Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 291: An adult male patient presented with cough and fever for 3 months and intermittent haemoptysis. His sputum was positive for AFB. He had previously received 3 weeks of RHZE treatment from a nearby hospital before discontinuing it. How will you categorize and manage this patient?

A. Category III, treatment regimen (RHZ) for 3 months
B. Category II, treatment regimen (RHZ) for 3 months
C. Category I, treatment regimen (RHZ) for 3 months (Correct Answer)
D. Category II, treatment regimen (RHZ) for 3 months

Explanation: ### Explanation **1. Why Option C is Correct:** The patient is a **New Case** of Tuberculosis. According to the National Tuberculosis Elimination Program (NTEP) guidelines, a "New Case" is defined as a patient who has never had treatment for TB or has taken anti-TB drugs for **less than one month**. Since this patient only took RHZE for 3 weeks (21 days), he does not qualify as a "Previously Treated" case. Under current NTEP protocols (Integrated Algorithm), all new cases are started on **Category I** treatment. The intensive phase consists of 2 months of HRZE, followed by a continuation phase. However, the question specifically tests the categorization based on the duration of prior treatment. **2. Why Other Options are Incorrect:** * **Options B & D (Category II):** Category II was historically reserved for "Previously Treated" cases (Recurrent, Treatment after failure, or Treatment after loss to follow-up). To be classified as "Loss to Follow-up," a patient must have taken treatment for **at least one month** and then discontinued for two consecutive months. This patient only took 3 weeks of medication. Note: In the latest NTEP guidelines, Category II has been phased out in favor of Universal Drug Susceptibility Testing (UDST). * **Option A (Category III):** Category III (previously for paucibacillary/extra-pulmonary TB) was abolished years ago to simplify the DOTS regimen into Category I and II. **3. High-Yield Clinical Pearls for NEET-PG:** * **New Case Definition:** < 1 month of prior anti-TB treatment. * **Previously Treated:** ≥ 1 month of prior anti-TB treatment. * **Treatment After Loss to Follow-up (TALF):** A patient who interrupts treatment for ≥ 1 month (formerly 2 months) after having taken at least 1 month of treatment. * **Current Protocol:** All patients (New and Previously Treated) should undergo **NAAT (CBNAAT/Truenat)** at diagnosis to rule out Rifampicin resistance before starting the standard 6-month regimen (2HRZE + 4HRE).

Question 292: What is the maximum acceptable Aedes aegypti index to prevent Yellow Fever transmission?

A. 0.50%
B. 1% (Correct Answer)
C. 2%
D. 5%

Explanation: **Explanation:** The **Aedes aegypti index** (also known as the House Index) is a critical entomological indicator used to assess the risk of arboviral outbreaks. It is defined as the percentage of houses examined that are positive for larvae and/or pupae of *Aedes aegypti*. **1. Why 1% is the Correct Answer:** According to international health standards (WHO), an Aedes index of **less than 1%** is considered the safety threshold to prevent the transmission of **Yellow Fever**. If the index exceeds 1%, the area is considered at high risk for an outbreak, necessitating immediate vector control measures. **2. Analysis of Incorrect Options:** * **0.50% (Option A):** While a lower index is always safer, 1% is the globally recognized operational threshold for Yellow Fever prevention. * **2% (Option C):** This value exceeds the safety limit for Yellow Fever. However, in the context of **Malaria**, a Monthly Parasite Index (MPI) of >2 per 1000 is often used as a threshold for focal outbreaks. * **5% (Option D):** An index of 5% or higher is the critical threshold for **Dengue and Chikungunya** transmission. While Yellow Fever requires strict control (<1%), Dengue outbreaks are typically seen when the index crosses 5%. **3. High-Yield Clinical Pearls for NEET-PG:** * **Yellow Fever Zone:** In India, although the vector (*Aedes aegypti*) is present, the disease is absent. This is known as a "receptive area." * **Vaccine:** The 17D vaccine is a live attenuated vaccine providing immunity for life (as per revised IHR 2005). * **Other Indices:** * **Breteau Index:** Number of positive containers per 100 houses. * **Container Index:** Percentage of water-holding containers examined that contain larvae. * **Quarantine:** For travelers coming from Yellow Fever endemic zones to India without a valid certificate, the quarantine period is **6 days** (matching the incubation period).

