UPSC-CMS 2021 - Community Medicine Practice Questions

Q: The most sensitive indicator of environmental iodine deficiency is

Urinary iodine excretion. ***Urinary iodine excretion*** - **Urinary iodine excretion** reflects recent dietary iodine intake, making it the most sensitive and commonly used indicator for assessing current iodine status in a population. - A median urinary iodine concentration of less than 100 μg/L in a population indicates **iodine deficiency**. *Prevalence of neonatal hypothyroidism* - While reflecting severe iodine deficiency, **neonatal hypothyroidism** occurs later in the deficiency cascade and is not sensitive enough to detect mild to moderate deficiencies early. - It would indicate a long-standing, significant deficiency rather than an early environmental change. *Prevalence of cretinism* - **Cretinism** is a severe and irreversible consequence of prolonged and profound iodine deficiency during critical periods of development (fetal and early infancy). - Its prevalence indicates severe, chronic iodine deficiency and is not a sensitive marker for early or mild environmental iodine deficiency. *Prevalence of goitre* - The **prevalence of goitre** (enlarged thyroid gland) can be used as an indicator of iodine deficiency, but it is less sensitive than urinary iodine excretion. - Goitre develops over a longer period in response to chronic iodine deficiency and may not reflect recent changes in environmental iodine levels.

Q: Which one of the following is a famous large prospective study that helped establish risk factors for coronary heart disease ?

Framingham study. ***Framingham study*** - The **Framingham Heart Study** is a landmark **long-term prospective cohort study** that began in 1948 in Framingham, Massachusetts, to identify common factors or characteristics that contribute to **cardiovascular disease (CVD)**. - This study has been instrumental in identifying major **CVD risk factors** such as high blood pressure, high cholesterol, smoking, obesity, diabetes, and physical inactivity. *Pittsburgh study* - While Pittsburgh is a hub for medical research, there isn't a single "Pittsburgh study" that holds the same widespread recognition for establishing **cardiovascular risk factors** as the Framingham study. - Various studies from Pittsburgh institutions might contribute to cardiovascular research, but none are as globally recognized for this specific contribution. *Adelaide study* - The "Adelaide study" generally refers to research conducted in Adelaide, Australia, which has produced various medical findings. - However, it is not known as a prominent, large-scale prospective study specifically designed to establish widespread **coronary heart disease risk factors** in the same league as the Framingham Heart Study. *Birmingham study* - Many medical studies are conducted in Birmingham (both in the UK and USA), but there isn't one definitive "Birmingham study" with the historical significance and impact on identifying **coronary heart disease risk factors** that the Framingham study has. - Research from Birmingham typically contributes to various medical fields, but not specifically as the primary source for these fundamental risk factor discoveries.

Q: Of the following international agencies, which agency has been assisting India in development of friendly models of sanitation ?

SIDA (Swedish International Development Agency). ***SIDA (Swedish International Development Agency)*** - **SIDA** has been a major development partner with India in the **water and sanitation sector** - Provided significant support for developing **community-friendly sanitation models**, including community-led total sanitation (CLTS) approaches - Their assistance included **technical expertise, financial aid, and capacity building** for sustainable sanitation infrastructure *CARE (Cooperative for Assistance and Relief Everywhere)* - **CARE** is a major international humanitarian organization focused primarily on **food security, health, and emergency relief** - While involved in community development, not specifically known for developing sanitation models in India *DANIDA (Danish Development Agency)* - **DANIDA's** major engagements in India have focused on **renewable energy, environmental protection, and poverty reduction** - While supporting general water and sanitation projects, not the leading agency for developing specific sanitation models in India *Ford Foundation* - A philanthropic organization focused on **social justice, education, and civil society building** - In India, primarily supports **NGOs and policy reforms** rather than direct development of sanitation infrastructure

Q: Which one among the following was used for measuring economic status of households, in the National Family Health Survey-III (NFHS-III) ?

