00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 3-year-old patient arrives at the Emergency department complaining of left loin pain,...

    Incorrect

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

      Your Answer: Trimethoprim

      Correct Answer: Co-amoxiclav

      Explanation:

      Antibiotic Recommendations for Urinary Tract Infection in Children

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

    • This question is part of the following fields:

      • Infectious Diseases
      117.2
      Seconds
  • Question 2 - A 35-year-old woman who works in a meat processing plant comes to the...

    Incorrect

    • A 35-year-old woman who works in a meat processing plant comes to the Emergency department with a skin ulcer that has a black center. She reports that it started as a small itchy bump that turned into an ulcer a few days later.

      What is the probable bacterium responsible for her symptoms?

      Your Answer: Bacillus cereus

      Correct Answer: Bacillus anthracis

      Explanation:

      Anthrax: Types, Symptoms, and Treatment

      Anthrax is a bacterial infection caused by Bacillus anthracis, a spore-forming bacterium. It is a rare but serious disease that can be acquired through contact with infected animals or contaminated animal products. There are three main types of anthrax: cutaneous, inhalation, and intestinal.

      Cutaneous anthrax is the most common type, accounting for 95% of cases. It is caused by direct contact with the skin or tissue of infected animals. The symptoms start with an itchy pimple that enlarges and eventually forms a black eschar. Inhalation anthrax, on the other hand, is caused by inhaling anthrax spores from infected animal products such as wool. The initial symptoms are similar to a cold, but respiratory failure may develop two to four days later. Intestinal anthrax is the rarest form and is caused by swallowing spores in contaminated meats. Symptoms include severe abdominal pain, nausea, and bloody diarrhea.

      Antibiotics are used to treat all three types of anthrax. It is important to start treatment as soon as possible after exposure to ensure maximum efficacy. The anthrax vaccine can also be given in combination with antibiotics. the types, symptoms, and treatment of anthrax is crucial in preventing and managing this serious disease.

    • This question is part of the following fields:

      • Infectious Diseases
      8.2
      Seconds
  • Question 3 - A 4-year-old girl is brought to the Emergency department with a red rash....

    Incorrect

    • A 4-year-old girl is brought to the Emergency department with a red rash. Her mother reports that it started behind her ears and then spread down her head and neck before spreading to the rest of her body. The mother is unsure if her daughter has received all of her vaccinations. Upon further questioning, the mother reveals that her daughter had been feeling unwell with cold-like symptoms and a low-grade fever in the week leading up to the rash.
      During the examination, you observe grey/white spots in the girl's mouth and throat, indicating an infectious illness. What is the most severe complication that can arise from this illness?

      Your Answer: Encephalitis

      Correct Answer: Subacute sclerosing panencephalitis

      Explanation:

      Measles and its Complications

      Measles is a highly contagious viral illness caused by an RNA paramyxovirus. Patients usually experience non-specific cold-like symptoms such as cough, fever, coryza, and conjunctivitis for a week before the appearance of a rash. Koplik spots, grey/white spots in the oral mucous membranes, are a telltale sign of the disease. Treatment is supportive, and symptoms usually resolve within one to two weeks in mild cases.

      However, measles can lead to various complications, including diarrhea, vomiting, conjunctivitis, and laryngitis. Less common complications include meningitis, pneumonia, encephalitis, hepatitis, bronchitis, thrombocytopenia, and croup. Rare complications such as optic neuritis and subacute sclerosing panencephalitis (SSPE) can also occur. SSPE is a fatal condition that can develop several years after the measles infection and is characterized by gradual psycho-neurological deterioration, seizures, ataxia, and coma. Fortunately, SSPE is rare, occurring in only 1 in 100,000 cases of measles.

    • This question is part of the following fields:

      • Infectious Diseases
      26255.6
      Seconds
  • Question 4 - What is a true statement about Koplik's spots? ...

    Correct

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

      Your Answer: Diagnostic of measles

      Explanation:

      Koplik’s Spots: A Diagnostic Sign of Measles

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      7.3
      Seconds
  • Question 5 - A 65-year-old man with an indwelling catheter due to urinary incontinence after a...

    Correct

    • A 65-year-old man with an indwelling catheter due to urinary incontinence after a stroke is brought to the emergency department by his wife. He has been experiencing fevers, left loin and suprapubic pain for the past two nights, and his wife is worried that he may have a urinary tract infection. Upon examination, he has a temperature of 38.9°C, a blood pressure of 100/60 mmHg, a pulse rate of 95 bpm, and regular rhythm. You confirm the tenderness in his left loin and suprapubic area. What is the most appropriate management for his suspected UTI?

