A 2-year-old who never received measles-rubella vaccine played with a cousin who developed the measles rash yesterday. The contact was 48 hours ago and the child is well, with no immune deficiency. What is the most appropriate action?

Give MR vaccine now, as it can prevent disease within 72 hours

Give immunoglobulin and postpone MR vaccine by three months

Give vitamin A alone, as the vaccine is useless after exposure

Wait, and vaccinate only after the incubation period has passed

By WHO and Indian drinking-water standards, Escherichia coli or thermotolerant coliform bacteria in treated drinking water must be:

Not detectable in any 100 mL sample

Fewer than 3 in 95% of 100 mL samples

Not detectable in any 10 mL sample

Fewer than 10 in any 100 mL sample

Under the Bio-Medical Waste Management Rules 2016, broken glass ampoules and discarded medicine vials (not cytotoxic) are placed in a:

Blue puncture-proof cardboard box

Red non-chlorinated plastic bag

White translucent puncture-proof container

Yellow non-chlorinated plastic bag

Communicable diseases, nutrition and environmental health

30 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Communicable diseases, nutrition and environmental health, part of Community Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 3-month-old, exclusively breastfed, is brought with a hoarse, almost silent cry, fast breathing, a rapid pulse, puffy face and an enlarged liver. The mother eats mainly highly polished rice and has numbness of her feet. Deficiency of which vitamin best explains the infant's illness?
1. ACobalamin (vitamin B12)
2. BRiboflavin (vitamin B2)
3. CThiamine (vitamin B1)
4. DNiacin (vitamin B3)
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Answer: C · Thiamine (vitamin B1)
Infantile beriberi strikes breastfed babies of 2-6 months whose mothers are thiamine deficient, often from a polished-rice diet. The acute form causes aphonia (a silent cry from laryngeal nerve involvement), tachycardia, oedema and cardiac failure, and it can be fatal within hours. The mother's numb feet suggest her own dry beriberi. Thiamine given to the infant and the mother brings rapid improvement.
- A: B12 deficiency in breastfed infants causes anaemia, hypotonia and regression, not acute heart failure with aphonia.
- B: Riboflavin deficiency causes angular stomatitis and glossitis, not cardiac failure.
- D: Niacin deficiency causes pellagra, a disease of older children and adults.
Question 2 · Medium
At a morning immunisation session, a nurse opened vials of pentavalent, BCG, measles-rubella and JE vaccines. All were kept at 2-8 °C with VVMs usable. Which vial may be carried back and used at sessions within the next 28 days?
1. AMeasles-rubella
2. BPentavalent
3. CJapanese encephalitis
4. DBCG
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Answer: B · Pentavalent
Under India's open vial policy, opened multi-dose vials of liquid vaccines such as pentavalent, Td, hepatitis B, OPV and PCV may be used for up to 28 days. Conditions apply: the vial is within expiry, kept at 2-8 °C, has a usable VVM, was not submerged in water and was handled aseptically. Freeze-dried vaccines that are reconstituted (BCG, MR and JE) contain no preservative. They are discarded 4 hours after reconstitution or at the end of the session, whichever comes first.
- A: Reconstituted MR vaccine can grow bacteria; its misuse has caused toxic shock deaths.
- C: JE vaccine is also reconstituted and is not covered by the open vial policy.
- D: BCG is reconstituted and must be discarded within 4 hours or at the end of the session.
Question 3 · Hard
A 2-year-old who never received measles-rubella vaccine played with a cousin who developed the measles rash yesterday. The contact was 48 hours ago and the child is well, with no immune deficiency. What is the most appropriate action?
1. AGive immunoglobulin and postpone MR vaccine by three months
2. BGive vitamin A alone, as the vaccine is useless after exposure
3. CGive MR vaccine now, as it can prevent disease within 72 hours
4. DWait, and vaccinate only after the incubation period has passed
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Answer: C · Give MR vaccine now, as it can prevent disease within 72 hours
Measles vaccine produces antibody faster than the wild virus completes its incubation of about 10 days. Given within 72 hours of exposure, it can prevent or modify the illness, and it also closes his immunity gap if he escapes infection. Immunoglobulin within 6 days is kept for contacts who cannot be vaccinated, such as infants under 6 months, pregnant women and the immunocompromised. Vitamin A is given to children who develop measles, not instead of vaccine.
- A: Immunoglobulin is for contacts who cannot receive the vaccine, which does not apply here.
- B: Vitamin A treats measles cases; it does not prevent infection in a contact.
- D: Waiting loses the 72-hour window in which vaccine can still prevent disease.
Question 4 · Easy
