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  • Question 1 - A 32-year-old woman presents to the Emergency Department with complaints of a headache....

    Incorrect

    • A 32-year-old woman presents to the Emergency Department with complaints of a headache. She has been experiencing flu-like symptoms for the past three days and the headache started gradually yesterday. The headache is described as being all over and worsens when looking at bright light or bending her neck. Upon examination, her temperature is 38.2º, pulse is 96/min, and blood pressure is 116/78 mmHg. There is neck stiffness present, but no focal neurological signs are observed. During a closer inspection, several petechiae are noticed on her torso. The patient has been cannulated and bloods, including cultures, have been taken. What is the most appropriate next step?

      Your Answer: Intramuscular benzypenicillin

      Correct Answer: IV cefotaxime

      Explanation:

      Immediate administration of appropriate intravenous antibiotics is crucial for this patient diagnosed with meningococcal meningitis. In light of modern PCR diagnostic techniques, there is no need to delay potentially life-saving treatment by conducting a lumbar puncture in suspected cases of meningococcal meningitis.

      The investigation and management of suspected bacterial meningitis are intertwined due to the potential negative impact of delayed antibiotic treatment. Patients should be urgently transferred to the hospital, and an ABC approach should be taken initially. A lumbar puncture should be delayed in certain circumstances, and IV antibiotics should be given as a priority if there is any doubt. The bloods and CSF should be tested for various parameters, and prophylaxis should be offered to households and close contacts of patients affected with meningococcal meningitis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - A 32-year-old man who has recently returned from Nigeria complains of a painful...

    Incorrect

    • A 32-year-old man who has recently returned from Nigeria complains of a painful ulcer on his genitals. Upon examination, you observe a lesion that is 1cm x 1cm in size and has a ragged border. Additionally, you notice tender lymphadenopathy in the groin area. What is the probable causative organism?

      Your Answer: Chlamydia trachomatis

      Correct Answer: Haemophilus ducreyi

      Explanation:

      Chancroid is the culprit behind painful genital ulcers that have a ragged border and are accompanied by tender inguinal lymphadenopathy. Haemophilus ducreyi is the organism responsible for causing chancroid. While herpes simplex virus can also cause painful genital ulcers, they tend to be smaller and multiple, and primary attacks are often accompanied by fever. On the other hand, lymphogranuloma venereum is caused by C. trachomatis, syphilis by T. pallidum, and granuloma inguinale by K. granulomatis, all of which result in painless genital ulcers.

      Understanding Chancroid: A Painful Tropical Disease

      Chancroid is a disease that is commonly found in tropical regions and is caused by a bacterium called Haemophilus ducreyi. This disease is characterized by the development of painful genital ulcers that are often accompanied by painful swelling of the lymph nodes in the groin area. The ulcers themselves are typically easy to identify, as they have a distinct border that is ragged and undermined.

      Chancroid is a disease that can be quite painful and uncomfortable for those who are affected by it.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 75-year-old man with type II diabetes mellitus is admitted to hospital with...

    Incorrect

    • A 75-year-old man with type II diabetes mellitus is admitted to hospital with pain and swelling in the left ear and face. On examination, he is febrile, the external auditory canal is red, tender and swollen with green purulent discharge. The left side of the face is swollen, with tenderness over the left temporal bone. He has left-sided facial nerve palsy involving the forehead.
      What is the primary micro-organism most likely responsible for this infection?

      Your Answer: Staphylococcus aureus

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      Bacterial Causes of Malignant Otitis Externa

      Malignant otitis externa is a serious infection that primarily affects patients with uncontrolled diabetes. The infection can spread to the temporal bone, causing osteomyelitis, cranial nerve palsies, and potentially central nervous system infection. The most common causative agent for this condition is Pseudomonas aeruginosa.

      Haemophilus influenzae is a Gram-negative coccobacillus that can cause various infections, including cellulitis, but it is not consistent with the symptoms of malignant otitis externa.

      Staphylococcus aureus, a commensal bacterium, can cause skin and soft-tissue infections, including malignant otitis externa. The characteristic signs and symptoms presented by the patient are more typical of this condition than cellulitis.

      Streptococcus pneumoniae is a common cause of pneumonia and meningitis, but it is not consistent with the symptoms of malignant otitis externa.

      Listeria monocytogenes is a rare cause of infection that primarily affects newborns, the elderly, and immunocompromised patients. It is not consistent with the clinical scenario provided.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 67-year-old man presents to the emergency department with a productive cough of...

    Incorrect

    • A 67-year-old man presents to the emergency department with a productive cough of green sputum. He has a history of COPD and is an active smoker. Upon examination, he is wheezy bilaterally and saturating at 94% on room air. A chest X-ray shows no signs of consolidation. The following blood tests were obtained:
      CRP 26 mg/L (< 5)
      Na+ 133 mmol/L (135 - 145)
      K+ 3.6 mmol/L (3.5 - 5.0)
      Bicarbonate 34 mmol/L (22 - 29)
      Urea 6 mmol/L (2.0 - 7.0)
      Creatinine 100 µmol/L (55 - 120)

      What is the most likely causative organism for this clinical presentation?

      Your Answer: Klebsiella pneumoniae

      Correct Answer: Haemophilus infuenzae

      Explanation:

      Haemophilus influenzae is the most frequent organism responsible for causing infective exacerbations of COPD, as evidenced by this man’s productive cough, increased shortness of breath, and wheezing.

      Acute exacerbations of COPD are a common reason for hospital visits in developed countries. The most common causes of these exacerbations are bacterial infections, with Haemophilus influenzae being the most common culprit, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Respiratory viruses also account for around 30% of exacerbations, with human rhinovirus being the most important pathogen. Symptoms of an exacerbation include an increase in dyspnea, cough, and wheezing, as well as hypoxia and acute confusion in some cases.

      NICE guidelines recommend increasing the frequency of bronchodilator use and giving prednisolone for five days. Antibiotics should only be given if sputum is purulent or there are clinical signs of pneumonia. Admission to the hospital is recommended for patients with severe breathlessness, acute confusion or impaired consciousness, cyanosis, oxygen saturation less than 90%, social reasons, or significant comorbidity.

      For severe exacerbations requiring secondary care, oxygen therapy should be used with an initial saturation target of 88-92%. Nebulized bronchodilators such as salbutamol and ipratropium should also be administered, along with steroid therapy. IV hydrocortisone may be considered instead of oral prednisolone, and IV theophylline may be used for patients not responding to nebulized bronchodilators. Non-invasive ventilation may be used for patients with type 2 respiratory failure, with bilevel positive airway pressure being the typical method used.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 20-year-old woman presents with complaints of malaise, tiredness, headache and abdominal discomfort...

