Professional Documents
Culture Documents
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Chapter 1
Evolution of Preventive Medicine
1. Who is the author of this famous quotation, "Since both in importance and in time,
health precedes disease, so we ought to consider first how health may be preserved,
and then how one may best cure disease".
a. Galen
b. Hippocrates
c. Atreya
Answer(a)
Galen(130-205 A.D.) the celebrated Roman physician was clearly ahead of his time. He believed that disease is
due to three factors: predisposing, exciting and environmental
3.
Ayurveda conceptualizes disease as being due to imbalance between three humors(tridosha) namely Vata
(wind), Pitta(bile) and Kapha(phlegm or mucous), whereas the hypothesis in Greek medicine was based on four
humors, ie, blood, phlegm. black bile and yellow bile.
9. Which military surgeon successfully evolved the principle of preventing noncommunicable disease with specific diet therapy?
a. Major Walter Reed
b. James Lind
c. Major Ronald Ross
d. Bruce
Answer(b)
James Lind(1716-1794), the British naval surgeon, based on his observations on sailors living on stored
preserved rations onboard ships successfully brought down the prevalence of scurvy among them by
mandatory issuance of one fresh lime per day to each sailor. British sailors thence became known as Limeys'.
Major Walter Reed is associated with discovery of yellow fever transmission with Aedes, Major Ronald Ross
with transmission of malaria by mosquito, and Bruce with African sleeping sickness transmission by Tse Tse
fly
Germany was the pioneer in bringing about social control of medicine and lead the way by introducing
compulsory sickness insurance in 1883. Other countries followed suit, e.g. England in 1911. France in 1928 and
so on. An excellent social and health insurance exists in India also in the form of Employees State Insurance (ESI)
enacted in 1948.
Chapter 2
Concepts of Health and Disease
1. Which of the following dimensions is not included in the WHO definition of health?
a. Physical well being
b. Occupational well being
c. Mental well being
d. Social well being
Answer(b)
WHO in the preamble to its constitution defines health as "Health is a state of complete physical. mental
and social well being and not merely an absence of disease or infirmity. In recent years, it has been
amplified to include spiritual well being and ability to lead a socially and economically productive life.
7. . Years of life lost to premature death and years lived with disability adjusted for
the severity of the disability' is known as:
a. HALE
b. DALYs
c. Sullivan's index
d. HDI
Answer(b)
DALYs is the measure of the burden of the disease in a population and the effectiveness of the interventions.
A health indicator in order to have scientific respectability should be valid, reliable, sensitive, specific,
feasible and relevant
Rewritten by Dr.AbdulQawi Al-Mohamadi
http://cutt.us/other_info
9. Scales used for assessing socio-economic status of populations are the following
except
a. Modified Udai Pareek scale
b. Modified Kuppuswamy scale
c. Likert scale
d. BG Prasad scale
Answer(c)
Likert scale is not related to assessment of socio-economic status(SES) and is designed to render scoring
criteria for responses during population based studies. BG Prasad scale takes into consideration mainly the
total income of the household. Modified Kuppuswamy scale takes into consideration education, occupation
and income, whereas Modified Udai Pareek scale assets into consideration in addition to all of the above,
household assets, land holding, caste, etc.
10. "The systematic study of the means by which biomedical and other relevant
knowledge is brought to bear on the health of individuals and communities under
given set of conditions' is the definition given to:
a. Biomedical research
b. Health systems research
c. Inter-sectorial research
d. Operations research
Answer b
Health systems research deals with all aspects of management of health services including prioritization of
health problems, planning, management, logistics and delivery of health care services as well as cost
benefit and cost effectiveness of health care systems and biomedical research.
Germ theory of disease. i.e. one-to-one relationship between causal agents(microbes) and disease held
ground throughout the and early part of the 20 century. It demolished supernatural theory of disease. The
modern concept of disease causation is" Web of Causation" suggested by McMahon and Pugg. It largely
dwells on the multi-factorial causation as well as the well-known 'epidemiological triad of disease' being the
result of interplay of agent, host and environmental factors.
13. "Course of a disease process without any intervention' is the definition of:
a. Spectrum of disease
b. Epidemiology of disease
c. Natural history of disease
d. Icebergs phenomenon
Answer(c)
Each disease has its own unique natural history in individuals which is not necessarily same in all the
individuals. On the other hand, spectrum of disease and iceberg phenomenon are related to behavior of the
disease in the community.
14. In the natural history of disease, the" pathogenesis phase' is deemed to start upon:
a. Entry of the disease agent in the human host
b. Interaction between agent, host and environ- mental factors
c. Appearance of signs and symptoms
d. Appearance of complications
Answer(a)
customarily, natural history of disease is described to have two phases, ie. Prepathogenesis and
pathogenesis. Prepathogenesis phase is interaction between agent, host and environment, the agent yet to
gain entry into the human body. All other states listed above are related to period of pathogenesis. This
understanding of natural history in relation to each disease is the key to plan interventions.
