Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 231: Which of the following organisms is associated with emergence or reemergence?

A. Polio virus
B. Measles virus
C. Nipah virus (Correct Answer)
D. West Nile virus

Explanation: ### Explanation **Correct Option: C. Nipah Virus** Nipah virus (NiV) is a classic example of an **emerging zoonotic virus**. Emerging diseases are those that have appeared in a population for the first time, or that may have existed previously but are rapidly increasing in incidence or geographic range. Nipah virus, first identified in 1998 in Malaysia, is transmitted from bats (*Pteropus* species) to humans or via intermediate hosts like pigs. Its periodic outbreaks (e.g., in Kerala, India) and high case-fatality rate (40% to 75%) categorize it as a significant public health threat under the WHO R&D Blueprint. **Analysis of Incorrect Options:** * **A & B. Polio and Measles Viruses:** These are **vaccine-preventable diseases** that are currently targeted for eradication (Polio) or elimination (Measles). They are not considered "emerging" because they have been well-characterized and prevalent in human populations for centuries. While "resurgence" can occur due to low vaccine coverage, they do not fit the standard definition of emerging/reemerging pathogens in this context. * **D. West Nile Virus:** While West Nile Virus (WNV) was an emerging pathogen when it first entered the Americas in 1999, in the context of standard NEET-PG preventive medicine curriculum, Nipah is the more frequently cited "emerging" threat due to its recent localized outbreaks in India and its status as a priority pathogen. **High-Yield Clinical Pearls for NEET-PG:** * **Emerging Diseases:** SARS-CoV-2, Ebola, Nipah, Zika, and H5N1. * **Re-emerging Diseases:** Dengue, Chikungunya, and MDR-TB (diseases that were previously declining but are now increasing again). * **Nipah Virus Key Facts:** * **Natural Reservoir:** Fruit bats (*Pteropus* genus). * **Transmission:** Consumption of raw date palm sap contaminated by bat saliva/urine, or direct contact with infected pigs/humans. * **Diagnosis:** RT-PCR (acute phase) and ELISA (IgG/IgM).

Question 232: Plague is transmitted by which of the following vectors?

A. Mite
B. Flea (Correct Answer)
C. Sand fly
D. None of the above

Explanation: **Explanation:** **Correct Answer: B. Flea** Plague is a zoonotic disease caused by the bacterium *Yersinia pestis*. The primary mode of transmission is through the bite of an infected **rat flea**, most commonly ***Xenopsylla cheopis*** (the Oriental rat flea). The transmission cycle involves the "blocked flea" phenomenon, where the bacteria multiply in the flea's proventriculus, forming a biofilm that prevents blood from entering the stomach. This causes the flea to become ravenous and regurgitate the bacteria into the host during subsequent feeding attempts. **Analysis of Incorrect Options:** * **A. Mite:** Mites (specifically *Leptotrombidium* larvae or chiggers) are the vectors for **Scrub Typhus** (*Orientia tsutsugamushi*). * **C. Sand fly:** Sand flies (specifically *Phlebotomus* species) are the vectors for **Leishmaniasis** (Kala-azar) and Sandfly fever. * **D. None of the above:** Incorrect, as the flea is the well-established vector for plague. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoirs:** The primary reservoirs are wild rodents (sylvatic cycle) and domestic rats (*Rattus rattus*). * **Types of Plague:** * **Bubonic:** Most common; characterized by painful lymphadenopathy (Buboes). * **Pneumonic:** Highly infectious; transmitted via respiratory droplets (person-to-person). * **Septicemic:** Disseminated infection leading to necrosis (Black Death). * **Index of Transmission:** The **Cheopis Index** (average number of *X. cheopis* per rat) is a critical epidemiological measure; an index **>1** indicates a high risk of a plague outbreak. * **Drug of Choice:** Streptomycin (Gentamicin is a common alternative).

Question 233: Which arthropod possesses four pairs of legs?