    Correct

    • A 20-year-old woman presents with complaints of malaise, tiredness, headache and abdominal discomfort over the past 3–4 days. She was prescribed amoxicillin two days ago and has developed a rash. She has lymphadenopathy and exudative tonsillitis. Her white cell count shows abnormal lymphocytosis.
      What is the most probable diagnosis?

      Your Answer: Infectious mononucleosis

      Explanation:

      Common Viral Infections: Symptoms and Characteristics

      Infectious mononucleosis, also known as the kissing disease, is caused by the Epstein-Barr virus and is characterized by fever, pharyngitis, and adenopathy. It is primarily transmitted through intimate contact with body secretions, particularly oropharyngeal secretions. Pharyngitis is caused by the proliferation of infected B lymphocytes in the lymphatic tissue of the oropharynx. It is most common in young adults and can be mistaken for streptococcal pharyngitis.

      German measles, or rubella, is a communicable exanthematous disease that is generally benign. However, pregnant women who contract the disease in the early weeks of gestation can experience teratogenic effects. The exanthema of rubella consists of a rose-pink maculopapular rash that starts on the face and neck and spreads to the trunk and extremities within 24 hours. It typically fades by the end of the third day.

      Chickenpox is a childhood illness caused by the varicella-zoster virus. It is characterized by a vesicular exanthem and is typically self-limited and mild.

      Herpes simplex viruses are host-adapted pathogens that cause a wide variety of disease states. HSV-1 is associated with orofacial disease, while HSV-2 is associated with genital disease. Oropharyngeal HSV-1 infection causes pharyngitis and tonsillitis more often than gingivostomatitis. Herpes labialis, or cold sores, is the most common manifestation of recurrent HSV-1 infection.

      Cytomegalovirus (CMV) infection is prevalent in developed countries, with at least 60% of the population having been exposed. It typically causes an asymptomatic infection or produces mild flu-like symptoms, with few clinical findings on physical examination. High-risk groups, such as fetuses whose mothers become infected during pregnancy or people with HIV, are more susceptible to severe complications.

      Overview of Common Viral Infections and Their Characteristics

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - An 80-year-old man presents with a 2-week history of profuse loose stools and...

    Incorrect

    • An 80-year-old man presents with a 2-week history of profuse loose stools and severe abdominal pain over the past 2 days. He has lost his appetite and is only tolerating small amounts of fluid over the past 24 hours. On examination, his heart rate is 118 bpm, respiratory rate is 22 breaths/min, temperature 38.1ºC and blood pressure is 104/74 mmHg. Significant left iliac fossa tenderness is noted. The patient is urgently admitted, and a stool culture confirms Clostridium difficile infection and severe colitis without perforation on imaging. What is the most appropriate treatment for this patient?

      Your Answer: IV vancomycin for 10 days

      Correct Answer: Oral vancomycin AND IV metronidazole

      Explanation:

      The treatment for life-threatening C. difficile infection involves administering vancomycin orally and metronidazole intravenously.

      Clostridioides difficile is a type of bacteria that is commonly found in hospitals. It is a Gram positive rod that produces an exotoxin which can cause damage to the intestines, leading to a condition called pseudomembranous colitis. This bacteria usually develops when the normal gut flora is suppressed by broad-spectrum antibiotics, with second and third generation cephalosporins being the leading cause of C. difficile. Other risk factors include proton pump inhibitors. Symptoms of C. difficile include diarrhea, abdominal pain, and a raised white blood cell count. The severity of the infection can be determined using the Public Health England severity scale, which ranges from mild to life-threatening.

      To diagnose C. difficile, a stool sample is tested for the presence of C. difficile toxin (CDT). Treatment for a first episode of C. difficile infection typically involves oral vancomycin for 10 days, with fidaxomicin or a combination of oral vancomycin and IV metronidazole being used as second and third-line therapies. Recurrent infections occur in around 20% of patients, increasing to 50% after their second episode. In such cases, oral fidaxomicin is recommended within 12 weeks of symptom resolution, while oral vancomycin or fidaxomicin can be used after 12 weeks. For life-threatening C. difficile infections, oral vancomycin and IV metronidazole are used, and surgery may be considered with specialist advice. Other therapies, such as bezlotoxumab and fecal microbiota transplant, may also be considered for preventing recurrences in certain cases.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 7 - A 28-year-old woman presents to her General Practitioner with a 12-day history of...

    Incorrect

    • A 28-year-old woman presents to her General Practitioner with a 12-day history of vaginal discharge. She describes the discharge as having a fishy smell and a white colour. There is no history of abdominal pain or urinary symptoms and she denies pregnancy. She is sexually active with one regular partner of three years and has the Mirena coil in situ.
      On examination, her observations are within normal limits. Her abdomen is soft and nontender. The bimanual examination is unremarkable with no adnexal tenderness elicited. Her vaginal pH is 5.
      What is the next best investigation to confirm the likely diagnosis?

      Select ONE option only

      Your Answer: Blood culture

      Correct Answer: Vaginal swab for microscopy and culture

      Explanation:

      Diagnostic Tests for Bacterial Vaginosis and Urinary Tract Infections

      Bacterial vaginosis is a common vaginal infection caused by an overgrowth of Gardnerella vaginalis. The diagnosis of bacterial vaginosis is based on Amsel’s criteria, which includes thin, white-colored vaginal discharge, vaginal pH > 4.5, positive whiff test, and clue cells on microscopy. A vaginal swab for microscopy and culture is needed to confirm the diagnosis, especially if the patient meets two of the four criteria.

      On the other hand, urine microscopy and culture are used to diagnose urinary tract infections, which share some symptoms with sexually transmitted infections. However, the presence of vaginal discharge makes a sexually transmitted infection more likely, and alternative investigations are more specific.

      Blood culture and hysteroscopy and culture are not indicated in the diagnosis of bacterial vaginosis. Blood culture is not usually necessary, while hysteroscopy and biopsy are invasive procedures used to diagnose endometrial disorders.

      Lastly, nucleic acid amplification testing is used to diagnose chlamydia, the most common sexually transmitted disease. Although chlamydia may cause symptoms similar to bacterial vaginosis, the presence of increased vaginal pH makes bacterial vaginosis more likely.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - You are counseling a patient regarding malaria chemoprophylaxis for their upcoming trip to...

