SAMSON PLAB ACADEMY Email: info@samsonplab.co.uk Tel: 07940433068 Address: Bow Business Centre 153-159 Bow Road London E32SE INFE EASES TURE NOT! a TOPICS: Causative Agents Hepatitis HIV AIDS Epstein Barr Virus Herpes Virus Varicella Zoster Cytomegalovirus ‘oo Brucellosis 40.Listeria Monocytogenes Ww 14.Pneumonia QO 12. Tuberculosis 13.Lyme Disease ‘ 14.Typhoid Fever \ 15 Streptococcal infections 16.Staphylococcal:] infections 17.Scabies | ( ' 18.Leishmani - ‘ 19 Schistosoi 20.Malaria 21 1 Toxoplasmosis ) ©OPNOMAeNS Infectious diseases plab 1CAUSATIVE AGENTS 1. Viruses 2.DNA viruses — papova/ adeno/ human herpes/ pox/ hepatitis B 3.RNA viruses — reo / picorna / toga / rhabdo / other hepatitis viruses 1 Bacteria 1.Cocci: i, gram +ve: staphylococcus / streptococcus / enterocootad ii, gram —ve: \neisseria meningitis)/ moraxella catarrhalis + Rods: ‘ YY a.gram +ve anaerobes: clostridium / actinomyces b.gram +ve aerobes: bacillus anthracis / comebatterium diptheria / listeria monocytoges'/ nocardia c.gram -ve: enterobacterias (e:coli/, shigella tthonella , Klebsiella) / pseudomonas aeruginosa / haemophills. influenzae / brucella/vibrio cholerae / campylobacterium jejuni. /'bordetela pertusis y & 1. HEPATITIS (A, B, C,D, 5) All are RNA viruses exept Bwhich is a DNA virus * Incubation period = 2-6 wks Investigations: + IgM antibody to Hepatitis A suggests acute infection’ + IgG'antibody to Hepatitis A persists for many years) + Prevention: active immunisation — vaccination for travellers, give three 2 Infectious diseases plab 1months protection passive immunization IgG.(Exposed to infection) + Treatment: supportive / avoid alcohol or any hepatotoxic drug / interferon « for fulminant hepatitis (peglated « 2a) Hepatitis B: + Spreads through blood products, IV drug abusers, and homosexuals’ Serological Markers: Aa < Antigens: + The presence of HBeAg implies high infectivity. (.(p\ 20>) * Persistence of HBsAg for >6 months defines carrier status Antibodies €. e — Anti-HBc IgM indicates acute infection ° Antibodies to hepatitis B core antigen (HBcAg) - ie anti-HBc - imply past infection \ e Antibodies to HBsAg/- ié anti-HBs - alone imply vaccination. 9 M~ recenh> =SurRORe s er Py . * Complications: Y y Fulminant hepatic failure (rafe) fy -an 8 Chronic hepatitis J | § * Cirrhosis (5-10 yrs)“, vate» ye . joma (HCC) —> 10\fold’t if HBs Ag is +ve; Hepato -cellular + Vaccination: ‘ Live attenuated virus © y assive: Anti-HBV Ig to non-immune contacts after high-risk Gey) exposure (scratch, bite, needle injury, baby of HBV +ve mother) + Treatment: Supportive - avoid alcohol In chronic HBV — Antivirals (Lamivudine / ribavirin) / adefovir), interferon’s; Infectious diseases plab |+ Incubation period — variable + Spread: IV drug abuse, sex, blood transfusions + Early infection: mild or asymptomatic + 35%: chronic infection + 20 %- 30 %: cirrhosis in 20 years time * Few — HCC Investigation: * HCV ron Hepatitis Di \ * Only coinfects with Hepatitis B infection wd + Investigation: Anti-HDV antibody Hepatitis E: a + Faeco- oral, * Causes acute hepatitis similar to Hepes A Increased mortality in pregnancy, Ve) + HIV type’’is responsible for most cases + HIV type 2'seems to have longer latent period’ + In the UK, hote commonly heterosexually acquired than homosexually + Transmission: Sexual 75%, infected blood, IV drug abuser , perinatal . 5 ical) route ¢ + Immunology: HIV binds to CD4 receptors on: + T lymphocytes(via gp 120 enveloped glycoprotein) + Monocytes + Macrophages + Neural cells) ()¥.’) (D4 +ve cells migrate to the lymphoid tissues where the virus 4 Infectious diseases plab 1replicates — producing new virions — infect new CD4+cell=> impaired function CD4+ve cell immune dysfunction The number of circulating viruses are referred to as viral load! > predicts onset of AIDS and also used for monitoring treatment ‘Stages of HIV: 1.Acute Infection: often this stage shows no symptoms 2.Sero-conversion: transient illness (2- 6 weeks after exposure) Fever, malaise, rash, pharyngitis, myalgia, meningo — engerhalitis (rare) 3. Stage of Lympadenopathy: Lymphodenopathy >tan in diameter, >/- 2cm in extra inguinal region, 4 Be SAE ee NAAR 4 5. AIDS) ’ cy ‘ACQUIRED IMMUNODEFICIENCY SYNDROME (D4 count sual SSDS ret Jergsente of indicator disease So=a200) re Prodrome of AIDS: a4 Related complex — ca symptoms 1.Pyrexia 2.Night sweats =<" 3.Weight loss“ 4.Diarrhoea — +/- Minor ©p| Nortunistic infection, oral candida, (oral hairy leukoplakiay) herpes 70S veourenbiSty seborrhoeic dermatitis, tinea infections. Si ‘ ~ HIV- antibodies by ELISA, usually confirmed by western blot (Window period 1-3 weeks after exposure) P24 Ag (earliest but not routine nearly 2 weeks) HIV RNA (viral load) — by PCR done to monitor treatment Prognosis - about 2 years if untreated Infectious diseases plab 1All patients who have newly diagnosed with HIV should have: 1.Tuberculin test 2.Toxoplasmosis test 3.CMV test 4.Hepatitis Band C” 5.Syphilis serology’ Tests 1,283 are used to identify past or current infection that may develop as immunosuppression progresses. Tests 4&5 are to test for coinfections of HIV (because of same mode of transmission), *COMPLICATIONS OF AIDS: Cryptosporidi ium © Signs & Symptoms: profuse cee seo RUQ pain, vomiting Investigation: Stool analysis < Treatment: No specific therapy’ usually responds spontaneously. Ds ‘Treat the underlying i u with highly active antiretroviral therapy. } Cryptococcus Meningitis < \ Signs & Symptoms:. Headache +/- meningism signs, seizures, confusion: ” Investigation: India ink stain of CSF, serum antigen. Treatment: Candida ( Signs & Symptoms: Curd-like white patches in the mouth. May also have marked erythema and soreness. Treatment: (Nystatin suspension. Second choice is oral (fluconazole. | Oesophageal candadiasis Signs & Symptoms: Dysphagia +/- retrosternal discomfort Treatment: (Oral fluconazole] is first line. Second choice is IV fluconazole. Infectious diseases plab 1Pneumocystis Jerovocii (Carini) HIV patient with dry cough is always Pneumocystis Jerovocii until proven otherwise. Proomerahs carinis > Raepmeniel Signs & Symptoms: |Dry cough] exertional dyspnea, tachypnea,fever, chest pain Investigation: PCR, chest x-ray (peri V Treatment: {Hi azole (trimethoprim/ sulfamethoxazole) ITM PAS Ae ) If CD 4 count <200, start prophylactic co-trimoxazole Signs & Symptoms: Presents