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  • Question 1 - A 25-year-old hiker comes to you with complaints of fever, joint pain, and...

    Incorrect

    • A 25-year-old hiker comes to you with complaints of fever, joint pain, and a red rash after being bitten by a tick during a recent hike. Upon examination, you find that his neurological and cardiovascular functions are normal. You suspect that he may have contracted Lyme disease and have ordered serology for Borrelia burgdorferi. What would be the most suitable course of action for managing this condition?

      Your Answer: 7 day course ceftriaxone

      Correct Answer: 14 day course of doxycycline

      Explanation:

      The recommended initial treatment for early Lyme disease is a 14-21 day regimen of oral doxycycline. For non-disseminated Lyme disease, the first line treatment is a 14-day course of oral doxycycline, making option 2 the correct answer. Amoxicillin may be used if doxycycline is contraindicated, such as during pregnancy. Ceftriaxone is reserved for disseminated disease. Treatment should be initiated based on clinical suspicion, as serology may take several weeks to become positive.

      Understanding Lyme Disease

      Lyme disease is a bacterial infection caused by Borrelia burgdorferi and is transmitted through tick bites. The early symptoms of Lyme disease include erythema migrans, a characteristic bulls-eye rash that appears at the site of the tick bite. This rash is painless, slowly increases in size, and can be more than 5 cm in diameter. Other early symptoms include headache, lethargy, fever, and joint pain.

      If erythema migrans is present, Lyme disease can be diagnosed clinically, and antibiotics should be started immediately. The first-line test for Lyme disease is an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to Borrelia burgdorferi. If the ELISA is negative but Lyme disease is still suspected, it should be repeated 4-6 weeks later. If Lyme disease is suspected in patients who have had symptoms for 12 weeks or more, an immunoblot test should be done.

      Tick bites can cause significant anxiety, but routine antibiotic treatment is not recommended by NICE. If the tick is still present, it should be removed using fine-tipped tweezers, and the area should be washed. In cases of suspected or confirmed Lyme disease, doxycycline is the preferred treatment for early disease, while ceftriaxone is used for disseminated disease. A Jarisch-Herxheimer reaction may occur after initiating therapy, which can cause fever, rash, and tachycardia.

      In summary, Lyme disease is a bacterial infection transmitted through tick bites. Early symptoms include erythema migrans, headache, lethargy, fever, and joint pain. Diagnosis is made through clinical presentation and ELISA testing, and treatment involves antibiotics. Tick bites do not require routine antibiotic treatment, and ticks should be removed using fine-tipped tweezers.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - You are asked to evaluate a 19-year-old student who has recently returned from...

    Incorrect

    • You are asked to evaluate a 19-year-old student who has recently returned from a gap-year trip to India. He complains of extreme fatigue and loss of appetite during the last week of his journey and noticed that he had jaundice just before his return home. He denies being an intravenous drug user and having unprotected sexual intercourse. Additionally, he did not receive any blood transfusions or tattoos during his trip. He reports having a fever, but it subsided once his jaundice appeared. After conducting liver function tests (LFTs), you find that his alanine aminotransferase (ALT) level is 950 iu/l (reference range 20–60 iu/l), total bilirubin level is 240 μmol/l (reference range <20 μmol/l), and his alkaline phosphatase (ALP) level is slightly above the upper limit of normal. His white blood cell count, albumin level, and prothrombin times are all normal. What is the most probable diagnosis based on this clinical presentation?

      Your Answer: Hepatitis C

      Correct Answer: Hepatitis A

      Explanation:

      Overview of Viral Infections and Their Clinical Manifestations

      Hepatitis A, B, and C, leptospirosis, and cytomegalovirus (CMV) are all viral infections that can cause a range of clinical manifestations. Hepatitis A is typically transmitted through ingestion of contaminated food and is most common in resource-poor regions. Leptospirosis is associated with exposure to rodents and contaminated water or soil. Hepatitis B is transmitted through blood and sexual contact, while hepatitis C is most commonly spread through injection drug use. CMV is typically asymptomatic but can cause severe disease in immunocompromised individuals. Understanding the transmission and clinical manifestations of these viral infections is important for accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 28-week premature infant is born after prolonged premature rupture of membranes (PROM)....

    Incorrect

    • A 28-week premature infant is born after prolonged premature rupture of membranes (PROM). The neonate develops temperature instability, respiratory distress, and lethargy about 18 hours after birth. Blood cultures confirm sepsis. What is the probable causative organism?

      Your Answer: Staphylococcus epidermidis

      Correct Answer: Group B Streptococcus

      Explanation:

      Sepsis in newborns can be difficult to diagnose as it often presents with non-specific symptoms. Therefore, it is important to have a high level of suspicion and to investigate promptly. There are two types of sepsis in newborns: early-onset (within 48 hours of birth) and late-onset (after 48 hours from birth). Early-onset sepsis is usually caused by microorganisms acquired from the mother’s birth canal, while late-onset sepsis is often caused by hospital-acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus. In this case, the newborn is likely to have early-onset sepsis, which is commonly caused by Group B Strep, a bacteria that is normally found in the female genital tract.

