FRCPath 1 practice questions Flashcards
A 20-year-old woman presented with a 2-day history of fever, headache and confusion.
On examination, her temperature was 39.0°C and her Glasgow coma score was 11. She had no
neck stiffness or rash.
Investigations:
CT scan of brain normal
cerebrospinal fluid: total protein 0.85 g/L (0.15–0.45) glucose 3.8 mmol/L (3.3–4.4) white cell count 126/µL (<5) lymphocyte count 120/µL (<3) neutrophil count 6/µL (0)
What is the most likely causative organism?
A cytomegalovirus B enterovirus C herpes simplex virus type 1 D human herpes virus 8 E varicella zoster virus
?
Not meningitis - this is encephalitis
slightly raised protein, normal glucose, lymphocytosis points towards viral cause
HSV - most common cause
A 12-year-old boy underwent appendicectomy for acute appendicitis.
At the time of surgery there was evidence of localised peritonitis, and a pus swab was sent for
culture.
Which is the most likely pathogen?
A Streptococcus agalactiae B Streptococcus anginosus C Streptococcus equi D Streptococcus gallolyticus E Streptococcus infantarius
Strep anginonus - part of Strep Milleri group
A 23-year-old woman was referred with a 1-week history of fever, malaise, night sweats and
painful joints. Two weeks previously she had had a sore throat.
On examination, her temperature was 38.2°C, pulse 110 beats per minute, blood pressure 105/65
mmHg. She had a pan-systolic murmur, her chest was clear on auscultation. Her right wrist and left
knee were hot, swollen and painful.
Investigations: serum C-reactive protein 221 mg/L (<10) anti-streptolysin O titre 1600 echocardiogram evidence of pericardial effusion with mitral regurgitation
Rheumatic fever is considered as a diagnosis
Which of the modified Duckett–Jones criteria are fulfilled to confirm the diagnosis?
A 1 major + 1 minor B 1 major + 2 minor C 2 major + 2 minor D 2 major + 3 minor E 3 major + 3 minor
Acute rheumatic fever - modified Duckett-Jones criteria
JONES CAFE PAL
Major - J - joints migrator O - myocarditis (looks like heart) N - nodules subcutaneous E - erythema marginatum S - subcutaneous nodules
Minor - C - CRP raised A - arthralgia, single joint F - fever E - ESR raised
P - prolonged PR
A - anaemia of rheumatism
L - leukocytosis
Answer - C?
Major - myocarditis, migratory polyarthralgia
Minor - raised CRP, fever
Diagnosis of rheumatic fever -
- evidence of Strep infection - swab/ ASO
- 2 major or 1 major + 2 minor
Duke criteria is for IE
A 72-year-old man developed fever and increased oxygen requirement while being ventilated 6
days after emergency surgery for a ruptured abdominal aortic aneurysm. Two days previously, he
had been started on intravenous vancomycin for infection at the site of a peripheral intravenous
cannula. He had a history of anaphylaxis following penicillin.
On examination, his temperature was 38.2°C, his pulse was 98 beats per minute and regular, and
his blood pressure was 124/78 mmHg. There was decreased air entry and coarse crackles were
audible at the right lung base.
Investigations:
chest X-ray new infiltrate in right
lower lung field
What is the most appropriate addition to his antibiotic treatment?
A ceftazidime B ciprofloxacin C co-trimoxazole D fosfomycin E tigecycline
VAP - >48 hours since intubation
Avoid cephalosporins. They are amber class - avoid in severe penicilling allergy
Avoid ciprofloxacin - increases risk of ruptured aneurym
Co-trimoxazole
A 24-year-old woman presented with a 2-day history of cough productive of green sputum.
On examination, there were signs of consolidation at the left lung base. Her CURB-65 score was 1.
She was attempting to conceive and was reluctant to take any antibiotic that might be harmful in
pregnancy.
Which antibiotic is most appropriate?
A amoxicillin B azithromycin C doxycycline D levofloxacin E vancomycin
Amoxicillin
Azithromycin avoid in pregnancy, unless benefit outweighs risk
A 35-year-old woman presented with a 3-day history of productive cough, breathlessness and
rigors.
She was treated empirically with intravenous vancomycin.
What is the site of action of vancomycin?
A cell membrane integrity B DNA synthesis C peptidoglycan cross-linking D protein synthesis via the 50S ribosomal subunit E RNA synthesis
C peptidoglycan cross-linking
Four patients on an elderly care ward were diagnosed with norovirus infection.
What immediate measure is most appropriate to prevent further spread within the institution?
A close down the kitchen supplying meals to the ward
B hydrogen peroxide vapour in affected areas
C introduce alcohol hand rub to the ward
D isolation of symptomatic patients
E transfer asymptomatic patients to other wards
D isolation of symptomatic patients
?
A 30-year-old man was diagnosed with acute hepatitis A virus infection. This was notified to the
Health Protection Unit (HPU).
