Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 201: Which of the following statements is true about BCG vaccination?

A. Distilled water is used as diluent for BCG vaccine
B. The site for injection should be cleaned thoroughly with spirit
C. Mantoux test becomes positive after 48 hours of vaccination
D. WHO recommends Danish 1331 strain for vaccine production (Correct Answer)

Explanation: ### Explanation **Correct Option: D (WHO recommends Danish 1331 strain)** The BCG (Bacillus Calmette-Guérin) vaccine is a live attenuated vaccine derived from *Mycobacterium bovis*. To ensure global uniformity in potency and efficacy, the WHO recommends the **Danish 1331 strain** for vaccine production. This strain is known for providing a consistent immunological response and is the most widely used strain globally. **Analysis of Incorrect Options:** * **Option A:** **Normal Saline (0.9% NaCl)** is the recommended diluent for BCG. Distilled water is never used because it is hypotonic and can cause irritation or damage to the live bacilli, leading to decreased vaccine potency. * **Option B:** The injection site should be cleaned with **plain water** or left uncleaned if not visibly soiled. Using **spirit or alcohol** is strictly contraindicated because it kills the live attenuated bacteria in the vaccine, rendering it ineffective. * **Option C:** Post-vaccination tuberculin sensitivity (Mantoux conversion) does not happen instantly. It typically takes **8 to 12 weeks** for the Mantoux test to become positive, reflecting the development of cell-mediated immunity. **High-Yield NEET-PG Pearls:** * **Dose:** 0.05 ml for neonates (under 1 month) and 0.1 ml for infants above 1 month. * **Route:** Strictly **Intradermal** (left upper arm) using a tuberculin/Omega syringe. * **Storage:** Highly heat and light sensitive; must be stored at **+2°C to +8°C** and used within 3–4 hours of reconstitution. * **The "BCG Scar":** A papule forms at 2–3 weeks, followed by a crust/ulcer at 5 weeks, which heals to leave a permanent tiny round scar by 6–12 weeks. * **Protective Effect:** Primarily protects against severe forms of childhood TB (Miliary TB and TB Meningitis), but has variable efficacy against adult pulmonary TB.

Question 202: Yellow fever is caused by which type of virus?

A. Arbovirus (Correct Answer)
B. Alphavirus
C. Sindbis virus
D. Chikungunya virus

Explanation: **Explanation:** **Yellow Fever** is an acute viral hemorrhagic disease caused by the **Yellow Fever virus**, which belongs to the family *Flaviviridae* and the genus *Flavivirus*. It is classified as an **Arbovirus** (Arthropod-borne virus) because it is transmitted to humans through the bite of infected mosquitoes, primarily *Aedes aegypti* (urban cycle) and *Haemagogus* or *Sabethes* species (sylvatic/jungle cycle). **Analysis of Options:** * **Option A (Correct):** Arbovirus is a functional category of viruses transmitted by arthropod vectors. Since Yellow Fever is transmitted by mosquitoes, it is a classic example of an arbovirus. * **Option B (Incorrect):** **Alphavirus** is a genus within the *Togaviridae* family. While many alphaviruses are also arboviruses, Yellow Fever belongs to the *Flavivirus* genus, not Alphavirus. * **Option C (Incorrect):** **Sindbis virus** is a specific member of the *Alphavirus* genus. It causes Sindbis fever but is unrelated to Yellow Fever. * **Option D (Incorrect):** **Chikungunya virus** is another member of the *Alphavirus* genus. Although it shares the same vector (*Aedes aegypti*) as Yellow Fever, it is a distinct viral entity. **High-Yield Clinical Pearls for NEET-PG:** * **Vaccine:** The **17D vaccine** is a live attenuated vaccine, providing immunity for life. International Health Regulations (IHR) state the certificate becomes valid **10 days** after vaccination. * **Incubation Period:** Typically 3 to 6 days. * **Councilman Bodies:** Characteristic eosinophilic degeneration of hepatocytes seen on liver biopsy (though biopsy is contraindicated in life due to bleeding risks). * **Faget’s Sign:** A clinical triad of high fever with a slow pulse (bradycardia), highly suggestive of Yellow Fever.

