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  • Question 1 - A 45-year-old woman is brought to the hospital with a high temperature, cough,...

    Correct

    • A 45-year-old woman is brought to the hospital with a high temperature, cough, and difficulty breathing. After conducting additional tests, she is diagnosed with a reportable illness. You fill out the notification form and reach out to the local health protection team.

      What is the most probable diagnosis in this case?

      Your Answer: Legionnaires’ disease

      Explanation:

      Public Health England (PHE) has the primary goal of promptly identifying potential disease outbreaks and epidemics. While accuracy of diagnosis is not the main focus, clinical suspicion of a notifiable infection has been sufficient since 1968.

      Registered medical practitioners (RMPs) are legally obligated to inform the designated proper officer at their local council or local health protection team (HPT) about suspected cases of specific infectious diseases.

      The Health Protection (Notification) Regulations 2010 outline the diseases that RMPs must report to the proper officers at local authorities. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - A 42 year old male is brought to the emergency department by a...

    Incorrect

    • A 42 year old male is brought to the emergency department by a friend due to concerns the patient has been experiencing fever and increasing lethargy. The patient is known to be an intravenous drug user. The patient is found to have a high-pitched systolic murmur and crepitations in both lung bases. The following observations are noted:

      Temperature: 38.8ºC
      Pulse rate: 116 bpm
      Blood pressure: 110/68 mmHg
      Respiration rate: 22 bpm
      Oxygen saturation: 96% on room air

      What is the most likely diagnosis?

      Your Answer: Pneumocystis pneumonia

      Correct Answer: Infective endocarditis

      Explanation:

      The presence of both fever and a murmur in an individual who engages in intravenous drug use (IVDU) should raise suspicion for infective endocarditis. IVDU is a significant risk factor for this condition. In this particular patient, the symptoms of fever and cardiac murmur are important indicators that may be emphasized in an exam scenario. It is important to note that infective endocarditis in IVDU patients typically affects the right side of the heart, with the tricuspid valve being the most commonly affected. Murmurs in this patient population can be subtle and challenging to detect during a clinical examination. Additionally, the presence of septic emboli can lead to the entry of infected material into the pulmonary circulation, potentially causing pneumonia and pulmonary vessel occlusion, which may manifest as a pulmonary embolism (PE).

      Further Reading:

      Infective endocarditis (IE) is an infection that affects the innermost layer of the heart, known as the endocardium. It is most commonly caused by bacteria, although it can also be caused by fungi or viruses. IE can be classified as acute, subacute, or chronic depending on the duration of illness. Risk factors for IE include IV drug use, valvular heart disease, prosthetic valves, structural congenital heart disease, previous episodes of IE, hypertrophic cardiomyopathy, immune suppression, chronic inflammatory conditions, and poor dental hygiene.

      The epidemiology of IE has changed in recent years, with Staphylococcus aureus now being the most common causative organism in most industrialized countries. Other common organisms include coagulase-negative staphylococci, streptococci, and enterococci. The distribution of causative organisms varies depending on whether the patient has a native valve, prosthetic valve, or is an IV drug user.

      Clinical features of IE include fever, heart murmurs (most commonly aortic regurgitation), non-specific constitutional symptoms, petechiae, splinter hemorrhages, Osler’s nodes, Janeway’s lesions, Roth’s spots, arthritis, splenomegaly, meningism/meningitis, stroke symptoms, and pleuritic pain.

      The diagnosis of IE is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Major criteria include positive blood cultures with typical microorganisms and positive echocardiogram findings. Minor criteria include fever, vascular phenomena, immunological phenomena, and microbiological phenomena. Blood culture and echocardiography are key tests for diagnosing IE.

      In summary, infective endocarditis is an infection of the innermost layer of the heart that is most commonly caused by bacteria. It can be classified as acute, subacute, or chronic and can be caused by a variety of risk factors. Staphylococcus aureus is now the most common causative organism in most industrialized countries. Clinical features include fever, heart murmurs, and various other symptoms. The diagnosis is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Blood culture and echocardiography are important tests for diagnosing IE.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A patient who has recently come back from a journey to South America...

    Incorrect

    • A patient who has recently come back from a journey to South America arrives with seizures and visual impairment. After conducting several tests, including a brain CT scan, the diagnosis of cysticercosis is established.
      What is the most probable organism responsible for this condition?

      Your Answer: Taenia saginata

      Correct Answer: Taenia solium

      Explanation:

      Two types of tapeworms, Taenia solium and Taenia saginata, can infest humans. Infestation occurs when people consume meat from intermediate hosts that contain the parasite’s tissue stages. Tapeworms compete for nutrients and infestation is often without symptoms. However, in more severe cases, individuals may experience epigastric pain, diarrhea, and vomiting. Diagnosis involves identifying characteristic eggs in the patient’s stool.

      Taenia solium infestation can also lead to a condition called cysticercosis. This occurs when larval cysts infiltrate and spread throughout the lung, liver, eye, or brain. Cysticercosis presents with neurological symptoms, seizures, and impaired vision. Confirmation of cysticercosis involves the presence of antibodies and imaging tests such as chest X-rays and CT brain scans.

      The treatment for tapeworm infestation is highly effective and involves the use of medications like niclosamide or praziquantel. However, it is important to seek specialist advice when managing Taenia infections in the central nervous system, as severe inflammatory reactions can occur.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 25-year-old college student comes to the emergency department complaining of a worsening...

    Incorrect

    • A 25-year-old college student comes to the emergency department complaining of a worsening sore throat, fever, and feeling unwell. The patient reports that the symptoms began 10 days ago. During the examination, the patient has a temperature of 38.0ºC, swollen lymph nodes in the neck, white patches on both tonsils, and tenderness in the right upper abdomen. Glandular fever is suspected.

      What would be the most suitable approach to confirm the suspected diagnosis?

      Your Answer:

      Correct Answer: FBC and monospot test

      Explanation:

      For adults and children over the age of 12 who are suspected to have glandular fever and have a normal immune system, it is recommended to conduct a Full Blood Count (FBC) and a monospot test during the second week of the illness. The timing and choice of investigations for glandular fever vary depending on the patient’s age, immune system status, and duration of symptoms. For children under the age of 12 and individuals with compromised immune systems, it is advised to perform a blood test for Epstein-Barr virus (EBV) viral serology after at least 7 days of illness. However, for immunocompetent adults and children older than 12, a FBC with differential white cell count and a monospot test (heterophile antibodies) should be conducted during the second week of the illness.

      Further Reading:

      Glandular fever, also known as infectious mononucleosis or mono, is a clinical syndrome characterized by symptoms such as sore throat, fever, and swollen lymph nodes. It is primarily caused by the Epstein-Barr virus (EBV), with other viruses and infections accounting for the remaining cases. Glandular fever is transmitted through infected saliva and primarily affects adolescents and young adults. The incubation period is 4-8 weeks.

      The majority of EBV infections are asymptomatic, with over 95% of adults worldwide having evidence of prior infection. Clinical features of glandular fever include fever, sore throat, exudative tonsillitis, lymphadenopathy, and prodromal symptoms such as fatigue and headache. Splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may also be present, and a non-pruritic macular rash can sometimes occur.

      Glandular fever can lead to complications such as splenic rupture, which increases the risk of rupture in the spleen. Approximately 50% of splenic ruptures associated with glandular fever are spontaneous, while the other 50% follow trauma. Diagnosis of glandular fever involves various investigations, including viral serology for EBV, monospot test, and liver function tests. Additional serology tests may be conducted if EBV testing is negative.

      Management of glandular fever involves supportive care and symptomatic relief with simple analgesia. Antiviral medication has not been shown to be beneficial. It is important to identify patients at risk of serious complications, such as airway obstruction, splenic rupture, and dehydration, and provide appropriate management. Patients can be advised to return to normal activities as soon as possible, avoiding heavy lifting and contact sports for the first month to reduce the risk of splenic rupture.

      Rare but serious complications associated with glandular fever include hepatitis, upper airway obstruction, cardiac complications, renal complications, neurological complications, haematological complications, chronic fatigue, and an increased risk of lymphoproliferative cancers and multiple sclerosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 2-year-old toddler is brought to the Emergency Department by his father with...

    Incorrect

    • A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
      Based on the NICE traffic light system, which of the subsequent symptoms or signs are indicative of an intermediate-risk of a severe illness?

      Your Answer:

      Correct Answer: Dry mucous membranes

      Explanation:

      The traffic light system is a useful tool for evaluating the potential risk of serious illness in children. This system categorizes clinical features into three groups based on severity: red (high-risk), amber (intermediate-risk), and green (low-risk).

      Children displaying any of the following symptoms or signs fall into the high-risk group for serious illness: pale/mottled/ashen/blue skin, lips or tongue; lack of response to social cues; appearing unwell to a healthcare professional; inability to wake or stay awake when roused; weak, high-pitched, or continuous cry; grunting; respiratory rate exceeding 60 breaths per minute; moderate or severe chest indrawing; reduced skin turgor; and bulging fontanelle.

      Children exhibiting any of the following symptoms or signs are considered at least intermediate-risk for serious illness: pallor of skin, lips or tongue reported by parent or caregiver; abnormal response to social cues; absence of a smile; waking only with prolonged stimulation; decreased activity; nasal flaring; dry mucous membranes; poor feeding in infants; reduced urine output; and rigors.

      Children displaying any of the following symptoms or signs are classified as low-risk for serious illness: normal color of skin, lips, and tongue; normal response to social cues; contentment and smiles; staying awake or quickly awakening; strong normal cry or absence of crying; normal skin and eyes; and moist mucous membranes.

      To summarize, children with fever and any symptoms or signs in the red column are considered high-risk, while those with fever and any symptoms or signs in the amber column (but none in the red column) are considered intermediate-risk. Children with symptoms and signs in the green column (and none in the amber or red columns) are classified as low-risk.

      For more information, you can refer to the NICE guidelines on the assessment and initial management of fever in children under 5, as well as the NICE Clinical Knowledge Summary on the management of feverish children.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - A 2-year-old toddler is brought to the Emergency Department by his father with...

    Incorrect

    • A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
      Based on the NICE traffic light system, which of the subsequent symptoms or signs indicate a high risk of a severe illness?

      Your Answer:

      Correct Answer: Appearing ill to a healthcare professional

      Explanation:

      The traffic light system is a useful tool for evaluating the potential risk of serious illness in children. This system categorizes clinical features into three groups based on severity: red (high-risk), amber (intermediate-risk), and green (low-risk).

      Children displaying any of the following symptoms or signs fall into the high-risk group for serious illness: pale/mottled/ashen/blue skin, lips or tongue; lack of response to social cues; appearing unwell to a healthcare professional; inability to wake or stay awake when roused; weak, high-pitched, or continuous cry; grunting; respiratory rate exceeding 60 breaths per minute; moderate or severe chest indrawing; reduced skin turgor; and bulging fontanelle.

      Children exhibiting any of the following symptoms or signs are considered at least intermediate-risk for serious illness: pallor of skin, lips or tongue reported by parent or caregiver; abnormal response to social cues; absence of a smile; waking only with prolonged stimulation; decreased activity; nasal flaring; dry mucous membranes; poor feeding in infants; reduced urine output; and rigors.

      Children displaying any of the following symptoms or signs are classified as low-risk for serious illness: normal color of skin, lips, and tongue; normal response to social cues; contentment and smiles; staying awake or quickly awakening; strong normal cry or absence of crying; normal skin and eyes; and moist mucous membranes.

      To summarize, children with fever and any symptoms or signs in the red column are considered high-risk, while those with fever and any symptoms or signs in the amber column (but none in the red column) are considered intermediate-risk. Children with symptoms and signs in the green column (and none in the amber or red columns) are classified as low-risk.

