Infectious Diseases Practice Questions

Q: Complications of measles are all except:

Pancreatitis. Pancreatitis - While measles can cause systemic inflammation, pancreatitis is not a commonly recognized or significant complication. - Complications of measles primarily affect the respiratory, neurological, and gastrointestinal systems, but direct pancreatic involvement is rare. Appendicitis - Measles can cause inflammation of the lymphoid tissue in the gut, including the Peyer's patches in the appendix. - This inflammation can mimic or, in some cases, truly lead to acute appendicitis. SSPE - Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal, neurodegenerative complication of measles occurring years after the initial infection [1]. - It is caused by persistent infection of the central nervous system with a defective measles virus [1]. Myocarditis - Myocarditis, or inflammation of the heart muscle, can occur during the acute phase of measles infection. - Viral infections, including measles, are known causes of cardiac complications due to direct viral invasion or immune-mediated damage.

Q: Koplik spots are characteristic of:-

Measles. ***Measles*** - **Koplik spots** are small, white, or bluish-white spots on an erythematous base on the buccal mucosa, typically appearing 1-2 days before the generalized rash of measles. - They are considered a **pathognomonic sign** of measles infection. *Chicken pox* - Characterized by a **pruritic rash** that progresses from macules to papules, vesicles, and scabs. - It does not involve Koplik spots; its oral lesions are typically **aphthous ulcers** or vesicles. *HIV* - A retroviral infection that can lead to acquired immunodeficiency syndrome (AIDS). - Oral manifestations of HIV include **oral candidiasis**, **hairy leukoplakia**, and **Kaposi's sarcoma**, but not Koplik spots. *Mumps* - A viral infection primarily affecting the **salivary glands**, causing painful swelling (parotitis). - While it can cause oral symptoms like difficulty swallowing, it is not associated with the presence of Koplik spots.

Q: Reye's syndrome following influenza is most commonly associated with -

Type B. ***Type B*** - Reye's syndrome is **classically and most strongly associated** with **influenza B virus infection** in children who have been given **aspirin** for symptomatic relief. - The combination of **viral infection (especially influenza B)** and **aspirin use** leads to mitochondrial dysfunction, particularly affecting the liver and brain. - Epidemiological studies during the peak incidence years showed a **stronger association with influenza B** than with other influenza types. *Type A* - While influenza A can precede Reye's syndrome, particularly during pandemics, the **classical and stronger epidemiological association** is with influenza B. - Both influenza A and B have been implicated, but **type B predominates** in most case series and textbook descriptions. *Type C* - Influenza C viruses typically cause **mild respiratory illness** and are rarely associated with severe complications. - There is **no significant association** between influenza C and the development of Reye's syndrome. *All of the options* - This is incorrect because Reye's syndrome exhibits a **stronger and more consistent association specifically with influenza B** compared to other influenza types. - While other viral infections (particularly **varicella-zoster virus**) can also precede Reye's syndrome, among influenza types, **type B is the most implicated**.

Q: In a small child diagnosed with H. influenzae meningitis, what investigation must be done before discharging him from the hospital?

Hearing assessment. ***Hearing assessment*** - **Sensorineural hearing loss** is a significant and common complication of *H. influenzae* meningitis, occurring in up to 30% of children. - Early detection through a **hearing assessment** is crucial for intervention and to minimize long-term developmental impact. *CT scan* - A CT scan is typically performed during the acute phase of meningitis to rule out complications like **hydrocephalus** or **brain abscess**, not routinely before discharge for long-term sequelae. - While it can identify structural abnormalities, it does not directly assess **auditory function**. *X-ray skull* - An X-ray of the skull has very limited utility in the diagnosis or follow-up of meningitis. - It does not provide information about brain pathology or potential **hearing damage**. *MRI* - MRI is a more sensitive imaging modality than CT for detecting subtle brain parenchymal changes and is sometimes used in complicated cases of meningitis. - However, like CT, it is not the primary investigation required to assess for **hearing loss** as a post-meningitis sequela before discharge.

Q: Which of the following is NOT a feature of HIV infection in childhood -

Kaposi sarcoma. ***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.

