Infectious Diseases Practice Questions

Q: Identify the cause of rash in the child:

Rubeola. ***Rubeola (Measles)*** - The image displays a **maculopapular rash**, which is characteristic of rubeola, commonly known as measles. The rash starts on the **face/behind the ears** and spreads downwards. - Measles rash is typically **blotchy** and can coalesce, and its distribution behind the ear is a classic early sign. *Rubella (German Measles)* - Rubella rash tends to be **finer** and **less confluent** than measles, often described as "rose-pink" macules. - While it also starts on the face and spreads, the rash is generally **milder** and disappears faster. *Varicella (Chickenpox)* - Varicella rash consists of **vesicles on an erythematous base** (dewdrop on a rose petal appearance), which then crust over. - The lesions appear in **crops**, leading to lesions of different stages simultaneously, which is not seen in the provided image. *Roseola infantum (Exanthem subitum)* - Roseola is characterized by a high fever for several days, followed by the sudden appearance of a **macular or maculopapular rash** once the fever breaks. - The rash typically starts on the **trunk** and spreads to the neck and extremities, which is a different pattern from the rash shown.

Q: Which is the most common complication of this rash?

Secondary skin infections. ***Secondary skin infections*** - The rash shows vesicles and pustules characteristic of **varicella (chickenpox)**. The lesions are intensely itchy, leading to scratching, which can break the skin barrier and introduce bacteria. - **Superinfection with *Staphylococcus aureus* or *Streptococcus pyogenes*** is the most common complication, resulting in impetigo, cellulitis, or even more severe invasive infections. *Otitis media* - While otitis media can occur during viral illnesses, it is not the most common complication and is generally less frequent than secondary skin infections in the context of **varicella**. - It arises from inflammation and fluid accumulation in the middle ear, often due to bacterial superinfection following viral upper respiratory tract infection, but not directly from the skin lesions. *Bronchopneumonia* - **Varicella pneumonia** can be a severe complication, especially in adults and immunocompromised individuals, but it is less common in healthy children than secondary skin infections. - Bronchopneumonia refers to widespread inflammation of the bronchi and bronchioles, often presenting with cough and respiratory distress. *Reye syndrome* - Reye syndrome is a rare but serious complication, primarily associated with **aspirin use** in children with viral infections like varicella or influenza. - It involves **acute encephalopathy** and **fatty liver degeneration**, but it is preventable by avoiding salicylates and is not a direct result of the rash itself.

Q: A 5-year-old child in a village went for open air defecation when he was attacked by a dog. He has been admitted in your hospital, all are correct about the condition except: (Recent NEET Pattern 2016-17)

Virus infects pyramidal cells leading to cytolysis. ***Virus infects pyramidal cells leading to cytolysis*** - The **rabies virus** primarily infects neurons and causes neuronal dysfunction rather than **cytolysis** (cell death and lysis), particularly in the early stages. - The characteristic pathological finding in rabies is the presence of **Negri bodies** (intracytoplasmic inclusions) which represent viral aggregates within unaffected neurons, not cytolytic destruction. *Category 3 bite* - A **Category 3 bite** involves single or multiple transdermal bites or scratches, licks on broken skin, or contamination of mucous membranes with saliva, especially if involving the head, neck, or digits, which appears to be the case given the severe facial injuries depicted with a dog bite. - Due to the high risk of rabies transmission in such severe wounds, Category 3 requires both **rabies vaccine** and **rabies immunoglobulin (RIG)** administration. *Wash with povidone-iodine* - Immediate and thorough **wound washing** with soap and water for at least 15 minutes is crucial for all animal bites, as it significantly reduces the viral load. - **Antiseptics** like povidone-iodine or alcohol can be used after washing to further disinfect the wound. *Administer vero cell vaccine with immunoglobulin* - For a **Category 3 rabies exposure**, both **rabies vaccine** (e.g., Vero cell vaccine) and **rabies immunoglobulin (RIG)** are indicated for post-exposure prophylaxis. - The vaccine provides active immunity, while the immunoglobulin provides immediate passive immunity, critical for high-risk exposures.

Q: A 6-year-old child from Kashmir is brought to New Delhi hospital in delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Blood culture was sterile after 48 hours of incubation, WeilFelix reaction shows increasing antibody titer and complement fixation test was positive. Which is the best treatment for the patient?

