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AIIMS MD/MS 2013 MAY QUESTION NO. 3 TO 17

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3. Ridley Jopling classification is based on
a) Clinical, bacteriological, immunological
b) Clinical, histopathological, epidemiological
c) Clinical, histopathological, bacteriological
d) Clinical, bacteriological, epidemiological

Ans: a 
RJ classification for Leprosy is based on Clinical (skin and nerve involvement), bacteriological (bacteriological/morphological index in skin and nasal smears) and immunological criteria (Lepromin test). 


4. Meningococcal meningitis is called hyper-endemic when incidence is- a) <2/100,000 b) 2-10/ 100,000 c) >10/100,000 d) >100/ 100,000

Ans: c 
WHO definition- 
In the African meningitis belt,  Epidemic - >100 cases/100 000 population/year 
Endemic countries High endemicity (hyperendemic)->10 cases/100 000 population/year Moderate endemicity-2–10 cases/100 000 population/year Low endemicity- <2 cases/100 000 population/year 
An outbreak outside the meningitis belt may be defined as a substantial increase in invasive meningococcal disease in a defined population above that which is expected by place and time. 

5. Meningococcal vaccine is given in- a) Male persons aged 65 year or above with Diabetes Mellitus b) Children aged 4-8 years c) Paramedical working in testing labs d) Adolescents 

Ans: c
Highly or moderately endemic countries
WHO recommends that countries with high (>10 cases/100 000 population/year) or intermediate endemic rates (2–10 cases/100 000 population/year) of invasive meningococcal disease and countries with frequent epidemics should introduce appropriate large- scale meningococcal vaccination programmes.
Low endemic countries
In countries where the disease occurs less frequently (<2 cases per 100 000 population/year), meningococcal vaccination is recommended for defined risk groups-
• Children and young adults residing in closed communities, e.g. boarding schools or military camp • Laboratory workers at risk of exposure to meningococci  • Travellers to high-endemic areas  • Individuals suffering from immunodeficiency, including asplenia, terminal complement deficiencies, or advanced HIV infection.
In Canada and the United States
Vaccines are recommended for 
• Routine administration to adolescents aged 11–18 years*  • Selective immunization of individuals aged 2–55 years who belong to certain high-risk groups (e.g. persons with asplenia or terminal complement deficiencies, advanced HIV infection, or laboratory personnel working with N. meningitidis).
*-In the United States it is also recommended that all previously vaccinated adolescents receive a booster dose of quadrivalent conjugate vaccine at 16 years of age.
Travel to Saudi Arabia
Vaccination is mandatory for all pilgrims ≥ 2 years to Mecca (Haj and Umra). It has to be administered 10 days before the trip and remains legally valid for 3 years 
Antibiotic Chemoprophylaxis
• Antibiotic chemoprophylaxis among close contacts of a patient with invasive meningococcal disease is recommended to prevent secondary cases.  • Antibiotic regimens for prophylaxis include rifampin, ciprofloxacin, and ceftriaxone. Ceftriaxone is recommended for pregnant women. • Chemoprophylaxis (preventive administration of antibiotics) for meningococcal meningitis has no place in travel medicine.  

6. If childhood blindness is assessed using blind school standards as compared to population survey standards, what will happen to prevalence of blindness?

a) Underestimated b) Overestimated c) Remain same d) None of them is used for evaluation

Ans: c
According to NAB (National Association for Blind), India Legal blindness is defined as visual acuity of not greater than 20/200 in the better eye with best correction or a visual field of less than 20 degrees. 
What does 20/200 means?
A person with normal visual acuity can see an object clearly, at 200 feet; a legally blind person must be 20 feet or closer to see the same object. Note: 20/200 feet is same as 6/60 meters 
According to NPCB, the criteria for blindness (Economic Blindness) is visual acuity of <6/60 in the better eye with best possible correction. 
Thus, since both the criteria are same, the prevalence will remain same. 
 
