Revised MCQs/Explanations: Q 4, 9, 18, 28€¦ · Mukhmohit’s RECENT TOPIC DISCUSSION – JAN 2020 For updates: telegram Group t.me/mukhmohit01 or | YouTube: mukhmohit community

Mukhmohit’s RECENT TOPIC DISCUSSION – JAN 2020 For updates: telegram Group t.me/mukhmohit01 or www.mukhmohit.com

www.mukhmohit.com | YouTube: mukhmohit community medicine simplified 1

Revised MCQs/Explanations: Q 4, 9, 18, 28 Recent All India / NEET pattern 2020 topics and question discussion. Please note This document is not for sale or commercial benefits. The document contains information based on collections from various platforms and does not adhere or represent any organisation for testing or examination purpose. Based on versatility of medical content and ever changing guidelines, protocols, the discussions are solely from author desk as per current knowledge and may differ from other sources. Resource used: CRPSM – Mukhmohit Singh, 2nd Edition. Conceptual review of PSM, CBS Publishers K Park, 25th Edition. Bhanot Publishers. Online resources and guidelines

================================ Q1. Maximum work hours for person including overtime under the factories act:

a. 48 b. 50 c. 60 d. 100

Ans: C. 60 hours. factories act permits work for 48 hours per week with 2 hours overtime every day. making it approximately 60 hours of maximum work as per the factories act of India Reference: Page 348, 2nd edn. CRPSM

Q2. liquid chemical waste is discarded in:

a. yellow category b. red category



c. blue category d. black category

Ans. A. yellow category. Reference: Page 858, 2nd edn. CRPSM

note: chemical waste is categorized into the yellow category. the hazardous chemical and cytotoxic waste is yellow category with special sign of “CYTOTOXIC” waste. other liquid waste as body secretions is categorized into the yellow category of biomedical waste guidelines, 2016 Q3. blood bags are discarded in:

a. yellow category b. red category c. blue category d. Blue category

Ans: A. Yellow category Reference: Page 858, 2nd edn. CRPSM remember: needles, scalpel, syringe with fixed needle, LP needle, suture needle, sharps: white category broken glass, empty vial, metallic body implants – blue foley’s, uro-bag, RT, iv bottle, gloves, syringe without needle, vacutainer – red category anatomical, animal, placenta, fetus, soiled waste, discarded linen, beddings – yellow microbiological, blood bags, lab waste, expired medicines – yellow cytotoxic drugs – yellow category (special mention – CYTOTOXIC waste) infectious liquid waste, body secretions, liquid chemical waste from lab, disinfectants, X-ray film liquid – YELLOW



edited: Q4. vaccine to be given after disaster

a. Mass vaccination against typhoid b. Mass vaccination against cholera c. vaccination against Tetanus, typhoid and cholera to health workers d. Mass vaccination against tetanus

Ans. vaccination against tetanus, typhoid and cholera to health workers. source:

1. https://www.who.int/immunization/sage/meetings/2012/april/2_SAGE_WGVHE_SG1__Lit_Review_CaseStudies.pdf

2. https://www.cdc.gov/disasters/immunizations.html 3. https://www.cdc.gov/disasters/disease/responderimmun.html

Remarks: We will mark the option with vaccine for health workers, as only such is indicated. there is NO recommendation for any vaccine for general population or mass vaccination until there’s a specific disease outbreak. Only the ongoing National immunization schedule should be ensured to cover universal immunization with specific focus on Measles and OPV vaccines. Explanation: The major concern for anyone exposed to unsanitary conditions is that they be up to date with tetanus-containing vaccine, because if they are injured (as is common in disaster settings) the injury is likely to be contaminated. Routinely recommended vaccines are recommended for evacuees, just like they are for everyone else. cholera and typhoid vaccine do not have any evidence for mass vaccination due to low level of exposure and prevention Tetanus and HepB vaccine is required for health care providers and first responders. Any other vaccine is also given to high risk individuals depending on the type, magnitude and impact of the disaster.

Q5. what is MONICA project:

a. Multinational MONItoring of trends and determinants in CArdiovascular disease



Q6. extended sickness benefit for tuberculosis under ESI Act is: a. 91 days b. 1 year c. 2 years d. 4 years

Ans. C. 2 years Reference: Page 349, CRPSM remember: sickness benefit – 91 days extended sickness benefit – 2 years Q7. A person reports 4 hours after a having a clean wound without laceration. He had taken TT 10 years before. the next step in management is:

a. Full course Tetanus vaccine to be given b. Full dose TT with TIG c. Single dose TT d. No need of any vaccine