like a _se2ed boupying lesion, progressive headache, seizures, confusion “»» Y) Investigation: CT (ring enhancing lesion)) > y Treatment: X (> Post-exp Hepatitis A + Human Normal immynogi \ebutin (HINIG) or hepatitis A vaccine: may be used ones oe on the clinical situation + HBsAg positi source: if the person exposed is a known ce BV vaccine then a booster dose should be given*Ifthey are in the mosessonmsinewacsiaaten or area + acombination of as soon as possible (i.e. ‘emtricitabine, lopinavif.and ritonavir) Within 1-2 hours, but may be started up to 7: exposure) for 4 weeks Infectious diseases plab 1+ serological testing at 12 weeks following completion of post- exposure prophylaxis + reduces risk of transmission by 80% Varicella zoster + \VZIG\for IgG negative pregnant women/immunosuppressed- Estimates of transmission risk for single needlestick injury: Hepatitis B_ 20-30% A Hepatitis C 0.5-2% HIV 0.3% Skin lesions may be nodular, a ee they may be red, purple, brown or black. (cmv. Causes Encephalitis and retinitis, Investigation: PCR v Treatment: mnie HIV patient with {productive cough.is always TB until proven otherwise— S O [EPSTEIN-BARR VIRUS! 2 i *~ Cafyeatise: ‘) + Lymphoma * Nasopharyngeal Carcinoma * Oral hairy leukoplakia, + Leiomyosarcoma * Common in young adults jlandular Fever): Infectious diseases plab 1+ Also known as Ki: * Incubation period 4-5 weeks * Self limiting infection Symptoms: * Sore throat + Fever * Anorexia + Lymphadenopathy (especially cervical) g + Palatal petechiae SN) + Splenomegaly y + Hepatomegaly A J * Haemolysis \ ” Investigations: + Lymphocytosis - nearly 20 % of White Cell couht (wer) Treatment: Supportive , sterol Sif tonsillitis is severe and S. athing difficultic NO IN MONO a patient with infectious + Meningitis : paeenat OC ) * Cranial Ni Nien (VII) + GuilliarsBarre Syndrome Spleen . Erythlen a multiforme Infectious diseases plab 1Herpes Simplex Virus Type 2/- causes multiple painful:genital ulcers’ (usually HSV 2) Herpes Simplex Type 1: * Gingivostomatitis : mouth ulcer, + Herpes Labialis: cold sores. Treatment: Topical aciclovir + Herpetic Whitlow; vesicle formation on the fingers ‘ops because it causes blindness. 7 y reset topical aciclovir + Herpes Simplex Virus Encephalitis: fever, fits, headaches; ‘odd behaviour, dysphasia, hemiparesis & spread centripetally) Investigation: PCR on CSF (urgent) XS InvestigationSwab the lesions. ¥ ¢ ) Incubation period: 1-2 days) ad Symptoms: ) + Fever y + (Crop: y starting on the back then to chest. Infectivity: 4 he rashy until all lesions are scabbed (crust) sew Remains dormant in the dorsal root ganglia — reactivation due to illness or immunosuppresion > Shingles (pain in dermatomal distribution which is unilateral and painful) NB. \Shingles cannot be transmitted unless the person who \fia3 been exposed has never had chicken pox before. TREATMENT FOR VARICELLA ZOSTER (CHICKENPOX): * Refer to specialist if it affects special system (ex. eye) or if _Pregnant (Aciclovir should be prescribed by a specialist) 24 hours if >12 years, immunocompetent to reduce duration and severity of symptoms 10 Infectious diseases plab 1+ IVacyclovir if immunocompromised, <28 days, or >80 years _ PROPHYLAXIS FOR VARICELLA ZOSTER (CHICKENPOX) * Give varicella IgG if 6 Neonates whose mothers develop chicken pox in the last ‘seven days or soon after delivery ° Women exposed to chickenpox Rien GRS _ especially in the first 20 weeks and those near-term ° Immunocompromised individual ¢ m TREATMENT FOR HERPES ZOSTER (SHINGLES): ¢ + Acyclovir oral within 3 days of onset of ynptoms can reduce severity and duration of pain + Pain’ Paracetemol” - Antidepressants (amitryptylline) or antiepileptics (gabapentin) + Conjunctivitis — beware iritis — feguler acuity check, acyclovir 3% ointment. Refer to c aasnpalieaieeic 2 ‘CYTOMEGALOVIRUS | Dy Spread through direct conta lood transfusion, organ transplantation Causes infections Grinchocompromsed patients eg. HIV patients, patients after Invesitins Serology, PCR, culture band cmv ment: Immuno-compromised mill. j wv JS Complications of CMV * Retinitis * Pneumonia * Hepatitis * Colitis Prevention: Use antiviral medications eg. Ganciclovir in patients undergoing organ transplant 11 Infectious diseases plab 1BACTERIAL INFECTIONS BRUCELLOSIS" It is a zoonosis meaning it is acquired from animals through animal contact, droplet inhalation, unpasteurized goat milk especially in:the Middle East, Far East, Bosnia ‘Typical history is a patient who traveled or worked ‘in a(farm|areas. * B. meletensis— sheep / goat w\ * B. suis — pigs <> * B.canis—dogs * B.abortis —> cattle Symptoms: indolent & last for years * Pyrexia of Unknown Origin y + Sweat, malaise, anorexia, weightloss + Hepatosplenomegaly Lv * Rash »¥ * Constipation oy + Myalgia, arthritis, spinal tenderness, bone pain Investigations * Blood culture”) + Serology ‘anti —O polysaccharides Abs) : Rose. Bengal test — screening i Complication: Osteomyelitis Treatment: Doxycycline + Gentamycin + Rifampici Source: pates, raw vegetables, unpasteurized milk & soft cheese 12 Infectious diseases plab 1Symptoms: + Flu-like illness Qo rooke + Pneumonia confuse. gover + Meningo-encephalitis sogt cheese * Ataxia + Rash — especially in immuno-compromised * Pregnant— miscarriage or still birth Investigation: Blood culture, CSF, amniotic fluid (neonatal sepsis) Treatment: Ampicillin’ + gentamycin. (if ae jic, give romycin) / NB. Listeria monocytogenes SS Patients[above 50 years of age. TUBERCULOSIS: a) Caused by Mycobacterium tuberculosis : History: Asia, Africa, Tuberculosis is More common in n Africa. Symptoms: zombia, 2ehegh! di, § * Weight loss ey * Night sweat "Cg i cop ps adi > 3 at) + Haemoptysis Screenin: | est Xray ile looking for dormant foci: Sputum seta for Acid Fast Bacilli_ Nosis . mins Acid Fast Bacillijin clinical samples like sputum, pus, urine PCR), CSF (PCR), ascites, * Culture: use the Lowein-Stein Jenson medium + Histopathology (biopsy) — Caseating granuloma * Radiology: CXR — consolidation, cavitation, fibrosis, calcification + Immunological: Tuberculin skin test (not in UK) Should be read between 48 and 72 hours after administration Interpretation: Depends on measurement in millimeters of the induration, and person’s risk of being infected with TB and of progression to disease if infected 13 Infectious diseases plab 1Treatment of