OSPE

Dr.Vinoth
Third Year PG
Department of Community Medicine
 1.Carefully observe the given photograph and answer the following
questions:

QUESTIONS:
1. Identify the disease.
2. Name the causative organism of the disease.
3. Name any one common complication of this disease.
4. What is the ideal age for vaccination of children for this
disease?
ANSWERS:

1. Chickenpox (Varicella).

2. Varicella Zoster virus (Human alpha herpes virus 3).

3. Hemorrhages, pneumonia, encephalitis, acute cerebellar ataxia, Reye’s

syndrome.

4. One year.
2. Carefully observe the given photograph and answer the
following questions:

QUESTIONS:

1. Name the pattern of fever shown.

2. Identify the disease with this pattern of fever.

3. Mention the drug of choice for the treatment of this fever.

4. Name any one common complication of this disease.

ANSWERS:

1. Step ladder pattern.

2. Typhoid fever (Enteric fever).

3. Fluoroquinolones/Cephalosporins.

4. Intestinal perforation, pneumonia, thrombophlebitis, myocarditis

3. Carefully observe the given photograph and answer the following
questions:

QUESTIONS:

1. Identify the spotter.

2. Name the drugs included.

3. How long is the duration of treatment?

ANSWERS:

1. Fixed dose combination - Treatment for drug-susceptible Tuberculosis.

2. There are two types of Adult FDCs available under NTEP,

• For Intensive Phase: 4 FDC (H 75, R 150, Z 400, E 275)

• For Continuation Phase: 3 FDC (H 75, R 150, E 275)

• 3. 6 months.
4. Carefully observe the given photograph and answer the following
questions:

QUESTIONS:

1. Name the disease with this test positive.

2. Mention the disease-causing agent.

3. Name the vector transmitting the disease.

4. Name the mainstay of treatment for this disease.

ANSWERS:

1. Dengue hemorrhagic fever.

2. Flavivirus (DENV-1,2 and 3).

3. Female Aedes mosquito.

4. Fluid replacement / Platelet transfusion.

5. Carefully observe the given photograph and answer the following
questions:

QUESTIONS:

1. Identify the disease.

2. Mention the causative organism for this disease.

3. Name the arthropod transmitting the disease.

4. Name the drug of choice for treating this disease.

ANSWERS:

1. Scrub typhus.

2. Rickettsia tsutsugamushi.

3. Trombiculid mite (Leptotrombidium delinse and L. akamushi).

4. Doxycycline / Tetracycline.
6. Mr. Ashok is a company executive. His height is 160 cm and his weight is 80 kg. He
is conscious of his physical fitness.

QUESTIONS:

1. Calculate BMI (Body Mass Index) for Mr. Ashok.

2. Write down the WHO Asian classification.

3. Interpret the results (based on WHO Asian classification)

ANSWERS:
1. BMI = Weight in Kgs / Height in Meters Square
= 80 / (1.60 x 1.60)
= 80 / 2.56 = 31.25 kg/m2
2. Obese class II

3. Nutritional status BMI (kg/m2)

Underweight <18.5
Normal range 18.5-22.9
Overweight 23-24.9
Obese I 25-29.9
Obese II >30
7. A 40-year-old male came to medical OPD with H/O frequent diarrhea for the last 3
weeks. O/E: He has bilateral symmetrical dermatitis on his exposed body surface. His
dietary habits revealed that he was dependent on cereals for a long time.

QUESTIONS:
1. What is the most likely diagnosis?
2. Which vitamin is most likely deficient?
3. How this nutritional deficiency disorder can be prevented in the community?
Answers:
1. Pellagra.

2. Vitamin B3 (Niacin or nicotinic acid).

3. Prevention of pellagra:

- Avoidance of total dependence on maize or sorghum

- Intake of a good balanced diet containing milk or meat is essential

8. Carefully observe the given photograph and answer the following questions:

QUESTIONS:

1. What is this condition?

2. How much of the mineral is permissible for daily intake?

3. What interventions can be taken to reduce the problem?

Answers:
1. Dental Fluorosis.

