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Question 1 of 153 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 1 of 153 At what CD4 count should highly active anti-retroviral treatment (HAART) commence in asymptomatic HIV patients? A Below 600/mm3 B Below 400/mm3 C Below 350/mm3 D Below 100/mm3 E Below 50/mm3 Explanation Timing of treatment in human immunodeficiency virus infection A number of cohorts exist, providing important data on the natural history and progression of HIV infection Multiple logistic regression can and has been used to determine the optimal point at which to start HAART, and it appears that the point where the benefit of HAART outweighs the risk is around 350 mm3 5490 Next Question Previous Question Tag Question Feedback End Review Difficulty: Average Peer Responses https://mypastest.pastest.com/Secure/TestMe/Browser/429893 1/2 8/9/2016 MyPastest Session Progress Responses Correct: 1 Responses Incorrect: 152 Responses Total: 153 Responses - % Correct: 1% Blog (https://www.pastest.com/blog) About Pastest (https://www.pastest.com/about-us) Contact Us (https://www.pastest.com/contact-us) Help (https://www.pastest.com/help) © Pastest 2016 https://mypastest.pastest.com/Secure/TestMe/Browser/429893 2/2 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 2 of 153 A 22-year-old woman returns from a holiday on the Kenyan coast. She develops a fever, deteriorates over the next 48 h and becomes unconscious and unrousable. She has acute renal failure. Which one of the following options is the most appropriate investigation? A Computed tomography (CT) scan, head B Electroencephalograph (EEG) C Erythrocyte sedimentation rate (ESR) D Repeated thick and thin blood smear E C-reactive protein (CRP) Explanation Complications in malaria treatment The patient in the present case has extremely severe falciparum malaria, with cerebral malaria (coma) and renal failure (usually pre-renal) needing renal replacement therapy Patients with full-blown cerebral malaria are at an increased risk of fitting, which may be treated with diazepam Administration of prophylactic anticonvulsants may be associated with an increased mortality Exchange transfusion is recommended for a parasitaemia > 10% with complications (or > 30% if no other complications) Treatment of the malaria is with IV quinine, which increases insulin secretion and the sensitivity of cells to insulin and can cause hypoglycaemia Malaria itself can cause hypoglycaemia too, so blood glucose should be monitored every 2 h 3678 Next Question https://mypastest.pastest.com/Secure/TestMe/Browser/429893 1/2 8/9/2016 MyPastest Previous Question Tag Question Feedback End Review Difficulty: Easy Peer Responses Session Progress Responses Correct: 1 Responses Incorrect: 152 Responses Total: 153 Responses - % Correct: 1% Blog (https://www.pastest.com/blog) About Pastest (https://www.pastest.com/about-us) Contact Us (https://www.pastest.com/contact-us) Help (https://www.pastest.com/help) © Pastest 2016 https://mypastest.pastest.com/Secure/TestMe/Browser/429893 2/2 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 3 of 153 Which one of the following organisms is the most frequent cause of hospital-acquired infections and is also developing increasing resistance to antimicrobial agents? A Staphylococcus aureus B Streptococcus pneumoniae C Toxoplasma gondii D Pneumocystis jirovecii (formerly called Pneumocystis carinii) E Listeria monocytogenes Explanation Staphylococcus aureus infection Epidemiological studies of Staphylococcus aureus infection, and increasingly these concern meticillin-resistant Staph. aureus (MRSA) strains, require typing methods to distinguish between epidemic and endemic strains Staph. aureus is part of the normal flora in some individuals; about 25% of people carry the organism permanently, a similar proportion never do, and the rest do so intermittently Common carriage sites are the nose, axillae, perineum and toe webs Nasal carriage rates vary from 10% to 40% in normal adults outside a hospital environment, but higher rates are often found in hospital patients, particularly those who have been in hospital for several weeks High carriage rates are also found in those with skin diseases such as eczema, those with insulin-dependent diabetes, patients on chronic haemodialysis or chronic ambulatory peritoneal dialysis, intravenous drug users and human immunodeficiency virus (HIV)-positive patients Some carriers disperse large numbers of staphylococci into the environment on skin squamae https://mypastest.pastest.com/Secure/TestMe/Browser/429893 1/2 8/9/2016 MyPastest The carrier state is highly relevant to the epidemiology of Staph. aureus infection as to whether or not this complicates surgery or trauma; the source of Staph. aureus in most