FMGE 2025 - Community Medicine Practice Questions

Q: A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Local Treatment + RIG + Vaccine. ***Local Treatment + RIG + Vaccine***- This regimen is mandatory for **Category III** rabies exposure, defined by single or multiple transdermal bites or scratches, which includes the described punctured wounds.- **Rabies Immunoglobulin (RIG)**, providing passive immediate protection, must be infiltrated into and around the wound, followed by the complete scheduled series of the Rabies **Vaccine** to establish long-term active immunity.*Local wound cleaning*- While immediate and thorough local wound cleaning with soap, water, and an antiseptic is the **most crucial first step**, it is insufficient alone for preventing rabies transmission in a Category III exposure.- Punctured wounds carry a high risk of deep inoculation, necessitating both passive (**RIG**) and active (**Vaccine**) immunization immediately.*Vaccine*- The **rabies vaccine** provides active immunity, but this protection takes several days to weeks to develop.- In high-risk, severe exposures (Category III), immediate passive immunity via **Rabies Immunoglobulin (RIG)** is essential to neutralize the virus before the vaccine takes effect.*Local Treatment + RIG*- This approach provides immediate passive neutralization through **RIG** and effective wound management, but it critically omits the **rabies vaccine**.- Omission of the vaccine prevents the development of necessary long-term protective active immunity, leaving the patient vulnerable after the short-term effect of RIG wanes.

Q: Which of the following health programmes is supported by DANIDA?

Blindness. ***Blindness*** - The **National Programme for Control of Blindness (NPCB)**, initiated in 1976, has historically received extensive financial and technical support from the **Danish International Development Agency (DANIDA)** for implementing **cataract surgery** and eye care services. - DANIDA's support was crucial in developing infrastructure, training ophthalmic personnel, and promoting primary eye care in the early and middle phases of the program. *TB* - The national TB control efforts (RNTCP/NTEP) primarily rely on domestic funding and significant support from the **Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)** and the **World Bank**. - The strategy centers on **Directly Observed Treatment, Short-course (DOTS)** and subsequent patient-centric care. *Malaria* - Malaria control is overseen by the **National Vector Borne Disease Control Programme (NVBDCP)**, which is typically supported by the Government of India, the **WHO**, and large global health funders like **GFATM**. - The main tools include vector control (e.g., **Insecticide Treated Nets**) and prompt diagnosis/treatment. *HIV* - HIV/AIDS programs, managed by the National AIDS Control Organisation (**NACO**), are heavily funded by the Government of India, along with major international partners like **GFATM** and the **US President’s Emergency Plan for AIDS Relief (PEPFAR)**. - Historically, **DANIDA** has not been the primary collaborating international agency for large-scale HIV/AIDS intervention programs in India.

Q: Which of the following is the use of Shakir's tape?

Appropriate technology. ***Appropriate technology*** - *Shakir's tape* (or **Mid-Upper Arm Circumference/MUAC tape**) is a simple, **low-cost device** used for screening **acute malnutrition** in children, making it an example of appropriate technology for primary healthcare settings - Appropriate technology refers to tools, techniques, and practices that are **practical, sustainable, and easily adaptable** to local conditions, perfectly describing the utility and design of Shakir's tape - It exemplifies the WHO principle of appropriate technology: simple, affordable, culturally acceptable, and maintainable with local resources *Intersectoral coordination* - This refers to collaboration between different sectors (e.g., health, education, agriculture) to achieve health goals - Shakir's tape is a **diagnostic/screening tool**, not a mechanism for policy coordination - Does not involve the organizational structures or policy dialogue necessary for effective intersectoral action *Equitable distribution* - This principle focuses on fair allocation of resources (e.g., vaccines, drugs, services) - While assessing malnutrition helps prioritize resource distribution, the tape itself is a **screening tool**, not a distribution mechanism - Equitable distribution is driven by **policy and resource management**, whereas the tape is a device used in **clinical assessment** *Community participation* - This involves involving the local population in health planning and implementation - While health workers often use the tape within the community, the tape itself is a **measurement instrument**, not a method for fostering participation - Community participation is achieved through **dialogue, decision-making inclusion**, and volunteerism, not through a specific measuring tool

Q: Which of the following is not caused by food adulteration?

Fluorosis. ***Fluorosis***- It results from excessive ingestion of **fluoride**, primarily through naturally high fluoride content in **drinking water** and not typically through intentional adulteration of processed food products.- The toxicity (dental or skeletal fluorosis) reflects a chronic environmental exposure problem rather than a case of acute or intentional food substance contamination.*Epidemic dropsy*- This condition is classically caused by the adulteration of **mustard oil** with **Argemone oil**, which contains the toxic alkaloid **sanguinarine**.- It is a recognized consequence of food fraud characterized by edema, skin pigmentation, and sometimes glaucoma.*Neurolathyrism*- It results from consuming food (such as chickpea flour) adulterated with excessive amounts of **Khesari dal (Lathyrus sativus)**.- The neurotoxin responsible is **BOAA (β-N-Oxalylamino-L-alanine)**, which causes irreversible motor neuron damage and spastic paraparesis.*Endemic ascites*- This condition, often presenting as **hepatic veno-occlusive disease (VOD)**, is caused by chronic consumption of food grains contaminated by **Pyrrolizidine alkaloids (PAs)**.- PAs are often found in weeds growing among food crops (like wheat or millets), and their inclusion during harvest is a form of accidental food contamination/adulteration leading to chronic liver damage.