    Incorrect

    • 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?

      Your Answer: Chloroquine

      Correct Answer: Atovaquone/Proguanil

      Explanation:

      Malaria Chemoprophylaxis: Choosing the Right Medication

      Malaria is a potentially fatal disease that requires chemoprophylaxis for individuals entering known malaria areas. Atovaquone/proguanil (Malarone) is a well-tolerated, once-daily medication that is effective in both preventing and treating malaria. It should be taken 24 hours before entering a malaria zone and continued for seven days after leaving. However, advice on bite avoidance is also crucial in preventing malaria.

      Doxycycline is a cheaper alternative to atovaquone/proguanil, but it may cause nausea and photosensitivity, which can be problematic for fair-skinned individuals. Chloroquine is an inferior choice due to widespread resistance, while mefloquine (Larium) may cause psychosis, making it unsuitable for patients with a psychiatric history.

      It is important to note that advising against chemoprophylaxis is not appropriate, as malaria poses a serious risk to all individuals, regardless of their previous exposure to malaria areas.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 5-day-old infant presents with congenital cataracts, sensorineural deafness, and pulmonary artery stenosis....

    Incorrect

    • A 5-day-old infant presents with congenital cataracts, sensorineural deafness, and pulmonary artery stenosis. What is the probable prenatal infection that the baby has been exposed to?

      Your Answer: Cytomegalovirus

      Correct Answer: Rubella

      Explanation:

      The neonate is diagnosed with congenital rubella syndrome, which is characterized by sensorineural deafness, eye abnormalities, and congenital heart disease. The risk of fetal infection is highest if the mother contracts the virus during the first trimester of pregnancy. Antenatal cytomegalovirus infection can lead to cerebral calcification, microcephaly, and sensorineural deafness. HIV does not pose a physical risk to the developing fetus, but there is a risk of perinatal transmission. Parvovirus B19 can cause hydrops fetalis and fetal death. Toxoplasmosis can result in intracranial calcification, hydrocephalus, and epilepsy in the affected child.

      Rubella and Pregnancy: Risks, Features, Diagnosis, and Management

      Rubella, also known as German measles, is a viral infection caused by the togavirus. Thanks to the introduction of the MMR vaccine, it is now rare. However, if contracted during pregnancy, there is a risk of congenital rubella syndrome, which can cause serious harm to the fetus. It is important to note that the incubation period is 14-21 days, and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.

      The risk of damage to the fetus is highest in the first 8-10 weeks of pregnancy, with a risk as high as 90%. However, damage is rare after 16 weeks. Features of congenital rubella syndrome include sensorineural deafness, congenital cataracts, congenital heart disease (e.g. patent ductus arteriosus), growth retardation, hepatosplenomegaly, purpuric skin lesions, ‘salt and pepper’ chorioretinitis, microphthalmia, and cerebral palsy.

      If a suspected case of rubella in pregnancy arises, it should be discussed immediately with the local Health Protection Unit (HPU) as type/timing of investigations may vary. IgM antibodies are raised in women recently exposed to the virus. It should be noted that it is very difficult to distinguish rubella from parvovirus B19 clinically. Therefore, it is important to also check parvovirus B19 serology as there is a 30% risk of transplacental infection, with a 5-10% risk of fetal loss.

      If a woman is tested at any point and no immunity is demonstrated, they should be advised to keep away from people who might have rubella. Non-immune mothers should be offered the MMR vaccination in the post-natal period. However, MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - Which of the following is a live attenuated vaccine? ...

    Correct

    • Which of the following is a live attenuated vaccine?

      Your Answer: Mumps

      Explanation:

      Live attenuated vaccines include BCG, MMR, oral polio, yellow fever, and oral typhoid.

      Types of Vaccines and Their Characteristics

      Vaccines are essential in preventing the spread of infectious diseases. However, it is crucial to understand the different types of vaccines and their characteristics to ensure their safety and effectiveness. Live attenuated vaccines, such as BCG, MMR, and oral polio, may pose a risk to immunocompromised patients. In contrast, inactivated preparations, including rabies and hepatitis A, are safe for everyone. Toxoid vaccines, such as tetanus, diphtheria, and pertussis, use inactivated toxins to generate an immune response. Subunit and conjugate vaccines, such as pneumococcus, haemophilus, meningococcus, hepatitis B, and human papillomavirus, use only part of the pathogen or link bacterial polysaccharide outer coats to proteins to make them more immunogenic. Influenza vaccines come in different types, including whole inactivated virus, split virion, and sub-unit. Cholera vaccine contains inactivated strains of Vibrio cholerae and recombinant B-subunit of the cholera toxin. Hepatitis B vaccine contains HBsAg adsorbed onto aluminium hydroxide adjuvant and is prepared from yeast cells using recombinant DNA technology. Understanding the different types of vaccines and their characteristics is crucial in making informed decisions about vaccination.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - A 25-year-old student taking the oral contraceptive pill develops pain and soreness around...

    Incorrect

    • 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?

      Your Answer: Primary syphilis

      Correct Answer: Genital herpes

      Explanation:

      Sexually Transmitted Diseases: Causes and Symptoms

      Sexually transmitted diseases (STDs) are infections that are spread through sexual contact. There are various types of STDs, each with its own set of symptoms and causes. Genital herpes is caused by herpes simplex viruses, with type 2 being responsible for the majority of cases. It can present as vesicular lesions around the genitals, rectum or mouth, but most individuals are asymptomatic. Granuloma inguinale is a chronic bacterial infection that results in nodular lesions that evolve into ulcers. Chancroid is a bacterial STD caused by Haemophilus ducreyi, characterised by painful necrotising genital ulcers. Primary syphilis is caused by the spirochaete Treponema pallidum, with lesions beginning as solitary, raised, firm, red papules that can be several centimetres in diameter. Lymphogranuloma venereum is an uncommon STD caused by Chlamydia trachomatis, characterised by self-limited genital papules or ulcers, followed by painful inguinal and/or femoral lymphadenopathy. Non-infectious causes include fixed drug reactions, Behçet’s disease, neoplasms and trauma. It is important to consider these alternative causes if evaluations for the infectious aetiologies do not lead to a diagnosis. HIV infection should always be considered and tested for.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - A 30-year-old teacher who recently returned after completing a 3-month assignment in Thailand...

