Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 271: Which of the following statements about leprosy is false?

A. It has been eliminated from India.
B. It can be transmitted through breast milk.
C. Lepromin test is not a diagnostic test.
D. MDT is contraindicated during pregnancy. (Correct Answer)

Explanation: **Explanation:** The correct answer is **D**, as the statement "MDT is contraindicated during pregnancy" is **false**. **1. Why Option D is the correct choice (The False Statement):** Multi-Drug Therapy (MDT), consisting of Rifampicin, Dapsone, and Clofazimine, is **completely safe and indicated** during pregnancy and breastfeeding. Leprosy often exacerbates during the puerperium due to shifts in cell-mediated immunity; therefore, stopping treatment poses a significant risk of relapse and permanent nerve damage to the mother. Standard doses are maintained, and no teratogenic effects have been documented for these drugs in the context of leprosy treatment. **2. Analysis of Other Options:** * **Option A:** India achieved the "Elimination" target (defined by WHO as a prevalence rate of **<1 case per 10,000 population**) at the national level in December 2005. Note: Elimination is a public health milestone, not to be confused with "Eradication" (zero cases globally). * **Option B:** *Mycobacterium leprae* has been detected in the breast milk of untreated lepromatous leprosy patients. However, breastfeeding is still encouraged as the benefits outweigh the risks, especially if the mother is on MDT. * **Option C:** The **Lepromin test** is used to assess the host's cell-mediated immune response and to **classify** the type of leprosy (Tuberculoid vs. Lepromatous) or determine prognosis. It is **not** used for diagnosis because it can be positive in healthy individuals. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for Lepra Reaction:** Steroids (Type 1) and Thalidomide (Type 2/ENL). *Note: Thalidomide is strictly contraindicated in pregnancy.* * **MDT Duration:** Paucibacillary (PB) = 6 months; Multibacillary (MB) = 12 months. * **Components of MDT:** Rifampicin (monthly supervised), Dapsone (daily), and Clofazimine (monthly supervised + daily). * **Side Effect:** Clofazimine causes brownish-black skin discoloration and ichthyosis.

Question 272: Which waist-to-hip ratio increases the risk of heart disease?

A. Greater than 0.80 in males
B. Greater than 0.80 in females
C. Greater than 0.85 in males
D. Greater than 0.85 in females (Correct Answer)

Explanation: **Explanation:** The **Waist-to-Hip Ratio (WHR)** is a critical anthropometric index used to measure **abdominal (central) obesity**. Central obesity is a significant risk factor for metabolic syndrome, Type 2 Diabetes, and cardiovascular diseases because visceral fat is more metabolically active and pro-inflammatory than subcutaneous fat. According to the **World Health Organization (WHO)** standards: * **For Females:** A WHR **> 0.85** indicates abdominal obesity and an increased risk of heart disease. * **For Males:** A WHR **> 0.90** indicates an increased risk. **Analysis of Options:** * **Option D (Correct):** In females, a ratio exceeding 0.85 signifies an "apple-shaped" body (android obesity), which correlates strongly with coronary artery disease. * **Option A & C (Incorrect):** For males, the cutoff for increased risk is **> 0.90**. A ratio of 0.80 or 0.85 in males is considered within the normal or low-risk range. * **Option B (Incorrect):** While 0.80 is the threshold for "good" health in women, the specific clinical "increased risk" threshold defined by WHO for cardiovascular complications starts above 0.85. **High-Yield Clinical Pearls for NEET-PG:** 1. **Waist Circumference Cut-offs (Asian Indians):** Due to higher visceral fat at lower BMIs, the cut-offs for Indians are lower: **> 90 cm for men** and **> 80 cm for women**. 2. **Gold Standard:** While WHR is excellent for risk prediction, **Waist Circumference** is often considered a simpler and more reliable standalone indicator of visceral fat. 3. **Metabolic Syndrome (NCEP ATP III):** One of the criteria is waist circumference > 102 cm (males) and > 88 cm (females). 4. **Quetelet Index:** Another name for BMI (Weight in kg / Height in $m^2$).

