UPSC-CMS 2013 - Community Medicine Practice Questions

Q: The most sensitive index for surveillance of malaria transmission is :

Spleen rate. ***Spleen rate*** - The **spleen rate** (percentage of children 2-9 years old with palpable splenomegaly) is the most sensitive and cost-effective index for **long-term surveillance of malaria transmission**, particularly in endemic areas. - An enlarged spleen is a common manifestation of **chronic malaria infection**, reflecting repeated exposure and immune response. *Infant parasite rate* - While helpful, the **infant parasite rate**, which measures parasites in infants, may not capture the full burden of transmission across all age groups or long-term trends. - It primarily indicates **recent or ongoing transmission** affecting the most vulnerable population. *Parasite density index* - **Parasite density index** is a measure of the number of parasites per unit volume of blood in infected individuals. - It is crucial for assessing **individual infection severity** and drug efficacy but is less suitable as a sole population-level surveillance tool for overall transmission dynamics. *Proportional case rate* - The **proportional case rate** measures the proportion of all reported cases that are malaria-related. - This index is influenced heavily by **diagnosis and reporting biases** and may not accurately reflect true transmission intensity.

Q: Integrated management of neonatal and childhood illness includes all except :

Tuberculosis. ***Tuberculosis*** - While tuberculosis can significantly affect children, especially in endemic areas, it is typically managed under **separate, specialized programs** (such as the National TB Elimination Programme) due to its **chronic nature**, specific diagnostic requirements (including tuberculin skin testing, chest X-rays, and microbiological investigations), and prolonged treatment regimens (6-12 months with multiple drugs). - The **Integrated Management of Neonatal and Childhood Illness (IMNCI)** strategy focuses on acute, common childhood illnesses that require rapid assessment and standardized treatment protocols, which differ fundamentally from the comprehensive, long-term management approach required for TB. - TB screening may be part of child health programs, but the actual management follows dedicated TB control protocols rather than IMNCI guidelines. *Pneumonia* - **Pneumonia** is a core component of the IMNCI strategy because it is a leading cause of childhood mortality worldwide and requires standardized assessment for danger signs, fast breathing, and chest indrawing. - IMNCI provides clear protocols for classifying and managing **acute respiratory infections** with appropriate antibiotic therapy based on severity. *Diarrhoea* - **Diarrhoea** is a major focus of IMNCI as it causes significant dehydration and mortality in young children. - IMNCI includes protocols for assessing dehydration status, providing oral rehydration therapy (ORT), administering zinc supplementation, and managing persistent diarrhea and dysentery. *Malaria* - In malaria-endemic regions, **malaria** is integrated into IMNCI with guidelines for rapid diagnostic testing (RDTs) or clinical diagnosis based on fever patterns. - IMNCI helps healthcare workers quickly identify and treat uncomplicated malaria in children with appropriate antimalarials to reduce morbidity and mortality.

Q: Toxic shock syndrome occurs after one of the following vaccinations :

DPT. ***DPT*** - Toxic shock syndrome has been **extremely rarely reported in isolated case reports following DPT** (diphtheria, pertussis, tetanus) vaccination, though it is **not a recognized or established complication** in standard medical literature. - The association is controversial and based on very limited data. Any potential link may be related to coincidental bacterial infection rather than a direct vaccine effect. - Among the options listed, this has the most (though minimal) reported association with **TSS-like reactions** in historical case reports. *Measles vaccine* - The measles vaccine is a **live attenuated vaccine** and does not cause toxic shock syndrome. - Its adverse effects are usually related to a mild form of the disease or allergic reactions, not **bacterial toxin-mediated illnesses like TSS**. *BCG vaccine* - The BCG (Bacille Calmette-Guérin) vaccine is used against tuberculosis and is a **live attenuated vaccine**. - Adverse effects are commonly local reactions or disseminated BCG disease in immunocompromised individuals, not **toxic shock syndrome**. *Recombinant DNA Vaccine against Hepatitis B* - Recombinant DNA vaccines, like the Hepatitis B vaccine, are highly purified and contain **no live pathogens or bacterial toxins**. - They are associated with very few severe adverse events, none of which include **toxic shock syndrome**.

Q: What is the method of sampling in which the units are picked up at regular intervals from the universe ?

Systematic random sampling. ***Systematic random sampling*** - This method involves selecting samples at a **fixed and regular interval** from a larger population after a random starting point is chosen. - It ensures representation across the entire population list by picking every nth unit, making it **efficient for large datasets**. *Stratified random sampling* - This method involves dividing the population into **homogeneous subgroups** (strata) and then drawing a random sample from each stratum. - It is used when there is a need to ensure **representation of specific subgroups**, which is not the primary characteristic described. *Snow-ball sampling* - This is a **non-probability sampling technique** where initial subjects recruit future subjects from among their acquaintances, typically used for hard-to-reach populations. - It relies on existing social networks and is not characterized by picking units at regular intervals. *Simple random sampling* - In this method, every member of the population has an **equal chance of being selected**, and selections are made fully at random. - While random, it does not involve the specific process of picking units at **regular, predetermined intervals**.