    Incorrect

    • 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

      Your Answer: Tuberculous meningitis

      Correct Answer: Viral meningitis

      Explanation:

      The cerebrospinal fluid (CSF) findings can help diagnose different types of meningitis. Viral meningitis typically shows clear CSF with a slightly elevated white blood cell count (5-1000 cells/µl, mostly lymphocytes), mildly elevated protein levels, and a normal or slightly low CSF-to-plasma-glucose ratio. Bacterial meningitis, on the other hand, often presents with turbid CSF, a high white blood cell count (>100 cells/µl, mostly neutrophils), elevated protein levels, and a very low CSF-to-plasma-glucose ratio. Fungal meningitis, such as cryptococcal meningitis, usually shows clear or cloudy CSF, a slightly elevated white blood cell count (5-100 cells/µl, mostly lymphocytes), elevated protein levels, and a low CSF-to-plasma-glucose ratio. Tuberculous meningitis typically presents with clear or cloudy CSF, a slightly elevated white blood cell count (5-100 cells/µl, mostly lymphocytes), significantly elevated protein levels, and a very low CSF-to-plasma-glucose ratio. A sub-arachnoid hemorrhage, which is not meningitis, typically presents with a sudden, severe headache and signs of increased intracranial pressure. The CSF in this case often shows xanthochromia.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A 25-year-old homeless person is brought into the general practice surgery, having been...

    Incorrect

    • A 25-year-old homeless person is brought into the general practice surgery, having been found nearby in a disoriented state.
      On examination, they have neck stiffness and a non-blanching rash on their arms. Their vital signs are stable except for fever and tachycardia. They score 13/15 on the Glasgow Coma Scale. An ambulance has been called to transfer them to the hospital.
      Which of the following is the most appropriate action to perform while awaiting the ambulance?

      Your Answer: Give an intravenous (IV) fluid bolus

      Correct Answer: Administer a dose of parenteral benzylpenicillin

      Explanation:

      Appropriate Actions for Suspected Bacterial Meningitis with Non-Blanching Rash

      When a patient presents with suspected bacterial meningitis and a non-blanching rash, it is crucial to take appropriate actions promptly. Administering a single dose of parenteral benzylpenicillin at the earliest opportunity is recommended, but this should not delay the transfer to the hospital. It is also important to notify the regional Public Health consultant about the suspected case.

      While administering paracetamol for fever and starting the patient on high-flow oxygen may be necessary in some cases, they would not take priority over the administration of parenteral benzylpenicillin. Additionally, an IV fluid bolus is not indicated unless the patient’s vital signs are unstable. By taking these appropriate actions, healthcare providers can help ensure the best possible outcome for patients with suspected bacterial meningitis and non-blanching rash.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A 56-year-old woman with a history of rheumatoid arthritis complains of bloody diarrhoea,...

    Incorrect

    • A 56-year-old woman with a history of rheumatoid arthritis complains of bloody diarrhoea, accompanied by fever and abdominal pain for the past week. She is on methotrexate for her rheumatoid arthritis, which is usually well-controlled. Upon testing her stool sample, Campylobacter jejuni is detected. What is the best course of action for treatment?

      Your Answer: Fluids + metronidazole

      Correct Answer: Fluids + clarithromycin

      Explanation:

      Campylobacter: The Most Common Bacterial Cause of Intestinal Disease in the UK

      Campylobacter is a Gram-negative bacillus that is responsible for causing infectious intestinal disease in the UK. The bacteria is primarily spread through the faecal-oral route and has an incubation period of 1-6 days. Symptoms of Campylobacter infection include a prodrome of headache and malaise, diarrhoea (often bloody), and abdominal pain that may mimic appendicitis.

      In most cases, Campylobacter infection is self-limiting and does not require treatment. However, the British National Formulary (BNF) recommends treatment with antibiotics if the patient is immunocompromised or if symptoms are severe (high fever, bloody diarrhoea, or more than eight stools per day) and have lasted for more than one week. The first-line antibiotic for Campylobacter infection is clarithromycin, although ciprofloxacin is an alternative. It is important to note that strains with decreased sensitivity to ciprofloxacin are frequently isolated.

      Complications of Campylobacter infection may include Guillain-Barre syndrome, reactive arthritis, septicaemia, endocarditis, and arthritis. It is important to seek medical attention if symptoms are severe or persist for an extended period of time.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - Which of the following characteristics is the least typical of Trichomonas vaginalis? ...

    Incorrect

    • Which of the following characteristics is the least typical of Trichomonas vaginalis?

      Your Answer: Frothy green discharge

      Correct Answer:

      Explanation:

      A pH level greater than 4.5 is linked to Trichomonas vaginalis and bacterial vaginosis.

      Understanding Trichomonas vaginalis and its Comparison to Bacterial Vaginosis

      Trichomonas vaginalis is a type of protozoan parasite that is highly motile and flagellated. It is known to cause trichomoniasis, which is a sexually transmitted infection. The infection is characterized by symptoms such as offensive, yellow/green, frothy vaginal discharge, vulvovaginitis, and strawberry cervix. The pH level is usually above 4.5, and in men, it may cause urethritis.

      To diagnose trichomoniasis, a wet mount microscopy is conducted to observe the motile trophozoites. The treatment for trichomoniasis involves oral metronidazole for 5-7 days, although a one-off dose of 2g metronidazole may also be used.

      When compared to bacterial vaginosis, trichomoniasis has distinct differences. Bacterial vaginosis is caused by an overgrowth of bacteria in the vagina, while trichomoniasis is caused by a protozoan parasite. The symptoms of bacterial vaginosis include a thin, grayish-white vaginal discharge with a fishy odor, and a pH level above 4.5. Unlike trichomoniasis, bacterial vaginosis is not considered a sexually transmitted infection.

      In conclusion, understanding the differences between trichomoniasis and bacterial vaginosis is crucial in diagnosing and treating these conditions effectively. Proper diagnosis and treatment can help prevent complications and improve overall health and well-being.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - A 25-year-old farm worker is admitted to hospital with a 5-day history of...

    Incorrect

    • A 25-year-old farm worker is admitted to hospital with a 5-day history of headache, fever, severe myalgia and a petechial rash. He is jaundiced, febrile, has tachycardia and has not passed urine for over 14 hours. His urea level is raised and liver function tests indicate hepatocellular damage.
      Which of the following is the most likely diagnosis?

