Common Childhood Infections — MCQs
Most common complication of diphtheria is -
A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
A 30 month old deaf boy whose development is slower than normal is being followed for congenital cytomegalovirus (CMV) infection in your clinic.The child's mother is pregnant again and is worried about her new baby. Which of the following is true?
According to WHO clinical staging of HIV in children oral hairy leukoplakia belongs to which clinical stages?
A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
All of the following statements are true about congenital rubella except
A 4-year-old child presented with fever for 6 days, generalized rash and cervical lymphadenopathy with strawberry tongue. What could be the diagnosis?
Which of the following is NOT a feature of HIV infection in childhood -
An asymptomatic infant with a history of TB exposure, is 3 months old and had taken 3 months of chemoprophylaxis, what is to be done next?
Prophylaxis with cotrimoxazole is recommended in all situations except for which of the following?
Common Childhood Infections Indian Medical PG Practice Questions and MCQs
Question 1: Most common complication of diphtheria is -
- A. Myocarditis (Correct Answer)
- B. Pneumonia
- C. Meningitis
- D. Endocarditis
Explanation: ***Myocarditis*** - Diphtheria toxin can directly damage myocardial cells, leading to inflammation and dysfunction of the heart muscle, making **myocarditis** the most common and serious complication. - This can result in **heart failure**, arrhythmias, and even death, highlighting its significance in diphtheria. *Pneumonia* - While respiratory complications can occur in diphtheria, **pneumonia** is not the most common or life-threatening complication associated with the diphtheria toxin itself. - Secondary bacterial infections might lead to pneumonia, but it is not a direct toxic effect like myocarditis. *Meningitis* - **Meningitis**, an inflammation of the membranes surrounding the brain and spinal cord, is an extremely rare complication of diphtheria. - Diphtheria primarily affects the upper respiratory tract and heart [1], with neurological complications typically manifesting as neuropathies rather than meningitis. *Endocarditis* - Although diphtheria can cause cardiac complications, **endocarditis** (inflammation of the heart's inner lining, including the valves) is not a common complication. - Myocarditis, due to the direct toxic effect on heart muscle, is far more prevalent than endocarditis in diphtheria.
Question 2: A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
- A. Diphtheria (Correct Answer)
- B. Follicular tonsillitis
- C. Aphthous ulcer
- D. Membranous tonsillitis
Explanation: ***Diphtheria*** - The image shows a **thick, grayish-white pseudomembrane** covering the tonsils and likely extending to other parts of the pharynx, which is a classic sign of diphtheria. - **Hoarseness** indicates laryngeal involvement, a severe complication of diphtheria due to pseudomembrane formation extending to the larynx, potentially causing airway obstruction. *Follicular tonsillitis* - This condition presents with **pus-filled follicles** or spots on the tonsils, which are typically yellow or white, rather than a confluent membrane. - While it causes throat pain and fever, it generally does not lead to the formation of a **firm, adherent pseudomembrane** or significant hoarseness from laryngeal obstruction as seen in diphtheria. *Aphthous ulcer* - An aphthous ulcer is a **small, painful, shallow sore** with a white or yellowish center and a red border, typically found on the non-keratinized oral mucosa. - It does not present as a widespread, thick membranous lesion covering the tonsils and causing hoarseness. *Membranous tonsillitis* - While "membranous tonsillitis" describes the presence of a membrane on the tonsils, this term is often used generally. However, the specific characteristics in the image (thick, grayish, adherent membrane with severe symptoms like hoarseness) are pathognomonic for **diphtheria**. - Other causes of membranous tonsillitis, such as infectious mononucleosis, typically present with a less adherent membrane and often lack the severe systemic toxicity and potential for rapid airway compromise seen in diphtheria.
Question 3: A 30 month old deaf boy whose development is slower than normal is being followed for congenital cytomegalovirus (CMV) infection in your clinic.The child's mother is pregnant again and is worried about her new baby. Which of the following is true?