Q: A 10-year-old girl presented with fever, convulsions, and neck rigidity. CSF findings are protein 150 mg/dL, sugar 40 mg/dL with lymphocytic pleocytosis –

Tuberculous meningitis. ***Tuberculous meningitis*** - The combination of **fever, convulsions, neck rigidity** (suggesting meningitis), elevated **CSF protein (150 mg/dL)**, **low CSF sugar (40 mg/dL)**, and **lymphocytic pleocytosis** is highly characteristic of tuberculous meningitis. - Tuberculous meningitis typically presents with a **subacute** or **chronic** course and CSF analysis reveals **elevated protein**, **low glucose**, and a **lymphocytic pleocytosis**. *Viral meningitis* - While viral meningitis presents with fever and meningeal signs, the **CSF protein** is usually mildly elevated ( 100 mg/dL)**, very low **CSF glucose (<40 mg/dL)**, and a predominant **neutrophilic pleocytosis**. - Symptoms are usually **acute and severe**, rapidly progressing over hours to days. *Cryptococcal meningitis* - This is more common in **immunocompromised individuals**, such as those with HIV/AIDS, and the clinical picture in a 10-year-old girl without immune compromise makes it less likely. - While it can cause elevated CSF protein and low glucose, the presence of **lymphocytic pleocytosis** is less specific for cryptococcal infection compared to tuberculous meningitis in this clinical context.

Q: Pathognomonic of measles?

Koplik spot. ***Koplik spot*** - **Koplik spots** are tiny, white spots with a bluish-white center found on the buccal mucosa opposite the molars; they are **pathognomonic** for measles [1]. - The appearance of Koplik spots often precedes the characteristic measles rash by 1-2 days and helps in early diagnosis [1]. *Rash* - While a **maculopapular rash** is a prominent feature of measles [1], it is not pathognomonic as similar rashes can be seen in other viral exanthems. - The measles rash typically starts on the face and behind the ears, spreading downwards, but its presence alone is insufficient for a definitive diagnosis. *Conjunctivitis* - **Conjunctivitis** is a common symptom in measles, contributing to the "3 C's" (cough, coryza, conjunctivitis), but it is a non-specific finding seen in many other viral illnesses. - It presents as red, watery eyes and is part of the prodromal phase but does not uniquely identify measles. *Fever* - **Fever** is a universal symptom of measles, usually high-grade, but it is a general sign of infection and not specific to measles. - Many viral and bacterial infections cause fever, making it a poor diagnostic indicator on its own.

Q: A child who was treated for H. influenzae meningitis is being discharged. Most important investigation to be done before discharge is:

Brainstem evoked auditory response. ***Brainstem evoked auditory response*** - **Sensorineural hearing loss** is a common and severe complication of *H. influenzae* meningitis, occurring in about 5-30% of cases due to damage to the auditory nerve or cochlea. - **Brainstem Evoked Auditory Response (BAER)** is an objective test that measures the electrical activity in the auditory pathway from the cochlea to the brainstem, making it the most reliable method for detecting hearing impairment in infants and children. *Growth screening test* - While chronic illness can affect growth, **growth faltering** is not specific to *H. influenzae* meningitis or its sequelae in the acute or subacute phase. - Growth checks are part of routine pediatric care and would be performed but are not the *most important* specific investigation for meningitis complications before discharge. *Psychotherapy* - **Psychotherapy** is a treatment modality for psychological and behavioral issues, not a diagnostic test. - It would only be considered if the child developed significant emotional or behavioral problems after meningitis, and these are typically assessed through clinical observation and neurodevelopmental screening, not a direct "psychotherapy" investigation. *MRI* - **MRI** is primarily used to detect structural brain abnormalities such as **hydrocephalus**, **subdural effusions**, **cerebral edema**, or **infarcts** that may result from meningitis. - While important for assessing neurological damage, **hearing loss** is a distinct and prevalent complication that requires a specific functional assessment (BAER), which MRI does not provide.

Q: Most serious characteristic finding of HIV in children is?

