Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 11: Which of the following best describes the outcome of successful vaccination with a killed vaccine?

A. Deploid cell inactivation
B. Killed vaccine administration
C. Long-lasting immunity (Correct Answer)
D. Primary immunization requiring two doses

Explanation: ### Explanation **Correct Option: C. Long-lasting immunity** The primary goal of any successful vaccination, whether live-attenuated or killed, is to induce **long-lasting immunity** by stimulating the immune system to produce memory B and T cells. While killed vaccines generally produce a weaker immune response compared to live vaccines (often requiring boosters), a "successful" vaccination implies that the protective threshold has been reached, providing the individual with durable protection against the target pathogen. **Analysis of Incorrect Options:** * **A. Deploid cell inactivation:** This is a distractor. While human diploid cells (like MRC-5) are used as substrates for growing certain viruses (e.g., Rabies, HAV), "inactivation" refers to the pathogen itself, not the host cells. * **B. Killed vaccine administration:** This describes the *process* or the *intervention*, not the *outcome*. The outcome of administration is the subsequent immune response. * **D. Primary immunization requiring two doses:** While many killed vaccines (e.g., Salk Polio, Hepatitis A) require multiple doses to achieve primary immunization, this is a procedural requirement rather than the ultimate clinical outcome of a successful vaccination. **High-Yield Clinical Pearls for NEET-PG:** * **Killed Vaccines (Inactivated):** These contain organisms killed by heat or chemicals (formalin). They are generally safe in immunocompromised patients and pregnant women (unlike live vaccines). * **Immune Response:** Killed vaccines primarily trigger a **humoral (antibody) response**. They usually do not induce local (IgA) immunity or a strong cell-mediated response compared to live vaccines. * **Adjuvants:** Killed vaccines often require **adjuvants** (like Aluminum salts) to enhance the immune response and multiple doses/boosters to maintain "long-lasting immunity." * **Examples to Remember:** Salk Polio (IPV), Whole-cell Pertussis, Rabies, Hepatitis A, and Influenza (injected).

Question 12: Normal saline is used as a diluent in which vaccine?

A. Measles
B. Rubella
C. BCG (Correct Answer)
D. Hepatitis A virus (HAV)

Explanation: **Explanation:** The correct answer is **BCG (Bacillus Calmette–Guérin)**. Vaccines are often supplied in a freeze-dried (lyophilized) form to maintain stability and require a specific diluent for reconstitution. For the BCG vaccine, **Normal Saline (0.9% NaCl)** is the recommended diluent. It is used because it is isotonic and maintains the viability of the live-attenuated *Mycobacterium bovis* bacilli. Using distilled water instead of saline can cause irritation and local inflammation due to tonicity differences. **Analysis of Options:** * **Measles and Rubella (MR):** These vaccines typically use **Sterile Water for Injection** as the diluent. Using saline for measles can potentially damage the live virus, reducing its potency. * **Hepatitis A (HAV):** This is generally available as a liquid, inactivated vaccine (e.g., Havrix) or a pre-filled syringe; it does not require reconstitution with a diluent. **High-Yield Clinical Pearls for NEET-PG:** * **BCG Reconstitution:** Once reconstituted, the vaccine must be used within **3 to 4 hours** (or by the end of the session). Any leftover vaccine must be discarded to prevent contamination (e.g., *Staphylococcal* Toxic Shock Syndrome). * **Storage:** Both the vaccine and the diluent should ideally be stored at **+2°C to +8°C** to prevent thermal shock during mixing. * **JE Vaccine:** The Japanese Encephalitis (live attenuated SA 14-14-2) vaccine uses **Phosphate Buffered Saline** as a diluent. * **Site of BCG:** It is administered strictly **intradermally** on the left upper arm to maintain uniformity in scar assessment.

Question 13: Which of the following is NOT included in the 'Roll Back Malaria' initiative?

