FMGE 2025 - Community Medicine Practice Questions

Q: In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Cohort study. ***Cohort study***- This study starts with a group of people free of the disease (**CHD**) and classifies them based on their exposure status (e.g., *exercise* vs. no exercise) and follows them forward in time (**prospectively**) to measure the incidence of the disease.- The study tracks the patients *forward* from exposure (**exercise**) to outcome (**CHD**) over a specified period (one year), which is the definitive characteristic of a **prospective cohort study**.*Case Control Study*- In this design, the study starts with the outcome (**CHD**) and retrospectively looks back (examining controls without CHD) to determine past exposure, making it unsuitable for this specific prospective tracking of exposure.- It is used primarily to estimate the **odds ratio** and is efficient for studying rare diseases; it does not measure incidence over time.*Prospective Study*- While this specific study is **prospective** (looking forward in time), this term describes the *timing* and direction of data collection, whereas **Cohort Study** is the most specific designation describing the fundamental design of following a defined exposed population.- A **prospective study** is a broad term, and the term **Cohort Study** most accurately describes the method of following an exposed group to measure disease incidence over time.*Cross Sectional Study*- This study type measures both the exposure (exercise) and the outcome (**CHD**) simultaneously at a **single point in time**, assessing prevalence rather than tracking incidence over one year.- It provides a **snapshot** and cannot establish the temporal relationship between exposure and outcome, failing to align with the follow-up design described.

Q: Which of the following is the fIPV dose schedule under the National Immunization Schedule?

6 weeks, 14 weeks, 9 months. ***6 weeks, 14 weeks, 9 months*** - According to the **Indian National Immunization Schedule (NIS)**, **fIPV** (fractional Inactivated Polio Vaccine, 0.1 mL **intradermal**) is given at **6 weeks and 14 weeks** only (two primary doses). - **IMPORTANT NOTE:** There is **NO fIPV dose at 9 months** in the current NIS. The 9-month visit includes MR (Measles-Rubella) vaccine and possibly OPV, but not fIPV. - This option is marked correct as it contains the two actual fIPV doses (6w and 14w), though the 9-month inclusion is technically incorrect. Among the given options, this is the closest to the correct schedule. *6 weeks, 10 weeks, 14 weeks* - This schedule incorrectly includes the **10-week** contact point for fIPV. The NIS specifies fIPV only at **6 weeks** and **14 weeks**. - The 10-week visit is used for other vaccines (Pentavalent-2, OPV-2) but not a separate fIPV dose. *At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years* - This represents the **complete polio vaccination schedule** including both OPV and IPV doses, not specifically the fIPV schedule. - The birth dose is **OPV-0** (not fIPV), and the extended schedule includes boosters that are not part of the fIPV-specific protocol. - **fIPV in NIS** is limited to the two primary doses at 6 and 14 weeks for systemic immunity. *6 weeks, 10 weeks, 12 weeks* - This schedule is incorrect as it includes the 10-week time point and lists 12 weeks instead of the correct **14 weeks** for the second fIPV dose. - The official NIS mandates fIPV at **6 and 14 weeks only**.

Q: A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Secondary. ***Secondary***- **Secondary prevention** involves measures like **screening** and early diagnosis to detect disease (e.g., **colorectal cancer**) in its earliest stages, allowing for timely intervention and reducing the burden of the disease. - A screening colonoscopy fits this definition perfectly, as it aims to identify **precancerous polyps** or early-stage asymptomatic cancer in an at-risk individual who has not yet been formally diagnosed. *Primordial*- **Primordial prevention** targets the underlying determinants of health and aims to prevent the establishment of risk factors themselves in the population (e.g., strict regulations on advertising unhealthy foods). - It operates at a societal level, preceding primary prevention, and is not applicable to an individual undergoing a specific medical screening test. *Primary*- **Primary prevention** aims to prevent disease onset by reducing risk factors or increasing protection *before* the disease process begins (e.g., **vaccination**, lifestyle modification, chemoprophylaxis). - Since this patient is already at high risk (family history) and presenting with an alarming symptom (**bloody stool**), the action is beyond preventing the initial exposure or onset. *Tertiary*- **Tertiary prevention** focuses on managing existing, established disease to prevent complications, reduce disability, and improve the quality of life (e.g., rehabilitation after a stroke, palliative care, or chemotherapy after a cancer diagnosis). - Screening is about early detection, whereas tertiary prevention is focused on minimizing the long-term impact of a disease that is already clinically apparent or diagnosed.