A. Insecta
B. Crustacea
C. Arachnida (Correct Answer)
D. None of the above

Explanation: **Explanation:** The classification of arthropods is a high-yield topic in Medical Entomology. The correct answer is **Arachnida** because members of this class are anatomically characterized by having **four pairs of legs** (8 legs total) in their adult stage and a body divided into two segments: a cephalothorax and an abdomen. **Analysis of Options:** * **Arachnida (Correct):** This class includes medically important vectors such as **Ticks** (Hard and Soft) and **Mites** (e.g., *Sarcoptes scabiei*, Trombiculid mites). These are wingless and lack antennae. * **Insecta (Incorrect):** This is the largest class and includes mosquitoes, flies, lice, and fleas. Insects are characterized by **three pairs of legs** (6 legs total), a body divided into three segments (head, thorax, abdomen), and usually one or two pairs of wings. * **Crustacea (Incorrect):** This class includes aquatic organisms like cyclops (intermediate host for Guinea worm). They typically possess **five or more pairs of legs** and two pairs of antennae. **High-Yield Clinical Pearls for NEET-PG:** * **Ticks vs. Insects:** Ticks (Arachnids) do not have antennae or wings, whereas insects do. * **Larval Exception:** Note that while adult Arachnids have 4 pairs of legs, the **larval stage** of ticks and mites possesses only **3 pairs**, often leading to confusion in exams. * **Disease Association:** * *Hard Ticks:* KFD, Tick paralysis, Indian Tick Typhus. * *Mites:* Scabies (Sarcoptes), Scrub Typhus (Trombiculid mite). * *Cyclops (Crustacea):* Dracunculiasis (Guinea worm) and Fish Tapeworm (Diphyllobothrium latum).

Question 234: All of the following statements are true about the DPT vaccine except:

A. It should be stored in a deep freezer. (Correct Answer)
B. Exposure to direct sunlight when in use should be avoided.
C. Stock supplies for three months are needed at the Primary Health Centre (PHC) level.
D. Partially used vials should not be put back into the cold chain after a vaccination session.

Explanation: ### Explanation **1. Why Option A is the correct (False) statement:** The DPT vaccine is **freeze-sensitive**. It contains an aluminum adjuvant (aluminum phosphate or hydroxide) which, if frozen, precipitates and forms clumps. This process irreversibly destroys the vaccine's potency and increases the risk of local adverse reactions (sterile abscesses). Therefore, DPT must **never** be stored in a deep freezer; it should be stored in the main compartment of an ILR (Ice-Lined Refrigerator) at **+2°C to +8°C**. **2. Analysis of Incorrect Options:** * **Option B:** Like most vaccines, DPT is heat and light-sensitive. Exposure to direct sunlight can lead to degradation of the toxoids, hence it must be protected during sessions. * **Option C:** According to standard UIP (Universal Immunization Programme) guidelines, the PHC is expected to maintain a stock of vaccines sufficient for **3 months**, while the Sub-center level maintains stock for 1 month. * **Option D:** Under the **Open Vial Policy**, while certain vaccines (like DPT, HepB, Hib) can be reused for up to 28 days if specific criteria are met, the traditional practice in many field settings—and a common distractor in exams—emphasizes that once a vial is taken to a site and partially used under sub-optimal conditions, it is safer to discard it to prevent contamination, though current WHO/GOI policy allows reuse if the cold chain is strictly maintained. However, in the context of this MCQ, Option A is the "most" false statement. **3. High-Yield Clinical Pearls for NEET-PG:** * **Shake Test:** Used to determine if a freeze-sensitive vaccine (DPT, TT, Pentavalent, HepB) has been damaged by freezing. If the vaccine settles faster than a control vial, it has been frozen and must be discarded. * **Freeze-Sensitive Vaccines:** DPT > HepB > TT (DPT is the most sensitive). * **Heat-Sensitive Vaccines:** OPV (most sensitive) > Measles > BCG. * **Storage Temperature:** All UIP vaccines at the PHC level are stored between **+2°C to +8°C**, except OPV which can be kept at -20°C for long-term storage.

