Community Medicine
5 questionsWhich of the following is NOT a criterion for defining a polio epidemic?
In typhoid, a person is considered a permanent carrier if they excrete bacilli for more than how many months?
Malaria is transmitted in Rural areas by?
What is the most common Anopheles mosquito responsible for malaria in India?
Which indicator best measures the operational efficiency of a malaria control programme?
NEET-PG 2013 - Community Medicine NEET-PG Practice Questions and MCQs
Question 651: Which of the following is NOT a criterion for defining a polio epidemic?
- A. Caused by same virus type
- B. Cases should occur in same locality
- C. 2 or more cases
- D. Cases occurring during a 6 month period (Correct Answer)
Explanation: ***Correct: Cases occurring during a 6 month period*** - The definition of a polio epidemic primarily focuses on criteria like the number of cases, their geographical proximity, and the viral serotype causing the infection, not a specific duration of time over which cases occur. - While an outbreak naturally unfolds over a period, a fixed 6-month window is **not a formal defining criterion** for an epidemic, which typically emphasizes a sudden, significant increase above expected levels. *Incorrect: 2 or more cases* - An epidemic is generally defined by an **unusual increase in disease incidence**, and even two confirmed cases, especially in areas with low endemicity or where polio is eradicated, can signal an outbreak. - The presence of **two or more paralytic polio cases** within a specific area is often considered a critical threshold for declaring an epidemic, particularly for **wild poliovirus**. *Incorrect: Cases should occur in same locality* - For an epidemic to be declared, the cases must be **geographically linked** to indicate a common source or local transmission. - Cases spread across different, unconnected regions would suggest **sporadic occurrences** rather than a localized epidemic. *Incorrect: Caused by same virus type* - An epidemic implies a **common etiologic agent**, meaning the cases should be linked to the same serotype of **poliovirus** (e.g., wild poliovirus type 1). - If cases are caused by different serotypes, it indicates **multiple independent introductions** rather than a single epidemic outbreak.
Question 652: In typhoid, a person is considered a permanent carrier if they excrete bacilli for more than how many months?
- A. 3 months
- B. 6 months
- C. 1 year (Correct Answer)
- D. 3 years
Explanation: **1 year** - A person is defined as a permanent carrier of typhoid if they excrete **Salmonella Typhi** in their feces or urine for **more than one year** after the acute illness. - This long-term excretion is often associated with chronic infection of the **gallbladder**, particularly in individuals with gallstones. - The definition of chronic/permanent carrier status is set at **≥12 months** of continuous bacillary excretion. *3 months* - Excreting bacilli for 3 months after acute typhoid is considered a **convalescent carrier state**, not a permanent one. - Many individuals clear the infection within this timeframe without becoming chronic carriers. *6 months* - While prolonged, 6 months of excretion still falls under the definition of a **convalescent or temporary carrier**, rather than a permanent carrier. - The threshold for "permanent" or "chronic" carrier status is typically set at 12 months. *3 years* - While a person excreting bacilli for 3 years would certainly be a permanent carrier, the established definition for permanent carrier status is met at **1 year**, not 3 years. - This option represents an unnecessarily longer duration than the standard definition.
Question 653: Malaria is transmitted in Rural areas by?
- A. Anopheles stephensi
- B. Anopheles dirus
- C. Anopheles culicifacies (Correct Answer)
- D. None of the options
Explanation: ***Anopheles culicifacies*** - **_Anopheles culicifacies_** is the **primary vector of malaria in rural areas of India** and is also found in Southeast Asia. - Its breeding habitats often include **rice fields, irrigation channels, and temporary water collections** common in rural agricultural settings. - It accounts for a major proportion of rural malaria transmission in the Indian subcontinent. *Anopheles stephensi* - **_Anopheles stephensi_** is a significant malaria vector primarily found in **urban and semi-urban areas**, including parts of the Middle East, India, and Iran. - Its preferred breeding sites are **artificial containers found in urban environments**, such as water storage tanks, overhead tanks, and cisterns. *Anopheles dirus* - **_Anopheles dirus_** is a dominant malaria vector in **forested and hilly regions of Southeast Asia**, often associated with forest malaria. - It's known for outdoor feeding behavior and maintaining transmission in relatively undisturbed natural environments. *None of the options* - This option is incorrect because **_Anopheles culicifacies_** is a well-established and significant vector for malaria in rural areas of India. - Identification of a specific primary vector for rural transmission makes this choice invalid.
Question 654: What is the most common Anopheles mosquito responsible for malaria in India?
