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  • Question 1 - A 35-year-old female patient complains of painful genital ulcers, accompanied by feelings of...

    Correct

    • A 35-year-old female patient complains of painful genital ulcers, accompanied by feelings of being unwell, feverish, headache, and muscle pains. She had engaged in unprotected sexual activity with a casual male partner two weeks prior to the onset of symptoms. Upon examination, multiple shallow ulcers are observed on her vulva, along with mildly tender muscles and a low-grade fever. What is the most probable diagnosis?

      Your Answer: Herpes simplex virus

      Explanation:

      Causes of Genital Ulcers

      Chancroid, a sexually transmitted infection, is characterized by multiple painful ulcers that appear within three to ten days after exposure to the bacteria. This infection is more common in tropical regions. On the other hand, genital infection with herpes simplex virus (HSV) typically presents with multiple painful ulcers one to two weeks after exposure to the virus. HSV is the most common cause of multiple painful genital ulcers and can also cause a systemic illness. Herpes zoster, another viral infection, can also cause multiple painful genital ulcers, but this is much less common than HSV. Lymphogranuloma venereum (LGV) usually causes a single, painless ulcer and is associated with unilateral inguinal lymphadenopathy. Finally, primary syphilis causes a single, painless ulcer, while secondary syphilis causes multiple painless ulcers. the different causes of genital ulcers is important for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - A 77-year-old man who resides in a nursing home has been treated with...

    Incorrect

    • A 77-year-old man who resides in a nursing home has been treated with co-amoxiclav for a chest infection. After completing the antibiotic course, he experiences abdominal pain, watery diarrhoea, and a temperature of 39.2°C. All other residents in the home are healthy. A stool sample is sent for testing as pseudomembranous colitis is suspected. What is the probable organism responsible for this condition?

      Your Answer: Escherichia coli

      Correct Answer: Clostridium difficile

      Explanation:

      Common Causes of Gastrointestinal Infections

      Gastrointestinal infections can be caused by a variety of bacteria and viruses. Among the most common are Clostridium difficile, Salmonella spp., Norovirus, Escherichia coli, and Campylobacter spp.

      Clostridium difficile is a spore-forming bacterium that causes pseudomembranous colitis, a form of colitis associated with antibiotic treatment. It produces toxins that damage the mucosal lining of the bowel, leading to diarrhea. Risk factors for developing C. difficile-associated diarrhea include age, antibiotic treatment, exposure to infected persons, and hospitalization.

      Salmonella spp. are associated with infections of the gastrointestinal tract and diarrhea. Infection is mostly associated with eating undercooked meat, poultry, eggs, or egg products.

      Norovirus is the most common viral gastroenteritis in the UK and spreads quickly within a contaminated environment. It is often seen in hospital wards and care homes.

      Escherichia coli is associated with infections of the gastrointestinal tract and can cause severe diarrhea. It is most commonly associated with ingestion of contaminated water, unpasteurized milk or cheese, and undercooked beef.

      Campylobacter spp. are a common cause of gastroenteritis, mostly associated with ingestion of contaminated food in the form of raw poultry and unpasteurized milk products.

      It is important to identify the causative organism early and treat it according to local treatment guidelines to prevent complications such as toxic megacolon, bowel perforation, septicemia, and death. All confirmed cases of gastrointestinal infections must be reported to Public Health.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 19-year-old female has suffered a minor cut on her right hand while...

    Incorrect

    • A 19-year-old female has suffered a minor cut on her right hand while gardening. She has received all necessary immunisations. What is the most appropriate course of action for tetanus prevention?

      Your Answer: I.M 0.5 ml tetanus toxoid should be administered as single dose

      Correct Answer: No action is required

      Explanation:

      Tetanus Toxoid Immunisation Schedule

      Active immunisation with tetanus toxoid is a routine vaccination given to infants at 2, 3, and 4 months of age as part of the DPT vaccine. A fourth dose is administered after three years, and a fifth dose is given before leaving school. Once a patient has received all five injections at the appropriate intervals, further toxoid is generally not required due to the risk of side effects and decreased immunity caused by overstimulation. Therefore, this man is considered fully immunised against tetanus.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 4-year-old child is brought to the General Practice by his mother. She...

    Incorrect

    • A 4-year-old child is brought to the General Practice by his mother. She informs you that her son has had a fever and has not been as active during play sessions. She decided to bring him into the surgery when he erupted in a rash two days ago. On examination, he has a vesicular rash which is widely disseminated and intensely pruritic. He has a temperature of 38 °C. You diagnose him with a common childhood infection. The next day, a patient, who is 14 weeks’ pregnant, reports that she briefly baby sat for the child before she knew about his infection. She has no recollection of having the infection as a child and she is well in herself.
      Given that the patient has been exposed to the infected child, what is the next best step in her management?