      Group B Streptococcus (GBS) is a common cause of severe infection in newborns. It is estimated that 20-40% of mothers carry GBS in their bowel flora, which can be passed on to their infants during labor and lead to serious infections. Prematurity, prolonged rupture of membranes, previous sibling GBS infection, and maternal pyrexia are all risk factors for GBS infection. The Royal College of Obstetricians and Gynaecologists (RCOG) has published guidelines on GBS management, which include not offering universal screening for GBS to all women and not offering screening based on maternal request. Women who have had GBS detected in a previous pregnancy should be offered intrapartum antibiotic prophylaxis (IAP) or testing in late pregnancy and antibiotics if still positive. IAP should also be offered to women with a previous baby with GBS disease, women in preterm labor, and women with a fever during labor. Benzylpenicillin is the preferred antibiotic for GBS prophylaxis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 67-year-old woman presents with a 2-week history of frequent loose stools, left...

    Incorrect

    • A 67-year-old woman presents with a 2-week history of frequent loose stools, left iliac fossa discomfort and fever without rectal bleeding.

      Three months ago she was treated for confirmed Clostridium difficile infection with oral vancomycin, with a resolution of symptoms.

      On examination, her heart rate is 90 bpm, respiratory rate of 18 breaths/min, temperature 37.6ºC and blood pressure of 130/86 mmHg. Her abdomen is generally mildly tender, without guarding.

      A repeat stool culture confirms Clostridium difficile infection.

      What is the most appropriate treatment for this patient?

      Your Answer: Oral vancomycin AND IV metronidazole

      Correct Answer: Oral fidaxomicin

      Explanation:

      If a patient experiences a recurrent episode of C. difficile within 12 weeks of symptom resolution, it is recommended to treat them with oral fidaxomicin. However, the use of bezlotoxumab to prevent recurrences is not currently supported by NICE due to cost-effectiveness concerns. Faecal microbiota transplant may be considered for patients who have had two or more previous episodes, but not on the first recurrence. In cases of life-threatening Clostridium difficile infection, both oral vancomycin and IV metronidazole should be used for treatment.

      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 5 - A 32-year-old woman who lives with her husband comes to you for advice....

    Incorrect

    • A 32-year-old woman who lives with her husband comes to you for advice. She has been experiencing anal discharge and itching for the past 4 days. She also has some symptoms of painful urination. A urethral smear shows intracellular diplococci.

      What is the most probable infectious agent that matches this clinical presentation?

      Your Answer: Treponema pallidum

      Correct Answer: Neisseria gonorrhoeae

      Explanation:

      Common Sexually Transmitted Infections and Diagnostic Methods

      Sexually transmitted infections (STIs) are a major public health concern worldwide. Here are some common STIs and their diagnostic methods:

      Neisseria gonorrhoeae: This bacterium causes gonorrhoea, which is a purulent infection of the mucous membranes. In men, symptoms include urethritis, acute epididymitis, and rectal infection. A Gram stain is the method of choice for detecting gonorrhoea in symptomatic men.

      Treponema pallidum: This spirochaete bacterium causes syphilis. Serologic testing is the standard method of detection for all stages of syphilis.

      Chlamydia trachomatis: This bacterium is an obligate intracellular micro-organism that infects squamocolumnar epithelial cells. Nucleic acid amplification testing (NAAT) is the most sensitive test for detecting C. trachomatis infection, and a urine sample is an effective specimen for this test.

      Herpes simplex virus type 1 (HSV-1): This virus is typically associated with orofacial disease. Tissue culture isolation and immunofluorescent staining can be used to diagnose HSV-1.

      Herpes simplex virus type 2 (HSV-2): This virus is typically associated with urogenital disease. Tissue culture isolation and immunofluorescent staining can be used to diagnose HSV-2.

      Common STIs and Their Diagnostic Methods

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - A 50-year-old man has presented to the emergency department with a 2-day history...

    Incorrect

    • A 50-year-old man has presented to the emergency department with a 2-day history of bloody diarrhoea 10 times per day associated with colicky abdominal pain.

      Observations are as follows: blood pressure 100/60 mmHg, pulse 90/min, respiratory rate 15/min, temperature 37.8ºC, oxygen saturation 97% on air. The examination is unremarkable apart from diffuse abdominal tenderness.

      Stool analysis revealed Campylobacter jejuni.

      What is the first-line treatment?

      Your Answer: Ciprofloxacin

      Correct Answer: Clarithromycin

      Explanation:

      If a patient experiences severe symptoms of Campylobacter infection such as bloody diarrhea and more than eight stools per day, treatment with clarithromycin may be necessary. While Campylobacter infection is typically self-limiting, the British National Formulary (BNF) recommends antibiotics for severe cases or for immunocompromised patients. NICE also advises antibiotic treatment for severe symptoms or if symptoms persist for more than one week. Supportive treatment may be sufficient for mild symptoms in immunocompetent patients. Ciprofloxacin is an alternative to clarithromycin, but strains with decreased sensitivity to ciprofloxacin are frequently isolated. Metronidazole and oral vancomycin are not recommended for Campylobacter treatment, but are first-line options for Clostridium difficile.

      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 7 - A middle-aged man presents with a round, slowly enlarging erythema on his thigh....

    Correct

    • A middle-aged man presents with a round, slowly enlarging erythema on his thigh. He also complains of joint discomfort and fatigue. Lyme disease is suspected.
      Which of the following is the most appropriate laboratory test to confirm this diagnosis?
      Select the SINGLE most appropriate laboratory test from the list below.

