Infectious Diseases Practice Questions

Q: A 3-year-old boy was admitted to the hospital for high fever and difficulty in breathing. He had been well until 4 days before admission, when he developed sneezing and a runny and stuffy nose followed by a non-productive cough the next day. This was followed by appearance of characteristic rash on face, trunk, extremities and back along with fever. On examination: Shotty anterior cervical and supraclavicular lymph nodes, hyperemic conjunctiva, and Koplik spots on buccal mucosa. The white blood cell count was 3,100/ml, with a differential of 70% polymorphonuclear leukocytes. All of the following are complications of the above disease EXCEPT?

Orchitis. ***Orchitis*** - **Orchitis** is a common complication of **mumps**, an unrelated viral infection, and is not typically associated with **measles (rubeola)**. - The presenting symptoms (rash, Koplik spots, lymphadenopathy, fever) are classic for **measles**, which does not cause orchitis. *Otitis media* - **Acute otitis media** is a frequent bacterial superinfection following measles, often caused by streptococcal species, and is one of the most common complications. - The **immunosuppression** caused by measles makes children highly susceptible to secondary bacterial infections, including ear infections. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, but fatal, chronic progressive encephalitis caused by persistent measles virus infection in the brain, developing years after the initial infection. - The measles virus can remain latent and reactivate, leading to severe neurological degeneration. *Encephalitis* - **Acute post-infectious encephalitis** is a serious neurological complication of measles, occurring in approximately 1 in 1000 cases, usually 5-7 days after the onset of the rash. - It is typically an **autoimmune demyelinating process**, rather than direct viral invasion of the brain.

Q: A child suffering from Rubella presented with small red spots (petechiae) on the soft palate. These are known as __________.

Forchheimer spots. **Forchheimer spots** - These are **petechiae** that appear on the **soft palate** and **uvula** during the **prodromal phase** of **Rubella** (German measles). - They are a classic, though not always present, clinical sign that helps in the diagnosis of Rubella. *Nagayama spots* - These are **erythematous papules** on the **uvula and soft palate** that are seen in **Roseola infantum** (Exanthem subitum), caused by HHV-6 and HHV-7. - While similar in location to Forchheimer spots, their viral etiology and morphology differ significantly. *Koplik spots* - These are **pathognomonic enanthem** of **measles** (rubeola), characterized by **tiny white spots** on an erythematous base on the **buccal mucosa** opposite the molars. - They are an early sign of measles and are distinctly different in appearance and location from Forchheimer spots. *None of the options* - This option is incorrect as **Forchheimer spots** specifically describe the petechiae on the soft palate seen in Rubella. - The other options refer to different clinical signs associated with other viral exanthems.

Q: Prior to discharge of a patient with H. influenzae meningitis, the essential investigation to be done is?

ABER. ***Correct: ABER*** - **Hearing loss** is a well-known and common complication following **H. influenzae meningitis**, making audiological assessment crucial before discharge. - An **Auditory Brainstem Response (ABR) test**, or ABER, is an **objective measure of hearing** that can detect sensorineural hearing loss, which might otherwise be missed in young children. - **Standard of care** recommends hearing assessment in all cases of bacterial meningitis prior to discharge as per IAP and AAP guidelines. *Incorrect: Developmental screening test* - While significant neurological insult from meningitis can affect development, a **developmental screening test** is not the *most essential* immediate post-meningitis investigation prior to discharge. - Neurological and developmental sequelae are typically assessed over time during follow-up rather than as a primary discharge screen. *Incorrect: ECG* - An **ECG (electrocardiogram)** assesses cardiac function and is generally not indicated for routine discharge after uncomplicated bacterial meningitis unless there are specific cardiac concerns. - **H. influenzae meningitis** primarily affects the central nervous system, not directly the heart. *Incorrect: EEG* - An **EEG (electroencephalogram)** measures brain electrical activity and is used to diagnose seizure disorders or assess for encephalopathy. - While seizures can be a complication, an EEG is typically performed if there are clinical signs of **seizure activity** or altered mental status, rather than as an essential routine discharge investigation for all patients.

Q: Fever stops and rash begins is diagnostic of –

Roseola infantum. ***Roseola infantum*** - This condition is characterized by a **high fever** that subsides abruptly, followed by the appearance of a **rose-pink maculopapular rash** on the trunk and neck. - The classic presentation is **"fever stops, rash begins,"** making this the most likely diagnosis. *Measles* - Measles typically presents with a **prodrome of fever**, cough, coryza, and conjunctivitis, followed by a **maculopapular rash that starts on the face** and spreads downwards, usually while the fever is still present. - **Koplik spots** are characteristic enanthem of measles, which are not seen in Roseola. *Fifth disease* - Also known as **Erythema infectiosum**, it classically presents with a **"slapped cheek" rash** on the face, followed by a **lacy, reticular rash** on the trunk and limbs, usually without preceding high fever. - Fever, if present, is usually **low-grade** and not followed by a rash upon its resolution. *Toxic shock syndrome* - This is a severe, acute condition characterized by **high fever**, hypotension, and a diffuse, **erythematous rash that can desquamate**, often associated with bacteremia. - The rash does not typically appear after the fever has resolved; rather, it's a concurrent symptom of severe illness.