Wealth index. ***Wealth index*** - The **National Family Health Survey-III (NFHS-III)** used a **wealth index** as a primary measure to assess the economic status of households. - This index is a composite measure derived from household assets and housing characteristics. *Lifestyle index* - The term "lifestyle index" is a general concept and was not the specific, officially recognized tool for measuring economic status in NFHS-III. - While lifestyle aspects can be indicators of economic status, they are typically integrated into broader indices like the wealth index rather than being a standalone measure in this context. *Pareek scale* - The **Pareek scale** was not used in NFHS-III for measuring household economic status. - The Pareek scale is a socio-economic status scale that primarily focuses on **occupational prestige** and education, and it is less commonly used for national health surveys in India compared to asset-based indices. *Kuppuswamy's scale* - **Kuppuswamy's Socioeconomic Status Scale** was not used in the NFHS-III survey. - This scale is an older and more commonly used tool in clinical and research settings within India, but it primarily classifies families based on **education** and **occupation** of the head of the family, and family income.

Q: In a town with one lakh population (1,00,000) there are a total of 2500 live births in a year. There were 75 total deaths of children before the age of one month, total 200 deaths before the age of one year, and a total 300 deaths before the age of three years. Which of the following statements regarding Infant Mortality Rate (IMR) of the town for the given year are correct? 1. The denominator is 1,00,000 2. The IMR of the town is higher than the current national average of IMR for India 3. The numerator is the number of children dying before the age of one month 4. The IMR of the town is 80 per 1000 live births

2 and 4 only. **IMR Formula:** Infant Mortality Rate = (Number of deaths under 1 year of age / Total live births in the same year) × 1000 **Analysis of each statement:** **Statement 1:** "The denominator is 1,00,000" - **INCORRECT** - The denominator for IMR is the **total number of live births (2,500)**, not the total population (1,00,000) - Population is not used in IMR calculation **Statement 2:** "The IMR of the town is higher than the current national average of IMR for India" - **CORRECT** - Calculated IMR = (200 deaths / 2,500 live births) × 1000 = **80 per 1000 live births** - India's current national IMR ≈ 27-28 per 1000 live births (as of 2020-2022 data) - 80 is significantly higher than the national average **Statement 3:** "The numerator is the number of children dying before the age of one month" - **INCORRECT** - The numerator for IMR is **deaths before the age of one year (200)**, not before one month - Deaths before one month (75) constitute the numerator for **Neonatal Mortality Rate**, not IMR **Statement 4:** "The IMR of the town is 80 per 1000 live births" - **CORRECT** - Calculation: (200 / 2,500) × 1000 = 80 per 1000 live births - This is the accurate IMR for the town ***Correct Answer: 2 and 4 only*** - Both statements 2 and 4 are correct as shown above - Statements 1 and 3 contain fundamental errors about the IMR formula components

Q: Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Janani Suraksha Scheme. ***Janani Suraksha Yojana (JSY)*** - This is the **flagship national scheme** launched in 2005 under the National Rural Health Mission (now National Health Mission). - It provides **cash incentives** to pregnant women for choosing to deliver in health facilities and to ASHA workers for promoting institutional deliveries. - Its primary objective is to reduce **maternal and neonatal mortality** by increasing institutional deliveries and ensuring access to essential obstetric care. *Ayushman Bharat Scheme* - This is a national health protection scheme (Pradhan Mantri Jan Arogya Yojana) that provides **health insurance coverage** up to ₹5 lakhs per family for secondary and tertiary care hospitalization. - While it contributes to overall health including maternal health, its primary focus is **broader healthcare access** rather than specifically promoting safe motherhood or reducing maternal mortality through institutional delivery incentives. *Mamta Scheme* - While several state-level maternal and child health programs exist under similar names (e.g., Bihar's MAMTA scheme), there is no widely recognized **national scheme** called "Mamta Scheme" that serves as the primary program for safe motherhood. - The **Janani Suraksha Yojana** remains the principal national initiative for this objective. *Vande Mataram Scheme* - This refers to voluntary initiatives encouraging private practitioners to provide maternal health services. - While supportive of safe motherhood, it is **not the primary comprehensive national scheme** with structured financial incentives and widespread implementation for reducing maternal mortality like JSY.

