Infectious diseases RACP MCQs Flashcards
RACP 2022 Q 12
Yersinia Pestis caused the bubonic plague in Europe in the middle ages. What is the main vector for Yersinia pestis that transmits the disease to
humans?
A. Ticks
B. Fleas
C. Rats
D. Mosquitos
Answer B
Pathogen: Yersinia pestis
Reservoir: prairie dogs, squirrels, rodents
Route of transmission: flea bites
RACP 2022 Q 15
15.Rabies is now common in Bali. A patient returns from Bali and reports a monkey bite 3 weeks ago. He did not receive any treatment in Bali. What should you administer?
A. Rabies immunoglobulin and rabies vaccination now
B. Rabies immunoglobulin only
C. Rabies vaccine only
D. Do nothing as he was bitten three weeks ago
Answer A or C - depending on patient’s vaccination status
- Post exposure prophylaxis - vaccination +/- rabies immunoglobulin ( Option B incorrect)
- Incubation period is 45 days but can be longer, only late for PEP when patient starts displaying clinical signs of rabies (Option D incorrect)
- If previously vaccinated against rabies - then PEP is only repeat rabies vaccination, if unvaccinated - then patient needs both vaccine and immunoglobulin
RACP 2022 Q16
16.75F with unilateral headache, photophobia, N+V with reddened left eye. What is the most appropriate initial investigation?
a. CT Brain
b. CT cerebral angiogram
c. Intraocular pressure measurement
d. Lumbar puncture
Answer C - quick and easy initial investigation to rule out acute closed-angle glaucoma
RACP 2022 Q 17
17.A patient reports one month history of deafness. Syphillis is suspected and his RPR positive, TPPA positive. What is the next appropriate step in management?
A. Benzathine benzylpenicillin 2.4 million units IM once-off
B. Benzathine benzylpenicillin 2.4 million units IM weekly for 3 weeks
C.Benzylpenicillin 1.8g IV 4hrly for 15 days
D. Procaine benzylpenicillin 1.5g IM daily for 10 days
Answer C
Otosyphilis is considered a manifestation of tertiary syphilis.
CDC guidelines: aqueous crystalline penicillin G 3-4mil units Q4h intravenously for 10-14 days
eTG: benzylpenicillin 1.8g q4h IV for 15 days
NB: aqueous crystalline penicillin G is also known as benzylpenicillin in Australia, 60mg of benpen is equivalent to 100,000 units of penicillin (i.e. 1.8g = 3mil units)
RACP 2022 Q 30
30ish male. Unprotected sex MSM 2 weeks ago. Presents with anal
discharge. Suspect infective proctitis. Sample sent for culture. Awaiting
result. What is the most appropriate empirical therapy?
A. Ceftriaxone + valacyclovir
B. Ceftriaxone + Doxycycline + valacyclovir
C. HIV PEP only
D. Nothing, wait for culture.
Answer B
Treat infective proctitis empirically as chlamydia, gonorrhoea, and HSV until culture results are known. Recommended treatment as per eTG is:
(1) ceftriaxone 500mg IM/IV once (N.gonorrhoea)
(2) doxycycline 100mg PO BD for 7 days (C.trachomatis)
(3) valaciclovir 500mg PO BD for 10 days (HSV)
RACP 2022 Q 50
- 25yo patient with restrictive VSD going for surgical wisdom tooth extraction.
What infective endocarditis prophylaxis should they be given?
A. Amoxicillin 2g PO 30-60min before procedure
B. Clindamycin 600mg PO 30-60min before procedure
C. Cefalexin 1g PO 30-60min before procedure
D. No prophylaxis required
Answer A
Antibiotic prophylaxis regimens for invasive dental or invasive oral procedures target prevention of viridians group streptococcal IE. The preferred regimen is oral amoxicillin (adults: 2 grams; children: 50 mg/kg). Antibiotics should be administered 30 to 60 minutes prior to the procedure.
Clindamycin is no longer recommended as an alternative antibiotic regimen for patients undergoing dental procedures, given more frequent and severe adverse reactions associated with this drug compared with other antibiotic agents.
Cefalexin is indicated in patients with penicillin allergy.
RACP 2022 Q62
62.Patient presents with fever, headache, red eyes. No diarrhoea mentioned in stem. Recent travel history including swimming in freshwater lakes in Malaysia. What is the most likely organism?
A. Aeromonas
B. Vibrio (species named; not cholera)
C. Leptospirosis
Answer C
- Leptospirosis is a zoonotic infection - caused by spirochetes that have a reservoir in rodents. Humans contract via exposure to infected rodent urine in soil or freshwater.
- Causes icteric and anicteric (more common) illness. Latter is characterised by abrupt onset of fever, rigors, myalgias (especially in the calves and lower back), and headache. A distinguishing feature is conjunctival suffusion, which occurs in over half of patients.
Aeromonas consists of gram-negative rods widely distributed in freshwater, estuarine, and marine environments. Diarrheal disease is the most common manifestation of Aeromonas infection, but can also cause wound infections and bacteraemia.
Vibrio sp. cause gastrointestinal illness, wound infections and bacteraemia associated with salt water and seafood (contaminated oysters and raw shellfish).
RACP 2022a Q88
88.EMQ: Which of the following causative organisms of infective endocarditis is
culture negative?
a. Coxiella burnetti
b. Strep gallolyticus
c. Haemophilus influenza
d. Acetinobacter Baumanii
e. Staph aureus
f. Aspergillus
Answer A and F
Coxiella burnetti and Bartonella spp. are fastidious organisms which require very specific conditions to grow and thus may not be positive on blood cultures.
Fungal bacteremia are also often negative on routine blood cultures.
RACP 2022a Q87
87.EMQ: Which of the following causative organisms of infective endocarditis is
associated with bowel cancer?
a. Coxiella burnetti
b. Strep gallolyticus
c. Haemophilus influenza
d. Acetinobacter Baumanii
e. Staph aureus
f. Aspergillus
Answer B
Streptococcus gallolyticus ( formerly known as Strep bovis) - associated with bowel cancer.
Patients with endocarditis secondary to S. bovis group should be investigated for a concurrent bowel neoplasm.
RACP 2022 P2 Q11
- How does probenecid affect the clearance of cephazolin?
A. Increased renal tubular reabsorption
B. Increased glomerular filtration
C. decreased tubular secretion
Answer C
Probenecid decreases secretion of beta-lactam antibiotics in the proximal convoluted tubule.
RACP 2022 P2 Q23
- What is the appearance of Listeria monogenes on gram stain?
A. Gram positive cocci
B. Gram negative rod
C. Gram positive rod
D. Gram negative coccobacilli
Answer C Gram positive rod
RACP 2022 Q56
- What is the most common cause of cellulitis?
A. Group A streptococcus
B. Staph aureus
C. Staph epidermidis
Answer A
Most common cause of cellulitis and erisypelas is beta-haemolytic strep (group A strep e.g. S.pyogenes) followed by MSSA
RACP 2021 Q2
Q2. A 53 year old woman presents with sudden onset joint pain and swelling. She is febrile with a WCC of 13. Joint aspirate shows 103,000 WCC with >95% neutrophils. What is the most appropriate initial choice of antibiotic?
A. Ceftazidime
B. Clindamycin
C. Flucloxacillin
D. Tazocin
Answer C
Patient has features of septic arthritis.
In absence of Gram stain results, presumption is most common causative organism - Staph aureus
Treatment for MSSA - flucloxacillin
RACP 2021 Q18
Q18. A 17 year old boy presents with group A streptococcal positive acute rheumatic fever, with arthritis, pericarditis and a prolonged PR. What is the shortest recommended duration of antibiotics for secondary
prevention of recurrence?
A. 1 year
B. 5 years
C. 10 years
D. 15 years
Answer B or C ( based on interpretation of documented history)
This patient has mild cardiac involvement of rheumatic heart disease characterised by:
Echocardiogram showing:
Mild regurgitation or mild stenosis of a
single valve
OR
Atrioventricular conduction abnormality
on ECG during ARF episode
Recommendations for secondary prophylaxis:
- If documented history of ARF:
Minimum of 10 years after the most recent
episode of ARF, or until age 21 years (whichever is longer)
If NO documented history of ARF and aged <35 years - Minimum of 5 years following diagnosis of RHD or until age 21 years (whichever is longer)
https://ccmsfiles.tg.org.au/s2/PDFs/ABG16-ARF-RHD-gx-duration-prophylaxis-March-2022-update.pdf
RACP 2021 Q34
Q34. A man is diagnosed with Entamoeba infection after recently travelling to India. He is treated with a 10 day course of metronidazole, but also needs further luminal treatment due to which phase of the entamoeba
lifecycle?
