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  • Question 1 - A 27-year-old male patient complains of fever, malaise, myalgia, and diarrhea that have...

    Correct

    • A 27-year-old male patient complains of fever, malaise, myalgia, and diarrhea that have been present for a week. Upon further inquiry, he reveals that he had unprotected sexual intercourse with multiple local women during his holiday in Thailand six weeks ago. The patient has no significant medical history except for receiving travel vaccinations and prophylactic medications. He has not visited his GP for several years. What tests would you conduct to confirm the diagnosis?

      Your Answer: HIV antibody/p24 antigen test

      Explanation:

      HIV Seroconversion Illness: Diagnosis and Differential Diagnosis

      HIV-related seroconversion illness is a non-specific illness that occurs between one to six weeks following infection. It often mimics infectious mononucleosis but may have additional signs such as oral candidiasis or CNS symptoms. The best way to diagnose acute infection is by the presence of p24 antigen or HIV RNA by PCR. Malaria is less likely in this case than HIV, and stool culture would be useful in the diagnosis of gastroenteritis but is unlikely to be the cause of symptoms in this case. A CT chest, abdomen, and pelvis is non-specific and would not yield the diagnosis. A genital swab would be of benefit if there were suspicions of other sexually transmitted infections, but the symptoms and timing of onset in this case clearly point towards HIV seroconversion. It is important to consider HIV testing and prevention in patients with risk factors for infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 2 - A 19-year-old female has suffered a minor cut on her right hand while...

    Incorrect

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

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

      Correct Answer: No action is required

      Explanation:

      Tetanus Toxoid Immunisation Schedule

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A sexually active 25-year-old woman comes to her GP complaining of lower abdominal...

    Correct

    • A sexually active 25-year-old woman comes to her GP complaining of lower abdominal pain that has been present for two days. She reports that her last menstrual period was six weeks ago and has experienced post coital bleeding along with deep dyspareunia. Upon examination, there is tenderness in the lower abdomen and adnexal tenderness during pelvic examination. What is the most suitable investigation for this patient?

      Your Answer: Pregnancy test

      Explanation:

      Pelvic Inflammatory Disease: Symptoms, Differential Diagnosis, and Treatment

      Pelvic inflammatory disease (PID) is a condition that affects the female reproductive system. It is often characterized by lower abdominal pain and abnormal vaginal discharge. However, these symptoms may also be indicative of other conditions, such as ectopic pregnancy, which is why it is important to consider differential diagnoses. Other symptoms of PID include intermenstrual and post-coital bleeding, dysuria, deep dyspareunia, and fever. The most common pathogens responsible for PID are Chlamydia trachomatis and Neisseria gonorrhoeae.

      Early treatment with appropriate antibiotics is crucial in reducing the risk of long-term complications, such as infertility. PID can lead to scarring and damage to the reproductive organs, which can result in difficulty getting pregnant.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 25-year-old graduate is referred to the renal clinic by the local health...

    Correct

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

      Your Answer: Chronic reflux nephropathy

      Explanation:

      Reflux Nephropathy and its Management

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 6-year-old girl arrives at the Emergency department with a complaint of sudden...

    Correct

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

      Your Answer: Staphylococcus aureus

      Explanation:

      Common Organisms in Osteomyelitis and Related Conditions

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 6 - A 62-year-old practising solicitor attends the Neurology Clinic with his wife. She is...

    Incorrect

    • A 62-year-old practising solicitor attends the Neurology Clinic with his wife. She is deeply concerned regarding his worsening memory. Over the past three months, he has become increasingly forgetful, to the point where he has had to take sick leave from work. He has had two recent presentations to the Emergency Department following falls, though a computed tomography (CT) head scan did not demonstrate any abnormality. On examination, there is an ataxic gait and you notice fasciculations and involuntary jerking movements of the upper limbs. He has had no family history of neurological disease and was previously fit and well.
      What is the most likely underlying cause of this presentation?

      Your Answer: Huntington’s disease

      Correct Answer: Creutzfeldt–Jakob disease (CJD)

      Explanation:

      Distinguishing Neurodegenerative Diseases: A Case Study

      A patient presents with rapidly progressive dementia, imbalance leading to falls, and myoclonus. The most likely diagnosis is Creutzfeldt–Jakob disease (CJD), a devastating prion disease without cure. Magnetic resonance imaging (MRI) is preferred for diagnosis, as CT head is ineffective.

      Vascular dementia, another common cause of cognitive impairment, typically has a slower and stepwise onset in patients with a significant vascular history. A CT head would likely identify existing small vessel disease in the brain of a patient with vascular dementia.

      Huntington’s disease, characterized by abnormal movements and cognitive impairment, is not the most likely diagnosis due to the rapid progression and lack of family history.

      Lewy body dementia, which features visual hallucinations and Parkinsonian symptoms, usually presents over a longer period of time.

      Motor neuron disease, which includes weakness and fasciculations, is unlikely due to the absence of weakness in this presentation. Frontotemporal dementia may rarely develop in motor neuron disease, but it is a slowly progressive phenomenon, unlike the rapid deterioration in this case.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 7 - A 77-year-old man who resides in a nursing home has been treated with...

