The following are parvovirus - related disease - population pairs. Identify the incorrect pair.
1. Aplastic anemia - Patient with hereditary hemolytic anemia
2. Non - immune hydrops - pregnant women
3. Erythema infectiosum - infants
4. Non - erosive arthritis - Patients of SLE
Q782
An ICU patient is suffering from Rhinovirus infection. How do we treat the patient?
Q783
A forest officer develops the lesion as shown in the image. Which of the following is not a differential to consider?
Q784
A 45-year-old man presents with well-circumscribed, hypopigmented patches on his face and arms. The lesions are asymmetric and show decreased sensation to light touch. Microscopic examination of a skin biopsy stained with Fite stain shows acid-fast bacilli within macrophages in dermal nerve bundles. Which of the following is the most appropriate treatment?
Q785
In HIV-positive patients with gonorrhea, which of the following statements is TRUE regarding management?
Q786
A 42-year-old man with a history of gout and hypertension presents to his family physician with a complaint of increased left knee pain over the past 2 days. He also reports swelling and redness of the left knee and is unable to bear weight on that side. He denies any prior surgery or inciting trauma to the knee. His temperature is 97.0°F (36.1°C), blood pressure is 137/98 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical examination reveals a left knee that is erythematous, swollen, warm-to-touch, and extremely tender to palpation and with attempted flexion/extension movement. His left knee range of motion is markedly reduced compared to the contralateral side. Joint aspiration of the left knee is performed with synovial fluid analysis showing turbid fluid with a leukocyte count of 95,000/mm^3, 88% neutrophils, and a low glucose. Gram stain of the synovial fluid is negative. Results from synovial fluid culture are pending. Which of the following is the best treatment regimen for this patient?
Q787
A 27-year-old woman who resides in an area endemic for chloroquine-resistant P. falciparum malaria presents to the physician with fatigue, malaise, and episodes of fever with chills over the last 5 days. She mentions that she has episodes of shivering and chills on alternate days that last for approximately 2 hours, followed by high-grade fevers; then she has profuse sweating and her body temperature returns to normal. She also mentions that she is currently in her 7th week of pregnancy. The physical examination reveals the presence of mild splenomegaly. A peripheral blood smear confirms the diagnosis of P. falciparum infection. Which of the following is the most appropriate anti-malarial treatment for the woman?
Q788
A 28-year-old man presents to the physician because of dizziness and palpitations for the past 12 hours and fever, malaise, headache, and myalgias for the past week. The patient traveled into the woods of Massachusetts 4 weeks ago. He has no known chronic medical conditions, and there is no history of substance use. His temperature is 38.3°C (100.9°F), pulse is 52/min, respirations are 16/min, and blood pressure is 126/84 mm Hg. His physical examination shows a single, 10-cm, round, erythematous lesion with a bull’s-eye pattern in the right popliteal fossa. His electrocardiogram shows Mobitz I second-degree atrioventricular (AV) block. The complete blood cell count and serum electrolyte levels are normal, but the erythrocyte sedimentation rate is 35 mm/hour. What is the most likely cause of the patient’s cardiac symptoms?
Q789
A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?
Q790
Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
Infectious Diseases Indian Medical PG Practice Questions and MCQs
Question 781: The following are parvovirus - related disease - population pairs. Identify the incorrect pair.
1. Aplastic anemia - Patient with hereditary hemolytic anemia
2. Non - immune hydrops - pregnant women
3. Erythema infectiosum - infants
4. Non - erosive arthritis - Patients of SLE
A. 1
B. 2
C. 3
D. 4 (Correct Answer)
Explanation: ***Non - erosive arthritis - Patients of SLE***
- While parvovirus B19 can cause **non-erosive arthritis**, it is not specifically associated with patients with **systemic lupus erythematosus (SLE)** as a common or unique presentation. Parvovirus B19-induced arthritis typically resolves spontaneously. [1]
- The given pairing implies a direct and specific link between parvovirus B19 arthritis and SLE patients, which is inaccurate.
*Aplastic anemia - Patient with hereditary hemolytic anemia*
- This is a **correct pairing**. Parvovirus B19 preferentially infects and destroys erythroid progenitor cells, leading to a temporary cessation of red blood cell production. [1]
- In patients with **hereditary hemolytic anemias** (e.g., sickle cell anemia, thalassemia), who have a rapid red blood cell turnover and depend on continuous erythropoiesis, this cessation can lead to a severe and life-threatening **aplastic crisis**. [1]
*Non - immune hydrops - pregnant women*
- This is a **correct pairing**. Parvovirus B19 infection in a pregnant woman can cross the placenta and infect the fetus.
