Neglected Tropical Diseases — MCQs
Name the parasite whose microfilariae have a sheath and no nuclei at the tail end.
National Leprosy Eradication Programme was started in -
A patient from Bihar is admitted with splenomegaly and clinical features suggestive of leishmaniasis. What is the vector responsible for transmitting this disease?
True regarding Japanese encephalitis is except -
Diseases under surveillance by WHO under International Health Regulations are all, EXCEPT:
DEC (diethylcarbamazine) is used for the treatment of:
Kala azar is transmitted by:
GET strategy is for which disease?
25-year-old male having fever and malaise for 2 weeks, arthritis of the ankle joint, and tender erythematous nodules over the shin. What is the diagnosis?
A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
Neglected Tropical Diseases Indian Medical PG Practice Questions and MCQs
Question 1: Name the parasite whose microfilariae have a sheath and no nuclei at the tail end.
- A. Brugia malayi
- B. Loa loa
- C. Onchocerca volvulus
- D. Wuchereria bancrofti (Correct Answer)
Explanation: **Wuchereria bancrofti** - **Wuchereria bancrofti** microfilariae are characterized by the presence of a **sheath** and a **clear tail end** that is devoid of nuclei. - This morphology is a key feature used in the microscopic differentiation of W. bancrofti from other filarial species. *Brugia malayi* - **Brugia malayi** microfilariae also have a **sheath**, but their tail end typically contains **two distinct nuclei** that are spaced apart. - They are generally shorter and have more kinky curves than W. bancrofti. *Loa loa* - **Loa loa** microfilariae possess a **sheath** but are distinguished by their **nuclei extending to the tip** of the tail, often in a more continuous pattern. - They are also known for their diurnal periodicity, which aids in diagnosis. *Onchocerca volvulus* - **Onchocerca volvulus** microfilariae are **unsheathed** and have nuclei that do **not extend to the tail tip**, leaving a distinct clear space. - They are typically found in the skin and subcutaneous tissue, rather than the blood.
Question 2: National Leprosy Eradication Programme was started in -
- A. 1949
- B. 1955
- C. 1973
- D. 1983 (Correct Answer)
Explanation: **Correct: 1983** - The **National Leprosy Eradication Programme (NLEP)** was launched in India in **1983** - Its goal was to eliminate leprosy as a public health problem by reducing its prevalence rate to less than 1 case per 10,000 population - This marked the shift from control to eradication strategy with the introduction of **Multi-Drug Therapy (MDT)** *Incorrect: 1949* - This year is not associated with the inception of a national leprosy eradication program in India - While efforts against leprosy existed, a comprehensive national program was not established at this time *Incorrect: 1955* - The **National Leprosy Control Programme (NLCP)** was launched in India in **1955** - This was a control program, preceding the eradication program, focusing on diagnosis and treatment with Dapsone monotherapy - NLCP was later upgraded to NLEP in 1983 *Incorrect: 1973* - This year is not cited as the start date for the national leprosy eradication program in India - The focus shifted from control to eradication in 1983 with the adoption of WHO-recommended MDT
Question 3: A patient from Bihar is admitted with splenomegaly and clinical features suggestive of leishmaniasis. What is the vector responsible for transmitting this disease?
- A. Phlebotomus (Correct Answer)
- B. Rat flea
- C. Black fly
- D. Chrysops fly
Explanation: ***Phlebotomus*** - **Phlebotomus** (sandfly), specifically ***Phlebotomus argentipes*** in India, is the principal vector for transmitting **Leishmania donovani** parasites causing **visceral leishmaniasis (kala-azar)**. - Bihar is a highly endemic region for kala-azar in India. - The sandfly transmits the parasite when it takes a blood meal from an infected host and then bites an uninfected individual. *Rat flea* - The **rat flea** (**Xenopsylla cheopis**) is the primary vector for diseases like **bubonic plague** and **murine typhus**, not leishmaniasis. - It transmits bacteria such as *Yersinia pestis* and *Rickettsia typhi*. *Black fly* - **Black flies** (**Simulium species**) are vectors for **onchocerciasis** (river blindness), caused by the parasitic worm *Onchocerca volvulus*. - They transmit the microfilariae when biting humans. *Chrysops fly* - The **Chrysops fly** (deer fly or mango fly) is the vector for **Loa loa filariasis** (African eye worm). - It transmits *Loa loa* eyeworm larvae when it bites humans.
Question 4: True regarding Japanese encephalitis is except -
- A. The iceberg phenomenon is observed.
- B. Human-to-human transmission is not reported.
- C. Mortality is 80-90%. (Correct Answer)
- D. Culicine mosquitoes are zoophilic.