7. Under HBNC, Remuneration is not given to ASHA for?  a) Recording of birth weight b) Registration of birth c) Giving first dose of OPV and DPT d) Institutional delivery

Ans: d 
Under HBNC, the ASHA will be paid Rs. 250/- for the care of the mother and the new born. She will be conducting  • Six visits in case of institutional delivery (Days 3,7,14,21,28 and 42) and  • Seven visits in case of home delivery (Days 1,3,7,14,21,28 and 42) 
The payment will be made subject to- • Ensuring that birth weight is recorded in the Maternal and Child Protection card • Ensuring that the newborn is immunized with: BCG, first doses of DPT and OPV and entered in MCP card • Ensuring birth registration
• Both mother and newborn are safe until the 42nd day of delivery 
At central level, some incentives recommended are as below-
• JSY-Institutional Delivery (rural) LPS Rs.350 for ASHA & Rs.250 for ref transport; Urban Rs. 200 • Motivation for Tubectomy/Motivation for Vasectomy/NS-Rs.150/200 • Immunization Session – Rs. 150 • Organizing Village Health Nutrition Day Rs.150 • DOTS Rs.250 • Household toilet promotion Rs.75 • Detection, referral, confirmation and registration of Leprosy case/after complete treatment for PB Leprosy cases/after complete treatment for MB Leprosy cases- Rs. 100/200/400 


8. An ophthalmologist working in district hospital can do following surgical procedure most commonly?  a) Phaco-emulsification  b) DCR  c) Bilateral Lamellar Tarsus Rotation  d) Pars plana  vitrectomy 


Ans: a 
Under NPCB, training of ophthalmologists is done on multiple topics. Out of which the universal training which is done for ophthalmologists even at sub-district hospital and district hospital level is - • ECCE/IOL implantation • SICS (Small Incision Cataract Surgery)  • Phaco Emulsification 
Also, cataract is the most common ophthalmic surgery done in India at all levels. 
 
9. A disease has 80% prevalence in a population of 100 persons. What will be the range of prevalence that will be obtained with 95% probability (confidence interval) if the test is repeated? a) 60-100% b) 65-95% c) 70- 80% d) 72-88% 
Ans: d
The 95% confidence limits for a proportion are p ± 1.96 s.e.p, where s.e.p is the standard error of a proportion.
p = sample proportion =proportion of diseased persons=0.8
q=1-p=0.2
s.e.p =
Square root (pXq/ n)
=square root (0.8X0.2/100)
=square root (0.0016)
=0.04 
Now the range with 95% confidence interval limits will be
=0.8+/- 2(0.04)
=0.8 +/- 0.08
=0.72-0.88
=72-88% 

10. In a population, 50 % of the population is diseased. If the investigator wants to say with 95% confidence that 45-55% of the population is diseased, then what should be the minimum sample?
a) 100  b) 200  c) 300  d) 400

Ans: d
In this example also, we need to use Standard Error of proportions
The 95% confidence limits for a proportion are p ± 1.96 s.e.p, where s.e.p is the standard error of a proportion.
p = sample proportion =proportion of diseased persons=0.5
q=1-p=0.5
s.e.p = Square root (pXq/ n)
Now here, the range of proportions with 95% confidence is mentioned as-
45-55%
hence,
2 s.e.p = 0.55-0.50=0.05
s.e.p =0.025
Further,
0.025=square root (pXq/n)
0.025= square root (0.5X0.5/n)
0.025=square root (0.25/n)
0.025= 0.5/square root n
Therefore,
Square root of n= 0.5/0.025
Square root of n=20
N=400
Thus, the sample size required will be 400 

11. HPI includes all except
a) Probability at birth of not surviving till age 40 b) Child literacy rate c) % of population not using an improved water source d) % of children underweight for age
 

Ans: b Human poverty index- 

HPI-1 (for developing countries) a. Long and healthy life- Vulnerability to death at early age- probability at birth of not surviving to age 40 years b. Knowledge- Illiteracy- adult literacy rate c. Standard of living- % of population not using an improved water source  % of children underweight for age
 HPI-2 (developed Countries) 
a. Probability at birth of not surviving to age 60 b. % of adults lacking functional literacy skills c. % of population below income-poverty line d. Rate of long-term unemployment. 

