Global Surveillance of Resistance — MCQs
All are true about ESBL except -
Which disease is most closely associated with intensive international surveillance for global eradication?
Multi drug resistant tuberculosis is defined as resistance to?
All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
A high-risk STI clinic sees increasing antibiotic resistance in N. gonorrhoeae isolates. Which laboratory strategy would best inform local treatment guidelines?
In dengue surveillance, indices that are commonly used to monitor Aedes aegypti infestation levels are all, EXCEPT:
Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?
Disease not included under International surveillance
Which of the following diseases is not under surveillance in the Integrated Disease Surveillance Project (P-Form)?
Which of the following statements about antibiotic resistance in N. gonorrhoeae is FALSE?
Global Surveillance of Resistance Indian Medical PG Practice Questions and MCQs
Question 1: All are true about ESBL except -
- A. Resistant to carbapenems (Correct Answer)
- B. Classification is based on 3rd generation cephalosporin sensitivity
- C. Cephalosporin sensitivity testing is required to confirm ESBL
- D. Ambler classification is based on molecular structure
Explanation: ***Resistant to carbapenems*** - **ESBL (Extended-Spectrum Beta-Lactamase)**-producing bacteria are typically **susceptible to carbapenems**. Carbapenems are a primary treatment option for serious ESBL infections. - Resistance to carbapenems suggests the presence of other resistance mechanisms, such as **carbapenemases**, not ESBLs. *Classification is based on 3rd generation cephalosporin sensitivity* - ESBLs are specifically defined by their ability to hydrolyze and confer resistance to **extended-spectrum cephalosporins** (e.g., ceftriaxone, ceftazidime) and aztreonam. - This characteristic resistance to third-generation cephalosporins is key to their definition and clinical identification. *Cephalosporin sensitivity testing is required to confirm ESBL* - **Phenotypic confirmatory tests** for ESBLs involve demonstrating increased resistance to an extended-spectrum cephalosporin alone compared to the same cephalosporin combined with a **beta-lactamase inhibitor** like clavulanic acid. - This testing is crucial for accurate detection and guiding appropriate antibiotic therapy. *Ambler classification is based on molecular structure* - The **Ambler classification system** categorizes beta-lactamases into classes A, B, C, and D based on their **amino acid sequence homology** and their active site mechanisms. - This classification helps in understanding the biochemical properties and substrate profiles of different beta-lactamases, including ESBLs.
Question 2: Which disease is most closely associated with intensive international surveillance for global eradication?
- A. Polio (Correct Answer)
- B. Hepatitis
- C. TB
- D. Leprosy
Explanation: **Polio** - **Polio** has been the focus of an intensive global eradication campaign, requiring robust **international surveillance** to track cases, mutations, and vaccine-derived polioviruses. - The **Global Polio Eradication Initiative (GPEI)**, a major international collaboration, relies heavily on coordinated surveillance efforts to ensure no wild poliovirus remains undetected. *Hepatitis* - While **hepatitis** is a significant global health burden, particularly hepatitis B and C, it is not subject to the same level of internationally coordinated, aggressive surveillance aimed at **global eradication** as polio. - Surveillance for hepatitis often focuses on prevalence, incidence, and risk factors at national and regional levels rather than a centralized, real-time eradication tracking system. *TB* - **Tuberculosis (TB)** is a major global health concern, and there are international efforts for control and elimination, but it is not currently targeted for **global eradication** in the same manner as polio. - Surveillance for TB often involves tracking drug-resistant strains and treatment outcomes, but it doesn't involve the immediate, outbreak-focused international alert system seen with diseases like polio or novel pandemics. *Leprosy* - **Leprosy** is a neglected tropical disease, and while there are international efforts for its control and elimination, primarily led by the WHO, it does not involve the same level of intensive, real-time global surveillance for eradication as **polio**. - Surveillance for leprosy is typically focused on case detection, treatment completion, and identifying areas with high endemicity rather than rapid international notification of individual cases for eradication purposes.
Question 3: Multi drug resistant tuberculosis is defined as resistance to?
- A. Rifampicin and Pyrazinamide
- B. INH and Rifampicin (Correct Answer)
- C. Resistance to all first line drugs
- D. INH and Pyrazinamide
Explanation: ***INH and Rifampicin*** - **Multidrug-resistant tuberculosis (MDR-TB)** is specifically defined by resistance to at least **isoniazid (INH)** and **rifampicin** [1], which are the two most potent first-line anti-TB drugs. - This dual resistance makes treatment significantly more challenging and prolonged compared to drug-susceptible TB. *Rifampicin and Pyrazinamide* - While resistance to these drugs is serious, it does not specifically define MDR-TB unless resistance to **isoniazid** is also present. - **Pyrazinamide** is another first-line drug, but its resistance pattern alone with rifampicin does not meet the MDR-TB criteria. *Resistance to all first-line drugs* - Resistance to all four first-line drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol) [1] is classified as **Extensively Drug-Resistant TB (XDR-TB)**, a more severe form of resistance than MDR-TB. - MDR-TB specifically refers to resistance to **INH and rifampicin**, not necessarily all first-line drugs. *INH and Pyrazinamide* - While resistance to both **isoniazid** and **pyrazinamide** is a concern, it does not meet the definition of MDR-TB. - The definition requires resistance to **rifampicin** in addition to isoniazid.
Question 4: All of the following conditions are immediate priorities in the WHO's "Vision -2020: The Right to sight" except:
- A. Cataract
- B. Epidemic conjunctivitis (Correct Answer)
- C. Onchocerciasis
- D. Trachoma
Explanation: ***Epidemic conjunctivitis*** - While **epidemic conjunctivitis** can cause significant discomfort and temporary vision impairment, it is generally **self-limiting** and rarely leads to permanent blindness. - It was not identified as one of the top five global causes of avoidable blindness targeted by the Vision 2020 initiative. *Cataract* - **Cataract** is the **leading cause of blindness** globally, accounting for approximately half of all cases. - It is a highly treatable condition through surgery, making it a critical priority for Vision 2020. *Onchocerciasis* - Also known as **river blindness**, onchocerciasis is a parasitic disease that causes severe visual impairment and blindness. - It is a significant public health problem in several regions, particularly in Africa, and was a key focus of Vision 2020 due to its widespread impact and the availability of preventive chemotherapy. *Trachoma* - **Trachoma** is the **leading infectious cause of blindness** worldwide, caused by *Chlamydia trachomatis*. - Given its preventable and treatable nature, and its prevalence in many impoverished areas, it was designated as one of the priority diseases under Vision 2020.
Question 5: A high-risk STI clinic sees increasing antibiotic resistance in N. gonorrhoeae isolates. Which laboratory strategy would best inform local treatment guidelines?
- A. Periodic random sampling of cases
- B. Selective culture of treatment failures
- C. Culture with antimicrobial susceptibility testing from all anatomical sites (Correct Answer)
- D. Universal NAAT testing only
Explanation: ***Culture with antimicrobial susceptibility testing from all anatomical sites*** - This approach allows for comprehensive determination of the **antibiotic resistance patterns** of *N. gonorrhoeae* isolates across all potential infection sites. - Tracking resistance from samples obtained from the **cervix, urethra, rectum, and pharynx** provides crucial data to adapt local treatment guidelines effectively and monitor the emergence of new resistant strains. *Periodic random sampling of cases* - While helpful for general surveillance, **random sampling** may not adequately capture the full spectrum of resistance patterns, especially for less common or emerging resistant strains. - This strategy might miss critical shifts in resistance if the sampling frequency is too low or the sample size is not representative of the population. *Selective culture of treatment failures* - This method is useful for confirming resistance in individual cases where treatment has failed, but it only provides information on a subset of the *N. gonorrhoeae* population already identified as problematic. - It does not offer a comprehensive picture of the **overall resistance epidemiology** in the clinic's patient population for proactive guideline adjustments. *Universal NAAT testing only* - **Nucleic Acid Amplification Tests (NAATs)** are highly sensitive for detecting *N. gonorrhoeae* DNA or RNA, but they do not provide information on antibiotic susceptibility. - Relying solely on NAATs would prevent the clinic from monitoring resistance trends and making informed decisions about **empirical treatment regimens**.