15. The term "disease control' employs" all of the following except:
a. Reducing the complications
b. Reducing the risk of further transmission
c. Reducing the incidence of disease
d. Reducing the prevalence of the disease
Answer(d)
In disease control, the agent continues to persist in the community though below the critical level where it
ceases to be a public health problem. A state of equilibrium is established between the disease agent, host
and environment so that new cases cease to occur. Most control activities focus on primary or secondary
prevention or both. As opposed to this, the term' eradication' is used to describe termination of all
transmission of infection by extermination of the infectious agent(tear out by roots The term eradication is
generally reserved to describe cessation of infection and disease from the entire world. As compared to
eradication, the term disease elimination' is used to describe interruption of transmission of disease
generally from a region, e.g. elimination of measles, polio, guinea worm, etc. Regional elimination is
considered an important precursor of eradication.
b. Sentinel surveillance
c. Passive surveillance
d. Monitoring
Answer(a)
Active surveillance implies activities designed to aggressively look for cases of a disease in the community.
It thus reveals true pattern of morbidity, whereas in passive surveillance only those cases get counted which
report to the health facility with specific symptoms of that disease. Thus many cases will go unrecorded.
Sentinel surveillance on the other hand, is the best way to find out hidden cases. In this, all patients
reporting to a health facility(sentinel facility) get checked for a particular disease even if they have reported
for other morbidities.
20.
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23. Concept of Hospice' related to:
a. Euthanasia for terminally ill patients
b. Family health advisory service abandoned
c. An association running orphanages for children
d. special group of people helping the old and terminally ill patients
Answer(d)
"Hospice" is derived from French word "Hospitium-Hospes'. Essentially this concept revolves around
providing an ashram- like organization designed to care for the terminally ill. It is an approach which
focuses on the patient and family rather than the disease, and comfort and pain relief rather than on
treating illness or prolonging life.
24. Any restriction or lack of ability to perform an activity in the manner or within the
range considered normal for a human being called:
a. Impairment
b. Handicap
c. Disability
d. Disease
Answer(c)
'Disability' is the consequence of an impairment whereby the affected person may be unable to carry out
certain activities commensurate with his/her age, sex, etc. Impairment' is defined as any loss or
abnormality of psychological, physiological or anatomical structure or function. On the other hand, a
handicap is the disadvantage a person suffers so that he/she is not able to discharge his/her due role in the
society. "Disease refers to any departure from a healthy condition in an organism.
Answer(c)
The 10th revision of ICD came into effect in January 1993.
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Chapter 3
Epidemiology: Principles and Practice
1. Epidemiology is
a. Branch of medical science which treats epidemics
b. Science of the mass phenomenon of infectious diseases
c. Study of disease, any disease as a mass phenomenon
d. Study of distribution and determinants of disease frequency in masses
e. All of the above
Answer(e)
Epidemiology has been variously described by different authors ranging from Hippocrates to the present
day. However, comprehensive definition of the science of epidemiology has been rendered by John M. Last
in 1988 as, "the study of the distribution and determinants of the health related states or events in specified
populations and the application of this study to the control of health problems". It is no longer restricted to
communicable diseases but encompasses all health related phenomenon from genetic disorders to noncommunicable diseases, e.g. accidents.
3. The most effective tool for measuring incidence of a disease in a community is:
a. Case control study
b. Cohort study
c. Cross sectional study
d. Cross over study
Answer(b)
Cohort study is a longitudinal study in which the number of new cases of a particular disease under study
automatically gets counted as the study progresses.
6. In a stable situation:
a. Prevalence = Incidence x Duration
b. Incidence = Prevalence x Duration
c. Prevalence = Incidence x Duration
d. Incidence = Prevalence x Duration
Answer(a)
Prevalence(P) of a disease depends upon two factors: the incidence and duration of illness. Assuming that
in a population, incidence and duration are stable: the prevalence will be a product of incidence and
duration (P = I x D). Using the same equation, incidence and duration can also be determined as:
I = P/D
D = P/I
It should be noted that the longer the duration. the higher win be prevalence rate, e.g. in tuberculosis
where new cases the continue to occur in the background of old cases continuing to exist for a long time
virtually adding to the prevalence rate Conversely, the term "prevalence' is not used in the case of onetime events such as food poisoning, accidents, etc.
7. If a drug prevents mortality but does not affect cure, then which of the following
will be true:
a. Incidence will decrease
b. Incidence will increase
c. Prevalence will decrease
d. Prevalence will increase
Answer(d)
To understand the above situation, the example of anti-retroviral therapy(ART in case of AIDS can be
considered, wherein ART prolongs the life but docs not cure AIDS. hence the prevalence of AIDS continues to
increase.