      For more information, you can refer to the NICE guidelines on the assessment and initial management of fever in children under 5, as well as the NICE Clinical Knowledge Summary on the management of feverish children.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 7 - A patient with a previous complaint of upper abdominal pain and frequent bowel...

    Incorrect

    • A patient with a previous complaint of upper abdominal pain and frequent bowel movements is diagnosed with a tapeworm infection. The infection was acquired after consuming a pork dish that was contaminated with the parasite.

      Which of the following organisms is the most probable cause of this infestation?

      Your Answer:

      Correct Answer: Taenia solium

      Explanation:

      Two types of tapeworms, Taenia solium and Taenia saginata, can infest humans. Infestation occurs when people consume meat from intermediate hosts that contain the parasite’s tissue stages. Tapeworms compete for nutrients and infestation is often without symptoms. However, in more severe cases, individuals may experience epigastric pain, diarrhea, and vomiting. Diagnosis involves identifying characteristic eggs in the patient’s stool.

      Taenia solium infestation can also lead to a condition called cysticercosis. This occurs when larval cysts infiltrate and spread throughout the lung, liver, eye, or brain. Cysticercosis presents with neurological symptoms, seizures, and impaired vision. Confirmation of cysticercosis involves the presence of antibodies and imaging tests such as chest X-rays and CT brain scans.

      The treatment for tapeworm infestation is highly effective and involves the use of medications like niclosamide or praziquantel. However, it is important to seek specialist advice when managing Taenia infections in the central nervous system, as severe inflammatory reactions can occur.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - A 32-year-old man is brought to the hospital with a known notifiable illness.
    What...

    Incorrect

    • A 32-year-old man is brought to the hospital with a known notifiable illness.
      What is the most probable diagnosis in this case?

      Your Answer:

      Correct Answer: Haemolytic uraemic syndrome

      Explanation:

      Public Health England (PHE) has the primary goal of promptly identifying potential disease outbreaks and epidemics. While accuracy of diagnosis is not the main focus, clinical suspicion of a notifiable infection has been sufficient since 1968.

      Registered medical practitioners (RMPs) are legally obligated to inform the designated proper officer at their local council or local health protection team (HPT) about suspected cases of specific infectious diseases.

      The Health Protection (Notification) Regulations 2010 outline the diseases that RMPs must report to the proper officers at local authorities. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 57 year old type 2 diabetic presents to the emergency department with...

    Incorrect

    • A 57 year old type 2 diabetic presents to the emergency department with redness on his foot. Upon examination, a foot ulcer measuring 1 cm in diameter is observed, exposing the superficial subcutaneous tissues. There is approximately 1 cm of erythema surrounding the ulcer and some pus at the base. The patient is not running a fever and appears to be in good overall health. It is determined that antibiotics should be initiated. The patient has no known allergies to medications. Which antibiotic would be the most suitable option?

      Your Answer:

      Correct Answer: Flucloxacillin 500 mg four times a day for 7 days

      Explanation:

      When treating diabetic foot ulcers that are infected, the severity of the ulcer is used to determine the appropriate antimicrobial therapy. In the case of a mild foot infection (PEDIS 2 grade), the first-line treatment is typically flucloxacillin. Based on the information provided, there is no indication that pseudomonas or MRSA should be suspected. For mild infections, it is reasonable to prescribe flucloxacillin at a dosage of 500 mg-1g four times a day for a duration of 7 days. It is important to reassess the patient at the end of the treatment course.

      Further Reading:

      Diabetic foot is a complication that can occur in individuals with diabetes due to long-standing high blood sugar levels. This leads to a process called glycation or glycosylation, where glucose binds to proteins and lipids in the body. Abnormal protein glycation can cause cellular dysfunction and various complications.

      One of the main problems in diabetic foot is peripheral vascular disease and peripheral neuropathy. These conditions can result in significant foot issues, as trauma to the feet may go unnoticed and untreated. Vascular disease also impairs wound healing and increases the risk of developing ulcers.

      Clinical features of diabetic foot include reduced sensation, especially to vibration, non-dermatomal sensory loss, foot deformities such as pes cavus and claw toes, and weak or absent foot pulses. It is important for diabetic patients to have their feet assessed regularly, at least annually, to identify any potential problems. Additional foot assessments should also be conducted during hospital admissions.

      During a diabetic foot assessment, the healthcare provider should remove shoes, socks, and any bandages or dressings to examine both feet. They should assess for neuropathy using a 10 g monofilament to test foot sensation and check for limb ischemia by examining pulses and performing ankle brachial pressure index (ABPI) measurements. Any abnormal tissue, such as ulcers, calluses, infections, inflammation, deformities, or gangrene, should be documented. The risk of Charcot arthropathy should also be assessed.

      The severity of foot ulcers in diabetic patients can be documented using standardized systems such as SINBAD or the University of Texas classification. The presence and severity of diabetic foot infection can be determined based on criteria such as local swelling, induration, erythema, tenderness, pain, warmth, and purulent discharge.

      Management of foot ulcers involves offloading, control of foot infection, control of ischemia, wound debridement, and appropriate wound dressings. Antibiotics may be necessary depending on the severity of the infection. Diabetic patients with foot ulcers should undergo initial investigations including blood tests, wound swabs, and imaging to assess for possible osteomyelitis.

      Charcot foot is a serious complication of diabetic peripheral neuropathy that results in progressive destructive arthropathy and foot deformity. Signs of Charcot foot include redness, swelling, warm skin, pain, and deformity. The hallmark deformity is midfoot collapse, known as the rocker-bottom foot.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - A 15 year old arrives at the emergency department complaining of a sore...

    Incorrect

    • A 15 year old arrives at the emergency department complaining of a sore throat, swollen glands, and feeling tired for the past 9 days. Glandular fever is suspected. What test should be ordered to confirm the diagnosis?

      Your Answer:

      Correct Answer: Monospot test

      Explanation:

      The monospot test is the preferred method for testing for infectious mononucleosis (glandular fever) when looking for heterophile antibodies. The timing and choice of investigations for glandular fever depend on factors such as the patient’s age, immune system status, and duration of symptoms. The monospot test is a latex agglutination test that uses equine erythrocytes as the primary substrate to detect specific heterophile antibodies produced by the human immune system in response to EBV infection. It is simpler and faster to use compared to the Paul Bunnell test, which uses sheep red cells. The monospot test is recommended by NICE due to its advantages. However, it has lower sensitivity and negative predictive value in young children, which is why EBV serology is preferred for those under 12 years old.

      Further Reading:

      Glandular fever, also known as infectious mononucleosis or mono, is a clinical syndrome characterized by symptoms such as sore throat, fever, and swollen lymph nodes. It is primarily caused by the Epstein-Barr virus (EBV), with other viruses and infections accounting for the remaining cases. Glandular fever is transmitted through infected saliva and primarily affects adolescents and young adults. The incubation period is 4-8 weeks.

      The majority of EBV infections are asymptomatic, with over 95% of adults worldwide having evidence of prior infection. Clinical features of glandular fever include fever, sore throat, exudative tonsillitis, lymphadenopathy, and prodromal symptoms such as fatigue and headache. Splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may also be present, and a non-pruritic macular rash can sometimes occur.

      Glandular fever can lead to complications such as splenic rupture, which increases the risk of rupture in the spleen. Approximately 50% of splenic ruptures associated with glandular fever are spontaneous, while the other 50% follow trauma. Diagnosis of glandular fever involves various investigations, including viral serology for EBV, monospot test, and liver function tests. Additional serology tests may be conducted if EBV testing is negative.

      Management of glandular fever involves supportive care and symptomatic relief with simple analgesia. Antiviral medication has not been shown to be beneficial. It is important to identify patients at risk of serious complications, such as airway obstruction, splenic rupture, and dehydration, and provide appropriate management. Patients can be advised to return to normal activities as soon as possible, avoiding heavy lifting and contact sports for the first month to reduce the risk of splenic rupture.

      Rare but serious complications associated with glandular fever include hepatitis, upper airway obstruction, cardiac complications, renal complications, neurological complications, haematological complications, chronic fatigue, and an increased risk of lymphoproliferative cancers and multiple sclerosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - A 32-year-old traveler returns from a visit to West Africa with frequent headaches...

    Incorrect

    • A 32-year-old traveler returns from a visit to West Africa with frequent headaches and occasional fevers. Laboratory tests reveal the presence of malaria. The patient is promptly initiated on treatment, but his condition worsens, leading to the development of jaundice, renal failure, and haemoglobinuria.

      What is the MOST LIKELY organism responsible for this illness?

      Your Answer:

      Correct Answer: Plasmodium falciparum

      Explanation:

      Malaria is a contagious illness that is spread by female mosquitoes of the Anopheles genus. It is a parasitic infection caused by the Plasmodium genus. There are five species of Plasmodium that are known to cause disease in humans: Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, and Plasmodium knowlesi.

      The main symptom of malaria is the malarial paroxysm, which is a recurring pattern of symptoms. It begins with a cold phase, during which the patient experiences intense chills. This is followed by a hot stage, where the patient feels extremely hot. Finally, there is a sweating stage, during which the fever subsides and the patient sweats profusely. Upon examination, the patient may exhibit signs of anemia, jaundice, and have an enlarged liver and spleen, but there is no evidence of swollen lymph nodes.

      If a patient develops haemoglobinuria (the presence of hemoglobin in the urine) and renal failure after treatment, it may indicate a condition called blackwater fever, which is caused by Plasmodium falciparum. In this condition, an autoimmune reaction occurs between the parasite and quinine, leading to the destruction of red blood cells, hemoglobinuria, jaundice, and renal failure. Blackwater fever can be life-threatening.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - A 2-year-old girl is brought in by her father with a reported high...

    Incorrect

    • A 2-year-old girl is brought in by her father with a reported high temperature at home. The triage nurse measures her temperature again as part of her initial assessment.
      Which of the following is suggested by NICE as being an acceptable method of measuring body temperature in this age group?

      Your Answer:

      Correct Answer: Infra-red tympanic thermometer

      Explanation:

      In infants who are less than 4 weeks old, it is recommended to measure their body temperature using an electronic thermometer placed in the armpit.

      For children between the ages of 4 weeks and 5 years, there are several methods that can be used to measure body temperature. These include using an electronic thermometer in the armpit, a chemical dot thermometer in the armpit, or an infra-red tympanic thermometer.

      It is important to note that measuring temperature orally or rectally should be avoided in this age group. Additionally, forehead chemical thermometers are not reliable and should not be used.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A student nurse on a clinical rotation in the Emergency Department experiences a...

    Incorrect

    • A student nurse on a clinical rotation in the Emergency Department experiences a needlestick injury from a patient with a history of chronic hepatitis B.
      Which ONE statement about hepatitis B prophylaxis is accurate?

      Your Answer:

      Correct Answer: An accelerated regime is available for post-exposure prophylaxis

      Explanation:

      Hepatitis B vaccination is included in the routine childhood immunisation schedule to provide long-term protection against hepatitis for children under 1 year of age. For these children, the vaccination consists of a primary course that includes the diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenza type B vaccine. This primary course is given at 4 weekly intervals.

      The Hepatitis B vaccine is a conjugate vaccine that contains a surface antigen of the hepatitis virus (HBsAg) and is combined with an aluminium adjuvant to enhance its effectiveness. It is produced using a recombinant DNA technique.

      When administering the vaccine to adults and older children, the preferred injection site is the deltoid muscle. However, in younger children, the anterolateral thigh is the preferred site. It is not recommended to inject the vaccine in the gluteal area as it has been found to have reduced efficacy.

      The standard vaccination regime for Hepatitis B consists of three primary doses. The initial dose is followed by further doses at one and six months later. A booster dose is recommended at five years if the individual is still at risk.

      In cases of post-exposure prophylaxis, an accelerated vaccination regime is used. This involves administering a vaccination at the time of exposure, followed by repeat doses at one and two months later.

