OSPE – Communicable Diseases

Q1.

1. Identify the infectious disease based on the above mentioned pathognomonic signs in
a 3 year old child? (1)

Measles (Presence of Koplik’s spots – small, bluish-white spots on a red base appears on
the buccal mucosa opposite to the first and second lower molars; Rash – dusky-red,
macular or maculopapular rash begins behind the ears and spreads rapidly over the face
and neck and extends down to the lower extremities)

2. Enumerate the agent, host and environmental factors influencing the transmission
of this disease? (2)

Agent:
RNA paramyxovirus; source – secretions of the nose, throat and respiratory tract of a
case of Measles and no carriers; no animal reservoir; communicability – 4 days before
and 4 days after the appearance of rash.

Host:
Age – 6 months and 3 years of age; gender – equal; immunity – life long immunity,
maternal antibodies; nutrition – malnutrition (lack of breastfeeding, Vitamin A
deficiency).

Environment:
Winter and early spring (January to April); low socio-economic conditions;
overcrowding.

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3. How will you prevent this infectious disease? (2)

Measles Vaccination:
 MR vaccine – 9 to 12 months and 16 to 24 months
 Live attenuated
 0.5 ml SC in right upper arm
 Epidemic – 6 months of age but not counted
 Protective efficacy – 85 to 95%
 No OVP (4 hours) – TSS
 ADR – Thrombocytopenic purpura, Anaphylaxis, Arthralgia, febrile seizures and
transient rash
 CI – Immunosuppression, Allergy and Pregnancy (CRS)
 HIV – no contraindication if the immunity is adequate

Immunoglobulins:
 Early in the incubation period
 WHO - 0.25 ml/ kg body weight
 Given within 3-4 days of exposure
 Vaccine after 8-12 weeks
 Need reduced due to effective vaccine

 Global Measles and Rubella Strategic Framework 2021 – 2030 (MRSF)

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Q2.

1. Identify the infections disease based on the above mentioned signs and symptoms in
a 5 year old child? (1)

Diphtheria

2. Describe the epidemiological determinants of this disease? (2)

Agent – Corynebacterium diphtheria (gram positive non-motile)

Source – case or carrier
Incubation Period – 2 to 6 days
Mode of transmission – droplet infection (main mode), directly from cutaneous lesions
and fomites
Period of infectivity – 14 to 28 days from onset of disease

3. Enumerate the preventive measures for this infectious disease? (2)

Immunization – DPT vaccine and Pentavalent vaccine in children; Td vaccine in

adolescents and pregnancy

Pentavalent vaccine:
 DPT + Hep B + Hib
 6, 10 and 14 weeks
 Birth dose of Hep B and two boosters of DPT (Hib – protection for 15 years)

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  Killed vaccine
 0.5 ml, IM in Anterolateral aspect of left mid-thigh
 2 – 8 degree celsius and freeze sensitive
 Protective efficacy – 85 to 95%
 Reduces nasopharyngeal carriage of H. Influenza – herd immunity
 OVP – 28 days
 CI – Allergy or acute illness
 ADR – Persistent inconsolable screaming, seizures, hypotonic hyporesponsive episode,
Anaphylaxis and Encephalopathy

Td vaccine:
 Pregnancy, 10 years and 16 years
 Epidemiological transition – Diphtheria outbreaks in adolescents and adults
 Killed toxoid
 0.5 ml IM in Upper arm
 2 to 8 degree celsius and not frozen (Shake test)

 Early detection, isolation and treatment of cases and carriers; contact

tracing.

Q3. A 1 year old lethargic child was brought to the PHC with complaints of fever, cough
and feeding difficulties for one week. On examination, fast breathing (RR - > 60 breaths/
min), stridor and chest indrawing were observed.

1. Classify the above condition according to IMNCI guidelines? (1)

Severe Pneumonia (Fast breathing, stridor and chest indrawing)

2. How will you manage this condition? (2)

Refer urgently to tertiary care centre (IMNCI colour coding - Pink)

Antibiotics (IM Injections of Benzyl Penicillin, Ampicillin or Chloramphenicol)
Treat fever and wheeze
Monitor fluid and food intake
Keep the child warm and prevent low sugar
Follow-up

3. Enlist the control measures to combat Acute Respiratory Infections in under 5

children? (2)

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 Improved living conditions
Better nutrition
Reduction of indoor air pollution
Better MCH care
Exclusive breastfeeding
Immunization – Measles vaccine, Hib vaccine, Pneumococcal vaccine

Q4. A 40 year old factory worker was brought to the hospital with complaints of fever and
cough for 2 weeks, breathing difficulty, evening rise of temperature and weight loss. He is a
known case of Diabetes Mellites for 5 years. Further, Acid Fast Bacilli was observed in Z-N
staining.

