WHO Package of Essential NCD interventions (PEN) for primary health care

ASSESSMENT TOOL FOR PARTICIPANTS TO SUPPORT CAPACITY BUILDING

Questions Answer
(All questions have a single correct answer)
1. WHO recommends ____servings of vegetables and fruits per day:
a. 3
b. 4
c. 5
d. 6

2. WHO recommends at least _______ minutes of moderate intensity physical

activity per week.
a. 60
b. 90
c. 120
d. 150

3. Dietary intake of salt should be restricted to grams/day.

a. 5gms
b. 6gms
c. 8gms
d. 10gms

4. Hypertension is diagnosed when blood pressure is

a. SBP ≥140 and /or DBP ≥ 90
b. SBP ≥135 and /or DBP ≥ 90
c. SBP ≥130 and /or DBP ≥ 80
d. SBP ≥140 and ≥DBP90

5. Which of the following is recommended for use in pregnant women as the first line
antihypertensive drug?
a. Angiotensin Receptor Blockers
b. ACE inhibitors
c. Thiazide diuretics
d. Calcium Channel Blockers

6. The following criteria is used for diagnosis of diabetes

a. HbA1C ≥6.0%
b. HbA1C ≥ 6.5%
c. HbA1C ≥ 7.0%
d. HbA1C ≥ 7.5%
7. In people with diabetes urgent referral is indicated if urine ketones are

a. 2+
b. 3+
c. 4+
d. 5+

8. Parameters used for lab-based CVD risk calculation are all EXCEPT
a. Age
b. Diastolic blood pressure
c. Diabetes
d. Cholesterol

9. Parameters used for non-lab-based CVD risk calculation are all EXCEPT
a. Sex
b. Tobacco use
c. BMI
d. History of diabetes

10. Management of individuals with lab-based CVD risk of 18 % includes all EXCEPT
a. Counsel on diet, physical activity, smoking cessation and avoiding
harmful use of alcohol
b. Consider drug treatment if persistent BP ≥ 140/90
c. Give a statin
d. Follow up every 3-6 months

11. Individuals with a non-lab CVD risk level of _______% and above should receive an
assessment using laboratory-based charts after measurement for diabetes and
cholesterol
a. 5 %
b. 10 %
c. 15 %
d. 20 %

12. To distinguish between asthma and COPD in a primary health care setting, which of
the following statement is NOT TRUE
a) After salbutamol administration, Improvement of Peak Expiratory Flow
rate (PEFR) more than 20% suggests asthma
b) Symptoms that are persistent with little day-to-day variation are
suggestive of asthma
c) Poorly treated tuberculosis can lead to COPD
d) Antibiotics should be given for all cases of exacerbation of COPD
13. According to guidelines, assessment of women with suspected breast cancer at a
primary health centre includes all EXCEPT
a. Assess signs and symptoms of breast cancer
b. Identify relevant risk factors in women aged 40 years and above
c. Clinical examination of both breasts, axillae and neck
d. Differential diagnosis to rule out benign breast diseases

14. You plan to start hypertension management in a primary health centre using
amlodipine as the first line treatment for an initial number of 50 patients.
Considering that your supply will be provided once a month, what is the reorder
factor for calculation of requirement of medicines?

a. 2
b. 3
c. 4
d. 6

15. Six-monthly control of blood pressure among people treated for hypertension is an
indicator for effectiveness of hypertension control programs. To calculate this
indicator which of the following is TRUE?

a. Numerator is the number of patients with controlled blood pressure

at any visit during the in the past six months
b. Numerator is the number of patients with controlled blood pressure
after six months of treatment.
c. Denominator is the number of patients registered for treatment of
hypertension after three months of treatment
d. Denominator is the number of patients registered for treatment of
hypertension in the past six months
 ANSWER KEYS WITH REFERENCE

Question Answer Explanation Reference

1. c At least five servings (400-500 g) of vegetables and fruits HEARTS H - Healthy
per day. One serving is equivalent, for example, to a single lifestyle counselling
orange, apple, mango, banana, or 3 tablespoons of cooked
vegetables. (Potatoes, sweet potatoes, cassava or other
starchy tubers or roots do not count as one of these
servings).

