UPSC-CMS 2019 - Community Medicine Practice Questions

Q: As per WHO recommendations which one of the following mumps vaccine strains should NOT be used in National Immunization Programme?

Rubini. ***Rubini*** - The **Rubini strain** of mumps vaccine is not recommended by the WHO for national immunization programs due to its **low immunogenicity** and **reduced efficacy**. - Studies have shown that the antibody response and protection offered by the Rubini strain are inferior compared to other widely used mumps vaccine strains. *Jeryl Lynn* - The **Jeryl Lynn strain** is a widely used and well-established mumps vaccine strain, with a good track record of efficacy and safety. - It is one of the strains commonly found in combined measles, mumps, and rubella **(MMR) vaccines** and is recommended by the WHO. *RIT 4385* - **RIT 4385** is another name for the **Jeryl Lynn strain** of mumps vaccine, referring to a specific manufacturing process or original isolate. - As such, it is a recommended and effective strain for national immunization programs. *L-Zagreb* - The **L-Zagreb strain** is a mumps vaccine strain that is also recommended by the WHO for inclusion in national immunization programs due to its demonstrated efficacy and safety profile. - It is used in various parts of the world as a component of MMR vaccines.

Q: All of the following are mass approaches towards education of general public EXCEPT:

Roleplaying. ***Roleplaying*** - **Roleplaying** is a participatory **small-group** or individual educational technique where participants act out scenarios, focusing on interpersonal communication and behavioral change. - It is not a **mass approach** because it requires active engagement and interaction from a limited number of participants. *Internet* - The **Internet** allows for the dissemination of health information to a vast, global audience through websites, social media, and digital campaigns. - Many individuals can access and consume this information simultaneously, making it a **mass communication channel**. *Posters, Bill boards and signs* - These are static visual aids designed to be placed in public spaces, reaching a large and diverse audience without direct interaction. - They rely on **exposure** to convey messages to the **general public** en masse. *Direct mailing* - **Direct mailing** involves sending educational materials to a large number of households or individuals through postal services. - Though personalized, it is still a **mass approach** because it targets a broad population segment rather than individual interventions.

Q: Which one of the following Ministries controls the Integrated Child Protection Scheme (ICPS)?

Ministry of Women and Child Development. ***Ministry of Women and Child Development*** - The **Integrated Child Protection Scheme (ICPS)** is a centrally sponsored scheme implemented by the Ministry of Women and Child Development. - This Ministry is responsible for designing and implementing policies and programs for the overall development and protection of women and children. *Ministry of Health and Family Welfare* - This ministry primarily focuses on **health services, disease prevention, and family planning** for the general population. - While it addresses child health, it is not the nodal ministry for the comprehensive protection and welfare of children as encompassed by ICPS. *Ministry of AYUSH* - The Ministry of AYUSH is responsible for the development and propagation of **Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy** systems of medicine. - It does not have oversight of child protection schemes like ICPS. *Ministry of Human Resource Development* - This ministry (now Ministry of Education) is primarily concerned with **education, literacy, and vocational training**. - While it deals with children in an educational context, it does not directly control child protection schemes.

Q: Which of the following is a contraindication for BCG vaccination in a newborn?

HIV infection-symptomatic. ***HIV infection-symptomatic*** - **Symptomatic HIV infection** in a newborn is a contraindication for BCG vaccination due to the risk of disseminated BCG disease in immunocompromised individuals. - Live attenuated vaccines like BCG can cause severe, life-threatening infections in individuals with compromised cellular immunity. *Prematurity* - **Prematurity** is generally not an absolute contraindication for BCG vaccination, although vaccination may be deferred until the infant is stable or reaches a certain weight. - The decision to vaccinate a premature infant often depends on the local epidemiology of tuberculosis and the infant's overall health status. *History of Tuberculosis in mother* - A maternal history of tuberculosis is **not a contraindication** for BCG vaccination in a newborn, especially if the newborn has been evaluated and is not actively infected. - Vaccinating infants in contact with TB cases can be an important part of preventing active disease. *Low birth weight* - **Low birth weight** is generally not an absolute contraindication for BCG vaccination, although it might lead to a delayed vaccination schedule. - The vaccine can be safely administered to healthy low birth weight infants, with careful consideration of their overall health.

