Chronic Respiratory Diseases — MCQs

10 questions

Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').

A 60-year-old male with COPD has FEV1 45% predicted, mMRC grade 2 dyspnea, and 2 exacerbations last year. Which GOLD category?

A concept directed against the development of risk factors of coronary artery disease is -

Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?

A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

Which of the following is primordial prevention for non-communicable diseases?

Which of the following is not a criterion suggesting causality in non communicable diseases?

STEPS is done for:

The preferred public health approach to control non-communicable disease is -

Q10

STEPwise approach to surveillance for Non-Communicable diseases step 2 is

Chronic Respiratory Diseases Indian Medical PG Practice Questions and MCQs

Question 1: Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').

A. Cricoarytenoid arthritis
B. Pleural effusion
C. Pulmonary hypertension
D. None of the options (Correct Answer)

Explanation: ***None of the options*** - All listed conditions—**cricoarytenoid arthritis**, **pleural effusion**, and **pulmonary hypertension**—are recognized extra-articular manifestations or complications of **rheumatoid arthritis (RA)** [1]. - Rheumatoid arthritis is a systemic inflammatory disease that can affect multiple organ systems beyond the joints. *Cricoarytenoid arthritis* - This condition involves inflammation of the **cricoarytenoid joint** in the larynx, leading to **hoarseness**, stridor, or even airway obstruction. - It is a known, though less common, upper airway manifestation of **rheumatoid arthritis**. *Pleural effusion* - **Rheumatoid pleuritis** commonly presents as a **pleural effusion**, often unilateral [1]. - Analysis of **rheumatoid pleural fluid** typically shows low glucose, high LDH, and sometimes rheumatoid factor. *Pulmonary hypertension* - **Pulmonary hypertension** in RA can result from various mechanisms, including **interstitial lung disease**, vasculitis, or chronic thromboembolism [1]. - It is a serious complication associated with increased morbidity and mortality in **rheumatoid arthritis** patients.

Question 2: A 60-year-old male with COPD has FEV1 45% predicted, mMRC grade 2 dyspnea, and 2 exacerbations last year. Which GOLD category?

A. GOLD A
B. GOLD D (Correct Answer)
C. GOLD B
D. GOLD C

Explanation: Gold D - This patient meets criteria for **GOLD D** due to both high symptom burden (mMRC grade 2 dyspnea) and a high risk of exacerbations (2 exacerbations last year) [1]. - COPD severity in GOLD D is characterized by an **FEV1 < 50% predicted** (in this case, 45%) along with significant symptoms and/or frequent exacerbations [1]. *GOLD A* - **GOLD A** patients have low symptom burden (mMRC 0-1 or CAT < 10) and a low risk of exacerbations (0-1 exacerbations not leading to hospitalization) [1]. - This patient's **mMRC grade 2** and **2 exacerbations** last year exclude him from GOLD A. *GOLD B* - **GOLD B** patients have a high symptom burden (mMRC ≥ 2 or CAT ≥ 10) but a low risk of exacerbations (0-1 exacerbations not leading to hospitalization) [1]. - This patient's **2 exacerbations** last year place him in a higher risk category than GOLD B. *GOLD C* - **GOLD C** patients have a low symptom burden (mMRC 0-1 or CAT < 10) but a high risk of exacerbations (≥ 2 exacerbations or ≥ 1 leading to hospitalization) [1]. - This patient's **mMRC grade 2** indicates a high symptom burden, which is not characteristic of GOLD C.

Question 3: A concept directed against the development of risk factors of coronary artery disease is -

A. Primordial prevention (Correct Answer)
B. Primary prevention
C. Secondary prevention
D. Health education

Explanation: ***Primordial prevention*** - **Primordial prevention** targets the prevention of the emergence of **risk factors** in the first place, often by addressing social, environmental, and behavioral determinants before they become established. - In the context of coronary artery disease, this would involve preventing the development of risk factors like **obesity**, **hypertension**, and **unhealthy diets** from an early age, even in populations that have not yet developed them. *Health education (general awareness and behavior change)* - While health education is a *method* used in prevention, it is not a level of prevention itself. - It contributes to various levels of prevention, including primordial and primary, by raising **awareness** and promoting **behavior change**. *Primary prevention (preventing disease onset)* - **Primary prevention** focuses on preventing the *onset* of disease in individuals who are already exposed to or have **risk factors**. - For coronary artery disease, this would include interventions like **blood pressure control** or **cholesterol management** in individuals already at risk. *Secondary prevention (early detection and management)* - **Secondary prevention** aims at early **detection** and prompt **management** of an existing disease to prevent its progression or complications. - In coronary artery disease, this would involve screening for asymptomatic heart disease or managing established CAD to prevent events like **heart attacks**.

Question 4: Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?

A. A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.
B. A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation. (Correct Answer)
C. Residual Volume (RV) is normal.
D. Total Lung Capacity (TLC) is decreased.