Pulmonary TB: Initial phase (2 months): Rifampicin, isoniazide, pyrazinamide, ethambutol Continuation phase: (4 months) Rifampicin & isoniazide Done as Direct Observation of Treatment (DOT), Isolation A)’ Done in patients with suspicious chest x-ray, past history of MDR-TB (multi drug resistant TB) SaynGsc rica ASS Termination of isolation: dsY After 3 or more -ve sputum sons on a stains for MDR- TB * Fatigue + Chills * Fever * Headache * Muscle & joint pain Complications * Cranial nerve palsy, (eocial) 14 Infectious diseases plab 1+ Lymph adenopathy Myocarditis Investigation: Blood tests are not necessary, it is a clinical diagnosis. But if the question asks for investigation, do serology. If — ve do PCR. ig seralagy(-) ~b do PCR. (ona) ‘Treatment * Doxycycline is the first choice, * Cefuroxime if both are contra-indicated and no > ety to penicillins + If pregnant or <12 years: Amoxi in or cefuroxine S" 10. TYPHOID FEVER. Caused by salmonella Symptoms — e + Fever ( x * Relative bradycardia (increase in Jemnperature without corresponding increase in heart rate) y * Rose spots on the abdomen “ ) Investigation: * Midaltest (ecloy nf X S ‘STREPTOCOCCAL INFECTIONS (om a) CELLULITIS — Infection of the skin. Commonest cause is Streptoccus, occasionally caused by Staphylococcus Signs & Symptoms: * Fever + Affected area is red, warm to touch * POORLY demarcated borders Infectious diseases plab 1‘Treatment: 1.If localized limb infection and no evidence of systemic upset give oral antibiotics. (Flucloxacillin + penicillin 21f systemically unwell, admit !and e IV antibiotics: flucloxacillin+ penicillin OR co-amoxiclav b) ERYSIPELAS: g ‘Streptococcal infection limited to more superficial parts of the skin Signs & Symptoms: { + Affected area is red, warm to touch ¢ + CLEARLY Yemarcated borders) i Treatment: Oral phenoxymethylpenicillin” C) TONSILLITIS” X Commonest cause is infectious mononucleosis. If bacterial infection will have pus. V h Signs & Symptoms: + Sore throat Y * Pain on swallowing , * Fever . + Enlarged hyperaemie tonsils with white exudates/ pus (bacterial) c~ Treatment:/Penicilii V} ¢ D) SCARLET FEVER, ae infection causing diffuse scarlet rash usually neck, chest, ind groin. Signs & Symptoms: + Rough sandpaper like skin (due to occlusion of sweat glands) Treatment: Penicillin. If allergic give Erythromycin. — 16 Infectious diseases plab 1F)|NECROTIZING FASCIITIS | Serious condition requiring prompt surgical attention. Rapidly progressing infection, spreads along fascial planes. Patient is usually septic and there is often multiorgan failure if treatment is delayed. Cause: Commonest B haemolytic streptococcus: Clinical Features: oN) * Could be recent trauma or surgery 2” + It may complicate chickenpox’ ~~ + Erythema/redness, necrosis, pus discharge \ + Fever, tachycardia, Investigations: * Swab and blood culture: + X-ray shows gas in the soft tissue, but may, be formal Treatment: Urgent surgical debri henettis the main treatment. Resuscitation with IV fluids, sant ics (penicillin & clindamycin) *Fournier’s gangrene - afipleteenionesen Sin S. aureus (Coaulase -ve) Hiiphiyifettiousssyperfica skin infection caused by Staphylococcus (may algo:be'caused by Streptococcus){‘Common in childreh}”” Clinical Features + Lesions usually start around mouth, and nose spreading rapidly on the face and other parts of the body. * Usually there are irregular{golden-yellow crusted lesions)in streptococcal infections - * Staphylococcus may cause bullous impetigo with a bulla-containing pus 17 Infectious diseases plab 1Treatment: Oral flucloxacillin or topical fusidic acid a. ‘STAPHYLOCOCCAL SCALDED SKIN SYNDROME Caused by Staph aureaus. Causes separation of the outer layers of the epidermis which slide off with minimal pressure leaving large ‘aw areas resembling a severe scald. Common in children. . ) a\ » a. OSTEOMYELITIS: Infection of the bone, common in children ahd \immunocompromised patients. Signs & Symptoms: Bone tenderness, fever, redness, swelling Treatment: IV clindamycin v SiH cell pscimonelia yy a. May develop on previously normal)heart valves as well as on diseased or prosthetic valves. ve hea * mur fhe A’ sever Signs & Symptoms: Fever + new murmur:is infective endocarditis until proven one XY od colly@s Treatment; Benz)! penicillin SO \y a Occurs particularly in immunocompromised patients and in IV drug abusers. Signs & Symptoms: High fever Treatment: IV Flucloxacillin’ a ‘TOXIC SHOCK SYNDROME Caused by S. Aureus._Common in women who_use_tampons, during menstrual period: May occur after surgical operations, burns, trauma, or 18 Infectious diseases plab 1local infections Signs & Symptoms: + High fever * Generalised rash * Confusion + Diarrhea +(Renal failure) * Hypotension Treatment: IV Flucloxacillin, refer to ICU ‘ jethicillin resistant Staphylococcal Ypically a \hospital-acquired infection} ening feumonia, septicaemia, wound infection and death. y” Prevention ¥ + Isolate patient with suspected MRSA’ + Wash hands before seeing patients + Screen patients for MRSA’). « Use gown and gloves wi beri dealing with infected or colonized patients + Take surveillan atients and staff during MRSA’ outbreaks “NS ‘CLOSTRIDIUM INFECTIONS ‘Gramtve anaerobic infections a) TETANUS’ Caused by Clostridium tetani (gram +ve). Spores are usually found in the soil and animal faeces and are transmitted when they contaminate the wound, The spores produces an exotoxin (tetanospasmin) which blocks the nerves in the CNS causing spasm and rigidity. Cesitolonad 19 Infectious diseases plab 1Acute fatal disease common in Asia, Africa and South America. Very rare in developed countries. Clinical features * Stiffness of masseter muscles causing difficulty opening mouth (trismus, ‘or lockjaw) + Spasm of chest muscles (may restrict breathing) + Abdominal rigidity + Stiffness of limbs Z * Forced extension of the back (opisthotonus) } + Fever is common ,* * Penicillin + metronidazole + Diazepam for spasms * Tetanus immunoglobulin (Ig) Prophylaxis’ Depends on the 1) wound and ofeiahus status of patient + Wound may be classified as ¥ Tetanus prone: « tet caper ey with soil or faeces: . patient presents after 6 hours) * Puncture wounds and animal bites: + NB. + DO NOT gor PATIENT HAD PREVIOUS SEVERE REACTION ‘REGARDLESS OF IMMUNISATION STATUS. )Full immunisation course: * Initial course (3 doses in infancy) + 2 