UPSC-CMS 2023 - Community Medicine Practice Questions

Q: With regard to lead poisoning, consider the following statements : 1. Coproporphyrin in urine is a useful screening test. 2. Hand washing before eating is an important measure of personal hygiene. 3. The use of d-penicillamine has been reported to be effective in management. How many of the statements given above is/are correct ?

All three. ***All three*** - **Statement 1 is correct**: Urinary **coproporphyrin III** is a useful screening test for lead poisoning. Lead interferes with heme synthesis by inhibiting enzymes like ferrochelatase and ALA dehydratase, leading to accumulation and excretion of porphyrin precursors including coproporphyrin in urine. - **Statement 2 is correct**: **Hand washing before eating** is a critical preventive measure, especially in children. Lead dust on contaminated hands is a major route of exposure, particularly in environments with lead paint or industrial contamination. This is a key personal hygiene measure recommended by WHO and CDC. - **Statement 3 is correct**: **D-penicillamine** has indeed been reported to be effective in lead poisoning management. While **EDTA, DMSA (succimer), and dimercaprol** are more commonly used as first-line chelating agents today, d-penicillamine remains a valid chelating agent for heavy metal poisoning including lead, with documented effectiveness in medical literature. *1 only* - This option is incorrect because it ignores the validity of statements 2 and 3. - While statement 1 is accurate, **hand washing** (statement 2) is unquestionably an important preventive measure for lead poisoning. - Statement 3 is also correct as d-penicillamine **has been reported** to be effective (the statement doesn't claim it's first-line therapy). *2 only* - This option is incorrect because it ignores statements 1 and 3. - **Coproporphyrin in urine** (statement 1) is well-established as a screening test for lead exposure. - Statement 3 regarding d-penicillamine effectiveness is also correct based on medical literature. *None of the options* - This option is completely incorrect as all three statements are medically accurate. - Each statement represents correct information about lead poisoning screening, prevention, or management.

Q: A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found ?

Malaria. ***Malaria*** - The description of **boat-shaped eggs**, laid singly, and possessing **lateral floats** is characteristic of the *Anopheles* mosquito. - *Anopheles* mosquitoes are the primary vectors for **malaria**, transmitting *Plasmodium* parasites to humans. *Dengue fever* - Dengue fever is primarily transmitted by the *Aedes* mosquito, which lays **single, oval-shaped eggs** on water surfaces, typically in domestic containers. - These eggs lack the **boat shape** and **lateral floats** seen with *Anopheles*. *Japanese encephalitis* - Japanese encephalitis is mainly spread by *Culex* mosquitoes, which lay their eggs in **rafts** on the surface of water. - Their eggs are not boat-shaped or laid singly with lateral floats. *Chikungunya fever* - Chikungunya fever is transmitted by *Aedes* mosquitoes (similar to dengue), which lay their eggs **singly** on the sides of containers above the water line. - The eggs are **oval** and do not have the distinct boat-shape or lateral floats of *Anopheles*.

Q: In the National Health Policy 2017, a target of 90 : 90 : 90 has been set for HIV/AIDS. Which among the following are targets for which a 90% level has been set as part of the National Health Policy ? 1. Proportion of couples who have safe sex 2. Proportion of people living with HIV who know their HIV status 3. Proportion of adolescents who have access to contraceptives 4. Proportion of people receiving antiretroviral therapy who have viral suppression Select the correct answer using the code given below :

2 and 4. ***2 and 4*** The **90-90-90 targets** for HIV/AIDS established by UNAIDS and adopted in India's National Health Policy 2017 have three specific goals: - **First 90**: 90% of all people living with HIV know their HIV status - **Second 90**: 90% of all people diagnosed with HIV receive sustained antiretroviral therapy (ART) - **Third 90**: 90% of all people receiving ART achieve viral suppression **Statement 2** correctly identifies the **first 90** (proportion of people living with HIV who know their status), and **Statement 4** correctly identifies the **third 90** (proportion on ART achieving viral suppression). *1 and 4* While promoting safe sex is crucial for HIV prevention, the **90-90-90 targets specifically focus on the cascade of diagnosis, treatment, and viral suppression** among people already living with HIV. The proportion of couples having safe sex is not part of these specific targets. *1 and 3* Neither the **proportion of couples having safe sex** nor **adolescent access to contraceptives** are part of the 90-90-90 targets for HIV/AIDS. These are important broader public health goals but not the precise metrics of the 90-90-90 HIV strategy. *2 and 3* While **Statement 2** (proportion knowing their HIV status) is indeed the first component of the 90-90-90 targets, the **proportion of adolescents with access to contraceptives** is not part of these HIV-specific targets. This is a separate reproductive health goal unrelated to the 90-90-90 framework.