Question 203: Reverse smoking is a known risk factor for which of the following conditions?

A. Carcinoma of the lip
B. Carcinoma of the hard palate (Correct Answer)
C. Carcinoma of the soft palate
D. Carcinoma of the lung

Explanation: **Explanation:** **Reverse smoking** is a unique form of tobacco use where the lit end of the cigarette or cheroot (locally known as *Chutta*) is placed inside the mouth. This practice is culturally prevalent in certain parts of India, particularly in the coastal regions of Andhra Pradesh and Odisha. **Why Carcinoma of the Hard Palate is the correct answer:** In reverse smoking, the oral cavity is subjected to extreme heat (pyrolysis) and high concentrations of combustion products. The **hard palate** bears the direct brunt of the intense heat and chemical carcinogens from the burning ember. This leads to a specific precancerous lesion known as **Palatal Keratosis**, which has a high rate of malignant transformation into **Squamous Cell Carcinoma of the hard palate**. While the hard palate is generally a rare site for oral cancer in the general population, it is the most common site in reverse smokers. **Analysis of Incorrect Options:** * **Carcinoma of the Lip:** Associated with conventional pipe smoking and chronic sun exposure (actinic cheilitis), but not specifically linked to the internal heat of reverse smoking. * **Carcinoma of the Soft Palate:** While the soft palate is exposed to smoke, it is not the primary site of contact for the lit end; the hard palate remains the anatomical "target" in this practice. * **Carcinoma of the Lung:** While all forms of smoking increase lung cancer risk, reverse smoking is primarily associated with localized **oral cavity** malignancies due to the direct thermal injury. **High-Yield NEET-PG Pearls:** * **Chutta:** The local name for the hand-rolled tobacco used in reverse smoking. * **Nicotina stomatitis:** A common finding in these patients, characterized by a "cobblestone" appearance of the palate with red dots (inflamed minor salivary gland ducts). * **Epidemiology:** Highest incidence is seen in females of the Vishakhapatnam district (Andhra Pradesh).

Question 204: School closure is recommended during an outbreak of swine flu. All of the following support this recommendation except?

A. Closure of school will not lead to a reduction in contact between children. (Correct Answer)
B. Children are the most commonly affected population by swine flu.
C. Increased rates of transmission due to more opportunities for contact.
D. Children playing together increases the transmission of the virus.

Explanation: **Explanation:** The core strategy behind school closure during a respiratory outbreak like Swine Flu (H1N1) is **Social Distancing**. The goal is to break the chain of transmission by reducing the "contact rate" among a highly susceptible population. **1. Why Option A is the Correct Answer:** The question asks for the "Except" option. Option A states that school closure *will not* lead to a reduction in contact. This is logically inconsistent with the purpose of the intervention. School closures are recommended precisely because they **do** reduce the frequency and intensity of contact between children, thereby lowering the effective reproduction number ($R_e$) of the virus. **2. Analysis of Incorrect Options:** * **Option B:** Children and young adults are indeed the most commonly affected demographic in Swine Flu outbreaks due to a lack of pre-existing immunity compared to older populations who may have cross-reactive antibodies from previous influenza strains. * **Option C & D:** Schools are "high-density" environments. Increased opportunities for contact and children playing in close proximity facilitate droplet transmission and fomite spread. These factors justify the recommendation for closure to mitigate a surge in cases. **High-Yield Clinical Pearls for NEET-PG:** * **Incubation Period:** Swine Flu (H1N1) typically has an incubation period of 1–4 days. * **Period of Communicability:** Adults are infectious from 1 day before to 7 days after symptom onset; children can remain infectious for up to 10–14 days. * **Drug of Choice:** Oseltamivir (Tamiflu) is the treatment of choice and should ideally be started within 48 hours of symptom onset. * **Categorization:** Remember the MOHFW categorization (A, B, C). Only Category C (breathlessness, chest pain, hypotension) requires mandatory hospitalization.

