Microbiology Flashcards
Questions from Blackboard and Clinical Pathology book
1
Q
A 25-year-old man with a history of recurrent chest infections presents to an infectious disease specialist. A subsequent chest X-ray demonstrates widespread pulmonary infiltrates. A sputum stain using Gomori’s methenamine silver reveals characteristic cysts. A Streptococcus pneumoniae B Moraxella catarrhalis C Haemophilus influenzae D Legionella pneumophila F Chlamydia pneumoniae G Mycobacterium tuberculosis H Pneumocystis jirovecii I Staphylococcus aureus E Mycoplasma pneumonia
A
H Pneumocystis jirovecii
2
Q
A 54-year-old woman admitted to the respiratory ward is found to have right sided consolidation on chest X-ray. Histological examination reveals Gram- positive cocci arranged in pairs. A Streptococcus pneumoniae B Moraxella catarrhalis C Haemophilus influenzae D Legionella pneumophila F Chlamydia pneumoniae G Mycobacterium tuberculosis H Pneumocystis jirovecii I Staphylococcus aureus E Mycoplasma pneumonia
A
A Streptococcus pneumoniae
3
Q
A 65-year-old woman is brought into accident and emergency with severe res- piratory distress. The patient’s history revealed that she had been seen by her GP due to a viral infection 2 weeks previously. Histological examination reveals Gram-positive cocci arranged in clusters. A Streptococcus pneumoniae B Moraxella catarrhalis C Haemophilus influenzae D Legionella pneumophila F Chlamydia pneumoniae G Mycobacterium tuberculosis H Pneumocystis jirovecii I Staphylococcus aureus E Mycoplasma pneumonia
A
I Staphylococcus aureus
4
Q
A 40-year-old HIV positive man is seen by his GP. The patient admits a 4-week history of cough. The GP requests acid-fast staining of the patient’s sputum. A Streptococcus pneumoniae B Moraxella catarrhalis C Haemophilus influenzae D Legionella pneumophila F Chlamydia pneumoniae G Mycobacterium tuberculosis H Pneumocystis jirovecii I Staphylococcus aureus E Mycoplasma pneumonia
A
G Mycobacterium tuberculosis
5
Q
A 36-year-old engineer presents to his GP with a 1-week history of headache, myalgia and cough. Blood tests reveal hyponatraemia. A urinary antigen test is found to be positive. A Streptococcus pneumoniae B Moraxella catarrhalis C Haemophilus influenzae D Legionella pneumophila F Chlamydia pneumoniae G Mycobacterium tuberculosis H Pneumocystis jirovecii I Staphylococcus aureus E Mycoplasma pneumonia
A
D Legionella pneumophila
6
Q
A 34-year-old HIV-positive woman is seen in the GP clinic due to 3 days of diarrhoea, headaches and fever. History reveals the patient had recently drunk unpasteurized milk. The causative organism is found to be -haemolytic with tumbling motility. A Vibrio cholerae B Staphylococcus aureus C Enterobacteriaecae D Listeria monocytogenes E Salmonella enteritidis F Shigellae G Campylobacter jejuni H Giardia lamblia I Entamoeba histolytica
A
D Listeria monocytogenes
7
Q
A 10-year-old girl has just returned from a summer swimming camp at Lake Windermere. She presents to accident and emergency with bloody diarrhoea and abdominal pain. Blood tests reveal anaemia and thrombocytopenia. A Vibrio cholerae B Staphylococcus aureus C Enterobacteriaecae D Listeria monocytogenes E Salmonella enteritidis F Shigellae G Campylobacter jejuni H Giardia lamblia I Entamoeba histolytica
A
C Enterobacteriaecae
8
Q
An 18-year-old on his gap year in India suddenly develops severe watery diarrhoea. Microscopy of his stool reveals no leukocytes but rods with fast movements. A Vibrio cholerae B Staphylococcus aureus C Enterobacteriaecae D Listeria monocytogenes E Salmonella enteritidis F Shigellae G Campylobacter jejuni H Giardia lamblia I Entamoeba histolytica
A
A Vibrio cholerae
9
Q
A 25-year-old homosexual man presents to his GP with a 3-day history of foul smelling, non-bloody diarrhoea, with abdominal cramps and flatulence. Stool microscopy reveals pear-shaped organisms. A Vibrio cholerae B Staphylococcus aureus C Enterobacteriaecae D Listeria monocytogenes E Salmonella enteritidis F Shigellae G Campylobacter jejuni H Giardia lamblia I Entamoeba histolytica
A
H Giardia lamblia
10
Q
A 35-year-old woman presents to accident and emergency with fever, diarrhoea and signs of shock. Her husband mentions that she had attended a work colleague’s barbeque the previous day. The consultant believes superantigens are responsible for the patient’s condition. A Vibrio cholerae B Staphylococcus aureus C Enterobacteriaecae D Listeria monocytogenes E Salmonella enteritidis F Shigellae G Campylobacter jejuni H Giardia lamblia I Entamoeba histolytica
A
B Staphylococcus aureus
11
Q
A 45-year-old man presents to his GP with a 2-month history of headache. After a CT scan demonstrates an opacity, a lumbar puncture is performed and cerebrospinal fluid (CSF) analysis reveals a protein level of 4.5 g/L (0.15–0.4), lymphocyte count 345 (1–5) and glucose 4.0 mmol/L (2.2–3.3). A Neisseria meningitides B Herpes simplex virus-2 C Leptospira interrogans D Listeria monocytogenes E Cryptococcus neoformans F Escherichia coli G Streptococcus pneumoniae H Borrelia burgdorferi I Mycobacterium tuberculosis
A
I Mycobacterium tuberculosis
12
Q
A 26-year-old man has recently returned to the UK from a year of working in Africa where he was taking part in a charity farming project. He presents to accident and emergency with signs of meningism. A serological microscopic agglutination test is positive. A Neisseria meningitides B Herpes simplex virus-2 C Leptospira interrogans D Listeria monocytogenes E Cryptococcus neoformans F Escherichia coli G Streptococcus pneumoniae H Borrelia burgdorferi I Mycobacterium tuberculosis
A
C Leptospira interrogans
13
Q
A 19-year-old woman who has recently started university is brought to accident and emergency with a headache and a spreading non-blanching rash. Gram- stain of a blood sample reveals the presence of Gram-negative diplococci A. Neisseria meningitides B Herpes simplex virus-2 C Leptospira interrogans D Listeria monocytogenes E Cryptococcus neoformans F Escherichia coli G Streptococcus pneumoniae H Borrelia burgdorferi I Mycobacterium tuberculosis
A
A. Neisseria meningitides
14
Q
A 46-year-old man with a history of HIV presents to accident and emergency with neck stiffness, fever and severe photophobia. Examination of the CSF with India ink reveals yeast cells surrounded by halos. A. Neisseria meningitides B Herpes simplex virus-2 C Leptospira interrogans D Listeria monocytogenes E Cryptococcus neoformans F Escherichia coli G Streptococcus pneumoniae H Borrelia burgdorferi I Mycobacterium tuberculosis
A
E Cryptococcus neoformans
15
Q
A 35-year-old woman presents to her infectious disease specialist due to recur- rent episodes of meningitis. During her last presentation CSF analysis reveals
a protein level of 0.8 g/L (0.15–0.4), lymphocyte count 290 (0–5) and glucose 2.2mmol/L (2.2–3.3).
A. Neisseria meningitides
B Herpes simplex virus-2
C Leptospira interrogans
D Listeria monocytogenes
E Cryptococcus neoformans
F Escherichia coli
G Streptococcus pneumoniae H Borrelia burgdorferi
I Mycobacterium tuberculosis
A
B Herpes simplex virus-2
16
Q
A 28-year-old woman sees her GP complaining of fever, lower abdominal pain and painful intercourse. Vaginal swabs are sent for a nucleic acid amplification test which reveal sexually transmitted bacteria that can also cause lymphogranuloma venereum. A Treponema pallidum B Klebsiella granulomatis C Neiserria gonorrhoeae D Trichomonas vaginalis E Candidia albicans F Chlamydia trachomatis G Bacterial vaginosis H Haemophilus ducreyi I Herpes simplex virus 2
A
F Chlamydia trachomatis
17
Q
A 68-year-old man presents to his GP with a gumma on his nose. On examina- tion, the patient is found to have pupils that accommodate to light but do not react. The man admits to unprotected sexual intercourse during his youth. A Treponema pallidum B Klebsiella granulomatis C Neiserria gonorrhoeae D Trichomonas vaginalis E Candidia albicans F Chlamydia trachomatis G Bacterial vaginosis H Haemophilus ducreyi I Herpes simplex virus 2
A
A Treponema pallidum
18
Q
A 35-year-old man presents to an infectious disease specialist with a painful penile ulcer and associated unilateral lymphadenopathy of the inguinal nodes. A swab of the ulcer is cultured on chocolate agar. A Treponema pallidum B Klebsiella granulomatis C Neiserria gonorrhoeae D Trichomonas vaginalis E Candidia albicans F Chlamydia trachomatis G Bacterial vaginosis H Haemophilus ducreyi I Herpes simplex virus 2
A
H Haemophilus ducreyi
19
Q
A 28-year-old woman sees her GP complaining of fever, lower abdominal pain and painful intercourse. A vaginal swab is taken and subsequent Gram-staining reveals Gram-negative diplococci. A Treponema pallidum B Klebsiella granulomatis C Neiserria gonorrhoeae D Trichomonas vaginalis E Candidia albicans F Chlamydia trachomatis G Bacterial vaginosis H Haemophilus ducreyi I Herpes simplex virus 2
A
C Neiserria gonorrhoeae
20
Q
A 35-year-old woman presents to her GP with a 2-week history of a fishy odorous vaginal discharge, which occurs especially after sexual intercourse. Microscopy of the discharge reveals clue cells. A Treponema pallidum B Klebsiella granulomatis C Neiserria gonorrhoeae D Trichomonas vaginalis E Candidia albicans F Chlamydia trachomatis G Bacterial vaginosis H Haemophilus ducreyi I Herpes simplex virus 2
A
G Bacterial vaginosis
21
Q
A 54-year-old man presents to his GP with a 1-week history of fever, cough and fatigue. On examination his respiratory rate is 20 breaths per minute and he is normotensive. Subsequent chest X-ray reveals right lower lobe consolidation. A Amoxicillin B Doxycycline C Co-amoxiclav IV D Meropenam E Chloramphenicol F Cefotaxime G Vancomycin H Trimethoprim I Flucloxacillin
A
A Amoxicillin
22
Q
A 38-year-old man presents to accident and emergency with an inflamed and swollen right leg. He mentions that he had cut the same leg 2 days previously playing football. A swab of the area isolates Staphylococcus aureus. A Amoxicillin B Doxycycline C Co-amoxiclav IV D Meropenam E Chloramphenicol F Cefotaxime G Vancomycin H Trimethoprim I Flucloxacillin
A
I Flucloxacillin
23
Q
A 34-year-old woman presents to her GP with lower abdominal pain and dysuria. A dipstick of her urine reveals the presence of protein, white cells and nitrites. A Amoxicillin B Doxycycline C Co-amoxiclav IV D Meropenam E Chloramphenicol F Cefotaxime G Vancomycin H Trimethoprim I Flucloxacillin
A
H Trimethoprim
24
Q
A 56-year-old man is being cared for on the surgical ward after excision of a segment of his bowel after being diagnosed with colorectal carcinoma. The following day the surgical wound site is found to be inflamed. The patient has a fever and his blood pressure is slowly declining. Blood cultures reveal Gram- positive cocci arranged in clusters that are resistant to -lactam antibiotics. A Amoxicillin B Doxycycline C Co-amoxiclav IV D Meropenam E Chloramphenicol F Cefotaxime G Vancomycin H Trimethoprim I Flucloxacillin
A
G Vancomycin
25
```
An 18-year-old woman student presents to accident and emergency with head- ache, neck stiffness and photophobia. CT scan reveals no raised intracranial pres- sure. Gram-negative diploccoci are visualized on Gram-staining of the patient’s CSF.
A Amoxicillin
B Doxycycline
C Co-amoxiclav IV
D Meropenam
E Chloramphenicol
F Cefotaxime
G Vancomycin
H Trimethoprim
I Flucloxacillin
```
F Cefotaxime
26
```
A 38-year-old man presents to his GP with vomiting, mild fever and loss of appetite. He admits to travelling to sub-Saharan Africa 2 months previously. On examination the patient is evidently jaundiced.
A Human immunodeficiency virus (HIV)
B Epstein–Barr virus (EBV)
C Hepatitis B virus
D Cytomegalovirus (CMV)
E Hepatitis D virus
F Varicella zoster virus
G Hepatitis C virus
H Human herpes virus 8
I Influenza virus
```
C Hepatitis B virus
27
```
A 39-year-old homosexual man is referred to the gastroenterology department for an oesophogastroduodenoscopy (OGD) due to recent onset odynophagia. The OGD reveals multiple raised white plaques that can be removed by endo- scopic scraping.
A Human immunodeficiency virus (HIV)
B Epstein–Barr virus (EBV)
C Hepatitis B virus
D Cytomegalovirus (CMV)
E Hepatitis D virus
F Varicella zoster virus
G Hepatitis C virus
H Human herpes virus 8
I Influenza virus
```
A Human immunodeficiency virus (HIV)
28
```
A 15-year-old girl presents to her GP complaining of a sore throat, fever, fatigue and loss of appetite. A blood film demonstrates atypical lymphocytes and monospot test is positive.
A Human immunodeficiency virus (HIV)
B Epstein–Barr virus (EBV)
C Hepatitis B virus
D Cytomegalovirus (CMV)
E Hepatitis D virus
F Varicella zoster virus
G Hepatitis C virus
H Human herpes virus 8
I Influenza virus
```
B Epstein–Barr virus (EBV)
29
```
A 68-year-old woman presents to her GP after a 3-day history of fever, cough, headache and nasal congestion. The doctor believes her symptoms are due to a virus that binds to sialic acid receptors.
A Human immunodeficiency virus (HIV)
B Epstein–Barr virus (EBV)
C Hepatitis B virus
D Cytomegalovirus (CMV)
E Hepatitis D virus
F Varicella zoster virus
G Hepatitis C virus
H Human herpes virus 8
I Influenza virus
```
I Influenza virus
30
```
A 55-year-old man who is being treated for lung cancer with chemotherapeutic agents sees his oncologist for a routine check-up. There is a rash in a dermatomal pattern on the patient’s forehead; the patient complains that there is a burning sensation in the distribution of the rash.
A Human immunodeficiency virus (HIV)
B Epstein–Barr virus (EBV)
C Hepatitis B virus
D Cytomegalovirus (CMV)
E Hepatitis D virus
F Varicella zoster virus
G Hepatitis C virus
H Human herpes virus 8
I Influenza virus
```
F Varicella zoster virus
31
```
A 40-year-old man presents to an infectious disease specialist with a 4-month history of weight loss, fever and malaise. On examination the patient has lymphadenopathy. His CD4 count is found to be 289 copies/μL. The patient is started on lamivudine, ritonavir and one other drug.
A Acyclovir
B Oseltamivir
C Interferon- alpha
D Zidovudine
E Gancylcovir
F Lamivudine
G Efivarenz
H Ritonavir
I Adamantadine
```
D Zidovudine
32
```
A 38-year-old intravenous drug user presents to an infectious disease special- ist with a 1-week history of fever and malaise; on examination hepatomegaly is noted. The patient is found to be HBeAg positive and is subsequently com- menced on lamivudine and one other drug.
A Acyclovir
B Oseltamivir
C Interferon- alpha
D Zidovudine
E Gancylcovir
F Lamivudine
G Efivarenz
H Ritonavir
I Adamantadine
```
C Interferon- alpha
33
```
A 25-year-old man presents to his GP with a 3-day history of fever, cough, body aches and severe headaches. The patient is told to rest and drink plenty of fluids. However, he returns the following week stating his symptoms have not improved and is started on a drug that acts on viral neuraminidase.
A Acyclovir
B Oseltamivir
C Interferon- alpha
D Zidovudine
E Gancylcovir
F Lamivudine
G Efivarenz
H Ritonavir
I Adamantadine
```
B Oseltamivir
34
```
A 3-year-old girl diagnosed with severe combined immunodeficiency is due to undergo a bone marrow transplant. She is given a drug as prophylaxis against cytomegalovirus infection.
A Acyclovir
B Oseltamivir
C Interferon- alpha
D Zidovudine
E Gancylcovir
F Lamivudine
G Efivarenz
H Ritonavir
I Adamantadine
```
E Gancylcovir
35
```
A 28-year-old woman presents to her GP with cold sores dotted across her lower lip. She is started on a medication that inhibits DNA polymerase function to speed the healing processes.
A Acyclovir
B Oseltamivir
C Interferon- alpha
D Zidovudine
E Gancylcovir
F Lamivudine
G Efivarenz
H Ritonavir
I Adamantadine
```
A Acyclovir
36
```
A 38-year-old man with known HIV presents to his GP with a 1-week history of white coloured creamy deposits inside his mouth. The patient is prescribed an oral nystatin wash.
A Cryptoccus neoformans
B Pityriasis versicolour
C Aspergillus flavus
D Histoplasma capsulatum
E Phialophora verrucosa
F Tinea capitis
G Sporothrix schenckii
H Tinea corporis
I Candida albicans
```
I Candida albicans
37
```
A 45-year-old man with known HIV presents to accident and emergency with headache, nausea, confusion and fever. Investigation of the patient’s CSF with India ink stain reveals yeast cells surrounded by a halo.
A Cryptoccus neoformans
B Pityriasis versicolour
C Aspergillus flavus
D Histoplasma capsulatum
E Phialophora verrucosa
F Tinea capitis
G Sporothrix schenckii
H Tinea corporis
I Candida albicans
```
A Cryptoccus neoformans
38
```
A 35-year-old woman presents to her GP with hyperpigmented spots on her back. Scrapings of the affected areas reveal a ‘spaghetti with meatballs’ appear- ance under the microscope.
A Cryptoccus neoformans
B Pityriasis versicolour
C Aspergillus flavus
D Histoplasma capsulatum
E Phialophora verrucosa
F Tinea capitis
G Sporothrix schenckii
H Tinea corporis
I Candida albicans
```
B Pityriasis versicolour
39
```
A 48-year-old HIV positive man who has recently migrated from sub-Saharan Africa presents to accident and emergency with chest pain, shortness of breath, fever and cough. A chest X-ray demonstrates a spherical opacity in the upper left lung field.
A Cryptoccus neoformans
B Pityriasis versicolour
C Aspergillus flavus
D Histoplasma capsulatum
E Phialophora verrucosa
F Tinea capitis
G Sporothrix schenckii
H Tinea corporis
I Candida albicans
```
C Aspergillus flavus
40
```
A 32-year-old gardener presents to his GP with small raised lesions on his left arm. He remembers working in a garden a few days previously which had been swamped with rose-thorns.
A Cryptoccus neoformans
B Pityriasis versicolour
C Aspergillus flavus
D Histoplasma capsulatum
E Phialophora verrucosa
F Tinea capitis
G Sporothrix schenckii
H Tinea corporis
I Candida albicans
```
G Sporothrix schenckii
41
```
A 45-year-old man has returned to the UK from a holiday to France. A week later he presents with flu-like symptoms, drenching sweats, a recurring fever and is beginning to complain of a lower back pain. He admits to have brought back some local cheeses on visits to regional farms.
A Psittacosis
B Rabies
C Brucellosis
D Q fever
E Leptospirosis
F Mycobacterium marinium
G Lyme disease
H Cat scratch disease
I Rocky mountain spotted fever
```
C Brucellosis
42
```
A 36-year-old man presents to his GP with a painful right knee. He states that he visited the Prairie regions of Canada a month previous to this episode and states that his wife had mentioned there was a red rash on his back; on examination a target shaped rash is observed.
A Psittacosis
B Rabies
C Brucellosis
D Q fever
E Leptospirosis
F Mycobacterium marinium
G Lyme disease
H Cat scratch disease
I Rocky mountain spotted fever
```
G Lyme disease
43
```
A 38-year-old sewage worker presents to his GP with 1-week history of flu- like symptoms with diarrhoea. A microscopic agglutination test reveals the diagnosis.
A Psittacosis
B Rabies
C Brucellosis
D Q fever
E Leptospirosis
F Mycobacterium marinium
G Lyme disease
H Cat scratch disease
I Rocky mountain spotted fever
```
E Leptospirosis
44
```
A 48-year-old man presents to his GP with flu-like symptoms. On examination the patient has a maculopapular rash on his trunk. The patient also shows an area where a vague bite mark is visible.
A Psittacosis
B Rabies
C Brucellosis
D Q fever
E Leptospirosis
F Mycobacterium marinium
G Lyme disease
H Cat scratch disease
I Rocky mountain spotted fever
```
I Rocky mountain spotted fever
45
```
A 34-year-old bird handler presents to his GP with a few days’ history of fever, mild cough and myalgia. The patient states that his shop had recently taken a new shipment of parrots from Central America. Giemsa staining of the patient’s sputum reveals cytoplasmic inclusions.
A Psittacosis
B Rabies
C Brucellosis
D Q fever
E Leptospirosis
F Mycobacterium marinium
G Lyme disease
H Cat scratch disease
I Rocky mountain spotted fever
```
A Psittacosis
46
```
A 10-year-old boy is brought to see the GP by his mother as he has recently developed parotid swelling associated with a fever. Blood tests reveal a raised amylase level. The boy’s mother reveals that his immunization schedule is not complete as they were living in Tunisia at the time.
A Rubella
B Syphilis
C Measles
D Hepatitis B
E Mumps
F Listeria monocytogenes
G Cytomegalovirus
H Haemophilus influenzae
I HIV
```
E Mumps
47
```
A 3-week-old baby develops vomiting and is feeding poorly. On examination he has a reduced level of consciousness and an arched back. Analysis of the CSF reveals the presence of Gram-positive rods.
A Rubella
B Syphilis
C Measles
D Hepatitis B
E Mumps
F Listeria monocytogenes
G Cytomegalovirus
H Haemophilus influenzae
I HIV
```
F Listeria monocytogenes
48
```
A 3-year-old girl presents to the GP with a cough, fever and runny nose. On examination, the child has white spots scattered on the buccal mucosa. Her mother admits that she denied her child a certain vaccine due to scares pre- sented by the media.
A Rubella
B Syphilis
C Measles
D Hepatitis B
E Mumps
F Listeria monocytogenes
G Cytomegalovirus
H Haemophilus influenzae
I HIV
```
C Measles
49
```
A 4-year-old boy presents to accident and emergency with a reduced level of consciousness, headache and neck stiffness. Analysis of the CSF reveals the pres- ence of Gram-negative rods. The child’s mother reveals that his immunization record is not complete as they have only migrated from Ethiopia recently.
