Community Medicine - PAST QUESTIONS (2005-2020) : Basic Definitions and Concept of Health & Disease

COMMUNITY MEDICINE –
PAST QUESTIONS (2005-2020)

(Compiled by Shahroze Ahmed, N-66, Nishtar Medical University)
▪ BASIC DEFINITIONS AND CONCEPT OF HEALTH & DISEASE
Program
1.
a) Define vertical program.
b) Define horizontal program.
[Annual 2006]
Concepts of Disease Control
1. The progression of many, if not most, diseases may be explained by the concept
which describes the unfolding or evolution of disease process in an individual over
time in the absence of treatment or intervention:
a) Name the concept of disease above-mentioned. (1)
b) Which are the interventions made at tertiary level of prevention elucidated by
this concept of disease? (1)
c) Which level of prevention is appropriate for screening of disease? (1)
d) Name the intervention made during that level of prevention. (1)
e) What is the basis of making that intervention? (1)
[Annual 2017]
2. Draw and label the epidemiolocal triad. [Annual 2010]
Levels of Prevention & Modes of Intervention
1. What do you mean by health promotion? (2)

[Annual 2016]
2. A student of primary class was feeling difficulty in listening which was detected by
his teacher. He was provided with a hearing aid to overcome this problem.
a) Name the mode of intervention used.
b) What do you mean by ‘Social Rehabilitation’? [Annual 2013]
3. Public health policy in Pakistan aims at avoiding the underlying reasons for the
development of environmental and atmospheric concentration of Sulphur dioxide
(SO₂) to protect the health of people.
a) Which level of prevention is applied in this aim of policy?
b) Enlist the other three levels of prevention and five modes of prevention.
[Annual 2008]
4. What measures are taken in general in Specific Protection (2nd level of prevention)?
[Supple 2006 held in 2007]
5.
a) Name levels of prevention.
b) Briefly describe types of ‘Rehabilitation’.
[Annual 2006]
6. Name six diseases against which chemoprophylaxis can be done. Mention name of
drug for each disease as well. [Supple 2006]
7. Write a note on primordial prevention. [Annual 2005]
WHO & UNICEF
1. The World Health Organization (WHO) is a specialized, non-political, health agency of

United Nations that has its own constitution and governing bodies.
a) What is the main objective of WHO? (1)
b) Enumerate eight functions of WHO. (4)
[Annual 2015]
Iceberg of Disease
1. Hypertension is the commonest cardiovascular disorder causing high morbidity and

mortality rates in Pakistan. It is known as ‘silent killer’ because of its high association
with coronary heart disease and stroke. Hypertension exhibits the phenomena of
‘ice-berg disease’. Justify this statement with the help of ‘rule of halves. (2.5)
Indicators of Health
1. Teaching hospitals in big cities of Pakistan are overcrowded and overburdened due
to lack of implementation of proper referral in health care delivery system. This
situation affects health care delivery and health care utilization rates both.
a) Differentiate between health care delivery and health care utilization indicators
with examples.
b) Enumerate the most important mortality indicator used to compare health status
of a country internationally. (1)
2. Enumerate different types of mortality rates used to assess the health status of a
country, (3) [Supple 2018 held in 2019]
3. Proper utilization of health care shows the effectiveness of health care system.
Name atleast five methods which are used to assess the health care services
utilization rate. (5) [Supple 2017 held in 2018]
4. A researcher is interested to compare the health status of people of Punjab with that
of Baluchistan.
a) Name three parameters to be used in this purpose.
b) Explain any one of these.
5. What do you mean by health index? [Annual 2013]
Millennium Development Goals & Indications
1. Write numbers and names of three millennium development goals related to health.
[Annual 2013]
▪ PRIMARY HEALTH CARE & HEALTH SYSTEMS IN PAKISTAN
Principles of PHC
1. Village councilors from Village A and Village B of the two union councils met district
health authorities and reported that their BHUs were always running short of
medicine. DHO sent team to assess the situation. It was found that only in BHU of
village B there was shortage of medicine. Therefore, BHU B was provided medicine
based on its OPD. Which principle of Primary Health Care (PHC) was operative in
above scenario? (1) [Supple 2019 held in 2020]
2.
a) Define Primary Health Care. (1)
b) Name the principles of Primary Health Care. (2)
c) Community participation is a major component in the approach to the whole
system of health care. Describe community participation. (2)
[Annual 2019]
3. Pakistan launched Tobacco-free initiative ‘TFI-Pak’ in 2000 by identifying smoking as

a leading cause of mortality in Pakistan. Identify the principles of primary health care
that can help in achieving objectives of this initiative. (1)
4. A ministry of health has released tunas to improve infrastructure of BHUs and RHCs.
As a public health officer, you have decided to invest more in BHUs of
underdeveloped areas as compared to BHUs of developed areas.
a) Which principle of Primary Health Care was applied in above scenario? (1)
b) Enlist principles of Primary Health Care. (4)
[Annual 2018]
5. What do you mean by community participation? (1.5) [Supple 2017 held in 2018]
6. WHO envisions security health and well-being of people around the world on basis
of primary health care which is a strategy to attain ‘Health for All’?
a) Define primary health care. (2)
b) Enlist its four principles. (1)
[Annual 2017]
7. Name the principles of Primary Health Care. [Supple 2016 held in 2017]
8. Strengthening of Primary Health Care is the key strategy for achievement of MDGs
(Millennial Development Goals)
a) What is Primary Health Care (PHC)?
b) Briefly explain atleast six principles of PHC.
9. In a village of Sindh where under-five mortality was high, a local high up donated a
room and furniture to set a child health center. Local volunteers were trained to
provide counselling services to mothers regarding prevention and treatment of
diarrhea, breast feeding and weaning. Briefly discuss two principles of PHC that were
taken into account for providing these services. (3) [Annual 2014]
10. Government constructed modern latrines in a village to overcome the problem of

hookworm infestation in the villagers. The people started using these latrines after
education and motivation. Name principle of primary health care operative in this
scenario. [Annual 2013]
11. In a village development project, manual labor was provided by the villager and
consultations were provided by different departments (health, education,
agriculture and livestock departments). Which principle of primary health care is
operated here? [Annual 2012]
12. Public health engineering department team visited a village where they were
interested to construct latrines to prevent open defecation practice but were facing
the problem of shortage of funds. After discussion, the people of the village offered
all types of help and resources.
a) Which principle of primary health care is operative in above scenario?
b) Write briefly three other principles of PHC with examples.
[Annual 2011]
13. Briefly explain the principles of primary health care. [Annual 2006]
Components/Elements of PHC
1. Enlist components of PHC. [Supple 2019 held in 2020]
2. What are eight elements of PHC. (2) [Annual 2017]
3. Define Primary Health Care. Enlist its 8 components. (2) [Annual 2014]
4. Enlist atleast 6 components of primary health care. [Annual 2012]
Levels of Health Care
1. Health care services are designed to meet the health needs of the country. The
health services in Pakistan are underutilized due to some reasons.
a) Write down the level of health care services. (1.5)
b) What are the characteristics of a good health care system? (2) [Supple 2017 held
in 2018]
First Level Healthcare Facilities
1. In a remote village, a basic health unit is present but is not functional on account of
non-availability of staff, so that village people go to a tertiary care hospital if the
need arises.
a) Does the situation indicate integration of health systems?
b) List the services that should be provided at a BHU.
[Annual 2009]
2. Secretary Health Punjab has recently inaugurated a health care facility in a small
village near Gujranwala. It will provide service to a population of 5000-10000 in an
area of 14-40 km.
a) Categorize this health care facility.
b) Enlist the services that will be provided at this facility.
[Annual 2008]
Problems in Healthcare
1. Pakistan has sufficient number of first level care facilities but these have failed to
achieve the desired level of health in our country largely owing to avoidable reasons.
What are reasons for the failure of these facilities to provide adequate services? (3)
[Annual 2016]
▪ GENERAL EPIDEMIOLOGY
Frequency Determinants
1. In a population of 60,000, there were 250 cases of T.B. on 1st January. During 1-year
period, 50 more cases were added. During this year, 20 patients with T.B. died while
40 were cured. Calculate:
a) Prevalence rate of T.B. at the end of this year.
b) Incidence rate of T.B. during the year.
[Annual 2013]
Epidemiological Methods
1. What are the different epidemiological studies? [Supple 2015]
Descriptive Studies
1. A study was conducted to assess the difference between hemoglobin levels of male
and female students of 4th Year MBBS in a private college and their association with
eating habits.
a) Identify the study design and appropriate sampling technique. (2)
b) Enumerate two qualitative and two quantitative variables for this research
proposal. (1) [Supple 2018 held in 2019]
2.
a) Enlist steps of conduction of cross-sectional study.
b) What are the steps to conduct such study?
[Supple 2015]
3. As a researcher, you want to find out the burden of malaria in a community. Which
type of study will you prefer to carry out?
Analytical Studies
1.
a) Compare and contrast case-control study with cohort study. (4)
b) Define Odds Ratio. (1)
2. The number of patients with cervical cancer is increasing in an area and the general
hypothesis is that it is associated with intake of Oral Contraceptive Pills (OCPs). You
conducted a study after the direction by high authority and enrolled 70 women who
used OCPs and as women who were not using OCPs after matching. After 5 years of
continuous monitoring, you found that out of women who were using OCPs, 14
developed cervical cancer and 2 developed the cancer in non-OCP users.
a) What is the type of this study?
b) What are the most appropriate risk measures?
c) Calculate the risk and interpret the result.
[Annual 2019]
3. In a study, history of smoking was taken to investigate the association of smoking
with oral cancers. Out of a total of 675 diseased participants, 14 were smokers;
whereas out of a total of 90 non-diseased participants, 32 were non-smokers.
a) Identify study design. (1)
b) Construct a 2x2 table to calculate the measure of association. (3)
c) Interpret the result. (1)
4. A researcher conducted a study in relationship between alcohol intake and liver

cirrhosis. He took 70 cases of liver cirrhosis patients out of which 50 used alcohol
regularly. Out of 50 controls, only 10 used alcohol.
a) Name the above-mentioned study design. (1)
b) From above scenario, calculate strength of association between liver cirrhosis
and alcohol intake using 2x2 contingency table. (4)
[Annual 2018]
5. A case control study was conducted to explore that obesity is a risk factor for
hypertension. 40 hypertensives were matched with 51 normotensives and data was
collected regarding obesity. Among hypertensives 18 and among non-hypertensives
11 were obese.
a) Construct 2x2 table. (2)
b) Calculate measure of risk. (1)
c) Interpret you results. (2)
6. A study was conducted to determine the association between betel chewing and oral
cancer through a cohort study. The results are as under:
Betel Chewing Oral cancer developed Oral cancer not developed

Positive 250 75
Negative 50 550
a) Calculate the incident rate of oral cancer in betel chewers. (2)

b) Calculate relative risk from the given data. (3)
[Supple 2017]
7. In a study of chemical workers, 400 with respiratory disease and 150 workers
without respiratory disease were selected for examination. The investigator
obtained a history of exposure to particular solvent in both groups of workers.
Among workers with respiratory disease, 250 gave history of exposure to the
solvent, compared to 50 of the workers without respiratory disease.
a) What is the study design?
b) Calculate measure of association and interpret the result.
c) Enlist two main disadvantages of this study design.
[Annual 2015]
8. A researcher took a sample of 50 children with diarrhea and 50 without diarrhea. He

inquired about the source of water supply to find out its association with diarrhea.
He consolidated the data as follows:
Source of water Disease status (YES) Disease status (NO)

