Infectious Diseases Practice Questions

Q: A 12-year-old boy develops a sore throat of 4-day duration. On examination, a yellow-grayish patch is seen over both tonsils, and a foul smell is coming from his mouth. Which non-suppurative complication is most commonly associated with streptococcal throat infections?

Acute rheumatic fever. ***Acute rheumatic fever*** - **Acute rheumatic fever (ARF)** is a serious **non-suppurative complication** of streptococcal pharyngitis, primarily caused by **Group A Streptococcus (GAS)** [1]. - It involves **inflammatory lesions** of the heart, joints, brain, and subcutaneous tissues [2]. *Acute glomerulonephritis* - This is also a **non-suppurative complication** of streptococcal infection but is typically less common than acute rheumatic fever following pharyngitis. - **Acute post-streptococcal glomerulonephritis** is more frequently associated with **streptococcal skin infections (impetigo)** than pharyngeal infections. *Scarlet fever* - **Scarlet fever** is a **toxin-mediated disease** that is a direct manifestation of a streptococcal infection, not a non-suppurative complication. - It presents with a characteristic **rash**, **strawberry tongue**, and fever, making it a different category of streptococcal sequela. *Both acute rheumatic fever and acute glomerulonephritis* - While both can be non-suppurative complications, **acute rheumatic fever** is the **most commonly associated** non-suppurative complication specifically with **streptococcal throat infections** [1]. - **Acute glomerulonephritis** has a stronger association with **skin infections** and is less common after pharyngitis compared to acute rheumatic fever.

Q: Manifestation of erythema nodosum leprosum (ENL) include all of the following except:

Pancreatitis. ***Pancreatitis*** - **Erythema nodosum leprosum (ENL)** is a type II **hypersensitivity reaction** in leprosy, which primarily affects the skin, nerves, and internal organs [1], [3]. - While ENL can affect various organs, **pancreatitis** is generally not considered a typical or common manifestation. *Fever* - **Fever** is a very common systemic symptom accompanying ENL, indicating a widespread inflammatory response. - It often acts as a key indicator of the acute phase of an ENL reaction. *Arthritis* - **Arthritis** and **arthralgia** (joint pain) are frequent musculoskeletal manifestations in patients with ENL. - It can affect both large and small joints, leading to pain and swelling [2]. *Lymphadenopathy* - **Lymphadenopathy** (enlarged lymph nodes) is a recognized systemic feature in patients experiencing ENL. - This indicates the involvement of the lymphatic system in the inflammatory process.

Q: Which of the following agents is least likely to cause meningitis in the elderly?

Herpes Simplex Virus - 2 (HSV-2).. Herpes Simplex Virus - 2 (HSV-2) - While HSV-2 can cause meningitis, it is **less common** in the elderly compared to bacterial pathogens, and primarily causes **aseptic meningitis**, often recurrently [1]. - Though immunocompromised elderly can be susceptible, HSV-2 meningitis is generally more prevalent in younger, sexually active individuals. *Listeria Monocytogenes* - This is a significant cause of **bacterial meningitis** in the elderly, particularly those over 60, due to their weakened immune systems. - It's known to affect individuals with **compromised cell-mediated immunity**, which is common in older adults. *Streptococcus pneumoniae* - **Pneumococcal meningitis** is one of the most common and severe forms of bacterial meningitis in all age groups, including the elderly [1]. - Elderly individuals have a higher risk of severe disease and complications from **S. pneumoniae** infections [1]. *Gram Negative bacteria* - **Gram-negative bacilli**, such as *Escherichia coli* and *Klebsiella pneumoniae*, are important causes of meningitis in older adults, especially those with comorbidities or who have undergone neurosurgery. - This risk increases with age due to factors like indwelling catheters, nursing home residence, and weakened immune responses [1].

Q: Which of the following is the most accurate description of thrush?

