Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 261: A 5-year-old boy presents with a bleeding wound from a bite by his pet dog, which was fully vaccinated. He previously completed anti-rabies immunization in December 2018. What post-exposure prophylaxis against rabies is recommended for this patient?

A. No anti-rabies vaccine required
B. Single site, 2 doses on day 0 and 3 (Correct Answer)
C. Single site, 4 doses on day 0, 3, 7, and 28
D. Rabies immunoglobulin and 4 doses of vaccine

Explanation: **Explanation:** The core concept here is **Re-exposure Prophylaxis** in a previously immunized individual. According to the latest WHO and National Guidelines (NRCP), if a person has documented evidence of a complete pre-exposure or post-exposure prophylaxis (PEP) course in the past, they require a simplified regimen upon re-exposure, regardless of the time elapsed since the last vaccination or the category of the bite. **Why Option B is Correct:** For re-exposure, the recommended regimen is **two doses** of the cell culture vaccine (CCV) administered intramuscularly (or intradermally) on **Day 0 and Day 3**. This "booster" effect is sufficient to trigger a rapid anamnestic immune response. Notably, Rabies Immunoglobulin (RIG) is **never** required for a previously immunized individual, even for Category III bites. **Analysis of Incorrect Options:** * **Option A:** Incorrect because even if the dog is vaccinated, any bite from a potential vector in an endemic area like India requires PEP. Immunity from previous vaccination wanes over time, necessitating booster doses. * **Option C:** This is the standard 4-dose Essen regimen (IM) for **unvaccinated** individuals. It is unnecessary for someone already primed. * **Option D:** RIG is contraindicated in previously vaccinated individuals as it can interfere with the rapid anamnestic response of the memory cells. **High-Yield NEET-PG Pearls:** * **Definition of "Previously Vaccinated":** Someone who has received a full course of PEP (ID or IM) or PrEP. * **Wound Management:** Immediate flushing with soap and water for 15 minutes remains the most critical first step for all categories. * **Vaccination Site:** In children, the anterolateral thigh is preferred; in adults, the deltoid. **Never** use the gluteal region (variable fat distribution affects absorption). * **Observation Period:** The 10-day observation of the dog is done concurrently with starting PEP; do not delay treatment.

Question 262: Overall survival is increased by screening in which of the following cancers?

A. Prostate Cancer
B. Lung cancer
C. Colon cancer (Correct Answer)
D. Ovarian cancer

Explanation: ### Explanation The primary goal of cancer screening is to reduce **disease-specific mortality** and, ideally, improve **overall survival**. **Why Colon Cancer is the Correct Answer:** Colon cancer screening (via colonoscopy, fecal occult blood testing, or sigmoidoscopy) is highly effective because it identifies **pre-cancerous lesions (adenomatous polyps)**. By removing these polyps before they undergo malignant transformation, screening not only detects cancer early but actually **prevents** its occurrence. Large-scale randomized trials have demonstrated that regular screening significantly reduces both colorectal cancer-specific mortality and overall mortality. **Analysis of Incorrect Options:** * **Prostate Cancer:** While PSA (Prostate-Specific Antigen) testing increases the detection of early-stage cancer, it leads to significant **overdiagnosis**. Most prostate cancers are slow-growing; screening has not consistently shown a significant improvement in overall survival and often leads to unnecessary treatment morbidity. * **Lung Cancer:** Low-dose CT (LDCT) scans reduce lung cancer-specific mortality in high-risk smokers, but its impact on **overall survival** in the general population is limited due to high false-positive rates and procedural complications. * **Ovarian Cancer:** Currently, there is no effective screening tool (including CA-125 and Transvaginal Ultrasound) that has been proven to reduce mortality. Most cases are diagnosed at an advanced stage (Stage III/IV) despite screening efforts. **High-Yield Clinical Pearls for NEET-PG:** * **Lead-time bias:** The false appearance of increased survival time due to earlier diagnosis, even if the course of the disease is unchanged. * **Length-time bias:** Screening tends to detect slow-growing, less aggressive tumors with a better prognosis. * **Wilson and Jungner Criteria:** The gold standard criteria used to decide if a disease should be screened. * **Other cancers with proven mortality benefits from screening:** Cervical cancer (Pap smear/HPV DNA) and Breast cancer (Mammography in women >50 years).

