Infectious Diseases Practice Questions

Q: Which of the following is true regarding tuberculosis in children?

All of the options. ***All of the options*** - All statements — **commonly sputum negative**, **incidence 10-15% of all TB cases**, and **clinically children do not show signs of florid TB** — are generally true for tuberculosis in children. - Children often have **paucibacillary disease** and less severe clinical presentations compared to adults, making diagnosis challenging. *Commonly sputum negative* - Children often have **paucibacillary disease**, meaning fewer bacteria are present in their sputum, making cultures negative or difficult to obtain. - Their smaller airways and inability to effectively expectorate sputum contribute to the **common finding of sputum negativity**. *Incidence 10-15% of all TB cases* - Tuberculosis in children accounts for a significant but smaller proportion of the global TB burden compared to adults. - This statistic reflects that a substantial number of TB cases still occur in the pediatric population, often as contacts of adult cases. *Clinically child does not show sign of florid TB.* - Pediatric TB often presents with **non-specific symptoms** like fever, weight loss, and failure to thrive, rather than the classic severe respiratory symptoms seen in adults. - This makes clinical diagnosis challenging as **florid (severe, overt) TB signs** are less common in children due to their developing immune systems and smaller bacterial loads.

Q: A HIV-positive mother delivers a baby. All are true, except:

Risk of HIV in the baby is up to 90%.. ***Risk of HIV in the baby is up to 90%.*** - Without intervention, the risk of mother-to-child transmission (MTCT) of HIV ranges from **15-45%**, not 90%. - This risk can be reduced to **less than 1%** with effective interventions like antiretroviral therapy (ART) during pregnancy, elective cesarean section, and avoiding breastfeeding. *HIV infection cannot be diagnosed in the baby with available methods.* - **HIV infection CAN be diagnosed in infants** using virological tests such as **HIV DNA PCR** or **HIV RNA PCR**. - These tests detect the actual virus, unlike antibody tests which would detect maternal antibodies that crossed the placenta and can persist up to 18 months. *Breast feeding can transmit HIV.* - **Breastfeeding is a known route of HIV transmission** from an infected mother to her child. - The risk of transmission through breastfeeding is estimated to be **5-20%** and varies with viral load and duration of breastfeeding. *HIV can be transmitted from mother to child during delivery.* - **Peripartum transmission** (during labor and delivery) is the most common route of MTCT of HIV. - This occurs through exposure to maternal blood and genital secretions during the birthing process.

Q: Which of the following is not a common manifestation of congenital Rubella -

Aortic stenosis. ***Aortic stenosis*** - While **congenital heart defects** are characteristic of congenital rubella syndrome, **aortic stenosis** is NOT typically associated. - The most common cardiac anomalies in **congenital rubella syndrome** are **patent ductus arteriosus (PDA)** and **peripheral pulmonary artery stenosis**. *PDA* - **Patent ductus arteriosus** is one of the most common and classic cardiac manifestations of **congenital rubella syndrome**, occurring in 50-75% of cases. - The rubella virus interferes with normal closure of the **ductus arteriosus** during fetal development. *Deafness* - **Sensorineural deafness** is the most common manifestation of **congenital rubella syndrome**, occurring in up to 80% of cases. - The virus damages the developing **cochlea** and auditory structures, often resulting in bilateral profound hearing loss. *Intellectual disability* - **Neurological complications**, including **intellectual disability** and developmental delays, are frequent in infants with **congenital rubella syndrome**. - The virus directly infects the developing brain, leading to various degrees of **cognitive and neurological impairment**.

Q: Most common cause of Pyogenic Meningitis in 6 month to 2 years of age is

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - *Streptococcus pneumoniae* is currently the most common cause of **bacterial meningitis** in children aged 6 months to 2 years, especially after the widespread use of the *H. influenzae* type b (Hib) vaccine. - The **pneumococcal conjugate vaccine (PCV)** has significantly reduced, but not eliminated, the incidence of pneumococcal meningitis. *H. influenzae* - Before the introduction of the Hib vaccine, *H. influenzae* type b was the most common cause of **bacterial meningitis** in this age group. - Due to successful vaccination programs, its incidence has drastically declined, making **pneumococcus** more common. *Staphylococcus aureus* - *Staphylococcus aureus* is a common cause of **meningitis** associated with neurosurgical procedures, trauma, or intravenous drug use. - It is not typically the leading cause of community-acquired pyogenic meningitis in otherwise healthy children aged 6 months to 2 years. *Neisseria meningitidis* - *Neisseria meningitidis* is a significant cause of **bacterial meningitis**, especially in older children, adolescents, and young adults. - While it can occur in infants, it is generally less common than *Streptococcus pneumoniae* in the 6-month to 2-year age group.

