TROPICAL MCQS

1. A 25 year old gentleman presented with a seven month history of low grade fever,
occurring daily associated with dry cough, diarrhea 3-4 motions per day, watery & lately
became blood stained.
O/E He looks ill, pale not jaundiced, there were cervical lymph nodes, firm, discrete, not
tender. Abdomen revealed a firm non tender spleen of 8 cm below the left subcostal
margin. Rest of physical examination was unremarkable.
The most probable diagnosis is:-
a. HIV Disease
b. Lymphoma
c. Visceral leishmaniasis
d. Chronic lymphocytic leukemia
e. Tuberculosis

2. A 30 year old lady presented to the ER (Emergency Room), complaining of one week
duration of fever, frontal headache & joint pains . Her symptoms increased in severity in
the last two days, as she noticed reddish urine, there is associated nausea and sometimes
vomiting. Examination showed a febrile lady with lemon tinge yellowish discoloration of
the sclera.
Investigations: Blood film for malaria negative, total WBCS count 3.5 x10 3/μL (3.6-11),
platelets count is 75 x103/μL (150–350); urine showed increased uroblinogen.
The diagnosis is:-
a. Infective hepatitis
b. Typhoid fever
c. Malaria
d. Acute brucellosis
e. Yellow fever

3. A 28 year old gentleman, working as an irrigation canal cleaner, presented six months
earlier to the medical department, where he received Praziquantel tablets for intestinal
schistosomaisis. Assessment for achievement of cure is based on:
a. Negative stool analysis for schistosoma ova
b. Negative ELISA test
c. No demonstrable antibodies to adult gut antigen
d. Positive schistosoma ova in stool examination, with negative hatching test
e. Normalization of pre-treatment eosinophilia
4. A 42 year old lady, hypertensive on amilodipine 5mg daily, presented for regular checkup.
Among other tests carried out on her, peripheral blood picture showed banana shaped
gametocytes. The appropriate drug indicated in her case to eradicate these gametes is:-
a. Artesunate
b. Mefloquine
c. Quinine
d. Primaquine
e. Halfantrine hydrochloride

5. A 20 year old gentleman presented with three days history of fever, followed by diarrhea,
small amounts, 8-10 times per day, associated with blood , lower abdominal pain as well
as tenesmus. Examination is unremarkable. Investigations showed blood urea 75 mg/dl
(20-40), serum creatinine 2.8 mg/dl (0.7–1.3), stool analysis showed fecal leucocytes and
RBCs. Peripheral blood picture showed fragmented RBCs.
The diagnosis is:-
a. Clostridium Difficuile colitis
b. Amebiasis
c. Campylobacter jejunei
d. Escherichia coli inection
e. Salmonellosis

6. A 20 year-old man presented with history of headache, high grade fever, nausea, vomiting
& a bleeding tendency; was found to be positive for malaria. The cause of his bleeding is:
a. Severe thrombocytopenia
b. Reduced anti thrombin III
c. Liver cell failure
d. Platelets dysfunction
e. Vitamin K- dependant coagulation factors defect

7. In a patient who is responding to treatment for visceral leishmaniasis, the followings are
true:
a. The lymph nodes will disappear within two weeks
b. Fever will subside in a week time
c. Splenomegly will persist for 6 months
d. LST (Leishmanin Skin Test) will remain negative for life
e. Serum albumin will return to normal in a month time
8. Wound debridement and antibiotics are essential for preventing further release of C.
tetani from the wound. The antibiotic of choice is:
a. Penicillin
b. Cephtriaxone
c. Gentamycin
d. Metronidazole
e. Chloramphenicol

9. A 54 years old man presents with prolonged fever and right upper subcostal pain and
tenderness. Abdominal ultrasound scan revealed a 6✕6 cm cystic lesion in right lobe of
liver.
Expected findings on further assessment include:
a. A raised blood alkaline phosphatase and neutrophil leucocytosis
b. Anormal alkaline phosphatate but raised serum bilirubin level
c. Markedly raised serum aphafetoprotein level
d. A normal CXR
e. Raised Ca 19.9 tumour marker

