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A 20 year old man has returned from India, where he was on holiday.

He has had a 10 day history of bloody diarrhoea. Which of the following is correct?

A. Shigellosis is a likely diagnosis B. The finding of cysts in the stools confirms acute amoebic dysentery C. A negative fluorescent antibody test excludes a diagnosis of acute amoebic dysentery D. Cholera is a likely diagnosis E. Giardiasis is a likely diagnosis Do question later!

A 40 year old man presented 14 days after return from a 6-week field trip to Papua New Guinea. He had a six day history of high fevers and rigors. On the day of presentation, he had become vague and confused. He had taken antimalarials as prophylaxis, but ceased when he found that local people did not take them. His temperature was 40oC, pulse rate 140 bpm, respiratory rate 28 per minute, and blood pressure 100/60 mmHg. He had dry mucous membranes, mild jaundice, pallor, splenomegaly and generalised crackles in both lungs. Full blood examination revealed: 6.5 WCC 2.5 x Platelet 10 x bilirubin 60 mol/L(320 lactate dehydrogenase 489 U/L (100225 U/L) creatinine 250 umol/l What is the likely diagnosis? g/dL 10^9/L 10^9/L mol/L)

A. Leishmaniasis B. Tick bite fever C. Endocarditis D. Falciparum malaria E. Viral haemorrhagic fever Do question later!

Severe malaria requires treatment with intravenous quinine.

P. falciparum rings in erythrocytes


A 25 year old veterinarian presents with a 2 week history of high fevers, night sweats, dry cough, and myalgia. He had no medical history and was taking no regular drug treatment. A travel and occupational history showed that he had lived and worked as a vet in northern India until 6 months ago, when he moved to London. On examination, the patient had a fever of 38.5C, a solitary cervical lymph node measuring 1 cm x 0.5 cm in size, and a palpable splenic tip. Initial investigations showed a CRP of 84 U/l and white cell count of 4.8 x 109/l. Three blood films for malaria parasites were negative. Standard liver function tests showed a raised serum alkaline phosphatase concentration of 520 U/l, a raised (gamma)-glutamyltransferase concentration of 450 U/l, and a raised serum aspartate aminotransferase concentration of 248 U/l); the serum bilirubin concentration was at the upper end of the normal range, at 18 mol/l. The serum angiotensin converting enzyme concentration was also raised, at 113 U/l. Which one of the following tests is most likely to yield the diagnosis?

A. Chlamydia serology B. Mycoplasma serology C. Brucella serology D. Legionella serology E. Paul bunnell test Do question later!

The occupation suggests that the patient had worked with animals e.g. cattle. Brucella is transmitted through milk and meat, especially in abbatoirs. The commonest cause is

Brucella melitensis. Detection of brucella may require extended culture of 6 weeks and blood agar plates. Detection of Brucella agglutinins (with the Coombs test) also helps confirm the diagnosis. Fever and rigors, followed by possible osteomyelitis, polyarthritis, endocarditis, pneumonia, hepatitis/jaundice, splenic abscess, meningitis/encephalitis, skin changes, orchitis/cervicitis and retinitis. Past infection causes positive serology and does not necessarily indicate active infection. Tetracycline and gentamicin are treatments of choice (better intracellular penetration).

Brucella melitensis - Gram-negative, aerobic, coccobacillus


A 65 year old man had been on holiday to Arizona in the united states 6 weeks ago. He was brought to hospital with high fever, rigors, malaise, and mild confusion. He had a generalised, nonpruritic maculopapular rash, predominantly on the trunk but also on the extremities, including the palms and soles. There was no history of animal or arthropod exposure, but his house was on the edge of forest. What is the most likely diagnosis?

A. Falciparum malaria B. Rickettsial spotted fever C. Tuberculosis D. Allergic bronchopulmonary aspergillosis E. Schistosomiasis Do question later!

Recommended treatment is doxycycline.

