Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 541: In lepromatous leprosy, for how long is the single drug dapsone continued?

A. 9 days
B. 90 days
C. 1 year (Correct Answer)
D. 10 years

Explanation: **Explanation:** The treatment of Leprosy is governed by the WHO Multi-Drug Therapy (MDT) guidelines. In **Lepromatous Leprosy (Multibacillary/MB)**, the standard regimen consists of Rifampicin, Clofazimine, and Dapsone. **Why 1 year is correct:** According to the current WHO guidelines for Multibacillary (MB) leprosy, the duration of treatment is **12 months (1 year)**. This regimen is designed to ensure the complete clearance of a high bacterial load and to prevent relapse. While the clinical symptoms may take longer to resolve, the standard duration for the administration of the MDT blister pack (which includes daily Dapsone) is fixed at 12 months. **Analysis of Incorrect Options:** * **9 days / 90 days:** These durations are far too short to achieve bacteriological cure in leprosy, which involves slow-growing *Mycobacterium leprae*. Short courses would lead to immediate treatment failure and drug resistance. * **10 years:** This reflects outdated practices. Before the introduction of MDT in 1982, Dapsone monotherapy was often continued for many years, sometimes for life in lepromatous cases. Modern MDT has significantly shortened the treatment duration while increasing efficacy. **High-Yield Clinical Pearls for NEET-PG:** * **MB Leprosy Regimen:** Rifampicin (600mg once a month), Clofazimine (300mg once a month + 50mg daily), and Dapsone (100mg daily) for **12 months**. * **PB Leprosy Regimen:** Rifampicin (600mg once a month) and Dapsone (100mg daily) for **6 months**. * **ROM Therapy:** For Single Lesion Paucibacillary leprosy, a single dose of **R**ifampicin, **O**floxacin, and **M**inocycline is used. * **Dapsone Side Effect:** Be wary of "Dapsone Syndrome" (exfoliative dermatitis, hepatitis, and lymphadenopathy) and hemolytic anemia in G6PD deficient patients.

Question 542: Which of the following statements regarding the composition of new WHO oral rehydration solution (ORS) is incorrect?

A. Sodium chloride: 2.6 grams/litre
B. Potassium chloride: 1.5 grams/litre
C. Glucose: 13.5 grams/litre
D. Total osmolarity: 300 mmol/L (Correct Answer)

Explanation: **Explanation:** The question asks for the **incorrect** statement regarding the composition of the **New (Reduced Osmolarity) WHO ORS**. **1. Why Option D is the Correct Answer (The Incorrect Statement):** The total osmolarity of the New WHO ORS is **245 mmol/L**, not 300 mmol/L. The WHO shifted from the standard ORS (311 mmol/L) to a reduced osmolarity formula to prevent hypertonicity. This change reduces stool output, decreases vomiting, and minimizes the need for unscheduled IV fluids, making it safer and more effective for children with non-cholera diarrhea. **2. Why Other Options are Incorrect (They are Correct Compositions):** * **Option A (Sodium Chloride - 2.6 g/L):** This is the correct weight for sodium chloride in the new formula. It provides 75 mmol/L of Sodium. * **Option B (Potassium Chloride - 1.5 g/L):** This is the correct weight, providing 20 mmol/L of Potassium to replace losses and prevent hypokalemia. * **Option C (Glucose - 13.5 g/L):** This is the correct weight for anhydrous glucose. It provides 75 mmol/L of glucose, maintaining a 1:1 molar ratio with sodium to optimize co-transport in the small intestine. **High-Yield Clinical Pearls for NEET-PG:** * **Composition in mmol/L:** Sodium (75), Chloride (65), Glucose (75), Potassium (20), Citrate (10). **Total = 245 mmol/L.** * **Trisodium Citrate (2.9 g/L):** Added to the ORS to correct acidosis and increase the shelf life of the packet. * **Rehydration Phase:** In Plan B (Some Dehydration), the amount of ORS given in the first 4 hours is **Weight (kg) × 75 ml**. * **Zinc Supplementation:** Always given alongside ORS (20 mg/day for 10–14 days; 10 mg for infants <6 months) to reduce the duration and recurrence of diarrhea.