2. 3-4 mg/day.

3. Interventions:

a. Changing the water source with lower fluoride content (0.5 to 0.8mg/dl).

b. Water can be chemically defluorinated in water treatment plants.

9. Carefully observe the given photograph and answer the following
questions:

QUESTIONS:

1.What is the major vitamin in this food?

2.What is the RDA of the vitamin in adults?

3.Write the Ocular manifestations in the deficiency of this

vitamin.
Answers:
1. Vitamin A.
2. Men - 900 mcg/day and Women - 700 mcg/day.
3. Ocular manifestations:
i. Night blindness
ii. Conjunctival xerosis
iii. Bitot’s spots
iv. Corneal xerosis
v. Keratomalacia
10. Carefully observe the given photograph and answer the
following questions:

QUESTIONS:

1. Mention the name of the disease.

2. What are the complications of the above condition?

3. How would you prevent the condition in children?

Answers:
1. Rickets (Vitamin D deficiency).

2.Complications may include bone fractures, muscle spasms, an abnormally curved spine, or
intellectual disability.

3. Prevention:

a. Education of parents to expose their children regularly to sunshine.

b. Vitamin D fortification of food especially milk.

c. Vitamin D Supplementation.
11. Carefully observe the given photograph and answer the
following questions:

QUESTIONS:

1. Write the daily requirement of iodine for adults.

2. Mention the level of iodization fixed under FSSI act at

consumer level and production level.

3. Name few Iodine deficiency disorders.

ANSWERS:

1. The daily requirement of iodine for adults: 150 micrograms.

2. 15 ppm at consumer level and 30 ppm at production point.

3. Cretinism, Goitre, Hypothyroidism / Hyperthyroidism.

12. Mrs. Malar, 25-year old reports at rural health centre CHRI, Poonjeri with bilateral
pedal oedema and blood pressure of 150/94 mm of Hg at the gestational age of 34 weeks.

QUESTIONS:

1. What is this condition called?

2. What are the risks to the baby & mother?

3. What is the drug of choice for gestational hypertension?

ANSWERS:

1. Pre-eclampsia.

2. Risks for baby: Low birth weight, death.

• Risks for mother: Eclampsia, maternal death.

3. Hydralazine, labetalol and nifedipine are the recommended first-line treatments for
severe hypertension in pregnancy.
 13. Carefully observe the given graph and answer the following
questions:
Developing Country Developed Country

QUESTIONS:

1. What is the diagrammatic illustration given above?

2. Enlist the features of this diagram for developing and

developed country.

3. Interpret the findings of this figure.

Answers:
1.Age Pyramid and its features.

2. Developing country: Broad base with a tapering top.

• Developed country: Bulge in the middle with a narrow base.

3. Developing country has high birth rate & high death rate where as in the developed
country both are low. Hence, the percentage of younger population will be more in
developing country and elderly population will be more in developed country.
14. Mrs. Kamala, 24/F, Primi has been admitted with labour pain. She gave
birth to a live female term baby. The baby cried soon after birth (Weight: 2.7
kgs).

QUESTIONS:

1. Comment on the birth weight of the baby.

2. Write the four immediate measures to be done for caring a normal newborn baby.
Answers:
1. Birth weight is normal (>2.5 kgs).

2. Immediate measures to be done for caring a normal newborn baby:

I. Clearing of airway (0.25)

ii. Maintenance of body temperature (0.25)

iii. Avoidance of infection (0.25)

iv. Establishment of satisfactory feeding regimen (0.25)

15. An 18-month-old girl, brought to the hospital by her mother who had
eight watery stools in the previous 12 hours. There is no blood in the
stool, has no fever and the baby is alert. She is eating poorly but drinks
eagerly. Her eyes look sunken, but capillary return is normal. The
patient health record indicates she has lost 5% of body weight.

