NCD Risk Factor Surveillance — MCQs
Which of the following is NOT a core component of the WHO's global STI control strategy?
HIV sentinel surveillance is used for:
Which of the following is primordial prevention for non-communicable diseases?
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
Which condition has the maximum relative risk attributed to obesity?
STEPS is done for:
The preferred public health approach to control non-communicable disease is -
What is the primary method of primordial prevention for Coronary Artery Disease (CAD)?
A concept directed against the development of risk factors of coronary artery disease is -
STEPwise approach to surveillance for Non-Communicable diseases step 2 is
NCD Risk Factor Surveillance Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a core component of the WHO's global STI control strategy?
- A. Case management
- B. Universal mandatory screening (Correct Answer)
- C. Strategic information systems
- D. Prevention services
Explanation: ***Universal mandatory screening*** - While screening is part of STI control, **universal mandatory screening** for all STIs in the general population is not a core component of the WHO's strategy due to feasibility, cost, and ethical considerations. - The strategy emphasizes **targeted screening** for at-risk populations and opportunistic screening. *Case management* - **Case management**, including accurate diagnosis and effective treatment, is a critical component for managing current infections and preventing further transmission. - This involves syndromic or etiologic approaches to treatment and partner notification. *Strategic information systems* - **Strategic information systems** are essential for monitoring trends, evaluating interventions, and informing policy decisions related to STI control. - This includes surveillance data, program monitoring, and research. *Prevention services* - **Prevention services** are a cornerstone of the WHO's strategy, aiming to reduce the incidence of new infections. - These services encompass health education, condom promotion and distribution, vaccination, and pre-exposure prophylaxis (PrEP).
Question 2: HIV sentinel surveillance is used for:
- A. Detection of high-risk group
- B. Prevalence of HIV infection
- C. Monitoring trends in HIV infection (Correct Answer)
- D. Monitoring disease trends
Explanation: ***Monitoring trends in HIV infection*** - **HIV sentinel surveillance** is specifically designed to track **HIV prevalence trends** over time in selected sentinel populations (ANC attendees, STD clinic attendees, high-risk groups). - The primary objective is to monitor **how HIV infection rates change** over time, helping identify emerging epidemics, evaluate intervention programs, and guide public health policy. - As per **NACO and WHO guidelines**, sentinel surveillance provides repeated cross-sectional prevalence measurements at fixed sites to detect temporal trends in HIV infection. *Monitoring disease trends* - This is **too broad and vague** for the specific purpose of HIV sentinel surveillance. - "Disease trends" could refer to AIDS progression, opportunistic infections, or other disease manifestations, which are **not the focus** of sentinel surveillance. - Sentinel surveillance specifically tracks **infection (seroprevalence)**, not general disease patterns. *Prevalence of HIV infection* - While sentinel surveillance **does measure prevalence**, this is a **method rather than the ultimate purpose**. - Prevalence measurements are taken repeatedly at different time points specifically to **monitor trends**, making this incomplete as the primary objective. *Detection of high-risk group* - Identification of high-risk groups is typically done through **epidemiological studies** and behavioral surveys, not sentinel surveillance. - Sentinel surveillance may **include** high-risk populations as sentinel sites, but its purpose is to monitor trends **within** these groups, not to detect them.
Question 3: 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 4: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 5: Which condition has the maximum relative risk attributed to obesity?
- A. Hypertension
- B. CHD
- C. DM (Correct Answer)
- D. Cancer
Explanation: ***DM*** - Obesity is a major risk factor for Type 2 Diabetes Mellitus (T2DM), with a **relative risk often exceeding 3-7 times that of normal-weight individuals**, and even higher for severe obesity. - The link is primarily due to **insulin resistance** caused by increased adipose tissue. *Hypertension* - Obesity significantly increases the risk of hypertension, with a relative risk typically in the range of **2 to 3 times higher** than normal-weight individuals. - The mechanisms involve increased **blood volume**, **sympathetic nervous system activity**, and **renal sodium reabsorption**. *CHD* - Obesity is a strong independent risk factor for Coronary Heart Disease (CHD), contributing to a relative risk of approximately **1.5 to 2.5 times higher** than normal weight. - It often acts by exacerbating other risk factors like **hypertension**, **dyslipidemia**, and **diabetes**. *Cancer* - Obesity is linked to various cancers, including endometrial, esophageal adenocarcinoma, renal cell, and breast cancer in postmenopausal women, with relative risks typically ranging from **1.2 to 2 times higher** for specific cancers. - The pathways include **chronic inflammation**, altered **hormone levels** (e.g., estrogen), and **insulin-like growth factor signaling**.
Question 6: 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 7: 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 8: What is the primary method of primordial prevention for Coronary Artery Disease (CAD)?
- A. Lifestyle change (Correct Answer)
- B. Coronary bypass
- C. Treatment of CAD
- D. Screening for hypertension
Explanation: ***Lifestyle change*** - **Primordial prevention** aims to prevent the development of risk factors themselves, which is best achieved through promoting healthy behaviors like diet, exercise, and avoiding tobacco at the population level. - This approach acts *before* the onset of risk factors, addressing societal and environmental determinants of health. - Examples include promoting healthy eating habits in schools, creating walkable communities, and tobacco-free environments. *Coronary bypass* - **Coronary bypass surgery** is a treatment for established CAD with significant blockages, not a preventive measure. - It falls under the category of **tertiary prevention**, aiming to reduce complications and improve quality of life in existing disease. *Treatment of CAD* - **Treating CAD** (e.g., medications like statins or antiplatelets, procedures like angioplasty) is a form of **secondary** or **tertiary prevention**. - It focuses on managing existing disease or preventing its progression, rather than preventing the initial development of risk factors. *Screening for hypertension* - **Screening** is a form of **secondary prevention** aimed at early detection of risk factors or disease. - While important, it occurs *after* risk factors have already developed, unlike primordial prevention which prevents risk factors from emerging.
Question 9: 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 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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