A 54 year old male patient has a history of cough productive of green sputum with shortness of breath and left pleuritic chest pain. His temperature is 38.4 C, respiratory rate 22 bpm, pulse 110bpm, WBC 12.4 x 109 /L and his CXR shows consolidation at the left base. What is the most likely causative organism for this presentation?
A Haemophilus influenzae
B Klebsiella pneumonia
C Mycoplasma pneumoniae
D Staphylococcus aureus
E Streptococcus pneumoniae
A 43 year old with a history of intravenous drug use has presented with a one week history of progressively worsening dyspnoea breath and a dry cough. On examination, he is cachectic, and he explains that he has been unintentionally losing weight for the past 6 months or so. He states he takes medicine to ‘help his AIDS’, but hasn’t taken any in a while. Blood tests show WCC 8.2 x 109 /L and on chest X ray there is patchy shadowing in both lung fields. What is the most likely causative organism for this presentation?
A Legionella pneumophila
B Mycoplasma pneumoniae
C Pneumocystis jiroveci
A 30 year old hepatitis C positive IV drug user presents with a three week history of fever, sweats and some shortness of breath. His temperature is 37.6 °C, respiratory rate 30 bpm, pulse 110bpm, WCC 14 x 109/L. He has an erythematous and painful rash on his inner thigh, which is the likely origin of his sepsis. What is the most likely causative organism associated with this?
A 27 year old lady presents to AMU with a three day history of shortness of breath and malaise. She is experiencing haemoptysis and temperature symptoms. Her bloods show WCC 15.0 and CRP is 125. She is otherwise fit and well. She and her partner recently moved home to a building where she states the water piping ‘wasn’t quite ready yet’. What is the most likely causative organism of this presentation?
A Chlamydia pneumonia
B Haemophilus influenzae
C Klebsiella pneumonia
D Legionella pneumophila
E Mycoplasma pneumoniae
A 54 year old gentleman presents to infectious diseases clinic for follow up of his tuberculosis treatment. He is concerned because he has found it difficult to see objects in the distance, in addition to worries that he has become colour blind. Which of his medications is most likely to be causing this defect?
A Ethambutol
B Isoniazid
C Prednisolone
D Pyraziniamide
E Rifampicin
Three weeks after a meal at a fast food cafe, a 21-year-old man develops malaise, fatigue, and loss of appetite. He notes passing dark urine. On examination, he has scleral icterus and right upper quadrant tenderness. Lab studies show serum AST of 62 U/L and ALT of 58 U/L. The total bilirubin concentration is 3.9 mg/dL, and the direct bilirubin concentration is 2.8 mg/dL. His symptoms abate over the next 3 weeks. On returning, he finds that it has been closed by the city's health department. Which of the following serologic test results is most likely to be positive in this patient?
A Anti-HBs
B IgM anti-HDV
C Anti-HCV
D IgM anti-HAV
E Anti-HBc
A 38 year old man presents with fatigue and general malaise five days after returning from a working placement in Guinea. His fever is relapsing and remitting and is happening every day in an irregular pattern. On admission to AMU he develops a fit and is profoundly hypoglycaemic. Which of the following is the most likely causative organism?
A Plasmodium falciparum
B Plasmodium knowlesi
C Plasmodium malariae
D Plasmodium ovale
E Plasmodium vivax
A 44 year old man, who has recently moved to the UK from Egypt, presents with bloody diarrhoea, right upper quadrant pain and haematuria. On examination he has hepatosplenomegaly. He is treated with supportive management and antibiotics, however he fails to return for follow-up. Ten years later, the gentleman re-presents, this time with haematuria. Cystoscopy identifies squamous cell cancer of the bladder. What is the most likely contributing organism for this patient’s symptoms?