      In high-risk situations, Hepatitis B immunoglobulin can be given up to 7 days after exposure. Ideally, it should be administered within 12 hours, but according to the BNF, it can still be effective if given within 7 days after exposure.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - A young toddler is brought in by his father with a high temperature...

    Incorrect

    • A young toddler is brought in by his father with a high temperature at home. The triage nurse measures his temperature again as part of her initial evaluation.

      Which SINGLE statement regarding temperature measurement in young children is accurate?

      Your Answer:

      Correct Answer: The rectal route should not be used to measure temperature

      Explanation:

      Reported parental perception of a fever should be regarded as valid and taken seriously by healthcare professionals.

      For infants under the age of 4 weeks, it is recommended to measure body temperature using an electronic thermometer in the axilla.

      In children aged 4 weeks to 5 years, body temperature can be measured using one of the following methods: an electronic thermometer in the axilla, a chemical dot thermometer in the axilla, or an infra-red tympanic thermometer.

      It is important to note that oral and rectal routes should not be utilized for temperature measurement in this age group. Additionally, forehead chemical thermometers are not reliable and should be avoided.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - You evaluate a 68-year-old individual who has been admitted to the emergency department...

    Incorrect

    • You evaluate a 68-year-old individual who has been admitted to the emergency department with suspected sepsis. Upon assessment, you observe that the patient is experiencing hypotension and you intend to prescribe intravenous fluids. In the case of a septic patient with hypotension, what is the recommended initial volume for intravenous fluid therapy in an adult?

      Your Answer:

      Correct Answer: 30 ml/kg of crystalloid fluid

      Explanation:

      For patients with sepsis and hypotension, it is recommended to administer 30ml of crystalloid fluid per kilogram of body weight. However, if the patient does not have acute kidney injury, is not hypotensive, and has a lactate level below 2 mmol/l, a 500ml immediate dose may be given.

      Further Reading:

      There are multiple definitions of sepsis, leading to confusion among healthcare professionals. The Sepsis 3 definition describes sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. The Sepsis 2 definition includes infection plus two or more SIRS criteria. The NICE definition states that sepsis is a clinical syndrome triggered by the presence of infection in the blood, activating the body’s immune and coagulation systems. The Sepsis Trust defines sepsis as a dysregulated host response to infection mediated by the immune system, resulting in organ dysfunction, shock, and potentially death.

      The confusion surrounding sepsis terminology is further compounded by the different versions of sepsis definitions, known as Sepsis 1, Sepsis 2, and Sepsis 3. The UK organizations RCEM and NICE have not fully adopted the changes introduced in Sepsis 3, causing additional confusion. While Sepsis 3 introduces the use of SOFA scores and abandons SIRS criteria, NICE and the Sepsis Trust have rejected the use of SOFA scores and continue to rely on SIRS criteria. This discrepancy creates challenges for emergency department doctors in both exams and daily clinical practice.

      To provide some clarity, RCEM now recommends referring to national standards organizations such as NICE, SIGN, BTS, or others relevant to the area. The Sepsis Trust, in collaboration with RCEM and NICE, has published a toolkit that serves as a definitive reference point for sepsis management based on the sepsis 3 update.

      There is a consensus internationally that the terms SIRS and severe sepsis are outdated and should be abandoned. Instead, the terms sepsis and septic shock should be used. NICE defines septic shock as a life-threatening condition characterized by low blood pressure despite adequate fluid replacement and organ dysfunction or failure. Sepsis 3 defines septic shock as persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mmHg or more, along with a serum lactate level greater than 2 mmol/l despite adequate volume resuscitation.

      NICE encourages clinicians to adopt an approach of considering sepsis in all patients, rather than relying solely on strict definitions. Early warning or flag systems can help identify patients with possible sepsis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - You receive a needlestick injury after drawing blood from a 45-year-old patient. The...

    Incorrect

    • You receive a needlestick injury after drawing blood from a 45-year-old patient. The patient is visiting due to experiencing frequent heart palpitations. Her only significant medical history is hypothyroidism, for which she is prescribed thyroxine.

      What should be your initial course of action in this situation?

      Your Answer:

      Correct Answer: Wash the wound with soap and water and gently encourage bleeding

      Explanation:

      First and foremost, the immediate concern is providing first aid for the wound. It is important to wash the wound with soap (or chlorhexidine) and water, while gently encouraging bleeding. It is crucial not to scrub or suck the wound. Additionally, if there are any splashes or body fluid that come into contact with the eyes or mouth, they should be thoroughly washed.

      For all healthcare workers who experience a needlestick injury, it is necessary to have a baseline serum sample taken and stored. This should be arranged through occupational health. The subsequent management of the injury depends on the risk of blood-borne virus transmission. This risk is determined by factors such as the source patient’s history (e.g. IV drug use), the circumstances of the injury (e.g. visible blood on the device, use of personal protection equipment), and the healthcare worker’s own characteristics (e.g. response to hepatitis B vaccination).

      If the patient consents after appropriate counseling, blood may be taken from the source patient for blood-borne virus testing. However, it is important to note that the injured healthcare worker should not be responsible for counseling and obtaining consent from the patient. Lastly, all needlestick injuries should be reported to the Health Protection Agency.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 17 - You are asked to participate in an ENT teaching session for the FY1's...

    Incorrect

    • You are asked to participate in an ENT teaching session for the FY1's rotating to the emergency department and prepare slides on glandular fever.

      What is the most frequent cause of glandular fever in adolescents?

      Your Answer:

      Correct Answer: Epstein-Barr virus

      Explanation:

      Infectious mononucleosis, also known as glandular fever, is a condition that is not clearly defined in medical literature. It is characterized by symptoms such as a sore throat, swollen tonsils with a whitish coating, enlarged lymph nodes in the neck, fatigue, and an enlarged liver and spleen. This condition is caused by a specific virus.

      Further Reading:

      Glandular fever, also known as infectious mononucleosis or mono, is a clinical syndrome characterized by symptoms such as sore throat, fever, and swollen lymph nodes. It is primarily caused by the Epstein-Barr virus (EBV), with other viruses and infections accounting for the remaining cases. Glandular fever is transmitted through infected saliva and primarily affects adolescents and young adults. The incubation period is 4-8 weeks.

      The majority of EBV infections are asymptomatic, with over 95% of adults worldwide having evidence of prior infection. Clinical features of glandular fever include fever, sore throat, exudative tonsillitis, lymphadenopathy, and prodromal symptoms such as fatigue and headache. Splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may also be present, and a non-pruritic macular rash can sometimes occur.

      Glandular fever can lead to complications such as splenic rupture, which increases the risk of rupture in the spleen. Approximately 50% of splenic ruptures associated with glandular fever are spontaneous, while the other 50% follow trauma. Diagnosis of glandular fever involves various investigations, including viral serology for EBV, monospot test, and liver function tests. Additional serology tests may be conducted if EBV testing is negative.

      Management of glandular fever involves supportive care and symptomatic relief with simple analgesia. Antiviral medication has not been shown to be beneficial. It is important to identify patients at risk of serious complications, such as airway obstruction, splenic rupture, and dehydration, and provide appropriate management. Patients can be advised to return to normal activities as soon as possible, avoiding heavy lifting and contact sports for the first month to reduce the risk of splenic rupture.

      Rare but serious complications associated with glandular fever include hepatitis, upper airway obstruction, cardiac complications, renal complications, neurological complications, haematological complications, chronic fatigue, and an increased risk of lymphoproliferative cancers and multiple sclerosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - A 28 year old IV drug user comes to the emergency department with...

    Incorrect

    • A 28 year old IV drug user comes to the emergency department with complaints of feeling sick. Considering the history of IV drug abuse, there is concern for infective endocarditis. Which structure is most likely to be impacted in this individual?

      Your Answer:

      Correct Answer: Tricuspid valve

      Explanation:

      The tricuspid valve is the most commonly affected valve in cases of infective endocarditis among intravenous drug users. This means that when IV drug users develop infective endocarditis, it is most likely to affect the tricuspid valve. On the other hand, in cases of native valve endocarditis and prosthetic valve endocarditis, the mitral valve is the valve that is most commonly affected.

      Further Reading:

      Infective endocarditis (IE) is an infection that affects the innermost layer of the heart, known as the endocardium. It is most commonly caused by bacteria, although it can also be caused by fungi or viruses. IE can be classified as acute, subacute, or chronic depending on the duration of illness. Risk factors for IE include IV drug use, valvular heart disease, prosthetic valves, structural congenital heart disease, previous episodes of IE, hypertrophic cardiomyopathy, immune suppression, chronic inflammatory conditions, and poor dental hygiene.

      The epidemiology of IE has changed in recent years, with Staphylococcus aureus now being the most common causative organism in most industrialized countries. Other common organisms include coagulase-negative staphylococci, streptococci, and enterococci. The distribution of causative organisms varies depending on whether the patient has a native valve, prosthetic valve, or is an IV drug user.

      Clinical features of IE include fever, heart murmurs (most commonly aortic regurgitation), non-specific constitutional symptoms, petechiae, splinter hemorrhages, Osler’s nodes, Janeway’s lesions, Roth’s spots, arthritis, splenomegaly, meningism/meningitis, stroke symptoms, and pleuritic pain.

      The diagnosis of IE is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Major criteria include positive blood cultures with typical microorganisms and positive echocardiogram findings. Minor criteria include fever, vascular phenomena, immunological phenomena, and microbiological phenomena. Blood culture and echocardiography are key tests for diagnosing IE.

      In summary, infective endocarditis is an infection of the innermost layer of the heart that is most commonly caused by bacteria. It can be classified as acute, subacute, or chronic and can be caused by a variety of risk factors. Staphylococcus aureus is now the most common causative organism in most industrialized countries. Clinical features include fever, heart murmurs, and various other symptoms. The diagnosis is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Blood culture and echocardiography are important tests for diagnosing IE.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - A 23-year-old arrives at the emergency department complaining of fatigue, a severe sore...

    Incorrect

    • A 23-year-old arrives at the emergency department complaining of fatigue, a severe sore throat, and swollen neck glands that have persisted for more than a week. He visited his primary care physician yesterday and was prescribed amoxicillin. However, today he woke up with a rash all over his body and his throat has not improved. During the examination, a widespread non-blanching maculopapular rash is observed.

      What is the probable underlying cause of the patient's symptoms?

      Your Answer:

      Correct Answer: Epstein-Barr virus

      Explanation:

      In cases of acute glandular fever, certain antibiotics like ampicillin and amoxicillin can potentially cause severe rashes that affect the entire body and specifically the extremities. The exact cause of these rashes is still unknown. If there is uncertainty in the diagnosis and the clinician wants to cover the possibility of streptococcal tonsillitis, it is recommended to use phenoxymethylpenicillin (penicillin V) as the preferred treatment.

      Further Reading:

      Glandular fever, also known as infectious mononucleosis or mono, is a clinical syndrome characterized by symptoms such as sore throat, fever, and swollen lymph nodes. It is primarily caused by the Epstein-Barr virus (EBV), with other viruses and infections accounting for the remaining cases. Glandular fever is transmitted through infected saliva and primarily affects adolescents and young adults. The incubation period is 4-8 weeks.

      The majority of EBV infections are asymptomatic, with over 95% of adults worldwide having evidence of prior infection. Clinical features of glandular fever include fever, sore throat, exudative tonsillitis, lymphadenopathy, and prodromal symptoms such as fatigue and headache. Splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may also be present, and a non-pruritic macular rash can sometimes occur.

      Glandular fever can lead to complications such as splenic rupture, which increases the risk of rupture in the spleen. Approximately 50% of splenic ruptures associated with glandular fever are spontaneous, while the other 50% follow trauma. Diagnosis of glandular fever involves various investigations, including viral serology for EBV, monospot test, and liver function tests. Additional serology tests may be conducted if EBV testing is negative.

