Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 391: Which of the following dietary changes is NOT advocated by the WHO for the prevention of heart diseases?

A. An increase in complex carbohydrate consumption (Correct Answer)
B. Reduction in fat intake to 20-30 percent of caloric intake
C. Consumption of saturated fats limited to less than 10% of total energy intake
D. Reduction of cholesterol to below 100mg per 1000 kcal per day

Explanation: **Explanation:** The prevention of Cardiovascular Diseases (CVD) through dietary modification focuses primarily on the quality and quantity of fats and the restriction of refined sugars, rather than a blanket increase in carbohydrates. **Why Option A is the Correct Answer:** While the WHO recommends replacing saturated fats with complex carbohydrates (like whole grains, vegetables, and fruits), it does **not** advocate for an overall *increase* in total carbohydrate consumption. In fact, high carbohydrate intake (especially refined carbs) can lead to obesity and metabolic syndrome. The goal is a **balanced distribution** of macronutrients, not an increase in the carbohydrate load. **Analysis of Other Options:** * **Option B (Fat intake 20-30%):** This is a standard WHO recommendation. Total fat should be limited to less than 30% of total energy intake to prevent unhealthy weight gain and atherosclerosis. * **Option C (Saturated fats <10%):** High saturated fat intake directly correlates with elevated LDL cholesterol. WHO guidelines strictly recommend limiting these to less than 10% of total energy, replacing them with polyunsaturated fatty acids (PUFAs). * **Option D (Cholesterol <100mg/1000 kcal):** This is a specific quantitative guideline for the primary prevention of heart disease to maintain healthy lipid profiles. **High-Yield Clinical Pearls for NEET-PG:** * **Salt Intake:** WHO recommends reducing salt intake to **<5 grams per day** (approx. 1 teaspoon) to reduce blood pressure and risk of stroke. * **Trans-fats:** Should be limited to **less than 1%** of total energy intake. * **Primal Prevention:** Refers to preventing the *emergence* of risk factors (e.g., discouraging children from picking up smoking or sedentary habits). * **Poli-meal:** A concept involving a combination of natural ingredients (almonds, fish, garlic, fruits) that can reduce CVD risk by up to 75%.

Question 392: Which of the following conditions is known to be transmitted vertically?

A. Herpes simplex (Correct Answer)
B. Leprosy
C. Tetanus
D. Whooping cough

Explanation: **Explanation:** **Vertical transmission** refers to the passage of a pathogen from the mother to the baby during the perinatal period. This can occur across the placenta (in utero), during delivery (parturition), or through breastfeeding. **1. Why Herpes Simplex is Correct:** Herpes Simplex Virus (HSV), particularly HSV-2, is a classic example of vertical transmission. It is most commonly transmitted **during childbirth** (intrapartum) through direct contact with infectious maternal secretions in the birth canal. It can also occur in utero (congenital HSV), leading to severe neonatal complications including skin vesicles, encephalitis, or disseminated multi-organ failure. **2. Why the Other Options are Incorrect:** * **Leprosy:** Caused by *Mycobacterium leprae*, it is transmitted via prolonged close contact through respiratory droplets. It is **not** transmitted vertically; infants born to affected mothers are generally healthy at birth. * **Tetanus:** Neonatal tetanus occurs due to **unsterile cord care** (infection of the umbilical stump) after birth. It is an environmental infection, not a vertical one. In fact, maternal immunization with Tetanus Toxoid provides *protective* IgG antibodies to the fetus. * **Whooping Cough (Pertussis):** This is a highly contagious respiratory infection transmitted via **droplets**. While newborns are at high risk, they acquire it postnatally from infected family members (cocooning strategy is used to prevent this). **High-Yield Clinical Pearls for NEET-PG:** * **TORCH Complex:** Remember the classic agents of vertical transmission: **T**oxoplasmosis, **O**thers (Syphilis, HIV, HBV, B19, VZV), **R**ubella, **C**ytomegalovirus, and **H**erpes Simplex. * **Most common timing:** Most HSV transmission (approx. 85-90%) occurs during the **intrapartum** period. * **Prevention:** Elective Cesarean section is indicated if active genital herpetic lesions are present at the time of labor to prevent vertical transmission.

