Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 251: Eradication is possible in all of the following diseases except?

A. Measles
B. Polio
C. Tuberculosis (Correct Answer)
D. Dracunculosis

Explanation: **Explanation:** The concept of **eradication** refers to the permanent reduction to zero of the worldwide incidence of an infection caused by a specific agent as a result of deliberate efforts. For a disease to be eradicable, it must meet specific criteria: no animal reservoir, an effective intervention (vaccine/treatment), and a clear diagnostic tool. **Why Tuberculosis (C) is the Correct Answer:** Tuberculosis cannot be eradicated with current technology for several reasons: 1. **Latent Infection:** *M. tuberculosis* can remain dormant in the body for decades (Latent TB), making it impossible to identify and clear all carriers. 2. **Environmental Persistence:** The bacteria can survive in the environment for periods. 3. **Ineffective Vaccine:** The BCG vaccine protects against severe childhood forms but does not prevent primary infection or reactivation in adults. 4. **Long Treatment Duration:** Complex drug regimens lead to poor compliance and the emergence of Multi-Drug Resistant (MDR) strains. **Analysis of Other Options:** * **A. Measles:** Targeted for eradication because humans are the only reservoir, and a highly effective live-attenuated vaccine exists. * **B. Polio:** On the verge of eradication. It has no animal reservoir and effective vaccines (OPV/IPV) are available. Only Type 1 wild poliovirus remains endemic in limited geographies. * **D. Dracunculosis (Guinea Worm):** Targeted for eradication. It has no animal reservoir, and the cycle can be broken by simple water filtration and containment of infected individuals. **High-Yield Clinical Pearls for NEET-PG:** * **Only Eradicated Disease:** Smallpox (declared eradicated on May 8, 1980). * **Only Eradicated Animal Disease:** Rinderpest. * **Eliminated from India:** Smallpox, Guinea worm (2000), Polio (2014), and Maternal & Neonatal Tetanus (2015). * **TB Goal:** India aims to **Eliminate** TB by 2025 (Incidence <1 per million), but **Eradication** is currently not feasible.

Question 252: Chandler index is used for the diagnosis of which condition?

A. Ancylostomiasis (Correct Answer)
B. Ascariasis
C. Dracunculiasis
D. Filariasis

Explanation: **Explanation:** The **Chandler Index** is a specific epidemiological tool used to measure the intensity of infection in a community for **Ancylostomiasis (Hookworm infestation)**. It is calculated by taking the average number of hookworm eggs per gram of feces across a sampled population. * **Why Option A is correct:** The Chandler Index assesses the "worm burden." It is clinically significant because the severity of iron-deficiency anemia in hookworm disease is directly proportional to the number of worms present. An index of **less than 200** is considered low, while an index **greater than 250** indicates a significant public health problem where clinical anemia is likely prevalent in the community. * **Why other options are incorrect:** * **Ascariasis (B):** Diagnosis is typically made via stool microscopy for eggs or the passage of adult worms; there is no specific "index" named after Chandler for this. * **Dracunculiasis (C):** Diagnosis is clinical (visualizing the emerging Guinea worm). * **Filariasis (D):** Epidemiological assessment uses the **Microfilaria Rate**, **Density**, and the **Mosquito Infection/Infectivity Rate**, not the Chandler Index. **High-Yield Clinical Pearls for NEET-PG:** * **Hookworm species:** *Ancylostoma duodenale* (consumes ~0.15 ml blood/day) and *Necator americanus* (consumes ~0.03 ml blood/day). * **Stoll’s Egg Counting Technique:** Another method used to estimate worm load. * **Key Association:** Ground itch (at entry site) and Loeffler’s syndrome (during pulmonary migration).

Question 253: Under the National Polio Eradication Programme, a case of Acute Flaccid Paralysis is confirmed as Polio under which of the following circumstances, except?