Question 6: In dengue surveillance, indices that are commonly used to monitor Aedes aegypti infestation levels are all, EXCEPT:
- A. Street index (Correct Answer)
- B. House index
- C. Breteau index
- D. Pupae index
Explanation: ***Street index*** - The **Street index** is not a standard entomological index used for monitoring *Aedes aegypti* infestation levels or density in dengue surveillance. - Surveillance efforts typically focus on household-level indices to assess mosquito breeding sites. *House index* - The **House index** (HI) measures the percentage of houses infested with *Aedes* larvae and/or pupae. - It provides an indication of the proportion of dwellings in an area that serve as mosquito breeding sites. *Breteau index* - The **Breteau index** (BI) calculates the number of positive containers per 100 houses inspected. - It reflects the density of breeding containers and is considered a more sensitive indicator of mosquito population density than the House index. *Pupae index* - The **Pupae index** (PI) measures the average number of pupae per person or per house. - This index is highly correlated with adult mosquito density and is considered the most accurate indicator of potential dengue transmission risk.
Question 7: Which of the following procedures is not typically covered by the National Programme for Control of Blindness (NPCB) for reimbursement of surgery done by a non-governmental organization (NGO) eye hospital?
- A. Cataract surgery
- B. Pan retinal photocoagulation for diabetic retinopathy
- C. Syringing and probing of the nasolacrimal duct (Correct Answer)
- D. Trabeculectomy surgery
Explanation: ***Syringing and probing of the nasolacrimal duct*** - While important for lacrimal drainage issues, procedures like **syringing and probing** are generally considered minor and less vision-restoring compared to the major surgeries targeted by the **NPCB**. - The **NPCB** focuses on interventions for leading causes of blindness, primarily **cataract** and other significant vision-threatening conditions, which this procedure typically isn't. *Cataract surgery* - **Cataract surgery** is a cornerstone of the **NPCB's** efforts, as cataracts are the leading cause of reversible blindness. - Reimbursement for **cataract surgery** is a primary objective to improve access and reduce the burden of blindness. *Pan retinal photocoagulation for diabetic retinopathy* - **Diabetic retinopathy** is a major cause of preventable blindness, and **pan retinal photocoagulation (PRP)** is a key intervention to preserve vision. - The **NPCB** includes procedures for **diabetic retinopathy** management due to its significant public health impact. *Trabeculectomy surgery* - **Trabeculectomy** is a surgical procedure for **glaucoma**, which is another significant cause of irreversible blindness. - The **NPCB** includes interventions for **glaucoma** given its severe vision-threatening nature and the need for surgical management in many cases.
Question 8: Disease not included under International surveillance
- A. Common cold
- B. Tension headache (Correct Answer)
- C. Rabies
- D. Malaria
- E. Yellow fever
Explanation: ***Tension headache*** - **Tension headaches** are a common, benign, and typically self-limiting condition that does not pose a public health threat requiring international attention. - They are **not communicable** and do not have the potential for widespread international spread. - This is a **non-infectious neurological symptom** with no epidemic potential. *Common cold* - While the **common cold** is highly contagious and caused by various respiratory viruses, it is **not under formal international surveillance**. - It is generally a mild, self-limiting illness that does not meet the criteria for International Health Regulations (IHR) reporting. - However, severe acute respiratory syndromes (like SARS or COVID-19) are under international surveillance due to their pandemic potential. *Rabies* - **Rabies** is a fatal zoonotic disease included under **WHO International Health Regulations (IHR)** surveillance. - It requires international monitoring due to high case-fatality rate (nearly 100%) and potential for cross-border transmission through animal movement. - WHO coordinates global surveillance to track animal reservoirs, implement vaccination programs, and prevent human deaths. *Malaria* - **Malaria** is a major disease under **WHO Global Malaria Programme** surveillance with mandatory reporting requirements. - International surveillance tracks disease burden, drug resistance patterns, vector control effectiveness, and progress toward elimination goals. - It causes significant morbidity and mortality, particularly in tropical and subtropical regions. *Yellow fever* - **Yellow fever** is a mosquito-borne viral hemorrhagic disease explicitly listed under **WHO International Health Regulations (IHR)**. - Countries must report outbreaks and maintain vaccination requirements for international travel from endemic areas. - International surveillance prevents epidemic spread and guides vaccination campaigns.
