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PE16.1-6,PE17.1 | Child Health Programs — Practice Quiz
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A 3-week-old infant is brought to the PHC with fever for 2 days. On IMNCI assessment, the infant has a bulging fontanelle and is not able to feed at all. According to IMNCI guidelines for young infants, this child should be classified as:
Inability to feed + bulging fontanelle in a young infant = classic PSBI (Possible Serious Bacterial Infection) signs → pink classification = urgent referral with pre-referral treatment (ampicillin + gentamicin).
In IMNCI for young infants (<2 months), ANY of the PSBI signs (not able to feed, convulsions, fast breathing ≥60/min, severe chest indrawing, grunting, bulging fontanelle, hypothermia, very high fever, movement only when stimulated) mandates pink classification and urgent referral with pre-referral antibiotics.
Inability to feed and bulging fontanelle are both PSBI/Very Severe Disease signs in young infants (<2 months). This is always a pink-category, urgent-referral case.
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A health worker is using IMNCI to assess a 9-month-old child. The child's respiratory rate is 52 breaths/min. The child has no stridor and no chest indrawing. How should this finding be classified?
For 2–12 months: fast breathing threshold is ≥50 breaths/min. A rate of 52/min = fast breathing → classified as Pneumonia → treat with oral amoxicillin, soothe throat, follow up in 2 days.
IMNCI fast-breathing thresholds: < 2 months = ≥60/min; 2–12 months = ≥50/min; 12 months–5 years = ≥40/min. Memorise these age-specific cut-offs — the exam commonly tests inter-age confusion.
The fast-breathing thresholds in IMNCI are age-stratified: <2 months = ≥60/min; 2–12 months = ≥50/min; 12 months–5 years = ≥40/min. At 9 months, 52/min is fast breathing = Pneumonia.
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During an IMNCI assessment of a 2-year-old with diarrhoea for 3 days, the child is irritable, has sunken eyes, drinks eagerly, and the skin pinch goes back slowly (>2 seconds). According to IMNCI dehydration classification, this child has:
Two or more of: restless/irritable, sunken eyes, drinks eagerly/thirsty, skin pinch goes back slowly = SOME DEHYDRATION → treat with ORS (Plan B: 75 mL/kg in 4 hours) and continue feeding.
IMNCI dehydration: No dehydration = <2 signs; Some dehydration = 2+ signs (restless/irritable, sunken eyes, eager to drink, skin pinch slowly) → ORS Plan B; Severe dehydration = 2+ signs (lethargic, not able to drink, skin pinch very slowly) → IV fluids Plan C.
IMNCI dehydration classification uses a two-sign rule: 2+ signs from the 'some' column = Some Dehydration. Severe dehydration requires at least 2 signs from the severe column (lethargic/unconscious, sunken eyes, not able to drink, skin pinch goes back very slowly >3 seconds).
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A mother brings her 18-month-old child with fever for 5 days. The IMNCI health worker finds the child is not able to drink, has a stiff neck, and generalised convulsions. Which classification is correct?
General danger signs (unable to drink + convulsions) + stiff neck = Very Severe Febrile Disease (VSFD) → pink classification → immediate referral with pre-referral treatment (injectable antibiotic, antimalarial if indicated, antipyretic). Never delay referral for observation.
The four IMNCI general danger signs (2 months–5 years) are: not able to drink or breastfeed, vomits everything, convulsions, lethargic or unconscious. ANY one = Very Severe Febrile Disease or comparable pink classification requiring immediate referral.
In IMNCI for children 2 months–5 years, the four general danger signs are: not able to drink/breastfeed, vomits everything, convulsions (past or present), lethargic/unconscious. ANY general danger sign = VSFD = urgent referral.
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A medical officer at a PHC is counselling a mother about IMNCI follow-up. Under the IMNCI colour-coded triage system, a child classified in the YELLOW category should be:
Yellow (e.g. Pneumonia, Some Dehydration, Non-severe anaemia, Possible bacterial infection in a young infant) = treat at the facility or at home with specific treatment + follow up within 2 days to re-assess.
IMNCI colour coding: Pink = refer urgently with pre-referral treatment; Yellow = specific outpatient treatment + 2-day follow-up; Green = home care + advice on when to return. This three-tier triage system is the operational core of IMNCI.
IMNCI three-colour risk stratification: Pink = severe/urgent referral; Yellow = treat and follow up at 2 days; Green = home care with anticipatory guidance.
