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Ans these questions According to psm 3rd yr mbbs

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Here are model answers for the GMERS Community Medicine (Practical) case-based scenario, based on Park's Textbook of PSM and standard clinical references.

A. Mr. Naman (52 yrs, headache, chest pain, smoker)

1. Four risk factors for his illness (2 marks) His presentation (occipital headache + chest pain + BP 154/104 mmHg) points to hypertension with early cardiovascular/cerebrovascular risk. Risk factors present:
  • Chronic cigarette smoking
  • Obesity – weight 84 kg, height 160 cm → BMI = 84/(1.6)² ≈ 32.8 kg/m² (obese)
  • Positive family history of cerebrovascular disease (father died of stroke)
  • Sedentary lifestyle/occupational stress – desk-bound IT job with physical inactivity, compounded by psychosocial stress of living alone away from family
2. Level of prevention applicable (2 marks) Secondary prevention. Mr. Naman is already hypertensive (BP 154/104) and symptomatic (headache, chest pain), i.e., disease has already begun at the pre-clinical/early clinical stage. Secondary prevention aims at early diagnosis and prompt, effective treatment to halt progression and prevent complications (stroke, MI, renal damage) — through BP/lipid/ECG screening, antihypertensive therapy, and regular follow-up. (Primary prevention — risk-factor modification such as quitting smoking, weight reduction, exercise — should also be reinforced simultaneously.)
  • Park's Textbook of PSM, "Levels of Prevention"
3. JNC 8 BP goal (1 mark) As per JNC 8, for a non-diabetic, non-CKD adult under 60 years (he is 52), the treatment goal is BP < 140/90 mmHg. (For those ≥60 years, goal is <150/90 mmHg.)
4. Special diet approach – DASH diet (2 marks) DASH (Dietary Approaches to Stop Hypertension) diet is recommended:
  • Low sodium intake (<2.4 g/day, ideally ~1500 mg/day)
  • Rich in fruits, vegetables, whole grains, and low-fat dairy products
  • Adequate potassium, calcium, and magnesium
  • Reduced total and saturated fat, cholesterol, and red meat
  • Limits sweets, sugar-sweetened beverages, and alcohol This pattern has been proven to significantly lower both systolic and diastolic BP, and works synergistically with weight loss and increased physical activity (Harrison's Principles of Internal Medicine; Goldman-Cecil Medicine).

B. 7-year-old girl (PHC Rancharda) – rash, fever, cough, conjunctivitis

1. Most probable diagnosis (1 mark) Measles (Rubeola). Classic picture: prodrome of fever and cough, followed by conjunctival congestion (conjunctivitis) and a maculopapular (morbilliform) rash starting on the face, spreading to trunk and limbs, with no vesicles — consistent with the "3 C's" (cough, coryza, conjunctivitis) plus rash of measles.
2. Two measures to prevent spread (2 marks)
  • Isolation of the case — respiratory/droplet isolation of the child, ideally till at least 4 days after the onset of rash (measles is highly infectious via droplets).
  • Protecting contacts/raising herd immunity — vaccination of susceptible contacts (ring vaccination) and ensuring high MR vaccine coverage in the community; case notification/surveillance under IDSP is also part of outbreak control.
  • Park's Textbook of PSM, Measles – Treatment/Prevention
3. Vaccine and UIP schedule (2 marks) Measles-Rubella (MR) vaccine, given as two doses under the Universal Immunisation Programme:
DoseAgeDoseRouteSite
MR-19 completed months – 12 months0.5 mlSubcutaneousLeft upper arm
MR-216–24 months0.5 mlSubcutaneousLeft upper arm
  • Park's Textbook of Preventive and Social Medicine, Table 43 (National Immunization Schedule)

C. Newly married couple – family planning clinic (wants no child for 3 years; unprotected sex yesterday)

Since they need to cover the "accident" of yesterday's unprotected intercourse and want spacing for 3 years, counsel on:
1. Emergency Contraceptive Pill (Levonorgestrel 1.5 mg)
  • Dose: single tablet, 1.5 mg levonorgestrel
  • Timing: taken as soon as possible, and effective up to 72 hours after unprotected intercourse (efficacy decreases with delay); this covers yesterday's exposure. Not intended for repeated/regular use.
2. Copper IUCD (Cu-T 380A)
  • Duration: effective spacing method for 10 years (Cu 375 gives 5 years) — ideal for their 3-year spacing need since it is easily removed whenever they wish to conceive.
  • Advice: can be inserted within 5 days of unprotected intercourse as emergency contraception itself, or electively within 12 days of the start of the next menstrual cycle for ongoing protection. Requires no daily compliance.
3. Combined Oral Contraceptive Pills (e.g., Mala-N)
  • Dose/Regimen: one tablet daily, starting from day 1 of the next menstrual cycle, continued for 21 days, followed by a 7-day gap (or with placebo/iron tablets for continuous use), then repeated cyclically.
  • Duration: can be continued as long as required (here, up to 3 years) with regular resupply from the sub-centre/ASHA; requires strict daily compliance.
(Alternative acceptable answers: barrier method/condoms for every act of intercourse, or injectable DMPA 150 mg IM every 12 weeks as a third spacing option.)
  • Park's Textbook of Preventive and Social Medicine, Family Planning chapter
If you'd like, I can also format this as a printable answer sheet (PDF/DOCX) for exam revision — just let me know.
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