UPSC-CMS 2021 Practice Questions

Q: A 25 year old woman is a sedentary worker. She is a lactating mother with a 3 month old child. Which one among the following is the best approximation of her energy requirement in terms of kilocalories per day ?

2500 kcal/d. ***2500 kcal/d*** - A lactating woman generally requires an additional 500 kcal/day above her baseline energy needs to support milk production. - For a sedentary woman, a typical baseline intake is around 2000 kcal/day, making 2500 kcal/day a good approximation during lactation. *1500 kcal/d* - This value is significantly low for a lactating woman, as it would likely lead to a **caloric deficit** and could compromise milk supply and maternal health. - This energy level might be appropriate for a woman on a **weight-loss diet**, but not for supporting lactation. *2250 kcal/d* - While closer than 1500 kcal/d, this value still falls slightly short of the recommended additional energy intake for lactation, which is typically an extra 500 kcal/day. - This might represent a moderate activity level for a non-lactating woman, but not optimal for **milk production**. *2830 kcal/d* - This amount would be more appropriate for a lactating woman with a **higher activity level** or a greater baseline energy requirement than a sedentary individual. - While some lactating women may need this much, it is likely an **overestimation** for a sedentary worker.

Q: The most sensitive indicator of environmental iodine deficiency is

Urinary iodine excretion. ***Urinary iodine excretion*** - **Urinary iodine excretion** reflects recent dietary iodine intake, making it the most sensitive and commonly used indicator for assessing current iodine status in a population. - A median urinary iodine concentration of less than 100 μg/L in a population indicates **iodine deficiency**. *Prevalence of neonatal hypothyroidism* - While reflecting severe iodine deficiency, **neonatal hypothyroidism** occurs later in the deficiency cascade and is not sensitive enough to detect mild to moderate deficiencies early. - It would indicate a long-standing, significant deficiency rather than an early environmental change. *Prevalence of cretinism* - **Cretinism** is a severe and irreversible consequence of prolonged and profound iodine deficiency during critical periods of development (fetal and early infancy). - Its prevalence indicates severe, chronic iodine deficiency and is not a sensitive marker for early or mild environmental iodine deficiency. *Prevalence of goitre* - The **prevalence of goitre** (enlarged thyroid gland) can be used as an indicator of iodine deficiency, but it is less sensitive than urinary iodine excretion. - Goitre develops over a longer period in response to chronic iodine deficiency and may not reflect recent changes in environmental iodine levels.

Q: Which one of the following is a famous large prospective study that helped establish risk factors for coronary heart disease ?

Framingham study. ***Framingham study*** - The **Framingham Heart Study** is a landmark **long-term prospective cohort study** that began in 1948 in Framingham, Massachusetts, to identify common factors or characteristics that contribute to **cardiovascular disease (CVD)**. - This study has been instrumental in identifying major **CVD risk factors** such as high blood pressure, high cholesterol, smoking, obesity, diabetes, and physical inactivity. *Pittsburgh study* - While Pittsburgh is a hub for medical research, there isn't a single "Pittsburgh study" that holds the same widespread recognition for establishing **cardiovascular risk factors** as the Framingham study. - Various studies from Pittsburgh institutions might contribute to cardiovascular research, but none are as globally recognized for this specific contribution. *Adelaide study* - The "Adelaide study" generally refers to research conducted in Adelaide, Australia, which has produced various medical findings. - However, it is not known as a prominent, large-scale prospective study specifically designed to establish widespread **coronary heart disease risk factors** in the same league as the Framingham Heart Study. *Birmingham study* - Many medical studies are conducted in Birmingham (both in the UK and USA), but there isn't one definitive "Birmingham study" with the historical significance and impact on identifying **coronary heart disease risk factors** that the Framingham study has. - Research from Birmingham typically contributes to various medical fields, but not specifically as the primary source for these fundamental risk factor discoveries.

Q: Of the following international agencies, which agency has been assisting India in development of friendly models of sanitation ?

