Which one of the following congenital infections is most characteristically associated with sensorineural deafness?
Correct Answer C:
Congenital rubella:
Congenital infections:
The major congenital infections encountered in examinations are rubella, toxoplasmosis and cytomegalovirus.
Cytomegalovirus is the most common congenital infection in the UK. Maternal infection is usually asymptomatic.
Congenital infections characteristic features:
A 31-year-old man who is known to be HIV positive presents with dyspnoea and a dry cough. He is currently homeless and has not been attending his outpatient appointments or taking antiretroviral medication.
Clinical examination reveals a respiratory rate of 24 / min. Chest auscultation is unremarkable with only scattered crackles. His oxygen saturation is 96% on room air but this falls rapidly after walking the length of the ward.
Given the likely diagnosis, what is the most appropriate first-line treatment?
Correct Answer B:
HIV: Pneumocystis jiroveci pneumonia: Whilst the organism Pneumocystis carinii is now referred to as Pneumocystis jiroveci, the term Pneumocystis carinii pneumonia (PCP) is still in common use:
Features:
Extrapulmonary manifestations are rare (1-2% of cases), may cause:
Investigation:
Management:
A 19-year-old man presents with a compound fracture of his leg following a fall from scaffolding. Examination reveals soiling of the wound with mud. He is sure he has had five previous tetanus vaccinations.
What is the most appropriate course of action to prevent the development of tetanus?
Correct Answer A: A soiled, compound fracture is regarded as high-risk for tetanus and intramuscular human tetanus immunoglobulin should be given. There is a role for antibiotics given the soiled wound although benzylpenicillin would not be the drug of choice.
Tetanus: vaccination: The tetanus vaccine is a cell-free purified toxin that is normally given as part of a combined vaccine.
Tetanus vaccine is currently given in the UK as part of the routine immunization schedule at:
This therefore provides 5 doses of tetanus-containing vaccine. Five doses is now considered to provide adequate long-term protection against tetanus.
Intramuscular human tetanus immunoglobulin should be given to patients with high-risk wounds (e.g. Compound fractures, delayed surgical intervention, significant degree of devitalized tissue) irrespective of whether 5 doses of tetanus vaccine have previously been given.
If vaccination history is incomplete or unknown then a dose of tetanus vaccine should be given combined with intramuscular human tetanus immunoglobulin for high-risk wounds.
A 44-year-old farmer presents with headache, fever and muscle aches. He initially thought he had a bad cold but his symptoms have got progressively worse over the past week. During the review of systems he reports nausea and a decreased urine output. On examination his temperature is 38.2ºC, pulse 102 / min and his chest is clear.
Subconjunctival haemorrhages are noted but there is no evidence of jaundice.
What is the most likely diagnosis?
Correct Answer E: The main clue in the question is the patients occupation. Mycoplasma and Legionella are less likely due to the absence of chest symptoms and signs. Liver failure is seen in only 10% of patients with leptospirosis.
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 be considered in high-risk patients with hepatorenal failure.
*The term Weil's disease is sometimes reserved for the most severe 10% of cases that are associated with jaundice.
A 57-year-old female presents with headache and fever to the Emergency Department. On examination neck stiffness is noted along with a positive Kernig's sign. A lumbar puncture is performed and reported as follows:
What is the most likely causative organism?
Correct Answer E:
Classification of bacteria:
Remember:
Therefore, only a small list of Gram positive rods (bacilli) need to be memorized to categorize all bacteria -mnemonic = ABCD L:
Remaining organisms are Gram negative rods.
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