Ans. C. single dose TT

Reference: Page 562, CRPSM 2nd edition Q8. Vector for Zika virus is:

a. Anopheles stephensi b. Aedes aegypti c. Culex pipens d. Phelebotomus papatasi

Ans. B. Aedes Aegypti Reference: Page 589, CRPSM



Edited: Q9 An image with diphtheria patient is shown. the patient reports to have another 3 year old sibling at home, who is fully immunized as per the immunization schedule. what is the best measure to prevent diphtheria in the sibling of the diphtheria case child.

a. Give diphtheria toxoid booster b. Give full course of DPT vaccine c. Give prophylactic erythromycin d. Nothing is required to be done

Ans. C. Give prophylactic erythromycin NOTE: Both D (as per PARK, 25ed) and C (as per WHO/CDC guidelines) may be the correct answer. This is purely personal opinion that C > D, keeping in mind the public health issues and impact of preventive measures in our country. Reference: https://www.cdc.gov/diphtheria/downloads/close-contacts.pdf (updated 2014) Page 623, 2nd ed. CRPSM Page 174, 25ed. PARK (guideline with cross reference is from 1979 year) As per the national immunization protocol, each child receives DPT booster at 16-24 months, and then at 5 years. now as the child in the MCQ is 3 years old and is immunized till date, the child must have received the DPT booster injection just within last 2 years. hence the child is protected and probably no added immune-prevention or vaccination is recommended, but chemoprophylaxis with antibiotics may be recommended in such cases. Let us look at the CDC/WHO update and summary of guidelines (May 2014):

1. Culture all close contacts, regardless of their immunization status. 2. After culture, all contacts should receive antibiotic prophylaxis (Benzathine

Penicillin G or oral erythromycin) 3. Inadequately immunized contacts should receive DTaP/DT/Td/Tdap boosters. 4. If fewer than three doses of diphtheria toxoid have been given, or vaccination

history is unknown, an immediate dose of diphtheria toxoid should be given and the primary series completed according to the current schedule.



5. If more than 5 years have elapsed since administration of diphtheria toxoid-containing vaccine, a booster dose should be given.

6. If the most recent dose was within 5 years, no booster is required Park page 174, 25th Ed – summary is as follows.

Primary immunization or booster dose received within 2 years No further action required

Primary immunization or booster dose received more than 2 years Booster dose of diphtheria toxoid

All Non immunized close contacts Prophylactic penicillin or erythromycin 1000-2000 IU of Diphtheria antitoxin Diphtheria immunization

So, to give antibiotic or not depends on the guideline followed. For exam set-up, it is recommended to follow the CDC/WHO guidelines as they are updated and may not be challenged until specific guidelines are issued by NHM or MoHFW Summary of WHO/CDC Diphtheria case management protocol: Source: https://www.cdc.gov/diphtheria/downloads/close-contacts.pdf (may 2014)



Q10. which of the following is not a post coital contraceptive:

a. Cut 200 b. Ru 486 c. Estrogens d. Danazol

Reference: Page 552, Park/25th. https://www.medicines.org.uk/emc/product/4380/smpc Post coital contraception: recommended within 72 hours of unprotected intercourse.

1. IUD – copper containing device within 5 days 2. hormonal

a. levonorgestrel 1.5mg b. levonorgestrel 0.75 mg in two doses (first within 72 hours and another

after 12 hours of first dose) c. two oral contraceptive pills containing 50 mcg of ethinyl estradiol with

72 hours and another after 12 hours of first dose d. 4 tablets OCPs with 30-35 mcg Ethinyl estradiol within 72 hrs and

another after 12 hours e. mifepristone 10mg once within 72 hours

Danazol capsules are recommended for the treatment of: 1. Endometriosis. To control pain, pelvic tenderness and other associated symptoms and to resolve or reduce the extent of endometriotic foci. Danazol capsules may be used as sole therapy, in preparation for or following surgery or in patients not responding to other treatments. 2. Dysfunctional uterine bleeding presenting as menorrhagia. To control excessive blood loss and to control associated dysmenorrhoea. 3. For the treatment of severe cyclical mastalgia with or without nodularity (fibrocystic disease) unresponsive to counselling or simple analgesics. To reduce pain, tenderness and nodularity. 4. For the control of benign, multiple or recurrent breast cysts in conjunction with aspiration. 5. Severe symptomatic gynaecomastia, both idiopathic as well as drug induced, to reduce the size of the breast and to control associated pain and tenderness. 6. Pre-operative thinning of the endometrium prior to hysteroscopic endometrial ablation. Q11. Which among these is a type A bioterrorism agent

a. Nipah virus b. Coxiella Brunetti c. Clostridium perfringes d. B anthracis

Ans. D. Anthrax. Reference: Page 835, 2nd ed. CRPSM



Q12. Recent Influenza Pandemic was due to:

a. H1N1 b. H5N1 c. H7N7 d. H3N2

Ans. A. H1N1… Reference: Page 495, 2nd Edn. CRPSM H1N1 – swine flu – cause the major flu Pandemic (1918 and 2009) H5N1 – avian influenza. may cause sporadic outbreaks or epidemics. It is associated with high mortality.