- A. The new infant should be isolated from the older child
- B. The mother has antibodies to CMV that are passed to the fetus (Correct Answer)
- C. Termination of pregnancy is advised
- D. The mother's infection cannot become reactivated
Explanation: ***The mother has antibodies to CMV that are passed to the fetus*** - The mother has a history of CMV infection, meaning she has developed **antibodies** against the virus. These maternal **IgG antibodies** can cross the placenta and provide passive immunity to the fetus. - This passive immunity helps protect the unborn baby from initial infection or reduce the severity of disease if exposure occurs, although it doesn't guarantee complete protection. *The new infant should be isolated from the older child* - Isolation is generally not necessary in this scenario because CMV is widespread and transmission through casual contact is common; strict isolation would be impractical and not significantly reduce risk. - While CMV can be shed in urine and saliva, the risk of symptomatic infection in the new infant from an older sibling with congenital CMV, especially if the mother is seropositive, is relatively low. *Termination of pregnancy is advised* - Termination of pregnancy is a major medical decision and is not advised solely based on a previous CMV infection in an older child. - The risk of severe congenital CMV in a subsequent pregnancy when the mother is already seropositive is significantly lower compared to a primary maternal infection during pregnancy. *The mother's infection cannot become reactivated* - CMV is a **herpesvirus** that establishes **latency** after primary infection, meaning it can reactivate later in life. - While reactivation can occur, particularly in immunocompromised individuals, it typically poses a much lower risk to a developing fetus compared to a primary infection during pregnancy, especially if the mother has pre-existing antibodies.
Question 4: According to WHO clinical staging of HIV in children oral hairy leukoplakia belongs to which clinical stages?
- A. Clinical stage 1
- B. Clinical stage 3
- C. Clinical stage 4
- D. Clinical stage 2 (Correct Answer)
Explanation: ***Clinical stage 2*** - **Oral hairy leukoplakia** is classified under WHO clinical stage 2 for HIV infection, representing mild symptomatic disease with moderate immune compromise. - Stage 2 includes conditions such as **angular cheilitis**, **papular pruritic eruptions**, **recurrent oral ulcerations**, **herpes zoster**, **lineal gingival erythema**, and **recurrent upper respiratory tract infections**. - **Note:** Oral hairy leukoplakia is **rare in children** and is more commonly seen in adults with HIV; it is caused by **Epstein-Barr virus** reactivation. *Clinical stage 1* - This stage includes **asymptomatic** HIV infection or **persistent generalized lymphadenopathy**. - Stage 1 represents minimal or no immune compromise with no clinical manifestations requiring intervention. *Clinical stage 3* - Clinical stage 3 represents **advanced symptomatic disease** with conditions like **unexplained severe malnutrition**, **unexplained persistent diarrhea**, **oral candidiasis**, **pulmonary tuberculosis**, and **severe recurrent bacterial pneumonia**. - These conditions indicate more severe immunodeficiency than oral hairy leukoplakia. *Clinical stage 4* - Clinical stage 4 represents **severe HIV disease** with AIDS-defining illnesses such as **Pneumocystis jirovecii pneumonia**, **extrapulmonary tuberculosis**, **Kaposi's sarcoma**, **HIV encephalopathy**, **CMV retinitis**, and **disseminated mycobacterial infections**. - Stage 4 conditions are life-threatening and indicate severe immunosuppression.
Question 5: A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
- A. Herpes simplex virus infection
- B. Toxoplasmosis caused by Toxoplasma gondii
- C. Cytomegalovirus (CMV) infection (Correct Answer)
- D. Infectious mononucleosis caused by Epstein-Barr virus
Explanation: ***Cytomegalovirus (CMV) infection*** - The presence of cells with an **owl's eye appearance** in urine sediment is a classic histological hallmark of **CMV infection**. - CMV can cause a variety of symptoms in children, including **fever and rash**, making this the most likely diagnosis. *Herpes simplex virus infection* - HSV causes characteristic **vesicular lesions** on mucocutaneous surfaces, often associated with fever. - While HSV can cause systemic illness, it does not typically present with **owl's eye inclusions** in urine cells. *Toxoplasmosis caused by Toxoplasma gondii* - **Toxoplasmosis** can cause fever and rash, especially in congenital infections or immunocompromised individuals. - However, it does not lead to **owl's eye inclusions** in urinary cells, which are pathognomonic for CMV. *Infectious mononucleosis caused by Epstein-Barr virus* - **Infectious mononucleosis** commonly presents with fever, fatigue, and lymphadenopathy, sometimes with a rash. - **Epstein-Barr virus (EBV)** infection does not produce cells with an **owl's eye appearance** in the urine; that is specific to CMV.