      Your Answer: Watch and wait

      Correct Answer: Check for varicella antibodies

      Explanation:

      Management of Varicella in Pregnancy

      Explanation:
      When a pregnant woman presents with a vesicular pruritic rash, it is important to consider the possibility of varicella zoster virus infection. Varicella is a teratogenic virus that can harm the fetus, so prompt management is necessary. The first step is to check the woman’s immune status by testing for varicella antibodies. If the results are not available within two working days, referral to secondary services for prophylaxis should be considered. Watching and waiting is not appropriate in this situation. Administering a varicella zoster vaccine is not recommended due to the theoretical risk to the fetus. Immunoglobulins for rubella are not indicated. acyclovir may be used for symptomatic patients, but informed consent is required as the evidence for its safety in pregnancy is not strong. Overall, prompt and appropriate management is crucial in protecting the health of both the mother and the fetus.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 35-year-old woman presents to her GP in Manchester with a week long...

    Incorrect

    • A 35-year-old woman presents to her GP in Manchester with a week long history of an offensive smelling greenish-yellow vaginal discharge with associated vulval itching. She does not complain of lower abdominal pain. She is unkempt and admits to sleeping on the streets. She refuses your request that she should be seen at the local GUM clinic. Examination reveals a greenish-yellow discharge but is otherwise unremarkable. For which of the options provided should the patient be treated?

      Your Answer: Bacterial vaginosis

      Correct Answer: All of the above

      Explanation:

      Syndromic Management for Vaginal Discharge

      When laboratory support is not available, the World Health Organisation recommends syndromic management based on signs and symptoms alone. This means that all possible conditions should be treated, as vaginal discharge is not a reliable indicator of the presence of a sexually transmitted infection (STI).

      Trichomoniasis is the most common non-viral STI worldwide and is more prevalent in less advantaged women in affluent countries. However, the possibility of Chlamydia trachomatis and gonorrhoeae depends on a risk assessment based on local factors.

      In summary, when laboratory support is not available, syndromic management should be used for vaginal discharge.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - Which drugs are classified as protease inhibitors? ...

    Incorrect

    • Which drugs are classified as protease inhibitors?

      Your Answer: Ritonavir and Telaprevir

      Correct Answer: Darunavir, Ritonavir, and Telaprevir

      Explanation:

      Protease Inhibitors: A Breakthrough in HIV and Hepatitis C Treatment

      Protease inhibitors are a class of drugs that block the activity of the viral enzyme called protease, which is essential for the maturation of the virus. Initially used for the treatment of HIV, protease inhibitors are now also used for the treatment of hepatitis C infections. Telaprevir is a protease inhibitor specifically designed for hepatitis C virus.

      Abacavir and rilpivirine are two other drugs used for HIV treatment. Abacavir is a nucleoside reverse transcriptase inhibitor (NRTI), while rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). Protease inhibitors are often used as second-line therapy for HIV treatment, with ritonavir commonly used as a booster with other protease inhibitors.

      For hepatitis C treatment, protease inhibitors such as telaprevir, boceprevir, simeprevir, and danoprevir are used in combination with interferon and ribavirin. These drugs inhibit NS3/4A protease, which is a promising development in hepatitis C management. They are said to decrease the treatment duration, but their high cost is a major limiting factor for their use.

      In conclusion, protease inhibitors have revolutionized the treatment of HIV and hepatitis C infections. While they are not without limitations, they offer hope for patients with these chronic viral diseases.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 7 - What is the most frequently occurring infectious agent linked to acute pyelonephritis? ...

    Correct

    • What is the most frequently occurring infectious agent linked to acute pyelonephritis?

      Your Answer: Escherichia coli

      Explanation:

      Common Pathogens in Acute Pyelonephritis

      Acute pyelonephritis is commonly caused by Escherichia coli, which accounts for more than 80% of cases. Other pathogens that can cause this condition include Enterococcus faecalis, Klebsiella, and Proteus species. The infection typically begins in the bladder and then spreads to the renal parenchyma. At first, the bacteria multiply within the tubules. However, within 48 hours, damage to the tubular epithelium begins to occur.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - A 75-year-old woman complains of an itchy rash on her hands, anterior aspects...

    Incorrect

    • A 75-year-old woman complains of an itchy rash on her hands, anterior aspects of both elbows, axillae and groins. Several other residents in her nursing home have reported similar symptoms.

      What could be the possible diagnosis?

      Your Answer:

      Correct Answer: Scabies

      Explanation:

      Skin Conditions and Their Characteristics

      Scabies is a skin infestation caused by the mite Sarcoptes scabiei. The mite burrows into the skin, resulting in a rash that is itchy and typically affects the skin folds and interdigital webs of the arms and legs. The itch may persist for a few weeks even after successful treatment. The condition is spread through skin contact and sharing of clothes and bedding. Treatment involves the use of permethrin-containing lotions.

      Henoch-Schönlein purpura is a type of vasculitis that affects the blood vessels in the skin. Psoriasis is characterized by plaques on the extensor surfaces of the body, which are topped with thick, silvery scales. Pemphigus vulgaris may present as crusted, weeping, diffuse lesions in elderly patients. If the blisters are intact, bullous pemphigoid or cicatricial pemphigoid may be considered. Look for involvement in other sites, as erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid is associated with new medication and involves the flexural areas of the body.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 50-year-old man has been diagnosed with pulmonary tuberculosis.

