Infectious Diseases Practice Questions

Q: Nagayama spots are seen in

Roseola infantum. ***Roseola infantum*** - **Nagayama spots** are **erythematous papules** on the **uvula and soft palate** that are characteristic of **roseola infantum**, also known as **exanthem subitum**. - This viral illness, typically caused by **HHV-6** or **HHV-7**, primarily affects infants and young children, presenting with a high fever followed by a characteristic rash. *Measles* - Measles (rubeola) is characterized by **Koplik spots**, which are **bluish-white spots on the buccal mucosa** adjacent to the molars. - While measles also causes a rash, its specific enanthem is distinct from Nagayama spots. *Mumps* - Mumps is a viral infection primarily causing **parotitis** (swelling of the salivary glands)**. - It does not typically present with specific oral lesions like Nagayama spots or Koplik spots. *Rubella* - Rubella, or German measles, is characterized by a **maculopapular rash** that spreads rapidly but less intensely than measles. - While it may cause **Forchheimer spots** (petechiae on the soft palate), these are different from Nagayama spots and often less distinct.

Q: While discharging a patient of meningitis due to Haemophilus influenzae, what is the essential step you would take?

Test for hearing loss using auditory response testing. ***Test for hearing loss using auditory response testing*** - **Hearing loss** is a common and serious complication of *Haemophilus influenzae* meningitis, potentially affecting up to 30% of survivors, and early detection is crucial for intervention [1]. - **Auditory brainstem response (ABR) testing** is a reliable method to assess hearing function in patients, especially children, after meningitis. *Perform an EEG to assess brain activity* - While meningitis can cause neurological complications like seizures, an **EEG** is primarily indicated for assessing **seizure activity** or other significant alterations in brain electrical function, not as a routine discharge step for all *Haemophilus influenzae* meningitis patients [2]. - An EEG would be performed if there were **clinical signs of seizures** or other neurological deficits requiring immediate investigation during hospitalization, rather than as a discharge routine. *Assess the patient's developmental milestones* - Assessing **developmental milestones** is important for all children, especially after a severe illness like meningitis, but it is a **long-term follow-up** concern and not an essential **immediate discharge step** focused on a specific, common complication. - Developmental assessments are typically part of routine pediatric check-ups and ongoing neurodevelopmental surveillance, rather than a single acute discharge intervention. *Refer the patient for physical rehabilitation* - **Physical rehabilitation** is necessary if the patient has experienced **motor deficits** or other physical impairments due to meningitis-related complications, such as stroke or cerebral palsy. - However, it is not an essential universal discharge step for all meningitis patients; it is only indicated if specific rehabilitation needs have been identified.

Q: Which throat infection in a child requires systemic antibiotic therapy?

Group A beta-hemolytic streptococci. ***Group A beta-hemolytic streptococci*** - **Group A streptococcal (GAS) pharyngitis** (strep throat) is a common bacterial infection in children that requires antibiotic treatment to prevent **rheumatic fever** and **glomerulonephritis**. - Systemic antibiotics are crucial to eradicate the bacteria and reduce the risk of these serious **post-streptococcal complications**. *Pneumococci* - **Pneumococcal infections** typically manifest as otitis media, pneumonia, or sinusitis, not primarily as throat infections warranting oral antibiotics in otherwise healthy children. - While *Streptococcus pneumoniae* can colonize the nasopharynx, it rarely causes pharyngitis requiring specific treatment as a sole diagnosis. *Staph aureus* - *Staphylococcus aureus* is an uncommon cause of **pharyngitis** in children and does not typically lead to the severe systemic complications associated with GAS that necessitate routine antibiotic therapy. - Pharyngeal infections with *S. aureus* are often more problematic in specific populations (e.g., immunocompromised) and do not usually present as typical "strep throat." *All of the options* - This option is incorrect because only **Group A beta-hemolytic streptococci** consistently require systemic antibiotic therapy for uncomplicated pharyngitis in children due to the risk of significant post-infectious complications. - **Pneumococci** and **Staph aureus** do not typically cause pharyngitis that necessitates this specific management strategy in the same context.

Q: Which of the following is not a complication of Congenital Rubella Syndrome (CRS)?

