Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 41: A patient is made to walk early after surgery. This is for:

A. Treating the patient
B. Reducing disability
C. Specific protection
D. Rehabilitation (Correct Answer)

Explanation: **Explanation:** The core concept in this question is the **Levels of Prevention** and the **Modes of Intervention**. **Why Rehabilitation is Correct:** Rehabilitation is defined as the combined and coordinated use of medical, social, educational, and vocational measures for training or retraining the individual to the highest possible level of functional ability. In the postoperative period, early ambulation (making the patient walk) is a form of **medical rehabilitation**. It aims to prevent complications like Deep Vein Thrombosis (DVT), pulmonary embolism, and pressure sores, while simultaneously restoring the patient's physical mobility and functional independence. According to the WHO, rehabilitation begins as soon as the diagnosis is made or the acute phase of illness is managed. **Analysis of Incorrect Options:** * **Treating the patient (Early Diagnosis and Treatment):** This belongs to **Secondary Prevention**. It involves interventions like surgery itself or medication to arrest the disease process. Walking is a post-treatment recovery measure. * **Reducing disability (Disability Limitation):** This is also **Tertiary Prevention** but focuses on preventing the transition from impairment to permanent disability (e.g., splinting a limb). While walking helps, the primary goal of active mobilization is functional restoration (Rehabilitation). * **Specific protection:** This belongs to **Primary Prevention**. It involves specific measures like immunizations or the use of helmets to prevent a disease/injury from occurring in the first place. **High-Yield Facts for NEET-PG:** * **Tertiary Prevention** includes two modes of intervention: Disability Limitation and Rehabilitation. * **Early Ambulation** is the most cost-effective rehabilitative measure to prevent postoperative pulmonary and vascular complications. * **Sequence of Disease Evolution:** Disease → Impairment → Disability → Handicap. Rehabilitation aims to break the cycle between disability and handicap.

Question 42: What is the minimum number of bacilli required for sputum-positive tuberculosis?

A. 10
B. 10^2
C. 10^3
D. 10^4 (Correct Answer)

Explanation: **Explanation:** The correct answer is **10^4 (Option D)**. The detection of *Mycobacterium tuberculosis* via sputum smear microscopy (using Ziehl-Neelsen staining) depends on the bacterial load present in the specimen. For a smear to be reported as "positive," there must be a sufficient density of acid-fast bacilli (AFB) to be visualized under a microscope. 1. **Why 10^4 is correct:** It is a well-established microbiological fact that approximately **5,000 to 10,000 (10^4) bacilli per milliliter** of sputum are required for a smear to consistently yield a positive result. If the concentration is lower than this threshold, the probability of a technician finding a bacillus in the limited number of microscopic fields examined drops significantly. 2. **Why other options are incorrect:** * **10 to 10^2 (Options A & B):** These concentrations are far too low for smear microscopy. However, they are significant for **cultures**. A liquid or solid culture (like LJ medium) can detect as few as 10–100 viable bacilli, making culture much more sensitive than microscopy. * **10^3 (Option C):** While closer, this remains below the reliable diagnostic threshold for routine light microscopy. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Culture remains the gold standard for TB diagnosis due to its high sensitivity (10–100 bacilli). * **Sputum Grading:** According to RNTCP/NTEP guidelines, a slide is graded "1+" if 10–99 AFB are found per 100 oil immersion fields. * **Infectivity:** Sputum-positive patients (10^4 bacilli/ml) are significantly more infectious than sputum-negative, culture-positive patients. * **Modern Diagnostics:** CBNAAT (GeneXpert) has a detection threshold of approximately 131 cfu/ml, making it much more sensitive than smear microscopy but less than culture.

Question 43: Glycosylated hemoglobin reflects the mean blood glucose level of the previous?

