Tropical Medicine 1

Question 1

1. The following are recognised causes of eosinophilia

a. malaria
b. visceral leishmaniasis
c. Churg-Strauss syndrome
d. drug hypersensitivity
e. visceral larva migrans (toxocariasis)

Answer 1

False a. malaria
False b. visceral leishmaniasis
True c. Churg-Strauss syndrome
True d. drug hypersensitivity
True e. visceral larva migrans (toxocariasis)

Question 2

what are important parasitic causes of eosinophilia?

Answer 2

Filarial worms
Tapeworms
Strongyloidiasis
Hydatid disease
Hookworm
Fascioliasis
Toxocariasis (visceral larva migrans)
Schistosomiasis
Trichinella spiralis
Intestinal nematodes
Tropical pulmonary eosinophilia (usually results from hypersensitivity to microfilariae)

Question 3

what are important non-parasitic causes of eosinophilia?

Answer 3

Allergic disorders -	
Asthma
Eczema
Hayfever
Drug hypersensitivity

Auto-immune -
Churg-Strauss syndrome
Wegener’s granulomatosis
Polyarteritis nodosa

Haematological -
Hodgkin’s disease
Eosinophilic leukaemia

Dermatological -
Bullous pemphigoid
Pemphigus vulgaris

Respiratory -
Allergic bronchopulmonary aspergillosis
Hypereosinophilic syndrome
Asthma

Miscellaneous -
Eosinophilia-myalgia syndrome caused by L-Tryptophan
Spanish toxic oil syndrome
Eosinophilic gastroenteritis

Question 4

2. Giardia lamblia

a. is usually acquired by ingestion of food or water contaminated by the trophozoites
b. trophozoites have four flagella
c. can effectively be treated by mepacrine
d. cysts are killed by standard chlorination of water
e. cysts survive in water boiled for ten minutes

Answer 4

False a. is usually acquired by ingestion of food or water contaminated by the trophozoites (ingestion of cysts)
False b. trophozoites have four flagella (have four pairs of flagella)
True c. can effectively be treated by mepacrine. Metronidazole more commonly used now
False d. cysts are killed by standard chlorination of water
False e. cysts survive in water boiled for ten minutes

Question 5

What is life cycle of Giradia?

Answer 5

During the trophozoite phase it lives in the proximal small bowel where it adheres to the mucosa. Each trophozoite has four pairs of flagella.

Infection is acquired though water contaminated with giardial cysts.

Question 6

3. Mosquitoes are the vector in the following disorders

a. onchocerciasis
b. visceral leishmaniasis
c. myiasis
d. African trypanosomiasis
e. Bancroftian filariasis

Answer 6

False a. onchocerciasis
False b. visceral leishmaniasis
False c. myiasis
False d. African trypanosomiasis
True e. Bancroftian filariasis

Question 7

What is vector for these diseases?

Onchocerciasis

Loa Loa

leishmaniasis

African Trypanosomiasis

South American Trypanosomiasis

Bancroftian filariasis

Myiasis

Answer 7

Onchocerciasis - similium fly

Loa loa - Chrysops

leishmaniasis - sandfly

African Trypanosomiasis - Tsetse

South American Trypanosomiasis - Reduviid bug

Bancroftian filariasis - various mosquitoes

Myiasis - tumbu fly

Question 8

4. Consumption of raw fish or shellfish is associated with infection caused by

a. Clonorchis sinensis
b. Ancylostoma duodenale
c. Schistosoma japonicum
d. Vibrio parahaemolyticus
e. Paragonimus westermani

Answer 8

True a. Clonorchis sinensis
False b. Ancylostoma duodenale
False c. Schistosoma japonicum
True d. Vibrio parahaemolyticus
False e. Paragonimus westermani

A. duodenale and S. japonicum both gain entry via penetration of intact skin by immature forms.

Other infectious diseases associated with shellfish / raw fish include hepatitis A and gnathostomiasis.

Question 9

5. Following splenectomy for trauma

a. thrombocytopaenia is typical
b. pneumococcal vaccine should be given
c. malaria is more severe
d. prophylactic penicillin should be taken for six weeks
e. Heinz bodies are characteristically seen on the blood film

Answer 9

False a. thrombocytopaenia is typical
True b. pneumococcal vaccine should be given
True c. malaria is more severe
False d. prophylactic penicillin should be taken for six weeks
False e. Heinz bodies are characteristically seen on the blood film

Splenectomy typically results in thrombocytosis.