Community tap 30 (a) 15 (b)
Indoor piped supply 20 (c) 35 (d)
a) What type of study is this?

b) Calculate exposure rate to community tap among diarrheal patients.
c) Measure the estimated risk of diarrhea among community tap user.
9. In a hypothetical cohort study of an association b/w smoking & coronary heart

disease (CHD), out of 3000 smokers 84 developed CHD. In 5000 non-smokers, 87
developed the disease.
a) Make 2x2 table & calculate the measure of risk.
b) Interpret the result.
[Annual 2014]
10.
Cigarette Smoking Lung Cancer Present Lung Cancer Absent

Yes 70 6930
No 03 2997
a) Calculate relative risk & write tis significance.

b) What is meant by attrition seen in cohort studies? What measure should be
taken to overcome this problem as it distorts the result of the study?
[Supple 2013]
11. In an epidemiological study, 1/3 of 90 subjects with myopia had +ve family history of
disease while 10 of the 100 subjects without myopia also have the +ve family history
of disease.
a) Which study best fit this type of scenario?
b) Conduct 2x2 table & calculate measure of risk.
c) Interpret your result.
[Annual 2012]
12. A cohort study was conducted to determine the association b/w alcohol intake and
peptic ulcer. Name measure used to determine strength of association b/w cause &
effect. Also write down formula to calculate it. [Supple 2011]
13.
H/O taking coffee Myocardial Infarction Present Myocardial Infarction Absent

Yes 60 90
No 90 60
a) Calculate odds ratio.

b) How will you interpret your result?
[Annual 2011]
14.
a) Show the basic structure of case-control study in a 2x2 table.
b) What is the measure of association in case-control study?
c) How is it calculated?
d) If the measure is 5, how is it interpreted?
[Annual 2010]
15. A researcher wanted to study the risk of perinatal mortality (PNM for 100,000 births)
caused by maternal anemia during pregnancy and found following observations.
Incidence of PNM/100,000 births:
Among anemic pregnant women 4000

Among non-anemic pregnant women 200
a) Calculate the attributable risk (risk-difference) & attributable fraction (%)

b) Interpret the result.
[Annual 2008]
16. A case-control study was conducted to find out association between lung cancer &
cigarette smoking.
a) Which measures give the strength of association between smoking and lung
cancer in this type of study?
b) How will you differentiate this study from cohort study?
[Annual 2007]
17. Name atleast six advantages/merits of case-control study. [Annual 2006]
18.
a) Define relative risk.
b) Explain relative risk derivation & interpretation of the results with the help of 2x2
dummy table. [Annual 2006]
19. List five features of cohort study. [Supple 2006]
Association & Causation
1. What is meant by temporal association? [Supple 2011]
Epidemic
1. A group of 20 students after the school went to the nearest fast food and had
burgers. Within 3 hours of eating, 10 students developed vomiting and diarrhea. 1
hour later, other 7 were affected, sparing 3.
a) The distribution of cases in time suggests which kind of epidemic?
b) Outline the steps taken to investigate an epidemic.
[Supple 2007]
2. Briefly describe the steps required to investigate an epidemic. [Annual 2005]
Surveillance
1. Write a short note on Sentinel Surveillance. [Supple 2016 held in 2017]

▪ EPIDEMIOLOGY OF COMMUNICABLE DISEASES
Dynamics of Disease Transmission
1.
a) What are sub-clinical cases in the dynamics of communicable diseases? (2)
b) Write down the epidemiological importance of these cases. (1)
c) How do these differ from latent infections? (2)
[Annual 2016]
Control of Infections
1.
a) Define Quarantine.
b) List Quarantinable diseases internationally.
Acute Diarrheal Diseases
1. About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in
developing countries where young children get diarrhea on average three times a
year. Frequent episodes of diarrhea are also a common cause of malnutrition. Other
long-term problems that can result include stunted growth and poor intellectual
development.
a) What is the definition of diarrhea according to WHO/UNICEF? (1)
b) What are the various host factors underlying diarrhea? (2)
c) What are the short term and long-term intervention measures to control
diarrhea? (2) [Annual 2017]
Chickenpox
1. A 7 years old child presented with typical pleomorphic rash consisting of macules,
papules as well as pustules with red base distributed all over body especially on
trunk along with high fever for 3 days. Fever increases with every new crop of rash.
There is a history of similar cases among other school fellows as well as during last 2
weeks.
a) What is your diagnosis? (1)
b) What steps will you take for specific protection related to primary level
prevention for this disease? (4)
Dengue
1. A 45-year-old gardener was brought in the Medical Outpatient Department with the
history of high-grade fever with chills for 5 days., intense headache, muscle and joint
pain, retro-orbital pain for last 3 days and photophobia. He gave history of
spontaneous bleeding from gums. On examination, maculopapular rashes were
present on chest and trunk. His lab reports showed thrombocytopenia, platelets <
100,000/mm3 and raised hematocrit.
a) Apply epidemiological triad on the disease. (2)
b) What environmental measures included roof-top management should be taken
to prevent the disease epidemic? (3)
[Annual 2019 + Annual 2014]
2. A university student presented with history of high-grade fever accompanied by

headache, severe body aches and maculopapular rashes. There was an increase in
hematocrit and thrombocytopenia in lab investigations.
a) What is the probable diagnosis? (1)
b) What measures would you recommend in responsible arthropod in this disease
transmission? (4) [Supple 2017 held in 2018]
3. A person currently visiting Pakistan from a neighboring country presents with severe
generalized aches and pains. A maculopapular rash is found on the body with
petechiae and purpuric spots. He also complains of intense retro-orbital pain
particular on eye movement. What is the likely diagnosis? [Annual 2009]
Diphtheria
1. A nurse (female) 20 years of age was appointed in nursery section pediatrics unit.
The professor asked her first to get herself tested for ‘Schick test’ which gave
positive result. She then got her throat swab cultured, which was negative. In such
scenario:
a) What is the status of the staff nurse against diphtheria?
b) Write your advice for the nurse in light of your interpretation.
2. Write a note on control of diphtheria in school. [Annual 2014]

Hydatid Disease
1. Wrote prevention and control measures against Hydatid disease. (3)

Malaria
1. Total population of a village is 8000. A researcher test MP (malarial parasite) I the

peripheral blood films of the total population. Results are as follows:
Out of total 1000 under-one year of age population, 250 were positive for MP. Out
of total 2000 above 1 year to 12 years of age population, 300 were found positive for
MP. Out of remaining 5000 population, 2000 were positive for MP.
a) Which rate indicates recent malarial transmission? (1)
b) Write down the formula of the selected rate. (2)
c) Justify your selection of rate. (2)
[Annual 2016]
2. A patient reports to you with fever, rigor and chills. He complains of severe
weakness and lethargy. He has body aches and pains. His peripheral blood film is
positive for ring of protozoa.
a) What is the most probable diagnosis? Name the vector of the disease.
b) What measures will you recommend to control the vector of this disease in the
community? [Annual 2012]
3. A 30-year-old farmer presented at BHU with complains of fever & rigors. His blood
film showed ring forms of protozoal parasite. The medical officer at the BHU
prescribed chloroquine tablets for four days, but he did not respond to the drug &
his fever persisted.
a) What would be the possible cause for this persistent fever?
b) Outline measures for prevention of this disease in the given community.
[Annual 2008]
Measles
1. A 4th class student of a school was seen by a school health medical officer with low-
grade fever and maculo-papular rash behind the ears and on the face.
a) What is probable diagnosis/
b) What measures will you recommend for his classmates and the child himself?
[Supple 2011]
2. Apply the concept of epidemiolocal triad on the disease ‘Measles’. [Annual 2010]
Meningococcal Meningitis
1. During the month of December 2014, five recruits of ages 20-22 years from
overcrowded barracks of army training center Quetta garrison reported to medical
officer of the center with complaints of fever, intense headache, vomiting and neck
stiffness.
a) What is the most likely diagnosis? (1)
b) How other recruits in the same barrack should be protected from the disease as a
short-term measure and long-term measure? (4)
[Annual 2015]
Mumps
1. A couple presents for investigation of infertility of male, 30 years old. He smokes

around 10 cigarettes per day whereas the female is only 18 and is slightly
underweight. The male gives history of mumps infection after reaching the puberty.
a) What is the possible cause of the infertility?
b) Give the mode of transmission and immunization for mumps.
[Supple 2008]
Pertussis
1. In an OPD, the doctor identified a child with fever and paroxysmal cough ending in a
loud (croupy) crowing inspiration. His mother confirmed insidious development of
the condition while coryza over the last 10-15 days. The child has been going to
school off and on during this period.
a) What is the likely diagnosis?
b) What measures should be taken to control disease spread among his school?
[Annual 2008]
Polio
1. For the last many years, Pakistan has been trying to eradicate polio without much
success. Many cases of polio have been reported from KPK, South Punjab, and a few
from other provinces. Enlist the causes of resurgence of polio in Pakistan. (2)
2. World Health Organization (WHO) developed the ‘Polio Eradication & End game
Strategic Plan 2013-2018’ which envisioned a polio-free world by 2018 and Pakistan
is still facing challenges to achieve its target.
a) What factors are hindering those targets in Pakistan? (3)
b) Differentiate between mopping up and line-listing. (2)
3. Pakistan is still having poliomyelitis.

a) What are the causes of failure in eradication of poliomyelitis in Pakistan?
b) How can we achieve eradication of polio in near future?
4. Give the current strategies to eradicate polio from Pakistan as recommended by

