Cross-Border Health Issues — MCQs

10 questions

Which disease comes under International Surveillance?

Which of the following diseases has the largest submerged portion in the iceberg model of disease?

In all of the following diseases chronic carriers are found except:

Which of the following diseases is specifically under surveillance by the World Health Organization for mandatory notification by national health authorities under the International Health Regulations (IHR) 2005?

Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?

The Roll Back Malaria programme focused mainly on

Which of the following diseases is not covered under the Integrated Disease Surveillance Project (IDSP)?

Mobile Medical Units (MMUs) under government health programs can operate through different models. Which of the following statements about MMU operations are correct? 1. MMUs are run by the government 2. MMUs are run by external agencies with medical supplies given by the government 3. MMUs are run by the government and medical supplies are also given by the government 4. MMUs are run by external agencies and medical supplies are also given by the external agency

Q10

Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

Cross-Border Health Issues Indian Medical PG Practice Questions and MCQs

Question 1: Match the following columns on Epidemiology Guidelines: | A. CARE | 1. RCT | | :-- | :-- | | B. CONSORT | 2. Case report | | C. PRISMA | 3. Observational study | | D. STROBE/MOOSE | 4. Systematic Review |

A. A2-B1-C4-D3 (Correct Answer)
B. A2-B4-C1-D3
C. A4-B1-C3-D2
D. A4-B1-C2-D3

Explanation: ***A2-B1-C4-D3*** - **CARE Guidelines** provide essential reporting standards for **case reports** and case series to enhance their value and transparency. - **CONSORT (Consolidated Standards of Reporting Trials)** is specifically designed for the reporting of **Randomized Controlled Trials (RCTs)**. - **PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)** provides a minimum set of items for reporting in **systematic reviews** and meta-analyses. - **STROBE (STrengthening the Reporting of OBservational studies in Epidemiology)** and **MOOSE (Meta-analysis Of Observational Studies in Epidemiology)** are reporting guidelines for **observational studies**, including cohort, case-control, and cross-sectional studies. *A2-B4-C1-D3* - Incorrectly pairs CONSORT with systematic reviews (should be RCTs) and PRISMA with RCTs (should be systematic reviews). - CONSORT is the gold standard for **reporting RCTs**, while PRISMA is designed for **systematic reviews and meta-analyses**. *A4-B1-C3-D2* - Incorrectly matches CARE with systematic reviews, PRISMA with observational studies, and STROBE/MOOSE with case reports. - CARE is specifically for **case reports and case series**, PRISMA for **systematic reviews**, and STROBE/MOOSE for **observational epidemiological studies**. *A4-B1-C2-D3* - Incorrectly pairs CARE with systematic reviews and PRISMA with case reports. - This reverses the actual purpose: CARE is designed for **case reports**, while PRISMA guides **systematic reviews and meta-analyses**.

Question 2: Which disease comes under International Surveillance?

A. Typhoid fever (Correct Answer)
B. Chikungunya fever
C. Hepatitis B
D. Salmonellosis

Explanation: ***Typhoid fever*** - **Typhoid fever** is monitored by the **World Health Organization (WHO)** through global surveillance systems to track incidence, guide vaccination strategies, and implement control measures. - While **not on the mandatory notification list** under the International Health Regulations (IHR) 2005, typhoid is included in **WHO's global disease surveillance** programs due to its significant disease burden in endemic regions. - Among the given options, typhoid fever has the **strongest international surveillance framework** through WHO's Global Foodborne Infections Network and regional surveillance systems. - **Note:** Diseases under **mandatory IHR surveillance** include cholera, plague, yellow fever, smallpox, poliomyelitis, SARS, and novel influenza subtypes. *Chikungunya fever* - Chikungunya is primarily monitored through **national and regional surveillance** systems rather than comprehensive international surveillance frameworks. - WHO tracks outbreaks through epidemic intelligence but it is **not part of mandatory IHR notification**. - Surveillance focuses on **vector control** and outbreak detection at local levels. *Hepatitis B* - **Hepatitis B** surveillance is conducted primarily at **national levels** through prevalence studies, vaccination coverage monitoring, and chronic infection programs. - It is **not under mandatory international surveillance** per IHR, though WHO maintains global estimates and monitoring frameworks. - Focus is on **prevention through vaccination** and treatment of chronic infections. *Salmonellosis* - Non-typhoidal **salmonellosis** is monitored mainly through **national food safety** and public health surveillance systems. - **Not designated for mandatory international surveillance** under IHR 2005. - International coordination occurs through networks like WHO's Global Foodborne Infections Network for outbreak investigation.