Maculopapular rash due to Rickettsial disease


A 62 year old man had been travelling around Asia for 3 months and returned several weeks ago to UK. He has a 7 day history of fever and confusion. His wife mentioned that they had been bitten by mosquitoes but had taken malarial prophylaxis. On examination, he had generalised upper motor neurone signs and a Glasgow coma score of 10. Computed tomography and magnetic resonance imaging showed multiple non-specific whitematter lesions bilaterally. An electroencephalogram (EEG) demonstrated diffuse slowing in the delta to theta range in both hemispheres, with preserved response to painful stimulation. Lumbar puncture showed clear cerebrospinal fluid (CSF), with a leukocyte count of 50 10^6 cells/L (81% mononuclear), raised protein level of 0.79 g/L (<5); glucose level of 4.3 mmol/L (2.8 4.0) and negative bacterial and fungal cultures. Thick and thin films were negative for malarial parasites. What is the diagnosis?

A. Plasmodium vivax infection B. Plasmodium falciparum infection C. Rickettsial disease D. HIV seroconversion E. Japanese encephalitis Do question later!

A 40 year old man has spent a year in South America working in the computer industry. He develops fevers, night sweats, vomiting and pain in the right upper quadrant. Blood tests reveal a raised white cell count but not eosinophil count. An CT of his abdomen shows a large cyst. Which is the best treatment?

A. Hepatectomy of hepatoma B. Surgical removal of aspergilloma

C. Albendazole for hydatid cyst D. Metronidazole for amoebic liver abscess E. Quadruple therapy for TB Do question later!

An 5 year old child presented with a one-day history of lethargy, jaundice, fever, and melaena. Upon admission, blood and CSF cultures were drawn, and antibiotics were administered. TORCH titer results were as follows: T. Rubella CMV HSV HSV Gondii IgG IgG I II IgG IgG IgG 0 58.4 2.7 0.25 0.70 IU/mL IU/mL IU/mL IU/mL IU/mL (>12 (>9.9 (>1.10 (>1.10 (>1.10 positive) positive) positive) positive) positive)

Which of the following is true regarding the disease?

A. Typically has an incubation period of 7-10 days B. Causes a rash on the forehead, suboccipital lymphadenopathy and polyarthritis C. May be complicated by polyarthralgia D. Is an indication for termination if it occurs in the first two months of pregnancy E. Can be prevented by vaccination in over 80% of individuals Do question later!

35 year old man has returned from a field trip in Malaysia. He now has a fever of 39C, headache, muscular aches and pains. Examination reveals an erythematous rash on his abdomen and thighs. There was cervical and inguinal lymphadenopathy. Blood tests show: Hb MCV WCC platelets urea creatinine sodium potassium bilirubin AST ALP albumin ESR CRP What is the likely illness? 14.0 80 7 120 7 100 142 4.2 16 120 1500 32 60 180 x x g/dl fl 10^9/l 10^9/l mol/l mol/l mmol/l mmol/l mol/l U/l U/l g/l mm/hr mg/l

A. Syphilis B. Chlamydia infection C. Dengue fever D. Yellow fever E. Typhoid fever Do question later!

A 30 year old man had a tender painful leg with fevers and a year later, progressively develops a swelling in the left leg. Which organism is likely to be responsible?

A. Loa loa B. Wuchereria bancrofti C. Schistosomiasis D. Leishmaniasis E. Toxoplasmosis Do question later!

Elephantiasis
A 35 year old man was in South East Asia on holiday backpacking alone. He has returned 5 days ago, having been there for a month. His temperature is 38 C and he has a swollen ankle and elbow joint. He also complains of purulent penile discharge. Which of the following conditions/infections is likely?

A. Reiter's syndrome

B. Chlamydia trachomatis C. Neisseria gonorrhoeae D. Staphyloccocus aureus E. Treponema pallidum Do question later!

Gram negative diplococci - N. Gonorrhoeae


A 23-year-old man presented to a hospital with a 3 day history of fever, rigors, confusion and malaise. A chest x-ray showed left lower-lobe pneumonia. He works in a factory close to a water tank which acts as a heat exchange for the welding cooling system. What is the most likely infective organism?

