Infectious Diseases — MCQs
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A 3-year-old child presented with fatigue, malaise, fever, sore throat, headache, nausea, abdominal pain, and myalgia. On examination, generalized lymphadenopathy, hepatosplenomegaly, tonsillar enlargement, palatal petechiae, rashes, and edema of the eyelids were observed. Some unusual cells were seen in the peripheral blood. A specific serological test was performed. What is the receptor involved in the pathogenesis of the disease associated with these symptoms?
Blood culture is positive in which infection caused by Staphylococcus aureus?
Loeffler's syndrome occurs in all except:
The most common site for amoebiasis is:
Which of the following is more frequently associated with Klebsiella pneumoniae than with Pseudomonas aeruginosa?
Romana's sign is seen in infection due to:
Mucormycosis of the paranasal sinus is most common in?
Which one of the following hepatitis viruses has significant perinatal transmission?
Which of the following structures is least likely to be affected by gonococcus?
Which of the following statements about hyperplastic tuberculosis is false?
Infectious Diseases Indian Medical PG Practice Questions and MCQs
Question 1291: A 3-year-old child presented with fatigue, malaise, fever, sore throat, headache, nausea, abdominal pain, and myalgia. On examination, generalized lymphadenopathy, hepatosplenomegaly, tonsillar enlargement, palatal petechiae, rashes, and edema of the eyelids were observed. Some unusual cells were seen in the peripheral blood. A specific serological test was performed. What is the receptor involved in the pathogenesis of the disease associated with these symptoms?
- A. CD21 (Correct Answer)
- B. CD20
- C. CD19
- D. CD117
Explanation: ***CD21*** - The constellation of symptoms (fatigue, fever, sore throat, lymphadenopathy, hepatosplenomegaly, tonsillar enlargement, palatal petechiae, edema of eyelids, and atypical lymphocytes) in a child strongly suggests **infectious mononucleosis**, which is most commonly caused by the **Epstein-Barr Virus (EBV)** [1]. - EBV primarily infects **B lymphocytes** by binding to the **CD21 receptor** (also known as complement receptor type 2, CR2) on the B cell surface. *CD20* - **CD20** is another transmembrane protein found on the surface of B lymphocytes, but it is not the primary receptor used by EBV for entry. - It plays a role in B cell activation and is a target for immunotherapy in some B cell malignancies. *CD19* - **CD19** is a B-cell specific surface marker that is part of a receptor complex involved in B cell activation and growth. - While present on B cells, it is not the direct receptor that EBV uses to enter the cell. *CD117* - **CD117** (c-Kit receptor) is a receptor tyrosine kinase primarily found on hematopoietic stem cells, mast cells, and interstitial cells of Cajal. - It is not expressed on B lymphocytes and is therefore not involved in EBV infection.
Question 1292: Blood culture is positive in which infection caused by Staphylococcus aureus?
- A. Infective endocarditis (Correct Answer)
- B. Impetigo
- C. Toxic Shock Syndrome (TSS)
- D. Staphylococcal Scalded Skin Syndrome (SSSS)
Explanation: ***Infective endocarditis*** - **Infective endocarditis** is characterized by the presence of bacteria in the bloodstream, leading to a **positive blood culture** [2]. *Staphylococcus aureus* is a common cause, particularly in intravenous drug users [1], [2]. - The infection involves the **endothelial lining of the heart**, often affecting heart valves, causing vegetations that can shed bacteria into the circulation [2], [3]. *Toxic Shock Syndrome (TSS)* - TSS is caused by toxins (e.g., **TSST-1**) produced by *Staphylococcus aureus*, not by the direct presence of bacteria in the bloodstream in high numbers that would consistently yield a positive blood culture. - While *S. aureus* is present, the systemic effects are primarily **toxin-mediated**, and blood cultures are often negative. *Impetigo* - Impetigo is a **superficial skin infection** caused by *Staphylococcus aureus* or *Streptococcus pyogenes*. - It does not involve systemic bacteremia, so **blood cultures are typically negative**. *Staphylococcal Scalded Skin Syndrome (SSSS)* - SSSS is a **toxin-mediated disease** caused by exfoliatin toxins produced by *Staphylococcus aureus*. - The bacteria usually remain localized at the site of infection (e.g., nose, throat, or skin), and **blood cultures are generally negative**.
