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Question 1
Correct
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A 25-year-old farm labourer presents with a lesion on his finger. The lesion began as a small red papule and has now grown to form a blood-tinged pustule-like lesion measuring 2 cm in diameter over the course of a week. He reports some lymphadenopathy but is otherwise asymptomatic.
What is the most probable diagnosis?Your Answer: Orf
Explanation:Common Skin Infections: Orf, Cat Scratch Disease, Ringworm, Pompholyx, and Lyme Disease
Orf, also known as contagious pustular dermatitis, is a skin infection caused by a poxvirus that is typically acquired from sheep or goats. The infection begins with a small, firm, red or reddish-blue lump that develops into a flat-topped, blood-tinged pustule or blister after an incubation period of 5-6 days. The lesion is usually 2-3 cm in diameter but can be as large as 5 cm. Although it may appear to contain pus, incising the lesion will reveal firm, red tissue underneath. Orf can also cause erythema multiforme and typically resolves within 6 weeks.
Cat scratch disease is a mild infectious disease that primarily affects children and is caused by the intracellular bacterium Bartonella henselae. Symptoms may include fever and a papule at the site of the scratch, as well as regional lymphadenopathy.
Ringworm, also known as tinea corporis, is a fungal infection that causes a slowly enlarging scaly lesion with central clearing. Pompholyx, on the other hand, is a type of eczema that presents with multiple vesicles on the palms and soles.
Finally, Lyme disease is a bacterial infection that is transmitted through tick bites. It causes a slowly spreading erythematous rash at the site of the bite, accompanied by flu-like symptoms.
In summary, these common skin infections can present with a variety of symptoms and should be diagnosed and treated by a healthcare professional.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 2
Incorrect
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A 35-year-old woman presents to her GP after discovering a tick on her right arm following a hike in the woods. She reports feeling fine and there is no apparent rash upon inspection.
What is the optimal method for removing the tick?Your Answer: Blunt-nose tweezers
Correct Answer: Fine-tipped tweezers
Explanation:To effectively remove a tick, it is best to use fine-tipped tweezers. The tick should be grasped as close to the skin as possible and pulled upwards with firm pressure. It is important to avoid using blunt-nose tweezers, petroleum jelly, or heat from a hot match as these methods can increase the risk of infection or cause the tick to regurgitate into the bite. After removal, the area should be thoroughly cleaned.
Understanding Lyme Disease
Lyme disease is an illness caused by a type of bacteria called Borrelia burgdorferi, which is transmitted to humans through the bite of infected ticks. The disease can cause a range of symptoms, which can be divided into early and later features.
Early features of Lyme disease typically occur within 30 days of being bitten by an infected tick. These can include a distinctive rash known as erythema migrans, which often appears as a bulls-eye pattern around the site of the tick bite. Other early symptoms may include headache, lethargy, fever, and joint pain.
Later features of Lyme disease can occur after 30 days and may affect different parts of the body. These can include heart block or myocarditis, which affect the cardiovascular system, and facial nerve palsy or meningitis, which affect the nervous system.
To diagnose Lyme disease, doctors may look for the presence of erythema migrans or use blood tests to detect antibodies to Borrelia burgdorferi. Treatment typically involves antibiotics, such as doxycycline or amoxicillin, depending on the stage of the disease.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 3
Incorrect
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A 28-year-old man who is known to be an intravenous heroin user presents as an emergency with a persistent fever, blood in his urine and shortness of breath. On further questioning he admits to recent weight loss and night sweats. On examination he has splinter haemorrhages, microscopic haematuria and a systolic heart murmur.
What is most likely diagnosis?Your Answer:
Correct Answer: Infective endocarditis
Explanation:Infective Endocarditis: Symptoms, Risk Factors, and Diagnosis
Infective endocarditis is a serious infection of the heart’s inner lining and valves. The classic diagnostic triad of this condition includes fever, new or changing murmurs, and embolic phenomena. Other symptoms may include fatigue, shortness of breath, and weight loss.