      Your Answer: Anti-Borrelia burgdorferi titre

      Explanation:

      Diagnostic Tests for Lyme Disease: Understanding the Results

      Lyme disease is a common illness caused by the spirochaete B. burgdorferi, transmitted to humans via tick bites. Serologic testing is the most frequently used diagnostic tool, but false positives and negatives are common. The enzyme immunoassay (EIA) or enzyme-linked immunosorbent assay (ELISA) is the first step, followed by a western blot if necessary. However, serologic results cannot distinguish active from inactive disease. Antinuclear antibodies and rheumatoid factor test results are negative in B. burgdorferi infection. The erythrocyte sedimentation rate is usually elevated but is not specific to detect infection. Culture of joint fluids can rule out gout and pseudogout, but detection of B. burgdorferi DNA in synovial fluid is not reliable. Blood cultures are impractical. Understanding the limitations of these tests is crucial for accurate diagnosis and treatment of Lyme disease.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - A 28-year-old woman comes to the doctor complaining of lower abdominal pain, pain...

    Incorrect

    • A 28-year-old woman comes to the doctor complaining of lower abdominal pain, pain during sexual intercourse, and an abnormal vaginal discharge. A vaginal swab reveals a positive chlamydia infection. She has no known allergies and is generally healthy. What is the most appropriate next step in managing this patient?

      Your Answer: Prescribe a 7-day course of oral penicillin

      Correct Answer: Prescribe a 7-day course of doxycycline

      Explanation:

      Treatment Options for Chlamydia Infections

      Chlamydia trachomatis is a common sexually transmitted infection that can be effectively treated with antibiotics. The National Institute for Health and Care Excellence (NICE) provides guidance on the appropriate antimicrobial prescribing for chlamydia infections.

      The first-line treatment for chlamydia is a 7-day course of doxycycline. This medication is highly effective against Chlamydia trachomatis and is well-tolerated by most patients. If doxycycline cannot be used, such as in cases of pregnancy or allergy, a 7-day course of azithromycin can be given as a second-line option.

      It is important for patients to complete their full course of antibiotics and to avoid sexual intercourse until treatment is complete. If the treatment is completed, there is no need for a test of cure to be carried out.

      Other antibiotics, such as oral penicillin and cefalexin, are not effective against chlamydia infections. A one-off dose of intramuscular ceftriaxone is the treatment of choice for gonorrhoea infections, but it is not indicated for the treatment of chlamydia.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 15-year-old girl comes to the emergency department complaining of a maculopapular rash...

    Incorrect

    • A 15-year-old girl comes to the emergency department complaining of a maculopapular rash that has been present for 1 day. She had visited her family doctor 2 days ago with symptoms of a cold and a sore throat and was given a course of oral antibiotics. Upon examination, she has a mild fever of 37.8ºC and a widespread maculopapular rash on her face and torso. Her tonsils are enlarged and erythematous, and she has palpable tender posterior cervical lymphadenopathy. What is the most appropriate diagnostic test to identify the underlying condition?

      Your Answer:

      Correct Answer: Monospot test

      Explanation:

      The patient in question is likely suffering from glandular fever, a viral illness caused by the Ebstein-Barr virus. Symptoms include a sore throat, fever, and general malaise, as well as palpable cervical lymphadenopathy and an erythematous throat. The illness is more common in teenagers and is often spread through respiratory droplets, earning it the nickname kissing disease. The patient was prescribed amoxicillin by their GP, which can cause a non-specific maculopapular rash in patients with glandular fever. The diagnosis is typically confirmed through a Monospot blood test, which detects the presence of heterophil antibodies produced in response to the virus.

      An anti-streptolysin O titre test can detect streptococcal infections, but it does not explain the patient’s rash following antibiotic use. A full blood count can be helpful in diagnosing glandular fever, as it often shows a lymphocytosis, but the Monospot test is more definitive. A nasopharyngeal aspirate for viral PCR can diagnose viral infections like measles, but this is less likely in a teenager in the UK due to vaccination. A sputum culture is not useful in diagnosing glandular fever, as the patient does not have a cough or sputum production.

      Understanding Infectious Mononucleosis

      Infectious mononucleosis, also known as glandular fever, is a viral infection caused by the Epstein-Barr virus (EBV) in 90% of cases. It is most commonly seen in adolescents and young adults. The classic triad of symptoms includes sore throat, pyrexia, and lymphadenopathy, which are present in around 98% of patients. Other symptoms include malaise, anorexia, headache, palatal petechiae, splenomegaly, hepatitis, lymphocytosis, haemolytic anaemia, and a maculopapular rash. The symptoms typically resolve after 2-4 weeks.

      The diagnosis of infectious mononucleosis is confirmed through a heterophil antibody test (Monospot test) in the second week of the illness. Management is supportive and includes rest, drinking plenty of fluids, avoiding alcohol, and taking simple analgesia for any aches or pains. It is recommended to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture.

      Interestingly, there is a correlation between EBV and socioeconomic groups. Lower socioeconomic groups have high rates of EBV seropositivity, having frequently acquired EBV in early childhood when the primary infection is often subclinical. However, higher socioeconomic groups show a higher incidence of infectious mononucleosis, as acquiring EBV in adolescence or early adulthood results in symptomatic disease.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - A 65-year-old patient scheduled for inguinal hernia repair is discovered to have MRSA...

