International Health Regulations — MCQs
What is the primary purpose of the World Health Organization's International Health Regulations?
Which disease comes under International Surveillance?
All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
What is the primary limitation of conducting a one-day census of inpatients in a mental hospital?
International certificate for travelling is required for -
All of the following are true with respect to ligation of internal iliac artery except -
Which of the following is least important in the maintenance of normal fecal continence?
Which of the following statements about the mammary gland is false?
Which of the following structures does NOT pass through the deep inguinal ring?
The method of choice for purification of highly polluted water on a large scale is :
International Health Regulations Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary purpose of the World Health Organization's International Health Regulations?
- A. To establish global health standards
- B. To coordinate international health responses
- C. To prevent the spread of diseases across borders (Correct Answer)
- D. To provide financial aid to countries in need
Explanation: ***To prevent the spread of diseases across borders*** - The **International Health Regulations (IHR)** are a legally binding international instrument designed to help countries work together to prevent and respond to **acute public health risks** that have the potential to spread globally. - Their core purpose is to prevent, protect against, control, and provide a public health response to the **international spread of disease** in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. *To establish global health standards* - While the IHR contribute to global health safety, their primary focus is on **risk management and response** rather than setting broad global health standards. - Other WHO initiatives and agreements are more specifically dedicated to establishing **global norms and standards** for health systems and services. *To coordinate international health responses* - The IHR provide a framework for coordination, but their fundamental purpose is to enable countries to **detect, assess, notify, and respond** to public health events of international concern. - Coordination is a means to achieve the goal of preventing international spread, rather than the primary goal itself. *To provide financial aid to countries in need* - The IHR do not involve the direct provision of **financial aid**; their scope is limited to public health measures and reporting. - Financial assistance for health initiatives typically falls under the purview of other **international development organizations** or specific funding mechanisms.
Question 2: Which disease comes under International Surveillance?
- A. Typhoid fever (Correct Answer)
- B. Chikungunya fever
- C. Hepatitis B
- D. Salmonellosis
Explanation: ***Typhoid fever*** - **Typhoid fever** is monitored by the **World Health Organization (WHO)** through global surveillance systems to track incidence, guide vaccination strategies, and implement control measures. - While **not on the mandatory notification list** under the International Health Regulations (IHR) 2005, typhoid is included in **WHO's global disease surveillance** programs due to its significant disease burden in endemic regions. - Among the given options, typhoid fever has the **strongest international surveillance framework** through WHO's Global Foodborne Infections Network and regional surveillance systems. - **Note:** Diseases under **mandatory IHR surveillance** include cholera, plague, yellow fever, smallpox, poliomyelitis, SARS, and novel influenza subtypes. *Chikungunya fever* - Chikungunya is primarily monitored through **national and regional surveillance** systems rather than comprehensive international surveillance frameworks. - WHO tracks outbreaks through epidemic intelligence but it is **not part of mandatory IHR notification**. - Surveillance focuses on **vector control** and outbreak detection at local levels. *Hepatitis B* - **Hepatitis B** surveillance is conducted primarily at **national levels** through prevalence studies, vaccination coverage monitoring, and chronic infection programs. - It is **not under mandatory international surveillance** per IHR, though WHO maintains global estimates and monitoring frameworks. - Focus is on **prevention through vaccination** and treatment of chronic infections. *Salmonellosis* - Non-typhoidal **salmonellosis** is monitored mainly through **national food safety** and public health surveillance systems. - **Not designated for mandatory international surveillance** under IHR 2005. - International coordination occurs through networks like WHO's Global Foodborne Infections Network for outbreak investigation.
Question 3: All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
- A. Cataract
- B. Epidemic conjunctivitis (Correct Answer)
- C. Onchocerciasis
- D. Trachoma
Explanation: ***Epidemic conjunctivitis*** - While **epidemic conjunctivitis** can cause significant discomfort and temporary vision impairment, it is generally **self-limiting** and rarely leads to permanent blindness. - It was not identified as one of the top five global causes of avoidable blindness targeted by the Vision 2020 initiative. *Cataract* - **Cataract** is the **leading cause of blindness** globally, accounting for approximately half of all cases. - It is a highly treatable condition through surgery, making it a critical priority for Vision 2020. *Onchocerciasis* - Also known as **river blindness**, onchocerciasis is a parasitic disease that causes severe visual impairment and blindness. - It is a significant public health problem in several regions, particularly in Africa, and was a key focus of Vision 2020 due to its widespread impact and the availability of preventive chemotherapy. *Trachoma* - **Trachoma** is the **leading infectious cause of blindness** worldwide, caused by *Chlamydia trachomatis*. - Given its preventable and treatable nature, and its prevalence in many impoverished areas, it was designated as one of the priority diseases under Vision 2020.