A Rubella
B Syphilis
C Measles
D Hepatitis B
E Mumps
F Listeria monocytogenes
G Cytomegalovirus
H Haemophilus influenzae
I HIV
```
H Haemophilus influenzae
50
```
An 8-month old girl is seen by a paediatrician due to concerns about developmental delay. On examination cataracts are noted in both eyes. Echocardiography reveals a patent ductus arteriosus.
A Rubella
B Syphilis
C Measles
D Hepatitis B
E Mumps
F Listeria monocytogenes
G Cytomegalovirus
H Haemophilus influenzae
I HIV
```
A Rubella
51
```
A 24 year-old Asian man presents with a persistent cough. A sputum sample is taken and cultured on Lowenstein–Jensen medium, appearing as brown, granular colonies after several weeks. The organism implicated is:
A Coxiella burnetti
B Streptococcus pneumoniae
C Mycobacterium tuberculosis
D Legionella pneumophilia
E Mycobacterium leprae
```
C Mycobacterium tuberculosis
52
A 24-year-old HIV-positive Asian man presents with a cough. A Mantoux test is performed. After 72 hours, the wheal diameter is measured at 5.8mm. This indicates:
A He has never been exposed to TB
B He has been exposed to TB
C He has had a BCG vaccination in the past
D He has latent TB which is now reactivated
E It is not possible to say
B He has been exposed to TB
53
```
An 18-year-old university student develops a lower lobe pneumonia, with a raised white cell count and CRP. A sputum culture reveals a Gram-positive optochin-sensitive diplococcus. The most likely causative agent is:
A Staphylococcus aureus
B Streptococcus viridans
C Mycoplasma pneumoniae
D Streptococcus pneumoniae
E Haemophilus influenzae
```
D Streptococcus pneumoniae
54
A 58-year-old Caucasian alcoholic man presents to his GP with a history of sudden onset high fever, flu-like symptoms and, thick, blood stained sputum.
A chest X-ray is arranged which shows marked upper lobe cavitation. The most likely causative agent is:
A Klebsiella pneumoniae
B Mycobacterium tuberculosis
C Staphylococcus aureus
D Moraxella catarrhalis
E Pnemocystis jirovecii
A Klebsiella pneumoniae
55
```
A 27-year-old intravenous drug user presents with a 2-week history of fevers, weight loss and a systolic murmur. The most likely causative agent is:
A Streptococcus viridans
B Candida albicans
C Staphylococcus aureus
D Streptococcus bovis
E Kingella
```
C Staphylococcus aureus
56
```
A patient with shingles is treated with an anti-viral. The drug used is a guano- sine analogue and acts as a substrate for viral thymidine kinase. The most likely drug she has been given is:
A Foscarnet
B Lamivudine
C Cidofovir
D Acyclovir
E Ganciclovir
```
D Acyclovir
57
```
According to the UK immunization schedule, which vaccine should be given to a 2-month-old baby who has already received DTaP (diptheria, tetanus, pertussis), IPV (polio) and Hib (Haemophilus influenzae type B) vaccines?
A Pneumococcus
B MMR
C Meningitis C
D BCG
E Hepatitis B
```
A Pneumococcus
58
```
A 24-year-old sexually active woman presents to her GP with dysuria. A urinary tract infection is diagnosed. Which of the following is the most likely causative agent?
A Enterobacter
B Escherichia coli
C Klebsiella pneumoniae
D Staphylococcus saphrophyticus
E Proteus mirabilis
```
B Escherichia coli
59
```
A 44-year-old woman patient returns from her holiday in India with a 2-day history of watery, offensive diarrhoea, bloating, excessive flatulence and abdomi- nal pain. The GP obtains a stool sample. Microscopy reveals a flagellate pear- shaped protozoan. The most likely organism implicated is:
A Bacillus cereus
B Salmonella enteritidis
C Giardia lamblia
D Entamoeba histolytica
E Cryptosporidium parvum
```
C Giardia lamblia
60
```
A 21-year-old medical student returns from her elective in India with a history of abdominal cramps, vomiting, fevers and profuse, watery stools which she describes as resembling ‘rice-water’. The GP obtains a stool sample. Analysis reveals curved, comma shaped organisms that were shown to be oxidase positive. The most likely organism implicated is:
A Hepatitis A
B Clostridium difficile
C Yersinia enterocolitica
D Campylobacter jejuni
E Vibrio cholerae
```
E Vibrio cholerae
61
```
A 35-year-old HIV-positive man presents to his GP complaining of a general feeling of tiredness, weight loss and night sweats. On examination there is hepato- splenomegaly and hyperpigmentation of the skin. The most likely diagnosis is:
A Visceral leishmaniasis
B Cutaneous leishmaniasis
C Mucocutaneous leishmaniasis
D Malaria
E Schistosomiasis
```
A Visceral leishmaniasis
62
```
A 22-year-old student presents to accident and emergency with a raised, erythe- matous, scaly ulcer on his forearm which has not been healing. On examination he is also found to have lymphadenopathy. He gives a history of recently return- ing from a 2-month trek in the rainforests of South America. Tissue is aspirated from the margin of the ulcer, and the organism is cultured in Novy–MacNeal– Nicolle medium. The organism implicated is:
A. Toxoplasma gondii
B. Treponema pallidum
C. Leishmania dovani
D. Leishmania major
E. Leishmania braziliensis
```
D. Leishmania major
63
```
A 35 year old male clothing merchant has returned to the UK 2 weeks ago from a visit home to Syria. A week later he presents with flu-like symptoms, drenching sweats and a recurring fever and is beginning to complain of lower back pain. After further questioning, he mentioned that he worked on a farm during his trip. He is successfully treated with oral doxycycline and gentamicin. What is the most likely diagnosis?
A Malaria
B Tuberculosis
C Influenza
D Brucellosis
E Typhoid
```
D Brucellosis
64
```
A 50-year-old man has returned from hiking a segment of the Appalachian Trail on the Eastern coast of the USA during the summer months. Ten days later he presents to casualty with flu-like illness and a rash showing some central fading. What is the most likely organism implicated?
A Herpes simplex
B Epstein–Barr virus
C Streptococcus pyogenes
D Treponema pallidum
E Borrelia burgdorferi
```
E Borrelia burgdorferi
65
```
A 26-year-old squash player is admitted with a red, swollen left knee. He reports no history of trauma. On examination he has a temperature of 38 C. A joint aspirate is taken. What is the most likely causative organism?
A Neisseria gonorrhoeae
B Staphyloccocus aureus
C Haemophilus influenzae
D Streptococcus viridans
E Chlamydia trachomatis
```
A Neisseria gonorrhoeae
66
A 26-year-old squash player is admitted with a red, swollen left knee. He reports no history of trauma. On examination he has a temperature of 38°C. A joint aspirate is taken which grows Gram-negative diplococci. What is the antibiotic treatment regimen of choice for this patient?
A Oral flucloxacillin for 4–6 weeks
B IV flucloxacillin for 4–6 weeks
C IV flucloxacillin for 2–4 weeks
D IV flucloxacillin and vancomycin for 6–8 weeks
E IV cefotaxime for 4–6 weeks
E IV cefotaxime for 4–6 weeks
67
You order hepatitis B serology tests for one of your patients, a 24-year-old man who is an intravenous drug user. The results that come back from the laboratory are as follows:
HBsAg = positive
Anti-HBs = negative
HBeAg = positive
Anti-HBe = negative
Anti-HBc IgM = negative Anti-HBc IgG = positive
What is the most likely diagnosis based on these results?
A The patient has chronic hepatitis B infection which is currently highly infectious
B The patient has chronic hepatitis B infection which is not currently infectious
C The patient has acute hepatitis B infection which is not currently infectious
D The patient is immune due to hepatitis B vaccination
E The patient is immune due to natural infection
A The patient has chronic hepatitis B infection which is currently highly infectious
68
You order hepatitis B serology tests for one of your patients, a 24-year-old man who is an intravenous drug user. The results that come back from the laboratory are as follows:
HBsAg = negative
Anti-HBs = positive
HBeAg = negative
Anti-HBe = negative
Anti-HBc IgM = negative Anti- HBc IgG = negative
What is the most likely diagnosis based on these results?
A The patient has chronic hepatitis B infection which is currently highly infectious
B The anti-HBs is a false positive result
C The patient has a resolved hepatitis B infection
D The patient is immune due to hepatitis B vaccination
E The patient is immune due to natural infection
D The patient is immune due to hepatitis B vaccination
69
A 79-year old woman is admitted to the hospital for treatment of pneumonia and is commenced on intravenous antibiotic therapy. Her respiratory symptoms begin to improve, but 5 days later she develops profuse diarrhoea. The most appropriate treatment is:
A Oral metronidazole for 7 days
B Oral metronidazole for 14 days
C Isolation and treatment with intravenous fluids
D IV metronidazole for 7 days
E Oral co-amoxiclav for 7 days
B Oral metronidazole for 14 days
70
A 79-year old woman is admitted to hospital for treatment of pneumonia and is commenced on intravenous antibiotic therapy. Her respiratory symptoms begin to improve, but 5 days later she develops profuse diarrhoea. After treatment with oral metronidazole she shows gradual improvement, but the profuse diarrhoea returns 2 weeks later. The same organism is found to be responsible. The most appropriate course of action is:
A Oral metronidazole for 7 days
B Oral metronidazole for 14 days
C Isolation and treatment with intravenous fluids
D IV metronidazole for 7 days
E Oral vancomycin for 14 days
B Oral metronidazole for 14 days
71
```
A 65-year old retired mechanic is brought by his family to his GP due to their concern over his recent increase in confusion. This has occurred rapidly over the past 4 months, and he now struggles to recognize members of his family. His daughter also reports occasionally seeing intermittent, jerky movements of both his arms. The GP organizes a CT scan and dementia screen, which are both found to be normal. Which is the next most useful diagnostic test for the GP to order?
A MRI brain
B Electroencephalogram
C Electrocardiogram
D Ultrasound scan of both carotids
E Tonsillar biopsy
```
B Electroencephalogram
72
A 61-year-old patient has recently been diagnosed with sporadic CJD. His GP is keen to do a lumbar puncture. Which of the following statements is true regard- ing this investigation in this situation?
A The lumbar puncture is used to look for the levels of protein, glucose and polymorphs
B The lumbar puncture is used to look for the levels of a protein called 14-3-3
C A lumbar puncture is the most specific test for variant CJD
D The lumbar puncture is not useful in sporadic CJD, but is an important test
in variant CJD
E A tonsillar biopsy would be a more useful test than a lumbar puncture for
sporadic CJD
B The lumbar puncture is used to look for the levels of a protein called 14-3-3
73
```
A 16-year-old student complains of a headache of recent onset at school. He is taken to accident and emergency and on examination has a temperature of 37.6°C. A lumbar puncture is performed, and the results are as follows:
Appearance: Clear fluid
Protein: 0.82 g/L
WCC: 90.5 107 (>95 per cent lymphocytes). What is the most likely diagnosis?
A Subarachnoid haemorrhage
B Tension headache
C Bacterial meningitis
D Viral meningitis
E Tuberculous meningitis
```
E Tuberculous meningitis
74
A 42-year-old alcoholic is admitted with abdominal distension. The shifting dullness test is positive and he is found to have diffuse abdominal tenderness. His observations are as follows: pulse 115, blood pressure 116/83, temperature 37.9°C. The next best course of action is:
A Begin therapeutic paracentesis
B Observe, administer analgesia and closely monitor his vital signs
C Commence intravenous spironolactone
D Commence intravenous amoxicillin
E Commence intravenous cefotaxime
E Commence intravenous cefotaxime
75
A 63-year-old asymptomatic housewife is referred to a gastroenterologist after her GP found that she had abnormal liver function tests on a routine blood test. A thorough history reveals that she received a blood transfusion during her preg- nancy in 1979. Further tests confirm that she has contracted hepatitis C. She is commenced on a course of anti-viral treatment. Which of the following factors is most significant in influencing her chance of clearing the virus?
A The length of time between contracting the disease and being diagnosed
B The route by which she contracted the disease
C Her liver function test results
D The virus genotype
E The level of alpha-feto-protein
D The virus genotype
76
```
A 63-year-old asymptomatic housewife is referred to a gastroenterologist after her GP found that she had abnormal liver function tests on a routine blood test. A thor- ough history reveals that she received a blood transfusion during her pregnancy in 1979. The best test to confirm whether the patient has hepatitis C would be:
A Liver biopsy
B Anti-hepatitis C antibodies
C Alanine aminotransferase levels
D Hepatitis C RNA PCR
E Viral genotyping
```
D Hepatitis C RNA PCR
77
```
A 33-year-old backpacker visits his GP complaining of feeling weak, lethargic and feverish since he returned from his trip to South Africa 3 months previously. He is accompanied by his wife, who reports a change in his behaviour and dis- turbed sleeping pattern since his return. On examination, his GP discovers that he has enlarged cervical lymph nodes, and there is a small chancre on his forearm that is approximately 2cm in diameter. The most likely causative organism is:
A Plasmodium falciparum
B Trypanosoma brucei gambiense
C Trypanosoma brucei rhodesiense
D Trypanosoma cruzi
E Leishmania infantum
```
C Trypanosoma brucei rhodesiense
78
```
A 20-year-old student seeks medical attention due to recent difficulty in swal- lowing, and severe weight loss. A thorough travel history reveals that he returned several months ago from a gap year in Brazil. During his trip he remembers becoming unwell at one point with a fever, diarrhoea, vomiting and swollen eyelids, but this resolved in approximately 3 weeks with no treatment. A chest X-ray is ordered as one of his investigations, and this reveals marked dila- tation of his oesophagus. The vector responsible for transmitting this disease is:
A Tsetse fly
B Reduviid bug
C Sandfly
D Aedes mosquito
E Ixodes tick
```
B Reduviid bug
American trypanosomiasis = also known as Chagas disease. Spread by triatomine bug (also known as Reduviid bug).
African trypanosomiasis is spread by the Tsetse fly
79
A 46-year-old Somalian woman presents to her GP with a dry cough and weight loss of 5kg over 3 weeks. She is sent to the hospital, and a chest X-ray reveals cavitating lung lesions. The most appropriate therapy is:
A Rifampicin and isoniazid for 6 months, ethambutol and pyrazinamide for 2 months
B Rifampicin and isoniazid for 2 months, ethambutol and pyrazinamide for 6 months
C Rifampicin and pyrazinamide for 4 months, ethambutol and isoniazid and for 2 months
D Rifampicin and streptomycin for 4 months, pyrazinamide and ethambutol for 2 months
E Rifampicin, isoniazid, ethambutol and pyrazinamide for 6 months
A Rifampicin and isoniazid for 6 months, ethambutol and pyrazinamide for 2 months
80
A 46-year-old Somalian woman presents to her GP with a dry cough and weight loss of 5kg over 3 weeks. She is sent to the hospital, and a chest X-ray reveals cavitating lung lesions. She is started on a course of anti-tuberculous medication. Which of the following statements about this regimen is true?
A Liver function tests only need to be checked in those with pre-existing liver disease
B Ethambutol can cause a peripheral neuropathy
C Pyridoxine should always be given with isoniazid treatment
D Rifampicin can cause optic neuritis
E Ethambutol should be avoided in renal failure
E Ethambutol should be avoided in renal failure
81
```
A 35-year-old banker develops a fever, vomiting and diarrhoea after a barbeque. This resolves within 2 weeks, but he then suddenly develops unilateral facial weakness. This is followed by severe muscle weakness which rapidly spreads over the next 5 days from his feet and legs to his trunk. The most likely diagnosis is:
A Polio
B Lyme disease
C Guillan–Barré syndrome
D Haemolytic uraemic syndrome
E Influenza
```
C Guillan–Barré syndrome
82
A young girl returns from visiting her relatives in India, feeling feverish and
with flu-like symptoms. A diagnosis of malaria is suspected. Her fevers started on Monday, regressed for a few days and then returned on Thursday. She was well again over the weekend, and was then brought to the GP the following Monday when her fever had again returned. The most likely causative agent in this case is:
A Plasmodium falciparum
B Plasmodium vivax
C Plasmodium ovale
D Plasmodium malariae
E Plasmodium knowlesi
D Plasmodium malariae
83
```
A young girl returns from visiting her relatives in India, feeling feverish and with flu-like symptoms. A diagnosis of malaria is suspected. The form of the malaria parasite which invades erythrocytes is known as a:
A Sporozite
B Schizont
C Merozite
D Hypnozoite
E Gametocyte
```
C Merozite
84
A 55-year-old housewife returns from visiting her relatives in India, with a high fever and with flu-like symptoms. A diagnosis of uncomplicated falciparum malaria is confirmed. The most appropriate management plan is:
A Discharge with oral quinine and doxycycline
B Discharge with oral mefloquine and chloroquine
C Admit, give IV paracetemol and observe
D Admit and give IV quinine
E Admit and give oral quinine and doxycycline
E Admit and give oral quinine and doxycycline
85
```
A 55-year-old housewife returns from visiting her relatives in India, with a high fever and with flu-like symptoms. Thick and thin films are requested, and Maurer’s clefts are seen under the microscope. The diagnosis is:
A Plasmodium falciparum
B Plasmodium vivax
C Plasmodium ovale
D Plasmodium malariae
E Plasmodium knowlesi
```
A Plasmodium falciparum
86
```
The antiviral which is given to untreated pregnant women with HIV to prevent vertical transmission of the virus during childbirth.
A. Nevirapine
B. Ribavirin
C. Ganciclovir
D. Neuraminidase inhibitor
E. Zidovudine
F. Oseltamivir
G. Aciclovir triphosphate
H. Interferon-g (gamma)
I. Entecevir
J. Aciclovir
K. Interferon-b (beta)
L. Aciclovir monophosphate
M. Interferon-α (alpha)
N. Cidofovir
O. Foscarnet
```
A. Nevirapine
87
```
An immunomodulatory therapy used in the treatment of hepatitis B.
A. Nevirapine
B. Ribavirin
C. Ganciclovir
D. Neuraminidase inhibitor
E. Zidovudine
F. Oseltamivir
G. Aciclovir triphosphate
H. Interferon-g (gamma)
I. Entecevir
J. Aciclovir
K. Interferon-b (beta)
L. Aciclovir monophosphate
M. Interferon-α (alpha)
N. Cidofovir
O. Foscarnet
```
M. Interferon-α (alpha)
88
```
An antiviral currently used to prevent and treat Influenza in the elderly and which has the potential to be used to prevent Avian influenza.
A. Nevirapine
B. Ribavirin
C. Ganciclovir
D. Neuraminidase inhibitor
E. Zidovudine
F. Oseltamivir
G. Aciclovir triphosphate
H. Interferon-g (gamma)
I. Entecevir
J. Aciclovir
K. Interferon-b (beta)
L. Aciclovir monophosphate
M. Interferon-α (alpha)
N. Cidofovir
O. Foscarnet
```
F. Oseltamivir
89
```
The final metabolite of the antiviral used to treat Herpes Simplex
A. Nevirapine
B. Ribavirin
C. Ganciclovir
D. Neuraminidase inhibitor
E. Zidovudine
F. Oseltamivir
G. Aciclovir triphosphate
H. Interferon-g (gamma)
I. Entecevir
J. Aciclovir
K. Interferon-b (beta)
L. Aciclovir monophosphate
M. Interferon-α (alpha)
N. Cidofovir
O. Foscarnet
```
G. Aciclovir triphosphate
90
```
An antiviral which can be used in aerosol form to prevent respiratory syncytial virus in children with heart and lung disease
A. Nevirapine
B. Ribavirin
C. Ganciclovir
D. Neuraminidase inhibitor
E. Zidovudine
F. Oseltamivir
G. Aciclovir triphosphate
H. Interferon-g (gamma)
I. Entecevir
J. Aciclovir
K. Interferon-b (beta)
L. Aciclovir monophosphate
M. Interferon-α (alpha)
N. Cidofovir
O. Foscarnet
```
B. Ribavirin
91
```
Which option is the product of the action of viral tyrosine kinase on aciclovir?
A. Varicella-zoster virus
B. Guanosine
C. Aciclovir triphosphate
D. AIDS
E. Famciclovir
F. Cytomegalovirus
G. Ribavarin
H. Aciclovir monophosphate
I. Aciclovir diphosphate
J. Thymidine
K. Influenza
```
H. Aciclovir monophosphate
92
```
Which option inhibits the action of viral DNA polymerase?
A. Varicella-zoster virus
B. Guanosine
C. Aciclovir triphosphate
D. AIDS
E. Famciclovir
F. Cytomegalovirus
G. Ribavarin
H. Aciclovir monophosphate
I. Aciclovir diphosphate
J. Thymidine
K. Influenza
```
C. Aciclovir triphosphate
93
```
The synthetic nucleoside analogue ganciclovir is the drug of choice against which infective virus?
A. Varicella-zoster virus
B. Guanosine
C. Aciclovir triphosphate
D. AIDS
E. Famciclovir
F. Cytomegalovirus
G. Ribavarin
H. Aciclovir monophosphate
I. Aciclovir diphosphate
J. Thymidine
K. Influenza
```
F. Cytomegalovirus
94
```
Ribavirin, a synthetic nucleoside that acts as an RNA polymerase inhibitor, is similar in structure to which of the options given above?
A. Varicella-zoster virus
B. Guanosine
C. Aciclovir triphosphate
D. AIDS
E. Famciclovir
F. Cytomegalovirus
G. Ribavarin
H. Aciclovir monophosphate
I. Aciclovir diphosphate
J. Thymidine
K. Influenza
```
B. Guanosine
95
```
Valaciclovir, a prodrug of aciclovir, is used to treat patients with which viral disease in the list, above?
