Infectious Diseases — MCQs

A 6-year-old child from Kashmir is brought to New Delhi hospital in delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Blood culture was sterile after 48 hours of incubation, WeilFelix reaction shows increasing antibody titer and complement fixation test was positive. Which is the best treatment for the patient?

Q360

A 4-year-old child presents with fever for 4 days with decreased oral intake. On examination a rough textured rash on trunk is seen which blanches on pressure. Later the rash fades and desquamation occurs. All are true about the condition except:

Infectious Diseases Indian Medical PG Practice Questions and MCQs

Question 351: A child has developed this complication after vaccination. Which is the vaccine responsible?

A. MMR
B. BCG (Correct Answer)
C. DPT
D. Hepatitis B

Explanation: ***BCG*** - The image shows **regional lymphadenopathy** (BCG adenitis/lymphadenitis) in a child, likely involving the **ipsilateral axillary lymph nodes**, indicated by the swelling in the shoulder/axillary region. This is a well-recognized complication of the **BCG vaccine**. - BCG vaccine, especially in infants, can cause localized reactions including **lymphadenitis** in the ipsilateral axilla or supraclavicular regions (occurs in **0.1-4.3%** of vaccinated infants). - Typically appears **2-6 months post-vaccination** and may progress to **suppuration, caseous necrosis**, and occasionally sinus/fistula formation. - **Management:** Most cases resolve spontaneously with observation; aspiration (not incision) may be needed for large fluctuant nodes; antitubercular therapy reserved for severe cases. *MMR* - The MMR vaccine (Measles, Mumps, Rubella) is a **live attenuated vaccine** but does not typically cause regional lymphadenopathy as a common complication. - Common side effects of MMR include **fever** (5-15 days post-vaccination), **transient rash**, and **arthralgia/arthritis** (especially in adult women), not the significant localized lymphatic swelling seen in the image. *DPT* - The DPT vaccine (Diphtheria, Pertussis, Tetanus) is an **inactivated vaccine** known for **local reactions at the injection site**, such as redness, swelling, and pain. - May cause fever and irritability, but does not commonly cause **regional lymphadenopathy** distal to the injection site, nor the type of persistent nodal swelling depicted. *Hepatitis B* - The Hepatitis B vaccine is an **inactivated recombinant subunit vaccine**. Its side effects are generally mild and localized. - Local side effects include **pain, swelling, and redness at the injection site**, but it is not associated with significant **regional lymphadenopathy** or suppurative lymphadenitis.

Question 352: A 6-week-old child with tuberous sclerosis, and on vigabatrin has been brought for vaccination. Which of the following vaccine should be given?

A. A (Correct Answer)
B. B
C. C
D. D

Explanation: ***Correct Option A (DTaP/Pentavalent Vaccine)*** - At **6 weeks of age**, the child is due for the first dose of **DPT (Diphtheria, Pertussis, Tetanus)** or Pentavalent vaccine as per the Indian National Immunization Schedule - **Tuberous sclerosis is NOT an immunocompromising condition** and does not contraindicate any routine vaccines - **Vigabatrin is NOT immunosuppressive** - it is an antiepileptic drug used specifically for infantile spasms in tuberous sclerosis and does not affect vaccine response or safety - All routine vaccines including inactivated and live vaccines can be safely administered to children with tuberous sclerosis on vigabatrin *Incorrect Option B (BCG Vaccine)* - BCG vaccine is administered **at birth** (or as early as possible in the neonatal period), not at 6 weeks of age - By 6 weeks, the child should have already received BCG - Even if BCG was delayed, tuberous sclerosis and vigabatrin are NOT contraindications for BCG vaccination - The misconception that these children are immunocompromised is incorrect *Incorrect Option C (Varicella/Live Vaccine)* - Varicella vaccine is not part of the routine immunization schedule at 6 weeks in India - It is typically given at 15 months of age or later - Even though it is a live vaccine, it would NOT be contraindicated in this child as tuberous sclerosis and vigabatrin do not cause immunosuppression *Incorrect Option D (Other Vaccine Formulation)* - This does not represent the standard vaccine indicated at 6 weeks of age - At 6 weeks, the priority is to administer the first dose of DPT/Pentavalent vaccine along with OPV/IPV, Hepatitis B, Hib, Rotavirus, and PCV as per the immunization schedule

