UPSC-CMS 2018 Practice Questions

Q: As per biomedical waste management rule 2016 the metallic body implants should be discarded in which of the following?

Separate collection system. ***Separate collection system*** - Metallic body implants, due to their nature and potential for **recycling or specific disposal methods**, are to be segregated into a **separate collection system** as per BMW Rule 2016. - This ensures they do not contaminate other biomedical waste streams and can be handled appropriately, often involving **recovery of precious metals**. *Red colored non-chlorinated plastic bag* - This category is typically for **reusable contaminated waste** such as tubing, catheters, IV sets, and urine bags, which are often plastic. - Metallic implants are not typically suitable for disposal in red bags because they are not meant for incineration or autoclaving in the same manner as these plastic items. *Yellow colored non-chlorinated plastic bag* - Yellow bags are used for **human anatomical waste**, animal anatomical waste, soiled waste, expired or discarded medicines, and **chemical waste**. - Metallic implants do not fall into any of these categories and require a different disposal method due to their material composition and potential for recycling. *Card board box with blue colored marking* - Blue or white translucent boxes/containers are designated for **sharps**, including needles, syringes with fixed needles, and blades, as well as broken or contaminated glass. - While metallic, body implants are not considered "sharps" in the same context, nor are they typically discarded in cardboard, which is unsuitable for their weight and specific disposal requirements.

Q: Which of the following is NOT a quantitative method in the management of health services?

Management by objectives. ***Management by objectives*** - **Management by objectives (MBO)** is a strategic management model that aims to improve organizational performance by clearly defining objectives that are agreed upon by both management and employees. - While MBO involves setting **quantifiable goals** and measurable outcomes, the methodology itself is primarily a **qualitative management philosophy** focused on communication, participation, integration, and alignment rather than mathematical modeling or statistical analysis. - Unlike true quantitative methods, MBO does not employ **mathematical algorithms, computational techniques, or statistical modeling** for decision-making—making it the correct answer to this "NOT quantitative" question. *System analysis* - **System analysis** is a quantitative method used to study and optimize complex systems by breaking them down into components to understand their interactions and behavior. - It involves **mathematical modeling, simulation, operations research, and data analysis** to identify bottlenecks, improve efficiency, and make data-driven decisions. *Network analysis* - **Network analysis** is a quantitative technique using mathematical algorithms to model and analyze relationships and flows within a system. - Applications include **project management (PERT/CPM)**, critical path method, resource allocation using computational techniques, and optimization algorithms. *Planning programming budgeting system* - **Planning Programming Budgeting System (PPBS)** is a comprehensive, quantitative approach to government planning and budgeting that links policy planning to resource allocation through numerical analysis. - It involves setting long-term goals, analyzing alternative programs using **cost-effectiveness analysis, benefit-cost ratios**, and allocating resources based on quantitative economic evaluation.

Q: Manual Vacuum Aspiration (MVA) that has been introduced in primary health centres helps in reducing which of the following indices?

Maternal mortality. ***Maternal mortality*** - **Manual Vacuum Aspiration (MVA)** is a safe and effective method for managing **incomplete abortion** and **early pregnancy loss**, which are significant causes of **maternal mortality**, especially when performed in primary healthcare settings. - By providing timely and accessible care for these complications, MVA helps prevent severe complications like hemorrhage and sepsis that can lead to a mother's death. *Preterm mortality* - Preterm mortality is primarily related to **preterm birth** and its associated complications, such as respiratory distress syndrome and infection. - MVA is a procedure for managing early pregnancy loss or incomplete abortion and does not directly impact the incidence or outcomes of preterm births. *Neonatal mortality* - Neonatal mortality refers to deaths of infants within the first 28 days of life, often due to issues like **birth asphyxia**, **prematurity**, and **neonatal infections**. - MVA addresses complications of pregnancy for the mother and does not directly relate to the common causes of death in newborns. *Infant mortality* - Infant mortality encompasses deaths from birth up to one year of age, including causes such as **sudden infant death syndrome (SIDS)**, congenital anomalies, and infections occurring after the neonatal period. - While improved maternal health can indirectly benefit infant survival, MVA directly tackles maternal health crises rather than primary causes of infant death.

Q: The agreement (yes/no) between two observers is statistically measured by:

Kappa coefficient. **Kappa coefficient** - The **kappa coefficient** measures the **inter-rater agreement** for qualitative items, such as a "yes/no" decision, beyond what would be expected by chance. - It takes into account the observed agreement and the agreement expected by chance, providing a more robust measure of agreement than simple percentage agreement. *Correlation coefficient* - The **correlation coefficient** measures the **strength and direction of a linear relationship between two quantitative variables**, not the agreement between two observers on a categorical outcome. - It is used for continuous data and indicates how closely data points fit a linear regression line. *Sensitivity* - **Sensitivity** is a measure of a test's ability to correctly identify individuals who **have a disease (true positive rate)**. - It is not used to assess the agreement between two observers but rather the performance of a diagnostic test against a gold standard. *Specificity* - **Specificity** is a measure of a test's ability to correctly identify individuals who **do not have a disease (true negative rate)**. - Like sensitivity, it evaluates the performance of a diagnostic test and not the consistency of observations between two different raters.

Q: How many postnatal visits should be made by the ANM to the house of a low birth weight baby?