A. Varicella-zoster virus
B. Guanosine
C. Aciclovir triphosphate
D. AIDS
E. Famciclovir
F. Cytomegalovirus
G. Ribavarin
H. Aciclovir monophosphate
I. Aciclovir diphosphate
J. Thymidine
K. Influenza
```
A. Varicella-zoster virus
96
```
An immunomodulator effective in HBV infection
A. Abacavir
B. Amantadine
C. Doxacyclin
D. Loviride
E. Interferon
F. Citalapram
G. Aciclovir
H. Ibuprofen
I. Zidovudine
J. Ribavarin
K. Foscarnet
L. Adefovir
M. Gancyclovir
```
E. Interferon
97
```
Used for the treatment of severe, resistant herpes infections
A. Abacavir
B. Amantadine
C. Doxacyclin
D. Loviride
E. Interferon
F. Citalapram
G. Aciclovir
H. Ibuprofen
I. Zidovudine
J. Ribavarin
K. Foscarnet
L. Adefovir
M. Gancyclovir
```
K. Foscarnet
98
```
The treatment of choice for CMV-induced hepatitis
A. Abacavir
B. Amantadine
C. Doxacyclin
D. Loviride
E. Interferon
F. Citalapram
G. Aciclovir
H. Ibuprofen
I. Zidovudine
J. Ribavarin
K. Foscarnet
L. Adefovir
M. Gancyclovir
```
M. Gancyclovir
99
```
A drug that is effective against influenza A but not influenza B
A. Abacavir
B. Amantadine
C. Doxacyclin
D. Loviride
E. Interferon
F. Citalapram
G. Aciclovir
H. Ibuprofen
I. Zidovudine
J. Ribavarin
K. Foscarnet
L. Adefovir
M. Gancyclovir
```
B. Amantadine
100
```
A purine nucleoside analogue that selects specifically for thymidine kinase
A. Abacavir
B. Amantadine
C. Doxacyclin
D. Loviride
E. Interferon
F. Citalapram
G. Aciclovir
H. Ibuprofen
I. Zidovudine
J. Ribavarin
K. Foscarnet
L. Adefovir
M. Gancyclovir
```
G. Aciclovir
101
```
A nucleoside analogue which inhibits reverse transcriptase
A. Zanamivir
B. Interferon
C. Enfuvirtide
D. Zidovudine
E. Human specific immunoglobulin
F. Human normal immunoglobulin
G. Ribavarin
H. Indinavir
I. Nevirapine
J. Amantadine
K. Ganciclovir
L. Efavirenz
M. Aciclovir
```
D. Zidovudine
102
```
The drug mechanisms which acts by stopping post-translational cleaving of polyproteins by inhibiting proteases
A. Zanamivir
B. Interferon
C. Enfuvirtide
D. Zidovudine
E. Human specific immunoglobulin
F. Human normal immunoglobulin
G. Ribavarin
H. Indinavir
I. Nevirapine
J. Amantadine
K. Ganciclovir
L. Efavirenz
M. Aciclovir
```
H. Indinavir
103
```
The drug that is selectively toxic to virally infected cells through its selective phosphorylation using viral thymidine kinase
A. Zanamivir
B. Interferon
C. Enfuvirtide
D. Zidovudine
E. Human specific immunoglobulin
F. Human normal immunoglobulin
G. Ribavarin
H. Indinavir
I. Nevirapine
J. Amantadine
K. Ganciclovir
L. Efavirenz
M. Aciclovir
```
M. Aciclovir
104
```
The drug which can be delivered by inhalation to treat both influenza A and B.
A. Zanamivir
B. Interferon
C. Enfuvirtide
D. Zidovudine
E. Human specific immunoglobulin
F. Human normal immunoglobulin
G. Ribavarin
H. Indinavir
I. Nevirapine
J. Amantadine
K. Ganciclovir
L. Efavirenz
M. Aciclovir
```
A. Zanamivir
105
```
The drug which works by attenuating or preventing rabies or hepatitis, following a known exposure but before the onset of signs and symptoms.
A. Zanamivir
B. Interferon
C. Enfuvirtide
D. Zidovudine
E. Human specific immunoglobulin
F. Human normal immunoglobulin
G. Ribavarin
H. Indinavir
I. Nevirapine
J. Amantadine
K. Ganciclovir
L. Efavirenz
M. Aciclovir
```
E. Human specific immunoglobulin
106
```
A 40yr old female non-smoker presents with a one week history of fever, shortness of breath and a cough productive of rusty coloured sputum. She complains of a sharp chest pain which “catches” her on inspiration. On examination she has increased vocal resonance in the right middle zone on auscultation. The x-ray shows right middle lobe consolidation.
A. K. pneumoniae
B. M. tuberculosis
C. C. neoformans
D. [None]
E. L. pneumophila
F. M. pneumoniae
G. S. aureus
H. S. pneumoniae
I. P. aeuruginosa
J. B. pertussis
K. C. psittaci
```
H. S. pneumoniae
107
```
A 37yr old American business man staying in a hotel presents with a headache, myalgia and a dry cough. He is also suffering with nausea, diarrhoea and abdominal pain. On examination he is tachypnoeic and has a pyrexia of 39ºC. Blood tests reveal lymphopenia and hyponatraemia.
A. K. pneumoniae
B. M. tuberculosis
C. C. neoformans
D. [None]
E. L. pneumophila
F. M. pneumoniae
G. S. aureus
H. S. pneumoniae
I. P. aeuruginosa
J. B. pertussis
K. C. psittaci
```
E. L. pneumophila
108
```
A 19yr old medical student who lives in residential halls presents with a one week history of headache, malaise, shortness of breath and a cough. Her WBC is not raised but tests reveal the presence of cold agglutinins.
A. K. pneumoniae
B. M. tuberculosis
C. C. neoformans
D. [None]
E. L. pneumophila
F. M. pneumoniae
G. S. aureus
H. S. pneumoniae
I. P. aeuruginosa
J. B. pertussis
K. C. psittaci
```
F. M. pneumoniae
109
```
A 30yr old lady presents with a three week history of tiredness, malaise, cough and weight loss. She feels her condition has worsened in the past week and she now also suffers from a fever and haemoptysis. In addition she complains of a “tender lump” in her supraclavicular region. Chest x-ray demonstrates nodular shadowing of the right upper zone.
A. K. pneumoniae
B. M. tuberculosis
C. C. neoformans
D. [None]
E. L. pneumophila
F. M. pneumoniae
G. S. aureus
H. S. pneumoniae
I. P. aeuruginosa
J. B. pertussis
K. C. psittaci
```
B. M. tuberculosis
110
```
Dry cough, new infiltrates on CXR, dyspnoea and target shaped lesions on the palms. No recent history of herpes.
A. K. pneumoniae
B. M. tuberculosis
C. C. neoformans
D. [None]
E. L. pneumophila
F. M. pneumoniae
G. S. aureus
H. S. pneumoniae
I. P. aeuruginosa
J. B. pertussis
K. C. psittaci
```
F. M. pneumoniae
111
```
An 80 year old clown appears at the GP having been discharged from hospital for a complicated bowel resection with a stint in the ITU. He has a cough and fever and is prescribed a macrolide antibiotic because he is penicillin allergic
A. Anaerobic infection
B. Burkholderia cepacia
C. PCP/ P jiroveci
D. MSSA
E. M. Catarrhalis
F. Chlamydia psittaci
G. MRSA
H. MSSA or MRSA
I. S. pneumoniae
J. Chlamydia pneumoniae
K. M tuberculosis
L. Legionella pneumophila
M. H. influenzae
```
D. MSSA
112
```
A 55 year old female clown, recovering from a cold, is found to have a cavitating lesion on CXR and a productive cough.
A. Anaerobic infection
B. Burkholderia cepacia
C. PCP/ P jiroveci
D. MSSA
E. M. Catarrhalis
F. Chlamydia psittaci
G. MRSA
H. MSSA or MRSA
I. S. pneumoniae
J. Chlamydia pneumoniae
K. M tuberculosis
L. Legionella pneumophila
M. H. influenzae
```
H. MSSA or MRSA
113
```
An 18 year old trainee clown is being seen in the cystic fibrosis clinic and is found to be colonised with a particularly persistent organism.
A. Anaerobic infection
B. Burkholderia cepacia
C. PCP/ P jiroveci
D. MSSA
E. M. Catarrhalis
F. Chlamydia psittaci
G. MRSA
H. MSSA or MRSA
I. S. pneumoniae
J. Chlamydia pneumoniae
K. M tuberculosis
L. Legionella pneumophila
M. H. influenzae
```
B. Burkholderia cepacia
114
```
A 40 year old clown specialist is found to have a lobar pneumonia which on culture grew Gram +ve diplococci.
A. Anaerobic infection
B. Burkholderia cepacia
C. PCP/ P jiroveci
D. MSSA
E. M. Catarrhalis
F. Chlamydia psittaci
G. MRSA
H. MSSA or MRSA
I. S. pneumoniae
J. Chlamydia pneumoniae
K. M tuberculosis
L. Legionella pneumophila
M. H. influenzae
```
I. S. pneumoniae
115
```
A 35 year old clown who is a specialist in bird/clown comedy is found to have an atypical pneumonia which is treated with Augmentin and Clarythromicin
A. Anaerobic infection
B. Burkholderia cepacia
C. PCP/ P jiroveci
D. MSSA
E. M. Catarrhalis
F. Chlamydia psittaci
G. MRSA
H. MSSA or MRSA
I. S. pneumoniae
J. Chlamydia pneumoniae
K. M tuberculosis
L. Legionella pneumophila
M. H. influenzae
```
F. Chlamydia psittaci
116
```
5 year old boy comes to the GP and shows you small pustules over his face, scalp and trunk, which have progressed from small macules in a matter of hours. The previous day he had a fever, headache and malaise but has now subsided. Virology showed the presence of Varicella Zoster Virus
A. Burkitt's lymphoma
B. Chicken Pox
C. Shingles
D. HHV 6
E. Primary Genital Herpes
F. Herpes Labialis (Cold sores)
G. Roseola infantum
H. HHV 7
I. Glandular fever
J. Keratitis
K. Cytomegaloviruses
```
B. Chicken Pox
117
```
A 25 year old man with a latex allergy comes into GUM clinic with small grouped vesicles and papules on the shaft and glans of his penis. This was accompanied with severe pain in his groin, buttocks and upper thighs, a fever, and dysuria. Virology showed the presence of an alpha herpesvirus, HHV 2.
A. Burkitt's lymphoma
B. Chicken Pox
C. Shingles
D. HHV 6
E. Primary Genital Herpes
F. Herpes Labialis (Cold sores)
G. Roseola infantum
H. HHV 7
I. Glandular fever
J. Keratitis
K. Cytomegaloviruses
```
E. Primary Genital Herpes
118
```
A 21 year old man came to hospital complaining of severe headache, fever, malaise and a sore throat. On examination he showed cervical lymphadenopathy, especially the posterior cervical nodes, and splenomegaly. Peripheral blood tests showed the presence of lymphocytosis with atypical mononuclear cells. The Paul Bunnell reaction was positive for heterophilic antibiodies
A. Burkitt's lymphoma
B. Chicken Pox
C. Shingles
D. HHV 6
E. Primary Genital Herpes
F. Herpes Labialis (Cold sores)
G. Roseola infantum
H. HHV 7
I. Glandular fever
J. Keratitis
K. Cytomegaloviruses
```
I. Glandular fever
119
```
67 year old man comes to A+E with lesions on the skin, that have a localised unilateral pattern that is concentrated in a dermatomal organisation. The previous days the patient complained of extreme pain in the same area. Virology the presence of Varicella Zoster virus.
A. Burkitt's lymphoma
B. Chicken Pox
C. Shingles
D. HHV 6
E. Primary Genital Herpes
F. Herpes Labialis (Cold sores)
G. Roseola infantum
H. HHV 7
I. Glandular fever
J. Keratitis
K. Cytomegaloviruses
```
C. Shingles
120
```
On your elective in central Africa a 7 year old child comes to your clinic with a large mass on his jaw. You take a biopsy of the lump, which shows EBV positive large cell lymphoma B cells. Histology shows a starry sky appearance (isolated histiocytes on a background of abnormal lymphoblasts). Genetic testing shows the presence of a 14q/8q translocation. The consultant suggests treating with cyclophosphamide and a single dose leads to a spectacular remission.
A. Burkitt's lymphoma
B. Chicken Pox
C. Shingles
D. HHV 6
E. Primary Genital Herpes
F. Herpes Labialis (Cold sores)
G. Roseola infantum
H. HHV 7
I. Glandular fever
J. Keratitis
K. Cytomegaloviruses
```
A. Burkitt's lymphoma
121
```
Herpes Simplex Type 1 is associated with which complication:
A. Exanthem Subitum
B. Measles
C. Shingles
D. Primary stomatitis
E. Neonatal Infection associated with vaginal delivery
F. Infection associated with Kaposi’s sarcoma
G. Mumps
H. Herpangina
I. Pneumonitis
J. Infectious Mononucleosis
K. Rubella
```
D. Primary stomatitis
122
```
Cytomegalovirus is associated with which complication:
A. Exanthem Subitum
B. Measles
C. Shingles
D. Primary stomatitis
E. Neonatal Infection associated with vaginal delivery
F. Infection associated with Kaposi’s sarcoma
G. Mumps
H. Herpangina
I. Pneumonitis
J. Infectious Mononucleosis
K. Rubella
```
I. Pneumonitis
123
```
Herpes Simplex type 2 is associated with which complication:
A. Exanthem Subitum
B. Measles
C. Shingles
D. Primary stomatitis
E. Neonatal Infection associated with vaginal delivery
F. Infection associated with Kaposi’s sarcoma
G. Mumps
H. Herpangina
I. Pneumonitis
J. Infectious Mononucleosis
K. Rubella
```
E. Neonatal Infection associated with vaginal delivery
124
```
Human Herpes Virus 8 is associated with which complication:
A. Exanthem Subitum
B. Measles
C. Shingles
D. Primary stomatitis
E. Neonatal Infection associated with vaginal delivery
F. Infection associated with Kaposi’s sarcoma
G. Mumps
H. Herpangina
I. Pneumonitis
J. Infectious Mononucleosis
K. Rubella
```
F. Infection associated with Kaposi’s sarcoma
125
```
Human Herpes virus 6 is associated with which complication:
A. Exanthem Subitum
B. Measles
C. Shingles
D. Primary stomatitis
E. Neonatal Infection associated with vaginal delivery
F. Infection associated with Kaposi’s sarcoma
G. Mumps
H. Herpangina
I. Pneumonitis
J. Infectious Mononucleosis
K. Rubella
```
A. Exanthem Subitum
126
```
Pneumonitis after a bone marrow transplant:
A. HIV
B. Varicella zoster virus (alpha)
C. Human herpes virus 7
D. Epstein-Barr virus (gamma)
E. Cytomegalovirus (beta)
F. Human herpes virus 8 (gamma)
G. Human herpes virus 6 (beta)
H. Herpes simplex virus type 2 (alpha)
I. Herpes simplex virus type 1 (alpha)
```
E. Cytomegalovirus (beta)
127
```
Endemic Burkitt's lymphoma:
A. HIV
B. Varicella zoster virus (alpha)
C. Human herpes virus 7
D. Epstein-Barr virus (gamma)
E. Cytomegalovirus (beta)
F. Human herpes virus 8 (gamma)
G. Human herpes virus 6 (beta)
H. Herpes simplex virus type 2 (alpha)
I. Herpes simplex virus type 1 (alpha)
```
D. Epstein-Barr virus (gamma)
128
```
Roseola infantum:
A. HIV
B. Varicella zoster virus (alpha)
C. Human herpes virus 7
D. Epstein-Barr virus (gamma)
E. Cytomegalovirus (beta)
F. Human herpes virus 8 (gamma)
G. Human herpes virus 6 (beta)
H. Herpes simplex virus type 2 (alpha)
I. Herpes simplex virus type 1 (alpha)
```
G. Human herpes virus 6 (beta)
129
```
Blistering rash in dermatomal distribution:
A. HIV
B. Varicella zoster virus (alpha)
C. Human herpes virus 7
D. Epstein-Barr virus (gamma)
E. Cytomegalovirus (beta)
F. Human herpes virus 8 (gamma)
G. Human herpes virus 6 (beta)
H. Herpes simplex virus type 2 (alpha)
I. Herpes simplex virus type 1 (alpha)
```
B. Varicella zoster virus (alpha)
130
```
Acute necrotising encephalitis
A. HIV
B. Varicella zoster virus (alpha)
C. Human herpes virus 7
D. Epstein-Barr virus (gamma)
E. Cytomegalovirus (beta)
F. Human herpes virus 8 (gamma)
G. Human herpes virus 6 (beta)
H. Herpes simplex virus type 2 (alpha)
I. Herpes simplex virus type 1 (alpha)
```
I. Herpes simplex virus type 1 (alpha)
131
```
A 43-year-old man with a known history of HIV presents to his doctor with creamy plaques coating his tongue and oral cavity. His symptoms subside after treatment with fluconazole.
A. CD25
B. MIP-1alpha
C. CD8
D. Kaposi's sarcoma
E. Hairy leukoplakia
F. Reverse transcriptase
G. Anti-HIV antibody (Western blot)
H. CCR5/CXCR4
I. Candidiasis
J. Viral load (PCR)
K. Integrase
L. CD4
M. gp120
```
I. Candidiasis
132
```
A 37-year-old woman with a past history of intravenous drug use presents to her GP for her methadone prescription. On examination they note pale rigid lesions on the side of her tongue. Alongside her methadone the GP prescribes aciclovir.
A. CD25
B. MIP-1alpha
C. CD8
D. Kaposi's sarcoma
E. Hairy leukoplakia
F. Reverse transcriptase
G. Anti-HIV antibody (Western blot)
H. CCR5/CXCR4
I. Candidiasis
J. Viral load (PCR)
K. Integrase
L. CD4
M. gp120
```
E. Hairy leukoplakia
133
```
In addition to CD4+ T-lymphocyte counts, HIV monitoring is typically assessed through which measurement?
A. CD25
B. MIP-1alpha
C. CD8
D. Kaposi's sarcoma
E. Hairy leukoplakia
F. Reverse transcriptase
G. Anti-HIV antibody (Western blot)
H. CCR5/CXCR4
I. Candidiasis
J. Viral load (PCR)
K. Integrase
L. CD4
M. gp120
```
J. Viral load (PCR)
134
```
Which of the above is a naturally occurring cytokine that is able to inhibit HIV fusion to CD4+ T-lymphocytes?
A. CD25
B. MIP-1alpha
C. CD8
D. Kaposi's sarcoma
E. Hairy leukoplakia
F. Reverse transcriptase
G. Anti-HIV antibody (Western blot)
H. CCR5/CXCR4
I. Candidiasis
J. Viral load (PCR)
K. Integrase
L. CD4
M. gp120
```
B. MIP-1alpha
135
```
Which viral protein is responsible for the binding or fusion of HIV to human CD4+ T-lymphocytes?
A. CD25
B. MIP-1alpha
C. CD8
D. Kaposi's sarcoma
E. Hairy leukoplakia
F. Reverse transcriptase
G. Anti-HIV antibody (Western blot)
H. CCR5/CXCR4
I. Candidiasis
J. Viral load (PCR)
K. Integrase
L. CD4
M. gp120
```
M. gp120
136
```
Vaccine given at 12 – 18 months to prevent otitis media, parotitis, and cataracts in patients.
A. Diptheria
B. BCG
C. Rabies
D. Influenza
E. Measles
F. Varicella-Zoster
G. Meningococcal
H. Tetanus
I. Pertussis
J. Hepatitis B
K. MMR
```
K. MMR
137
```
An immunocompromised HIV positive patient should not receive this vaccine.
A. Diptheria
B. BCG
C. Rabies
D. Influenza
E. Measles
F. Varicella-Zoster
G. Meningococcal
H. Tetanus
I. Pertussis
J. Hepatitis B
K. MMR
```
B. BCG
138
```
Haemophiliacs and patients in receipt of regular blood transfusions should be vaccinated against this virus.
A. Diptheria
B. BCG
C. Rabies
D. Influenza
E. Measles
F. Varicella-Zoster
G. Meningococcal
H. Tetanus
I. Pertussis
J. Hepatitis B
K. MMR
```
J. Hepatitis B
139
```
Toxoid given as part of ‘triple’ vaccine during first year of life to prevent cardinal features of the disease: muscle spasms and rigidity.
A. Diptheria
B. BCG
C. Rabies
D. Influenza
E. Measles
F. Varicella-Zoster
G. Meningococcal
H. Tetanus
I. Pertussis
J. Hepatitis B
K. MMR
```
H. Tetanus
140
```
Vaccine recommended for high risk patients with chronic respiratory diseases, but contraindicated in patients hypersensitive to eggs.
A. Diptheria
B. BCG
C. Rabies
D. Influenza
E. Measles
F. Varicella-Zoster
G. Meningococcal
H. Tetanus
I. Pertussis
J. Hepatitis B
K. MMR
```
D. Influenza
141
```
75 year old female has been diagnosed with MRSA bacteraemia secondary to an infected leg ulcer.
A. Linezolid
B. Erthyromycin
C. Ciprofloxacin
D. Ceftriaxone
E. Metronidazole
F. Benzyl Penicillin
G. Flucloxacillin
H. Vancomycin
I. Gentamicin
```
H. Vancomycin
142
```
Treatment of an 18 year old with Meningitis.
A. Linezolid
B. Erthyromycin
C. Ciprofloxacin
D. Ceftriaxone
E. Metronidazole
F. Benzyl Penicillin
G. Flucloxacillin
H. Vancomycin
I. Gentamicin
```
D. Ceftriaxone
143
```
35 year old household wife presents with an infected insect bite. In the past she has been treated with Penicillin and responded with facial swelling and acute shortness of breath.
A. Linezolid
B. Erthyromycin
C. Ciprofloxacin
D. Ceftriaxone
E. Metronidazole
F. Benzyl Penicillin
G. Flucloxacillin
H. Vancomycin
I. Gentamicin
```
B. Erthyromycin
144
```
Patient with an abdominal collection that contains gram –ve anaerobes.
A. Linezolid
B. Erthyromycin
C. Ciprofloxacin
D. Ceftriaxone
E. Metronidazole
F. Benzyl Penicillin
G. Flucloxacillin
H. Vancomycin
I. Gentamicin
```
E. Metronidazole
145
```
56 year old male with endocarditis caused by VRE.
A. Linezolid
B. Erthyromycin
C. Ciprofloxacin
D. Ceftriaxone
E. Metronidazole
F. Benzyl Penicillin
G. Flucloxacillin
H. Vancomycin
I. Gentamicin
```
A. Linezolid
146
```
Community-acquired UTI
A. Trimethoprim
B. Penicillin V
C. Erythromycin
D. Gentamicin
E. Flucloxacillin
F. Metronidazole
G. Cefuroxime
H. Linezolid
I. Ciprofloxacin
J. Vancomycin
K. Rifampacin
```
A. Trimethoprim
147
```
C.difficile colitis where metronidazole has failed
A. Trimethoprim
B. Penicillin V
C. Erythromycin
D. Gentamicin
E. Flucloxacillin
F. Metronidazole
G. Cefuroxime
H. Linezolid
I. Ciprofloxacin
J. Vancomycin
K. Rifampacin
```
J. Vancomycin
148
```
Severe systemic infection before cause has been identified
A. Trimethoprim
B. Penicillin V
C. Erythromycin
D. Gentamicin
E. Flucloxacillin
F. Metronidazole
G. Cefuroxime
H. Linezolid
I. Ciprofloxacin
J. Vancomycin
K. Rifampacin
```
G. Cefuroxime
149
```
Atypical pneumonia caused by Legionella in individuals with penicillin allergy
A. Trimethoprim
B. Penicillin V
C. Erythromycin
D. Gentamicin
E. Flucloxacillin
F. Metronidazole
G. Cefuroxime
H. Linezolid
I. Ciprofloxacin
J. Vancomycin
K. Rifampacin
```
C. Erythromycin
150
```
Long-term prophylactic treatment for post-splenectomy patients
A. Trimethoprim
B. Penicillin V
C. Erythromycin
D. Gentamicin
E. Flucloxacillin
F. Metronidazole
G. Cefuroxime
H. Linezolid
I. Ciprofloxacin
J. Vancomycin
K. Rifampacin
```
B. Penicillin V
151
```
A 75 yr old lady develops severe wound infection following hip replacement. MRSA is isolated from the wound.