SIDA (Swedish International Development Agency). ***SIDA (Swedish International Development Agency)*** - **SIDA** has been a major development partner with India in the **water and sanitation sector** - Provided significant support for developing **community-friendly sanitation models**, including community-led total sanitation (CLTS) approaches - Their assistance included **technical expertise, financial aid, and capacity building** for sustainable sanitation infrastructure *CARE (Cooperative for Assistance and Relief Everywhere)* - **CARE** is a major international humanitarian organization focused primarily on **food security, health, and emergency relief** - While involved in community development, not specifically known for developing sanitation models in India *DANIDA (Danish Development Agency)* - **DANIDA's** major engagements in India have focused on **renewable energy, environmental protection, and poverty reduction** - While supporting general water and sanitation projects, not the leading agency for developing specific sanitation models in India *Ford Foundation* - A philanthropic organization focused on **social justice, education, and civil society building** - In India, primarily supports **NGOs and policy reforms** rather than direct development of sanitation infrastructure

Q: Which one among the following was used for measuring economic status of households, in the National Family Health Survey-III (NFHS-III) ?

Wealth index. ***Wealth index*** - The **National Family Health Survey-III (NFHS-III)** used a **wealth index** as a primary measure to assess the economic status of households. - This index is a composite measure derived from household assets and housing characteristics. *Lifestyle index* - The term "lifestyle index" is a general concept and was not the specific, officially recognized tool for measuring economic status in NFHS-III. - While lifestyle aspects can be indicators of economic status, they are typically integrated into broader indices like the wealth index rather than being a standalone measure in this context. *Pareek scale* - The **Pareek scale** was not used in NFHS-III for measuring household economic status. - The Pareek scale is a socio-economic status scale that primarily focuses on **occupational prestige** and education, and it is less commonly used for national health surveys in India compared to asset-based indices. *Kuppuswamy's scale* - **Kuppuswamy's Socioeconomic Status Scale** was not used in the NFHS-III survey. - This scale is an older and more commonly used tool in clinical and research settings within India, but it primarily classifies families based on **education** and **occupation** of the head of the family, and family income.

Q: In a town with one lakh population (1,00,000) there are a total of 2500 live births in a year. There were 75 total deaths of children before the age of one month, total 200 deaths before the age of one year, and a total 300 deaths before the age of three years. Which of the following statements regarding Infant Mortality Rate (IMR) of the town for the given year are correct? 1. The denominator is 1,00,000 2. The IMR of the town is higher than the current national average of IMR for India 3. The numerator is the number of children dying before the age of one month 4. The IMR of the town is 80 per 1000 live births

2 and 4 only. **IMR Formula:** Infant Mortality Rate = (Number of deaths under 1 year of age / Total live births in the same year) × 1000 **Analysis of each statement:** **Statement 1:** "The denominator is 1,00,000" - **INCORRECT** - The denominator for IMR is the **total number of live births (2,500)**, not the total population (1,00,000) - Population is not used in IMR calculation **Statement 2:** "The IMR of the town is higher than the current national average of IMR for India" - **CORRECT** - Calculated IMR = (200 deaths / 2,500 live births) × 1000 = **80 per 1000 live births** - India's current national IMR ≈ 27-28 per 1000 live births (as of 2020-2022 data) - 80 is significantly higher than the national average **Statement 3:** "The numerator is the number of children dying before the age of one month" - **INCORRECT** - The numerator for IMR is **deaths before the age of one year (200)**, not before one month - Deaths before one month (75) constitute the numerator for **Neonatal Mortality Rate**, not IMR **Statement 4:** "The IMR of the town is 80 per 1000 live births" - **CORRECT** - Calculation: (200 / 2,500) × 1000 = 80 per 1000 live births - This is the accurate IMR for the town ***Correct Answer: 2 and 4 only*** - Both statements 2 and 4 are correct as shown above - Statements 1 and 3 contain fundamental errors about the IMR formula components

