Case-Scenario in community medicine�(PBQ),DR NARENDRA KUMAR YADAV

Case-Scenario in community medicine�(PBQ),DR NARENDRA KUMAR YADAV

1. Case-Scenario in community medicine (PBQ) DR NARENDRA KUMAR YADAV MD Community Medicine & Tropical Diseases, BPKIHS

2. PBQ: Kwashiorkor: Case-Scenario: Q. 2 years old girl was is brought to OPD with pitting edema in the B/L lower limbs, diffuse pigmentation ( flaky paint dermatitis) over the skin & flag sign of hair. The child is lethargic & his appetite is poor. On physical examination, the liver is enlarged and the abdomen is distended. Serum albumin is very low (2 gm/ dL ).(2 +2+2+4) What is your diagnosis and justify your diagnosis? Write the socioeconomic factors for the given health condition? List the complications of the given disease? How will you prevent its occurrence in the community? 5/7/24 4

3. Case-Scenario: KWASHIWORKOR Q. A male child of 36 months of age is brought to OPD with pitting edema in the B/L lower limbs , diffuse pigmentation ( flaky paint dermatitis) on the skin & flag signs of hair. The child is lethargic & his appetite is poor. On physical examination, the liver is enlarged and the abdomen is distended. Serum albumin is very low (2 gm/dL). (2+1+2+2+3) A. What is your diagnosis and justify your diagnosis? B. Write the socioeconomic factors for the given health condition? C. List the complications of the given disease? D. How will you treat the case? E. How will you prevent its occurrence in the community?  

4. Case-Scenario: KWASHIWORKOR QQ . A female child of 26 months of age is brought to OPD with pitting edema in the bilateral lower limbs, diffuse pigmentation & thin hair. The child is lethargic & his appetite is poor. On physical examination, the liver is enlarged and the abdomen is distended. Serum albumin is very low (2 gm/ dL ). (2+2+2+3) a. What is your diagnosis and justify your diagnosis?(2) b. What are the causes of the problem given in the question?(2) c. How will you treat the case?(3) d. How will you prevent its occurrence in the community?(3)  

5. CHORINATION OF WATER Q. In a medical college hostel, there is a square tank of 8 meter length & 8 meter of breath with a 10 meter depth of water is to be disinfected. Horrock’s test shows blue color in the 6th cup. (4+1+1+1+3) Calculate the amount of bleaching powder required to disinfect the given tank? Write the name of the indicator solution used in Horrock’s Apparatus? What does this blue coloration mean? What is the recommended level of free/residual chlorine in drinking water after chlorination? Write the use and contents of the Horrock’s Apparatus?

6. CHORINATION OF WATER Q. In a slum, there is a circular well which is measuring 4 meter in diameter. The depth of the water is 10 meter. Horrocks test shows blue color in the 5th cup. (3+3+3+1) A.  Calculate the quantity of bleaching powder (CaOCl2) required to disinfect the well? B.  Explain the action of bleaching powder? C.  Explain the steps in well disinfection? D.  What is a Breakpoint Chlorination

7. IDA Q . A 25 years old pregnant lady came to OPD with the complaints of fatigue, weakness & shortness of breath. On Physical examination, she has angular stomatitis, atrophic glossitis & koilonychia. Her conjunctiva, tongue, and nails are pale. Her serum hemoglobin is 8 gm/dl with decreased serum iron, and an increased total iron binding capacity (TIBC). The peripheral blood smear in the patient shows hypochromic microcytic anemia.  (2+1+2+1+4) What is the likely diagnosis and justify your diagnosis? What investigation will you ask for in this case to conform your clinical impressions? List the important causes for the given health condition? How will you treat anemia in this case? Briefly discuss the strategies for prevention and control of anemia in pregnancy?

8. Vitamin A deficiency Q. Aradhya is a 12 years old child from Baijanath Rural Municipality who was brought by her mother to Pediatrics OPD of NGMCH with the complaints that she often fell down in the late evening while playing around with friends. She had been weaned at an early age and the food she was receiving contained only rice and potato. On examination, a triangular silvery white patch was noticed on both sclera. (2+2+4+2) A. What is your diagnosis and justify your diagnosis? B. How will you treat the case? C. How will you prevent its occurrence in other children? D. What is xerophthalmia? Name the ocular manifestations of xerophthalmia.

