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Question 1
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Incorrect
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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: Motor neuron 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
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A 32-year-old woman is diagnosed with advanced HIV disease. What is involved in strategic planning with antiretroviral medications?
Your 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Incorrect
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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: Tuberculous hepatitis
Correct 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
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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: 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
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Question 7
Incorrect
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What is the most frequently occurring infectious agent linked to acute pyelonephritis?
Your Answer: Staphylococcus aureus
Correct Answer: Escherichia coli
Explanation:Common Pathogens in Acute Pyelonephritis
Acute pyelonephritis is commonly caused by Escherichia coli, which accounts for more than 80% of cases. Other pathogens that can cause this condition include Enterococcus faecalis, Klebsiella, and Proteus species. The infection typically begins in the bladder and then spreads to the renal parenchyma. At first, the bacteria multiply within the tubules. However, within 48 hours, damage to the tubular epithelium begins to occur.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Incorrect
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A teenage girl is brought to you by her concerned mother. The girl has an erythematosus rash on her cheeks but is feeling fine otherwise. Upon examination, she has a 'slapped cheek' appearance.
What is the most probable organism responsible for this?Your Answer: Human herpesvirus 6 (HHV6)
Correct Answer: Parvovirus B19
Explanation:Common Causes of Skin Rashes and Their Symptoms
Parvovirus B19: This virus causes erythema infectiosum or ‘fifth disease’ which is a self-limited disease with mild constitutional symptoms. Symptomatic management can be provided with NSAIDs.
Staphylococcus aureus: This common bacteria can cause skin diseases like folliculitis, cellulitis, impetigo, or secondary skin infections of wounds.
Human herpesvirus 6 (HHV6): HHV6A and HHV6B can cause diarrhoea, fever, and occasionally a roseola rash in young children. Infection with this virus does not cause the characteristic ‘slapped cheek’ rash.
Beta-haemolytic Streptococcus: Group B Streptococcus can cause complications during pregnancy and can be passed on to the newborn baby.
Measles virus: Measles causes a generalised maculopapular erythematous rash, alongside symptoms of fever, cough, runny nose, and red eyes. A child with a rash who is otherwise well is unlikely to have measles.
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This question is part of the following fields:
- Infectious Diseases
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Question 9
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
Incorrect
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A 20-year-old male patient comes to you with a fever and rash one week after returning from a trip to Puerto Rico. He reports that his fever began five days ago and was followed by the appearance of a rash. Additionally, he has noticed bleeding gums while brushing his teeth and has experienced two nosebleeds since returning from his vacation. During the examination, you observe multiple mosquito bites on his legs. What is the probable diagnosis?
Your Answer: Malaria
Correct Answer: Dengue fever
Explanation:Dengue Fever
Dengue fever is a viral infection that is transmitted through the bite of an infected Aedes mosquito. It is prevalent in tropical countries, with an estimated 100 million people being infected annually. The symptoms of dengue fever include fever, headache, muscle pain, nausea, vomiting, skin rash, and mild bleeding. However, it cannot be spread from person to person.
The high-risk areas for dengue fever include the Indian subcontinent, Southeast Asia, Southern China, Taiwan, Pacific Islands, Caribbean, Mexico, Africa, and Central and South America. Diagnosis is made through a blood test to identify the virus, and treatment is supportive with symptom control. Unfortunately, there are currently no vaccines available to prevent dengue fever.
The best way to prevent infection is to avoid mosquito bites. This can be done by wearing protective clothing, using mosquito repellent, and staying in air-conditioned or screened areas. the symptoms and risk factors of dengue fever can help individuals take necessary precautions to protect themselves from this potentially serious illness.
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This question is part of the following fields:
- Infectious Diseases
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