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What's inside the PDF:

• DUHS exam format (LAQ 15M + 5 SAQ + 10 Objectives)

• Frequency table of all NCD topics asked from 2008-2024
• Highlighted LAQs and Short Notes with year references

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   NCD PSM DUHS Notes

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• 📊 Previous year question analysis (2008–2024 DUHS papers)
• 🎯 CAUTION mnemonic (visual card for cancer danger signs)
• 📋 All 10 topics with color-coded boxes and tables
• ⚡ Quick revision section (23 key numbers/facts)
• 📝 Model answer frameworks for all top LAQs
• Works offline once loaded, mobile-optimized layout

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📋 NON-COMMUNICABLE DISEASES – PSM NOTES

MBBS 3rd Year | DUHS Chhattisgarh (Ayush University)

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📊 PREVIOUS YEAR QUESTION ANALYSIS

• Hypertension – epidemiology, risk factors, prevention (2015, S'16, S'09, S'13)
• CHD – risk factors + prevention (2012, S'16, S'09, S'13)
• Diabetes – epidemiology + primary prevention (2014)
• Cancer – types in India + warning signs + Ca Cervix prevention (2009, 2013)
• NPCDCS – components, objectives (S'16)
• RTA – measures as BMOH (2009)

• Risk factors/classification of Hypertension
• Screening for cancer cervix (Pap smear, VIA)
• Oral cancer
• Diabetes – diagnostic criteria
• Obesity – BMI, waist circumference
• Framingham Heart Study
• NPCDCS
• Metabolic syndrome
• Stroke – risk factors
• Cancer registration (PBCR, HBCR)

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1. INTRODUCTION TO NCDs

• NCDs cause 74% of all deaths globally = 41 million/year
• 77% of NCD deaths in low/middle-income countries
• In India (2016): NCDs = 60% of all deaths

• T – Tobacco (~7 million deaths/year; 71% lung cancers)
• A – Alcohol (3.3 million deaths/year = 5.9% of global deaths)
• P – Physical inactivity (1.6 million deaths/year; 20–30% increased mortality)
• U – Unhealthy diet (high salt → HTN; 4.1M CVD deaths from excess sodium)

• Raised blood pressure – 9.4 million deaths/year (12.8% all deaths)
• Overweight/Obesity – 2.8 million+ deaths/year
• Raised blood glucose

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2. CORONARY HEART DISEASE (CHD) ⭐⭐⭐

Risk Factors

• Age (risk rises after 50 years)
• Sex (males at higher risk; post-menopausal women catch up)
• Family history/Genetics (polygenic)

• Diabetes mellitus (2–4x CHD risk)
• Obesity (BMI >30)
• Unhealthy diet (high saturated fat, salt)
• Type A personality (competitive, aggressive, time-pressured)
• Heavy alcohol use
• Oral contraceptives (especially in smokers)

Prevention – 3 Strategies

1. Population Strategy – Target whole community; health education, dietary changes, anti-smoking, physical activity promotion. Greatest potential (Geoffrey Rose)
2. High-Risk Strategy – Target individuals with risk factors; screen, treat HTN/dyslipidaemia/DM, smoking cessation
3. Secondary Prevention – Established CHD patients; aspirin, statins, beta-blockers, ACE inhibitors, PTCA/CABG

Framingham Heart Study – Short Note

• Started 1951, Framingham, Massachusetts, USA
• Best-known prospective cohort study on CHD
• Established 4 major CHD risk factors: elevated cholesterol, smoking, hypertension, sedentary habits
• Coined the term "risk factor"
• Still ongoing – multiple generations enrolled

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3. HYPERTENSION ⭐⭐⭐

Classification (JNC 7)

Problem Statement

• Global: ~22% of adults have raised BP (2015)
• Causes 9.4 million deaths/year (12.8% of all deaths)
• India: 20–40% urban, 12–17% rural adults

Risk Factors

• Age: BP rises with age. Children of 2 hypertensive parents → 45% risk (vs 3% if both normotensive)
• Sex: Males higher in young adults
• Genetics: Polygenic – confirmed by twin & family studies
• Race: Higher in Black populations