A. Pneumococcus B. Legionella C. Mycoplasma D. Tuberculosis E. Klebsiella Do question later!

A 2 year old girl presented with a 12-hour history of fever and poor feeding. The family owned two cats. Her temperature was 39.5C, and she was irritable, with no localising signs or skin lesions. A full septic screen was performed. Cerebrospinal fluid (CSF) showed a neutrophilic pleocytosis and gram-negative coccobacilli. She was treated with intravenous cefotaxime and gentamicin. Within 24 hours both CSF and blood cultures showed growth of gram-negative bacilli. What is the likely infective organism?

A. Legionella pneumophilia B. Haemophilus influenzae

C. Pasteurella multicoda D. E coli E. Pseudomonas aeruginosa Do question later!

Pasteurella meningitis occurs at extremes of age (infants), in the immunocompromised (associated with liver cirrhosis, renal disease and haematological malignancies) and after traumatic head injury.
A 16 year old boy with previous tuberculosis had a 7-day history of progressive cough, wheeze and tachypnoea, despite 4 days of intravenous flucloxacillin and cefotaxime therapy. Total serum IgE titre was 1600 IU (normal range, 0180 IU) and the skin prick test was positive for Aspergillus fumigatus. What should he be treated with?

A. Praziquantel B. Aciclovir C. Itraconazole D. Rifampicin E. HAART Do question later!

Allergic bronchopulmonary aspergillosis (ABPA) is a diagnosis which can be confirmed by significantly elevated serum IgE titre, positive skinprick tests for aspergillus, positive IgG aspergillus precipitins. Treatment is with antifungals. Steroids may be required in patients with respiratory distress
An 75 year old man presents to hospital unwell with diarrhea. He has a BP of 100/70, heart rate 110 and Temp 38 C. A diastolic murmur is heard in aortic area. His bloods show: Hb 9.0 g/dl MCV 85 fl WCC 13 x 10^9/l platelets 270 x 10^9/l urea 6 mol/l creatinine 80 mol/l sodium 140 mmol/l potassium 3.8 mmol/l ESR 80 mm/hr CRP 220 mg/l

Which organism is likely to grow in the blood cultures?

A. Streptococcus mitis B. Staphylococcus aureus C. Streptococcus bovis D. Escherichia coli E. Brucella melitensis Do question later!

A 25 year old secretary comes to the clinic complaining of fevers, crampy abdominal pains and diarrhoea. She has returned from Turkey on a holiday. Whilst there, she visited two spas and spent a long time in jacuzzis. Which of the following organisms might be isolated from stool culture?

A. Vibrio cholerae B. Cryptosporidium C. Salmonella D. Shigella E. Actinomyces Do question later!

A 35 year old man has lymphopenia on his white cell differential. He complains of headaches. A CT scan of his brain showed a 5 cm ring enhancing lesion in the frontal lobe. Which is the likely infective organism?

A. Cryptosporidia B. Toxoplasma gondii C. Aspergillus D. Cryptococcus neoformans E. Mycobacterium avium intracellulare Do question later!

Ring enhancing lesion in the Basal ganglia


Which of the following is the commonest world wide cause of traveller's diarrhoea?

A. E coli B. Giardia C. Shigella D. Salmonella E. Campylobacter Do question later!

A 22 year old woman presented with a 1-day history of fever, chills and severe back pain, with no other focal symptoms. On examination, she was febrile with a blood pressure of 75/40 mmHg, and had begun vomiting. She was treated empirically with intravenous ceftriaxone and flucloxacillin and resuscitated with intravenous fluids. Over several hours, the back pain resolved, and a widespread erythrodermic rash developed, centred mainly on the trunk. Further questioning revealed that the patient had removed a tampon shortly before presentation, as she had just ceased menstruating. What is the diagnosis?

A. Haemolytic uraemic syndrome B. E coli sepsis C. Fungal infection D. Toxic shock syndrome E. Meningococcal septicaemia Do question later!

A 28 year old banker goes on holiday to Brazil. He visits various holiday spots including a cattle

ranch. He has headaches and a temperature of 38 C. Examination reveals hepatosplenomegaly and spinal tenderness. His blood cultures do not grow any organisms. Which is the likely infective organism?

