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
Q
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
A
F Cefotaxime
26
Q
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
A
C Hepatitis B virus
27
Q
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
A Human immunodeficiency virus (HIV)
28
Q
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
A
B Epstein–Barr virus (EBV)
29
Q
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
A
I Influenza virus
30
Q
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
A
F Varicella zoster virus
31
Q
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
A
D Zidovudine
32
Q
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
A
C Interferon- alpha
33
Q
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
A
B Oseltamivir
34
Q
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
A
E Gancylcovir
35
Q
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
A Acyclovir
36
Q
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
A
I Candida albicans
37
Q
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
A Cryptoccus neoformans
38
Q
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
A
B Pityriasis versicolour
39
Q
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
A
C Aspergillus flavus
40
Q
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
A
G Sporothrix schenckii
41
Q
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
A
C Brucellosis
42
Q
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
A
G Lyme disease
43
Q
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
A
E Leptospirosis
44
Q
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
A
I Rocky mountain spotted fever
45
Q
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
A Psittacosis
46
Q
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
A
E Mumps
47
Q
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
A
F Listeria monocytogenes
48
Q
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
A
C Measles
49
Q
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
A
H Haemophilus influenzae
50
Q
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
A Rubella
51
Q
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
A
C Mycobacterium tuberculosis
52
Q
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
A
B He has been exposed to TB
53
Q
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
A
D Streptococcus pneumoniae
54
Q
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
A Klebsiella pneumoniae
55
Q
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
A
C Staphylococcus aureus
56
Q
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
A
D Acyclovir
57
Q
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
A Pneumococcus
58
Q
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
A
B Escherichia coli
59
Q
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
A
C Giardia lamblia
60
Q
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
A
E Vibrio cholerae
61
Q
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
A Visceral leishmaniasis
62
Q
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
A
D. Leishmania major
63
Q
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
A
D Brucellosis
64
Q
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
A
E Borrelia burgdorferi
65
Q
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
A Neisseria gonorrhoeae
66
Q
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
A
E IV cefotaxime for 4–6 weeks
67
Q
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
A The patient has chronic hepatitis B infection which is currently highly infectious
68
Q
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
A
D The patient is immune due to hepatitis B vaccination
69
Q
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
A
B Oral metronidazole for 14 days
70
Q
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
A
B Oral metronidazole for 14 days
71
Q
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
A
B Electroencephalogram
72
Q
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
A
B The lumbar puncture is used to look for the levels of a protein called 14-3-3
73
Q
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
A
E Tuberculous meningitis
74
Q
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
A
E Commence intravenous cefotaxime
75
Q
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
A
D The virus genotype
76
Q
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
A
D Hepatitis C RNA PCR
77
Q
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
A
C Trypanosoma brucei rhodesiense
78
Q
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
A
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
Q
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
A Rifampicin and isoniazid for 6 months, ethambutol and pyrazinamide for 2 months
80
Q
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
A
E Ethambutol should be avoided in renal failure
81
Q
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
A
C Guillan–Barré syndrome
82
Q
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
A
D Plasmodium malariae
83
Q
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
A
C Merozite
84
Q
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
A
E Admit and give oral quinine and doxycycline
85
Q
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
A Plasmodium falciparum
86
Q
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
A. Nevirapine
87
Q
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
A
M. Interferon-α (alpha)
88
Q
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
A
F. Oseltamivir
89
Q
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
A
G. Aciclovir triphosphate
90
Q
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
A
B. Ribavirin
91
Q
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
A
H. Aciclovir monophosphate
92
Q
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
A
C. Aciclovir triphosphate
93
Q
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
A
F. Cytomegalovirus
94
Q
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
A
B. Guanosine
95
Q
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
A. Varicella-zoster virus
96
Q
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
A
E. Interferon
97
Q
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
A
K. Foscarnet
98
Q
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
A
M. Gancyclovir
99
Q
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
A
B. Amantadine
100
Q
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
A
G. Aciclovir
101
Q
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
A
D. Zidovudine
102
Q
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
A
H. Indinavir
103
Q
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
A
M. Aciclovir
104
Q
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
A. Zanamivir
105
Q
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
A
E. Human specific immunoglobulin
106
Q
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
A
H. S. pneumoniae
107
Q
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
A
E. L. pneumophila
108
Q
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
A
F. M. pneumoniae
109
Q
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
A
B. M. tuberculosis
110
Q
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
A
F. M. pneumoniae
111
Q
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
A
D. MSSA
112
Q
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
A
H. MSSA or MRSA
113
Q
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
A
B. Burkholderia cepacia
114
Q
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
A
I. S. pneumoniae
115
Q
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
A
F. Chlamydia psittaci
116
Q
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
A
B. Chicken Pox
117
Q
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
A
E. Primary Genital Herpes
118
Q
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
A
I. Glandular fever
119
Q
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
A
C. Shingles
120
Q
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
A. Burkitt’s lymphoma
121
Q
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
A
D. Primary stomatitis
122
Q
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
A
I. Pneumonitis
123
Q
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
A
E. Neonatal Infection associated with vaginal delivery
124
Q
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
A
F. Infection associated with Kaposi’s sarcoma
125
Q
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
A. Exanthem Subitum
126
Q
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)
A
E. Cytomegalovirus (beta)
127
Q
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)
A
D. Epstein-Barr virus (gamma)
128
Q
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)
A
G. Human herpes virus 6 (beta)
129
Q
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)
A
B. Varicella zoster virus (alpha)
130
Q
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)
A
I. Herpes simplex virus type 1 (alpha)
131
Q
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
A
I. Candidiasis
132
Q
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
A
E. Hairy leukoplakia
133
Q
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
A
J. Viral load (PCR)
134
Q
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
A
B. MIP-1alpha
135
Q
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
A
M. gp120
136
Q
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
A
K. MMR
137
Q
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
A
B. BCG
138
Q
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
A
J. Hepatitis B
139
Q
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
A
H. Tetanus
140
Q
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
A
D. Influenza
141
Q
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
A
H. Vancomycin
142
Q
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
A
D. Ceftriaxone
143
Q
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
A
B. Erthyromycin
144
Q
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
A
E. Metronidazole
145
Q
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
A. Linezolid
146
Q
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
A. Trimethoprim
147
Q
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
A
J. Vancomycin
148
Q
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
A
G. Cefuroxime
149
Q
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
A
C. Erythromycin
150
Q
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
A
B. Penicillin V
151
Q
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
A
H. vancomycin
152
Q
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
A
B. Ceftriaxone
153
Q
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
A
D. cefuroxime & clarithromycin
154
Q
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
A
M. isoniazid
155
Q
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
A. Erythromycin
156
Q
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
A
H. Hepatitis A
157
Q
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
A
E. Vibrio cholera
158
Q
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
A. Shigella
159
Q
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
A
F. Clostridium difficile
