---

PAPER 1 - ANSWERS

---

SAQ (5 marks each)

---

Q1. E-waste: Impact on Health and Preventive/Control Measures (2+3)

• Lead: Neurotoxicity, cognitive decline, developmental delays in children, anemia, renal damage
• Mercury: Neurological and renal toxicity; Minamata disease-like symptoms
• Cadmium: Nephrotoxicity (Itai-Itai disease pattern), bone disease
• Arsenic: Carcinogenic; skin lesions, peripheral neuropathy
• Dioxins/Furans (from burning): Carcinogens; cause immunosuppression, endocrine disruption
• Polycyclic Aromatic Hydrocarbons: Carcinogenic
• General effects: Respiratory diseases, skin disorders, endocrine disruption, reproductive toxicity, increased cancer risk in workers

• E-Waste (Management) Rules 2016 (amended 2018) - mandates Extended Producer Responsibility (EPR)
• Hazardous Waste Management Rules
• Under EPR, manufacturers are responsible for take-back and recycling of their products

• Formal e-waste collection centers (not informal roadside dismantlers)
• Authorization of e-waste recyclers by State Pollution Control Boards
• National Green Tribunal (NGT) orders to prevent informal burning

• Controlled dismantling with protective equipment (PPE - gloves, masks, goggles)
• Proper smelting/pyrometallurgy in enclosed facilities
• Hydrometallurgy (acid leaching in controlled settings)

• Health monitoring of workers in e-waste facilities
• Education of informal workers on hazards and safe practices
• "Reduce, Reuse, Refurbish, Recycle" (4R principle)
• Awareness campaigns for consumers on proper disposal

---

Q2. Medical Officer in Flood-Prone Area (5 marks)

1. Hazard mapping - Identify flood-prone zones, vulnerable populations
2. Disaster Management Plan - Standard operating procedures for emergency response
3. Training and Mock Drills - Train health staff, ASHA/ANM workers in first aid and evacuation
4. Resource Stockpiling - ORS packets, IV fluids, antibiotics (ciprofloxacin, tetracycline), vaccines (typhoid, hepatitis A), antidiarrheal drugs, water purification tablets (chlorine tablets), bleaching powder
5. Communication System - Backup communication (wireless, satellite phones), early warning systems
6. Coordination - Liaison with district administration, NDRF, local NGOs, blood banks
7. Identification of safe shelters - Relief camps with clean water and sanitation

• Cholera vaccine (OCV - Oral Cholera Vaccine)
• Typhoid vaccine (Vi polysaccharide)
• Hepatitis A vaccine (in children and non-immune adults)
• Tetanus toxoid (for wound injuries from debris)
• Measles vaccine (in displaced children in camps to prevent outbreaks)

---

Q3. National Nutrition Policy (NNP) of India - Objectives, Strategies & National Programs (3+2)

1. Reduction of protein-energy malnutrition (PEM) in children
2. Reduction of prevalence of anemia among women and children
3. Reduction of Vitamin A deficiency (VAD) and blindness
4. Reduction of iodine deficiency disorders (IDD) and goiter
5. Promotion of appropriate infant and young child feeding (IYCF) practices
6. Prevention of diet-related non-communicable diseases (NCDs)
7. Ensuring household food security

• Supplementary nutrition (ICDS)
• Vitamin A and iron-folic acid supplementation
• Iodization of salt (universal salt iodization)
• Nutrition education and counseling

• Improving food production (Green Revolution, public distribution system)
• Poverty alleviation programs
• Improvement of literacy especially female literacy
• Safe drinking water and sanitation
• Primary health care strengthening

1. POSHAN Abhiyaan (PM's Overarching Scheme for Holistic Nourishment) - 2018; targets stunting, wasting, anemia, low birth weight
2. ICDS (Integrated Child Development Services) - 1975; supplements nutrition for children 0-6 years and pregnant/lactating mothers
3. Mid-Day Meal Scheme (PM POSHAN) - School feeding program
4. National Iron Plus Initiative (NIPI) - Iron supplementation across all age groups
5. Vitamin A Supplementation Program - Biannual doses for children 6 months - 5 years
6. National Iodine Deficiency Disorders Control Program (NIDDCP)
7. MAA Program (Mothers' Absolute Affection) - Promotes breastfeeding

