Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 491: A patient with tubercular pleural effusion falls under which category of WHO grading of TB?

A. I (Correct Answer)
B. II
C. III
D. IV

Explanation: **Explanation:** The classification of Tuberculosis into treatment categories is based on the **Revised National Tuberculosis Control Programme (RNTCP)** guidelines, which align with WHO standards. This system prioritizes patients based on the severity of the disease and their treatment history. **Why Option A is Correct:** **Category I** includes **New cases** (never treated for TB or treated for <1 month) who are: 1. Sputum smear-positive pulmonary TB. 2. Sputum smear-negative pulmonary TB with extensive parenchymal involvement. 3. **Seriously ill patients with Extra-Pulmonary TB (EPTB).** **Tubercular Pleural Effusion** is classified as a "seriously ill" form of extra-pulmonary TB. Therefore, a new patient presenting with this condition is placed in Category I for treatment initiation (2HRZE + 4HR). **Why Other Options are Incorrect:** * **Option B (Category II):** This category was historically reserved for **previously treated cases** (Recurrent, Treatment after failure, or Treatment after loss to follow-up). Under newer WHO/NTEP guidelines, the distinction between Category I and II has been blurred in favor of Universal Drug Susceptibility Testing (UDST), but for exam purposes, Category II remains for "Retreatment" cases. * **Option C & D (Category III & IV):** **Category III** previously included non-seriously ill EPTB or smear-negative PTB, but it has been merged into Category I in modern protocols. **Category IV** is reserved for **Multi-Drug Resistant TB (MDR-TB)** or Chronic cases. **High-Yield Clinical Pearls for NEET-PG:** * **Seriously ill EPTB (Category I):** Includes pleural effusion, meningitis, miliary TB, pericarditis, peritonitis, spinal TB, and intestinal TB. * **Non-seriously ill EPTB:** Includes peripheral lymph node TB and isolated skin TB. * **Standard Regimen for Category I:** 2 months of Intensive Phase (HRZE) and 4 months of Continuation Phase (HRE). Note that Ethambutol is now often continued in the CP. * **Diagnosis:** Pleural fluid analysis typically shows an exudative pattern with high protein, low glucose, and elevated **Adenosine Deaminase (ADA)** levels (>40 U/L).

Question 492: As per the Revised National Tuberculosis Control Programme (RNTCP) Category-1 guidelines, what is the drug regimen?

A. Four drugs for two months and two drugs for four months (Correct Answer)
B. Three drugs for two months and two drugs for four months
C. Includes retreatment cases
D. The regimen is given daily

Explanation: **Explanation:** Under the **Revised National Tuberculosis Control Programme (RNTCP)**, now integrated into the **National TB Elimination Programme (NTEP)**, Category-1 is indicated for new cases of tuberculosis (both pulmonary and extra-pulmonary). **1. Why Option A is correct:** The standard regimen for Category-1 consists of two phases: * **Intensive Phase (IP):** 2 months of four drugs—**HRZE** (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol). * **Continuation Phase (CP):** 4 months of two drugs—**HR** (Isoniazid and Rifampicin). The goal of the IP is to rapidly kill the bacterial load, while the CP eliminates semi-dormant bacilli to prevent relapse. **2. Why other options are incorrect:** * **Option B:** Three drugs are insufficient for the Intensive Phase in new cases; Ethambutol is essential to prevent resistance. * **Option C:** Category-1 is strictly for **New Cases**. Retreatment cases (Relapse, Treatment after default, Failure) were previously classified under Category-2 (which has since been phased out in favor of Universal Drug Susceptibility Testing). * **Option D:** While the program has transitioned to a **Daily Regimen**, the question specifically asks for the "drug regimen" (composition and duration). In the context of traditional RNTCP MCQ patterns, Option A defines the core pharmacological structure of Category-1. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage:** Fixed-Dose Combinations (FDCs) are used based on weight bands. * **Pyridoxine (Vitamin B6):** Always co-administered (10–25 mg/day) to prevent Isoniazid-induced peripheral neuropathy. * **Extension:** There is no longer an extension of the Intensive Phase if the sputum is positive at 2 months; instead, the patient proceeds to CP and undergoes DST. * **CP Duration:** In cases of TB Meningitis or Bone/Joint TB, the CP may be extended to 7–10 months.

