Micro Flashcards
1
Q
Returned from holiday with fever, headache and confused
A
Legionella
2
Q
Hypernatraemic, diarrhoea, abdo pain, just stayed in hotel
A
Legionella
with Hepatitis
3
Q
Legionella Ix and Mx
A
Urine or serum Ag detection
Macrolides e.g. azithromycin
4
Q
50yo, LLL pneumonia, haemoptysis, cavitation, gram -ve coccobacilli
A
H. influenzae
Associated with smoking/COPD
5
Q
Which respiratory infection is more common in
- Diabetics
- Post influenza
A
- S. aureus
2. S. aureus
6
Q
Silver stain, boat shaped organism, eosinophils in alveoli, dry cough
A
Pneumocystis jirovecii pneumonia
7
Q
Man goes to wedding in devon, comes back with pneumonia and confusion. What’s the organism?
A
Legionella (hyponatraemia –> confusion)
8
Q
Transplant patient develops pneumonia, halo sign on Xray/CT
A
Aspergillosis
9
Q
Complement deficiency, septicaemia, rash and arthritis after unprotected sex
A
Disseminated gonorrheoa
10
Q
Wet slide microscopy
A
Trichomonas Vaginalis
11
Q
Gram +ve coccus, Coag neg
A
S. epidermis
S. aureus is coag positive
12
Q
Gram neg rod
Lactose fermenting
Name 2
A
E coli
Klebsiella
13
Q
UTI ass with renal calculus
A
Proteus
14
Q
Excess ammonia –> what type of renal stones?
A
Phosphate stones
15
Q
Rotavirus vs norovirus
- Age group
- Length of presentation
- Classical symptoms
A
Rota:
- young children or old adults
- lasts for 1 week
- D&V and dehydration
Noro:
- Adults and children
- Similar presentation but for 2-3 days
16
Q
Diarrhoea after BBQ
- Potential organisms
- Ix
A
- Salmonella/shigella
2. Stool culture
17
Q
MSM is abroad hiking, severe flatulence, foul smelling stool, steatorrhoea, cysts, pear shaped trophozoite
A
Giardia
Do stool microscopy and immunoassay to diagnose
18
Q
Post surgery boil on legs, not responding to fluclox etc. What pathogen & treatment?
A
MRSA –> vancomycin/teicoplanin
19
Q
MSSA with penicillin allergy
A
Macrolide e.g. erythromycin OR 3rd gen cephalosporin (but DO NOT use a ceph during acute penicillin reaction i.e. rash still present)
20
Q
Psuedomonas Abx
A
Tazocin
21
Q
Good for pseudomonas bad for anaerobes
A
Ciprofloxacin
22
Q
Macrolide antibiotic for atypical pneumonias
A
Azithromycin
23
Q
Jaundice, seizures, intracranial calcification in neonate, what antenatal infection?
A
Toxoplasmosis
24
Q
STI can cross placenta 3rd trimester
A
Syphilis
25
If mother is highly infectious it requires rapid vaccination and immunoglobulins at birth
Hep B
26
Haemorrhagic cystitis in kids
Adenovirus
27
PTLD virus
EBV
28
PML virus
JC virus
29
Molluscum contagiosum virus
Pox virus
30
Patient has a skin infection and his son also has a sore throat
Strep pyogenes
31
Child has red oedematous rash on face then nasal bridge then spread
Erysipelas (?) - strep pyogenes
32
Painless ulcer on finger after trip to Afghanistan
1. Condition
2. Bugs
3. Vector
1. Cutaneous Leishmania
2. L.major, L.tropica
3. Sandfly
33
Diarrhoea, sweating, tenesmus, RUQ abscess, flask shaped ulcer on microscopy
Entamoeba Histolytica
34
Comma shaped, oxidase positive, bloody smelly diarrhoea
Campylobacter
35
Abdo pain, fever, no diarrhoea, constipation, rose spots, gram negative
Salmonella
36
Sandflies
Leishmaniasis
37
Fever, headache, shakes, confusion, just been to Tanzania
Malaria (falciparum)
38
Treponome specific Ab test (type of microscopy)
Dark-field / dark-ground
39
Antiviral for severe RS bronchiolitis
Ribavirin
Rsv, Ribavirin
40
Flu antiviral
Oseltamavir
41
Can enterovirus cause damage antenatally?
