Question book 3 Flashcards

1
Q

Hospital food preparation policy is being revised. Which organism is able to grow up to 1x10power2 cfu/g in coleslaw?

E. coli
Campylobacter
Listeria
Vibrio haemolyticum
Salmonella Tyhpimurium
A

Listeria

Can grow between 0 and 45 degC, so can end up in prepared foods
Soft cheese, cooked meats, pate are risks

Risk to immunocompromised patients and pregnant staff

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2
Q

Outbreak of dirrhoea on medical ward - including patients and staff. Norovirus is the cause

What action should be taken

substitute cleaning solution with peroxygen compounds
substitute cleaning solution with 100000ppm chlorine
use liquid soap and warm water as per WHO 5 moments
use alcohol hand gel as per WHO 5 moments
use gloves, aprons, and masks for interactions with patients with diarrhoea

A

use liquid soap and warm water as per WHO 5 moments

Norovirus is non-enveloped - so resistant to alcohol hand wash
masks are useless as non-aerosolised
1000ppm chlorine is used for cleaning

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3
Q

Which operation would benefit from having procedure in laminar flow theatre?

brain biopsy
renal transplant
total knee replacement
CABG
open reduction and internal fixation of hip fracture
A

total knee replacement

Earlier evidence showed reduced surgical site infections in orthopaedic procedures.
However, this is under review as meta-analysis did not demonstrate as big an imapct

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4
Q

Operating theatres are being reconditioned and air quality must be checked.

How is this best achieved?

air sampling
environmental swabs
air filters swabs
quantification of air circulation per hour
epidemiological survey of patient infection rates

A

air sampling

can use agar as “settle” plates, which catch any bacteria in air
or can use active air sampler which uses air pump to direct air towards plates

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4
Q

Operating theatres are being reconditioned and air quality must be checked.

How is this best achieved?

air sampling
environmental swabs
air filters swabs
quantification of air circulation per hour
epidemiological survey of patient infection rates

A

air sampling

can use agar as “settle” plates, which catch any bacteria in air
or can use active air sampler which uses air pump to direct air towards plates

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5
Q

3 year old has fever, barking cough. Diagnosed with Croup

What is most common cause?

rhinovirus
RSV
parainfluenza
coronavirus

A

Parainfluenza

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6
Q

32 year old IVDU had popped heroin into left buttock 1 week ago

Presents with extending necrosis and swelling over left buttock and genitalia. Has fever and rigors.
Requires multi-organ support

What is most likely diagnosis?

Anthrax
Fournier's gangrene
Gas gangrene
Type 1 (polymicrobial) necrotising fasciitis
Clostridium sordellii
A

Anthrax

Anthrax associated with injection, does not behave like normal cutaneous anthrax - so does not produce an eschar

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7
Q

What are components of anthrax toxin?

A

oedema factor
lethal factor
protective factor

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8
Q

60 year old had mtiral valve repalcement 6 weeks previously.

Presents with fever, lethargy, SOB.
Prosthetic valve endocarditis suspected.

Gram pos bacilli grown on blood culture.

What is likely organism>

Corynebacterium jeikeium
Corynebacterium striatum
Staphylococcus epidermidis
Arcanobacterium haemolyticum
Corynebacterium pseudodiphteriticum
A

Corynebacterium pseudodiptheriticum

Early prosthetic valve infection is within 60 days of implantation.

Staph aureus and epidermidis are lower risk than Corynebacterium pseudodiptheriticum.
Other Corynebacterium species and Arcanobacterium cause infections in native valves, not prosthetic valve

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9
Q

44 year old with painful discharging lesions in scrotal region over months. Some improvement with courses of flucloxacillin and clindamicin.
Swabs have grown staph aureus

On examination there is scrotal swelling with erythema, which is tender. There are discharging lesions in tunnel-like formation with normal looking skin between lesions.

What is most likely diagnosis?