    Which investigation is crucial...

    Incorrect

    • A 50-year-old man has been diagnosed with pulmonary tuberculosis.

      Which investigation is crucial before initiating antituberculous treatment?

      Your Answer:

      Correct Answer: Liver function test

      Explanation:

      Hepatotoxicity in Antituberculous Treatment

      Hepatotoxicity, or liver damage, is a common occurrence in antituberculous treatment. To prevent further complications, the Joint Tuberculosis Committee of the British Thoracic Society recommends that liver function should be checked before starting treatment for clinical cases. This is to ensure that the liver is healthy enough to handle the medication and to monitor any changes in liver function during treatment. By doing so, healthcare professionals can adjust the treatment plan accordingly and prevent further liver damage. It is important to prioritize liver function monitoring in antituberculous treatment to ensure the safety and well-being of patients.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - What is a true statement about Koplik's spots? ...

    Incorrect

    • What is a true statement about Koplik's spots?

      Your Answer:

      Correct Answer: Diagnostic of measles

      Explanation:

      Koplik’s Spots: A Diagnostic Sign of Measles

      Koplik’s spots are a distinctive sign of measles, characterized by small, irregular, bright red spots with blue-white centers. These spots are typically found on the inside of the cheek next to the premolars and are only seen in cases of measles, making them a diagnostic indicator of the disease.

      Koplik’s spots usually appear briefly after the onset of fever and a few days before the generalized rash associated with measles appears. In some cases, the spots may disappear as the rash develops. These spots typically start to appear around two days after initial infection.

      Overall, the presence of Koplik’s spots is an important diagnostic sign of measles and can help healthcare professionals identify and treat the disease more effectively.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - What is the accurate information about primary pulmonary tuberculosis? ...

    Incorrect

    • What is the accurate information about primary pulmonary tuberculosis?

      Your Answer:

      Correct Answer: May be totally asymptomatic

      Explanation:

      When you see the CD symbol on a prescription, it means that the medication is a controlled drug. This indicates that the substance must be requested by a qualified practitioner and signed and dated. The prescription must also include the prescriber’s address. Additionally, the prescriber must write the patient’s name and address, the preparation, and the dose in both figures and words. If the prescription is written by a dentist, it should state for dental use only. Controlled drugs include opiates and other substances that require careful monitoring and regulation. By the CD symbol and the requirements for prescribing controlled drugs, patients can ensure that they receive safe and effective treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - A 4-year-old girl is brought to the general practitioner (GP) by her parents....

    Incorrect

    • A 4-year-old girl is brought to the general practitioner (GP) by her parents. She has been experiencing a dry cough with coryzal symptoms. On examination, there is evidence of conjunctivitis and an erythematosus rash on her forehead and neck which is confluent. Oral examination reveals red spots with a white centre on the buccal mucosa, adjacent to the lower second molar tooth. She is currently apyrexial, though her parents state she has been feverish over the past two days. Her heart rate is 80 bpm. No one else in her family is unwell, though her sister did have chickenpox earlier in the month.
      What is the most likely cause for this presentation?

      Your Answer:

      Correct Answer: Measles

      Explanation:

      Distinguishing Between Measles and Other Viral Infections

      Measles, a highly contagious viral infection, is often mistaken for other viral illnesses such as rubella, Kawasaki disease, mumps, and parvovirus B19. However, there are distinct differences in their clinical presentations. Measles is characterized by cough, coryza, and conjunctivitis, along with the presence of Koplik spots on the buccal mucosa. Rubella, on the other hand, presents with low-grade fever, conjunctivitis, and an erythematosus rash, but without Koplik spots. Kawasaki disease is an idiopathic vasculitis that affects young children and is associated with fever, inflammation of the mouth and lips, and cervical lymphadenopathy. Mumps, caused by a paramyxovirus, typically affects the salivary glands and is not associated with a rash. Parvovirus B19, also known as fifth disease, causes an erythematosus rash on the cheeks and can also cause a morbilliform rash, but without Koplik spots. Therefore, recognizing the presence of Koplik spots is crucial in distinguishing measles from other viral infections.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A 35-year-old woman who is negative for HBV surface antigens is considering having...

    Incorrect

    • A 35-year-old woman who is negative for HBV surface antigens is considering having unprotected sexual intercourse with a man who is positive for HBV.

      What should she do in this situation?

      Your Answer:

      Correct Answer: Vaccine

      Explanation:

      Hepatitis B Vaccine in the UK

      Although the risk of hepatitis B is low in the UK, certain individuals are considered to be at high risk and are offered the vaccine. These high-risk groups include individuals who inject drugs or have a partner who injects drugs, those who receive regular blood transfusions, people with chronic liver disease, close family or sexual partners of someone with hepatitis B, and individuals traveling to high-risk countries.