QUESTIONS:

1. What is your diagnosis?

2. How will you manage this case?

3. What is the osmolarity and composition of ORS?

Answers:
1. Acute Diarrheal Disease with mild dehydration.

2. Continue usual diet. Give plenty of home available fluid. Give Oral rehydration salt
solution (ORS).
3. Reduced
ORS
osmolarity
grams/litre
Reduced
ORS
osmolarity
mmol/litre

Sodium chloride 2.6 Sodium 75

Glucose, anhydrous 13.5 Chloride 65

Potassium chloride 1.5 Glucose, anhydrous 75

Trisodium citrate,
dihydrate 2.9 Potassium 20

Citrate 10
Total Osmolarity 245
16. Mid-day meal program was implemented in a primary school consisting
of 120 children. 12 to 24 hours after eating the meal, many children had
fever, nausea, vomiting and watery diarrhoea. The meal menu consisted of
rice, sambar and boiled eggs, some of which smelt and tasted differently.

QUESTIONS:

1. What is your diagnosis?

2. What is the agent factor?

3. How will you confirm your diagnosis?

4. What is the type of epidemic?

Answers:
1. Food poisoning.
2. Salmonella.
3. Stool culture.
4. Common source single exposure epidemic.
17. 11-months old child Ramu was brought to the PHC with a history of cough
and cold for the past 4 days. On examination, the respiratory rate was 56/min.
There was no chest indrawing or wheeze or stridor or cyanosis.

QUESTIONS:

1. What is your diagnosis?

2. Name two commonest organisms which cause this disease.

3. What is the drug (antibiotic) used to treat this disease under IMNCI?
Answers:
1.Acute respiratory infection.
2. Commonest organisms:
a) Pneumonia
b) Haemophilus influenza
c) Streptococcus pneumoniae
3. Cotrimoxazole.
18. In a rural area near Kanchipuram it’s found that there was a high
prevalence of microcytic hypochromic anaemia among the farmers. Most
of them had Hb levels less than 9 mg% and had common complaints of
abdomen pain.

QUESTIONS:

1. What can be the most likely cause of the problem?

2. Write two preventive measures.

Answers:

1. Hook worm infestation.

2. Sanitary disposal of human excreta to prevent or reduce faecal contamination of

soil, Provision of safe drinking water, Food hygiene habits, Health education of the
community in the use of sanitary latrines, personal hygiene, changing behavioural
patterns and wearing protective footwear.
19. 20-year old Mr. Ramu came to the skin out-patient clinic with H/O hypo
pigmented patches over his body. O/E: There were 8 hypo-pigmented patches over the
body and there was thickening of lateral popliteal nerve and ulnar nerve. Skin smear
from patches shows acid fast bacilli.

QUESTIONS:

1. What is your diagnosis?

2. What is the duration of treatment?

3. Write the multi-drug therapy (MDT) for this disease.

Answers:

1. Multi bacillary leprosy.

2. 12 months.

3. a) Rifampicin: 600mg once monthly

b) Dapsone: 100mg daily

c) Clofazimine: 300mg once monthly

d) Clofazimine: 50mg daily

20. 25-year old Mrs. Kamala came to the skin outpatient clinic with H/O hypo-
pigmented patches over her body. O/E: There were 4 hypo-pigmented patches
over the body and there was thickening of ulnar nerve. Skin smear from
patches shows negative for acid fast bacilli.

QUESTIONS:

1. What is your diagnosis?

2. What is the duration of treatment?

3. Write the multi-drug therapy (MDT) for this disease.

Answers:

1. Pauci bacillary leprosy.

2. 6 months.

3. a) Rifampicin: 600mg once monthly

b) Dapsone: 100mg daily

21. Mr. Ashok, a businessman is traveling from India to South Africa for
the first time on his business trip and will be returning after three weeks.

QUESTIONS:

1. What vaccine do you recommend?

2. What is the type of vaccine?

3. What is the recommended dosage and site of administration for it?

4. What is the recommended regimen?

Answers:

1. Yellow fever vaccine.

2. Live attenuated vaccine.

3. 0.5 ml subcutaneous single dose.

