A 14-year-old boy in Kolkata, with blood-culture-proven typhoid fever in the second week, becomes delirious and stuporous; he picks at the bedclothes. BP 84/50 mmHg after fluids, pulse 124/min. There is no meningism and CSF is normal. He is already on IV ceftriaxone. What should be added?

High-dose intravenous dexamethasone

A 28-year-old woman in Patna has fever for 9 days. Widal on day 4: TO 1:80, TH 1:160. Repeat on day 11: TO 1:640, TH 1:320. Blood culture was not sent before she received antibiotics from a local practitioner. How should these Widal results be interpreted?

A fourfold rise in O titre supports current enteric fever

A high H titre alone proves past vaccination

Both titres are below significant levels, so typhoid is excluded

The results show paratyphoid A, not typhoid

A 26-year-old migrant worker in Surat has fever with chills every alternate day for a week. His peripheral smear shows enlarged red cells with Schuffner's dots and amoeboid trophozoites; G6PD testing is normal. He is not severely ill. Which treatment follows India's national malaria drug policy?

Chloroquine for 3 days and primaquine for 14 days

Artesunate plus sulfadoxine-pyrimethamine for 3 days

Intravenous artesunate followed by an oral ACT

Tropical fevers: malaria, dengue, enteric fever, scrub typhus, leptospirosis

35 NEET-PG practice questions on Tropical fevers: malaria, dengue, enteric fever, scrub typhus, leptospirosis, part of General Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
On day 5 of fever, as his temperature settles, a 24-year-old man in Kochi is reviewed in the medicine OPD; dengue NS1 was positive on day 2. Pulse 98/min, BP 112/76 mmHg, extremities warm. Today's findings: 1. Persistent vomiting since morning. 2. Haematocrit up from 39% to 47% while platelets fell from 1,20,000 to 38,000/µL. 3. Fresh bleeding from the gums. 4. Total leucocyte count 2,800/µL with a positive tourniquet test. Which of these are warning signs that call for admission and close monitoring?
1. A1 and 2 only
2. B1, 2, 3 and 4
3. C2, 3 and 4 only
4. D1, 2 and 3 only
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Answer: D · 1, 2 and 3 only
Statements 1, 2 and 3 are warning signs in the WHO dengue classification; the others are abdominal pain or tenderness, clinical fluid accumulation, lethargy or restlessness and liver enlargement over 2 cm. Statement 4 is false: leucopenia and a positive tourniquet test are criteria for probable dengue, so they support the diagnosis but do not signal severity. Defervescence marks the critical phase, when plasma leakage peaks, so a patient with any warning sign is admitted and given IV isotonic crystalloid adjusted to serial haematocrit, pulse, BP and urine output. Prophylactic platelet transfusion is not given to a stable patient.
- A: Omits mucosal bleeding (statement 3), which is itself a warning sign.
- B: Includes leucopenia with a positive tourniquet test, a feature of probable dengue rather than a warning sign.
- C: Includes statement 4, which supports the diagnosis but is not a warning sign, and omits persistent vomiting.
Question 2 · Hard
A 14-year-old boy in Kolkata, with blood-culture-proven typhoid fever in the second week, becomes delirious and stuporous; he picks at the bedclothes. BP 84/50 mmHg after fluids, pulse 124/min. There is no meningism and CSF is normal. He is already on IV ceftriaxone. What should be added?
1. AHigh-dose intravenous dexamethasone
2. BIntravenous artesunate
3. CIntravenous acyclovir
4. DIntravenous chloramphenicol
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Answer: A · High-dose intravenous dexamethasone
Typhoid with delirium, obtundation or shock (typhoid encephalopathy, the 'typhoid state') is severe enteric fever with high mortality. In this setting high-dose dexamethasone for 48 hours, given with an effective antibiotic, reduced mortality in a classic trial, and it is recommended in standard texts. Normal CSF excludes meningitis, and the confusion is due to the systemic illness. He also needs ICU care and watch for perforation and bleeding.
- B: Artesunate is an antimalarial and has no role in proven typhoid.
- C: Acyclovir treats herpes encephalitis, which normal CSF and proven typhoid make unlikely.
- D: Adding chloramphenicol gives no benefit over effective ceftriaxone and adds marrow toxicity.
Question 3 · Medium
A 28-year-old woman in Patna has fever for 9 days. Widal on day 4: TO 1:80, TH 1:160. Repeat on day 11: TO 1:640, TH 1:320. Blood culture was not sent before she received antibiotics from a local practitioner. How should these Widal results be interpreted?