A. Cysts
B. Merozoite
C. Schizont
D. Trophozoite
Answer A
- The goals of antibiotic therapy of intestinal amebiasis are to eliminate the invading trophozoites and to eradicate intestinal carriage of the organism.
- For all infections, regardless of the presence of symptoms - treatment with paromomycin to eliminate intraluminal cysts
- For symptomatic infections - metronidazole or tinidazole rather than an intraluminal agent alone
- Once treatment of invasive amoebiasis is completed, follow with a luminal agent to eradicate cysts and prevent relapse.
RACP 2021 Q38
Q38. A 75 year old male is diagnosed with methicillin-sensitive Staphylococcus aureus infection of his pacemaker leads. He is placed on IV flucloxacillin.
What additional treatment is required to achieve a cure?
A. Addition of gentamicin
B. Addition of probenecid
C. Addition of rifampicin and fusidic acid
D. Removal of pacemaker
Answer D
CIED removal (leads, including residual non-functional leads, and pulse generator recommended in the following situations:
- Patients with TEE or other imaging demonstrating valve or lead vegetation with suspicion or confirmation of bloodstream infection
- Patients with bacteremia due to S. aureus, coagulase-negative Staphylococcus (high grade), Cutibacterium (formerly Propionibacterium) species (high grade), Candida species, or high-grade bacteremia due to another organism with propensity to cause endocarditis
- Patients with CIED pocket infection
Device retention may be reasonably attempted in
- absence of vegetation on TEE in the setting of bacteremia due to a gram-negative organism or S. pneumoniae
- transient bacteremia from a clear alternative source due to an organism that does not commonly cause endocarditis
RACP 2021 Q46
Q46. A nurse has been exposed to a needlestick injury when caring for a patient. The patient has bloods with
serology is as follows: Hepatitis B surface antigen positive, HIV serology negative and Hepatitis C serology negative. The nurse’s blood tests from an earlier in the year show: Hepatitis B core negative, HIV negative, Hepatitis C negative and Hepatitis B surface antibody > 1000 IU.
What treatment do you suggest?
A. Prophylactic Entacavir
B. Hepatitis B immunoglobulin
C. Reassure and do no investigations
D. Hepatitis surface antigen serology at 6 and 12 weeks
Answer C
As per eTG:
- For source Hep B surface antigen positive (or unknown) , if exposed person is immune, no further investigations or preventative treatment is needed.
This nurse has negative Hep B core ab - suggesting no previous/ current infection and has Hep B surface ab positive with titre > 1000IU. Any immunocompetent patient who has completed a course of vaccination against HBV administered according to an approved schedule is considered immune as long as their anti-HBs titre has ever been measured as being >10 mIU/mL. Hence she is immune.
RACP 2021 Q50
Q50. A 24 year old male with a history of IVDU presents with fevers and is found to have multiple lung abscesses.
A new tricuspid regurgitation murmur is heard and infective endocarditis is confirmed after investigations. What is
the most likely causative organism?
A. Candida albicans
B. Escherichia coli
C. Streptococcus pyogenes
D. Staphylococcus aureus
Answer D
S. aureus is the most common cause of right-sided IE, accounting for up to 70 percent of cases. Streptococci and enterococci are the next most common pathogens, accounting for 5 to 30 percent and 2 to 5 percent of cases, respectively. Approximately 90 percent of patients with right-sided IE are people who inject drugs (PWID).
RACP 2021 Q58
Q58. An 84 year old female presented to the medical ward for management of congestive cardiac failure. A routine urine MCS was done on admission. Patient has no urinary symptoms.
Urine culture: E.coli
WCC 10-100
RBC <10
Squamous epithelial cells <10
Sensitivities:
Amoxicillin sensitive
Cefuroxime parenteral sensitive
Cefuroxime oral intermediate
Trimethoprim resistant
What’s the next best step?
A. No additional intervention/management
B. Repeat urine culture
C. Oral urine alkalinating agent
D. Oral amoxicillin
Answer A
Patient is presenting with asymptomatic bacteriuria. Only groups that warrant treatment
- Pregnancy
- Due for urological procedures
- Renal transplant recipient (< 3 months of transplant) —> eTG does not recognise this indication.
RACP 2021 Q65
Q65. A 70 year old female has a history of RA which is well controlled on long term methotrexate and prednisolone. She presents with a fever and shortness of breath and has audible crackles on the left lung base on auscultation. What is the most likely diagnosis?
A. Community acquired pneumonia
B. Methotrexate induced pneumonitis
C. Pulmonary embolism
D. PJP pneumonia
RACP 2021 Q69
Q69. A patient is on a vancomycin infusion for MSSA bacteremia. You are given some data:
Target concentration 20mg/L
Half life is 6 hours
Vd is 0.5L/kg
Bioavailability <5
Protein binding 30%
Patient weight 60kg
+ other information about insensible clearance
What is the maintenance dose?
A. 2mg/hr
B. 5mg/hr
C. 85mg/hr
D. 120mg/hr
RACP 2021 Q78
Q78. A patient recently returned from Thailand with fevers and was admitted to hospital. Dengue was confirmed.
Apart from bleeding, which of the following is most suggestive of severe Dengue?
A. Arthralgia
B. Ascities
C. Retro-orbital pain
D. Widespread rash
Answer B
Severe DENV infection includes infection with at least one of the following:
- Severe plasma leakage leading to:
* Shock
* Fluid accumulation with respiratory distress
- Severe bleeding (as evaluated by clinician)
- Severe organ involvement:
* Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L
* Impaired consciousness
* Organ failure
RACP 2021 Q89
Q89. A 60 year old woman with a history of bronchiectasis presents with cough productive of purulent sputum
and is commenced Amoxicillin 1g TDS with no clinical improvement. Her sputum cultures grew pan-sensitive Pseudomonas aeruginosa. How would you treat next?
A. Azithromycin
B. Ciprofloxacin
C. Inhaled tobramycin
D. Moxifloxacin
B ciprofloxacillin
RACP 2021 Q105
Q105. Persistence of which viral component prevents hepatitis B cure?
A. Covalently closed circular DNA
B. Hepatitis B surface antigen
C. Precore protein
D. Pregenomic RNA
RACP 2021 Q125
Q125. What is the most important pharmacological determinant for penicillin in terms of its bacterial eradication and clinical response?
A. AUC:MIC ratio
B. Time above MIC
C. Peak concentration
D. Trough level
RACP 2021 Q130
Q130. A patient with gastroenteritis tests positive to norovirus on stool PCR. They are admitted to hospital for management of dehydration and AKI. How long before the patient can be deisolated from contact and droplet precautions?
A. 24hrs after diarrhoea stops
B. 48hrs after diarrhoea stops
C. 72hrs after diarrhoea stops
D. Only after discharge from hospital
Answer B
As per CDC:
Place patients with norovirus gastroenteritis on Contact Precautions for a minimum of 48 hours after the resolution of symptoms to prevent further exposure of susceptible patients
RACP 2021 Q146
Q146. What drives the process of carditis in acute rheumatic fever?
A. Bacterial infection
B. Endotoxin release
C. Exotoxin release
D. Molecular mimicry
Answer D
Molecular mimicry implies structural similarity between some infectious or other exogenous agent and human proteins, such that antibodies and T cells activated in response to the exogenous agent react with the human protein. In ARF, antibodies directed against GAS antigens crossreact with host antigens
The alpha-helical protein structures found in M protein and N-acetyl-beta-D-glucosamine (NABG, the immunodominant carbohydrate antigen of GAS) share epitopes with myosin, and antibody crossreactivity has been demonstrated in humans
RACP 2021 Q153
Q153. Cereulide is the name of a toxin produced by bacillus cereus. It can lead to vomiting, most commonly how many hours after ingestion?
A. 0-6 hours
B. 7-12 hours
C. 13-18 hours
D. 19-24 hours
Answer A 0 -6 hrs
RACP 2021 Q159
Q159. Progressive multifocal leucoencephalopathy is caused by which of the following viruses?
A. JC virus
B. Adenovirus
C. EBV
D. HSV
Answer A
PML is a potentially fatal demyelinating disease of the central nervous system caused by a reactivation of the JC polyomavirus (JCV) that occurs almost exclusively in immunosuppressed individuals
RACP 2021 Q164
Q164. A patient is started in Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for confirmed active TB. Which
complication of ethambutol would warrant stopping treatment with this agent?