    Incorrect

    • A 65-year-old patient scheduled for inguinal hernia repair is discovered to have MRSA during pre-admission screening. Should any treatment be provided to him?

      Your Answer:

      Correct Answer: Nasal mupirocin + chlorhexidine for the skin

      Explanation:

      Understanding MRSA and Screening for Infection

      Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that can cause serious infections and is particularly dangerous in hospital settings. To prevent the spread of MRSA, certain patients should be screened for the infection, including those awaiting elective admissions and all emergency admissions starting in 2011. Screening involves taking a nasal swab and checking for skin lesions or wounds. If a patient is found to be a carrier of MRSA, treatment involves using antibiotics such as vancomycin, teicoplanin, or linezolid. However, some strains may develop resistance to these antibiotics, so newer options like linezolid, quinupristin/dalfopristin combinations, and tigecycline should be reserved for resistant cases. It is important to suppress MRSA from carriers to prevent the spread of infection. This can be done through the use of mupirocin and chlorhexidine gluconate. By understanding MRSA and screening for infection, healthcare providers can take steps to prevent the spread of this dangerous bacteria.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - A 28-year-old female is admitted to the Medical Admissions Unit with symptoms of...

    Incorrect

    • A 28-year-old female is admitted to the Medical Admissions Unit with symptoms of neck stiffness, photophobia, and fever. No rash is present, and her GCS is 15. Upon lumbar puncture, her CSF shows increased opening pressure and turbidity, with a raised white cell count and low glucose. Ceftriaxone is initiated, but what additional treatment is necessary to enhance outcomes?

      Your Answer:

      Correct Answer: Dexamethasone

      Explanation:

      The patient’s presentation and CSF results strongly suggest bacterial meningitis, for which appropriate antibiotic therapy has been initiated. To improve neurological outcomes and reduce the risk of sequelae such as deafness, dexamethasone is the recommended additional treatment. However, it should be noted that dexamethasone is contraindicated in cases of septic shock or meningococcal septicaemia. Antivirals such as aciclovir are not indicated in bacterial meningitis, while fluconazole, an anti-fungal, is also not appropriate. Prednisolone has no role in the treatment of 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 12 - A 28-year-old woman is seeking screening for sexually transmitted infections due to starting...

    Incorrect

    • A 28-year-old woman is seeking screening for sexually transmitted infections due to starting a new relationship. What is the most frequently diagnosed sexually transmitted infection in the UK?

      Your Answer:

      Correct Answer: Chlamydia

      Explanation:

      Chlamydia is a common sexually transmitted infection caused by Chlamydia trachomatis. It is prevalent in the UK, with approximately 1 in 10 young women affected. The incubation period is around 7-21 days, but many cases are asymptomatic. Symptoms in women include cervicitis, discharge, and bleeding, while men may experience urethral discharge and dysuria. Complications can include epididymitis, pelvic inflammatory disease, and infertility.

      Traditional cell culture is no longer widely used for diagnosis, with nuclear acid amplification tests (NAATs) being the preferred method. Testing can be done using urine, vulvovaginal swab, or cervical swab. Screening is recommended for sexually active individuals aged 15-24 years, and opportunistic testing is common.

      Doxycycline is the first-line treatment for Chlamydia, with azithromycin as an alternative if doxycycline is contraindicated or not tolerated. Pregnant women may be treated with azithromycin, erythromycin, or amoxicillin. Patients diagnosed with Chlamydia should be offered partner notification services, with all contacts since the onset of symptoms or within the last six months being notified and offered treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - Which infection is most strongly linked to the development of Guillain-Barre syndrome? ...

    Incorrect

    • Which infection is most strongly linked to the development of Guillain-Barre syndrome?

      Your Answer:

      Correct Answer: Campylobacter jejuni

      Explanation:

      Understanding Guillain-Barre Syndrome and Miller Fisher Syndrome

      Guillain-Barre syndrome is a condition that affects the peripheral nervous system and is often triggered by an infection, particularly Campylobacter jejuni. The immune-mediated demyelination of the peripheral nervous system occurs due to the cross-reaction of antibodies with gangliosides. Studies have shown a correlation between the clinical features of the syndrome and the presence of anti-ganglioside antibodies, particularly anti-GM1 antibodies, which are present in 25% of patients.

      Miller Fisher syndrome is a variant of Guillain-Barre syndrome that is characterized by ophthalmoplegia, areflexia, and ataxia. Unlike other forms of Guillain-Barre syndrome, Miller Fisher syndrome usually presents as a descending paralysis, with the eye muscles typically affected first. In 90% of cases, anti-GQ1b antibodies are present.

      Understanding the pathogenesis and clinical features of Guillain-Barre syndrome and Miller Fisher syndrome is crucial for accurate diagnosis and effective treatment. Further research is needed to fully understand the mechanisms behind these conditions and to develop more targeted therapies.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A patient with pyogenic meningitis has been admitted and the husband is worried...

    Incorrect

    • A patient with pyogenic meningitis has been admitted and the husband is worried about contracting the disease. What is the recommended prophylaxis in this situation? Choose ONE option from the list provided.

