Infectious Diseases Practice Questions

Q: Which of the following is NOT transmitted through the sexual route?

Hepatitis E. **Explanation:** The transmission of Hepatitis viruses is a high-yield topic for NEET-PG. To answer this correctly, one must distinguish between **Enteric** (fecal-oral) and **Parenteral/Sexual** routes. **Why Hepatitis E is the correct answer:** Hepatitis E (HEV) is primarily transmitted via the **fecal-oral route**, most commonly through contaminated drinking water. While Hepatitis A is also enteric, current medical literature and epidemiological studies (including CDC and WHO guidelines) indicate that Hepatitis E has **no documented sexual transmission** route. In contrast, Hepatitis A can be transmitted sexually, particularly through oral-anal contact (common in MSM populations). **Analysis of Incorrect Options:** * **Option A (Hepatitis A):** While primarily fecal-oral, HAV is recognized as a sexually transmitted infection (STI) among men who have sex with men (MSM) due to direct or indirect oral-anal contact. * **Option C (Hepatitis A & E):** This is incorrect because, as established, Hepatitis A *can* be transmitted sexually, whereas Hepatitis E cannot. * **Option D (Hepatitis D):** Hepatitis D (Delta virus) requires the presence of Hepatitis B (HBsAg) to replicate. It shares the same transmission routes as HBV, which includes percutaneous, mucosal, and **sexual contact**. **High-Yield Clinical Pearls for NEET-PG:** * **Vowels (A & E):** Transmitted via the **Enteric** route (Fecal-oral). * **Consonants (B, C, D):** Transmitted via **Blood**/Body fluids (Parenteral/Sexual). * **Pregnancy Warning:** Hepatitis E is notorious for causing high mortality (up to 20%) in pregnant women due to fulminant hepatic failure. * **Chronic Status:** Hepatitis A and E generally cause acute infection only (except HEV in immunocompromised hosts), while B, C, and D can lead to chronic carrier states.

Q: Following the identification of a case of acute flaccid paralysis (AFP), what is the next step in management?

Reporting the case to public health authorities. ### Explanation **Correct Answer: B. Reporting the case to public health authorities** **Concept:** Under the Global Polio Eradication Initiative, **Acute Flaccid Paralysis (AFP) surveillance** is the gold standard for detecting the transmission of wild poliovirus. In any surveillance system, the **immediate next step** upon identifying a suspected case is **notification/reporting**. In India, any case of AFP in a child under 15 years of age (or any person of any age if polio is suspected) must be reported to the District Immunization Officer within **24 hours**. This triggers the investigation process, including stool sample collection and mapping. **Analysis of Incorrect Options:** * **A. Administering OPV:** While vaccination is preventive, it is not the immediate management step for a patient already presenting with paralysis. Outbreak response immunization (mop-up rounds) occurs only after laboratory confirmation. * **C. Performing stool culture:** This is a critical part of the investigation (two "adequate" stool samples 24 hours apart within 14 days of onset), but it can only be initiated systematically *after* the case is reported and an investigation ID is generated. * **D. Initiating chemoprophylaxis:** There is no chemoprophylaxis available for Polio; it is a viral disease managed through supportive care and prevented via vaccination. **High-Yield Pearls for NEET-PG:** * **AFP Definition:** Sudden onset of flaccid paralysis in a child <15 years. * **Surveillance Indicators:** 1. **Non-Polio AFP Rate:** Should be $\geq$ 2 per 100,000 children <15 years (indicator of system sensitivity). 2. **Stool Adequacy:** $\geq$ 80% of reported cases should have two stool samples collected 24 hours apart within 14 days of paralysis onset. * **Zero Reporting:** Even if no cases are found, a "nil" report must be submitted weekly to ensure the surveillance system is active.

Q: Post-exposure prophylaxis is indicated in all of the following conditions EXCEPT:

Japanese encephalitis. **Explanation:** Post-exposure prophylaxis (PEP) is the administration of drugs or vaccines after a potential exposure to a pathogen to prevent the development of disease. **Why Japanese Encephalitis (JE) is the correct answer:** JE is a vector-borne viral disease transmitted by the *Culex* mosquito. There is **no recommended PEP** for JE because there is no evidence that post-exposure vaccination or antiviral therapy prevents the onset of the disease once a person has been bitten by an infected mosquito. Prevention relies solely on pre-exposure vaccination and vector control. **Analysis of other options:** * **HIV:** PEP is a standard of care involving a 28-day course of Antiretroviral Therapy (ART), ideally started within 2 hours (and no later than 72 hours) after needle-stick injuries or sexual exposure. * **Varicella Zoster:** PEP is indicated for susceptible individuals (e.g., immunocompromised, pregnant women, or neonates) using **Varicella-Zoster Immunoglobulin (VZIG)** or the Varicella vaccine within 3–5 days of exposure. * **Swine Influenza (H1N1):** Oseltamivir (Tamiflu) is indicated as PEP for high-risk individuals (e.g., household contacts with comorbidities) who have been exposed to a confirmed case. **High-Yield Clinical Pearls for NEET-PG:** * **Rabies:** The most critical PEP in India; involves wound cleaning, RIG (Immunoglobulin), and modern cell culture vaccines (ARV). * **Hepatitis B:** PEP involves HBIG and the Hep B vaccine series for unvaccinated individuals after percutaneous exposure. * **Meningococcal Meningitis:** Chemoprophylaxis with **Rifampicin** (drug of choice), Ciprofloxacin, or Ceftriaxone is indicated for close contacts.

Q: What is the recommended distance for vector control around an airport for yellow fever?

400 m. **Explanation:** The correct answer is **400 meters (Option A)**. This distance is a standard International Health Regulation (IHR) requirement aimed at preventing the transmission of Yellow Fever via its primary vector, the *Aedes aegypti* mosquito. **Why 400 meters?** The "Aedes-free zone" or "Sanitary zone" is established around airports and seaports to ensure that mosquitoes do not board aircraft or ships. The distance of 400 meters is chosen because it exceeds the typical flight range of the *Aedes aegypti* mosquito, which is generally limited to 100–200 meters. By maintaining a 400m buffer zone free of breeding sites, the risk of "imported" or "exported" yellow fever is significantly minimized. **Analysis of Incorrect Options:** * **Option B (200 m):** While this is the average flight range of the mosquito, it does not provide a sufficient safety margin for international quarantine standards. * **Option C (500 m) & Option D (100 m):** These distances are not recognized by the WHO or IHR for specific vector control perimeters regarding yellow fever. 100m is too short to be effective, and 500m is not the standardized regulatory figure. **High-Yield Clinical Pearls for NEET-PG:** * **Vector:** *Aedes aegypti* (Urban yellow fever) and *Haemagogus* (Sylvan/Jungle yellow fever). * **Vaccine:** 17D strain (Live attenuated). It becomes effective **10 days** after administration and provides **lifelong immunity** (as per 2016 WHO amendments). * **Validity of Certificate:** For international travel, the yellow fever vaccination certificate is valid for life, starting 10 days after vaccination. * **Incubation Period:** 3 to 6 days. * **India Status:** India is "Yellow Fever receptive" (vector is present, but the disease is not). Therefore, strict quarantine and vector control at entry points are mandatory.

Q: What is the primary reservoir for scrub typhus?

Rodents. **Explanation:** **Scrub Typhus** is a rickettsial zoonosis caused by *Orientia tsutsugamushi*. Understanding the transmission cycle is crucial for NEET-PG. **1. Why Rodents are the Correct Answer:** In the transmission cycle of scrub typhus, **rodents** (specifically field mice and rats) serve as the **primary reservoir** of the infection in nature. They maintain the bacteria in the environment, providing a persistent source of infection for the vectors. **2. Analysis of Incorrect Options:** * **Mites (Option A):** While mites (specifically the larval stage called **chiggers**) are the **vectors** that transmit the disease to humans, they are not the primary reservoir. However, they can maintain the bacteria through *transovarial transmission* (acting as a secondary reservoir). * **Humans (Option B):** Humans are **accidental, dead-end hosts**. We do not transmit the disease further and are not involved in maintaining the infection cycle in nature. * **Dogs (Option C):** Dogs are not involved in the epidemiological cycle of scrub typhus. **3. High-Yield Clinical Pearls for NEET-PG:** * **Vector:** Larval stage of trombiculid mites (*Leptotrombidium deliense*). * **Pathognomonic Sign:** The **Eschar** (a painless, black crusty sore at the site of the mite bite) is the most important clinical diagnostic clue. * **Habitat:** "Mite islands" (areas of scrub vegetation where the vector and reservoir coexist). * **Drug of Choice:** **Doxycycline** is the gold standard treatment. Azithromycin is an alternative, especially in pregnancy. * **Diagnosis:** The **Weil-Felix test** (OX-K positive) is a classic but non-specific test; IgM ELISA is now the preferred diagnostic method.