A. Hepatitis
B. Optic neuritis
C. Adrenal failure
D. Seizures
Answer B
Optic neuropathy (usually manifested as a change in visual acuity or red-green colour blindness) is the most important ethambutol toxicity. The reported incidence of optic neuropathy when ethambutol is taken for more than two months increases with higher dosing of the drug. Optic neuritis is reversible in most patients. It is generally recommended that patients receiving ethambutol as part of combination therapy for treatment of a mycobacterial infection undergo baseline Snellen visual acuity and red-green colour perception testing.
RACP 2021 Oct Q3
- When does the rash occur in measles in relation to other symptoms such as
fever, coryza, conjunctivitis?
A. At the same time as conjunctivitis
B. 2 - 4 days after fever
C. 2 - 4 days after cough
D. 1 - 2 days after coryza
Answer B
The exanthem of measles arises approximately two to four days after onset of fever; it consists of an erythematous, maculopapular, blanching rash, which classically begins on the face and spreads cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities
RACP 2021 Oct Q73
- 26F at 28/40 gestation presents with fever, neck stiffness. LP high
lymphocytes and Protein. Culture gram + cocci . Ceftriaxone is commenced and Benzylpenicillin added. What organism is the benzylpen to cover?
A. Listeria
B. H. Influenza
C. Staph aureus
D. Strep. Pneumonia
Answer A
Listeria monocytogenes is intrinsically resistant to cephalosporins. For patients who are older than 50 years, immunocompromised, pregnant or debilitated, or those with a history of hazardous alcohol consumption, to treat Listeria, add to the above regimen: benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 4-hourly.
NOTE: Listeria monocytogenes are gram positive rods
RACP 2021 Oct Q 74
- 22F with 2 weeks history of behavioural change, perseveration, mutism,
echolalia, strange neurological movements, thinks mother is someone else. What is the cause? Pt was on tramadol for joint operation.
A. Drug use
B. HSV encephalitis
C. NMDA encephalitis
D. Serotonin syndrome
RACP 2021 Oct Q79
- What pharmacokinetic/pharmacodynamic parameters determine efficacy
of penicillin drugs in treatment of staph?
A. AUC:MIC ratio
B. Time above MIC.
C. Peak Level
D. ?
RACP 2021 Oct Q93
- What part of Hep B does Hep D need to replicate?
A. HbsAb
B. Hb e antigen
C. Core antigen
? None of the listed options
The hepatitis D virion comprises an RNA genome, a single HDV encoded antigen, and a lipoprotein envelope provided by hepatitis B virus (HBV). The lipoprotein envelope of HDV is provided by the HBV and consists of the same proteins (large, middle, and small S) that are found in the HB virion; their relative proportion depends upon the level of HBV replication.
RACP 2021 Oct Q108
- Pt is admitted to hospital with sepsis. Hypotensive despite fluid resus. Taken to ICU for NORAD. Pt is on 3 mg pred/day. What else can be added?
A. more fluid
B. Stress dose steroids
C. second inotrope
RACP 2021 Oct
35 yo lady ,sexually active, presents with painful knee joint. Gram stain of
aspirate shows Gm positive diplococci.
What’s the organism?
A. Chlamydia trachomatis
B. Strep pneumonia
C. Nieserria gonorrhoea
D. rhubarb
Answer B
Nieserria gonorrhoea - common cause of septic joint in sexually active young adults, but is Gram negative diplococci
A. Chlamydia trachomatis - Gm -ve coccobacilli
B. Strep pneumonia = Gm +ve diplococci
C. Nieserria gonorrhoea - Gm -ve diplococci
D. rhubarb
RACP 2020 Q1
Choose the most appropriate therapy for a 70 year old woman, with febrile neutropenia on cyclophosphamide +. Feeling well, no allergies, no hepatic or renal impairment. BP 105/80.
A. Ciprofloxacin
B. Ceftriaxone
C. Taz + Gent
D. Piperacillin-tazobactam
Answer C
For patients without septic shock and not requiring intensive care support (including patients with risk factors for infection with a multidrug-resistant Gram-negative bacterium, except if known to be colonised or recently infected with a resistant bacterium), use:
piperacillin+tazobactam 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) intravenously, 6-hourly
OR
cefepime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly [Note 4]
OR
ceftazidime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly
RACP 2020 Q15
- What is the most common side effect of osteltamivir?
A) Hepatitis
B) Rash
C) Nausea and vomiting
D) Confusion
Answer C
Oseltamivir can cause nausea and vomiting
RACP 2020 Q22
- In addition to influenza, which vaccine is indicated in COPD?
A) Hemophilus
B) Pneumococcal
C) Varicella
D) Meningococcal
Answer B
RACP 2020a Q 36
- What is the most common presentation of gentamicin induced ototoxicity?
A) High frequency hearing loss
B) Low frequency hearing loss
C) Oscillopsia + vertigo
D) Ataxia + vertigo
Answer ? C
Gentamicin, tobramycin and streptomycin are preferentially vestibulotoxic, whereas amikacin and kanamycin are primarily cochleotoxic. Cochleotoxicity presents with hearing impairment. Vestibulotoxicity typically manifests with ataxia, dysequilibrium and oscillopsia (visual blurring with head movement), which should be elicited on history taking.1,2,6 Vertigo is usually absent, because aminoglycoside-induced toxicity causes symmetric bilateral vestibular loss
RACP 2020 Q29
- How often should patients on PrEP (pre-exposure prophylaxis) be screened for HIV?
A) 3 monthly
B) 6 monthly
C) 12 monthly
D) After every high risk exposure
Answer A
RACP 2020 Q31
- A 58 year old non-smoker with a past history of asthma presents to the emergency department with 4 days of productive cough and a temperature of 38.3. Her chest X-ray is shown below (pic). Which of the following is the most likely diagnosis?
A) Empyema
B) Middle lobe collapse/consolidation
C) Lower lobe collapse/consolidation
D) Pulmonary infarction
ANS: Picture was of right lower ZONE collapse consolidation. Appeared to have silhouette sign of right diaphragm but not right heart border
RACP 2020 Q32
- In an otherwise healthy but unvaccinated individual undergoing a splenectomy, which of the follow options is the best approach to vaccination for pneumococcus?
A) Administer conjugate vaccination before procedure then polysaccharide 8 weeks later
B) Administer polysaccharide vaccination before procedure then conjugate 8 weeks later
C) Two doses of conjugate vaccination at least 8 weeks apart
D) Two doses of polysaccharide vaccination at least 8 weeks apart
RACP 2020 Q62
- Sandra is 6 months post renal transplant on tacrolimus, prednisolone, and mycophenolate with increasing BK viraemia. What is an effective strategy to reduce the risk of BK nephropathy?
A) Add cidofovir
B) Prednisolone
C) Reduce tacrolimus and mycophenolate
D) Add Bactrim DS
RACP 2020 Q68
- Guy ate rice that was microwaved three times. Diarrhoea +++ within 3 hours. What is the likely causative organism?
A) Bacillus cereus
B) Enterotoxigenic E. coli
C) Salmonella
D) Shigella
RACP 2020 Q73
- What is the most important benefit of tenofovir alafenamide (TAF) compared to tenofovir disoproxil fumurate (TDF) in the treatment of human immunodeficiency virus or aquired immunodeficiency syndrome (HIV/AIDS)?
A) Blockade of chemokine receptor type 5 (CCR5)
B) Elimination of nephrotoxicity
C) Improved efficacy as pre-exposure prophylaxis (PrEP)
D) Limited potential for drug resistance
RACP 2020 Q80
- Needlestick injury of a nurse from a patient with HbSag positive blood. Nurse’s HbSAb titre >100IU/L
A) Hepatitis B Immunoglobulin
B) No treatment
C) Hepatitis B vaccination
D) Re-test hepatitis B antigen after 3 months
RACP 2020
- In addition to chorioretinitis, which ocular manifestation is associated with candidemia?
A.Endopthalmitis
B.Dacrocystitis
C. Iritis
D. Keratitis
RACP 2020
- What is the vaccination regime for pneumococcus in a patient with a splenectomy?
A) Conjugate vaccine and repeat conjugate vaccine in 8 weeks
B) Conjugate vaccine first and polysaccharide vaccine in 8 weeks
C) Polysaccharide vaccine and repeat polysaccharide vaccine in 8 weeks
D) Polysaccharide vaccine first and conjugate vaccine 8 weeks after
RACP 2020
- Known asthmatic. Febrile. SOB. Radiograph as shown - what is the diagnosis?
A) Right Middle lobe collapse/consolidation
B) Right lower lobe collapse/consolidation
C) Sarcoidosis
RACP 2020
- A 27 year old patient from Zimbabwe who migrated to Australia when he was 19 presents with his first episode of a seizure. No other background medical history. The MRI shows calcific nodules (see picture).