10. On a busy night in the ER the on call team received three patients from a village in
Algezira referred with febrile illness associated with variable symptoms of headache,
muscle pains, vomiting of blood and bruising under the skin.
Which of the following next step is most appropriate?
a. They should all be referred to the Bleeding Centre for urgent endoscopy
b. They should be treated with intravenous quinine
c. The Public Health Department should be immediately notified
d. They should be treated with intravenous antibiotics
e. Commence intravenous omeprazole and observe

11. A 44 year old male with advanced HIV/AIDS, CD4 count of 4 cells/mm3 (400-1200)
presented to the ER complaining of a headache for the last 14 days. He also complained of
intolerance to light and neck stiffness. He vomited 3 times over the last 3 days. He denied
any fever or night sweats. CSF examination revealed: WBC 46 cells/μl (0 - 5), lymphocytes
83%. Protein 147 mg/dl (12 - 60). Glucose 28 mg/dl (40 - 80). Blood glucose 117. CSF
microscopy: Yeasts seen.
What is the best course of action?
a. Start Ceftriaxone and Vancomycin
b. Start intravenous Dexamethasone
c. Start Amphotericin B and Flucytosine
d. Start antituberculous therapy with 4 drugs
e. Start Acyclovir
12. A patient with HIV and CD4 count of less than 200 cells/mm3 presents with fever, night
sweats, cough and profound weight loss. You suspect tuberculosis coinfection. Which of
the following statements is correct?
a. Extrapulmonary TB is less likely than in HIV negative patients
b. Sputum smear for acid and alcohol fact bacilli is always positive
c. CXR will be abnormal in most patients
d. Mantoux test is often strongly positive
e. Antituberculous treatment should be started before antiretroviral therapy
13) A 25 year old male patient, presented with symptoms and signs of amoebic
liver abscess, which of the following is true:
a) Typically presents with fever
b) Jaundice is usual
c) Is more likely to have concomitant colitis
d) Have a clear casual relation with alcohol abuse
e) Sub acute presentation is unlikely

14) Which of the following is highly suggestive of schistosomal periportal fibrosis in

a patient with portal hypertension:
a) Caput medusae
b) Venous hum
c) Palpable left lobe of the liver
d) oesophageal varices
e) Splenomegaly

15) A 30 year old male patient presenting with anaemia, high blood urea and
bloody stool that showed microscopically the presence of leucocytes; is due
to:
a) Amoebic dysentry
b) Escherichia coli
c) Campylobacter jejueni infection
d) Clostridium difficle
e) Pseudomembranous colitis

15. In a very ill patient with malaria arterial blood gas results showed
pH 7.25 (Normal 7.35 - 7.45) and bicarbonate 14 mmol/l (Normal
22 - 26 mmol/l ). The likely cause is:
a) Acute kidney injury
b) Hypoglycemia
 c) Lactic acidosis
d) Hepatic failure
e) Heavy parasitemia

16. Stool analysis in a female patient showed the presence of both E. Histolytica
trophozoites & cyst forms; the drug treatment of choice is:
a) Metronidazole
b) Tinidazole
c) Mebendazole
d) Ciprofloxacine and mebendazole
e) Albendazole

17. The most serious complication of brucellosis is:

a) Depression
b) Endocarditis
c) Osteomylitis
d) Sacroillitis
e) Hepatitis

18. A 25 – year- old male presented with fever & right hypochonderial pain for two
weeks. Examination & investigation showed firm & tender hepatomegally, total
WBC 14000/µl & high alkaline phosphatase. The most likely diagnosis is:
a) Bacterial cholangitis
b) Subphrenic abscess
c) Amoebic liver abscess
d) Right basal pneumonia
e) Pyogenic liver abscess

19. Hypereoisinophilia is encountered in the following condition:

a) Ascaris infection
b) Onchocerciasis
c) Loa loa
d) Strongoiloidis
 e) Katayama syndrome.

