Tuberculosis in Children Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Tuberculosis in Children. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Tuberculosis in Children Indian Medical PG Question 1: A healthcare worker develops fever, night sweats, and cough. Sputum shows acid-fast bacilli. What is the next diagnostic test?
- A. Gram stain
- B. Serology for TB
- C. NAAT for TB (Correct Answer)
- D. Sputum culture
Tuberculosis in Children Explanation: ***NAAT for TB***
- Nucleic Acid Amplification Tests (**NAAT**) rapidly confirm the presence of **Mycobacterium tuberculosis** DNA or RNA, crucial after an **acid-fast bacilli (AFB) smear** is positive [1].
- This test offers high sensitivity and specificity and can also detect **drug resistance**, guiding immediate treatment decisions [1].
*Gram stain*
- A **Gram stain** is not appropriate for **Mycobacterium tuberculosis** because these bacteria have a unique cell wall that makes them **acid-fast**, not readily stained by the Gram method.
- The initial finding of **acid-fast bacilli** already indicates a general type of organism, making a Gram stain redundant and uninformative for TB.
*Serology for TB*
- **Serological tests for TB** (detecting antibodies to M. tuberculosis) are generally **not recommended** for the diagnosis of active pulmonary TB due to their **poor sensitivity and specificity**.
- They have limited utility in diagnosing active disease and are not endorsed by major health organizations for this purpose.
*Sputum culture*
- **Sputum culture** is the **gold standard** for confirming TB diagnosis and for **drug susceptibility testing**, but it is a **slow process** (taking several weeks) [2].
- While essential for definitive diagnosis and resistance profiling, it is not the **"next" rapid diagnostic test** required given the positive AFB smear.
Tuberculosis in Children Indian Medical PG Question 2: Why is a regimen of four drugs recommended for a TB patient on the first visit?
- A. To prevent emergence of drug-resistant strains (Correct Answer)
- B. To reduce bacterial load effectively
- C. To minimize treatment duration
- D. None of the options
Tuberculosis in Children Explanation: ***To prevent emergence of drug-resistant strains***
- Using a **four-drug regimen** at the initial stage significantly reduces the likelihood of **Mycobacterium tuberculosis** developing resistance to any single drug.
- This strategy ensures that even if a small number of bacteria are naturally resistant to one drug, the other drugs will still be effective in killing them, preventing the proliferation of **resistant strains**.
*To minimize treatment duration*
- While a multi-drug regimen is effective, its primary goal is not to minimize treatment duration but rather to ensure **eradication of the infection** and prevent resistance.
- Treatment duration is determined by the need to kill both actively multiplying and dormant bacteria, which typically takes several months even with multiple drugs.
*To reduce bacterial load effectively*
- Reducing bacterial load is certainly a goal of TB treatment, but the use of four drugs is specifically aimed at achieving this while simultaneously preventing **drug resistance**.
- A single effective drug could reduce bacterial load, but it would quickly lead to the emergence of resistant bacteria, making the long-term goal of **cure** impossible.
*None of the options*
- This option is incorrect because the primary reason for a **four-drug regimen** in TB treatment is indeed to prevent the emergence of **drug-resistant strains**.
Tuberculosis in Children Indian Medical PG Question 3: A patient presents with hemoptysis, weight loss, and fatigue. Chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?
- A. Lung abscess
- B. Pulmonary embolism
- C. Bronchiectasis
- D. Tuberculosis (Correct Answer)
Tuberculosis in Children Explanation: ### Tuberculosis
- The combination of **hemoptysis**, **weight loss**, and **fatigue** is highly suggestive of active pulmonary tuberculosis [1, 2].
- **Cavitary lesions** in the **upper lobes** on chest X-ray are a classic radiographic finding for post-primary (reactivation) tuberculosis [3].
### Lung abscess
- While it can cause **hemoptysis** and **fatigue**, weight loss is less prominent unless chronic, and abscesses are typically solitary and may be located anywhere in the lung, not exclusively upper lobes [1].
- Lung abscesses are often associated with **fever**, **purulent sputum**, and a history of **aspiration**, which are not mentioned.
### Pulmonary embolism
- Symptoms usually include **acute dyspnea**, **chest pain**, and sometimes **hemoptysis**, but **weight loss** and **fatigue** are not typical chronic symptoms [1].