Question 263: Duration of immunity after typhoid vaccination is for?

A. 3 years (Correct Answer)
B. 5 years
C. 7 years
D. 6 months

Explanation: **Explanation:** The duration of immunity for typhoid vaccines depends on the type of vaccine administered. For the most commonly used vaccines in public health programs—the **Vi polysaccharide vaccine** (injectable) and the **Ty21a vaccine** (oral)—the protective efficacy lasts for approximately **3 years**. 1. **Why 3 years is correct:** * **Vi Polysaccharide Vaccine:** Administered as a single subcutaneous or intramuscular dose. It provides about 70% protection, which wanes significantly after 3 years, necessitating a booster dose every 3 years. * **Ty21a (Live Attenuated) Vaccine:** Administered orally (3-4 doses). It provides comparable protection for 3 years, though some studies suggest slightly longer persistence in endemic areas due to natural boosting. 2. **Why other options are incorrect:** * **5-7 years:** While newer **Typhoid Conjugate Vaccines (TCV)**, like the PedaTyph or Typbar-TCV, show promise for longer-lasting immunity (potentially up to 5 years or more) and are recommended for infants, the standard benchmark for traditional vaccines remains 3 years. * **6 months:** This is too short for typhoid vaccines. This duration is more characteristic of the older, now-obsolete parenteral whole-cell killed vaccines which had high reactogenicity and short-lived protection. **High-Yield NEET-PG Pearls:** * **Typhoid Conjugate Vaccine (TCV):** The only typhoid vaccine licensed for children as young as **6 months** of age. It provides superior immunogenicity. * **Vi Vaccine Age:** Cannot be given to children **<2 years** (poor T-cell independent response). * **Ty21a Age:** Not recommended for children **<6 years**. * **Control Measure:** The most effective method for long-term typhoid control remains the improvement of sanitation and water supply, not just vaccination.

Question 264: Which of the following drug regimens is true for Typhoid carriers?

A. Ciprofloxacin plus azithromycin
B. Cotrimoxazole
C. Amoxicillin plus probenecid (Correct Answer)
D. None of the above

Explanation: ### Explanation **Correct Answer: C. Amoxicillin plus probenecid** #### Why it is correct: Typhoid carriers are individuals who continue to excrete *Salmonella typhi* in their stools for more than one year after the initial infection. The primary site of carriage is the **gallbladder** (often associated with gallstones). * **Amoxicillin** is highly effective against *S. typhi* and achieves good concentrations in the bile. * **Probenecid** is added because it inhibits the renal tubular secretion of amoxicillin, thereby increasing and sustaining its plasma and biliary concentrations. * **Standard Regimen:** Amoxicillin (4–6 g/day) plus Probenecid (2 g/day) for **6 weeks**. If gallstones are present, cholecystectomy may be required alongside antibiotics to achieve a permanent cure. #### Why other options are incorrect: * **A. Ciprofloxacin plus azithromycin:** While Ciprofloxacin is a drug of choice for *acute* typhoid fever, it is not the standard textbook regimen for long-term carrier eradication in this specific combination. * **B. Cotrimoxazole:** Although previously used for typhoid, widespread resistance has limited its efficacy. It is no longer the primary recommendation for carrier states compared to high-dose amoxicillin. #### NEET-PG High-Yield Pearls: * **Definition of Carrier:** * *Temporary:* Excretion for 3 months to 1 year. * *Chronic:* Excretion for >1 year. * **Types of Carriers:** Fecal carriers (more common, gallbladder focus) and Urinary carriers (rare, associated with *Schistosoma haematobium*). * **Drug of Choice for Acute Typhoid:** Ceftriaxone (Injectable) or Azithromycin (Oral) due to increasing Fluoroquinolone resistance (NALD - Nalidixic Acid Resistant *S. typhi*). * **Public Health Significance:** The "Typhoid Mary" phenomenon highlights the role of carriers in food handling and disease transmission.

Question 265: Meningococcal vaccines should be stored at what temperature range?

