Paediatric infections: tuberculin anergy: practice question

A Pediatrics 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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Pediatrics · Paediatric infections: tuberculin anergy

Sample item

A 3-year-old with severe acute malnutrition and fever has miliary mottling on chest radiograph, but the Mantoux test reads 0 mm at 72 hours. Which explanation is most likely?

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

The answer and the reasoning

D. Anergy from malnutrition and overwhelming disseminated infection

Tuberculin skin tests can be falsely negative in severe malnutrition, miliary disease, measles, HIV and other immunosuppression, because delayed hypersensitivity is impaired. A negative test therefore does not exclude tuberculosis. Decisions rely on clinical and radiological evidence and microbiology.

Option by option

  • A. Reading the test too late

    Reading is done at 48 to 72 hours, so timing was appropriate.

  • B. Infection with non-tuberculous mycobacteria

    Nothing in the picture suggests non-tuberculous mycobacteria.

  • C. Prior BCG vaccination

    BCG tends to cause a small, not an absent, response and does not explain miliary disease.

  • D. Anergy from malnutrition and overwhelming disseminated infection (correct)

    Correct. Impaired cell-mediated immunity causes a false-negative test in this setting.

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.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Anergy from malnutrition and overwhelming disseminated infection. Tuberculin skin tests can be falsely negative in severe malnutrition, miliary disease, measles, HIV and other immunosuppression, because delayed hypersensitivity is impaired.

Why is "Reading the test too late" not the answer?

Reading is done at 48 to 72 hours, so timing was appropriate.

Why is "Infection with non-tuberculous mycobacteria" not the answer?

Nothing in the picture suggests non-tuberculous mycobacteria.

Why is "Prior BCG vaccination" not the answer?

BCG tends to cause a small, not an absent, response and does not explain miliary disease.

What concept does this question test?

It tests Paediatric infections: tuberculin anergy in Pediatrics. A negative test therefore does not exclude tuberculosis. Decisions rely on clinical and radiological evidence and microbiology.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Paediatric infections: tuberculin anergy?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.