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Infectious Diseases Module 2

Infectious Diseases Module 2

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Question 1 of 29

1. Question

A 45-year-old HIV-seropositive man presents with a two-week history of global headache, progressive confusion, and disorientation. His CD4 count three weeks ago was 50 cells/mm³. He declined antiretroviral therapy but takes co-trimoxazole as prophylaxis against Pneumocystis jirovecii pneumonia.

Examination reveals mild left-sided hemiparesis and a right homonymous hemianopia; fundoscopy is normal without papilloedema.

CT brain shows several areas of low attenuation in both cerebral hemispheres, without contrast enhancement or mass effect.

What is the most likely diagnosis?

Progressive multifocal leukoencephalopathy
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Cerebral lymphoma
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Cerebral toxoplasmosis
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HIV encephalopathy
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Neurosyphilis
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Question 2 of 29

2. Question

A patient with suspected bacterial meningitis was started on IV ceftriaxone, benzylpenicillin, and dexamethasone. CSF cultures grow Listeria monocytogenes. Regarding the dexamethasone, what is the most appropriate next step?

Stop dexamethasone
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Continue dexamethasone
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Add vancomycin.
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Add ciprofloxacin
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Increase dose of dexamethasone
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Question 3 of 29

3. Question
A patient with known HIV has the following CSF findings:
- JC virus PCR positive.
- Toxoplasma, EBV, CMV, TB, and Cryptococcus all negative.
- Serum anti-Toxoplasma IgG negative.
- CT brain shows multiple hypodense, non-enhancing cerebral white matter lesions involving the cerebellum and brainstem, without mass effect.
What is the most likely diagnosis?
Progressive multifocal leukoencephalopathy (PML)
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Toxoplasma gondii encephalitis
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CMV encephalitis
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Primary CNS lymphoma
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Tuberculous meningitis
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Question 4 of 29

4. Question

A patient with suspected bacterial meningitis was started on IV ceftriaxone, benzylpenicillin, and dexamethasone. CSF cultures grow Streptococcus pneumoniae with a ceftriaxone MIC of 1.5 mg/L.

What is the antibiotic regimen of choice?

IV Vancomycin and ceftriaxone
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IV ceftriaxone monotherapy
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IV penicillin plus gentamicin
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IV ampicillin
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Continue with IV ceftriaxone and benzylpenicillin
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Question 5 of 29

5. Question

CMV prophylaxis is routinely recommended in each of the following patient groups, except?

SLE patient on cyclophosphamide
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Renal transplant patient on sirolimus
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Heart transplant patient on tacrolimus
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Liver transplant patient on cyclosporine.
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Patient with allogeneic hematopoetic stem cell transplant
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Question 6 of 29

6. Question

What is the most common cause of aseptic meningitis?

Enterovirus
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Mycobacteria
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Fungi
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Spirochete
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Legionella
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Question 7 of 29

7. Question

Which of the following procedures is NOT an indication for antibiotic prophylaxis (to prevent procedure-related infection)?

Diagnostic gastroscopy
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Endoscopic band ligation of oesophageal varices
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ERCP with biliary obstruction
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Endoscopic ultrasound with FNA of a cystic pancreatic lesion
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PEG insertion
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Question 8 of 29

8. Question

What is the recommended empirical antibiotic regimen for a brain abscess following penetrating head trauma, where the causative organism is still unknown?

Vancomycin and ceftriaxone
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Ceftriaxone alone
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Ceftriaxone and metronidazole
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Ceftriaxone, metronidazole and vancomycin
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Ceftriaxone and rifampicin
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Question 9 of 29

9. Question

Which of the following antibiotics does NOT have a role in the treatment of a brain abscess?

Gentamicin
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Benzylpenicillin
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Ceftriaxone
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Metronidazole
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Vancomycin
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Question 10 of 29

10. Question

A patient is suspected to have necrotising fasciitis secondary to Group A Streptococcal infection. In addition to early surgical debridement, what is the antibiotic regimen of choice?

Penicillin and clindamycin
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Penicillin alone
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Penicillin and gentamicin
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Ampicillin and metronidazole
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Flucloxacillin
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Question 11 of 29

11. Question

A patient with an indwelling vascular catheter for total parenteral nutrition develops fever and a new murmur, raising suspicion of infective endocarditis.

What is the most likely causative organism?

Staphylococcus aureus
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Streptococcus gallolyticus (bovis)
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Streptococcus mutans
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Streptococcus (viridans group)
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Enterococcus faecalis
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Question 12 of 29

12. Question

Each of the following is a recognised cause of culture-negative infective endocarditis, except?

Enterococcus faecalis
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Coxiella burnetii
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Bartonella
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Chlamydia
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Legionella
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Question 13 of 29

13. Question

According to the modified Duke criteria (and 2023 Duke-ISCVID update), each of the following is a major criterion for infective endocarditis, except?

Septic pulmonary infarcts
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Persistently positive blood cultures with a typical organism
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Typical organism from two separate blood cultures in the absence of a primary focus
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A positive serological test for Q fever (Coxiella burnetii phase I IgG >1:800)
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Echocardiographic evidence of vegetation, abscess, or new prosthetic valve dehiscence
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Question 14 of 29

14. Question

A patient with early syphilis is treated with a single intramuscular dose of benzathine penicillin G 2.4 million units. What is the pharmacological rationale for this treatment?

