What are 20 difficult multiple-choice questions (MCQs) with answers on common parasitic infestations in pediatric patients?

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I'll provide 20 difficult multiple-choice questions with answers on common parasitic infestations in children, prioritizing morbidity, mortality, and quality of life as outcomes. Here's a comprehensive pretest covering various aspects of pediatric parasitic infections including epidemiology, clinical manifestations, diagnosis, and treatment.

Questions 1-5

• Question 1: Which of the following is the most common mode of transmission for Enterobius vermicularis (pinworm)? A) Fecal-oral route B) Direct person-to-person contact C) Autoinfection via finger-to-mouth D) Contaminated food and water (Answer: C) 1.
• Question 2: A 4-year-old presents with perianal itching worse at night. The most appropriate diagnostic test is: A) Stool ova and parasite examination B) Scotch tape test C) Serology D) Skin biopsy (Answer: B) 2.
• Question 3: Which antihelminthic agent is contraindicated in children under 2 years of age? A) Albendazole B) Mebendazole C) Pyrantel pamoate D) Ivermectin (Answer: D) 3.
• Question 4: The most common complication of untreated Giardia lamblia infection in children is: A) Malabsorption syndrome B) Intussusception C) Appendicitis D) Biliary obstruction (Answer: A) 4.
• Question 5: A child with Ascaris lumbricoides may present with all the following EXCEPT: A) Loeffler's syndrome B) Intestinal obstruction C) Rectal prolapse D) Biliary colic (Answer: C) 5.

Questions 6-10

• Question 6: Which parasite is most commonly associated with growth stunting in endemic areas? A) Trichuris trichiura B) Giardia lamblia C) Cryptosporidium parvum D) Entamoeba histolytica (Answer: A) 2.
• Question 7: The recommended treatment for Cryptosporidium infection in an immunocompetent child is: A) Metronidazole 30 mg/kg/day for 5-7 days B) Nitazoxanide 100 mg BID (1-3 years) or 200 mg BID (4-11 years) for 3 days C) Paromomycin 25-35 mg/kg/day for 7 days D) Trimethoprim-sulfamethoxazole 5 mg/kg/day for 7-10 days (Answer: B) 4.
• Question 8: Which of the following parasites can cause seizures in children? A) Taenia solium B) Enterobius vermicularis C) Trichuris trichiura D) Ancylostoma duodenale (Answer: A) 1.
• Question 9: The most sensitive diagnostic test for neurocysticercosis is: A) Stool examination B) Serum ELISA C) Brain MRI D) CSF PCR (Answer: C) 3.
• Question 10: Which intestinal parasite is most likely to cause iron deficiency anemia in children? A) Giardia lamblia B) Hookworm C) Ascaris lumbricoides D) Trichuris trichiura (Answer: B) 2.

Questions 11-15

• Question 11: The recommended treatment for a 10-year-old with Strongyloides stercoralis hyperinfection syndrome is: A) Albendazole 400 mg daily for 3 days B) Ivermectin 200 μg/kg daily until stool and/or sputum exams are negative for 2 weeks C) Mebendazole 100 mg BID for 3 days D) Pyrantel pamoate 11 mg/kg (maximum 1 g) once (Answer: B) 1.
• Question 12: Which parasitic infection is most likely to cause eosinophilic meningitis in children? A) Angiostrongylus cantonensis B) Toxoplasma gondii C) Plasmodium falciparum D) Trypanosoma cruzi (Answer: A) 4.
• Question 13: The first-line treatment for cutaneous larva migrans in children is: A) Oral albendazole 400 mg daily for 3-5 days B) Topical thiabendazole 15% applied TID for 5-7 days C) Oral ivermectin 200 μg/kg as a single dose D) Topical corticosteroids (Answer: B) 3.
• Question 14: Which of the following is NOT typically seen in toxocariasis? A) Eosinophilia B) Hepatomegaly C) Bloody diarrhea D) Retinal granuloma (Answer: C) 2.
• Question 15: The drug of choice for treating Trichomonas vaginalis in adolescents is: A) Albendazole 400 mg once B) Metronidazole 2 g as a single dose C) Nitazoxanide 500 mg BID for 3 days D) Paromomycin 25-35 mg/kg/day for 7 days (Answer: B) 4.

Questions 16-20

• Question 16: Which parasitic infection should be suspected in a child with right upper quadrant pain, hepatomegaly, and eosinophilia who recently immigrated from a sheep-raising region? A) Amebiasis B) Hydatid disease C) Schistosomiasis D) Fascioliasis (Answer: B) 3.
• Question 17: The most common neurological manifestation of cerebral malaria in children is: A) Seizures B) Cranial nerve palsies C) Cerebellar ataxia D) Extrapyramidal signs (Answer: A) 1.
• Question 18: Which of the following parasites can be transmitted through breast milk? A) Strongyloides stercoralis B) Trypanosoma cruzi C) Toxoplasma gondii D) Giardia lamblia (Answer: B) 4.
• Question 19: A 6-year-old presents with chronic diarrhea, failure to thrive, and recurrent respiratory infections. Stool microscopy shows acid-fast oocysts. The most likely diagnosis is: A) Cryptosporidiosis B) Giardiasis C) Cyclosporiasis D) Isosporiasis (Answer: A) 2.
• Question 20: The recommended treatment for cerebral schistosomiasis in children is: A) Praziquantel 40 mg/kg/day in 2 divided doses for 1 day B) Albendazole 400 mg daily for 3 days C) Ivermectin 200 μg/kg daily until stool and/or sputum exams are negative for 2 weeks D) Mebendazole 100 mg BID for 3 days (Answer: A) 5.