National health programmes and their latest guidelines

38 NEET-PG practice questions on National health programmes and their latest guidelines, part of Community Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A 45-year-old daily-wage worker weighing 52 kg has had a cough for 3 weeks. Sputum NAAT at the block PHC detects Mycobacterium tuberculosis with rifampicin resistance not detected, and line probe assay later shows isoniazid susceptibility. He has never taken anti-TB treatment. Which regimen does NTEP prescribe?

   1. A2 months HRZE, then 4 months HR daily
   2. B6 months BPaLM daily
   3. C2 HRZES, 1 HRZE, then 5 HRE daily
   4. D2 months HRZE, then 4 months HRE daily

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   Answer: D · 2 months HRZE, then 4 months HRE daily

   Under NTEP, drug-sensitive TB (new or previously treated) gets the same daily regimen: 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, then 4 months of isoniazid, rifampicin and ethambutol, as weight-band fixed-dose combinations. India keeps ethambutol in the continuation phase, unlike the WHO standard of 4 months HR. The old Category II regimen with streptomycin has been withdrawn. BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin) is the shorter regimen for eligible patients with MDR/RR-TB, not for drug-sensitive disease.

   • A: Continuation with HR alone is the WHO regimen; NTEP adds ethambutol.
   • B: BPaLM is for MDR/RR-TB, and this strain is drug-sensitive.
   • C: The streptomycin-based Category II regimen is no longer used.

2. Question 2 · Medium

   A targeted intervention NGO under the National AIDS Control Programme works with people who inject drugs in a north-eastern city. Many clients share needles and want to stop heroin. Which service in this programme reduces HIV transmission among them?

   1. ADisulfiram given to every client daily
   2. BCompulsory detention in de-addiction centres
   3. COpioid substitution therapy with buprenorphine
   4. DHIV testing without consent at drop-in centres

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   Answer: C · Opioid substitution therapy with buprenorphine

   Harm reduction for people who inject drugs under NACP includes needle and syringe exchange, opioid substitution therapy with sublingual buprenorphine, condoms, HIV testing with consent, and linkage to ART. Opioid substitution reduces injecting and needle sharing, and so HIV and hepatitis C transmission. Compulsory detention and testing without consent violate rights and drive people away from services. Disulfiram is used for alcohol dependence, not opioids.

   • A: Disulfiram is for alcohol, not opioid, dependence.
   • B: Compulsory detention is not part of NACP and drives clients away.
   • D: Testing without consent breaches the HIV Act.

3. Question 3 · Medium

   A private physician diagnoses pulmonary TB in a 35-year-old bank officer by sputum NAAT. The patient asks the doctor not to inform any government office, as he fears his employer will find out. What should the physician do?

   1. ARespect his wish and not notify the case
   2. BNotify the case and keep his details confidential
   3. CInform his employer to protect colleagues
   4. DNotify only if he stops taking his treatment

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   Answer: B · Notify the case and keep his details confidential

   TB has been a notifiable disease in India since 2012, and every diagnosed case, including those in the private sector, must be notified to the public health system, through Ni-kshay. Notification is a legal duty, and failure to notify can be penalised. Notified information is confidential and is used to provide free drugs, drug-resistance testing, nutritional support and contact tracing; it is not shared with employers. The doctor should explain this to the patient, which usually relieves his fear.

   • A: Notification is mandatory and does not depend on the patient's wish.
   • C: Disclosure to an employer breaches confidentiality.
   • D: Notification is required at diagnosis, not only on default.

4. Question 4 · Easy

   A 40-year-old daily-wage labourer is notified on Ni-kshay with drug-sensitive pulmonary TB at a PHC. He is worried that he cannot afford good food while he is unable to work. Which NTEP scheme supports him?

   1. AA one-time cash award paid on being cured
   2. BJanani Suraksha Yojana, a cash incentive for completing treatment
   3. CPM-JAY, cover for inpatient treatment only
   4. DNikshay Poshan Yojana, a monthly cash transfer for nutrition

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   Answer: D · Nikshay Poshan Yojana, a monthly cash transfer for nutrition

   Under Nikshay Poshan Yojana, every notified TB patient receives monthly nutritional support by direct benefit transfer into a bank account for the whole duration of treatment. Undernutrition is a major risk factor for TB and for poor treatment outcomes, which is why the programme links nutrition to treatment. Community support through Ni-kshay Mitras under the Pradhan Mantri TB Mukt Bharat Abhiyaan adds food baskets. Janani Suraksha Yojana is a maternal scheme, and PM-JAY covers hospital care.

   • A: Support is monthly through treatment, not a single award at cure.
   • B: JSY is for institutional delivery, not TB.
   • C: PM-JAY covers hospital admission, not monthly nutrition.

5. Question 5 · Medium

   In a kala-azar endemic block, sandflies are found resting in cracks of mud walls inside houses and cattle sheds. Which vector control measure is the mainstay under the elimination programme?

