RACP-ID Flashcards
A 75-year-old Chinese man who is being treated with a TNF inhibitor for Rheumatoid Arthritis develops fevers, night sweats and a productive cough. You suspect Tuberculosis. The most sensitive test for diagnosing active TB infection is:
a) Three consecutive sputum samples sent for acid fast bacilli staining
b) Three consecutive sputum samples sent for TB culture
c) Transbronchial biopsy
d) Quantiferon Gold Assay
e) Tuberculin Skin Test
b) Three consecutive sputum samples sent for TB culture
What is the treatment of C-Diff?
First episode
Mild-moderate: metronidazole or vancomycin
Severe: Vancomycin +/- metronidazole
First recurrence: vancomycin or fidaxomicin
Second and subsequent recurrence: Faecal microbiota
A 35-year-old gentleman presents with abdominal pain and fevers after returning from a three-month holiday in India. Abdominal CT was performed which shows a liver abscess. The patient is commenced on Ceftriaxone and Metronidazole. What is the most likely organism?
a) Aeromonas veronii
b) Entamoeba histolytica
c) Salmonella typhi
d) Shigella dysenteriae
e) Escherichia Coli
b) Entamoeba histolytica
can treat with ceftriaxone and metronidazole
38-year-old male with Chronic Hepatitis B is on Tenofovir. Urinalysis reveals protein ++ and glucose ++.
Which of the following laboratory abnormalities is most likely to be present?
a) Hypocalcuria
b) Hypophosphataemia
c) Hypomagnesaemia
d) Hyperkalaemia
e) Hyperglycaemia
b) Hypophosphataemia
Tenofovir, especially the tenofovir disoproxil fumarate (TDF) form, is known to be associated with proximal tubular dysfunction, which can lead to Fanconi syndrome. This syndrome is characterized by defects in the reabsorption of phosphate, glucose, amino acids, and bicarbonate in the proximal renal tubule
A 25 year old male is diagnosed with MSSA endocarditis with a perivalvular vegetation. He is commenced on IV flucloxacillin. What is the optimal duration of treatment?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
E) 12 weeks
C) 6 weeks
If uncomplicated 4 weeks, due to vegetation 6 weeks
What is the response rate of ledipasvir + sofosbuvir in Hepatitis C genotype 1?
A. 65%
B. 75%
C. 85%
D. 95%
D. 95%
A 25 year old man is admitted with severe necrotising fasciitis. He has grown Streptococcus pyogenes in his blood culture and is started on high dose IV benzylpenicillin. Which of the following antimicrobials would you add?
A. Ceftriaxone
B. Clindamycin
C. Moxifloxacin
D. Vancomycin
B. Clindamycin
- What is the most important benefit of tenofovir alafenamide (TAF) compared to tenofovir disoproxil fumurate (TDF) in the treatment of human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS)
A) Blockade of chemokine receptor type 5 (CCR5)
B) Elimination of nephrotoxicity
C) Improved efficacy as pre-exposure prophylaxis (PrEP)
D) Limited potential for drug resistance
TAF is a prodrug, so is less in the systemic circulation and less ability to cause nephrotoxicity and less effect on bone mineral density.
- In addition to chorioretinitis, which ocular manifestation is associated with candidaemia
A) Endopthalmitis
B) Dacrocystitis
C) Iritis
D) Keratitis
A) Endopthalmitis
- A patient with a prosthetic aortic valve is undergoing a dental extraction. What prophylaxis should he receive?
A) Amoxicillin monotherapy
B) Amoxicillin-Clavulanic Acid
C) No prophylaxis
D) Amoxicillin + Metronidazole
A) Amoxicillin monotherapy
Indications for antibiotic prophylaxis against infective endocarditis
(1) Cardiac condition at high risk of IE
a. Prosthetic cardiac valve, any prosthetic cardiac material
b. previous IE, rheumatic heart disease
c. Congenital heart disease ONLY IF UNREPAIRED cyanotic defects, repaired defect with residual defects
(2) High risk procedure – dental, tonsillectomy or adenoidectomy, invasive respiratory tract procedure, involving the infection area
- A patient at high risk of HIV on PrEP. How often should HIV testing be performed?
A) After every sexual encounter
B) 3 monthly
C) 6 monthly
D) Yearly
B) 3 monthly
- In an otherwise healthy but unvaccinated individual undergoing a splenectomy, which of the follow options is the best approach to vaccination for pneumococcus?
A) Administer conjugate vaccination before procedure then polysaccharide 8 weeks later
B) Administer polysaccharide vaccination before procedure then conjugate 8 weeks later
C) Two doses of conjugate vaccination at least 8 weeks apart
D) Two doses of polysaccharide vaccination at least 8 weeks apart
A) Administer conjugate vaccination before procedure then polysaccharide 8 weeks later
- What is the most common presentation of gentamicin induced ototoxicity?
A) High frequency hearing loss
B) Low frequency hearing loss
C) Oscillopsia + vertigo
D) Ataxia + vertigo
A) High frequency hearing loss
Q2. A 53 year old woman presents with sudden onset joint pain and swelling. She is febrile with a WCC of 13. Joint
aspirate shows 103,000 WCC with >95% neutrophils. What is the most appropriate initial choice of antibiotic?
A. Ceftazidime
B. Clindamycin
C. Flucloxacillin
D. Tazocin
C. Flucloxacillin
2021
Q18. A 17 year old boy presents with group A streptococcal positive acute rheumatic fever, with arthritis,
pericarditis and a prolonged PR. What is the shortest recommended duration of antibiotics for secondary
prevention of recurrence?
A. 1 year
B. 5 years
C. 10 years
D. 15 years
C. 10 years
No carditis: 5 years or until 21 years of age (whichever is longer).
Carditis without residual valvular disease: 10 years or until 21 years of age (whichever is longer).
Carditis with residual valvular disease: 10 years or until 40 years of age (or lifelong in severe cases).
