Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 581: WHO global target for prevention and control of non-communicable diseases by 2025 is to decrease hypertension by:

A. 25% (Correct Answer)
B. 55%
C. 75%
D. 35%

Explanation: ***25%*** - The World Health Organization (WHO) set a **global target** to reduce the prevalence of high blood pressure (hypertension) by **25%** among individuals aged 18+ years by 2025, from a 2010 baseline. - This target is part of a broader WHO effort to combat **non-communicable diseases (NCDs)** and improve global health outcomes. *55%* - This percentage is not recognized as a specific WHO global target for the reduction of hypertension prevalence. - The NCD targets generally focus on more achievable and evidence-based reductions to ensure global feasibility. *75%* - A 75% reduction in hypertension prevalence is an exceptionally ambitious target that has not been set by WHO for the 2025 timeframe. - Such a drastic reduction is typically not seen in global public health goals due to the complex nature of NCDs and their determinants. *35%* - While significant, a 35% reduction is not the specified WHO global target for hypertension by 2025. - The established target reflects a balance between ambition and realistic attainability across diverse global health systems.

Question 582: The preferred public health approach to control non-communicable disease is -

A. Focus on high risk individuals for reduction of risk
B. Early diagnosis and treatment of identified cases
C. Shift to the population-based approach (Correct Answer)
D. Individual disease-based vertical programs

Explanation: ***Shift to the population-based approach*** - A **population-based approach** aims to reduce the average risk across the entire population, leading to a larger overall reduction in NCD burden. - This strategy focuses on broad interventions like health promotion, policy changes, and environmental modifications that benefit everyone. *Focus on high risk individuals for reduction of risk* - This approach, while important, only targets a smaller subset of the population and may miss individuals who are at moderate risk but contribute significantly to the overall disease burden. - It relies on identifying and intervening with specific individuals, which can be resource-intensive and may not achieve widespread impact. *Early diagnosis and treatment of identified cases* - This is a crucial component of secondary prevention but primarily addresses **existing disease** rather than preventing its occurrence in the first place across the population. - While it improves outcomes for affected individuals, it does not tackle the root causes of NCDs at a population level. *Individual disease-based vertical programs* - **Vertical programs** are highly focused on a single disease, which can lead to fragmentation of services and inefficient use of resources. - They often fail to address the common risk factors and determinants that contribute to multiple NCDs, hindering a holistic public health response.

Question 583: Descending order of cancer prevalence in males in India?

A. Oral > lung > pharynx > esophagus
B. Pharynx > lung > oral > esophagus
C. Lung > oral > pharynx > esophagus (Correct Answer)
D. Esophagus > oral > stomach > lung

Explanation: ***Lung > oral > pharynx > esophagus*** - This order represents the **most common cancer prevalence pattern** in Indian males according to **ICMR-NCDIR** population-based cancer registries. - **Lung cancer** ranks highest nationally, strongly associated with **smoking** (bidi and cigarette use). - **Oral cavity cancer** is extremely prevalent in India due to **tobacco chewing, betel quid, and gutka consumption**. - **Pharyngeal cancer** and **esophageal cancer** follow, also linked to tobacco and alcohol use. - Regional variations exist, but this order reflects **national-level data** for Indian males. *Oral > lung > pharynx > esophagus* - While **oral cancer prevalence is very high** in India (competing with lung cancer in some regions), at the **national aggregate level**, lung cancer typically ranks first. - This order may be accurate for **specific regions** with high tobacco chewing prevalence but does not represent the overall national pattern. *Pharynx > lung > oral > esophagus* - **Pharyngeal cancer** is less prevalent than both **lung and oral cancers** in Indian males. - This sequence incorrectly places pharyngeal cancer at the top, which contradicts **Indian cancer registry data**. *Esophagus > oral > stomach > lung* - This order is incorrect as **esophageal and stomach cancers** are significantly less prevalent than **lung and oral cancers** in Indian males. - **Lung cancer consistently ranks at or near the top** in Indian male cancer statistics, making this order epidemiologically inaccurate.

Question 584: Which of the following is primordial prevention for non-communicable diseases?

A. Salt restriction in high NCD area
B. Smoking cessation in high NCD area
C. Preservation of traditional diet in low NCD area (Correct Answer)
D. Early diagnosis & Treatment

Explanation: ***Preservation of traditional diet in low NCD area*** - **Primordial prevention** targets the underlying causes of disease before risk factors are established, often at a population level. - Preserving a **healthy traditional diet** in an area with low rates of non-communicable diseases (NCDs) prevents the emergence of shared risk factors like processed food consumption and sedentary lifestyles. *Salt restriction in high NCD area* - This is an example of **primary prevention**, as it aims to reduce a specific risk factor (high salt intake) in a population susceptible to NCDs like hypertension. - It intervenes when risk factors are already present or emerging, unlike primordial prevention which aims to prevent their development. *Smoking cessation in high NCD area* - Also a form of **primary prevention**, as it targets an existing modifiable risk factor (smoking) to prevent the onset of NCDs. - It focuses on individuals or groups already exposed to a risk factor rather than preventing the societal conditions that lead to its emergence. *Early diagnosis & Treatment* - This falls under **secondary prevention**, which aims to detect and treat diseases early to halt their progression and prevent complications. - It occurs after the disease has already begun but before significant symptoms or irreversible damage have occurred.