A. 15 days
B. 1 month
C. 3 months (Correct Answer)
D. 6 months

Explanation: **Explanation:** **1. Why Option C is Correct:** Glycosylated hemoglobin (HbA1c) is formed by the non-enzymatic, irreversible attachment of glucose to the hemoglobin molecule within red blood cells (RBCs). Because this binding is permanent for the life of the cell, the HbA1c level is directly proportional to the average blood glucose concentration over the lifespan of the erythrocyte. Since the **average lifespan of an RBC is approximately 120 days (4 months)**, HbA1c provides a weighted average of blood glucose levels over the preceding **2 to 3 months**, with the most recent 30 days contributing the most to the final value. **2. Why Other Options are Incorrect:** * **Option A (15 days) & B (1 month):** These durations are too short to reflect the cumulative glucose exposure captured by hemoglobin. However, **Fructosamine** (glycated albumin) is used to monitor glucose control over a shorter period of **2–3 weeks**, as albumin has a shorter half-life than RBCs. * **Option D (6 months):** This exceeds the 120-day physiological lifespan of the RBC. By 6 months, the original population of glycated RBCs would have been cleared by the spleen and replaced. **3. High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Cut-off:** According to WHO/ADA, an **HbA1c ≥ 6.5%** is diagnostic for Diabetes Mellitus. * **Pre-diabetes:** HbA1c range of **5.7% to 6.4%**. * **False Lows:** Conditions with high RBC turnover (e.g., Hemolytic anemia, pregnancy, recent blood transfusion, or treatment for iron/B12 deficiency). * **False Highs:** Conditions that prolong RBC lifespan (e.g., Splenectomy) or iron deficiency anemia (due to altered glycation kinetics). * **Target:** For most diabetic patients, the goal is to keep HbA1c **< 7%** to prevent microvascular complications.

Question 44: Prevalence of tuberculosis infection is determined by?

A. Sputum examination
B. Mantoux test (Correct Answer)
C. Clinical examination
D. MMR vaccine

Explanation: **Explanation:** The distinction between **Tuberculosis Infection** and **Tuberculosis Disease** is a high-yield concept in Community Medicine. **Why Mantoux Test is Correct:** The prevalence of **infection** (the presence of *M. tuberculosis* in the body without clinical symptoms) is measured using the **Mantoux Test** (Tuberculin Skin Test). It measures delayed hypersensitivity to Purified Protein Derivative (PPD). In epidemiological surveys, the "Annual Risk of Tuberculosis Infection" (ARTI) is calculated based on the prevalence of infection among children, serving as a key indicator of the transmission rate in a community. **Analysis of Incorrect Options:** * **Sputum Examination:** This is the gold standard for determining the prevalence of **infectious cases (Disease)**, not subclinical infection. It identifies "open cases" who are actively shedding the bacilli. * **Clinical Examination:** This identifies symptomatic patients (Disease). It is unreliable for prevalence surveys due to low sensitivity and specificity, as many TB cases are asymptomatic or mimic other respiratory conditions. * **MMR Vaccine:** This is a live attenuated vaccine for Measles, Mumps, and Rubella. It has no diagnostic or preventive role in Tuberculosis (where the BCG vaccine is used). **High-Yield Clinical Pearls for NEET-PG:** * **Standard Dose:** 0.1 ml of 5 TU (Tuberculin Units) of PPD injected intradermally. * **Reading:** Induration (not erythema) is measured after 48–72 hours. * **Interpretation:** In India, an induration of **≥10 mm** is generally considered positive. * **Chest X-ray:** Used in prevalence surveys to screen for radiologically active disease, usually followed by sputum confirmation.

Question 45: Acute flaccid paralysis is reported in a child aged -

A. 0-3 years
B. 0-5 years
C. 0-15 years (Correct Answer)
D. 0-25 years

Explanation: ### Explanation **1. Why Option C is Correct:** Under the **Global Polio Eradication Initiative**, Acute Flaccid Paralysis (AFP) surveillance is the gold standard for detecting poliomyelitis. The operational definition for AFP surveillance includes any child **under the age of 15 years** who presents with recent onset of floppy weakness (including Guillain-Barré syndrome, transverse myelitis, or traumatic neuritis). Additionally, the surveillance system includes any person of any age if polio is strongly suspected by a clinician. The 0–15 age group is targeted because children in this bracket are most susceptible to paralytic poliomyelitis. **2. Why Other Options are Incorrect:** * **Option A (0-3 years) & B (0-5 years):** While children under 5 are at the highest risk for contracting the poliovirus, surveillance must be broader to ensure no cases are missed. Limiting surveillance to these ages would result in poor sensitivity and failure to detect late-childhood cases. * **Option D (0-25 years):** This range is too broad for routine AFP surveillance. While adults can contract polio, the epidemiological focus for eradication remains on the pediatric population where transmission is most active. **3. High-Yield Clinical Pearls for NEET-PG:** * **AFP Surveillance Goal:** To achieve a "Non-polio AFP rate" of at least **2 per 100,000** children under 15 years (an indicator of a sensitive surveillance system). * **Stool Collection:** Two "adequate" stool samples must be collected **24–48 hours apart** within **14 days** of the onset of paralysis. * **Zero Reporting:** This is a key component where health facilities must report "zero cases" weekly if no AFP cases are detected, ensuring active monitoring. * **India Status:** India was declared Polio-free by the WHO on **March 27, 2014** (last case reported in Jan 2011, Howrah, West Bengal).

Question 46: According to the World Health Organization (WHO), which of the following is a notifiable disease?

