Exam (Year 4)

Question 1

Manifestations of herpes simplex infection? (3)

Answer 1

Gingivostomatitis (children)
Cold sores (usually HSV-1)
Genital ulcers (usually HSV-2)

Question 2

Management of herpes simplex?

Answer 2

Oral/topical aciclovir

Chlorhexidine mouthwash for gingivostomatitis

Question 3

Classification of bacteria:

a) Gram positive cocci (2)
b) gram negative cocci (2)
c) Gram positive rods (ABCD L)
d) gram negative rods

Answer 3

a) staphylococci + streptococci
b) Neisseira species (meningitides and gonorrhoea), moxarella
c) Actinomyces, bacillus anthracis, clostridium, diphtheria, listeria

d) all remaining are gram negative rods

Question 4

SIRS criteria?

Answer 4

Two of:

Body temp <36 or >38
Heart rate >90/min
RR >20/min
WCC <4 or >12

Question 5

What is the sepsis 6?

Answer 5

Give: fluid, oxygen, antibiotics
Take: blood cultures, serum lactate, urine output

Question 6

HIV patient with ring-enhancing lesions on CT head

Answer 6

Toxoplasmosis

Question 7

Clostridium species? (4)

Answer 7

Perfringens- gas gangrene
Botulinum- botulism (paralysis)
Difficile- pseumembranous colitis
Tetani- tetanus (paralysis)

Question 8

Streptococci:

a) pneumonia, meningitis, otitis media
b) erysipelas, pharyngitis, tonsillitis
c) neonatal meningitis

Answer 8

a) strep pneumoniae
b) Group A strep (pyogenes)
c) group-B strep

Question 9

Potential complications of group A strep infection? (3)

Answer 9

Immunological- rheumatic fever, glomerulonephritis

Toxin-mediated- scarlet fever

Question 10

Erythema chronica migrans rash

Answer 10

Lyme disease

Question 11

Investigation of Lyme disease?

Answer 11

Serology- antibodies to Borrelia burgdorferi

Question 12

Indications for IV antibiotics? (6)

Answer 12

No oral formulation available
Oral route compromised
Deep-seated infections e.g. endocarditis, septic arthritis
Febrile with neutropenia/immunosuppression
Post surgery- unable to tolerate 1L of oral fluids
Two SIRS criteria

Question 13

Antibiotic treatment:

Meningitis

Answer 13

IV Ceftriaxone 2g + Dexamethasone + Amoxicillin if older than 60 or immunocompromised

Question 14

Antibiotic treatment:

Community acquired pneumonia

Answer 14

Mild/Moderate- Amoxicillin/Doxycycline

Severe- Co-amoxiclav + Clarithromycin (levofloxacin if penicillin allergic)

Question 15

Antibiotic treatment:

Hospital acquired pneumonia

Answer 15

Non severe- amoxicillin + metronidazole

Severe- amox + met + gent

Question 16

Antibiotic treatment:

Infective exacerbation of COPD

Answer 16

Amoxicillin/doxycycline

Question 17

Antibiotic treatment:

Clostridium difficile

Answer 17

Non severe- metronidazole

Severe- vancomycin

Question 18

Antibiotic treatment:

Biliary tract/intra-abdominal

Answer 18

Amox + Met + Gent

Question 19

Antibiotic treatment:

Male/female lower UTI

Answer 19

Nitrofurantoin or trimethoprim (3 days female, 7 days male)

Question 20

Antibiotic treatment:

Complicated UTI/pyelonephritis/urosepsis

Answer 20

IV Amoxicillin + Gentamicin

Question 21

Antibiotic treatment:

Cellulitis

Answer 21

Flucloxacillin

Question 22

Antibiotic treatment:

Pharyngitis with 3 Centor criteria

Answer 22

Penicillin V

Question 23

Antibiotic treatment:

Sinusitis

Answer 23

Penicillin V

Question 24

Antibiotic treatment:

Otitis media

Answer 24

Amoxicillin

Question 25

Antibiotic treatment:

Chlamydia

Answer 25

Azithromycin 1g stat

Question 26

Antibiotic treatment:

Gonorrheoa

Answer 26

IM Ceftriaxone + oral azithromycin