A. If a case is lost to follow-up
B. If a case could not be confirmed because the patient died before confirmation
C. If a wild strain of poliovirus is isolated from stool
D. If a patient develops paralysis 30 days after diagnosis of AFP (Correct Answer)

Explanation: ### Explanation The National Polio Eradication Programme (NPEP) uses a specific surveillance protocol for **Acute Flaccid Paralysis (AFP)**. Under the "Virological Classification" system, a case is confirmed as Polio if it meets specific criteria related to virus isolation or clinical outcomes in the absence of adequate samples. **Why Option D is the Correct Answer (The Exception):** The definition of AFP itself is the **sudden onset** of weakness/paralysis. Paralysis is the *presenting* feature of the diagnosis, not a complication that occurs 30 days later. For a case to be confirmed as polio based on clinical grounds (when stool samples are inadequate), the patient must have **residual weakness/paralysis at 60 days** follow-up. Developing paralysis 30 days *after* an AFP diagnosis is clinically inconsistent with the disease progression of poliomyelitis. **Analysis of Incorrect Options:** * **Option A & B:** These are classified as **"Probable"** or **"Clinically Confirmed"** cases. If a case has inadequate stool samples and the patient either dies, is lost to follow-up, or has residual weakness at 60 days, it is classified as Polio by the Expert Review Committee to ensure no potential case is missed. * **Option C:** This is the **Gold Standard** for confirmation. Isolation of Wild Poliovirus (WPV) from stool samples (ideally two samples collected 24 hours apart within 14 days of onset) confirms the case regardless of clinical outcome. ### High-Yield Pearls for NEET-PG: * **AFP Surveillance Age Group:** All children <15 years of age (and any person of any age if Polio is suspected). * **Adequate Stool Samples:** 2 samples, 24 hours apart, within 14 days of onset of paralysis. * **Zero Reporting:** Mandatory weekly reporting even if no AFP case is found. * **Non-Polio AFP Rate:** A key indicator of surveillance quality; it should be **≥2 per 100,000** children under 15 years. * **India Status:** Declared Polio-free by the WHO on **March 27, 2014**.

Question 254: What is the standard treatment for P. Vivax malaria?

A. Chloroquine
B. Primaquine
C. Chloroquine plus Primaquine (Correct Answer)
D. None of the above

Explanation: The standard treatment for *Plasmodium vivax* malaria requires a dual approach to ensure both clinical cure and the prevention of relapse. **Explanation of the Correct Answer:** *Plasmodium vivax* (and *P. ovale*) has a unique life cycle stage called the **hypnozoite**, which remains dormant in the liver. 1. **Chloroquine** is a blood schizonticide that kills the erythrocytic stages of the parasite, thereby providing symptomatic relief and clearing the clinical infection. 2. **Primaquine** is a tissue schizonticide (anti-relapse drug) that targets the dormant hypnozoites in the liver. To achieve a **radical cure**, both drugs must be administered concurrently. **Why other options are incorrect:** * **Option A (Chloroquine alone):** While it treats the active blood infection, it cannot kill liver hypnozoites. Using Chloroquine alone leads to frequent relapses. * **Option B (Primaquine alone):** Primaquine is relatively weak against the erythrocytic (blood) stages. Using it alone would not provide rapid clinical improvement or clear the high parasite load in the blood. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage:** Under the National Vector Borne Disease Control Programme (NVBDCP) in India, the regimen for *P. vivax* is Chloroquine (25 mg/kg over 3 days) plus Primaquine (**0.25 mg/kg daily for 14 days**). * **G6PD Deficiency:** Before administering Primaquine, patients should ideally be screened for G6PD deficiency, as the drug can cause life-threatening **hemolysis**. * **Contraindication:** Primaquine is strictly **contraindicated in pregnancy** and in infants under 6 months of age. * **P. falciparum vs. P. vivax:** For *P. falciparum*, Primaquine is given as a single dose (0.75 mg/kg) on Day 2 as a gametocide to prevent transmission, not for radical cure.

Question 255: At what temperature should the measles vaccine be stored at a primary health care centre?