Question 3: Which of the following diseases has the largest submerged portion in the iceberg model of disease?

A. Influenza (Correct Answer)
B. Chickenpox
C. Tetanus
D. Rabies

Explanation: **The Iceberg Model of Disease** represents the concept that for many diseases, only a small portion of cases (the "tip" above water) are clinically apparent and reported, while a much larger portion (the "submerged" part) consists of asymptomatic, subclinical, or undiagnosed cases. ***Influenza*** - Has the **largest submerged portion** among the given options, with **50-75% of infections being asymptomatic or mild** and going undiagnosed - High transmissibility and varied clinical presentation contribute to significant hidden burden - Only severe cases requiring hospitalization typically get reported, representing just the "tip of the iceberg" - Classic example of diseases with large subclinical-to-clinical ratio *Chickenpox* - Most cases are **clinically apparent** with characteristic vesicular rash - Asymptomatic infections are rare due to distinctive clinical features - High visibility of cases reduces the submerged portion significantly *Tetanus* - **Severe, acute neurological condition** with distinct clinical manifestations (trismus, risus sardonicus, opisthotonus) - Almost all cases are diagnosed due to dramatic presentation - Virtually no submerged portion - what exists clinically is recognized *Rabies* - **Nearly uniformly fatal** once symptoms appear, making all symptomatic cases clinically evident - No asymptomatic or mild phase after symptom onset - Minimal to no submerged portion in the iceberg model

Question 4: In all of the following diseases chronic carriers are found except:

A. Typhoid
B. Gonorrhoea
C. Measles (Correct Answer)
D. Hepatitis B

Explanation: ***Measles*** - Measles is caused by a **highly contagious virus** and typically results in an acute illness followed by lifelong immunity; it does not establish a chronic carrier state. - Individuals either recover completely or succumb to the disease, without becoming asymptomatic carriers who can transmit the virus for extended periods. *Typhoid* - **Chronic carriers** of *Salmonella Typhi* can harbor the bacteria in their **gallbladder** or urinary tract for years, shedding it in their feces or urine. - These carriers, despite showing no symptoms themselves, can transmit the infection to others, posing a significant public health risk. *Gonorrhoea* - Some individuals infected with *Neisseria gonorrhoeae* can be **asymptomatic carriers**, particularly women, and can transmit the infection without knowing they are infected. - While generally not considered "chronic" in the same way as typhoid or hepatitis B, asymptomatic carriage can persist for several weeks or months. *Hepatitis B* - Many individuals infected with the **Hepatitis B virus (HBV)**, especially if infected during infancy or early childhood, can become **chronic carriers**. - These chronic carriers can continue to transmit the virus and are at increased risk for developing serious liver diseases such as **cirrhosis** and **hepatocellular carcinoma**.

Question 5: Which of the following diseases is specifically under surveillance by the World Health Organization for mandatory notification by national health authorities under the International Health Regulations (IHR) 2005?