- Fetal infection can cause severe anemia and heart failure, leading to **non-immune hydrops fetalis**, a condition characterized by abnormal fluid accumulation in two or more fetal compartments.
*Erythema infectiosum - infants*
- This is a **correct pairing**. **Erythema infectiosum**, also known as "fifth disease," is the most common clinical manifestation of parvovirus B19 infection. [1]
- It primarily affects **children** (including infants) and is characterized by a "slapped cheek" rash on the face followed by a lacy rash on the trunk and extremities. [1]
Question 782: An ICU patient is suffering from Rhinovirus infection. How do we treat the patient?
A. Piperacillin + Tazobactam + Azithromycin
B. Clarithromycin
C. Cephalosporin + Ganciclovir
D. Supportive care only (Correct Answer)
Explanation: ***Supportive care only***
- **Rhinovirus** is a common cause of the **common cold**, and there is no specific antiviral treatment available for it. [1]
- Management focuses on alleviating symptoms such as fever, congestion, and cough to ensure patient comfort and prevent secondary complications, especially in an ICU setting.
*Piperacillin + Tazobactam + Azithromycin*
- This combination is a broad-spectrum antibiotic regimen (piperacillin/tazobactam is an extended-spectrum penicillin, and azithromycin is a macrolide) targeting bacterial infections. [2]
- **Rhinovirus is a virus**, and antibiotics are ineffective against viral infections, making this an inappropriate treatment.
*Clarithromycin*
- **Clarithromycin** is a macrolide antibiotic primarily used to treat bacterial infections, such as respiratory tract infections caused by **atypical bacteria** or community-acquired pneumonia. [2]
- It has no activity against **Rhinovirus**, a common cold virus.
*Cephalosporin + Ganciclovir*
- **Cephalosporins** are a class of beta-lactam antibiotics used for various bacterial infections. [2]
- **Ganciclovir** is an antiviral agent specifically used to treat **cytomegalovirus (CMV)** infections, not Rhinovirus.
Question 783: A forest officer develops the lesion as shown in the image. Which of the following is not a differential to consider?
A. Cutaneous anthrax
B. KFD (Correct Answer)
C. Scrub typhus
D. Healing brown recluse spider bite
Explanation: ***KFD***
- **Kyasanur Forest Disease** (KFD) is a viral hemorrhagic fever, but it does **not** typically present with a **skin lesion** or eschar like the one shown.
- KFD is characterized by fever, headache, myalgia, and gastrointestinal symptoms, with hemorrhagic manifestations in severe cases, but not a primary cutaneous lesion.
*Cutaneous anthrax*
- **Cutaneous anthrax** commonly presents as an **eschar**, often with surrounding edema and vesicles, which can resemble the lesion in the image.
- Exposure through handling infected animal products or contact with contaminated soil is common, aligning with a forest officer's occupation.
*Scrub typhus*
- **Scrub typhus** characteristically causes an **eschar** (tache noire) at the bite site of the chigger mite.
- The lesion in the image, an ulcer with a central black crust, is highly suggestive of such an eschar seen in rickettsial infections.
*Healing brown recluse spider bite*
- A **brown recluse spider bite** can cause a **necrotic ulcer** with a central dark eschar as the wound heals, fitting the appearance of the lesion.
- The profession of a forest officer increases the likelihood of exposure to spiders in their natural habitat.
Question 784: A 45-year-old man presents with well-circumscribed, hypopigmented patches on his face and arms. The lesions are asymmetric and show decreased sensation to light touch. Microscopic examination of a skin biopsy stained with Fite stain shows acid-fast bacilli within macrophages in dermal nerve bundles. Which of the following is the most appropriate treatment?
A. Multidrug therapy with dapsone, rifampin, and clofazimine (Correct Answer)
B. Topical steroids
C. Oral terbinafine
D. Oral acyclovir
E. Phototherapy
Explanation: ***Multidrug therapy with dapsone, rifampin, and clofazimine***
- The clinical presentation of **hypopigmented patches with decreased sensation**, along with the presence of **acid-fast bacilli (AFB) in dermal nerve bundles** on Fite stain, is characteristic of **leprosy** (Hansen's disease) [1].
- This specific regimen of **dapsone, rifampin, and clofazimine** is the standard and most effective **multidrug therapy (MDT)** for treating **multibacillary leprosy**, ensuring eradication of the pathogen and preventing drug resistance [1].
