Infectious Diseases — MCQs

Infectious Diseases Indian Medical PG Practice Questions and MCQs

Question 1071: A 25-year-old female presents with night sweats and fever. She has been previously treated for tuberculosis. Sputum examination reveals acid-fast bacilli (AFB). What category of treatment should be initiated?

A. Category I
B. Category II (Correct Answer)
C. Category III
D. Category IV

Explanation: ***Category II*** - This category is specifically designed for **retreatment cases** of tuberculosis, defined by a patient previously treated for TB who has now relapsed or failed treatment. Treatment failure is defined as a positive sputum smear or culture at 5 months [2]. - The presence of **night sweats**, **fever**, and **acid-fast bacilli (AFB)** [3] in sputum indicates active disease requiring reinstitution of a more intensive treatment regimen. *Category I* - This category is used for **newly diagnosed cases** of tuberculosis, [1] meaning patients who have never been treated for TB or have received less than one month of treatment. - The patient's history of **previous tuberculosis treatment** makes this category inappropriate. *Category III* - This category is typically reserved for **less severe forms of TB**, such as smear-negative pulmonary TB or non-severe extrapulmonary TB, in new patients. - The findings of **sputum AFB positivity** and a history of previous treatment rule out this category. *Category IV* - This category is for patients with **multidrug-resistant TB (MDR-TB)** or other forms of drug-resistant TB, requiring highly specialized and individualized treatment regimens. - While previous treatment failure might lead to drug resistance, the immediate indication from the given information is for a standard **retreatment regimen**, not necessarily MDR-TB directly.

Question 1072: Which disease is characterized by severe watery diarrhea and is associated with a toxin-producing bacterium?

A. Gastroenteritis
B. Cholera (Correct Answer)
C. Dysentery
D. Typhoid fever

Explanation: ***Cholera*** - Cholera is known for causing **severe, watery diarrhea** (often described as "rice water stools") due to the action of **cholera toxin** produced by *Vibrio cholerae* [1], [2]. - The toxin stimulates excessive fluid and electrolyte secretion in the small intestine, leading to rapid **dehydration** and electrolyte imbalance [2]. *Gastroenteritis* - This is a general term for **inflammation of the stomach and intestines**, which can be caused by various pathogens (viruses, bacteria, parasites) and toxins. - While it often presents with diarrhea, it doesn't specifically imply the **severe watery diarrhea** linked to a specific toxin as seen in cholera. *Dysentery* - Dysentery is characterized by **bloody diarrhea**, often accompanied by **fever and abdominal cramps**, indicating inflammation and damage to the intestinal lining [3]. - It is typically caused by bacteria like *Shigella* or *entamoeba histolytica*, distinct from the purely watery diarrhea of cholera [3]. *Typhoid fever* - Typhoid fever is a systemic illness caused by *Salmonella typhi*, characterized by **sustained fever, headache, malaise**, and can include **constipation or mild diarrhea**. - It does not primarily present with **severe watery diarrhea** induced by a specific toxin, unlike cholera.

Question 1073: A healthcare worker exposed to a needlestick injury from a hepatitis B positive patient tests positive for HBsAg after 3 months. What is the next best step in management?

A. Administer hepatitis B vaccine
B. Administer hepatitis B immunoglobulin
C. Start antiviral therapy (Correct Answer)
D. Monitor liver function tests

Explanation: ***Start antiviral therapy*** - A positive **HBsAg** (Hepatitis B surface antigen) at 3 months indicates **active hepatitis B infection** [1]. - Since the patient has already developed chronic infection (indicated by positive HBsAg after 3 months), **antiviral therapy** is the appropriate next step to manage the infection, prevent disease progression, and reduce transmission risk [1]. *Administer hepatitis B vaccine* - The vaccine would have been appropriate for **pre-exposure prophylaxis** or immediate post-exposure prophylaxis if the worker was not previously vaccinated and tested negative for HBsAg and HBsAb following exposure. - Administering the vaccine after the development of active infection (positive HBsAg) is **ineffective** as it is designed to prevent infection, not treat it. *Administer hepatitis B immunoglobulin* - **Hepatitis B immunoglobulin (HBIG)** provides passive immunity and is typically administered as part of **post-exposure prophylaxis (PEP)** immediately after exposure, ideally within 24 hours (and up to 7 days), especially for unvaccinated individuals, in conjunction with the vaccine [2]. - It is not indicated for treating established active or chronic hepatitis B infection, as the patient already has a positive HBsAg. *Monitor liver function tests* - Monitoring **liver function tests (LFTs)** is an important component of managing hepatitis B, both acutely and chronically, to assess liver damage and disease progression [1]. - However, simply monitoring LFTs without initiating specific treatment is **insufficient** in a patient with confirmed active hepatitis B infection. Treatment is necessary to prevent further liver damage and complications.