A. Cryptococcus
B. HIV encephalopathy
C. Toxoplasmosis
D. Neurocysticercosis
RACP 2020
- A patient with a prosthetic aortic valve is undergoing a dental extraction. What prophylaxis should he receive?
A. Amoxicillin monotherapy
B. Amoxicillin-Clavulanic Acid
C. No prophylaxis
D. Amoxicillin + Metronidazole
RACP 2020
- Recurrent MSSA boils & infections. When should mupirocin 2% decolonisation be performed?
- Young non-pregnant woman with a symptomatic UTI (dysuria, urinary frequency). No flank pain. Afebrile. Urine culture shows 300 WCC and fully sensitive E.Coli. What treatment should be initiated?
A) Ciprofloxacin
B) Gentamicin
C) Ceftriaxone
D) Trimethoprim
RACP 2020
- Man in his 30s who works with stone kitchen bench tops presenting with dry cough. X-ray shows bilateral upper fibrosis. What is the diagnosis?
A) Tuberculosis
B) Silicosis
C) Asbestosis
D) Hypersensitivity pneumonitis
RACP 2020
- Which antibiotic is most associated with QT prolongation?
A) Ceftriaxone
B) Amoxicillin
C) Gentamicin
D) Ciprofloxacin
RACP 2020
- What is the most common mechanism of carbapenem resistance in gram negative organisms?
A) Efflux pumps
B) Drug hydrolysis
C) Beta-lactamases
RACP 2020
- A patient at high risk of HIV on PrEP. How often should HIV testing be performed?
A. After every sexual encounter
B. 3 monthly
C. 6 monthly
D. Yearly
RACP 2019b Q5
Question 5
Treatment of asymptomatic bacteriuria is recommended before which procedure?
A. CABG
B. TURP
C. Total hip replacement
D. Colonoscopy
RACP 2019 Q1
What is the response rate of ledipasvir + sofosbuvir in Hepatitis C genotype 1?
A. 65%
B. 75%
C. 85%
D. 95%
RACP 2019 Q35
A patient with replapsing-remitting multiple sclerosis has been treated with natalizumab for 4 years. She develops new neurological symptoms and MRI shows white matter changes. Progressive multifocal leukoencephalopathy is suspected. What is the most specific CSF test?
A. Neuron specific enolase
B. JC virus
C. Oligoclonal bands
D. 14-3-3 protein
RACP 2019 Q45
What vaccination besides H. influzenzae, pneumoccoal and meningococcal would you give to an asplenic patient?
A. Bordetella
B. Rubella
C. Influenza
D. Varicella zoster
RACP 2019 Q46
A 30 year old man presents with a three month history of bloody diarrhoea associated with mucous, tenesmus and three kilograms of weight loss. He last travelled to Thailand six months ago. Blood tests revealed an anaemia with Hb 115 g/L, CRP 80 mg/L, ESR 25 mm/Hr. WCC, B12, iron and folate were normal. What is the most likely diagnosis?
A. Crohn’s disease
B. Ulcerative Colitis
C. Ischaemic colitis
D. Salmonella enteritis
RACP 2019 Q54
A 35 year old man presents with progressive cough for more than a year. He works in an office, does not smoke, lives alone, and has not travelled overseas. There is no family history of lung disease and he reports no contact with other persons with pulmonary disease or chest infection. Clinical examination is unremarkable. His chest x-ray is shown:
?Unexciting CXR – not the same as last year’s though
Which of the following is the most likely diagnosis?
A. Extrinsic allergic alveolitis
B. Lung cancer
C. Sarcoidosis
D. Tuberculosis
RACP 2019 Q57
A 25 year old man is admitted with severe necrotising fasciitis. He has grown Streptococcus pyogenes in his blood culture and is started on high dose IV benzylpenicillin. Which of the following antimicrobials would you add?
A. Ceftriaxone
B. Clindamycin
C. Moxifloxacin
D. Vancomycin
Answer B
Clindamycin or lincomycin is recommended for S. pyogenes necrotising fasciitis because of a theoretical reduction in bacterial toxin production; however, clinical evidence is limited.
RACP 2019 Q77
A 54 year old man has stage 3 colorectal cancer on capcitabine and oxaliplatin. He is currently experiencing 8 episodes of diarrhoea a day, despite taking loperamide. There are no other infective symptoms. What medication would you add to manage his symptoms?
A. Methylprednisolone
B. Subcutaneous morphine
C. Metronidazole
D. Infliximab
RACP 2019 Q89
A 26yo Indigenous woman presents with arthralgias, rash and a new cardiac murmur on auscultation. She mentions she had been unwell recently with a sore throat. What is the most likely diagnosis?
A. Acute rheumatic fever
B. Infective endocarditis
C. Sarcoidosis
D. Pericardial effusion
Answer A (ARF)
RACP 2019 P2 Q6
Patient returns from India with a UTI and on subsequent urinalysis found to isolate ESBL.
What is the most likely mechanism of antibiotic resistance?
A. Drug efflux
B. Drug Hydrolysis
C. Altered binding protein
D. Decreased permeability
RACP 2019 P2 Q12
In patients with malaria treated with artemether and lumefantrine, they are then given two weeks of primaquine. Which part of the malaria life cycle does primaquine treat?
A. Blood schizonts
B. Hypnozoites
C. Trophozoites
D. Sporozoites
RACP 2019 P2 Q34
There is an outbreak of vomiting and diarrhoea in a nursing home. The vomiting and diarrhoea lasts for approximately 24 hours before resolving but spreads rapidly throughout residents. What is the most likely pathogen?
A. Enteric adenovirus
B. Rotavirus
C. Norovirus
D. Coronavirus
RACP 2019 P2 Q55
A 19 year old female is admitted with meningococcal meningitis. What contact precautions are required in the first 24 hours of her admission?
A. Negative pressure
B. Droplet
C. Airborne
D. Contact
RACP 2019 P2 EMQ (incomplete)
Q: Autoinfection and hyperinfection in immunocompromised
A. CMV
B. Pneumocytis jirovecii
C. Strongyloides
D. Burkholderia
RACP 2019 P2 EMQ (incomplete)
Q. Transplant patients need prophylaxis regardless of donor or recipient status
A. CMV
B. Pneumocytis jirovecii
C. Strongyloides
D. Burkholderia
RACP 2018 Q17
A 76-year-old man with prior mechanical aortic valve replacement requires a colonoscopy and likely colonic biopsy. What endocarditis prophylaxis is appropriate?
A. Ampicillin.
B. Ceftriaxone.
C. Gentamicin.
D. Metronidazole.
E. No prophylaxis.
Answer E - No prophylaxis
Antibiotic prophylaxis for genitourinary and gastrointestinal tract procedures is indicated only if surgical antibiotic prophylaxis is required or for patients with an established infection
RACP 2018 Q25
- A patient presents with severe sepsis, hypotension and a swollen red area of cellulitis on the right leg. You suspect necrotising fasciitis. Confirmation of the diagnosis is best made by which of the following?
A. Clinical crepitus.
B. Clinical response to IV antibiotics.
C. CT imaging.
D. Culture of group A Streptococcus.
E. Surgical exploration.
Answer E
Definitive diagnosis of necrotising fasciitis is made on visualisation of the tissue on surgical exploration.
CT imaging with contrast can show enhancement at areas of necrosis but should not delay surgical debridement.
Clinical crepitus is suggestive of gas in soft tissue and is present in 50% of patients with NF.
RACP 2018a Q60
- Which factor is the strongest indication for surgery in native valve bacterial endocarditis?
A. Intravenous drug use and tricuspid valve endocarditis.
B. Mobile vegetation of 5 mm on echocardiography.
C. Pulmonary infarction.
D. Staphylococcal bacteraemia for 3 days despite therapy.
E. Valve regurgitation resulting in heart failure.
Answer E
Indications for surgery in IE:
- Prosthetic valve endocarditis
- Valve dysfunction leading to heart failure
- Uncontrolled infection: e.g., enlarging vegetation, persistent bacteremia (> 7 days of appropriate treatment)
- Perivalvular extension or complications: e.g., abscess, pseudoaneurysm, fistula, heart block
- Fungal endocarditis
- High embolic risk: e.g., mobile vegetation > 10 mm, recurrent embolism
RACP 2018 Q61
A 40-year-old HIV positive man with a CD4 count of 450 cells/μL [650–2000] presents with a 3 day history of fever, cough, sputum production and a right lower lobe consolidation on chest x-ray. What is the most likely organism causing his pneumonia?
