ADDS ON COMMONLY ASKED QUESTIONS (PART – A)

Chapter – 1 – HEALTH & DISEASE

Que. 1. What does the subjective component of the concept of wellbeing refer?

Ans. 1. Quality of life.

Que. 2. What does the objective component of the concept of wellbeing refer?

Ans. 2. Standard (level) of living.

Que. 3. What does the standard of living include?

Ans. 3. It includes –

• Level of education
• Employment status
• Food
• Dress
• House
• Entertainment or recreation
• Comfort of modern living.

Que. 4. On which measure, does standard of living depend?

Ans. 4. Per capita GNP.

Que. 5. What is the difference between level of living and quality of life?

Ans. 5. Level of living consists of objective criteria while Quality of life denotes individuals own subjective evaluation of wellbeing.

Que. 6. What is the Human Development Index (HDI) score & rank of India in 2023?

Ans. 6. Score is 0.633 & rank is 132 across world.

Que. 7. Which country has the highest HDI in 2023?

Ans. 7. Switzerland (0.96).

Que. 8. Which is the most widely used measure of general economic performance?

Ans. 8. Per capita GNP.

Que. 9. What important things does economic status determine?

Ans. 9. Purchasing power, Standard of living, quality of life, health seeking behavior, family size, behavior, pattern of illness etc.

Que. 10. Which is the most reliable quantitative indicator of political commitment?

Ans. 10. The percentage of GNP spent on health.

Que. 11. What is the target of WHO in relation to health expenditure of a country?

Ans. 11. At least 5% expenditure of each country’s GNP on health & family welfare.

Que. 12. What is the status of India in relation to WHO target on health expenditure?

Ans. 12. 1% of GNP on expenditure on health & family welfare.

Que. 13. What is the purpose of health services?

Ans. 13. To improve the health status of the population.

Que. 14. According to constitution, who is responsible for the health of its people?

Ans. 14. State.

Que. 15. How will you define crude death rate?

Ans. 15. It is the number of deaths per thousand population per year in a given community.

Que. 16. What is the current crude death rate of India?

Ans. 16. 6.2 deaths/1000 population/ year (SRS 2018).

Que. 17. What is the current crude birth rate of India?

Ans. 17. 20.0 births/ 1000 population/ year (SRS 2018).

Que. 18. Define expectation of life.

Ans. 18. It is the average number of years that will be lived by those born alive into a population if the current age specific mortality rate persists.

Que. 19. Define Infant Mortality Rate (IMR).

Ans. 19. It is the ratio of deaths under one year of age in a given year to the total number of live births in the same year. It is usually denoted by a rate per 1000 live births.

Que. 20. Which is the most sensitive indicator of the availability, utilization and effectiveness of perinatal health care?

Ans. 20. Infant Mortality Rate (IMR).

Que. 21. What is the current IMR in India?

Ans. 21. 35.2 / thousand live births (NFHS 5; 2019-21).

Que. 22. What is the current under 5 mortality rate (U5MR) in India?

Ans. 22. 41.9 / thousand live births (NFHS 5; 2019-21).

Que. 23. What is the current neonatal mortality rate in India?

Ans. 23. 24.9 / thousand live births (NFHS 5; 2019-21).

Que. 24. What is the current Maternal Mortality Rate (MMR) in India?

Ans. 24. 97/ lakh live births (SRS 2018-20).

Que. 25. What do you mean by Years of potential life lost (YPLL)?

Ans. 25. It is based on the years of life lost through premature death.

Que. 26. What do you mean by Health adjusted life expectancy (HALE)?

Ans. 26. Previously called Disability adjusted life expectancy (DALE), it is based on life expectancy at birth but includes adjustments for time spent in poor health.

Que. 27. What does 1 QALY (quality adjusted life year) signify?

Ans. 27. 1 QALY signify 1 year of live lived in perfect health.

Que. 28. What do you mean by disability free life expectancy?

Ans. 28. It is the average number of years an individual is expected to live free of disability if current pattern of mortality and disability is considered.

Que. 29. How will you calculate Disability adjusted life years (DALY)?

Ans. 29. DALY = Year of lost life (YLL) + Year lost to disability (YLD).

Que. 30. Enumerate three policy indicators.

Ans. 30. Three policy indicators are –

• Proportion of GNP spent on health services
• Proportion of GNP spent on health related activities.
• Proportion of total health resources devoted to primary health care.

Que. 31. How many goals and targets are there in Sustainable development goals (SDGs)?

Ans. 31. 17 goals & 169 targets including one specific goal (3^rd) for health with 13 targets.

Que. 32. What do you mean by Health Index given by NITI AAYOG?

Ans. 32. It is a composite weighted index which is based on the indicators in 3 domains –

• Health Outcomes (70%)
• Governance & Information (12%)
• Key input & processes (18%)

Each domain is given a weight based on its importance.

Que. 33. What are the obstacles to the implementation of Primary Health Care in India?

Ans. 33. The obstacles are as follows –

• Lack of health staff
• Predominant curative culture within the existing health system
• Highly rich urban areas in terms of health services and skilled manpower.

Que. 34. What is the major limitation of germ theory of disease?

Ans. 34. Not every one exposed to disease agent develops disease e.g. TB, Leprosy, Beta hemolytic streptococci infection.

Que. 35. What do you mean by pre-pathogenesis phase in the natural history of disease?

Ans. 35. This is the period before the onset of disease in humans. Disease agent has not entered in human, but the factors which favor its interaction with the human host are present in the environment.

Que. 36. What are the risk factors for motor vehicle accidents?

Ans. 36. Alcohol, High Speed, not using seat belt, automobile design & roadway design.

Chapter – 2 – Health Planning & Management

Que. 37. What is the first step in health planning?

Ans. 37. Analysis of the health situation.

Que. 38. What is the end result of analysis of the health situation?

Ans. 38. It tells about the health problem, health needs and health demands of the given community.

Que. 39. What are the drawbacks of not setting objectives in health planning?

Ans. 39. The drawbacks are –

• Haphazard activity
• Uneconomical use of funds
• Poor performance
• End results are unsatisfactory

Que. 40. What is the purpose of evaluation in health planning?

Ans. 40. To assess the achievements of the stated objectives of the program.

Que. 41. What is the difference between administration and management?

Ans. 41. Administration means GETTING THE THINGS DONE while management is purposeful and effective use of resources to track objectives.

Que. 42. What do you mean by cost benefit analysis?

Ans. 42. A management technique in which economic benefits of any program are compared with the cost of the program.

Que. 43. What do you mean by Cost Effective Analysis?

Ans. 43. A management technique which is similar to cost benefit analysis except that benefit, instead of being expressed in monetary terms is expressed in terms of results achieved e. g. no. of life saved, illness or disability avoided etc.

Que. 44. What do you mean by input-output analysis?

Ans. 44. It tells how much of each input is required to produce a unit amount of each output.

Que. 45. What does system analysis offer?

Ans. 45. System Analysis helps to find out the cost-effectiveness of the available alternatives.

Que. 46. What do you mean by Network Analysis?

Ans. 46. A network is a graphic plan of all events and activities to be completed in order to attain an objective. It is a systemic way of planning. Common types of network analysis are –

• Program Evaluation & Review Technique (PERT)
• Critical Path Method (CPM).

Que. 47. What is the essential requirement of PERT?

Ans. 47. To construct an arrow diagram. The diagram shows logical sequence of events.

Que. 48. What do you mean by Planning-Programming-Budgeting System (PPBS)?

Ans. 48. It is primarily a system to help decision makers to allocate resources so that they are used in most effective way in achieving objectives of the program.

Que. 49. What do you understand by Zero Budget Approach?

Ans. 49. In this approach, initially zero budget is given to an organization and further budget/funds are added for the activities which are justified logically on a year to year basis.

Que. 50. Which modern contexts were addressed in National Health Policy, 2017?

Ans. 50. Following modern contexts were addressed in National Health Policy, 2017 –

• Health priorities have changed because –
• Maternal & child mortality have declined but still are at unacceptable level.
• Infectious diseases are still major public health problem
• Increase in trend of non-communicable diseases.
• Emergence of a robust health care delivery growing at 15% compound annual growth rate (CAGR).
• Catastrophic expenditure due to health care costs is increasing which is an important contributor to poverty.
• Fiscal capacity has increased due to economic growth.

Que. 51. What do you mean by SWASTH NAGRIK ABHIYAN?

Ans. 51. A concept, to promote environment for health, includes 7 approaches which are as follows –

• Swacch Bharat Abhiyan
• Balanced & healthy diets
• Nasha Mukti Abhiyan
• Yatri Suraksha
• Nirbhaya Nari
• Reduce stress & safety at work place
• Reducing indoor & outdoor pollution.

Que. 52. Name the diseases to be eliminated under National Health Policy (NHP), 2017?

Ans. 52. TB (2025), Leprosy (2018), Kala-azar (2017) & lymphatic filariasis (2017).

Que. 53. What is the target of percentage expenditure of GDP for health under NHP, 2017?

Ans. 53. 2.5% (2025).

Que. 54. What is the target of number of beds per 1000 population under NHP, 2017?

Ans. 54. 2 beds per 1000 population (2025).

Que. 55. When was NITI AAYOG established?

Ans. 55. 1^st January 2015.

Que. 56. What is the role of Central Government in health sector?

Ans. 56. Main role is policy making, planning, guiding, assisting, evaluating & coordination activities with the states.

Que. 57. When was community development program launched in India?

Ans. 57. 2^nd October 1952.

Que. 58. What is the basic unit of a Community Development Program?

Ans. 58. Community Development Block.

Que. 59. Ideally, one community development block should cover how many villages?

Ans. 59. Around 100 villages.

Que. 60. What is the main drawback of community development program?

Ans. 60. Benefits of the program could not reach the weaker and marginalized sections of the community.

Que. 61. When was integrated rural development program (IRDP) launched?

Ans. 61. April 1978.

Que. 62. What was the purpose of IRDP?

Ans. 62. To eliminate rural poverty & improve the quality of life of rural poors.

Chapter 3 – Health Care of the Community

Que. 63. What do you mean by referral system in health care?

