Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 21: What is true about kala-azar?

A. More common in females than males
B. Has been eliminated from India
C. Non-human reservoirs are present (Correct Answer)
D. Incubation period is 1-3 months

Explanation: **Explanation:** **Kala-azar (Visceral Leishmaniasis)** is a vector-borne disease caused by *Leishmania donovani* and transmitted by the sandfly (*Phlebotomus argentipes*). **Why Option C is Correct:** While Kala-azar in the Indian subcontinent was traditionally considered purely anthroponotic (human-to-human), recent evidence and studies have identified **non-human reservoirs**, specifically domestic animals like dogs, cattle, and goats, which can harbor the parasite. This zoonotic potential complicates elimination efforts as these reservoirs can maintain the transmission cycle. **Analysis of Incorrect Options:** * **Option A:** Kala-azar is actually **more common in males** than females. This is attributed to higher occupational exposure to sandfly habitats and potential biological susceptibility. * **Option B:** India has **not yet eliminated** Kala-azar. Although cases have declined significantly under the National Vector Borne Disease Control Programme (NVBDCP), the goal is to achieve "elimination as a public health problem" (defined as <1 case per 10,000 population at the block level). * **Option C:** The incubation period is highly variable, typically ranging from **1 to 4 months**, but it can be as short as 10 days or as long as several years. Option D is too restrictive. **High-Yield NEET-PG Pearls:** * **Drug of Choice:** Liposomal Amphotericin B (single dose of 10mg/kg is the current WHO recommendation for the Indian subcontinent). * **Diagnostic Gold Standard:** Bone marrow or splenic aspirate (demonstration of LD bodies/Amastigote stage). * **Screening Test:** rK39 antigen-based rapid diagnostic test. * **Post-Kala-azar Dermal Leishmaniasis (PKDL):** A sequel occurring in 5-10% of cases in India, acting as a major parasite reservoir during inter-epidemic periods.

Question 22: What is the chosen method for the measurement of obesity?

A. Skinfold thickness (Correct Answer)
B. Body electrolyte count
C. Height-weight-sex chart
D. Basal oxygen consumption

Explanation: **Explanation:** Obesity is defined as an abnormal or excessive accumulation of fat that poses a risk to health. The measurement of obesity focuses on quantifying body fat content rather than just total body weight. **Why Skinfold Thickness is Correct:** Skinfold thickness is the most widely used clinical method for estimating body fat percentage. It is based on the principle that approximately **50% of total body fat is located subcutaneously**. Measurements are typically taken using **Harpenden calipers** at specific sites (Triceps, Biceps, Subscapular, and Supra-iliac). The triceps skinfold is the most common site used to screen for obesity in population studies. **Analysis of Incorrect Options:** * **Body electrolyte count:** While obesity can influence total body water and electrolyte distribution, it is not a diagnostic or measurement tool for fat mass. * **Height-weight-sex charts:** These were historically used (e.g., Life Insurance Corporation charts) to determine "ideal" weight. However, they are now considered outdated because they do not distinguish between muscle mass and fat mass. * **Basal oxygen consumption:** This measures the Basal Metabolic Rate (BMR). While BMR is related to lean body mass, it is not a direct or practical measure of obesity. **High-Yield Clinical Pearls for NEET-PG:** * **Quetelet’s Index (BMI):** The most common epidemiological tool. Formula: $Weight (kg) / Height (m^2)$. * **Ponderal Index:** $Height (cm) / \sqrt[3]{Weight (kg)}$. * **Waist-Hip Ratio (WHR):** A measure of central (android) obesity. Risk increases if WHR > 0.9 in men or > 0.85 in women. * **Gold Standard:** Underwater weighing (Hydrostatiometry) or DEXA scans are the most accurate research methods, but skinfold thickness remains the "chosen" practical clinical method.

Question 23: Which one of the following is a rare complication of the use of hormonal contraceptives?

