S8 E6 NVBDCP, Entomology

[00:00:01]Hi friends, Namaskar and a very warm welcome to this uh season 8 episode number six of the MCQ discussions.

[00:00:09]Uh in this whole MCQ discussions and the quiz discussions beta we are talking about the newly made freshly made MCQs.

[00:00:17]These are made uh directly like very freshly made prepared MCQs from the important high yield points the recent trends of the exams the MCQs which are being asked in your exam the recent advances in community medicine and the updates in community medicine. So this is a PSM revision series where we talk about the MCQs from the updates not directly the updates. So talking about let's just directly dive into it. Uh the topic is vectorborn diseases and entomology. [snorts] Which of the following disease outbreaks can be restricted without the effective use of chemical insecticides or larvisides? So options given to you are Malayan ferasis, chicken gona malaria, Japanese encphilitis. Of course we all know that Japanese encphilitis it is transmitted by the culix mosquito. Malaria is by enorles mosquito. The chicken gona is via the ades mosquito and malayan filerasis that is transmitted via the manssonia mosquito. So beta this topic we have discussed so many times in the exam and in the in the classes in the in the modules in the main videos in maro and in all everywhere I discussed this topic about vector bond illnesses. We know these four vectors Mensonia adesix and anophles. Betammensia it attaches to the the larvae of the mensonia mosquito. It attaches to the roots of the plants. The pistia plant and the waterinsense. Ades is there in artificial stored containers and often clean stagnant water. Both can be there in urban areas. Both can be there in overhead tanks and kulix is in dirty polluted water. So common sense it is imperative. I don't have to explain anything that if you if you think about it manonia mosquito with the roots bit if you pull out the plant no plant no root no root no larvae so obviously I think it is common sense which can be you finished without the use of insecticides it is malayan filerasis please remember the burian brujian ferasis that is transmitted by culix malayan is by mansonia mosquito okay let's go to the next one which of the following is not a correct match for diagnostic capacities. Cerological test is confirmatory for kalazar. Peripheral blood film is commonly used for diagnosis of lymphatic files. Peripheral blood smear is for malaria surveillance and Montenegro test is confirmatory for kalazar. So which one do you think is the correct answer like which is the wrong one? So if you talk about kalazar beta the cerological test is confirmatory for kalazar. This is correct answer RK39 that is the name of the cerological test. Now a recent update is there. There is a small update on kalazar. Government of India wants to achieve a kalazar elimination level by year 2027. When do we say this elimination it's will be there? When the number of cases will be less than one case per 10,000 population. When the number of cases will be less than one one per 10,000 population. and government of India you'll be happy to know that we have already achieved this level for in year 2024 so for the next three years we are going to maintain this level to achieve to achieve a certification for the kalazar elimination level so for this we are also very thankful to Dr. Shams Sundar who has uh received the president award recently for his work on both the things that is uh RK39 that is the rapid diagnostic kit number 39 and the use of liposomaal lampotin B for kalazar. So kalazar liposomaal amphoterosin b rk39 lamb that is lamb that is the drug of choice for kalazar. Okay. So coming back to this MCQ obviously this is a true option. Peripheral blood film is used for lymphatic friases. Absolutely true.

[00:04:04]That is the investigation of choice.

[00:04:06]Blood smear I think everybody knows about it. Thick smear and thin smear we use for malaria. This is also a true answer. Montenegro test bit beta. This is an old test. It is not used. It was used for kalazar but we don't use it for kalazar anymore. It is not a confirmatory. It is just an indicative of cell mediated immunity for kalazar or whether the patient may have some antigen for kalazar. It's not a confirmatory test. It is just a test to talk about the cell mediated immunity in kala azar. So obviously this is the correct one for you to mark. This is an incorrect. It is not used as a diagnostic test. So option D is the best one for you guys to mark. Question number 30 uh three. A 48-year-old farmer from a rural village in eastern India presents with uh progressive swelling of right lower limb for the past 10 years.

[00:04:56]He gives a history of recurrent episodes of fever associated with swelling of the groin as well that subsided with medication. Examination reveals that's important non-pitting edema thickened he hypercaratic skin with bulky swollen leg. The next step for clinical investigation is peripheral blood film will you do DC provocation test membrane filtration or toway test. So I think it is a common uh very common MCQ. We are talking about microfilaria. We are talking about lymphatic filerasis. We are talking about elephantiasis.