Ans. 63. Referral system is a fundamental & necessary function of health care system. It must be a two way exchange of information and returning patients to those who referred them for follow up care. It ensures continuity of care.

Que. 64. What proportion of total deaths in India is due to Non Communicable diseases (NCDs)?

Ans. 64. 63% (2016)

Que. 65. What proportion of total blindness in India is due to vitamin A deficiency?

Ans. 65. 0.4 percent.

Que. 66. What is the current growth rate of our country?

Ans. 66. 1.3 percent.

Que. 67. What is the suggested norms for nurses?

Ans. 67. 1 per 5,000 population.

Que. 68. What is the suggested norms for pharmacists?

Ans. 68. 1 per 10,000 population.

Que. 69. What is the suggested norms for lab technicians?

Ans. 69. 1 per 10,000 population.

Que. 70. What are the criteria for selection of ASHAs?

Ans. 70. Selection criteria are as follows –

• Must be resident of village.
• A woman (married/widow/divorced) preferably in age group of 25-45 years
• With formal education (up to 8^th Class)
• With communication skills
• With leadership qualities.

Que. 71. What are the roles and responsibilities of ASHA?

Ans. 71. The roles and responsibilities of ASHA are as follows –

• Create awareness & provide information to community on determinants of health
• Will counsel women on important aspects e.g. birth preparedness, safe delivery, vaccination etc.
• Will mobilize the community and facilitate them in accessing health and health related services.
• Will develop comprehensive village health plan in consultation with Village Health, Sanitation & Nutrition Committee (VHSNC).
• Will escort or accompany pregnant women & sick children requiring treatment to the nearest suitable health facility.
• Will provide primary medical care for minor ailments such as diarrhoea, fever etc. and first aid for minor injuries.
• Will act as DOTS provider in the given area.
• Will act as depot holder for essential commodities e.g. ORS, IFA tablets, oral pills, antimalarial drugs, condoms, e-pills etc.
• Will provide home based newborn care & home based young infant care. Other areas will be explored by the states.
• Will inform about birth, death, marriage, and any outbreak of disease in her area to higher officials.
• Will promote construction of household toilets under total sanitary campaigns.

Que. 72. Who will support the Anganwadi Workers (AWWs) in mobilizing pregnant and lactating women and infants for nutritional support?

Ans. 72. ASHA.

Que. 73. Who will be depot holder for drug kit at village level?

Ans. 73. AWW. She issues and replenishes the drug kits to ASHA.

Que. 74. Who are responsible for updating the list of eligible couples?

Ans. 74. AWW with the help of ASHA.

Que. 75. Who is responsible for training of ASHA at village level?

Ans. 75. ANM & AWW will act as resource person.

Que. 76. In India, in ICDS program, how much population is being covered by each ANM?

Ans. 76. 400-600.

Que. 77. How many AWCs exist in each ICDS project?

Ans. 77. 100.

Que. 78. How much money is paid to AWW for honorarium?

Ans. 78. INR 1500/- per month.

Que. 79. Which is the first point of contact between the primary health care system & community in urban area?

Ans. 79. Urban Health & Wellness Center (UHWC).

Que. 80. How will you classify the Health & Wellness Centers (HWCs) as per revised IPHS 2022?

Ans. 80. HWCs can be classified as per IPHS 2022 norms as follows –

• Health & Wellness Centers – Primary Health Centers

1. HWC – PHC in Rural areas
2. HWC – UPHC in urban areas

• Health & Wellness Centers – Sub Health Centers

1. HWC – SHC in Rural areas
2. Urban Health & Wellness Centers (UHWC) in urban area.

Que. 81. Under Comprehensive Primary Health Care (CPHC), which facilities will provide primary care services?

Ans. 81. HWC-SHC, UHWCs, PHCs & UPHCs (poly clinics).

Que. 82. Where all rural & urban HWCs having National Identification No. (NIN-Id)will be registered?

Ans. 82. AB-HWC portal.

Que. 83. In order to ensure delivery of CPHC services, existing sub-health centers has been converted to which facility?

Ans. 83. HWCs.

Que. 84. Which is the key to attain Universal Health Coverage (UHC)?

Ans. 84. Comprehensive Primary Health Care (CPHC).

Que. 85. What should be time to care keeping in mind the establishments of HWCs?

Ans. 85. Not more than 30 minutes.

Que. 86. Which are the staffs attached or posted at HWC – SHC?

Ans. 86. Multipurpose workers (Male & female) & ASHAs under the leadership of Community Health Officer (CHO).

Que. 87. What will be major role of HWC-PHC in a rural area?

Ans. 87. Will serve as the first referral point for many disease conditions for the cluster of HWC-SHCs in its jurisdiction. It will also deliver expanded range of primary care services.

Que. 88. Which expanded range of primary care services are offered by HWCs-SHC & PHC?

Ans. 88. The services offered are as follows –

• Care in pregnancy & child birth
• Neonatal & infant health care services
• Childhood & adolescent health care services
• Family planning, contraceptive services & other reproductive health care services
• Management of communicable diseases including National Health Programs.
• Management of common communicable diseases and outpatient care for acute simple illnesses and minor ailments.
• Screening, prevention, control & management of NCDs.
• Care for common ophthalmic & ENT problems.
• Basic Oral Health Care
• Elderly & Palliative health care services
• Emergency Medical Services
• Screening & Basic Management of Mental Health ailments.

Que. 89. What are the key elements of HWC?

Ans. 89. The key elements of HWCs are as follows –

• Expanded service delivery
• Expanded HR & multiskilling
• Medicines & expanding diagnostics – Point of care & new technologies
• Community Mobilization & Health Promotion
• Infrastructure
• Financial/provider payment reforms
• Robust IT system
• Partnership for knowledge & Implementation
• Continuum of care – Telehealth/referral

Que. 90. What is the new name given to HWC?

Ans. 90. Ayushman Arogya Mandir.

Que. 91. What proportion of Indian population have access to safe water?

Ans. 91. 97% of urban population & 93% of rural population (2017).

Que. 92. What proportion of Indian population have adequate facilities for safe disposal of wastes?

Ans. 93. 63% of urban population & 28% of rural population (2017).

Chapter 4 – NUTRITION

Que. 94. What proportion of body weight in an adult is constituted by protein?

Ans. 94. 20 percent.

Que. 95. What do you mean by biologically incomplete protein?

Ans. 95. When one or more of essential amino acids are absent or lacking, the protein is called biologically incomplete protein.

Que. 96. What are the functions of the protein?

Ans. 96. The functions of the protein are as follows –

• Body building and maintenance
• Repair and maintenance of body tissues
• Osmotic pressure maintenance
• Synthesis of substances e.g. antibiotics, hemoglobin, enzymes, hormones etc.
• Maintains immune system of body
• Protein also provides energy (4 kcal/gm)

Que. 97. What are the sources of protein?

Ans. 97. Milk, egg, meat, cheese, fish and fowl (animal sources).

Pulses, legumes, cereals, beans, nuts, oil seeds (vegetable sources).

Que. 98. How much protein is found in 100 gm of meat?

Ans. 98. 18-26 grams.

Que. 99. How much protein is found in 100 grams of fish?

Ans. 99. 15-23 grams.

Que. 100. What is the protein content of 100 grams of cereals?

Ans. 100. 6-13 grams.

Que. 101. What is the protein content of 100 grams of pulses?

Ans. 101. 21-28 grams.

Que. 102. What is the protein content of 100 grams of Soyabean?

Ans. 102. 43.2 grams.

Que. 103. What is the recommended daily intake of protein in an adult?

Ans. 103. 0.83 gm/kg body weight/day.

Que. 104. What proportion of body weight in an adult is constituted by adipose tissues?

Ans. 104. 10-15 percent of the body weight.

Que. 105. In which form most of the body fat is deposited?

Ans. 105. Adipose tissue (in the form of triglycerides).

Que. 106. Which animal fat/oil do provide mostly unsaturated fat?

Ans. 106. Cod liver oil & Sardine oil.

Que. 107. What is the content of invisible fat in rice, wheat, jowar and bajra?

Ans. 107. Rice – 3 percent, Wheat – 3 percent, Jowar – 4 percent & Bajra – 6.5 percent.

Que. 108. Which is the richest source of essential fatty acid, Linoleic acid?

Ans. 108. Safflower oil (73 percent).

Que. 109. What are the dietary sources of essential fatty acids?

Ans. 109. The dietary sources of essential fatty acids are –

• Linoleic acid – Safflower oil, corn oil, sunflower oil, Soyabean oil, Seasame oil, Groundnut oil, mustard oil, palm oil & coconut oil.
• Arachidonic acid – Meat, eggs & milk.
• Linolenic acid – Soyabean oil, Green leafy vegetables.
• Eicosapentaenoic acid – Fish oil.

Que. 110. What are the functions of fat?

Ans. 110. The functions of fat are as follows –

• Provides energy to the body (9Kcal/gm)
• Serves as a vehicle for fat soluble vitamins.
• Supports body organs or viscera
• Protects from cold (being present below skin)
• Required in growth, for structural integrity of cell membrane and decreased platelet adhesions.
• Diet rich in essential fatty acids, decreases serum cholesterol & low density lipoproteins
• Polyunsaturated fatty acids are precursors of prostaglandins.
• Cholesterol is essential ingredient of cell membranes & nervous tissues and is a precursor steroid hormones and bile acids.

Que. 111. Which are the major sources of trans-fatty acids?

Ans. 111. Deep fried fast foods, cookies and candy, packaged doughnuts, pies & cakes, chips & crackers & wipped toppings, cake mixes, cereals & energy bars etc.

Que. 112. What are the effects of intake of trans-fatty acids?

Ans. 112. Elevates LDL cholesterol and decreases HDL cholesterol thus increasing the risk of Coronary Artery disease.

Que. 113. What are the advantages of refined oils?

Ans. 113. Advantages are as follows –

• Does not affect unsaturated fatty acid content of the oil.
• Improves the quality & taste of oil.

Que. 114. What do you mean by PHRENODERMA?