20. In typhoid fever:

a) Stool culture in the first week settles the diagnosis
b) Animal reservoir is well recognized
c) Complications occur in the second week
d) Follows an attack of severe malaria
e) Intestinal perforation is a recognized serious and frequently fatal complication

21. A 45 year old male patient, with visceral leishmaniasis, received intravenous sodium
stibogluconate 20mg/kg daily for 30 days showed no response. The next step will be:
a) Repeat the course of sodium stibogluconate
b) Start multifosine
c) Start Liposomal amphoteracin
d) Start Paromomycin
e) Start Allopurinpl
22. A 25 year old male patient, presented with symptoms and signs of amoebic liver
abscess, which of the following is true:

f) Typically presents with fever.

g) Jaundice is usual
h) Is more likely to have concomitant colitis
i) Have a clear casual relation with alcohol abuse
j) Sub acute presentation is unlikely

23. Which of the following is highly suggestive of schistosomal periportal fibrosis in a

patient with portal hypertension:

f) Caput medusae
g) Venous hum
h) Palpable left lobe of the liver
i) oesophageal varices
j) Macronodular hepatomegally
24. Hemolytic uremic syndrome in a 30 year old male patient presenting with bloody
stool that showed microscopically the presence of leucocytes; normal WBC count is
due to:

a) E.Coli
b) Bacillary dysentery
c) Campylobacter jejueni infection
d) Clostridium difficle
e) Pseudomembranous colitis

25. Acidosis, hyperventilation and circulatory failure in severe malaria are caused by :

f) Acute kidney injury

g) Hypoglycemia
h) Lactic acidosis
i) Hepatic failure
j) Heavy parasitemia

26. Stool analysis in a female patient showed the presence of both E. Histolytica
trophozoites forms & cysts forms; the drug active against both forms is

f) Metronidazole
g) Tinidazole
h) Paromomycin
i) Diloxanide fuorate
j) Albendazole

27. In cutaneous leishmaniasis ,nodular lesion will appear after the bite of sand fly
within:

a) Few minutes
b) Few hours
c) Three days
d) Three weeks
e) 2-3 months
 28. A 50 year old male patient presented with skin itching, hyperpigmentation ,
skin nodules together with visual deterioration, biopsy taken from the nodule
recovered Onchocerca volvolus ; which of the following is most appropriate:

a) Micofilaria are recovered by nocturnal blood film

b) Micofilaria invade the posterior chamber of the eye
c) Isolated skin lesions do not require treatment
d) Blindness is mainly due to optic atrophy
e) Both macro & microfilaria respond to Ivermectin

29. A 55 year old farmer with prolonged nocturnal fever, headache sweating and
hepatosplenomegally; the best test performed to settle the diagnosis of
brucellosis is:

a) Widal test for brucellosis

b) Blood culture
c) Bone marrow culture
d) Splenic puncture
e) Imaging of sacroiliac spine

30. In typhoid fever:

f) The disease affects humans only

g) Animal reservoir is well recognized
h) Complications occur in the second week
i) Follows an attack of severe malaria
j) Stool culture in the first week settles the diagnosis

31. A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium stibogluconate 20mg/kg daily for 30 days showed no response. The
next step will be:

f) Repeat the course of sodium stibogluconate

g) Start multifosine
h) Start Liposomal amphoteracin
i) Start Paromomycin
j) Start Allopurinpl
 32. The treatment of choice in a pregnant lady with brucellosis is:
a) Streptomycin + doxycycline
b) Doxycycline + rifampicin
c) Rifampicin + co-trimoxazole
d) Co-trimoxazole + ofloxacin
e) Ofloxacin + streptomycin

33. The best diagnostic test for typhoid fever with regard to sensitivity and
specificity is:
a) TWBC showing leukopenia
b) Blood culture
c) Widal test for somatic Ag ( IgM )
d) Widal test for flagellar Ag ( IgG )
e) Bone marrow culture

34. In a patient with bacterial meningitis the best empirical treatment is:
a) Crystalline penicillin
b) Amoxicillin
c) Chloramphenicol
d) Ceftriaxone
e) Co-trimoxazole

35. The most serious complication of brucellosis is:

f) Depression
g) Endocarditis
h) Osteomylitis
i) Sacroillitis
j) Hepatitis

36. In a patient who is responding to treatment of visceral leishmaniasis, the

following is true:
a) The lymph nodes will disappear within two weeks
b) Fever will subside in a week time
c) Splenomegly will persist for 6 months
d) Leishmanin Skin Test will remain negative for life
e) Serum albumin will return to normal in a month time.
 37. Hypereoisinophilia is encountered in the following condition:
f) Ascaris infection
g) Onchocerciasis
h) Loa loa
i) Strongoiloidis
j) Katayama syndrome.

