Non-Communicable Diseases — MCQs

Non-Communicable Diseases Indian Medical PG Practice Questions and MCQs

Question 71: Dengue hemorrhagic fever most commonly occurs when:

A. Malnourished patients
B. Immunocompromised patients
C. A person previously infected with one dengue serotype is infected with a different serotype (Correct Answer)
D. Persons experiencing high-grade fever

Explanation: **Explanation:** The correct answer is **C**. The primary mechanism behind Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) is a phenomenon known as **Antibody-Dependent Enhancement (ADE)**. When a person is infected with a specific dengue serotype (e.g., DEN-1) for the first time, they develop lifelong immunity to that serotype. However, if they are later infected with a **different serotype** (e.g., DEN-2), the pre-existing non-neutralizing antibodies from the first infection bind to the new virus. Instead of neutralizing it, these antibodies facilitate the virus's entry into macrophages and monocytes. This leads to an exaggerated immune response, massive release of cytokines ("cytokine storm"), increased vascular permeability, and plasma leakage—the hallmarks of DHF. **Why other options are incorrect:** * **A & B:** Unlike many infectious diseases, DHF is not primarily driven by malnutrition or a weakened immune system. In fact, DHF is often seen in previously healthy children with robust immune systems because the pathology is **immunopathological** (caused by the immune system's overreaction). * **D:** While high-grade fever is a symptom of Dengue, it is not the *cause* of the hemorrhagic manifestation. DHF typically manifests during the "critical phase" when the fever starts to subside (defervescence). **High-Yield Pearls for NEET-PG:** * **Halstead’s Hypothesis:** Another name for the Antibody-Dependent Enhancement theory. * **Vector:** *Aedes aegypti* (Day biter, breeds in artificial collections of clean water). * **Tourniquet Test:** A positive test (≥10 petechiae per square inch) is a clinical indicator of capillary fragility in Dengue. * **Warning Signs:** Abdominal pain, persistent vomiting, mucosal bleed, and a rapid drop in platelet count with a rise in hematocrit.

Question 72: The net reproduction rate of 1 can be achieved only if which of the following rates exceeds 60%?

A. Total fertility rate
B. Total marital fertility rate
C. Age-specific marital fertility rate
D. Couple protection rate (Correct Answer)

Explanation: **Explanation:** The goal of the National Family Welfare Programme in India is to achieve a **Net Reproduction Rate (NRR) of 1**, which is the demographic equivalent of **Replacement Level Fertility**. NRR = 1 means that a mother is replaced by exactly one daughter who survives through her reproductive years. **Why the Correct Answer is Right:** To achieve an NRR of 1, the demographic transition requires a significant portion of the population to practice effective family planning. According to the National Health Policy, an NRR of 1 can only be achieved if the **Couple Protection Rate (CPR)** exceeds **60%**. CPR is the percentage of eligible couples effectively protected against childbirth by one or the other approved methods of family planning. It serves as a direct proxy for the success of family welfare programs in stabilizing the population. **Why the Incorrect Options are Wrong:** * **Total Fertility Rate (TFR):** This is the average number of children a woman would have in her lifetime. While NRR = 1 roughly corresponds to a **TFR of 2.1**, the question asks for the rate that must *exceed 60%*. TFR is a numerical count, not a percentage. * **Total Marital Fertility Rate (TMFR) & Age-Specific Marital Fertility Rate (ASMFR):** These measure fertility within marriage. While they influence population growth, they are indicators of birth patterns rather than the programmatic targets required to achieve NRR = 1. **High-Yield Pearls for NEET-PG:** * **NRR = 1** is the demographic goal of the National Health Policy. * **Replacement Level Fertility:** TFR = 2.1. * **Eligible Couple:** A currently married couple where the wife is in the reproductive age group (15–49 years). * **Proximate Determinant:** CPR is the most significant proximate determinant of fertility decline in a population.

Question 73: Which of the following is a characteristic of poliomyelitis?

