Occupational Infections — MCQs
What is the diagnosis of a child with a small abrasion over the face who develops fever with chills, induration, and fiery red swelling over the face extending to the ear?
Ringworm fungi live in
Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?
Erysipeloid is transmitted by which route?
A plant prick can produce sporotrichosis. Which of the following statements about sporotrichosis is false?
A 56 year old gardener presents with an ulcerative nodule with purulent discharge on his right index finger. He had a prick with a thorn, at the same site around a month back. Which one of the following infections is most likely?
A 42-year-old Bengali male presents with painless nodules over the face. The face is erythematous, and the surface of some of the large nodules is discolored. He gives a history of an insect bite in the past while he went to the jungle for work. What is the most likely diagnosis?
Patient on anti-TB drugs develops tender nodules on shins. Most likely diagnosis is:
A hospital implements a policy to reduce occupational hand dermatitis in healthcare workers. They propose: (A) Switching from latex to nitrile gloves, (B) Installing alcohol-based hand rub dispensers, (C) Providing emollients, (D) Reducing glove use frequency. Synthesize the best evidence-based strategy.
Evaluate the following scenario: A 38-year-old worker in an electronics manufacturing unit develops hand dermatitis. Initial patch testing shows multiple positive reactions to metals (nickel, cobalt, chromium). Despite workplace modifications and protective equipment, the dermatitis persists. Re-evaluation reveals positive patch test to colophony. What is the best strategic approach?
Occupational Infections Indian Medical PG Practice Questions and MCQs
Question 1: What is the diagnosis of a child with a small abrasion over the face who develops fever with chills, induration, and fiery red swelling over the face extending to the ear?
- A. Anthrax
- B. Carbuncle
- C. Cellulitis
- D. Erysipelas (Correct Answer)
Explanation: ***Erysipelas*** - The presentation of **fiery red swelling** with well-demarcated, raised borders, rapidly extending from a small abrasion, especially on the face and involving the ear, is classic for erysipelas. - It also includes systemic symptoms like **fever and chills** and **induration**, which are characteristic of this superficial skin infection usually caused by **Streptococcus pyogenes**. *Anthrax* - Cutaneous anthrax typically presents with a papule that develops into a **vesicle**, then a painless ulcer with a distinctive **black eschar**, which is not described here. - While it can cause fever, the characteristic skin lesion is distinct from the red, spreading swelling seen in this case. *Carbuncle* - A carbuncle is a deep infection involving multiple hair follicles, presenting as a painful, interconnected lesion with **multiple draining sinuses**. - It is typically more localized, deeper, and pus-filled than the superficial, rapidly spreading, fiery red swelling described. *Cellulitis* - Cellulitis is a deeper infection of the dermis and subcutaneous fat, presenting with redness, warmth, and tenderness, but its borders are typically **less well-demarcated** and not as raised as in erysipelas. - While it can also occur on the face and cause systemic symptoms, the description of "fiery red" and "extending to the ear" with sharp borders makes erysipelas a more precise diagnosis.
Question 2: Ringworm fungi live in
- A. Basal Cell layer
- B. Prickle Cell layer
- C. Stratum Corneum (Correct Answer)
- D. Dermis
Explanation: ***Stratum Corneum*** - **Dermatophytes**, the fungi causing ringworm, are keratinophilic and thrive in the **superficial keratinized layers** of the skin. - The **stratum corneum** is the outermost layer of the epidermis, composed of dead cells rich in keratin, providing an ideal environment for these fungi. *Basal Cell layer* - The **basal cell layer** (stratum basale) is the deepest layer of the epidermis, responsible for cell proliferation. - Dermatophytes usually do not penetrate beyond the **stratum granulosum** and are rarely found in the basal layer. *Prickle Cell layer* - The **prickle cell layer** (stratum spinosum) is located just above the basal layer and contains actively metabolizing keratinocytes. - While dermatophytes can cause inflammatory reactions in these deeper epidermal layers, their primary habitat and growth occur superficially in the **stratum corneum**. *Dermis* - The **dermis** is the layer of skin beneath the epidermis, containing connective tissue, blood vessels, nerves, and hair follicles. - Dermatophytes generally do not invade the dermis, as they are specifically adapted to colonize **keratinized structures** and the immune system typically contains them within the epidermis.
Question 3: Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?
- A. Typhoid vaccine administration is the best method of preventing transmission.
- B. Person-to-person transmission is the primary mode of spread.
- C. Drug resistance in typhoid is not as big a problem as in TB.
