Immune Deficiency and ENT Manifestations — MCQs
An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on the throat upon inspection. The child's brother is immunized. What is the first step in management?
WHO AIDS defining illnesses are all EXCEPT:
Which of the following disorders presents with repeated catalase positive infections?
In primary immune deficiency, the following plasma protein fraction can be reduced:
Which of the following statements about malignant otitis externa is true?
Agammaglobulinemia can present with?
A patient with a recent upper respiratory infection develops worsening facial pain, purulent nasal discharge, and tenderness over the maxillary sinuses. Symptoms have now persisted for more than 10 days without improvement. What is the most appropriate initial treatment?
What is the primary cause of Common Variable Immunodeficiency (CVID)?
A 5-year-old male child presents to the clinic with a history of recurrent infections. On examination, he was found to have rashes. On routine blood investigation, a low platelet count was found. What will be the diagnosis?
Mass Drug Administration is NOT routinely used as the primary strategy for:
Immune Deficiency and ENT Manifestations Indian Medical PG Practice Questions and MCQs
Question 1: An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on the throat upon inspection. The child's brother is immunized. What is the first step in management?
- A. Diphtheria antitoxin (Correct Answer)
- B. Diphtheria toxoid
- C. Penicillin
- D. Isolation and supportive care
- E. Tracheostomy
Explanation: ***Diphtheria antitoxin*** - The presence of a **white membranous layer** on the **throat** in an **unimmunized child**, along with the high contagiousness (brother's immunization is relevant to exposure), strongly suggests **diphtheria**. - **Diphtheria antitoxin (DAT)** is the crucial first-line treatment to neutralize the **exotoxin** produced by *Corynebacterium diphtheriae*, which is responsible for the severe systemic effects. - Antitoxin must be administered **immediately** without waiting for culture confirmation, as it only neutralizes unbound toxin. *Diphtheria toxoid* - **Diphtheria toxoid** is used for **active immunization** (vaccination) to prevent diphtheria, not for emergency treatment of an active infection. - Administering toxoid during an acute infection would not rapidly neutralize the circulating toxin. *Penicillin* - **Penicillin** (or erythromycin) is used to **eradicate the bacteria** (*Corynebacterium diphtheriae*) from the patient's throat and prevent further toxin production and transmission. - While important for source control, it does not neutralize the pre-formed toxin, which is the immediate threat to life. - Antibiotics should be given **after** antitoxin administration. *Isolation and supportive care* - **Isolation** is essential to prevent transmission, but it does not treat the patient's infection. - **Supportive care** is also crucial, but it addresses symptoms rather than the underlying cause or the effects of the toxin. *Tracheostomy* - **Tracheostomy** may be required later for airway obstruction if the membrane extends to the larynx or causes significant respiratory compromise. - However, it is **not the first step** in management; securing airway patency comes after antitoxin administration unless there is immediate life-threatening airway obstruction. - The priority is neutralizing the toxin to prevent further membrane formation and systemic complications.
Question 2: WHO AIDS defining illnesses are all EXCEPT:
- A. Persistent generalized lymphadenopathy (Correct Answer)
- B. P. carinii pneumonia
- C. CMV retinitis
- D. Oropharyngeal candidiasis
Explanation: ***Persistent generalized lymphadenopathy*** - While associated with HIV infection, **persistent generalized lymphadenopathy** itself is not classified as an **AIDS-defining illness** by the WHO or CDC, but rather a common manifestation of chronic HIV infection (Stage 1 or 2) [1]. - AIDS-defining illnesses are typically severe opportunistic infections or cancers that occur when the immune system is severely compromised (CD4 count below 200 cells/µL). *P. carinii pneumonia* - **P. carinii pneumonia** (now known as **Pneumocystis jirovecii pneumonia** or **PJP**) is a classic and common **AIDS-defining opportunistic infection**. - Its presence indicates severe immunosuppression, often with CD4 counts below 200 cells/µL. *CMV retinitis* - **Cytomegalovirus (CMV) retinitis** is a severe opportunistic infection, particularly of the eye, that is recognized as an **AIDS-defining illness**. - It signifies profound immunodeficiency, typically with CD4 counts below 50 cells/µL. *Oropharyngeal candidiasis* - While common in HIV-infected individuals, **oropharyngeal candidiasis** (thrush) alone is generally not considered an **AIDS-defining illness** [1]. - It is classified as an HIV Stage 2 condition, indicating moderate immune compromise rather than severe, AIDS-defining immunosuppression [1].
Question 3: Which of the following disorders presents with repeated catalase positive infections?