1. AA fourfold rise in O titre supports current enteric fever
2. BA high H titre alone proves past vaccination
3. CBoth titres are below significant levels, so typhoid is excluded
4. DThe results show paratyphoid A, not typhoid
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Answer: A · A fourfold rise in O titre supports current enteric fever
A single Widal titre is hard to interpret in India, where background antibody levels are common. A fourfold or greater rise between paired sera taken about a week apart (here TO 1:80 to 1:640) is the strongest Widal evidence of current infection, and O antibodies reflect recent infection better than H. A culture remains the true confirmation, and bone marrow culture can be positive even after antibiotics. Treatment should continue as for enteric fever.
- B: H antibodies persist after vaccination, but the rising O titre points to current infection.
- C: The O titre has risen eightfold, which is significant.
- D: The antigens tested are for S. Typhi (TO, TH), not paratyphoid A.
Question 4 · Easy
A 26-year-old migrant worker in Surat has fever with chills every alternate day for a week. His peripheral smear shows enlarged red cells with Schuffner's dots and amoeboid trophozoites; G6PD testing is normal. He is not severely ill. Which treatment follows India's national malaria drug policy?
1. AChloroquine for 3 days and primaquine for 14 days
2. BArtesunate plus sulfadoxine-pyrimethamine for 3 days
3. CChloroquine for 3 days alone
4. DIntravenous artesunate followed by an oral ACT
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Answer: A · Chloroquine for 3 days and primaquine for 14 days
The smear shows Plasmodium vivax. National policy treats vivax malaria with chloroquine over 3 days to clear blood-stage parasites, plus primaquine 0.25 mg/kg daily for 14 days for radical cure: it kills the dormant liver hypnozoites that cause relapse. G6PD status matters because primaquine can cause haemolysis in deficient patients. Primaquine is not given in pregnancy or to infants.
- B: ACT-SP is for falciparum malaria, and SP resistance makes it unsuitable for vivax.
- C: Chloroquine alone clears the blood but leaves hypnozoites, so relapse follows.
- D: Intravenous artesunate is for severe malaria, which he does not have.
Question 5 · Medium
Three cases of typhoid occur over 2 months among regular customers of a small eatery in Indore. The 50-year-old cook has never been ill, but his stool cultures repeatedly grow Salmonella Typhi, and ultrasound shows gallstones. Where do the bacteria most likely persist in him?
1. AGallbladder
2. BMesenteric lymph nodes
3. CBone marrow
4. DPeyer's patches of the ileum
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Answer: A · Gallbladder
Chronic carriers excrete Salmonella Typhi for more than a year, and the usual reservoir is the gallbladder, especially when gallstones are present; the bacteria form biofilms on the stones. Carriers are common in older women and people with gallstones. Prolonged antibiotics (such as a fluoroquinolone when susceptible) may clear carriage, and cholecystectomy is considered when gallstones persist. Carriers must not handle food until cleared.
- B: Mesenteric nodes are involved early in infection, not in carriage.
- C: Bone marrow holds bacteria during acute illness, not in chronic carriers.
- D: Peyer's patches are involved in acute disease, not long-term carriage.
Question 6 · Easy
A 25-year-old woman, 20 weeks pregnant, from a village near Shimla has had fever and headache for 6 days. There is a painless black-crusted ulcer in the left groin with tender inguinal nodes. Malaria and dengue tests are negative. Which antibiotic is the drug of choice for her?
1. AAzithromycin
2. BDoxycycline
3. CCiprofloxacin
4. DChloramphenicol
Answer and explanation in LearnFree account
Question 7 · Easy
A 19-year-old hostel student in Delhi has had a step-ladder rise of fever for 5 days with headache, a coated tongue and mild abdominal discomfort. Pulse is 88/min with a temperature of 39.6°C. He has had no antibiotics. Which investigation is most useful now to confirm the diagnosis?
1. AWidal test
2. BBlood culture
3. CStool culture
4. DTyphidot IgM card test
Answer and explanation in LearnFree account
Question 8 · Medium
A 27-year-old man was treated for falciparum malaria with an ACT 12 days ago and became afebrile on day 2. He returns for a fitness certificate, feeling well. A bivalent RDT done at the clinic is positive for the HRP2 band, while a carefully read thick smear shows no parasites. What is the best interpretation?