By WHO and Indian drinking-water standards, Escherichia coli or thermotolerant coliform bacteria in treated drinking water must be:
1. AFewer than 3 in 95% of 100 mL samples
2. BNot detectable in any 10 mL sample
3. CNot detectable in any 100 mL sample
4. DFewer than 10 in any 100 mL sample
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Answer: C · Not detectable in any 100 mL sample
E. coli is the indicator of recent faecal contamination, because it lives only in the gut and does not multiply in water. Its presence means that faecal pathogens may also be present. For that reason, drinking water must contain no E. coli in any 100 mL sample. A positive result calls for checking the chlorination and the supply for a leak or a source of contamination.
- A: A tolerance for occasional positive samples is not allowed for E. coli.
- B: The standard volume tested is 100 mL; a 10 mL sample would miss low contamination.
- D: Any E. coli count, even below 10, shows faecal contamination and is unsafe.
Question 5 · Easy
Under the Bio-Medical Waste Management Rules 2016, broken glass ampoules and discarded medicine vials (not cytotoxic) are placed in a:
1. ARed non-chlorinated plastic bag
2. BWhite translucent puncture-proof container
3. CBlue puncture-proof cardboard box
4. DYellow non-chlorinated plastic bag
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Answer: C · Blue puncture-proof cardboard box
Glassware, including broken or discarded medicine vials and ampoules and metallic body implants, goes into the blue category: a puncture-proof cardboard box or container with a blue marking. It is disinfected or autoclaved and then recycled. Glass contaminated with cytotoxic drugs is the exception and goes to the yellow category. Correct segregation at the point of generation protects waste handlers from cuts.
- A: The red bag is for contaminated recyclable plastics such as tubing and catheters.
- B: The white container is for sharps such as needles, blades and syringes with fixed needles.
- D: The yellow bag is for anatomical, soiled, chemical and cytotoxic waste for incineration.
Question 6 · Medium
After a chemotherapy infusion on the oncology ward, the nurse has an empty glass vial of cyclophosphamide. Under the Bio-Medical Waste Management Rules 2016, it goes into the:
1. AYellow category, for incineration
2. BBlue category, for recycling
3. CRed category, for autoclaving
4. DWhite category, for shredding
Answer and explanation in LearnFree account
Question 7 · Hard
A district has an estimated 2,000 adults with hypertension. If the 'rule of halves' holds, how many of them have their blood pressure adequately controlled?
1. A250
2. B1,000
3. C125
4. D500
Answer and explanation in LearnFree account
Question 8 · Hard
An 18-month-old boy has a MUAC of 11.0 cm and no oedema. He is alert, eats his test feed of therapeutic food well and has no fever, chest indrawing, dehydration or other medical complication. Following WHO guidance, what is the most appropriate plan?
1. AAdmission to hospital for a starter feed by nasogastric tube
2. BSupplementary ICDS take-home ration and review in a month
3. CCommunity-based care with therapeutic food and follow-up
4. DAdmission to a Nutrition Rehabilitation Centre today
Answer and explanation in LearnFree account
Question 9 · Medium
Several members of a family develop swelling of both legs, reddish skin patches and breathlessness, and one has raised intraocular pressure. All use mustard oil bought loose from a local market. The likely adulterant is:
1. AMetanil yellow dye
2. BArgemone oil
3. CMineral oil
4. DKhesari dal flour
Answer and explanation in LearnFree account
Question 10 · Medium
Under the National Iodine Deficiency Disorders Control Programme, iodised salt should contain iodine of at least:
1. A30 ppm at the consumer level
2. B15 ppm at the production level
3. C50 ppm at the consumer level
4. D15 ppm at the consumer level
Answer and explanation in LearnFree account
Question 11 · Hard
Ten days after clearing flood debris in Kerala, a 42-year-old man has high fever, severe calf pain, red eyes without discharge, jaundice and passing little urine. Bilirubin 8 mg/dL, creatinine 3.4 mg/dL, platelets 90,000/µL. Malaria smear is negative and there is no eschar. What is the most likely diagnosis?
1. ASevere leptospirosis (Weil's disease)
2. BScrub typhus with multi-organ involvement
3. CAcute hepatitis E with liver failure
4. DDengue fever with warning signs
Answer and explanation in LearnFree account
Question 12 · Easy
Noise-induced hearing loss is likely when workers are regularly exposed, through an 8-hour working day, to sound levels above about:
1. A85 dB
2. B40 dB
3. C120 dB
4. D60 dB
Answer and explanation in LearnFree account
Question 13 · Medium
Pellagra is seen in people whose staple cereal is jowar (sorghum), even though jowar contains enough tryptophan. The accepted explanation is that jowar:
1. AIs very low in tryptophan, the precursor of niacin