Certain risk factors increase the likelihood of developing infective endocarditis. These include intravenous drug abuse, having artificial heart valves, congenital heart defects such as ventricular septal defects, and undergoing invasive surgical procedures, especially dental work.
Diagnosis of infective endocarditis typically involves a combination of physical examination, blood tests, and imaging studies such as echocardiography. Treatment may involve antibiotics and, in some cases, surgery to repair or replace damaged heart valves. Early diagnosis and treatment are crucial for a successful outcome.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 4
Incorrect
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A rather embarrassed 27-year-old man is seen at the out-of-hours centre complaining of dysuria and discharge from his penis. This started about a week earlier and is increasingly uncomfortable. He is normally fit and well. You send a urethral swab for microscopy and culture and urine sample for NAAT & microscopy & culture. The results come back showing a few pus cells in his urine but no growth on either culture & negative NAAT.
What is the single most likely diagnosis?
Your Answer:
Correct Answer: nonspecific urethritis
Explanation:Common Genitourinary Conditions and Diagnostic Methods
Chronic prostatitis is a condition that often results in pain in the perineal area. Gonorrhoea, on the other hand, can be diagnosed through a nucleic acid amplification test (NAAT) using urine samples in men or through a positive culture of urethral discharge. Urinary tract infections (UTIs) can be detected through a midstream urine culture. Meanwhile, balanitis xerotica et obliterans is a chronic condition characterized by atrophic white patches on the foreskin and glans penis. These conditions can be diagnosed through various diagnostic methods, which are essential in determining the appropriate treatment plan.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 5
Incorrect
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You are working in the urgent care centre, where John, a 44-year-old man comes to see you with a laceration to his right lower leg. He explains that 2 hours ago he was using a sharp tool to cut wood when it slipped and hit deep into his foot.
On examination, there is a 6 cm laceration on the lateral aspect of John's right lower leg which is 4 cm deep. There is a lot of sawdust visible inside the wound.
John is unsure about his tetanus immunisation history and there is no further information about this in his records.
What is the most appropriate option to manage John's wound with regards to tetanus prophylaxis?Your Answer:
Correct Answer: Booster vaccine and tetanus immunoglobulin should be given
Explanation:If a patient’s tetanus vaccination history is uncertain, they should receive a booster vaccine and immunoglobulin, unless the wound is minor and less than six hours old. In the case of Sarah, who has a tetanus-prone wound contaminated with soil, she requires treatment with human tetanus immunoglobulin. According to NICE guidelines, if a person’s immunisation status is unknown or uncertain, an immediate dose of vaccine should be given, followed by a full five-dose course if necessary to ensure future immunity. Therefore, the correct course of action is to administer both a booster vaccine and tetanus immunoglobulin. Waiting to confirm the tetanus immunisation history is not recommended, as tetanus prophylaxis needs to be given urgently. Advising that no tetanus prophylaxis is required is also incorrect, especially in the case of a tetanus-prone wound, which requires both a booster vaccine and tetanus immunoglobulin.
Tetanus Vaccination and Management of Wounds
The tetanus vaccine is a purified toxin that is given as part of a combined vaccine. In the UK, it is given as part of the routine immunisation schedule at 2, 3, and 4 months, 3-5 years, and 13-18 years, providing a total of 5 doses. This is considered to provide long-term protection against tetanus.
When managing wounds, the first step is to classify them as clean, tetanus-prone, or high-risk tetanus-prone. Clean wounds are less than 6 hours old and non-penetrating with negligible tissue damage. Tetanus-prone wounds include puncture-type injuries acquired in a contaminated environment, wounds containing foreign bodies, and compound fractures. High-risk tetanus-prone wounds include wounds or burns with systemic sepsis, certain animal bites and scratches, heavy contamination with material likely to contain tetanus spores, wounds or burns that show extensive devitalised tissue, and wounds or burns that require surgical intervention.