Question 1074: A patient with a history of organ transplantation presents with fever and a dry cough. Imaging reveals diffuse interstitial pneumonia. What is the most likely diagnosis?

A. Cytomegalovirus infection (Correct Answer)
B. Bacterial pneumonia
C. Fungal pneumonia
D. Tuberculosis

Explanation: ***Cytomegalovirus infection*** - **CMV pneumonia** is a common and serious opportunistic infection in **transplant recipients** due to their immunosuppressed state. - Presentation with **fever**, **dry cough**, and **diffuse interstitial infiltrates** on imaging is highly characteristic of CMV pneumonitis. *Bacterial pneumonia* - While possible, bacterial pneumonia typically presents with a **productive cough**, **purulent sputum**, and often **lobar consolidation** rather than diffuse interstitial infiltrates. - **Immunosuppression** does increase the risk, but the classic imaging and cough characteristics point away from a common bacterial etiology. *Fungal pneumonia* - **Fungal infections** often cause pneumonia in transplant patients but typically present with nodular lesions, cavitations, or discrete infiltrates, sometimes with a more indolent course, rather than diffuse interstitial pneumonia. - Common fungal pathogens like *Pneumocystis jirovecii* can cause diffuse interstitial pneumonia but often present with more severe **hypoxemia** and imaging may show a **ground-glass appearance**. *Tuberculosis* - **Tuberculosis** can reactivate in transplant patients and cause pneumonia, but it usually presents with **upper lobe infiltrates**, **cavitation**, or **miliary patterns**, and often a more chronic cough, sometimes with hemoptysis and night sweats. - **Diffuse interstitial pneumonia** as the primary presentation is less typical for tuberculosis.

Question 1075: A patient from India presents with high fever, hepatosplenomegaly, and pancytopenia. A blood smear shows Leishmania donovani. What is the recommended treatment?

A. Chloroquine
B. Metronidazole
C. Pentavalent antimony
D. Amphotericin B (Correct Answer)

Explanation: **Amphotericin B** - **Liposomal amphotericin B** is the drug of choice for visceral leishmaniasis (kala-azar) caused by *Leishmania donovani*, especially in regions like India where resistance to older drugs is prevalent [1]. - Its effectiveness stems from its ability to form pores in the parasite and fungal cell membranes, leading to cell death. *Chloroquine* - **Chloroquine** is an antimalarial drug and is not effective against *Leishmania* infections. - It acts by preventing the detoxification of heme inside the malarial parasite. *Pentavalent antimony* - While **pentavalent antimonials** (e.g., sodium stibogluconate) were historically the first-line treatment for leishmaniasis, significant resistance has emerged, particularly in regions like India [1]. - Their use is now limited due to toxicity and widespread treatment failures in many endemic areas. *Metronidazole* - **Metronidazole** is an antimicrobial effective against various anaerobic bacteria and protozoa like *Giardia* and *Trichomonas*, but it has no activity against *Leishmania donovani*. - It works by disrupting DNA synthesis in susceptible organisms.

Question 1076: What is the role of fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection?

