Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 321: Which of the following steps are done for surveillance of non-communicable diseases?

A. Surveillance of incidence of non-communicable disease
B. Surveillance of risk factors of non-communicable disease (Correct Answer)
C. Surveillance of evaluation of treatment of noncommunicable disease
D. Surveillance of mortality from non-communicable disease

Explanation: ### Explanation **1. Why the Correct Answer is Right:** The cornerstone of Non-Communicable Disease (NCD) surveillance is the **surveillance of risk factors**. Unlike infectious diseases, NCDs (like Diabetes, Hypertension, and CVD) have a long latency period and are largely preventable by modifying behaviors. The **WHO STEPwise approach (STEPS)** is the global standard for NCD surveillance, which focuses on monitoring risk factors (e.g., tobacco use, physical inactivity, unhealthy diet) to predict future disease burden and plan primary prevention strategies. Monitoring risk factors provides an "early warning system" before the clinical disease actually manifests. **2. Analysis of Incorrect Options:** * **Option A (Incidence):** Measuring the incidence (new cases) of NCDs is extremely difficult and resource-intensive because NCDs have an insidious onset. There is no specific "point of infection," making it an unreliable primary surveillance tool. * **Option C (Evaluation of treatment):** This falls under "Health System Performance" or "Clinical Audit" rather than public health surveillance. Surveillance aims to monitor the health status of a population, not the efficacy of individual clinical management. * **Option D (Mortality):** While mortality data is collected via Vital Statistics, it is a "lagging indicator." By the time mortality rises, the opportunity for prevention has passed. It does not help in the early control of the NCD epidemic. **3. NEET-PG High-Yield Pearls:** * **WHO STEPS Framework:** * **Step 1:** Questionnaire-based (Behavioral risk factors like tobacco, alcohol, diet). * **Step 2:** Physical measurements (BP, Height, Weight/BMI, Waist circumference). * **Step 3:** Biochemical measurements (Blood glucose, Cholesterol). * **Key Concept:** NCD surveillance is "Integrated" (monitoring multiple diseases through common risk factors). * **Rule of Halves:** Commonly associated with Hypertension surveillance (Half are diagnosed, half of those are treated, half of those are controlled).

Question 322: What is the recommended content of Sodium chloride in WHO Oral Rehydration Solution (ORS)?

A. 2-5 gm (Correct Answer)
B. 1.5 gm
C. 10 gm
D. 20 gm

Explanation: **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.

Question 323: What is the recommended schedule of immunisation for rabies vaccine in human diploid cells?

A. 0, 3, 4, 14, 30, 0
B. 0, 5, 14, 30, 900
C. 0, 3, 7, 14, 30, 90 (Correct Answer)
D. 0, 3, 7, 14, 30, 70

Explanation: ### 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.

Question 324: Which of the following cancers are screened for in the general population?

A. Breast cancer (Correct Answer)
B. Colon cancer
C. Cervical cancer
D. Ovarian cancer

Explanation: **Explanation:** The screening of cancers in a population is governed by **Wilson and Jungner’s criteria**, which state that the disease must be a significant health problem with a recognizable latent stage and an effective, acceptable screening test available. **Why Breast Cancer is the Correct Answer:** In the context of the **National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)** in India, population-based screening is actively implemented for three specific cancers: **Oral, Breast, and Cervical cancer**. For Breast Cancer, the primary screening modality in the general population (especially in resource-limited settings) is **Clinical Breast Examination (CBE)** performed by trained health workers for women aged 30–65 years. **Analysis of Other Options:** * **Cervical Cancer (Option C):** While cervical cancer is screened for in the general population (via VIA or Pap smear), in many competitive exams, if a single best answer must be chosen among multiple "screenable" cancers, the question often refers to the specific priorities of national health missions or the most common cancer in females globally/nationally. (Note: In many MCQ formats, both A and C are technically correct; however, Breast Cancer is currently the leading cancer among Indian women). * **Colon Cancer (Option B):** While screened for in Western countries (via Colonoscopy or FIT), it is **not** part of the routine mass screening program in the general population in India due to lower prevalence and high cost. * **Ovarian Cancer (Option D):** There is currently **no effective screening tool** (CA-125 and Ultrasound have low specificity) that reduces mortality in the general population; hence, it is not recommended for routine screening. **High-Yield NEET-PG Pearls:** * **Screening Age (India):** 30–65 years for Oral, Breast, and Cervical cancer. * **Cervical Screening:** Visual Inspection with Acetic Acid (VIA) is the preferred low-resource setting tool. * **Breast Screening:** Mammography is the "Gold Standard," but CBE is the "Public Health Standard" in India. * **Self-Examination:** Breast Self-Examination (BSE) is recommended for "Breast Awareness" rather than as a formal screening tool.

Question 325: Raltegravir belongs to which class of drugs?

A. Nucleoside inhibitors (NIs)
B. Non-nucleoside inhibitors (NNIs)
C. Integrase strand transfer inhibitors (INSTIs) (Correct Answer)
D. CCR5 antagonist

Explanation: **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.