      In the case of a patient whose partner has tested positive for the surface antigen (HBsAg), indicating that they are infected with hepatitis B, the patient may not require post-exposure treatment if they plan on having regular unprotected sexual intercourse. In this situation, the best course of action would be to receive the hepatitis B vaccine alone. It is important for individuals in high-risk groups to consider getting vaccinated to protect themselves against this potentially serious infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A 25-year-old sexually active man comes to the clinic complaining of a rash...

    Incorrect

    • A 25-year-old sexually active man comes to the clinic complaining of a rash that has been present all over his body for the past two weeks. He also reports having a painless sore on his penis a few weeks prior to the onset of the rash. Upon examination, a maculopapular rash is observed on his entire body, including the palms of his hands and soles of his feet. However, his penis appears normal. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Secondary syphilis

      Explanation:

      Syphilis and its Symptoms

      Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease is transmitted through intimate contact with an infected person. The primary symptom of syphilis is a painless ulcer called a chancre, which may not be reported by the patient. The secondary stage of syphilis is characterized by a maculopapular rash that affects the entire body, including the palms and soles. This rash is known as keratoderma blennorrhagica.

      It is important to note that HIV seroconversion illness may also present with a rash, but it typically does not affect the palms and soles. Additionally, constitutional symptoms such as fever and malaise are common with HIV seroconversion illness. None of the other conditions typically present with a rash.

      Treatment for secondary syphilis involves the use of long-acting penicillin.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - A 25-year-old graduate is referred to the renal clinic by the local health...

    Incorrect

    • A 25-year-old graduate is referred to the renal clinic by the local health center. She has poorly controlled hypertension despite taking 10 mg of ramipril and 5 mg of amlodipine. Her medical history reveals recurrent urinary tract infections during childhood and recent use of ibuprofen for a knee injury. On examination, her blood pressure is 178/95 mmHg, pulse is regular at 74 bpm, and BMI is 22 kg/m2. Her creatinine level is elevated at 178 μmol/L. What is the most likely reason for her presentation?

      Your Answer:

      Correct Answer: Chronic reflux nephropathy

      Explanation:

      Reflux Nephropathy and its Management

      Recurrent urinary tract infections during childhood are most likely caused by reflux nephropathy, which can lead to renal scarring, resistant hypertension, and chronic renal failure over time. Early intervention is crucial, including investigation in childhood, antibiotics, and referral to a urologist to identify and correct any anatomical abnormalities. Chronic interstitial nephritis caused by analgesic use is unlikely in this case, as the patient’s knee injury was likely acute. IgA nephropathy typically presents after respiratory tract infections, while post-streptococcal glomerulonephritis occurs 10-14 days after streptococcal pharyngitis. Essential hypertension is diagnosed based on the absence of an underlying cause. Proper management of reflux nephropathy can prevent long-term complications and improve the patient’s quality of life.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - A 42-year-old man, known to have human immunodeficiency virus (HIV), attends his regular...

    Incorrect

    • A 42-year-old man, known to have human immunodeficiency virus (HIV), attends his regular clinic appointment. He has missed an earlier appointment and is poorly compliant with his antiretroviral therapy, which he puts down to his busy work schedule. He has recently noticed blotches on his nose. His partner reports that the patient also has similar lesions on his back.
      On examination, you note several red-purple papules across the patient’s back and face.
      Which of the following viruses may have caused these lesions?

      Your Answer:

      Correct Answer: Human herpesvirus 8

      Explanation:

      The patient has Kaposi’s sarcoma, which is caused by human herpesvirus 8. This condition can be the first presentation of AIDS in some HIV patients and is more common in males and men who have sex with men. The skin lesions appear as red-purple papules or plaques and can also be found on mucous membranes. Kaposi’s sarcoma mainly affects the skin, but it can also affect the lungs and gastrointestinal tract. Symptoms of pulmonary Kaposi’s sarcoma include cough, shortness of breath, and haemoptysis, while gastrointestinal involvement can cause intestinal obstruction.

      CMV infection can occur as reactivation or primary infection, usually in those with low CD4+ counts. In the immunocompromised, it can present with chorioretinitis, encephalitis, pneumonitis, or gastrointestinal disease. HPV is a common virus that causes genital warts, verrucas, and warts on the lips/oral mucosa. It is also a major risk factor for cervical and anal cancers. In immunosuppressed patients, the severity of HPV symptoms and risk of cancer are increased. HSV 1 and 2 are common viruses that can cause oral and genital herpes. In immunosuppression, these viruses may reactivate more frequently and cause more severe symptoms. Cryptococcus neoformans is a fungus that can cause opportunistic infections in AIDS, mostly causing fungal pneumonia and subacute meningitis, but it does not typically cause skin lesions.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 17 - A healthcare assistant in her mid-30s presents to her general practitioner (GP) for...

