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Question 1
Incorrect
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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: Treat with oral co-trimoxazole for 10 days
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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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A 30-year-old teacher who recently returned after completing a 3-month assignment in Thailand presented to the Emergency Department with fever, headache, confusion and vomiting in the last two days. She was suspected of having meningitis and underwent a lumbar puncture (LP). The LP findings are as follows:
Normal opening pressure, clear cerebrospinal fluid (CSF).
Investigation Result Normal value
CSF white blood cell count (WBC) 400 cells/µl, 70% lymphocytes < 5 cells/µl
CSF protein 0.5 g/l 0.15–0.4 g/l
CSF glucose 3.8 mmol/l 2.6–4.5 mmol/l
CSF–plasma-glucose ratio 0.72 ≥ 0.66
What is the most likely diagnosis?
Select the SINGLE best answer from the list below.
Select ONE option onlyYour Answer: Viral meningitis
Explanation:The cerebrospinal fluid (CSF) findings can help diagnose different types of meningitis. Viral meningitis typically shows clear CSF with a slightly elevated white blood cell count (5-1000 cells/µl, mostly lymphocytes), mildly elevated protein levels, and a normal or slightly low CSF-to-plasma-glucose ratio. Bacterial meningitis, on the other hand, often presents with turbid CSF, a high white blood cell count (>100 cells/µl, mostly neutrophils), elevated protein levels, and a very low CSF-to-plasma-glucose ratio. Fungal meningitis, such as cryptococcal meningitis, usually shows clear or cloudy CSF, a slightly elevated white blood cell count (5-100 cells/µl, mostly lymphocytes), elevated protein levels, and a low CSF-to-plasma-glucose ratio. Tuberculous meningitis typically presents with clear or cloudy CSF, a slightly elevated white blood cell count (5-100 cells/µl, mostly lymphocytes), significantly elevated protein levels, and a very low CSF-to-plasma-glucose ratio. A sub-arachnoid hemorrhage, which is not meningitis, typically presents with a sudden, severe headache and signs of increased intracranial pressure. The CSF in this case often shows xanthochromia.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Correct
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A 29-year-old individual visits the GP complaining of explosive diarrhoea and vomiting that started 24 hours ago. Upon further inquiry, the patient denies any presence of blood in their stool and has not traveled abroad recently. The patient mentions consuming rice that was kept warm in a rice cooker for multiple days. What is the probable causative agent responsible for the patient's symptoms?
Your Answer: Bacillus cereus
Explanation:It is probable that this young man is suffering from toxigenic food poisoning caused by Bacillus cereus, which is known to occur after consuming reheated rice. The spores of Bacillus cereus germinate in cooked rice and produce toxins if the cooked product is not adequately chilled. While S. aureus can also cause toxigenic food poisoning, the specific history of this case makes it less likely to be the underlying organism. Norwalk virus, on the other hand, can cause severe diarrhea and vomiting, but it is not associated with any particular food item. Bacterial food poisoning caused by Campylobacter and Shigella typically involves a longer history of bloody diarrhea.
Gastroenteritis can occur either at home or while traveling, known as travelers’ diarrhea. This condition is characterized by at least three loose to watery stools in 24 hours, accompanied by abdominal cramps, fever, nausea, vomiting, or blood in the stool. The most common cause of travelers’ diarrhea is Escherichia coli. Acute food poisoning is another pattern of illness that results in sudden onset of nausea, vomiting, and diarrhea after ingesting a toxin. Staphylococcus aureus, Bacillus cereus, or Clostridium perfringens are typically responsible for acute food poisoning.
There are several types of infections that can cause gastroenteritis, each with its own typical presentation. Escherichia coli is common among travelers and causes watery stools, abdominal cramps, and nausea. Giardiasis results in prolonged, non-bloody diarrhea, while cholera causes profuse, watery diarrhea and severe dehydration leading to weight loss. Shigella causes bloody diarrhea, vomiting, and abdominal pain, while Staphylococcus aureus results in severe vomiting with a short incubation period. Campylobacter typically starts with a flu-like prodrome and progresses to crampy abdominal pains, fever, and diarrhea, which may be bloody and mimic appendicitis. Bacillus cereus can cause two types of illness, vomiting within six hours, typically due to rice, or diarrheal illness occurring after six hours. Amoebiasis has a gradual onset of bloody diarrhea, abdominal pain, and tenderness that may last for several weeks.