Doxycycline. ***Doxycycline*** - The clinical presentation (high-grade fever, delirium, blanching rash on soles and palms, splenohepatomegaly, sterile blood culture, positive Weil-Felix) is highly suggestive of **scrub typhus**, a rickettsial infection. - **Doxycycline** is the treatment of choice for rickettsial infections, including scrub typhus, across all age groups, given its superior efficacy and limited alternatives. *Amoxicillin clavulanic acid* - This antibiotic combination is effective against a broad spectrum of **bacterial infections**, but it is not effective against rickettsial organisms. - The presented symptoms and lab results (especially positive Weil-Felix and sterile blood culture for common bacteria) rule out typical bacterial infections treatable by amoxicillin-clavulanic acid. *Ciprofloxacin* - Ciprofloxacin is a **fluoroquinolone antibiotic** typically used for various bacterial infections, including some atypical bacteria. - While it has some activity against rickettsia, it is not considered the first-line treatment and is less effective than doxycycline for scrub typhus. *Rifabutin* - Rifabutin is an antibiotic primarily used for the treatment of **mycobacterial infections**, such as those caused by *Mycobacterium avium complex* (MAC) or tuberculosis. - It has no role in the treatment of rickettsial infections like scrub typhus.

Q: A 6-year-old child from Kashmir is brought to New Delhi hospital in a delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Probable diagnosis is:

Rickettsia. ***Rickettsia*** - The combination of **high-grade fever**, **delirium**, **non-blanching rash** on palms and soles, and **splenohepatomegaly** is highly suggestive of severe rickettsial infection, especially with the child being from Kashmir where rickettsial diseases like Indian Tick Typhus are endemic. - The **non-blanching rash** (petechial/purpuric) on palms and soles is a classic, though not universally present, sign of severe rickettsial infection, reflecting vascular damage. *Cerebral malaria* - While cerebral malaria can cause **delirium**, **high fever**, and **splenohepatomegaly**, it typically does not present with a prominent **blanching rash** on the palms and soles. - Malaria is often endemic in Kashmir, but the rash pattern described is less typical for it. *Dengue hemorrhagic fever* - Dengue hemorrhagic fever can cause high fever, rash, and in severe cases, neurological symptoms due to shock or encephalopathy. However, the rash is typically **maculopapular** or **petechial**, and while it can involve extremities, the prominent *blanching* nature and distribution solely on **palms and soles** are less characteristic. - While splenomegaly can occur, prominent **splenohepatomegaly** in conjunction with this specific rash and neurological status points away from uncomplicated or even severe dengue as the primary diagnosis. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a chronic, progressive, and fatal neurodegenerative disease that usually develops several years after measles infection. - It presents with progressive neurological deterioration, including **cognitive decline**, **myoclonus**, and **seizures**, but does not typically involve acute high fever or a rash like the one described.

Q: A 4-year-old child presents with fever for 4 days with decreased oral intake. On examination a rough textured rash on trunk is seen which blanches on pressure. Later the rash fades and desquamation occurs. All are true about the condition except:

Perioral cyanosis. ***Perioral cyanosis*** - **Perioral cyanosis** (bluish discoloration around the mouth) is *not* a characteristic feature of scarlet fever. It typically indicates **hypoxemia**, which is not directly caused by the streptococcal exotoxins in this condition. - Scarlet fever is characterized by a "circumoral pallor" where the area around the mouth appears pale in contrast to the flushed cheeks, rather than cyanotic. *Caused by streptococcal pyrogenic exotoxins A, B, and C* - Scarlet fever is indeed caused by strains of *Streptococcus pyogenes* that produce **streptococcal pyrogenic exotoxins (SPEs)**, particularly types A, B, and C. - These exotoxins act as **superantigens** and are responsible for the characteristic rash and systemic symptoms of scarlet fever. *Sandpaper rash* - The description of a **rough textured rash on the trunk that blanches on pressure**, fades, and then undergoes desquamation is characteristic of the **sandpaper rash** seen in scarlet fever. - This rash is a hallmark clinical sign of scarlet fever, caused by the erythrogenic toxins. *Red strawberry tongue* - The **red strawberry tongue** (initially white with red papillae, then becoming uniformly red) is a classic oral manifestation of scarlet fever. - This finding is due to the inflammation of the tongue papillae and is a key diagnostic feature of the condition.

Q: A 12-year-old child presents with fever, sore throat for 3 days and posterior cervical lymphadenopathy. Peripheral smear was performed. Diagnosis is?