---

Q4. Role of 6×6×6 Strategy in Anemia Mukt Bharat

1. Children 6-59 months
2. Children 5-9 years
3. Adolescents 10-19 years
4. Pregnant women
5. Lactating mothers
6. Women of reproductive age (15-49 years, non-pregnant/non-lactating)

1. Prophylactic iron-folic acid (IFA) supplementation - Age-specific dosing
2. Deworming (Albendazole) - Bi-annual for children and adolescents
3. Intensified year-round IFA delivery through healthcare platforms
4. Behaviour change communication (BCC) and demand generation
5. Testing for anemia (using digital hemoglobinometers - "Anemia testing machines")
6. Treatment of non-nutritional anemia - Addressing malaria, hemoglobinopathies, fluorosis

1. Health platform (Sub-Health Centre, PHC)
2. Nutrition platform (ICDS/POSHAN)
3. Education platform (Schools)
4. PMMVY/Social protection platform
5. Intensified program (difficult geographies, tribal areas)
6. Convergence across ministries (Health, Women & Child, Education)

---

Q5. Classification of Health Indicators and Most Important for Health Facility Access (3+2)

• Crude Death Rate (CDR)
• Infant Mortality Rate (IMR) - most sensitive indicator of overall health
• Under-5 Mortality Rate (U5MR)
• Maternal Mortality Ratio (MMR)
• Disease-specific mortality rates

• Incidence rate
• Prevalence rate
• Attack rate (during epidemics)
• Hospitalization rates

• Anthropometric measurements (weight-for-age, height-for-age, BMI)
• Biochemical indicators (Hb levels, serum ferritin)

• Doctor-population ratio
• Nurse-population ratio
• Hospital beds per 1000 population
• Coverage of antenatal care, immunization

• Per capita income, literacy rate (especially female)
• Proportion below poverty line

• OPD attendance rates
• Bed occupancy rate (BOR)

• Human Development Index (HDI)
• Physical Quality of Life Index (PQLI)
• Disability-Adjusted Life Year (DALY)

• IMR reflects the quality and utilization of health services (antenatal care, delivery care, postnatal care, immunization, nutrition programs)
• It is sensitive to changes in healthcare provision
• It captures socioeconomic conditions, maternal health, and child health
• It is easily measurable and internationally comparable
• WHO recognizes IMR as the single best indicator of health status

---

Q6. Behaviour Change Communication (BCC) to Improve Sanitation - Open Defecation (5 marks)

• Assess prevalence of OD through household survey
• Understand barriers: lack of latrines, cultural norms, convenience, lack of awareness, financial constraints
• Identify influencers: panchayat leaders, ASHA workers, teachers, religious leaders

• Short-term: Increase awareness about health risks of OD
• Medium-term: Motivate at least 50% households to construct/use latrines
• Long-term: Achieve Open Defecation Free (ODF) village status

• Primary: Adults who practice OD
• Secondary: Women (mothers, who influence household behavior)
• Tertiary: Community leaders, school teachers, youth

• OD causes fecal-oral transmission of diarrhea, cholera, typhoid, hepatitis A, polio
• Especially harmful for children (diarrhea leading cause of U5 deaths)
• Link: Dirt/flies → contaminated food/water → disease → stunting/death

• Interpersonal: ASHA/ANM home visits; "Triggering" method (from CLTS - Community-Led Total Sanitation)
• Group Communication: Village meetings (gram sabhas), self-help group sessions, nukkad nataks (street plays)
• Mass Media: Swachh Bharat Mission (SBM) messaging, radio jingles, wall paintings, posters in public spaces

• Incentive of Rs. 12,000 per household for toilet construction under SBM
• Link families to beneficiary lists and district officials

• Pre- and post-intervention surveys to measure OD rates
• Regular follow-up visits by ASHA workers
• Record ODF certification status

---

LAQ (10 marks)