      Management of glandular fever involves supportive care and symptomatic relief with simple analgesia. Antiviral medication has not been shown to be beneficial. It is important to identify patients at risk of serious complications, such as airway obstruction, splenic rupture, and dehydration, and provide appropriate management. Patients can be advised to return to normal activities as soon as possible, avoiding heavy lifting and contact sports for the first month to reduce the risk of splenic rupture.

      Rare but serious complications associated with glandular fever include hepatitis, upper airway obstruction, cardiac complications, renal complications, neurological complications, haematological complications, chronic fatigue, and an increased risk of lymphoproliferative cancers and multiple sclerosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A 75-year-old patient presents to the emergency department complaining of offensive smelling diarrhea...

    Incorrect

    • A 75-year-old patient presents to the emergency department complaining of offensive smelling diarrhea and discomfort in the lower abdomen for the past 5 days. The patient had a previous episode of clostridium difficile diarrhea 4 months ago and recently completed a course of amoxicillin for a respiratory infection 12 days ago. The patient's primary care physician sent a stool sample for testing 3 days ago, which came back positive for clostridium difficile. Based on the diagnosis of a moderate clostridium difficile infection, what is the most appropriate treatment for this patient?

      Your Answer:

      Correct Answer: Prescribe vancomycin 125 mg orally QDS for 10 days

      Explanation:

      The first-line treatment for C.diff infection is typically oral vancomycin. When managing moderate cases, it is important to stop the antibiotics that caused the infection, ensure proper hydration, and provide guidance on hygiene measures. The recommended treatment is to prescribe oral vancomycin 125 mg four times a day for 10 days. Alternatively, fidaxomicin 200 mg twice a day for 10 days can be used as a second-line treatment. In severe cases, oral vancomycin may be combined with intravenous metronidazole, but it is advisable to consult with a local microbiologist or infectious disease specialist before proceeding.

      Further Reading:

      Clostridium difficile (C.diff) is a gram positive rod commonly found in hospitals. Some strains of C.diff produce exotoxins that can cause intestinal damage, leading to pseudomembranous colitis. This infection can range from mild diarrhea to severe illness. Antibiotic-associated diarrhea is often caused by C.diff, with 20-30% of cases being attributed to this bacteria. Antibiotics such as clindamycin, cephalosporins, fluoroquinolones, and broad-spectrum penicillins are frequently associated with C.diff infection.

      Clinical features of C.diff infection include diarrhea, distinctive smell, abdominal pain, raised white blood cell count, and in severe cases, toxic megacolon. In some severe cases, diarrhea may be absent due to the infection causing paralytic ileus. Diagnosis is made by detecting Clostridium difficile toxin (CDT) in the stool. There are two types of exotoxins produced by C.diff, toxin A and toxin B, which cause mucosal damage and the formation of a pseudomembrane in the colon.

      Risk factors for developing C.diff infection include age over 65, antibiotic treatment, previous C.diff infection, exposure to infected individuals, proton pump inhibitor or H2 receptor antagonist use, prolonged hospitalization or residence in a nursing home, and chronic disease or immunosuppression. Complications of C.diff infection can include toxic megacolon, colon perforation, sepsis, and even death, especially in frail elderly individuals.

      Management of C.diff infection involves stopping the causative antibiotic if possible, optimizing hydration with IV fluids if necessary, and assessing the severity of the infection. Treatment options vary based on severity, ranging from no antibiotics for mild cases to vancomycin or fidaxomicin for moderate cases, and hospital protocol antibiotics (such as oral vancomycin with IV metronidazole) for severe or life-threatening cases. Severe cases may require admission under gastroenterology or GI surgeons.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - A 28 year old IV drug user presents to the emergency department with...

    Incorrect

    • A 28 year old IV drug user presents to the emergency department with complaints of feeling ill. Considering the history of IV drug abuse, there is a concern for infective endocarditis. What is the most characteristic clinical manifestation of infective endocarditis?

      Your Answer:

      Correct Answer: Fever

      Explanation:

      The most common symptom of infective endocarditis is fever, which occurs in the majority of cases and is consistently present throughout the course of the disease. Cardiac murmurs are also frequently detected, although they may only be present in one third of patients at the initial presentation. Individuals who use intravenous drugs often develop right-sided disease affecting the tricuspid and pulmonary valves, making it challenging to detect cardiac murmurs in these cases. Splinter hemorrhages and other symptoms may also be observed.

      Further Reading:

      Infective endocarditis (IE) is an infection that affects the innermost layer of the heart, known as the endocardium. It is most commonly caused by bacteria, although it can also be caused by fungi or viruses. IE can be classified as acute, subacute, or chronic depending on the duration of illness. Risk factors for IE include IV drug use, valvular heart disease, prosthetic valves, structural congenital heart disease, previous episodes of IE, hypertrophic cardiomyopathy, immune suppression, chronic inflammatory conditions, and poor dental hygiene.

      The epidemiology of IE has changed in recent years, with Staphylococcus aureus now being the most common causative organism in most industrialized countries. Other common organisms include coagulase-negative staphylococci, streptococci, and enterococci. The distribution of causative organisms varies depending on whether the patient has a native valve, prosthetic valve, or is an IV drug user.

      Clinical features of IE include fever, heart murmurs (most commonly aortic regurgitation), non-specific constitutional symptoms, petechiae, splinter hemorrhages, Osler’s nodes, Janeway’s lesions, Roth’s spots, arthritis, splenomegaly, meningism/meningitis, stroke symptoms, and pleuritic pain.

      The diagnosis of IE is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Major criteria include positive blood cultures with typical microorganisms and positive echocardiogram findings. Minor criteria include fever, vascular phenomena, immunological phenomena, and microbiological phenomena. Blood culture and echocardiography are key tests for diagnosing IE.

      In summary, infective endocarditis is an infection of the innermost layer of the heart that is most commonly caused by bacteria. It can be classified as acute, subacute, or chronic and can be caused by a variety of risk factors. Staphylococcus aureus is now the most common causative organism in most industrialized countries. Clinical features include fever, heart murmurs, and various other symptoms. The diagnosis is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Blood culture and echocardiography are important tests for diagnosing IE.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 22 - You evaluate a 32-year-old man with a previous history of intravenous drug use....

    Incorrect

    • You evaluate a 32-year-old man with a previous history of intravenous drug use. He acknowledges sharing needles in the past. Currently, he presents with symptoms resembling the flu and a skin rash. You suspect that he might be going through an HIV seroconversion illness.
      Choose from the following options the test that can provide the most accurate diagnosis of HIV during this stage.

      Your Answer:

      Correct Answer: p24 antigen test

      Explanation:

      ELISA and other antibody tests are highly sensitive methods for detecting the presence of HIV. However, they cannot be used in the early stages of the disease. There is usually a window period of 6-12 weeks before antibodies are produced, and these tests will yield negative results during a seroconversion illness.

      The p24 antigen, which is the viral protein that forms the majority of the HIV core, is present in high concentrations in the first few weeks after infection. Therefore, the p24 antigen test is a valuable tool for diagnosing very early infections, such as those occurring during a seroconversion illness.

      During the early stages of HIV infection, CD4 and CD8 counts are typically within the normal range and cannot be used for diagnosis in such cases.

      The ‘rapid HIV test’ is an antibody test for HIV. Consequently, it will also yield negative results during the early ‘window period’. This test is referred to as ‘rapid’ because it can detect antibodies in blood or saliva much faster than other antibody tests, with results often available within 20 minutes.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 23 - A 52-year-old type 2 diabetic visits the emergency department on the weekend complaining...

    Incorrect

    • A 52-year-old type 2 diabetic visits the emergency department on the weekend complaining of persistent bloody diarrhea and developing a fever over the past three days. During triage, the patient's temperature is recorded as 38.5ºC. The patient mentions seeing their general practitioner on the day the symptoms started, and due to recent travel to the Middle East, a stool sample was sent for testing. Upon reviewing the pathology result, it is found that the stool sample tested positive for campylobacter. The decision is made to prescribe antibiotics. What is the most appropriate choice?

      Your Answer:

      Correct Answer: Clarithromycin

      Explanation:

      According to NICE guidelines, when treating a campylobacter infection, clarithromycin is recommended as the first choice of antibiotic. Antibiotics are typically only prescribed for individuals with severe symptoms, such as a high fever, bloody or frequent diarrhea, or for those who have a weakened immune system, like this patient who has diabetes. NICE advises a dosage of clarithromycin 250-500 mg taken twice daily for a duration of 5-7 days. It is best to start treatment within 3 days of the onset of illness.

      Further Reading:

      Campylobacter jejuni is a common cause of gastrointestinal infections, particularly travellers diarrhoea. It is a gram-negative bacterium that appears as curved rods. The infection is transmitted through the feco-oral route, often through the ingestion of contaminated meat, especially poultry. The incubation period for Campylobacter jejuni is typically 1-7 days, and the illness usually lasts for about a week.

      The main symptoms of Campylobacter jejuni infection include watery, and sometimes bloody, diarrhea accompanied by abdominal cramps, fever, malaise, and headache. In some cases, complications can arise from the infection. Guillain-Barre syndrome (GBS) is one such complication that is associated with Campylobacter jejuni. Approximately 30% of GBS cases are caused by this bacterium.

      When managing Campylobacter jejuni infection, conservative measures are usually sufficient, with a focus on maintaining hydration. However, in cases where symptoms are severe, such as high fever, bloody diarrhea, or high-output diarrhea, or if the person is immunocompromised, antibiotics may be necessary. NICE recommends the use of clarithromycin, administered at a dose of 250-500 mg twice daily for 5-7 days, starting within 3 days of the onset of illness.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 24 - You are asked to evaluate a 14 year old who has arrived at...

    Incorrect

    • You are asked to evaluate a 14 year old who has arrived at the emergency department with a sore throat, fatigue, and fever lasting for 5 days. After conducting your examination, you inform the patient that you suspect she may have mononucleosis.

      Which of the following is a commonly known complication of mononucleosis?

      Your Answer:

      Correct Answer: Splenic rupture

      Explanation:

      Glandular fever, also known as infectious mononucleosis, can lead to a rare but potentially life-threatening complication called splenic rupture. Although splenomegaly (enlarged spleen) is common in glandular fever, it often does not cause any symptoms and cannot be felt during a physical examination. However, this increases the risk of splenic rupture, which can occur spontaneously or with minimal trauma. The spleen typically reaches its maximum size around two weeks into the illness before gradually shrinking. To prevent splenic rupture, patients are advised to avoid heavy lifting and contact sports for at least one month from the onset of the illness. Other complications of glandular fever include prolonged fatigue, mild hepatitis leading to jaundice, thrombocytopenia (low platelet count) with an increased risk of bleeding, neurological conditions such as Guillain-Barré syndrome, optic neuritis, Bell’s palsy, myocarditis, and nephritis.

      Further Reading:

      Glandular fever, also known as infectious mononucleosis or mono, is a clinical syndrome characterized by symptoms such as sore throat, fever, and swollen lymph nodes. It is primarily caused by the Epstein-Barr virus (EBV), with other viruses and infections accounting for the remaining cases. Glandular fever is transmitted through infected saliva and primarily affects adolescents and young adults. The incubation period is 4-8 weeks.

      The majority of EBV infections are asymptomatic, with over 95% of adults worldwide having evidence of prior infection. Clinical features of glandular fever include fever, sore throat, exudative tonsillitis, lymphadenopathy, and prodromal symptoms such as fatigue and headache. Splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may also be present, and a non-pruritic macular rash can sometimes occur.

      Glandular fever can lead to complications such as splenic rupture, which increases the risk of rupture in the spleen. Approximately 50% of splenic ruptures associated with glandular fever are spontaneous, while the other 50% follow trauma. Diagnosis of glandular fever involves various investigations, including viral serology for EBV, monospot test, and liver function tests. Additional serology tests may be conducted if EBV testing is negative.

