UPSC-CMS 2023 - Community Medicine Practice Questions

Q: Basophilic stippling of the RBCs is a sensitive index of

Lead poisoning. ***Correct: Lead poisoning*** - **Basophilic stippling** is a classic and sensitive hematologic finding in lead poisoning [1] - Results from inhibition of **pyrimidine 5'-nucleotidase**, which impairs RNA degradation in red blood cells - The presence of these **ribonucleoprotein granules** indicates defective heme synthesis and red cell maturation due to lead toxicity [1] - Other findings in lead poisoning include microcytic anemia and increased zinc protoporphyrin [1] *Incorrect: Silicosis* - A **lung disease** caused by inhaling **silica dust**, leading to pulmonary fibrosis and nodular lesions [2] - Does not primarily affect red blood cell morphology or cause basophilic stippling - Findings are limited to the respiratory system *Incorrect: Asbestosis* - A chronic **lung disease** caused by inhaling **asbestos fibers**, resulting in pulmonary fibrosis [2] - Does not directly cause changes in red blood cell morphology such as basophilic stippling - Associated with pleural plaques and increased risk of mesothelioma [2] *Incorrect: Arsenic poisoning* - Can cause various hematologic abnormalities including **anemia** and **pancytopenia** - **Not typically associated** with prominent basophilic stippling as a key diagnostic feature - Neurological symptoms (peripheral neuropathy), gastrointestinal symptoms, and dermatological findings (Mees' lines, hyperpigmentation) are more characteristic **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 695-699.

Q: Which of the following will qualify as a Class III exposure to Rabies?

Bites by wild animals. ***Bites by wild animals*** - All bites and scratches by **wild carnivores (dogs, jackals, wolves, foxes)** or **bats** are **ALWAYS considered Category III exposures** regardless of the wound severity or location. - This is because wild animals cannot be observed for 10 days, and the risk of rabies is extremely high. - This classification mandates immediate post-exposure prophylaxis (PEP) with both **rabies immunoglobulin (RIG)** and **vaccine**. - This is the **most definitive** Category III exposure among the options. *Bites on legs by a dog* - According to WHO guidelines, **any transdermal bite or scratch** (breaking the skin) is technically a **Category III exposure**. - However, the classification can be modified if the biting dog is a **healthy domestic dog** that can be kept under **observation for 10 days**. - If the dog remains healthy during observation, PEP can be discontinued. - The question stem asks which "will qualify" - implying certainty. Wild animal bites are **always** Category III, while domestic dog bites may have conditional management based on observation. *Drinking unboiled milk of a suspect animal* - Rabies virus is transmitted through **saliva** via bites, scratches, or mucous membrane contamination. - The virus is **inactivated by gastric acid** and cannot be transmitted through the gastrointestinal route. - Ingesting milk from a suspect animal poses **no risk** of rabies transmission. - This is **not a rabies exposure** and does not require PEP. *Licks on intact skin by a dog* - Licks on **intact skin** are classified as **Category I exposure**. - Rabies virus **cannot penetrate healthy, unbroken skin**. - Category I exposures do **not warrant** any rabies post-exposure prophylaxis.

Q: Consider the following : 1. Magnesium Sulphate 2. Calcium bicarbonate 3. Calcium Sulphate 4. Magnesium bicarbonate Hardness of water relates to the presence of which of the above?

1, 2, 3 and 4. **Correct Answer: 1, 2, 3 and 4** **Hardness of water** is caused by the presence of dissolved multivalent metallic cations, primarily **calcium (Ca²⁺)** and **magnesium (Mg²⁺)** ions. These ions combine with various anions to form compounds that cause water hardness: - **Magnesium sulfate (MgSO₄)** - Causes **permanent hardness** (cannot be removed by boiling) - **Calcium bicarbonate (Ca(HCO₃)₂)** - Causes **temporary hardness** (can be removed by boiling) - **Calcium sulfate (CaSO₄)** - Causes **permanent hardness** - **Magnesium bicarbonate (Mg(HCO₃)₂)** - Causes **temporary hardness** **Therefore, all four compounds (1, 2, 3, and 4) contribute to water hardness.** *Why other options are incorrect:* *1, 2 and 3 only* - Incorrectly excludes **magnesium bicarbonate**, which is a significant contributor to temporary hardness *2, 3 and 4 only* - Incorrectly excludes **magnesium sulfate**, which contributes to permanent hardness *1 and 4 only* - Incorrectly omits **calcium bicarbonate** and **calcium sulfate**, which are major contributors to both temporary and permanent hardness

Q: Which of the following is a third generation intrauterine device?

