Common childhood infections and IMNCI

26 NEET-PG practice questions on Common childhood infections and IMNCI, part of Paediatrics. 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.

1. Question 1 · Medium

   An 18-month-old boy weighing 10 kg has had watery diarrhoea for 2 days. At the PHC he is restless and irritable, his eyes are sunken, he drinks eagerly and a skin pinch goes back slowly. There is no blood in the stool. Besides zinc, what should the medical officer give?

   1. A1,000 mL of IV Ringer lactate
   2. B750 mL of ORS over the next 4 hours
   3. C50-100 mL of ORS after each loose stool
   4. DOral ciprofloxacin with ORS at home

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   Answer: B · 750 mL of ORS over the next 4 hours

   Two or more of restlessness, sunken eyes, eager drinking and a slow skin pinch classify the child as having some dehydration under IMNCI, which is treated with Plan B. Plan B is 75 mL/kg of low-osmolarity ORS over 4 hours at the facility, here 75 x 10 = 750 mL, followed by reassessment. Zinc 20 mg daily for 14 days is added for children aged 6 months and above. Antibiotics are not used for watery diarrhoea; ciprofloxacin is for dysentery.

   • A: IV fluids (Plan C) are for severe dehydration, which he does not have.
   • C: ORS after each stool (Plan A) is for children with no dehydration.
   • D: Antibiotics are for dysentery, not for watery diarrhoea.

2. Question 2 · Medium

   A 3-year-old boy weighing 13 kg is brought to the paediatric OPD in Lucknow with fever, abdominal cramps and frequent small stools with visible blood for 2 days. He drinks normally, his eyes are not sunken and a skin pinch goes back immediately. Besides ORS and zinc, what is the most appropriate treatment?

   1. AOral ciprofloxacin for 3 days
   2. BNo antibiotic; ORS and zinc only
   3. COral cotrimoxazole for 5 days
   4. DOral metronidazole for 5 days

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   Answer: A · Oral ciprofloxacin for 3 days

   Diarrhoea with visible blood in a young child is classified as dysentery, and in India the commonest cause is Shigella. WHO and IMNCI recommend oral ciprofloxacin (15 mg/kg twice daily for 3 days) as the first-line antibiotic, with follow-up after 2 days and a change of antibiotic if there is no improvement. Shigella invades colonic mucosa and needs only a small inoculum, so hand-washing protects household contacts. Metronidazole is kept for amoebiasis proven on stool microscopy.

   • B: Bloody diarrhoea in a young child needs an antibiotic, unlike watery diarrhoea.
   • C: Shigella resistance to cotrimoxazole is widespread, so it is no longer recommended.
   • D: Metronidazole is for amoebic dysentery confirmed by trophozoites with ingested red cells, not first-line.

3. Question 3 · Medium

   In a measles outbreak in a tribal block of Madhya Pradesh, a resident teaches interns using four statements: 1. Koplik spots appear before the rash. 2. The rash starts behind the ears and along the hairline and spreads downwards. 3. As the rash fades it leaves a brownish staining with fine scaling. 4. The rash fades first from the legs and last from the face. Which statements are correct?

   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 correct. Koplik spots appear in the prodrome, a day or two before the rash, which begins behind the ears and at the hairline, spreads down over the face, trunk and limbs over about 3 days and becomes confluent on the face and upper body. It fades in the same order as it appeared, beginning with the face, leaving brownish staining and fine branny desquamation. Statement 4 is therefore wrong; this order of fading helps distinguish measles from other rashes.

   • A: Omits the brownish staining and scaling, a true feature.
   • B: Includes statement 4; the rash fades first from the face.
   • C: Omits Koplik spots and includes the wrong order of fading.

4. Question 4 · Medium

   A 5-year-old girl in Shillong has had fever and sore throat for 2 days. She now has a fine, rough, sandpaper-like red rash that is denser in the skin creases of the elbows, a flushed face with pallor around the mouth, and a red tongue with prominent papillae. Why is a full course of penicillin important for her?