He had attended a wedding reception 4 weeks previously. The HPU ascertained that that eight
other guests out of a total of 50 had developed acute hepatitis.
What is the most appropriate approach to investigating the source of this outbreak?
A case control study B cohort study C environmental investigation of the catering facility D randomised controlled trial E serological surveillance
Case control??
Known cause, and cant compare what cases ate vs what controls ate
A 1-day old baby was visited by his 5-year-old sister who developed chickenpox the following day.
The baby had been born at 30 weeks’ gestation and weighed 990g. The mother had not had any
obvious illness during the pregnancy.
The maternal antenatal blood taken at 13 weeks was retrieved for investigation
Investigations:
Varicella zoster virus IgG positive
What is the most appropriate intervention for the baby?
A commence intravenous aciclovir
B commence oral valganciclovir
C give intramuscular human normal immune globulin
D give intramuscular varicella zoster immune globulin
E no action required
D give intramuscular varicella zoster immune globulin
Mother tested at 13 weeks IgG positive - if term baby, ample time for maternal antibody to cross placenta, so baby should be protected.
Babies born <28 weeks, or weigh <1000g, maternal antibodies may not be present despite positive history of chickenpox. Such infants should be tested for immunity. If non-immune - give VZV IgG. In terms of question, doesn’t suggest testing, so just give VZIG
VZIG is recommended for infants whose mothers develop chickenpox (but not herpes zoster) in the period seven days before to seven days after delivery.
VZIG can be given without antibody testing of the infant.
VZIG is not usually required for infants born more than seven days after the
onset of maternal chickenpox or whose mothers develop zoster before or after
delivery, as these infants will have maternal antibody.
VZIG is also recommended for:
● VZ antibody-negative infants exposed to chickenpox or herpes zoster
(other than in the mother) in the first seven days of life
● VZ antibody-negative infants of any age, exposed to chickenpox
or herpes zoster while still requiring intensive or prolonged special
care nursing.
A 6-year-old boy was brought by his mother to the emergency department after accidentally
stabbing himself with a needle found discarded in the park. His mother had brought the needle with
them.
On examination, the child was well, apart from a minor scratch to the right hand.
What is the most appropriate management?
A give hepatitis B immunoglobulin
B issue HIV post-exposure prophylaxis
C request urgent blood-borne virus serology
D start an accelerated course of hepatitis B vaccine
E test the needle for blood-borne viruses
D start an accelerated course of hepatitis B vaccine?
Unknown status - don’t think needs HIV PEP?
A 32-year-old woman presented to the TB contact clinic after her husband had been diagnosed
with fully sensitive smear-positive pulmonary tuberculosis. She was well and had no symptoms.
On examination she had a BCG scar. Her chest was clear.
Investigations:
chest X-ray normal
interferon gamma release assay positive
What is the most appropriate advice about chemoprophylaxis?
A isoniazid for 3 months B none required C rifampicin for 6 months D rifampicin plus ethambutol for 3 months E rifampicin plus isoniazid for 3 months
E rifampicin plus isoniazid for 3 months - latent TB
Likely assess husband at 3 months - if he is smear negative can stop prophylaxis.
Check guidelines - CDC suggests isoniazid for 6 months is option
A 35-year-old woman presented to a travel clinic prior to a 1-week beach holiday in the Gambia.
She was taking fluoxetine.
What is the most appropriate malarial chemoprophylaxis?
A atovaquone/proguanil B chloroquine and proguanil C doxycycline D mefloquine E none required
atovaquone-proguanil
avoid doxycycline as states “beach holiday”
Chloroquine/ mefloquine contraindicated
What is the most appropriate confirmation test following an initial reactive hepatitis B surface
antigen (HBsAg) screening result by enzyme immunoassay (EIA)?
A neutralisation of the reactivity using hepatitis B surface antibody
B repeat the EIA
C test the sample for hepatitis B core total antibody
D test the sample for HBV DNA
E test the sample for hepatitis B e antigen and hepatitis B e antibody
A neutralisation of the reactivity using hepatitis B surface antibody
A 20-year-old man presented with a 5-day history of fever. He had received a haematopoietic stem
cell transplant for acute myeloid leukaemia 7 months previously.
Investigations: blood adenovirus DNA 100 000 copies/mL (lower limit of detection 10) cytomegalovirus DNA 100 000 IU/mL (lower limit of detection 10)
Which anti-viral agent is active against both viruses? A aciclovir B cidofovir C foscarnet D ganciclovir E ribavirin
B cidofovir
must be given with probenicid to reduce toxicity
A 42-year-old woman was admitted to ICU with severe community acquired pneumonia. She was
known to have advanced HIV disease and had recently returned from the mid-west of the USA.
Investigations
Non-directed bronchial lavage
Gram stain
Yeast 2+
Which of the following poses greatest risk to laboratory staff?
A Candida dubliniensis B Cryptococcus neoformans C Histoplasma capsulatum D Rhodotorula rubrum E Trichosporon beigelii
C Histoplasma capsulatum