4. Yellow fever vaccine must be taken 10 days before travelling to yellow

fever endemic areas.
22.Carefully observe the given graph and answer the following
questions:

QUESTIONS:

1.Identify and describe the diagram.

2.Name three diseases transmitted by
faeco-oral route
Answers:

1. Sanitation barrier. It is the barrier that is created by sanitary latrines which

prevents the contact of human feces with flies, fingers, food and water, thus helps in
preventing faeco-oral diseases.

2. Typhoid, Cholera, Dysentery, Polio.

1. Sanitation barrier. It is the barrier that is created by sanitary latrines which
prevents the contact of human feces with flies, fingers, food and water, thus
helps in preventing faeco-oral diseases.

2. Typhoid, Cholera, Dysentery, Polio.

23. Carefully observe the given photograph and answer the following:

QUESTIONS:

1. Identify the diagram.

2. Describe scabies with the help of above diagram.
Answers:

1. Epidemiological triad.

2. Host: Man

Agent: Itch mite (Sarcoptis scabi)

Environment: Close contact, unhygienic conditions

 24. Weight-for-age BOYS
Birth to 5 years (percentiles

QUESTIONS:
1.What is the provided growth
pattern?
2. Mention 2 characteristics of the
growth pattern to support your
answer.
Answers:

1. Normal growth.

2. The growth curve indicates that the child's growth pattern is normal
starting from normal birth weight and by showing that the curve is going
between and parallel to the 5th and 95th percentile curves.
25. A 58-year-old man presented at a clinic with a long history of
haemoptysis. The diagnosis was advanced pulmonary tuberculosis.
Immediately after admission, the patient had an acute and massive
pulmonary haemorrhage and died 10 hours later. Write the patient's
cause of death, Approx interval between onset and death?
Answers:
a) Pulmonary haemorrhage – 10 hours

b) Advanced Pulmonary Tuberculosis

c) Nil
 26.

QUESTIONS:
1. What do you see in this image?
2. What are its types?
3. Where it is used and why?
4. Give inference on the given image.
Answers:

1. The above image shows Vaccine vial monitor.

2.There are four different types of VVMs for different vaccines depending on
their heat stability. VVM 30, VVM14, VVM 7 and VVM2.

3. VVMs are small indicators that adhere to vaccine vials and change colour as
the vaccine is exposed to cumulative heat, letting health workers know whether
the vaccine has exceeded a pre-set limit beyond which the vaccine should not be
used.

4. A & B can be used whereas C & D should not be administered.

27.

QUESTIONS:

1.Mention 2 types of infections that could be transmitted in the

picture

2. Mention the Post Exposure Prophylaxis vaccination guidelines

3. Mention 2 specific preventive measures given to the boy post

Answers:
1. Rabies/tetanus.
2. Days - 0, 3, 7, 14 and 28 (Essen regimen - IM).
3. • Extensive washing and local treatment of the bite wound or scratch as
soon as possible after a suspected exposure.
• A course of potent and effective rabies vaccine that meets WHO standards
and the administration of rabies immunoglobulin (RIG).
28. Miss. Asha, a 22-year-old female, hailing from a hilly village in Himachal Pradesh, presented with
chief complaints of swelling in the anterior aspect of the neck. She reported developing a small
swelling that gradually increased to attain the present size. Now it is associated with difficulty in
breathing on bending the neck and difficulty in swallowing.

O/E: Inspection showed a swelling of size 16x12cms; moves up with deglutition and lower border of
swelling could be made out.

Palpation showed a soft globular swelling measuring 16x12cms with smooth surface was found
involving both lobes of the thyroid gland.

Investigation: Thyroid profile revealed a TSH level of 0.3 microunits/ml.

