Q1. The single most important treatment in acute cholera is: A. Antibiotics B. AGGRESSIVE REHYDRATION C. Antimotility drugs D. Zinc alone ANSWER: B — rehydration. Why: death in cholera is from hypovolaemia, and shock can develop within hours. Antibiotics shorten the illness and reduce shedding but are an adjunct, never a substitute for fluid. LEARNING POINT: replace ONGOING losses, not just the initial deficit.

Q2. Which is the diagnostic test of choice in suspected typhoid fever? A. Widal test B. BLOOD CULTURE, taken before antibiotics C. Stool microscopy D. Full blood count ANSWER: B — blood culture. Why: the Widal test has poor sensitivity and specificity, so it should not be used to confirm or exclude. Blood culture is the test, and antibiotics taken beforehand reduce the yield. LEARNING POINT: typhoid is a systemic illness — the organism is in the blood.

Q3. A 22-year-old has 12 days of stepwise fever, headache, abdominal discomfort and CONSTIPATION, with a pulse that seems slow for his temperature. Typhoid is dismissed because he has no diarrhoea. This reasoning is: A. Correct — typhoid always causes diarrhoea B. INCORRECT — constipation is as common as diarrhoea early in typhoid C. Correct if stool culture is negative D. Correct in adults only ANSWER: B. Why: enteric fever is a systemic febrile illness acquired through the gut. Expecting a diarrhoeal presentation is the commonest reason the diagnosis is missed. LEARNING POINT: stepwise fever with relative bradycardia fits well — take blood cultures.

Q4. A patient in the third week of typhoid develops sudden severe abdominal pain with guarding and rigidity, then becomes shocked. The most likely cause is: A. Worsening fever B. INTESTINAL PERFORATION C. Drug reaction D. Constipation ANSWER: B — intestinal perforation. Why: the ulcerated ileum can perforate, characteristically in the later weeks. Sudden severe pain with peritonism in a patient with typhoid is perforation until proven otherwise. LEARNING POINT: this is a surgical emergency — attributing new peritonism to the known diagnosis is how it is missed.

Q5. A man has three weeks of fever, right upper quadrant pain and tender hepatomegaly, with no diarrhoea now but a history of bloody stools months ago. Consider: A. Amoebic liver abscess B. Cholera C. Bacillary dysentery D. Viral hepatitis A ANSWER: A — amoebic liver abscess. Why: amoebiasis can spread from the colon to the liver, and the abscess frequently presents after the bowel symptoms have settled. Absence of current diarrhoea does not argue against it. LEARNING POINT: ask about past dysentery in any unexplained liver abscess.

Q6. Why are antimotility drugs avoided in BLOODY diarrhoea? A. They cause vomiting B. Slowing the gut retains the organism and its toxin and can precipitate serious complications C. They interfere with rehydration D. They are ineffective ANSWER: B. Why: in invasive infection, reducing transit retains pathogens and toxin in contact with damaged mucosa. They are also avoided in children with diarrhoea of any type. LEARNING POINT: rehydration, not slowing the gut, is the treatment.

Q7. Why do chronic typhoid carriers matter for public health? A. They relapse frequently B. They continue to EXCRETE the organism while asymptomatic and can sustain transmission for years C. They develop liver abscesses D. They are always symptomatic ANSWER: B. Why: carriage, classically from the gallbladder, allows an apparently well person to keep infecting others — which matters most when that person handles food. LEARNING POINT: this is why occupational restrictions and follow-up of carriers exist.