9. Prevalence of a disease:
a. Can only be determined by a cohort study
b. Is the number of new cases in a defined population
c. Describes the balance between incidence, mortality and recovery
d. Is the best measure of in disease frequency a etiological studies
Answer(c)
10. At the end of year 2000, the population of a tribal district was 2,00,000 and number
of cases of tuberculosis were 800. At the end of the year 2001 the population was
2,10,000 and 200 new cases were detected and 12 cases had died. Based on this data,
all of the following rates can be calculated except
a. Prevalence
b. Incidence
c. Proportional mortality
d. Case fatality
Answer(c)
For calculating proportional mortality(in this case due to tuberculosis) total number of deaths because of
all causes' is essential as a denominator.
12. Study of time, place and person distribution of health related events is known as:
a. Descriptive epidemiology
b. Experimental epidemiology
c. Analytical epidemiology
d. Clinical epidemiology
Answer(a)
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Descriptive epidemiology is generally the first phase of epidemiological investigations. The aim is to
determine: who are the people affected(person distribution), where are they affected(place distribution),
when are they affected(time distribution). Once the time, place and person distribution have been defined,
the characteristics associated with presence or absence of disease in an individual can also be identified and
a hypothesis formulated.
13. The changes that occur in a disease frequency over many years is called:
a. Cyclic trend
b. Secular trend
c. Seasonal trend
d. All of the above
Answer(b)
The term' secular trend' implies changes in the occurrence of disease(progressive increase or decrease)
over a long period of time, generally several years or decades; e.g. communicable diseases have shown a
declining trend and non-communicable diseases have shown an increasing trend in developed countries.
other terms used regarding fluctuations in disease frequency are seasonal trend and cyclic trend. Seasonal
variations in disease occurrence may be related to environmental conditions, i e. temperature, humidity,
rainfall, overcrowding, life cycle of vectors, etc. Cyclic trends refer to some diseases, which occur in cycles
over short periods of time. Such cyclical occurrences are related to variations in herd immunity(buildup of
susceptible
15. Which not the true reason for cyclic trend of a disease?
a. Antigenic variation
b. Buildup of susceptible
c. Herd immunity variation
d. Environmental conditions
Answer(d)
21. Which of the following ls the most useful study design In a hospital setting?
a. Cohort
b. Case control
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c. Cross sectional
d. Longitudinal
Answer(b)
The case control studies have three essential features:
i. Both exposure and outcome(disease) have occurred before the start of study.
ii. The study proceeds backwards from effect to cause.
iii. It uses a control group to support or refute an inference.
All these conditions are readily met in a hospital setting. Therefore case control studies are readily feasible and
cost- effective in a hospital setting. However, quality of hospital records will determine the quality of case
control study.
22. All of the following are characteristics of a case control study except
a. Least risk to subjects
b. Rapid and cost-effective
c. Risk factors can be identified
d. Less prone to bias
Answer(d)
23. In relation to case control study, which of the following is not correct?
a. Many etiological/risk factors can be studied at the same time
b. Proceeds from effect to cause
c. Sequence of events is not known
d. Several possible outcomes can be studied
Answer(d)
Since the case control studies proceed backwards from effect to cause, the outcome(effect is already
established. Hence there is no possibility of cases with multiple outcomes being included in the study.
24. All of the following are advantages of case control studies except
a. Relative risk can be calculated
b. Odds ratio can be calculated
c. Useful in rare diseases
d. Quick results are obtained
Answer(a)
Since incidence rates are essential for calculation of relative risk, which are not provided by case control
studies as appropriate denominator, or population at risk is not available, relative risk cannot be calculated
with the help of case control studies. It can only be determined from a cohort study.
25. In a case control study of a suspected association between breast cancer and
contraceptive pill, all of the following are true statements except
a. The controls should exclude women known to be taking the pill at the time of the
survey
b. All the controls need to be healthy
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c. The attributable risk of breast cancer resulting from the pill may be directly
measured
d. The control should come from a population that has the same potential for the
breast cancer as the cases
Answer(c)
The attributable risk cannot be calculated with the help of a case control study as incidence rates among the
exposed and non-exposed persons cannot be calculated.
26. "Systematic error in the determination of the association between the exposure and
disease' is termed as:
a. Chance
b. Probability
c. Bias
d. Confounding
Answer(c)
28. In a case control study of smoking and lung cancer, which of the following can be a
possible conclusion
a. Smoking is a cause of lung cancer
b. Lung cancer is commoner in smokers than non- smokers
c. If smoking is stopped, the number of cases of lung cancer will decrease
d. Smoking is associated with lung cancer
Answer(d)
Since case control studies proceed backward from effect to cause. they mainly indicate statistical
association between exposure and occurrence of disease. Statistical association does not imply causation,
however, strength of this association can be measured by odds ratio.
29. The ratio between incidence of disease among exposed persons and incidence among
non-exposed persons is commonly known as:
a. Odds ratio
b. Relative risk
c. Attributable risk
d. Population attributable risk
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Answer(b)
Relative risk(also known as risk ratio) is an estimate of disease risk associated with an exposure to a risk
factor case control studies do not provide incidence rates from which relative risk can be calculated directly
as these is no denominator or population available. Relative risk, therefore. can be determined exactly only
from a cohort study.
