OSPE

Communicable Diseases (question on the disease, management, control,

prevention and programme)
1. Malaria

Q. A 22 yr old college student was brought to the PHC with history of

fever recurring 2-3 days, chills, rigor, sweating and myalgia. He had
travelled to North eastern states before 10 days. The peripheral smear
picture was as shown below

1. What is the probable diagnosis? (1 mark)

2. Name any 4 vectors involved and the disease-causing agents? (1
mark)
3. How do you diagnose the disease? (1 mark)
4. Treatment regime for uncomplicated cases of different species of
the disease-causing agents? (1 mark)

Ans:
1. Malaria
2. An.culicifacies, An.stephensi, An.fluviatilis, An.minimus, An.dirus
and An.epiroticus. Agents- P.falciparum, P.ovale, P.malariae,
P.vivax
3. Clinical examination and Laboratory diagnosis – Microscopy,
Serological test, RDT
4. Treatment for P.vivax (CQ 25mg/kg for 3 days & PQ 0.25mg/kg
daily for 14 days) and uncomplicated P.falciparum in North East
(ACT-AL: Artemether 20mg + Lumefantrine 120mg and PQ 0.75
mg/kg on day 2) and other states (ACT-SP : Artesunate 4mg/kg for
 3 days + Sulfadoxine 25mg/kg – Pyraminthamine 1.25kg on first
day and PQ 0.75 mg/kg on day 2).

2. Rabies
Q. A 12-year-old boy comes to the OP with history of scratch from his
pet dog. On examination, there was a 1 cm linear abrasion on his forearm.
1. What is this category of injury? (1 mark)
2. How do you manage this case? (2 marks)
3. What is the dose of rabies immunoglobulin? (1 mark)

Ans:
1. Category II
2. Local Wound management and Rabies Vaccine (0.1 ml intradermal
injections on bilateral deltoid on Day 0,3,7 and 28 or 0.5ml
intramuscular single side on Day 0,3,7,14 and 28)
3. HRIG: 20IU/Kg of body weight and ERIG: 40 IU/Kg of body weight

3. Leptospirosis
Q. A 37-year-old sewer cleaner presented in the OPD with Fever,
headache, muscle aches, jaundice and subconjunctival hemorrhage. On
investigation, the gold standard Microscopic agglutination test (MAT) test
was positive.
1. What is the diagnosis? Mention its causative agent and the vector (1/2
+ 1/2 mark)
2. List 4 occupations with high risk of acquiring this disease. (1/2 + 1/2
mark)
3. What is the drug of choice and what is the drug used as
chemoprophylaxis (1 mark)
4. What are the preventive measures? (1 mark)
Ans
1. Leptospirosis. Leptospira and Rats
2. Farmers, veterinarians, Miners, Construction workers, slaughter house
workers, military personnels, Sewer / Drain cleaners, Laboratory
workers
3. Penicillin and Doxycycline
4. Environmental measures and vaccination
4. Leishmaniasis
Q. A 34-year-old migrant labourer from Bihar was brought to the PHC
with irregular bouts of fever, weight loss, anemia, hepatosplenomegaly,
 and abdominal pain. Aldehyde test of Napier was positive. Needle
aspiration of spleen showed amastigote form of the parasite.

1. What is the probable diagnosis? (1 mark)

2. Name 2 vectors for this disease? (1 mark)
3. What are the control measures? (1 mark)
4. Name the National Programme for this disease? (1 mark)
Ans:
1. Leishmaniasis
2. Female sandfly – P.argentipes, P.papatasi, P.sergenti
3. 1.Control of Reservoir: Treatment- Inj.Liposomal Amphotericin ,
Miltefosine. 2. sandfly control. 3.Personal prophylaxis.
4. National Vector Borne Disease Control Program (NVBDCP)

5. STD
Q. A 54 year truck driver comes to your OPD with complaints of urethral
discharge. He gives the history of sexual intercourse with multiple
women.
1. Treatment of this patient. (1 mark)
2. Name the National programme for this disease. (1 mark)
3. Write the number, colour and syndrome for which the colour coded kits
are available. (2 marks)
Ans:
1. Tab Cefixime 400mg orally, single dose + Tab. Azithromycin 1g
orally, single dose.
2. NACP
3. Pre-packed STD colour coded kits. Kit 1- Grey, for urethral discharge,
ano-rectal discharge and cervicitis; Kit 2- Green, for vaginitis; Kit 3-
White, for genital ulcers; Kit 4- blue, for genital ulcers; Kit 5- red, for
genital ulcers; Kit 6 – yellow, for lower abdominal pain; Kit 7- black,
for inguinal bubo.