Howell-Jolly bodies are small pieces of nuclear material usually removed from erythrocytes by the spleen.

Heinz bodies are oxidised, denatured bits of haemoglobin found in G-6-PD deficiency for example. Special stains are required to see Heinz bodies.

Question 10

6. Nephrotic syndrome is a recognised complication of infection with

a. Schistosoma mansoni
b. Plasmodium malariae
c. Hepatitis B virus
d. Mycobacterium leprae
e. Loa loa

Answer 10

True a. Schistosoma mansoni
True b. Plasmodium malariae
True c. Hepatitis B virus
True d. Mycobacterium leprae
True e. Loa loa

Question 11

7. HIV positive patients may receive

a. measles vaccine
b. TY21a (oral typhoid vaccine)
c. Hib vaccine
d. BCG
e. Havrix (hepatitis A vaccine)

Answer 11

True a. measles vaccine
False b. TY21a (oral typhoid vaccine)
True c. Hib vaccine
False d. BCG
True e. Havrix (hepatitis A vaccine

BCG contraindicated at all CD4 counts
Most other live vaccines ok if CD4 >200

Question 12

8. Steroids are of benefit in the treatment of

a. visceral leishmaniasis
b. Eschericia coli septicaemia
c. cerebral malaria
d. severe typhoid fever
e. herpes zoster recrudescence (shingles)

Answer 12

False a. visceral leishmaniasis
False b. Eschericia coli septicaemia
False c. cerebral malaria
True d. severe typhoid fever??? 
False e. herpes zoster recrudescence (shingles)

Steroids beneficial:
Severe typhoid
Hib meningitis in children
Croup
Tuberculoid leprosy
Severe pneumocystis pneumonia
Tuberculous meningitis
Tuberculous pericarditis
Tuberculous pleural effusion
Type 1 lepra reaction
Katayama fever

Question 13

9. In tuberculoid leprosy

a. peripheral nerves are involved symmetrically
b. the lepromin test is positive
c. hair growth is normal in affected skin lesions
d. smear negative cases can be treated with steroids alone
e. skin lesions usually have a well-demarcated, raised edge

Answer 13

a. peripheral nerves are involved symmetrically
True b. the lepromin test is positive
c. hair growth is normal in affected skin lesions
d. smear negative cases can be treated with steroids alone
True e. skin lesions usually have a well-demarcated, raised edge

Peripheral nerves may be thickened but are characteristically involved asymmetrically.

There are typically only 1 or 2 skin lesions which are well-demarcated, dry, scaly, hypopigmented, anaesthetic and hairless.

Question 14

What is treatment of leprosy?

Answer 14

Treatment of tuberculoid leprosy should include daily dapsone and supervised monthly rifampicin for six months.

Question 15

10. Plasmodium falciparum

a. causes more severe disease in pregnancy
b. is associated with recurrent relapses after initial treatment because of liver hypnozoites
c. is the only malarial parasite causing greater than 20% parasitaemia
d. infection is typically associated with thrombocytopaenia
e. is the only cause of cerebral malaria

Answer 15

True a. causes more severe disease in pregnancy
False b. is associated with recurrent relapses after initial treatment because of liver hypnozoites
True c. is the only malarial parasite causing greater than 20% parasitaemia
True d. infection is typically associated with thrombocytopaenia
True e. is the only cause of cerebral malaria

Question 16

11. The following infectious diseases are correctly matched to their period of infectivity:

a. chicken pox: from appearance of rash until the last spot is crusted over
b. rubella: 7 days before onset of rash until 4 days after onset of rash
c. mumps: 7 days before salivary swelling until appearance of salivary swelling
d. scarlet fever: from appearance of rash until completion of 1 day’s penicillin
e. measles: from onset of prodrome until 4 days after onset of ras

Answer 16

False a. chicken pox: from appearance of rash until the last spot is crusted over

True b. rubella: 7 days before onset of rash until 4 days after onset of rash

False c. mumps: 7 days before salivary swelling until appearance of salivary swelling

True d. scarlet fever: from appearance of rash until completion of 1 day’s penicillin

True e. measles: from onset of prodrome until 4 days after onset of rash

Chicken pox: 5 days before rash to six days after last crop.

Mumps: 3 days before until 7 days after salivary swelling.

Whooping cough: 1 week after exposure to 3 weeks after onset of symptoms. The period of infectivity may be shortened by antibiotics.