Yes - associated with intrauterine foetal death
42
Vector for Trypsanoma Brucei Rhodensiense
Tsetse fly
Causes African Trypsanomiasis
43
Man eats chicken and gets foul smelling bloody diarrhoea with abdo cramps
Campylobacter jejuni
44
Most common UTI organism in pregnant women
E coli
45
Urease-producing organism ass. with renal stones
Proteus
proteuS Stones
46
Catheter associated UTIs
S. epidermis
47
26 year old cuts leg shaving, 2 days later she presents with a well demarcated area of induration and erythema surrounding the wound - organism?
S. aureus
48
34 year old farmer/gardener cuts his leg whilst working, 3 days later presents to A&E with grossly oedematous leg that is discoloured with multiple necrotic bullae - organism?
Clostridium perfringens
49
6 year old girl presents with a well demarcated erythematous rash of her face in the nasolabial distribution - organism?
Strep pyogenes --> Erisypelas
50
Cysts on microscopy (lung infection)
PCP
51
Legionella diagnostic test
Urine Antigen Test
52
Listeria microscopy
V/L shaped, tumbling motility
53
Bloody travellers diarrhoea, anaemia and low platelets
HUS
54
Which GI infections have superantigens?
S. aureus
B. cereus
C. diff
C. perfringens
55
CSF: high protein, normal glucose, lymphocytes
Viral meningitis e.g. HSV
56
CSF: high protein, low glucose, lymphocytes
TB
57
CSF: high protein, low glucose, neutrophils
Bacterial
58
Chancroid
```
Haemophilus ducreyi (on choc agar)
Painful ulcer, unilateral LNpathy
```
59
Mild CAP treatmetn
Amoxicillin
60
Severe CAP treatmetn
Co-amoxiclav and clarithromycin
61
Staph aureus resistant to ß-lactamase & treatment
MRSA (Methicillin-resistant Staph aureus)
| Vancomycin/Teicoplanin
62
adynophagia meaning
painful swallowing
63
EBV on blood film and special test
Atypical lymphocytes
| Positive monospot test
64
Oseltamavir target
NA on influenza
65
Hep B treatment
IFNa
66
Acyclovir (MoA and use)
Guanosine
| HSV, VZV, EBV
67
Light and dark spots on body
| Spag with meatballs on microscopy
Pitoriasis versicolour
68
Zoonoses from animals and dairy
Brucellosis
69
Ticks and macpap rash
Rickettsia
70
Rocky Mt Spotted fever
Rickettsia
71
Negribodies
Rabies
72
Lowen Jensen Culture
TB --> Brown granular
73
Pneumonia in alcoholics (+ list two more features)
Klebsiella pneumponiae
| Cavitation + haemoptysis (red currant jelly haemoptysis)
74
GI infection which attaches to bowel but does not invade --> malnutrition, bloating, weight loss
Giardia lambia
75
Crusty ulcer and LNpathy after walking on the beach
Leishmania (cutaneous)
Leishmania major/tropica
Sandflies are vector
76
Kala azar
Visceral leishmania (fever and splenomegaly)
77
Presentation like cutaneous leishmania but with mouth ulcers too (later)
1. Name
2. Pathogen
Muco-cutaneous Leishmania
| L. braziliensis
78
Leishmanias are what type of organism
Protozoa
79
Visceral Leishmania pathogens
donovania, chagasi and infantum
80
Septic arthritis pathogen
Gon > chlam
81
sCJD vs vCJD
Sporadic Creutzfeldt–Jakob disease
- 14-3-3 in CSF
- Neuro mainly
Variant Creutzfeldt–Jakob disease
- tonsillar biopsy
- psych before neuro
82
HBeAg
High Infectivity
83
HBsAg
acute or chronic
84
Anti-HBc (HBcAb) IgM
Acutely infected
85
HBcAb IgG
What if HBsAg also +ve?