6. Leprosy

Q. During a medical camp at the Migrants settlement in your PHC area,

you find a 41 years old man with 7 hypopigmented patches with loss of
sensation to light touch and pain (in his body) and no nerve thickening on
palpation during clinical examination.
1. What is the clinical classification of this patient according to WHO? (1
mark)
 2. What is the treatment for this patient (1 mark)
3. Name the National programme for this disease (1 mark)
4. What are the modes of intervention for tertiary prevention in this case
(1 mark)
Ans.
1. Multibacillary leprosy
2. MB blister pack for 12 months. Rifampicin – 450mg once daily,
Dapsone-50mg daily, Clofazimine 150mg once a month + 50mg daily.
3. NLEP
4. Reaction management, self-care practices, provision of MCR
footwear, aids and appliances, referral services.

7. AIDS
Q. A 43 year old male came with h/o loss of weight, chronic diarrhoea
and fever for more than 1 month. On examination there was generalised
lymphadenopathy and oral candidiasis.
1. List 4 minor signs of HIV (1 mark)
2. What are the services of ICTC (1 marks)
3. Name the National programme for HIV (1 marks)
4. What are the preventive measures for his partner? (1 mark)

Ans
1. persistent cough > 1 month, generalized pruritic derma

titis, h/o herpes zoster, oropharyngeal candidiasis, chronic progressive or

disseminated herpes simplex infection, generalised lymphadenopathy.
2. Early detection of HIV, counselling, IEC on modes of transmission and
prevention for promoting behavioural change and reducing vulnerability,
condom supply, linking PLHIV with HIV care and treatment services.
3. NACP
4. HIV testing and treatment, Pre-exposure prophylaxis, safe sex
practices, Emotional Support and counselling.

8. Tuberculosis

A 35-year-old male, a construction worker, presents to the community

health center with a history of persistent cough for 3 weeks, weight loss,
fever in the evenings, and night sweats. On further inquiry, he mentions
that he has had a history of exposure to a person who was diagnosed with
pulmonary tuberculosis. He has also been feeling fatigued and has a
decreased appetite.

1. List the key clinical features you would expect in a case of pulmonary
tuberculosis based on this patient’s presentation. (2 Marks)

 Cough (more than 2 weeks duration): Persistent cough is a hallmark

symptom of pulmonary TB.
 Weight loss (Cachexia): A common finding due to chronic infection.
 Fever (especially evening or night sweats): Often seen in TB as part of
the systemic inflammatory response.
 Fatigue and Weakness: General malaise due to chronic infection.
 Hemoptysis (in some cases): Though not always, some TB patients
present with blood-tinged sputum.
 Loss of appetite: Associated with weight loss and systemic symptoms of
TB.

2. What are the standard diagnostic tests that you would recommend for
confirming a diagnosis of tuberculosis. (2 Marks)

 Sputum Smear Microscopy (Ziel-Neelsen Staining): To detect acid-fast

bacilli (AFB).
 Chest X-ray: To identify characteristic lung lesions, such as cavitary
lesions and infiltrates.
 Sputum Culture for Mycobacterium tuberculosis: This is more sensitive
than smear microscopy and is the gold standard for diagnosing TB.
 Molecular Tests (e.g., GeneXpert MTB/RIF): Rapid test for detecting
Mycobacterium tuberculosis and rifampicin resistance.

9. Poliomyelitis

A 2-year-old child is brought to the clinic with fever and sudden-onset

weakness in the right leg. Tripod sign is positive.

1. Identify the likely condition and caustative agent?(1 mark)

 Acute Flaccid Paralysis, likely due to poliomyelitis.

2. Name the mode of transmission of this disease.(1 mark)

 Fecal-oral route
3. Suggest a preventive measure to control the disease at the community
level.(2 marks)

 Routine immunization using Oral Polio Vaccine (OPV) or Inactivated

Polio Vaccine (IPV), and maintaining sanitation.

10. Food poisoning

A group of 20 people attended a wedding and reported similar symptoms of

diarrhea, abdominal pain, and fever 12–24 hours after consuming food.

1. What steps would you take to investigate this outbreak? (2mark)

 Obtain a detailed history of food consumption from all affected

individuals.
 Collect stool samples from patients and suspected food items for
laboratory analysis.
 Conduct an inspection of the food preparation site for hygiene practices.
 Identify common exposures among affected individuals.