30. "A group of people who share a common characteristic or experience within a
defined time period' is known as:
a. Cases
b. Controls
c. Cohort
d. None of the above
Answer(c)
A group of people born on the same day or same period of time form a 'birth cohort', persons exposed to a
common drug or infection within a specified period are called "exposure cohort and so on. Such cohorts
provide a valuable universe for selection of cases and controls to design a cohort study which is also known
as prospective study, incidence study, longitudinal study, forward looking study and so on.
35. A study began in 1975 in Bombay(now Mumbai) with a group of 10,000 adults who
were asked about their alcohol consumption. The occurrence of cancer was
analyzed among the same population for the period 1995-2000. This design of study
ls known as:
a. Case control study
b. Retrospective cohort study
c. Concurrent cohort study
d. Cross sectional study
Answer(c)
Cohort studies are long term studies entailing follow up of a group of people(cohort) over a period of time.
Common types of cohort studies are: prospective(concurrent) cohort studies, retrospective(historical)
cohort studies and a combination of retrospective and prospective cohort studies.
36. Which is the best measure for strength of association between exposure and
outcome of interest?
a. Relative risk
b. Attributable risk
c. Population attributable risk
d. Odds ratio
Answer(a)
Relative risk(RR) is a direct measure of the strength of association between suspected cause and effect,
therefore, it becomes important in etiological enquiries. RR 1 indicates nil association whereas RR 1
suggests positive association between exposure and disease under study, e.g. RR 22 indicates that incidence
of disease is 2 times higher in the exposed group as compared to unexposed. In other words, this represents
a 100% increase in the risk. It should, however, be noted that risk does not necessarily imply causal
association.
38. Which is the best measure for estimating impact of health interventions in general
population?
a. Relative risk
b. Attributable risk
c. Population attributable risk
d. All of the above
Answer(c)
Both attributable risk and PAR are good measures for the impact of specific interventions. However, PAR is
useful applying to general population as it provides an estimate of the amount by which the disease could be
reduced in that population if suspected factor was eliminated or modified because PAR is dependent on the
prevalence of the risk factor.
39. which of the following is a good measure of the severity of an acute disease?
a. Standardized mortality ratio
b. Cause-specific death rate
c. Case fatality rate
d. Age-specific death rate
Answer(c)
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Case fatality rate(CFR) is actually a ratio of the total number of deaths due to a particular disease to total
number of cases due to the same disease expressed as a percentage. The salient features of CFR are: It
represents the killing power of a disease and virulence of an agent. The time interval is not specified. It is
used in acute infectious diseases(e.g. dengue, cholera, food poisoning, etc.) but its usefulness in chronic
diseases is limited because of long and variable period from onset to death CFR may be variable for the same
disease in different epidemics of changes in agent, host, and environmental factors.
40. Number of deaths due to a particular cause(or In a specific age group) per 100(or
1000) total deaths' is known as:
a. Specific death rate
b. Proportional mortality rate
c. Case fatality rate
d. Standardized mortality rate
Answer(b)
Proportional mortality rate(PMR) is usually computed for a broad disease group, e.g. communicable
diseases on the whole or for a specific disease of major public health importance, e.g. tuberculosis in
developing countries. Salient features of PMR(ratio) are: Used when population data are not available.
Since it depends on two variables, both of which may differ, it is of limited value in making comparisons
between population groups or different time periods. It does not indicate the risk of members of the
population contracting or dying of a particular disease. Since the prevailing causes of death may vary
according to age and sex, the proportional mortality should be calculated separately for each age and sex
group. It is especially useful in relation to preventable conditions.
42. Ideally suited measure for comparing health status of the populations is:
a. Standardized mortality rate
b. Proportional mortality rate
c. Specific death rate
d. Crude death rate
Answer(a)
Rates are comparable only if the concerned populations are comparable, which is difficult to obtain in real
life. Hence standardization or adjustment for variables likes age, sex, race, parity, etc., needs to be
carried out. This is known as age adjustment or age standardization and generates age-adjusted rates, sexadjusted rates and so on. As compared to above, crude death rate is not the correct yardstick because it
does not specify the age composition of the population. Similarly, it is not practicable to use a series of age
specific-death rates. Hence the answer is age adjustment or age standardization. There are two methods of
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standardizing the population: direct and indirect standardization. For both methods, the essential input is
choosing a standard population(and not the age structure of the population).
44. "Ratio of the total number of deaths that occur in the study group to the number of
deaths expected to occur if the same group had experienced the death rates of a
reference population' is known as:
a. Age-specific death rate
b. Proportional mortality rate
c. Standardized mortality ratio
d. Case fatality rate
Answer(c)
48. As compared to a routine case control study, nested case control study avoids
problems related to:
a. Confounding bias
b. Need for long follow up
c. Temporal association
d. Randomization
Answer(c)
A nested case control study draws its cases and controls from a cohort population that has been followed
for a period of time. Its salient features are:
It is carried out when it is either too costly or not feasible to perform analysis on the entire cohort.