   1. ALarvivorous fish in village ponds
   2. BTemephos in household water pots
   3. CIndoor residual spraying of walls
   4. DSpace fogging along the streets

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   Answer: C · Indoor residual spraying of walls

   Phlebotomus argentipes, the vector of kala-azar in India, breeds in moist soil rich in organic matter and rests in cracks and crevices of mud walls, mostly low down. Indoor residual spraying of house and cattle-shed walls up to about 6 feet with a synthetic pyrethroid kills resting sandflies. Plastering cracks and keeping houses and sheds clean add to this. Sandflies do not breed in water, so fish and larvicides in water are useless.

   • A: Sandflies do not breed in water, so fish do not help.
   • B: Temephos acts on mosquito larvae in water, not sandflies.
   • D: Fogging has little effect on sandflies resting indoors.

6. Question 6 · Medium

   A 34-year-old man with sputum-positive pulmonary TB completed 6 months of the drug-sensitive regimen. His sputum smear was negative at the end of the intensive phase and again in the last month of treatment. How should his treatment outcome be recorded?

   1. ATreatment success not evaluated
   2. BLost to follow-up
   3. CTreatment completed
   4. DCured

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   An ASHA is being trained to refer people for TB testing during active case finding in her village. The medical officer lists four complaints: 1. Cough for 2 weeks or more. 2. Fever for 2 weeks or more. 3. Significant weight loss. 4. Coughing up blood. Which of these should make her refer the person as presumptive TB?

   1. A1 only
   2. B1, 2 and 3 only
   3. C1 and 4 only
   4. D1, 2, 3 and 4

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8. Question 8 · Medium

   A 26-year-old woman at 22 weeks of her first pregnancy has had only one antenatal visit, with an ANM. She lives near a PHC that runs the Pradhan Mantri Surakshit Matritva Abhiyan. What does this scheme offer her?

   1. AFree antenatal check-up by a doctor on the 9th of every month
   2. BA free ultrasound every month until delivery
   3. CA cash incentive for every antenatal visit made at a PHC or CHC
   4. DFree delivery at a private hospital of her choice

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9. Question 9 · Easy

   A state leprosy officer states that India achieved elimination of leprosy as a public health problem at the national level in 2005. Which criterion defines this elimination?

   1. ANo new child case for five years
   2. BNew cases below 1 per 1,00,000 population
   3. CPrevalence below 1 per 10,000 population
   4. DGrade 2 disability below 1 per million

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10. Question 10 · Medium

    A 24-year-old woman at 14 weeks of pregnancy tests HIV positive at her first antenatal visit at a CHC; her CD4 count is 520 cells/µL and she is well. What should be done to prevent transmission to her baby?

    1. AStart lifelong ART at once
    2. BSingle-dose nevirapine in labour only
    3. CZidovudine alone from 28 weeks
    4. DStart ART at 28 weeks and stop after birth

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11. Question 11 · Hard

    During a mass drug administration round for lymphatic filariasis with DEC and albendazole, a drug distributor visits a household with these members: 1. A woman who is 5 months pregnant. 2. An 18-month-old boy. 3. A healthy 7-year-old girl. 4. A healthy 35-year-old man. Who should be given the drugs?

    1. A3 and 4 only
    2. B1, 3 and 4 only
    3. C1, 2, 3 and 4
    4. D2, 3 and 4 only

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12. Question 12 · Medium

    A 25-year-old woman delivers by caesarean section at a district hospital. Her husband, a farm labourer, asks the doctor how much they will have to pay. Under Janani Shishu Suraksha Karyakram, what are they entitled to?

    1. AA partial refund of charges after discharge
    2. BFree care only if she holds a below poverty line card
    3. CFree surgery, drugs, tests, diet, blood and transport home
    4. DFree surgery only; medicines and diet are paid for by the family

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13. Question 13 · Hard

    A 22-year-old primigravida attends a PHC at 16 weeks of pregnancy. Her haemoglobin is 11.4 g/dL. The medical officer plans: 1. One IFA tablet (60 mg elemental iron and 500 µg folic acid) daily, for at least 180 days. 2. Calcium 500 mg twice daily. 3. A single dose of albendazole 400 mg now, in the second trimester. 4. Folic acid alone without iron, as she is not anaemic. Which plans follow the national guidelines?

    1. A2, 3 and 4 only
    2. B1, 2 and 3 only
    3. C1 and 2 only
    4. D3 and 4 only

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14. Question 14 · Medium

    Several children from a rice-growing district of eastern Uttar Pradesh are admitted with acute encephalitis syndrome during the monsoon. Many families keep pigs near their homes, and Japanese encephalitis is confirmed in some children. What role do the pigs play?

    1. AAmplifying hosts of the virus
    2. BDead-end hosts of the virus
    3. CMain vectors of the virus
    4. DNatural reservoirs of the virus

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15. Question 15 · Easy

    A 29-year-old man is newly diagnosed with HIV at an ICTC. He has no symptoms, no opportunistic infection and a CD4 count of 650 cells/µL. When should antiretroviral therapy be started?