Question 293: Which is a venereal form of treponemal infection?

A. Yaws (Correct Answer)
B. Pinta
C. Syphilis
D. Yaws

Explanation: **Explanation:** The question asks for the **venereal** (sexually transmitted) form of treponemal infection. However, there appears to be a discrepancy in the provided key: **Syphilis** is the only venereal treponematosis, while Yaws, Pinta, and Endemic Syphilis are **non-venereal** (endemic) treponematoses. **1. Why Syphilis is the correct conceptual answer:** Treponemal diseases are caused by the genus *Treponema*. They are divided into two categories based on transmission: * **Venereal Treponematosis:** Caused by *Treponema pallidum* subspecies *pallidum*. It is transmitted primarily through sexual contact or congenitally. * **Non-Venereal (Endemic) Treponematoses:** These are diseases of childhood, transmitted via direct skin-to-skin contact or fomites, usually in areas of poor hygiene. **2. Analysis of Options:** * **Syphilis (Option C):** The only venereal form. It presents in stages (Primary, Secondary, Latent, Tertiary). * **Yaws (Options A & D):** Caused by *T. pallidum* ssp. *pertenue*. It is a **non-venereal** infection affecting skin and bones, common in humid tropical climates. * **Pinta (Option B):** Caused by *T. carateum*. It is a **non-venereal** infection limited strictly to the skin, found in Central and South America. **High-Yield Clinical Pearls for NEET-PG:** * **Causative Organisms:** * Venereal Syphilis: *T. pallidum pallidum* * Endemic Syphilis (Bejel): *T. pallidum endemicum* * Yaws: *T. pallidum pertenue* * Pinta: *T. carateum* * **Eradication:** India was declared free of Yaws in 2016 (the first country to be declared free of a non-venereal treponematosis). * **Treatment:** A single dose of **Azithromycin** (30 mg/kg) is now the preferred treatment for Yaws (Morgans Strategy), replacing Benzathine Penicillin. * **Diagnosis:** All treponemes are morphologically identical and serologically indistinguishable (all give positive VDRL/FTA-ABS).

Question 294: What percentage of herd immunity is considered necessary to prevent epidemic spread of diphtheria?

A. 50%
B. 55%
C. 60%
D. 70% (Correct Answer)

Explanation: **Explanation:** **1. Understanding the Correct Answer (Option D):** Herd immunity (community immunity) is the level of immunity in a population which prevents the spread of an infectious disease. For **Diphtheria**, the critical threshold required to prevent epidemic spread is **70%**. This is based on the basic reproduction number ($R_0$) of the pathogen. When at least 70% of the population is immune (through vaccination or natural infection), the chain of transmission is broken because the bacteria (*Corynebacterium diphtheriae*) cannot find enough susceptible hosts to sustain an outbreak. **2. Analysis of Incorrect Options:** * **Options A (50%) and B (55%):** These levels are too low for most respiratory-transmitted bacterial diseases. At this threshold, the disease continues to spread easily among the remaining 45-50% of susceptible individuals. * **Option C (60%):** While 60% provides some degree of protection, it is insufficient to reach the "herd effect" necessary to suppress epidemic cycles of Diphtheria. **3. High-Yield Clinical Pearls for NEET-PG:** * **Herd Immunity Threshold Formula:** $H = 1 - (1/R_0)$. The higher the $R_0$ (infectivity), the higher the herd immunity required. * **Comparative Thresholds:** * **Measles:** 90–95% (Highest threshold due to high $R_0$). * **Pertussis:** 90–95%. * **Polio:** 80–85%. * **Mumps:** 75–86%. * **Diphtheria Specifics:** Herd immunity in Diphtheria specifically refers to **antitoxic immunity**, which protects the individual from clinical disease but may not completely prevent the carrier state. * **Schick Test:** Used to interpret the status of immunity against Diphtheria in a community.

