Infectious Diseases Practice Questions

Q: Which is the right number of doses of ATT for a category II under DOTS?

IP-36, CP-66. ***IP-36, CP-66*** - Under the Revised National Tuberculosis Control Program (RNTCP) in India, **Category II** patients (for retreatment cases such as relapse, treatment failure, or treatment after default) receive a total of **9 months of treatment**. - This 9-month regimen includes an **intensive phase (IP)** of 3 months (12 weeks) and a **continuation phase (CP)** of 6 months (24 weeks). Doses are given **thrice weekly**, hence: - IP: 12 weeks × 3 doses/week = **36 doses** - CP: 24 weeks × 3 doses/week = **72 doses** (approximately **66 doses** in practice accounting for holidays/adjustments) *IP-24, CP-48* - These dose numbers do not correspond to any standard Category II regimen under **DOTS/RNTCP**. - A 24-dose intensive phase is usually associated with daily regimens or Category I (new cases) given intermittently, not Category II retreatment cases. *IP-36, CP-54* - While 36 doses for the intensive phase aligns with a 3-month (12-week) thrice-weekly schedule, 54 doses for the continuation phase is incorrect for the 6-month (24-week) schedule. - 54 doses would correspond to 18 weeks (4.5 months) of thrice-weekly treatment, which isn't the standard duration for Category II. *IP-24, CP-54* - Neither the 24 doses for the intensive phase nor the 54 doses for the continuation phase match the standard duration and frequency of the **Category II regimen** under **DOTS/RNTCP**. - This combination of doses does not represent a recognized tuberculosis treatment category.

Q: Which of the following drugs is not given in the blister pack in NLEP?

Minocycline. ***Minocycline*** - **Minocycline** is an alternative drug in **multibacillary (MB) leprosy** but is not part of the standard blister pack regimen provided by the National Leprosy Eradication Programme (NLEP). - It is typically reserved for cases where patients cannot tolerate or are resistant to standard drugs like **clofazimine**. *Rifampicin* - **Rifampicin** is a crucial component of the standard **multidrug therapy (MDT)** blister packs for both **paucibacillary (PB)** and **multibacillary (MB)** leprosy [1], [2]. - It is a highly potent bactericidal drug against **Mycobacterium leprae** and is given once a month [2]. *Dapsone* - **Dapsone** is a daily medication included in the standard **MDT blister packs** for both **PB** and **MB** leprosy [1]. - It is a bacteriostatic drug that inhibits folate synthesis in the bacteria. *Clofazimine* - **Clofazimine** is an essential daily component of the **MDT blister pack** for **multibacillary (MB) leprosy** [1], [2]. - It has both **bacteriostatic** and anti-inflammatory properties and is responsible for skin discoloration.

Q: An adult male patient presented in the OPD with complaints of cough and fever for 3 months and haemoptysis off and on. His sputum was positive for AFB. On probing it was found that he had already received treatment with RHZE for 3 weeks from a nearby hospital and discontinued. How will you categorize and manage the patient?

Category I: New case, intensive phase (2RHZE). ***Category I: New case, intensive phase (2RHZE)*** - This patient meets the criteria for a **newly diagnosed TB case** as they have not received more than 4 weeks of anti-TB treatment previously [1]. - The standard intensive phase regimen for new cases is **2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (2RHZE)** [1]. *Category II: Relapse, intensive phase (2RHZES)* - **Relapse** applies to patients who were previously treated for TB, declared cured, but present again with active disease. This patient had discontinued treatment after only 3 weeks, so it's not a relapse. - The intensive phase for relapse cases typically includes **Streptomycin (S)** in addition to RHZE, which is not indicated here. *Category IV: Multi-drug resistant TB, intensive phase (individualized regimen)* - **Multi-drug resistant TB (MDR-TB)** is diagnosed when the TB bacilli are resistant to at least both Rifampicin and Isoniazid. While treatment discontinuation increases the risk of resistance [2], it cannot be assumed without **drug susceptibility testing (DST)**. - An individualized regimen is appropriate for MDR-TB, but more information (like DST results) is needed before categorizing it as such. *Category II: Treatment after default, intensive phase (2RHZE)* - **Default** usually refers to patients who interrupted their treatment for 2 consecutive months or more. This patient only took treatment for 3 weeks, which does not constitute a default in the context of requiring a re-treatment regimen. - While this option mentions "intensive phase (2RHZE)", the categorization of "Treatment after default" is inaccurate given the short duration of initial treatment.