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Antibiotics for Meningitis: Recommended Drugs and Dosages

      Meningitis is a serious infection that affects the membranes surrounding the brain and spinal cord. Antibiotics are the mainstay of treatment for meningitis, and prophylactic antibiotics are also recommended for close contacts of infected individuals. Here are the recommended drugs and dosages for meningitis treatment and prophylaxis:

      Ciprofloxacin: This antibiotic is now the preferred choice for prophylaxis in all age groups and in pregnancy. It is a single dose and readily available in pharmacies, and does not interact with oral contraceptives. It should be given to all close contacts of probable or confirmed meningococcal meningitis, with dosages ranging from 250 mg to 500 mg depending on age.

      Metronidazole: This drug has no role in the treatment of acute meningitis.

      Ceftriaxone: This antibiotic has good penetration into inflamed meninges and can be given via intramuscular or oral route. It can be used in monotherapy in adults under 60 years old, or in dual therapy with amoxicillin in older adults.

      Co-trimoxazole: This drug is an alternative to cefotaxime or ceftriaxone in older adults, and is also used in individuals with meningitis from Listeria monocytogenes infection.

      Vancomycin: This antibiotic is recommended in cases of penicillin resistance or suspected penicillin-resistant pneumococci, but should never be used in monotherapy due to doubts about its penetration into adult CSF.

      Chemoprophylaxis: Close contacts of infected individuals should receive prophylactic antibiotics to prevent nasopharyngeal carriage of the organism. Ciprofloxacin is the first-line choice, with dosages ranging from 10 mg/kg to 600 mg depending on age. Rifampicin can be given as an alternative for those unable to take ciprofloxacin.

      It is important to seek microbiology and public health advice if in doubt about the appropriate antibiotics and dosages for meningitis treatment and prophylaxis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - A 38-year-old teacher presents with ongoing fatigue. During a routine blood test, abnormal...

    Incorrect

    • A 38-year-old teacher presents with ongoing fatigue. During a routine blood test, abnormal liver function tests are detected, prompting a hepatitis screen. The results are as follows:
      Negative for Anti-HAV IgG
      Negative for HBsAg
      Positive for Anti-HBs
      Negative for Anti-HBc
      Positive for Anti-HCV
      What is the most likely interpretation of these results?

      Your Answer:

      Correct Answer: Hepatitis C infection with previous hepatitis B vaccination

      Explanation:

      To determine if a patient still has the hepatitis C virus, a HCV PCR test is necessary as only a small percentage of patients naturally clear the infection. Unfortunately, there is currently no vaccine available for hepatitis C.

      When interpreting hepatitis B serology, the presence of surface antigen (HBsAg) typically indicates acute disease and triggers the production of anti-HBs. If HBsAg is present for more than six months, it suggests chronic disease and is infectious. Anti-HBs indicates immunity from either exposure or vaccination, while anti-HBc suggests previous or current infection. The appearance of IgM anti-HBc during acute or recent hepatitis B infection lasts for about six months. HbeAg is a marker of infectivity as it results from the breakdown of core antigen from infected liver cells.

      Understanding Hepatitis C: Transmission, Complications, and Management

      Hepatitis C is a viral infection that is expected to become a significant public health concern in the UK in the coming years. It is estimated that around 200,000 people in the country are chronically infected with the virus, with intravenous drug users and those who received blood transfusions prior to 1991 being at higher risk. The virus is an RNA flavivirus with an incubation period of 6-9 weeks.

      Transmission of the virus can occur through needle stick injuries, vertical transmission from mother to child (especially if coexistent with HIV), and sexual intercourse (although the risk is low). There is currently no vaccine for hepatitis C. Symptoms of acute infection include a transient rise in serum aminotransferases, jaundice, fatigue, and arthralgia.

      Around 15-45% of patients will clear the virus after an acute infection, while the majority (55-85%) will develop chronic hepatitis C. This can lead to complications such as rheumatological problems, cirrhosis, hepatocellular cancer, and cryoglobulinemia. Treatment for chronic infection depends on the viral genotype and aims for sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy. Interferon-based treatments are no longer recommended, with protease inhibitors such as daclatasvir and sofosbuvir or sofosbuvir and simeprevir being used instead. However, these treatments can have side effects such as haemolytic anaemia, cough, flu-like symptoms, depression, and fatigue.

      In conclusion, understanding the transmission, complications, and management of hepatitis C is crucial in addressing this growing public health concern.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - 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:

      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.

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

    Incorrect

    • 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:

      Correct 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.

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      • Infectious Diseases
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  • Question 18 - A 25-year-old student presents to his General Practitioner with a 10-day history of...