Question 17

12. Amoebic liver abscess:

a. should be treated by diloxanide furoate alone
b. should be aspirated routinely
c. is associated with eosinophilia
d. usually affects the right lobe of the liver
e. occur most commonly in men aged 20-60 years

Answer 17

False a. should be treated by diloxanide furoate alone
False b. should be aspirated routinely
False c. is associated with eosinophilia
True d. usually affects the right lobe of the liver
True e. occur most commonly in men aged 20-60 years

In approximately 50% of cases there is no previous history of amoebic dysentery.

The patient typically presents with fever and right upper quadrant pain of fairly acute onset. Treatment of the fever with chloroquine may modify the clinical presentation.
Neutrophilia is usual, not eosinophilia.

Treatment is metronidazole and then diloxanide or paromomycin to kill GI parasites

Question 18

13. A woman who had not previously travelled abroad spent five days in Zambia. She went on safari on the fifth day and on the following day she became ill with fever and an erythematous rash. She is likely to be suffering from:

a. hepatitis A
b. loa loa
c. falciparum malaria
d. brucellosis
e. Hodgkin’s disease

Answer 18

All false

Question 19

14. In enteric fever

a. severe cases should receive high dose dexamethasone
b. ciprofloxacin is the treatment of choice in the UK. for adults
c. jaundice is a recognised complication
d. myocarditis is a recognised complication
e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality

Answer 19

True a. severe cases should receive high dose dexamethasone???
True b. ciprofloxacin is the treatment of choice in the UK. for adults??? Ceftriaxone
True c. jaundice is a recognised complication
True d. myocarditis is a recognised complication
False e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality.

Question 20

15. Hepatitis B.
    a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.

b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly in homosexuals.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.

Answer 20

a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.
b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly with homosexual transmission.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.

Question 21

16. E.coli 0157 / H7:

a. is a bowel commensal
b. causes haemorrhagic colitis
c. is an important cause of cholera-like illness
d. is a recognised cause of the haemolytic uraemic syndrome
e. can be prevented from causing clinical illness by vaccination

Answer 21

False a. is a bowel commensal
True b. causes haemorrhagic colitis
False c. is an important cause of cholera-like illness
True d. is a recognised cause of the haemolytic uraemic syndrome
False e. can be prevented from causing clinical illness by vaccination

Question 22

17. Melioidosis:

a. is caused by Pseudomonas pseudotuberculosis
b. is more common in diabetics
c. should be treated with cefuroxime
d. is confined to equatorial Africa and South America
e. is commonly complicated by parotitis

Answer 22

False a. is caused by Pseudomonas pseudotuberculosis
True b. is more common in diabetics
False c. should be treated with cefuroxime
False d. is confined to equatorial Africa and South America
True e. is commonly complicated by parotitis

The causative organism is Pseudomonas pseudomallei.

The treatment of choice is ceftazidime. Cefuroxime does not cover Pseudomonas species.

Question 23

18. The following neoplasms have a known infective aetiology:

a. Burkitt’s lymphoma
b. squamous carcinoma of the penis
c. hepatocellular carcinoma
d. squamous carcinoma of the bronchus
e. nasopharyngeal carcinoma

Answer 23

True a. Burkitt's lymphoma
True b. squamous carcinoma of the penis
True c. hepatocellular carcinoma
False d. squamous carcinoma of the bronchus
True e. nasopharyngeal carcinoma

Question 24

19. Characteristic findings in visceral leishmaniasis (kala azar) include:

a. eosinophilia
b. pancytopaenia
c. polyclonal hypergammaglobulinaemia
d. positive leishmanin test
e. lymphadenopathy

Answer 24

False a. eosinophilia

True b. pancytopaenia - due to marrow suppression and hypersplenism

True c. polyclonal hypergammaglobulinaemia

False d. positive leishmanin test

True e. lymphadenopathy

Question 25

20. Parvovirus B19:

a. is the causative agent of fifth disease (erythema infectiosum)
b. was discovered after parvovirus B16
c. antibodies are present in 70% of the UK adult population
d. is a recognised cause of aplastic anaemia
e. is known to cause hydrops fetalis

Answer 25

True a. is the causative agent of fifth disease (erythema infectiosum)

False b. was discovered after parvovirus B16

True c. antibodies are present in 70% of the UK adult population

True d. is a recognised cause of aplastic anaemia

True e. is known to cause hydrops fetalis

Due to naming of Human Papilloma Virus HPV, it was named B19 after the well on a tray of early isolate. No parvo B16

Question 26

21. Subcutaneous nodules are a typical finding in:

a. neurofibromatosis
b. hydatid disease
c. cysticercosis
d. onchocerciasis
e. trichinosis

Answer 26

True a. neurofibromatosis
False b. hydatid disease
True c. cysticercosis
True d. onchocerciasis
False e. trichinosis

In hydatid disease the cysts are typically found in the liver and the lung.