- D. Hygiene practice and clean sanitation control are more important than the typhoid vaccine. (Correct Answer)
Explanation: ***Hygiene practice and clean sanitation control is more important than the typhoid vaccine.*** - **Improved sanitation**, safe water supplies, and adequate hygiene practices are fundamental in controlling the spread of **typhoid fever**, as the disease is primarily transmitted through the **oral-fecal route**. - While vaccines are an important tool, they offer only partial protection and must be combined with **robust public health infrastructure** and **sanitation measures** for effective prevention. *Typhoid vaccine administration is the best method of preventing transmission.* - Typhoid vaccines offer protection, but their effectiveness is not 100%, and they typically require **booster doses** - **Vaccination campaigns** are most effective when implemented alongside improvements in **water and sanitation infrastructure**, as vaccines alone cannot fully prevent transmission in areas with poor hygiene. *Person-to-person transmission is the primary mode of spread.* - While person-to-person transmission can occur, especially in settings with poor hygiene, the primary mode of spread for typhoid is through the **ingestion of food or water contaminated** with the feces of an infected person or carrier. - This emphasizes the crucial role of **water and food safety** rather than just focusing on direct person-to-person contact. *Drug resistance in typhoid is not as big a problem as in TB.* - **Antimicrobial resistance (AMR)** in typhoid fever, particularly to fluoroquinolones and extended-spectrum beta-lactamase (ESBL) producing strains, is a **significant and growing global health concern**, complicating treatment. - While TB also faces serious drug resistance issues, the escalating problem of **extensively drug-resistant (XDR)** and **multi-drug resistant (MDR)** typhoid strains makes it a substantial threat, impacting treatment options and increasing morbidity and mortality.
Question 4: Erysipeloid is transmitted by which route?
- A. Droplet
- B. Mosquito bite
- C. Fecal-oral
- D. Direct contact (Correct Answer)
Explanation: ***Direct contact*** - Erysipeloid, caused by *Erysipelothrix rhusiopathiae*, is transmitted through direct contact with **infected animal products**, especially fish, shellfish, and raw meat. - The bacteria typically enter through a **break in the skin**, such as a cut or abrasion, making occupational exposure common among butchers and fishmongers. *Droplet* - **Droplet transmission** involves the spread of respiratory droplets through coughing or sneezing, which is characteristic of airborne diseases like influenza. - Erysipeloid is primarily a **skin infection** and is not transmitted via the respiratory route. *Mosquito bite* - **Mosquito bites** are vectors for diseases like malaria, dengue, and West Nile virus, where the pathogen is injected directly into the bloodstream. - Erysipeloid is a bacterial infection acquired through **skin contact with contaminated materials**, not insect vectors. *Fecal-oral* - The **fecal-oral route** involves ingesting pathogens from contaminated food or water, often associated with gastrointestinal infections like cholera or giardiasis. - Erysipeloid is a **cutaneous infection** and does not involve the gastrointestinal tract as its primary mode of transmission.
Question 5: A plant prick can produce sporotrichosis. Which of the following statements about sporotrichosis is false?
- A. Enlarged lymph nodes extending centripetally as a beaded chain are a characteristic finding
- B. Most cases are acquired via cutaneous inoculation
- C. It is an occupational disease of butchers, doctors (Correct Answer)
- D. Is a chronic mycotic disease that typically involves skin, subcutaneous tissue and regional lymphatics
Explanation: ***It is an occupational disease of butchers, doctors*** - Sporotrichosis is an **occupational hazard for gardeners, florists, and agricultural workers** due to exposure to decaying plant matter, not typically for butchers or doctors. - The disease is caused by **direct inoculation** of the fungus *Sporothrix schenckii* into the skin, often through a thorn prick or minor trauma. *Most cases are acquired via cutaneous inoculation* - This statement is **true** as sporotrichosis is primarily caused by **traumatic implantation** of fungal spores into the skin. - Common sources include **thorns, splinters, sphagnum moss**, and other plant materials. *Enlarged lymph nodes extending centripetally as a beaded chain are a characteristic finding* - This statement is **true** and describes the classic **lymphocutaneous sporotrichosis**, where lesions and **nodular lymphangitis** track along lymphatic channels. - The "beaded chain" appearance refers to the multiple subcutaneous nodules formed along the lymphatic vessels. *Is a chronic mycotic disease that typically involves skin, subcutaneous tissue and regional lymphatics* - This statement is **true** because sporotrichosis is a **slow-progressing fungal infection** that primarily affects the skin, the tissue just beneath the skin, and the lymphatics draining the infected area. - While systemic dissemination can occur in immunocompromised individuals, the **cutaneous and lymphocutaneous forms** are most common.
