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Question 1
Correct
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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: Cytomegalovirus (CMV)
Explanation:CMV is a common virus in the herpesvirus family that can cause serious illness in newborns when contracted congenitally from the mother during pregnancy. Congenital CMV infection can lead to various neurological manifestations, including hydrocephaly (enlargement of the fluid-filled spaces within the brain), seizures, and chorioretinitis (inflammation of the retina in the eye). These symptoms can result in significant morbidity and long-term complications for the affected infant.
Other congenital infections such as toxoplasmosis, rubella, herpes simplex virus (HSV), and syphilis can also cause similar symptoms in newborns. However, given the presentation described, CMV is the most likely infectious agent.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A 32 year old Indian male presents to the clinic with fever, cough and an enlarged cervical lymph node. Examination reveals a caseating granuloma in the lymph node. Which of the following is the most likely diagnosis?
Your Answer: TB adenitis
Explanation:Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or a related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercle).
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Correct
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A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?
Your Answer: IV normal saline
Explanation:The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.
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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 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.
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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 homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Mantoux test
Correct Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Correct
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A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives history of having had a sore throat, fever and lymphadenitis during pregnancy. Which organism may be responsible for causing deafness in her infant?
Your Answer: Cytomegalovirus (CMV)
Explanation:CMV is a common viral infection that can be transmitted from a pregnant woman to her unborn child, leading to congenital CMV infection. Congenital CMV infection can result in a range of symptoms and complications in newborns, including deafness. In fact, CMV is one of the leading causes of non-genetic sensorineural hearing loss in children.
Given the mother’s history of symptoms during pregnancy and the concern for deafness in the infant, CMV should also be considered as a potential cause.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Incorrect
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Her parents with a severe headache present a 24-year-old woman. She is afraid of light and sun and prefers darker environments. On examination, a generalized rash that does not blanch on pressure is noticed. What is the best action in this case?
Your Answer: Blood culture
Correct Answer: IV benzylpenicillin
Explanation:The rash is a characteristic sign of meningitis. Added to photophobia, headache and neck rigidity, meningitis is highly suggested diagnosis. IV antibiotics should be started immediately.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Correct
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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: 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 9
Correct
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Regarding neonatal meningitis, which of the following statements is true?
Your Answer: Has an above average incidence in babies with a meningomyelocele
Explanation:The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.
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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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Which of the following diseases correctly matches the incubation period?
Your Answer: Hand foot and mouth disease: 7 - 10 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Correct
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A 25 year old female presented with blisters on the tongue. Some of them secreted pinkish fluid while some were crusted. Which of the following is the most probable diagnosis?
Your Answer: HSV1
Explanation:The history is suggestive of acute gingivostomatitis, which is a manifestation of primary HSV-1 infection. Patients present with gingivitis and vesicular lesions which develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.
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This question is part of the following fields:
- Infectious Diseases
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Question 12
Correct
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Which of the following vaccines do not contain live organisms?
Your 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Correct
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A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?
Your Answer: Streptococcus pneumoniae
Explanation:Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Correct
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A 31-year-old homosexual male is complaining of recent weight loss and blurred vision. A fundoscope was performed showing retinal haemorrhage. What is the single most appropriate option?
Your Answer: HIV/AIDS
Explanation:Given the symptoms described in a 31-year-old homosexual male, along with the findings of weight loss, blurred vision, and retinal hemorrhage, the single most appropriate option to consider is HIV/AIDS.
HIV/AIDS can manifest with a wide range of symptoms, including unintentional weight loss and blurred vision. Retinal hemorrhage can also occur as a complication of HIV/AIDS, particularly in advanced stages when the immune system is severely compromised.
In this case, it’s important to conduct further diagnostic tests, including HIV testing, to confirm the diagnosis. Additionally, prompt initiation of antiretroviral therapy (ART) is crucial for managing HIV/AIDS and preventing further complications. Referral to an infectious disease specialist for comprehensive management is recommended.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Correct
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Incorrect
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A 55-year-old woman diagnosed with type 2 diabetes presents with vomiting and diarrhoea after eating a meal of chicken and chips. She said her stool had small amounts of blood in. Campylobacter Jejuni was found on her stool culture exam. Which of the following is the most appropriate therapy?
Your Answer: Amoxicillin
Correct Answer: IV fluids
Explanation:Campylobacter is the most likely cause of diarrheal illness often due to undercooked meat being ingested. It is also a major cause of traveller’s diarrhoea. Sufficient fluid replacement and anti-emetics are indicated first followed by the antibiotic, Erythromycin although antibiotic treatment in adults is still in question. Ciprofloxacin and Tetracycline may also be effective.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Correct
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 20
Correct
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 21
Correct
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In which one of the following diseases does the patient have to be isolated?
Your Answer: Measles
Explanation:Measles and chickenpox are spread by droplets. Thus, patients should be isolated.
Rheumatic fever and post-streptococcal glomerulonephritis are immune mediated diseases that don’t require isolation.
Herpetic gingivostomatitis spreads by direct transmission of infected secretions to the stratified squamous epithelium.
HSP is not an infectious disease. -
This question is part of the following fields:
- Infectious Diseases
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Question 22
Correct
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The following are commonly recognized disease syndromes associated with Clostridium species, except:
Your Answer: exfoliative skin rash
Explanation:Clostridium species do not present with an exfoliative skin rash. C. perfringens is a common aetiology in necrotizing infections (gas gangrene) as well as food poisoning, which often also includes diarrhoea. C. difficle causes diarrhoea. C. tetany and C. botulinum have neurotoxins that can lead to paralysis.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Correct
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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: 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 24
Incorrect
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Which of the following drugs is NOT used in the treatment of MRSA?
Your Answer: Doxicycline
Correct 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.
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This question is part of the following fields:
- Infectious Diseases
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Question 25
Correct
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A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from shortness of breath, weight loss and dry cough due to Kaposi's sarcoma but no fever was noted. Which is the most likely causative organism?
Your Answer: Pneumocystis jiroveci
Explanation:Pneumocystis Jiroveci. This causative organism is responsible for pneumonia in individuals that have a compromised immune system. Symptoms include cyanosis, dry cough and in some cases, diffuse bilateral alveolar shadows on CXR. Co-trimoxazole is normally the treatment for this.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Correct
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An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?
Your Answer: Scabies
Explanation:Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
Henoch-Schönlein purpura is a type of vascular inflammation.
Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication. -
This question is part of the following fields:
- Infectious Diseases
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Question 27
Incorrect
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Regarding Giardia Lamblia which one of the following statements is true?
Your Answer: May be cause of haemolytic uremic syndrome (HUS)
Correct Answer: May cause intestinal malabsorption
Explanation:Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Correct
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A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?
Your Answer: Escherichia coli 0157
Explanation:The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
Crohn’s disease rarely manifests in an acute manner.
Polio and giardiasis usually manifest with non-bloody diarrhoea. -
This question is part of the following fields:
- Infectious Diseases
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Question 29
Correct
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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.
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This question is part of the following fields:
- Infectious Diseases
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Question 30
Correct
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A 45-year-old woman is HIV positive. She is very concerned that she is at increased risk of cancer. Which one of the following cancers is NOT increased in HIV positive people?
Your Answer: Breast cancer
Explanation:Breast cancer has a lower incidence in HIV positive patients. Seminoma, Hodgkin’s disease, anal cancer, and non-small cell lung cancer are all increased incidence. Memorize this breast cancer fact.
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This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
