Respo – Com-Med/Behavioural sciences

✅ Risk factors include <5 and >65 age

🧠 Explanation (Why this is correct):

Community-acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside of a hospital setting. Certain populations are at higher risk:

• Extremes of age: Children under 5 years and adults over 65 years have weaker or compromised immune systems.

• Other risk factors include chronic diseases (COPD, diabetes), smoking, and immunosuppression.

Thus, the statement about age-based risk factors is the most accurate.

❌ Explanation of Incorrect Options:

The most frequently identified organisms are gram-negative
❌ Wrong — In CAP, the most common organisms are Gram-positive:

• Streptococcus pneumoniae is the leading cause.

• Gram-negative organisms (e.g., Klebsiella) are less common and often seen in hospital-acquired cases.

It mostly presents like bronchopneumonia
❌ Wrong — CAP can present as lobar pneumonia or bronchopneumonia, but lobar pneumonia is classically more common in adults. Saying “mostly bronchopneumonia” is inaccurate.

Symptoms always include hemoptysis
❌ Wrong — Hemoptysis is uncommon in CAP and is not a required symptom. Most patients present with cough, fever, sputum production, and dyspnea.

Symptoms always include pleurisy
❌ Wrong — Pleuritic chest pain occurs in some patients but is not universal.

✅ Correct Answer: Doctor taking entire control which is not apparent virtually

Explanation:
The vertical model (also called the paternalistic model) in the doctor–patient relationship is one in which the doctor holds a dominant and authoritative role, making most or all decisions regarding the patient’s care.

• The doctor assumes responsibility for determining the diagnosis and treatment plan, believing that it is in the patient’s best interest.

• The patient’s role is largely passive, expected to comply with the physician’s instructions.

• This model reflects a hierarchical or “top-down” relationship, where control and knowledge are primarily held by the doctor.

It is termed “vertical” because the relationship is unequal in power — the physician stands “above” the patient in terms of authority.

❌ Patient plays a mutual role in deciding the treatment plan
Describes a shared decision-making or partnership (mutual participation) model, not the vertical model.

❌ Patient makes all the decisions on their own
Represents the consumer or autonomous model, where the patient directs care choices independently.

❌ Doctor helps patient find their preferences
Reflects the deliberative model, where the physician guides the patient to identify values and make informed decisions.

❌ Doctor only provides facts to the patient
Describes the informative model, where the doctor supplies medical facts and the patient makes the final decision.

✅ Correct Answer: At birth

Explanation:
The BCG (Bacillus Calmette–Guérin) vaccine is administered as soon as possible after birth, ideally within the first 24 hours.
It provides protection against severe forms of childhood tuberculosis, such as miliary TB and tuberculous meningitis.
In national immunization programs (like Pakistan’s EPI schedule), BCG is included in the birth dose group along with the oral polio vaccine (OPV-0) and hepatitis B vaccine (Hep B-birth dose).

❌ 14 weeks – By this time, third doses of DPT and polio vaccines are given, not BCG.
❌ 2 years – Too late; BCG is a neonatal vaccine.
❌ 6 weeks – The starting point for DPT and OPV, not for BCG.
❌ 4 weeks – If not given at birth, it can be given later, but the recommended timing remains at birth.

• → Moving from open-ended to specific (closed-ended) questions✅ Correct answer: Paraphrasing

  Explanation:

  • Paraphrasing means the doctor restates what the patient has said in their own words — often during the conversation, not just at the end.
  • The purpose is to show understanding and confirm accuracy of what the patient meant.
  • It’s a key active listening skill in doctor–patient communication.

  Example:

  Patient: “I’ve been feeling exhausted all week; I can barely get out of bed.”

  Doctor (paraphrasing): “So you’ve been feeling very tired lately and it’s been hard to manage your daily activities.”

  Why not “Summarizing”?

  • Summarizing happens at the end of the conversation or section to wrap up key points.
  • The question says the doctor “listens, then repeats and concludes it at the end,” which can sound like summarizing — but if the goal is to reflect the patient’s statement in simpler or confirming words, that’s paraphrasing.

  • Many exam questions use this wording to test understanding that “repeating in own words” = paraphrasing.

✅ Correct answer: Doctor taking entire control which is not apparent virtually

Explanation:

The vertical model in the doctor–patient relationship is a paternalistic approach where the doctor dominates decision-making and assumes full control over the patient’s care. The patient’s role is passive, and their autonomy or preferences are minimized. The doctor acts as the ultimate authority, believing they know what’s best for the patient.

