Case studies Flashcards
A student presents in the ED having become acutely unwell today. She is pale, feverish and complains of headaches, achey joints, stiff neck and photophobia. Lets results show a non blanching rash, high temp, high reps rate and low BP.
What is the likely diagnosis?
How do you manage this condition?
What microbe is most likely?
Meningitis and suspect sepsis
Inform a senior, refer to ITU, Sepsis 6 within 1 hr (O2, Fluids, measure urine output, blood culture, ceftriaxone IV and lactate levels)
Monitor patient closely and check renal, liver, clotting and lung functions.
Neisseria Meningitis
A two yearly comes in with a rash on his face. Mum says he has been well other than a bit of a sore throat last week. What do you think this might be? How might you treat?
Impetigo from strep pyogenes
Advise not to share face towel etc. Monitor kidney function for ARF
GP referred man with 2 week history of fatigue, abdo pair, loss of appetite, nausea and some jaundice. The GP sent bloods off which show abnormal LFTs (raised bilirubin, ALT and slightly raised ALP). The man is normally well but has recently travelled and admits to drug use and unprotected sex. What is suspected?
Hep B suspected
A medical student gets a needle stick injury from an intravenous drug user. She takes all the appropriate action, bleeding and washing out the wound. Taking patient blood and her own for testing. She informs Occupational health and starts PEP for HIV. What is the guidance for this?
If HBsAb is >100 no booster needed
HIV PEP 3x per day for 28 days to halt viral replication and dissemination
Use condoms while are risk
Counselling and follow up
12 week Hep C and HIV test
An intravenous drug user presents with fatigue and nausea. What is it important we test for?
HIV- Blood test
Hep B- all serology
Hep C- viral PCR and the Hep C antibody
Young man arrives in A and E with fever, shaking, head ache and sweats. He has just returned from a gap year in Malawi 10 days ago. He has been unwell for 2 days and have tried amoxicillin from the GP but is no better, in fact he is drifting in and out of consciousness. What is your differential diagnosis?
Malaria- need a treble negative blood smear to rule out
A recently married woman travels back to India and came back two weeks ago. For the last 5 days she has been constipated and had abdo cramps with a dry cough and head aches. She also has a rose spot rash on her tummy.
Temp is high, HR and BP are normal. Chest is clear, ado is generally tender and the splenic tip is palpable.
What tests do you order? (results in answers to help diagnose)
How is this infection spread?
Low FBC U+E normal ALT, ALP and CRP elevates CXR and AXR normal Splenomegaly Blood culture - salmonella typhi
Spread faecal-oral from food and water
Sources are cases or carriers
