UPSC-CMS 2020 - Community Medicine Practice Questions

Q: In the context of NCD prevention and control in India, the extent of relative reduction in household use of solid fuels as a primary source of energy for cooking by 2025 is targeted at:

50 %. ***50 %*** - The **WHO Global Action Plan for Prevention and Control of NCDs 2013-2020** includes voluntary global targets, which India has adopted through its **National Action Plan for NCDs**. - Target 5 of this action plan addresses environmental risk factors and aims for a **50% relative reduction** in household use of solid fuels as a primary source of energy for cooking by 2025. - This target is aligned with efforts to improve **indoor air quality** and reduce the burden of **respiratory and cardiovascular NCDs** associated with solid fuel combustion and household air pollution. *40 %* - While significant, a **40% reduction** is less ambitious than the established national target for solid fuel use reduction adopted from WHO's voluntary global targets. - This figure does not correspond to the specific goal outlined in India's NCD prevention strategies for 2025 regarding solid fuels. *60 %* - A **60% reduction** would be a more aggressive target, exceeding the current official target set for 2025 in the context of NCD prevention. - While desirable for public health impact, it is not the officially stated target adopted by India from the WHO Global Action Plan for solid fuel use reduction by 2025. *30 %* - A **30% reduction** represents a less ambitious target and would likely be insufficient to achieve the desired public health impact on NCDs related to indoor air pollution. - This figure falls short of the adopted national health policy goals for household solid fuel reduction by 2025 under the NCD action framework.

Q: Consider the following criteria which may indicate elimination of lymphatic filariasis in a community: 1. When lymphatic filariasis ceases to be a public health problem in the community 2. When the number of microfilaria carriers declines to 1.5 % within the community 3. When children born in the community after the initiation of elimination programme are free from circulating antigenaemia Which of the criteria stated above hold true?

1, 2 and 3. ***1, 2 and 3*** - All three criteria reflect the **WHO framework for elimination of lymphatic filariasis** as a public health problem. - **Criterion 1**: Represents the overarching goal that the disease burden and transmission have been reduced such that it no longer poses a significant public health threat in the community. - **Criterion 2**: A **microfilaria carrier rate < 1-1.5%** indicates substantial reduction in active infection and transmission potential in the population. - **Criterion 3**: **Transmission Assessment Survey (TAS)** criteria include demonstrating that children born after program initiation are free from circulating filarial antigen (< 2% antigen prevalence in 6-7 year age group), confirming **interruption of transmission**. - Together, these criteria provide epidemiological, clinical, and transmission-based evidence of elimination. *1 and 3 only* - This option incorrectly excludes the **decline in microfilaria carrier prevalence** as a criterion. - Reduction in **microfilaremia prevalence** is a critical epidemiological indicator showing decreased infection reservoir and reduced transmission potential in the community. *1 and 2 only* - This option incorrectly excludes the criterion related to **children being free from circulating antigenaemia**. - The **TAS (Transmission Assessment Survey)** uses antigen testing in children as the primary tool to verify interruption of transmission, making this criterion essential for confirming elimination. *2 and 3 only* - This option excludes the overarching criterion that **lymphatic filariasis ceases to be a public health problem**. - While specific measurable criteria (2 and 3) are important, the overall assessment that the disease no longer constitutes a public health problem remains a fundamental elimination indicator.

Q: Hold over time of cold chain equipment depends on all of the following factors EXCEPT:

Types of vaccines kept. ***Types of vaccines kept*** - The **type of vaccine** stored does not directly influence how long the cold chain equipment can maintain its temperature. - The physical parameters of the equipment and its contents, not the biological nature of the vaccines, determine the hold-over time. *Condition of icepack lining* - The **integrity and condition of icepack lining** are crucial as damaged linings can lead to faster melting of ice, reducing the hold-over time. - A good lining ensures optimal insulation and prolonged effectiveness of the icepacks in maintaining cold temperatures. *Ambient temperature* - **Higher ambient temperatures** will naturally cause the cold chain equipment to warm up more quickly, thus reducing its hold-over time. - Conversely, lower ambient temperatures will extend the period for which the equipment can maintain the required temperature range. *Quantity of vaccines kept* - An **increased quantity of vaccines (or other contents)** within the cold chain equipment can influence the hold-over time, particularly if they are not pre-cooled. - The thermal mass of the contents can either help maintain temperature if pre-cooled or absorb cold if warmer, affecting the equilibrium and duration of optimal temperature.

