Chronic Disease Management — MCQs
Which of the following is not a measure of primary prevention of hypertension?
An elderly hypertensive patient has diabetes mellitus and bilateral renal artery stenosis. The best management is:
The preferred public health approach to control non-communicable disease is -
STEPS is done for:
To reduce mortality by CHD, best strategy -
Which of the following is true regarding nicotine substitution therapy?
According to WHO guidelines, to decrease both coronary heart disease and diabetes, triple treatment involves:
What is the diagnosis of a 55-year-old woman with chronic low backache?
A patient with recurrent gout attacks was started on a drug that inhibits uric acid synthesis. His symptoms were reduced after therapy. Which drug was he started on?
Adenocarcinoma of the esophagus is commonly found in patients with which of the following conditions?
Chronic Disease Management Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is not a measure of primary prevention of hypertension?
- A. Exercise promotion
- B. Reduction of salt intake
- C. Weight reduction
- D. Early diagnosis of hypertension (Correct Answer)
Explanation: ***Early diagnosis of hypertension*** - **Early diagnosis** is a measure of **secondary prevention**, aiming to detect and manage a condition that has already developed but is not yet symptomatic or severe. - **Primary prevention** aims to prevent the disease from occurring in the first place, whereas secondary prevention seeks to halt its progression. *Weight reduction* - **Weight reduction** is a key lifestyle modification that can prevent the development of **hypertension**, especially in individuals with overweight or obesity. - Maintaining a **healthy weight** reduces the strain on the cardiovascular system and can normalize blood pressure. *Exercise promotion* - Promoting **regular physical activity** helps to improve cardiovascular health, maintain a healthy weight, and **lower blood pressure**, thereby preventing hypertension. - **Aerobic exercise** strengthens the heart and makes blood vessels more elastic, reducing the risk of developing high blood pressure. *Reduction of salt intake* - **Reducing dietary salt intake** is a well-established strategy to prevent hypertension, as excessive sodium contributes to fluid retention and increased blood pressure. - Limiting **sodium** in the diet can significantly lower the risk of developing hypertension, particularly in salt-sensitive individuals.
Question 2: An elderly hypertensive patient has diabetes mellitus and bilateral renal artery stenosis. The best management is:
- A. Enalapril
- B. Beta blockers
- C. Thiazides
- D. Verapamil (Correct Answer)
Explanation: ***Verapamil*** - **Verapamil**, a **calcium channel blocker**, is a suitable choice for this patient as it effectively lowers blood pressure without adversely affecting renal function in the presence of **bilateral renal artery stenosis**. - It also does not worsen **diabetes mellitus** or interfere with glucose metabolism, making it a safer option for this specific patient profile. *Enalapril* - **Enalapril**, an **ACE inhibitor**, is contraindicated in patients with **bilateral renal artery stenosis** because it can severely impair renal function and lead to acute kidney injury by reducing glomerular filtration pressure [1]. - While generally good for hypertension and diabetes, the presence of **bilateral renal artery stenosis** overrides these benefits due to the high risk of renal compromise [1], [2]. *Beta blockers* - **Beta blockers** can be used in hypertension, but they can **mask symptoms of hypoglycemia** in diabetic patients and may negatively affect lipid profiles and glucose control. - While not strictly contraindicated by renal artery stenosis, their potential metabolic side effects in a diabetic patient make them less ideal than **calcium channel blockers**. *Thiazides* - **Thiazide diuretics** can cause **glucose intolerance** and worsen glycemic control in patients with diabetes, which is a significant concern for this patient. - Although effective for hypertension, their use in patients with **renal artery stenosis** can sometimes lead to reduced renal blood flow due to volume depletion, potentially compromising kidney function.