38. Treatment of choice for hyper-reactive malarial splenomegly consists of

proguanil plus one of the following drugs:
a) Quinine
b) Fansidar
c) Mefloquine
d) Chloroquine
e) Artemesinin

39. A 19 year male residing in a an endemic region of malaria had never suffered
an attack of malaria. He is most likely to be:
a) SS disease
b) Hemoglobin O Arab
c) Congenital spherocytosis
d) Duffy positive blood group
e) Sickle cell trait AS

40. A 25 year old female patient presented with abdominal pain, fever, watery
diarrhea for 48 hours followed by bloody diarrhea .The most likely cause is:
a) Viral enteritis
b) Dysenteric malaria
c) Giardiasis
d) Bacillary dysentery
e) Drug induced (antibiotics)

41. A 35 year old patient with hepatosplenic schistosomiasis, the second

commonest site to be affected with schistosomiasis is:
a) Spinal cord
b) Lungs
c) Kidneys
d) Brain
e) Skin
 42. A 20 year-old man presented with history of headache, high grade fever,
nausea, vomiting & a bleeding tendency; was found to be positive for malaria.
The cause of his bleeding is:
a. Severe thrombocytopenia
b. Reduced anti thrombin III
c. Liver cell failure
d. Platelets dysfunction
e. Vitamin K- dependant coagulation factors defect

43. Which of the following is highly suggestive of schistosomal periportal fibrosis

in a patient with portal hypertension:
a) Caput medusae
b) Venous hum
c) Palpable left lobe of the liver
d) Oesophageal varices
e) Macronodularhepatomegaly

44. A 25 – year- old male presented with fever & right hypochonderial pain for
two weeks. Examination & investigation showed firm & tender hepatomegally,
total WBC 14000/µl & high alkaline phosphatase. The most likely diagnosis is:
f) Bacterial cholangitis
g) Subphrenic abscess
h) Amoebic liver abscess
i) Right basal pneumonia
j) Pyogenic liver abscess

45. A 20 year man presented with history of headache, high fever, nausea, vomiting & a
bleeding tendency; was found to be positive for malaria. The cause of his bleeding is :
a) Severe thrombocytopenia
b) Reduced anti thrombin III
c) Liver cell failure
d) Platelets dysfunction
e) Vitamin K- dependant coagulation factors defect
46. Oxamniquine:
a) Is an organophosphorous derivative
b) Commonly causes convulsions
c) Is effective in S. hematobium infection
d) causes fever in the first day of treatment
e) results in elevation of alkaline phosphatase

47. A 45 year old women presented with abdominal discomfort, her stool was examined
& the result showed Entamoeba histolytica cysts ,The drug indicated in her case is
a) metronidazole
b) tinidazole
c) diloxanate fuorate
d) albendazole
e) thiabendazole

48. The treatment of choice in brucellosis is:

a) Streptomycin +Rifampicin
b) Doxycycline +Rifampicin
c) Rifampicin +Co-trimoxazole
d) Streptomycin + Doxycycline
e) Doxycycline+ Ofloxacin

49. The most lethal complication of typhoid is:

a) Intestinal perforation
b) Intestinal hemorrhage
c) Myocarditis
d) Acute renal failure
e) Meningitis

50. In a patient with visceral leishmaniasis the most yielding result would be obtained
from:
a) peripheral blood
b) lymph node
c) spleen
d) liver
e) bone marrow
 51. Which of the following findings favor amoebic rather than bacillary dysentery:
a) acidic reaction of stool
b) tenesmus
c) fever
d) vomiting
e) leukocytosis

