Non-Communicable Diseases Practice Questions

Q: What is the recommended content of Sodium chloride in WHO Oral Rehydration Solution (ORS)?

2-5 gm. **Explanation:** The World Health Organization (WHO) Oral Rehydration Solution (ORS) is a life-saving formulation designed to treat dehydration by utilizing the **sodium-glucose co-transport mechanism** in the small intestine. **1. Why Option A is Correct:** The current **WHO Reduced Osmolarity ORS** formulation contains exactly **2.6 grams** of Sodium Chloride (NaCl) per liter of water. This falls within the range of **2–5 gm** provided in the options. This specific concentration is calculated to provide 75 mmol/L of Sodium, which is optimal for maximizing water absorption while minimizing the risk of osmotic diarrhea or hypernatremia. **2. Analysis of Incorrect Options:** * **Option B (1.5 gm):** This is too low. Insufficient sodium would fail to correct the sodium deficit caused by diarrhea and would not provide enough solute to drive the co-transport mechanism effectively. * **Option C & D (10 gm & 20 gm):** These concentrations are dangerously high. Excessive sodium intake leads to hypernatremia and can cause "osmotic pull," drawing water out of the cells and into the gut, thereby worsening dehydration. **3. High-Yield Clinical Pearls for NEET-PG:** * **Total Osmolarity:** The WHO Reduced Osmolarity ORS has a total osmolarity of **245 mOsm/L** (the older formulation was 311 mOsm/L). * **Composition per Liter:** * Sodium Chloride: **2.6 g** * Glucose (Anhydrous): **13.5 g** * Potassium Chloride: **1.5 g** * Trisodium Citrate: **2.9 g** * **Role of Citrate:** It is added to correct metabolic acidosis and increases the shelf life of the ORS packet. * **Zinc Supplementation:** Always remember that for pediatric diarrhea, Zinc (20 mg/day for 14 days; 10 mg for infants <6 months) is recommended alongside ORS to reduce the duration and severity of the episode.

Q: What is the recommended schedule of immunisation for rabies vaccine in human diploid cells?

0, 3, 7, 14, 30, 90. ### Explanation **1. Understanding the Correct Answer (Option C: 0, 3, 7, 14, 30, 90)** The standard Post-Exposure Prophylaxis (PEP) regimen for rabies using Modern Cell Culture Vaccines (MCCVs), such as **Human Diploid Cell Vaccine (HDCV)** or Purified Chick Embryo Cell Vaccine (PCECV), historically follows the **Essen Protocol**. This intramuscular (IM) schedule consists of 5 doses administered on days **0, 3, 7, 14, and 28/30**. A **6th dose (Day 90)** is considered an optional "booster" or "safety dose," particularly recommended in the Indian context for Category III bites or in immunocompromised individuals to ensure long-lasting immunity. While the WHO now often recommends a 4-dose IM regimen (0, 3, 7, 14-28), the 5 or 6-dose schedule remains a classic benchmark for NEET-PG questions based on standard textbooks like Park’s PSM. **2. Analysis of Incorrect Options** * **Option A & D:** These contain arbitrary numbers (4, 70) that do not align with any recognized WHO or National Center for Disease Control (NCDC) protocols. * **Option B:** The interval of 5 days and 900 days is medically incorrect. Rabies PEP requires early, frequent dosing to induce neutralizing antibodies before the virus reaches the CNS. **3. High-Yield Clinical Pearls for NEET-PG** * **Site of Injection:** Always **Deltoid** in adults; **Anterolateral thigh** in children. **Never** in the gluteal region (fat interferes with absorption). * **Intradermal Regimen (Thai Red Cross):** 2-2-2-0-2 (0.1 ml at 2 sites on days 0, 3, 7, and 28). * **Pre-exposure Prophylaxis (PrEP):** 3 doses on days 0, 7, and 21 or 28. * **Re-exposure:** If a previously vaccinated person is bitten, only **2 doses** are needed (Days 0 and 3); RIG is not required. * **Rule of Thumb:** Rabies vaccine is never contraindicated, even in pregnancy or infancy, as the disease is 100% fatal.

Q: Raltegravir belongs to which class of drugs?

