FMGE 2025 - Community Medicine Practice Questions

Q: A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Tele MANAS. ***Tele MANAS*** - **Tele MANAS** (Tele Mental Health Assistance and Networking Across States) is the Government of India's national initiative providing **24/7 tele-counseling and mental health support** across the country, making it the correct service for a schizophrenia patient. - It functions as a **tele-mental health facility** under the National Mental Health Programme, offering critical assistance and linkage to specialized services. *eSanjeevani* - **eSanjeevani** is the GOI's national telemedicine platform providing **general healthcare consultations** through doctor-to-doctor (eSanjeevani HWC) and patient-to-doctor (eSanjeevani OPD) services. - While it offers broad healthcare services, it is **not the dedicated mental health support system** - that specific function is served by **Tele MANAS**. *NIKSHAY* - **NIKSHAY** is the standardized web-enabled application used for monitoring and tracking all patients diagnosed with **Tuberculosis (TB)** in India. - It handles notification, diagnosis, treatment adherence, and outcomes for **TB control**, having no operational role in providing mental health counseling. *U-WIN* - **U-WIN** is the digital platform developed by the GOI for managing and digitizing data related to the **Universal Immunization Programme (UIP)**. - It focuses specifically on **immunization records**, tracking vaccination status, scheduling, and overall coverage, making it unrelated to mental health services.

Q: In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Unpaired t-test. ***Unpaired t-test***- It is the most appropriate statistical test used to compare the means of two independent (unrelated) groups when the data is continuous (like **blood pressure**).- This test assesses the null hypothesis that there is no significant difference between the **population means** of the two comparison groups.*Paired t-test*- This test is specifically designed to compare means when the observations are dependent, meaning the data comes from the **same subjects** measured twice (e.g., pre-treatment and post-treatment).- It is used for **within-group comparisons** rather than comparisons between two independent cohorts, as requested in the scenario.*Chi-square test*- The chi-square test is used to determine the association between **two categorical variables** (e.g., proportions or frequencies).- It is unsuitable here because the variable being compared (blood pressure) is **continuous data**, and the study requires comparing means, not counted frequencies.*ANOVA*- ANOVA (Analysis of Variance) is used when comparing the means of **three or more** independent groups.- While acceptable for two groups (where it gives equivalent results to the t-test), the **unpaired t-test** is the most specific and standard test for comparing means of exactly two independent samples.

Q: Secondary prevention is most useful in the early detection and treatment of which of the following cancers?

Cervical cancer. ***Cervical cancer*** - Cervical cancer is a classic example of successful **secondary prevention** due to effective screening tests like the **Papanicolaou (Pap) test** and **Human Papillomavirus (HPV) testing**, which can detect precancerous lesions (**cervical intraepithelial neoplasia, CIN**). - The image displays a **colposcopy**, where **acetic acid** is applied to the cervix, causing abnormal cells with high nuclear density to turn white (**acetowhite changes**). This guides biopsy and allows for early treatment, preventing progression to invasive cancer. *Pancreatic cancer* - There is currently no effective or recommended screening test for **pancreatic cancer** in the asymptomatic, average-risk population. - It often presents with non-specific symptoms at a late stage due to its retroperitoneal location, leading to a delayed diagnosis and poor prognosis. *Ovarian cancer* - Routine screening with **CA-125** and **transvaginal ultrasound** is not recommended for the general population as it has not been proven to reduce mortality. - These screening methods have a high rate of **false positives**, leading to unnecessary invasive procedures and patient anxiety. *Glioblastoma* - There are no established screening protocols for **glioblastoma**, a highly aggressive primary brain tumor. - Diagnosis is typically made after the onset of neurological symptoms, such as headaches or seizures, at which point the tumor is usually advanced.

Q: A long-term study found that individuals who had high blood pressure (BP) during childhood continued to have high BP in adulthood, and those with low BP in childhood tended to maintain lower levels later in life. Which of the following epidemiological concepts does this pattern best represent?

Tracking of blood pressure. ***Tracking of blood pressure***- This term refers to the phenomenon where an individual's **relative position** (e.g., high or low) within a distribution of a biological variable, such as blood pressure or cholesterol, is maintained over time from childhood into adulthood.- The observation that high childhood BP predicts high adult BP is the classic definition of **tracking**, implying that early life measurements have significant predictive value for later life risk.*Rule of halves*- This is a concept used in the management of chronic conditions, particularly **hypertension**, stating that only about half of the people affected are diagnosed, and only about half of those diagnosed are treated.- It describes an inefficiency in public health management effectiveness, not the **longitudinal stability** of a physiological measurement within an individual.*Regression to the mean*- This statistical phenomenon occurs when an extreme measurement on a variable is followed by a second measurement that is closer to the **population average** or mean.- This would suggest that extremely high BP moves towards the average upon repeat measurement, which contradicts the finding that the high BP *persists* over time (tracking).*Cohort effect*- A cohort effect is variation in outcomes that arise from the unique **temporal experiences** or exposure of a specific group (birth cohort) that differentiates them from other age groups.- While the study involves a cohort, the specific epidemiological term describing the maintenance of an individual's relative **rank** over time is **tracking**.