WHO. [Annual 2009]
Rabies
1. A 35-year-old female was bitten by a dog on her left leg causing lacerated wound. It
was unprovoked bite and dog was not available for inspection. She had previous
history of dog bite 2 years back for which she received immunization from a hospital.
a) Outline plan of immunization and management. (2.5)
b) What is the significance of initial wound management? (2.5)
[Annual 2018]
2. A 40 years old guard of forestry presented in emergency with a dog bite on his left
leg. Physical examination revealed multiple lacerated wounds on his leg with
scratches on face & palm. He received a complete course of immunization against
rabies last year.
a) Categorize the intensity of bite.
b) Give the line of management.
[Annual 2008]
3. A pregnant woman at term with complete immunization against tetanus was bitten
by a neighbor’s dog and came to you with a wound on left leg.
a) Outline the steps of management in this particular case.
b) What health education would you give regarding the prevention of dog bite?
[Annual 2007]
4. A boy of ten years reports to you with a dog bite on left leg. What plan of action will
you take under following circumstances?
a) Bite is by a pet dog available with the owner
b) The dog had escaped
c) The dog is dead
d) The boy was immunized 4 months back as he was bitten by a rabid dog
5. Write note on management of a pregnant lady in 1st trimester bitten by a rabid dog
and being previously vaccinated. [Annual 2005]
Rubella
1. A 55-year-old lady going to visit her neighbor where a boy is suffering from rubella.
Her unmarried FSC student daughter wants to accompany her.
a) Should the lady take her daughter with her?
b) Justify your answer.
[Supple 2013]
2. A low-birth-weight infant is born with deafness, cardiac manifestations, cataract and

cerebral palsy.
a) What is the most probable diagnosis?
b) What preventive measures will you advise to protect the community against
above given problem?
[Annual 2012]
3. A four-year-old boy was brought by her mother to a general practitioner with the
history of low-grade fever, posterior auricular and cervical lymphadenopathy.
Maculopapular rash was present on the body, which first appeared on the face and
then spread rapidly to the trunk and extremities.
a) What is likely diagnosis?
b) Give the primary prevention of the disease.
[Annual 2009]
Scabies
1. The teacher referred a child of his class, who scratching his hands and axilla
repeatedly, to the school medical officer for examination and treatment. On
examination, reddish papules were seen in the web spaces of fingers, toes and
axillary folds. Name the disease and the organism causing it. (1+1)
Tetanus
1. An 18 years old boy involved in a road side traffic accident with multiple lacerated
wounds was brought in Emergency Room of a tertiary care hospital. The boy was
unaware of his vaccination history. What plan of action will you follow as a casualty
medical officer with respect to?
a) Vaccination against tetanus
b) General wound management
[Annual 2014]
2. Two (one boy, one girl) 4th year MBBS class students reported to you to get
themselves vaccinated against tetanus. Both had complete EPI schedule in their
childhood. Write complete vaccination schedule i.e., primary and booster for both
the students monitoring dose, route of administration and number of times vaccine
required. [Annual 2013]
3. A twelve-year-old boy is brought to the accident department of a hospital suffering

from soiled laceration on limbs after being involved in a road side traffic accident. He
further gave history of complete primary immunization under expanded program of
immunization (EPI).
a) What vaccination he might need?
b) How would you manage the case as a doctor?
[Annual 2010]
4. A boy was delivered by an untrained birth attendant in a village. She cut the cord of
the baby with an unsterilized dusty blade. Baby dies within seven days after
developing severe muscular spasms, arching of the back and respiratory failure.
a) What do you think was the possible cause of death?
b) Could this death be prevented? If yes, how?
[Supple 2007]
5. Write dosage, route of administration and complete schedule of immunization

against tetanus in the following:
a) A new born baby
b) A child-bearing age unmarried lady aged 20 years.
Typhoid Fever
1. A patient reports to you in a Basic Health Centre with chills, high fever and headache
along with abdominal pain. The fever was in step-ladder fashion. On physical
examination, there was relative bradycardia and abdominal tenderness.
b) The control of this disease is within the scope of public health. Explain three main
lines of defense against this disease especially vaccination, if available. (4)
[Annual 2019]
2.
a) What are the five ‘Fs’ of feco-oral transmission of disease?
b) Apply the above five to control typhoid (enteric fever) in a household.
[Annual 2010]
Yellow Fever
1.
a) Why yellow fever is of public health concern in Pakistan? Give comments.
b) What are the measures to control the spread of yellow fever in Pakistan?
2. A person travelling from Africa landed at Karachi airport. His international

vaccination certificate indicates he had received vaccine against yellow fever two
days back.
a) Will you put him under quarantine?
[Annual 2011]
3. What is the significance of yellow fever with special references to Pakistan? How can
it be controlled? [Annual 2005]
Sexually-transmitted Diseases
1. In 2019, many cases of HIV have been reported from some parts of Interior Sindh
and Punjab like an epidemic, which caught attention of WHO as well. Majority of the
sufferers were children.
a) Enlist modes of transmission of HIV/AIDS in Pakistan. (3)
b) Name two other common diseases transmitted like HIV. (2) [Supple 2019 held in
2020]
2. A 30-year-old I/V drug abuser reported with diarrhea, unexplained weight loss and
prolonged fever. Clinical examination revealed oral thrush. Chest X-ray showed basal
pneumonia.
b) Name four measures to prevent this havoc in the community.
[Annual 2012]
Viral Hepatitis
1. Mr. X, 22 years old, married, working as a laboratory technician got a needle-stick

injury while drawing blood from a known case of Hepatitis B.
a) Discuss prophylaxis against Hepatitis B in this particular case.
b) What measures should be taken to protect other laboratory workers?
▪ EPIDEMIOLOGY OF NON-COMMUNICABLE DISEASES
Accidents
1.
a) Why road traffic accidents (RTA) are much more common in Pakistan that in
developed countries. Give a comparison.
b) What personal, community and legislative measures should be taken to tackle
this problem? [Annual 2014]
Cancer
1. In Asia, Pakistan has the highest rate of breast cancer. Around 40,000 women lose
their lives every year in Pakistan due to breast cancer.
a) What could be the strategies and interventions to control and prevent this
menace at community and health facility level? (2.5)
b) Enlist four common occupational cancers. (2.5)
[Annual 2018]
2. Current evidence shows that about 60-90% of the cancers are initiated by various
factors in the environment and cancers are the leading cause of mortality next to
coronary heart disease.
a) Write down agent, host and environmental factors causing cancers in human
population.
b) What are different measures for prevention of breast cancer?
Coronary Heart Disease (CHD)
1. Prevalence of coronary heart disease is increasing in Pakistan. What are the

guidelines for preventing coronary heart disease? [Supple 2015]
2.
a) List six important risk factors for Coronary Heart Disease (CHD)
b) Name preventive measures against CHD.
[Annual 2006]
Diabetes Mellitus
1. A patient with uncontrolled Diabetes Mellitus had to undergo below-knee

amputation to a gangrene of his left foot. As a junior doctor, what specific health
education advice and counseling will you offer before his discharge? [Annual 2010]
Hypertension
1. Hypertension is the commonest cardiovascular disorder causing high morbidity and

mortality rates in Pakistan. It is known as ‘silent killer’ because of its high association
with coronary heart disease and stroke. What is meant by ‘tracking of blood
pressure’ and what is its significance? (2.5) [Supple 2018 held in 2019]
Snake Bite
1. In the month of July, a snake bit a farmer. Soon he started developing numbness of
feet, slurred speech, difficulty in breathing, ptosis and paralysis. On examination,
two visible fang marks were present on the right leg.
a) Outline plan of management. (3)
b) Enlist prevention of snakebites. (2)
2. A farmer reports to you with breathing difficulty following a snake bite.
a) Which types of snakes come in your mind?
b) Outline the steps of management.
[Annual 2011]
3. A man bitten by a snake presents with ptosis, slurred speech and labored
respiration.
a) Name the likely snake.
b) Outline the steps of management.
4. How snake bite can be prevented? [Annual 2005]
▪ IMMUNOLOGY
Herd Immunity
1. Herd immunity can be quoted as an example of public good. High level of herd
immunity gives protection to susceptible or non-immunized individual.
a) What do you understand by herd structure? (2)
b) Which are the elements which contribute to herd immunity? (3)
[Annual 2017]
Immunizing Agents
1. What is difference between toxin and toxoid? [Supple 2006 held in 2007]
Cold Chain
1. Name atleast four equipment used for maintenance of cold chain at different levels
of health care outlets for storage/transportation of vaccines. (2) [Annual 2016]
2. Write a note on cold chain. [Annual 2005]

Expanded Program of Immunization (EPI)
1. Write in tabulated form with age, route and dosage the vaccines of Expanded
Program of Immunization (EPI) Pakistan for under-five children. (3) [Supple 2019
held in 2020]
2. A mother brings her 6 weeks child who received BCG and OPV at birth and now she
wants her child’s vaccination. State the vaccines given at this time and schedule of
remaining vaccines according to EPI in Pakistan. (2+3) [Annual 2019]
3. Under-five mortality rate is very high in Pakistan. To address this issue, government
of Pakistan is immunizing against ten diseases starting from birth. Write in tabulated
form EPI schedule of Pakistan with its dosage and route of administration. (5)
[Annual 2018]
4. Expanded Program of Immunization (EPI) started to protect the children from six
disabling diseases. Some other diseases have been added in this program with the
passage of time. Write down the complete schedule of EPI showing vaccine, disease,
age, dose and route of administration in a tabulated form. (5)
5. Under EPI schedule Measles vaccine is given at the age of 9 months to the infants.
Now a second dose at the age of 12-15 months is added. Why this second dose is
included in vaccination schedule? (2) [Annual 2016]
6. A mother brought her one-day old child in the EPI center. She said that the child
received no vaccines before.
a) How will you proceed for immunization of this child keeping in view the EPI
schedule? Write schedule and site of administration of each vaccine. (4)
b) Mention two vaccines which are not included in EPI schedule and can be given to
children under-five years of age. (1)
[Annual 2015]
7. A mother reports to you with her three years old child limping due to post-polio
paralysis of left leg. She asks for vaccination under EPI schedule as she had not got
her child vaccinated before against any disease.
a) Will you include polio vaccine in the schedule?
8. A program of immunization of children started in Pakistan during the year 1974 with
the objective of reducing morbidity and mortality associated with six childhood
diseases initially but some others were added later.
a) What is this program called?
b) Give the disease and schedule of immunization.
[Annual 2007]
Some Common Vaccines
1. For the last many years, Pakistan has been trying to eradicate polio without much
success. Many cases of polio have been reported from KPK, South Punjab, and a few
from other provinces. Enlist the causes of resurgence of polio in Pakistan. (2)
2. Pakistan is still having cases of Poliomyelitis.

a) What are the causes of failure in eradication of poliomyelitis in Pakistan?
b) How can we achieve polio eradication in near future?
3. Two (one boy, one girl) 4th year MBBS class students reported to you to get
themselves vaccinated against tetanus. Both had complete EPI schedule in their
childhood. Write complete vaccination schedule i.e., primary and booster for both
the students monitoring dose, route of administration and number of times vaccine
required. [Annual 2013]
4. A mother reported to you along with her young unmarred daughter with the view to
know what vaccine her daughter needs to make her future reproductive life safe.
Give the names and schedule of vaccine she needs. [Annual 2012]
5. A twelve-year-old boy is brought to the accident department of a hospital suffering

from soiled laceration on limbs after being involved in a road side traffic accident. He
further gave history of complete primary immunization under expanded program of
immunization (EPI).
c) What vaccination he might need?
d) How would you manage the case as a doctor?
[Annual 2010]
6. Write dosage, route of administration and complete schedule of immunization

against tetanus in the following:
a) A new born baby
b) A child-bearing age unmarried lady aged 20 years.
Immunization Recommendation for Travelers
1. Name the vaccines which are mandatory for all Muslims proceeding for Holy Hajj
(Pilgrimage). (1) [Annual 2016]
▪ SCREENING & SAMPLING
Criteria for Screening
1. Enlist six criteria which made a disease suitable for screening. [Annual 2006s]
Sensitive, Specificity and Predictive Accuracy
1. In a breast cancer screening program, 12 out of 30 with mammography test result

