NEET-PG 2013 Practice Questions

Q: Which of the following is NOT a criterion for defining a polio epidemic?

Cases occurring during a 6 month period. ***Correct: Cases occurring during a 6 month period*** - The definition of a polio epidemic primarily focuses on criteria like the number of cases, their geographical proximity, and the viral serotype causing the infection, not a specific duration of time over which cases occur. - While an outbreak naturally unfolds over a period, a fixed 6-month window is **not a formal defining criterion** for an epidemic, which typically emphasizes a sudden, significant increase above expected levels. *Incorrect: 2 or more cases* - An epidemic is generally defined by an **unusual increase in disease incidence**, and even two confirmed cases, especially in areas with low endemicity or where polio is eradicated, can signal an outbreak. - The presence of **two or more paralytic polio cases** within a specific area is often considered a critical threshold for declaring an epidemic, particularly for **wild poliovirus**. *Incorrect: Cases should occur in same locality* - For an epidemic to be declared, the cases must be **geographically linked** to indicate a common source or local transmission. - Cases spread across different, unconnected regions would suggest **sporadic occurrences** rather than a localized epidemic. *Incorrect: Caused by same virus type* - An epidemic implies a **common etiologic agent**, meaning the cases should be linked to the same serotype of **poliovirus** (e.g., wild poliovirus type 1). - If cases are caused by different serotypes, it indicates **multiple independent introductions** rather than a single epidemic outbreak.

Q: Which of the following is the primary component of the AFP (Acute Flaccid Paralysis) case definition used in polio surveillance?

Onset of acute flaccid paralysis. ***Onset of acute flaccid paralysis*** - The primary component of the **AFP case definition** for polio surveillance is the acute onset of **flaccid paralysis** in a child under 15 years, or paralytic illness in a person of any age when polio is suspected. - This definition is crucial for identifying all potential cases of polio, regardless of the cause, to ensure thorough investigation and prevent outbreaks. *Stool specimen positive for poliovirus* - A positive stool specimen for poliovirus is a **laboratory confirmation** of polio infection, but it is not the primary component of the initial case definition. - The AFP case definition aims for **high sensitivity** to capture all possible cases for investigation, even before laboratory results are available. *Presence of residual paralysis after 60 days* - Residual paralysis after 60 days is an important indicator for **classifying a confirmed polio case** and understanding the long-term impact. - However, it is a **follow-up criterion** used after the initial detection of AFP, not the primary component that triggers the initial surveillance. *All of the above* - While laboratory confirmation and residual paralysis provide further information about a case, the **initial identification relies specifically on the clinical presentation** of acute flaccid paralysis. - The broad clinical definition ensures that no potential polio case is missed, initiating an immediate public health response.

Q: Infectivity period of chickenpox is ?

1 day before and 4 days after appearance of rash. ***1 day before and 4 days after appearance of rash*** - The infectivity period of **chickenpox (varicella)** begins approximately **1-2 days (24-48 hours) before the rash appears**. - It extends until **all lesions have crusted over**, which typically occurs around **5-6 days after rash onset**, though some sources cite **4-5 days**. - This option represents the **commonly accepted timeframe** taught in Indian medical curricula and NEET PG examinations. *4 days before and 5 days after appearance of rash* - The **pre-rash infectivity period is too long** in this option; chickenpox is infectious for only **1-2 days before rash**, not 4 days. - While the "5 days after" is medically accurate, the incorrect pre-rash duration makes this option wrong. *Only when scab falls* - This statement is **incorrect**; infectivity starts much earlier, **1-2 days before the rash appears**. - By the time scabs fall, the person is **no longer infectious**, as crusted lesions contain non-infectious material. - This option ignores the critical **pre-rash and early rash infectious period**. *Entire incubation period* - The **incubation period** for chickenpox is usually **10-21 days**, during which the individual is **not infectious** for most of this time. - Infectivity begins only in the **last 1-2 days of incubation** (just before rash onset) and continues into the eruptive phase, not for the entire duration.

Q: At what age is the BCG vaccination administered in India?

