Infectious Diseases — MCQs

Infectious Diseases Indian Medical PG Practice Questions and MCQs

Question 1051: A 35-year-old man presents with an eschar following a recent hike in a scrub typhus-endemic area. Despite initial doxycycline therapy, the patient remains febrile after 48 hours. What is the most appropriate next step?

A. Evaluate for antibiotic resistance and consider alternative antibiotics (Correct Answer)
B. Increase the doxycycline dose
C. Switch to a third-generation cephalosporin
D. Add azithromycin to the treatment regimen

Explanation: ***Evaluate for antibiotic resistance and consider alternative antibiotics*** - Persistent fever after 48-72 hours of appropriate doxycycline therapy for **scrub typhus** suggests potential **antibiotic resistance** or an alternative diagnosis. - In such cases, it is crucial to re-evaluate the diagnosis and consider alternative antibiotics like **azithromycin** or **chloramphenicol**. *Increase the doxycycline dose* - Increasing the dose of **doxycycline** without clear evidence of resistance or inadequate dosing is unlikely to be effective and may lead to increased side effects. - The standard dose of doxycycline for **scrub typhus** is typically highly effective, and treatment failure usually points to resistance or another pathogen. *Switch to a third-generation cephalosporin* - **Cephalosporins** are generally not effective against **rickettsial infections** like **scrub typhus**, as these bacteria are intracellular and require antibiotics that can penetrate host cells. - Switching to this class of antibiotics would be an inappropriate choice for suspected **scrub typhus** treatment failure. *Add azithromycin to the treatment regimen* - While **azithromycin** is an effective alternative for **scrub typhus**, adding it *on top* of a failing doxycycline regimen without evaluating for resistance or considering a complete switch might be suboptimal. - It would be more appropriate to **switch** to azithromycin if doxycycline is suspected to be ineffective due to resistance, rather than combination therapy initially.

Question 1052: A patient with HIV presents with a chronic cough and weight loss. A chest X-ray shows bilateral interstitial infiltrates. What is the most likely cause?

A. Kaposi's sarcoma
B. Pneumocystis jiroveci pneumonia (Correct Answer)
C. Mycobacterium avium complex
D. Cryptococcal meningitis

Explanation: ***Pneumocystis jiroveci pneumonia*** - **Pneumocystis jiroveci pneumonia (PJP)** is a common opportunistic infection in HIV patients, presenting with **chronic cough**, **weight loss**, and **bilateral interstitial infiltrates** on chest X-ray [1]. - The insidious onset and classic radiographic findings are highly suggestive of PJP, especially in individuals with advanced HIV [1]. *Kaposi's sarcoma* - While common in HIV, **Kaposi's sarcoma** typically manifests as **cutaneous lesions**, though it can affect internal organs, including the lungs. - Lung involvement usually presents with **nodular** or **peribronchial infiltrates** and sometimes **pleural effusions**, which differ from the diffuse interstitial pattern described [1]. *Mycobacterium avium complex* - **Mycobacterium avium complex (MAC)** infection in HIV patients typically causes **disseminated disease** with fever, weight loss, and anemia [2]. - Pulmonary MAC often presents with **nodular** or **cavitary lesions** on imaging, not bilateral interstitial infiltrates. *Cryptococcal meningitis* - **Cryptococcal meningitis** is a central nervous system infection causing **headache**, **fever**, and **altered mental status**, not primarily respiratory symptoms [1]. - While *Cryptococcus* can cause pulmonary disease (**cryptococcosis**), it's less common to present with chronic cough and exclusively interstitial infiltrates compared to PJP.

Question 1053: A 60-year-old male with a history of gardening presents with pneumonia and a nodular pulmonary infiltrate. A sputum sample grows filamentous bacteria that form branching rods. What is the likely pathogen, and what are the implications for treatment?

A. Nocardia spp. (Correct Answer)
B. Aspergillus spp.
C. Actinomyces spp.
D. Mycobacterium tuberculosis

Explanation: Nocardia spp. - The combination of **pneumonia**, **nodular pulmonary infiltrate**, **gardening exposure** (soil organism), and **filamentous, branching rods** in sputum is highly characteristic of *Nocardia* infection. - *Nocardia* infections often require **prolonged treatment** with antibiotics such as **trimethoprim-sulfamethoxazole (TMP-SMX)** given its intracellular survival and tendency for recurrence. *Aspergillus spp.* - While *Aspergillus* can cause pulmonary infiltrates and is a filamentous fungus, it is typically described as having **hyphae with septations and acute-angle branching**, not bacterial rods [1]. - *Aspergillus* infections are often treated with **antifungal agents** like voriconazole, not antibiotics effective against bacteria. *Actinomyces spp.* - *Actinomyces* are also **filamentous branching bacteria**, but they are typically **anaerobic** and more commonly cause **cervicofacial** or **abdominal abscesses** with "sulfur granules," not usually pneumonia with nodular infiltrates in this clinical context. - *Actinomyces* infections are typically treated with **high-dose penicillin** for an extended period. *Mycobacterium tuberculosis* - *Mycobacterium tuberculosis* causes pulmonary disease and can lead to nodular infiltrates, but it is characterized as a **rod-shaped bacterium** that is **acid-fast**, not typically as filamentous or branching. - Treatment for **tuberculosis** involves a multi-drug regimen (e.g., RIPE therapy) for several months, which is distinct from the treatment for Nocardia.

Question 1054: A patient from a Lyme disease-endemic area presents with erythema migrans, fatigue, and arthralgia. Laboratory tests show positive IgM antibodies against Borrelia burgdorferi. Evaluate the stage of Lyme disease.

A. Early localized (Correct Answer)
B. Early disseminated
C. Late disseminated
D. Post-Lyme disease syndrome

Explanation: ***Early localized*** - **Erythema migrans** is the hallmark rash of early localized Lyme disease, typically appearing within days to weeks of a tick bite [1]. - The presence of **fatigue** and **arthralgia** are non-specific symptoms that can occur at any stage, but along with positive **IgM antibodies**, are consistent with early infection. *Early disseminated* - This stage involves multiple erythema migrans lesions, **cranial nerve palsies** (e.g., Bell's palsy), **meningitis**, or **cardiac involvement** like AV block, none of which are described. - While fatigue and arthralgia can persist, the specific presentation points to the earliest stage before systemic spread with major organ involvement. *Late disseminated* - Characterized by chronic **arthritis** (especially in large joints), **encephalopathy**, or **neuropathy**, which typically develop months to years after the initial infection. - The patient's current symptoms are not indicative of these severe, chronic manifestations. *Post-Lyme disease syndrome* - Refers to persistent symptoms such as fatigue, joint pain, and cognitive difficulties lasting for more than 6 months after successful treatment of Lyme disease. - This patient presents with active infection symptoms, not chronic residual symptoms after treatment.

Question 1055: What is the initial step in the management of a patient with suspected meningitis following neurosurgery?

A. Conduct a lumbar puncture
B. Perform a CT scan of the head
C. Administer empirical antibiotics (Correct Answer)
D. Monitor neurological status

Explanation: Administer empirical antibiotics - In suspected post-neurosurgical meningitis, empirical antibiotics should be initiated promptly to cover likely pathogens, given the high morbidity and mortality associated with delayed treatment [1]. - Delaying antibiotics for diagnostic procedures can worsen outcomes, especially if the patient's condition is deteriorating [1]. *Conduct a lumbar puncture* - While a lumbar puncture (LP) is crucial for definitive diagnosis, it should typically be performed *after* empirical antibiotics have been started, especially if there's a risk of intracranial pressure or focal neurological deficits. - An LP may be contraindicated or need careful consideration until imaging rules out mass effect, but delaying antibiotics for LP alone is generally not recommended in this critical situation. *Perform a CT scan of the head* - A CT scan is important to rule out mass lesions, hydrocephalus, or other surgical complications *prior* to a lumbar puncture, especially in neurosurgical patients. - However, performing a CT scan should not delay the administration of empirical antibiotics, which is the immediate priority in suspected meningitis. *Monitor neurological status* - Monitoring neurological status is an ongoing and essential part of managing any neurosurgical patient, including those with suspected meningitis. - However, mere monitoring is not an *initial step* in intervention; rather, it informs the urgency and effectiveness of active treatments like antibiotic administration.

Question 1056: A patient with chronic hepatitis B is being evaluated for antiviral therapy. Recent lab results show high HBV DNA levels and normal ALT levels. What is the most appropriate next step in management?

A. Monitor liver function tests closely before deciding
B. Consider starting antiviral therapy immediately (Correct Answer)
C. Switch to a different antiviral agent if necessary
D. Perform a liver biopsy to assess fibrosis

Explanation: Consider starting antiviral therapy immediately - **High HBV DNA levels** in a patient with chronic hepatitis B, even with normal ALT, indicate an **active viral replication** phase [1]. - This scenario often represents **HBeAg-positive (immune tolerant) phase** or early **HBeAg-negative (immune active) disease**, where treatment is often warranted to prevent progression to cirrhosis and hepatocellular carcinoma [1]. *Monitor liver function tests closely before deciding* - While monitoring ALT is important, **high HBV DNA levels** indicate ongoing viral activity and potential for liver damage, even if current ALT is normal [1]. - Delaying therapy based solely on normal ALT could miss an opportunity to prevent **long-term complications**. *Switch to a different antiviral agent if necessary* - This option is relevant for patients already on therapy who are experiencing **treatment failure** or resistance, which is not indicated here as the patient is being evaluated for *initiation* of therapy. - There is no mention of prior antiviral treatment, so switching agents is not applicable. *Perform a liver biopsy to assess fibrosis* - A liver biopsy can provide information about the degree of inflammation and fibrosis, but it is an **invasive procedure** and often reserved for cases where the decision to treat is not clear-cut based on non-invasive markers. - In cases of high viral load, treatment is often initiated regardless of biopsy findings, and **non-invasive tests** (e.g., FibroScan) are increasingly preferred for fibrosis assessment.

Question 1057: A 25-year-old man presents with non-anesthetic hypopigmented macules on his arm and has a family history of leprosy. What is the most appropriate diagnostic test?

A. KOH mount
B. PCR for Mycobacterium leprae
C. Skin biopsy (Correct Answer)
D. Slit skin smear

Explanation: ***Skin biopsy*** - A **skin biopsy** of the affected lesion, particularly the edge, is the most appropriate diagnostic test to confirm leprosy by identifying **acid-fast bacilli (AFB)** or characteristic histological changes like granulomas and nerve involvement. - It allows for the differentiation of leprosy from other hypopigmenting conditions and classification into specific types based on the **Ridley-Jopling classification**. *KOH mount* - A **KOH mount** is primarily used to diagnose **fungal infections** by dissolving keratinocytes and allowing visualization of fungal elements. - It would not be useful for identifying the acid-fast bacilli of *Mycobacterium leprae* or for assessing nerve involvement. *PCR for Mycobacterium leprae* - While **PCR is highly sensitive** for detecting *M. leprae* DNA, it is not the **first-line diagnostic test** and is usually reserved for cases where conventional methods are inconclusive or for research purposes. - It may not always correlate with disease activity or viability of the bacilli, and false positives can occur. *Slit skin smear* - A **slit skin smear** is used to determine the **bacterial index (BI)** and **morphological index (MI)** in leprosy, particularly in patients with multiple lesions or suspected lepromatous leprosy [1]. - However, in cases of **paucibacillary leprosy** (tuberculoid type), the smear may be negative, making a biopsy more reliable for diagnosis and classification, especially with **non-anesthetic hypopigmented macules** [1].

Question 1058: A patient with AIDS presents with fever and weight loss. A biopsy of a lymph node shows intracellular amastigotes. Which organism is likely responsible?

A. Trypanosoma cruzi (causes Chagas disease)
B. Plasmodium falciparum (causes malaria)
C. Toxoplasma gondii (opportunistic infection)
D. Leishmania donovani (causes visceral leishmaniasis) (Correct Answer)