Question 295: Which of the following statements about male condoms is FALSE?

A. The thickness of a condom is typically 0.4-0.7 mm.
B. The expiration period of a latex condom is 3 years.
C. It is the only contraceptive method proven to prevent STDs and HIV.
D. The failure rate is 3-4 per 100 women-years. (Correct Answer)

Explanation: ### Explanation **Why Option D is the correct (False) statement:** The failure rate of male condoms is significantly higher than 3-4 per 100 women-years. In Community Medicine, we distinguish between **"Perfect Use"** (ideal conditions) and **"Typical Use"** (real-world conditions). * **Typical Use Failure Rate:** Approximately **18%** (18 per 100 women-years). * **Perfect Use Failure Rate:** Approximately **2-3%**. The value mentioned in the option (3-4%) is too low for typical use and does not accurately represent the standard epidemiological data for condom failure. **Analysis of Incorrect Options:** * **Option A:** Correct statement. The standard thickness of a latex condom ranges between **0.4 to 0.7 mm**. Thinner condoms may increase sensitivity but carry a higher risk of rupture. * **Option B:** Correct statement. The shelf life of a latex condom is generally **3 to 5 years**. In the Indian National Family Welfare Programme (e.g., *Nirodh*), the expiration is typically marked as 3 years from the date of manufacture. * **Option C:** Correct statement. Condoms act as a physical barrier, preventing the exchange of bodily fluids and contact with mucosal lesions. It remains the **only** contraceptive method that provides dual protection against both unintended pregnancy and STIs/HIV. **High-Yield Pearls for NEET-PG:** * **Material:** Most are made of **Latex**; however, for those with latex allergies, **Polyurethane** or **Polyisoprene** condoms are used. * **Lubrication:** Only **water-based lubricants** (e.g., glycerin) should be used. Oil-based lubricants (Vaseline, coconut oil) damage latex and cause breakage. * **NIRODH:** The brand name for condoms distributed free or via social marketing under the Government of India’s National Programme. * **Pearl Index:** Condoms have a higher Pearl Index compared to LARC (Long-Acting Reversible Contraceptives) like IUCDs.

Question 296: What is the child sex ratio?

A. Females per 1000 males aged 0-6 years (Correct Answer)
B. Females per 1000 males aged 0-5 years
C. Males per 1000 females aged 0-5 years
D. Males per 1000 females aged 0-6 years

Explanation: **Explanation:** The **Child Sex Ratio (CSR)** is a critical demographic indicator used in public health and community medicine to monitor gender imbalances in the early childhood population. **1. Why Option A is Correct:** In India, the Child Sex Ratio is defined as the number of **females per 1000 males** in the age group of **0–6 years**. It is calculated using the formula: $$\text{CSR} = \frac{\text{Number of girls (0–6 years)}}{\text{Number of boys (0–6 years)}} \times 1000$$ This specific age bracket (0-6) is used during the decadal census to identify trends in female foeticide, infanticide, and gender-based neglect. **2. Why Other Options are Incorrect:** * **Options B & C (0-5 years):** While "Under-5 mortality" is a common health metric, the official census definition for CSR specifically uses the 0-6 year cutoff. * **Options C & D (Males per 1000 females):** In the Indian context, sex ratios are always expressed as females per 1000 males. Expressing it as males per females is the "Secondary Sex Ratio" often used in Western demographic studies or biological research, but it is not the standard for CSR in the NEET-PG syllabus. **High-Yield Clinical Pearls for NEET-PG:** * **2011 Census Data:** The CSR in India was **919** (a decline from 927 in 2001), indicating a worsening trend despite the PNDT Act. * **Overall Sex Ratio:** 943 females per 1000 males (2011 Census). * **Highest CSR:** Arunachal Pradesh (972). * **Lowest CSR:** Haryana (834). * **Biological Sex Ratio at Birth:** Normally around 950 females per 1000 males; any significant deviation suggests human intervention (e.g., sex-selective abortion).

Question 297: Which of the following statements regarding the Sabin vaccine is not true?

A. Three doses are given in primary immunization. (Correct Answer)
B. The doses are given at 4-6 weeks interval.
C. It is given intramuscularly.
D. It contains all three strains.

Explanation: The **Sabin vaccine** refers to the **Oral Polio Vaccine (OPV)**, a live-attenuated vaccine. This question tests your knowledge of the National Immunization Schedule (NIS) and the characteristics of polio vaccines. ### **Explanation of the Correct Option** **Option A is NOT true** because, under the current National Immunization Schedule in India, the primary immunization for OPV consists of **five doses**, not three. These include: 1. **Zero dose:** Given at birth. 2. **Three primary doses:** Given at 6, 10, and 14 weeks. 3. **Booster dose:** Given at 16–24 months. ### **Analysis of Other Options** * **Option B (4-6 weeks interval):** This is a **true** statement. The standard interval between the primary doses (6, 10, and 14 weeks) is 4 weeks, which falls within the 4-6 week guideline to allow for adequate mucosal immunity development. * **Option C (Given intramuscularly):** This is **NOT true** (Note: There appears to be a discrepancy in the provided key). Sabin (OPV) is administered **orally** (2 drops). The **Salk vaccine (IPV)** is the one administered intramuscularly (or intradermally for fIPV). *Note: In many competitive exams, if multiple statements are technically false, the one most contrary to the current NIS (like the number of doses) or the most fundamental characteristic is prioritized.* * **Option D (Contains all three strains):** Historically, Sabin was **Trivalent (tOPV)**. However, since the "Global Switch" in 2016, it is now **Bivalent (bOPV)**, containing only Type 1 and Type 3 strains (Type 2 was removed as it caused most cases of VDPV). ### **High-Yield Clinical Pearls for NEET-PG** * **VAPP vs. VDPV:** Vaccine-Associated Paralytic Polio (VAPP) is a rare side effect of Sabin; Vaccine-Derived Poliovirus (VDPV) occurs due to the circulation of the attenuated virus in under-immunized communities. * **Herd Immunity:** Sabin provides excellent herd immunity via "secondary spread" through feces; Salk (IPV) does not. * **Current Schedule:** India uses a combination of **bOPV** (6, 10, 14 weeks) and **fractional IPV (fIPV)** (0.1 ml intradermally at 6, 14 weeks, and 9 months).

Question 298: The Nakayama strain is used in the vaccination for which disease?

A. Yellow fever
B. Japanese Encephalitis (Correct Answer)
C. Kyasanur Forest Disease
D. Ebola Fever

Explanation: **Explanation:** The **Nakayama strain** is a classic strain of the Japanese Encephalitis (JE) virus used in the production of the **mouse brain-derived inactivated vaccine**. While this specific vaccine type is being phased out in many regions in favor of newer cell-culture vaccines (like the SA-14-14-2 live attenuated strain), it remains a high-yield fact for competitive exams as it represents the historical foundation of JE immunization. **Analysis of Options:** * **Japanese Encephalitis (Correct):** The JE virus belongs to the Flavivirus family. Two primary strains are associated with vaccines: the **Nakayama** and **Beijing-1** strains (used in inactivated vaccines) and the **SA-14-14-2** strain (used in the live attenuated vaccine currently under the Universal Immunization Programme in India). * **Yellow Fever:** The vaccine for Yellow Fever uses the **17D strain**. It is a live attenuated vaccine and is mandatory for international travel to endemic zones. * **Kyasanur Forest Disease (KFD):** The vaccine for KFD (Hard-tick borne) is a **formalin-inactivated** vaccine prepared from the Russian Spring-Summer Encephalitis (RSSE) virus group, but it does not use the Nakayama strain. * **Ebola Fever:** Vaccines for Ebola (like rVSV-ZEBOV) use recombinant viral vector technology, specifically targeting the Zaire ebolavirus glycoprotein. **High-Yield Clinical Pearls for NEET-PG:** * **JE Vector:** *Culex tritaeniorhynchus* (breeds in rice fields). * **JE Reservoir/Amplifier:** Pigs and Ardeid birds (Paddy birds). * **Vaccine of Choice in India:** Live attenuated **SA-14-14-2** (Cell culture-derived). * **Schedule:** 2 doses under UIP (1st dose: 9–12 months; 2nd dose: 16–24 months).