A. Relapsing fever
B. Paralytic polio (Correct Answer)
C. Louse-borne typhus fever
D. All of the options

Explanation: ***Paralytic polio*** - **Poliomyelitis due to wild-type poliovirus** is one of only three diseases requiring **mandatory notification** under **Annex 2 of the International Health Regulations (IHR) 2005**, regardless of context or scale. - The other two diseases requiring mandatory notification are **smallpox** and **human influenza caused by a new subtype** (SARS was added subsequently). - This reflects the global commitment to **polio eradication** under the **Global Polio Eradication Initiative (GPEI)**. - Rapid detection and reporting of wild poliovirus cases trigger immediate public health responses, including **vaccination campaigns**, **surveillance intensification**, and **outbreak response activities**. *Relapsing fever* - While a serious infectious disease caused by *Borrelia* species, relapsing fever is **not specifically designated** for mandatory notification under IHR 2005. - Surveillance is typically managed at **national or regional levels** based on local epidemiological priorities and disease burden. - May require notification to WHO if it meets criteria for potential PHEIC through the decision algorithm. *Louse-borne typhus fever* - Caused by *Rickettsia prowazekii*, louse-borne typhus is a significant public health concern but is **not among the diseases requiring mandatory notification** to WHO under IHR 2005. - Surveillance efforts are guided by **local disease burden**, outbreak potential, and epidemic risk. - Like relapsing fever, would require notification only if meeting PHEIC criteria. *All of the options* - This option is incorrect because only **paralytic polio** (specifically wild-type poliovirus) is listed for **mandatory notification** under IHR 2005 among the given choices. - IHR 2005 focuses on a **select group of diseases** with potential for international spread and severe public health impact, not all infectious diseases.

Question 6: Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?

A. Typhoid vaccine administration is the best method of preventing transmission.
B. Person-to-person transmission is the primary mode of spread.
C. Drug resistance in typhoid is not as big a problem as in TB.
D. Hygiene practice and clean sanitation control are more important than the typhoid vaccine. (Correct Answer)

Explanation: ***Hygiene practice and clean sanitation control is more important than the typhoid vaccine.*** - **Improved sanitation**, safe water supplies, and adequate hygiene practices are fundamental in controlling the spread of **typhoid fever**, as the disease is primarily transmitted through the **oral-fecal route**. - While vaccines are an important tool, they offer only partial protection and must be combined with **robust public health infrastructure** and **sanitation measures** for effective prevention. *Typhoid vaccine administration is the best method of preventing transmission.* - Typhoid vaccines offer protection, but their effectiveness is not 100%, and they typically require **booster doses** - **Vaccination campaigns** are most effective when implemented alongside improvements in **water and sanitation infrastructure**, as vaccines alone cannot fully prevent transmission in areas with poor hygiene. *Person-to-person transmission is the primary mode of spread.* - While person-to-person transmission can occur, especially in settings with poor hygiene, the primary mode of spread for typhoid is through the **ingestion of food or water contaminated** with the feces of an infected person or carrier. - This emphasizes the crucial role of **water and food safety** rather than just focusing on direct person-to-person contact. *Drug resistance in typhoid is not as big a problem as in TB.* - **Antimicrobial resistance (AMR)** in typhoid fever, particularly to fluoroquinolones and extended-spectrum beta-lactamase (ESBL) producing strains, is a **significant and growing global health concern**, complicating treatment. - While TB also faces serious drug resistance issues, the escalating problem of **extensively drug-resistant (XDR)** and **multi-drug resistant (MDR)** typhoid strains makes it a substantial threat, impacting treatment options and increasing morbidity and mortality.

Question 7: The Roll Back Malaria programme focused mainly on

A. IEC campaigns for community awareness
B. Insecticide treated bed nets (Correct Answer)
C. Development of larvivorous fishes for eradication of larvae.
D. Presumptive treatment of malaria case

