Prevention Strategies — MCQs
All of the following are methods of health promotion except:
Which of the following is NOT a core component of the WHO's global STI control strategy?
To reduce mortality by CHD, best strategy -
All of the following are components of primordial prevention EXCEPT
Avoidance of food is seen in
Which one of the following factors is the most significant as a risk factor for post-partum psychosis?
Which of the following is NOT true about anorexia nervosa?
Which of the following features is not seen in Anorexia Nervosa?
Which eating disorder is characterized by normal weight?
What is true about Anorexia nervosa?
Prevention Strategies Indian Medical PG Practice Questions and MCQs
Question 1: All of the following are methods of health promotion except:
- A. Immunization (Correct Answer)
- B. Behavioral changes
- C. Nutritional education
- D. Health education
Explanation: ***Immunization (Correct - This is the EXCEPTION)*** - Immunization is primarily a form of **specific protection** under primary prevention, NOT a health promotion strategy - While essential for **disease prevention**, it targets specific diseases rather than enabling broad lifestyle improvements - Health promotion focuses on **non-specific measures** that enable people to increase control over and improve their overall health *Behavioral changes (Incorrect - This IS health promotion)* - Promoting **positive behavioral changes** (e.g., increased physical activity, smoking cessation) is a **core component of health promotion** - These changes empower individuals to adopt healthier lifestyles and reduce disease risk through non-specific measures *Nutritional education (Incorrect - This IS health promotion)* - **Educating individuals** and communities about healthy eating habits is a **fundamental aspect of health promotion** - It helps prevent diet-related diseases and improves overall well-being through lifestyle modification *Health education (Incorrect - This IS health promotion)* - Providing accessible and understandable **health information** is a **key method of health promotion** - This knowledge empowers individuals to make informed decisions about their health and adopt healthier behaviors
Question 2: Which of the following is NOT a core component of the WHO's global STI control strategy?
- A. Case management
- B. Universal mandatory screening (Correct Answer)
- C. Strategic information systems
- D. Prevention services
Explanation: ***Universal mandatory screening*** - While screening is part of STI control, **universal mandatory screening** for all STIs in the general population is not a core component of the WHO's strategy due to feasibility, cost, and ethical considerations. - The strategy emphasizes **targeted screening** for at-risk populations and opportunistic screening. *Case management* - **Case management**, including accurate diagnosis and effective treatment, is a critical component for managing current infections and preventing further transmission. - This involves syndromic or etiologic approaches to treatment and partner notification. *Strategic information systems* - **Strategic information systems** are essential for monitoring trends, evaluating interventions, and informing policy decisions related to STI control. - This includes surveillance data, program monitoring, and research. *Prevention services* - **Prevention services** are a cornerstone of the WHO's strategy, aiming to reduce the incidence of new infections. - These services encompass health education, condom promotion and distribution, vaccination, and pre-exposure prophylaxis (PrEP).
Question 3: 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 4: All of the following are components of primordial prevention EXCEPT
- A. Behavioural changes
- B. Health education
- C. Nutritional education
- D. Immunization (Correct Answer)
Explanation: ***Immunization*** - **Immunization** is a component of **primary prevention**, aiming to prevent the onset of disease in healthy individuals. - Primordial prevention focuses on preventing the establishment of risk factors themselves, rather than preventing the disease directly. *Behavioural changes* - **Behavioural changes**, such as encouraging healthy lifestyles from a young age, are central to primordial prevention. - The goal is to prevent the adoption of unhealthy behaviours that could lead to disease later in life. *Health education* - **Health education**, particularly in early life stages, is a key strategy for primordial prevention. - It helps in fostering healthy habits and promoting awareness before risk factors emerge. *Nutritional education* - Providing **nutritional education** to prevent the development of poor dietary habits is a core aspect of primordial prevention. - This aims to prevent the establishment of risk factors like obesity and hypertension from an early age.
