Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 411: Which of the following is not included in the calculation of the infant mortality rate?

A. Stillbirths (Correct Answer)
B. Early neonatal deaths
C. Late neonatal deaths
D. Post-neonatal deaths

Explanation: ### Explanation **1. Why Stillbirths is the Correct Answer:** The **Infant Mortality Rate (IMR)** is defined as the number of deaths of children **under one year of age** per 1,000 **live births** in a given year. The fundamental concept here is the denominator: "Live Births." By definition, a stillbirth (fetal death after 28 weeks of gestation) does not show any signs of life at birth and is therefore never counted as a live birth. Since IMR only tracks deaths occurring *after* a live birth, stillbirths are excluded. They are instead accounted for in the Stillbirth Rate and the Perinatal Mortality Rate. **2. Why the Other Options are Incorrect:** Infant mortality is the sum of neonatal and post-neonatal deaths. * **Early Neonatal Deaths (Option B):** Deaths occurring within the first 7 days of life (0–6 days). * **Late Neonatal Deaths (Option C):** Deaths occurring from day 7 to under 28 days of life. * **Post-Neonatal Deaths (Option D):** Deaths occurring from 28 days to under one year of age. All three categories represent deaths of infants born alive who died before their first birthday, making them integral components of the IMR. **3. High-Yield Clinical Pearls for NEET-PG:** * **IMR Formula:** (Number of deaths under 1 year of age / Total live births) × 1000. * **Indicator Status:** IMR is considered the most sensitive indicator of the availability, utilization, and effectiveness of health care (particularly maternal and child health). * **Perinatal Mortality Rate (PMR):** Includes late fetal deaths (stillbirths) plus early neonatal deaths. * **Neonatal Mortality Rate (NMR):** This contributes to nearly 75% of the IMR in India, with the majority occurring in the early neonatal period.

Question 412: What is the definition of relapse in tuberculosis (TB)?

A. A patient who is sputum positive after previously completing treatment and then remaining sputum negative for at least 2 months.
B. A patient who returns to being sputum positive after having been previously cured by treatment. (Correct Answer)
C. A patient who remains sputum positive throughout 5 months of treatment.
D. None of the above.

Explanation: ### Explanation **Correct Answer: B. A patient who returns to being sputum positive after having been previously cured by treatment.** In the context of the National Tuberculosis Elimination Programme (NTEP), a **Relapse** is defined as a patient who was previously treated for TB, was declared "Cured" or "Treatment Completed" at the end of their most recent course of treatment, and is now diagnosed with a recurrent episode of TB (either bacteriologically positive or clinically diagnosed). The core concept is the reappearance of the disease after a successful outcome. **Analysis of Options:** * **Option A:** This is technically incorrect because the definition of relapse does not mandate a specific "2-month" window of negativity; rather, it requires the patient to have achieved a successful treatment outcome (Cured/Completed) before the new episode occurs. * **Option C:** This describes **Treatment Failure**. Under NTEP, a patient whose biological specimen is positive at 4 months or later during treatment is considered a failure. * **Option D:** Incorrect as Option B accurately reflects the clinical definition. **High-Yield Clinical Pearls for NEET-PG:** * **Recurrent TB:** This is the umbrella term for any patient previously treated for TB (for >1 month) who is now diagnosed with TB again. It includes both Relapse and Reinfection. * **Treatment After Loss to Follow-up (ALF):** Previously called "Default," this refers to a patient who returns to treatment after interrupting it for **one month or more** consecutively. * **Cured vs. Treatment Completed:** * **Cured:** Microbiologically confirmed TB at baseline who is smear/culture negative in the last month of treatment. * **Treatment Completed:** Patient who completed treatment but does not have a documented negative smear/culture in the last month (often used for clinically diagnosed cases).

Question 413: The last known case of smallpox originated from which country?

