1. A 26 year old mother brought her male child aged 2 years and 6 months to the OPD.

The
boy weighs 9 kg at present. Answer the following questions.
a) Plot the weight in the growth chart (1 mark)
b) Interpret the growth chart. (1 mark)
c) Which pattern in the growth chart indicates earliest sign of PEM? (1 mark)
d) What is wasting and stunting? What does each indicate? (4 marks)
e) How will you manage the above child? (3 marks)

ANSWER

a) Plot the weight in the growth chart (1 mark)

b) Interpret the growth chart. (1 mark)
Underweight (below -2SD)
c) Which pattern in the growth chart indicates earliest sign of PEM? (1 mark)
Flattening of the curve
d) What is wasting and stunting? What does each indicate? (4 marks)
• Wasting is a child less than 70% of expected weight for height. It indicates
acute malnutrition
• Stunting is a child less than 90% of expected height for age. It indicates
chronic malnutrition.
e) How will you manage the above child? (3 marks)
• Investigations to rule out infections
• Treatment of any illness if present
• Nutritional supplement
• Advice on proper feeding
• Vaccination up to date
• Regular follow up
• Advice the mother regarding danger signs
2. Sudha, delivered a boy baby who weighs 2.8 kg by normal vaginal delivery. The baby was
normal and cried immediately after birth. Breast feeding was started within one hour of delivery.

Answer the following questions:

a. What are the vaccines you would like to administer to the baby?
Draw a table mentioning the dose, route of administration and site of administration of the
vaccines you would administer to the baby. (6 marks)
b. Classify the given vaccines (3 marks)
c. What is the importance of open vial policy? (1 mark)

ANSWER
a. What are the vaccines you would like to administer to the baby?
Draw a table mentioning the dose, route of administration and site of administration of the
vaccines you would administer to the baby. (6 marks)
Vaccine Dose Route Site
BCG 0.05 ml Intra dermal Left upper arm
OPV – Zero dose 2 drops Oral Oral
Hepatitis B birth dose 0.5 ml Intra muscular Antero-lateral side
of mid-thigh

b. Classify the given vaccines (3 marks)

BCG – live attenuated vaccine
OPV – live attenuated vaccine
HBV – recombinant vaccine
c. What is the importance of open vial policy? (1 mark)
Open vial policy allows reuse of partially used multi-dose vials of certain applicable vaccines
(PENTA, DPT, Td, HBV, OPV, IPV, PCV) up to 28 days thus reducing vaccine wastage.
 3. A pregnant woman is bitten by a stray dog on her left leg. There was bleeding
from the wound. Answer the following
Marks
1. How do you categorize this wound? 2
2. What first aid measures to be done for this category wound 2
3. Outline the steps of management of this case. 3
4. Write the Regimens available for rabies vaccine/IM schedule 3

ANSWER

Marks
1. Category III wound 2
2. Wash wound with soap in running tap water 2
Tetanus vaccination
3. If a pregnant woman is bitten by a rabid dog, it is advisable to give both active 3
and passive immunization, as Rabies vaccine is a killed vaccine and it can be
given safely during pregnancy.
Wound toilet with proper antiseptic measures should be done.
No suturing should be done before 24 hours.
4. Essen schedule- intra muscular 0-3-7-14-28 days 3
Zagreb schedule 0- 7-14-21 (two doses-zeroth day)

4. 1 1/2 years old boy brought by his mother to Anganwadi centre for immunization.
The boy weighs 6.5 kg at present. Answer the following

1. Mark and interpret the growth chart 2 marks

2. Which is the first indicator of PEM 2 marks

3. What is the criteria for severe acute 3 marks

malnutrition
4. Mention any two preventive measures for PEM 3 marks

ANSWER

1. Severly Underweight (below -3SD)

2. Under weight for age
3. Very low weight for height/length (Z-score below -3SD of the median WHO
child growth standards)
Mid upper arm circumference <11.5cm
 Or presence of nutritional edema

4. Health promotion like low cost weaning foods, Nutrition education,

Family planning, proper spacing of birth
Specific protection like immunization, Diet containing protein and
energy rich foods (Milk,eggs, fresh fruits), food fortification
Early diagnosis and treatment of infections and diarrhoea, deworming,
Development of supplementary feeding programmes
Rehabilitation like nutritional rehabilitation services, follow-up care

5. Varshini, a 3 year old child residing in keeladi village with complaints of cough &high fever
past three days & seizures for past 1/2 hour today was rushed to the PHC nearby. The
medical officer on examination observed stridor in the child. Answer the following

a) According to IMNCI, Classify the illness in this child and colour coding?(2.5
marks)

b) What is the next step to be taken by the medical officer in PHC?(2.5 marks)

c) Based on national immunization schedule(NIS), mention the PCV- Pneumococcal

conjugate vaccine schedule , route and site of administration?(5 marks)