• Salt (Sodium): WHO recommends <5g/day; INTERSALT study confirmed the link
• Obesity: 10 kg weight loss → lowers SBP by 5–20 mmHg
• Alcohol: Limit <2 drinks/day men, <1 drink/day women
• Physical inactivity: Regular aerobic exercise lowers SBP by 4–9 mmHg
• Low potassium/calcium, high saturated fat
• Stress/Psychosocial factors
• Oral contraceptives (oestrogen-containing OCP raises BP)

Tracking of Blood Pressure

Prevention

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4. DIABETES MELLITUS ⭐⭐⭐

Classification (WHO 2019)

Diagnostic Criteria (WHO)

Risk Factors / Epidemiological Determinants

• Age: Type 2 DM rises after 40 years
• Genetics: Monozygotic twin concordance ~90% for Type 2
• Ethnicity: Higher in South Asians, Pima Indians
• Gestational history: GDM, macrosomic babies

• Obesity (especially abdominal): MOST IMPORTANT – 44% of global diabetes burden
• Physical inactivity – alters insulin-receptor interaction
• Unhealthy diet – high saturated fat, low fibre; fibre >20g/day is protective
• Alcohol – damages pancreas, promotes obesity
• Viral infections – Rubella, mumps, Coxsackie B4 trigger Type 1 DM
• Malnutrition – PEM in early infancy → β-cell damage
• Stress – cortisol → insulin resistance

Primary Prevention of Type 2 DM

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5. CANCER ⭐⭐⭐

Global & India Burden (2020)

7 Danger Signals of Cancer – Mnemonic: CAUTION ⭐

• C – Change in bowel or bladder habits
• A – A sore that does not heal
• U – Unusual bleeding or discharge
• T – Thickening or lump in breast or elsewhere
• I – Indigestion or difficulty in swallowing
• O – Obvious change in wart or mole
• N – Nagging cough or hoarseness of voice

Oral Cancer ⭐

• Most common cancer in males in India!
• Risk factors: Tobacco (smoking + smokeless), Alcohol, Betel nut chewing, HPV, poor oral hygiene, OSMF
• Precancerous lesions: Leukoplakia, Erythroplakia, OSMF
• Prevention: Tobacco cessation programs, early detection

Cancer Cervix & Screening ⭐

• 2nd most common cancer in women in India
• Risk factors: Early sex, multiple partners, HPV 16 & 18 (70% cases), multiparity, low SES, smoking

• Primary: HPV vaccination (Gardasil/Cervarix) for girls 9–26 yrs; delay sexual debut; safe sex; tobacco cessation
• Secondary: Pap smear / VIA screening programs
• Tertiary: Cryotherapy, LEEP, cone biopsy for early lesions

Cancer Registration in India

• Cancer is NOT a notifiable disease in India
• PBCR (Population-Based Cancer Registry): Incidence & mortality data
• HBCR (Hospital-Based Cancer Registry): Hospital patient data
• NCRP (National Cancer Registry Programme): Under ICMR, started 1981
• India has 30+ PBCRs covering ~15% of population

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6. STROKE ⭐⭐

Types

• Ischaemic Stroke – Thrombotic/embolic occlusion of cerebral artery (~80–85%)
• Haemorrhagic Stroke – Rupture of cerebral blood vessel (~15–20%)
• TIA – Symptoms <24 hours; "mini-stroke"; warning sign

Risk Factors

• Hypertension: SINGLE MOST IMPORTANT modifiable risk factor
• Diabetes mellitus (2–3x risk)
• Smoking (doubles stroke risk)
• Atrial fibrillation (5x embolic stroke risk)
• Dyslipidaemia, Obesity, Physical inactivity

Prevention

• Control HTN (reduces stroke by 35–40%)
• Anti-platelet therapy (aspirin) for high-risk
• Anticoagulation for atrial fibrillation
• Statins for dyslipidaemia
• Lifestyle: stop smoking, exercise, healthy diet, weight control