      Your Answer: Lyme disease

      Correct Answer: Weil’s disease

      Explanation:

      Comparing Zoonotic Infections: Symptoms and Characteristics

      Weil’s Disease, Brucellosis, Lyme Disease, Orf, and Rat-bite Fever are all zoonotic infections that can be transmitted from animals to humans. However, each infection has its own unique symptoms and characteristics.

      Weil’s Disease is a severe form of leptospirosis caused by Leptospira icterohaemorrhagiae. It is transmitted via direct or indirect contact with animals, especially rodents. Symptoms include flu-like symptoms, severe headache, petechial or purpuric rashes, epistaxis, jaundice, renal failure, meningism, and multiorgan failure.

      Brucellosis is caused by the bacterial genus Brucella and is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols. Symptoms include fever, myalgia, weight loss, coughing, vomiting, lymphadenopathy, and splenomegaly. Males may develop epididymo-orchitis.

      Lyme Disease is caused by Borrelia burgdorferi and is transmitted to humans via tick bites from infected ticks. Symptoms include isolated erythema migrans, the characteristic skin rash which has the appearance of a ‘bull’s eye’ and a febrile illness. Untreated patients may go on to develop cardiac, neurological or rheumatological symptoms months after the initial bite.

      Orf is a zoonotic mucocutaneous lesion caused by a pox virus and is most commonly seen in workers who handle sheep. Symptoms include firm red papules that develop, enlarge, and become painful before spontaneously resolving. Systemic illness is rare with orf.

      Rat-bite Fever is an acute, febrile illness caused by bacteria transmitted by rodents. Symptoms include fever, a rash, and polyarthritis. The rash is usually widespread and may be maculopapular, petechial, or purpuric.

      In summary, each zoonotic infection has its own unique symptoms and characteristics, making it important to accurately diagnose and treat each infection accordingly.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 17 - A 28-year-old woman is screened for hepatitis B following a needlestick injury at...

    Correct

    • A 28-year-old woman is screened for hepatitis B following a needlestick injury at work. Her test findings are as follows:
      HBsAg negative
      Anti-HBs positive
      IgG anti-HBc negative
      IgM anti-HBc negative
      What is the doctor's interpretation of these results?

      Your Answer: Previous immunisation

      Explanation:

      These test results indicate that the patient has been previously immunized against hepatitis B. The vaccine used for immunization only contains the surface antigen, so the absence of antibodies to the core antigen is expected.

      If the patient had an acute infection, they would test positive for the hepatitis B antigen and likely have positive IgG and IgM antibodies for the core antigen, but not for the surface antigen.

      In the case of a chronic infection, the patient would test positive for the antigen and likely have a positive IgG antibody to the core protein, but a negative IgM antibody and no antibody response to the surface protein.

      A negative result for all four tests would indicate no previous infection or immunization.

      If the patient had a previous, resolved infection, they would test positive for both anti-HBs and anti-HBc, but the absence of HBsAg would indicate that they are not currently infected.

      Interpreting hepatitis B serology is an important skill that is still tested in medical exams. It is crucial to keep in mind a few key points. The surface antigen (HBsAg) is the first marker to appear and triggers the production of anti-HBs. If HBsAg is present for more than six months, it indicates chronic disease, while its presence for one to six months implies acute disease. Anti-HBs indicates immunity, either through exposure or immunization, and is negative in chronic disease. Anti-HBc indicates previous or current infection, with IgM anti-HBc appearing during acute or recent hepatitis B infection and persisting IgG anti-HBc. HbeAg is a marker of infectivity and HBV replication.

      To illustrate, if someone has been previously immunized, their anti-HBs will be positive, while all other markers will be negative. If they had hepatitis B more than six months ago but are not a carrier, their anti-HBc will be positive, and HBsAg will be negative. However, if they are now a carrier, both anti-HBc and HBsAg will be positive. If HBsAg is present, it indicates an ongoing infection, either acute or chronic if present for more than six months. On the other hand, anti-HBc indicates that the person has caught the virus, and it will be negative if they have been immunized.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - A 45-year-old construction worker complains of headache, fever and muscle pains. Initially, he...

    Incorrect

    • A 45-year-old construction worker complains of headache, fever and muscle pains. Initially, he thought it was just a common cold but his symptoms have worsened over the past week. He also reports feeling nauseous and having decreased urine output. Upon examination, his temperature is 38.2ºC, pulse is 102 / min and his chest is clear. There are subconjunctival haemorrhages present but no signs of jaundice. What is the probable diagnosis?

      Your Answer: Mycoplasma pneumonia

      Correct Answer: Leptospirosis

      Explanation:

      Leptospirosis: A Tropical Disease with Flu-Like Symptoms

      Leptospirosis is a disease caused by the spirochaete Leptospira interrogans, which is commonly spread through contact with infected rat urine. While it is often seen in individuals who work in sewage, farming, veterinary, or abattoir settings, it is more prevalent in tropical regions and should be considered in returning travelers. The disease has two phases, with the early phase lasting around a week and characterized by flu-like symptoms and fever. The second immune phase may lead to more severe disease, including acute kidney injury, hepatitis, and aseptic meningitis. Diagnosis can be made through serology, PCR, or culture, with high-dose benzylpenicillin or doxycycline being the recommended treatment.

      Leptospirosis is a tropical disease that presents with flu-like symptoms and is commonly spread through contact with infected rat urine. While it is often seen in individuals who work in certain settings, it is more prevalent in tropical regions and should be considered in returning travelers. The disease has two phases, with the early phase lasting around a week and characterized by flu-like symptoms and fever. The second immune phase may lead to more severe disease, including acute kidney injury, hepatitis, and aseptic meningitis. Diagnosis can be made through serology, PCR, or culture, with high-dose benzylpenicillin or doxycycline being the recommended treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - A 25-year-old woman presents to the Genitourinary Medicine Clinic with a 1-week history...

    Incorrect

    • 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

      Your Answer: Vaginal pH

      Correct Answer: Nucleic acid amplification testing (NAAT)

      Explanation:

      Investigations for Pelvic Inflammatory Disease

      Pelvic inflammatory disease (PID) is a condition that can cause deep dyspareunia and lower abdominal and adnexal tenderness. The most common cause of PID is Chlamydia trachomatis, which can be diagnosed through nucleic acid amplification testing (NAAT). This involves taking a urine sample and a swab from the vagina or cervix to test for the organism. While a blood culture may be considered for a febrile patient, it is not routinely used for diagnosing C. trachomatis. Vaginal microscopy and culture used to be the preferred method for diagnosis, but NAAT is now recommended. Testing vaginal pH is commonly used for vaginal infections, but is not useful for PID. Urine microscopy and culture is used for UTIs, but the presence of vaginal discharge and deep dyspareunia suggests PID instead.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A 28-year-old woman complains of a yellowish-green vaginal discharge that began two weeks...