TCu-380A. **TCu-380A** - The **TCu-380A** is a copper-containing intrauterine device designed with a T-shape and has a surface area of 380 mm² of copper. - It is classified as a **third-generation IUD** due to its enhanced design and higher copper content, providing greater contraceptive efficacy and a longer duration of action compared to older models. *Cu-7* - The **Cu-7** is a first-generation copper IUD, characterized by its "7-shaped" design and lower copper content. - It had a shorter lifespan and lower efficacy compared to later generations of copper IUDs. *TCu-200* - The **TCu-200** is a second-generation copper IUD, a T-shaped device with 200 mm² of copper surface area. - While improved over first-generation devices, it offered less longevity and efficacy than the current third-generation models. *Progestasert* - **Progestasert** was one of the first hormone-releasing IUDs, releasing progesterone. - It is significantly different from copper IUDs and is not classified among the copper-containing generations; it had a shorter lifespan and less common use today compared to modern levonorgestrel-releasing IUDs.

Q: In which of the following diseases is post-exposure immunisation prescribed?

Rabies. ***Rabies*** - **Rabies post-exposure prophylaxis (PEP)** is critical with documented or suspected exposure, given its near 100% fatality rate once symptoms appear. - PEP consists of both **rabies vaccine** and **rabies immunoglobulin** administered as soon as possible after exposure. *Poliomyelitis* - Poliovirus vaccination is a **pre-exposure intervention** aimed at preventing infection in the first place through herd immunity. - There is no specific post-exposure immunization strategy for polio once exposure has occurred. *Yellow fever* - The yellow fever vaccine is a highly effective **pre-exposure preventive measure** for individuals traveling to or living in endemic areas. - While it provides long-lasting immunity, it is not used as a post-exposure treatment. *Cholera* - Cholera vaccines are primarily used for **pre-exposure prevention**, especially for travelers or populations in endemic areas. - Post-exposure management of cholera focuses on **rehydration therapy** and antibiotics, not immunization.

Q: NACO (National AIDS Control Organization) in India works towards which of the following causes? 1. Screening high-risk cases of HIV 2. Facilitating adoption of orphans 3. Public education towards safe sex 4. Providing antiretroviral therapy. Select the correct answer using the code given below:

1, 3 and 4. **1, 3 and 4** - **NACO** (National AIDS Control Organization) is the primary body in India responsible for formulating policy and implementing programs for **HIV/AIDS prevention and control**. - Its core functions include **screening high-risk cases** for HIV, conducting **public education campaigns** on safe sex practices to prevent transmission, and ensuring access to **antiretroviral therapy (ART)** for those infected. *2, 3 and 4* - While NACO focuses on preventing and managing HIV/AIDS, **facilitating the adoption of orphans** (Option 2) is not a direct or primary function of NACO. - NACO's mandate centers on health-related interventions, not social welfare programs like adoption. *1, 2 and 4* - This option incorrectly includes "facilitating adoption of orphans" (Option 2) as a function of NACO. - Public education (Option 3) is a crucial component of NACO's strategy that is omitted in this selection. *1, 2 and 3* - This option incorrectly includes "facilitating adoption of orphans" (Option 2) and omits "providing antiretroviral therapy" (Option 4). - Providing **ART** is a fundamental and critical service directly managed and supported by NACO.

Q: Which one of the following is defined as "the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group" ?

Total Fertility Rate (TFR). **Total Fertility Rate (TFR)** - The **Total Fertility Rate (TFR)** is a measure of the average number of children a woman is expected to have over her lifetime, assuming current age-specific fertility rates. - It is a synthetic measure that reflects the reproductive patterns of a given population at a specific time. *Net Reproduction Rate (NRR)* - The **Net Reproduction Rate (NRR)** is similar to the Gross Reproduction Rate but also accounts for **mortality rates** among females before completing their reproductive years. - It measures the number of daughters a newborn girl can expect to have during her lifetime, considering current age-specific fertility and mortality rates. *General Fertility Rate (GFR)* - The **General Fertility Rate (GFR)** calculates the number of live births per 1,000 women of reproductive age (typically 15-49 years). - It is a broader measure than age-specific rates but does not project the total number of children a woman might have. *Age-Specific Fertility Rate (ASFR)* - An **Age-Specific Fertility Rate (ASFR)** measures the number of live births to women in a particular age group per 1,000 women in that same age group. - While it provides data for specific age cohorts, it does not combine these to give a lifetime average as described in the definition.

Q: Which among the following is correct about yellow fever vaccination requirement for international travellers ? 1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person. 2. Lifetime validity of the certificate applies automatically to all existing and new certificates. 3. Validity of the certificate begins 4 days after vaccination. 4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016. Select the correct answer using the code given below :

1 and 2. ***1 and 2*** - The **term of validity** of the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever changed from 10 years to **lifetime duration** on **July 11, 2016** (WHO IHR amendment). - This **lifetime validity** applies automatically to all existing and new ICVPs, regardless of when they were issued. - Both statements accurately reflect current WHO International Health Regulations. *2 and 4* - While statement 2 is correct, statement 4 is incorrect; **India does not require a booster dose** for yellow fever even if the certificate is prior to 2016. - The lifetime validity supersedes all previous recommendations, and India follows WHO guidelines. *2 and 3* - While statement 2 is correct, statement 3 is incorrect; the **validity of the certificate begins 10 days after vaccination**, not 4 days. - This 10-day period allows for the development of adequate immune response to the yellow fever vaccine. *1 and 3* - While statement 1 is correct regarding the change to lifetime validity, statement 3 is incorrect; the **certificate's validity begins 10 days after vaccination**, not 4 days. - The 10-day waiting period is a standard requirement under WHO IHR.