A. First-line treatment option
B. Only effective with antibiotics
C. Beneficial in select cases (Correct Answer)
D. No significant benefit

Explanation: ***Beneficial in select cases*** - **Fecal microbiota transplantation (FMT)** is highly effective in restoring the normal gut microbiota in patients with **recurrent *Clostridium difficile* infection (CDI)**, preventing further episodes. - It is particularly recommended for patients who have had at least **three episodes of mild to moderate CDI** unresponsive to antibiotic therapy, or at least **two episodes of severe CDI** requiring hospitalization. *First-line treatment option* - **FMT** is not a **first-line treatment** for *C. difficile* infection; initial episodes are typically managed with oral antibiotics like **vancomycin** or **fidaxomicin**. - Its role is primarily in preventing **recurrence** after standard antibiotic treatment has failed. *Only effective with antibiotics* - **FMT** is typically administered *after* a course of antibiotics has cleared the acute *C. difficile* infection, with its benefit coming from **restoring microbial diversity** rather than acting synergistically with antibiotics during active infection. - While sometimes antibiotics are used to clear the initial infection before FMT, the effectiveness of FMT itself in preventing recurrence is largely independent of concurrent antibiotic use at the time of transplantation. *No significant benefit* - Numerous studies, including randomized controlled trials, have demonstrated that **FMT** significantly **reduces recurrence rates** of *C. difficile* infection, often with success rates exceeding 85%. - This high efficacy position's FMT as a crucial intervention for patients with recurrent CDI.

Question 1077: A patient with AIDS presents with shortness of breath and a dry cough. A chest X-ray shows interstitial infiltrates. What is the most likely diagnosis?

A. Pneumocystis jirovecii pneumonia (Correct Answer)
B. Tuberculosis
C. Kaposi sarcoma
D. Community-acquired pneumonia

Explanation: ***Pneumocystis jirovecii pneumonia*** - **Pneumocystis jirovecii pneumonia (PJP)** is an **opportunistic infection** common in **AIDS patients** with CD4 counts typically below 200 cells/mm³ [1]. - Classic presentation includes **shortness of breath**, **dry cough**, and diffuse **interstitial infiltrates** on chest X-ray [1]. *Tuberculosis* - While TB is common in AIDS patients, the typical presentation often involves **cavitary lesions** or **upper lobe infiltrates**, and can present with systemic symptoms like **night sweats** and **weight loss**, which are not specified here [1]. - The **interstitial pattern** is less characteristic of primary pulmonary TB in immunocompromised patients, though atypical presentations are possible [1]. *Kaposi sarcoma* - **Kaposi sarcoma** in the lungs typically presents with **nodular** or **peribronchovascular infiltrates** and can cause pleural effusions, not the diffuse interstitial pattern seen here [2]. - It is a **vasoproliferative malignancy**, less likely to cause acute respiratory symptoms as the primary manifestation in this context compared to infection. *Community-acquired pneumonia* - **Community-acquired pneumonia (CAP)** in AIDS patients can be caused by various typical bacteria, but often presents with **lobar consolidation** or more focal infiltrates, and may be accompanied by fever and productive cough [2]. - The **diffuse interstitial infiltrates** and **dry cough** are less typical for most bacterial CAPs and point more specifically towards PJP in an AIDS patient [1].

Question 1078: A 45-year-old woman presents with a persistent cough, weight loss, and night sweats. A chest X-ray reveals a cavitary lesion in the upper lobe, and sputum is positive for acid-fast bacilli. Which of the following is the most appropriate initial treatment regimen?

A. Isoniazid and rifampin only
B. Rifampin and pyrazinamide only
C. Isoniazid, rifampin, pyrazinamide, and ethambutol (Correct Answer)
D. Streptomycin and ethambutol

Explanation: ***Isoniazid, rifampin, pyrazinamide, and ethambutol*** - This **four-drug regimen** is the standard initial treatment for active **tuberculosis** due to the high risk of drug resistance with fewer agents [1]. - The combination of these drugs increases treatment efficacy and reduces the likelihood of developing **multi-drug resistant TB** [1]. *Isoniazid and rifampin only* - This two-drug regimen is used for the **continuation phase** of TB treatment, after an initial intensive phase with more drugs [1]. - Administering only two drugs initially for active TB could lead to **treatment failure** and the development of drug-resistant strains [1]. *Rifampin and pyrazinamide only* - This combination is insufficient for initial treatment of active TB, as it lacks the broad coverage needed to prevent **resistance** and ensure optimal eradication of the bacteria [1]. - Both isoniazid and ethambutol are essential components of the initial phase to achieve **sterilization** and prevent the emergence of resistant organisms. *Streptomycin and ethambutol* - **Streptomycin** is an older injectable drug sometimes used in specific cases, but it is not a first-line backbone for initial treatment, especially given its toxicities [1]. - This combination lacks the central powerful oral agents like **isoniazid** and **rifampin** which are crucial for effective initial therapy.

