A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?
A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?
What is the usual method of collecting a sample of urine to detect UTI?
Which of the following is the correct arrangement about the levels of health care?
Which of the following is not a food adulteration disease?
During the assessment of drinking water from a village tank, which of the following parameters is not within the acceptable limits for safe drinking water?
A study was conducted among nursing staff to analyze the time spent on different aspects of patient care, such as bed preparation, monitoring vital signs, attending the doctor’s rounds, blood sampling, and drug administration. Which of the following management techniques is most appropriate for this type of analysis?
What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?
During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?
Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?
FMGE 2025 - Community Medicine FMGE Practice Questions and MCQs
Question 21: A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?
- A. Tertiary
- B. Primary
- C. Secondary (Correct Answer)
- D. Primordial
Explanation: ***Secondary***- **Secondary prevention** involves measures like **screening** and early diagnosis to detect disease (e.g., **colorectal cancer**) in its earliest stages, allowing for timely intervention and reducing the burden of the disease. - A screening colonoscopy fits this definition perfectly, as it aims to identify **precancerous polyps** or early-stage asymptomatic cancer in an at-risk individual who has not yet been formally diagnosed. *Primordial*- **Primordial prevention** targets the underlying determinants of health and aims to prevent the establishment of risk factors themselves in the population (e.g., strict regulations on advertising unhealthy foods). - It operates at a societal level, preceding primary prevention, and is not applicable to an individual undergoing a specific medical screening test. *Primary*- **Primary prevention** aims to prevent disease onset by reducing risk factors or increasing protection *before* the disease process begins (e.g., **vaccination**, lifestyle modification, chemoprophylaxis). - Since this patient is already at high risk (family history) and presenting with an alarming symptom (**bloody stool**), the action is beyond preventing the initial exposure or onset. *Tertiary*- **Tertiary prevention** focuses on managing existing, established disease to prevent complications, reduce disability, and improve the quality of life (e.g., rehabilitation after a stroke, palliative care, or chemotherapy after a cancer diagnosis). - Screening is about early detection, whereas tertiary prevention is focused on minimizing the long-term impact of a disease that is already clinically apparent or diagnosed.
Question 22: A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?
- A. Primary
- B. Tertiary
- C. Primordial
- D. Secondary (Correct Answer)
Explanation: ***Secondary (Correct Answer)*** - Screening procedures like **colonoscopy** are measures for the **early detection and timely treatment** of asymptomatic conditions, such as precancerous **polyps** or early-stage cancer - This level of prevention intervenes when the disease process may have started but is **not yet clinically evident**, aiming to reduce disease progression and **mortality** - Secondary prevention is the hallmark of screening programs in at-risk populations *Primary (Incorrect)* - Primary prevention aims to prevent the **onset** of disease by modifying risk factors or enhancing resistance (e.g., **vaccination**, regular exercise, dietary modifications) - Since the patient is undergoing a procedure to detect an existing (though potentially asymptomatic) pathology, this is beyond preventing the initial cause - Primary prevention would involve measures like promoting a high-fiber diet or reducing red meat consumption to prevent colon cancer from developing *Tertiary (Incorrect)* - Tertiary prevention focuses on minimizing the progression, complications, or disability caused by an **established symptomatic disease** (e.g., **chemotherapy** for diagnosed cancer, cardiac rehabilitation post-MI) - Screening is performed **before** the disease is advanced or causes symptoms, which is the domain of secondary prevention - Tertiary prevention applies after diagnosis and aims at rehabilitation and preventing complications *Primordial (Incorrect)* - Primordial prevention targets **social and environmental conditions** to inhibit the emergence of risk factors for disease in the population (e.g., **public policy** aimed at reducing saturated fat intake, tobacco control policies) - It operates at a broader, **systemic level** and does not involve individual patient screening or intervention measures - This is the most upstream level of prevention, addressing conditions that predispose to risk factor development
Question 23: What is the usual method of collecting a sample of urine to detect UTI?