To maintain sustained, prolonged treponemicidal penicillin concentrations to eradicate slowly dividing treponemes
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The organism is fully sensitive to penicillin-based agents
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It is the only agent ever shown to work in syphilis
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To prevent antibiotic resistance
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To obtain synergy with gentamicin
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Question 15 of 29

15. Question

Which test is best used to monitor disease activity and treatment response in syphilis?

VDRL and RPR
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T. pallidum EIA
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FTA-ABS
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TPHA
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TPPA
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Question 16 of 29

16. Question

Which of the following antibiotic has no role in the treatment of Mycobacterium avium complex (MAC) infection?

Penicillin
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Clarithromycin
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Azithromycin
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Rifabutin
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Ethambutol
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Question 17 of 29

17. Question

What is the most commonly reported adverse reaction to the seasonal influenza vaccine in New Zealand?

Injection site inflammation
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Arm pain
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Headache
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Fever
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Vasovagal reaction
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Question 18 of 29

18. Question

Which factor is a major risk determinant for perinatal (vertical) transmission of hepatitis C virus?

Maternal HCV viral load (and concurrent HIV co-infection)
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Breastfeeding
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Concomitant hepatitis B infection
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Concomitant human immunodeficiency virus (HIV) infection.
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Mode of delivery
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Question 19 of 29

19. Question

The annual influenza epidemics are best explained by which of the following mechanisms?

Antigenic drift in the H and N proteins of influenza A
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Antigenic shift in the H and N proteins of influenza A
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Point mutations in the M protein of influenza A
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Development of neuraminidase resistance.
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Recombination of influenza A and B haemagglutinins.
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Question 20 of 29

20. Question

The effect of neuraminidase inhibitors (e.g., zanamivir, oseltamivir) when started early (within 48 hours of symptom onset) in otherwise healthy adults with influenza is best described as?

Reduction in the severity of symptoms and shortening of symptom duration by approximately one day
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Complete suppression of influenza symptoms within a day of treatment
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Reduction in symptom severity with no effect on duration of illness
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Reduction in illness duration by three to five days, with no effect on symptom severity
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No effect on the illness, but a marked reduction in the individual's infectivity
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Question 21 of 29

21. Question

Which of the following best describes the antiviral mechanism of oseltamivir against the influenza virus?

Inhibition of viral neuraminidase
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Inhibition of M2 ion channel activity
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Competitive blocking of surface haemagglutinin
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Inhibition of reverse transcriptase
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Inhibition of DNA polymerase
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Question 22 of 29

22. Question

What is the most sensitive and specific test for the diagnosis of pertussis in the early phase of illness?

Culture from nasopharyngeal secretions
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PCR (nucleic acid amplification testing) for Bordetella pertussis
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Serology
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Direct fluorescent antibody (DFA) testing
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Pulsed-field gel electrophoresis
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Question 23 of 29

23. Question

Which of the following vaccines is the most inappropriate for a significantly immunosuppressed patient?

Yellow fever
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Hepatitis A
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Hepatitis B
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Influenzae
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Tetanus toxoid
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Question 24 of 29

24. Question

A 57-year-old patient is suspected of having bacterial meningitis. CSF Gram stain reveals gram-positive bacilli.

What is the most likely causative organism?

Listeria monocytogenes
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Cryptococcus neoformans
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Haemophilus influenzae
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Streptococcus pneumoniae
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Escherichia coli
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Question 25 of 29

25. Question

Which of the following is the most likely mechanism of vancomycin resistance in enterococci?

Alteration of cell-wall peptidoglycan precursors preventing vancomycin binding
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Increased production of a beta-lactamase.
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Alteration of ribosomal targets preventing vancomycin binding
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Increased enzymatic breakdown of vancomycin
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Diminished affinity of penicillin-binding proteins (PBPs).
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Question 26 of 29

26. Question

Which of the following best describes the most common mechanism of ampicillin resistance in Haemophilus influenzae?

Production of beta-lactamase
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Altered penicillin-binding proteins
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Decreased cell-wall permeability
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Efflux pump activity
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Pus formation
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Question 27 of 29

27. Question

Which of the following best describes the mode of action of aminoglycoside antibiotics?

Inhibition of protein synthesis
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Disruption of cytoplasmic membrane function.
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Inhibition of bacterial DNA gyrase
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Inhibition of cell-wall synthesis
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Interference with bacterial folic acid metabolism.
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Question 28 of 29

28. Question

Which of the following is most predictive of multidrug-resistant tuberculosis (MDR-TB) in a patient with tuberculosis infection?

Prior treatment for TB
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Acquisition of TB infection overseas
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Cavitating lesion on chest X-ray
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Extrapulmonary TB
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Smear-positive sputum
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Question 29 of 29

29. Question

In adults older than 65, which vaccine is most likely to improve survival?

Influenza
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Diphteria and tetanus
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Pertussis
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Pneumococcal
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Varicella
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