Question 1293: Loeffler's syndrome occurs in all except:
- A. Toxocara
- B. Strongyloides
- C. Ascaris
- D. Giardia (Correct Answer)
Explanation: ***Giardia*** - **Giardia lamblia** is an intestinal flagellate that causes **giardiasis**, primarily presenting with gastrointestinal symptoms such as diarrhea, abdominal cramps, and malabsorption [1]. - It does not undergo a **pulmonary migration phase** in its life cycle, which is a prerequisite for causing eosinophilic pneumonitis (Loeffler's syndrome). *Toxocara* - **Toxocara canis** and **Toxocara cati** larvae migrate through the lungs, causing **visceral larva migrans (VLM)** and pulmonary eosinophilia [1]. - This migration can trigger an immune response in the lungs, leading to symptoms consistent with **Loeffler's syndrome**. *Strongyloides* - **Strongyloides stercoralis** larvae migrate through the lungs as part of their life cycle (both in initial infection and in auto-infection), which can cause **eosinophilic pneumonitis** [1]. - This pulmonary migration commonly results in respiratory symptoms and is associated with **Loeffler's syndrome**. *Ascaris* - **Ascaris lumbricoides** larvae undergo essential **pulmonary migration** after ingestion, breaking out of capillaries into the alveoli before being coughed up and swallowed [1]. - This larval migration through the lungs is a classic cause of **Loeffler's syndrome**, characterized by transient pulmonary infiltrates and eosinophilia [1].
Question 1294: The most common site for amoebiasis is:
- A. Sigmoid colon
- B. Transverse colon
- C. Caecum (Correct Answer)
- D. Liver
Explanation: ***Caecum*** - The **caecum** is the most common site for intestinal amoebiasis because it provides an ideal environment for the **trophozoites** of *Entamoeba histolytica* to embed and colonize [1]. - The slower transit time and abundant bacterial flora in the caecum contribute to its susceptibility to **amoebic invasion and ulceration**. *Sigmoid colon* - While the sigmoid colon can be affected by amoebiasis, leading to symptoms like **dysentery**, it is not the initial or most frequent site of colonization [1]. - Involvement of the sigmoid colon typically indicates more widespread or severe intestinal infection. *Transverse colon* - The transverse colon can also be involved in amoebiasis, especially in cases of extensive disease, but it is less commonly the primary site compared to the caecum. - Symptoms related to transverse colon involvement are often diffuse and can include **abdominal pain** and **tenderness**. *Liver* - The **liver** is the most common site for **extraintestinal amoebiasis**, leading to an **amoebic liver abscess** [1]. - However, the question asks for the most common site for amoebiasis in general, implying initial infection, which is typically in the intestine (specifically the caecum).
Question 1295: Which of the following is more frequently associated with Klebsiella pneumoniae than with Pseudomonas aeruginosa?