boosters (4 years and 14 years) When to give the vaccine after a wound: a.Fully immunised patient (5 doses): No vaccine b.Initial course incomplete or boosters not up to date: Give vaccine now and refer to GP to complete full course of vaccination 20 Infectious diseases plab 1¢.Not immunized or immunisation status unknown or uncertain: Give vaccine now refer to GP to complete full course of vaccination Antibiotic Prophylaxis + Not required for most wounds. * Give antibiotics in open fractures’ (penicillin + flucloxacillin), hand wounds, mouth wounds, human bites, animal bites, contaminated wound, puncture wounds, patients present after 6 hours. b) BOTULISM: leans) ~ b sin gach Exotoxin paralyses the autonomic and motor nerves wy blocking Acetylcholine at the neuromuscular junction. Infection from eating te res rt with C. Botulinum spores. ‘> Clinical Features: wy + Dry mouth ¢ * Cranial nerve palsies (ptosis, squirt Coma r + Limb weakness c) GAS G: Caused by Rapidly spreading infection of muscles. Fatal if untreated. « involve wounds of the buttocks, amputations for vascular disease or gtinshot wounds. Clinigal Features: + Sudden severe pain at wound site * Sweating + Fever * Swelling and discolouration around wound Investigations: * Xray shows soft tissue gas 21 Infectious diseases plab 1+ (Swab of wound discharge? Treatment: IV Penicillin + IV clindamycin c) PSEUDOMEMBRANOUS COLITIS — Caused by C. Difficile. ‘Also known as Clostridium difficile-associated diarrhoea/disease (CDAD), CD-positive diarrhoea, antibiotic-associated colitis. Risk factors’ ) * Prolonged courses of antibiotics or multiple antibiotic usage * + Increasing age, severe comorbidity + Nonsurgical invasive gastrointestinal procedur * Increasing duration of hospital stay, patients j in long term care facilities. + Immunocompromised patient Clinical Features: + Symptoms usualy between Sand 10 ays ater antbiotc therapy May occur up to10 weeks after: * Watery diarrhoea + blood-stained slools, abdominal cramps, fever * Severe cases: rigors + septicaémia. +» Severe abdominal pain is uheommon but may mimic an acute abdomen. + Frank rectal Heng ages other causes (eg. inflammatory bowel disease). x Investigations: Gg ifficile toxin in stool (Stool cytotoxin test) ( Treatment: .. * Stop offending antibiotic if possible + Give oral metronidazole, + Use oral ‘in if severe ? ) TRAVELLERS DIARRHEA + Most common cause is E. coli) ks. = Illness lasts 3-5 days with nausea, abdominal cramps, watery diarrhea with no blood 22 Infectious diseases plab 1Treatment: Oral hydration ‘Giardiasis * Causes chronic diarrhea (>14 days) + Suspect Giardiasis in any diarrhea lasting more thar 14 days|~ + Caused by Giardia lamblia * Spread by feco-oral route. * Investigation: Stool microscopy, for cyst * Treatment: Metronidazole ¢ Cholera’ \ Y + Profuse rice-water diarrhea, vomiting, fever, abdathinal * Caused by Vibrio cholera Ky + Uncommon in Western nation, usually after aston offi seafood + Treatment: Self limiting disease but tetracycline may be used « If diarrhoea presents with blood(gossble causes are = dysentery, shigella, A, Supls nko Bacterial Dysentery + Usually caused ely hal) + Feco-oral transmissi6n) @ + Usually causes.blaody diarrhea * Treatment: > >” . + Couggadby tamoet * Gu Se intermittent diarrhea +/- blood in stool Risk factors: Homosexuals, and patients with recent travel to third world countries, + Investigations: Stool culture and microscopy for amoebic cyst + Treatment: Fluid replacement, metronidazole’ OTHER INFECTIONS 23 Infectious diseases plab 1Caused by the mite Sarcoptes scabei. Clinical Features + Most often found in fingerwebs and flexor aspect of the wrist. + Intense itching (allergy to toxin produced by the mite) * May form burrows in between fingers + Commonly found in nursing homes * Usually spreads in families Treatment: ‘ 1. Permethrin or malathione. \ 2. Oral antihistamine for severe itching. 2. LEISHMANIASIS ) + Granulomatous disease caused by the protozoa Leishmania + Transmitted by the (sand fl “India Middle East, Mediterranean, Latin America and Southern USA \/ Types: O, » 1.Cutaneous Leishmaniasis 2.Mucocutaneous Leishmani 3.Visceral| Leishmaniasis. is 1.Cutaneous: Leishmaniasis - lesions develop at the bite from an itchy papule whi h crusts and falls off to leave an ulcer} Heals with’ ‘ascar. j Culture and microscopy of aspiration from - 4,.Mucocutaneous Leishmaniasis - may spread to mucosa of nose (called (espundia), pharynx, plate, larynx and upper lip. Causes severe scarring. Investigation: Leishmanin skin test, antibodies or PCR Treatment: Sodium stibogluconate 1.Nisceral Leishmaniasis also called\Black Sickness|- spreads via the 24 Infectious diseases plab 1lymphatics from the skin and multiplies in the reticuloendothelial system. Presents with dry warty ‘hypo pigmented skin lesions, pyrexia, sweats, arthralgia, abdominal pain, hepatosplenomegaly, lymphadenopathy. Investigation: Microscopy of lymph nodes, bone marrow or spleen Treatment: Liposomal amphotericin B is the first line. Can also use miltefosine. 3. SCHISTOSOMIASIS — Causative organisms: + Schistosoma japonicum . Schistosoma mansoni + Schistosoma{haematobiury - oa irinary tract infection which increases risk for bladder carcinoma ) Usually there is history of of wave toto tes an smming i, (rivers. sonia Ps Signs & Symptoms: Earliest symptom may be swimmer’s itch) homwiur eo Complications: Increased risk, of-bladder cancer with S. haem < Pasa falciparum . esponsi le for severe disease and malaria-related deaths. \eubation 7-14 days (up to 1 year if semi-immune); most travellers present within 8 weeks. 7 Gassatmarealh ona subtertif periodicity (paroxysms at 48- and 36- hour intervals) are now rare, + Plasmodium Vivax’ ° Causes benign tertian malaria - fever every third day. » Incubation period of 12-17 days. ° Relapse due to dormant parasites in the liver. 25 Infectious diseases plab 1+ Plasmodium ovale + Relapsing course as with P. vivax. + Incubation period of 15-18 days. + Plasmodium malaria * Causes benign quartan malaria - fever every 4th day, (not common in early infection) * Long incubation period (18-40 days) Parasites can remain dormant in the blood. 