Question 235: A 2-year-old boy with Vitamin A deficiency is treated with what dosage regimen?

A. 1 lakh IU on days 0, 1, and 14
B. 1 lakh IU on days 0, 1, and 6
C. 2 lakh IU on days 0, 1, and 14 (Correct Answer)
D. 2 lakh IU on days 0, 1, and 6

Explanation: ### Explanation **1. The Correct Answer: C (2 lakh IU on days 0, 1, and 14)** The treatment of clinical Vitamin A deficiency (Xerophthalmia) follows a specific therapeutic schedule to rapidly replenish hepatic stores and prevent permanent blindness. According to WHO and National Guidelines, children **aged 1 year and older** (or weighing >8 kg) should receive **200,000 IU (2 lakh IU)** of Vitamin A orally at three specific intervals: * **Day 0:** Immediately upon diagnosis. * **Day 1:** The following day (to build up liver reserves). * **Day 14:** Two weeks later (to ensure long-term adequacy). **2. Why the Other Options are Incorrect:** * **Option A & B (1 lakh IU):** This dosage is reserved for infants aged **6–11 months** (or children weighing <8 kg). Using this for a 2-year-old would be a sub-therapeutic dose for clinical treatment. * **Option D (Days 0, 1, and 6):** The third dose must be administered on **Day 14**. A gap of two weeks is physiologically required to ensure the stabilization of systemic Vitamin A levels. **3. High-Yield Clinical Pearls for NEET-PG:** * **Prophylaxis vs. Treatment:** Do not confuse the *Treatment* schedule (0, 1, 14 days) with the *Prophylaxis* schedule (every 6 months). * **Prophylaxis Schedule (National Vitamin A Prophylaxis Programme):** * **9 months:** 1 lakh IU (with Measles/MR vaccine). * **18 months to 5 years:** 2 lakh IU every 6 months. * **Total doses:** 9 doses (Total 17 lakh IU). * **Infant Treatment (<6 months):** 50,000 IU on days 0, 1, and 14. * **Bitot’s Spots:** While Bitot's spots (X1B) indicate deficiency, the treatment regimen remains the same for all clinical stages of xerophthalmia to prevent progression to Keratomalacia (X3).

Question 236: What is the definition of MDR (Multidrug-resistant tuberculosis) regimen?

A. Isoniazid (INH) only
B. Isoniazid (INH) and Rifampicin (Correct Answer)
C. More than two drugs
D. Isoniazid (INH), Pyrazinamide, and Ethambutol

Explanation: ### Explanation **Correct Answer: B. Isoniazid (INH) and Rifampicin** **1. Understanding the Concept:** Multidrug-resistant tuberculosis (MDR-TB) is specifically defined as tuberculosis caused by *Mycobacterium tuberculosis* strains that show resistance to **at least Isoniazid (H) and Rifampicin (R)**, the two most powerful first-line anti-TB drugs. This resistance can occur with or without resistance to other first-line drugs (Ethambutol or Pyrazinamide). Because H and R form the backbone of short-course chemotherapy, resistance to both necessitates the use of more toxic and less effective second-line regimens. **2. Analysis of Incorrect Options:** * **Option A (Isoniazid only):** Resistance to Isoniazid alone is termed **Monoresistance**. While serious, it does not meet the criteria for MDR-TB. * **Option C (More than two drugs):** This is too vague. Resistance to three drugs (e.g., H, E, and Z) without Rifampicin resistance is "Poly-resistance," not MDR. MDR specifically requires resistance to the H+R combination. * **Option D (INH, Pyrazinamide, and Ethambutol):** Resistance to these three without Rifampicin resistance is classified as **Poly-drug resistance**. **3. NEET-PG High-Yield Pearls:** * **XDR-TB (Extensively Drug-Resistant):** MDR-TB plus resistance to any **Fluoroquinolone** AND at least one of the three **Group A drugs** (Bedaquiline or Linezolid). *Note: WHO updated this definition in 2021.* * **Pre-XDR TB:** MDR-TB plus resistance to any Fluoroquinolone. * **Rifampicin Resistance (RR-TB):** Resistance to Rifampicin detected using phenotypic or genotypic methods. In clinical practice, RR-TB is treated as MDR-TB. * **Diagnostic Gold Standard:** **CBNAAT (GeneXpert)** is the initial diagnostic test to detect Rifampicin resistance under the National TB Elimination Program (NTEP).