positive were found to be suffering from the disease, whereas 16 out of 130 with
mammography test result negative were found to have the disease.
a) Make a 2x2 table (2)
b) Calculate Specificity of the test (1.5)
c) Calculate Negative Predictive value of the test. (1.5)
2. 80 people were checked for their serum calcium levels at an endocrine clinic out of
15 who have high levels of serum calcium, 12 were found to be suffering from
hyperparathyroidism. Out of 65 with normal serum calcium levels, 8 suffered from
the disease.
a) Make a 2x2 table.
b) Calculate:
i) Sensitivity of the test
ii) Specificity of the test
iii) False positive error rate
iv) False negative error rate
[Annual 2014]
3. A screening test was done for identification of Hepatitis B infection among 1000
adult population working in a factory. The screening test was positive in 200
individuals, out of which only 70 were positive for disease on PCR test, while 500
individuals were found absolutely healthy.
a) Construct 2x2 table.
b) Calculate sensitivity, specificity and predictive value of the screening test.
Sampling
1. Sampling is a process of selecting a number of subjects from all subjects in a

particular group or universe.
a) Why do we need to study the sample rather than the whole population? (1)
b) What are the uses of table of random numbers in sampling? (1)
c) For a population that is hard to reach like injection drug users, which sampling
method is appropriate?
d) Write a short note on stratified random sampling
[Annual 2017]
2. A researcher is interested to assess writing skills of post-graduate medical trainees

working in different hospitals of Lahore city. Total number of trainees is 8000, who
are working in different specialties and different years of training. If he is desirous to
select a sample of 2000 trainees,
a) What sampling technique would you recommend that is most appropriate in the
given situation? (2)
b) Write steps of selected sampling technique. (3)
[Annual 2016]
3. To evaluate the teaching methodology, opinion of final year MBBS students is to be

assessed. The total number of students in final year class is 150. The desire sample
size is 30.
a) Write the most appropriate sampling technique.
b) Write procedure for selected technique.
[Annual 2012]
4. To conduct a study in city, the population was first divided into different groups and
sample was taken from each group on proportionate basis.
a) Name the sampling technique used in above study.
b) Name any three non-probability sampling techniques.
[Annual 2011]
5. Explain systematic random sampling with examples. [Annual 2006]

▪ BIOSTATISTICS
Data and its Presentation
1.
a) What is the difference between data and information?
b) What are the different ways of graphically presenting the quantitative data?
[Annual 2010]
Measures of Central Tendency & Dispersion and Skewness
1. Name two measures of dispersion. (2) [Supple 2019 held in 2020]
2. Diastolic blood pressure of randomly selected 10 students from a medical college

was 83, 77, 81, 79, 71, 95, 75, 77, 82, 90.
a) Calculate three measures of central tendency in the above data. (1)
b) Name the type of skewedness in the above scenario. (2)
c) What can we say of the true mean of the students from which the sample was
taken if the standard deviation of the said sample is 7.31? (2)
[Annual 2019]
3. Differentiate between ‘Negative Skewed’ and ‘Positively Skewed’ curve with the help
of diagram. (2.5) [Annual 2018]
4. Cholesterol level of 12 nurses of final year class was recorded and the values were as
under:
164, 168, 140, 168, 175, 123, 168, 135, 180, 185, 190, 124 mg/100 ml.
a) Calculate measures of central tendency. (3)
b) Name the type of distribution in this type of data. (2)
5. 10 government employees came for their annual medical examination in a hospital

laboratory. They also gave blood to check their serum cholesterol levels. They were
as follows: 185, 250, 220, 245, 220, 200, 220, 210, 230, 220 mg/100 ml.
a) Work out the indices of central tendency. (3)
b) If standard deviation is 10, calculate the 95% of the population under study. (2)
6. In 9 families, the number of children per family were 4, 6, 2, 2, 4, 3, 2,1, 7. Calculate
the mean, median, mode from this data. [Supple 2015]
7.
a) Enlist measures of dispersion.
b) Calculate standard deviation of: 1, 2, 4, 7, 10, 12
[Annual 2014]
8. A study was conducted on 100 pregnant women to determine the prevalence of

anemia in pregnancy. The mean hemoglobin level was 12 gm/dL with standard
deviation of 2.
a) What will be the variance in this sample?
b) Calculate the standard error.
[Annual 2013]
9. The record of labor room from a hospital showed that in the month of April the total
deliveries were 150 and 15 newborns were low birth weight. Their weights were as
follows: 1.3, 1.7, 1.8, 1.8, 1.9, 2.0, 2.1, 2.1, 2.2, 2.2. 2.2, 2.2, 2.3, 2.3, 2.4, 2.4
a) Calculate the measures of central tendency.
b) Name the type of skewness in data.
[Annual 2009]
10. A study was conducted to determine the heights of 10 lady doctors working in the
department of community medicine and pathology. The data obtained were 5.8, 5.6,
5.6, 5.0, 4.11, 5.3, 5.7, 5.4, 5.6 & 5.2
a) Calculate the measures of central tendency.
b) Classify different types of variables and categorize the type of variable under
study. [Annual 2008]
11. The total number of students in a private school was 123. There were ten classes
with different strength. A survey was conducted to assess the number of students in
each class. The data provided was 10, 10, 10, 10, 12, 12, 13, 14, 15, 17.
Calculate measures of central tendency in above data. [Annual 2007]
12. Calculate the mean, median and mode of the following data.
8, 10, 12, 12, 12, 12, 13, 14, 15, 16, 17, 20, 22, 29
Tests of Significance
1. A researcher wants to compare average weights of 100 women at the start and end
of pregnancy.
a) Which test of significance should be selected for analysis and why? (3)
b) What would be your conclusion regarding rejection or acceptance of null
hypothesis if alpha was set at 0.05 and the P value obtained is
i) 0.04
ii) 0.07 (2) [Annual 2016]
2. Results from isoniazid trial after 6 months follow-up are given in the following table:
Dead Alive Total

Placebo 21 110 131
Isoniazid 11 121 132
Total 32 231 263
a) Formulate null hypothesis.

b) Is there any significant difference between placebo and isoniazid?
(chi-square value for P value 0.05 is 3.84)
[Annual 2015]
Normal Distribution Curve
1. Draw and label normal distribution curve. (3) [Supple 2019 held in 2020]
2. Write down salient features of normal distribution curve with the help of diagram.
(2.5) [Annual 2018]
3. What is the normal distribution curve? [Supple 2015]
4.
a) What are the characteristics of a normal distribution curve?
b) Elaborate the distribution of observations around the mean in the normal
distribution curve. [Supple 2008 held in 2009]
5. Write a note on normal distribution curve. [Annual 2005]

▪ DEMOGRAPHY
Definitions
1. Demography deals with five demographic processes. Name them. [Annual 2010]
2. Define demography. [Annual 2005]
Population Doubling Time (PDT)
1. Country X has population of 200 million; the growth rate of that country is 2%. What
will be the population doubling time of that country? (1) [Supple 2019 held in 2020]
Growth Rate
1. A country X in the year 2012 had a population of 150,000,000. During that year, the
total births in that area were 15,500 and total deaths were 12,800. The net migration
rate in the same year was calculated to be 1350. With the help of the demographic
equation, calculate the change in the population that would be expected. (2)
2. It is unfortunate that when population grows at exponential rates, they work against
them. Nature of exponential growth has nature of when things get bad, they get bad
in hurry. Concept of doubling time is useful for financial and demographic analysis.
a) Write down basic demographic equation by which we can understand dynamics
or changes in population? (2)
b) If 1% increase in population in one-year causes population to double in 70 years,
what will be doubling time if population increases at 3% per year? (1)
[Annual 2017]
3. Population of Pakistan is growing at a very rapid rate, giving rise to many problems
relating to health, education, employment and available resources. How will you
differentiate between growth rate and natural increase rate in population?
4. Pakistan is 6th most populated country of the world and has one of the highest
population growth rates in world.
a) What is current populations growth rate of Pakistan?
b) How rapid population growth can be rectified? [Annual 2015]
5. A town had a population of 70,000. During the year of 2012, total births were 3000
and total deaths were 1200. 3000 people migrated to Canada, while 250 displaced
persons were received from Sindh and 50 came back from abroad to town for the
year 2012. Calculate the annual population growth rate of the town for the year
2012. [Annual 2013]
6. In a village with 50,000 population, total annual births are recorded to be 3000,
which total deaths are 1000. Total infant deaths are 200 in that year. No migration
took place during this year.
a) Calculate annual population growth rate % (taking migration as zero) and vital
index.
b) Interpret your results.
[Annual 2011]
Fertility or Natality
1. Enlist determinants of Fertility. (3) [Supple 2019 held in 2020]
2. What are determinants of fertility. (2.5) [Annual 2019]
3. How does the infant mortality affect fertility? [Annual 2013]
4. Enlist the determinants of fertility. [Annual 2007]
5. What do you understand by determinants of fertility? [Annual 2005]
Basic Fertility Measures
1. Define replacement fertility level. [Annual 2017]
2. Enumerate four measures of fertility. [Annual 2015]
3. How will you differentiate between general and total fertility rates? [Annual 2005]
Population Pyramid
1.
a) Define age pyramid. (1)
b) What information an age pyramid gives? (2)
c) What are the main differences between the age pyramids of developed and
developing countries? (2)
2. Comment on the population growth rate of country A, B and C based on Crude Birth
Rate and Crude Death Rate as inferred from pictures below. [Annual 2016]
Sex Ratio
1. Define sex ratio. What are the main reasons for a low sex ratio in some developing
countries? [Annual 2016]
Demographic Transition, Cycle & Trap
1. Over centuries there are variations in birth and death rates in different times which
change the birth and death rates in different countries.
a) Name that demographic process. (1)
b) Explain that process with the help of a diagram. (3)
c) Define demographic trap. (1)
[Annual 2018]
2. Draw and label process of demographic transition. (3) [Supple 2016 held in 2017]
3. What is demographic trap? [Supple 2014 held in 2015]

4. Pakistan has reduced both birth rate and death rate, but despite all efforts birth rate
is still higher than the death rate.
a) Keeping in view the above transition, which state of demographic stage Pakistan
is in?
b) Name the other stages of demographic transition.
[Annual 2012]
5. Explain demographic transition with the help of a diagram. [Annual 2006]
Population Momentum
1. About three-fourths of the world’s population lives in developing countries and still
trends of population growth is moving upward. What is the momentum of
population growth? (2.5) [Annual 2019]
2. What is the momentum of population growth? [Annual 2007]
Dependency Ratio
1. The hypothetical population of a country is as follows:

Population under 15 years of age: 11,245,500
Population above 65 years of age: 9,015,600
Population in age bracket 15-64 years: 38,232,800
a) Calculate dependency ratio.
b) What does dependency ratio indicate?
[Annual 2014]
Implications of High Population Growth
1. What are implications of high population growth? [Annual 2010]
Vital Index
1. Define Vital Index. [Supple 2019 held in 2020]
2. In a village with 50,000 population, total annual births are recorded to be 3000,
which total deaths are 1000. Total infant deaths are 300 in that year. No migration
took place during this year.
c) Calculate annual population growth rate % (taking migration as zero) and vital
index.
d) Interpret your results.
[Annual 2011]
▪ ENVIRONMENTAL HEALTH
Definitions
1. Define ‘safe and wholesome’ water. [Annual 2006]
2. Define potable water. [Annual 2005]
Cone of Filtration
1. In a village, after consumption of well-water, most of the people developed acute

gastroenteritis which indicated that well water is contaminated as well as
surrounded by ponds and heaps of filth. How will you find out the source of pollution
in the above well? [Supple 2013 + Supple 2012]
2. How will you detect source of contamination of well water? [Supple 2006]
Purification of Water
1.
a) Enlist the physical and chemical methods to purify the water at household level.
(3)
b) Write a note on bleaching powder. (2)
2. A well was present in a rural area where an unsanitary bore-hole latrine with lots of
flies was present within 10 feet distance. What measures can be taken to make this
well water safe for drinking? [Annual 2009]
3. Name four methods along with brief explanation for purification of water at
domestic level. [Annual 2006]
4. Describe briefly the methods of chlorination of water. [Annual 2005]

Swimming Pool Sanitation
1. Name health hazards and diseases associated with swimming pool. (1.5+1.5)
[Annual 2019]
2. Name four health hazards associated with swimming pool.