A. Insecticide-treated nets
B. Strengthening the health system
C. Development of new insecticides
D. Training of health workers (Correct Answer)

Explanation: The **Roll Back Malaria (RBM)** initiative was launched in 1998 by WHO, UNICEF, UNDP, and the World Bank with the goal of halving the global malaria burden. It focuses on evidence-based technical strategies rather than general administrative training. ### **Explanation of the Correct Option** **D. Training of health workers:** While human resource development is essential for any health program, it is considered a **general supportive activity** rather than a core technical pillar of the RBM initiative. RBM focuses on specific interventions like vector control, prompt treatment, and infrastructure strengthening. In the context of NEET-PG, "Training" is often a distractor when compared to specific technical interventions like ITNs or drug development. ### **Analysis of Incorrect Options** * **A. Insecticide-treated nets (ITNs):** This is a primary technical strategy of RBM for vector control and personal protection. * **B. Strengthening the health system:** RBM emphasizes that malaria control cannot succeed in isolation; it requires a robust health delivery system to ensure the reach of commodities (like ACTs and RDTs). * **C. Development of new insecticides:** RBM actively promotes Research and Development (R&D) to combat the emerging threat of insecticide resistance. ### **High-Yield Clinical Pearls for NEET-PG** * **The Four Pillars of RBM:** 1. Early diagnosis and prompt treatment (using ACTs). 2. Multiple preventive measures (ITNs, Indoor Residual Spraying). 3. Strengthening health systems. 4. Research and development for new tools (vaccines, drugs, insecticides). * **Global Technical Strategy (GTS) 2016–2030:** The current framework aiming for a 90% reduction in malaria mortality and incidence by 2030. * **Drug of Choice:** Artemisinin-based Combination Therapy (ACT) is the cornerstone of RBM’s treatment strategy for *P. falciparum*.

Question 14: Tracking of blood pressure implies?

A. Blood pressure increases with age
B. Blood pressure decreases with age
C. Blood pressure of a normotensive individual becomes hypertensive
D. Blood pressure of a hypertensive individual remains hypertensive (Correct Answer)

Explanation: ### Explanation **Concept of Tracking** "Tracking" is a longitudinal phenomenon in epidemiology where the relative rank or position of an individual within a population distribution remains constant over time. In the context of blood pressure, it implies that children or young adults whose blood pressure is at the higher end of the distribution (e.g., above the 90th percentile) are more likely to maintain that high-ranking position and become hypertensive adults. **Why Option D is Correct** The correct answer is **"Blood pressure of a hypertensive individual remains hypertensive."** This describes the stability of the BP rank. If an individual is identified as having high blood pressure early on, they tend to "track" along that same high-pressure curve throughout their life. This makes early identification of high-risk individuals crucial for primary prevention. **Analysis of Incorrect Options** * **Options A & B:** While blood pressure generally tends to increase with age in many populations, this is a physiological trend, not "tracking." Tracking refers to the **consistency of rank** relative to peers, not the direction of the absolute value. * **Option C:** A normotensive individual becoming hypertensive describes the **incidence** or natural history of the disease, but it contradicts the principle of tracking, which emphasizes the maintenance of the initial BP status (high stays high, low stays low). **High-Yield Pearls for NEET-PG** * **Predictive Value:** Tracking is the strongest predictor of adult blood pressure based on childhood readings. * **Other Parameters:** Tracking is also observed in other variables like **Serum Cholesterol** and **Body Mass Index (BMI)**. * **Clinical Significance:** It underscores the importance of the **"High-risk strategy"**—identifying children with high BP to prevent established hypertension in adulthood through lifestyle modifications.

Question 15: If a new sputum smear positive patient of tuberculosis continues to be smear positive at the end of the intensive phase of category I treatment under DOTS, what should be the further management of this patient?