      Management of glandular fever involves supportive care and symptomatic relief with simple analgesia. Antiviral medication has not been shown to be beneficial. It is important to identify patients at risk of serious complications, such as airway obstruction, splenic rupture, and dehydration, and provide appropriate management. Patients can be advised to return to normal activities as soon as possible, avoiding heavy lifting and contact sports for the first month to reduce the risk of splenic rupture.

      Rare but serious complications associated with glandular fever include hepatitis, upper airway obstruction, cardiac complications, renal complications, neurological complications, haematological complications, chronic fatigue, and an increased risk of lymphoproliferative cancers and multiple sclerosis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 25 - A 32-year-old man is brought to the hospital with a known notifiable illness.
    Which...

    Incorrect

    • A 32-year-old man is brought to the hospital with a known notifiable illness.
      Which of the following is the LEAST probable diagnosis?

      Your Answer:

      Correct Answer: Leptospirosis

      Explanation:

      Public Health England (PHE) has a primary goal of promptly identifying potential disease outbreaks and epidemics. While accuracy of diagnosis is important, it is not the main focus. Since 1968, the clinical suspicion of a notifiable infection has been sufficient for reporting purposes.

      Registered medical practitioners (RMPs) are legally obligated to notify the designated proper officer at their local council or local health protection team (HPT) when they suspect cases of certain infectious diseases.

      The Health Protection (Notification) Regulations 2010 specify the diseases that RMPs must report to the proper officers. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.

      It is worth noting that leptospirosis is not considered a notifiable disease, making it the least likely option among the diseases listed above.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 26 - You evaluate a 30-year-old woman with a confirmed diagnosis of HIV. She inquires...

    Incorrect

    • You evaluate a 30-year-old woman with a confirmed diagnosis of HIV. She inquires about her diagnosis and has some questions for you.
      Choose from the options provided below the ONE CD4 count that indicates advanced HIV disease (also referred to as AIDS).

      Your Answer:

      Correct Answer: 200 cells/mm3

      Explanation:

      A normal CD4 count ranges from 500-1000 cells/mm3. In individuals diagnosed with HIV, the CD4 count is typically monitored every 3-6 months. It is important to note that the CD4 count can fluctuate on a daily basis and can be influenced by the timing of the blood test as well as the presence of other infections or illnesses.

      When the CD4 count falls below 350 cells/mm3, it is recommended to consider starting antiretroviral therapy. A CD4 count below 200 cells/mm3 is indicative of advanced HIV disease, also known as AIDS defining.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 27 - A child under your supervision is diagnosed with a reportable illness.
    Select from the...

    Incorrect

    • A child under your supervision is diagnosed with a reportable illness.
      Select from the options below the one condition that is currently a reportable illness.

      Your Answer:

      Correct Answer: Scarlet fever

      Explanation:

      The Health Protection (Notification) Regulations currently require the reporting of certain diseases. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ Disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, SARS, scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 28 - A 25-year-old individual comes in with a fever and symptoms resembling the flu....

    Incorrect

    • A 25-year-old individual comes in with a fever and symptoms resembling the flu. They also complain of muscle pain, diarrhea, and a dry cough. During the examination, their temperature is measured at 38.3°C and they exhibit tenderness in the upper right quadrant of their abdomen. Upon further inquiry, it is revealed that they recently returned from a backpacking trip to Malawi, where they recall developing blisters on their ankles after swimming in a lake. Blood tests indicate a significant increase in eosinophils.

      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Schistosomiasis

      Explanation:

      Schistosomiasis, also known as bilharzia, is a tropical disease caused by parasitic trematodes (flukes) of the Schistosoma type. The transmission of this disease occurs when water becomes contaminated with faeces or urine containing eggs, and a specific freshwater snail serves as the intermediate host. Human contact with water inhabited by the intermediate host snail is necessary for transmission to occur.

      There are five species of Schistosoma that can cause human disease, namely S. japonicum, S. mansoni, S. haematobium, S. intercalatum, and S. mekongi. Schistosomiasis is the second most impactful tropical disease in terms of public health, following malaria, with over 200 million people worldwide being infected. It is prevalent in the Middle East, Africa, and parts of South America and the Caribbean. Infection can manifest as either acute or chronic.

      Acute schistosomiasis is characterized by the early clinical sign of swimmers itch, which involves the development of blisters and an urticarial response at the site where the Schistosoma parasite enters the skin. This typically occurs a few days after the parasite has penetrated the skin. While most acute infections are asymptomatic, some individuals may experience an acute syndrome.

      The most common acute syndrome is known as Katayama fever, which primarily affects children or young adults with no previous exposure to the disease. It is caused by an allergic reaction to the sudden release of highly antigenic eggs and usually occurs a few weeks after initial exposure to S. japonicum. Symptoms of Katayama fever include fever, flu-like illness, arthralgia, myalgia, abdominal pain, diarrhea, and cough. Patients may also exhibit right upper quadrant tenderness and hepatosplenomegaly. An extremely high eosinophil count is often present.

      Chronic schistosomiasis can manifest in two major forms: intestinal and urogenital. Intestinal schistosomiasis is primarily caused by S. japonicum and S. mansoni, while S. haematobium is the main cause of urogenital schistosomiasis. In intestinal schistosomiasis, adult worms migrate from the liver to the mesenteric venules, where female worms continuously lay eggs. Common symptoms include abdominal pain and bloody diarrhea.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 29 - A 3-year-old girl presents with a temperature of 39 degrees. She appears fussy,...

    Incorrect

    • A 3-year-old girl presents with a temperature of 39 degrees. She appears fussy, and a non-blanching rash is observed on her abdomen. Tragically, she passes away later that day from Meningococcal septicaemia.

      To whom should a report be submitted?

      Your Answer:

      Correct Answer: Consultant in Communicable Disease Control

      Explanation:

      Registered medical practitioners in England and Wales are legally obligated to inform a designated official from the Local Authority if they suspect a patient has contracted specific infectious diseases. For more information on which diseases and their causative organisms require reporting, please refer to the following resource: Notifiable diseases and causative organisms: how to report.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 30 - A 28-year-old medical student has experienced a needlestick injury while working in the...

    Incorrect

    • A 28-year-old medical student has experienced a needlestick injury while working in the Emergency Department.
      Select from the list of options below the single correct seroconversion rate for the specified pathogen.

      Your Answer:

      Correct Answer: 0.3% for percutaneous exposure to HIV-infected blood

      Explanation:

      The estimated rates of seroconversion are provided below:

      – Percutaneous exposure of a non-immune individual to an HBeAg positive contact results in a seroconversion rate of approximately 30%.

      – When exposed to HCV-infected blood with detectable RNA through percutaneous means, the seroconversion rate ranges from 0.5% to 1.8%.

      – Mucocutaneous exposure to HIV-infected blood leads to a seroconversion rate of 0.1%.

      – Lastly, percutaneous exposure to HIV-infected blood results in a seroconversion rate of 0.3%.

      Please note that these rates are estimates and may vary depending on individual circumstances.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 31 - A 2-year-old child is diagnosed with a condition that you identify as a...

    Incorrect

    • A 2-year-old child is diagnosed with a condition that you identify as a notifiable infection. You fill out the notification form and reach out to the local health protection team.
      Which of the following is the LEAST probable diagnosis?

      Your Answer:

      Correct Answer: Roseola infantum

      Explanation:

      Public Health England (PHE) has a primary goal of swiftly identifying potential disease outbreaks and epidemics. While accuracy of diagnosis is important, it is not the main focus. Since 1968, clinical suspicion of a notifiable infection has been sufficient for reporting.
      Registered medical practitioners (RMPs) are legally obligated to notify the designated proper officer at their local council or local health protection team (HPT) if they suspect cases of certain infectious diseases.
      The Health Protection (Notification) Regulations 2010 specify the diseases that RMPs must report to the proper officers at local authorities. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.
      It is worth noting that roseola infantum is not considered a notifiable disease, making it the least likely option among the diseases listed above.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 32 - A 35-year-old traveler returns from a vacation in India with a high temperature...

    Incorrect

    • A 35-year-old traveler returns from a vacation in India with a high temperature and stomach issues. After medical examination, he is confirmed to have typhoid fever.

      Your Answer:

      Correct Answer: The incubation period is between 7 and 21 days

      Explanation:

      Typhoid fever is a bacterial infection caused by Salmonella typhi. Paratyphoid fever, on the other hand, is a similar illness caused by Salmonella paratyphi. Together, these two conditions are collectively known as the enteric fevers.

      Typhoid fever is prevalent in India and many other parts of Asia, Africa, Central America, and South America. It is primarily transmitted through the consumption of contaminated food or water that has been infected by the feces of an acutely infected or recovering person, or a chronic carrier. About 1-6% of individuals infected with S. typhi become chronic carriers. The incubation period for this illness ranges from 7 to 21 days.

      During the first week of the illness, patients experience weakness and lethargy, accompanied by a gradually increasing fever. The onset of the illness is usually subtle, and constipation is more common than diarrhea in the early stages. Other early symptoms include headaches, abdominal pain, and nosebleeds. In cases of typhoid fever, the fever can occur with a relatively slow heart rate, known as Faget’s sign.

      As the illness progresses into the second week, patients often become too fatigued to get out of bed. Diarrhea becomes more prominent, the fever intensifies, and patients may become agitated and delirious. The abdomen may become tender and swollen, and approximately 75% of patients develop an enlarged spleen. In up to a third of patients, red macules known as Rose spots may appear.

      In the third week, the illness can lead to various complications. Intestinal bleeding may occur due to bleeding in congested Peyer’s patches. Other potential complications include intestinal perforation, secondary pneumonia, encephalitis, myocarditis, metastatic abscesses, and septic shock.

      After the third week, surviving patients begin to show signs of improvement, with the fever and symptoms gradually subsiding over the course of 7-14 days. Untreated patients have a mortality rate of 15-30%. Traditionally, drugs like ampicillin and trimethoprim have been used for treatment. However, due to the emergence of multidrug resistant cases, azithromycin or fluoroquinolones are now the primary treatment options.

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      • Infectious Diseases
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  • Question 33 - A traveler contracts a viral haemorrhagic fever while on a backpacking adventure during...

    Incorrect

    • A traveler contracts a viral haemorrhagic fever while on a backpacking adventure during their gap year.
      Which of the following is NOT a viral haemorrhagic fever?

      Your Answer:

      Correct Answer: Chagas disease

      Explanation:

      The viral hemorrhagic fevers (VHFs) are a group of infectious diseases caused by four distinct types of RNA viruses. These include Filoviruses (such as Marburg virus and Ebola), Arenaviruses (like Lassa fever and Argentine haemorrhagic fever), Bunyaviruses (including Hantavirus and Rift Valley fever), and Flavivirus (such as Yellow fever and dengue fever). VHFs are serious multi-system disorders that can be potentially fatal. Each type of VHF has a natural reservoir, which is an animal or insect host, and they are typically found in the areas where these host species reside. Outbreaks of these hemorrhagic fevers occur sporadically and irregularly, making them difficult to predict.

      The typical clinical features of VHFs include fever, headache, myalgia, fatigue, bloody diarrhea, haematemesis, petechial rashes and ecchymoses, edema, confusion and agitation, as well as hypotension and circulatory collapse.

      On the other hand, Chagas disease is not classified as a VHF. It is a tropical disease caused by the protozoan Trypanosoma cruzi. This disease is transmitted by Triatomine insects, commonly known as kissing bugs. Initially, Chagas disease causes a mild acute illness that resembles flu. However, around 10% of individuals develop chronic Chagas disease, which can lead to various complications. These complications include cardiac issues like dilated cardiomyopathy, neurological problems such as neuritis, and gastrointestinal complications like megacolon.