Q: Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Janani Suraksha Scheme. ***Janani Suraksha Yojana (JSY)*** - This is the **flagship national scheme** launched in 2005 under the National Rural Health Mission (now National Health Mission). - It provides **cash incentives** to pregnant women for choosing to deliver in health facilities and to ASHA workers for promoting institutional deliveries. - Its primary objective is to reduce **maternal and neonatal mortality** by increasing institutional deliveries and ensuring access to essential obstetric care. *Ayushman Bharat Scheme* - This is a national health protection scheme (Pradhan Mantri Jan Arogya Yojana) that provides **health insurance coverage** up to ₹5 lakhs per family for secondary and tertiary care hospitalization. - While it contributes to overall health including maternal health, its primary focus is **broader healthcare access** rather than specifically promoting safe motherhood or reducing maternal mortality through institutional delivery incentives. *Mamta Scheme* - While several state-level maternal and child health programs exist under similar names (e.g., Bihar's MAMTA scheme), there is no widely recognized **national scheme** called "Mamta Scheme" that serves as the primary program for safe motherhood. - The **Janani Suraksha Yojana** remains the principal national initiative for this objective. *Vande Mataram Scheme* - This refers to voluntary initiatives encouraging private practitioners to provide maternal health services. - While supportive of safe motherhood, it is **not the primary comprehensive national scheme** with structured financial incentives and widespread implementation for reducing maternal mortality like JSY.

Q: Insulin Resistance Syndrome (Syndrome X) is associated with which of the following? 1. Type 2 Diabetes Mellitus 2. Hyperinsulinaemia 3. Dyslipidaemia 4. Hypercalcaemia

1, 2 and 3. ***1, 2 and 3*** - **Insulin Resistance Syndrome** (metabolic syndrome) is characterized by a cluster of conditions including **insulin resistance**, **type 2 diabetes mellitus**, **hyperinsulinemia**, and **dyslipidemia** [1], [2]. - **Hyperinsulinemia** results from the pancreas overproducing insulin to compensate for tissue insensitivity, and **dyslipidemia** (abnormal lipid levels) is a common component [1]. *1, 3 and 4* - This option correctly identifies **type 2 diabetes mellitus** and **dyslipidemia** as components of insulin resistance syndrome but incorrectly includes **hypercalcemia**. - **Hypercalcemia** (high calcium levels) is not a defining feature or direct consequence of insulin resistance syndrome. *2, 3 and 4* - This option includes **hyperinsulinemia** and **dyslipidemia**, which are core features, but incorrectly includes **hypercalcemia**. - It also omits **type 2 diabetes mellitus**, which is a significant clinical manifestation of prolonged insulin resistance [1]. *1, 2 and 4* - This option correctly identifies **type 2 diabetes mellitus** and **hyperinsulinemia** as associated conditions but incorrectly includes **hypercalcemia**. - This option omits **dyslipidemia**, which is a very common and important component of the metabolic syndrome, contributing to cardiovascular risk.

Q: The "DASH diet" is a lifestyle modification for management of which of these conditions ?

Hypertension. ***Hypertension*** - The **DASH (Dietary Approaches to Stop Hypertension) diet** was specifically developed and promoted to lower **blood pressure**. [1] - It emphasizes foods rich in **potassium, calcium, and magnesium**, and low in sodium, saturated fat, and cholesterol. [1] *Diabetes* - While a healthy diet is crucial for **diabetes management**, the DASH diet is primarily designed for blood pressure control, though it can benefit individuals with diabetes due to its overall healthy composition. - The primary dietary focus for diabetes is on **carbohydrate control** and glycemic index management. *Cancer* - While a healthy diet can reduce **cancer risk**, the DASH diet is not specifically tailored as a cancer management or prevention strategy. - Cancer prevention diets often highlight **antioxidants** and avoidance of processed foods, which overlap but are not identical to DASH principles. *Anemia* - **Anemia** is typically managed by addressing nutrient deficiencies, most commonly **iron**, or underlying medical conditions. - The DASH diet does not primarily focus on increasing **iron absorption** or other nutrients critical for anemia.

