-
Question 1
Correct
-
A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?
Your Answer: CSF analysis
Explanation:This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 2
Incorrect
-
A 48 year old male patient presents with fever and signs of delirium. A few hours ago, blisters appeared on his trunk. His past history revealed nothing serious and he's not on any medication. He admits that he went to Italy five months ago on vacation. What is the most probable diagnosis?
Your Answer: Bullous pemphigus
Correct Answer: Chicken pox
Explanation:Chicken pox in adults may manifest with acute encephalitis, causing the confusional syndrome known as delirium. Blisters on the trunk favour the diagnosis. The trip to Italy however seems unimportant since the incubation period of chicken pox is 10 to 21 days.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 3
Incorrect
-
Which of the following diseases correctly matches the incubation period?
Your Answer: Measles: 5 - 7 days
Correct Answer: Mumps: 14 - 18 days
Explanation:The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease.
- Chickenpox: 7-21 days.
- Whooping cough: 10-14 days.
- Hand, foot and mouth disease: 2-6 days.
- German measles: 14-21 days.
- Mumps: 14-18 days.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 4
Correct
-
Which of the following is true of Koplik’s spots?
Your Answer: Are diagnostic of measles
Explanation:Koplik’s spots are pathopneumonic for MEASLES. They are blue/white spots, small, occurring on the buccal mucosa. They typically occur next to premolars, not opposite to the incisors. They are not related to fever height. They are not on the hands. They usually occur BEFORE the rash.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 5
Correct
-
An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the most significant long-term risk following this infection?
Your Answer: Cervical cancer
Explanation:Human-papilloma virus (HPV) can lead to cervical cancer. There are many different types, but the types associated with cervical cancer most commonly are 16, 18, 31, 33, and 35. The vaccination against HPV protects against the most common types of HPV that are seen in cervical cancer and is recommended for children/young teens. Cervical cancer has a clear association with HPV, making this the best answer over all of the other answer choices.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 6
Incorrect
-
A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?
Your Answer: Syphilis
Correct Answer: Cytomegalovirus (CMV)
Explanation:CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 7
Correct
-
A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?
Your Answer: Varicella zoster virus (VZV)
Explanation:Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 8
Correct
-
A 3 month old infant born to an HIV positive mother presents with jaundice, epileptic seizures and microcephaly. The most likely cause will be?
Your Answer: Cytomegalovirus
Explanation:Congenital CMV infection can occur when a pregnant woman is infected with the cytomegalovirus (CMV) and passes the virus to her unborn child. Infants infected with CMV during pregnancy can exhibit a range of symptoms, including jaundice, seizures, and microcephaly (abnormally small head size). These symptoms are consistent with congenital CMV infection.
Given the mother’s HIV-positive status, the infant may have been at increased risk of acquiring other infections, including CMV, due to potential immunodeficiency.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 9
Incorrect
-
A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?
Your Answer: Iliac
Correct Answer: Superficial inguinal
Explanation:The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 10
Incorrect
-
A woman who is 36 weeks pregnant presents with chickenpox. How should she be treated?
Your Answer: Steroids
Correct Answer: Acyclovir
Explanation:Acyclovir is the correct answer. There has been no documented evidence of harm in pregnancy yet. Chickenpox can cause fetal abnormalities, and varicella zoster Immunoglobulin should be given to the infant immediately after birth (not the mother, won’t help). Steroids will actually make the chicken pox worse. Painkillers only, is obviously the wrong answer and pose severe risk to foetus.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 11
Correct
-
A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed. What is the appropriate treatment?
Your Answer: Acyclovir
Explanation:You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 12
Correct
-
An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 13
Correct
-
Which of the following drugs is NOT used in the treatment of MRSA?
Your Answer: Ceftriaxone
Explanation:Cephalosporins, such as ceftriaxone, do not cover methicillin-resistant staph aureus. They do cover some gram positives and gram negatives. Vancomycin and teicoplanin given intravenously have good coverage of MRSA and other gram positive bacteria. Rifampicin and doxycycline, although not the best treatment, can be used for outpatients if there are no systemic signs of illness.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 14
Correct
-
A 60-year-old male who has been on IV antibiotics for severe pneumonia developed profuse, watery, green coloured diarrhoea on the fifth day of antibiotics. What is the most likely organism responsible for this condition?
Your Answer: Clostridium difficile
Explanation:The most probable cause for diarrhoea is pseudomembranous colitis which is caused by Clostridium difficile. Pseudomembranous colitis is an inflammatory disease of the colon where the antibiotic-induced change in the balance of normal gut flora allows overgrowth of C difficile. Any antibiotic can cause this but the chances are higher with ampicillin, clindamycin, fluoroquinolones, and cephalosporins.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 15
Incorrect
-
A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?
