta blockers – Atenolol ,metoprolol.
16 .which is the first line drug used for a patient if he is diabetic and
hypertensive?
* CCB is the first line drug used for a patient if he is diabetic and
hypertensive next to ARBs.
* Thiazide may cause hyperglycemia. So it is avoided.

17. What is X syndrome or metabolic syndrome?

A cluster of conditions that increases the risk of heart disease,stroke,
and diabetes.
It includes central obesity,high blood pressure, high triglycerides,
Low HDL - cholesterol ,insulin resistance.
18.What is the common risk factor approach for hypertension?
* Preload of BP
* Risk factor ( DM /impaired glucose tolerance, smoking, dyslipidemia,
male gender, age >55yrs in male , obesity).
* Target organ damage ( heart , kidney, retina).
* Presence of associated clinical conditions ( kidney disease,
Cerebrovascular disease, coronary artery disease).

19.What are the dietary approaches for the treatment for

Hypertension?
Patients should be encouraged to ,
* Reduce salt intake ( <5 g/day),
* moderate fat intake,
* Avoidance of alcohol,
* restriction of energy intake appropriate to body needs ,
* Consuming diet rich in fruits, vegetables, low fat dairy products.
20. What id DASH therapy?
* Dietary approaches to stop hypertension
* The plan emphasize whole – grain products, fish, poultry, nuts,
low- fat dairy, vegetables,and fruits. It limits red meat , sweets,
And sugar beverages .

21.What is the recommended salt intake per person per day?

<5 g / day.

22.What is the common cause of hypertension in our country?

* Age , Alcohol, Smoking, chewing tobacco,BMI, Central obesity,
Consumption of low vegetables/fruits,High consumption of dietary fat
and salt and Sendentary activity.
23.Explain the difference between Hypertensive emergency and
Hypertensive urgency.

HYPERTENSIVE URGENCY:
Blood pressure > 180/100 mm Hg.
Asymptomatic hypertension with no acute target organ dysfunction.
HYPERTENSIVE EMERGENCY:
Severe elevation in BP ( 200/110 mm Hg) complicated by impending
or progressive target organ damage.