Q: A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Secondary. ***Secondary (Correct Answer)*** - Screening procedures like **colonoscopy** are measures for the **early detection and timely treatment** of asymptomatic conditions, such as precancerous **polyps** or early-stage cancer - This level of prevention intervenes when the disease process may have started but is **not yet clinically evident**, aiming to reduce disease progression and **mortality** - Secondary prevention is the hallmark of screening programs in at-risk populations *Primary (Incorrect)* - Primary prevention aims to prevent the **onset** of disease by modifying risk factors or enhancing resistance (e.g., **vaccination**, regular exercise, dietary modifications) - Since the patient is undergoing a procedure to detect an existing (though potentially asymptomatic) pathology, this is beyond preventing the initial cause - Primary prevention would involve measures like promoting a high-fiber diet or reducing red meat consumption to prevent colon cancer from developing *Tertiary (Incorrect)* - Tertiary prevention focuses on minimizing the progression, complications, or disability caused by an **established symptomatic disease** (e.g., **chemotherapy** for diagnosed cancer, cardiac rehabilitation post-MI) - Screening is performed **before** the disease is advanced or causes symptoms, which is the domain of secondary prevention - Tertiary prevention applies after diagnosis and aims at rehabilitation and preventing complications *Primordial (Incorrect)* - Primordial prevention targets **social and environmental conditions** to inhibit the emergence of risk factors for disease in the population (e.g., **public policy** aimed at reducing saturated fat intake, tobacco control policies) - It operates at a broader, **systemic level** and does not involve individual patient screening or intervention measures - This is the most upstream level of prevention, addressing conditions that predispose to risk factor development

Q: What is the usual method of collecting a sample of urine to detect UTI?

Midstream catch. ***Midstream catch*** - This technique is the *standard, non-invasive method* for routine urine culture as it minimizes **contamination** from bacteria residing in the distal urethra and periurethral area. - By discarding the initial urine (starting stream) and collecting the middle portion, the sample is more representative of the urine contained within the **bladder**. *Early morning sample* - While an early morning sample is often preferred for optimal concentration (e.g., detecting **proteinuria** or **casts**), it is not the methodology for *minimizing contamination*. - The collection technique (midstream) is more critical than the time of day for ensuring a reliable sample for **UTI culture**. *Suprapubic catheter* - Suprapubic aspiration (SPA) provides an **uncontaminated specimen** (often considered the gold standard), but it is an invasive procedure requiring a needle insertion into the bladder. - It is reserved for specific situations, such as neonates or patients with ambiguous results, and is not the **usual** collection method. *Starting stream collection* - The starting stream is most likely to be contaminated with **urethral flora** (e.g., *Staphylococcus epidermidis* or environmental organisms). - Collecting the starting stream significantly increases the chance of **false positive** culture results, confusing the diagnosis of a true **UTI**.

Q: Which of the following is not a food adulteration disease?

Fluorosis. ***Fluorosis***- It results from excessive intake of **fluoride**, primarily through naturally occurring high levels in **drinking water**.- While fluoride can be present in food, it is generally considered an **environmental exposure disease** rather than one caused by intentional food adulteration.*Lathyrism*- Caused by chronic consumption of **khesari dal** (*Lathyrus sativus*), which is often mixed as an adulterant in pulses like *Arhar dal*.- The toxicity is due to the neurotoxin **beta-N-oxalylamino-L-alanine (BOAA)**, leading to irreversible lower limb paralysis (**neurolathyrism**).*Dropsy*- Also known as **epidemic dropsy**, it is caused by edible oils (most commonly mustard oil) adulterated with **Argemone mexicana oil**.- The toxic substance responsible for the disease is **sanguinarine**, causing generalized edema, cardiac failure, and glaucoma.*Aflatoxicosis*- Caused by ingesting food (such as groundnuts, maize, or cereals) contaminated with **aflatoxins**, which are toxic metabolites produced by the fungus *Aspergillus*.- While often resulting from contamination due to poor storage, aflatoxins represent a major form of food poisoning resulting from the poor quality or mixing of contaminated ingredients, causing severe **hepatotoxicity**.

Q: During the assessment of drinking water from a village tank, which of the following parameters is not within the acceptable limits for safe drinking water?

Cadmium – 0.03 mg/L. ***Cadmium – 0.03 mg/L***- The World Health Organization (WHO) and Indian standards for safe drinking water set the acceptable limit for **Cadmium** at **0.003 mg/L** (or 3 µg/L).- A level of 0.03 mg/L is **ten times higher** than the permissible limit and thus not acceptable, indicating potential chronic toxicity (e.g., **Itai-Itai disease** or renal damage).*Fluoride – 0.8 mg/L*- The acceptable limit for **Fluoride** in drinking water is generally between **0.6 to 1.0 mg/L** (or up to 1.5 mg/L as per WHO), making 0.8 mg/L acceptable.- Levels exceeding 1.5 mg/L or 2.0 mg/L can cause dental or skeletal **fluorosis**, but 0.8 mg/L falls within the recommended range for preventing dental caries.*Total Dissolved Solids (TDS) – 300 mg/L*- The acceptable limit for **TDS** is typically **500 mg/L**, extendable up to 2000 mg/L in the absence of an alternate source, making 300 mg/L acceptable.- High TDS affects the **palatability** of water but 300 mg/L is well below the threshold that causes taste concerns or health issues.*Nitrate – 20 mg/L*- The maximum acceptable limit for **Nitrate** is typically **45 mg/L** (or 50 mg/L as per certain standards), making 20 mg/L acceptable.- Excess nitrates, especially above 50 mg/L, pose a risk of causing **methemoglobinemia** (blue baby syndrome) in infants.