A. -20°C
B. 0°C
C. +2°C to 8°C (Correct Answer)
D. Any temperature not exceeding room temperature

Explanation: **Explanation:** The correct answer is **C (+2°C to 8°C)**. In the Universal Immunization Programme (UIP) in India, the storage temperature for vaccines at the peripheral level (Primary Health Centres and Community Health Centres) is standardized. While the measles vaccine is heat-sensitive and can be stored at sub-zero temperatures at higher levels of the cold chain (like GMSDs or State stores), it is stored in the **ILR (Ice-Lined Refrigerator)** at **+2°C to 8°C** at the PHC level to ensure operational uniformity and to prevent accidental freezing of other co-stored vaccines. **Analysis of Incorrect Options:** * **A (-20°C):** This is the storage temperature for the **OPV (Oral Polio Vaccine)** at the district level and for measles at the national/regional level. However, at the PHC level, deep freezers are primarily used for preparing ice packs, not for vaccine storage. * **B (0°C):** This is not a standard storage temperature for any vaccine in the cold chain. * **D (Room Temperature):** Measles is a live-attenuated vaccine and is highly heat-sensitive. Exposure to room temperature leads to rapid loss of potency. **High-Yield Clinical Pearls for NEET-PG:** * **Most Heat-Sensitive Vaccine:** OPV (followed by Measles). * **Most Heat-Resistant Vaccine:** TT (Tetanus Toxoid). * **Freeze-Sensitive Vaccines:** Hep B, DPT, Pentavalent, and TT. These must **never** be frozen (the "Shake Test" is used to check if they have been damaged by freezing). * **Reconstitution Rule:** Once reconstituted, the measles vaccine must be used within **4 hours** or discarded. It must be kept on an ice pad during the session. * **VVM (Vaccine Vial Monitor):** Always check the VVM before administration. If the inner square matches or is darker than the outer circle, the vaccine must be discarded.

Question 256: Which of the following statements is FALSE regarding coronary heart disease?

A. Heavy cigarette smoking is a risk factor.
B. Coronary heart disease in India typically occurs one decade later than in Western populations. (Correct Answer)
C. Males are affected more frequently than females.
D. None of the above statements are false.

Explanation: **Explanation:** The correct answer is **B** because it is a false statement. In reality, Coronary Heart Disease (CHD) in the Indian population occurs **one decade earlier** than in Western populations. Indians exhibit a unique "South Asian phenotype," characterized by a genetic predisposition to premature atherosclerosis, higher truncal obesity, and metabolic syndrome, leading to a significantly younger age of onset. **Analysis of Options:** * **Option A (True):** Heavy cigarette smoking is a major modifiable risk factor. It accelerates atherosclerosis, causes endothelial dysfunction, and increases platelet aggregation. * **Option B (False):** As noted, CHD in India is characterized by **premature onset**. While the peak incidence in the West is often in the 5th or 6th decade, in India, it is frequently seen in the 4th decade. * **Option C (True):** Males are generally affected more frequently and at an earlier age than females. Estrogen provides a protective effect in pre-menopausal women, though this risk gap narrows significantly after menopause. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Halves:** In hypertension/CHD, only half the cases are diagnosed, half of those are treated, and half of those treated are controlled. * **Risk Factors:** The "Big Four" modifiable risk factors are Smoking, Hypertension, Hypercholesterolemia, and Diabetes. * **Lipid Profile:** Indians often have a specific dyslipidemia pattern: **Low HDL** and **High Triglycerides**, even with normal total cholesterol levels. * **Metabolic Syndrome:** Also known as "Syndrome X," it is a potent predictor of CHD in the Indian context.

