INFECTIOUS DISEASE1. Regarding Malaria A. Caused by Plasmodium falciparum, P.vivax, P.ovale, and P.malariae. B. Transmitted by the bite of male anopheline mosquitoes. C. P.ovale is now resistant to chloroquine. D. Quinine is the drug of choice. E. Thick and thin blood films are required to diagnose.2. Congenital Toxoplasmosis A. There is 60% transmission rate to the fetus in pregnant women with toxoplasmosis. B. Chance of transmission highest in early pregnancy. C. Greatest chance of transmission in the third trimester. D. Main features are retinochoroiditis, microcephaly and hydrocephalus. E. Many fetal infections are subclinical at birth.3. Lymphatic filiariasis A. Vectors are Mansonia sp, Aedes sp and Anopheles sp. B. Caused by filiarial worms which are Wuchereria bancrofti and Brugia malayi. C. More adult worms, more microfiliarisis in the body. D. Higher eosinophilia, more severe symptoms. E. Tropical Pulmonary Eosinophilia (TPE) present in acute stage4. HIV A. There were 3 clinical stages. B. Passive partners have more risk to get infected than active partners. C. Most common transmission in Malaysia is through sharing needles. D. The median interval from infection to the development of symptoms is around 7 to 10 years. E. AIDS defined when HIV patient has PCP.5. Clinical stages of HIV A. PGL present at inguinal lymph nodes only. B. Angular cheilitis is caused by iron deficiency. C. Oral hairy leukoplakia present in clinical stage 3. D. Pneumocystis pneumonia can preset with cyanosis. E. Oral ulcers were diagnosed clinically.6. Opportunistic infections A. Esophageal candidiasis is treated with fluconazole. B. Cryptococcal meningitis is one of the opportunistic infections. C. Toxoplasmosis treated with pyrimethamine, clindamycin and folinic acid. D. Usually occur in person that have CD4 count >500cells/mm3. E. Penicillosis is treated with Amphotericin B.7. Sexual transmitted diseases A. Neisseria gonorrhoea is intracellular organism.
B. Urethral pus present in male with gonorrhoea infections. C. ‘Clue cells’ seen in gonorrhoea. D. White curds can be present in bacterial vaginosis. E. Painless ulcer present in syphilis.8. Typhoid fever A. Caused by Salmonella typi and S. paratyphi. B. Spread by fecal-oral route. C. Incubation period between 3 to 21 days. D. Osteomyelitis is one of the complications. E. 1% becomes chronic carriers.9. Cryptococcus neoformans A. Caused meningitis. B. Common found in immunocompromised patients. C. Cryptococcus meningitis is not contraindications in lumbar puncture. D. Indian ink staining is confirmation test. E. Treated with Amphotericin B.Answers1. Regarding Malaria A) T ( cdc.gov/malaria/about/biology) B) F – by females Anopheles mosquitoes ( cdc.gov/malaria/about/biology) C) F – it is highly effective against erythrocytic form s of P.vivax, P.ovale and P.malariae,sensitive strains of P.falciparum and gametocytes of P.vivax.( malariasite.com/malaria/chloquine) D) F – Chloroquine is the first choice for all cases. Quinine is only for resistant P.falciparum.(malaria site.com/malaria/antimalarial) E) T – peripheral smear examination for malarial parasite is the gold standard in confirmingdiagnosis. ( malariasite.com/malaria/staining_techniques)2. Congenital Toxoplasmosis A. F: about 1/3 of women who acquire infection with T. Gondi during pregnancy transmit the parasite to the fetus (Harisson’s Principle of Internal Medicine, 16th Edition, pg 1243-1244) B. F: If the mother being infected during 1st trimester, the incidence of transplacental transmission is 15% and if mother being infected at 3rd trimester the incidence increase to 65%. So (Harisson’s Principle of Internal Medicine, 16th Edition, pg 1244) C. T: explanation sama dengan B D. T: Clinical features of congenital toxoplasmosis: severe neurological complications hydrocephalus, microcephaly, mental retardation, chorioretinitis. (Harisson’s Principle of Internal Medicine, 16th Edition, pg 1245)