Q: Which of the following statements regarding Congenital Rubella Syndrome (CRS) is FALSE?

Cataract in CRS is always bilateral.. ***Cataract in CRS is always bilateral.*** - While **cataracts** are a common manifestation of **Congenital Rubella Syndrome (CRS)**, they are **not always bilateral**; they can affect one or both eyes. - The severity and presentation of CRS features, including ocular defects, can vary. *Infants with Congenital Rubella Syndrome can shed virus in respiratory secretions for up to 1 year of age.* - Infants with **CRS** can indeed shed the rubella virus for an extended period, often up to a year or even longer, posing a risk of transmission to susceptible contacts. - This prolonged shedding highlights the importance of **infection control measures** when caring for affected infants. *Risk of congenital defects is high when fetus is infected during the first trimester.* - The risk of severe congenital defects is highest when the mother is infected with rubella during the **first trimester** of pregnancy, particularly in weeks 8-10. - This is due to the critical period of **organogenesis**, where viral infection can disrupt major developmental processes. *CRS is associated with increased risk of hearing loss and cardiac defects.* - **Sensorineural hearing loss** is one of the most common and significant sequelae of CRS, along with **cardiac defects** such as **patent ductus arteriosus (PDA)** and **pulmonary artery stenosis**. - These are considered part of the classic triad of CRS, which also includes eye abnormalities.

Q: What is the recommended duration of erythromycin prophylaxis for children exposed to pertussis?

14 days of prophylactic antibiotics. ***14 days of prophylactic antibiotics*** - For **post-exposure prophylaxis of pertussis** with **erythromycin**, the recommended duration is **14 days** (40-50 mg/kg/day in 4 divided doses, max 2 g/day). - This duration aims to **eradicate Bordetella pertussis** and prevent disease development or reduce severity in exposed contacts. - **Note:** Azithromycin (5 days) and clarithromycin (7 days) are shorter alternative regimens, but erythromycin specifically requires 14 days for adequate prophylaxis. *10 days of prophylactic antibiotics* - A 10-day course is **insufficient for erythromycin prophylaxis** against pertussis. - Premature discontinuation may lead to **treatment failure** and continued risk of disease transmission. *12 days of prophylactic antibiotics* - A 12-day course is **not the standard recommendation** for erythromycin-based pertussis prophylaxis. - The established CDC and AAP guidelines specify **14 days** for complete eradication. *11 days of prophylactic antibiotics* - An 11-day course is **inadequate** for erythromycin prophylaxis in pertussis-exposed children. - Adhering to the **full 14-day regimen** is crucial for optimal prevention and public health control.

Q: As per the Indian immunization schedule (IAP), at what age is the Hepatitis A vaccine recommended?

1 year. ***1 year*** - The **Hepatitis A vaccine** is recommended as a 2-dose series for all children, with the first dose typically administered between **12 and 23 months of age**. - This timing ensures early protection against **Hepatitis A virus infection**, which can cause liver inflammation. *2 years* - While some vaccinations might be administered around this age, the **initial dose of hepatitis A** is generally given earlier. - Delaying the first dose until 2 years would miss the recommended primary vaccination window for most children. *5 years* - By 5 years of age, children should have already completed their **Hepatitis A vaccine series**. - Vaccination at this age would only be for those who somehow missed the recommended earlier doses. *10 years* - The Hepatitis A vaccine is not primarily recommended at 10 years of age for routine childhood immunization. - Vaccination at this age would typically only occur if a child had not previously received the vaccine, often due to travel to endemic areas or other specific risk factors.

Q: False regarding erythema infectiosum is -

Associated with HHV-6. ***Associated with HHV-6*** - Erythema infectiosum, or fifth disease, is caused by **parvovirus B19**, not **Human Herpesvirus 6 (HHV-6)** - **HHV-6** is the causative agent of **roseola infantum** (sixth disease), which presents with high fever followed by a rash - This is the **FALSE statement** making it the correct answer *Marked erythema of the cheeks or slapped cheek appearance often with relative circum-oral pallor* - This is a **classic and defining clinical feature** of erythema infectiosum - The **"slapped cheek" appearance** is often the first and most recognizable symptom in children - This statement is TRUE, therefore incorrect as an answer *Infection during pregnancy can result in hydrops fetalis due to fetal anemia* - **Parvovirus B19 infection** in pregnant women can cross the placenta and cause **severe fetal anemia** - This can result in **hydrops fetalis**, a serious and potentially fatal condition - This statement is TRUE, therefore incorrect as an answer *Arthritis is a complication* - **Arthralgia** or **arthritis** is a recognized complication of parvovirus B19 infection, particularly in adult women - The joint pain is typically symmetrical and self-limiting, resolving over weeks to months - This statement is TRUE, therefore incorrect as an answer

Q: In an infant born to a HIV infected mother, at what age can the ELISA test reliably diagnose HIV infection?