- A. Chediak higashi syndrome
- B. SCID
- C. X linked hypogammaglobulinemia
- D. CGD (Correct Answer)
Explanation: ***CGD*** - Chronic Granulomatous Disease (CGD) is characterized by a defect in **NADPH oxidase**, preventing phagocytes from producing a **respiratory burst** to kill certain bacteria and fungi. - Patients with CGD are particularly susceptible to infections by **catalase-positive organisms** because these organisms degrade hydrogen peroxide, which CGD phagocytes rely on for killing. *Chediak higashi syndrome* - This syndrome involves defective lysosomal trafficking, leading to impaired neutrophil chemotaxis and degranulation, resulting in recurrent infections, but not specifically to **catalase-positive organisms**. - Other features include **partial albinism**, peripheral neuropathy, and normal respiratory burst. *SCID* - Severe Combined Immunodeficiency (SCID) involves a profound defect in both **T-cell and B-cell immunity**, leading to severe and recurrent infections by a wide range of pathogens, not limited to catalase-positive ones [1]. - Patients typically present in infancy with **failure to thrive**, opportunistic infections, and lack of lymphoid tissue [1]. *X linked hypogammaglobulinemia* - Also known as **Bruton's agammaglobulinemia**, this disorder involves a defect in B-cell maturation, leading to the absence of antibodies and recurrent bacterial infections [1]. - The infections are typically with **encapsulated bacteria** and are not specifically linked to catalase-positive organisms [1].
Question 4: In primary immune deficiency, the following plasma protein fraction can be reduced:
- A. Alpha2 globulin
- B. Gamma globulin (Correct Answer)
- C. Alpha1 globulin
- D. Beta globulin
Explanation: ***Gamma globulin*** - In primary immune deficiency, there is a significant reduction in **gamma globulin**, resulting from impaired antibody production [1]. - This protein fraction primarily contains **immunoglobulins**, which are crucial for the immune response [1][2]. *Alpha1 globulin* - Typically associated with **protease inhibitors** and **transport proteins**, its levels are not directly impacted in primary immune deficiency. - This fraction does not primarily play a role in the **immune response** like gamma globulins do. *Alpha2 globulin* - Contains **haptoglobin** and **ceruloplasmin**, which often remain stable in immunodeficiencies. - Its reduction is not characteristic of primary immune deficiency, as it does not directly relate to **antibody function**. *Beta globulin* - Includes fractions such as **transferrin** and **complement proteins**, generally unaffected by primary immune deficiencies. - While important, these proteins do not primarily comprise **antibodies** and do not show a decrease in these conditions.
Question 5: Which of the following statements about malignant otitis externa is true?
- A. Not painful
- B. Common in diabetics and old age (Correct Answer)
- C. Caused by streptococcus
- D. Responds to topical antibiotics alone
Explanation: ***Common in diabetics and old age*** - **Malignant otitis externa** is an aggressive infection primarily affecting the external auditory canal and surrounding structures. - It most commonly occurs in **immunocompromised individuals**, especially **elderly diabetics**, due to impaired immune response and microvascular complications. *Not painful* - Malignant otitis externa is characterized by **severe, unrelenting otalgia (ear pain)** that often worsens at night and is disproportionate to the clinical findings. - The pain is due to the **inflammatory and destructive process** involving cartilage, bone, and nerves. *Caused by streptococcus* - The most common causative organism for malignant otitis externa is **Pseudomonas aeruginosa** (>90% of cases), not Streptococcus. - **Streptococcus species** are more commonly associated with acute otitis media or common skin infections. *Responds to topical antibiotics alone* - Malignant otitis externa requires **prolonged systemic antibiotic therapy** (typically 4-6 weeks of intravenous or oral fluoroquinolones like ciprofloxacin). - Topical antibiotics alone are **insufficient** due to the invasive nature of the infection, which extends beyond the external canal to involve bone and soft tissues.
Question 6: Agammaglobulinemia can present with?
- A. Rhinitis
- B. Bronchiectasis
- C. Giardia infections
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Agammaglobulinemia**, characterized by the absence of **B cells** and very low levels of antibodies, leads to significant **immunodeficiency** [1]. - This deficiency results in a broad range of infections and inflammatory conditions affecting various body systems, encompassing all the listed options. *Rhinitis* - Patients with agammaglobulinemia are prone to **recurrent bacterial infections** of the upper respiratory tract [1]. - This susceptibility often manifests as **chronic or recurrent rhinitis** and sinusitis due to impaired antibody-mediated host defense [1]. *Bronchiectasis* - Due to frequent and inadequately controlled **bacterial infections of the lower respiratory tract**, such as pneumonia and bronchitis. - These chronic infections can cause irreversible damage and dilation of the **bronchial airways**, leading to bronchiectasis. *Giardia infections* - **Agammaglobulinemia** severely impairs the body's ability to produce **IgA antibodies**, which are crucial for mucosal immunity in the gastrointestinal tract. - This deficiency makes patients highly susceptible to **chronic and severe infections** with enteric pathogens, such as *Giardia lamblia* [1].
Question 7: A patient with a recent upper respiratory infection develops worsening facial pain, purulent nasal discharge, and tenderness over the maxillary sinuses. Symptoms have now persisted for more than 10 days without improvement. What is the most appropriate initial treatment?