A. -4 °C
B. 0 °C
C. 2-8 °C (Correct Answer)
D. -20 °C

Explanation: ### Explanation **Correct Answer: C. 2-8 °C** **Underlying Medical Concept:** Most vaccines used in the Universal Immunization Programme (UIP) and clinical practice are thermolabile and require a strict "Cold Chain" to maintain potency. Meningococcal vaccines (both polysaccharide and conjugate versions) are **heat-sensitive** but, more importantly, **freeze-sensitive**. They must be stored in the refrigerator compartment (2-8 °C) and never in the freezer. Freezing can cause the antigen to precipitate or damage the adjuvant, leading to a loss of immunogenicity and potential increase in local adverse reactions. **Analysis of Incorrect Options:** * **A (-4 °C) & D (-20 °C):** These temperatures are below freezing. Storing Meningococcal vaccines here would lead to irreversible damage. Sub-zero temperatures (specifically -20 °C) are reserved for highly heat-sensitive vaccines like **OPV** (Oral Polio Vaccine) and **Yellow Fever** vaccine. * **B (0 °C):** This is the freezing point of water. Maintaining a vaccine exactly at 0 °C carries a high risk of accidental freezing due to thermostat fluctuations, making it an unsafe storage target. **High-Yield Clinical Pearls for NEET-PG:** * **Freeze-Sensitive Vaccines:** Remember the mnemonic **"DPT-Hep-M"** (DPT, DT, TT, Hepatitis B, and Meningococcal/Hib). These must **never** be frozen. * **The Shake Test:** If you suspect a freeze-sensitive vaccine (like Meningococcal or DPT) has been frozen, perform the **Shake Test**. If the vaccine settles faster than a control vial, it has been damaged and must be discarded. * **Storage Level:** In an Ice-Lined Refrigerator (ILR), Meningococcal vaccines are stored in the **basket** (top/middle) to keep them away from the colder bottom surface. * **Most Heat Sensitive:** OPV. * **Least Heat Sensitive:** TT (Tetanus Toxoid).

Question 266: The Integrated Disease Surveillance Programme recommends which of the following for non-communicable diseases?

A. Sentinel surveillance
B. Periodic surveys
C. Regular surveillance (Correct Answer)
D. All the above

Explanation: **Explanation:** The **Integrated Disease Surveillance Programme (IDSP)**, launched in 2004, is a decentralized, state-based surveillance system in India. While the IDSP is primarily known for monitoring infectious disease outbreaks through S (Suspected), P (Presumptive), and L (Laboratory) forms, it also encompasses the surveillance of **Non-Communicable Diseases (NCDs)**. **Why "Regular Surveillance" is correct:** Under the IDSP framework, NCD surveillance is integrated into the routine reporting system. The program recommends **regular, continuous surveillance** of NCD risk factors (such as tobacco use, physical inactivity, and obesity) rather than just episodic data collection. This ensures a steady flow of data to monitor trends, identify high-risk populations, and evaluate the impact of public health interventions like the NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke). **Analysis of Incorrect Options:** * **Sentinel Surveillance:** This involves collecting data from a limited number of selected reporting sites (e.g., specific hospitals for HIV or Hepatitis). While useful for specific diseases, it is not the primary recommendation for the broad scope of NCDs under IDSP. * **Periodic Surveys:** While surveys like NFHS or STEPs are conducted periodically to gather NCD data, the IDSP's specific recommendation is to move toward a systematic, **regular** reporting mechanism to ensure data continuity. **High-Yield Pearls for NEET-PG:** * **IDSP Phases:** NCD surveillance was specifically emphasized in **Phase II** of the IDSP. * **Data Types:** IDSP collects three types of data: Syndromic (by ASHAs/ANMs), Probable (by Doctors), and Laboratory confirmed. * **NCD Risk Factors:** The IDSP focuses on the **WHO STEPwise approach** for monitoring NCD risk factors. * **Reporting Unit:** The District Surveillance Unit (DSU) is the critical hub for data compilation in IDSP.

Question 267: Bivalent oral polio vaccine contains which strains of poliovirus?

