OSPE – Non-communicable Disease
Q1.
1. What does this diagram depicts? (1)
Rule of halves
2. What are the modifiable and non-modifiable risk factors in hypertension? (1 1/2)
Modifiable risk factors:
Obesity • Diet (Salt, Saturated fat s, Dietary fibres) • Alcohol • Tobacco • Physical
activity • Stress • Socio‐Economic Status
Non-modifiable risk factors:
Age • Sex • Genetic factors • Ethnicity
3. Mention the classification of hypertension? (1 1/2)
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4. What is meant by ‘DASH’ strategy? (1)
Dietary Approaches to Stop Hypertension (DASH) - Consume diet rich in fruits,
eating plan vegetables & low‐ fat diary products with reduced content of saturated fat &
total fat.
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Q2. A 45 year old technical support manager visits a PHC. He is a known case of Diabetes
and Hypertension for the past 5 years and is not taking the drugs regularly. Owing to his
stress filled life, he is addicted to smoking and alcoholism for the past 10 years. In addition,
he is physically inactive and obese. Recently, his 70 year old father died of Myocardial
Infarction.
1. What are the modifiable and non-modifiable risks for the development of an acute
coronary event in the next few years in this person? (1 1/2)
Non-modifiable risk factors – Age, Sex and Family history
Modifiable risk factors – Sedentary lifestyle, stress, physical inactivity and obesity, smoking,
alcoholism, DM and HTN
2. How will you prevent coronary artery disease in this person? (2)
3. Enlist the key strategies in NPCDCS Programme? (1 ½)
Health promotion through behavior change with involvement of community, civil
society, community based organizations, media etc.
Outreach Camps are envisaged for opportunistic screening at all levels in the health care
delivery system from sub-centre and above for early detection of diabetes, hypertension
and common cancers.
Management of chronic Non-Communicable diseases, especially Cancer, Diabetes,
CVDs and Stroke through early diagnosis, treatment and follow up through setting up of
NCD clinics.
Build capacity at various levels of health care for prevention, early diagnosis, treatment,
IEC/BCC, operational research and rehabilitation.
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Provide support for diagnosis and cost effective treatment at primary, secondary and
tertiary levels of health care.
Provide support for development of database of NCDs through a robust Surveillance
System and to monitor NCD morbidity, mortality and risk factors.
Q3. A 56 year old business man developed weakness in his right arm, face and legs and
shifted immediately to the emergency department. On examination, power was reduced
in right upper and lower limbs. He was started on r TPA and underwent
physiotherapy. He was also put on anti-platelets, anti-hypertensives and statins. He is a
known case of Hypertension for the past 10 years.
1. What is the most likely diagnosis based on the above mentioned case scenario? (1)
Stroke/ CVA (Right Hemiplegia)
2. Mention the common risk factors for this disease? (1 ½)
High BP
Smoking, Alcoholism
Obesity
High cholesterol
Diabetes
TIA
Physical inactivity
Family history, age and gender
Prolonged OCP usage
Mental and emotional stress
Sleep Apnea
Pre-existing cardiovascular disease
3. How will you prevent this condition? (1 ½)
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4. Name the programmes related to this disease? (1)
NPCDCS
National Stroke Registry Programme
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Q4.
1. Based on the above signs and symptoms, identify the disease condition? (1)
Rheumatic Heart Disease (Jones Criteria)
2. What is iceberg phenomenon of Rheumatic Heart Disease? (2)
3. How will you prevent this disease? (2)
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Q5. Mention the risk factors and preventive measures for the following cancers (5)
A. Cervical cancer
HPV infection, middle age, early marriage and coitus, early child bearing,
multiparity, lack of personal hygiene, multiple sex partners, low
socioeconomic status, oral contraceptive usage, illiteracy.
Hygiene, health education, vaccination, screening.
B. Breast CA
Genetic, Family history, age, parity, marriage, lifestyle, high SES, OCP usage,
diet and alcohol consumption.
Diet, exercise, screening.
C. Oral cancer
Smoking, Smokeless forms of Tobacco
Tobacco Control Legislation
D. Lung cancer
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Smoking, occupational exposure, indoor air pollution, radiation exposure
Tobacco Control Legislation, Ergonomics, avoiding firewood cooking
E. Hepatocellular CA
Hepatitis B and C infection, Afalatoxin
Vaccination, avoiding food additives
Q6. Identify the cancers based on the risk factors (5)
A. Low socioeconomic status
Cervical CA
B. High socioeconomic status
Breast CA
C. Lack of dietary fibres
Colorectal CA
D. Excessive dietary fats
Breast CA
E. Smokeless forms of tobacco
Oral CA
F. Smoking
Lung CA
G. Viral infection
Hepatocellular CA and Cervical CA
H. Aflatoxin
Hepatocellular CA
I. Family History
Breast and ovarian CA
J. Obesity
Breast CA
Q7. 1. Mention screening tests for the following cancers (2 1/2)
A. Prostatic CA
Prostate specific antigen
B. Colorectal CA
Fecal occult blood and endoscopy
C. Cervical CA
Visual inspection with 5% acetic acid and Pap smear
D. Breast CA
Breast self examination and Mammography
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E. Oral CA
Visual inspection of oral cavity for precancerous lesions
2. Enlist the methods of cancer screening? (1)
Mass and selective screening
3.Enumerate the types of cancer registries? (1 ½)
Hospital-based and population-based cancer registries
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Q8.
1. Identify the above mentioned tabulation and state its’ significance? (1 1/2)
The Haddon Matrix is the most commonly used paradigm in the injury prevention field.
Developed by William Haddon in 1970, the matrix looks at factors related to personal
attributes, vector or agent attributes and environmental attributes; before, during and after
an injury or death. By utilizing this framework, one can then think about evaluating the
relative importance of different factors and design interventions.
2. Enumerate the agent, host and environmental factors in road traffic accidents? (1
½)
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3. What are the control measures to prevent road traffic accidents? (2)
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Q9. A 60 year old male with history of DM for the past 10 years is experiencing progressive
blurring of vision in his left eye and his glycemic control is poor.
1. What is your provisional diagnosis based on the above mentioned case scenario? (1)
Diabetic Retinopathy
2. What are the causes for avoidable blindness and how it can be prevented? (2)
3. Discuss about ‘Vision 2020’? (2)
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Q10. A 45 year old male presented with complaints of painlessnon-healing ulcer in the
right great toe and he is having symptoms of polyuria, polydipsia and polyuria. His mother
is a known case of Diabetes for the past 10 years.
1. Based on the above case scenario, what is your most probable diagnosis? (1)
Diabetic foot ulcer (Peripheral Neuropathy)
2. Enumerate the WHO recommended criteria for the diagnosis of hypertension? (2)
3. Discuss briefly about the levels of prevention in Diabetes? (2)
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