Explanation: ***Insecticide treated bed nets*** - The **Roll Back Malaria (RBM)** program, launched in 1998, focused significantly on key interventions including the promotion and distribution of **insecticide-treated nets (ITNs)**. - ITNs are highly effective in **preventing mosquito bites**, thus reducing malaria transmission, especially in vulnerable populations. *IEC campaigns for community awareness* - While **Information, Education, and Communication (IEC)** campaigns are crucial for health programs, they were a supportive component rather than the primary focus of RBM's core intervention strategy. - RBM emphasized **tangible interventions** with direct impact on disease transmission. *Development of larvivorous fishes for eradication of larvae* - The use of **larvivorous fish** is a form of biological control, which is typically part of **integrated vector management** but not the central pillar of RBM's strategy. - RBM prioritized interventions with **broad, immediate impact** across larger populations. *Presumptive treatment of malaria case* - **Presumptive treatment** (treating based on symptoms without laboratory confirmation) was an important aspect of early malaria control but not the main strategic thrust of the RBM initiative. - RBM's primary focus was on **prevention and rapid diagnosis/treatment** using effective antimalarials, and vector control strategies.

Question 8: Which of the following diseases is not covered under the Integrated Disease Surveillance Project (IDSP)?

A. Tuberculosis
B. Cholera
C. Herpes zoster (Correct Answer)
D. Meningococcal disease

Explanation: ***Herpes zoster*** - **Herpes zoster** (shingles) is not included in the Integrated Disease Surveillance Project (IDSP) as it is neither an epidemic-prone disease nor a notifiable disease under the program. - IDSP focuses on diseases with significant public health impact, epidemic potential, or those requiring immediate public health response. - While herpes zoster can cause morbidity in immunocompromised individuals, it does not pose a widespread public health threat requiring national surveillance. *Tuberculosis* - **Tuberculosis (TB)** is explicitly covered under IDSP as a major notifiable disease due to its high burden in India and significant public health importance. - TB surveillance under IDSP helps monitor disease trends, detect outbreaks, and evaluate the effectiveness of the National Tuberculosis Elimination Programme. - Regular reporting and surveillance are essential for achieving TB elimination goals. *Cholera* - **Cholera** is a priority disease under IDSP as an epidemic-prone disease with potential for rapid outbreaks and high mortality if untreated. - It is part of the core surveillance list due to its ability to cause severe dehydration and waterborne epidemics. - Early detection through IDSP enables timely implementation of control measures including safe water supply and oral rehydration therapy. *Meningococcal disease* - **Meningococcal disease** (acute bacterial meningitis) is covered under IDSP due to its high case fatality rate, epidemic potential, and need for urgent public health response. - Surveillance is critical for early outbreak detection and implementation of preventive measures such as mass vaccination and chemoprophylaxis. - Close monitoring helps identify circulating serotypes and guide vaccination strategies.

Question 9: Mobile Medical Units (MMUs) under government health programs can operate through different models. Which of the following statements about MMU operations are correct? 1. MMUs are run by the government 2. MMUs are run by external agencies with medical supplies given by the government 3. MMUs are run by the government and medical supplies are also given by the government 4. MMUs are run by external agencies and medical supplies are also given by the external agency

A. 1, 2, 3, and 4
B. 1 and 2
C. 1, 2, and 3 (Correct Answer)
D. Only 1

Explanation: ***1, 2, and 3*** - This option correctly identifies the flexible operational models of **Mobile Medical Units (MMUs)** under government health programs. - MMUs can be directly managed by the **government**, managed by **external agencies** with government-provided supplies, or managed by the government with **government-provided supplies**. *1, 2, 3, and 4* - This option incorrectly includes the scenario where MMUs are run by **external agencies** and medical supplies are also provided by the **external agency**. - While external agencies can run MMUs, government health programs typically ensure that essential medical supplies are provided or funded by the **government** to maintain standardization and accessibility. *1 and 2* - This option is incomplete as it misses the model where both the MMU operation and medical supplies are provided by the **government** (statement 3). - Government health programs often have fully integrated models, especially in remote areas. *Only 1* - This option is too restrictive, as it only includes the model where MMUs are run by the **government**. - MMUs often involve partnerships with **external agencies** for operational efficiency or specialized services.

Question 10: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

A. A-3, B-4, C-2, D-1
B. A-1, B-4, C-3, D-2 (Correct Answer)
C. A-4, B-2, C-3, D-1
D. A-2, B-4, C-3, D-1

Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.

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