Infectious Diseases Practice Questions

Q: Most common complication of mumps in children:

Aseptic meningitis. ***Aseptic meningitis*** - **Aseptic meningitis** is the most frequent complication of mumps, occurring in approximately 10-30% of cases, primarily in children. - It usually presents with mild symptoms like **headache**, **fever**, and **nuchal rigidity** and typically resolves without specific treatment or long-term sequelae. - This is a benign, self-limiting condition that represents **CNS involvement** during mumps infection. *Myocarditis* - Myocarditis can occur as a complication of mumps, but it is **relatively rare** and much less common than aseptic meningitis. - While it can be serious, it is not considered the most common complication in children. *Orchitis* - Orchitis (inflammation of the testicles) is a well-known complication of mumps, but it primarily affects **post-pubertal males** and is uncommon in prepubertal children. - In the pediatric age group specifically, it is **less common than aseptic meningitis**. - Can lead to testicular atrophy and potential fertility issues in adults. *Pancreatitis* - Pancreatitis is a known but **less frequent complication**, occurring in about 2-5% of mumps cases. - While it can cause abdominal pain and elevated serum amylase, it is not the most common complication of mumps in children.

Q: A child presents with complaints of cough. Characteristic inspiratory whoop present. He is not immunised. Sample for investigation is:

Nasopharyngeal swab. ***Nasopharyngeal swab*** - A **nasopharyngeal swab** is the preferred sample for diagnosing **whooping cough** (pertussis) caused by *Bordetella pertussis*, especially for PCR testing. - This method provides the best yield for detecting the bacterium which colonizes the **nasopharynx**. *Sputum culture* - **Sputum culture** is generally not recommended for diagnosing pertussis as *Bordetella pertussis* is a fastidious organism and less likely to be found in sputum. - Sputum collection can also be challenging and less effective in young children. *Tracheal aspiration* - **Tracheal aspiration** is an invasive procedure and is generally reserved for critically ill patients or those with specific indications like ventilator-associated pneumonia, not routine pertussis diagnosis. - The primary site for *Bordetella pertussis* colonization is the nasopharynx, not typically deep within the trachea for initial sampling. *Cough plate culture* - **Cough plate culture** involves exposing a culture medium directly to a patient's cough, but it is an older technique with lower sensitivity and specificity compared to nasopharyngeal swabs and PCR. - Modern diagnostic methods, such as PCR from nasopharyngeal samples, offer faster and more accurate results for pertussis.

Q: Which of the following is true regarding Typhoid in children -

Mild splenomegaly is usual. ***Mild splenomegaly is usual*** - **Splenomegaly** is a common finding in children with typhoid fever, often mild to moderate. - The spleen may enlarge due to bacterial dissemination and the body's immune response to the infection. *Urine culture is positive in 4 to 6 days* - **Urine culture** typically becomes positive much later in the course of typhoid fever, usually after the first week or even later, once bacteria have disseminated more widely. - **Blood culture** is the most reliable diagnostic test in the first week of illness. *Leukocytosis is characteristic* - **Leukopenia** (low white blood cell count), sometimes with relative lymphocytosis, is characteristic of typhoid fever, especially in the early stages. - **Leukocytosis** (high white blood cell count) is atypical and may suggest a different infection or a complication. *Encephalitis is common* - **Encephalopathy** (altered mental status, confusion) can occur in severe cases of typhoid fever, sometimes referred to as "typhoid encephalopathy." - True **encephalitis** (inflammation of the brain parenchyma) is a less common neurological complication and is not characteristic for every case.

Q: Roseola infantum is caused by ______

HHV 6. ***HHV 6*** - **Roseola infantum**, also known as **exanthem subitum**, is characteristically caused by **Human Herpesvirus 6 (HHV 6)**. - This virus typically causes an illness in infants and young children featuring a **high fever for several days** followed by a **maculopapular rash** after the fever subsides. *Rubeola* - **Rubeola** is the virus responsible for **measles**, a disease distinctly different from roseola with prominent symptoms like **Koplik spots** and a rash that appears during the fever. - Measles rash typically starts on the face and spreads downwards, while roseola rash appears after the fever breaks. *Rubella* - **Rubella** causes **German measles**, characterized by a **milder rash** and relatively few systemic symptoms compared to measles. - Unlike roseola, rubella's rash often appears coincident with or shortly after the fever, and the fever is generally not as high. *HHV 5* - **HHV 5** refers to **Cytomegalovirus (CMV)**, which is associated with a wide range of clinical manifestations, including congenital infections, mononucleosis-like syndrome, and opportunistic infections in immunocompromised individuals. - CMV typically does not cause the classic fever-then-rash presentation seen in roseola infantum.