Abscesses caused by PVL staph aureus
Cutaneous Crohn's disease
Hidradenitis suppurativa
Fournier's gangrene
Steatocystoma multiplex
A

Hidradenitis suppurative

Recurrent suppurating lesions in apocrine gland-bearing regions, due to disease of hair follicles

Antibiotics can be beneficial, if superadded infection. Biologics can be used to reduce inflammation

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10
Q

35 year old on chemotherapy has fever, headache, photophobia. Known to be neutropenic

CSF suggests meningitis
TB PCR neg
Gram stain no orgnaisms

CT head - NAD

What is most likely cause?

TB
Staph capitis
Cryptococcus
Candida auris
Nocardia
A

Cryptococcus

TB unlikely as PCR neg
Staph capitis only causes meningitis in neonates
Candida auris - commonly causes line infections
Nocardia - would expect pulmonary symptoms/ lesions

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11
Q

What are the two types of amoebic encephalitis?

A

Primary amoebic meningoencephalitis - due to Naegleria fowleri. Water exposure with facial trauma

Granulomatous amoebic meningoencehalitis - Acanthomoeba and Balamuthia are more insidious in onset

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12
Q

42 year old with lump on face, and outer thigh.

Recent travel to Italy last year.

Biopsy of outer thigh lesion performed

What is the most likely diagnosis?

sarcoidoisis
dirofilariasis
loa loa
penicilliosis
cutaneous TB
A

dirofilariasis

zoonosis transmitted by mosquitoes. Dirofilaria end up in humans as dead end hosts - resulting in subcutaneous nodules most commonly

penicilliosis is from SE Asia
TB is unlikely distribution
sarcoidosis unlikely
loa loa - calabar swellings have different distribution

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13
Q

30 year old with fever, weight loss, mild abdominal pain.
Travelled across all the Americas, Africa and Asia.

CT abodemn reveleaed bilateral adrenal masses which were biopsied

Histopathology - granulomatous inflammation with histiocytes
TB PCR - neg

What is most likely cause of granulomatous disease?

Dirofilariasis
TB
Histoplasmosis
Wegner's granulomatosis
Sarcoidosis
A

Histoplasmosis

distribution in adrenal glands is suspicious of histoplasma. Commonly causes pulmonary infection

dirofilariasis normally has lesions in skin

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14
Q

35 year old with enlarged cervical lymph node.

CT shows necrotic lymph node.
Has fever and weight loss

What is the cause

Kikuchi's disease
Toxoplasmosis
Lymphma
TB
Sarcoidosis
A

Kikuchi’s disease is necrotising lymphadenopathy

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15
Q
Patient with non-painful erythema of his leg.
No other focal symptoms
Observations normal.
No lymphadenopathy
CRP10

What is most likely organisms associated with this?

Staph aureus
Streptococcus pyogenes
Yersinia enterocolitica
Mycoplasma Pneumoniae
Mycobacterium tuberculosis
A

Strep pyogenes

Not cellulitis - normal CRP, no other symptoms

It is erythema nodosum - panicullitis usually of anterior shins. Associated with infection, AI conditions, IBD, pregnancy, drugs.
commonly associated with strep throat

16
Q

CF patient presents with worsening SOB.

What organism causes severe respiratory failure in CF patients

Pseudomonas aeruginosa
Staphylococcus aureus
Burkholderia cepacia
Haemophilus influenzae
Burkholderia pseudomallei
A

Pseudomonas aeurogina

17
Q

Baby with sensorineural hearing loss.
Mother serology shows recent CMV infection.
Baby saliva CMV positive PCR.

What is reocmmendation?

Refer to paediatric infectious diseases on discharge
IV gancilocivr for 2 weeks
oral valganciclovir 6 weeks
oral vanganciclovir 6 months
CMV immunoglobulin
A

oral vanganciclovir 6 months

baby has confirmed cCMV, with evidence of disease

18
Q

51 year old from Egypt presents with fever and vesicular rash that covers multiple dermatomes on his face, chest and abdomen.