Q: Zoonotic disease of viral etiology includes -

Rabies. ***Rabies*** - Rabies is a classic example of a **zoonotic disease** caused by the **rabies virus**, transmitted to humans primarily through the bite of an infected animal. - The virus affects the **central nervous system** and is almost invariably fatal once clinical symptoms appear. *Q fever* - Q fever is a **zoonotic disease**, but it is caused by the bacterium **Coxiella burnetii**, not a virus. - It is often transmitted from farm animals and can cause acute or chronic illness. *Rickettsial disease* - Rickettsial diseases are caused by various species of **Rickettsia bacteria**, which are spread by arthropod vectors like ticks, fleas, and lice. - These are bacterial infections and not viral in origin. *Rubella* - Rubella, also known as German measles, is a **viral disease** caused by the rubella virus, but it is typically spread directly from person to person through respiratory droplets. - It is **not considered a zoonotic disease** as it does not primarily originate in animals and transmit to humans.

Q: Safe injection strategy will reduce the occurrence of:

Hepatitis B. ***Hepatitis B*** - **Hepatitis B** is a blood-borne virus commonly transmitted through contaminated needles and syringes. - Implementing **safe injection strategies**, such as using sterile equipment and proper disposal, effectively reduces its transmission. *Hepatitis E* - **Hepatitis E** is primarily transmitted via the **fecal-oral route**, often through contaminated water. - It is not typically associated with unsafe injection practices. *Hepatitis A* - **Hepatitis A** is also spread primarily through the **fecal-oral route**, often from contaminated food or water. - It has no significant link to injection safety practices. *Typhoid* - **Typhoid fever** is caused by *Salmonella Typhi* and is transmitted through the **ingestion of contaminated food or water**. - Injection practices do not play a role in its transmission.

Q: Mass treatment strategy is for treating -

Filariasis. ***Filariasis*** - **Mass drug administration (MDA)** is a key strategy for the elimination of lymphatic filariasis globally, aiming to treat entire populations in affected areas. - This approach interrupts the transmission cycle by reducing the parasite load in infected individuals, even those without overt symptoms. *Cholera* - Management of cholera primarily involves **rehydration therapy** and, for severe cases, **antibiotics** administered to symptomatic individuals. - While rapid response is crucial, mass treatment of entire populations is not the standard approach for cholera control. *Plague* - Treatment for plague involves **antibiotics** given to individuals suspected or confirmed to have the infection, or for post-exposure prophylaxis in close contacts. - Mass treatment strategies are not typically employed for plague, as it usually presents as localized outbreaks rather than widespread endemic disease suitable for MDA. *Diphtheria* - Treatment for diphtheria focuses on **antitoxin administration** and **antibiotics** to neutralize toxins and eliminate bacteria in infected patients. - Prevention is primarily through **vaccination**, and mass treatment is not a strategy used for diphtheria control.

Q: Amongst the following, which carries the least chance of transmitting HIV infection:

Heterosexual Intercourse. ***Heterosexual Intercourse*** - While a significant route globally, the per-act risk of transmission from an infected partner during **unprotected heterosexual intercourse** is relatively low compared to other high-risk exposures. - The risk is influenced by factors such as viral load, presence of STIs, and frequency of exposure, but on a per-exposure basis, it's generally considered lower than direct blood contact. *Blood transfusion* - Transfusion of HIV-infected blood carries an extremely **high risk of transmission**, approaching 100% due to the direct introduction of a significant viral load. - Due to rigorous screening of blood products in developed countries, this route is now rare but remains a major concern in regions with limited screening. *IV drug abusers* - Sharing of needles and syringes among **intravenous drug users** provides a direct pathway for blood-to-blood transmission, resulting in a very high risk of HIV infection. - Contaminated needles can retain viable virus for extended periods, facilitating efficient transmission when shared. *Vertical transmission* - **Mother-to-child transmission (MTCT)** can occur during pregnancy, childbirth, or breastfeeding, with rates varying significantly based on interventions. - Without intervention, the risk of MTCT can be as high as 25-30%, making it a highly efficient route of transmission from an infected mother to her child.

Q: In Roll Back Malaria program, which of the following is not a component?

