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Question 1
Correct
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A 48 year old male patient presents with fever and signs of delirium. A few hours ago, blisters appeared on his trunk. His past history revealed nothing serious and he's not on any medication. He admits that he went to Italy five months ago on vacation. What is the most probable diagnosis?
Your Answer: Chicken pox
Explanation:Chicken pox in adults may manifest with acute encephalitis, causing the confusional syndrome known as delirium. Blisters on the trunk favour the diagnosis. The trip to Italy however seems unimportant since the incubation period of chicken pox is 10 to 21 days.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives history of having had a sore throat, fever and lymphadenitis during pregnancy. Which organism may be responsible for causing deafness in her infant?
Your Answer: Cytomegalovirus (CMV)
Explanation:CMV is a common viral infection that can be transmitted from a pregnant woman to her unborn child, leading to congenital CMV infection. Congenital CMV infection can result in a range of symptoms and complications in newborns, including deafness. In fact, CMV is one of the leading causes of non-genetic sensorineural hearing loss in children.
Given the mother’s history of symptoms during pregnancy and the concern for deafness in the infant, CMV should also be considered as a potential cause.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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A 25 year old female presented with multiple small genital ulcers, which are painful following a sexual intercourse with an unknown man. Which of the following can be used topically for this presentation?
Your Answer: Foscarnet
Correct Answer: Acyclovir
Explanation:The most probable diagnosis is Herpes Simplex infection. Topical Acyclovir can be used in early stages.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Correct
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Which of the following drugs is NOT used in the treatment of MRSA?
Your Answer: Ceftriaxone
Explanation:Cephalosporins, such as ceftriaxone, do not cover methicillin-resistant staph aureus. They do cover some gram positives and gram negatives. Vancomycin and teicoplanin given intravenously have good coverage of MRSA and other gram positive bacteria. Rifampicin and doxycycline, although not the best treatment, can be used for outpatients if there are no systemic signs of illness.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Incorrect
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer: Add IV amoxicillin
Correct Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A 45-year-old woman is HIV positive. She is very concerned that she is at increased risk of cancer. Which one of the following cancers is NOT increased in HIV positive people?
Your Answer: Seminoma
Correct Answer: Breast cancer
Explanation:Breast cancer has a lower incidence in HIV positive patients. Seminoma, Hodgkin’s disease, anal cancer, and non-small cell lung cancer are all increased incidence. Memorize this breast cancer fact.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Correct
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A 32 year old Indian male presents to the clinic with fever, cough and an enlarged cervical lymph node. Examination reveals a caseating granuloma in the lymph node. Which of the following is the most likely diagnosis?
Your Answer: TB adenitis
Explanation:Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or a related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercle).
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Incorrect
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A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Flucloxacillin PO
Correct Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
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This question is part of the following fields:
- Infectious Diseases
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Question 9
Correct
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Which of the following vaccines do not contain live organisms?
Your Answer: Polio (Salk)
Explanation:Live virus vaccines include: Vaccinia (smallpox), Measles, Mumps, Rubella (MMR combined vaccine), Varicella (chickenpox), Influenza (nasal spray), Rotavirus, Zoster (shingles) and Yellow fever. Inactivated vaccines are Polio (IPV), Hepatitis A and Rabies.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
Incorrect
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There are number of diseases that have to be notified to the consultant responsible for communicable disease control. Which of the following conditions does not belong to above category?
Your Answer: Campylobacter food poisoning
Correct Answer: Pneumococcal pneumonia
Explanation:There are number of diseases that have to be notified to relevant authorities to prevent or reduce their spread. Those conditions include Cholera, Diphtheria, Food poisoning, Infectious bloody diarrhoea, Malaria, Measles, Meningococcal septicaemia, Mumps, Plague, Rabies and Rubella.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Incorrect
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A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?
Your Answer: Giardiasis
Correct Answer: Escherichia coli 0157
Explanation:The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
Crohn’s disease rarely manifests in an acute manner.
Polio and giardiasis usually manifest with non-bloody diarrhoea. -
This question is part of the following fields:
- Infectious Diseases
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Question 12
Correct
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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A urine culture of a 50-year-old patient with urosepsis has isolated a multi-drug resistant Escherichia coli. What is the most likely reason for the multi-drug resistance?