Q13. Mission Indradhanush is for:

A. Non-communicable diseases B. Universal immunization C. family planning D. safe water and sanitation

Ans. B. Universal immunization nothing to explain. it’s a direct question Reference: Page 720, 2nd Edn. CRPSM Q14. A study had a normal distribution with the median value as 200 and standard deviation 20 . 68 % will fall between

a. 160-240 b. 170-230 c. 180-220 d. 190-210

Ans. C. 180-220 As the median value is 200 and the standard deviation is 20, the normal distribution is: 68% of the population will have values between – median +/- 1 SD = 220 +/- 20 = 180-220 95% of the population will have values between – median +/- 2 SD = 220 +/- 40 = 160-240 68% of the population will have values between – median +/- 3 SD = 220 +/- 60 = 140-260 Note: in the MCQ, as the data shows a normal distribution, the median will be equal to mean and the mode. Q15. All of the following are correct for JE EXCEPT

a. Humans are reservoirs b. Main vector is Culex tritaeniorhynchus c. Birds are maintenance hosts d. It has seasonal transmission

Ans: A. Humans are reservoirs Reference: Page 556/2nd ed CRPSM Humans are dead end host and the reservoirs



Pls note: Culex quinquefasciatus is NOT the main vector for JE. It is a vector for bancroftian filariasis, west Nile fever, western equine encephalitis Q16: Which of the following is a technique/method based on behaviour sciences

a. Management by objective b. Network analysis c. Systems analysis d. Decision making

Ans. A. Management by objectives Reference: Page 934, 25ed, PARK The methods based on behaviour sciences include 1. organisational design 2. personal management 3.Management by objectives 4.information systems 5.communication The Quantitative methods include:

1. cost benefit analysis 2. cost effective analysis 3. input output analysis 4. network analysis as PERT and CPM 5. Planning programming budgeting systems 6. decision making

Q17. as per the sustainable development goals, The target for MMR is to achieve maternal deaths of

a. < 70 / Lac live births b. < 100 / lac live births c. < 7 / 1000 live births d. < 10 / 1000 live births

Ans: < 70 / Lac live births Reference: Page 463, 2nd Edn. CRPSM



Edited Q18. Best indicators for Air pollution are: Indicators for Air Quality Index for monitoring of Air pollution Include:

a. sulphur dioxide, smoke, and Suspended particles b. sulphur dioxide, Hydrogen sulphide, carbon monoxide c. carbon dioxide, hydrogen sulphide, lead d. sulphur dioxide, Lead and particulate matter

Ans. A. Sulphur dioxide, Smoke, and Suspended particles Reference: Pg 796, 25th ed. K PARK http://aqicn.org/map/india/ https://pib.gov.in/newsite/PrintRelease.aspx?relid=110654 Note: There could be different variants of this MCQ. if the MCQ mentions for Air Quality Index – which takes into account multiple indicators, it would include

1. Particulate matter (less than 2.5 micrometre and 10 micrometre – PM2.5 and PM10)

2. nitrogen dioxide (NO2) 3. sulphur dioxide (SO2) 4. carbon monoxide (CO) 5. Ozone (O3) 6. ammonia (NH3) 7. lead (Pb)

Source: The World Air Quality Project, US



Q19. the variation in a data is compared with another data set by:

a. variance b. coefficient of variation c. standard error of mean d. standard deviation

Ans. B. coefficient of variation Reference: Page 90, 2nd edtn, CRPSM

variance Is the square of SD. it tells about the standard deviation coefficient of variation

It may help by comparing the variations in the data set

standard error of mean

It is to compare the means of the data sets which have different sample size, central tendency and standard deviations

standard deviation It is the deviation of values from the mean



Q20. Identify the image below:

a. Female condom b. Male condom c. Chaaya d. Today

Ans. A. female condom Reference: Page 405, 2nd edn. CRPSM Q21. the difference between the incidence in exposed and non-exposed group is best given by:

a. relative risk b. attributable risk c. population attributable risk d. Odds ratio

Ans. B Attributable Risk Reference: Page 9, 2nd ed CRPSM

The relative risk is:



Q22. Monetary benefit is measured in :

a. Program budgeting system b. Network analysis c. Cost effective analysis d. Cost benefit analysis