[00:05:30]We are talking about elephantiasis which is lympadeema of the lower limb. And these are like classical pictures of lympadema of the lower limb. And the investigation of choice is of course a peripheral blood film. But this peripheral blood film it is dur done during the nighttime and therefore it is not a good clinical investigation. The best answer for you guys to mark is DEEC provocation test. And how do we give DEEC provocation test? DEEC is given and within 30 minutes to 1 hour we have to do the peripheral blood film only. So you do the peripheral blood film only but after giving DEEC that is called as DEC provocation test. If you get single best answer you can mark minimum time we take is 30 minutes and membrane filtration. Yes this is a very most sensitive investigation but of course membrane filtration is also like if you do it without a DEC provocation test it will again be more uh sensitive and specific only during the night time. So therefore like membrane filtration is also not the best answer. Please remember three MCQs. What is the investigation of choice? Peripheral blood film. Which is the clinical test of choice? Alternate investigation. It is called as the DEC provocation test.

[00:06:42]Which is the most sensitive investigation? Membrane filtration.

[00:06:45]Torniqua test is not used in lymphatic files. It is a test which is used in dingu to find out dingu hemorrhagic fever. Right. Coming to question number four. Which of the following is not a correct statement for treatment of malaria? Treatment of malaria.

[00:07:00]Primacqueen is given for 14 days and YVAX. Single dose Primacqueen is given for falsiparam.

[00:07:08]Injectable actal is advised for pregnant female with falsiparam. Chlorocqueen is recommended for pregnant females with plasmodium vivax malaria. So which of the following is not a correct statement? You have to find the false one. You have to find the not correct.

[00:07:24]So in case of plasmodium vivaca we give chlorocqueen for 3 days plus we also give primacqueen it is given for 14 days. So obviously a answer is true.

[00:07:34]Single dose primacqueen is given for falsipar for falsiparam inject infections we give act for 3 days. ACT could be a al or we can give give the act plus we also give primacqueen as single dose as single dose on day two.

[00:07:53]So obviously option B is also correct answer. Option C we give injectable actal. This is a wrong answer. We do not give injectable. It is oral only. Please do note that for pregnant females primacqueen is contraindicated.

[00:08:08]Injectable is not given. It is simple oral act or oral act. So ACA or you give SP you can give anything but prim is contraindicated in pregnancy. So obviously option C is the false one.

[00:08:25]Chloroqueen is recommended for pregnant females with vivax malaria. Yes, for pregnant females in case of vivax we give chlorocqueen. Primma queen is contraindicated chlorocqueen for 3 days.

[00:08:36]Also I would like to tell you that for pregnant females with falsiparam pregnant females with falsiparam you have to see whether the female is from first trimester or second or third trimester. First trimester we give quinine salts and the second third trimester we can give ACT. So obviously option D is also correct. So which is the best answer for you guys to mark it is injectable falsiparam which is the wrong answer. Coming to next MCQ the proxy indicator for burden of fever in an area is given by burden of fever prevalence of fever is best given by uh it's a direct question direct answer it is annual blood examination rate. points for you to remember. Slide positivity rate that is an outbreak indicator.

[00:09:22]Infant parasite rate it is a very good in indicator about recent malaria transmission.

[00:09:29]Recent malaria transmission and annual parasite incidence that is the best indicator for malaria burden in the area. Malaria burden or the number of new cases. Annual blood examination rates that is for operational efficacy that is for operational efficacy of the program and it is also important indicator about the prevalence of fever or the fever burden in the area. So obviously it's a direct question direct answer a e r that is the best indicator for prevalence of fever in the area.

[00:10:06]Identify the disease which is transmitted by this vector. So what do you think is the correct answer?

[00:10:11]identify the disease which is transmitted by this vector. So um if you can just see this with this vector beta this vector what you can see what you can appreciate over here is that there are some bands like these. So now it is important to understand that is it a white color band or a black color band is it a black body and a white band or a white body with a black bands. So this this uh mosquito beta this mosquito is a cullex mosquito because these bands these are light brown color bands. These are light brown color bands and this mosquito is not 80s mosquito. So if you just look at this mosquito, second differentiating feature in this mosquito is if you just appreciate this mosquito, you can see that the head is like this and the tail is also like this. The tail is also coming down. You can see the angle of the tail which is coming down. The angle of the tail because it is coming down.

