ID - OSCE

Question 1

Differentials of Fever, signs of shock, recent travel West Africa

Answer 1

Malaria
Ebola - Viral haemorrhagic fever
Septic shock - gram negative
TTP (renal failure and low platelets)

Question 2

What clinical signs would differentiate Ebola from malaria

Answer 2

Extensive bruising

Upper GI bleeding

Question 3

Management features of Ebola/malaria (general)

Answer 3

High degree of suspicion
ABCDE etc
Isolation - negative pressure room or specialists tents
Limit staff/family exposure
Escalate to named ID consultant and nurse
On-call micro and public health
Treat specific organism

Refer to specialist Ebola centre - Royal Free

Question 4

Tests for Ebola

Answer 4

Ebola virus serology - IgG and IgM

Antigen capture ELISA

PCR

Question 5

Type of virus is Ebola

Transmission vector

How is it transmitted

Answer 5

RNA filovirus

Primary reservoir is fruit bats

Body fluids - blood , saliva, sweat etc
Non human primates eating fruit bats

Question 6

Differential of Ebola

Answer 6

Malaria
Dengue fever
Lassa fever
Yellow fever

Question 7

Causative organism of Leptospirosis

Answer 7

Spirochete - Leptospira

Question 8

Vectors of Leptospirosis

Answer 8

Livestock

Rodents

Bats

Marsupials

Question 9

Describe the phases of leptospirosis

Answer 9

Leptospira enters through mucous membranes

Incubation 2-20 days

Biphasic - 1) acute spiraemic phase 2)immunogenic phase

Widespread vasculitis and endothelial damage - MOF

Question 10

Risk factors of leptospirosis

Answer 10

Occupational (cattle, banana cultivation)

Handling animal carcasses

Indirect exposure - rodent urine

Recreational - swimming/adventure sports

Endemic regions - south east Asia, North Africa

Question 11

Features of leptospirosis

Answer 11

Spiraemic phase:
Flu like illness
Headache, myalgia, rigours etc
Vomiting/jaundice

Immunogenic phase
      Renal failure
      Hepatic failure
      Aspectic meningitis
     Pulmonary haemorrhage
     Myosotis/rhabdo

Question 12

Ix for lepto

Answer 12

Leptospira PCR test

Culture - blood, urine, CSF (EMHj media)

Serology - Microscopic Agglutination Test (MAT) gold standard

Question 13

Criteria for lepto

Answer 13

Isolation of pathogenic Leptospira

OR

4x increase in the MAT titre

OR sing high MAT tires

Suggestive - lepto IgM, or lepto nuclei acid test

Question 14

Treatment

Answer 14

ABCDE, resus and organ support

Doxycycline
Ceftriazone
Cefotaxime
Ben Pen

Notifiable
ID input