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      • Infectious Diseases
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  • Question 34 - A 25-year-old engineering student returns from a hiking trip in South America with...

    Incorrect

    • A 25-year-old engineering student returns from a hiking trip in South America with a high temperature, body aches, and shivering. After further examination, they are diagnosed with Plasmodium falciparum malaria.

      Which of the following statements about Plasmodium falciparum malaria is correct?

      Your Answer:

      Correct Answer: There may be a continuous fever

      Explanation:

      Plasmodium falciparum malaria is transmitted by female mosquitoes of the Anopheles genus. The Aedes genus, on the other hand, is responsible for spreading diseases like dengue fever and yellow fever. The parasite enters hepatocytes and undergoes asexual reproduction, resulting in the release of merozoites into the bloodstream. These merozoites then invade the red blood cells of the host. The incubation period for Plasmodium falciparum malaria ranges from 7 to 14 days.

      The main symptom of malaria is known as the malarial paroxysm, which consists of a cyclical pattern of cold chills, followed by a stage of intense heat, and finally a period of profuse sweating as the fever subsides. However, some individuals may experience a continuous fever instead.

      Currently, the recommended treatment for P. falciparum malaria is artemisinin-based combination therapy (ACT). This involves combining fast-acting artemisinin-based compounds with drugs from a different class. Companion drugs used in ACT include lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine, and chlorproguanil/dapsone. Artemisinin derivatives such as dihydroartemisinin, artesunate, and artemether are also used.

      If artemisinin combination therapy is not available, oral quinine or atovaquone with proguanil hydrochloride can be used as an alternative. However, quinine is not well-tolerated for prolonged treatment and should be combined with another drug, typically oral doxycycline (or clindamycin for pregnant women and young children).

      Severe or complicated cases of falciparum malaria require specialized care in a high dependency unit or intensive care setting. Intravenous artesunate is recommended for all patients with severe or complicated falciparum malaria, as well as those at high risk of developing severe disease (e.g., if more than 2% of red blood cells are parasitized) or if the patient is unable to take oral treatment. After a minimum of 24 hours of intravenous artesunate treatment and improvement in the patient’s condition, a full course of artemisinin combination therapy should be administered orally.

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      • Infectious Diseases
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  • Question 35 - A 35 year old male comes to the emergency department after being bitten...

    Incorrect

    • A 35 year old male comes to the emergency department after being bitten by a stray dog. The patient has three small puncture wounds and mentions slight bleeding from both puncture wounds after the initial bite that ceased after applying pressure for 10 minutes. The patient inquires about the necessity of antibiotics. What is the most suitable reply?

      Your Answer:

      Correct Answer: Issue a prescription for a 3 day course of co-amoxiclav

      Explanation:

      It is recommended to administer prophylactic oral antibiotics to individuals who have experienced a cat bite that has broken the skin and cause bleeding. For patients over one month of age, co-amoxiclav should be prescribed for a duration of 3 days. In cases where the patient is allergic to penicillin, a combination of metronidazole and doxycycline should be given for 3 days. If the wound shows signs of infection, the antibiotic treatment should be extended to 5 days.

      Prophylactic oral antibiotics may also be considered for individuals with a cat bite that has broken the skin but has not caused bleeding, especially if the wound is deep.

      Debridement, the removal of dead tissue, should be considered for wounds that are damaged, have abscess formation, lymphangitis, severe cellulitis, osteomyelitis, septic arthritis, necrotising fasciitis, or infected bite wounds that are not responding to treatment. Additionally, individuals who are systemically unwell should also undergo debridement.

      Antibiotics should also be considered for other animal bites, such as dog bites, that have broken the skin and cause bleeding.

      Further Reading:

      Bite wounds from animals and humans can cause significant injury and infection. It is important to properly assess and manage these wounds to prevent complications. In human bites, both the biter and the injured person are at risk of infection transmission, although the risk is generally low.

      Bite wounds can take various forms, including lacerations, abrasions, puncture wounds, avulsions, and crush or degloving injuries. The most common mammalian bites are associated with dogs, cats, and humans.

      When assessing a human bite, it is important to gather information about how and when the bite occurred, who was involved, whether the skin was broken or blood was involved, and the nature of the bite. The examination should include vital sign monitoring if the bite is particularly traumatic or sepsis is suspected. The location, size, and depth of the wound should be documented, along with any functional loss or signs of infection. It is also important to check for the presence of foreign bodies in the wound.

      Factors that increase the risk of infection in bite wounds include the nature of the bite, high-risk sites of injury (such as the hands, feet, face, genitals, or areas of poor perfusion), wounds penetrating bone or joints, delayed presentation, immunocompromised patients, and extremes of age.

      The management of bite wounds involves wound care, assessment and administration of prophylactic antibiotics if indicated, assessment and administration of tetanus prophylaxis if indicated, and assessment and administration of antiviral prophylaxis if indicated. For initial wound management, any foreign bodies should be removed, the wound should be encouraged to bleed if fresh, and thorough irrigation with warm, running water or normal saline should be performed. Debridement of necrotic tissue may be necessary. Bite wounds are usually not appropriate for primary closure.

      Prophylactic antibiotics should be considered for human bites that have broken the skin and drawn blood, especially if they involve high-risk areas or the patient is immunocompromised. Co-amoxiclav is the first-line choice for prophylaxis, but alternative antibiotics may be used in penicillin-allergic patients. Antibiotics for wound infection should be based on wound swab culture and sensitivities.

      Tetanus prophylaxis should be administered based on the cleanliness and risk level of the wound, as well as the patient’s vaccination status. Blood-borne virus risk should also be assessed, and testing for hepatitis B, hepatitis C, and HIV should be done.

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  • Question 36 - You are requested to evaluate a 6-year-old child who has arrived at the...

    Incorrect

    • You are requested to evaluate a 6-year-old child who has arrived at the emergency department displaying irritability, conjunctivitis, fever, and a widespread rash. Upon further investigation, you discover that the patient is a refugee and has not received several vaccinations. The diagnosis of measles is confirmed.

      What guidance should you provide regarding the exclusion of this child from school due to measles?

      Your Answer:

      Correct Answer: 4 days from onset of rash

      Explanation:

      The current school exclusion advice for certain infectious diseases with a rash is as follows:

      – For chickenpox, children should be excluded for at least 5 days from the onset of the rash and until all blisters have crusted over.
      – In the case of measles, children should be excluded for 4 days from the onset of the rash, provided they are well enough to attend.
      – Mumps requires a 5-day exclusion after the onset of swelling.
      – Rubella, also known as German measles, requires a 5-day exclusion from the onset of the rash.
      – Scarlet fever necessitates exclusion until 24 hours after starting antibiotic treatment.

      It is important to note that school exclusion advice has undergone changes in recent years, and the information provided above reflects the updated advice as of May 2022.

      Further Reading:

      Measles is a highly contagious viral infection caused by an RNA paramyxovirus. It is primarily spread through aerosol transmission, specifically through droplets in the air. The incubation period for measles is typically 10-14 days, during which patients are infectious from 4 days before the appearance of the rash to 4 days after.

      Common complications of measles include pneumonia, otitis media (middle ear infection), and encephalopathy (brain inflammation). However, a rare but fatal complication called subacute sclerosing panencephalitis (SSPE) can also occur, typically presenting 5-10 years after the initial illness.

      The onset of measles is characterized by a prodrome, which includes symptoms such as irritability, malaise, conjunctivitis, and fever. Before the appearance of the rash, white spots known as Koplik spots can be seen on the buccal mucosa. The rash itself starts behind the ears and then spreads to the entire body, presenting as a discrete maculopapular rash that becomes blotchy and confluent.

      In terms of complications, encephalitis typically occurs 1-2 weeks after the onset of the illness. Febrile convulsions, giant cell pneumonia, keratoconjunctivitis, corneal ulceration, diarrhea, increased incidence of appendicitis, and myocarditis are also possible complications of measles.

      When managing contacts of individuals with measles, it is important to offer the MMR vaccine to children who have not been immunized against measles. The vaccine-induced measles antibody develops more rapidly than that following natural infection, so it should be administered within 72 hours of contact.

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  • Question 37 - A 35 year old female presents to the emergency department complaining of loose...

    Incorrect

    • A 35 year old female presents to the emergency department complaining of loose watery stools, abdominal cramps, and intermittent vomiting for the past 48 hours. The patient mentions that several of her coworkers have been absent from work due to a stomach virus. Based on these symptoms and history, what is the most probable causative organism for this patient's condition?

      Your Answer:

      Correct Answer: Norovirus

      Explanation:

      Norovirus is the leading cause of gastroenteritis in adults in the UK. Viruses are responsible for the majority of cases of infectious diarrhea, with norovirus being the most common culprit in adults. Among young children, rotavirus is the primary pathogen, although its prevalence has decreased since the introduction of a rotavirus vaccine. As of 2023, rotavirus remains the most common cause of viral gastroenteritis in children.

      Further Reading:

      Gastroenteritis is a transient disorder characterized by the sudden onset of diarrhea, with or without vomiting. It is caused by enteric infections with viruses, bacteria, or parasites. The most common viral causes of gastroenteritis in adults include norovirus, rotavirus, and adenovirus. Bacterial pathogens such as Campylobacter jejuni and coli, Escherichia coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Salmonella typhi and paratyphi, and Shigella dysenteriae, flexneri, boydii, and sonnei can also cause gastroenteritis. Parasites such as Cryptosporidium, Entamoeba histolytica, and Giardia intestinalis or Giardia lamblia can also lead to diarrhea.

      Diagnosis of gastroenteritis is usually based on clinical symptoms, and investigations are not required in many cases. However, stool culture may be indicated in certain situations, such as when the patient is systemically unwell or immunocompromised, has acute painful diarrhea or blood in the stool suggesting dysentery, has recently taken antibiotics or acid-suppressing medications, or has not resolved diarrhea by day 7 or has recurrent diarrhea.

      Management of gastroenteritis in adults typically involves advice on oral rehydration. Intravenous rehydration and more intensive treatment may be necessary for patients who are systemically unwell, exhibit severe dehydration, or have intractable vomiting or high-output diarrhea. Antibiotics are not routinely required unless a specific organism is identified that requires treatment. Antidiarrheal drugs, antiemetics, and probiotics are not routinely recommended.

      Complications of gastroenteritis can occur, particularly in young children, the elderly, pregnant women, and immunocompromised individuals. These complications include dehydration, electrolyte disturbance, acute kidney injury, haemorrhagic colitis, haemolytic uraemic syndrome, reactive arthritis, Reiter’s syndrome, aortitis, osteomyelitis, sepsis, toxic megacolon, pancreatitis, sclerosing cholangitis, liver cirrhosis, weight loss, chronic diarrhea, irritable bowel syndrome, inflammatory bowel disease, acquired lactose intolerance, Guillain-Barré syndrome, meningitis, invasive entamoeba infection, and liver abscesses.

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  • Question 38 - A 68 year old female is brought into the emergency home from her...

    Incorrect

    • A 68 year old female is brought into the emergency home from her nursing home due to severe diarrhea for the past 3 days. You observe that over the past month the patient has undergone three rounds of antibiotics for recurrent cellulitis. You contemplate the likelihood of a Clostridium difficile infection. What proportion of antibiotic-associated diarrhea is attributed to Clostridium difficile infection?

      Your Answer:

      Correct Answer: 20-30%

      Explanation:

      Clostridium difficile (C.diff) is a gram positive rod commonly found in hospitals. Some strains of C.diff produce exotoxins that can cause intestinal damage, leading to pseudomembranous colitis. This infection can range from mild diarrhea to severe illness. Antibiotic-associated diarrhea is often caused by C.diff, with 20-30% of cases being attributed to this bacteria. Antibiotics such as clindamycin, cephalosporins, fluoroquinolones, and broad-spectrum penicillins are frequently associated with C.diff infection.

