Infectious Diseases Practice Questions

Q: According to WHO clinical staging of HIV in children oral hairy leukoplakia belongs to which clinical stages?

Clinical stage 2. ***Clinical stage 2*** - **Oral hairy leukoplakia** is classified under WHO clinical stage 2 for HIV infection, representing mild symptomatic disease with moderate immune compromise. - Stage 2 includes conditions such as **angular cheilitis**, **papular pruritic eruptions**, **recurrent oral ulcerations**, **herpes zoster**, **lineal gingival erythema**, and **recurrent upper respiratory tract infections**. - **Note:** Oral hairy leukoplakia is **rare in children** and is more commonly seen in adults with HIV; it is caused by **Epstein-Barr virus** reactivation. *Clinical stage 1* - This stage includes **asymptomatic** HIV infection or **persistent generalized lymphadenopathy**. - Stage 1 represents minimal or no immune compromise with no clinical manifestations requiring intervention. *Clinical stage 3* - Clinical stage 3 represents **advanced symptomatic disease** with conditions like **unexplained severe malnutrition**, **unexplained persistent diarrhea**, **oral candidiasis**, **pulmonary tuberculosis**, and **severe recurrent bacterial pneumonia**. - These conditions indicate more severe immunodeficiency than oral hairy leukoplakia. *Clinical stage 4* - Clinical stage 4 represents **severe HIV disease** with AIDS-defining illnesses such as **Pneumocystis jirovecii pneumonia**, **extrapulmonary tuberculosis**, **Kaposi's sarcoma**, **HIV encephalopathy**, **CMV retinitis**, and **disseminated mycobacterial infections**. - Stage 4 conditions are life-threatening and indicate severe immunosuppression.

Q: Most common complication of mumps in children:

Aseptic meningitis. ***Aseptic meningitis*** - **Aseptic meningitis** is the most frequent complication of mumps, occurring in approximately 10-30% of cases, primarily in children. - It usually presents with mild symptoms like **headache**, **fever**, and **nuchal rigidity** and typically resolves without specific treatment or long-term sequelae. - This is a benign, self-limiting condition that represents **CNS involvement** during mumps infection. *Myocarditis* - Myocarditis can occur as a complication of mumps, but it is **relatively rare** and much less common than aseptic meningitis. - While it can be serious, it is not considered the most common complication in children. *Orchitis* - Orchitis (inflammation of the testicles) is a well-known complication of mumps, but it primarily affects **post-pubertal males** and is uncommon in prepubertal children. - In the pediatric age group specifically, it is **less common than aseptic meningitis**. - Can lead to testicular atrophy and potential fertility issues in adults. *Pancreatitis* - Pancreatitis is a known but **less frequent complication**, occurring in about 2-5% of mumps cases. - While it can cause abdominal pain and elevated serum amylase, it is not the most common complication of mumps in children.

Q: Most common cause of HIV infection in infant is –

Intrapartum transmission. ***Intrapartum transmission*** - **Intrapartum transmission** (during labor and delivery) accounts for approximately **60-70% of mother-to-child HIV transmission** without interventions, making it the most common single route of HIV infection in infants. - This occurs when the infant is exposed to maternal blood and bodily fluids during the birth process. - The risk is highest during vaginal delivery, though transmission can occur with cesarean section as well. *Transplacental (in utero)* - **Transplacental transmission** occurs during pregnancy when the virus crosses the placental barrier. - This accounts for approximately **25-30% of mother-to-child transmission** without interventions. - While significant, it is less common than transmission during delivery. *Breast milk* - **Breastfeeding** can transmit HIV from mother to infant and accounts for approximately **10-15% of MTCT** in the absence of antiretroviral therapy. - Postnatal transmission through breastfeeding is an important but less common route compared to transmission during the birthing process. - The risk is cumulative over the duration of breastfeeding. *Blood transfusion* - **Blood transfusion** was a significant cause of HIV transmission in the past before routine screening. - With modern blood safety measures and universal screening of blood products, this route has become extremely rare. - This is no longer a common cause of HIV infection in infants in countries with proper blood screening protocols.

Q: Which of the following is true regarding Typhoid in children -

Mild splenomegaly is usual. ***Mild splenomegaly is usual*** - **Splenomegaly** is a common finding in children with typhoid fever, often mild to moderate. - The spleen may enlarge due to bacterial dissemination and the body's immune response to the infection. *Urine culture is positive in 4 to 6 days* - **Urine culture** typically becomes positive much later in the course of typhoid fever, usually after the first week or even later, once bacteria have disseminated more widely. - **Blood culture** is the most reliable diagnostic test in the first week of illness. *Leukocytosis is characteristic* - **Leukopenia** (low white blood cell count), sometimes with relative lymphocytosis, is characteristic of typhoid fever, especially in the early stages. - **Leukocytosis** (high white blood cell count) is atypical and may suggest a different infection or a complication. *Encephalitis is common* - **Encephalopathy** (altered mental status, confusion) can occur in severe cases of typhoid fever, sometimes referred to as "typhoid encephalopathy." - True **encephalitis** (inflammation of the brain parenchyma) is a less common neurological complication and is not characteristic for every case.