The incubation period for gastroenteritis varies depending on the type of infection. Staphylococcus aureus and Bacillus cereus have an incubation period of 1-6 hours, while Salmonella and Escherichia coli have an incubation period of 12-48 hours. Shigella and Campylobacter have an incubation period of 48-72 hours, while Giardiasis and Amoebiasis have an incubation period of more than seven days.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Correct
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A 42-year-old man was seen by his General Practitioner and diagnosed with community-acquired pneumonia. He has completed a 7-day course of antibiotics but continues to have a fever and productive cough. He is not confused, and his observations are all normal apart from a fever of 39 °C. His chest X-ray has signs of atypical pneumonia. He has no drug allergies.
Which of the following is the most appropriate antibiotic therapy?Your Answer: Clarithromycin
Explanation:Antibiotics for Different Types of Pneumonia
Pneumonia can be caused by various types of bacteria and viruses, and different antibiotics are used to treat them. Atypical pneumonia, caused by organisms such as chlamydia pneumoniae and mycoplasma pneumoniae, does not respond to amoxicillin and requires a 10-14 day course of macrolide antibiotics such as clarithromycin. On the other hand, severe hospital-acquired infections with multidrug-resistant Gram-negative bacteria are treated with aminoglycoside antibiotics like amikacin. Amoxicillin is recommended as first-line treatment for mild community-acquired pneumonia caused by Streptococcus pneumoniae and other bacteria, but it is not effective against atypical pneumonia. Imipenem, a broad-spectrum antibiotic, is used for a range of bacterial infections but not for atypical pneumonia. Cefuroxime, a second-generation cephalosporin antibiotic, is effective against certain bacteria but not indicated for atypical pneumonia. Knowing which antibiotics to use for different types of pneumonia is crucial for effective treatment.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Correct
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A 32-year-old man comes to the clinic with a maculopapular rash and mouth ulcers. He had a painless penile ulcer two months ago. What is the most probable causative organism for his symptoms?
Your Answer: Treponema pallidum
Explanation:The symptoms exhibited by this individual suggest the presence of secondary syphilis.
Understanding Syphilis: Symptoms and Stages
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The infection progresses through three stages: primary, secondary, and tertiary. The incubation period can range from 9 to 90 days.
During the primary stage, a painless ulcer called a chancre appears at the site of sexual contact. Local lymph nodes may also become swollen, but this symptom may not be visible in women if the lesion is on the cervix.
The secondary stage occurs 6 to 10 weeks after the primary infection and is characterized by systemic symptoms such as fevers and lymphadenopathy. A rash may appear on the trunk, palms, and soles, along with buccal ulcers and painless warty lesions on the genitalia.
In the tertiary stage, granulomatous lesions called gummas may develop on the skin and bones, and there may be an ascending aortic aneurysm. Other symptoms include general paralysis of the insane, tabes dorsalis, and Argyll-Robertson pupil.
Congenital syphilis can also occur if a pregnant woman is infected. Symptoms include blunted upper incisor teeth, linear scars at the angle of the mouth, keratitis, saber shins, saddle nose, and deafness.
Understanding the symptoms and stages of syphilis is important for early detection and treatment. It is a treatable infection, but if left untreated, it can lead to serious complications.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Correct
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A 30-year-old presents to the emergency department following an altercation. He reports being involved in a physical altercation while under the influence of alcohol at a bar. His recollection of the event is unclear, but he recalls being hit in the face and bitten on his hand. Upon examination, there is significant bruising around the left eye and a bite wound on the outer aspect of the left hand. What antibiotic should be administered for the bite?
Your Answer: Co-amoxiclav
Explanation:When it comes to treating human bites, it is recommended to use co-amoxiclav, which is also used for treating animal bites. This medication is effective in targeting the primary organisms that are commonly associated with human bites, such as Streptococcus, Staphylococcus, Eikenella, Corynebacterium, and other anaerobes. It is important to note that even if there are no visible signs of infection, antibiotics should still be prescribed.
Animal and Human Bites: Causes and Management
Animal and human bites are common injuries that can lead to infections caused by various microorganisms. Dogs and cats are the most common animals involved in bites, with Pasteurella multocida being the most commonly isolated organism. On the other hand, human bites can cause infections from both aerobic and anaerobic bacteria, including Streptococci spp., Staphylococcus aureus, Eikenella, Fusobacterium, and Prevotella.