Your Answer: Extended spectrum beta-lactamase (ESBL) production
Explanation:Extended-spectrum beta-lactamases (ESBL) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. Extended spectrum beta-lactamase (ESBL) production is the main reason for multi-drug resistance among E.coli. Commonly used medications to treat ESBL-involved infections include carbapenems (imipenem, meropenem, and doripenem), cephamycins (cefoxitin and cefotetan), Fosfomycin, nitrofurantoin, beta-lactamase inhibitors (clavulanic acid, tazobactam, or sulbactam), non-beta-lactamases and colistin (if all other medications have failed.)
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Incorrect
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A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?
Your Answer: Chlamydia
Correct Answer: Herpes simplex virus
Explanation:The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?
Your Answer: HepB full vaccine and Ig
Explanation:Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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Regarding neonatal meningitis, which of the following statements is true?
Your Answer: Is most commonly caused by Haemophilus influenzae
Correct Answer: Has an above average incidence in babies with a meningomyelocele
Explanation:The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Incorrect
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A 38-year-old woman returns from a summer holiday with a dry cough. Her CXR shows bilateral consolidated areas. Which antibiotic would you suggest?
Your Answer: Clarithromycin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a well-established broad-spectrum fluoroquinolone antibiotic that penetrates well into the lung tissues.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Incorrect
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What is the mode of spread of chickenpox?
Your Answer: Close contact
Correct Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Incorrect
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A 55 year old lady who a known case of normal pressure hydrocephalus (NPH) presented with complaints of weakness in her lower limbs, urinary incontinence and progressively worsening confusion. Which of the following statements is true regarding NPH?
Your Answer: Is not associated with raised intracranial pressure
Correct Answer: Is associated with gait disturbance
Explanation:Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.
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This question is part of the following fields:
- Infectious Diseases
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Question 20
Incorrect
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Her parents with a severe headache present a 24-year-old woman. She is afraid of light and sun and prefers darker environments. On examination, a generalized rash that does not blanch on pressure is noticed. What is the best action in this case?
Your Answer: Isolate patient
Correct Answer: IV benzylpenicillin
Explanation:The rash is a characteristic sign of meningitis. Added to photophobia, headache and neck rigidity, meningitis is highly suggested diagnosis. IV antibiotics should be started immediately.
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This question is part of the following fields:
- Infectious Diseases
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Question 21
Correct
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A 60-year-old male who has been on IV antibiotics for severe pneumonia developed profuse, watery, green coloured diarrhoea on the fifth day of antibiotics. What is the most likely organism responsible for this condition?
Your Answer: Clostridium difficile
Explanation:The most probable cause for diarrhoea is pseudomembranous colitis which is caused by Clostridium difficile. Pseudomembranous colitis is an inflammatory disease of the colon where the antibiotic-induced change in the balance of normal gut flora allows overgrowth of C difficile. Any antibiotic can cause this but the chances are higher with ampicillin, clindamycin, fluoroquinolones, and cephalosporins.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Incorrect
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A 14-day-old baby presented in NICU with the signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer: Toxoplasmosis
Correct Answer: Cytomegalovirus (CMV)
Explanation:CMV is a common virus in the herpesvirus family that can cause serious illness in newborns when contracted congenitally from the mother during pregnancy. Congenital CMV infection can lead to various neurological manifestations, including hydrocephaly (enlargement of the fluid-filled spaces within the brain), seizures, and chorioretinitis (inflammation of the retina in the eye). These symptoms can result in significant morbidity and long-term complications for the affected infant.
Other congenital infections such as toxoplasmosis, rubella, herpes simplex virus (HSV), and syphilis can also cause similar symptoms in newborns. However, given the presentation described, CMV is the most likely infectious agent.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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A 3 month old infant born to an HIV positive mother presents with jaundice, epileptic seizures and microcephaly. The most likely cause will be?
Your Answer: Rubella
Correct Answer: Cytomegalovirus
Explanation:Congenital CMV infection can occur when a pregnant woman is infected with the cytomegalovirus (CMV) and passes the virus to her unborn child. Infants infected with CMV during pregnancy can exhibit a range of symptoms, including jaundice, seizures, and microcephaly (abnormally small head size). These symptoms are consistent with congenital CMV infection.
Given the mother’s HIV-positive status, the infant may have been at increased risk of acquiring other infections, including CMV, due to potential immunodeficiency.
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This question is part of the following fields:
- Infectious Diseases
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Question 24
Correct
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A 32 year old man notices a pruritic scaly annular rash on his thigh. He claims that the rash appeared after a walk in the park. Which drug would you suggest he starts?