A. Social Security, Indian Factory Act - Health & Welfare of Women Workers (1+2+2)

1. Medical Benefits - Free treatment, hospitalization, specialist care
2. Maternity Benefits - Paid leave, cash benefits during childbirth
3. Sickness Benefits - Cash allowance during illness
4. Disability/Injury Benefits - Compensation for occupational injuries/diseases
5. Death Benefits - Dependent benefits to family of deceased worker
6. Old Age Pension - Financial security after retirement

• Cleanliness, ventilation, lighting, and temperature control in workplace
• Disposal of waste and effluents
• Adequate toilet/restroom facilities (separately for women)

• Section 19: Separate latrines and urinals for female workers (clearly marked, kept clean)
• Section 48: Crèche/child care facility mandatory in factories employing 30+ women workers
• Section 66: Women workers shall NOT be employed between 7 PM and 6 AM (protection from night work)
• Section 27: Women and children prohibited from working near cotton openers (dangerous machinery)
• Maternity Benefit Act 1961 (linked): 26 weeks paid maternity leave for first 2 children
• Prevention of Sexual Harassment at Workplace (POSH) Act 2013 - Internal complaints committee mandatory

---

B. Ayushman Bharat

• Deprived rural families based on SECC 2011 (Socio-Economic Caste Census) criteria
• Urban workers falling under 11 occupational categories
• Covers approximately 50 crore (500 million) beneficiaries - bottom 40% of India's population (poorest and vulnerable)
• No cap on family size or age; includes women, children, elderly, and transgenders

• 1.5 lakh Sub-Health Centres and PHCs upgraded to HWCs
• Provide comprehensive primary and preventive care close to the community
• Services: maternal and child health, NCD screening (diabetes, hypertension, cancer), mental health, palliative care, AYUSH
• Managed by Community Health Officers (CHOs) - mid-level providers

• Provides health insurance cover of Rs. 5 lakh per family per year for secondary and tertiary hospitalization
• Cashless and paperless treatment at empanelled government and private hospitals
• Covers 1,949+ procedures (medical, surgical, day care)
• Portable across India (can use in any state)
• Aadhaar-linked beneficiary identification

1. Coverage: Rs. 5 lakh per family per year - world's largest government-funded health insurance
2. Cashless and Paperless - No premium paid by beneficiary; no pre-insurance forms
3. Portability - Benefit can be availed in any empanelled hospital across India
4. Pre-existing conditions covered from Day 1
5. No cap on family size, gender, or age
6. Entitlement-based - Determined by SECC 2011 data
7. PM-JAY ID card (Ayushman Card) acts as identification
8. Quality assurance through NABH accreditation of hospitals
9. PM-JAY IT platform for real-time monitoring and fraud prevention
10. ASHA workers as facilitators to identify and enroll eligible beneficiaries

---

VSAQ (2 marks each) - Part 2

• Iodized salt - Addition of iodine (potassium iodate) to common salt to prevent Iodine Deficiency Disorders (goiter, cretinism)
• Iron-fortified rice/wheat flour - Addition of iron to prevent iron-deficiency anemia (e.g., Fortified Rice under PMGKAY)
• (Other examples: Vitamin A fortified vanaspati/edible oil; Vitamin D fortified milk)

---

---

• Digital immunization registry - Records every vaccine given to every child and pregnant woman
• Due-list generation - Automatically alerts ASHA/ANM about children due for vaccination
• Tracking beneficiaries - Prevents dropout; helps track migrant children across states
• Real-time data - Provides live vaccine coverage data to program managers
• Antenatal and child vaccination records maintained from birth
• Launched as part of India's digital health mission (Ayushman Bharat Digital Mission - ABDM)
• Replaces manual registers at sub-center level

---

1. Common Source Epidemic:

• Point source - All cases exposed simultaneously (e.g., a single contaminated water supply); epidemic curve shows rapid rise and fall
• Continuous (Propagated) source - Continued exposure over time; epidemic curve shows plateau
• Intermittent source - Exposure occurs at intervals

1. Propagated Epidemic (Person-to-person):

• Disease spreads from one person to another (e.g., influenza, measles)
• Epidemic curve shows multiple successive peaks corresponding to incubation periods

1. Explosive epidemic - Sudden large number of cases (usually point source, e.g., food poisoning)
2. Slow/Smoldering epidemic - Cases appear gradually over long time (e.g., typhoid from chronic carrier)
3. Seasonal epidemic - Occurs in specific seasons (e.g., dengue in monsoon)
4. Pandemic - Worldwide spread (e.g., COVID-19, influenza 1918)