12. Diseases under IDSP a/e
a. Snake bite   b. Upper RTI    c. Leptospirosis  d. Tuberculosis
 

Ans: b
Communicable Diseases under IDSP
For the purpose of surveillance under IDSP, the following diseases are to be reported under the P form. The list is as given below:
1. Acute Diarrheal Disease (including acute gastroenteritis)  2. Bacillary Dysentery 3. Viral Hepatitis 4. Enteric Fever 5. Malaria 6. Dengue/Dengue Hemorrhagic Fever (DHF)/ Dengue shock syndrome (DSS)  7. Chikungunya 8. Acute Encephalitis Syndrome (AES) 9. Meningitis 10. Measles 11. Diphtheria 12. Pertussis 13. Chicken Pox 14. Fever of unknown origin (PUO) 15. Acute Respiratory Infection (ARI)/Influenza Like illness (ILI) 16. Pneumonia 17. Leptospirosis 18. Acute Flaccid Paralysis < 15 years of age 19. Dog Bite 20. Snake Bite 21.Any other state specific disease (check with your district surveillance additional list of diseases) 22. Unusual syndrome (not being captured by any of the above) 

13. Number of MDG goals directly related to health are-
a. 3   b. 4   c. 5   d. 6


Ans: a The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world's main development challenges. It was adopted in 2000. 
In total there are 8 goals, 21 quantifiable targets and 60 indicators.
Out of these, 3 goals, 8 targets and 18 indicators are directly related to health.
Goal 1: Eradicate extreme poverty and hunger • Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day • Halve, between 1990 and 2015, the proportion of people who suffer from hunger Goal 2: Achieve universal primary education • Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Goal 3: Promote gender equality and empower women • Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 Goal 4: Reduce child mortality • Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Goal 5: Improve maternal health • Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio • Achieve, by 2015, universal access to reproductive health Goal 6: Combat HIV/AIDS, malaria and other diseases • Have halted by 2015 and begun to reverse the spread of HIV/AIDS • Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it • Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases (tuberculosis) Goal 7: Ensure environmental sustainability • Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Goal 8: Develop a Global Partnership for Development • In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries 
 
14. About deworming under national child health program true are all except
a. It is done for all pre school and school children yearly b. Albendazole 400mg for>2 years c. Mebendazole 100mg for>1year d. It is linked with Vitamin A supplementation program


Ans: c 
The Government of India has come with following guidelines for deworming of children Category Prevalence* Action for deworming High More than 70%  Preschool and school-age children 2-3 times each year
Moderate 50-70% Preschool and school-age children at least once each year
Low Less than 50% Only symptomatic individuals (i.e. those who pass worms in their stools)
*- Refers to percentage of children with any one of the three STH infections (Ascariasis, Trichuriasis or hookworm infection) 
Drugs and their dosages for routine deworming in children- Drug Doses by age Below 1 year 1 -2 years 2 years upwards
Albendazole (400 mg tablets)
Not to be given  (Safety not established)
Half tablet One tablet
Mebendazole (500 mg tablets)
Not to be given  (Safety not established)
One tablet One tablet 
Deworming should be linked with Vitamin A prophylaxis program for children between the ages of 13-59 months 
15. Number of primary vision centers according to Vision 2020
a. 100,000    b. 20,000    c. 40,000   d. 30,000

Ans: b 

16. 3 year bachelor para-medical course for rural health service was given by
a. Sundar committee    b. Srivastava committe c. High level expert group of universal health program for India     d. Central bureau of health intelligence


Ans: c It was proposed by Ministry of Health and family welfare and received backing of Planning Commission of India’s HLEG on UHC 
17. If the confidence interval is increased, what will happen?
a) Previously significant values would become insignificant b) Previously insignificant values will become significant c) No change d) Cannot be commented on the basis of information provided
Centres of excellence - 20   

 
Training centre- 200 Tertiary eye care including retinal surgery, corneal transplantation, glaucoma surgery, training and CME    
 
Service centres 2000 2 ophthalmic surgeons & 8 ophthalmic paramedics-Cataract surgery, other common eye surgeries, facilities for refraction, referral services    
 
Vision centres  20,000 1 per 50,000 populations,1 Ophthalmic assistant Primary eye care, refraction and prescription of glasses, school eye screening programme, screening and referral SERVICES
Ans: b Confidence interval gives the range of the values. When we are using 95% confidence intervals, it means that we are 95% confident that the values in the range are significant. Beyond the range are insignificant. Thus, when we increase the confidence interval range, the insignificant also becomes significant. 
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AIIMS MD/MS MAY 2013 QUESTION NO. 2

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Amount of vitamin A given to mother postpartum (in IU) 
a) 50, 000
b) 1Lakh
c) 1.5 lakh
d) 2 Lakh


AIIMS MD/MS MAY 2013 QUESTIONS 1.

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1. Type of growth chart used by Anganwadi workers (ICDS) for growth monitoring -
a) NCHS
b) CDC
c) IAP
d) MGRS


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