Q: Which of the following statements regarding Physical Quality of Life Index (PQLI) are correct? 1. It consolidates infant mortality, life expectancy at age one, and literacy 2. It does not measure economic growth but measures the result of economic policies 3. For each component, the performance of individual countries is placed on a scale of 0-100 Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The **Physical Quality of Life Index (PQLI)** indeed consolidates **infant mortality**, **life expectancy at age one**, and **literacy rate** as its three core components, reflecting key aspects of well-being. - PQLI specifically aims to measure the **outcomes of economic policies** on human well-being rather than economic growth itself, making it a valuable tool for assessing social progress. The PQLI scales each component from **0 to 100**, where 0 represents the worst performance (e.g., highest infant mortality) and 100 represents the best (e.g., lowest infant mortality), allowing for standardized comparison across countries. *1 and 2 only* - This option incorrectly omits the third correct statement regarding the **0-100 scaling** of individual components, which is a fundamental aspect of how the PQLI is calculated and interpreted. - While statements 1 and 2 are accurate individually, they do not encompass all the correct information provided in the question's premise. *1 and 3 only* - This option omits the correct statement that PQLI measures the **results of economic policies** rather than economic growth, which is a crucial distinguishing characteristic of the index. - While statements 1 and 3 are correct, they do not fully capture all the accurate descriptions of the PQLI. *2 and 3 only* - This option incorrectly excludes the first statement, which correctly identifies the three core components of the PQLI: **infant mortality**, **life expectancy at age one**, and **literacy**. - Without including the components, the understanding of PQLI is incomplete, despite accurately describing other features.

Q: Disability-adjusted life years (DALYs) include:

Both YLL and YLD. ***Both YLL and YLD*** - **DALYs (Disability-Adjusted Life Years)** are a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death. - They are calculated as the sum of **Years of Life Lost (YLL)** due to premature mortality and **Years Lost due to Disability (YLD)** for people living with a health condition or its consequences. *Neither YLL nor YLD* - This statement is incorrect because DALYs are explicitly designed to integrate both premature mortality (YLL) and the impact of non-fatal health outcomes (YLD). - Excluding both components would render DALYs meaningless as a comprehensive health metric. *Years lost to disability (YLD)* - While **YLD** is a crucial component of DALYs, focusing solely on YLD would ignore the impact of premature mortality. - A healthy life lost due to early death is as significant as years living with a disability in assessing disease burden. *Years of lost life (YLL)* - While **YLL** is an essential component, considering only YLL would overlook the burden of morbidity and disability. - Many chronic diseases cause significant disability and reduced quality of life without necessarily leading to premature death, which YLD accounts for.

Q: Which of the following are health care delivery indicators? 1. Population per trained birth attendant 2. Population per health/sub centre 3. Doctor-nurse ratio Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - All three indicators (Population per trained birth attendant, Population per health/sub centre, and Doctor-nurse ratio) are direct measures reflecting the **availability and distribution of healthcare resources** and personnel. - These metrics help assess the **accessibility and quality** of healthcare delivery within a population. *2 and 3 only* - This option incorrectly excludes "Population per trained birth attendant," which is a crucial indicator of access to **maternal and child healthcare services**. - While "Population per health/sub centre" and "Doctor-nurse ratio" are important, neglecting birth attendants provides an incomplete picture of healthcare delivery. *1 and 2 only* - This option misses the "Doctor-nurse ratio," which is vital for evaluating the **skill mix and capacity** of the healthcare workforce. - An adequate doctor-nurse ratio ensures effective patient care and **resource utilization** within facilities. *1 and 3 only* - This option excludes "Population per health/sub centre," a key indicator of the **physical infrastructure and primary care accessibility** for a population. - The presence and reach of health centers are fundamental to delivering basic healthcare services to the community.