55. Acute toxemic schistosomaiasis:

a) Is commonly seen in schistosoma hematobium infection
b) is not uncommon in indigenous population of endemic areas
c) presents as Swimmer’s itch
d) is diagnosed by antibodies against adult schistosme gut antigen
e) causes bloody stool
56. In a patient with severe malaria:
a) retinal hemorrhages occur in 5% of patients
b) signs of meningeal irritation are typical of cerebral malaria
c) presence of schizonts in the peripheral blood is a poor prognostic feature
d) prolongation of APTT is not recognized
e) non cardiogenic pulmonary edema is a common association

57. Which of the following is highly suggestive of schistosomal periportal fibrosis is a patient
with portal hypertension:
f) Caput medusae
g) Venous hum
h) Palpable left lobe of the liver
i) oesophageal varices
j) Macronodular hepatomegally

58. A 25 – year- old male presented with fever & right hypochonderial pain for two weeks.
Examination & investigation showed firm &tender hepatomegally, total WBC 14000/µl. &
high alkaline phosphatase. The most likely diagnosis is:
k) bacterial cholangitis
l) subphrenic abscess
m) amoebic liver abscess
n) right basal pneumonia
o) pyogenic liver abscess
59. In bacillary dysentery
a) fever is rare
b) Shigella shiga causes the mild form of the disease
c) Rieter’s syndrome, affects males only
d) the stool is alkaline in reaction
e) Doxycycline is the drug of choice

60. The pathogenesis of cerebral malaria is mainly due to:

a) immune complex deposition in the brain tissue
b) cerebral edema
c) cerebral anoxia
d) increased tumor necrosis factor (TNF )level
e) cerebral hemorrhage

61. The treatment of choice in a pregnant lady with brucellosis is:

a) streptomycin +doxycycline
b) streptomycin +rifampicin
c) doxycycline +rifampicin
d) rifampicin alone
e) streptomycin +cotrimoxazole

62. The most serious complication of typhoid fever is:

a) gastrointestinal hemorrhage
b) gastrointestinal perforation
c) lobar pneumonia
d) toxic psychosis
e) myocarditis

63. Which of the following drugs can be administered orally for the treatment of visceral
leishmaniasis:
a) Sodium stibogluconate
b) Pentamidine
c) Paromomycin
d) Itraconazole
e) Miltefosine
64. In a patient with tetanus the CSF analysis will reveal:
a) normal contents
b) high cells , proteins and normal sugar
c) high cells , normal proteins
d) high proteins and normal cells
e) high cells, proteins and sugar

65. 56-year-old man who is known to have bilharzial periportal fibrosis and portal
hypertension, presented to a district hospital with vomiting of bright red blood. Blood
pressure was 110/65 mm Hg, Hb: 9.3 gm/dl. ECG showed a depressed ST segment and
inverted T wave in the anterior leads. It will take 3 hours to send the patient for
endoscopy at the nearest central hospital. What is the best pharmacological treatment
before endoscopy?

a. IV nitroglycerine.
b. IV octreotide.
c. IV vasopressin.
d. IV propranolol
e. IV omeprazole.

66. In the first week of Typhoid fever :

a. Blood culture are usually positive

b. Stool culture are diagnostic
c. Widal test is significantly reactive
d. Spleen is palpable
e. No skin rash is detected

67. A 45 year old patient presenting with fever, huge splenomegaly and pancytopenia.
Which one of the following is the best investigation to confirm the diagnosis?

a. Peripheral blood smear

b. Blood culture
c. Liver biopsy
d. Bone marrow examination
e. Splenic puncture
68. The treatment of choice in a pregnant lady who has typhoid fever is:

a. Cortrimoxozole
b. Ofloxacin
c. Ciprofloxacin
d. Cephalosporin
e. Chloramphenicol

69. A 65 year old male from El Managil is discovered to have periportal fibrosis (PPF), his
ultra sound showed evidence of concomitant PPF and cirrhosis. The most likely cause of
his cirrhosis is:

a. Hepatitis B virus
b. Hepatitis A virus
c. Hepatitis C virus
d. Delta virus
e. Hepatitis E virus
70. Which of the following favours amoebic rather than bacillary dysentery.

a. Tenesmus
b. Fever
c. Acidic Stool reaction
d. Entamoeba histolytica cysts in the stool
e. Presence of pus cells in stool

71. The following are true regarding Tetanus:

a. Analysis of the CSF is usually normal.

b. paraplegia is a common sequale of vertebral compression fracture
c. long lasting immunity occurs after recovery from disease
d. disturbance of consciousness occurs late in the disease
e. confirmation of the diagnosis is by blood culture.