Previous infection, now immune
HBsAg +ve: Chronic infection
86
HBsAb (anti-HBs)
Recovered from natural infection
| If all others negative = vaccinated
87
Vancomycin side effect
Red man syndrome (and only has gram +ve cover and MRSA)
| Consider when treating C diff
88
C. diff protocol
Metronidazole 10-14 days (two trials before moving onto vancomycin 10-14d)
89
P. falciparum on blood film
Maurer's cleft (membrane-limited vacuoles or sack-like structures in the cytosol of the erythrocyte)
90
Treatment for listeria meningitis
Amoxicillin + gentamycin
| Ampicillin + gentamycin
91
```
Meningitis
• Escherichia coli
• HSV
• Listeria monocytogenes
• Neisseria meningitidis
• Streptococcus pneumoniae
```
A. A girl has been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose, what organism is the cause?
B. An 18 year old student is found to have Gram negative diplococcus causing meningitis
C. A man is found to have a Gram positive diplococcus causing meningitis
D. Gram negative rod causing sepsis in a neonate
E. Gram positive rod causing meningitis in a 72 year-old
```
A. HSV
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Escherichia coli
E. Listeria monocytogenes
```
92
HIV RNA forms HIV, via which error prone enzyme?
a. RNA polymerase
b. DNA polymerase
c. RNA transcriptase
d. Reverse transcriptase
d. Reverse transcriptase
93
Which vector transmits Trypanosoma brucei rhodesiense?
a. Anopheles mosquitoes
b. Sandfly
c. Tsetse Fly
d. Aedes
c. Tsetse Fly
a. Anopheles mosquitoes – Causes Malaria. Females carry the disease.
b. Sandfly – Causes Leishmaniasis (also known as Kala Azar)
d. Aedes – Causes Aedes aegypti (Yellow Fever)(Pyramids are in Egypt and pyramids are yellow)
94
What does the number of True positives divided by the total number who have the disease describe?
a. Positive predictive value
b. Negative predictive value
c. Sensitivity
d. Specificity
e. Z score
c. Sensitivity
95
Which of these does not lead to/cause Chronic Hepatitis?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
a. Hepatitis A
96
35. Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
c. Enterovirus
97
39. Which of these is the most likely causative organism of a hospital acquired pneumonia?
a. Haemophilus influenza
b. Steptococcus pneumonia
c. Staphylococcus aureus
d. Microplasma meunomia
e. Pseudomonas aregenosa
f. Aspergillus
c. Staphylococcus aureus (Commonly MRSA)
Steptococcus pneumonia - Most common community acquired pneumonia
98
Which/What is the most common cause of jaundice/fever in a returning traveller with a fever?
a. Malaria
b. Hepatitis
c. HIV seroconversion
d. Typhoid
e. Dengue
a. Malaria
99
Name an infectious gram +ve and -ve microorganism which is a common cause of meningitis in 3 months or older?
```
+ve = Streptococcus pneumoniae
-ve = Neisseria Meningitis
```
100
What drug is used to treat severe falciparum malaria?
Artesunate (and you only use quinine to treat severe malaria infections if artesunate isn’t available)
101
What zoonotic disease does the Ixodes Tick cause?
Lyme disease
102
```
Antivirals treatment
• Aciclovir
• Ganciclovir
• Oseltamivir
• Ribavirin
```
- CMV retinitis
- HSV meningitis
- VZV
- Child with RSV
- Asthmatic with flu
- Ganciclovir
- Aciclovir
- Aciclovir
- Ribavirin
- Oseltamivir
103
Cat scratch disease full name (genus and species) of bacteria
Bartonella henselae
104
Stain used for acid-fast bacilli
Ziehl-Neelsen stain (Mycobacterium tuberculosis)
105
Name 1 of 3 characteristics of influenza A that could cause a pandemic
- Novel antigenicity
- Efficient replication in human airway
- Efficiency viral transmission between people
106
Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria monocytogenes
107
What virus increases risk of nasopharyngeal cancer?
EBV
108
What additional virus apart from HIV and HBV are screened for in platelet donations to pregnant women?
Cytomegalovirus
109
Has contact with someone with TB, what is the risk of getting active TB?