Q: What is the status of the marked individual?

Adopted from another family. ***Adopted from another family*** - In pedigree analysis, square **brackets `[ ]`** placed around an individual's symbol (a circle for female, a square for male) specifically denote that the person has been **adopted** into the family. - The relationship lines connecting an adopted individual to their adoptive parents are typically represented as **dashed lines** to distinguish them from biological parent-offspring lines, which are solid. *Has a disease of chronic origin* - An individual affected by a genetic disease or trait is represented by a **shaded or filled-in** symbol, not by brackets. The circle in the image is not shaded, indicating an unaffected status. - Pedigree symbols do not typically differentiate between chronic and acute diseases; they primarily indicate the **presence or absence** of the specific trait being studied. *Curable disease* - The **prognosis or curability** of a disease is not represented by a standard pedigree symbol. An affected status is shown by **shading the symbol**, irrespective of the disease's nature. - The symbol for adoption (`[ ]`) is distinct and unrelated to any health status or medical condition. *Twin* - **Twins** are indicated by two individual symbols branching from the same point on the parental line. A horizontal line connecting the symbols signifies **monozygotic (identical) twins**. - The symbol shown represents a single individual, and the brackets denote adoption, not a twin relationship.

Q: A person from an Assam village is depicted with genu valgum (knock-knees), a condition observed in multiple individuals in the community. What is the most likely diagnosis?

Skeletal fluorosis. ***Skeletal fluorosis*** - This condition is caused by chronic, excessive intake of **fluoride**, often through contaminated drinking water, which can lead to endemic outbreaks in specific geographical areas like villages in Assam. - It manifests with skeletal changes including osteosclerosis, calcification of ligaments, and deformities such as **genu valgum** (knock-knees) or genu varum (bow-legs). *Calcium deficiency* - Primarily leads to **osteoporosis** in adults, which is a reduction in bone mass, increasing the risk of fractures rather than causing specific deformities like genu valgum. - While severe deficiency can contribute to bone softening, it is typically associated with Vitamin D deficiency and is less likely to cause a community-wide endemic presentation compared to a waterborne toxin. *Vitamin C deficiency* - This deficiency results in **scurvy**, which affects **collagen synthesis** and presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages. - It does not cause the kind of gross skeletal deformities seen in the image, such as **genu valgum**. *Vitamin D deficiency (Osteomalacia)* - This condition leads to defective bone mineralization (**osteomalacia**), causing bone pain, muscle weakness, and potential deformities. - Although it can cause genu valgum, the context of an entire community in a specific village being affected makes an environmental exposure like **endemic fluorosis** a more probable diagnosis.

Q: A family consumes a diet predominantly of rice and pulses and developed signs of muscle weakness and movement. Which of the following should be given for prophylaxis?

Thiamine. ***Thiamine*** - A diet relying mainly on **polished rice** lacks essential micronutrients, particularly **thiamine (Vitamin B1)**, which is removed during the polishing process. - Deficiency of thiamine causes **Beriberi**, manifesting as neurological deficits (dry Beriberi leading to muscle weakness and neuropathy) or cardiovascular symptoms (wet Beriberi leading to high-output cardiac failure). *Calcium* - Calcium deficiency typically results in **hypocalcemia**, presenting as symptoms like **tetany**, muscle spasms, and paresthesia, which are distinct from Beriberi's clinical picture. - Although important for musculoskeletal health, supplementing calcium alone would not prevent the severe neurological and motor impairment seen in **thiamine deficiency**. *Vitamin D* - Deficiency of Vitamin D causes disorders of bone mineralization—**Rickets** in children and **Osteomalacia** in adults, primarily characterized by bone pain and fractures. - While Vitamin D deficiency can cause myopathy, it does not explain the specific cluster of symptoms (weakness and movement issues) related to a rice-dominant diet lacking the coenzyme necessary for carbohydrate metabolism. *Iron* - Iron deficiency leads to **microcytic hypochromic anemia**, whose primary symptoms include fatigue, dizziness, and pallor, not the characteristic movement and muscle weakness indicative of **Beriberi**. - Iron supplementation would address anemia but would fail to protect against severe neurological illness resulting from the lack of **thiamine**, which is crucial for energy generation in neural tissues.

Q: Which of the following substances, at the given concentration, makes water unsuitable for human consumption according to safety standards?

