Social Stigma and Health — MCQs

10 questions

The commonly used theory to predict individual's behaviour regarding preventive health care is:

Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?

Arthritis mutilans is seen in?

India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:

Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.

Which of the following diseases shows the LEAST difference in incidence between rural and urban populations?

A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?

What is the most important test to assess the prevalence of tuberculosis infection in a community?

You are the DOTS provider for a patient. He has completed his 6 months of treatment. He was sputum +ve to begin with, but after the intensive phase of treatment he became sputum -ve. He was again confirmed to be sputum negative 2 months after starting the continuation phase. This patient can be termed as:

Q10

Epidemic marker of TB?

Social Stigma and Health Indian Medical PG Practice Questions and MCQs

Question 1: The commonly used theory to predict individual's behaviour regarding preventive health care is:

A. Salutogenic model
B. Transtheoretical model
C. Social cognitive theory
D. Health belief model (Correct Answer)

Explanation: ***Health belief model*** - This model is widely used for **predicting preventative health behaviors**, as it focuses on an individual's perceptions of threat and benefits. - It considers factors like **perceived susceptibility, perceived severity, perceived benefits, perceived barriers**, cues to action, and self-efficacy in motivating health actions. *Salutogenic model* - The salutogenic model emphasizes factors that **promote health and well-being**, rather than focusing on disease or risk factors. - It centers around an individual's **sense of coherence**, which is their capacity to comprehend, manage, and find meaning in life's challenges. *Transtheoretical model* - This model describes **stages of change** that individuals go through when modifying a health behavior, such as precontemplation, contemplation, preparation, action, and maintenance. - While useful for understanding behavior change, it is more about the **process of change** rather than predicting initial engagement in preventative care. *Social cognitive theory* - Social cognitive theory emphasizes the role of **observational learning, social experiences, and self-efficacy** in the development of personality and health behaviors. - While it explains how individuals learn and perform health actions, it is not as directly focused on the **cognitive factors influencing preventative care decisions** as the Health Belief Model.

Question 2: Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?

A. Cataract surgery
B. Pan retinal photocoagulation for diabetic retinopathy
C. Syringing and probing of the nasolacrimal duct (Correct Answer)
D. Trabeculectomy surgery

Explanation: ***Syringing and probing of the nasolacrimal duct*** - While important for lacrimal drainage issues, procedures like **syringing and probing** are generally considered minor and less vision-restoring compared to the major surgeries targeted by the **NPCB**. - The **NPCB** focuses on interventions for leading causes of blindness, primarily **cataract** and other significant vision-threatening conditions, which this procedure typically isn't. *Cataract surgery* - **Cataract surgery** is a cornerstone of the **NPCB's** efforts, as cataracts are the leading cause of reversible blindness. - Reimbursement for **cataract surgery** is a primary objective to improve access and reduce the burden of blindness. *Pan retinal photocoagulation for diabetic retinopathy* - **Diabetic retinopathy** is a major cause of preventable blindness, and **pan retinal photocoagulation (PRP)** is a key intervention to preserve vision. - The **NPCB** includes procedures for **diabetic retinopathy** management due to its significant public health impact. *Trabeculectomy surgery* - **Trabeculectomy** is a surgical procedure for **glaucoma**, which is another significant cause of irreversible blindness. - The **NPCB** includes interventions for **glaucoma** given its severe vision-threatening nature and the need for surgical management in many cases.

Question 3: Arthritis mutilans is seen in?

A. Rheumatoid arthritis
B. Spondyloarthropathy
C. Reactive arthritis
D. Psoriatic arthropathy (Correct Answer)

Explanation: ***Psoriatic arthropathy*** - **Arthritis mutilans** is a severe, destructive form of psoriatic arthritis characterized by marked **osteolysis** and telescoping deformities of the digits [1]. - This condition is almost exclusively associated with **psoriatic arthritis**, representing its most aggressive subtype [1]. *Rheumatoid arthritis* - While rheumatoid arthritis can cause severe joint destruction, it typically manifests as **erosive arthritis** with joint deformities like **swan-neck** and **boutonnière deformities**, but not true arthritis mutilans [3]. - The pattern of bone destruction (osteolysis) seen in arthritis mutilans is distinct from the erosions in rheumatoid arthritis. *Spondyloarthropathy* - This is a broad category that includes diseases like ankylosing spondylitis and reactive arthritis, which primarily affect the **axial skeleton** and entheses. - While some spondyloarthropathies can cause peripheral joint involvement, they generally do not lead to the extreme osteolysis and telescoping digits characteristic of arthritis mutilans. *Reactive arthritis* - Reactive arthritis is an aseptic inflammatory arthritis that often follows infection, characterized by **oligoarthritis**, dactylitis, and enthesitis [2]. - This condition does not typically cause the severe, mutilating joint destruction seen in arthritis mutilans.