    Correct

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

      Your Answer: Clostridium difficile

      Explanation:

      Common Causes of Gastrointestinal Infections

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 8 - Which statement about Japanese encephalitis is the most accurate? ...

    Incorrect

    • Which statement about Japanese encephalitis is the most accurate?

      Your Answer: Previous exposure to a flavivirus predisposes to increased risk of death on infection with Japanese encephalitis

      Correct Answer: Transplacental transmission occurs

      Explanation:

      Japanese Encephalitis: A Viral Infection Endemic in Asia

      Japanese encephalitis is a type of RNA virus that is commonly found in India, East Asia, Malaysia, and the Philippines. Interestingly, previous exposure to other viruses in the Flavivirus family, such as dengue, can actually provide some protection against serious illness or death from Japanese encephalitis. This means that individuals who have been infected with dengue in the past may have a lower risk of severe symptoms if they contract Japanese encephalitis.

      Despite being endemic to certain regions, Japanese encephalitis can still affect travelers who spend only short periods of time in these areas. Additionally, the virus can be transmitted from mother to fetus during pregnancy.

      Fortunately, there is an immunization available for travelers who may be at risk of contracting Japanese encephalitis. It is important for individuals traveling to endemic areas to take precautions and consider getting vaccinated to protect themselves from this potentially serious viral infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 27-year-old man has recently come back from a bachelor party in Latvia....

    Correct

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

      Your Answer: gonorrhoeae

      Explanation:

      Differentiating gonorrhoeae from Other Infections

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 10 - A 4-year-old girl is brought to the general practitioner (GP) by her parents....

    Correct

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

      Your Answer: Measles

      Explanation:

      Distinguishing Between Measles and Other Viral Infections

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - A 47-year-old woman arrives at the Emergency department with weakness in her arms...

    Incorrect

    • A 47-year-old woman arrives at the Emergency department with weakness in her arms and legs. She had recently attended a BBQ where she consumed canned food. During the examination, you observe weakness in all four limbs, bilateral ptosis, and slurred speech. Her husband reports that she experienced diarrhea the day before and has been constipated today. What is the probable diagnosis?

      Your Answer: Viral gastroenteritis

      Correct Answer: Botulism

      Explanation:

      Botulism: Causes, Types, Symptoms, and Treatment

      Botulism is a severe illness caused by the botulinum toxin, which is produced by the bacteria Clostridium botulinum. There are three main types of botulism: food-borne, wound, and infant botulism. Food-borne botulism occurs when food is not properly canned, preserved, or cooked, and becomes contaminated with infected soil. Wound botulism occurs when a wound becomes infected with the bacteria, usually in intravenous drug abusers. Infant botulism occurs when a baby ingests spores of the C. botulinum bacteria.

      Symptoms of botulism can occur between two hours and eight days after exposure to the toxin. These symptoms include blurred vision, difficulty swallowing (dysphagia), difficulty speaking (dysphonia), diarrhea and vomiting, and descending weakness/paralysis that may progress to flaccid paralysis. In certain serotypes, patients may rapidly progress to respiratory failure. It is important to note that patients remain alert throughout the illness.

      Botulism is a serious condition that requires prompt treatment. The antitoxin is effective, but recovery may take several months. Guillain-Barré syndrome, which is an ascending paralysis that often occurs after a viral infection, would not fit the case vignette described. Myasthenia gravis is an autoimmune chronic condition that typically worsens with exercise and improves with rest. A cerebrovascular accident usually causes weakness in muscles supplied by one specific brain area, whereas the weakness in botulism is generalized. Viral gastroenteritis is not usually associated with weakness, unless it is Guillain-Barré syndrome a few weeks after the infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - A 30-year-old pregnant woman comes to the clinic with a new fever and...

    Correct

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

      Your Answer: Parvovirus B19

      Explanation:

      Differential Diagnosis of a Morbilliform Rash: Parvovirus B19

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A 35-year-old female patient complains of painful genital ulcers, accompanied by feelings of...

    Correct

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

      Your Answer: Herpes simplex virus

      Explanation:

      Causes of Genital Ulcers

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 14 - An 82-year-old man has presented to the Emergency Department, following a 3-day history...

    Incorrect

    • An 82-year-old man has presented to the Emergency Department, following a 3-day history of progressive shortness of breath, productive cough and fever. His past medical history is significant for type II diabetes, currently controlled with metformin. He is a non-smoker, denies recent travel and has no regular contact with animals.
      An examination is performed, which reveals a heart rate of 91 bpm, a blood pressure of 98/59 mmHg, a temperature of 38.2 °C and a respiratory rate of 22 breaths/minute. Coarse crackles are heard on auscultation of the right lower lobe. A chest X-ray is performed, which confirms the presence of a right lower lobe pneumonia. The patient is admitted to the Respiratory Ward for intravenous (IV) empirical antibiotics and fluid resuscitation. A sputum culture result has been received two days later:
      Investigation Result
      Sputum
      Rust-coloured sputum
      After two days of growth, a Gram-positive spherical bacterium which tends to grow in chains is observed
      Partial haemolysis is observed on blood agar plate
      Which of the following organisms is the most likely responsible for the patient’s pneumonia?

      Your Answer: Staphylococcus aureus

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Bacterial Causes of Pneumonia

      Pneumonia is a respiratory infection that can be caused by various bacteria. The most common organism associated with pneumonia is Streptococcus pneumoniae, which can be identified by its Gram-positive spherical shape and chain formation. It is also known for causing rust-coloured sputum. Staphylococcus aureus, another Gram-positive bacterium, grows in clusters rather than chains. Klebsiella pneumoniae, a Gram-negative rod-shaped bacterium, is commonly associated with aspiration pneumonia. Haemophilus influenzae, a small Gram-negative rod-shaped bacterium, is often linked to exacerbation of COPD. Streptococcus pyogenes, a Gram-positive spherical bacterium that aligns in clusters, does not typically cause pneumonia and is associated with complete haemolysis on a blood agar plate. Knowing the characteristics of these bacteria can aid in the diagnosis and treatment of pneumonia.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - What is the probable diagnosis for a 20-year-old woman who has been experiencing...

    Correct

    • What is the probable diagnosis for a 20-year-old woman who has been experiencing myalgia, high fever, headache, diarrhea, and an erythematosus rash that started in the groin and has spread over the past four days?

      Your Answer: Toxic shock syndrome

      Explanation:

      Skin Disorders

      Toxic shock syndrome (TSS) is a condition caused by Staphylococcus aureus. Half of the cases of TSS are linked to tampon use in women, while the other half result from localized infections. The initial symptom is often sudden and severe pain, which is followed by tenderness or physical findings. In some cases, patients may experience an influenzae-like syndrome, which includes fever, chills, myalgia, nausea, vomiting, and diarrhea. Fever is the most common early sign, but hypothermia may be present in patients with shock. Therefore, TSS should always be considered in young women presenting with these symptoms.

      Toxic epidermal necrolysis is a life-threatening skin disorder that causes blistering and peeling of the top layer of skin. Staphylococcal scalded skin syndrome is another skin infection that is characterized by peeling skin. The most common symptoms include an erythematosus painful infection site, blistering, fever, chills, weakness, fluid loss, and peeling of the top layer of skin in large sheets. Epidermolysis bullosa is a group of diseases that cause blister formation after minor injury to the skin. This family of disorders, most of which are inherited, ranges in degrees of severity from mild to severely disabling and life-threatening diseases of the skin.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - A 36-year-old HIV positive woman has been experiencing occasional headaches for the past...

    Incorrect

    • A 36-year-old HIV positive woman has been experiencing occasional headaches for the past 6 months but has not received any treatment. Recently, she started vomiting frequently and developed diplopia and a stiff neck. She was taken to the accident and emergency department for treatment. What are the possible treatment options for this woman?

      Your Answer: Ceftriaxone

      Correct Answer: CSF drainage

      Explanation:

      Cryptococcal Meningitis in HIV-Infected Individuals

      HIV-infected individuals are susceptible to various opportunistic infections, including meningitis caused by viruses, mycobacteria, or fungi. Cryptococcal meningitis is a common infection in these individuals and can present insidiously, leading to much morbidity. This infection is notorious for causing raised intracranial tension, which can result in vomiting and altered consciousness.

      Treatment for cryptococcal meningitis involves periodic drainage of cerebrospinal fluid (CSF), as steroids and mannitol have not been found to be effective in lowering CSF pressure. The mainstay of treatment is Amphotericin B, with 5-flucytosine or fluconazole added. Diagnosis may be delayed as overt signs of meningism, such as neck stiffness, may be absent.

      Tubercular meningitis may present similarly, but it progresses faster than cryptococcal meningitis. Steroids are used in tubercular meningitis but not in isolation, so they are not a good choice for cryptococcal meningitis. Acute bacterial meningitis is treated with ceftriaxone and vancomycin, but this case was slowly evolving over six months and is unlikely to be bacterial meningitis. acyclovir is used for viral meningitis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 17 - A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She...

    Incorrect

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

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

      Your Answer: Campylobacter

      Correct Answer: Yersinia enterocolitica

      Explanation:

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - What is the accurate information about primary pulmonary tuberculosis? ...

    Correct

    • What is the accurate information about primary pulmonary tuberculosis?

      Your Answer: May be totally asymptomatic

      Explanation:

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - A 35-year-old woman presents to her GP in Manchester with a week long...

    Incorrect

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

      Your Answer: Chlamydia trachomatis

      Correct Answer: All of the above

      Explanation:

      Syndromic Management for Vaginal Discharge

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A 25-year-old sexually active man comes to the clinic complaining of a rash...

    Correct

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

      Your Answer: Secondary syphilis

      Explanation:

      Syphilis and its Symptoms

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - A 25-year-old woman presents with a nine-week history of fever. She has been...

    Incorrect

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

      Your Answer: Bacterial endocarditis

      Correct Answer: Adult onset Still's disease

      Explanation:

      Adult Onset Still’s Disease

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

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

    • This question is part of the following fields:

      • Infectious Diseases
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