Infectious Diseases Module 2

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Question 1 of 27

1. Question
A patient suspected to have bacterial meningitis has been commenced on IV ceftriaxone and benzyl penicillin together with dexamethasone.Cultures have revealed Listeria monocytogenes.

What should be the next step?
- Stop dexamethasone
- Continue dexamethasone
- Add vancomycin.
- Add ciprofloxacin
- Increase dose of dexamethasone
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Question 2 of 27

2. Question
A patient suspected to have bacterial meningitis has been commenced on IV ceftriaxone and benzyl penicillin together with dexamethasone.Cultures have revealed Strep pneumoniae with an MIC of 1.5 mg/L for ceftriaxone.

Which should be the antibiotic of choice?
- IV Vancomycin and Ceftriaxone
- IV Ceftriaxone only
- IV Penicillin plus Gentamicin
- IV Ampicillin
- Continue with IV ceftriaxone and Benzylpenicillin
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Question 3 of 27

3. Question
CMV prophylaxis is recommended in the following patient group except?
- SLE patient on cyclophosphamide
- Renal transplant patient on sirolimus
- Heart transplant patient on tacrolimus
- Liver transplant patient on cyclosporine.
- Patient with allogeneic hematopoetic stem cell transplant
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Question 4 of 27

4. Question
What is the most common cause of aseptic meningitis?
- Enterovirus
- Mycobacteria
- Fungi
- Spirochete
- Legionella
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Question 5 of 27

5. Question
Which of the following procedure is NOT an indication for antibiotic prophylaxis?
- Gastroscopy
- Treatment of esophageal varices
- ERCP with obstruction
- Endoscopic ultrasound with FNA
- PEG insertion
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Question 6 of 27

6. Question
What is the recommended empiric antibiotic regime for brain abscess following a penetrating trauma?
- Vancomycin and ceftriaxone
- Ceftriaxone alone
- Ceftriaxone and metronidazole
- Ceftriaxone, metronidazole and benzylpenicillin
- Ceftriaxone and rifampicin
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Question 7 of 27

7. Question
Which of the following antibiotic does NOT have a role in the treatment of brain abscess?
- Gentamicin
- Benzylpenicillin
- Ceftriaxone
- Metronidazole
- Vancomycin
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Question 8 of 27

8. Question
A patient is suspected to have necrotising fasciitis secondary to a Group A Streptococcal infection.

Besides, early surgical debribement, what would be the antibiotic of choice?
- Penicillin and Clindamycin
- Penicillin alone
- Penicillin and Gentamicin
- Ampicillin and metronidazole
- Flucloxacillin
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Question 9 of 27

9. Question
A patient who has an indwelling vascular catheter for TPN develops fever and a new murmur and therefore suspected to have infective endocarditis.

Which organism is likely to be the cause?
- Staph aureus
- Strep Bovis
- Strep mutans
- Strep viridans
- Enterococci fecalis
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Question 10 of 27

10. Question
The following are causes for culture negative endocarditis except?
- Enterococcus fecalis
- Coxiella burnetti
- Bortenella
- chlamydia
- Legionella
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Question 11 of 27

11. Question
The following are major criterion for the diagnosis of infective endocarditis based on the modified Duke’s criteria, except?
- Septic pulmonary infarcts
- A positive blood culture for IE. Typical organism growing in 2 cultures in absence of a primary focus.
- A persistently positive blood culture
- A positive serological test for Q fever
- ECHO evidence of mass, abscess, dehiscence
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Question 12 of 27

12. Question
A patient is suspected to have infective endocarditis.Not an IVDU and does not have indwelling catheter.

What is the most appropriate empiric antibiotic to initiate while awaiting culture results?
- Flucloxacillin, Penicillin and gentamicin
- Gentamicin alone
- Ampicillin and gentamicin
- Vancomycin alone
- Flucloxacillin
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Question 13 of 27

13. Question
A patient with early syphilis is treated with intramuscular procaine penicillin(long acting) 1g daily for 10 days.

What is the rationale for the use of this antibiotic?
- To obtain continuous levels of penicillin to eliminate the treponemes.
- To prevent antibiotic resistance
- To obtain synergy with gentamicin
- Is the only efficacious agent proven to work in syphilis.
- The organism if fully sensitive to penicillin based agents.
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Question 14 of 27

14. Question
which of the following test can be used to monitor disease activity in syphilis?
- VDRL and RPR
- T. pallidum EIA
- FTA- Abs
- TPHA
- TPPA
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Question 15 of 27

15. Question
Which of the following drug has no role in the treatment of Mycobacterium avium complex(MAC) infection?
- Penicillin
- Clarithromycin
- Azithromycin
- Rifabutin
- Ethambutol
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Question 16 of 27

16. Question
What is the most commonly reported adverse reaction of the seasonal influenza vaccine in New Zealand?
- Injection site inflammation
- Arm pain
- Headache
- Fever
- Vasovagal reaction
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Question 17 of 27

17. Question
Which one of the following is the major determinant of risk of perinatal transmission of hepatitis C virus?
- Maternal viral load.
- Breastfeeding
- Concomitant hepatitis B infection
- Concomitant human immunodeficiency virus (HIV) infection.
- Mode of delivery
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Question 18 of 27

18. Question
The annual influenzae epidemics best explained by which of the following mechanisms?
- Antigenic drift in H and N proteins of influenza A.
- Antigenic shift in H and N proteins of influenza A.
- Point mutations in the M proteins of influenza A.
- Development of neuraminidase resistance.
- Recombination of influenza A and B haemagglutinins.
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Question 19 of 27

19. Question
The effect of neuraminidase inhibitors (such as zanamivir) when given within 24 hours of onset of symptoms on the course of influenza infection is best described as:
- reduction in the severity of influenza symptoms and shortening of the duration of symptoms by one to two days
- complete suppression of influenza symptoms within a day of commencing treatment
- reduction in the severity of influenza symptoms with no effect on duration of illness
- reduction in the duration of illness by three to five days, with no effect on the severity of symptoms
- no effect on the course of the illness itself, but a marked reduction in the infectivity of the individual.
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Question 20 of 27

20. Question
Which of the following best describes the antiviral effect of oseltamivir on the influenza virus?
- Inhibition of viral neuraminidase
- Inhibition of M2 ion channel activity.
- Competitive blocking of surface haemagglutinins.
- Inhibition of reverse transcriptase
- Inhibition of DNA polymerase
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Question 21 of 27

21. Question
Which one of the following vaccines would be the most inappropriate for an immunosuppressed patient?
- Yellow fever
- Hepatitis A
- Hepatitis B
- Influenzae
- Tetanus toxoid
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Question 22 of 27

22. Question
A 57 year old patient is suspected to have bacterial meningitis. A lumbar puncture is performed and the CSF reported as follow:

Gram positive bacilli

What is the most likely organism?
- Listeria monocytogenes
- Cryptococcus
- Haemophilus influenzae
- Streptococcus pneumoniae
- E.coli
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Question 23 of 27

23. Question
Which one of the following is the most likely cause of vancomycin resistance in enterococci?
- Changes in the enterococcal cell wall to prevent vancomycin binding.
- Increased production of a beta-lactamase.
- Alterations to enterococcal ribosomes to prevent vancomycin binding.
- Increased breakdown of vancomycin
- Diminished affinity of penicillin-binding proteins (PBPs).
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Question 24 of 27

24. Question
Which of the following best describes the mechanism of resistance of Haemophilus influenzae to ampicillin?
- Production of beta lactamase
- Altered binding proteins.
- Decreased permeability of cell wall.
- Efflux pump.
- Pus formation
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Question 25 of 27

25. Question
Which of the following best describes the mode of action of aminoglycoside antibiotics?
- Inhibition of protein synthesis
- Disruption of cytoplasmic membrane function.
- Inhibition of bacterial DNA gyrase
- Inhibition of cell wall synthesis.
- Interference with bacterial folic acid metabolism.
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Question 26 of 27

26. Question
Which of the following is most predictive of the presence of multi-drug resistance in a patient with tuberculosis infection?
- Prior treatment for TB
- Acquisition of TB infection overseas
- Cavitating lesion on CXR
- Extra-pulmonary TB
- Smear positive sputum
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Question 27 of 27

27. Question
In adults older than 65, which vaccine is most likely to improve survival?
- Influenza
- Diphteria and tetanus
- Pertussis
- Pneumococcal
- Varicella
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