- Chest X-rays in pulmonary embolism usually show **normal findings** or **non-specific changes** like a Westermark sign or Hampton hump, not cavitations.
### Bronchiectasis
- Characterized by **chronic cough with copious purulent sputum** and recurrent infections, leading to **dilated bronchi**.
- While **hemoptysis** can occur due to bronchial artery erosion, **weight loss** is less common, and chest X-rays typically show **"tram-track" opacities** or **cystic changes**, not cavitations as the primary finding [1].
Tuberculosis in Children Indian Medical PG Question 4: An 11-year-old boy presented with a cough for 15 days. On examination, he was found to have cervical lymphadenopathy. Lymph node biopsy showed the following findings. What could be the diagnosis?
- A. Leprosy
- B. Sarcoidosis
- C. Syphilis
- D. Tuberculosis (Correct Answer)
Tuberculosis in Children Explanation: ***Tuberculosis***
- The image likely displays **granulomatous inflammation** with **caseous necrosis**, which is highly characteristic of **tuberculosis**, especially in someone presenting with a persistent cough and lymphadenopathy.
- The presence of **cervical lymphadenopathy** along with a **cough** for 15 days in an 11-year-old boy points towards extrapulmonary tuberculosis or primary tuberculosis infection affecting the mediastinal lymph nodes with cervical involvement.
*Leprosy*
- While leprosy also causes granulomas, it typically manifests as skin lesions and nerve involvement, and lymphadenopathy is less common or specific as the primary initial presentation.
- The granulomas in leprosy are often **epithelioid** with **foamy histiocytes** and numerous acid-fast bacilli, which are not explicitly described or obvious in the provided context for a definitive diagnosis without special stains.
*Sarcoidosis*
- Sarcoidosis involves **non-caseating granulomas**, meaning there is no central necrosis, which is a key differentiating feature from the caseating necrosis often seen in tuberculosis.
- Although sarcoidosis can cause lymphadenopathy and cough, the microscopic features in the image, particularly if showing necrosis, would argue against sarcoidosis.
*Syphilis*
- Syphilis can cause lymphadenopathy (especially in secondary syphilis), but the characteristic histological finding is usually a **plasma cell-rich infiltrate** with **endarteritis obliterans**, not typically prominent granulomas with caseous necrosis.
- Clinical presentation with cough and chronic lymphadenopathy in an 11-year-old would also make syphilis a less likely primary consideration without other suggestive signs.
Tuberculosis in Children Indian Medical PG Question 5: An asymptomatic infant with a history of TB exposure, is 3 months old and had taken 3 months of chemoprophylaxis, what is to be done next?
- A. Immunise with BCG and stop prophylaxis
- B. Continue prophylaxis for 3 months
- C. Test sputum, then decide
- D. Tuberculin test, then decide (Correct Answer)
Tuberculosis in Children Explanation: ***Tuberculin test, then decide***
- A **tuberculin skin test (TST)** or **IGRA** should be performed after completing the initial chemoprophylaxis period to determine if the infant has developed **latent TB infection (LTBI)**.
- According to **IAP guidelines**, if TST is **negative**, complete a total of **6 months of prophylaxis** and then administer **BCG vaccine**.
- If TST is **positive**, it indicates LTBI and the infant should complete the full course of treatment as per standard protocols.
- The decision to continue, modify, or stop treatment depends on **TST results** and **clinical evaluation**.
*Immunise with BCG and stop prophylaxis*
- **BCG vaccination** should not be given during or immediately after stopping prophylaxis without first performing a **TST**.
- In TB-endemic areas, BCG is ideally given at birth, but if delayed due to TB exposure, it should only be given after **ruling out infection** with a negative TST.
- Stopping prophylaxis prematurely without assessment can increase the risk of developing **active TB**.
*Continue prophylaxis for 3 months*
- While the standard duration of prophylaxis is **6 months total**, blindly continuing for another 3 months without TST assessment is not the most appropriate next step.
- The decision to continue should be based on **TST results** performed at this juncture, not arbitrary time extension.
- Prolonged unnecessary prophylaxis can lead to **drug toxicity** and **poor compliance**.
*Test sputum, then decide*
- An **asymptomatic infant** is unlikely to produce sputum, making this test impractical and inappropriate.
- Sputum testing is used for diagnosing **active pulmonary TB**, which is not suspected in this asymptomatic child.