Your Answer: Doxycycline
Explanation:The clinical picture of an itchy, scaly annular rash after a walk in the park suggests erythema migrans. The pathogen responsible is a spirochete, Borrelia Burgdorferi transmitted by ticks leading to Lyme disease. Doxycycline is the antibiotic of choice if no contraindications.
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This question is part of the following fields:
- Infectious Diseases
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Question 25
Incorrect
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Which of the following procedures does not require antibiotic prophylaxis?
Your Answer: Emergency sigmoid colectomy
Correct Answer: Dental procedure for a patient with an atrial septal defect
Explanation:According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Incorrect
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Regarding Giardia Lamblia which one of the following statements is true?
Your Answer: May be excluded by stool microscopy
Correct Answer: May cause intestinal malabsorption
Explanation:Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.
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This question is part of the following fields:
- Infectious Diseases
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Question 27
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Toxoplasmosis
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Incorrect
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A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?
Your Answer: Ig + vaccine
Correct Answer: Ig
Explanation:After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.
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This question is part of the following fields:
- Infectious Diseases
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Question 29
Correct
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. Which is the most appropriate strategy for this child?
Your Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 30
Incorrect
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A woman who is 36 weeks pregnant presents with chickenpox. How should she be treated?
Your Answer: Immediate delivery of the child
Correct Answer: Acyclovir
Explanation:Acyclovir is the correct answer. There has been no documented evidence of harm in pregnancy yet. Chickenpox can cause fetal abnormalities, and varicella zoster Immunoglobulin should be given to the infant immediately after birth (not the mother, won’t help). Steroids will actually make the chicken pox worse. Painkillers only, is obviously the wrong answer and pose severe risk to foetus.
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This question is part of the following fields:
- Infectious Diseases
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Question 31
Incorrect
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A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?
Your Answer: Syphilis
Correct Answer: Cytomegalovirus (CMV)
Explanation:CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.
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This question is part of the following fields:
- Infectious Diseases
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Question 32
Correct
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A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed. What is the appropriate treatment?
Your Answer: Acyclovir
Explanation:You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 33
Incorrect
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A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?
Your Answer: Impetigo
Correct Answer: Varicella zoster
Explanation:Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.
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This question is part of the following fields:
- Infectious Diseases
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Question 34
Correct
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A man was admitted to the hospital and developed varicella zoster after 48h. Which of the following categories of people should be administered immunoglobulin only?
Your Answer: All pregnant women who are tested negative for antibodies.
Explanation:Immunoglobulin should be given to all seronegative women within 4 days. However, it is strongly advised to seek medical care immediately if the disease develops.
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This question is part of the following fields:
- Infectious Diseases
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Question 35
Correct
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A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?
Your Answer: Superficial inguinal
Explanation:The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Infectious Diseases
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Question 36
Correct
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A 35-year-old female presented with complaints of earache and a high-grade fever. During examination, numerous small vesicles were found within the ear canal and her ear is very tender. Which one of the following organisms is most likely to be responsible for such a condition?
Your Answer: Herpes zoster
Explanation:Herpes zoster is a viral disorder in which painful vesicular lesions are present in a specific dermatome area. High-grade fever may present as well due to infection. Varicella zoster, measles, herpes simplex and HIV do not present with tender lesions of a limited area.
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This question is part of the following fields:
- Infectious Diseases
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Question 37
Correct
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A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?
Your Answer: Mumps
Explanation:Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.
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This question is part of the following fields:
- Infectious Diseases
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Question 38
Correct
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An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the most significant long-term risk following this infection?
Your Answer: Cervical cancer
Explanation:Human-papilloma virus (HPV) can lead to cervical cancer. There are many different types, but the types associated with cervical cancer most commonly are 16, 18, 31, 33, and 35. The vaccination against HPV protects against the most common types of HPV that are seen in cervical cancer and is recommended for children/young teens. Cervical cancer has a clear association with HPV, making this the best answer over all of the other answer choices.
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This question is part of the following fields:
- Infectious Diseases
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Question 39
Correct
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 40
Incorrect
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A 55-year-old woman diagnosed with type 2 diabetes presents with vomiting and diarrhoea after eating a meal of chicken and chips. She said her stool had small amounts of blood in. Campylobacter Jejuni was found on her stool culture exam. Which of the following is the most appropriate therapy?