A. Erythromycin
B. Ceftriaxone
C. rifampicin
D. cefuroxime & clarithromycin
E. Chloramphenicol
F. Cefalexin
G. linezolid
H. vancomycin
I. trimethoprim
J. no antibiotics required
K. Flucloxacillin
L. Amoxicillin
M. isoniazid
```
H. vancomycin
152
```
An 18 yr old female presents with fever, headache, neck stiffness, and petechial rash.
A. Erythromycin
B. Ceftriaxone
C. rifampicin
D. cefuroxime & clarithromycin
E. Chloramphenicol
F. Cefalexin
G. linezolid
H. vancomycin
I. trimethoprim
J. no antibiotics required
K. Flucloxacillin
L. Amoxicillin
M. isoniazid
```
B. Ceftriaxone
153
```
An 82 yr old gentleman, living at home, develops severe dyspnoea with a productive cough and fever. His PaO2 has fallen below 8kPa, and he is becoming confused.
A. Erythromycin
B. Ceftriaxone
C. rifampicin
D. cefuroxime & clarithromycin
E. Chloramphenicol
F. Cefalexin
G. linezolid
H. vancomycin
I. trimethoprim
J. no antibiotics required
K. Flucloxacillin
L. Amoxicillin
M. isoniazid
```
D. cefuroxime & clarithromycin
154
```
A 6 month old child whose father has just been diagnosed with tuberculosis.
A. Erythromycin
B. Ceftriaxone
C. rifampicin
D. cefuroxime & clarithromycin
E. Chloramphenicol
F. Cefalexin
G. linezolid
H. vancomycin
I. trimethoprim
J. no antibiotics required
K. Flucloxacillin
L. Amoxicillin
M. isoniazid
```
M. isoniazid
155
```
A 12 yr old boy requests treatment for widespread impetigo. He developed an urticarial rash 3 yrs ago when he was given penicillin V.
A. Erythromycin
B. Ceftriaxone
C. rifampicin
D. cefuroxime & clarithromycin
E. Chloramphenicol
F. Cefalexin
G. linezolid
H. vancomycin
I. trimethoprim
J. no antibiotics required
K. Flucloxacillin
L. Amoxicillin
M. isoniazid
```
A. Erythromycin
156
```
This microbe is spread by faecal-oral route, and often occurs in epidemics. Shellfish from seawater contained by sewage can harbour this microbe.
A. Shigella
B. Escherichia Coli
C. Entamoeba histolytica
D. Aeromonas
E. Vibrio cholera
F. Clostridium difficile
G. Yersinia
H. Hepatitis A
I. Salmonella
```
H. Hepatitis A
157
```
Gram-negative curved rod, whose toxin affects adenyl cyclase. Its major cause of death is shock, metabolic acidosis and renal failure
A. Shigella
B. Escherichia Coli
C. Entamoeba histolytica
D. Aeromonas
E. Vibrio cholera
F. Clostridium difficile
G. Yersinia
H. Hepatitis A
I. Salmonella
```
E. Vibrio cholera
158
```
This microbes affects mainly the distal colon, producing acute mucosal inflammation and erosion. It is spread by person-to-person contact, and its clinical features include fever, pain, diarrhoea and dysentery.
A. Shigella
B. Escherichia Coli
C. Entamoeba histolytica
D. Aeromonas
E. Vibrio cholera
F. Clostridium difficile
G. Yersinia
H. Hepatitis A
I. Salmonella
```
A. Shigella
159
```
Infection with this microbe produces pseudomembranous colitis.
A. Shigella
B. Escherichia Coli
C. Entamoeba histolytica
D. Aeromonas
E. Vibrio cholera
F. Clostridium difficile
G. Yersinia
H. Hepatitis A
I. Salmonella
```
F. Clostridium difficile
160
```
This microbe affects the ileum, appendix and colon. Its peyer patch invasion leads to mesenteric lymph node enlargement with necrotising granulomas. Complication can include peritonitis, pharyngitis and pericarditis.
A. Shigella
B. Escherichia Coli
C. Entamoeba histolytica
D. Aeromonas
E. Vibrio cholera
F. Clostridium difficile
G. Yersinia
H. Hepatitis A
I. Salmonella
```
G. Yersinia
161
```
A 40 year old female, who is a ex-smoker, who has recently returned from a holiday in India, comes to A+E complaining of severe abdominal cramps and bloody diarrhoea. She mentions that her mother suffered from similar symptoms in the past.
A. Clostridium difficile
B. Giardiasis
C. Bacillus cereus
D. Bacterial Dysentry
E. Verotoxin-producing E.coli
F. Salmonella
G. Cholera
H. Rotavirus
I. Tuberculosis of the gut
J. Stress
K. Ulcerative colitis
```
K. Ulcerative colitis
162
```
A 25 year old male student woke up in the middle of the night with sudden vomiting. He has been vomiting for the past few hours. The night before, him and his flatmate had had a Chinese takeaway. He ate rice whilst his friend had noodles.
A. Clostridium difficile
B. Giardiasis
C. Bacillus cereus
D. Bacterial Dysentry
E. Verotoxin-producing E.coli
F. Salmonella
G. Cholera
H. Rotavirus
I. Tuberculosis of the gut
J. Stress
K. Ulcerative colitis
```
C. Bacillus cereus
163
```
A 30 year old male is brought into hospital. He is very dehydrated and is feeling very weak. He has had unrelenting diarrhoea, which came on suddenly. He describes the stools as looking like rice water. He has no abdominal pain.
A. Clostridium difficile
B. Giardiasis
C. Bacillus cereus
D. Bacterial Dysentry
E. Verotoxin-producing E.coli
F. Salmonella
G. Cholera
H. Rotavirus
I. Tuberculosis of the gut
J. Stress
K. Ulcerative colitis
```
G. Cholera
164
```
A 70 year old male who has been in hospital for 3 weeks develops profuse, watery diarrhoea and he has a fever. There is sometimes blood in the stool. On a sigmoidoscopy, the bowel appeared inflamed. He has been taking amoxycillin
A. Clostridium difficile
B. Giardiasis
C. Bacillus cereus
D. Bacterial Dysentry
E. Verotoxin-producing E.coli
F. Salmonella
G. Cholera
H. Rotavirus
I. Tuberculosis of the gut
J. Stress
K. Ulcerative colitis
```
A. Clostridium difficile
165
```
A 34 year old female returned from Indonesia two weeks ago. She complains of diarrhoea, abdominal pain, weight loss, nausea and vomiting for the past few days. She has no fever. Investigation reveals steatorrhoea and stools appear to contain numerous cysts.
A. Clostridium difficile
B. Giardiasis
C. Bacillus cereus
D. Bacterial Dysentry
E. Verotoxin-producing E.coli
F. Salmonella
G. Cholera
H. Rotavirus
I. Tuberculosis of the gut
J. Stress
K. Ulcerative colitis
```
B. Giardiasis
166
```
80 year old man develops severe, foul smelling watery diarrhoea following treatment in hospital for a chest infection.
A. Camplyobacter Jejuni
B. Taenia Solium
C. Shigella
D. Salmonella
E. Clostridium Difficile
F. Entamoeba Histolytica
G. Giardia Lamblia
H. Vibrio Cholera
I. E. coli
J. Yersinia Enterocolitica
K. Typhoid
L. Taenia Saginata
M. Laxative abuse
```
E. Clostridium Difficile
167
```
Following a trip to Brazil, a patient develops bloody diarrhoea, with a high fever, sweating and on examination the patient is found to have RUQ pain.
A. Camplyobacter Jejuni
B. Taenia Solium
C. Shigella
D. Salmonella
E. Clostridium Difficile
F. Entamoeba Histolytica
G. Giardia Lamblia
H. Vibrio Cholera
I. E. coli
J. Yersinia Enterocolitica
K. Typhoid
L. Taenia Saginata
M. Laxative abuse
```
F. Entamoeba Histolytica
168
```
Following a barbeque, a 41 year old develops watery diarrhoea and vomiting. On retrospect, he wondered whether he should have had that dodgy looking shish kebab...
A. Camplyobacter Jejuni
B. Taenia Solium
C. Shigella
D. Salmonella
E. Clostridium Difficile
F. Entamoeba Histolytica
G. Giardia Lamblia
H. Vibrio Cholera
I. E. coli
J. Yersinia Enterocolitica
K. Typhoid
L. Taenia Saginata
M. Laxative abuse
```
D. Salmonella
169
```
Whilst on a backpacking trip to India, a 30 year old develops severe watery diarrhoea, whilst clearly in discomfort, he notices it has the look of rice water
A. Camplyobacter Jejuni
B. Taenia Solium
C. Shigella
D. Salmonella
E. Clostridium Difficile
F. Entamoeba Histolytica
G. Giardia Lamblia
H. Vibrio Cholera
I. E. coli
J. Yersinia Enterocolitica
K. Typhoid
L. Taenia Saginata
M. Laxative abuse
```
H. Vibrio Cholera
170
```
A 40 year old homosexual man develops severe flatulence, accompanied by bloating and explosive diarrhoea.
A. Camplyobacter Jejuni
B. Taenia Solium
C. Shigella
D. Salmonella
E. Clostridium Difficile
F. Entamoeba Histolytica
G. Giardia Lamblia
H. Vibrio Cholera
I. E. coli
J. Yersinia Enterocolitica
K. Typhoid
L. Taenia Saginata
M. Laxative abuse
```
G. Giardia Lamblia
171
```
Mrs A became ill at about midnight after eating chicken wings for lunch at a summer BBQ. Mrs A complained of nausea, vomiting and non-bloody diarrhoea. Her symptoms resolved 3 days later.
A. Salmonella
B. Rotavirus
C. Bacillus cereus
D. Escherichia coli
E. Clostridium botulinum
F. Campylobacter
G. Entamoeba histolytica
H. Staphylococcus
I. Shigella
```
A. Salmonella
172
```
Mr J and his wife became unwell with vomiting, abdominal cramps and nausea in the early hours of the morning. They had ordered a Chinese take away for dinner that night and the only dish that they had both eaten was the egg fried rice.
A. Salmonella
B. Rotavirus
C. Bacillus cereus
D. Escherichia coli
E. Clostridium botulinum
F. Campylobacter
G. Entamoeba histolytica
H. Staphylococcus
I. Shigella
```
C. Bacillus cereus
173
```
Mr S became ill with nausea, vomiting and watery diarrhoea about 4 hours after eating some ham at a conference buffet lunch. Mr B’s illness was attributed to a heat stable, preformed toxin in the ham. His symptoms resolved within 24hours.
A. Salmonella
B. Rotavirus
C. Bacillus cereus
D. Escherichia coli
E. Clostridium botulinum
F. Campylobacter
G. Entamoeba histolytica
H. Staphylococcus
I. Shigella
```
H. Staphylococcus
174
```
Mr C complained of fever and severe (>10 bowel movements/day) diarrhoea after looking after his neighbours dogs for a few days. Laboratory analysis of Mr C’s stools found the causative organism to be a S-shaped microaerophillic bacteria.
A. Salmonella
B. Rotavirus
C. Bacillus cereus
D. Escherichia coli
E. Clostridium botulinum
F. Campylobacter
G. Entamoeba histolytica
H. Staphylococcus
I. Shigella
```
F. Campylobacter
175
```
Miss D initially complained of a dry mouth and visual disturbance a few days after ingesting some home canned produce. She sought medical attention after she began to experience bilateral descending paralysis. Miss A later died from respiratory failure.
A. Salmonella
B. Rotavirus
C. Bacillus cereus
D. Escherichia coli
E. Clostridium botulinum
F. Campylobacter
G. Entamoeba histolytica
H. Staphylococcus
I. Shigella
```
E. Clostridium botulinum
176
```
An organism commonly linked to antibiotic-associated diarrhoea
A. Cholera
B. Salmonella
C. Bacillus cereus
D. Clostridium botulinum
E. Staphylococcus aureus
F. Shigella
G. Giardia lamblia
H. E. coli
I. C. difficile
```
I. C. difficile
177
```
Different geographical populations of this organism often give rise to traveller’s diarrhoea
A. Cholera
B. Salmonella
C. Bacillus cereus
D. Clostridium botulinum
E. Staphylococcus aureus
F. Shigella
G. Giardia lamblia
H. E. coli
I. C. difficile
```
H. E. coli
178
```
A toxin-mediated organism that does not damage or invade the gastrointestinal epithelium
A. Cholera
B. Salmonella
C. Bacillus cereus
D. Clostridium botulinum
E. Staphylococcus aureus
F. Shigella
G. Giardia lamblia
H. E. coli
I. C. difficile
```
A. Cholera
179
```
An organism linked with food poisoning from Chinese fried rice
A. Cholera
B. Salmonella
C. Bacillus cereus
D. Clostridium botulinum
E. Staphylococcus aureus
F. Shigella
G. Giardia lamblia
H. E. coli
I. C. difficile
```
C. Bacillus cereus
180
```
An organism that gives rise to ‘rice water stools’ upon infection
A. Cholera
B. Salmonella
C. Bacillus cereus
D. Clostridium botulinum
E. Staphylococcus aureus
F. Shigella
G. Giardia lamblia
H. E. coli
I. C. difficile
```
A. Cholera
181
```
Bubonic plague:
A. Spirillum minus
B. Borrelia burgdorferi
C. Bartonella henselae
D. Cryptosporidium parvum
E. Brucella abortus
F. Francisella tularensis
G. Trypanosoma cruzi
H. Yersinia pestis
I. Campylobacter jejuni
J. Rickettsia prowazekii
```
H. Yersinia pestis
182
```
A student who presented with two day history of bloody diarrhoea, vomiting, fever, headache and myalgia. He has just returned from camping in the country side near a farm where he had fresh cow’s milk for breakfast everyday.
A. Spirillum minus
B. Borrelia burgdorferi
C. Bartonella henselae
D. Cryptosporidium parvum
E. Brucella abortus
F. Francisella tularensis
G. Trypanosoma cruzi
H. Yersinia pestis
I. Campylobacter jejuni
J. Rickettsia prowazekii
```
I. Campylobacter jejuni
183
```
A 2 year old boy living in the slums who has a one day history of profuse watery diarrhoea, fever and abdominal cramps. His family’s main source of water is the river near their squatters.
A. Spirillum minus
B. Borrelia burgdorferi
C. Bartonella henselae
D. Cryptosporidium parvum
E. Brucella abortus
F. Francisella tularensis
G. Trypanosoma cruzi
H. Yersinia pestis
I. Campylobacter jejuni
J. Rickettsia prowazekii
```
D. Cryptosporidium parvum
184
```
A man was bitten by a rat in Asia. Ten days later he complains of fever, malaise, headache and myalgia.
A. Spirillum minus
B. Borrelia burgdorferi
C. Bartonella henselae
D. Cryptosporidium parvum
E. Brucella abortus
F. Francisella tularensis
G. Trypanosoma cruzi
H. Yersinia pestis
I. Campylobacter jejuni
J. Rickettsia prowazekii
```
A. Spirillum minus
185
```
Cat-scratch disease:
A. Spirillum minus
B. Borrelia burgdorferi
C. Bartonella henselae
D. Cryptosporidium parvum
E. Brucella abortus
F. Francisella tularensis
G. Trypanosoma cruzi
H. Yersinia pestis
I. Campylobacter jejuni
J. Rickettsia prowazekii
```
C. Bartonella henselae
186
```
A 6 month old baby is brought to A&E with sudden onset fever, vomiting and diminished conciousness. A widespread haemorrhagic rash is also observed which does not blanch upon application of pressure.
A. Listeriosis
B. Lyme disease
C. Meningococcal Septicaemia
D. Leptospirosis
E. Brucellosis
F. Tularaemia
G. Rheumatic fever
```
C. Meningococcal Septicaemia
187
```
A 10 year old boy of Middle-Eastern origin presents with general malaise and loss of appetite. He also complains of fever and joint pain. A throat swab is taken, revealing the presence of Group A Streptococci.
A. Listeriosis
B. Lyme disease
C. Meningococcal Septicaemia
D. Leptospirosis
E. Brucellosis
F. Tularaemia
G. Rheumatic fever
```
G. Rheumatic fever
188
```
A zoonosis associated with hepatitis, jaundice, conjunctival injection and renal impairment. Transmission normally occurs by direct contact with either the urine or tissues of an infected animal.
A. Listeriosis
B. Lyme disease
C. Meningococcal Septicaemia
D. Leptospirosis
E. Brucellosis
F. Tularaemia
G. Rheumatic fever
```
D. Leptospirosis
189
```
A 22 year old student, who returned from a holiday in the Mediterranean 3 weeks ago, presents with an undulant fever, malaise, weakness and generalized bone pain. Upon examination lymphadenopathy and hepatosplenomegaly are also noted.
A. Listeriosis
B. Lyme disease
C. Meningococcal Septicaemia
D. Leptospirosis
E. Brucellosis
F. Tularaemia
G. Rheumatic fever
```
E. Brucellosis
190
```
A 45 year old male farmer presents with a raised, erythematous rash, with clearing in the centre. He also complains of headache, fever, athralgia and malaise.
A. Listeriosis
B. Lyme disease
C. Meningococcal Septicaemia
D. Leptospirosis
E. Brucellosis
F. Tularaemia
G. Rheumatic fever
```
B. Lyme disease
191
```
A 30 year man presented with jaundice and conjunctival haemorrhages. He had recently been canoeing in the US and had felt ‘run-down’ upon his return to the UK.
A. Leishmania major.
B. Leptospira interrogans
C. Bacillus anthracis
D. Yersina pestis
E. Brucella melitensis
F. Brucella abortus
G. Rabies
H. Borrelia burgdorferi
I. Rickettsia typhi
```
B. Leptospira interrogans
192
```
A 25 year old Maltese man presented to his GP with lethargy for a month and headaches and fever. On examination, he had a temperature of 39°C and one fingerbreadth splenomegaly. Small Gram-negative coccobacilli were seen on culture in Casteneda’s medium.
A. Leishmania major.
B. Leptospira interrogans
C. Bacillus anthracis
D. Yersina pestis
E. Brucella melitensis
F. Brucella abortus
G. Rabies
H. Borrelia burgdorferi
I. Rickettsia typhi
```
E. Brucella melitensis
193
```
A 22 year old student presented to her GP upon return from a biology field trip, with a lesion on her leg which was 3” in diameter and flat, with a red edge and dim centre. She also mentioned feeling tired and suffering from headaches. On examination, the GP noted a fever of 38.0°C and an irregular heartbeat.
A. Leishmania major.
B. Leptospira interrogans
C. Bacillus anthracis
D. Yersina pestis
E. Brucella melitensis
F. Brucella abortus
G. Rabies
H. Borrelia burgdorferi
I. Rickettsia typhi
```
H. Borrelia burgdorferi
194
```
A tanner on holiday from India presented to hospital with an ulcerating papule on his hand. On inspection of the ulcer, the centre was black and necrotic. Gram-positive rods grew on blood agar culture and responded to treatment with large doses of penicillin.
A. Leishmania major.
B. Leptospira interrogans
C. Bacillus anthracis
D. Yersina pestis
E. Brucella melitensis
F. Brucella abortus
G. Rabies
H. Borrelia burgdorferi
I. Rickettsia typhi
```
C. Bacillus anthracis
195
```
A 49 year old man was admitted in A&E with a 3 day history of worsening right arm pain and a 1 day history of dysphagia, hypersalivation, agitation and generalised muscle twitching. Vital signs and blood tests were normal but he became confused. He developed renal failure and died 4 days later.
A. Leishmania major.
B. Leptospira interrogans
C. Bacillus anthracis
D. Yersina pestis
E. Brucella melitensis
F. Brucella abortus
G. Rabies
H. Borrelia burgdorferi
I. Rickettsia typhi
```
G. Rabies
196
```
A 6 month old baby presents at his GP with nappy rash. Which is the most likely causative fungus?
A. Corynebacterium minutissimum
B. Histoplasmosis capsulatum
C. Cryptococcus neoforms
D. Pityrosporum orbiculare
E. Candida albicans
F. Epidermophyton floccosum
G. Pneumocystis carinii
H. Trichophytum rubrum
I. Aspergillus flavus
```
E. Candida albicans
197
```
A 21 year old man presents at his GP complaining of an itchy, scaly rash on the soles of his feet. Skin scrapings are taken and sent away for microscopic examination. Which fungi might be identified?
A. Corynebacterium minutissimum
B. Histoplasmosis capsulatum
C. Cryptococcus neoforms
D. Pityrosporum orbiculare
E. Candida albicans
F. Epidermophyton floccosum
G. Pneumocystis carinii
H. Trichophytum rubrum
I. Aspergillus flavus
```
H. Trichophytum rubrum
198
```
A 55 year old farmer is seen in the Oncology clinic with a diagnosis of hepatocellular carcinoma. He is a lifelong teetotal and his virology has all been negative. Which fungus may have indirectly been a cause of his cancer?
A. Corynebacterium minutissimum
B. Histoplasmosis capsulatum
C. Cryptococcus neoforms
D. Pityrosporum orbiculare
E. Candida albicans
F. Epidermophyton floccosum
G. Pneumocystis carinii
H. Trichophytum rubrum
I. Aspergillus flavus
```
I. Aspergillus flavus
199
```
A 27 year old lady from Botswana presents at A+E complaining of a dry cough and feeling feverish. A chest x-ray is normal, but fine crackles were heard on auscultation. Serology shows a CD4+ count of 50 and she is admitted. Later a high resolution CT of the chest shows a ground glass appearance of the lungs. What AIDS defining infection does this lady have?
A. Corynebacterium minutissimum
B. Histoplasmosis capsulatum
C. Cryptococcus neoforms
D. Pityrosporum orbiculare
E. Candida albicans
F. Epidermophyton floccosum
G. Pneumocystis carinii
H. Trichophytum rubrum
I. Aspergillus flavus
```
G. Pneumocystis carinii
200
```
A 17 year old Nigerian girl presents at her GP with patches of hypopigmentation on her trunk. After an initial trial of steroid cream, the girl returns complaining that the rash is spreading. Woods lamp examination of the rash produces a yellow fluorescence. What is the causative fungus?
A. Corynebacterium minutissimum
B. Histoplasmosis capsulatum
C. Cryptococcus neoforms
D. Pityrosporum orbiculare
E. Candida albicans
F. Epidermophyton floccosum
G. Pneumocystis carinii
H. Trichophytum rubrum
I. Aspergillus flavus
```
D. Pityrosporum orbiculare
201
```
A 23 year old female on a camping holiday used the local rowing club showers nearby. A few days later she noticed an itchy sensation between some her toes. What is the most likely diagnosis?