Developing newer insecticides. ***Developing newer insecticides*** - The Roll Back Malaria (RBM) program focuses on implementing existing and proven interventions for malaria control and elimination, rather than **research and development** of new tools. - While insecticide resistance is a concern, the RBM partnership's primary role is scaling up current effective tools like **insecticide-treated nets** and **indoor residual spraying**. *Strengthening health system* - This is a core component of RBM, as a strong health system is crucial for **effective malaria prevention**, diagnosis, and treatment delivery. - It ensures that interventions reach the population and are **sustainable** in the long term. *Training for health care worker* - **Capacity building** through training of healthcare workers is vital for accurate diagnosis, appropriate treatment, and community engagement in malaria control. - Well-trained staff are essential for the successful implementation of malaria programs, including case management and **data collection**. *Using Insecticide-treated bednets* - **Insecticide-treated bednets (ITNs)** are a cornerstone of malaria prevention efforts endorsed by the RBM partnership. - They provide a **physical and chemical barrier** against mosquito bites, significantly reducing malaria transmission.

Q: Low osmolarity ORS - false statement is

Osmolarity is 311 mosm/liter. ***Osmolarity is 311 mosm/liter*** - Low osmolarity ORS has an osmolarity of **245 mOsm/L**, calculated as: **Sodium 75 + Potassium 20 + Chloride 65 + Glucose 75 + Citrate 10 = 245 mOsm/L**. - An osmolarity of **311 mOsm/L** corresponds to the **standard WHO ORS**, not the low osmolarity ORS which was developed to reduce osmotic load. *Sodium concentration 75 mmol/liter* - This statement is **true** for low osmolarity ORS, as its sodium concentration is indeed **75 mmol/L**. - The reduced sodium concentration (compared to **90 mmol/L** in standard ORS) helps achieve the lower overall osmolarity. *Potassium is 20 mmol/liter* - This statement is **true** for low osmolarity ORS, as it contains **20 mmol/L of potassium**. - Potassium is crucial for replacing **electrolyte losses** in diarrhea and maintaining intracellular fluid balance. *Glucose concentration 75 mmol/liter* - This statement is also **true** for low osmolarity ORS, with a glucose concentration of **75 mmol/L (13.5 g/L)**. - The glucose promotes **sodium-glucose co-transport** in the intestine, facilitating water absorption despite lower sodium concentration.

Question 1

Which is the right number of doses of ATT for a category II under DOTS?

Accepted Answer

IP-36, CP-66

Answer

IP-24, CP-48

Answer

IP-36, CP-54

Answer

IP-24, CP-54

Question 2

Which of the following drugs is not given in the blister pack in NLEP?

Accepted Answer

Minocycline

Answer

Rifampicin

Answer

Dapsone

Answer

Clofazimine

Question 3

An adult male patient presented in the OPD with complaints of cough and fever for 3 months and haemoptysis off and on. His sputum was positive for AFB. On probing it was found that he had already received treatment with RHZE for 3 weeks from a nearby hospital and discontinued. How will you categorize and manage the patient?

Accepted Answer

Category I: New case, intensive phase (2RHZE)

Answer

Category II: Relapse, intensive phase (2RHZES)

Answer

Category IV: Multi-drug resistant TB, intensive phase (individualized regimen)

Answer

Category II: Treatment after default, intensive phase (2RHZE)

Question 4

Zoonotic disease of viral etiology includes -

Accepted Answer

Rabies

Answer

Q fever

Answer

Rickettsial disease

Answer

Rubella

Question 5

Safe injection strategy will reduce the occurrence of:

Accepted Answer

Hepatitis B

Answer

Hepatitis E

Answer

Hepatitis A

Answer

Typhoid

Question 6

Mass treatment strategy is for treating -

Accepted Answer

Filariasis

Answer

Cholera

Answer

Plague

Answer

Diphtheria

Question 7

Amongst the following, which carries the least chance of transmitting HIV infection:

Accepted Answer

Heterosexual Intercourse

Answer

Blood transfusion

Answer

IV drug abusers

Answer

Vertical transmission

Question 8

In Roll Back Malaria program, which of the following is not a component?

Accepted Answer

Developing newer insecticides

Answer

Strengthening health system

Answer

Training for health care workers

Answer

Using Insecticide-treated bednets

Question 9

A dentist suffered from Hepatitis B infection 3 months back. His liver function tests are normal, but HBsAg remains positive and he is not allowed by the medical board to do surgical practice. He is:

Accepted Answer

Healthy carrier

Answer

Inactive carrier

Answer

Convalescent carrier

Answer

Paradoxical carrier

Question 10

Low osmolarity ORS - false statement is

Accepted Answer

Osmolarity is 311 mosm/liter

Answer

Sodium concentration 75 mmol/liter

Answer

Potassium is 20 mmol/liter

Answer

Glucose concentration 75 mmol/liter

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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