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  • Question 1 - A urine culture of a 50-year-old patient with urosepsis has isolated a multi-drug...

    Correct

    • A urine culture of a 50-year-old patient with urosepsis has isolated a multi-drug resistant Escherichia coli. What is the most likely reason for the multi-drug resistance?

      Your Answer: Extended spectrum beta-lactamase (ESBL) production

      Explanation:

      Extended-spectrum beta-lactamases (ESBL) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. Extended spectrum beta-lactamase (ESBL) production is the main reason for multi-drug resistance among E.coli. Commonly used medications to treat ESBL-involved infections include carbapenems (imipenem, meropenem, and doripenem), cephamycins (cefoxitin and cefotetan), Fosfomycin, nitrofurantoin, beta-lactamase inhibitors (clavulanic acid, tazobactam, or sulbactam), non-beta-lactamases and colistin (if all other medications have failed.)

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - Her parents with a severe headache present a 24-year-old woman. She is afraid...

    Incorrect

    • Her parents with a severe headache present a 24-year-old woman. She is afraid of light and sun and prefers darker environments. On examination, a generalized rash that does not blanch on pressure is noticed. What is the best action in this case?

      Your Answer: Isolate patient

      Correct Answer: IV benzylpenicillin

      Explanation:

      The rash is a characteristic sign of meningitis. Added to photophobia, headache and neck rigidity, meningitis is highly suggested diagnosis. IV antibiotics should be started immediately.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin....

    Correct

    • A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?

      Your Answer: Cytomegalovirus (CMV)

      Explanation:

      CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 27 year old woman presents with a 4cm bleeding ulcer on her...

    Incorrect

    • A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 25-year-old pregnant female suddenly developed a rash on her torso. It started...

    Incorrect

    • A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?

      Your Answer:

      Correct Answer: Varicella zoster virus (VZV)

      Explanation:

      Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old...

    Incorrect

    • A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?

      Your Answer:

      Correct Answer: Herpes simplex virus

      Explanation:

      The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 7 - A 19-year-old male presented with a fever and fatigue. On examination, he had...

    Incorrect

    • A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Varicella zoster

      Explanation:

      Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - A woman who is 36 weeks pregnant presents with chickenpox. How should she...

    Incorrect

    • A woman who is 36 weeks pregnant presents with chickenpox. How should she be treated?

      Your Answer:

      Correct Answer: Acyclovir

      Explanation:

      Acyclovir is the correct answer. There has been no documented evidence of harm in pregnancy yet. Chickenpox can cause fetal abnormalities, and varicella zoster Immunoglobulin should be given to the infant immediately after birth (not the mother, won’t help). Steroids will actually make the chicken pox worse. Painkillers only, is obviously the wrong answer and pose severe risk to foetus.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 32-year-old patient that has just returned from India, complains of dyspnoea. On...

    Incorrect

    • A 32-year-old patient that has just returned from India, complains of dyspnoea. On examination, you notice grey membranes on the uvula and tonsils and a low-grade fever. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Diphtheria

      Explanation:

      Characteristic findings on patients suffering from diphtheria are the grey membrane on the uvula and tonsils together with the low grade fever and dyspnoea. It’s of great importance that the patient has recently been to India where there is a know prevalence.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - A 60-year-old male who has been on IV antibiotics for severe pneumonia developed...

    Incorrect

    • A 60-year-old male who has been on IV antibiotics for severe pneumonia developed profuse, watery, green coloured diarrhoea on the fifth day of antibiotics. What is the most likely organism responsible for this condition?

      Your Answer:

      Correct Answer: Clostridium difficile

      Explanation:

      The most probable cause for diarrhoea is pseudomembranous colitis which is caused by Clostridium difficile. Pseudomembranous colitis is an inflammatory disease of the colon where the antibiotic-induced change in the balance of normal gut flora allows overgrowth of C difficile. Any antibiotic can cause this but the chances are higher with ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - Which of the following is true of Koplik’s spots? ...

    Incorrect

    • Which of the following is true of Koplik’s spots?

      Your Answer:

      Correct Answer: Are diagnostic of measles

      Explanation:

      Koplik’s spots are pathopneumonic for MEASLES. They are blue/white spots, small, occurring on the buccal mucosa. They typically occur next to premolars, not opposite to the incisors. They are not related to fever height. They are not on the hands. They usually occur BEFORE the rash.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - Which of the following drugs is NOT used in the treatment of MRSA?...

    Incorrect

    • Which of the following drugs is NOT used in the treatment of MRSA?

      Your Answer:

      Correct Answer: Ceftriaxone

      Explanation:

      Cephalosporins, such as ceftriaxone, do not cover methicillin-resistant staph aureus. They do cover some gram positives and gram negatives. Vancomycin and teicoplanin given intravenously have good coverage of MRSA and other gram positive bacteria. Rifampicin and doxycycline, although not the best treatment, can be used for outpatients if there are no systemic signs of illness.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A 17-year-old man presents with fever and extensive pre-auricular swelling on the right...