- Sputum testing is invasive and reserved for children with **clinical symptoms** suggestive of active disease such as persistent cough, fever, or weight loss.
Tuberculosis in Children Indian Medical PG Question 6: A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?
- A. Breast feeding and BCG immunization
- B. Breast feeding and isoniazid administration (Correct Answer)
- C. Expressed breast milk and BCG immunization
- D. Stop feeds and isoniazid administration
Tuberculosis in Children Explanation: ***Breast feeding and isoniazid administration***
- **Breastfeeding** is safe and encouraged for infants of mothers with active tuberculosis, as the benefits of breast milk (nutrition, antibodies) outweigh the minimal risk of TB transmission through milk.
- **Isoniazid (INH) chemoprophylaxis** for the infant provides additional protection in high-risk exposure settings, particularly when the mother has active pulmonary TB and close contact is inevitable.
- This approach represents a conservative strategy prioritizing immediate chemoprophylaxis in a poverty-stricken setting where follow-up may be challenging.
*Breast feeding and BCG immunization*
- **Breastfeeding** is beneficial and appropriate.
- **BCG immunization** at birth is the current standard recommendation per WHO and IAP guidelines for infants born to TB-positive mothers.
- However, in settings with very high exposure risk and uncertain follow-up, some protocols additionally recommend INH prophylaxis, making the first option more comprehensive for this specific scenario.
*Expressed breast milk and BCG immunization*
- Expressing breast milk offers no significant additional protection against TB transmission compared to direct breastfeeding.
- Direct breastfeeding has additional benefits for mother-infant bonding and is not contraindicated in maternal TB.
- While **BCG immunization** is appropriate, this option unnecessarily complicates feeding.
*Stop feeds and isoniazid administration*
- **Stopping breastfeeding** is not indicated and would deprive the infant of essential nutrition and passive immunity.
- Breastfeeding is not contraindicated in maternal tuberculosis.
- While **isoniazid administration** may be appropriate, cessation of feeding is an incorrect recommendation.
Tuberculosis in Children Indian Medical PG Question 7: A child with acute respiratory distress showing hyperinflation of the unilateral lung in X-ray is due to –
- A. Staphylococcal bronchopneumonia
- B. Foreign body aspiration (Correct Answer)
- C. Congenital lobar emphysema
- D. Aspiration pneumonia
Tuberculosis in Children Explanation: ***Foreign body aspiration***
- A **foreign body** partially obstructing a bronchus acts as a **one-way valve**, allowing air to enter the lung on inspiration but trapping it on expiration, leading to **hyperinflation** of the distal lung.
- This is a common cause of acute respiratory distress and unilateral lung hyperinflation in children, as they frequently aspirate small objects.
*Staphylococcal bronchopneumonia*
- This typically presents with **consolidation** and **infiltrates** on chest X-ray, rather than hyperinflation.
- While it can cause respiratory distress, it does not characteristically lead to **unilateral hyperinflation** as its primary X-ray finding.
*Congenital lobar emphysema*
- This causes **progressive hyperinflation of a single lobe** (typically upper or middle lobe), not the entire lung, due to abnormal bronchial cartilage or extrinsic compression.
- While it can present acutely in infancy, the X-ray shows **lobar** hyperinflation with mediastinal shift, distinct from the **whole lung** hyperinflation seen with foreign body aspiration.
*Aspiration pneumonia*
- Aspiration pneumonia is caused by inhaling gastric contents or other substances, leading to **inflammation and infection** of the lung parenchyma.
- It typically presents with **infiltrates**, **consolidation**, or **abscess formation** on X-ray, not unilateral hyperinflation.
Tuberculosis in Children Indian Medical PG Question 8: Stridor in an infant is most commonly due to:
- A. Laryngomalacia (Correct Answer)
- B. Foreign body aspiration
- C. Diphtheria
- D. Acute epiglottitis
Tuberculosis in Children Explanation: ***Laryngomalacia***
- **Laryngomalacia** is the most common cause of **congenital inspiratory stridor** in infants, resulting from supraglottic laryngeal structures collapsing inward during inspiration.
- The stridor is typically **worse when crying, feeding, or lying supine** and usually improves spontaneously by 12-18 months of age.
*Foreign body aspiration*
- While foreign body aspiration can cause **acute stridor**, it is an event-specific occurrence, not a persistent condition from birth, and often presents with **sudden onset choking and respiratory distress**.