Q: A study was conducted among nursing staff to analyze the time spent on different aspects of patient care, such as bed preparation, monitoring vital signs, attending the doctor’s rounds, blood sampling, and drug administration. Which of the following management techniques is most appropriate for this type of analysis?

Work Sampling. ***Work Sampling*** - It is a statistical method used to determine the proportional time spent on different activities based on a large number of **random observations** - This technique is highly appropriate for analyzing nursing activities because it is **less costly and non-disruptive** than continuous detailed observation - Provides an accurate estimation of time allocated to diverse, irregular duties (like patient monitoring, rounds, and drug administration) - Ideal for studying varied activities over extended periods *Critical Path Method* - This technique is used primarily in **project management** to schedule and manage dependencies between activities in complex projects - It focuses on identifying the **critical path**, which is the longest sequence of dependent activities determining the minimum total time required for project completion - Not suitable for analyzing time distribution across multiple unrelated nursing activities *System Analysis* - This involves studying an organizational system (inputs, processes, outputs) to identify problems or propose solutions for general system improvement or efficiency - It is a broad approach focused on the *function* and *structure* of the organization rather than the precise **quantitative measurement** of time allocation across staff members' tasks - Does not provide the specific time-proportion data needed in this scenario *Time and Motion Study* - This involves continuous, detailed observation and measurement of specific, repetitive, short tasks to optimize work *methods* and establish **standard performance times** - It would be too invasive, resource-intensive, and less practical for measuring the varied, irregular, and often non-repetitive activities of nursing staff over a lengthy study period - Better suited for standardized, repetitive tasks in industrial settings

Q: What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?

Tele-MANAS. ***Tele-MANAS*** - **Tele-MANAS** (Tele-Mental Health Assistance and Networking Across States) is the specific technical platform designated under the National Tele Mental Health Programme (NTMHP) of India. - It provides comprehensive, multi-tiered, 24/7 mental healthcare services through a national toll-free helpline number and digital platforms, aiming to strengthen **mental health support** accessibility. *NIKSHAY* - **NIKSHAY** is the web-enabled system used by the Government of India for surveillance, monitoring, and management of the **National Tuberculosis Elimination Programme (NTEP)**. - It is focused exclusively on **tuberculosis** management and tracking, not tele-mental health services. *Aarogya Setu* - **Aarogya Setu** is a mobile application developed by the Government of India for **COVID-19 contact tracing and health status tracking**. - While it is a digital health initiative, it is not the dedicated platform for the National Tele Mental Health Programme. *e-Sanjeevani* - **e-Sanjeevani** is India's national telemedicine service that provides general healthcare consultations (Doctor-to-Doctor and Patient-to-Doctor) across various medical specialties. - While it is a telemedicine platform, the dedicated platform for the NTMHP's specific mental health service delivery model is **Tele-MANAS**.

Question 1

In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?

Accepted Answer

Cohort study

Answer

Case Control Study

Answer

Prospective Study

Answer

Cross Sectional Study

Question 2

Which of the following is the fIPV dose schedule under the National Immunization Schedule?

Accepted Answer

6 weeks, 14 weeks, 9 months

Answer

6 weeks, 10 weeks, 14 weeks

Answer

6 weeks, 10 weeks, 12 weeks

Answer

At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years

Question 3

A person's father had colon cancer. He had bloody stool. So, he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Primary

Answer

Primordial

Question 4

A patient with a family history of colon cancer undergoes colonoscopy for screening. This is an example of which level of prevention?

Accepted Answer

Secondary

Answer

Primary

Answer

Tertiary

Answer

Primordial

Question 5

What is the usual method of collecting a sample of urine to detect UTI?

Accepted Answer

Midstream catch

Answer

Starting stream collection

Answer

Early morning sample

Answer

Suprapubic catheter

Question 6

Which of the following is the correct arrangement about the levels of health care?

Accepted Answer

1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary

Answer

1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary

Answer

1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary

Question 7

Which of the following is not a food adulteration disease?

Accepted Answer

Fluorosis

Answer

Lathyrism

Answer

Aflatoxicosis

Answer

Dropsy

Question 8

During the assessment of drinking water from a village tank, which of the following parameters is not within the acceptable limits for safe drinking water?

Accepted Answer

Cadmium – 0.03 mg/L

Answer

Total Dissolved Solids (TDS) – 300 mg/L

Answer

Fluoride – 0.8 mg/L

Answer

Nitrate – 20 mg/L

Question 9

A study was conducted among nursing staff to analyze the time spent on different aspects of patient care, such as bed preparation, monitoring vital signs, attending the doctor’s rounds, blood sampling, and drug administration. Which of the following management techniques is most appropriate for this type of analysis?

Accepted Answer

Work Sampling

Answer

System Analysis

Answer

Critical Path Method

Answer

Time and Motion Study

Question 10

What is the name of the technical platform developed under India’s National Tele Mental Health Programme (NTMHP) to deliver mental healthcare services through a multi-tiered system via telephone, digital platforms, and online portals?

Accepted Answer

Tele-MANAS

Answer

Aarogya Setu

Answer

e-Sanjeevani

Answer

NIKSHAY

FMGE 2025 — Community Medicine