3. Name three diseases which may be transmitted through swimming pool.

[Supple 2013 + Supple 2012]
Sampling of Water
1. Examination of tap water sample reveals presence of five coliforms in 100 ml and a
raised nitrate level.
a) Is this water fit for drinking?
b) If you want to take another sample from the tap, how will you take it? Elaborate
the steps. [Supple 2008 held in 2009]
Surveillance of Drinking Water
1. Surveillance of drinking water is essential public health measure to prevent water-

borne diseases in people of an area.
a) Name elements of water surveillance program. (2)
b) Write down criteria of bacteriologic quality of drinking water. (3)
Water-related Diseases
1. It is said that majority of hospital admissions in Pakistan are due to drinking

contaminated and polluted water.
a) Enlist four common infectious diseases transmitted through water to humans. (2)
b) What is the significance of nitrates/nitrites, arsenic and fluorides in drinking
water? (2) [Supple 2019 held in 2020]
2. Which diseases can occur due to consumption of contaminated water? How these
can be prevented? [Supple 2015 held in 2016]
3. A well was present in a rural area where an unsanitary bore-hole latrine with lots of
flies was present within 10 feet distance. Enlist the diseases likely to be transmitted
through drinking this well water. [Annual 2009]
4. Enlist the diseases which are transmitted through water. [Annual 2005]
Air Pollution
1. Rapid mechanization and industrialization are resulting into increased concentration

of harmful gases like CO₂, SO₂, NO₂ and CFC in the atmosphere; which are causing
damaging effects to all forms of life. What are the main sources and impact of air
pollution in human population? (2) [Annual 2019]
2.
a) Name the sources of Air Pollution. (2)
b) What measures would you recommend to prevent and control Air Pollution? (3)
[Annual 2016]
3. Rapid mechanization and industrialization are resulting into increased concentration

of harmful gases like CO₂, SO₂, NO₂ and CFC in the atmosphere; which are causing
damaging effects to all forms of life. Name atleast five effects due to this
phenomenon. [Supple 2014 held in 2015]
4. In the city of Lahore, high levels of air pollution are being reported during peak rush
hours and in areas where factories are located next to residential areas.
a) Enlist various pollutants causing air pollution in Lahore. What are their associated
health hazards?
b) What measures can be taken to control air pollution in Lahore?
[Annual 2014]
Greenhouse effect & Global Warming
1. Climate change and rising temperatures has emerged as a serious threat to mankind
with 2.6 billion poor across the glove more prone to this phenomenon. Pakistan may
also be one of the worse victims of climate change.
a) What are the contributing factors to this rapid climate change? (2)
b) What are major risks associated with climate change? (3)
[Annual 2015]
2. According to research carried out by students of environmental sciences
department, concentration of certain harmful gases was increasing in the
atmosphere owing to which the surface of earth has become hotter than it was
before.
a) What is this effect called?
b) What are the harmful effects of rising temperature on earth?
[Annual 2008]
Housing and Overcrowding
1. A family of 10 persons is living in a two-room house in a rural area with animals and
poultry.
a) What health effects may arise in such situation?
b) What is meant by overcrowding?
Noise
1. The 20th century has been described as ‘century of noise’. Noise is resulting in many
ill effects on health. Suggest measures to control this menace. [Annual 2011]
2. What are the different effects of excessive noise on human body? What measures
would you take to control noise pollution in cities? [Annual 2010]
Climate & Health
1. A traffic constable was brought to an emergency department with history of sudden

loss of consciousness during working hours in June, 2018. On examination, his pulse
was feeble with BP of 110/60 mm Hg. His temperature was 105 F.
a) What is the most probable diagnosis for this man? (1)
b) What are the other conditions caused by exposure to excessive heat during
working hours? (2)
c) What preventive measures should be suggested to control and prevent such
conditions in hot and humid weather? (2)
▪ HOSPITAL WASTE MANAGEMENT
Types of Hospital Waste
1. Hospital waste management system is the base of quality assurance of healthcare

facilities. It poses great risk to health of general community and hospital staff if not
disposed properly. How will you classify healthcare waste? (2.5)
2. Inappropriate disposal of hospital waste poses a great threat to healthcare workers

and exposures to hazardous waste results in disease transmission or injuries.
Hospital waste needs proper planning and implementation strategies. How would
you classify healthcare waste? (2.5) [Supple 2017 held in 2018]
Risk from Healthcare Waste
1. Inadequate and inappropriate handling of healthcare waste may have serious public
health consequences and a significant impact on environment. In this context:
a) Enumerate various hazards associated with hospital waste. (2)
b) What is most dangerous hazard of open-burning of plastic waste from the
hospital? (1) [Annual 2017]
Steps in Waste Management
1. Hospital waste management system is the base of quality assurance of healthcare

facilities. It poses great risk to health of general community and hospital staff if not
disposed properly. What are different techniques of treatment & disposal of
healthcare waste? (2.5) [Supple 2018 held in 2019]
2. Inappropriate disposal of hospital waste poses a great threat to healthcare workers

and exposures to hazardous waste results in disease transmission or injuries.
Hospital waste needs proper planning and implementation strategies. Enlist
treatment and disposal technologies for healthcare waste. (2.5)
3. Enumerate two most common measures for hospital waste disposal used in
Pakistan. (2) [Annual 2017]
▪ OCCUPATION HEALTH & LEAD POISONING
Pneumoconiosis
1. A 50-year-old industry worker in a textile mill presented with complaints of

breathlessness cough and sputum. X-ray chest revealed extensive fibrosis of lungs.
a) Name the occupational disease he acquired. (1)
b) Write preventive measures you recommend for occupational lung diseases. (4)
2. A worker of 45 years of age who was engaged in building and construction work
visited a tertiary care hospital with history of cough, dyspnea on exertion and chest
pain. On X-ray chest snow-storm appearance was shown with impairment of total
lung capacity.
b) What measures should be taken to avoid such problem in other workers in the
same job? (4) [Annual 2019]
3. A 45-year-old farmer presented in medical OPD with history of breathlessness,

weakness, fatigue and irritability for the last 2 weeks. The chest X-ray shows non-
specific pulmonary fibrosis. He describes farming as his main profession.
a) What is the most probable diagnosis? (1)
b) Enlist preventive measures that should be adopted to decrease frequency of
pneumoconiosis in workers. (4)
[Annual 2018]
4. Few cases of fibrotic lung disease reported in a tertiary care hospital. On history, it
was revealed that the disease was progressive in nature and patients were working
in a sugar factory.
a) Name the disease these patients are suffering from. (1)
b) What is the causative agent? (1)
c) Name atleast five preventive measures against this condition. (3)
5. A 50 years old laborer working in glass industry for the last 20 years, presented with
irritating cough, dyspnea and chest pain. On chest X-ray, snow-storm appearance
was revealed.
b) Name four other industries where workers may suffer from such problem. (2)
c) Name atleast four preventive measures against this issue. (2)
[Annual 2016]
6. A laborer working in ship-building industry of Karachi since last 10 years presents to

you with breathlessness. On examination, he is cyanosed and has clubbing of fingers.
X-ray chest showed diffuse fibrosis with ground glass appearance in lower two-thirds
of lungs.
a) What is probable diagnosis? (1)
b) What preventive measures would you recommend to prevent this condition? (4)
[Annual 2015]
7.
a) Define pneumoconiosis.
b) Which control measures should be taken to prevent pneumoconiosis in the
industries? [Supple 2014 held in 2015]
8. A worker aged 45 years is engaged in building and construction work, reports with
cough, dyspnea on exertion and chest pain. Chest X-ray shows ‘snow-storm’
appearance in the lung field.
a) What is the likely diagnosis?
b) What measures should be taken to avoid same problem in other workers?
9. A medical officer in charge of social security health outlet attended about six
patients with fibrotic lung disease. History revealed that they were working in a gas
kit industry for the last ten years.
a) Name the most likely disease and its causative agent.
b) List three preventive measures.
[Annual 2013]
10. A worker from brick-lining industry reported to you with complains of chronic cough,
dyspnea and clubbing of fingers.
b) Name the specific picture of X-ray in such patients.
c) Name three preventive measures.
[Annual 2012]
11. A worker who is working in roof tiling industry for the last 15 years reports to you
with the presenting complains of cough and dyspnea. On examination, clubbing of
fingers and cyanosis is observed. Chest X-ray shows ground-glass appearance in the
lower 2/3 of the lung field.
a) What is your most probable diagnosis?
b) What preventable measures would you suggest for other people working in the
industry? [Supple 2011 held in 2012]
12. A worker aged 45 working in a cardboard industry for the last 17 years complains of
dyspnea, irritating cough, hemoptysis, slight fever and clubbing of fingers.
a) What is the most probable condition in this worker? Name the specific picture of
X-ray in such patient.
b) Name three prevention measures to protect the other workers from this
problem. [Annual 2011]
13. A person aged 40 years who had been working in the grain market for the last 25
years presented with the history of repeated attacks of respiratory infections from
the last 1 year. X-ray showed pulmonary fibrosis.
a) Give the likely diagnosis.
b) What is the role of occupational health service in the prevention of the given
problem? [Annual 2009]
14. A 40 years old pottery industry worker presented with complaints of fever & weight
loss; he also complained about cough & blood-stained sputum. X-ray confirmed
fibrosis of lungs and hilar lymphadenopathy.
a) Which factor in the particular trade has led to development of this condition?
b) Which measures do you recommend for prevention of this condition?
[Annual 2008]
15. A patient presented with shortness of breath and cyanosis. He gave history of
exposure to silica dust as he worked in sand-blasting.
a) What is likely diagnosis?
b) Outline measures to prevent this problem.
[Annual 2007]
16.
a) Enumerate four different types of pneumoconiosis.
b) Give various measures for prevention of occupational diseases.
17. A forty-year-old pottery industry worker presented with complains of fever and
weight loss he also complained about cough and blood-stained sputum. X-ray of
chest confirmed fibrosis of lungs and hilar lymphadenopathy.
a) What is the diagnosis?
b) Outline general measures for prevention of this condition.
18. Define pneumoconiosis. Enlist six pneumoconiosis diseases along with the causative
agents. [Annual 2006]
Prevention of Occupational Health Hazards
1. Workers all over world are exposed to increasing threats which include exposure to
dusts, gases, toxic substance, noise, slippery floors, unsafe plants and equipment,
fire, extreme temperatures, radiation, toxic metals, chemicals and falling from
height. Because of these hazards, work-related accidents and disease are common in
all parts of world.
a) Enlist atleast six engineering measures which promote occupational safety and
health among workers. (3)
b) Write a short note on pre-replacement examination. (2)
[Annual 2017]
2. While recruiting a worker in some industry, his/her medical examination is necessary

according to the factory laws. It is named as Pre-placement Examination.
a) What activities are carried out during Pre-placement Examination? (3)
b) What is the significance of a Pre-placement Examination? (2)
3. Describe any six general measures against occupational hazards.