Question 493: Which of the following statements is NOT true regarding the Ponderal Index?

A. It is a measure of obesity.
B. It is height and weight independent. (Correct Answer)
C. It is height and weight dependent.
D. It is age independent.

Explanation: ### Explanation The **Ponderal Index (PI)**, also known as the Rohrer's Index, is a measure used to assess body composition and nutritional status. It is calculated using the formula: **PI = Weight (kg) / Height³ (m³)** #### Why Option B is the Correct Answer (The "Not True" Statement) The Ponderal Index is **mathematically derived from height and weight**. Therefore, stating that it is "height and weight independent" is factually incorrect. Unlike the Body Mass Index (BMI = kg/m²), which is often used for adults, the PI is particularly useful in pediatrics and neonatology because it accounts for the fact that body proportions change as a person grows taller. #### Analysis of Other Options * **Option A (Measure of obesity):** This is true. Like BMI, PI is used to categorize individuals as underweight, normal, or obese. In neonates, it helps distinguish between symmetric and asymmetric Intrauterine Growth Restriction (IUGR). * **Option C (Height and weight dependent):** This is true. The formula itself requires both parameters to calculate the index. * **Option D (Age independent):** This is true. One of the primary advantages of the Ponderal Index over other anthropometric measures is that it remains relatively stable across different age groups, making it a reliable tool for longitudinal growth assessment. #### High-Yield Clinical Pearls for NEET-PG * **Neonatal Significance:** A low Ponderal Index in a newborn suggests **asymmetric IUGR** (wasting), where the weight is affected more than the length (e.g., due to placental insufficiency). * **PI vs. BMI:** While BMI is the gold standard for adult obesity screening, the Ponderal Index is considered more accurate for very short or very tall individuals because it follows the geometric scaling of a 3D object (mass vs. volume). * **Quetelet’s Index:** This is another name for BMI (Weight/Height²). Do not confuse it with the Ponderal Index.

Question 494: Which form of plague is the most contagious?

A. Bubonic plague
B. Septicemic plague
C. Pneumonic plague (Correct Answer)
D. Wild plague

Explanation: **Explanation:** **Pneumonic plague** is the most contagious and lethal form of the disease. Unlike other forms, it is the only one that can be transmitted directly from **person-to-person via respiratory droplets** (aerosol transmission). It has a very short incubation period (1–3 days) and, if untreated, a case fatality rate approaching 100%. Its ability to spread rapidly through coughing makes it a significant public health threat and a potential bioterrorism agent. **Analysis of Incorrect Options:** * **Bubonic Plague:** The most common clinical form, characterized by painful lymph node swelling (buboes). It is transmitted via the **bite of an infected rat flea** (*Xenopsylla cheopis*). It is not directly contagious between humans unless there is contact with suppurating buboes. * **Septicemic Plague:** Occurs when the bacteria (*Yersinia pestis*) multiply in the bloodstream. It can be a primary infection or a complication of bubonic plague. While highly fatal, it is not contagious through respiratory routes. * **Wild Plague:** Also known as Sylvatic plague, this refers to the infection circulating in wild rodent populations (e.g., marmots, ground squirrels) rather than a specific clinical manifestation in humans. **High-Yield Clinical Pearls for NEET-PG:** * **Causative Agent:** *Yersinia pestis* (a Gram-negative coccobacillus showing characteristic **bipolar "safety-pin" staining**). * **Vector:** The Oriental rat flea (*Xenopsylla cheopis*) is the most efficient vector. * **Drug of Choice:** **Streptomycin** is the traditional DOC; Gentamicin and Doxycycline are effective alternatives. * **Chemoprophylaxis:** Doxycycline or Tetracycline is recommended for close contacts of pneumonic plague patients. * **Indicator:** A "Rat Fall" (sudden death of rats) is a precursor to a human bubonic plague outbreak.