To manage animal and human bites, it is important to cleanse the wound thoroughly. Puncture wounds should not be sutured closed unless there is a risk of cosmesis. The current recommendation for treatment is co-amoxiclav, but if the patient is allergic to penicillin, doxycycline and metronidazole are recommended. It is also important to consider the risk of viral infections such as HIV and hepatitis C in human bites.
In summary, animal and human bites can lead to infections caused by various microorganisms. Proper wound cleansing and appropriate antibiotic treatment are essential in managing these injuries. Additionally, healthcare providers should consider the risk of viral infections in human bites.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Correct
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A 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: 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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This question is part of the following fields:
- Infectious Diseases
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Question 8
Correct
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An 80-year-old man presents with a 2-week history of profuse loose stools and severe abdominal pain over the past 2 days. He has lost his appetite and is only tolerating small amounts of fluid over the past 24 hours. On examination, his heart rate is 118 bpm, respiratory rate is 22 breaths/min, temperature 38.1ºC and blood pressure is 104/74 mmHg. Significant left iliac fossa tenderness is noted. The patient is urgently admitted, and a stool culture confirms Clostridium difficile infection and severe colitis without perforation on imaging. What is the most appropriate treatment for this patient?
Your Answer: Oral vancomycin AND IV metronidazole
Explanation:The treatment for life-threatening C. difficile infection involves administering vancomycin orally and metronidazole intravenously.
Clostridioides difficile is a type of bacteria that is commonly found in hospitals. It is a Gram positive rod that produces an exotoxin which can cause damage to the intestines, leading to a condition called pseudomembranous colitis. This bacteria usually develops when the normal gut flora is suppressed by broad-spectrum antibiotics, with second and third generation cephalosporins being the leading cause of C. difficile. Other risk factors include proton pump inhibitors. Symptoms of C. difficile include diarrhea, abdominal pain, and a raised white blood cell count. The severity of the infection can be determined using the Public Health England severity scale, which ranges from mild to life-threatening.
To diagnose C. difficile, a stool sample is tested for the presence of C. difficile toxin (CDT). Treatment for a first episode of C. difficile infection typically involves oral vancomycin for 10 days, with fidaxomicin or a combination of oral vancomycin and IV metronidazole being used as second and third-line therapies. Recurrent infections occur in around 20% of patients, increasing to 50% after their second episode. In such cases, oral fidaxomicin is recommended within 12 weeks of symptom resolution, while oral vancomycin or fidaxomicin can be used after 12 weeks. For life-threatening C. difficile infections, oral vancomycin and IV metronidazole are used, and surgery may be considered with specialist advice. Other therapies, such as bezlotoxumab and fecal microbiota transplant, may also be considered for preventing recurrences in certain cases.
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This question is part of the following fields:
- Infectious Diseases
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Question 9
Correct
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A 50-year-old businessman comes to the clinic complaining of watery, non-bloody diarrhea, anorexia, and abdominal bloating that has been going on for 10 days. He recently returned from a trip to India and his symptoms started 3 days after his return. Upon examination, he has dry mucous membranes but normal skin turgor and no fever. What is the probable organism responsible for his symptoms?
Your Answer: Giardia lamblia
Explanation:The symptoms experienced by the patient, such as bloating and watery diarrhoea lasting for an extended period, suggest that the cause of their illness is Giardiasis rather than the more typical culprit, Escherichia coli, which is commonly associated with travellers’ diarrhoea.
Understanding Giardiasis
Giardiasis is a condition caused by a type of protozoan called Giardia lamblia. It is transmitted through the faeco-oral route and can be contracted through various means such as foreign travel, drinking water from rivers or lakes, and even male-male sexual contact. While some individuals may not experience any symptoms, others may suffer from non-bloody diarrhea, bloating, abdominal pain, lethargy, flatulence, and weight loss. In severe cases, malabsorption and lactose intolerance may occur. Diagnosis can be made through stool microscopy, stool antigen detection assay, or PCR assays. Treatment typically involves the use of metronidazole.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
Incorrect
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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: Vancomycin
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.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Correct
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Which of the following vaccinations should be avoided in individuals who have HIV, and what is the reason for this recommendation?
Your 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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This question is part of the following fields:
- Infectious Diseases
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Question 12
Incorrect
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Which of the following characteristics is the least typical of Trichomonas vaginalis?
Your Answer: Strawberry cervix
Correct Answer:
Explanation:A pH level greater than 4.5 is linked to Trichomonas vaginalis and bacterial vaginosis.