Question 543: A patient with a known history of tuberculosis is now found to be resistant to Rifampicin and Isoniazid. Which of the following treatment regimens would be most appropriate?

A. Administer 6 drugs for 4 months, followed by 4 drugs for 12 months.
B. Administer 4 drugs for 4 months, followed by 6 drugs for 12 months.
C. Administer 6 drugs for 6 months, followed by 4 drugs for 18 months. (Correct Answer)
D. Administer 5 drugs for 2 months, followed by 4 drugs for 1 month, and then 3 drugs for 5 months.

Explanation: **Explanation** The patient is resistant to both **Rifampicin and Isoniazid**, which defines **Multidrug-Resistant Tuberculosis (MDR-TB)**. According to the National TB Elimination Program (NTEP) guidelines in India, the standard treatment for MDR-TB follows the **Longer All-Oral Mdr-TB Regimen**. 1. **Why Option C is Correct:** The Longer MDR-TB regimen consists of two phases: * **Intensive Phase (IP):** 6 months of treatment with at least 6 drugs (typically including Bedaquiline for the full duration, along with Levofloxacin, Linezolid, Clofazimine, and Cycloserine). * **Continuation Phase (CP):** 18 months of treatment with 4 drugs (after Bedaquiline and potentially another drug are stopped). The total duration is **18–24 months**, making the "6 months IP + 18 months CP" the standard pharmacological approach for durable cure in MDR-TB. 2. **Why Other Options are Incorrect:** * **Options A & B:** These durations (4 months IP or 12 months CP) are insufficient for MDR-TB. Shorter regimens (9–11 months) exist but follow a specific 4-6 month IP and 5 month CP structure, which does not match these options. * **Option D:** This represents an outdated "Category II" or older retreatment regimen which is no longer recommended under the current "Universal Drug Susceptibility Testing" (UDST) protocols. **High-Yield Clinical Pearls for NEET-PG:** * **MDR-TB Definition:** Resistance to at least Isoniazid (H) and Rifampicin (R). * **Extensively Drug-Resistant (XDR-TB):** MDR-TB plus resistance to any fluoroquinolone AND at least one additional Group A drug (Bedaquiline or Linezolid). * **Bedaquiline:** The "backbone" of modern MDR-TB therapy; it inhibits mycobacterial ATP synthase. * **NTEP Goal:** India aims to achieve "End TB" by **2025**, five years ahead of the global SDG target of 2030.

Question 544: What is the incubation period of Nipah virus?

A. 4-14 days (Correct Answer)
B. 2-6 days
C. 3-8 days
D. 5-10 days

Explanation: **Explanation:** The incubation period (IP) of **Nipah Virus (NiV)** typically ranges from **4 to 14 days**. However, it is important to note that incubation periods as long as 45 days have been reported in rare instances. **Why Option A is Correct:** According to the World Health Organization (WHO) and the CDC, the most common interval between exposure and symptom onset is 4–14 days. This period represents the time required for the virus to replicate sufficiently within the host’s respiratory or neurological systems to manifest clinical symptoms like fever, encephalitic syndrome, or respiratory distress. **Analysis of Incorrect Options:** * **Option B (2-6 days):** This is too short for Nipah but is characteristic of viruses like **Influenza** or **Ebola** (which has a broader range but often presents early). * **Option C (3-8 days):** This range is more typical for **Dengue fever** (3–14 days, commonly 4–7). * **Option D (5-10 days):** While overlapping with the Nipah range, it is too narrow and is more representative of the IP for **Leptospirosis** or certain Rickettsial infections. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoir:** Fruit bats of the genus *Pteropus* (Flying foxes). * **Transmission:** Consumption of raw date palm sap contaminated with bat excreta, direct contact with infected pigs, or human-to-human transmission (especially in hospital settings). * **Clinical Hallmark:** Acute Encephalitis (high mortality rate: 40%–75%) and severe respiratory illness. * **Diagnosis:** RT-PCR (from throat swabs, CSF, or urine) and ELISA (IgG/IgM). * **Treatment:** Primarily supportive; **Ribavirin** has been used in some outbreaks, and monoclonal antibodies (m102.4) are under investigation.

