Chempath: bugs and others EMQs

Question 1

High Ca
Normal PTH

what’s the diagnosis?

Answer 1

Primary hyperparathyroidism (PTH would be low in a healthy patient with high Ca)

Question 2

Primary hyperparathyroidism - what will hand X-Ray show?

A. Normal. B) Loosers zones C) ulnar aspect cystic changes D) radial aspect cystic changes E) random changes in carpal bones

Answer 2

Radial aspect cystic changes

Loosers zones = will develop in vitamin D deficiency

Question 3

Bone histology in 1ary hyperparathyroidism?

Answer 3

Brown’s tumours aka OFC (osteitis fibrosis cystica)

Question 4

45 year old afrocaribbean man presents with SOB. Most helpful Ix?
a) FBC B) U+Es) C) CXR D) ECG E) echo

Answer 4

CXR = most helpful

Question 5

Pt is SOB. CXR shows BHL.
Serum Ca is raised.

What result would you expect for PTH?
Tx?

Answer 5

Sarcoid is the cause.

PTH would be low
Tx = high dose steroids

Question 6

Mechanism of sarcoidosis –> hypercalcemia?

Answer 6

macrophages express high levels of 1-a-hydroxylase

Question 7

19yo man returns from Spain
4/52 later, hot swollen, painful red knee joint.
Join aspirate is cloudy yellow and has gram - intracellular diplococci

Answer 7

Neisseria Gonorrheae

Question 8

19yo student
Septic, pyrexial, confused
Stiff next
LP shows Gram - intracellular diplococci

Answer 8

Neisseria meningitides

Question 9

6yo boy
Septic, pyrexial, confused
Stiff neck
LP shows gram - rods

Answer 9

Haemophilus influenzae

Question 10

19yo student
Septic, pyrexial, confused
Blood cultures: gram positive diplococci

Answer 10

Streptococcus (pneumoniae)

Question 11

19yo student
Septic, pyrexial, confused
Blood cultures: grow nothing.
Cold agglutinins are positive

Answer 11

Mycoplasma pneumoniae

Question 12

19yo
Boil on his leg + painful
Grows Gram + cocci in clusters

Answer 12

Staph Aureus

Question 13

19yo with mild fever for several months
No cause found
2 months later - blood cultures grow gram + cocci

Answer 13

Strep viridans

Question 14

Name some gram - rods which AREN’T E. Coli

Answer 14

Salmonella
Shigella
Klebsiella
yersinia

Question 15

Name3 causes of cold agglutinin disease

Answer 15

Lymphoma
EBV
Mycoplasma pneumonia

Question 16

Which Gram +ve cocci causes:

• cellulitis?
• boil in the skin?

Answer 16

Strep –> cellulitis (it can invade into the dermis using hyaluronidase)

Staph –> boil on the skin

Question 17

Tx of staph –> boil

Answer 17

Flucloxacillin

Question 18

Tx of strep induced cellulitis

Answer 18

penicillin

Question 19

Common cause of subacute endocarditis in patients with damaged heart valves

Answer 19

Strep viridans

Question 20

Common cause of subacute endocarditis in patients with damaged heart valves

Answer 20

Strep viridans –> roth spots, clubbing etc can develop as it’s a long disease course

Question 21

Common cause of endocarditis in IVDUs?

Answer 21

Staph aureus –> acute endocarditis (septicaemia, v quick course of severe disease)