It can utilize the exposure data originally collected before the onset of the disease, thus reducing
the risk of recall bias and ambiguity.
It includes cases and controls drawn from the same cohort study thus decreasing the chances of
selection bias.
It is considered a strong observational study; comparable to its parent cohort study in the likelihood
of an unbiased association between an exposure and an outcome.
49. All of the following features are true about cross sectional study except
a. Follow up is not a necessary feature
b. Cause and effect relationship can be established
c. All cases are seen at one point in time
d. More useful for chronic diseases
Answer(b)
Cross sectional study is the simplest form of an observational study and includes one-time observation of the
population for the presence or absence of a disorder or specific factor. As time sequence, which is essential
for establishing the concept of causatively is not there in cross sectional studies, a causal association cannot
be deduced with the help of cross sectional studies.
51. All are true for randomized controlled trial (RCT) except:
a. Bias may arise during evaluation
b. The groups should be representative of the population
c. Both study and control group should be comparable
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53. The number of patients required in a clinical trial to treat a specific disease
increases as:
a. The incidence of the disease decreases
b. The size of the expected treatment effect increases
c. The drop-out rate increases
d. The significance level increases
Answer(c)
55. All of the following are characteristics of cross over studies Except
a. All subjects receive the new therapy
b. Not suitable if therapy of interest cures the disease
c. Ideally suitable if disease changes radically during the study only
d. Not suitable if therapy of interest is effective during a certain stage of disease
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Answer(c)
56. studies have limitations as listed in the question. Which of the following is not true
in a non-randomized trial?
a. Approach is crude
b. The experiment can serve as its own control or can utilize a natural control
c. Degree of comparability is high
d. Several trials needed before evaluation is considered conclusive
Answer(c)
Although the experimental studies or randomized control trials are ideal and almost always to be preferred,
it is not always possible to use it in human beings due to administrative, ethical or other reasons, e.g.
smoking and lung cancer have never been experimented directly on human beings. In such situations nonrandomized non-experimental trials are resorted to, in which case effects of preventive interventions on
community basis(community trials of water fluoridation) can be studied. Further, when disease frequency
is low and natural history is long(cancer cervix), RCT will be impracticable, as it will require follow up of
thousands of cases for a decade or more. However, non randomized studies have intrinsic disadvantages,
as the degree o comparability will be low and chances of spurious results higher due to non-randomization.
Some common examples of non- randomized trials are proving validity of Pap test for cervical cancer, John
Snow's famous community diagnosis of cholera related to a certain well and before and after comparison
study in Australia regarding significant difference in the motor accident deaths before and after compulsory
introduction of seat belts.
assumed to have occurred. Similarly, correlation does not measure risk. It may be said that causation
implies correlation but correlation does not imply causation
59. All of the following put together contribute to a probability of the association being
causal except
a. Temporal association
b. Biological plausibility
c. Strength of the association
d. Predictive value
e. Consistency of the association
Answer(d)
All of the above except predictive value are considered additional criteria for judging causality when
controlled experimental evidence is absent. Temporal association centres around the question whether the
suspected cause preceded the observed effect, ie. the exposure to the suspected cause must take place
before the occurrence of the effect. Strength of association relates firstly to relative risk(it should be large),
secondly, if there is a dose-response and/or duration-response relationship. The association is consistent if
the results are replicated when studied in different settings and/or by different methods. Biological
plausibility means the association agrees with the current understanding of physiology and the response of
cells/tissues/ organs systems to stimuli. The other criteria useful when considered with the above include
specificity of the association and coherence of the association.
61. 61. "A clinically manifest disease of man or animal resulting from an infection' is
called:
a. Infectious disease
b. Contagious disease
c. iatrogenic disease
d. Nosocomial disease
Answer(a)
Contagious disease is the one which is transmitted through contact. e.g. scabies, sexually transmitted
diseases(STDs), trachoma. etc. Communicable disease is an illness due to a specific infectious agent or its
toxic products capable of being directly or indirectly transmitted from man to man, animal to man, man to
animal or animal to animal or from environment to man or animal. Infectious disease and communicable
disease are both generic terms used interchangeably. The term "nosocomial disease' is restricted to
consequence of hospital acquired infection, whereas iatrogenic(physician induced) disease connotates any
untoward or adverse consequence of preventive/diagnostic/therapeutic procedure
63. Infection maintained in both man and lower vertebrate animals that can be
transmitted in either direction is:
a. Amphixenoses
b. Zooanthroponose
c. Anthropozoonoses
d. Epornithic
Answer(a)
a generic All of the above are examples of zoonoses which is term defined as "an infection or infectious
disease transmissible from vertebrate animals to man under natural conditions'. It may be enzootic(like
endemic in man) or epizootic(like epidemic in man). An outbreak of disease in a bird population is called
epornithic.