If the patient has had a full course of tetanus vaccines with the last dose less than 10 years ago, no vaccine or tetanus immunoglobulin is required regardless of the wound severity. If the patient has had a full course of tetanus vaccines with the last dose more than 10 years ago, a reinforcing dose of vaccine is required for tetanus-prone wounds, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for high-risk wounds. If the vaccination history is incomplete or unknown, a reinforcing dose of vaccine is required regardless of the wound severity, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for tetanus-prone and high-risk wounds.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 6
Incorrect
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A 42-year-old woman who is taking oral prednisolone for a flare-up of her rheumatoid arthritis is planning a 4-week holiday to a remote jungle region of Asia. She has completed her childhood vaccination programme and received a polio booster six years ago. However, she has heard that she requires further travel vaccinations. Her travel agent has suggested the items below, but she is a bit concerned about the safety of these given her medical history.
Which vaccine would be contraindicated in this patient?Your Answer:
Correct Answer: Yellow fever
Explanation:Vaccination Considerations for Immunocompromised Individuals
Live vaccines, such as rubella, measles, mumps, BCG, yellow fever, and oral polio vaccine, should not be administered to individuals who are immunocompromised. However, the hepatitis, typhoid Vi, and tetanus vaccines, which are formaldehyde-inactivated virus, polysaccharide antigen, and adsorbed toxoid, respectively, pose no risk to these individuals. Although their efficacy may be reduced in immunocompromised individuals, inactivated polio vaccine is available if needed. It is important to note that polio has been eradicated in the Americas since 1991. The main concern for immunocompromised individuals is the yellow fever vaccine.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 7
Incorrect
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A 28-year-old woman is being seen at the genitourinary medicine clinic for vaginal discharge and dysuria. Upon examination, an endocervical swab revealed a Gram-negative coccus identified as Neisseria gonorrhoea, marking her third episode of gonorrhoea in the last two years. What is the probable outcome of repeated infections?
Your Answer:
Correct Answer: Infertility
Explanation:Pelvic inflammatory disease (PID) resulting in infertility is frequently seen as a complication of gonorrhoea, with Chlamydia being the only cause of PID that is more common. Arthropathy is a rare occurrence in comparison. Chlamydia trachomatis is responsible for causing lymphogranuloma venereum.
Understanding Gonorrhoea: Causes, Symptoms, and Treatment
Gonorrhoea is a sexually transmitted infection caused by the Gram-negative diplococcus Neisseria gonorrhoeae. It can occur on any mucous membrane surface, including the genitourinary tract, rectum, and pharynx. Symptoms in males include urethral discharge and dysuria, while females may experience cervicitis leading to vaginal discharge. However, rectal and pharyngeal infections are usually asymptomatic. Unfortunately, immunisation is not possible, and reinfection is common due to antigen variation of type IV pili and Opa proteins.
If left untreated, gonorrhoea can lead to local complications such as urethral strictures, epididymitis, and salpingitis, which may result in infertility. Disseminated infection may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults. The pathophysiology of disseminated gonococcal infection is not fully understood but is thought to be due to haematogenous spread from mucosal infection.
Management of gonorrhoea involves the use of antibiotics. Ciprofloxacin used to be the treatment of choice, but there is now increased resistance to it. Cephalosporins are now more widely used, with a single dose of IM ceftriaxone 1g being the new first-line treatment. If sensitivities are known, a single dose of oral ciprofloxacin 500mg may be given. Disseminated gonococcal infection and gonococcal arthritis may also occur, with symptoms including tenosynovitis, migratory polyarthritis, and dermatitis.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 8
Incorrect
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A 5-year-old girl presents in the early evening with symptoms that have progressively worsened during the day. Her temperature is 39 oC and she has a cough, stridor, drooling of saliva and respiratory distress.
Select the single most likely diagnosis.Your Answer:
Correct Answer: Acute epiglottitis
Explanation:Acute Epiglottitis and Croup: Two Respiratory Conditions in Children
Acute epiglottitis is a rare but life-threatening condition that causes inflammation of the epiglottis and surrounding soft tissues. It is most common in children between the ages of 2 and 8 and is often caused by Haemophilus influenza type b. Throat examination with a tongue depressor should be avoided, and urgent referral for laryngoscopy is necessary. Intubation may be required in over 30% of patients, and prophylactic intubation may be carried out in those with dyspnoea or stridor.