    Incorrect

    • A 28-year-old woman complains of a yellowish-green vaginal discharge that began two weeks ago. During examination, her vagina appears swollen and red.
      What is the most probable diagnosis?

      Your Answer: Acquired immune deficiency syndrome (AIDS)

      Correct Answer: Trichomoniasis

      Explanation:

      Common Genitourinary Infections: Symptoms and Diagnosis

      Trichomoniasis, Candidiasis, AIDS, HPV, and Lactobacilli infection are some of the most common genitourinary infections. Trichomoniasis is caused by Trichomonas vaginalis and presents with abnormal vaginal discharge, odour, itching, burning, soreness, and dyspareunia. Candidiasis is a fungal infection caused by yeasts from the genus Candida and presents with pruritus, vaginal discharge, dysuria, and dyspareunia. AIDS is a viral infection that has a hyperacute onset and is unlikely in patients with no past medical history or risk factors. HPV infection is common and often goes unnoticed, but can manifest as warty lesions on the genital or anal area. Lactobacilli infection is not associated with causing infection. Diagnosis of these infections depends on laboratory testing, with culture being the current criterion standard for trichomoniasis and physical examination for candidiasis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - A 67-year-old man is brought to the emergency department by his daughter who...

    Incorrect

    • A 67-year-old man is brought to the emergency department by his daughter who is worried about his confusion after a recent chest infection. She mentions that he did not get better even after taking amoxicillin. During the examination, crackles are heard on the left side of his chest and his vital signs show a respiratory rate of 28/min, blood pressure of 90/60 mmHg, and heart rate of 110/min.

      What would be the suitable fluid therapy to administer?

      Your Answer: 20 ml/kg over 1 hour

      Correct Answer: 500ml stat

      Explanation:

      This individual displays several indicators of red flag sepsis, such as confusion, hypotension, and elevated respiratory rate. It is imperative to initiate the sepsis 6 protocol.
      According to the NICE guidelines for sepsis, when administering intravenous fluid resuscitation to patients aged 16 and above, it is recommended to use crystalloids containing sodium levels between 130-154 mmol/litre, with a 500 ml bolus administered in less than 15 minutes.

      Understanding Sepsis: Classification and Management

      Sepsis is a life-threatening condition caused by a dysregulated host response to an infection. In recent years, the classification of sepsis has changed, with the old category of severe sepsis no longer in use. Instead, the Surviving Sepsis Guidelines now recognize sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, and septic shock as a more severe form of sepsis. The term ‘systemic inflammatory response syndrome (SIRS)’ has also fallen out of favor.

      To manage sepsis, it is important to identify and treat the underlying cause of the infection and support the patient regardless of the cause or severity. However, if any red flags are present, the ‘sepsis six’ should be started immediately. This includes administering oxygen, taking blood cultures, giving broad-spectrum antibiotics, giving intravenous fluid challenges, measuring serum lactate, and measuring accurate hourly urine output.

      NICE released its own guidelines in 2016, which focus on the risk stratification and management of patients with suspected sepsis. For risk stratification, NICE recommends using red flag and amber flag criteria. If any red flags are present, the sepsis six should be started immediately. If any amber flags are present, the patient should be closely monitored and managed accordingly.

      To help identify and categorize patients, the Sequential (Sepsis-Related) Organ Failure Assessment Score (SOFA) is increasingly used. The score grades abnormality by organ system and accounts for clinical interventions. A SOFA score of 2 or more reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection. Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness of this condition and the need for prompt and appropriate intervention.

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      • Infectious Diseases
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  • Question 22 - A human immunodeficiency virus (HIV)-positive teenager who recently returned from the tropics presents...

    Incorrect

    • A human immunodeficiency virus (HIV)-positive teenager who recently returned from the tropics presents with severe diarrhoea (up to 30 times per day).
      Which of the following is the most likely cause?

      Your Answer: Staphylococcus aureus

      Correct Answer: Cryptosporidium species

      Explanation:

      Differential diagnosis of diarrhoea in an HIV-positive patient

      Human cryptosporidiosis, caused by Cryptosporidium species, is a common opportunistic infection in HIV/AIDS patients, leading to prolonged and severe diarrhoea. Escherichia coli can cause urinary and enteric infections, but an alternative aetiology is more likely in this case. Staphylococcus aureus is a commensal bacterium that can cause various infections, but it is not suggested by this clinical scenario. Entamoeba histolytica, which causes amoebiasis, is more prevalent in developing countries and may cause dysentery and invasive extra-intestinal manifestations, but an alternative aetiology is more likely in this case. Salmonella species can be transmitted orally via contaminated food or beverages and may cause non-typhoidal enterocolitis, focal disease, or typhoid fever, but an alternative aetiology is more likely in this case, given the severity of diarrhoea and the patient’s HIV-positive status. Therefore, a thorough differential diagnosis is necessary to identify the underlying cause of diarrhoea in this patient and provide appropriate treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 23 - Which one of the following statements regarding the vaccine used to routinely immunise...

    Correct

    • Which one of the following statements regarding the vaccine used to routinely immunise adults against influenza is accurate?

      Your Answer: It is a live vaccine

      Explanation:

      Influenza Vaccination: Who Should Get It and What to Expect

      Seasonal influenza remains a significant health concern in the UK, with the flu season typically starting in November. To prevent the spread of the virus, it is recommended that individuals receive the influenza vaccine between September and early November. There are three types of influenza virus, with types A and B causing the majority of clinical disease.

      Prior to 2013, flu vaccination was only offered to the elderly and at-risk groups. However, a new NHS influenza vaccination programme for children was announced in 2013. The children’s vaccine is given intranasally, with the first dose administered at 2-3 years and subsequent doses given annually. It is a live vaccine and is more effective than the injectable vaccine.

      Adults and at-risk groups are also recommended to receive the influenza vaccine annually. This includes individuals over 65 years old, those with chronic respiratory or heart disease, chronic kidney or liver disease, chronic neurological disease, diabetes mellitus, immunosuppression, asplenia or splenic dysfunction, pregnant women, and those with a body mass index of 40 kg/m² or higher. Health and social care staff, those living in long-stay residential care homes, and carers of the elderly or disabled person may also be eligible for the vaccine.