Macrocephaly. ***Macrocephaly*** - While CRS can lead to various neurological complications, **macrocephaly** (abnormally large head circumference) is not a typical manifestation of the syndrome. Neurological issues in CRS more commonly involve **microcephaly** due to brain damage. - Other common neurological complications include **meningoencephalitis** and developmental delays, but not an enlarged head. *Retinopathy* - **Pigmentary retinopathy** (salt-and-pepper retinopathy) is a classic ocular manifestation of CRS, often present at birth. - This is a direct consequence of the rubella virus affecting the developing retinal structures. *Spontaneous abortion* - Maternal rubella infection, especially during the **first trimester**, carries a significant risk of **spontaneous abortion** due to severe fetal damage. - The virus's teratogenic effects can be so profound that the fetus is not viable. *Cardiac abnormalities* - **Congenital heart defects** are a hallmark of CRS, with **patent ductus arteriosus (PDA)** and **pulmonary artery stenosis** being the most common. - These abnormalities result from the rubella virus interfering with normal cardiac development during embryogenesis.

Q: Treatment of whooping cough is

Erythromycin. ***Erythromycin*** - **Macrolide antibiotics** like erythromycin are the **first-line treatment** for whooping cough (*Bordetella pertussis*), especially when administered early in the catarrhal stage. - They work by **eradicating the bacteria**, **reducing the duration of infectiousness**, and can lessen the severity and duration of symptoms if given promptly. *Rifampicin* - **Rifampicin** is primarily used in the treatment of **tuberculosis** and other mycobacterial infections, not whooping cough. - Its mechanism of action involves inhibiting bacterial RNA synthesis, which is not the preferred strategy for *Bordetella pertussis*. *Tetracycline* - While **tetracyclines** are broad-spectrum antibiotics, they are generally **not recommended for whooping cough** due to potential side effects, particularly in young children (e.g., tooth discoloration). - Macrolides are superior and safer alternatives for *Bordetella pertussis* infection. *Ampicillin* - **Ampicillin** is a **beta-lactam antibiotic** commonly used for various bacterial infections, but it is **ineffective against *Bordetella pertussis***. - *Bordetella pertussis* shows resistance to penicillins and other beta-lactams, likely due to **beta-lactamase production** and the organism's location in the respiratory tract where beta-lactams may not achieve adequate bactericidal concentrations.

Q: At what age is the MMR vaccination typically administered?

One year. ***One year*** - The **first dose** of the MMR (measles, mumps, and rubella) vaccine is typically given to children between **12 and 15 months of age**. - This timing is chosen because maternal antibodies, which might interfere with vaccine effectiveness, generally wane by this age. - The **second dose** is administered between 4 and 6 years of age. *Incorrect: 1.5 years* - While some vaccination schedules may show 18 months as acceptable, the **standard recommendation for the first dose is earlier**, between 12-15 months. - Delaying beyond 15 months leaves children vulnerable to measles during a high-risk period. *Incorrect: 6 months* - Administering the MMR vaccine at 6 months is generally **not recommended** for routine first dose. - At this age, **maternal antibodies** can still be present, which might neutralize the vaccine and reduce its effectiveness. - However, in outbreak situations or before international travel, a dose may be given as early as 6 months (but must be repeated after 12 months). *Incorrect: 2 months* - At 2 months, infants receive other routine vaccines (DTaP, IPV, Hib, PCV, Rotavirus), but **not MMR**. - MMR is a **live attenuated vaccine** requiring a more mature immune system to mount an effective response. - Maternal antibodies present at 2 months would interfere with MMR vaccine effectiveness.

Question 1

Nagayama spots are seen in

Accepted Answer

Roseola infantum

Answer

Measles

Answer

Mumps

Answer

Rubella

Question 2

While discharging a patient of meningitis due to Haemophilus influenzae, what is the essential step you would take?

Accepted Answer

Test for hearing loss using auditory response testing

Answer

Assess the patient's developmental milestones

Answer

Refer the patient for physical rehabilitation

Answer

Perform an EEG to assess brain activity

Question 3

Which throat infection in a child requires systemic antibiotic therapy?

Accepted Answer

Group A beta-hemolytic streptococci

Answer

Pneumococci

Answer

Staph aureus

Answer

All of the options

Question 4

Which of the following is not a complication of Congenital Rubella Syndrome (CRS)?

Accepted Answer

Macrocephaly

Answer

Retinopathy

Answer

Cardiac abnormalities

Answer

Spontaneous abortion

Question 5

Treatment of whooping cough is

Accepted Answer

Erythromycin

Answer

Rifampicin

Answer

Tetracycline

Answer

Ampicillin

Question 6

At what age is the MMR vaccination typically administered?

Accepted Answer

One year

Answer

1.5 years

Answer

2 months

Answer

6 months

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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