Q: Which of the following is the most appropriate treatment for a child with severe falciparum malaria with high parasitemia?

Artesunate injection. ***Artesunate injection*** - **Artesunate** is the drug of choice for severe malaria due to its rapid action and high efficacy in reducing parasite load and mortality. - It is recommended by the **WHO** for initial treatment of severe malaria in both children and adults. *Hyperbaric oxygen* - This treatment is primarily used for conditions like **carbon monoxide poisoning** or **decompression sickness**, not malaria. - It does not directly target the **Plasmodium falciparum** parasite or its pathophysiology. *Exchange transfusion* - While sometimes considered in very severe cases with extremely high parasitemia (>10%) and multiple organ dysfunction, it is an **invasive procedure** with risks and is not the primary treatment. - Its efficacy in improving outcomes in severe malaria is **not definitively established** and it is often reserved for situations where standard antimalarials are failing or unavailable. *IV corticosteroids* - **Corticosteroids** are generally contraindicated in severe malaria as they can worsen the outcome, especially in **cerebral malaria**. - They have been shown to have **no benefit** and may increase the risk of complications such as infections and gastrointestinal bleeding.

Q: A young child of 7 years of age is seen with indurated ulcers, lymphadenopathy and fever. The likely treatment is:

Systemic antibiotics. ***Systemic antibiotics*** - This clinical triad of **indurated ulcers, lymphadenopathy, and fever** in a child is highly suggestive of **ulceroglandular tularemia** (Francisella tularensis), **cat-scratch disease** (Bartonella henselae), or **atypical mycobacterial infection**. - **Tularemia** presents with a painful ulcer at the inoculation site with regional lymphadenopathy and systemic symptoms - treated with **streptomycin or gentamicin**. - **Cat-scratch disease** may present similarly after feline contact - treated with **azithromycin**. - **Atypical mycobacteria** (M. marinum) cause "swimming pool granuloma" with similar features - requiring **clarithromycin and rifampicin**. - **Systemic antibiotic therapy is essential** to prevent complications and disease progression. *Symptomatic treatment* - **Symptomatic treatment alone is inadequate** for bacterial infections presenting with indurated ulcers and lymphadenopathy. - While fever and pain management may be adjunctive, **definitive antimicrobial therapy is required** for these infectious conditions. - Failure to treat appropriately can lead to **systemic dissemination** and serious complications. *Excise the lesion* - **Surgical excision is not the primary treatment** for infectious ulcers with lymphadenopathy. - Excision may be considered for **localized atypical mycobacterial lymphadenitis** that fails medical therapy, but is not first-line. - The presence of **systemic symptoms (fever)** indicates need for medical rather than surgical management. *I.V. fluids* - **Intravenous fluids are supportive therapy** for dehydration, not definitive treatment. - The clinical presentation requires **antimicrobial therapy**, not just hydration. - IV fluids may be needed as adjunctive therapy if the child is unable to maintain oral hydration, but do not address the underlying infection.

Q: According to WHO, the major clinical sign of HIV infection in children in stage 1 is the following.

Generalised lymphadenopathy. ***Generalised lymphadenopathy*** - According to WHO staging for HIV infection in children, **persistent generalized lymphadenopathy (PGL)** is a major clinical sign in Stage 1. - This stage is characterized by asymptomatic or mild clinical manifestations, with PGL being one of the key visible indicators. - PGL is defined as enlarged lymph nodes (>1 cm) in two or more non-contiguous sites, excluding inguinal nodes. *Not gaining weight* - **Failure to thrive** or **unexplained moderate malnutrition** typically falls under WHO clinical Stage 2 or 3, not Stage 1. - While weight loss can occur in HIV, it usually signifies more advanced disease progression in children. *Oral candidiasis* - **Oral candidiasis** in children with HIV usually indicates more advanced disease and is classified under **WHO clinical Stage 2 or 3**, depending on its persistence and severity. - It suggests a compromised immune system beyond the earliest stages of HIV infection. *None of the options* - This option is incorrect because **generalized lymphadenopathy** is indeed a major clinical sign of HIV infection in children in Stage 1, according to WHO criteria. - The other options provided represent signs found in later stages of HIV disease in children.