Q: The amount of iron lost per 28 day cycle in menstruating women is

15.5 mg. ***15.5 mg*** - The typical **iron loss** during a 28-day menstrual cycle in menstruating women is approximately **15-28 mg**, with an average of about **15.5 mg**. - This calculation is based on average menstrual blood loss of **30-40 mL per cycle** and iron content of approximately **0.5 mg per mL of blood**. - This physiological iron loss explains why menstruating women have **higher iron requirements** (18 mg/day) compared to men (8 mg/day). - If dietary iron intake is insufficient to compensate for this loss, **iron deficiency anemia** can develop over time. *5.5 mg* - This value significantly **underestimates** the actual iron loss during menstruation. - Such a low amount would not explain the increased iron requirements in menstruating women. - This does not align with measured menstrual blood loss volumes. *8.5 mg* - This value is still **lower than the typical physiological range** of iron loss during menstruation. - While closer than 5.5 mg, it underestimates the actual iron depletion that occurs. *12.5 mg* - This value is **within the lower range** but still below the commonly accepted average. - While individual variations exist, standard teaching emphasizes higher values (15-28 mg range).

Question 1

A 25 year old woman is a sedentary worker. She is a lactating mother with a 3 month old child. Which one among the following is the best approximation of her energy requirement in terms of kilocalories per day ?

Accepted Answer

2500 kcal/d

Answer

1500 kcal/d

Answer

2250 kcal/d

Answer

2830 kcal/d

Question 2

The most sensitive indicator of environmental iodine deficiency is

Accepted Answer

Urinary iodine excretion

Answer

Prevalence of neonatal hypothyroidism

Answer

Prevalence of cretinism

Answer

Prevalence of goitre

Question 3

Which one of the following is a famous large prospective study that helped establish risk factors for coronary heart disease ?

Accepted Answer

Framingham study

Answer

Pittsburgh study

Answer

Adelaide study

Answer

Birmingham study

Question 4

Of the following international agencies, which agency has been assisting India in development of friendly models of sanitation ?

Accepted Answer

SIDA (Swedish International Development Agency)

Answer

CARE (Cooperative for Assistance and Relief Everywhere)

Answer

DANIDA (Danish Development Agency)

Answer

Ford Foundation

Question 5

Which one among the following was used for measuring economic status of households, in the National Family Health Survey-III (NFHS-III) ?

Accepted Answer

Wealth index

Answer

Lifestyle index

Answer

Pareek scale

Answer

Kuppuswamy’s scale

Question 6

In a town with one lakh population (1,00,000) there are a total of 2500 live births in a year. There were 75 total deaths of children before the age of one month, total 200 deaths before the age of one year, and a total 300 deaths before the age of three years. Which of the following statements regarding Infant Mortality Rate (IMR) of the town for the given year are correct?

1. The denominator is 1,00,000
2. The IMR of the town is higher than the current national average of IMR for India
3. The numerator is the number of children dying before the age of one month
4. The IMR of the town is 80 per 1000 live births

Accepted Answer

2 and 4 only

Answer

1, 2 and 4

Answer

1 and 3 only

Answer

2 only

Question 7

Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Accepted Answer

Janani Suraksha Scheme

Answer

Ayushman Bharat Scheme

Answer

Mamta Scheme

Answer

Vande Mataram Scheme

Question 8

Insulin Resistance Syndrome (Syndrome X) is associated with which of the following?

1. Type 2 Diabetes Mellitus
2. Hyperinsulinaemia
3. Dyslipidaemia
4. Hypercalcaemia

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 9

The "DASH diet" is a lifestyle modification for management of which of these conditions ?

Accepted Answer

Hypertension

Answer

Diabetes

Answer

Cancer

Answer

Anemia

Question 10

The amount of iron lost per 28 day cycle in menstruating women is

Accepted Answer

15.5 mg

Answer

8.5 mg

Answer

12.5 mg

Answer

5.5 mg

UPSC-CMS 2021

Community Medicine

Internal Medicine

Physiology