Question 4: What is the primary limitation of conducting a one-day census of inpatients in a mental hospital?
- A. Provides a snapshot of the current patient demographic but lacks longitudinal data. (Correct Answer)
- B. Gives reliable estimates of seasonal factors in admissions.
- C. Allows for conclusions about the overall mental health trends in India.
- D. Enables estimation of the distribution of different diagnoses over time.
Explanation: ***Provides a snapshot of the current patient demographic but lacks longitudinal data.*** - A **one-day census** inherently captures data from a single point in time, offering a **"snapshot"** of the inpatient population on that specific day. - This method cannot provide information about changes in patient demographics, diagnoses, or treatment outcomes **over time**, which is essential for understanding trends and the effectiveness of interventions. *Gives reliable estimates of seasonal factors in admissions.* - A **single-day census** cannot provide reliable information about **seasonal variations** in admissions because it does not include data across different time periods. - Understanding seasonal factors requires data collected over a **longer duration**, typically spanning multiple seasons or a full year. *Allows for conclusions about the overall mental health trends in India.* - A census from a **single mental hospital** on one day provides highly localized data and cannot be extrapolated to represent **overall mental health trends** for an entire country like India. - Such broad conclusions require **nationwide epidemiological studies** with representative samples. *Enables estimation of the distribution of different diagnoses over time.* - A one-day census, by its very nature, provides data on the distribution of diagnoses only for that specific day, not **over time**. - To estimate changes in diagnostic distribution, **repeated censuses** or continuous data collection over an extended period would be necessary.
Question 5: International certificate for travelling is required for -
- A. Yellow fever (Correct Answer)
- B. Plague
- C. Cholera
- D. Pertussis
Explanation: ***Yellow fever*** - An **International Certificate of Vaccination or Prophylaxis (ICVP)**, often called a "yellow card," is required for entry into certain countries by travelers coming from or transiting through areas with a risk of yellow fever transmission. - This certificate is proof of vaccination against **yellow fever** and is a key measure in preventing international spread of the disease. *Plague* - While plague is a serious infectious disease, there is generally **no international certificate or mandatory vaccination requirement** for travel to or from areas with plague outbreaks. - Control measures for plague typically involve isolation of cases, contact tracing, and treatment, rather than pre-travel certification. *Cholera* - Although cholera is a diarrheal illness with potential for rapid spread, **international certificates of vaccination are generally not required for cholera** for travel purposes. - The World Health Organization (WHO) does not recommend this as an entry requirement for any country. *Pertussis* - Pertussis (**whooping cough**) is a highly contagious respiratory infection, but there are **no international certificate requirements** for vaccination against it for travel. - Routine childhood vaccination programs are the primary public health strategy for pertussis control.
Question 6: All of the following are true with respect to ligation of internal iliac artery except -
- A. Bleeding is always controlled with it (Correct Answer)
- B. Collateral circulation is established later between middle sacral and lateral sacral arteries
- C. The artery should be ligated and not transected
- D. For hemostasis, anterior division is to be ligated
Explanation: ***Bleeding is always controlled with it*** - Ligation of the internal iliac artery reduces **pulse pressure** and **blood flow** to the pelvic organs but does not guarantee complete cessation of bleeding. - Significant **collateral circulation** within the pelvis can maintain bleeding, especially from multiple sites or larger vessels. *Collateral circulation is established later between middle sacral and lateral sacral arteries* - This statement is true; these vessels are part of the vast **collateral network** that can supply the pelvic organs after internal iliac artery ligation. - The **middle sacral artery** (a branch of the aorta) and **lateral sacral arteries** (branches of the internal iliac) form anastomoses that become more prominent over time. *The artery should be ligated and not transected* - This is true because ligation (tying off) reduces blood flow without disrupting the vessel wall, preserving **vascular integrity**. - **Transecting** the artery would create two open ends, potentially leading to immediate or delayed hemorrhage and making subsequent control more challenging. *For hemostasis, anterior division is to be ligated* - This is true because the **anterior division** of the internal iliac artery supplies most of the pelvic organs implicated in obstetric and gynecological hemorrhage. - Ligation of the anterior division effectively reduces blood flow to the uterus, vagina, and bladder with less impact on essential structures than ligating the main trunk or posterior division.
Question 7: Which of the following is least important in the maintenance of normal fecal continence?
