Non-Communicable Diseases

Non-Communicable Diseases Indian Medical PG Question 1: Which of the following is not a differential diagnosis of non-accidental injury?

• A. Osteogenesis imperfecta
• B. Scurvy
• C. Caffey's disease
• D. Osteopetrosis (Correct Answer)

Non-Communicable Diseases Explanation: ***Correct: Osteopetrosis*** - Osteopetrosis is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function - While it causes bones to be brittle and prone to fracture, it has **distinctive radiological features** including diffuse sclerosis and "bone-within-bone" appearance - The **increased bone density on X-ray** is pathognomonic and readily distinguishes it from NAI, making it **less likely to be confused** with non-accidental injury in clinical practice - Fractures occur but the radiological pattern is diagnostic of the underlying metabolic bone disease *Incorrect: Osteogenesis imperfecta* - This is a **classic differential** for NAI causing **multiple brittle bone fractures** that can be mistaken for abuse - Features include **blue sclera**, **dentinogenesis imperfecta**, **wormian bones**, and **family history** - Often presents with multiple fractures at different stages of healing, mimicking the pattern seen in NAI *Incorrect: Scurvy* - Caused by **vitamin C deficiency**, leads to defective collagen synthesis - Results in **subperiosteal hemorrhages**, **metaphyseal fractures**, and **periosteal elevation** that closely mimic NAI - Additional features include **gingival bleeding**, **petechiae**, **follicular hyperkeratosis**, and **poor wound healing** *Incorrect: Caffey's disease* - Also known as **infantile cortical hyperostosis**, presents in infants under 6 months - Causes **periosteal reactions**, **bone thickening**, and **soft tissue swelling** in long bones, ribs, and mandible - The periosteal new bone formation can be mistaken for healing fractures from NAI, making it an important differential

Non-Communicable Diseases Indian Medical PG Question 2: Which National Programme came into existence during 11th Five Year Plan?

• A. National Cardiovascular diseases and Stroke control programme
• B. National Diabetes and Cancer control programme
• C. National Cancer control programme
• D. National Programme for prevention and control of Cancer, Diabetes, Cardiovascular diseases and Stroke (Correct Answer)

Non-Communicable Diseases Explanation: ***National Programme for prevention and control of Cancer, Diabetes, Cardiovascular diseases and Stroke*** - This comprehensive national program was launched during the **11th Five Year Plan** to address the growing burden of non-communicable diseases in India. - It integrates the prevention and control efforts for **Cancer, Diabetes, Cardiovascular diseases, and Stroke** under a single umbrella. *National Cardiovascular diseases & Stroke control programme* - While cardiovascular diseases and stroke are a major focus, this particular phrasing does not represent the full scope of the program initiated during the 11th Five Year Plan. - The actual program was broader, encompassing other significant non-communicable diseases. *National Diabetes and Cancer control programme* - This option is incomplete as it omits **cardiovascular diseases (CVDs)** and **stroke**, which were crucial components of the integrated program. - The 11th Five Year Plan emphasized a more holistic approach to major non-communicable diseases. *National Cancer control programme* - A **National Cancer Control Programme** existed prior to and was integrated into the broader initiative during the 11th Five Year Plan. - This option only refers to a specific disease, failing to capture the comprehensive nature of the new program.

Non-Communicable Diseases Indian Medical PG Question 3: Which of the following is not the criteria for diagnosis of Metabolic syndrome?