Q: The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system ?

Dual-record system. ***Dual-record system*** - This system involves two independent sources of data collection, such as a continuous enumeration and a periodic survey, to estimate vital events with greater accuracy by **cross-checking and matching the records** - The independent enumeration by an enumerator and a separate survey by an investigator-supervisor perfectly aligns with the principles of a **dual-record system**, designed to improve data quality and completeness - The SRS uses this methodology to capture births and deaths that might be missed by a single source *Triple-record system* - This system would involve **three independent sources** of data collection, which is more complex and not described in the given scenario - While potentially offering even higher accuracy, it's not applicable here as only two sources are mentioned *Double blinding* - **Double blinding** is a technique used in clinical trials where neither the participants nor the researchers know who is receiving a particular treatment - This method is used to **prevent bias** in clinical studies and is completely unrelated to vital statistics data collection methodology *Double data entry* - **Double data entry** is a process where data is entered twice by two different operators and then compared to **identify and correct errors** - This technique focuses on improving the accuracy of data input for a single data source, not on combining two independent sources of information for surveillance

Q: Cross-over type of study designs are those in which each subject serves as his/her own control. In which of the following conditions is a cross-over study not suitable ?

If the drug of interest cures the disease. ***If the drug of interest cures the disease*** - A **crossover study** relies on subjects experiencing both treatment and control conditions, which is **not possible** if a drug cures the disease, as the initial treatment would eliminate the condition for the second phase. - The carryover effect of a cure would invalidate the comparison between the treatment and control periods, making subsequent observations on the same subject non-independent. *If the disease changes radically during the period of time required for the study* - **Radical changes in disease progression** would introduce significant **confounding variables**, making it difficult to attribute changes in outcome solely to the intervention. - The **baseline state** for the second treatment period would be vastly different from the first, violating the assumption of comparable conditions inherent in crossover designs. *None of the options* - This option is incorrect because there is a specific scenario among the choices where a crossover study is unsuitable, as detailed in the correct answer. *If the drug is effective during all stages of the disease* - A drug's effectiveness across all disease stages would actually **make a crossover study more suitable**, as the treatment effects could be consistently observed regardless of when the intervention is given. - This scenario would reduce the variability in response due to disease progression, allowing for a clearer comparison between treatment and control periods.

Q: In which one of the following diseases are the source of infection and reservoir of infection the same ?

Hookworm infection. ***Hookworm infection*** - In hookworm infection, the **infected human host** is considered both the **source** and **reservoir** of infection in the epidemiological chain. - The adult worms live in the **human intestine** (reservoir), and humans excrete eggs in feces that contaminate soil, where larvae develop and subsequently infect other humans, perpetuating the cycle within the human population. - While larvae develop in soil, the **ultimate source and reservoir is the infected human**, as without human hosts, the transmission cycle cannot be maintained. *Tetanus* - The **reservoir** for tetanus is **soil and the gastrointestinal tract of animals**, where *Clostridium tetani* spores persist. - The **source of infection** is contaminated soil or rusty objects entering wounds. - Humans are **accidental hosts** (dead-end hosts) and do not serve as reservoirs, so source and reservoir are distinct (both environmental). *Cholera* - The **reservoir** for cholera is primarily **humans**, with *Vibrio cholerae* colonizing the intestinal tract. - The **source of infection** is typically **water or food contaminated with feces** from infected individuals. - While humans are the main reservoir, aquatic environments can serve as secondary environmental reservoirs, and the immediate source (contaminated water/food) is often considered distinct from the human reservoir in classical teaching. *Typhoid* - The **reservoir** for typhoid is exclusively **humans**, particularly chronic carriers who harbor *Salmonella typhi* in the gallbladder. - The **source of infection** is **food or water contaminated** by infected human carriers. - Although humans are the sole reservoir, the immediate source (contaminated food/water) is conventionally distinguished from the reservoir (the carrier), making them technically distinct in the transmission chain.