64. Keeping the frequency of illness within acceptable limits is best described as
a. Elimination
b. Eradication
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c. Control
d. Surveillance
e. Monitoring
Answer(c)
Surveillance is defined as "the continuous scrutiny of the factors that determine the occurrence and
distribution of disease'. Monitoring is the routine day-to-day activity for carrying out surveillance.
Surveillance is necessary for effective control of disease. The term 'elimination' is used to describe removal
of a disease from a large geographical area or state, e.g. measles; whereas the term 'eradication' is used
to describe termination of all transmission of infection by extermination of the infectious agent itself by
surveillance and control measures, e.g. smallpox.
65. "Host in which a parasite attains maturity or passes its sexual stage' is known as:
a. Definitive host
b. Intermediate host
c. Paratenic host
d. Incidental host
Answer(a)
67. 'Natural habitat in which organism metabolizes and replicates' is known as:
a. Reservoir
b. Source of infection
c. Carrier(d) Host
Answer(a)
The term reservoir and source are not always synonymous, e.g. in Hookworm infection reservoir is man but
the source of infection is the soil contaminated with Hookworm larva. Thus the term 'source' refers to the
immediate source of infection which may or may not be a part of the reservoir. Reservoir may be of three
types: human reservoir, animal reservoir and reservoir in non-living things.
c. Secondary case
d. None of the above
Answer(b)
The term 'index case' refers to the first case, which is identified by the investigator. It may not always be
the primary case. Secondary cases are those, which develop from contact with the primary case
69. All of the following are true about sub-clinical cases except
a. Responsible for immunity in adults to a variety of infections(b)
b. can be detected only by laboratory tests(c)
c. Host does not shed the infectious agent(d)
d. Play a significant role in maintaining endemicity (chain of infection) in the
community.
Answer(c)
cases, 'in-apparent' or
'covert' cases, The disease agent may multiply in the host but does not manifest itself by signs and
symptoms. These cases are equally important as sources of infection, hence maintain endemicity in an area
by constantly shedding disease agent on the other hand, some of cases harbour disease agent but do not
shed the same in the community. The disease agent lies dormant within the host and may not be detectable
in blood, tissues or other secretions. For such a situation. the term 'latent infection' is used.
72. Which of the following ls the essential criterion for defining a carrier state?
a. Presence of disease agent in the body
b. Absence of recognizable symptoms and signs of the disease
c. Shedding of the disease agent in the discharges or secretions
d. All of the above
Answer(d)
74. An agent with low pathogenicity and high infectivity would result in:
a. Clinical case
b. Carrier
c. Pandemic
d. Epidemic
Answer(b)
77. All of the following are modes of direct transmission of communicable disease
except
a. Droplet infection
b. Contact with soil
c. Transplacental
d. Droplet nuclei
Answer(d)
Droplet nuclei are a type of particles in the range of 1-1o um. These represent dried residues of droplets and
have a tendency to remain air-borne for long periods. Particles in the range of 1-5 um are liable to reach
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right up to alveoli of the lungs. These are thus indirect modes of transmission(air-borne transmission).
Diseases spread by droplet nuclei include tuberculosis, influenza, chickenpox, measles, etc.
78. All of the following diseases are transmissible by contact with soil except
a. Ancylostomiasis
b. Leptospirosis
c. Anthrax
d. Leishmaniasis
Answer(d)
Leishmaniasis is a vector-borne disease transmitted by the bite of Phleboromus spp.
79. Vertical transmission refers to a mode of transmission of disease agent by the agency of:
a. Placenta
b. Blood transfusion
c. Breast milk
d. All of the above
Answer(a)
Vertical transmission is a term exclusively used for Transplacental transmission, which is another form of
direct transmission, e.g. TORCH agents, human immunodeficiency virus(HIV). Even some of the non-living
disease agents can also be transmitted transplacentally, eg. thalidomide, diethyl stilbestrol. etc.
84. The time interval between receipt of infection by a host and maximal infectivity of
that host is:
a. Incubation period
b. Period of communicability
c. Generation time
d. Latent period
e. Serial interval
Answer(c)
the incubation period in general, generation time roughly matches period but these two terms are not
synonymous, Incubation period (clinical incubation period is defined as, "the time interval between invasion
by an infectious agent and appearance of the first sign or symptoms of the disease in question The term"
median incubation period' is used to define the time required for 50% of the cases to occur following
exposure. Period of communicability" refers to the time during which an infectious agent may be
transferred from infected man or animal to another man or animal directly or indirectly. This period may be
shorter than incubation period or prolonged beyond incubation period. "Latent period' is the term used in
relation to non-infectious diseases such as cancer, heart diseases. etc. as equivalent of incubation period.
The term 'serial interval' is applied in relation to outbreaks and describes "the gap in time between the onset
of primary case and secondary case'. It gives an indication of the incubation period during an outbreak of
the disease
85. The time between invasion of an infectious agent and detection of evidence of the
infectious agent by laboratory means' is known as:
a. Prepatent period
b. Incubation period
c. Generation time
d. Serial interval
Answer(a)
Prepatent period is generally shorter than clinical incubation period, e.g. IgM antibodies may become
detectable in many cases before appearance of clinical signs and symptoms.