Question 393: Leprosy is not yet eradicated because:

A. There is no effective vaccine. (Correct Answer)
B. It is highly infectious but has low pathogenicity.
C. Only humans serve as reservoirs.
D. It has a long incubation period.

Explanation: ### Explanation **Correct Answer: A. There is no effective vaccine.** The primary reason leprosy remains a challenge for global eradication is the **lack of a highly effective, specific vaccine**. While the BCG vaccine provides partial cross-protection (estimated at 20–80% efficacy), it is insufficient to break the chain of transmission entirely. Eradication typically requires a "primary prevention" tool like a potent vaccine to achieve zero incidence; currently, leprosy control relies on secondary prevention (early diagnosis and Multi-Drug Therapy). **Analysis of Incorrect Options:** * **B. It is highly infectious but has low pathogenicity:** This statement is factually incorrect. *Mycobacterium leprae* is characterized by **high infectivity but low virulence/pathogenicity**. Most individuals (95%) have natural immunity and do not develop the disease despite exposure. * **C. Only humans serve as reservoirs:** This is incorrect. While humans are the primary reservoir, **extra-human reservoirs** exist, such as nine-banded armadillos (in the Americas) and certain primates, which complicates eradication efforts. * **D. It has a long incubation period:** While true (average 3–5 years), a long incubation period is a characteristic of the disease but not the *primary* barrier to eradication. Diseases with long incubation periods can still be eradicated if effective primary prevention (vaccine) or vector control exists. **High-Yield NEET-PG Pearls:** * **Elimination vs. Eradication:** Leprosy was "eliminated" as a public health problem globally in 2000 (defined as prevalence <1 case per 10,000 population), but it is **not eradicated**. * **Infectivity:** The most infectious cases are Multibacillary (LL and BL) types. * **NLEP Goal:** The current National Leprosy Eradication Programme (NLEP) aims for a "Leprosy Free India" by 2027. * **Chemoprophylaxis:** A single dose of **Rifampicin (SDR)** is now recommended for contacts of leprosy patients to reduce the risk of transmission.

Question 394: Which of the following is true about the epidemiology of malaria?

A. The extrinsic incubation period is 0-14 days.
B. In India, it is common during January to June.
C. Man acts as the definitive host.
D. The mosquito acts as the definitive host. (Correct Answer)

Explanation: **Explanation:** In parasitology, the **definitive host** is defined as the host in which the parasite undergoes its **sexual cycle** of reproduction. In the case of Malaria (*Plasmodium* species), the sexual phase (sporogony) occurs within the female *Anopheles* mosquito. Conversely, the asexual phase (schizogony) occurs in humans, making **Man the intermediate host**. **Analysis of Options:** * **Option D (Correct):** As stated above, the mosquito is the definitive host because the fusion of gametes (syngamy) and the formation of the oocyst occur in the mosquito's gut. * **Option A (Incorrect):** The **extrinsic incubation period** (the time taken for the parasite to develop inside the mosquito) is typically **10–21 days**, depending on the species and ambient temperature. It is rarely as low as 0 days. * **Option B (Incorrect):** In India, malaria transmission is seasonal and peaks during and after the **monsoon (July to November)** due to the availability of stagnant water for mosquito breeding. January to June is generally the dry/off-season. * **Option C (Incorrect):** Man is the intermediate host because only asexual reproduction occurs in human hepatocytes and erythrocytes. **High-Yield NEET-PG Pearls:** * **Intrinsic Incubation Period:** The time interval between the bite of an infected mosquito and the onset of clinical symptoms in man (usually 10–14 days for *P. falciparum*). * **Infective Stage:** For humans, it is the **Sporozoite**; for mosquitoes, it is the **Gametocyte**. * **Temperature:** Optimal transmission occurs between **20°C and 30°C**. Transmission ceases if the temperature falls below 16°C or rises above 30°C. * **Humidity:** Relative humidity of **60% or more** is essential for the survival of the mosquito.