Your Answer: Trimethoprim
Correct Answer: IV fluids
Explanation:Campylobacter is the most likely cause of diarrheal illness often due to undercooked meat being ingested. It is also a major cause of traveller’s diarrhoea. Sufficient fluid replacement and anti-emetics are indicated first followed by the antibiotic, Erythromycin although antibiotic treatment in adults is still in question. Ciprofloxacin and Tetracycline may also be effective.
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This question is part of the following fields:
- Infectious Diseases
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Question 41
Correct
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A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?
Your Answer: CSF analysis
Explanation:This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.
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This question is part of the following fields:
- Infectious Diseases
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Question 42
Incorrect
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Which of the following diseases correctly matches the incubation period?
Your Answer: Chicken pox: 5 - 7 days
Correct Answer: Mumps: 14 - 18 days
Explanation:The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease.
- Chickenpox: 7-21 days.
- Whooping cough: 10-14 days.
- Hand, foot and mouth disease: 2-6 days.
- German measles: 14-21 days.
- Mumps: 14-18 days.
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This question is part of the following fields:
- Infectious Diseases
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Question 43
Correct
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An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?
Your Answer: Scabies
Explanation:Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
Henoch-Schönlein purpura is a type of vascular inflammation.
Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication. -
This question is part of the following fields:
- Infectious Diseases
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Question 44
Incorrect
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A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?
Your Answer: May be associated with poliomyelitis-like paralysis
Correct Answer: Treatment including with interferon, immunoglobulin and Ribavirin is effective
Explanation:West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.
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This question is part of the following fields:
- Infectious Diseases
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Question 45
Correct
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A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?
Your Answer: IV normal saline
Explanation:The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.
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This question is part of the following fields:
- Infectious Diseases
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Question 46
Correct
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A 32-year-old patient that has just returned from India, complains of dyspnoea. On examination, you notice grey membranes on the uvula and tonsils and a low-grade fever. What is the most likely diagnosis?
Your Answer: Diphtheria
Explanation:Characteristic findings on patients suffering from diphtheria are the grey membrane on the uvula and tonsils together with the low grade fever and dyspnoea. It’s of great importance that the patient has recently been to India where there is a know prevalence.
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This question is part of the following fields:
- Infectious Diseases
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Question 47
Correct
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Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?
Your Answer: Amoxicillin
Explanation:Tetracycline is not recommended in pregnancy because of the risk to fetal development (bones, teeth!). Metronidazole in pregnancy: currently not thought to be an increased risk in pregnancy; however this is not effective against chlamydia. Amoxicillin is shown to be an adequate treatment for chlamydia, so this is the correct answer.
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This question is part of the following fields:
- Infectious Diseases
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Question 48
Correct
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A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from shortness of breath, weight loss and dry cough due to Kaposi's sarcoma but no fever was noted. Which is the most likely causative organism?
Your Answer: Pneumocystis jiroveci
Explanation:Pneumocystis Jiroveci. This causative organism is responsible for pneumonia in individuals that have a compromised immune system. Symptoms include cyanosis, dry cough and in some cases, diffuse bilateral alveolar shadows on CXR. Co-trimoxazole is normally the treatment for this.
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This question is part of the following fields:
- Infectious Diseases
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Question 49
Correct
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Which of the following is true of Koplik’s spots?
Your Answer: Are diagnostic of measles
Explanation:Koplik’s spots are pathopneumonic for MEASLES. They are blue/white spots, small, occurring on the buccal mucosa. They typically occur next to premolars, not opposite to the incisors. They are not related to fever height. They are not on the hands. They usually occur BEFORE the rash.
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This question is part of the following fields:
- Infectious Diseases
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Question 50
Correct
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A 31-year-old homosexual male is complaining of recent weight loss and blurred vision. A fundoscope was performed showing retinal haemorrhage. What is the single most appropriate option?
Your Answer: HIV/AIDS
Explanation:Given the symptoms described in a 31-year-old homosexual male, along with the findings of weight loss, blurred vision, and retinal hemorrhage, the single most appropriate option to consider is HIV/AIDS.
HIV/AIDS can manifest with a wide range of symptoms, including unintentional weight loss and blurred vision. Retinal hemorrhage can also occur as a complication of HIV/AIDS, particularly in advanced stages when the immune system is severely compromised.
In this case, it’s important to conduct further diagnostic tests, including HIV testing, to confirm the diagnosis. Additionally, prompt initiation of antiretroviral therapy (ART) is crucial for managing HIV/AIDS and preventing further complications. Referral to an infectious disease specialist for comprehensive management is recommended.