    Incorrect

    • A 25-year-old student presents to his General Practitioner with a 10-day history of fever and sore throat. He recently completed a course of amoxicillin despite developing a rash a few days into the course. On examination, he is febrile and his tonsils are inflamed but no exudate is present; there are petechial spots on his palate and he has a widespread maculopapular rash, cervical lymphadenopathy and splenomegaly.
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Infectious mononucleosis

      Explanation:

      Differential Diagnosis of a Patient with Sore Throat and Fever

      Infectious mononucleosis, also known as glandular fever, is a common cause of sore throat and fever in adolescents. It is caused by the Epstein-Barr virus and presents with symptoms such as sore throat, fever, and lethargy. The duration of symptoms is longer than other causes of acute sore throat, and examination findings may include lymphadenopathy and splenomegaly. Palatal petechiae is a distinguishing feature between glandular fever and streptococcal tonsillitis. A maculopapular rash may also be present, but it is important to note that amoxicillin can cause a rash in patients with glandular fever. Stevens-Johnson syndrome, bacterial tonsillitis, candidiasis, and mumps are other possible differential diagnoses. However, Stevens-Johnson syndrome is a severe mucocutaneous reaction to medications or infections, bacterial tonsillitis presents with enlarged, inflamed tonsils with exudate and cervical lymphadenopathy, candidiasis presents with white coating of buccal membranes, throat, or tongue, and mumps presents with bilateral parotid gland enlargement. Therefore, based on the patient’s history and examination findings, infectious mononucleosis is the most likely diagnosis.

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      • Infectious Diseases
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  • Question 19 - A 19-year-old non-pregnant, asymptomatic woman with no past medical history is found to...

    Incorrect

    • A 19-year-old non-pregnant, asymptomatic woman with no past medical history is found to have 106 colony-forming units of Escherichia coli/ml of urine on a routine health check.
      Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: No antibiotics are indicated

      Explanation:

      Management of Asymptomatic Bacteriuria

      Asymptomatic bacteriuria is a common finding in clinical practice, but it does not require antibiotic treatment. Patients with asymptomatic bacteriuria are at increased risk for symptomatic UTI, but treatment does not decrease the frequency of symptomatic UTIs nor improve other outcomes. Therefore, screening for or treatment of asymptomatic bacteriuria is not appropriate and should be discouraged.

      Treatment of asymptomatic bacteriuria in women should be reserved for pregnant patients, those undergoing a urological procedure that may produce mucosal bleeding, and the significantly immunosuppressed. Pregnant patients are considered immunosuppressed UTI hosts due to the physiological changes associated with pregnancy, which increase the risk for serious complications even in healthy pregnant women. However, it should not be treated in diabetic patients, elderly individuals, or those with indwelling catheters.

      Antibiotic treatment is not recommended in this clinical scenario, even in symptomatic UTIs. Current UK antimicrobial guidance recommends treatment for 3-7 days, depending on the clinical case, not with a single-dose administration. Investigating the renal tract is also not necessary for a single finding of asymptomatic bacteriuria.

      Intravenous antibiotic treatment is reserved for complicated UTIs, in which case the patient would present far more unwell than what is seen in this scenario. Underlying conditions that predispose patients to complicated UTIs include diabetes, renal failure, functional or anatomic abnormality of the urinary tract, renal transplantation, an indwelling catheter stent, or immunosuppression.

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      • Infectious Diseases
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  • Question 20 - A 32-year-old male immigrant from India undergoes testing for latent TB. Results from...

    Incorrect

    • A 32-year-old male immigrant from India undergoes testing for latent TB. Results from both the Mantoux skin test and interferon release gamma assay confirm the presence of latent TB. What treatment options are available for the patient?

      Your Answer:

      Correct Answer: Isoniazid with pyridoxine for 6 months

      Explanation:

      Treatment Options for Latent Tuberculosis

      Latent tuberculosis is a disease that can remain dormant in the body for years without causing any symptoms. However, if left untreated, it can develop into active tuberculosis, which can be life-threatening. To prevent this from happening, NICE now offers two choices for treating latent tuberculosis.

      The first option is a combination of isoniazid (with pyridoxine) and rifampicin for three months. This is recommended for people under the age of 35 who are concerned about the hepatotoxicity of the drugs. Before starting this treatment, a liver function test is conducted to assess the risk factors.

      The second option is a six-month course of isoniazid (with pyridoxine) for people who are at risk of interactions with rifamycins. This includes individuals with HIV or those who have had a transplant. The risk factors for developing active tuberculosis include silicosis, chronic renal failure, HIV positivity, solid organ transplantation with immunosuppression, intravenous drug use, haematological malignancy, anti-TNF treatment, and previous gastrectomy.

      In summary, the choice of treatment for latent tuberculosis depends on the individual’s clinical circumstances and risk factors. It is important to consult with a healthcare professional to determine the best course of action.

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      • Infectious Diseases
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  • Question 21 - A 23-year-old male patient complains of fatigue and a persistent sore throat for...

    Incorrect

    • A 23-year-old male patient complains of fatigue and a persistent sore throat for the last two weeks. During the examination, his temperature is 37.8ºC, pulse rate is 78/min, and there is widespread cervical lymphadenopathy with palatal petechiae. What is the potential complication that this patient may face due to the likely diagnosis?

      Your Answer:

      Correct Answer: Splenic rupture

      Explanation:

      It is recommended to refrain from participating in contact sports for a period of 4 weeks if diagnosed with glandular fever.

      Understanding Infectious Mononucleosis

      Infectious mononucleosis, also known as glandular fever, is a viral infection caused by the Epstein-Barr virus (EBV) in 90% of cases. It is most commonly seen in adolescents and young adults. The classic triad of symptoms includes sore throat, pyrexia, and lymphadenopathy, which are present in around 98% of patients. Other symptoms include malaise, anorexia, headache, palatal petechiae, splenomegaly, hepatitis, lymphocytosis, haemolytic anaemia, and a maculopapular rash. The symptoms typically resolve after 2-4 weeks.