- A. Starting stream collection
- B. Early morning sample
- C. Midstream catch (Correct Answer)
- D. Suprapubic catheter
Explanation: ***Midstream catch*** - This technique is the *standard, non-invasive method* for routine urine culture as it minimizes **contamination** from bacteria residing in the distal urethra and periurethral area. - By discarding the initial urine (starting stream) and collecting the middle portion, the sample is more representative of the urine contained within the **bladder**. *Early morning sample* - While an early morning sample is often preferred for optimal concentration (e.g., detecting **proteinuria** or **casts**), it is not the methodology for *minimizing contamination*. - The collection technique (midstream) is more critical than the time of day for ensuring a reliable sample for **UTI culture**. *Suprapubic catheter* - Suprapubic aspiration (SPA) provides an **uncontaminated specimen** (often considered the gold standard), but it is an invasive procedure requiring a needle insertion into the bladder. - It is reserved for specific situations, such as neonates or patients with ambiguous results, and is not the **usual** collection method. *Starting stream collection* - The starting stream is most likely to be contaminated with **urethral flora** (e.g., *Staphylococcus epidermidis* or environmental organisms). - Collecting the starting stream significantly increases the chance of **false positive** culture results, confusing the diagnosis of a true **UTI**.
Question 24: Which of the following is the correct arrangement about the levels of health care?
- A. 1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary (Correct Answer)
- B. 1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary
- C. 1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary
- D. 1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary
Explanation: ***Option 1: Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary*** This is the **correct arrangement** of healthcare levels in India: - **Primary Healthcare** consists of **Sub Centres (SC)** and **Primary Health Centres (PHC)** - the first point of contact for basic preventive and curative care in the community - **Secondary Healthcare** is provided by **Community Health Centres (CHC)** - offers specialist consultation and manages referrals from primary care - **Tertiary Healthcare** includes **Medical colleges and district/teaching hospitals** - provides super-specialized services and critical care *Incorrect Option 2: CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary* This is incorrect because: - **CHC is a secondary level** facility, not primary - it serves as a referral center from PHC/SC with specialist services - **Sub Centres and PHCs are primary level** institutions delivering basic healthcare at the grassroots level *Incorrect Option 3: Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary* This reverses the hierarchy incorrectly: - **Medical colleges and hospitals are tertiary level** facilities providing advanced specialized care, not primary care - **Sub Centres and PHCs are primary level**, not tertiary - they handle basic health needs and preventive services *Incorrect Option 4: PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary* This is incorrect because: - While **PHC is correctly primary level**, the **Sub Centre is also primary level**, not secondary - **Sub Centres** serve smaller peripheral populations (3,000-5,000) and are the most basic unit of primary healthcare - **Secondary care starts at CHC level**, not at Sub Centre level
Question 25: Which of the following is not a food adulteration disease?
- A. Lathyrism
- B. Aflatoxicosis
- C. Dropsy
- D. Fluorosis (Correct Answer)
Explanation: ***Fluorosis***- It results from excessive intake of **fluoride**, primarily through naturally occurring high levels in **drinking water**.- While fluoride can be present in food, it is generally considered an **environmental exposure disease** rather than one caused by intentional food adulteration.*Lathyrism*- Caused by chronic consumption of **khesari dal** (*Lathyrus sativus*), which is often mixed as an adulterant in pulses like *Arhar dal*.- The toxicity is due to the neurotoxin **beta-N-oxalylamino-L-alanine (BOAA)**, leading to irreversible lower limb paralysis (**neurolathyrism**).*Dropsy*- Also known as **epidemic dropsy**, it is caused by edible oils (most commonly mustard oil) adulterated with **Argemone mexicana oil**.- The toxic substance responsible for the disease is **sanguinarine**, causing generalized edema, cardiac failure, and glaucoma.*Aflatoxicosis*- Caused by ingesting food (such as groundnuts, maize, or cereals) contaminated with **aflatoxins**, which are toxic metabolites produced by the fungus *Aspergillus*.- While often resulting from contamination due to poor storage, aflatoxins represent a major form of food poisoning resulting from the poor quality or mixing of contaminated ingredients, causing severe **hepatotoxicity**.
