FMGE 2023 - Community Medicine Practice Questions

Q: A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Wound cleaning+ rabies vaccine on day 0 & 3. ***Wound cleaning+ rabies vaccine on day 0 & 3***- Since the patient received prophylaxis 6 months ago, they are considered **previously immunized**, meaning **Rabies Immunoglobulin (RIG)** is *not* required, even for a **Category 3 bite**.- For a previously immunized individual with a Category III exposure, the required management is a **booster regimen** consisting of the rabies vaccine given on **Day 0** and **Day 3** (two doses). *Wound cleaning only*- This action is inadequate for managing a **Category 3 bite**, which involves severe exposure like deep puncture wounds or mucosal contamination.- Even in previously vaccinated individuals, a **booster dose** is necessary to ensure adequate and rapid protective antibody levels against the high viral load typical of a severe animal bite. *Wound cleaning+rabies vaccine on day 0,3 & 7*- While this 3-dose schedule is sometimes used, the **standard recommended booster regimen** for previously immunized individuals with a new Category III exposure is the **2-dose schedule** (Day 0 and Day 3) as per WHO and IAPSM guidelines.- The 2-dose booster is sufficient to rapidly achieve protective antibody titers in individuals who have received complete prior vaccination. *Wound cleaning+IM vaccine +RIG*- The administration of **Rabies Immunoglobulin (RIG)** is unnecessary and contraindicated in patients who have been **previously immunized** with a full course of the rabies vaccine.- RIG is reserved for **unvaccinated** patients with Category II or III exposures to provide immediate passive immunity before the active immune response develops.

Q: A government plans to outline tobacco control laws. What is the level of prevention here?

Primordial prevention. ***Primordial prevention*** - Tobacco control laws represent **primordial prevention** as they are **policy-level interventions** aimed at preventing the emergence of risk factors in the population - This involves creating conditions that minimize hazards to health through **legislative and regulatory measures** - By outlining tobacco control laws, the government prevents the establishment of patterns of tobacco use at the **population level** before individual exposure occurs *Primary prevention* - Refers to interventions targeting individuals who are at risk but haven't developed disease (e.g., smoking cessation programs, health education campaigns) - Operates at the **individual level** rather than policy level *Secondary prevention* - Involves early detection and treatment of disease in asymptomatic individuals (e.g., screening programs) - Not applicable to legislative measures *Tertiary prevention* - Focuses on reducing complications and disability in those already diagnosed with disease (e.g., rehabilitation programs) - Not related to policy formulation

Q: Hand washing during COVID-19 is what level of prevention?

Primary prevention. ***Primary prevention***- Hand washing is a crucial public health measure that provides **specific protection** by removing SARS-CoV-2 from the skin surface, thereby preventing the entry and establishment of the disease.- This level of prevention focuses on actions taken *before* the onset of disease to reduce the incidence of infection, aligning with efforts like **vaccination** and health education.*Primordial prevention*- This is the earliest stage, aimed at preventing the emergence and establishment of **environmental or social conditions** that may lead to the development of risk factors (e.g., discouraging unhealthy lifestyle trends globally).- It addresses pre-existing **underlying determinants** of health, whereas hand washing directly targets an infectious agent.*Secondary prevention*- This level involves actions aimed at early diagnosis and prompt treatment of an existing condition to halt progression (e.g., large-scale **testing/screening** of asymptomatic cases for COVID-19).- Actions taken at this stage occur *after* the infection has begun but before significant symptoms or complications arise.*Tertiary prevention*- This level focuses on measures taken when the disease has already fully developed, aiming to reduce the severity of **complications**, limit disability, and provide **rehabilitation** (e.g., physical therapy for post-COVID syndrome).- It deals with the management and recuperation phase of established illness, which is not applicable to preventive hygiene practices.

Q: School health service should include all the following except

Doctor on premises. ***Doctor on premises***- A full-time, dedicated **doctor** is generally not considered an essential or standard component of basic school health services, which are typically managed by a **school health nurse** or auxiliary personnel.- School health services focus on periodic **health screening**, first aid, and referral services, rather than requiring an immediate physician presence for routine needs.*Education of handicapped children*- This falls under the necessary provision of **health promotion** and specialized services to ensure **inclusive education** for all students.- School health services must coordinate resources and adaptive support to facilitate the educational outcomes of children with **special needs**.*Dental and eye health services*- These are crucial components of **health screening** and early detection efforts required in school health services.- Identifying and referring issues like **dental caries** and **visual impairments** prevents academic hindrance and long-term morbidity.*School health records*- Maintaining comprehensive **cumulative health records** is paramount for monitoring the health status of students and ensuring continuity of care throughout their schooling.- These records are essential for tracking **immunization status**, screening results, and medical history, which is critical during emergencies.