[00:11:13]It is a culix mosquito. If it would have had been an 80s, this is difficult for you to uh maybe see. If you just see like this, this mosquito is a cullex mosquito. Okay. So if you if this was an 80s mosquito, if by chance this was an 80s mosquito, then this would have been a typically black color mosquito with stripes on the body. The stripes would have been a white color stripes and this would have been a very jet black mosquito. And the mosquito would have had parallel would be resting parallel to the surface. So parall to surface that is what is the 80s mosquito. This mosquito has its tail. This mosquito has its tail which is just uh like coming down. It is called as hunchback position. Hunchback position. So obviously if you understand this mosquito beta dingo mosquito it is via 80s mosquito which is not the correct answer. Japanese encphilitis it is by cullex. Mensonia is by malayan is by mensonia. Malaria is by enoples. So obviously which is the correct answer that is Japanese encphilitis to be marked in this question. Urban malaria is mostly transmitted by which of the following species? Direct question direct answer I don't have anything to explain over here. It is an offly defensy that is for urban areas. You have to memorize this. Urban malaria is transmitted most commonly by anophles defensey anoples qy facius qyacience that is in rural areas. in off Dirus and Sundaius. Sundaius is mostly in um coastal areas or in southern parts we have Sundaius and Dirus is also in coastal areas but in Andaman and Nicobar islands and most of the island areas it is in offles dirus it's it's it's also there in an off dirus will also be there in forest areas. So these are some of the special features about the species of the mosquito. Of course it's a direct question direct answer. Question number eight, identify the ricketetts disease which has frequent outbreaks. The reservoir is a cattle, sheep or goat and may be transmitted by aerosols or droplet. It usually does not have any transmitting vector. It's a direct question, direct answer frequently asked in your exam. The special answer, the special fever that is the Q fever. So why does Q fever spread? We don't know.

[00:13:39]It spreads Q, right? Q, it is Q fever.

[00:13:42]There is no vector. It is transmitted by aerosols and this is the only one disease. Q fever is the only disease which also has no rash. It is predominantly fever only.

[00:13:55]All ricketettia will have rash except Q fever. Murine typhus that is endemic typhus. Endemic typhus it is a fleeborn illness. Right? So trench fever, rocky mountains fevers these are all tickborn illnesses. Trench fever we can have uh trench fever is the only fever recettial disease which has human reservoir. Human reserve wire is for trench fever. Right?

[00:14:18]So these are uh some of the important uh things that you have to remember for rkettial illnesses. Coming to next one and a 28year-old pregnant female. This female is a pregnant female from an area with ongoing mosquitoborn viral transmission presents with low-grade fever, macropopular rash with conjunctal congestion and joint pains for 3 days.

[00:14:41]So this looks like a dingu kind of illness. She reports that the symptoms are milder compared to dingu fever and this illness is known to be similar to dingu. So it's not dingu but no severe thrombocytoenia.

[00:14:53]It is transmitted by H. That's a that's kind of a question where everybody might be thinking scratching their heads around. This says dingu and dingo like illness. So this could be chicken gona.

[00:15:06]This could be chicken gona and this could also be chicken gona.

[00:15:12]This could also be a zika virus disease.

[00:15:16]Zika virus disease. Mostly it looks like a zika virus disease. The characteristic feature in a Zika virus disease will be bone pains. Arthralgia will be there.

[00:15:25]Joint pains will be there. Like chicken gonia it is more with arthralgia.

[00:15:30]Arthralgia it is pretty high. Zika virus it is a very typical feature is conjunctivitis or conjunctiv congestion.

[00:15:38]Conjunctiva will be very predominantly involved in Zika. It is a very mild illness. It is not having no severe no severe thrombocytoenia. It's a very mild illness. This could be like chicken gonuna. It could be zika virus and they both are ads transmitted. So the correct answer over here is ads infection only because inoples is for malaria. Qlex is for Japanese encphilitis. Flabotamus papatasi that is related uh to some of the oraya fever, sandfly fevers or that is the sandfly family and that is also not the correct answer. Question number 10. Which of the following statement is not correct for Japanese encphilitis?

[00:16:18]Which is not correct for Japanese encphilitis? Humans are the maintenance host main vector. So which is not correct?

[00:16:26]Main vector for culix tritenure rinkus and has seasonal transmission. Pigs are amplifying hosts. Eggrot, egrets and herons are part of the life cycle. So which of the following is not correct?