10%
110
A 20 y/o woman presents w 2 days of dysuria, increased urinary frequency, and suprapubic pain. Rank the organisms by likelihood of being causative:
a. Proteus mirabilis
b. Acinetobacter baumanii
c. Candida albicans
d. Escherichia coli
e. Staphylococcus saprophyticus
d. Escherichia coli
e. Staphylococcus saprophyticus
c. Candida albicans
a. Proteus mirabilis
b. Acinetobacter baumanii
111
A neonate develops meningitis at 36 hours old. Rank the organisms by likelihood of being causative:
a. Escherichia coli
b. Group B Strep
c. Cryptococcus neoformans
d. Pseudomonas aeruginosa
e. Listeria monocytogenes
b. Group B Strep
a. Escherichia coli
e. Listeria monocytogenes
c. Cryptococcus neoformans
d. Pseudomonas aeruginosa
112
Most common cause of constrictive pericarditis in developing world?
Tuberculosis
113
Which organism causes pneumonia with ‘red currant jelly sputum’ in alcoholics and diabetics?
Klebsiella pneumoniae
114
What is the most common cause of myocarditis?
Viral infection
115
What is the most common cause of portal vein thrombosis?
Cirrhosis
116
What is the most common primary breast cancer?
Invasive ductal carcinoma
117
Which underlying pathology is commonly associated with nephrotic syndrome in adults?
Membranous glomerulonephritis or Focal segmental glomerulosclerosis
118
What is the most common primary tumour of the heart?
Myxoma
119
Raised anti-mitochondrial antibodies is associated with which liver disease?
Primary biliary cirrhosis
120
What is the equivalent of a dysgerminoma in a testis?
Seminoma
121
Intestinal metaplasia in Barrett’s oesophagus is most commonly due to the presence of which cell?
Simple columnar epithelial cells
122
What type of emphysema is associated with smoking and chronic bronchitis?
Centrilobular
123
Which vascular tumour is associated with HHV8?
Kaposi’s sarcoma
124
Which virus causes encephalitis that particularly affects the temporal lobes?
Herpes Simplex virus
125
29 y/o man returns from charity work in Yemen with profuse watery diarrhoea that “looks like water after you cook rice in it”. What is the causative organism?
Vibrio cholerae
126
43 y/o receiving chemotherapy for leukaemia has ongoing fever and raised inflammatory markers after broad spectrum antibiotic therapy with Meropenem and Amikacin. CT chest shows nodules with surrounding hypoattenuation (halo signs). What is the most likely causative organism?
Aspergillus fumigatus
127
18 y/o man with 1 day history of headache, neck stiffness, and photophobia, but no confusion or other signs of encephalitis. HSV1 detected in CSF PCR. What antiviral treatment would you recommend?
Aciclovir
128
A 4 y/o presents to A&E with bloody diarrhoea and haemolytic-uraemic syndrome after visiting a petting farm. What is the likely causative organism?
Escherichia coli (specifically the 0157:H7 serotype)
129
What property of the MMR vaccine makes it unsuitable for pregnant women?
It is a live vaccine
130
42 y/o man returns from India with high fever and abdo pain but no diarrhoea. Blood cultures grow Gram negative bacilli and Malaria rapid test is negative. What is the most appropriate initial antibiotic therapy?
Ceftriaxone
131
Which virus can cause hydrops fetalis if it infects a pregnant woman in the first 20 weeks?
Parvovirus B19
132
Which Herpes virus causes post-transplant lymphoproliferative disorder?
Epstein-Barr virus (HHV4)
133
27 y/o poorly controlled HIV patient presents with meningism (headache, stiff neck, photophobia) and CSF has yeasts in it. What is the likely causative organism?
Cryptococcus neoformans
134
37 y/o woman with hot swollen, painful left knee has Gram positive cocci in clusters on joint aspirate. NKDA and MRSA screen is negative: which narrow spectrum antibiotic is most appropriate here?
Flucloxacillin
135
73 y/o woman with headache, confusion, photophobia, and fever. Gram positive rods are found in her CSF, what is the likely causative organism?
Listeria monocytogenes
136
This vaccine-preventable disease presents with headache, fever, and parotid swelling. Can cause epididymo-orchitis in adults and sometimes even meningitis. What is the causative organism?