Question 545: What is the standard treatment for a patient with recently diagnosed sputum-positive pulmonary tuberculosis?

A. Rifampicin + Isoniazid + Pyrazinamide
B. Rifampicin + Isoniazid + Pyrazinamide + Streptomycin
C. Rifampicin + Isoniazid + Pyrazinamide + Ethambutol (Correct Answer)
D. Rifampicin + Isoniazid + Ethambutol

Explanation: ### Explanation **Correct Answer: C. Rifampicin + Isoniazid + Pyrazinamide + Ethambutol** **1. Why Option C is Correct:** According to the **National TB Elimination Program (NTEP)** guidelines (based on WHO standards), the standard treatment for all new cases of drug-sensitive pulmonary tuberculosis consists of a **6-month regimen**. This is divided into two phases: * **Intensive Phase (IP) - 2 months:** Four drugs are used (**HRZE**: Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol). The goal is to rapidly kill actively multiplying bacilli and prevent the emergence of drug resistance. * **Continuation Phase (CP) - 4 months:** Three drugs are used (**HRE**). Note: Ethambutol was added to the CP in recent updates to prevent relapse in cases of high initial Isoniazid resistance. **2. Why Other Options are Incorrect:** * **Option A:** This lacks Ethambutol. Using only three drugs in the intensive phase increases the risk of developing multi-drug resistant TB (MDR-TB) if there is baseline resistance to Isoniazid. * **Option B:** Streptomycin was previously used in the "Category II" regimen for retreatment cases. However, the NTEP has phased out Category II; all patients (new or previously treated) now receive the same HRZE regimen unless drug resistance is detected. * **Option D:** This lacks Pyrazinamide. Pyrazinamide is essential in the first 2 months for its "sterilizing" effect on semi-dormant bacilli inside macrophages, which significantly shortens the total duration of treatment. **3. NEET-PG High-Yield Pearls:** * **Dosage:** Under NTEP, drugs are administered as **Fixed-Dose Combinations (FDC)** based on the patient's weight bands. * **Daily vs. Intermittent:** The regimen is now **Daily**, replacing the old thrice-weekly schedule to improve efficacy and reduce relapse. * **Ethambutol's Role:** It is primarily bacteriostatic and acts as a "safety net" to prevent resistance to Rifampicin if the strain is already resistant to Isoniazid. * **Side Effects:** Always remember **Pyrazinamide** causes hyperuricemia, **Ethambutol** causes optic neuritis (monitor visual acuity), and **Rifampicin** causes orange-colored urine.

Question 546: During a year, 100 cases of malaria were detected by a thick smear in a population of 100,000. What is the annual parasite index?

A. 1 per 1000 (Correct Answer)
B. 2 per 1000
C. 10 per 1000
D. 20 per 1000

Explanation: ### Explanation **1. Understanding the Correct Answer (Option A)** The **Annual Parasite Index (API)** is a key epidemiological indicator used under the National Center for Vector Borne Diseases Control (NCVBDC) to measure the incidence of malaria in a community. It is defined as the number of confirmed malaria cases (positive slides) per 1000 population per year. The formula for API is: $$\text{API} = \frac{\text{Total number of positive slides for parasite in a year}}{\text{Total population under surveillance}} \times 1000$$ **Calculation:** * Total positive cases = 100 * Total population = 100,000 * $\text{API} = (100 / 100,000) \times 1000 = \mathbf{1 \text{ per } 1000}$ **2. Analysis of Incorrect Options** * **Option B (2 per 1000):** This would require 200 cases in the same population. * **Option C (10 per 1000):** This would require 1,000 cases in the same population. * **Option D (20 per 1000):** This would require 2,000 cases. This level often triggers intensified control measures (API > 2 is the threshold for indoor residual spray in many guidelines). **3. NEET-PG High-Yield Pearls** * **API vs. ABER:** While API measures disease burden, the **Annual Blood Examination Rate (ABER)** measures the efficiency of the surveillance system. A minimum ABER of **10%** is required for effective malaria monitoring. * **Slide Positivity Rate (SPR):** This is the percentage of slides examined that are positive for malaria. * **Thresholds:** An **API < 1** is often the target for moving from the "control" phase to the "elimination" phase in the National Framework for Malaria Elimination in India. * **Thick vs. Thin Smear:** Thick smears are used for **detection** (higher sensitivity), while thin smears are used for **species identification** and quantification.