- Its incidence is higher in **toddlers and older children** who are mobile and exploring their environment, rather than infants.
*Diphtheria*
- **Diphtheria** is a rare cause of stridor due to widespread vaccination and is characterized by a **"bull neck"** and a **pseudomembrane in the pharynx**, which is distinct from the typical presentation of laryngomalacia.
- The stridor associated with Diphtheria is typically progressive and can lead to severe **respiratory obstruction and systemic toxicity**.
*Acute epiglottitis*
- **Acute epiglottitis** typically presents with sudden onset of **high fever, dysphagia, drooling, and muffled voice** in older children, rather than stridor from birth in an infant.
- Due to **Hib vaccine**, acute epiglottitis is now very rare and its stridor is usually rapidly progressive and life-threatening.
Tuberculosis in Children Indian Medical PG Question 9: Most dangerous sign in lower respiratory tract infection (LRTI) in children is:
- A. Chest retraction
- B. Grunting (Correct Answer)
- C. Tachypnea
- D. Abdominal breathing
Tuberculosis in Children Explanation: ***Grunting***
- **Grunting** is an expiratory sound produced by partial closure of the glottis to maintain positive end-expiratory pressure (PEEP), indicating **severe respiratory distress** and **impending respiratory failure**.
- This compensatory mechanism suggests significant **alveolar collapse** or **pulmonary edema** and is a **critical danger sign** requiring immediate intervention in children with LRTI.
- According to WHO and IMNCI guidelines, grunting is classified as a **danger sign** warranting urgent referral and management.
*Incorrect: Chest retraction*
- **Chest retractions** occur when the intercostal muscles, suprasternal, or subcostal areas pull inward during inspiration due to increased negative intrathoracic pressure.
- Although it is a sign of respiratory distress indicating increased work of breathing, it is less dire than grunting, which signifies a more critical phase of respiratory failure.
*Incorrect: Tachypnea*
- **Tachypnea** (increased respiratory rate) is an early and common sign of LRTI in children, as the body attempts to compensate for hypoxemia or increased metabolic demand.
- While concerning, it is often an initial response and, by itself, is not as immediately life-threatening as grunting, which suggests severe impairment of gas exchange.
*Incorrect: Abdominal breathing*
- **Abdominal breathing** (or diaphragmatic breathing) is a normal compensatory mechanism in infants and young children during respiratory distress.
- While it indicates increased work of breathing, it is not as dangerous as grunting, which signifies a more advanced stage of respiratory compromise.
Tuberculosis in Children Indian Medical PG Question 10: A child with recent onset of upper respiratory tract infection after 2 days presents with acute onset of breathlessness, cough, and fever. Which of the following treatments is contraindicated?
- A. Antipyretics
- B. Morphine (Correct Answer)
- C. Antibiotics
- D. O2 inhalation
Tuberculosis in Children Explanation: ***Morphine (CONTRAINDICATED)***
- Morphine is a **potent respiratory depressant** and is **absolutely contraindicated** in a child with acute breathlessness and respiratory infection.
- It suppresses the respiratory drive, worsening hypoxia and potentially leading to **respiratory failure**.
- The sedative effects mask crucial clinical signs of deteriorating respiratory status, delaying life-saving interventions.
- **Opioids should never be used** in acute respiratory distress in children.
*Antipyretics (NOT contraindicated)*
- **Paracetamol** or **ibuprofen** are safe and appropriate for fever management in children with respiratory infections.
- They improve patient comfort without adversely affecting respiratory function.
- Fever reduction helps decrease metabolic demand and oxygen consumption.
*Antibiotics (NOT contraindicated)*
- Indicated when **bacterial pneumonia** or bacterial superinfection complicates the viral URI.
- Choice depends on clinical assessment, chest X-ray findings, and laboratory markers (elevated WBC, CRP).
- Common organisms include *Streptococcus pneumoniae* and *Haemophilus influenzae*.
*O2 inhalation (NOT contraindicated)*
- **Essential treatment** for hypoxia (SpO2 <92-94%) in acute respiratory distress.
- Delivered via nasal prongs, face mask, or high-flow nasal cannula depending on severity.
- Oxygen therapy is a **life-saving intervention** and should never be withheld.
More Tuberculosis in Children Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
