UPSC-CMS 2019 Practice Questions

Q: Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Zinc deficiency. ***Zinc deficiency*** - **Rashtriya Bal Swasthya Karyakram (RBSK)** under the 4Ds framework (Defects, Deficiencies, Diseases, Development delays) screens for specific nutritional deficiencies, but **zinc deficiency is NOT included** in the standard screening protocol. - RBSK focuses on identifying **severe acute malnutrition, vitamin A deficiency, and anemia (iron deficiency)** as priority nutritional deficiencies. - While zinc supplementation may be provided during diarrhea management, routine zinc deficiency screening is not part of RBSK. *Vitamin D deficiency* - **Vitamin D deficiency screening is NOT explicitly part of RBSK protocol**, though clinical manifestations like **rickets** may be identified during general examination. - RBSK does not conduct routine biochemical screening for vitamin D levels in the 0-18 years age group. - However, some sources may consider rickets under skeletal abnormalities, making this option potentially debatable. *Severe acute malnutrition* - **Severe acute malnutrition (SAM)** is a **major screening target** under RBSK's deficiency category. - Children are screened using **mid-upper arm circumference (MUAC), weight-for-height Z-scores**, and clinical signs of malnutrition. - Identified SAM cases are referred to **Nutrition Rehabilitation Centers (NRCs)** for management. *Vitamin A deficiency* - **Vitamin A deficiency** is a **key screening target** under RBSK, particularly to identify **xerophthalmia** and prevent childhood blindness. - RBSK teams screen for clinical signs including **Bitot's spots, night blindness**, and corneal involvement. - This aligns with national programs for vitamin A supplementation and prevention of nutritional blindness.

Q: Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Twice weekly in first month and then once a week. ***Twice weekly in first month and then once a week*** - According to national guidelines for the management of **Severe Acute Malnutrition (SAM)** in India, children discharged from NRCs require intensive follow-up to prevent relapse. - This specific schedule ensures close monitoring initially when the child is most vulnerable, gradually reducing frequency as their health stabilizes. *Once a week for first month and then twice weekly* - This option reverses the logical progression of follow-up frequency, suggesting increased visits after the first month, which is not aligned with standard protocols. - Initial follow-up for SAM children needs to be more frequent than once a week in the first month. *Twice weekly in first month and then once fortnightly* - While initial follow-up is appropriate, reducing the frequency to **once fortnightly** after the first month might be too infrequent for continued close monitoring of a child recovering from SAM. - This schedule could miss early signs of deterioration. *Once a week for first month and then once fortnightly* - This schedule provides insufficient monitoring both in the **initial critical month** (only once a week) and in the subsequent period (once fortnightly is too spread out). - It does not meet the recommended intensity of follow-up for children discharged after SAM treatment.

Q: The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Complications during ANC, PNC are not covered. ***Complications during ANC, PNC are not covered*** - The **Janani Shishu Suraksha Karyakram (JSSK)** aims to eliminate out-of-pocket expenses for pregnant women, including those arising from **complications during ANC (Antenatal Care)** and **PNC (Postnatal Care)**. - Therefore, this statement is incorrect as JSSK *does* cover such complications to ensure comprehensive care. *Free diet up to 3 days during normal delivery* - The JSSK scheme provides **free diet** for mothers up to **3 days** for normal deliveries and **7 days** for C-sections, while they are admitted in public health institutions. - This benefit aims to reduce financial burden and ensure adequate nutrition post-delivery. *All pregnant women delivery in public health institution to have absolutely free and no expense delivery including cesarean section* - A core component of JSSK is to ensure **absolutely free and no-expense delivery** for all pregnant women delivering in public health institutions, regardless of whether it's a normal delivery or a **cesarean section**. - This includes free drugs, consumables, diagnostics, and blood. *Free diagnosis and free blood whenever required* - The JSSK programme includes provisions for **free diagnostics** (e.g., blood tests, ultrasound) and **free blood transfusions** whenever required during pregnancy and delivery. - This is crucial to manage complications and ensure the safety of both the mother and the newborn.

Q: Open vial policy applies to which one of the following vaccines?

