Regarding World Health Organization Roll Back Malaria plan

You are working with the public health minister of Malawi in a project to decrease malarial deaths in children younger than 5 years of age.

All of the following strategies are part of the World Health Organization Roll Back Malaria plan EXCEPT:
A. Artemisinin-based combination therapy
B. Early treatment with chloroquine alone
C. Indoor residual spraying
D. Insecticide-treated bed nets
E. Intermittent preventive treatment during pregnancy

Answer:

A patient presenting with fever and deranged LFTs ....

A 29-yr-old Catholic priest returns from a trip to Brazil with fevers and deranged LFTs. He has an ALT of 2500 U/l and bilirubin of 75 μmol/l. He attended a travel clinic and was vaccinated prior to travel. He also took mefloquine malaria prophylaxis.

What is the most likely diagnosis?

A. Malaria
B. Hepatitis A
C. Hepatitis B
D. Hepatitis E
E. Dengue fever

Answer:

Regarding Disorders Of The Thyroid Gland...

Regarding Disorders Of The Thyroid Gland answer the following questions...

1. What are the key features in a patient's history that are important in assessing for a possible functional thyroid disorder?
2. What are the important physical examination findings?
3. What laboratory data are used to confirm or refute the existence of a functional thyroid abnormality?

Answers And Discussion

1. What are the key features in a patient's history that are important in assessing for a possible functional thyroid disorder?
When assessing a patient's history for clues to a functional thyroid disease, it is important to keep in mind that thyroid hormones in general control metabolism. Therefore, when questioning patients about their medical history, it is important to ask specifically about elements related to metabolism.

For example, in the setting of hyperthyroidism,

• weight loss,
• anxiety, 
• tremor, 
• palpitations, 
• heat intolerance, 
• hyperdefecation, 
• insomnia,
• restlessness, and 
• changes in the hair or skin are important features. 

In contrast, in patients with suspected hypothyroidism, look for clues that indicate decreased metabolic activity. These include

Regarding Tetanus Prophylaxis

A 19-year-old man presents with a compound fracture of his leg following a fall from scaffolding. Examination reveals soiling of the wound with mud. He is sure he has had five previous tetanus vaccinations. What is the most appropriate course of action to prevent the development of tetanus?

A. Clean wound + intramuscular human tetanus immunoglobulin
B. Clean wound + tetanus vaccine
C. Clean wound + tetanus vaccine + intramuscular human tetanus immunoglobulin
D. Clean wound + tetanus vaccine + benzylpenicillin
E. Clean wound

Answer:

A 44-year-old male presents to the emergency room with an acutely swollen right knee

A 44-year-old male presents to the emergency room with an acutely swollen right knee. He has been in good health, and he has no chronic health conditions and no history of trauma. 

The most important evaluation should be:
A. MRI of the knee
B. Erythrocyte sedimentation rate
C. Diagnostic arthrocentesis of the knee
D. Complete blood count
E. Rheumatoid factor

Answer:

A patient presenting with signs and symptoms of cerebral malaria...

A 41-yr-old bird-watcher goes on a beach holiday in Gambia. She takes no malaria prophylaxis. On return to the UK she develops high fevers and self-medicates at home with Lemsip® ( a cough & cold medicine that contains paracetamol & phenylephrine).
On presentation to hospital, she had a fever of 40°C and looked markedly unwell, with a pulse of 130 bpm and BP 90/50 mmHg. She was commenced on IV ceftriaxone and quinine in casualty. Despite this, she deteriorated rapidly, and after 2 hours is found to have a GCS of 3.
Her blood film is reported as showing trophozoites and schizonts of Plasmodium falciparum with a parasitaemia of 20%.

Which of the following is most important as the next step in the management of this patient, once her airway, breathing and circulation have been stabilized?
A. Urgent CT brain scan
B. Blood glucose testing
C. U&E laboratory testing
D. Commence a phenytoin infusion
E. Start chloroquine

Answer:

Regarding the prevention and treatment of hepatitis C?

Which one of the following statements best describes the prevention and treatment of hepatitis C?

A. No vaccine is available and treatment is only successful in around 10-15% of patients
B. No vaccine and no treatment is available
C. A vaccine is available and treatment is successful in around 50% of patients
D. A vaccine is available but no treatment has been shown to be effective
E. No vaccine is available but treatment is successful in around 50% of patients

Answer:

A 20-year-old female college student presents with a 5-day history of cough and low-grade fever ...

