Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 351: Which of the following statements is NOT true about Kala-Azar?

A. Sandfly is the vector
B. Man is the only reservoir in India
C. Aldehyde test is diagnostic
D. Man has the flagellar stage of the organism (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Man has the flagellar stage of the organism** **Why Option D is NOT true:** The causative agent of Kala-azar, *Leishmania donovani*, exists in two distinct morphological forms. The **flagellar stage (Promastigote)** is found only in the vector (Sandfly) and in artificial cultures. In the human host (Man), the parasite exists exclusively in the **aflagellar stage (Amastigote)**, also known as Leishman-Donovan (LD) bodies, residing within the reticuloendothelial system (macrophages). **Analysis of Other Options:** * **A. Sandfly is the vector:** This is true. The disease is transmitted by the bite of the female *Phlebotomus argentipes*. * **B. Man is the only reservoir in India:** This is true. Unlike in other parts of the world (where dogs or rodents may be reservoirs), Indian Kala-azar is **anthroponotic**, meaning humans are the sole reservoir of infection. * **C. Aldehyde test is diagnostic:** While technically a non-specific screening tool, in the context of classic medical exams, the Napier’s Aldehyde test is associated with Kala-azar. It depends on the increase in serum gamma globulins. Note: It only becomes positive after 3 months of illness. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Demonstration of LD bodies in **splenic aspirate** (highest sensitivity) or bone marrow aspirate. * **Drug of Choice:** **Liposomal Amphotericin B** (single dose of 10mg/kg is the current WHO recommendation for India). * **PKDL (Post Kala-azar Dermal Leishmaniasis):** A non-ulcerative condition appearing years after "cure"; it serves as a major parasite reservoir in the community. * **Elimination Goal:** To reduce the annual incidence to less than **1 case per 10,000 population** at the block level.

Question 352: What is the recommended duration for the treatment of Multi-drug resistant Tuberculosis (MDR-TB)?

A. 8-12 months
B. 12-16 months
C. 16-24 months
D. 2-3 years (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. 2-3 years** **1. Why Option D is Correct:** Multi-drug resistant Tuberculosis (MDR-TB) is defined as resistance to at least **Isoniazid (H) and Rifampicin (R)**. Because these two most potent bactericidal drugs are ineffective, the treatment must rely on second-line drugs which are generally less effective and have slower bactericidal activity. Under the traditional WHO and National Tuberculosis Elimination Program (NTEP) guidelines, the **Conventional MDR-TB Regimen** lasts for **18 to 24 months** (often extending up to 2 years or more depending on culture conversion). In the context of standard medical examinations like NEET-PG, the duration of 2–3 years reflects the prolonged nature of treatment required to ensure complete sterilization of the lesions and prevent relapse. **2. Why Other Options are Incorrect:** * **Options A & B (8–16 months):** These durations are too short for conventional MDR-TB treatment. While a "Shorter MDR-TB Regimen" (9–11 months) exists for specific eligible patients, it is not the standard "duration of treatment" unless specified. * **Option C (16–24 months):** While 24 months falls within this range, the standard textbook answer for the maximum duration required for difficult cases or those with slow clinical response often extends into the 3rd year, making "2-3 years" the most comprehensive choice for traditional MDR-TB management. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition:** MDR-TB = Resistance to H + R. XDR-TB (Extensively Drug Resistant) = MDR-TB + resistance to any Fluoroquinolone + at least one Group A drug (Bedaquiline or Linezolid). * **Newer Regimens:** The NTEP is transitioning toward the **BPaLM regimen** (Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin) which can reduce treatment duration to **6 months**, but for exam purposes, the conventional 18–24+ month duration remains a classic benchmark. * **Site of Treatment:** MDR-TB is managed under the Programmatic Management of Drug-Resistant TB (PMDT).

Question 353: What is the primary change in the Revised National Tuberculosis Control Programme (RNTCP)?

A. Therapy based on Directly Observed Treatment, Short-course (DOTS)
B. Diagnosis via sputum microscopy
C. Therapy not based on DOTS (Correct Answer)
D. Early diagnosis and treatment