   1. ATo prevent acute rheumatic fever
   2. BTo prevent coronary artery aneurysms
   3. CTo prevent toxic shock from the rash
   4. DTo prevent post-measles encephalitis

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   Answer: A · To prevent acute rheumatic fever

   A sandpaper rash accentuated in the flexures (Pastia lines), circumoral pallor and a strawberry tongue after sore throat are scarlet fever, caused by group A Streptococcus producing pyrogenic exotoxin. Penicillin for 10 days eradicates the organism from the throat and prevents acute rheumatic fever if started within about 9 days of the sore throat. It does not reliably prevent post-streptococcal glomerulonephritis. Amoxicillin is an accepted alternative, and macrolides are used in penicillin allergy.

   • B: Coronary aneurysms are the feared complication of Kawasaki disease, a non-infective mimic.
   • C: The rash is toxin-mediated but not a sign of toxic shock, which treatment is not aimed at here.
   • D: The illness is streptococcal, not measles.

5. Question 5 · Medium

   A 9-year-old boy in Malappuram who had measles at the age of 1 year has been doing badly at school for 4 months. He now has sudden repetitive jerks of the limbs and frequent falls. EEG shows periodic high-voltage complexes, and CSF shows a markedly raised anti-measles antibody titre. What is the most likely diagnosis?

   1. AJuvenile myoclonic epilepsy
   2. BMeasles inclusion body encephalitis
   3. CSubacute sclerosing panencephalitis
   4. DAcute post-measles encephalomyelitis

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   Answer: C · Subacute sclerosing panencephalitis

   Subacute sclerosing panencephalitis appears years after measles, usually caught in infancy, from persistence of a defective measles virus in the brain. It presents with intellectual and behavioural decline, then myoclonic jerks, and later rigidity and coma. Periodic complexes on EEG and high measles antibody in the CSF confirm it. There is no curative treatment, which is one more reason to vaccinate every child on time.

   • A: Juvenile myoclonic epilepsy causes morning jerks without intellectual decline or raised CSF antibody.
   • B: Inclusion body encephalitis occurs within months in immunocompromised children.
   • D: Post-measles encephalomyelitis is an acute demyelinating illness days after the rash.

6. Question 6 · Medium

   During a cholera outbreak in a resettlement colony in Kolkata, a 6-year-old with profuse rice-water stools keeps absorbing oral rehydration solution although the cholera toxin is still raising cyclic AMP in his enterocytes. Which mechanism allows ORS to work in this situation?

   1. APotassium in ORS reverses the activated adenylate cyclase
   2. BCitrate in ORS neutralises the bound cholera toxin
   3. CSodium-glucose co-transport through SGLT1 stays intact
   4. DGlucose closes the CFTR channel that the toxin opens

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7. Question 7 · Medium

   A 5-year-old girl living with her grandfather, who has sputum-positive tuberculosis, is screened in the paediatric OPD. She recovered from measles 3 weeks ago. Her tuberculin skin test shows 2 mm induration at 72 hours. Why may this result be falsely negative?

   1. AMeasles depresses cell-mediated immunity for weeks
   2. BVitamin A given for measles blocks the reaction
   3. CMeasles IgG antibodies neutralise the tuberculin
   4. DRecent fever lowers the skin's local blood flow

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8. Question 8 · Medium

   A 4-month-old boy in Chennai in December has had a runny nose for 2 days, followed by cough, wheeze and difficulty feeding. He is afebrile, breathes 54/min with mild subcostal retractions, has fine crackles and wheeze on both sides, and SpO2 is 95% on room air. What is the most appropriate management?

   1. AOral prednisolone for 5 days
   2. BOral amoxicillin for 5 days
   3. CNebulised salbutamol every 4 hours
   4. DSupportive care with nasal suction and small feeds

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9. Question 9 · Medium

   A 14-month-old girl with several infected boils on her thigh develops high fever and rapidly worsening breathlessness over 2 days in a district hospital ward. A repeat chest X-ray shows thin-walled air-filled cysts in the right lung and a new right pyopneumothorax. Which organism is most likely?