Ans. D. Cost Benefit Analysis Reference: Page 465, 2nd ed. CRPSM

Q23. If one variable is given then you can find another variable by

a. Coefficient of variation b. Coefficient of correlation c. Coefficient of regression d. Coefficient of determination

Ans. C. coefficient of regression Reference: Page 103, 2nd ed. CRPSM



Q24. Prospective screening is done in case of? A. Neonate for thyroid diseases B. Immigrant screening C. Pap smear for 45 year female D. Diabetes mellitus for 40 year male Ans. B. Immigrant Screening Reference: Page 52, 2nd edtn. CRPSM

Q. 25. A researcher want to prove relation between COPD and smoking. He collected patients record from government hospital and record of cigarette sale from finance and taxation department. This is an example of which study design:

a. Cross sectional b. Posological study c. Ecological study d. Operations research

Ans. C. Ecological study design Reference: page 8, 2nd Ed. CRPSM



Q26. The active disinfectant property of bleaching powder is due to:

a. Chlorine b. Hypochloric acid c. Hypochlorous acid d. Chloramines

Ans. C. Hypochlorous acid Reference: Page 261, 2nd Edn. CRPSM



Q 27. A study was done to assess the malnutrition among young children. 100 children were selected each from rural and urban areas. Out of these, 30 among rural and 20 among urban were found to be malnourished. which of the following statistical test is used to compare the data sets?

a. Paired t test b. Chi square c. Standard error of mean d. ANOVA

Ans. B. Chi square test Reference: Page 98, 2nd Edn. CRPSM



EDITED: Q28. a 3 year old child presents to PHC with fever. He had chest indrawing and Respiratory rate of 38 per minute. The next step in management is:

a. give antipyretics only b. not an emergency, give oral antibiotics and follow up c. refer urgently to a tertiary care centre d. give antibiotics and refer to a tertiary care centre

Ans. B. Not an emergency, give oral antibiotics and follow up Reference: WHO Revised WHO classification and treatment of childhood pneumonia at health facilities. 2014. https://apps.who.int/iris/bitstream/handle/10665/137319/9789241507813_eng.pdf;jsessionid=68B5D3B52D484E5ABDAA841475E0894F?sequence=1 Recommendation 1

• Children with fast breathing pneumonia with no chest indrawing or general danger sign should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily (80mg/kg/day) for five days.

• In areas with low HIV prevalence, give amoxicillin for three days. • Children with fast-breathing pneumonia who fail on first-line treatment with

amoxicillin should have the option of referral to a facility where there is appropriate second-line treatment.



Recommendation 2

• Children age 2–59 months with chest indrawing pneumonia should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily for five days.

Recommendation 3

• Children aged 2–59 months with severe pneumonia should be treated with parenteral ampicillin (or penicillin) and gentamicin as a first-line treatment.

o Ampicillin: 50 mg/kg, or benzyl penicillin: 50 000 units per kg IM/IV every 6 hours for at least five days

o Gentamicin: 7.5 mg/kg IM/IV once a day for at least five days • Ceftriaxone should be used as a second-line treatment in children with severe

pneumonia having failed on the first-line treatment. Recommendation 4

• Ampicillin (or penicillin when ampicillin is not available) plus gentamicin or ceftriaxone are recommended as a first-line antibiotic regimen for HIV-infected and - exposed infants and for children under 5 years of age with chest indrawing pneumonia or severe pneumonia.

• For HIV-infected and - exposed infants and for children with chest indrawing pneumonia or severe pneumonia, who do not respond to treatment with ampicillin or penicillin plus gentamicin, ceftriaxone alone is recommended for use as second-line treatment.

Recommendation 5

• Empiric cotrimoxazole treatment for suspected Pneumocystis Jirovecii (previously Pneumocystis carinii) pneumonia (PCP) is recommended as an additional treatment for HIV-infected and -exposed

• infants aged from 2 months up to 1 year with chest indrawing or severe pneumonia.

• Empirical cotrimoxazole treatment for Pneumocystis Jirovecii pneumonia (PCP) is not recommended for HIV-infected and -exposed children over 1 year of age with chest indrawing or severe pneumonia.

Copyright by mukhmohit. compiled from online resources. For doubts and permissions for print please mail us at: [email protected] website www.mukhmohit.com www.psmsimplified.com YouTube Dr Mukhmohit’s Community medicine Simplified Facebook update page @mukhmohitdr Facebook Discussion forum Mukhmohit’s community and medicine discussion Telegram https://t.me/mukhmohit01

Documents

Revised MCQs/Explanations: Q 4, 9, 18, 28€¦ · Mukhmohit’s RECENT TOPIC DISCUSSION – JAN 2020 For updates: telegram Group t.me/mukhmohit01 or | YouTube: mukhmohit community