Polio Clinical Features and Diagnosis Quiz

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Questions and Answers

At what duration after TT 3 should TT 4 be given?

6 months

3 years

1 year (correct)

4 years

What is the primary host of the measles virus?

Humans (correct)

Monkeys

Pigs

Rats

During which phase of measles does the rash typically appear?

Recovery phase

Exanthematous phase (correct)

Prodromal phase

Incubation phase

What is the recommended interval for giving booster doses of the MMR vaccine according to WHO?

12 months and between 4-6 years Signup and view all the answers

What serves as a pathognomonic sign of measles?

Koplik’s spots Signup and view all the answers

How long do patients remain infectious after the onset of the rash in measles?

4-6 days Signup and view all the answers

What are the primary structural proteins of the measles virus important in immunity induction?

Hemagglutinin and Fusion protein Signup and view all the answers

What is the recommended interval for giving TT 3 after TT 2 or subsequent pregnancy?

6 months Signup and view all the answers

What is the other name for pertussis?

Whooping cough Signup and view all the answers

Which microorganism is the sole cause of epidemic pertussis?

Bordetella Pertussis Signup and view all the answers

What is the peak incidence age range for pertussis?

1-5 years Signup and view all the answers

Who are the major reservoirs of pertussis infection?

Adolescents and adults Signup and view all the answers

What is the incubation period of pertussis?

7-10 days Signup and view all the answers

During which period does infectivity occur in pertussis?

First 4 weeks Signup and view all the answers

Which season is pertussis more common in?

Raining season Signup and view all the answers

After how many years does protection begin to wane following vaccination?

3-5 years Signup and view all the answers

What substance produced by B. pertussis plays a central multiple role in the pathogenesis and is responsible for systemic manifestations?

Pertussis toxin Signup and view all the answers

At which stage does the cough in pertussis become initially dry and intermittent, followed by inexorable/relentless paroxysms?

Paroxysmal stage Signup and view all the answers

What is the best diagnostic method for pertussis?

Culture from posterior nasopharynx Signup and view all the answers

Which drug is preferred in neonates for the treatment of pertussis due to concerns of infantile hypertrophic pyloric stenosis?

Azithromycin Signup and view all the answers

What is a possible respiratory complication of pertussis?

Apnea Signup and view all the answers

Which of the following is a clinical feature of spinal paralytic polio?

Distribution of paralysis is spotty with single muscles, multiple muscles, or group of muscles involved in any pattern Signup and view all the answers

What is the most common trigger for sudden painful muscle spasms in patients with tetanus?

Sudden noises [touch] Signup and view all the answers

What is the typical cause of neonatal tetanus?

Unsanitary delivery practices Signup and view all the answers

What distinguishes localized tetanus from other forms of tetanus?

Muscle rigidity close to the injury site Signup and view all the answers

What is a common cause of cephalic tetanus?

Head trauma Signup and view all the answers

Which diagnostic test is used to elicit the gag reflex and identify tetanus?

Spatula test Signup and view all the answers

What is the recommended treatment for eradicating clostridium tetani in a wound?

Metronidazole Signup and view all the answers

Which medication is used for neutralizing circulating tetanus toxin?

TIG Signup and view all the answers

What is the recommended action regarding wound manipulation after administration of antitoxin?

Delayed until several hours after administration of antitoxin Signup and view all the answers

What is the most frequently studied and used drug for sedation and seizure control in tetanus patients?

Diazepam Signup and view all the answers

Which level of prevention focuses on specific protection through immunization and good antenatal care?

Level 2 Specific protection Signup and view all the answers

What is the recommended preventive measure for women to avoid tetanus?

Good antenatal care and delivery practices Signup and view all the answers

Which antibiotic is no longer the drug of choice for eradicating clostridium tetani due to its antagonistic effects on GABA?

Penicillin G Signup and view all the answers

What is the characteristic clinical feature of polio encephalitis?

Seizures and coma Signup and view all the answers

How is laboratory diagnosis of paralytic poliomyelitis usually performed?

Recovery of poliovirus from a stool sample or pharyngeal swab Signup and view all the answers

What is the recommended long-term rehabilitation for polio patients?

Physical therapy and corrective shoes Signup and view all the answers

In spinal polio, what determines whether paralysis will be permanent or temporary?

The affected nerve cells being completely destroyed or not Signup and view all the answers

Which toxin is responsible for the spasms in tetanus?