      The influenza vaccine is an inactivated vaccine and cannot cause influenza. It is around 75% effective in adults, although this figure decreases in the elderly. It takes around 10-14 days after immunisation before antibody levels are at protective levels. The vaccine should be stored between +2 and +8ºC and shielded from light. Contraindications include hypersensitivity to egg protein. While a minority of patients may experience fever and malaise after receiving the vaccine, it is generally well-tolerated.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 24 - A 7-year-old boy who has recently arrived from India complains of fever. During...

    Incorrect

    • A 7-year-old boy who has recently arrived from India complains of fever. During examination, extensive cervical lymphadenopathy is observed and a grey coating is seen surrounding the tonsils. What is the probable diagnosis?

      Your Answer: Dengue fever

      Correct Answer: Diphtheria

      Explanation:

      Understanding Diphtheria: Causes, Symptoms, and Treatment

      Diphtheria is a bacterial infection caused by the Gram positive bacterium Corynebacterium diphtheriae. The pathophysiology of this disease involves the release of an exotoxin encoded by a β-prophage, which inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2. This toxin commonly causes a ‘diphtheric membrane’ on tonsils, resulting in a grey, pseudomembrane on the posterior pharyngeal wall. Systemic distribution may produce necrosis of myocardial, neural, and renal tissue.

      Possible presentations of diphtheria include sore throat with a ‘diphtheric membrane’, bulky cervical lymphadenopathy, and neuritis of cranial nerves. It may also result in a ‘bull neck’ appearance and heart block. People who have recently visited Eastern Europe, Russia, or Asia are at a higher risk of contracting this disease.

      To diagnose diphtheria, a culture of throat swab is taken using tellurite agar or Loeffler’s media. The treatment for diphtheria involves intramuscular penicillin and diphtheria antitoxin.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 25 - A 21-year-old college student is brought to the emergency department by her roommates,...

    Incorrect

    • A 21-year-old college student is brought to the emergency department by her roommates, presenting confusion and fever. She had been complaining of a severe headache and neck stiffness since yesterday. Her roommates have also noticed what appears to be bruising.
      Upon examination, she appears acutely unwell, with a fever and nuchal rigidity. A widespread purpuric rash is observed, as well as general pallor and mottling.
      Considering the probable diagnosis, what should be provided to her roommates?

      Your Answer: Intravenous benzylpenicillin if they develop symptoms

      Correct Answer: Oral ciprofloxacin now

      Explanation:

      Prophylaxis for contacts of patients with meningococcal meningitis involves the use of oral ciprofloxacin or rifampicin. In this case, the patient’s symptoms indicate meningococcal meningitis, and therefore, household members and close contacts should be offered prophylaxis with ciprofloxacin as the preferred drug. Intramuscular benzylpenicillin is not appropriate for prophylaxis, but may be given to a patient with suspected meningococcal meningitis in a pre-hospital setting. Intravenous benzylpenicillin is a treatment option for the patient, not for contacts. Intravenous cefotaxime is also a treatment option for the patient, but not a suitable prophylactic antibiotic for contacts. Waiting until symptoms develop to give oral ciprofloxacin is not recommended – it should be given immediately.

      The investigation and management of suspected bacterial meningitis are intertwined due to the potential negative impact of delayed antibiotic treatment. Patients should be urgently transferred to the hospital, and an ABC approach should be taken initially. A lumbar puncture should be delayed in certain circumstances, and IV antibiotics should be given as a priority if there is any doubt. The bloods and CSF should be tested for various parameters, and prophylaxis should be offered to households and close contacts of patients affected with meningococcal meningitis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 26 - A 20-year-old male patient visits his GP clinic with a complaint of painful...

    Incorrect

    • A 20-year-old male patient visits his GP clinic with a complaint of painful blisters and ulcers on his glans, accompanied by pain during urination. He is sexually active and does not use protection during intercourse. His last unprotected sexual encounter was a week ago. What medication would be beneficial for this patient?

      Your Answer: Intramuscular benzathine penicillin

      Correct Answer: Oral aciclovir

      Explanation:

      Male patients with gonorrhea typically experience urethral discharge and dysuria as symptoms, rather than painful ulcers.

      Understanding Genital Herpes

      Genital herpes is a viral infection caused by the herpes simplex virus (HSV). There are two strains of the virus, HSV-1 and HSV-2, which were previously thought to cause oral and genital lesions respectively. However, there is now considerable overlap between the two strains. The infection is characterized by painful genital ulceration, which may be accompanied by dysuria and pruritus. Primary infections are usually more severe than recurrent episodes and may present with systemic symptoms such as headache, fever, and malaise. Tender inguinal lymphadenopathy and urinary retention may also occur.

      To diagnose genital herpes, nucleic acid amplification tests (NAAT) are the preferred investigation method as they are considered superior to viral culture. HSV serology may be useful in certain situations, such as recurrent genital ulceration of unknown cause. Management of the infection involves general measures such as saline bathing, analgesia, and topical anaesthetic agents like lidocaine. Oral aciclovir is also prescribed, and some patients with frequent exacerbations may benefit from longer-term aciclovir.

      In pregnant women, a primary attack of herpes occurring after 28 weeks gestation may require an elective caesarean section at term. Women with recurrent herpes who are pregnant should be treated with suppressive therapy and advised that the risk of transmission to their baby is low. Understanding genital herpes and its management is crucial in preventing transmission and managing symptoms.

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      • Infectious Diseases
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  • Question 27 - A 23-year-old female with a history of cystic fibrosis presents to the emergency...

    Correct

    • A 23-year-old female with a history of cystic fibrosis presents to the emergency department with a fever and productive cough. Upon examination, she has a respiratory rate of 22 breaths per minute, a pulse rate of 121 beats per minute, and oxygen saturation of 93% on air. Crackles are heard at the base of the left lung and wheezing is present throughout. A chest x-ray reveals a patchy opacity at the left base with minor blunting of the left costophrenic angle, enlarged airways in both lung fields, and fluid levels. Which organism is most likely responsible for this patient's clinical presentation?

