Non-Communicable Diseases — MCQs

Consider the following statements regarding Infant Mortality Rate: 1. Infant mortality rate takes into account the death of infants within a month after birth. 2. Infant mortality rate is the number of infant deaths in a particular year per 100 live births during that year. Which of the above statements is/are correct?

Q478Easy

How many doses of vaccine are involved in pre-exposure prophylaxis for rabies with HDVC?

Q479Medium

Maternal antibodies are not present for which of the following diseases?

Q480Easy

In a sub-centre with a population of 5000, and a birth rate of 30 per thousand, what is the estimated number of pregnant women?

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 471: Who developed the oral polio vaccine?

A. Louis Pasteur
B. Albert Sabin (Correct Answer)
C. Jonas Salk
D. None of the above

Explanation: **Explanation:** The correct answer is **Albert Sabin**. In 1961, Albert Sabin developed the **Oral Polio Vaccine (OPV)**, which contains live-attenuated viruses. This vaccine is administered orally and is instrumental in global eradication efforts because it induces both systemic immunity (IgG) and local mucosal immunity (IgA) in the gut, effectively blocking the transmission of the wild poliovirus. **Analysis of Options:** * **Jonas Salk:** He developed the first successful polio vaccine in 1955, known as the **Inactivated Polio Vaccine (IPV)**. Unlike Sabin’s vaccine, IPV is administered via injection and contains killed viruses. It provides systemic immunity but limited mucosal immunity. * **Louis Pasteur:** A pioneer in microbiology, he developed vaccines for **Rabies and Anthrax**, but was not involved in polio vaccine development. * **None of the above:** Incorrect, as Albert Sabin is the recognized developer of the OPV. **High-Yield Clinical Pearls for NEET-PG:** * **Vaccine Strains:** OPV (Sabin) originally contained types 1, 2, and 3. Currently, the **bOPV (Bivalent OPV)** used in routine immunization contains only types 1 and 3 (Type 2 was removed to prevent Vaccine-Derived Poliovirus/VDPV). * **Pulse Polio Immunization:** Uses OPV to create "herd immunity" by displacing wild viruses from the community. * **VAPP vs. VDPV:** Vaccine-Associated Paralytic Poliomyelitis (VAPP) is a rare adverse effect of OPV, whereas VDPV occurs due to the long-term circulation of the attenuated virus in under-immunized populations. * **Current Strategy:** India currently uses a combination of **bOPV** and **fractional doses of IPV (fIPV)** administered intradermally at 6, 14 weeks, and 9 months.

Question 472: Leprosy is not yet eradicated because of which of the following reasons?

A. Absence of an effective vaccine
B. High infectivity with low pathogenicity
C. Humans are the only reservoir
D. Long incubation period (Correct Answer)

Explanation: **Explanation:** The primary reason leprosy remains a challenge for global eradication is its **long incubation period**, which typically ranges from **3 to 5 years** (can extend up to 20 years). This prolonged "silent" phase means that an infected individual can remain asymptomatic for years while potentially contributing to the transmission chain. By the time clinical symptoms appear and the patient is diagnosed, they may have already infected several close contacts, making it difficult to map and break the transmission cycle effectively. **Analysis of Options:** * **A. Absence of an effective vaccine:** While there is no specific "leprosy vaccine," the **BCG vaccine** provides significant cross-protection (approx. 50%) against *M. leprae*. While a more potent vaccine would help, the long incubation period is a more fundamental barrier to eradication. * **B. High infectivity with low pathogenicity:** This is actually a characteristic of leprosy (high infectivity but low virulence/pathogenicity). However, this usually favors control efforts because most people exposed do not develop the disease. It is the *latency*, not the infectivity pattern, that hinders eradication. * **C. Humans are the only reservoir:** This is generally true (though armadillos are a minor zoonotic source in the Americas). If humans were the *only* reservoir, it would actually make eradication **easier** (similar to Smallpox), not harder. **NEET-PG High-Yield Pearls:** * **Causative Agent:** *Mycobacterium leprae* (Acid-fast, obligate intracellular, grows best at 30°C). * **Elimination vs. Eradication:** Leprosy was "eliminated" as a public health problem (defined as <1 case per 10,000 population) globally in 2000, but **eradication** (zero cases) is not yet achieved. * **Most Infectious Form:** Multibacillary (lepromatous) leprosy. * **First Sign:** Usually a pale or reddish patch with loss of sensation.