    1. ANow, whatever the CD4 count
    2. BWhen the CD4 count falls below 500
    3. COnly after WHO stage 3 disease
    4. DWhen the CD4 count falls below 350

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16. Question 16 · Medium

    A 36-year-old factory worker living with HIV is dismissed after his supervisor learns his HIV status from a colleague. He asks the ART centre doctor what legal remedy he has. Under the HIV and AIDS (Prevention and Control) Act, 2017, to whom can he complain?

    1. AThe Ombudsman appointed by the state
    2. BThe district TB officer
    3. CThe National Medical Commission
    4. DThe ICTC counsellor of the district

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17. Question 17 · Medium

    A 28-year-old truck driver attends a designated STI/RTI (Suraksha) clinic with burning micturition and a purulent urethral discharge for 3 days. There is no genital ulcer. Under syndromic management, what treatment should he receive?

    1. ABenzathine penicillin and azithromycin, once
    2. BSecnidazole 2 g and fluconazole 150 mg, once
    3. CAcyclovir 400 mg three times daily for 7 days
    4. DCefixime 400 mg and azithromycin 1 g orally, once

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18. Question 18 · Medium

    During a house visit, an ASHA fills the Community Based Assessment Checklist (CBAC) for a 48-year-old man who smokes, has a large waist and whose father had diabetes. His score is high. He has no symptoms. What should happen next under NP-NCD?

    1. AStart metformin from the ASHA's drug kit
    2. BDirect referral to the district NCD clinic
    3. CScreening for BP, blood sugar and oral cancer at the HWC
    4. DRepeat the checklist next year without any testing in between

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19. Question 19 · Easy

    An ASHA is listing the people in her village to be invited for population-based screening for hypertension, diabetes and common cancers under NP-NCD. Who is eligible?

    1. AAll persons aged 18 years and above
    2. BAll persons aged 40 years and above
    3. CAll persons aged 30 years and above
    4. DOnly persons with a family history

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20. Question 20 · Hard

    At a district training on the national malaria drug policy, the trainer makes four statements: 1. In the north-eastern states, uncomplicated falciparum malaria is treated with artemether-lumefantrine. 2. Elsewhere, uncomplicated falciparum malaria is treated with artesunate plus sulfadoxine-pyrimethamine and a single dose of primaquine. 3. Vivax malaria is treated with chloroquine for 3 days and primaquine for 14 days. 4. Pregnant women with vivax malaria receive primaquine to prevent relapse. Which statements are correct?

    1. A2 and 3 only
    2. B1, 2 and 3 only
    3. C2, 3 and 4 only
    4. D1, 3 and 4 only

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21. Question 21 · Hard

    A district has a population of 25 lakh. At the end of the year, 200 leprosy patients are on multidrug therapy. During the year, 350 new cases were detected, 35 of them children and 10 with grade 2 disability. What is the prevalence rate, and has the district reached the elimination level?

    1. A0.8 per 10,000; elimination level reached
    2. B0.8 per 10,000; elimination level not reached
    3. C1.4 per 10,000; elimination level not reached
    4. D8 per 10,000; elimination level not reached

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22. Question 22 · Medium

    In a remote hamlet of Jharkhand, a woman gives birth at home, helped by her mother-in-law, before the ambulance can arrive. Mother and baby are well, and the ASHA reaches the house a few hours later. Under Home-Based Newborn Care, how many home visits should the ASHA plan for this baby, and when is the first?

    1. AThree visits, the first in week one
    2. BSeven visits, the first on the day of birth
    3. CSix visits, the first on the third day of life
    4. DFour visits, the first on day 7

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23. Question 23 · Hard

    A 48-year-old man is newly diagnosed with drug-sensitive pulmonary TB at a CHC. The medical officer reviews four statements about the collaborative activities he should receive: 1. He should be offered an HIV test. 2. He should be screened for diabetes. 3. If he had been living with HIV, he would have been screened for TB at every visit using the four-symptom screen. 4. HIV testing is offered only to TB patients who report high-risk behaviour. Which statements are correct?

    1. A2 and 3 only
    2. B1, 2 and 3 only
    3. C1 and 3 only
    4. D1, 2, 3 and 4

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24. Question 24 · Hard

    A district has completed several annual rounds of mass drug administration for lymphatic filariasis with good coverage. Night blood surveys at sentinel and spot-check sites now show a microfilaria rate below 1% at every site. What is the next step before MDA can be stopped?

    1. AStop MDA at once without any further survey
    2. BA night blood survey of every adult in all villages of the district
    3. CA transmission assessment survey in children aged 6-7 years
    4. DContinue MDA for five further rounds

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25. Question 25 · Medium

    A 50-year-old man is diagnosed with pulmonary TB at a PHC designated microscopy centre: two sputum smears show acid-fast bacilli. The medical officer starts the drug-sensitive regimen. Under NTEP, what further test must be arranged on his sputum?

    1. ATesting for rifampicin resistance by NAAT
    2. BNo further test, as the smear is diagnostic
    3. CA repeat smear at the end of treatment only
    4. DCulture only if he fails to improve

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