Mumps orthorubulavirus
137
Name an antibiotic class with concentration-dependent killing and prolonged persistent effects where the goal is to maximise the concentration above the Minimum Inhibitory Concentration (Peak>MIC)
Aminoglycosides
Fluoroquinolones
Ketolides
138
78 y/o woman has loose green mucoid stool after a week of I.V. Ceftriaxone. What is the causative organism?
Clostridium difficile
139
64 y/o man with poorly controlled T2DM develops periorbital oedema, headache, sinus pain, purulent nasal discharge, and orbital cellulitis. The symptoms started yesterday and he is taken to theatre as an emergency. What anti-fungal should be started immediately?
Amphotericin B
140
Which virus is associated with nasopharyngeal carcinoma?
a. Epstein-Barr virus
b. Hepatitis B virus
c. Hepatitis C virus
d. HHV8
e. HPV16
a. Epstein-Barr virus
141
What is the most common type of skin cancer?
a. Basal cell carcinoma
b. Keratoacanthoma
c. Melanoma
d. Metastatic cancer
e. Squamous cell carcinoma
a. Basal cell carcinoma
142
What is the inheritance pattern of hereditary haemochromatosis?
a. Autosomal dominant
b. Autosomal recessive
c. Polygenic
d. X-linked dominant
e. X-linked recessive
b. Autosomal recessive
143
An extradural/ epidural haemorrhage is caused by damage to which blood vessel?
a. Berry aneurysm
b. Bridging veins
c. Internal carotid
d. Middle cerebral artery
e. Middle meningeal artery
e. Middle meningeal artery
144
Which type of necrosis is associated with a myocardial infarction?
a. Abscess formation
b. Caseous necrosis
c. Coagulative necrosis
d. Fat necrosis
e. Liquefactive necrosis
c. Coagulative necrosis
145
What is the most common glial cell of the CNS?
a. Astrocytes
b. Endothelial cells
c. Ependymal cells
d. Microglia
e. Oligodendrocytes
a. Astrocytes
146
What is the most common cause of pancreatitis in adults? (not specified whether acute or chronic)
a. Alcohol
b. Autoimmune
c. Cystic fibrosis
d. Drugs
e. Gallstones
e. Gallstones (acute)
| a. Alcohol (chronic)
147
What is the most common cause of mitral valve stenosis?
a. Congenital
b. Infective endocarditis
c. Pulmonary hypertension
d. Rheumatic heart disease
e. Systemic lupus
d. Rheumatic heart disease
148
What is the most common type of ovarian tumour?
a. Brenner tumour
b. Mucinous cystadenocarcinoma
c. Mucinous cystadenoma
d. Serous cystadenoma
e. Serous mucinous cystadenocarcinoma
d. Serous cystadenoma
149
What is the mechanism behind pulmonary oedema due to liver disease?
a. Decreased osmotic pressure
b. Direct injury to the alveolar wall
c. Increased hydrostatic pressure
d. Indirect injury to the alveolar wall
e. Lymphatic obstruction
a. Decreased osmotic pressure
150
Which of the following occurs near the surface of the brain and is frequently asymptomatic?
a. Glioblastoma multiforme
b. Haemangioma
c. Meningioma
d. Oligodendroglioma
e. Schwannoma
c. Meningioma
151
What is the most common cause of acute respiratory distress syndrome?
a. Aspiration
b. Drug reaction
c. Pancreatitis
d. Sepsis
e. Trauma
d. Sepsis
152
Which valve is classically involved in infectious endocarditis in I.V. drug users?
a. Aortic
b. Mitral
c. Prosthetic
d. Pulmonary
e. Tricuspid
e. Tricuspid
153
Which of the following is a characteristic of hypercalcaemia?
a. Diarrhoea
b. Easy bruising
c. Hypotension
d. Polyuria and polydipsia
e. Tetany
d. Polyuria and polydipsia
154
```
25 y/o man brought to A&E with abdominal pain followed by collapse. His blood pressure shows he is in shock and his blood gas results are:
Na+ 120 (low)
K+ 6.2 (high)
HCO3 10.1 (low)
Urea 9.4 (high)
Creatinine 146 (high)
Glucose 2.5 (low)
pH 7.2 (low)
pCO2 3.0 (low)
What is the most likely cause of the abnormal potassium?