Is characterized by white patches in the oral cavity. ***Is characterized by white patches in the oral cavity*** - Thrush, or **oral candidiasis**, classically presents as creamy **white patches** on the tongue, inner cheeks, roof of the mouth, and back of the throat. - These patches can often be **scraped off**, revealing reddened and sometimes bleeding tissue underneath. *Occurs in individuals of all ages* - While thrush can occur at any age, it is most common in **infants**, **elderly individuals**, and those with **compromised immune systems**. - It is less common in healthy adults, making this description not the *most* accurate and comprehensive. *Is caused by a fungal infection* - Thrush is indeed caused by the fungus ***Candida albicans***, a type of yeast. - However, simply stating the cause does not fully describe the condition's distinct clinical presentation, which is essential for diagnosis. *Responds to antifungal treatment* - Thrush is typically treated with **antifungal medications** such as nystatin, clotrimazole, or fluconazole. - While true, describing the treatment is not the most direct or accurate description of the condition itself, which focuses on its characteristic features.

Q: Tropical splenomegaly is characterized by all the following, except which one?

Persistent high grade fever. ***Persistent high grade fever*** - **Tropical splenomegaly syndrome (TSS)**, also known as **hyperreactive malarial splenomegaly (HMS)**, typically does not present with **persistent high-grade fever**. - Fever, if present, is usually **low-grade** or intermittent, and the primary symptom is a massively enlarged spleen. *Moderate to massive splenomegaly* - This is a **defining characteristic** of tropical splenomegaly, as the condition is named for this prominent feature. - The spleen can become significantly enlarged, sometimes extending into the pelvis [1]. *Residence in areas endemic for Malaria* - **TSS/HMS** is a condition found in individuals living in or migrating from **malaria-endemic regions**, particularly those with stable, high-level transmission [2]. - It represents an abnormal immune response to chronic or repeated malarial exposure. *Clinical response to antimalarials* - Patients with tropical splenomegaly typically show **clinical improvement** and a reduction in spleen size after a prolonged course of **antimalarial treatment**. - This response helps differentiate it from other causes of splenomegaly.

Q: What is the most common complication associated with immunosuppression in patients?

Infection. ***Infection*** - Immunosuppressive agents **weaken the immune system's host defense**, making patients highly susceptible to various **opportunistic and common infections** [1]. - This increased vulnerability applies to bacterial, viral, fungal, and parasitic pathogens, making **infection the leading cause of morbidity and mortality** in immunosuppressed individuals [1], [3]. *Malignancy* - While immunosuppression does increase the risk of developing certain **malignancies**, such as post-transplant lymphoproliferative disorder (PTLD) or skin cancers, this complication is **less common than infection** [1]. - The latency period for developing malignancy is typically longer than for infections. *Graft rejection* - Graft rejection is a primary concern in organ transplantation and is precisely what immunosuppressive therapies aim to prevent, but it's **not the most common complication of immunosuppression itself** [2]. - The goal of immunosuppression is to avoid rejection, and if successful, rejection does not occur, whereas the risk of infection remains high due to the suppressed immune state. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) can be an adverse effect of certain immunosuppressive drugs, but it is **not the most common or universal complication** associated with overall immunosuppression. - Its occurrence is drug-specific and often manageable, unlike the pervasive risk of infection.

Q: In which of the following conditions are Anti-TNF agents contraindicated?

RA with Hepatitis B. ***RA with Hepatitis B*** - **Anti-TNF agents** can cause reactivation of **latent Hepatitis B virus (HBV)** infection, leading to severe hepatitis and liver failure [1]. Therefore, screening for HBV is crucial before initiating these medications [1]. - Patients with active or chronic HBV infection often require **antiviral therapy** before or concurrently with anti-TNF treatment to prevent reactivation. *RA with HIV* - While caution is advised, **anti-TNF agents** can be used in patients with **well-controlled HIV infection** on antiretroviral therapy, often with close monitoring for infections. - The risk of opportunistic infections is carefully balanced against the benefits of controlling rheumatoid arthritis and preventing joint damage [1]. *RA with HCV* - **Anti-TNF agents** are generally considered safe for patients with **Hepatitis C virus (HCV)** infection, especially if the HCV is stable or being treated. - There is no strong evidence to suggest that anti-TNF therapy commonly causes HCV reactivation or worsening of liver disease. *RA with pulmonary fibrosis* - The use of **anti-TNF agents** in patients with established **pulmonary fibrosis** is generally not contraindicated, though careful monitoring for worsening respiratory symptoms is important. - Some anti-TNF agents have been associated with **interstitial lung disease**, but this is typically a new onset condition rather than exacerbation of pre-existing fibrosis.

Q: Most common symptom of tetanus is

Lock-jaw. ***Lock-jaw*** - **Trismus**, or "lock-jaw," is the **hallmark initial symptom** of tetanus, resulting from spasms of the masseter muscles [1]. - It often progresses to generalized muscle rigidity and spasms, making it difficult to open the mouth or swallow [1]. *Tonic-clonic seizures* - While tetanus can cause severe muscle spasms, **generalized tonic-clonic seizures** are not the most common initial or presenting symptom [2]. - Tetanic spasms are characterized by sustained muscle contractions, which are distinct from the rhythmic jerking seen in tonic-clonic seizures. *Hemiplegia* - **Hemiplegia**, or unilateral paralysis, is typically associated with **stroke** or focal brain injury [2]. - Tetanus causes **generalized muscular rigidity** and spasms, not focal paralysis. *Opisthotonus* - **Opisthotonus** is a severe symptom of tetanus characterized by **extreme hyperextension of the head and spine**, forming an arch. - While a classic sign of severe tetanus, it is usually a **later manifestation** after lock-jaw has developed.

Question 1

A 12-year-old boy develops a sore throat of 4-day duration. On examination, a yellow-grayish patch is seen over both tonsils, and a foul smell is coming from his mouth. Which non-suppurative complication is most commonly associated with streptococcal throat infections?

Accepted Answer

Acute rheumatic fever

Answer

Acute glomerulonephritis

Answer

Scarlet fever

Answer

Both acute rheumatic fever and acute glomerulonephritis

Question 2

Manifestation of erythema nodosum leprosum (ENL) include all of the following except:

Accepted Answer

Pancreatitis

Answer

Fever

Answer

Arthritis

Answer

Lymphadenopathy

Question 3

Which of the following agents is least likely to cause meningitis in the elderly?

Accepted Answer

Herpes Simplex Virus - 2 (HSV-2).

Answer

Listeria Monocytogenes

Answer

Gram Negative bacteria

Answer

Streptococcus pneumoniae

Question 4

Which of the following is the most accurate description of thrush?

Accepted Answer

Is characterized by white patches in the oral cavity

Answer

Occurs in individuals of all ages

Answer

Is caused by a fungal infection

Answer

Responds to antifungal treatment

Question 5

Tropical splenomegaly is characterized by all the following, except which one?

Accepted Answer

Persistent high grade fever

Answer

Moderate to massive splenomegaly

Answer

Residence in areas endemic for Malaria

Answer

Clinical response to antimalarials

Question 6

Which of the following statements is true regarding dengue hemorrhagic fever?

Accepted Answer

Dengue hemorrhagic fever is associated with bleeding tendencies due to thrombocytopenia.

Answer

Thrombosis is a common complication of dengue hemorrhagic fever

Answer

Dengue hemorrhagic fever presents with fever.

Answer

Thrombocytopenia is a characteristic finding in dengue hemorrhagic fever

Question 7

What is the most common complication associated with immunosuppression in patients?

Accepted Answer

Infection

Answer

Malignancy

Answer

Graft rejection

Answer

Thrombocytopenia

Question 8

In which of the following conditions are Anti-TNF agents contraindicated?

Accepted Answer

RA with Hepatitis B

Answer

RA with HCV

Answer

RA with pulmonary fibrosis

Answer

RA with HIV

Question 9

Most common symptom of tetanus is

Accepted Answer

Lock-jaw

Answer

Tonic-clonic seizures

Answer

Opisthotonus

Answer

Hemiplegia

Question 10

Winterbottom's sign in sleeping sickness refers to.

Accepted Answer

Posterior cervical lymphadenopathy (indicative of chronic African trypanosomiasis)

Answer

Unilateral conjunctivitis

Answer

Fever and malaise

Answer

Chancre at the site of the tsetse fly bite

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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