Question 473: What material is an Intrauterine Contraceptive Device (IUCD) primarily made of?

A. Nickel
B. Strontium
C. Copper
D. Polyethylene (Correct Answer)

Explanation: **Explanation:** The correct answer is **Polyethylene**. While copper is the active medicated component in most modern IUCDs, the **frame or skeleton** of the device is primarily made of non-toxic, non-tissue reactive **Polyethylene**. Specifically, high-grade polyethylene is used because it is flexible, allowing the device to be folded into an inserter and then regain its original shape (memory) once inside the uterine cavity. Most IUCDs (like Cu-T 380A) also contain **Barium Sulfate** mixed with the polyethylene to make the device **radiopaque** for X-ray visualization. **Analysis of Incorrect Options:** * **Nickel (A):** Nickel is not used in IUCDs as it is a common allergen and can cause hypersensitivity reactions in the uterine lining. * **Strontium (B):** Strontium has no role in contraception. It is occasionally used in bone-seeking radiopharmaceuticals but is not a component of intrauterine devices. * **Copper (C):** This is a common distractor. Copper is the **active contraceptive agent** (spermicidal) wrapped around the frame, but it is not the primary structural material of the device itself. **High-Yield Clinical Pearls for NEET-PG:** * **Generations:** 1st Gen (Non-medicated, e.g., Lippes Loop), 2nd Gen (Copper-bearing, e.g., Cu-T 380A), 3rd Gen (Hormone-releasing, e.g., LNG-20/Mirena). * **Lippes Loop:** Made of polyethylene; it is the only 1st generation IUCD still used in some parts of the world. * **Mechanism:** Copper IUCDs work primarily by causing a sterile inflammatory response and being spermicidal. * **Ideal Candidate:** A woman who has had at least one child, is in a stable monogamous relationship, and has no history of Pelvic Inflammatory Disease (PID).

Question 474: Chander's index is defined as?

A. No. Of eggs / gm of stool (Correct Answer)
B. No. Of larvae / 100g of stool
C. No. Of larvae / gm of stool
D. No. Of eggs / 100g of stool

Explanation: ### Explanation **Chander’s Index** is a classic epidemiological tool used to estimate the **intensity of Hookworm infection** (Ancylostomiasis) in a community. It is defined as the **average number of eggs per gram (EPG) of stool** across a surveyed population. #### Why Option A is Correct: The index relies on the quantitative estimation of helminthic eggs. By calculating the mean number of eggs per gram of stool, public health officials can categorize the severity of the infection in a locality. * **Index < 200 to 250:** Indicates a light infection of minor public health importance. * **Index > 250:** Indicates a significant public health problem where clinical hookworm disease (anemia) is likely prevalent. #### Why Other Options are Incorrect: * **Options B & C:** These refer to **larvae**. Hookworm diagnosis in stool is primarily based on detecting eggs (using techniques like Kato-Katz). Larvae are typically seen only if the stool sample is old or cultured (e.g., Harada-Mori culture), making them an unreliable metric for a standardized index. * **Option D:** The standard unit for helminthic egg counting in international public health (and the Kato-Katz method) is **per gram** of feces, not per 100g. Using 100g would result in unnecessarily large numbers and is not the conventional denominator for Chander’s Index. #### High-Yield Clinical Pearls for NEET-PG: * **Hookworm Species:** *Ancylostoma duodenale* (consumes ~0.15 ml blood/day) and *Necator americanus* (consumes ~0.03 ml blood/day). * **Clinical Hallmark:** Iron deficiency anemia (Microcytic Hypochromic). * **Ground Itch:** A local dermatitis caused by the entry of **L3 (Filariform) larvae**, which is the infective stage. * **Other Indices:** Do not confuse this with the **Breteau Index** (used for Aedes mosquitoes/Dengue) or the **Spleen Rate** (used for Malaria).

Question 475: Which of the following is an emerging infection in India?

A. Chikungunya (Correct Answer)
B. Hanta virus
C. Ebola virus
D. None of the above

Explanation: **Explanation:** **Emerging infections** are defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. **Chikungunya (Option A)** is the correct answer because it fits the definition of a re-emerging/emerging infection in India. After a long period of quiescence since the 1970s, India witnessed a massive outbreak in 2006 affecting several states. Since then, it has established a persistent presence with periodic outbreaks, driven by the widespread distribution of its vectors, *Aedes aegypti* and *Aedes albopictus*. **Analysis of Incorrect Options:** * **Hanta virus (Option B):** While sporadic cases or serological evidence may exist, it is not classified as a major emerging public health threat in the Indian context compared to Chikungunya. * **Ebola virus (Option C):** This is an exotic pathogen. While there is a risk of importation, there has been no established transmission or "emergence" of Ebola within the Indian population. **High-Yield Clinical Pearls for NEET-PG:** * **Vector:** Primarily *Aedes aegypti* (day biter). * **Hallmark Symptom:** Severe, often debilitating joint pain (arthralgia) which can persist for months (chronic stage), distinguishing it from Dengue. * **Incubation Period:** Typically 3–7 days. * **Diagnosis:** ELISA for IgM antibodies (after 5 days) or RT-PCR (during the first few days of viremia). * **Other Emerging/Re-emerging diseases in India:** Dengue, Japanese Encephalitis, Kyasanur Forest Disease (KFD), Nipah virus, and Scrub Typhus.

Question 476: Which of the following is true about Q fever?

A. Rash on palms and soles, headache, and fever are common symptoms.
B. Transmitted by the human body louse.
C. Inhaled aerosols spread the infection. (Correct Answer)
D. Mosquito bite prevention is important in its prevention.

Explanation: **Explanation:** **Q Fever** is a zoonotic disease caused by the obligate intracellular bacterium ***Coxiella burnetii***. Unlike other rickettsial diseases, it has unique epidemiological and clinical characteristics. **1. Why Option C is Correct:** The primary mode of transmission for Q fever is the **inhalation of contaminated aerosols** or dust. The bacteria are shed in high concentrations in the birth products (placenta), feces, urine, and milk of infected livestock (sheep, goats, and cattle). *C. burnetii* is highly resistant to environmental stressors and can travel long distances via wind, making inhalation the most common route of human infection. **2. Why the Other Options are Incorrect:** * **Option A:** Unlike most rickettsial infections (like Rocky Mountain Spotted Fever), **Q fever typically does not present with a rash.** The classic triad includes fever, pneumonia, and hepatitis. * **Option B:** Transmission via the human body louse is characteristic of **Epidemic Typhus** (*Rickettsia prowazekii*), not Q fever. * **Option D:** While ticks maintain the cycle in wildlife, **arthropod vectors (like mosquitoes or ticks) play a negligible role** in human transmission. Prevention focuses on pasteurization of milk and dust control in livestock areas rather than mosquito bite prevention. **High-Yield Clinical Pearls for NEET-PG:** * **Organism:** *Coxiella burnetii* (formerly Rickettsial, now classified as Gammaproteobacteria). * **Diagnosis:** Serology (Indirect Immunofluorescence Assay) is the gold standard. * **Chronic Q Fever:** Most commonly manifests as **culture-negative endocarditis**. * **Occupational Hazard:** High risk in veterinarians, farmers, and abattoir workers. * **Treatment:** **Doxycycline** is the drug of choice. * **Biological Warfare:** It is classified as a Category B bioterrorism agent due to its low infectious dose and stability in aerosol form.