Infectious mononucleosis. ***Infectious mononucleosis*** - The image shows an **atypical lymphocyte** (Downey cell), characterized by a large, irregularly shaped nucleus and abundant, basophilic cytoplasm, often indenting surrounding red blood cells. These are characteristic of infectious mononucleosis. - The clinical presentation of **fever**, **sore throat**, and **posterior cervical lymphadenopathy** in a 12-year-old child is typical for infectious mononucleosis, commonly caused by the **Epstein-Barr virus (EBV)**. *Hodgkin lymphoma* - While Hodgkin lymphoma presents with lymphadenopathy, it typically involves **Reed-Sternberg cells** on biopsy, which are not seen in a peripheral smear. - Furthermore, the clinical course and presentation of Hodgkin lymphoma are usually more chronic and would not typically present with the acute viral-like syndrome described. *CLL* - **Chronic Lymphocytic Leukemia (CLL)** is a malignancy of mature B lymphocytes, primarily affecting older adults, and would be rare in a 12-year-old. - Peripheral smears in CLL show mature-appearing lymphocytes, often with "smudge cells," which are distinct from the atypical lymphocytes seen in the image. *Herpangina* - Herpangina is a viral illness causing **fever** and **painful mouth sores** (vesicles and ulcers) in the posterior oropharynx, often caused by Coxsackievirus. - While it can cause fever and sore throat, it does not typically present with significant lymphadenopathy, especially **posterior cervical lymphadenopathy**, and would not show atypical lymphocytes on a peripheral smear.

Q: A child is brought to your OPD with rashes as shown below along with fever. Diagnosis is:

Meningococcemia. ***Meningococcemia*** - The image shows a **purpuric rash** with some confluent lesions, which are highly characteristic of **meningococcemia**, especially in a child with fever. - This rash is caused by **endotoxin-mediated vascular damage**, leading to petechiae and purpura that do not blanch under pressure. *Dengue haemorrhagic fever* - While dengue can cause petechiae and purpuric rashes, it typically presents with a more generalized rash, bleeding manifestations like **epistaxis** or **gum bleeding**, and often a history of mosquito exposure. - The rash in dengue is often described as an **"islands of white in a sea of red"** pattern, which is distinct from the more widespread, darker purpuric lesions seen in the image. *Leptospirosis* - Leptospirosis can manifest with a rash, but it is typically **maculopapular** or **erythematous**, sometimes appearing petechial. However, it rarely presents with the extensive, dark purpuric lesions shown, which are indicative of widespread microvascular damage. - Other classic features include **conjunctival suffusion**, myalgia, and severe headache, often following exposure to contaminated water or animal urine. *Scrub typhus* - Scrub typhus typically presents with a **maculopapular rash** that may become generalized, often sparing the face, palms, and soles. A characteristic **eschar** at the site of the chigger bite is a key diagnostic feature. - While petechiae can occur, the widespread, dark purpuric lesions seen in the image are not typical for scrub typhus.

Q: Which of the following statements are correct regarding vaccination routes for children? I. Hepatitis B vaccine given in deltoid region has reduced efficacy II. Two vaccines may be given in the same thigh, but separated by 1 inch III. Separate sites are used when administering a vaccine and an immunoglobulin IV. Two intramuscular vaccines should never be given on the same day Select the answer using the code given below:

II and III. ***II and III*** - Hepatitis B vaccine can be given in the **deltoid region** for older children and adults with good efficacy; reduced efficacy primarily occurs if administered in the gluteal region due to high fat content, not the deltoid. Administering two vaccines in the same thigh, separated by 1 inch, is a recognized practice when multiple injections are needed and separate limbs are not feasible. - Administering a vaccine and an immunoglobulin at **separate sites** is crucial to prevent the immunoglobulin from neutralizing the live attenuated vaccine, thereby reducing its efficacy. *I and III* - Statement I is incorrect because the **deltoid region** is an appropriate and effective site for Hepatitis B vaccine administration in older children and adults. - Statement III is correct, as separating the sites for vaccine and immunoglobulin prevents **immune interference**. *III only* - While statement III is correct regarding the separation of vaccine and immunoglobulin administration, statement II is also correct, making this option incomplete. - **Multiple injections** on the same limb with adequate spacing are acceptable under certain guidelines. *II, III, and IV* - Statement IV is incorrect; multiple **intramuscular vaccines** *can* be given on the same day if clinically indicated and the child is due for them, often in different limbs or at appropriately spaced sites on the same limb. - Statements II and III are correct, but the inclusion of the incorrect statement IV makes this option invalid.