A. Methicillin resistant Staphylococcus aureus.
B. Mycobacterium avium complex.
C. Mycobacterium tuberculosis.
D. Pneumocystis jirovecii.
E. Streptococcus pneumoniae.
RACP 2018 Q77
A 32-year-old man has returned from 8 weeks in India 16 days previously. Since his arrival home, he has had fevers, abdominal pain, constipation and lethargy. Gram negative bacilli have grown in both aerobic and anaerobic blood culture samples 13 hours after being drawn. What is the most likely diagnosis?
A. Dengue.
B. Escherichia coli O157.
C. Leptospirosis.
D. Malaria.
E. Typhoid.
RACP 2018 Q78
A 90-year-old resident of a nursing home develops offensive diarrhoea after a 7-day period of constipation. He is being treated with paracetamol and a transdermal opioid for chronic persistent pain and has also received long-term coloxyl with senna two tablets daily. He had a 5-day course of cephalexin for a urinary tract infection 5 days ago. What is the most likely cause for the diarrhoea?
A. Clostridium difficile.
B. Diverticulitis.
C. Drug-induced colitis.
D. Laxative abuse.
E. Overflow diarrhoea.
RACP 2018 Q80
A 35-year-old man presents with fevers and myalgias 10 days after returning to Australia from Uganda. He had no pre-travel advice or vaccinations and did not take antimalarials.
Investigations reveal Plasmodium falciparum (parasite count 9.2%), anaemia (haemoglobin
85 g/L [135–175]), thrombocytopoenia (platelets 40 × 109/L [150–400]), acute kidney injury and a raised bilirubin (60 μmol/L [3–18]). The hospital has all antimalarial therapies available for emergency use.
Which antimalarial agent should be commenced?
A. Intravenous artesunate monotherapy.
B. Intravenous quinine dihydrochloride monotherapy.
C. Oral combination artemether+lumefantrine.
D. Oral doxycycline monotherapy.
E. Oral mefloquine monotherapy.
RACP 2018 Q81
- Use of antibiotics (especially vancomycin and broad-spectrum antibiotics) leads to an increase in the incidence of vancomycin-resistant Enterococcus (VRE).
What other factor contributes to colonisation with VRE?
A. Antifungal drugs.
B. Chronic immunosuppression.
C. Clostridium difficile infection.
D. Diabetes mellitus.
E. Residential care.
RACP 2018 Q97
- Which antifungal is first-line therapy for treatment of invasive aspergillosis?
A. 5-Flucytosine.
B. Caspofungin.
C. Fluconazole.
D. Griseofulvin.
E. Itraconazole.
F. Liposomal amphotericin.
G. Terbinafine.
H. Voriconazole.
RACP 2018 Q98
- Which antifungal is first-line therapy for an intensive care patient with Candida glabrata candidaemia?
A. 5-Flucytosine.
B. Caspofungin.
C. Fluconazole.
D. Griseofulvin.
E. Itraconazole.
F. Liposomal amphotericin.
G. Terbinafine.
H. Voriconazole.
RACP 2018 Q 106
106.The in vitro gamma interferon release assay Quantiferon TB GoldTM is commonly used in patients with suspected Mycobacterium tuberculosis (MTB).
What is the main role of the Quantiferon Gold test?
A. Detect exposure to MTB.
B. Determine extent of MTB disease.
C. Determine response to MTB therapy.
D. Predict active MTB.
E. Rule out MTB.
RACP 2018 Q109
109.Which of the following is a minor criterion for the diagnosis of acute rheumatic fever?
A. Carditis.
B. Polyarthritis.
C. Prolonged PR interval.
D. Proteinuria.
E. Subcutaneous nodules.
RACP 2018 Q117
117.Molecular mimicry may account for the development of carditis in acute rheumatic fever. The streptococcal M protein and N-acetyl-beta-D-glucosamine share epitopes with which component of cardiac tissue?
A. Actin.
B. Desmosomes.
C. Myosin.
D. T-tubules.
E. Troponin.
RACP 2018 Q145
145.Kidney stones contain a variety of crystalline and non-crystalline material. Stone composition can influence urological intervention. Which crystalline material is associated with Proteus mirabilis, a urease-producing bacteria?
A. Calcium oxalate.
B. Calcium phosphate.
C. Cystine.
D. Struvite.
E. Uric acid.
RACP 2018b Q170
170.Which antibiotic is most commonly associated with this adverse drug reaction?
Pulmonary fibrosis.
A. Azithromycin.
B. Cefaclor.
C. Cefepime.
D. Ciprofloxacin.
E. Clindamycin.
F. Flucloxacillin.
G. Nitrofurantoin.
H. Rifampicin.
RACP 2018 Q169
Which antibiotic is most commonly associated with this adverse drug reaction?
169.Achilles tendonitis and rupture.
A. Azithromycin.
B. Cefaclor.
C. Cefepime.
D. Ciprofloxacin.
E. Clindamycin.
F. Flucloxacillin.
G. Nitrofurantoin.
H. Rifampicin.
RACP 2018 Q164
164.Vibrio cholerae causes diarrhoea primarily by what mechanism?
A. Hypermotility.
B. Inflammatory.
C. Malabsorption.
D. Osmotic.
E. Secretory.
RACP 2017
A 75-year-old Chinese man who is being treated with a TNF inhibitor for Rheumatoid Arthritis develops fevers, night sweats and a productive cough. You suspect Tuberculosis. The most sensitive test for diagnosing active TB infection is:
A. Three consecutive sputum samples sent for acid fast bacilli staining
B. Three consecutive sputum samples sent for TB culture
C. Transbronchial biopsy
D. Quantiferon Gold Assay
E. Tuberculin Skin Test
RACP 2017
A 31-year-old male has had a renal transplant five years ago, and he presents to you with a headache, fever and signs of meningism.
The salient features of the LP are:
Mild elevation of protein
Low Glucose
WCC 700 (Neutrophils 630 Mononuclear 70)
RBC 52
Gram stain and PCR is pending
What is the most likely causative agent?
A. Herpes Simplex
B. Listeria monocytogenes
C. Streptococcus pneumonia
D. Klebsiella pneumonia
E. Mycobacterium tuberculosis
RACP 2017
A 35-year-old gentleman presents with poorly demarcated erythema, pain, and tenderness involving the skin around his left eye. You notice there is a degree of chemosis involving the left eye. The patient states that movement of his left eyeball is restricted and painful.Which of the following treatments is most appropriate for managing this condition?
What is the most appropriate empirical antibiotic regimen?
A. Clindamycin
B. Benzylpenicillin and Metronidazole
C. Flucloxacillin and Ceftriaxone
D. Flucloxacillin
E. Ciprofloxacin
RACP 2017
An 82-year-old female with hypertension, Type 2 Diabetes and Chronic Kidney Disease (eGFR 35 mL/min/1.73m2) presents to the outpatient clinic with an uncomplicated urinary tract infection. She’s current on Spironolacto’e, Losartan and Gliclazide. Which of the following is the most appropriate antibiotic agent?
A. Cephalexin
B. Ciprofloxacin
C. Nitrofurantoin
D. Norfloxacin
E. Trimethoprim
RACP 2017
A 25-year-old HIV negative man who has sex with other men presented with a fever, rash and malaise. His Treponema Pallidum Particle Agglutination assay is positive and he has a Rapid Plasma Reagin titre of 1:64. At that time he was diagnosed with secondary Syphilis infection and treated with one dose of IM Benzathine Penicillin.
One year later, his RPR titre is noted to be 1:256. What is the most likely explanation for his markedly elevated RPR titre?
A. Co-infection with Chlamydia trachomatis
B. Re-infection with Syphilis
C. Insufficient initial treatment
D. Antibiotic resistance
E. False positive result
RACP 2017
A 35-year-old gentleman presents with abdominal pain and fevers after returning from a three-month holiday in India. Abdominal CT was performed which shows a liver abscess. The patient is commenced on Ceftriaxone and Metronidazole. What is the most likely organism?
A. Aeromonas veronii
B. Entamoeba histolytica
C. Salmonella typhi
D. Shigella dysenteriae
E. Escherichia Coli
RACP 2017
A 28-year-old man presents with fever, neck stiffness and photophobia after spending one week in Thailand. A lumbar puncture is consistent with eosinophilic meningitis.
What is the most likely causative organism?
A. Ascaris lumbricoides
B. Angiostrongylus cantonensis
C. Enterobius vermicularis
D. Schistosoma haematobium
E. Taenia saginata
RACP 2016 Q48
A 25 year old healthy male returns from Papua New Guinea with fevers. He is systemically apart from a fever. Investigations in ED confirm a diagnosis of malaria but identification of the type is not available until the morning. What is the most appropriate treatment to start?
