Common Presentations

Question 1

Diarrhoea with severe abdominal pain, low fever
Recent chicken consumption in past couple of days

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 1

Campylobacter most likely, also salmonella

Stool culture + microscopy

Supportive treatment

Question 2

Diarrhoea, no fever
From care home

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 2

Norovirus

Clinical or PCR

Supportive

Question 3

Diarrhoea, no fever
Child

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 3

Rotavirus

Clinical or PCR

Supportive

Question 4

Diarrhoea, severe abdominal pain
Recent travel

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 4

E. Coli (toxigenic)

Stool culture for serotyping

Supportive or Abx in severe

Question 5

Bloody diarrhoea with fever and nausea
Farmer

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 5

E. Coli O157

Stool culture

Supportive - DO NOT GIVE antibiotics

Question 6

Diarrhoea with abdominal pain and fever
Recent antibiotic use

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 6

C. Diff

Sigmoidoscopy
Stool culture and toxin

Metronidazole OR Vancomycin OR Fidaxomicin

Question 7

2-day fever with cough, headache, myalgia and malaise

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 7

Flu

Especially if during winter months/outbreak
Swab nose/throat and CXR if pneumonia possible

Oseltamivir/zanamivir if onset <48 hours previous or severe

Question 8

Fever with reduced mental state
Tachycardia and low BP

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 8

?Sepsis?

Lactate + Blood Culture + Urine output

O2 + IV Abx + IV fluids

Question 9

Fever, malaise
Lymphadenopathy
Oral thrush

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 9

HIV

P24 antigen and HIV antibodies
CD4 count and viral load

HAART - 3+ drugs from 2+ classes

Question 10

Fever, headache
Reduced mental state, nausea
Neck stiffness

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 10

Meningitis

LP - CSF testing
Blood cultures

Benzylpenicillin and ceftriaxone in unconfirmed/bacterial
Supportive in viral

Question 11

Jaundice
Hepatic tenderness
Fever, nausea

Recent travel to developing country and MSM

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 11

Hep A

Serology for IgM

Supportive

Question 12

Jaundice
Hepatic tenderness

MSM and IVDU

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 12

Hep B (or possibly C if not transmitted sexually)

Serology:
Hep B surface antigen > core ABs > surface ABs
or Hep C antibodies

Supportive
Antivirals in cirrhotic Hep B or chronic Hep C

Question 13

Intermittent fever with chills
Headache and myalgia

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 13

Malaria

Thick and thin giemsa-stained blood films

Quinine/chloroquine/artemether+lumefantrine

Question 14

Persistent febrile illness
No white cell changes

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 14

Possible typhoid

Blood/stool/urine culture

Ceftriaxone
Azithromycin

Question 15

Fever
Flushed skin
Aches

Give most likely diagnosis (and other likely), diagnostic test, and treatment

Answer 15

Haemorrhagic fever (e.g. Dengue)

Serology/PCR for viral antigen

Supportive treatment

Question 16

Groin itch
Abdominal pain
Haematuria

Answer 16

Schistosomiasis

Stool/urine microscopy

Praziquantel

Question 17

Small bite with surrounding maculopapular rash

- no erythema migrans

Answer 17

Rickettsiosis

Serology

Tetracycline

Question 18

Headache, fever
Lethargy, mania/coma

Animal bite

Answer 18

Rabies

Saliva/CSF PCR

Human rabies IG + 4 doses of vaccine over 14 days

Question 19

Fever, headache
Myalgia
Farmer

Answer 19

Leptospirosis (or Brucellosis)

Serology/PCR

Antibiotics (doxycycline/rifampicin in brucellosis)

Question 20

Fever, malaise, headache

Erythema migrans

Answer 20

Lyme disease

Clinical or serology

Doxycycline/amoxicillin/ceftriaxone for 3-4 weeks

Look for Acrodermatitis Chronica Atrophicans on distal extensor surfaces

Question 21

Fever, cough and pleuritic pain

History of COPD

Answer 21

Aspergillosis

Cultures/biopsy

Voriconazole and isauconazole

Question 22

Unexplained fever

Recent broad-spectrum antibiotic use

Answer 22

Possible invasive candidiasis

Echinocandins and fluconazole

Question 23

Headache and pneumonia-like symptoms in person with known HIV

Answer 23

Possible cryptococcal infection, also cryptococcal meningitis

Blood culture (or CSF)

Amphotericin B + flucytosine and fluconazole

Question 24

Facial vesicles with erythema and golden crust

Give most likely diagnosis (and other likely), most likely organism, and treatment

Answer 24

Impetigo

Likely SA

Topical antibiotics
Add IV if large areas

Question 25

Painful red area with elevated borders
Fever

Give most likely diagnosis (and other likely), most likely organism, and treatment

Answer 25

Erysipelas

Likely strep pyogenes

Antibiotics

Question 26

Spreading area of erythema

Fever

Answer 26

Cellulitis

Strep pyogenes or SA

Antibiotics

Consider in Diabetes

Question 27

Rapid onset of erythema with following oedema and pain

Anaesthesia at site of infection

Answer 27

Necrotising fasciitis

Type I - mixed aerobe/anaerobe (staph, strep, entero, gram negs)
Type II - mono (usually strep pyogenes)

Broad spectrum ABx and surgical review