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Question 1
Correct
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A 4 year old girl presents to the clinic with sore throat and a small painful ulcer in her mouth since yesterday and small painful ulcers on palms and soles that are not itchy. She is febrile (38.5 degree Celsius) and is refusing to eat for the past two days. Which of the following will be the most likely cause of this presentation?
Your Answer: Coxsackie virus
Explanation:Coxsackie viruses are a group of RNA viruses with over 20 serotypes| depending on specific viral characteristics, these serotypes are further divided into groups A and B. Infection is associated with a wide range of symptoms, which are dependent on the exact serotype. Hand, foot, and mouth disease (HFMD) and herpangina are commonly caused by group A coxsackie viruses, while pleurodynia and myocarditis are caused by group B coxsackie viruses. Both groups may cause viral meningitis, conjunctivitis, or flu‑like symptoms. Diagnostic procedures and treatment should be tailored to the specific disease manifestation. Coxsackie A :HerpanginaHand, foot, and mouth diseaseCharacteristics: highly contagiousClinical presentationGeneral symptoms: fever, reduced general conditionSkin/mucosaMaculopapular and partially vesicular rash on the hands and feetOral ulcersDiagnosis: clinicalTreatment: symptomaticPrognosis: almost always self‑limiting
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Incorrect
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A 16-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?
Your Answer: Acute mastoiditis
Correct Answer: Mumps
Explanation:Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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A 6 year old boy arrives at the clinic seven hours after having injured his hand with a metal spike. Examination reveals a puncture wound 0.5 cm deep. His immunization schedule is uptodate. How will you manage this patient?
Your Answer: Antibiotics
Correct Answer: Tetanus Ig + antibiotics
Explanation:Cleansing and debridement is paramount in dealing with tetanus-prone wounds (severe crushing injuries, piercing wounds, blisters and burns are outstanding examples, particularly if contaminated with dirt, grass or other debris).Prophylaxis then is relatively easy in persons who have been actively immunized by toxoid injections. For them, a “booster” injection is indicated. There is experimental evidence that antibiotics of the tetracycline group, given soon after injury, may have prophylactic effect against tetanus.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?
Your Answer: Hepatitis B
Correct Answer: Cytomegalovirus (CMV)
Explanation:CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Correct
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A 3 month old infant born to an HIV positive mother presented with jaundice, epileptic seizures and microcephaly. What is the most likely cause?
Your Answer: Cytomegalovirus
Explanation:Congenital cytomegalovirus infection causes: jaundice, hepatosplenomegaly, petechia, microcephaly, hearing loss and seizures.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Staphylococcus
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Correct
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Correct
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In which one of the following diseases does the patient have to be isolated?
Your Answer: Measles
Explanation:Measles and chickenpox are spread by droplets. Thus, patients should be isolated. Rheumatic fever and post-streptococcal glomerulonephritis are immune mediated diseases that don’t require isolation. Herpetic gingivostomatitis spreads by direct transmission of infected secretions to the stratified squamous epithelium. HSP is not an infectious disease.
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This question is part of the following fields:
- Infectious Diseases
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Question 9
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Toxoplasmosis
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
Incorrect
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A 6 year old presents with fever and multiple vesicles on his back. What is the single most appropriate next step?
Your Answer: Topic acyclovir
Correct Answer: None
Explanation:This clinical picture is typical of chickenpox, which is treated with antihistamines and calamine lotion. In the case of fever, acetaminophen can be used. Generally treatment is purely for symptomatic relief.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Incorrect
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Sensorineural deafness is strongly associated with which one of the following?
Your Answer: Treponema pallidum
Correct Answer: Rubella
Explanation:Primary rubella infection during pregnancy, particularly during the first trimester, can affect several organs and cause birth defects that are responsible for congenital rubella syndrome (CRS). The most common defects of CRS are hearing impairment (unilateral or bilateral sensorineural), eye defects (e.g., cataracts, congenital glaucoma, or pigmentary retinopathy), and cardiac defects (e.g., patent ductus arteriosus or peripheral pulmonic stenosis). Congenital hearing loss is the most common sequela, occurring in approximately 60% of cases, especially when infection occurs in the 4th month of pregnancy.
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This question is part of the following fields:
- Infectious Diseases
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Question 12
Correct
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. Which is the most appropriate strategy for this child?
Your Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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A 10-month-old boy is brought to clinic. His parents are concerned because two days ago, he met another child with mumps. What is the most appropriate management for this child?
Your Answer: Do nothing now but give MMR at the appropriate age
Explanation:Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Incorrect
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A 3-year-old boy was brought at the hospital by his mother due to sudden onset pyrexia with emesis and bilateral facial swelling. Upon history taking, she mentions that she brought her son to the GP who suggested analgesics for his bilateral parotid pain, 2 days ago. What would be the next step of your management?
Your Answer: Antibiotic
Correct Answer: Reassurance
Explanation:The history is suggestive of mumps. Mumps is a viral disease with initial signs and symptoms including fever, muscle pain, headache, poor appetite, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Mumps is a self-limiting condition treated only for symptomatic relief. As he currently is taking analgesics for pain relief, one should only offer reassurance.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Correct
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A 14-day-old baby presented in NICU with the signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer: Toxoplasmosis
Explanation:Maternal and fetal toxoplasma infection may be avoided by advising pregnant women to wear gloves when gardening or handling cat litter and to cook meat thoroughly. Affected babies are treated with pyrimethamine, sulfadiazine, and folic acid.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Correct
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Regarding neonatal meningitis, which of the following statements is true?
Your Answer: Has an above average incidence in babies with a meningomyelocele
Explanation:The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Correct
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A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?
Your Answer: Mumps
Explanation:Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Incorrect
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An 8 year old boy presented with easy bruising following falls. FBC showed leucocytosis and thrombocytopenia with normal haemoglobin levels. His ESR was high and Paul-Bunnell test was positive. Which of the following is the most probable diagnosis?
Your Answer: Idiopathic thrombocytopenia purpura (ITP)
Correct Answer: Glandular fever
Explanation:Glandular fever (Infectious Mononucleosis) is caused by Epstein–Barr virus (EBV). Leucocytosis rules in infectious mononucleosis and thrombocytopenia is not an uncommon association. ESR is elevated in most of the cases. Paul-Bunnell test is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).
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This question is part of the following fields:
- Infectious Diseases
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Question 20
Correct
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A 14-day-old baby presented in NICU with signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer: Toxoplasmosis
Explanation:Maternal and fetal toxoplasma infection may be avoided by advising pregnant women to wear gloves when gardening or handling cat litter and to cook meat thoroughly. Affected babies are treated with pyrimethamine, sulfadiazine, and folic acid.
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This question is part of the following fields:
- Infectious Diseases
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