A. Start category I treatment again
B. Treat as failure and start category II treatment under DOTS
C. Continue the intensive phase of treatment for one more month (Correct Answer)
D. Start continuation phase under category I

Explanation: ### Explanation **1. Why Option C is Correct:** Under the traditional RNTCP (DOTS) guidelines for Category I patients (New cases), the Intensive Phase (IP) lasts for 2 months. If a patient remains sputum smear-positive at the end of these 2 months, the **Intensive Phase is extended for one additional month**. This is done to ensure sputum conversion before moving to the Continuation Phase (CP), as persistent positivity indicates a high bacterial load or delayed response, though not necessarily drug resistance at this stage. **2. Why Other Options are Incorrect:** * **Option A:** Restarting Category I is incorrect because the patient has already completed the initial IP; restarting would lead to unnecessary drug toxicity and delay in treatment progression. * **Option B:** Treatment failure is defined only if the patient is smear-positive at **5 months or later**. Labeling a patient as a "failure" at the end of the IP (2 months) is premature. (Note: Category II has been phased out in newer WHO/NTEP guidelines, but remains relevant for historical exam questions). * **Option D:** Moving to the Continuation Phase while the smear is still positive increases the risk of treatment failure and the development of Multi-Drug Resistant TB (MDR-TB), as the CP uses fewer drugs (HR) compared to the IP (HRZE). **3. High-Yield Clinical Pearls for NEET-PG:** * **NTEP Update:** Under the current **National Tuberculosis Elimination Program (NTEP)**, the "Extension of IP" has been largely replaced by **Universal Drug Susceptibility Testing (UDST)**. If a patient is smear-positive at the end of IP now, the priority is to perform a **CBNAAT/NAAT** to rule out Rifampicin resistance. * **Definition of Sputum Conversion:** The change from smear-positive to smear-negative status at the end of the IP. It is a key indicator of the success of the DOTS program. * **Category I Regimen:** 2 months of HRZE (IP) + 4 months of HRE (CP) in the daily regimen.

Question 16: What is the chemoprophylaxis dose of chloroquine per week?

A. 300 mg twice a week
B. 600 mg once a week
C. 600 mg once a week
D. 300 mg once daily per week (Correct Answer)

Explanation: **Explanation** The chemoprophylaxis of Malaria is a high-yield topic for NEET-PG. According to the National Vector Borne Disease Control Programme (NVBDCP) guidelines, the standard chemoprophylaxis for travelers or individuals at risk in chloroquine-sensitive areas is **Chloroquine**. **Why the correct answer is right:** The standard dose of Chloroquine for prophylaxis is **300 mg (base)** taken **once weekly**. It is important to distinguish between the "base" and the "salt." 500 mg of Chloroquine phosphate salt is equivalent to 300 mg of Chloroquine base. The regimen should start 1 week before entering the endemic area and continue for 4 weeks after leaving. (Note: Option D is phrased as "300 mg once daily per week," which in medical entrance exams refers to the weekly cumulative dose administered as a single weekly bolus). **Analysis of Incorrect Options:** * **A (300 mg twice a week):** This exceeds the recommended prophylactic dose and increases the risk of toxicity (retinopathy/GI distress) without added benefit. * **B & C (600 mg once a week):** 600 mg (base) is the **loading dose** used in the clinical treatment of malaria (Day 1), not for long-term prophylaxis. **High-Yield Clinical Pearls for NEET-PG:** * **Mefloquine:** Used for prophylaxis in chloroquine-resistant areas. Dose: 250 mg once weekly. Contraindicated in patients with a history of seizures or psychiatric disorders. * **Doxycycline:** Used for short-term prophylaxis in areas with multi-drug resistance. Dose: 100 mg **daily**. * **Pregnancy:** Chloroquine is safe and is the drug of choice for malaria prophylaxis in pregnant women visiting sensitive areas. * **Duration:** For long-term travelers, Chloroquine prophylaxis is generally not recommended beyond 3 years due to the risk of cumulative retinal toxicity.

Question 17: BCG vaccine is contraindicated in patients with which of the following conditions?