Ans. 114. It is a condition resulting from deficiency of essential fatty acids in diet. It is also known as Toad Skin. Treatment is diet rich in essential fatty acids & B complex. It is generally found in India in Kerala, Karnataka & Gujarat.

Que. 115. What is the main function of high density lipoprotein (HDL)?

Ans. 115. HDL protects the heart by preventing the development of atherosclerosis.

Que. 116. What is the disadvantage of LDL & VLDL cholesterol?

Ans. 116. Promotes development of atherosclerosis.

Que. 117. What will you happen if you replace saturated fatty acids with polyunsaturated fatty acids (PUFA) in diet?

Ans. 117. It will decrease LDL cholesterol concentration and the total/HDL cholesterol ratio. If we replace saturated fatty acids with monounsaturated fatty acids (MUFA), similar but less effective result will occur.

Que. 118. What will happen if you replace carbohydrate with MUFAs?

Ans. 118. It will increase HDL cholesterol concentration.

Que. 119. What is the dietary intake recommendation for trans-fatty acids?

Ans. 119. Less than 1 percent.

Que. 120. What is the dietary intake recommendation of cholesterol in diet?

Ans. 120. Less than 300 mg per day.

Que. 121. What are the basis of recommendations for dietary fats for Indians by WHO & FAO?

Ans. 121. Basis of recommendations for dietary fats for Indians are –

• Source of dietary fats
• Availability of dietary fats
• Total fat, individual fatty acids & health promoting non glyceride components.

Que. 122. What is the recommended minimum intake of visible fats for an adult man?

Ans. 122. Sedentary worker – 25 gm per day; Moderate worker – 30 gm per day & heavy worker – 40 gm per day.

Que. 123. What is the recommended minimum intake of visible fats for an adult woman?

Ans. 123. Sedentary worker – 20 gm per day; Moderate worker – 25 gm per day & heavy worker – 30 gm per day.

Que. 124. What proportion of calorie intake should be contributed by fat?

Ans. 124. Minimum level 20 percent of total energy intake.

Que. 125. What is the recommended minimum intake of visible fat for pregnant & lactating women?

Ans. 125. 30 grams per day.

Que. 126. What is the carbohydrate reserve (glycogen) of an adult human?

Ans. 126. 500 grams.

Que. 127. What is the glycemic index?

Ans. 127. Glycemic Index (GI) is a measure of how quickly a food can make your blood sugar (glucose) rise. Only foods that contain carbohydrates have a glycemic index.

Que. 128. How is Glycemic index (GI) classified?

Ans. 128. Low GI (GI 55 or less) – Most fruits & vegetables (except potato, watermelon & sweetcorn), whole grains, pasta foods, beans & lentils.

Medium GI (GI 56-69) – Sucrose, basmati rice, brown rice.

High GI (More than 70) – Corn flakes, baked potato, white bread, Jasmine rice, candy bars & syrupy foods.

Que. 129. What is desirable dietary intake of fibres daily?

Ans. 129. 30 gm per 2000 kcals.

Que. 130. One retinol equivalent (RE) is equal to how much IU of vitamin A?

Ans. 130. 3.333 IU of Vitamin A.

Que. 131. What are the functions of Vitamin A?

Ans. 131.  The functions of vitamin A are –

• Helps in normal vision & contributes to production of retinal pigments which are needed for vision in dim light.
• Necessary for maintaining the integrity and the normal functioning of glandular and epithelial cells.
• Supports skeletal growth
• Anti-infective in nature
• May protect against certain epithelial cancers e.g. bronchial cancers.

Que. 132. Which are the richest sources of Vitamin A?

Ans. 132. Halibut liver oil, cod liver oil, liver & carrot.

Que. 133. In which form vitamin A is stored in liver?

Ans. 133. Retinol palmitate.

Que. 134. How much vitamin A is stored in the body of a well fed person?

Ans. 134. To meet his needs 6-9 months or more.

Que. 135. Which are the nutritionally important forms of vitamin D in humans?

Ans. 135. Nutritionally important forms of vitamin D in humans are –

• Calciferol (Vit D2)
• Cholecalciferol (Vit D3)

Que. 136. Where is vitamin D stored in the body?

Ans. 136. Fat deposits (adipose tissues).

Que. 137. What are the functions of vitamin D in human body?

Ans. 137. Functions of vitamin D in human body are as follows –

• Promotes intestinal absorption of calcium and phosphorus
• In bones, stimulates normal mineralization, enhances bone reabsorption and affects collagen maturation.
• Increases tubular reabsorption of phosphorus and has variable effects on reabsorption of calcium.
• Permits normal growth especially skeletal growth.

Que. 138. Which foods are richest source of vitamin D?

Ans. 138. Halibut liver oil, cod liver oil & shark liver oil.

Que. 139. In which age group, vitamin deficiency disease, Rickets, is more common?

Ans. 139. Between 6 months to 2 years.

Que. 140. What are the characteristic features of rickets?

Ans. 140. Characteristic features of rickets are –

• Growth failures due to reduced calcifications of growing bones
• Bone deformity
• Muscular hypotonia
• Tetany
• Convulsions
• Raised serum alkaline phosphatase level

Que. 141. In which adult condition, osteomalacia is more common?

Ans. 141. In pregnant & lactating women.

Que. 142. What are the preventive measures of Vitamin D deficiency diseases?

Ans. 142. Preventive measures are as follows –

• Educating parents to expose their children regularly to sunshine.
• Periodic prophylaxis of children
• Fortification of foods with vitamin D.

Que. 143. Where is vitamin D stored in human body?

Ans. 143. Fatty tissues and liver of human body.

Que. 144. Which is the most feasible method of preventing vitamin D deficiency?

Ans. 144. Periodic prophylaxis of children.

Que. 145. Which is the most potent form of vitamin E?

Ans. 145. Alpha-tocopherol.

Que. 146. Which is the rich source of Vitamin E?

Ans. 146. Vegetable oils, cotton-seed, sunflower seed, egg yolk & butter.

Que. 147. What is the recommended intake of vitamin E?

Ans. 147. 0.8 mg/gm of essential fatty acids.

Que. 148. What is the rich source of vitamin K1?

Ans. 148. Fresh green vegetables, some fruits & cow’s milk.

Que. 149. Which type of vitamin K is synthesized by intestinal flora?

Ans. 149. Vitamin K2.

Que. 150. Where is vitamin k stored in human body?

Ans. 150. Liver.

Que. 151. What is the daily requirement of vitamin K?

Ans. 151. 0.03 mg per kg body weight.

Que. 152. Which intramuscular vitamin injection is given to all newborns within 24 hours of birth?

Ans. 152. Injection Vitamin K1.

Que. 153. Why intramuscular vitamin k1 injection is given to all newborn?

Ans. 153. To prevent early vitamin K deficiency bleeding.

Que. 154. Whether newborns do contain low vitamin K?

Ans. 154. Yes, as gut of newborn is not mature and colonic bacteria, responsible for vitamin K synthesis, has not developed and there is no placental transfer of vitamin K from mother to newborn.

Que. 155. What is the dose of intramuscular vitamin K1 given to newborn?

Ans. 155. 0.5 mg.

Que. 156. What does deficiency of vitamin B1 (thiamine) cause?

Ans. 156. Beriberi & Wernicke’s encephalopathy.

Que. 157. What are the forms of vitamin B1 deficiency disease, Beriberi?

Ans. 157. Three forms occur –

1) Dry Beriberi – Peripheral neuritis

2) Wet Beriberi – cardiac involvement

3) Infantile Beriberi – seen in infants of 2-4 months of age

Que. 158. What is the commonest reason of infantile beriberi?

Ans. 158. The thiamine deficient mother with signs of peripheral neuropathy, breastfeeding the affected children.

Que. 159. Who are at risk of developing Wernicke’s encephalopathy?

Ans. 159. Alcoholics and people doing fasting.

Que. 160. What are the characteristic features of Wernicke’s encephalopathy?

Ans. 160. Ophthalmoplegia, polyneuritis, ataxia & mental deterioration.

Que. 161. Who are at increased risk of developing Beriberi?

Ans. 161. Those people with rice as staple diet especially those consuming polished rice.

Que. 162. What is the daily recommended intake of thiamine?

Ans. 162. 30 mg.

Que. 163. Why thiamine deficiency is vanishing?

Ans. 163. Improved economic conditions & varied diet availability and consumption.

Que. 164. What is the fundamental role of Vitamin B2 (Riboflavin)?

Ans. 164. Helps in cellular oxidation.

Que. 165. What does deficiency of riboflavin cause?

Ans. 165. Angular stomatitis especially in malnourished children, cheilosis, glossitis, nasolabial dyssbacia & increased susceptibility to cataract.

Que. 166. What is the daily requirement of riboflavin?

Ans. 166. 1.96 mg per 1000 Kcal of energy intake.

Que. 167. Which are the food items rich in niacin or Vitamin B3?

Ans. 167. Liver, kidney, meat, poultry, fish, legumes and groundnuts.

Que. 168. Give example of food which is poor in niacin but rich in tryptophan?

Ans. 168. Milk.

Que. 169. Which deficiency disease is more common in maize eaters?

Ans. 169. Pellagra.

Que. 170. Why maize & jowar eaters are more prone to develop pellagra?

Ans. 170. Excess of leucine present in maize & bajra appears to interfere in the conversion of tryptophan to niacin resulting in niacin deficiency.

Que. 171. What is the daily recommended intake of niacin?

Ans. 171. 12 mg per 1000 Kcal of energy intake.

Que. 172. What is the role of vitamin B6 (Pyridoxine) in human body?

Ans. 172. Plays an important role in the metabolism of amino-acids, fats and carbohydrates.

Que. 173. What is the recommended daily intake of pyridoxine?

Ans. 173. Adults – 2 mg per day; Pregnant & lactating women – 2.5 mg per day.

Que. 174. What is the recommended daily intake of vitamin B5 (pantothenic acid)?

Ans. 174. 5 mg/day.

Que. 175. What are the roles of folate in human body?

Ans. 175. The role of folate in human body are as follows –

• Helps in synthesis of nucleic acids.
• Needed for normal development of blood cells in the bone marrow.

Que. 176. Which vitamin B group deficiency has been reported in babies given milk food subjected to heat sterilization?