A. 1, 8c, 2
B. 2 and 3
C. 1 and 3 (Correct Answer)
D. 3 and 4

Explanation: **Explanation:** The correct answer is **C (1 and 3)**. The **Bivalent Oral Polio Vaccine (bOPV)** was introduced globally as part of the "Polio Endgame Strategy" following the eradication of Wild Poliovirus Type 2 (WPV2), which was last detected in 1999 and declared eradicated in 2015. 1. **Why Option C is correct:** bOPV contains live-attenuated Sabin strains of **Poliovirus Type 1 and Type 3**. Since Type 2 was eradicated, its inclusion in the oral vaccine was discontinued to prevent cases of Vaccine-Derived Poliovirus Type 2 (VDPV2) and Vaccine-Associated Paralytic Polio (VAPP). 2. **Why Options A, B, and D are incorrect:** * **Option A & B:** These include Type 2. The switch from Trivalent OPV (tOPV, containing 1, 2, and 3) to bOPV occurred in April 2016. Type 2 is now only covered via the **Inactivated Polio Vaccine (IPV)** to maintain immunity without the risk of shedding live virus. * **Option D:** There are only three known serotypes of poliovirus (1, 2, and 3); Type 4 does not exist. **High-Yield Clinical Pearls for NEET-PG:** * **The Switch:** India switched from tOPV to bOPV on **April 25, 2016**. * **WPV Status:** Type 2 (1999) and Type 3 (2012) have been eradicated globally. Only Type 1 remains endemic (primarily in Afghanistan and Pakistan). * **VAPP vs. VDPV:** VAPP is a rare adverse event in the vaccine recipient; VDPV occurs due to prolonged circulation of the vaccine virus in under-immunized communities. Type 2 was responsible for >90% of VDPV cases. * **Current Schedule (Universal Immunization Programme):** bOPV at 6, 10, and 14 weeks (plus booster at 16-24 months) and Fractional IPV (fIPV) at 6 and 14 weeks (intradermal).

Question 268: Which of the following is a non-modifiable risk factor for hypertension?

A. Obesity
B. Age (Correct Answer)
C. Salt intake
D. Environmental stress

Explanation: **Explanation:** Risk factors for Hypertension are broadly classified into two categories: **Modifiable** and **Non-modifiable**. **Why Age is the Correct Answer:** Age is a **non-modifiable risk factor** because it is an inherent biological process that cannot be altered by medical intervention or lifestyle changes. As age increases, the risk of hypertension rises due to structural changes in the blood vessels, primarily the stiffening of large arteries (arteriosclerosis) and a decrease in arterial compliance. In most populations, systolic blood pressure rises progressively with age. **Analysis of Incorrect Options:** * **A. Obesity:** This is a major **modifiable** risk factor. A high Body Mass Index (BMI) is directly correlated with increased blood pressure. Weight reduction through diet and exercise is a primary intervention in hypertension management. * **C. Salt Intake:** This is a **modifiable** dietary factor. High sodium intake leads to fluid retention and increased peripheral resistance. The WHO recommends less than 5g of salt per day to reduce cardiovascular risk. * **D. Environmental Stress:** This is a **modifiable** psychosocial factor. Chronic stress triggers the sympathetic nervous system and the Renin-Angiotensin-Aldosterone System (RAAS). Stress management techniques (yoga, meditation) can effectively lower blood pressure. **High-Yield Clinical Pearls for NEET-PG:** * **Non-modifiable factors:** Age, Genetic factors (Family history), Gender (higher in men until age 45; higher in women after age 65), and Ethnicity. * **Modifiable factors:** Obesity, Salt intake, Saturated fat intake, Alcohol consumption, Physical inactivity, and Stress. * **Rule of Halves:** A classic epidemiological concept in hypertension stating that half the people with HTN are diagnosed, half of those diagnosed are treated, and half of those treated are well-controlled. * **Most common cause of Secondary HTN:** Renal parenchymal disease.

Question 269: Which of the following is true about meningococcal meningitis?

A. Case fatality rate is less than 10% in untreated cases.
B. Cases are the main source of infection.
C. Rifampicin is the drug of choice for treatment.
D. Treatment in the first 2 days can save the lives of 95% of cases. (Correct Answer)