A. Brucella melitensis B. Listeria C. Cryptosporidium D. Shigella E. Schistosomiasis Do question later!

A 40 year old man has been to Malaysia for 6 months. He has an erythematous, serpiginous, pruritic, cutaneous eruption on the medial side of the ankle. What is the diagnosis?

A. Lyme disease B. Cutaneous larval migrans C. Leishmaniasis D. Sarcoidosis E. Tuberculosis Do question later!

Treatment is often necessary because of intense pruritus, long duration (over a year) and complications, such as impetigo and allergic reactions. Therapy comprises ivermectin, albendazole or thiabendazole.

Cutaneous Larval Migrans


A 25 year old male man has urethral discharge. Gram stain of the discharge sample shows gram negative intracellular diplococci. The patient is treated with cefotaxime as a 500mg single intramuscular dose. A week later, the patient still has urethral discharge. Which of the following organisms is likely to be responsible?

A. Neisseria gonorrhoeae

B. Ureaplasma C. Chlamydia trachomatis D. Staphyloccocus aureus E. Escherichia coli Do question later!

A 34 year old patient has a CD4+ count of 80/mm. He has had a generalised seizure recently. An MRI scan is performed, it shows multiple 1 cm white matter lesions. Which of these diagnoses is likely?

A. Progressive multifocal leukoencephalopathy B. Demyelination C. Calcified tubers D. Behcet's disease E. Systemic lupus erythematosus Do question later!

Multifocal areas of demyelination in PML


A 20 year old student travelled to India during his gap year. He is hospitalised due to nausea and rigors. On examination Temp is 39C and he has a palpable spleen and liver. Which of the following infections is likely?

A. Schistosomiasis B. Tuberculosis C. Leishmaniasis D. Malaria E. Salmonella infection Do question later!

Macrophages with several amastigote forms of Leishmania donovani.


A 23 year old student has just returned from India having been on a holiday. He was bitten by flies whilst he was there. He has been lethargic for two months and has a fever. Clinical examination reveals hepatosplenomegaly. Ultrasound of the abdomen reveals lymphadenopathy. One of the lymph nodes are biopsied (a smear shows amastigotes within a macrophage). What is the diagnosis?

A. Kala azar B. Babesiosis C. Schistosomiasis D. Malaria E. Amoebiasis Do question later!

Three Leishmania amastigotes, each with a clearly visible nucleus


A 35 year old patient has a stiff neck, myalgia and joint pains in the knees, shoulders and elbows. He had felt that his heart beat was irregular. He also developed a rash that came and went on the back over several weeks. Which is the best diagnostic test?

A. Monospot test B. Herpes virus serology C. Immunofluorescent antibodies to Borrelia burgdorferi D. Coxsackie virus serology E. Serum Anti streptolysin O titres Do question later!

Erythema Chronicum Migrans


A middle-aged, obese man had previously been treated for chronic venous insufficiency-related swelling and cellulitis. He had hyperpigmentation and hemosiderin deposition. A further wound swab grew Pseudomonas aeruginosa. Which one of the following antibiotics is recommended?

A. Ciprofloxacin B. Flucloxacillin C. Benzylpenicillin D. Cephalexin E. Metronidazole Do question later!

A 38 year old man with previously treated early syphilis and hepatitis C infection presented to a hospital complaining of 3 months of tender right inguinal lymphadenopathy. An excisional biopsy showed the formation of necrotising granuloma indicative of Lymphogranuloma venereum. What should he be treated with?

A. Benzylpenicillin B. Erythromycin C. Clindamycin

D. Gentamicin E. Doxycycline Do question later!

Confirmation of a diagnosis of LGV requires serological tests or PCR on genitourinary specimens. Prolonged treatment with doxycycline or roxithromycin for 3 weeks is required for affected patients.

Lymphogranuloma venereum
A 45 year old patient presents with meningism. There is no past medical history. CT scan was normal and he had the following CSF results. There were 150 X 10^6/ml white cells (90% lymphocytes) , protein was 6g/l and glucose 2.2 mmol/l. Microscopy revealed no gram positive organisms and no Acid fast bacilli were seen. Which is the best diagnostic test?

A. TB PCR of the cerebrospinal fluid B. CSF cytology C. Heaf test D. Herpes viral serology E. Blood cultures Do question later!

A 62 year old lady presents with fever and persistent difficulty in speaking. Her signs show a termperature of 39C. The patient was alert and oriented with respect to time but unable to name objects properly. Dysarthria and occasional word substitution were noted. The patient followed two but not three-step commands. A provisional diagnosis of an aphasic temporal lobe lesion was made. A CT scan showed a low attenuation lesion involving the medial and posterior aspect of the left temporal lobe and inferior basal ganglia. What is the diagnosis?

A. Polymorpho leukoencephalopathy B. Cerebral toxoplasmosis

C. Herpes simplex encephalitis D. Multiple sclerosis E. Meningococcal meningitis Do question later!

A 30 year old lady presents with headache and neck stiffness. Her temperature is 38.5 C, BP 100/65 and she has a petechial rash in the thigh. CSF examination reveals gram negative diplococci. Which is the best antibiotic therapy?

A. Gentamicin B. Flucloxacillin C. Cefuroxime D. Ciprofloxacin E. Benzylpenicillin Do question later!

Meningococcal Rash
A patient with HIV takes several different drugs is concerned about changing facial appearance. Which drug is most likely to cause lipodystrophy?

A. Lamivudine (3TC) B. Zidovudine (AZT) C. Didanosine (DDI) D. Nevirapine E. Saquinavir Do question later!

Protease inhibitors, such as saquinavir, ritonavir and indinavir cause lipodystrophy. Lamivudine is an nucleoside reverse transcriptase inhibitor (NRTI), it commonly causes peripheral neuropathy. AZT (nucleoside reverse transcriptase inhibitor) more commonly causes bone marrow suppression and liver damage. DDI causes pancreatitis. Nevirapine is a non nucleoside reverse transcriptase inhibitor (NNRTI) with stevens johnsons / rash as main side effect.

Facial lipodystrophy
An 18 year old girl was studying for examinations together with a friend who was hospitalised 2 days ago with meningitis. The blood cultures in her friend grew meningococcus group A. Which of the following actions should be taken towards the girl who was in contact with the patient?

A. Immunisation with meningococcus A vaccine B. Immunisation with meningococcus A and C vaccine C. Immunisation with meningococcus A and C vaccine, and rifampicin D. Rifampicin only E. Full treatment for meningitis A Do question later!

A 40 year old diabetic lady presents with a hot swollen left leg. On examination has a temperature of 39C and her leg is tender to compression. She was treated with intravenous flucloxacillin and benzylpenicillin. However, the erythema has spread even further after 3 days, she is persistently hypotensive with a systolic BP of < 90 mmHg. Which of the following antibiotics should be added?

A. Gentamicin B. Tazocin C. Chloramphenicol D. Clindamycin E. Amoxycillin Do question later!

A 22 year old man had been to a Greek island on holiday 2 months ago. He presented with a 2week history of dry cough, diarrhoea, lethargy, anorexia and fever. He had a past history of cutaneous vasculitis of uncertain aetiology. He was not taking any regular medication. On examination, the patients temperature was 37.5C, but no other abnormalities were evident. Investigations showed that he had pancytopenia, raised erythrocyte sedimentation rate and hypergammaglobulinaemia. A second bone marrow biopsy at this time revealed occasional macrophages containing amastigotes. Further history revealed that he had been bitten by sandflies. What is the diagnosis?

A. Schistosomiasis B. Cutaneous leishmaniasis C. Visceral leishmaniasis D. Malaria E. Dengue fever Do question later!

Visceral leishmaniasis is caused by Leishmania donovani, L. infantum or L. chagasi. The incubation period of visceral leishmaniasis is usually 28 months. Many infections are subclinical, but the classic presentation is with fever, weight loss, hepatosplenomegaly, pancytopenia and hypergammaglobulinaemia. The definitive diagnosis depends on demonstrating either amastigotes in tissue or promastigotes in culture. Splenic puncture is the most sensitive means of obtaining a diagnosis, but biopsy of the bone marrow and liver is almost as good. Pentavalent antimony compounds have been used to treat leishmaniasis for decades, but often have severe side effects, and resistance is developing.Amphotericin can achieve 98% long-term cure in both antimonial-unresponsive and previously untreated patients.
A 30 year old lady presents with headache and neck stiffness. Her temperature is 38.5 C, BP 100/65 and she has a petechial rash in the thigh. CSF examination reveals gram negative diplococci. Which is the best antibiotic therapy?