Question 9: Which of the following diseases is not under surveillance in the Integrated Disease Surveillance Project (P-Form)?
- A. Snake bite (Correct Answer)
- B. Acute respiratory tract infections
- C. Tuberculosis
- D. Leptospirosis
Explanation: ***Snake bite*** - While a public health concern, **snake bites** are generally not included in the list of diseases under routine surveillance by the Integrated Disease Surveillance Project (IDSP) P-Form, which focuses on infectious diseases with epidemic potential. - The IDSP primarily monitors for **communicable diseases**, outbreaks, and other public health threats requiring rapid detection and response. *Acute respiratory tract infections* - **Acute respiratory tract infections (ARIs)**, including severe acute respiratory infections (SARIs), are a major focus of IDSP surveillance due to their high transmissibility and potential for large-scale outbreaks. - Surveillance helps in detecting trends, identifying new pathogens, and implementing timely control measures. *Tuberculosis* - **Tuberculosis (TB)** is a priority disease for surveillance under the IDSP due to its high prevalence, chronic nature, and the need for continuous monitoring of incidence, prevalence, and treatment outcomes. - The IDSP plays a role in tracking TB cases and drug resistance patterns to inform national control programs. *Leptospirosis* - **Leptospirosis** is an emerging infectious disease with epidemic potential, especially in areas with poor sanitation and during floods, making it a crucial disease for IDSP surveillance. - Surveillance helps in early detection of outbreaks and implementation of control measures to prevent spread.
Question 10: Which of the following statements about antibiotic resistance in N. gonorrhoeae is FALSE?
- A. Ceftriaxone resistance typically involves alterations in the penA gene
- B. Resistance to fluoroquinolones is often due to mutations in gyrA and parC genes
- C. Spectinomycin resistance remains extremely rare globally
- D. Tetracycline resistance is primarily mediated by beta-lactamase production (Correct Answer)
Explanation: ***Tetracycline resistance is primarily mediated by beta-lactamase production*** - This statement is **FALSE**. Beta-lactamases (such as TEM-1 and TEM-135) in *N. gonorrhoeae* confer resistance to **penicillins and related beta-lactam antibiotics**, not tetracyclines. - **Tetracycline resistance** in *N. gonorrhoeae* is mediated by two distinct mechanisms: **plasmid-borne TetM determinants** (conferring high-level resistance through ribosomal protection) and **chromosomal mutations** (affecting mtrR, penB, and rpsJ genes, leading to increased efflux or altered ribosomal targets). - Beta-lactamase production and tetracycline resistance are independent resistance mechanisms. *Ceftriaxone resistance typically involves alterations in the penA gene* - This is **TRUE**. Ceftriaxone resistance in *N. gonorrhoeae* is primarily associated with **mosaic _penA_ alleles** encoding altered penicillin-binding protein 2 (PBP2). - These mosaic alleles result in decreased affinity of PBP2 for cephalosporins, reducing drug effectiveness. - Additional mechanisms include mtrR mutations (increasing efflux) and penB mutations (decreasing permeability). *Resistance to fluoroquinolones is often due to mutations in gyrA and parC genes* - This is **TRUE**. Fluoroquinolone resistance in *N. gonorrhoeae* primarily results from mutations in the **quinolone resistance-determining regions (QRDRs)** of **_gyrA_** and **_parC_** genes. - These genes encode subunits of DNA gyrase and topoisomerase IV respectively, the primary targets of fluoroquinolones. - The most common mutation is S91F in GyrA, with additional mutations in ParC contributing to higher-level resistance. *Spectinomycin resistance remains extremely rare globally* - This is **TRUE**. Spectinomycin resistance in *N. gonorrhoeae* remains **extremely rare worldwide**, with only sporadic case reports. - Resistance is mediated by mutations in the **16S rRNA gene** (particularly at position 1192), but this mechanism has not become widespread. - Spectinomycin remains a valuable alternative therapy, particularly for patients with cephalosporin allergies or in areas with cephalosporin resistance.
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