      Clinical features of C.diff infection include diarrhea, distinctive smell, abdominal pain, raised white blood cell count, and in severe cases, toxic megacolon. In some severe cases, diarrhea may be absent due to the infection causing paralytic ileus. Diagnosis is made by detecting Clostridium difficile toxin (CDT) in the stool. There are two types of exotoxins produced by C.diff, toxin A and toxin B, which cause mucosal damage and the formation of a pseudomembrane in the colon.

      Risk factors for developing C.diff infection include age over 65, antibiotic treatment, previous C.diff infection, exposure to infected individuals, proton pump inhibitor or H2 receptor antagonist use, prolonged hospitalization or residence in a nursing home, and chronic disease or immunosuppression. Complications of C.diff infection can include toxic megacolon, colon perforation, sepsis, and even death, especially in frail elderly individuals.

      Management of C.diff infection involves stopping the causative antibiotic if possible, optimizing hydration with IV fluids if necessary, and assessing the severity of the infection. Treatment options vary based on severity, ranging from no antibiotics for mild cases to vancomycin or fidaxomicin for moderate cases, and hospital protocol antibiotics (such as oral vancomycin with IV metronidazole) for severe or life-threatening cases. Severe cases may require admission under gastroenterology or GI surgeons.

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  • Question 39 - A 70-year-old patient arrives at the emergency department complaining of fever, fatigue, and...

    Incorrect

    • A 70-year-old patient arrives at the emergency department complaining of fever, fatigue, and loss of appetite for the past 3 weeks. During the examination, you observe a pansystolic murmur that was not detected during a pre-operative assessment for a cholecystectomy 4 months ago. You start considering the likelihood of infective endocarditis. Which of the following symptoms is commonly associated with infective endocarditis?

      Your Answer:

      Correct Answer: Janeway lesions

      Explanation:

      Infective endocarditis is a condition that can be identified by certain signs, although none of them are definitive proof of the disease. The most reliable indicators are the presence of a heart murmur and a fever. However, there are other signs that are commonly associated with infective endocarditis, including splinter hemorrhages, Osler’s nodes, Janeway lesions, and Roth spots. It is important to note that these signs can also appear in other conditions, and they are not always present in patients with infective endocarditis. In fact, each of these signs is typically found in less than a third of patients diagnosed with the disease.

      Further Reading:

      Infective endocarditis (IE) is an infection that affects the innermost layer of the heart, known as the endocardium. It is most commonly caused by bacteria, although it can also be caused by fungi or viruses. IE can be classified as acute, subacute, or chronic depending on the duration of illness. Risk factors for IE include IV drug use, valvular heart disease, prosthetic valves, structural congenital heart disease, previous episodes of IE, hypertrophic cardiomyopathy, immune suppression, chronic inflammatory conditions, and poor dental hygiene.

      The epidemiology of IE has changed in recent years, with Staphylococcus aureus now being the most common causative organism in most industrialized countries. Other common organisms include coagulase-negative staphylococci, streptococci, and enterococci. The distribution of causative organisms varies depending on whether the patient has a native valve, prosthetic valve, or is an IV drug user.

      Clinical features of IE include fever, heart murmurs (most commonly aortic regurgitation), non-specific constitutional symptoms, petechiae, splinter hemorrhages, Osler’s nodes, Janeway’s lesions, Roth’s spots, arthritis, splenomegaly, meningism/meningitis, stroke symptoms, and pleuritic pain.

      The diagnosis of IE is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Major criteria include positive blood cultures with typical microorganisms and positive echocardiogram findings. Minor criteria include fever, vascular phenomena, immunological phenomena, and microbiological phenomena. Blood culture and echocardiography are key tests for diagnosing IE.

      In summary, infective endocarditis is an infection of the innermost layer of the heart that is most commonly caused by bacteria. It can be classified as acute, subacute, or chronic and can be caused by a variety of risk factors. Staphylococcus aureus is now the most common causative organism in most industrialized countries. Clinical features include fever, heart murmurs, and various other symptoms. The diagnosis is based on the modified Duke criteria, which require the presence of certain major and minor criteria. Blood culture and echocardiography are important tests for diagnosing IE.

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  • Question 40 - A 25-year-old traveler returns from a recent trip to Northern India with frequent...

    Incorrect

    • A 25-year-old traveler returns from a recent trip to Northern India with frequent headaches and occasional fevers. She describes experiencing intense chills, followed by feeling hot and then sweating profusely.

      During examination, she appears drowsy and has a temperature of 38.9°C. There are no noticeable swollen lymph nodes or rash, but upon examining her abdomen, hepatosplenomegaly is observed.

      Today's blood tests reveal the following results:
      - Sodium (Na): 140 mmol/L (135-147 mmol/L)
      - Potassium (K): 4.9 mmol/L (3.5-5.5 mmol/L)
      - Urea: 11.5 mmol/L (2.0-6.6 mmol/L)
      - Creatinine: 268 mmol/L (75-125 mmol/L)

      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Malaria

      Explanation:

      Malaria is a contagious illness that is spread by female mosquitoes of the Anopheles genus. It is caused by a parasitic infection from the Plasmodium genus. There are five species of Plasmodium that can cause disease in humans: Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, and Plasmodium knowlesi.

      The main symptom of malaria is the malarial paroxysm, which is a recurring cycle of cold, hot, and sweating stages. During the cold stage, the patient experiences intense chills, followed by an extremely hot stage, and finally a stage of profuse sweating. Upon examination, the patient may show signs of anemia, jaundice, and have an enlarged liver and spleen, but no signs of swollen lymph nodes.

      Plasmodium falciparum is the most severe form of malaria and is responsible for the majority of deaths. Severe or complicated malaria is indicated by impaired consciousness, seizures, low blood sugar, anemia, kidney damage, difficulty breathing, and spontaneous bleeding. Given the presentation, it is likely that this case involves Plasmodium falciparum.

      Currently, artemisinin-based combination therapy (ACT) is recommended for treating P. falciparum malaria. This involves combining fast-acting artemisinin-based compounds with a drug from a different class. Companion drugs include lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine, and chlorproguanil/dapsone. Artemisinin derivatives include dihydroartemisinin, artesunate, and artemether.

      If ACT is not available, oral quinine or atovaquone with proguanil hydrochloride can be used. Quinine is highly effective but not well tolerated for long-term treatment, so it should be combined with another drug, usually oral doxycycline (or clindamycin for pregnant women and young children).

      Severe or complicated falciparum malaria should be managed in a high dependency unit or intensive care setting. Intravenous artesunate is recommended for all patients with severe or complicated falciparum malaria, or those at high risk of developing severe disease (such as if more than 2% of red blood cells are infected), or

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  • Question 41 - A 6-year-old girl comes to her pediatrician complaining of a headache, neck stiffness,...

    Incorrect

    • A 6-year-old girl comes to her pediatrician complaining of a headache, neck stiffness, and sensitivity to light. Her vital signs are as follows: heart rate 124, blood pressure 86/43, respiratory rate 30, oxygen saturation 95%, and temperature 39.5oC. She has recently developed a rash of small red spots on her legs that do not fade when pressed.
      What is the MOST suitable next course of action in managing this patient?

      Your Answer:

      Correct Answer: Give IM benzylpenicillin 600 mg

      Explanation:

      In a child with a non-blanching rash, it is important to consider the possibility of meningococcal septicaemia. This is especially true if the child appears unwell, has purpura (lesions larger than 2 mm in diameter), a capillary refill time of more than 3 seconds, or neck stiffness. In the UK, most cases of meningococcal septicaemia are caused by Neisseria meningitidis group B.

      In this particular case, the child is clearly very sick and showing signs of septic shock. It is crucial to administer a single dose of benzylpenicillin without delay and arrange for immediate transfer to the nearest Emergency Department via ambulance.

      The recommended doses of benzylpenicillin based on age are as follows:
      – Infants under 1 year of age: 300 mg of IM or IV benzylpenicillin
      – Children aged 1 to 9 years: 600 mg of IM or IV benzylpenicillin
      – Children and adults aged 10 years or older: 1.2 g of IM or IV benzylpenicillin.

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  • Question 42 - A 25-year-old engineering student returns from a hiking trip in South America with...

    Incorrect

    • A 25-year-old engineering student returns from a hiking trip in South America with a high temperature, body pains, and shivering. After further examination, they are diagnosed with malaria.

      Which of the following statements about malaria is correct?

      Your Answer:

      Correct Answer: Haemoglobinuria and renal failure following treatment is suggestive of Plasmodium falciparum

      Explanation:

      Plasmodium ovale has the longest incubation period, which can extend up to 40 days. On the other hand, Plasmodium falciparum has a shorter incubation period of 7-14 days. The transmission of malaria occurs through the female mosquitoes belonging to the Anopheles genus.

      Blackwater fever, which is caused by Plasmodium falciparum, can be indicated by the presence of haemoglobinuria and renal failure following treatment. This condition is a result of an autoimmune reaction between the parasite and quinine, leading to haemolysis, haemoglobinuria, jaundice, and renal failure. It is a potentially fatal complication. The diagnosis of malaria is typically done using the Indirect Fluorescence Antibody Test (IFAT).

      Currently, the recommended treatment for P. falciparum malaria is artemisinin-based combination therapy (ACT). This involves combining fast-acting artemisinin-based compounds with a drug from a different class. Some companion drugs used in ACT include lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine, and chlorproguanil/dapsone. Artemisinin derivatives such as dihydroartemisinin, artesunate, and artemether are also used.

      In cases where artemisinin combination therapy is not available, oral quinine or atovaquone with proguanil hydrochloride can be used as an alternative. However, quinine is highly effective but not well-tolerated in prolonged treatment, so it is usually combined with another drug, typically oral doxycycline (or clindamycin in pregnant women and young children).

      Severe or complicated falciparum malaria requires management in a high dependency unit or intensive care setting. Intravenous artesunate is recommended for all patients with severe or complicated falciparum malaria, or those at high risk of developing severe disease (e.g., if more than 2% of red blood cells are parasitized), or if the patient is unable to take oral treatment. After a minimum of 24 hours of intravenous artesunate treatment and improvement in the patient’s condition, a full course of artemisinin combination therapy should be administered orally.

      The benign malarias, namely P. vivax, P. malariae, and P. ovale,

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  • Question 43 - A 2-year-old child is diagnosed with a condition that you identify as a...

    Incorrect

    • A 2-year-old child is diagnosed with a condition that you identify as a reportable infection. You fill out the notification form and reach out to the local health protection team.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Mumps

      Explanation:

      Public Health England (PHE) has the primary goal of promptly identifying potential disease outbreaks and epidemics. While accuracy of diagnosis is not the main focus, clinical suspicion of a notifiable infection has been sufficient since 1968.

      Registered medical practitioners (RMPs) are legally obligated to inform the designated proper officer at their local council or local health protection team (HPT) about suspected cases of specific infectious diseases.

      The Health Protection (Notification) Regulations 2010 outline the diseases that RMPs must report to the proper officers at local authorities. These diseases include acute encephalitis, acute infectious hepatitis, acute meningitis, acute poliomyelitis, anthrax, botulism, brucellosis, cholera, COVID-19, diphtheria, enteric fever (typhoid or paratyphoid fever), food poisoning, haemolytic uraemic syndrome (HUS), infectious bloody diarrhoea, invasive group A streptococcal disease, Legionnaires’ disease, leprosy, malaria, measles, meningococcal septicaemia, mumps, plague, rabies, rubella, severe acute respiratory syndrome (SARS), scarlet fever, smallpox, tetanus, tuberculosis, typhus, viral haemorrhagic fever (VHF), whooping cough, and yellow fever.