Clinical &X-ray

QUESTIONS:
1. Spot the diagnosis.
2. What is the cause?
3. Mention the preventive measures.
Answers:

1. Goitre is a swelling in the neck resulting from an enlarged thyroid gland.

2. Over 90% of goitre cases are caused by iodine deficiency.

3. Iodine RDA of adults:150mcg. Common salt is replaced with iodized salt.

Food fortification.
29. A 2-year-old boy was admitted with chief complaints of lag in his growth and development
in comparison to other children of same age and sex in the community.

O/E: The child was conscious but irritable, had puffy face, sparse hair, flag sign was present
and skin showed flaky paint dermatosis. He had severe pallor and bilateral pitting pedal
oedema. His height and weight were less than expected for his age. Abdomen palpation
revealed enlarged, soft and palpable liver.

On investigation, serum albumin level was less than normal.

QUESTIONS:

1. Give a diagnosis for the above condition.

2. Mention its types.

3. Write any two differentiating features based on its types.

Answers:
1 Protein energy malnutrition.
2. Kwashiorkor, Marasmus and Marasmic Kwashiorkor.
3.
Feature Kwashiorkor Marasmus
Aetiology • Due to protein deficiency • Due to protein and calorie deficiency
• Late weaning • Early and abruptly stopped weaning
• Acute illness, trauma, • Prolonged periods of starvation
infections or sepsis
• Repeated infection

Occuirence • Young children (6 months to • Infants are most affected

5 years)
• Mostly in developed countries, cities and
• Mostly in devel oping towns
countries, in rural areas

Appetite ■ High/Ieeder ■ Poor

Charges ir • Presence of oedema of • Oedema is absent
exlremities
• Shrinked stomach
physical • Bulging protruding slomach
• Ribs are prominent
• Ribs are not very prominent
appearance • Dry skin
■ Flaky skin
• Severe weight loss
• Mild.nil weight loss

Muscle wasting Mild/nil Severe

Liver Enlarged due to fatty liver Absence of fatty liver
Subcutaneous fat Present Absent
Prognosis Poor Good
Diet rich in proteins, carbohydrates, fat and other
Treatment High protein diet nutrients.
30. In an area, a medical practitioner was frequently getting cases with the
complaints of profuse, painless, watery stools followed by vomiting. The exact
reason for the above mentioned symptoms was unknown, hence a study was
conducted in that particular area. The result of the study was as follows.

QUESTIONS:

1. Identify the picture.

2. Mention the epidemiologist related with above scenario.

3. What is the infection based on the above mentioned symptoms and the
causative organism?
Answers:
1. Investigation of an epidemic using the spot map.

2. This outbreak, which killed 616 people, is best known for the physician John
Snow's study of its causes and his hypothesis that germ-contaminated water was the
source of infection.

3. Cholera is an infection of the small intestine by the bacterium: Vibrio cholerae.

 31. Master Kalyan was brought to the hospital by his mother with the
complaints of rashes all over the body & fever for the past 3 days. Rashes
initially started behind the ear & then it got spread to other areas.

Bluish white spot in the mucosa Rashes

behind the ears
QUESTIONS:
1. What is the diagnosis based on the
above findings and causative
organism?
2. How is it transmitted?
3. What is its pathognomonic feature?
Answers:
1. Measles is a highly contagious infectious disease caused by the measles virus.

2. Measles is an airborne disease which spreads easily through the coughs and sneezes of
infected people but it can also be spread through direct contact with mouth or nasal
secretions.

3. Small white spots known as Koplik's spots may form inside the mouth two or three days
after the start of symptoms.

4. Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and
pneumonia (6%). These occur in part due to measles-induced immunosuppression.
32. A 11-year-old girl was admitted with chief complaints of fever for past 10 days and
swelling of both parotid glands for past 7 days. Pain and stiffness on opening the mouth.

O/E: Bilateral swelling of parotid glands which is tender on palpation. Both eyes are
congested and watering. Hoarseness of voice present and temperature is 103°F. Tongue
coated and dry. Abdomen is distended and tender on deep palpation. Spleen is just
palpable. Liver is not palpable. She is not taking oral foods. Lungs - clear; Heart –
Normal; Pulse rate: 120/min volume and tension moderate.