*Topical steroids*
- **Topical steroids** are primarily used for inflammatory skin conditions like eczema or psoriasis and would not be effective against **bacterial infections** like leprosy [1].
- While steroids might be used as an adjunct to manage **leprosy reactions**, they do not treat the underlying bacterial infection [1].
*Oral terbinafine*
- **Oral terbinafine** is an **antifungal medication** used to treat fungal infections, such as onychomycosis or ringworm.
- It has no activity against the **acid-fast bacillus** responsible for leprosy.
*Oral acyclovir*
- **Oral acyclovir** is an **antiviral medication** used to treat viral infections, particularly those caused by herpesviruses.
- It is completely ineffective against **bacterial infections** like leprosy.
*Phototherapy*
- **Phototherapy**, using ultraviolet light, is a treatment modality for certain skin conditions like psoriasis, vitiligo, or severe eczema.
- It is not an effective treatment for **bacterial infections** and would not address the underlying pathology of leprosy.
Question 785: In HIV-positive patients with gonorrhea, which of the following statements is TRUE regarding management?
A. Standard treatment protocols are followed (Correct Answer)
B. Prophylactic antifungals should be added
C. Treatment duration should be extended
D. Higher doses of antibiotics are required
Explanation: ***Standard treatment protocols are followed***
- Current guidelines from organizations like the **CDC** recommend the same treatment regimens for gonorrhea in both HIV-positive and HIV-negative individuals.
- **Ceftriaxone** plus **azithromycin** is the standard empiric therapy, and its efficacy is maintained in HIV-positive patients.
*Prophylactic antifungals should be added*
- There is **no evidence** to support routine prophylactic antifungal administration during gonorrhea treatment in HIV-positive patients.
- Antifungals are prescribed only when there is a concurrent **fungal infection**.
*Treatment duration should be extended*
- **Standard duration** of therapy is sufficient, as HIV infection does not typically alter the bactericidal activity of recommended antibiotics against *Neisseria gonorrhoeae*.
- Extending treatment duration without clinical indication can contribute to **antibiotic resistance**.
*Higher doses of antibiotics are required*
- **Standard antibiotic dosages** for gonorrhea are effective in HIV-positive individuals because pharmacokinetic studies generally show similar drug concentrations and efficacy.
- **Increasing doses** without specific rationale can lead to higher toxicity risks and does not improve outcomes.
Question 786: A 42-year-old man with a history of gout and hypertension presents to his family physician with a complaint of increased left knee pain over the past 2 days. He also reports swelling and redness of the left knee and is unable to bear weight on that side. He denies any prior surgery or inciting trauma to the knee. His temperature is 97.0°F (36.1°C), blood pressure is 137/98 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical examination reveals a left knee that is erythematous, swollen, warm-to-touch, and extremely tender to palpation and with attempted flexion/extension movement. His left knee range of motion is markedly reduced compared to the contralateral side. Joint aspiration of the left knee is performed with synovial fluid analysis showing turbid fluid with a leukocyte count of 95,000/mm^3, 88% neutrophils, and a low glucose. Gram stain of the synovial fluid is negative. Results from synovial fluid culture are pending. Which of the following is the best treatment regimen for this patient?
A. Ceftriaxone
B. Piperacillin-tazobactam
C. Vancomycin and ceftazidime (Correct Answer)
D. Indomethacin and colchicine
E. Acetaminophen and ibuprofen
Explanation: ***Vancomycin and ceftazidime***
- The patient presents with **acute monoarticular arthritis** with signs of **septic arthritis**, including a highly inflammatory synovial fluid (95,000 WBCs/mm^3, 88% neutrophils, low glucose) and inability to bear weight [1].
- **Empiric broad-spectrum antibiotic coverage** is crucial before culture results, typically involving an agent effective against **Gram-positive bacteria** (e.g., vancomycin for MRSA) and an agent against **Gram-negative bacteria** (e.g., ceftazidime for *Pseudomonas* or other resistant gram-negatives), especially in patients with comorbidities like gout [1].
*Ceftriaxone*
- Ceftriaxone is a **third-generation cephalosporin** that provides good coverage for many Gram-negative bacteria and some Gram-positive bacteria.
- However, it **does not cover *Pseudomonas aeruginosa* or methicillin-resistant *Staphylococcus aureus* (MRSA)**, which are important pathogens to consider in septic arthritis, especially without a definitive causative organism.