   1. AHaemophilus influenzae type b
   2. BStaphylococcus aureus
   3. CKlebsiella pneumoniae
   4. DStreptococcus pneumoniae

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10. Question 10 · Hard

    An 8-month-old girl weighing 6 kg is brought to a district hospital with profuse watery diarrhoea for 2 days. She is lethargic, cannot drink, her eyes are sunken and a skin pinch goes back very slowly. An IV line is secured. Which Ringer lactate regimen should be started?

    1. A180 mL in 30 minutes, then 420 mL over 2.5 hours
    2. B450 mL over the first 4 hours
    3. C180 mL in 1 hour, then 420 mL over 5 hours
    4. D600 mL in 1 hour, then reassess

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11. Question 11 · Medium

    A mother brings her 15-month-old son with 2 days of watery diarrhoea and no dehydration to a PHC in Assam. The medical officer reviews four pieces of advice: 1. Give zinc for 14 days even if the diarrhoea stops earlier. 2. Give an antibiotic for every episode of watery diarrhoea. 3. Continue breastfeeding and usual foods. 4. Give loperamide syrup to reduce stool frequency. Which advice is correct?

    1. A1, 3 and 4 only
    2. B3 and 4 only
    3. C1, 2 and 3 only
    4. D1 and 3 only

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12. Question 12 · Medium

    A 10-month-old girl is brought to a CHC in Odisha with loose stools for 16 days. She is restless and irritable, her eyes are sunken, she drinks eagerly and a skin pinch goes back slowly. There is no blood in the stool. How should she be classified under IMNCI?

    1. ASome dehydration only
    2. BSevere persistent diarrhoea
    3. CDysentery with dehydration
    4. DPersistent diarrhoea

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13. Question 13 · Easy

    A 4-year-old boy from a Bihar village, who missed his MR doses, is seen on day 3 of an illness with high temperature, coryza, conjunctival congestion and a brassy cough. No rash has appeared. Tiny bluish-white specks on a red base are visible on the inner cheek opposite the lower molars. What is the most likely diagnosis?

    1. AScarlet fever
    2. BRubella
    3. CRoseola infantum
    4. DMeasles

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14. Question 14 · Hard

    A 6-month-old boy is brought to casualty in Jaipur in May after 3 days of diarrhoea; his mother had been mixing two ORS packets in one litre of water. He is irritable with doughy skin; serum sodium is 164 mmol/L. He is given rapid IV 0.45% saline, and 6 hours later sodium is 148 mmol/L, but he has a generalised seizure. What is the most likely cause of the seizure?

    1. ACerebral oedema from a rapid fall in serum sodium
    2. BCentral pontine myelinolysis from overcorrection
    3. CIntracranial bleed from the initial hypernatraemia
    4. DHypocalcaemia from rapid rehydration

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15. Question 15 · Medium

    A 6-year-old girl with chickenpox in Pune was given aspirin by a neighbour for the fever. Five days later she has persistent vomiting and becomes drowsy and combative. She is not jaundiced; ALT is 620 U/L, serum bilirubin 0.8 mg/dL, blood ammonia is raised and glucose is 52 mg/dL. What would a liver biopsy most likely show?

    1. AMacrovesicular fat with Mallory bodies
    2. BMicrovesicular fatty change of hepatocytes
    3. CInterface hepatitis with plasma cells
    4. DMassive hepatocyte necrosis with collapse

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16. Question 16 · Easy

    An 8-month-old boy is brought to an Anganwadi health day with cough for 2 days. He is breastfeeding well and has no danger signs. The medical officer counts his breathing for a full minute while he is calm. Under IMNCI, from what rate is his breathing classed as fast?

    1. A30 breaths per minute or more
    2. B60 breaths per minute or more
    3. C40 breaths per minute or more
    4. D50 breaths per minute or more

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17. Question 17 · Hard

    During a cholera outbreak after floods in Bihar, a 7-year-old boy with rice-water stools and severe dehydration is rehydrated with IV fluids. The resident lists four points: 1. Stool microscopy will show many pus cells and red cells. 2. On TCBS agar the organism forms yellow colonies. 3. A single dose of azithromycin can shorten the illness. 4. The IV fluid of choice is 5% dextrose in 0.45% saline. Which points are correct?

