UPSC-CMS 2023 - Community Medicine Practice Questions

Q: Under the National Leprosy Eradication Programme, ASHAs have been entrusted to which of the following activities ? 1. ASHAs are to search for suspected cases of leprosy in their villages and take them to the PHCs for diagnosis and treatment. 2. ASHAs arrange an amount of ₹ 5,000 as an incentive to each leprosy affected person in their village for undergoing reconstructive surgery. 3. ASHAs ensure that each leprosy affected person in their village receives micro-cellular rubber footwear for protection of insensitive feet. 4. ASHAs follow up all confirmed cases of leprosy in their village to ensure their treatment completion. Select the correct answer using the code given below :

1 and 4 only. ***1 and 4 only*** - ASHAs are actively involved in **community-based surveillance**, including **searching for suspected cases of leprosy** in their villages and referring them to Primary Health Centers (PHCs) for diagnosis and treatment. - They also play a crucial role in ensuring **treatment adherence** by following up on all confirmed cases to ensure **treatment completion**, which is vital for leprosy eradication. *2 and 3 only* - While ASHAs facilitate access to services, their role does not directly include arranging **incentive payments** for reconstructive surgery or directly providing **micro-cellular rubber footwear**. These services are typically handled by other program components or higher levels of the healthcare system. - ASHAs primarily focus on **case detection, referral, and treatment supervision**, not direct financial or material provision for reconstructive surgery incentives or specialized footwear. *1 and 2 only* - ASHAs are indeed involved in **case detection and referral (statement 1)**. - However, they are **not responsible for arranging direct incentive payments (statement 2)** for reconstructive surgery; this falls outside their designated activities within the National Leprosy Eradication Programme. *3 and 4 only* - ASHAs are primarily involved in **follow-up for treatment completion (statement 4)**. - However, their role does not include directly **providing micro-cellular rubber footwear (statement 3)**; this is usually provided through other channels within the healthcare system to support prevention of disabilities.

Q: The cost of implementation of 'Ayushman Bharat Pradhan Mantri Jan Arogya Yojana' is borne by :

Both Central Government and State Government. ***Both Central Government and State Government*** - The **Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)** is a centrally sponsored scheme, meaning its funding is shared between the **Central Government** and participating **State Governments**. - The funding mechanism generally follows a ratio, for instance, a 60:40 split between the Centre and States, though this can vary for special category states. *State Government only* - If the scheme were solely funded by the state government, it would be a state scheme, not a **centrally sponsored national health protection scheme**. - The scale and ambition of AB PM-JAY require significant central government contributions to ensure **uniform implementation** and coverage across India. *Private institutions only as a part of their Corporate Social Responsibility* - While private institutions may engage in healthcare initiatives through **Corporate Social Responsibility (CSR)**, AB PM-JAY is a government-funded scheme. - The primary financial responsibility for this large-scale health insurance program rests with the **government bodies**, not private entities via CSR. *Central Government only* - While the **Central Government** provides a substantial portion of the funding, this scheme is not fully funded by the Centre. - State governments are required to contribute their share, underscoring the **collaborative federal structure** of its financing and implementation.

Q: All of the following are dashboard indicators used for monitoring of India Newborn Action Plan (INAP). Which one of them is an impact level indicator ?

Neonatal mortality rate. ***Neonatal mortality rate*** - This is a key **impact indicator** because it directly measures the ultimate outcome of newborn health interventions: the reduction of deaths in the neonatal period. - Changes in the neonatal mortality rate reflect the overall effectiveness of programs aimed at improving newborn survival. *Caesarean section rate* - This is typically an **outcome or process indicator**, reflecting healthcare service delivery and utilization rather than the direct impact on newborn survival. - While relevant to maternal and newborn health, it doesn't directly measure newborn mortality or morbidity as an outcome. *Percentage of preterm births* - This is an **intermediate outcome indicator** or a **risk factor indicator**, as preterm birth is a major cause of neonatal mortality and morbidity. - While crucial for monitoring, it is a determinant of neonatal mortality rather than the direct impact itself. *Exclusive breastfeeding rate* - This is generally a **process indicator** or a **behavioral indicator**, reflecting the adoption of a recommended practice that supports newborn health. - While exclusive breastfeeding positively impacts newborn survival, the rate itself is not an impact measure of mortality reduction.