Q: In which one of the following diseases, the transmission chain is 'Man-Snail-Man' ?

Schistosomiasis. ***Schistosomiasis*** - The transmission cycle for **schistosomiasis** involves humans as the definitive host and **snails** as the intermediate host. - Eggs are passed in human feces or urine, hatch in freshwater to **miracidia**, which then infect snails. Snails release **cercariae** that penetrate human skin, completing the 'Man-Snail-Man' chain. *Malaria* - The transmission chain for **malaria** is typically 'Man-Mosquito-Man', where Anopheles mosquitoes serve as the vector. - There is no involvement of **snails** in the life cycle of the Plasmodium parasite. *Onchocerciasis* - **Onchocerciasis**, or river blindness, is transmitted by the bite of infected blackflies (Simulium species). - The life cycle involves microfilariae maturing into adult worms in the human host, with blackflies as the **arthropod vector**. *Fish tapeworm* - The **fish tapeworm (Diphyllobothrium latum)** has a complex life cycle involving copepods (crustaceans) and fish as intermediate hosts. - Humans become infected by consuming raw or undercooked infected fish, not through **snail** involvement.

Q: Which of the following mosquito-borne diseases are transmitted chiefly by Aedes mosquito ? 1. Dengue 2. West Nile fever 3. Yellow fever 4. Zika fever Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - **Dengue**, **Yellow fever**, and **Zika fever** are all primarily transmitted by the *Aedes* mosquito, especially *Aedes aegypti* and *Aedes albopictus*. - These mosquitoes are known for biting during the day and thrive in urbanized environments. *1 and 3 only* - This option is incomplete as **Zika fever** is also transmitted by *Aedes* mosquitoes. - Excluding Zika fever makes this option incorrect, as Zika's primary vector is well-established as *Aedes*. *1, 2 and 3* - **West Nile fever** is primarily transmitted by *Culex* mosquitoes, not *Aedes*. - Therefore, its inclusion invalidates this option because *Aedes* is not the chief vector for West Nile fever. *2 and 4 only* - This option is incorrect because **West Nile fever** is not primarily transmitted by *Aedes* mosquitoes. - Moreover, it omits **Dengue** and **Yellow fever**, which are classic examples of *Aedes*-borne diseases.

Q: Consider the following vaccines : 1. BCG Vaccine 2. Hepatitis B Vaccine 3. Inactivated Polio Vaccine (IPV) 4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?

4→3→2→1. ***4→3→2→1 (OPV → IPV → Hepatitis B → BCG)*** * **Oral Polio Vaccine (OPV)** is the **most heat-sensitive** vaccine among these options. As a live attenuated viral vaccine, it requires storage at -20°C (freezer storage) and is extremely thermolabile, necessitating the strictest cold chain management with VVM monitoring. * **Inactivated Polio Vaccine (IPV)** is the second most heat-sensitive vaccine, requiring refrigeration at 2-8°C. While more stable than OPV due to inactivation, it remains highly sensitive to heat exposure and requires careful cold chain maintenance. * **Hepatitis B Vaccine** has moderate heat sensitivity. As a recombinant subunit vaccine, it requires storage at 2-8°C but is more thermostable than the polio vaccines. It can tolerate brief temperature excursions better than live attenuated vaccines. * **BCG Vaccine** is the **least heat-sensitive** among these four vaccines, though it still requires proper cold chain management at 2-8°C. While BCG is light-sensitive, it demonstrates relatively better heat stability compared to OPV, IPV, and Hepatitis B vaccines in field conditions per National Immunization Schedule guidelines. *Incorrect Option 2→1→3→4* - Incorrectly places Hepatitis B as most sensitive when OPV is actually most thermolabile *Incorrect Option 2→3→1→4* - Wrong order placing Hepatitis B first instead of OPV *Incorrect Option 3→1→4→2* - Incorrectly suggests IPV is most sensitive and has an inaccurate sequence

Q: The Employees State Insurance Act, 1948 of India provides for certain benefits to employees. Which among the following are benefits to insured persons or to other dependents under the Act ? 1. Disablement benefit 2. Funeral expenses 3. Maternity benefit 4. Travel benefit Select the correct answer using the code given below :