Question 257: All of the following dietary goals are recommended for patients at high risk of coronary heart disease, EXCEPT:

A. LDL cholesterol <100 mg/dL
B. Saturated fat < 7% of total calories
C. Salt restriction < 6 gm/day
D. Avoid alcohol (Correct Answer)

Explanation: **Explanation:** The dietary management of Coronary Heart Disease (CHD) focuses on controlling dyslipidemia and hypertension. The correct answer is **D (Avoid alcohol)** because current clinical guidelines (such as the AHA/ACC and NCEP-ATP III) do not mandate absolute abstinence for CHD prevention. Instead, they recommend **moderation** (up to 1 drink/day for women and 2 for men). While excessive alcohol increases triglycerides and blood pressure, moderate consumption is not strictly contraindicated in primary or secondary prevention. **Analysis of Options:** * **LDL Cholesterol <100 mg/dL:** This is a primary target for high-risk individuals. For patients with established CHD or "CHD equivalents" (like Diabetes), the goal is often even more stringent (<70 mg/dL), but <100 mg/dL remains a standard benchmark for high-risk groups. * **Saturated fat <7% of total calories:** According to the **Therapeutic Lifestyle Changes (TLC) diet**, saturated fats must be restricted to less than 7% to effectively lower LDL levels. * **Salt restriction <6 gm/day:** The WHO and national guidelines recommend limiting salt to <5–6 grams/day (approx. 2.4g Sodium) to prevent hypertension, a major risk factor for CHD. **High-Yield Clinical Pearls for NEET-PG:** * **Dietary Fiber:** High-risk patients should consume **20–30 g/day** of total dietary fiber (specifically 10–25g of soluble fiber). * **Total Fat:** Should be limited to **25–35%** of total daily calories. * **Physical Activity:** At least **30 minutes** of moderate-intensity exercise most days of the week is recommended. * **Rule of Thumb:** In CHD prevention, "Restriction" is the keyword for salt and fats, while "Moderation" is the keyword for alcohol.

Question 258: Which one of the following is the most sensitive and specific screening test to detect breast cancer?

A. Regular X-ray
B. Self breast examination
C. Mammography (Correct Answer)
D. Regular biopsy

Explanation: ### Explanation **Correct Answer: C. Mammography** **Why Mammography is the Correct Choice:** Mammography is currently the "Gold Standard" for breast cancer screening. It is highly sensitive (77–95%) and specific (90–95%), capable of detecting non-palpable tumors and microcalcifications (the earliest sign of malignancy) up to two years before they can be felt clinically. In the context of public health and screening programs, it is the only method proven to reduce breast cancer mortality by approximately 20–30% in women over 50. **Analysis of Incorrect Options:** * **A. Regular X-ray:** Standard chest or skeletal X-rays lack the soft-tissue resolution required to differentiate between normal glandular tissue and malignant masses. Mammography is a specialized low-dose X-ray technique designed specifically for breast tissue. * **B. Self Breast Examination (SBE):** While SBE increases "breast awareness," it has low sensitivity and high false-positive rates. Large-scale trials have shown that SBE does not reduce mortality and often leads to unnecessary biopsies of benign lesions. * **D. Regular Biopsy:** A biopsy is a **diagnostic** tool, not a screening test. It is invasive, expensive, and impractical for asymptomatic populations. Screening is applied to healthy individuals to identify those at risk, whereas biopsy confirms the disease. **NEET-PG High-Yield Pearls:** * **Screening Age:** The WHO recommends mammography screening every 1–2 years for women aged 50–69 in settings with good health infrastructure. * **Triple Assessment:** The standard diagnostic protocol for a breast lump includes: 1. Clinical Examination, 2. Imaging (Mammography/Ultrasound), and 3. Pathology (FNAC/Core Biopsy). * **MRI Breast:** More sensitive than mammography but less specific; it is reserved for high-risk screening (e.g., BRCA1/2 carriers). * **BI-RADS:** The standardized reporting system used for mammography results.

Question 259: What is true about the Oral Polio Vaccine?