Your Answer: May be associated with poliomyelitis-like paralysis
Correct Answer: Treatment including with interferon, immunoglobulin and Ribavirin is effective
Explanation:West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 16
Correct
-
A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 17
Incorrect
-
A 32 year old man notices a pruritic scaly annular rash on his thigh. He claims that the rash appeared after a walk in the park. Which drug would you suggest he starts?
Your Answer: Penicillin
Correct Answer: Doxycycline
Explanation:The clinical picture of an itchy, scaly annular rash after a walk in the park suggests erythema migrans. The pathogen responsible is a spirochete, Borrelia Burgdorferi transmitted by ticks leading to Lyme disease. Doxycycline is the antibiotic of choice if no contraindications.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 18
Correct
-
A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?
Your Answer: Varicella zoster
Explanation:Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 19
Incorrect
-
Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?
Your Answer: Metronidazole
Correct Answer: Amoxicillin
Explanation:Tetracycline is not recommended in pregnancy because of the risk to fetal development (bones, teeth!). Metronidazole in pregnancy: currently not thought to be an increased risk in pregnancy; however this is not effective against chlamydia. Amoxicillin is shown to be an adequate treatment for chlamydia, so this is the correct answer.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 20
Correct
-
There are number of diseases that have to be notified to the consultant responsible for communicable disease control. Which of the following conditions does not belong to above category?
Your Answer: Pneumococcal pneumonia
Explanation:There are number of diseases that have to be notified to relevant authorities to prevent or reduce their spread. Those conditions include Cholera, Diphtheria, Food poisoning, Infectious bloody diarrhoea, Malaria, Measles, Meningococcal septicaemia, Mumps, Plague, Rabies and Rubella.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 21
Incorrect
-
Which of the following vaccines do not contain live organisms?
Your Answer: Typhoid (TY 21a)
Correct Answer: Polio (Salk)
Explanation:Live virus vaccines include: Vaccinia (smallpox), Measles, Mumps, Rubella (MMR combined vaccine), Varicella (chickenpox), Influenza (nasal spray), Rotavirus, Zoster (shingles) and Yellow fever. Inactivated vaccines are Polio (IPV), Hepatitis A and Rabies.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 22
Incorrect
-
A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?
Your Answer: Vaccine only
Correct Answer: Ig
Explanation:After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 23
Incorrect
-
A 14-day-old baby presented in NICU with the signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer: Toxoplasmosis
Correct Answer: Cytomegalovirus (CMV)
Explanation: -
This question is part of the following fields:
- Infectious Diseases
-
-
Question 24
Incorrect
-
Which of the following procedures does not require antibiotic prophylaxis?
Your Answer: Total hip replacement
Correct Answer: Dental procedure for a patient with an atrial septal defect
Explanation:According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 25
Incorrect
-
A 38-year-old woman returns from a summer holiday with a dry cough. Her CXR shows bilateral consolidated areas. Which antibiotic would you suggest?
Your Answer: Clarithromycin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a well-established broad-spectrum fluoroquinolone antibiotic that penetrates well into the lung tissues.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 26
Correct
-
A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?
Your Answer: Herpes simplex virus
Explanation:The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 27
Correct
-
A 30-year-old male presented with a history of bloody and mucoid diarrhoea since that morning. He is also complaining of abdominal spasm and bloating. Which of the following investigations is the most suitable one in this case?
Your Answer: Stool culture and sensitivity
Explanation:In a case of sudden bloody and mucoid diarrhoea, stool culture and sensitivity are required to access which organism is causing the problem and to discuss appropriate antibiotics.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 28
Correct
-
Which of the following is correct regarding toxoplasmosis?
Your Answer: Can present with fits in patients with AIDS
Explanation:T. gondii infection in immunocompetent people is usually asymptomatic. It can present as fits in patients with AIDs, who are immunosuppressed. Additionally, infection in the first trimester of pregnancy is very harmful. Congenital toxoplasmosis presents with intracranial calcifications, classically. It can also present with hydrocephalus, microcephaly, blindness, petechiae. Siramycin is the drug of choice to try to prevent vertical transmission from mother to baby. It is typically gotten from cat faeces or raw/undercooked meat, not raw eggs (raw eggs: think salmonella).
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 29
Correct
-
A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?
Your Answer: Mumps
Explanation:Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 30
Incorrect
-
What is the mode of spread of chickenpox?
Your Answer: Close contact
Correct Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
-
This question is part of the following fields:
- Infectious Diseases
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)