KZM (Final Part I, 6/2018)

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PSM OLD QUESTIONS (UM 1, UMM, UM 2, UMMG)
Preventive and Social Medicine
1. What is social medicine? (2m)Why concept of social medicine is important in clinical
practices? (3m)Briefly explain the aspect of social medicine with examples.
(10m)Describe how would you apply concepts of social medicine in clinical
management? (7m)Aspects of social medicine (5m/SN)
2. What is Preventive Medicine?

Concept of Health and Disease

1. State WHO definition and operational definition of health. (UM 2) Define Health
according WHO. (2m)Give your comment on WHO definition of Health. (3m)
(UMMG).
2. Describe the concepts of health.
3. Explain how the human health is multi-dimensional.
4. What do you understand the term “Quality of Life”? (8m) Physical Quality of Life
Index (5m/SN)
5. What do you understand about “spectrum of health”?
6. List determinants of health. Discuss how socioeconomic condition influence on health
and disease with examples. (10m)Name the important determinants of health. Explain
how the health status of majority of the world people is determined by their socio-
economic development.
7. What is health indicator and mention the types of health indicators? (5m)What
indicators would you use the maternal and child health care services? These indicators
are important in MCH services. Why? (5m)What are the characteristics of ideal
indicators? List the health indicators and outline their uses. Describe the indicators of
Quality of Life in detail. (15m)
8. Define disease, illness and sickness. Briefly explain the web of causation with
examples. (7m)
9. Briefly describe the natural history of disease.
10. What do you understand Comprehensive Health Care? (2m)How would you achieve
the comprehensive health care of the community by applying the knowledge of levels
of prevention with examples? (18m) (UMMG). Explain the levels of prevention based
on natural history of disease. (15m)Levels of prevention (5m/SN) Name levels of
prevention. Describe the “primary prevention”.
11. Ice-berg Phenomenon (5m/SN)

Family Health
1. Define family and family health care. (3m)Briefly describe the factors influencing the
health and disease of family with examples. (12)Factors influencing family health
(5m/SN)
KZM (Final Part I, 6/2018)
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Environmental Health
1. What is environmental health and environmental hazards? (4m)Define environmental
health and environmental hazard. Enumerate the areas covered by environmental
health. (4m)What are wider problems of environmental issues? (10m)Define
“environmental sanitation”
2. Enumerate the diseases associated with water pollution. How can you ensure to get a
safe water supply in small scale? (15m)What is meant by “water sanitation”? Describe
how to provide protection and purification of shallow well in rural areas.
3. What do you understand food sanitation and briefly explain about the food sanitation
process with diagram. (7m) Define food safety. Draw the schematic diagram of food
sanitation process. Describe the food adulteration and food preservation. (15m)Define
food. What are the food-borne diseases? Describe how to provide sanitation of
drinking and eating establishments.
4. Sanitary land-filling (5m/SN)
5. Enumerate the diseases that can be transmitted through improper disposal of excreta.
Describe basic requirements of a sanitary pit latrine. (8m)What are the requirements
of proper excreta disposal? Describe how to provide a sanitary latrine for rural
communities.
6. Sanitation barrier (5m/SN)
7. Septic tank (5m/SN)
8. What is “substandard housing”? What are the health aspects of housing? Describe the
principles of healthful housing.
9. What is urbanization? Why rural people move to urban area? Describe challenges of
unplanned urbanization. (15m)
10. Define indoor air pollution. What are the sources of indoor air pollution? How do you
prevent the indoor air pollution? (7m) Indoor air pollution (5m/SN)
11. What is climate change? Explain the health hazards of climate change. (7m)Climate
change adaptation and mitigation (5m/SN)Climate change mitigation (5m/SN)
12. What is pest? What are Arthropods? List the common Arthropod borne diseases in
Myanmar. Briefly explain the Arthropod control in general. (8m) Vector control
measures in general. (5m/SN)Describe the mosquito control measures.
13. Anti-rodent measures (5m/SN)
14. Outline the recommended disinfection procedures in health care setting. (8m) Page-95