Question 27

22. Characteristic features of kwashiorkor include:

a. patient aged less than 1 year
b. anorexia
c. flakey discoloured skin
d. hepatomegaly
e. splenomegaly

Answer 27

False a. patient aged less than 1 year
True b. anorexia
True c. flakey discoloured skin
True d. hepatomegaly
Fasle e. splenomegaly

The word kwashiorkor is from West Africa, originally meaning the child who has been displaced from the breast. It is most common in children aged 1-2 year

Question 28

23. Concerning meningococcal disease:

a. vaccine is available for meningococci groups A and C
b. sporadic outbreaks in the UK. are usually due to type B meningococcus
c. close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose
d. outbreaks of disease occur seasonally in parts of sub-Saharan Africa.
e. is the most common cause of bacterial meningitis in the UK.

Answer 28

True a. vaccine is available for meningococci groups A and C
True b. sporadic outbreaks in the UK. are usually due to type B meningococcus
False c. close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose
True d. outbreaks of disease occur seasonally in parts of sub-Saharan Africa.
True e. is the most common cause of bacterial meningitis in the UK.

N. meningitidis is the most common cause of bacterial meningitis in the UK and world wide. Asymptomatic nasal carriage occurs in 10-15% of normal people. Serious meningococcal disease is accompanied by the typical purpuric rash in two thirds of cases.

Contacts are usually given rifampicin 600mg b.d. for two days.

The part of Africa affected by epidemic meningitis is known as the meningitis belt. These outbreaks are caused by Group A organisms.

Question 29

24. Staphylococcus epidermidis:

a. is coagulase positive
b. on microscopy are Gram positive cocci in chains
c. are usually sensitive to penicillin
d. grown in blood cultures are due to contamination and should be ignored
e. are destroyed by povodine iodine

Answer 29

False a. is coagulase positive
False b. on microscopy are Gram positive cocci in chains
False c. are usually sensitive to penicillin
False d. grown in blood cultures are due to contamination and should be ignored
True e. are destroyed by povodine iodine

Question 30

25. Concerning tuberculin skin testing:

a. patients with tuberculous pericarditis are usually tuberculin positive
b. previous BCG vaccination usually results in a strongly positive reaction
c. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases
d. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive.
e. the test is usually negative in miliary tuberculosis

Answer 30

True a. patients with tuberculous pericarditis are usually tuberculin positive
False b. previous BCG vaccination usually results in a strongly positive reaction
True c. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases
False d. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive.
True e. the test is usually negative in miliary tuberculosis

Question 31

26. Hookworm

a. is usually spread by the faeco-oral route
b. is usually diagnosed by microscopy of adhesive tape prints taken from the perianal area
c. may block the pancreatic duct causing pancreatitis
d. eggs can be readily distinguished microscopically from those of Strongyloides sp.
e. commonly causes diarrhoea in non-immunes

Answer 31

all false

soil transmitted helminth

hookworm species include Necator americanus and Ancylostoma duodenale, which are indistinguishable on light microscopy

Question 32

27. The following are associated with an increased risk of vertical transmission of HIV

a. breast feeding
b. high titres of p24 antigen in maternal serum perinatally
c. low maternal CD4 counts during pregnancy
d. prolonged labour
e. HIV-1 compared to HIV-2

Answer 32

True a. breast feeding
True b. high titres of p24 antigen in maternal serum perinatally
True c. low maternal CD4 counts during pregnancy
False d. prolonged labour
True e. HIV-1 compared to HIV-2

breast feeding benefits usually outweigh risk of HIV transmission

Question 33

28. Concerning African trypanosomiasis

a. it has an incubation period of 4-6 months
b. it may cause erythema chronicum migrans in light skinned persons
c. the Gambian form progresses more rapidly
d. the Gambian form is associated with a more prominent chancre
e. the Gambian form can be treated with pentamidine

Answer 33

False a. it has an incubation period of 4-6 months
False b. it may cause erythema chronicum migrans in light skinned persons
False c. the Gambian form progresses more rapidly
False d. the Gambian form is associated with a more prominent chancre
True e. the Gambian form can be treated with pentamidine

circinate erythema may occur in light skinned people. Erythema chronicum migrans is characteristic of lyme disease

Rhodesian form more rapidly progressively

Question 34

what is treatment of African trypanosomiasis?