A. Generalised eczema
B. Infective dermatosis
C. Hypogammaglobulinaemia
D. All of the above (Correct Answer)

Explanation: **Explanation:** The BCG (Bacillus Calmette-Guérin) vaccine is a **live attenuated vaccine** derived from *Mycobacterium bovis*. Because it contains live organisms, its administration is strictly contraindicated in individuals with compromised skin integrity or impaired immune systems to prevent systemic dissemination of the bacillus (BCG-osis). **Why "All of the Above" is Correct:** 1. **Generalised Eczema & Infective Dermatosis (Options A & B):** BCG is administered intradermally. In conditions where the skin barrier is extensively breached (like generalized eczema, dermatitis, or skin infections), there is a high risk of secondary infection and "BCG-osis" or severe local reactions. Vaccination should be deferred until the skin condition has resolved. 2. **Hypogammaglobulinaemia (Option C):** This represents a primary immunodeficiency. Live vaccines are contraindicated in patients with impaired cell-mediated or humoral immunity (e.g., HIV with low CD4 counts, leukemia, or congenital immunodeficiencies) because the body cannot contain the attenuated pathogen, leading to life-threatening systemic infection. **High-Yield Clinical Pearls for NEET-PG:** * **Method:** Intradermal (using a tuberculin/Omega syringe). * **Site:** Left upper arm (deltoid region) – standardized to avoid confusion with other scars. * **Evolution of Scar:** Papule (2-3 weeks) → Glazed ulcer (5-6 weeks) → Permanent pitted scar (6-12 weeks). * **Reconstitution:** Always use **Normal Saline**. Never use Distilled Water (causes irritation/necrosis). * **Stability:** Must be used within **4-6 hours** of reconstitution; discard thereafter to prevent *Staph. aureus* contamination (Toxic Shock Syndrome). * **Absolute Contraindications:** Pregnancy, symptomatic HIV/AIDS, and generalized skin diseases.

Question 18: What is the clinical goal for the prevention of coronary heart disease regarding the ratio of cholesterol to HDL?

A. 1.5
B. 2.5
C. 3.5 (Correct Answer)
D. 4.5

Explanation: **Explanation:** The **Total Cholesterol to HDL (High-Density Lipoprotein) ratio** is a significant predictor of cardiovascular risk. In preventive cardiology and community medicine, this ratio is used to assess the balance between "bad" cholesterol (pro-atherogenic) and "good" cholesterol (anti-atherogenic). **1. Why 3.5 is the Correct Answer:** According to standard clinical guidelines (including Park’s Textbook of Preventive and Social Medicine), the primary goal for the prevention of Coronary Heart Disease (CHD) is to maintain a **Total Cholesterol/HDL ratio below 3.5**. A ratio lower than 3.5 is associated with a significantly lower risk of plaque formation and myocardial infarction. **2. Analysis of Incorrect Options:** * **Option A (1.5) & B (2.5):** While these ratios are excellent and indicate very low cardiovascular risk, they are not the standard "threshold" or clinical goal defined for the general population in public health guidelines. * **Option D (4.5):** A ratio above 4.5 is considered an indicator of **high risk** for CHD. In clinical practice, a ratio of 5.0 or higher suggests a doubling of cardiovascular risk compared to the ideal. **3. High-Yield Clinical Pearls for NEET-PG:** * **HDL (The "Good" Cholesterol):** It facilitates reverse cholesterol transport. A level **< 40 mg/dL** is a major risk factor for CHD. * **LDL (The "Bad" Cholesterol):** It is the primary target of statin therapy. For high-risk individuals, the goal is often **< 70 mg/dL**. * **Triglycerides:** Levels **> 150 mg/dL** are considered a component of Metabolic Syndrome. * **Rule of Thumb:** For CHD prevention, the goal is to keep the Total Cholesterol/HDL ratio **< 3.5** and the LDL/HDL ratio **< 3.0**.

Question 19: What is the primary cause of death associated with morbid obesity?