❌ Patient plays a mutual role in deciding the treatment plan – this describes the shared (mutual) model, where both doctor and patient collaborate equally.

❌ Patient makes all the decisions on their own – this fits the consumer or informative model, where the patient has full autonomy.

❌ Doctor helps patient find their preferences – this describes the interpretive model, focusing on aligning treatment with the patient’s values.

❌ Doctor only provides facts to the patient – this is the informative model, where the doctor acts as a source of medical information only.

✅ Correct Answer: The movement of our facial muscles can trigger emotions

Explanation:

The facial feedback hypothesis states that facial expressions themselves can influence emotional experiences.

In Sarah’s case, even though she is in a bad mood, forcing a smile activates the same muscles used when genuinely happy — this sends feedback to the brain, which can actually improve her mood.

So, facial movement can trigger or enhance emotional feelings.

Why the others are incorrect:

• ❌ “Once we know how we are feeling, we can change our facial expression” – That’s the reverse of the hypothesis; it’s about emotion influencing expression, not the other way around.
• ❌ “Some people disguise their emotions if they look in a mirror” – Not relevant; that’s about self-awareness or social masking, not facial feedback.
• ❌ “We can judge someone else’s mood by looking at their face” – That describes emotional recognition, not the facial feedback effect.
• ❌ “None of the above” – Incorrect because one option is correct.

In classical conditioning, when a conditioned stimulus (CS) — such as a bell — is repeatedly presented without the unconditioned stimulus (US) — such as food — the conditioned response (CR) — salivation — gradually weakens and eventually disappears. This process is known as extinction.

However, after some time has passed with no further conditioning, if the CS is presented again, the CR may suddenly reappear, even though no new learning has taken place. This unexpected return of the extinguished response is called ✨spontaneous recovery✨. The recovered response is usually weaker and may extinguish more quickly if the CS continues to appear without the US.

Why the Other Options Are Incorrect:

• ❌ Stimulus Generalization: Occurs when stimuli similar to the original CS (e.g., different tones of a bell) also elicit the CR.

• ❌ Operant Conditioning: A form of learning based on reinforcement and punishment, not on associations between stimuli.

• ❌ Extinction: Refers to the disappearance of the CR due to repeated presentation of the CS without the US — not its reappearance.

• ❌ Learning: A general term for acquiring new knowledge or behaviors; it doesn’t describe this specific phenomenon.

✨ In short: After extinction, the sudden return of a previously extinguished conditioned response — without any retraining — is called spontaneous recovery

In the doctor-patient relationship, empathy is the ability to cognitively and emotionally understand the patient’s experiences and feelings without necessarily experiencing them oneself.

• Key aspects:

  • Active listening

  • Understanding the patient’s perspective

  • Responding appropriately to concerns

Other options:

• Feeling exactly what the patient feels → emotional contagion, not professional empathy

• Being ignorant / not listening / just careful → do not constitute empathy

Elderly individuals (especially >65 years old) are at increased risk of respiratory tract infections, particularly pneumonia and influenza.

Preventive vaccination is the most effective strategy to reduce hospitalizations and mortality from these infections.

1. Pneumococcal Vaccine

Protects against Streptococcus pneumoniae, the most common cause of Community-acquired pneumonia

2. Influenza Vaccine

Protects against seasonal Influenza A and B viruses, which commonly cause severe respiratory illness in the elderly.

• Annual vaccination is recommended because influenza virus strains change each year.
• Reduces mortality, hospitalization rates, and post-influenza pneumonia.

❌ Why the Other Options Are Incorrect:

• Washing hands and maintaining hygiene:

  • Important for general infection prevention but not sufficient alone in preventing serious lower respiratory tract infections in the elderly.

  • Vaccination directly targets the main pathogens responsible for repeated hospitalizations.

• Haemophilus influenzae type b (Hib) vaccine:

  • Crucial for infants and young children but not routinely indicated for adults unless they are immunocompromised or have asplenia.

  • Rarely causes respiratory infections in elderly patients.

• Adenovirus vaccine:

  • Used primarily in military recruits, not recommended for elderly or the general population.

  • Adenovirus infections are usually self-limiting and less severe than pneumococcal or influenza infections.

• Proper diet:

  • While nutrition supports overall immunity, it cannot replace specific immunization against high-risk pathogens.

Tobacco use—whether through smoking or smokeless forms—is the leading preventable cause of cancer worldwide, responsible for approximately 22% of all cancer-related deaths.

