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Nursing level: kmtc style sets mcqs on communicable diseases

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I have gathered sufficient information from the medical library. Now I'll compose a comprehensive KMTC-style MCQ set on communicable diseases.

KMTC Nursing: Communicable Diseases - MCQ Set

Kenya Medical Training College (KMTC) Style Nursing Level | Communicable Diseases Total: 40 Questions | Time: 60 Minutes

SECTION A: GENERAL CONCEPTS OF COMMUNICABLE DISEASES

1. Which of the following BEST defines a communicable disease?
A. A disease caused by nutritional deficiency B. A disease that can be transmitted from one host to another C. A disease caused exclusively by genetic mutations D. A disease that only affects animals
Answer: B Communicable diseases are those capable of being transmitted from an infected individual (or reservoir) to a susceptible host, directly or indirectly.
2. The "chain of infection" includes all of the following EXCEPT:
A. Susceptible host B. Mode of transmission C. Infectious agent D. Nutritional status of the community
Answer: D The chain of infection consists of: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
3. Which of the following is an example of DIRECT transmission of a communicable disease?
A. Drinking contaminated water B. Mosquito bite C. Droplet contact during coughing D. Eating contaminated food
Answer: C Direct transmission involves immediate transfer from an infected person to a susceptible host, such as droplets from coughing or sneezing.
4. A nurse is caring for a patient with pulmonary tuberculosis. The PRIMARY precaution to implement is:
A. Contact precautions B. Airborne precautions C. Droplet precautions D. Standard precautions only
Answer: B M. tuberculosis is transmitted via airborne nuclei (droplet nuclei <5 µm) that remain suspended in the air. Airborne precautions including N95 respirator use are required.
5. The period between exposure to a pathogen and the appearance of signs and symptoms is called the:
A. Prodromal period B. Incubation period C. Period of decline D. Period of convalescence
Answer: B The incubation period is the time from infection to clinical manifestation of disease.

SECTION B: TUBERCULOSIS (TB)

6. Mycobacterium tuberculosis is BEST described as:
A. A Gram-negative rod B. A Gram-positive coccus C. An acid-fast bacillus D. A spirochete
Answer: C M. tuberculosis is an acid-fast bacillus (AFB) - it retains carbol fuchsin after acid washing due to its waxy mycolic acid cell wall.
7. The MOST common site of primary TB infection in adults is the:
A. Liver B. Meninges C. Lungs (pulmonary TB) D. Kidney
Answer: C Over 80% of TB cases are pulmonary. Primary infection occurs via inhalation of airborne droplet nuclei containing M. tuberculosis.
8. BCG vaccine is routinely given to neonates to protect primarily against:
A. Pulmonary tuberculosis in adults B. Miliary TB and TB meningitis in children C. Latent TB infection D. Multi-drug resistant TB
Answer: B BCG is most effective against severe forms of childhood TB - miliary TB and TB meningitis - providing about 80% protection against these forms.
9. Under Kenya's DOTS (Directly Observed Treatment Short-course) strategy, the standard first-line TB treatment for a new smear-positive adult patient is:
A. 2 months Isoniazid + Rifampicin, then 4 months Isoniazid B. 2 months HRZE + 4 months HR C. 6 months Isoniazid monotherapy D. 2 months Streptomycin + 4 months Isoniazid
Answer: B Standard DOTS first-line regimen: 2 months Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) - intensive phase; followed by 4 months HR - continuation phase.
10. A patient on TB treatment develops yellow discoloration of the eyes. Which drug is MOST likely responsible?
A. Ethambutol B. Pyrazinamide C. Rifampicin D. Streptomycin
Answer: C Rifampicin causes orange-red discoloration of body fluids including urine, tears, and saliva. Jaundice (yellow eyes) can indicate hepatotoxicity - a side effect shared by Rifampicin, Isoniazid, and Pyrazinamide, but Rifampicin-induced hepatitis is most classically cited.
11. The nurse educates a TB patient about preventing transmission at home. Which instruction is MOST important?
A. "Take paracetamol for fever daily" B. "Cover your mouth and nose when coughing or sneezing" C. "Avoid eating protein-rich foods" D. "Sleep with windows closed to keep warm"
Answer: B Respiratory hygiene (cough etiquette) - covering the mouth and nose, proper disposal of sputum - is the most effective TB transmission-prevention measure at home. Good ventilation (open windows) is also encouraged.