• A. High LDL (Correct Answer)
• B. Hyperiglyceridemia
• C. Hypertension
• D. Central obesity

Non-Communicable Diseases Explanation: ***High LDL*** - While **high LDL (low-density lipoprotein)** is a risk factor for cardiovascular disease [1], it is **not** one of the specific diagnostic criteria for metabolic syndrome. - The criteria for metabolic syndrome focus on a cluster of metabolic abnormalities associated with insulin resistance. *Hypertriglyceridemia* - **Elevated triglycerides** (typically ≥ 150 mg/dL or on drug treatment for elevated triglycerides) is one of the key diagnostic criteria for metabolic syndrome. - It reflects impaired lipid metabolism often associated with insulin resistance [2]. *Hypertension* - **Elevated blood pressure** (systolic ≥ 130 mmHg or diastolic ≥ 85 mmHg, or on antihypertensive drug treatment) is a core component of metabolic syndrome. - Hypertension in this context is often linked to underlying insulin resistance. *Central obesity* - **Increased waist circumference** (varying by ethnicity and sex, e.g., >102 cm in men and >88 cm in women for adults of European descent) is a primary criterion for metabolic syndrome. - It is a strong indicator of visceral fat accumulation, which is closely linked to insulin resistance [3].

Non-Communicable Diseases Indian Medical PG Question 4: Which of the following is not a criterion suggesting causality in non communicable diseases?

• A. Specificity of association
• B. Dose response relationship
• C. Strength of association
• D. Lack of temporal association (Correct Answer)

Non-Communicable Diseases Explanation: ***Lack of temporal association*** - For an exposure to cause a non-communicable disease, the exposure must precede the disease onset; therefore, a **lack of temporal association** explicitly argues *against* causality. - This criterion is a fundamental principle of causality, as the **cause must occur before the effect**. *Specificity of association* - This criterion suggests that a single exposure should lead to a single disease. However, in non-communicable diseases, a single risk factor may contribute to multiple diseases (e.g., smoking and lung cancer, heart disease, stroke), and a single disease can have **multiple causes**. - While it was important in the original Bradford Hill criteria, its relevance is diminished in modern epidemiology due to the **multifactorial nature of chronic diseases**. *Dose response relationship* - This criterion implies that as the **amount or duration of exposure increases**, the **risk or severity of the disease also increases**. - This is a strong indicator of causality because it suggests a biological gradient. *Strength of association* - A strong association, often measured by a **high relative risk or odds ratio**, increases the likelihood of a causal relationship. - A weak association, while not ruling out causality, makes it less likely to be directly causal and more likely to be influenced by other factors or confounding variables.

Non-Communicable Diseases Indian Medical PG Question 5: STEPS is done for:

• A. Surveillance of risk factors of non-communicable disease (Correct Answer)
• B. Surveillance of mortality from non-communicable disease
• C. Surveillance of evaluation of treatment of non-communicable disease
• D. Surveillance of incidence of non-communicable disease

Non-Communicable Diseases Explanation: ***Surveillance of risk factors of non-communicable disease*** - STEPS is a **WHO-designed sequential survey** that tracks **risk factors** of non-communicable diseases (NCDs) in a stepwise approach. - It collects data on behavioral risk factors (e.g., tobacco use, unhealthy diet, physical inactivity), physical measurements (e.g., blood pressure, weight, height), and biochemical measurements (e.g., blood glucose, cholesterol). *Surveillance of mortality from non-communicable disease* - While related to NCDs, STEPS primarily focuses on **risk factors** that lead to these diseases, not directly on mortality data. - Mortality surveillance is typically conducted through **vital registration systems** and health information systems. *Surveillance of evaluation of treatment of non-communicable disease* - STEPS surveys are not designed to evaluate the **effectiveness of specific treatments** for NCDs. - Evaluating treatment efficacy usually involves **clinical trials** or specific cohort studies. *Surveillance of incidence of non-communicable disease* - Although the presence of risk factors influences incidence, STEPS primarily measures the **prevalence of risk factors**, not the incidence (new cases) of NCDs themselves. - Incidence studies require longitudinal follow-up of populations.