Ans. 176. Folate deficiency.

Que. 177. In which phase of life, folate deficiency due to poor diet is observed?

Ans. 177. Pregnancy & lactation.

Que. 178. What does the folate deficiency cause?

Ans. 178. Megaloblastic anemia, glossitis, cheilosis and GI deficiency. Severe deficiency may lead to infertility or sterility.

Que. 179. Which are the biochemical tests required to know the status of folate deficiency?

Ans. 179. Serum folate & red cell folate concentration.

Que. 180. What are the advantage of folic acid supplementation in entire pregnancy?

Ans. 180. Found to increase the birth weights of newborn and reduce the incidence of LBW.

Que. 181. In which B group vitamin, active compound contains cobalt?

Ans. 181. Vitamin B12.

Que. 182. What is the role of vitamin B12 in human body?

Ans. 182. Helps in synthesis of DNA & synthesis of fatty acids in myelin.

Que. 183. What does vitamin B12 deficiency cause?

Ans. 183. Megaloblastic anemia & demyelinating lesions in the spinal cord.

Que. 184. For which vitamin absorption from stomach & terminal ileum, intrinsic factors are required?

Ans. 184. Vitamin B12.

Que. 185. What are the rich food sources of vitamin B12?

Ans. 185. Not found in vegetable food. Good sources are animal foods e.g. liver, kidney, milk, egg, meat, fish & cheese. Also synthesized by bacteria in colon.

Que. 186. Where does vitamin B12 stored in human body?

Ans. 186. Predominantly in liver (2 gm). Storage is sufficient for supply of vitamin B12 for the 3 years in case of deficiency.

Que. 187. What is the recommended intake of vitamin B12 in adults?

Ans. 187. The recommended intake of vitamin B12 is as follows –

Adult – 2.2 microgram per day.

Pregnancy – +0.25 microgram per day

Lactation – +1.0 microgram per day.

Que. 188. Which vitamin is most sensitive to heat?

Ans. 188. Vitamin C.

Que. 189. What is the estimated requirement of vitamin C for adults per day?

Ans. 189. 40 mg.

Que. 190. Which is the richest source of vitamin C?

Ans. 190. Amla (600 mg/100 gm).

Que. 191. Name the minerals associated with clearly recognizable clinical situations in man?

Ans. 191. Calcium, Phosphorus, Potassium, Sodium, Iron, Fluorine & Iodine.

Que. 192. How much of calcium does an average adult body has?

Ans. 192. 1200 mg.

Que. 193. How much calcium is provided by one litre of cow’s & human milk?

Ans. 193. Cow’s milk – 1200 mg/litre

                  Human milk – 300 mg/litre

Que. 194. What is the limiting factor for absorption of calcium from green leafy vegetables?

Ans. 194. Oxalic acid which interferes the absorption of calcium.

Que. 195. What is the limiting factor for absorption of calcium from cereals?

Ans. 195. Phytic acid which forms an insoluble compound with calcium, calcium phytate.

Que. 196. Presence of which compounds affect the absorption of calcium?

Ans. 196. Vitamin D increases the absorption of calcium while presence of oxalates, phytate and fatty acids in diet reduces calcium absorption.

Que. 197. What is the recommended daily intake of calcium?

Ans. 197. 1000 gm.

Que. 198. What is the role of phosphorus in human body?

Ans. 198. Phosphorus is essential for the formation of bones & teeth.

Que. 199. What is the total sodium ion content of the body?

Ans. 199. 100 gm of sodium ions.

Que. 200. What is the recommended daily intake of sodium chloride?

Ans. 200. 5 grams.

Que. 201. What is the desirable Sodium : Potassium ratio in the diet?

Ans. 201. 1:1 (in mmol).

Que. 202. In which conditions, magnesium deficiency may occur?

Ans. 202. Magnesium deficiency may occur in –

• Chronic alcoholics
• Cirrhosis of liver
• Toxemias of pregnancy
• Protein energy malnutrition
• Malabsorption Syndrome

Que. 203. What are the features of magnesium deficiency?

Ans. 203. Irritability, tetany & hyper-reflexia or sometime hypo-reflexia.

Que. 204. What is the recommended daily intake of magnesium for adults?

Ans. 204. 440 mg/day.

Que. 205. Which food items do promote absorption of iron from the GIT?

Ans. 205. Ascorbic acid rich foods (Ascorbic acid/ vitamin C).

Que. 206. Which is the part of GIT from where absorption of iron takes place?

Ans. 206. Duodenum & jejunum.

Que. 207. In which form iron is transported to organs that store iron?

Ans. 207. Serum ferritin.

Que. 208. In which organ/parts of the body, iron is stored?

Ans. 208. Liver, spleen, bone marrow & kidney.

Que. 209. What is the average iron loss in a menstruating lady?

Ans. 209. 12.5 mg per 28 day cycle.

Que. 210. How much iron loss is prevented by use of hormonal contraceptives in a lady?

Ans. 210. 50% reduction.

Que. 211. How will you recognize latent iron deficiency?

Ans. 211. By measuring serum ferritin levels.

Que. 212. What are the effects of iron deficiency?

Ans. 212. The effects of iron deficiency are as follows –

• Anemia
• Impaired cell-mediated immunity
• Reduced resistance to infection
• Reduced work performance
• Increased morbidity & mortality.

Que. 213. What is the cut-off point of MCHC for the diagnosis of anemia?

Ans. 213. 34 percent.

Que. 214. Which value of serum iron concentration does indicate iron deficiency?

Ans. 214. Value below 0.50 mg/L.

Que. 215. Which value of human serum ferritin does indicate an absence of stored iron?

Ans. 215. Values below 100 mcg/L.

Que. 216. What is the normal value of serum transferrin saturation?

Ans. 216. 30 percent.

Que. 217. What is the normal blood level of iodine?

Ans. 217. 8-12 micrograms/dl.

Que. 218. What is the daily requirement of iodine for adults?

Ans. 218. 150 micrograms. In pregnancy – 250 micrograms.

Que. 219. Which test is recommended for surveillance of iodine deficiency disorder control program?

Ans. 219. Urinary iodine excretion.

Que. 220. Which indicator has been found to be a sensitive indicator of environmental iodine deficiency?

Ans. 220. Neonatal hypothyroidism.

Que. 221. What is the role of fluorine in human body?

Ans. 221. It is essential for the normal mineralization of bones and formation of dental enamel.

Que. 222. Which are the rich dietary sources of fluorine?

Ans. 222. Sea fish, cheese & tea.

Que. 223. What is the suggested daily intake of zinc?

Ans. 223. Adults – 17 mg/day (men).

Women – 13.2 mg/ day.

Children – 10 mg/day.

Infants – 5 mg/day.

Que. 224. Name the conditions in which hypocupremia does occur?

Ans. 224. Conditions in which hypocupremia does occur –

• Nephrosis patients
• Wilson’s disease
• PEM
• Prolonged infant feeding on cow’s milk.

Que. 225. What is the estimated copper requirements for adults?

Ans. 225. 2.0 mg/day

Que. 226. In which human condition, selenium deficiency is observed?

Ans. 226. Protein-energy malnutrition.

Que. 227. What is the effect of combined selenium and vitamin E deficiency?

Ans. 227. Decrease in antibody production.

Que. 228. What is the recommended intake of selenium?

Ans. 228. 40 microgram per day.

Que. 229. Which mineral deficiency may cause mouth & oesophageal cancer?

Ans. 229. Molybdenum.

Que. 230. What is the role of chromium in human body?

Ans. 230. Plays important role in carbohydrate metabolism & insulin function.

Que. 231. What is the cereals contribution to Indian diet?

Ans. 231. Contribute 70-80% of the total energy intake and more than 50% of protein intake.

Que. 232. What is the effect of milling process on nutritive content of the rice?

Ans. 232. May lead to up to 15% losses of protein, 75% losses of thiamine & 60% losses of thiamine & niacin.

Que. 233. People persistently eating white or polished rice are prone to which disease?

Ans. 233. Beriberi.

Que. 234. Name the technique of parboiling suggested by the Central Food Technological Research, Mysore.

Ans. 234. Hot soaking process.

Que. 234. Which disease is caused by consumption of Khesari dal?

Ans. 234. Lathyrism.

Que. 235. Which nutritive element’s presence in pulses may lead to flatulence?

Ans. 235. High amount of oligosaccharides.

Que. 236. Which anti-nutritional factors are present in pulses?

Ans. 236. Phytates & tannins.

Que. 237. Which is the limiting amino-acid in pulses?

Ans. 237. Methionine.

Que. 238. Which nutrients are present in good amount in green leafy vegetables?

Ans. 238. Carotenes (vitamin A), calcium, iron and vitamin C. It is also good source of folic acid & riboflavin.

Que. 239. Which amino-acid is present in good amount in green leafy vegetables?

Ans. 239. Lysine.

Que. 240. What is the recommended daily intake of green leafy vegetables for an adult?

Ans. 240. 40 gram.

Que. 241. What is the caloric value of 100 grams of green leafy vegetables?

Ans. 241. 25-50 Kcal.

Que. 242. What is the recommended daily intake of roots & tubers?

Ans. 242. 50-60 gm/day/adult.

Que. 243. Among nuts, which is the richest source of iron?

Ans. 243. Pistachio (14 mg of iron/100 gm). Cashewnuts & almonds are good source of iron.

Que. 244. What are the fat contents of the different nuts?

Ans. 244. Walnuts (64.5%), almonds (58.7%), Cashewnuts (46.9%) & groundnuts (40%).

Que. 245. Among nuts, which is the richest source of protein?

Ans. 245. Groundnut (26.7% of protein).

Que. 246. Why do peanuts for human consumption thoroughly dried & stored properly?

Ans. 246. To avoid the growth of Aspergillus flavus which produce AFLATOXINS.

Que. 247. Which type of urine is produced on intake of fruits?

Ans. 247. Alkaline urine.

Que. 248. What is the estimated daily intake of fruits?

Ans. 248. 85 gm or more fresh fruits.

Que. 249. Among animal foods, name two nearly perfect foods.