Q: Which of the following key action areas are incorporated in the Ottawa Charter? 1. Building healthy public policy 2. Strengthening community action for health 3. Reorienting health services Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The **Ottawa Charter for Health Promotion** delineates five key action areas, all of which are crucial for health improvement. These include **building healthy public policy**, **creating supportive environments**, **strengthening community action**, **developing personal skills**, and **reorienting health services**. - This option correctly identifies three of the five key action areas, demonstrating a comprehensive understanding of the Charter's framework. *1 and 2 only* - While **building healthy public policy** and **strengthening community action** are indeed key areas in the Ottawa Charter, this option is incomplete as it omits other important action areas. - The Charter's framework is holistic, requiring the integration of all five areas for effective health promotion. *2 and 3 only* - This option correctly includes **strengthening community action** and **reorienting health services**, but it fails to mention other fundamental aspects. - Focusing on only two of the areas would lead to an incomplete strategy for health promotion as envisioned by the Ottawa Charter. *1 and 3 only* - This option correctly identifies **building healthy public policy** and **reorienting health services** but overlooks other essential components of the Ottawa Charter. - A full understanding of the Charter requires recognition of all five action areas rather than just a subset.

Q: Under Chapter XXI of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), lifestyle-related problems fall under which of the following code range?

Z 72.0 – Z 72.5. ***Z 72.0 – Z 72.5*** - This **ICD-10 Chapter XXI** code range is specifically assigned to **problems related to lifestyle**, which includes issues such as unhealthy diet, lack of physical activity, and stress. - These codes are used to identify factors influencing health status and contact with health services, contributing to a holistic view of patient care. *U 50.0 – U 50.5* - The **"U" code series** (U00-U99) in ICD-10 is generally reserved for **codes for special purposes**, such as provisional assignment of new diseases of uncertain etiology or for research purposes. - This range does not categorize lifestyle-related problems; instead, it is designated for emerging or yet-to-be-classified conditions. *U 10.0 – U 10.5* - Similar to the previous option, this **"U" code range** is part of the category for **codes for special purposes** and is not used for classifying lifestyle factors. - These codes are typically used for emergency situations, specific research projects, or temporary classifications. *Z 10.0 – Z 10.5* - The **"Z" codes** (Z00-Z99) in ICD-10 are generally used for **factors influencing health status and contact with health services**, but the Z10-Z13 range is specifically for **routine general health examinations** of defined subpopulations. - This range does not classify general lifestyle-related problems but rather specific types of health screenings or check-ups.

Q: Which of the following diseases are spread by airborne transmission? 1. Influenza 2. Chicken pox 3. Q-fever 4. Psittacosis Select the correct answer using the code given below:

3 and 4 only. ***3 and 4 only*** - **Q-fever (Coxiella burnetii)** and **Psittacosis (Chlamydia psittaci)** are true **airborne diseases** that spread via droplet nuclei or dust particles <5 μm that remain suspended in air and can travel long distances. - **Q-fever** spreads through inhalation of contaminated aerosols from infected animal products (particularly during parturition in livestock). - **Psittacosis** spreads via inhalation of aerosolized dried bird droppings or respiratory secretions from infected birds. - **Airborne transmission** requires particles small enough to remain suspended in air for extended periods and travel beyond 1-2 meters. *1, 2, 3 and 4* - This option is incorrect because **Influenza** is classified as a **droplet-borne disease**, not airborne. - **Influenza** spreads primarily through large respiratory droplets (>5 μm) that travel <1 meter and settle quickly, requiring close contact for transmission. - **Chickenpox**, while highly contagious, has both airborne and direct contact routes, but the primary emphasis in this question context should be on strict airborne diseases (Q-fever and Psittacosis). - The distinction between droplet and airborne transmission is critical for infection control measures (surgical masks vs N95 respirators). *1 and 3 only* - This option is incorrect as **Influenza** is not an airborne disease but rather spreads via droplet transmission. - While **Q-fever** is correctly identified as airborne, including Influenza makes this combination incorrect. - **Psittacosis** is also airborne and should be included. *1 and 4 only* - This option is incorrect because **Influenza** does not meet the criteria for airborne transmission. - While **Psittacosis** is correctly identified, the inclusion of Influenza and exclusion of Q-fever makes this choice inaccurate. - Both Q-fever and Psittacosis are classic examples of airborne zoonotic infections.