Explanation: **Explanation:** The correct answer is **C. Therapy not based on DOTS**. This question highlights a significant paradigm shift in India’s tuberculosis management strategy. In 2020, the RNTCP was renamed the **National Tuberculosis Elimination Program (NTEP)**. The primary change is the transition from the traditional "DOTS" (Directly Observed Treatment, Short-course) strategy to a more patient-centric approach. Under the revised guidelines, the program has moved away from the mandatory "Direct Observation" (where a provider must watch the patient swallow pills) because it was often perceived as stigmatizing and burdensome. Instead, the NTEP focuses on **Treatment Support**, utilizing digital tools (like Nikshay) and family-led supervision to ensure adherence, effectively making the therapy "not strictly based on DOTS" in its classical sense. **Analysis of Incorrect Options:** * **Option A:** DOTS was the cornerstone of the *old* RNTCP. The revision focuses on decentralized, patient-friendly support rather than rigid direct observation. * **Option B:** While sputum microscopy was the primary tool previously, the revised program prioritizes **Molecular Diagnostics (CBNAAT/NAAT)** as the initial diagnostic test to detect drug resistance early. * **Option D:** While early diagnosis and treatment remain goals, they are general principles of any public health program and do not represent the specific structural change in the revised strategy. **High-Yield Clinical Pearls for NEET-PG:** * **Goal:** India aims to eliminate TB by **2025** (5 years ahead of the Global SDG goal of 2030). * **Daily Regimen:** NTEP uses a daily fixed-dose combination (FDC) instead of the older intermittent (thrice-weekly) regimen. * **Nikshay Poshan Yojana:** Provides ₹500/month nutritional support to all TB patients. * **Universal Drug Susceptibility Testing (UDST):** Every diagnosed TB patient is tested for Rifampicin resistance at the outset.

Question 354: The Montenegro test is performed to diagnose which of the following conditions?

A. Hydatid disease
B. Taeniasis
C. Filariasis
D. Kala-azar (Correct Answer)

Explanation: **Explanation:** The **Montenegro test** (also known as the Leishmanin skin test) is a delayed-type hypersensitivity (Type IV) reaction used to detect prior exposure to *Leishmania* parasites, the causative agents of **Kala-azar** (Visceral Leishmaniasis). **Why Kala-azar is correct:** The test involves the intradermal injection of a suspension of killed *Leishmania* promastigotes. A positive result (induration ≥5 mm after 48–72 hours) indicates a cell-mediated immune response. It is important to note that the test is typically **negative** during active visceral leishmaniasis (due to suppressed cell-mediated immunity) but becomes **positive** after successful treatment or in cases of Cutaneous Leishmaniasis and Post-Kala-azar Dermal Leishmaniasis (PKDL). **Why other options are incorrect:** * **Hydatid disease:** Diagnosed primarily via imaging (USG/CT) and the **Casoni’s test** (though now largely replaced by serology like ELISA). * **Taeniasis:** Diagnosed by stool microscopy for eggs or proglottids; no specific skin test is used for routine diagnosis. * **Filariasis:** Diagnosed by demonstrating microfilariae in peripheral blood (night samples) or using the ICT (Immunochromatographic test) for circulating filarial antigen. **High-Yield Clinical Pearls for NEET-PG:** * **Vector:** Sandfly (*Phlebotomus argentipes*). * **Drug of Choice:** Liposomal Amphotericin B (current standard). * **RK-39 Immunochromatographic test:** The rapid diagnostic test of choice for active Kala-azar in field settings. * **Aldehyde Test (Napier’s test):** Based on hypergammaglobulinemia; it is non-specific but used for screening.

Question 355: In which year was the Pulse Polio immunization program introduced?

A. 1995 (Correct Answer)
B. 2000
C. 1999
D. 2001

Explanation: **Explanation:** The **Pulse Polio Immunization (PPI)** program was launched in India in **1995** (specifically on December 9, 1995) following the World Health Assembly resolution of 1988. The program aimed at 100% coverage under the Global Polio Eradication Initiative. **Why 1995 is correct:** The strategy involved administering two doses of Oral Polio Vaccine (OPV) to all children under five years of age, regardless of their previous immunization status, on "National Immunization Days" (NIDs). This "pulse" approach was designed to flood the community with the vaccine virus to displace the wild poliovirus. **Analysis of Incorrect Options:** * **1999 & 2000:** These years represent the intensification phase of the program. In 1999, "House-to-House" vaccination was introduced to reach missed children, but the program itself was already well-established. * **2001:** By this time, India had significantly reduced polio cases, but this date does not correlate with any major milestone in the program's inception. **High-Yield Clinical Pearls for NEET-PG:** * **Last Case of Polio in India:** Reported on January 13, 2011, in Howrah, West Bengal. * **WHO Certification:** India was declared "Polio Free" on **March 27, 2014**. * **Vaccine Shift:** India switched from Trivalent OPV (tOPV) to **Bivalent OPV (bOPV)** in April 2016. * **Current Strategy:** Inclusion of **Inactivated Poliovirus Vaccine (IPV)** in the routine immunization schedule to prevent Vaccine-Associated Paralytic Polio (VAPP).

Question 356: Which of the following is NOT helpful for the elimination of Filariasis?

A. Microfilariae do not multiply in vectors.
B. Microfilariae multiply in humans.
C. Larvae are deposited on the skin surface where they cannot survive. (Correct Answer)
D. None of the above.

