ID MCQs 1

“Fish fancier’s finger” is caused by all of the following EXCEPT:

A Mycobacterium marinum

B Mycobacterium fortuitum

C Mycobacterium tuberculosis

D Mycobacterium ulcerans

Answer

2

Which of the following is FALSE regarding needlestick exposure from a known positive source?

A Risk of HIV from percutaneous exposure = 0.3%

B Risk of HIV from mucocutaneous exposure = 0.09%

C Risk of HCV from percutaneous exposure = 2-10%

D Risk of Hep B from percutaneous exposure from Hep B +ve source = 10-15%

Answer

3

Malaria, the following are true, EXCEPT

A P.falciparum causes the most morbidity and mortality

B Non-cardiogenic pulmonary oedema is most common in pregnant females and carries a 80 % mortality

C Complications from ‘cerebral malaria’ is the most common cause of death

D Haemolytic anaemia, thrombocytopenia, hyponatraemia represents a typical triad in 80 % of cases.

Answer

4

Regarding soft tissue infections, which is TRUE?

A Coral cuts are usually treated with Flucloxacillin

B Infections of the feet are often caused by Pseudomonas

C The presence of gas on soft tissue X ray confirms the diagnosis of gas gangrene

D Erysipelas is usually treated with Ciprofloxacin

Answer

6

Fournier’s gangrene of the scrotum

A Has a mortality rate of up to 75%

B Causes marked palpable skin crepitation in most patients

C Is more common in Asian males

D Leads to skin necrosis and sloughing within 12-24 hours

Answer

5

Regarding HIV infection, which is TRUE?

A Tuberculosis is an uncommon late stage infection

B Brain abscess would be the most common reason for a ring enhancing space occupying cerebral lesion

C Quantitative HIV RNA test is a poor prognostic indicator

D Cryptococcal meningitis is the most common cause of fever and neck stiffness

Answer

7

Which is INCORRECT?

A 90% of contaminated wounds demonstrate Clostridium sp.

B Spontaneous gas gangrene is fatal in 2/3rds of cases

C 60% of cases of gas gangrene are post-traumatic and caused by Clostridium perfringens

D Gas gangrene infection spreads at the rate of 2cm / day

Answer

8

The MOST common infective organism in cellulitis from wounds inflicted underwater?

A Aeromonas Hydrophila

B Vibrio Cholera

C Staphylococci/Streptococci

D Anaerobes

Answer

9

Which infective organism is LEAST likely to exist in salt water?

A Vibrio Vulnificus

B Aeromonas Hydrophila

C E. Coli

D Staphylococcus Aureus

Answer

10

Regarding tetanus

A Suxamethonium is contraindicated in intubation for tetanus

B Neonatal tetanus has a good prognosis

C Tetanolysin is the more significant of the two exotoxins

D Magnesium may be useful in inhibiting adrenaline and noradrenaline release

Answer

11

All of the following increase your chance so having underlying bacterial illness EXCEPT

A Temperature > 39.4

B ESR > 30

C WCC > 15,000

D diabetes mellitus

Answer

12

The following are all features of the SIRS EXCEPT

A Temp >39 or < 36

B Resp rate > 20

C Heart rate > 90

D WCC > 12,000

Answer

13

Which of the following statements is FALSE in regard to community acquired methicillin resistant Staphylococcus aureus (MRSA) infections?

A They are potentially more virulent than non-MRSA Staphylococcal infections.

B The Panton-Valentine leukocidin exotoxin is produced in a subset of S. aureus isolates.

C Community acquired MRSA predominately causes cutaneous infections.

D Treatment guidelines suggest empiric treatment with Vancomycin as it is the drug of choice.

Answer

14

Which statement regarding Anti-Retroviral drug therapy is FALSE?

A Inhaled Fluticasone and Ritonavir can cause Cushing’s syndrome.

B Anti-retroviral therapy is an independent risk factor for ischaemic heart disease.

C Anti-retroviral therapy usually starts with 2 nucleoside(tide) analogue reverse transcriptase inhibitors plus either a non-nucleoside reverse transcriptase inhibitor or a ‘ritonavir boosted’ protease inhibitor.

D Drug therapy should be commenced with CD4 count > 350/microlitre.

Answer

15

With regard to cellulitis all of the following associations are true EXCEPT

A “Hot tub” folliculitis and Strep pyogenes.

B Facial cellulitis and Staph aureus, H influenzae or Staph pneumoniae.

C Infections from wounds on the feet and Pseudomonas aeruginosa.

D Diabetics with cellulitis and anaerobes or gram negative organisms.

