UPSC-CMS 2019 Practice Questions

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: The capillary refill time is prolonged in all types of shock EXCEPT:

Septic shock. ***Septic shock*** - In **warmed septic shock**, capillary refill time may be **normal or even brisk** due to peripheral vasodilation caused by inflammatory mediators. - While other forms of shock present with decreased peripheral perfusion and prolonged capillary refill, early septic shock can manifest with a **hyperdynamic circulation**. *Obstructive shock* - This type of shock, often due to conditions like **tension pneumothorax** or **cardiac tamponade**, leads to reduced cardiac output and poor peripheral perfusion. - Reduced peripheral blood flow results in a **prolonged capillary refill time**. *Hypovolemic shock* - Characterized by a significant **loss of circulating blood volume**, leading to reduced cardiac output and vasoconstriction. - This peripheral vasoconstriction directly causes a **prolonged capillary refill time** as blood flow to the capillaries is diminished. *Cardiogenic shock* - Results from **primary heart failure**, leading to decreased cardiac output and systemic hypoperfusion. - The reduced effective circulating volume and compensatory vasoconstriction cause impaired peripheral perfusion, manifesting as a **prolonged capillary refill time**.

Q: Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** is not a characteristic feature of refeeding syndrome; rather, fluid retention can sometimes lead to dilutional hyponatremia, but it's not a direct electrolyte shift caused by refeeding. - The core biochemical derangements in refeeding syndrome involve shifts of potassium, magnesium, and phosphate intracellularly [1]. *Hypomagnesemia* - **Hypomagnesemia** is a common and characteristic feature of refeeding syndrome as magnesium is required for ATP generation and cell growth, leading to intracellular shift [1]. - This can contribute to various symptoms such as arrhythmias, weakness, and altered mental status. *Hypocalcemia* - While less direct than other electrolyte disturbances, **hypocalcemia** can occur in refeeding syndrome, partly due to the association with hypophosphatemia and hypomagnesemia. - It may also be exacerbated by vitamin D deficiency or increased parathyroid hormone resistance in malnourished states. *Hypophosphatemia* - **Hypophosphatemia** is the biochemical hallmark of refeeding syndrome, as phosphate is rapidly taken up by cells for ATP synthesis and other metabolic processes during refeeding [1]. - Severe hypophosphatemia can lead to **respiratory failure**, cardiac dysfunction, and rhabdomyolysis.

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

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 2

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

Accepted Answer

Hep B

Answer

JE

Answer

BCG

Answer

Measles

Question 3

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 4

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 5

The capillary refill time is prolonged in all types of shock EXCEPT:

Accepted Answer

Septic shock

Answer

Obstructive shock

Answer

Hypovolaemic shock

Answer

Cardiogenic shock

Question 6

Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

Accepted Answer

Hyponatremia

Answer

Hypomagnesemia

Answer

Hypocalcemia

Answer

Hypophosphatemia

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

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Pharmacology