- A. Cystic fibrosis
- B. Diabetes mellitus
- C. Upper lobe cavitation (Correct Answer)
- D. Artificial ventilation
Explanation: Upper lobe cavitation - **Upper lobe cavitation** is a characteristic feature of pneumonia caused by **Klebsiella pneumoniae**, particularly in chronic alcoholics or individuals with poor host defenses [1]. - While *Pseudomonas aeruginosa* can cause severe pneumonia, **cavitary lesions** are less frequently reported and typically occur in immunocompromised patients. *Artificial ventilation* - **Artificial ventilation** is a significant risk factor for nosocomial pneumonia caused by both *Klebsiella pneumoniae* and *Pseudomonas aeruginosa*. - However, the question asks for a feature *more frequently associated* with *Klebsiella pneumoniae*, and ventilation is a common risk for both. *Cystic fibrosis* - **Cystic fibrosis** is overwhelmingly associated with chronic *Pseudomonas aeruginosa* infections, which establish persistent biofilms in the respiratory tract. - While *Klebsiella pneumoniae* can colonize CF patients, it is not the primary or most frequent pathogen linked to this condition. *Diabetes mellitus* - **Diabetes mellitus** increases susceptibility to various infections, including those caused by *Klebsiella pneumoniae* and *Pseudomonas aeruginosa*. - However, it is an underlying condition and not a specific clinical characteristic of the pneumonia itself that differentiates the two organisms.
Question 1296: Romana's sign is seen in infection due to:
- A. Trypanosoma cruzi (Correct Answer)
- B. Trypanosoma brucei
- C. Leishmania donovani
- D. Onchocerca volvulus
Explanation: ***Trypanosoma cruzi*** - **Romana's sign** is characteristic of the **acute phase** of **Chagas disease**, caused by *Trypanosoma cruzi*. - It presents as **unilateral periorbital edema** and swelling, indicating the site of parasite entry, often from the bite of a **reduviid bug** near the eye or by rubbing the parasite-laden feces into the eye. *Trypanosoma brucei* - This parasite causes **African trypanosomiasis** (sleeping sickness), which presents with distinct symptoms like **fever**, **headache**, **lymphadenopathy** (winterbottom's sign), and later neurological involvement [2]. - Ocular signs are not typically a primary or diagnostic feature in the way Romana's sign is for Chagas disease. *Leishmania donovani* - *Leishmania donovani* is the causative agent of **visceral leishmaniasis** (**kala-azar**), characterized by **fever**, **splenomegaly**, **hepatomegaly**, and **pancytopenia** [1]. - It does not cause Romana's sign; ocular involvement, if present, is usually different and not a hallmark diagnostic feature. *Onchocerca volvulus* - This filarial nematode causes **onchocerciasis** (river blindness), primarily associated with **subcutaneous nodules**, **dermatitis**, and **ocular lesions** leading to blindness. - While it causes eye pathology, it does not involve the specific periorbital edema known as Romana's sign.
Question 1297: Mucormycosis of the paranasal sinus is most common in?
- A. Diabetes (Correct Answer)
- B. Individuals with HIV
- C. Individuals on immunosuppressive therapy
- D. Patients who have undergone surgery
Explanation: Diabetes - **Diabetic ketoacidosis** significantly impairs neutrophil function, reducing the body's ability to resist fungal infections like mucormycosis. [1] - The **hyperglycemic** and **acidotic** environment in uncontrolled diabetes promotes the growth and invasiveness of Mucorales fungi. [1] *Individuals with HIV* - While HIV can lead to **immunocompromise**, mucormycosis is less common in this population than in those with diabetes; other opportunistic infections are more prevalent with HIV. - HIV primarily affects **CD4+ T-lymphocytes**, whereas mucormycosis is more often associated with defects in phagocytic function. *Individuals on immunosuppressive therapy* - **Immunosuppressive therapy**, such as corticosteroids or chemotherapy, can increase the risk of fungal infections, but **uncontrolled diabetes** is the most significant risk factor for rhinocerebral mucormycosis. [1] - The type of immunosuppression and underlying condition are critical; while relevant, it is not as uniquely predisposing as diabetic ketoacidosis. [1] *Patients who have undergone surgery* - Surgical patients, especially those with prolonged hospital stays or extensive wounds, can be susceptible to various infections, but mucormycosis is not specifically or most commonly linked to surgery as an isolated risk factor. - **Nosocomial infections** after surgery are often bacterial; fungal infections, when they occur, are typically associated with profound immunosuppression or specific device-related issues, not surgery alone.
Question 1298: Which one of the following hepatitis viruses has significant perinatal transmission?