patients who develop a staphylococcal infection is endogenous 1308 Next Question Previous Question Tag Question Feedback End Review Difficulty: Easy Peer Responses Session Progress Responses Correct: 1 Responses Incorrect: 152 Responses Total: 153 Responses - % Correct: 1% Blog (https://www.pastest.com/blog) About Pastest (https://www.pastest.com/about-us) Contact Us (https://www.pastest.com/contact-us) Help (https://www.pastest.com/help) © Pastest 2016 https://mypastest.pastest.com/Secure/TestMe/Browser/429893 2/2 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 4 of 153 A 49-year-old woman is referred to you by her GP for suspected chronic fatigue syndrome. Which one of the following features would suggest that this was an incorrect diagnosis? A Dysphagia B Frequent headaches C Memory impairment D Recurrent sore throats E Severe myalgia Explanation Chronic fatigue syndrome A diagnosis of chronic fatigue syndrome (CFS) requires the presence of unexplained chronic fatigue for more than six months Although several formal definitions exist, cardinal features of CFS (besides fatigue) include impaired memory or concentration, sore throats, myalgia, arthralgia, headaches, unrefreshing sleep and post-exertion malaise CFS is a diagnosis of exclusion, which requires the absence of any other underlying organic or psychiatric problem Dysphagia Dysphagia might reflect an underlying oesophageal cancer, and should be investigated urgently 1643 Next Question https://mypastest.pastest.com/Secure/TestMe/Browser/429893 1/2 8/9/2016 MyPastest Previous Question Tag Question Feedback End Review Difficulty: Average Peer Responses Session Progress Responses Correct: 1 Responses Incorrect: 152 Responses Total: 153 Responses - % Correct: 1% Blog (https://www.pastest.com/blog) About Pastest (https://www.pastest.com/about-us) Contact Us (https://www.pastest.com/contact-us) Help (https://www.pastest.com/help) © Pastest 2016 https://mypastest.pastest.com/Secure/TestMe/Browser/429893 2/2 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 5 of 153 A 25-year-old soldier presents to the Emergency Department with a high fever, diarrhoea and vomiting. He returned from his recent posting to rural Sierra Leone 10 days ago and has become unwell over the last 24 h. On admission he looks unwell and has a temperature of 39 °C. He has a pulse rate of 110 bpm. Examination is otherwise unremarkable. Which one of the following options is the most appropriate next step? A Send samples for FBC, clotting, U&Es, LFTs and a malaria film to the lab B Send the patient direct to an isolation unit C Send samples for a malaria film to the lab D Send samples for FBC, clotting, U&Es, LFTs, a malaria film and blood cultures to the lab E Send the patient home Explanation Malaria/Viral Haemorrhagic Fever Differential The most likely diagnosis in the present case is malaria, in the current climate however the major concern is for viral haemorrhagic fever, in particular a differential of Ebola, and as such guidance has changed from that previously recommended In the past, in someone returning from rural Sierra Leone guidance was send only one sample for malaria (if positive for malaria, can relax and treat for malaria) New guidance dictates that if suspicion of viral haemorrhagic fever, then don't even take a single sample to avoid exposure risk for lab staff, send directly to an isolation unit (Royal Free, Newcastle, Liverpool, Sheffield) - so this would encompass anyone returning from rural West Africa and with a differential of viral haemorrhagic fever and within the 21 day maximum incubation period 624 Next Question https://mypastest.pastest.com/Secure/TestMe/Browser/429893 1/2 8/9/2016 MyPastest Previous Question Tag Question Feedback End Review Difficulty: Difficult Peer Responses Session Progress Responses Correct: 1 Responses Incorrect: 152 Responses Total: 153 Responses - % Correct: 1% Blog (https://www.pastest.com/blog) About Pastest (https://www.pastest.com/about-us) Contact Us (https://www.pastest.com/contact-us) Help (https://www.pastest.com/help) © Pastest 2016 https://mypastest.pastest.com/Secure/TestMe/Browser/429893 2/2 8/9/2016 MyPastest Back to Filters (/Secure/TestMe/Filter/429893/QA) Question 6 of 153 A 12-year-old boy has had a gradually progressive plaque on his buttock for the past 3 years. The plaque is 15 cm in diameter, irregular in shape with crusting and induration at the periphery and scarring at the centre. Which one of the following options is the most likely diagnosis? A Tinea corporis B Granuloma annulare C Lupus vulgaris D Borderline leprosy E Cutaneous leishmaniasis Explanation Differential diagnosis of plaque-forming infections Lupus vulgaris An irregular plaque like lesion with
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