Explanation: ***Mortality is 80-90%.*** - The **mortality rate** for Japanese encephalitis is generally reported between **20-30%** among symptomatic cases, particularly in children. - A mortality rate of 80-90% is excessively high and **inaccurate** for Japanese encephalitis. *The iceberg phenomenon is observed.* - The **iceberg phenomenon** is characteristic of Japanese encephalitis, meaning that for every symptomatic case, there are many **asymptomatic infections** that go undetected. - Only a small proportion of infected individuals develop severe neurological disease, while the majority remain subclinical. *Human-to-human transmission is not reported.* - Japanese encephalitis is a **vector-borne disease** transmitted primarily by mosquitoes; it is **not transmitted directly** from person to person. - The virus circulates between mosquitoes, amplifying hosts (like pigs), and humans are typically dead-end hosts. *Culicine mosquitoes are zoophilic.* - **Culicine mosquitoes**, particularly *Culex tritaeniorhynchus*, are the primary vectors and are indeed **zoophilic**, meaning they prefer to feed on animals (like pigs and wading birds). - This zoophilic nature contributes to the amplification cycle of the virus in animal reservoirs before humans are incidentally bitten.
Question 5: Diseases under surveillance by WHO under International Health Regulations are all, EXCEPT:
- A. Malaria
- B. Smallpox
- C. Louse-borne typhus fever
- D. Leprosy (Correct Answer)
Explanation: ***Leprosy*** - **Leprosy** is considered a **neglected tropical disease** and is not currently listed among the diseases under *mandatory surveillance* by the WHO under the International Health Regulations (IHR). - While it remains a public health concern, particularly in endemic areas, its *global surveillance requirements* differ from those diseases deemed to have immediate international public health implications. *Malaria* - **Malaria** is a disease under *mandatory surveillance* by the WHO, as it has a high epidemic potential and can quickly spread across borders, posing a significant public health risk. - Countries are required to report outbreaks and implement control measures under the IHR. *Smallpox* - Although **smallpox** has been *eradicated*, it remains on the list of diseases that must be notified under IHR due to the potential threat of its re-emergence by accident or bioterrorism. - Any suspected case would trigger an immediate international health response. *Louse-borne typhus fever* - **Louse-borne typhus fever**, caused by *Rickettsia prowazekii*, is listed as a disease requiring notification under the IHR due to its potential for *epidemic spread*, especially in conditions of overcrowding and poor hygiene. - Its ability to cause *severe illness* and its *historical impact* on populations make it a disease of international concern.
Question 6: DEC (diethylcarbamazine) is used for the treatment of:
- A. Dracunculiasis (Dracunculus medinensis)
- B. Schistosomiasis (Schistosoma species)
- C. Taeniasis (Taenia species)
- D. Filariasis (Wuchereria bancrofti and Brugia malayi) (Correct Answer)
Explanation: ***Filariasis (Wuchereria bancrofti and Brugia malayi)*** - **Diethylcarbamazine (DEC)** is the drug of choice for treating **lymphatic filariasis** caused by *Wuchereria bancrofti* and *Brugia malayi*. - DEC works by killing the **microfilariae** and adult worms in the lymphatic system. *Dracunculiasis (Dracunculus medinensis)* - Treatment for **dracunculiasis** primarily involves mechanical removal of the worm by winding it around a stick, with supportive care like analgesics and antibiotics for secondary infections. - DEC is **ineffective** against *Dracunculus medinensis*. *Schistosomiasis (Schistosoma species)* - The standard treatment for all forms of **schistosomiasis** is **praziquantel**. - DEC has **no significant efficacy** against *Schistosoma* species. *Taeniasis (Taenia species)* - **Taeniasis**, caused by tapeworms like *Taenia saginata* and *Taenia solium*, is effectively treated with **praziquantel** or **niclosamide**. - DEC is **not indicated** for the treatment of tapeworm infections.
Question 7: Kala azar is transmitted by:
- A. Tse tse fly
- B. Sandfly (Correct Answer)
- C. Hard tick
- D. Culex mosquito
Explanation: ***Sandfly*** - **Kala azar**, also known as **visceral leishmaniasis**, is a severe parasitic disease caused by **Leishmania donovani**. - This parasite is transmitted to humans through the bite of an infected female **phlebotomine sandfly**. *Tse tse fly* - The **tse tse fly** is the vector for **African trypanosomiasis**, also known as **sleeping sickness**. - It transmits **Trypanosoma brucei**, a different parasitic organism than the one causing kala azar. *Hard tick* - **Hard ticks** are vectors for several diseases, including **Lyme disease** (Borrelia burgdorferi), **Rocky Mountain spotted fever** (Rickettsia rickettsii), and **anaplasmosis**. - They are not associated with the transmission of leishmaniasis. *Culex mosquito* - The **Culex mosquito** is a common vector for diseases such as **West Nile virus**, **Japanese encephalitis**, and **filariasis**. - It does not transmit the **Leishmania parasite** responsible for kala azar.
Question 8: GET strategy is for which disease?