- A. Hepatitis E virus
- B. Hepatitis C virus
- C. Hepatitis B virus (Correct Answer)
- D. Hepatitis A virus
Explanation: ***Hepatitis B virus*** - **Perinatal transmission** is a major mode of HBV spread, occurring from an infected mother to her baby during birth. - Infants born to HBV-positive mothers have a high risk of developing **chronic HBV infection**, leading to serious liver disease later in life if not properly managed with immunization and immunoglobulin. *Hepatitis E virus* - Primarily transmitted via the **fecal-oral route**, often through contaminated water. - While it can be transmitted vertically, significant **perinatal transmission** leading to chronic outcomes in the infant is not a primary concern compared to HBV. *Hepatitis C virus* - While vertical transmission from mother to child can occur, the rate of **perinatal HCV transmission** is much lower (around 5%) compared to HBV. - It is mainly transmitted through exposure to infected blood, such as via **intravenous drug use** or blood transfusions prior to screening. *Hepatitis A virus* - Transmitted almost exclusively via the **fecal-oral route**, usually through contaminated food or water. - Perinatal transmission is **extremely rare** and does not represent a significant mode of global HAV spread or burden of disease.
Question 1299: Which of the following structures is least likely to be affected by gonococcus?
- A. Seminal vesicle
- B. Testis (Correct Answer)
- C. Urethra
- D. Prostate
Explanation: ***Testis*** - The **testis** itself is relatively protected from direct gonococcal infection and is thus least likely to be primarily affected. - While epididymitis can occur due to gonococcus, orchitis (inflammation of the testis) without epididymitis is rare and generally caused by other pathogens like mumps virus. *Urethra* - The **urethra** is the most common site of initial gonococcal infection in males, leading to **urethritis** [1]. - Symptoms often include dysuria and purulent discharge [1]. *Prostate* - The **prostate** can be affected by ascending gonococcal infection from the urethra, leading to **prostatitis**. - This typically presents with pelvic pain, dysuria, and fever. *Seminal vesicle* - The **seminal vesicles** can also be involved in ascending gonococcal infections, often alongside epididymitis or prostatitis. - Inflammation can contribute to pain and reproductive complications.
Question 1300: Which of the following statements about hyperplastic tuberculosis is false?
- A. Antitubercular therapy is the treatment of choice.
- B. Most common site is the ileocecal region.
- C. Presents as a mass in the right iliac fossa.
- D. Surgery is the primary treatment modality. (Correct Answer)
Explanation: ***Surgery is the primary treatment modality.*** - This statement is **false** because while surgery may have a role in complicated cases of hyperplastic tuberculosis (e.g., obstruction, perforation, massive bleeding), **antitubercular therapy (ATT)** is the primary and initial treatment modality for intestinal tuberculosis. - Surgery is typically reserved for patients who do not respond to ATT or present with complications that require surgical intervention for immediate relief. *Most common site is the ileocecal region.* - This statement is **true** because the **ileocecal region** is indeed the most common site for intestinal tuberculosis due to its rich lymphatic tissue, relative stasis of intestinal contents, and increased absorption. - The Peyer's patches in the ileum are particularly susceptible to Mycobacterium tuberculosis infection. *Presents as a mass in the right iliac fossa.* - This statement is **true** as hyperplastic intestinal tuberculosis often leads to **fibrotic thickening** of the bowel wall and mesentery, forming a palpable mass. - The **right iliac fossa** is the common location for such a mass due to the frequent involvement of the ileocecal region. *Antitubercular therapy is the treatment of choice.* - This statement is **true** as **antitubercular therapy (ATT)**, a multi-drug regimen, is the cornerstone of treatment for all forms of tuberculosis, including hyperplastic intestinal tuberculosis. - ATT aims to eradicate the infection, reduce inflammation, and prevent complications.
Practice by Chapter
Principles of Antimicrobial Therapy
Practice Questions
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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