[00:16:38]So if you look at the life cycle beta in this we have a maintenance host. Who is the maintenance host? The maintenance host is by ardeed birds. Rdeed birds.

[00:16:49]These are the rdeed birds.

[00:16:53]Arded birds. What are the arded birds?

[00:16:55]That is egrets and herons. These are the ardeed birds. Then we also have pigs.

[00:17:00]Pigs are the amplifying oats and humans are the dead end host. Humans are the dead end host. They are not the maintenance host. Main vector is absolutely correct. Cullex titano rinkus and they have seasonal prevalence. So the correct answer over here is humans are the maintenance host. That is the wrong answer. Question 11. Which of the following is not a correct answer for genvac vaccine? Genvac vaccine is recently being used in India. Earlier we were using a live vaccine. a live vaccine which was SA14142.

[00:17:34]So SA 14142 it is also being used in India but it is now a restricted use. We have more prevalent use of the Genvac vaccine. So Genvac which of the following is not correct killed vaccine.

[00:17:45]Yes, this is a true answer. It is a verosell cultured vaccine. It is a veroculture vaccine. This is true answer. It is a colar strain vaccine.

[00:17:54]That is also true answer. It does not contain aluminium hydroxide. This is a false answer. Why? Because it contains it contains aluminium hydroxide. Because it contains aluminium hydroxide as a as an aduent, it is a freeze sensitive vaccine. It will be a freeze sensitive.

[00:18:13]And please note genvac vaccine. It is pre uh it has pre like reconstituted.

[00:18:20]It is reconstituted with phosphate buffer. It is reconstituted with phosphate buffer. Earlier in the SA442, it was a powdered vaccine liophilized vaccine and it was supposed to be reconstituted with the phosphate buffer.

[00:18:37]But the Genvac vaccine that is pre-reconstituted with the phosphate buffer and it contains the aluminium hydroxide. So obviously this is the correct one for you guys to mark in the exam. Question 12. Which of the following is a fleaorn illnesses?

[00:18:52]Endemic typhus, epidemic typhus, kalazar, sugarosis or uh or uh endemic typhus [clears throat] or epidemic typhus. So, [snorts] so if you talk about endemic typhus beta, endemic typhus that is the only fleeborn ricketettsial illness. Epidemic typhus is a lousborn illness. Epidemic typhus is a lousborn illness. Scalazar is via the sandfly or the fleotamus argentipus and chigarosis is a mightborn illness. So which of the following is a fleaorn? It's a common question, direct question, direct answer. It is endemic typhus that is also called as murine typhus. Question number 13. A 32year-old male from a rural area presents with prolonged fever for 3 months, weakness, darkening of skin and abdominal distension. So on examination he has massive spleenomegaly. That's kind of important because he has massive spleenomegaly along with hepatomegali.

[00:19:56]Very few conditions will have massive spleenomegaly hpatomegali and pansytopenia. It's a classical triad.

[00:20:02]Bone marrow shows intracellular organisms with macrofasages. I think everybody understands the diagnosis. The possible diagnosis is this is beta kala azar which is by lishmania donovini.

[00:20:15]This is a typical feature of kalaza that is visceral leismanasis. It is not trapanosomiasis. It is not malaria. It's not lymphatic fyasis. The correct answer over here is visceral lismansis. A few points about kalazar. There is prolonged irregular fe fever and the classical massive spleenomegali that is the classical feature in kalazar along with along with pansytoenia. panytoenia and there is LD bodies amastigots inside the macrofasages and there is hyperpigmentation that's the name of it kala azar and these are typical features of kalazar option B is the correct one for you guys to mark coming to question 14 which of the following is not a feature of flabotamus argentipus so nocturnal preference of biting hairy insect size as 2 to 3 mm both male and female they transmit the illness so which is not a feature of this not Insect plotamus argentipus that is what we call as the sandfly. If you talk about a sandfly beta a few points in sandfly sandfly it is a very hairy insect. That is what you see over here.

[00:21:21]It's a very hairy insect. It is a very hairy insect. It is a very small insect very small in size 2 to 3 mm and hairy insect poor flight range. It loves to stay in dark humid places animal shelters or organic rich soil. It is a very like barely you can see it with human eye and it is only the female who takes the blood meal. Males are super cool. They enjoy the nectar and fruits.