a. Renal loss of sodium
b. Vomiting
c. Renal failure
d. Perforated appendix
e. Dehydration
```
a. Renal loss of sodium
155
Which of the following tests is useful in diagnosing invasive Candida albicans infection?
a. Beta-D-Glucan
b. Galactomannan
c. RPR
d. TPPA
e. Widal test
a. Beta-D-Glucan
156
A 22 y/o man is a close household contact of someone diagnosed with TB. What is his lifetime risk of developing the disease?
a. 0.1%
b. 1%
c. 10%
d. 50%
e. 90%
c. 10%
157
Which of the following is the most appropriate antibiotic for Legionella pnemophilia pneumonia?
a. Amoxicillin
b. Azithromycin
c. Ceftriaxone
d. Co-trimoxazole
e. Meropenem
b. Azithromycin
158
Which virus is associated with severe hepatic disease and potentially death if it infects a pregnant patient?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
e. Hepatitis E
159
What is the most common form of prion disease?
a. Fatal familial insomnia
b. Iatrogenic Creutzfeldt-Jakob disease
c. Kuru
d. Sporadic Creutzfeldt-Jakob disease
e. Variant Creutzfeldt-Jakob disease
d. Sporadic Creutzfeldt-Jakob disease
160
Streptobacillus moniliformis causes which infection?
a. Bacillary angiomatosis
b. Lyme disease
c. Q fever
d. Rat bite fever
e. Syphilis
d. Rat bite fever
161
A 45 y/o woman with malaria has a GCS of 11, temp 39.1, HR 108, BP 90/60. Her parasitaemia is 10%, what is the most appropriate anti-malarial therapy?
a. Intravenous Artesunate
b. Intravenous Quinine
c. Oral artemether and proguanil
d. Oral atorvaquone and proguanil
e. Oral mefloquine
a. Intravenous Artesunate
162
Which of the following drugs is used to treat Hepatitis B?
a. Aciclovir
b. Oseltamivir
c. Ribavirin
d. Tenofovir
e. Zanamivir
d. Tenofovir
163
Infants under 1 year of age shouldn’t be fed honey because of the risk of infection with which organism?