1. ATreatment failure needing a second-line ACT
2. BPersistent HRP2 antigen after cure
3. CVivax malaria missed by the smear
4. DA false-positive test from rheumatoid factor
Answer and explanation in LearnFree account
Question 9 · Medium
A 30-year-old man from Kottayam has had fever, headache and myalgia for 5 days after cleaning a flooded cowshed. He has red eyes without discharge and tender calves. Four statements are made about his likely illness: 1. Infection is acquired through cuts or mucosa from water contaminated with animal urine. 2. Conjunctival suffusion is a characteristic sign. 3. Kidney injury in this disease is typically oliguric with hyperkalaemia. 4. The microscopic agglutination test is the reference serological test. Which statements are correct?
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2 and 4 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 10 · Medium
A 39-year-old farm labourer in a district hospital in Himachal Pradesh has fever for 7 days with myalgia. There is no eschar on careful search and no clear focus. Malaria RDT and smear, dengue NS1 and IgM are negative; platelets 96,000/µL, creatinine 1.6 mg/dL. Blood culture is sent. Which single empirical antibiotic covers both scrub typhus and leptospirosis?
1. ACiprofloxacin
2. BChloroquine
3. CCeftriaxone
4. DDoxycycline
Answer and explanation in LearnFree account
Question 11 · Hard
A 35-year-old man with dengue received IV fluids for 3 days for warning signs. On day 8 his fever has gone, appetite is returning, platelets are rising (from 30,000 to 95,000/µL) and haematocrit has fallen from 48% to 36%. He is now breathless with a respiratory rate of 30/min, bibasal crepitations and bilateral pleural effusions; BP 146/90 mmHg, pulse 88/min, urine output good. IV fluids are still running at the same rate. What is the next best step?
1. AStart intravenous ceftriaxone for pneumonia
2. BGive a crystalloid bolus for plasma leakage
3. CStop intravenous fluids and give intravenous furosemide
4. DTransfuse packed red cells for the falling haematocrit
Answer and explanation in LearnFree account
Question 12 · Hard
A 44-year-old man with severe falciparum malaria and GCS 10 is admitted to the ICU of a medical college in Ranchi. The registrar's plan: 1. IV artesunate at 0, 12 and 24 hours, then daily. 2. Capillary glucose every 4 hours and with any deterioration. 3. IV dexamethasone to reduce cerebral oedema. 4. A full oral ACT course once he has had at least 24 hours of parenteral treatment and can swallow. Which parts of the plan are correct?
1. A1, 2 and 3 only
2. B1, 2 and 4 only
3. C1, 2, 3 and 4
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 13 · Medium
A 34-year-old man with leptospirosis is given his first dose of intravenous benzylpenicillin. Two hours later he has rigors, a temperature of 40°C, flushing, tachycardia and a fall in BP to 96/60 mmHg; there is no rash, wheeze or angioedema. What is the most likely cause?
1. APenicillin anaphylaxis
2. BSeptic shock from a second infection
3. CJarisch-Herxheimer reaction
4. DInfusion of contaminated fluid
Answer and explanation in LearnFree account
Question 14 · Medium
A 20-year-old man in the third week of untreated typhoid fever develops sudden severe abdominal pain, guarding and rigidity. Erect chest X-ray shows free gas under the diaphragm. At laparotomy, where is the perforation most likely to be found, and why?
1. ASigmoid colon, from a ruptured diverticulum
2. BFirst part of the duodenum, from acid hypersecretion
3. CGastric antrum, from stress ulceration
4. DAntimesenteric border of the terminal ileum, at an ulcerated Peyer's patch
Answer and explanation in LearnFree account
Question 15 · Medium
A 35-year-old man from Gadchiroli has had fever for 6 days and is now jaundiced and confused. Smear shows Plasmodium falciparum rings in 6% of red cells. Bilirubin 6.8 mg/dL, creatinine 3.6 mg/dL, glucose 92 mg/dL, BP 108/70 mmHg. Which drug should be started?
1. AOral artesunate plus sulfadoxine-pyrimethamine
2. BIntravenous artesunate
3. CIntravenous quinine plus doxycycline as first choice
4. DOral artemether-lumefantrine
Answer and explanation in LearnFree account
Question 16 · Medium
A 24-year-old woman, 26 weeks pregnant, in a village of Chhattisgarh has fever with chills. Smear shows Plasmodium vivax; she is not severely ill. How should she be treated?
1. APrimaquine alone for 14 days
2. BChloroquine now, with primaquine deferred until after delivery