At birth. ***At birth*** - In India, the **BCG vaccine** is routinely administered to infants **at birth** or as early as possible thereafter as per the **Universal Immunization Programme (UIP)**. - This early vaccination aims to provide protection against **severe forms of tuberculosis (TB)**, particularly **tuberculous meningitis** and **disseminated (miliary) TB** in young children. - Early administration is crucial as infants are at highest risk of developing severe TB if exposed. *Incorrect: 1 year* - While other vaccinations might be given at 1 year (such as MMR), the BCG vaccine is specifically recommended at or soon after birth. - Delaying BCG vaccination until 1 year increases the risk of early exposure to TB before immunity can be established, defeating its protective purpose. *Incorrect: 2 years* - The recommended schedule for BCG vaccination in India does not include administration at 2 years of age. - By 2 years, potential exposure to TB may have already occurred, and the vaccine's efficacy in preventing severe forms of the disease would be compromised. *Incorrect: 6 weeks* - At 6 weeks, other vaccines like OPV, DPT, Hepatitis B, Hib, and Rotavirus are administered as part of the UIP schedule. - BCG is specifically given at birth, not at 6 weeks, to provide early protection against severe childhood tuberculosis.

Q: All of the following are required more during lactation as compared to pregnancy, except ?

Iron. ***Iron*** - **Iron requirements are significantly higher during pregnancy** (~27 mg/day) due to the expansion of maternal red blood cell mass, fetal development, and placental iron needs. - During lactation, iron requirement decreases to **~9-10 mg/day**, lower than in pregnancy, as **lactational amenorrhea** (absence of menstruation) reduces iron loss. - This represents the **most significant decrease** in requirement from pregnancy to lactation among the listed nutrients. *Vitamin A* - The **recommended daily allowance (RDA) for Vitamin A is higher during lactation** (~1300 μg/day) compared to pregnancy (~800 μg/day). - This increased requirement ensures **adequate transfer to breast milk** to support infant's **vision development and immune function**. *Niacin* - **Niacin requirements during lactation** (~17 mg/day) are **similar to pregnancy** (~18 mg/day). - While lactation involves increased metabolic demands, niacin requirements do not show a marked increase compared to pregnancy, unlike Vitamin A and Energy. - This option is less clearly "required more" during lactation. *Energy* - **Energy requirements are significantly higher during lactation** to fuel milk production, which is energetically demanding. - A lactating woman typically needs an **additional 500 kcal/day**, compared to ~300 kcal/day in the 2nd/3rd trimester of pregnancy.

Q: According to the immunization schedule, how many doses of influenza vaccine should children under 9 years of age receiving the vaccine for the first time typically receive?

2 doses at 4 weeks interval. ***2 doses at 4 weeks interval*** - Children **under 9 years of age** receiving the influenza vaccine for the **first time** require **two doses** administered at least **4 weeks (28 days) apart**. - This two-dose priming schedule is essential to ensure adequate immune response and protection against circulating influenza strains. - This recommendation is consistent across **IAP (Indian Academy of Pediatrics)** and **CDC guidelines**. - Children 9 years and older, and younger children who have been previously vaccinated, require only **1 dose annually**. *3 doses at 4 weeks interval* - The standard protocol for influenza vaccination does **not involve three doses**. - A three-dose schedule is typically seen with vaccines like **Hepatitis B**, **DTaP**, or **Hib**, but not for influenza. *2 doses at 4 weeks interval with a booster dose for high-risk children* - While high-risk children (chronic lung disease, heart disease, immunocompromised) are priority groups for influenza vaccination, the schedule remains **two initial doses** for first-time recipients under 9 years. - There is **no additional booster dose** beyond the two-dose series within the same influenza season, even for high-risk children. - Subsequent years require only **1 dose annually**. *None of the options* - This is incorrect as the standard recommendation is clearly established in immunization guidelines. - The **two-dose schedule at 4-week intervals** for first-time recipients under 9 years is well-documented by IAP and international guidelines.

Q: What is the annual infection rate of tuberculosis?

Percentage of new patients positive for tuberculin test. ***Percentage of new patients positive for tuberculin test*** - The **annual infection rate of tuberculosis (AIRT)** is defined as the percentage of individuals (typically children aged 1-9 years) who show **tuberculin conversion** (from negative to positive) in a given year. - Among the given options, this is the **closest representation** as it focuses on **newly infected individuals** rather than prevalent cases. - AIRT is a key epidemiological indicator reflecting **ongoing transmission** and the **annual risk of tuberculous infection** in a community. - This measure helps assess TB control program effectiveness and disease burden. *Percentage of total patients positive for tuberculin test* - This represents the **prevalence of tuberculosis infection** in the population, including both old and new infections. - It does not specifically measure the **annual rate of acquiring new infections**, which is what AIRT captures. *Percentage of sputum positive total patients* - This indicates the **prevalence of active, infectious pulmonary tuberculosis** in a population. - It refers to individuals with **active TB disease** who are shedding bacteria in sputum, not latent infection detected by tuberculin testing. *Percentage of sputum positive new patients* - This represents the **incidence of new, active, infectious tuberculosis cases** (case detection rate). - While important for TB surveillance, it measures **active disease** rather than **infection rate** detected by tuberculin skin test.