    Incorrect

    • A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Mumps

      Explanation:

      Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A 4-year-old boy admitted with fever for 2 days had a left sided...

    Incorrect

    • A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?

      Your Answer:

      Correct Answer: CSF analysis

      Explanation:

      This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - Which of the following diseases correctly matches the incubation period? ...

    Incorrect

    • Which of the following diseases correctly matches the incubation period?

      Your Answer:

      Correct Answer: Mumps: 14 - 18 days

      Explanation:

      The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease.

      • Chickenpox: 7-21 days.
      • Whooping cough: 10-14 days.
      • Hand, foot and mouth disease: 2-6 days.
      • German measles: 14-21 days.
      • Mumps: 14-18 days.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - A 25 year old female presented with blisters on the tongue. Some of...

    Incorrect

    • A 25 year old female presented with blisters on the tongue. Some of them secreted pinkish fluid while some were crusted. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: HSV1

      Explanation:

      The history is suggestive of acute gingivostomatitis, which is a manifestation of primary HSV-1 infection. Patients present with gingivitis and vesicular lesions which develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 17 - A health professional plans to visit Brazil but has recently come to know...

    Incorrect

    • A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?

      Your Answer:

      Correct Answer: Treatment including with interferon, immunoglobulin and Ribavirin is effective

      Explanation:

      West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - A 3 month old infant born to an HIV positive mother presents with...

    Incorrect

    • A 3 month old infant born to an HIV positive mother presents with jaundice, epileptic seizures and microcephaly. The most likely cause will be?

      Your Answer:

      Correct Answer: Cytomegalovirus

      Explanation:

      Congenital CMV infection can occur when a pregnant woman is infected with the cytomegalovirus (CMV) and passes the virus to her unborn child. Infants infected with CMV during pregnancy can exhibit a range of symptoms, including jaundice, seizures, and microcephaly (abnormally small head size). These symptoms are consistent with congenital CMV infection.

      Given the mother’s HIV-positive status, the infant may have been at increased risk of acquiring other infections, including CMV, due to potential immunodeficiency.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - A 28-year-old male complained of an annular rash following an insect bite he...

    Incorrect

    • A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?

      Your Answer:

      Correct Answer: Doxycycline PO

      Explanation:

      The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A 6-year-old boy with fever and malaise for 2 days recently developed bloody...

    Incorrect

    • A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?

      Your Answer:

      Correct Answer: Escherichia coli 0157

      Explanation:

      The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
      Crohn’s disease rarely manifests in an acute manner.
      Polio and giardiasis usually manifest with non-bloody diarrhoea.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - A 30-year-old man has been unwell for the last 3 weeks and now...

    Incorrect

    • A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed. What is the appropriate treatment?

      Your Answer:

      Correct Answer: Acyclovir

      Explanation:

      You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 22 - An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia,...

    Incorrect

    • An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Rubella

      Explanation:

      The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 23 - An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin....

    Incorrect

    • An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Scabies

      Explanation:

      Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
      Henoch-Schönlein purpura is a type of vascular inflammation.
      Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 24 - A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary...

    Incorrect

    • A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Varicella

      Explanation:

      Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 25 - What is the mode of spread of chickenpox? ...

    Incorrect

    • What is the mode of spread of chickenpox?

      Your Answer:

      Correct Answer: Airborne

      Explanation:

      Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 26 - A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a...

    Incorrect

    • A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?

      Your Answer:

      Correct Answer: PCR of CSF for Mycobacterium TB

      Explanation:

      Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 27 - A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from...

    Incorrect

    • A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from shortness of breath, weight loss and dry cough due to Kaposi's sarcoma but no fever was noted. Which is the most likely causative organism?

      Your Answer:

      Correct Answer: Pneumocystis jiroveci

      Explanation:

      Pneumocystis Jiroveci. This causative organism is responsible for pneumonia in individuals that have a compromised immune system. Symptoms include cyanosis, dry cough and in some cases, diffuse bilateral alveolar shadows on CXR. Co-trimoxazole is normally the treatment for this.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 28 - Which of the following procedures does not require antibiotic prophylaxis? ...

    Incorrect

    • Which of the following procedures does not require antibiotic prophylaxis?

      Your Answer:

      Correct Answer: Dental procedure for a patient with an atrial septal defect

      Explanation:

      According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 29 - A homeless woman presented with a cough and fever for the last 3...

    Incorrect

    • A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?

      Your Answer:

      Correct Answer: Acid fast bacilli

      Explanation:

      History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 30 - A 38-year-old woman returns from a summer holiday with a dry cough. Her...

    Incorrect

    • A 38-year-old woman returns from a summer holiday with a dry cough. Her CXR shows bilateral consolidated areas. Which antibiotic would you suggest?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Ciprofloxacin is a well-established broad-spectrum fluoroquinolone antibiotic that penetrates well into the lung tissues.

    • This question is part of the following fields:

      • Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY

Infectious Diseases (2/3) 67%
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