A. Contraceptive failure (Correct Answer)
B. Cardiovascular effects
C. Carcinogenesis
D. Metabolic effects

Explanation: **Explanation:** The correct answer is **A. Contraceptive failure**. **Why it is the correct answer:** Hormonal contraceptives, particularly Combined Oral Contraceptive Pills (COCPs), are among the most effective birth control methods available. When used correctly (perfect use), the failure rate is as low as **0.1 per 100 woman-years**. Even with typical use, the failure rate remains significantly lower than barrier methods. Therefore, in the context of pharmacological outcomes, a complete failure of the intended therapeutic effect (pregnancy prevention) is considered a **rare complication** compared to the physiological and systemic side effects that occur more frequently. **Analysis of Incorrect Options:** * **B. Cardiovascular effects:** These are well-documented and relatively common side effects. Estrogen increases the synthesis of clotting factors, leading to an increased risk of venous thromboembolism (VTE), hypertension, and myocardial infarction, especially in smokers over 35. * **C. Carcinogenesis:** While the overall risk is low, the association is significant. There is a slight increase in the risk of breast and cervical cancer. Conversely, they are highly protective against ovarian and endometrial cancers. * **D. Metabolic effects:** These occur frequently. Progestogens can decrease HDL and increase LDL levels, while estrogens can impair glucose tolerance and increase serum triglycerides. **NEET-PG High-Yield Pearls:** * **Pearl Index:** This is the standard measure for contraceptive failure (Number of failures × 1200 / Total months of exposure). * **Most common side effect of OCPs:** Breakthrough bleeding (spotting). * **Protective Effect:** OCPs reduce the risk of Ovarian and Endometrial cancer by approximately 50%. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of VTE/Stroke, active liver disease, and smokers >35 years old (>15 cigarettes/day).

Question 24: What is the recommended treatment for lepromatous leprosy?

A. Rifampicin and Dapsone
B. Rifampicin and Clofazimine
C. Rifampicin, Dapsone, and Clofazimine (Correct Answer)
D. Rifampicin, Ofloxacin, and Minocycline

Explanation: **Explanation:** The treatment of Leprosy is based on the World Health Organization (WHO) Multi-Drug Therapy (MDT) guidelines, which categorize patients into Paucibacillary (PB) and Multibacillary (MB) types. **Lepromatous Leprosy** is a form of Multibacillary disease characterized by a high bacterial load and poor cell-mediated immunity. **Why Option C is correct:** The standard WHO-MDT regimen for **Multibacillary (MB) Leprosy** consists of three drugs: **Rifampicin, Dapsone, and Clofazimine**. This triple therapy is essential to prevent the emergence of drug resistance and to ensure the killing of *Mycobacterium leprae*. The duration of treatment for MB leprosy is **12 months**. **Analysis of Incorrect Options:** * **Option A & B:** These are incomplete regimens. Rifampicin and Dapsone alone are used for **Paucibacillary (PB) Leprosy** (duration: 6 months). Clofazimine is specifically added in MB cases to provide additional bactericidal activity and to help prevent Type 2 Lepra reactions (ENL). * **Option D:** This combination (ROM) is used for **Single Lesion Paucibacillary (SLPB)** leprosy as a single-dose treatment, though it is no longer the primary recommendation in many national programs. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage (MB Leprosy):** Rifampicin (600mg once monthly, supervised), Clofazimine (300mg once monthly supervised + 50mg daily self-administered), and Dapsone (100mg daily self-administered). * **Side Effects:** Clofazimine causes **brownish-black skin discoloration** and ichthyosis. Dapsone can cause **hemolysis** (especially in G6PD deficiency) and "Dapsone Syndrome." * **Accompanied MDT:** WHO now recommends a uniform MDT (U-MDT) in some settings, but for exam purposes, stick to the 3-drug regimen for MB and 2-drug for PB. * **Definition of MB:** Presence of 6 or more skin lesions, or positive slit-skin smear at any site.