Question 395: Which type of Intrauterine Device (IUD) has the lowest expulsion rate?

A. Lippes loop
B. Levonorgestrel-releasing IUD
C. Progestasert (Correct Answer)
D. Copper T-220

Explanation: **Explanation:** The expulsion rate of an Intrauterine Device (IUD) is primarily influenced by its design, size, and the degree of uterine irritability it induces. **Why Progestasert is correct:** Progestasert is a first-generation hormone-releasing IUD (releasing progesterone). It is clinically recognized for having the **lowest expulsion rate** among the options provided. This is attributed to its specific T-shaped design and the local effect of progesterone, which tends to reduce uterine contractility and irritability compared to inert or copper-containing devices. **Analysis of Incorrect Options:** * **Lippes loop:** As a first-generation non-medicated (inert) IUD, it has the **highest expulsion rate** and highest incidence of side effects like bleeding and pain due to its large size and bulk. * **Levonorgestrel-releasing IUD (Mirena):** While highly effective and having a low expulsion rate (approx. 3–5%), in comparative classical studies cited in standard textbooks (like Park’s PSM), Progestasert is traditionally noted for the lowest expulsion figures. * **Copper T-220:** Medicated IUDs (Second Generation) have lower expulsion rates than inert ones, but the mechanical irritation caused by copper can still trigger uterine contractions leading to higher expulsion compared to progesterone-based systems. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of IUD:** Bleeding (followed by pain). * **Most common cause for IUD removal:** Bleeding. * **Ideal time for IUD insertion:** During menstruation or within 10 days of the beginning of the period. * **Mechanism of Cu-T:** Primarily biochemical changes in the endometrium and impairment of sperm motility (spermicidal). * **Mechanism of Hormone IUDs:** Thickening of cervical mucus and endometrial atrophy.

Question 396: Which of the following is an absolute contraindication for combined oral contraceptive pills?

A. Diabetes mellitus
B. Migraine
C. Previous history of thromboembolism (Correct Answer)
D. Heart disease

Explanation: **Explanation:** The correct answer is **Previous history of thromboembolism**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which increases the hepatic synthesis of clotting factors (II, VII, IX, and X) and decreases anticoagulant levels (Antithrombin III). This creates a hypercoagulable state. Therefore, any condition involving active or past venous thromboembolism (VTE), pulmonary embolism, or major surgery with prolonged immobilization is an **absolute contraindication** (WHO Medical Eligibility Criteria Category 4). **Analysis of Incorrect Options:** * **Diabetes Mellitus:** It is generally a relative contraindication. It only becomes an absolute contraindication if there are vascular complications (nephropathy, retinopathy, neuropathy) or if the duration of diabetes is >20 years. * **Migraine:** Migraine *without* aura is a relative contraindication (Category 3). However, Migraine *with* aura at any age is an absolute contraindication due to the significantly increased risk of ischemic stroke. * **Heart Disease:** This is a broad term. While ischemic heart disease or complicated valvular disease are absolute contraindications, mild forms of heart disease are not. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (WHO Category 4):** Smoker >35 years (≥15 cigarettes/day), Hypertension (≥160/100 mmHg), Current Breast Cancer, and Acute Hepatitis/Cirrhosis. * **Cancer Risk:** COCPs *decrease* the risk of Ovarian and Endometrial cancers (protective effect) but slightly *increase* the risk of Breast and Cervical cancers. * **Drug Interaction:** Rifampicin and Antiepileptics (enzyme inducers) decrease the efficacy of COCPs.

Question 397: Which of the following is a non-modifiable risk factor for hypertension?