4. ***4*** - For a **low birth weight (LBW) baby**, as per traditional guidelines, an **Auxiliary Nurse Midwife (ANM)** makes postnatal home visits on **day 1, day 3, day 7, and day 14** after birth = **4 visits**. - This represents the **minimum essential visits** during the critical first two weeks for monitoring growth, feeding, and identifying complications. - **Note**: Current HBNC guidelines recommend at least 6 visits (adding day 28 and 42) for all newborns, with more intensive follow-up for LBW babies. *8* - Eight visits are **not the standard recommendation** for a low birth weight baby's postnatal care by an ANM. - While more frequent follow-ups may be clinically indicated in some complex cases, it is not the general guideline for all LBW babies. *2* - Two postnatal visits are **insufficient** for proper monitoring of a **low birth weight baby**, who is at higher risk for health issues. - This number of visits would miss critical periods for identifying complications or providing essential care. *6* - Six postnatal visits represent the **current HBNC (Home Based Newborn Care) guideline** for all newborns (days 1, 3, 7, 14, 28, 42). - However, the answer key for this UPSC-CMS 2018 question indicates **4 visits** as the expected answer, likely reflecting guidelines at that time.

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: Consider the following hemodynamic changes occurring during pregnancy: 1. Increase in cardiac output 2. Increase in stroke volume 3. Increase in colloid oncotic pressure 4. Increase in pulse rate Which of the statements given above are correct?

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1: Increase in cardiac output** - CORRECT - Cardiac output increases by **30-50% during pregnancy**, peaking at 28-32 weeks - This increase is driven by increased blood volume (40-50% increase), higher metabolic demands, and the need to perfuse the uteroplacental unit **Statement 2: Increase in stroke volume** - CORRECT - Stroke volume increases by **20-30% during pregnancy**, particularly in the first and second trimesters - This contributes significantly to the overall increase in cardiac output alongside increased heart rate **Statement 3: Increase in colloid oncotic pressure** - INCORRECT - Colloid oncotic pressure actually **decreases during pregnancy** from normal values of 25-28 mmHg to approximately 22-24 mmHg - This occurs due to **hemodilution** (plasma volume increases more than red cell mass) and **decreased serum albumin concentration** (dilutional hypoalbuminemia) - The reduced oncotic pressure contributes to the **increased tendency for peripheral edema** in pregnant women **Statement 4: Increase in pulse rate** - CORRECT - Heart rate increases by **10-20 beats per minute** during pregnancy - This tachycardia helps maintain adequate cardiac output to meet the increased circulatory demands of pregnancy *Incorrect Options:* *1, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases, not increases *2, 3 and 4* - Statement 3 is incorrect as colloid oncotic pressure decreases during pregnancy *1, 2 and 3* - Statement 3 is incorrect; colloid oncotic pressure falls due to hemodilution and hypoalbuminemia

Q: When should breastfeeding be initiated to an infant born via a normal delivery?

Within one hour of birth. ***Within one hour of birth*** - Initiating breastfeeding within the first hour of birth is recommended by global health organizations like WHO and UNICEF to optimize **breastfeeding success** and ensure the infant receives vital **colostrum**. - Early initiation helps establish **successful lactation** for the mother and provides the infant with immediate immunological benefits and nutritional support. - The guideline "within one hour" means breastfeeding should be initiated **as soon as possible** during this window, with earlier being preferable. *After 4 hours of birth* - Delaying breastfeeding beyond four hours can miss the critical window for establishing good feeding practices and the infant's **initial suckling reflex**. - This delay might lead to difficulties in latching and **lower rates of exclusive breastfeeding** in the long term. *Within half an hour* - Initiating breastfeeding within half an hour is **equally appropriate** and falls well within the WHO-recommended timeframe of one hour. - This option is not incorrect per se, but "within one hour" is the **standard guideline** most commonly cited in medical literature and policy documents. - Many institutions actually aim for breastfeeding within 30 minutes as a **best practice goal**. *Within 2–4 hours of birth* - This window is acceptable if there are initial medical concerns or delays, but it is **not the ideal time** for routine initiation of breastfeeding. - Waiting beyond one hour can reduce the infant's **alertness and readiness** to feed effectively, potentially leading to challenges.

Question 1

As per biomedical waste management rule 2016 the metallic body implants should be discarded in which of the following?

Accepted Answer

Separate collection system

Answer

Red colored non-chlorinated plastic bag

Answer

Yellow colored non-chlorinated plastic bag

Answer

Card board box with blue colored marking

Question 2

Which of the following is NOT a quantitative method in the management of health services?

Accepted Answer

Management by objectives

Answer

System analysis

Answer

Network analysis

Answer

Planning programming budgeting system

Question 3

Manual Vacuum Aspiration (MVA) that has been introduced in primary health centres helps in reducing which of the following indices?

Accepted Answer

Maternal mortality

Answer

Preterm mortality

Answer

Neonatal mortality

Answer

Infant mortality

Question 4

The agreement (yes/no) between two observers is statistically measured by:

Accepted Answer

Kappa coefficient

Answer

Correlation coefficient

Answer

Sensitivity

Answer

Specificity

Question 5

How many postnatal visits should be made by the ANM to the house of a low birth weight baby?

Accepted Answer

4

Answer

8

Answer

2

Answer

6

Question 6

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 7

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 8

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 9

Consider the following hemodynamic changes occurring during pregnancy:

1. Increase in cardiac output
2. Increase in stroke volume
3. Increase in colloid oncotic pressure
4. Increase in pulse rate
Which of the statements given above are correct?

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 10

When should breastfeeding be initiated to an infant born via a normal delivery?

Accepted Answer

Within one hour of birth

Answer

After 4 hours of birth

Answer

Within half an hour

Answer

Within 2–4 hours of birth

UPSC-CMS 2018

Community Medicine

Obstetrics and Gynecology

Pediatrics