Question 25: Which of the following is NOT a true statement about filariasis?

A. The extrinsic incubation period is 10-14 days.
B. Man serves as the intermediate host. (Correct Answer)
C. Adult worms reside in the lymphatics of the host.
D. There is no multiplication of the parasite within the mosquito vector.

Explanation: ### Explanation In the life cycle of *Wuchereria bancrofti*, **Man is the Definitive Host**, not the intermediate host. By definition, a definitive host is one in which the parasite reaches maturity and undergoes sexual reproduction. In filariasis, adult male and female worms mate within the human lymphatic system to produce microfilariae. The **Mosquito (Culex/Aedes/Anopheles) serves as the Intermediate Host**, where the parasite undergoes essential developmental stages (L1 to L3 larvae) but does not reproduce sexually. **Analysis of Other Options:** * **Option A:** The **Extrinsic Incubation Period** (the time taken for microfilariae to develop into infective L3 larvae inside the mosquito) is typically **10–14 days**, depending on environmental temperature and humidity. * **Option C:** Adult worms primarily inhabit the **afferent lymphatic vessels** and lymph nodes, leading to the classic clinical manifestations of lymphatic filariasis like lymphedema and elephantiasis. * **Option D:** Filariasis follows a **Cyclo-developmental** pattern of transmission. This means the parasite undergoes essential developmental changes (stages) within the vector, but there is **no multiplication** (one microfilaria ingested becomes only one infective larva). **NEET-PG High-Yield Pearls:** * **Infective Stage for Man:** L3 (Third-stage) larvae. * **Diagnostic Stage:** Microfilariae (found in peripheral blood, usually with nocturnal periodicity). * **Drug of Choice:** Diethylcarbamazine (DEC) 6mg/kg for 12 days. * **Mass Drug Administration (MDA):** Uses a single annual dose of DEC + Albendazole (or IDA: Ivermectin + DEC + Albendazole in specific areas). * **Vector for *W. bancrofti* in India:** *Culex quinquefasciatus* (breeds in dirty/stagnant water).

Question 26: Risk of damage to the fetus by maternal rubella infection is maximum if the mother gets infected during which period of pregnancy?

A. 6-12 weeks (Correct Answer)
B. 20-24 weeks
C. 24-28 weeks
D. 32-36 weeks

Explanation: **Explanation:** The risk of congenital malformations following maternal rubella infection is inversely proportional to the gestational age at the time of infection. This is because the **first trimester** is the period of organogenesis, during which the developing fetus is most vulnerable to the virus. * **Why 6-12 weeks is correct:** During the first trimester (specifically the first 12 weeks), the virus can cross the placenta and cause chronic fetal infection, leading to cell death and inhibited cell division. If infection occurs before 11–12 weeks of pregnancy, the risk of **Congenital Rubella Syndrome (CRS)** is as high as 80–90%. The damage is most severe during this window, often resulting in the classic triad of cataracts, cardiac defects, and sensorineural deafness. * **Why B, C, and D are incorrect:** As the pregnancy progresses beyond the first trimester, the risk of major structural malformations decreases significantly. By **20 weeks** and beyond, the organs are fully formed. While infection in the late second or third trimester can still lead to fetal growth restriction or systemic illness, it rarely results in the multi-organ structural defects characteristic of CRS. **High-Yield Clinical Pearls for NEET-PG:** * **Gregg’s Triad:** Cataract (most common eye lesion), PDA (most common cardiac lesion), and Sensorineural deafness (most common overall manifestation). * **Expanded CRS:** Includes "Blueberry muffin" spots (extramedullary hematopoiesis), radiolucent bone lesions (celery stalking), and microcephaly. * **Vaccination:** Rubella vaccine (RA 27/3 strain) is a live-attenuated vaccine. It is contraindicated in pregnancy, and pregnancy should be avoided for **1 month** (formerly 3 months) after vaccination. * **Diagnosis:** Presence of **Rubella-specific IgM** in the newborn is diagnostic of CRS.