Q: A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –

Obtain HBeAg and anti-HBe levels. **Obtain HBeAg and anti–HBe levels** - Given the child is **HBsAg positive** on two separate occasions and has a mother with **chronic hepatitis B**, evaluating **HBeAg** and **anti-HBe levels** is crucial to determine if the child is in a high replicative immune tolerant phase or an immune clearance phase. - This information helps differentiate between persistent infection, risk of vertical transmission, and guides subsequent management, including the potential for antiviral therapy and monitoring requirements. *Repeat another course of Hepatitis B vaccine* - Repeating the vaccine is not indicated as the child is already **HBsAg positive**, indicating an active infection or carrier state, not a need for further immunization. - Vaccination aims to prevent infection, but in this case, the child is already confirmed to be infected. *Repeat HBsAg* - The question states the child was detected to be **HBsAg positive on two separate occasions**, making another repeat unnecessary for confirmation of infection. - The next step should aim to characterize the infection rather than re-confirm its presence. *Obtain anti HBs levels* - **Anti-HBs antibodies** indicate immunity from vaccination or resolved infection. Since the child is **HBsAg positive**, indicating active infection, anti-HBs levels would likely be negative or low and would not provide critical information about the current stage of infection. - The focus should be on characterizing the active infection, not assessing protective immunity.

Q: A mother brings her 9 month old child for vaccination. Which of the following statements is false regarding immunization of Japanese encephalitis?

Live vaccine SA 14-14-2 is administered intramuscularly. ***Live vaccine SA 14-14-2 is administered intramuscularly*** - The live attenuated **JE vaccine SA 14-14-2** is approved for subcutaneous (SC) administration, not intramuscular (IM). - While some vaccines are given IM, the specific instructions for this live JE vaccine specify the **subcutaneous route**. *2 doses are recommended at age 9 months and 18 months* - This statement is **true** for the live attenuated Japanese Encephalitis vaccine, as two doses at 9 and 18 months provide good long-term protection. - This schedule is commonly adopted in JE-endemic regions for comprehensive immunization. *The live attenuated vaccine can be given to adolescents* - This statement is **true**, as the live attenuated JE vaccine is approved for use across a wide age range, including adolescents, for primary immunization or as a booster. - The vaccine is generally well-tolerated and effective in this age group. *The strain used for live vaccine is JE strain SA 14-14-2* - This statement is **true**; the **SA 14-14-2 strain** is the most widely used and well-characterized live attenuated Japanese Encephalitis vaccine globally. - It has demonstrated high efficacy and a good safety profile in preventing JE caused by various genotypes.

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: Which of the following is the most common clinical manifestation of human parvovirus B19?

Erythema infectiosum. ***Erythema infectiosum*** - This is also known as **fifth disease** and is characterized by a "slapped cheek" rash on the face followed by a lacy rash on the trunk and limbs. - It is a common and usually mild illness in children, caused by **human parvovirus B19**. *Hydrops fetalis* - While parvovirus B19 can cause hydrops fetalis in pregnant women by infecting fetal red blood cell precursors, it is a severe, less common manifestation rather than a **common clinical presentation** across all infected individuals. - Hydrops fetalis is characterized by **extensive fetal edema** and effusions, leading to high mortality. *Aplastic crisis in hemolytic anemia patients* - Parvovirus B19 can cause transient aplastic crisis, especially in individuals with **pre-existing hemolytic anemias** (e.g., sickle cell disease), due to its tropism for erythroid progenitor cells. - However, this is a specific complication in a susceptible population, not the **most common clinical manifestation** in the general population. *Anemia in neonatal period* - Parvovirus B19 infection can cause severe anemia in newborns if the mother is infected during pregnancy. - However, direct infection causing anemia in the neonatal period is less common than erythema infectiosum, which is widespread in children.

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**.

Question 1

Most common complication of mumps in children:

Accepted Answer

Aseptic meningitis

Answer

Myocarditis

Answer

Pancreatitis

Answer

Orchitis

Question 2

A child presents with complaints of cough. Characteristic inspiratory whoop present. He is not immunised. Sample for investigation is:

Accepted Answer

Nasopharyngeal swab

Answer

Sputum culture

Answer

Tracheal aspiration

Answer

Cough plate culture

Question 3

Which of the following is true regarding Typhoid in children -

Accepted Answer

Mild splenomegaly is usual

Answer

Urine culture is positive in 4 to 6 days

Answer

Leukocytosis is characteristic

Answer

Encephalitis is common

Question 4

Roseola infantum is caused by ______

Accepted Answer

HHV 6

Answer

Rubeola

Answer

Rubella

Answer

HHV 5

Question 5

A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –

Accepted Answer

Obtain HBeAg and anti-HBe levels

Answer

Repeat another course of Hepatitis B vaccine

Answer

Repeat HBsAg

Answer

Obtain anti HBs levels

Question 6

Which statement is FALSE about '100 Day Cough'?

Accepted Answer

Incidence and fatality are more common in males than females.

Answer

Incubation period is 7-14 days.

Answer

Erythromycin is the drug of choice.

Answer

There is no subclinical or chronic carrier state.

Question 7

A mother brings her 9 month old child for vaccination. Which of the following statements is false regarding immunization of Japanese encephalitis?

Accepted Answer

Live vaccine SA 14-14-2 is administered intramuscularly

Answer

2 doses are recommended at age 9 months and 18 months

Answer

The live attenuated vaccine can be given to adolescents

Answer

The strain used for live vaccine is JE strain SA 14-14-2

Question 8

Koplik spots are characteristic of:-

Accepted Answer

Measles

Answer

Chicken pox

Answer

HIV

Answer

Mumps

Question 9

Which of the following is the most common clinical manifestation of human parvovirus B19?

Accepted Answer

Erythema infectiosum

Answer

Hydrops fetalis

Answer

Aplastic crisis in hemolytic anemia patients

Answer

Anemia in neonatal period

Question 10

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

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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