bugs and others#

Question 1

what scan should you do if worried about osteoporosis

Answer 1

DEXA

Question 2

what scan should you do for bony mets

Answer 2

bisphosphonate mbp scan - radiolable bisphosphonate - if get mets in bone -> increased bone formation around met - take up bisphosphonate

Question 3

what scan should you do for metabolically active mets

Answer 3

PET scan, fdg (radiolabelled fdg ie flurodioxyglucose - metabolic cell take up glucose, fluride stays in cells - heart and brain will be hot, rest should not be - so will show mets)

Question 4

what does this show

Answer 4

LV hypertrophy

Question 5

what happens to the apex of a heart with LVH

Answer 5

Hypertrophy doesn’t cause shift of apex beat - only get that when dilated in HF
LV hypertrophy doesn’t cause apex to displace because muscle grows inwards - causes change to ECG - tall R waves and deep S waves
CXR normal
Commonest cause of LVH is hypertension

Question 6

what is the bug

Answer 6

neisseriae Gonorrhoea

Septic joint - gonorrhoea is commonest cause of septic arthritis in 19-35yrs

Question 7

Answer 7

neisseriae meningitidis

Question 8

Answer 8

In a 6yr old

Haemophilus influenzae - less common in vaccinated children

E coli is a gram -ve rod - but only cause meningitis in premature children

6yr old always haemophillus and unvaccinated

Strep pneumoniae - gram +ve cocci

Question 9

Answer 9

Strep pneumoniae - typical sepsis

Question 10

Answer 10

Mycoplasma

Fever of 39 - unusually high fever for autoimmune encephalitis.
This is delerium

Question 11

Answer 11

Staph aureus

?staph epidermidis - on skin, can get through the skin but less aggressive than staph aureus

Question 12

Answer 12

Staph viridans
Endocarditis

Slowly damages the endocardium
Organism not very aggressive so sit on the valve and then form endocarditis

Strep pyogenes - cause strep sepsis because too aggressive

Question 13

what are the clinical signs of subacute endocarditis and how

Answer 13

Splenomegaly
Haematuria
Spinter haemorrhage
Janeway lesion
New heart murmur

If have strep viridans - slow growing so time to get haematuria and splenomegaly
Clubbing if left long enough because viridans not aggressive

If staph aureus when IVDU - more aggressive so die first. Get septic.

Acute endocarditis - sepsis and death in 2wks
Subacute - can go on for months - older pts, damaged valves