24. What is NPCDCS?

* National programme for prevention and control of cancer, diabetes,Cardiovascular
disease and stroke.
* The programme focuses on the health promotion, capacity building including human
resource development, early diagnosis and management of these diseases .
1. What are “Non communicable diseases”?
Non communicable diseases are disease that are not spread through infection or through
other people, but are typically caused by unhealthy behaviours.
These include cardiovascular, renal, nervous and mental diseases, musculoskeletal
conditions such as arthritis and allied diseases, chronic non-specific respiratory diseases
(e.g., chronic bronchitis, emphysema, asthma), permanent results of accidents, senility,
blindness, cancer, diabetes, obesity and various other metabolic and degenerative diseases
and chronic results of communicable diseases.
2. What are the leading causes of death from non-communicable diseases?
*Cardiovascular diseases
*Cancer
3. What do you mean by the term Risk factor?
A risk factor is a characteristic condition, or behaviour that increases the likelihood of
getting a disease or injury
4. What are modifiable and non-modifiable risk factors?
Modifiable risk factor- risk factors that can be controlled, or changed. E.g., smoking,
alcohol obesity, healthy eating, physical activity.
Non-modifiable risk factor- risk factors that cannot be controlled. E.g., gender, race, age,
family history
5. How does smoking increase the risk for developing CHD?
*Carbon monoxide induced atherogenesis
* Nicotine stimulation of adrenergic drive raising both blood pressure and myocardial
oxygen demand
* Lipid metabolism with fall in HDL, etc.,
6. Relationship between alcoholism and NCD
Approximately 3.3 million people die each year from the harmful use of alcohol,
accounting for about 5.9% of all deaths in the world and 5.1 per cent DALYs were
attributable to alcoholism.
More than half of these deaths occur from NCDs including cancers, cardiovascular disease
and liver cirrhosis.
More over there is a close relationship between drinking and violent crime including
domestic violence.
7. How does hypertension increase the risk for developing CHD?
Hypertension accelerates the atherosclerotic process, especially if hyperlipidaemia is also
present and contributes importantly to CHD.
8. What are the different types of cholesterol?
LDL, VLDL, HDL, Triglycerides.
9. Name the cholesterol which protective against CHD
HDL
10. What is the cut-off level for serum cholesterol?
Total cholesterol- less than 200mg/dl
11. What is the normal cut off for cholesterol/HDL ratio and why is it needed?
Cut-off -- less than 3.5
High ratio indicates a higher risk for developing heart disease
12. What are the strategies by WHO to prevent CHD?
1) Population strategy
a) Prevention in whole populations.
b) Primordial prevention in whole population.
 2) High risk strategy
3) Secondary prevention
13. How to prevent CHD under population strategy?
Mass approach focussing mainly on the control of underlying causes in whole
populations
Specific interventions:
The population strategy centres round the following key areas;
1)Dietary changes:
- reduction of fat intake to 20-30 per cent of total energy intake
- consumption of saturated fats must be limited to less than 10 per cent of total
energy intake
- reduction of dietary cholesterol to below 100mg per 1000kcal per day
- increase in complex carbohydrate consumption
- avoidance of alcohol consumption, reduction of salt intake to 5g daily or less
2) Smoking: achieving smoke free society
3) Blood pressure: high blood pressure reduced to mean population blood pressure levels
4) Physical activity.
14. Describe primordial, primary and secondary prevention for CHD
Primordial prevention: prevention of the development of clinical risk factors through
maintenance or adoption of a healthy lifestyle will sustain in a low risk profile and
consequently, reduce the incidence of CHD
Primary prevention: Dietary changes, smoking cessation, maintaining blood pressure,
avoiding alcohol, physical activity etc.,
Secondary prevention: is to prevent the recurrence and progression of CHD. Beta blockers
15. What is high risk strategy for prevention of CHD?
Identifying risk→ Specific advice
Identifying risk- by elevated blood pressure and high blood cholesterol, those who smoke,
strong family history of CHD, diabetes, obesity and young women using contraceptives.
Specific advice- high risk individuals will be brought under preventive care and positive
action against all identifiable risk factors are taken. E.g., treating elevated bp, break smoking
habit, reduction of serum cholesterol etc.,
16. Name and describe one risk factor intervention trail
Oslow diet/ smoking intervention Study
This study began in 1973.
16,202 Norwegian men aged 40-49 yrs were screened for coronary risk factors; of
these 1232 healthy normotensive men at high risk (total serum cholesterol 290-379mg/dl;
smoking) of CHD were selected for a 5 year randomised trial. The aim of the study was to
determine whether lowering of serum lipids and cessation of smoking would reduce the
incidence of first attack of CHD in males aged 40-50.
The intervention group underwent techniques designed to lower serum cholesterol
level through dietary means (e.g., a polyunsaturated fat diet), and to decrease or eliminate
smoking. At the end of 5 yrs, the incidence of myocardial infarction (fatal and nonfatal) was
lowered by 47 per cent in the intervention group than in the control group.
With this study, primary prevention of CHD entered the practical field of
preventive medicine in an impressive manner
17. What are secondary prevention trials?
 Aimed at preventing a subsequent coronary attack or sudden death. A wide range of
trials have been performed with four main groups of drugs- anticoagulants, lipid lowering
agents, anti-thrombotic agents and beta blockers.
18. What is stroke?
WHO defined stroke as “rapidly developed clinical signs of focal disturbance of cerebral
function; lasting more than 24 hrs or leading to death, with no apparent cause other than
vascular origin”
19. What is Transient Ischaemic Attack?
It is defined as rapidly developed clinical signs of focal disturbance of cerebral function;
lasting less than 24 hrs.
These are episodes of focal, reversible, neurological deficit of sudden onset and of less
than 24hrs duration.
20. What is the prevalence of stroke?
21. What are the causes of stroke?
Ischaemic stroke:
Lacunar infarct
Carotid circulation obstruction
Vertebro-basilar obstruction
Haemorrhagic stroke
Spontaneous intracerebral haemorrhage
Subarachnoid haemorrhage
Intracranial aneurysm
Arteriovenous malformations
22. What is ‘Golden Hour’ in stroke?
The first hour is considered to be the golden hour because stroke patients have a high
chance of survival and prevention of long-term brain damage if they receive medical
treatment and drug therapy within the first 60 minutes of the onset of symptoms.
23. What are the risk factors for stroke?
Hypertension-main risk factor
Others-cardiac abnormalities (left ventricular hypertrophy, cardiac dilatation), diabetes,
elevated blood lipids, obesity, smoking, glucose intolerance, blood clotting and viscosity, oral
contraceptives, etc.,
24. What are the clinical manifestations of a stroke patient?
Signs and symptoms are related to site and extent of area involved and underlying causes.
These include coma, hemiplegia, paraplegia, monoplegia, multiple paralysis, speech
disturbances, nerve paresis, sensory impairment, etc.,
25. What is ‘stroke in young’?
Stroke in people less than 45yrs of age
26. What are the danger signs for referral of a stroke patient to higher centre?
27. How do you manage a stroke patient at primary centre?
Stabilization of airway and breathing, blood glucose and blood pressure control,
Thrombolytic therapy, intravenous access and cardiac monitoring etc..,
28. What are the recommendations to the community?
29. What is the primary level of prevention in stroke?
Risk reduction
Cigarette smoking, physical inactivity, overweight and obesity, dyslipidaemia, hypertension,
and diabetes be addressed and managed to decrease the risk of stroke.
30. What are the rehabilitation measures taken for a stroke patient?
 1) Speech therapy
2) Physical therapy
3) Occupational therapy
31. What are the complications a stroke patient would develop?
Brain swelling, seizures, memory loss, vision and hearing problems, muscle weakness, bed
sores, depression, risk of pneumonia, UTI, bowel and bladder problems, mobility problems
and falls.
32. What is included in the long term follow up of a patient with stroke?
The follow up consists of coaching on physical activity by physiotherapist.
33. Describe the national programme for stroke
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke(NPCDCS)—2010.