    1. A2, 3 and 4 only
    2. B1 and 2 only
    3. C2 and 3 only
    4. D1, 2 and 3 only

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18. Question 18 · Hard

    A 3-year-old girl admitted with right lower lobe pneumonia in Nagpur is still febrile after 4 days of IV ceftriaxone. Breath sounds are reduced and the right base is stony dull. Ultrasound shows a large pleural collection with septations; a diagnostic tap gives turbid fluid with pH 6.9 and glucose 20 mg/dL. What is the next best step?

    1. AChange to vancomycin and observe for 48 hours
    2. BIntercostal tube drainage, continuing antibiotics
    3. CRepeat needle aspiration on alternate days
    4. DBronchoscopy to exclude a foreign body

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19. Question 19 · Medium

    A 7-year-old boy in Ahmedabad has had a stepwise rising fever for 5 days with headache, abdominal discomfort and a coated tongue. His pulse is 92/min at a temperature of 39.5 °C and the spleen is just palpable. Which investigation is most likely to confirm the diagnosis at this stage?

    1. ATyphidot IgM test
    2. BBlood culture
    3. CStool culture
    4. DWidal test

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20. Question 20 · Easy

    At a block training session, a medical officer tells ASHA workers that the ORS packets now supplied cause less vomiting and smaller stool output than the old WHO formula, because their sodium and glucose content was lowered. What is the total osmolarity of this reduced-osmolarity ORS?

    1. A311 mOsm/L
    2. B275 mOsm/L
    3. C290 mOsm/L
    4. D245 mOsm/L

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21. Question 21 · Medium

    A 5-week-old girl is brought to the PHC because she is feeding less. She breathes 68/min on two counts, has severe chest indrawing and an axillary temperature of 38.2 °C. Using the IMNCI chart for young infants, what should the medical officer do?

    1. AGive paracetamol and advise home care
    2. BGive oral cotrimoxazole and review in 5 days
    3. CGive oral amoxicillin and review in 2 days
    4. DGive first dose of IM antibiotics and refer urgently

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22. Question 22 · Hard

    A 4-month-old girl born to a mother with HIV is brought to casualty with 4 days of rapidly worsening breathlessness and little fever. She was never started on cotrimoxazole prophylaxis. RR 72/min, SpO2 82% on room air, few crackles on auscultation, diffuse bilateral haziness on X-ray and a raised LDH. Besides oxygen and antibiotics for bacterial pneumonia, what should be added?

    1. AIntravenous immunoglobulin alone
    2. BHigh-dose cotrimoxazole with a corticosteroid
    3. CIV acyclovir for herpes pneumonia
    4. DIV fluconazole for Candida pneumonia

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23. Question 23 · Easy

    A 3-year-old girl from a slum in Kanpur has had watery diarrhoea for a day. At the PHC she is alert, drinks normally, her eyes are not sunken and a skin pinch goes back immediately. She is sent home on ORS. What zinc should the medical officer prescribe?

    1. A20 mg a day for 5 days
    2. B20 mg a day for 14 days
    3. C10 mg a day for 14 days
    4. D10 mg a day for 7 days

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24. Question 24 · Medium

    A 2-year-old boy weighing 12 kg is brought to the PHC with cough and fever for 3 days. His respiratory rate is 48/min and there is lower chest wall indrawing. He is drinking, has no danger sign, and his SpO2 is 95% on room air. Using the revised WHO (2014) classification for children aged 2-59 months, what is the correct classification and plan?

    1. ASevere pneumonia: oral amoxicillin and oxygen
    2. BSevere pneumonia: refer after injectable antibiotic
    3. CPneumonia: oral amoxicillin at home
    4. DNo pneumonia: cough or cold, home care

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25. Question 25 · Easy

    A 2-year-old girl is brought to a sub-centre in Jharkhand with fever and loose stools for 3 days. Four findings are noted by the community health officer. Which of these is a general danger sign under IMNCI?

    1. AShe has had fever for 5 days
    2. BHer eyes are sunken and she is thirsty
    3. CShe vomits everything she takes
    4. DShe breathes 46 times a minute

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