Infection Incorrects

Question 1

A 76 year old man has nausea, fever and rigors. He has foul smelling urine. He was discharged 3 days ago after being treated for a PE. He has been having low molecular weight heparin injections twice daily since the diagnosis. He had a cholecystectomy 12 years ago.His temperature is 39.7°C, pulse rate 100 bpm and BP 92/41 mmHg.Investigations:
APTT 43 seconds (22–41) PT 18 seconds (10–12)
Which is the most likely cause of the prolonged prothrombin time?
A. Disseminated intravascular coagulation
B. Liver disease
C. Low molecular weight heparin
D. Lupus anticoagulant
E. Vitamin K deficiency

Answer 1

A = Sepsis causing DIC

Question 2

chlamydia first line treatment?

Answer 2

doxycycline

Question 3

A 24 year old woman has 1 week of watery diarrhoea and abdominal
cramping. She is a keen swimmer and there has been a recent outbreak of
diarrhoeal disease amongst her swimming club. She is otherwise well. A
stool sample shows oocysts of cryptosporidium.
Which is the most appropriate management?

Answer 3

no therapy required, self limiting illness

Question 4

A child with scarlet fever can return to school x hours after commencing antibiotics?

Answer 4

24

Question 5

Non-pregnant women with uncomplicated lower UTI, treatment with antibiotics for how many days?

Answer 5

3 days! of nitro

Question 6

when would you send a urine culture/MSU for patients with a UTI?

Answer 6

women with a suspected UTI if associated with visible or non-visible haematuria

Question 7

All men with a suspected UTI should have a urine culture sent before starting antibiotics

Question 8

Do not treat asymptomatic bacteria in catheterised patients

Question 9

UTI in a pregnant woman in the third trimester management?

Answer 9

amoxicillin or cefalexin for 7 days

Question 10

A 41-year-old man with HIV attends his GP complaining of shortness of breath. He has a dry cough which has been present for the past 5 months and occasional symptoms of chest tightness and discomfort.

On examination his temperature is 36.7ºC, his heart rate is 69 bpm, his blood pressure is 131/86 mmHg and his oxygen saturations on air are 98%. Examination of his chest is normal but when he is asked to stand and walk 10m, upon returning to his chair his oxygen saturations on air are measured as 89%. A chest x-ray is subsequently performed which shows some patchy opacities in the right apex and bilateral hilar enlargement.

What is the most likely causative organism of this man’s symptoms?

Answer 10

Pneumocystis jiroveci pneumonia causes desaturation on exercise

Question 11

ABG shows a metabolic acidosis and raised lactate which further points towards sepsis. Apyrexia does not rule out sepsis.

systolic blood pressure < 90mmHg or > 40mmHg fall from baseline
mean arterial pressure < 65mmHg
heart rate > 131 per minute
respiratory rate > 25 per minute
unresponsive or responsive only to voice or pain.

Question 12

what type of swab is 1st line for chlamydia/ gonorrhea?

Answer 12

Vulvo-vaginal swab

Question 13

trichomonas treatment?

Answer 13

meTronidazole

Question 14

whooping cough management?

Answer 14

oral macrolide (e.g. clarithromycin, azithromycin or erythromycin)

Question 15

Women who suffer regular urinary tract infection following sexual intercourse can be offered post-coital antibiotic prophylaxis

Question 16

All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against Pneumocystis jiroveci pneumonia with what medication addedd to their antivirals?

Answer 16

Co-trimoxazole

Question 17

Antibiotic prohylaxis to prevent infective endocarditis is not routinely recommended in the UK for dental and other procedures

Question 18

criteria for admission for croup?

in addition to oral dex

Answer 18

moderate or severe croup eg audible stridor at rest
< 3 months of age

Question 19

moderate or severe croup
< 3 months of age

Question 20

A 40-year-old patient is reviewed in the urgent neurology clinic after suffering a first seizure 3 days ago. They have a past medical history of HIV. As part of a series of investigations, a brain CT is performed which shows a single lesion with homogenous enhancement. A thallium SPECT scan later demonstrates increased uptake and is therefore reported as positive.

What is the most likely cause of the patient’s symptoms?