Q: Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Zinc deficiency. ***Zinc deficiency*** - **Rashtriya Bal Swasthya Karyakram (RBSK)** under the 4Ds framework (Defects, Deficiencies, Diseases, Development delays) screens for specific nutritional deficiencies, but **zinc deficiency is NOT included** in the standard screening protocol. - RBSK focuses on identifying **severe acute malnutrition, vitamin A deficiency, and anemia (iron deficiency)** as priority nutritional deficiencies. - While zinc supplementation may be provided during diarrhea management, routine zinc deficiency screening is not part of RBSK. *Vitamin D deficiency* - **Vitamin D deficiency screening is NOT explicitly part of RBSK protocol**, though clinical manifestations like **rickets** may be identified during general examination. - RBSK does not conduct routine biochemical screening for vitamin D levels in the 0-18 years age group. - However, some sources may consider rickets under skeletal abnormalities, making this option potentially debatable. *Severe acute malnutrition* - **Severe acute malnutrition (SAM)** is a **major screening target** under RBSK's deficiency category. - Children are screened using **mid-upper arm circumference (MUAC), weight-for-height Z-scores**, and clinical signs of malnutrition. - Identified SAM cases are referred to **Nutrition Rehabilitation Centers (NRCs)** for management. *Vitamin A deficiency* - **Vitamin A deficiency** is a **key screening target** under RBSK, particularly to identify **xerophthalmia** and prevent childhood blindness. - RBSK teams screen for clinical signs including **Bitot's spots, night blindness**, and corneal involvement. - This aligns with national programs for vitamin A supplementation and prevention of nutritional blindness.

Q: Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Twice weekly in first month and then once a week. ***Twice weekly in first month and then once a week*** - According to national guidelines for the management of **Severe Acute Malnutrition (SAM)** in India, children discharged from NRCs require intensive follow-up to prevent relapse. - This specific schedule ensures close monitoring initially when the child is most vulnerable, gradually reducing frequency as their health stabilizes. *Once a week for first month and then twice weekly* - This option reverses the logical progression of follow-up frequency, suggesting increased visits after the first month, which is not aligned with standard protocols. - Initial follow-up for SAM children needs to be more frequent than once a week in the first month. *Twice weekly in first month and then once fortnightly* - While initial follow-up is appropriate, reducing the frequency to **once fortnightly** after the first month might be too infrequent for continued close monitoring of a child recovering from SAM. - This schedule could miss early signs of deterioration. *Once a week for first month and then once fortnightly* - This schedule provides insufficient monitoring both in the **initial critical month** (only once a week) and in the subsequent period (once fortnightly is too spread out). - It does not meet the recommended intensity of follow-up for children discharged after SAM treatment.

Q: The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Complications during ANC, PNC are not covered. ***Complications during ANC, PNC are not covered*** - The **Janani Shishu Suraksha Karyakram (JSSK)** aims to eliminate out-of-pocket expenses for pregnant women, including those arising from **complications during ANC (Antenatal Care)** and **PNC (Postnatal Care)**. - Therefore, this statement is incorrect as JSSK *does* cover such complications to ensure comprehensive care. *Free diet up to 3 days during normal delivery* - The JSSK scheme provides **free diet** for mothers up to **3 days** for normal deliveries and **7 days** for C-sections, while they are admitted in public health institutions. - This benefit aims to reduce financial burden and ensure adequate nutrition post-delivery. *All pregnant women delivery in public health institution to have absolutely free and no expense delivery including cesarean section* - A core component of JSSK is to ensure **absolutely free and no-expense delivery** for all pregnant women delivering in public health institutions, regardless of whether it's a normal delivery or a **cesarean section**. - This includes free drugs, consumables, diagnostics, and blood. *Free diagnosis and free blood whenever required* - The JSSK programme includes provisions for **free diagnostics** (e.g., blood tests, ultrasound) and **free blood transfusions** whenever required during pregnancy and delivery. - This is crucial to manage complications and ensure the safety of both the mother and the newborn.

Q: Open vial policy applies to which one of the following vaccines?

Hep B. ***Hepatitis B*** - The **Hepatitis B vaccine** is a **liquid multi-dose vial vaccine** that follows the **Open Vial Policy (OVP)**. - Under OVP, once opened, **Hep B can be used for up to 28 days** if: the vaccine vial monitor (VVM) has not reached the discard point, the expiry date has not passed, vaccines are stored under appropriate cold chain conditions (2-8°C), and the vial has not been contaminated or submerged in water. - **OVP applies specifically to liquid vaccines in multi-dose vials**, helping to reduce vaccine wastage in immunization programs. *BCG* - **BCG is a freeze-dried vaccine** that requires reconstitution before use. - Once reconstituted, BCG must be **discarded after 6 hours or at the end of the immunization session**, whichever is earlier. - This is **NOT classified under OVP** but follows the **reconstituted vaccine policy**. OVP specifically refers to liquid vaccines that can be kept for longer periods (up to 28 days). *Measles* - **Measles vaccine** is also a **freeze-dried vaccine** requiring reconstitution. - Like BCG, once reconstituted it must be **discarded within 6 hours or at the end of the session**. - Does **NOT fall under OVP** as it is not a liquid vaccine. *JE* - **Japanese Encephalitis (JE) vaccine** is a **freeze-dried vaccine** requiring reconstitution. - Must be **discarded within 6 hours** of reconstitution or at the end of the session. - Does **NOT follow OVP** as it requires reconstitution before use. **Key Point:** Open Vial Policy applies only to **liquid multi-dose vial vaccines** (DPT, TT, Hepatitis B, IPV, liquid Pentavalent), NOT to reconstituted vaccines (BCG, Measles, JE) which have a 6-hour discard rule.