Explanation: ### **Explanation** The elimination of Lymphatic Filariasis is biologically feasible because the parasite (*Wuchereria bancrofti*) has an **inefficient transmission cycle**. **Why Option C is the Correct Answer:** The statement "Larvae are deposited on the skin surface where they cannot survive" is **incorrect** regarding the biology of transmission. During a mosquito bite, the infective larvae (L3 stage) are not injected directly into the bloodstream (unlike Malaria). Instead, they are deposited **near the puncture site** on the skin. However, they do not simply die; they actively swim into the puncture wound to enter the lymphatic system. This step is a "bottleneck" because many larvae fail to enter, making transmission inefficient—a factor that actually **helps** elimination efforts. The option as phrased suggests they *cannot* survive at all, which is factually wrong in the context of a successful life cycle. **Analysis of Other Options:** * **Option A:** Microfilariae **do not multiply** in the mosquito vector; they only undergo developmental changes (L1 to L3). Since one microfilaria can only ever become one infective larva, the parasite burden is limited by the number of bites. This helps elimination. * **Option B:** Microfilariae **do not multiply** in the human host either. One infective larva develops into only one adult worm. To increase the worm load, a human must be bitten repeatedly over a long period. This lack of multiplication in both hosts makes the disease easier to control via Mass Drug Administration (MDA). **NEET-PG High-Yield Pearls:** * **GPEL (Global Programme to Eliminate Lymphatic Filariasis):** Aimed for elimination by 2020 (now 2030) using two pillars: **MDA** and **Morbidity Management (MMDP)**. * **Drug Regimen:** The WHO now recommends the **IDA strategy** (Ivermectin + Diethylcarbamazine + Albendazole) for rapid elimination. * **Transmission Index:** A high "critical density" of vectors is required to maintain transmission, making it a "vulnerable" disease for eradication.

Question 357: A disease that is transmitted from vertebrate animals to humans under natural conditions is called:

A. Zoonosis (Correct Answer)
B. Exotic
C. Epizoonotic
D. Amphixenotic

Explanation: ### Explanation **Correct Option: A. Zoonosis** According to the World Health Organization (WHO), **Zoonoses** are defined as diseases and infections which are naturally transmitted between vertebrate animals and man. The transmission can be direct (e.g., Rabies via bite) or indirect (e.g., Plague via flea vector). This is a fundamental concept in epidemiology used to classify diseases based on their natural reservoir. **Analysis of Incorrect Options:** * **B. Exotic:** This refers to a disease that is not native to a specific geographic area but is imported from another country (e.g., Yellow Fever is exotic to India). * **C. Epizoonotic:** This is a distractor term. The correct epidemiological term is **Epizootic**, which refers to an outbreak (epidemic) of disease in an animal population (e.g., Anthrax or Avian Flu in birds). * **D. Amphixenotic:** This is a specific sub-type of zoonosis where the infection is maintained in both man and lower vertebrate animals and can be transmitted in either direction (e.g., *Trypanosoma cruzi*). **High-Yield NEET-PG Pearls:** * **Anthropozoonoses:** Infections transmitted from animals to man (e.g., Rabies, Leptospirosis). * **Zooanthroponoses:** Infections transmitted from man to animals (e.g., Human Tuberculosis to cattle). * **Cyclozoonoses:** Require more than one vertebrate host species to complete the life cycle (e.g., Echinococcosis, Taeniasis). * **Metazoonoses:** Transmitted to humans via an invertebrate vector (e.g., Plague, Arboviruses). * **Saprozoonoses:** Require a non-animal site like soil or decaying matter for the life cycle (e.g., Tetanus, Histoplasmosis).

Question 358: For controlling an outbreak of cholera, all of the following measures are recommended except?

A. Mass chemoprophylaxis (Correct Answer)
B. Proper disposal of excreta
C. Chlorination of water
D. Early detection and management of cases

Explanation: ### Explanation The control of a cholera outbreak focuses on breaking the chain of transmission through environmental sanitation and rapid clinical intervention. **Why Mass Chemoprophylaxis is NOT recommended (Option A):** Mass chemoprophylaxis (administering antibiotics to an entire community) is contraindicated in cholera control for several reasons: 1. **Drug Resistance:** It rapidly leads to the emergence of antibiotic-resistant strains of *Vibrio cholerae*. 2. **False Sense of Security:** It diverts resources from essential measures like water sanitation and creates a false sense of safety among the public. 3. **Short Duration of Effect:** Antibiotics only provide very brief protection, which is ineffective for a prolonged outbreak. *Note: Chemoprophylaxis is only recommended for **household contacts** (selective chemoprophylaxis).* **Analysis of Incorrect Options:** * **Option B (Excreta Disposal):** Cholera is a feco-oral disease. Safe disposal of stools and vomitus is critical to prevent environmental contamination. * **Option C (Chlorination):** This is the most important single measure. Ensuring a free residual chlorine level of **0.5 mg/L** in drinking water effectively kills the vibrios. * **Option D (Early Detection):** Rapid identification of cases and immediate rehydration (ORS/IV fluids) is the mainstay of reducing the Case Fatality Rate (CFR) to less than 1%. **High-Yield NEET-PG Pearls:** * **Drug of Choice (DOC):** For treatment, **Doxycycline** (single dose) is the DOC for adults; **Azithromycin** is preferred for children and pregnant women. * **Selective Chemoprophylaxis:** The DOC for household contacts is also **Doxycycline**. * **Best Indicator of Water Quality:** Orthotolidine Arsenite (OTA) test is used to measure free and combined chlorine. * **Vaccination:** Not recommended for managing an *ongoing* outbreak; it is a pre-emptive tool for endemic areas or high-risk populations.

