UPSC-CMS 2018 - Community Medicine Practice Questions

Q: The difference between Type A and Type B sub centre as per Indian Public Health standards is in terms of:

Labour room or delivery facility. ***Labour room or delivery facility*** - A **Type A Sub-centre** is defined as one where **deliveries are not conducted**, focusing primarily on basic health services, antenatal and postnatal care, and health promotion. - A **Type B Sub-centre** is distinguished by the **provision of delivery services**, requiring specific infrastructure like a labour room and trained personnel to conduct safe deliveries. *Staffing pattern* - While there are specific staffing norms for both types of sub-centres, the fundamental difference between Type A and Type B is not solely based on the general staffing pattern. - The staffing complement in Type B sub-centres is specifically augmented to include personnel capable of assisting with deliveries, which is a consequence of the delivery facility rather than the primary differentiating factor itself. *Location* - The location of a sub-centre (either Type A or Type B) is determined by population norms and geographical accessibility, aiming to serve a defined rural population. - Location itself does not differentiate between Type A and Type B; rather, the services offered at these locations define their type. *Availability of drugs* - Both Type A and Type B sub-centres are expected to maintain a basic stock of essential drugs to provide primary healthcare services to their target population. - The range of drugs might expand in a Type B sub-centre to support delivery services, but the core distinction isn't merely the general availability of drugs.

Q: Which of the following Screening methods for Disease is the least useful?

Mass screening. ***Mass screening*** - Mass screening is the **least useful** screening method when applied indiscriminately to entire unselected populations, particularly for diseases with **low prevalence**. - This approach tests everyone regardless of risk factors, making it highly **resource-intensive** with low efficiency and poor **positive predictive value** for rare conditions. - The high rate of **false positives** leads to unnecessary follow-up investigations, patient anxiety, and wastage of healthcare resources, making it the least cost-effective screening strategy. *Selective screening* - **Selective screening** targets specific high-risk groups or individuals with certain exposures, significantly improving the **yield** and **cost-effectiveness** of the screening program. - This approach focuses resources where the **prevalence of disease** is higher, increasing the likelihood of detecting true cases and reducing false positives compared to mass screening. *High risk group screening* - **High-risk group screening** focuses on individuals with known risk factors, family history, or exposures that significantly increase their likelihood of developing a disease. - This method is highly effective for diseases with clear risk profiles, as it maximizes the **positive predictive value** of the screening test and optimizes resource allocation. *Multiphasic screening* - **Multiphasic screening** involves the simultaneous application of multiple screening tests to detect several conditions at once during a single healthcare encounter. - This approach can be efficient for detecting multiple prevalent diseases in certain populations, offering comprehensive health assessment while being more useful than mass screening due to its targeted nature.

Q: Which one of the following is an indicator for evaluation of impact of family planning?

Family size. ***Family size*** - This is a true **impact indicator** that measures the long-term effect of family planning programs on demographic outcomes. - A reduction in **average family size** over time directly reflects the program's effectiveness in helping individuals and couples achieve their desired number of children and birth spacing. - Impact indicators measure the ultimate goal of a program, and family size is one of the most important metrics alongside birth rate, fertility rate, and population growth rate. *Community needs assessment* - This is a **planning tool** used to **identify health needs and priorities** of a community, typically conducted *before* implementing a program. - It serves as a baseline for program design rather than an indicator of the *impact* of an already implemented family planning program. - This is part of the initial assessment phase, not an evaluation metric. *Number of postpartum services availed* - This is an **output/utilization indicator** that measures **service delivery** rather than program impact. - While important for monitoring service uptake, it does not directly evaluate the overall impact or effectiveness of family planning on birth rates or family size decisions. - Output indicators measure what was done, not the effect achieved. *Change in behaviour of people* - While behavioral changes (e.g., increased contraceptive use) are important, this option is too **broad and vague** to serve as a specific measurable indicator. - This could be considered a **process or intermediate outcome indicator** but is not a direct measure of program impact. - Changes in family size are a more concrete and quantifiable outcome reflecting the combined effect of behavioral changes.

Q: All of the following statements are correct about vasectomy EXCEPT:

It increases the incidence of testicular cancer. ***It increases the incidence of testicular cancer*** - Research has consistently shown **no causal link** between vasectomy and an increased risk of testicular cancer. - The reported incidence of testicular cancer in men who have undergone vasectomy is similar to that in the general population. *No Scalpel Vasectomy (NSV) was first developed in China.* - The **no-scalpel vasectomy (NSV)** technique was indeed developed in China by Dr. Li Shunqiang in 1974. - This method involves a smaller puncture incision rather than a traditional scalpel incision, leading to fewer complications. *It is less time consuming than tubectomy* - Vasectomy is generally a **simpler, less invasive, and quicker procedure** than tubectomy (female sterilization). - Tubectomy often requires general anesthesia and a more complex surgical approach, making it more time-consuming overall. *Addition contraception should be used for 3 months after vasectomy* - It takes approximately **3 months or 20 ejaculations** for all residual sperm to be cleared from the reproductive tract after a vasectomy. - Therefore, additional contraception is crucial during this period until a **sperm analysis (semen analysis)** confirms azoospermia (absence of sperm).

Q: Which one of the following statements about male sterilization is NOT true?

It is performed under general anaesthesia. ***It is performed under general anaesthesia*** - **Vasectomies** are most commonly performed in an outpatient setting under a **local anaesthetic**, not general anaesthesia. - The procedure involves minimal discomfort, and the patient remains awake, reducing risks associated with general anaesthesia. *It is safer and less expensive* - **Male sterilization (vasectomy)** is generally considered safer than female sterilization (tubal ligation) due to its less invasive nature. - It is also typically less expensive due to the simpler outpatient procedure and local anaesthesia. *Most men develop antisperm antibodies* - After a vasectomy, a significant number of men (approximately 50-70%) develop **antisperm antibodies**. - These antibodies are usually not clinically significant but can interfere with fertility if a reversal is attempted. *It has a low failure rate* - **Vasectomy** is highly effective, with a very **low failure rate** once confirmed by a negative post-vasectomy semen analysis. - The failure rate is typically less than 1%, making it one of the most reliable forms of contraception.

Question 1

The difference between Type A and Type B sub centre as per Indian Public Health standards is in terms of:

Accepted Answer

Labour room or delivery facility

Answer

Staffing pattern

Answer

Location

Answer

Availability of drugs

Question 2

Which of the following Screening methods for Disease is the least useful?

Accepted Answer

Mass screening

Answer

Selective screening

Answer

High risk group screening

Answer

Multiphasic screening

Question 3

Which one of the following is an indicator for evaluation of impact of family planning?

Accepted Answer

Family size

Answer

Community needs assessment

Answer

Number of postpartum services availed

Answer

Change in behaviour of people

Question 4

All of the following statements are correct about vasectomy EXCEPT:

Accepted Answer

It increases the incidence of testicular cancer

Answer

No Scalpel Vasectomy (NSV) was first developed in China.

Answer

It is less time consuming than tubectomy

Answer

Additional contraception should be used for 3 months after vasectomy

Question 5

Which one of the following statements about male sterilization is NOT true?

Accepted Answer

It is performed under general anaesthesia

Answer

It is safer and less expensive

Answer

Most men develop antisperm antibodies

Answer

It has a low failure rate

UPSC-CMS 2018 — Community Medicine