9. IDA Q. A 25 years old pregnant lady came to Obs & Gynae OPD of NGMCH with the complaints of fatigue, weakness & shortness of breath. On Physical examination, she has angular stomatitis, atrophic glossitis & koilonychia. Her conjunctiva, tongue, and nails are pale. Her serum hemoglobin is 8 gm/dl with decreased serum iron, and an increased total iron binding capacity (TIBC). The peripheral blood smear in the patient shows hypochromic microcytic anemia. (1+1+2+1+2.5) What is the likely diagnosis and justify your diagnosis? What investigation will you ask for in this case to conform your clinical impressions? List the important causes for the given health condition? How will you treat anemia in this case? Briefly discuss the strategies for prevention and control of anemia in pregnancy?

10. NUTRITION Q. A family consists of following members (3+2.5+2) i . Adult male - 50kg ii. Adult female- 45 kg(lactating) iii child of 2 years -14 kg How much protein they require per day? Mention the source of protein. Why egg protein is reference protein?

11. VIT D DEFICIENCY Q. 5 year child visited Hospital with mother and she complaints of soft bone in skull and on examination it was felt like Ping-Pong ball.(3+2.5+2) What is your diagnosis and its cause. Mention its other clinical features. What are the other disease associated with its deficiency

12. Case-Scenario: Chickenpox Q. During the month of January 2018, 15 children from the local brick factories attended at Hospital with complain of mild grade fever, cough and skin rashes. The attending pediatrician clinically diagnosed as chicken pox(Varicella). Only five children got full vaccination according to national EPI. Describe epidemiology of chicken pox. What is pathognomonic sign of chicken pox? List the vaccines included in the national EPI program. Discuss the prevention and control of Varicella.

13. MEASLES Q. A 3 years male child was brought in OPD with fever, cough, sneezing, running nose, and redness of eyes. The mother told that her child developed a fever 4 days back. On examination: Some small, bluish-white spots on a red base were seen on the buccal mucosa opposite the first and second lower molars. The immunization status of the child was not known.   What is your probable diagnosis? Justify your diagnosis. (2)   What is the Pathognomonic clinical feature of the upper mentioned disease? (1) Explain the clinical stages in the natural history of this disease. (2) What are the complications of this disease? (2) Discuss the prevention and control measures of the disease in community.(3)

14. EPID EX

15. PBQ Q. The test result of ECG is given below: Find out the following measures of ECG test: a. Sensitivity b. Specificity c. Positive predictive value d. Negative Predictive value   MI Present MI Absent Positive ECG 300 100 Negative ECG 25 75

16. BPQ

17. BPQ

18. BPQ

19. BPQ

20. BPQ: MEASLES

21. EPID EX

22. BPQ

23. BPQ

24. BPQ

25. BPQ

26. PBQ

27. PBQ 1. In a town with mid-year population of 150,000 following vital events occurred (7.5) Total live birth: 3200 Total death: 1400 Infant death: 270 Maternal death: 10 Calculate: (a) Crude Birth Rate, (b) Crude Death Rate, (c) Infant mortality rate, (d) Maternal mortality rate

28. PBQ FAMILY MEDICINE Please read PBQ about: Diarrhoea Pneumonia TB MEASLES HIV/AIDS CHICKENPOX

29. PBQ Q. Calculate Rate, ratio, Proportion

30. PBQ PLEASE READ PBQ about: FOOD POISONING WATER POLLUTION/ Chlorination of water water-borne diseases

31. ARI/PNEUMONIA

32. HIV/AIDS

33. Case Scenario: Acute diarrheal diseases Q. A 8 months old child presents to the hospital in emergency. He started vomiting in the morning. After six hours, he started passing watery stools and watery stools passed 4 times. On examination, he is drowsy, has sunken eyes, and skin pinch takes 2 seconds to go back. What is your diagnosis? Justify your diagnosis. Write about m ode of transmission and risk factors of the given health condition. How much dehydration is presentation?(Assessment of dehydration). How will you manage this child? Discuss on control of disease in the community. 42

34. HIV/AIDS

35. TB

36. TB

37. TB

38. PBQ Community Medicine Dr Narendra Kumar Yadav

39. Cont.……………..