A. Initial febrile illness followed by development of asymmetrical paralysis (Correct Answer)
B. Symmetrical muscle weakness with frequent paresthesia but normal reflexes
C. Ascending motor paralysis with preservation of reflexes and sensation
D. Pain in the affected limb with sensorimotor deficit

Explanation: ### Explanation **Correct Answer: A. Initial febrile illness followed by development of asymmetrical paralysis** Poliomyelitis is an acute viral infection caused by the Poliovirus (an enterovirus). The classic clinical presentation of paralytic polio involves a **biphasic illness**. It begins with a "minor illness" (fever, malaise, sore throat), followed by a brief asymptomatic period, leading into the "major illness" characterized by **Acute Flaccid Paralysis (AFP)**. The paralysis is characteristically **asymmetrical**, descending in nature, and primarily affects the proximal lower limb muscles. The virus destroys the **anterior horn cells** of the spinal cord, leading to lower motor neuron (LMN) signs. **Analysis of Incorrect Options:** * **Option B:** Symmetrical weakness with paresthesia and normal reflexes is inconsistent with Polio. Polio is strictly a motor disease; sensory involvement (paresthesia) is absent, and reflexes are typically lost (areflexia). * **Option C:** **Ascending** paralysis is the hallmark of **Guillain-Barré Syndrome (GBS)**. In Polio, the paralysis is usually descending or random but notably asymmetrical. * **Option D:** While "Polio" means grey and "Myelon" means marrow, the disease does not typically present with sensory deficits. Any significant sensorimotor deficit points toward peripheral neuropathy or spinal cord compression rather than Polio. **High-Yield Clinical Pearls for NEET-PG:** * **Most common presentation:** Inapparent/Asymptomatic infection (>90% of cases). * **Pathognomonic sign:** Asymmetrical flaccid paralysis with fever at the onset of paralysis. * **CSF Findings:** "Cell-protein dissociation" (initially high neutrophils, then lymphocytes; protein rises later). Note: This is different from the "Albuminocytologic dissociation" seen in GBS. * **Eradication Status:** India was declared Polio-free by the WHO in **2014**. The last case was reported in Howrah, West Bengal (2011). * **Vaccine:** OPV (Sabin) produces local intestinal immunity (IgA), while IPV (Salk) produces systemic immunity (IgG).

Question 74: Typhoid vaccine is for which disease?

A. Cholera
B. Tuberculosis
C. Pertussis
D. Typhoid (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Typhoid**. Typhoid fever is a systemic infection caused by the bacterium *Salmonella Typhi*. Vaccination is a primary preventive strategy used to induce immunity against this pathogen, particularly in endemic regions like India. **Why the correct answer is right:** Typhoid vaccines (such as the Vi polysaccharide, live attenuated Ty21a, or the newer Typhoid Conjugate Vaccine - TCV) work by stimulating the immune system to produce antibodies against *S. Typhi* antigens. TCV is currently preferred as it provides longer-lasting immunity and can be administered to infants as young as 6 months. **Analysis of Incorrect Options:** * **A. Cholera:** Prevented by Oral Cholera Vaccines (OCVs) like Shanchol or Dukoral, which target *Vibrio cholerae*. * **B. Tuberculosis:** Prevented by the **BCG (Bacillus Calmette-Guérin)** vaccine, a live attenuated strain of *Mycobacterium bovis*. * **C. Pertussis:** Prevented by the **'P' component** of the DPT (Diphtheria, Pertussis, Tetanus) or DTaP vaccine. **High-Yield Clinical Pearls for NEET-PG:** * **Typhoid Conjugate Vaccine (TCV):** It is the only typhoid vaccine licensed for children <2 years of age. It provides ~80-85% efficacy. * **Route of Administration:** Vi polysaccharide is given Intramuscularly (IM), while Ty21a is an oral vaccine (given on days 1, 3, and 5). * **Public Health:** Typhoid is primarily transmitted via the **fecal-oral route**. While vaccines are effective, the "gold standard" for control remains the improvement of sanitation and safe drinking water. * **Diagnosis:** Remember the **BASU** mnemonic for timing of tests: **B**lood culture (1st week), **A**ntibody/Widal (2nd week), **S**tool culture (3rd week), **U**rine culture (4th week).