Q: 'Slapped cheeks' appearance is seen in:

Erythema infectiosum. ***Erythema infectiosum*** - This condition, also known as **Fifth Disease**, is caused by **Parvovirus B19** and classically presents with a distinctive erythematous rash on the cheeks, giving them a **"slapped cheeks" appearance**. - The facial rash is often followed by a **lacy, reticulate rash** on the trunk and extremities. *Erythema multiforme* - Characterized by **target lesions** with multiple rings of color, commonly found on the extremities and trunk. - It is typically a **hypersensitivity reaction** to infections (e.g., HSV) or medications, not a primary viral exanthem with a "slapped cheeks" presentation. *Erythema subitum* - This term is a synonym for **Roseola infantum**, a common childhood viral illness. - It does not primarily present with a "slapped cheeks" rash; rather, it's known for a **high fever followed by a truncal rash** once the fever breaks. *Roseola infantum* - Caused by **Human Herpesvirus 6 (HHV-6)** or sometimes HHV-7, it is characterized by **3-5 days of high fever** that resolves suddenly. - A **maculopapular rash** then appears on the trunk and neck, sparing the face, not the "slapped cheeks" rash.

Q: All of the following are complications of meningitis in a child EXCEPT:

Thyroid dysfunction. ***Thyroid dysfunction*** - **Thyroid dysfunction** is NOT a recognized complication of bacterial or viral meningitis in children. - Meningitis causes neurological complications due to inflammation of the meninges and brain parenchyma, but does not directly affect endocrine organs like the thyroid gland. - This is the correct answer as it is the exception. *Arachnoiditis* - **Arachnoiditis** is inflammation of the arachnoid membrane that can occur as a complication of meningitis. - It leads to scarring and adhesions within the subarachnoid space, potentially causing chronic pain, neurological deficits, and **hydrocephalus** due to impaired CSF circulation. - This is a recognized late complication. *Intellectual disability* - **Intellectual disability** can result from severe or prolonged meningitis causing significant brain damage. - Widespread inflammation, cerebral edema, ischemia, and direct neuronal injury can damage regions responsible for cognitive function. - This affects learning, memory, and developmental milestones in children. *Status epilepticus* - **Status epilepticus** is a life-threatening complication where prolonged or recurrent seizures occur without recovery of consciousness. - It results from direct cortical irritation by inflammation, cerebral edema, metabolic derangements, or hypoxia. - Requires emergency treatment to prevent permanent brain damage and systemic complications.

Question 1

A 3-year-old child is brought to the outpatient department with an upper respiratory tract infection. On asking about their previous immunization history, it is found that they have had no primary immunizations from birth. What is the most appropriate step in the management of this patient?

Accepted Answer

Give BCG, OPV, DPT, measles vaccines and vitamin A

Answer

Give BCG, OPV, DPT and advise to come after 4 weeks for the next doses of OPV and DPT

Answer

Advise to come on the fixed immunization day of the week

Answer

Give BCG, OPV, DPT, measles vaccines

Question 2

A 3-year-old boy was admitted to the hospital for high fever and difficulty in breathing. He had been well until 4 days before admission, when he developed sneezing and a runny and stuffy nose followed by a non-productive cough the next day. This was followed by appearance of characteristic rash on face, trunk, extremities and back along with fever. On examination: Shotty anterior cervical and supraclavicular lymph nodes, hyperemic conjunctiva, and Koplik spots on buccal mucosa. The white blood cell count was 3,100/ml, with a differential of 70% polymorphonuclear leukocytes. All of the following are complications of the above disease EXCEPT?

Accepted Answer

Orchitis

Answer

Otitis media

Answer

SSPE

Answer

Encephalitis

Question 3

A child suffering from Rubella presented with small red spots (petechiae) on the soft palate. These are known as __________.

Accepted Answer

Forchheimer spots

Answer

Nagayama spots

Answer

Koplik spots

Answer

None of the options

Question 4

Prior to discharge of a patient with H. influenzae meningitis, the essential investigation to be done is?

Accepted Answer

ABER

Answer

Developmental screening test

Answer

ECG

Answer

EEG

Question 5

Fever stops and rash begins is diagnostic of –

Accepted Answer

Roseola infantum

Answer

Measles

Answer

Fifth disease

Answer

Toxic shock syndrome

Question 6

Which of the following is the most appropriate treatment for a child with severe falciparum malaria with high parasitemia?

Accepted Answer

Artesunate injection

Answer

Hyperbaric oxygen

Answer

Exchange transfusion

Answer

IV corticosteroids

Question 7

A young child of 7 years of age is seen with indurated ulcers, lymphadenopathy and fever. The likely treatment is:

Accepted Answer

Systemic antibiotics

Answer

Excise the lesion

Answer

Symptomatic treatment

Answer

I.V. fluids

Question 8

According to WHO, the major clinical sign of HIV infection in children in stage 1 is the following.

Accepted Answer

Generalised lymphadenopathy

Answer

Not gaining weight

Answer

Oral candidiasis

Answer

None of the options

Question 9

'Slapped cheeks' appearance is seen in:

Accepted Answer

Erythema infectiosum

Answer

Erythema multiforme

Answer

Erythema subitum

Answer

Roseola infantum

Question 10

All of the following are complications of meningitis in a child EXCEPT:

Accepted Answer

Thyroid dysfunction

Answer

Arachnoiditis

Answer

Intellectual disability

Answer

Status epilepticus

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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