- A. Amoxicillin-clavulanate (Correct Answer)
- B. Corticosteroid
- C. Antihistamine
- D. Topical decongestant
Explanation: ***Amoxicillin-clavulanate*** - Symptoms persisting >10 days with **purulent nasal discharge** and **facial pain** meet criteria for **acute bacterial rhinosinusitis**, making this the **first-line empirical antibiotic treatment**. - Provides broad-spectrum coverage against common pathogens including **Streptococcus pneumoniae**, **Haemophilus influenzae**, and **beta-lactamase producing organisms**. *Topical decongestant* - While it may provide temporary **symptomatic relief** by reducing nasal congestion, it does not address the underlying **bacterial infection**. - Prolonged use (>3-5 days) can lead to **rhinitis medicamentosa** with rebound congestion, worsening the clinical picture. *Antihistamine* - Primarily effective for **allergic rhinitis** by blocking histamine-mediated symptoms like sneezing and watery discharge. - **Ineffective against bacterial infections** and may worsen symptoms by drying mucous membranes and impairing **mucociliary clearance**. *Corticosteroid* - **Intranasal corticosteroids** may serve as adjunctive therapy to reduce inflammation but are insufficient as **monotherapy** for bacterial sinusitis. - Does not provide antimicrobial coverage needed for the suspected **bacterial pathogen** causing the persistent purulent symptoms.
Question 8: What is the primary cause of Common Variable Immunodeficiency (CVID)?
- A. Defective B cell function
- B. Absent B cells
- C. Reduced number of B cells
- D. Defective B cell differentiation (Correct Answer)
Explanation: ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.
Question 9: A 5-year-old male child presents to the clinic with a history of recurrent infections. On examination, he was found to have rashes. On routine blood investigation, a low platelet count was found. What will be the diagnosis?
- A. Wiskott-Aldrich syndrome (Correct Answer)
- B. Hyper-IgE syndrome
- C. Chediak-Higashi syndrome
- D. None of the options
Explanation: ***Wiskott-Aldrich syndrome*** - This syndrome is characterized by the classic triad of **recurrent infections** (due to immunodeficiency), **eczema-like rashes**, and **thrombocytopenia** (low platelet count), which perfectly matches the clinical presentation. - The underlying defect involves the WAS protein, crucial for **hematopoietic cell function**, leading to severe combined immunodeficiency. *Hyper-IgE syndrome* - While it features **recurrent infections** and **eczema**, it is primarily associated with **elevated IgE levels** and typically presents with a hallmark finding of **"cold" abscesses**. - **Low platelet count** is not a defining characteristic of Hyper-IgE syndrome. *Chediak-Higashi syndrome* - This syndrome involves **recurrent infections** and findings like **partial oculocutaneous albinism** and neurologic abnormalities. - While it can manifest with bleeding tendencies due to **platelet dysfunction**, the defining features of **eczema** and a consistently **low platelet count** as seen here are less prominent compared to Wiskott-Aldrich. *None of the options* - The presenting symptoms of **recurrent infections, rashes, and low platelet count** are highly specific for Wiskott-Aldrich syndrome, making this option incorrect.
Question 10: Mass Drug Administration is NOT routinely used as the primary strategy for:
- A. Vitamin A Deficiency
- B. Scabies (Correct Answer)
- C. Lymphatic Filariasis
- D. Worm infestation
Explanation: ***Scabies*** - While **mass drug administration with oral ivermectin** has shown effectiveness in specific endemic outbreak settings, MDA is generally **not the primary recommended strategy** for routine scabies control in most public health contexts. - Scabies control typically prioritizes **case finding, contact tracing, simultaneous household treatment, and environmental decontamination**—which are more complex to implement than standard MDA programs. - Unlike the other conditions listed, scabies lacks well-established **routine MDA programs** at the scale of national public health initiatives, making it the least suitable option for MDA among these choices. *Vitamin A Deficiency* - **Vitamin A supplementation** through MDA is a **highly effective and widely implemented** WHO-recommended strategy to combat Vitamin A deficiency in at-risk populations, particularly children under 5 years. - Regular mass supplementation helps prevent **xerophthalmia** and reduces morbidity and mortality from infectious diseases. - This is a cornerstone of routine public health programs globally. *Lymphatic Filariasis* - **Lymphatic filariasis** is a classic example where MDA with anti-filarial drugs like **diethylcarbamazine (DEC), albendazole,** or **ivermectin** is the cornerstone strategy for interrupting transmission. - MDA is the **primary WHO-recommended approach** to achieve elimination of lymphatic filariasis, with established national programs in endemic countries. *Worm infestation* - **Mass deworming programs** using drugs like **albendazole** or **mebendazole** represent highly effective and well-established forms of MDA for controlling **soil-transmitted helminth infections**. - These routine programs significantly reduce disease burden in school-aged children, improving nutritional status, growth, and learning outcomes.
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