Community Medicine

Community medicine 1. Stages of demographic cycle a. 1st Stage (High stationary) – high birth rate & death rate b. 2nd Stage (early expanding) – high birth rate & death rate declining c. 3rd Stage (Late expanding) – death rate declines further & birth rate starts declining d. 4th Stage (Low stationary) – both rates low & stable e. 5th Stage (Declining) – birth rate lower than death rate 2. Judgement of counselling and casuality (smoking and CAD) 3. Write on epidemiology of ca cervix and obesity. 4. Case Control study- advantages a. Odds ratio (Cross product ratio) It is the Estimation of association between the risk factors and the outcome. Incidence is not needed. ad/bc Based on 3 assumptions – disease investigated is relatively rare. Cases are representatives of Diseased. Controls must represent those without disease. b. AR, RR c. Biasi. Bias d/t Confounding factors ii. Recall (Memory) bias iii. Interviewer bias iv. Selection bias v. Berkesonian bias d. observational and p e. Cohort and case control study f. Five features of cohort study i. Cause to effect study ii. Cohorts are identified before appearance of disease iii. RR, AR, Population AR can be calculated iv. Incidence can be calculated v. Lengthy study g. 3 advantage of case control study i. Easy, short, less expensive, rare disease can be studied ii. Multiple risk factors of single disease can be studied iii. No attrition, ethical problem, no risk to subjects 5. Sensitivity, Specificity. a. I and prevalence b. Incidence-characteristics 6. Bimodal distribution-characteristics 7. Mortality measures 8. Cohort study- elements a. Selection of Cohort b. Obtaining data on Exposure c. Selection of Comparison group i. Internal

ii. External iii. Comparison with general population d. Follow up e. Analysis i. RR, AR, Population AR ii. incidence 9. 10. Net reproductive rate It is the total number of daughters a newborn girl will have if she passes through her reproductive age (15-49) with the age specific fertility rate and mortality. 11. Total Fertility Rate It is the average no. of children a woman will have if she were to pass through her reproductive age with current age specific fertility rates and assuming no mortality. 12. PMR 13. Steps in investigation of an epidemic. a. Confirmation of the disease b. Verification of the existence of Epidemic c. Defining the Population at risk i. Get the Map, population d. Rapid search for cases and their characteristics i. Search for more cases e. Data Analysis i. Time, Place and Person f. Generation of Hypothesis g. Testing of hypothesis h. Evaluation of ecological factors i. Further investigation of population at risk j. Writing of Report 14. DefineEpidemic – occurance of any disease or health related event in excess of expected occurrence. 15. IP, specific protection 16. Primary prevention each- 2 examples- DM, neonatal tetanus, pneumoconiosis, STI 17. Ix of measles epidemic 18. polygon, Random sampling, Frequency 19. Ratio 20. Indicators of morbidity 21. Rate, ratio, program 22. Specific mortality rate, Couple protection rate, Contraception prevalence rate, Total fertility rate 23. HDI, QOL, Purchasin partiy 24. EPI a. Sub NID and its use. How many districts? b. Vitamin A program in Nepal, Prevention of vitamin A deficiency

c. Main objectives and problems of EPI, strategies d. Define AFP i. What is the most probable dx? ii. When DHO should be informed? iii. Stool collection and how many, duration, gap iv. Rationale for pulse polio immunization for eradication v. Sub NID- how many districts e. Cold chain temperature for DPT and OPV f. For or against eradication polio, Herd immunity MEQ1. Screening, True +, True –, PPV, NPV, Specificity, sensitivity Use of screening 2. Mean , Mode, Median Confidentiality limits- calculate 3. Diagrams, Frequency diagram/dispersion, Standard deviation 4. Kala A program and its constituents 5. Functions of TBA. How does sutketi samagri help in SCCM 6. Micronutrient- defn 7. FCHV, role in ARTI 8. Objectives of TBA program 9. Indication of safe motherhood program 10. Nutritional program- targets 11. Community based ARI and CDD program 12. Counselling HIV, STI 13. Strategies for controlling IDD 14. Define septic tank, work and maintenance 15. Components of rapid sand filter 16. 3 ways of sanitary waste disposal 17. High risk approach? High rf for pregnancy? 18. Child with grade 3 PEM (wt, age given) a. Write IAP grade b. Mx c. How to assess dehydration? d. Advice to parents on weaning 19. ANC in harinagar for normal preg a. When to visit b. Advice c. Drugs 20. Write on depoprovera 21. Suspected PTB a. When to refer? b. What category? c. DD d. T/t with doses

22. Occupational lung disease (Dysp+hemop+cement factory) a. DD b. Ix c. Probable dx d. Preventive measures e. Engineering method of decreasing occupational health hazard f. Define ergonomic and its implications in occupational health g. Define counseling, ppls h. Personal protection in occupational disease i. Sound- extraauditory effects j. Medical measures of protection against occupational diseases 23. Ppls of health education 24. PHC-ppls a. Principles of PHC outreach b. Elements of primary health delivery 25. Cost effectiveness and cost benefit ration- analyze the difference betn them MEQ AIDS Net reproductive rate Fn-failure in Nepal Risk assessment in analytical step of primordial process. Definition of IHD. New attitude towards health practices Slow sand filter Malaria stigmata Filariasis index Quantitive management methods Health policy- staff Pasturization Food addictions egs Rabies- prevention, prophylaxis Example of zoonosis--bacterial/viral/parasitic Vector transmission of giardiasis. Biological transmission of typhoid Drug abuse- cardinal sxs Waterlow classification of PEM MEQ1. AIDS, 2. CAD, 3. KA, 4. dehydration, 5. TB

1. 2. 3. 4.

5 diff between Active and passive immunization Cultural beliefs in child care IEC Function of DHO

5. Strategies for controlling IDD 6. Short notes- WHO, Health planning, DOTS in Nepal, ICT, MDT leprosy MEQ 1. rabies- local tt, bite, PEP 1. 2. 3. 4. 5. 6.

Components of environmental sanitation. Diptheria antitoxin 5 methods of waste disposal Network analysis Missed pill in mid cycle…mx Signs and sxs of vit A deficiency

MEQ Umbilical sepsis 1. Advice to mother 2. ANC h/o tetanus, how elicitated 3. 5 cause 4. Who should attend the delivery from SHP? Geriatrics 1. Reasons for decreased vision 2. Physical illnesses 3. Psychological illnesses 4. 2 remedies 5. Social rehabilitation centre MEQ Malaria Manure pit IEC Tap- figure Salk vs Sabin vaccine What is BCG? Role in TB program? Limitation Epidemiology and prevalence of RHD Epidemiological surveillance 1. Fever, cough 1 month a. 2 important history b. Inv TB program

c. Cat I d. If sputum +ve at 2 months then further management 2. You are the DHO of rangeli…committee plans to install Xray machine a. What mx technique you could apply? b. Describe graphically the steps you will take c. With is PERT and CPI 3. JE a. b. c. d. e.

DD of sudden fever with chills and rigors What other info is required for confirmation of its epidemic With ix to confirm it? 2 steps to confirm JE epidemins Vaccine

4. Function and staff of a health post HA, AHW, ANM, Mukhiya, VHW, Peon Sub HP AHW, ANM, MCHW, VHW How information is transferred from grass root to the center Objectives of TBA program