Question 3: 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 4: 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 5: To reduce mortality by CHD, best strategy -
- A. Secondary prevention
- B. Primordial prevention (Correct Answer)
- C. Tertiary prevention
- D. None of the options
Explanation: ***Primordial prevention*** * This strategy aims to prevent the **development of risk factors** for CHD in the first place, thus preventing the disease itself. * It focuses on promoting healthy lifestyles and environments from early life, targeting populations rather than individuals. *Secondary prevention* * This involves actions taken after an individual has developed **risk factors** for CHD or has been diagnosed with the disease, to prevent recurrence or worsening. * Examples include medication (e.g., statins, antiplatelets) for people with high cholesterol or a history of heart attack. *Tertiary prevention* * This strategy aims to reduce the **impact of an existing disease** on a patient's daily life and prevent further complications, disability, or death. * For CHD, this would include cardiac rehabilitation, surgical interventions like CABG, and managing co-morbidities to improve quality of life and prolong survival. *None of the options* * Given that primordial prevention directly addresses the prevention of risk factors and thus the disease itself, it is the most effective strategy for **reducing overall mortality** at the population level. * Therefore, one of the provided options is indeed the best strategy.
Question 6: Which of the following is true regarding nicotine substitution therapy?
- A. Preferably given by gastrointestinal route.
- B. Varenicline comes with a black box warning of cardiovascular death
- C. There should be a 15-minute gap between nicotine gum and coffee/soda/acidic food as they decrease its absorption (Correct Answer)
- D. Nicotine chewing gum is better for constant use as it gives 25% higher blood level than lozenges
Explanation: ***There should be a 15-minute gap between nicotine gum and coffee/soda/acidic food as they decrease its absorption*** - **Acidic beverages** like coffee, soda, and fruit juices can alter the pH of the mouth and stomach, which significantly **reduces the absorption of nicotine** from gum. - This recommendation ensures optimal **nicotine delivery** and effectiveness of the therapy in reducing withdrawal symptoms. *Preferably given by gastrointestinal route* - Nicotine has poor bioavailability when taken orally due to **extensive first-pass metabolism** in the liver. - Nicotine substitution therapies are therefore preferentially administered via **transdermal**, **buccal** (gum, lozenges), or **nasal routes** to bypass first-pass metabolism and achieve therapeutic blood levels more effectively. *Varenicline comes with a black box warning of cardiovascular death* - Varenicline (Chantix) previously had a black box warning for **neuropsychiatric side effects**, including suicidal ideation and depression, which has since been removed due to further studies. - It does not carry a black box warning specifically for **cardiovascular death**, though cardiovascular events have been a subject of study, particularly in patients with pre-existing cardiovascular conditions. *Nicotine chewing gum is better for constant use as it gives 25% higher blood level than lozenges* - While both nicotine gum and lozenges are effective, the **blood levels achieved are comparable**, and the choice often depends on patient preference and proper technique. - Nicotine gum is best used with a **"chew and park" technique** to allow buccal absorption, and constant chewing can lead to excessive swallowing of nicotine, causing gastrointestinal upset.
Question 7: 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 8: What is the diagnosis of a 55-year-old woman with chronic low backache?
- A. Osteoporosis (Correct Answer)
- B. Hurler's syndrome
- C. Paget’s disease
- D. Renal osteodystrophy
Explanation: ***Osteoporosis*** - The image shows **loss of bone density** and **vertebral compression fractures**, especially visible in the lumbar spine, which are characteristic findings in osteoporosis. - Osteoporosis is common in post-menopausal women, and **chronic low backache** is a frequent symptom due to microfractures or vertebral collapse. *Hurler's syndrome* - This is a lysosomal storage disease (mucopolysaccharidosis type I) that primarily affects **children** and presents with distinct **skeletal deformities** (dysostosis multiplex), facial features, and organ involvement. - It would not typically present as chronic low backache in a 55-year-old woman, and the radiological findings are not consistent with Hurler's syndrome. *Paget’s disease* - Paget's disease of bone involves abnormal bone remodeling, leading to **enlarged and weakened bones**, often with a characteristic **cotton wool appearance** on X-ray, which is not seen here. - While it can cause bone pain and affect the spine, the primary radiological features seen in this image are more consistent with generalized bone density loss and fractures rather than focal expansion and abnormal bone architecture. *Renal osteodystrophy* - This condition occurs in patients with **chronic kidney disease** and results from imbalances in calcium, phosphate, and parathyroid hormone. - Radiographic features include **osteosclerosis (rugger jersey spine)**, bone erosions, or osteomalacia, which are different from the generalized osteopenia and compression fractures observed in this X-ray.