      Your Answer: You should change his indwelling catheter then begin antibiotic therapy

      Explanation:

      Management of Suspected Bacterial Urinary Tract Infection in Patients with Long Term Catheters

      Chronic colonisation of catheters can make it difficult to completely eliminate infections in patients with long term catheters. Therefore, it is recommended to change the catheter before starting antibiotic therapy. Dipstick testing and microscopy are not reliable in such cases, so the management of suspected bacterial urinary tract infection in adults should be based on symptoms of acute bacterial sepsis, according to SIGN guidelines. Local policies determine the choice of antibiotics, but co-amoxiclav is often the first line empirical option in this situation.

      It is important to note that patients with long term catheters require special attention and care to prevent infections. The management of suspected bacterial urinary tract infection in such patients should be based on careful observation of symptoms and adherence to local policies for antibiotic therapy. By following these guidelines, healthcare professionals can help prevent complications and improve patient outcomes.

    • This question is part of the following fields:

      • Infectious Diseases
      3649.6
      Seconds
  • Question 6 - A 6-year-old girl is brought to the Emergency Department by her parents. She...

    Correct

    • A 6-year-old girl is brought to the Emergency Department by her parents. She has been suffering from a sore throat over the past few days, and now her parents have noticed that she has become increasingly drowsy and is complaining of a headache and neck stiffness. On examination, she is pyrexial at 38.2 °C. She has marked signs of meningism.
      Investigations:
      Investigation Result Normal value
      Haemoglobin 121 g/l 115–155 g/l
      White cell count (WCC) 15.2 × 109/l 5.0–12.0 × 109/l
      Platelets 110 ×109/l 150–400 × 109/l
      Sodium (Na+) 140 mmol/l 135–145 mmol/l
      Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
      Creatinine 100 μmol/l 29–53 µmol/l
      Lumbar puncture Gram positive diplococci identified
      Which of the following is the most likely diagnosis?

      Your Answer: Streptococcus pneumoniae

      Explanation:

      Bacterial Causes of Meningitis: A Comparison

      Meningitis is a serious condition that can be caused by various bacterial pathogens. In this case, the symptoms of meningism suggest a diagnosis of S. pneumoniae meningitis, which is most common in the very young and the very old. While resistance testing has shown some resistance to ceftriaxone/penicillin, the majority of isolates are still sensitive to cefotaxime.

      N. meningitidis is another pathogen that can cause meningitis, but it is a Gram-negative bacteria and therefore not the cause in this case. M. pneumoniae, on the other hand, causes pneumonia, not meningitis. H. influenzae can cause meningitis, but it is a Gram-negative cocco-bacilli and not the causative pathogen in this case.

      L. monocytogenes is a cause of meningitis in older adults, but it is uncommon in infants and children. Overall, it is important to identify the specific pathogen causing meningitis in order to provide appropriate treatment.

    • This question is part of the following fields:

      • Infectious Diseases
      1025.4
      Seconds
  • Question 7 - A 35-year-old man with HIV disease visits the clinic with complaints of fatigue...

    Incorrect

    • A 35-year-old man with HIV disease visits the clinic with complaints of fatigue and weakness. His lab results, taken eight weeks apart, are shown below.

      Results 1:
      Hb - 145 g/L
      WBC - 4.0 ×109/L
      Platelets - 70 ×109/L
      CD4 - 120 cells/mm3

      Results 2:
      Hb - 76 g/L
      WBC - 4.3 ×109/L
      Platelets - 200 ×109/L
      CD4 - 250 cells/mm3

      The normal ranges for these values are:
      Hb - 130-180 g/L
      WBC - 4-11 ×109/L
      Platelets - 150-400 ×109/L

      What is the most likely explanation for these results?

      Your Answer: Cytomegalovirus infection

      Correct Answer: Started highly active antiretroviral therapy

      Explanation:

      HAART and its Effects on CD4 and Platelet Counts

      Treatment with highly active antiretroviral therapy (HAART) has been initiated between the first and second test results. This therapy involves a combination of three or more antiretroviral agents from different classes, including two nucleoside analogues and either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor. The use of HAART has resulted in an increase in both CD4 count and platelet count.

      However, antiretroviral therapies can also cause anaemia in HIV-positive patients, with zidovudine (AZT) being the most common culprit due to its bone marrow suppression effects. In severe cases, patients may require blood transfusions. Macrocytosis, or the presence of abnormally large red blood cells, is a common finding in patients taking AZT and can be used as an indicator of adherence to therapy.

    • This question is part of the following fields:

      • Infectious Diseases
      139.8
      Seconds
  • Question 8 - Which drugs are classified as protease inhibitors? ...

    Incorrect

    • Which drugs are classified as protease inhibitors?

      Your Answer: Ritonavir and Telaprevir

      Correct Answer: Darunavir, Ritonavir, and Telaprevir

      Explanation:

      Protease Inhibitors: A Breakthrough in HIV and Hepatitis C Treatment

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

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      4.3
      Seconds
  • Question 9 - 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
      214.2
      Seconds
  • Question 10 - A 49-year-old Asian man undergoes a Mantoux test during his immigration screening upon...