Ans. 249. Egg & milk.

Que. 250. Name the proteins present in milk.

Ans. 250. Casein (majority), lacto-albumin & lacto-globulin.

Que. 251. Which amino-acids are present in greater quantity in human milk in comparison to animal milk?

Ans. 251. Cysteine & tryptophan.

Que. 252. What do you mean by vegetable milk? Name two vegetable foods from which milk can be prepared?

Ans. 252. Milk prepared from vegetable foods is called generally vegetable milk. Groundnut & Soyabean are examples of such vegetable foods.

Que. 253. Which nutrients are not found in egg?

Ans. 253. Carbohydrate & vitamin C.

Que. 254. What is the nutritive value of a 60 gram egg?

Ans. 254. Provides 70 kcal of energy, 6 gm of protein, 6 gm of fat, 30 mg of calcium & 1.5 mg of iron. Each egg also provide 250 mg of cholesterol.

Que. 255. What is the value of Net protein utilization (NPU) for meat, egg & milk?

Ans. 255. Meat – 80; Milk – 75; Egg – 100.

Que. 256. Which sea foods are rich in iodine?

Ans. 256. Lobsters & oysters.

Que. 257. What are the advantages of fish?

Ans. 257. The advantages of fish are –

• Provides 15-25% protein
• Rich in unsaturated fatty acids
• Rich in vitamin A & vitamin D (esp. fish liver oil)
• Fish bones provide calcium, phosphorus and fluorides
• Rich source of iodine (esp. sea fishes)
• Almost no carbohydrates.

Que. 258. What are the advantages of meat?

Ans. 258. The advantages of meat are –

• Provides 15-20% protein.
• Good source of essential amino-acids
• Readily absorbable iron’s presence (2-4 mg/100gm)
• Provides minerals e.g. zinc and vitamin b complex
• Rich in phosphorus.

Que. 259. Which disease may result from excessive consumption of condiments?

Ans. 259. Peptic ulcer.

Que. 260. How much energy does alcohol provide?

Ans. 260. 7 Kcal per gram.

Que. 261. How much increased energy intake is recommended in pregnancy & lactation?

Ans. 261. Pregnancy – + 350 kcal daily

Lactation (0-6 months) – + 600 kcal per day

Lactation (7-12 months) – +520 kcal per day.

Que. 262. What is recommended energy intake above 40 years?

Ans. 262. 40-60 years – 5% reduction in requirement per decade.

>60 years – 10% reduction in intake per day.

Que. 263. What is current energy requirement for adult men?

Ans. 263. Current energy requirement for adult men is as follows –

• Sedentary work – 2110 Kcal/day
• Moderate work – 2710 Kcal/day
• Heavy work – 3470 Kcal/day

Que. 264. What is the current energy requirement for adult women?

Ans. 264. Current energy requirement for adult women is as follows –

• Sedentary work – 1660 Kcal/day
• Moderate work – 2710 Kcal/day
• Heavy work – 2720 Kcal/day

Que. 265. How much energy may dietary fibres provide?

Ans. 265. 2 Kcal/gram.

Que. 266. Name two methods of qualitative assessment of proteins.

Ans. 266. Two methods of qualitative assessment of proteins –

• Amino-acid score
• Net Protein Utilization (NPU).

Que. 267. What do you mean by Amino-acid score?

Ans. 267. It measures the concentration of each essential amino-acid in the test protein, which is expressed as a percentage of amino-acid in the reference protein. Amino-acid score for animal food is 70 to 80 while 50 to 60 for vegetable food.

Que. 268. How will you calculate Net Protein Utilization (NPU)?

Ans. 268. NPU = Nitrogen retained by body/Nitrogen intake *100.

1 gram of nitrogen = 6.25 gram of protein.

Que. 269. Name important measure to assess protein quantity.

Ans. 269. Protein-efficiency ratio (PE ratio or percentage).

Que. 270. How will you calculate PE ratio?

Ans. 270. PE ratio = Energy from protein/Total energy in diet*100.

It should be at least 10-12% of the total energy intake.

Que. 271. How much increased intake of protein is recommended in pregnancy and lactation?

Ans. 271. For 10 kg weight gain during pregnancy, recommended protein intake will be as follows –

1^st trimester – 1 gram/day.

2^nd trimester – 9.5 gram/day

3^rd trimester – 22 gram/day

For lactation (0-6 months) – 13 gram/day.

Que. 272. What are the important causes of low birth weight (LBW)?

Ans. 272. The important causes of LBW are as follows –

• Maternal malnutrition
• Anemia
• Maternal infections
• Hard physical labour during pregnancy
• Improper antenatal care
• Smoking
• Less spacing between births
• High parity
• Very young age etc.

Que. 273. What is the current figure of LBW in India?

Ans. 273. 18.5% (NFHS 5).

Que. 274. What is the status of underweight children in India?

Ans. 274. 32.1% (NFHS 5).

Que. 275. What is the status of stunted and wasted children in India?

Ans. 275. 35.5% & 19.3% respectively (NFHS 5).

Que. 276. Which anthropometric indicator measure prevalence of underweight in a community?

Ans. 277. Weight for Age (WFA).

Que. 278. Which anthropometric index does help in measuring stunting in children in a community?

Ans. 278. Height for Age (HFA).

Que. 279. Which anthropometric index does help in measuring wasting in children in a community?

Ans. 279. Weight for height (WFH).

Que. 280. What is the percentage of adult men & adult women having Body Mass Index (BMI) below 18.5, a level indicating chronic energy deficiency?

Ans. 280. 16.2% adult men & 18.7% adult women.

Que. 281. Which indicator is used to assess changes in the magnitude of malnutrition over time?

Ans. 281. Underweight.

Que. 282. Which indicator is used to indicate past growth failure?

Ans. 282. Stunting.

Que. 283. What are the factors responsible for stunting?

Ans. 283. The factors responsible for stunting are as follows –

• Chronic intake of food in insufficient quantity.
• Frequent or repeated infections
• Inappropriate feeding practices
• Poverty

Que. 284. What does wasting indicate?

Ans. 284. Current or acute malnutrition.

Ans. 285. Define severe acute malnutrition.

Ans. 285. May be defined as very low weight height (Z score below -3SD of the median WHO child growth standards), a mid-upper arm circumference or by presence of pedal oedema. It has 9 times more mortality in comparison to well-nourished children.

Que. 286. What are the main symptoms of marasmus?

Ans. 286. The main symptoms of marasmus are –

• Cachexia/severe wasting
• Little or oedema
• Minimum subcutaneous tissue
• Severe muscular wasting

Que. 287. What are the main symptoms of Kwashiorkor disease?

Ans. 287. The main symptoms of Kwashiorkor are –

• Oedema
• Wasting
• Hepatomegaly
• Steatosis
• Depigmentation of skin & hair.

Que. 288. Mention the health promotion measures in prevention & control of PEM?

Ans. 288. Health promotion measures are –

• Measures for pregnant and lactating women (Supplementation – IFA & Ca & Education)
• Breast feeding promotion.
• Adopting low cost locally available weaning foods
• Improvement in family diet
• Nutritional education
• Family planning and adequate spacing among children
• Family environment
• Health economics

Que. 289. Mention the specific protection measures in prevention and control of PEM?

Ans. 289. Specific protection measures are –

• Balanced diet
• Immunization
• Food fortification

Que. 290. What is the magnitude of vitamin A deficiency (VAD) in India?

Ans. 290. 5.7% children suffer from it (eye signs).

Que. 291. What is the prevalence of anemia in women in 15-49 years age group?

Ans. 291. 57% (NFHS 5 2019-21).

Que. 292. What is the prevalence of anemia in men in India?

Ans. 292. 25.1 percent (NFHS 5 2019-21).

Que. 293. What is the prevalence of anemia in adolescent girls in India?

Ans. 293. 72.6 percent (NFHS 5 2019-21).

Que. 294. What is the prevalence of severe anemia in adolescent girls in India?

Ans. 294. 21.1%.

Que. 295. What is the target for accelerating the annual rate of decline of anemia under Anemia Mukt Bharat?

Ans. 295. 1-3% annually.

Que. 296. What is the strategy adopted in Anemia Mukt Bharat?

Ans. 296. 6*6*6 strategy. Meaning that 6 beneficiaries, 6 interventions & 6 institutional mechanisms.

Que. 297. Which are the groups covered under 6 beneficiaries?

Ans. 297. The groups covered are –

• Children 6-59 months
• Children 5-9 years
• Adolescent girls & boys (10-19 years)
• Women in reproductive age group (15-49 years)
• Pregnant women
• Lactating women.

Que. 298. What are the actions included under 6 interventions?

Ans. 298. 6 interventions are –

• Prophylactic iron & folic acid supplementation.
• Deworming
• Intensified year round BCC campaign
• Testing of anemia using digital methods & point of care treatment
• Mandatory provision of IFA fortified foods
• Addressing non-nutritional causes of anemia.

Que. 299. What are the 6 institutional mechanisms included in the strategies of Anemia Mukt Bharat?

Ans. 299. 6 institutional mechanisms are –

• Intra-ministerial coordination
• Nutritional Centre of excellence & advanced research on anemia control.
• Strengthening supply chain & logistics
• National Anemia Mukt Bharat Unit.
• Convergence with other ministries
• Anemia Mukt Bharat Dashboard & digital portal.

Que. 300. Which drug is recommended for the treatment of moderate to severe anemia?

Ans. 300. IV Iron Sucrose or Ferric carboxyl maltose.

Que. 301. Use of which type of salt is recommended in Anemia Mukt Bharat?

Ans. 301. Double (Iodine & Iron) fortified salt.

Que. 302. When was Anemia Control Program in India started?

Ans. 302. 1970 as National Nutritional Anemia Prophylaxis Program (NNAPP).

Que. 303. When was Anemia Mukt Bharat Program launched?

Ans. 303. In 2018.

Que. 304. What is the cut off criteria of hemoglobin (gm/dl) for mild anemia in pregnant & non-pregnant women in India?

Ans. 304. Pregnant women – Less than 11.

Non-pregnant women – less than 12.

Que. 305. What is the cut off criteria of Hemoglobin % for severe anemia?