Gambian

Rhodesian

eflornithine
melarsoprol
pentamidine
suramin

Answer 34

Gambian -
CNS not involved - pentamidine (1st choice) PLUS suramin or eflornithine
CNS involved - melarsaprol

Rhodesian -
CNS not involved - suramin
CNS involved - melarsaprol

Rhodesian tends to be more severe
Gambiense more likely present with Witnerbottom’s sign and chancre at inoculation site

Question 35

29. Vivax malaria

a. may be complicated by anaemia
b. may be complicated by jaundice
c. in a traveller may present more than six months after exposure
d. is sensitive to chloroquine
e. may co-exist with falciparum malaria in the same patient

Answer 35

all true

Question 36

30. The following infections are zoonoses

a. salmonellosis
b. leprosy
c. tularaemia
d. Weil’s disease (leptospirosis)
e. cholera

Answer 36

True a. salmonellosis
Falseb. leprosy
True c. tularaemia
True d. Weil's disease (leptospirosis)
False e. cholera

armadillo is only other vertebrate which develops leprosy

Salmonella Typhi only human-human transmission

Question 37

31. A fever of two weeks’ duration associated with neutropaenia is characteristically due to

a. disseminated tuberculosis
b. brucellosis
c. malaria
d. influenza B
e. amoebic liver abscess

Answer 37

True a. disseminated tuberculosis
True b. brucellosis
True c. malaria
False d. influenza B
False e. amoebic liver abscess

Question 38

32. Quinine

a. is gametocidal for mature gametocytes of Plasmodium falciparum.
b. is active against schizonts of Plasmodium malariae
c. resistance occurs in Plasmodium falciparum in South East Asia
d. cerebrospinal fluid levels are much lower than serum levels following oral or intravenous administration
e. causes hypoglycaemia

Answer 38

False a. is gametocidal for mature gametocytes of Plasmodium falciparum.
True b. is active against schizonts of Plasmodium malariae
True c. resistance occurs in Plasmodium falciparum in South East Asia
True d. cerebrospinal fluid levels are much lower than serum levels following oral or intravenous administration
True e. causes hypoglycaemia

Quinine is schizonticidal to all four types of malaria. The gametocytes of P.vivax, P.ovale and P.malariae are also susceptible. The mature gametocytes of P.falciparum and the hypnozoites of P.ovale and P.vivax are not susceptible.

Quinine-resistant P.falciparum has been reported in South East Asia.

Most anti-malarials are active against schizonts

Question 39

33. Rheumatic fever

a. is most common in the third decade
b. is more common in areas of social deprivation
c. causes erosive arthritis
d. relapse rate may be reduced by prophylactic antibiotics
e. is more common following streptococcal pharyngitis than streptococcal cellulitis

Answer 39

False a. is most common in the third decade
True b. is more common in areas of social deprivation
False c. causes erosive arthritis
True d. relapse rate may be reduced by prophylactic antibiotics
True e. is more common following streptococcal pharyngitis than streptococcal cellulitis

peak age onset 5-15 years

arthritis usually leaves the joints undamaged

streptococcal skin infections rarely cause rheumatic fever. Usually just streptococcal pharyngitis

Question 40

34. The following are correctly paired

a. erythema nodosum tuberculosis
b. erythema marginatum Lyme disease
c. erythema multiforme orf
d. erythema induratum syphilis
e. erythema infectiosum parvovirus B19

Answer 40

True a. erythema nodosum: tuberculosis
False b. erythema marginatum: Lyme disease
True c. erythema multiforme: orf
False d. erythema induratum: syphilis
True e. erythema infectiosum: parvovirus B19

Question 41

35. HIV-associated Kaposi’s sarcoma is

a. radiosensitive
b. chemosensitive
c. a cause of pleural effusion
d. more common in intravenous drug abusers than homosexuals
e. associated with infection by HHV-8 (Herpes hominis virus type 8)

Answer 41

True a. radiosensitive
True b. chemosensitive
True c. a cause of pleural effusion
False d. more common in intravenous drug abusers than homosexuals
True e. associated with infection by HHV-8 (Herpes hominis virus type 8)

The skin and palate are particularly common sites for KS. Cutaneous and lymph node KS responds to radiotherapy. Systemic KS (i.e. bowel, pulmonary) responds to chemotherapy: vincristine, bleomycin, etoposide.