Q: What is the concentration of sodium in mOsm/L in low osmolar ORS?

75. **Explanation:** The WHO and UNICEF recommended the shift from standard ORS to **Low Osmolar ORS** (Reduced Osmolarity ORS) to improve clinical outcomes. The primary goal was to reduce the risk of hypernatremia and decrease the need for unscheduled IV fluids by lowering the total osmolarity. **1. Why 75 mOsm/L is correct:** In the Reduced Osmolarity ORS formulation, the concentration of **Sodium is 75 mmol/L (or mOsm/L)** and **Glucose is 75 mmol/L**. This 1:1 molar ratio is critical because it optimizes the sodium-glucose cotransport mechanism in the small intestine, ensuring maximum water absorption while reducing stool output and vomiting compared to the older formula. **2. Analysis of Incorrect Options:** * **Option A (45):** This is too low for standard rehydration in diarrhea, though some specialized maintenance fluids or "ReSoMal" (used in severe acute malnutrition) have lower sodium levels (approx. 45 mmol/L). * **Option C (90):** This was the sodium concentration in the **Old/Standard WHO ORS**. While effective for cholera, it was found to increase the risk of hypernatremia in children with non-cholera diarrhea. * **Option D (60):** This does not correspond to the sodium concentration of any standard WHO-recommended ORS formulation. **High-Yield Clinical Pearls for NEET-PG:** * **Total Osmolarity of Low Osmolar ORS:** 245 mOsm/L (Old ORS was 311 mOsm/L). * **Composition Breakdown:** Sodium (75), Glucose (75), Potassium (20), Chloride (65), and Trisodium Citrate (10). * **Citrate vs. Bicarbonate:** Citrate is used because it increases the shelf life of the ORS packet and helps correct acidosis. * **Zinc Supplementation:** Always remember that Zinc (20mg/day for 14 days; 10mg for infants <6 months) is given alongside ORS to reduce the duration and severity of diarrhea.

Q: What is the recommended threshold for parasite prevalence (API) for initiating Malaria Mass Drug Administration?

Greater than 2. **Explanation:** In the context of Malaria control and elimination strategies, the **Annual Parasite Incidence (API)** is the most common indicator used to measure the malaria burden in a population. It is defined as the number of confirmed cases per 1,000 population per year. **Why Option B is Correct:** According to the National Framework for Malaria Elimination (NFME) in India and WHO guidelines, an **API > 2** is the critical threshold used to categorize "High Burden" areas (Category 3). In these high-transmission settings, **Mass Drug Administration (MDA)** or targeted mass treatments are recommended as a rapid intervention to reduce the parasite reservoir in the community, interrupt transmission, and prevent outbreaks. **Analysis of Incorrect Options:** * **Option A (API > 5):** While an API > 5 indicates very high transmission, the intervention threshold for aggressive measures like MDA is lower (at 2) to ensure early containment before the burden reaches such high levels. * **Option C (15) and D (25):** These values are significantly higher than the standard epidemiological thresholds used for public health decision-making in malaria elimination programs. An API of 15-25 would indicate a severe epidemic state rather than a strategic threshold for initiating MDA. **High-Yield Clinical Pearls for NEET-PG:** * **API Formula:** (Total number of positive slides / Total population) × 1000. * **API 10%** to ensure adequate surveillance. * **SPR (Slide Positivity Rate):** A more sensitive indicator of recent changes in transmission than API. * **MDA Drugs:** Usually involves a combination of an ACT (Artemisinin-based Combination Therapy) and a single dose of Primaquine (as a gametocytocide).