[00:21:47]So they are fruit eating. Female will be blood eating. And the shape of the wings it's kind of a shape which is a nonsense shape. The god has given its wing but the wings are like more upwards and upward facing. They don't they are not at all aerodynamic. At least god should have given them wings and the wings should be able to fly. But this wings are like useless wings. They are upward- facing wings and these are V-shaped like you can see over here these are Vshape of wings. These are called as the lancolate shape. And how do we kill a sandfly? It is by use of synthetic pythroidids that is the insecticide of choice for killing the sandflies. So obviously nocturnal preference that is true. Hairy insect small insect that is true. Both males and females it's not the males who transmit. So obviously the correct answer over here is option D.

[00:22:37]Question number 15. I think the second last MCQ all of the following are live vaccines except so which one is not a live vaccine. If even if you don't know the answer still you can rule out the options. So everybody knows it it is genvac vaccine which is a killed vaccine but a QA denaxia xic these are important vaccines which have been recently introduced. Cena and denwaxia common sense as the name says they are for dingu vaccines. A few points about this dingu vaccine beta Qinga that is uh from that is manufactured the strain that is T AK. Why do we say TAK? That is from Teada Pharmaceuticals in Japan. They they were the original people who manufactured this who made this QA invented this QA vaccine. It is applicable. It is approved for 6 to 16 years. It is given in two doses 3 months apart. It is a subcutaneous vaccine and it has been manufactured by Japanese people from the teeda pharmaceuticals but also very recent introduction. Uh they have tied up with the be biological e pharmaceut limited pharmaceuticals in India for mass production and it is a subcutaneous injection and qinga is a vaccine for dingu. We also have dingia that is a cdv uh cydtv vaccine. It is live attenuated and interestingly it is based on the yellow fever 17 delta particle. So they just take the yellow fever particle virus particle and and give the coating of the of the dingo viruses cereotypes. So the the base is which they use is the yellow fever vaccine uh yellow fever 17 delta particle. And then the there is third vaccine that is deni all it is made in it is manufactured made in India. It has been invented in India and it is in phase three trials not yet approved but very soon probably we are going to get a good report on the result from the ding vaccia dingi vaccine. Also talking about the mosquics vaccine we have the RTS so1 vaccine. So we have this RTS that is for mosquics and R21 M protein vaccine. XIC vaccine beta vaccine it is the chicken gona vaccine. It is again a live vaccine which is used for chicken gona. It is it was made in Austria and it is again used for approved for use age more than 18 years. So it contains a live chicken gona virus particle. So which one is the live vaccine? All are live vaccines except the genvac. Genvac we have already discussed it is a killed vaccine. Coming to the last MCQ in the mosquix vaccine. So coming back to the Mosquerix vaccine which is RTS comma S type the S stands for what do you think is the S? S S is a sporooid protein hepatitis B surface antigen spike protein or subcutaneous root. So the S stands for interestingly if you look at it more closely now RTS SAS1 vaccine that is first MCQ to be known is it is used only for plasmodium falsiparam. has not yet been found useful for other types other species of malaria of plasmodia that is the bivwax or any other species. Now the vaccine is RTS comma S vaccine where S stands for the hepatitis B surface antigen beta that is the stabilizing protein which is used like you use in Qenga we use the yellow fever virus particle in malaria vaccine which is a circumspoid vaccine we are using hepatitis B surface antigen so that surface antigen is there and on the surface antigen we'll put the circumspoid protein repeat region T- cell epitope region and all these things and then there is this ESO1 which is the aduent system and adjuant contains like MPL monophospher lipid A and also contains the saponins the QS21 and these are the adjuants which are used in the Mosquerix vaccine. It is a WH approved vaccine. It is a WH and FDA approved vaccine. It is currently being used in many parts of the world wherever there is malaria like hyperindemicity. Also we have a new vaccine that is R21 matrix M plasmid protein vaccine. It's a plasmid protein vaccine. It's a reompinent vaccine. These are two vaccines which you should be remembering for malaria.

[00:27:02]Coming back to this question. So it's a direct question direct answer. The correct answer over here is hepatitis B surface antigen. And with that uh I'd like to thank you so much for watching this whole module on national vectorborn disease control program and uh and all the vectors which are important for your exam. Keep on studying, keep on doing the hard work. Uh all the very best and take care.