2. List four key preventive measures to avoid food poisoning. (2mark)

 Maintain proper hand hygiene and cleanliness during food preparation.

 Store perishable foods at appropriate temperatures (below 5°C or above
60°C).
 Avoid cross-contamination by using separate utensils for raw and cooked
foods.
 Ensure thorough cooking of foods, especially meat and poultry.

11. Typhoid fever

A 25-year-old male presents to the outpatient department with a history of

fever for 10 days, associated with abdominal pain, headache, and
constipation. On examination, his temperature is 39°C, and he has a coated
tongue and splenomegaly.

1. What is the most likely diagnosis? (1mark)

 Typhoid fever

2. List two specific laboratory tests to confirm this diagnosis. (1 mark)

 Widal test (serology for Salmonella typhi antibodies).

  Blood culture (to isolate Salmonella typhi).

3. Suggest two preventive measures to be advised to the person to prevent

further occurrence of such episode. (2 marks)

 Ensure safe drinking water through chlorination or boiling.

 Promote proper hand hygiene, especially before eating and after using the
toilet.
12.1ADD

A 2-year-old child presents to the community health center with acute onset
of loose, watery stools for the past two days. The child appears lethargic
and has sunken eyes.

1. What is the likely complication in this patient? (1 mark)

 Dehydration.

2. What are the signs to assess dehydration? (2 marks)

 Appearance – Drowsy, limp cold, sweaty, may be comatose
 Radial Pulse - Rapid , feeble sometimes inpalpable
 Blood pressure – Less than 80mmhg
 Skin elasticity – Pinch retracts very slowly (more than 2 seconds)
 Tongue – Very dry
 Ant.Fontanelle – Very sunken
 Urine Flow – Little or none

3. How will you classify this child under IMNCI? (1 mark)

This child has to be categorized under PINK category.

13. Dengue

A 28-year-old male presents to the community health center with high-

grade fever for the past five days, accompanied by severe headache, retro-
orbital pain, and myalgia. On examination, he has a positive tourniquet test
and petechial rashes on his limbs.

1. What is the probable diagnosis & two laboratory investigations you

would recommend to confirm the diagnosis. (1 mark)

 Dengue Fever
  Dengue NS1 antigen test (early detection). Platelet count and hematocrit
levels.

2. List two environmental control measures to reduce mosquito breeding. (1

mark)

 Eliminate stagnant water from containers, tires, and flowerpots.

 Cover water storage containers to prevent mosquito breeding.

3. When will you say that this individual has shock syndrome? (2 marks)

 Tachycardia, cool extremities,delayed capiilary refill,weak pulse, lethargy

or restlessness.

(or)

 Pulse pressure < 20mmhg with increased diastolic pressure, 100/80mmhg

(or)

 Hypotension by age, defined as systolic pressure < 80mmhg for those

aged < 5 years, or 80 to 90mmhg for older children / adults.

NON-COMMUNICABLE DISEASES
1. Obesity
A 35-year-old female came to OPD with complaints of weight gain has h/o
consuming oral contraceptives. On examination her weight was 80kgs and
height was 154cms.
1. Define Body mass index? (2 marks)
It is defined as the weight in kilograms divided by the square of height in
metres
2. What is the BMI of this patient? (1 mark)
BMI= Weight(kg)/Height(m2)
BMI= 80/(1.54×1.54) = 33.75
3. Enlist any 2 drugs causing weight gain. (1 mark)
Corticosteroids, Contraceptives, β- adrenergic blockers, insulin