Question 26: During the assessment of drinking water from a village tank, which of the following parameters is not within the acceptable limits for safe drinking water?
- A. Total Dissolved Solids (TDS) – 300 mg/L
- B. Cadmium – 0.03 mg/L (Correct Answer)
- C. Fluoride – 0.8 mg/L
- D. Nitrate – 20 mg/L
Explanation: ***Cadmium – 0.03 mg/L***- The World Health Organization (WHO) and Indian standards for safe drinking water set the acceptable limit for **Cadmium** at **0.003 mg/L** (or 3 µg/L).- A level of 0.03 mg/L is **ten times higher** than the permissible limit and thus not acceptable, indicating potential chronic toxicity (e.g., **Itai-Itai disease** or renal damage).*Fluoride – 0.8 mg/L*- The acceptable limit for **Fluoride** in drinking water is generally between **0.6 to 1.0 mg/L** (or up to 1.5 mg/L as per WHO), making 0.8 mg/L acceptable.- Levels exceeding 1.5 mg/L or 2.0 mg/L can cause dental or skeletal **fluorosis**, but 0.8 mg/L falls within the recommended range for preventing dental caries.*Total Dissolved Solids (TDS) – 300 mg/L*- The acceptable limit for **TDS** is typically **500 mg/L**, extendable up to 2000 mg/L in the absence of an alternate source, making 300 mg/L acceptable.- High TDS affects the **palatability** of water but 300 mg/L is well below the threshold that causes taste concerns or health issues.*Nitrate – 20 mg/L*- The maximum acceptable limit for **Nitrate** is typically **45 mg/L** (or 50 mg/L as per certain standards), making 20 mg/L acceptable.- Excess nitrates, especially above 50 mg/L, pose a risk of causing **methemoglobinemia** (blue baby syndrome) in infants.
Question 27: A study was conducted among nursing staff to analyze the time spent on different aspects of patient care, such as bed preparation, monitoring vital signs, attending the doctor’s rounds, blood sampling, and drug administration. Which of the following management techniques is most appropriate for this type of analysis?
- A. System Analysis
- B. Critical Path Method
- C. Time and Motion Study
- D. Work Sampling (Correct Answer)
Explanation: ***Work Sampling*** - It is a statistical method used to determine the proportional time spent on different activities based on a large number of **random observations** - This technique is highly appropriate for analyzing nursing activities because it is **less costly and non-disruptive** than continuous detailed observation - Provides an accurate estimation of time allocated to diverse, irregular duties (like patient monitoring, rounds, and drug administration) - Ideal for studying varied activities over extended periods *Critical Path Method* - This technique is used primarily in **project management** to schedule and manage dependencies between activities in complex projects - It focuses on identifying the **critical path**, which is the longest sequence of dependent activities determining the minimum total time required for project completion - Not suitable for analyzing time distribution across multiple unrelated nursing activities *System Analysis* - This involves studying an organizational system (inputs, processes, outputs) to identify problems or propose solutions for general system improvement or efficiency - It is a broad approach focused on the *function* and *structure* of the organization rather than the precise **quantitative measurement** of time allocation across staff members' tasks - Does not provide the specific time-proportion data needed in this scenario *Time and Motion Study* - This involves continuous, detailed observation and measurement of specific, repetitive, short tasks to optimize work *methods* and establish **standard performance times** - It would be too invasive, resource-intensive, and less practical for measuring the varied, irregular, and often non-repetitive activities of nursing staff over a lengthy study period - Better suited for standardized, repetitive tasks in industrial settings
Question 28: What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?