- A. Anopheles stephensi
- B. Anopheles subpictus
- C. Anopheles culicifacies (Correct Answer)
- D. Anopheles fluviatilis
Explanation: ***Anopheles culicifacies*** - This species is the **most common and primary malaria vector in India**, responsible for approximately 60-70% of all malaria transmission in the country. - It is the **major rural vector** of malaria, especially in agricultural areas, and transmits both *Plasmodium vivax* and *P. falciparum*. - Given that the majority of India's population resides in rural areas where malaria burden is highest, *A. culicifacies* is the most important vector overall. *Anopheles stephensi* - This species is recognized as the **primary urban vector** of malaria in India, particularly for *P. vivax* and *P. falciparum*. - Its ability to breed in artificial containers makes it well-adapted to urban environments, but it accounts for a smaller proportion of total malaria cases compared to *A. culicifacies*. *Anopheles fluviatilis* - This species is an **important vector in hilly and forest areas** of India, rather than being the most common overall. - It is known to transmit both *P. vivax* and *P. falciparum* in these specific ecological niches. *Anopheles subpictus* - While present in India, *A. subpictus* is generally considered a **poor vector** of malaria due to its low susceptibility to Plasmodium infection. - It mainly breeds in diverse habitats including paddy fields and brackish water.
Question 655: Which indicator best measures the operational efficiency of a malaria control programme?
- A. Infant parasite rate
- B. Slide positivity rate
- C. Mosquito bite rate
- D. Annual blood examination rate (Correct Answer)
Explanation: ***Annual blood examination rate*** - The **Annual Blood Examination Rate (ABER)** directly reflects the proportion of the population that has been tested for malaria, indicating the reach and effectiveness of surveillance activities. - A high ABER suggests that active case detection and diagnosis are being effectively implemented, which is crucial for operational efficiency in identifying and managing cases. *Infant parasite rate* - The **infant parasite rate** measures the prevalence of malaria infection among infants, serving as an indicator of recent transmission intensity. - While important for assessing disease burden and transmission, it doesn't directly measure the operational effectiveness of interventions like testing or treatment programs. *Slide positivity rate* - The **slide positivity rate (SPR)** is the proportion of positive malaria slides among all slides examined, indicating the likelihood of an individual seeking testing to actually have malaria. - While SPR helps understand disease activity among tested individuals, it doesn't reflect the full operational reach of a program in the general population or the overall testing effort. *Mosquito bite rate* - The **mosquito bite rate** measures the number of mosquito bites per person per night, indicating the level of human exposure to malaria vectors. - This is an entomological indicator of transmission risk and the impact of vector control, but it does not directly assess the operational efficiency of human-centric interventions like diagnosis and treatment programs.
Internal Medicine
2 questionsWhich of the following statements about polio is false?
Which of the following is NOT a symptom of mild dehydration?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 651: Which of the following statements about polio is false?
- A. 99% non paralytic
- B. Aseptic meningitis
- C. Flaccid paralysis
- D. Increased tendon reflexes (Correct Answer)
Explanation: ***Increased tendon reflexes*** - Polio causes **lower motor neuron damage**, specifically to the anterior horn cells of the spinal cord [1]. - This damage leads to **flaccid paralysis** and **decreased or absent deep tendon reflexes**, not increased reflexes [3]. *99% non paralytic* - The vast majority of poliovirus infections (approximately 95-99%) are **asymptomatic** or cause only mild, non-specific symptoms. - Only a small percentage of infected individuals develop the more severe paralytic form of the disease. *Flaccid paralysis* - Poliovirus directly attacks and destroys **motor neurons** in the anterior horn of the spinal cord [1]. - This damage results in **muscle weakness** and loss of muscle tone, leading to **flaccid paralysis** [3]. *Aseptic meningitis* - About 1-5% of poliovirus infections can manifest as **aseptic meningitis**, characterized by symptoms like fever, headache, neck stiffness, and vomiting without bacterial infection [2]. - This form of meningitis is typically **self-limiting** and does not lead to paralysis [2].
Question 652: Which of the following is NOT a symptom of mild dehydration?
- A. Thirst
- B. Restlessness
- C. Dry tongue
- D. Normal BP (Correct Answer)
Explanation: ***Normal BP*** - In **mild dehydration**, the body's compensatory mechanisms, such as increased heart rate and vasoconstriction, typically manage to maintain a **normal blood pressure**. [1] - A significant drop in **blood pressure** (hypotension) is usually indicative of **moderate to severe dehydration**, where these compensatory mechanisms begin to fail. [2] *Thirst* - **Thirst** is one of the **earliest and most reliable** indicators of dehydration, as the body signals a need for fluid intake. [3] - It arises in response to increased plasma osmolality and decreased blood volume, both occurring even in **mild dehydration**. [3] *Restlessness* - **Restlessness** can be an early sign of discomfort and altered mental status associated with **mild dehydration**, particularly in infants and young children. - As the body struggles to maintain fluid balance, individuals may experience irritability and general unease. *Dry tongue* - A **dry tongue** and **dry sticky mucous membranes** are common signs of mild to moderate dehydration. - This symptom results from reduced salivary production due to decreased fluid volume in the body.