Explanation: ***Leishmania donovani (causes visceral leishmaniasis)*** - The presence of **intracellular amastigotes** in a lymph node biopsy, combined with fever and weight loss in an **AIDS patient**, is highly suggestive of **visceral leishmaniasis** caused by *Leishmania donovani* [1]. - **Immunocompromized individuals**, particularly those with AIDS, are highly susceptible to severe and disseminated forms of leishmaniasis, leading to **visceral involvement** [1]. *Trypanosoma cruzi (causes Chagas disease)* - While *Trypanosoma cruzi* is an intracellular parasite and can be found in tissue, its amastigotes are typically found within **cardiac and smooth muscle cells**, not primarily in lymph nodes. - **Chagas disease** primarily affects the heart and gastrointestinal tract, and while amastigotes are seen, the overall clinical context and preferred tissue for biopsy differ. *Plasmodium falciparum (causes malaria)* - *Plasmodium falciparum* are **intracellular parasites** that infect **red blood cells**, not lymph nodes. - The classic presentation of malaria involves **cyclic fevers**, chills, and anemia, and the diagnosis is made by identifying parasites in **blood smears**. *Toxoplasma gondii (opportunistic infection)* - *Toxoplasma gondii* can cause disseminated disease in **AIDS patients**, particularly **encephalitis**, and forms **cysts** (bradyzoites) in various tissues including the brain, muscle, and lymph nodes. - However, the characteristic finding in *Toxoplasma* infection is usually **cysts** or **tachyzoites** in tissue, not the distinct amastigote form seen in Leishmania, and lymph node involvement is often as a toxoplasmic lymphadenitis rather than disseminated amastigotes.

Question 1059: A patient presents with diarrhea following a course of broad-spectrum antibiotics. Stool tests positive for toxin B DNA. What is the best management approach?

A. Continue current antibiotics
B. Switch to a different antibiotic
C. Initiate oral vancomycin treatment (Correct Answer)
D. Recommend probiotics only

Explanation: ***Initiate oral vancomycin treatment*** - The patient's symptoms (diarrhea post-antibiotics) and positive **toxin B DNA** indicate **Clostridioides difficile infection (CDI)** [1]. - **Oral vancomycin** is a first-line treatment for CDI due to its bioavailability in the GI tract, effectively targeting the bacteria [2]. *Continue current antibiotics* - Continuing the **broad-spectrum antibiotics** would likely exacerbate the CDI by further disrupting the normal gut flora [3]. - The current antibiotics are the probable cause of the initial **gut dysbiosis** allowing *C. difficile* to proliferate [1]. *Switch to a different antibiotic* - Switching to another broad-spectrum antibiotic is unlikely to treat CDI effectively and may even worsen the condition. - CDI requires specific treatment with agents like **vancomycin** or **fidaxomicin** that target *C. difficile* [2]. *Recommend probiotics only* - While probiotics can sometimes help restore normal gut flora, they are **insufficient as a sole treatment** for established CDI. - Probiotics do not directly eradicate *C. difficile* and are not a substitute for targeted antibiotic therapy in symptomatic infection.

Question 1060: A 45-year-old woman presents with jaundice and elevated liver enzymes. A serological test is positive for HBsAg and anti-HBc IgM. What is the stage of her hepatitis B infection?

A. Acute (Correct Answer)
B. Chronic
C. Resolved
D. Carrier

Explanation: ***Acute*** - The presence of **HBsAg** (hepatitis B surface antigen) indicates active infection, while **anti-HBc IgM** (antibody to hepatitis B core antigen, IgM class) specifically points to a recent, **acute infection** [1]. - Elevated liver enzymes and jaundice further support a recent, **active inflammatory process** in the liver. *Chronic* - Chronic hepatitis B is characterized by the presence of **HBsAg for more than 6 months**, often with **anti-HBc IgG** rather than IgM [1]. - The presence of **anti-HBc IgM** rules out a purely chronic infection, as it signifies recent exposure. *Resolved* - A resolved infection typically shows **negative HBsAg** and **positive anti-HBs** (antibody to hepatitis B surface antigen), indicating immunity [1]. - The presence of **HBsAg** means the infection is still active, not resolved. *Carrier* - The term "carrier" refers to a person with chronic hepatitis B infection (HBsAg positive for >6 months), often with relatively stable liver enzymes and minimal liver damage, but can also refer to chronic active hepatitis. - The presence of **anti-HBc IgM** indicates an **acute phase**, not a stable carrier state without acute viral replication.

Practice by Chapter

Principles of Antimicrobial Therapy

Practice Questions

Fever of Unknown Origin

Practice Questions

HIV/AIDS and Related Infections

Practice Questions

Tuberculosis and Mycobacterial Diseases

Practice Questions

Tropical and Parasitic Infections

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Viral Infections (Hepatitis, Herpes, etc.)

Practice Questions

Healthcare-Associated Infections

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Fungal Infections

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Sepsis and Septic Shock

Practice Questions

Infection in Immunocompromised Hosts

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Emerging and Re-emerging Infections

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Antimicrobial Resistance

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Vaccination Principles

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