QUESTIONS:
1. What is your diagnosis and mention
its causative organism?
2. How is it transmitted?
3. When does the symptoms resolve?
4. What are the common
Answers:
1. Mumps is a viral disease caused by the mumps virus.
2. The virus is transmitted by respiratory droplets or direct contact with an
infected person.
3. Symptoms typically occur 16 to 18 days after exposure and resolve after
7 to 10 days.
4. Complications may include orchitis, pancreatitis, meningo-encephalitis,
thyroiditis, neuritis, hepatitis and myocarditis.
33. A 42-year old male Mr.Kumar, driver by occupation, presented with chief complaints of
ulceration on the skin over the genitals which was painless. On taking a detailed history,
patient says he had sexual contact with multiple partners.
O/E: Ulcer was present on the shaft of the penis and its base was indurated. His investigation
showed positive VDRL test.

Clinical picture shows lesions on the genitals

QUESTIONS:
1. What is your interpretation on the above condition?
2. How is it transmitted?
3. Mention its signs and symptoms based on the
various stages.
Answers:
1. Syphilis is a sexually transmitted infection caused by the bacterium: Treponema
pallidum, subspecies pallidum.
2. Syphilis is most commonly spread through sexual activity. It may also be
transmitted from mother to baby during pregnancy or at birth, resulting in
congenital syphilis.
3. The primary stage classically presents with a single chancre (a firm, painless,
non-itchy skin ulceration usually between 1 cm and 2 cm in diameter) though there
may be multiple sores. In secondary syphilis, a diffuse rash occurs, which
frequently involves the palms of the hands and soles of the feet. There may also be
sores in the mouth or vagina. In latent syphilis, which can last for years, there are
few or no symptoms. In tertiary syphilis, there are gummas (soft, non-cancerous
growths), neurological problems, or heart symptoms.
34. Mr. Ramu, a 25-year-old male w h o belongs to socio-economic class 5
according to t h e m o d i f i e d Kuppusamy scale, presented to Derm O.P with the
chief complaints of itching in the wrist and between the fingers and it gets worse at
night O/E: Presence of burrows and rashes in the finger webs, wrists & feet.

Pictures showing burrows and rashes in finger webs and wrists

QUESTIONS:
1.What is your inference based on the above
scenario?
2. Mention its causative organism.
3. How will you prevent & treat this condition?
Answers:
1. Scabies.

2. It is a contagious skin infestation by the mite: Sarcoptes scabiei.

3. Scabies are prevented by avoiding direct skin-to-skin contact with an infested person
or with items such as clothing or bedding used by an infested person. Scabies treatment
usually is recommended for members of the same household, particularly for those who
have had prolonged skin-to-skin contact. Both oral and topical agents can be used.
Ivermectin, Permethrin cream 5% & Benzyl benzoate 25% can be used for treatment.
 35. A 67-year-old male, Mr. Kumar, who is a security worker in the shopping
mall, presented to O.P. with a H/O nonhealing ulcer in the foot for the past
one year. He is a known case of diabetes for 20 years and hypertensive for 8
years. O/E: An ulcer of size 18x14 cm on the left foot. Investigations: Fasting
sugar level: 350mg/dl, Postprandial sugar level: 470mg/dl

QUESTIONS:
1. What is your inference from the above-
given condition?
2. How will you treat this condition?
3. Mention the other complications of the
Answers:
1. Diabetic foot ulcer is a major complication of diabetes mellitus and probably
the major component of the diabetic foot.

2. Treatment of diabetic foot ulcers should include: Blood sugar control, removal
of dead tissue from the wound, wound dressings, and removing pressure from the
wound through techniques such as total contact casting and surgery in some cases
may improve outcomes.

