Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 421: Which of the following is NOT an early warning sign of cancer that the public should be aware of?

A. Persistent cough
B. Lump or hard area in breast
C. Unexplained weight gain (Correct Answer)
D. Change in wart or mole

Explanation: **Explanation:** The early warning signs of cancer are traditionally summarized by the American Cancer Society using the mnemonic **CAUTION**. The correct answer is **Unexplained weight gain** because, in the context of malignancy, **unexplained weight loss** (typically >10% of body weight over 6 months) is a classic systemic warning sign, not weight gain. Weight loss in cancer is often due to hypermetabolism and the release of cytokines like TNF-alpha (cachexin). **Analysis of Options:** * **A. Persistent cough:** This is the **'C'** in CAUTION (Cough or hoarseness). A cough lasting more than 3 weeks can be an early indicator of lung or laryngeal cancer. * **B. Lump or hard area in breast:** This represents the **'T'** in CAUTION (Thickening or lump in breast or elsewhere). It is one of the most common early signs of breast or soft tissue malignancies. * **D. Change in wart or mole:** This represents the **'O'** in CAUTION (Obvious change in a wart or mole). It is a critical warning sign for malignant melanoma, often assessed using the ABCDE criteria. **NEET-PG High-Yield Pearls:** * **CAUTION Mnemonic:** * **C:** Change in bowel/bladder habits (Colorectal/Bladder CA) * **A:** A sore that does not heal (Skin/Oral CA) * **U:** Unusual bleeding or discharge (Cervical/Endometrial CA) * **T:** Thickening or lump (Breast/Testicular CA) * **I:** Indigestion or difficulty swallowing (Esophageal/Gastric CA) * **O:** Obvious change in wart/mole (Melanoma) * **N:** Nagging cough or hoarseness (Lung/Laryngeal CA) * **Primary Prevention:** Tobacco cessation is the most effective strategy to reduce cancer burden. * **Secondary Prevention:** Screening for early detection (e.g., Pap smear for Cervical CA, Mammography for Breast CA).

Question 422: A 3-year-old male child presents with a bat bite on the face. Categorize the wound for rabies post-exposure prophylaxis.

A. Category 1
B. Category 2
C. Category 3 (Correct Answer)
D. Category 4

Explanation: ### Explanation **Correct Answer: C. Category 3** The categorization of rabies exposure is based on the severity of contact and the risk of virus transmission. According to WHO and National Guidelines (NRCP), **Category 3** exposure includes: 1. Single or multiple transdermal bites or scratches. 2. Licks on broken skin. 3. Contamination of mucous membranes with saliva (licks on eyes/mouth). 4. **Direct contact with bats.** In this case, the child has a bat bite on the face. Any direct contact with bats is automatically classified as Category 3 due to the high risk of rabies transmission and the often-imperceptible nature of bat bites. Furthermore, bites on highly vascular areas like the **face, head, neck, and fingertips** are always treated with the highest priority. **Why other options are incorrect:** * **Category 1:** Refers to touching or feeding animals, or licks on intact skin. No prophylaxis is required. * **Category 2:** Refers to minor scratches or abrasions without bleeding, or nibbling of uncovered skin. This requires vaccination but not Rabies Immunoglobulin (RIG). * **Category 4:** There is no "Category 4" in the standard WHO/National Rabies classification system. **High-Yield Clinical Pearls for NEET-PG:** * **Management of Category 3:** Requires immediate local wound washing (15 mins with soap and water), **Rabies Vaccine (ARV)**, and **Rabies Immunoglobulin (RIG)** infiltrated into the wound. * **Bat Bites:** In many regions, bat bites are considered Category 3 even if the bite is not visible. * **Site Importance:** Bites on the face have a shorter incubation period because the virus reaches the CNS faster via cranial nerves. * **Rule of Thumb:** If it bleeds, it is Category 3. If it involves a bat, it is Category 3.

Question 423: In the grading of trachoma, trachomatous inflammation - follicular is defined as the presence of?

A. 5 or more follicles in the lower tarsal conjunctiva
B. 3 or more follicles in the lower tarsal conjunctiva
C. 5 or more follicles in the upper tarsal conjunctiva (Correct Answer)
D. 3 or more follicles in the upper tarsal conjunctiva

Explanation: This question tests your knowledge of the **WHO Simplified Grading System for Trachoma**, which was developed to facilitate easy diagnosis by non-specialist health workers in the field. ### **Explanation of the Correct Answer** **Trachomatous Inflammation—Follicular (TF)** is the earliest clinical stage of active trachoma. According to the WHO criteria, it is defined as the presence of **5 or more follicles** in the **central part of the upper tarsal conjunctiva**. Each follicle must be at least **0.5 mm** in diameter. The upper tarsal conjunctiva is the specific site of examination because it is the primary area where *Chlamydia trachomatis* infection manifests and leads to subsequent scarring. ### **Analysis of Incorrect Options** * **Options A & B (Lower Tarsal Conjunctiva):** These are incorrect because follicles in the lower conjunctiva are non-specific and can occur in various other types of viral or allergic conjunctivitis. The WHO grading system specifically mandates the examination of the **upper** eyelid. * **Option D (3 follicles):** This is incorrect because the diagnostic threshold is strictly **5 follicles**. A count of fewer than 5 is not considered significant enough for a diagnosis of TF in epidemiological surveys. ### **High-Yield Clinical Pearls for NEET-PG** To remember the WHO **"FISTO"** grading system: 1. **TF (Follicular):** $\geq$ 5 follicles (0.5 mm) on the upper tarsal conjunctiva. 2. **TI (Intense Inflammation):** Pronounced inflammatory thickening that obscures >50% of the normal deep tarsal vessels. 3. **TS (Scarring):** Presence of easily visible white fibrous bands (Arlt's line). 4. **TT (Trichiasis):** At least one eyelash rubbing against the eyeball. 5. **CO (Corneal Opacity):** Easily visible opacity over the pupil. **Note:** For the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement), the community-wide antibiotic (Azithromycin) is indicated if the prevalence of **TF** is >5% in children aged 1–9 years.

Question 424: Measles vaccination is given at what age?

A. Birth
B. 9 months (Correct Answer)
C. 1.5 years
D. 2 months

Explanation: **Explanation:** In the National Immunization Schedule (NIS) of India, the first dose of the **Measles-Rubella (MR) vaccine** is administered at **9 completed months** (up to 12 months). **Why 9 months?** The timing is based on the persistence of **maternally derived antibodies**. If the vaccine is given too early, these passive antibodies neutralize the vaccine virus, preventing an effective immune response. By 9 months, maternal antibody levels decline sufficiently in most infants to allow for successful seroconversion. **Analysis of Options:** * **A. Birth:** Vaccines given at birth include BCG, OPV-0, and Hepatitis B. Measles is not given due to high maternal antibody interference. * **C. 1.5 years (16–24 months):** This is the timing for the **second dose** (MR-2) to cover those who did not seroconvert after the first dose. * **D. 2 months:** At this age, the Pentavalent vaccine (DPT, HepB, Hib), Rotavirus, and IPV are administered. **High-Yield Clinical Pearls for NEET-PG:** * **Route & Dose:** 0.5 ml, Subcutaneous (SC) in the right upper arm. * **Outbreak Response:** During a measles outbreak, the vaccine can be given as early as **6 months** (known as the "Measles-0" dose), but this does not count towards the routine schedule; the 9-month dose must still be administered. * **Vitamin A:** It is mandatory to administer 1 lakh IU of Vitamin A along with the 9-month measles dose to reduce morbidity and prevent post-measles blindness. * **Type of Vaccine:** Live attenuated (Edmonston-Zagreb strain is commonly used in India).

Question 425: Chandler's Index is used to assess the prevalence of which helminthic infection?

A. Roundworm
B. Hookworm (Correct Answer)
C. Pinworm
D. Guinea worm

Explanation: **Explanation:** **Chandler’s Index** is the standard epidemiological measure used to assess the prevalence and intensity of **Hookworm** (*Ancylostoma duodenale* and *Necator americanus*) infection in a community. It is calculated as the **average number of eggs per gram (EPG) of stool** across the entire population sampled. This index is crucial because the clinical severity of hookworm (primarily iron-deficiency anemia) is directly proportional to the worm burden. An index of less than 200-250 EPG indicates a minor public health problem, while higher values signify a significant health threat. **Analysis of Incorrect Options:** * **A. Roundworm (*Ascaris lumbricoides*):** While EPG is used to estimate worm burden, Chandler’s Index is specifically nomenclature reserved for Hookworm. Roundworm prevalence is usually measured by simple prevalence rates. * **C. Pinworm (*Enterobius vermicularis*):** Diagnosis and prevalence are assessed via the **NIH Swab** or **Scotch Tape test**, as eggs are rarely found in routine stool samples. * **D. Guinea worm (*Dracunculus medinensis*):** This is monitored through case surveillance of skin ulcers. India was certified Guinea worm-free in 2000. **High-Yield Clinical Pearls for NEET-PG:** * **Hookworm:** Associated with "Ground Itch" (larval entry) and microcytic hypochromic anemia. * **Stool Examination:** The **Kato-Katz technique** is the gold standard for quantifying EPG for Hookworm, Ascaris, and Trichuris. * **Public Health Threshold:** A Chandler’s Index **>250-300** is generally considered the threshold for initiating mass deworming programs in a community.

Question 426: KFD is caused by which of the following?

A. Flavivirus (Correct Answer)
B. Myxovirus
C. Alphavirus
D. Phlebovirus

Explanation: **Explanation:** **Kyasanur Forest Disease (KFD)**, also known as "Monkey Fever," is caused by the **Kyasanur Forest Disease Virus (KFDV)**, which belongs to the family **Flaviviridae** and the genus **Flavivirus**. 1. **Why Flavivirus is Correct:** KFDV is a tick-borne virus genetically related to other Flaviviruses like Yellow Fever, Dengue, and West Nile virus. It is primarily transmitted to humans through the bite of infected ticks (*Haemaphysalis spinigera*), often following contact with dead monkeys (Langurs and Bonnet macaques), which act as amplifier hosts. 2. **Why Incorrect Options are Wrong:** * **Myxovirus:** This group includes Orthomyxoviruses (e.g., Influenza) and Paramyxoviruses (e.g., Measles, Mumps). These are primarily respiratory viruses. * **Alphavirus:** This genus belongs to the Togaviridae family and includes viruses like Chikungunya and Eastern Equine Encephalitis. * **Phlebovirus:** This genus belongs to the Phenuiviridae family (formerly Bunyaviridae) and includes Rift Valley Fever and Sandfly Fever viruses. **High-Yield Clinical Pearls for NEET-PG:** * **Geographic Distribution:** Endemic to the Western Ghats of India (first discovered in Shimoga district, Karnataka, 1957). * **Vector:** *Haemaphysalis spinigera* (Hard tick). * **Reservoirs:** Rodents, shrews, and monkeys. * **Clinical Feature:** Biphasic illness characterized by sudden onset high fever, severe headache, myalgia, and hemorrhagic manifestations. * **Vaccination:** A formalin-inactivated KFDV vaccine is used in endemic areas (given to individuals aged 7–65 years).

Question 427: Which disease is primarily spread through contaminated water?

A. Hepatitis B
B. Hepatitis C
C. HIV
D. Typhoid (Correct Answer)

Explanation: **Explanation:** **Typhoid fever** (Enteric fever) is caused by *Salmonella typhi*. It is primarily transmitted via the **fecal-oral route**, most commonly through the ingestion of **contaminated water** or food handled by an infected person or chronic carrier. In areas with poor sanitation, water serves as the major vehicle for transmission, leading to endemicity or explosive outbreaks. **Analysis of Incorrect Options:** * **Hepatitis B & C:** These are **blood-borne viruses**. Transmission occurs through parenteral routes (infected blood/blood products), sexual contact, or vertical transmission (mother to child). They are not transmitted through contaminated water or food. (Note: Hepatitis A and E are the types transmitted via the fecal-oral route). * **HIV:** Human Immunodeficiency Virus is transmitted through sexual contact, contaminated needles, blood transfusions, and from mother to child (in utero, during delivery, or via breastfeeding). It is not waterborne. **NEET-PG High-Yield Pearls:** * **The "Carrier" State:** The gallbladder is the most common site of chronic colonization in typhoid carriers (e.g., the famous case of "Typhoid Mary"). * **Diagnostic Tests:** Use the **BASU** mnemonic for timing: **B**lood culture (1st week), **A**ntibody/Widal test (2nd week), **S**tool culture (3rd week), **U**rine culture (4th week). * **Clinical Sign:** Look for "Rose Spots" on the trunk and "Step-ladder" pattern fever. * **Public Health:** The most effective preventive measure for waterborne diseases like Typhoid is the improvement of environmental sanitation and "Chlorination" of water supplies.

Question 428: A patient develops red eye two days after an episode of malaria. What is the probable cause?

