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Question 1
Incorrect
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A patient with profuse watery diarrhoea was found to have C. difficile cytotoxin. Which of the following complications is NOT a typical complication of pseudomembranous colitis:
Your Answer: Acute kidney injury
Correct Answer: Volvulus
Explanation:Dehydration, electrolyte imbalance, acute kidney injury secondary to diarrhoea, toxic megacolon, bowel perforation, and sepsis secondary to intestinal infection are all possible complications of pseudomembranous colitis.
When the intestine twists around itself and the mesentery that supports it, an obstruction is created. This condition is known as a volvulus. Volvulus is caused by malrotation and other anatomical factors, as well as postoperative abdominal adhesions, and not by Clostridium difficile infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 2
Correct
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Regarding shingles, which of the following statements is CORRECT:
Your Answer: You can catch chickenpox from a patient with shingles.
Explanation:After primary infection, VZV remains latent in sensory ganglia and in about 20% of patients will reactivate resulting in shingles, a painful vesicular rash in the related dermatome. Shingles usually affects older people and the immunocompromised. Shingles lesions are infectious to non-immune individuals who are at risk of developing chickenpox. Shingles can not be contracted directly from chickenpox, or from other cases of shingles. Shingles is treated with systemic antiviral treatment to reduce the severity and duration of pain, reduce complications, and reduce viral shedding.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 3
Incorrect
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Which of the following is NOT a typical complication associated with mumps:
Your Answer: Pancreatitis
Correct Answer: Subacute sclerosing panencephalitis
Explanation:Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Correct
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A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?
Your Answer: Escherichia coli
Explanation:Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome.
Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Incorrect
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An elderly man with chronic heart and lung disease develops Legionnaires' disease. Which of the following clinical features is NOT typical of Legionnaires' disease:
Your Answer: Haemoptysis
Correct Answer: Confusion
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
AnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Incorrect
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Question 7
Correct
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Clostridium difficile primarily causes which of the following infectious diseases:
Your Answer: Pseudomembranous colitis
Explanation:Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 8
Correct
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Question 9
Incorrect
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Regarding meningococcal meningitis, which of the following statements is CORRECT:
Your Answer: Infection is most common in the summer months.
Correct Answer: Infection occurs most commonly below the age of 5 years.
Explanation:About half of meningococcal disease occurs in children aged less than five years, and babies are at the highest risk because their immune systems have not yet fully developed. There is a second, smaller increase in risk for older adolescents, mainly for social and behavioural reasons. Infection is most common in winter months. Antibiotics should be given as soon as the diagnosis is suspected (ideally cultures should be performed first but this should not delay treatment), and ceftriaxone/cefuroxime is the first line antibiotic. Only healthcare workers who have been directly exposed to large particle droplets/secretions from the respiratory tract of the index case should receive prophylaxis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 10
Correct
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Which of the following serology results is consistent with chronic hepatitis B infection:
Your Answer: HBsAg positive and anti-HBc IgG positive
Explanation:Disease state vs Serology
Acute hepatitis: BHBsAg, HBeAg, anti-HBc IgM
Chronic hepatitis B (low infectivity): HBsAg (>6/12), anti-HBe, anti-HBc IgG
Chronic hepatitis B (high infectivity): HBsAg (>6/12), HBeAg, anti-HBc IgG
Cleared infection: Anti-HBs, anti-HBe, anti-HBc IgG
Vaccinated: Anti-HBs -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Correct
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What is the primary route of transmission of Norovirus?
Your Answer: Oral-faecal route
Explanation:Norovirus is spread primarily by faecal-oral contact, but it can also be spread through contact with an infected person, ingestion of contaminated food or water, or contact with contaminated surfaces or items.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 12
Correct
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Bordetella pertussis causes which of the following infectious diseases:
Your Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
Incorrect
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A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?
Your Answer: Benzylpenicillin
Correct Answer: Ceftriaxone
Explanation:When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation.
The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 14
Incorrect
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Regarding Legionella species which of the following statements is CORRECT:
Your Answer: They are transmitted via the respiratory droplet route.
Correct Answer: They are Gram-negative organisms.
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
Anorexia
Legionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 15
Correct
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Regarding tapeworm, which of the following statements is CORRECT:
Your Answer: Diagnosis is by direct visualisation of characteristic eggs in the stool.
Explanation:Diagnosis of tapeworm is by direct visualisation of characteristic eggs in stool. Humans may be infected by pork or beef tapeworm. Treatment is with praziquantel or niclosamide. Specialist advice should be sought for the management of neurocysticercosis.Iron-deficiency anaemia is typically seen in hookworm infection. Threadworms migrate from the intestine at night to lay eggs on the perianal skin. Mebendazole is first line treatment for threadworms.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 16
Incorrect
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Which of the following is diagnostic for acute hepatitis B infection:
Your Answer: HBsAg
Correct Answer: anti-HBc IgM
Explanation:Anti-HBc IgM antibodies are diagnostic for acute hepatitis B infection. Anti-HBc IgG antibodies indicate previous exposure, either chronic state or cleared infection. HBsAg is also positive in acute infection but is not diagnostic as this remains positive in chronic infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Correct
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Regarding hepatitis B, which of the following statements is CORRECT:
Your Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.
Explanation:Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 18
Incorrect
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Hepatitis A is transmitted by which of the following routes:
Your Answer: Sexual transmission
Correct Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 19
Incorrect
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A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.
What is the most likely causative pathogen?
Your Answer: Neisseria gonorrhoea
Correct Answer: Chlamydia trachomatis
Explanation:Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 20
Incorrect
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Which of the following pathogens is most commonly implicated in croup:
Your Answer: Bordetella pertussis
Correct Answer: Parainfluenza
Explanation:Parainfluenza virus is the most commonly implicated infectious agent in croup.
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This question is part of the following fields:
- Microbiology
- Pathogens
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