2. Hypertension
A 53-year-old male came to OPD with giddiness with no postural variation
for 2 months. While examining his Blood pressure at sitting posture for 3
consecutive days the Blood pressure read 150/100mmHg, 146/100mmHg,
140/90mmHg.
1. What are all the sources of error in recording blood pressure? (1
mark)
Observer error, Instrumental error, Subject error
2. Enlist any 4 modifiable risk factors of hypertension (1 mark)
Diet intake, Physical inactivity, Alcohol intake, stress, Low Socio-
economic status, Obesity
3. How will you advise lifestyle modifications for this patient? (2 marks)
 Maintain normal body weight
 Adopt DASH diet
 Reduce dietary sodium intake to no more than 100mEq/day
 Engage in regular aerobic physical activity(at least 30 minutes/
day)
 Limit consumption to no more than two drinks/day
3. Diabetes Mellitus
A 42-year-old male came to OPD with complaints of increased thirst,
frequent urination for 2 months. On examination his Fasting blood
glucose was 222mg/dl, postprandial blood glucose was 331mg/dl and his
HbA1c was 8.2%
1. How will you classify Diabetes Mellitus? (2 marks)
 Type 1 DM(due to autoimmune b cell destruction)
 Type 2 DM (due to progressive loss of adequate b cell insulin
secretion)
 Specific types of diabetes due to other causes e.g., neonatal
diabetes, maturity onset diabetes of the young, cystic fibrosis,
pancreatitis, drug induced, gestational diabetes
2. What is the ADA recommended diagnostic criteria for Diabetes
Mellitus? (2marks)
 HbA1c ≥6.5% or
 Fasting plasma glucose ≥ 126mg/dL (Fasting intake is defined as
no caloric intake for at least 8 hours) or
 2- hour plasma glucose ≥ 200mg/dL during an OGTT or
 In a patient with classic symptoms of hyperglycemia or
hyperglycemic crisis, a random plasma glucose ≥ 200mg/dL
4. Cancer
A 35-year-old woman presents with post-coital bleeding and a foul-smelling
vaginal discharge for the past 2 months
1. What are the important risk factors you enquire for this patient? (2
marks)
 Early age at first sexual intercourse
 Multiple sexual partners
 History of Sexually transmitted Infection
 Smoking
 Immunosuppression
 Long term use of oral contraceptive
2. What investigation you will perform in this patient? (1 mark)
 Pap smear
 HPV test
 Colposcopy
 Cervical biopsy
3. What is the National programme in India for prevention of this
condition? (1 mark)
National Programme for Control and Prevention of Non- Communicable
diseases
5. Blindness
A 55-year-old male presents with gradual painless loss of vision in both eyes
over the past few years
1. Define blindness according to WHO? (2 marks)
Blindness is defined as visual acuity of less than 3/60 or corresponding
visual field loss in the better eye with the best possible correction
2. What are the risk factors for blindness? (1 mark)
 Age related macular degeneration
 Diabetic retinopathy
 Glaucoma
 Cataract
 Hypertension
 Family history of eye diseases
3. What is the National programme in India for prevention of
blindness? (1 mark)
 National programme for the control of Blindness and visual impairment
6. Mental health
A 25-year-old male presents with a history of low mood, decreased interest
in activities, difficulty concentrating, and loss of appetite for the past 2
weeks.
1. Enlist any 4 warning signals of poor mental health (2 marks)
 Are you always worrying?
 Are you unable to concentrate because of unrecognized reasons?
 Are you continually unhappy without justified cause?
 Do you lose your temper easily and often?
 Are you troubled by regular insomnia
 Do you have wide fluctuations in mood?
 Do you continually dislike to be with people?
 Are you upset if the routine of your life is disturbed?
 Do your children consistently get on your nerves?
 Are you browned off or constantly better
 Are you afraid without real cause?
 Are you always right and the other person always wrong?
2. What is the National programme benefitting this patient? (1 mark)
 District Mental Health programme
3. Enlist the components of the programme for this patient (2 marks)

 Early detection & treatment.

 Training: imparting short term training to general physicians for
diagnosis and treatment of common mental illnesses with limited
number of drugs under guidance of specialist. The Health workers
are being trained in identifying mentally ill persons.
 IEC: Public awareness generation.
 Monitoring: the purpose is for simple Record Keeping.

7. Estimation of pregnancies in an area

Consider yourself a medical officer at a Primary Health centre (PHC) of an
area with a birth rate 20/1000 population and the population under the
PHC being 12,000. You are tasked to train the ANM of the particular area
in calculating the expected number of live births per year
 1. Calculate the Expected number of pregnancies for the above-
mentioned scenario (2marks)
 Expected no of live birth/ year= (Birth rate/1000 population) ×
(population of area)
1000
 Correction factor of 10% to be added with final value to still births,
abortions may be missed
 Expected no of live birth/ year= 20 × 12,000
1000
=240 births
 Correction factor(10% of 240 births) =24
 Total number of expected pregnancy/ year= 240 + 24=264
births/year
2. What is the responsibility of ANM if the registered number of
pregnancies is less than the expected number of pregnancies? (2
marks)
If the number of registration is less for a month ANM should approach
community leaders and key people to ensure registration. ASHA must
visit all the house and ensure all pregnant women are registered. ANM
must keep tract of all the pregnant women in her area.