Hep B. ***Hepatitis B*** - The **Hepatitis B vaccine** is a **liquid multi-dose vial vaccine** that follows the **Open Vial Policy (OVP)**. - Under OVP, once opened, **Hep B can be used for up to 28 days** if: the vaccine vial monitor (VVM) has not reached the discard point, the expiry date has not passed, vaccines are stored under appropriate cold chain conditions (2-8°C), and the vial has not been contaminated or submerged in water. - **OVP applies specifically to liquid vaccines in multi-dose vials**, helping to reduce vaccine wastage in immunization programs. *BCG* - **BCG is a freeze-dried vaccine** that requires reconstitution before use. - Once reconstituted, BCG must be **discarded after 6 hours or at the end of the immunization session**, whichever is earlier. - This is **NOT classified under OVP** but follows the **reconstituted vaccine policy**. OVP specifically refers to liquid vaccines that can be kept for longer periods (up to 28 days). *Measles* - **Measles vaccine** is also a **freeze-dried vaccine** requiring reconstitution. - Like BCG, once reconstituted it must be **discarded within 6 hours or at the end of the session**. - Does **NOT fall under OVP** as it is not a liquid vaccine. *JE* - **Japanese Encephalitis (JE) vaccine** is a **freeze-dried vaccine** requiring reconstitution. - Must be **discarded within 6 hours** of reconstitution or at the end of the session. - Does **NOT follow OVP** as it requires reconstitution before use. **Key Point:** Open Vial Policy applies only to **liquid multi-dose vial vaccines** (DPT, TT, Hepatitis B, IPV, liquid Pentavalent), NOT to reconstituted vaccines (BCG, Measles, JE) which have a 6-hour discard rule.

Q: A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

67. ***67*** - **Correct calculation for ANM pregnancy registration**: - Annual births = (25/1000) × 5000 = **125 births per year** - Monthly births = 125 ÷ 12 = **10.42 births per month** - **Active pregnancy follow-up period** = 6.5 months (from early second trimester until delivery) - Expected pregnancies registered = (125 ÷ 12) × 6.5 = 10.42 × 6.5 = **67.7 ≈ 67** - **Rationale**: The ANM (Auxiliary Nurse Midwife) typically provides active antenatal care from the second trimester (around 3-4 months) through delivery. This represents approximately 6.5 months of the 9-month pregnancy period. The calculation accounts for the number of women currently under active ANC supervision at any given time. - **Key formula**: Number of pregnancies = (Annual births ÷ 12) × Active follow-up months *Incorrect Option 69* - Would imply 6.6 months of active follow-up: 69 ÷ 10.42 = 6.62 months - This overestimates the standard ANC registration period *Incorrect Option 66* - Would imply 6.3 months of active follow-up: 66 ÷ 10.42 = 6.33 months - This underestimates the expected ANC registration period *Incorrect Option 68* - Would imply 6.53 months of active follow-up: 68 ÷ 10.42 = 6.53 months - Close to the standard calculation but less precise than 67 when using the 6.5-month follow-up period

Q: In India, for providing HIV treatment services Link ART Centres are situated at:

Sub-district level hospitals and Community Health Centres. ***Sub-district level hospitals and Community Health Centres*** - **Link ART Centres** are strategically established at **sub-district level hospitals** and **Community Health Centres (CHCs)** as part of the **National AIDS Control Programme (NACO)**. - These centres were created to **decentralize HIV treatment services** and bring them closer to patients, reducing the burden on main ART centres. - They provide **first-line antiretroviral therapy (ART)** and follow-up care for stable patients, improving accessibility and adherence. *Medical colleges and district level hospitals* - These facilities host **main ART Centres** (not Link ART Centres), which serve as primary hubs for HIV treatment. - Main ART Centres handle more complex cases, second-line therapy, and provide training and support to Link ART Centres. *Select medical colleges* - Medical colleges typically host **ART Centres** or **Centres of Excellence (CoE)** for HIV care. - These are tertiary care facilities providing comprehensive HIV services including specialized care and second-line treatment. *Primary Health Centres* - **PHCs** serve as the first point of contact in rural healthcare but lack the infrastructure and specialized staff for ART services. - They play a role in **HIV testing, counseling, and referral** to ART/Link ART Centres but do not provide ART themselves.

Q: LNG-20 (Mirena) is a third generation intra uterine device. What are the advantages of its use? 1. Low uterine pregnancy rates 2. Prevents anemia 3. Long effective life of 5 years 4. No effect on incidence of ectopic pregnancy Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - LNG-20 (Mirena) significantly reduces the risk of **uterine pregnancy** due to its local progestin release, which thins the endometrium and thickens cervical mucus. - It often leads to **reduced menstrual blood loss** or even amenorrhea, thereby preventing or improving **anemia** in many users. - Mirena is effectively contraceptive for **up to 5 years**, providing a long-acting reversible contraceptive option. *1, 2 and 4* - While LNG-20 offers low uterine pregnancy rates and can prevent anemia, it **does not eliminate the risk of ectopic pregnancy** and may slightly increase its relative incidence if pregnancy occurs. - Therefore, the statement "no effect on incidence of ectopic pregnancy" is incorrect. *1, 3 and 4* - Although LNG-20 provides low uterine pregnancy rates and a 5-year effective life, the claim of "no effect on incidence of ectopic pregnancy" is **inaccurate**. - LNG-IUDs reduce overall pregnancy risk but if conception does occur, it's more likely to be ectopic than with no contraception. *2, 3 and 4* - LNG-20 does prevent anemia and has a long effective life, but it **does not have no effect on ectopic pregnancy incidence**; rather, it shifts the proportion of pregnancies that are ectopic if contraception fails. - It also provides low uterine pregnancy rates, making the exclusion of statement 1 incorrect.