Tobacco contains over 7,000 chemicals, of which at least 70 are proven carcinogens, including polycyclic aromatic hydrocarbons (PAHs), nitrosamines, benzopyrene, arsenic, formaldehyde.

Cancers linked to tobacco use:

• Lung cancer (most strongly associated)

• Oral cavity, larynx, pharynx, and esophagus

• Pancreatic, bladder, kidney, and cervical cancers

❌ Why Other Options Are Incorrect:

• Environmental pollutants: Contribute to some cancers (e.g., asbestos → mesothelioma, benzene → leukemia), but the global burden is far lower than tobacco.

• Hydrocarbons: Present in smoke and industrial exposure, but not a standalone major cause like tobacco.

• Sun exposure: Major cause of skin cancers (especially melanoma), but accounts for a smaller proportion of global cancer deaths.

• Radiation: Causes cancers (e.g., thyroid, leukemia) but is responsible for a minor global percentage compared to tobacco-related malignancies.

Nicotine is the most damaging and addictive component of tobacco due to its powerful physiological and psychological effects. It acts as a potent stimulant of the autonomic nervous system and is the primary reason people develop dependence on tobacco products.

Here’s how nicotine causes harm:

1. Addiction: Nicotine stimulates nicotinic acetylcholine receptors in the brain, releasing dopamine in the reward pathways, leading to addiction and compulsive use.

2. Cardiovascular effects: It increases heart rate, blood pressure, and myocardial oxygen demand, predisposing to hypertension, atherosclerosis, and coronary artery disease.

3. Systemic toxicity: Chronic nicotine exposure causes oxidative stress, endothelial dysfunction, and carcinogenesis, both directly and indirectly through other tobacco compounds.

4. Gateway effect: Nicotine addiction reinforces long-term smoking behavior, exposing the user to thousands of additional harmful chemicals, including carcinogens like benzopyrene and nitrosamines.

❌ Why Other Options Are Incorrect:

• Arsenic: Present in small amounts in tobacco; it is carcinogenic but not the main addictive or systemic agent.

• Ammonia: Enhances nicotine absorption in the lungs but is not a major direct toxin in typical smoking concentrations.

• Butane: A hydrocarbon used in cigarette manufacturing; mainly a combustion product, not the core damaging compound in systemic terms.

• Lead: A toxic heavy metal found in some tobacco; can cause long-term effects, but its contribution is minor compared to nicotine’s widespread systemic harm.

The biopsychosocial model is a comprehensive framework used in medicine to understand health and disease through the integration of biological, psychological, and social factors.

Here’s how each component contributes:

• Biological: Focuses on genetic, biochemical, and physiological aspects of disease.

• Psychological: Considers emotions, personality, cognition, and coping mechanisms.

• Social: Emphasizes social, cultural, familial, and environmental factors influencing illness.

The social model specifically explores how social determinants of health — such as culture, socioeconomic status, family support, environment, and community structure — affect both the experience and expression of disease.

For example, in some cultures, depression may be expressed primarily as physical symptoms (somatization) rather than emotional distress — an example of cultural and social influence on illness behavior.

❌ Why Other Options Are Incorrect:

• Psychological model:
  Focuses on mental and emotional processes (e.g., coping, perception, and motivation), not external social or cultural factors.

• Ecological model:
  Primarily used in public health to examine relationships between individuals and their broader environment (e.g., policy, community design), not specifically illness expression in patients.

• Biological model:
  Reduces illness to physiological or genetic causes only, ignoring cultural and social dimensions.

• Cultural model:
  Considers cultural influences alone but does not encompass broader social and environmental aspects included in the social model.

✅ Correct Answer: Doctor taking entire control which is not apparent virtually

Explanation of Correct Option:

• The vertical model of the doctor–patient relationship is also called the paternalistic model.
• In this model, the doctor assumes full control over the medical decisions and acts in what they believe is the best interest of the patient.
• The patient plays a passive role, following the doctor’s advice without actively participating in decision-making.
• It’s termed “vertical” because the relationship is hierarchical — the doctor is in a superior (top) position, and the patient is in a subordinate (lower) one.

Explanation of Incorrect Options:

❌ Patient plays a mutual role in deciding the treatment plan

• This describes the mutual participation or shared model, where both doctor and patient cooperate in making decisions.

❌ Patient makes all the decisions on their own

• This represents the consumer or autonomous model, in which the patient is completely independent in decision-making.

❌ Doctor helps patient find their preferences

• This fits the interpretive model, where the doctor helps the patient clarify their values and preferences before making a choice.