Question 27: Crude birth rate is the simplest measure of fertility because it includes:

A. Total population
B. Mid-year population (Correct Answer)
C. Live births only
D. Pre-term births

Explanation: ### Explanation **Crude Birth Rate (CBR)** is defined as the number of live births per 1,000 estimated mid-year population in a given year. It is considered the "simplest" measure of fertility because it requires only two pieces of data: the total number of live births and the total population. **Why Mid-year Population is Correct:** In demography, the population of an area changes daily due to births, deaths, and migration. To standardize the denominator for annual rates, the **Mid-year Population** (as of July 1st) is used. This represents the average number of people alive and "at risk" during that year. It is the standard denominator for all "Crude" rates in public health. **Analysis of Incorrect Options:** * **A. Total Population:** While CBR relates to the whole population, "Total Population" is vague. In statistics, the specific point-in-time estimate required is the mid-year value to account for fluctuations. * **C. Live births only:** This refers to the numerator, not the reason why it is a measure of the *population's* fertility. * **D. Pre-term births:** These are included in the numerator (as long as they are live births), but they do not define the "crude" nature of the rate. **High-Yield NEET-PG Pearls:** * **Formula:** $CBR = \frac{\text{Number of live births during the year}}{\text{Mid-year population}} \times 1000$. * **Why "Crude"?:** It is called crude because it includes groups not at risk of childbearing (men, children, and the elderly) in the denominator. * **Refined Measures:** To improve accuracy, experts use the **General Fertility Rate (GFR)**, which uses the "Mid-year female population in the reproductive age group (15-44 or 49 years)" as the denominator. * **Vital Statistics:** In India, the Sample Registration System (SRS) is the primary source for CBR data.

Question 28: Which of the following is an example of a zoonotic disease?

A. Anthrax (Correct Answer)
B. Brucellosis
C. Leptospirosis
D. Chagas disease

Explanation: **Explanation:** **Anthrax** is the correct answer as it is a classic example of a **zoonotic disease**, specifically a "cyclo-zoonosis." It is caused by *Bacillus anthracis*, a spore-forming bacterium. It primarily affects herbivores (cattle, sheep, goats); humans are accidental hosts, usually infected through contact with contaminated animal products (hides, wool, meat) or soil containing spores. **Analysis of Options:** * **Anthrax (Correct):** Known as "Woolsorter’s disease," it is a quintessential zoonosis. The spores are highly resistant and can persist in the environment for decades. * **Brucellosis & Leptospirosis:** While these are also zoonotic diseases, in the context of standard NEET-PG MCQ patterns, if multiple zoonoses are listed, the question often seeks the "most representative" or "obligatory" zoonosis. However, technically, **Options A, B, and C are all zoonotic**. In such cases, Anthrax is often the preferred answer in traditional textbooks (like Park) when discussing occupational zoonoses. *Note: If this were a "Multiple Select" question, A, B, and C would all be correct.* * **Chagas Disease:** This is a parasitic disease caused by *Trypanosoma cruzi*. While it involves animal reservoirs, it is primarily classified as a **vector-borne disease** (transmitted by the Triatomine or "kissing" bug). **High-Yield NEET-PG Pearls:** 1. **Classification of Zoonoses:** * **Orthozoonoses:** Cycle maintained in one vertebrate (e.g., Rabies). * **Cyclozoonoses:** Requires more than one vertebrate host (e.g., Echinococcosis). * **Metazoonoses:** Requires an invertebrate vector (e.g., Plague). * **Saprozoonoses:** Requires a non-animal site like soil (e.g., Anthrax). 2. **Anthrax Clinical Forms:** Cutaneous (hide porter’s disease - most common), Pulmonary (Woolsorter’s disease), and Intestinal. 3. **Reverse Zoonosis (Anthropozoonosis):** Disease transmitted from humans to animals (e.g., Human Tuberculosis to cattle).

