Non-Communicable Diseases Practice Questions

Q: Benzathine penicillin treatment in Rheumatic Heart Disease (RHD) is aimed at which of the following types of prevention?

Secondary prevention. **Explanation:** The correct answer is **Secondary Prevention**. In the context of Rheumatic Heart Disease (RHD), the use of Benzathine Penicillin is aimed at preventing the recurrence of Acute Rheumatic Fever (ARF). Since the patient has already suffered an initial attack or has established heart disease, the goal is to prevent further Group A Streptococcal (GAS) infections that would exacerbate the condition. By definition, secondary prevention involves early diagnosis and treatment to prevent complications or recurrences of a disease already present. **Analysis of Options:** * **Primordial Prevention:** Focuses on preventing the emergence of risk factors (e.g., improving socio-economic conditions and housing to prevent overcrowding). * **Primary Prevention:** Aims at preventing the *first* attack of ARF by treating an initial sore throat (GAS pharyngitis) with antibiotics before it triggers the autoimmune response. * **Tertiary Prevention:** Focuses on limiting disability and rehabilitation in advanced disease (e.g., valve replacement surgery for mitral stenosis). **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzathine Penicillin G (1.2 million units IM every 3–4 weeks) is the gold standard for secondary prophylaxis. * **Duration of Prophylaxis:** * *ARF without Carditis:* 5 years or until age 21 (whichever is longer). * *ARF with Carditis (no valvular disease):* 10 years or until age 21 (whichever is longer). * *ARF with persistent Valvular Disease:* 10 years or until age 40 (sometimes lifelong). * **Jones Criteria:** Used for the diagnosis of the initial attack of ARF (Primary prevention stage).

Q: What does CBNAAT stand for?

Cartridge Based Nucleic Acid Amplification Test. **Explanation:** **CBNAAT** stands for **Cartridge Based Nucleic Acid Amplification Test**. It is a revolutionary molecular diagnostic tool used primarily for the rapid detection of *Mycobacterium tuberculosis* (MTB) and rifampicin resistance. **Why Option D is Correct:** The technology (commercially known as GeneXpert) utilizes a self-contained, single-use **cartridge** that houses all necessary reagents for DNA extraction, amplification, and detection. Because the entire process occurs within this closed cartridge, it minimizes the risk of cross-contamination and requires minimal laboratory infrastructure, making it a "point-of-care" test. **Why Other Options are Incorrect:** * **Options A, B, and C:** The terms "Category," "Case," and "Clinical" are incorrect prefixes. While CBNAAT is used for clinical diagnosis and case finding, the nomenclature specifically refers to the **method of delivery** (the cartridge system) rather than the clinical application. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It is a hemi-nested real-time PCR assay that targets the **rpoB gene** of MTB. * **Turnaround Time:** Provides results within **2 hours**, significantly faster than traditional culture (which takes weeks). * **NTEP Guidelines:** Under the National Tuberculosis Elimination Programme (NTEP), CBNAAT is the **preferred first-line diagnostic test** for all presumptive TB cases, especially for pediatric TB, HIV-positive individuals, and extra-pulmonary TB. * **Sensitivity:** It has a much higher sensitivity than sputum smear microscopy, particularly in paucibacillary cases. * **Limitation:** It cannot differentiate between live and dead bacilli; hence, it is not used for monitoring treatment response.

Q: A woman with a Body Mass Index of 20 is classified as:

Normal weight. **Explanation:** The Body Mass Index (BMI), or Quetelet index, is a simple index of weight-for-height that is commonly used to classify underweight, overweight, and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres ($kg/m^2$). According to the **World Health Organization (WHO)** classification: * **Normal weight:** BMI ranges from **18.50 to 24.99 $kg/m^2$**. Since the woman in the question has a BMI of 20, she falls squarely within this healthy range. **Analysis of Incorrect Options:** * **Undernourished (Underweight):** This is defined as a BMI **< 18.50 $kg/m^2$**. * **Overweight:** This is defined as a BMI **$\geq$ 25.00 $kg/m^2$** (specifically 25.00–29.99). * **Obese:** This is defined as a BMI **$\geq$ 30.00 $kg/m^2$**. **High-Yield Facts for NEET-PG:** 1. **Asian-Indian Specific Criteria:** Due to a higher risk of metabolic syndrome at lower BMIs, the revised criteria for Indians are: * Normal: 18–22.9 $kg/m^2$ * Overweight: 23–24.9 $kg/m^2$ * Obese: $\geq$ 25 $kg/m^2$ 2. **Ponderal Index:** Another measure of body fat, calculated as $Weight (kg) / Height^3 (m^3)$. 3. **Waist-Hip Ratio:** A significant indicator of central obesity. Risk increases if > 0.9 in men and > 0.85 in women. 4. **Broca’s Index:** A quick bedside formula for Ideal Body Weight (IBW): $Height (cm) - 100$.

Q: What is the type of Diphtheria associated with the highest mortality?

Laryngeal. ### Explanation **Correct Answer: C. Laryngeal** **Why Laryngeal Diphtheria has the highest mortality:** Laryngeal diphtheria is considered the most dangerous form because it carries a high risk of **acute airway obstruction**. The characteristic "pseudomembrane" (composed of fibrin, WBCs, and dead epithelial cells) can detach or cause significant edema in the narrow subglottic region. This leads to "croupy" cough, inspiratory stridor, and ultimately, asphyxiation. Unlike other forms, the primary cause of death here is often mechanical respiratory failure rather than just systemic toxemia. **Analysis of Incorrect Options:** * **A. Pharyngeal:** This is the **most common** clinical form. While it causes significant systemic toxemia (leading to myocarditis), the risk of immediate mechanical airway death is lower than in the laryngeal type. * **B. Nasal:** This is generally the **mildest** form. It presents with serosanguinous discharge and has low systemic toxin absorption, leading to a very low mortality rate. * **D. Conjunctival:** This is a rare localized form. While it can cause local tissue destruction and corneal scarring, it is rarely fatal. **High-Yield Clinical Pearls for NEET-PG:** * **Causative Agent:** *Corynebacterium diphtheriae* (Gram-positive, club-shaped, Chinese-letter pattern). * **Most Common Site:** Faucial/Pharyngeal. * **Most Fatal Site:** Laryngeal (due to asphyxia). * **The Membrane:** It is a **true pseudomembrane**; attempting to scrape it off results in profuse bleeding. * **Complications:** The most common cause of late death in diphtheria is **Myocarditis** (due to exotoxin). * **Schick Test:** Used to demonstrate the immune status of an individual (susceptibility). * **Drug of Choice:** Erythromycin (to stop toxin production) + Diphtheria Antitoxin (to neutralize circulating toxin).

Q: Which of the following complications has been associated with rotavirus vaccine?

Intussusception. **Explanation:** The correct answer is **Intussusception**. **Why Intussusception is correct:** Intussusception is a condition where one part of the intestine slides into an adjacent part (telescoping), leading to bowel obstruction. Historically, the first rotavirus vaccine (Rotashield) was withdrawn in 1999 due to a strong association with intussusception. Current vaccines (Rotarix and RotaTeq) carry a much lower, but still statistically significant, risk (approximately 1 to 5 cases per 100,000 vaccinated infants). The risk is highest within the first 7 days following the first dose. **Why other options are incorrect:** * **Guillain-Barré syndrome (GBS):** This is most famously associated with the **Influenza vaccine** and *Campylobacter jejuni* infections, not rotavirus. * **Hemolytic anemia:** This is typically an autoimmune or drug-induced reaction (e.g., methyldopa, penicillin) and is not a recognized complication of the rotavirus vaccine. * **Febrile seizures:** While common after the **MMR or DPT** vaccines due to the systemic inflammatory response/fever, they are not a specific or hallmark complication of the oral rotavirus vaccine. **High-Yield Clinical Pearls for NEET-PG:** * **Vaccine Type:** Rotavirus vaccines are **Live Attenuated** oral vaccines. * **Contraindication:** A history of previous intussusception or uncorrected congenital malformation of the GI tract (like Meckel’s diverticulum) is an absolute contraindication. * **Administration:** Under the Universal Immunization Programme (UIP) in India, Rotavirus vaccine (Rotavac) is given at **6, 10, and 14 weeks** (5 drops orally). * **Age Limit:** The first dose should ideally be administered before 15 weeks of age, and the series should be completed by 8 months.