    Incorrect

    • A healthcare assistant in her mid-30s presents to her general practitioner (GP) for a routine check-up. She reports a needlestick injury at work that occurred over a month ago, but she did not report it to occupational health as she believed the patient was low risk. She is now concerned about her infection status. The GP orders viral serology tests, which reveal the following results:
      HIV PCR: Negative
      Hepatitis C antibody: Negative
      Hepatitis B surface antigen (HBsAg): Negative
      Immunoglobulin M (IgM) anti-hepatitis B core (HBc) antigen: Negative
      Anti-HBc (hepatitis B core antigen): Negative
      Anti-HBs (hepatitis B surface antibody): Positive
      Based on these results, what is the healthcare assistant's hepatitis status?

      Your Answer:

      Correct Answer: Vaccinated against infection

      Explanation:

      Understanding Hepatitis B Serology Results

      Hepatitis B is a viral infection that can cause liver damage and even liver cancer. Vaccination is the best way to prevent infection, but it’s important to understand the results of hepatitis B serology tests to determine if someone is immune, currently infected, or susceptible to infection.

      Vaccinated against infection: This result indicates that the patient has previously been vaccinated with hepatitis B and is now immune to infection.

      Current chronic infection: A positive HBsAg, anti-HBc, and positive IgG anti-HBc result would indicate a current chronic infection. However, the picture shown represents a vaccinated individual.

      Current acute infection: A positive HBsAg, anti-HBc, and IgM anti-HBc result would indicate a current acute infection. However, the picture shown represents a vaccinated individual.

      Resolved infection: A positive anti-HBs and anti-HBc result, in addition to a negative HBsAg result, would indicate a resolved infection.

      Susceptible to infection: A completely negative serology result would indicate that the patient is susceptible to infection and should consider vaccination.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - A 32-year-old woman is diagnosed with advanced HIV disease. What is involved in...

    Incorrect

    • A 32-year-old woman is diagnosed with advanced HIV disease. What is involved in strategic planning with antiretroviral medications?

      Your Answer:

      Correct Answer: HIV patients should be started with ART at any CD4 count

      Explanation:

      Myth-busting HIV Treatment Guidelines

      Debunking Common Misconceptions about HIV Treatment Guidelines

      There are several misconceptions about HIV treatment guidelines that need to be addressed. Firstly, it is not necessary to wait until a patient’s CD4 count drops below 350 cells/ml before starting antiretroviral therapy (ART). Both the World Health Organization (WHO) and the British HIV Association (BHIVA) recommend starting treatment at any CD4 count.

      Secondly, intravenous didanosine should not be used for the treatment of pregnant women. The WHO has warned against the use of didanosine and stavudine in pregnant women due to an increased risk of lactic acidosis. Women who are already taking ART and/or PCP prophylaxis before pregnancy should not discontinue their medication. If starting ART during pregnancy, potent combinations of three or more antiretroviral drugs are recommended, but this should be delayed until after the first trimester if possible.

      Thirdly, HIV treatment does not involve three nucleoside analogues. Instead, treatment involves a combination of three drugs, which includes two nucleotide reverse transcriptase inhibitors (NRTIs) and one ritonavir-boosted protease inhibitor (PI/r), one non-nucleoside reverse transcriptase inhibitor (NNRTI), or one integrase inhibitor (INI).

      Lastly, the use of zidovudine in post-exposure prophylaxis (PEP) for needlestick injuries in healthcare workers does not completely remove the risk of seroconversion. While this treatment option has been shown to reduce the risk, it does not eliminate it entirely.

      In conclusion, it is important to stay up-to-date with current HIV treatment guidelines and to dispel any misconceptions that may exist. Starting ART at any CD4 count, avoiding certain medications during pregnancy, using a combination of three drugs, and understanding the limitations of PEP are all crucial components of effective HIV treatment.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - A 30-year-old woman, who is 20 weeks’ pregnant, presents to the Emergency Department...

    Incorrect

    • A 30-year-old woman, who is 20 weeks’ pregnant, presents to the Emergency Department with concerns about her exposure to chickenpox. She recently spent time with her niece who was diagnosed with the virus. The patient is worried about the potential impact on her pregnancy and reports having had chickenpox as a child. Upon examination, there is no rash present. What is the best course of action to address the patient’s concerns?

      Your Answer:

      Correct Answer: Check varicella zoster immunoglobulin G (IgG) antibodies

      Explanation:

      Managing Chickenpox in Pregnancy: Testing and Treatment Options

      Chickenpox, caused by the varicella zoster virus, can pose a risk to pregnant women and their unborn babies. If a patient is unsure whether they have had chickenpox in the past, it is important to test for immunity before deciding on a course of action. This is done by checking varicella zoster IgG levels. If a patient has confirmed lack of immunity and is exposed to chickenpox, they may be offered varicella zoster immunoglobulin as prophylaxis. High-risk patients with confirmed chickenpox may require IV acyclovir treatment, while oral acyclovir is reserved for certain patients. Reassurance alone is not appropriate in this situation. It is important to take steps to manage chickenpox in pregnancy to ensure the health and safety of both the mother and the baby.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A tool known as PrePex™ has been sanctioned by various organizations to reduce...

    Incorrect

    • A tool known as PrePex™ has been sanctioned by various organizations to reduce the spread of HIV. What is the purpose of this device?