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7. OBESITY ⭐⭐

BMI Classification

• Males: >102 cm (global) / >90 cm (Asian)
• Females: >88 cm (global) / >80 cm (Asian)
• Android (apple-shaped) obesity is more dangerous than gynoid (pear-shaped)

Health Consequences

• CVD: Hypertension, CHD, Stroke
• Metabolic: Type 2 DM, dyslipidaemia, metabolic syndrome
• Cancers: Breast, colorectal, endometrium, kidney, oesophagus
• Musculoskeletal: Osteoarthritis, gout
• Respiratory: Sleep apnoea
• GI: GERD, gallstones, fatty liver (NAFLD)
• Psychosocial: Depression, low self-esteem

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8. NPCDCS ⭐⭐

• NCDs = 60% of all deaths in India (2016)
• 11th Five Year Plan: 100 districts in 21 states
• 12th Five Year Plan: All districts covered

Objectives

1. Prevent and control NCDs through behaviour and lifestyle changes
2. Provide early diagnosis and management of common NCDs
3. Build capacity at various levels of health care
4. Train human resources (doctors, paramedics, nurses)
5. Establish capacity for palliative and rehabilitative care

Implementation Strategy

• Opportunistic screening of persons above 30 years
• NCD Clinic established at CHC and District level
• Implementation through 20,000 sub-centres and 700 CHCs in 100 districts
• BCC messages: Healthy food, physical activity, avoid tobacco/alcohol, stress management

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9. ROAD TRAFFIC ACCIDENTS (RTA) ⭐

• ~1.35 million deaths/year globally (2018)
• India: ~1.5 lakh RTA deaths/year
• Leading cause of death in 5–29 year age group
• 50% involve pedestrians, cyclists, motorcyclists

Role of BMOH in Reducing RTA

1. Health education on drunk driving, speeding, helmet/seatbelt use
2. Trauma care preparedness – first aid training, stabilization room at BPHC
3. Coordination with police, PWD, transport department
4. Establish referral system to district hospital
5. Maintain RTA surveillance data
6. Community involvement – VHCs, NGOs
7. Golden hour concept – treatment within 1 hour of injury

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10. MENTAL HEALTH ⭐

• Mental disorders affect 1 in 4 people globally
• Depression is the leading cause of disability worldwide
• ~800,000 suicides/year; 2nd leading cause of death in 15–29 yr age
• India NMHS 2015–16: 10.6% prevalence of mental disorders

National Mental Health Programme (NMHP)

• Launched in 1982 in India
• District Mental Health Programme (DMHP) – integration at district level
• Mental Healthcare Act 2017 – Right to access mental health care

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⚡ QUICK REVISION – KEY NUMBERS

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📝 MODEL ANSWER FRAMEWORKS

Hypertension LAQ (12–15 marks)

1. Introduction + Definition (JNC 7) — 1–2 marks
2. Problem statement – Prevalence India & globally — 2 marks
3. Classification table — 2 marks
4. Risk factors – Non-modifiable + Modifiable (table) — 3–4 marks
5. Prevention – Primordial, Primary, Secondary, Tertiary — 3–4 marks
6. NPCDCS mention — 1 mark
7. Conclusion — 1 mark

Diabetes LAQ (12 marks)

1. Introduction + WHO 2019 Classification — 2 marks
2. Problem statement – India 77 million, 2nd worldwide — 1 mark
3. Diagnostic criteria table — 2 marks
4. Epidemiological determinants – Non-modifiable + Modifiable — 3 marks
5. Primary prevention – Weight, Diet, Exercise, Metformin, Screening — 4 marks

Cancer LAQ (12 marks)

1. Introduction + magnitude in India — 2 marks
2. Common cancers in India – Males & Females (table) — 2 marks
3. Early warning signs – CAUTION mnemonic — 3 marks
4. Prevention of Ca Cervix – HPV vaccine, Pap smear, VIA — 4 marks
5. Cancer control in community — 1 mark

CHD LAQ (12 marks)

1. Definition of CHD/IHD — 1 mark
2. Problem statement + Framingham Study — 1 mark
3. Risk factors – Non-modifiable + Big 4 + Other modifiable (table) — 6 marks
4. Prevention – 3 strategies — 4 marks

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