Question 547: Which of the following are vectors for plague transmission?

A. Xenopsylla cheopis
B. Xenopsylla astia
C. Pulex irritans
D. All of the above (Correct Answer)

Explanation: **Explanation:** Plague is a zoonotic disease caused by the bacterium *Yersinia pestis*. While it is primarily a disease of rodents, it is transmitted to humans via the bite of infected fleas. 1. **Xenopsylla cheopis (Oriental Rat Flea):** This is the **most efficient** and primary vector for plague transmission globally. It is highly susceptible to "blocking" (where the bacteria multiply in the flea's proventriculus), which forces the flea to bite humans more frequently to feed, thereby spreading the infection. 2. **Xenopsylla astia:** This is a common flea species found in India and Southeast Asia. While it is a less efficient vector than *X. cheopis*, it is still capable of transmitting the disease and has been implicated in various outbreaks. 3. **Pulex irritans (Human Flea):** Although humans are not the primary reservoir, *P. irritans* can act as a mechanical or biological vector, especially in areas with poor sanitation or during large-scale epidemics. **Why "All of the above" is correct:** While *X. cheopis* is the most significant vector, the transmission of plague is not exclusive to one species. Multiple flea species across different genera can harbor and transmit *Y. pestis*. **High-Yield Clinical Pearls for NEET-PG:** * **Vector Indices:** The **Cheopis Index** (average number of *X. cheopis* per rat) is a critical surveillance tool. An index **>1** indicates a high risk of a plague outbreak. * **Blocking Phenomenon:** This is the physiological mechanism in the flea that ensures transmission. * **Drug of Choice:** **Streptomycin** is the traditional drug of choice, though Gentamicin and Doxycycline are also used. * **Diagnosis:** Identification of "safety-pin" appearance (bipolar staining) on Wayson or Giemsa stain.

Question 548: Sputum examination under DTP is indicated when a patient presents with which of the following?

A. Cough of 1-2 weeks duration
B. Persistent cough of 1-2 weeks duration
C. Hemoptysis (Correct Answer)
D. Chest pain

Explanation: **Explanation:** Under the **District Tuberculosis Programme (DTP)** and the current **National TB Elimination Programme (NTEP)** guidelines, the primary objective is the early identification of "Presumptive TB" cases. **Why Hemoptysis is the Correct Answer:** Hemoptysis (coughing up blood) is considered a "cardinal symptom" of pulmonary tuberculosis. According to the diagnostic algorithm, any individual presenting with hemoptysis—regardless of the duration of other symptoms—must undergo a sputum examination (Sputum Smear or NAAT/CBNAAT) to rule out active TB. It signifies potential parenchymal lung damage or cavitary disease, making it a high-priority clinical indicator. **Analysis of Incorrect Options:** * **Options A & B (Cough of 1-2 weeks):** Current NTEP guidelines define a "Presumptive TB" case as an individual with a **persistent cough for 2 weeks or more**. A cough of only 1 week, unless accompanied by other red flags like hemoptysis or significant weight loss, does not automatically trigger a sputum mandate under the standard screening protocol. * **Option D (Chest pain):** While chest pain can occur in TB (especially with pleural involvement), it is a non-specific symptom. On its own, without a persistent cough or hemoptysis, it is not a primary indication for sputum examination under the DTP. **High-Yield Clinical Pearls for NEET-PG:** * **Presumptive TB Definition:** Persistent cough ≥ 2 weeks, fever ≥ 2 weeks, significant weight loss, or **hemoptysis**. * **Diagnostic Gold Standard:** In the NTEP, **NAAT (CBNAAT/Truenat)** has replaced sputum microscopy as the initial diagnostic test where available. * **Sputum Collection:** Under the RNTCP/NTEP, two samples are required (one spot and one morning sample), though the focus has shifted toward rapid molecular diagnostics.