Question 273: All of the following statements regarding the Salk vaccine are true EXCEPT:

A. OPV cannot be given as a booster dose. (Correct Answer)
B. Injections during an epidemic can cause paralysis.
C. It induces circulating antibody but no local immunity.
D. It does not prevent multiplication of wild virus in the gut.

Explanation: **Explanation:** The **Salk vaccine (Inactivated Poliovirus Vaccine - IPV)** is a killed vaccine administered parenterally. The question asks for the "Except" statement, making Option A the correct answer because it is a **false** statement. **1. Why Option A is the correct answer (False statement):** OPV **can** be given as a booster dose even if the primary immunization was done with IPV. In fact, the current National Immunization Schedule (NIS) in India utilizes a sequential schedule or fractional IPV (fIPV) alongside OPV to provide both systemic and mucosal immunity. Using OPV as a booster helps provide intestinal immunity which IPV lacks. **2. Analysis of Incorrect Options (True statements regarding IPV):** * **Option B:** Injections (including IPV) during a polio epidemic can trigger **"Provocative Paralysis"** in a child already incubating the wild poliovirus. This is why routine intramuscular injections are often discouraged during active outbreaks. * **Option C:** Since IPV is an injectable killed vaccine, it induces high titers of **circulating IgG antibodies** (humoral immunity) but fails to induce significant **Secretory IgA** in the gut (local immunity). * **Option D:** Because IPV lacks local gut immunity, it **does not prevent the multiplication** of the wild virus in the intestinal tract. Consequently, an IPV-vaccinated individual can still shed the virus in feces and contribute to community transmission. **High-Yield NEET-PG Pearls:** * **Sabin (OPV):** Live attenuated; induces both systemic (IgG) and local (IgA) immunity; prevents subclinical infection; risk of VAPP/VDPV. * **Salk (IPV):** Killed; induces only systemic (IgG) immunity; safer (no risk of VAPP); does not stop community spread. * **Current Schedule:** India uses **fractional IPV (0.1 ml, intradermal)** at 6, 14 weeks, and 9 months of age.

Question 274: Chandler's endemic index is used in the diagnosis or assessment of which condition?

A. Dengue hemorrhagic fever
B. Malaria
C. Hookworm infestation (Correct Answer)
D. Cholera

Explanation: **Explanation:** **Chandler’s Index** is a specific epidemiological tool used to assess the **severity of Hookworm infestation** in a community. Unlike simple prevalence rates, this index measures the "worm burden" by calculating the **average number of eggs per gram (EPG) of stool** across a population sample. * **Why it is correct:** Hookworm pathogenicity is directly related to the number of worms present (intensity of infection) rather than just their presence. Chandler’s Index categorizes the public health significance: an index below 200-250 is considered low, while an index above 500 indicates a significant public health problem where clinical hookworm anemia is likely prevalent. **Analysis of Incorrect Options:** * **A. Dengue Hemorrhagic Fever:** Monitored using entomological indices like the House Index, Container Index, and Breteau Index (measuring *Aedes aegypti* density). * **B. Malaria:** Assessed using the Annual Parasite Incidence (API), Annual Blood Examination Rate (ABER), and Splenic Index. * **C. Cholera:** Monitored through surveillance of "Acute Diarrheal Diseases" and confirmed via stool culture (Gold Standard) or the presence of "Rice water stools." **High-Yield Clinical Pearls for NEET-PG:** * **Hookworm Species:** *Ancylostoma duodenale* (causes more blood loss, ~0.15ml/day) and *Necator americanus* (~0.03ml/day). * **Clinical Feature:** The hallmark is **Iron Deficiency Anemia** (Microcytic Hypochromic). * **Treatment of Choice:** Albendazole (400mg single dose). * **Public Health Strategy:** Periodic deworming (National Deworming Day) and improving sanitation to prevent skin penetration (Ground itch).