A. Lumefantrine and arthmeter
B. Artesunate
C. Chloroquine
D. Mefloquine
E. Quinine
RACP 2016 Q60
A 25 year old male is diagnosed with MSSA endocarditis with a perivalvular vegetation. He is commenced on IV flucloxacillin. What is the optimal duration of treatment?
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
E. 12 weeks
Answer C - 6 weeks
For patients with uncomplicated native valve endocarditis caused by methicillin-susceptible staphylococci, 4 weeks of antibiotic therapy is often adequate. For patients with complicated infections (eg perivalvular abscess, septic metastatic complications), use 6 weeks of therapy.
RACP 2016 Q65
A 32 year old man with treated HIV presents with painless ulcer on the glans penis with curled edge. He report he is still having unprotected sex.
What is the most likely cause of the legion?
A. Chancroid
B. Donovanosis
C. Herpes simplex
D. Lupus vulgaris
E. Syphilis
RACP 2016 Q81
A 60year old presents febrile and neutropenic post induction chemotherapy for AML. A CT chest is concerning for fungal infection and bronchoscopy culture demonstrates Aspergillus fumigatus.
What is the most appropriate treatment?
A. Posaconazole
B. Fluconazole
C. Itraconazole
D. Carbimazole
E. Voriconazole
RACP 2016 Q97 EMQ
Question 97
Bloody diarrhoea in a traveller one day back from Thailand
A. Cryptosporidium
B. Yersinia
C. Rotavirus
D. Shigella
E. Enterotoxigenic E. Coli (ETEC)
F. Toxoplasmosis
G. Vibrio Cholerae
H. Tuberculosis
RACP 2016 Q98 EMQ
The most likely cause of chronic watery diarrhoea in a HIV patient with CD4 count < 200.
A. Cryptosporidium
B. Yersinia
C. Rotavirus
D. Shigella
E. Enterotoxigenic E. Coli (ETEC)
F. Toxoplasmosis
G. Vibrio Cholerae
H. Tuberculosis
RACP 2016 P2 Q16
A urinalysis was positive for leukocytes but negative for nitrites. A microorganism was grown on culture. Which microorganism is it most likely?
A. Pseudomonas aeruginosa
B. Enterococcus faecalis
C. E.coli
D. Enterobacter cloacae
E. Klebsiella pneumoniae
RACP 2016 P2 Q38
- What is the optimal timing of cephazolin administration for a surgical joint replacement?
A. 12 hours pre and post surgery
B. 24 hours pre and 48 hours post surgery
C. 24 hours pre surgery
D. At time of incision
E. 60 minutes prior to surgery
Answer E
RACP 2016 P2 Q57
Question 57
Haemolytic Uraemic Syndrome and bloody diarrhoea can occur as a consequence of EHEC. The pathogenesis involves the production of which of the following?
A. Shiga toxin
B. Heat stable endotoxin
C. Intimin
D. Cytotoxin
E. Adherin
RACP 2015 Q10
Clindamycin is often added to meropenem to treat a suspected necrotising fasciitis. The reason for this is:
A. To enhance the activity of meropenam
B. To treat MRSA
C. For anaerobic coverage
D. To cover Streptococcus pyogenes toxin
E. To overcome resistance to meropenem
Answer D
Clindamycin or lincomycin is recommended for S. pyogenes necrotising fasciitis because of a theoretical reduction in bacterial toxin production; however, clinical evidence is limited.
RACP 2015 Q29
What is the most common side effect of the antimicrobial therapy for Enterococcal endocarditis?
A. Neuropathy
B. Encephalopathy
C. Aplastic anaemia
D. Vestibular toxicity
Answer D Vestibular toxicity
Enterococci are intrinsically more resistant to bactericidal antibiotics than other common causes of infective endocarditis, so require a synergistic combination of bactericidal antibiotics for a prolonged duration (usually 6 weeks). Therefore, even if the pathogen is susceptible to penicillin or vancomycin, treat enterococcal endocarditis concomitantly with gentamicin (unless there is high-level gentamicin resistance, or gentamicin is contraindicated or relevant precautions preclude its use).
Treatment for Enterococcal IE
IV benzylpenicillin OR IV ampicillin OR IV amoxicillin PLUS gentamicin
Common side effects of gentamicin - nephrotoxicity and ototoxicity; uncommon - neuromuscular blockade, peripheral neuropathy and bronchospasm
RACP 2015 Q39
A 25 year old man presents to hospital two days after returning from Fiji with fever, rash and arthralgia’s. Dengue fever is confirmed on PCR and antigen testing. What signifies his risk of severe dengue and shock?
A. Decreased lymphocyte count
B. Increased creatinine
C. Increases haematocrit
D. Worsening diarrhoea
E. Worsening rash
RACP 2015 Q46
What would be the most likely serology finding in a patient with acute EBV infection:
RACP 2015 Q62
What is the cause of increased shock in sepsis?
A. Increased preload
B. Decreased cardiac output
C. Decreased heart rate
D. Decreased peripheral vascular resistance
E. Increased afterload
RACP 2015 Q48
What is the most common manifestation of secondary immunodeficiency caused by chronic systemic steroid use?
A. Bacterial bronchopneumonia
B. Folliculitis
C. Herpes zoster
D. Oral candidiasis
E. Viral meningitis
RACP 2015 Q57
Which of the following populations would you treat in asymptmatic bacteriuria
A. Nursing home patient
B. Spinal cord injury with IDC
C. Pregnant woman 28 weeks
D. General medical patient
E. Someone about to have hip/knee replacement
RACP 2015
A 45 year old woman is diagnosed with endocarditis involving her native mitral valve. Blood cultures yield Enterococcus faecalis demonstrating sensitivity to ampicillin and vancomycin, but high-level resistance to gentamicin. What antibiotic regimen should she receive?
A. Ampicillin monotherapy
B. Vancomycin monotherapy
C. Ampicillin and vancomycin
D. Ampicillin and gentamicin
E. Ampicillin and ceftriaxone
Answer E Ampicillin and ceftriaxone
For patients with native or prosthetic valve E. faecalis endocarditis susceptible to penicillin, but with either high-level aminoglycoside resistance, or relevant contraindications or precautions that preclude the use of gentamicin as a two-drug regimen, use:
- Amoxicillin 2 g intravenously, 4-hourly for 6 weeks OR
- Ampicillin 2 g intravenously, 4-hourly for 6 weeks PLUS (with either of the above drugs)
- Ceftriaxone 2 g intravenously, 12-hourly for 6 weeks
RACP 2015 Q66
58 M with mitral valve endocarditis, blood cultures grow Enterococcus faecalis that is fully sensitive to penicillin as well as vancomycin. In addition to amoxicillin which medication would you use intravenously to treat his endocarditis?
A. Ceftriaxone
B. Doxycycline
C. Linezolid
D. Quinupristin and dalfopristin
E. Teicoplanin
Answer A
Enterococci are intrinsically more resistant to bactericidal antibiotics than other common causes of infective endocarditis, so require a synergistic combination of bactericidal antibiotics for a prolonged duration (usually 6 weeks). Therefore, even if the pathogen is susceptible to penicillin or vancomycin, treat enterococcal endocarditis concomitantly with gentamicin (unless there is high-level gentamicin resistance, or gentamicin is contraindicated or relevant precautions preclude its use - then replace gentamicin with ceftriaxone).
RACP 2014
80 y.o male presents tot the outpatient department with bilateral leg erythema. He has a normal white cell count and CRP. Swabs are taken which grow staph aureus, sensitive to flucloxacilin, and pseudomonas aeruginosa sensitive to ceftazidime and timentin. What is the next best management?
A. Flucloxacillin and clindamycin
B. Timentin
C. Topical steroid cream
D. Compression bandages
E. Topical emollients.
RACP 2014 Q 26
A middle aged female has returned from a holiday in India with urinary symptoms. A urine culture reveals a gram-negative bacteria resistant to ampicillin, vancomycin and meropenem. What is the most appropriate choice of intravenous antibiotic?
a) Colistin
b) Linezolid
c) Tigecycline
d) Moxifloxacin
e) Irtapenem
RACP 2014 Q47
A 20 year old male presents with a 3 day history of cough, fever, cold and conjunctivitis. He has a maculopapular rash.
Which diagnosis would require urgent isolation?
A. Influenza A
B. EBV
C. Measles
D. Rubella
E. Syphilis
RACP 2014 Q7
A 32 year old woman presents with abdominal pain, bloody diarrhoea and fever. Two days earlier she ate takeaway chicken. Her husband shared this meal with her, and is similarly unwell. They have had no recent overseas travel.