Q: All of the following are features of poliomyelitis except –

Progressive course. Progressive course - Poliomyelitis typically presents with an **acute onset of flaccid paralysis**, not a progressive worsening over a long period, distinguishing it from conditions like amyotrophic lateral sclerosis [1]. - While post-polio syndrome can have a progressive course years after the initial infection, the primary disease itself is characterized by an acute phase followed by a stable or improving state [1]. *Intact sensation* - Poliomyelitis specifically affects the **anterior horn cells** of the spinal cord, leading to motor weakness and paralysis. - Sensory pathways are generally unaffected, so patients with polio typically retain **intact sensation**. [1] *Acute onset* - The classic presentation of paralytic poliomyelitis is an **acute development of muscle weakness** and paralysis, often reaching its peak within days. - This acute onset is a hallmark feature of the disease's paralytic forms [1]. *Febrile onset* - Poliomyelitis often begins with a **prodromal febrile illness**, characterized by fever, headache, malaise, and sometimes gastrointestinal symptoms. - This initial febrile phase precedes the onset of neurological symptoms in paralytic cases.

Q: An appropriate single antibiotic for the empiric treatment of presumed bacterial meningitis in a six month old child would be:

Cefotaxime. ***Cefotaxime*** - As a **third-generation cephalosporin**, cefotaxime has excellent penetration into the **cerebrospinal fluid (CSF)** and provides broad-spectrum coverage against common bacterial meningitis pathogens in young children, including *Streptococcus pneumoniae*, *Neisseria meningitidis*, and *Haemophilus influenzae*. - In a 6-month-old child, cefotaxime is an excellent choice for empiric therapy. While both cefotaxime and ceftriaxone are appropriate at this age, cefotaxime is specifically preferred over ceftriaxone in **neonates younger than 28 days** due to concerns about biliary pseudolithiasis and bilirubin displacement, which can worsen jaundice and increase the risk of kernicterus. *Ampicillin* - While effective against *Listeria monocytogenes* (particularly important in neonates and infants <3 months) and Group B *Streptococcus*, ampicillin provides **insufficient coverage** for many other common causes of bacterial meningitis in this age group, particularly penicillin-resistant *Streptococcus pneumoniae* and *Haemophilus influenzae*. - Its use alone as empiric therapy for bacterial meningitis in a 6-month-old would be inadequate, often warranting combination therapy with a third-generation cephalosporin in younger infants. *Cefadroxil* - Cefadroxil is a **first-generation cephalosporin** primarily used for skin, soft tissue, and urinary tract infections. - It has **poor penetration into the CSF** and therefore is not an appropriate choice for treating meningitis. *Cefuroxime* - Cefuroxime is a **second-generation cephalosporin** with limited activity against *Streptococcus pneumoniae* and certain **Gram-negative bacteria** compared to third-generation cephalosporins. - While it has some central nervous system penetration, its efficacy is **inferior to third-generation cephalosporins** like cefotaxime or ceftriaxone for treating bacterial meningitis, especially considering the potential for resistant strains.

Q: In which disease a generalized papular rash, fever, conjunctivitis & lesion on buccal mucosa shown below are seen?

Measles. **Measles** - The combination of a generalized **papular rash**, **fever**, **conjunctivitis**, and especially the presence of **Koplik spots** on the buccal mucosa, is pathognomonic for measles. - Koplik spots are small, white, or bluish-white lesions on an erythematous base found on the oral mucosa and are highly characteristic of the prodromal phase of measles. *Mumps* - Mumps primarily presents with **parotitis** (swelling of the salivary glands) and fever, rather than a generalized rash or Koplik spots on the buccal mucosa. - While a rash can sometimes occur, it is not a prominent or defining feature, and conjunctivitis is less common. *Rubella* - Rubella (German measles) is characterized by a **maculopapular rash** and mild fever, but the rash typically starts on the face and spreads rapidly, clearing within 3 days. - Unlike measles, rubella does not feature Koplik spots, and conjunctivitis, if present, is usually milder. *Chickenpox* - Chickenpox (varicella) is characterized by a **vesicular rash** that progresses from macules to papules, vesicles, and scabs, appearing in successive crops. - While fever can be present, the rash is pruritic and presents as fluid-filled blisters, which differs significantly from the papular rash and Koplik spots seen in the given description.

