Serious & Notifiable Infections — MCQs

A 48-year-old man with recently diagnosed smear-positive pulmonary tuberculosis has been on standard four-drug therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) for 10 days. He now presents with sudden onset severe left-sided pleuritic chest pain. Chest X-ray shows a large left-sided pneumothorax. What is the most likely explanation for this complication?

A 2-year-old girl is brought to the emergency department with a 3-hour history of fever, lethargy, and a non-blanching purpuric rash on her legs. She is tachycardic with a capillary refill time of 4 seconds. Blood pressure is 85/50 mmHg. After initial fluid resuscitation and blood cultures, which antibiotic should be administered immediately?

A 36-year-old man from Vietnam presents with a 6-week history of malaise, weight loss, and back pain. He reports no respiratory symptoms. Examination reveals tenderness over the L2-L3 vertebrae and reduced straight leg raise bilaterally. MRI spine shows destruction of L2-L3 vertebral bodies with a paravertebral abscess. Which investigation is most likely to establish the diagnosis?

A 6-year-old boy presents with fever, headache and vomiting. Lumbar puncture is performed. CSF analysis shows: glucose 3.2 mmol/L (plasma glucose 5.8 mmol/L), protein 0.6 g/L, white cell count 180 cells/mm³ (90% lymphocytes). Gram stain is negative. What is the most appropriate initial antimicrobial therapy?

A 41-year-old man from India who moved to the UK 6 months ago presents with a 10-week history of progressive headache, low-grade fever, and confusion. He has lost 8 kg in weight. CT head shows basal meningeal enhancement and hydrocephalus. Lumbar puncture reveals: opening pressure 32 cmH₂O, CSF glucose 1.2 mmol/L (serum 5.6 mmol/L), protein 3.2 g/L, white cells 240/mm³ (70% lymphocytes). Ziehl-Neelsen stain and TB PCR of CSF are negative. What is the most appropriate next step in management?

A 29-year-old woman presents with headache, fever, and photophobia. Lumbar puncture shows: opening pressure 18 cmH₂O, CSF glucose 3.1 mmol/L (serum 5.4 mmol/L), protein 0.65 g/L, white cells 580/mm³ (85% lymphocytes), red cells 15/mm³. Gram stain is negative. CSF PCR for enterovirus is positive. She is currently 10 weeks pregnant. What is the most appropriate management?

A 38-year-old man with cavitating pulmonary tuberculosis has been on treatment for 3 weeks with rifampicin, isoniazid, pyrazinamide, and ethambutol. His baseline liver function tests were normal. He now presents with jaundice. Blood tests show: bilirubin 156 μmol/L, ALT 420 U/L, AST 385 U/L, ALP 178 U/L. What is the most appropriate management approach?

A 8-month-old infant is brought to the emergency department with a 12-hour history of fever of 39.8°C, irritability, and poor feeding. There is no rash. Lumbar puncture is performed: CSF glucose 1.4 mmol/L (blood glucose 4.8 mmol/L), protein 2.8 g/L, white cells 1200/mm³ (90% polymorphs). Gram stain shows Gram-negative coccobacilli. Intravenous ceftriaxone is commenced. Which organism is most likely responsible for this presentation?

A 62-year-old woman with end-stage renal failure on haemodialysis presents with a 4-week history of fever, night sweats, and cough. Chest X-ray shows bilateral miliary shadowing. Sputum is positive for acid-fast bacilli and culture confirms Mycobacterium tuberculosis fully sensitive to first-line agents. She weighs 65 kg. What is the most appropriate dosing regimen for the intensive phase of treatment?

A 52-year-old man with HIV infection (CD4 count 180 cells/mm³, viral load undetectable on antiretroviral therapy) presents with a 3-week history of headache and fever. CT head with contrast shows multiple ring-enhancing lesions in the basal ganglia and thalamus. Lumbar puncture shows: opening pressure 24 cmH₂O, CSF glucose 2.6 mmol/L (serum 5.8 mmol/L), protein 0.85 g/L, white cells 45/mm³ (80% lymphocytes). India ink stain is positive. What is the most appropriate initial management?