Question 477: Consider the following statements regarding Infant Mortality Rate: 1. Infant mortality rate takes into account the death of infants within a month after birth. 2. Infant mortality rate is the number of infant deaths in a particular year per 100 live births during that year. Which of the above statements is/are correct?

A. Statement 1 only
B. Statement 2 only
C. Both statements 1 and 2
D. Neither statement 1 nor statement 2 (Correct Answer)

Explanation: ### Explanation The correct answer is **D (Neither statement 1 nor statement 2)** because both statements contain fundamental errors in the definition and calculation of the Infant Mortality Rate (IMR). **1. Why Statement 1 is incorrect:** Infant Mortality Rate refers to the death of a child **under one year of age** (0–364 days). Death within one month (specifically the first 28 days) is defined as **Neonatal Mortality Rate (NMR)**. IMR encompasses both neonatal and post-neonatal deaths. **2. Why Statement 2 is incorrect:** The denominator for IMR is **1,000 live births**, not 100. It is expressed as a rate per thousand, making it a probability of dying before the first birthday. **Analysis of Options:** * **Option A & C:** Incorrect because Statement 1 confuses "Infant" (up to 1 year) with "Neonatal" (up to 28 days). * **Option B:** Incorrect because Statement 2 uses the wrong multiplier (100 instead of 1,000). --- ### High-Yield Clinical Pearls for NEET-PG: * **IMR Formula:** $\frac{\text{Number of deaths under 1 year of age in a year}}{\text{Total live births in the same year}} \times 1000$. * **Sensitive Indicator:** IMR is considered the most sensitive index of the **socio-economic status** of a community and the availability of health services. * **Components of IMR:** * **Neonatal Mortality (0-28 days):** Reflects prenatal and natal factors (endogenous). * **Post-Neonatal Mortality (28 days - 1 year):** Reflects environmental and nutritional factors (exogenous). * **Current Trend:** In India, the Neonatal Mortality Rate contributes to approximately **70%** of the total IMR, highlighting the need for better institutional delivery and newborn care.

Question 478: How many doses of vaccine are involved in pre-exposure prophylaxis for rabies with HDVC?

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

Explanation: **Explanation:** The correct answer is **3 doses**. According to the World Health Organization (WHO) and National Guidelines in India, Pre-exposure Prophylaxis (PrEP) for Rabies using High-Dose Cell Culture Vaccines (HDVC) or Purified Chick Embryo Cell Vaccines (PCECV) involves a **3-dose schedule** administered on **Days 0, 7, and 21 (or 28)**. **Why 3 doses is correct:** PrEP is intended for individuals at high risk of exposure (vets, lab workers, animal handlers). The 3-dose regimen ensures the development of adequate neutralizing antibodies. This primary series "primes" the immune system, allowing for a rapid anamnestic response if a future exposure occurs, eliminating the need for Rabies Immunoglobulin (RIG). **Analysis of Incorrect Options:** * **1 dose:** Insufficient to create lasting immunological memory or protective titers. * **2 doses:** While some recent WHO updates discuss shortened 2-dose PrEP schedules (Days 0 and 7) for specific scenarios, the standard academic and exam-oriented answer for NEET-PG remains the classic 3-dose regimen. * **4 doses:** This is typically part of the **Post-exposure Prophylaxis (PEP)** schedule (Essen regimen: 0, 3, 7, 14, 28) for unvaccinated individuals, not PrEP. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** PrEP can be given Intramuscularly (IM) (0.5 or 1 ml) or Intradermally (ID) (0.1 ml). * **Site:** Always the **Deltoid** muscle. Never give rabies vaccine in the gluteal region (lower neutralizing antibody response due to fat). * **Post-exposure in a previously PrEP-immunized person:** Only **2 booster doses** are required (Days 0 and 3). **RIG is contraindicated** in these patients as it may interfere with the rapid booster response. * **Re-exposure:** If a person is bitten again within 3 months of completing a full PEP/PrEP course, no vaccine is needed, only wound toilet.