      The diagnosis of infectious mononucleosis is confirmed through a heterophil antibody test (Monospot test) in the second week of the illness. Management is supportive and includes rest, drinking plenty of fluids, avoiding alcohol, and taking simple analgesia for any aches or pains. It is recommended to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture.

      Interestingly, there is a correlation between EBV and socioeconomic groups. Lower socioeconomic groups have high rates of EBV seropositivity, having frequently acquired EBV in early childhood when the primary infection is often subclinical. However, higher socioeconomic groups show a higher incidence of infectious mononucleosis, as acquiring EBV in adolescence or early adulthood results in symptomatic disease.

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      • Infectious Diseases
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  • Question 22 - What is the most suitable antibiotic for treating uncomplicated Chlamydia infection in a...

    Incorrect

    • What is the most suitable antibiotic for treating uncomplicated Chlamydia infection in a 22-year-old female who is not expecting?

      Your Answer:

      Correct Answer: Doxycycline

      Explanation:

      Doxycycline is the recommended treatment for chlamydia.

      Chlamydia is a common sexually transmitted infection caused by Chlamydia trachomatis. It is prevalent in the UK, with approximately 1 in 10 young women affected. The incubation period is around 7-21 days, but many cases are asymptomatic. Symptoms in women include cervicitis, discharge, and bleeding, while men may experience urethral discharge and dysuria. Complications can include epididymitis, pelvic inflammatory disease, and infertility.

      Traditional cell culture is no longer widely used for diagnosis, with nuclear acid amplification tests (NAATs) being the preferred method. Testing can be done using urine, vulvovaginal swab, or cervical swab. Screening is recommended for sexually active individuals aged 15-24 years, and opportunistic testing is common.

      Doxycycline is the first-line treatment for Chlamydia, with azithromycin as an alternative if doxycycline is contraindicated or not tolerated. Pregnant women may be treated with azithromycin, erythromycin, or amoxicillin. Patients diagnosed with Chlamydia should be offered partner notification services, with all contacts since the onset of symptoms or within the last six months being notified and offered treatment.

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      • Infectious Diseases
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  • Question 23 - Which of the following vaccinations should be avoided in individuals who have HIV,...

    Incorrect

    • Which of the following vaccinations should be avoided in individuals who have HIV, and what is the reason for this recommendation?

      Your Answer:

      Correct Answer: BCG

      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.

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      • Infectious Diseases
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  • Question 24 - A 35-year-old woman presents with fatigue, fever, dry cough, headache, chest discomfort and...

    Incorrect

    • A 35-year-old woman presents with fatigue, fever, dry cough, headache, chest discomfort and worsening difficulty breathing. She works as a factory worker in a plant that produces air filters.
      Which of the following pathogens is the most probable cause of this illness?

      Your Answer:

      Correct Answer: Legionella species

      Explanation:

      Differentiating Between Possible Causes of Pneumonia

      Pneumonia can be caused by a variety of pathogens, making it important to identify the specific cause in order to provide appropriate treatment. Legionella pneumophila is a common cause of community-acquired and nosocomial pneumonia in adults, often transmitted through contaminated water sources. Chlamydophila psittaci can cause pneumonia after exposure to infected birds, while Staphylococcus aureus can cause various infections when skin or mucosal barriers are breached. Mycoplasma pneumoniae typically causes mild respiratory tract infections, while different groups of Streptococci can cause a range of infections including pneumonia. In this clinical scenario, the patient’s occupation and symptoms suggest an atypical infection, making Legionella pneumophila the most probable cause.

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      • Infectious Diseases
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  • Question 25 - You want to screen a 60-year-old patient for hepatitis B. What is the...

    Incorrect

    • You want to screen a 60-year-old patient for hepatitis B. What is the most appropriate test to conduct?

      Your Answer:

      Correct Answer: HBsAg

      Explanation:

      If the result of the anti-HBs test is positive, it means that the person is immune to hepatitis B either through vaccination or previous infection. On the other hand, a positive HBsAg test indicates that the person is currently infected with hepatitis B, either in its acute or chronic form.

      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.

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      • Infectious Diseases
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  • Question 26 - A 70-year-old man is admitted to the hospital with a 5-day history of...

    Incorrect

    • A 70-year-old man is admitted to the hospital with a 5-day history of severe diarrhoea accompanied by abdominal pain, fever, and fatigue. He has never experienced these symptoms before. In the past 3 months, the patient has undergone treatment for upper urinary tract infections with both co-amoxiclav and ciprofloxacin. He has no known allergies and does not take any regular medications. Blood tests reveal an elevated white cell count, and a stool sample confirms the presence of Clostridium difficile toxin. According to national guidelines, what is the most appropriate treatment for this patient?

      Your Answer:

      Correct Answer: A course of oral vancomycin

      Explanation:

      The recommended first-line antibiotic for patients with confirmed Clostridium difficile infection is oral vancomycin. This infection typically occurs in patients who have recently taken broad-spectrum antibiotics, such as co-amoxiclav and ciprofloxacin, which disrupt the gut flora. Discontinuing the implicated antibiotic and starting appropriate eradicative therapy is necessary. Oral fidaxomicin is an alternative but is less available. Metronidazole is no longer a first-line antibiotic due to lower cure rates than vancomycin, but it may be used if vancomycin is not available. IV vancomycin is ineffective as insufficient quantities are excreted into the gut lumen. Clindamycin is not a cure for Clostridium difficile but is associated with an increased risk of developing it. Conservative management is not recommended as the infection may worsen and lead to complications such as toxic megacolon.