Q: How much percent of GNP does WHO recommend being spent on the healthcare sector?

5%. ***5%***- The **World Health Organization (WHO)** recommends that countries aim to spend at least **5%** of their **Gross Domestic Product (GDP)** or **Gross National Product (GNP)** on health.- This minimum threshold is deemed necessary to establish basic **universal health coverage** and ensure robust primary healthcare services.*2.0%*- Spending only **2.0%** of GNP is drastically low and associated with poor health outcomes and high rates of **out-of-pocket expenses** for citizens.- This level of allocation is insufficient to fund essential public health functions or maintain a functional **healthcare system**.*2.5%*- While slightly better than 2.0%, **2.5%** remains well below the recognized international benchmark required for adequate health investment.- This level fails to provide resources for comprehensive care, including preventative services and necessary **infrastructure development**.*3.5%*- Allocating **3.5%** shows some governmental commitment but still falls short of the WHO's target for sustainable and effective health financing.- The shortfall between 3.5% and 5% often represents a gap in funding for critical areas like **health workforce training** and access to specialized care.

Q: Eligible couple registers are maintained at which of the following centres?

Sub-centre. ***Sub-centre (Correct Answer)*** - The **sub-centre** is the most peripheral and first contact point between the primary health care system and the community, typically serving 3,000 to 5,000 population - It is the operational unit responsible for maintaining essential household and community registers, including the **Eligible Couple Register**, used for planning and delivering family planning services - The **Auxiliary Nurse Midwife (ANM)** posted at the sub-centre maintains this register as part of grassroots family planning surveillance *PHC (Incorrect)* - A **Primary Health Centre (PHC)** serves a larger population (20,000 to 30,000) and supervises 4-6 sub-centres - Its role is more administrative and higher-level curative care - While the PHC utilizes the data for planning, the actual maintenance of the **Eligible Couple Register** is done at the sub-centre level *CHC (Incorrect)* - A **Community Health Centre (CHC)** functions as a referral center for 4 PHCs, offering specialized services like obstetrics, surgery, and pediatrics - Typically serves 80,000 to 1,20,000 population - CHCs are higher-level referral units and do not maintain ground-level household/couple-specific registers *District Hospital (Incorrect)* - The **District Hospital** is the highest-level facility in the district, focusing on advanced tertiary care, specialist consultation, and training - It is far removed from the grassroots fieldwork and record-keeping required for community health surveillance - Does not maintain individual **Eligible Couple Registers** for specific villages

Q: An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

100,000 IU. ***100,000 IU*** - This is the correct **single dose per day** of Vitamin A for infants aged 6 to 11 months in the therapeutic regimen for Vitamin A deficiency or measles. - According to **WHO guidelines**, the therapeutic protocol for this age group involves administering **100,000 IU on Day 1** and **100,000 IU on Day 2** (and a third dose on Day 14 for severe deficiency). - This dose is both safe and effective for treating deficiency in this specific age group. *25,000 IU* - This dose is significantly lower than the recommended therapeutic level for infants 6-11 months and would be **ineffective** for treating Vitamin A deficiency. - Doses of this magnitude are not part of standardized WHO supplementation protocols for this age group. *50,000 IU* - This is the standard single dose recommended for **infants under 6 months** of age (1-5 months) for both prophylactic and therapeutic purposes. - For an 8-month-old infant (6–11 months age group), 50,000 IU is **insufficient** for effective therapeutic intervention. *200,000 IU* - This is the standard single dose for **children aged 12 months to 5 years** for routine supplementation. - Giving 200,000 IU as a single dose to an 8-month-old infant carries significant risk of **acute hypervitaminosis A toxicity** including symptoms such as bulging fontanelle, nausea, vomiting, and headache.

Q: The shelf life of copper T 380 A is

10 years. ***10 years*** - The **Copper T 380A** is approved for continuous use for up to **10 years** - This is the longest duration among all copper IUDs due to its large copper surface area (380 mm²) - Endorsed by **FDA, WHO, and ICMR** as a highly effective long-acting reversible contraception (LARC) - Most cost-effective IUD due to its prolonged efficacy *5 years* - This duration applies to **Copper T 200B** (lower copper content) - Also the approved duration for hormonal IUDs like **Mirena** (levonorgestrel-releasing) - Not applicable to Copper T 380A which has extended efficacy *3 years* - Associated with lower-dose hormonal IUDs like **Skyla** or **Jaydess** - Much shorter than Copper T 380A due to different mechanism (hormonal vs copper) - Not relevant to copper-based contraception duration *7 years* - Not a standard approved duration for any commonly used IUD - Some clinical studies suggest efficacy beyond labeled duration, but 7 years is not the official approval for Copper T 380A - The standard maximum approved duration remains **10 years**

Q: Confidentiality is maintained in which of the following conditions?