Question 549: Which of the following is a newer type of Influenza vaccine?

A. Split-virus vaccine (Correct Answer)
B. Conjugate vaccine
C. Live attenuated vaccine
D. Killed vaccine

Explanation: **Explanation:** The **Split-virus vaccine** is considered a "newer" generation of inactivated influenza vaccines compared to the traditional whole-virus killed vaccines. It is produced by treating the influenza virus with detergents or solvents (like ether) to disrupt the viral envelope. This process "splits" the virus, leaving the surface antigens (Hemagglutinin and Neuraminidase) intact while reducing the internal pyrogenic components. This results in a vaccine that is **highly immunogenic but has a significantly lower incidence of side effects** (fewer febrile reactions), making it the preferred choice for pediatric and adult populations. **Analysis of Incorrect Options:** * **B. Conjugate vaccine:** This technology (linking a polysaccharide to a protein carrier) is used for bacteria like *H. influenzae* type b (Hib) or *S. pneumoniae*, not for the influenza virus. * **C. Live attenuated vaccine (LAIV):** These are administered intranasally (e.g., Flumist). While used, they are not classified as the "newer" modification of the standard injectable inactivated platform in the context of this specific comparison. * **D. Killed vaccine:** This refers to the traditional **Whole-virion** inactivated vaccine. While effective, it is the "older" type and is associated with higher rates of local and systemic reactions compared to split-virus or subunit vaccines. **NEET-PG High-Yield Pearls:** * **Composition:** Most flu vaccines are **trivalent** (2A + 1B strain) or **quadrivalent** (2A + 2B strains). * **Strains:** The WHO recommends strains annually based on global surveillance (GISRS). * **Egg Allergy:** Most influenza vaccines are grown in embryonated chicken eggs; however, recombinant vaccines (egg-free) are now available. * **Target:** The primary target for neutralizing antibodies is the **Hemagglutinin (HA)** protein.

Question 550: Which year was the Medical Termination of Pregnancy (MTP) Act passed?

A. 1971 (Correct Answer)
B. 1981
C. 1957
D. 1961

Explanation: **Explanation:** The **Medical Termination of Pregnancy (MTP) Act** was passed by the Indian Parliament in **1971** and came into force on April 1, 1972. It was enacted to provide a legal framework for the termination of certain pregnancies by registered medical practitioners, primarily to reduce the incidence of maternal mortality and morbidity caused by illegal abortions. **Analysis of Options:** * **1971 (Correct):** The year the MTP Act was enacted. It is a landmark legislation in reproductive health. Note that the Act was recently amended in **2021**, increasing the upper gestation limit to 24 weeks for specific categories of women. * **1981 (Incorrect):** This year is associated with the launch of the National Leprosy Eradication Programme (NLEP) and the first reported cases of HIV/AIDS globally. * **1957 (Incorrect):** This year is significant for the launch of the National Tuberculous Survey in India, but unrelated to abortion laws. * **1961 (Incorrect):** This year saw the enactment of the **Dowry Prohibition Act** and the Maternity Benefit Act in India. **High-Yield Clinical Pearls for NEET-PG:** * **Shantilal Shah Committee (1964):** Their recommendations led to the drafting of the MTP Act. * **MTP Amendment Act 2021:** * Termination up to **20 weeks** requires the opinion of **one** doctor. * Termination between **20-24 weeks** (for special categories) requires **two** doctors. * Beyond **24 weeks** (for fetal abnormalities), a State-level **Medical Board** must decide. * **Confidentiality:** The name and particulars of the woman must not be revealed except to a person authorized by law (Section 5A).

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