Q: A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:

1 and 3 only. ***1 and 3 only*** - **Exclusive breastfeeding** for the first six months is crucial for **nutrition** and **immunity**, especially for low birth weight babies. - **Kangaroo Mother Care (KMC)**, involving skin-to-skin contact, helps regulate the baby's temperature, promotes bonding, and supports weight gain in LBW infants. *2 and 3 only* - While **Kangaroo Mother Care (KMC)** is appropriate for this baby, the recommendation to delay vaccination is incorrect. - **BCG vaccination** should be given at birth to babies weighing **≥2 kg** as per IAP guidelines, so a 2.2 kg baby qualifies for immediate vaccination. *1 and 2 only* - **Exclusive breastfeeding** is appropriate, but delaying vaccinations is not indicated for a baby weighing 2.2 kg. - **BCG** is given at birth for babies ≥2 kg, and routine immunization schedule should be followed without delay based on birth weight alone. *1, 2 and 3* - While statements 1 and 3 correctly identify beneficial practices (exclusive breastfeeding and kangaroo care), statement 2 is incorrect. - **Vaccination guidelines** (IAP/UIP) recommend administering **BCG at birth** for babies ≥2 kg, and routine immunizations as per schedule without weight-based delays for a 2.2 kg baby.

Q: All of the following drugs are effective for treatment of hookworm infection in single dose EXCEPT:

Piperazine. ***Piperazine*** - **Piperazine** is primarily effective against **Ascaris lumbricoides** and **Enterobius vermicularis**, acting as a depolarizing neuromuscular blocker. - It is **not effective** against hookworm infections and is therefore unsuitable for treating the human reservoir of hookworms. *Albendazole* - **Albendazole** is a broad-spectrum anthelminthic highly effective against hookworm infections, including **Necator americanus** and **Ancylostoma duodenale**. - A **single dose** is often sufficient due to its effectiveness in eliminating adult worms and reducing egg excretion. *Levamisole* - **Levamisole** is an anthelminthic that can be effective against hookworm species, working as a **ganglionic stimulant** causing paralysis of the worms. - A **single dose** regimen is typically adequate for hookworm treatment. *Pyrantel* - **Pyrantel pamoate** is effective against hookworms by causing **neuromuscular blockade**, leading to expulsion of the worms. - It is often given as a **single dose** for effective treatment of hookworm infections.

Question 1

Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Accepted Answer

Zinc deficiency

Answer

Vitamin D deficiency

Answer

Severe acute malnutrition

Answer

Vitamin A deficiency

Question 2

Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Accepted Answer

Twice weekly in first month and then once a week

Answer

Once a week for first month and then twice weekly

Answer

Twice weekly in first month and then once fortnightly

Answer

Once a week for first month and then once fortnightly

Question 3

The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Accepted Answer

Complications during ANC, PNC are not covered

Answer

Free diet up to 3 days during normal delivery

Answer

Free diagnosis and free blood whenever required

Answer

All pregnant women delivering in public health institution to have absolutely free and no expense delivery including cesarean section

Question 4

Open vial policy applies to which one of the following vaccines?

Accepted Answer

Hep B

Answer

JE

Answer

BCG

Answer

Measles

Question 5

A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

Accepted Answer

67

Answer

69

Answer

66

Answer

68

Question 6

In India, for providing HIV treatment services Link ART Centres are situated at:

Accepted Answer

Sub-district level hospitals and Community Health Centres

Answer

Select medical colleges

Answer

Primary Health Centres

Answer

Medical colleges and district level hospitals

Question 7

LNG-20 (Mirena) is a third generation intra uterine device. What are the advantages of its use?

1. Low uterine pregnancy rates
2. Prevents anemia
3. Long effective life of 5 years
4. No effect on incidence of ectopic pregnancy

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 8

A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken?

1. The baby should be exclusively breast fed for first six months
2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight
3. Baby should be kept with mother and kangaroo care to be given

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 9

All of the following drugs are effective for treatment of hookworm infection in single dose EXCEPT:

Accepted Answer

Piperazine

Answer

Albendazole

Answer

Levamisole

Answer

Pyrantel

UPSC-CMS 2019

Community Medicine

Obstetrics and Gynecology

Pediatrics

Pharmacology