Non-Communicable Diseases Indian Medical PG Question 6: WHO global target for prevention and control of non communicable diseases by 2025 is to decrease the prevalence of raised blood pressure (hypertension) by

• A. 75%
• B. 25% (Correct Answer)
• C. 90%
• D. 55%

Non-Communicable Diseases Explanation: ***25%*** - The World Health Organization (WHO) set a **global target** to achieve a **25% relative reduction** in the prevalence of **raised blood pressure (hypertension)** by 2025 (compared to 2010 baseline). - This target is part of the **WHO Global Action Plan for NCDs** and the Global Monitoring Framework to combat **non-communicable diseases (NCDs)**. *75%* - A 75% reduction in hypertension prevalence is an **unrealistically ambitious** target given current global health challenges and interventions. - While significant reductions are desired, the evidence-based target set by WHO is a more achievable 25% reduction. *90%* - A 90% reduction is not one of the specifically stated **WHO global targets** for hypertension by 2025. - Such a drastic reduction would require unprecedented public health interventions and is not supported by current evidence. *55%* - 55% is not a recognized **WHO target** for the prevention and control of hypertension by 2025. - The established global target from the WHO NCD Global Monitoring Framework specifically focuses on a **25% relative reduction**.

Non-Communicable Diseases Indian Medical PG Question 7: Which of the following are criteria for cancer screening? I. Screening test should be sensitive and specific II. Screening test should be acceptable to the screened population III. The disease should be an uncommon one for screening to be effective IV. Disease should be recognisable at an early stage Select the correct answer using the code given below :

• A. II, III and IV
• B. I, III and IV
• C. I, II and III
• D. I, II and IV (Correct Answer)

Non-Communicable Diseases Explanation: ***I, II and IV*** - A successful **screening test** should be **sensitive** (correctly identify those with the disease) and **specific** (correctly identify those without the disease) to minimize false negatives and false positives. - For a screening program to be effective, the test must be **acceptable** to the target population to ensure high participation rates. The disease should also be **recognizable at an early stage** to allow for timely and effective intervention. *II, III and IV* - This option is partially correct as it includes acceptability and early recognition, but incorrectly states that the disease should be uncommon. In reality, screening is often more impactful for diseases with a higher prevalence. - The claim that the disease should be uncommon is incorrect; screening programs are often prioritized for relatively common diseases where early detection can significantly alter outcomes. *I, III and IV* - This option correctly identifies the need for a sensitive and specific test, and early disease recognition, but it incorrectly asserts that the disease should be an uncommon one. - Screening is generally most beneficial for diseases with a significant prevalence, allowing for a substantial impact on public health. *I, II and III* - This option accurately points to the necessity of a sensitive and specific test and its acceptability to the screened population, but it mistakenly suggests that the disease should be uncommon. - Effective screening targets diseases where early detection can lead to improved outcomes, which are often diseases with a notable burden in the population.

Non-Communicable Diseases Indian Medical PG Question 8: All of the following are global targets for WHO Global Action Plan (2013–2020) for Prevention and Control of NCDs, EXCEPT:

• A. A 30% relative reduction in mean population intake of salt/sodium
• B. A 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases
• C. At least 10 % relative reduction in the harmful use of alcohol
• D. A 15% relative reduction in healthcare costs related to NCDs (Correct Answer)

Non-Communicable Diseases Explanation: ***A 15% relative reduction in healthcare costs related to NCDs*** - While reducing healthcare costs is an important outcome of NCD prevention, it was **not explicitly stated as one of the nine global targets** in the WHO Global Action Plan (2013–2020) for the Prevention and Control of NCDs. - The targets primarily focused on **risk factor reduction and mortality reduction**, rather than direct cost reduction percentages. *A 30% relative reduction in mean population intake of salt/sodium* - This is one of the **specified global targets** of the WHO NCD Global Action Plan, aiming to reduce a significant dietary risk factor for cardiovascular diseases. - High sodium intake is a major contributor to **hypertension**, a leading risk factor for NCDs. *A 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases* - This represents the **overarching mortality reduction target** for the key NCDs, making it a central goal of the WHO action plan. - Reducing premature mortality is a direct measure of the **effectiveness of NCD prevention and control strategies**. *At least 10 % relative reduction in the harmful use of alcohol* - This is another **identified global target** within the WHO NCD Global Action Plan, recognizing alcohol as a major modifiable risk factor for NCDs. - Harmful alcohol use contributes to various NCDs, including **liver disease, cardiovascular disease, and certain cancers**.