Q: Consider the following statements about correlation between two variables : 1. The correlation is done between an independent variable X and a dependent variable Y. 2. The coefficient of correlation can range from -1 to ∞. 3. If coefficient of correlation (r) is equal to 1, it indicates there is no association between X and Y. 4. Correlation does not necessarily prove causation. Which of the statements given above are correct ?

4 only. ***Correct: 4 only*** - **Correlation** measures the strength and direction of a linear relationship between two variables, but it **does not imply that one causes the other**; other factors or confounding variables might be involved. - This statement is a fundamental principle in statistics, emphasizing that causality requires more rigorous evidence, such as controlled experiments, beyond a simple correlation. - **Only statement 4 is correct** among all the given statements. *Incorrect: 1 only* - While correlation is often explored between dependent and independent variables, it can also be used to assess the relationship between **any two quantitative variables**, whether one is clearly designated as independent or dependent. - Statement 1 is partially incorrect as correlation isn't exclusively between designated independent and dependent variables. *Incorrect: 1, 2 and 3* - Statement 1 is partially incorrect as correlation isn't exclusively between designated independent and dependent variables. - Statement 2 is incorrect because the **coefficient of correlation (r) ranges from -1 to +1**, not to infinity, with -1 indicating a perfect negative correlation and +1 a perfect positive correlation. - Statement 3 is incorrect because an **r equal to 1 indicates a perfect positive linear association** between X and Y, meaning they move in the same direction proportionally, not no association. *Incorrect: 1 and 4 only* - Statement 1 is incorrect because **correlation can be performed between any two variables** to assess their relationship, not just an explicitly independent and dependent pair. - While statement 4 is correct, the inclusion of statement 1 makes this option incorrect.

Q: With regard to lead poisoning, consider the following statements : 1. Coproporphyrin in urine is a useful screening test. 2. Hand washing before eating is an important measure of personal hygiene. 3. The use of d-penicillamine has been reported to be effective in management. How many of the statements given above is/are correct ?

All three. ***All three*** - **Statement 1 is correct**: Urinary **coproporphyrin III** is a useful screening test for lead poisoning. Lead interferes with heme synthesis by inhibiting enzymes like ferrochelatase and ALA dehydratase, leading to accumulation and excretion of porphyrin precursors including coproporphyrin in urine. - **Statement 2 is correct**: **Hand washing before eating** is a critical preventive measure, especially in children. Lead dust on contaminated hands is a major route of exposure, particularly in environments with lead paint or industrial contamination. This is a key personal hygiene measure recommended by WHO and CDC. - **Statement 3 is correct**: **D-penicillamine** has indeed been reported to be effective in lead poisoning management. While **EDTA, DMSA (succimer), and dimercaprol** are more commonly used as first-line chelating agents today, d-penicillamine remains a valid chelating agent for heavy metal poisoning including lead, with documented effectiveness in medical literature. *1 only* - This option is incorrect because it ignores the validity of statements 2 and 3. - While statement 1 is accurate, **hand washing** (statement 2) is unquestionably an important preventive measure for lead poisoning. - Statement 3 is also correct as d-penicillamine **has been reported** to be effective (the statement doesn't claim it's first-line therapy). *2 only* - This option is incorrect because it ignores statements 1 and 3. - **Coproporphyrin in urine** (statement 1) is well-established as a screening test for lead exposure. - Statement 3 regarding d-penicillamine effectiveness is also correct based on medical literature. *None of the options* - This option is completely incorrect as all three statements are medically accurate. - Each statement represents correct information about lead poisoning screening, prevention, or management.

Q: A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found ?