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Under IMNCI assessment of a young infant (<2 months), fast breathing is defined as respiratory rate ≥ _____ breaths per minute counted over one full minute.
For infants <2 months, fast breathing = ≥60 breaths/min. This is a PSBI sign when found in the context of danger signs, and classifies as Pneumonia in the 2-month–5-year algorithm.
Respiratory rate thresholds in IMNCI (count for a full minute when calm): <2 months = ≥60/min; 2–12 months = ≥50/min; 1–5 years = ≥40/min. These thresholds must be applied age-specifically — confusing them is a common exam trap.
Fast-breathing thresholds by age: <2 months = ≥60/min; 2–12 months = ≥50/min; 12 months–5 years = ≥40/min.
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A child is identified at a Rashtriya Bal Swasthya Karyakram (RBSK) screening camp to have cleft palate and developmental delay. Under RBSK, which set of conditions is the programme designed to screen and provide early intervention for?
RBSK screens children 0–18 years for the 4Ds: Diseases (e.g. congenital heart disease, cleft palate, NTDs), Deficiencies (anaemia, vitamin A/D), Developmental delays, and Disabilities. Identified children are referred to District Early Intervention Centres (DEICs).
RBSK (Rashtriya Bal Swasthya Karyakram) screens 0–18-year-old children for 4Ds: Diseases, Deficiencies, Developmental delays, Disabilities. Positive screens are managed at District Early Intervention Centres (DEICs) with free treatment under NHM.
RBSK's 4Ds: Diseases, Deficiencies, Developmental delays, Disabilities. These four D's are the official NHM categorisation for RBSK's mandate.
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Mission Indradhanush was launched by the Government of India primarily to improve vaccination coverage. Under NHM, which goal does Mission Indradhanush aim to achieve?
Mission Indradhanush (launched 2014) targeted districts with <50% vaccine coverage, aiming to achieve 90%+ full immunization coverage (all NIS vaccines) across India. It covers all unvaccinated and partially vaccinated children <2 years and pregnant women.
Mission Indradhanush (2014): Target = >90% immunization coverage for all NIS vaccines. Intensified Mission Indradhanush (iMI, 2017): 4 rounds/year in high-risk districts, later expanded. JSSK (Janani Shishu Suraksha Karyakram) provides free maternal and newborn care entitlements in public facilities.
Mission Indradhanush targets: achieving and sustaining >90% immunization coverage for all NIS vaccines through special immunization drives in underserved areas.
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Under IMNCI guidelines, a 4-month-old infant is found to have a weight-for-height Z-score of −3.5 SD with no bilateral pedal oedema. According to the IMNCI criteria for identifying undernutrition and planning referral, this child should be classified as:
SAM criteria include weight-for-height/length < −3 SD (Z-score), MUAC <11.5 cm (6–59 months), or bilateral oedema. A Z-score of −3.5 SD clearly meets SAM criteria → refer for Nutrition Rehabilitation Centre (NRC)/inpatient therapeutic feeding.
IMNCI SAM criteria: weight-for-height Z-score < −3 SD, or MUAC <11.5 cm (for 6–59 months), or bilateral pedal oedema. SAM = pink/red — refer. MUAC cut-offs: SAM <11.5 cm; MAM 11.5–12.5 cm; Normal ≥12.5 cm (6–59 mo).
SAM in IMNCI: weight-for-height Z-score < −3 SD OR MUAC <11.5 cm (age 6–59 mo) OR bilateral oedema = SAM → refer. MAM = Z-score −2 to −3 SD.
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The RMNCH+A strategy of NHM focuses on a continuum of care from adolescence through newborn period. Which of the following correctly represents the full expansion of 'RMNCH+A'?
RMNCH+A = Reproductive, Maternal, Newborn, Child Health + Adolescents. It is the flagship convergent framework under NHM addressing the entire life cycle from adolescents through newborn care.
RMNCH+A (Reproductive, Maternal, Newborn, Child Health + Adolescents) is the NHM continuum-of-care strategy. Nested programmes include JSSK (free intrapartum/newborn care), RBSK (child health screening), RKSK (adolescent health under Rashtriya Kishor Swasthya Karyakram), and Mission Indradhanush.
RMNCH+A stands for Reproductive, Maternal, Newborn, Child Health plus Adolescents — the life-cycle continuum of care strategy under NHM.
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