Question 9: A patient with recurrent gout attacks was started on a drug that inhibits uric acid synthesis. His symptoms were reduced after therapy. Which drug was he started on?
- A. Probenecid
- B. Colchicine
- C. Diclofenac
- D. Allopurinol (Correct Answer)
Explanation: ***Allopurinol*** - **Allopurinol** is a **xanthine oxidase inhibitor** that effectively reduces uric acid synthesis by blocking the enzyme responsible for converting hypoxanthine and xanthine to uric acid. - It is a cornerstone therapy for preventing recurrent gout attacks in patients with **hyperuricemia**. *Probenecid* - **Probenecid** is a **uricosuric agent** that increases the excretion of uric acid in the urine, rather than inhibiting its synthesis. - It works by inhibiting the reabsorption of uric acid in the renal tubules. *Colchicine* - **Colchicine** is an **anti-inflammatory agent** primarily used to treat acute gout flares and prevent future attacks by disrupting microtubule function and inhibiting neutrophil migration. - It does not affect uric acid synthesis or excretion. *Diclofenac* - **Diclofenac** is a **non-steroidal anti-inflammatory drug (NSAID)** used to manage the pain and inflammation associated with acute gout attacks. - It works by inhibiting prostaglandin synthesis and has no effect on uric acid levels.
Question 10: Adenocarcinoma of the esophagus is commonly found in patients with which of the following conditions?
- A. Chronic smoking
- B. Barrett's esophagus (Correct Answer)
- C. Achalasia cardia
- D. Plummer-Vinson syndrome
Explanation: ***Barrett's esophagus*** - **Barrett's esophagus** is a **precancerous condition** where the stratified squamous epithelium lining the distal esophagus is replaced by metaplastic columnar epithelium [1] [2]. This metaplasia is a direct risk factor for developing **esophageal adenocarcinoma** [1] [2]. - The chronic inflammation and cellular changes associated with **gastroesophageal reflux disease (GERD)** predispose individuals to Barrett's esophagus, which then increases the risk of malignant transformation [1] [2]. *Achalasia cardia* - **Achalasia** is a disorder characterized by the inability of the lower esophageal sphincter to relax and a lack of peristalsis in the esophageal body. While it increases the risk of **squamous cell carcinoma**, it is not primarily associated with adenocarcinoma. - The exact mechanism for increased cancer risk in achalasia is thought to be related to chronic inflammation and stasis of food, which can lead to squamous cell dysplasia. *Plummer-Vinson syndrome* - **Plummer-Vinson syndrome** is a rare condition characterized by iron deficiency anemia, dysphagia (due to esophageal webs), and atrophic glossitis. It is a risk factor for **squamous cell carcinoma** of the esophagus, pharynx, and oral cavity, but not adenocarcinoma. - The esophageal webs are typically located in the proximal or mid-esophagus, and chronic irritation from dysphagia may contribute to squamous epithelial changes. *Chronic smoking* - **Chronic smoking** is a major risk factor for various cancers, including esophageal cancer. However, it is more strongly associated with **squamous cell carcinoma** of the esophagus, particularly in the upper and middle thirds. - While smoking can indirectly contribute to GERD and thus potentially Barrett's esophagus, its primary association with esophageal cancer is with the squamous cell type rather than adenocarcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 764-766. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 348-349.
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