*Piperacillin-tazobactam*
- Piperacillin-tazobactam is a **broad-spectrum antibiotic** with good coverage for Gram-positive, Gram-negative (including *Pseudomonas*), and anaerobic bacteria.
- While it offers good broad coverage, it also **does not reliably cover MRSA**, which is a significant concern in empirical treatment of septic arthritis given its prevalence.
*Indomethacin and colchicine*
- This regimen is specific for the treatment of **acute gout flares** by reducing inflammation.
- While the patient has a history of gout, the **highly elevated leukocyte count** with a predominance of neutrophils and low glucose in the synovial fluid strongly indicate **septic arthritis**, which is a medical emergency requiring antibiotic treatment [1].
*Acetaminophen and ibuprofen*
- These medications provide **analgesia and anti-inflammatory effects** for pain relief.
- They are **insufficient as primary treatment** for septic arthritis, which necessitates urgent antimicrobial therapy to prevent joint destruction and systemic complications.
Question 787: A 27-year-old woman who resides in an area endemic for chloroquine-resistant P. falciparum malaria presents to the physician with fatigue, malaise, and episodes of fever with chills over the last 5 days. She mentions that she has episodes of shivering and chills on alternate days that last for approximately 2 hours, followed by high-grade fevers; then she has profuse sweating and her body temperature returns to normal. She also mentions that she is currently in her 7th week of pregnancy. The physical examination reveals the presence of mild splenomegaly. A peripheral blood smear confirms the diagnosis of P. falciparum infection. Which of the following is the most appropriate anti-malarial treatment for the woman?
A. Chloroquine phosphate plus primaquine
B. Quinine sulfate plus clindamycin (Correct Answer)
C. Mefloquine only
D. Quinine sulfate plus doxycycline
E. Quinine sulfate plus sulfadoxine-pyrimethamine
Explanation: ***Quinine sulfate plus clindamycin***
- This combination is the recommended first-line treatment for **uncomplicated chloroquine-resistant *P. falciparum* malaria** in the **first trimester of pregnancy**. Both drugs are considered safe during this period.
- **Quinine** is highly effective against the **asexual erythrocytic stages** of *P. falciparum*, and **clindamycin** provides synergistic activity while being safe for fetal development.
*Chloroquine phosphate plus primaquine*
- **Chloroquine** is inappropriate here due to the patient residing in an area endemic for **chloroquine-resistant *P. falciparum***.
- **Primaquine** is **contraindicated in pregnancy** as it can cause **hemolytic anemia** in the fetus if they have G6PD deficiency and has a risk of methemoglobinemia in the pregnant woman [1].
*Mefloquine only*
- While **mefloquine** can be used in the **second and third trimesters**, its use in the **first trimester** is generally avoided due to concerns about potential teratogenicity, although evidence is conflicting [1].
- Monotherapy with mefloquine might not be sufficient for severe or highly resistant cases.
*Quinine sulfate plus doxycycline*
- **Doxycycline** is **contraindicated in pregnancy**, particularly in the second and third trimesters, due to its potential to cause **fetal tooth discoloration** and **bone abnormalities**.
- While quinine is a good choice, the doxycycline component makes this regimen unsuitable for a pregnant woman.
*Quinine sulfate plus sulfadoxine-pyrimethamine*
- **Sulfadoxine-pyrimethamine** is generally **contraindicated in the first trimester** of pregnancy due to its potential teratogenic effects, especially concerning **folate metabolism**.
- Although it is used for intermittent preventive treatment (IPTp) in the second and third trimesters, it is not recommended for acute treatment in early pregnancy.
Question 788: A 28-year-old man presents to the physician because of dizziness and palpitations for the past 12 hours and fever, malaise, headache, and myalgias for the past week. The patient traveled into the woods of Massachusetts 4 weeks ago. He has no known chronic medical conditions, and there is no history of substance use. His temperature is 38.3°C (100.9°F), pulse is 52/min, respirations are 16/min, and blood pressure is 126/84 mm Hg. His physical examination shows a single, 10-cm, round, erythematous lesion with a bull’s-eye pattern in the right popliteal fossa. His electrocardiogram shows Mobitz I second-degree atrioventricular (AV) block. The complete blood cell count and serum electrolyte levels are normal, but the erythrocyte sedimentation rate is 35 mm/hour. What is the most likely cause of the patient’s cardiac symptoms?
