Infectious Diseases Practice Questions

Q: Fever stops and rash begins is diagnostic of –

Roseola infantum. ***Roseola infantum*** - This condition is characterized by a **high fever** that subsides abruptly, followed by the appearance of a **rose-pink maculopapular rash** on the trunk and neck. - The classic presentation is **"fever stops, rash begins,"** making this the most likely diagnosis. *Measles* - Measles typically presents with a **prodrome of fever**, cough, coryza, and conjunctivitis, followed by a **maculopapular rash that starts on the face** and spreads downwards, usually while the fever is still present. - **Koplik spots** are characteristic enanthem of measles, which are not seen in Roseola. *Fifth disease* - Also known as **Erythema infectiosum**, it classically presents with a **"slapped cheek" rash** on the face, followed by a **lacy, reticular rash** on the trunk and limbs, usually without preceding high fever. - Fever, if present, is usually **low-grade** and not followed by a rash upon its resolution. *Toxic shock syndrome* - This is a severe, acute condition characterized by **high fever**, hypotension, and a diffuse, **erythematous rash that can desquamate**, often associated with bacteremia. - The rash does not typically appear after the fever has resolved; rather, it's a concurrent symptom of severe illness.

Q: Which of the following is the most appropriate treatment for a child with severe falciparum malaria with high parasitemia?

Artesunate injection. ***Artesunate injection*** - **Artesunate** is the drug of choice for severe malaria due to its rapid action and high efficacy in reducing parasite load and mortality. - It is recommended by the **WHO** for initial treatment of severe malaria in both children and adults. *Hyperbaric oxygen* - This treatment is primarily used for conditions like **carbon monoxide poisoning** or **decompression sickness**, not malaria. - It does not directly target the **Plasmodium falciparum** parasite or its pathophysiology. *Exchange transfusion* - While sometimes considered in very severe cases with extremely high parasitemia (>10%) and multiple organ dysfunction, it is an **invasive procedure** with risks and is not the primary treatment. - Its efficacy in improving outcomes in severe malaria is **not definitively established** and it is often reserved for situations where standard antimalarials are failing or unavailable. *IV corticosteroids* - **Corticosteroids** are generally contraindicated in severe malaria as they can worsen the outcome, especially in **cerebral malaria**. - They have been shown to have **no benefit** and may increase the risk of complications such as infections and gastrointestinal bleeding.

Q: A young child of 7 years of age is seen with indurated ulcers, lymphadenopathy and fever. The likely treatment is:

Systemic antibiotics. ***Systemic antibiotics*** - This clinical triad of **indurated ulcers, lymphadenopathy, and fever** in a child is highly suggestive of **ulceroglandular tularemia** (Francisella tularensis), **cat-scratch disease** (Bartonella henselae), or **atypical mycobacterial infection**. - **Tularemia** presents with a painful ulcer at the inoculation site with regional lymphadenopathy and systemic symptoms - treated with **streptomycin or gentamicin**. - **Cat-scratch disease** may present similarly after feline contact - treated with **azithromycin**. - **Atypical mycobacteria** (M. marinum) cause "swimming pool granuloma" with similar features - requiring **clarithromycin and rifampicin**. - **Systemic antibiotic therapy is essential** to prevent complications and disease progression. *Symptomatic treatment* - **Symptomatic treatment alone is inadequate** for bacterial infections presenting with indurated ulcers and lymphadenopathy. - While fever and pain management may be adjunctive, **definitive antimicrobial therapy is required** for these infectious conditions. - Failure to treat appropriately can lead to **systemic dissemination** and serious complications. *Excise the lesion* - **Surgical excision is not the primary treatment** for infectious ulcers with lymphadenopathy. - Excision may be considered for **localized atypical mycobacterial lymphadenitis** that fails medical therapy, but is not first-line. - The presence of **systemic symptoms (fever)** indicates need for medical rather than surgical management. *I.V. fluids* - **Intravenous fluids are supportive therapy** for dehydration, not definitive treatment. - The clinical presentation requires **antimicrobial therapy**, not just hydration. - IV fluids may be needed as adjunctive therapy if the child is unable to maintain oral hydration, but do not address the underlying infection.

Q: According to WHO, the major clinical sign of HIV infection in children in stage 1 is the following.