Q: Endemic ascites occurs due to:

Naturally occurring toxin. ***Naturally occurring toxin*** - Endemic ascites, specifically **hepatic veno-occlusive disease (HVOD)** leading to ascites, is primarily caused by **pyrrolizidine alkaloids**. - These are **naturally occurring toxins** found in certain plants (e.g., *Crotalaria*, *Heliotropium*) that contaminate food supplies, particularly in endemic regions. *Fungal toxin* - While some fungal toxins (e.g., aflatoxins) are hepatotoxic, they are more commonly associated with **hepatocellular carcinoma** or acute liver failure rather than endemic ascites due to veno-occlusive disease. - HVOD is specifically linked to plant-derived toxins. *Bacterial toxin* - Bacterial toxins are generally not implicated in the pathogenesis of **endemic ascites** through the mechanism of **veno-occlusive disease**. - Bacterial infections can cause liver damage or sepsis, but not typically the specific form of ascites seen in endemic situations. *Viral toxin* - Viruses, such as hepatitis viruses, can cause chronic liver disease and ascites, but this is due to **viral replication and immune-mediated damage**, not a viral toxin in the traditional sense. - Endemic ascites due to toxins refers specifically to exogenous, non-biological toxins.

Question 1

In the context of NCD prevention and control in India, the extent of relative reduction in household use of solid fuels as a primary source of energy for cooking by 2025 is targeted at:

Accepted Answer

50 %

Answer

40 %

Answer

60 %

Answer

30 %

Question 2

Consider the following criteria which may indicate elimination of lymphatic filariasis in a community:

1. When lymphatic filariasis ceases to be a public health problem in the community

2. When the number of microfilaria carriers declines to 1.5 % within the community

3. When children born in the community after the initiation of elimination programme are free from circulating antigenaemia Which of the criteria stated above hold true?

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 3

Hold over time of cold chain equipment depends on all of the following factors EXCEPT:

Accepted Answer

Types of vaccines kept

Answer

Condition of icepack lining

Answer

Ambient temperature

Answer

Quantity of vaccines kept

Question 4

Which of the following statements regarding Physical Quality of Life Index (PQLI) are correct?

1. It consolidates infant mortality, life expectancy at age one, and literacy
2. It does not measure economic growth but measures the result of economic policies
3. For each component, the performance of individual countries is placed on a scale of 0-100

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Question 5

Disability-adjusted life years (DALYs) include:

Accepted Answer

Both YLL and YLD

Answer

Neither YLL nor YLD

Answer

Years lost to disability (YLD)

Answer

Years of lost life (YLL)

Question 6

Which of the following are health care delivery indicators?

1. Population per trained birth attendant
2. Population per health/sub centre
3. Doctor-nurse ratio

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 3 only

Question 7

Which of the following key action areas are incorporated in the Ottawa Charter?

1. Building healthy public policy
2. Strengthening community action for health
3. Reorienting health services

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 8

Under Chapter XXI of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), lifestyle-related problems fall under which of the following code range?

Accepted Answer

Z 72.0 – Z 72.5

Answer

U 50.0 – U 50.5

Answer

U 10.0 – U 10.5

Answer

Z 10.0 – Z 10.5

Question 9

Which of the following diseases are spread by airborne transmission?

1. Influenza
2. Chicken pox
3. Q-fever
4. Psittacosis

Select the correct answer using the code given below:

Accepted Answer

3 and 4 only

Answer

1 and 3 only

Answer

1 and 4 only

Answer

1, 2, 3 and 4

Question 10

Endemic ascites occurs due to:

Accepted Answer

Naturally occurring toxin

Answer

Fungal toxin

Answer

Bacterial toxin

Answer

Viral toxin

UPSC-CMS 2020 — Community Medicine