OCCUPATIONAL DISEASES
I. Lead poisoning:
Scenario: A 4-year-old child is brought to the clinic with complaints of
abdominal pain, constipation, irritability, and clinical examination he had bluish
gum line. On further inquiry, it is found that the family live in an old house with
peeling paint and he always plays outside with barefoot.
1.) What is the most likely diagnosis?
2.) What is the most likely source of exposure in this child?
3.) List out the clinical features?
4.) What lab investigations would you do to confirm your diagnosis?

Key:
1. What is the most likely diagnosis?
Lead Poisoning is the most likely diagnosis based on the child's
symptoms.
2. What is the most likely source of exposure in this child?
The most likely source of exposure in this case is lead-based paint. The
child lives in an old house with peeling paint, and exposure to lead-based
paint dust is a common cause of lead poisoning, especially in children.
3. List out the clinical features:
 Gastrointestinal: Abdominal pain, constipation, loss of appetite, vomiting
 Neurological: Irritability, hyperactivity, learning difficulties,
developmental delays, seizures, coma
 Hematological: Anemia
 Renal: Kidney damage
 Other: Blue-gray line on the gums (Burton's line)
4. What lab investigations would you do to confirm your diagnosis?

1. ALA (Aminolevulinic Acid) in urine: >5mg/L indicates lead absorption.

2. CPU (coproporphyrin in urine)
3. Blood Lead Level (BLL): This is the gold standard for diagnosing lead
poisoning. A BLL of >70 µg/100ml is associated with clinical symptoms
4. Lead in urine >0.8mg
5. Complete Blood Count (CBC): To assess for anemia, a common
complication of lead poisoning.
6. Kidney Function Tests: To evaluate kidney function, as lead can damage
the kidneys.
7. Other tests: Depending on the severity of the poisoning, other tests may
be considered, such as X-ray of the abdomen to check for lead-based
paint chips in the gastrointestinal tract.

II. Hazards of agricultural worker

Scenario: A 42-year-old male farmer presents to the clinic with complaints of
headache, nausea, dizziness, and muscle twitching after spraying pesticides on
his crops for several hours on without any protective gear. He was also exposed
to direct sunlight during the activity. On examination, he has pinpoint pupils,
excessive salivation, and sweating. Laboratory investigations reveal decreased
serum cholinesterase levels.
1.) What is the most likely cause of the symptoms in this farmer?
2.) What preventive measure could have reduced the risk of this condition?
3.) List out the various occupational hazards of agricultural worker? (2m)

Key:
1.) What is the most likely cause of the symptoms in this farmer?
Pesticide poisoning most likely organophosphate poisoning

2.) What preventive measure could have reduced the risk of this condition?

Wearing appropriate protective gear: This includes wearing a mask,

gloves, goggles, and protective clothing to minimize skin and respiratory
exposure.

3.) List out the various occupational hazards of agricultural worker? (2m)

Zoonotic diseases : tetanus, brucellosis, tb bovine, rabies etc

Accidents: including insect and dog bite

Toxic hazards: fertilizers, insecticides, pesticides

Others like Parasitic infestation, physical hazards, respiratory diseases

III. Control of occupational diseases
Scenario: A 45-year-old male working in a cement manufacturing plant for 10
years presents with chronic cough, breathlessness, and occasional wheezing. He
reports inadequate ventilation in his workplace and absence of personal
protective equipment. His chest X-ray reveals early signs of pneumoconiosis.
1.) List out the engineering measures to control occupational diseases in this
setting? (2m)
2.) Which medical measure is most appropriate for early detection of
occupational diseases in this worker population? (2m)
3.) Which legislation specifically governs occupational health and safety in
industries in India?

Key:
1.) List out the engineering measures to control occupational diseases in this
setting? (2m)
 Improved Ventilation, install Local Exhaust Ventilation (LEV).
Ventilation: Ensure adequate air exchange within the workplace to dilute
and remove airborne contaminants.
 Process Modification: Wet Methods, Enclosure, Automation,
Substitution.

2.) Which medical measure is most appropriate for early detection of

occupational diseases in this worker population? (2m)

Regular Medical Surveillance:

Periodic Health Checkups: Conduct regular medical examinations,
including:
 Chest X-ray: To monitor for pneumoconiosis.
 Spirometry: To assess lung function.
  Blood tests: To check for any associated blood
abnormalities.
Occupational History: Detailed occupational history should be taken
at each checkup to identify potential exposures and risk factors.

3.) Which legislation specifically governs occupational health and safety in

industries in India?

The Factories Act, 1948: This act provides for the health, safety, and
welfare of workers in factories.