Pharmacology
3 questionsWhat is the initial loading dose of chloroquine base for treating uncomplicated malaria in children?
Drug for prophylaxis of malaria in chloroquine resistant P.falciparum ?
An Englishman travels to a place which is resistant to chloroquine and mefloquine. What should he take as prophylaxis?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 651: What is the initial loading dose of chloroquine base for treating uncomplicated malaria in children?
- A. 5 mg/kg
- B. 10 mg/kg (maximum 600 mg) (Correct Answer)
- C. 15 mg/kg
- D. 25 mg/kg
Explanation: ***10 mg/kg (maximum 600 mg)*** - The standard **initial loading dose** of chloroquine base for uncomplicated malaria in children is **10 mg/kg body weight**, with a maximum cap of **600 mg** to prevent toxicity. - This is followed by **5 mg/kg** at 6 hours, 24 hours, and 48 hours (total course of 25 mg/kg over 3 days). - This represents **WHO-recommended** weight-based dosing for pediatric malaria treatment. *5 mg/kg* - **5 mg/kg** is the dose for the **subsequent doses** (at 6, 24, and 48 hours after the initial dose), not the initial loading dose. - The initial dose must be higher (10 mg/kg) to rapidly achieve therapeutic blood levels. *15 mg/kg* - **15 mg/kg** exceeds the recommended initial dose and increases the risk of **chloroquine toxicity**. - Chloroquine has a narrow therapeutic index, and overdosing can cause serious **cardiovascular** (arrhythmias, hypotension) and **neurological** effects (seizures, visual disturbances). *25 mg/kg* - **25 mg/kg** represents the **total cumulative dose** over the entire 3-day treatment course, not the initial single dose. - Giving this amount as a single dose would result in severe toxicity and is contraindicated.
Question 652: Drug for prophylaxis of malaria in chloroquine resistant P.falciparum ?
- A. Mefloquine (Correct Answer)
- B. Quinine
- C. Halofantrine
- D. Artesunate
Explanation: ***Mefloquine*** - **Mefloquine** is a well-established and effective drug for prophylaxis against **chloroquine-resistant Plasmodium falciparum**. - It is often used in regions with high chloroquine resistance, although it can have significant neuropsychiatric side effects. *Quinine* - **Quinine** is primarily used for the *treatment* of severe or complicated malaria, especially in cases of multidrug resistance. - It is not typically recommended for malaria **prophylaxis** due to its relatively short half-life and potential for side effects with chronic use. *Halofantrine* - **Halofantrine** is an *antimalarial treatment* drug, not a prophylactic agent. - Its use is limited due to potential for **cardiotoxicity** (QT prolongation) and poor bioavailability. *Artesunate* - **Artesunate** is an **artemisinin derivative** and a potent antimalarial drug used for the *treatment* of acute malaria, particularly severe cases. - It has a very short half-life and is not suitable for **prophylaxis**.
Question 653: An Englishman travels to a place which is resistant to chloroquine and mefloquine. What should he take as prophylaxis?
- A. Primaquine
- B. Atovaquone-proguanil (Correct Answer)
- C. Doxycycline
- D. Proguanil
Explanation: ***Atovaquone-proguanil*** - This combination, known as **Malarone**, is the most appropriate prophylactic agent for areas with **multi-drug resistant malaria**, including resistance to chloroquine and mefloquine [1], [2]. - It targets multiple stages of the parasite life cycle, providing excellent protection and is generally well-tolerated with specific **WHO and CDC recommendations** for chloroquine and mefloquine resistant areas [1], [3]. *Primaquine* - **Primaquine** is primarily used for **causal prophylaxis** against *P. vivax* and *P. ovale* to prevent relapse, not as primary prophylaxis [2]. - It is not typically recommended as the primary prophylactic agent in areas with **chloroquine and mefloquine resistance** and requires **G6PD testing** due to risk of hemolysis [1]. *Proguanil* - While proguanil is used for malaria prophylaxis, **proguanil alone** is not effective enough for prophylaxis in areas with multi-drug resistant malaria. - It is typically used in **combination with atovaquone** rather than as monotherapy for effective protection [3]. *Doxycycline* - **Doxycycline** is also an effective prophylactic agent for areas with **chloroquine and mefloquine-resistant malaria** and is commonly recommended [1], [2]. - While effective, it can cause **photosensitivity** and **gastrointestinal upset**, making atovaquone-proguanil the preferred first-line choice.