PM Notes Flashcards
fever, rash, relative bradycardia and abdominal pain plus leukopaenia and raised transaminases in a returning traveller are suggestive of a diagnosis of [] fever, which is caused by []
fever, rash, relative bradycardia and abdominal pain plus leukopaenia and raised transaminases in a returning traveller are suggestive of a diagnosis of typhoid (enteric) fever, which is caused by Salmonella typhi.
A patinet has returned from his travels and comes to you because hes worried about spots that have developed on his chest.
Upon examination you notice he is bradycardic and has a fever.
What is the most likely diagnosis?
How would you treat?
The rash is termed ‘rose spots’ and is seen in both typhoid and paratyphoid fever.
Treatment is 14 days of oral fluoroquinolone (ciprofloxacin) or IV ceftriaxone in severe disease.
A 24 year old male presents to the GP practice after suffering from shingles affecting his T3 dermatome. The scab has now crusted over. He describes a burning type pain over the affected area. Regular paracetamol and ibuprofen have not helped.
All his observations are stable and on examination he looks well but is in significant discomfort.
What is the next best step in the management of this patient?
gabapentin and pregabalin
Which of the following drugs is most likely responsible for his liver function derangement?
Ethambutol
Pyrazinamide
Streptomycin
Rifampicin
Isoniazid
Pyrazinamide is most commonly associated with the side effect of liver enzyme derangement.
On examination she has a soft but tender abdomen, and there are multiple salmon-coloured spots on her abdomen. Her temperature is 39.5°C.
Which of the following is the most likely organism responsible for her illness?
Clostridium difficile
1
Escherichia coli
2
Salmonella typhi
3
Shigella dysenteriae
4
Vibrio cholerae
On examination she has a soft but tender abdomen, and there are multiple salmon-coloured spots on her abdomen. Her temperature is 39.5°C.
Which of the following is the most likely organism responsible for her illness?
Clostridium difficile
1
Escherichia coli
2
Salmonella typhi
3
Shigella dysenteriae
4
Vibrio cholerae
A 35-year-old man presents with watery diarrhoea, vomiting and a low-grade fever after recently travelling to a developing country. Stool examination shows comma-shaped gram-negative bacilli.
What is the most likely diagnosis?
Shigella
1
Campylobacter
2
Cholera
3
Norovirus
4
C.difficile
A 35-year-old man presents with watery diarrhoea, vomiting and a low-grade fever after recently travelling to a developing country. Stool examination shows comma-shaped gram-negative bacilli.
What is the most likely diagnosis?
Shigella
1
Campylobacter
2
Cholera
3
Norovirus
4
C.difficile
A 34-year-old man presents with fever, chills and worsening erythema around his recent surgical wound. Blood cultures grow coagulase-negative staphylococci.
What is the recommended treatment?
Co-amoxiclav
Daptomycin
Ceftriaxone
Vancomycin
Metronidazole
Vancomycin
Vancomycin is the recommended empiric therapy for severe infections in the setting of a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant CoNS.
A 45-year-old male presents with a productive cough, chest pain and fever. Chest X-ray shows a cavity in the right lung. Sputum culture grows gram-positive cocci in clusters.
Which of the following is the most likely organism causing the lung cavity?
Staphylococcus aureus
Mycobacterium tuberculosis
Pseudomonas aeruginosa
Klebsiella pneumoniae
Aspergillus fumigatus
A 45-year-old male presents with a productive cough, chest pain and fever. Chest X-ray shows a cavity in the right lung. Sputum culture grows gram-positive cocci in clusters.
Which of the following is the most likely organism causing the lung cavity?
Staphylococcus aureus
Mycobacterium tuberculosis
Pseudomonas aeruginosa
Klebsiella pneumoniae
Aspergillus fumigatus
A 22-year-old male presents with a sore throat and fatigue for the past week. Physical examination is significant for tonsillar enlargement with exudates. Laboratory results show elevated liver enzymes and a positive heterophile antibody test.
What is the most likely cause of this patient’s symptoms?
Streptococcus pyogenes
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Influenza virus
Adenovirus
Epstein-Barr virus (EBV)
EBV is a common cause of infectious mononucleosis which typically affects young adults. Common symptoms include sore throat, fatigue, lymphadenopathy, hepatosplenomegaly and rash. Investigations may show elevated liver enzymes, leukocytosis and a positive heterophile antibody test - also known as the Monospot test. Treatment is typically supportive and includes rest, hydration and paracetamol for pain and fever relief.
A 29 year old woman has nausea and fatigue and appears jaundiced. She is 28 weeks pregnant with her first child. She appears confused. Her husband reports attending a family BBQ last month. She deteriorates over the next few days and unfortunately dies.
What is the most likely diagnosis?
Hep E
A 4-year-old girl is brought to the acute afternoon GP clinic by her mother. She reports a two-hour history of extensive vomiting and diarrhoea. The mother reports that her daughter was her normal self this morning, and attended a birthday party at a friend’s house where she ate home-made sandwiches and cupcakes for lunch. The patient is diagnosed with infective gastroenteritis.