Non-Communicable Diseases Indian Medical PG Question 9: Prevention of emergence of risk factors in a community is called:

• A. Primordial prevention (Correct Answer)
• B. Secondary prevention
• C. Tertiary prevention
• D. Primary prevention

Non-Communicable Diseases Explanation: ***Primordial prevention*** - This level of prevention focuses on preventing the **emergence or development of risk factors** themselves in a community. - It targets underlying **social, economic, and environmental conditions** that contribute to risk factor development. - Examples include policies to prevent smoking initiation in youth or promoting healthy dietary patterns before diseases emerge. *Primary prevention* - This involves **preventing disease occurrence** by controlling risk factors that already exist. - Examples include **vaccination**, health education, and lifestyle modifications (e.g., promoting exercise to prevent obesity). - Differs from primordial as it addresses established risk factors rather than preventing their emergence. *Secondary prevention* - This involves **early detection and prompt treatment** of diseases to prevent their progression. - Examples include **screening programs** (e.g., mammography for breast cancer) and regular blood pressure checks. *Tertiary prevention* - This aims to **reduce the impact of an established disease** and prevent disability or complications through rehabilitation. - Examples include **physical therapy** after a stroke or support groups for chronic illnesses.

Non-Communicable Diseases Indian Medical PG Question 10: What is the most cost-effective screening strategy for STIs in resource-limited settings according to WHO guidelines?

• A. Risk-based screening
• B. Periodic mass treatment
• C. Syndromic management (Correct Answer)
• D. Universal screening

Non-Communicable Diseases Explanation: ***Syndromic management*** - This approach involves diagnosing and treating STIs based on the **clinical symptoms** presented by the patient, without the need for expensive laboratory tests. - It is highly cost-effective in resource-limited settings as it reduces the need for costly diagnostics while ensuring prompt treatment to prevent complications and onward transmission. *Risk-based screening* - While helpful, identifying high-risk individuals and conducting targeted screening still requires some level of diagnostic testing, which can be **expensive** or **unavailable** in resource-limited settings. - It may miss STIs in individuals who do not fit predefined risk categories but are still infected. *Periodic mass treatment* - This strategy involves treating a large population group for STIs regardless of their symptom status, which can lead to **antimicrobial resistance** and is not specifically recommended by WHO for routine STI control. - It is generally **inefficient** and potentially wasteful of resources, as many individuals treated may not be infected. *Universal screening* - This approach involves comprehensive diagnostic testing for all individuals, which is highly effective but **prohibitively expensive** and logistically challenging for resource-limited settings. - It requires significant infrastructure for laboratory testing and follow-up, which is often lacking where resources are scarce.

Non-Communicable Diseases Flashcard 1 of 8

Question: SDG goal is to reduce premature mortality from NCD by _____%

Answer: 33

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Non-Communicable Diseases Flashcard 2 of 8

Question: Therapeutic assessment is _____ included in the STEP approach of WHO.

Answer: not

Non-Communicable Diseases Flashcard 3 of 8

Question: The two goals of cancer screening are to catch:(1) to catch _____ before it becomes carcinoma (2) detect carcinoma before clinical symptoms arise

Answer: dysplasia

Non-Communicable Diseases Flashcard 4 of 8

Question: _____ program is launched by Govt. for control of RHD/RF

Answer: Jai vigyan mission

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Non-Communicable Diseases Flashcard 5 of 8

Question: In the United States, cancer is the second leading cause of death in which of the following age groups? _____

Answer:

Non-Communicable Diseases Flashcard 6 of 8

Question: most deaths from cancer are caused by _____

Answer: lung cancer

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Non-Communicable Diseases Flashcard 7 of 8

Question: globally mc cancer is _____

Answer: breast carcinoma

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Non-Communicable Diseases Flashcard 8 of 8

Question: d4f504e7accc43959ee4fe5ea41ccd3b-ao-4

Answer: world tobacco day

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