Q: What is the incubation period for filariasis?

8 - 16 months. **Explanation:** In Lymphatic Filariasis, the **incubation period** refers to the time interval between the entry of infective larvae ($L_3$) via a mosquito bite and the first appearance of clinical signs and symptoms. For *Wuchereria bancrofti*, this period typically ranges from **8 to 16 months**, though it can vary based on the host's immune response and the intensity of infection. * **Why Option B is correct:** The biological development of the parasite from the $L_3$ stage to mature adults, followed by the host's inflammatory response to the adult worms, generally takes approximately 8 to 16 months to manifest clinically as lymphangitis or lymphadenitis. * **Why Options A, C, and D are incorrect:** 1–8 months (Option A) is too short for the parasite to mature and trigger a significant clinical immune response. Periods exceeding 16 months (Options C and D) represent outliers or delayed presentations rather than the standard epidemiological average defined in standard textbooks like Park’s PSM. **High-Yield Clinical Pearls for NEET-PG:** * **Pre-patent Period:** The time between the entry of infective larvae and the first appearance of microfilariae in the blood. For *W. bancrofti*, this is usually **6 to 12 months**. * **Vector:** *Culex quinquefasciatus* is the most common vector in India. * **Drug of Choice:** Diethylcarbamazine (DEC) 6 mg/kg for 12 days. * **Mass Drug Administration (MDA):** Uses a combination of DEC + Albendazole (or IDA: Ivermectin + DEC + Albendazole in specific areas) once a year to interrupt transmission.

Q: What is the Clinical GOAL recommended by WHO for Prevention of CAD?

Cholesterol / HDL ratio. ### Explanation **Correct Answer: B. Cholesterol / HDL ratio** The WHO recommends the **Total Cholesterol / HDL ratio** as a primary clinical goal and a powerful predictor of Coronary Artery Disease (CAD) risk. This ratio is often referred to as the **Atherogenic Index**. * **Medical Concept:** Total cholesterol represents all circulating lipoproteins, while HDL (High-Density Lipoprotein) is "good cholesterol" that facilitates reverse cholesterol transport (removing fat from arteries). A high ratio indicates that the pro-atherogenic components outweigh the protective components. According to WHO guidelines, the clinical goal is to keep this ratio **below 3.5 or 4.0**. A ratio above 5.0 indicates a high risk for ischemic heart disease. **Analysis of Incorrect Options:** * **A. Cholesterol / LDL ratio:** While LDL is the "bad cholesterol," the ratio of Total Cholesterol to LDL is not a standard clinical marker because LDL is already a major component of Total Cholesterol; they tend to move in the same direction. * **C. Triglycerides / LDL ratio:** This ratio is sometimes used in research to assess LDL particle size, but it is not a WHO-recommended clinical goal for CAD prevention. * **D. Triglycerides / HDL ratio:** While this is an emerging marker for insulin resistance and metabolic syndrome, it has not replaced the Total Cholesterol/HDL ratio in standard WHO CAD prevention protocols. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Halves:** In Hypertension/CAD, half the people are unaware, half of those aware are not treated, and half of those treated are not controlled. * **Primary Prevention of CAD:** Focuses on controlling risk factors like smoking, hypertension, and hypercholesterolemia in the general population. * **Serum Cholesterol Levels:** WHO recommends keeping serum cholesterol **<200 mg/dl** for the general population. * **HDL Levels:** Low HDL (**<40 mg/dl**) is an independent risk factor for CAD.

Q: In which of the following conditions is post-exposure prophylaxis not useful?

Pertussis. **Explanation:** The concept of **Post-Exposure Prophylaxis (PEP)** involves administering vaccines, immunoglobulins, or antibiotics after exposure to a pathogen to prevent the onset of disease. **Why Pertussis is the correct answer:** While antibiotics (like Azithromycin) are given to close contacts of a Pertussis case, this is technically classified as **Post-Exposure Chemoprophylaxis**, not "prophylaxis" in the context of preventing the disease once the incubation period has significantly progressed or through vaccination. More importantly, in the context of standard NEET-PG patterns, Pertussis vaccination is strictly for **primary prevention**. The vaccine takes too long to induce an immune response to be effective after exposure, unlike Measles or Rabies. **Analysis of Incorrect Options:** * **Measles:** Post-exposure vaccination is effective if given within **72 hours** of exposure. Immunoglobulins can be given within **6 days**. * **Rabies:** This is the classic example of PEP. Due to the long incubation period, a combination of Wound Management, Rabies Vaccine, and Rabies Immunoglobulin (RIG) can successfully prevent the disease. * **Hepatitis B:** PEP is standard for needle-stick injuries or sexual exposure, involving the Hepatitis B vaccine and/or Hepatitis B Immunoglobulin (HBIG) within **24 hours** (ideally) to 7 days. **High-Yield Clinical Pearls for NEET-PG:** * **Measles PEP:** Vaccine within 72 hours is the preferred method for outbreaks in susceptible populations. * **Hepatitis A:** PEP is also useful (Vaccine or IG within 14 days). * **Varicella:** PEP with Varicella Zoster Immunoglobulin (VZIG) is effective if given within 96 hours–10 days. * **Tetanus:** Post-injury management is a form of PEP involving TT/Td vaccine and TIG based on wound severity and immunization history.

Question 1

Benzathine penicillin treatment in Rheumatic Heart Disease (RHD) is aimed at which of the following types of prevention?

Accepted Answer

Secondary prevention

Answer

Primary prevention

Answer

Primordial prevention

Answer

Tertiary prevention

Question 2

What does CBNAAT stand for?

Accepted Answer

Cartridge Based Nucleic Acid Amplification Test

Answer

Category Based Nucleic Acid Amplification Test

Answer

Case Based Nucleic Acid Amplification Test

Answer

Clinical Based Nucleic Acid Amplification Test

Question 3

Which of the following is a common cause of infective diarrhea?

Accepted Answer

Rotavirus

Answer

Calicivirus

Answer

Flavivirus

Answer

Enterovirus

Question 4

A woman with a Body Mass Index of 20 is classified as:

Accepted Answer

Normal weight

Answer

Undernourished

Answer

Overweight

Answer

Obese

Question 5

What is the type of Diphtheria associated with the highest mortality?

Accepted Answer

Laryngeal

Answer

Pharyngeal

Answer

Nasal

Answer

Conjunctival

Question 6

Which of the following complications has been associated with rotavirus vaccine?

Accepted Answer

Intussusception

Answer

Guillain-Barré syndrome

Answer

Hemolytic anemia

Answer

Febrile seizures

Question 7

What is the incubation period for filariasis?

Accepted Answer

8 - 16 months

Answer

1 - 8 months

Answer

16 - 24 months

Answer

More than 24 months

Question 8

What is the Clinical GOAL recommended by WHO for Prevention of CAD?

Accepted Answer

Cholesterol / HDL ratio

Answer

Cholesterol / LDL ratio

Answer

Triglycerides / LDL ratio

Answer

Triglycerides / HDL ratio

Question 9

In which of the following conditions is post-exposure prophylaxis not useful?

Accepted Answer

Pertussis

Answer

Measles

Answer

Rabies

Answer

Hepatitis B

Question 10

What is the desired parameter for the control of hypertension?

Accepted Answer

Cholesterol/HDL ratio < 3.5

Answer

HDL/Cholesterol ratio < 3.5

Answer

LDL/Cholesterol ratio > 10 mg%

Answer

HDL < 30 mg%

Non-Communicable Diseases — MCQs

Non-Communicable Diseases — MCQs

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