Q: Acute flaccid paralysis is reported in a child aged -

0-15 years. ### Explanation **1. Why Option C is Correct:** Under the **Global Polio Eradication Initiative**, Acute Flaccid Paralysis (AFP) surveillance is the gold standard for detecting poliomyelitis. The operational definition for AFP surveillance includes any child **under the age of 15 years** who presents with recent onset of floppy weakness (including Guillain-Barré syndrome, transverse myelitis, or traumatic neuritis). Additionally, the surveillance system includes any person of any age if polio is strongly suspected by a clinician. The 0–15 age group is targeted because children in this bracket are most susceptible to paralytic poliomyelitis. **2. Why Other Options are Incorrect:** * **Option A (0-3 years) & B (0-5 years):** While children under 5 are at the highest risk for contracting the poliovirus, surveillance must be broader to ensure no cases are missed. Limiting surveillance to these ages would result in poor sensitivity and failure to detect late-childhood cases. * **Option D (0-25 years):** This range is too broad for routine AFP surveillance. While adults can contract polio, the epidemiological focus for eradication remains on the pediatric population where transmission is most active. **3. High-Yield Clinical Pearls for NEET-PG:** * **AFP Surveillance Goal:** To achieve a "Non-polio AFP rate" of at least **2 per 100,000** children under 15 years (an indicator of a sensitive surveillance system). * **Stool Collection:** Two "adequate" stool samples must be collected **24–48 hours apart** within **14 days** of the onset of paralysis. * **Zero Reporting:** This is a key component where health facilities must report "zero cases" weekly if no AFP cases are detected, ensuring active monitoring. * **India Status:** India was declared Polio-free by the WHO on **March 27, 2014** (last case reported in Jan 2011, Howrah, West Bengal).

Q: Case Fatality Rate (CFR) of Rabies is:

100%. ### Explanation **1. Understanding the Correct Answer (C. 100%)** Case Fatality Rate (CFR) is a measure of the **virulence** or killing power of a disease, calculated as the number of deaths divided by the total number of diagnosed cases. Rabies is unique in clinical medicine because once the virus enters the central nervous system and symptoms appear, it is considered **universally fatal**. There is no effective cure for clinical rabies, and death typically occurs within 2 to 10 days due to respiratory paralysis or cardiac arrest. Therefore, the CFR is mathematically and clinically 100%. **2. Analysis of Incorrect Options (A, B, D)** Options A (80%), B (90%), and D (95%) are incorrect because they suggest a possibility of survival or recovery after the onset of symptoms. While modern intensive care (e.g., the Milwaukee Protocol) has attempted to treat symptomatic patients, these cases are extreme statistical outliers and have not successfully altered the established 100% CFR in medical literature. **3. NEET-PG High-Yield Clinical Pearls** * **Definition of CFR:** It is a ratio (expressed as a percentage), not a rate, as it does not involve a time component in the denominator. * **Indicator of Virulence:** CFR is the best indicator of the virulence of an infectious agent. * **Rabies Prevention:** While the CFR is 100%, the disease is **100% preventable** through timely Post-Exposure Prophylaxis (PEP), including wound washing, Rabies Vaccine, and Rabies Immunoglobulin (RIG). * **Incubation Period:** Typically 1–3 months but can range from 1 year. * **Diagnostic Hallmark:** Presence of **Negri bodies** (intracytoplasmic inclusion bodies) in the hippocampus and cerebellum (post-mortem).

Question 1

Which of the following is an example of a zoonotic disease?

Accepted Answer

Anthrax

Answer

Brucellosis

Answer

Leptospirosis

Answer

Chagas disease

Question 2

Which of the following is NOT transmitted through the sexual route?

Accepted Answer

Hepatitis E

Answer

Hepatitis A

Answer

Hepatitis A & E

Answer

Hepatitis D

Question 3

Following the identification of a case of acute flaccid paralysis (AFP), what is the next step in management?

Accepted Answer

Reporting the case to public health authorities

Answer

Administering Oral Polio Vaccine (OPV)

Answer

Performing stool culture for enteroviruses

Answer

Initiating chemoprophylaxis

Question 4

Post-exposure prophylaxis is indicated in all of the following conditions EXCEPT:

Accepted Answer

Japanese encephalitis

Answer

HIV

Answer

Varicella zoster

Answer

Swine influenza

Question 5

What is the recommended distance for vector control around an airport for yellow fever?

Accepted Answer

400 m

Answer

200 m

Answer

500 m

Answer

100 m

Question 6

What is the primary reservoir for scrub typhus?

Accepted Answer

Rodents

Answer

Mites

Answer

Humans

Answer

Dogs

Question 7

What is the concentration of sodium in mOsm/L in low osmolar ORS?

Accepted Answer

75

Answer

45

Answer

90

Answer

60

Question 8

What is the recommended threshold for parasite prevalence (API) for initiating Malaria Mass Drug Administration?

Accepted Answer

Greater than 2

Answer

Greater than 5

Answer

15

Answer

25

Question 9

Acute flaccid paralysis is reported in a child aged -

Accepted Answer

0-15 years

Answer

0-3 years

Answer

0-5 years

Answer

0-25 years

Question 10

Case Fatality Rate (CFR) of Rabies is:

Accepted Answer

100%

Answer

80%

Answer

90%

Answer

95%

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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