      Your Answer: Pseudomonas aeruginosa

      Explanation:

      Pseudomonas aeruginosa is a significant cause of lower respiratory tract infections (LRTI) in patients with cystic fibrosis. These patients develop bronchiectasis early in life, leading to frequent hospitalizations due to LRTI. Bronchiectasis causes sputum accumulation in the larger airways, leading to bacterial and fungal colonization. Pseudomonas aeruginosa is the most common bacteria found in these patients, and should be considered when providing empirical treatment. If the patient is stable, antibiotic sensitivities should be obtained from a culture sample before starting treatment. However, an anti-pseudomonal agent such as piperacillin with tazobactam or ciprofloxacin should be used as part of empirical treatment for sepsis in cystic fibrosis patients. Staphylococcus aureus is less common in cystic fibrosis patients and is more associated with pre-existing influenza infection. Haemophilus pneumoniae is also an important pathogen in cystic fibrosis, but not as common as Pseudomonas. Haemophilus is the most common pathogen in patients with chronic obstructive pulmonary disease (COPD). Legionella is more likely to cause infections in cystic fibrosis patients than in the general population, but is still less common than Pseudomonas. Klebsiella infection is rare and is usually associated with malnourished alcoholics rather than cystic fibrosis.

      Pseudomonas aeruginosa: A Gram-negative Rod Causing Various Infections in Humans

      Pseudomonas aeruginosa is a type of bacteria that is commonly found in the environment. It is a Gram-negative rod that can cause a range of infections in humans. Some of the most common infections caused by Pseudomonas aeruginosa include chest infections, skin infections (such as burns and wound infections), otitis externa, and urinary tract infections.

      In the laboratory, Pseudomonas aeruginosa can be identified as a Gram-negative rod that does not ferment lactose and is oxidase positive. It produces both an endotoxin and exotoxin A, which can cause fever, shock, and inhibit protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2.

      Overall, Pseudomonas aeruginosa is a significant pathogen that can cause a range of infections in humans. Its ability to produce toxins and resist antibiotics makes it a challenging organism to treat. Therefore, it is important to identify and treat infections caused by Pseudomonas aeruginosa promptly and appropriately.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 28 - A 25-year-old female presented to her GP with a grey, thin, creamy vaginal...

    Incorrect

    • A 25-year-old female presented to her GP with a grey, thin, creamy vaginal discharge.
      Which of the following is the best verbal advice to give her?

      Your Answer: Yoghurt containing live bacteria may relieve symptoms

      Correct Answer: Avoid perfumed soaps

      Explanation:

      Bacterial Vaginosis: Symptoms, Risk Factors, and Diagnosis

      Bacterial vaginosis (BV) is a common vaginal infection caused by an overgrowth of bacteria. It is important for patients to understand the symptoms, risk factors, and diagnosis of BV in order to properly manage and treat the condition.

      Symptoms of BV include vaginal odor, increased vaginal discharge, vulvar irritation, and rarely, dysuria or dyspareunia. Risk factors for BV include recent antibiotic use, decreased estrogen production, presence of an intrauterine device, douching, and sexual activity that could lead to transmission.

      Physical findings of BV include grey, thin, and homogeneous vaginal discharge that adheres to the vaginal mucosa, increased light reflex of the vaginal walls, and typically little or no evidence of inflammation. Diagnosis of BV is made through microscopic examination of the discharge, with demonstration of three of the following four Amsel criteria: clue cells on a saline smear, a pH >4.5, characteristic discharge, and a positive whiff test.

      Patients with BV should be advised to wash only with hypoallergenic bar soaps or no soap at all, avoid liquid soaps, body washes, and perfumed soaps, and not to douche or use over-the-counter vaginal hygiene products. While studies have shown inconsistent results, some patients may find relief from symptoms by using yogurt containing live bacteria.

      It is important to properly manage and treat BV, as long-standing or untreated cases may lead to more serious complications such as endometritis, salpingitis, pelvic inflammatory disease, or pregnancy complications. However, with proper care and attention, the prognosis for uncomplicated cases of BV is generally excellent.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 29 - A 32-year-old female sex worker presents to the emergency department complaining of a...

    Incorrect

    • A 32-year-old female sex worker presents to the emergency department complaining of a high fever and severe headache. During the physical examination, you observe neck stiffness and mild photophobia, prompting you to perform a lumbar puncture. The results of the lumbar puncture reveal the presence of a yeast and a capsule in the CSF stained with India ink.
      What is the most probable diagnosis?

      Your Answer: Aspergillus abscess

      Correct Answer: Cryptococcal meningitis

      Explanation:

      Cryptococcus neoformans is a yeast that has a protective capsule and requires oxygen to survive. It can thrive in both plants and animals, and when it infects humans, it causes cryptococcosis. While the infection typically affects the lungs, it can also lead to fungal meningitis and encephalitis in individuals with weakened immune systems. HIV-positive patients are particularly susceptible to this infection, and given the patient’s history as a sex worker, it’s possible that they have an undiagnosed HIV infection that has progressed to AIDS. Additionally, cryptococcus neoformans can be detected through india ink staining during a lumbar puncture.

      The investigation and management of suspected bacterial meningitis are intertwined due to the potential negative impact of delayed antibiotic treatment. Patients should be urgently transferred to the hospital, and an ABC approach should be taken initially. A lumbar puncture should be delayed in certain circumstances, and IV antibiotics should be given as a priority if there is any doubt. The bloods and CSF should be tested for various parameters, and prophylaxis should be offered to households and close contacts of patients affected with meningococcal meningitis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 30 - A 21-year-old man is seeking advice as his girlfriend has been diagnosed with...

    Incorrect

    • A 21-year-old man is seeking advice as his girlfriend has been diagnosed with meningococcal meningitis. He is concerned about the possibility of contracting the disease. What is the recommended antibiotic prophylaxis for individuals in close contact with someone who has meningococcal meningitis?

      Your Answer: Oral erythromycin

      Correct Answer: Oral ciprofloxacin

      Explanation:

      Prophylaxis for contacts of patients with meningococcal meningitis now favors the use of oral ciprofloxacin over rifampicin.

      The investigation and management of suspected bacterial meningitis are intertwined due to the potential negative impact of delayed antibiotic treatment. Patients should be urgently transferred to the hospital, and an ABC approach should be taken initially. A lumbar puncture should be delayed in certain circumstances, and IV antibiotics should be given as a priority if there is any doubt. The bloods and CSF should be tested for various parameters, and prophylaxis should be offered to households and close contacts of patients affected with meningococcal meningitis.

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      • Infectious Diseases
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Infectious Diseases (5/30) 17%
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