Formative

Question 1

What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?

1. adenovirus
2. enteroviruses
3. Epstein Barr virus
4. norovirus
5. rotavirus

Answer 1

4. Norovirus

Question 2

What is the commonest cause of travellers diarrhoea?

1. campylobacter
2. cryptosporidium
3. E coli O157
4. enterotoxigenic E coli
5. giardia

Answer 2

4. enterotoxigenic E. coli

Question 3

Which of the following is not diagnosed by culture?

1. campylobacter jejuni
2. clostridium difficile
3. E. coli O157
4. Salmonella enterica
5. vibrio cholerae

Answer 3

2. clostridium difficile

Question 4

A 22 year old man presents to A&E with a rash on his hand which extends in patches over his chest, abdomen and legs, and developed over 6 hours. He is hypotensive (80/50) and pyrexial (39.1)

What should your immediate actions be?

1. call for senior help
2. give fast IV fluids
3. IV high dose cephalosporin
4. blood cultures
5. all of the above

Answer 4

5. all of the above

Question 5

What should the family of the man presenting with the rash be given?

1. amoxicillin or chloramphenicol
2. rifampicin or ciprofloxacin
3. chloramphenicol or cefalexin
4. cefalexin or trimethoprim
5. none of the above

Answer 5

2. rifampicin or ciprofloxacin

Question 6

4 days later, the man who presented with the rash becomes hypotensive and is noted to have a low sodium and high potassium, the most likely reason is;

1. too little saline in the IV fluid regime
2. syndrome of inappropriate ADH secretion
3. adrenal insufficiency
4. renal failure
5. antibiotic-associated diarrhoea

Answer 6

3. adrenal insufficiency

Question 7

In meningococcal meningitis, what would you expect to find in the CSF?

1. high protein, high glucose, gram positive bacilli
2. low protein, high glucose, gram positive cocci
3. high protein, low glucose, gram negative cocci

Answer 7

3. high protein, low glucose, gram negative cocci

Question 8

What component of neisseria meningitidus causes septic shock?

1. capsule
2. fimbriae
3. lipo-polysaccharide
4. peptidoglycan
5. superantigens

Answer 8

3. lipo-polysaccharide

Question 9

A 30 year old IV drug user is admitted with jaundice. His lab results are;
HBsAg negative
HB core antibody negative
HB surface antibody positive
Hepatitis A IgM antibody positive
Hepatitis C antibody positive 

1. He has acute hepatitis A infection
2. He has acute hepatitis B infection

Answer 9

1. He has acute hepatitis A infection

Question 10

A 30 year old IV drug user is admitted with jaundice. His lab results are;
HBsAg negative
HB core antibody negative
HB surface antibody positive
Hepatitis A IgM antibody positive
Hepatitis C antibody positive

1. He has previously had hepatitis B infection
2. He has previously been immunised against hepatitis B

Answer 10

2. He has previously been immunised against hepatitis B

Question 11

For which of the following infections is there no vaccine?

1. Hepatitis A
2. malaria
3. polio
4. typhoid
5. yellow fever

Answer 11

2. malaria

Question 12

Which of the following is true of active immunisation?

1. always contains live organism
2. contains immunoglobulin
3. gives immediate protection against infection
4. stimulates the host immune response

Answer 12

4. stimulates the host immune response

Question 13

A 38-year-old man presents with a 3 week history of difficulty swallowing and on examination appears to have oral thrush, what its he most likely causative organism?

1. Epstein-Barr virus
2. Human immunodeficiency virus
3. Herpes zoster virus
4. Candida albicans
5. group A strep

Answer 13

4. candida albicans

Question 14

The patient with oral thrush and difficulty swallowing is found to be HIV positive. The candida is treated with fluconazole. His further treatment should be;

1. Immunise with BCG as he is at great risk of developing TB
2. Commence at least 3 antiretrovirals
3. Wait until he has an AIDS defining illness and then commence antiretrovirals
4. Immunotherapy with an HIV vaccine

Answer 14

2. Commence at least 3 antiretrovirals

Question 15

You are taking blood from an acutely ill HIV positive patient in the Infection unit at midnight and you accidentally stab yourself with the needle, what do you do first?

1. Phone the on-call occupational health doctor
2. call the registrar
3. wash the wound and encourage bleeding

Answer 15

3. wash the wound and encourage bleeding

Question 16

What virus carries the highest risk of blood-borne transmission?