5-10% present over a year after infection Signs & Symptoms + Fever, often recurring * Chills & rigors * Headache, cough, myalgia \ + GI upset. \ + Splenomegaly & hepatomegaly LS + Jaundice > bdominal tenderness: ) Signs of severe disease (usually. falciparum) * Impaired consciousness" + Shortness of breath \ + Bleeding Jy ” + Fits f + Hypovolaemia y? + Hypoglycaemia + Renal failure + Nephrotic oma Complicatio Investigation:| d thin blood film! eal lon: (thick nd thin TREATMENT OF NON-FALCIPARUM MALARIA: Ps loroquine + P. Vivax and ovale: Chloroquine and primaquine + Prevention of relapse: primaquine Cerebral malaria - 20% mortality TREATMENT FOR UNCOMPLICATED FALCIPARUM MALARIA” 26 Infectious diseases plab 1+ Oral quinine + doxycycline. Give sugar because quinine will lead to TREATMENT OF SEVERE OR COMPLICATED FALCIPARUM MALARIA + IV quinine is first-line. ECG monitoring is required. * Switch to oral quinine once patient is well enough to complete a 5- to 7-day course in total, * Give Doxycycline (clindamycin for pregnant women) for-a:total of 7 days from when the patient can swallow, < } PROPHYLAXIS: ~~ + Take 1 week before travel up until 4 weeks after return._\ * Not a guarantee against infection + Medicine depends on the area of travel + No chloroquine resistance areas, give Chlofod + Moderate chloroquine resistance aréas) give Chloroquine plus proguanil (include folate in pregnancy), ~~ + High choloroquine resistance areas give Quinine + doxycycline + In pregnant patients give Quinine ‘clindamycin 5. TOXOPLASMOSIS, \>y" The cause is Toxoplasmosis gondii and is usually acquired from cat faeces’ through the feco-ora fu . 50% in UK are\affected (presents only when immunocompromised especially with HIV) Cr head ngenarcinglesons Cah Treatment: Pyrimethamine + sulfadiazine Tape worms; Tape worms are made up of repeated segments called proglottids; Cysticercosis 27 Infectious diseases plab 1* caused by Taenia solium (from pork) and Taenia saginata (from beef) + management: eras caused by the dog tapeworm Echinococcus granulosus + life-cycle involves dogs ingesting hydatid cysts from sheep liver * — often seen in farmers” C : + may cause liver cysts ny management: albendazole ) eheparenscmeszin a Two main form of this protozoal disease are recognised - Afric trypanosomiasis (sleeping sickness) and lamnagpsereanss (Chagas' disease) Two forms of African trypanosomiasis, \di’sleeping sickness, are seen - Trypanosoma gambiense in \West)Africa and Trypanosoma rhodesiense in East Africa. Y \ Management “) + treatment is most effétive i in the acute phase using azole or nitroderivatives suchas benznidazole or nifurtimox * chronic disease mahagement involves treating the complications % e.g., heart failureLeprosy NS ) « Leprosyis-a granulomatous disease primarily affecting the peripheral newey and skin. It is caused by Mycobacterium leprae. Features + patches of hypopigmented skin typically affecting the buttocks, face, and extensor surfaces of limbs sensory loss) The degree of cell medi a patient will develop. ated immunity determines the type of leprosy 28 Infectious diseases plab 1High degree of cell mediated immunity > tuberculoid leprosy (‘paucibacillary') + limited skin disease + asymmetric nerve involvement Management + triple therapy: rifampicin, dapsone and clofazimine Or FUgAS < Genital warts (also known as condylomata accuminata) area common cause of attendance at genitourinary a They are caused by the many varieties of thed Kuan papilloma virus HP, especially types 6 & 111. It is now well-established that HPV (primarily types 16,18 & 33) predisposes Lo paces cy Features + small (2 - 5 mm) fleshy protperances which are slightly pigmented ¥ * may bleed or itch y +) Management yy 0.05 + topical jor cryotherapy are commonly used as first line treatments depending on the location and type of lesion. Mi Maftiple, non-keratinised warts are generally best treated, with’ ‘topical agents whereas solitary, keratinised warts resp nd-better to cryotherapy iMiquimod is a topical cream which is generally used second . Vv E. Plasmodium falc; we 2. A45 years old pati ada with palpable cervical lymph’ nodes and has , fever low grade. What is the single most appropria' te iagnosis? v® Lm B 7 D. Brucellosis E. Plasmodium falciparum 5 prece 3. A 40 years old patient working in a| in South America comes with (splenomegaly and{fever) What is the single most appropriate diagnosis? diqore «oh A. LymphomaB. TB C. Lyme AD) Brucellosis E. Plasmodium falciparum 4. A45 years old patient who just returned from Zambialhas _, A and splenomegaly. What is the single most ¢ ¢ appropriate diagnosis? > A. Lymphoma B. TB C. Lyme D. Brucellosis E.) Plasmodium falciparum since 10 years, takes ingle most likely 5. A patient with long history 0: >\-pcimetidine but no relief. What i is complication? A. Plasmodium Vivax. ” B. Plasmon Qvale 7© Lymph felicoeac! ere 6. ie ‘years old pregnant woman who is in her last trimester of preghancy, & her husband is infected with varicella. What is the Single most appropriate management? A. Oral acyclovir B. IV acyclovir C. No treatment required at present “@) Varicellalg pop \oxs 2Cc E. Quarantine 7. A boy who is taking steroids for asthma got chicken pox. What is the single most appropriate management? 4) A. Oral acyclovir , “ . / (BD IV acyclovir ~ C. No treatment required at present < {Cy D. Varicella Ig E. Quarantine 8. A child having lymphoma/leukaemia, his fades Shingles What is the single most appropriate managemént? A. Oral acyclovir B. IV acyclovir » ’ C. No treatment required at ha) “(DD Varicella Ig (pre ver 1 ~ E. Quarantine 9. A10 years old oy Is ra developed chicken pox. He has a sister who has idneyytr ansplant & is returning from hospital. What is the sit ost appropriate management for his sister? A. O1 iclovir B.A ia lo treatment required at present SS Varicella Ig ) Le Quarantine (no comact yet) 10. 