A. Gentamicin B. Flucloxacillin C. Cefuroxime D. Ciprofloxacin

E. Benzylpenicillin Do question later!

A 45 year old HIV positive man presents with breathlessness. He has a temperature of 38C. The blood gases show a pH of 7.30, pO2 of 8kPa and pCO2 of 3 kPa. CXR shows bilateral interstitial and alveolar consolidation. Which of the following medications should be used?

A. Quadruple anti TB therapy B. Amphotericin C. Co-trimoxazole D. Gentamicin E. Teicoplanin Do question later!

A 25 year old man presented to an emergency department with a 1-day history of fever, headache and myalgia. Two weeks before his presentation, he had returned from a 10-day trip to Costa Rica, where he had injured the sole of his foot on coral. After injuring his foot, he had swum in freshwater rivers. Thick and thin blood films examined at the time for malaria parasites were negative. What is the likely diagnosis?

A. Amoebiasis B. Leishmaniasis C. Schistosomiasis D. Leptospirosis E. Brucella abortius Do question later!

Pathogenic leptospiras rapidly invade the bloodstream after penetrating skin or mucous membranes, and multiply in small blood vessel endothelium, resulting in damage and vasculitis in major organs. The mortality rate ranges from 4% to 10%, and adverse indicators are dyspnoea, oliguria, raised white cell count, abnormalities on ECG, and alveolar infiltrates on chest x-ray. Oral doxycycline is highly efficacious.
A 20 year old man has recently returned from holiday in Spain. He has fever and a sorethroat. Examination reveals palpable lymphadenopathy in the cervical and inguinal areas. Blood tests show:

Hb WCC platelets urea creatinine sodium potassium bilirubin AST ALP albumin CRP 110 mg/l What is likely diagnosis?

11.0 12 145 7 80 140 4.2 22 90 280 32 x x

g/dl 10^9/l 10^9/l mol/l mol/l mmol/l mmol/l mol/l U/l U/l g/l

A. CMV infection B. Typhoid fever C. Infectious mononucleosis D. Yellow fever E. Schistosomiasis Do question later!

Pharyngitis due to infectious mononucleosis


A 75 year man has severe headaches and photophobia. Examination reveals a temperature of 40C and neck stiffness. Fundoscopy and CT scan reveal no abnormalities. CSF examination shows Gram positive diplococci. What is the diagnosis?

A. Listeria meningitis B. TB meningitis C. Meningococcal meningitis

D. Pneumococcal meningitis E. Mycoplasma infection Do question later!

Gram positive diplococci


A 35 year old woman presented with a non-healing genital ulcer. She had travelled through Africa 3 years previously. On examination, An indurated 1.5 cm ulcer was present on the inner aspect of the left labia majoris. Skin biopsy of the lesion revealed a granuloma surrounding a schistosome egg. Schistosoma haematobium eggs were detected in terminal urine collected between midday and 2 pm. What should she be treated with?

A. Quinine B. Benzylpenicillin C. Tetracycline D. Flucloxacillin E. Praziquantel Do question later!

Treatment is with praziquantel.

Schistosomal Egg in the urine


A 42 year old man presented 10 days after returning from a 8-week holiday in South-East Asia. He had an eight-day history of malaise, chills, headache, sore throat and generalised rash. He had reported many mosquito bites. He had fever, a macular rash and generalised lymphadenopathy with mild splenomegaly, but no meningism and no eschar present. Full blood examination revealed lymphocytosis with numerous atypical lymphocytes and thrombocytopenia. Blood cultures and malaria films were negative. Liver function tests revealed marginally elevated serum transaminase levels. Serological testing revealed past infection with EpsteinBarr virus and cytomegalovirus and was negative for Q fever, dengue, rubella, measles and rickettsial infection. What is the most likely diagnosis?