3. Acute complications: Hyperosmolar hyperglycemic state, diabetic ketoacidosis.

Chronic complications: Diabetic retinopathy, nephropathy, neuropathy, CAD, and
CVA.
36. A 10-year-old male child, presented to OPD with C/O bleeding from the gum. He also has h/o generalized weakness for the past one week.
O/E: The child was malnourished.
The triangle-shaped area between the teeth shows bleeding and redness of the gums.

QUESTIONS:

1. Provide the diagnosis for the

above condition.

2. Mention the clinical features of

this disorder.
Answers:
1. Scurvy is a disease resulting from a lack of vitamin C (ascorbic acid).

2. Early symptoms of deficiency include weakness, feeling tired, and sore arms & legs.
Without treatment, it leads to decreased red blood cells, gum disease, changes to hair, and
bleeding from the skin may occur. As scurvy worsens there can be poor wound healing,
personality changes, and finally death from infection or bleeding.

3. Treatment is with vitamin C supplements taken by mouth. Improvement often begins in a

few days with complete recovery in a few weeks. Sources of vitamin C in the diet include
citrus fruit and a number of vegetables such as tomatoes, and red bell pepper.
37. A 16-year-old female patient, presented to OPD with C/O shortness of breath on
exertion along with weakness and easy fatiguability.
O/E: The palpable conjunctiva was pale in color and spooning of nails was seen.
Microscopic examination: Microcytic and hypochromic RBC’s Blood test: Hb - 6.8g/dl

QUESTIONS:

1. What is your impression of the

above condition?
2. What are the causes?
Answers:

1. Iron-deficiency anemia.

2. Iron deficiency anemia is caused by blood loss, insufficient dietary intake, or

poor absorption of iron from food.

3. Weekly, 1 Iron and Folic Acid tablet. Each tablet contains 60 mg elemental Iron +
500 mcg Folic Acid, sugar-coated and red-color.
38. A 35-year old male patient presented to OPD with the C/O fever, vomiting and
pain in the right side of the abdomen. He gave a H/O eating outside foods in the last 2
weeks.
O/E: Patient had yellowish discoloration of eye
Investigation: Serum bilirubin - 5.3mg/dl

QUESTIONS:

1. What is your inference on the given

condition?

2. How does it spread?

Answers:
1. The given condition Hepatitis A is an infectious disease of the liver caused by
Hepatovirus A.

2. It is usually spread by eating food or drinking water which is contaminated.

3. Improved sanitation, food safety, and immunization are the most effective ways to
combat hepatitis A.

The spread of hepatitis A can be reduced by:

• Adequate supplies of safe drinking water.

• Proper disposal of sewage within communities and

• Personal hygiene practices such as regular handwashing before meals and after going to
the bathroom.
39. A 28-year-old male came with the complaint of fever for the past 3 days. The fever
was high grade, intermittent, which was associated with chills and rigor.
O/E: Anaemia was present with enlargement of spleen (splenomegaly)

Blood smear of the patient

QUESTIONS:
1. Give the diagnosis for the above
condition.
2. What is the cause?
3. How will you treat this
Answers:
1. Malaria is a mosquito-borne infectious disease that affects humans and other animals.

2. It is caused by the Plasmodium parasite. The disease is most commonly spread by an infected
female Anopheles mosquito.

3.
 40. A 52-year-old male patient, Mr. Murugan came with chief complaints of breathlessness, chest
pain, and cough with hemoptysis for the past 5 months. Expectoration was purulent in the
beginning and changed to blood-stained sputum in the past 2 weeks.
Gives h/o evening rise of temperature, night sweats, loss of weight and loss of appetite. There is h/o
contact with tuberculosis cases at work place. He is a smoker for the past 20 years. O/E: Patient is thin
built and pale, trachea is shifted to the right, percussion note is impaired in the right infraclavicular
area and mammary area, Bronchial breath sounds are heard. Vocal resonance increased and crackles
were heard.
Investigations: Sputum smear is done