A. Somalia (Correct Answer)
B. Ethiopia
C. India
D. Bangladesh

Explanation: The correct answer is **Somalia**. ### **Explanation** Smallpox, caused by the *Variola virus*, is the only human infectious disease to be completely eradicated globally. The timeline of its elimination is a high-yield topic for NEET-PG: * **The Last Natural Case:** The last case of **Variola minor** (the milder form) occurred in **Ali Maow Maalin** in **Somalia** on **October 26, 1977**. This is considered the "last known case" originating from a natural transmission cycle. * **Global Eradication:** Following a two-year surveillance period with no new cases, the WHO officially declared the world free of smallpox on **May 8, 1980**. ### **Analysis of Incorrect Options** * **B. Ethiopia:** Ethiopia was one of the last strongholds of smallpox in Africa, but the chain of transmission was broken there shortly before the final cases in Somalia. * **C. India:** The last case of smallpox in India occurred in **May 1975** (Saiban Bibi, West Bengal). India was declared smallpox-free in April 1977. * **D. Bangladesh:** The last case of **Variola major** (the more severe form) occurred in **Rahima Banu** in Bangladesh in **October 1975**. While significant, it was not the final case of smallpox globally. ### **High-Yield Clinical Pearls for NEET-PG** * **Last Laboratory Case:** In 1978, a medical photographer (Janet Parker) died due to a laboratory accident in **Birmingham, UK**. This is the absolute last human death from smallpox, but it was not a "natural" case. * **Vaccine:** Smallpox was eradicated using the **Bifurcated Needle** and the **Ring Vaccination** strategy (surveillance and containment). * **Incubation Period:** 7–17 days (Average 12 days). * **Rash Distribution:** Centrifugal (more on face and extremities than the trunk). This distinguishes it from Chickenpox (Centripetal).

Question 414: With regard to hypertension, which is not a mode of primary prevention?

A. Weight reduction
B. Exercise
C. Reduced salt intake
D. Early diagnosis of hypertension (Correct Answer)

Explanation: ### Explanation The core of this question lies in understanding the **Levels of Prevention** in Public Health. **1. Why "Early diagnosis of hypertension" is the correct answer:** Early diagnosis and prompt treatment constitute **Secondary Prevention**. Secondary prevention aims to halt the progress of a disease in its incipient stage and prevent complications. Since the individual already has the condition (hypertension) but is being diagnosed early to manage it, it cannot be primary prevention. **2. Why the other options are incorrect (Primary Prevention):** Primary prevention aims to prevent the onset of disease by controlling causes and risk factors. It is applied to the "Pre-pathogenesis" phase. * **Weight reduction (A):** Obesity is a major risk factor. Reducing weight prevents the development of hypertension. * **Exercise (B):** Regular physical activity improves cardiovascular health and prevents the rise of blood pressure. * **Reduced salt intake (C):** High sodium intake is a direct causal factor; limiting it is a classic example of "Specific Protection" (a sub-type of primary prevention). **3. NEET-PG High-Yield Pearls:** * **Primordial Prevention:** This is the prevention of the *emergence* of risk factors (e.g., discouraging children from starting a sedentary lifestyle or smoking). * **Primary Prevention:** Includes **Health Promotion** (lifestyle changes) and **Specific Protection** (immunization, salt restriction). * **Secondary Prevention:** Includes **Early Diagnosis** (screening, case finding) and **Treatment**. * **Tertiary Prevention:** Includes **Disability Limitation** and **Rehabilitation** (e.g., post-stroke physiotherapy). * **Rule of Halves:** In hypertension, only half of the people are aware they have it; only half of those aware are on treatment; and only half of those treated have their BP controlled.

Question 415: Screening for which carcinoma is beneficial?

A. Carcinoma of the cervix (Correct Answer)
B. Lung carcinoma
C. Stomach carcinoma
D. None of the above

Explanation: **Explanation:** The correct answer is **Carcinoma of the cervix**. For a screening program to be considered "beneficial" and viable in public health, the disease must have a recognizable latent or early asymptomatic stage, and there must be an effective, acceptable treatment available. **1. Why Carcinoma of the Cervix is correct:** Cervical cancer is the "ideal" cancer for screening. It has a long natural history (pre-malignant phase lasting 10–15 years), allowing for early detection via **Pap smear** or **VIA (Visual Inspection with Acetic Acid)**. Screening significantly reduces morbidity and mortality because treating pre-invasive lesions (CIN) is highly effective and curative. **2. Why the other options are incorrect:** * **Lung Carcinoma:** Screening (e.g., Low-dose CT) is generally not recommended for the mass population. By the time it is detectable, it is often advanced, and there is no evidence that mass screening significantly improves overall survival rates in the general population. * **Stomach Carcinoma:** While screening is practiced in high-prevalence countries like Japan (using endoscopy), it is not considered beneficial or cost-effective as a global standard or in the Indian context due to the invasive nature of the tests and poor prognosis even with early detection. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Recommendation:** Screening for cervical cancer should start at age 30 (25 in some guidelines) and continue every 5–10 years. * **VIA:** The most cost-effective screening method in low-resource settings (like India). * **Wilson and Jungner Criteria:** These are the gold standard criteria used to decide if a disease should be screened. * **Other beneficial screenings:** Breast cancer (Mammography) and Colorectal cancer (Fecal Occult Blood Test/Colonoscopy).

Question 416: According to WHO, mass drug administration is indicated for all conditions except?

A. Lymphatic Filariasis
B. Vitamin A Deficiency
C. Worm Infestation
D. Scabies (Correct Answer)

Explanation: **Explanation:** Mass Drug Administration (MDA) is a public health strategy where the entire population of a specific geographic area (regardless of individual disease status) is given curative/preventive medication simultaneously to achieve control or elimination of a disease. **Why Scabies is the Correct Answer:** While Scabies is a significant public health problem, the WHO does not currently recommend universal **Mass Drug Administration** for it as a global standard policy in the same vein as Neglected Tropical Diseases (NTDs). Instead, management focuses on **Mass Treatment** of cases and their close contacts (household members). While some pilot studies use MDA with Ivermectin for Scabies in high-prevalence endemic islands, it is not a standard WHO-mandated MDA program like those for Filariasis or Soil-Transmitted Helminths. **Analysis of Incorrect Options:** * **Lymphatic Filariasis:** A classic example of MDA. The WHO Global Programme to Eliminate Lymphatic Filariasis (GPELF) uses annual single doses of **DEC + Albendazole** (or Ivermectin in specific areas) for the entire at-risk population. * **Vitamin A Deficiency:** Under the National Prophylaxis Programme against Nutritional Blindness, periodic mass administration of high-dose Vitamin A is given to all children aged 6 months to 5 years. * **Worm Infestation:** The WHO recommends MDA (Deworming) using **Albendazole or Mebendazole** for all children in areas where the prevalence of soil-transmitted helminths is over 20%. **High-Yield Clinical Pearls for NEET-PG:** * **National Deworming Day (India):** Observed on **February 10th** (with a mop-up day on Feb 15th). * **Trachoma:** Also managed via MDA using the **SAFE strategy** (Surgical care, Antibiotics—Azithromycin MDA, Facial cleanliness, Environmental improvement). * **Onchocerciasis:** Managed via MDA using **Ivermectin**. * **Schistosomiasis:** Managed via MDA using **Praziquantel**.

Question 417: All of the following are true about Typhoid fever except:

A. Incubation period is 10-14 days
B. It is most common among males
C. Carriers can be treated by ampicillin
D. The highest incidence occurs in the 30-40 years age group (Correct Answer)

Explanation: **Explanation:** The correct answer is **D**. In endemic areas like India, Typhoid fever (Enteric fever) primarily affects children and young adults. The highest incidence is typically observed in the **5–19 years age group**, not the 30–40 years group. By the fourth decade of life, many individuals have developed partial immunity due to repeated subclinical exposures. **Analysis of Options:** * **Option A:** The incubation period is typically **10–14 days**, though it can range from 3 days to 3 weeks depending on the dose of inoculum. * **Option B:** Epidemiological data shows a higher prevalence in **males** compared to females, often attributed to greater outdoor exposure and consumption of contaminated street food/water. * **Option C:** Chronic carriers (who harbor *S. typhi* in the gallbladder) can be treated with **Ampicillin or Amoxicillin** (4-6g/day) combined with Probenecid for 6 weeks. However, in the presence of gallstones, cholecystectomy is often required for a permanent cure. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoir:** Man is the only known reservoir. * **Carrier State:** A "Chronic Carrier" excretes bacilli for more than **one year**. The **Ty21a** oral vaccine is a live attenuated strain, while the **Vi polysaccharide** is injectable. * **Clinical Signs:** Look for "Step-ladder pyrexia," "Rose spots" (2nd week), and "Relative bradycardia" (Faget’s sign). * **Diagnosis:** Use the **BASU** mnemonic for culture: **B**lood (1st week), **A**gglutination/Widal (2nd week), **S**tool (3rd week), **U**rine (4th week). Bone marrow culture is the most sensitive.

Question 418: The pearl index indicates the number of accidental pregnancies per?

