Main case 2 - diagnosing infection

Question 1

Risk factor for infective endocarditis

Answer 1

IVDU

Question 2

Imaging for infective endocarditis

Answer 2

Trans-thoracic echocardiogram (TTE)

- look for vegetation, abscess, dehiscence of prosthetic valve

Question 3

Investigations for IE

Answer 3

Blood cultures

Imaging: CXR (consolidation, abscesses, cavities), TTE

Question 4

HIV screening test

Answer 4

HIV antibodies

Question 5

Hep B test for current infection

Answer 5

Hep B surface antigen (HBsAg)

Question 6

Test for Hep B immunity

Answer 6

Hep B surface antibody (in both vaccinated and previously infected)

Question 7

Most common IE pathogens

Answer 7

Strep viridans - most common
Staph aureus - esp if acute, IVDU
Staph epidermidis - prosthetic valve
Strep bovis - assoc with colorectal cancer
Strep mitis - following dental work

Question 8

Investigations for suspected meningitis

Answer 8

Blood cultures
Viral and bacterial throat swabs
Meningococcal PCR
Pneumococcal urinary antigen
Lumbar puncture

Question 9

Requests on CSF sample

Answer 9

Culture and sensitivity
Microscopy and gram stain
Viral PCR including HSV, enterovirus, parechovirus

Question 10

Empirical treatment for meningitis

Answer 10

Cefotaxime or ceftriaxone

Question 11

CURB 65

Answer 11

Confusion
Urea >7
RR >=30
BP - SBP <90 or DBP <= 60
>=65

Question 12

Legionella pneumophilia

Answer 12

Water droplets from AC, water tanks, shower heads, medical equipment
Warm stagnant water
Urine antigen test with pneumonia

Question 13

Investigations in CAP

Answer 13

Urine legionella and pneumococcal antigen
Mycoplasma serology
Blood cultures
HIV test

Question 14

Beta-D-glucan

Answer 14

Diagnostics of invasive fungal infections

rule-out test

Question 15

Best empirical Abx for septic arthritis

Answer 15

IV flucloxacillin

usually staph aureus