2. d Adults should perform at least 150 minutes of moderate HEARTS H - Healthy

physical activity (a mild increase in heart rate or breathing lifestyle counselling
rate resulting from, for example, brisk walking, climbing
stairs, dancing, gardening or doing household chores)
spread throughout the week

3. a Adults should consume less than 5 g of salt per day HEARTS H - Healthy
(equivalent to approximately 1 level teaspoon) lifestyle counselling
including salt added while cooking or eating, as well as salt
contained in foods such as processed foods and bread.

4. a The diagnosis of hypertension should be confirmed at an WHOPEN hypertension

additional patient visit, usually 1 to 4 weeks after the first chapter
measurement. In general, hypertension is diagnosed if, on HEARTS E: evidence-
two visits on different days: based treatment
systolic blood pressure on both days is ≥140 mmHg and/or protocols.
diastolic blood pressure on both days is ≥90 mmHg

5. d Pregnant women and women of childbearing age not on WHOPEN hypertension

effective contraception should not be given ACE inhibitors, chapter
ARBs, or thiazide/thiazide-like diuretics; CCBs should be HEARTS E: evidence-
used. based treatment
protocols.

6. b Diagnosis of diabetes is based on values of plasma glucose WHOPEN diabetes

or glycated haemoglobin (HbA1c). chapter
HbA1c of6.5% is the diagnostic cut-off value HEARTS D :Diagnosis and
management of type 2
diabetes
7. a If urine ketonesis≥2+, person should be immediately WHOPEN diabetes
referred to a higher centre chapter
HEARTS D :Diagnosis and
management of type 2
diabetes
8. b Systolic blood pressure is used for calculation CVD risk. WHOPEN CVD chapter
Other parameters for calculation of lab -based CVD risk. HEARTS R :risk based
are: age, sex, smoking status CVD management
presence or absence of diabetes, and total blood
cholesterol

9. d Parameters required for calculating non lab-based CVD risk WHOPEN CVD chapter
are: Age, sex, smoking status, systolic blood pressure and HEARTS R :risk based
BMI CVD management

10. c Statin is recommended in individuals with CVD risk (lab WHOPEN CVD chapter
based )>20% HEARTS R :risk based
CVD management

11. b Individuals with a total CVD risk level of 10% and above WHOPEN CVD chapter
should receive an assessment using laboratory-based HEARTS R :risk based
charts after measurement for diabetes and cholesterol. CVD management
Advice on lifestyle modification should be given as needed.

12. b Symptoms that are persistent with little day-to-day WHOPEN – Chronic
variation are suggestive of COPD. respiratory diseases
In asthma, symptoms are worse at night or early morning

13. b Regarding assessment of women with suspected breast WHOPEN – Cancer early
cancer, identify relevant risk factors in women aged 30 diagnosis- breast cancer
years and above.

14. a The reorder factor is 2 if supplies are delivered once a HEARTS A: Access to
month (1 x 2 = 2) essential medicines and
The reorder factor is a number that will help to calculate technology
how much of each item one needs to order. It includes the
requirement to hold enough stock to cover demand up to
the next reordering, and an additional buffer to protect
against higher and anticipated demand or delays in
delivery/pickup.
Usually the recommended reorder factors are (supply
interval (month) x 2) for most primary-level health care
facilities
15. b Numerator is the number of patients with controlled blood HEARTS S: systems for
pressure after six months of treatment. monitoring

As a health facility indicator,

Six-monthly control of blood pressure is defined as
“Proportion of patients registered for hypertensive
treatment at the health facility whose blood pressure is
controlled 6 months after treatment initiation”
The purpose is to measure the effectiveness of clinical
services in the programme to control blood pressure
among cohorts of treated patients.