3. CChloroquine and primaquine for 14 days
4. DIntravenous artesunate for 24 hours, then an oral ACT
Answer and explanation in LearnFree account
Question 17 · Hard
A 24-year-old woman, 22 weeks pregnant, is brought to a district hospital in Bastar with fever for 5 days, now confused, with jaundice. Thin smear shows Plasmodium falciparum rings; haemoglobin 7.4 g/dL, glucose 52 mg/dL, creatinine 2.0 mg/dL. Fetal heart sounds are present. Which antimalarial treatment is most appropriate?
1. AIntravenous artesunate
2. BIntravenous quinine because she is pregnant
3. CChloroquine with single-dose primaquine
4. DOral artemether-lumefantrine
Answer and explanation in LearnFree account
Question 18 · Medium
A 24-year-old software engineer in Hyderabad has had fever for 8 days. Blood culture grows Salmonella Typhi, reported resistant to nalidixic acid with reduced ciprofloxacin susceptibility. He is eating, has no complications and will be treated as an outpatient. Which antibiotic is the best choice?
1. AOral metronidazole
2. BOral azithromycin
3. COral ciprofloxacin
4. DOral amoxicillin-clavulanate
Answer and explanation in LearnFree account
Question 19 · Hard
At a primary health centre in Varanasi, the medical officer reviews a 16-year-old boy with suspected enteric fever and notes: 1. Blood culture is most likely to be positive in the first week of illness. 2. Stool culture is most likely to be positive in the first week of illness. 3. Oral azithromycin is suitable for uncomplicated disease. 4. Reduced fluoroquinolone susceptibility is widespread in Salmonella Typhi in India. Which statements are correct?
1. A1, 2 and 3 only
2. B1 and 4 only
3. C1, 3 and 4 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 20 · Easy
After the monsoon floods in Alappuzha, a 28-year-old volunteer will spend the next 3 weeks wading through floodwater to clear drains. Which measure is advised to prevent leptospirosis?
1. ADoxycycline 200 mg once a week during exposure
2. BLeptospirosis vaccine before the work
3. CAmoxicillin 500 mg three times daily for 5 days
4. DCiprofloxacin 500 mg once before exposure
Answer and explanation in LearnFree account
Question 21 · Easy
A 22-year-old engineering student in Bengaluru, during a dengue outbreak, has had high fever, severe body ache and pain behind the eyes for 2 days. He is well hydrated and has no bleeding. Which test best confirms dengue at this stage of the illness?
1. ADengue IgM capture ELISA
2. BHaemagglutination inhibition test
3. CNS1 antigen ELISA
4. DDengue IgG ELISA
Answer and explanation in LearnFree account
Question 22 · Medium
A 31-year-old man from a tea garden in Assam has fever with chills for 3 days. The bivalent RDT is positive for Plasmodium falciparum. He is walking, eating and has no danger signs. Which treatment follows the national policy for his state?
1. AArtesunate plus sulfadoxine-pyrimethamine with single-dose primaquine
2. BArtemether-lumefantrine for 3 days with single-dose primaquine
3. CChloroquine for 3 days with primaquine for 14 days
4. DIntravenous artesunate for 24 hours
Answer and explanation in LearnFree account
Question 23 · Medium
A 45-year-old sanitation worker in Mumbai has severe leptospirosis with jaundice and acute kidney injury after the monsoon. He is vomiting and cannot take oral drugs. Which antibiotic should be started?
1. AOral doxycycline
2. BIntravenous ceftriaxone
3. CIntravenous metronidazole
4. DIntravenous vancomycin
Answer and explanation in LearnFree account
Question 24 · Medium
On day 4 of fever, a 33-year-old woman with NS1-positive dengue has abdominal pain, repeated vomiting and tender hepatomegaly. Pulse 104/min, BP 110/80 mmHg, haematocrit 46% (baseline 38%), platelets 52,000/µL. She cannot keep oral fluids down. What should be given?
1. AIV albumin as the first fluid
2. BPlatelet concentrate before fluids
3. CIV 5% dextrose in water
4. DIV Ringer's lactate or normal saline
Answer and explanation in LearnFree account
Question 25 · Medium
A 42-year-old man admitted with dengue on day 6 is stable: pulse 86/min, BP 118/78 mmHg, good urine output, no bleeding. His platelet count is 26,000/µL. His relatives demand a platelet transfusion, saying a neighbour received one. What is the most appropriate response?
1. AExplain that platelets are not needed now and continue monitoring
2. BGive fresh frozen plasma to prevent bleeding
3. CTransfuse one unit of single-donor apheresis platelets
4. DTransfuse 4 units of random-donor platelets
Answer and explanation in LearnFree account