What is the most likely causative organism?
a. Cytomegalovirus
b. Norovirus
c. Staphylococcus aureus
d. Campylobacter jejuni
e. Bacillus cereus
RACP 2014 Q37
Urine dipstick nitrites is a useful tool in the ED for helping to diagnose urinary tract infections. Which of these organisms is likely to be negative for dipstick nitrites in the setting of culture-proven UTI?
A. Enterobacter cloacae
B. Enterococcus faecalis
C. Escherichia coli
D. Klebsiella oxytoca
E. Pseudomonas aeruginosa
RACP 2013 Q6
A patient with a history of psychosis and depression (who is on on medication for both) is brought in to ED unconscious, febrile at 40 degrees, tachycardic and with muscle rigidity. What is the most likely diagnosis?
A. Serotonin syndrome
B. Malignant neuroleptic syndrome
C. Acute dystonia
D. Sepsis
RACP 2013 Q7
In a diabetic patient with foot ulcers, which sign best predicts osteomyelitis?
A. Ability to probe to bone
B. Extensive cellulitis
C. Local pain
D. Malodorous discharge
E. Capillary refill >2 sec
Answer A
- A positive probe-to-bone test is strongly suggestive of osteomyelitis, especially in diabetic patients with risk factors for osteomyelitis.
- Probing to bone with a sterile blunt metal tool should be included in the initial assessment of diabetic patients with infected pedal ulcers. A positive result consists of detection of a hard, gritty surface.
- In a systematic review evaluating the performance of the probe-to-bone test (using bone histopathology or culture as the reference standard), the pooled sensitivity and specificity for the test were 87 and 83 percent, respectively.
RACP 2013 Q36
A 75 y.o female presents with a vesicular rash suggestive of VZV. In what nerve involvement would the presentation mimic meningitis.
a) Trigeminal nerve (mandibular branch)
b) Trigeminal nerve (ophthalmic branch)
c) Facial nerve
d) Glossopharyngeal nerve
e) Greater occipital nerve
RACP 2013 Q54
Question 54
What presentation of invasive Neisseria species infection has the highest mortality?
a) Gonococcal infection
b) Pneumonia
c) Meningococcaemia
d) Meningitis
e) Disseminated gonococcal infection
RACP 2013 Q67
Question 67
A 67yo male from the community presents with subacute onset clubbing, haematuria, and a new mitral regurgitation murmur
A. Aspergillus niger
B. E. Coli
C. Klebsiella pneumoniae
D. Enterococcus faecalis
E. Staph aureus
F. Staph mitis
RACP 2013 Q68
Question 68
A 50yo patient in ICU with pneumonia with a femoral central line in situ and currently on Tazocin is noted to have a new fever and drop in BP
A. Aspergillus niger
B. E. Coli
C. Klebsiella pneumoniae
D. Enterococcus faecalis
E. Staph aureus
F. Staph mitis
RACP 2013 P2 Q4
Question 4
A 30 year old gentleman 200 days post cord stem cell transplant presents with fever and feeling slightly unwell. His BP is 110/70mmHg and has a heart rate of 100bpm. He has widespread lesions on his skin as shown below
Where should he be best managed?
A. HDU
B. Negative pressure room
C. Positive pressure room
D. Ward
E. Home
RACP 2013 P2 Q29
A 48F who has recently received 6 cycles of multi-agent chemotherapy for non-Hodgkin lymphoma presents with a 2 week history of diplopia and bladder disturbance, and a 3 day history of leg weakness. On examination, she has a left 6th cranial nerve palsy, weakness in the L5 distribution of the L leg, and tendon reflexes which are difficult to elicit. A lumbar puncture is performed, which demonstrates elevated protein and WBC (90% lymphocytes). What is the most likely diagnosis?
A. CMV infection
B. Paraneoplastic phenomenon
C. Lymphoma recurrence
D. Cryptococcal meningitis
E. Cerebral tuberculosis
RACP 2013 P2 Q67
Question 67
Mrs Higginbottom is on natalizumab for multiple sclerosis. She reports feeling “a wee bit off, love.” She thus has an MRI brain which looks like this. What is the best test to diagnose her brain infection?
a. Cryptococcal antigen.
b. Toxoplasma culture
c. John Cunningham virus PCR
d. Herpes simplex 1 virus PCR
e. Mycoplasma culture
RACP 2012b Q9
What is the best treatment for this patient?
A. Flucloxacillin
B. Metronidazole
C. Ivermectin
D. Steroids
E. Albendazole
RACP 2012b Q26
A 52 year old female, has poorly controlled seropositive rheumatoid arthritis. She
presents for management of an ulcer, which despite regular dressing has not healed. What is the most likely underlying pathology for the ulcer?
A. Infection
B. Pressure
C. Vasculitis
D. Venous insufficiency
E. Neuropathic
RACP 2012b Q75
An elderly gentleman presents to hospital with symptoms and signs of a chest
infection. Urinary strep antigen is positive. He is treated for a strep pneumonia with
IV penicillin G. After 5 days of treatment he is still unwell with spiking fevers and
shortness of breath and his chest xray is as follows:
What is the next best management plan?
A. Add azithromycin
B. Change antibiotics to ceftriaxone
C. Chest physiotherapy
D. Perform CTPA
E. Arrange thorascopic drainage
RACP 2012b Q95
A 45 year old doctor has had a two week history of a sore throat. He has self-
prescribe a five day course of amoxycillin but his symptoms have not resolved. He is now finding it very difficult to swallow. Examination of his throat reveals the following:
What is the likely diagnosis?
A. Epstein Barr Virus
B. Tonsillar lymphoma
C. Streptococcal pharyngitis
D. Quinsy
E. Acute tonsillitis
RACP 2011b Q11
Question 11
A 30 year old day care work er presenting with red eye, fever and pharyngitis. What is the most likely causative agent?
A. adenovirus
B. HSV
C. CMV
D. Leptospirosis
E. Streptococcus pyogenes
RACP 2011b Q48
A m ale patient with a history of intravenous drug use presents with a rash, myalgias , arthralgias. He is afebrile. He is positive to hepatitis C antibody and rheumatoid
factor. He C4 complement level is reduced with normal C3 levels. His ANA is positive
at 1:160 speckled. Hi s rash is shown below:
W hat is the most likely diagnosis?
A. Cryoglobulinaemic vasculitis
B. Henoch- Schoenlein purpura
C. Rheumatoid vasculitis
D. Subacute bacterial endocarditis
E. Meningococcal disease
RACP 2010b Q1
57 yr old gentleman presenting with drowsiness, confusion and word finding difficulties. LP reveals
mildly elevated protein, WCC 5, CT Brain NAD. His MRI brain (Photo shown).
Most important management:
A. Acyclovir
B. Steroids
C. Ceftriaxone
D. Thrombolysis
E. Fluconazole
RACP 2006a Q41
An 18-year-old male develops a rash and becomes critically ill.
The rash is demonstrated above. The most likely finding on blood cultures would be:
A. gram negative rods.
B. gram positive rods.
C. gram negative diplococci.
D. gram positive diplococci.
E. gram positive cocci.
RACP 2005 b Q26
A 56-year-old forestry worker develops a widespread rash involving the trunk and lower limbs two weeks following a tick bite. He is generally unwell with myalgias, fevers, headache and anorexia. The rash is papular, non-blanching and not itchy, and is shown above.
What is the most appropriate management?
A. Treat expectantly.
B. Doxycycline.
C. Ciprofloxacin.
D. Ceftriaxone.
E. Phenoxymethylpenicillin (penicillin V).
RACP 2005b Q41
A 54-year-old woman presents with a six-month history of intensely itchy papules and vesicles on elbows, knees and buttocks as shown above. She is systemically well other than mild diarrhoea. Blood count is reported as normal. Serum ferritin is 5 μg/L [20-380] and red blood cell folate is 180 nmol/L [600-1600].
Which of the following investigations is most likely to confirm the diagnosis of the rash shown above?
A. IgA endomysial antibodies.
B. Direct immunofluorescence of perilesional skin.
C. Light microscopy of unexcoriated vesicle.
D. Jejunal biopsy.
E. Response to gluten-free diet.
RACP 2004b Q11
QUESTION 11
Which of the following is the most likely organism causing the presentation shown in the photographs below?
A. Neisseria meningitidis.
B. Staphylococcus aureus.
C. Mycoplasma pneumoniae.
D. Listeria monocytogenes.
E. Coxsackievirus.
RACP 2004b Q36
A 35-year-old man with a history of severe penicillin allergy presents with fever and a widespread rash, part of which is shown in the photograph below.
