International Health Regulations — MCQs
What is the primary purpose of the World Health Organization's International Health Regulations?
What is the maximum age limit for children covered under the Integrated Child Development Services (ICDS) scheme?
All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
Which of the following statements about Anganwadi workers is incorrect?
International certificate for travelling is required for -
Internal podalic version was done for transverse lie, which of these is a possible complication?
A case of ante-partum haemorrhage is seen at a Primary Health Centre. The treatment will consist of:
Which complication would you expect during internal podalic version in case of transverse lie?
On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?
Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?
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: What is the maximum age limit for children covered under the Integrated Child Development Services (ICDS) scheme?
- A. 6 years (Correct Answer)
- B. 10 years
- C. 4 years
- D. 8 years
Explanation: ***6 years*** - The **Integrated Child Development Services (ICDS) scheme** is primarily designed to address the nutritional, health, and developmental needs of children under the age of 6. - This age limit ensures that critical early childhood development—from infancy through preschool—is supported with interventions like **supplementary nutrition**, **immunization**, health check-ups, and pre-school education. *10 years* - This age range would extend coverage beyond the **critical early childhood development period** that ICDS focuses on. - Programs for children aged 6 to 10 years typically fall under primary education or other health initiatives, not the targeted ICDS framework. *4 years* - This is **insufficient** as ICDS is specifically designed to cover the entire **0-6 years age group**, ensuring comprehensive early childhood development support. - Limiting coverage to 4 years would exclude preschool-aged children (4-6 years) from crucial developmental interventions during a critical growth period. *8 years* - An 8-year age limit would also exceed the primary target group for ICDS, which emphasizes **early childhood intervention** up to 6 years. - Children aged 6 to 8 are usually enrolled in primary school, and their specific needs are often addressed through educational and school-based health programs.
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: Which of the following statements about Anganwadi workers is incorrect?
- A. Training for 40 days
- B. Under ICDS scheme
- C. Mostly female
- D. Covers a population of 2000 (Correct Answer)
Explanation: ***Covers a population of 2000*** - An **Anganwadi center** typically covers a population of **1000** in rural and urban areas, and **700** in tribal areas, not 2000. - This statement is incorrect because the specified population coverage is double the standard norm for an Anganwadi center. *Mostly female* - The vast majority of **Anganwadi workers** are **women** from the local community. - This is a correct statement, reflecting the gender composition of the Anganwadi workforce. *Training for 40 days* - **Anganwadi workers** undergo an initial **training program of 40 days**. - This statement is correct, outlining the standard duration of their foundational training. *Under ICDS scheme* - **Anganwadi centers** are a crucial part of the **Integrated Child Development Services (ICDS) scheme**. - This statement is correct, as the ICDS scheme established and oversees Anganwadi centers to provide health, nutrition, and early childhood education services.
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: Internal podalic version was done for transverse lie, which of these is a possible complication?
- A. Uterine rupture (Correct Answer)
- B. Cervical laceration
- C. Vaginal laceration
- D. Uterine inertia
Explanation: ***Uterine rupture*** - **Internal podalic version** involves manually inserting a hand into the uterus to grasp the fetal feet and turn the fetus from transverse to longitudinal lie, requiring significant uterine manipulation and stretching. - This is the **most serious and classically described complication**, particularly in multiparous women, those with previous uterine scars, or overdistended uterus. - The forceful manipulation and traction can cause **tearing of the uterine wall**, making this a life-threatening emergency. - Due to this high risk, internal podalic version has been largely **replaced by cesarean section** in modern obstetrics. *Cervical laceration* - While cervical lacerations can occur during internal version (especially if performed through an incompletely dilated cervix), this is **not the primary or most characteristic complication** of the procedure. - More commonly associated with rapid fetal descent or instrumental delivery in the second stage. *Vaginal laceration* - Vaginal tears are possible but are **less directly related** to the internal version itself and more associated with the subsequent vaginal delivery. - Not the most significant or characteristic complication of internal podalic version. *Uterine inertia* - **Uterine inertia** (inadequate uterine contractions) is not a direct mechanical complication of internal podalic version. - This refers to labor dysfunction rather than a procedural complication of the manipulation itself.
Question 7: A case of ante-partum haemorrhage is seen at a Primary Health Centre. The treatment will consist of:
- A. Assessment of general condition of the patient, intravenous drip and reference to a hospital (Correct Answer)
- B. Packing the vagina to stop the bleeding and then reference to a hospital
- C. Internal podalic version and delivery
- D. Vaginal examination and reference to a hospital only if diagnosed as placenta praevia
Explanation: ***Assessment of general condition of the patient, intravenous drip and reference to a hospital*** - Initial management of **ante-partum haemorrhage (APH)** at a primary level focuses on **stabilizing the mother** and arranging **urgent transfer** to a facility with comprehensive obstetric care. - An **intravenous drip** helps restore circulating volume and manage shock, while assessing the general condition guides immediate life-saving interventions. *Packing the vagina to stop the bleeding and then reference to a hospital* - **Vaginal packing** is contraindicated in APH as it can worsen bleeding, conceal the amount of blood loss, and potentially compromise fetal circulation, especially in cases of **placenta previa**. - The focus should be on rapid assessment, resuscitation, and transport, not on attempting to stop the bleeding locally. *Internal podalic version and delivery* - **Internal podalic version** is an obstetric maneuver used to change the fetal presentation for vaginal delivery, which is **not indicated** for management of APH. - Delivery decisions for APH, particularly in cases of placenta previa or abruption, often involve careful assessment and may necessitate **cesarean section**, which cannot be performed at a primary health centre. *Vaginal examination and reference to a hospital only if diagnosed as placenta praevia* - A **vaginal examination** should be **avoided** in cases of undiagnosed APH, as it can precipitate or worsen serious bleeding if **placenta previa** is present. - All cases of APH, regardless of the suspected cause, require prompt transfer to a hospital for definitive diagnosis and management, as even a minor bleed can rapidly escalate.
Question 8: Which complication would you expect during internal podalic version in case of transverse lie?
- A. Cervical laceration
- B. Vaginal laceration
- C. Uterine atony
- D. Uterine rupture (Correct Answer)
Explanation: ***Uterine rupture*** - Internal podalic version in a transverse lie, especially if the uterus is stressed or poorly contracted, carries a significant risk of **uterine rupture** due to excessive manipulation and stretching of the lower uterine segment. - This is a rare but life-threatening complication for both mother and fetus, often requiring immediate surgical intervention. *Cervical laceration* - While possible during any vaginal delivery, a **cervical laceration** is not the *most expected major complication* specifically linked to the forceful internal manipulation of podalic version in a transverse lie. - Cervical lacerations are more commonly associated with rapid or instrumentation-assisted deliveries. *Vaginal laceration* - Similar to cervical lacerations, **vaginal lacerations** can occur during vaginal birth but are not the primary, most severe complication uniquely associated with the risks of internal podalic version for a transverse lie. - These are typically related to the passage of the fetal head or instrumentation. *Uterine atony* - **Uterine atony** is a common cause of postpartum hemorrhage, but it is not a direct complication *during* internal podalic version itself. - It usually occurs *after* delivery due to the uterus failing to contract, not from the manipulative procedure.
Question 9: On conducting the autopsy on a victim of hanging, the ligature mark is seen at the lower 1/3rd of the neck. The victim is seen to have a protruded tongue. He was found with his head hanging to his left side with saliva dribbling from the left angle of his mouth. The right pupil appears constricted and there is ptosis (drooping) of the right eyelid. Compression of which of the following structures is the most probable reason for the unilateral ptosis in this case?
- A. Left vagus nerve
- B. Right internal jugular vein
- C. Right internal carotid artery
- D. Cervical sympathetic chain (Correct Answer)
Explanation: ***Cervical sympathetic chain*** - The combination of **unilateral ptosis**, **miosis** (constricted pupil), and sometimes **anhidrosis** (lack of sweating) is characteristic of **Horner's syndrome**, which results from damage to the **cervical sympathetic chain**. - Hanging can cause compression or injury to this chain, leading to the observed **Horner's syndrome** on the ipsilateral side of the injury. *Left vagus nerve* - Compression of the **vagus nerve** is associated with cardiac arrhythmias, bradycardia, or gastric disturbances, not directly with ptosis. - The symptoms observed are specific to sympathetic dysfunction, not parasympathetic vagal stimulation. *Right internal jugular vein* - Compression of the **internal jugular vein** would cause venous congestion and edema in the head and neck, not neurological signs like ptosis or miosis. - While it can be injured in hanging, it does not directly explain the specific neurological findings. *Right internal carotid artery* - Compression of the **internal carotid artery** could lead to cerebral ischemia or stroke symptoms, such as weakness or sensory deficits, but not typically isolated ptosis and miosis. - The observed symptoms point to a specific sympathetic pathway disruption rather than arterial occlusion.
Question 10: Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?
- A. Teres major tear
- B. Subscapularis tear (Correct Answer)
- C. Acromioclavicular joint dislocation
- D. Long head of biceps tear
Explanation: ***Subscapularis tear*** - The patient can perform **internal rotation** but has difficulty lifting the arm *off* the lumbosacral spine, indicating weakness in **subscapularis function**. - The **lift-off test** is a specific clinical test for subscapularis integrity, where the inability to lift the hand off the back suggests a tear. *Teres major tear* - A tear in the **teres major** would primarily affect **adduction** and **internal rotation** of the arm. - The patient's ability to internal rotate and abduct the arm makes a primary teres major tear less likely. *Acromioclavicular joint dislocation* - This condition presents with **pain** and **tenderness** over the AC joint, and a visible deformity ("step-off"). - While it can cause shoulder pain and limit movement, it does not typically present with the specific internal rotation and lift-off deficits described. *Long head of biceps tear* - A tear of the **long head of the biceps** usually presents with a "Popeye" deformity and pain with **supination** and **flexion of the elbow**. - The symptoms described (difficulty with lift-off, intact internal rotation) are not characteristic of a biceps tear.
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