Q: Which is the nodal ministry of disaster management?

Ministry of Home Affairs. ***Ministry of Home Affairs*** - The **Ministry of Home Affairs (MHA)** is the nodal ministry for disaster management in India as per the **Disaster Management Act, 2005** - The **National Disaster Management Authority (NDMA)** functions under the MHA and is chaired by the Prime Minister - MHA coordinates disaster management activities including prevention, mitigation, preparedness, response, and recovery - Responsible for policy formulation, capacity building, and overseeing state disaster management authorities *Ministry of Human Resource and Development* - Now renamed as Ministry of Education - Deals with educational policies and programs, not disaster management coordination *Ministry of Education* - Handles education sector disaster preparedness but is not the nodal ministry - May implement safety protocols in educational institutions during disasters *Ministry of Health and Family Welfare* - Plays a crucial role in health emergency response during disasters (medical relief, epidemic control) - However, it is a supporting ministry, not the nodal coordinating authority for disaster management

Q: A total of 60 patients were diagnosed with COVID-19. Out of which, 12 deaths were reported. Calculate the Case Fatality Rate?

20%. ***20%*** - The **Case Fatality Rate (CFR)** is calculated by dividing the number of deaths from a specific disease by the total number of confirmed cases of that disease, multiplied by **100** to get the percentage. - Based on the data: (12 deaths / 60 cases) * 100 = **0.20** * 100 = **20%**. *30%* - This result is incorrect; it would correspond to **18 deaths** out of 60 cases, not the reported 12 deaths. - A calculation error yielding **30%** does not align with the standard formula for CFR using the given figures. *40%* - This percentage represents a CFR where **24 deaths** were reported among 60 cases, which is double the actual number of fatalities. - Such a high error suggests a significant misapplication of the **CFR formula**. *10%* - This value is incorrect; **10%** CFR would be obtained if only **6 deaths** occurred (6/60 * 100). - This result significantly underestimates the **Case Fatality Rate** as it is half of the calculated actual rate.

Q: In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?

79-85. ***79-85***- For a **normal distribution**, the range covering two standard deviations (2 SD) is calculated using the formula: **Mean $\pm$ (2 $\times$ SD)**. The $2\sigma$ interval encompasses approximately **95.45%** of the data points.- Calculation: Lower limit $= 82 - (2 \times 1.5) = 82 - 3 = 79$. Upper limit $= 82 + (2 \times 1.5) = 85$. The correct range is **79-85**. *60-68*- This range is highly incorrect as it is centered far below the **mean of 82** and the width (8 units) is too wide for a total of 3 units (2 SD) dispersion. - The lower limit of 60 is over 14 standard deviations away from the mean, indicating it is an outlier range not relevant to the $2\sigma$ calculation. *50-57*- This range is excessively far from the **mean of 82** and its width (7 units) does not correspond to the required 3 units of dispersion needed for $\pm 2$ SD. - Ranges like this would include virtually none of the observations expected in a population with a mean of 82 and a small **standard deviation** of 1.5. *40-49*- This interval is centered around 44.5, which is highly divergent from the actual **mean of 82**, and therefore cannot represent the population's $\pm 2$ SD range. - In a normal distribution, the data is symmetric around the mean; any calculated range must therefore include the mean near its center, which this option fails to do.

Q: Which vaccine is contraindicated in pregnancy?

Varicella. ***Varicella (Correct Answer)*** - This is a **live attenuated vaccine** that is **contraindicated in pregnancy** due to the theoretical risk of causing congenital infection, such as **fetal varicella syndrome** - Vaccination should be postponed until the **postpartum period** - If an unprotected pregnant woman is exposed, **Varicella-Zoster Immune Globulin (VZIG)** may be indicated *Influenza (Incorrect)* - The **inactivated influenza vaccine** (injectable form) is **recommended and safe** for all pregnant women, regardless of the trimester - Vaccination protects both the mother and the newborn by reducing the risk of severe **influenza-related morbidity** in the mother - Provides passive antibody transfer to protect the infant during the first 6 months of life *Rabies (Incorrect)* - This is an **inactivated (non-live) vaccine** that is **safe to administer during pregnancy** if post-exposure prophylaxis (**PEP**) is indicated - The necessity of protection against a life-threatening disease like **rabies** outweighs the minimal risks associated with the inactivated vaccine - No contraindication in pregnancy when indicated *TDaP (Incorrect)* - TDaP (**Tetanus, Diphtheria, and acellular Pertussis**) is a **recommended non-live vaccine** given during *every* pregnancy - Ideally administered between **27-36 weeks of gestation** to ensure maximum maternal antibody transfer to the fetus - Provides passive immunity to the newborn against **pertussis** (whooping cough), protecting vulnerable infants

