Infectious Diseases Module 1

A 30-year-old woman from India presents with biopsy-confirmed tuberculosis involving a cervical lymph node. Drug susceptibility testing reveals resistance to rifampicin and isoniazid (multidrug-resistant TB), with fluoroquinolone susceptibility retained.

What is the most appropriate treatment regimen?

Bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM)

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Isoniazid, rifampicin, ethambutol, and pyrazinamide

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Rifampicin, moxifloxacin, ethambutol, and pyrazinamide

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Streptomycin, kanamycin, ethionamide, and clofazimine

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Amikacin, levofloxacin, and cycloserine

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A 45-year-old man presents with severe left leg pain of 24 hours’ duration, described as out of proportion to physical findings. On examination, the leg is swollen with purplish discolouration and several violaceous bullae. He is febrile, hypotensive, and appears systemically unwell.

What is the most likely diagnosis?

Necrotizing fasciitis

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Deep vein thrombosis

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Steven-Johnson syndrome

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Acute compartment syndrome

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Erysipelas

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A 56-year-old man presents with a five-day history of fevers and night sweats, profound fatigue, and recent-onset chest pain.

His background includes hypertension, diabetes, and a mitral valve replacement one month ago.

Examination reveals mild erythema at the sternotomy site. Routine septic screen has been negative.

What is the most likely causative organism?

Mycobacterium chimaera

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Staphylococcus aureus

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Enterococcus faecalis

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Coxiella burnetii

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Staphylococcus epidermidis

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A 30-year-old man presents with fever, weight loss, and chronic cough. He is diagnosed with HIV and disseminated Mycobacterium avium complex (MAC) infection. His CD4 count is <50 cells/µL with a high viral load. He is commenced on ART together with azithromycin, ethambutol, and rifabutin. His symptoms resolve within 1–2 weeks. One month later he re-presents with fevers and new tender cervical lymphadenopathy.

What is the most likely cause?

Immune reconstitution inflammatory syndrome

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Coccidioidomycosis

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Histoplasmosis

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Disseminated tuberculosis

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Non-Hodgkin's lymphoma

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Each of the following has an established role in the management of severe COVID-19 pneumonia, except?

Ivermectin

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Venous thromboembolism prophylaxis

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Prone positioning

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Dexamethasone

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Remdesivir

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What is the recommended empirical antibiotic regimen for a patient with a brain abscess arising from haematogenous spread (e.g., bacteraemia or endocarditis, with multiple abscesses in the middle cerebral artery distribution)?

Metronidazole and ceftriaxone (with vancomycin added if staphylococcal source suspected)

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Meropenem monotherapy

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Vancomycin and cefepime

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Ceftriaxone monotherapy

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Flucloxacillin and gentamicin

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Ertapenem is a useful carbapenem for ESBL-producing Enterobacterales infections but lacks activity against which of the following organisms?

Pseudomonas aeruginosa

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Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli

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Bacteroides fragilis

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Streptococcus anginosus

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Klebsiella pneumoniae (including ESBL-producing isolates)

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A 42-year-old woman with HIV infection presents with a six-week history of malaise, fever, night sweats, and 5 kg weight loss. She emigrated from Papua New Guinea five years ago and is not on antiretroviral therapy.

Her HIV viral load is high and CD4 count is 0.04 × 10⁹/L (40 cells/µL). Chest X-ray shows left upper zone consolidation and sputum culture confirms Mycobacterium tuberculosis.

When should antiretroviral therapy be commenced?

After 8 to 12 weeks of TB therapy

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Before commencing anti-TB therapy

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After 12 months of anti-TB therapy

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Within 2 weeks of commencing anti-TB therapy

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No need for ART as CD4 count is normal

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Which of the following is the preferred treponemal test for automated laboratory screening for syphilis?

Treponema pallidum enzyme immunoassay (EIA) / chemiluminescence immunoassay (CIA)

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Fluorescent treponemal antibody absorption (FTA-ABS)

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Treponema pallidum haemagglutination/particle agglutination assay (TPHA/TPPA)

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Venereal Disease Research Laboratory (VDRL)

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Rapid plasma reagin (RPR)

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Regarding antiretroviral therapy (ART) in patients with HIV and active tuberculosis, which statement is false?

Rifapentine is the preferred rifamycin in HIV-infected patients on ART for treatment of active TB

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All HIV patients with active TB should be started on ART

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Rifabutin is preferred in patients on a protease inhibitor-based regimen

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Directly observed therapy (DOT) is recommended for TB treatment

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Risk of IRIS is high with low CD4 count and high viral load

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Which of the following statements regarding the interferon-gamma release assay (IGRA) in tuberculosis is incorrect?

A negative IGRA essentially excludes active TB

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IGRA detects T-cell responses to Mycobacterium tuberculosis antigens

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IGRA has high specificity in low-prevalence populations without risk factors

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IGRA is not recommended for diagnosing active TB

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The magnitude of IGRA positivity does not distinguish active from latent TB

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All of the following may be used in the treatment of multidrug-resistant tuberculosis (MDR-TB), except?

Clarithromycin

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Moxifloxacin

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Amikacin

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Capreomycin

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Linezolid

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What is the approximate sensitivity of Xpert MTB/RIF (GeneXpert) for detecting smear-positive pulmonary tuberculosis from a single sputum sample?

98%

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72%

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60%

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85%

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90%

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In pneumococcal meningitis, what is the recommended regimen for a patient with a severe cephalosporin allergy?