A. Zygomycosis
B. Tinea pedis
C. Aspergillosis
D. Cryptococcis
E. Chromomycosis
F. Coccidiodomyosis
G. Candidiasis
H. Sporotrichosis
I. Blastomyosis
J. Pediculosis capitis
K. Tinea corporis
L. Tinea cruris
M. Mycetoma (Madura foot)
```
B. Tinea pedis
202
```
A homosexual male presented with painful dyspagia and was noted to have whitish velvety plaques on the mucous membranes of the mouth and tongue. When his GP scraped away the whitish material pinpoint bleeding occurred. What is the most likely diagnosis?
A. Zygomycosis
B. Tinea pedis
C. Aspergillosis
D. Cryptococcis
E. Chromomycosis
F. Coccidiodomyosis
G. Candidiasis
H. Sporotrichosis
I. Blastomyosis
J. Pediculosis capitis
K. Tinea corporis
L. Tinea cruris
M. Mycetoma (Madura foot)
```
G. Candidiasis
203
```
A fertile woman presents to her GP with an itchy vaginal discharge. What is the most likely diagnosis?
A. Zygomycosis
B. Tinea pedis
C. Aspergillosis
D. Cryptococcis
E. Chromomycosis
F. Coccidiodomyosis
G. Candidiasis
H. Sporotrichosis
I. Blastomyosis
J. Pediculosis capitis
K. Tinea corporis
L. Tinea cruris
M. Mycetoma (Madura foot)
```
G. Candidiasis
204
```
A 47 year old man is admitted following lung transplantation three months ago with cough and breathlessness. He has a cavitating lesion on chest X-ray. At the time of his transplant, building work was being done on the hospital campus in close proximity to the surgical ward.
A. Zygomycosis
B. Tinea pedis
C. Aspergillosis
D. Cryptococcis
E. Chromomycosis
F. Coccidiodomyosis
G. Candidiasis
H. Sporotrichosis
I. Blastomyosis
J. Pediculosis capitis
K. Tinea corporis
L. Tinea cruris
M. Mycetoma (Madura foot)
```
C. Aspergillosis
205
```
A 45 year old female whose main hobby was pigeon racing was noted by her GP to an enlarged lymph node in her neck. What is the most likely diagnosis?
A. Zygomycosis
B. Tinea pedis
C. Aspergillosis
D. Cryptococcis
E. Chromomycosis
F. Coccidiodomyosis
G. Candidiasis
H. Sporotrichosis
I. Blastomyosis
J. Pediculosis capitis
K. Tinea corporis
L. Tinea cruris
M. Mycetoma (Madura foot)
```
D. Cryptococcis
206
```
An 8 year-old boy presents to casualty with a painful and swollen right thigh after being kicked in a football match. On examination a boil is found on the upper part of his right thigh and blood cultures are positive.
A. Candidiasis
B. Lyme disease
C. Tuberculous arthritis
D. Rubella
E. Infectious mononucleosis
F. Gonococcal arthritis
G. Staphylococcal arthritis
H. Staphylococcal osteomyelitis
I. Tuberculous osteomyelitis
J. Brodie's abscess
K. Viral hepatitis
```
H. Staphylococcal osteomyelitis
207
```
A 24 year-old woman presents to A&E a month after a trip to the New Forest with malaise, a migratory erythematous rash, and arthralgia. She also complains of being more forgetful in recent times.
A.Candidiasis
B. Lyme disease
C. Tuberculous arthritis
D. Rubella
E. Infectious mononucleosis
F. Gonococcal arthritis
G. Staphylococcal arthritis
H. Staphylococcal osteomyelitis
I. Tuberculous osteomyelitis
J. Brodie's abscess
K. Viral hepatitis
```
B. Lyme disease
208
```
A 19 year-old student presents to her GP with a macular rash and suboccipital lymphadenopathy. She also complains of pain on moving her hands and wrists.
A.Candidiasis
B. Lyme disease
C. Tuberculous arthritis
D. Rubella
E. Infectious mononucleosis
F. Gonococcal arthritis
G. Staphylococcal arthritis
H. Staphylococcal osteomyelitis
I. Tuberculous osteomyelitis
J. Brodie's abscess
K. Viral hepatitis
```
D. Rubella
209
```
A diabetic 78 year-old man with chronic arthritis presents to A&E with an acutely painful and swollen knee 2 days after he had been given an intra-articular steroid injection.
A.Candidiasis
B. Lyme disease
C. Tuberculous arthritis
D. Rubella
E. Infectious mononucleosis
F. Gonococcal arthritis
G. Staphylococcal arthritis
H. Staphylococcal osteomyelitis
I. Tuberculous osteomyelitis
J. Brodie's abscess
K. Viral hepatitis
```
G. Staphylococcal arthritis
210
```
A 30 year-old man presents to casualty with a painful, swollen and erythematous left forearm one week after sustaining a compound fracture in a motorcycle accident.
A.Candidiasis
B. Lyme disease
C. Tuberculous arthritis
D. Rubella
E. Infectious mononucleosis
F. Gonococcal arthritis
G. Staphylococcal arthritis
H. Staphylococcal osteomyelitis
I. Tuberculous osteomyelitis
J. Brodie's abscess
K. Viral hepatitis
```
H. Staphylococcal osteomyelitis
211
```
A 35 year old lady with a history of TB presents with collapsed cervical vertebrae, a marked kyphosis causing difficulty in moving.
A. Salmonella osteomyelitis
B. Lateral epicondylitis
C. Pott's disease
D. Osteoporosis
E. Leukaemia
F. Painful crisis
G. Paget's disease
H. Brodie's abscess
I. Tuberculous osteomyelitis
J. Septic arthritis
K. Clutton's joints
L. Staphylococcus osteomyelitis
```
C. Pott's disease
212
```
Mr PD, a 26 year old musician, arrives in A&E with a warm, painful abscess on his inner upper forearm surrounded by puncture marks, he has a low grade fever. He reports no problem in playing his guitar, but does forget lyrics on stage
A. Salmonella osteomyelitis
B. Lateral epicondylitis
C. Pott's disease
D. Osteoporosis
E. Leukaemia
F. Painful crisis
G. Paget's disease
H. Brodie's abscess
I. Tuberculous osteomyelitis
J. Septic arthritis
K. Clutton's joints
L. Staphylococcus osteomyelitis
```
L. Staphylococcus osteomyelitis
213
```
Accompanying Mr PD, is a 17 year old female with a larger, redder, painful abscess on her inner upper forearm. She has almost no movement in her elbow.
A. Salmonella osteomyelitis
B. Lateral epicondylitis
C. Pott's disease
D. Osteoporosis
E. Leukaemia
F. Painful crisis
G. Paget's disease
H. Brodie's abscess
I. Tuberculous osteomyelitis
J. Septic arthritis
K. Clutton's joints
L. Staphylococcus osteomyelitis
```
J. Septic arthritis
214
```
Your Consultant spotlights you to expand on the diagnosis of osteomyelitis in a gentleman with a history of sickle cell crises, presenting with bone pain and excessive sweating. On X-ray he informs you there is “cortical destruction, involucrum and sequestra”.
A. Salmonella osteomyelitis
B. Lateral epicondylitis
C. Pott's disease
D. Osteoporosis
E. Leukaemia
F. Painful crisis
G. Paget's disease
H. Brodie's abscess
I. Tuberculous osteomyelitis
J. Septic arthritis
K. Clutton's joints
L. Staphylococcus osteomyelitis
```
A. Salmonella osteomyelitis
Salmonella is a very rare cause of osteomyelitis, except in sickle cell disease
215
```
A 10 year old boy presents with moderate pain in his lower leg, little redness and swelling, remitting for 6 months. His mother gives you the X-ray report from the previous episode, which showed “a well defined ovoid shape with a surrounding sclerotic margin but little involucrum in his tibia”.
A. Salmonella osteomyelitis
B. Lateral epicondylitis
C. Pott's disease
D. Osteoporosis
E. Leukaemia
F. Painful crisis
G. Paget's disease
H. Brodie's abscess
I. Tuberculous osteomyelitis
J. Septic arthritis
K. Clutton's joints
L. Staphylococcus osteomyelitis
```
H. Brodie's abscess
A subacute osteomyelitis which may persist for years before becoming frank osteomyelitis
Involucrum = layer of new bone growth outside existing bone
216
```
A 19 year old student presents with a short history of severe headache and photophobia. O/E he has a non-blanching rash over his abdomen. CSF is performed and shows gram- negative cocci
A. Clostridium difficile
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Neisseria meningitides
E. Campylobacter jejuni
F. Staphylococcus aureus
G. Escherichia coli
H. Salmonella typhi
```
D. Neisseria meningitides
217
```
A 30 year old builder develops abdominal pain and diarrhoea 48 hours after having Texa Fried Chicken. Faecal culture shows motile, oxidase-positive colonies and gram stain shows gram-negative rods.
A. Clostridium difficile
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Neisseria meningitides
E. Campylobacter jejuni
F. Staphylococcus aureus
G. Escherichia coli
H. Salmonella typhi
```
E. Campylobacter jejuni
218
```
A homeless man presents to St Mary’s A&E with history of cough and shortness of breath. Chest X-Ray was performed and showed consolidation. Sputum cultures were taken and showed gram positive diplocci and neutrophilia.
A. Clostridium difficile
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Neisseria meningitides
E. Campylobacter jejuni
F. Staphylococcus aureus
G. Escherichia coli
H. Salmonella typhi
```
B. Streptococcus pneumoniae
219
```
A teenager develops a post-operative wound infection after a road traffic accident. Cultures show coagulase-positive golden yellow colonies and gram positive cocci
A. Clostridium difficile
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Neisseria meningitides
E. Campylobacter jejuni
F. Staphylococcus aureus
G. Escherichia coli
H. Salmonella typhi
```
F. Staphylococcus aureus
220
```
A 27 year old teacher presents with symptoms of dysuria of 3 days duration. MSU gram stain shows neutrophils, erythrocytes and gram negative bacilli
A. Clostridium difficile
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Neisseria meningitides
E. Campylobacter jejuni
F. Staphylococcus aureus
G. Escherichia coli
H. Salmonella typhi
```
G. Escherichia coli
221
```
A 37 year old woman is complaining of pain a tenderness surrounding a recently sutured wound on her forehead. On examination you notice erythema and minimal serous discharge. Which pathogen is the most likely cause of this infection?
A. Oral administration with penicillin G
B. Oral administration of flucloxacillin
C. Heart valve replacement
D. Removal of a breast carcinoma
E. Airborne contamination
F. Oral administration of ampicillin
G. Escherichia coli
H. Streptococcus pneumoniae
I. Haemophilus influenzae
J. Implantation of a prosthetic hip
K. Drainage and evacuation of pus
L. I. V. injection of tetanus antitoxin
M. Staphylococcal aureus
```
M. Staphylococcal aureus
222
```
A 55 year old man comes into A&E complaining of a increasing difficulty in opening is mouth and that the muscles on his face occasionally spasm. On examination you observe that his eyes are partially closed and that the angles of his mouth are stretched outwards and slightly downwards. You also note that he has a very rigid abdomen. Which treatment option should be carried out first for this patient?
A. Oral administration with penicillin G
B. Oral administration of flucloxacillin
C. Heart valve replacement
D. Removal of a breast carcinoma
E. Airborne contamination
F. Oral administration of ampicillin
G. Escherichia coli
H. Streptococcus pneumoniae
I. Haemophilus influenzae
J. Implantation of a prosthetic hip
K. Drainage and evacuation of pus
L. I. V. injection of tetanus antitoxin
M. Staphylococcal aureus
```
L. I. V. injection of tetanus antitoxin
223
```
Which of the above is an example where prophylactic systemic antibiotic therapy should not be used.
A. Oral administration with penicillin G
B. Oral administration of flucloxacillin
C. Heart valve replacement
D. Removal of a breast carcinoma
E. Airborne contamination
F. Oral administration of ampicillin
G. Escherichia coli
H. Streptococcus pneumoniae
I. Haemophilus influenzae
J. Implantation of a prosthetic hip
K. Drainage and evacuation of pus
L. I. V. injection of tetanus antitoxin
M. Staphylococcal aureus
```
D. Removal of a breast carcinoma
224
```
Postoperative inspection of a wound in the left axilla reveals the presence of an abscess. What is the appropriate treatment to resolve the abcess
A. Oral administration with penicillin G
B. Oral administration of flucloxacillin
C. Heart valve replacement
D. Removal of a breast carcinoma
E. Airborne contamination
F. Oral administration of ampicillin
G. Escherichia coli
H. Streptococcus pneumoniae
I. Haemophilus influenzae
J. Implantation of a prosthetic hip
K. Drainage and evacuation of pus
L. I. V. injection of tetanus antitoxin
M. Staphylococcal aureus
```
K. Drainage and evacuation of pus
225
```
A man is recovering from surgery and inspection of the wound reveals that it has become infected. A swab is taken and the laboratory results show Staphylococcal aureus infection. What is appropriate treatment for this man?
A. Oral administration with penicillin G
B. Oral administration of flucloxacillin
C. Heart valve replacement
D. Removal of a breast carcinoma
E. Airborne contamination
F. Oral administration of ampicillin
G. Escherichia coli
H. Streptococcus pneumoniae
I. Haemophilus influenzae
J. Implantation of a prosthetic hip
K. Drainage and evacuation of pus
L. I. V. injection of tetanus antitoxin
M. Staphylococcal aureus
```
B. Oral administration of flucloxacillin
226
```
A 35 year old HIV positive male presents with fever lasting a few weeks, night sweats and appetite loss.
A. Drug induced fever
B. SLE
C. Sarcoidosis
D. Plasmodium malariae
E. Mycobacterium avium complex
F. Hodgkin’s lymphoma
G. Mycobacterium tuberculosis
H. Hepatitis B
I. Hepatitis A
J. Epstein-Barr virus
K. Escherichia coli
L. Hepatitis C
M. Brucellosis
```
G. Mycobacterium tuberculosis
227
```
A 15 year old girl consults her GP after experiencing a high temperature and several headaches over the last three weeks. She has no medical history of note and has recently begun a weekend job helping at a local farm.
A. Drug induced fever
B. SLE
C. Sarcoidosis
D. Plasmodium malariae
E. Mycobacterium avium complex
F. Hodgkin’s lymphoma
G. Mycobacterium tuberculosis
H. Hepatitis B
I. Hepatitis A
J. Epstein-Barr virus
K. Escherichia coli
L. Hepatitis C
M. Brucellosis
```
M. Brucellosis
228
```
A 55 year old female school teacher presents at A&E with a high fever three days after her return from India. On admission, her temperature chart shows an intermittent pyrexia every 72 hours (quartan fever)
A. Drug induced fever
B. SLE
C. Sarcoidosis
D. Plasmodium malariae
E. Mycobacterium avium complex
F. Hodgkin’s lymphoma
G. Mycobacterium tuberculosis
H. Hepatitis B
I. Hepatitis A
J. Epstein-Barr virus
K. Escherichia coli
L. Hepatitis C
M. Brucellosis
```
D. Plasmodium malariae
229
```
An 80 year old man returns to his GP two weeks after being prescribed co-trimoxazole for a UTI. His urinary symptoms have now eased, but he is still experiencing a fever. His blood count shows eosinophilia.
A. Drug induced fever
B. SLE
C. Sarcoidosis
D. Plasmodium malariae
E. Mycobacterium avium complex
F. Hodgkin’s lymphoma
G. Mycobacterium tuberculosis
H. Hepatitis B
I. Hepatitis A
J. Epstein-Barr virus
K. Escherichia coli
L. Hepatitis C
M. Brucellosis
```
A. Drug induced fever
230
```
A 40 year old female intravenous drug user presents at A&E with a mild ongoing fever, nausea and vomiting. Her partner mentions that she is a bit yellow
A. Drug induced fever
B. SLE
C. Sarcoidosis
D. Plasmodium malariae
E. Mycobacterium avium complex
F. Hodgkin’s lymphoma
G. Mycobacterium tuberculosis
H. Hepatitis B
I. Hepatitis A
J. Epstein-Barr virus
K. Escherichia coli
L. Hepatitis C
M. Brucellosis
```
H. Hepatitis B
231
```
A 32 yr old intravenous drug user (IDU) presents with pyrexia, fever, jaundice and hepatomegaly. Most likely cause?
A. Infectious Mononucleosis (EBV)
B. Hepatitis C virus
C. Hepatitis B virus
D. Hepatitis E virus
E. Transfusion-transmitted virus
F. Yellow fever
G. Hepatitis A virus
H. Hepatitis Delta virus
I. Cytomegalovirus
```
C. Hepatitis B virus
232
```
18 yr old female presents with pyrexia, jaundice and a history of lymphadenopathy and sore throat. Most likely cause?
A. Infectious Mononucleosis (EBV)
B. Hepatitis C virus
C. Hepatitis B virus
D. Hepatitis E virus
E. Transfusion-transmitted virus
F. Yellow fever
G. Hepatitis A virus
H. Hepatitis Delta virus
I. Cytomegalovirus
```
A. Infectious Mononucleosis (EBV)
233
```
10 and 8 yr old brothers present with mild illness and mild hepatomegaly without jaundice after a recent trip to Bangladesh. Most likely cause?
A. Infectious Mononucleosis (EBV)
B. Hepatitis C virus
C. Hepatitis B virus
D. Hepatitis E virus
E. Transfusion-transmitted virus
F. Yellow fever
G. Hepatitis A virus
H. Hepatitis Delta virus
I. Cytomegalovirus
```
G. Hepatitis A virus
234
```
40 yr old male presents with jaundice, fever, hepatomegaly, and a positive past history of HBV. Most likely cause?
A. Infectious Mononucleosis (EBV)
B. Hepatitis C virus
C. Hepatitis B virus
D. Hepatitis E virus
E. Transfusion-transmitted virus
F. Yellow fever
G. Hepatitis A virus
H. Hepatitis Delta virus
I. Cytomegalovirus
```
H. Hepatitis Delta virus
235
```
60 yr old female presents with liver cirrhosis. PMH- non IDU, tee-total, post partum haemhorrage requiring transfusion with first child (aged 25 yr old). Most likely cause?
A. Infectious Mononucleosis (EBV)
B. Hepatitis C virus
C. Hepatitis B virus
D. Hepatitis E virus
E. Transfusion-transmitted virus
F. Yellow fever
G. Hepatitis A virus
H. Hepatitis Delta virus
I. Cytomegalovirus
```
B. Hepatitis C virus
236
```
A 33 year old lady presents with headache, malaise and fever. She has a widespread macular rash. A lumber puncture reveals a clear CSF with a high number of lymphocytes and a protein of 0.7g/L. CSF glucose is normal.
A. Glandular Fever
B. Migraine
C. Streptococcus Pneumoniae
D. Subdural haemorrhage
E. Mycobacterium Tuberculosis
F. Meningioma
G. Viral Encephalitis
H. Neiserria Meningitidis
I. Viral Meningitis
J. Cerebral Abscess
```
I. Viral Meningitis
237
```
A 20 year old male presents with a sore throat and headache. He has a maculopapular and petechial rash on his hands and feet. The CSF sample grows Gram negative diplococcus.
A. Glandular Fever
B. Migraine
C. Streptococcus Pneumoniae
D. Subdural haemorrhage
E. Mycobacterium Tuberculosis
F. Meningioma
G. Viral Encephalitis
H. Neiserria Meningitidis
I. Viral Meningitis
J. Cerebral Abscess
```
H. Neiserria Meningitidis
238
```
A 49 year old male presents with fever, vomiting and seizures. His WCC is increased. He recently had a dental infection. The MRI of his brain shows a ring-enhancing lesion.
A. Glandular Fever
B. Migraine
C. Streptococcus Pneumoniae
D. Subdural haemorrhage
E. Mycobacterium Tuberculosis
F. Meningioma
G. Viral Encephalitis
H. Neiserria Meningitidis
I. Viral Meningitis
J. Cerebral Abscess
```
J. Cerebral Abscess
239
```
A 25 year old lady is brought to A&E. She complained earlier of headaches. She has a fever and speech disturbance. She starts to lose consciousness.
A. Glandular Fever
B. Migraine
C. Streptococcus Pneumoniae
D. Subdural haemorrhage
E. Mycobacterium Tuberculosis
F. Meningioma
G. Viral Encephalitis
H. Neiserria Meningitidis
I. Viral Meningitis
J. Cerebral Abscess
```
G. Viral Encephalitis
240
```
A 40 year old man presents with haemoptysis, neck stiffness and photophobia. He has been feeling unwell for the past week. CSF was turbid with a high level of protein.
A. Glandular Fever
B. Migraine
C. Streptococcus Pneumoniae
D. Subdural haemorrhage
E. Mycobacterium Tuberculosis
F. Meningioma
G. Viral Encephalitis
H. Neiserria Meningitidis
I. Viral Meningitis
J. Cerebral Abscess
```
E. Mycobacterium Tuberculosis
241
```
A 30 year old gentleman presents with headache, fever and general malaise. He reports no neck stiffness or photophobia. A lumbar puncture revealed clear CSF with no bacteria present, a high number of lymphocytes and protein of 0.75g/L. CSF glucose was within normal range.
A. Subarachnoid haemorrhage
B. Poliovirus
C. Subdural haemorrhage
D. Neisseria meningitis
E. Streptococcus pneumoniae
F. Migraine
G. Eschericha Coli
H. Viral meningitis
I. Haemophilus influenzae
J. Meningioma
K. Mycobacterium tuberculosis
```
H. Viral meningitis
242
```
A 42 year old East African woman presents with haemoptysis and neck stiffness and photophobia and subsequent impairment of consciousness. On questioning it is revealed that she has been feeling unwell for a couple of weeks. CSF from a lumbar puncture was turbid with a high level of protein (2.3g/L).
A. Subarachnoid haemorrhage
B. Poliovirus
C. Subdural haemorrhage
D. Neisseria meningitis
E. Streptococcus pneumoniae
F. Migraine
G. Eschericha Coli
H. Viral meningitis
I. Haemophilus influenzae
J. Meningioma
K. Mycobacterium tuberculosis
```
K. Mycobacterium tuberculosis
243
```
A 3 year old girl with incomplete vaccinations presents with insidious symptoms of meningism over the course of a couple of days. Blood culture revealed presence of Gram negative coccibacilli.
A. Subarachnoid haemorrhage
B. Poliovirus
C. Subdural haemorrhage
D. Neisseria meningitis
E. Streptococcus pneumoniae
F. Migraine
G. Eschericha Coli
H. Viral meningitis
I. Haemophilus influenzae
J. Meningioma
K. Mycobacterium tuberculosis
```
I. Haemophilus influenzae
244
```
A 73 year old gentleman presents with high fever and neck stiffness of acute onset. A complete history reveals that he is recovering from a recurrent pneumonia.