1. HIV
2. Hepatitis C
3. Hepatitis B

Answer 16

3. Hepatitis B risk is highest

Question 17

You have isolated E. coli from two sets of blood cultures taken on a jaundiced patient who was admitted in septic shock. Which of the following is the likely source?

1. biliary sepsis
2. gastroenteritis
3. infective endocarditis
4. osteomyelitis
5. pneumonia

Answer 17

1. biliary sepsis

Question 18

What is the commonest cause of infective diarrhoea in the UK?

1. salmonella
2. E. coli O157
3. campylobacter
4. entamoeba histolytica

Answer 18

3. campylobacter

Question 19

27 year old female presents with a 6 week history of dry cough, weight loss and fevers, 3 months after returning from working in a Bolivian orphanage. 
The most likely diagnosis 
1. miliary TB 
2. HIV 
3. mycoplasma pneumonia 
4. pneumococcal pneumonia 
5. pulmonary tuberculosis

Answer 19

5. pulmonary TB

Question 20

What rapid test would help confirm the diagnosis of pulmonary TB?

1. gram stain
2. india ink
3. overnight culture
4. ZN stain

Answer 20

4. ZN stain

Question 21

The patient with pulmonary TB should be initially treated with;

1. Rifampicin
2. isoniazid
3. pyrazinamide
4. ethambutol
5. all of the above

Answer 21

5. all of the above

Question 22

How do you make an initial diagnosis of Legionnaire’s disease?

1. blood culture
2. serology
3. sputum culture
4. urinary antigen

Answer 22

4. urinary antigen

Question 23

A 28-year-old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting and unwell. The most important investigation is;

1. CXR
2. blood cultures
3. urgent stool microscopy and culture for typhoid
4. malaria film and antigen test
5. urgent HIV test

Answer 23

4. malaria film and antigen test

Question 24

The offshore worker is confirmed to have malaria. He should be treated with;

1. artemether/lumefantrine
2. IV quinine/artesunate
3. IV ciprofloxacin
4. oral quinine unless parasitaemia increases
5. chloroquine IV or orally if tolerated

Answer 24

2. IV quinine/artesunate

Question 25

Cellulitis would most commonly be treated with; 1. benzylpenicillin and gentamicin 2. ciprofloxacin and rifampicin 3. flucloxacillin 4. metronidazole 5. tazocin and gentamicin

Answer 25

3. flucloxacillin

Question 26

What is the most common cause of UTI? 1. erythrovirus 2. Neisseria meningitidis 3. viridans streptococcus 4. hepatitis C virus 5. Pseudomonas auruginosa 6. Mycoplasma pneumoniae 7. Staphylococcus aureus 8. Escherichia coli 9. Epstein Barr virus

Answer 26

8. E. coli

Question 27

What is the most common cause of glandular fever? 1. erythrovirus 2. Neisseria meningitidis 3. viridans streptococcus 4. hepatitis C virus 5. Pseudomonas auruginosa 6. Mycoplasma pneumoniae 7. Staphylococcus aureus 8. Escherichia coli 9. Epstein Barr virus

Answer 27

9. EBV

Question 28

What is the most common cause of wound infection? 1. erythrovirus 2. Neisseria meningitidis 3. viridans streptococcus 4. hepatitis C virus 5. Pseudomonas auruginosa 6. Mycoplasma pneumoniae 7. Staphylococcus aureus 8. Escherichia coli 9. Epstein Barr virus

Answer 28

7. staph aureus

Question 29

What antibiotic would be the best choice for treatment of bacterial endocarditis caused by MRSA? 1. rifampicin 2. tetracycline 3. flucloxacillin 4. benzylpenicillin 5. clarithromycin 6. gentamicin 7. nitrofurantoiin 8. vancomycin 9. isoniazid

Answer 29

8. vancomycin

Question 30

What antibiotic would be used orally to treat C. diff infection? 1. rifampicin 2. tetracycline 3. flucloxacillin 4. benzylpenicillin 5. clarithromycin 6. gentamicin 7. nitrofurantoiin 8. vancomycin 9. isoniazid

Answer 30

8. vancomycin

Question 31

What antibiotic would be the best choice for treatment of gram negative sepsis in a patient with septic shock? 1. rifampicin 2. tetracycline 3. flucloxacillin 4. benzylpenicillin 5. clarithromycin 6. gentamicin 7. nitrofurantoiin 8. vancomycin 9. isoniazid

Answer 31

6. gentamicin