2. BHolds its niacin in a bound form that the gut cannot absorb
3. CContains an antithiamine factor that destroys B vitamins
4. DHas excess leucine, which hinders niacin synthesis from tryptophan
Answer and explanation in LearnFree account
Question 14 · Medium
During a waterborne outbreak of hepatitis E after a pipeline leak, which group of patients faces the highest risk of death?
1. AChildren below five years of age
2. BAdults with past hepatitis A infection
3. CElderly men with diabetes mellitus
4. DPregnant women in the third trimester
Answer and explanation in LearnFree account
Question 15 · Medium
A nurse advises families to eat rice with dal rather than rice alone. Combining the two improves protein quality because:
1. ADal supplies tryptophan and rice supplies lysine
2. BDal supplies lysine and rice supplies methionine
3. CBoth foods together supply more total protein
4. DRice supplies leucine and dal supplies threonine
Answer and explanation in LearnFree account
Question 16 · Hard
A mother is diagnosed with sputum-positive pulmonary TB. Her 3-year-old son, who had BCG at birth, has no cough, fever, weight loss or other symptoms on screening. Under NTEP, what should be done for the boy?
1. AStart TB preventive treatment once active TB is ruled out
2. BObserve and test him only if symptoms appear later
3. CGive a repeat BCG dose to boost his protection
4. DStart the full four-drug treatment for active TB
Answer and explanation in LearnFree account
Question 17 · Easy
A man has a single bite on the forearm from a stray dog that broke the skin and drew blood. Under the national rabies guidelines, this Category III exposure needs:
1. AWound washing and observation of the dog
2. BWound washing and vaccine alone
3. CWound washing, rabies immunoglobulin and vaccine
4. DRabies immunoglobulin alone, without vaccine
Answer and explanation in LearnFree account
Question 18 · Easy
Lathyrism, a spastic paralysis of the lower limbs seen in poor rural areas, is caused by a neurotoxin present in:
1. AGroundnuts contaminated with aflatoxin
2. BKhesari dal (Lathyrus sativus)
3. CMustard oil adulterated with argemone oil
4. DBajra infested with ergot fungus
Answer and explanation in LearnFree account
Question 19 · Medium
The ILR thermometer at a PHC read -3 °C one morning. In a shake test, a Td vial from the ILR settles much more slowly than a control vial of the same batch that was frozen on purpose. The nurse should:
1. AUse the Td vials, as they were not damaged by freezing
2. BDiscard the Td vials, as they were exposed to freezing
3. CKeep the Td vials aside and repeat the test after 24 hours
4. DUse the Td vials only after the VVM has been checked again
Answer and explanation in LearnFree account
Question 20 · Medium
During a dengue outbreak, health workers treat water stored in household drums and cement tanks used for drinking, to kill Aedes larvae. The larvicide recommended for drinking-water containers is:
1. AMalathion
2. BParis green
3. CTemephos
4. DDiesel oil
Answer and explanation in LearnFree account
Question 21 · Medium
Urban malaria in many Indian cities is spread mainly by a vector that breeds in overhead tanks, wells, cisterns and construction sites. This vector is:
1. AAnopheles stephensi
2. BAnopheles minimus
3. CAnopheles fluviatilis
4. DAnopheles culicifacies
Answer and explanation in LearnFree account
Question 22 · Medium
The orthotoluidine-arsenite (OTA) test is preferred to the plain orthotoluidine test for checking chlorinated water because it:
1. AShows the dose of bleaching powder to be added
2. BMeasures the chlorine demand of the water
3. CMeasures free and combined chlorine separately
4. DDetects coliform bacteria as well as chlorine
Answer and explanation in LearnFree account
Question 23 · Easy
Which of the following gives artificially acquired passive immunity?
1. ARecovery from an attack of chickenpox
2. BAn injection of human tetanus immunoglobulin
3. CMaternal IgG crossing the placenta
4. DA dose of measles-rubella vaccine
Answer and explanation in LearnFree account
Question 24 · Medium
Under Anaemia Mukt Bharat, school-going adolescents aged 10-19 years receive prophylactic iron and folic acid as:
1. A100 mg iron and 500 mcg folic acid every day
2. B60 mg iron and 500 mcg folic acid once a week
3. C45 mg iron and 400 mcg folic acid once a week
4. D20 mg iron and 100 mcg folic acid twice a week
Answer and explanation in LearnFree account
Question 25 · Hard
A survey examines 1,200 schoolchildren aged 6-12 years in a hill district, and 150 have a palpable or visible goitre. By WHO criteria, a total goitre rate below 5% means no deficiency, 5-19.9% mild, 20-29.9% moderate and 30% or more severe. How should the district be classified?
1. ANo iodine deficiency public health problem
2. BModerate iodine deficiency, a public health problem
3. CMild iodine deficiency, a public health problem
4. DSevere iodine deficiency, a public health problem
Answer and explanation in LearnFree account