What is the most likely causative organism?
Giardia lamblia
Escherichia coli
Salmonella enterica
Staphylococcus aureus
Campylobacter jejuni
Staphylococcus aureus gastroenteritis is associated with a rapid onset (often only several hours) and home-made foods and dairy products. Both of these features are present here making this the most likely causative organism.
How do you differeniate between food poisoining from Staph. aureus vs Salmonella enterica? [1]
Salmonella enterica has an intubation period of 12 hours to three days
Staphylococcus aureus gastroenteritis is associated with a** rapid onset (often only several hours)**
Describe the treatment regime for Group A strep sore throat [3]
- Phenoxymethylpenicillin 500mg TDS
- Erythromycin 500mg QDS
[] causes a gastroenteritis that may mimic appendicitis. It may last between one and three weeks. It is often caught by eating undercooked pork
Yersinia enterocolitica
How do you uncomplicated [1] and complicated [1] shingles?
Uncomplicated: reassurance
Complicated: acyclovir
Describe the test used to differentiate dengue fever from acute gastroenteritis [1]
The positive tourniquet test:
- inflating a blood pressure cuff to midway between systolic and diastolic for 5 minutes. You then look to see if there are ten or more petechiae per inch squared. If there are, it is a positive test and dengue is suspected
A 28 year old man presents to A+E after mild vomiting and diarrhoea for 24 hours. Whilst he cannot tolerate food, he is able to tolerate small amounts of fluid. On further questioning he says he had a barbecue yesterday with his family which consisted of chicken and beef.
His observations are as follows RR- 18 02 sats-97% HR 80 BP 130/78 Temp 37.4. Clinically, he appears euvolaemic.
What is the next best step in the management of this patient?
Ceftriaxone and Metronidazole orally
Oral rehydration salts
Benzylpenicillin orally
IV 500ml 0.9% sodium chloride
Intravenous Ciprofloxacin
Oral rehydration salts
This is likely to be a simple episode of gastroenteritis, most probably caused by Campylobacter jejuni. This is commonly acquired due to undercooked poultry. This patients observations are stable and he is not showing any signs of shock or severe infection. Therefore he would not require antibiotics or intravenous fluid resuscitation at present, as this will likely resolve on its own
A 50-year-old male presents to the emergency department with fever and lethargy. He has also complained of backache and weight loss over the last 2-3 months. He works as a farmer. On examination, he has a new heart murmur and palpable hepatosplenomegaly. An echocardiogram is performed, which reveals vegetations on the aortic valve, and initial blood cultures are negative.
What is the likely organism responsible?
Staphylococcus
Clostridium
Candida
Pseudomonas
Brucella
Brucellosis is a zoonotic infection, and high-risk occupations include farmers and vets. The symptoms are often vague, and complications include subacute and infective endocarditis, which is likely in this case. This form of infective endocarditis is often culture-negative.
What would indicate a postive mantoux test? [1]
a positive result would have been 5mm or more
This bacteria is the most common cause of food poisoning in the UK
Campylobacter jejuni
Which contanimated food substances are associated with gastroenteritis from 1. Campylobacter jejuni, 2. Staphylococcus aureus and 3. Bacillus cereus
Describe what the effect might be on a patient with regards to symptoms for each?
Campylobacter jejuni:
- chicken
- bloody & mucus diarrhoea
Staph aureus:
- milk products or hand-prepared foods such as sandwiches, puddings, pastries and sliced meats
- vomiting and non-bloody diarrhoea
Bacillus cereus:
- reheated rice
- vomiting
A 37 year old female presents to the clinic with a 4-week history of fevers, night sweats, myalgia and joint pain affecting the hips and lower back. She has no past medical history, has no allergies, and works as a research assistant in a veterinary laboratory. She has had no recent travel abroad.
What is the most likely reason for her PUO? [1]
Brucellosis
This patient has presented with a Pyrexia of Unknown Origin (PUO), in addition to non-specific systemic symptoms and hepatosplenomegaly. As a research assistant in a veterinary laboratory, this suggests she has contact with animals, dead meat and/or bodily samples. She is therefore at risk of Brucellosis, and her symptoms correlate with this diagnosis. Blood culture will be needed to confirm this diagnosis. Other classical clues in questions relating to brucellosis include work in abattoirs or consumption of unpasteurized dairy products in high risk countries
What is the treatment for Eron class I cellulitis [1]
What is the second line or if they are CI to ^?[2]
oral flucloxacillin as first-line treatment for mild/moderate cellulitis
oral clarithromycin, erythromycin (in pregnancy) or doxycycline is recommended in patients allergic to penicillin
flucloxacillin cellulitis
Management is guided by the Eron classification for cellulitis.
What is the treatment for Eron Class III-IV cellulitis? [3]
NICE recommend: oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