A. Gender (Correct Answer)
B. Obesity
C. Salt intake
D. Cultural characteristics acquired over time

Explanation: **Explanation:** Risk factors for hypertension are broadly categorized into two groups: **Non-modifiable** (factors that cannot be changed) and **Modifiable** (behavioral or environmental factors that can be intervened upon). **Why Gender is the Correct Answer:** Gender is a biological attribute determined at birth and cannot be altered through lifestyle or medical intervention. In the context of hypertension, males are generally at a higher risk at younger ages. However, post-menopause, the risk in females increases and often equals or exceeds that of males due to the loss of the protective effects of estrogen. Other non-modifiable factors include age, genetics/family history, and ethnicity. **Analysis of Incorrect Options:** * **B. Obesity:** This is a major modifiable risk factor. Weight reduction (maintaining a BMI between 18.5–24.9 kg/m²) is one of the most effective lifestyle interventions to lower blood pressure. * **C. Salt Intake:** High dietary sodium (>5g of NaCl/day) is a modifiable risk factor. Reducing salt intake is a primary preventive strategy in community medicine. * **D. Cultural characteristics:** While "culture" sounds fixed, these are "acquired over time" (e.g., dietary habits, sedentary lifestyle, or tobacco use). Since these are learned behaviors, they are considered modifiable through health education and behavioral change. **High-Yield NEET-PG Pearls:** * **Rule of Halves:** In hypertension, half the people in a community are aware of their status; half of those aware are on treatment; and half of those treated have their BP controlled. * **Most common modifiable risk factor:** Obesity/Sedentary lifestyle. * **Primary Prevention:** Focuses on population-based strategies (e.g., salt reduction) and high-risk strategies (e.g., weight loss). * **Tracking of Blood Pressure:** This phenomenon suggests that children whose BP is in the higher percentiles tend to maintain that position into adulthood.

Question 398: Which of the following statements is true about endemic typhus?

A. Is caused by Rickettsia rickettsii
B. Is transmitted by the bite of fleas (Correct Answer)
C. Has no mammalian reservoir
D. Can be cultured in a chemically defined culture medium

Explanation: **Explanation:** **Endemic Typhus** (also known as Murine Typhus) is caused by the bacterium ***Rickettsia typhi***. It is a zoonotic infection primarily maintained in a cycle between rats and fleas. 1. **Why Option B is Correct:** The primary vector for endemic typhus is the **rat flea (*Xenopsylla cheopis*)**. Transmission to humans occurs when flea feces containing the bacteria are rubbed into the bite wound or other abrasions on the skin. This distinguishes it from Epidemic Typhus, which is transmitted by the human body louse. 2. **Why Other Options are Incorrect:** * **Option A:** *Rickettsia rickettsii* is the causative agent of **Rocky Mountain Spotted Fever**, not endemic typhus. * **Option C:** Endemic typhus has a significant mammalian reservoir, primarily **commensal rats** (*Rattus rattus* and *Rattus norvegicus*). * **Option D:** Rickettsiae are **obligate intracellular pathogens**. They cannot be grown on cell-free, chemically defined media; they require living host cells (like yolk sacs of embryonated eggs or cell cultures) for growth. **High-Yield Clinical Pearls for NEET-PG:** * **The "Typhus Group":** Includes Endemic Typhus (*R. typhi*) and Epidemic Typhus (*R. prowazekii*). * **Weil-Felix Reaction:** A heterophile agglutination test used for diagnosis. Endemic Typhus shows a positive reaction with **OX-19**. * **Drug of Choice:** **Doxycycline** is the gold standard treatment for all rickettsial diseases. * **Brill-Zinsser Disease:** This is a recrudescence (relapse) of *Epidemic* typhus years after the primary attack, not endemic typhus.

Question 399: What is the best method to identify cases of tuberculosis within a community?

A. Chest X-ray
B. Mantoux test
C. Sputum smear examination (Correct Answer)
D. Sputum culture and sensitivity

Explanation: **Explanation:** In the context of public health and community medicine, **Sputum Smear Examination** (specifically for Acid-Fast Bacilli via Ziehl-Neelsen staining) remains the gold standard for **case identification** in a community setting. This is because it identifies "infectious cases"—those individuals who are actively shedding the bacteria and are responsible for the continued transmission of tuberculosis within the community. It is cost-effective, rapid, and highly specific for identifying the most contagious patients. **Analysis of Options:** * **A. Chest X-ray:** While highly sensitive, it is not specific for TB. It cannot differentiate between active infection, healed lesions, or other lung pathologies (like pneumonia or malignancy). It is used as a screening tool, not for definitive case identification. * **B. Mantoux Test:** This is a test of "infection," not "active disease." A positive result only indicates that the person has been exposed to *M. tuberculosis* at some point; it does not mean they currently have TB or are infectious. * **D. Sputum Culture:** This is the "absolute gold standard" for diagnosis and is more sensitive than a smear. However, it is **not the best method for community identification** because it takes 2–8 weeks to yield results, requires sophisticated laboratory infrastructure, and is expensive. **NEET-PG High-Yield Pearls:** * **Primary Tool:** Under the National TB Elimination Program (NTEP), **Sputum Smear** is the primary tool for diagnosis, though **NAAT (CBNAAT/Truenat)** is now the preferred initial diagnostic test where available. * **Infectivity:** One "smear-positive" case can infect 10–15 close contacts in a year if left untreated. * **Screening vs. Diagnosis:** In a community survey, Chest X-ray is the best **screening** tool, but Sputum examination is the best **diagnostic** tool.

Question 400: Malaria recrudescence is defined as:

A. Parasitemia resistant to treatment
B. Relapse of infection from dormant liver forms
C. Relapse specifically in Plasmodium vivax and ovale infections
D. Reappearance of parasitemia after a period of subpatent parasitemia during treatment (Correct Answer)

Explanation: **Explanation:** **1. Why Option D is Correct:** Recrudescence refers to the reappearance of malaria parasites in the blood after a period of being "subpatent" (levels too low to be detected by microscopy). This occurs because the initial treatment failed to completely clear the **erythrocytic (blood-stage)** parasites. It is essentially a failure of the drug to achieve total parasite clearance, allowing the surviving blood-stage parasites to multiply again. It can occur in all Plasmodium species, most notably *P. falciparum*. **2. Why Other Options are Incorrect:** * **Option A:** While recrudescence is often a clinical sign of drug resistance, the term itself describes the *phenomenon* of reappearance, not the definition of resistance. * **Options B & C:** These describe **Relapse**. Relapse is caused by the activation of dormant liver stages (**hypnozoites**), which are unique to *P. vivax* and *P. ovale*. Recrudescence, conversely, originates from surviving blood forms, not liver forms. **3. NEET-PG High-Yield Pearls:** * **Recrudescence:** Seen in all species (especially *P. falciparum*). Due to inadequate dosage, drug resistance, or incomplete treatment of blood stages. * **Relapse:** Seen only in *P. vivax* and *P. ovale*. Due to hypnozoites in the liver. **Primaquine** is the drug of choice to prevent relapse (Radical Cure). * **Incubation Period:** *P. falciparum* (12 days) < *P. vivax* (14 days) < *P. malariae* (28 days). * **Recurrence:** A broad term encompassing both recrudescence and relapse, or a new infection (re-infection).

Practice by Chapter

Epidemiology of NCDs

Practice Questions

Cardiovascular Disease Prevention

Practice Questions

Diabetes Control Program

Practice Questions

Cancer Screening and Control

Practice Questions

Chronic Respiratory Diseases

Practice Questions

Mental Health Program

Practice Questions

Blindness Control Program

Practice Questions

Accident and Injury Prevention

Practice Questions

NCD Risk Factor Surveillance

Practice Questions

National Program for Prevention and Control of Cancer, Diabetes, CVD, and Stroke

Practice Questions

Oral Health Program

Practice Questions

Geriatric Health Issues

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free