A. Subarachnoid haemorrhage
B. Poliovirus
C. Subdural haemorrhage
D. Neisseria meningitis
E. Streptococcus pneumoniae
F. Migraine
G. Eschericha Coli
H. Viral meningitis
I. Haemophilus influenzae
J. Meningioma
K. Mycobacterium tuberculosis
```
E. Streptococcus pneumoniae
245
```
An 18 year old student presents to his GP with a sore throat and headache. He also admitted to being more irritable recently. A complete examination revealed a mixed petechial and maculopapular rash on his extremities. CSF sample showed infection with a Gram negative diplococcus
A. Subarachnoid haemorrhage
B. Poliovirus
C. Subdural haemorrhage
D. Neisseria meningitis
E. Streptococcus pneumoniae
F. Migraine
G. Eschericha Coli
H. Viral meningitis
I. Haemophilus influenzae
J. Meningioma
K. Mycobacterium tuberculosis
```
D. Neisseria meningitis
246
```
A 24 yr old male is brought to A&E by his distressed girlfriend. They had just returned from a 2 week stay in Scotland when her boyfriend began to feel generally unwell. Since then he has become hyperactive and becomes uncontrollable when he sees or even hears water with jerky head and body movements. On examination he is severely dehydrated and you notice a small bite mark on his shoulder. You also notice ptyalism.
A. Viral encephalitis
B. Toxoplasmosis
C. Polio
D. Acute viral meningitis
E. Cerebral abscess
F. Septicaemia
G. Acute bacterial meningitis
H. TB meningitis
I. Encephalomyelitis
J. Prion disease (CJD)
K. Acute leptomeningitis
L. Myelitis
```
A. Viral encephalitis
247
```
A 56 yr old male presents with fever, vomiting and seizures. Examination reveals a well established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.
A. Viral encephalitis
B. Toxoplasmosis
C. Polio
D. Acute viral meningitis
E. Cerebral abscess
F. Septicaemia
G. Acute bacterial meningitis
H. TB meningitis
I. Encephalomyelitis
J. Prion disease (CJD)
K. Acute leptomeningitis
L. Myelitis
```
E. Cerebral abscess
248
```
A 1 yr old child is brought into A&E by his mother. She has noticed he has a fever and is now becoming increasingly restless and will not stop screaming. He has a non-blanching rash on his thigh.
A. Viral encephalitis
B. Toxoplasmosis
C. Polio
D. Acute viral meningitis
E. Cerebral abscess
F. Septicaemia
G. Acute bacterial meningitis
H. TB meningitis
I. Encephalomyelitis
J. Prion disease (CJD)
K. Acute leptomeningitis
L. Myelitis
```
G. Acute bacterial meningitis
249
```
An 18 yr old student comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and 0.7 g/L protein with a lymphocyte count of 15
A. Viral encephalitis
B. Toxoplasmosis
C. Polio
D. Acute viral meningitis
E. Cerebral abscess
F. Septicaemia
G. Acute bacterial meningitis
H. TB meningitis
I. Encephalomyelitis
J. Prion disease (CJD)
K. Acute leptomeningitis
L. Myelitis
```
D. Acute viral meningitis
250
```
A 70 yr old man presents with his wife. She complains that he has become increasingly forgetful and now she is unable to understand what he says. On examination you notice some ataxia and sudden spasms of his muscles. An EEG shows periodic sharp waves.
A. Viral encephalitis
B. Toxoplasmosis
C. Polio
D. Acute viral meningitis
E. Cerebral abscess
F. Septicaemia
G. Acute bacterial meningitis
H. TB meningitis
I. Encephalomyelitis
J. Prion disease (CJD)
K. Acute leptomeningitis
L. Myelitis
```
J. Prion disease (CJD)
251
```
The cause of infections which are particularly common in sexually active, young females
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
P. Candida
252
```
Used as antimicrobial treatment of UTIs during the initial stages of pregnancy. Concentrated in the urine.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
E. Nitrofurantoin
253
```
These infections are almost invariably associated with functional or anatomical abnormalities of the renal tract. Tip: also causes cavitating pneumonia.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
H. Klebsiella
254
```
The most common cause of uncomplicated UTI in young women
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
G. Escherichia coli
255
```
Broad spectrum penicillin traditionally used in the treatment of UTIs.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
M. Ampicillin
256
```
One of the 1st line drugs for UTIs in non pregnant women but contra-indicated in pregnant women
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
D. Trimethoprim
257
```
The most common cause of UTI in catheterized men
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
G. Escherichia coli
258
```
The 2nd commonest cause of uncomplicated UTI in young women
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
I. Staph saprophyticus
259
```
Can be used as monotherapy for acute pyelonephritis and should always be prescribed orally because its bioavailability is near 100% and iv dosing is 30 times more expensive.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
K. Ciprofloxacin
260
```
Causes haemorrhagic cystitis in children.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
J. Adenovirus
261
```
A cephalosporin used for treating pseudomonal infections in cystic fibrosis
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
C. Ceftazidime
262
```
In combination with iv ampicillin, this drug is used iv for very sick patients with obstructed infected upper UTIs and gram negative septicaemia.
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
C. Ceftazidime
263
```
Given IM as a single shot for gonococcal urethritis
A. Piperacillin
B. Ceftriaxone
C. Ceftazidime
D. Trimethoprim
E. Nitrofurantoin
F. Gentamicin
G. Escherichia coli
H. Klebsiella
I. Staph saprophyticus
J. Adenovirus
K. Ciprofloxacin
L. Staph epidermidis
M. Ampicillin
N. Tuberculosis
O. Pseudomonas
P. Candida
```
B. Ceftriaxone
264
```
A 40-year-old Indian male presents to A&E with dysuria and back pain. He has recently noticed blood in his urine and his past medical history reveals that he has had hypertension for 5 years. After some initial reluctance, he admits to having HIV, which was diagnosed on his arrival in the UK 7 years previously.
A. Urethral Syndrome
B. Intrarenal Abscess
C. Renal Tuberculosis
D. Calculi
E. Acute Prostatitis
F. Polycystic Kidney
G. Inadequately treated UTI
H. Bladder Tumour
I. Interstitial Nephritis
J. Papillary Necrosis from Analgaesic Overdose
K. Acute Pyelonephritis
L. Cystitis
M. Perinephric Abscess
```
C. Renal Tuberculosis
265
```
A 27-year-old Caucasian female, who is 7 months pregnant, presents to A&E with a 2 day history of vomiting, rigors and loin pain. On examination, she is found to be pyrexic (39oC). Urine dipstick indicates the presence of leucocytes, nitrite, proteinuria and haematuria.
A. Urethral Syndrome
B. Intrarenal Abscess
C. Renal Tuberculosis
D. Calculi
E. Acute Prostatitis
F. Polycystic Kidney
G. Inadequately treated UTI
H. Bladder Tumour
I. Interstitial Nephritis
J. Papillary Necrosis from Analgaesic Overdose
K. Acute Pyelonephritis
L. Cystitis
M. Perinephric Abscess
```
K. Acute Pyelonephritis
266
```
A 23-year-old Caucasian women presents to her GP with urinary frequency, urgency and burning. She also complained of slow stream as well as suprapubic pain. She has had several UTIs in the past and analysis of her urine showed no significant bacteruria.
A. Urethral Syndrome
B. Intrarenal Abscess
C. Renal Tuberculosis
D. Calculi
E. Acute Prostatitis
F. Polycystic Kidney
G. Inadequately treated UTI
H. Bladder Tumour
I. Interstitial Nephritis
J. Papillary Necrosis from Analgaesic Overdose
K. Acute Pyelonephritis
L. Cystitis
M. Perinephric Abscess
```
A. Urethral Syndrome
267
```
A 50-year-old Caucasian male presents to his GP with sudden onset of painless, frank haematuria. He reports that the blood is of a deep red colour and has been treated for numerous UTIs in the past 6 months. He is a smoker, who admits to smoking 20 cigarettes/day since he was 18.
A. Urethral Syndrome
B. Intrarenal Abscess
C. Renal Tuberculosis
D. Calculi
E. Acute Prostatitis
F. Polycystic Kidney
G. Inadequately treated UTI
H. Bladder Tumour
I. Interstitial Nephritis
J. Papillary Necrosis from Analgaesic Overdose
K. Acute Pyelonephritis
L. Cystitis
M. Perinephric Abscess
```
H. Bladder Tumour
268
```
A 42-year-old African American male presents to A&E with severe loin pain that radiates to the groin. He complains of painful urination, interrupted flow and increased urinary frequency. Urine dipstick reveals the presence of leucocytes, nitrites, haematuria and proteinuria. Intravenous uretogram shows a filling defect of the right kidney.
A. Urethral Syndrome
B. Intrarenal Abscess
C. Renal Tuberculosis
D. Calculi
E. Acute Prostatitis
F. Polycystic Kidney
G. Inadequately treated UTI
H. Bladder Tumour
I. Interstitial Nephritis
J. Papillary Necrosis from Analgaesic Overdose
K. Acute Pyelonephritis
L. Cystitis
M. Perinephric Abscess
```
D. Calculi
269
```
A 30 year old previously healthy lady presents to her GP complaining of urinary frequency and dysuria for the preceding three days. She uses diaphragm contraception. She is afebrile and has no loin pain, although she has suprapubic tenderness. Microscopy and culture revealed 3 x 105 Escherichia Coli per ml urine.
A. Pulmonary tuberculosis
B. Fungal cystitis
C. Recurrent UTI
D. Schistosomiasis of the bladder
E. Viral cystitis
F. Weber's syndrome
G. Renal tuberculosis
H. Non-infective cystitis
I. Bacterial prostatitis
J. Relapse of UTI
K. Eosinophilic cystitis
L. Urethral syndrome
M. Acute bacterial cystitis
N. Abacterial cystitis
```
M. Acute bacterial cystitis
270
```
A 63 year old gentleman has a two day history of fever and rigors with lower back pain and discomfort on passing urine. Urine microscopy and culture revealed 2 x 104 Escherichia Coli per ml urine.
A. Pulmonary tuberculosis
B. Fungal cystitis
C. Recurrent UTI
D. Schistosomiasis of the bladder
E. Viral cystitis
F. Weber's syndrome
G. Renal tuberculosis
H. Non-infective cystitis
I. Bacterial prostatitis
J. Relapse of UTI
K. Eosinophilic cystitis
L. Urethral syndrome
M. Acute bacterial cystitis
N. Abacterial cystitis
```
I. Bacterial prostatitis
271
```
A 40 year old lady was previously diagnosed with acute UTI and treated with trimethoprim. Ten days later she returns to her GP with the same symptoms of dysuria and frequency, and urine microscopy reveals a positive culture of the same bacteria.
A. Pulmonary tuberculosis
B. Fungal cystitis
C. Recurrent UTI
D. Schistosomiasis of the bladder
E. Viral cystitis
F. Weber's syndrome
G. Renal tuberculosis
H. Non-infective cystitis
I. Bacterial prostatitis
J. Relapse of UTI
K. Eosinophilic cystitis
L. Urethral syndrome
M. Acute bacterial cystitis
N. Abacterial cystitis
```
J. Relapse of UTI
272
```
Individuals who walk or swim in the river Nile put themselves at risk of developing this condition.
A. Pulmonary tuberculosis
B. Fungal cystitis
C. Recurrent UTI
D. Schistosomiasis of the bladder
E. Viral cystitis
F. Weber's syndrome
G. Renal tuberculosis
H. Non-infective cystitis
I. Bacterial prostatitis
J. Relapse of UTI
K. Eosinophilic cystitis
L. Urethral syndrome
M. Acute bacterial cystitis
N. Abacterial cystitis
```
D. Schistosomiasis of the bladder
273
```
A 35 year old Asian gentleman has recently migrated to the United Kingdom. He presents with urinary frequency, dysuria and loin tenderness. Urine culture is negative, however he has pyuria.
A. Pulmonary tuberculosis
B. Fungal cystitis
C. Recurrent UTI
D. Schistosomiasis of the bladder
E. Viral cystitis
F. Weber's syndrome
G. Renal tuberculosis
H. Non-infective cystitis
I. Bacterial prostatitis
J. Relapse of UTI
K. Eosinophilic cystitis
L. Urethral syndrome
M. Acute bacterial cystitis
N. Abacterial cystitis
```
G. Renal tuberculosis
274
```
An 84year old male being treated for chest infection on care-of –the elderly ward develops increasingly severe diarrhoea. Sigmoidoscopy shows white plaques on the mucosal surface. Faecal analysis isolates a toxin that is cytopathic in cell culture.
A. Hand hygiene
B. Amphotericin B
C. Aspergillus Fumigatis
D. Eschericia coli
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
F. Staphylococcus aureus
G. MRSA
H. Endocarditis
I. Pneumocystis pneumonia
J. Legionella
K. Cef. & Met. 6hrs before incision & for 2 days post-surgery
L. Clostridium difficile
M. Serotyping
```
L. Clostridium difficile
275
```
A 32 year old male recently underwent a kidney transplant procedure. During his time in hospital he was continually disturbed by the noise of building work. He started to develop fever, dyspnoea an dslight confusion.
A. Hand hygiene
B. Amphotericin B
C. Aspergillus Fumigatis
D. Eschericia coli
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
F. Staphylococcus aureus
G. MRSA
H. Endocarditis
I. Pneumocystis pneumonia
J. Legionella
K. Cef. & Met. 6hrs before incision & for 2 days post-surgery
L. Clostridium difficile
M. Serotyping
```
C. Aspergillus Fumigatis
276
```
A 12 year old boy develops wound infection after a right hemicolectomy for Crohn’s disease. Gram stain of exuded pus shows clusters of Gram-positive cocci. Culture shows coagulase-positive yellow colonies.
A. Hand hygiene
B. Amphotericin B
C. Aspergillus Fumigatis
D. Eschericia coli
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
F. Staphylococcus aureus
G. MRSA
H. Endocarditis
I. Pneumocystis pneumonia
J. Legionella
K. Cef. & Met. 6hrs before incision & for 2 days post-surgery
L. Clostridium difficile
M. Serotyping
```
F. Staphylococcus aureus
277
```
A 74 year old male is soon to undergo colorectal surgery and hospital procedures of antibiotic prophylaxis is followed.
A. Hand hygiene
B. Amphotericin B
C. Aspergillus Fumigatis
D. Eschericia coli
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
F. Staphylococcus aureus
G. MRSA
H. Endocarditis
I. Pneumocystis pneumonia
J. Legionella
K. Cef. & Met. 6hrs before incision & for 2 days post-surgery
L. Clostridium difficile
M. Serotyping
```
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
278
```
A 35 year old woman receiving chemotherapy for high grade lymphoma develps SOB and dry cough. CXR shows bilateral reticulonodular shadowing. A transbronchial biopsy shows alveoli filled with foamy eosinophilic material and numerous boat-shaped organisms staining positively with silver stain. Sputum culture is negative.
A. Hand hygiene
B. Amphotericin B
C. Aspergillus Fumigatis
D. Eschericia coli
E. Cef. & Met. 0-2hrs before incision & no longer than 24 hrs post-surgery
F. Staphylococcus aureus
G. MRSA
H. Endocarditis
I. Pneumocystis pneumonia
J. Legionella
K. Cef. & Met. 6hrs before incision & for 2 days post-surgery
L. Clostridium difficile
M. Serotyping
```
I. Pneumocystis pneumonia
279
```
An 18 year old boy with cystic fibrosis recently underwent a knee operation. After a couple of days recovering in the ward he starts to wheeze, becomes breathless and coughs up sputum. He has a fever and blood cultures indicate the presence of gram-negative bacteria.
A. Staph. aureus
B. Burkholderia cepacia
C. MRSA
D. Salmonella
E. Aspergillus Fumigatis
F. Clostridium difficile
G. Urinary Tract Infection
H. Legionella
I. Amphotericin B
J. Hepatitis C
K. Toxoplasma gondi
L. Pneumocystis pneumonia
M. Endocarditis
```
B. Burkholderia cepacia
280
```
A 32 year old man admitted to hospital with pain from a gastric ulcer develops a dry cough, diarrhoea and become confused. The patient becomes hyponatraemic and has a four fold increase in antibody titre in the blood. The hospital has recently has repairs conducted to its air conditioning system.
A. Staph. aureus
B. Burkholderia cepacia
C. MRSA
D. Salmonella
E. Aspergillus Fumigatis
F. Clostridium difficile
G. Urinary Tract Infection
H. Legionella
I. Amphotericin B
J. Hepatitis C
K. Toxoplasma gondi
L. Pneumocystis pneumonia
M. Endocarditis
```
H. Legionella
281
```
A 68 year old woman who has undergone colorectal surgery develops boils on her legs and impetigo. She has a fever and culture of her skin lesions indicates the presence of Staph. Aureus. Treatment with methicillin and flucoxacillin shows no improvement in her condition
A. Staph. aureus
B. Burkholderia cepacia
C. MRSA
D. Salmonella
E. Aspergillus Fumigatis
F. Clostridium difficile
G. Urinary Tract Infection
H. Legionella
I. Amphotericin B
J. Hepatitis C
K. Toxoplasma gondi
L. Pneumocystis pneumonia
M. Endocarditis
```
C. MRSA
282
```
A 78 year old man on the ward is suffering from supra-pubic pain and there is blood in his urine. Dipstick test of urine taken from his catheter bag reveals the presence of nitrites and leucocyte esterases.
A. Staph. aureus
B. Burkholderia cepacia
C. MRSA
D. Salmonella
E. Aspergillus Fumigatis
F. Clostridium difficile
G. Urinary Tract Infection
H. Legionella
I. Amphotericin B
J. Hepatitis C
K. Toxoplasma gondi
L. Pneumocystis pneumonia
M. Endocarditis
```
G. Urinary Tract Infection
283
```
An 80 year old woman on the ward develops severe diarrhoea. Examination of her stool using ELISA shows the presence of toxin A. She has been on antibiotic therapy for a week prior to the diarrhoea.
A. Staph. aureus
B. Burkholderia cepacia
C. MRSA
D. Salmonella
E. Aspergillus Fumigatis
F. Clostridium difficile
G. Urinary Tract Infection
H. Legionella
I. Amphotericin B
J. Hepatitis C
K. Toxoplasma gondi
L. Pneumocystis pneumonia
M. Endocarditis
```
F. Clostridium difficile
284
```
A 60-year-old man was admitted for coronary artery bypass graft. Three days following his operation, his blood culture grew coagulase-positive staphylococcus spp. which was resistant to flucloxacillin. His wound swab also grew the same organism. Identical isolates were obtained from four other adjacent patients and were also found in the nasal swabs of one of the surgeons. These isolates were subsequently shown to be of the same phage-type.
A. Methicillin-resistant S. aureus (MRSA)
B. Bacillus subtilis
C. Salmonella enteridis
D. Pseudomonas aeruginosa
E. Respiratory syncytial virus
F. Klebsiella pneumoniae
G. Streptococcus Group A
H. Streptococcus viridans
I. Herpes Simplex, Type 1
J. Vancomycin-resistant enterococcus(VRE)
K. Rotavirus
```
A. Methicillin-resistant S. aureus (MRSA)
285
```
A 50-year-old man was admitted with acute pancreatitis and underwent emergency pancreatectomy. He was in ITU for four weeks for respiratory support where he remained febrile and septic. Blood cultures and wound swabs grew gram-positive cocci in chains, which grew on MacConkey plate and was aesculin-positive. This isolate was also resistant to the conventional anti-streptococcal antibiotics.
A. Methicillin-resistant S. aureus (MRSA)
B. Bacillus subtilis
C. Salmonella enteridis
D. Pseudomonas aeruginosa
E. Respiratory syncytial virus
F. Klebsiella pneumoniae
G. Streptococcus Group A
H. Streptococcus viridans
I. Herpes Simplex, Type 1
J. Vancomycin-resistant enterococcus(VRE)
K. Rotavirus
```
J. Vancomycin-resistant enterococcus(VRE)
286
```
A patient with 20% burns with open wounds is awaiting skin grafting. The wound swab grew gram-negative bacilli that produced a green pigment and was oxidase-positive. A similar organism was isolated from other patients on the same unit. Bacteriological typing subsequently proved all the isolates were of the same type.
A. Methicillin-resistant S. aureus (MRSA)
B. Bacillus subtilis
C. Salmonella enteridis
D. Pseudomonas aeruginosa
E. Respiratory syncytial virus
F. Klebsiella pneumoniae
G. Streptococcus Group A
H. Streptococcus viridans
I. Herpes Simplex, Type 1
J. Vancomycin-resistant enterococcus(VRE)
K. Rotavirus
```
D. Pseudomonas aeruginosa
287
```
Following Christmas dinner in hospital, eight out of the junior doctors came down with fever and diarrhoea 18 hours later. On interrogation some patients in different wards were found to be similarly affected. The common food history of all those suffers was the Christmas turkey. Stool cultures grew gram-negative bacilli that were oxidase-negative and urease-negative and gave positive agglutination test for an enteric pathogen.
A. Methicillin-resistant S. aureus (MRSA)
B. Bacillus subtilis
C. Salmonella enteridis
D. Pseudomonas aeruginosa
E. Respiratory syncytial virus
F. Klebsiella pneumoniae
G. Streptococcus Group A
H. Streptococcus viridans
I. Herpes Simplex, Type 1
J. Vancomycin-resistant enterococcus(VRE)
K. Rotavirus
```
C. Salmonella enteridis
288
```
Three patients on the same ward/medical firm came down with diarrhoea and vomiting within 24 hours. The attention is drawn to the ward sister that many patients started their symptoms at the same time. Stool samples were sent for bacterial cultures and viral studies. Subsequently, the diagnosis was obtained by electron microscopy, which showed the same pathogen for all patients
A. Methicillin-resistant S. aureus (MRSA)
B. Bacillus subtilis
C. Salmonella enteridis
D. Pseudomonas aeruginosa
E. Respiratory syncytial virus
F. Klebsiella pneumoniae
G. Streptococcus Group A
H. Streptococcus viridans
I. Herpes Simplex, Type 1
J. Vancomycin-resistant enterococcus(VRE)
K. Rotavirus
```
K. Rotavirus
289
```
A 45 year old man was admitted for a perforated gastric ulcer for which he had emergency surgery. He was maintained in ITU for the following 2 weeks. His wound culture grew gram positive cocci in chains, which was aesculin-positive and resistant to the conventional anti-streptococcal antibiotics.