Q: Regarding active immunization against Typhoid fever, consider the following statements : 1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly. 2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day. 3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days. 4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received. Which of the statements given above is/are correct ?

1 only. ***1 only*** - The **typhoid polysaccharide vaccine** (ViCPS vaccine) is an **injectable vaccine**, typically administered **intramuscularly**. While subcutaneous administration might occur in specific situations, intramuscular is the standard route. - This statement accurately describes the general nature and administration route of the typhoid polysaccharide vaccine. *2 and 3 only* - The **typhoid polysaccharide vaccine (ViCPS) is usually given as a single dose** for primary immunization, not two doses on day 0 and 7. Boosters may be given every 2-3 years. - The **oral Ty21a vaccine requires three or four doses** (depending on the formulation and guidelines) taken on alternate days, typically on days 1, 3, and 5 (for a 3-dose regimen) or 1, 3, 5, and 7 (for a 4-dose regimen), not specifically on days 0, 3rd, and 7th. *1 and 2 only* - As explained, Statement 2 is incorrect because the **typhoid polysaccharide vaccine is generally a single-dose vaccine** for initial immunization. - Therefore, this option containing an incorrect statement cannot be the correct answer. *1, 3 and 4* - Statement 3 is incorrect as the **oral Ty21a vaccine dosing schedule is typically on alternate days** (e.g., 1, 3, 5 or 1, 3, 5, 7), not specifically 0, 3rd, and 7th. - Statement 4 is incorrect because **protective immunity from typhoid vaccines is not achieved immediately**; it takes about 1-2 weeks for the immune system to develop a sufficient response.

Question 1

Under the DOTS strategy of Revised National Tuberculosis Programme, the recommended line of management in Category I patients, if the sputum is positive after 2 months of Intensive Phase treatment with 4 drugs, is to

Accepted Answer

Continue the Intensive Phase of treatment with 4 drugs for 1 more month only, regardless of sputum positivity after that

Answer

Add one more drug, that is, to use 5 drugs until the sputum becomes negative

Answer

Continue the Intensive Phase of treatment with 4 drugs until the sputum becomes negative

Answer

Start the continuation phase with INH and Rifampicin

Question 2

Basophilic stippling of the RBCs is a sensitive index of

Accepted Answer

Lead poisoning

Answer

Silicosis

Answer

Asbestosis

Answer

Arsenic poisoning

Question 3

Which of the following will qualify as a Class III exposure to Rabies?

Accepted Answer

Bites by wild animals

Answer

Bites on legs by a dog

Answer

Drinking unboiled milk of a suspect animal

Answer

Licks on intact skin by a dog

Question 4

Consider the following :

1. Magnesium Sulphate
2. Calcium bicarbonate
3. Calcium Sulphate
4. Magnesium bicarbonate

Hardness of water relates to the presence of which of the above?

Accepted Answer

1, 2, 3 and 4

Answer

1, 2 and 3 only

Answer

2, 3 and 4 only

Answer

1 and 4 only

Question 5

Which of the following is a third generation intrauterine device?

Accepted Answer

TCu-380A

Answer

Cu-7

Answer

TCu-200

Answer

Progestasert

Question 6

In which of the following diseases is post-exposure immunisation prescribed?

Accepted Answer

Rabies

Answer

Poliomyelitis

Answer

Yellow fever

Answer

Cholera

Question 7

NACO (National AIDS Control Organization) in India works towards which of the following causes?

1. Screening high-risk cases of HIV
2. Facilitating adoption of orphans
3. Public education towards safe sex
4. Providing antiretroviral therapy.

Select the correct answer using the code given below:

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 8

Which one of the following is defined as "the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group" ?

Accepted Answer

Total Fertility Rate (TFR)

Answer

Net Reproduction Rate (NRR)

Answer

General Fertility Rate (GFR)

Answer

Age-Specific Fertility Rate (ASFR)

Question 9

Which among the following is correct about yellow fever vaccination requirement for international travellers ?

1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person.
2. Lifetime validity of the certificate applies automatically to all existing and new certificates.
3. Validity of the certificate begins 4 days after vaccination.
4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.

Select the correct answer using the code given below :

Accepted Answer

1 and 2

Answer

2 and 4

Answer

2 and 3

Answer

1 and 3

Question 10

Regarding active immunization against Typhoid fever, consider the following statements :

1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly.
2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day.
3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days.
4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received. Which of the statements given above is/are correct ?

Accepted Answer

1 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 3 and 4

UPSC-CMS 2023 — Community Medicine