Question 479: Maternal antibodies are not present for which of the following diseases?

A. Polio
B. Diphtheria
C. Pertussis (Whooping cough) (Correct Answer)
D. Tetanus

Explanation: **Explanation:** The correct answer is **Pertussis (Whooping cough)**. **Why Pertussis is the correct answer:** Maternal immunity is primarily mediated by the transplacental transfer of **IgG antibodies**, which typically provides passive protection to the newborn during the first few months of life. However, in the case of Pertussis, maternal antibodies (whether from natural infection or prior vaccination) are either **insufficient in titer** or **decay too rapidly** to provide effective passive protection to the neonate. This creates a "protection gap," making infants highly vulnerable to whooping cough until they receive their own primary immunization (starting at 6 weeks under the National Immunization Schedule). **Analysis of Incorrect Options:** * **Polio:** Maternal IgG antibodies against poliovirus are efficiently transferred across the placenta and provide protection to the infant for approximately 6–9 months. * **Diphtheria:** Newborns usually possess passive immunity through the placental transfer of antitoxins from the mother, which lasts for several weeks to months. * **Tetanus:** This is a classic example of effective passive immunity. Vaccinating pregnant women with Tetanus Toxoid (TT/Td) induces high maternal antibody titers that cross the placenta, successfully preventing **Neonatal Tetanus**. **High-Yield Clinical Pearls for NEET-PG:** * **Cocooning Strategy:** Because maternal antibodies do not protect the newborn from Pertussis, the "Cocooning" strategy is recommended—vaccinating all close family members and caregivers to create a circle of protection around the infant. * **Vaccination in Pregnancy:** To mitigate the lack of natural passive transfer, many international guidelines (like CDC/ACOG) now recommend **Tdap vaccination during every pregnancy** (ideally between 27–36 weeks) to maximize the transfer of pertussis antibodies. * **Measles:** Maternal antibodies for Measles are very strong and can interfere with live vaccines, which is why the Measles vaccine is delayed until 9 months of age.

Question 480: In a sub-centre with a population of 5000, and a birth rate of 30 per thousand, what is the estimated number of pregnant women?

A. 150
B. 155
C. 160
D. 165 (Correct Answer)

Explanation: ### Explanation The correct answer is **165 (Option D)**. **1. Why Option D is Correct (The Calculation)** To estimate the number of pregnant women in a community (often for planning ANC services), we use the standard public health formula: * **Step 1: Calculate Expected Live Births** $\text{Live Births} = \frac{\text{Population} \times \text{Birth Rate}}{1000}$ $\text{Live Births} = \frac{5000 \times 30}{1000} = 150$ * **Step 2: Account for Pregnancy Wastage** In community health planning, it is estimated that approximately **10% of pregnancies** end in wastage (miscarriages, stillbirths, etc.). Therefore, the total number of pregnant women is calculated as: $\text{Total Pregnancies} = \text{Live Births} + 10\% \text{ of Live Births}$ $150 + (0.10 \times 150) = 150 + 15 = \mathbf{165}$ **2. Why Other Options are Incorrect** * **Option A (150):** This represents only the number of live births. It fails to account for the 10% pregnancy wastage required for resource allocation. * **Options B (155) and C (160):** These values do not correspond to the standard 10% correction factor used in the National Health Programs. **3. Clinical Pearls & High-Yield Facts for NEET-PG** * **Pregnancy Wastage:** Always add 10% to the live birth count when calculating the "Target Group" for Antenatal Care (ANC). * **Eligible Couples:** In a standard Indian population, there are approximately **150-180 eligible couples per 1000 population**. * **Sub-centre Norms:** A sub-centre typically covers 5,000 people in plain areas and 3,000 in hilly/tribal areas. * **Vital Statistics:** Birth rate is calculated per 1000 mid-year population. It is the most sensitive indicator of fertility.

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