Question 6: All of the following statements are true about congenital rubella except
- A. Infection after 16 weeks of gestation results in major congenital defects (Correct Answer)
- B. It is diagnosed when IgG antibodies persist for more than 6 months
- C. It is diagnosed when the infant has IgM antibodies at birth
- D. Most common congenital defects are deafness, congenital heart disease and cataract
Explanation: *** Infection after 16 weeks of gestation result in major congenital defects*** - The risk and severity of **congenital rubella syndrome (CRS)** are highest when the mother is infected during the **first trimester** of pregnancy. - After **16 weeks of gestation**, the risk of major congenital defects with CRS significantly decreases, although **late-onset manifestations** such as hearing loss can still occur. *It is diagnosed when Ig G antibodies persist for more than 6 months* - **Persistence of IgG antibodies** beyond 6-12 months in an infant is a strong indicator of congenital rubella, as maternal IgG antibodies typically wane by this age. - This persistence signifies that the infant's own immune system is producing antibodies in response to **persistent viral infection**, which is characteristic of CRS. *M.C. congenital defects are deafness, congenital heart disease and cataract* - The classic triad of **congenital rubella syndrome** includes **sensorineural deafness**, **congenital heart defects** (such as patent ductus arteriosus or pulmonary artery stenosis), and **ocular abnormalities** (such as cataracts or retinopathy). - These are indeed the most common and significant birth defects associated with early gestational rubella infection. *It is diagnosed when the infant has IgM antibodies at birth* - The presence of **rubella-specific IgM antibodies** in a newborn's blood at birth or shortly thereafter is diagnostic of congenital rubella infection. - IgM antibodies do not cross the placenta, so their presence in the infant indicates that the infant's immune system has produced them in response to an **intrauterine infection**.
Question 7: A 4-year-old child presented with fever for 6 days, generalized rash and cervical lymphadenopathy with strawberry tongue. What could be the diagnosis?
- A. Kimura disease
- B. Scarlet fever
- C. Kawasaki disease (Correct Answer)
- D. Rosai-Dorfman disease
Explanation: ***Kawasaki disease*** * Kawasaki disease is a **vasculitis** affecting medium-sized arteries, predominantly in children. * **Persistent fever** for more than 5 days, **generalized rash**, **cervical lymphadenopathy**, and **strawberry tongue** are key diagnostic criteria. * The child's age (4 years) is also consistent with the typical presentation of Kawasaki disease. *Kimura disease* * Kimura disease is a **rare chronic inflammatory condition** primarily affecting the head and neck, characterized by subcutaneous nodules and enlarged lymph nodes. * It typically presents with **painless subcutaneous masses**, often in young adults of Asian descent, and does not commonly include a generalized rash or strawberry tongue. *Scarlet fever* * Scarlet fever is caused by **Group A Streptococcus** and typically presents with a **fine, sandpaper-like rash**, **strawberry tongue**, and fever. * While a strawberry tongue and rash are present, the rash of Kawasaki disease is more polymorphous, and cervical lymphadenopathy is often more pronounced and less generalized than in scarlet fever. *Rosai Dorfman disease* * Rosai-Dorfman disease, also known as **sinus histiocytosis with massive lymphadenopathy**, is characterized by striking, often **painless and massive lymph node enlargement**, predominantly in the cervical region. * Systemic symptoms like fever and rash can occur, but the classic presentation does not typically include a "strawberry tongue" or the specific constellation of symptoms seen in Kawasaki disease.
Question 8: Which of the following is NOT a feature of HIV infection in childhood -
- A. Failure to thrive
- B. Hepatomegaly
- C. Kaposi sarcoma (Correct Answer)
- D. Lymphoid interstitial pneumonitis
Explanation: ***Kaposi sarcoma*** - While Kaposi's sarcoma is a common HIV-associated malignancy in adults, it is **very rare in HIV-infected children**. - Its presence in children with HIV usually suggests a **more aggressive and rapidly progressing disease course**, but it is not a typical or common feature. *Failure to thrive* - **Failure to thrive** is a very common manifestation of HIV infection in children, often due to **poor nutrient absorption**, increased metabolic demands, and chronic infections. - It leads to **poor weight gain and growth faltering**, negatively impacting overall development. *Hepatomegaly* - **Hepatomegaly**, or an enlarged liver, is a frequent finding in HIV-infected children due to various causes such as **opportunistic infections**, drug side effects, and direct HIV involvement of the liver. - It can be a clinical sign indicating **inflammation or dysfunction** of the liver. *Lymphoid interstitial pneumonitis* - **Lymphoid interstitial pneumonitis (LIP)** is a prevalent pulmonary complication specific to HIV infection in children, characterized by **lymphocytic infiltration of the alveolar septa and peribronchial spaces**. - It often leads to **chronic cough**, hypoxemia, and is considered an **AIDS-defining condition** in pediatric HIV.