80-years-old man develops ophthalmic shingles. What is the single most appropriate management? A. Oral acyclovir/@®) IV acyclovir C. No treatment required at present D. Varicella Ig E. Quarantine 11. An 8 years old boy has developed vesicles all the over the body & also has high fever. What is the single most appropriate management? ’ A. Oral acyclovir And B. IV acyclovir : /(C) No treatment required at present D. Varicella Ig 4 E. Quarantine » V y 12. A 40 years old woman with, wesicles on small part of the chest. What is the single most appropriate management? a) (BK) Oral acyclovir (s\ B. IV acyclovir C C. No teoaty Fequired at present Dz. Varicella’ ie" y E, Qrapine 13. & ‘29syears-old man with human immunodeficiency virus (HIV); Who is taking antiretroviral drugs and has a falling T cell count, presents with a two-day history of herpes zoster rash over \Athe C8 dermatome. What is the single most appropriate ) ‘management? (A) Acyclovir (intravenous) B. Acyclovir (oral) C. Amitriptyline (oral)D. Co-amoxiclav (oral) E. Dihydrocodeine (oral) 14. A 19-years-old woman presents with a herpes zoster rash over the L4 dermatome. The rash is itchy but not painful. What Ak is the single most appropriate management? A. Acyclovir (intravenous) / (B) Acyclovir (oral) C. Amitriptyline (oral) a D. Co-amoxiclav (oral) AD ») . . aoNy E. Dihydrocodeine (oral) \) \ 15. A 59-years-old man presents witl a herpes zoster rash affecting all three divisions of the7tigeminal nerve. He has severe conjunctivitis and catMagt ‘lose his eyes. What is the single most appropriate m: ment? A. Inoxuridine paint B. Paraceti C. Predi Vian D. & up vratic treatment N Gident referral to ophthalmologist ‘An 80-years-old woman presents with a painful herpes \Paoster rash, which appeared yesterday on her trunk. What is the ) single most appropriate management? Y® Acyclovir (intravenous) (or 80) B. Acyclovir (oral) C. Prednisolone (oral)D. Symptomatic treatment E. Urgent referral to ophthalmologist 17. A55-years-old woman present with severe post herpetic neuralgia following an episode of ophthalmic herpes, which occurred six months ago. Co-codamol tablets are not relieving the pain. She is desperate for something to control the pain at night. What is the single most appropriate management? A. Acyclovir (intravenous) B. Acyclovir (oral) . Y@® Amitriptyline (oral) Cares. ov) exagelSS KADY ) D. Co-amoxiclay (oral) E. Dihydrocodeine (oral) av, 18 A 28-years-old police officer is bitten by a heroin addict during the course of an arrest for | theft, The police officer presents to the accident and emeyy gency Department with a deep wound on his right hand. Whati is\the single most appropriate investigation? “% > A. Blood film malaria Parasites B. Chest x-rdy) Y C. Fal Blgodbedunt FBC Dz Jabpatits Aserology A&, SFebatts B serology T9A 16- -years-old girl has a lesion on her right thigh. She \Yremoved an inseet from her leg after through alforest)three ‘weeks ago. The lesion is red and raised. What is the single most : appropriate investigation? A. Leptospirosis serology ./ B) Lyme’s disease serology C. Magnetic resonance imaging MRI scan of the head 6D. Nasal swab E. Skin prick test 20. A 52-years-old business man presents to the accident and emergency department with{fever)and {rigors ten days after returning from qffip to| Zambia What is the single most appropriate test? aN ) /@ Blood film malarial parasites B. Chest x-ray C. Full blood count FBC D. Hepatitis A serology E. Hepatitis B serology AA) Oral 1 acyclovir & seek B. IV acyclovir C. Varicella mn D. Topical ac vin E. Oral ac: aay 1 2 days 22. Ay 3 with leukaemia,and his sister developed chicken, hat is the single most appropriate treatment? . Oral acyclovir & seek expert opinion B) vy acyclovir © Varicella immunoglobin gro¢laxis D. Topical acyclovir E. Oral acyclovir for 2 days23. An elderly lady develops shingles on her head with redness of her right eye. She complains of blurring of her vision, What is the single most appropriate treatment? “(AY Oral acyclovir & seek expert opinion B. IV acyclovir C. Varicella immunoglobin D. Topical acyclovir « ,) E. Oral acyclovir for 2 days aA 24, An elderly lady develops shingles on the right si dof ‘her face. She is started on acyclovir but complains fs Seyere pain . What is the single most appropriate treatment? > ‘A. Oral 7 days wy B. Reassurance ~ (Cs Carbamazepine D. Steroids Y y E. IV or y 25. A 17-years- irl presents with a five-day history of urinary Teme my dysuria, She has weight loss of 2 kg despite a good appetite she has been taking over the counter medicationsf6 premenstrual tension for several months. Urinalysis shows no glycosuria but is positive for nitrites. What is thes sietgle ‘most appropriate management? ANG ‘Clotting screen V4 y B. Reassurance C. Refer to the dermatologist D. Refer to child protection team / E) Give antibiotics26. A six-years-old girl has worsening swelling of her left eye for the last 24 hours. She has had an upper respiratory tra infection (URTI). The eye is proptosed but her visual acuity is normal. What is the single most appropriate investigation? A) Computer tomography CT of the orbits +B. Magnetic resonance imaging MRI of the orb: C. Nasal endoscopy D. Plain x-ray of the sinuses 4 \ E. Ultrasound scan of the orbits 27. A 60-years-old woman had an emergency. sa to remove a perforated gallbladder. She remains. os { during the post-operative period with fever and tach dia. Over a period a 48 hours her breathing became hae nd‘ her Pa02 drops to 6 KPa despite full support in the hi hde endency unit. What is the single most appropriate treatme rio ea 7 AS Laparotomy and excision lead tissue* B. Oxygen by inl » C. Percutaneous draiis Same “D) Ventilato a E. Wide’ < idement of soft tissue ~ 28. A hyo woman presents with a high fever. She is eo ‘om chicken pox and has been scratching some s] ir er LN Around one of these there is’ ( in) Over the next hour her ie out op WA all = aoe continues to rise and the area of ion increases in size. What is the single most appropriate treatment? A. Laparotomy and excision of dead tissue B. Oxygen by mask C. Percutaneous drainageD. Ventilatory support wand . 0 3 / ED Wide debridement of soft tissue a. 29. A 22 years old, man is admitted with acute pancreatitis. Despite early improvement, his overall condition deteriorates and id by the sixth day he has a high temperature, Tachycardia a Computed tomography (CT) shows non- A enhancement of the distal pancreas and\peri-pancreatic fluid, What is the single most appropriate treatment? A. Insertion of stent a\ B. Intravenous IV Catecholamine C. Intravenous IV Corticosteroid . (D) Laparotomy and excision of dead E. Oxygen by mask large bowel obstruction. She is wélljuntil the seventh post- operative day when she becomes weak and shivery. Her temperature is raised and ht ‘active protein has also risen. Ultrasound reveals a What is the single most appropfiate t 30. A 75-years-old woman has ee shency operation for a SY . Intravenous IV Catecholamine \Y -( inftavdnous TV Corticosteroid Laparotomy and excision of dead tissue ‘ . Oxygen by mask ) “E) Percutaneous drainage WoKrenic Ov 31. A 10-years-old girl has just been discharged from hospital after a kidney transplant operation. Her brother has just been diagnosed with chicken pox. What is the single most appropriate intervention? 10¢ ~~ CA) Quarantine B. Reassurance and no further action C. Rectal swab D. Refer to communicable disease consultant E. Serological tests ws ¢ 32. A20-years-old primiparous woman is 24 weeks pregnant. She presents to the accident and emergency department , it concerned about a recent rash, which she developed following, contact with her three old niece who was suffering fim rubella. What is the single most appropriate intervention? S \ » A. ti ~\ Quarantine Wa ) y > B. Reassurance and no further action“, C. Rectal swab CX” Consultant ( D. Refer to communicable disea xonee / (E} Serological tests x 33. A 15-years-old boytsaysthat he suffers from recurrent cold sores. What is the single Ost appropriate management? A. Aone “ y E. Varicella — zoster immunoglobin VAG 39. A 57-years-old man with i methotege itis is on prednisolone 7.5 mg daily and methdtrexate 5 mg weekly. His wife develops herpes zoster. He hadhchitken pox in childhood. What is the single most likely intéryention? A. Idoxuridine (topical), /*y / B) No immediate aclignmeeded €. Serology fox Varela immunity D. Steroi ‘Coral E. Ve icbler— zoster immunoglobin VZIG x 40. ‘edge: What is the single most likely organism? | 4 y ? enpige! { y . Mycoplasma pneumoniae Pseudomonas aeruginosa . Staphylococcus aureus . Streptococcus pneumoniae X { soa w > .. Streptococcus pyogenes ) O@ 49. A 24 years old previoush he¥ithty man presents with a dry cough and increasing breatiess. Chest x-ray shows|patchy) « ikey owanim? syste fields, What is the single most likely organism? 4B Mycopla eamoniae <. clarthiomyc™ B. Pseudom as aeruginosa ~ c. sihphplococcus aureus & Streptococcus pneumoniae 1. Streptococcus pyogenes \'50. A 43-years-old man presents with an axillary{abscess) What _ is the single most likely organism? ‘A. Mycoplasma pneumoniae B. Pseudomonas aeruginosa / C. Staphylococcus aureus 16D. Streptococcus pneumoniae E. Streptococcus pyogenes 51. A 65-years-old woman has been treated with an intrayenous (IV) cephalosporin. She develops severe diarrhoea and she is passing blood and mucus per rectum. What is the single most likely organism? YA ) A. Bordetella pertussis d > oye see acorn B) Clostridium difficile t¥ ¥@ C. Cryptosporidium D. Influenza A ZL S. E. Influenza B a Y 52. A 25-years-old man presents with a\two-Way history of thral e,) less thari ond,week after unprotected sexual intercourse. What is the sin; st useful diagnostic test? Va A. Culture of catheter kimnen of urine B. Culture of mid- on ‘specimen of urine ¢ \C) Gonococcah D. a = culture wus urogram IVU 53. = ae ears-old man presents with a three-week history of Soe? ea and mild dysuria. His regular female _Parther gives a history of recent treatment for pelvic (10) at is the single most useful diagnostic A. Syphilis serology ¥@) Urethral Chlamydia culture C. Urethral haemophilus ducreyi culture 17D. Urethroscopy E. Urine cytology 54, A 25-years-old man presents with a two-day history of intense dysuria. Examination shows (three small ulcersjat the is the single most useful diagnostic test? A A. Syphilis serology fanc leet \ A . B. Urethral Chlamydia culture C) Urethral haemophilus ducreyi culture D. Urethroscopy E. Urine cytology < 55. An 85-years-old man has had a urinary, Sitheter in situ for six months. He develops suprapubi, pain, haematuria and blood stained discharge at the meatus. What is the single most useful diagnostic test? Vy CA) Culture of catheter Spekimen of urine B. Culture of mid-stgam Specimen of urine Cc. Gonoeoegahsaute D. Herpes simplex virus culture E. ios urogram (IVU) 56.¢A: 40syears-old man returns from a business trip to [Asig. He gives. history of unprotected intercourse over several months. ne describes a| at has now resolved. \ Examination show only pai y ingt , “lymphadenopathy. What is the single most appropriate investigation? ~(&, Syphilis serology B. Urethral Chlamydia culture C. Urethral haemophilus ducreyi culture 18D. Urethroscopy E. Urine cytology 57. A five-years-old girl presents with a three-day history of ©» feyer, cough and runny nose. This is followed by non-blanching ue A pinpoint spots on both legs. What is the single most appropriate investigation? A. Auto antibodies B. Blood culture C. Borrelia burgdoferi antibodies /(D) Full blood count FBC (\7\ P) E. Glandular fever screening x history of beging on 58. 13-years-old girl presents with four®we unwell with mild fever, jointpain and’ What is the sing] e most appropriate investigations? SLE ry Y@® Auto antibodies Y B. Blood a eaiaph ~y Cc. oe ‘i antibodies D. Full it FBC E. Sem it fever screening 59. bass) year-old Brcsents with fever, drowsiness, yomiting and widespread, sh on his arms and legs. What is h single most appropriate investigation? « aNiNg! Ais “A. Auto antibodies * B) Blood culture C. Borrelia burgdoferi antibodies D. Full blood count FBCE. Glandular fever screening 60. A two-years-old a presents with a 10-day history of fever n \ ingen most (appropriate\ Investigation? dia cove A) Liver function tests LFTs B. Stool culture x C. Varicella zoster antibodies D. Borrelia burgdoderi antibodies E. Full blood ct 61. A 10-years- rola boy frst ‘presented wit His general practitioner (GP) treated him with short course of (amoxicillin Two days later he develops\ ywidespread \maculopapular rash) What is the single most appropriate investigation? A. Auto antibodies B. Blood culture Ds C. Borrelia burddodgti antibodies Dz. Zul broeoutt FBC 4@® Bandar fever screening 62. A cae tert aneedle stick injury while taking blood frof a patient known to have late stage human dmmunodeficiency virus (HIV). Post exposure prophylaxis with \esantivirals is being considered. However, the nurse now admits to \‘te possibility of already being HIV positive. What is the most ) ‘single useful immediate blood test? A. Hepatitis C ribonucleric acid RNA /@®) Human immunodeficiency virus HIV antibody test C. Human immunodeficiency virus HIV viral load 20Cc D. Liver function tests LFTs E. Retain serum sample 63. Anurse who is known to be hepatitis