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Communicable diseases, nutrition and environmental health

A 3-month-old, exclusively breastfed, is brought with a hoarse, almost silent cry, fast breathing, a rapid pulse, puffy face and an enlarged liver. The mother eats mainly highly polished rice and has numbness of her feet. Deficiency of which vitamin best explains the infant's illness?

At a morning immunisation session, a nurse opened vials of pentavalent, BCG, measles-rubella and JE vaccines. All were kept at 2-8 °C with VVMs usable. Which vial may be carried back and used at sessions within the next 28 days?

A 2-year-old who never received measles-rubella vaccine played with a cousin who developed the measles rash yesterday. The contact was 48 hours ago and the child is well, with no immune deficiency. What is the most appropriate action?

By WHO and Indian drinking-water standards, Escherichia coli or thermotolerant coliform bacteria in treated drinking water must be:

Under the Bio-Medical Waste Management Rules 2016, broken glass ampoules and discarded medicine vials (not cytotoxic) are placed in a:

After a chemotherapy infusion on the oncology ward, the nurse has an empty glass vial of cyclophosphamide. Under the Bio-Medical Waste Management Rules 2016, it goes into the:

A district has an estimated 2,000 adults with hypertension. If the 'rule of halves' holds, how many of them have their blood pressure adequately controlled?

An 18-month-old boy has a MUAC of 11.0 cm and no oedema. He is alert, eats his test feed of therapeutic food well and has no fever, chest indrawing, dehydration or other medical complication. Following WHO guidance, what is the most appropriate plan?

Several members of a family develop swelling of both legs, reddish skin patches and breathlessness, and one has raised intraocular pressure. All use mustard oil bought loose from a local market. The likely adulterant is:

Under the National Iodine Deficiency Disorders Control Programme, iodised salt should contain iodine of at least:

Noise-induced hearing loss is likely when workers are regularly exposed, through an 8-hour working day, to sound levels above about:

Pellagra is seen in people whose staple cereal is jowar (sorghum), even though jowar contains enough tryptophan. The accepted explanation is that jowar:

During a waterborne outbreak of hepatitis E after a pipeline leak, which group of patients faces the highest risk of death?

A nurse advises families to eat rice with dal rather than rice alone. Combining the two improves protein quality because:

A mother is diagnosed with sputum-positive pulmonary TB. Her 3-year-old son, who had BCG at birth, has no cough, fever, weight loss or other symptoms on screening. Under NTEP, what should be done for the boy?

A man has a single bite on the forearm from a stray dog that broke the skin and drew blood. Under the national rabies guidelines, this Category III exposure needs:

Lathyrism, a spastic paralysis of the lower limbs seen in poor rural areas, is caused by a neurotoxin present in:

The ILR thermometer at a PHC read -3 °C one morning. In a shake test, a Td vial from the ILR settles much more slowly than a control vial of the same batch that was frozen on purpose. The nurse should:

During a dengue outbreak, health workers treat water stored in household drums and cement tanks used for drinking, to kill Aedes larvae. The larvicide recommended for drinking-water containers is:

Urban malaria in many Indian cities is spread mainly by a vector that breeds in overhead tanks, wells, cisterns and construction sites. This vector is:

The orthotoluidine-arsenite (OTA) test is preferred to the plain orthotoluidine test for checking chlorinated water because it:

Which of the following gives artificially acquired passive immunity?

Under Anaemia Mukt Bharat, school-going adolescents aged 10-19 years receive prophylactic iron and folic acid as:

A survey examines 1,200 schoolchildren aged 6-12 years in a hill district, and 150 have a palpable or visible goitre. By WHO criteria, a total goitre rate below 5% means no deficiency, 5-19.9% mild, 20-29.9% moderate and 30% or more severe. How should the district be classified?