Occupational Health
1. Ergonomics (5m/SN)
2. What do you understand the words of Environmental Assessment (EA) and Health
Impact Assessment (HIA) (5m)
3. How can you prevent the occupational hazards in general? (10m)Briefly describe
about prevention of occupational diseases.
4. Health hazards of shift work (5m/SN)

Management of Fairs and Festivals

1. Describe how to manage a pagoda festival in rural area.
KZM (Final Part I, 6/2018)
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Disasters
1. What is disaster? List the different types of disaster. What are the possible effects of
floods and briefly describe the three fundamental aspects of disaster management.
(15m)Define disaster. Briefly explain roles of health sector in disaster management.
(15m)Define and classify disaster. Describe role of health sector in management of
disaster. (15m)Define disaster. Describe the activities required for the disaster
prevention.

Epidemiology
1. Define Epidemiology. Enumerate the uses of epidemiology. (8m)What are the
components of epidemiology? Briefly describe the types of epidemics with examples.
(7m)
2. Briefly describe the two basic measures of frequency in epidemiology and discuss
relationship between them. (8m)Relative Risk and Attributable Risk (5m/SN) Briefly
describe the tools of trades in epidemiology. Describe details about “Prevalence” and
“Incidence”, their uses and relationship between them.
3. Describe the epidemiological triad of disease distribution. (15m)
4. Explain importance of Host and Environmental factors in causation of diseases, both
communicable and non-communicable diseases. (10m) (page 2 vol.3) Name the
epidemiological triads of disease causation. Describe the factors related to living
agents and non-living agents.
5. Source/Reservoir (5m/SN) Name the chains of infectious disease transmission.
Describe details about reservoir/source of infection and susceptible host.
6. Outline the control measures that you would adopt to interrupt the chain of
transmission. (15m)What is Epizootic? List the common zoonotic diseases in
Myanmar. Describe how you would interrupt the chains of an infectious disease
which is common in Myanmar.
7. Explain risk measures and its interpretation for Cohort and Case Control studies.
(7m)Describe strength and weakness of different types of analytic study designs.
(8m)What types of epidemiological study are there? (5m)Outline the case-control
study. (5m)Classify the epidemiological study designs. Describe about “Cohort
Study”. (9m)
8. What are the objectives of outbreak investigation?
9. List the diseases under national surveillance. (5m)Describe the core functions in
surveillance of any health events and support function which can improve the core
function. (7m)Define surveillance. What are the objectives of surveillance? (7m)
Write down the core functions and support functions in surveillance of health events.
(9m)
10. List diseases under VBDC program in Myanmar with their agents and vectors. (5m)
11. Define Screening. What is/are role of screening in epidemiology? (4m)Explain lead
time concept. (3m)Evaluate the proficiency of a screening test. Explain the false
positive and false negative rate in screening test. (8m)Describe the different types of
bias in evaluating the screening program. (7m)Mention the types of screening. Lead
time (5m/SN)Criteria for a screening program (5m/SN)
KZM (Final Part I, 6/2018)
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12. AEFI (5m/SN) What are the vaccine preventable diseases? Why is vaccination
important? Explain causes and significance of Herd immunity. (8m) Herd immunity
(5m/SN)
13. Emerging and remerging diseases (5m/SN)