Malaria. ***Malaria*** - The description of **boat-shaped eggs**, laid singly, and possessing **lateral floats** is characteristic of the *Anopheles* mosquito. - *Anopheles* mosquitoes are the primary vectors for **malaria**, transmitting *Plasmodium* parasites to humans. *Dengue fever* - Dengue fever is primarily transmitted by the *Aedes* mosquito, which lays **single, oval-shaped eggs** on water surfaces, typically in domestic containers. - These eggs lack the **boat shape** and **lateral floats** seen with *Anopheles*. *Japanese encephalitis* - Japanese encephalitis is mainly spread by *Culex* mosquitoes, which lay their eggs in **rafts** on the surface of water. - Their eggs are not boat-shaped or laid singly with lateral floats. *Chikungunya fever* - Chikungunya fever is transmitted by *Aedes* mosquitoes (similar to dengue), which lay their eggs **singly** on the sides of containers above the water line. - The eggs are **oval** and do not have the distinct boat-shape or lateral floats of *Anopheles*.

Q: In the National Health Policy 2017, a target of 90 : 90 : 90 has been set for HIV/AIDS. Which among the following are targets for which a 90% level has been set as part of the National Health Policy ? 1. Proportion of couples who have safe sex 2. Proportion of people living with HIV who know their HIV status 3. Proportion of adolescents who have access to contraceptives 4. Proportion of people receiving antiretroviral therapy who have viral suppression Select the correct answer using the code given below :

2 and 4. ***2 and 4*** The **90-90-90 targets** for HIV/AIDS established by UNAIDS and adopted in India's National Health Policy 2017 have three specific goals: - **First 90**: 90% of all people living with HIV know their HIV status - **Second 90**: 90% of all people diagnosed with HIV receive sustained antiretroviral therapy (ART) - **Third 90**: 90% of all people receiving ART achieve viral suppression **Statement 2** correctly identifies the **first 90** (proportion of people living with HIV who know their status), and **Statement 4** correctly identifies the **third 90** (proportion on ART achieving viral suppression). *1 and 4* While promoting safe sex is crucial for HIV prevention, the **90-90-90 targets specifically focus on the cascade of diagnosis, treatment, and viral suppression** among people already living with HIV. The proportion of couples having safe sex is not part of these specific targets. *1 and 3* Neither the **proportion of couples having safe sex** nor **adolescent access to contraceptives** are part of the 90-90-90 targets for HIV/AIDS. These are important broader public health goals but not the precise metrics of the 90-90-90 HIV strategy. *2 and 3* While **Statement 2** (proportion knowing their HIV status) is indeed the first component of the 90-90-90 targets, the **proportion of adolescents with access to contraceptives** is not part of these HIV-specific targets. This is a separate reproductive health goal unrelated to the 90-90-90 framework.

Q: The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system ?

Dual-record system. ***Dual-record system*** - This system involves two independent sources of data collection, such as a continuous enumeration and a periodic survey, to estimate vital events with greater accuracy by **cross-checking and matching the records** - The independent enumeration by an enumerator and a separate survey by an investigator-supervisor perfectly aligns with the principles of a **dual-record system**, designed to improve data quality and completeness - The SRS uses this methodology to capture births and deaths that might be missed by a single source *Triple-record system* - This system would involve **three independent sources** of data collection, which is more complex and not described in the given scenario - While potentially offering even higher accuracy, it's not applicable here as only two sources are mentioned *Double blinding* - **Double blinding** is a technique used in clinical trials where neither the participants nor the researchers know who is receiving a particular treatment - This method is used to **prevent bias** in clinical studies and is completely unrelated to vital statistics data collection methodology *Double data entry* - **Double data entry** is a process where data is entered twice by two different operators and then compared to **identify and correct errors** - This technique focuses on improving the accuracy of data input for a single data source, not on combining two independent sources of information for surveillance

Q: Cross-over type of study designs are those in which each subject serves as his/her own control. In which of the following conditions is a cross-over study not suitable ?