- A. Anorectal angulation
- B. Rectal innervation
- C. Internal sphincter
- D. Haustral valve (Correct Answer)
Explanation: **Haustral valve** - The **haustral valve** (or redundant mucosal folds within the haustra) primarily functions to *increase surface area* for water absorption and slow the passage of contents through the colon. - While critical for digestive function, it plays a *negligible direct role* in the mechanisms preventing involuntary stool leakage. *Anorectal angulation* - The **anorectal angle**, formed by the pull of the **puborectalis muscle**, creates a sharp bend that acts as a flap valve, significantly contributing to continence. - Loss of this angle (e.g., due to injury or structural changes) substantially impairs continence. *Rectal innervation* - **Intact innervation** of the rectum provides crucial sensory feedback regarding rectal distension and stool consistency, allowing for conscious control of defecation. - It also mediates the **rectoanal inhibitory reflex** and the ability to voluntarily contract external anal sphincters, both vital for continence. *Internal sphincter* - The **internal anal sphincter** is an *involuntary smooth muscle* responsible for approximately 70-80% of the resting anal tone, providing continuous passive continence. - Damage to this sphincter leads to substantial impairment in continence, particularly against flatus and liquid stool.
Question 8: Which of the following statements about the mammary gland is false?
- A. Is a modified sweat gland
- B. Extends from 2nd to 6th rib vertically
- C. Supplied by internal mammary artery
- D. Nipple is supplied by 6th intercostal nerve (Correct Answer)
Explanation: ***Nipple is supplied by 6th intercostal nerve*** - The **nipple and areola** are primarily supplied by branches of the **4th intercostal nerve**. - The 6th intercostal nerve supplies the lower part of the breast and is not the primary innervation for the nipple. *Is a modified sweat gland* - The mammary gland, or breast, is indeed a **modified apocrine sweat gland**. - This embryological origin explains its glandular structure and function of milk production. *Extends from 2nd to 6th rib vertically* - The vertical extent of the mammary gland typically ranges from the **2nd to the 6th rib**. - This anatomical positioning is consistent with its location on the anterior thoracic wall. *Supplied by internal mammary artery* - The **internal mammary artery (internal thoracic artery)** is a major blood supply to the medial aspect of the breast [2]. - Other significant arteries include the lateral thoracic and thoracoacromial arteries for the lateral aspect. The mammary gland is embedded in subcutaneous fat, although fat is absent beneath the nipple and areola [1]. Mature resting breasts lie between the skin and the pectoralis major muscle, supported by Cooper's ligaments [3].
Question 9: Which of the following structures does NOT pass through the deep inguinal ring?
- A. Spermatic cord
- B. Internal spermatic fascia
- C. Round ligament
- D. Ilioinguinal nerve (Correct Answer)
Explanation: The ilioinguinal nerve typically passes through the superficial inguinal ring but does not travel through the deep inguinal ring [1]. It lies in the inguinal canal, superficial to the spermatic cord in males and the round ligament in females [1]. The spermatic cord in males enters the inguinal canal through the deep inguinal ring [2]. It contains structures like the vas deferens, testicular artery, pampiniform plexus, and nerves. The internal spermatic fascia is a covering of the spermatic cord that originates from the transversalis fascia at the deep inguinal ring [2]. In females, the round ligament of the uterus is the homologous structure to the spermatic cord in males, and it passes through the deep inguinal ring to enter the inguinal canal. It helps maintain the anteversion of the uterus.
Question 10: The method of choice for purification of highly polluted water on a large scale is :
- A. Chlorination only
- B. Ultraviolet light treatment
- C. Boiling and chlorination
- D. Super-chlorination followed by de-chlorination (Correct Answer)
Explanation: ***Super-chlorination followed by de-chlorination*** - **Super-chlorination** involves adding a very large dose of chlorine to water to ensure the destruction of all pathogenic microorganisms and removal of organic matter, making it suitable for **highly polluted water**. - **De-chlorination** is then necessary to remove residual chlorine, as high levels can be harmful and impart an unpleasant taste and odor. *Chlorination only* - While effective for disinfection, **chlorination alone** might not be sufficient to purify highly polluted water with significant organic load or diverse pathogens. - Excessive chlorine content without subsequent de-chlorination can lead to **undesirable by-products** and make the water unpalatable. *Ultraviolet light treatment* - **UV light treatment** is an effective disinfectant that inactivates microorganisms, but it does not remove suspended solids, dissolved organic matter, or chemical pollutants often found in **highly polluted water**. - Its efficacy can be reduced by water turbidity, which is common in highly contaminated sources, requiring extensive pre-treatment. *Boiling and chlorination* - **Boiling** is effective for killing most microorganisms but is impractical and energy-intensive for **large-scale water purification**. - **Chlorination** after boiling would still be needed for residual disinfection, but the combination isn't the method of choice for the high volumes typical of municipal water treatment of highly polluted sources.
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