SECTION C: MALARIA

12. Malaria is transmitted to humans by the bite of:
A. Male Anopheles mosquito B. Female Anopheles mosquito C. Female Aedes mosquito D. Female Culex mosquito
Answer: B Only the female Anopheles mosquito transmits malaria because she requires a blood meal for egg development.
13. The MOST dangerous species of malaria parasite causing cerebral malaria is:
A. Plasmodium vivax B. Plasmodium malariae C. Plasmodium ovale D. Plasmodium falciparum
Answer: D P. falciparum causes the most severe malaria, including cerebral malaria (altered consciousness/coma), severe anaemia, and organ failure.
14. A child presents with fever, chills, rigors, and headache occurring every 48 hours. Which malaria parasite is MOST likely?
A. P. malariae (72-hour cycle) B. P. falciparum (irregular/daily) C. P. vivax or P. ovale (48-hour tertian cycle) D. P. knowlesi (24-hour cycle)
Answer: C P. vivax and P. ovale cause tertian malaria with fever paroxysms every 48 hours (every 3rd day). P. malariae causes quartan (every 72 hours).
15. Which of the following is the FIRST-LINE treatment for uncomplicated P. falciparum malaria in Kenya?
A. Chloroquine B. Quinine monotherapy C. Artemether-Lumefantrine (Coartem) D. Mefloquine
Answer: C Artemether-Lumefantrine (AL/Coartem) is the first-line treatment for uncomplicated P. falciparum malaria across sub-Saharan Africa including Kenya.
16. A nurse is educating a pregnant woman in a malaria-endemic area. The BEST preventive measure to recommend is:
A. Daily chloroquine prophylaxis throughout pregnancy B. Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) C. Staying indoors during the day D. Drinking boiled water only
Answer: B IPTp-SP (at least 3 doses from 2nd trimester) is the WHO-recommended prevention for malaria in pregnancy in endemic areas, alongside insecticide-treated nets (ITNs).
17. The life cycle stage of the malaria parasite responsible for the clinical symptoms (fever, chills) is:
A. Sporozoite stage (in mosquito salivary glands) B. Exoerythrocytic stage (liver) C. Erythrocytic schizogony (RBC rupture releasing merozoites) D. Gametocyte stage
Answer: C Symptoms occur when erythrocytic schizonts rupture red blood cells, releasing merozoites, pyrogens, and parasitic debris into the bloodstream.

SECTION D: CHOLERA AND TYPHOID (ENTERIC DISEASES)

18. Cholera is caused by:
A. Salmonella typhi B. Vibrio cholerae C. Shigella dysenteriae D. Escherichia coli O157:H7
Answer: B Cholera is caused by Vibrio cholerae, a comma-shaped Gram-negative rod. It produces a powerful enterotoxin (cholera toxin) that causes massive fluid secretion.
19. The CLASSIC stool description in cholera is:
A. Bloody and mucoid (red currant jelly) B. Watery, profuse, "rice-water" stools C. Pale, fatty, foul-smelling stools D. Small, frequent, mucoid stools with tenesmus
Answer: B Cholera produces profuse, watery, odourless stools described as "rice-water" - white and flecked with mucus. Fluid losses can exceed 1 litre/hour.
20. A patient presents with severe dehydration from cholera. The FIRST priority nursing intervention is:
A. Administer oral rehydration salts (ORS) B. Start intravenous Ringer's lactate immediately C. Administer tetracycline antibiotic D. Send stool for culture and sensitivity
Answer: B In severe dehydration, IV fluid resuscitation (Ringer's lactate or normal saline) is the first priority to restore circulating volume. ORS is for mild-moderate dehydration.
21. Typhoid fever is caused by:
A. Vibrio cholerae B. Salmonella typhi C. Shigella flexneri D. Campylobacter jejuni
Answer: B Typhoid fever is caused by Salmonella enterica serotype Typhi (S. typhi), transmitted via the fecal-oral route through contaminated food and water.
22. "Rose spots" appearing on the abdomen are a clinical feature characteristic of:
A. Cholera B. Meningococcal meningitis C. Typhoid fever D. Leptospirosis
Answer: C Rose spots (salmon-coloured, blanching macules on the trunk) appear in the 2nd week of typhoid fever in about 30% of patients.
23. The "Widal test" is used in the diagnosis of:
A. Malaria B. Typhoid fever C. Cholera D. Hepatitis B
Answer: B The Widal test detects agglutinating antibodies against Salmonella typhi O and H antigens in the patient's serum.