Answer 20

CNS lymphoma

Cryptococcus will show meningeal enhancement and cerebral oedema on CT scan.

In toxoplasmosis multiple lesions are often seen on CT scan and the thallium SPECT scan will be negative.

Question 21

HIV test?

Answer 21

Combination HIV p24 antigen and HIV antibody test

viral antigen and antibody

Question 22

A 55-year-old business man presents with a 15 day history of watery, non-bloody diarrhoea associated with anorexia and abdominal bloating. His symptoms started 4 days after returning from a trip to Pakistan. On examination he is apyrexial with dry mucous membranes but normal skin turgor. What is the most likely causative organism?

Answer 22

Although Escherichia coli is the most common cause of travellers’ diarrhoea, in this particular case the length of illness and nature of symptoms (bloating, watery diarrhoea) points to a diagnosis of Giardiasis!!!

Question 23

which antibiotic should be avoided in the first trimester of pregnancy?

Answer 23

trimethoprim

Question 24

criteria for MSU in women?

Answer 24

mid-stream urine sample should be sent for women with a suspected lower urinary tract infection to look for resistant or atypical organisms with the following indications:
Have symptoms that are persistent or do not resolve with antibiotic treatment.
Have recurrent UTI (2 episodes in 6 months or 3 in 12 months).
Have a urinary catheter in situ or have recently been catheterised.
Have risk factors for resistance or complicated UTI such as abnormalities of the genitourinary tract, renal impairment, residence in a long-term care facility, hospitalisation for more than 7 days in the last 6 months, recent travel to a country with increased resistance or previous resistant UTI.
Have atypical symptoms.
Have visible or non-visible (on urine dipstick) haematuria.
Pregnant
Age more than 65 years old.

Question 25

Household contacts of patients with head lice do not need to be treated unless they are also affected

Question 26

HIV seroconversion occurs from 3-12 weeks

Question 27

ritonavir is what type of HIV drug?

Answer 27

protease inhibitor
‘Navir tease a pro’ - HIV drugs that end with -navir are protease inhibitors

Question 28

which valve is most commonly affected in infective endocarditis?

Answer 28

mitral valve

Question 29

HIV, neuro symptoms, widespread demyelination diagnosis

Answer 29

PML

Question 30

most useful ix to diagnose infective endocarditis?

Answer 30

blood cultures

Question 31

What finding is best in determining the severity of c difficile infection?

Answer 31

white blood cell count

Question 32

A 38-year-old lady who smokes heavily presents with recurrent episodes of infection in the right breast. On examination, she has an indurated area at the lateral aspect of the nipple areolar complex. Imaging shows no mass lesions. What is the most likely diagnosis?

Answer 32

Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav.

Question 33

Joint aspiration is performed and synovial fluid is sent to the lab. A Gram stain of the fluid shows Gram-positive cocci in clusters, which are coagulase positive. The following day they are shown to be resistant to flucloxacillin. The patient is scheduled for a joint washout on the same day.

What is the most appropriate next step with regard to antibiotics?

Answer 33

vancomycin! - this is mrsa

Question 34

if effective removal of milk has not improved the symptoms of lactational mastitis after 12-24 hours flucloxacillin is the 1st line empirical treatment

Question 35

A 35-year-old man who is known to have advanced HIV disease presents with dysphagia and odynophagia. What is the most likely cause of his problems?

Answer 35

Oesophageal candidiasis

Question 35

chlamydia in pregnancyy treatment

Answer 35

Azithromycin, erythromycin or amoxicillin

not doxxyyy

Question 36

Do not treat asymptomatic bacteria in catheterised patients

Question 37

second line antibiotic to treat MRSA after vancomycin?

Answer 37

Linezolid

Question 40

Toxic shock in a woman, most appropriate investigation?

Answer 40

speculum exam

Question 40

The majority of patients with suspected shingles should be treated with antivirals within 72 hours of onset; aciclovir, famiciclovir etc

Question 41

Most common cause of endocarditis:
Staphylococcus aureus iif > 2 months post valve surgery
Staphylococcus epidermidis if < 2 months post valve surgery

Question 42

empirical treatment of choice in native valve endocarditis?

Answer 42

IV amoxicillin