Question 4: India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:

A. 1,4 (Correct Answer)
B. 1,2
C. 2,3
D. 3,4

Explanation: ***1,4*** - **Good communication** is paramount in healthcare, especially in a diverse country like India, to ensure **patient understanding**, **adherence** to treatment plans, and overall patient satisfaction. - Considering a patient's **religion and cultural perceptions** allows the physician to tailor treatment and communication in a sensitive and **respectful manner**, fostering trust and better **health outcomes**. *1,2* - While good communication (1) is vital, **insisting solely on an interpreter** (2) may not always be feasible or necessary, particularly if the physician and patient share a common language or if the patient prefers direct communication. This can also disrupt the flow of rapport building. - **Over-reliance on interpreters** can sometimes lead to misinterpretations or loss of non-verbal cues if the interpreter is not trained in medical interpretation. *2,3* - **Insisting only on an interpreter** (2) can be restrictive and may compromise direct patient-physician rapport, as discussed above. - **Treating patients regardless of their cultural perceptions** (3) is an ethnocentric approach that can lead to mistrust, non-adherence, and ultimately **poor health outcomes** as it disregards the patient's beliefs and values regarding health and illness. *3,4* - **Treating patients regardless of their cultural perceptions** (3) can result in a lack of understanding and non-adherence if the treatment conflicts with the patient's deeply held beliefs. - While considering religion and cultural perception (4) is crucial, this option includes an incorrect approach (3) that can undermine patient care.

Question 5: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.

A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
C. Statements 1 and 2 are incorrect
D. Statement 1 is incorrect

Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris

Question 6: Which of the following diseases shows the LEAST difference in incidence between rural and urban populations?

A. Lung Cancer
B. TB (Correct Answer)
C. Bronchitis
D. Mental illness

Explanation: ***Correct: TB*** - **Tuberculosis (TB)** shows relatively **similar incidence rates** in both rural and urban populations in India, making it the disease with the **LEAST difference** between the two settings. - While urban areas have **overcrowding and slums** as risk factors, rural areas have **poverty, malnutrition, and poor access to healthcare**, which are equally important TB risk factors. - TB is endemic in India across all geographic settings, with the disease burden driven more by **socioeconomic factors** than by rural vs urban location per se. - Both settings face challenges with **poor ventilation** (urban slums vs rural housing), **poverty**, and **inadequate sanitation**. *Incorrect: Lung Cancer* - Lung cancer shows a **clear urban predominance** due to higher exposure to **industrial air pollution**, **vehicular emissions**, and **occupational carcinogens**. - Urban populations historically had higher smoking rates, though this gap is narrowing. - Rural areas have significantly lower lung cancer incidence. *Incorrect: Bronchitis* - Chronic bronchitis is **more common in urban areas** due to **air pollution** from industries and vehicles. - While rural areas may have biomass fuel smoke exposure, the overall incidence of bronchitis shows notable rural-urban differences. - Urban environmental factors contribute to higher prevalence of chronic obstructive airway diseases. *Incorrect: Mental illness* - While mental illness occurs in both settings, there are **differences in types and recognition**. - Urban areas may have higher reported rates due to better access to mental health services and less stigma in seeking care. - Rural areas face challenges with **underdiagnosis** and **limited mental health infrastructure**, making true incidence comparisons difficult.

Question 7: A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?

A. 1.5
B. 6 (Correct Answer)
C. 0.17
D. 0.67

Explanation: ***6*** - To calculate the odds ratio, we first construct a 2x2 table [1]: - Bipolar Disorder (Cases): 500 - No Bipolar Disorder (Controls): 500 (1000 total subjects - 500 cases) - Cases exposed to more social media (>2 hrs/day): 300 - Cases not exposed to more social media (≤2 hrs/day): 200 (500 - 300) - Controls not exposed to more social media (≤2 hrs/day): 400 - Controls exposed to more social media (>2 hrs/day): 100 (500 - 400) - The odds ratio (OR) is calculated as (odds of exposure in cases) / (odds of exposure in controls) = (300/200) / (100/400) = 1.5 / 0.25 = **6** [1]. *1.5* - This value represents the **odds of exposure** (more than 2 hours of social media) in individuals with bipolar disorder (300 cases exposed / 200 cases unexposed = 1.5). - It is not the odds ratio, which compares these odds to the odds of exposure in the control group. *0.17* - This value is close to the reciprocal of 6 (1/6 ≈ 0.166), suggesting a potential miscalculation or an inverted odds ratio. - An odds ratio of 0.17 would imply a protective effect (lower odds of bipolar disorder with more social media), which is contrary to the calculation and typical interpretation in this context. *0.67* - This value is the reciprocal of 1.5 (1/1.5 ≈ 0.67) which represents the odds of *not* being exposed in cases (200/300). - It does not represent the correct odds ratio, which compares the odds of exposure in cases to the odds of exposure in controls.