Understanding Trichomonas vaginalis and its Comparison to Bacterial Vaginosis
Trichomonas vaginalis is a type of protozoan parasite that is highly motile and flagellated. It is known to cause trichomoniasis, which is a sexually transmitted infection. The infection is characterized by symptoms such as offensive, yellow/green, frothy vaginal discharge, vulvovaginitis, and strawberry cervix. The pH level is usually above 4.5, and in men, it may cause urethritis.
To diagnose trichomoniasis, a wet mount microscopy is conducted to observe the motile trophozoites. The treatment for trichomoniasis involves oral metronidazole for 5-7 days, although a one-off dose of 2g metronidazole may also be used.
When compared to bacterial vaginosis, trichomoniasis has distinct differences. Bacterial vaginosis is caused by an overgrowth of bacteria in the vagina, while trichomoniasis is caused by a protozoan parasite. The symptoms of bacterial vaginosis include a thin, grayish-white vaginal discharge with a fishy odor, and a pH level above 4.5. Unlike trichomoniasis, bacterial vaginosis is not considered a sexually transmitted infection.
In conclusion, understanding the differences between trichomoniasis and bacterial vaginosis is crucial in diagnosing and treating these conditions effectively. Proper diagnosis and treatment can help prevent complications and improve overall health and well-being.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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A 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: 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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This question is part of the following fields:
- Infectious Diseases
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Question 14
Correct
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A 42-year-old woman presents with increasing fatigue and cough. She attributes it to the stress she experienced during a recent business trip to Italy. Since then, she has been feeling feverish and tired, and her cough started two days ago. She has no medical history, but she admits to having had unprotected sex recently. A chest x-ray reveals consolidation in both lung bases. Her blood tests are as follows:
- White blood cell count: 12 * 10^9/l
- Hemoglobin: 135 g/l
- C-reactive protein: 145 mg/l
- Sodium: 125 mmol/l
- Potassium: 4.7 mmol/l
- Alanine transaminase: 87 IU/l
What is the causative organism?Your Answer: Legionella pneumophilia
Explanation:Legionella is characterized by typical symptoms such as flu-like illness, dry cough, confusion, and relative bradycardia. Blood tests may reveal hyponatremia.
Outbreaks of Legionella pneumonia often occur in communities with shared water supplies, as hinted at in the question with the reference to the recent conference in Spain. This type of pneumonia frequently affects both lungs, as seen in the question. Additionally, Legionella can cause abnormal liver function tests and hyponatremia, which can lead to confusion in some cases, although this is not mentioned in the question.
The mention of unprotected sex is a distractor, as it would take years for HIV infection to make a person susceptible to infections like TB and Pneumocystis jiroveci.
Legionnaire’s Disease: Symptoms, Diagnosis, and Management
Legionnaire’s disease is a type of pneumonia caused by the Legionella pneumophilia bacterium, which is commonly found in water tanks. It is not transmitted from person to person. Symptoms of the disease include flu-like symptoms such as fever, dry cough, confusion, and lymphopaenia. Other features include relative bradycardia, hyponatraemia, and deranged liver function tests. Pleural effusion is seen in around 30% of patients.
Diagnosis of Legionnaire’s disease can be done through a urinary antigen test. Treatment involves the use of erythromycin or clarithromycin. Chest x-ray features of the disease are non-specific but may include patchy consolidation with a mid-to-lower zone predominance.
Compared to Mycoplasma pneumonia, Legionnaire’s disease has distinct differences in symptoms and diagnostic methods. It is important to be aware of the potential for Legionnaire’s disease in cases where water tanks or air-conditioning systems may be involved, as early diagnosis and treatment can lead to better outcomes.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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A 45-year-old man of South Asian descent presents with bilateral leg swelling. He works as a construction worker and has a history of multiple sexual partners without protection.
During examination, his body weight is 40 kg, and you observe some mouth sores.