Which of the following is the most appropriate immediate treatment?
A. Penicillin.
B. Ceftriaxone.
C. Erythromycin.
D. Ciprofloxacin.
E. Vancomycin.
RACP 2004b Q 54
A 45-year-old woman presents with a three-year history of recurrent rash, characterised as palpable purpura over both legs. Some of these lesions have ulcerated.
Laboratory results include:
Which of the following is the most appropriate management?
A. Plasmapheresis and corticosteroids.
B. Corticosteroids and interferon α.
C. Interferon α and ribavirin.
D. Cyclophosphamide and corticosteroids.
E. Cyclophosphamide and ribavirin.
RACP 2004b Q57
QUESTION 57
A 47-year-old man on long-term haemodialysis presents with a fever (39.5°C) and chills. He has had multiple thrombosed fistulas and a thrombosed right axillary vein. He had a left subclavian catheter inserted under ultrasound guidance three days ago.
On examination he looks well, with a blood pressure of 170/80 mmHg and an exit site of the vascular access catheter with the appearance shown below.
Which of the following management strategies would be most appropriate in his case?
A. Intravenous vancomycin and observation.
B. Immediate haemodialysis.
C. Intravenous cephalexin and observation.
D. Intravenous vancomycin and catheter removal.
E. Replace vascular catheter with a re-wire technique.
RACP 2004b Q67
A 26-year-old man presents with a two-day history of fevers, rigors, headache, malaise, nausea and vomiting, dry cough, mild arthralgia and backache. He reports no shortness of breath, diarrhoea, neck stiffness or photophobia. He reports that he returned from a diving trip to the Solomon Islands seven days ago. He had taken doxycycline regularly as malarial prophylaxis.
On day 3 after the onset of the illness he develops a rash over his trunk (shown below) and face. A petechial rash was noted on his lower limbs
Which of the following is the most likely diagnosis?
A. Malaria.
B. Dengue fever.
C. Typhoid fever.
D. Q fever.
E. Measles.
RACP 2003b Q15
QUESTION 15
A 19-year-old man, who is sexually active and admits to occasional recreational drug use, presents with a three-day history of severe pain over the left sacroiliac area. Examination reveals a temperature of 38°C, pulse rate of 80/minute and blood pressure of 120/80 mmHg. The only other findings are ridged nails and pain on movement of the spine or when pressure is applied to the sacroiliac joints.
Investigations show:
X-rays of the spine and pelvis are normal. The bone scan is shown below.
The most likely diagnosis is:
A. reactive arthritis following Chlamydia trachomatis infection.
B. psoriatic arthritis.
C. gonococcal arthritis.
D. septic sacroiliitis.
E. undifferentiated spondylarthropathy.
RACP 2002b Q76
QUESTION 76
A 56-year-old previously well man presents to the emergency department with a three-day history of headaches, fever, chills and rigors. On examination he has focal neurological signs. A computed tomography (CT) scan is performed and is shown below.
The most appropriate empirical antimicrobial therapy is:
A. ceftriaxone, metronidazole and aciclovir.
B. ceftriaxone, metronidazole and benzylpenicillin.
C. ceftriaxone, metronidazole and rifampicin.
D. ceftriaxone, metronidazole and vancomycin
RACP 2002b Q99
A patient presents with the rash shown in the photograph below and is found to have a rapid plasma reagin (RPR) test titre of 1:256 and a positive fluorescent treponemal antibody absorbed (FTA-ABS) test.
The most appropriate treatment is:
A. doxycycline 100 mg twice daily for 14 days (oral).
B. benzylpenicillin 1.8 g sixth hourly for 10 days (intravenous).
C. benzathine penicillin 1.8 g as a single dose (intramuscular).
D. procaine penicillin 1g daily for 10 days (intramuscular).
E. ceftriaxone 250 mg daily for 5 days (intramuscular).
RACP 2001b Q25
A 57-year-old HIV (human immunodeficiency virus)-positive man presents with a six-month history of gradual enlargement of the abnormality shown in the photographs above. Investigations reveal a CD4+ T cell count of 30/µL and a plasma HIV RNA concentration (viral load) of 158,000 copies/mL. Current medications are four antiretroviral drugs (zidovudine, lamivudine, ritonavir and saquinavir), antimicrobial prophylactic agents (cotrimoxazole, azithromycin) and amitriptyline. Routine blood count and biochemistry screen are normal except for an elevated fasting blood sugar level of 11.0 mmol/L [3.9-5.5].
Which one of the following represents the most likely pathogenesis for the abnormality shown in the photographs?
A. Opportunistic infection.
B. Malignancy.
C. Cortisol excess.
D. Drug toxicity.
E. Autoimmune inflammation.
RACP 2001b Q75
A 25-year-old man presents with dysuria and frequency after a trip to South-East Asia. A urethral swab is obtained and a Gram stain is performed (shown in the photograph below).
Which one of the following would be the optimal antibiotic treatment for this man?
A. Ceftriaxone 250 mg (intramuscularly, as a single dose).
B. Ciprofloxacin 500 mg and azithromycin 1 g (both orally, as a single dose).
C. Amoxicillin 3 g, probenecid 1 g and azithromycin 1 g (all orally, as a single dose).
D. Amoxicillin 3 g, probenecid 1 g (both orally, as a single dose) and doxycycline 100 mg (orally, 12 hourly for 10 days).
E. Benzathine penicillin 1.8 g (intramuscularly, as a single dose).
RACP 2001b Q82
A 45-year-old man with known human immunodeficiency virus (HIV) infection presents with painful swallowing (odynophagia). He has not had any AIDS (acquired immune deficiency syndrome)-defining illnesses. He takes no medication.
An upper endoscopy is performed. A photograph of the mid-oesophagus is shown below. Biopsies are taken.
The most appropriate treatment at this stage is oral:
A. aciclovir.
B. fluconazole.
C. nystatin.
D. aciclovir and fluconazole.
E. aciclovir and nystatin.
RACP 2001b Q97
A chest X-ray and a Ziehl-Nielsen (ZN) stain of sputum from a patient who is about to commence appropriate therapy are shown above. The patient is isolated with respiratory precautions. How long should the patient stay in respiratory isolation?
A. Until the patient is smear-negative (ZN stain-negative).
B. Two to three weeks.
C. Until the patient is culture-negative.
D. Until therapy is commenced.
E. Until asymptomatic.
RACP 1999b Q61
A 45-year-old man presents with acute respiratory distress and is noted to have oral candidiasis. Chest X-ray shows bilateral alveolar infiltrates. Arterial PaO2 on air is 55 mmHg.
A silver-stained preparation of his sputum is shown below.
Which one of the following is the most appropriate initial therapy?
A. Intravenous itraconazole.
B. Intravenous itraconazole and oral prednis(ol)one.
C. Intravenous amphotericin.
D. Intravenous cotrimoxazole.
E. Intravenous cotrimoxazole and oral prednis(ol)one.
RACP 1999b Q77
A 23-year-old woman has returned from a two-month trip to Burma with an acute febrile illness and has become obtunded in the last four hours. Her peripheral blood smear is shown.
Which one of the following is the most appropriate initial treatment?
A. Quinine.
B. Quinidine.
C. Doxycycline.
D. Chloroquine.
E. Mefloquine
Answer - NONE from the options
IV artesunate for P falciparum causing cerebral malaria
RACP 1999b Q99
A 35-year-old man became unwell while returning to Perth from a holiday in Johannesburg. On arrival, he has clinical signs of meningitis. The appearance of a Gram stain of his cerebrospinal fluid is shown.
The most appropriate initial intravenous antibiotic therapy is:
A. penicillin.
B. ceftriaxone.
C. ceftazidime.
D. ceftriaxone and vancomycin.
E. clindamycin and rifampicin.
Answer B
Image shows Gram negative diplococci likely Neisseria meningitidis (meningococcal meningitis),
Treatment including in patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use:
ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly for 5 days
OR
cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly for 5 days.
If susceptibility to benzylpenicillin is confirmed and the patient is not hypersensitive to penicillin, de-escalate therapy and use:
benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 4-hourly for 5 days.
For penicillin severe hypersensitivity
ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 8-hourly for 5 days
RACP 2013b Q78
Question 78
A 25yo man has recently been to Thailand (returned 1 week ago). He has never been vaccinated in his life. For the last 3 days, he has experienced a maculopapular rash (pictured), conjunctivitis and fever. What is the diagnosis?
A. Dengue fever
B. Influenza
C. Measles
D. Tuberculosis
E. Typhoid
Answer C Measles