A. Cholera (Correct Answer)
B. Malaria
C. Dengue
D. Pneumonia

Explanation: **Explanation:** The concept of "Notifiable Diseases" under the **International Health Regulations (IHR 2005)** by the WHO is a high-yield topic for NEET-PG. According to IHR guidelines, certain diseases must be reported to the WHO to prevent international spread and ensure global health security. **Why Cholera is the Correct Answer:** Under the IHR (2005), there are three specific diseases that are always considered "notifiable" because they have the potential to cause serious public health impact and spread rapidly across borders. These are **Cholera, Plague, and Yellow Fever.** Any single case of these diseases must be notified to the WHO immediately. **Analysis of Incorrect Options:** * **B. Malaria:** While Malaria is a major public health concern and is reportable under many national surveillance programs (like IDSP in India), it is not globally mandated as a notifiable disease under the WHO IHR unless it poses an unusual or unexpected threat. * **C. Dengue:** Similar to Malaria, Dengue is a reportable disease in endemic countries to monitor outbreaks, but it does not fall under the mandatory global notification list of the IHR. * **D. Pneumonia:** This is a clinical syndrome caused by various pathogens. It is monitored via sentinel surveillance but is not a specific notifiable entity under international regulations. **High-Yield Clinical Pearls for NEET-PG:** 1. **IHR (2005) Mandatory Notification:** Includes Cholera, Plague, Yellow Fever, Smallpox, Wild-type Polio, Human Influenza caused by a new subtype, and SARS. 2. **National Level (India):** Under the Integrated Disease Surveillance Programme (IDSP), diseases are categorized into P (Presumptive), L (Laboratory), and S (Syndromic) formats for reporting. 3. **Key Distinction:** Do not confuse "Notifiable to WHO" (International) with "Notifiable to Health Authorities" (National/State level). Cholera remains a classic favorite for examiners in both categories.

Question 47: Drug of choice for chemoprophylaxis of plague?

A. Erythromycin
B. Cotrimoxazole
C. Tetracycline (Correct Answer)
D. Sulfadiazine

Explanation: **Explanation:** **1. Why Tetracycline is the Correct Answer:** Tetracycline is the established drug of choice (DOC) for the chemoprophylaxis of plague (*Yersinia pestis*). In an outbreak or after a known exposure (such as a flea bite or contact with an infected person/animal), it is administered for 7 days. It effectively prevents the progression of the disease by inhibiting bacterial protein synthesis. For children and pregnant women, where tetracyclines are generally avoided, **Sulfadiazine** or **Cotrimoxazole** are used as alternatives. **2. Analysis of Incorrect Options:** * **A. Erythromycin:** This macrolide has poor efficacy against *Yersinia pestis* and is not recommended for prophylaxis or treatment. * **B. Cotrimoxazole:** While it can be used for prophylaxis in children or as a second-line agent, it is not the primary drug of choice when Tetracycline is an option. * **D. Sulfadiazine:** Historically used for prophylaxis, especially in children, but it is less effective than Tetracyclines and is considered a second-line alternative. **3. High-Yield Clinical Pearls for NEET-PG:** * **DOC for Treatment:** **Streptomycin** (Aminoglycoside) is the drug of choice for treating all forms of plague (Bubonic, Septicemic, and Pneumonic). Gentamicin is a common alternative. * **Vector:** The most common vector is the **Rat Flea** (*Xenopsylla cheopis*). * **Diagnosis:** The characteristic finding on a Wayson or Giemsa stain is **"Safety-pin appearance"** (bipolar staining). * **Quarantine:** The international quarantine period for plague is **6 days**. * **Chemoprophylaxis Duration:** Prophylaxis should be continued for **7 days** post-exposure.

Question 48: Which viral infection always causes clinical disease in human beings?