ANSWER

a) According to IMNCI, Classify the illness in this child and colour coding?(2.5
marks)
Ans: severe or very severe pneumonia, Red/pink colour
b) What is the next step to be taken by the medical officer in PHC?(2.5 marks)
ANS: GIVE FIRST DOSE OF ANTIBIOTIC & REFER THE CHILD TO
HIGHER CENTRE
c) Based on national immunization schedule(NIS), mention the PCV- Pneumococcal
conjugate vaccine schedule , route and site of administration?(5 marks)
Ans: schedule - two primary dose at 6 th and 14th week followed by booster dose at
9th to 12th month of age
0.5 ml dose – intramuscular route – at anterolateral aspect of mid thigh
6. Raju a 4 year old boy from thenur was brought to primary health centre with complaints of
cough and fever past 4 days and did not resolve on local medications taken. On examination
by the doctor, she noticed chest indrawing and fast breathing but stridor is absent? Answer
the following
a) According to IMNCI, Classify the illness in this child and colour coding?(2)
b) When do you infer as fast breathing for this child? (1)
c) What are the danger signs that doctor should look for in this child?(2)
d) Name any three viral agents causing Acute respiratory infections (ARI) in
young children? (3)
e) Name any two vaccines recommended in children to reduce potential death
from pneumonia ? (2)

ANSWER

a) According to IMNCI, Classify the illness in this child and colour coding?(2)
Ans: pneumonia – yellow colour

b) When do you infer as fast breathing for this child? (1)

Ans: Respiratory rate > or = 40 breaths/min
c) What are the danger signs that doctor should look for in this child?(2)
Ans: consciousness state : lethargic/unconscious, convulsions, unable to feed,
stridor
d) Name any three viral agents causing Acute respiratory infections (ARI) in
young children? (3)
Ans: Respiratory syncytial virus , measles , adeno virus and rhino virus
e) Name any two vaccines recommended in children to reduce potential death
from pneumonia ? (2)
Ans: measles, haemophilus influenza B and PCV
7. Kayalvizhi, a 3 year old child came to PHC with complaints of loose stools for past 3 days .
on examination , the doctor observed the child looks irritable but when given water drinks
eagerly and skin pinch test in abdomen goes back slowly? Answer the following
a) According to IMNCI, Classify the illness in this child and colour coding?(2)
b) Mention the dosage and schedule of zinc tablet for this child? (1)
c) What should be the amount of ORS to be given during first 4 hours ?(1)
d) Mention the four rules for home treatment? (4)
e) How to make home made ORS ? (2)

ANSWER

a) According to IMNCI, Classify the illness in this child and colour coding?(2)
Ans: some dehydration – yellow colour
b) Mention the dosage and schedule of zinc tablet for this child? (1)
Ans: tab zinc – 1 tablet ( 20mg) – 14 days
c) What should be the amount of ORS to be given during first 4 hours ?(1)
Ans: 960-1200 ml
d) Mention the four rules for home treatment? (4)
i) Give extra fluids
ii) Give zinc tablet
iii) Continue feeding (EXCLUSIVE BREAST FEEDING if less than 6
months)
iv) When to return
e) How to make home made ORS ? (2)
Ans: Mix 1 tea spoon of salt and 6 tea spoon of sugar in one litre of water

8. A 45 days old female baby brought by her mother to PHC with complaints of fever,
vomiting, diarrhoea for the past 2 days. On examination, the baby looks drowsy and
had dry tongue, sunken anterior fontanelle. Skin pinch retracts very slowly(> 2
seconds). Answer the following

1. How do you classify this dehydration? Most probable cause of dehyaration 3 marks
in this baby?
 2. Mention the name of the vaccines available for this condition 2 mark
3.Write the recommended schedule, dose and route of vaccine as per 3
universal immunization program?
4.Write the complication associated with this vaccine if the first dose 2
given to infants aged >12 weeks?

Answers Marks
1. Severe dehydration, Rota virus infection 3
2. Rotarix, RotaTeq 2
3.Live attenuated oral vaccine given at ages of 6, 10, 14 weeks. 3
Dose- 5 drops,Oral
4. Intussusception 2

9. A CRMI performed a suturing for the lacerated wound of a Road Traffic accident patient, he
sutured the wound under local anaesthesia with lignocaine injection with sterile aseptic
precautions. Answer the following

a) How would you segregate the Biomedical wastes generated during the procedure? (5
marks)

b) What is the treatment and disposal options for

1) Soiled waste
2) Syringes and gloves
3) Waste sharps
4) Glass ware (4 marks)
c) Biomedical waste rule is prescribed by which ministry ? ( 1 mark

Answer key :

1) a) How would you segregate the Biomedical wastes generated during the procedure?
( 5 marks)
a) syringe – red , Needle – White , Glove –Red, blood stained cotton and gauze -
yellow ,broken vial –blue
b) What is the treatment and disposal options for

i. Soiled waste
ii. Syringes and gloves
iii. Waste sharps
 iv. Glass ware
b) soiled waste – incineration or plasma pyrolysis or deep burial,
syringes and gloves – autoclaving or microwaving followed by shredding
waste sharps—autoclaving or Dry heat sterilization followed by shredding
Glassware – disinfection or autoclaving or microwaving and sent for recycling

c) Biomedical waste rule is prescribed by which ministry ?

c) ministry of environment and forests.

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