Question 42

36. Cholera

a. Vibrio cholera of the 01 serotype is the only cause of clinical disease
b. low gastric pH protects against infection
c. cholera toxin produces its effect by reducing intracellular levels of cAMP
d. hypoglycaemia is a recognised complication in children
e. fever is usual in adults

Answer 42

False a. Vibrio cholera of the 01 serotype is the only cause of clinical disease
True b. low gastric pH protects against infection
False c. cholera toxin produces its effect by reducing intracellular levels of cAMP
True d. hypoglycaemia is a recognised complication in children
False e. fever is usual in adults

Question 43

what is the structure of cholera toxin, and how does it work?

Answer 43

cholera toxin is an 84kDa protein consisting of one A (activating) and five B (binding) subunits. The A1 part of the A subunit enters the mucosal cell. Here it catalyses the transfer of ADP-ribose to GTP-binding regulatory protein. GTP regulatory protein is altered in conformation and this leads to reduced inhibition of adenyl cyclase. The intracellular concentration of cAMP rises and a net loss of isotonic fluid into the gut occurs.

Question 44

37. The following drugs are contraindicated or should be used with caution in epileptics:

a. doxycycline
b. chloroquine
c. ciprofloxacin
d. mefloquine
e. metronidazole

Answer 44

False a. doxycycline
True b. chloroquine
True c. ciprofloxacin
True d. mefloquine
False e. metronidazole

Mefloquine is contra-indicated in epileptics. In the normal population there is a 1 in 10,000 chance of serious neuropsychiatric complications. The risk is greater in epileptics.

Chloroquine should only be used with caution as it reduces seizure threshold. Doxycycline is an acceptable alternative for malaria prophylaxis. It is suitable for short term use and has the additional advantage of protecting against rickettsial infections, plague and leptospirosis.

Ciprofloxacin and other quinolones should be used with caution in epilepsy as they lower seizure threshold and may induce convulsions

Question 45

38. Hepatitis C

a. cirrhosis develops in most untreated cases
b. blood transfusion is the commonest mode of transmission in the UK.
c. most children born to hepatitis C infected mothers will have the infection
d. a normal serum alanine transaminase level excludes active liver disease
e. genotype 1 has the most favourable response to treatment

Answer 45

All false

The ALT level is not closely associated with the severity of liver disease so most HCV-RNA positive patients are offered liver USS/ biopsy

10-20% of cases develop chronic active hepatitis or cirrhosis. 3% develop hepatocellular carcinoma.

HCV transmission: most cases are due to intravenous drug abuse / needle-sharing. Sexual transmission accounts for about 5% of cases as does vertical transmission. In the U.K. all donated blood has been screened since 1991.

Question 46

39. Coagulopathy is a recognised complication of

a. epidemic typhus
b. relapsing fever
c. pneumococcal septicaemia
d. envenomation by Latrodectus spiders (black widow spiders)
e. envenomation by Physalia physalis (Portuguese-man-of-war)

Answer 46

True a. epidemic typhus
True b. relapsing fever
True c. pneumococcal septicaemia
False d. envenomation by Latrodectus spiders (black widow spiders)
False e. envenomation by Physalia physalis (Portuguese-man-of-war)

Haemorrhagic rash is a characteristic feature of both epidemic typhus and relapsing fever. DIC is a potential complication of septicaemia.

Envenomation by the black widow spider causes local reactions, neurotoxicity, sweating and muscle spasm. Coagulation defects are not well described.

Likewise with stings from a Portuguese-man-of-war, local reactions, cardiovascular toxicity and muscle spasms may occur but coagulopathy is not well described.

Coagulopathy may follow envenomation by African pit vipers.

Question 47

40. Cryptococcal meningitis

a. is caused only by Cryptococcus neoformans neoformans
b. is more common than cryptococcal pneumonia
c. characteristically causes leucopaenia
d. only occurs in the immunosuppressed
e. should be treated with ketoconazole

Answer 47

False a. is caused only by Cryptococcus neoformans neoformans
True b. is more common than cryptococcal pneumonia
False c. characteristically causes leucopaenia
False d. only occurs in the immunosuppressed
False e. should be treated with ketoconazole

Ketoconazole does not cross the blood brain barrier. Usually treatment is with intravenous amphoteracin B with or without flucytosine. In AIDS patients relapse is inevitable and lifelong prophylaxis with fluconazole or itraconazole is recommended. High dose fluconazole has been used successfully for treatment as an alternative to amphoteracin B.