❌ Doctor only provides facts to the patient

• This describes the informative model, where the doctor acts as a technical expert, providing all medical information but leaving decisions entirely to the patient.

✅ Correct Answer: Selective listening

Explanation of Correct Option:

Selective listening means paying attention only to parts of a message that interest you or confirm your own opinions, while ignoring other important details.

• This leads to misunderstanding, incomplete information exchange, and poor feedback, making it a key barrier to effective communication.

Explanation of Incorrect Options:

❌ Reasonable eye contact

• Promotes attentiveness and trust.
• Helps the speaker feel heard — enhances, not obstructs, communication.

❌ Selective reflection

• Involves reflecting key ideas to confirm understanding.
• A helpful technique for clarity, not a barrier.

❌ Active listening

• Means fully focusing, understanding, and responding thoughtfully.
• It improves communication effectiveness.

❌ Paraphrasing

• Restating what the other person said in your own words ensures mutual understanding.
• It is a facilitator, not an obstruction.

✅ Correct Answer: Breastfeeding

Explanation:

Exclusive breastfeeding for the first 6 months of life is the most effective preventive measure against acute respiratory tract infections (ARIs) in infants.

• Breast milk contains maternal antibodies (especially IgA), immune cells, and antimicrobial factors that provide passive immunity.
• It also promotes optimal nutrition and immune development, reducing both the frequency and severity of respiratory infections.
• Studies consistently show that exclusively breastfed infants have lower rates of pneumonia, bronchiolitis, and otitis media compared to formula-fed infants.

Thus, in addition to immunization, promoting and maintaining exclusive breastfeeding is the most applicable and impactful preventive strategy.

❌ Immediate care in case of fever:

While early medical attention helps manage infections promptly, it is not preventive—it’s a curative measure after illness has occurred.

❌ Control of indoor pollution:

This is important (especially reducing smoke exposure from stoves or cigarettes) but is secondary to breastfeeding in terms of direct protection against ARIs in infants.

❌ Better nutrition:

Proper nutrition strengthens immunity but has less immediate protective effect than breastfeeding in a 2-month-old who relies solely on milk.

❌ Better hygiene:

Good hygiene reduces transmission but cannot provide immunologic protection like breastfeeding does.

Explanation:

DALYs are a summary measure of population health that quantify the overall disease burden by combining:

• Years of life lost (YLL) due to premature mortality
• Years lived with disability (YLD) due to illness or injury

Introduced by the World Health Organization (WHO) in 2000, DALYs provide a single number representing the total number of healthy years lost in a population, allowing comparison across diseases, regions, and populations.

❌ YLD (Years Lost to Disability): Only measures time lived with disability, ignoring years lost due to premature death.

❌ YLL (Years of Lost Life): Only measures premature mortality, ignoring disability during life.

❌ Surveillance: Refers to monitoring disease occurrence; it does not quantify the burden numerically.

❌ Morbidity: Describes the presence of disease, but not in a way that combines mortality and disability into a single metric.

✅ Correct Answer: Addiction

Explanation:

Addiction refers to the physical and psychological dependence of the body on a substance, such as alcohol, drugs, or nicotine, to function normally. In addiction, the body adapts to the presence of the substance, leading to tolerance (needing higher doses for the same effect) and withdrawal symptoms when the substance is stopped. Alcohol addiction (alcoholism) is a chronic condition where the brain’s reward and motivation pathways are altered, making it extremely difficult for the individual to quit even when they recognize the harmful effects.

❌ Rehabilitation – This refers to the process of medical and psychological recovery and treatment that helps individuals overcome addiction, not the dependence itself.

❌ Incontinence – Describes loss of control over urination or defecation, completely unrelated to substance dependence.

❌ Habituation – Refers to psychological dependence where a person repeatedly uses a substance for pleasure or relief, but without physical withdrawal symptoms when it is stopped — unlike addiction.

❌ Dysfunction – Refers to abnormal or impaired functioning of an organ or system, not specifically related to substance use.

✅ Correct Answer:

Summarizing

When a doctor listens carefully to a patient’s statements and then repeats and concludes the main points at the end, the communication technique used is called summarizing.

It helps the doctor:

• Confirm understanding of the patient’s story,

• Show that they were actively listening, and

• Clarify or correct any misunderstandings before proceeding.

Summarizing is often used at the end of a consultation segment or before moving to a new topic to ensure shared understanding between doctor and patient.

