Infections in MRCP Part 2

Questions about common infections in MRCP......

1)A 20-year-old man undergoes successful renal transplantation with a matched related donor graft. One month later he presents with a high fever and leukopoenia. He becomes dyspnoeic. Liver function tests are markedly deranged.
Which of the following is the most likely cause of his illness?

1 ) Adenovirus 2 ) Coxsackievirus 3 ) Cytomegalovirus
4 ) Influenza virus 5 ) Parvovirus B19

ANSWER: 3

2) A 22-year-old girl with sickle cell disease presents with pain in her left thigh. A plain X-ray film shows changes consistent with osteomyelitis of the left femur.
Which of the following is the most likely causative organism?

1 ) Clostridium perfringens 2 ) Enterococcus faecium 3 ) Listeria monocytogenes 4 ) Staphylococcus aureus 5 ) Salmonella enteritiditis

ANSWER: 5

3)A 23-year-old man is noted by his partner to be jaundiced. Two weeks previously he suffered a mild flu-like illness. His investigations are shown.Hb 7.3 g/dlMCV 99 fLWCC 8.0x109/LPlt 340x109/LReticulocytes 6.8%Albumin 41 g/LTotal Bilirubin 42 µmol/LAST 36 IU/LALP 40 IU/LUrine dipstick urobilinogen ++, bilurubin negative, protein negative, blood ++
What antiobiotics would be useful in treating his condition?

1 ) ampicillin 2 ) macrolides 3 ) aminoglycosides 4 ) cephalosporins 5 ) penicillin

ANSWER: 2

4)A 23-year-old Indian man is diagnosed with pulmonary tuberculosis and is started on rifampicin, isoniazid, and pyrazinamide. Four weeks later he presents with fever, myalgia, and lethargy.Investigations:Haemoglobin 14.5 g/dLWBC 7.5 x 109/LNeutrophils 5.5 x 109/LLymphocytes 0.8 x 109/LMonocytes 0.05 x 109/LEosinophils 1.14 x 109/LBasophils 0.01 x 109/LPlatelets 350 x 109/LSerum sodium 141 mmol/LSerum potassium 5.1 mmol/L Serum urea 27.9 mmol/LSerum creatinine 400 umol/LSerum bilirubin 7umol/L Serum aspartate transaminase 31 IU/LSerum alkaline phosphatase 97 IU/LSerum albumin 39 g/LUrinalysis Protein +, Leucocytes +, no bacteriaUrine culture Negative
What is the most likely cause of his renal impairment?

1 ) Acute interstitial nephritis 2 ) Isoniazid toxicity 3 ) Plasmodium vivax malaria 4 ) Renal tuberculosis 5 ) Rhabdomyolysis

ANSWER: 1

5)A 27 year old man presents with complaints of pains in multiple joints one weeks after returning from a holiday in Thailand. He describes flitting arthralgia beginning I both knees, migrating to both wrists intermittently. His main complaint is of more severe pain in his left knee. On examination, he is febrile 38.5°C. The left knee is swollen, warm and tender. Several pustular lesions are noted on three digits of his right hand.InvestigationsHb 14.8 g/dlWCC 12.3 x 109/lPlatelets 450 x 109/lPlasma sodium 141 mmol/lPlasma potassium 4.9 mmol/lPlasma urea 3.8 mmol/lPlasma creatinine 116 mmol/lAntinuclear antibody NegativeRheumatoid factor NegativeBlood cultures NegativeKnee aspiration: Microscopy Yellow turbid fluid. Numerous polymorphs.Culture Negative Gram stain of the synovial fluid is likely to show:

1 ) Gram negative bacilli 2 ) Gram negative coccobacillus 3 ) Gram negative intracellular diplococci 4 ) Gram positive cocci in clusters 5 ) Negatively birefringent crystals

ANSWER: 3

6)A 26-year-old homosexual man presented to hospital with a fever, dry cough and dyspnoea. Oropharyngeal candidiasis was noted. He was found to be HIV antibody positive and Pneumocystis carinii was found on bronchoalveolar lavage. His Pneumocystis carinii pneumonia (PCP) was treated with intravenous co-trimoxazole and he was subsequently started on highly active antiretroviral therapy (HAART).Four weeks later he presented to clinic complaining of weakness and generalised aching. He was taking highly active antiretroviral therapy (zidovudine (AZT), lamivudine (3TC), nelfinavir), co-trimoxazole as Pneumocystis carinii prophylaxis and fluconazole.Investigations:Serum creatine kinase 900 IU/l (24-195)
What is the cause of this problem?

1 ) Co-trimoxazole 2 ) Fluconazole 3 ) Lamivudine (3TC) 4 ) Nelfinavir 5 ) Zidovudine (AZT)

ANSWER:5