MISCELLANEOUS FACTS FROM PASSMED Flashcards
A 24-year-old man presents with a three day history of painful ulcers on the shaft of his penis and dysuria. He has had no similar previous episodes. A clinical diagnosis of primary genital herpes is made. What is the most appropriate management?
Topical famciclovir
No treatment is indicated
Topical podophyllotoxin
Topical valaciclovir
Oral aciclovir
Oral aciclovir
Oral antiviral therapy is indicated for primary genital herpes infections, even if the presentation is delayed for up to 5 days
A 39 year old HIV positive man complains of a two week history of worsening headache, facial weakness and visual hallucinations. He also reports new onset eye pain. An MRI head reveals multiple ring shaped contrast enhancing lesions. He is regularly followed up in the HIV clinic and his latest CD4 count was 140 cells/mm³. Which treatment should be started immediately?
Valganciclovir
Trimethoprim + sulfamethoxazole
Dexamethasone
Pyrimethamine + sulfadiazine
Ethambutol + rifampicin
Pyrimethamine + sulfadiazine
The symptoms and MRI findings are highly suggestive of toxoplasmosis, a disease caused by the protozoan Toxoplasma gondii.
A 6 month treatment regimen of sulfadiazine and pyrimethamine should be commenced immediately. Patients should be given lifelong secondary prophylaxis.
A 33-year-old man who is HIV positive is admitted to the Emergency Department with confusion and drowsiness. He has been complaining of headaches for a number of days. On examination heart rate is 90/min, blood pressure 104/78 mmHg and temperature is 37.2ºC. He is confused giving a Glasgow Coma Scale (GCS) score of 14. There is no photophobia or neck stiffness.
His infectious diseases consultant reports that he is prescribed highly active antiretroviral treatment (HAART) but his compliance is poor and he often misses clinic appointments.
A CT brain is requested:
CT brain (with contrast): Multiple hypodense regions predominantly in the basal ganglia which show ring enhancement. Minimal surrounding oedema. No mass effect.
What is the most likely diagnosis?
Progressive multifocal leukoencephalopathy
Cryptococcal infection
Cerebral toxoplasmosis
CMV encephalitis
Tuberculosis
Cerebral toxoplasmosis
HIV - multiple ring enhancing lesions = toxoplasmosis
Cerebral toxoplasmosis is the most common neurological infection seen in HIV, occurring in up to 10% of patients
A 25-year-old man returned from a stag weekend in Latvia three days ago.
He is complaining of pain on passing urine and a white discharge from the end of his penis. He is also complaining of a painful and swollen left knee.
On examination he has a white discharge from his penis and his left knee is erythematous, swollen and tender.
Which of these is the most likely diagnosis?
Chlamydial infection
Gonorrhoea
Pyelonephritis
Reactive arthritis
Trichomoniasis
Gonorrhoea
This is a classic description of gonorrhoea in someone returning from an area with a high prevalence.
The acute monoarthritis is a manifestation of disseminated gonococcal infection. Gram stain will show intracellular Gram negative diplococci.