Generalised lymphadenopathy. ***Generalised lymphadenopathy*** - According to WHO staging for HIV infection in children, **persistent generalized lymphadenopathy (PGL)** is a major clinical sign in Stage 1. - This stage is characterized by asymptomatic or mild clinical manifestations, with PGL being one of the key visible indicators. - PGL is defined as enlarged lymph nodes (>1 cm) in two or more non-contiguous sites, excluding inguinal nodes. *Not gaining weight* - **Failure to thrive** or **unexplained moderate malnutrition** typically falls under WHO clinical Stage 2 or 3, not Stage 1. - While weight loss can occur in HIV, it usually signifies more advanced disease progression in children. *Oral candidiasis* - **Oral candidiasis** in children with HIV usually indicates more advanced disease and is classified under **WHO clinical Stage 2 or 3**, depending on its persistence and severity. - It suggests a compromised immune system beyond the earliest stages of HIV infection. *None of the options* - This option is incorrect because **generalized lymphadenopathy** is indeed a major clinical sign of HIV infection in children in Stage 1, according to WHO criteria. - The other options provided represent signs found in later stages of HIV disease in children.

Q: 'Slapped cheeks' appearance is seen in:

Erythema infectiosum. ***Erythema infectiosum*** - This condition, also known as **Fifth Disease**, is caused by **Parvovirus B19** and classically presents with a distinctive erythematous rash on the cheeks, giving them a **"slapped cheeks" appearance**. - The facial rash is often followed by a **lacy, reticulate rash** on the trunk and extremities. *Erythema multiforme* - Characterized by **target lesions** with multiple rings of color, commonly found on the extremities and trunk. - It is typically a **hypersensitivity reaction** to infections (e.g., HSV) or medications, not a primary viral exanthem with a "slapped cheeks" presentation. *Erythema subitum* - This term is a synonym for **Roseola infantum**, a common childhood viral illness. - It does not primarily present with a "slapped cheeks" rash; rather, it's known for a **high fever followed by a truncal rash** once the fever breaks. *Roseola infantum* - Caused by **Human Herpesvirus 6 (HHV-6)** or sometimes HHV-7, it is characterized by **3-5 days of high fever** that resolves suddenly. - A **maculopapular rash** then appears on the trunk and neck, sparing the face, not the "slapped cheeks" rash.

Q: All of the following are complications of meningitis in a child EXCEPT:

Thyroid dysfunction. ***Thyroid dysfunction*** - **Thyroid dysfunction** is NOT a recognized complication of bacterial or viral meningitis in children. - Meningitis causes neurological complications due to inflammation of the meninges and brain parenchyma, but does not directly affect endocrine organs like the thyroid gland. - This is the correct answer as it is the exception. *Arachnoiditis* - **Arachnoiditis** is inflammation of the arachnoid membrane that can occur as a complication of meningitis. - It leads to scarring and adhesions within the subarachnoid space, potentially causing chronic pain, neurological deficits, and **hydrocephalus** due to impaired CSF circulation. - This is a recognized late complication. *Intellectual disability* - **Intellectual disability** can result from severe or prolonged meningitis causing significant brain damage. - Widespread inflammation, cerebral edema, ischemia, and direct neuronal injury can damage regions responsible for cognitive function. - This affects learning, memory, and developmental milestones in children. *Status epilepticus* - **Status epilepticus** is a life-threatening complication where prolonged or recurrent seizures occur without recovery of consciousness. - It results from direct cortical irritation by inflammation, cerebral edema, metabolic derangements, or hypoxia. - Requires emergency treatment to prevent permanent brain damage and systemic complications.

Q: The most common manifestation of congenital toxoplasmosis is?

Chorioretinitis. ***Chorioretinitis*** - **Chorioretinitis** is the most common and often the primary manifestation of congenital toxoplasmosis, affecting the eyes. - It results from the parasitic infection of the retina and choroid, leading to inflammation, scarring, and potentially severe **vision loss**. *Hepatosplenomegaly* - While **hepatosplenomegaly** can be a feature of congenital toxoplasmosis, it is less common than chorioretinitis. - It indicates systemic involvement but is not considered the most defining or frequent symptom. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) can occur in severe cases of congenital toxoplasmosis but is not the most common manifestation. - It is more indicative of disseminated disease or bone marrow suppression. *Hydrocephalus* - **Hydrocephalus** is a significant but less common finding in congenital toxoplasmosis compared to chorioretinitis. - It arises from inflammation and blockage of CSF flow, often in conjunction with **intracranial calcifications**.

Q: What is the most common presentation of AIDS in infants?