If the drug of interest cures the disease. ***If the drug of interest cures the disease*** - A **crossover study** relies on subjects experiencing both treatment and control conditions, which is **not possible** if a drug cures the disease, as the initial treatment would eliminate the condition for the second phase. - The carryover effect of a cure would invalidate the comparison between the treatment and control periods, making subsequent observations on the same subject non-independent. *If the disease changes radically during the period of time required for the study* - **Radical changes in disease progression** would introduce significant **confounding variables**, making it difficult to attribute changes in outcome solely to the intervention. - The **baseline state** for the second treatment period would be vastly different from the first, violating the assumption of comparable conditions inherent in crossover designs. *None of the options* - This option is incorrect because there is a specific scenario among the choices where a crossover study is unsuitable, as detailed in the correct answer. *If the drug is effective during all stages of the disease* - A drug's effectiveness across all disease stages would actually **make a crossover study more suitable**, as the treatment effects could be consistently observed regardless of when the intervention is given. - This scenario would reduce the variability in response due to disease progression, allowing for a clearer comparison between treatment and control periods.

Question 1

Under the National Leprosy Eradication Programme, ASHAs have been entrusted to which of the following activities ?

1. ASHAs are to search for suspected cases of leprosy in their villages and take them to the PHCs for diagnosis and treatment.

2. ASHAs arrange an amount of ₹ 5,000 as an incentive to each leprosy affected person in their village for undergoing reconstructive surgery.

3. ASHAs ensure that each leprosy affected person in their village receives micro-cellular rubber footwear for protection of insensitive feet.

4. ASHAs follow up all confirmed cases of leprosy in their village to ensure their treatment completion.

Select the correct answer using the code given below :

Accepted Answer

1 and 4 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

3 and 4 only

Question 2

The cost of implementation of 'Ayushman Bharat Pradhan Mantri Jan Arogya Yojana' is borne by :

Accepted Answer

Both Central Government and State Government

Answer

State Government only

Answer

Private institutions only as a part of their Corporate Social Responsibility

Answer

Central Government only

Question 3

All of the following are dashboard indicators used for monitoring of India Newborn Action Plan (INAP). Which one of them is an impact level indicator ?

Accepted Answer

Neonatal mortality rate

Answer

Caesarean section rate

Answer

Percentage of preterm births

Answer

Exclusive breastfeeding rate

Question 4

Which of the following are health education models ?

1. Medical model
2. Motivation model
3. Persuasion model
4. Social intervention model

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 5

Consider the following statements about correlation between two variables :

1. The correlation is done between an independent variable X and a dependent variable Y.

2. The coefficient of correlation can range from -1 to ∞.

3. If coefficient of correlation (r) is equal to 1, it indicates there is no association between X and Y.

4. Correlation does not necessarily prove causation. Which of the statements given above are correct ?

Accepted Answer

4 only

Answer

1 only

Answer

1, 2 and 3

Answer

1 and 4 only

Question 6

With regard to lead poisoning, consider the following statements :

1. Coproporphyrin in urine is a useful screening test.
2. Hand washing before eating is an important measure of personal hygiene.
3. The use of d-penicillamine has been reported to be effective in management. How many of the statements given above is/are correct ?

Accepted Answer

All three

Answer

None of the options

Answer

2 only

Answer

1 only

Question 7

A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found ?

Accepted Answer

Malaria

Answer

Dengue fever

Answer

Japanese encephalitis

Answer

Chikungunya fever

Question 8

In the National Health Policy 2017, a target of 90 : 90 : 90 has been set for HIV/AIDS. Which among the following are targets for which a 90% level has been set as part of the National Health Policy ?

1. Proportion of couples who have safe sex

2. Proportion of people living with HIV who know their HIV status

3. Proportion of adolescents who have access to contraceptives

4. Proportion of people receiving antiretroviral therapy who have viral suppression

Select the correct answer using the code given below :

Accepted Answer

2 and 4

Answer

1 and 4

Answer

1 and 3

Answer

2 and 3

Question 9

The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system ?

Accepted Answer

Dual-record system

Answer

Triple-record system

Answer

Double blinding

Answer

Double data entry

Question 10

Cross-over type of study designs are those in which each subject serves as his/her own control. In which of the following conditions is a cross-over study not suitable ?

Accepted Answer

If the drug of interest cures the disease

Answer

If the disease changes radically during the period of time required for the study

Answer

None of the options

Answer

If the drug is effective during all stages of the disease

UPSC-CMS 2023 — Community Medicine