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?
SAFE strategy is for:
According to WHO guidelines, to decrease both coronary heart disease and diabetes, triple treatment involves:
In a 2-5 year-old child with DM, target HbA1C is:
What is the diagnosis of a 55-year-old woman with chronic low backache?
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: SAFE strategy is for:
- A. Onchocerciasis
- B. Glaucoma
- C. Diabetic retinopathy
- D. Trachoma (Correct Answer)
Explanation: ***Trachoma*** - The **SAFE strategy** is a comprehensive public health approach designed to eliminate **trachoma**, a preventable cause of blindness. - SAFE stands for **Surgery** for trichiasis, **Antibiotics** to treat active infection, **Facial cleanliness** to reduce transmission, and **Environmental improvement** (especially access to water and sanitation) to prevent reinfection. *Onchocerciasia* - This condition, also known as **river blindness**, is primarily managed through mass drug administration of **ivermectin**. - While public health interventions are crucial for onchocerciasis, the specific SAFE acronym is not associated with its control program. *Glaucoma* - The management of glaucoma focuses on lowering **intraocular pressure** through medications, laser treatment, or surgery. - It is a chronic eye condition that does not involve infectious agents like trachoma, and the SAFE strategy is irrelevant. *Diabetic retinopathy* - This complication of diabetes is managed by controlling **blood sugar**, blood pressure, and lipids, along with specific ophthalmological treatments like laser photocoagulation or anti-VEGF injections. - It is a non-infectious, metabolic disease, making the SAFE strategy inapplicable.
Question 8: 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 9: In a 2-5 year-old child with DM, target HbA1C is:
- A. < 8% (Correct Answer)
- B. < 7%
- C. < 7.5%
- D. < 6.5%
Explanation: ***< 8%*** - For children aged **2-5 years** with diabetes mellitus, the target **HbA1c** is **< 8%** (some guidelines recommend < 8.5%) to balance glycemic control with the significant risk of hypoglycemia. - This age group is at **critical neurodevelopmental stage**, and severe hypoglycemia can have lasting cognitive effects, hence a more lenient target is recommended. - The higher target accounts for **unpredictable eating patterns, variable activity levels**, and difficulty in recognizing hypoglycemic symptoms at this young age. *< 7%* - An **HbA1c** target of **< 7%** is too stringent for very young children (2-5 years) and significantly increases the risk of **severe hypoglycemia**. - This target may be appropriate for **adults** or older adolescents with good awareness and self-management skills, but not for this vulnerable age group. - Achieving this target in toddlers would require intensive monitoring and could compromise safety and quality of life. *< 7.5%* - An **HbA1c** target of **< 7.5%** is the recommended target for **older children (6-12 years)** and **adolescents (13-19 years)**, not for children aged 2-5 years. - While more achievable than < 7%, this target is still too aggressive for the 2-5 year age group and increases hypoglycemia risk without proportional long-term benefit. *< 6.5%* - An **HbA1c** target of **< 6.5%** is far too aggressive for children aged 2-5 years and would pose an **unacceptable risk of severe and frequent hypoglycemia**. - This target approaches near-normal glycemia and is only considered in select adult patients who can achieve it safely with minimal hypoglycemia risk. - In young children, such tight control could result in seizures, developmental harm, and psychological stress for families.
Question 10: 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.
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