Epidemiology of Communicable Diseases

1. List the principal epidemic diseases of Myanmar.
2. How would you investigate Cholera outbreak? (10m)Briefly explain the epidemiology
of cholera. Discuss the prevention and control of cholera among community.
(15m)Describe how you would conduct systemic investigation and control of cholera
outbreak in a community.
3. Describe surveillance and preventive measures of DHF. (10m)Describe surveillance
activities of DHF and explain why these are important in prevention and control of
DHF outbreak. (8m)
4. Essential HIV service packages (5m/SN) Describe the modes of transmission and
high risk groups of HIV infection. Explain the importance of HIV testing and
counseling. List the milestones for Myanmar National Strategic Plan on HIV/AIDS
(2016-2020).
5. Malaria is still important public health problem. Give your comments. Describe the
challenges for malaria elimination. (8m)Briefly describe measures for prevention and
control of Malaria. (7m)Briefly describe the basic factors for transmission of Malaria.
(6m)
6. Japanese encephalitis (5m/SN) Purpose and features of the JEE process (5m/SN)
7. TB is considered as a national concern and treated as a priority in Myanmar. Why?
(4m)What is the patients’ charter for tuberculosis care? (4m)Briefly describe
International Standard for Tuberculosis Care related to diagnosis. (7m) End TB
strategy (5m/SN) THE END TB STRATEGY 2016-2035 (5m/SN)
8. Outline the post-exposure prophylaxis of Rabies including WHO guidelines. (8m)
What is zoonosis? List common zoonotic diseases in Myanmar. (5m) How do
diseases spread between animal and human? Briefly describe prevention and control
of Rabies. (15m) Describe the epidemiology and prevention of any one zoonotic
disease. (10m)
9. Neonatal tetanus (5m/SN)
10. Obstacles to measles eradication (5m/SN) Measles eradication (5m/SN)
11. Polio eradication (5m/SN) Explain global strategy for polio eradication. (7m) Explain
why polio eradication is feasible. Write down the global strategies for polio
eradication. Describe about “Acute Flaccid Paralysis (AFP) Surveillance”.
12. Syndromic management for STDs (5m/SN) page-173 What are the social and
demographic factors for increasing sexually transmitted infections in developing
countries. (8m)
13. Explain National strategic plan (2017-2020) for viral hepatitis. (7m)Prevention of
hepatitis B viral infection (5m/SN)
KZM (Final Part I, 6/2018)
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Epidemiology of Non-communicable Diseases and Conditions
1. Explain the word “Double Burden of Diseases”. Name the common non-
communicable diseases and, intermediate and behavioral risk factors for them.
2. Now, NCDs are becoming more prevalent in developing countries, why? (4m)
Describe the prevention and control of common NCDs through integrated approach.
(11m)
3. Describe the common risk factors of NCDs. (4m)
4. List the six key sets of risk factors for major non-communicable diseases.
5. Describe the preventive measures for coronary heart diseases.
6. Describe the epidemiology and prevention of the Cancer diseases? (11m)
7. Mention environmental risk factors for diabetes mellitus (DM). How would you
reduce this disease problem according to levels of prevention?
8. Describe the preventive measures for road traffic accidents (RTA) in the developing
countries according to the influencing factors. Factors influencing Road Traffic
Accidents. (5m/SN)
9. Host factor responsible for drug addiction. (5m/SN) Preventive and control measures
of substance abuse. (5m/SN) Briefly describe about the prevention and control of drug
abuse.

Nutritional Assessment of a Community

1. Nutritional assessment (5m/SN)
2. (a) Describe the anthropometric measures as a nutritional assessment of a child in the
community.
3. Describe the major nutritional problems and intervention programs in Myanmar. (8m)
4. Hazards of obesity. (5m/SN) Complications of Obesity (5m/SN)
5. Consequence of Iodine deficiency

Vital Statistics
1. What is vital statistics? Explain their uses. Define the vital statistics. What are roles of
vital statistics? (2m)
2. Certification of death. (5m/SN)
3. Explain the early life mortalities. (4m)
4. Define Infant Mortality Rate (IMR). List the socioeconomic causes of Infant
Mortality. Describe the causes of maternal and infant mortalities.
5. Define perinatal mortality rate and describe the causes of it. (9m)

Biostatistics
1. Measures of central tendency (5m/SN) Measurement of central tendency and
dispersion (5m/SN)
2. Normal distribution. (5m/SN)
KZM (Final Part I, 6/2018)
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Management
1. Define the terms of Management, Administration, Effectiveness and Efficiency. (4m)
2. Define Management. Mention the principles of management and describe one
principle in detail. (10m)
3. What is management? (2m) Explain the planning function of management. (8m)
4. Learning from experience. (5m/SN)