Q: Identify A and B in the image of the mosquito larvae given

A-Anopheles, B-Culex. ***A-Anopheles, B-Culex*** - Larva A is identified as **Anopheles** because it rests **parallel** to the water surface and lacks a respiratory **siphon**, breathing through palmate hairs on its abdominal segments. - Larva B is identified as **Culex** as it hangs at an **angle** to the water surface and breathes through a long, narrow respiratory **siphon**. *A-Culex, B-Aedes* - This is incorrect as larva A exhibits the characteristics of **Anopheles** (no siphon, parallel resting), not **Culex**. - While **Aedes** larvae also hang at an angle, larva B's long siphon is more typical of **Culex**; **Aedes** larvae usually have a shorter, stouter siphon. *A-Culex, B-Anopheles* - This option incorrectly reverses the identities. Larva A is **Anopheles** and larva B is **Culex** based on their distinct resting postures and respiratory structures. - The key differentiating feature is the presence of a **siphon** in B (**Culex**) and its absence in A (**Anopheles**). *A-Anopheles, B-Mansonia* - Although the identification of A as **Anopheles** is correct, larva B is not **Mansonia**. - **Mansonia** larvae are unique as they attach to the roots of aquatic plants to obtain oxygen and do not hang from the surface, unlike the larva shown in B.

Q: Which of the following is the formula for sensitivity?

TP/(TP+FN)x100. ***TP/(TP+FN)x100***- This is the formula for **sensitivity** (or True Positive Rate), which is the proportion of individuals who truly have the disease (**True Positives, TP**) who are correctly identified by the test.- The denominator $TP + FN$ accounts for all individuals who actually have the disease according to the **gold standard**, including those who tested negatively (**False Negatives, FN**).*TP/(TP+FP)x100*- This formula calculates the **Positive Predictive Value (PPV)**, which indicates the probability that a positive test result represents a true positive.- The denominator $TP + FP$ includes everyone who tested positive, regardless of their actual disease status (**True Positives** and **False Positives**).*TN/(TN+FP)x100*- This formula calculates **specificity** (or True Negative Rate), which is the proportion of individuals who are truly disease-free (**True Negatives, TN**) correctly identified by the test.- The denominator $TN + FP$ accounts for all individuals without the disease, including those who were incorrectly identified as positive (**False Positives, FP**).*TN/(TN+FN)x100*- This formula calculates the **Negative Predictive Value (NPV)**, which is the probability that a negative test result represents a true negative.- The denominator $TN + FN$ includes everyone who tested negative, reflecting the proportion of subjects with a negative test result who are truly disease-free.

Question 1

A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Accepted Answer

Local Treatment + RIG + Vaccine

Answer

Local wound cleaning

Answer

Local Treatment + RIG

Answer

Vaccine

Question 2

Which of the following health programmes is supported by DANIDA?

Accepted Answer

Blindness

Answer

HIV

Answer

TB

Answer

Malaria

Question 3

Which of the following is the use of Shakir's tape?

Accepted Answer

Appropriate technology

Answer

Intersectoral coordination

Answer

Community participation

Answer

Equitable distribution

Question 4

Which of the following is not caused by food adulteration?

Accepted Answer

Fluorosis

Answer

Endemic ascites

Answer

Epidemic dropsy

Answer

Neurolathyrism

Question 5

Which is the nodal ministry of disaster management?

Accepted Answer

Ministry of Home Affairs

Answer

Ministry of Human Resource and Development

Answer

Ministry of Education

Answer

Ministry of Health and Family Welfare

Question 6

A total of 60 patients were diagnosed with COVID-19. Out of which, 12 deaths were reported. Calculate the Case Fatality Rate?

Accepted Answer

20%

Answer

40%

Answer

10%

Answer

30%

Question 7

In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?

Accepted Answer

79-85

Answer

60-68

Answer

40-49

Answer

50-57

Question 8

Which vaccine is contraindicated in pregnancy?

Accepted Answer

Varicella

Answer

TDaP

Answer

Rabies

Answer

Influenza

Question 9

Identify A and B in the image of the mosquito larvae given

Accepted Answer

A-Anopheles, B-Culex

Answer

A-Culex, B-Anopheles

Answer

A-Culex, B-Aedes

Answer

A-Anopheles, B-Mansonia

Question 10

Which of the following is the formula for sensitivity?

Accepted Answer

TP/(TP+FN)x100

Answer

TN/(TN+FP)x100

Answer

TP/(TP+FP)x100

Answer

TN/(TN+FN)x100

FMGE 2025 — Community Medicine