Question 359: The Human Poverty Index includes all of the following EXCEPT:

A. Infant mortality (Correct Answer)
B. Longevity
C. Knowledge
D. Standard of living

Explanation: The **Human Poverty Index (HPI)** was introduced by the UNDP in 1997 to measure deprivation in the same three basic dimensions as the Human Development Index (HDI). **Why Infant Mortality is the Correct Answer:** Infant Mortality Rate (IMR) is **not** a direct component of the Human Poverty Index. While IMR is a sensitive indicator of a community's health status and socioeconomic development, the HPI specifically uses **Longevity** (measured by the probability of not surviving to age 40) rather than infant-specific mortality. **Analysis of Incorrect Options:** The HPI is calculated based on three dimensions of deprivation: * **Longevity (Option B):** Represented by the percentage of people expected to die before age 40. * **Knowledge (Option C):** Represented by the **Adult Literacy Rate**. It measures exclusion from the world of reading and communication. * **Standard of Living (Option D):** This is a composite of three variables: percentage of people with access to **health services**, percentage with access to **safe water**, and the percentage of **malnourished children** (underweight for age). **High-Yield Clinical Pearls for NEET-PG:** * **HPI-1 vs. HPI-2:** HPI-1 measures poverty in developing countries, while HPI-2 is used for developed (OECD) countries and includes a fourth dimension: **Social Exclusion** (measured by long-term unemployment). * **HDI vs. HPI:** HDI measures average achievement, while HPI measures **deprivation** in those same achievements. * **PQLI (Physical Quality of Life Index):** Do not confuse HPI with PQLI. PQLI components are **Infant Mortality**, **Life Expectancy at Age 1**, and **Literacy**. * **MPI:** The HPI was replaced by the **Multidimensional Poverty Index (MPI)** in 2010, which uses 10 indicators across Health, Education, and Standard of Living.

Question 360: What type of surveillance is included in an integrated disease control program for non-communicable diseases?

A. Sentinel surveillance (Correct Answer)
B. Regular surveillance
C. Periodic regular survey
D. Additional state priority

Explanation: ### Explanation The **National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)**, which is the cornerstone of NCD control in India, utilizes a multi-pronged surveillance strategy. **Why Sentinel Surveillance is Correct:** Sentinel surveillance involves the collection of data from specific, selected sites (sentinel sites) to identify trends and monitor the burden of diseases. For NCDs, this is the preferred method because these diseases are chronic and do not require the real-time, universal reporting used for acute outbreaks. Sentinel sites (like tertiary care hospitals or specific districts) provide high-quality, standardized data on risk factors and disease outcomes, which can then be extrapolated to the larger population. **Analysis of Incorrect Options:** * **B. Regular surveillance:** This usually refers to routine, passive reporting of all cases from all health facilities. While used for infectious diseases (like Malaria), it is resource-intensive and often inaccurate for NCDs due to the long latency period and under-diagnosis. * **C. Periodic regular survey:** While NCD monitoring uses periodic surveys (like the NFHS or STEPs survey), "Sentinel Surveillance" is the specific systemic framework integrated into the national program for continuous monitoring. * **D. Additional state priority:** This is a programmatic administrative category rather than a technical type of epidemiological surveillance. **High-Yield Clinical Pearls for NEET-PG:** * **WHO STEPwise approach:** The global standard for NCD risk factor surveillance (Step 1: Questionnaire; Step 2: Physical measurements; Step 3: Biochemical measurements). * **Integrated Disease Surveillance Programme (IDSP):** Primarily focuses on epidemic-prone communicable diseases, whereas NPCDCS handles NCD-specific surveillance. * **Sentinel Sites:** In the context of NCDs, these are often used to monitor "Morbidity and Mortality" trends rather than just simple case counts.

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Epidemiology of NCDs

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Cardiovascular Disease Prevention

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Diabetes Control Program

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Cancer Screening and Control

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Chronic Respiratory Diseases

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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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Geriatric Health Issues

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