Question 1079: A 60-year-old male with diabetes presents with fever, cough, and pleuritic chest pain. A chest X-ray reveals right lower lobe consolidation. What is the most appropriate initial antibiotic therapy?

A. Azithromycin
B. Amoxicillin
C. Levofloxacin
D. Ceftriaxone and azithromycin (Correct Answer)

Explanation: ***Ceftriaxone and azithromycin*** - This combination provides broad-spectrum coverage for **community-acquired pneumonia (CAP)**, targeting both typical bacteria (e.g., *Streptococcus pneumoniae*) and atypical pathogens (e.g., *Mycoplasma pneumoniae*, *Chlamydophila pneumoniae*) [1]. - Ceftriaxone is a **third-generation cephalosporin** effective against Gram-positive bacteria, while azithromycin is a **macrolide** covering atypical organisms and providing additional anti-inflammatory effects [2]. *Amoxicillin* - While effective against common pathogens like *Streptococcus pneumoniae*, **amoxicillin alone** may not adequately cover atypical pathogens or resistant strains, especially in patients with comorbidities like diabetes [3]. - It does not cover **atypical pneumonia**, which can be a significant cause of CAP. *Azithromycin* - Azithromycin is effective against **atypical pathogens** but does not provide sufficient coverage for common typical bacteria like *Streptococcus pneumoniae* when used as monotherapy in patients with comorbidities [2]. - Monotherapy with a macrolide like azithromycin is generally reserved for otherwise healthy individuals with **mild CAP**. *Levofloxacin* - Levofloxacin is a **respiratory fluoroquinolone** that offers broad-spectrum coverage, including typical and atypical pathogens, and can be used as monotherapy [2]. - However, due to concerns about increasing **antibiotic resistance** and potential side effects (e.g., QT prolongation, tendon rupture), it is often reserved for patients who cannot tolerate beta-lactams or macrolides, or in cases of severe CAP not responding to initial therapy.

Question 1080: A 40-year-old man who recently traveled to South America presents with a chronic, ulcerative lesion on his arm. A biopsy reveals amastigotes within macrophages. What is the most likely diagnosis?

A. Cutaneous leishmaniasis (Correct Answer)
B. Cutaneous tuberculosis
C. Sporotrichosis
D. Mycetoma

Explanation: ### Cutaneous leishmaniasis - The patient's recent travel to **South America**, a region endemic for Leishmaniasis, combined with a chronic, **ulcerative lesion** and the presence of **amastigotes within macrophages** on biopsy, are classic diagnostic features [1]. - Amastigotes are the non-motile, intracellular form of Leishmania parasites found in human tissues [1]. *Cutaneous tuberculosis* - While it can manifest as chronic ulcerative lesions, the biopsy would show **granulomas with caseation necrosis** containing acid-fast bacilli, not amastigotes within macrophages. - Diagnosis typically involves isolation of *Mycobacterium tuberculosis* or molecular tests, which is not described. *Sporotrichosis* - Characterized by **nodular lesions** that can ulcerate and spread along lymphatic channels, often associated with a history of **thorn prick** or contact with decaying vegetation. - Biopsy would reveal **cigar-shaped budding yeasts** (Sporothrix schenckii), not amastigotes within macrophages. *Mycetoma* - Presents as a chronic, destructive infection primarily affecting the **feet**, characterized by **swelling, sinuses, and grains** (macroscopic aggregates of microorganisms) being discharged. - Histology would show **granulomas with characteristic grains** (fungal hyphae or bacterial filaments), significantly different from amastigotes.

Practice by Chapter

Principles of Antimicrobial Therapy

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Fever of Unknown Origin

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HIV/AIDS and Related Infections

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Tuberculosis and Mycobacterial Diseases

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Tropical and Parasitic Infections

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Viral Infections (Hepatitis, Herpes, etc.)

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Healthcare-Associated Infections

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Fungal Infections

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Sepsis and Septic Shock

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Infection in Immunocompromised Hosts

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Emerging and Re-emerging Infections

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Antimicrobial Resistance

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Vaccination Principles

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