Q: A 2 year old child has presented for vaccination, who has never been vaccinated earlier. As per the Universal Immunization Program, which vaccines will be administered to the child on the first visit?

BCG, DPT-I and Measles vaccine. ***BCG, DPT-I and Measles vaccine*** - As per the **Universal Immunization Program (UIP)** for a previously unvaccinated child, **all age-appropriate vaccines** should be administered on the first visit. - At 2 years of age, the child is eligible for **BCG**, the first dose of **DPT (DPT-I)**, and **Measles vaccine** (if no prior measles vaccination, which is the case here). *BCG and Hepatitis B vaccine* - While **BCG** is appropriate, **Hepatitis B vaccine** is typically given at birth and then subsequent doses at 6, 10, and 14 weeks as part of the primary series. A 2-year-old would likely need further doses of DPT and Measles. - This option misses other crucial age-appropriate vaccines like **DPT-I** and the **Measles vaccine** for a 2-year-old child. *DPT-I vaccine only* - Administering only **DPT-I** would result in missed opportunities for protection against **tuberculosis (BCG)** and **measles**, both of which are critical for a 2-year-old. - This approach does not follow the principle of providing **all age-appropriate vaccines** on the first contact with an unvaccinated child. *DPT-I and Hepatitis B vaccine* - This option correctly includes **DPT-I** but misses the essential **BCG** and **Measles vaccine** for a 2-year-old, which are crucial for this age group. - While Hepatitis B is important, the primary series would have been missed, and focusing solely on DPT-I and Hepatitis B for a 2-year-old is an incomplete vaccination schedule.

Q: DANIDA, the international aid agency of Denmark, is known for its assistance to which one of India’s National Health Programmes ?

National Blindness Control Programme. ***National Blindness Control Programme*** - **DANIDA (Danish International Development Agency)** has been a significant international partner providing funding and technical assistance to India’s **National Programme for Control of Blindness (NPCB)** since its inception. - This collaboration aimed at reducing the prevalence of blindness through various interventions, including **cataract surgeries**, development of eye care infrastructure, and training of personnel. *National Tuberculosis Control Programme* - The **National Tuberculosis Control Programme (NTP)**, later restructured as the Revised National Tuberculosis Control Programme (**RNTCP**), received substantial support from organizations such as the **World Bank**, Global Fund, and other bilateral agencies. - DANIDA's primary focus was not on the tuberculosis control program, though general health system strengthening could indirectly benefit all health programs. *National Deafness Control Programme* - The **National Programme for Prevention and Control of Deafness (NPPCD)** is a newer initiative compared to the other programs listed, and its international funding sources are typically distinct. - While international aid agencies often support health initiatives, DANIDA's specific historical and sustained involvement is not primarily with India's deafness control efforts. *National AIDS Control Programme* - The **National AIDS Control Programme (NACP)** has received significant international funding and technical support from organizations such as the **Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)**, **UNAIDS**, and the **World Bank**. - DANIDA's contributions have primarily been directed towards other health areas, with its major programmatic support in India being for the control of blindness.

Q: After attending a birthday party in a hostel around 50 students reported having loose stools, fever and a few reported vomiting. This outbreak can be identified as what type of outbreak ?

Common point source only. ***Common point source only*** - This outbreak shows all characteristics of a **common point source (point source) outbreak** where multiple individuals were exposed to the same contaminated source at a **single time and place** (the birthday party). - The symptoms (loose stools, fever, vomiting) all represent **clinical manifestations of food poisoning**, not evidence of secondary transmission. - Common point source outbreaks typically show a **sharp rise in cases followed by a rapid decline**, with all cases occurring within **one incubation period** of the exposure. - This is the classic pattern seen in **foodborne outbreaks** at events like parties, weddings, or gatherings. *Both propagated and common point source* - There is **no evidence of person-to-person transmission** or secondary cases in this scenario. - Vomiting is simply a **symptom of the foodborne illness**, not an indicator of propagated spread. - A mixed outbreak would require evidence of **successive waves of cases** beyond the initial exposure, which is not described here. *Common source continuous* - Continuous common source outbreaks occur when exposure to the contaminated source is **prolonged or intermittent** over time, creating a plateau in the epidemic curve. - This scenario describes a **single event** (birthday party) with acute exposure, not ongoing contamination. - Examples of continuous source outbreaks include contaminated water supplies or ongoing food contamination at a restaurant. *Propagated only* - Propagated outbreaks are characterized by **person-to-person transmission** leading to successive waves of cases over **multiple incubation periods**. - This scenario has a clear **point source exposure** (birthday party) as the initiating event, not person-to-person spread. - Examples of propagated outbreaks include measles, chickenpox, or other communicable diseases spreading through a population.

Question 1

The most sensitive indicator of environmental iodine deficiency is

Accepted Answer

Urinary iodine excretion

Answer

Prevalence of neonatal hypothyroidism

Answer

Prevalence of cretinism

Answer

Prevalence of goitre

Question 2

Which one of the following is a famous large prospective study that helped establish risk factors for coronary heart disease ?

Accepted Answer

Framingham study

Answer

Pittsburgh study

Answer

Adelaide study

Answer

Birmingham study

Question 3

Of the following international agencies, which agency has been assisting India in development of friendly models of sanitation ?

Accepted Answer

SIDA (Swedish International Development Agency)

Answer

CARE (Cooperative for Assistance and Relief Everywhere)

Answer

DANIDA (Danish Development Agency)

Answer

Ford Foundation

Question 4

Which one among the following was used for measuring economic status of households, in the National Family Health Survey-III (NFHS-III) ?

Accepted Answer

Wealth index

Answer

Lifestyle index

Answer

Pareek scale

Answer

Kuppuswamy’s scale

Question 5

In a town with one lakh population (1,00,000) there are a total of 2500 live births in a year. There were 75 total deaths of children before the age of one month, total 200 deaths before the age of one year, and a total 300 deaths before the age of three years. Which of the following statements regarding Infant Mortality Rate (IMR) of the town for the given year are correct?

1. The denominator is 1,00,000
2. The IMR of the town is higher than the current national average of IMR for India
3. The numerator is the number of children dying before the age of one month
4. The IMR of the town is 80 per 1000 live births

Accepted Answer

2 and 4 only

Answer

1, 2 and 4

Answer

1 and 3 only

Answer

2 only

Question 6

Which of the following schemes is primarily aimed at promoting safe motherhood and reducing maternal mortality in India?

Accepted Answer

Janani Suraksha Scheme

Answer

Ayushman Bharat Scheme

Answer

Mamta Scheme

Answer

Vande Mataram Scheme

Question 7

A 2 year old child has presented for vaccination, who has never been vaccinated earlier. As per the Universal Immunization Program, which vaccines will be administered to the child on the first visit?

Accepted Answer

BCG, DPT-I and Measles vaccine

Answer

BCG and Hepatitis B vaccine

Answer

DPT-I vaccine only

Answer

DPT-I and Hepatitis B vaccine

Question 8

Consider the following statements :

Statement-1 : In the National Immunization Program, BCG vaccine is given only on the left upper arm

Statement-2 : This is done to maintain uniformity and for helping surveyors in verifying receipt of the vaccine

Which one of the following is correct in respect of the above Statements ?

Accepted Answer

Both Statement-1 and Statement-2 are correct and Statement-2 is the correct explanation for Statement-1

Answer

Statement-1 is true but Statement-2 is false

Answer

Both Statement-1 and Statement-2 are correct and Statement-2 is not the correct explanation for Statement-1

Answer

Statement-2 is true but Statement-1 is false

Question 9

DANIDA, the international aid agency of Denmark, is known for its assistance to which one of India’s National Health Programmes ?

Accepted Answer

National Blindness Control Programme

Answer

National Tuberculosis Control Programme

Answer

National Deafness Control Programme

Answer

National AIDS Control Programme

Question 10

After attending a birthday party in a hostel around 50 students reported having loose stools, fever and a few reported vomiting. This outbreak can be identified as what type of outbreak ?

Accepted Answer

Common point source only

Answer

Common source continuous

Answer

Propagated only

Answer

Both propagated and common point source

UPSC-CMS 2021 — Community Medicine