- A. Aarogya Setu
- B. Tele-MANAS (Correct Answer)
- C. e-Sanjeevani
- D. NIKSHAY
Explanation: ***Tele-MANAS*** - **Tele-MANAS** (Tele-Mental Health Assistance and Networking Across States) is the specific technical platform designated under the National Tele Mental Health Programme (NTMHP) of India. - It provides comprehensive, multi-tiered, 24/7 mental healthcare services through a national toll-free helpline number and digital platforms, aiming to strengthen **mental health support** accessibility. *NIKSHAY* - **NIKSHAY** is the web-enabled system used by the Government of India for surveillance, monitoring, and management of the **National Tuberculosis Elimination Programme (NTEP)**. - It is focused exclusively on **tuberculosis** management and tracking, not tele-mental health services. *Aarogya Setu* - **Aarogya Setu** is a mobile application developed by the Government of India for **COVID-19 contact tracing and health status tracking**. - While it is a digital health initiative, it is not the dedicated platform for the National Tele Mental Health Programme. *e-Sanjeevani* - **e-Sanjeevani** is India's national telemedicine service that provides general healthcare consultations (Doctor-to-Doctor and Patient-to-Doctor) across various medical specialties. - While it is a telemedicine platform, the dedicated platform for the NTMHP's specific mental health service delivery model is **Tele-MANAS**.
Question 29: During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?
- A. The used vaccine vial should be discarded in a blue bag
- B. The needle should be bent and thrown in a red bag
- C. The syringe with the needle should be disposed of in a black translucent container
- D. A used cotton swab should be discarded in a yellow bag (Correct Answer)
Explanation: ***A used cotton swab should be discarded in a yellow bag*** - Used cotton swabs contaminated with blood or body fluids are classified as **soiled waste** (Category 3) under the **Biomedical Waste Management Rules 2016**. - Soiled waste including cotton swabs, dressings, and gauze must be disposed of in **YELLOW bags** for treatment and disposal as per current BMW Rules. *The syringe with the needle should be disposed of in a black translucent container* - Used needles and syringes are categorized as **sharps waste** (Category 4) under BMW Rules 2016. - They must be collected in **WHITE translucent puncture-proof containers**, not black containers which are for general non-biomedical waste. *The used vaccine vial should be discarded in a blue bag* - Used vaccine vials made of glass are classified as **waste sharps** including glass materials. - As per BMW Rules 2016, glass vials should be discarded in **BLUE containers/boxes** specifically designed for pharmaceutical waste, not blue bags. *The needle should be bent and thrown in a red bag* - **Bending, breaking, or recapping** used needles is strictly prohibited as it poses high risk of **needle-stick injuries**. - Used needles must be immediately placed into a **WHITE translucent puncture-proof sharps container** without any manipulation or bending.
Question 30: Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?
- A. Village Health Guide
- B. Anganwadi Worker
- C. ASHA
- D. Multipurpose Worker (Female) (Correct Answer)
Explanation: ***Multipurpose Worker (Female)***- The Multipurpose Worker (Female) (also known as Auxiliary Nurse Midwife or ANM in some contexts) is the primary worker at the sub-centre level responsible for providing **Maternal and Child Health (MCH)** and **family planning** services.- Their core duties include identifying, counseling, and formally **registering eligible couples (ECs)** in the operational area and maintaining detailed records (like the EC register) of their contraceptive choices and follow-up.*ASHA*- ASHAs (Accredited Social Health Activists) are primarily **community-level linkages** and promoters, tasked with mobilization, counseling, and facilitating the uptake of services.- They refer eligible couples to the sub-centre or Primary Health Centre (PHC), but the **official record-keeping and maintenance** are done by the MPW (F)/ANM.*Village Health Guide*- The role of the Village Health Guide was established to provide basic health education and first aid, often serving as a primary link between the PHC and the community.- This cadre is often being phased out or subsumed by ASHA; they do not have the **formal administrative responsibility** for maintaining designated family planning registers.*Anganwadi Worker*- Anganwadi Workers are primarily focused on the **Integrated Child Development Services (ICDS)** scheme, concentrating on nutrition, growth monitoring, and pre-school education.- While they aid in health awareness and may assist in gathering community data, they are not the designated functionary for **family planning service registration** and record maintenance under the national health system.