A. 100 population
B. 100 live births
C. 100 women in the age group of 15 to 44 years
D. 100 women-years (Correct Answer)

Explanation: **Explanation:** The **Pearl Index (PI)** is the most common method used in clinical trials and epidemiological studies to measure the **effectiveness of a contraceptive method**. It calculates the failure rate by determining the number of unintended pregnancies per 100 woman-years of exposure. **1. Why the Correct Answer is Right:** The denominator of the Pearl Index is **"Woman-Years of exposure."** One woman-year represents 12 months (or 13 lunar cycles) of contraceptive use by one woman. By expressing the rate per **100 woman-years**, the index provides a standardized measure of how many women out of 100 would become pregnant if they used the specific contraceptive method for exactly one year. * **Formula:** $PI = \frac{\text{Total Accidental Pregnancies} \times 1200}{\text{Total Months of Exposure}}$ (or $\times 1300$ if using lunar cycles). **2. Why the Other Options are Wrong:** * **Option A & C:** These are general population or demographic denominators. They do not account for the *duration of time* a woman is at risk of pregnancy while using a specific contraceptive. * **Option B:** "Per 100 live births" is typically used for calculating ratios like the Maternal Mortality Ratio (MMR), not contraceptive efficacy. **3. High-Yield Clinical Pearls for NEET-PG:** * **Lower the Pearl Index, higher the efficacy:** For example, Implants (0.05) and Vasectomy (0.1) have very low PIs, whereas the Rhythm method has a high PI (~25). * **Limitation:** The Pearl Index assumes a constant failure rate over time, failing to account for the fact that most contraceptive failures occur in the first few months of use. * **Life Table Analysis:** This is considered superior to the Pearl Index because it calculates "failure rates" at specific intervals (e.g., at 6 months, 12 months), providing a more accurate picture of user experience over time.

Question 419: Which of the following drugs is NOT used for malaria prophylaxis?

A. Doxycycline
B. Aesunate (Correct Answer)
C. Chloroquine
D. Mefloquine

Explanation: **Explanation:** The core concept here is the distinction between **chemoprophylaxis** (prevention) and **chemotherapy** (treatment) of malaria. **Why Artesunate is the correct answer:** Artesunate is a water-soluble Artemisinin derivative. It is the drug of choice for the **treatment** of severe and complicated malaria (P. falciparum) due to its rapid action on the erythrocytic stages of the parasite. However, it is **never used for prophylaxis** because of its very short half-life (approx. 30–60 minutes), which would require multiple daily doses, and to prevent the development of drug resistance to this life-saving class of antimalarials. **Analysis of Incorrect Options:** * **Chloroquine (Option C):** Historically the gold standard for prophylaxis. It is still used for prophylaxis in areas with chloroquine-sensitive malaria (e.g., parts of Central America). * **Mefloquine (Option D):** Used for long-term prophylaxis in areas with chloroquine resistance. It is taken once weekly, starting 2 weeks before travel. * **Doxycycline (Option A):** Used for short-term prophylaxis, especially in areas with multi-drug resistant P. falciparum. It is taken daily. **High-Yield NEET-PG Pearls:** 1. **Prophylaxis Choice:** Depends on the duration of stay. **Short-term** (<6 weeks): Doxycycline; **Long-term** (>6 weeks): Mefloquine. 2. **Contraindications:** Mefloquine is contraindicated in patients with neuropsychiatric disorders or seizures. Doxycycline is contraindicated in pregnancy and children <8 years. 3. **Pregnancy:** Chloroquine is safe for prophylaxis in all trimesters. 4. **Primaquine:** Used for "Terminal Prophylaxis" to prevent relapses of P. vivax and P. ovale by targeting hypnozoites. Always check G6PD status before administration.

Question 420: Which type of carrier receives organisms from another carrier?

A. Contact carrier
B. Paradoxical carrier (Correct Answer)
C. Convalescent carrier
D. Chronic carrier

Explanation: ### Explanation **Correct Answer: B. Paradoxical carrier** In epidemiology, a **Paradoxical carrier** is defined as an individual who acquires the infectious agent from another carrier, rather than from a clinical case. This creates a "paradox" where the infection circulates within a population without an obvious symptomatic source. #### Analysis of Options: * **Contact carrier (Option A):** This is a person who acquires the organism through contact with a **clinical case** (an ill person). They harbor the pathogen but do not show symptoms themselves. * **Convalescent carrier (Option C):** This refers to a person who continues to shed the infectious agent during the period of **recovery** (convalescence) after suffering from the clinical disease. * **Chronic carrier (Option D):** This is an individual who continues to harbor the infectious agent for an extended period (usually **more than 3 to 6 months** depending on the disease) following the initial infection. --- ### High-Yield NEET-PG Pearls: * **Carrier State:** Defined by three elements: Presence of specific antibodies, absence of clinical symptoms, and the ability to shed the organism (source of infection). * **Incubatory Carrier:** Sheds the agent during the incubation period (e.g., Measles, Mumps, Hepatitis B). * **Pseudo-carrier:** A term sometimes used for individuals who harbor non-pathogenic organisms that resemble pathogens. * **Typhoid Mary:** The most famous example of a **Chronic carrier** (Gallbladder is the reservoir for *S. typhi*). * **Epidemiological Importance:** Carriers are often more dangerous than cases because they are "hidden" in the community, move around freely, and do not seek treatment.

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