Question 585: National Cancer Awareness Day is celebrated on:

A. 31st November
B. 7th November (Correct Answer)
C. 31st May
D. 7th May

Explanation: ***7th November*** - **National Cancer Awareness Day** in India is observed annually on **November 7th** to raise awareness about cancer symptoms, prevention, and early detection. - This date marks the birth anniversary of **Madame Marie Curie**, whose pioneering work in radioactivity significantly contributed to cancer treatment. *31st November* - **November has only 30 days**, making "31st November" an invalid date. - This date is not recognized for any significant health awareness campaign related to cancer. *31st May* - **May 31st** is recognized globally as **World No Tobacco Day**, an initiative by the World Health Organization (WHO) to highlight the health risks of tobacco. - While tobacco use is a major cause of cancer, this day is not specifically designated as National Cancer Awareness Day. *7th May* - **May 7th** does not hold specific recognition as **National Cancer Awareness Day** in India. - While there are various cancer awareness initiatives throughout the year, this particular date is not associated with this specific observance.

Question 586: STEPS is done for:

A. Surveillance of risk factors of non-communicable disease (Correct Answer)
B. Surveillance of mortality from non-communicable disease
C. Surveillance of evaluation of treatment of non-communicable disease
D. Surveillance of incidence of non-communicable disease

Explanation: ***Surveillance of risk factors of non-communicable disease*** - STEPS is a **WHO-designed sequential survey** that tracks **risk factors** of non-communicable diseases (NCDs) in a stepwise approach. - It collects data on behavioral risk factors (e.g., tobacco use, unhealthy diet, physical inactivity), physical measurements (e.g., blood pressure, weight, height), and biochemical measurements (e.g., blood glucose, cholesterol). *Surveillance of mortality from non-communicable disease* - While related to NCDs, STEPS primarily focuses on **risk factors** that lead to these diseases, not directly on mortality data. - Mortality surveillance is typically conducted through **vital registration systems** and health information systems. *Surveillance of evaluation of treatment of non-communicable disease* - STEPS surveys are not designed to evaluate the **effectiveness of specific treatments** for NCDs. - Evaluating treatment efficacy usually involves **clinical trials** or specific cohort studies. *Surveillance of incidence of non-communicable disease* - Although the presence of risk factors influences incidence, STEPS primarily measures the **prevalence of risk factors**, not the incidence (new cases) of NCDs themselves. - Incidence studies require longitudinal follow-up of populations.

Question 587: According to WHO guidelines, to decrease both coronary heart disease and diabetes, triple treatment involves:

A. Healthy diet, regular physical exercise, avoiding tobacco (Correct Answer)
B. Lipid lowering drug, avoiding tobacco, poly pill
C. Healthy diet, regular physical exercise, decreased salt intake
D. Decreased salt intake, poly pill, vegetarian diet

Explanation: ***Correct: Healthy diet, regular physical exercise, avoiding tobacco*** - This represents the **WHO's core triple intervention strategy** for primary prevention of both **coronary heart disease** and **diabetes mellitus** - **Healthy diet** addresses obesity, dyslipidemia, and insulin resistance—common risk factors for both conditions - **Regular physical exercise** improves glucose metabolism, insulin sensitivity, and cardiovascular fitness while reducing multiple CVD risk factors - **Avoiding tobacco** prevents endothelial dysfunction, reduces inflammation, and decreases risk of both macrovascular complications in diabetes and atherosclerotic heart disease - These three lifestyle modifications form the foundation of WHO's **Global Action Plan for Prevention and Control of NCDs** *Incorrect: Healthy diet, regular physical exercise, decreased salt intake* - While **decreased salt intake** is important for blood pressure control and CVD prevention, it is not part of the specific "triple treatment" framework for both CHD and diabetes - Salt reduction is more targeted toward hypertension management rather than diabetes prevention - The WHO emphasizes **tobacco avoidance** over salt reduction when addressing both conditions simultaneously *Incorrect: Lipid lowering drug, avoiding tobacco, poly pill* - These are **pharmacological interventions** rather than lifestyle modifications - The question asks about primary prevention measures that apply universally, not secondary prevention or high-risk treatment strategies - While **poly pills** have a role in secondary prevention, they are not first-line "triple treatment" for primary prevention *Incorrect: Decreased salt intake, poly pill, vegetarian diet* - **Vegetarian diet** is a specific dietary pattern, not the universal "healthy diet" recommendation - **Poly pill** is a pharmacological intervention, not suitable for population-wide primary prevention - This combination does not reflect WHO's core triple intervention framework