72. In Visceral leishmaniasis DAT:direct agglutlnation test and LST:leishmanin skin test

a. Both DAT& LST are +ve

b. DAT is -ve & LST is +ve
c. DAT is +ve & LST is –ve
d. DAT & LST are both -ve
e. Both LST & DAT are not useful
73. . The best treatment for a patient with multi-drug resistant Falciparm malaria is:

a. Artemether
b. Fansidar
c. Mefloquine
d. Quinine
e. Primaquine

74. Which of the following antibilharzial drugs acts only on S. haematobium.

a. Praziquantel
b. Hycanthone (Etrinol)
c. Niridazole
d. Oxamniquine
e. Metrifonate

75. A blind patient from Waw was discovered to have onchocerciasis, the most likely cause of
his blindness is.

a. Optic atrophy
b. Papilloedema
c. Choroido-retinitis
d. Corneal opacity
e. Cataract.

76. A six month pregnant lady presented with headache and fever of 38 °C. Her blood film
showed P.falciparum. This patient should be given:

a. Mefloquine tabs
b. Intramuscular cloroquine
c. Quinine tabs
d. Quinine infusion
e. Artesumine ( sulphadoxine + pyrimithamine + artisunate)

77. Acquired immunodefincy syndrome (AIDS)

a. Is transmitted by repeated mosquito bites

b. Is preventable by vaccination
c. Is transmitted by droplets
d. Affects mainly sexually active adults
e. Is transmitted during labour
78. The most common complication of P. vivax malaria infection is:

a. Severe anaemia
b. Ruptured spleen
c. convulstion
d. Black water fever
e. Severe hypoglycaemia

79. The most lethal complication of severe Malaria in an adult is:

a. Cerebral malaria
b. Severe anaemia
c. Acute renal Failure
d. Adult respiratory distress syndrome
e. lactic acidosis

80. A patient with HIV and CD4 count of less than 200 cells/mm3 presents with fever, night
sweats, cough and profound weight loss. You suspect tuberculosis coinfection. Which of
the following statements is correct?
a. Extrapulmonary TB is less likely than in HIV negative patients
b. Sputum smear for acid and alcohol fact bacilli is always positive
c. CXR will be abnormal in most patients
d. Mantoux test is often strongly positive
e. Antituberculous treatment should be started before antiretroviral therapy

81. An adult patients with bacterial meningitis who developed neurological sequalae, the most
likely aetiological agent will be:
a. N.meningitidis
b. St. pneumoniae
c. H. infleunzae
d. E. coli
e. Salmonella paratyphi C.

82. Which of the following antibilharzial drugs acts only on S. haematobium.

a. praziquantel
b. Hycanthone (Etrinol)
c. Niridazole
d. Oxamniquine
e. Metrifonate
 CASES

1. A-36 year old male from Sinkat presented to the casualty with fatigability and palpitations.
He had a three months history of low grade fever associated with sweating but no rigors;
also he had anorexia, weight loss and mild cough. There were no symptoms referable to
the bowel or urinary system. He had no past medical history of significance. He did not
smoke or consume alcohol.
O/E he looked ill, was pale, not jaundiced with a temperature of 38.2 0 C. He had
generalized lymphadenopathy. The lymph nodes were discrete, firm and not tender. The
spleen was 8cm below the costal margin, firm and not tender. The liver was 6cm below the
costal margin with a span of 18cm. there was a short systolic murmur over the precordium.
His respiratory and central nervous systems were normal.
Investigation: Hb 9gms/dl. Chest X-ray showed bilateral hilar enlargement. Ultrasound of the
abdomen showed no evidence of portal hypertension or ascites. Urine and stool were normal.