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This question is part of the following fields:
- Infectious Diseases
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Question 51
Correct
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A 30-year-old male presented with a history of bloody and mucoid diarrhoea since that morning. He is also complaining of abdominal spasm and bloating. Which of the following investigations is the most suitable one in this case?
Your Answer: Stool culture and sensitivity
Explanation:In a case of sudden bloody and mucoid diarrhoea, stool culture and sensitivity are required to access which organism is causing the problem and to discuss appropriate antibiotics.
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This question is part of the following fields:
- Infectious Diseases
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Question 52
Correct
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A 25 year old female presented with blisters on the tongue. Some of them secreted pinkish fluid while some were crusted. Which of the following is the most probable diagnosis?
Your Answer: HSV1
Explanation:The history is suggestive of acute gingivostomatitis, which is a manifestation of primary HSV-1 infection. Patients present with gingivitis and vesicular lesions which develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.
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This question is part of the following fields:
- Infectious Diseases
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Question 53
Incorrect
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A 16-year-old male fell whilst playing football and was injured by a sharp wooden splinter sustaining a cut to his left shin. His immunisation history is up to date and he had a booster tetanus shot 3 years ago. In relation to tetanus prevention, select the most suitable management step.
Your Answer: Human tetanus immunoglobulin 250 units should be given
Correct Answer: No action is required
Explanation:The most suitable management step for tetanus prevention in this scenario would be to ensure that the individual receives a tetanus toxoid-containing vaccine if they have not had a booster dose within the last five years. Tetanus toxoid-containing vaccines are routinely given during childhood immunization schedules, but booster doses are recommended every 10 years thereafter to maintain immunity. Since the individual’s immunization history is up to date, if they have received their primary series of tetanus vaccinations and a booster dose within the last five years, no further action would be needed regarding tetanus prevention.
However, if the individual’s immunization status is uncertain or if it has been more than five years since their last tetanus booster, they should receive a tetanus toxoid-containing vaccine promptly. Additionally, if the wound is contaminated or considered high risk for tetanus infection, tetanus immune globulin (TIG) may also be administered for immediate protection against tetanus toxins.
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This question is part of the following fields:
- Infectious Diseases
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Question 54
Incorrect
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Which of the following is correct regarding toxoplasmosis?
Your Answer: Prophylactic immunoglobulins should be given to pregnant women if their IgM anti-toxoplasma antibodies detected
Correct Answer: Can present with fits in patients with AIDS
Explanation:T. gondii infection in immunocompetent people is usually asymptomatic. It can present as fits in patients with AIDs, who are immunosuppressed. Additionally, infection in the first trimester of pregnancy is very harmful. Congenital toxoplasmosis presents with intracranial calcifications, classically. It can also present with hydrocephalus, microcephaly, blindness, petechiae. Siramycin is the drug of choice to try to prevent vertical transmission from mother to baby. It is typically gotten from cat faeces or raw/undercooked meat, not raw eggs (raw eggs: think salmonella).
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This question is part of the following fields:
- Infectious Diseases
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Question 55
Correct
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A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?
Your Answer: Varicella zoster virus (VZV)
Explanation:Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 56
Correct
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A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?
Your Answer: Mycobacterium tuberculosis
Explanation:Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.
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This question is part of the following fields:
- Infectious Diseases
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Question 57
Correct
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In which one of the following diseases does the patient have to be isolated?
Your Answer: Measles
Explanation:Measles and chickenpox are spread by droplets. Thus, patients should be isolated.
Rheumatic fever and post-streptococcal glomerulonephritis are immune mediated diseases that don’t require isolation.
Herpetic gingivostomatitis spreads by direct transmission of infected secretions to the stratified squamous epithelium.
HSP is not an infectious disease. -
This question is part of the following fields:
- Infectious Diseases
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Question 58
Correct
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The following are commonly recognized disease syndromes associated with Clostridium species, except:
Your Answer: exfoliative skin rash
Explanation:Clostridium species do not present with an exfoliative skin rash. C. perfringens is a common aetiology in necrotizing infections (gas gangrene) as well as food poisoning, which often also includes diarrhoea. C. difficle causes diarrhoea. C. tetany and C. botulinum have neurotoxins that can lead to paralysis.
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This question is part of the following fields:
- Infectious Diseases
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Question 59
Incorrect
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Mycobacterium TB
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 60
Correct
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A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?
Your Answer: Streptococcus pneumoniae
Explanation:Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.
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This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