Ans. 305. Less than 7 gm% – Children 6-59 months & pregnant women.

Less than 8 gm% – Children (5-14 years), Non-pregnant women (>15 years) & men (>15 years of age)

Que. 306. What are the recommended devices for testing anemia?

Ans. 306. At facility level – by semi-auto analyzer

At health facility below block level & field level – Digital hemoglobinometer.

Que. 307. What are the components of prophylaxis of anemia?

Ans. 307. IFA supplementation & deworming.

Que. 308. What are the colors of IFA tablets for different age groups?

Ans. 308. Following are the color of IFA tablets for different age groups –

• Children 5-9 years of age – PINK.
• Adolescent girls & boys – BLUE.
• Pregnant women, Lactating women & non-pregnant women – RED.

Que. 309. What is the prophylactic dosage for IFA supplementation for children 6-59 months of age?

Ans. 309. Biweekly 1 ml of IFA syrup.

Que. 310. How much IFA is present in each ml of IFA syrup?

Ans. 310. 20 mg of elemental iron & 100 micro grams of folic acid.

Que. 311. When prophylaxis with IFA should be withheld for children 6-59 months of age?

Ans. 311. In case of acute illnesses (fever, diarrhoea, pneumonia etc.) and in known case of thalassemia major.

Que. 312. What is the prophylactic dose of IFA supplementation for children 5-9 years of age?

Ans. 312. One pink IFA tablet weekly.

Que. 313. How much IFA is present in one pink IFA tablet for 5-9 years age children?

Ans. 313. 40 mg of elemental iron & 400 microgram of folic acid, sugar coated.

Que. 314. What is the prophylactic dose of IFA supplementation in adolescent boys and girls (10-19 years)?

Ans. 314. One blue IFA tablet weekly. One blue IFA tab contains 60 mg elemental iron & 500 microgram of folic acid. Blue IFA tablet is sugar coated.

Que. 315. What is the prophylactic dose of IFA supplementation in women of reproductive age (Non-pregnant, non-lactating)?

Ans. 315. One red sugar coated IFA tablet weekly.

Que. 316. How much iron & folic acid is contained in each red IFA tablet?

Ans. 316. 60 mg of elemental iron & 500 microgram of folic acid.

Que. 317. What is the prophylactic dose of IFA supplementation in pregnant & lactating women?

Ans. 317. One red IFA once daily in lactating women for 6 months while once daily in pregnant women after 1^st trimester for 6 months.

Que. 318. How much red IFA tablets should be given to pregnant & lactating women for prophylaxis?

Ans. 318. 180 red IFA tablet to each PW & LW.

Que. 319. When one should take IFA tablet?

Ans. 319. Preferably one hour after major meals to prevent side effects such as nausea.

Que. 320. Intake of which food should be encouraged along with IFA tablet?

Ans. 320. Foods rich in vitamin C as these increase absorption of iron.

Que. 321. Intake of which food items should be discouraged along with IFA tablets?

Ans. 321. Tea & coffee within a hour & Calcium tablets (as interfere with iron absorption).

Que. 322. What should be the interval between calcium & IFA tablet intake?

Ans. 322. Calcium tablet should be taken along with food as it causes gastritis. After two hours of calcium tablet intake, one may take IFA tablet as calcium interferes with iron absorption.

Que. 323. Which is the drug of choice for deworming?

Ans. 323. Albendazole.

Que. 324. Why deworming is important in prophylaxis of anemia?

Ans. 324. Worm infestation (particularly hookworm infestation) along with nutritional deficiency is an important cause of anemia & thus deworming is an intervention for prophylaxis of anemia.

Que. 325. What is the schedule of deworming in pregnant women?

Ans. 325. One tablet of 400 mg Albendazole after the first trimester, preferably in 2^nd trimester.

Que. 326. What is the schedule of deworming in children 12-24 months of age?

Ans. 326. Biannually half tablet of Albendazole (400 mg).

Que. 327. What is the schedule of deworming in older age groups?

Ans. 327. Biannually one tablet of Albendazole (400 mg).

Que. 328. Which is the most common formulation used for parenteral iron therapy?

Ans. 328. Iron-sucrose.

Que. 329. What are the indications of IV iron-sucrose?

Ans. 329. The indications of IV iron-sucrose are as follows –

• Moderate anemia during pregnancy (after the 1^st trimester of pregnancy) and during post-partum period if –
• Oral iron is not tolerated
• Non-compliance to oral iron
• No improvement in Hemoglobin level or improvement <1 gm/dl after one month of oral IFA treatment.
• Severe anemia (HB – 6.9 to 5 gm/dl) during 13 to 34 weeks of pregnancy.

Que. 330. What are the contraindications of iron-sucrose therapy?

Ans. 330. The contraindications of iron-sucrose therapy are as follows –

• Patient with evidence of iron overload.
• Patient with known hypersensitivity
• Patient with anemia not caused by iron deficiency.
• Liver diseases like jaundice, cirrhosis & renal failure
• Patients with acute cardiac failure.

Que. 331. What is the prevalence of IDD in India?

Ans. 331. More than 10%.

Que. 332. How much population is estimated to be suffering from Iodine Deficiency Disorders (IDD) in India?

Ans. 332. 71 million persons.

Que. 333. What are the components of National Iodine Deficiency Disorders Control Program (NIDDCP)?

Ans. 333. There are 4 components –

• Iodine salts
• Monitoring & Surveillance
• Manpower training
• Mass Communication

Que. 334. Where is endemic fluorosis observed?

Ans. 334. Where drinking water contains excessive of fluorine (3-5 mg/L).

Que. 335. What are the toxic manifestations of endemic fluorosis?

Ans. 335. Dental & skeletal fluorosis & Genu Vulgum.

Ans. 336. With which level of fluorine in water & its daily intake is associated with skeletal fluorosis?

Ans. 336. Fluorine level in water 3 to 6 mg/L.

Que. 337. What is the characteristic feature of dental fluorosis?

Ans. 337. Mottling of dental enamel.

Que. 338. With which level of fluorine in water & its daily intake is associated with mottling of dental enamel?

Ans. 338. Above 1.5 mg/L daily intake.

Que. 339. Mention the name of technique of defluoridation of water recommended by National Environmental Engineering Research Institute (NEERI), Pune?

Ans. 339. Nalgonda technique.

Que. 340. Use of fluoride toothpaste is not recommended in children under 6 years in areas of _____________ ?

Ans. 340. Endemic fluorosis.

Que. 341. What is neurolathyrism?

Ans. 341. It is a crippling disease of the nervous system in adults who consume the pulse, Khesari Dal (Lathyrus sativus) in large quantities.

Que. 342. What are the different stages of neurolathyrism?

Ans. 342. The different stages of neurolathyrism are –

• Latent stage
• No-stick stage
• One-stick stage
• Two-stick stage
• Crawling stage

Que. 343. Name the toxin causing neurolathyrism.

Ans. 343. Beta Oxalyl Amino Alanine (BOAA), the toxin, present in Lathyrus seeds.

Que. 344. Which are the possible interventions for prevention and/or control of lathyrism?

Ans. 344. The possible interventions are –

• Vitamin C prophylaxis – 500-1000 mg for a week once a day.
• Legal action for banning the crop.
• Removal of toxin BOAA by – Steeping method & parboiling.
• Health education
• Genetic modifications of crop.

Que. 345. What are the methods of nutritional assessment?

Ans. 345. The methods of nutritional assessment are as follows –

A – Anthropometry

B – Biochemical Evaluation

C – Clinical Assessment

D – Dietary Assessment

E – Ecological Studies

Que. 346. Define nutritional Surveillance.

Ans. 346. May be defined as keeping watch over nutrition, in order to make decisions that will lead to improvement in nutrition of population.

Que. 347. Which nutritional indicator does denote status of maternal nutrition?

Ans. 347. Birth weight of the newborn.

Que. 348. Which nutritional indicators do denote status of infant & preschool child nutrition?

Ans. 348. Nutritional indicators are as follows –

• Proportion being breastfeed
• Proportion on complementary foods
• Age specific mortality rates
• If age known,
• Height for age
• Weight for age
• If age unknown,
• Weight for height
• Mid arm circumference

Que. 349. Which nutritional indicators do denote status of school child nutrition?

Ans. 349. Weight for age & Weight for height (at 7 years or school admission).

Que. 350. Which are ecological factors related to etiology of malnutrition?

Ans. 350. Ecological factors related to etiology of malnutrition are as follows –

• Conditioning influences e.g. infectious diseases in children.
• Cultural influences
• Food habits, customs, beliefs, traditions & attitude
• Religion
• Food pads
• Cooking practices
• Child rearing practices
• Socio-economic factors
• Food production
• Health & other services
• Nutritional surveillance & rehabilitation
• Nutritional supplementation
• Health Education.

Que. 351. What is the primary aim of food hygiene?

Ans. 351. To prevent food poisoning and other food borne illnesses.

Que. 352. What do you mean by term food hygiene?

Ans. 352. It is hygiene in the production, handling, distribution and serving of all types of food.

Que. 353. What do you mean by aflatoxins?

Ans. 353. Aflatoxins are a group of fungal toxins. These are produced by Aspergillus flavus & A. parasiticus which infest food grains like groundnut, maize, parboiled rice, wheat, rice etc. under conditions of improper storage and produce aflatoxins which are hepatotoxic and carcinogenic.

Que. 354. What are the control & preventive measures of aflatoxicosis?

Ans. 354. The control & preventive measures are as follows –

• Drying
• Proper storage conditions – moisture content <10%.
• Not consuming contaminated foods
• Health education on the health hazards of consuming contaminated grains.

Que. 355. Which disease may result after consumption of claviceps purpurae (field fungus) infested grains?

Ans. 355. Ergotism.

Que. 356. Which are the food grains commonly infested by fungus, ergot?

Ans. 356. Bajra (most commonly), rye, sorghum & wheat.

Que. 357. How will you remove ergot from infested grains?

Ans. 357. Ergot may be removed from infested grains by –

• Floating them in 20% salt water
• Air floatation
• Hand picking.

Que. 358. Which is the toxin responsible for epidemic dropsy?