B immune suffers a superficial scratch while taking blood from a patient. The patient’s own hepatitis and human immunodeficiency virus (HIV) markers are negative. The nurse is advised to have a human immunodeficiency virus (HIV) antibody test in three ¢% months’ time. What is the most single useful immediate next, step? . { A. Hepatitis C ribonucleric acid RNA B. Human immunodeficiency virus HIV antibody test C. Human immunodeficiency virus myriad D. Liver function tests LFTs v > ~(E) Retain serum sample C , 64. A doctor suffers a needle sti¢injury while taking blood from a patient known to be-ajchronic hepatitis B carrier. The patient needs a test so that tlie doctor can be advised of his risk of acquiring hepatitis B fifection. What is the most single useful immediate blood test?) A. CD4 cou > ? B. Full pled count FBC Cc. Hepatit 's B core antibody past infection - DNgepatits B ‘e’ antibody past infection % (CE) Hepatitis Be antigen x 65. A doctor suffers a needle stick injury while taking blood from a patient known to be hepatitis C antibody positive. The patient needs a test so that the doctor can be advised of her own risk of becoming infected. What is the most single useful immediate blood test? / (A) Hepatitis C RNA 21B. Human immunodeficiency virus HIV antibody test C. Human immunodeficiency virus HIV viral load D. Liver function tests LFTs E. Retain serum sample 66. A doctor suffered a needle stick injury while taking blood from a patient with suspected acute malaria. The patient needs‘a’ test to confirm the diagnosis. What is the most single useful,” immediate blood test? 4A OY ’. Bronchial carcinoma \ B. Brucellosis C. Lyme disease D. Lymphoma “ (®) Plasmodium falciparum malaria 2372. A 28-year-old man from. ‘sub-Saharan Africa presents with ‘recurrent cough haemoptysis weight loss any pyrexi ‘the single most likely diagnosis? A. Plasmodium vivax malaria B. Recurrent urinary tract infection C. Renal cell carcinoma ¢ 7 D. Sarcoidosis ? id E,) Tuberculosis A \ 73. ASQ year old woman presents with lethargy, anotexia, weight loss and perfuse night sweats. She has enlarged, painless palpable cervical lymph nodes, a palpable : and low grade pyrexia. What is the single most likely diagnosis? A. Bronchial carcinoma B. Brucellosis C. Lyme disease (D) D) Lymphoma ho has worked long in the(dye istory of haematuria and intermittent a modium vivax malariae aniline SB: Recurrent urinary tract infection amy “C. Renal cell carcinoma op. Sarcoidosis “GB Tuberculosis eladdet Carcinome 75. A10 years old boy returns to the accident and emergency department a week afier open appendectomy, unwell and with a 24discharging scars, culture shows growth of methicillin-resistant staphylococcus-aureus (MRSA). He is admitted, isolated and treated and successfully with vancomycin. What other measure should the hospital take to prevent further cases? A. Give all patients on the surgical unit prophylactic vancomycin B. Issue all hospital staff with antibiotic nasal spray « < C. Move all patients on the surgical unit to other wards “\_) D. Stop all effective surgery in the entire hospital,“ “@) Take culture Swabs from all staff on surgi ni 76. A 14 years old boy who was previously él >A immunized 2 years ago against meningococcal group Chas been diagnosed with {group B|meningococcal septicaemija, Hid not require resuscitation. He lives at home with-his Mother, father & six weeks old breastfed brother who areall/well. He attends a local secondary day school. Which is tfe-single most appropriate contact/group of contacts lorgecive rifampicin prophylaxis? A. Novone wy B. The six weeks ol Nether C. The six-w «old brother and both parents D) The-siweek old brother, both parents and attending doctor and nurses K “The six week old brother, parents, doctors, nurses and ~\ ‘school pupils \P97. Which organisms are responsible for swollen hot leg, ‘painful and indurated ulcer? M ® Streptococcus pyogens B. Staphylococcal aureus C. Staphylococcal epidimidis 25D. Pneumococcal pyogens E. Clostridium difficile 78. What organisms are responsible for an axillary abscess? A. Clamydia pneumonia B) Staphylococcal aureus C. Staphylococcal epidimidis { D. Pneumococcal pyogens E. Clostridium difficile ) 79. A patient previously healthy come¥with dry cough, increasing breathlessness, x-ray show: ion all over the lung field. Which organi: ae are responsible for this? No A) Mycoplasma x. B. legionella (wr C. Strept pneumonae Y . D. Staph auretis) yY E. Mycobiefétium TB Cy je patient on antibiotics develops diarrhoea. What ‘ofgahisms are responsible for this? Vv ‘A. Clamydia pneumonia B. Staphylococcal aureus C. Staphylococcal epidimidis D. Pneumococcal pyogens /(ED Clostridium difficile 2681. A 33 years old man presents with anlitchy scaly annular} rash on his thigh after a walk in the\park: Which of the following drugs will treat his condition? a Erythromycin Lye 18 Doxycycline ad c Penicillin d. Amoxicillin 82. A child presents with clean woun, “ihe has never been immunized as his parents were oni about it. There is no contraindication to immunize hat is the best management? oO. (a) Full course of b. 1 singleinjetfoh DT c. 1 sin@ld injéction DTP d. x i 'S a Deas old lady presents with painful ulcers on her wulva, what is the appropriate investigation, which will lead ‘0 the diagnosed? Anti-HSV antibodies Dark ground microscopy of the ulcer c. Treponema palladium antibody test d. Rapid plasma regain test 27e. VDRL oe 84.An old lady had UTI and was treated with antibiotics. She then developed diarrhea, What is the single most likely treatment? a. Co-amoxiclav b. Piperacillin + tazobactam. , c Ceftriaxone Ah “@ Vancomycin | \ 85.A.74 years old female presents with headéclie gind neck stiffness to the Emergency department¢Following a LP the patient was started on IV ceftriaxone. CSF/culture shows listeria monocytogenes. What is the\appropriate treatment? a. Add IV amoxicillin ~“ (b) Change to IV ai a Add IV, co-aljoxiclav 86.A 32 years Cid hothosexual comes with history of weight loss. Fundoscopy reveals retinal hemorrhages. What is the single-most, appropriate option? - Mycobacterium avium . ) Ww ” CMY 4 Hemophilus influenze rhinal haeworrhege> Non Hodgkin lymphoma cM. e. Pneumocystic jerovici 87. A pregnant woman returns from (Sudan now presenting with intermittent fever, rigor and seizures. What is the diagnosis? 28