1, 2 and 3 only. ***1, 2 and 3 only*** - The **Employees' State Insurance Act of 1948** provides comprehensive social security benefits including **Disablement Benefit** for temporary or permanent incapacitation, **Funeral Expenses** for the deceased insured person, and **Maternity Benefit** to women. - These benefits are designed to protect employees and their dependents against various health-related and economic contingencies. *2 and 4 only* - This option is incorrect because **funeral expenses** are indeed covered, but there is no specific "travel benefit" as a standard provision under the ESI Act for insured persons or their dependents. - While medical benefits allow for treatment in ESI hospitals, a general travel benefit akin to reimbursement for personal travel is not part of the scheme. *1, 2, 3 and 4* - This option is incorrect because while **Disablement Benefit**, **Funeral Expenses**, and **Maternity Benefit** are provided, a general **Travel Benefit** is not one of the statutory benefits offered by the ESI Act. - The Act focuses on medical care, income support during sickness/maternity/disablement, and dependent support, not general travel. *1 and 3 only* - This option is incomplete as it correctly identifies **Disablement Benefit** and **Maternity Benefit** but excludes **Funeral Expenses**, which are explicitly covered as part of the benefits package under the ESI Act. - Funeral expenses provide financial support to the family of a deceased insured person to some extent.

Question 1

With regard to lead poisoning, consider the following statements :

1. Coproporphyrin in urine is a useful screening test.
2. Hand washing before eating is an important measure of personal hygiene.
3. The use of d-penicillamine has been reported to be effective in management. How many of the statements given above is/are correct ?

Accepted Answer

All three

Answer

None of the options

Answer

2 only

Answer

1 only

Question 2

A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found ?

Accepted Answer

Malaria

Answer

Dengue fever

Answer

Japanese encephalitis

Answer

Chikungunya fever

Question 3

In the National Health Policy 2017, a target of 90 : 90 : 90 has been set for HIV/AIDS. Which among the following are targets for which a 90% level has been set as part of the National Health Policy ?

1. Proportion of couples who have safe sex

2. Proportion of people living with HIV who know their HIV status

3. Proportion of adolescents who have access to contraceptives

4. Proportion of people receiving antiretroviral therapy who have viral suppression

Select the correct answer using the code given below :

Accepted Answer

2 and 4

Answer

1 and 4

Answer

1 and 3

Answer

2 and 3

Question 4

The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system ?

Accepted Answer

Dual-record system

Answer

Triple-record system

Answer

Double blinding

Answer

Double data entry

Question 5

Cross-over type of study designs are those in which each subject serves as his/her own control. In which of the following conditions is a cross-over study not suitable ?

Accepted Answer

If the drug of interest cures the disease

Answer

If the disease changes radically during the period of time required for the study

Answer

None of the options

Answer

If the drug is effective during all stages of the disease

Question 6

In which one of the following diseases are the source of infection and reservoir of infection the same ?

Accepted Answer

Hookworm infection

Answer

Tetanus

Answer

Cholera

Answer

Typhoid

Question 7

In which one of the following diseases, the transmission chain is 'Man-Snail-Man' ?

Accepted Answer

Schistosomiasis

Answer

Malaria

Answer

Onchocerciasis

Answer

Fish tapeworm

Question 8

Which of the following mosquito-borne diseases are transmitted chiefly by Aedes mosquito ?

1. Dengue
2. West Nile fever
3. Yellow fever
4. Zika fever

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1 and 3 only

Answer

1, 2 and 3

Answer

2 and 4 only

Question 9

Consider the following vaccines :

1. BCG Vaccine
2. Hepatitis B Vaccine
3. Inactivated Polio Vaccine (IPV)
4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?

Accepted Answer

4→3→2→1

Answer

2→1→3→4

Answer

2→3→1→4

Answer

3→1→4→2

Question 10

The Employees State Insurance Act, 1948 of India provides for certain benefits to employees. Which among the following are benefits to insured persons or to other dependents under the Act ?

1. Disablement benefit 
2. Funeral expenses 
3. Maternity benefit 
4. Travel benefit

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3 only

Answer

2 and 4 only

Answer

1, 2, 3 and 4

Answer

1 and 3 only

UPSC-CMS 2023 — Community Medicine