Question 353: A child presents with the ocular findings shown in the image below. Identify the most likely underlying illness:

A. Tetanus
B. Measles
C. Trachoma
D. Pertussis (Correct Answer)

Explanation: ***Pertussis (Whooping Cough)*** - The image shows **subconjunctival hemorrhage**, which is a **classic complication** of pertussis in children - Pertussis causes severe **paroxysmal coughing fits** that dramatically increase intrathoracic and intravascular pressure - This elevated pressure leads to rupture of conjunctival blood vessels, resulting in subconjunctival hemorrhages and facial petechiae - These hemorrhages are well-recognized **diagnostic clues** for pertussis, especially when accompanied by the characteristic whooping cough - This is a **primary manifestation** of the disease process, not merely an incidental finding *Trachoma* - Trachoma, caused by *Chlamydia trachomatis*, presents with **chronic follicular conjunctivitis** and progressive scarring - Classic features include follicles on upper tarsal conjunctiva, conjunctival scarring, trichiasis, and pannus formation - While it causes conjunctival inflammation, **acute subconjunctival hemorrhage is NOT a typical feature** of trachoma - Trachoma is a chronic, scarring disease rather than an acute hemorrhagic condition *Tetanus* - Tetanus is a neurological disorder characterized by **muscle rigidity** and **spasms**, beginning with trismus (lockjaw) - Ocular manifestations are limited to **risus sardonicus** (facial muscle spasm) and potential ophthalmoplegia - Does NOT cause subconjunctival hemorrhage as a direct manifestation *Measles* - Measles presents with **maculopapular rash**, fever, the three C's (cough, coryza, conjunctivitis), and **Koplik spots** - The conjunctivitis in measles is typically a **bilateral, non-hemorrhagic inflammation** with watery discharge - Does NOT typically cause prominent subconjunctival hemorrhage as shown in the image

Question 354: Identify the cause of rash in the child:

A. Rubeola (Correct Answer)
B. Rubella
C. Varicella
D. Roseola infantum

Explanation: ***Rubeola (Measles)*** - The image displays a **maculopapular rash**, which is characteristic of rubeola, commonly known as measles. The rash starts on the **face/behind the ears** and spreads downwards. - Measles rash is typically **blotchy** and can coalesce, and its distribution behind the ear is a classic early sign. *Rubella (German Measles)* - Rubella rash tends to be **finer** and **less confluent** than measles, often described as "rose-pink" macules. - While it also starts on the face and spreads, the rash is generally **milder** and disappears faster. *Varicella (Chickenpox)* - Varicella rash consists of **vesicles on an erythematous base** (dewdrop on a rose petal appearance), which then crust over. - The lesions appear in **crops**, leading to lesions of different stages simultaneously, which is not seen in the provided image. *Roseola infantum (Exanthem subitum)* - Roseola is characterized by a high fever for several days, followed by the sudden appearance of a **macular or maculopapular rash** once the fever breaks. - The rash typically starts on the **trunk** and spreads to the neck and extremities, which is a different pattern from the rash shown.

Question 355: The following disease presentation is caused by:

A. Scarlet fever
B. Arthus phenomenon
C. Human parvovirus B19 (Correct Answer)
D. Epstein-Barr virus

Explanation: ***Human parvovirus B19*** - The image shows a classic "slapped cheek" rash, which is a hallmark clinical presentation of **fifth disease**, caused by **Human parvovirus B19**. - This rash typically spares the circumoral area and develops after a prodromal phase of mild fever and malaise. *Scarlet fever* - Scarlet fever is characterized by a "sandpaper" rash, which feels rough, and often presents with **circumoral pallor**, but does not typically present as a "slapped cheek" appearance. - Patients often exhibit a **strawberry tongue** and high fever, not typically associated with the image provided. *Arthus phenomenon* - The Arthus phenomenon is a localized **type III hypersensitivity reaction** characterized by pain, swelling, and redness at the site of antigen injection, not a diffuse facial rash like the one seen. - This reaction is an immune complex-mediated process and is not an infectious disease causing a generalized rash. *Epstein-Barr virus* - Epstein-Barr virus (EBV) primarily causes **infectious mononucleosis**, which can produce a maculopapular rash, especially if the patient is treated with amoxicillin. - However, EBV rash does not typically manifest as the distinctive "slapped cheek" appearance seen in the image.