Recurrent chest infection. ***Recurrent chest infection*** - **Recurrent chest infections**, particularly with common bacterial pathogens, are a hallmark of HIV in children due to their underdeveloped immune systems being further compromised. - Children with HIV are highly susceptible to respiratory infections such as **pneumonia** and **bronchiolitis**, leading to frequent hospitalizations and poor outcomes. *Kaposi sarcoma is common* - **Kaposi sarcoma** is a well-known HIV-associated malignancy, but it is much more prevalent in **HIV-positive adults**, especially men who have sex with men, rather than in children. - While it can occur in children, it is not considered a *characteristic* or common presenting feature, as other opportunistic infections and non-specific symptoms are far more frequent. *Cryptococcal diarrhoea is common* - **Cryptococcal infection** primarily manifests as **meningitis** or disseminated disease, particularly in adults with advanced HIV. - While gastrointestinal symptoms can occur, **Cryptococcal diarrhea** is not a common or characteristic presentation of HIV in children. *Recurrent candidiasis* - While **recurrent oral candidiasis** (thrush) is common in HIV-infected children, it is often one of the **earliest indicators** and can be present even in less advanced disease. - However, **recurrent chest infections** generally represent a more significant and debilitating manifestation of immune compromise in pediatric HIV.

Q: All of the following statements regarding measles are true, except:

Koplik spot are seen on retina. ***Koplik spot are seen on retina*** - **Koplik spots** are pathognomonic for measles and are typically found on the **buccal mucosa** (inside the cheeks), not on the retina [1]. - These are small, white, or bluish-white lesions with a red halo, appearing before the characteristic rash. *I-P is 10-14 days* - The **incubation period (I-P)** for measles, from exposure to the onset of symptoms, typically ranges from **10 to 14 days**. - This period includes the initial prodromal symptoms before the rash appears. *Long term complication may be seen in form of SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, but fatal, **late complication** of measles infection [1]. - It results from persistent measles virus infection in the central nervous system, often developing years after the initial infection [1]. *Caused by RNA virus* - Measles is caused by the **measles virus**, which is a **single-stranded RNA virus** belonging to the *Paramyxoviridae* family. - It is an enveloped virus that primarily infects respiratory epithelial cells and replicates in lymphoid tissues. *Rash appears first on face* - The characteristic **maculopapular rash** of measles typically begins on the **face and behind the ears**. - It then spreads downwards to the trunk and extremities, fading in the same order [1].

Question 1

Complications of measles are all except:

Accepted Answer

Pancreatitis

Answer

Appendicitis

Answer

SSPE

Answer

Myocarditis

Question 2

Koplik spots are characteristic of:-

Accepted Answer

Measles

Answer

Chicken pox

Answer

HIV

Answer

Mumps

Question 3

Reye's syndrome following influenza is most commonly associated with -

Accepted Answer

Type B

Answer

Type C

Answer

Type A

Answer

All of the options

Question 4

In a small child diagnosed with H. influenzae meningitis, what investigation must be done before discharging him from the hospital?

Accepted Answer

Hearing assessment

Answer

CT scan

Answer

X-ray skull

Answer

MRI

Question 5

Which of the following is NOT a feature of HIV infection in childhood -

Accepted Answer

Kaposi sarcoma

Answer

Failure to thrive

Answer

Hepatomegaly

Answer

Lymphoid interstitial pneumonitis

Question 6

A 10-year-old girl presented with fever, convulsions, and neck rigidity. CSF findings are protein 150 mg/dL, sugar 40 mg/dL with lymphocytic pleocytosis –

Accepted Answer

Tuberculous meningitis

Answer

Viral meningitis

Answer

Pyogenic meningitis

Answer

Cryptococcal meningitis

Question 7

Pathognomonic of measles?

Accepted Answer

Koplik spot

Answer

Rash

Answer

Conjunctivitis

Answer

Fever

Question 8

A child who was treated for H. influenzae meningitis is being discharged. Most important investigation to be done before discharge is:

Accepted Answer

Brainstem evoked auditory response

Answer

Growth screening test

Answer

Psychotherapy

Answer

MRI

Question 9

Most serious characteristic finding of HIV in children is?

Accepted Answer

Recurrent chest infection

Answer

Kaposi sarcoma is common

Answer

Cryptococcal diarrhoea is common

Answer

Recurrent candidiasis

Question 10

All of the following statements regarding measles are true, except:

Accepted Answer

Koplik spot are seen on retina

Answer

I-P is 10-14 days

Answer

Long term complication may be seen in form of SSPE

Answer

Caused by RNA virus

Answer

Rash appears first on face

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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