Question 75: The H1N1 strain of influenza is responsible for which of the following conditions?

A. Avian influenza
B. Bird flu
C. Swine flu (Correct Answer)
D. None of the above

Explanation: **Explanation:** **Correct Answer: C. Swine flu** The **H1N1** strain is the primary subtype of Influenza A virus responsible for **Swine flu**. It gained global prominence during the 2009 pandemic. The nomenclature "H" and "N" refers to the surface glycoproteins: **Hemagglutinin (H)**, which facilitates viral entry into host cells, and **Neuraminidase (N)**, which assists in the release of new viral progeny. Swine flu is a respiratory disease of pigs that can cross the species barrier to cause human infections, primarily through droplet transmission. **Analysis of Incorrect Options:** * **Options A & B (Avian influenza / Bird flu):** These terms are synonymous. Avian influenza is caused by different strains of the Influenza A virus, most notably **H5N1** (highly pathogenic) and **H7N9**. While H1N1 is adapted to humans and swine, H5N1 remains primarily adapted to birds, though it carries a much higher mortality rate in humans. **High-Yield Clinical Pearls for NEET-PG:** * **Antiviral of Choice:** **Oseltamivir** (Tamiflu) is the drug of choice for H1N1, acting as a Neuraminidase inhibitor. * **Diagnostic Gold Standard:** Real-time **Reverse Transcriptase-PCR (RT-PCR)** is the preferred method for confirmation. * **Antigenic Shift vs. Drift:** * **Shift:** Major genetic changes (reassortment) leading to **pandemics** (e.g., 2009 H1N1). * **Drift:** Minor point mutations leading to **epidemics** and the need for annual vaccine updates. * **Vaccination:** The influenza vaccine is typically quadrivalent, covering two strains of Influenza A (H1N1, H3N2) and two lineages of Influenza B.

Question 76: After two doses of vaccination against plague, for how long will the immunity last?

A. Six months (Correct Answer)
B. One year
C. Eighteen months
D. Twenty-four months

Explanation: **Explanation:** The correct answer is **Six months (Option A)**. Plague vaccines, historically used to prevent *Yersinia pestis* infections, are known for providing relatively short-lived immunity. The standard killed whole-cell vaccine (the most common type historically) requires a primary series of two doses. However, the antibody levels decline rapidly following the initial series. According to the World Health Organization (WHO) and standard textbooks of Community Medicine (Park’s PSM), the immunity conferred by the plague vaccine lasts for only about **6 months**. Therefore, individuals at continuous high risk (such as laboratory workers or field researchers in endemic areas) require booster doses every 6 months to maintain protective titers. **Analysis of Incorrect Options:** * **Option B (One year):** While many bacterial vaccines (like the injectable Typhoid vaccine) offer protection for 1–3 years, the plague vaccine's cell-mediated and humoral response wanes much faster, making one year an overestimate. * **Options C and D (18 and 24 months):** These durations are significantly longer than the documented efficacy of the plague vaccine. No currently available plague vaccine provides two years of protection without multiple boosters. **High-Yield Clinical Pearls for NEET-PG:** * **Vaccine Type:** The traditional vaccine is a killed (formalin-inactivated) vaccine. Live attenuated vaccines (EV76 strain) exist but are generally not used due to high reactogenicity. * **Indications:** Vaccination is **not** recommended for the general public during an outbreak; it is reserved for high-risk occupational groups. * **Chemoprophylaxis:** For immediate protection during an outbreak or post-exposure, the drug of choice is **Doxycycline** or **Tetracycline**. * **Control of Outbreak:** In a plague outbreak, the priority is **flea control** (using insecticides) *before* rodent control to prevent "flea jump" to humans.

Question 77: Under the revised National Tuberculosis Control Programme, what is the schedule of treatment for category I patients?