Question 5: Avoidance of food is seen in
- A. Binge eating disorder
- B. Pica
- C. Bulimia nervosa
- D. Anorexia nervosa (Correct Answer)
Explanation: ***Anorexia nervosa*** - Individuals with anorexia nervosa restrict their food intake significantly, often to the point of **starvation**, driven by an intense fear of gaining weight. - This eating disorder is characterized by a **distorted body image** where the person sees themselves as overweight even when severely underweight. - **Food avoidance and restriction** are the core features of this disorder. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, accompanied by a feeling of loss of control. - Unlike anorexia, there are no regular compensatory behaviors, and the primary issue is **overconsumption**, not avoidance. *Bulimia nervosa* - Bulimia nervosa involves recurrent episodes of **binge eating followed by compensatory behaviors** like self-induced vomiting, excessive exercise, or laxative misuse. - While there is concern about weight, the pattern is one of binging and purging, rather than consistent food avoidance. *Pica* - Pica involves **persistent eating of non-nutritive substances** (e.g., soil, chalk, paper) for at least one month. - This is not characterized by food avoidance, but rather inappropriate consumption of non-food items.
Question 6: Which one of the following factors is the most significant as a risk factor for post-partum psychosis?
- A. History of post-partum psychosis (Correct Answer)
- B. Primiparity
- C. Undesired pregnancy
- D. Unmarried status
Explanation: ***History of post-partum psychosis*** - A **prior episode of postpartum psychosis** is the strongest risk factor for recurrence, with recurrence rates estimated to be as high as 50-70%. - This indicates a heightened **biological vulnerability** to the hormonal and psychosocial stresses of the postpartum period. *Primiparity* - While primiparity can be associated with increased stress, it is a **less significant risk factor** for postpartum psychosis compared to a history of the condition. - The stress of a first pregnancy and childbirth can contribute to other perinatal mood disorders, but does not carry the same high recurrence risk as previous psychosis. *Undesired pregnancy* - An undesired pregnancy is often associated with **increased maternal stress, anxiety, and depression**, but it is generally a **weaker predictor** of postpartum psychosis than a personal history of the disorder. - While it can complicate the perinatal period, it doesn't confer the same high risk for a severe psychotic episode. *Unmarried status* - Unmarried status may increase the risk of **postpartum depression** due to lack of social support or increased stress, but it is **not a primary risk factor** for postpartum psychosis itself. - The familial and social support systems are important for overall well-being, but a previous psychotic episode is a much stronger predictor.
Question 7: Which of the following is NOT true about anorexia nervosa?
- A. Leukopenia
- B. Amenorrhea
- C. Self-induced vomiting (Correct Answer)
- D. More common in adult females
Explanation: **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a distorted body image and an intense fear of gaining weight, leading to restricted energy intake and significantly low body weight. **Why "Self-induced vomiting" is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia, it is **not a mandatory diagnostic feature** or a universal finding. In contrast, self-induced vomiting is a hallmark and often defining compensatory behavior of **Bulimia Nervosa**. In Anorexia, the primary mechanism of weight loss is typically severe caloric restriction and excessive exercise. **Analysis of other options:** * **Leukopenia (A):** This is a common hematological complication of starvation in AN due to bone marrow hypoplasia (gelatinous transformation of marrow). * **Amenorrhea (B):** Though no longer a strict DSM-5 diagnostic criterion, it remains a classic clinical feature caused by hypogonadotropic hypogonadism (low FSH/LH due to hypothalamic dysfunction). * **More common in adult females (D):** AN has a significant female-to-male preponderance (roughly 10:1), typically peaking in adolescence and young adulthood. **NEET-PG High-Yield Pearls:** 1. **Most common cause of death:** Suicide (psychiatric) or Cardiac Arrhythmias (medical, often due to hypokalemia). 2. **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (hallmark), hypokalemia, and hypomagnesemia when food is reintroduced too rapidly. 3. **Physical signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). 4. **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents.
Question 8: Which of the following features is not seen in Anorexia Nervosa?
- A. Decreased total brain volume
- B. Lowered metabolic rate
- C. Impaired regulation in growth hormone levels
- D. Decreased serum protein (Correct Answer)
Explanation: **Explanation:** In **Anorexia Nervosa (AN)**, despite severe emaciation and malnutrition, the body employs remarkable compensatory mechanisms to maintain essential biochemical functions. **Why "Decreased serum protein" is the correct answer:** Counterintuitively, serum protein and albumin levels are typically **normal** in patients with Anorexia Nervosa. This is a classic "trap" in medical exams. The body prioritizes the synthesis of visceral proteins (like albumin) by breaking down somatic protein (muscle mass). Low serum protein is more characteristic of **Kwashiorkor** (protein-energy malnutrition) rather than the calorie-restricted starvation seen in AN. If an AN patient presents with low albumin, it usually indicates a very late stage of the disease or an alternative diagnosis. **Analysis of Incorrect Options:** * **A. Decreased total brain volume:** Chronic starvation leads to "pseudo-atrophy" of the brain, characterized by enlarged ventricles and reduced gray/white matter volume (reversible with refeeding). * **B. Lowered metabolic rate:** To conserve energy, the body enters a hypometabolic state. This manifests clinically as bradycardia, hypotension, and hypothermia. * **C. Impaired regulation in growth hormone (GH) levels:** In AN, there is a state of **GH resistance**. GH levels are actually **increased**, but Insulin-like Growth Factor-1 (IGF-1) is decreased, leading to impaired growth and regulatory feedback loops. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or Suicide. * **Endocrine hallmark:** Hypogonadotropic hypogonadism (leading to amenorrhea). * **Hematology:** Leukopenia is the most common blood abnormality. * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when starting nutrition; it is the most critical electrolyte shift to monitor.