Question 237: Exacerbation of lesions in patients of borderline leprosy is seen in which type of reaction?

A. Erythema nodosum leprosum (ENL)
B. Type I lepra reaction (Correct Answer)
C. Jarisch-Herxheimer reaction
D. Resolving leprosy

Explanation: **Explanation:** **Type I Lepra Reaction (Delayed Hypersensitivity)** is the correct answer because it is specifically associated with **Borderline forms of leprosy** (BT, BB, and BL). It occurs due to a sudden change in the patient's cell-mediated immunity (CMI). Clinically, it manifests as the **exacerbation of existing lesions**, which become erythematous, edematous, and painful. New lesions may appear, and there is often associated acute neuritis (nerve tenderness and loss of function). **Analysis of Incorrect Options:** * **A. Erythema Nodosum Leprosum (ENL):** Also known as Type II lepra reaction, this is a humoral (Type III) hypersensitivity reaction seen primarily in **lepromatous (LL)** and occasionally **borderline lepromatous (BL)** leprosy. It presents with crops of tender, evanescent subcutaneous nodules, fever, and systemic symptoms, rather than the exacerbation of existing skin patches. * **C. Jarisch-Herxheimer Reaction:** This is a systemic inflammatory response seen following the initiation of antibiotic treatment for spirochetal infections (e.g., Syphilis, Leptospirosis), caused by the release of endotoxin-like products from dying organisms. It is not a feature of leprosy. * **D. Resolving Leprosy:** This refers to the healing phase where lesions become flatter, less erythematous, and lose their activity, which is the clinical opposite of an exacerbation. **High-Yield Clinical Pearls for NEET-PG:** * **Type I Reaction:** Can be "Upgrading" (Reversal reaction – shift toward Tuberculoid pole) or "Downgrading" (shift toward Lepromatous pole). * **Treatment of Choice:** Systemic Corticosteroids (Prednisolone) are the mainstay for both Type I and Type II reactions to prevent permanent nerve damage. * **Thalidomide:** Highly effective for Type II (ENL) but contraindicated in Type I and pregnancy.

Question 238: Keratomalacia is seen in which of the following conditions?

A. Chicken pox
B. Mumps
C. Diarrhoea
D. Measles (Correct Answer)

Explanation: **Explanation:** **Measles (Rubeola)** is the correct answer because it is a major cause of childhood blindness in developing countries. The virus causes a severe depletion of **Vitamin A** stores in the body. This occurs through multiple mechanisms: increased metabolic demand during high fever, decreased intestinal absorption, and increased urinary excretion of the vitamin. The resulting Vitamin A deficiency leads to **Xerophthalmia**, which progresses through stages (X1A to X3B). **Keratomalacia (X3B)** is the most severe stage, characterized by liquefactive necrosis and perforation of the cornea, leading to permanent blindness. Measles also causes direct viral keratitis, which further exacerbates corneal damage. **Analysis of Incorrect Options:** * **Chickenpox:** Caused by the Varicella-Zoster virus, it typically presents with vesicular rashes. While it can cause mild conjunctivitis, it does not significantly deplete Vitamin A or lead to keratomalacia. * **Mumps:** Primarily involves the parotid glands and can cause orchitis or meningitis. It has no direct association with Vitamin A deficiency or corneal melting. * **Diarrhoea:** While chronic or severe diarrhoea can lead to malabsorption of Vitamin A, **Measles** is the specific infectious disease most classically and acutely associated with rapid progression to keratomalacia in public health contexts. **Clinical Pearls for NEET-PG:** * **WHO Protocol:** All children diagnosed with Measles must receive two doses of Vitamin A (200,000 IU for >1 year; 100,000 IU for 6–12 months) on consecutive days to prevent blindness and reduce mortality. * **Koplik Spots:** Pathognomonic sign of Measles found on the buccal mucosa. * **Xerophthalmia Classification:** Remember **X3A** (Corneal ulcer <1/3rd surface) vs. **X3B** (Keratomalacia/Corneal ulcer >1/3rd surface).