a. Campylobacter jejuni
b. Clostridium botulinum
c. Escherichia coli 0157
d. Salmonella typhi
e. Vibrio cholerae
b. Clostridium botulinum
164
```
Pneumonia
• Aspergillus fumigatus
• Klebsiella pneumoniae
• Legionella pneumophilia
• Pneumocystis jirovecii
• Streptococcus pneumoniae
```
A. HIV patient who desaturates on exercise
B. Girl receiving chemotherapy for leukaemia with ‘Halo’ sign on CXR
C. Lower lobe pneumonia in a 22 year-old who is coughing up rusty coloured sputum
D. Upper lobe cavitation on CXR in an alcoholic
E. Smoker back from holiday in Spain, also hyponatraemic and confused
```
A. Pneumocystis jirovecii
B. Aspergillus fumigatus
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae
E. Legionella pneumophilia
```
165
```
Fungi
• Coccioides
• Cryptococcus neoformans
• Malassezia furfur
• Rhizopus species
• Trichophytum rubrum
```
A. HIV patient with CD4+ count of 150 with meningitis
B. Water polo player with itchy scaly rash on lateral toe which then moved along lateral side of foot
C. Pityriasis versicolor
D. Lady came back from visiting her sister in Arizona with systemic symptoms, fever etc.
E. Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion
```
A. Cryptococcus neoformans
B. Trichophytum rubrum
C. Malassezia furfur
D. Coccioides
E. Rhizopus species
```
166
```
Traveller's infections
• Entamoeba histolytica
• Leishmaniasis
• Malaria
• Salmonella typhi
• Treponema pallidum
```
A. A soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
B. Snail trail oral ulcer in a homosexual man
C. A South American man presents to a doctor in the UK with fever and bloody diarrhoea, and investigations detect a cyst in the right lobe of the liver
D. A Nigerian man presenting with fever and chills, has just returned from Nigeria, did not take prophylaxis, and was bitten a lot
E. A woman returning from travel in Asia presents with abdo pain, headache, and constipation. A Gram- rod is later cultured from her blood
```
A. Leishmaniasis
B. Treponema pallidum
C. Entamoeba histolytica
D. Malaria
E. Salmonella typhi
```
167
```
Maternal viral infections
• CMV
• HSV
• Parvovirus
• Rubella
• Varicella-Zoster
```
A. Virus that may cause Hydrops fetalis if caught in first 20wks of pregnancy
B. Immunoglobulin may be given to the mother if she is exposed to this virus in pregnancy to prevent infection
C. Virus that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
D. Virus that can cause baby to have cataracts, sensorineural deafness, hepatomegaly and thrombocytopenia
E. Virus which if transmitted to baby: they can initially be symptomless but then come down with long term sequelae
```
A. Parvovirus
B. Varicella-Zoster
C. HSV
D. Rubella
E. CMV
```
168
```
GI infections
• Bacillus cereus
• Campylobacter jejuni
• Clostridium difficile
• Entero-toxigenic Escherichia coli
• Norovirus
```
A. The most common cause of traveller’s diarrhoea
B. A man develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque
C. A woman develops vomiting a few hours after eating a Chinese meal with lots of rice
D. Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea
E. A ward sister gets diarrhoea, and patients on the ward have been ill recently with similar symptoms
```
A. Entero-toxigenic Escherichia coli
B. Campylobacter jejuni
C. Bacillus cereus
D. Clostridium difficile
E. Norovirus
```
169
```
Antibiotics
• Amoxicillin
• Benzylpenicillin
• Flucloxacillin
• Trimethoprim
• Vancomycin
```
A. Included in meningitis treatment to cover Listeria monocytogenes
B. Antibiotic for Group A Strep pharyngitis
C. Young women with cystitis and fully sensitive E-Coli
D. Which antibiotic would you use for cellulitis with MRSA
E. Which antibiotic would you use to treat someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus
```
A. Amoxicillin
B. Benzylpenicillin
C. Trimethoprim
D. Vancomycin
E. Flucloxacillin
```
170
```
Antibiotics
• Amoxicillin
• Ceftazidime
• Ciprofloxacin
• Clarithromycin
• Vancomycin
```
A. Beta lactam with anti-pseudomonal activity
B. Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
C. A glycopeptide used to treat MRSA
D. A DNA synthesis inhibitor used to treat Pseudomonal infections but poor against anaerobes
E. Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias
```
A. Ceftazidime
B. Amoxicillin
C. Vancomycin
D. Ciprofloxacin
E. Clarithromycin
```
171
```
STIs
• Chlamydia trachomatis
• HPV
• Neisseria gonorrhoea
• Treponema pallidum
• Trichomonas vaginalis
```
A. Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found
B. Teenager with genital warts
C. Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy
D. Lady with PID and positive urinary NAAT test
E. Man with discharge - Gram negative diplococci found
```
A. Treponema pallidum
B. HPV
C. Trichomonas vaginalis
D. Chlamydia trachomatis
E. Neisseria gonorrhoea
```
172
```
Misc. infections
• Group B Streptococcus
• Staphylococcus aureus
• Staphylococcus saprophyticus
• Streptococcus pneumoniae
```
A. Woman with UTI - culture grows Gram positive cocci in clusters
B. 49 Year old with no medical problems has septic arthritis
C. 19 year old rugby player with boils, members of his team have similar boils, as do members of his family
D. Neonate has meningitis, Gram positive organism in chains
E. 50 year old male smoker has meningitis with Gram positive diplococci
```
A. Staphylococcus saprophyticus
B. Staphylococcus aureus
C. Staphylococcus aureus
D. Group B Streptococcus
E. Streptococcus pneumoniae
```
173
```
Vaccine-preventable diseases
• Diphtheria
• Measles
• Mumps
• Polio
• Tetanus
```
A. Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
B. Develops a grey film over the back of the throat
C. Causes lumps on parotid and neck
D. Maculopapular rash moves from face that can cause encephalitis and pneumonitis
E. Lockjaw
```
A. Polio
B. Diphtheria
C. Mumps
D. Measles
E. Tetanus
```
174
Receptor/cytokine mutation that could be protective in HIV?