A. HIV B. Dengue fever C. Syphilis D. Lyme disease E. Malaria Do question later!

An 8 year old child develops fevers, myalgia, lethargy and joint pains over 5 days, having been in contact with another child with a similar illness. She has a temperature of 39 C. On examination, she has a cheek rash, synovitis of the hand and knee joints, and palpable lymph nodes in the cervical area. Which is a likely diagnosis?

A. Infectious mononucleosis B. Lyme disease C. Listeriosis D. Leptospirosis E. Parvovirus B19 Do question later!

Slapped Cheek s
A 45 year old pig farmer is admitted to A+E following two generalised seizures. CT scan shows periventricular cystic lesions. There is eosinophilia of 10%. Whic infective organisms is likely?

A. Toxocara canii B. Ascaris lumbricoides C. Schistosoma mansoni D. Yersinia enterolitica E. Taenia solium Do question later!

Toxocariasis is commonly passed on from dog and cat faeces. Ascariasis is roundworm infection which commonly causes abdominal symptoms. Yersninia is a bacterial infection spread from half cooked meat and unpasteurised milk, causing abdominal symptoms and diarrhoea. Taenia solium is the pork tapeworm which causes the condition cysticercosis described above. Cysts are commonly found in the brain and seizures are common.

Taenia Solium yndrome


A pregnant 18 year old woman came to the clinic with a low-grade fever,malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later with a macular rash on her trunk, arms, hands, and feet. Further questioning of the patient when serology results were known revealed that I month previously, she had a painless ulcer on her vagina that healed spontaneously. Which of the following is the most likely diagnosis?

A. Lyme disease B. Lymphogranumoma venereum

C. Behcet's disease D. Endocarditis E. Syphilis Do question later!

T pallidum is sensitive to the penicillins and is easily treatable in the early stages.

Maculopapular rash in secondary syphilis


A 18 year old man was admitted to the emergency room due to fever, headache, vomiting, irritability, and myalgia that had begun 24 hours ago. There was no evidence of previous infection in the upper airways. On examination, the patient was lethargic, disoriented and hypotensive, with petechiae in the legs and upper limbs, and he had conjunctival suffusion. Cerebrospinal fluid (CSF) was turbid, with 5300 cells/mm3 (97% neutrophils and 3% monocytes)and protein was 0.9 (<0.5). What is the treatment of choice?

A. Erythromycin B. Gentamicin C. Ceftriaxone D. Metronidazole E. Hydrocortisone Do question later!

Meningococcal Rash
A 32 year old sailor is admitted to hospital with a 3 day history of fever, generalised lymphadenopathy and a macular rash over the trunk and legs. Which of the following diseases may present in this way?

A. Infectious mononucleosis B. Sarcoidosis C. Mumps D. Primary syphillis E. Familial mediterranean fever Do question later!

Sarcoidosis causes lupus pernio and erythema nodosum but not rashes on the trunk. Also causes hilar lymphadenopathy and lung parenchyma fibrosis, uveitis, arthralgia, cardiomyopathy, cranial nerve palsy and hypercalcaemic nephropathy. Intradermal injection of sarcoid spleen tissue (Kveim test) gives a positive granulomatous response. Mumps causes parotitis, orchitis, and lymphocytic meningitis. Secondary syphillis can present with a rash and lymphadenopathy, but primary syphillis does not. Although systemic amyloidosis may present like this, familial mediterranean fever is a form of polyserositis which presents with features of arthritis. It is found in Ashkenazi Jews and Armenians
20 year old man has recently returned from holiday in Spain. He has fever and a sorethroat. Examination reveals palpable lymphadenopathy in the cervical and inguinal areas. Blood tests show: Hb WCC platelets urea 11.0 12 145 7 x x g/dl 10^9/l 10^9/l mol/l

creatinine sodium potassium bilirubin AST ALP albumin CRP 110 mg/l What is likely diagnosis?

80 140 4.2 22 90 280 32

mol/l mmol/l mmol/l mol/l U/l U/l g/l

A. CMV infection B. Typhoid fever C. Infectious mononucleosis D. Yellow fever E. Schistosomiasis Do question later!

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