Ans. 358. Sanguinarine derived from argemone oil. Epidemic dropsy is caused by consumption of mustard oil contaminated with argemone oil.

Que. 359. What is the mechanism of action of Sanguinarine?

Ans. 359. Interferes with the oxidation of pyruvic acid resulting in its accumulation in the blood.

Que. 360. Which are the tests used for the detection of argemone oil?

Ans. 360. The tests are –

• Nitric Acid test
• Paper chromatography test.

Que. 361. What does result in Endemic Ascites?

Ans. 361. Consumption of millet, Panicum milare (known locally as Gondhli), contaminated with weed seeds of crotalaria (Jhunjhunia). Crotalaria seeds contain pyrrolizidine alkaloids which are hepatotoxic.

Que. 362. How much population does a mini AWC cover?

Ans. 362. 150-400.

Que. 363. Who does supervise the work of Anganwadi worker?

Ans. 363. Mukhya Sevikas.

Que. 364. When was the Mid-day meal program launched?

Ans. 364. 1961.

Que. 365. Which broad principles should be kept in mind while formulating mid day meals for school children?

Ans. 365. The broad principles are –

• The meal should be a supplement & not a substitute to the human diet.
• The meal should supply at least one-third of the total energy requirement & half of the protein need.
• The cost of the meal should be reasonably low.
• The meal should be such that it can be prepared easily in schools; no complicated cooking process should be involved.
• As far as possible, locally available foods should be used; reducing the cost of the foods.
• The menu should be frequently changed to avoid monotony.

Que. 366. When was the mid-day meal scheme launched?

Ans. 366. 15^th August 1995 & then revised in 2004.

Que. 367. What are the other names of mid-day meal scheme?

Ans. 367. PM poshan Scheme or National program of Nutritional Support to Primary education.

Chapter – 5 – Mental Health

Que. 368. What do you mean by term Mental Health?

Ans. 368. Mental Health is a state of wellbeing in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community (WHO).

Que. 369. What are the factors affecting mental health?

Ans. 369. The factors affecting mental health are –

• BIOLOGICAL FACTORS –
• Chemical imbalance in brain
• Genetics
• Brain injury
• Chronic illness
• Medications
• Stress
• PSYCHOLOGICAL FACTORS –
• Poor self esteem
• Negative thinking
• SOCIAL FACTORS –
• Family conflict
• Poverty
• Unemployment
• Poor housing
• Infertility
• Loneliness
• EVENTS IN CHILDHOOD –
• Violence & abuse
• Emotional neglect
• Death of a parent

Que. 370. What are the barriers of mental health treatment?

Ans. 370. The barriers of mental health treatment are as follows –

• Stigma
• Lack of access to care
• Lack of affordability
• Poor cultural understanding by the therapists
• Poor health seeking behaviour.

Que. 371. What are the recommended strategies to maintain positive mental health?

Ans. 371. The recommended strategies are –

• Keeping in touch with friends and families who can provide emotional support.
• Engaging in physical activity every day.
• Saying no to new responsibilities when you are already overburdened.
• Getting enough sleep.
• Seeking help from a mental health professional when stress becomes overwhelmed.

Que. 372. Name the most common psychiatric disorders presenting in general health care.

Ans. 372. Anxiety & Depression.

Que. 373. What do you mean by severe mental disorders?

Ans. 373. These cause marked disruption of bio-psycho-socio-occupational functioning. These may affect a person’s ability to recognize & react rationally to the reality and also associated with odd thinking, perception & behaviour.

Que. 374. Name important severe mental disorders.

Ans. 374. Schizophrenia, bipolar affective disorders & delusional disorders.

Que. 375. What are the methods to detect mental illness in the community?

Ans. 375. The methods are –

• Mental Health awareness to the community.
• Capacity building.
• Community Mental Health Camp (Camp Approach)
• Focusing on risk population
• Use of screening tools.

Que. 376. What are the barriers of drug adherence for treatment of mental illnesses?

Ans. 376. The barriers are –

• Lack of awareness about illness
• Medications side effects
• Patient’s lack of belief in benefits of treatment
• Barriers to care or medications
• Complexity of treatments
• The perceived cost of treatment
• Poor relationship with one’s health care provider
• Core psychiatric symptoms
• Missed appointments
• Inadequate follow-up

Que. 377. Name the strategies to improve drug adherence during treatment of mental illnesses?

Ans. 377. Strategies to improve drug adherence are as follows –

• Define illness from patient’s perspective
• Define target symptoms & severity
• Empathy & support
• Provide rationale for use of medication
• Elicit patients resistance
• Disclose the need of medicine & prescribe dose
• Convey hope & optimism
• Develop the therapeutic alliance
• Discuss alternative treatments
• Manage side effects of medication.

Que. 378. What do you mean by Schizophrenia?

Ans. 378. It is a major psychiatric disorder. Onset of the disorder can be sudden or insidious & some time gradual. Disorder mostly has long & continuous course. It affects all the domains of functioning of a person. Paranoid, Catatonic, Hebephrenic, Simple & residual Schizophrenia are the subtypes of Schizophrenia.

Que. 379. What do you mean by Delusional disorders?

Ans. 379. Delusional disorders are characterized by a single or a group of related delusions which are persistent & last long without any other psychiatric symptoms. People with delusional disorders often do not have any significant problems on their socio-occupational functioning apart from the subject of their delusions.

Que. 380. Which are the common delusions encountered in Delusional disorders?

Ans. 380. The common delusions encountered are –

• Delusion of prosecution (Suspicion that somebody may harm)
• Somatic (false belief of having some illness) delusion
• Delusion of grandiose (false belief of having extraordinary power).

Que. 381. What do you mean by mood (affective) disorders?

Ans. 381. It is the most common, severe & persistent psychiatric disorder. Depression, Mania & Bipolar disorders are major categories of mood disorders. Depression & Mania can be graded into mild, moderate and severe based on the severity of symptoms.

Que. 382. What are the anxiety disorders?

Ans. 382. These are a category of mental disorders with complaints of persistent & irrational fear of certain events, objectives & situations.

Que. 383. What are the common anxiety disorders?

Ans. 383. Social phobia, Specific phobia, generalized anxiety disorders, Obsessive Compulsive Disorder, dissociative disorder and somatoform disorders.

Que. 384. What are the diagnostic criteria of drug addiction given by WHO (ICD-10)?

Ans. 384. The diagnostic criteria of drug addiction are –

• Strong desire or sense of compulsion to take the substance
• Loss of control in consuming the substance
• Physiological withdrawal state
• Tolerance
• Progressive neglect of alternate pleasure or interests
• Continuation of use despite of harmful effects

Que. 385. Enumerate common organic mental disorders.

Ans. 385. Dementia & Delirium.

Que. 386. What are the common mental health disorders in children?

Ans. 386. Mental retardation, Learning disability & Attention Deficit Hyperactive Disorder (ADHD).

Que. 387. What are the characteristic symptoms of depression?

Ans. 387. Main symptoms are –

• Depressed mood
• Loss of interest
• Reduced energy or increased fatigue.

Other symptoms are –

• Reduced attention & concentration
• Reduced self esteem
• Ideas of guilt & worthlessness
• Ideas or acts of suicide
• Disturbed sleep
• Decreased appetite

Que. 388. What are the characteristic symptoms of Mania?

Ans. 388. Characteristic symptoms of Mania are as follows –

• Elevated mood
• Increased speech activity
• Sexual energy
• Over familiarity
• Irritability
• Feeling of well being
• Decreased need for sleep

Que. 389. What are the characteristic features of bipolar affective disorder?

Ans. 389. Characterized by periods of prolonged depression alternate with elevated irritable mood or mania.

Que. 390. What are the diagnostic criteria of dementia?

Ans. 390. The diagnostic criteria of dementia are –

• Progressive decline in memory & thinking
• Impairment in the activities of daily living
• Impairment in thinking
• Impairment in memory majority affecting registration, storage and recollection
• Patient has these symptoms in clear consciousness
• Symptoms are present for last 6 months.

Que. 391. What are the diagnostic criteria of delirium?

Ans. 391. The diagnostic criteria of delirium are –

• Impairment in consciousness & attention
• Disorientation & cognitive disturbances
• Psychomotor disturbances
• Disturbances in sleep
• Emotional disturbances
• Sudden onset with fluctuating course.

Que. 392. What are the diagnostic criteria of mental retardation?

Ans. 392. The diagnostic criteria of mental retardation are –

• Impairment in skills
• Development delays in all areas
• Difficulties with functioning in everyday activities of life
• Poor academic performance
• Difficulty in comprehension
• Development delays with or without any other physical or mental problems.

Que. 393. What are the diagnostic criteria of ADHD?

Ans. 393. The diagnostic criteria of ADHD are as follows –

• Impaired attention & over activity
• Frequent change from one activity to other activity
• Accident prone
• Difficulty to discipline
• Frequently makes careless mistakes
• Frequently lose things
• Easily get distracted or get bored
• Often interrupts others
• Early onset (Within 5 years of age).

Que. 394. What are the diagnostic criteria of learning disability in children?

Ans. 394. The diagnostic criteria of learning disability are as follows –

• Difficulty in writing/reading/calculations
• Difficulty in remembering
• Trouble in following directions
• Problem in staying organized
• Inconsistent school performance
• Problems in understanding words & concepts
• Problems in eye-hand coordination
• Difficulty in placing in letters in correct sequence
• Delayed speech development
• Normal IQ.

Que. 395. How will you broadly group psycho-social interventions?

Ans. 395. Psycho-social interventions can be grouped as –

• Individual patient interventions
• Family interventions
• Community based interventions
• Programs aimed at leisure & spare time
• Programs aimed at vocational training, sheltered employment etc.
• Day centres &/or psycho-social rehabilitation centres
• Intensive case management approach & assertive community treatment.

Que. 396. What do you mean by psychoeducation?

Ans. 396. Psychoeducation is an educative method based on clinical findings for providing information & training to families with psychiatrically ill persons to work together with mental health professionals as part of an overall clinical treatment plan for their ill family member.

Que. 397. What do you mean by psychosocial rehabilitation?

