ID- random

Question 1

Which organism causes malaria? What are the types and how do they differ?

Answer 1

Plasmodium sp
Falciparum: most severe form. Tertian (48hrly)
Vivax: has chronic liver stage. Tertian.
Ovale: has chronic liver stage. Tertian
Malariae: quartan (72hrly)

Question 2

Describe the presentation of malaria

Answer 2

History of travel to endemic area

• Paroxysmal fever + rigors
• Fatigue, headache, myalgia
• Jaundice, hepatosplenomegaly

Severe falciparum:

• AKI
• ARDS
• Hypoglycaemia
• Neuro: seizures, confusion

Question 3

Describe the investigations for malaria

Answer 3

• Bloods: FBC, CRP, U+Es, LFTs, glucose, clotting, VBG, culture + thick and thin films
• Imaging as indicated eg. CXR to rule out other DDx

Question 4

Describe the management of malaria

Answer 4

Depends on type + severity
Non-falciparum: chloroquine -> primaquine
Mild falciparum: malarone, Riamet (combo therapy)
Severe falciparum: IV artesunate

Question 5

Describe the types of GI worms + management

Answer 5

Threadworm/pinworm: very common, children. Tiny white thread-like worms. Anal itching, visible in stool. Emerge at night. Rx with hygiene measures and whole family mebendazole

Hookworm: enter through the skin and migrate to GIT. Present with cutaneous worm, iron deficiency. Rx with mebendazole

Tapeworm: contracted through eating infected meat, usually pork. Usually asymptomatic. Rx with praziquantel

Question 6

Describe the common pathogens causing gastroenteritis

Answer 6

Viral: Norovirus (very common), rotavirus (kids)
Bacterial: E coli, Campylobacter, Salmonella, Shigella, S aureus, Listeria, C difficule, etc
Protozoal: Giardia

Question 7

Describe the aetiology, presentation and management of Clostridium difficile infection

Answer 7

History of antibiotic use: 
-Cephalosporins 
-Ciprofloxacin 
-Clindamycin 
Persistent foul smelling diarrhoea +/- blood, abdo pain
Management:
-Isolation + cleaning with chlorine
-Stop ABx
-Metronidazole -> x2 -> vanc

Question 8

Describe the presentation of Salmonella typhi

Answer 8

MP rash- rose spots
Fever
Constipation
Headache
Cough
Splenomegaly

Question 9

Which pathogens cause UTI?

Answer 9

Commonly E coli
Staph saprophyticus
Proteus (assoc with stones)
Klebsiella

Question 10

Describe the presentation of UTI

Answer 10

Dysuria
Frequency, urgency
Nocturia
Strong smelling, cloudy urine
Suprapubic pain 

In elderly, may be confusion + no localising symptoms

Question 11

Describe the investigations for UTI

Answer 11

Urine dip for all
MC&S: men, pregnant women, not improving after Tx, pyelonephritis

If severe/hospital:
-Bloods: FBC, CRP, U+Es, VBG

USS: in men, children, pyelonephritis

Question 12

What is asymptomatic bacteriuria? When is it treated?

Answer 12

No symptoms +
Bacteria >10^5 cfu/ml

Only screened for and treated in pregnant women

Question 13

Describe the presentation of pyelonephritis

Answer 13

Fever, malaise
Loin/back pain
Vomiting
History of lower UT symptoms eg. dysuria, frequency

Question 14

Describe the management of UTI, pyelonephritis and prostatitis

Answer 14

UTI:

• Female: nitro 100mg modified release BD, trimethoprim. 3 days
• Pregnant: nitro (not at term), cefalexin, amox
• Male: trimethoprim or nitro. 7 days

Pyelonephritis:

• PO (7-10 days): cefalexin, co-amox, trimethoprim
• IV: co-amox, cefuroxime
• Pregnant: cefalexin or cefuroxime

Prostatitis:
-Cipro or trimethoprim 14 days