Question 356: Which is the most common complication of this rash?

A. Otitis media
B. Bronchopneumonia
C. Secondary skin infections (Correct Answer)
D. Reye syndrome

Explanation: ***Secondary skin infections*** - The rash shows vesicles and pustules characteristic of **varicella (chickenpox)**. The lesions are intensely itchy, leading to scratching, which can break the skin barrier and introduce bacteria. - **Superinfection with *Staphylococcus aureus* or *Streptococcus pyogenes*** is the most common complication, resulting in impetigo, cellulitis, or even more severe invasive infections. *Otitis media* - While otitis media can occur during viral illnesses, it is not the most common complication and is generally less frequent than secondary skin infections in the context of **varicella**. - It arises from inflammation and fluid accumulation in the middle ear, often due to bacterial superinfection following viral upper respiratory tract infection, but not directly from the skin lesions. *Bronchopneumonia* - **Varicella pneumonia** can be a severe complication, especially in adults and immunocompromised individuals, but it is less common in healthy children than secondary skin infections. - Bronchopneumonia refers to widespread inflammation of the bronchi and bronchioles, often presenting with cough and respiratory distress. *Reye syndrome* - Reye syndrome is a rare but serious complication, primarily associated with **aspirin use** in children with viral infections like varicella or influenza. - It involves **acute encephalopathy** and **fatty liver degeneration**, but it is preventable by avoiding salicylates and is not a direct result of the rash itself.

Question 357: A 2-year-old unimmunized child from a village presents with fever, decreased feeding and ear ache. All are true about the virus responsible for the condition shown except: (Recent NEET Pattern 2016-17)

A. Belongs to genus morbillivirus (Correct Answer)
B. Nonsuppurative parotitis
C. Can lead to aseptic meningitis
D. Causative virus possesses both H and N proteins

Explanation: The image shows a child with characteristic swelling of the parotid gland, indicative of Mumps. The clinical presentation (unimmunized child, fever, decreased feeding, ear ache, and parotid swelling) strongly points to Mumps. ***Correct Answer: Belongs to genus morbillivirus*** - This statement is **FALSE** and therefore the correct answer to this "EXCEPT" question. - The virus responsible for Mumps is the **Mumps virus**, which belongs to the **genus Rubulavirus** within the family Paramyxoviridae, NOT Morbillivirus. - Morbillivirus is the genus to which the **Measles virus** belongs. *Incorrect: Nonsuppurative parotitis* - **TRUE statement** - Mumps is classically characterized by **nonsuppurative parotitis**, meaning inflammation of the salivary glands (primarily parotid) without pus formation. - This is a key diagnostic feature of Mumps. *Incorrect: Can lead to aseptic meningitis* - **TRUE statement** - Aseptic meningitis is one of the most common and significant complications of Mumps, occurring in 10-15% of cases. - This complication typically presents with headache, stiff neck, and photophobia, without bacterial infection. *Incorrect: Causative virus possesses both H and N proteins* - **TRUE statement** - The Mumps virus, a member of the Paramyxoviridae family, possesses a combined **HN (hemagglutinin-neuraminidase) protein** on its surface. - The HN protein has both hemagglutinin and neuraminidase activities, responsible for binding to host cells and facilitating release of new virions from infected cells.

Question 358: A 5-year-old child in a village went for open air defecation when he was attacked by a dog. He has been admitted in your hospital, all are correct about the condition except: (Recent NEET Pattern 2016-17)

A. Category 3 bite
B. Wash with povidone-iodine
C. Administer vero cell vaccine with immunoglobulin
D. Virus infects pyramidal cells leading to cytolysis (Correct Answer)