      Your Answer:

      Correct Answer: Painless circumcision

      Explanation:

      PrePex Device Offers Painless Male Circumcision for HIV Prevention

      The PrePex device is a new method of male circumcision that is painless, sutureless, and does not require anaesthesia. It has been approved in countries such as Rwanda and is currently only available in sub-Saharan Africa. The World Health Organization (WHO) has found scientific evidence that male circumcision can significantly reduce the risk of HIV transmission. As a result, WHO is promoting this strategy in sub-Saharan Africa, where there has been a significant increase in the number of circumcision operations. However, it is important to note that circumcision should be used in conjunction with other measures, such as condom use, to reduce the incidence of HIV infection. The PrePex device is not designed for any other purposes.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - A 3-year-old patient arrives at the Emergency department complaining of left loin pain,...

    Incorrect

    • A 3-year-old patient arrives at the Emergency department complaining of left loin pain, offensive smelling urine, and fever. The child's temperature is 38.5°C and a clean catch urine test shows positive results for blood, protein, and nitrites. What is the recommended initial antibiotic treatment for this patient?

      Your Answer:

      Correct Answer: Co-amoxiclav

      Explanation:

      Antibiotic Recommendations for Urinary Tract Infection in Children

      When it comes to treating urinary tract infections in children, it is important to choose an antibiotic that has a low potential for resistance. According to the NICE guidelines on Urinary tract infection in children (CG54), cephalosporin or co-amoxiclav are recommended options. On the other hand, quinolones and tetracyclines are not recommended for this age group. While amoxicillin and trimethoprim are potential options, they also carry the risk of resistance. Therefore, it is crucial to carefully consider the choice of antibiotic to ensure effective treatment and prevent the development of antibiotic resistance.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 22 - A 30-year-old pregnant woman comes to the clinic with a new fever and...

    Incorrect

    • A 30-year-old pregnant woman comes to the clinic with a new fever and a pruritic rash on her trunk and limbs. The rash is mainly macular and has a reticular pattern. She also reports experiencing pain in her knees, elbows, and wrists, with slight swelling in her left wrist. What is the probable infectious agent responsible for her symptoms?

      Your Answer:

      Correct Answer: Parvovirus B19

      Explanation:

      Differential Diagnosis of a Morbilliform Rash: Parvovirus B19

      A patient presents with a generalised, macular rash with a lacy appearance on the trunk and extremities, along with arthralgia and arthritis. The differential diagnosis for a morbilliform rash includes infections such as measles virus, rubella, parvovirus B19, human herpesvirus 6, enterovirus, and other non-specific viruses. However, the lacy appearance of the rash and the presence of arthralgia and arthritis suggest a parvovirus B19 infection. In children, this infection presents with slapped cheek erythema, while in adults, it presents with a lacy erythematous rash and rheumatoid arthritis-like arthropathy. Diagnosis is made through positive anti-B19 IgM serology or positive serum B19 DNA polymerase chain reaction. Other infections, such as rubella, may also cause a morbilliform rash with arthropathy, but they do not typically have a lacy appearance. Human herpesvirus 6 does not cause arthropathy or a lacy rash, while staphylococcal toxins cause a sunburn-like or exfoliative rash. Measles is associated with a prodrome of conjunctivitis, coryza, and cough, but not arthritis, and the rash is not reticular in appearance. Therefore, parvovirus B19 should be considered in the differential diagnosis of a morbilliform rash with arthralgia and arthritis.

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      • Infectious Diseases
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  • Question 23 - A 34-year-old male presents to the Emergency department with sudden onset pain in...

    Incorrect

    • A 34-year-old male presents to the Emergency department with sudden onset pain in his left calf and inability to bear weight while cycling. He reports having cystic fibrosis, but it does not hinder his active lifestyle of going to the gym three times a week. The patient was hospitalized nine months ago for a chest infection, which was treated, but he still has residual Pseudomonas colonization that is managed with prophylactic azithromycin and ciprofloxacin. He also takes regular insulin and Creon for pancreatic insufficiency and supplements with Calcichew D3 and alendronic acid. Upon examination and radiography of his left leg, there is no evidence of a bone injury, but there is a palpable gap in the gastrocnemius muscle tendon. Which medication is likely contributing to this pathology?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:
      • Ciprofloxacin is a well-tolerated antibiotic with broad action, but it can reduce intestinal flora and increase the risk of tendon rupture.
      • Azithromycin is a macrolide antibiotic used for respiratory conditions, with potential drug interactions.
      • Alendronic acid is a bisphosphonate used for bone protection, but can cause gastrointestinal side effects and musculoskeletal symptoms.
      • Calcium supplements are not directly linked to tendon damage, but may contribute to calcific tendonitis.
      • Creon is a pancreatic enzyme preparation used for cystic fibrosis patients, without known musculoskeletal side effects.

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      • Infectious Diseases
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  • Question 24 - A 50-year-old man who engages in sexual activity with other men comes to...