Has fever. HIV neg

What is next management priority for this patient?

IV aciclovir
oral aciclovir
high-flow oxygen
positive pressure isolation
VZIG
A

oral aciclovir

likely disseminated varicella zoster
UK has temperate climate, so most people had chickenpox by adolescence. Egypt it is less common

IV aciclovir if respiratory or neurological symptoms

19
Q

Which malignancy is EBV associated with?

AML
Hodgkin's lymphoma
ALL
CML
Non-Hogkin's lymphoma
A

Hodgkin’s lymphoma

results in latent B-lymphocyte infection, with potential for induction of lymphoblastoid cell lines capable of indefinite growth

Also linked to:
nasopharyngeal carcinoma
OHL
Burkitt's lymphoma
PTLD

ALL and T-cell lymphoma associated with HTLV

20
Q

What diseases is HTLV associated with?

A

Spastic paraparesis
T-cell lymphoma
ALL

21
Q

Patient with subacute encephalitis
Has myoclonus

What are possible causes?

A

Measles - SSPE
CJD
Whipples disease - if associated ataxia

Alzheimers
Huntington’s
Wilson’s disease

22
Q

6 month old previously fit and well.
Up-to-date with immunisations

Sudden onset respiratory failure, with significant lymphocytosis

What is most likely cause

Bordetella pertussis
Listeria monocytogenes
CMV
RSV
Human metapneumovirus
A

Bordetella pertussis

23
Q

30 year old keeps tropical fish presents with violaceous hand nodules, and swollen painful lymph nodes at her elbow.

What is the best way to culture a biopsy of the hand lesion to correctly diagnose this infection?

Culture on Lowenstein-Jensen at 30degC
Culture on Lowenstein-Jensen at 37degC
Culture on Sabouraud's agar at 30degC
Culture on Sabouraud's agar at 37degC
Culture on Sabouraud's agar at 42degC
A

Culture on Lowenstein-Jensen at 30degC

Possible diagnoses are M. marinum and nocardia

Mycobacterium marinum is most likely diagnosis
This likes to grow at 30degC, and not 37degC like Mycobacterium tuberculosis

M. marinum is photochromogenic, so change from cream colour to yellow in light

Sabouraud’s agar is primarily used for fungal pathogens and Nocardia

24
Q

25 year old pregnant female presents at 30 weeks gestation, having been with a new partner for 3 months

VDRL pos
TPPA neg

What is optimal advice?

no need to screen aprtner
treat with doxycycline
treat with penicillin
do nothing, this is latent syphilis
increased frequency of antenatal ultrasound
A

no need to screen partner

VDRL can be false pos for number of AI conditions. Because it did not confirm, means there is no evidence of syphilis infection

25
Q

29 week pregnant patient has spontaneous rupture of membranes and fever. Neonate born unwell, with poor apgar scores.
Empirical antibiotics are being started.

What would you recommend?

cefotaxime
cefotaxime and gentamicin
Tazocin
Benpen + gent
fluclox + gent
A

Benpen + gent

Broad coverage.
Perform LP and tailor antibiotics depending on culture results, and local resistance patterns

26
Q

32 year old has painless rectal ulcer which has been there for 2 weeks.
Inguinal adenopathy, not uclerated.
Penile discharge

What is most likely cause?

HSV
Lice
Haemophilus ducreyi (chancroid)
Treponema pallidum
Neisseria gonorrhoeae
A

Treponema pallidum

  • Painless ulcer differential also includes Donovanosis (Klebsiella granulomatis). However, this normally bursts with slowly oozing lesions
  • Painless ulcer differential also includes LVG (chlamydia trachomatis) presents as painless ulcer, with adenopathy. (not an answer choice)

Painful ulcers:
HSV
Haemophilus ducreyi (chancroid)

27
Q

Which infections are implicated in causing foetal microcephaly?