Lead Poisoning
1. A worker in ship-building industry suffering from anorexia, intestinal colic, persistent

headache, abdominal cramps and constipation. On examination, there was a blue
line on gums and his hemoglobin level was less than 11 g/dL.
a) What is the probable diagnosis?
b) As an occupational health officer, how would you prevent this condition in other
workers? [Annual 2014]
2. A worker in a storage batteries manufacturing factory came to the OPD of hospital
complaining of colicky abdominal pain, constipation and loss of appetite. On
examination, a blue line on gums was visible. Blood examination showed anemia and
stippling of RBCs.
a) What is your likely diagnosis?
b) As an occupational health officer, what preventive strategies will you suggest to
the management to prevent such cases in future?
[Annual 2010]
▪ REPRODUCTIVE HEALTH
Maternal mortality & morbidity
1. A pregnant female in her third trimester presented in emergency with blood

pressure of 170/100, swelling of feet, puffiness of face, urine R/E contains ++
albumin.
a) Would you like to treat the woman at primary health care facility or refer it?
Justify your answer. (2.5)
b) Enlist the common causes of maternal mortality in Pakistan. (2.5)
2. One woman dies in every minute in Pakistan from complications during childbirth.
According to the population council fact sheet 2015, it estimated that every year on
an average 14,000 mothers die in Pakistan. Write three well-established delays at
different levels contributing to maternal mortality. (2.5) [Annual 2018]
High-risk Approach in Pregnancy
1. An 18-year-old primigravidae was received in emergency unit with fits. While taking
history, her mother-in-law informed about repeated episodes of headache and
sometimes blurring of vision. Physical examination revealed blood pressure of
180/110 mm Hg.
a) What is the most probable diagnosis? (1)
b) Which tests will you perform for confirmation of diagnosis? (1)
c) Enumerate other high-risk situations for pregnant ladies which can lead to high
maternal mortality in Pakistan. (3)
2. The risk of maternal death in developing countries is estimated to be 1 in 61 while
for developed countries it is about 1 in 2800. Antenatal care is an important
determinant of safe delivery although certain obstetric emergencies cannot be
predicted through antenatal screening. Women can be educated to recognize and
act on symptoms leading to potentially serious conditions. The central purpose of
antenatal care is to identify high-risk cases.
a) Enlist atleast six high risk conditions which need to be identified by taking risk
approach. (3)
b) Which warning signs the mother should be given in clear cut instructions? (2)
[Annual 2017]
3. A 36-year-old pregnant lady, already having 6 kids, reports to you for antenatal
checkup at 20th week of pregnancy.
a) What do you think is she a high-risk lady?
b) List 4 factors which make a pregnant lady high risk?
[Annual 2013]
4. An 8 months pregnant lady reports to a lady doctor with complaints of giddiness and
heavy feet. On examination, she exhibits pitting edema and BP of 155/95 mm Hg.
a) What is your likely diagnosis?
b) What are the risks for mother and baby in this case?
Mother & Child Healthcare (MCHC)
1. Write down atleast four factors in restoration of health of mother in postpartum

period. [Annual 2016]
2. A 28-week primigravida with raised BP comes to you for her first prenatal check-up.
As a community physician, what will you advise her about the required lab
investigations and warning signs in pregnancy? [Supple 2015 held in 2016]
3. A 25-year-old primigravida comes to your clinic for her first antenatal check-up. On
GPE pallor is positive. Her complete blood exam report showed that Hb is 10g/dL and
MCHC is below 34%.
a) What mineral supplements will you prescribe?
b) What specific nutritional counselling will you do to improve her condition?
[Annual 2014]
4. Pakistan is a developing country were most of the deliveries are conducted at home
by traditional birth attendant or trained Dais.
a) Write name given to such deliveries.
b) Name 2 advantages and 2 disadvantages of such deliveries.
5. A mother who received a proper antenatal care and was declared fit for normal
delivery, underwent a delivery by a trained birth attendant at home.
[Annual 2012]
6. A 4-month pregnant lady reported first time for antenatal care in an RHC.
a) What essential lab investigations are to be done at first visit?
b) What is the schedule for antenatal visits for remaining period of pregnancy?
[Annual 2011]
7. A 30-year-old primigravidae in her 1st trimester of pregnancy comes to your

community clinic for antenatal checkup and advice.
a) What general and systemic investigations will you perform?
b) What investigations will you order?
c) What nutritional advice will you give her?
[Annual 2010]
8. A mother with normal obstetric history delivered a baby at her home by a TBA who
was in close liaison with doctors at RHC.
[Annual 2009]
9. Name 6 activities carried out on a 1st visit of pregnant lady to MCH center for
antenatal care. [Supple 2006 held in 2007]
Growth Monitoring & Promotion
1. A mother brings her six months old baby to you whose weight is not increasing
according to his age. She asks you to assess his nutritional status. You plotted his
weight against the age on Growth Chart and observed that the weight of the child
falls in the red area of the chart.
a) What is your diagnosis? (1)
b) What questions would you like to ask from the mother before managing the
case? (4) [Annual 2015]
2. You are working as a medical officer at a BHU. A mother brings her 1 year old child to
you for growth monitoring. His reported weight is 6 kg and present weight is 3 kg.
a) What is the opinion about the weight of the baby?
b) What advice will you give to this mother keeping the current nutritional status of
baby in mind? [Annual 2008]
Breastfeeding, Artificial Feeding & Weaning
1. A mother visits MCH center to seek advice regarding feeding of her breast fed 6-
month-old baby. She wants to know
a) What is weaning and why is it needed?
b) What supplementary foods could be advised at his age?
2. Give the advantages of breastfeeding. [Supple 2008 held in 2009]
3.
a) Define weaning.
b) What are the advantages of breastfeeding for a child?
c) What is the role of TBA in prevention and control of Tetanus Neonatorum?
[Annual 2005]
IMR, NMR & Perinatal Mortality
1. In a district of South Punjab, population of females of reproductive age group was

270,000. Total live births in this district recorded were 55,000 during 2016 where
6125 children less than one year of age died in the same year.
a) Calculate the infant mortality rate for that year. (2)
b) How can we reduce this high infant mortality rate in this district? (3)
2. Pakistan belongs to the group of countries where infant mortality rate is high. Name
atleast ten socio-cultural factors playing part in increased mortality in infants in
Pakistan. (5) [Supple 2016 held in 2017]
3. A 22-year-old primigravida reports to you for antenatal checkup in 7th month of

pregnancy for the first visit.
a) Which immunization do you give and what is the schedule?
b) How would you provide the antenatal care?
[Annual 2007]
4. Define infant mortality rate. [Supple 2006 held in 2007]
Safe Motherhood
1. What do you understand by safe motherhood initiative? (2.5) [Annual 2018]
2. What do you understand by safe motherhood? [Supple 2008 held in 2009]
▪ FAMILY PLANNING
Intra-uterine Contraceptives
1. What advice will you like to impart to a lady after insertion of intra-uterine
contraceptive device? [Supple 2012 held in 2013]
2. A married couple with 2 children comes to you for advice on contraception. They
want long-term contraception for 4 to 5 years. The man is not motivated by using a
contraceptive method. The wife, aged 35, has been a known hypertensive for many
years.
a) Which type of contraceptive method would you advise to this lady?
b) How would you counsel the woman regarding use of this method?
[Annual 2008]
Hormonal Methods
1. A 32-year-old female with two kids comes to a family planning clinic to seek advice
about use of oral contraceptive pills.
a) What are the components of WHO checklist which should be kept in
consideration while prescribing oral contraceptive pills in this lady? (3)
b) According to the checklist, this woman is found unsuitable for OCP usage. What
the other most suitable method for this lady? Justify your answer. (2)
Terminal Methods/Sterilization
1. An illiterate child underwent vasectomy. What advice a surgeon would impart to
that client? (3) [Annual 2016]
Contraceptive Prevalence
1. A team of researchers visited a remote small town of South Punjab to study

Contraceptive Prevalence Rate (CPR). The population of town is ten thousand. The
team selected 2000 eligible females. Out of those 200 were using contraceptive
methods.
a) Calculate the contraceptive prevalence rate in that area. (2.5)
b) Define unmet need of family planning. (2.5)
Evaluation of Contraceptive Methods
1. In a study to determine the failure rate of condoms as contraceptives, 30 couples

were observed for 30 years, 40 for 2 years, 10 for 1.5 years and 30 couples for 6
months. During observation period, conception took place in 20 couples.
a) Name denominator to be used to calculate failure rate.
b) Calculate failure rate of condoms as contraceptive.
[Annual 2011]
▪ NUTRITION
Balanced Diet & Caloric Requirements
1. A 25-year-old male sedentary person weighting 80 kg reports to you for dietary

advice. On inquiry, it is estimated that he is taking approximately 600g of
carbohydrates, 140 g of fats and 100g of proteins per day.
a) What do you think is he taking required amount of energy?
b) How much calories should he take per day and what should be the proportion of
macronutrients, as he is interested to reduce weight to the reference level?
Dietary Goals
1. For development of a country, a healthy nation is pivot. To keep people healthy,