    Incorrect

    • A 50-year-old man who engages in sexual activity with other men comes to the clinic complaining of fatigue, pain in the upper right quadrant of his abdomen, and yellowing of his eyes. He has had several casual sexual partners in the past few months and confesses to not consistently using protection. He has not traveled abroad recently. During the physical examination, he displays jaundice, tenderness in the upper right quadrant, and a palpable liver edge. What is the most probable infection he has contracted?

      Your Answer:

      Correct Answer: Hepatitis B

      Explanation:

      Likely Diagnosis of Hepatitis in a Male Patient

      Although hepatitis can be caused by cytomegalovirus (CMV) and Epstein-Barr virus (EBV), it is unlikely that these viruses are the cause of hepatitis in a male patient over the age of 55. However, hepatitis A is a possible diagnosis, especially in men who have sex with men, despite no history of overseas travel. While hepatitis C can also be spread sexually, its prevalence among men who have sex with men is lower than that of hepatitis B. Additionally, hepatitis B is more easily transmitted through sexual contact, making it the more likely diagnosis in this case. It is important to note that there is a 5-10% chance that the patient may become a chronic carrier.

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      • Infectious Diseases
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  • Question 25 - A 20-year-old male patient comes to you with a fever and rash one...

    Incorrect

    • A 20-year-old male patient comes to you with a fever and rash one week after returning from a trip to Puerto Rico. He reports that his fever began five days ago and was followed by the appearance of a rash. Additionally, he has noticed bleeding gums while brushing his teeth and has experienced two nosebleeds since returning from his vacation. During the examination, you observe multiple mosquito bites on his legs. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Dengue fever

      Explanation:

      Dengue Fever

      Dengue fever is a viral infection that is transmitted through the bite of an infected Aedes mosquito. It is prevalent in tropical countries, with an estimated 100 million people being infected annually. The symptoms of dengue fever include fever, headache, muscle pain, nausea, vomiting, skin rash, and mild bleeding. However, it cannot be spread from person to person.

      The high-risk areas for dengue fever include the Indian subcontinent, Southeast Asia, Southern China, Taiwan, Pacific Islands, Caribbean, Mexico, Africa, and Central and South America. Diagnosis is made through a blood test to identify the virus, and treatment is supportive with symptom control. Unfortunately, there are currently no vaccines available to prevent dengue fever.

      The best way to prevent infection is to avoid mosquito bites. This can be done by wearing protective clothing, using mosquito repellent, and staying in air-conditioned or screened areas. the symptoms and risk factors of dengue fever can help individuals take necessary precautions to protect themselves from this potentially serious illness.

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      • Infectious Diseases
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  • Question 26 - For which disease is isolation of the patient necessary? ...

    Incorrect

    • For which disease is isolation of the patient necessary?

      Your Answer:

      Correct Answer: Measles

      Explanation:

      Infectious Diseases and Their Modes of Transmission

      Children who have chicken pox and measles should be kept away from others as there is a high chance of spreading the infection to others. This is because these diseases are highly contagious and can easily spread from one person to another. It is important to isolate these children to prevent the spread of the disease.

      Post streptococcal GN and rheumatic fever are caused by immune complexes that develop after an initial infection. These diseases are not contagious and cannot be spread from one person to another. However, it is important to treat the initial infection to prevent the development of these diseases.

      Herpetic gingivostomatitis is a disease that is spread through direct contact with infected secretions. This means that the disease can be transmitted when infected secretions come into contact with the skin of an uninfected person. There is no risk of aerosol spread, which means that the disease cannot be spread through the air.

      HSP is a disease that is not infectious and cannot be spread from one person to another. This disease is caused by an abnormal immune response and is not contagious.

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      • Infectious Diseases
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  • Question 27 - A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She...

    Incorrect

    • A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She had been feeling well until three days ago when she started experiencing abdominal discomfort and frequent bowel movements. Her vital signs are stable with a blood pressure of 105/70 mmHg, pulse rate of 90 bpm, respiratory rate of 14 breaths/min, and body temperature of 38.1 °C. She is alert and oriented. Mild abdominal tenderness is present, particularly in the right lower quadrant, without rigidity or guarding. A tender mass is palpable in the right lower quadrant. The anterior lower leg has multiple erythematous and tender patches. A stool sample is sent for examination of red cells, leukocytes, bacteria, ova and parasites, and culture.

      Which of the following microorganisms is most likely responsible for this condition?

      Your Answer:

      Correct Answer: Yersinia enterocolitica

      Explanation:

      Bacterial Causes of Gastroenteritis: Yersinia, Vibrio, E. coli, Campylobacter, and Salmonella

      Gastroenteritis is a common condition caused by various bacterial pathogens. Yersinia enterocolitica is one such pathogen that can cause invasive gastroenteritis, leading to mesenteric lymphadenitis and erythema nodosum. Vibrio vulnificus is another Gram-negative bacterium that causes gastroenteritis and skin blisters after consuming contaminated oysters, with chronic liver disease patients at higher risk. Escherichia coli has several pathogenic strains, including enterotoxigenic, enteropathogenic, enteroinvasive, and enterohaemorrhagic, each causing different types of gastroenteritis. Campylobacter is the most common cause of bacterial gastroenteritis worldwide, with invasive symptoms and often bloody stool. Salmonella, a non-lactose fermenter, can also cause gastroenteritis and diarrhea, usually non-bloody. Understanding the different bacterial causes of gastroenteritis is crucial for proper diagnosis and treatment.