Question 9: An asymptomatic infant with a history of TB exposure, is 3 months old and had taken 3 months of chemoprophylaxis, what is to be done next?
- A. Immunise with BCG and stop prophylaxis
- B. Continue prophylaxis for 3 months
- C. Test sputum, then decide
- D. Tuberculin test, then decide (Correct Answer)
Explanation: ***Tuberculin test, then decide*** - A **tuberculin skin test (TST)** or **IGRA** should be performed after completing the initial chemoprophylaxis period to determine if the infant has developed **latent TB infection (LTBI)**. - According to **IAP guidelines**, if TST is **negative**, complete a total of **6 months of prophylaxis** and then administer **BCG vaccine**. - If TST is **positive**, it indicates LTBI and the infant should complete the full course of treatment as per standard protocols. - The decision to continue, modify, or stop treatment depends on **TST results** and **clinical evaluation**. *Immunise with BCG and stop prophylaxis* - **BCG vaccination** should not be given during or immediately after stopping prophylaxis without first performing a **TST**. - In TB-endemic areas, BCG is ideally given at birth, but if delayed due to TB exposure, it should only be given after **ruling out infection** with a negative TST. - Stopping prophylaxis prematurely without assessment can increase the risk of developing **active TB**. *Continue prophylaxis for 3 months* - While the standard duration of prophylaxis is **6 months total**, blindly continuing for another 3 months without TST assessment is not the most appropriate next step. - The decision to continue should be based on **TST results** performed at this juncture, not arbitrary time extension. - Prolonged unnecessary prophylaxis can lead to **drug toxicity** and **poor compliance**. *Test sputum, then decide* - An **asymptomatic infant** is unlikely to produce sputum, making this test impractical and inappropriate. - Sputum testing is used for diagnosing **active pulmonary TB**, which is not suspected in this asymptomatic child. - Sputum testing is invasive and reserved for children with **clinical symptoms** suggestive of active disease such as persistent cough, fever, or weight loss.
Question 10: Prophylaxis with cotrimoxazole is recommended in all situations except for which of the following?
- A. All symptomatic HIV infected children > 5 years of age irrespective of CD4 (Correct Answer)
- B. All HIV infected infants less than 1 year age irrespective of symptoms or CD4 counts
- C. All HIV exposed infants till HIV infection can be ruled out
- D. As secondary prophylaxis after initial treatment for Pneumocystis jirovecii pneumonia
Explanation: ***All symptomatic HIV infected children > 5 years of age irrespective of CD4*** - Cotrimoxazole prophylaxis is generally recommended for HIV-infected children with **CD4 counts below certain thresholds** or **specific clinical scenarios**, not just based on age and symptoms alone for those > 5 years. - The guidelines often focus on preventing **Pneumocystis jirovecii pneumonia (PJP)** and other opportunistic infections in pediatric HIV, with a nuanced approach to older children based on immune status. *All HIV exposed infants till HIV infection can be ruled out* - **Cotrimoxazole prophylaxis** is strongly recommended for **all HIV-exposed infants** from 4-6 weeks of age until HIV infection is definitively ruled out. - This prevents **P. jirovecii pneumonia**, which has a high mortality rate in this vulnerable population. *All HIV infected infants less than 1 year age irrespective of symptoms or CD4 counts* - **Cotrimoxazole prophylaxis** is indicated for **all HIV-infected infants younger than 1 year of age**, regardless of their clinical symptoms or CD4 counts. - This is due to their **immature immune system** and high risk of **opportunistic infections**, especially PJP. *As secondary prophylaxis after initial treatment for pneumocystis carini pneumonia* - **Cotrimoxazole** is the **standard drug** used for **secondary prophylaxis** following successful treatment of **Pneumocystis jirovecii pneumonia (PJP)**. - This prevents recurrence of PJP, which can be life-threatening in immunocompromised individuals.
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