Communicable diseases: scrub typhus: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Communicable diseases: scrub typhus

Sample item

A 40-year-old farm labourer has fever for 6 days, headache, lymphadenopathy and a painless black eschar in the axilla after working in a scrub-covered field. Which drug is the treatment of choice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Doxycycline

Scrub typhus is caused by Orientia tsutsugamushi and transmitted by the bite of larval trombiculid mite (chigger), leaving an eschar at the bite site. Doxycycline is the drug of choice and rapid defervescence within 48 hours supports the diagnosis. Beta-lactams and fluoroquinolones are ineffective against these obligate intracellular bacteria.

Option by option

  • A. Doxycycline (correct)

    Correct. Doxycycline is the drug of choice for scrub typhus.

  • B. Ceftriaxone

    Ceftriaxone, a beta-lactam, does not act on Orientia and is not appropriate.

  • C. Amoxicillin-clavulanate

    Amoxicillin-clavulanate is a beta-lactam combination without activity against Orientia.

  • D. Ciprofloxacin

    Ciprofloxacin is ineffective against Orientia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More PSM questions

Questions about this PSM question

What is the answer to this PSM question?

The best answer is A, Doxycycline. Scrub typhus is caused by Orientia tsutsugamushi and transmitted by the bite of larval trombiculid mite (chigger), leaving an eschar at the bite site.

Why is "Ceftriaxone" not the answer?

Ceftriaxone, a beta-lactam, does not act on Orientia and is not appropriate.

Why is "Amoxicillin-clavulanate" not the answer?

Amoxicillin-clavulanate is a beta-lactam combination without activity against Orientia.

Why is "Ciprofloxacin" not the answer?

Ciprofloxacin is ineffective against Orientia.

What concept does this question test?

It tests Communicable diseases: scrub typhus in PSM. Doxycycline is the drug of choice and rapid defervescence within 48 hours supports the diagnosis. Beta-lactams and fluoroquinolones are ineffective against these obligate intracellular bacteria.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Communicable diseases: scrub typhus?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.