MISCELLANEOUS FACTS FROM PASSMED Flashcards
You review a 45-year-old woman who has been admitted feeling generally unwell. Four months ago she had a renal transplant and has since been taking a combination of ciclosporin and mycophenolate for immunosuppression. For the past three days she has had fever, dyspnoea and a dry cough. A chest x-ray shows bilateral interstitial infiltrates. What is the most likely diagnosis?
Graft-versus host disease
Cytomegalovirus pneumonitis
Cell mediated acute transplant rejection
Mycophenolate pneumonitis
Cryptococcus neoformans pneumonia
Cytomegalovirus pneumonitis
A patient who has recently been on a camping holiday comes to see you as she is concerned that she may have developed Lyme disease. Since returning from holiday she has developed a rash and has felt tired and achy. What is the most appropriate investigation to test for Lyme disease?
Skin biopsy
Blood test for serology
Test for urinary antigen
Blood culture
Sputum culture
Blood test for serology
Which one of the following antibiotics is most likely to cause pseudomembranous colitis?
Erythromycin
Trimethoprim
Penicillin V
Doxycycline
Cefaclor
Cefaclor
Cephalosporins, not just clindamycin, are strongly linked to Clostridium difficile
A 54-year-old diabetic female presents with cellulitis of the right foot, spreading from an ulcer overlying the plantar surface of the head of the right third metatarsal. The ulcer had been present for 4 weeks before the onset of cellulitis. She was treated with oral flucloxacillin and the cellulitis improved but after a week of treatment the ulcer was still discharging and on examination there was a tender area of swelling over the ulcer.
What is the most likely explanation?
The strain of the likely causative agent is intrinsically resistant to the antibiotic
The strain of the likely causative agent has developed extrinsic resistance to the antibiotic
The pathology present is not infective in nature
The patient has a collection of pus which requires surgical drainage
The antibiotic is not sufficiently bactericidal for this infection
The patient has a collection of pus which requires surgical drainage
The patient has a collection of pus which requires surgical drainage. The patient most likely has osteomyelitis of his metatarsal. The history of diabetes and a chronic ulcer increase the risk.
A 52-year-old man with a history of alcohol dependence is admitted with fever and feeling generally unwell. An admission chest x-ray shows consolidation in the right upper lobe with early cavitation. What is the most likely causative organism?
Streptococcus pneumoniae
Legionella pneumophilia
Staphylococcus aureus
Klebsiella pneumoniae
Mycoplasma pneumoniae
Klebsiella pneumoniae
Pneumonia in an alcoholic - Klebsiella
A 25-year-old man presents with two day history of fever and arthralgia. On examination a target shaped red rash is seen on his leg. What is the most likely diagnosis?
Legionella
Leptospirosis
Lyme disease
Actinomycosis
Rheumatic fever
Lyme disease
Erythema chronicum migrans is an early feature of Lyme disease
A 45-year-old female presents to the Emergency Department three days after returning from Thailand complaining of severe muscle ache, fever and headache. On examination she has a widespread maculopapular rash. Results show:
Malaria film: negative Hb 16.2 *109 g/dl Plt 96 *109/l WBC 2.4 *109/l ALT 146 iu/l
What is the most likely diagnosis?
Hepatitis A
Japanese encephalitis
Rheumatic fever
Malaria
Dengue fever
Dengue fever
A 58-year-old farmer attends the emergency department with his wife. He has a high fever and is sweating profusely. On examination he has several black blisters which produce foul smelling discharge.
Which of the following organisms is usually associated with this condition?
Group B streptococci
Staphylococcus aureus
Clostridium perfringens
Group A streptococci
Pseudomonas aeruginosa
Clostridium perfringens
Gas gangrene is a life-threatening bacterial infection with gangrene that can cause muscle necrosis, sepsis, gas production and ultimately, death.
There are two main ways that gas gangrene can occur, either traumatic (or surgical) inoculation of a wound with bacteria or spontaneous, often seen in immunocompromised patients.
There are multiple causes of gas gangrene but often clostrida species, particularly clostridium perfringens are implicated. Key features often begin with pain and then become systemic (fever, dehydration). This progresses on to skin changes, which are often seen as blisters which can burst produced a foul smelling discharge. Often crepitus can be heard on movement.