The following investigations are conducted:
Investigation Result Normal value
Haemoglobin (Hb) 120 g/l 135–175 g/l
White cell count (WCC) 5.0 × 109/l 4.0–11.0 × 109/l
Neutrophils 2.0 × 109/l 2.5–7.58 × 109/l
Lymphocytes 1.5 × 109/l 1.5–3.5 × 109/l
Eosinophils 0.8 × 109/l 0.1–0.4 × 109/l
Urine Protein 2+
Cholesterol 4.8 mmol/l < 5.2 mmol/l
What is the next recommended test for this patient?Your Answer: Human immunodeficiency virus (HIV) test
Explanation:Diagnostic Tests and Treatment for HIV-Associated Nephropathy
HIV infection is a high possibility in a patient with risk factors and presenting with emaciation, oral ulcers, and lymphopenia. HIV serological testing and a CD4 count should be done urgently to establish the diagnosis. HIV-associated nephropathy is a common complication, with focal and segmental glomerulosclerosis being the most frequent pathological diagnosis. Other variants include membranoproliferative nephropathy, diffuse proliferative glomerulonephritis, minimal change disease, and IgA nephropathy. Treatment involves angiotensin-converting enzyme inhibitors and antiretroviral therapy. Renal biopsy may be necessary, but HIV testing should be performed first. Serum complement levels and anti-nuclear factor may be useful in diagnosing SLE-associated nephropathy or other connective tissue diseases, but the lack of systemic symptoms in this case makes it less likely. Serum IgA levels may be elevated in IgA nephropathy, but it typically presents with haematuria rather than proteinuria.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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An epidemic of diarrhoea and vomiting has broken out on one of the elderly care wards. The catering suppliers assure you that their food is unlikely to be responsible because they follow the strictest hygiene procedures. A total of 15 elderly patients on the ward have become unwell with a sudden onset of diarrhoea and vomiting. Those infected earlier have recovered with rehydration therapy after about 48 hours. Examination of faeces by electron microscopy has revealed circular virus particles with radiating spokes.
Which virus is most likely to be responsible for this outbreak?Your Answer: Norovirus
Correct Answer: Rotavirus
Explanation:Common Viruses that Cause Gastroenteritis
Gastroenteritis is a self-limiting illness caused by several viruses, including rotavirus, enteric adenovirus, small round-structured virus (SRSV), norovirus, and astrovirus. Among these, rotavirus is the most common cause of gastroenteritis in children under 5 years of age, while norovirus affects people of all ages. Rotavirus causes infant deaths worldwide, but acquired immunity develops after one episode. Norovirus is usually transmitted through contaminated food or water, while adenovirus is endemic throughout the year and commonly affects children in daycare settings. SRSV is another name for norovirus, and astrovirus is associated with contaminated food and water. Symptoms of gastroenteritis include anorexia, low-grade fever, vomiting, and watery diarrhea, but most cases do not require medication and can be managed with supportive treatment. Death from dehydration remains common in developing countries.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Correct
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Which one of the following statements regarding the vaccine used to routinely immunise adults against influenza is accurate?
Your Answer: It is a live vaccine
Explanation:Influenza Vaccination: Who Should Get It and What to Expect
Seasonal influenza remains a significant health concern in the UK, with the flu season typically starting in November. To prevent the spread of the virus, it is recommended that individuals receive the influenza vaccine between September and early November. There are three types of influenza virus, with types A and B causing the majority of clinical disease.
Prior to 2013, flu vaccination was only offered to the elderly and at-risk groups. However, a new NHS influenza vaccination programme for children was announced in 2013. The children’s vaccine is given intranasally, with the first dose administered at 2-3 years and subsequent doses given annually. It is a live vaccine and is more effective than the injectable vaccine.
Adults and at-risk groups are also recommended to receive the influenza vaccine annually. This includes individuals over 65 years old, those with chronic respiratory or heart disease, chronic kidney or liver disease, chronic neurological disease, diabetes mellitus, immunosuppression, asplenia or splenic dysfunction, pregnant women, and those with a body mass index of 40 kg/m² or higher. Health and social care staff, those living in long-stay residential care homes, and carers of the elderly or disabled person may also be eligible for the vaccine.
The influenza vaccine is an inactivated vaccine and cannot cause influenza. It is around 75% effective in adults, although this figure decreases in the elderly. It takes around 10-14 days after immunisation before antibody levels are at protective levels. The vaccine should be stored between +2 and +8ºC and shielded from light. Contraindications include hypersensitivity to egg protein. While a minority of patients may experience fever and malaise after receiving the vaccine, it is generally well-tolerated.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Incorrect
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You are taking the history of an Emergency Department patient who was assaulted. The victim is a 20-year-old female who has a deep laceration on her thigh caused by a rusty machete. The wound has exposed tendon, muscle, and subcutaneous fat. According to her medical records, she received all her childhood immunizations on schedule, including 5 doses of tetanus vaccine, with the last one administered when she was 16 years old.