CCR5/Mip-1a/b
175
What is the definition of herd immunity threshold?
The proportion of immune healthy people needed within a population to stop a pathogen’s spread: 1- (1/R0)%
176
Returning traveller with fever and constipation (salmonella typhi) - what abx do you give if she hasn’t been started on them already?
Ceftriaxone
177
Septic arthritis in a 56yo man - likely organism?
Staphylococcus aureus
178
What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth?
It is a poor sample and has not properly been taken mid-stream
179
What is the most common cause of traveller’s diarrhoea?
Enterotoxigenic Escherichia coli
180
Which bacterial species causes scarlet fever?
Streptococcus pyogenes
181
What is the most common cause of viral meningitis?
Non-polio enteroviruses (Echoviruses & Coxsackie viruses)
182
What is the most likely cause of early-onset sepsis in a neonate?
Group B Streptococcus
183
HIV +ve patient with v low CD4 + purple lesions seen on trunk. What virus causes this cancer?
HHV8
184
What is the treatment for MRSA?
Vancomycin
185
What does John Cunningham (JC) virus cause?
Progressive multifocal leukoencophalopathy
186
Diffuse white plaques that can be easily brushed away are seen on an OGD, what is the diagnosis?
Oesophageal candidiasis
187
Painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer - organism?
Treponema pallidum
188
What is the treatment for pseudomembranous colitis?
Metronidazole or Vancomycin depending on severity (if in doubt say Vancomycin)
189
Via which route does Hep A spread?
Faeco-oral
190
Which would be the most useful test in confirming acute EBV infection 2 weeks after possible exposure in an immunocompetent patient?
IgM
191
Name a complication of infection of a pregnant woman with Parvovirus B19
Hydrops foetalis
192
How do you initially treat Malaria falciparum; 38.9 fever, hypotension, 4% parasitaemia?
I.V. Artesunate or I.V. Quinine if Artesunate not available
193
Young gentleman brough to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?
HSV
194
Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?
Escherichia coli
195
Gram +ve cocci UTI in a young woman?
Staphylococcus saprophyticus
196
Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Corynebacterium diphtheriae
197
What cell type is raised in the blood in schistosomiasis?
Eosinophils
198
Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body, which organism has most likely triggered this?
Escherichia coli 0157:H7
199
```
Natural antibodies against what can confer protective immunity against HIV?
A. HIV – GAG
B. HIV – gp120
C. CXCR4
D. Protease
E. Reverse transcriptase
```
B. HIV – gp120
200
```
Which of the following is the most common cause of cellulitis?
A. S. epidermidis
B. S. saprophyticus
C. S. pyogenes
D. S. agalactiae
E. E. coli
```
C. S. pyogenes
201
```
A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist. What is the most likely cause of the rash?
A. Drug reaction
B. Penicillin allergy
C. Mastocytosis
D. Erythema nodosum
E. Pyoderma gangrenosum
```
A. Drug reaction
202
```
A 69 year old man presents with a red, hot swollen knee. He has type 2 diabetes mellitus and osteoarthritis but it is a native joint. In this case of septic arthritis, rank the causative organisms below in order of likelihood, with (1) being the most likely and (5) being the least likely.
A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Brucella melitensis
D. Escherichia coli
E. Streptococcus pyogenes
```
```
B. Staphylococcus aureus
E. Streptococcus pyogenes
D. Escherichia coli
A. Staphylococcus epidermidis
C. Brucella melitensis
```
203
```
A 23 year old man presents with cellulitis having cut himself while skateboarding. A wound swab has grown Streptococcus pyogenes (Group A Streptococcus). List the following antimicrobials which can beused for treatment in order of spectrum of activity with being the narrowest spectrum and 5 being the broadest spectrum agent.
Ceftriaxone
Meropenem
Piperacillin/tazobactam
Benzylpenicillin
Amoxicillin
```
```
Benzylpenicillin
Ceftriaxone
Amoxicillin
Piperacillin/tazobactam
Meropenem
```