Question 588: STEPwise approach to surveillance for Non-Communicable diseases step 2 is

A. Biochemical Measurement
B. Behavioral measurement
C. Physical measurement (Correct Answer)
D. Emotional Assessment

Explanation: ***Physical measurement*** - The **STEPwise approach** to NCD surveillance involves three steps, with Step 2 specifically focusing on **physical measurements**. - This step includes measurements like **blood pressure**, BMI, weight, height, and waist circumference, which provide crucial data on NCD risk factors. *Biochemical Measurement* - This is typically **Step 3** in the WHO STEPwise approach, focusing on biological measurements from blood or urine samples. - Examples include **blood glucose**, cholesterol levels, and other biomarkers. *Behavioral measurement* - This corresponds to **Step 1** of the WHO STEPwise approach, which involves self-reported data on lifestyle factors. - It covers aspects like **diet**, physical activity, and tobacco/alcohol consumption. *Emotional Assessment* - While emotional and mental health are relevant to overall well-being, **emotional assessment** is not a standard, distinct step in the core WHO STEPwise approach for NCD surveillance. - The STEPs focus on behavioral, physical, and biochemical indicators of NCD risk.

Question 589: Primordial prevention in coronary heart disease:

A. Salt restriction (Correct Answer)
B. BP monitoring
C. Statins
D. Regular exercise program

Explanation: ***Salt restriction*** - **Primordial prevention** aims to prevent risk factors from developing in the first place through population-wide policies and environmental changes. - **Salt restriction** through food industry regulations, public policy, and reducing salt content in processed foods is a classic example of primordial prevention targeting entire populations. - This prevents hypertension from developing at the population level, which is a key risk factor for coronary heart disease (CHD). *BP monitoring* - **BP monitoring** is a form of **primary prevention** (or secondary prevention if hypertension is already diagnosed), as it involves screening or managing an existing risk factor (high blood pressure). - It does not prevent the development of the risk factor itself but rather identifies or controls it once it has emerged. *Statins* - **Statins** are used for **primary or secondary prevention** of CHD by lowering cholesterol levels in individuals who already have elevated lipid levels or an increased risk of cardiovascular events. - This intervention manages an existing risk factor rather than preventing its initial development in the population. *Regular exercise program* - While promoting physical activity can be part of primordial prevention at the policy level, a **regular exercise program** typically refers to **primary prevention** aimed at individuals or high-risk groups to prevent disease onset. - In the context of this question, salt restriction through population-level policy interventions (e.g., reducing salt in processed foods) is the most direct and established primordial prevention strategy for CHD risk factors. - Exercise programs, when individualized, focus on preventing disease in susceptible individuals rather than preventing risk factors from emerging in the entire population.

Question 590: Which of the following is not a criterion suggesting causality in non communicable diseases?

A. Specificity of association
B. Dose response relationship
C. Strength of association
D. Lack of temporal association (Correct Answer)

Explanation: ***Lack of temporal association*** - For an exposure to cause a non-communicable disease, the exposure must precede the disease onset; therefore, a **lack of temporal association** explicitly argues *against* causality. - This criterion is a fundamental principle of causality, as the **cause must occur before the effect**. *Specificity of association* - This criterion suggests that a single exposure should lead to a single disease. However, in non-communicable diseases, a single risk factor may contribute to multiple diseases (e.g., smoking and lung cancer, heart disease, stroke), and a single disease can have **multiple causes**. - While it was important in the original Bradford Hill criteria, its relevance is diminished in modern epidemiology due to the **multifactorial nature of chronic diseases**. *Dose response relationship* - This criterion implies that as the **amount or duration of exposure increases**, the **risk or severity of the disease also increases**. - This is a strong indicator of causality because it suggests a biological gradient. *Strength of association* - A strong association, often measured by a **high relative risk or odds ratio**, increases the likelihood of a causal relationship. - A weak association, while not ruling out causality, makes it less likely to be directly causal and more likely to be influenced by other factors or confounding variables.

Practice by Chapter

Epidemiology of NCDs

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Cardiovascular Disease Prevention

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Diabetes Control Program

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Cancer Screening and Control

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Chronic Respiratory Diseases

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Mental Health Program

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Blindness Control Program

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Accident and Injury Prevention

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NCD Risk Factor Surveillance

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National Program for Prevention and Control of Cancer, Diabetes, CVD, and Stroke

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Oral Health Program

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Geriatric Health Issues

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