A. 2 (HRZE)3 + 4(HR)3
B. 2 HRZE+ 4 HRE (Correct Answer)
C. 2(HRZES)3 + 1(HRZE)3 + 5(HRE)3
D. 2(HR)3 + 4 (HR)3

Explanation: ### Explanation The treatment of Tuberculosis in India has transitioned from intermittent therapy to **Daily Regimen** under the National TB Elimination Programme (NTEP), formerly RNTCP. **1. Why Option B is Correct:** For **Category I (New Cases)**, the standard treatment consists of: * **Intensive Phase (IP):** 2 months of **HRZE** (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) administered daily. * **Continuation Phase (CP):** 4 months of **HRE** (Isoniazid, Rifampicin, and Ethambutol) administered daily. * *Note:* Ethambutol was added to the CP to prevent drug resistance in areas with high baseline Isoniazid resistance. **2. Analysis of Incorrect Options:** * **Option A [2 (HRZE)3 + 4(HR)3]:** This represents the old **intermittent (thrice-weekly)** regimen for new cases. This was phased out in 2017 in favor of daily fixed-dose combinations (FDCs). * **Option C [2(HRZES)3 + 1(HRZE)3 + 5(HRE)3]:** This was the old **Category II** regimen for "Previously Treated" cases (Retreatment). Category II has been **abolished**; all patients (New or Previously Treated) now receive the same 2HRZE + 4HRE regimen unless Drug-Resistant TB is suspected. * **Option D [2(HR)3 + 4 (HR)3]:** This is an inadequate regimen lacking Pyrazinamide and Ethambutol, which are essential for preventing resistance and achieving sterilization. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dosage:** Drugs are administered as **Fixed-Dose Combinations (FDCs)** based on the patient's weight (4 weight bands). * **Pyridoxine (Vitamin B6):** Should be supplemented (10–25 mg/day) to prevent Isoniazid-induced peripheral neuropathy, especially in high-risk groups. * **Extension of IP:** Under the daily regimen, the Intensive Phase is **no longer extended** by one month if the 2-month sputum is positive. Instead, the patient moves to CP, and a DST (Drug Susceptibility Test) is performed. * **Public Health Goal:** India aims to eliminate TB by **2025**, five years ahead of the global SDG target of 2030.

Question 78: What is the recommended cholesterol level for the prevention of coronary artery disease?

A. < 250 mg/dl
B. < 220 mg/dl
C. < 300 mg/dl
D. < 200 mg/dl (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. < 200 mg/dl**. In the context of Community Medicine and Preventive Cardiology, the primary goal for preventing Coronary Artery Disease (CAD) is to maintain a favorable lipid profile. According to the **National Cholesterol Education Program (NCEP) - Adult Treatment Panel (ATP III)** guidelines, Serum Total Cholesterol levels are classified as follows: * **Desirable:** < 200 mg/dl * **Borderline High:** 200–239 mg/dl * **High:** ≥ 240 mg/dl Maintaining levels below 200 mg/dl is associated with a significantly lower risk of atherosclerotic plaque formation and subsequent ischemic heart disease. **Analysis of Incorrect Options:** * **A (< 250 mg/dl) & C (< 300 mg/dl):** These levels are well into the "High" risk category. Total cholesterol > 240 mg/dl is a major modifiable risk factor for myocardial infarction. * **B (< 220 mg/dl):** While lower than 250, this falls into the "Borderline High" range (200–239 mg/dl), which still necessitates lifestyle modifications to prevent progression to CAD. **High-Yield Clinical Pearls for NEET-PG:** * **LDL (The "Bad" Cholesterol):** The primary target of lipid-lowering therapy. Optimal level is **< 100 mg/dl**. * **HDL (The "Good" Cholesterol):** Protective against CAD. Levels **< 40 mg/dl** are considered a major risk factor, while **≥ 60 mg/dl** is considered protective. * **Triglycerides:** Normal level is **< 150 mg/dl**. * **Rule of Thumb:** For every 1% reduction in total serum cholesterol, there is a 2% reduction in the risk of coronary heart disease.

Question 79: Which of the following statements is NOT true about the Inactivated Polio Vaccine (IPV)?

A. It is given in 4 doses.
B. It cannot be given in an AIDS patient. (Correct Answer)
C. It is a killed vaccine.
D. It is also known as the Salk vaccine.