National Health Plan (NHP) (2017-2021)

1. Explain the guiding principles and Strategies to implement NHP (2017-2021) (10m)

Primary Health Care

1. Describe the concepts of primary health care [PHC].

MCH/RH
1. Write down the specific objectives and strategies of “Safe Motherhood”. Describe the
pillars of sage motherhood. (15m)
2. What are “High Risk Cases” in maternal and child health?
3. Discuss the adolescent health problems. How can you promote the health status of
adolescence? (9m)

School Health
1. Name the functions of school health services. Describe the environmental health for
schoolchildren.
2. Give the reasons for giving priority to school health services. (3m) Mention current
health status of school children in Myanmar and explain the comprehensive school
health strategies and describe function of school health team. (12m)
3. How do you understand health promoting school? Outline ten key steps for creating
Health Promoting School. (7m)
4. Heath promotion school (5m/SN)
Concepts and Practice of Community Medicine
1. Define community medicine. What do you understand the word “integrated
medicine”? Draw a diagram to describe the stages of “Community Oriented Primary
Care”. Discuss how you would conduct the community diagnosis for a community
that you are responsible for their health. (25m)
2. What are Community Medicine and COPC? (5m) Mention the stages of COPC. How
can you get the community diagnosis and community treatment? (10m)

Health Education
1. Briefly describe the principles and practice of health education.
KZM (Final Part I, 6/2018)
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Care of the Aged
1. Comprehensive health care of elderly person. (5m/SN)
2. What is aging? (2m) What are the health problems of aged and explain the
comprehensive services given to the elderly person. (13m)

Universal Coverage
1. Fair financing towards Universal Coverage. (5m/SN)
2. Universal Health Coverage. (5m/SN)

Communication & Doctor-Patient Relationship

1. Factors influencing the doctor-patient relationship. (5m/SN)

Residential Field Training

1. Based on your experience during the residential field training.
a. Describe organization set up and the township health profiles of THD you
visited. (7m)
b. Describe the health problems related with socio-behavioral and environmental
situation of both urban and rural areas of that township. (12m)
c. Describe the roles of NGOs in prevention of diseases and promotion of health
status of that community. (6m)
2. As a TMO, how would you plan to improve the health status of community in a
township? (11m)
3. As being a recently appointed TMO in remote area, how would you implement
primary health care activities in your township? (15m)
4. Being as a TMO, explain how to manage for success of immunization program in
your township. (15m)
5. As a TMO, how would you get more than 95% coverage of EPI in your township by
using the principles of management? (15m)
6. What are the objectives of Residential Field Training? Outline the lessons learned
from Residential Field Training (RFT). (10m)Draw an organogram and mention the
functions of Township Health Department that you have visited during RFT period.
As a Township Medical Officer (TMO), describe the problems encountered to
implement these functions and discuss the possible ways of solution. (15m)
7. Name the common health problems of the township that you have visited during RFT
and describe the factors influencing these problems. (10m)What health care activities
are being carried out by TMO to improve the health status of community? What
difficulties can be encountered and discuss the possible ways of solutions for these
difficulties? (15m)
8. (a) Describe the roles and responsibilities of a Township Medical Officer (TMO). (b)
Based on your learning experiences during “Residential Rural Field Training”,
describe one of the leading causes of morbidity or mortality and its related factors you
had observed. Give your suggestions to solve that health problem as responsible
health personnel of that community. (25m)
KZM (Final Part I, 6/2018)
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9. (a) What do you understand about the terms management and health management?
Describe the steps in planning process. (b) Based on your learning experiences during
“Residential Rural Field Training”, discuss the factors related to successful
implementation of expanded program of immunization (EPI) in that community. Give
your suggestions to improve the EPI program. (25m)