What is the appropriate management for tetanus risk in this patient?Your Answer: Tetanus vaccine booster and tetanus immunoglobulin administration
Correct Answer: No tetanus vaccine booster and no immunoglobulins required
Explanation:If a patient has received 5 doses of the tetanus vaccine, with the most recent dose administered less than 10 years ago, they do not need a booster vaccine or immunoglobulins, regardless of the severity of the wound. This is the correct course of action. The patient’s childhood vaccinations would have included 5 doses of the tetanus vaccine, with the last dose given at age 14 or later. Therefore, the patient is already adequately protected and does not require a booster or immunoglobulin, regardless of the severity of the wound.
The option of administering a tetanus vaccine booster with antibiotics is not the correct course of action. While antibiotics may be considered for protection against other bacteria, the patient already has sufficient protection against tetanus and does not require vaccination.
Similarly, administering a tetanus vaccine booster with tetanus immunoglobulin is not necessary. As previously mentioned, the patient already has adequate protection from previous vaccinations. Immunoglobulin would only be necessary if the patient had an incomplete or unknown vaccine history or if it had been more than 10 years since the last vaccine.
Lastly, administering a tetanus vaccine booster alone is not necessary. The patient already has protection from previous vaccinations and does not require a booster.
Tetanus Vaccination and Management of Wounds
The tetanus vaccine is a purified toxin that is given as part of a combined vaccine. In the UK, it is given as part of the routine immunisation schedule at 2, 3, and 4 months, 3-5 years, and 13-18 years, providing a total of 5 doses for long-term protection against tetanus.
When managing wounds, the first step is to classify them as clean, tetanus-prone, or high-risk tetanus-prone. Clean wounds are less than 6 hours old and have negligible tissue damage, while tetanus-prone wounds include puncture-type injuries acquired in a contaminated environment or wounds containing foreign bodies. High-risk tetanus-prone wounds include wounds or burns with systemic sepsis, certain animal bites and scratches, heavy contamination with material likely to contain tetanus spores, wounds or burns with extensive devitalised tissue, and wounds or burns that require surgical intervention.
If the patient has had a full course of tetanus vaccines with the last dose less than 10 years ago, no vaccine or tetanus immunoglobulin is required regardless of the wound severity. If the patient has had a full course of tetanus vaccines with the last dose more than 10 years ago, a reinforcing dose of vaccine is required for tetanus-prone wounds, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for high-risk wounds. If the vaccination history is incomplete or unknown, a reinforcing dose of vaccine is required regardless of the wound severity, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for tetanus-prone and high-risk wounds.
Overall, proper vaccination and wound management are crucial in preventing tetanus infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Incorrect
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A 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: Scarlet fever
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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This question is part of the following fields:
- Infectious Diseases
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Question 20
Correct
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A 50-year-old woman started treatment for tuberculosis infection 3 months ago and now complains of a burning sensation at the base of her feet. Which medication could be responsible for this new symptom?
Your Answer: Isoniazid
Explanation:Isoniazid treatment may lead to a deficiency of vitamin B6, which can result in peripheral neuropathy. This is a well-known side effect of TB medications that is often tested in medical school exams. The patient’s symptoms suggest the possibility of peripheral neuropathy caused by a lack of vitamin B6 due to Isoniazid therapy. Typically, pyridoxine hydrochloride is prescribed concurrently with Isoniazid to prevent peripheral neuropathy.
The Importance of Vitamin B6 in the Body
Vitamin B6 is a type of water-soluble vitamin that belongs to the B complex group. Once it enters the body, it is converted into pyridoxal phosphate (PLP), which acts as a cofactor for various reactions such as transamination, deamination, and decarboxylation. These reactions are essential for the proper functioning of the body.
One of the primary causes of vitamin B6 deficiency is isoniazid therapy, which is a medication used to treat tuberculosis. When the body lacks vitamin B6, it can lead to peripheral neuropathy, which is a condition that affects the nerves outside the brain and spinal cord. It can also cause sideroblastic anemia, which is a type of anemia that affects the production of red blood cells.
Overall, vitamin B6 plays a crucial role in the body, and its deficiency can have severe consequences. It is essential to ensure that the body receives an adequate amount of this vitamin through a balanced diet or supplements.
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This question is part of the following fields:
- Infectious Diseases
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