Question 9: Which eating disorder is characterized by normal weight?
- A. Anorexia nervosa
- B. Bulimia nervosa (Correct Answer)
- C. Binge eating disorder
- D. None of the above
Explanation: **Explanation:** The hallmark of **Bulimia Nervosa (BN)** is the maintenance of a **normal or near-normal body weight** (BMI ≥ 18.5 kg/m²). Patients engage in a cycle of binge eating followed by inappropriate compensatory behaviors (purging via vomiting, laxatives, or excessive exercise). Unlike other eating disorders, the caloric intake during binges is offset by these compensatory mechanisms, preventing significant weight loss or gain, which often makes the disorder "invisible" to family members. **Analysis of Incorrect Options:** * **Anorexia Nervosa (AN):** The defining clinical feature is **significantly low body weight** (BMI < 18.5 kg/m² in adults) due to restricted energy intake and an intense fear of gaining weight. Even the "Binge-eating/Purging type" of AN is distinguished from Bulimia by the presence of underweight status. * **Binge Eating Disorder (BED):** While patients binge, they do **not** engage in regular compensatory behaviors. Consequently, BED is most commonly associated with being **overweight or obese**. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in BN). * **Metabolic Profile:** Bulimia often presents with **Hypokalemia**, Hypochloremia, and **Metabolic Alkalosis** (due to loss of gastric HCl). * **Parotid Gland Swelling:** Sialadenosis is a frequent physical finding in purging-type Bulimia. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).
Question 10: What is true about Anorexia nervosa?
- A. Anorexia nervosa is more common than bulimia nervosa.
- B. Anorexia nervosa can present with a low T4 in the presence of a normal T3.
- C. Anorexia nervosa may be associated with hypochloremic hypokalemic alkalosis.
- D. Anorexia nervosa is more commonly associated with constipation than diarrhea. (Correct Answer)
Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by a distorted body image, intense fear of gaining weight, and severe self-imposed dietary restriction. **Why Option D is Correct:** Constipation is the most common gastrointestinal complication of Anorexia Nervosa. It occurs due to **decreased caloric intake**, starvation-induced **slowing of colonic transit time**, and atrophy of the intestinal mucosa. While laxative abuse (in the binge-purge subtype) can cause diarrhea, the physiological hallmark of starvation is a significant reduction in bowel motility. **Analysis of Incorrect Options:** * **Option A:** Bulimia nervosa is statistically **more common** in the general population than Anorexia nervosa. * **Option B:** In AN, patients often exhibit **"Euthyroid Sick Syndrome."** This is characterized by **low T3** (triiodothyronine) levels and a low-normal T4, as the body attempts to conserve energy by reducing the peripheral conversion of T4 to the more active T3. * **Option C:** While hypochloremic hypokalemic alkalosis is seen in the **Binge-Eating/Purging type** of AN (due to vomiting), it is not a universal feature of the disorder. It is more classically the hallmark of Bulimia Nervosa. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Complications of starvation (cardiac arrhythmias) or suicide. * **ECG findings:** Bradycardia, QTc prolongation, and U-waves (if hypokalemic). * **Endocrine changes:** Increased Growth Hormone, increased Cortisol, decreased FSH/LH (leading to amenorrhea). * **Physical sign:** **Lanugo hair** (fine, downy hair) and **Russell’s sign** (calluses on knuckles from self-induced vomiting). * **Treatment:** Nutritional rehabilitation is the priority. **Fluoxetine** is FDA-approved for Bulimia, but has limited efficacy in underweight Anorexic patients.
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