Community Medicine Exam Solution: A Blue Print

#Kathmandu University

#MBBS II [February 7, 2024]

#SECTION “B”

1. Define family and its type. What is the role of family in health and disease? (3 + 2 = 5)

2. Describe the natural history of disease and discuss the levels of prevention. (2 + 3 = 5)

3. Classify epidemiological studies. Mention the differences between case control and cohort studies.(2 + 3 = 5)

4. Define Medical Entomology. What type of transmission cycles are involved in the spread of arthropod borne disease?(1 + 4 = 5)

5. Write short notes on:
a. Principles of medical ethics (2.5)
b. Objectives of community diagnosis programme (2.5)

6. Define “Safe and Wholesome water.” What are the methods of water purification on large scale?(2 + 3 = 5)

#SECTION “C”

#Problem – I

7. A three-year-old boy was brought to the hospital. He had recurrent attacks of diarrhea for the last few months. He had edema in the legs and arms, his skin showed diffuse pigmentation. The child was apathetic. The child belonged to a joint family of eight members with poor socio-economic conditions. The weaning of bottle milk was started to the child at the age of three months.

a. What is your provisional diagnosis? Give reasons to support your answer. (2)

b. Enumerate the major nutritional problems in Nepal. (2)

c. Write in brief the methods of nutritional status assessment of under-five children in a community. (3)

d. Discuss preventive measures of Protein Energy Malnutrition. (3)

#Problem – II

8. Hari Pariyar is a 47-year-old poor farmer from Kavre. He has been living with his three young children and a wife in a rented room in Bhaktapur of 12 feet by 10 feet size. The room has an attached kitchen and has very poor ventilation. For the last two months, Hari has been suffering from on and off cough and fever in the evening. He complains of decreased appetite and has significantly lost his weight. Further, he gets easily tired these days and skips his work frequently. His wife has forced him to go to the Bhaktapur TB hospital for a check-up. The doctor examined him and advised him to go for sputum test.

a. What is the probable diagnosis? Justify. (2)

b. Which additional information would you like to ask in the history? (2)

c. Besides the clinical features, which determinants of health are important in making a diagnosis in this case? List them. (2)

d. Is his place of residence overcrowded? Explain. (2)

e. Which additional tests do you think can confirm the disease? (2)

#SECTION “B”

#1. Define family and its types. Role of family in health and disease. (3+2)

Family (Definition):
A family is a group of persons related by blood, marriage, or adoption, usually living together under one roof, sharing a common kitchen, and interacting with each other.

Types of family:

• Nuclear family: Parents and their unmarried children

• Joint/Extended family: Two or more generations living together

• Three-generation family: Grandparents, parents, and children living together

Role of family in health and disease:

• Promotes health through nutrition, care, emotional support, and healthy behaviors

• Influences occurrence, prevention, and management of disease through living conditions, care-seeking behavior, and transmission patterns

#2. Describe the natural history of disease and discuss the levels of prevention.(2+3)

Natural history of disease (2 marks)

The natural history of disease refers to the progression of a disease in an individual from its inception to its final outcome, in the absence of intervention.

Phases:

• Pre-pathogenesis phase: Interaction of agent, host, and environment before disease onset

• Pathogenesis phase: Development of disease → clinical illness → recovery, disability, or death

Levels of prevention (3 marks)

• Primordial prevention
  Prevention of the emergence of risk factors by improving social, economic, and environmental conditions
  (e.g., promoting healthy lifestyle, tobacco control policies)

• Primary prevention
  Prevention of disease occurrence

  • Health promotion

  • Specific protection

• Secondary prevention
  Early detection and prompt treatment to halt disease progression

  • Screening

  • Early diagnosis and treatment

• Tertiary prevention
  Reduction of disability and complications and restoration of function

  • Disability limitation

  • Rehabilitation

#3. Classify epidemiological studies. Differences between case-control and cohort studies. (2+3)

#Classify Epidemiological Studies (2 marks)

Epidemiological studies are classified as:

1. Descriptive studies

   • Case report

   • Case series

   • Cross-sectional studies

2. Analytical studies

   • Case–control studies

   • Cohort studies

3. Experimental (Interventional) studies

   • Randomized controlled trials (RCTs)

   • Field trials

   • Community trials

Differences between case-control and cohort studies:

#4. Define Medical Entomology. What type of transmission cycles are involved in the spread of arthropod borne disease? (1+4)

#Define Medical Entomology (1 mark)

Medical entomology is the branch of science that deals with the study of arthropods of medical importance, particularly those involved in the transmission of diseases to humans.

#Transmission cycles involved in arthropod-borne diseases (4 marks)

1. Man–arthropod–man cycle

   • Disease is transmitted from an infected human to another human through an arthropod vector

   • Example: Malaria, Filariasis

2. Animal–arthropod–man cycle (Zoonotic cycle)

   • Infection is maintained among animals and transmitted to humans by arthropods

   • Example: Plague, Japanese encephalitis

3. Man–arthropod–animal cycle

   • Humans act as a source of infection for animals via arthropods

   • Example: Human trypanosomiasis

4. Transovarial (vertical) transmission

   • Infection is passed from adult arthropod to its offspring through eggs

   • Example: Scrub typhus, Tick-borne diseases

#5. Short notes

a. Principles of medical ethics (2.5):

1. Autonomy

   • Respecting the patient’s right to make informed decisions about their own health care.