SECTION E: HIV/AIDS

24. HIV primarily destroys which cells, leading to immunodeficiency?
A. B lymphocytes B. Neutrophils C. CD4+ T-helper lymphocytes D. Natural killer cells
Answer: C HIV binds to CD4 receptors on T-helper lymphocytes (CD4+ cells), enters, replicates, and destroys them. CD4 count below 200 cells/µL defines AIDS.
25. The MOST common route of HIV transmission in sub-Saharan Africa is:
A. Blood transfusion B. Intravenous drug use C. Heterosexual intercourse D. Vertical (mother-to-child)
Answer: C In sub-Saharan Africa, heterosexual intercourse accounts for the majority of HIV transmission.
26. A nurse sustains a needlestick injury from an HIV-positive patient. The FIRST action to take is:
A. Start post-exposure prophylaxis (PEP) within 72 hours B. Immediately test the nurse for HIV C. Wash the site with soap and water and allow to bleed freely D. Report the incident to the nurse in charge
Answer: C The first immediate action is wound care - wash thoroughly with soap and running water, allow to bleed freely. Then report, assess, and start PEP within 72 hours if indicated.
27. The "window period" in HIV infection refers to:
A. The period when a person is most infectious B. The time from HIV exposure to appearance of AIDS-defining illness C. The period between HIV infection and detectable antibodies (before seroconversion) D. The time after starting ART when viral load becomes undetectable
Answer: C The window period (approximately 2-12 weeks) is when a person is infected with HIV but HIV antibody tests may be negative as antibodies have not yet developed to detectable levels.
28. Which of the following is an AIDS-defining opportunistic infection in Kenya?
A. Common cold B. Pneumocystis jirovecii pneumonia (PCP) C. Tinea pedis D. Oral herpes labialis
Answer: B PCP (caused by Pneumocystis jirovecii) is a classic AIDS-defining opportunistic infection occurring when CD4 count falls below 200 cells/µL.

SECTION F: LEPROSY AND MENINGITIS

29. Leprosy is caused by:
A. Mycobacterium tuberculosis B. Mycobacterium leprae C. Treponema pallidum D. Borrelia burgdorferi
Answer: B Leprosy (Hansen's disease) is caused by Mycobacterium leprae, an obligate intracellular acid-fast bacillus with a very long incubation period (average 5 years).
30. The EARLIEST and MOST consistent sign of leprosy is:
A. Claw hand deformity B. Loss of eyebrows C. Hypopigmented or erythematous skin patch with loss of sensation D. Leonine facies
Answer: C The earliest sign is a skin lesion (patch) with loss of sensation (anaesthesia) - particularly light touch, temperature and pain - due to nerve involvement.
31. A patient with bacterial meningitis presents with neck stiffness. This is tested clinically by:
A. Romberg's sign B. Kernig's sign C. Babinski's sign D. Chvostek's sign
Answer: B Kernig's sign (inability to extend the knee when the hip is flexed) indicates meningeal irritation. Brudzinski's sign (flexion of knees when neck is flexed) is another meningeal sign.
32. The characteristic rash of meningococcal meningitis is:
A. Maculopapular rash on the trunk B. Vesicular rash on dermatomes C. Non-blanching petechial/purpuric rash D. Rose spots on the abdomen
Answer: C Neisseria meningitidis can cause septicaemia with a distinctive non-blanching petechial or purpuric rash - a medical emergency indicating DIC.

