I.D.

Question 1

28 year old woman is admitted via the Accident & Emergency department.
She had not gone to work due to feeling flu-like that morning.

Her boyfriend has brought her in to Accident & Emergency as she has become drowsy and has developed a rash.

She is febrile, hypotensive and confused with marked neck stiffness and purpuric rash

• diagnosis and bug?

Answer 1

meningitis

n. meningitis

Question 2

72 year old, usually fit and well woman has been sent to the medical admissions unit with fever, headache and neck pain.

On admission she is unwell with fever, tachycardia, neck stiffness and confusion (MSQ 6/10).

LP = white blood cells 1000/mm3 (all neutrophils), red blood cells 3/mm3, and Gram positive cocci are seen

• bug?

Answer 2

Strep. Pneumonia

Question 3

Ix for C. Diff

Answer 3

Stool toxin

Question 4

Ix for E. Coli

Answer 4

Stool Culture

Question 5

Ix for influenzae

Answer 5

Throat swab for viral PCR

Question 6

Tayside empirical therapy for intra-abdominal sepsis

Answer 6

IV Amox + Met + Gent

Question 7

Tayside empirical therapy for intra-abdominal sepsis - step down therapy

Answer 7

PO Co-Trimoxazole and Metronidazole

Question 8

Tx for Pyelonephritis

Answer 8

IV Amox and Gent

Question 9

Tx for Pyelonephritis - if pen allergic

Answer 9

IV Co-Trimoxazole and Gent

Question 10

Tx for severe CAP

Answer 10

Co-Amox and Clarithromycin

Question 11

cellulitis tx

Answer 11

flucloxacillin

Question 12

cellulitis tx - if pen allergic

Answer 12

IV Vancomycin

Question 13

c.diff tx - non-severe

Answer 13

PO Metronidazole

Question 14

c.diff tx - severe

Answer 14

PO Vancomycin

Question 15

A 26 year old woman presented with dysuria but no frequency. She was prescribed co-amoxiclav but has returned after three days saying her symptoms are no better and she now has vaginal discharge

• why has treatment failed?

Answer 15

The patients symptoms are probably caused by a fungal infection

i.e. thrush

vaginal discharge is not a symptom of UTI

Question 16

An 86 year old resident of a nursing home has become more confused. A week ago the nurses noticed that her urine was smelly and a urine culture grew Escherichia coli sensitive to Trimethoprim. Her temperature was 37oC, pulse 76bpm, respiratory rate 18 per minute, BP 130/80 mmHg. She has no other symptoms. She was treated with Trimethoprim but after 5 days of treatment her confusion has not improved.

• why has treatmetn failed?

Answer 16

The patients symptoms are probably not caused by infection

bacteria in catheter bag not causing symptoms

Question 17

preventative action required if MRSA found?

Answer 17

hand hygiene

Question 18

preventative action required if Norovirus found?

Answer 18

isolation of the patients and/or cohort nursing, ward closure

Question 19

preventative action for THR elective operation?

Answer 19

antibiotic prophylaxis

Question 20

1st line treatment for MRSA

Answer 20

IV Vancomycin

Question 21

1st line treatment for MSSA

Answer 21

Flucloxacillin

Question 22

68 year old woman is admitted with sepsis secondary to E.coli urinary tract infection. She has no allergies and has been compliant with her treatment. She has been treated with Trimethoprim by her GP but has not responded.

• reason for treatment failure

Answer 22

Extrinsic resistance

Question 23

A patient is admitted with a non-severe community acquired pneumonia. You treat with Amoxicillin. Serology confirms Mycoplasma pneumoniae and the patient is not improving.

• reason for treatment failure

Answer 23

Intrinsic resistance

Mycoplasma pneumoniae is one of the organisms that cause the atypical pneumonias

Question 24

An 80 year old man required a central venous catheter following admission for a myocardial infarction and shock. Four days later his temperature is documented as 37.8oC and all other signs are normal. His WCC is 6.7 x 103 A blood culture taken through the central line reveals a growth Gram positive cocci in one bottle after 72 hours of incubation. Peripheral blood cultures taken at the same time are sterile.

• definition?

Answer 24

bacteraemia

Question 25

A 91 year old woman with a long standing urinary catheter is admitted with smelly urine, mild confusion and fatigue. Her She has no other signs or symptoms. WCC is normal. Her catheter urine culture, taken by the residential home, has grown E.coli.

• definition

Answer 25

colonisation

Question 26

Ix for TB if no productive cough

Answer 26

Bronchoscopy with lavage

Question 27

A 38 year old labourer present to the gastroenterology clinic with 3 months of weight loss, recurrent oral thrush and fatigue. His full blood count reveals lymphopenia

• likely diagnosis

Answer 27

HIV

Question 28

An intravenous drug user has been an inpatient on the liver unit for investigation and management of his chronic liver disease. A phlebotomist is carrying out a venesection and sustains a significant needle stick injury. The phlebotomist has previously been adequately vaccinated against blood borne virus infections. What infection is most likely to be acquired from exposure to this patient? .

Answer 28

Hep C