Explanation: **Explanation:** **Meningococcal Meningitis** is a life-threatening bacterial infection caused by *Neisseria meningitidis*. The key to survival is early diagnosis and immediate antibiotic intervention. **1. Why Option D is Correct:** Meningococcal meningitis has a very high mortality rate if left untreated. However, it is highly responsive to appropriate antibiotics. If treatment is initiated within the **first 24–48 hours** of symptom onset, the prognosis improves dramatically, saving approximately **95% of cases**. This highlights the importance of "early diagnosis and prompt treatment" in public health. **2. Why the Other Options are Incorrect:** * **Option A:** In untreated cases, the Case Fatality Rate (CFR) is extremely high, often reaching **50% or more**. With treatment, it typically drops to 5–10%. * **Option B:** In the epidemiology of meningococcal disease, **carriers** (asymptomatic individuals harboring the bacteria in their nasopharynx) are the main source of infection, not clinical cases. The carrier-to-case ratio is often very high during inter-epidemic periods. * **Option C:** **Ceftriaxone** (or intravenous Penicillin G) is the drug of choice for **treatment**. Rifampicin is primarily used for **chemoprophylaxis** of close contacts to eliminate the carrier state, not for treating an active clinical case. **High-Yield Clinical Pearls for NEET-PG:** * **Agent:** *Neisseria meningitidis* (Gram-negative diplococci). * **Most common serogroups:** A, B, C, W135, X, and Y. (Group A is often associated with epidemics in the "Meningitis Belt" of Africa). * **Chemoprophylaxis of choice:** Rifampicin (5-10 mg/kg in children, 600 mg in adults BID for 2 days). Alternatives include Ciprofloxacin (single dose) or Ceftriaxone. * **Vaccine:** Both polysaccharide and conjugate vaccines are available (Quadrivalent A, C, Y, W135).

Question 270: A 10-day-old neonate presents with sneezing. On examination, the respiratory rate is 40/minute and coarse sounds are heard on auscultation. There are no intercostal retractions. How should this neonate be treated?

A. Normal saline nose drops (Correct Answer)
B. Oral antihistamines
C. Oral antibiotics
D. Parenteral antibiotics

Explanation: ### Explanation This question tests the clinical application of the **IMNCI (Integrated Management of Neonatal and Childhood Illness)** guidelines regarding the assessment of respiratory distress in neonates. **1. Why Option A is Correct:** The neonate presents with sneezing and coarse sounds but has a **normal respiratory rate** (normal for a neonate is <60 breaths/min) and **no chest indrawing** (intercostal retractions). In the absence of fast breathing or danger signs, these symptoms indicate a **Common Cold** or simple upper respiratory tract congestion. In neonates, nasal passages are narrow; mucus or dried secretions can cause "coarse sounds" (referred noise) and sneezing. The management is supportive, focusing on clearing the airway using **Normal Saline (NS) nose drops** to liquefy secretions. **2. Why Other Options are Incorrect:** * **Option B (Oral antihistamines):** These are contraindicated in neonates and young infants due to the risk of over-sedation and lack of efficacy in this age group. * **Option C & D (Antibiotics):** The neonate does not meet the criteria for "Pneumonia" or "Very Severe Disease." Antibiotics are only indicated if there is fast breathing (RR ≥60), severe chest indrawing, or other danger signs (lethargy, convulsions, poor feeding). Overprescribing antibiotics for viral upper respiratory infections contributes to antimicrobial resistance. **3. High-Yield Clinical Pearls for NEET-PG:** * **IMNCI Cut-offs for Fast Breathing:** * <2 months: ≥ 60 breaths/min * 2–12 months: ≥ 50 breaths/min * 12 months–5 years: ≥ 40 breaths/min * **Referred Sounds:** Coarse sounds heard in the chest that disappear after clearing the nose are "transmitted" from the upper airway and do not indicate pneumonia. * **Danger Signs in Neonates:** Inability to feed, convulsions, tachypnea (≥60), severe chest indrawing, and axillary temperature >37.5°C or <35.5°C. Presence of any of these requires urgent referral and parenteral antibiotics.

Practice by Chapter

Epidemiology of NCDs

Practice Questions

Cardiovascular Disease Prevention

Practice Questions

Diabetes Control Program

Practice Questions

Cancer Screening and Control

Practice Questions

Chronic Respiratory Diseases

Practice Questions

Mental Health Program

Practice Questions

Blindness Control Program

Practice Questions

Accident and Injury Prevention

Practice Questions

NCD Risk Factor Surveillance

Practice Questions

National Program for Prevention and Control of Cancer, Diabetes, CVD, and Stroke

Practice Questions

Oral Health Program

Practice Questions

Geriatric Health Issues

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free