A. Pneumocystis carinii
B. Streptococcus viridans
C. Klebsiella pneumoniae
D. Methicillin resistant Staphylococcus aereus
E. Cryptococcus neoformans
F. Pseudomonas aeruginosa
G. Vancomycin resistant enterococcus
H. Staphylococcus epidermidis
I. Legionalla
J. Bacillus cereus
K. Clostridium difficile
L. Staphylococcus aureus
M. Aspergillus
N. Rotavirus
O. Escherichia coli
```
G. Vancomycin resistant enterococcus
290
```
A 25% burns patient with significant wounds grew gram-negative bacilli that produced a green pigment and was oxidase positive. Three other patients in the same ward were found to isolate the same organism.
A. Pneumocystis carinii
B. Streptococcus viridans
C. Klebsiella pneumoniae
D. Methicillin resistant Staphylococcus aereus
E. Cryptococcus neoformans
F. Pseudomonas aeruginosa
G. Vancomycin resistant enterococcus
H. Staphylococcus epidermidis
I. Legionalla
J. Bacillus cereus
K. Clostridium difficile
L. Staphylococcus aureus
M. Aspergillus
N. Rotavirus
O. Escherichia coli
```
F. Pseudomonas aeruginosa
291
```
A 85-year-old man admitted for "off-legs" who was catheterised developed a fever. He complained of mild suprapubic pain.
A. Pneumocystis carinii
B. Streptococcus viridans
C. Klebsiella pneumoniae
D. Methicillin resistant Staphylococcus aereus
E. Cryptococcus neoformans
F. Pseudomonas aeruginosa
G. Vancomycin resistant enterococcus
H. Staphylococcus epidermidis
I. Legionalla
J. Bacillus cereus
K. Clostridium difficile
L. Staphylococcus aureus
M. Aspergillus
N. Rotavirus
O. Escherichia coli
```
O. Escherichia coli
292
```
A 65 year old lady was admitted for CABG. Blood cultures went on to grow coagulase-positive staphylococcus sp., which was resistant to flucloxacillin. Her wound swab also grew the same organism
A. Pneumocystis carinii
B. Streptococcus viridans
C. Klebsiella pneumoniae
D. Methicillin resistant Staphylococcus aereus
E. Cryptococcus neoformans
F. Pseudomonas aeruginosa
G. Vancomycin resistant enterococcus
H. Staphylococcus epidermidis
I. Legionalla
J. Bacillus cereus
K. Clostridium difficile
L. Staphylococcus aureus
M. Aspergillus
N. Rotavirus
O. Escherichia coli
```
D. Methicillin resistant Staphylococcus aereus
293
```
Sitting in on your consultant’s GUM clinic, you see a shy 30-year-old woman who admits to losing her virginity a week ago and now is worried about the appearance of insect bite-like marks in her genital region and a concurrent fever. On intense questioning, she reveals that her partner seemed to have a painful sore on his penis.
A. Chlamidiae Psittacosis
B. HSV type 2
C. Syphilis
D. Chancroid
E. HIV
F. Chlamydiae Trachomatis
G. Chlamidiae Pneumoniae
H. Gonorrhoea-associated salpingitis
I. Non-gonococcal urethritis
J. Lymphogranuloma venereum
K. Gonococcal conjunctivitis
L. Disseminated gonococcal infection
```
B. HSV type 2
294
```
On Tuesday, a confident African friend comes to you for advice. He has noticed a painful ulcer on his penis, from which he has helpfully collected exudate. Sneaking into the labs at Chelsea & Westminster late one evening, you culture this. Later, you note the presence of Haemophilus ducreyi.
A. Chlamidiae Psittacosis
B. HSV type 2
C. Syphilis
D. Chancroid
E. HIV
F. Chlamydiae Trachomatis
G. Chlamidiae Pneumoniae
H. Gonorrhoea-associated salpingitis
I. Non-gonococcal urethritis
J. Lymphogranuloma venereum
K. Gonococcal conjunctivitis
L. Disseminated gonococcal infection
```
D. Chancroid
295
```
Deciding to break with tradition and make two appearances on firms in one week, you find your incompetent registrar helping out in the GUM clinic on Wednesday morning. With alcohol-tinged breath, he tells you of his inability to diagnose the first patient of the day, a 25-year-old homosexual man who presented with purplish lesions on his skin and pneumonia. A stunningly swift culture from the labs determines the organism is Pneumocystis carinii. Before reporting your registrar to the GMC, you fill in the diagnosis on the patient’s notes.
A. Chlamidiae Psittacosis
B. HSV type 2
C. Syphilis
D. Chancroid
E. HIV
F. Chlamydiae Trachomatis
G. Chlamidiae Pneumoniae
H. Gonorrhoea-associated salpingitis
I. Non-gonococcal urethritis
J. Lymphogranuloma venereum
K. Gonococcal conjunctivitis
L. Disseminated gonococcal infection
```
E. HIV
296
```
On Thursday evening, you receive a panicked phone call from your mother. Your 16-year-old sister, whom you have always been close to (since her diagnosis at age 3 with a complement disorder), has been feeling feverish, has a rash and painful joints. Suddenly, you remember having seen Jim, one of her many ‘boyfriends’, secretively sneaking out of GUM clinic. You vaguely remember that microscopy showed a gram negative diplococcus
A. Chlamidiae Psittacosis
B. HSV type 2
C. Syphilis
D. Chancroid
E. HIV
F. Chlamydiae Trachomatis
G. Chlamidiae Pneumoniae
H. Gonorrhoea-associated salpingitis
I. Non-gonococcal urethritis
J. Lymphogranuloma venereum
K. Gonococcal conjunctivitis
L. Disseminated gonococcal infection
```
L. Disseminated gonococcal infection
297
```
After a Friday night out, you return to your room in halls with Helga, a promiscuous fellow student on your corridor. Before copulating, you notice Helga has some muco-purulent discharge from her vagina. Upon questioning, she admits to a history of pelvic pain. You abandon your amorous advances and accompany Helga to A&E, where you impress the doctors on call with your spot diagnosis.
A. Chlamidiae Psittacosis
B. HSV type 2
C. Syphilis
D. Chancroid
E. HIV
F. Chlamydiae Trachomatis
G. Chlamidiae Pneumoniae
H. Gonorrhoea-associated salpingitis
I. Non-gonococcal urethritis
J. Lymphogranuloma venereum
K. Gonococcal conjunctivitis
L. Disseminated gonococcal infection
```
F. Chlamydiae Trachomatis
298
```
45 year old female presents with fever. O/E she is pyrexial, has hepatosplenomegaly, lymphadenopathy and a severely swollen eyelid. She returned from Guatemala 2 days ago.
A. Chagas Disease
B. Plasmodium vivax
C. Schistosomiasis
D. Tuberculosis
E. Dengue fever
F. Mucocutaneous Leishmaniasis
G. Plasmodium falciparum
H. Plasmodium malariae
I. Giardia lamblia
J. Amoebiasis
K. Tropical sprue
```
A. Chagas Disease
299
```
A 21 year old male presents with a swinging fever, severe rigors, vomiting and confusion. Travel history reveals that he returned from Kenya 14 days ago. O/E he was pyrexial, had hepatosplenomegaly but no lymphadenopathy and was slightly jaundiced. His GCS was 11.
A. Chagas Disease
B. Plasmodium vivax
C. Schistosomiasis
D. Tuberculosis
E. Dengue fever
F. Mucocutaneous Leishmaniasis
G. Plasmodium falciparum
H. Plasmodium malariae
I. Giardia lamblia
J. Amoebiasis
K. Tropical sprue
```
G. Plasmodium falciparum
300
```
A 45 year old male presents with frequency, dysuria and haematuria. Blood tests reveal a marked eosinophilia. He arrived back to the UK 4 months ago after travelling Africa; his best memory was diving in Lake Malawi.
A. Chagas Disease
B. Plasmodium vivax
C. Schistosomiasis
D. Tuberculosis
E. Dengue fever
F. Mucocutaneous Leishmaniasis
G. Plasmodium falciparum
H. Plasmodium malariae
I. Giardia lamblia
J. Amoebiasis
K. Tropical sprue
```
C. Schistosomiasis
301
```
A 21 year old female presents with chronic diarrhoea beginning 2 days before her return to the UK from India 3 weeks ago. She has lost weight, feels bloated and also complains of very offensive burps.
A. Chagas Disease
B. Plasmodium vivax
C. Schistosomiasis
D. Tuberculosis
E. Dengue fever
F. Mucocutaneous Leishmaniasis
G. Plasmodium falciparum
H. Plasmodium malariae
I. Giardia lamblia
J. Amoebiasis
K. Tropical sprue
```
I. Giardia lamblia
302
```
A 35 year old male complains of a persistent ulcer in the mucosa of the mouth. When questioned further admits to remembering a small ulcer on his upper arm which healed without treatment when holidaying in Brazil one year ago.
A. Chagas Disease
B. Plasmodium vivax
C. Schistosomiasis
D. Tuberculosis
E. Dengue fever
F. Mucocutaneous Leishmaniasis
G. Plasmodium falciparum
H. Plasmodium malariae
I. Giardia lamblia
J. Amoebiasis
K. Tropical sprue
```
F. Mucocutaneous Leishmaniasis
303
```
A 45 year-old Egyptian male complains of haematuria. On further investigation, cystoscopy reveals a squamous cell carcinomatous lesion
A. Plasmodium falciparum
B. Trypanosoma brucei gambiense
C. Leishmania donovani
D. Trypanosoma brucei rhodesiense
E. Schistosoma mansoni
F. Schistosoma haematobium
G. Wuchereria bancrofti
H. Salmonella typhi
I. Pneumocystis carinii
J. Mycobacterium leprae
K. Hepatitis B virus
```
F. Schistosoma haematobium
304
```
A 23 year-old female presents with headache and fever 6 weeks after returning from her gap year.
A. Plasmodium falciparum
B. Trypanosoma brucei gambiense
C. Leishmania donovani
D. Trypanosoma brucei rhodesiense
E. Schistosoma mansoni
F. Schistosoma haematobium
G. Wuchereria bancrofti
H. Salmonella typhi
I. Pneumocystis carinii
J. Mycobacterium leprae
K. Hepatitis B virus
```
A. Plasmodium falciparum
305
```
An African woman and her 33 year-old husband come to their doctor because she is worried that he is not as alert as he used to be. On examination, he has non-tender lymphadenopathy, hepatomegaly and marked CNS abnormalities. He is noted to be quite lethargic.
A. Plasmodium falciparum
B. Trypanosoma brucei gambiense
C. Leishmania donovani
D. Trypanosoma brucei rhodesiense
E. Schistosoma mansoni
F. Schistosoma haematobium
G. Wuchereria bancrofti
H. Salmonella typhi
I. Pneumocystis carinii
J. Mycobacterium leprae
K. Hepatitis B virus
```
B. Trypanosoma brucei gambiense
306
```
A thin peripheral blood film from a 59 year-old female demonstrates eosinophilia and microfilariae. On examination, the skin overlying her superficial lymph nodes is streaky red and tender.
A. Plasmodium falciparum
B. Trypanosoma brucei gambiense
C. Leishmania donovani
D. Trypanosoma brucei rhodesiense
E. Schistosoma mansoni
F. Schistosoma haematobium
G. Wuchereria bancrofti
H. Salmonella typhi
I. Pneumocystis carinii
J. Mycobacterium leprae
K. Hepatitis B virus
```
G. Wuchereria bancrofti
307
```
A 43 year-old Asian male with AIDS presents with a prolonged fever, dizziness and a persistent cough. On examination, he is found to have marked splenomegaly and rough, dry skin. Blood results reveal pancytopenia.
A. Plasmodium falciparum
B. Trypanosoma brucei gambiense
C. Leishmania donovani
D. Trypanosoma brucei rhodesiense
E. Schistosoma mansoni
F. Schistosoma haematobium
G. Wuchereria bancrofti
H. Salmonella typhi
I. Pneumocystis carinii
J. Mycobacterium leprae
K. Hepatitis B virus
```
C. Leishmania donovani
308
```
A 5 year-old girl presents unconscious and unrousable. Neck rigidity is not present and kernig’s sign is negative. She dies 3 hours after presentation.
A. Visceral leishmaniasis (kala-azar)
B. Amoebic dysentery
C. Severe malaria
D. Trypanosomiasis
E. Cutaneous leishmaniasis
F. Trichuris trichiura
G. Chagas disease
H. Giadiasis
I. Brain worm
J. Pulmonary tuberculosis
K. Miliary tuberculosis
```
C. Severe malaria
309
```
A 20 year-old man presents with a persisting intermittent fever which began whilst he was travelling in South America the previous week. He has a dry cough and a massively enlarged spleen. Sandfly parasites are detected in a spleen aspirate.
A. Visceral leishmaniasis (kala-azar)
B. Amoebic dysentery
C. Severe malaria
D. Trypanosomiasis
E. Cutaneous leishmaniasis
F. Trichuris trichiura
G. Chagas disease
H. Giadiasis
I. Brain worm
J. Pulmonary tuberculosis
K. Miliary tuberculosis
```
A. Visceral leishmaniasis (kala-azar)
310
```
A 16 year-old boy complains that his friends keep ‘taking the mick’ out of his ‘smelly, eggy burps’. He also mentions he has experienced some diarrhoea and abdominal pain.
A. Visceral leishmaniasis (kala-azar)
B. Amoebic dysentery
C. Severe malaria
D. Trypanosomiasis
E. Cutaneous leishmaniasis
F. Trichuris trichiura
G. Chagas disease
H. Giadiasis
I. Brain worm
J. Pulmonary tuberculosis
K. Miliary tuberculosis
```
H. Giadiasis
311
```
A 55 year-old Gambian man presents with a low-grade fever which has been coming and going for about 2 months. He says it started when visiting his family in Gambia when he was also feeling weak and sleeping a lot.
A. Visceral leishmaniasis (kala-azar)
B. Amoebic dysentery
C. Severe malaria
D. Trypanosomiasis
E. Cutaneous leishmaniasis
F. Trichuris trichiura
G. Chagas disease
H. Giadiasis
I. Brain worm
J. Pulmonary tuberculosis
K. Miliary tuberculosis
```
D. Trypanosomiasis
312
```
A 7 year-old girl presents with a few week’s history of fever, malaise and weight loss. She has hepatosplenomegaly and neck stiffness. Chest x-ray shows diffuse, small, nodular opacities.
A. Visceral leishmaniasis (kala-azar)
B. Amoebic dysentery
C. Severe malaria
D. Trypanosomiasis
E. Cutaneous leishmaniasis
F. Trichuris trichiura
G. Chagas disease
H. Giadiasis
I. Brain worm
J. Pulmonary tuberculosis
K. Miliary tuberculosis
```
K. Miliary tuberculosis
313
```
A 16 yr old boy complains of a one week history of fever, muscle aches, nausea/vomiting/diarrhoea with general malaise following a trip to Zimbabwe visiting relatives. On further questioning he remembers developing an itchy rash on his right thigh following wading in Lake Kariba whilst on holiday. O/E He has generalised lymphadenopathy with hepatosplenomegaly. Initial blood tests reveal raised WCC with eosinophillia.
A. Toxoplasma gondii
B. Clonorchis sinensis
C. Trichinella spiralis
D. Loa-Loa
E. Wucheria bancrofti
F. Taenia saginata
G. Leishmania donovani
H. Schistosoma mansoni
I. Ancylostoma duodenale
J. Giardia lamblia
K. Entamoeba histolytica
L. Enchinococcus granulosus
M. Plasmodium falciparum
```
H. Schistosoma mansoni
314
```
A 25 yr old female humanitarian volunteer complaining of swinging fever, profound abdominal pain with severe malaise. On further questioning she reveals a history of self limiting diarrhoeal illness 3/52 ago during which she passed mucus and some blood. You are also informed she recently returned from a humanitarian mission to Ghana 6/52 ago. O/E she is unwell with exquisitely tender hepatomegaly. You also find increased breath sounds and a dull percussion note in the lower region of the right lung.
A. Toxoplasma gondii
B. Clonorchis sinensis
C. Trichinella spiralis
D. Loa-Loa
E. Wucheria bancrofti
F. Taenia saginata
G. Leishmania donovani
H. Schistosoma mansoni
I. Ancylostoma duodenale
J. Giardia lamblia
K. Entamoeba histolytica
L. Enchinococcus granulosus
M. Plasmodium falciparum
```
K. Entamoeba histolytica
315
```
A 24 yr old male complaining of 3/52 history of fever/chills with muscular aches and spasms. On further questioning he reveals the he also an episode of diarrhoea/vomiting with a headache lasting 48hrs. This followed his participation in an amateur eating competition 1/12 ago, during which he may have eaten some improperly cooked pork. O/E he has marked periorbital oedema with conjunctivitis. Blood tests reveal a marked eosinophillia, while gastrocnemius biopsy demonstrates the presence of encysted larvae.
A. Toxoplasma gondii
B. Clonorchis sinensis
C. Trichinella spiralis
D. Loa-Loa
E. Wucheria bancrofti
F. Taenia saginata
G. Leishmania donovani
H. Schistosoma mansoni
I. Ancylostoma duodenale
J. Giardia lamblia
K. Entamoeba histolytica
L. Enchinococcus granulosus
M. Plasmodium falciparum
```
C. Trichinella spiralis
316
```
An acutely unwell 42 yr old male presents to A&E with high fever accompanied by chills, sweats and vomiting with a 24 hour history. O/E he is clinically jaundiced with cool clammy skin. He is tachypnoeic and tachycardic. You note hepatosplenomegaly and that he is producing small amounts of dark brown urine in his catheter bag. His wife tells you that they recently returned from safari in Tanzania 10 days ago.
A. Toxoplasma gondii
B. Clonorchis sinensis
C. Trichinella spiralis
D. Loa-Loa
E. Wucheria bancrofti
F. Taenia saginata
G. Leishmania donovani
H. Schistosoma mansoni
I. Ancylostoma duodenale
J. Giardia lamblia
K. Entamoeba histolytica
L. Enchinococcus granulosus
M. Plasmodium falciparum
```
M. Plasmodium falciparum
317
```
A 32 yr old female complaining of the presence of small pale bodies in her stools on a number of occasions. On further questioning she admits some occasional mild epigastric pain over the past 4/12. O/E she appears clinically well. There is no significant travel history.
A. Toxoplasma gondii
B. Clonorchis sinensis
C. Trichinella spiralis
D. Loa-Loa
E. Wucheria bancrofti
F. Taenia saginata
G. Leishmania donovani
H. Schistosoma mansoni
I. Ancylostoma duodenale
J. Giardia lamblia
K. Entamoeba histolytica
L. Enchinococcus granulosus
M. Plasmodium falciparum
```
F. Taenia saginata
318
```
A 35 yr old male presented with bloody, mucoid diarrhoea, headache, nausea and anorexia. He had recently returned from a holiday in the tropics with his male partner. On examination of his stool, E. histolytica trophozoites were present.
A. Giardiasis
B. Ameobiasis
C. American trypanosomiasis
D. Toxoplasmosis
E. Trichomoniasis
F. Vivax malaria
G. African trypanosomiasis
H. Cryptosporidiosis
I. Babesiosis
J. Visceral Leishmania
K. Falciparum malaria
```
B. Ameobiasis
319
```
A 25yr old man who had recently returned from travel in Afrcia presented with fever, diarrhoea and hepatoslenomegaly. He also noted skin changes which had developed over the past month.
A. Giardiasis
B. Ameobiasis
C. American trypanosomiasis
D. Toxoplasmosis
E. Trichomoniasis
F. Vivax malaria
G. African trypanosomiasis
H. Cryptosporidiosis
I. Babesiosis
J. Visceral Leishmania
K. Falciparum malaria
```
J. Visceral Leishmania
320
```
A 40 yr old Indian lady who was vacationing in the UK presented with fever which followed no particular pattern, vomiting and the production of brown-black urine.
A. Giardiasis
B. Ameobiasis
C. American trypanosomiasis
D. Toxoplasmosis
E. Trichomoniasis
F. Vivax malaria
G. African trypanosomiasis
H. Cryptosporidiosis
I. Babesiosis
J. Visceral Leishmania
K. Falciparum malaria
```
K. Falciparum malaria
321
```
An 18 yr old boy presented with diarrhoea, anorexia abdominal discomfort and distension. He noted that he had been passing pale, fatty stools. He had been back-packing in North America. Both cysts and trophozoites were present on stool examination.
A. Giardiasis
B. Ameobiasis
C. American trypanosomiasis
D. Toxoplasmosis
E. Trichomoniasis
F. Vivax malaria
G. African trypanosomiasis
H. Cryptosporidiosis
I. Babesiosis
J. Visceral Leishmania
K. Falciparum malaria
```
A. Giardiasis
322
```
A 25 year old man presents with weight loss and diarrhoea. He has recently been on holiday in India. On examination of his stool cysts and “tear-drop” shaped trophozoites are present.
A. Leishmania donovani
B. Trypanosoma gambiense
C. Plasmodium falciparum
D. Cryptosporidium parvum
E. Naegleria fowleri
F. Toxoplasma gondii
G. Giardia lamblia
H. Trypanosoma cruzi
I. Trichomonas vaginalis
J. Trypanosoma rhodesiense
K. Entamoeba histolytica
```
G. Giardia lamblia
323
```
The CT scan of a neonate shows diffuse intracranial calcification and hydrocephalus. On questioning, his mother tells you that she used to work in a slaughterhouse and has five cats.
A. Leishmania donovani
B. Trypanosoma gambiense
C. Plasmodium falciparum
D. Cryptosporidium parvum
E. Naegleria fowleri
F. Toxoplasma gondii
G. Giardia lamblia
H. Trypanosoma cruzi
I. Trichomonas vaginalis
J. Trypanosoma rhodesiense
K. Entamoeba histolytica
```
F. Toxoplasma gondii
324
```
A 10 year old girl presents with fever, hepatomegaly, splenomegaly and anaemia. She recently emigrated from the Sudan. Her mother tells you that 6 months ago the girl developed dark patches on her hands and forehead.
A. Leishmania donovani
B. Trypanosoma gambiense
C. Plasmodium falciparum
D. Cryptosporidium parvum
E. Naegleria fowleri
F. Toxoplasma gondii
G. Giardia lamblia
H. Trypanosoma cruzi
I. Trichomonas vaginalis
J. Trypanosoma rhodesiense
K. Entamoeba histolytica
```
A. Leishmania donovani
325
```
An 18 month old girl from Brazil sees you whilst on a short holiday in Britain. Her parents are worried because she appears to have had fever for the last few weeks, seems more tired and out of spirits than usual, has loss of appetite, vomiting and diarrhoea and complains of pains in her legs. On examination she has general lymphadenitis and non-pitting oedema in her legs and feet. Her Machado-Guerreiro test is positive.
A. Leishmania donovani
B. Trypanosoma gambiense
C. Plasmodium falciparum
D. Cryptosporidium parvum
E. Naegleria fowleri
F. Toxoplasma gondii
G. Giardia lamblia
H. Trypanosoma cruzi
I. Trichomonas vaginalis
J. Trypanosoma rhodesiense
K. Entamoeba histolytica
```
H. Trypanosoma cruzi
326
```
At birth, a neonate is diagnosed with sensorineural deafness, retinopathy and cardiovascular abnormalities. The mother suffered from German measles during the 1st trimester of Pregnancy, which was treated with Paracetamol. The mother had not been vaccinated before pregnancy.