Answer

16

Listeriosis most commonly causes

A Meningo-encephalitis.

B Mild gastro-enteritis.

C Pneumonia.

D Septicaemia and shock.

Answer

17

Regarding Hepatitis C:

A Human Immunoglobulin is indicated post needle stick from known Hep C pt

B Sexual transmission is common

C Greater than 50% of infected patients develop chronic hepatitis

D Is a picornavirus

Answer

18

Which side effect profile is INCORRECT:

A Ototoxicity - aminoglycosides

B Tendon rupture - ciprofloxacin

C Doxycycline - oesophagitis

D Vancomycin – pseudomembranous colitis

Answer

19

Regarding STD’s all the following are true EXCEPT:

A Chlamydia is the leading cause of non-gonococcal urethritis

B The primary chancre of lymphogranuloma venereum is painful, thus distinguishing it from syphilis

C Buboes are suppurative inguinal lymph nodes found in Chancroid and Lymphogranuloma venereum

D The ulcerative lesions found in Donovanosis are painless and have a beefy red appearance

Answer

20

In regards to infectious diseases and sepsis the following are true EXCEPT:

A Systemic inflammatory response syndrome (SIRS) is defined as the presence of 2 or more of the following – T > 38oC or <36oC, P >90, RR >20, WBC > 12,000 or < 4000

B Jaundice in a febrile patient is unlikely to be due to viral hepatitis

C Early meningococcal rash may resemble early measles (ie macular)

D Peripheral venous lactate levels correlate well with arterial and central venous levels

Answer

21

All the below are true statements EXCEPT:

A Asplenic patients are more prone to overwhelming pneumococcal septicaemia

B Renal transplant patients are more prone to listeria meningitis

C Normal CSF examination excludes cerebral abscess

D Severe muscle pain in the absence of fever may be an early symptom of staphylococcal or streptococcal bacteraemia

Answer

22

The following are true EXCEPT

A Herpes zoster affects up to 50% of patients>85 yrs

B EBV is associated with Infectious mononucleosis in over 90% of cases

C Acyclovir does not inhibit EBV replication

D Toxoplasmosis infections classically cause hepatosplenomegaly

Answer

23

Regarding TB

A The Ghon focus is classically perihilar

B Reactivation classically presents with apical lesions and pleural effusions

C Primary infection is usually a benign self limiting disease

D Immunization effectively prevents infection

Answer

24

With regard to animal and human bites, Which is TRUE?

A Lacerations are more likely to become infected than puncture wounds

B Pasteurella sp. are uncommon isolates from dog bites

C Prophylactic antibiotics are effective in preventing infection in cat and dog bites

D There is an higher infection rate in cat vs dog bites

Answer

25

Regarding blood cultures, which is FALSE?

A The routine use of anaerobic cultures in not warranted

B It is not necessary to change needles between inoculation of culture bottles

C Corynebacterium species are typical contaminants

D Best yield is achieved if multiple samples are taken in rapid succession during a period of fever

Answer

26

All of the following are AIDS indicator conditions EXCEPT

A Herpes zoster

B Kaposi’s sarcoma

C Herpes simplex

D Cryptococcosis

Answer

27

Which is LEAST likely to be an effective treatment of MRSA cellulitis?

A Cotrimoxazole

B Clindamycin

C Doxycycline

D Cefuroxime

Answer

28

Which of the following is TRUE re HIV?

A Blood transfusion in Australia is screened with an ELIZA test

B According to World Health Organization Guidelines, HIV is an absolute contra-indication to breast feeding

C World wide, TB is the commonest fatal opportunistic infection

D Lumbar puncture is contra-indicated in suspected cryptococcal meningitis

Answer

29

Which of the following is FALSE re malaria

A Mefloquine and doxycycline chemoprophylaxis is effective in preventing plasmodium falciparum malaria

B Primaquine should be given as part of P.vivax treatment

C Mosquito to human transmission has been recorded in Australia within the past 20 years

D Pregnant women and children should be cautioned re travelling to an endemic area

Answer

30

Which of the following pairs is CORRECT ?

A Cat bite and Klebsiella

B Fox and lyssavirus

C Beef tartare and pin worm.

D Eggs and Gp G streptococcus

Answer

31

With regard to types of/settings for skin infections and an expected pathogen, which combination is FALSE?

A Dog bite – Capnocytophaga canimorsus

B Belly piercing – C tetani

C Hot tub – Eikenella corrodens

D Fish tank – Mycobacterium marinum

Answer

32

Which of the following pathogens is MOST likely to give a true positive nitrite result on urinary dipstick in the setting of a UTI?