1. Based the above case scenario identify the disease condition? (1)

Bacteriologicaly Confirmed Tuberculosis

2. List out the investigations and laboratory tests available for the above condition? (2)

Microbiological Confirmation:
1. Sputum smear microscopy (for AFB)
 Zeihl Neelsen staining
 Fluorescence staining
2. Culture
 Solid - Lowenstein Jensen Media
 Automated Liquid Culture - BACTEC MGIT 960, BacT Alert or Versatrek

Rapid Molecular Tests:

 Line probe assay (LPA) for MTB complex and detection of RIF & INH resistance (FL
LPA) and FQ and SLI resistance (SL LPA)
 Nucleic acid amplification test (NAAT) - CBNAAT/ Truenat

Clinical Diagnosis:
 Chest X-ray and other radiological tests
 Tuberculin Skin test (TST), Interferon gamma release assay (IGRA) and other blood
tests, histopathology and other tissue-based tests

3. Explain the pharmacological treatment for the above disease condition? (2)

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Q5.

1. Identify this vaccine preventable disease? (1)

Poliomyelitis

2. What do you mean by ‘SWITCH’? (2)

 Background - type 2 eradicated since 1999 and risk of VDPP (Type 2)
 So, tOPV converted to bOPV (1,3)

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  Addition of fIPV at 6 and 14 weeks (protect against type 2)
 2015 to 2016

3. Mention the preventive strategies to eradicate this infectious disease in India? (2)

• Rapid Response team in outbreaks

• UP & Bihar - new born child vaccinated in polio immunization campaigns and tracked
for 8 rounds
• PPI every year and monitoring
• Transit points - mobile teams
• AFP Surveillance and environmental surveillance
• Sanitation, hygiene and clean drinking water
• Migratory population covered in Sub National Immunization Day in UP & Bihar
• Social mobilization and community participation
• Emergency stock of OPV

Q6. A 30 year old male, who is an injecting drug user, has presented with features of
yellowish discoloration of eyes and dark urine. On examination, he is also found to have an
enlarged liver.

1. Based on the above case scenario what is your most probable diagnosis? (1)

Hepatitis B

2. Mention the high risk groups susceptible for this infection and the modes of
transmission? (2)

IV drug users (Parenteral transmission)

Sex workers (Sexual transmission)
Healthcare professionals (Parenteral transmission)
Recipients of organ transplantation and blood transfusion (Parenteral transmission)
Child of an infected mother (Perinatal transmission)

3. Mention the National Health Programme launched by Ministry of Health and

Family Welfare for preventing this disease and its’ key strategies? (2)

National Viral Hepatitis Control Programme

1. Enhance community awareness on hepatitis and lay stress on preventive measures among
general population especially high-risk groups and in hotspots.

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 2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis
and its complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human
resource and raise additional human resources, where required, for providing
comprehensive services for management of viral hepatitis and its complications in all
districts of the country.
5. Develop linkages with the existing National programmes towards awareness, prevention,
diagnosis and treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain
a registry of persons affected with viral hepatitis and its sequelae.

Q7.

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1. Identify the disease based the above signs and symptoms? (1)

Leprosy (Hanson’s disease) caused by Mycobacterium leprae

2. Mention the clinical classification and treatment for this disease? (2)

3. Briefly enumerate the key strategies in National Programme to eradicate this

disease? (2)

Strategies in National Leprosy Eradication Programmne:

 Case detection
 Disability prevention and medical rehabilitation
 IEC and BCC
 Human resource and capacity building
 Program management

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Q8. On the 7th day of postpartum, a baby delivered at home by an untrained dai became
unable to suck and developed rigidity in the body. On history, it was found that the mother
was illiterate and had no antenatal checkups and immunization. In addition, cow dung was
applied over the umbilical stump.

1. What is your most probable diagnosis based on the above mentioned case scenario?
(1)

Tetanus neonatorum caused by Clostridium tetani

2. List out the six clean delivery practices to prevent this infection? (1)
 Clean surface
 Clean hands
 Clean blade
 Clean cord tie
 Clean stump
 Clean perineum

3. Discuss about the post exposure prophylaxis following injury to prevent this
disease? (1½)

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4. What are the initiatives undertaken by Indian Government to eliminate this
disease? (11/2)

 Increasing and sustaining TT immunization of pregnant women

 Promotion of Institutional Deliveries
 Training of birth attendants
 Ensuring adequate supply of Disposable Delivery kits
 Strengthening the surveillance system
 Continuation of IEC

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Q9.

1. Identify this rickettsial disease? (1)

Scrub Typhus
(Eschar; Mite)

2. What is Tsutsugamushi triangle? (1)

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 3. Enumerate the agent, host and environmental factors involved in the transmission
of this infection? (2)

Agent:

Orientia tsutsugamushi

Reservoir and vector – Leptotrombidium deliense (Thromboculid mite)

Host:

Natural infection in rodents

Humans are accidental hosts while entering jungle

No human to human transmission

Environment:

Sandy beaches, mountain deserts, rain forests and clearance of forest area

4. Name the most widely used test to diagnose this infection? (1)

Weil- Felix test (Serological test) – In Scrub typhus strongly positive for Proteus strain
OXK.

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Q10.

1. Identify this vector borne disease? (1)

Lymphatic Filarias

2. Discuss about the breeding habits of vectors involved in transmitting this disease?
(2)

Culex (Wuchereria bancrofti) – dirty and polluted waters

Mansonia (Burgia Malayi )– Aquatic plants like Pistia

3. How will you prevent this disease? (2)

 Microfilaria survey
 Annual Mass Drug Administration (DEC and Albendazole)
 Integrated Vector control measures

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