- A. Onchocerciasis
- B. Vitamin A supplementation
- C. Cataracts and other eye diseases
- D. Trachoma and other neglected tropical diseases (Correct Answer)
Explanation: ***Trachoma and other neglected tropical diseases*** - **GET 2020** (Global Elimination of Trachoma by 2020) is the WHO initiative specifically targeting **trachoma elimination** - Trachoma is controlled using the **SAFE strategy**: Surgery for trichiasis, Antibiotics (azithromycin), Facial cleanliness, and Environmental improvement - GET represents the goal/initiative name, with trachoma being the primary target among neglected tropical diseases (NTDs) - The initiative aims to eliminate trachoma as a public health problem globally *Onchocerciasis* - **Onchocerciasis** (river blindness) is controlled through mass drug administration with **ivermectin** and vector control - While also an NTD, it is not the target of the GET initiative - Its elimination program is separate from GET 2020 *Cataracts and other eye diseases* - **Cataracts** are managed through surgical intervention (cataract extraction with intraocular lens implantation) - Not part of the GET initiative, which specifically targets infectious causes of blindness - Cataracts are age-related or congenital, not infectious diseases requiring elimination strategies *Vitamin A supplementation* - **Vitamin A supplementation** is a nutritional intervention to prevent xerophthalmia and reduce child mortality - Part of broader child health programs, not a disease elimination initiative - Does not constitute a disease-specific elimination strategy like GET 2020
Question 9: 25-year-old male having fever and malaise for 2 weeks, arthritis of the ankle joint, and tender erythematous nodules over the shin. What is the diagnosis?
- A. Erythema nodosum (Correct Answer)
- B. Weber- Christian disease
- C. Nodular Vasculitis
- D. Hansen's disease
Explanation: ***Erythema nodosum*** - Erythema nodosum presents with **tender, erythematous nodules** on the shins, often associated with a **prodrome of fever and malaise**, and can be accompanied by **arthralgia or arthritis**, particularly in the ankle joint [1]. - It is a **panniculitis** (inflammation of subcutaneous fat) that can be triggered by various systemic conditions, infections, or drugs. *Hansen's disease* - Also known as **leprosy**, this infectious disease primarily affects the skin, peripheral nerves, upper respiratory tract, eyes, and testes, typically presenting with **hypopigmented skin lesions** with loss of sensation. - While it can cause skin nodules (lepromas) and nerve damage leading to joint deformities, the acute onset of tender erythematous shin nodules accompanying a generalized inflammatory response is **not characteristic** of its initial presentation. *Weber-Christian disease* - This is a rare, relapsing, febrile **panniculitis** that causes subcutaneous fat inflammation, often resulting in tender nodules or plaques, but it is not typically associated with prominent arthralgia/arthritis as primary symptoms. - The lesions tend to be more widespread than just the shins and can involve visceral fat, and it lacks the specific association with ankle arthritis seen in erythema nodosum. *Nodular Vasculitis* - This condition is a form of **cutaneous vasculitis** that presents with multiple, tender, often ulcerating nodules, typically on the lower legs, which are characterized by inflammation of blood vessels. - While it involves nodules, it is fundamentally a vasculitic process and usually presents with symptoms of **vascular damage** such as ulcers, purpura, or livedo reticularis, which are not described in the patient's presentation of fever, malaise, and arthritis.
Question 10: A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
- A. Serum protein electrophoresis
- B. Vitamin 25(OH) D level
- C. Vitamin B12 levels (Correct Answer)
- D. Anti-gliadin antibodies
Explanation: ***Vitamin B12 levels*** - A **vegan diet** for an extended period puts patients at high risk for **vitamin B12 deficiency**, as B12 is primarily found in animal products [1]. - Symptoms like **tingling, numbness (paresthesias)**, and **impaired gait (ataxia)** are classic neurological manifestations of severe vitamin B12 deficiency, often due to **subacute combined degeneration** of the spinal cord [1]. *Serum protein electrophoresis* - This test is used to detect and quantify various proteins in the serum, primarily for suspected **monoclonal gammopathies** like multiple myeloma or Waldenström macroglobulinemia. - Her symptoms are primarily neurological and directly attributable to her dietary choices, making ser um protein electrophoresis less relevant as an initial diagnostic step. *Vitamin 25(OH) D level* - While vegans are at risk for **vitamin D deficiency** due to limited dietary sources and insufficient sun exposure, the primary symptoms of vitamin D deficiency are typically **bone pain, muscle weakness**, or fatigue, not the present neurological signs [2]. - Although vitamin D deficiency can cause non-specific neurological symptoms, the specific combination of paresthesia and ataxia in a long-term vegan points more strongly to B12 deficiency. *Anti-gliadin antibodies* - These antibodies are ordered to screen for **celiac disease**, an autoimmune disorder triggered by gluten consumption. - While celiac disease can present with neurological symptoms, there is no information in the patient's history to suggest a malabsorption disorder other than dietary restrictions, and her strict vegan diet directly points to a lack of B12.
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