SECTION G: HELMINTHIC INFECTIONS AND VIRAL DISEASES

33. Schistosomiasis (bilharzia) is transmitted via:
A. Mosquito bite B. Contact with contaminated freshwater containing cercariae C. Ingestion of undercooked pork D. Sandfly bite
Answer: B Schistosome cercariae are released from infected freshwater snails and penetrate human skin during water contact (swimming, wading, bathing).
34. A patient presents with fever, jaundice, right upper quadrant pain, and a history of returning from western Kenya. The MOST likely diagnosis is:
A. Typhoid fever B. Viral hepatitis C. Malaria with hepatic involvement D. Amoebic liver abscess
Answer: C Western Kenya is highly malaria-endemic. Fever + jaundice in a returning traveller strongly suggests P. falciparum malaria with hepatic involvement. However, viral hepatitis must also be excluded.
35. Oral rehydration salts (ORS) work in diarrhoeal diseases primarily because:
A. They kill the causative pathogens B. Glucose co-transports sodium and water across the intestinal wall even during secretory diarrhoea C. They reduce intestinal motility D. They alkalize the gut environment
Answer: B Glucose-coupled sodium transport (via SGLT1 transporter) remains functional even in cholera. This co-transport drives water absorption - the physiological basis of ORS.
36. Which vaccine is given at birth as part of the Kenya Expanded Programme on Immunization (KEPI)?
A. Yellow fever vaccine B. Meningococcal vaccine C. BCG and Oral Polio Vaccine (OPV-0) D. Hepatitis B only
Answer: C Kenya's KEPI schedule gives BCG (against TB) and OPV-0 (against polio) at birth.

SECTION H: INFECTION CONTROL AND NURSING CARE

37. Standard precautions apply to:
A. Only patients with known infectious diseases B. All patients regardless of diagnosis C. Only patients with blood-borne infections D. Immunocompromised patients only
Answer: B Standard precautions apply to ALL patients in all care settings at all times, treating all blood and body fluids as potentially infectious.
38. The correct sequence for donning (putting on) PPE is:
A. Gloves → Gown → Mask → Eye protection B. Gown → Mask/Respirator → Eye protection → Gloves C. Mask → Gloves → Gown → Eye protection D. Eye protection → Mask → Gloves → Gown
Answer: B WHO sequence for donning PPE: Gown first (full body protection), then Mask/Respirator (mouth/nose), then Eye protection (goggles/face shield), then Gloves (last, over gown cuffs).
39. The recommended hand washing technique (WHO 6 steps) should take a minimum of:
A. 5-10 seconds B. 20-30 seconds C. 40-60 seconds D. 2 minutes
Answer: C WHO recommends 40-60 seconds for handwashing with soap and water using the 6-step technique.
40. A patient is admitted with suspected Ebola Virus Disease (EVD). The nurse should FIRST:
A. Administer antipyretics and IV fluids B. Immediately isolate the patient in a single room and implement enhanced barrier nursing precautions C. Collect blood samples and wait for results before isolating D. Inform the patient's family members
Answer: B Immediate isolation with full barrier nursing precautions (full PPE including face shield, impermeable gown, double gloves) is the FIRST priority. Ebola spreads via direct contact with blood and body fluids.

SUMMARY ANSWER KEY

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1B11B21B31B
2D12B22C32C
3C13D23B33B
4B14C24C34C
5B15C25C35B
6C16B26C36C
7C17C27C37B
8B18B28B38B
9B19B29B39C
10C20B30C40B

TOPICS COVERED

Disease/TopicQuestions
General concepts & chain of infection1-5
Tuberculosis6-11
Malaria12-17
Cholera & Typhoid18-23
HIV/AIDS24-28
Leprosy & Meningitis29-32
Other infections & immunity33-36
Infection control & nursing practice37-40
Exam Tips for KMTC Students:
  • Focus on mode of transmission - examiners test this frequently
  • Know incubation periods for common diseases (TB: 4-12 weeks; Malaria: 7-14 days; Cholera: 6 hours-5 days; Typhoid: 10-14 days)
  • Understand the chain of infection and which intervention breaks each link
  • Memorise Kenya KEPI immunisation schedule
  • Know first-line drugs for TB (HRZE/HR), Malaria (Artemether-Lumefantrine), and HIV (ART regimens)
  • PPE donning/doffing sequences are commonly examined
Sources: Park's Textbook of Preventive and Social Medicine; Harrison's Principles of Internal Medicine 22E; Sherris & Ryan's Medical Microbiology 8E; Red Book 2021 - Infectious Diseases.
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