Gender-Affirming Care

Gender-Affirming Care Indian Medical PG Question 1: Which of the following is a validated screening tool for alcohol use disorder?

• A. AUDIT
• B. CAGE questionnaire
• C. SADQ
• D. All of the options (Correct Answer)

Gender-Affirming Care Explanation: ***CAGE questionnaire and AUDIT*** - Both **CAGE** and **AUDIT** are widely validated screening tools specifically designed for alcohol use disorder [1]. - **CAGE** is a brief 4-item tool focusing on **C**ut down, **A**nnoyed, **G**uilty, and **E**ye-opener - ideal for quick screening in clinical settings [1]. - **AUDIT** (Alcohol Use Disorders Identification Test) is a comprehensive 10-item tool assessing consumption patterns, drinking behaviors, and alcohol-related problems. - AUDIT is considered the **gold standard** for screening and can assess risk levels and severity. *Why not SADQ alone?* - **SADQ** (Severity of Alcohol Dependence Questionnaire) is primarily a **severity assessment tool**, not a screening tool. - It is a 20-item instrument used to measure the **degree of alcohol dependence** in individuals already identified with alcohol problems. - While valuable for treatment planning, SADQ is more detailed and designed for assessment rather than initial screening [1]. - However, all three tools are validated and used in alcohol use disorder evaluation - CAGE and AUDIT for screening, SADQ for severity assessment.

Gender-Affirming Care Indian Medical PG Question 2: Finasteride is classified as a:

• A. 5-alpha reductase inhibitor (Correct Answer)
• B. Phosphodiesterase inhibitor
• C. Alpha-1 blocker
• D. Androgen receptor antagonist

Gender-Affirming Care Explanation: ### ***5-alpha reductase inhibitor*** - **Finasteride** specifically inhibits the enzyme **5-alpha reductase**, preventing the conversion of **testosterone** to **dihydrotestosterone (DHT)** [2], [4]. - This reduction in DHT is clinically useful for treating conditions like **benign prostatic hyperplasia (BPH)** and **androgenetic alopecia** [4]. ### *Phosphodiesterase inhibitor* - **Phosphodiesterase inhibitors** (e.g., sildenafil) typically work by increasing levels of **cyclic GMP**, leading to **vasodilation** and are used for **erectile dysfunction** [3]. - Their mechanism of action is distinct from finasteride's effect on **hormone metabolism**. ### *Alpha-1 blocker* - **Alpha-1 blockers** (e.g., tamsulosin) primarily relax **smooth muscle** in the prostate and bladder neck, improving **urine flow** in BPH [3], [5]. - They act on **adrenergic receptors** and do not affect **hormone synthesis** or **metabolism** [3]. ### *Androgen receptor antagonist* - **Androgen receptor antagonists** (e.g., flutamide) directly block the binding of **androgens** (like testosterone and DHT) to their receptors [1], [4]. - While they also affect androgen action, their mechanism is different from finasteride's **enzyme inhibition** [4].

Gender-Affirming Care Indian Medical PG Question 3: In implementation of a health programme, best thing to do is -

• A. Discussion with leaders in community and implement accordingly
• B. Discussion with people in community and decide according to it
• C. Discussion and decision taken by the health ministry regarding implementation
• D. Discussion with doctors in PHC and implement accordingly (Correct Answer)

Gender-Affirming Care Explanation: ***Discussion with doctors in PHC and implement accordingly*** - **Primary Healthcare (PHC) doctors** possess critical hands-on knowledge of common health issues, local demographics, and daily health challenges faced by the community. - Their involvement ensures the program is **practically viable** and tailored to the specific needs and resources available at the grassroots level for effective implementation. *Discussion with leaders in community and implement accordingly* - While engaging community leaders is important for acceptance and dissemination, they may lack the **medical expertise** required to design effective and clinically sound health interventions. - Relying solely on leaders might lead to programs that are **socially acceptable but not medically optimal** or comprehensive. *Discussion with people in community and decide according to it* - Involving the community is crucial for program adherence and understanding local needs, but **laypersons** may not have the necessary medical knowledge to make informed decisions about complex health interventions. - Their input is valuable for relevance and acceptance, but medical and public health expertise is required for program design and implementation to ensure **efficacy and safety**. *Discussion and decision taken by the health ministry regarding implementation* - The health ministry sets policies and provides overall strategic direction, but they often lack direct, **on-the-ground understanding** of specific local health issues and implementation challenges. - A top-down approach without involving local healthcare providers can lead to programs that are **not feasible** or effective in the local context.