    Correct

    • A 49-year-old Asian man undergoes a Mantoux test during his immigration screening upon arrival in the United Kingdom. The test comes back positive, but his chest X-ray appears normal, and he is prescribed isoniazid and pyridoxine (vitamin B6). However, he returns to the hospital four weeks later complaining of fever, abdominal pain, and jaundice. What is the probable cause of his symptoms?

      Your Answer: Isoniazid-induced hepatitis

      Explanation:

      Isoniazid Monotherapy for TB Prevention

      Isoniazid monotherapy is a treatment used to prevent active tuberculosis in individuals who have been exposed to M. tuberculosis. However, it is important to note that isoniazid-induced hepatitis can occur in approximately 1% of patients, with a higher risk in those over the age of 35. The risk of hepatitis is less than 0.3% in patients under 20 years old, but increases to 2-3% in individuals over 50 years old.

      Aside from hepatitis, other side effects of isoniazid therapy include peripheral neuritis, which can be prevented by taking pyridoxine prophylactically. Additionally, a systemic lupus erythematosus (SLE)-like syndrome may also occur. It is important for healthcare providers to monitor patients closely for any adverse reactions while on isoniazid therapy.

    • This question is part of the following fields:

      • Infectious Diseases
      14.8
      Seconds
  • 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: Guillain-Barré syndrome

      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
      57.1
      Seconds
  • Question 12 - A 27-year-old man has recently come back from a bachelor party in Latvia....

    Incorrect

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

      Your Answer: Reactive arthritis

      Correct Answer: gonorrhoeae

      Explanation:

      Differentiating gonorrhoeae from Other Infections

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      93.3
      Seconds
  • Question 13 - 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: Lyme disease

      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
      900.5
      Seconds
  • Question 14 - A 25-year-old sexually active man comes to the clinic complaining of a rash...

    Incorrect

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

      Your Answer:

      Correct Answer: Secondary syphilis

      Explanation:

      Syphilis and its Symptoms

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 15 - A 15-year-old girl arrives at the Emergency department with breathing difficulties. Earlier that...

    Incorrect

    • A 15-year-old girl arrives at the Emergency department with breathing difficulties. Earlier that day, she had visited her general practitioner for a sore throat and was diagnosed with tonsillitis. The doctor prescribed a five-day course of oral amoxicillin. The patient has a history of ulcerative colitis and takes mesalazine 400 mg tds regularly.

      Upon examination, the girl appears distressed with laboured breathing and stridor. She is pale, sweaty, and cyanosed, sitting up with an open mouth and drooling saliva. Her temperature is 39°C, pulse 120/minute and regular, blood pressure 90/35 mmHg. Her lungs are clear.

      What is the immediate treatment required for this patient?

      Your Answer:

      Correct Answer: Endotracheal intubation

      Explanation:

      Acute Epiglottitis: Diagnosis and Management

      Acute epiglottitis is a possible diagnosis when a patient presents with sudden airway obstruction. It is crucial to seek the assistance of an anaesthetist immediately as attempting to visualize the inflamed epiglottis without proper expertise may cause acute airway obstruction. The diagnosis can be confirmed by directly visualizing a cherry-red epiglottis. Early intubation is necessary, especially when respiratory distress is present. Although adult epiglottitis is rare, it has a higher mortality rate.

      In summary, acute epiglottitis is a serious condition that requires prompt diagnosis and management. It is essential to involve an anaesthetist and avoid touching the inflamed tissue until proper expertise is present. Early intubation is crucial, and adult epiglottitis should be considered in patients with respiratory distress.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 16 - A 35-year-old female patient complains of painful genital ulcers, accompanied by feelings of...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 17 - A 6-year-old girl arrives at the Emergency department with a complaint of sudden...

    Incorrect

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

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Common Organisms in Osteomyelitis and Related Conditions

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 18 - A 29-year-old electrician was referred to the hospital by his GP. He had...

    Incorrect

    • A 29-year-old electrician was referred to the hospital by his GP. He had presented a week ago with malaise, headache, and myalgia, which was followed by a dry cough and fever. Despite a course of amoxicillin/clavulanic acid, his symptoms persisted. At the time of referral, he complained of cough, mild dyspnea, global headache, myalgia, and arthralgia. On examination, he appeared unwell, had a fever of 39°C, and a maculopapular rash on his upper body. Fine crackles were audible in the left mid-zone of his chest, and mild neck stiffness was noted. Investigations revealed abnormal levels of Hb, WBC, reticulocytes, Na, creatinine, bilirubin, alk phos, and AST, and patchy consolidation in both mid-zones on chest x-ray. What is the most likely cause of his symptoms?