❌ Incorrect Options:

• Selective reflection — ❌ Involves focusing on and echoing specific emotional or meaningful parts of what the patient said, not the full summary.

• Paraphrasing — ❌ Means rewording the patient’s message briefly to show understanding, usually mid-conversation, not concluding it.

• Funneling — ❌ A questioning technique that moves from broad, open-ended questions to specific, focused ones.

• Empathy — ❌ The emotional understanding of a patient’s feelings; it can accompany summarizing but is not the same communication skill.

✅ Correct Answer:

Vertical model

In the vertical model of doctor–patient relationship, the doctor dominates the interaction and makes all the decisions, while the patient plays a passive role. The relationship is authoritarian and one-directional, where communication flows from doctor to patient only.

This approach often ignores patient autonomy and is now considered outdated, replaced by more collaborative (mutual) models in modern healthcare emphasizing shared decision-making.

❌ Incorrect Options:

• Immutual participation — ❌ Not a recognized model in medical ethics; the term is incorrect.

• Teacher–student model — ❌ Implies the doctor explains and educates, but the patient still learns actively — not total passivity.

• Mutual participation — ❌ A modern model where doctor and patient share responsibility; communication is two-way.

• Horizontal model — ❌ Represents equality in power and decision-making — the opposite of the vertical (authoritarian) approach.

According to the World Health Organization (WHO):

• Roughly one in four people globally are infected with Mycobacterium tuberculosis (the bacteria that cause TB).

• This means about 25% of the world’s population has latent TB infection — they carry the bacteria but do not show active symptoms.

Only a small fraction (about 5–10%) of those infected will develop active TB disease during their lifetime, especially if their immune system becomes weak.

Correct Answer:
✅ Over 3900

• Explanation: The natural tobacco plant and its smoke contain more than 3,900 chemical compounds, and over 60 of these are known carcinogens (cancer-causing). When tobacco is burned, additional toxic substances are formed — including carbon monoxide, formaldehyde, benzene, hydrogen cyanide, and nitrosamines — which contribute to cardiovascular disease, cancer, and respiratory illnesses.

Incorrect Options:

❌ Around 1000

• Too low; this underestimates the number of identified compounds in tobacco smoke.

❌ Around 100

• Far fewer than the true number of constituents.

❌ Over 2000

• Closer, but still below the established figure of over 3,900 compounds.

❌ Below 50

• Completely incorrect — even a single cigarette releases hundreds of chemicals.

A modern-day doctor should embody a patient-centered approach, meaning that the patient’s needs, values, preferences, and well-being are at the heart of all clinical decisions.

This approach represents a shift from older, disease-centered or hospital-centered models. Instead of focusing solely on curing the illness, patient-centered care emphasizes healing the person, through empathy, communication, shared decision-making, and respect for individual differences.

It also involves holistic care — considering physical, psychological, and social aspects — and ensuring patients feel heard, understood, and involved in their treatment plans.

❌ Why the Other Options Are Incorrect:

• Hospital-centered:
  Focuses more on institutional goals, resources, and efficiency than on individual patient welfare — not aligned with modern ethics.

• Wealth-centered:
  Prioritizing profit over patient care is unethical and contradicts the Hippocratic Oath and professional integrity.

• Time-centered:
  While time management is important, prioritizing speed over patient understanding can compromise care quality.

• Judgemental:
  Doctors must be empathetic, nonjudgmental, and culturally sensitive; judgment impedes trust and effective communication.

The Tuberculin Skin Test (TST)—also known as the Mantoux test—is the best test to assess tuberculosis (TB) at the community level.

At the community level, public health officials are primarily concerned with identifying latent TB infections or estimating the prevalence of TB exposure in a population. The Mantoux test fulfills these criteria because it is:

1. Inexpensive – requires minimal resources.

2. Easily administered – a small intradermal injection of purified protein derivative (PPD) into the forearm.

3. Simple to interpret – the size of the induration (not redness) after 48–72 hours indicates exposure.

4. Scalable for field use – can be applied in mass surveys without needing advanced lab infrastructure.

This makes it ideal for epidemiological surveys and community-level screening, even though it is not the most specific or confirmatory test for active TB disease.

How it works:

• The TST measures a delayed-type (Type IV) hypersensitivity reaction to tuberculin (PPD).

• A person previously infected or vaccinated (BCG) will have sensitized T-cells that release cytokines upon exposure, causing induration.

• The diameter of induration (commonly ≥10 mm for general population, ≥5 mm for immunocompromised, ≥15 mm for low-risk individuals) indicates a positive result.