Question 275: Typhoid oral vaccine is given at which intervals?

A. 1, 3, 5 days (Correct Answer)
B. 1, 2, 3 days
C. 1, 2, 4 days
D. 1, 7, 14 days

Explanation: The oral typhoid vaccine (Ty21a) is a live-attenuated vaccine derived from the *Salmonella typhi* strain. Understanding its administration schedule is crucial for NEET-PG, as it differs significantly from injectable vaccines. ### **Explanation of the Correct Answer** **Option A (1, 3, 5 days)** is correct. The standard primary immunization schedule for the oral Ty21a vaccine consists of **three doses** taken on alternate days (Day 1, Day 3, and Day 5). This spacing is designed to allow the live-attenuated bacteria to colonize the gut and stimulate a robust mucosal immune response (IgA) in the Peyer's patches of the small intestine. In some non-endemic countries (like the US), a 4-dose schedule (Days 1, 3, 5, and 7) is used, but the 3-dose regimen is the standard taught in Indian preventive medicine. ### **Analysis of Incorrect Options** * **Options B and C (1, 2, 3/4 days):** Daily administration does not provide sufficient time for the intestinal mucosa to respond effectively to each subsequent dose of the live vaccine. * **Option D (1, 7, 14 days):** This interval is too long for the primary series of an oral live vaccine, which relies on a specific "priming" window in the gut-associated lymphoid tissue. ### **High-Yield Clinical Pearls for NEET-PG** * **Minimum Age:** Oral Ty21a is given only to children **>6 years** of age (Injectable Vi polysaccharide is given >2 years). * **Storage & Administration:** Capsules must be kept refrigerated and taken with **cold or lukewarm water** (never hot) on an empty stomach. * **Antibiotic Interference:** Since it is a live bacterial vaccine, it should not be taken within 72 hours of antibiotic consumption. * **Booster:** A booster dose is recommended every **3 years** for those living in or traveling to endemic areas. * **Efficacy:** It provides approximately 50-80% protection.

Question 276: Which of the following is not a zoonotic disease?

A. Typhoid (Correct Answer)
B. Brucellosis
C. Q fever
D. Plague

Explanation: **Explanation:** The correct answer is **Typhoid (A)**. A zoonotic disease is defined as an infection or infestation that is naturally transmissible from vertebrate animals to humans. **Why Typhoid is the correct answer:** Typhoid fever is caused by *Salmonella typhi*. It is an **anthroponotic** disease, meaning humans are the only natural reservoir and host. Transmission occurs via the feco-oral route through contaminated food or water, typically originating from a human case or a chronic carrier (e.g., "Typhoid Mary"). There is no animal involvement in its natural life cycle. **Analysis of incorrect options:** * **Brucellosis:** A classic zoonosis (also known as Malta Fever) transmitted to humans through contact with infected livestock (cattle, goats, sheep) or consumption of unpasteurized dairy products. * **Q Fever:** Caused by *Coxiella burnetii*, it is a zoonotic infection primarily associated with cattle, sheep, and goats. Humans usually get infected by inhaling contaminated dust or aerosols from animal birth products. * **Plague:** Caused by *Yersinia pestis*, it is a famous zoonosis maintained in a cycle involving wild rodents and transmitted to humans via the bite of an infected rat flea (*Xenopsylla cheopis*). **High-Yield NEET-PG Pearls:** * **Reverse Zoonosis:** When a disease is transmitted from humans to animals (e.g., Human tuberculosis to cattle). * **Cyclozoonosis:** Requires more than one vertebrate host to complete the life cycle (e.g., Echinococcosis, Taeniasis). * **Saprozoonosis:** Has a vertebrate host and a non-animal reservoir like soil or plants (e.g., Tetanus, Histoplasmosis). * **Key Anthroponoses:** Typhoid, Cholera, Amoebiasis, Measles, and Polio.