nutritional and food policy formation is essential. WHO has recommended various
dietary goals (prudent diet). Write atleast five dietary goals. (5) [Annual 2017]
Micronutrients
1. A mother reported to you with her 2 years old child with the complaints that her son
walks with difficulty. On physical examination, the child had curved legs, knock knees
and pigeon chest.
a) What is the most likely diagnosis and the factor involved? (2)
b) Enlist atleast three measures for the prevention and control of this disease. (3)
[Annual 2019]
2. Iodine deficiency disorders (IDD) constitute a major public health issue in hilly areas
of Pakistan. WHO has classified a wide spectrum of clinical presentation of IDD in
community?
a) Enlist different forms of clinical presentation classified by World Health
Organization under the category of Iodine Deficiency Disorders. (3)
b) What measures are taken by Government of Pakistan to combat its deficiency?
(2) [Supple 2018 held in 2019]
3. A 20-year-old girl from Kalar Kahar presented in primary car setting with swelling in
front of neck. Further, she noted difficulty in swallowing, coarse skin, weight gain,
monotonous speech and intolerance to cold.
a) Name the most likely nutritional disorder. (1)
b) How can this be address at community level? (4)
[Annual 2018]
4. A mother brought her six years old son with complaints of repeated chest infections,
difficulty of vision in dim light and anorexia. On examination, his conjunctiva was
found dry and dull. Skin was toad-like.
b) Write down sources of this deficient item.
[Annual 2013]
5. A mother reported to you with her two-year-old child with the complain that her son
walks with difficulty. On examination, knock knees, pot belly, curving of legs were
noted.
a) What is your most likely diagnosis and factor responsible?
b) Enlist three measures to combat this problem.
[Annual 2012]
6. School children inspection revealed that most of students were having decaying
teeth. On water analysis, fluoride level was found to be 0.2 mg/dL.
a) Name the problem in children.
b) What measures you will necessarily take to overcome this problem?
c) Name what mode of prevention it will be.
[Annual 2011]
7.
d) What do you understand by the term iodine deficiency disorder?
e) What are the different strategies to prevent iodine deficiency nationwide?
[Annual 2010]
8. A 7-year-old child presents with complains of inability to see in the dark. Examination
of the eyes reveals conjunctival xerosis, bitot’s spots and corneal haziness.
a) Which nutritional factor is responsible for this condition?
b) What will be the primary prevention for this?
Food Fortification & Adulteration
1. Adulterators are fearless mixing hazardous chemicals and substances in food and
edibles, which are causing serious health issues for the citizens.
a) What is adulteration of food? (1)
b) Give three examples of common types of food adulteration. (3)
c) What was the theme of World Health Day 2015? (1)
[Annual 2015]
Food Infections
1. A passenger was travelling from Rawalpindi to Lahore. He stops at Chakri resort and
bus a tin of preserved food. He checks its expiry but it is still in valid period. At the
time of opening, he noticed that covering on both sides of tin are bulging.
a) Should he use that food?
[Annual 2011]
Assessment of Nutritional Status
1. The 4th year MBBS class was assigned a task to visit a peri-urban area of a city ‘A’ to
assess the nutritional status of pre-school children by applying anthropometric
methods. Name these methods of anthropometric assessment for this group. (3)
2. You are asked to assess the nutritional status of under-five children in your village
with the objective to identify the prevalent nutritional problems.
a) Which anthropometric measurements are required to be done in this age group?
b) How these measurements are used to determine the nutritional status?
[Annual 2014]
Protein-Energy Malnutrition (PEM)
1. Child under 5 years of age from a village were surveyed for Protein Energy
Malnutrition (PEM)
a) Write Waterloo’s classification of PEM. (4)
b) List atleast two common micronutrient deficiencies associated with PEM. (1)
[Annual 2018]
2. The 4th year MBBS class was assigned a task to visit a peri-urban area of a city ‘A’ to
assess the nutritional status of pre-school children by applying anthropometric
methods. Enumerate four socio-cultural factors affecting the nutritional status of
these children. (2) [Supple 2017 held in 2018]
3. A mother reports to you with her two-year-old child with the complains of skin
pigmentation and cracks and changes in hair color. Examination showed weight
slightly below the standard for age but it was marked by generalized body edema.
a) What will be your probable diagnosis?
b) What measures should be taken to overcome this problem in children?
4. A child of 1-year age presented with muscle wasting, loss of subcutaneous fat with
no sign of edema and weight below 60% of WHO standard. The mother gave history
of not giving enough proteins and other nutrients to the child after six months of
age.
a) Name the likely condition and give its causes.
b) Write primary prevention of the condition.
[Annual 2007]
5. Enlist and briefly explain etiological factors related to Malnutrition. [Annual 2006]
Nutritional Anemia
1. A research was conducted in obstetric department regarding the effects of

nutritional status of pregnant women on their deliveries and outcomes. It was
observed that 60% of women who presented during pregnancy with pallor,
palpitations and dyspnea on exertion, they developed complications at the time of
delivery and their baby were below 2.5 kg of weight at birth.
a) Which nutritional condition is hinted in these women?
b) Suggest the measures to decrease the prevalence of this condition among
pregnant women. [Annual 2008]
2. A 25 years old comes to your clinic for her first antenatal checkup. On general
physical examination, pallor is positive. Her complete blood examination report
showed Hb 11 g/dL and MCHC below 34%.
a) Which mineral supplement will you prescribe?
b) What specific nutritional counseling will you do to improve her condition?
[Annual 2014]
Preventive Measures Against Food Poisoning
1. Ten boys went to a hotel to celebrate their friend’s birthday. They ate salad and
burgers. Within four hours of meal, eight boys develop severe vomiting and profuse
diarrhea with mild fever and chills.
a) Give the likely diagnosis.
b) Which health promotive measures will you adopt regarding the above condition?
[Annual 2009]
▪ RADIATION
Definitions
1. Define ionizing radiation. [Annual 2007]
Biological Effects of Radiation
1. In a pathology lab, radioactive material is used in radioimmunoassay procedure.

What hazards a worker of this lab is exposed to? [Annual 2012]
2. Enumerate the radiation hazards faced by the health professional in radiology
department of a hospital. [Annual 2007]
▪ COMMUNICATION IN HEALTH EDUCATION
Channels of Communication
1. Channels of communication have pivotal role in transmission of message to the

audience in creation of health awareness.
a) Name these channels of communication. (3)
b) Write a note on ‘interpersonal communication’? (2)
Types of Communication
1. What are different types of communication? Explain Socratic method. (2+1)

[Annual 2019]
2. Health communication has become essential in promoting general public health in

myriad situations. One of health communication most important applications has
been throughout major environmental events e.g., hurricanes, flooding etc. and
addressing affected audience questions and needs quickly and efficiently keeping
protection of public health and forefront of their message. Enlist types of
communication. (3) [Annual 2017]
Methods of Healthcare Communication
1. How a ‘seminar ‘differs from a workshop? (2.5) [Annual 2018]
Qualities of a Good Message & Sender
1. you are going to educate a group of rural population regarding preventive measures
of Hepatitis B infection. Enlist characteristics of a good message. (2) [Annual 2019]
2. A health education program is to be initiated at a village about prevention of
smoking. Write with slight description four qualities of a good sender
(communicator). [Supple 2017 held in 2018]
Barriers of Communication
1. During epidemic of dengue fever in Pakistan, government decided to health educate

the community about preventive strategies against the spread of this disease. What
are different barriers of communication which can be encountered during this
campaign? (2) [Supple 2018 held in 2019]
2. Health communication has become essential in promoting general public health in
myriad situations. One of health communication most important applications has
been throughout major environmental events e.g., hurricanes, flooding etc. and
addressing affected audience questions and needs quickly and efficiently keeping
protection of public health and forefront of their message. What are various cultural
barriers? Give atleast four examples. (2) [Annual 2017]
3. What barriers may affect effective communication? [Annual 2016]
4. Professor of community medicine arranged a symposium to health educate medical

students of a medical college against smoking.
a) What is the format of symposium?
b) Enlist barriers of communication the student could face.
[Annual 2013]
Approaches to Health Education
1. Health Education is indispensable in achieving individual and community health.

a) Define Health Education.
b) Enumerate three approaches to health education. (3)
[Annual 2015]
Contents of Health Education
1. You are given the task to develop the Health Education Program for adolescents. For
adolescents in Pakistan, which issues will you include for Health Education? List
atleast four. (2) [Annual 2016]
Principles of Health Education
1. During epidemic of dengue fever in Pakistan, government decided to health educate

the community about preventive strategies against the spread of this disease. What
are different principles of health education that should be kept in mind while
planning this health education campaign for Pakistani community? (3)
2. Role of health education in patient care cannot be denied. Physicians who are well
equipped with techniques of health education and not only motivate patients in
adopting health lifestyles but also help in decreasing toll of many diseases. Write
down principles of health education. (2.5) [Annual 2018]
3. A health education program is to be initiated at a village about prevention of

smoking. Write atleast six important principles necessary for education.
▪ DISASTER MANAGEMENT
Types of Disasters
1. Due to climate change in the past few years, violent storms and hurricanes are
hitting the different coastal areas of the world resulting in loss of life and damage to
property. Name the type of disaster. (1) [Supple 2019 held in 2020]
Pre-Disaster Management
1. What pre-disaster management steps are needed to be adopted to minimize the

damage due to floods? (2.5) [Annual 2019]
2. A recent hurricane has devastated some coastal areas of North America. It seems to
have its links with climate change. Climate change not only increases the frequency
of such disasters but also their intensity. What preventive measures are to be taken
to curb this menace? (2.5) [Annual 2018]
3. What do you understand by disaster preparedness? [Annual 2007]
During Disaster Management
1. Due to climate change in the past few years, violent storms and hurricanes are
hitting the different coastal areas of the world resulting in loss of life and damage to
property.
a) Name the type of disaster. (1)
b) Explain the term ‘TRIAGE’. (4)
2. Every year, floods in Pakistan play havoc in different parts of the country resulting in
disruption of normal routine activities.
a) Write a note on disaster-relief phase. (2)
b) List personal protective measures which are to be taken in different types of
disasters/emergencies. (3) [Annual 2016]
3. Recently a violent storm struck Japan resulting in mass destruction of all types.
a) What type of disaster was it?
b) What is meant by triage?
[Annual 2011]
Post-Disaster Management
1. The natural and man-made disasters in an area generally lead to loss of life and
property of affected local population.
a) Write 4 basic and essential items immediately required by affected people in
relief phase right after the disaster. (3)
b) Name any four commonly faced disasters in various parts of Pakistan. (2)
[Annual 2017]
2. Floods affect large areas of our country causing scores of families to either stay in
open or take shelter in camps. Give five measures to counter likely hazards that they
face in the shelter camps in the post-disaster period. (5)
3. Every year, on account of heavy rains during monsoon season, enormous areas of
Pakistan become flooded. Numerous people become homeless and are forced to
stay in camps. List a number of facilities that must be provided to these displaced
individuals. (3) [Annual 2015]
4. Due to heavy rains and floods last year, millions of people of Sindh province were
displaced. They were accommodated in camps in different areas.
a) Name the type of disaster.
b) What measures are to be taken to prevent possible health problem in these
people? [Annual 2013]
5. About 3 years back, a vast population of Sindh province was struck by heavy rains
and floods. They were forced to leave their areas in search of safe shelter.
a) Name the type of disaster.
b) Enlist the responsibilities of health authority in the recovery phase of such floods.
[Annual 2012]
6. The war against terror has displaced millions of people from Swat and Bunaer mainly
in 2009. These people are adjusted in relief camps in different areas.
a) Categorize the event, is it an accident or a disaster?
b) What measures can be taken to make this stay safe?
[Annual 2009]
The Surveillance Cycle
1. Floods play havoc every year in a country. In relation to floods, write down atleast
ten components of surveillance cycle. (5) [Supple 2017 held in 2018]
Specific Disasters
1. Floods are natural disasters which occur frequently in Pakistan. It has been observed
that massive losses of life and property occur every year due to a cause that is very
much preventable. Enlist major outcomes of massive floods. (2.5)
[Annual 2019]
2. A recent hurricane has devastated some coastal areas of North America. It seems to
have its links with climate change. Climate change not only increases the frequency
of such disasters but also their intensity. Describe effects of above-mentioned
phenomena on health and environment. (2.5) [Annual 2018]
3. Every year, on account of heavy rains during monsoon season, enormous areas of
Pakistan become flooded. Numerous people become homeless and are forced to
stay in camps. Enumerate various health threats posed to these displaced people. (2)
[Annual 2015]
4. Famine is present in Thar region of Pakistan.