Purpose at the community level:

• To estimate the prevalence of latent TB infection  in a population.

• To identify high-risk groups and plan targeted public health interventions.

❌ Why the Other Options Are Incorrect:

• Interferon Gamma Release Assay (IGRA):

  • A blood test measuring interferon-γ released by T-cells in response to TB antigens.

  • Advantages: More specific than TST, unaffected by BCG vaccination.

  • Limitations: Expensive, requires laboratory setup, not feasible for large-scale community surveys in resource-limited settings.

  • Use: Preferred in individual testing in high-income or specialized settings, not for population-level screening.

• Sputum Culture:

  • Gold standard for diagnosis of active TB.

  • Takes weeks for growth and identification, requires lab facilities, biosafety precautions, and trained personnel.

  • Used for diagnosis and drug sensitivity testing, not for mass screening.

• Chest X-ray:

  • Useful for detecting active pulmonary TB lesions, but expensive and not portable for large community-based studies.

  • Requires electricity, equipment, and trained radiologists for interpretation.

  • May show non-specific findings and cannot differentiate latent infection from active disease.

• Gene Xpert (CBNAAT):

  • A molecular test detecting Mycobacterium tuberculosis DNA and rifampicin resistance.

  • Highly sensitive and specific, gives results within hours.

  • Limitation: Costly, equipment-dependent, not feasible for community-wide use—ideal for clinical diagnosis, not epidemiological surveys.

✅ Correct Answer: 

Open ended

Doctors should start with open-ended questions, because they allow patients to describe their concerns in their own words. This promotes better rapport, ensures important symptoms aren’t missed, and helps uncover hidden worries. For example: “Can you tell me more about what brings you in today?”

❌ Why not the others?

• Semi-structured → ❌ Used in research interviews or psychosocial assessments, but not the primary approach in clinical history-taking.
• Close ended → ❌ Useful later to clarify details (yes/no), but if used first, they can limit the patient’s expression.
• Specific → ❌ Important for targeted clarification, but not the best initial way to gather information.
• Lea → ❌ Not a valid category; likely a distractor.

✅ Correct Answer: 

Moving communication from general to specific aspects

• In communication skills, selective reflection means steering the conversation by highlighting certain parts of what the patient says and progressively narrowing focus from broad/general topics to more specific concerns.
• This helps the healthcare provider guide the discussion without interrupting the patient’s narrative.
• Example: If a patient describes many vague problems, the doctor may selectively reflect on the most relevant symptom and encourage elaboration on that.

❌ Why the Other Options Are Wrong

• Repeat what the patient is saying from time to time → This is simple reflection or paraphrasing, not selective reflection.
• Feeling what the patient is feeling → This is empathy, not reflection.
• Discuss the issue with the patient → This is more about problem-solving/counseling, not selective reflection.
• None of these → Incorrect, since the first option is correct.

✅ Correct Answer: 

Sphingomyelinase

• Sphingomyelinase catalyzes the hydrolysis of sphingomyelin → ceramide + phosphorylcholine.
• It’s a lysosomal enzyme.
• Deficiency leads to Niemann–Pick disease (types A and B) → hepatosplenomegaly, neurodegeneration, “cherry-red spot” on the macula.

❌ Why the Other Options Are Wrong

• Glucocerebrosidase → breaks down glucocerebroside → glucose + ceramide.
  • Deficiency → Gaucher disease.
• Glucosidase → generic enzyme that breaks down glucose-containing compounds (e.g., maltose, glycogen), not sphingomyelin.
• Phosphatase → removes phosphate groups from molecules, not specific to sphingomyelin.
• Ceramidase → breaks down ceramide → sphingosine + fatty acid, not sphingomyelin.

Correct Answer:
✅ At birth

• Explanation: The Bacillus Calmette–Guérin (BCG) vaccine is given at birth (or as soon as possible after birth) to protect against tuberculosis (TB), particularly severe forms such as miliary TB and TB meningitis in children. It is a live attenuated vaccine derived from Mycobacterium bovis.

Incorrect Options:

❌ 14 weeks

• At this age, infants typically receive the third doses of DPT, Hepatitis B, Hib, Polio (as per EPI schedule), not BCG.

❌ 6 weeks

• This is when the first doses of DPT, Polio, Hep B, Hib, Rotavirus, Pneumococcal are given.

❌ 2 years

• There is no scheduled BCG dose at this age.

❌ 4 weeks

• At this time, no separate vaccination is scheduled; BCG is already given at birth.