Study guides
Infectious Diseases
2 guides for this subject — how to prepare, what to practise, and how to know it has gone in.
A practice question
Choose an answer and it is marked, with the explanation. From Infectious Diseases Practice Questions: 8 Clinical Cases.
A 32-year-old returning traveller has a blood film positive for Plasmodium falciparum. They are confused and cannot take oral medication. What is the most appropriate immediate treatment?
Altered consciousness is a feature of severe malaria. Give intravenous artesunate promptly; do not wait for a parasite-density threshold or use oral treatment in a patient unable to take it. Once the patient can take oral medication, complete a full course of an effective oral combination regimen.
A spoken answer, marked
An examiner's question, answered out loud and marked criterion by criterion. From Infectious Diseases Viva Questions: 3 Worked Stations.
Examiner
A 34-year-old with newly diagnosed HIV, a CD4 count of 28 cells/µL and ten days of worsening headache is febrile but alert. Talk me through your immediate assessment and management.
You recognised advanced immunosuppression and assessed observations, mental state and signs of raised intracranial pressure.
ImproveState early that deterioration, reduced consciousness or physiological instability requires urgent escalation and stabilisation.
You included serum cryptococcal antigen and cerebrospinal fluid testing, including opening pressure, if lumbar puncture is safe.
ImproveMake the sequence explicit: assess safety for lumbar puncture, measure opening pressure, and send CSF for cryptococcal antigen, microscopy and culture.
You identified induction antifungal therapy and therapeutic lumbar punctures for raised pressure.
ImproveSay that suspected or confirmed disease needs urgent specialist-led antifungal treatment guided by local protocols, and that pressure relief may require repeat lumbar punctures.
You correctly avoided immediate ART initiation and mentioned specialist review.
ImproveExplain that ART is generally deferred for several weeks in cryptococcal meningitis because early initiation can worsen inflammatory complications; coordinate timing with the treating team.
A strong answerI am concerned about cryptococcal meningitis in a person with advanced HIV, and I would first assess airway, breathing, circulation, observations, mental state and signs of raised intracranial pressure. I would arrange urgent senior and infectious diseases input, check serum cryptococcal antigen and, if it is safe, perform lumbar puncture with opening pressure and CSF cryptococcal antigen, microscopy and culture. If the patient is unstable or has features making lumbar puncture unsafe, I would stabilise and investigate urgently rather than proceed without assessment. I would start specialist-directed induction antifungal treatment promptly when indicated and manage raised intracranial pressure with therapeutic lumbar punctures as required. I would not start ART immediately; I would agree its timing with the specialist team, alongside management of other HIV-related needs and close monitoring.
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Guides
- Infectious Diseases Practice Questions: 8 Clinical CasesWork through eight infectious diseases practice questions on malaria, HIV, endocarditis, meningitis, rabies and more, with explained answers.
- Infectious Diseases Viva Questions: 3 Worked StationsPractise three infectious diseases viva stations on cryptococcal meningitis, endocarditis and malaria, with model answers and marking points.
Studying infectious diseases? Build your infectious diseases board from your own notes — the cards, papers and lectures are written from it. Free plan: 20 cards, a paper, a lecture and a viva to try.
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