a) What consequences can be faced by people living over there?
b) how will you manage the disaster?
5. Pakistan faced the worst floods in its history in July 2010. The human death toll was
more than 1000 with extensive damage to houses and livestock. As a member of
disaster management team, make a disaster management plan to deal with such
calamity in future. [Annual 2009]
6. On account of heavy rain during monsoon season, enormous area in Southern

Punjab had been flooded. Numerous people became homeless and suffered
infections.
a) What is the type of calamity?
b) What strategies should have been adopted by health and related departments to
prevent the loss of life and property during and after the catastrophe?
[Annual 2008]
7. Vast areas in Pakistan were stricken by floods this year, disrupting lives of many
people. Give type of disaster and health problems that occurred in those areas.
[Annual 2007]
▪ SCHOOL HEALTH SERVICES
Objectives of School Health Services
1. List 8 objectives of school health services. [Annual 2009]
Duties of members of School Health Team
1. What are duties of a school health nurse? (3) [Supple 2019 held in 2020]
2. Enumerate the duties of a school health officer.
Aspects of School Health Services
1. As in charge of school health program of a secondary school, what logistics will you
carry out for school health services? [Supple 2014 held in 2015]
2.
a) What minimum standards should and be set to maintain healthful environment
in schools?
b) What specific health education should be provided to students of school-going
age to prevent transmission of diseases via feco-oral route. [Annual 2014]
Types of Desks
1. A school purchased furniture of a new section of class four. After a month, school
medical officer noticed that many pupils of this section had complaints of backache
and eye strain. What type of desks has been there in this section? [Annual 2009]
School Health Problems
1. In Pakistan, there is no effective school health service in public schools. As a result of

a lot of preventable congenital and acquired diseases could not be identified at a
school level unlike in first world countries. Enlist common school health problems in
Pakistan. (2) [Supple 2019 held in 2020]
▪ COMMUNITY MENTAL HEALTH
Etiology of Mental Illness
1. Mental health is a balanced development of person’s personality and emotional

attitudes. Enlist different causes of mental ill health. (2.5) [Annual 2019]
2. According to an article published in journal of Pak Medical Association, incidence and

prevalence of mental illness have both increased tremendously in background of
growing insecurity, terrorism, political uncertainty, unemployment and disruption of
social fabric. What are various causes of mental ill health. (2) [Annual 2017]
3. What are the possible reasons of mental illness in adolescents?

4. Write down four environmental factors affecting mental health. [Annual 2013]
5. What are the possible causes leading to a mental illness? [Annual 2007]
Mentally Healthy Person
1. An 8th class by was brought by his parents to you. The boy exhibits fear, compulsions
and obsessions. Do you think he is mentally healthy? Enlist characteristics of
mentally healthy person. [Supple 2013 held in 2014]
2. A young boy is brought to a hospital by his parents. The boy in unable to react
normally to life situations; he exhibits morbid fears, compulsions and obsessions.
Does this boy appear mentally healthy? If not then enlist the characteristics of
mentally healthy people to support your assessment. [Annual 2007]
Common Mental Health Problems
1. A 3-year-old child presented in pediatric OPD with history of impaired social

interaction, verbal and non-verbal communication and restricted and repetitive
behavior.
b) As a public health physician, how will you improve mental health in community
setup? (4) [Annual 2018]
2. A mother brought her only daughter to a psychiatrist. She said that she reacts
abnormally to different situations. She exhibits fear, compulsions and obsessions.
What is the likely diagnosis? [Annual 2013]
Prevention of Common Mental Health Problems
1. Enlist prevention of common mental health problems in Pakistan. (3)

2. As the social structure of our society is disintegrating, the mental illnesses are on an
increase day by day. Apply three levels of prevention to prevent this menace.
[Annual 2011]
Mental Health Services
1. What are services that are included in the community mental health program? (2.5)
[Annual 2019]
2. What are various components which comprises mental health services? (3)
[Annual 2017]
Drug Addiction & Dependence
1. In the recent past, there is exponential increase in number of people using different
types of addictives like Meth ice and much more. In Pakistan, situation is not
different and use of crystal ice has been reported among the youth. Enlist harmful
effects of addiction on addict and his family. (2) [Supple 2019 held in 2020]
2. The menace of Drug Dependence has reached to epidemic proportions in the world
including less developed countries.
a) Enlist four most common factors contributing towards drug dependence. (2)
b) Describe two preventive approaches which are adopted against drug
dependence. (3) [Annual 2016]
3. In Pakistan, addiction is increasing in alarming rate.

a) Name four substances used by these addicts.
b) Name atleast six factors leading to addiction.
[Annual 2011]
Alcoholism
1. A 40-year-old man came to hospital with complaints of gastritis. He also reported his
dependence on a substance. On examination, he had signs of peripheral neuropathy
and cirrhosis of liver. His gait was ataxic ad speech slurred.
a) Name the likely abused substance.
b) It factors responsible for the substance used.
[Annual 2009]
2. A man is brought to you with history of inadequate dietary intake and signs of
thiamine deficiency. Upon further interviewing he is found to be taking 30 units of
alcohol weekly (one unit 9 gm)
a) What is your opinion about the quantity of alcohol intake in this person?
b) What social and physiological effects are likely in this person?
[Annual 2008]
Tobacco Smoking
1. Pakistan launched tobacco free initiative ‘TFI-Pak’ in 2000 by identifying smoking as a

leading cause of mortality in Pakistan. Enlist the objectives of this initiative. (4)
2. A researcher who conducted study abroad about smoking habits of medical students
reported that 35% of them still smoke in spite of having knowledge about its harmful
effects. Give five measures to reduce the incidence of his social evil among medical
students. (5) [Supple 2017]
3. Tobacco smoking has adopted the shape of an epidemic. What are the tobacco
control policies recommended by WHO to combat tobacco smoking in countries? (5)
[Annual 2015]
4.
a) Enumerate smoking related disorders.
b) Discuss psycho-socio-cultural and economic factors that promote smoking in
teenagers. [Annual 2014]
5.
a) List four factors to start tobacco smoking.
b) What are the adverse effects of tobacco smoking?
▪ MEDICAL ENTOMOLOGY
Mosquito
1.
a) What are mosquitos’ preferences (habits)?
b) How this knowledge can be used to prevent mosquito bite?
[Annual 2010]
▪ MEDICAL PARASITOLOGY
Helminths
1. Soil transmitted helminth infections are most common infections worldwide. Over
270 million preschool children and over 600 million school-age children are in need
of treatment and preventive interventions.
a) Enlist soil transmitted helminths. (1)
b) What is mode of transmission of hookworm? (2)
c) Write primary prevention of soil transmitted helminths? (2)
[Annual 2017]
2. Worldwide infections with soil transmitted parasitic worm are among the most
common infection.
a) Enumerate two species which most infect people in Pakistan. (1)
b) How they are transmitted? (2)
c) How can we control and prevent these infections? (2)
[Annual 2015]
3. A patient reports to you complaining of abdominal discomfort, anorexia and chronic

indigestion. On inquiry, he gave history of passing segments of parasite during
defecation.
b) List atleast four measures against this parasite.
[Annual 2013]
4. An 18-year-old farmer who works barefooted 10-12 hours on his field daily,
complains of weakness, breathlessness on exertion and diminished capacity for
sustained hard work. On examination, he looks pale.
a) What is the diagnosis?
b) How do you prevent and control this problem?
[Annual 2009]
▪ MISCELLANEOUS
1.
a) What are the health problems of the ageing population in Pakistan?
b) What preventive measures will you take to deal with such problems?
[Annual 2010]

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COMMUNITY MEDICINE –

PAST QUESTIONS (2005-2020)

▪ BASIC DEFINITIONS AND CONCEPT OF HEALTH & DISEASE

Concepts of Disease Control

2. Draw and label the epidemiolocal triad. [Annual 2010]

Levels of Prevention & Modes of Intervention

1. What do you mean by health promotion? (2)

7. Write a note on primordial prevention. [Annual 2005]

WHO & UNICEF

1. The World Health Organization (WHO) is a specialized, non-political, health agency of

1. Hypertension is the commonest cardiovascular disorder causing high morbidity and

5. What do you mean by health index? [Annual 2013]

Millennium Development Goals & Indications

▪ PRIMARY HEALTH CARE & HEALTH SYSTEMS IN PAKISTAN

3. Pakistan launched Tobacco-free initiative ‘TFI-Pak’ in 2000 by identifying smoking as

10. Government constructed modern latrines in a village to overcome the problem of

1. Enlist components of PHC. [Supple 2019 held in 2020]

2. What are eight elements of PHC. (2) [Annual 2017]

4. Enlist atleast 6 components of primary health care. [Annual 2012]

Levels of Health Care

First Level Healthcare Facilities

1. What are the different epidemiological studies? [Supple 2015]

4. A researcher conducted a study in relationship between alcohol intake and liver

Betel Chewing Oral cancer developed Oral cancer not developed

a) Calculate the incident rate of oral cancer in betel chewers. (2)

8. A researcher took a sample of 50 children with diarrhea and 50 without diarrhea. He

Source of water Disease status (YES) Disease status (NO)

a) What type of study is this?

9. In a hypothetical cohort study of an association b/w smoking & coronary heart

Cigarette Smoking Lung Cancer Present Lung Cancer Absent

a) Calculate relative risk & write tis significance.

H/O taking coffee Myocardial Infarction Present Myocardial Infarction Absent

a) Calculate odds ratio.

Among anemic pregnant women 4000

a) Calculate the attributable risk (risk-difference) & attributable fraction (%)

17. Name atleast six advantages/merits of case-control study. [Annual 2006]

19. List five features of cohort study. [Supple 2006]

Association & Causation

1. What is meant by temporal association? [Supple 2011]

2. Briefly describe the steps required to investigate an epidemic. [Annual 2005]

1. Write a short note on Sentinel Surveillance. [Supple 2016 held in 2017]

Dynamics of Disease Transmission

Acute Diarrheal Diseases

2. A university student presented with history of high-grade fever accompanied by

2. Write a note on control of diphtheria in school. [Annual 2014]

1. Wrote prevention and control measures against Hydatid disease. (3)

1. Total population of a village is 8000. A researcher test MP (malarial parasite) I the

1. A couple presents for investigation of infertility of male, 30 years old. He smokes

3. Pakistan is still having poliomyelitis.

4. Give the current strategies to eradicate polio from Pakistan as recommended by

2. A low-birth-weight infant is born with deafness, cardiac manifestations, cataract and

3. A twelve-year-old boy is brought to the accident department of a hospital suffering

5. Write dosage, route of administration and complete schedule of immunization

2. A person travelling from Africa landed at Karachi airport. His international

1. Mr. X, 22 years old, married, working as a laboratory technician got a needle-stick

▪ EPIDEMIOLOGY OF NON-COMMUNICABLE DISEASES

Coronary Heart Disease (CHD)

1. Prevalence of coronary heart disease is increasing in Pakistan. What are the