Vancomycin plus moxifloxacin

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Chloramphenicol

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Gentamicin

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Benzylpenicillin

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Ciprofloxacin

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To which class of antifungal agents does caspofungin belong?

Echinocandins

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Polyenes

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Allyamines

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Triazoles

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Nikkomycins

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In aspiration pneumonia, which patient group is most likely to benefit from the addition of anaerobic cover (e.g., metronidazole) to the treatment regimen?

Chronic hazardous alcohol consumption

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Active heavy smoker

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Residential aged-care resident

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Mild periodontal disease

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Intravenous drug user

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Daptomycin is useful in the treatment of each of the following, except?

Pneumonia

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Skin infection

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Staphylococcus aureus bacteraemia

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Right-sided Staphylococcus aureus endocarditis

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Soft tissue infection

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The New Delhi metallo-β-lactamase (NDM-1), found in Klebsiella pneumoniae and Escherichia coli, belongs to which Ambler molecular class of beta-lactamases?

Ambler Class B

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Ambler Class A

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Ambler Class C

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Ambler Class D

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Ambler Class E

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A 50-year-old man returned from pilgrimage (Hajj) in Mecca, Saudi Arabia, 15 days ago. One week ago he developed fever, cough, dyspnoea, and diarrhoea.

Chest X-ray shows bilateral lower zone infiltrates, and MERS-CoV infection is suspected.

Which investigation offers the highest diagnostic yield?

Bronchoalveolar lavage (BAL) for PCR

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Stool culture for PCR

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Nasopharyngeal swab for PCR

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No testing required

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Blood culture

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Which of the following is most useful in differentiating smallpox from chickenpox?

Varicella causes a centrifugal (peripheral) rash predominating on the limbs

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Smallpox has no or only a mild prodrome

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Smallpox lesions progress more rapidly than varicella lesions

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Patients with smallpox are usually afebrile

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In smallpox, all lesions in a given area are at the same stage of development, whereas in varicella, lesions appear in successive crops at differing stages

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A patient is diagnosed with pertussis. The causative organism belongs to which group of bacteria?

Gram-negative coccobacilli

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Gram-positive cocci

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Gram-positive bacilli

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Gram-negative cocci

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Anaerobes

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Dexamethasone is recommended as an adjunct in suspected bacterial meningitis, given with or before the first dose of antibiotics.

What is the principal rationale for this?

To reduce the rate of hearing loss and other neurological complications

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To achieve synergy with cephalosporins

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To prevent cerebral herniation

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To treat Listeria monocytogenes

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To stimulate the innate immune system

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What is the most consistently observed risk factor for hospital acquisition of vancomycin-resistant enterococci (VRE)?

Previous antimicrobial therapy

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Hospitalisation longer than 72 hours

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Colonisation pressure

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Exposure to contaminated surfaces in patient rooms

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Residence in long-term care facilities

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A 19-year-old athlete received his first dose of the Pfizer (BNT162b2) COVID-19 vaccine. One week later he presents with acute left-sided chest pain and breathlessness. Pulse 110, BP 120/80, RR 24, SpO₂ 95% on air. ECG shows sustained atrial tachycardia. CRP is 120 mg/L and troponin is 250 ng/L (normal <15 ng/L).

What is the next best step in management?

Refer to cardiology and arrange echocardiography (and consider cardiac MRI)

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Reassure, discharge, and advise strict bed rest

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Treat with NSAIDs for one week and discharge

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Reassure and advise resumption of sport as usual

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Reassure and discharge, advising against the second vaccine dose

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According to current recommendations, which patient is most likely to require additional COVID-19 vaccine doses beyond the standard schedule owing to significant immunocompromise?

A 50 year old man receiving active chemotherapy for acute myeloid leukemia

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A 65-year-old woman with polymyalgia rheumatica on prednisone 5 mg daily

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A 25 year old man with HIV on ART with a CD4 count of 450 cells/mm3

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A 70-year-old woman with severe COPD and previously resected lung cancer

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A 60 year old man with poorly controlled type 2 diabetes

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Regarding the epidemiology of carbapenemase-producing Enterobacterales (CPE) in New Zealand, which of the following statements is incorrect?

The most common carbapenemase types are NDM and OXA-48-like enzymes

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The majority of CPE have historically been isolated from patients recently overseas

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Approximately two-thirds of CPE patients had been hospitalised while overseas

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The Indian subcontinent has historically been the most common overseas source

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Most CPE are isolated from patients with clinical infections caused by CPE

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From what minimum age are updated (variant-adapted) COVID-19 mRNA vaccines authorised for use?

Children aged 6 months and older

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Children aged 1-5 years only

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Children under 6 months

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Adults aged 65 and older only

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Which of the following immunomodulatory agents has NOT been shown to reduce 28-day mortality in patients with severe COVID-19?

Infliximab and abatacept

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Dexamethasone

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Baricitinib and tocilizumab

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Cenicriviroc

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Sarilumab and anakinra

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What is the effect of Bacille Calmette-Guérin (BCG) vaccination on the risk of COVID-19 infection?

BCG vaccination has no significant effect on the risk of COVID-19 infection

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BCG vaccination reduces the severity of COVID-19 but does not prevent infection

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BCG vaccination increases susceptibility to COVID-19 due to immune tolerance mechanisms

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BCG vaccination reduces the risk of SARS-CoV-2 infection through enhanced innate immune responses

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BCG vaccination provides cross-protection against SARS-CoV-2 and is recommended as a COVID-19 vaccine strategy

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Infectious Diseases Module 1

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