Question 6: A 56 year old gardener presents with an ulcerative nodule with purulent discharge on his right index finger. He had a prick with a thorn, at the same site around a month back. Which one of the following infections is most likely?
- A. Chromoblastomycosis
- B. Phaeohyphomycosis
- C. Mycetoma
- D. Sporotrichosis (Correct Answer)
Explanation: ***Sporotrichosis*** - This presentation, an **ulcerative nodule with purulent discharge** on a finger after a **thorn prick** in a gardener, is classic for **sporotrichosis** (rose gardener's disease). - The organism, *Sporothrix schenckii*, is found in soil, plants, and decaying vegetation and typically enters through **skin trauma**. *Chromoblastomycosis* - Characteristically presents with **verrucous (warty) plaques or nodules** that slowly enlarge; it does not typically show the ulcerative nodule with purulent discharge found here. - While it can be acquired through trauma, the **morphology of the lesions** differs from the described case. *Phaeohyphomycosis* - This is a broad term for infections caused by dematiaceous (pigmented) fungi that typically present as **subcutaneous cysts, abscesses, or nodules**, but the specific clinical picture of **lymphocutaneous spread** following trauma is less characteristic than sporotrichosis. - The lesions tend to be more **encapsulated or abscess-like** rather than the ulcerative, purulent nodule described. *Mycetoma* - Mycetoma presents as a **chronic, localized, progressively destructive infection** of the skin, subcutaneous tissue, fascia, and bone, often characterized by **swelling, draining sinuses, and grains** (microcolonies of the causative organism). - While it can be acquired via trauma, the typical presentation is much more **extensive and chronic** than the initial ulcerative nodule described.
Question 7: A 42-year-old Bengali male presents with painless nodules over the face. The face is erythematous, and the surface of some of the large nodules is discolored. He gives a history of an insect bite in the past while he went to the jungle for work. What is the most likely diagnosis?
- A. Chronic Fungal infections
- B. Cutaneous Leishmaniasis (Correct Answer)
- C. Cutaneous tuberculosis
- D. Leprosy
Explanation: ***Cutaneous Leishmaniasis*** - The presentation of **painless erythematous nodules** on the face, especially in a person with a history of **insect bites** and exposure to a **jungle environment** (where sandflies, vectors of Leishmania, are common), strongly suggests cutaneous leishmaniasis. - The discoloration of the surface of large nodules is also consistent with the typical appearance of **chronic cutaneous leishmaniasis lesions**. *Chronic Fungal infections* - While chronic fungal infections can cause skin nodules, they typically present with features like **scaling, itching, or satellite lesions**, which are not described here. - The specific history of **insect bites** and geographical context points away from common fungal etiologies. *Cutaneous tuberculosis* - Cutaneous tuberculosis can manifest as nodules (**lupus vulgaris** or **scrofuloderma**), but these are often associated with other signs of tuberculosis, such as **pulmonary involvement** or **lymph nodal enlargement**, and typically have a slower progression. - The history of **insect bite** is not a primary risk factor for cutaneous tuberculosis. *Leprosy* - Leprosy, particularly **lepromatous leprosy**, can cause extensive facial nodules, but these are often associated with **nerve involvement** leading to sensory loss, and the lesions tend to be diffusely infiltrative rather than discrete, discolored nodules. - The rapid onset or history of a single insect bite is less characteristic of leprosy, which has a very **long incubation period**.
Question 8: Patient on anti-TB drugs develops tender nodules on shins. Most likely diagnosis is:
- A. Sweet syndrome
- B. Panniculitis
- C. Erythema multiforme
- D. Erythema nodosum (Correct Answer)
Explanation: ***Erythema nodosum*** - Erythema nodosum is a common **cutaneous adverse drug reaction** to anti-TB medications, presenting with **tender, erythematous nodules** typically on the shins. - It is a form of **panniculitis** (inflammation of subcutaneous fat) specifically associated with various triggers, including infections and drugs, making it highly probable in this context. *Sweet syndrome* - Sweet syndrome (acute febrile neutrophilic dermatosis) presents with **tender, erythematous plaques and nodules** often associated with fever and leukocytosis. - While it can be drug-induced, it typically involves a more widespread skin eruption and prominent systemic symptoms like **fever**, which are not specified here. *Panniculitis* - Panniculitis is a general term for **inflammation of the subcutaneous fat**, and erythema nodosum is a type of panniculitis. - This option is too broad; while accurate, "Erythema nodosum" is the **most specific and likely diagnosis** given the patient’s presentation in the context of anti-TB drug use. *Erythema multiforme* - Erythema multiforme is characterized by **target lesions** (concentric rings of erythema and edema) and often involves mucous membranes. - The description of **tender nodules on shins** does not fit the characteristic morphology of erythema multiforme.