      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.

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      • Infectious Diseases
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  • Question 27 - A 55-year-old rancher presents to the ER with his spouse. He is experiencing...

    Incorrect

    • A 55-year-old rancher presents to the ER with his spouse. He is experiencing a high fever and excessive sweating. During the examination, multiple black blisters are observed, which are producing a malodorous discharge. What is the typical microorganism linked to this ailment?

      Your Answer:

      Correct Answer: Clostridium perfringens

      Explanation:

      Gas gangrene is a severe bacterial infection that can lead to muscle necrosis, sepsis, gas production, and ultimately, death. The infection can occur in two ways: through traumatic or surgical inoculation of a wound with bacteria, or spontaneously, which is often observed in immunocompromised patients. While there are multiple causes of gas gangrene, clostridium perfringens, a type of clostridia species, is frequently implicated. The condition typically begins with pain and progresses to systemic symptoms such as fever and dehydration. Skin changes, including blisters that can burst and produce a foul-smelling discharge, are also common. Movement may produce a crackling sound known as crepitus.

      Clostridia: Gram-Positive Anaerobic Bacilli

      Clostridia are a group of gram-positive, obligate anaerobic bacilli. There are several species of Clostridia, each with their own unique features and pathologies. C. perfringens produces α-toxin, a lecithinase, which can cause gas gangrene and haemolysis. Symptoms of gas gangrene include tender, oedematous skin with haemorrhagic blebs and bullae, and crepitus may be present on palpation. C. botulinum is typically found in canned foods and honey and can cause flaccid paralysis by preventing the release of acetylcholine. C. difficile is known for causing pseudomembranous colitis, which is often seen after the use of broad-spectrum antibiotics. This species produces both an exotoxin and a cytotoxin. Finally, C. tetani produces an exotoxin called tetanospasmin, which prevents the release of glycine from Renshaw cells in the spinal cord, leading to spastic paralysis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 28 - A child is admitted for assessment on the Infectious Diseases Ward and is...

    Incorrect

    • A child is admitted for assessment on the Infectious Diseases Ward and is identified to have a notifiable disease. The nurses suggest that you should inform the Consultant in Communicable Disease Control (CCDC).
      Which of the following is the most likely diagnosis (recognised as a notifiable disease)?

      Your Answer:

      Correct Answer: Malaria

      Explanation:

      Notifiable Diseases in England

      In England, Public Health England is responsible for detecting possible outbreaks of disease and epidemics as quickly as possible. The accuracy of diagnosis is not the primary concern, and since 1968, clinical suspicion of a notifiable infection is all that is required. Malaria, caused by various species of Plasmodium, is a notifiable disease. However, Mycoplasma pneumonia, HIV, necrotising fasciitis, and acute rheumatic fever are not notifiable diseases in England.

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      • Infectious Diseases
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  • Question 29 - 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:

      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.

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      • Infectious Diseases
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  • Question 30 - A 6-year-old girl is brought to her general practitioner by her mother, with...

    Incorrect

    • A 6-year-old girl is brought to her general practitioner by her mother, with a 3-day history of fever up to 37.8 °C. She had no history of lesions on the buccal mucosa but developed a maculopapular rash across the face and trunk. A few days before the appearance of the rash, she complained of some eye pain, sore throat and general body aches. On physical examination, she has a discrete rose-pink maculopapular rash on the face, neck and trunk, low-grade fever and enlarged posterior auricular and suboccipital lymph nodes.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Rubella

      Explanation:

      Distinguishing Between Viral Diseases: Rubella, Mumps, Meningitis, Scarlet Fever, and Erythema Infectiosum

      Rubella, also known as German measles, is a typically mild viral disease that often goes unnoticed, with almost half of those infected showing no symptoms. However, it can have severe consequences for pregnant women, especially in the early stages of pregnancy. Symptoms include eye pain, sore throat, low-grade fever, and a rose-pink rash that starts on the face and spreads to the trunk and extremities within 24 hours.

      Mumps is another viral disease caused by rubulavirus. It typically presents with low-grade fever, malaise, headache, and myalgia, followed by painful swelling of the salivary glands and tender cervical lymphadenopathy. Mumps is highly contagious and has become less common in developing countries due to vaccination.

      Meningitis is a serious condition characterized by inflammation of the meninges. Symptoms include fever, headache, and neck stiffness, and it requires urgent medical attention.

      Scarlet fever is caused by group A β-hemolytic streptococci and presents with exudative pharyngitis, fever, and a bright red rash. It typically evolves from a tonsillar/pharyngeal focus and is uncommon without buccal lesions.

      Erythema infectiosum, also known as fifth disease, is a mild childhood illness caused by parvovirus B19. It presents with a bright red rash on the cheeks and may have atypical rashes in adults.

      It is important to distinguish between these viral diseases to ensure proper treatment and prevent complications.

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      • Infectious Diseases
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