Cadmium – 0.3 mg/L. ***Cadmium – 0.3 mg/L*** - The maximum permissible limit for **Cadmium** in drinking water is extremely low, typically around **0.003 mg/L** (WHO standard), due to its high toxicity. - A concentration of 0.3 mg/L is 100 times the safe limit and poses severe health risks, particularly **kidney damage**. *Fluoride – 0.8 mg/L* - The optimal acceptable range for **Fluoride** is generally between **0.6 and 1.5 mg/L**, a concentration that helps prevent dental caries. - A concentration of 0.8 mg/L is well within the acceptable limit and is often considered optimal for public health. *Chloride – 200 mg/L* - The acceptable limit for **Chloride** is usually **250 mg/L** (or up to 1000 mg/L as the maximum permissible limit), with higher levels primarily affecting taste and causing corrosion. - 200 mg/L is below the acceptable range and does not render the water unsuitable for drinking. *Calcium – 7 mg/L* - **Calcium** is an essential mineral, and its typical acceptable limit for drinking water is much higher, often around **75 mg/L** (or related to overall water hardness). - This concentration is extremely low and poses no health risk; it is perfectly safe for consumption.

Q: Which mosquito species is recognized as the principal secondary vector for Zika virus transmission globally?

Aedes albopictus. ***Aedes albopictus*** - This mosquito, commonly known as the **Asian tiger mosquito**, is recognized as the **principal secondary vector** for Zika virus transmission globally. - It is a competent vector capable of transmitting **Zika**, **Dengue**, and **Chikungunya** viruses across multiple continents including Asia, Europe, Africa, and the Americas. - While *Aedes aegypti* remains the primary vector, *Aedes albopictus* plays a significant role in Zika transmission, particularly in temperate regions where *Ae. aegypti* is less prevalent. - Its adaptability to diverse climates and ability to breed in natural and artificial water containers make it epidemiologically important. *Aedes polynesiensis* - This species is primarily known as a vector for **lymphatic filariasis** (*Wuchereria bancrofti*) in Pacific islands. - While it was involved in Zika virus transmission during the **French Polynesia outbreak (2013-2014)**, it is geographically restricted and not considered a principal vector for global Zika transmission. - Its role is limited to specific Pacific island populations. *Aedes australis* - This species is endemic to Australia and transmits **Ross River virus** and other Australian arboviruses. - It is **not** a recognized vector for Zika virus transmission. - Its geographical distribution and host preferences exclude it from the Zika transmission cycle. *Aedes mitchellae* - This species is not documented in major public health literature as a vector for Zika virus. - It belongs to a mosquito species complex with no established role in arboviral transmission to humans. - Epidemiologically insignificant for Zika virus transmission.

Question 1

A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Accepted Answer

Tele MANAS

Answer

eSanjeevani

Answer

NIKSHAY

Answer

U-WIN

Question 2

In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Accepted Answer

Unpaired t-test

Answer

Chi-square test

Answer

ANOVA

Answer

Paired t-test

Question 3

Secondary prevention is most useful in the early detection and treatment of which of the following cancers?

Accepted Answer

Cervical cancer

Answer

Pancreatic cancer

Answer

Ovarian cancer

Answer

Glioblastoma

Question 4

A long-term study found that individuals who had high blood pressure (BP) during childhood continued to have high BP in adulthood, and those with low BP in childhood tended to maintain lower levels later in life. Which of the following epidemiological concepts does this pattern best represent?

Accepted Answer

Tracking of blood pressure

Answer

Rule of halves

Answer

Cohort effect

Answer

Regression to the mean

Question 5

Which of the following refers to the tendency of an individual’s relative position within a distribution (e.g., BP levels) to remain consistent over time, meaning those with high BP in childhood often remain at the higher end of BP in adulthood, and those with low BP tend to stay lower, even though absolute values may change with age?

Accepted Answer

Tracking of blood pressure

Answer

Regression to the mean

Answer

Rule of halves

Answer

Cohort effect

Question 6

What is the status of the marked individual?

Accepted Answer

Adopted from another family

Answer

Has a disease of chronic origin

Answer

Curable disease

Answer

Twin

Question 7

A person from an Assam village is depicted with genu valgum (knock-knees), a condition observed in multiple individuals in the community. What is the most likely diagnosis?

Accepted Answer

Skeletal fluorosis

Answer

Calcium deficiency

Answer

Vitamin C deficiency

Answer

Vitamin D deficiency (Osteomalacia)

Question 8

A family consumes a diet predominantly of rice and pulses and developed signs of muscle weakness and movement. Which of the following should be given for prophylaxis?

Accepted Answer

Thiamine

Answer

Iron

Answer

Vitamin D

Answer

Calcium

Question 9

Which of the following substances, at the given concentration, makes water unsuitable for human consumption according to safety standards?

Accepted Answer

Cadmium – 0.3 mg/L

Answer

Calcium – 7 mg/L

Answer

Chloride – 200 mg/L

Answer

Fluoride – 0.8 mg/L

Question 10

Which mosquito species is recognized as the principal secondary vector for Zika virus transmission globally?

Accepted Answer

Aedes albopictus

Answer

Aedes polynesiensis

Answer

Aedes australis

Answer

Aedes mitchellae

FMGE 2025 — Community Medicine