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      • Infectious Diseases
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  • Question 28 - A 25-year-old woman presents with a nine-week history of fever. She has been...

    Incorrect

    • A 25-year-old woman presents with a nine-week history of fever. She has been experiencing daily temperatures up to 40°C, malaise, and occasional aches in the hands and knees. She also noticed a transient pink rash on her abdomen. Her GP prescribed a one-week course of ampicillin, but it had little effect. On examination, she has a temperature of 38.9°C, a pulse of 110 per minute, and a faint systolic ejection murmur. Her spleen is palpable 3 cm below the left costal margin. Her haemoglobin level is 115 g/L, and her white cell count is 12.8 ×109/L. Her ASO titre is 250 units, and her rheumatoid factor and ANF are negative. Blood cultures have been requested but are not yet available. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Adult onset Still's disease

      Explanation:

      Adult Onset Still’s Disease

      Adult onset Still’s disease is a type of inflammatory disorder that affects young adults. Its exact cause and development are still unknown, but it is characterized by various symptoms such as fever, rash, joint pain, and organ enlargement. The disease can have systemic exacerbations and chronic arthritis, with periods of remission in between. To diagnose adult onset Still’s disease, a person must have at least five criteria, including two major criteria such as high fever lasting for a week or longer, joint pain lasting for two weeks or longer, rash, and abnormal white blood cell count. Minor criteria include sore throat, lymph node or spleen swelling, liver problems, and the absence of rheumatoid arthritis.

      It is important to note that mildly raised ASO titres may be present in inflammatory or infective conditions, but an ASO titre of at least 500-1000 is expected in active acute rheumatic fever. Additionally, an ejection systolic murmur may be caused by the hyperdynamic circulation in adult onset Still’s disease, unlike acute rheumatic fever or acute bacterial endocarditis, which cause acute valvular regurgitation and result in pan-systolic or early-diastolic murmurs. Lastly, bacterial endocarditis does not cause the pink rash associated with adult onset Still’s disease.

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      • Infectious Diseases
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  • Question 29 - A 6-year-old girl arrives at the Emergency department with a complaint of sudden...

    Incorrect

    • A 6-year-old girl arrives at the Emergency department with a complaint of sudden pain in her upper tibia. She has a fever and is unwilling to move her leg. The medical team suspects osteomyelitis. What is the probable causative organism?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Common Organisms in Osteomyelitis and Related Conditions

      Acute osteomyelitis in children over the age of 4 years is most commonly caused by Staphylococcus aureus. Fortunately, immunisation has greatly reduced the incidence of haematogenous osteomyelitis caused by Haemophilus influenzae. In sickle cell anaemia, Salmonella is the typical organism responsible for infection. Meanwhile, Pseudomonas infection is frequently seen in haemodialysis patients and intravenous drug users. These organisms can cause serious infections that require prompt medical attention. It is important to be aware of the common organisms associated with osteomyelitis and related conditions in order to facilitate early diagnosis and treatment.

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      • Infectious Diseases
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  • Question 30 - A 27-year-old man has recently come back from a bachelor party in Latvia....

    Incorrect

    • A 27-year-old man has recently come back from a bachelor party in Latvia. He is experiencing pain while urinating and a white discharge from the tip of his penis. Additionally, he is suffering from a swollen and painful left knee. During the examination, the doctor observes a white discharge from his penis and an erythematosus, tender, and swollen left knee. The man is also running a fever of 38.1 degrees. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: gonorrhoeae

      Explanation:

      Differentiating gonorrhoeae from Other Infections

      gonorrhoeae is a common sexually transmitted infection that can cause urethritis and arthritis. When someone returns from an area with a high prevalence of gonorrhoeae, they may experience symptoms such as a purulent discharge, fever, and joint pain. This is not a reactive arthritis because the patient has both urethritis and arthritis at the same time, and is pyrexial during the current illness.

      The acute monoarthritis is a manifestation of disseminated gonococcal infection, which can be confirmed through a Gram stain that shows intracellular Gram negative diplococci. While reactive arthritis can occur after gonorrhoeae, it typically presents as a polyarthritis and has a lag of one to three weeks from the time of the initial disease.

      Chlamydial infection, on the other hand, does not usually cause a purulent discharge and symptoms usually occur slightly longer after exposure than with gonorrhoeae. Pyelonephritis presents with fever and pain in the renal angles, while trichomoniasis is much less common than gonorrhoeae and does not usually present with arthritis. By the differences between these infections, healthcare providers can accurately diagnose and treat patients.

    • This question is part of the following fields:

      • Infectious Diseases
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Infectious Diseases (2/7) 29%
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