A 48-year-old salesman presents with a 5 day history of cough and pleuritic chest pain. He has no past medical history of note. On examination his temperature is 38.2ºC, blood pressure is 120/80 mmHg, respiratory rate 18/min and pulse 84/min. Auscultation of the chest reveals bronchial breathing in the left base and the same area is dull to percussion.
What is the most suitable management?
Correct Answer A:
Pneumonia: community-acquired:
Community acquired pneumonia (CAP) may be caused by the following infectious agents:
Klebsiella pneumoniae is classically in alcoholics.
Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia.
Characteristic features of pneumococcal pneumonia:
Management:
The British Thoracic Society published guidelines in 2009:
What is the first line treatment in hydatid disease?
Correct Answer D:
Tape worms:
Tape worms are made up of repeated segments called proglottids. These are often present in faeces and are useful diagnostically.
Cysticercosis:
Hydatid disease:
Which one of the following is least likely to result from Streptococcus pyogenes infection?
Correct Answer E: Streptococcus pyogenes rarely causes pneumonia.
Streptococci:
Streptococci are gram-positive cocci. They may be divided into alpha and beta haemolytic types Alpha haemolytic streptococci (partial haemolysis).
The most important alpha haemolytic Streptococcus is Streptococcus pneumoniae(pneumococcus). Pneumococcus is a common cause of pneumonia, meningitis and otitis media. Another clinical example is Streptococcus viridans.
Beta haemolytic streptococci (complete haemolysis):
These can be subdivided into groups A-H. Only groups A, B & D are important in humans.
Group A:
Group B:
Group D:
Which one of the following organisms is most contagious?
Chickenpox:
Chickenpox is caused by primary infection with varicella zoster virus. Shingles is reactivation of dormant virus in dorsal root ganglion.
Chickenpox is highly infectious:
Clinical features (tend to be more severe in older children/adults):
Management is supportive:
A common complication is secondary bacterial infection of the lesions. Rare complications include:
*It was traditionally taught that patients were infective until all lesions had scabbed over.
A 50-year-old sewage worker presents with a one week history of fever and feeling generally unwell.
Which one of the following features would be least consistent with a diagnosis of leptospirosis?
Correct Answer C: Pulmonary complications can occur in leptospirosis but generally happen in severe and late-stage disease.
Severe disease may result in acute respiratory distress syndrome or pulmonary haemorrhage.
Leptospirosis:
Also known as Weil's disease*, leptospirosis is commonly seen in questions referring to sewage workers, farmers, vets or people who work in abattoir. It is caused by the spirochaete Leptospira interrogans (serogroup L icterohaemorrhagiae), classically being spread by contact with infected rat urine. Weil's disease should always be considered in high-risk patients with hepatorenal failure.
Features:
*The term Weil's disease is sometimes reserved for the most severe 10% of cases that are associated with jaundice.
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