Integrase strand transfer inhibitors (INSTIs). **Explanation:** **Raltegravir** is a potent antiretroviral drug used in the management of HIV-1 infection. Its mechanism of action involves inhibiting the catalytic activity of **HIV-1 integrase**, an enzyme required for viral replication. By blocking this enzyme, Raltegravir prevents the covalent insertion (integration) of the HIV DNA into the host cell genome, thereby halting the formation of the HIV provirus. **Analysis of Options:** * **Integrase Strand Transfer Inhibitors (INSTIs):** This is the correct class. Raltegravir was the first FDA-approved drug in this category. Other drugs in this class include Dolutegravir, Elvitegravir, and Bictegravir. * **Nucleoside Reverse Transcriptase Inhibitors (NRTIs):** These act as chain terminators by competing with natural deoxynucleotides for binding to reverse transcriptase (e.g., Zidovudine, Abacavir, Tenofovir). * **Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):** These bind non-competitively to a distinct site on the reverse transcriptase enzyme, causing a conformational change (e.g., Efavirenz, Nevirapine). * **CCR5 Antagonists:** These are entry inhibitors that block the CCR5 receptor on the surface of T-cells, preventing viral attachment (e.g., Maraviroc). **High-Yield Clinical Pearls for NEET-PG:** * **Dolutegravir** is currently the preferred drug for the "Test and Treat" policy under the National AIDS Control Programme (NACP) in India. * **Raltegravir** is specifically preferred in **Post-Exposure Prophylaxis (PEP)** regimens and for preventing mother-to-child transmission due to its rapid viral load reduction. * A common side effect associated with INSTIs is an increase in **creatine kinase** levels and potential myopathy.

Q: BCG vaccine is classified as which of the following?

Live vaccine. **Explanation:** The **BCG (Bacillus Calmette-Guérin)** vaccine is a **live attenuated bacterial vaccine** derived from a strain of *Mycobacterium bovis*. It is primarily used to protect against severe forms of childhood tuberculosis, such as tubercular meningitis and miliary TB. * **Why Option A is correct:** BCG is produced by attenuating (weakening) the virulence of the live *M. bovis* bacterium through serial subculturing (historically 230 passages over 13 years). Because it contains live organisms, it mimics a natural infection to trigger a robust cell-mediated immune response without causing the disease itself. * **Why Option B is incorrect:** Killed vaccines (e.g., Salk Polio, Whole-cell Pertussis) contain pathogens that have been destroyed by heat or chemicals. They generally require multiple doses and boosters, unlike the single-dose primary response of BCG. * **Why Option C is incorrect:** Toxoids (e.g., Tetanus, Diphtheria) are inactivated toxins produced by bacteria. BCG is the whole bacterium, not a modified toxin. **High-Yield Clinical Pearls for NEET-PG:** * **Strain used:** The most common strain used globally is the **Danish 1331** strain. * **Diluent:** It must be reconstituted only with **Normal Saline (0.9% NaCl)**. Using distilled water causes irritation, while dextrose can lead to contamination. * **Administration:** Given **Intradermally** (0.05 ml for neonates 1 month) using an Omega/Tuberculin syringe. * **The "BCG Scar":** It follows a specific sequence: Papule (2-3 weeks) → Glazed ulcer (5-6 weeks) → Permanent tiny round pitted scar (6-12 weeks). * **Storage:** It is highly heat and light-sensitive; once reconstituted, it must be used within **4-6 hours**.

Q: What are the measles elimination criteria?

Less than 1/100,000 cases. ### Explanation The correct answer is **C. Less than 1/100,000 cases.** **1. Understanding the Concept** Measles elimination is defined by the World Health Organization (WHO) as the absence of endemic measles virus transmission in a defined geographical area (e.g., a region or country) for at least 12 months, in the presence of a high-quality surveillance system. The specific epidemiological threshold used to monitor progress toward this goal is an annual incidence of **less than 1 case per 1 million population** (or <0.1 per 100,000). However, for examination purposes and standardized public health metrics, the benchmark for "elimination levels" of transmission is often cited as **less than 1 case per 100,000 population per year.** **2. Analysis of Incorrect Options** * **Options A, B, and D:** These values (1/100, 1/1,000, and 1/10,000) represent much higher incidence rates. At these levels, the disease is considered endemic or in a "pre-elimination" phase. A rate of 1/1,000, for example, would still imply thousands of cases in a large country, indicating active community spread. **3. High-Yield Clinical Pearls for NEET-PG** * **Eradication vs. Elimination:** Measles is targeted for *elimination* (regional) because *eradication* (global) requires the total absence of the pathogen worldwide. * **Surveillance Indicator:** The key performance indicator for measles surveillance is the "Non-measles febrile rash illness rate," which should be **≥ 2 per 100,000 population.** * **Vaccination Strategy:** To achieve elimination, **MCV1 and MCV2 coverage must be ≥ 95%** at the national level and in every district. * **India Context:** India has missed previous deadlines and is currently working towards the goal of Measles and Rubella (MR) elimination. * **Vitamin A:** Always remember that Vitamin A supplementation is a crucial part of measles management to reduce mortality.

