FMGE 2025 - Community Medicine Practice Questions

Q: During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?

A used cotton swab should be discarded in a yellow bag. ***A used cotton swab should be discarded in a yellow bag*** - Used cotton swabs contaminated with blood or body fluids are classified as **soiled waste** (Category 3) under the **Biomedical Waste Management Rules 2016**. - Soiled waste including cotton swabs, dressings, and gauze must be disposed of in **YELLOW bags** for treatment and disposal as per current BMW Rules. *The syringe with the needle should be disposed of in a black translucent container* - Used needles and syringes are categorized as **sharps waste** (Category 4) under BMW Rules 2016. - They must be collected in **WHITE translucent puncture-proof containers**, not black containers which are for general non-biomedical waste. *The used vaccine vial should be discarded in a blue bag* - Used vaccine vials made of glass are classified as **waste sharps** including glass materials. - As per BMW Rules 2016, glass vials should be discarded in **BLUE containers/boxes** specifically designed for pharmaceutical waste, not blue bags. *The needle should be bent and thrown in a red bag* - **Bending, breaking, or recapping** used needles is strictly prohibited as it poses high risk of **needle-stick injuries**. - Used needles must be immediately placed into a **WHITE translucent puncture-proof sharps container** without any manipulation or bending.

Q: Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?

Multipurpose Worker (Female). ***Multipurpose Worker (Female)***- The Multipurpose Worker (Female) (also known as Auxiliary Nurse Midwife or ANM in some contexts) is the primary worker at the sub-centre level responsible for providing **Maternal and Child Health (MCH)** and **family planning** services.- Their core duties include identifying, counseling, and formally **registering eligible couples (ECs)** in the operational area and maintaining detailed records (like the EC register) of their contraceptive choices and follow-up.*ASHA*- ASHAs (Accredited Social Health Activists) are primarily **community-level linkages** and promoters, tasked with mobilization, counseling, and facilitating the uptake of services.- They refer eligible couples to the sub-centre or Primary Health Centre (PHC), but the **official record-keeping and maintenance** are done by the MPW (F)/ANM.*Village Health Guide*- The role of the Village Health Guide was established to provide basic health education and first aid, often serving as a primary link between the PHC and the community.- This cadre is often being phased out or subsumed by ASHA; they do not have the **formal administrative responsibility** for maintaining designated family planning registers.*Anganwadi Worker*- Anganwadi Workers are primarily focused on the **Integrated Child Development Services (ICDS)** scheme, concentrating on nutrition, growth monitoring, and pre-school education.- While they aid in health awareness and may assist in gathering community data, they are not the designated functionary for **family planning service registration** and record maintenance under the national health system.

Q: A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Tele MANAS. ***Tele MANAS*** - **Tele MANAS** (Tele Mental Health Assistance and Networking Across States) is the Government of India's national initiative providing **24/7 tele-counseling and mental health support** across the country, making it the correct service for a schizophrenia patient. - It functions as a **tele-mental health facility** under the National Mental Health Programme, offering critical assistance and linkage to specialized services. *eSanjeevani* - **eSanjeevani** is the GOI's national telemedicine platform providing **general healthcare consultations** through doctor-to-doctor (eSanjeevani HWC) and patient-to-doctor (eSanjeevani OPD) services. - While it offers broad healthcare services, it is **not the dedicated mental health support system** - that specific function is served by **Tele MANAS**. *NIKSHAY* - **NIKSHAY** is the standardized web-enabled application used for monitoring and tracking all patients diagnosed with **Tuberculosis (TB)** in India. - It handles notification, diagnosis, treatment adherence, and outcomes for **TB control**, having no operational role in providing mental health counseling. *U-WIN* - **U-WIN** is the digital platform developed by the GOI for managing and digitizing data related to the **Universal Immunization Programme (UIP)**. - It focuses specifically on **immunization records**, tracking vaccination status, scheduling, and overall coverage, making it unrelated to mental health services.

Q: In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Unpaired t-test. ***Unpaired t-test***- It is the most appropriate statistical test used to compare the means of two independent (unrelated) groups when the data is continuous (like **blood pressure**).- This test assesses the null hypothesis that there is no significant difference between the **population means** of the two comparison groups.*Paired t-test*- This test is specifically designed to compare means when the observations are dependent, meaning the data comes from the **same subjects** measured twice (e.g., pre-treatment and post-treatment).- It is used for **within-group comparisons** rather than comparisons between two independent cohorts, as requested in the scenario.*Chi-square test*- The chi-square test is used to determine the association between **two categorical variables** (e.g., proportions or frequencies).- It is unsuitable here because the variable being compared (blood pressure) is **continuous data**, and the study requires comparing means, not counted frequencies.*ANOVA*- ANOVA (Analysis of Variance) is used when comparing the means of **three or more** independent groups.- While acceptable for two groups (where it gives equivalent results to the t-test), the **unpaired t-test** is the most specific and standard test for comparing means of exactly two independent samples.

Q: Secondary prevention is most useful in the early detection and treatment of which of the following cancers?

Cervical cancer. ***Cervical cancer*** - Cervical cancer is a classic example of successful **secondary prevention** due to effective screening tests like the **Papanicolaou (Pap) test** and **Human Papillomavirus (HPV) testing**, which can detect precancerous lesions (**cervical intraepithelial neoplasia, CIN**). - The image displays a **colposcopy**, where **acetic acid** is applied to the cervix, causing abnormal cells with high nuclear density to turn white (**acetowhite changes**). This guides biopsy and allows for early treatment, preventing progression to invasive cancer. *Pancreatic cancer* - There is currently no effective or recommended screening test for **pancreatic cancer** in the asymptomatic, average-risk population. - It often presents with non-specific symptoms at a late stage due to its retroperitoneal location, leading to a delayed diagnosis and poor prognosis. *Ovarian cancer* - Routine screening with **CA-125** and **transvaginal ultrasound** is not recommended for the general population as it has not been proven to reduce mortality. - These screening methods have a high rate of **false positives**, leading to unnecessary invasive procedures and patient anxiety. *Glioblastoma* - There are no established screening protocols for **glioblastoma**, a highly aggressive primary brain tumor. - Diagnosis is typically made after the onset of neurological symptoms, such as headaches or seizures, at which point the tumor is usually advanced.

Q: A long-term study found that individuals who had high blood pressure (BP) during childhood continued to have high BP in adulthood, and those with low BP in childhood tended to maintain lower levels later in life. Which of the following epidemiological concepts does this pattern best represent?

Tracking of blood pressure. ***Tracking of blood pressure***- This term refers to the phenomenon where an individual's **relative position** (e.g., high or low) within a distribution of a biological variable, such as blood pressure or cholesterol, is maintained over time from childhood into adulthood.- The observation that high childhood BP predicts high adult BP is the classic definition of **tracking**, implying that early life measurements have significant predictive value for later life risk.*Rule of halves*- This is a concept used in the management of chronic conditions, particularly **hypertension**, stating that only about half of the people affected are diagnosed, and only about half of those diagnosed are treated.- It describes an inefficiency in public health management effectiveness, not the **longitudinal stability** of a physiological measurement within an individual.*Regression to the mean*- This statistical phenomenon occurs when an extreme measurement on a variable is followed by a second measurement that is closer to the **population average** or mean.- This would suggest that extremely high BP moves towards the average upon repeat measurement, which contradicts the finding that the high BP *persists* over time (tracking).*Cohort effect*- A cohort effect is variation in outcomes that arise from the unique **temporal experiences** or exposure of a specific group (birth cohort) that differentiates them from other age groups.- While the study involves a cohort, the specific epidemiological term describing the maintenance of an individual's relative **rank** over time is **tracking**.

Q: A child comes after a train accident with stable vitals but a big laceration on the leg. Which triage category does the patient come under?

Yellow. ***Yellow (Correct Answer)*** - This category is used for casualties with **serious, non-life-threatening injuries** who require medical attention but whose treatment can be **delayed** for a few hours without causing immediate death or major morbidity. - A stable patient following trauma, despite having a **big laceration**, is categorized as Yellow because the immediate risk to life (indicated by **stable vitals**) is low, allowing for prioritized care after Red category patients are addressed. - The combination of **stable vitals + significant injury** = Yellow/Delayed category. *Red (Incorrect)* - This category is reserved for patients needing **immediate life-saving intervention** (within minutes), such as those with unstable vitals, airway obstruction, or uncontrolled severe hemorrhage leading to shock. - Since the patient has **stable vitals** (implying adequate circulation and respiration), they do not meet the criteria for immediate criticality required for the Red category. *Green (Incorrect)* - Green is assigned to the **'walking wounded'** or minor injuries like sprains, abrasions, or small cuts, where definitive treatment can be delayed indefinitely. - A **"big laceration"** implies a significant injury needing prompt management, ruling out the minor nature associated with the Green category. *Black (Incorrect)* - This category is for patients who are either confirmed **deceased** or have catastrophic injuries where survival is deemed highly unlikely (expectant categorization), and resources are better spent on higher priority patients. - Given the child has **stable vitals** and is salvageable with appropriate care, this category is inappropriate.

Q: A person from an Assam village is depicted with genu valgum (knock-knees), a condition observed in multiple individuals in the community. What is the most likely diagnosis?

Skeletal fluorosis. ***Skeletal fluorosis*** - This condition is caused by chronic, excessive intake of **fluoride**, often through contaminated drinking water, which can lead to endemic outbreaks in specific geographical areas like villages in Assam. - It manifests with skeletal changes including osteosclerosis, calcification of ligaments, and deformities such as **genu valgum** (knock-knees) or genu varum (bow-legs). *Calcium deficiency* - Primarily leads to **osteoporosis** in adults, which is a reduction in bone mass, increasing the risk of fractures rather than causing specific deformities like genu valgum. - While severe deficiency can contribute to bone softening, it is typically associated with Vitamin D deficiency and is less likely to cause a community-wide endemic presentation compared to a waterborne toxin. *Vitamin C deficiency* - This deficiency results in **scurvy**, which affects **collagen synthesis** and presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages. - It does not cause the kind of gross skeletal deformities seen in the image, such as **genu valgum**. *Vitamin D deficiency (Osteomalacia)* - This condition leads to defective bone mineralization (**osteomalacia**), causing bone pain, muscle weakness, and potential deformities. - Although it can cause genu valgum, the context of an entire community in a specific village being affected makes an environmental exposure like **endemic fluorosis** a more probable diagnosis.

Q: A family consumes a diet predominantly of rice and pulses and developed signs of muscle weakness and movement. Which of the following should be given for prophylaxis?

Thiamine. ***Thiamine*** - A diet relying mainly on **polished rice** lacks essential micronutrients, particularly **thiamine (Vitamin B1)**, which is removed during the polishing process. - Deficiency of thiamine causes **Beriberi**, manifesting as neurological deficits (dry Beriberi leading to muscle weakness and neuropathy) or cardiovascular symptoms (wet Beriberi leading to high-output cardiac failure). *Calcium* - Calcium deficiency typically results in **hypocalcemia**, presenting as symptoms like **tetany**, muscle spasms, and paresthesia, which are distinct from Beriberi's clinical picture. - Although important for musculoskeletal health, supplementing calcium alone would not prevent the severe neurological and motor impairment seen in **thiamine deficiency**. *Vitamin D* - Deficiency of Vitamin D causes disorders of bone mineralization—**Rickets** in children and **Osteomalacia** in adults, primarily characterized by bone pain and fractures. - While Vitamin D deficiency can cause myopathy, it does not explain the specific cluster of symptoms (weakness and movement issues) related to a rice-dominant diet lacking the coenzyme necessary for carbohydrate metabolism. *Iron* - Iron deficiency leads to **microcytic hypochromic anemia**, whose primary symptoms include fatigue, dizziness, and pallor, not the characteristic movement and muscle weakness indicative of **Beriberi**. - Iron supplementation would address anemia but would fail to protect against severe neurological illness resulting from the lack of **thiamine**, which is crucial for energy generation in neural tissues.

Question 1

During a field visit to monitor training given to an ANM (Auxiliary Nurse Midwife) on safe immunization practices, you observe that she has used a syringe with a needle, a vaccine vial, and a cotton swab. After completing the immunization, which of the following statements about biomedical waste disposal is correct?

Accepted Answer

A used cotton swab should be discarded in a yellow bag

Answer

The used vaccine vial should be discarded in a blue bag

Answer

The needle should be bent and thrown in a red bag

Answer

The syringe with the needle should be disposed of in a black translucent container

Question 2

Who is primarily responsible for registering eligible couples for family planning and maintaining their records under the national health system?

Accepted Answer

Multipurpose Worker (Female)

Answer

Village Health Guide

Answer

Anganwadi Worker

Answer

ASHA

Question 3

A girl with schizophrenia presents to a Primary Health Centre (PHC) in India. Which of the following online applications, provided by the Government of India (GOI), is used for mental health service support?

Accepted Answer

Tele MANAS

Answer

eSanjeevani

Answer

NIKSHAY

Answer

U-WIN

Question 4

In a study, an investigator compared the mean blood pressure and standard deviation between two independent groups. Which of the following is the most appropriate statistical test to assess the significance of the difference between the two means?

Accepted Answer

Unpaired t-test

Answer

Chi-square test

Answer

ANOVA

Answer

Paired t-test

Question 5

Secondary prevention is most useful in the early detection and treatment of which of the following cancers?

Accepted Answer

Cervical cancer

Answer

Pancreatic cancer

Answer

Ovarian cancer

Answer

Glioblastoma

Question 6

A long-term study found that individuals who had high blood pressure (BP) during childhood continued to have high BP in adulthood, and those with low BP in childhood tended to maintain lower levels later in life. Which of the following epidemiological concepts does this pattern best represent?

Accepted Answer

Tracking of blood pressure

Answer

Rule of halves

Answer

Cohort effect

Answer

Regression to the mean

Question 7

Which of the following refers to the tendency of an individual’s relative position within a distribution (e.g., BP levels) to remain consistent over time, meaning those with high BP in childhood often remain at the higher end of BP in adulthood, and those with low BP tend to stay lower, even though absolute values may change with age?

Accepted Answer

Tracking of blood pressure

Answer

Regression to the mean

Answer

Rule of halves

Answer

Cohort effect

Question 8

A child comes after a train accident with stable vitals but a big laceration on the leg. Which triage category does the patient come under?

Accepted Answer

Yellow

Answer

Black

Answer

Green

Answer

Red

Question 9

A person from an Assam village is depicted with genu valgum (knock-knees), a condition observed in multiple individuals in the community. What is the most likely diagnosis?

Accepted Answer

Skeletal fluorosis

Answer

Calcium deficiency

Answer

Vitamin C deficiency

Answer

Vitamin D deficiency (Osteomalacia)

Question 10

A family consumes a diet predominantly of rice and pulses and developed signs of muscle weakness and movement. Which of the following should be given for prophylaxis?

Accepted Answer

Thiamine

Answer

Iron

Answer

Vitamin D

Answer

Calcium

FMGE 2025 — Community Medicine