Question 205: Which one of the following gives strong evidence of Typhoid Fever carrier status?

A. Isolation of core antigen
B. Isolation of Vi antigen (Correct Answer)
C. Persistence of Vi antibodies
D. Demonstration of Typhoid bacilli in stools

Explanation: ### Explanation The detection of **Vi (Virulence) antigen** or its corresponding antibodies is the hallmark of identifying chronic carriers of *Salmonella Typhi*. **1. Why "Isolation of Vi antigen" is the correct answer:** The Vi antigen is a surface polysaccharide capsule of *S. Typhi*. In chronic carriers, the bacilli persist in the gallbladder or biliary tract, continuously shedding the Vi antigen. While the presence of Vi antibodies is a common screening tool, the **isolation/demonstration of the Vi antigen** itself (or high titers of Vi antibodies) provides the strongest evidence of a carrier state, as these levels typically subside after recovery in non-carriers. **2. Analysis of Incorrect Options:** * **A. Isolation of core antigen:** This is not a standard diagnostic marker for Typhoid. The primary antigens used are O (Somatic), H (Flagellar), and Vi (Surface). * **C. Persistence of Vi antibodies:** While Vi antibodies are used for **screening** potential carriers (especially in food handlers), their presence is suggestive rather than definitive. A definitive diagnosis of a carrier requires the isolation of the organism or its specific components. * **D. Demonstration of Typhoid bacilli in stools:** While carriers do shed bacilli in stools, shedding is often **intermittent**. A single negative stool culture does not rule out a carrier state. To confirm a carrier via stool, at least three consecutive negative samples are required. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition of Chronic Carrier:** A person who excretes *S. Typhi* in stool or urine for **more than one year** after the initial episode. * **Common Site:** The **gallbladder** is the most common site for chronic carriage (often associated with gallstones). * **Screening Tool of Choice:** Vi antibody titer (1:10 or more is significant). * **Gold Standard for Carrier Detection:** Repeated stool cultures or culture of bile (string test). * **Urinary Carriers:** Often associated with *Schistosoma haematobium* infection.

Question 206: Which of the following is NOT a recognized side effect of oral contraceptive pills?

A. Weight gain
B. Breast discomfort
C. Ovarian malignancy (Correct Answer)
D. Deep vein thrombosis (DVT)

Explanation: **Explanation:** The correct answer is **Ovarian malignancy** because Oral Contraceptive Pills (OCPs) are actually **protective** against ovarian cancer, rather than being a causative factor. **1. Why Ovarian Malignancy is the correct answer:** Combined Oral Contraceptive Pills (COCPs) suppress ovulation. By reducing the "incessant ovulation" and the associated trauma to the ovarian epithelium, they significantly decrease the risk of **Ovarian and Endometrial cancers**. This protective effect increases with the duration of use and persists for several years after discontinuation. **2. Analysis of Incorrect Options:** * **Weight Gain (A):** This is a commonly reported side effect, primarily due to the fluid-retention properties of estrogen and the anabolic effects of certain progestogens. * **Breast Discomfort (B):** Estrogen causes ductal proliferation and fluid retention, leading to mastalgia (breast tenderness), a frequent minor side effect. * **Deep Vein Thrombosis (DVT) (D):** Estrogen increases the synthesis of clotting factors (II, VII, IX, X) in the liver and decreases Antithrombin III. This creates a hypercoagulable state, making DVT and pulmonary embolism serious, well-recognized risks of OCP use. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Risks:** OCPs *increase* the risk of **Cervical cancer** and **Breast cancer** (slight increase), but *decrease* the risk of **Ovarian and Endometrial cancer**. * **Benign Tumors:** OCPs are associated with an increased risk of **Hepatic Adenoma**. * **Absolute Contraindications:** Smokers >35 years, history of Thromboembolism (DVT/PE), undiagnosed vaginal bleeding, and active liver disease. * **Non-contraceptive benefits:** Reduced risk of Ectopic pregnancy, PID, and Iron deficiency anemia (due to reduced menstrual flow).

Question 207: In the Revised National Tuberculosis Control Programme (RNTCP), what is the schedule for sputum examination after beginning chemotherapy for Category I patients?

A. 2, 4, and 6 months (Correct Answer)
B. 1, 2, and 3 months
C. 3, 5, and 6 months
D. 1, 3, and 5 months

Explanation: **Explanation:** Under the **Revised National Tuberculosis Control Programme (RNTCP)**—now integrated into the **National TB Elimination Programme (NTEP)**—the monitoring of treatment response for Category I patients (New cases) is primarily done through follow-up sputum smear examinations. **Why Option A is correct:** For Category I patients, the standard treatment duration is 6 months (2 months of Intensive Phase and 4 months of Continuation Phase). Sputum examinations are scheduled at the **end of the Intensive Phase (2 months)** to check for smear conversion, and subsequently at **4 months** and **6 months** (end of treatment) to confirm cure. This timeline ensures that any failure to convert or late-stage relapse is identified promptly. **Analysis of Incorrect Options:** * **Option B (1, 2, 3 months):** This frequency is too early and frequent; it does not account for the full duration of the Continuation Phase. * **Option C (3, 5, 6 months):** This was historically the schedule for **Category II** (Retreatment) patients under older guidelines, where the Intensive Phase lasted 3 months. * **Option D (1, 3, 5 months):** This does not align with the standard 2-month Intensive Phase transition point used in the national protocol. **High-Yield Clinical Pearls for NEET-PG:** * **Smear Conversion:** If the sputum is still positive at 2 months, the Intensive Phase is **not** extended (as per newer daily regimen guidelines); the patient starts the Continuation Phase, and sputum is repeated at 3 months. * **Definition of "Cured":** A patient who was initially smear-positive, completed treatment, and had a negative smear at the end of treatment (6th month) plus at least one previous follow-up (2nd or 4th month). * **NTEP Update:** While the program has shifted toward **NAAT (CBNAAT/Truenat)** for initial diagnosis, sputum smear microscopy remains the standard for monitoring treatment progress.

Question 208: Which of the following is NOT an epidemiological indicator for malaria?

A. Annual falciparum incidence
B. Annual parasite incidence
C. Annual blood examination rate
D. Annual parasite index (Correct Answer)

Explanation: **Explanation:** The correct answer is **D (Annual Parasite Index)** because it is a **terminological distractor**. In malaria epidemiology, the standard metric used to measure the incidence of malaria cases in a community per 1,000 population per year is the **Annual Parasite Incidence (API)**. There is no standard epidemiological indicator formally termed "Annual Parasite Index" in the National Vector Borne Disease Control Programme (NVBDCP) guidelines. **Analysis of Options:** * **Annual Parasite Incidence (API):** This is the most sensitive index for measuring the malaria burden in an area. It is calculated as: *(Total confirmed cases during the year / Total population under surveillance) × 1000*. * **Annual Blood Examination Rate (ABER):** This measures the efficiency and operational coverage of the surveillance system. It represents the percentage of the population screened for malaria annually (Target: >10%). * **Annual Falciparum Incidence (AFI):** This specifically tracks the incidence of *Plasmodium falciparum* cases per 1,000 population, which is crucial for monitoring drug resistance and severe malaria trends. **High-Yield Clinical Pearls for NEET-PG:** * **API < 2:** Criteria for an area to enter the "Pre-elimination phase." * **Slide Positivity Rate (SPR):** *(Total positive slides / Total slides examined) × 100*. It is a reliable indicator of malaria prevalence. * **Slide Falciparum Rate (SFR):** *(Total P. falciparum positive slides / Total slides examined) × 100*. * **P. falciparum Percentage (Pf%):** Proportion of total cases caused by *P. falciparum*. * **Infant Parasite Rate (IPR):** The best indicator of **recent/ongoing transmission** in a locality.

Question 209: Q fever is caused by which Rickettsial Agent?

A. R. prowazekii
B. R. tsutsugamushi
C. C. burnetii (Correct Answer)
D. Rochalimaea quintana

Explanation: **Explanation:** **Correct Answer: C. Coxiella burnetii** Q fever is caused by *Coxiella burnetii*. Although historically classified under the family Rickettsiaceae due to its obligate intracellular nature, it is genetically distinct. Unlike other rickettsial diseases, Q fever is unique because it **does not present with a rash** and does not require an arthropod vector for human transmission; it is primarily acquired through the inhalation of infected aerosols from livestock (cattle, sheep, goats). **Analysis of Incorrect Options:** * **A. R. prowazekii:** This agent causes **Epidemic Typhus**, which is transmitted by the human body louse. * **B. R. tsutsugamushi (Orientia tsutsugamushi):** This agent causes **Scrub Typhus**, transmitted by the bite of a larval mite (chigger). * **C. Rochalimaea quintana (Bartonella quintana):** This agent causes **Trench Fever**, also transmitted by the human body louse. **High-Yield Clinical Pearls for NEET-PG:** * **Weil-Felix Test:** Q fever is **Weil-Felix negative** (unlike most other rickettsial infections). * **Resistance:** *C. burnetii* is highly resistant to environmental stressors (heat, drying) due to its spore-like form. * **Diagnosis:** The gold standard is Serology (IFA). * **Clinical Presentation:** Often presents as an atypical pneumonia or hepatitis. In chronic cases, **culture-negative endocarditis** is a classic association. * **Drug of Choice:** Doxycycline.

Question 210: Which of the following is not a type of VDPV?

A. mVDPV (Correct Answer)
B. aVDPV
C. iVDPV
D. cVDPV

Explanation: **Explanation:** The correct answer is **A (mVDPV)**. Vaccine-Derived Polioviruses (VDPVs) are rare strains of poliovirus that have genetically mutated from the attenuated virus contained in the Oral Polio Vaccine (OPV). According to the World Health Organization (WHO), VDPVs are classified into three specific categories based on their origin and transmission; **"mVDPV" is not a recognized category.** **Analysis of Options:** * **cVDPV (Circulating VDPV):** These are the most common and clinically significant. They occur in communities with low vaccination coverage where the attenuated vaccine virus circulates for a prolonged period (usually >12 months), regaining neurovirulence and causing outbreaks. * **iVDPV (Immunodeficiency-associated VDPV):** These are isolated from individuals with rare primary immunodeficiencies (e.g., B-cell deficiency). These patients cannot clear the intestinal infection and may excrete the mutated virus for years. * **aVDPV (Ambiguous VDPV):** These are "catch-all" isolates that do not fit the other two categories. They include isolates from healthy people in communities with no known circulation or isolates from sewage where the source is unknown. **High-Yield NEET-PG Pearls:** * **Genetic Divergence:** A poliovirus is classified as a VDPV if it is **>1% divergent** from the parent OPV strain for Type 1 and 3, and **>0.6%** for Type 2. * **Type 2 Predominance:** Historically, Type 2 (OPV2) was responsible for >90% of cVDPV cases, leading to the global "switch" from trivalent to bivalent OPV. * **Public Health Importance:** While OPV is essential for stopping wild polio, the risk of VDPVs is the primary reason the world must eventually transition entirely to Inactivated Polio Vaccine (IPV).

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