Non-communicable Diseases Globally — MCQs
The non-modifiable risk factor for hypertension is -
Which of the following is a non- modifiable risk factor for CHD -
In all of the following diseases chronic carriers are found except:
To reduce mortality by CHD, best strategy -
WHO global target for prevention and control of non communicable diseases by 2025 is to decrease the prevalence of raised blood pressure (hypertension) by
Which of the following is NOT a risk factor for atherosclerosis?
Target interventions of National AIDS Control Organisation include all, except?
Posterior communicating artery is a branch of?
All of the following take part in the blood supply of the optic chiasm except:
Which of the following is not a criterion suggesting causality in non communicable diseases?
Non-communicable Diseases Globally Indian Medical PG Practice Questions and MCQs
Question 1: The non-modifiable risk factor for hypertension is -
- A. Environment stress
- B. Obesity
- C. Salt intake
- D. Age (Correct Answer)
Explanation: ***Age*** - Age is a **non-modifiable** risk factor because it is an inherent biological process that cannot be changed. [3] - The risk of developing **hypertension** generally increases with advancing age due to arterial stiffening and other physiological changes. [1] *Environment stress* - **Environmental stress** is considered a **modifiable** risk factor because individuals can learn coping mechanisms or make lifestyle changes to reduce its impact. - Chronic stress can lead to **sympathetic nervous system activation**, contributing to elevated blood pressure. [4] *Obesity* - **Obesity** is a **modifiable** risk factor, as it can be directly addressed through diet, exercise, and other lifestyle interventions. [2] - It increases the risk of hypertension by fostering **insulin resistance**, **inflammation**, and increased **cardiac output**. *Salt intake* - **Salt intake** is a **modifiable** risk factor as it can be controlled through dietary choices. [2] - Excessive sodium consumption can lead to **fluid retention** and increased blood volume, thereby raising blood pressure.
Question 2: Which of the following is a non- modifiable risk factor for CHD -
- A. Diabetes
- B. Smoking
- C. Hypertension
- D. Old age (Correct Answer)
Explanation: Old age - Age is a **non-modifiable risk factor** for Coronary Heart Disease (CHD) because it is an inherent biological process that cannot be changed [3]. - The risk of developing CHD **increases with age** due to cumulative exposure to other risk factors and natural wear and tear on the cardiovascular system [3]. *Diabetes* - Diabetes is a **modifiable risk factor** for CHD because it can be managed and controlled through lifestyle changes, medication, and regular monitoring [2]. - **Poorly controlled diabetes** significantly increases the risk of heart disease by damaging blood vessels and promoting atherosclerosis. *Smoking* - Smoking is a highly **modifiable risk factor** for CHD as it can be completely stopped [1], [2]. - **Cessation of smoking** significantly reduces the risk of heart attack and stroke over time [1]. *Hypertension* - Hypertension is a **modifiable risk factor** for CHD because blood pressure can be lowered through lifestyle interventions, such as diet and exercise, and pharmacotherapy [2]. - **Uncontrolled high blood pressure** places increased stress on the heart and blood vessels, accelerating the development of atherosclerosis [1].
Question 3: In all of the following diseases chronic carriers are found except:
- A. Typhoid
- B. Gonorrhoea
- C. Measles (Correct Answer)
- D. Hepatitis B
Explanation: ***Measles*** - Measles is caused by a **highly contagious virus** and typically results in an acute illness followed by lifelong immunity; it does not establish a chronic carrier state. - Individuals either recover completely or succumb to the disease, without becoming asymptomatic carriers who can transmit the virus for extended periods. *Typhoid* - **Chronic carriers** of *Salmonella Typhi* can harbor the bacteria in their **gallbladder** or urinary tract for years, shedding it in their feces or urine. - These carriers, despite showing no symptoms themselves, can transmit the infection to others, posing a significant public health risk. *Gonorrhoea* - Some individuals infected with *Neisseria gonorrhoeae* can be **asymptomatic carriers**, particularly women, and can transmit the infection without knowing they are infected. - While generally not considered "chronic" in the same way as typhoid or hepatitis B, asymptomatic carriage can persist for several weeks or months. *Hepatitis B* - Many individuals infected with the **Hepatitis B virus (HBV)**, especially if infected during infancy or early childhood, can become **chronic carriers**. - These chronic carriers can continue to transmit the virus and are at increased risk for developing serious liver diseases such as **cirrhosis** and **hepatocellular carcinoma**.
Question 4: 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 5: WHO global target for prevention and control of non communicable diseases by 2025 is to decrease the prevalence of raised blood pressure (hypertension) by
- A. 75%
- B. 25% (Correct Answer)
- C. 90%
- D. 55%
Explanation: ***25%*** - The World Health Organization (WHO) set a **global target** to achieve a **25% relative reduction** in the prevalence of **raised blood pressure (hypertension)** by 2025 (compared to 2010 baseline). - This target is part of the **WHO Global Action Plan for NCDs** and the Global Monitoring Framework to combat **non-communicable diseases (NCDs)**. *75%* - A 75% reduction in hypertension prevalence is an **unrealistically ambitious** target given current global health challenges and interventions. - While significant reductions are desired, the evidence-based target set by WHO is a more achievable 25% reduction. *90%* - A 90% reduction is not one of the specifically stated **WHO global targets** for hypertension by 2025. - Such a drastic reduction would require unprecedented public health interventions and is not supported by current evidence. *55%* - 55% is not a recognized **WHO target** for the prevention and control of hypertension by 2025. - The established global target from the WHO NCD Global Monitoring Framework specifically focuses on a **25% relative reduction**.
Question 6: Which of the following is NOT a risk factor for atherosclerosis?