1) Mention two differential diagnoses.

a) Lymphoma
b) Visceral Leishmaniasis
2) Mention three investigations that help in reaching a diagnosis.
a) Lymph Node Biopsy for Reed Sternberg cells
b) Bone marrow Aspirate for Lymphoblasts <25% indicates lymphoma
c) CBC with differential & PBF showing pancytopenia & immature lymphocytes

3) Outline the treatment of your first diagnosis

a) Chemotherapy
 A 30 Year old, male patient presented to the medical outpatient with fever,
right hypochondrial pain, nausea & anorexia for the last 12 days. He had no
symptoms referable to other systems. There was no past history of significance.
On examination, he was febrile not jaundiced, no lymphadenopathy.
Cardiovascular & nervous system were normal; chest examination showed signs
of mild right sided pleural effusion. Abdominal examination showed
hepatomegaly about 11 cm below the right costal margin. The liver was firm and
tender .There was no splenomegaly or ascites.
Investigations showed WBC count 13000, ESR 80 mm in 1st hour.

a) Mention THREE differential diagnoses:

- Amoebic Liver abscess
- Pyogenic Liver Abscess
- Infected Hydatid Cyst
- Cholangitis

b) Mention THREE investigations that help in the diagnosis

- Abdominal US
- US Guided Aspiration
- Stool Antigen detection by ELISA
- Abdominal CT
- Serum ALP

c) Mention the drug treatment of your most appropriate diagnosis

- Tissue amebicidal (Metronidazole) & Luminal amebicidal (Dilunoxnide
fuorate)
A 19 year old man from Singa, presented to the hospital with 16 days history of
fever which was of high grade, associated with rigors, myalgia, arthralgia and
headache. He also had nausea, anorexia, mild weight loss
and dry cough. He was given artemether injections and ciprofloxacin tablets
without improvement. He has no past medical history of significance.
On examination he looked ill, febrile, temp 38.50C and pale. His BP was
100/65.mmHg; pulse was 90 beats/min. Cardiovascular and respiratory systems
were normal. Abdominal examination revealed hepatomegaly 8 cms below the
costal margin and splenomegaly 12 cms both were firm and non-tender. His CBC
showed pancytopenia with normal blood picture. Stool analysis and CXR were
normal.

1. What further signs would you look for?

- Lymphadenopathy
- Venous Hum / Splenic Rub / Ascites
- Jaundice
- Petechial Hemorrhage
- Sternal Tenderness

2. Mention THREE differential diagnoses:

- Visceral Leishmaniasis
- Chronic Brucellosis
- Lymphoma
- Hyperreactive Malaria Splenomegaly Syndrome

3. Mention THREE investigations to confirm your first diagnosis:

- Lymph node Aspirate
- Bone Marrow Aspirate
- RK 39
- DAT (Direct Agglutination Test)
4. Mention the treatment of your first Diagnosis?
- IV Sodium Stibogluconate + Paromomycin for 17 days
 A 50 year old male Sudanese patient, presented to the outpatient clinic
complaining of fever ,headache & general body pains for the last two months, there
was also feeling of fatigue & weakness, the patient sought medical advice, received
various courses of antibiotics and antimalarial without response. Recently he
started to complain of abdominal pain, constipation and diarrhea as well. He had a
history of schistosoma mansoni for which he is not sure of the medications he had
had. Since then he had no complains related to.
O/E: he looks ill, pale, not cyanosed, febrile .Pulse 65 beats /minutes, BP
110/60 mmHg .Chest, cardiovascular & nervous system were normal
Abdomen: Spleen palpable 6cm below the left subcostal region, firm not
tender .Liver palpable 4cm, below the right subcostal region; firm not tender. No
ascites or palpable lymph nodes.
Investigations: Hb 8g/dl; WBC count 3300; ESR 75 mm in 1st hour. AST 60
IU/DL; ALT 70 IU/DL
Ultrasound showed: splenomegaly. Hepatomegaly; with discrete para-aortic
lymph nodes.