E. T: Many infant remain asymptomatic during birth because diagnosis if difficult to make. (Harisson’s Principle of Internal Medicine, 16th Edition, pg 1244-1245)3. Lymphatic filiariasis A) True B) TrueBerdasarkan keterangan di atas maka, jawapan A-true dan jawapan B-true.(KUMAR AND CLARK, CLINICAL MEDICINE 7E, PAGE 163-164,http://www.itg.be/itg/distancelearning/lecturenotesvandenendene/41_Filariasisp3.htm C) TrueBased on the life cycle, adult worms will give rise to microfilariae. Maka jawapan C –true.(www.cdc.gov)D) True - Chronic hypereosinophilia can cause cardiac lesions such as or fibroplasticendocarditis. The contents of the eosinophilic granules (including major basic protein) are toxicto the endocardium and the adjacent myocardium. A restrictive cardiomyopathy can follow.http://www.itg.beE)True - TPE ni common kat india, southeast asia. Pulmonary symptoms are predominant:cough, dyspnoea, "asthmatic syndrome". Chest X-rays very consistently show patchy infiltrates.Sometimes the lymph nodes swell and splenomegaly occurs. The erythrocyte sedimentationrate increases and there is marked eosinophilia. There are no microfilariae in the peripheralblood. Serological tests for filariae are strongly positive. This condition responds very well totherapy with DEC (diethylcarbamazine)Pathophysio die, Migrating parasites traversing the lungs may cause bronchospasm, dyspnea,and pulmonary infiltrates. Embolization of microfilariae or eggs, which degenerate and exposeantigens to the local immune system, leads to granuloma formation. Local elaboration ofchemokines and cytokines plays a role in T-cell recruitment and granuloma formation. Persistentinflammation may lead to parenchymal necrosis and fibrosis.
It could be an acute setting because the symptoms are mainly pulmonary and may mimicsbronchial asthma.http://emedicine.medscape.com/article/301070-overview#showallwww.itg.be4. HIVA. F- kerna mengikut WHO clinical staging, ade 4 iaitu:asymptomatic, mild symptoms,advanced symptoms dan severe symptomsB. F- sah2 falseC. T- mengikut UNICEF report terkini, IVDU memegang 57% takhta penyebab HIV.D. T- kerna PCP hanya berlaku bila CD4 count less than 200X 100kuase6 / L.E. T - http://www.ucsfhealth.org/conditions/aids/diagnosis.html5. Clinical stages of HIV a) FALSE. Persistent Generalized Lymphadenopathy(PGL) is not present at inguinal lymph node, becoz it is defined as nodes more than 1cm diameter, at two or more extrainguinal site, persisting for 3 months or longer. (Ref: OHCM 7th edition ,page 396) b) TRUE By definition, angular chelitis/stomatitis is inflamed painful cracking of the skin at mouth corner due to iron deficiency, excess saliva or poorly fitting dentures. (Ref: Macleod’s Clinical Examination 12th edition,page 350) c) TRUE Based on WHO clinical staging of HIV disease in adults and adolescents (2006 revision), oral hairy leukoplakia is included in clinical symptom of stage 3. (Ref: http://www.avert.org/stages-hiv-aids.htm) d) TRUE Additional findings in children with severe pneumocystis pneumonia include cyanosis, nasal flaring, and intercostal retractions.(Ref: http://emedicine.medscape.com/article/225976-overview#aw2aab6b7) e) TRUE http://www.nlm.nih.gov/medlineplus/ency/article/001448.htm6. Opportunistic infectionA) T- Treatment is with oral azole drug. Where azole-resistant candida is present, caspofungin or amphociterin can be use.From Davidson page 386B) T- it caused by Cryptococcus Neoformans when CD4 count < 50cells/mm3.From Davidson page 394C) F- treatment of choice for toxoplasmosis are the combination of sulphadiazine 4-6g/ day andpyrimathamine 50-100mg a day. Both are by oral in divided doses with folinic acid 15 mg daily.