---

1. Ayurveda - India's ancient system based on Tridosha theory (Vata, Pitta, Kapha); uses herbal formulations; widely used for chronic conditions and wellness
2. Homeopathy - Based on principle of "like cures like" and ultra-dilution; widely used in Punjab for acute and chronic conditions

---

---

PAPER 2 - ANSWERS

---

SAQ (5 marks each) - Part 2

---

P2-Q1. Sampling: Types, Advantages and Limitations (1+2+2)

---

P2-Q2. Classification of Pollutions and Monitoring of Air Pollution (2+3)

1. Air Pollution - Contamination of atmosphere (indoor and outdoor)
2. Water Pollution - Contamination of surface/ground water
3. Soil Pollution - Contamination of land with chemicals, heavy metals, pesticides
4. Noise Pollution - Excessive sound levels causing health effects
5. Radiation Pollution - Ionizing and non-ionizing radiation
6. Marine/Ocean Pollution - Oil spills, plastic waste
7. Thermal Pollution - Heat from industries into water bodies
8. Light Pollution - Excessive artificial light

• Point source (identifiable single source, e.g., factory chimney)
• Non-point/Diffuse source (traffic, agriculture)

• Physical, Chemical, Biological, Radioactive

• Particulate Matter (PM 2.5 and PM 10)
• Gaseous pollutants: SO₂, NO₂, CO, O₃, NH₃
• Volatile Organic Compounds (VOCs)
• Heavy metals (lead, arsenic in PM)
• PAHs (Polycyclic Aromatic Hydrocarbons)

1. National Ambient Air Quality Monitoring (NAAQM) Program - CPCB operates network of manual and automatic stations in major cities
2. CAAQMS (Continuous Ambient Air Quality Monitoring Stations):

• Real-time continuous automated monitoring
• Measures PM2.5, PM10, SO₂, NOx, CO, Ozone simultaneously
• Data transmitted online to CPCB; publicly displayed on AQI website

1. Air Quality Index (AQI):

• Composite index for 8 pollutants (PM2.5, PM10, NO₂, SO₂, CO, O₃, NH₃, Pb)
• Scale: 0-50 (Good) → 51-100 (Satisfactory) → 101-200 (Moderate) → 201-300 (Poor) → 301-400 (Very Poor) → 401-500 (Severe)

1. National Clean Air Program (NCAP) 2019:

• Target: 20-30% reduction in PM2.5 and PM10 by 2024 in 102 non-attainment cities
• Expanded monitoring network

1. Methods:

• Gravimetric: High Volume Sampler (HVS) for SPM and RSPM (respirable)
• Spectrophotometry: For gaseous pollutants
• Satellite-based remote sensing for large-scale monitoring

---

P2-Q3. Ethical Approach to Disclosing a Medical Error to Patient's Family (5 marks)

• Non-maleficence - Do not cause additional harm by concealment
• Beneficence - Act in patient's best interest
• Autonomy - Family's right to know and decide
• Veracity (Truthfulness) - Honesty is a core medical virtue
• Justice - Accountability in the system

• Assess the child immediately for any adverse effects of the wrong injection
• Administer any antidote, reversal agent, or symptomatic treatment if applicable
• Document vitals and clinical status; involve senior/specialist if needed
• Do NOT delay disclosure for fear of consequences

• Gather facts: what was given, what was ordered, the nature and dose of the wrong drug
• Involve the supervising doctor or department head
• Choose a quiet, private setting

• Meet with parents/guardians in a calm, private environment
• Introduce team members present
• Use clear, simple, non-technical language
• State clearly: "I made an error. I gave your child [X] instead of [Y]. I am very sorry."
• Explain what the error was, how it occurred, and what health effects are possible
• Explain what actions have already been taken to address it
• Express sincere apology (without admitting legal guilt in adversarial terms, but being humanly accountable)

• Allow parents to ask questions; listen without defensiveness
• Provide honest, complete answers
• Avoid blame-shifting