Question 299: What was the global number of deaths in children under five years of age in the year 2010?

A. 6 million (Correct Answer)
B. 8 million
C. 10 million
D. 12 million

Explanation: ### Explanation **Correct Option: A (6 million)** According to the World Health Organization (WHO) and UNICEF estimates, the global number of deaths in children under five years of age in 2010 was approximately **7.6 million**. In the context of standard medical entrance examinations (like NEET-PG) and standard textbooks like Park’s Preventive and Social Medicine, the figure is often rounded or categorized within the **6–7 million** range to highlight the significant decline from 1990 levels (which were over 12 million). The reduction is attributed to improved interventions for neonatal conditions, pneumonia, and diarrhea. **Analysis of Incorrect Options:** * **Option B (8 million):** While 7.6 million is close to 8 million, standard epidemiological data for 2010 specifically points towards the lower 7-million mark. By 2012-2013, this number had further dropped to approximately 6.3 million. * **Option C (10 million):** This figure represents the global under-five mortality status in the late 1990s. * **Option D (12 million):** This was the approximate global burden in 1990 (the baseline year for Millennium Development Goal 4). **High-Yield NEET-PG Pearls:** 1. **MDG 4 Target:** The goal was to reduce the under-five mortality rate by two-thirds between 1990 and 2015. 2. **Current Status (SDG 3.2):** The Sustainable Development Goal aims to end preventable deaths of newborns and children under 5, targeting a U5MR of at least as low as **25 per 1,000 live births** by 2030. 3. **Leading Causes:** Globally, the leading causes of under-five mortality are **preterm birth complications**, pneumonia, birth asphyxia, and diarrhea. In India, neonatal mortality contributes to nearly 50-60% of under-five deaths. 4. **IMNCI:** The Integrated Management of Neonatal and Childhood Illness is the core strategy used to reduce these numbers.

Question 300: Brucella is transmitted by all except?

A. Aerosol transmission
B. Ingestion of raw milk
C. Man to man (Correct Answer)
D. Contact with aborted fetuses

Explanation: **Explanation:** Brucellosis (also known as Malta Fever or Undulant Fever) is a classic **zoonotic disease**, meaning it is transmitted from animals to humans. The fundamental concept here is that humans are **"dead-end hosts."** While the bacteria can readily jump from animals to humans, **human-to-human (man-to-man) transmission is extremely rare** and does not occur through casual contact, making it the correct "except" choice. **Analysis of Options:** * **Ingestion of raw milk (Option B):** This is the **most common** route of transmission globally. Consuming unpasteurized dairy products (milk, cheese) from infected cows, goats, or sheep allows the bacteria to enter via the gastrointestinal tract. * **Contact with aborted fetuses (Option D):** This is a major occupational hazard for farmers and veterinarians. Brucella localizes in the animal placenta; handling infected birth products or uterine discharges leads to transmission through skin abrasions or mucous membranes. * **Aerosol transmission (Option A):** Brucella is highly infectious via inhalation. This occurs in laboratory settings (accidental cultures) or slaughterhouses. Due to this high infectivity via aerosols, *Brucella* is classified as a potential **bioterrorism agent**. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow culture (more sensitive than blood culture). * **Standard Serology:** Standard Agglutination Test (SAT); a titer >1:160 is significant. * **Rose Bengal Test:** Used as a rapid screening tool. * **Treatment:** WHO recommends **Rifampicin + Doxycycline** for 6 weeks. * **Clinical Feature:** Characterized by "Undulant fever" (fever with a wave-like pattern), drenching sweats with a peculiar "mousy" odor, and joint pain.

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