Answer(c)
Secondary attack rate(SAR) is defined as, "the number of exposed persons developing the disease within the
range of incubation period following exposure to the primary case'. It is deduced from the formula: Number
of exposed persons developing the disease within one incubation period x 100 SARA Total number of exposed
susceptible contacts It may be noted that immune contacts are to be excluded from the denominator:
primary case is to be excluded both from numerator and denominator, e.g. in a family of eight including the
parents(immune), the grandparents(immune) and four children(susceptible), for a disease like measles, if
there is a primary case of measles followed by two secondary cases among the remaining children the SAR
will be 2/3, ie. 66.6%.
87. All of the following are used as proxy measures for incubation period except
a. Serial interval
b. Period of communicability
c. Latent period
d. Generation time
Answer(b)
88. Infants are protected against infectious diseases in first 3 months of life on account
of:
a. Antibodies and other factors in breast milk
b. Presence of foetal haemoglobin
c. Maternal antibodies transferred to the baby
d. All of the above
e. None of the above
Answer(d)
89. All of the following are true statements in relation to herd immunity except
a. It is affected by occurrence of clinical cases
b. It is not affected by occurrence of sub-clinical Cases
c. It is affected by the presence and distribution of alternative animal hosts
d. It refers to group protection beyond that afforded by the protection of immunized
individuals
Answer(b)
Herd immunity implies level of resistance of a community or a group of people(herd) to a particular
disease. It depends on three factors:
i. Occurrence of clinical and sub-clinical infections in the herd
ii. Immunization status of the herd
iii. Herd structure, which is never constant due to new births. deaths, migrations, etc. and
includes presence of hosts of other species like animals, insects as well as environmental and
social factors It may be noted that herd immunity does not protect the individual in case of
tetanus.
Primary response depends on the dose of antigen, to the extent that with a small dose
only IgM response may be elicited which is immediate. I response peaks in 7-10 days
but needs about 50 times the dose of antigen. An important outcome of the response
is development of immunological memory based on T The accelerated secondary
response on a subsequent antigenic stimulus(booster) is the result of this
immunological memory.
93. All of the following are characteristics of a secondary immune response' except
a. Antibody production is more abundant
b. Antibodies have greater capacity to bind with the antigen
c. Response lasts for a shorter period
d. Shorter latent period
Answer(c)
94. Which of the following statements is not true in relation to live vaccines?
a. Produce a long and durable immunity
b. Are more potent than killed vaccines because have the entire major and minor
antigenic components
c. Booster doses are required to maintain the level of immunity
d. Are more potent than killed vaccines as organisms can multiply in the host thus
resulting in greater antigenic dose
Answer(c)
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98. 98. After administration of live vaccine, immunoglobulins can be given after:
a. 1 week
b. 2 weeks
c. 8 weeks
d. 12 weeks
Answer(b)
Immunoglobulins should not be given within 2 weeks of administration of live vaccine as this may jeopardize
the immune response to the vaccine.
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100. Which of the following vaccines must be stored in the freezer compartment of the
refrigerator?
a. Oral polio
b. Measles
c. Both of the above
d. None of the above
Answer(c)
All vaccines as a general rule must be stored under the conditions recommended by the manufacturer. Polio
and measles are live vaccines which are thermo-labile and should be stored preferably at-20C. Vaccines
which must never be allowed to freeze but stored in the cold part of the refrigerator(4-8C) are typhoid,
DPT, DT, TT, BCG and diluents.
102. A-year-old child has not received primary immunization. Which of the following
is the best vaccination advice to such a child?
a. BCG, DPT1, OPV1, and DPT2, OPV2 after 4 weeks
b. BCG, DT1, OPV1, measles, Vitamin A
c. BCG, DPT1, OPV1, measles, HB1, Vitamin A
d. DTI, DT2 and booster after 1 year.
Answer(c)
As per Indian Academy of Pediatrics(LAP) guidelines, schedules have been suggested for unimmunized
children aged less than 5 years as apart from more than 5 years. The schedules take into consideration
possibility of faulty compliance on subsequent dosage. Hence measles/MMR vaccine can be given at the
first contact itself along with other vaccines. The suggested schedule for unimmunized child is as under:
The EPI was originally started by WHO in 1974 and was adopted by the Government of India in 1978. It
included only BCG, DPT and typhoid for children under 5 years of age. It did not include measles vaccine and
OPV was added in 1979. This programme continued up to 1987. EPI was supplanted by Universal
Immunization Programme(UIP) in 1985. The Government of India subsequently set up the Technology
mission on vaccination and immunization of vulnerable populations, specially children'. The UIP is current
till now and is integral part of Reproductive and Child Health(RCH) Programme since 1997. The
immunization activities in India are largely supported by UNICEF.