A. Cardiovascular complications (Correct Answer)
B. Pickwickian syndrome
C. Hypothyroid crisis
D. Cushing syndrome

Explanation: ### Explanation **1. Why Cardiovascular Complications is Correct:** Morbid obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities) is a systemic inflammatory state. It is the leading driver of the **Metabolic Syndrome**, characterized by dyslipidemia, insulin resistance, and hypertension. These factors accelerate **atherosclerosis**, leading to coronary artery disease (CAD), myocardial infarction, and congestive heart failure. Epidemiological data consistently show that cardiovascular disease (CVD) is the primary cause of mortality in obese individuals, accounting for the majority of excess deaths. **2. Analysis of Incorrect Options:** * **Pickwickian Syndrome (Obesity Hypoventilation Syndrome):** While a serious respiratory complication of morbid obesity characterized by hypercapnia and sleep apnea, it is a significant *morbidity* but not the most common cause of *mortality* compared to CVD. * **Hypothyroid Crisis (Myxedema Coma):** This is a life-threatening complication of severe hypothyroidism. While hypothyroidism can cause weight gain, it is a hormonal etiology rather than a primary consequence of morbid obesity itself. * **Cushing Syndrome:** This is a clinical condition resulting from excess cortisol. Like hypothyroidism, it is a *cause* of secondary obesity rather than a fatal *complication* arising from lifestyle-induced morbid obesity. **3. NEET-PG High-Yield Pearls:** * **BMI Classification (WHO):** Overweight (25–29.9), Obese (≥30), Morbidly Obese (≥40). * **Indian/Asian Cut-offs:** Overweight (23–24.9), Obese (≥25). * **Best Indicator of Abdominal Obesity:** Waist-to-hip ratio (Males >0.9, Females >0.85) or simply Waist Circumference. * **Pickwickian Triad:** Obesity, sleep apnea, and daytime hypercapnia (PaCO2 >45 mmHg). * **Cancer Link:** Obesity is also a major risk factor for endometrial, breast (post-menopausal), and colon cancers.

Question 20: What are the primary hosts involved in the natural transmission cycle of the Japanese encephalitis virus?

A. Pigs and Mosquitoes (Correct Answer)
B. Cattle and Birds
C. Pigs and Humans
D. Birds and Pigs

Explanation: ### Explanation **Japanese Encephalitis (JE)** is a zoonotic viral disease caused by a Group B Arbovirus (Flavivirus). The natural transmission cycle involves a complex interplay between reservoirs, amplifiers, and vectors. **1. Why Option A is Correct:** The transmission cycle of JE is primarily **Enzootic**. * **Pigs** act as the **Amplifier Host**. They develop high-level viremia without showing clinical signs, allowing mosquitoes to pick up the virus easily. * **Mosquitoes** (primarily *Culex tritaeniorhynchus*) act as the **Vector**. They transmit the virus from the amplifier host to humans. * **Ardeid birds** (herons, egrets) act as the **Natural Reservoir/Maintenance Host**. **2. Why Other Options are Incorrect:** * **Option B (Cattle and Birds):** While birds are reservoirs, cattle are "dead-end" hosts. They develop antibodies but do not maintain enough viremia to infect mosquitoes. * **Option C (Pigs and Humans):** Humans are **"Dead-end Hosts."** The level and duration of viremia in humans are insufficient to infect a biting mosquito; therefore, humans do not contribute to the transmission cycle. * **Option D (Birds and Pigs):** While both are involved in the cycle, the question asks for the primary hosts involved in *transmission*. The cycle typically alternates between the vector (mosquito) and the host (pig/bird). **High-Yield Clinical Pearls for NEET-PG:** * **Vector:** *Culex tritaeniorhynchus* (breeds in stagnant water/paddy fields; "Outdoor biters"). * **Amplifier Host:** Pig (The "Link" between nature and man). * **Dead-end Hosts:** Humans and Horses. * **Vaccination:** Live attenuated **SA-14-14-2** is the most commonly used vaccine in the National Immunization Schedule (given at 9 months and 16–24 months). * **Sentinel Surveillance:** Done by monitoring pigs to predict an outbreak.

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