A Enterococcus faecalis

B Staphylococcus saprophyticus

C Corynebacterium spp.

D Proteus mirabilis

Answer

33

In regards to Inflammatory Bowel Disease, which of the following is TRUE?

A Cyclosporin is effective treatment of Crohn’s Dx

B Skip lesions are a feature of Ulcerative Colitis

C NSAIDs are preferred to opiates for analgesia

D Intra-abdominal sepsis is an indication for surgical admission

Answer

34

Regarding the development of dengue haemorrhagic fever, which factor increases the risk?

A Increasing Age

B Prior Dengue Virus infection

C Malnourishment

D Black ethnicity

Answer

35

Regarding malaria, which of the following is FALSE?

A Falciparum malaria has the highest mortality and morbidity.

B Adults tend to recover more rapidly than children from severe malaria

C Renal failure is less common in children

D Non-cardiogenic pulmonary oedema is a significant cause of mortality in pregnant women

Answer

36

Necrotising Fasciitis is NOT associated with

A Cutaneous nerve infarction

B Diabetes Mellitus

C Intravenous drug use

D Clostridial infection

Answer

37

Assuming there are 2 billion children worldwide, that 35% are nominally Christian (and have all been good) with an average of 3 children per household, how fast would Santa’s sleigh have to travel to visit all the children in the world on Christmas Eve? Please do not include toilet stops or “chimney time” in your calculations.

A 734,320 km/hr

B 4,204,382 km/hr

C 10,703,437 km/hr

D 96,765,256 km/hr

Answer

38

If Santa eats a single mince pie at each household, approximately how many miles will he have to walk to burn off the calories consumed? Assume Santa weighs 21stones and walks at 3 miles per hour.

A 450 million

B 315 million

C 120 million

D It’s Christmas who cares?

Answer

39

Which of the following statements regarding antibiotics is INCORRECT

A 3rd generation cephalosporins have good activity against enterococcus

B Moxifloxacin has anti-pseudomonal activity

C Most anaerobes originating above the diaphragm are susceptible to penicillin

D Clindamycin achieves good tissue penetration

Answer

40

The organism that when cultured in blood most likely reflect contamination is:

A Bacillus spp.

B Streptococcus pneumoniae

C Salmonella spp.

D Bacteroides

Answer

Answers

1. C

2. D

3. D

4. B

5. D

6. A

7. D

8. C

9. B

10. D

11. A

12. A

13. D

14. D

15. A

16. B

17. C

18. D

19. B

20. D

21. C

22. D

23. C

24. D EM Practice article bites and stuff

25. D Dunn. Chapter 14: Infection diseases

26. A Tintinalli 6th edition page 927

27. D

28. C A False, PCR at a cost of $250 million per case HIV prevented compared with

ELIZA B False, more children die of malnutrition/gastro than breast milk HIV

transmission C T-WHO D False-LP therapeutic and diagnostic E False-can be very

difficult to diagnose with profound immunosuppression (often no classical changes)

29. A A F-buys time to get definitive treatment B T-treats hypnozoites C T- Cairns

airport D T-Higher likelihood of serious disease with fewer chemoprophylaxis options

E T-Can modify presentation

30. D Centor criteria. EMPRAC article Pharyngitis in ED, may 2004.Vol 6

31. C Pseudomonas aeruginosa. Eikenella from human bites (depends on hot tub

activities I guess....) Cameron, 3rd Ed, pg 427

32. D Ps aeruginosa and Gram positives give false negative results Cameron, 3rd Ed,

pg 420-423

33. D Cameron 3E pp353-5 A – Cyclosporin is effective for UC B – Skip lesions are

a feature of CD, UC is continuous C – NSAIDS exacerbate IBD, Opiates may

increase risk toxic megacolon but are still preferred D – Total colectomy curative

only in UC E – Intraabdo sepsis, perforation, obstruction, toxic megacolon all warrant

surg admission

34. B Uptodate – pathogenesis of dengue virus infection

35. B

36. D (gas Gangrene) Cameron Ch 9.6

37. C http://www.telegraph.co.uk/topics/christmas/6859529/Father-Christmass- Christmas-

Eve-in-figures.html

38. A or D http://www.telegraph.co.uk/topics/christmas/6859529/Father-Christmass-

Christmas-Eve-in-figures.html

39. A Dunn, EMP – antibiotics in ED

40. A Cameron (Textbook of Paediatric Emergency Medicine), p. 268. B, C and D are

always significant when isolated from blood cultures