1. Doctors must notify the Proper Office of the local authority (which is usually the consultant in communicable disease control) when attending a patient suspected of suffering from certain diseases.Which ONE of the following conditions is NOT a notifiable disease? Select ONE option only.

A. Cholera
B. Human Immunodeficiency Virus (HIV)
C. Mumps
D. Tuberculosis
E. Whooping cough

Answer: B

The statutory requirement for the notification of certain infectious diseases came into being towards the end of the 19th century. The list of diseases has been increased over the decades and now stands at about 30.The prime purpose of the notifications system is speed in detecting possible outbreaks and epidemics. Accuracy of diagnosis is secondary, and since 1968 clinical suspicion of a notifiable infection is all that is required.The full list of notifiable diseases can be found on the Health Protection Agency website at www.hpa.org.uk

2. A 54 year-old woman attends complaining of intermittent blurred vision in her left eye for the last two weeks. She is currently taking treatment for pulmonary tuberculosis. On examination the visual acuity is 6/9 in the right eye and 6/18 in the left eye.Which SINGLE drug is the most likely cause of this patient’s symptoms? Select ONE option only. [Show Discussion]

A. Ethambutol
B. Isoniazid
C. Pyrazinamide
D. Rifampicin
E. Streptomycin

Answer: A

Visual acuity should always be tested before ethambutol is used, since its side-effects are largely confined to visual disturbances in the form of loss of acuity, colour blindness and restriction of visual fields.These toxic effects are more common where excessive dosage is used or if the patient’s renal function is impaired.The earliest features of ocular toxicity are subjective and patients should be advised to discontinue therapy immediately if they develop deterioration in vision and promptly seek further advice.Early discontinuation of the drug is almost always followed by recovery of eyesight.www.bnf.org.ukIsoniazid, rifampicin and pyrazinamide are associated with liver toxicity, and therefore hepatic function should be checked before treatment with these drugs. Those with pre-existing liver disease or alcohol dependence should have frequent checks particularly in the first two months.Streptomycin is now rarely used in the UK except for resistant organisms.

3. Which ONE of the following statements represents the standard regime for treatment of tuberculosis in the UK? Select ONE option only. [Show Discussion]

A. 4 months of isoniazid and rifampicin, plus pyrazinamide and ethambutol for the first 1 month
B. 4 months of isoniazid and rifampicin, plus pyrazinamide and ethambutol for the first 2 months
C. 6 months of isoniazid and rifampicin, plus pyrazinamide and ethambutol for the first 1 month
D. 4 months of isoniazid and rifampicin, plus pyrazinamide and ethambutol for the first 2 months
E. 6 months of isoniazid and rifampicin, plus pyrazinamide and ethambutol for the first 3 months

Answer: E

Initial phase treatment should be continued for two months, whilst continuous phase treatment is continued for a further four months.Longer treatment is necessary if there are complications of meningitis or spinal cord involvement, and for resistant organisms which may also require modification of the regimen.

4. In which ONE of the following situations should a BCG vaccination be offered to a newborn baby? Select ONE option only.
A. Born in an area with tuberculosis (TB) notification rate greater than 20 per 100,000 population
B. Born in an area with TB notification rate greater than 40 per 100,000 population
C. Family history of TB in previous 5 years
D. Family history of TB in previous 10 years
E. Family history of TB in previous 15 years

Answer: B

Primary care organisations with a high incidence of TB should consider vaccinating all neonates.www.nice.org.uk