SCE ID Sample Questions

8/2/2019 SCE ID Sample Questions

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SCEIDSampleQs-Dec-11

Specialty Certificate in Infectious Diseases Sample Questions

Question: 1

A 65-year-old man presented with a 4-week history of generalised fatigue. He was found

to have bacterial endocarditis caused by Streptococcus bovis. He was treated withpenicillin and gentamicin. One week after starting the treatment the patient wassymptomatically much improved. His appetite had returned and he no longer had fever.

What further action is most appropriate?

A colonoscopyB CT scan of abdomenC cystoscopyD dental assessmentE gastroscopy


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Question: 2

A 28-year-old woman presented with symmetrical pain in her elbows, shoulders andknees, 4 weeks after starting quadruple therapy for pulmonary tuberculosis.

Investigations:

haemoglobin 116 g/L (115165)

white cell count 6.4 109/L (4.011.0)

platelet count 184 109/L (150400)erythrocyte sedimentation rate 24 mm/1st h (


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Question: 3

A 55-year-old woman, originally from Thailand, presented with significant weight loss andwas found to have HIV infection.

Investigations:

HIV viral load 156 250 copies/mL(lower detection limit 40)

CD4 count 285 106/L (4301690)

hepatitis B surface antigen positivehepatitis B surface antigen positiveanti-hepatitis B core antibody positiveanti-hepatitis B surface antibody negativehepatitis B DNA 950 IU/mL (lower detection limit 250)

What is the most appropriate anti-retroviral therapy?

A abacavir, lamivudine and efavirenzB abacavir, lamivudine and nevirapineC tenofovir, emtricitabine and efavirenzD tenofovir, emtricitabine and nevirapineE zidovudine, lamivudine and nevirapine


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Question: 4

A 22-year-old woman was admitted with fever, severe myalgia and a rash 8 days afterreturning from a holiday in Thailand. She had not taken any antimalarial prophylaxis or hadany immunisations prior to travel, and had only visited Bangkok, Phuket and Koh Samui.

Four days before admission, she had seen her general practitioner, who had given her acourse of amoxicillin.

On examination, her temperature was 38.4C. There was mild erythema in the pharynxand a widespread macular rash that was becoming confluent in some areas. A few smallcervical lymph nodes were palpable.

Investigations:

haemoglobin 106 g/L (115165)haematocrit 0.32 (0.360.47)

white cell count 2.4 109/L (4.011.0)neutrophil count 1.1 109/L (1.57.0)

lymphocyte count 0.7 109/L (1.54.0)

eosinophil count 0.3 109/L (0.040.40)

platelet count 84 109/L (150400)

blood film no malarial parasites; a few atypicallymphocytes seen

serum total bilirubin 21 mol/L (122)

serum alanine aminotransferase 117 U/L (535)serum alkaline phosphatase 143 U/L (45105)

What is the most likely diagnosis?

A allergic reaction to amoxicillinB dengue feverC HIV seroconversion illnessD infectious mononucleosis due to EpsteinBarr virusE malaria


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Question: 5

A 27-year-old woman presented with a short history of general malaise, increasedfrequency of passing urine and dysuria. She was attempting to conceive and was reluctantto take any antibiotic that could be harmful in pregnancy.

Which antibiotic is most appropriate?

A cefalexinB ciprofloxacinC co-trimoxazoleD doxycyclineE trimethoprim


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Question: 6

A 45-year-old man presented with a 6-month history of weight loss and anorexia. He had along history of alcohol abuse. Ten years previously, he had been found to be hepatitis Cantibody-positive and PCR-positive.

On examination, he appeared lean and unkempt. The liver edge was smooth and palpablethree finger-breadths below the costal margin.

Investigations:




serum albumin 29 g/L (3749)

serum alanine aminotransferase 375 U/L (535)serum gamma glutamyl transferase 306 U/L (


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Question: 7

A 53-year-old woman with no previous medical history or healthcare exposure wasadmitted in septic shock. Her husband said that she had been pruning roses the daybefore and had sustained scratches in the process.

On examination, she was febrile (39.5C), her pulse was 132 beats per minute and herblood pressure was 80/40 mmHg. Her right arm showed extensive spreading cellulitis withblistering over the hand and distal forearm. She had marked pain on all movements of thefingers and wrist.

What is the most appropriate antimicrobial treatment?

A benzylpenicillin and clindamycinB benzylpenicillin and gentamicinC ceftriaxone and vancomycin

D flucloxacillin and gentamicinE vancomycin and meropenem


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Question: 8

A 33-year-old man was admitted to hospital with a 5-week history of fevers and nightsweats. He had lost 3 kg in weight over the previous 2 months, and complained ofanorexia, fatigue, arthralgia and intermittent non-specific macular rashes.