Q: Which of the following statements about polio is false?

Increased tendon reflexes. ***Increased tendon reflexes*** - Polio causes **lower motor neuron damage**, specifically to the anterior horn cells of the spinal cord [1]. - This damage leads to **flaccid paralysis** and **decreased or absent deep tendon reflexes**, not increased reflexes [3]. *99% non paralytic* - The vast majority of poliovirus infections (approximately 95-99%) are **asymptomatic** or cause only mild, non-specific symptoms. - Only a small percentage of infected individuals develop the more severe paralytic form of the disease. *Flaccid paralysis* - Poliovirus directly attacks and destroys **motor neurons** in the anterior horn of the spinal cord [1]. - This damage results in **muscle weakness** and loss of muscle tone, leading to **flaccid paralysis** [3]. *Aseptic meningitis* - About 1-5% of poliovirus infections can manifest as **aseptic meningitis**, characterized by symptoms like fever, headache, neck stiffness, and vomiting without bacterial infection [2]. - This form of meningitis is typically **self-limiting** and does not lead to paralysis [2].

Q: Most common cause of death in diphtheria is due to

Toxic cardiomyopathy. ***Toxic cardiomyopathy*** - Diphtheria toxin primarily targets and damages the **myocardium**, leading to heart failure, arrhythmias, and ultimately death. - Myocardial damage can occur even in mild cases and is the most frequent cause of **fatality** in both treated and untreated diphtheria. *Airway obstruction* - While significant **pharyngeal and laryngeal pseudomembrane formation** can cause severe respiratory distress and obstruction, it is not the most common cause of death overall. - Prompt medical intervention, such as **tracheostomy** or antitoxin administration, can often alleviate acute airway issues. *Septic shock* - Diphtheria itself is a **toxin-mediated disease**, not typically characterized by overwhelming bacterial sepsis leading to septic shock as the primary cause of death. - While secondary infections can occur, direct **toxin-induced organ damage** is the main concern. *Descending polyneuropathy (rare)* - **Neurological complications**, such as polyneuropathy, can occur later in the course of diphtheria due to toxin effects. - However, these are generally less common and less immediately life-threatening than **cardiac complications**, and rarely the direct cause of death.

Question 1

Which of the following is NOT a criterion for defining a polio epidemic?

Accepted Answer

Cases occurring during a 6 month period

Answer

Caused by same virus type

Answer

Cases should occur in same locality

Answer

2 or more cases

Question 2

Which of the following is the primary component of the AFP (Acute Flaccid Paralysis) case definition used in polio surveillance?

Accepted Answer

Onset of acute flaccid paralysis

Answer

All of the above

Answer

Stool specimen positive for poliovirus

Answer

Presence of residual paralysis after 60 days

Question 3

Infectivity period of chickenpox is ?

Accepted Answer

1 day before and 4 days after appearance of rash

Answer

Only when scab falls

Answer

Entire incubation period

Answer

4 days before and 5 days after appearance of rash

Question 4

At what age is the BCG vaccination administered in India?

Accepted Answer

At birth

Answer

1 year

Answer

2 years

Answer

6 weeks

Question 5

All of the following are required more during lactation as compared to pregnancy, except ?

Accepted Answer

Iron

Answer

Niacin

Answer

Energy

Answer

Vitamin A

Question 6

According to the immunization schedule, how many doses of influenza vaccine should children under 9 years of age receiving the vaccine for the first time typically receive?

Accepted Answer

2 doses at 4 weeks interval

Answer

2 doses at 4 weeks interval with a booster dose for high-risk children

Answer

3 doses at 4 weeks interval

Answer

None of the options

Question 7

What is the annual infection rate of tuberculosis?

Accepted Answer

Percentage of new patients positive for tuberculin test

Answer

Percentage of total patients positive for tuberculin test

Answer

Percentage of sputum positive total patients

Answer

Percentage of sputum positive new patients

Question 8

What is the most common cause of infant mortality in developing countries?

Accepted Answer

Low Birth Weight (LBW)

Answer

Injuries

Answer

Tetanus infection

Answer

Birth asphyxia

Question 9

Which of the following statements about polio is false?

Accepted Answer

Increased tendon reflexes

Answer

99% non paralytic

Answer

Aseptic meningitis

Answer

Flaccid paralysis

Question 10

Most common cause of death in diphtheria is due to

Accepted Answer

Toxic cardiomyopathy

Answer

Airway obstruction

Answer

Septic shock

Answer

Descending polyneuropathy (rare)

NEET-PG 2013

Community Medicine

Internal Medicine