Q: Complications of measles are all except:

Pancreatitis. Pancreatitis - While measles can cause systemic inflammation, pancreatitis is not a commonly recognized or significant complication. - Complications of measles primarily affect the respiratory, neurological, and gastrointestinal systems, but direct pancreatic involvement is rare. Appendicitis - Measles can cause inflammation of the lymphoid tissue in the gut, including the Peyer's patches in the appendix. - This inflammation can mimic or, in some cases, truly lead to acute appendicitis. SSPE - Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal, neurodegenerative complication of measles occurring years after the initial infection [1]. - It is caused by persistent infection of the central nervous system with a defective measles virus [1]. Myocarditis - Myocarditis, or inflammation of the heart muscle, can occur during the acute phase of measles infection. - Viral infections, including measles, are known causes of cardiac complications due to direct viral invasion or immune-mediated damage.

Q: Koplik spots are characteristic of:-

Measles. ***Measles*** - **Koplik spots** are small, white, or bluish-white spots on an erythematous base on the buccal mucosa, typically appearing 1-2 days before the generalized rash of measles. - They are considered a **pathognomonic sign** of measles infection. *Chicken pox* - Characterized by a **pruritic rash** that progresses from macules to papules, vesicles, and scabs. - It does not involve Koplik spots; its oral lesions are typically **aphthous ulcers** or vesicles. *HIV* - A retroviral infection that can lead to acquired immunodeficiency syndrome (AIDS). - Oral manifestations of HIV include **oral candidiasis**, **hairy leukoplakia**, and **Kaposi's sarcoma**, but not Koplik spots. *Mumps* - A viral infection primarily affecting the **salivary glands**, causing painful swelling (parotitis). - While it can cause oral symptoms like difficulty swallowing, it is not associated with the presence of Koplik spots.

Q: Reye's syndrome following influenza is most commonly associated with -

Type B. ***Type B*** - Reye's syndrome is **classically and most strongly associated** with **influenza B virus infection** in children who have been given **aspirin** for symptomatic relief. - The combination of **viral infection (especially influenza B)** and **aspirin use** leads to mitochondrial dysfunction, particularly affecting the liver and brain. - Epidemiological studies during the peak incidence years showed a **stronger association with influenza B** than with other influenza types. *Type A* - While influenza A can precede Reye's syndrome, particularly during pandemics, the **classical and stronger epidemiological association** is with influenza B. - Both influenza A and B have been implicated, but **type B predominates** in most case series and textbook descriptions. *Type C* - Influenza C viruses typically cause **mild respiratory illness** and are rarely associated with severe complications. - There is **no significant association** between influenza C and the development of Reye's syndrome. *All of the options* - This is incorrect because Reye's syndrome exhibits a **stronger and more consistent association specifically with influenza B** compared to other influenza types. - While other viral infections (particularly **varicella-zoster virus**) can also precede Reye's syndrome, among influenza types, **type B is the most implicated**.

Question 1

According to WHO clinical staging of HIV in children oral hairy leukoplakia belongs to which clinical stages?

Accepted Answer

Clinical stage 2

Answer

Clinical stage 1

Answer

Clinical stage 3

Answer

Clinical stage 4

Question 2

Most common complication of mumps in children:

Accepted Answer

Aseptic meningitis

Answer

Myocarditis

Answer

Pancreatitis

Answer

Orchitis

Question 3

Most common cause of HIV infection in infant is –

Accepted Answer

Intrapartum transmission

Answer

Transplacental

Answer

Breast milk

Answer

Blood transfusion

Question 4

Which of the following is true regarding Typhoid in children -

Accepted Answer

Mild splenomegaly is usual

Answer

Urine culture is positive in 4 to 6 days

Answer

Leukocytosis is characteristic

Answer

Encephalitis is common

Question 5

All of the following are features of poliomyelitis except –

Accepted Answer

Progressive course

Answer

Intact sensation

Answer

Acute onset

Answer

Febrile onset

Question 6

An appropriate single antibiotic for the empiric treatment of presumed bacterial meningitis in a six month old child would be:

Accepted Answer

Cefotaxime

Answer

Ampicillin

Answer

Cefadroxil

Answer

Cefuroxime

Question 7

In which disease a generalized papular rash, fever, conjunctivitis & lesion on buccal mucosa shown below are seen?

Accepted Answer

Measles

Answer

Mumps

Answer

Rubella

Answer

Chickenpox

Question 8

Complications of measles are all except:

Accepted Answer

Pancreatitis

Answer

Appendicitis

Answer

SSPE

Answer

Myocarditis

Question 9

Koplik spots are characteristic of:-

Accepted Answer

Measles

Answer

Chicken pox

Answer

HIV

Answer

Mumps

Question 10

Reye's syndrome following influenza is most commonly associated with -

Accepted Answer

Type B

Answer

Type C

Answer

Type A

Answer

All of the options

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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