104. The funding agency for Global Alliance for Vaccine and Immunization(GAVI)
is:
a. UNICEF
b. WHO
c. Ford foundation
d. Bill and Melinda Gates foundation
Answer(d)
GAVI was set up in 1999 as an international coalition of multinational funding agencies, vaccine
manufactures, non government organizations(NGOs) and governments of 74 developing countries. The
activities are organized through a vaccine fund. Bill and Melinda Gates foundation and Rockefeller
foundation are the main funding agencies for GANI The GAVI India project has launched free hepatitis B
immunization in some urban slums and promotes safe injection practices and use of auto-disable syringes for
immunization as part of a countrywide initiative
105. For HIV positive infants, the immunization schedule recommended is:
a. No vaccine
b. Only killed vaccines
c. Normal schedule as per UlP
d. Killed and live vaccines without BCG
Answer(c)
WHO UNICEF categorizes HIV positive children for the purpose of immunization into symptomless and
symptomatic HIV infection. Normal UIP schedule is recommended for both categories except for BCG, which
is contraindicated in symptomatic HIV infection being dependent on cell-mediated immunity
106. Measles vaccine is prepared from which of the following viral strains?
a. Edmonston-Zagreb strain grown on human diploid cells
b. OKA strain grown on human diploid cells
c. Genetically engineered recombinant vaccine
d. Sabin strain grown in primary monkey kidney(PMK) cells
Answer(a)
Answer(b)
Ring vaccination immunization is an operational device for creating a virtual isolation of the infected person
with a barrier of immune persons in order to contain the infection locally. This method was successfully used
for eradication of smallpox. This method is also being applied in North America in measles control and
eradication.
110. Isolation is useful in preventing the spread of all of the following diseases except
a. Cholera
b. Diphtheria
c. Hepatitis A
d. Pneumonic plague
Answer(c)
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112. The process, which destroys all microbial life including spores' is known as:
a. Disinfection
b. Antisepsis
c. Deodorization
d. Sterilization
Answer(d)
"Antisepsis' relates to destruction or inhibition of microorganisms in living tissues, e.g. Savlon, Dettol,
chlorhexidine,etc. Deodorant is a substance which suppresses or neutralizes bad odours, e.g. lime,
bleaching powder. Detergents' are surface cleaning agents and act by lowering the surface tension there
breaking up the by fat covering of dirt, e.g. Disinfection' is the killing of infectious agents outside the body
by direct exposure to chemical or physical agents. The term is usually applied to inanimate objects or
surfaces, e.g. phenol, sunlight, cresol, hypochlorite solution, etc. Chemical disinfectants in small doses or
dilutions can also act as antiseptics.
114.
122. Which of the following is not a suitable agent for disinfection of faeces and urine?
a. 5% cresol
b. 1-2% formalin
c. 5% bleaching powder
d. 10% phenol A nou or
Answer b
124. Which of the following best describes the objective of an epidemic investigation?
a. To define the magnitude of the epidemic
b. To determine particular conditions and factors responsible
c. Identify the cause/source of infection
d. To make recommendations to prevent recurrence
e. All of the above
Answer(e)
125. First step in the sequence of actions for investigation of an epidemic is:
a. Confirmation of the existence of an epidemic
b. Defining the population at risk
c. Rapid search for all cases and their characteristics
d. Verification of diagnosis
Answer(d)
Verification of diagnosis is the first step in an epidemic investigation as it may happen, not infrequently,
that the so- called occurrence of an epidemic may be based on misinterpretation of signs and symptoms by
the lay public and or media. Once the diagnosis has been verified on the spot as quickly as possible, the
logical sequence of steps to be taken for investigation is as follows:
i.
ii.
iii.
iv.
v.
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Chapter 4
Screening for Disease
1. The active search for unrecognized disease or defect in apparently healthy people
using rapidly applied tests or procedures' is:
a. Case finding
b. Active surveillance
c. Screening
d. Monitoring
e. All of the above
Answer(c)
Screening is the fundamental disease prevention action. It is an effective device to uncover the hidden
portion of iceberg of disease' and thus forms the cornerstone for secondary prevention action, i e. 'early
diagnosis and treatment'. Screening has got a wider application than mere "case finding' as we are able
to detect disease very early in its natural history when clinical signs and symptoms may not be present.
2. Periodic health examinations differ from screening for disease in the following
respects:
a. Not capable of wide application
b. Relatively expensive
c. Require considerable physician time
d. All of the above
Answer(d)
3. The time interval between diagnosis by early detection and diagnosis by other
means is:
a. Serial interval
b. Lead time
c. Time lag.
d. Latent period
Answer(b)
Lead time is the advantage gained by screening. Therefore screening Programmes are useful for those
conditions where the time lag between the disease onset and final critical point for treatment to be
effective is sufficiently long.
d. Less expensive
Answer(b)
Screening tests are only arbitrary, less accurate, less expensive and do not form the basis for treatment
as a specific diagnostic test' will need to be performed to confirm the diagnosis suggested by a screening
test in order to start a specific treatment.
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