A 20-year-old female college student presents with a 5-day history of cough, low-grade fever (temperature 100°F), sore throat, and coryza.
On examination, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.
Laboratory findings are as follows:
Hct: 38
WBC: 12,000/μL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates


The sputum Gram stain is likely to show
a. Gram-positive diplococci
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli

Answer:

HIV Post Exposure Prophylaxis

While inserting a central line, a medical senior house officer injures herself with a suture needle that had been used to stitch a patient with HIV infection. The injury is sufficient to draw blood. The Patient is 45 yrs old and has been infected with HIV for 11 yrs. He has been compliant with therapy for several years and has recently changed his tablets because of alterations in his appearance. His last CD4 count was 350 cells/mm3. The house officer is offered post exposure prophylaxis.
Which regimen should she take?
A. AZT and lamivudine
B. Tenofovir and emtricitabine
C. AZT, lamivudine, abacavir
D. AZT, lamivudine, DDI
E. AZT, lamivudine, stavudine

Answer:

A 25-year-old male student presents with the chief complaint of rash...

A 25-year-old male student presents with the chief complaint of rash. There is no headache, fever, or myalgia. A slightly pruritic maculopapular rash is noted over the abdomen, trunk, palms of the hands, and soles of the feet.
Inguinal, occipital, and cervical lymphadenopathy is also noted.
Hypertrophic, flat, wartlike lesions are noted around the anal area.
Laboratory studies show the following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/μL
Diff:
Segmented neutrophils: 50%
Lymphocytes: 50%

The most useful laboratory test in this patient is
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures

Answer: b. Venereal Disease Research Laboratory (VDRL) test

The treatment of choice for this patient is
a. Penicillin
b. Ceftriaxone
c. Tetracycline
d. Interferon α
e. Erythromycin

Answer: a. Penicillin

Discussion:

Management of a nurse who accidentally stabs himself with a used needle from a patient infected with the HCV...

A 34-yr-old CCU nurse accidentally stabs himself with a used needle from a patient infected with the HCV. He attends the occupational health dept and asks for advice. Which would be the most appropriate next step suggested by the occupational health doctor?

A. Monthly hepatitis C antibody testing
B. Monthly hepatitis C RT PCR/PCR testing
C. 6 months’ ribavirin therapy
D. 6 months’ lamivudine therapy
E. 6 months of weekly interferon therapy

Answer:

A 44 year old man who keeps pigeons presents with pneumonia....

A 44-yr-old man is admitted with right-sided pneumonia. According to him he has been unwell for three to four days with malaise, fever, cough and muscular pain. He also has a rash on his abdomen and neck pain.
He was previously fit and has not traveled abroad. He is a plumber and also keeps pigeons. According to his wife, two of his favorite pigeons died two weeks ago.

Which organism would you be suspicious of as being responsible for his pneumonia?
A. Streptococcus pneumonia
B. Legionella pneumophila
C. Coxiella burnetii
D. Chlamydia psittaci
E. Mycoplasma pneumoniae

Answer:

Screening For Hepatitis B, Hepatitis C & HIV in A Patient With Past History of Drug Abuse...

A 23-yr-old with a history of intravenous drug abuse in the past is seen in the medical out patient's clinic following DVT 2 moths ago for which he is on warfarin therapy.
He has the following blood results:
U&E, normal;
Albumin, 39 g/l;
ALT, 170 U/l;
GGT, 20 U/l;
LDH, 500 U/l;
Bilirubin, 23 μmol/l;
INR, 2.5;
Hb, 13.3 g/dl;
WCC, 4.2 x 109/l;
Platelets, 300 x 106/l.
You suggest that he should be screened for hepatitis B and C and HIV.
The results subsequently come back as follows:
HIV-1 and -2 antibody tests, negative;
Hepatitis B core IgG, positive;
Hepatitis B surface antigen, positive;
Hepatitis B e antigen, negative;
Hepatitis C IgG and PCR, negative.

Which test is most likely to lead to the correct diagnosis?

A. Hepatitis B DNA
B. Hepatitis D test
C. VDRL
D. AFP
E. Hepatitis E test

Answer:

A 29-yr-old man is admitted to hospital with a rash and high fevers....