Explanation: ***Virus infects pyramidal cells leading to cytolysis*** - The **rabies virus** primarily infects neurons and causes neuronal dysfunction rather than **cytolysis** (cell death and lysis), particularly in the early stages. - The characteristic pathological finding in rabies is the presence of **Negri bodies** (intracytoplasmic inclusions) which represent viral aggregates within unaffected neurons, not cytolytic destruction. *Category 3 bite* - A **Category 3 bite** involves single or multiple transdermal bites or scratches, licks on broken skin, or contamination of mucous membranes with saliva, especially if involving the head, neck, or digits, which appears to be the case given the severe facial injuries depicted with a dog bite. - Due to the high risk of rabies transmission in such severe wounds, Category 3 requires both **rabies vaccine** and **rabies immunoglobulin (RIG)** administration. *Wash with povidone-iodine* - Immediate and thorough **wound washing** with soap and water for at least 15 minutes is crucial for all animal bites, as it significantly reduces the viral load. - **Antiseptics** like povidone-iodine or alcohol can be used after washing to further disinfect the wound. *Administer vero cell vaccine with immunoglobulin* - For a **Category 3 rabies exposure**, both **rabies vaccine** (e.g., Vero cell vaccine) and **rabies immunoglobulin (RIG)** are indicated for post-exposure prophylaxis. - The vaccine provides active immunity, while the immunoglobulin provides immediate passive immunity, critical for high-risk exposures.

Question 359: A 6-year-old child from Kashmir is brought to New Delhi hospital in delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Blood culture was sterile after 48 hours of incubation, WeilFelix reaction shows increasing antibody titer and complement fixation test was positive. Which is the best treatment for the patient?

A. Doxycycline (Correct Answer)
B. Amoxicillin clavulanic acid
C. Ciprofloxacin
D. Rifabutin

Explanation: ***Doxycycline*** - The clinical presentation (high-grade fever, delirium, blanching rash on soles and palms, splenohepatomegaly, sterile blood culture, positive Weil-Felix) is highly suggestive of **scrub typhus**, a rickettsial infection. - **Doxycycline** is the treatment of choice for rickettsial infections, including scrub typhus, across all age groups, given its superior efficacy and limited alternatives. *Amoxicillin clavulanic acid* - This antibiotic combination is effective against a broad spectrum of **bacterial infections**, but it is not effective against rickettsial organisms. - The presented symptoms and lab results (especially positive Weil-Felix and sterile blood culture for common bacteria) rule out typical bacterial infections treatable by amoxicillin-clavulanic acid. *Ciprofloxacin* - Ciprofloxacin is a **fluoroquinolone antibiotic** typically used for various bacterial infections, including some atypical bacteria. - While it has some activity against rickettsia, it is not considered the first-line treatment and is less effective than doxycycline for scrub typhus. *Rifabutin* - Rifabutin is an antibiotic primarily used for the treatment of **mycobacterial infections**, such as those caused by *Mycobacterium avium complex* (MAC) or tuberculosis. - It has no role in the treatment of rickettsial infections like scrub typhus.

Question 360: A 4-year-old child presents with fever for 4 days with decreased oral intake. On examination a rough textured rash on trunk is seen which blanches on pressure. Later the rash fades and desquamation occurs. All are true about the condition except:

A. Caused by streptococcal pyrogenic exotoxins A, B, and C
B. Perioral cyanosis (Correct Answer)
C. Sandpaper rash
D. Red strawberry tongue

Explanation: ***Perioral cyanosis*** - **Perioral cyanosis** (bluish discoloration around the mouth) is *not* a characteristic feature of scarlet fever. It typically indicates **hypoxemia**, which is not directly caused by the streptococcal exotoxins in this condition. - Scarlet fever is characterized by a "circumoral pallor" where the area around the mouth appears pale in contrast to the flushed cheeks, rather than cyanotic. *Caused by streptococcal pyrogenic exotoxins A, B, and C* - Scarlet fever is indeed caused by strains of *Streptococcus pyogenes* that produce **streptococcal pyrogenic exotoxins (SPEs)**, particularly types A, B, and C. - These exotoxins act as **superantigens** and are responsible for the characteristic rash and systemic symptoms of scarlet fever. *Sandpaper rash* - The description of a **rough textured rash on the trunk that blanches on pressure**, fades, and then undergoes desquamation is characteristic of the **sandpaper rash** seen in scarlet fever. - This rash is a hallmark clinical sign of scarlet fever, caused by the erythrogenic toxins. *Red strawberry tongue* - The **red strawberry tongue** (initially white with red papillae, then becoming uniformly red) is a classic oral manifestation of scarlet fever. - This finding is due to the inflammation of the tongue papillae and is a key diagnostic feature of the condition.

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