Family Health Care Visit

1. What do you understand “Comprehensive Family Health Care”? (2m) Mention health
problems/diseases related to life cycle. (5m) Discuss socio-demographic, economic
and environmental factors influencing health and disease of the assigned family.
(10m) Share your experiences of comprehensive health care for that family during
your FHC visits. (8m)

Problems
Epidemiology
1. A study evaluated the role of exercise in the prevention of coronary events in diabetic
patients. Although all patients were advised to take exercise one hour regularly at
least 5 days per week, only 300 patients had taken exercise regularly and among them
50 diabetic patients developed acute coronary events at time of follow up after one
year. Over the same time, 100 diabetic patients out of 200 who had not taken exercise
had coronary events. What is the type of study and calculate appropriate risk
measures? (8m)
2. A research team has conducted a study to determine the relationship between having
regular exercise and the development of Ischemic Heart Disease (IHD). The research
team followed 100 people who taking regular exercise and 400 people who not taking
regular exercise for 10 years. At the end of study period, among 100 who taking
regular exercise, 10 persons develop IHD. For not taking regular exercise group, 120
persons develop IHD. Based on this finding, can you conclude that there is
association between having regular exercise and development of IHD? (7m)
3. A study was done to prove relationship between cigarette smoking and myocardial
infarction (MI). History of long-term smoking was thoroughly obtained. Of 80
patients with MI, 20 had history of long-term smoking. Of 160 healthy persons
without MI, 10 had history of long-term smoking. Name the type of study. Calculate
the appropriate risk measure and interpret the result. (6m)

4. The following table shows some hypothetical results from investigation of a food-
poisoning outbreak at a wedding reception. There were 100 guests and 25 reported
vomiting within 24 hours of attending the reception.
Food-poisoning
Ate Salmon Total
Yes No
Yes 20 15 35
No 5 60 65
Total 25 75 100
Does this mean salmon was the source of the food-poisoning? Why? (5m)
KZM (Final Part I, 6/2018)
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Screening
1. A new screening test with 90% sensitivity and 80% specificity was performed on 500
subjects for the detection of prostate cancer. The prevalence of prostate cancer is
10%. Construct 2 by 2 table. Calculate and interpret PPV and NPV. (8m)
2. Visual Inspection (VI) can be used as a screening test for cervical cancer, when
histopathology is taken as the gold standard. For finding this, investigator took
subjects from clinics. 5000 women who were established to be having cervical
dysplasia on biopsy and 10,000 age and parity matched women who were not having
cervical cancer were subjected to VI, which was positive in 3600 of the dysplasia
subjects and in 1600 of the non-dysplasia group. Answer the following: (a) what are
the sensitivity and specificity of VI, (b) what is the PPV? (7m)

Vital Statistics
1. Calculate the maternal mortality ratio, perinatal mortality ratio and stillbirth ratio with
given data.
Mid-year population of township X of Myanmar in 2017 = 200,000
Crude birth rate = 20 per 1000
population
Neonatal death = 60
Late neonatal death = 20
Stillbirths = 40
Pregnancy related maternal deaths = 12
2. Demographic data of a town for 2018 were as follows;
No. of live births during 2018 = 5,000
No. of total deaths during 2018 = 1,600
No. of maternal deaths = 10
No. of under 1 year deaths = 150
No. of neonatal deaths = 50
No. of stillbirths = 100
No. of deaths within 7 days of life = 20
Calculate Infant Mortality Rate, Maternal Mortality Ratio, Post-neonatal Mortality
Rate and Perinatal Mortality Rate. (8m)
3. The demographic data of a town for year 2018 was given below.
Estimated population on 01/01/2018 = 90,000
Estimated population on 31/12/2018 = 110,000
Number of live births = 2000
Number of total deaths = 800
Number of maternal deaths = 10
Number of infant deaths = 80
Number of deaths of age under one month = 30
Number of stillbirths = 50
Number of deaths within 7 days of life = 15
Calculate IMR, MMR and perinatal mortality rate. (6m)