GI infection. ***GI infection*** - **Chronic diarrhea** and gastrointestinal infections are among the most common presentations of AIDS in infants, often leading to **failure to thrive** and malabsorption. - Infants frequently present with **persistent diarrhea** lasting more than 2 weeks, which is a common AIDS-defining illness in pediatric populations. - **Malnutrition** and poor weight gain secondary to GI manifestations are hallmark features of pediatric AIDS presentation. - Common pathogens include **Cryptosporidium**, **Salmonella**, **Cytomegalovirus**, and other opportunistic organisms. *Lymphadenopathy* - While **generalized lymphadenopathy** can occur in HIV-infected children, it is more commonly seen in older children and adults rather than as the primary presentation in infants. - It indicates immune system activation but is not the most frequent initial manifestation in the infant population. *Rashes* - Various **dermatological manifestations** such as seborrheic dermatitis, persistent candidiasis, and recurrent skin infections can occur in pediatric AIDS. - However, these are less common than gastrointestinal manifestations as the initial presentation in infants. *Persistent cough* - **Respiratory infections** including *Pneumocystis jirovecii* pneumonia (**PCP**) are serious and common opportunistic infections in infants with AIDS. - PCP is the most common serious opportunistic infection in pediatric AIDS, but chronic diarrhea and GI problems present more frequently overall as initial manifestations. - Other respiratory infections like recurrent pneumonia and lymphoid interstitial pneumonitis are also seen.

Q: Pertussis most severely affects which age group?

<5. **<5** - Pertussis, or **whooping cough**, is most severe and common in **infants and young children** who have not yet completed their primary vaccination series. - Children under **five years of age** are particularly vulnerable to severe complications such as pneumonia, seizures, and encephalopathy. *2–3* - While children in this age group can certainly contract pertussis, the peak incidence and severity are generally observed in **younger infants**. - This option is too restrictive as it excludes infants under 2 years who are at high risk. *5–7* - At this age, most children would have received their primary series of pertussis vaccinations, making severe infection **less common**. - Though breakthrough infections can occur, the age group under 5 years is still at higher risk for severe outcomes. *> 10 years* - Adults and older children can get pertussis, but their symptoms are often **milder** and less typical than in infants. - The question asks which age group pertussis affects, implying where it causes the most significant disease, which is not typically in those over 10 years.

Question 1

Fever stops and rash begins is diagnostic of –

Accepted Answer

Roseola infantum

Answer

Measles

Answer

Fifth disease

Answer

Toxic shock syndrome

Question 2

Which of the following is the most appropriate treatment for a child with severe falciparum malaria with high parasitemia?

Accepted Answer

Artesunate injection

Answer

Hyperbaric oxygen

Answer

Exchange transfusion

Answer

IV corticosteroids

Question 3

A young child of 7 years of age is seen with indurated ulcers, lymphadenopathy and fever. The likely treatment is:

Accepted Answer

Systemic antibiotics

Answer

Excise the lesion

Answer

Symptomatic treatment

Answer

I.V. fluids

Question 4

According to WHO, the major clinical sign of HIV infection in children in stage 1 is the following.

Accepted Answer

Generalised lymphadenopathy

Answer

Not gaining weight

Answer

Oral candidiasis

Answer

None of the options

Question 5

'Slapped cheeks' appearance is seen in:

Accepted Answer

Erythema infectiosum

Answer

Erythema multiforme

Answer

Erythema subitum

Answer

Roseola infantum

Question 6

All of the following are complications of meningitis in a child EXCEPT:

Accepted Answer

Thyroid dysfunction

Answer

Arachnoiditis

Answer

Intellectual disability

Answer

Status epilepticus

Question 7

The most common manifestation of congenital toxoplasmosis is?

Accepted Answer

Chorioretinitis

Answer

Hepatosplenomegaly

Answer

Thrombocytopenia

Answer

Hydrocephalus

Question 8

What is the most common presentation of AIDS in infants?

Accepted Answer

GI infection

Answer

Rashes

Answer

Lymphadenopathy

Answer

Persistent cough

Question 9

All of the following statements about congenital rubella are true except:

Accepted Answer

Increased risk of congenital malformation if infection occurs after 16 weeks

Answer

Most common anomalies are hearing and heart defects

Answer

IgM antibody is present at birth

Answer

IgG persists for more than 6 months

Question 10

Pertussis most severely affects which age group?

Accepted Answer

<5

Answer

2–3

Answer

5–7

Answer

> 10 years

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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