Q: In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Tender swelling behind the ear. ***Tender swelling behind the ear*** - A **tender swelling behind the ear**, particularly in a child with an ear problem, is a classic sign of **mastoiditis**, which is a serious complication requiring urgent medical attention due to the risk of intracranial spread. - **Mastoiditis** often presents with fever, pain, and a prominent, pushed-out auricle. *Pus seen draining from the ear, and discharge reported for more than or equal to 14 days* - This suggests **chronic suppurative otitis media (CSOM)**, which typically requires a referral to ENT for assessment and management but is not usually an *urgent* referral unless there are signs of complications. - While concerning, the chronicity itself doesn't immediately indicate an acute emergency in the absence of other symptoms like fever or severe pain. *Pus seen draining from the ear, and discharge reported for less than 14 days* - This indicates acute otitis media (AOM) with perforation, which is very common in children. - It usually resolves with antibiotics and local care, and while a follow-up is important, it doesn't typically require urgent hospital referral. *Pus seen draining from both ears, irrespective of duration* - Bilateral ear discharge suggests bilateral acute or chronic otitis media, but does not inherently imply an acute emergency that requires urgent hospital referral. - The key factor for urgency would be signs of complications, such as mastoiditis or intracranial involvement, rather than the bilaterality of discharge alone.

Question 1

Identify the cause of rash in the child:

Accepted Answer

Rubeola

Answer

Rubella

Answer

Varicella

Answer

Roseola infantum

Question 2

Which is the most common complication of this rash?

Accepted Answer

Secondary skin infections

Answer

Otitis media

Answer

Bronchopneumonia

Answer

Reye syndrome

Question 3

A 5-year-old child in a village went for open air defecation when he was attacked by a dog. He has been admitted in your hospital, all are correct about the condition except: (Recent NEET Pattern 2016-17)

Accepted Answer

Virus infects pyramidal cells leading to cytolysis

Answer

Category 3 bite

Answer

Wash with povidone-iodine

Answer

Administer vero cell vaccine with immunoglobulin

Question 4

A 6-year-old child from Kashmir is brought to New Delhi hospital in delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Blood culture was sterile after 48 hours of incubation, WeilFelix reaction shows increasing antibody titer and complement fixation test was positive. Which is the best treatment for the patient?

Accepted Answer

Doxycycline

Answer

Amoxicillin clavulanic acid

Answer

Ciprofloxacin

Answer

Rifabutin

Question 5

A 6-year-old child from Kashmir is brought to New Delhi hospital in a delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Probable diagnosis is:

Accepted Answer

Rickettsia

Answer

Cerebral malaria

Answer

Dengue hemorrhagic fever

Answer

SSPE

Question 6

A 4-year-old child presents with fever for 4 days with decreased oral intake. On examination a rough textured rash on trunk is seen which blanches on pressure. Later the rash fades and desquamation occurs. All are true about the condition except:

Accepted Answer

Perioral cyanosis

Answer

Caused by streptococcal pyrogenic exotoxins A, B, and C

Answer

Sandpaper rash

Answer

Red strawberry tongue

Question 7

A 12-year-old child presents with fever, sore throat for 3 days and posterior cervical lymphadenopathy. Peripheral smear was performed. Diagnosis is?

Accepted Answer

Infectious mononucleosis

Answer

Hodgkin lymphoma

Answer

CLL

Answer

Herpangina

Question 8

A child is brought to your OPD with rashes as shown below along with fever. Diagnosis is:

Accepted Answer

Meningococcemia

Answer

Dengue haemorrhagic fever

Answer

Leptospirosis

Answer

Scrub typhus

Question 9

Which of the following statements are correct regarding vaccination routes for children?
I. Hepatitis B vaccine given in deltoid region has reduced efficacy
II. Two vaccines may be given in the same thigh, but separated by 1 inch
III. Separate sites are used when administering a vaccine and an immunoglobulin
IV. Two intramuscular vaccines should never be given on the same day

Select the answer using the code given below:

Accepted Answer

II and III

Answer

I and III

Answer

III only

Answer

II, III, and IV

Question 10

In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Accepted Answer

Tender swelling behind the ear

Answer

Pus seen draining from the ear, and discharge reported for more than or equal to 14 days

Answer

Pus seen draining from the ear, and discharge reported for less than 14 days

Answer

Pus seen draining from both ears, irrespective of duration

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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