Infectious Diseases Module 1

A 30-year-old woman from India presents with a biopsy-confirmed diagnosis of highly resistant tuberculosis (TB) involving her cervical lymph node. Antibiotic susceptibility testing reveals resistance to multiple first-line drugs.

What is the most appropriate treatment option for her condition?

A 45-year-old man presents to the emergency department with severe pain in his left leg that started 24 hours ago. He describes the pain as out of proportion to the physical findings.

On examination, his leg appears swollen with purplish discoloration along with a couple of violaceous bullae.

He is febrile, hypotensive, and appears generally unwell.

What is the most likely diagnosis?

A 56 year old man presented to hospital with a five day history of fevers and night sweats. He had felt extremely fatigued at home and in the last few days started complaining of some pain in his chest. He has a background of hypertension, diabetes and only a month ago underwent cardiac surgery for a mitral valve replacement.

Examination is unremarkable apart from some mild erythema around the sternotomy site. Routine septic screen has been negative thus far.

What would be the most likely culprit organism that would explain his symptoms?

A 30 year old male presents with fever, weight loss and chronic cough. He is subsequently diagnosed with HIV and pulmonary MAC. His CD4 count is <200 and his viral load is high. He is commenced on ART in addition to rifampicin, ethambutol and clarithromycin.

His symptoms resolve within 1-2 weeks and he feels well again.

However, one month later he presents with fevers and new palpable cervical lymphadenopathy.

What is the most likely cause of his new symptoms?

The following intervention has a useful role in the treatment of severe COVID-19 pneumonia except?

What is the recommended empiric antibiotic regime for patients with a brain abscess from hematogenous spread (eg, bacteremia, endocarditis; multiple abscesses in middle cerebral artery distribution)?

Ertapenem covers all of the following organism except?

A 42-year-old woman with human immunodeficiency virus (HIV) infection presents to the emergency department with a six week history of general malaise, fever, night sweats and loss of 5kg weight. She was born in Papua New Guinea but came to Australia five years ago. She is not on any anti-retroviral therapy.

Her viral load is undetectable and CD4 count is 0.41 x 109/L [0.45-1.4 x 109/L]. Examination is unremarkable.

Her Chest X-ray shows patchy consolidation in the left upper zone.Sputum culture confirms the presence of mycobacterial tuberculosis.

When should she be commenced on anti-retroviral therapy?

A 60 year old man just tested positive for COVID-19 after presenting with two days history of fever and cough. His vital signs are stable and he is not hypoxic.

Which of the following factors would make him a good candidate for intravenous Sotrovimab?

Which of the following is the best treponemal screening test for syphilis?

With regards to treatment with anti-retroviral therapy (ART) in patients with HIV and active tuberculosis, which of the following statement is false?

Which of the following statement is incorrect regarding the role of Interferon Gamma Release Assay (IGRA) in tuberculosis?

All of the following drugs could be used in the treatment of multi-drug resistant tuberculosis (MDR-TB) except?

How sensitive is the Xpert MTB/RIF (GeneXpert) in picking up smear positive tuberculosis and identifying rifampicin resistance from a sputum sample?

In pneumococcal meningitis, what is the agent of choice for patients with cephalosporin allergy?

Which class of anti-fungal does Caspofungin belong to?

In a patient with rheumatic mixed mitral valve disease, for which of the following procedures is there the strongest indication for antibiotic prophylaxis?

What is the main mechanism of gram negative resistance with Linezolid?

With regards to aspiration pneumonia, which of the following patient group would benefit from the addition of metronidazole in their treatment regime?

Daptomycin is useful in the treatment of the following conditions except?

The recently described New Delhi metallo-β-lactamase (NDM-1) found in Klebsiella pneumoniae and Escherichia coli belongs to which molecular group of enyzme based on the Ambler classification of Betalactamases?

A 50 year old man had just returned from his Pilgrimage in Mecca, Saudi Arabia 15 days ago. A week ago he developed a fever with cough, dyspnea and diarrhea. His CXR reveals bilateral lower zone
infiltrates.

You suspect that this man may have been infected by the Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV).

Which of the following investigation would have the best diagnostic yield?

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

A patient is diagnosed to have pertussis. The organism responsible for this disease is most likely from which group of bacteria?

Dexamethasone is recommended as an adjunct for the treatment of bacterial meningitis prior to gram stain results being available.

Which of the following is the rationale for this treatment?

What is the most consistently observed risk factor for hospital acquisition of Vancomycin Resistant Enterococci (VRE) ?

A 19 year old athlete had his first dose of Pfizer COVID-19 vaccine two days ago. A week later he presents to the emergency department with acute left sided chest pain and breathlessness.

On examination, his pulse is 110, BP 120/80, RR: 24 and oxygen saturation of 95 percent on air. His ECG shows a sustained atrial tachycardia. He has an elevated CRP of 120 and troponin of 250 ng/L (normal <15ng/l)

What is the next best step in management? 

In regards to vaccination against COVID-19, which of the following group of patients should receive a three-dose primary mRNA vaccine series rather than a two-dose series?

The following statements are true regarding the epidemiology of Carbapenemase Producing Enterobacterales (CPE) in New Zealand, except?

Which age group is recommended to receive the updated COVID-19 mRNA vaccine?

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

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