Question 495: In an area not covered by measles immunization, what is the expected attack rate of measles?

A. 70%
B. 80%
C. 90% (Correct Answer)
D. 100%

Explanation: **Explanation:** The correct answer is **90%**. This question tests your knowledge of the **Secondary Attack Rate (SAR)** and the high infectivity of the Measles virus. **1. Why 90% is Correct:** Measles is one of the most highly contagious infectious diseases known to medicine. In a **virgin population** (an area where there is no natural immunity and no vaccination coverage), the virus spreads rapidly. The Secondary Attack Rate—defined as the probability that infection occurs among susceptible persons within a specific group (like a household or a community) following exposure to a primary case—is approximately **>90%**. This high percentage reflects the virus's efficient respiratory droplet transmission and its high $R_0$ (Basic Reproduction Number), which ranges between 12 and 18. **2. Why other options are incorrect:** * **70% and 80%:** These figures underestimate the extreme contagiousness of Measles. While these might be relevant for other childhood exanthematous illnesses (like Mumps or Rubella), they do not reflect the near-universal susceptibility of an unimmunized population to Measles. * **100%:** While the attack rate is exceptionally high, it is rarely 100% due to factors like subclinical infections, variations in host genetics, or the "luck of exposure" where a small fraction of the population may not receive an infectious dose. **3. NEET-PG High-Yield Pearls:** * **Secondary Attack Rate (SAR):** Measles (>90%) > Pertussis (80%) > Chickenpox (75%) > Mumps (30-40%). * **Herd Immunity Threshold:** For Measles, because it is so contagious, the herd immunity threshold is very high, requiring **94-95%** vaccination coverage to stop community transmission. * **Infectivity Period:** A patient is infectious from **4 days before to 4 days after** the appearance of the rash. * **Koplik’s Spots:** These are the pathognomonic enanthem appearing 1-2 days before the rash.

Question 496: According to the Revised National Tuberculosis Control Programme (RNTCP), a case of tubercular pericarditis should be treated under which category of anti-tubercular regimen?

A. Category I (Correct Answer)
B. Category II
C. Category III
D. Category IV

Explanation: **Explanation:** In the context of the Revised National Tuberculosis Control Programme (RNTCP), treatment categorization is based on the severity of the disease and the patient’s treatment history. **Why Category I is correct:** Tubercular pericarditis is classified as **Seriously Ill Extra-Pulmonary Tuberculosis (EP-TB)**. Under RNTCP guidelines, all new cases of tuberculosis—whether Sputum Smear Positive, Sputum Smear Negative, or Extra-Pulmonary—are treated under **Category I**. Because pericarditis involves a vital organ and carries a high risk of mortality or long-term complications (like constrictive pericarditis), it is categorized as a "serious" form of EP-TB requiring the intensive 6-month regimen (2HREZ + 4HR). **Analysis of Incorrect Options:** * **Category II:** This was previously reserved for "Retreatment" cases (relapse, failure, or treatment after default). However, under the latest WHO and NTEP (formerly RNTCP) updates, Category II has been phased out in favor of drug-susceptibility testing (DST) guided treatment. * **Category III:** Historically, this was used for "Non-serious" Extra-Pulmonary or Smear-negative cases. This category was abolished years ago to ensure all patients receive a full four-drug intensive phase. * **Category IV:** This is reserved for Multi-Drug Resistant TB (MDR-TB) or Rifampicin-resistant cases, requiring second-line drugs. **High-Yield Clinical Pearls for NEET-PG:** * **Seriously Ill EP-TB (Category I):** Includes pericarditis, spinal TB (Pott’s disease), meningitis, miliary TB, intestinal TB, and bilateral/extensive pleurisy. * **Steroid Use:** In TB pericarditis, adjunctive corticosteroids (e.g., Prednisolone) are often recommended to reduce the risk of constrictive pericarditis and mortality. * **NTEP Update:** Remember that RNTCP is now the **National Tuberculosis Elimination Programme (NTEP)**, and the current standard is **Daily Fixed-Dose Combinations (FDC)** rather than intermittent therapy.

Question 497: All of the following are true regarding the acute attack of Polio, except?

A. Fecal sample is carried in a cold box.
B. Three consecutive stool samples are positive. (Correct Answer)
C. Investigation done within 48 hours.
D. Throat swab is taken for diagnosis.

Explanation: **Explanation:** The diagnosis of Poliomyelitis under the **Global Polio Eradication Initiative** relies on the "Virological Case Classification." **Why Option B is the Correct Answer (The Exception):** For the laboratory diagnosis of Polio, the standard protocol requires **two "adequate" stool samples** collected **24–48 hours apart**, within **14 days** of the onset of paralysis. There is no requirement for "three consecutive positive samples." A single positive culture from these two samples is sufficient to confirm the presence of the poliovirus. **Analysis of Other Options:** * **Option A:** Poliovirus is thermolabile. Stool specimens must be transported at **4°C in a cold box** with frozen ice packs to ensure the virus remains viable for culture at the laboratory. * **Option C:** While samples can be taken up to 14 days post-paralysis, the investigation (notification and initial sample collection) should ideally be initiated as soon as possible, often targeted within **48 hours of reporting** a case of Acute Flaccid Paralysis (AFP) to maintain high surveillance sensitivity. * **Option D:** Although the virus is present in the pharynx early in the infection, **stool samples** are the gold standard because the virus is excreted in feces for a longer duration (3–6 weeks) and in higher concentrations compared to throat swabs. However, throat swabs can be used for diagnosis in the very early acute phase. **High-Yield Clinical Pearls for NEET-PG:** * **AFP Surveillance:** The key indicator is a rate of **≥2 cases per 100,000** children under 15 years. * **Specimen Quantity:** Each stool sample should be about **5–8 grams** (roughly the size of two adult thumbnails). * **Reverse Cold Chain:** This term refers to the process of transporting samples from the field to the laboratory at 2–8°C to prevent viral degradation. * **Last Case in India:** Reported on January 13, 2011 (Howrah, West Bengal). India was declared Polio-free on March 27, 2014.

Question 498: Which of the following statements is NOT true regarding the Tuberculin test?

A. It is the only tool available for estimating the prevalence of TB in a community.
B. An induration of 10 mm indicates a positive test.
C. It is a specific test. (Correct Answer)
D. New cases occur more commonly in patients who are tuberculin reactors.

Explanation: ### Explanation The Tuberculin Skin Test (TST), or Mantoux test, is a classic screening tool for latent TB infection. The correct answer is **Option C** because the Tuberculin test is **not a specific test**. **1. Why Option C is the correct answer (Why it is NOT true):** The TST lacks specificity due to cross-reactivity. A false-positive result can occur in individuals previously vaccinated with **BCG** or those infected with **Non-Tuberculous Mycobacteria (NTM)**. Because the Purified Protein Derivative (PPD) contains antigens shared by various mycobacterial species, it cannot distinguish between *M. tuberculosis* infection and other exposures. **2. Analysis of other options:** * **Option A:** In epidemiological surveys, the TST remains the standard tool for estimating the **Annual Risk of Tuberculous Infection (ARTI)** and the overall prevalence of infection in a community. * **Option B:** In the Indian context and for most general populations, an induration of **≥10 mm** is the standard cut-off for a positive result. (Note: ≥5 mm is used for HIV-positive or immunocompromised patients). * **Option D:** Tuberculin "reactors" (those with a positive test) represent the pool of latent infection. Statistically, the majority of new clinical cases of TB emerge from this pre-existing pool of reactors through endogenous reactivation. **High-Yield Clinical Pearls for NEET-PG:** * **Type of Hypersensitivity:** TST is a **Type IV (Delayed-type)** hypersensitivity reaction. * **Reading the Test:** Read results between **48–72 hours**. Measure only the **induration** (palpable hardening), not the erythema. * **False Negatives:** Can occur in miliary TB, malnutrition, HIV/AIDS (anergy), or recent viral infections like Measles. * **Alternative:** The **IGRA (Interferon-Gamma Release Assay)** is more specific than TST as it does not cross-react with the BCG vaccine.

Question 499: Diabetes mellitus is best diagnosed by which of the following criteria?

A. Fasting blood sugar > 100 mg/dL and postprandial blood sugar > 140 mg/dL
B. Fasting blood sugar > 126 mg/dL and postprandial blood sugar > 199 mg/dL (Correct Answer)
C. HbA1C = 5.5%
D. Fasting blood sugar > 70 mg/dL

Explanation: **Explanation:** The diagnosis of Diabetes Mellitus (DM) is based on standardized glycemic thresholds established by the WHO and ADA. **Option B** is correct because it aligns with the diagnostic criteria: a **Fasting Plasma Glucose (FPG) ≥ 126 mg/dL** (after at least 8 hours of fasting) or a **2-hour Post-Prandial (PP) / Oral Glucose Tolerance Test (OGTT) value ≥ 200 mg/dL** (often simplified as > 199 mg/dL). These thresholds are clinically significant as they represent the point at which the risk of microvascular complications, particularly retinopathy, increases sharply. **Analysis of Incorrect Options:** * **Option A:** These values (FBS > 100 and PP > 140) define the upper limit of "Normal" and the beginning of **Prediabetes** (Impaired Fasting Glucose and Impaired Glucose Tolerance). * **Option C:** An **HbA1C of 5.5%** is considered normal. The diagnostic cutoff for Diabetes is **HbA1C ≥ 6.5%**, while 5.7%–6.4% indicates prediabetes. * **Option D:** FBS > 70 mg/dL is within the physiological normal range (70–100 mg/dL). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The OGTT (using 75g anhydrous glucose) is the gold standard for diagnosis, though HbA1C is more convenient. * **Random Blood Sugar:** A value **≥ 200 mg/dL** in a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, weight loss) is also diagnostic. * **Screening:** In the community, the **Indian Diabetes Risk Score (IDRS)** is a high-yield tool used to identify individuals at risk based on age, abdominal obesity, physical activity, and family history.

Question 500: Isolation is strictly recommended for which of the following conditions?

A. HIV
B. Measles
C. Brucellosis
D. Pneumonic plague (Correct Answer)

Explanation: **Explanation:** The correct answer is **Pneumonic Plague**. In public health and epidemiology, **isolation** refers to the separation of infected individuals from others during the period of communicability to prevent the direct or indirect transmission of the infectious agent. **1. Why Pneumonic Plague is the Correct Answer:** Pneumonic plague, caused by *Yersinia pestis*, is one of the most lethal infectious diseases. It is transmitted via respiratory droplets and has a near 100% fatality rate if untreated. Due to its high infectivity, rapid progression, and potential for large-scale outbreaks, **strict respiratory isolation** is mandatory until the patient has completed at least 48 hours of appropriate antibiotic therapy (e.g., Streptomycin or Gentamicin) and shows clinical improvement. **2. Analysis of Incorrect Options:** * **HIV:** Transmission occurs through blood, sexual contact, or vertical transmission. It is not spread by casual contact or droplets; therefore, isolation is never indicated. Standard precautions are sufficient. * **Measles:** While highly contagious, measles is usually managed with "respiratory precautions" rather than strict hospital isolation in general practice. In the community, children are simply excluded from school. * **Brucellosis:** This is a zoonotic disease transmitted via contaminated dairy or direct contact with animal tissues. There is no documented human-to-human transmission, making isolation unnecessary. **3. NEET-PG High-Yield Pearls:** * **Quarantine vs. Isolation:** Quarantine is for healthy **contacts** (exposed persons) for the duration of the longest incubation period. Isolation is for **cases** (infected persons) for the period of communicability. * **International Health Regulations (IHR):** Diseases requiring international notification include Plague, Cholera, and Yellow Fever. * **Plague Prophylaxis:** The drug of choice for chemoprophylaxis in contacts of pneumonic plague is **Doxycycline** or Tetracycline.

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