Gender-Affirming Care Indian Medical PG Question 4: In NRHM, the ASHA workers are recruited from the same village. Which part of principles of primary health care is followed here?

• A. Appropriate technology
• B. Community participation (Correct Answer)
• C. Intersectorial coordination
• D. Equitable distribution

Gender-Affirming Care Explanation: **Community participation** - Recruiting ASHA workers from the same village exemplifies **community participation** by empowering local individuals to lead health initiatives and ensures their understanding of local customs and needs. - This approach fosters trust and acceptability within the community, making health services more **accessible and relevant** to the population. *Appropriate technology* - This principle refers to the use of **scientifically sound and acceptable methods** and tools that are affordable and relevant to local conditions. - While ASHAs use appropriate technologies, their recruitment method itself doesn't directly illustrate this principle. *Intersectorial coordination* - This involves collaborative efforts between the health sector and other sectors like education, agriculture, and sanitation, to address the **social determinants of health**. - Recruiting ASHAs addresses human resources within the health sector, not coordination between different sectors. *Equitable distribution* - This principle aims to ensure that health resources and services are **available to all people regardless of their geographic location** or socioeconomic status. - While having ASHAs in rural areas contributes to equity, the specific act of recruiting them *from the same village* primarily highlights community involvement and local ownership, rather than just the distribution of services.

Gender-Affirming Care Indian Medical PG Question 5: Which of the following are correct regarding puerperal blues ? I. Its incidence is around 50 %. II. There is no specific metabolic or endocrine derangement. III. Treatment is reassurance and psychological support. Select the answer using the code given below :

• A. I, II and III (Correct Answer)
• B. I and II only
• C. II and III only
• D. I and III only

Gender-Affirming Care Explanation: ***I, II and III*** - Puerperal blues, or **baby blues**, are very common, affecting around **50-80%** of new mothers within a few days postpartum. - It is a transient condition thought to be related to **hormonal shifts** after childbirth, but without a specific, long-lasting metabolic or endocrine derangement requiring medical intervention. Its management involves **reassurance and psychological support**, as it typically resolves on its own without formal psychiatric treatment. *I and II only* - While statement I (incidence around 50%) is correct, and statement II (no specific metabolic or endocrine derangement) is also correct, this option excludes the crucial aspect of management, which is important for understanding the condition. - The typical management of puerperal blues involves reassurance and support, making statement III integral to a complete understanding. *II and III only* - This option correctly identifies the lack of specific derangement and the treatment approach, but it underestimates the prevalence of puerperal blues. - The incidence is significantly higher than implied by excluding statement I, making it a less accurate choice overall. *I and III only* - This option accurately describes the high incidence and the treatment strategy but overlooks the scientific understanding of its etiology. - The lack of a specific metabolic or endocrine derangement (statement II) is a key characteristic differentiating it from more severe postpartum psychiatric conditions.

Gender-Affirming Care Flashcard 1 of 5

Question: The prognosis of gynecologic tumor epidemiology can be remembered with the mnemonic: CEOs often go from best to worst as they get olderC_____ > Endometrial > Ovarian

Answer: ervical

Gender-Affirming Care Flashcard 2 of 5

Question: 98fda84365eb4fc0826a85021d206697-ao-1

Answer: 5 Cleans of intranatal care

Extra Information: 

Gender-Affirming Care Flashcard 3 of 5

Question: A BPP score of _____ indicates imminent delivery

Answer: 0 to 2

Gender-Affirming Care Flashcard 4 of 5

Question: A BPP score of _____ requires repeat testing and delivery if persistent

Answer: 4 to 6

Gender-Affirming Care Flashcard 5 of 5

Question: _____ method is used for replacing the uterus in case of uterine inversion.

Answer: O Sullivan's