Non-Communicable Diseases Practice Questions

Q: Duration of immunity after typhoid vaccination is for?

3 years. **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.

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

Amoxicillin plus probenecid. ### 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.

Q: Meningococcal vaccines should be stored at what temperature range?

2-8 °C. ### 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).

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

Regular surveillance. **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.

Q: Bivalent oral polio vaccine contains which strains of poliovirus?

1 and 3. **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).

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

Age. **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 1

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?

Accepted Answer

Single site, 2 doses on day 0 and 3

Answer

No anti-rabies vaccine required

Answer

Single site, 4 doses on day 0, 3, 7, and 28

Answer

Rabies immunoglobulin and 4 doses of vaccine

Question 2

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

Accepted Answer

Colon cancer

Answer

Prostate Cancer

Answer

Lung cancer

Answer

Ovarian cancer

Question 3

Duration of immunity after typhoid vaccination is for?

Accepted Answer

3 years

Answer

5 years

Answer

7 years

Answer

6 months

Question 4

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

Accepted Answer

Amoxicillin plus probenecid

Answer

Ciprofloxacin plus azithromycin

Answer

Cotrimoxazole

Answer

None of the above

Question 5

Meningococcal vaccines should be stored at what temperature range?

Accepted Answer

2-8 °C

Answer

-4 °C

Answer

0 °C

Answer

-20 °C

Question 6

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

Accepted Answer

Regular surveillance

Answer

Sentinel surveillance

Answer

Periodic surveys

Answer

All the above

Question 7

Bivalent oral polio vaccine contains which strains of poliovirus?

Accepted Answer

1 and 3

Answer

1, 8c, 2

Answer

2 and 3

Answer

3 and 4

Question 8

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

Accepted Answer

Age

Answer

Obesity

Answer

Salt intake

Answer

Environmental stress

Question 9

Which of the following is true about meningococcal meningitis?

Accepted Answer

Treatment in the first 2 days can save the lives of 95% of cases.

Answer

Case fatality rate is less than 10% in untreated cases.

Answer

Cases are the main source of infection.

Answer

Rifampicin is the drug of choice for treatment.

Question 10

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?

Accepted Answer

Normal saline nose drops

Answer

Oral antihistamines

Answer

Oral antibiotics

Answer

Parenteral antibiotics

Non-Communicable Diseases — MCQs

Non-Communicable Diseases — MCQs

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