A Giardia lamblia
B Human Immunodeficiency Virus
C Leishmania
D Shistosoma haematobium
E Trypanosoma brucei
A 19 year old man is brought into A&E by his flatmates after he has been vomiting, complaining of neck stiffness and not liking the lights being on. He has no past medical history. You see he has had a lumbar puncture done and the results have just returned and are as follows: • Appearance: clear • Opening pressure: elevated • White cell count: >100 cells/µL (>90% PMN) • Glucose level: low • Protein level: elevated (>50 mg/dL) What is the most likely diagnosis?
a) Aseptic meningitis
b) Bacterial meningitis
c) Fungal meningitis
d) Parasitic meningitis
e) Viral meningitis
A 68 year old woman is brought into hospital after becoming severely out of breath at home. Observations on arrival include a respiratory rate of 28 breathes per minute, blood pressure of 85/53mmHg, heart rate of 103 beats per minute and oxygen saturation of 87% on air. Blood urea is 6mmol/L and AMTS is 7/10 with no previous confusion. What is the CURB65 score for this patient?
a) 1
b) 2
c) 3
d) 4
e) 5
An 87 year old man is in hospital due to a collapse at home after complaining of pain when urinating. He has a history of COPD, hypertension and benign prostate hyperplasia but no other conditions. Observation and investigations in hospital reveal the following results: a) Heart rate of 96bpm b) Respiratory rate of 19bpm c) Temperature of 38.4°C d) Oxygen saturation of 83% on air e) Blood pressure is156/98mmHg f) Blood glucose 6.5mmol/L g) AMTS 10/10 h) WCC 13x109/L How many criteria of SIRS does he meet?
a. 2
b. 3
c. 4
d. 5
e. 6
A 22 year old woman who lives in the barracks where she is a soldier has come into see the Doctor after feeling run down. She complains of a headache, vomiting and malaise for the last week and is just beginning to develop a dry cough. Examination reveals a low grade fever and 'target lesions' developing on her body. What is the most likely causative pathogen for this presentation?
a) Haemophilus influenzae
b) Legionella pneumophilia
c) Mycoplasma pneumoniae
d) Mycobacterium tuberculosis
e) Streptococcus pneumoniae
A 29 year old man is brought into hospital with a fever of 38.5°C and fatigue. He admits to a history of IV drug use but has had no other illnesses. Examination shows Janeway lesions and a new grade 2 murmur. He has had one positive blood culture in hospital but not had time for any more cultures. Which of the following minor criteria in Duke’s criteria for infective endocarditis has not been met?
a) Fever
b) Immunological phenomena
c) Microbiological evidence
d) Predisposition
e) Vascular phenomena
You are the F2 in general practice when a 27 year old female comes in after having had a routine Papanicolaou (Pap) smear testing for cervical dysplasia. Before you see her you look at the pathology report which indicates a cervical intraepithelial neoplasia (CIN) 2 lesion. The pathology report also indicates that the lesion is human papillomavirus (HPV) positive. Which of these serotypes is most likely to cause cervical dysplasia?
A. HPV-6
B. HPV-11
C. HPV-16
D. HPV-53
E. HPV-58
You are the F2 in general practice where you see a mother who is concerned about her daughter’s vaccination she will be receiving the following week. At age 12, the daughter will be receiving the human papillomavirus (HPV) vaccination to prevent cervical cancer and genital warts. The mother is a biomedical scientist and is keen to know as much information about the vaccine as possible in order to ease her concerns. Which serotypes of HPV are included in the vaccine currently offered as part of the UK childhood vaccinations programme?
A. 2 serotypes: 16 and 18
B. 2 serotypes: 6 and 11
C. 2 serotypes: 11 and 16
D. 4 serotypes: 1, 2, 16 and 18
E. 4 serotypes: 6, 11, 16 and 18
A 58-year-old Ethiopian man presents with pain in his legs and a difficulty in walking. He has no co-morbidities and denies smoking, alcohol and drug use. He has had a history of same sex partners and has been a frequent attender to GUM clinics. On examination you find that he has a loss of proprioception and reflexes in the lower limbs along with a pupil that only responds to accommodation. His initial blood tests are unremarkable with normal B12 levels. What is the correct diagnosis?
A. Diabetic neuropathy
B. Guillian-Barre syndrome
C. Lead poisoning
D. Sub-acute degeneration of the cord
E. Tertiary syphilis
A 28-year-old male presents at the GUM clinic with an ulcer on his penis. He does not complain of any pain due to the ulcer or any discharge. He has a history of same sex partners and has had unprotected sex 3 weeks ago. He denies smoking and alcohol or drug use. What is the most appropriate treatment for this patient?
A. Azithromycin 1g
B. Azithromycin 2g
C. Benzathine penicillin 2.4 mega units IM
D. Ceftriaxone 500mg IM
E. Doxycycline 100mg PO for 7 days