Explanation: ***A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation.*** [1] - This is the **hallmark diagnostic criterion** for COPD, confirming persistent **airflow obstruction** that is not fully reversible. [1] - The threshold typically used is **< 0.70** or below the **fifth percentile** of the lower limit of normal (LLN). *A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.* - An FEV1/FVC ratio **above the threshold** indicates the absence of significant **airflow obstruction**, but does not automatically guarantee normal lung function as other parameters like **FEV1** could be affected. - This measurement would suggest a **restrictive lung disease** or **normal lung function**, depending on other spirometry values. *Residual Volume (RV) is normal.* - In COPD, **air trapping** due to airflow obstruction leads to an **increased Residual Volume (RV)**, not a normal RV. - An elevated RV reflects **hyperinflation** of the lungs, a characteristic feature of emphysema and chronic bronchitis. *Total Lung Capacity (TLC) is decreased.* - COPD is characterized by **hyperinflation**, which typically results in an **increased Total Lung Capacity (TLC)** as the lungs become more distended. - A **decreased TLC** would be indicative of a **restrictive lung disease**, which is different from obstructive patterns seen in COPD.

Question 5: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

A. Intermittent asthma
B. Mild persistent asthma
C. Moderate persistent asthma
D. Severe persistent asthma (Correct Answer)

Explanation: ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.

Question 6: Which of the following is primordial prevention for non-communicable diseases?

A. Salt restriction in high NCD area
B. Smoking cessation in high NCD area
C. Preservation of traditional diet in low NCD area (Correct Answer)
D. Early diagnosis & Treatment

Explanation: ***Preservation of traditional diet in low NCD area*** - **Primordial prevention** targets the underlying causes of disease before risk factors are established, often at a population level. - Preserving a **healthy traditional diet** in an area with low rates of non-communicable diseases (NCDs) prevents the emergence of shared risk factors like processed food consumption and sedentary lifestyles. *Salt restriction in high NCD area* - This is an example of **primary prevention**, as it aims to reduce a specific risk factor (high salt intake) in a population susceptible to NCDs like hypertension. - It intervenes when risk factors are already present or emerging, unlike primordial prevention which aims to prevent their development. *Smoking cessation in high NCD area* - Also a form of **primary prevention**, as it targets an existing modifiable risk factor (smoking) to prevent the onset of NCDs. - It focuses on individuals or groups already exposed to a risk factor rather than preventing the societal conditions that lead to its emergence. *Early diagnosis & Treatment* - This falls under **secondary prevention**, which aims to detect and treat diseases early to halt their progression and prevent complications. - It occurs after the disease has already begun but before significant symptoms or irreversible damage have occurred.

Question 7: 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)

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.

Question 8: 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

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.

Question 9: The preferred public health approach to control non-communicable disease is -

A. Focus on high risk individuals for reduction of risk
B. Early diagnosis and treatment of identified cases
C. Shift to the population-based approach (Correct Answer)
D. Individual disease-based vertical programs

Explanation: ***Shift to the population-based approach*** - A **population-based approach** aims to reduce the average risk across the entire population, leading to a larger overall reduction in NCD burden. - This strategy focuses on broad interventions like health promotion, policy changes, and environmental modifications that benefit everyone. *Focus on high risk individuals for reduction of risk* - This approach, while important, only targets a smaller subset of the population and may miss individuals who are at moderate risk but contribute significantly to the overall disease burden. - It relies on identifying and intervening with specific individuals, which can be resource-intensive and may not achieve widespread impact. *Early diagnosis and treatment of identified cases* - This is a crucial component of secondary prevention but primarily addresses **existing disease** rather than preventing its occurrence in the first place across the population. - While it improves outcomes for affected individuals, it does not tackle the root causes of NCDs at a population level. *Individual disease-based vertical programs* - **Vertical programs** are highly focused on a single disease, which can lead to fragmentation of services and inefficient use of resources. - They often fail to address the common risk factors and determinants that contribute to multiple NCDs, hindering a holistic public health response.

Question 10: STEPwise approach to surveillance for Non-Communicable diseases step 2 is

A. Biochemical Measurement
B. Behavioral measurement
C. Physical measurement (Correct Answer)
D. Emotional Assessment

Explanation: ***Physical measurement*** - The **STEPwise approach** to NCD surveillance involves three steps, with Step 2 specifically focusing on **physical measurements**. - This step includes measurements like **blood pressure**, BMI, weight, height, and waist circumference, which provide crucial data on NCD risk factors. *Biochemical Measurement* - This is typically **Step 3** in the WHO STEPwise approach, focusing on biological measurements from blood or urine samples. - Examples include **blood glucose**, cholesterol levels, and other biomarkers. *Behavioral measurement* - This corresponds to **Step 1** of the WHO STEPwise approach, which involves self-reported data on lifestyle factors. - It covers aspects like **diet**, physical activity, and tobacco/alcohol consumption. *Emotional Assessment* - While emotional and mental health are relevant to overall well-being, **emotional assessment** is not a standard, distinct step in the core WHO STEPwise approach for NCD surveillance. - The STEPs focus on behavioral, physical, and biochemical indicators of NCD risk.

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