Explanation: **Explanation:** The core concept tested here is the safety profile of **Killed (Inactivated) vs. Live Attenuated vaccines** in immunocompromised individuals. **Why Option B is the correct answer (The False Statement):** Inactivated vaccines, like IPV, do not contain live organisms; therefore, they cannot replicate or cause disease in the recipient. Consequently, **IPV is safe and indicated for immunocompromised individuals**, including those with AIDS, symptomatic HIV, or those on immunosuppressive therapy. In contrast, the Oral Polio Vaccine (OPV) is a live vaccine and is strictly contraindicated in these patients due to the risk of Vaccine-Associated Paralytic Poliomyelitis (VAPP). **Analysis of Incorrect Options:** * **Option A:** Under the current National Immunization Schedule (NIS) in India, the **Fractional IPV (fIPV)** is administered in 3 doses (6, 14 weeks, and 9 months). However, the global **Sequential Polio Vaccination Schedule** or specific catch-up schedules often involve 4 doses to ensure full seroconversion, making this a plausible true statement in a general clinical context. * **Option C:** IPV is indeed a **killed vaccine**, produced by inactivating wild-type poliovirus strains (Mahoney, MEF-1, and Saukett) using formaldehyde. * **Option D:** IPV was developed by **Jonas Salk** in 1955, hence it is universally known as the Salk vaccine (whereas OPV is the Sabin vaccine). **NEET-PG High-Yield Pearls:** * **Route:** fIPV is given **Intradermal (ID)** on the right upper arm; full-dose IPV is given **Intramuscular (IM)**. * **VAPP & VDPV:** These are risks associated only with OPV, never with IPV. * **Herd Immunity:** IPV provides excellent individual (humoral) immunity but poor intestinal (mucosal) immunity compared to OPV; thus, it does not effectively stop community transmission.

Question 80: Which of the following statements regarding leprosy is incorrect?

A. Multibacillary leprosy is defined as having 6 or more skin lesions.
B. Regular multidrug therapy (MDT) implies that patients have completed 2/3rds of the prescribed treatment schedule.
C. In paucibacillary leprosy, more than 2 nerves are involved. (Correct Answer)
D. Loss of sensation may be a presenting symptom of leprosy.

Explanation: ### Explanation This question tests your knowledge of the **WHO Classification of Leprosy** and the operational definitions used under the National Leprosy Eradication Programme (NLEP). **1. Why Option C is Incorrect (The Correct Answer):** According to the WHO clinical classification, **Paucibacillary (PB) leprosy** is defined by the involvement of **only one nerve trunk**. If more than one nerve is involved (even if skin lesions are few), it is classified as Multibacillary (MB) leprosy. Therefore, the statement that "more than 2 nerves are involved" in PB leprosy is false. **2. Analysis of Other Options:** * **Option A:** Correct. Under the WHO simplified classification, **Multibacillary (MB)** leprosy is defined as having **6 or more skin lesions**. * **Option B:** Correct. For operational purposes, a patient is considered "regular" on MDT if they have consumed at least **2/3rds (66%)** of the prescribed doses within the specified timeframe. * **Option C:** Correct. Cardinal signs of leprosy include hypopigmented patches with **partial or total loss of sensation**, thickened nerves, and a positive skin smear for Acid Fast Bacilli. --- ### High-Yield Clinical Pearls for NEET-PG * **WHO Classification (Based on Lesions):** * **PB:** 1 to 5 skin lesions; only 1 nerve involved; skin smear negative. * **MB:** 6 or more skin lesions; 2 or more nerves involved; skin smear positive (at any site). * **MDT Regimen Durations:** * **PB:** 6 blister packs to be completed within 6–9 months. * **MB:** 12 blister packs to be completed within 12–18 months. * **Drug of Choice for Reactions:** * **Type 1 (Reversal):** Corticosteroids. * **Type 2 (ENL):** Thalidomide (Drug of choice), but Clofazimine is also used. * **Accompanied MDT (A-MDT):** Provided to patients whose mobility is restricted, ensuring they have a full course of treatment at home.

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