RACP-ID

Question 1

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

Answer 1

b) Three consecutive sputum samples sent for TB culture

Question 2

What is the treatment of C-Diff?

Answer 2

First episode
Mild-moderate: metronidazole or vancomycin
Severe: Vancomycin +/- metronidazole

First recurrence: vancomycin or fidaxomicin
Second and subsequent recurrence: Faecal microbiota

Question 3

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

Answer 3

b) Entamoeba histolytica

can treat with ceftriaxone and metronidazole

Question 4

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

Answer 4

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