Q: A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

67. ***67*** - **Correct calculation for ANM pregnancy registration**: - Annual births = (25/1000) × 5000 = **125 births per year** - Monthly births = 125 ÷ 12 = **10.42 births per month** - **Active pregnancy follow-up period** = 6.5 months (from early second trimester until delivery) - Expected pregnancies registered = (125 ÷ 12) × 6.5 = 10.42 × 6.5 = **67.7 ≈ 67** - **Rationale**: The ANM (Auxiliary Nurse Midwife) typically provides active antenatal care from the second trimester (around 3-4 months) through delivery. This represents approximately 6.5 months of the 9-month pregnancy period. The calculation accounts for the number of women currently under active ANC supervision at any given time. - **Key formula**: Number of pregnancies = (Annual births ÷ 12) × Active follow-up months *Incorrect Option 69* - Would imply 6.6 months of active follow-up: 69 ÷ 10.42 = 6.62 months - This overestimates the standard ANC registration period *Incorrect Option 66* - Would imply 6.3 months of active follow-up: 66 ÷ 10.42 = 6.33 months - This underestimates the expected ANC registration period *Incorrect Option 68* - Would imply 6.53 months of active follow-up: 68 ÷ 10.42 = 6.53 months - Close to the standard calculation but less precise than 67 when using the 6.5-month follow-up period

Q: In India, for providing HIV treatment services Link ART Centres are situated at:

Sub-district level hospitals and Community Health Centres. ***Sub-district level hospitals and Community Health Centres*** - **Link ART Centres** are strategically established at **sub-district level hospitals** and **Community Health Centres (CHCs)** as part of the **National AIDS Control Programme (NACO)**. - These centres were created to **decentralize HIV treatment services** and bring them closer to patients, reducing the burden on main ART centres. - They provide **first-line antiretroviral therapy (ART)** and follow-up care for stable patients, improving accessibility and adherence. *Medical colleges and district level hospitals* - These facilities host **main ART Centres** (not Link ART Centres), which serve as primary hubs for HIV treatment. - Main ART Centres handle more complex cases, second-line therapy, and provide training and support to Link ART Centres. *Select medical colleges* - Medical colleges typically host **ART Centres** or **Centres of Excellence (CoE)** for HIV care. - These are tertiary care facilities providing comprehensive HIV services including specialized care and second-line treatment. *Primary Health Centres* - **PHCs** serve as the first point of contact in rural healthcare but lack the infrastructure and specialized staff for ART services. - They play a role in **HIV testing, counseling, and referral** to ART/Link ART Centres but do not provide ART themselves.

Question 1

As per WHO recommendations which one of the following mumps vaccine strains should NOT be used in National Immunization Programme?

Accepted Answer

Rubini

Answer

Jeryl Lynn

Answer

RIT 4385

Answer

L-Zagreb

Question 2

All of the following are mass approaches towards education of general public EXCEPT:

Accepted Answer

Roleplaying

Answer

Internet

Answer

Posters, Bill boards and signs

Answer

Direct mailing

Question 3

Which one of the following Ministries controls the Integrated Child Protection Scheme (ICPS)?

Accepted Answer

Ministry of Women and Child Development

Answer

Ministry of Health and Family Welfare

Answer

Ministry of AYUSH

Answer

Ministry of Human Resource Development

Question 4

Which of the following is a contraindication for BCG vaccination in a newborn?

Accepted Answer

HIV infection-symptomatic

Answer

Prematurity

Answer

History of Tuberculosis in mother

Answer

Low birth weight

Question 5

Rashtriya Bal Swasthya Karyakram (RBSK) attempts to identify all of the following deficiencies in children in the age group 0–18 years EXCEPT:

Accepted Answer

Zinc deficiency

Answer

Vitamin D deficiency

Answer

Severe acute malnutrition

Answer

Vitamin A deficiency

Question 6

Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Accepted Answer

Twice weekly in first month and then once a week

Answer

Once a week for first month and then twice weekly

Answer

Twice weekly in first month and then once fortnightly

Answer

Once a week for first month and then once fortnightly

Question 7

The facilities provided to pregnant women under the Janani Shishu Suraksha Karyakram are all EXCEPT:

Accepted Answer

Complications during ANC, PNC are not covered

Answer

Free diet up to 3 days during normal delivery

Answer

Free diagnosis and free blood whenever required

Answer

All pregnant women delivering in public health institution to have absolutely free and no expense delivery including cesarean section

Question 8

Open vial policy applies to which one of the following vaccines?

Accepted Answer

Hep B

Answer

JE

Answer

BCG

Answer

Measles

Question 9

A village 'X' has a population of 5000 with a birth rate of 25 per thousand. In any given month, how many pregnancies should be registered with the ANM of this village?

Accepted Answer

67

Answer

69

Answer

66

Answer

68

Question 10

In India, for providing HIV treatment services Link ART Centres are situated at:

Accepted Answer

Sub-district level hospitals and Community Health Centres

Answer

Select medical colleges

Answer

Primary Health Centres

Answer

Medical colleges and district level hospitals

UPSC-CMS 2019 — Community Medicine