      Your Answer:

      Correct Answer: Mycoplasma pneumoniae

      Explanation:

      Mycoplasma pneumonia commonly affects individuals aged 15-30 years and presents with systemic upset, dry cough, fever, myalgia, and arthralgia. It can also cause extrapulmonary manifestations such as haemolytic anaemia, renal failure, hepatitis, myocarditis, meningism, transverse myelitis, cerebellar ataxia, and erythema multiforme. Haemolysis is associated with the presence of cold agglutinins. Diagnosis is based on the demonstration of anti-mycoplasma antibodies in paired sera.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • 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:

      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
      0
      Seconds
  • Question 20 - A 4-year-old girl is brought to the general practitioner (GP) by her parents....

    Incorrect

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

      Your Answer:

      Correct Answer: Measles

      Explanation:

      Distinguishing Between Measles and Other Viral Infections

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 21 - A 30-year-old pregnant woman comes to the clinic with a new fever and...

    Incorrect

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

      Your Answer:

      Correct Answer: Parvovirus B19

      Explanation:

      Differential Diagnosis of a Morbilliform Rash: Parvovirus B19

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 22 - A 34-year-old male presents to the Emergency department with sudden onset pain in...

    Incorrect

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

      Your Answer:

      Correct Answer: Ciprofloxacin

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 23 - A 27-year-old male patient complains of fever, malaise, myalgia, and diarrhea that have...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 24 - A 42-year-old man, known to have human immunodeficiency virus (HIV), attends his regular...

    Incorrect

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

      Your Answer:

      Correct Answer: Human herpesvirus 8

      Explanation:

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 25 - 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:

      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
      0
      Seconds
  • Question 26 - A 30-year-old woman, who is 20 weeks’ pregnant, presents to the Emergency Department...

    Incorrect

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

      Your Answer:

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

      Explanation:

      Managing Chickenpox in Pregnancy: Testing and Treatment Options

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 27 - A 32-year-old woman is diagnosed with advanced HIV disease. What is involved in...

    Incorrect

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

      Your Answer:

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

      Explanation:

      Myth-busting HIV Treatment Guidelines

      Debunking Common Misconceptions about HIV Treatment Guidelines

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

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

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

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

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 28 - A 2-year-old toddler has been brought into the general practice by their parent...

    Incorrect

    • A 2-year-old toddler has been brought into the general practice by their parent with the presenting complaint of a new rash around the lips, gumline and tongue. The parent reports that the rash is new, approximately three days old, and has become significantly worse. They find that their child is not eating or drinking and is very difficult to settle. The parent comments that they had a normal delivery, without post-delivery complications, and the child has been up-to-date with their vaccination protocol. Moreover, you assess that the toddler has normal growth and development. There is no family history of oral lesions.
      On general examination, the toddler is visibly upset, although interacting appropriately with their parent. Temperature is recorded as 38.1 °C. Heart rate is 110 bpm, blood pressure 84/60 mmHg and oxygen saturation (SpO2) is 100% on air. On inspection of the oral cavity, multiple vesicular lesions are present on the lips, gum and anterior aspect of the tongue. You notice a small number of these have become ulcerated. There are no further rashes observed on the trunk and upper and lower limbs.
      What is the most likely organism which has given rise to this clinical picture?

      Your Answer:

      Correct Answer: Herpes simplex virus

      Explanation:

      Common Viral Infections and Their Oral Manifestations

      Herpes simplex virus, Parvovirus B19, Coxsackie A16, Molluscum contagiosum, and Varicella-zoster are all common viral infections that can cause various oral manifestations. Herpes simplex virus can cause gingivostomatitis, which can lead to dehydration and require treatment with acyclovir. Parvovirus B19 can result in ‘slapped cheek syndrome’ with a maculopapular rash and non-specific viral symptoms. Coxsackie A16 can cause hand, foot and mouth disease with vesicular and ulcerative oral lesions and macular lesions on the hands and feet. Molluscum contagiosum can cause papular lesions with a central dimple, but rarely in the oral cavity. Varicella-zoster can cause chickenpox with itchy, papular lesions progressing to vesicles, but blisters in the mouth are less common. Understanding these viral infections and their oral manifestations can aid in diagnosis and treatment.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 29 - A tool known as PrePex™ has been sanctioned by various organizations to reduce...

    Incorrect

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

      Your Answer:

      Correct Answer: Painless circumcision

      Explanation:

      PrePex Device Offers Painless Male Circumcision for HIV Prevention

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 30 - A 4-year-old child is brought to the General Practice by his mother. She...

    Incorrect

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

      Your Answer:

      Correct Answer: Check for varicella antibodies

      Explanation:

      Management of Varicella in Pregnancy

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

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infectious Diseases (5/13) 38%
Passmed