10 more Tropical fevers: malaria, dengue, enteric fever, scrub typhus, leptospirosis questions

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Tropical fevers: malaria, dengue, enteric fever, scrub typhus, leptospirosis

A 14-year-old boy in Kolkata, with blood-culture-proven typhoid fever in the second week, becomes delirious and stuporous; he picks at the bedclothes. BP 84/50 mmHg after fluids, pulse 124/min. There is no meningism and CSF is normal. He is already on IV ceftriaxone. What should be added?

A 28-year-old woman in Patna has fever for 9 days. Widal on day 4: TO 1:80, TH 1:160. Repeat on day 11: TO 1:640, TH 1:320. Blood culture was not sent before she received antibiotics from a local practitioner. How should these Widal results be interpreted?

A 26-year-old migrant worker in Surat has fever with chills every alternate day for a week. His peripheral smear shows enlarged red cells with Schuffner's dots and amoeboid trophozoites; G6PD testing is normal. He is not severely ill. Which treatment follows India's national malaria drug policy?

Three cases of typhoid occur over 2 months among regular customers of a small eatery in Indore. The 50-year-old cook has never been ill, but his stool cultures repeatedly grow Salmonella Typhi, and ultrasound shows gallstones. Where do the bacteria most likely persist in him?

A 25-year-old woman, 20 weeks pregnant, from a village near Shimla has had fever and headache for 6 days. There is a painless black-crusted ulcer in the left groin with tender inguinal nodes. Malaria and dengue tests are negative. Which antibiotic is the drug of choice for her?

A 19-year-old hostel student in Delhi has had a step-ladder rise of fever for 5 days with headache, a coated tongue and mild abdominal discomfort. Pulse is 88/min with a temperature of 39.6°C. He has had no antibiotics. Which investigation is most useful now to confirm the diagnosis?

A 34-year-old man with leptospirosis is given his first dose of intravenous benzylpenicillin. Two hours later he has rigors, a temperature of 40°C, flushing, tachycardia and a fall in BP to 96/60 mmHg; there is no rash, wheeze or angioedema. What is the most likely cause?

A 20-year-old man in the third week of untreated typhoid fever develops sudden severe abdominal pain, guarding and rigidity. Erect chest X-ray shows free gas under the diaphragm. At laparotomy, where is the perforation most likely to be found, and why?

A 35-year-old man from Gadchiroli has had fever for 6 days and is now jaundiced and confused. Smear shows Plasmodium falciparum rings in 6% of red cells. Bilirubin 6.8 mg/dL, creatinine 3.6 mg/dL, glucose 92 mg/dL, BP 108/70 mmHg. Which drug should be started?

A 24-year-old woman, 26 weeks pregnant, in a village of Chhattisgarh has fever with chills. Smear shows Plasmodium vivax; she is not severely ill. How should she be treated?

A 24-year-old software engineer in Hyderabad has had fever for 8 days. Blood culture grows Salmonella Typhi, reported resistant to nalidixic acid with reduced ciprofloxacin susceptibility. He is eating, has no complications and will be treated as an outpatient. Which antibiotic is the best choice?

After the monsoon floods in Alappuzha, a 28-year-old volunteer will spend the next 3 weeks wading through floodwater to clear drains. Which measure is advised to prevent leptospirosis?

A 22-year-old engineering student in Bengaluru, during a dengue outbreak, has had high fever, severe body ache and pain behind the eyes for 2 days. He is well hydrated and has no bleeding. Which test best confirms dengue at this stage of the illness?

A 31-year-old man from a tea garden in Assam has fever with chills for 3 days. The bivalent RDT is positive for Plasmodium falciparum. He is walking, eating and has no danger signs. Which treatment follows the national policy for his state?

A 45-year-old sanitation worker in Mumbai has severe leptospirosis with jaundice and acute kidney injury after the monsoon. He is vomiting and cannot take oral drugs. Which antibiotic should be started?

On day 4 of fever, a 33-year-old woman with NS1-positive dengue has abdominal pain, repeated vomiting and tender hepatomegaly. Pulse 104/min, BP 110/80 mmHg, haematocrit 46% (baseline 38%), platelets 52,000/µL. She cannot keep oral fluids down. What should be given?

A 42-year-old man admitted with dengue on day 6 is stable: pulse 86/min, BP 118/78 mmHg, good urine output, no bleeding. His platelet count is 26,000/µL. His relatives demand a platelet transfusion, saying a neighbour received one. What is the most appropriate response?