2. Beneficence

   • Acting in the best interest of the patient to promote well-being and prevent harm.

3. Non-maleficence

   • “Do no harm” – avoiding actions that may cause unnecessary harm or injury to the patient.

4. Justice

   • Fair and equitable distribution of healthcare resources and services.

5. Confidentiality (optional but often included)

   • Protecting patient information and maintaining privacy

b. Objectives of community diagnosis programme (2.5):

• Identify health problems

  • To determine the major health issues affecting a specific community.

• Assess health needs and resources

  • Evaluate the availability of health services, facilities, and manpower.

• Plan and prioritize interventions

  • Guide the development of targeted health programs based on community needs.

• Monitor and evaluate

  • Assess the effectiveness of health interventions and programs.

• Promote community participation

  • Involve community members in identifying problems and implementing solutions.

#6. 6. Define “Safe and Wholesome water.” What are the methods of water purification on large scale (2+3)

#Define “Safe and Wholesome Water” (2 marks)

Safe and wholesome water is water that is free from pathogenic organisms, harmful chemicals, and toxic substances, and is aesthetically acceptable in terms of taste, color, and odor. It should be suitable for drinking, cooking, and domestic use without causing health hazards.

#Methods of Large-Scale Water Purification (3 marks)

1. Storage

   • Allowing water to settle so that suspended solids can sediment naturally.

2. Filtration

   • Slow sand filters or rapid sand filters to remove suspended particles, turbidity, and microorganisms.

3. Disinfection/Chlorination

   • Adding chlorine or other disinfectants to kill pathogenic microorganisms.

4. Coagulation and Sedimentation

   • Adding coagulants (e.g., alum) to clump fine particles, followed by settling.

5. Other methods (if applicable)

   • UV irradiation, ozonation, or fluoridation depending on local requirements.

#SECTION “C”

#Problem – I

7. A three-year-old boy was brought to the hospital. He had recurrent attacks of diarrhea for the last few months. He had edema in the legs and arms, his skin showed diffuse pigmentation. The child was apathetic. The child belonged to a joint family of eight members with poor socio-economic conditions. The weaning of bottle milk was started to the child at the age of three months.

a. What is your provisional diagnosis? Give reasons to support your answer. (2)

b. Enumerate the major nutritional problems in Nepal. (2)

c. Write in brief the methods of nutritional status assessment of under-five children in a community. (3)

d. Discuss preventive measures of Protein Energy Malnutrition. (3)

#a. Provisional diagnosis with reasons. (2)

Diagnosis: Kwashiorkor
Reasons:

• Edema, skin pigmentation, apathy

• Early bottle feeding, poor socioeconomic condition

#b. Major nutritional problems in Nepal. (2)

• Protein Energy Malnutrition

• Micronutrient deficiencies (iron, iodine, vitamin A)

#c. Nutritional status assessment of under-5 children. (3)

• Anthropometry (weight, height, MUAC)

• Clinical assessment

• Dietary assessment

#d. Preventive measures of Protein Energy Malnutrition. (3)

• Exclusive breastfeeding and appropriate complementary feeding

• Nutrition education and food security

• Growth monitoring and early intervention

#Problem – II

8. Hari Pariyar is a 47-year-old poor farmer from Kavre. He has been living with his three young children and a wife in a rented room in Bhaktapur of 12 feet by 10 feet size. The room has an attached kitchen and has very poor ventilation. For the last two months, Hari has been suffering from on and off cough and fever in the evening. He complains of decreased appetite and has significantly lost his weight. Further, he gets easily tired these days and skips his work frequently. His wife has forced him to go to the Bhaktapur TB hospital for a check-up. The doctor examined him and advised him to go for sputum test.

a. What is the probable diagnosis? Justify. (2)

b. Which additional information would you like to ask in the history? (2)

c. Besides the clinical features, which determinants of health are important in making a diagnosis in this case? List them. (2)

d. Is his place of residence overcrowded? Explain. (2)

e. Which additional tests do you think can confirm the disease? (2)

#a. Probable diagnosis with justification. (2)

Diagnosis: Pulmonary Tuberculosis
Justification:

• Chronic cough, evening fever, weight loss

• Poor living condition and overcrowding

#b. Additional history to ask. (2)

• History of contact with TB patient

• Past TB treatment or HIV status

#c. Determinants of health important in diagnosis. (2)

• Socioeconomic status

• Housing and ventilation

#d. Is his residence overcrowded? Explain. (2)

Yes.
Overcrowding exists when available floor space per person is less than the recommended standard; 12×10 ft room for 5 persons indicates overcrowding.

#e. Additional tests to confirm the disease. (2)

• Sputum smear microscopy / GeneXpert

• Chest X-ray