Counselling. ***Counselling***- **Counselling** is a private, one-on-one interaction where the counselor is ethically and legally bound to maintain the client's information as **confidential**.- The foundation of successful **counselling** relies heavily on establishing trust, which is achieved through adherence to strict **confidentiality** rules.*Group discussion*- *Group discussion* involves multiple participants discussing a topic, making the shared information inherently public among the group members, thus negating **confidentiality**.- While privacy among group members might be implied, there is no formal professional obligation or structure ensuring that information remains strictly private outside the *group discussion*.*Panel discussion*- A *panel discussion* is a public forum where a group of experts discusses a subject in front of a larger audience, meaning all information shared is immediately public and not **confidential**.- The primary goal is dissemination of information and expert opinion to a broad audience, conflicting with the concept of **confidentiality**.*Seminar*- A *seminar* is an educational presentation or meeting, usually involving a presenter and an audience, where information is shared publicly.- The format of a *seminar* is designed for open learning and exchange, preventing the maintenance of **confidentiality** for any data or client-specific details presented.

Q: An 8 weeks pregnant woman, working in an industry, consults a doctor. According to the ESI act, what is the duration of maternity leave that she can get?

26 weeks, starting from 8 weeks before delivery. ***26 weeks, starting from 8 weeks before delivery*** - This duration is mandated by the **Maternity Benefit (Amendment) Act, 2017**, which governs the maternity benefits paid through the **ESI scheme** for eligible insured women - This applies for the first two surviving children - The total paid leave entitlement is **26 weeks** (or 182 days), which can be availed for a period not exceeding **8 weeks** immediately preceding the expected date of delivery *4 months* - Four months is approximately **17 weeks**, which is substantially less than the **26 weeks** maximum paid leave guaranteed under the ESI Act and the Maternity Benefit Act - Such a short duration does not comply with current statutory requirements aimed at promoting maternal health and child welfare *28 weeks, starting from 4 weeks after delivery* - The statutory maximum paid maternity leave duration is **26 weeks**, making **28 weeks** an excess entitlement not provided under the current law - The woman is legally entitled to begin her leave up to **8 weeks** prior to the expected delivery date, not just post-delivery, enabling vital pre-natal rest *9 months* - Nine months (approximately **39 weeks**) is significantly longer than the standard paid maternity leave duration of **26 weeks** provided by the ESI Act - While some organizations may offer extended unpaid leave, **9 months** is not the statutory duration for compensated maternity benefit

Question 1

A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Accepted Answer

Wound cleaning+ rabies vaccine on day 0 & 3

Answer

Wound cleaning only

Answer

Wound cleaning+IM vaccine +RIG

Answer

Wound cleaning+rabies vaccine on day 0,3 & 7

Question 2

A government plans to outline tobacco control laws. What is the level of prevention here?

Accepted Answer

Primordial prevention

Answer

Secondary prevention

Answer

Tertiary prevention

Answer

Primary prevention

Question 3

Hand washing during COVID-19 is what level of prevention?

Accepted Answer

Primary prevention

Answer

Secondary prevention

Answer

Tertiary prevention

Answer

Primordial prevention

Question 4

School health service should include all the following except

Accepted Answer

Doctor on premises

Answer

Dental and eye health services

Answer

School health records

Answer

Education of handicapped children

Question 5

How much percent of GNP does WHO recommend being spent on the healthcare sector?

Accepted Answer

5%

Answer

3.5%

Answer

2.5%

Answer

2.0%

Question 6

Eligible couple registers are maintained at which of the following centres?

Accepted Answer

Sub-centre

Answer

District hospital

Answer

PHC

Answer

CHC

Question 7

An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

Accepted Answer

100,000 IU

Answer

25,000 IU

Answer

50,000 IU

Answer

200,000 IU

Question 8

The shelf life of copper T 380 A is

Accepted Answer

10 years

Answer

5 years

Answer

7 years

Answer

3 years

Question 9

Confidentiality is maintained in which of the following conditions?

Accepted Answer

Counselling

Answer

Group discussion

Answer

Panel discussion

Answer

Seminar

Question 10

An 8 weeks pregnant woman, working in an industry, consults a doctor. According to the ESI act, what is the duration of maternity leave that she can get?

Accepted Answer

26 weeks, starting from 8 weeks before delivery

Answer

4 months

Answer

28 weeks, starting from 4 weeks after delivery

Answer

9 months

FMGE 2023 — Community Medicine