A 29-yr-old man from Srilanka is admitted to hospital with a rash and high fevers. He gives a long history of pains in his hands and feet.
On Examination, he has an erythematous rash over his nose and cheeks.
ANA testing and dsDNA are strongly positive.
As part of his screening for pyrexia of unknown origin, an HIV antibody test is carried out, which proves positive.
His blood results are as follows:
Na, 136 mmol/l;
K, 3.7 mmol/l;
Urea, 3.5 mmol/l;,
Creatine, 67 U/l;
LFTs, normal;
Hb, 12.9 g/dl;
WCC, 2.4× 109/l (lymphocytes 0.8 × 109/l);
Platelets, 200 ×106/l;
ANA, positive;
dsDNA, positive;
CD4, 80 cells/mm3;
HIV antibody, positive;
Blood cultures, negative;
Syphilis serology, negative.

What is the most appropriate treatment  for his rash and arthropathy?
A. Combivir, efavirenz, co-trimoxazole
B. Prednisolone
C. Combivir, efavirenz, co-trimoxazole, prednisolone
D. Prednisolone, co-trimoxazole
E. Combivir, efavirenz

Answer:

A Patient With A history Of Fever and rash....

A 34-yr-old man returns from a journey to West USA with fevers and a rash affecting his hands and feet. He says he was admitted to hospital and has a medical note from the hospital informing you that he was admitted for several days with high fevers and a tachycardia of 105 bpm but that his BP did not drop at any time. After several days of illness, he developed desquamation of his hands and feet. He received some treatment and is now better.
His GP sent some tests that revealed a normal FBC and U&Es. Syphilis serology is negative. What treatment did he most likely receive?
A. IV cefuroxime
B. IV benzylpenicillin
C. Oral doxycycline
D. Oral erythromycin
E. None

Answer:

Management Of Pneumonia In A Patient With Cushing Disease.

A 25-yr-old lawyer from Edinburgh was brought into hospital with a 3-day Hx of increasing
shortness of breath and fevers. She recently received a Dx of Cushing’s disease and is awaiting
treatment.
Initial examination revealed a respiratory rate of 20 breaths/min and bilateral sparse crackles, with a characteristic buffalo hump and centripetal obesity.
CXR revealed sparse perihilar shadowing only. She has been on the admission’s ward for 2 days and is being treated with IV cefotaxime and oral clarithromycin. Overnight, she has deteriorated and ABG reveal a p(O2) of 6.5 on 24% oxygen.

What management is most appropriate?
A. Increase the oxygen to 100% and arrange admission to medical HDU for closer monitoring, and change the antibiotics to IV Tazocin
B. Increase the oxygen to 100% and arrange admission to medical HDU, with the addition of IV co-trimoxazole
C. Increase the oxygen to 100% and arrange admission to medical HDU, with the addition of amphotericin iv
D. Increase the oxygen to 100% and arrange admission to medical HDU, with no change in therapy
E. Increase the oxygen to 100% and arrange admission to medical HDU, adding cotrimoxazole, amphotericin and switching to iv Tazocin

Answer:

Treatment After Being Bitten By Pet Dog...

A 40-yr-old man presents with a swollen erythematous finger and right axillary tenderness, 24 hours after being bitten by his pet dog. What is the best Rx?
A. Metronidazole
B. Aciclovir
C. Fluconazole
D. Flucloxacillin
E. Co-amoxiclav

Answer:

Treatment For A Suspected Case Of Tuberculous Meningitis

A 40-yr-old woman presents with progressive confusion and mild neck stiffness. She has
suffered from increasing headaches over the past 4-6 wks, and over the past wk she has begun
to suffer from worsening drowsiness and confusion, with neck stiffness. A CT scan showed basal
meningeal enhancement. A lumbar puncture showed an opening pressure of 200 mmH2O, a
turbid CSF with 500 leucocytes/ml (90% lymphocytes), a glucose concentration of 1 mmol/l and
negative results with Gram, Indian ink and Ziehl–Neelsen stains. CSF protein is elevated at
1.05g/l (<0.50).
What is the best Rx?
A. Rifampicin + INAH + pyrazinamide + Ethambutol
B. Ceftriaxone
C. Aciclovir
D. Corticosteroids
E. Liposomal amphotericin B


Answer: