ID Flashcards
before starting on TB tx, what Ix need doing?
UE
LFT - hepatotoxic
vision testing
FBC
how many doses of tetanus generally gives lifelong protection>?
5 (2 months 3 months 4 months 3-5 years 13-18 years)
36M-ED 1/7 hx SOB and cough. hr 126, bp 103/57 mmHg. RR 28, sats 93% air, t 39.6ºC. 8 months previously he underwent an emergency laparotomy and splenectomy following trauma. dx?
pneumococcal sepsis
following splenectomy this risk is highest in first 2 years
strep pneumo, Hib commonest
A 24-F->GP 3/7 diarrhoea. No blood in the stools or history of fever. BO 3x/day with watery stool. BG: RA. She has well-controlled on methotrexate and adalimumab. She does not smoke or drink alcohol.
Very mild abdominal tenderness. There is no guarding and her abdomen is soft. Bowel sounds are present.
Stool microscopy, which grows Campylobacter jejuni. mx?
clarithromycin
normally watch and wait but as immunosuppressed and severe infection give abx
type of bacteria is campylobacter jejuni?
gram negative bacillus
A 33-M HIV positive presents with a 2 day history of diarrhoea. What is the most likely cause of his diarrhoea?
cryptosporidium
UTI in pregnant woman 10/40- abx?
Pregnant women with a UTI: 7/7 nitrofurantoin is first-line unless the woman is close to term
Results of a human immunodeficiency virus (HIV) test. The antibodies and p24 antigen are reported as negative. You check the records and find it was requested by your colleague who is on holiday. The patient is a man who had requested an HIV test after an encounter with a sex worker; your colleague had asked him to attend the sexual health clinic but he had declined, wanting tests done via the GP. The HIV test had been taken 4 weeks after the episode.
What should the patient be told about the result?
HIV unlikely but offer a test at 12 weeks post-exposure
in asx pts offer first test 4 weeks after exposure
A 35-M who is known to have advanced HIV disease presents with dysphagia and odynophagia. What is the most likely cause of his problems?
oesophageal candidiasis
A 20-F 16/40 pregnant presents with pain passing urine and an irritating rash. Tender, red, vesicular rash on her vulva. Urine dipstick shows both blood and white cells. What is the best treatment?
Oral acyclovir delivery by C section
HSV
which antiviral in HSV always?
acyclovir
39-M returns from a two week business trip to Kenya. Four weeks after his return he presents to his GP complaining of malaise, headaches and night sweats. On examination there is a symmetrical erythematous macular rash over his trunk and limbs associated with cervical and inguinal lymphadenopathy. What is the most likely diagnosis?
HIV seroconversion
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests what?
leptospirosis
rose spot’ macular rash and a relative bradycardia.??
enteric fever
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago???
no futher jab - supportive mx
The CSF results are consistent with bacterial meningitis……>
low glucose, high protein, high polymorphs
meningitis prophylaxis?
cipro
Renal transplant + infection ?
CMV
61-M diabetic foot clinic because of a chronic ulcer on his left leg. The ulcer has been present for the past 5 months and is well demarcated with no sensation at the base of the ulcer. He has grown the same bacteria from swabs taken from the ulcer multiple times. HR 81, BP 132/83 temp 37.1ºC. The base is wet with a pale green slough over it and smells damp and offensive.
Which organism is most likely to be responsible for this ulcer based on this clinical picture?
pseudomonas aeruginosa
common cause of chronic wound infections
A 27-M returns from a recent trip to South America. -> ED with symptoms of fever, headache, arthralgia, constipation and abdominal pain. On examination, he has splenomegaly and blanching maculopapular rose spots on his trunk. What is the most likely diagnosis?
typhoid fever
salmonella typhi causes rose spots too
Yellow fever presents with
fever, chills, headache, backache, and muscle aches, but it would not present with a rash
incubation 2-14/7
what type of fever is typhoid fever?
enteric fever
21-M ->ED 5-week history of progressive lethargy and intermittent dizziness and palpitations, particularly on exertion and often related to shortness of breath. Today he has had a syncopal episode and is concerned that there may be something wrong with his heart as he has a strong family history of heart disease.
No PMH, ex-smoker with a 3 pack year history and takes no recreational drugs. He has recently emigrated from India and is working in an office. Weight stable for the last year and he reports no change in bowel habit or appetite. Itchy rash on his feet appearing several months ago, but this self resolved.
anaemic. eosinophillia. cause?
hookworm can cause IDA in endemic areas
travel
pig meat related is which hepatitis in exams?
hep E
BCG measles, mumps, rubella (MMR) influenza (intranasal) oral rotavirus oral polio yellow fever oral typhoid these are all??
live attenuated vaccines
CI in HIV pts
rabies
hepatitis A
influenza (intramuscular)
these are all??
inactivated vaccines
tetanus
diphtheria
pertussis
these are all?
toxoid - inactivated toxin vaccine
Disseminated gonococcal infection triad =
tenosynovitis, migratory polyarthritis, dermatitis
29F->GP past 3 weeks noticed a rash on her thighs which then appeared on her forearms. It is dry, itchy and red. Then she began to have pain in her knees which was worse on movement, the same pain then spread to her left wrist and began to limit her movement. In the last week she has noticed difficulty in moving some of her right fingers from a bent to straight position, it being painful to do so. Cultures sent. What is most likely to been seen on microscopy?
gram negative diplococci
gonococcal - niesseria gonorrhoea
Gram negative rods with a single flagella would be
pseudomonas aeruginosa
Gram-positive cocci in clusters is
s. aureus
gram-positive diplococcus that is often found in the reproductive tract but is does not usually disseminate.
GBS
Gram-positive flagellated rods are
listeria monocytogenes
UTI and on MTX: tx?
nitrofurantoin
elderly gentleman presents with a three day history of bloody diarrhoea and feverishness. He has no significant travel history. His past medical history is listed as hypertension, osteoarthritis and gout. On examination his temperature is 38.0ºC, heart rate 95/min, blood pressure 120/80 mmHg and his abdomen is soft and non-tender. A stool sample has grown Salmonella. What is the best treatment?
cipro
26-M presents with nausea, malaise and jaundice. He returned 3 weeks ago from a holiday to India. Moderate hepatosplenomegaly and yellowing of the sclera. He also has dark urine and pale stools. dx?
Hep A
faeco-oral transmission
pregnant woman brings her 5-year-old son to the GP because of a rash present on his cheeks and arms, he is otherwise well. She denies any diarrhoea or vomiting but is concerned because his school said he cannot come in whilst he has this rash.
Given the likely diagnosis, what would be the most appropriate action?
check maternal IGs as parvovirus B19 risk to pregnancy;
hydrops
kid can go to school - not infectious when rash has developed
63-F farmer presents with a severely painful right leg. She accidentally impaled herself with a pitchfork whilst moving hay 12 hours ago. The wound was approximately 1cm deep, stopped bleeding within 20 minutes, and she covered it with a plaster. Over the last 12 hours, the pain has been increasing steadily and is now very severe. She has no other symptoms. She takes metformin for T2DM. HR 85, RR 18, BP 124/82, temp 38.5ºC. 1cm wound on her lower right calf. It is surrounded by an area of prominent erythema and swelling that is approximately 15cm at its widest diameter. There is also a very dark purple area around the wound. There is one blister with foul-smelling discharge. The wound is very tender.
An emergency x-ray demonstrates air bubbles in the tissues. Swabs are taken and broad-spectrum antibiotics are started. What is the most likely organism to be isolated?
clostridium perfingens
Gas gangrene is caused by C. perfringens
C perfringens is what on gram stain?
gram positive bacillus that is spore-forming
A 33-year-old woman who was diagnosed as having HIV-1 two years ago is reviewed in clinic. She is fit and well currently and has no symptoms of note. The only medication she takes is the occasional paracetamol for tension headaches. CD4 325 * 106/l
What is the most appropriate action with regard with to anti-retroviral therapy?
start now
everyone offered ART regardless of CD4 count
The flu-like symptoms, bilateral consolidation and erythema multiforme (target lesions) point to a diagnosis of???
mycoplasma pneumoniae
can also cause immune-related neuro disorders (GBS-like sx)
ix mycoplasma?
mycoplasma serology
28F -> ED with a prior history of chlamydia, low-grade fever and abdominal pain that has worsened over the past 6 hours. She says the pain is worst on the right-hand side and radiates into the shoulder.
what is this cx of PID?
Fitz-hugh-curtis syndrome
liver inflammation
which abx should be added to tx of pneumonia caused by influenza?
fluclox
pneumonia post-influenza infection - staph aureus
if ?nec fasc what is mx?
IV abx + SURGICAL debridement
Immunocompromised patients with toxoplasmosis are treated with ???
pyrimethamine plus sulphadiazine
only pyrimethamine in non-IC pts but severe inf - if not severe - not tx
strep pyogenes rarely causes which infection type?
pneumonia
which organism can cause hyponatraemia and cause a pneumonia?
legionella
also bilat infiltrates, brady, confusion, LFTs off
The first line treatment in amoebiasis is:
metronidazole
28-F sex worker -> ED: severe headache and fever. On examination you elicit some neck stiffness and and mild photophobia and as such a lumbar puncture is performed. The results of the lumbar puncture show a yeast and a capsule in the CSF stained with India ink.
dx?
cryptococcal meningitis
28-F 10/40 pregnant. The urine sample was collected during her recent appointment with her midwife and the result has returned showing the presence of Escherichia coli. asymptomatic. tx?
7 day course nitrofurantoin (should be avoided near term), amoxicillin or cefalexin
Incubation period GE pathogens:
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
which type of pneumonia associated with erythema multiforme (target lesions on skin)?
mycoplasma pneumoniae
tx mycoplasma pneumonia?
doxy/macrolide
most common cause of travellers diarrhoea?
e coli
mx of red man syndrome with vancomycin?
stop vanc and infuse at a lower rate
42-F ID ward due to an erythematous lesion on her ankle and some periorbital oedema which she noticed weeks after returning from a trip to South America. She is diagnosed with Chagas’ disease. She is incredibly worried about her prognosis and wants to begin treatment immediately.
Which severe complication is it most important to warn her about?
cardiomyopathy - do an echo
Trypanosomiasis: 2 types:
Two main form of this protozoal disease are recognised - African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas’ disease).
23-M-> GP with a one week history of pain on urination and a pus-like discharge from the end of his penis. There is no history of haematuria, fever, abdominal pain or joint pain and the patient is otherwise well. He is sexually active and has had penetrative sex with three women in the past two months.
Examination of the genitalia is unremarkable.
chlamydia trachomonatis likely
urethritis+/-discharge
chlamydia trachamonatis ix?
first catch urine nucleic amplification test
tx chlamydia?
either oral doxycycline for 7 days or single dose of oral azithromycin
(never doxy if pregnant)
The incubation period of Ebola virus is
2-21 days
A description of the contents for amoebic liver abscesses is described as ‘anchovy sauce’ - organism?
entamoeba histolytica
cause dysentery
what is the most common cause of type 2 necrotising fasciitis??
strep pyogenes
Bacterial vaginosis in pregnancy: abx??
metronidazole PO ( still ) even when breast feeding - high doses stat are CI
Genital wart treatment??
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
2nd line top imiquimod
four fleshy, protuberant lesions on her vulva which are slightly pigmented????
genital warts
MSM: ano-oral sex: which STI commonest
Although Hepatitis B is associated with sexual transmission, anal-oral sex is responsible for the transmission of Hepatitis A
what can give false mantoux negative?
long term steroid use eg well controlled UC
sarcoidosis
AIDS
lymphoma
multiple erythematous ulcers over the external genital area, and there is evidence of excoriation. No discharge can be seen.
dx? ix?
genital herpes
NAAT
tx genital herpes?
PO aciclovir
Erythema chronicum migrans is an early feature of ??
lyme disease
‘bulls eye’ rash
later can be bilat facial nerve palsy
spirochaete Borrelia burgdorferi causes:
lyme disease
Atypical lymphocytes - ?
glandular fever
infective mononucleosis
constipation points to which causative organism??
typhoid
what is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic?
erythromycin
Parvovirus b19: IgG negative & IgM positive mx?
non-immune. Recent parvovirus infection in last 4 weeks. Refer immediately for further tests/fetal medicine.
which 2 compounds make up co-amoxiclav?
amoxicillin
clavulanic acid
what purpose does clavulanic acid serve in co-amox?
B-lactamase inhibitor
not effective itself as an abx, overcomes resistance in bacteria which produce B-lactamase
what is Augmentin?
co-amox
how does levofloxacin kill bacteria?
quinolone
inhibits DNA gyrase and topoisomerase and prevents the supercoiling of the DNA during replication
bacteriocide
Lyme disease in asymptomatic patients bitten by a tick mx?
no treatment - no abx
first line in the treatment of Lyme disease?
doxycycline
33-M HIV positive -> ED confusion and drowsiness. He has been complaining of headaches for a number of days. hr 90, BP 104/78 temp 37.2ºC. He is confused GCS 14. There is no photophobia or neck stiffness. His ID consultant reports that he is prescribed HAART but his compliance is poor and he often misses clinic appointments. CT brain (with contrast): Multiple hypodense regions predominantly in the basal ganglia which show ring enhancement. Minimal surrounding oedema. No mass effect. dx?
cerebral toxoplasmosis
HIV, neuro symptoms, multiple brain lesions with ring enhancement -
toxoplasmosis
CSF: high opening pressure, India ink test positive in which cerebral infection?
cryptococcal
which infection is due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)?
Progressive multifocal leukoencephalopathy (PML)
10-M ->GP. Dull headache and neck pain since last night. Looks unwell and there is an erythematous non-blanching rash across his legs. HR 140, BP 100/60, RR 24, temp 39°C. Given the likely diagnosis, you consider administering antibiotics to the child. The father reports that his son developed a rash after being given flucloxacillin for a different illness. What is the immediate management of this clinical scenario?
IM BenPen and transfer to hospital
doesn’t matter about the previous rash - this isn’t a CI
if previous anaphylaxis to pen - transfer w/o abx
Lyme disease can be diagnosed clinically if?
erythema migrans present - PO doxy la
Necrotising fasciitis: most commonly affected site???
perineum
what is erysipelas?
superficial cellulitis
mx erysipelas?
fluclox
what type of virus is Hep A?
RNA picornavirus
MSM get vaccine vs this
31-F noted an offensive, fishy vaginal discharge. She describes a grey, watery discharge. What is the most likely diagnosis?
Bacterial Vaginosis
clue cells
Bacterial vaginosis - overgrowth of predominately which organism?
gardnerella vaginalis
pH >4.5
treatment of choice for Gonorrhoea?
IM ceftriaxone stat dose
if don’t want IM - PO cefixime + azithromycin
5M known sickle cell disease -> ED 1/7 hx fevers, arthralgia and a facial rash, associated with worsening shortness of breath on exertion and lethargy. He also experienced 2 nosebleeds yesterday, which he has never had before. Cause of his symptoms?
erythema infectiosum
parvovirus b19 -> aplastic anaemia crisis in patients with sickle cell disease/HS
what blood result is associated with cholera?
hypoglycaemia
also hypokalaemia and metabolic acidosis
A 22-year-old man has undergone an inguinal hernia repair. Seven days later he presents with an erythematous and tender wound that is discharging a purulent material. What is the most likely cause?
staph aureus
first line in persistent LRTI in pen allergic 10yo?
clari
34F->ED dry cough, headache and malaise 3/7. Loose green stool. Pakistan about two weeks ago. BG asthma - salbutamol PRN, OD steroid inhalers. Full course of anti-malarial prophylaxis. BCG vaccine. hr 59, rr 14, bp 115/75, sats 97% air; Temp 40.4ºC.
Hot to touch, fatigued. HS 1+2+0. Her chest is clear. She has mild epigastric abdominal pain, and bowel sounds are normal. Bloods pending. CXR and ECG NAD. Which single additional test will be most useful in establishing the diagnosis?
blood cultures
relative bradycardia indicates typhoid fever
first-line investigation for suspected Lyme disease in patients with no history of erythema migrans?
elisa test - blood serology
Prison GP bitten by a patient who is known to have hepatitis B. The GP has a documented full history of hepatitis B vaccination and was known to be a responder. What is the most appropriate action to reduce the chance of contracting hepatitis B?
give hep B vaccine booster
if not ‘responder’ - HBIG+vaccine
31F on the labour ward high fever (39.1ºC) 2 days post-partum. She complains of dysuria, and frequency, you suspect UTI. She is choosing to breast feed, has severe anaphylactic reactions to penicillins. Which antibiotic would be appropriate?
trimethoprim
Is spread by the parenteral, sexual and vertical transmission route - ?
hep B or C
Cloudy appearance, glucose 70% of plasma, protein 0.5 g/l, WCC 500 per mm^3 (lymphs) - which type of meningitis?
viral
A 35-year-old intravenous drug user presents with decompensated liver disease. They do not drink alcohol. On examination a number of purpura are found - ?
hep C
(no vaxx). common in IVDUs
An elderly patient presents with fever and a cough productive of ‘rusty’ coloured sputum. On examination there is dullness at the right base of the lung and bronchial breathing - organism?
strep pneumoniae
can be associated with cold sores too - hsv reactivation
commonest cause of community acquired pneumonia?
strep pneumoniae
initial empirical therapy of meningitis (aged > 50 years)
initial empirical therapy of meningitis (aged < 3 months)
????
IV cefotaxime + amoxicillin
Which one of the hepatitis viruses may cause cryoglobulinaemia?
hep C
which hepatitis may cause polyarteritis nodosa -
hep B
HIV, purple/red skin lesions in a question is most likely to indicate:
kaposi sarcoma
HHV-8
A 23-year-old woman presents to the GP with a widespread rash and a fever. She has had multiple sexual partners over the last 6 months. Syphilis serology is positive. What stage of syphilis does she have?
secondary - systemic symptoms present
also patchy hair loss and condylomata lata
buccal snail track ulcers
organism causes syphilis?
treponema pallidum
features of primary syphilis?
chancre - painless ulcer at site of contact
local painless lymphadenopathy
often not seen in women
tertiary syphilis features?
gummas (granulomatous lesions of the skin and bones) ascending aortic aneurysms general paralysis of the insane tabes dorsalis Argyll-Robertson pupil
blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness
features of???
congenital syphilis
28-M painful genital ulcers a few weeks after a trip to Kenya. Multiple eroded genital ulcers, as well as a tender, enlarged lymph node present in the right inguinal region. He is systemically well. haemophilus ducreyi grown. dx?
chancre
painful with ducreyi
doses Benpen?
<1 300mg IM
1-9 600mg IM
10+ 1200mg IM
29M 12/7 hx watery diarrhoea that developed one week after returning from India. He had travelled around northern India for two months. Apyrexial and his abdo is soft and non-tender. What is the most likely causative organism?
giardiasis
prolonged incubation period and non-bloody diarrhoea
tx = metron
commonest STI UK?
chlamydia
?leptospirosis - which ix?
serology but abs may not be present until 7/7
tx high dose benpen or doxy
57M homeless worsening breathlessness, haemoptysis and fatigue. PMH nil. He is pyrexic. Bronchial breathing heard over the right upper lobe and the right lower lobe is dull to percussion. Chest X-ray shows patchy areas of consolidation and right-sided pleural effusion. Sputum microscopy reveals acid-fast bacilli. what other test does he need?
all TB patients should get a HIV test
24M Sudan presents with a lymphadenopathy and weight loss. TB suspected and a lymph node biopsy is performed. Staining with which agent most likely to facilitate identification of the causative organism?
Ziehl-Neelsen
34F IVDU back pain, bilateral leg weakness and fever. A spinal epidural abscess is suspected. What imaging investigation is required to confirm the diagnosis?
MRI whole spine
- skip lesions
56-M->GP recurrent fevers and a persisting sore throat with swollen glands. Past two months and not improving with over the counter analgesics. Lost weight over the last six months. Obs normal. His throat is not red but he does have bilateral cervical lymphadenopathy which is non-tender.
Bloods show raised WCC, lymphs.
Ix?
dx - likely lymphoma if persistent pyrexia unknown origin + lymphadenopathy + high WCC
Ix - Lymph node biopsy
32M -ED severe shortness of breath, fever, and dry cough. He gets a chest x-ray and bronchoalveolar lavage, and is found to have Pneumocystis jiroveci pneumonia (PCP). nil allergies. tx?
co-trimoxazole
35M -ED with RUQ pain that has come on over the past 24 hours. This has been accompanied by pruritus and fever. He denies any weight loss.
Ongoing treatment of Hep B. Compliant with his medications, never had any symptoms since diagnosis. Denies drinking alcohol but says that he does use recreational drugs. Jaundiced and has needle track marks on his arms. dx?
hep D superinfection
should be a ddx for anyone with Hep B + acute flare up
photosensitive after abx??
doxy
A 25-year-old man returns from a gap-year in Central and South America and presents with a 2 month history of an ulcerating lesion on his lower lip. Examination of his nasal and oral mucosae reveals widespread involvement. dx?
leishmaniasis
which HSV more commonly associated with oral ulcers?
1
TPHA remains positive, VDRL becomes negative after?
successful tx for syphilis
benpen - even in preg
commonly presents desaturation on exertion and often Chest x-ray appears normal. It almost exclusively happens in immunosuppressed patients…..?
PCP (jiroveci)
son who is currently backpacking in Thailand. Earlier in the day he was bitten by a dog whilst staying in a rural community. Prior to travelling, he received vaccination against rabies as he was going to be visiting many rural areas. What is the most appropriate advice?
see urgent medical attention - booster needed and abx
if not vaccinated - full course of vaccine + IG
16-F immigrated from South Asia ->GP with pales blotches on her arm. Large hypopigmented lesions on her left arm. There is loss of sensation to fine touch over the lesion. She is systemically well. dx?
leprosy
of course
A 6-month-old who is ‘chesty’, has rhinitis and is off her feeds. Auscultation of her chest reveals bibasal crackles and an expiratory wheeze. org?
RSV
syncytial
53F -ED cough productive of green sputum and palpitations. She feels very unwell, feverish and lethargic. Bronchial breathing at her right base with rr 25/min, sats 95% air. Her heart sounds are normal with an irregularily irregular heartbeat. Her heart rate was 120/min and blood pressure 90/40 mmHg. An ECG shows atrial fibrillation with a fast ventricular rate. She has no history of atrial fibrillation. What is the first treatment that should be given?
IV fluids
she is septic - pushed her into new AF
when PAINFUL ulcers genital - think?
HSV
17F. Four days ago she presented to her doctor with a severe sore throat, lethargy and headache. Prescribed amoxicillin for URTI. 2/7 developed a widespread, pruritic maculopapular rash. Her original symptoms have also not improved. diagnosis?
infectious mononucleosis
EBV
glandular fever
23M 3/7 hx general malaise and low-grade temperature. Yesterday he developed extensive painful ulceration of his mouth and gums. t 37.4ºC, pulse 84 / min and there is submandibular lymphadenopathy. dx?
HSV
gingivostomatitis
84F long standing urinary catheter is admitted with smelly urine. She has no other symptoms or signs. Obs normal. WCC is normal. Three samples taken under sterile conditions from catheter all grown E. coli.
define this scenario?
colonisation
which presents with flu-like symptoms, RUQ pain, tender hepatomegaly and cholestatic LFTs?
Hep A
55-F oral antibiotics for mild diverticulitis. She attends a birthday party and soon afterwards complains of flushing, headache, vomiting and palpitations. Her heart rate is 115 beats/min. Had 1 glass of wine at the party. dx?
metronidazole+alc = disulfiram-like reax
55M hosp following a stroke two weeks ago. Yesterday fever and confused. A septic screen has shown radiological evidence of pneumonia. RR 36/min, pulse 112/min, oxygen saturations of 95% air and bp 102/66 mmHg. What is the most appropriate antibiotic to use?
IV Pip-taz
HAP
Phlebotomist who has received a needlestick injury after taking blood from a haemophiliac. What is the latest time that HIV post-exposure prophylaxis may be given?
72 hours after event
GP 2/7 following a 1-month volunteering trip to sub-Saharan Africa. Very feverish recently >38.0ºC. They report feeling very tried recently. They appear jaundiced. Tender abdomen. Hypoglycaemic and has a low platelet count. The diagnosis is confirmed on performing a blood-film.
diagnosis?
malaria
plasmodium falciprum
can also have splenomegaly
commonest malaria organism?
plasmodium falciparum
what is Lymphogranuloma venereum?
caused by chlamydia trachomatis and characterised by unilateral tender lymphadenopathy
45-year-old female presents three days after returning from Thailand complaining of severe muscle ache, fever and headache. On examination she has a widespread maculopapular rash.
High Hb, low plts, raised ALT. dx ->
dengue fever
tx - supportive only, no antivirals
local vs systemic cx of gonorrhoea?
local - urethral stricture, PID, batholian’s abscess
systemic - peri-hepatitis, reactive arthritis
repeated infection - infertility
CSF lymphocytosis combined with a glucose greater than half the serum level points towards ??
viral meningitis
CSF in TB meningitis?
low glucose, cloudy, fibrin web, high protein, WCC 30-300 (lymphocytes)
human bites, like animal bites, abx?
co-amox
if allergic - doxy, metro
if severe - clinda, cipro
primary case suspect cellulitis - dx based on?
clinical only no need for further ix
if not septic then oral abx la
44M farmer headache, fever and muscle aches. He initially thought he had a bad cold but his symptoms have got progressively worse over the past week. Nausea and a decreased urine output. t38.2ºC, hr 102 and his chest is clear. Subconjunctival haemorrhages are noted but no evidence of jaundice. dx?
leptospirosis
farmer another high risk job, abattoir.
returning traveller
34M presents with a widespread maculopapular rash and mouth ulcers.2/12 ago presented to the local GUM clinic after developing a painless penile ulcer. At the time he was noted to have inguinal lymphadenopathy. organisms is most likely to be responsible?
treponema pallidum
2nd syphilis
30M -GP. Ex-girlfriend stating she has tested positive for Chlamydia. He last slept with her 2 months ago. He has no symptoms of note, in particular no dysuria or discharge. What is the most appropriate management?
test for chlamydia and tx without waiting for results
doxy
A 9-year-old boy who has recently arrived from India presents with fever. On examination a grey coating is seen surrounding the tonsils and there is extensive cervical lymphadenopathy. dx?
diptheria
diphtheric membrane’ on tonsils caused by necrotic mucosal cells - grey
Pearly penile papules??
not a cause for concern - normal variant
no tx
HIV, neuro symptoms, single brain lesions with homogenous enhancement - positive on thallium spect scan?
CNS lymhpoma
40-M HIV neurology clinic worsening clumsiness over the past month; he regularly falls into door frames. Unsteady gait and dysdiadochokinesia. Cranial nerve testing and speech were normal. MRI scan was found to show multifocal non-enhancing lesions. which virus caused this?
JC virus - Progressive multifocal leukoencephalopathy (PML)
demyelinating
which vaccines do pregnant women get?
flu and pertussis
men with dysuria sounds like UTI - tx?
nitro/trimethoprim 7/7
only refer if ?prostatitis
Pyrazinamide should be given for the first two months of therapy - side-effects include ?
hepatitis and gout
Peripheral neuropathy is a side-effect of which TB drug?
isoniazid
what should be checked before starting ethambutol?
visual acuity
response to hep B vaccine? 3 options?
good response >100 - 5yr booster
ok 10-100 - give 1 more dose of vaccine
<10 bad response - give 3 doses and HBIG and test for virus and HIV
The phlebotomist in a GP surgery sustains a needlestick injury whilst taking blood from a patient who is known to be HIV positive. Following thorough washing of the wound what is the most appropriate management?
immediate ED referral + PO ART for 4/52
post-exposure prophylaxis
Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis =
lymphogranuloma venereum
You are reviewing a 31-year-old man in the liver clinic. He is currently on triple therapy for hepatitis C. What is the best way to assess his response to treatment?
Viral load
The appearance of ground-glass hepatocytes on light microscopy can point towards a diagnosis of?
chronic hep B
give pneumo vaxx
A negative e-antigen suggests low infectivity, but positive surface and core antigens with a negative surface antibody suggest ??
current chronic hep B infection
surface Ag positive for >6/12
Most common organism found in central line infections -?
staph epidermidis
fever on alternate days think?
malaria
Trichomonas vaginalis + bacterial vaginosis are associated with a pH?
> 4.5
metronidazole
strawberry cervix, vulvovaginitis, urethritis in men, frothy green discharge all features of?
trichomonas vaginalis (protozoa) metronidazole
48M farmer -ED 7/7 after cutting his arm from falling on barbed wire in his field. He complaints of fever, headache and painful spasms in his neck and back which last several minutes. Suspect tetanus and he tells you he has completed a course of tetanus vaccination previously. treatment?
IM tetanus IG
high risk wound
EBV: associated malignancies: (3)
Burkitts lymphoma
Hodgkins lymphoma
nasopharyngeal carcinoma
untreated chlamydia cx?
infertility
perihepatitis
reactive arthritis
increased risk ectopics
Patients with an uncertain tetanus vaccination history should be given?
booster of tetanus vaccine and IG unless wound very minor and <6h old
which common op needs Abx prophylaxis?
appendicectomy
A 73-year-old man presents with worsening cellulitis. The nurse takes his observations which are the following a respiratory rate of 28/min, heart rate 110/min, blood pressure 100/70 mmHg and a temperature of 39.5ºC. Blood cultures are taken and later reported as growing a gram positive, catalase and coagulase positive cocci. org?
staph aureus
24-M immigrant from Albania ED- fever, headache and malaise. 1/7 developed bilateral pain and swelling at the angle of the jaw, which is made worse by talking or chewing. HR 90/min, temperature 38.4ºC and bilateral palpable, tender parotid glands are noted dx, cx?
mumps
orchitis
hearing loss, meningitis, pancreatitis
parents of 12yo Bangledeshi boy come to ask if he can have BCG vaccine - mx?
tuberculin skin test prior to vaccine to check previous exposure to TB
risk factor for aspergillosis?
immunocompromised
Deterioration in patient with hepatitis B - ?
hepatocellular carcinoma
A 14-month-old boy who has a barking cough which is worse at night.
org?
parainfluenza virus
croup
A 33-year-old man who is known to be HIV positive presents with cough and dyspnoea. Auscultation of his chest is unremarkable but he is noted to desaturate on exertion.
org?
PCP
A 30-year-old woman presents with a headache, myalgia, fever and a cough. On auscultation her chest is clear but she has a temperature of 38.6ºC. org?
influenza virus
A 26-year-old gentleman presents to the GP with a two week history of a tongue lesion. It is not painful. He has a past medical history of asthma, gonorrhoea and syphilis. He does not smoke. On examination, the lesion is a white, streaky plaque that is present only the side of the tongue. It cannot be scraped off. dx, ix?
HIV test
hairy leukaemia presents as a white streak on side of tongue - EBV related
32M-ED by his girlfriend. Behaving very unusually towards her over 2/7, confused and disorientated. Jerking movements which she believes were seizures. No PMH. t 39ºC, bp 124/76, hr 103, rr 13.
There is no rash, neck stiffness or focal neurology present. He has not had any foreign travel recently. CSF analysis reveals a high protein, normal glucose, and a predominance of mononuclear cells. dx, org?
HSV encephalitis
commonest cause of encephalitis in adults
what may be seen on the CXR of a patient with latent TB?
calcified ghon complex
Acute toxoplasmosis in the immunocompetent patient ……
can mimic acute EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise) should suspect if negative EBV serology but with VCA IgG and EBNA postiive
glandular fever - sports advice?
not for 8 weeks la
young adults bacterial meningitis mx?
IV ceftriaxone
dex improves outcomes too
A patient who is awaiting an inguinal hernia repair is found to be positive for MRSA after screening at the pre-admission clinic. What treatment should he be offered, if any?
nasal mupirocin and chlorhexadine for the skin
best prophylaxis = hand hygiene
A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with>
clostridium botulinum
All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against Pneumocystis jiroveci pneumonia. which abx>
co-trimoxazole
who gets offered bcg?
high risk jobs
organism causing LRTI in cystic fibrosis patients?
pseudomonas aeruginosa
For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?
2 weeks before surgery
unwell when due for flu vaccine?
postpone til better
pubic lice tx?
malathion
commonest cause pyelonephritis?
e coli
67F known emphysema -ED 2/52 hx cough productive of blood stained sputum. CXR : circular area of dense right upper lobe consolidation. Despite 7/7 IV abx (piperacillin and tazobactam) his condition has not improved. An urgent inpatient bronchoscopy reveals no endobronchial lesion but broncho-alveolar lavage reveals an underlying pathogenic organism. Ziehl-Nielson staining is negative. What organism would you suspect?
aspergillus fumigatus
Miliary TB is due to the spread of the bacteria through
pulmonary venous system
A 56-year-old man with a longstanding history of chronic kidney disease (CKD) undergoes a renal transplant. The operation is successful, but four weeks later he notices blurring of his vision in his right eye. He is currently taking prednisolone and tacrolimus maintenance therapy. On fundoscopy, a mixture of cotton-wool spots, infiltrates and haemorrhages can be seen in the right eye. dx?
CMV retinitis
58F PMH TB youth, presents with small volume haemoptysis. RA controlled on methotrexate. She is a non-smoker. Her father died of mesothelioma. Dullness to percussion at the right upper zone. CXR: partially-filled cavity with a crescent of air. dx?
aspergilloma
in previous TB cavity
Reinfection with syphilis should be suspected if???
RPR (rapid plasma reagin) rises by four-fold
tx STAT benpen
Swabs for chlamydia and gonorrhoea in women should be taken from the?
vulvo-vaginal region (introitus)
naat
legionella dx?
urinary ag
children with only generalised lymphadenopathy suggestive of lymphoma but HIV +?
kaposi sarcoma
is HIV notifiable disease?
no
trimethoprim causes which electrolyte abnormality?
hyperkalaemia
tubular dysfunction and raised creat
The most common causes of viral meningitis in adults are?
enteroviruses
coxsackie virus B
Genital warts - 90% are caused by
HPB 6, 11
abx can cause black hairy tongue and metallic taste?
tetracyclines
extensive otitis externa tx?
fluclox
PID tx?
metro+doxy+ceftriaxone
cefalexin in pen allergy?
no 10% cephalosporins will cause reax
40/40 woman attends her routine antenatal clinic. There are no concerns throughout her pregnancy but her repeat urine dip today demonstrates nitrites positive. She has no symptoms. She reports having a ‘dodgy stomach’ a few times after having penicillin in the past. mx?
cefalexin, amoxicillin
sepsis 6 - what comes first cultures or abx?
cultures
‘Navir tease a pro’ - HIV drugs that end with -navir are ?
protease inhibitors
It’s grave/great you integrate’: HIV drugs that end with -gravir are?
integrase inhibitors
Farmer, fever, transaminitis ?
Q fever
coxiella burnetti
fevers, headaches, fatigue and muscle aches.
doxy
tonsilitis bacterial cause?
strep pyogenes
thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection.???
leierre’s syndrome
assess drug sensitivities in TB?
sputum culture
MRSA tx?
vanc/teic
linezolid
why doesn’t pen V help vs Hib?
b-lactamases made by Hib
ix for latent tb?
mantoux
A 27-year-old woman presents with painful genital and oral ulceration. Her past medical history includes treatment for a deep vein thrombosis three years ago.
dx?
behcets
Infective exacerbation of COPD tx?
amox or doxy or clarithro
Acute pyelonephritis tx?
broad spectrum cephalosporin or quinolone
72M had central venous catheter following MI and cardiogenic shock. 4/7 later t 37.6ºC and other obs normal. WCC of 5.8 * 10^9/l . A blood culture taken through the central lines grows gram positive cocci. A peripheral venous sample also tests positive for gram positive cocci. definition of this?
bacteraemia - in the blood
mastoiditis org?
saureus
A phlebotomist gives herself a needlestick injury whilst taking blood from a patient who is known to be hepatitis B positive. The phlebotomist has just started her job and is in the process of being immunised for hepatitis B but has only had one dose to date. What is the most appropriate action to minimise her risk of contracting hepatitis B from the needle?
accellerated course hep B vaccine + IG
checked before commencing a patient on terbinafine (to treat a fungal nail infection)?
LFTs - heptox
What is the mechanism of action of doxycycline?
inhibit 30s subunit of ribosomes
A patient who was an intravenous drug user in the 1990s asks for a hepatitis C test. What is the most appropriate action?
arrange anti-HCV antibody test
severe hepatitis in a pregnant woman - which one?
Hep E
prodromal symptoms, Koplik spots. maculopapular rash starting behind the ears and conjunctivitis - dx?
measles
Jarisch-Herxheimer reaction??
post-syphilis rx with penicillin causes fever rash and tachycardia but NOT anaphylaxis. due to endotoxins
rx with antipyretics
Severe falciparum malaria - rx?
IV artesunate
what is most common and serious complication of chickenpox infection in adults. rx?
varicella pneumonia
IV aciclovir