Tetanospasmin Signup and view all the answers

How do tetanus toxins enter the nerves in the body?

By binding at the neuromuscular junction and entering the nerves by endocytosis Signup and view all the answers

What is the incubation period for generalized tetanus after injury?

2-14 days Signup and view all the answers

Which type of tetanus is characterized by early complaints of nuchal rigidity and jaw lock?

Generalized tetanus Signup and view all the answers

In which type of poliomyelitis do we observe hypoxia & hypercapnia caused by inadequate ventilation due to respiratory insufficiency?

Paralytic poliomyelitis [encephalitis] Signup and view all the answers

Match the following childhood vaccine-preventable diseases with their clinical features:

Measles = Pathognomonic sign of Koplik's spots Mumps = Parotitis and orchitis in males Tetanus = Early complaints of nuchal rigidity and jaw lock Poliomyelitis = Characteristic clinical feature of polio encephalitis Signup and view all the answers

Match the tetanus clinical feature with its description:

Tonic contractions = Cause opisthotonos from a flexion and adduction of the arms, clenching of the fists, and extension of the lower extremities Laryngeal and airway muscle spasms = Can lead to airway obstruction and asphyxiation Fever = May result from substantial metabolic consumption by spastic muscles Autonomic effects = Include tachycardia, dysrhythmias, sweating, and changes in blood pressure Signup and view all the answers

Match the type of tetanus with its characteristic:

Neonatal tetanus = Results from umbilical cord contamination during unsanitary delivery, cutting of the umbilical cord with rusted contaminated sharps, and cultural practices Localised tetanus = Present with persistent rigidity in the muscle group close to the injury site; no further central nervous system (CNS) involvement occurs Cephalic tetanus = Usually occurs after head trauma or otitis media; patients present with cranial nerve (CN) palsies Tetanus diagnosis = There is usually a history of a contaminated wound followed by jaw stiffness, stiffness of neck or other muscles, dysphagia and subsequent spasms Signup and view all the answers

Match the principle of tetanus treatment with its description:

Eradication of clostridium tetani = Metronidazole, erithromycin and tetracycline Neutralization of circulating toxins = Passive immunization with human tetanus immunoglobulin (TIG) to neutralize circulating toxins before they bind to muscles; also administer tetanus toxoid by IM injection at a separate site Proper wound care = Recommended that at least 2cm of normal viable tissue around the wound margin be excised; abscesses should be incised and drained; wound manipulation delayed until several hours after administration of antitoxin Sedation and seizure control = Use of diazepam to reduce anxiety, produce sedation, and relax muscles; lorazepam is an effective alternative; chlorpromazine is an alternative anticonvulsant for controlling spasms Signup and view all the answers

Match the antibiotic used for eradicating clostridium tetani with its effectiveness:

Metronidazole = Effective against clostridium tetani and associated with lower mortality Erythromycin and tetracycline = Used in persons older than 8 years for decreasing vegetative forms of clostridium tetani in the wound Penicillin G = No longer the drug of choice for eradicating clostridium tetani as it is a known antagonist of GABA Antimicrobials = Used to decrease vegetative forms of clostridium tetani in the wound Signup and view all the answers

Match the following diseases with their diagnostic methods:

Polio = Recovery of poliovirus from a stool sample or pharyngeal swab; CSF analysis with elevated protein and lymphocytosis Tetanus = Clinical observation of characteristic symptoms; wound culture for clostridium tetani Pertussis = PCR testing for Bordetella pertussis; serologic testing for antibodies Measles = Detection of measles virus RNA in clinical specimens; serologic testing for IgM antibodies Signup and view all the answers

Match the following diseases with their respective pathogenic agents:

Polio = Affects nerve cells leading to paralysis; causes respiratory insufficiency in some cases Tetanus = Produces toxins tetanolysin and tetanospasmin; affects neuromuscular junctions and inhibitory interneurons Pertussis = Produces pertussis toxin that plays a central role in pathogenesis; affects ciliated respiratory epithelium Measles = Affects lymphoid tissues; causes systemic manifestations including rash and immunosuppression Signup and view all the answers

Match the measles phase with its characteristic features:

Incubation phase = Symptom-free period of 10-14 days Prodromal phase = Fever, malaise, and the 3 C’s Exanthematous phase = Appearance of a rash 2-4 days after prodromal symptoms Recovery phase = Desquamation of the rash and resolution of cough Signup and view all the answers

Match the measles prevention measure with its corresponding recommendation:

Maternal antibodies transfer = Protects the child till about 9 months of age Vaccination schedule in developing countries = 2 doses at 6 & 9 months, booster doses at 12 months and between 4-6 years Booster doses recommendation by WHO = Given at 12 months and between 4-6 years of age as part of a three-part MMR vaccine Association between measles vaccine and autism = False claim Signup and view all the answers

Match the following pertussis clinical features with their corresponding stages:

Catarrhal stage = Congestion, rhinorrhea, sneezing Paroxysmal stage = Inexorable/relentless paroxysms, machine gun burst of uninterrupted cough Convalescent stage = Frequency, severity and duration of the cough episodes diminishes Signup and view all the answers

Match the following pertussis complications with their associated effects:

Respiratory complications = Apnea, pneumonia, atelectasis Sequelae of forceful cough = Epistaxis, subconjunctival hemorrhages, intracranial bleeding Central nervous system complications = Convulsions, intracranial hemorrhages, encephalopathy Signup and view all the answers

Match the following diagnostic methods for pertussis with their identifying features:

Culture = Gold standard for diagnosis, specimen from posterior nasopharynx Direct Fluorescent Antibody staining = PCR alternative, identifies B. pertussis antigen in acute and convalescent samples PCR = Identifies B. pertussis DNA Serology - Antibody test = Most sensitive for the immunized Signup and view all the answers

Match the following poliomyelitis clinical features with their corresponding types:

Spinal paralytic polio = Asymmetric flaccid paralysis or paresis occurs within 12 days Bulbar poliomyelitis = Nasal twang to the child's voice or cry, inability to swallow smoothly Acute flaccid paralysis (AFP) = Rapid onset of weakness of the muscles of the limbs Signup and view all the answers

Match the following poliomyelitis clinical features with their effects:

Spinal paralytic polio effects = Involvement of only one leg common followed by involvement of one arm Bulbar poliomyelitis effects = Hypertension & other autonomic disturbances are common Signup and view all the answers

Study Notes

Measles

The primary host of the measles virus is humans.
The rash typically appears during the prodromal phase of measles.
Koplik's spots serve as a pathognomonic sign of measles.
Patients remain infectious for 4 days before and 4 days after the onset of the rash in measles.

Pertussis

The other name for pertussis is whooping cough.
The sole cause of epidemic pertussis is Bordetella pertussis.
The peak incidence age range for pertussis is 1-5 years.
Humans are the major reservoirs of pertussis infection.
The incubation period of pertussis is 7-14 days.
Infectivity occurs during the catarrhal stage of pertussis, which lasts for 2-3 weeks.
Pertussis is more common in winter and spring.
Protection begins to wane following vaccination after 5-10 years.
Pertussis toxin (PT) produced by B. pertussis plays a central multiple role in the pathogenesis and is responsible for systemic manifestations.
The cough in pertussis becomes initially dry and intermittent, followed by inexorable/relentless paroxysms during the paroxysmal stage.
The best diagnostic method for pertussis is PCR (polymerase chain reaction).

Tetanus

The typical cause of neonatal tetanus is umbilical stump infection.
Localized tetanus is distinguished from other forms of tetanus by its limited involvement of a single limb or group of muscles.
Cephalic tetanus is often caused by otitis media or a wound in the head.
The gag reflex is used to diagnose tetanus.
The recommended treatment for eradicating Clostridium tetani in a wound is metronidazole.
Tetanus immune globulin is used for neutralizing circulating tetanus toxin.
The recommended action regarding wound manipulation after administration of antitoxin is to avoid it.
Diazepam is used for sedation and seizure control in tetanus patients.

Poliomyelitis

The characteristic clinical feature of polio encephalitis is flaccid paralysis.
Laboratory diagnosis of paralytic poliomyelitis is usually performed using PCR (polymerase chain reaction).
The recommended long-term rehabilitation for polio patients focuses on physical therapy and orthotics.
The extent of paralysis in spinal polio is determined by the amount of neurons affected.

Vaccination and Prevention

The recommended interval for giving TT 3 is 6-12 months after TT 2 or subsequent pregnancy.
The recommended interval for giving booster doses of the MMR vaccine according to WHO is every 10 years.
The recommended preventive measure for women to avoid tetanus is immunization during pregnancy.

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Description

Test your knowledge of the clinical features and diagnosis of polio, including symptoms like hypotension, shock, irregular respiratory effort and the diagnostic process for paralytic poliomyelitis in children.