Alternatively, clarithromycin 2g per day can be given or atovaquonene 750 mg 4x/day per oralwith pyrimethamine 50-100mg/day per oral.From ABC of AIDS page 48D) F- AIDS is defined as development of specified opportunistic infections, tumor or else. So,both AIDS and opportunistic infections occur when CD4 count< 200cells/mm3From Davidson page 384E) T - it caused by Penicillium marneffei when CD4 count < 50 cells/mm3. The fungus is sensitiveto amphotericin B, itraconazole, and ketoconazoleFrom http://www.cdc.gov/ncidod/eid/vol7no3_supp/sirisanthana.htm7. Sexual transmitted diseases F. Neisseria gonorrhoea is intracellular organism. Ans = True Reference – harrisons’ Volume I page 824 “smear of gonococcal reveals gram negative intracellular diplococcic” G. Urethral pus present in male with gonorrhoea infections. Ans = True Reference – harrisons’ volume I page 916 Gonorrhea infection in male can cause urethritis & major symptoms include are urethral discharge + dysuria w/o urinary frequency or urgency. H. ‘Clue cells’ seen in gonorrhoea. Ans = False Reference = Harrison’s page 827 & table 124-5 page 826 + wikipedia Clue cells are epithelial cells of the vagina (squamous) that get their distinctive stippled appearance by being covered with bacteria (coccobacilli). It is sign of bacterial vaginosis cause by gardnerella vaginosis. I. White curds can be present in bacterial vaginosis. Ans = True Reference = http://www.womanshealthvibe.com/bacterial-vaginosis/ Maksud Curd – coagulated acidic milk product made into cheese In Bacterial vaginosis - Discharge is different in appearance and smell to a yeast infection. Where as thrush usually causes thick white curd like discharge bacterial vaginosis cause it to be grey in colour and very foul smelling. J. Painless ulcer present in syphilis. Ans = True Reference = harrisons Volume I page325 Characteristis of syphilis = chancre (painless ulcer)8. Typhoid fever A. FALSE - “Typhoid caused by Salmonella typhi, S.paratyphi cause paratyphoid” -Kumar & Clark pg.85- B. TRUE - “S.typhi transmitted in contaminated food or water”
-Kumar & Clark pg.85 and OHCM pg.414- C. TRUE - “The incubation period is 3-21 days.” -OHCM pg.414- D. TRUE - “Usually in 3rd week of illness (without treatment) can lead to complications; meningitis, lobar pneumonia, osteomyelitis, intestinal perforation and hemorrhage.” -Kumar & Clark pg.85- E. TRUE - “Between 1% and 4% will continue to carry the organism for more than a year: this is chronic carriage” -Kumar & Clark pg.859. Cryptococcus neoformansA) T – the infection range from harmless colonization of airway and asymptomatic infection tomeningitis and disseminated diseases (emedicine.medscape.com – cryptococcosis)B) T - http://emedicine.medscape.com/article/215354-overviewC) T –For any patient who are suspected to have meningitis, it is important to perform a LP(nlm.nih.gov -meningitis cryptococcal)D)T – An India ink preparation is commonly used with CSF to identify organisms and support thepresumptive diagnosis (emedicine.medscape.com - crptococcosis Lab studies)E) T – All type of cyptococcal infection treated initially with amphotericin B.(emedicine.medscape.com. cryptococcosis treatment and management)10. Below is true regarding skin lesions terminology a. True - Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatricks color atlas and synopsis of clinical dermatology. New York: McGraw-Hill Medical Pub. Division b. FALSE: vesicle is <0.5mm c. TRUE d. FALSE – The above is definition of excoriation. Lichenification is chronic thickening of skin with increased skin markings, result of rubbing/scratching http://www.avreskincare.com/misc/about_skincare/about_skin.html e. FALSE: scale is palpable flakes. Yang thickened horny die cakap tu referring to Horn.11. All are true regarding side effect of topical steroids on the skinSide effects of tropical steroids: 1. Internal Cushing’s Syndrome (>500g hydrocortisone in one week) 2. Skin side effects skin atrophy, stretch mark (striae), easy bruising, perioral dermatitis, enlarged blood vessel (telangiectasia), allergic reactions, increased susceptibility to skin infection (http://www.dermnetnz.org/treatments/topical-steroids.html, 24th April 2011, 4.53pm) A. T B. T C. T D. T E. F