MSRA Category: Infectious Diseases

MSRA-1203

A 45-year-old woman presents to her General Practitioner with a 3-day history of increased urinary frequency, urgency, nocturia and mild, lower abdominal discomfort.
On examination, she looks well. She is afebrile, while her abdomen is soft and nontender. A urine dipstick is performed. Her estimated glomerular filtration rate was normal: > 90 ml/minute per 1.73 m2 three months ago.
Urinalysis reveals the following:
Investigation Result
Leukocytes +++
Nitrates +
Blood +
What is the most appropriate initial treatment option?

MSRA-1196

A 25-year-old student taking the oral contraceptive pill develops pain and soreness around the genitals. She has just completed an elective year in the United States (USA). On examination, there are multiple, shallow and tender ulcers at the skin and mucous membrane of the vagina.
Which of the following is the most probable diagnosis?

MSRA-1197

A 35-year-old woman presents with a 7-day history of mucopurulent anal discharge, bloody stool and pain during defecation. She denies any recent travel and has not experienced any vomiting episodes.

Which of the following is the most probable diagnosis?

MSRA-1198

A 25-year-old woman presents to the Genitourinary Medicine Clinic with a 1-week history of a change in her vaginal discharge. She says it has a thin and white consistency with a fishy odour. There is no history of abdominal pain or urinary symptoms. She is sexually active with one regular partner and takes the combined oral contraceptive pill regularly.
On examination, her observations are within normal limits. Her abdomen is soft and nontender. Bimanual examination is unremarkable, with no adnexal tenderness elicited.
Microscopic examination reveals the presence of clue cells.
What is the most likely diagnosis?
Select the SINGLE likely diagnosis from the list below.
Select ONE option only.

MSRA-1199

A 45-year-old woman returns to her General Practitioner for the results of a human immunodeficiency virus (HIV) test; the result is positive. Which of the following investigations will be most useful in estimating her risk of developing an opportunistic infection (OI)?

MSRA-1200

A 30-year-old teacher who recently returned after completing a 3-month assignment in Thailand presented to the Emergency Department with fever, headache, confusion and vomiting in the last two days. She was suspected of having meningitis and underwent a lumbar puncture (LP). The LP findings are as follows:
Normal opening pressure, clear cerebrospinal fluid (CSF).
Investigation Result Normal value
CSF white blood cell count (WBC) 400 cells/µl, 70% lymphocytes < 5 cells/µl
CSF protein 0.5 g/l 0.15–0.4 g/l
CSF glucose 3.8 mmol/l 2.6–4.5 mmol/l
CSF–plasma-glucose ratio 0.72 ≥ 0.66
What is the most likely diagnosis?
Select the SINGLE best answer from the list below.
Select ONE option only

MSRA-1185

If you sustain a needlestick injury while taking blood from a patient suspected of having human immunodeficiency virus (HIV), what should be your first course of action?

MSRA-1186

A 25-year-old woman presents to the Genitourinary Medicine Clinic with a 1-week history of lower abdominal pain and deep dyspareunia. She has also noticed a creamy foul-smelling vaginal discharge. There is no past medical history of note and she takes no regular medications.
On examination, her temperature is 38.1 °C. The remainder of her observations are within normal limits. There is palpable lower abdominal tenderness and guarding in the left iliac fossa. Bimanual examination elicits bilateral adnexal tenderness. There is no inguinal lymphadenopathy.
Given the likely diagnosis, what is the most appropriate investigation to confirm the causative organism?

Select ONE option only

MSRA-1187

A 32-year-old woman comes to her General Practitioner complaining of dysuria and lower abdominal pain for the past three days. She has also noticed an unusual vaginal discharge since yesterday. She has been in a committed relationship for the past year and is sexually active. The urine dipstick is normal and her pregnancy test is negative.
What is the most suitable investigation to be performed next, given the most probable diagnosis?
Choose the SINGLE most appropriate investigation from the options below.

MSRA-1188

You are counseling a patient regarding malaria chemoprophylaxis for their upcoming trip to the coast of Kenya. The patient is a 60-year-old with fair skin and a history of psychiatric illness. The area is known for malaria with widespread chloroquine resistance, and the species of malaria found in the area include P. falciparum, P. Vivix, and P. Ovale. Based on this information, which anti-malarial medication would you suggest for this patient?