Question 326: What is the most important feature to diagnose severe anemia?

A. Chest indrawing (Correct Answer)
B. Cyanosis
C. Grunting
D. Nasal flaring

Explanation: ### Explanation In the context of integrated management protocols (such as IMNCI) and clinical assessment in Community Medicine, the diagnosis of **Severe Anemia** in children is primarily clinical. **Why Chest Indrawing is the Correct Answer:** Severe anemia leads to a significant reduction in the oxygen-carrying capacity of the blood. To compensate for the resulting tissue hypoxia, the body increases the work of breathing and heart rate. **Chest indrawing** (subcostal recession) is a critical clinical sign indicating severe respiratory distress or the body's compensatory struggle to oxygenate tissues. In a child with severe palmar pallor, the presence of chest indrawing or a very fast respiratory rate signifies "Very Severe Disease," necessitating urgent referral and blood transfusion. **Analysis of Incorrect Options:** * **B. Cyanosis:** This indicates a high concentration of deoxygenated hemoglobin (>5g/dL). In severe anemia, hemoglobin levels are so low that even if the blood is poorly oxygenated, there isn't enough total hemoglobin to produce the characteristic blue discoloration. * **C. Grunting:** This is a sign of alveolar collapse (often seen in pneumonia or RDS) where the child breathes against a partially closed glottis to maintain functional residual capacity. While serious, it is less specific to the systemic compensatory mechanism of anemia than chest indrawing. * **D. Nasal Flaring:** This is an early sign of respiratory distress used to reduce airway resistance. While it can be present in severe anemia, chest indrawing is considered a more definitive marker of "severe" distress and impending heart failure in the pediatric clinical algorithm. **Clinical Pearls for NEET-PG:** * **IMNCI Criteria:** Severe anemia is classified by **Severe Palmar Pallor**. If associated with respiratory distress (chest indrawing), it is managed as a medical emergency. * **Hemoglobin Cut-off:** For children (6–59 months), severe anemia is defined as **Hb < 7 g/dL** (WHO). * **Key Sign:** Always look for **congestive heart failure** signs (hepatomegaly, gallop rhythm) in cases of severe anemia presenting with chest indrawing.

Question 327: Which of the following is NOT a contraindication for progestasert?

A. Pelvic inflammatory disease
B. Uterine fibroids
C. Previous history of ectopic pregnancy
D. Previous history of abortion (Correct Answer)

Explanation: **Explanation:** **Progestasert** is a first-generation hormone-releasing Intrauterine Device (IUD) that releases progesterone (38mg) at a rate of 65 µg/day. Understanding its contraindications is vital for NEET-PG, as they align closely with general IUD contraindications but include specific hormonal considerations. **Why "Previous history of abortion" is the correct answer:** A previous history of abortion (spontaneous or induced) is **not** a contraindication for IUD insertion. In fact, an IUD can be inserted immediately following a first-trimester abortion (Post-abortal IUCD), provided there is no evidence of pelvic infection or trauma. **Analysis of Incorrect Options (Contraindications):** * **Pelvic Inflammatory Disease (PID):** This is an absolute contraindication. Inserting an IUD in the presence of active or chronic pelvic infection can exacerbate the condition and lead to life-threatening sepsis or tubal damage. * **Uterine Fibroids:** Large or submucosal fibroids cause **distortion of the uterine cavity**. This prevents proper placement of the device, increasing the risk of expulsion and accidental pregnancy. * **Previous history of ectopic pregnancy:** Progestasert (and other progesterone-only methods) primarily works by thickening cervical mucus and altering the endometrium. However, if a pregnancy does occur with an IUD in situ, there is a higher statistical risk that it will be ectopic. Therefore, a prior history of ectopic pregnancy is a relative contraindication for Progestasert. **High-Yield Clinical Pearls for NEET-PG:** * **Lifespan:** Progestasert must be replaced **annually** (every 1 year), unlike Mirena (LNG-20), which lasts for 5–8 years. * **Mechanism:** It primarily acts locally on the endometrium and thickens cervical mucus; it does not consistently inhibit ovulation. * **Side Effects:** The most common reason for removal is irregular menstrual bleeding or intermenstrual spotting. * **Ideal Candidate:** A woman who has at least one child and is in a stable monogamous relationship (low risk for STIs/PID).

Question 328: BCG vaccine is classified as which of the following?

A. Live vaccine (Correct Answer)
B. Killed vaccine
C. Toxoid
D. None of the above

Explanation: **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; 0.1 ml for infants >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**.

Question 329: What are the measles elimination criteria?

A. Less than 1/1000 cases
B. Less than 1/10,000 cases
C. Less than 1/100,000 cases (Correct Answer)
D. Less than 1/100 cases

Explanation: ### 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.

Question 330: Reverse smoking is common in which Indian state?

A. Maharashtra
B. Gujarat
C. Andhra Pradesh (Correct Answer)
D. Rajasthan

Explanation: **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).

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