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  • Question 44 - You evaluate a 82 year old who has been admitted to the emergency...

    Incorrect

    • You evaluate a 82 year old who has been admitted to the emergency department due to high fever and worsening disorientation in the past few days. During chest examination, you observe left basal crackles. A chest X-ray confirms the presence of pneumonia. Your diagnosis is pneumonia with suspected sepsis. What is the mortality rate linked to sepsis?

      Your Answer:

      Correct Answer: 30%

      Explanation:

      The mortality rate linked to sepsis can vary depending on various factors such as the patient’s age, overall health, and the severity of the infection. However, on average, the mortality rate for sepsis is estimated to be around 30%.

      Further Reading:

      There are multiple definitions of sepsis, leading to confusion among healthcare professionals. The Sepsis 3 definition describes sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. The Sepsis 2 definition includes infection plus two or more SIRS criteria. The NICE definition states that sepsis is a clinical syndrome triggered by the presence of infection in the blood, activating the body’s immune and coagulation systems. The Sepsis Trust defines sepsis as a dysregulated host response to infection mediated by the immune system, resulting in organ dysfunction, shock, and potentially death.

      The confusion surrounding sepsis terminology is further compounded by the different versions of sepsis definitions, known as Sepsis 1, Sepsis 2, and Sepsis 3. The UK organizations RCEM and NICE have not fully adopted the changes introduced in Sepsis 3, causing additional confusion. While Sepsis 3 introduces the use of SOFA scores and abandons SIRS criteria, NICE and the Sepsis Trust have rejected the use of SOFA scores and continue to rely on SIRS criteria. This discrepancy creates challenges for emergency department doctors in both exams and daily clinical practice.

      To provide some clarity, RCEM now recommends referring to national standards organizations such as NICE, SIGN, BTS, or others relevant to the area. The Sepsis Trust, in collaboration with RCEM and NICE, has published a toolkit that serves as a definitive reference point for sepsis management based on the sepsis 3 update.

      There is a consensus internationally that the terms SIRS and severe sepsis are outdated and should be abandoned. Instead, the terms sepsis and septic shock should be used. NICE defines septic shock as a life-threatening condition characterized by low blood pressure despite adequate fluid replacement and organ dysfunction or failure. Sepsis 3 defines septic shock as persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mmHg or more, along with a serum lactate level greater than 2 mmol/l despite adequate volume resuscitation.

      NICE encourages clinicians to adopt an approach of considering sepsis in all patients, rather than relying solely on strict definitions. Early warning or flag systems can help identify patients with possible sepsis.

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      • Infectious Diseases
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  • Question 45 - A 2-year-old toddler is brought to the Emergency Department by his father with...

    Incorrect

    • A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
      Based on the NICE traffic light system, which of the subsequent symptoms or signs indicate a low risk of a serious illness?

      Your Answer:

      Correct Answer: Not crying

      Explanation:

      The traffic light system is a useful tool for evaluating the potential risk of serious illness in children. This system categorizes clinical features into three groups based on severity: red (high-risk), amber (intermediate-risk), and green (low-risk).

      Children displaying any of the following symptoms or signs fall into the high-risk group for serious illness: pale/mottled/ashen/blue skin, lips or tongue; lack of response to social cues; appearing unwell to a healthcare professional; inability to wake or stay awake when roused; weak, high-pitched, or continuous cry; grunting; respiratory rate exceeding 60 breaths per minute; moderate or severe chest indrawing; reduced skin turgor; and bulging fontanelle.

      Children exhibiting any of the following symptoms or signs are considered at least intermediate-risk for serious illness: pallor of skin, lips or tongue reported by parent or caregiver; abnormal response to social cues; absence of a smile; waking only with prolonged stimulation; decreased activity; nasal flaring; dry mucous membranes; poor feeding in infants; reduced urine output; and rigors.

      Children displaying any of the following symptoms or signs are classified as low-risk for serious illness: normal color of skin, lips, and tongue; normal response to social cues; contentment and smiles; staying awake or quickly awakening; strong normal cry or absence of crying; normal skin and eyes; and moist mucous membranes.

      To summarize, children with fever and any symptoms or signs in the red column are considered high-risk, while those with fever and any symptoms or signs in the amber column (but none in the red column) are considered intermediate-risk. Children with symptoms and signs in the green column (and none in the amber or red columns) are classified as low-risk.

      For more information, you can refer to the NICE guidelines on the assessment and initial management of fever in children under 5, as well as the NICE Clinical Knowledge Summary on the management of feverish children.

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      • Infectious Diseases
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  • Question 46 - A 25-year-old woman presents with a 5-day history of a painful throat, high...

    Incorrect

    • A 25-year-old woman presents with a 5-day history of a painful throat, high temperature, diarrhea, and muscle aches. Her temperature today is 38.6°C. Approximately 8 months ago, she began misusing intravenous drugs and acknowledges sharing needles. During the examination, you confirm the existence of lymph node swelling in the neck and armpits. Additionally, she has developed a widespread rash consisting of small raised bumps on her chest and abdomen.

      Select from the options below the most probable diagnosis.

      Your Answer:

      Correct Answer: HIV seroconversion illness

      Explanation:

      This man is at high risk of contracting HIV due to his history of intravenous drug abuse and sharing needles. If a patient has a flu-like illness and a history of risk factors, it is important to suspect that they may be experiencing an HIV seroconversion illness.

      Around 20-60% of individuals who contract HIV go through a seroconversion illness. This typically occurs within 1 to 6 weeks after exposure and presents with symptoms similar to the flu. Common clinical features include fever, malaise, myalgia, pharyngitis, diarrhea, headaches, maculopapular rash, lymphadenopathy, and neuralgia.

      During this stage of the disease, antibody tests will show negative results. However, a diagnosis of HIV can still be made by conducting a P24 antigen test or measuring HIV RNA levels. CD4 and CD8 counts are usually within the normal range at this stage.

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      • Infectious Diseases
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  • Question 47 - A 25-year-old engineering student returns from a hiking trip in South America with...

    Incorrect

    • A 25-year-old engineering student returns from a hiking trip in South America with a high temperature, body aches, and shivering. After further examination, they are diagnosed with Plasmodium falciparum malaria.
      Which of the following statements about Plasmodium falciparum malaria is NOT true?

      Your Answer:

      Correct Answer: It is commonly the result of travel in the Indian subcontinent

      Explanation:

      Plasmodium falciparum malaria is transmitted by female mosquitoes of the Anopheles genus. While it can be found worldwide, it is most prevalent in Africa. The incubation period for this type of malaria is typically between 7 to 14 days.

      The parasite, known as sporozoites, invades hepatocytes (liver cells). Inside the hepatocyte, the parasite undergoes asexual reproduction, resulting in the production of merozoites. These merozoites are then released into the bloodstream and invade the red blood cells of the host.

      Currently, the recommended treatment for P. falciparum malaria is artemisinin-based combination therapy (ACT). This involves combining fast-acting artemisinin-based compounds with drugs from different classes. Some of the companion drugs used in ACT include lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine, and chlorproguanil/dapsone. Artemisinin derivatives such as dihydroartemisinin, artesunate, and artemether are also used.

      In cases where artemisinin combination therapy is not available, oral quinine or atovaquone with proguanil hydrochloride can be used as alternatives. However, quinine is not well-tolerated for prolonged treatment and should be combined with another drug, typically oral doxycycline (or clindamycin for pregnant women and young children).

      For severe or complicated cases of falciparum malaria, it is recommended to manage the patient in a high dependency unit or intensive care setting. Intravenous artesunate is indicated for all patients with severe or complicated falciparum malaria, as well as those at high risk of developing severe disease (e.g., if more than 2% of red blood cells are parasitized) or if the patient is unable to take oral treatment. After a minimum of 24 hours of intravenous artesunate treatment and once the patient has shown improvement and can tolerate oral treatment, a full course of artemisinin combination therapy should be administered.

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      • Infectious Diseases
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  • Question 48 - A 45-year-old woman who is originally from Brazil has recently developed dilated cardiomyopathy...

    Incorrect

    • A 45-year-old woman who is originally from Brazil has recently developed dilated cardiomyopathy and difficulty swallowing. She remembers being bitten by an insect approximately 10 years ago, which resulted in a fever and flu-like symptoms. On her ankle, where the bite occurred, she now has a firm, violet-colored lump.
      What is the SINGLE most probable diagnosis?

      Your Answer:

      Correct Answer: Chagas disease

      Explanation:

      Chagas disease, also known as American Trypanosomiasis, is a tropical illness caused by the protozoan Trypanosoma cruzi. It is transmitted by Triatomine insects, commonly known as kissing bugs, which belong to the Reduviidae family. This zoonotic disease is prevalent in Central and South America, with an estimated 8 million people infected in the region. In Brazil alone, there are approximately 120,000 new cases reported each year.

      The disease progresses through two stages: the acute stage and the chronic stage. During the acute stage, many patients may not experience any symptoms, and the infection can go unnoticed. However, some individuals may exhibit symptoms such as fever, malaise, muscle pain, loss of appetite, and occasionally vomiting and diarrhea. Clinical signs may include swollen lymph nodes and enlargement of the liver and spleen. At the site of the insect bite, an inflammatory response called a chagoma can occur. This is characterized by a swollen, violet-colored nodule that can last up to 8 weeks. Another distinctive sign of acute Chagas disease is Romaña’s sign, which is eyelid swelling caused by accidentally rubbing bug feces into the eyes.

      Following the acute stage, an estimated 10-30% of individuals progress to the chronic stage of Chagas disease. There is typically a latent phase between the acute and chronic phases, which can last for as long as 20-30 years. The chronic phase is associated with various complications, including cardiovascular problems such as dilated cardiomyopathy, heart failure, and arrhythmias. Gastrointestinal issues like megacolon, megaesophagus, and secondary achalasia can also arise. Neurological complications, such as neuritis, sensory and motor deficits, and encephalopathy, may occur. Additionally, psychiatric symptoms, including dementia, can manifest in some cases.

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      • Infectious Diseases
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  • Question 49 - You review a 30-year-old woman with a known diagnosis of HIV. She asks...

    Incorrect

    • You review a 30-year-old woman with a known diagnosis of HIV. She asks you some questions about her diagnosis.
      What is the median incubation period from HIV infection until the development of advanced HIV disease (also referred to as AIDS)?

      Your Answer:

      Correct Answer: 10 years

      Explanation:

      The estimated median incubation period from HIV infection to the onset of advanced HIV disease, also known as AIDS, is around ten years.

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      • Infectious Diseases
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  • Question 50 - A child with a history of stomach pain and loose stools is diagnosed...

    Incorrect

    • A child with a history of stomach pain and loose stools is diagnosed with a tapeworm infection after finding eggs in their stool.
      What is the most suitable treatment for this infection?

      Your Answer:

      Correct Answer: Praziquantel

      Explanation:

      Two types of tapeworms, Taenia solium and Taenia saginata, can infest humans. Infestation occurs when people consume meat from intermediate hosts that contain the parasite’s tissue stages. Tapeworms compete for nutrients and infestation is often without symptoms. However, in more severe cases, individuals may experience epigastric pain, diarrhea, and vomiting. Diagnosis involves identifying characteristic eggs in the patient’s stool.

      Taenia solium infestation can also lead to a condition called cysticercosis. This occurs when larval cysts infiltrate and spread throughout the lung, liver, eye, or brain. Cysticercosis presents with neurological symptoms, seizures, and impaired vision. Confirmation of cysticercosis involves the presence of antibodies and imaging tests such as chest X-rays and CT brain scans.

      The treatment for tapeworm infestation is highly effective and involves the use of medications like niclosamide or praziquantel. However, it is important to seek specialist advice when managing Taenia infections in the central nervous system, as severe inflammatory reactions can occur.

    • This question is part of the following fields:

      • Infectious Diseases
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