On examination, his temperature was 38.2C, his pulse was 95 beats per minute and hisblood pressure was 105/85 mmHg. His chest was dull to percussion over the lower lungswith reduced air entry basally. Abdominal examination revealed minorhepatosplenomegaly. He was given empirical treatment with intravenous ceftriaxone butwas still intermittently febrile after 5 days.

Investigations:



neutrophil count 15.9 109/L (1.57.0)platelet count 540 109/L (150400)

serum alkaline phosphatase 125 U/L (45105)serum gamma glutamyl transferase 55 U/L (


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Question: 9

An 88-year-old woman was admitted from a residential care home with confusionsecondary to a urinary tract infection, which had been treated by her general practitionerwith a course of antibiotics. Shortly after admission, she developed persistent diarrhoea.

She was given intravenous fluids, but her condition deteriorated over the next 48 hours.

On examination, her temperature was 38.5C and she appeared unwell with tachycardia,hypotension and a tender distended abdomen.

Investigations:



neutrophil count 28.1 109/L (1.57.0)


serum urea 9.5 mmol/L (2.57.0)serum creatinine 130 mol/L (60110)

faecal Clostridium difficile toxin negative

X-ray of abdomen dilated large bowel with thickenedbowel wall


A campylobacter gastroenteritisB diverticulitisC Escherichia coli O157 infectionD norovirus infectionE pseudomembranous colitis


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Question: 10

A 45-year-old office worker presented having felt unwell since returning from a 4-weekholiday in Egypt.

On examination, he was jaundiced.

Investigations:

HBsAg not detectedanti-hepatitis A virus IgM detectedanti-hepatitis A virus IgG not detectedanti-hepatitis C virus antibody not detected

For how long should he be excluded from working in his office?

A no exclusion necessaryB until 7 days from onset of jaundiceC until 14 days from onset of symptomsD until asymptomaticE until faecal samples are negative for hepatitis A virus


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Question: 11

A 37-year-old South African man was reviewed in the HIV clinic. He had arrived in the UK2 months previously. He was asymptomatic, with no significant medical history other thanHIV infection.

There were no abnormalities on physical examination. He was takingzidovudine/lamivudine (Combivir) and efavirenz and was very reluctant to change hismedication.

Investigations:

CD4 count 485 106/L (4301690)

serum albumin 35 g/L (3749)serum total bilirubin 13 mol/L (122)

serum alanine aminotransferase 25 U/L (535)serum alkaline phosphatase 120 U/L (45105)

HBsAg positiveHBeAg negativehepatitis C antibody negativeHIV viral load undetectable

What is the most appropriate investigation to guide antiviral therapy?

A hepatic elastography (FibroScan)B HIV resistance (genotype) assayC HIV tropism assayD quantitative HBV DNA assayE ultrasound scan of liver


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Question: 12

A 22-year-old Indian student was found to have pulmonary tuberculosis. He was treatedwith rifampicin, isoniazid, pyrazinamide and ethambutol.

What is the mechanism of action of rifampicin in the treatment of mycobacterial infection?

A increases mycobacterial cell wall permeabilityB inhibits mycobacterial protein synthesisC inhibits mycobacterial RNA polymeraseD inhibits synthesis of mycobacterial fatty acidsE inhibits synthesis of mycolic acid in mycobacterial cell wall


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Question: 13

A 48-year-old man with a past history of prostatic carcinoma presented with a 4-weekhistory of fever and back pain secondary to L1/L2 discitis. Escherichia coli was isolatedfrom blood cultures and he was treated with intravenous ertapenem. His condition

improved and his temperature settled within 5 days. Two weeks into treatment, his feverreturned.

On examination, his temperature was 39.0C; there were no other abnormal clinical signs.

Investigations:




serum C-reactive protein 14 mg/L (


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Question: 14

A 76-year-old man with a prosthetic aortic valve replacement developed macroscopichaematuria. Urine cultures were sterile, and an elective cystoscopy was planned.

What antimicrobial prophylaxis against infective endocarditis is most appropriate?

A intravenous amoxicillin plus gentamicinB intravenous teicoplanin plus gentamicinC noneD oral amoxicillinE oral clindamycin


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Question: 15

A 45-year-old woman from the Dominican Republic presented with a 1-day history ofsevere headache, fever and photophobia. She had been unwell for the previous monthwith persistent diarrhoea.

On examination, she had a temperature of 38.5C, neck stiffness and a positive Kernigssign. Diffuse generalised lymphadenopathy was present.

Investigations:

cerebrospinal fluid (CSF):total protein 1.2 g/L (0.150.45)

white cell count 2000/L ( 5)

lymphocyte count 200/L ( 3)neutrophil count 1800/L (0)

CSF culture Enterococcus faecalis

chest X-ray patchy opacities throughout bothlung fields

sputum microscopy Strongyloides stercoralis larvae seen

What is the most likely underlying diagnosis?

A colonic carcinomaB diverticulitisC HTLV-1 infectionD intestinal tuberculosisE Schistosoma mansoni infection


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Question: 16

An 18-year-old man was admitted to hospital with a rash. Before admission, his generalpractitioner had prescribed amoxicillin for a presumptive streptococcal pharyngitis.

On examination, he had a rash (see image).


A infectious mononucleosisB measlesC primary HIV infectionD scarlet feverE secondary syphilis


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Question: 17

A 34-year-old man presented to hospital with excruciating pain in his right shin, havingsustained a blow to it 24 hours previously. He had a rigor and was admitted to hospital.

On examination, he was pyrexial (38.5C) and hypotensive (blood pressure 90/60 mmHg).He had extensive cellulitis extending up his right leg and was taken to theatre fordebridement.

Investigations:

Gram stain of tissue received from theatre see image

What is the most likely pathogen?

A Clostridium perfringens

B Staphylococcus aureusC Streptococcus agalactiaeD Streptococcus pneumoniaeE Streptococcus pyogenes


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Question: 18

A 25-year-old soldier presented 7 months after a 3-month tour in Afghanistan. He had a 5-day history of malaise, rigors and fever. He had completed a full course of doxycyclinechemoprophylaxis.

Investigations:

blood film see image

What is the most appropriate treatment?

A artemether/lumefantrine (Riamet) and clindamycinB artemether/lumefantrine (Riamet) and primaquineC chloroquine and doxycyclineD chloroquine and primaquineE quinine and doxycycline


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Question: 19

A randomised controlled trial was carried out in patients presenting with an influenza-likeillness. The aim was to determine whether oseltamivir is useful in preventing hospitaladmission. The null hypothesis stated that there would be no difference between treatment

and no-treatment arms in the proportion of patients requiring hospital admission.

Six hundred and forty patients were randomly allocated to receive oseltamivir or notreatment in an open-label study. The study was designed to have 80% power to find aclinically important difference between groups with 95% confidence. Fifteen per cent of thestudy participants were lost to follow-up, and 20% did not complete the originally allocatedtreatment.

Which feature of the study is most likely to result in a type 1 error (that is, falsely rejectingthe null hypothesis)?

A failure to use double-blind, placebo-controlled study designB large number of patients lost to follow-upC large number of patients who did not complete the treatment to which they were

originally allocatedD recruitment of inadequate number of patientsE use of insufficiently strict probability value to declare statistically significant difference

between groups


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Question: 20

A 23-year-old man presented with a 3-day history of worsening abdominal pain and feverfollowing a dog bite. He had a history of splenectomy.

On examination, he was obtunded, with a temperature of 37.9C, a pulse of 138 beats perminute and a blood pressure of 80/45 mmHg.

Investigations:

blood culture oxidase-positive, Gram-negative rod

What is the most likely organism?

A Capnocytophaga canimorsusB Eikenella corrodens

C Haemophilus influenzaeD Kingella kingaeE Pseudomonas aeruginosa


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Question: 21

A 55-year-old woman, originally from Thailand, presented with significant weight loss andwas found to have HIV infection.

Investigations:

HIV viral load 156 250 (log 5.2) copies/mL (lowerdetection limit 40)

CD4 count 285 106/L (4301690)

HBsAg positivehepatitis B e antigen negativeanti-hepatitis B core antibody positiveHBV DNA 950 (log 2.9) IU/mL (lower detection

limit 250)

What is the most appropriate antiretroviral therapy?

A abacavir/lamivudine (Kivexa) and efavirenzB abacavir/lamivudine (Kivexa) and nevirapineC tenofovir/emtricitabine (Truvada) and efavirenzD tenofovir/emtricitabine (Truvada) and nevirapineE zidovudine/lamivudine (Combivir) and nevirapine


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Question: 22

A 22-year-old man was bitten on the hand by a monkey, on the last day of his backpackingholiday in India. He had not sought medical attention at the time but presented to theemergency department in the UK the next day, 28 hours after the bite. He had received

rabies vaccine before travel.

On examination, there was a small wound with broken skin on the back of his hand, whichappeared clean.

What is the most appropriate intervention?

A rabies vaccine, five doses on days 0, 3, 7, 14 and 30B rabies vaccine, five doses on days 0, 3, 7, 14 and 30 plus rabies immunoglobulin on

day 0C rabies vaccine, five doses on days 0, 3, 7, 14 and 30 plus rabies immunoglobulin on

days 0 and 7D rabies vaccine, two doses on days 0 and 3E rabies vaccine, two doses on days 0 and 3 plus rabies immunoglobulin on day 0


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Question: 23

A 76-year-old Caucasian man presented with a 2-week history of increasingbreathlessness and cough productive of yellow sputum. He had a 40 pack-year history ofsmoking. He was known to have chronic obstructive lung disease, and he had never been

in close contact with anyone with tuberculosis as far as he was aware.

