A 12-year-old girl is prescribed oseltamivir for suspected influenza.
What is the mechanism of action of oseltamivir?
Correct Answer C:
H1N1 influenza pandemic:
The 2009 H1N1 influenza (swine flu) outbreak was first observed in Mexico in early 2009. In June 2009, the WHO declared the outbreak to be a pandemic.
H1N1:
The H1N1 virus is a subtype of the influenza A virus and the most common cause of flu in humans. The 2009 pandemic was caused by a new strain of the H1N1 virus.
The following groups are particularly at risk:
Features:
The majority of symptoms are typical of those seen in a flu-like illness:
A minority of patients may go on to develop an acute respiratory distress syndrome which may require ventilator support.
Treatment:
There are two main treatments currently available:
1- Oseltamivir (Tamiflu):
2- Zanamivir (Relenza):
*Intravenous preparations are available for patients who are acutely unwell.
A 29-year-old HIV positive man is admitted with right-sided hemiplegia. For the past four days he has been complaining of headache and flu-like symptoms. CT scan shows multiple ring enhancing lesions. A diagnosis of cerebral toxoplasmosis is suspected.
What is the most suitable management?
Correct Answer D:
Toxoplasmosis:
Toxoplasma gondii is a protozoa which infects the body via the GI tract, lung or broken skin. It's oocysts release trophozoites which migrate widely around the body including to the eye, brain and muscle. The usual animal reservoir is the cat, although other animals such as rats carry the disease.
Most infections are asymptomatic. Symptomatic patients usually have a self-limiting infection, often having clinical features resembling infectious mononucleosis (fever, malaise, lymphadenopathy).
Other less common manifestations include meningio-encephalitis and myocarditis.
Investigation:
Treatment is usually reserved for those with severe infections or patients who are immunosuppressed:
Congenital toxoplasmosis is due to transplacental spread from the mother. It causes a variety of effects to the unborn child including microcephaly, hydrocephalus, cerebral calcification and choroidoretinitis.
A 22-year-old female presents with an offensive vaginal discharge. History and examination findings are consistent with a diagnosis of bacterial vaginosis.
What is the most appropriate initial management?
Correct Answer C: Bacterial vaginosis: oral metronidazole.
Bacterial vaginosis: Bacterial vaginosis (BV) describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.
Whilst BV is not a sexually transmitted infection it is seen almost exclusively in sexually active women.
Amsel's criteria for diagnosis of BV - 3 of the following 4 points should be present:
Management:
Bacterial vaginosis in pregnancy:
A 29-year-old woman presents to the genitourinary medicine clinic for treatment of recurrent genital warts.
Which one the following viruses are most likely to be responsible?
Correct Answer C: Genital warts - 90% are caused by HPV 6 & 11
Types 6 and 11 are responsible for 90% of genital warts cases.
Genital warts: Genital warts (also known as condylomata accuminata) are a common cause of attendance at genitourinary clinics. They are caused by the many varieties of the human papilloma virus HPV, especially types 6 & 11. It is now well established that HPV (primarily types 16,18 & 33) predisposes to cervical cancer.
Which one of the following vaccines uses an inactivated preparation of the organism or virus?
Vaccinations:
It is important to be aware of vaccines which are of the live-attenuated type as these may pose a risk to immunocompromised patients. The main types of vaccine are as follows:
Live attenuated:
Inactivated preparations:
Detoxified exotoxins:
Extracts of the organism/virus (sometimes termed fragment)**:
Notes:
*whole cell typhoid vaccine is no longer used in the UK
**May also be produced using recombinant DNA technology
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