Croup, on the other hand, is a relatively mild and self-limiting condition that causes a barking cough and stridor. It is typically associated with viral upper respiratory infections and affects children between 6 months and 3 years of age. Symptoms are often worse at night.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 9
Incorrect
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A 32-year-old female patient comes to the clinic 2 weeks after returning from a family vacation involving kayaking. She complains of feeling extremely tired due to persistent fatty diarrhea, abdominal pain, bloating, and flatulence that began during her trip. She notes that her symptoms worsen whenever she consumes dairy products. What is the probable reason for her symptoms?
Your Answer:
Correct Answer: Giardiasis
Explanation:The patient’s ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss, and recent travel suggest giardiasis as the likely cause. Giardiasis is often associated with foreign travel and exposure to contaminated water sources. Treatment with metronidazole may be beneficial. Cholera and hepatitis D are unlikely causes as their symptoms and characteristics differ from those of giardiasis.
Understanding Giardiasis
Giardiasis is a disease caused by a type of protozoan called Giardia lamblia. It is transmitted through the faeco-oral route and can be contracted through various means such as foreign travel, drinking water from rivers or lakes, and even male-male sexual contact. While some people may not experience any symptoms, others may suffer from non-bloody diarrhea, bloating, abdominal pain, lethargy, flatulence, and weight loss. In some cases, malabsorption and lactose intolerance may also occur. To diagnose giardiasis, stool microscopy for trophozoite and cysts is usually done, although stool antigen detection assay and PCR assays are also being developed. Treatment for giardiasis involves the use of metronidazole.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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Question 10
Incorrect
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A mother brings her 3-year old daughter, Lily into your clinic with concerns about vaccinations. Lily has recently undergone a liver transplant and is on immunosuppressants. The mother is worried that some vaccinations may not be safe for her daughter. Which of the following vaccinations can be administered in this situation?
Your Answer:
Correct Answer: Pertussis vaccine
Explanation:Live attenuated vaccines, such as those for seasonal nasal flu, oral polio, mumps, and measles, are commonly used. The pertussis vaccine, on the other hand, is an inactivated whole-cell vaccine that is safe for immunocompromised individuals. Immunization schedules for both children and adults are undergoing rapid changes, and some candidates may not be aware of these changes or recommendations for special groups. Although the administration of vaccinations is often delegated to clinical staff, it is important for GPs to be aware of contraindications and schedules in order to advise patients and parents. Auditing specific target groups may reveal a need for catch-up immunization in cases where recommendations have changed.
Vaccinations: Types and Precautions
Vaccinations are an important aspect of preventive healthcare. However, it is crucial to be aware of the different types of vaccines and their potential risks, especially for immunocompromised individuals. Live-attenuated vaccines, such as BCG, MMR, and oral polio, may pose a risk to these patients. In contrast, inactivated preparations, such as rabies and hepatitis A, and toxoid vaccines, such as tetanus and diphtheria, are safer options. Subunit and conjugate vaccines, which use only part of the pathogen or link bacterial polysaccharide outer coats to proteins, respectively, are also available for diseases like pneumococcus, haemophilus, meningococcus, hepatitis B, and human papillomavirus.
It is important to note that different types of influenza vaccines are available, including whole inactivated virus, split virion, and sub-unit. Additionally, the cholera vaccine contains inactivated strains of Vibrio cholerae and the recombinant B-subunit of the cholera toxin. The hepatitis B vaccine is prepared from yeast cells using recombinant DNA technology and contains HBsAg adsorbed onto an aluminum hydroxide adjuvant.
In summary, vaccinations are an essential tool in preventing the spread of infectious diseases. However, it is crucial to understand the different types of vaccines and their potential risks to make informed decisions about vaccination.
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This question is part of the following fields:
- Infectious Disease And Travel Health
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