A. Systemic fungal infection
B. Viral infection transmitted by Aedes aegypti mosquito bite
C. Spirochete infection (Correct Answer)
D. Sexually transmitted bacterial infection
E. Mycoplasma infection
Explanation: ***Spirochete infection***
- The patient's presentation with a **"bull's-eye" rash (erythema migrans)** [1], recent travel to endemic areas (Massachusetts woods), non-specific viral-like symptoms (fever, malaise, headache, myalgias), and later development of **cardiac involvement (Mobitz I AV block)** is highly characteristic of **Lyme disease**, which is caused by the spirochete *Borrelia burgdorferi* [1].
- Lyme carditis, a manifestation of disseminated Lyme disease, can cause various conduction disturbances, including different degrees of AV block, as seen in this patient [1].
*Systemic fungal infection*
- Systemic fungal infections can cause fever and malaise, but they typically do not present with a **migratory erythematous rash** or specifically with **Mobitz I AV block** in this manner.
- The epidemiological context (travel in woods) is more consistent with tick-borne diseases.
*Viral infection transmitted by Aedes aegypti mosquito bite*
- **Aedes aegypti mosquitoes** transmit diseases like dengue, Zika, and chikungunya, which can cause fever, myalgias, and rash.
- However, the characteristic **erythema migrans ("bull's-eye" rash)** and specific **cardiac conduction abnormalities** like Mobitz I AV block are not typical features of these viral infections.
*Sexually transmitted bacterial infection*
- Sexually transmitted bacterial infections (e.g., syphilis, gonorrhea, chlamydia) do not typically present with an **erythema migrans rash** or acute onset of **Mobitz I AV block** as described.
- While syphilis (also a spirochete) can cause cardiovascular complications in its tertiary stage, the acute presentation with the bull's-eye rash points away from this diagnosis.
*Mycoplasma infection*
- *Mycoplasma pneumoniae* can cause respiratory infections, fever, and myalgias, and rarely, cardiac complications like myocarditis.
- However, a **"bull's-eye" rash (erythema migrans)** is not a feature of *Mycoplasma pneumoniae* infection, making this option less likely.
Question 789: A 35-year-old lady who presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?
A. Brachial cyst
B. Secondaries
C. Lymphoma
D. TB (Correct Answer)
Explanation: ***TB***
- **Tuberculosis (TB)** lymphadenopathy often presents as a **painless, fluctuant, non-transilluminant cervical swelling** (scrofula) with possible **thin, watery discharge** from a sinus tract [1].
- The 6-month duration indicates a **chronic process**, consistent with the indolent nature of TB infection [1].
*Brachial cyst*
- A **branchial cleft cyst** typically presents as a **smooth, movable, and sometimes fluctuant neck mass**, but it is usually **transilluminant** unless infected.
- While it can discharge, the fluid is often mucoid, and the discharge is less commonly described as thin and watery; also it typically develops during childhood or early adulthood.
*Secondaries*
- **Metastatic lymph nodes (secondaries)** are generally **firm, non-fluctuant, and non-tender**, and do not typically discharge thin watery fluid unless there is necrosis or ulceration of the overlying skin.
- The absence of associated primary malignancy symptoms also makes this less likely.
*Lymphoma*
- **Lymphoma** presents as often **painless rubbery, firm, and non-fluctuant lymph node enlargement**, and discharge is not a typical feature unless there is skin involvement or ulceration in advanced stages.
- The described fluctuance and watery discharge are not characteristic of simple lymphoma.
Question 790: Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
A. Rubella
B. Varicella
C. Mumps
D. Measles (Correct Answer)
Explanation: ***Measles***
- **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal degenerative disease of the central nervous system caused by persistent infection with a defective **measles virus**. [1]
- It typically develops **years after the initial measles infection**, affecting children and young adults, leading to cognitive decline, seizures, and motor dysfunction. [1], [2]
*Rubella*
- While rubella can cause congenital rubella syndrome, it is **not associated with SSPE**.
- Complications of rubella usually involve birth defects, such as **cardiac malformations**, **deafness**, and **cataracts**, when acquired during pregnancy.
*Varicella*
- **Varicella-zoster virus (VZV)** causes chickenpox and shingles, but it is **not a known cause of SSPE**.
- Neurological complications of VZV can include **cerebellar ataxia** or **encephalitis** acutely, or **postherpetic neuralgia** in later life.
*Mumps*
- Mumps virus can cause **parotitis**, **orchitis**, and **meningitis/encephalitis**, but it is **not implicated in the development of SSPE**.
- The encephalitis associated with mumps typically occurs during the acute infection and generally has a good prognosis.