Q: Reverse smoking is common in which Indian state?

Andhra Pradesh. **Explanation:** **Correct Answer: C. Andhra Pradesh** **Medical Concept & Rationale:** Reverse smoking (also known as *chutta* smoking) is a peculiar form of tobacco use where the lit end of a homemade cigar or cigarette is placed inside the mouth. This practice is culturally prevalent in the coastal districts of **Andhra Pradesh** (specifically Visakhapatnam and Srikakulam) and parts of Odisha. From a medical standpoint, reverse smoking is a high-yield topic because it is the primary risk factor for **Palatal Keratosis**. The extreme heat and combustion products directed toward the hard palate lead to a high incidence of **Carcinoma of the Hard Palate**, a site otherwise rarely affected by oral cancer in the general population. **Analysis of Incorrect Options:** * **A. Maharashtra:** While tobacco use (specifically *mishri* or smokeless tobacco) is common, reverse smoking is not a traditional practice here. * **B. Gujarat:** This state has a high prevalence of smokeless tobacco (betel quid/mava) leading to Oral Submucous Fibrosis (OSMF), but not reverse smoking. * **C. Rajasthan:** Tobacco is commonly consumed via *hookah* or *bidis* in the traditional manner, but the reverse technique is absent. **High-Yield Clinical Pearls for NEET-PG:** * **Site-Specific Cancer:** Reverse smoking is the most common cause of **Hard Palate Cancer** in India. * **Nicotina Palati:** This is the clinical term for the palatal changes (hyperpigmentation, whitening, and red dots representing inflamed salivary gland orifices) seen in these smokers. * **Demographics:** It is most commonly practiced by elderly women in rural coastal communities. * **Differential:** Do not confuse this with *Bidi* smoking (common nationwide) or *Hookli* (clay pipe smoking common in Gujarat).

Question 1

Which of the following steps are done for surveillance of non-communicable diseases?

Accepted Answer

Surveillance of risk factors of non-communicable disease

Answer

Surveillance of incidence of non-communicable disease

Answer

Surveillance of evaluation of treatment of noncommunicable disease

Answer

Surveillance of mortality from non-communicable disease

Question 2

What is the recommended content of Sodium chloride in WHO Oral Rehydration Solution (ORS)?

Accepted Answer

2-5 gm

Answer

1.5 gm

Answer

10 gm

Answer

20 gm

Question 3

What is the recommended schedule of immunisation for rabies vaccine in human diploid cells?

Accepted Answer

0, 3, 7, 14, 30, 90

Answer

0, 3, 4, 14, 30, 0

Answer

0, 5, 14, 30, 900

Answer

0, 3, 7, 14, 30, 70

Question 4

Which of the following cancers are screened for in the general population?

Accepted Answer

Breast cancer

Answer

Colon cancer

Answer

Cervical cancer

Answer

Ovarian cancer

Question 5

Raltegravir belongs to which class of drugs?

Accepted Answer

Integrase strand transfer inhibitors (INSTIs)

Answer

Nucleoside inhibitors (NIs)

Answer

Non-nucleoside inhibitors (NNIs)

Answer

CCR5 antagonist

Question 6

What is the most important feature to diagnose severe anemia?

Accepted Answer

Chest indrawing

Answer

Cyanosis

Answer

Grunting

Answer

Nasal flaring

Question 7

Which of the following is NOT a contraindication for progestasert?

Accepted Answer

Previous history of abortion

Answer

Pelvic inflammatory disease

Answer

Uterine fibroids

Answer

Previous history of ectopic pregnancy

Question 8

BCG vaccine is classified as which of the following?

Accepted Answer

Live vaccine

Answer

Killed vaccine

Answer

Toxoid

Answer

None of the above

Question 9

What are the measles elimination criteria?

Accepted Answer

Less than 1/100,000 cases

Answer

Less than 1/1000 cases

Answer

Less than 1/10,000 cases

Answer

Less than 1/100 cases

Question 10

Reverse smoking is common in which Indian state?

Accepted Answer

Andhra Pradesh

Answer

Maharashtra

Answer

Gujarat

Answer

Rajasthan

Non-Communicable Diseases — MCQs

Non-Communicable Diseases — MCQs

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