18 months. ***18 months*** - At **18 months of age**, maternal HIV antibodies passed to the infant are usually no longer present, allowing for accurate detection of the infant's own antibody response via ELISA. - Before this age, a positive ELISA test might reflect the presence of **maternal antibodies** rather than true infant infection. *3 months* - An ELISA test at 3 months would not reliably diagnose HIV infection as **maternal antibodies** are still typically present in the infant's system. - Early diagnosis in infants usually requires **virological tests** (e.g., PCR for HIV DNA or RNA) that detect the virus itself, not antibodies. *9 months* - While maternal antibodies may start to wane by 9 months, they can still be present, leading to **false positive** ELISA results. - Virological testing remains the preferred method for definitive diagnosis before 18 months. *12 months* - A significant proportion of infants may still have detectable **maternal antibodies** at 12 months, making ELISA unreliable for true infection diagnosis. - Confirmation of HIV infection at this age would still ideally involve **virological testing**.

Question 1

Which of the following is true regarding tuberculosis in children?

Accepted Answer

All of the options

Answer

Commonly sputum negative

Answer

Incidence 10-15% of all TB cases

Answer

Clinically child does not show sign of florid TB.

Question 2

A HIV-positive mother delivers a baby. All are true, except:

Accepted Answer

Risk of HIV in the baby is up to 90%.

Answer

HIV infection cannot be diagnosed in the baby with available methods.

Answer

Breast feeding can transmit HIV.

Answer

HIV can be transmitted from mother to child during delivery.

Question 3

Which of the following is not a common manifestation of congenital Rubella -

Accepted Answer

Aortic stenosis

Answer

PDA

Answer

Deafness

Answer

Intellectual disability

Question 4

Most common cause of Pyogenic Meningitis in 6 month to 2 years of age is

Accepted Answer

Streptococcus pneumoniae

Answer

H. influenzae

Answer

Staphylococcus aureus

Answer

Neisseria meningitidis

Question 5

Which of the following statements regarding Congenital Rubella Syndrome (CRS) is FALSE?

Accepted Answer

Cataract in CRS is always bilateral.

Answer

Infants with Congenital Rubella Syndrome can shed virus in respiratory secretions for up to 1 year of age.

Answer

Risk of congenital defects is high when fetus is infected during the first trimester.

Answer

CRS is associated with increased risk of hearing loss and cardiac defects.

Question 6

What is the recommended duration of erythromycin prophylaxis for children exposed to pertussis?

Accepted Answer

14 days of prophylactic antibiotics

Answer

10 days of prophylactic antibiotics

Answer

12 days of prophylactic antibiotics

Answer

11 days of prophylactic antibiotics

Question 7

As per the Indian immunization schedule (IAP), at what age is the Hepatitis A vaccine recommended?

Accepted Answer

1 year

Answer

2 years

Answer

5 years

Answer

10 years

Question 8

False regarding erythema infectiosum is -

Accepted Answer

Associated with HHV-6

Answer

Marked erythema of the cheeks or slapped cheek appearance often with relative circum-oral pallor

Answer

Infection during pregnancy can result in hydrops fetalis due to fetal anemia

Answer

Arthritis is a complication

Question 9

A four year old female presents to the emergency room with fever and a petechial rash. A sepsis workup is performed, and parenteral antibiotics are administered. Gram-negative diplococci are identified in the CSF. Which of the following is true of this condition?

Accepted Answer

Antibiotic prophylaxis of fellow daycare attendees is necessary

Answer

The most common neurologic residual is sensorineural hearing loss

Answer

The presence of meningitis improves the survival rate

Answer

Shock is the usual cause of death, which most often occurs within 48 hours of hospitalization

Question 10

In an infant born to a HIV infected mother, at what age can the ELISA test reliably diagnose HIV infection?

Accepted Answer

18 months

Answer

3 months

Answer

9 months

Answer

12 months

Infectious Diseases — MCQs

Infectious Diseases — MCQs

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