ANSWER KEY: SET 5

Total questions:4 Total marks: 35

Question 1: 8 marks

A house tank containing 9000 L of water is to be disinfected. You are provided with bleaching
powder containing 11% chlorine. Horrock’s 2nd cup shows blue. How much bleaching powder
is to be used for disinfection?

Solution:

Amount of bleaching powder required for 455 L sample water = 2n grams i.e. 2 X 2 = 4 grams.

So, Amount of bleaching powder required for 9000 L water

= 4/455 * 9000 = 197.80 grams

As the provided bleaching powder containing 11% chlorine is used to prepare stock solution
in Horrock’s test, there is no need to calculate for the bleaching powder containing 33%
chlorine.

Question 2: 9 marks

In 2009, a 7 months’ old unvaccinated boy child was brought to OPD by his mother with
the complaints that the child was not moving his left lower extremity for 2 days. On
probing for detailed history, mother recollects that the child had fever of low grade 4 - 5
days back. On examination, sensory system was found be normal.

A. What is the most probable diagnosis? Substantiate with supporting factors. [2 marks]
B. Mention 4 other differential diagnosis. [2 marks]
C. What precautions should be taken for children to reduce the risk of developing this
condition in present situation in India? [2 marks]
D. Discuss in brief the steps of surveillance of acute flaccid paralysis (AFP). [2 marks]
E. Mention any 1 indicator of AFP surveillance and the target to be achieved. [1 mark]

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Solution:
A. What is the most probable diagnosis? Substantiate with at least 3 supporting factors.
[2 marks]
Most probable diagnosis: Paralytic Poliomyelitis.
Supporting factors: [Any of the 3 to be written]
i. Host factors: Age (7 months) falls under the most vulnerable age group for
Poliomyelitis which is 6 months to 3 years. Gender of the child is male; and for
polio, male to female ratio is 3:1.
ii. Unvaccinated child.
iii. Asymmetric paralysis of the extremities.
iv. Fever prior to onset of paralysis.
v. Sensory system unaffected.

B. Mention 4 other differential diagnosis. [2 marks]

i. Guillian-Barre syndrome. v. Hypokalemia.
ii. Transverse myelitis. vi. Scurvy.
iii. Traumatic neuritis. vii. Acute osteomyelitis.
iv. Trauma. viii. Meningo-encephalitis.

C. What precautions should be taken for children to reduce the risk of developing this
condition in present situation in India? [3 marks]
Precautions that could have been taken for this child to reduce the risk of developing this
condition are as follows:
i. Vaccination:
a. Oral Polio Vaccine: Oral route, 2 drops.
• ‘0’ (zero) dose at birth.
• OPV – 1st, 2nd and 3rd dose at 6, 10 and 14 weeks of age.
b. Inactivated Polio vaccine: Intradermal route, 0.1 mL.
• Two fractional doses at 6 and 14 weeks of age.
c. Pulse Polio Immunization:
• 2 drops OPV to children < 5 years, irrespective of immunization
status on National Immunization Days.
ii. Maintaining personal hygiene and environmental sanitation.

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D. Discuss in brief the steps of surveillance of acute flaccid paralysis (AFP). [2 marks]
i. Finding and reporting AFP:
• Reporting of all AFP of < 15 years.
• Regular surveillance of hospitals and rehabilitation centers by public health
staff to search for AFP which may be overlooked / misdiagnosed.
ii. Transporting stool samples for analysis:
• 2 stool samples, collected 24 – 48 hours apart (ideally within 2 weeks of
onset of paralysis).
• Specimen to reach designated virology laboratory within 72 hours of
collection, with cold chain maintained (4-8°C).
iii. Isolating Poliovirus:
• Isolating the virus and distinguish between wild virus and vaccine virus.
iv. Mapping the virus:
• To determine genetic make-up of the virus, to identify geographical origin
so that appropriate measures can be taken.

E. Mention any 1 indicator of AFP surveillance and the target to be achieved. [1 mark]
Any 1 of the following to be written
AFP surveillance indicators
Completeness of reporting
Sensitivity of surveillance
Completeness of case
investigation
Completeness of Follow up
Targets
At least 80% of the expected routine reports should
be received on time, including zero reports.
At least 1 non-Polio AFP should be detected
annually per 1,00,000 population aged < 15 years
All AFP cases should have a full clinical and
virological investigation with at least 80% of AFP
cases having adequate stool specimens connected.
At least 80% of AFP cases to have a follow up
examination for residual paralysis at 60 days after
the onset of paralysis

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 Question 3: 9 marks

Construct a balanced diet for lactating woman.

Solution:

Proteins
Portions

portions
Grams/
Energy Protein
FOOD Grams Energy (gms) in
(kcal) / portion
GROUP In diet (k/cal) Balanced
/portion (grams)
diet
Cereals 330 1100 33
11 30 100 3
& Millets (11*30) (11*100) (11*3)
250
Pulses 2.5 30 100 75 (2.5*30) 6 15 (2.5*6)
(2.5*100)
300 210
Milk 3 100 70 3 9 (3*3)
(3*100) (3*70)
Roots 200 160 2.6
2 100 80 1.3
& Tubers (2*100) (2*80) (2*1.3)

Green Leafy 100 45 3.6

1 100 45 3.6
Vegetables (1*100) (1*45) (1*3.6)

Other 200 60 3.4

2 100 30 1.7
Vegetables (2*100) (2*30) (2*1.7)
100
Fruits 1 100 40 40 (1*40) _ _
(1*100)
120
Sugar 6 5 20 30 (6*5) _ _
(6*20)
225
Oils/Fats 5 5 45 25 (5*5) _ _
(5*45)
2210 66.6
(+600= (+19=
TOTAL 2810) 85.6)
(+520= (+13=
2730) 79.6)
RDA (0- 2230 55
6M)+600 (+600= (+ 19 =
(Moderate 2830) 74)
Worker) 2230 55
RDA(6- (+520= (+ 13 =
12M)+520 2750) 68)

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 Question 4: 9 marks

In a city of one lakh population there were 910 deaths in a year. There were 60 cases of
lung cancer of which 50 died. Calculate

A. Crude death rate

B. Specific death rate due to lung cancer
C. Case fatality rate of lung cancer
D. Proportional mortality rate of lung cancer

Solution:
A. Crude death rate
total deaths in a year 910
= X 1000= X 1000
total population of that year 1,00,000

= 9.1 per 1000 population

B. Specific death rate due to lung cancer

total deaths in a year due to lung cancer 50
= X 1000= X 1000
total population of that year 1,00,000

= 0.5 per 1000 population

C. Case fatality rate of lung cancer

total deaths in a year due to lung cancer 50
= X 100= X 100
total cases of lung cancer in that year 60

= 83.33 %

D. Proportional mortality rate of lung cancer

total deaths in a year due to lung cancer 50
= X 100= X 100
total deaths in that year 910

= 5.49 %

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