Question 239: Which of the following is not part of control measures for diphtheria?

A. Treatment of cases with antitoxin and erythromycin
B. Treatment of carriers with antitoxin (Correct Answer)
C. Isolation of cases, suspected cases and carriers
D. Regular immunization of under-fives

Explanation: **Explanation:** The correct answer is **B. Treatment of carriers with antitoxin.** In Diphtheria management, **Diphtheria Antitoxin (ADS)** is used to neutralize the circulating exotoxin produced by *Corynebacterium diphtheriae*. In carriers, the bacteria are present, but they do not produce the toxin in quantities that cause systemic illness; therefore, there is no circulating toxin to neutralize. Using antitoxin in carriers is unnecessary and carries a risk of hypersensitivity reactions. Carriers are instead treated with a 10-day course of oral **Erythromycin** (or aqueous penicillin) to eradicate the organism and prevent community spread. **Analysis of other options:** * **Option A:** This is the standard protocol for **cases**. Antitoxin neutralizes the toxin, while Erythromycin stops further toxin production and clears the infection. * **Option B:** As explained, carriers require antibiotics only, not antitoxin. * **Option C:** Isolation is a crucial public health measure. Cases and carriers should be isolated until two consecutive nose and throat swabs (taken 24 hours apart) are negative. * **Option D:** Primary immunization (Pentavalent/DPT) and boosters are the most effective long-term control measures to maintain herd immunity. **High-Yield Pearls for NEET-PG:** * **Schick Test:** Used to distinguish between susceptible individuals and those immune to diphtheria. * **Carrier Rate:** In an endemic area, the carrier rate is usually 1–5%. * **Cutaneous Diphtheria:** Often acts as a reservoir for respiratory diphtheria. * **Laryngeal Diphtheria:** The most dangerous form due to the risk of acute airway obstruction by the "pseudomembrane."

Question 240: DOTS indicates?

A. Short term treatment under supervision (Correct Answer)
B. Short term treatment without supervision
C. Long term treatment with supervision
D. Long term treatment without supervision

Explanation: **Explanation:** **DOTS** stands for **Directly Observed Treatment, Short-course**. It is the internationally recommended strategy for tuberculosis (TB) control, currently integrated under the National TB Elimination Programme (NTEP). 1. **Why Option A is correct:** * **Short-course:** The treatment duration for drug-sensitive TB is typically 6 months (2 months Intensive Phase + 4 months Continuation Phase), which is considered "short" compared to older regimens that lasted 18–24 months. * **Supervision:** The core pillar of DOTS is "Direct Observation." A trained health worker or a designated community member (DOT provider) watches the patient swallow their medication. This ensures **adherence**, prevents drug resistance (MDR-TB), and monitors for side effects. 2. **Why other options are incorrect:** * **Options B & D (Without supervision):** Self-administered treatment often leads to poor compliance, irregular dosing, and treatment failure, which are the primary drivers of the TB epidemic. * **Options C & D (Long term):** Modern chemotherapy uses potent bactericidal drugs (Rifampicin, Isoniazid), making long-term (multi-year) treatment unnecessary for standard cases. **High-Yield Clinical Pearls for NEET-PG:** * **Five Components of DOTS:** Political commitment, Good quality microscopy, Uninterrupted supply of drugs, Standardized recording/reporting, and Direct observation. * **NTEP Update:** India has moved from intermittent (thrice weekly) to **Daily Regimen** using Fixed-Dose Combinations (FDCs) based on weight bands. * **Nikshay:** The unified ICT platform for TB monitoring in India. * **Goal:** India aims to eliminate TB by **2025**, five years ahead of the global Sustainable Development Goal (2030).

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