Question 9: A hospital implements a policy to reduce occupational hand dermatitis in healthcare workers. They propose: (A) Switching from latex to nitrile gloves, (B) Installing alcohol-based hand rub dispensers, (C) Providing emollients, (D) Reducing glove use frequency. Synthesize the best evidence-based strategy.
- A. Implement all four measures as glove occlusion worsens dermatitis
- B. Implement only A and C to reduce costs
- C. Implement A, B, and C; avoiding D as it compromises infection control (Correct Answer)
- D. Focus only on B and C as glove material is not the primary issue
Explanation: ***Implement A, B, and C; avoiding D as it compromises infection control*** - Combining **non-latex (nitrile) gloves**, **alcohol-based rubs**, and **emollients** is the evidence-based triad for reducing **irritant contact dermatitis** and **Type I hypersensitivity** while maintaining skin barrier integrity. - Reducing the frequency of glove use (D) is an inappropriate strategy because it directly **compromises infection control** and increases the risk of **bloodborne pathogen exposure**. *Implement all four measures as glove occlusion worsens dermatitis* - While **glove occlusion** can contribute to dermatitis, intentionally reducing glove use (D) violates standard precautions for **patient and provider safety**. - The goal is to optimize the **type of glove** and **skin care regimen** rather than sacrificing necessary barrier protection. *Implement only A and C to reduce costs* - Excluding **alcohol-based hand rubs (B)** is counterproductive, as frequent washing with water and detergent is actually more **irritating to the skin** than alcohol rubs. - A strategy based solely on cost ignores the clinical evidence that **barrier creams and emollients** work best when integrated with less damaging hand hygiene methods. *Focus only on B and C as glove material is not the primary issue* - This ignores the significant prevalence of **latex allergy** and sensitivity to **accelerants** found in standard gloves, which contributes to **allergic contact dermatitis**. - Switching to **nitrile gloves (A)** is a critical step in a comprehensive occupational policy to eliminate **Type I latex hypersensitivity** risks.
Question 10: Evaluate the following scenario: A 38-year-old worker in an electronics manufacturing unit develops hand dermatitis. Initial patch testing shows multiple positive reactions to metals (nickel, cobalt, chromium). Despite workplace modifications and protective equipment, the dermatitis persists. Re-evaluation reveals positive patch test to colophony. What is the best strategic approach?
- A. The persistent dermatitis indicates evolution to chronic actinic dermatitis
- B. Colophony in soldering flux is the relevant occupational allergen; the metal sensitivities may be cross-reactions or co-sensitization (Correct Answer)
- C. All positive reactions are equally relevant and complete job change is mandatory
- D. The multiple sensitivities indicate systemic contact dermatitis requiring systemic therapy
Explanation: ***Colophony in soldering flux is the relevant occupational allergen; the metal sensitivities may be cross-reactions or co-sensitization*** - **Colophony** (rosin) is a frequent sensitizer in the **electronics industry**, where it is used as a flux in **soldering** to prevent oxidation. - Persistence of symptoms despite metal avoidance highlights the importance of identifying the **relevant allergen** versus incidental background sensitivity or **cross-reactivity**. *The persistent dermatitis indicates evolution to chronic actinic dermatitis* - **Chronic actinic dermatitis** is a photosensitive condition and is not a typical progression of **allergic contact dermatitis** caused by chemical exposure. - There is no clinical evidence of **photosensitivity** or UV-induced lesions mentioned in this occupational scenario. *All positive reactions are equally relevant and complete job change is mandatory* - Not all positive **patch tests** translate to clinical relevance; some may represent **excited skin syndrome** or past, non-relevant exposures. - A **job change** is a last resort; the management focus should be on specific **allergen substitution** or improved engineering controls for the **colophony** exposure. *The multiple sensitivities indicate systemic contact dermatitis requiring systemic therapy* - **Systemic contact dermatitis** occurs when an allergen is medicinally or dietarily ingested, not through **occupational cutaneous contact**. - Primary management involves **allergen avoidance** and topical therapists rather than initiating long-term **systemic immunosuppression** for manageable contactants.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free