On examination, his temperature was 37.2C, his pulse was 96 beats per minute and hisblood pressure was 120/76 mmHg. He was treated with oral amoxicillin and prednisoloneand nebulised salbutamol.

Investigations:



serum C-reactive protein 24 mg/L (


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Question: 24

An 18-year-old man presented with fever, cough and shortness of breath. He had beenpreviously well. He recalled having a severe sore throat 4 days before presentation.

On examination, he had a temperature of 38.2C, his pulse was 50 beats per minute andhis blood pressure was 94/55 mmHg. His oxygen saturation was 89% (9498) breathingroom air.

Investigations:

blood culture (after 3 days) anaerobic Gram-negative bacillus

chest X-ray patchy consolidation in both lungfields

What is the most likely identity of the organism found on blood culture?

A Bacteroides fragilisB Fusobacterium necrophorumC Haemophilus influenzaeD Klebsiella pneumoniaeE Pseudomonas aeruginosa


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Question: 25

A 35-year-old woman presented with a 2-day history of fever, dysuria and increasedurinary frequency. She had recently returned from visiting relatives in Pakistan. During her

visit, she had been admitted to hospital following a road traffic accident.

Investigations:

urine microscopy pus cells 3+

urine culture Klebsiella pneumoniae

susceptibility results resistant to cefotaxime, ceftazidime,aztreonam, ciprofloxacin, gentamicin,amikacin, ertapenem and

meropenem

What is the most appropriate therapy?

A colistinB daptomycinC imipenemD tigecyclineE tobramycin


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Question: 26

A 32-year-old woman was admitted with a 2-day history of flu-like illness during anepidemic of H1N1 influenza. She was 30 weeks pregnant. She had been vaccinated

against H1N1 influenza 4 weeks previously.

What is the most appropriate management?

A intravenous pooled human immunoglobulinB intravenous zanamivirC oral amoxicillinD oral oseltamivirE symptomatic treatment


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Question: 27

A 67-year-old man presented with a 3-day history of progressive breathlessness,productive cough and intermittent confusion. He had a past medical history of ischaemic

heart disease, hypercholesterolaemia, type 2 diabetes mellitus and chronic kidney diseasestage 3.

On examination, he had a temperature of 38.2C, with a blood pressure of 140/70 mmHgand a respiratory rate of 25 breaths per minute. He had an abbreviated mental test scoreof 7/10. There was reduced air entry at the right base associated with coarse crackles.

Investigations:


neutrophil count 19.4 109/L (1.57.0)

serum urea 17.9 mmol/L (2.57.0)serum creatinine 154 mol/L (60110)

chest X-ray right basal consolidation

What is the CURB-65 score for this patient?

A 1B 2

C 3D 4E 5


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Question: 28

Five patients who required admission arrived in the emergency department.

Patient 1 was a 17-year-old girl with meningococcal meningitis. Patient 2 was a 23-year-old man with acute varicella pneumonia. Patient 3 was a 79-year-old man with chronic legulcers and previous colonisation with MRSA. Patient 4 was an 89-year-old nursing homeresident with unexplained diarrhoea following a course of co-amoxiclav for a lowerrespiratory tract infection. Patient 5 was a 22-year-old man with a peritonsillar abscess.

There was only one single room available in the department.

From an infection control perspective, which patient should be given highest priority forimmediate placement in the single room?

A Patient 1B Patient 2C Patient 3D Patient 4E Patient 5


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Question: 29

A 19-year-old woman presented to her general practitioner for advice. She was 14 weekspregnant, and 2 weeks previously she had been in contact with a 2-year-old child who had

subsequently developed chickenpox the day before the patients presentation. She wasunsure about her varicella immune status.

What is the most appropriate next step in management?

A ask her to present if a rash developsB check varicella IgG statusC check varicella IgM statusD give aciclovir prophylaxisE give human varicella zoster immunoglobulin


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Answers

1. Answer: A

2. Answer: D

3. Answer: C

4. Answer: B

5. Answer: A

6. Answer: A

7. Answer A

8. Answer A

9. Answer E

10. Answer B11. Answer D

12. Answer C

13. Answer A

14. Answer C

15. Answer C

16. Answer A

17. Answer E

18. Answer D

19. Answer A

20. Answer A

21. Answer C

22. Answer D

23. Answer B

24. Answer B

25. Answer A

26. Answer D

27. Answer C

28. Answer B

29. Answer A

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