A. Conjunctivitis
B. Anterior uveitis
C. Viral keratitis (Correct Answer)
D. Endophthalmitis

Explanation: **Explanation:** The correct answer is **Viral Keratitis** (specifically Herpes Simplex Keratitis). **Medical Concept:** The association between malaria and viral keratitis is a classic clinical correlation. Malaria causes high-grade fever, which acts as a potent trigger for the reactivation of the **Herpes Simplex Virus (HSV)** latent in the trigeminal ganglion. This reactivation leads to the development of dendritic ulcers on the cornea, manifesting as a "red eye" shortly after the febrile episode. In medical literature, these are often referred to as "malarial ulcers," though the causative agent is viral, not the plasmodium parasite itself. **Analysis of Incorrect Options:** * **Conjunctivitis:** While it causes red eye, it is usually associated with discharge (mucopurulent or watery) and is not specifically triggered by a prior malarial febrile paroxysm. * **Anterior Uveitis:** This typically presents with photophobia, deep-seated pain, and a ciliary flush. While it can be associated with systemic diseases, it is not the classic post-malarial ocular complication. * **Endophthalmitis:** This is a severe intraocular inflammation (usually bacterial or fungal) typically following surgery or trauma. It is an ophthalmic emergency and not a sequela of systemic malaria. **High-Yield Pearls for NEET-PG:** * **Trigger Factor:** Any condition causing high fever (Malaria, Pneumonia, Influenza) can reactivate HSV. * **Clinical Sign:** The hallmark of HSV keratitis is the **dendritic ulcer** (stained with fluorescein). * **Treatment Contraindication:** Never use topical steroids in active dendritic keratitis, as it can lead to a "geographic ulcer." * **Drug of Choice:** Topical Acyclovir 3% ointment.

Question 429: Death in poliomyelitis is usually due to?

A. Hypertension
B. Respiratory Paralysis (Correct Answer)
C. Aspiration
D. Arrhythmias

Explanation: **Explanation:** The primary cause of mortality in Poliomyelitis is **Respiratory Paralysis**. While the majority of polio cases are asymptomatic or mild, paralytic polio occurs in about 1% of infections. Death occurs when the virus affects the motor neurons responsible for breathing. This happens through two main mechanisms: 1. **Bulbar Polio:** The virus attacks the brainstem (medulla oblongata), paralyzing the cranial nerves and the vital respiratory control centers. 2. **Spinal Polio:** High cervical cord involvement leads to paralysis of the **phrenic nerve** (C3-C5), causing diaphragm failure, or involvement of thoracic segments leading to intercostal muscle paralysis. **Analysis of Incorrect Options:** * **Hypertension (A):** While autonomic dysfunction can occur in bulbar polio leading to blood pressure fluctuations, it is rarely the direct cause of death. * **Aspiration (C):** Bulbar involvement causes pharyngeal paralysis and loss of gag reflex, which significantly increases the risk of aspiration pneumonia. While a serious complication, the immediate cause of death in the acute phase is typically the failure of the respiratory pump itself. * **Arrhythmias (D):** Involvement of the cardiovascular centers in the medulla can lead to tachycardia or arrhythmias, but these are secondary to the profound hypoxia caused by respiratory failure. **High-Yield Pearls for NEET-PG:** * **Most common type of Polio:** Inapparent/Asymptomatic infection (91-96%). * **Most common strain causing paralysis:** Type 1 (Brunhilde). * **Eradication status:** Type 2 (1999) and Type 3 (2012) have been globally eradicated. * **Clinical Sign:** "Tripod sign" (inability to sit upright without supporting hands behind the back) indicates meningeal irritation. * **Post-Polio Syndrome:** Occurs 15–40 years after recovery due to the gradual degeneration of remaining motor neurons.

Question 430: Which of the following is not monitored in malaria surveillance currently?

A. ABER
B. Infant parasite rate (Correct Answer)
C. Annual parasite incidence
D. Slide positivity rate

Explanation: **Explanation:** In the current strategy of the **National Center for Vector Borne Diseases Control (NCVBDC)**, surveillance focuses on the active and passive detection of cases within the general population to monitor transmission intensity and program efficiency. **Why "Infant Parasite Rate" is the correct answer:** The **Infant Parasite Rate (IPR)** is defined as the percentage of infants (under 1 year) showing parasites in their blood. While it was historically considered the best indicator of **recent/current malaria transmission** in a locality, it is no longer used for routine monitoring under the current National Program. Modern surveillance shifted towards more comprehensive community-wide indices. **Analysis of Incorrect Options:** * **ABER (Annual Blood Examination Rate):** This monitors the **efficiency of the surveillance system**. It measures the number of slides examined per 100 population per year. A minimum ABER of 10% is generally required to ensure adequate case detection. * **API (Annual Parasite Incidence):** This is the **primary indicator** used to classify malaria endemicity in an area. It is calculated as (Total confirmed cases / Total population) × 1000. * **SPR (Slide Positivity Rate):** This measures the proportion of slides found positive among those examined. It is a sensitive indicator of the **prevalence of malaria** in a community at a given time. **High-Yield Pearls for NEET-PG:** * **API < 1** is the threshold for an area to enter the "Elimination Phase." * **Annual Falciparum Incidence (AFI)** and **Slide Falciparum Rate (SFR)** are used specifically to monitor the burden of *P. falciparum*. * **Active Surveillance:** Health workers visit houses (usually fortnightly) to detect fever cases. * **Passive Surveillance:** Cases are detected when patients voluntarily visit health facilities.

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