Question 8: What is the most important test to assess the prevalence of tuberculosis infection in a community?

A. Mass miniature radiography
B. Tuberculin test (Correct Answer)
C. Sputum examination of AFB
D. Clinical examination

Explanation: ***Tuberculin test*** - The **tuberculin skin test (TST)**, or Mantoux test, measures the delayed-type hypersensitivity reaction to tuberculin, indicating prior exposure to *Mycobacterium tuberculosis*. - A positive TST reflects **tuberculosis infection**, whether latent or active, making it a valuable tool for assessing prevalence in a community. *Mass miniature radiography* - This method, now largely replaced by digital radiography, primarily detects **active pulmonary tuberculosis** by identifying lung lesions like infiltrates or cavities. - It is less effective for detecting **latent tuberculosis infection (LTBI)**, which represents the majority of infected individuals in a community. *Sputum examination of AFB* - This test is crucial for diagnosing **active pulmonary tuberculosis** by identifying acid-fast bacilli (AFB) in sputum. - However, it only detects individuals who are actively shedding bacteria and may not capture the broader prevalence of **latent infection** in a community. *Clinical examination* - A clinical examination primarily identifies individuals with **symptoms of active tuberculosis**, such as persistent cough, fever, or weight loss. - It is not a reliable method for assessing the overall **prevalence of tuberculosis infection**, particularly asymptomatic latent cases, in a community.

Question 9: You are the DOTS provider for a patient. He has completed his 6 months of treatment. He was sputum +ve to begin with, but after the intensive phase of treatment he became sputum -ve. He was again confirmed to be sputum negative 2 months after starting the continuation phase. This patient can be termed as:

A. Transfer out
B. Cured (Correct Answer)
C. Defaulted
D. Treatment completed

Explanation: ***Cured*** - According to **RNTCP guidelines**, a patient is classified as **cured** when they are initially sputum smear-positive, complete the full course of treatment, and have **negative sputum smear results on at least two occasions** - one at the end of treatment and another on a previous occasion. - This patient was initially **sputum positive**, became **sputum negative after the intensive phase**, and was confirmed **sputum negative 2 months into the continuation phase**, meeting the criteria for cured status. - With documented negative sputum on multiple occasions during treatment, this represents successful bacteriological cure. *Treatment completed* - This category is used for TB patients who have **completed their full course of treatment** but do NOT have sputum smear results available at the end of treatment (either not done or results unavailable). - Since this patient has **documented negative sputum results** on multiple occasions, the appropriate classification is "cured" rather than "treatment completed". - Treatment completed is reserved for cases where bacteriological confirmation of cure is absent. *Transfer out* - This classification is for patients who are **transferred to another treatment unit** and whose treatment outcome is **unknown to the original reporting unit**. - The patient completed treatment under the same DOTS provider without transfer, making this classification incorrect. *Defaulted* - A patient is classified as having **defaulted** if they interrupt their treatment for **two consecutive months or more** after registration. - This patient completed the full 6-month treatment course without interruption, making defaulting an incorrect classification.

Question 10: Epidemic marker of TB?

A. Tuberculin test positivity rate
B. Sputum AFB positivity rate (Correct Answer)
C. Chest x-ray positivity rate
D. None of the options

Explanation: ***Sputum AFB positivity rate*** - The **sputum acid-fast bacilli (AFB) positivity rate** directly indicates the number of individuals actively shedding viable *Mycobacterium tuberculosis* in their respiratory secretions. - This metric reflects the **infectious pool** within a community, making it a robust marker for assessing ongoing transmission and the epidemic status of tuberculosis. *Tuberculin test positivity rate* - The **tuberculin skin test (TST)** measures exposure to TB and latent infection, not active, infectious disease. - A high positivity rate indicates a high prevalence of **latent TB infection**, but doesn't differentiate between old exposure, cleared infection, or active disease, nor does it directly measure transmissibility. *Chest x-ray positivity rate* - **Chest X-rays** can identify pulmonary abnormalities consistent with TB, including active disease. - However, CXR findings are **non-specific** for TB and can be suggestive of previous infection or other lung conditions, making it less precise than sputum AFB for defining an active epidemic. *None of the options* - This option is incorrect because the **sputum AFB positivity rate** is a well-established and direct indicator of active TB disease transmission and epidemic activity.

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