DNB CET Community Medicine and Forensic Medicine Syllabus

What is the goal of the National Health Policy 2017 regarding health expenditure?

To raise public health expenditure to 2.5% of GDP and provide Universal Health Coverage with assured comprehensive primary health care.

What does the IMNCI strategy address and what are its components?

Integrated Management of Neonatal and Childhood Illness addresses major causes of under-5 mortality. Components: improving case management skills of health workers, strengthening the health system, and improving family/community practices.

Define epidemic, endemic, and pandemic.

Endemic: constant/usual presence of a disease in a population/area. Epidemic: occurrence clearly in excess of expected. Pandemic: epidemic spread over several countries/continents affecting large numbers.

What is herd immunity and why is it important?

Herd immunity is the resistance of a group to disease invasion when a high proportion are immune, interrupting transmission and protecting susceptible individuals. The threshold varies by disease (e.g., measles ~95%).

Differentiate active and passive surveillance.

Active surveillance: health agency proactively seeks out case reports (e.g., field visits). Passive surveillance: relies on routine reporting from health facilities to the agency; cheaper but underreports.

What is the chemoprophylaxis for contacts in a meningococcal meningitis outbreak?

Rifampicin (or single-dose ciprofloxacin/ceftriaxone) is given to close contacts as chemoprophylaxis to eliminate nasopharyngeal carriage.

Define the secondary attack rate.

Secondary Attack Rate = (Number of new cases among contacts within the incubation period / Total susceptible contacts) x 100. It measures infectiousness/communicability of a disease.

What are the components of the RMNCH+A strategy?

Reproductive, Maternal, Newborn, Child, and Adolescent Health. The '+A' emphasizes adolescent health as a distinct life-stage intervention point.

What is the Janani Suraksha Yojana (JSY)?

A safe-motherhood cash-incentive scheme under the National Health Mission promoting institutional delivery among poor pregnant women to reduce maternal and neonatal mortality.

Define Maternal Mortality Ratio (MMR) and India's current target.

MMR = (Maternal deaths / Live births) x 100,000. India's SDG target is to reduce MMR to below 70 per 100,000 live births by 2030.

What is the Infant Mortality Rate (IMR) formula?

IMR = (Number of deaths of infants under 1 year of age in a year / Number of live births in the same year) x 1000. It is a sensitive index of a population's health.

Name the grades of Protein Energy Malnutrition by IAP classification.

IAP classification by weight-for-age: Grade I (71-80% of expected), Grade II (61-70%), Grade III (51-60%), Grade IV (<50%). Below 80% indicates malnutrition.

Differentiate marasmus and kwashiorkor.

Marasmus: severe wasting, marked muscle/fat loss, 'old man' face, no edema, due to total calorie deficiency. Kwashiorkor: edema, hepatomegaly, hair/skin changes, due to protein deficiency.

What permissible limits define safe drinking water turbidity and residual chlorine?

Turbidity should be < 1 NTU (acceptable up to 5 NTU). Free residual chlorine should be 0.5 mg/L after 1 hour of contact to ensure disinfection.

What is the threshold limit value concept in occupational health?

Threshold Limit Value (TLV) is the maximum permissible concentration of a hazardous substance in workplace air to which workers can be exposed daily (8 hours) without adverse effects.

Name the occupational lung disease caused by silica dust and one by coal dust.

Silica dust causes silicosis (with risk of TB); coal dust causes anthracosis/coal workers' pneumoconiosis. Asbestos causes asbestosis and mesothelioma.

Define thanatology and list the three immediate signs of death.

Thanatology is the science of death. Immediate signs: cessation of circulation (no pulse/heartbeat), cessation of respiration, and loss of nervous system functions (no reflexes/responsiveness).

Describe rigor mortis: mechanism, onset, and order of appearance.

Rigor mortis is post-mortem muscle stiffening from ATP depletion (actin-myosin binding). Begins 1-2 hours after death, completes in ~12 hours, persists 12 hours, then passes off. Follows Nysten's rule: starts in eyelids/face/neck, descends to limbs.

What is livor mortis (post-mortem lividity) and its medicolegal value?

Bluish-purple discoloration from gravitational settling of blood in dependent areas. Appears 1-3 hours after death, fixed by 6-8 hours. Indicates time since death and whether the body was moved after death.

What does cherry-red post-mortem lividity suggest, and what does brick-red suggest?

Cherry-red lividity suggests carbon monoxide poisoning (or cold exposure); brick-red/cherry-pink suggests cyanide poisoning. Brown lividity suggests potassium chlorate/nitrites (methemoglobinemia).

What is algor mortis and how is it used?

Algor mortis is post-mortem cooling of the body. The body loses heat at roughly 1.5 F (about 0.8-1 C) per hour initially; rectal temperature is used to estimate time since death.

How can age be determined from teeth and ossification?

Teeth: eruption timing of milk and permanent teeth indicates age in children. Ossification: appearance and fusion of epiphyseal centers (e.g., wrist X-ray) help estimate skeletal age; full fusion ~25 years.

Differentiate an abrasion, contusion, and laceration.

Abrasion: superficial injury to epidermis (graze/scratch). Contusion (bruise): rupture of subcutaneous blood vessels with intact skin. Laceration: tearing/splitting of skin and tissues by blunt force.

Differentiate an incised wound from a stab wound.

Incised wound: length on skin surface greater than depth, caused by a sharp-edged weapon drawn across skin (clean margins). Stab/punctured wound: depth greater than length/width, caused by a pointed weapon thrust in.

How are entry and exit firearm wounds differentiated?

Entry wound: smaller, inverted margins, abrasion collar, may have blackening/tattooing if close range. Exit wound: larger, everted margins, no abrasion collar or burning, often irregular.

How is suicidal cut throat distinguished from homicidal?

Suicidal: high up, multiple superficial hesitation cuts, directed from left to right (in right-handed), no defense wounds. Homicidal: lower, deep, single cut, defense wounds on hands present.

Define asphyxia and list the classic post-mortem signs.

Asphyxia is interference with oxygen uptake/utilization causing hypoxia and hypercapnia. Classic signs: cyanosis, petechial hemorrhages (Tardieu spots), congestion, and fluidity of blood.

Differentiate the ligature mark in hanging from that in strangulation.

Hanging: ligature mark is high up (above thyroid), oblique, non-continuous, directed upward toward the knot. Strangulation: mark is low (below thyroid), horizontal, continuous around the neck.

What are the diagnostic findings in drowning and the Gettler test?

Drowning shows fine white froth at mouth/nostrils, water/weeds in airways, and waterlogged heavy lungs (emphysema aquosum). Gettler test compares chloride content of blood in the two heart chambers to distinguish fresh- vs salt-water drowning.

Define organophosphate poisoning mechanism and its antidote.

Organophosphates inhibit acetylcholinesterase causing cholinergic excess (SLUDGE/muscarinic, nicotinic, CNS effects). Antidotes: atropine (reverses muscarinic effects) and pralidoxime/oximes (reactivate cholinesterase).

Differentiate informed consent, expressed consent, and the age of valid consent in India.

Informed consent: given after disclosure of risks/benefits. Expressed consent: stated orally or in writing. In India, 18 years is the age for valid consent for general procedures (12 years for examination); consent below age requires guardian.