A 44-year-old farmer presents to the Emergency Department due to a high temperature and confusion. On examination his pulse is 124 bpm, blood pressure 84/56 mmHg and temperature 39.8ºC. He has a generalized erythematous rash which is starting to desquamate on his palms and is also noted to have a paronychial infection of a fingernail on the left hand.
What is the most likely diagnosis?
Correct Answer C:
Staphylococcal toxic shock syndrome: Staphylococcal toxic shock syndrome describes a severe systemic reaction to staphylococcal exotoxins. It came to prominence in the early 1980's following a series of cases related to infected tampons.
Centers for Disease Control and Prevention diagnostic criteria:
A 45-year-old man presents to the Emergency Department due to severe pain in the perineal area over the past 6 hours. On examination the skin is cellulitic, extremely tender and haemorrhagic bullae are seen.
What is the most appropriate management?
Correct Answer A: Surgical referral is the single most important step in the management of necrotizing fasciitis. There has been little change in the mortality of necrotizing fasciitis since the introduction of antibiotics.
Necrotizing fasciitis:
Necrotizing fasciitis is a medical emergency that is difficult to recognize in the early stages It can be classified according to the causative organism:
Features:
Management:
Which one of the following features is least likely to occur in a patient with visceral leishmaniasis?
Correct Answer B: The most common symptoms seen in patients with visceral leishmaniasis are pyrexia, splenomegaly (which is often massive), weight loss and night sweats. Pancytopaenia occurs secondary to hypersplenism. Diarrhoea is not a typical feature.
Leishmaniasis: Leishmaniasis is caused by the intracellular protozoa Leishmania, usually being spread by sand flies. Cutaneous, mucocutaneous leishmaniasis and visceral forms are seen.
Cutaneous leishmaniasis:
Mucocutaneous leishmaniasis:
Visceral leishmaniasis (kala-azar):
*occasionally patients may report increased appetite with paradoxical weight loss.
You attend a meeting with the hospital management. There is currently an increased incidence of MRSA septicaemia in the hospital and a strategy is being drawn up to tackle this.
What is the most effective single step to reduce the incidence of MRSA?
Correct Answer B: Whilst tackling MRSA requires a multi-pronged approach the evidence base demonstrates that hand hygiene is the single most important step.
MRSA: Methicillin-resistant Staphylococcus aureus (MRSA) was one of the first organisms which highlighted the dangers of hospital-acquired infections.
Who should be screened for MRSA?
How should a patient be screened for MRSA?
Suppression of MRSA from a carrier once identified:
The following antibiotics are commonly used in the treatment of MRSA infections:
Some strains may be sensitive to the antibiotics listed below but they should not generally be used alone because resistance may develop:
Relatively new antibiotics such as linezolid, quinupristin/dalfopristin combinations and tigecycline have activity against MRSA but should be reserved for resistant cases.
A newly qualified staff nurse at the local hospital undergoes vaccination against hepatitis B. The following results are obtained three months after completion of the primary course:
What is the most appropriate course of action?
Correct Answer D:
Hepatitis B: Hepatitis B is a double-stranded DNA virus and is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child. The incubation period is 6-20 weeks.
Immunization against hepatitis B (please see the Green book link for more details):
Complications of hepatitis B infection:
Management of hepatitis B:
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