Q: A village has a total of 100 under-five children. The coverage with measles vaccine in these age groups is 60%. Following the occurrence of a measles case in a child after a visit outside, twenty six children developed measles later. The secondary attack rate of measles is :

66.6%. ***66.6%*** - The **secondary attack rate** is calculated as (number of secondary cases / number of susceptible contacts exposed to the primary case) × 100. - Total children = 100, with 60% vaccinated (60 children), leaving **40 susceptible children**. - The primary case (one child from the village who visited outside) is part of these 40 susceptible children. - After the primary case occurs, the **remaining susceptible contacts** = 40 - 1 = **39 children**. - Number of secondary cases = 26, so secondary attack rate = (26/39) × 100 = **66.67% ≈ 66.6%**. *65.0%* - This option incorrectly uses all 40 susceptible children as the denominator (26/40 × 100 = 65%). - The error lies in **not excluding the primary case** from the denominator when calculating the secondary attack rate. - The primary case cannot be counted among those "at risk" of secondary infection since they already have the disease. *26.0%* - This represents the **overall attack rate** calculated as (26/100) × 100, using the total population as the denominator. - It fails to account for **vaccination status** and does not represent the secondary attack rate among susceptible contacts. - This is epidemiologically incorrect for measuring disease transmission among susceptibles. *16.6%* - This option appears to use an incorrect denominator, possibly 26/156 or another erroneous calculation. - It does not reflect any standard epidemiological rate calculation for this scenario. - The value is too low to represent the true risk among susceptible contacts.

Q: The method of choice for purification of highly polluted water on a large scale is :

Super-chlorination followed by de-chlorination. ***Super-chlorination followed by de-chlorination*** - **Super-chlorination** involves adding a very large dose of chlorine to water to ensure the destruction of all pathogenic microorganisms and removal of organic matter, making it suitable for **highly polluted water**. - **De-chlorination** is then necessary to remove residual chlorine, as high levels can be harmful and impart an unpleasant taste and odor. *Chlorination only* - While effective for disinfection, **chlorination alone** might not be sufficient to purify highly polluted water with significant organic load or diverse pathogens. - Excessive chlorine content without subsequent de-chlorination can lead to **undesirable by-products** and make the water unpalatable. *Ultraviolet light treatment* - **UV light treatment** is an effective disinfectant that inactivates microorganisms, but it does not remove suspended solids, dissolved organic matter, or chemical pollutants often found in **highly polluted water**. - Its efficacy can be reduced by water turbidity, which is common in highly contaminated sources, requiring extensive pre-treatment. *Boiling and chlorination* - **Boiling** is effective for killing most microorganisms but is impractical and energy-intensive for **large-scale water purification**. - **Chlorination** after boiling would still be needed for residual disinfection, but the combination isn't the method of choice for the high volumes typical of municipal water treatment of highly polluted sources.

Q: The useful fertility indicator where birth registration statistics do not exist or are inadequate is :

Child-woman ratio. ***Child-woman ratio*** - The **child-woman ratio** is a common **fertility indicator** used in areas where reliable birth registration data is unavailable. - It calculates the number of **children under 5 years old per 1000 women of childbearing age** (typically 15-49 years), providing an estimate of recent fertility. *Abortion rate* - The **abortion rate** measures the number of abortions per 1,000 women of reproductive age. - While it reflects a component of reproductive behavior, it does not directly measure live births or general fertility and relies on accurate abortion statistics which may also be inadequate. *Net reproduction rate* - The **net reproduction rate (NRR)** is a sophisticated measure that indicates the average number of daughters a woman will have if she survives to the end of her reproductive years, taking into account mortality. - This indicator requires **detailed birth and death statistics by age**, which are precisely what are lacking when birth registration is inadequate. *Male-female ratio* - The **male-female ratio**, or sex ratio, compares the number of males to females in a population. - This ratio is a demographic indicator used to understand population structure but **does not directly measure fertility**.

Q: Direct mailing as a means of communication, is an example of:

Individual approach. ***Individual approach*** - Direct mailing involves sending messages to **specific individuals by name and address**, making it a **personalized communication** method. - Each recipient receives an individually addressed communication, allowing for **tailored content** based on recipient characteristics. - It permits **individual follow-up and response**, which is characteristic of individual approach methods in health education. - In Community Medicine classification, direct mail is considered an individual approach because it targets specific persons, not undifferentiated masses. *Mass approach* - Mass approach uses **mass media** (TV, radio, newspapers, billboards) that reach large populations simultaneously without individual targeting. - Mass communication cannot identify or address specific individuals by name. - Direct mailing, despite reaching many people, addresses each person individually, distinguishing it from true mass communication. *Group approach* - Group approach involves communication with **defined small groups** with shared context (group discussions, seminars, demonstrations). - Direct mailing lacks the **interactive, collective experience** characteristic of group communication methods. *Two way communication* - While direct mailing allows for responses, the initial transmission is **one-way**. - However, the individual addressing makes it an individual approach, not defined by its one-way nature.

Q: Mansonioides mosquito transmits the following disease :

Brugian filariasis. ***Brugian filariasis*** - **Mansonioides mosquitoes** are the primary vectors for **Brugian filariasis**, caused by **Brugia malayi** and **Brugia timori**. - This form of filariasis is characterized by **lymphatic obstruction** and **elephantiasis**, predominantly affecting the limbs. *Dengue* - **Dengue** is a viral disease transmitted exclusively by **Aedes mosquitoes**, particularly **Aedes aegypti** and **Aedes albopictus**. - Symptoms include severe fever, headache, retro-orbital pain, muscle and joint pains, and a characteristic skin rash. *Bancroftian filariasis* - **Bancroftian filariasis**, caused by **Wuchereria bancrofti**, is primarily transmitted by **Culex** (e.g., *Culex quinquefasciatus*) and sometimes **Anopheles** or **Aedes mosquitoes**. - While leading to similar lymphatic complications as Brugian filariasis, its vector species differ from Mansonioides. *Malaria* - **Malaria** is transmitted solely by **Anopheles mosquitoes**, which carry the **Plasmodium parasite**. - The disease is characterized by recurring fever, chills, and flu-like symptoms, and can be life-threatening.

Q: Failure rate of contraceptive method is determined by:

Pearl index. ***Pearl index*** - The **Pearl index** is a common measure of the effectiveness of a birth control method, indicating the number of accidental pregnancies per 100 women-years of exposure. - A lower Pearl index signifies a **more effective contraceptive method**, meaning fewer pregnancies occur during its use. *Total fertility rate* - The **total fertility rate (TFR)** represents the average number of children born to a woman over her lifetime if she were to experience current age-specific fertility rates. - It reflects overall **population reproduction trends** and not the failure rate of a specific contraceptive method. *Age specific fertility rate* - The **age-specific fertility rate (ASFR)** measures the number of births to women in a particular age group per 1,000 women in that age group per year. - This rate provides insights into **fertility patterns across different age brackets** but does not quantify contraceptive effectiveness. *Half life index* - The term **"half-life index"** is not a standard epidemiological or public health measure for contraceptive failure rates. - Half-life usually refers to the **time it takes for a substance to decrease by half** (e.g., drug elimination) or for a radioactive isotope to decay.

Question 1

The most sensitive index for surveillance of malaria transmission is :

Accepted Answer

Spleen rate

Answer

Infant parasite rate

Answer

Parasite density index

Answer

Proportional case rate

Question 2

Integrated management of neonatal and childhood illness includes all except :

Accepted Answer

Tuberculosis

Answer

Pneumonia

Answer

Diarrhoea

Answer

Malaria

Question 3

Toxic shock syndrome occurs after one of the following vaccinations :

Accepted Answer

DPT

Answer

Measles vaccine

Answer

BCG vaccine

Answer

Recombinant DNA Vaccine against Hepatitis B

Question 4

What is the method of sampling in which the units are picked up at regular intervals from the universe ?

Accepted Answer

Systematic random sampling

Answer

Stratified random sampling

Answer

Snow-ball sampling

Answer

Simple random sampling

Question 5

A village has a total of 100 under-five children. The coverage with measles vaccine in these age groups is 60%. Following the occurrence of a measles case in a child after a visit outside, twenty six children developed measles later. The secondary attack rate of measles is :

Accepted Answer

66.6%

Answer

26.0%

Answer

65.0%

Answer

16.6%

Question 6

The method of choice for purification of highly polluted water on a large scale is :

Accepted Answer

Super-chlorination followed by de-chlorination

Answer

Chlorination only

Answer

Ultraviolet light treatment

Answer

Boiling and chlorination

Question 7

The useful fertility indicator where birth registration statistics do not exist or are inadequate is :

Accepted Answer

Child-woman ratio

Answer

Abortion rate

Answer

Net reproduction rate

Answer

Male-female ratio

Question 8

Direct mailing as a means of communication, is an example of:

Accepted Answer

Individual approach

Answer

Group approach

Answer

Two way communication

Answer

Mass approach

Question 9

Mansonioides mosquito transmits the following disease :

Accepted Answer

Brugian filariasis

Answer

Dengue

Answer

Bancroftian filariasis

Answer

Malaria

Question 10

Failure rate of contraceptive method is determined by:

Accepted Answer

Pearl index

Answer

Total fertility rate

Answer

Age specific fertility rate

Answer

Half life index

UPSC-CMS 2013 — Community Medicine