MCQ brightspace - clinical

Question 1

A 35 year old aid-worker returns from a 3-week exploratory mission to eastern Zambia in southern Africa. He develops fever one week after return. This persists over several weeks with lymphadenopathy and anaemia, followed by behavioural change and confusion. This presentation would be most typical of infection with which organism?

Answer 1

Trypanosoma Brucei Rhodesiense

Question 2

An adult presenting to hospital in the Phillippines with two weeks of fever and headache has a lumbar puncture. Cerebrospinal fluid (CSF) analysis was consistent with central nervous system infection, showing:
Opening pressure 15cm (normal range <20cm)
Red cells <1/µL
Neutrophils 10/µL
Lymphocytes 240/µL
Protein 2.4g/L
Glucose 1.9mmol/L (blood glucose 6.0mmol/L)
What is the most likely causative pathogen?

Answer 2

M. TB

Question 3

A 28 year-old woman presents to her local rural district hospital in Tanzania. Her main complaint is fever for 3 days. Clinical examination reveals a temperature of 38.5oC, spleen palpable 8 cms below the costal margin, some abdominal distention with ascites, and visible varices around the umbilicus. She is haemodynamically stable. Her haemoglobin is 8g/dl and stool microscopy reveals large (115 µm) eggs with lateral spine. The likely cause of her portal hypertension is:

Answer 3

S. Mansoni

Question 4

During a ward round on a medical ward in Ghana you review a 20 year old man with sickle cell disease. What is true about his blood film?

Answer 4

Nucleated red cells will be a common finding on his blood film if he is having a haemolytic sickle cell crisis

Question 5

Which schistosoma causes nephrotic syndrome?

Answer 5

S. Mansoni

Question 6

which Schistosoma causes SCC?

Answer 6

Haematobium

Question 7

pathophysiology anthrax ?

Answer 7

Toxin related

Question 8

A Jarisch-Herxheimer reaction is most likely to occur in patients receiving antibiotics for:

Answer 8

Louse-borne relapsing fever

Question 9

24M British ED 3/7 fever, myalgia
1/7 confusion.
Returned 4 days previously from 1/12 backpacking in Laos and Vietnam. Been white-water rafting.
T 37.8°C, P 102bpm, BP 105/75.
Mild jaundice, intermittently mildly disoriented but able to speak and cooperate with physical examination. Dx>

Answer 9

Leptospirosis

Question 10

True about mother to child transmission of hepatitis B virus?

Answer 10

• dose of hepatitis B vaccine given to the neonate within 24 (ideally 0) hours of birth can prevent maternal transmission
• Tenofivir, entecavir for final trimester
• IgG within 24h for newborn. Other limb
• COmmonest transmission route, can cause child cirrhosis

Question 11

Primaquine PH tool - how>

Answer 11

Given to all those with falciparum malaria in low-transmission areas in the pre-elimination phase of malaria control

Question 12

60M hospital NE Thailand 2/7 fever and signs of severe sepsis.
BM 21
Hb 11.5
Lymphs 0.9
Neuts 12.1
Abdo USS 3 hypoechoic lesions R lobe liver 2-4.5 cm
Dx?

Answer 12

Melliodosis

Burkholderia Pseudomallei

DM!

Question 13

Need to know re snake bites and rx?

Answer 13

antitoxin same dose children v adult - not weight based - snake delivers same dose

Question 14

Gujarat, Northern India. 32F muscle aches and rigors. Malaria RDT = P. vivax. Thin film: ring form trophozoites with amoeboid cytoplasm and schuffner’s dots. No features of severe malaria, preg ix negative. Qualitative G6PD POC > 30% G6PD activity. As well as chloroquine or an ACT, what else needed?

Answer 14

Primaquine 1x wkly for 8 weeks under supervision with counselling

Question 15

eosinophillia causes?

Answer 15

Stronglyloides
Shistosomiasis
Hookworm
Ascaris
LF
Lung fluke

Question 16

Brucellosis abx?

Answer 16

Gent and doxy