A
Toxoplasma
CMV
HSV
Rubella
Zika
28
Q

22 year old has had 5 episodes of genital herpes over past year.
They are non-severe, and not distressed by them.
HIV neg, no immunosuppression.
Previously treated with aciclovir with good effect. She is keen to reduce the frequency of her infections.

What would you recommend for further management?

Episodic oral aciclovir 400mg TDS 5 days
Episodic oral valaciclovir 500mg BD for 3 days
Oral suppressive therapy aciclovir 400mg BD
Oral suppressive therapy valaciclovir 500mg OD
Oral suppressive therapy famciclovir 250mg BD

A

Oral suppressive therapy aciclovir 400mg BD

Eligible if 4-6 episodes per year

Specifically asking for suppressive therapy, not episodic therapy.
Episodic therapy involves starting treatment within 24 hours of symptoms - little evidence for either

29
Q

30 year gives birth to healthy baby.
Bloods on admission are VDRL/ TPPA pos, with raised RPR.

What is best treatment option?

reassure mother that lack of clinical signs means no further action
Treat mother benzathine penicillin IM, baby IV benzylpenicillin
Treat mother IV ceftraixone
Treat mother benzathine penicillin IM, baby IV ceftriaxone
Treat mother benzathine penicillin IM, baby IV cefotaxime

A

Treat mother benzathine penicillin IM, baby IV benzylpenicillin

Must treat both, as baby likely infected
IM benzathine penicillin is first line for mother
IV benzylpenicillin first line for baby, ceftriaxone is suitable alternative

30
Q

33 year old with vaginal discharge.
Heterosexual relationship. Partner is asymptomatic

Swab from cervix reveals motile flagellated organisms.

What is the organism?

Gardenerella vaginalis
Neisseria gonorrhoea
Chlamydia trachomatis
Trichomonas vaginalis
Treponema pallidum
A

Trichomonas vaginalis

TV is a flagellated protozoa
Metronidazole first line therapy

31
Q

33 year old mother presents with 7 day old baby with conjunctivitis
Swab is NAAT positive for Chlamydia trachomatis.

What is recommended treatment?

ofloxacin eye drops
azithromycin orally
erythromycin orally
IM ceftriaxone
doxycycline orally
A

erythromycin orally

conjunctivitis usually develops 5-12 days after birth

Azithromycin is first line, but avoided in children.
Doxycycline avoided in children
Ceftriaxone is for gonococcal infection

32
Q

20 year old with itchy rash, worse at night. Had beach holiday in Thailand.
Slept with two female travellers. HIV neg.
Erythematous papules on hands, wrists, umbilicus, genital area. Short wavy greyish elevations of approximately 5mm

What treatment would you recommend?

ivermectin orally
albdenazole orally
IM benzathine penicillin
permethrin 5% cream
benzylbenzoate 25% emulsion
A

permethrin 5% cream - diagnosis of scabies
Itchy at night, rash distribution, short wavy burrows on skin

benzylbenzoate no longer recommended
oral ivermectin and topical permethrin recommended for Norweigan scabies

33
Q

45 year old male has sepsis following dog bite. Washes wound on hand, but does not help

Day 2 blood culture grew gram neg bacilli anaerobic plate
No growth on blood agar

What is most likely cause?

Capnocytophaga canimorsus
Pasteurella multocida
Fusobacterium necrophorum
Bacteroides fragilis
Streptococcus pyogenes
A

Capnocytophaga canimorsus

Pasteruella is another gram neg, but would usually grow on blood agar

Strep pyogenes is gram pos

34
Q

32 year old with fever, myalgia, left sided chest pain. ECG, ECHO, troponin, CT thorax all normal.
Diagnosed with Bornholm disease

What is the cause?

Adenovirus
Echovirus
Coxsackie virus A
Coxsackie virus B
Poliovirus
A

Coxsackie virus B

Coxsackie virus A caused HFNM, conjunctivitis, and herpangina

35
Q

What does the word Echo virus stand for?

A

Enteric Cytopathic Human Orphan virus

can cause mild self-limiting rash, or myocarditis, or aseptic meningitis