Mount Kenya University · School of Medicine · Internal Medicine
Paper details
- Paper: "WM Quiz: Treatment of Infectious Disease", five case-based multiple choice questions. The scan has no printed date or unit code, so it is filed as undated.
- Question 1 has a lateral neck X-ray in the original. It is not reproduced here. The film shows a swollen epiglottis, and the question text gives everything needed to answer.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Topics tested: epiglottitis, tetanus, skin abscess in pregnancy, ascending cholangitis, genital ulcer disease.
1. Gilbert, 24, has a 3-day progressive sore throat, cannot swallow, drools, and has a muffled voice. He is distressed, febrile, HR 113, BP 94/55, WBC 21.7 with 88% polymorphs. A lateral neck film is shown (arrow). Diagnosis and action?
- A. Viral laryngitis: supportive care, paracetamol, oral fluids
- B. "Croup" caused by parainfluenza virus: admit for monitoring and supportive care
- C. Epiglottitis caused by H. influenzae: examine the airway with surgical assistance given the risk of urgent tracheostomy
- D. Group A streptococcal pharyngitis: amoxicillin for 10 days to prevent rheumatic fever
2. Nelson, 54, with alcoholism and diabetes, has an infected non-healing foot ulcer. He develops sudden neck pain and stiffness with no fever or headache. Temp 36.8, HR 134, BP 188/67, bilateral trismus, a stiff neck with spastic contraction, clear chest, and a foul-smelling wound. What is happening?
- A. Bacterial meningitis: stat ceftriaxone and lumbar puncture
- B. Tuberculous meningitis: RHZE, prednisolone and lumbar puncture
- C. Cervical spine injury after alcohol binge: plain films
- D. Botulism: supportive care
- E. Tetanus: consult surgery for wound debridement, give tetanus immunoglobulin and immunisation, and diazepam for spasms
3. Gladys, 24, 12 weeks pregnant, has a 2-week painful boil on her right thigh, with subjective fever and malaise. She has normal vitals, a 3 cm indurated fluctuant abscess with no cellulitis, HIV negative, WBC 7.7. You incise and drain it (grossly purulent) and send a culture. What should you give her before discharge?
- A. Amoxicillin-clavulanic acid for 7 days
- B. Ciprofloxacin plus doxycycline to cover resistant Staph. aureus for 10 days
- C. Symptomatic therapy with paracetamol and warm compresses
- D. Co-trimoxazole (Septrin) 1920 mg daily for 5 days
4. Elizabeth, 49, has 2 weeks of abdominal pain, now with jaundice and fever. Temp 38.4, HR 124, BP 89/56, scleral icterus, right upper quadrant pain and a positive Murphy's sign, no peritonism. WBC 25.5, Hb 8.8, platelets 795,000, HIV negative. (Hint: severe sepsis: start with volume resuscitation and broad-spectrum antibiotics.) Then?
- A. Cholecystitis: consult surgery for cholecystectomy
- B. Viral hepatitis: check hepatitis B surface antigen and hepatitis C antibody
- C. Perforated viscus: upright abdominal film and laparotomy
- D. Ascending cholangitis: consult endoscopy for ERCP
5. Charles, 34, with HIV/AIDS, has a painful rounded 1 cm penile ulcer with heaped-up edges and tender suppurative inguinal lymphadenopathy. He is non-toxic. Cause and treatment?
- A. Primary syphilis: darkfield microscopy and penicillin
- B. Chancroid: azithromycin 1 g as a single dose
- C. Lymphogranuloma venereum: doxycycline 100 mg twice daily for 21 days
- D. Genital herpes: acyclovir 400 mg three times daily
- E. Behçet's syndrome: high-dose corticosteroids