• Document the incident fully in the patient record and hospital incident reporting system
• Report to hospital patient safety committee as per protocol
• This is NOT about punishment but about system improvement

• Provide parents with a contact person for ongoing updates
• Arrange follow-up appointments to monitor the child
• Support parents emotionally; consider patient grievance mechanism

• Root cause analysis (RCA) to prevent recurrence
• May involve training, protocol revision, double-check systems for high-alert medications

---

P2-Q4. Screening Tool: Sensitivity, Specificity, and Screening vs Diagnostic Test

• Total community: 10,000 people
• Truly diseased: 1,000
• Truly healthy: 9,000
• Test correctly identifies 900 of diseased as positive → True Positives (TP) = 900; False Negatives (FN) = 100
• Test misidentifies 900 healthy as positive → False Positives (FP) = 900; True Negatives (TN) = 8,100

• The test has 90% sensitivity - it correctly detects 90% of truly diseased persons
• The test has 90% specificity - it correctly identifies 90% of truly healthy persons as negative
• Both values are equal and high - this is a reasonably good screening test

---

P2-Q5. Classification of Epidemiological Studies and Steps in Case-Control Study (2+3)

Epidemiological Studies
│
├── Observational Studies
│   ├── Descriptive Studies
│   │   ├── Case Report / Case Series
│   │   ├── Cross-sectional (Prevalence) Study
│   │   └── Ecological (Correlational) Study
│   │
│   └── Analytical Studies
│       ├── Case-Control Study (Retrospective)
│       └── Cohort Study (Prospective / Retrospective)
│
└── Experimental (Interventional) Studies
    ├── Randomized Controlled Trial (RCT)
    ├── Field Trial
    ├── Community Trial
    └── Quasi-experimental

• Define what constitutes a "case" (diagnostic criteria)
• Ensure cases are incident (new) rather than prevalent (old) where possible
• Source: hospital cases, disease registry, community surveys
• Cases must be representative of all cases with that disease

• Controls are individuals from the same population who do NOT have the disease
• Must be comparable to cases in all characteristics except exposure
• Matching: frequency matching or individual matching (age, sex, socioeconomic status)
• Sources: hospital controls (other patients), neighborhood controls, community controls
• Number: 1 control per case (1:1); up to 4:1 to increase power

• Assess past exposure history in BOTH cases and controls
• Methods: structured interviews, medical records, biological samples (serum, urine)
• Use standardized questionnaire; blinded interviewers to minimize recall/interviewer bias

• OR > 1: Exposure associated with increased risk
• OR < 1: Exposure protective

• Statistical methods: stratification (Mantel-Haenszel), logistic regression
• Recognize limitations: recall bias (cases remember exposure better), selection bias

• Is OR statistically significant? (95% CI not crossing 1)
• Apply Bradford Hill criteria for causation if appropriate

---

P2-Q6. Nutritional Assessment of Pregnant Woman in 2nd Trimester (Qualitative + Quantitative) (5 marks)

• Weight: Current weight; compare to pre-pregnancy weight; expected weight gain in 2nd trimester is 0.5 kg/week (total recommended: 11.5-16 kg for normal BMI)
• Height: To calculate pre-pregnancy BMI
• Mid-Upper Arm Circumference (MUAC): < 21 cm indicates undernutrition; < 23 cm warrants monitoring in pregnancy
• Fundal height (obstetric indicator of fetal growth)

• Hemoglobin (Hb): Anemia defined as Hb < 11 g/dL in pregnancy (WHO); check for iron-deficiency anemia (most common in India)
• Serum ferritin: Indicator of iron stores
• Serum albumin: Indicates protein status (normal >3.5 g/dL)
• Blood glucose (OGTT 75g): Screen for Gestational Diabetes Mellitus (GDM) - done at 24-28 weeks
• Urine protein: Screen for pre-eclampsia (related to nutritional status)
• Serum calcium, Vitamin D levels if indicated
• TFT (Thyroid Function Tests): Iodine deficiency assessment

• 24-hour dietary recall: Ask her to recall all foods and quantities consumed in past 24 hours
• Food frequency questionnaire: How often different food groups are consumed per week
• Calculate caloric intake (extra 350 kcal/day needed in 2nd trimester) and protein intake (extra 23 g/day)

• Pallor (conjunctival, palmar) → Anemia (Iron/Folate/B12)
• Edema → Protein deficiency, pre-eclampsia
• Glossitis, angular stomatitis → Riboflavin, B2 deficiency
• Night blindness, Bitot's spots → Vitamin A deficiency
• Goiter → Iodine deficiency
• Bleeding gums → Vitamin C deficiency
• Tetany (Trousseau's/Chvostek's sign) → Calcium deficiency
• Skin changes: Dermatitis → Niacin/Zinc deficiency

• Food habits, food preferences, food taboos (e.g., avoiding certain foods during pregnancy)
• Pica (craving non-food items - associated with iron deficiency)
• Number of meals per day, whether she skips meals
• Breastfeeding history of previous children

• Household income and food security
• Access to ration card (PDS), ICDS, POSHAN supplements
• Enrollment in Pradhan Mantri Matru Vandana Yojana (PMMVY) for cash benefit
• Literacy and awareness about nutrition in pregnancy

• Previous pregnancies - low birth weight babies, stillbirths (indicate nutritional risk)
• Current antenatal care enrollment, IFA tablet compliance

---

LAQ (10 marks) - Paper 2

Clinical Case: 52-year-old Corporate Executive with Asymptomatic Diabetes and Hypertension

---

• He has objective biochemical evidence of disease (raised blood glucose, raised BP)
• But he has NO symptoms (feels fine, energetic)
• This is the stage BEFORE clinical illness manifests - disease is progressing silently

NATURAL HISTORY OF DISEASE
─────────────────────────────────────────────────────────────────────────────
                     │           │           │              │
  STAGE 1            │  STAGE 2  │  STAGE 3  │   STAGE 4   │   STAGE 5
  SUSCEPTIBILITY     │ SUBCLINICAL│ CLINICAL  │   DISABILITY │   DEATH/
                     │ (Pre-symp)│  ILLNESS  │   (Sequelae) │   RECOVERY
                     │           │           │              │
─────────────────────────────────────────────────────────────────────────────
Agent, Host &        Pathological Early signs  Advanced      Terminal
Environment          changes begin/ and symptoms disease/      outcome
factors interact     detectable by (symptomatic) Complications
(risk factors:       tests but
 obesity, genetics,  asymptomatic
 diet, stress)
─────────────────────────────────────────────────────────────────────────────

LEVELS OF PREVENTION:
|← Primary Prevention →|← Secondary Prevention →|← Tertiary Prev →|
  (Remove risk factors)  (Screening/Early Dx)      (Rehabilitation)

                        ↑
              THIS PATIENT IS HERE
         (Detected on routine health checkup)

• Stage 1 (Susceptibility): Family history of MI (father died at 55), likely long-standing metabolic syndrome with obesity/sedentary lifestyle
• Stage 2 (Subclinical/Pre-symptomatic): CURRENT STAGE - measurable disease (DM2, HTN) but no symptoms
• If untreated: will progress to Stage 3 (Symptomatic angina, myocardial infarction, stroke, diabetic nephropathy, retinopathy)

---

• This health checkup represents SECONDARY PREVENTION because it involves screening of an apparently healthy individual to detect disease in its subclinical/early stage.
• The aim is early detection and prompt treatment to halt disease progression.
• The principle applied is: "Detect and treat early"

• Additionally, initiate antihypertensive therapy - Amlodipine 5 mg once daily OR ACE inhibitor (Ramipril 5 mg OD) - particularly appropriate given his diabetic status (ACE inhibitors are preferred in diabetic hypertension for renoprotection)

---

• He is part of the HIDDEN BURDEN of disease
• He has real disease (DM2 + HTN) but was completely asymptomatic and UNKNOWN to the health system before the routine checkup
• He was only detected because of a special occupational health screening
• Without this checkup, he would have continued as an undiagnosed case, progressing silently until a catastrophic event (MI, stroke) made him visible

         _______________
        /  VISIBLE TIP  \    ← Clinically manifest, diagnosed, symptomatic
       /                 \      cases (seek medical care)
      /---WATERLINE-------\
     /                     \
    /    SUBMERGED PART      \  ← Subclinical cases (like THIS patient before screening),
   /                         \    Latent cases, carriers, susceptible individuals
  /                           \
 /_____________________________\

• Above waterline (Tip): Symptomatic patients who present to hospitals - the diagnosed, clinically apparent cases
• Below waterline (Bulk): Subclinical cases (this patient), latent cases, carriers, mild/undiagnosed cases, those with risk factors but not yet diseased

---

Quick Reference - All Questions Answered

PAPER 1

1. E-waste - Definition, health effects (neurotoxicity, nephrotoxicity, carcinogenicity from lead/mercury/cadmium/dioxins), preventive measures (E-Waste Rules 2016, EPR, formal recycling, PPE, 4R principle)
2. Flood Preparedness - Disaster preparedness (hazard mapping, stockpiling, mock drills), Triage (START system, RED/YELLOW/GREEN/BLACK categories), Vaccination (cholera, typhoid, hepatitis A, tetanus, measles)
3. National Nutrition Policy - Objectives (reduce PEM, anemia, VAD, IDD), strategies (direct + indirect), major programs (POSHAN Abhiyaan, ICDS, Mid-Day Meal, NIPI)
4. 6×6×6 Anemia Mukt Bharat - 6 beneficiary groups × 6 interventions (IFA, deworming, testing, BCC, treatment) × 6 institutional platforms
5. Health Indicators - Mortality, morbidity, nutrition, service, socioeconomic, utilization, composite; IMR as most important indicator
6. BCC for Sanitation - Situation analysis, CLTS triggering approach, interpersonal + mass media channels, Swachh Bharat Mission linkage, ODF monitoring

• A: Social Security - Definition, benefits, Factory Act provisions for women (Section 19 separate toilets, Section 48 crèche, Section 66 no night work, Section 27 dangerous machinery)
• B: Ayushman Bharat - Beneficiaries (50 crore via SECC 2011), 2 pillars (HWCs + PM-JAY), key features (Rs. 5 lakh/year, cashless, portable, pre-existing covered)

1. Food fortification - iodized salt, iron-fortified flour
2. Type I (false positive) and Type II (false negative) errors
3. U.WIN - digital immunization registry platform
4. Types of epidemics - common source, propagated, explosive, seasonal, pandemic
5. Ayurveda and Homeopathy (most prevalent in Punjab)

---

PAPER 2

1. Sampling - Definition; probability (SRS, systematic, stratified, cluster, multistage) vs non-probability (convenience, purposive, snowball, quota); advantages and limitations of each
2. Pollution + Air Monitoring - 8 types of pollution; NAAQM, CAAQMS, AQI (8 pollutants, 6-color scale), NCAP 2019, monitoring methods (gravimetric HVS, spectrophotometry)
3. Medical Error Disclosure - Ethical principles (autonomy, non-maleficence, veracity), 7 steps: immediate treatment → preparation → disclosure meeting → answer questions → document → follow-up → root cause analysis
4. Screening Test Calculations:
   • Sensitivity = 90% (900/1000)
   • Specificity = 90% (8100/9000)
   • Screening (asymptomatic, high sensitivity, presumptive) vs Diagnostic (symptomatic, high specificity, confirmatory)
5. Epidemiological Studies - Observational (descriptive + analytical) vs Experimental; 7 steps of case-control study (define question → select cases → select controls → assess exposure → calculate Odds Ratio → control confounders → interpret)
6. Nutritional Assessment in Pregnancy (2nd trimester) - Quantitative (anthropometry: weight/MUAC; biochemistry: Hb, ferritin, OGTT; 24-hr dietary recall); Qualitative (clinical signs: pallor/goiter/edema; food habits/taboos; socioeconomic status; obstetric history)

1. Natural History of Disease - Patient is in Subclinical/Presymptomatic stage (Stage 2); labeled 5-stage diagram with levels of prevention
2. Level of Prevention = Secondary Prevention (screening); Intervention: start Metformin for DM2 + ACE inhibitor/Amlodipine for HTN
3. Iceberg of Disease - Patient represents the submerged hidden portion; tip = symptomatic diagnosed cases; bulk below waterline = subclinical (this patient), latent, carriers, undiagnosed individuals