Ans. 397. A series of psychosocial & social intervention strategies that complement the pharmacological interventions and management of symptoms & whose aim is to improve personal & social functioning, quality of life & support to the community integration of people affected by chronic & severe mental illnesses.

Que. 398. What are the objectives of district mental health program (DMHP)?

Ans. 398. The objectives of DMHP are –

• To provide mental health services including prevention, promotion & long term continuing care at different levels of district health care delivery system.
• To augment institutional capacity in terms of infrastructure, equipment & human resource for mental health care.
• To promote community awareness & participation in the delivery of mental health services.
• To broad base mental health into other related programs.

Que. 399. What are the components of DMHP?

Ans. 399. The components of DMHP are as follows –

• Service delivery
• Capacity building of staff
• Awareness generation through IEC activities
• Monitoring & Supervision

Que. 400. What is the staffing pattern under DMHP at district level?

Ans. 400. The staffing pattern under DMHP at district level are –

• Psychiatrist – 01
• Clinical psychologist – 01
• Psychiatric nurse – 01
• Psychiatric social worker – 01
• Community Nurse – 01
• Monitoring & evaluation officer – 01
• Case registry assistant – 01
• Ward assistant – 01

Que. 401. What are the details of staff approved at CHC level under National Mental Health Program (NMHP)?

Ans. 401. The staff approved at CHC level under NMHP are –

• Medical Officer – 01
• Clinical psychologist or psychiatric social worker – 01.

Que. 402. What are the details of staff approved at PHC level under NMHP?

Ans. 402. The staff approved at PHC level under NMHP are –

Community Health Worker – 02.

Que. 403. What services come under service provision at district hospital level under NMHP?

Ans. 403. Service provision includes –

• Outpatient services
• Registration
• Assessment
• Counselling/psycho-social education
• Treatment prescription
• Inpatient treatment services
• Dispensing of drugs
• Psychosocial interventions
• Referral/linkages

Chapter 6 – Immunization

Que. 404. What do you mean by term Vaccine Efficacy?

Ans. 404. It refers to percentage reduction in disease incidence in a vaccinated group compared to unvaccinated group, under optimal conditions.

Que. 405. What do you mean by term Vaccine Effectiveness?

Ans. 405. It refers to the benefit it actually provides to the beneficiaries, not under optimal conditions.

Que. 406. What do you mean by term Vaccine Efficiency?

Ans. 406. It is the ratio of outputs & inputs in an immunization program i.e. overall gains made in immunization program through reduction in VPD related mortality & morbidity against the resources invested into the program.

Que. 407. What are the factors on that vaccine efficacy depend?

Ans. 407. Vaccine efficacy depends upon following factors –

• The type of vaccine
• Age at which vaccine is administered
• of doses of the vaccine administered
• Gap between administration of 2 doses
• Administration of booster doses
• Correct route of administration
• Potency of vaccines

Que. 408. What do you mean by term disease extinction?

Ans. 408. It is the stage when a specific infectious agent causing a disease no longer exists in nature or in the laboratory. No disease has been made extinct so far.

Que. 409. What are the criteria for considering a disease a candidate for eradication?

Ans. 409. Considering a disease a candidate for eradication depends on following factors –

• No known animal reservoir
• No long term carrier state
• Lifelong immunity, after recovering from the disease
• Case detection is simple
• People with subclinical infection do not transmit the disease
• Availability of highly effective vaccine providing long term protection
• Global Cooperation & commitment.

Que. 410. Which diseases have been successfully eliminated or eradicated by use of vaccines in routine immunization?

Ans. 410. Smallpox (1977), Poliomyelitis (2014) & Neonatal Tetanus (2015).

Que. 411. What do you mean by HERD IMMUNITY?

Ans. 411. Also known as Community Immunity or Population Immunity. A population with a high number of members with immunity to a particular disease or pathogen may give protection from infection to small number of its non-immune members. This phenomenon is called as Herd Immunity.

Que. 412. What do you mean by term Vaccine Hesitancy?

Ans. 412. It is the behaviour of parents, caregivers or the community, who hesitate to get their children vaccinated inspite of immunization services being available and accessible.

Que. 413. What are the factors contributing to vaccine hesitancy?

Ans. 413. The factors contributing to vaccine hesitancy are –

• Inadequate immunization services
• Non-availability of vaccines
• Absenteeism of vaccinator
• Long distances to vaccination/session sites
• Low perception of benefits of vaccines
• Loss of wages
• Social beliefs/myths
• Fear of AEFIs
• Inadequate IPS skills of health workers
• Geographical barriers

Que. 414. What do you mean by Vaccine Confidence?

Ans. 414. It is when parents, caregivers or the community understand the value of vaccination & voluntarily demand vaccination services as a right. Vaccine confidence is the result of adequate awareness about the benefits of the vaccine, both to the individual and community and trust of quality vaccination.

Que. 415. What do you mean by LEFT OUTS in an immunization program?

Ans. 415. From a service delivery perspective, LEFT OUTS are those children who have never been vaccinated or reached (Unimmunized).

Que. 416. What do you mean by DROP OUTS in an immunization program?

Ans. 416. From a service delivery perspective, DROP OUTS are those children who started vaccination but did not complete the schedule (Partially immunized).

Que. 417. Name the vaccines introduced during last 15 years in India in its Universal Immunization Program?

Ans. 417. Pentavalent Vaccine (2011), IPV (2015), Rotavirus Vaccine (2016), PCV (2017) & Measles-Rubella (MR) vaccine (2017).

Que. 418. What are the upper age limits for various vaccines?

Ans. 418. In National Immunization Schedule, some vaccines have upper age limits on crossing which vaccine should not be given to beneficiaries –

• BCG – up to one year of age.
• OPV – Up to 5 years (OPV zero dose till 15 days of birth)
• MR vaccine – up to 5 years (In MR campaign, 9 months to 15 years of age)
• DPT – up to 7 years of age
• JE – up to 15 years of age.

Que. 419. What is the age limit for pentavalent, IPV, PCV & Rotavirus vaccines?

Ans. 419. These vaccines can be given up to one year of age. If at least one dose of these vaccines are given below one year of age, then remaining doses can be administered & schedule must be completed irrespective of the age of child.

If first dose of the above vaccines are not administered before one year of age, then vaccine cannot be administered to child under UIP.

Que. 420. Which vaccines should be given to a newborn irrespective of place of delivery?

Ans. 420. One dose each of three vaccines – OPV, BCG & Hepatitis B.

Que. 421. Why birth dose of Hepatitis B should be given within 24 hours of birth?

Ans. 421. As it protects the newborn from possible hepatitis B infection transmitted from mother during delivery. It has been found that this vaccination does not protect the newborn if given beyond 24 hours of birth.

Que. 422. At which time Hepatitis B birth dose should be given for maximum protection against hepatitis B transmission?

Ans. 422. Within 12 hours of birth.

Que. 423. Why is the dose of polio vaccine given within 15 days of birth called the zero dose?

Ans. 423. The dose of OPV given within 15 days of birth is called the zero dose because –

• It is given before the scheduled 3 primary doses.
• It is an extra dose which protects the individual from poliomyelitis.

Que. 424. How can pain & swelling at the injection site be managed?

Ans. 424. Can be managed by –

• Cold Compresses
• Paracetamol Syrup or tablet in divided doses.

Que. 425. Can a sick child be vaccinated?

Ans. 425. If a child is sick and suffering from mild illnesses (cough, cold, mild fever & mild diarrhoea) can be safely vaccinated. A child suffering from moderate to severe illness should not be vaccinated during the acute phase.

Que. 426. Can vaccines, especially oral vaccines, be administered to a child with diarrhoea and vomiting?

Ans. 426. Oral vaccines should not be given to a child with recurrent vomiting. Once vomiting is controlled, oral vaccines may be given. Child with mild diarrhoea can receive oral vaccines. Child with moderate to severe diarrhoea should not be given oral vaccines.

Que. 427. Why it is not advisable to clean the injection site with a spirit swab before vaccination?

Ans. 427. This is because some of the live components of the vaccines are killed on applying spirit swab on injection site.

Que. 428. Why do we give the DPT vaccine in the anterolateral mid-thigh & not in gluteal region?

Ans. 428. To prevent the damage to the sciatic nerve. Moreover, the vaccine deposited in the fat of gluteal region does not invoke the appropriate immune response.

Que. 429. Why do we give BCG vaccine only on the left upper arm?

Ans. 429. BCG is given on the left upper arm to maintain uniformity & for helping surveyors in verifying the receipt of the vaccine.

Que. 430. Why do we give 0.05 ml dose of BCG vaccine to newborns (Below 1 month of age)?

Ans. 430. This is because the skin of the newborns is thin & an intradermal injection of 0.1 ml may break the skin or penetrate in to the deeper tissues & cause abscess & enlarged axillary lymph nodes. Dose of 0.05 ml is sufficient to elicit adequate protection.

Que. 431. Why is BCG given only up to one year of age?

Ans. 431. Most children acquire natural clinical / sub clinical TB infection by the age of one year. BCG vaccine also protects against severe form of childhood tuberculosis.

Que. 432. If no scar appears after administering BCG, should one revaccinate the child?

Ans. 432. There is no need to re-vaccinate the child, even if there is no scar.

Que. 433. If the mother permits administration of only one injection during an infant’s first visit at 9 months of age, which vaccine should be given?

Ans. 433. At 9 months of age, priority is to give MR vaccine as injection, followed by OPV & Vitamin A.

SUGGESTED FURTHER READINGS:

1. Park; Park’s textbook of Preventive & Social Medicine, 27^th edition, 2023
2. Government of India; Anaemia Mukt Bharat Guidelines; Ministry of Health & Family Welfare, GoI, 2018
3. AH Suryakantha; Community Medicine with Recent Advances, 3^rd
4. Mahajan & Gupta; Textbook of Preventive & Social Medicine; 4^th edition
5. Government of India; Ayushman Bharat Comprehensive primary health care through health & wellness Centre, Operational guideline; NHSRC, 2018.
6. Government of India; A Guide to Mental Health for Social Worker; National Mental Health Program, 2016.