PMDC National Licensing Examination Community Medicine and Behavioral Sciences Syllabus

List the measures of central tendency and state which is best for skewed data.

Mean, median, and mode. For skewed (non-normal) distributions, the median is the most appropriate measure of central tendency as it is not affected by extreme values.

What does the standard deviation measure, and what proportion of data lies within ±1, ±2, and ±3 SD in a normal distribution?

SD measures dispersion/spread around the mean. In a normal distribution: ~68% lies within ±1 SD, ~95% within ±2 SD, and ~99.7% within ±3 SD.

Which statistical test compares means of two independent groups, and which compares proportions/categorical data?

Student's t-test compares means of two groups (ANOVA for >2 groups). The Chi-square test compares proportions/categorical data.

What is a p-value, and what is the conventional threshold for statistical significance?

The p-value is the probability of obtaining the observed result (or more extreme) if the null hypothesis is true. Conventionally, p < 0.05 is considered statistically significant.

Define Type I and Type II errors in hypothesis testing.

Type I error (alpha): rejecting a true null hypothesis (false positive). Type II error (beta): accepting a false null hypothesis (false negative). Power = 1 − beta.

Define the basic reproduction number (R0) and its epidemiologic significance.

R0 is the average number of secondary cases produced by one infected person in a fully susceptible population. If R0 > 1 the infection spreads; if R0 < 1 it dies out.

Distinguish between epidemic, endemic, and pandemic.

Endemic: constant/usual presence of a disease in a population/area. Epidemic: occurrence clearly in excess of normal expectancy. Pandemic: an epidemic spread over several countries/continents affecting many people.

What is herd immunity and how does it relate to vaccination?

Herd immunity is protection of a population when a sufficiently high proportion is immune, interrupting transmission and protecting susceptibles. The threshold rises with higher R0.

Differentiate the incubation period from the latent period of an infectious disease.

Incubation period: time from infection to onset of clinical symptoms. Latent period: time from infection to becoming infectious (when transmission can begin).

What are the components of the epidemiologic triad of infectious disease?

Agent (pathogen), Host (susceptible individual), and Environment. Disease results from their interaction, with the vector sometimes added as a fourth element.

List the antigens included in the standard WHO/Pakistan EPI schedule.

BCG, OPV/IPV (polio), Pentavalent (DPT + Hep B + Hib), PCV (pneumococcal), Rotavirus, Measles, and Typhoid conjugate vaccine (TCV).

In the Pakistan EPI schedule, when is BCG given and what does it protect against?

BCG is given at birth and protects against tuberculosis (particularly severe forms like miliary TB and TB meningitis in children).

At what ages are the primary pentavalent (DPT-HepB-Hib) doses given in the EPI schedule?

The three primary pentavalent doses are given at 6 weeks, 10 weeks, and 14 weeks of age.

When are the two doses of measles-containing vaccine given in the Pakistan EPI schedule?

Measles dose 1 at 9 months and measles dose 2 at 15 months of age.

What is the cold chain in immunization, and what is the recommended storage temperature range for most vaccines?

The cold chain is the system of storing and transporting vaccines at recommended low temperatures from manufacture to administration. Most vaccines are stored at +2°C to +8°C.

Which EPI vaccines are most heat-sensitive and which are most sensitive to freezing?

Most heat-sensitive: OPV (and BCG, measles). Most freeze-sensitive (must NOT be frozen): Pentavalent/DPT, Hepatitis B, and other aluminium-adjuvanted/liquid vaccines.

List the major modifiable risk factors shared by most non-communicable diseases (NCDs).

Tobacco use, harmful alcohol use, unhealthy diet, and physical inactivity. These lead to intermediate factors: raised blood pressure, blood glucose, lipids, and obesity.

What are the four main NCDs responsible for the majority of NCD deaths worldwide?

Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes mellitus.

Define DALY (Disability-Adjusted Life Year) and its components.

DALY = one lost year of healthy life. DALY = YLL (Years of Life Lost due to premature death) + YLD (Years Lived with Disability). It measures total disease burden.

What are the principles/elements of Primary Health Care as declared at Alma-Ata (1978)?

Equitable distribution, community participation, intersectoral coordination, appropriate technology, and a focus on prevention. The goal was 'Health for All.'

List the essential components/elements of Primary Health Care (Alma-Ata).

Education on health problems; food/nutrition; safe water and sanitation; maternal and child health including family planning; immunization; control of endemic diseases; treatment of common diseases/injuries; and provision of essential drugs.

What are the three levels of disease prevention with an example of each?

Primary (preventing disease onset, e.g., immunization). Secondary (early detection/treatment, e.g., screening). Tertiary (limiting disability/rehabilitation, e.g., physiotherapy after stroke).

What is the Lady Health Worker (LHW) Programme in Pakistan designed to provide?

It delivers community-based primary health care—maternal and child health, family planning, immunization promotion, and health education—at the doorstep, linking communities to the formal health system.

What does the Pakistan EPI's polio eradication strategy rely on for interrupting transmission?

Routine OPV/IPV immunization plus Supplementary Immunization Activities (National/Sub-national Immunization Days, NIDs/SNIDs) and acute flaccid paralysis (AFP) surveillance.

Define Maternal Mortality Ratio (MMR) and its formula.

MMR = number of maternal deaths due to pregnancy/childbirth-related causes per 100,000 live births = (Maternal deaths / Live births) × 100,000.

Define Infant Mortality Rate (IMR) and its formula.

IMR = number of deaths of infants under 1 year per 1000 live births in a year = (Deaths < 1 year / Live births) × 1000. It is a sensitive indicator of population health.

Differentiate neonatal, perinatal, and under-5 mortality rates.

Neonatal: deaths < 28 days per 1000 live births. Perinatal: stillbirths + early neonatal deaths (first week) per 1000 total births. Under-5: deaths < 5 years per 1000 live births.

What does the GOBI-FFF strategy for child survival stand for?

Growth monitoring, Oral rehydration, Breastfeeding, Immunization — plus Female education, Family spacing, and Food supplementation.

What components make up Antenatal Care (ANC) as recommended by WHO for safe motherhood?

Regular ANC visits, screening for risk factors, tetanus toxoid immunization, iron/folic acid supplementation, monitoring of BP and weight, and counseling on nutrition and danger signs.

What are the levels of water classified by WHO for fluoride, and what diseases result from deficiency and excess?

Optimal fluoride ≈ 0.5–1.0 mg/L. Deficiency causes dental caries; excess causes dental fluorosis (mottled enamel) and, at high levels, skeletal fluorosis.

Name common nutritional deficiency diseases and their causative micronutrient.

Vitamin A deficiency → xerophthalmia/night blindness; Iron deficiency → anemia; Iodine deficiency → goiter/cretinism; Vitamin D deficiency → rickets/osteomalacia; Vitamin C → scurvy; Niacin → pellagra; Thiamine → beriberi.