Infectious Diseases — MCQs

Infectious Diseases Indian Medical PG Practice Questions and MCQs

Question 1311: Tropical splenomegaly is characterized by all the following, except which one?

A. Moderate to massive splenomegaly
B. Persistent high grade fever (Correct Answer)
C. Residence in areas endemic for Malaria
D. Clinical response to antimalarials

Explanation: ***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.

Question 1312: Which of the following statements is true regarding dengue hemorrhagic fever?

A. Thrombosis is a common complication of dengue hemorrhagic fever
B. Dengue hemorrhagic fever presents with fever.
C. Thrombocytopenia is a characteristic finding in dengue hemorrhagic fever
D. Dengue hemorrhagic fever is associated with bleeding tendencies due to thrombocytopenia. (Correct Answer)

Explanation: ***Dengue hemorrhagic fever is associated with bleeding tendencies due to thrombocytopenia.*** - This statement is true because the characteristic feature of **dengue hemorrhagic fever (DHF)** is severe plasma leakage leading to shock or fluid accumulation, along with significant **thrombocytopenia** (platelet count < 100,000/mm³) [1]. - The severe reduction in **platelets** directly contributes to the bleeding tendencies observed in DHF patients, ranging from petechiae and purpura to severe gastrointestinal hemorrhages [1]. *Thrombocytopenia is a characteristic finding in dengue hemorrhagic fever* - While **thrombocytopenia** is indeed a characteristic finding in DHF, this statement alone is not as complete as the correct answer. The critical aspect of DHF is not just thrombocytopenia but its direct contribution to the **bleeding diathesis**. - **Thrombocytopenia** can occur in various viral infections; in DHF, its severity and association with vascular permeability and bleeding define the syndrome [1]. *Thrombosis is a common complication of dengue hemorrhagic fever* - **Thrombosis** is not a common complication of DHF; instead, **hemorrhage** and **increased vascular permeability** are the hallmark features [1]. - While some complex interactions with coagulation pathways can occur, the primary and dangerous complication is **bleeding**, not blood clot formation. *Dengue hemorrhagic fever presents with fever.* - While **fever** is indeed a presenting symptom of DHF, it is a very general symptom of dengue infection in its initial stages and is not specific enough to define dengue hemorrhagic fever [1]. - All forms of **dengue infection**, including dengue fever and DHF, begin with a febrile phase. The differentiating features of DHF are related to severe plasma leakage, hemorrhage, and organ impairment.

Question 1313: Which of the following is the most accurate description of thrush?

A. Is characterized by white patches in the oral cavity (Correct Answer)
B. Occurs in individuals of all ages
C. Is caused by a fungal infection
D. Responds to antifungal treatment

Explanation: ***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.

Question 1314: Which of the following agents is least likely to cause meningitis in the elderly?

A. Listeria Monocytogenes
B. Gram Negative bacteria
C. Herpes Simplex Virus - 2 (HSV-2). (Correct Answer)
D. Streptococcus pneumoniae

Explanation: 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].

Question 1315: 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?

A. Acute glomerulonephritis
B. Acute rheumatic fever (Correct Answer)
C. Scarlet fever
D. Both acute rheumatic fever and acute glomerulonephritis

Explanation: ***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.

Question 1316: What is the most common complication associated with immunosuppression in patients?

A. Malignancy
B. Graft rejection
C. Infection (Correct Answer)
D. Thrombocytopenia

Explanation: ***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.

Question 1317: Manifestation of erythema nodosum leprosum (ENL) include all of the following except:

A. Pancreatitis (Correct Answer)
B. Fever
C. Arthritis
D. Lymphadenopathy

Explanation: ***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.

Question 1318: Winterbottom's sign in sleeping sickness refers to.

A. Unilateral conjunctivitis
B. Fever and malaise
C. Posterior cervical lymphadenopathy (indicative of chronic African trypanosomiasis) (Correct Answer)
D. Chancre at the site of the tsetse fly bite

Explanation: ***Posterior cervical lymphadenopathy (indicative of chronic African trypanosomiasis)*** - **Winterbottom's sign** is the characteristic **swelling of the lymph nodes** in the **posterior cervical triangle**, a classic indicator of chronic African trypanosomiasis. [1] - This symptom reflects the body's immune response to the **Trypanosoma brucei parasites** disseminating beyond the initial infection site. [1] *Unilateral conjunctivitis* - While conjunctivitis can occur in some infectious diseases, it is **not a defining feature** of Winterbottom's sign or specific to advanced sleeping sickness. - Conjunctivitis would not typically be linked to such a specific pattern of lymphadenopathy. *Fever and malaise* - **Fever and malaise** are **non-specific symptoms** common to the early stages of many infections, including the initial stages of sleeping sickness. - They do not represent Winterbottom's sign, which is an objective physical finding. *Chancre at the site of the tsetse fly bite* - A **trypanosomal chancre** is an inflammatory nodule that forms at the site of the **tsetse fly bite** in the early, hemolymphatic stage of sleeping sickness. [1] - This is an initial local lesion, distinct from the systemic lymphadenopathy seen in Winterbottom's sign which occurs later in the disease progression.

Question 1319: Most common symptom of tetanus is

A. Tonic-clonic seizures
B. Lock-jaw (Correct Answer)
C. Opisthotonus
D. Hemiplegia

Explanation: ***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 1320: In which of the following conditions are Anti-TNF agents contraindicated?

A. RA with Hepatitis B (Correct Answer)
B. RA with HCV
C. RA with pulmonary fibrosis
D. RA with HIV

Explanation: ***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.

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

Practice Questions

Viral Infections (Hepatitis, Herpes, etc.)

Practice Questions

Healthcare-Associated Infections

Practice Questions

Fungal Infections

Practice Questions

Sepsis and Septic Shock

Practice Questions

Infection in Immunocompromised Hosts

Practice Questions

Emerging and Re-emerging Infections

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Antimicrobial Resistance

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Vaccination Principles

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