Question 277: What are the WHO criteria for the diagnosis of diabetes based on fasting venous blood sugar levels?

A. Fasting venous blood sugar 140 to 200 mg/100ml
B. Fasting venous blood sugar 120 to 180 mg/100ml (Correct Answer)
C. Fasting venous blood sugar 120 to 200 mg/100ml
D. Fasting venous blood sugar 140 to 180 mg/100ml

Explanation: **Explanation:** The diagnosis of Diabetes Mellitus is based on specific glycemic thresholds established by the WHO. According to the classic WHO criteria (often cited in standard Community Medicine textbooks like Park), the diagnostic cut-off for **Diabetes Mellitus** using **fasting venous plasma** is **≥126 mg/dL (7.0 mmol/L)**. However, when considering **fasting venous whole blood**, the threshold is **≥120 mg/dL**. For a diagnosis based on a glucose challenge (OGTT), the 2-hour post-load value must be **≥200 mg/dL** (venous plasma) or **≥180 mg/dL** (venous whole blood). Therefore, the range **120 to 180 mg/100ml** represents the critical diagnostic thresholds for fasting and post-prandial states respectively in venous blood samples. **Analysis of Options:** * **Option B (Correct):** Correctly reflects the WHO diagnostic thresholds for venous blood (Fasting ≥120 mg/dL; 2-hr PP ≥180 mg/dL). * **Options A, C, and D:** These values do not align with the standardized WHO criteria. 140 mg/dL was an older fasting threshold (pre-1997), and 200 mg/dL is the threshold for plasma, not venous blood, in the fasting state. **High-Yield Clinical Pearls for NEET-PG:** 1. **Impaired Glucose Tolerance (IGT):** Fasting <126 mg/dL AND 2-hr post-load glucose between 140–200 mg/dL (Plasma). 2. **Impaired Fasting Glucose (IFG):** Fasting plasma glucose 110–125 mg/dL (WHO) or 100–125 mg/dL (ADA). 3. **HbA1c:** A value of **≥6.5%** is diagnostic for Diabetes. 4. **Gold Standard:** The Oral Glucose Tolerance Test (OGTT) remains the definitive diagnostic test, though HbA1c is more convenient for screening.

Question 278: Which date is observed as World Anti-Tobacco day?

A. 31st May (Correct Answer)
B. 1st December
C. 7th April
D. 29th September

Explanation: **Explanation:** **World No Tobacco Day (WNTD)** is observed annually on **31st May**. This initiative was established by the World Health Organization (WHO) in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. In the context of Non-Communicable Diseases (NCDs), tobacco is a primary shared risk factor for cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. **Analysis of Options:** * **31st May (Correct):** Designated as World Anti-Tobacco Day. It focuses on advocating for policies to reduce tobacco consumption and highlighting the specific health risks associated with both active and passive smoking. * **1st December:** This is **World AIDS Day**, dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. * **7th April:** This is **World Health Day**, marking the anniversary of the founding of the WHO in 1948. Each year focuses on a specific contemporary health priority. * **29th September:** This is **World Heart Day**, aimed at informing people about cardiovascular diseases, which are the world’s leading cause of death. **High-Yield Clinical Pearls for NEET-PG:** * **MPOWER Strategy:** A package of six evidence-based measures introduced by WHO to help countries implement the Framework Convention on Tobacco Control (FCTC). * **Tobacco & Cancer:** Tobacco is the leading cause of preventable cancers worldwide, most notably bronchogenic carcinoma and oral cavity cancers. * **Cotinine:** The most reliable biomarker (metabolite of nicotine) used to assess tobacco exposure in clinical and epidemiological studies. * **National Tobacco Control Programme (NTCP):** Launched in India in 2007-08 to facilitate the implementation of the COTPA (Cigarettes and Other Tobacco Products Act), 2003.

Question 279: What is the microfilaria endemicity index?