A. Rubella
B. Poliomyelitis
C. Measles (Correct Answer)
D. Chicken pox

Explanation: **Explanation:** The correct answer is **Measles**. This question tests the concept of **Inapparent-to-Apparent Infection Ratio** and the clinical spectrum of viral diseases. **Why Measles is the Correct Answer:** Measles is characterized by high **pathogenicity**, meaning the virus has a near 100% ability to produce clinical disease in a susceptible host. In medical epidemiology, Measles is considered a "classic" example of a disease with **no subclinical or inapparent infections**. If an individual is infected, they will invariably manifest the clinical syndrome (fever, cough, coryza, conjunctivitis, and the pathognomonic Koplik’s spots followed by a rash). **Analysis of Incorrect Options:** * **Poliomyelitis:** This is the opposite of Measles. Over 90–95% of Polio cases are **inapparent/subclinical**. Only a tiny fraction (1%) leads to paralytic disease. * **Rubella:** Often called "German Measles," it frequently presents as a subclinical infection (up to 25–50% of cases), making it dangerous during pregnancy as the mother may not know she is infected. * **Chickenpox (Varicella):** While highly contagious, subclinical cases do occur, particularly in second attacks or in partially immune individuals, though it is less common than in Polio or Rubella. **NEET-PG High-Yield Pearls:** * **Iceberg Phenomenon:** Measles and Rabies do **not** show the Iceberg Phenomenon because there are no hidden (subclinical) cases. The "tip of the iceberg" represents the whole disease. * **Serial Interval:** For Measles, it is roughly **10–12 days**. * **Secondary Attack Rate (SAR):** Measles has one of the highest SARs (>80%), indicating extreme infectivity. * **Elimination:** Because there is no subclinical carrier state and no animal reservoir, Measles is a candidate for global eradication.

Question 49: A patient presents with a dog bite on the palm and fingers, with oozing of blood on the neck region. To which class of exposure does this situation belong?

A. Class I
B. Class II
C. Class III (Correct Answer)
D. None of the above

Explanation: **Explanation:** The classification of rabies exposure is based on the severity of the contact and the risk of viral transmission. This patient falls into **Class III (Category III)** exposure due to the nature and location of the injuries. **1. Why Class III is correct:** According to WHO and National Guidelines, Class III exposure involves: * **Single or multiple transdermal bites or scratches** (wounds that draw blood). * **Licks on broken skin** or contamination of mucous membranes with saliva. * **Exposure to bats.** * **High-risk locations:** Bites on highly innervated areas like the **palms, fingers, face, and neck** are automatically considered high-risk because the virus has a shorter distance to travel to the central nervous system. Since this patient has bleeding wounds on the palm/fingers and neck, it is a definitive Class III exposure requiring both **Rabies Vaccine** and **Rabies Immunoglobulin (RIG)**. **2. Why other options are incorrect:** * **Class I:** Involves touching or feeding animals, or licks on intact skin. No treatment is required. * **Class II:** Involves minor scratches or abrasions without bleeding, or nibbling of uncovered skin. These require immediate vaccination but usually do not require RIG. **High-Yield Clinical Pearls for NEET-PG:** * **Management of Class III:** Wound washing (15 mins) + Full course of Vaccine + RIG (infiltrated around the wound). * **Site of Injection:** Intramuscular (IM) vaccine is given in the **deltoid** (never the gluteal region). * **Post-Exposure Prophylaxis (PEP):** Modern cell culture vaccines (IDRV) follow the **Updated Thai Red Cross Schedule** (2-2-2-0-2) or the **Essen Schedule** (1-1-1-1-1). * **Rule of Thumb:** Any bite that draws blood is Category III. Any bite on the head, neck, or hands is treated with maximum caution.

Question 50: Paralysis in polio is characterized by?

A. Exaggerated tendon reflexes
B. Symmetrical paralysis
C. Tonic paralysis
D. Lower motor neurone type (Correct Answer)

Explanation: **Explanation:** Poliomyelitis is caused by an enterovirus that specifically targets and destroys the **anterior horn cells** of the spinal cord. These cells are the primary cell bodies of the **Lower Motor Neurons (LMN)**. **1. Why "Lower motor neurone type" is correct:** Since the pathology involves the destruction of the anterior horn cells, the resulting paralysis follows a classic LMN pattern. This is characterized by **Acute Flaccid Paralysis (AFP)**, which includes loss of muscle tone (atonia), loss of reflexes (areflexia), and muscle wasting/atrophy. **2. Why the other options are incorrect:** * **Exaggerated tendon reflexes:** This is a feature of Upper Motor Neuron (UMN) lesions. In Polio, reflexes are typically diminished or absent (hyporeflexia/areflexia). * **Symmetrical paralysis:** Polio is characteristically **asymmetrical**. It often affects one limb more than the other (most commonly the legs) and follows a "random" distribution based on which specific neuronal clusters are destroyed. * **Tonic paralysis:** Polio causes **flaccid** paralysis. Tonic (spastic) paralysis is seen in UMN lesions or conditions like Tetanus. **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark of Polio:** Asymmetrical, descending, flaccid paralysis with intact sensory perception (Sensory loss is NEVER seen in Polio). * **Tripod Sign:** A clinical sign where the child sits with hands placed behind for support due to spinal muscle weakness. * **Post-Polio Syndrome:** Occurs decades after the initial infection due to the gradual failure of over-exerted surviving motor neurons. * **Surveillance:** Under the Global Polio Eradication Initiative, any case of AFP in a child <15 years must be investigated (requires two stool samples 24 hours apart within 14 days of onset).

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