- A. Smoking
- B. High blood pressure
- C. High cholesterol
- D. Normal LDL cholesterol (Correct Answer)
Explanation: ***Normal LDL cholesterol*** - Maintaining **normal LDL cholesterol levels** indicates a healthy lipid profile and does not promote the accumulation of plaque in arteries, thus it is not a risk factor for atherosclerosis. - In fact, keeping LDL cholesterol within the normal range is a **protective factor** against the development and progression of atherosclerosis. *Smoking* - **Smoking** is a significant risk factor for atherosclerosis as it damages the **endothelium** (the inner lining of blood vessels), making it more susceptible to plaque formation. - It also reduces **HDL cholesterol** (good cholesterol) and increases **blood viscosity**, further contributing to arterial damage and clot formation. *High blood pressure* - **High blood pressure (hypertension)** is a major risk factor because it creates increased force against the artery walls, leading to **endothelial injury** and promoting the infiltration of lipids [1], [2]. - This chronic stress on the arterial walls accelerates the development of **atherosclerotic plaques** and stiffening of arteries [1]. *High cholesterol* - Specifically, **high levels of LDL cholesterol** (low-density lipoprotein, often referred to as "bad" cholesterol) directly contribute to atherosclerosis by depositing cholesterol within the arterial walls [3], [4]. - These deposits form **fatty streaks** that can progress into mature atherosclerotic plaques, narrowing arteries and impeding blood flow [3].
Question 7: Target interventions of National AIDS Control Organisation include all, except?
- A. Detection & treatment for sexually transmitted infections
- B. Abscess prevention & management in injecting drug users
- C. Condom promotion & distribution
- D. Provision of lubricants to Injecting drug users (Correct Answer)
Explanation: ***Provision of lubricants to Injecting drug users*** - The provision of lubricants is primarily relevant for **safe sexual practices** to prevent friction and condom breakage, not directly for injecting drug users to mitigate injection-related risks. - While **harm reduction** is a key focus, this specific intervention does not align with the direct prevention of HIV transmission routes typically targeted for injecting drug users, such as shared needles or inadequate sterile practices. *Detection & treatment for sexually transmitted infections* - **STIs** increase the risk of HIV transmission by causing genital lesions and inflammation, thus their detection and treatment are crucial for HIV prevention. - This intervention is a cornerstone of National AIDS Control Organisation (NACO) programs to reduce HIV vulnerability in high-risk populations. *Abscess prevention & management in injecting drug users* - **Abscesses** are common complications of injecting drug use, often resulting from unsterile practices or shared needles, which are also routes for HIV transmission. - Addressing these complications is part of a broader **harm reduction strategy** aimed at minimizing health risks among injecting drug users, including HIV. *Condom promotion & distribution* - **Condom promotion and distribution** is a fundamental intervention for preventing sexual transmission of HIV by providing a physical barrier. - This is a central component of NACO's strategy to promote safer sexual practices among the general population and high-risk groups.
Question 8: Posterior communicating artery is a branch of?
- A. Internal carotid (Correct Answer)
- B. External carotid
- C. Middle cerebral
- D. Superior cerebellar
Explanation: ***Internal carotid*** - The **posterior communicating artery** connects the **internal carotid artery** circulation (anterior circulation) with the posterior cerebral artery (vertebrobasilar circulation). - It is a key component of the **circle of Willis**, ensuring collateral blood flow to the brain. *External carotid* - The **external carotid artery** primarily supplies the face, scalp, and neck, not the intracranial structures directly involved in the circle of Willis. - Its branches include the **superficial temporal artery** and **facial artery**, which are distinct from cerebral circulation. *Middle cerebral* - The **middle cerebral artery** is a **direct continuation** of the internal carotid artery, supplying large parts of the cerebral hemispheres. - While it arises from the internal carotid, the posterior communicating artery branches off the internal carotid **before** the middle cerebral artery. *Superior cerebellar* - The **superior cerebellar artery** is a branch of the **basilar artery**, supplying the superior cerebellum and parts of the brainstem. - This artery is part of the **vertebrobasilar system**, which is distinct from the primary origin of the posterior communicating artery.
Question 9: All of the following take part in the blood supply of the optic chiasm except:
- A. Anterior cerebral artery
- B. Middle cerebral artery (Correct Answer)
- C. Anterior communicating artery
- D. Internal carotid artery
Explanation: ***Middle cerebral artery*** - The **middle cerebral artery (MCA)** primarily supplies the lateral surface of the cerebral hemispheres, including portions of the frontal, parietal, and temporal lobes, but does not typically contribute to the direct blood supply of the **optic chiasm** [2]. - Its branches are more directed towards the **sylvian fissure** and cortical structures, rather than the deep midline structures like the optic chiasm [2]. *Anterior cerebral artery* - The **anterior cerebral artery (ACA)**, through its branches, including the **anterior communicating artery**, helps supply the anterior part of the optic chiasm [3]. - It forms part of the **Circle of Willis**, from which small perforating arteries can arise to supply deep brain structures [1]. *Anterior communicating artery* - The **anterior communicating artery (AComA)** connects the two anterior cerebral arteries and gives rise to small branches that directly contribute to the vascular supply of the **optic chiasm** [3]. - These branches are crucial for maintaining blood flow to this critical visual pathway structure. *Internal carotid artery* - The **internal carotid artery (ICA)** gives rise to the **ophthalmic artery** and the **anterior cerebral artery**, both of which contribute to the blood supply of the optic chiasm [3]. - Perforating branches from the ICA itself, particularly its terminal portion before bifurcating, can also directly supply the optic chiasm [3].
Question 10: 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.
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