QUESTIONS:
1. What is the probable diagnosis of this patient and
causative organism?
2. What is seen in the sputum smear and what staining
method is this?
Answers:
1. Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium
tuberculosis (MTB) bacteria.
2. Conventional smear microscopy with the Ziehl-Neelsen (ZN) stain is a rapid and
practical method for detecting acid-fast bacilli (AFB).
3. Isoniazid (INH), Rifampin (RIF), Ethambutol (EMB), and Pyrazinamide (PZA)
are considered first-line anti-TB drugs.
4. The cartridge-based nucleic acid amplification test (CBNAAT) assay is a real-
time polymerase chain reaction (PCR) cartridge-based assay for the simultaneous
detection of Mycobacterium tuberculosis complex and rifampicin resistance from
biological specimen samples within two hours.
 41. A 30-year-old male from Kumbakonam, came to O.P. with the chief complaints of progressive
swelling in the left leg for the past one year. His socio-economic status is class 4, living in a kutcha
house, with a breeding place for mosquitoes around his house. He gives a past history of fever,
pain, tenderness, and erythema in the left leg, The episodes last for a few days but recur several
times in a year.
O/E: Nonpitting edema, enlarged regional lymph nodes. Coarsening, corrugation, and Assuring
of the skin. Investigation: Microfilaria in peripheral blood at night and ELISA shows antibodies.

QUESTIONS:
1. What do you infer from the above findings? Clinical picture of the patient
2. Mention the causative organism.
3. What is the treatment of choice?
4. What are the other types of filariasis?
Answers:
1. The patient is suffering from lymphatic filariasis.

2. Lymphatic filariasis is caused by the worms: Wuchereria bancrofti, Brugia

malayi, and Brugia timori.

3. Diethylcarbamazine citrate (DEC), which is both microfilaricidal and active

against the adult worm, is the drug of choice for lymphatic filariasis.

4. Subcutaneous filariasis and Serous cavity filariasis

42. A 6-year-old girl presented with chief complaints of fever for 7 days along
with reduced sensation on the right lower limb. She also gives h/o neck pain
and back pain. On physical examination, the deep tendon reflex was
diminished. On stool examination, the virus was isolated.

QUESTIONS:
1. What is the inference on the above-
given scenario?
2. How does it spread?
3. What is AFP?
Answers:
1. The child is affected by Polio, also called poliomyelitis or infantile paralysis, is an
infectious disease caused by the poliovirus.
2. Poliovirus is usually spread from person to person through infected fecal matter entering
the mouth. It may also be spread by food or water containing human feces and less
commonly from infected saliva.

3. AFP stands for Acute Flaccid Paralysis, which is a sudden onset of paralysis or weakness
in one or more limbs, often accompanied by fever or respiratory illness. AFP is an important
indicator for monitoring the status of polio eradication efforts because it is one of the most
common symptoms of polio infection.

4. VAPP stands for Vaccine-Associated Paralytic Polio, which is a rare but serious adverse
event associated with the administration of oral polio vaccine (OPV).
43. A 4-year-old boy was brought by his mother with complaints of fever, sore throat,
and difficulty in swallowing.
O/E: The boy was febrile, had erythema and a localized membrane was seen on the
posterior pharynx.
Investigation: Smear shows the presence of gram-positive bacteria.

Smear showing gram-positive bacteria Clinical picture of the patient

QUESTIONS:
1. What is the diagnosis on this given scenario?
2. Mention its causative organism and how does it spread?
3. What are the complications of this infection?
4. What is the pathognomonic feature?
Answers:
1. Diphtheria.

2. Diphtheria is an infection caused by the bacterium: Corynebacterium diphtheriae.

Diphtheria is usually spread between people by direct contact or through the air.

3. Complications may include myocarditis, inflammation of nerves, kidney problems and

bleeding problems due to low levels of platelets. Myocarditis may result in an abnormal
heart rate and inflammation of the nerves may result in paralysis.

4. The pathognomonic feature of diphtheria is the presence of a grayish-white

pseudomembrane that forms in the throat and/or nose. This membrane is composed of dead
cells, fibrin & bacteria and it adheres tightly to the underlying tissue.