Question 29: Hypertension is associated with all of the following except:

A. Excess salt
B. Excess exercise (Correct Answer)
C. Phaeochromocytoma
D. Obesity

Explanation: **Explanation:** Hypertension is a multifactorial condition influenced by genetic, environmental, and lifestyle factors. **Why "Excess Exercise" is the correct answer:** Regular physical activity is a **protective factor**, not a risk factor, for hypertension. Exercise improves cardiovascular efficiency, reduces peripheral vascular resistance, and helps maintain a healthy weight. While acute, strenuous exertion causes a transient rise in systolic blood pressure, chronic "excess" exercise (as seen in athletes) typically leads to lower resting blood pressure and bradycardia. Therefore, it is not associated with the development of clinical hypertension. **Analysis of Incorrect Options:** * **Excess Salt:** High dietary sodium intake (typically >5g/day) leads to water retention and increased peripheral resistance, making it a primary modifiable risk factor for hypertension. * **Phaeochromocytoma:** This is a classic cause of **secondary hypertension**. This catecholamine-secreting tumor of the adrenal medulla causes paroxysmal or sustained hypertension due to excessive release of epinephrine and norepinephrine. * **Obesity:** There is a linear relationship between Body Mass Index (BMI) and blood pressure. Adiposity leads to increased sympathetic activity and activation of the Renin-Angiotensin-Aldosterone System (RAAS). **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Halves:** In hypertension, half the people are unaware of the condition, half of those aware are not on treatment, and half of those treated do not have their BP controlled. * **Tracking Phenomenon:** Blood pressure levels tend to maintain their peer-group rank over time from childhood to adulthood. * **Salt Intake:** WHO recommends less than **5 grams of salt (2 grams of sodium)** per day for adults. * **Most common cause of Secondary Hypertension:** Renal parenchymal disease.

Question 30: Which of the following is NOT transmitted through the sexual route?

A. Hepatitis A
B. Hepatitis E (Correct Answer)
C. Hepatitis A & E
D. Hepatitis D

Explanation: **Explanation:** The transmission of Hepatitis viruses is a high-yield topic for NEET-PG. To answer this correctly, one must distinguish between **Enteric** (fecal-oral) and **Parenteral/Sexual** routes. **Why Hepatitis E is the correct answer:** Hepatitis E (HEV) is primarily transmitted via the **fecal-oral route**, most commonly through contaminated drinking water. While Hepatitis A is also enteric, current medical literature and epidemiological studies (including CDC and WHO guidelines) indicate that Hepatitis E has **no documented sexual transmission** route. In contrast, Hepatitis A can be transmitted sexually, particularly through oral-anal contact (common in MSM populations). **Analysis of Incorrect Options:** * **Option A (Hepatitis A):** While primarily fecal-oral, HAV is recognized as a sexually transmitted infection (STI) among men who have sex with men (MSM) due to direct or indirect oral-anal contact. * **Option C (Hepatitis A & E):** This is incorrect because, as established, Hepatitis A *can* be transmitted sexually, whereas Hepatitis E cannot. * **Option D (Hepatitis D):** Hepatitis D (Delta virus) requires the presence of Hepatitis B (HBsAg) to replicate. It shares the same transmission routes as HBV, which includes percutaneous, mucosal, and **sexual contact**. **High-Yield Clinical Pearls for NEET-PG:** * **Vowels (A & E):** Transmitted via the **Enteric** route (Fecal-oral). * **Consonants (B, C, D):** Transmitted via **Blood**/Body fluids (Parenteral/Sexual). * **Pregnancy Warning:** Hepatitis E is notorious for causing high mortality (up to 20%) in pregnant women due to fulminant hepatic failure. * **Chronic Status:** Hepatitis A and E generally cause acute infection only (except HEV in immunocompromised hosts), while B, C, and D can lead to chronic carrier states.

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