A. % of persons showing microfilaria in blood among diseased individuals (Correct Answer)
B. % of persons showing microfilaria in blood
C. Number of microfilaria in the blood
D. Average number of persons with positive slides

Explanation: ### Explanation **1. Why Option A is Correct:** The **Microfilaria Endemicity Index** is a specific epidemiological metric used to assess the intensity of lymphatic filariasis in a population. It is defined as the **percentage of persons showing microfilaria (mf) in their peripheral blood among those who already exhibit clinical signs of the disease** (e.g., elephantiasis or hydrocele). This index helps clinicians understand the relationship between active parasitemia and established clinical morbidity in an endemic area. **2. Analysis of Incorrect Options:** * **Option B:** This describes the **Microfilaria Rate (mf rate)**, which is the percentage of the *general population* (not just the diseased) positive for microfilaria. It is the most common indicator used to measure the prevalence of infection. * **Option C:** This refers to **Microfilaria Density**, which measures the actual count of mf per unit volume of blood (usually 20 mm³), reflecting the intensity of infection in an individual. * **Option D:** This is a distractor. The **Average Infestation (Average mf density)** is the total number of mf counted divided by the number of positive slides. **3. NEET-PG High-Yield Pearls:** * **Best time for blood collection:** Between **10 PM and 2 AM** (Nocturnal periodicity) for *W. bancrofti* and *B. malayi*. * **Drug of Choice:** **Diethylcarbamazine (DEC)** 6 mg/kg for 12 days. Note: DEC is contraindicated in Onchocerciasis (causes Mazzotti reaction). * **Mass Drug Administration (MDA):** The current WHO strategy for elimination involves a single annual dose of **DEC + Albendazole** (or IDA: Ivermectin + DEC + Albendazole in specific areas). * **Filariasis Control:** The target is to bring the mf rate below **1%** to interrupt transmission.

Question 280: What is the protective effect period of measles vaccine when given to a contact of a measles case?

A. 1 day
B. 3 days
C. 7 days (Correct Answer)
D. 10 days

Explanation: **Explanation:** The correct answer is **7 days**. This concept is rooted in the **incubation period** of measles and the kinetics of the immune response following vaccination. **1. Why 7 days is correct:** Measles has an incubation period of approximately 10–14 days. When a susceptible individual is exposed to a measles case, the virus begins replicating. However, if the **Measles Vaccine** (live attenuated) is administered within **72 hours (3 days)** of exposure, it can prevent or modify the disease. Once administered, the vaccine-induced antibodies take time to develop. The "protective effect period" refers to the duration for which the vaccine provides active immunity that can "overtake" the natural infection process. In public health guidelines, the protective immunity from the vaccine is considered robust enough to offer protection for up to **7 days** post-exposure in a contact management scenario. **2. Why other options are incorrect:** * **1 day:** This is too short for the immune system to generate any meaningful response to the vaccine. * **3 days:** This is the **window of opportunity** (72 hours) within which the vaccine must be administered to be effective as post-exposure prophylaxis. It is not the duration of the protective effect itself. * **10 days:** This is the average time for the prodromal symptoms of natural measles to appear; by this time, the vaccine would be ineffective if the person was already infected. **High-Yield Clinical Pearls for NEET-PG:** * **Post-Exposure Prophylaxis (PEP):** * **Measles Vaccine:** Give within **3 days (72 hours)** of exposure. * **Immunoglobulin (IG):** Give within **6 days** of exposure (preferred for infants <6 months, pregnant women, and immunocompromised individuals). * **Secondary Attack Rate (SAR):** Measles has a very high SAR (>90%), making prompt PEP crucial. * **Isolation:** A measles patient is infectious from **4 days before to 4 days after** the appearance of the rash.

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Cancer Screening and Control

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Mental Health Program

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Blindness Control Program

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Accident and Injury Prevention

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NCD Risk Factor Surveillance

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

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Oral Health Program

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