1) Mention THREE differential diagnoses:

- Brucellosis
- Shistosalmenolosis
- Lymphoma
- Abdominal Tuberculosis
- Visceral Leishmaniasis
-
2) List THREE investigations for the definitive diagnosis (one for each
differential)
- Blood culture for brucella
- Blood Culture for S.typhi
- Rising titer of salmonella typhi
- LN Biopsy for Lymphoma
- PCR for Tuberculosis
 A 23 year old man from Southern Kordofan was brought to hospital with a
three week history of fever which was of high grade and was accompanied with
chills, sweating, myalgia, and arthralgia and excess fatigue. He also has epistaxis
from both nostrils, yellow discoloration of sclera and urine. He has no cough or
neurological symptoms. He has no past history of note.
O/E he was ill, febrile, pale, jaundiced and has petechial rash over the skin
and mucus membranes. His cardiorespiratory and gastrointestinal systems were
normal. Central nervous system was normal apart from mild confusion.
Investigations showed blood urea 161 mg/dl, creatinine 3.2 mg/dl. Liver
function tests: ALT 323 IU/L, AST 290 IU/L (N 6-40 IU/L), serum bilirubin 6.3 mg/dl
(N 0.1–1.0 mg/dL). Full blood count: platelets 19000/dl, TWBC 4900/dl, Hb 62%.
Urine showed two crosses of bile pigment.

1. Mention three possible diagnoses?

- Yellow Fever
- Dengue hemorrhagic Fever
- Severe Malaria
- Viral Hepatitis

2. Mention three investigations to help you reach a diagnosis?

- Serology (ELISA) for Specific viral IgM
- PCR
- Blood film for Malaria
- Viral hepatitis serology screening

3. Considering the most likely diagnosis, how is this disease transmitted?

- Aedis Egyptii Mosquito

4. Mention two principal prevention measures:

- Vaccination by Yellow fever D17 vaccine
- Vector control; impregnated mosquito nets
 A 45 year-old man presented to the medical outpatient department
complaining of fever for the last three months, the fever is of low grade, occurs
mostly at the evening, associated with nocturnal sweating, and had anorexia and
weight loss. He also complained of dry cough, there was no abdominal pain, he had
diarrhea about three motions per day, and the stools contain no blood. He sought
medical advice and received various medications with no response
OE: looks ill, pale, not jaundiced, afebrile,
Pulse , blood pressure were normal, neck examination showed a group of
posterior triangle lymph nodes, firm, discrete, not tender , there were no
epitrochlear nodes, but there were inguinal lymph nodes bilaterally. Both chest and
cardiovascular examinations were within normal
Abdominal examination, showed palpable spleen, of 10 cm, below the left
subcostal region, firm non tender, liver span is 12 cm, there was positive shifting
dullness. No venous hum or splenic rub
Investigations revealed normal WBC count, total and differential, Hb 9.6 g/dl.
Ultrasound showed normal portal vein diameter and liver and spleen were of
coarse texture and the kidney were bulky
1) State THE MOST LIKELY diagnosis
- Lymphoma

2) State TWO OTHER possible diagnoses

- Chronic Brucellosis
- Tuberculosis

3) State ONE investigation to establish the diagnosis

- Lymph Node Biopsy

4) What is the appropriate treatment modality

- Chemotherapy
 A 26 year old male from Kosti presented to the outpatient clinic with a four
week history of upper abdominal pain and high grade fever which was
accompanied with rigors. He also has mild cough and anorexia. He has no past
history of significance.
On examination he looks ill, febrile temp 39. Cardio-respiratory and
neurological examinations were normal. Abdominal examination revealed tender
hepatomegaly 9 cm below costal margin. Spleen not palpable and no ascites.
Investigations showed: TWBC 18500 x103/μL (3.6-11) with 85% Neutrophils. Blood
film and ICT were negative for malaria.

a) What is the most likely diagnosis ?

- Amoebic Liver Abscess

b) Mention TWO other differential diagnoses?

- Pyogenic Liver Abscess
- Infected Hydatid cyst

c) Mention THREE investigations that help in reaching a diagnosis?

- Abdominal US
- US Guided Aspiration
- Stool Antigen detection by ELISA
- Abdominal CT / Serum ALP

d) What treatment is indicated in this case ?

- Tissue amebicidal (Metronidazole) & Luminal amebicidal (Dilunoxnide
fuorate)
- Aspiration of abscess