A. Causes poliomyelitis in recipients (Correct Answer)
B. Causes poliomyelitis in contacts of non-recipients
C. Causes Guillain-barre syndrome
D. Causes vomiting and fever

Explanation: ### Explanation The correct answer is **A: Causes poliomyelitis in recipients.** **1. Why Option A is Correct:** The Oral Polio Vaccine (OPV) contains **live-attenuated** Sabin strains of the poliovirus. While these strains are weakened, they can rarely undergo genetic mutation or reversion to neurovirulence during replication in the human gut. This results in **Vaccine-Associated Paralytic Poliomyelitis (VAPP)**. VAPP can occur in the vaccine recipient (typically after the first dose) or in their close susceptible contacts. Therefore, the statement that it causes poliomyelitis in recipients is a recognized, albeit rare, medical fact. **2. Analysis of Incorrect Options:** * **Option B:** While OPV can cause paralysis in contacts (Contact VAPP), the option specifies "contacts of **non-recipients**," which is logically incorrect. It causes paralysis in contacts of *recipients* who are shedding the virus. * **Option C:** Guillain-Barré Syndrome (GBS) is more classically associated with the **Influenza vaccine** or infections like *Campylobacter jejuni*. It is not a standard complication of OPV. * **Option D:** While minor systemic symptoms can occur with any vaccine, vomiting and fever are non-specific and are not the defining clinical concern or "true" characteristic associated with OPV in a competitive exam context. **3. NEET-PG High-Yield Pearls:** * **VAPP vs. VDPV:** VAPP is a rare adverse event (1 in 2.7 million doses). **VDPV (Vaccine-Derived Poliovirus)** occurs when the excreted vaccine virus circulates in an under-immunized community for over 6 months, regaining strength to cause outbreaks. * **Storage:** OPV is the most **heat-sensitive** vaccine. It must be stored at **-20°C** (deep freeze) for long-term storage and uses the **Vaccine Vial Monitor (VVM)** to check potency. * **Switch:** India has switched from tOPV (Trivalent) to **bOPV (Bivalent)**, removing the Type 2 strain, which was responsible for most VDPV cases. * **Current Strategy:** To mitigate the risk of VAPP, India now uses a combination of **bOPV and fIPV** (fractional Inactivated Polio Vaccine).

Question 260: Which Indian state has the least neonatal mortality rate?

A. Delhi
B. Tamil Nadu (Correct Answer)
C. Karnataka
D. Maharashtra

Explanation: **Explanation:** The **Neonatal Mortality Rate (NMR)** is defined as the number of deaths of infants under 28 days of age per 1,000 live births. It is a key indicator of the quality of antenatal, intrapartum, and postnatal care. **Why Tamil Nadu is Correct:** Among the given options, **Tamil Nadu** consistently performs as a leader in healthcare indices in India. According to the Sample Registration System (SRS) and NFHS-5 data, Tamil Nadu has successfully reduced its NMR (approx. 10-12 per 1,000 live births) through robust public health infrastructure, high rates of institutional deliveries (nearly 100%), and the effective implementation of the "Sick Newborn Care Units" (SNCU) model. **Analysis of Incorrect Options:** * **Delhi:** While it has advanced tertiary care centers, the NMR remains higher than Tamil Nadu due to a large migratory population and disparities in primary healthcare access in urban slums. * **Maharashtra & Karnataka:** Both states have made significant progress in maternal and child health; however, their NMR figures (ranging between 14-18) remain statistically higher than Tamil Nadu's due to regional disparities in tribal and rural belts. **High-Yield NEET-PG Pearls:** * **Lowest NMR in India:** **Kerala** holds the absolute lowest NMR (approx. 4-5 per 1,000 live births). Since Kerala is not in the options, Tamil Nadu is the best choice. * **Highest NMR in India:** Madhya Pradesh or Uttar Pradesh (per SRS data). * **Target:** The Sustainable Development Goal (SDG) 3.2 aims to reduce NMR to at least **12 per 1,000 live births** by 2030. * **Most Common Cause of Neonatal Mortality:** Preterm birth/Low Birth Weight (LBW), followed by Birth Asphyxia and Neonatal Sepsis.

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