A. Congenital Toxoplasmosis
B. Neonatal Meningitis
C. E.Coli infection
D. Neonatal HIV infection
E. Neonatal Herpes Simplex Infection
F. EBV-related infectious mononucleosis
G. Neonatal Respiratory Tract Infection
H. Group B Streptococci Syndrome
I. Chlamydial conjunctivitis in the newborn
J. Conjunctivitis caused by a blocked tear duct
K. Congenital Rubella Syndrome
```
K. Congenital Rubella Syndrome
327
```
An infant is diagnosed with pneumonia in her 5th day of life. Vaginal swabs from the mother as well as umbilical and oral swabs from the neonate showed a Gram positive coccus. The infant is given antibiotics and is monitored in hospital for a period of time until respiration and appetite improve.
A. Congenital Toxoplasmosis
B. Neonatal Meningitis
C. E.Coli infection
D. Neonatal HIV infection
E. Neonatal Herpes Simplex Infection
F. EBV-related infectious mononucleosis
G. Neonatal Respiratory Tract Infection
H. Group B Streptococci Syndrome
I. Chlamydial conjunctivitis in the newborn
J. Conjunctivitis caused by a blocked tear duct
K. Congenital Rubella Syndrome
```
H. Group B Streptococci Syndrome
328
```
A 2 week old infant develops swollen red eyelids. The mother explains that the initial ocular discharge seen at 10 days was watery, but has become copious, thick and purulent. Mother, father and infant are shown to all be infected with the same bacterium and are treated with penicillin.
A. Congenital Toxoplasmosis
B. Neonatal Meningitis
C. E.Coli infection
D. Neonatal HIV infection
E. Neonatal Herpes Simplex Infection
F. EBV-related infectious mononucleosis
G. Neonatal Respiratory Tract Infection
H. Group B Streptococci Syndrome
I. Chlamydial conjunctivitis in the newborn
J. Conjunctivitis caused by a blocked tear duct
K. Congenital Rubella Syndrome
```
I. Chlamydial conjunctivitis in the newborn
329
```
A French mother brings her 2 month old daughter with fever to hospital. The infant is shown to have elevated hepatic enzymes and is treated with pyrimethamine, sulphadiazine and folic acid for a year after appropriate investigations are performed.
A. Congenital Toxoplasmosis
B. Neonatal Meningitis
C. E.Coli infection
D. Neonatal HIV infection
E. Neonatal Herpes Simplex Infection
F. EBV-related infectious mononucleosis
G. Neonatal Respiratory Tract Infection
H. Group B Streptococci Syndrome
I. Chlamydial conjunctivitis in the newborn
J. Conjunctivitis caused by a blocked tear duct
K. Congenital Rubella Syndrome
```
A. Congenital Toxoplasmosis
330
```
An infant is born prematurely and subsequently has low birth weight. In addition, he has encephalitis and vesicular skin lesions. Despite being recommended to have a caesarean due to active viral lesions, the mother refuses and the neonate was delivered vaginally. Emperic Acyclovir is given to the neonate.
A. Congenital Toxoplasmosis
B. Neonatal Meningitis
C. E.Coli infection
D. Neonatal HIV infection
E. Neonatal Herpes Simplex Infection
F. EBV-related infectious mononucleosis
G. Neonatal Respiratory Tract Infection
H. Group B Streptococci Syndrome
I. Chlamydial conjunctivitis in the newborn
J. Conjunctivitis caused by a blocked tear duct
K. Congenital Rubella Syndrome
```
E. Neonatal Herpes Simplex Infection
331
```
A 2 week old female had an enlarged liver and spleen and her skin was tinged yellow. She was not eating much nor was she vomiting. She also suffered from regular seizures. Investigation revealed intra-cranial calcification.
A. Bordetella pertussis
B. Group B streptococci
C. Listeria
D. Bacterial meningitis
E. Chlamydial ophthalmia
F. Hepatitis B
G. Congenital toxoplasmosis
H. E. coli
I. Viral meningitis
J. Neonatal HSV infection
K. Congenital rubella syndrome
L. Chickenpoc (VZV)
```
G. Congenital toxoplasmosis
332
```
A newly born male presented with microphthalmia, deafness and hepatosplenomegaly. His platelet count was 50 x 10^9/L. In addition, rashes were noticed on his body. He suffers from SOB and is unable to finish feeding.
A. Bordetella pertussis
B. Group B streptococci
C. Listeria
D. Bacterial meningitis
E. Chlamydial ophthalmia
F. Hepatitis B
G. Congenital toxoplasmosis
H. E. coli
I. Viral meningitis
J. Neonatal HSV infection
K. Congenital rubella syndrome
L. Chickenpox (VZV)
```
K. Congenital rubella syndrome
333
```
The CSF in a neonate showed a raised WCC, consisting mainly of polymorphs. Culture showed pneumococcus.
A. Bordetella pertussis
B. Group B streptococci
C. Listeria
D. Bacterial meningitis
E. Chlamydial ophthalmia
F. Hepatitis B
G. Congenital toxoplasmosis
H. E. coli
I. Viral meningitis
J. Neonatal HSV infection
K. Congenital rubella syndrome
L. Chickenpox (VZV)
```
D. Bacterial meningitis
334
```
A prematurely born 1 week old infant presented with microcephaly, chorioretinitis and vesicular skin lesions. He also had non-specific features of fever, irritability and failure to feed.
A. Bordetella pertussis
B. Group B streptococci
C. Listeria
D. Bacterial meningitis
E. Chlamydial ophthalmia
F. Hepatitis B
G. Congenital toxoplasmosis
H. E. coli
I. Viral meningitis
J. Neonatal HSV infection
K. Congenital rubella syndrome
L. Chickenpox (VZV)
```
J. Neonatal HSV infection
335
```
A 6 day old baby presented with eyelid oedema and conjunctivitis with micropurulent discharge. Cultures obtained using Dracon swabs were positive for C. trachomatis.
A. Bordetella pertussis
B. Group B streptococci
C. Listeria
D. Bacterial meningitis
E. Chlamydial ophthalmia
F. Hepatitis B
G. Congenital toxoplasmosis
H. E. coli
I. Viral meningitis
J. Neonatal HSV infection
K. Congenital rubella syndrome
L. Chickenpox (VZV)
```
E. Chlamydial ophthalmia
336
```
A 31 year old man presents to a GUM clinic complaining of pain on passing urine and a penile discharge. His history reveals that he had travelled to Bangkok 10 days earlier “on a business trip”. On examination he had a purulent urethral discharge and a swollen tender prostate. Gram negative diplococci were found in smears of the discharge and culture of the causative agent confirmed the presumed diagnosis.
A. Genital Herpes
B. Hepatitis C
C. Syphilis
D. Hepatitis B
E. AIDS
F. HIV associated Kaposi’s sarcoma
G. Chancroid
H. Chlamydia
I. Gonorrhoea
```
I. Gonorrhoea
337
```
A camp 37 year old male presents to the Chelsea and Westminster GUM clinic. He has been referred by his GP after complaining of fever and malaise, 6 weeks after noticing the presence of a hard ulcer on his penis. Examination reveals the ulcer is painless; the patient had lymphadenopathy and a rash on the palms and soles of his feet. Treponeme-specific antibody test was positive and proved diagnostic. Untreated, this patient is at risk of later cardiac and neurological complications.
A. Genital Herpes
B. Hepatitis C
C. Syphilis
D. Hepatitis B
E. AIDS
F. HIV associated Kaposi’s sarcoma
G. Chancroid
H. Chlamydia
I. Gonorrhoea
```
C. Syphilis
338
```
An 18 year old man has recently returned from a “lad’s holiday” in Tenerife. He admits to multiple sexual partners whilst there but cannot remember many of them or whether he had unprotected sex at any point. He complains of fever, generally unwell and a painful rash on his penis (which he would like treated before he visits his girlfriend). On examination inguinal lymphadenopathy was noticed and the rash consisted of grouped vesicles and papules. Diagnosis was made by culture of this group of viruses.
A. Genital Herpes
B. Hepatitis C
C. Syphilis
D. Hepatitis B
E. AIDS
F. HIV associated Kaposi’s sarcoma
G. Chancroid
H. Chlamydia
I. Gonorrhoea
```
A. Genital Herpes
339
```
A pregnant 24 year old woman suffered an ectopic pregnancy after her sexually transmitted infection (STI) remained asymptomatic (and therefore undiagnosed) for many years. After surgical intervention, an endocervical swab was taken and the intracellular bacteria C.trachomatis revealed the cause of the STI.
A. Genital Herpes
B. Hepatitis C
C. Syphilis
D. Hepatitis B
E. AIDS
F. HIV associated Kaposi’s sarcoma
G. Chancroid
H. Chlamydia
I. Gonorrhoea
```
H. Chlamydia
340
```
A 17 year old known female prostitute has presented to a walk-in clinic complaining of fever, being generally unwell, weight loss and joint pain. She admits to having unprotected sex with one of her clients. On examination a yellow discolouration of the sclera was found along with hepatomegaly, a rash which says is itchy, and needle “track marks”. Investigations proved positive for the surface antigen of the causative DNA virus
A. Genital Herpes
B. Hepatitis C
C. Syphilis
D. Hepatitis B
E. AIDS
F. HIV associated Kaposi’s sarcoma
G. Chancroid
H. Chlamydia
I. Gonorrhoea
```
D. Hepatitis B
341
```
27 year old male presents with urethral discharge and urethritis for several days. Culture of organisms present produced gram negative oxidase positive diplococci
A. Syphilis
B. Hepatitis C
C. Trichomoniasis vaginal infection
D. HIV
E. Neisseria gonorrhoea
F. Bacterial vaginosis
G. Chlamydia trachomatis
```
E. Neisseria gonorrhoea
342
```
19 year old woman presents with cervicitis, erythema and oedema. Cultures were unable to be grown with agar but were subsequently grown using tissue medium.
A. Syphilis
B. Hepatitis C
C. Trichomoniasis vaginal infection
D. HIV
E. Neisseria gonorrhoea
F. Bacterial vaginosis
G. Chlamydia trachomatis
```
G. Chlamydia trachomatis
343
```
29 year old male presents with a painless ulcer on the penis. The lesion organism was identified using dark ground microscopy to show treponemes.
A. Syphilis
B. Hepatitis C
C. Trichomoniasis vaginal infection
D. HIV
E. Neisseria gonorrhoea
F. Bacterial vaginosis
G. Chlamydia trachomatis
```
A. Syphilis
344
```
22 year old woman with homogenous vaginal discharge, vulvar erythema and a strong odour which is worse after sexual intercourse and washing with soap.
A. Syphilis
B. Hepatitis C
C. Trichomoniasis vaginal infection
D. HIV
E. Neisseria gonorrhoea
F. Bacterial vaginosis
G. Chlamydia trachomatis
```
F. Bacterial vaginosis
345
```
Presents as a shallow painful ulcer, sometimes progressing to a lymphadenopathy.
A. Chlamydial infection
B. Bacterial vaginosis
C. Chancroid
D. Genital herpes
E. Gonorrhoea
F. Candidal infection
G. Syphilis
H. Trichomoniasis
```
C. Chancroid
346
```
Disseminated infection can be found in people with deficiencies in late complement components
A. Chlamydial infection
B. Bacterial vaginosis
C. Chancroid
D. Genital herpes
E. Gonorrhoea
F. Candidal infection
G. Syphilis
H. Trichomoniasis
```
E. Gonorrhoea
347
```
Is a major cause of infertility in Europe
A. Chlamydial infection
B. Bacterial vaginosis
C. Chancroid
D. Genital herpes
E. Gonorrhoea
F. Candidal infection
G. Syphilis
H. Trichomoniasis
```
A. Chlamydial infection
348
```
Treponemes in dark-ground microscopy is diagnostic
A. Chlamydial infection
B. Bacterial vaginosis
C. Chancroid
D. Genital herpes
E. Gonorrhoea
F. Candidal infection
G. Syphilis
H. Trichomoniasis
```
G. Syphilis
349
```
Causative organism is Haemophilus Ducreyi
A. Chlamydial infection
B. Bacterial vaginosis
C. Chancroid
D. Genital herpes
E. Gonorrhoea
F. Candidal infection
G. Syphilis
H. Trichomoniasis
```
C. Chancroid
350
```
What treatment should be prescribed for a 25-year old lady complaining of pruritus and a creamy vaginal discharge?
A. Syphilis
B. Non-specific vaginosis
C. Trichomonas vaginalis
D. Haemophilus ducreyi
E. Acyclovir
F. Metronidazole
G. Oral fluconazole
H. Tetracycline
I. Chancroid
J. Gonorrhoea
K. Calymmatobacterium granulomatis
L. Erythromycin
M. Chlamydia
N. Lymphogranuloma venerum
O. Genital warts
P. HIV
```
G. Oral fluconazole
351
```
A 33-year old man presents with purulent urethral discharge and dysuria. He later reveals that he had had unprotected sex with a prostitute. Gram-negative diplococci were found in smears of the urethral discharge.
A. Syphilis
B. Non-specific vaginosis
C. Trichomonas vaginalis
D. Haemophilus ducreyi
E. Acyclovir
F. Metronidazole
G. Oral fluconazole
H. Tetracycline
I. Chancroid
J. Gonorrhoea
K. Calymmatobacterium granulomatis
L. Erythromycin
M. Chlamydia
N. Lymphogranuloma venerum
O. Genital warts
P. HIV
```
J. Gonorrhoea
352
```
What treatment may be instituted for an infection where clusters of vesicles appear on the genitalia, progressing to painful, shallow ulcers?
A. Syphilis
B. Non-specific vaginosis
C. Trichomonas vaginalis
D. Haemophilus ducreyi
E. Acyclovir
F. Metronidazole
G. Oral fluconazole
H. Tetracycline
I. Chancroid
J. Gonorrhoea
K. Calymmatobacterium granulomatis
L. Erythromycin
M. Chlamydia
N. Lymphogranuloma venerum
O. Genital warts
P. HIV
```
E. Acyclovir
353
```
A neonate is referred and presents with skin lesions, lymphadenopathy and failure to thrive.
A. Syphilis
B. Non-specific vaginosis
C. Trichomonas vaginalis
D. Haemophilus ducreyi
E. Acyclovir
F. Metronidazole
G. Oral fluconazole
H. Tetracycline
I. Chancroid
J. Gonorrhoea
K. Calymmatobacterium granulomatis
L. Erythromycin
M. Chlamydia
N. Lymphogranuloma venerum
O. Genital warts
P. HIV
```
A. Syphilis
354
```
A 22-year old male medical student is prescribed erythromycin after presenting with mucopurulent discharge. No gram negative organisms seen.
A. Syphilis
B. Non-specific vaginosis
C. Trichomonas vaginalis
D. Haemophilus ducreyi
E. Acyclovir
F. Metronidazole
G. Oral fluconazole
H. Tetracycline
I. Chancroid
J. Gonorrhoea
K. Calymmatobacterium granulomatis
L. Erythromycin
M. Chlamydia
N. Lymphogranuloma venerum
O. Genital warts
P. HIV
```
M. Chlamydia
355
What are the three different types of clostridia?
```
Clostridium botulinum (canned foods, treat with antitoxin)
Clostridium perfringens (reheated food)
Clostridium dificle (treat with metronidazole and vancomycin)
```
356
Gram positive beta haemolytic bacteria, with tumbling motility?
Listeria monocytogenes
| Treat: ampicillin
357
```
Which of the following is the target of amphotericin B?
A. Cell membrane synthesis
B. DNA/RNA synthesis
C. Cell wall synthesis
D. Protein synthesis
```
A. Cell membrane synthesis
Amphotericin B is a polyene antifungal. It binds to steroid in fungal cell membrane
358
```
Which of the following is the target of fluconazole?
A. Cell membrane synthesis
B. DNA/RNA synthesis
C. Cell wall synthesis
D. Protein synthesis
```
A. Cell membrane synthesis
It is an azole antifungal. It prevents the enzyme lanosterol 14 alpha demethylase from converting lanosterol to ergosterol. There is some cross reaction with mammalian cells and it can cause drug interactions, e.g. with warfarin.
359
```
Which of the following is the target of Echinocandins?
A. Cell membrane synthesis
B. DNA/RNA synthesis
C. Cell wall synthesis
D. Protein synthesis
```
C. Cell wall synthesis
They inhibit beta (1,3) gluten synthase which causes a loss of cell wall. Examples include caspofungin, micafungin and anidulafungin.
360
```
Which of the following is the target of flucytosine?
A. Cell membrane synthesis
B. DNA/RNA synthesis
C. Cell wall synthesis
D. Protein synthesis
```
B. DNA/RNA synthesis
It inhibits DNA in fungal cells.
Side effects include: d&v, LFT derangement, blood disorders
361
What is the treatment for schistosomiasis?
Praziquantel
362
```
Which of the following is a Nematode?
A. Pork tape worm
B. Schistomsoma
C. Hydatid
D. Beef tape worm
E. Strongyloides
```
E. Strongyloides
Nematodes: Strongyloides, ascaris, filariasis, myiasis
Trematodes: schistosoma
Cestodes: pork and beef tape worm, hydatid
363
How is filariasis spread?
By black flies and mosquitoes.
It can be divided into: lymphatic filariasis, subcutaneous filariasis, serous cavity filiriasis
364
```
What is the main vector for tania solium cysticercosis?
A. Cows
B. Pigs
C. Dogs
D. Rats
E. Bats
```
B. Pigs
It causes infection of the tissues with pork tapeworm larva. Common cause of adult onset epilepsy
365
What is the prodrug of aciclovir?
Valaciclovir
366
In which cells does CMV reside?
Blood monocytes and dendritic cells
367
List some of the complications seen in CMV in immunosuppressive patients?
Bone marrow suppression, retinitis, pneumonitis, hepatitis, colitis, encephalitis
368
What is the action of cidofovir?
Competitive inhibitor of viral DNA synthesis (nucleotide analogue)
It does not require phosphorylation to be activated
369
What is the action of rituximab and give an example of an indication?
Anti CD20 monoclonal antibody
| Used to treat post transplant lymphoproliferative disease
370
What would you use to treat RSV in immunocompromised patient?
Ribavirin (guanisine analogue)
371
What viral infection is peramivir used to treat?
Influenza A only
372
What type of bacteria is C.dificle?
Gram positive spore forming anaerobes
373
Name three pathogens in the enterobacteriaceae family.
Salmonella, E.coli, klebsiella, shigella, enterobacter, proteus
374
What is the classic triad of symptoms seen in congenital rubella syndrome?
PDA, cataracts, microcephaly
375
In which trimester is a mother most at risk of fetal defects if infected with rubella?
First trimester is most risk: more than 90% CRS and 20% fetal loss
Third trimester there is low risk of deafness and retinopathy
376
What is the commonest non genetic cause of neurosensory hearing loss in newborns?
CMV congenital infection
377
Which poses the highest risk for neonatal HSV infection:
A. Mother having first episode, primary infection
B. Mother having first episode, non primary infection
C. Recurrent infection
A. First episode, primary infection = 57% risk of neonatal infection
378
Which trimester has the highest risk of neonatal infection with HSV?
Maternal primary infection in the 3rd trimester (particularly within 6 weeks of delivery)
Neonatal disease can be:
SEM = skin eyes and mouth
CNS
Disseminated
379
What are the risk factors to the fetus if a mother has parvovirus B19 during pregnancy?
Fetal anaemia, high output congestive heart failure, hydrous fetalis
380
When is it classified as a neonatal infection?
First 4-6 weeks of life
381
Three pathogens that most commonly cause early onset infection in neonates?
GBS
E.Coli
Listeria
382
```
Out of the following who is most at risk of developing an opportunist infection?
A. Solid organ transplant recipient
B. Advanced HIV
C. Taking steroids
D. Cytotoxic chemotherapy
E. Allogenic stem cell transplant
```
E. Allogenic stem cell transplant
```
In the following order (from highest risk to lowest)
Allogenic SC transplant
Advanced HIV
Solid organ transplant
Monoclonal ab therapy
Cytotoxic chemo
DMARDs and steroids
```
383
Give two complications of HSV infection.
Oesophagitis
| Hepatitis
384
In the immunocompromised, give 2 complications of VZV infection.
```
Acute retinal necrosis
Progressive outer retinal necrosis
VZV associated vasculopathy
Encephalitis
Hepatitis
Pneumonitis
```
385
```
Progressive outer retinal necrosis is a complication of which viral infection?
A. CMV
B. HSV
C. BK virus
D. VZV
E. EBV
```
D. VZV in immunocompromised
386
```
Post transplant lymphoproliferative disease can be seen in which of the following viral infections
A. EBV
B. CMV
C. VZV
D. HSV
```
A. EBV
387
Which virus causes Kaposi sarcoma?
HHV 8
388
How do you treat non falciparum malaria?
Chloroquine and primaquine
389
How do you treat mild falciparum malaria?
Oral malarone and ACT (artemisinin combo therapy)
390
How do you treat severe falciparum malaria?
IV artesunate
391
```
Which of the following features would make it mild falciparum as opposed to severe?
A. Parasitaemia of 10%
B. Parasitaemia of 1%
C. Vomiting
D. Fevers
```
B. Parasitaemia of 1%
Features of mild: not vomiting, ambulant, parasitaemia of <2%
392
```
A patient comes in with retro orbital pain and an erythrodermic rash that leaves a hand print when pressed.
A. Malaria
B. Typhoid
C. Dengue
D. HSV encephalitis
```
C. Dengue
Vector is the aedes mosquito
393
List three features of typhoid fever
```
Rose spots
Fever
Relative bradycardia
Dry cough
Constipation
Headache
```
Treat with ceftriaxone and azithromycin
394
Which cells does HIV invade and which receptor is involved?
CD4 T cells via the GP120 receptor
395
What is the definition of pyrexia of unknown origin?
Fever of over 38.3 lasting more than 3 weeks
| Uncertain diagnosis after 7 days in hospital
396
What are the features of Stills disease?
High spiking fevers
Salmon pink rash
Arthritis
Very high ferritin
397
What is R0?
A. The % of fully immune individuals required to stop spread of a disease
B. The number of people that one sick person will infect
C. The minimum concentration of antibiotic required to clear the infection
B. The number of people that one sick person will infect
A. refers to the her immunity threshold
398
What is the definition of herd immunity threshold?
A. The % of fully immune individuals required to stop spread of a disease
B. The % of fully immune individuals required to start a pandemic
C. The number of people that one sick person will infect
A. The % of fully immune individuals required to stop spread of a disease
399
What drugs are used to treat toxoplasmosis?
Pyrimethamine and sulfadiazine
