Which one of the following is the most common cause of visceral larva migrans?
Correct Answer D:
Nematodes: Ancylostoma braziliense:
Strongyloides stercoralis:
Toxocara canis:
A 7-year-old male presents with generalized lymphadenopathy.
Which one of the following is least likely to result in this presentation?
Correct Answer A: Kawasaki disease causes only cervical lymphadenopathy.
Lymphadenopathy:
There are many causes of generalized lymphadenopathy.
Infective:
Neoplastic:
Others:
A 23-year-old male presents with a purulent urethral discharge. A sample of the discharge is shown to be a Gram negative diplococcus.
What is the most appropriate antimicrobial therapy?
Correct Answer E: Cephalosporins are now the treatment of choice for Gonorrhoea.
Ciprofloxacin should only be used if the organism is known to be sensitive due to increasing resistance.
Penicillin, previously first-line treatment, is rarely used now due to widespread resistance.
Gonorrhoea: Gonorrhoea is caused by the Gram negative diplococcus Neisseria gonorrhoea. Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx. The incubation period of gonorrhoea is 2-5 days.
Features:
Management:
Disseminated gonococcal infection (DGI) and gonococcal arthritis may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults. The pathophysiology of DGI is not fully understood but is thought to be due to haematogenous spread from mucosal infection (e.g. Asymptomatic genital infection). Initially there may be a classic triad of symptoms: tenosynovitis, migratory polyarthritis and dermatitis. Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome).
Key features of disseminated gonococcal infection:
A 43-year-old man from Sierra Leone presents with a flu-like illness. On examination he has very large posterior cervical lymph nodes. A diagnosis of African trypanosomiasis is confirmed on blood smear.
What is the most appropriate treatment?
Correct Answer E:
Trypanosomiasis:
Two main form of this protozoal disease are recognized:
Two forms of African trypanosomiasis, or sleeping sickness, are seen - Trypanosoma gambiense in West Africa and Trypanosoma rhodesiense in East Africa. Both types are spread by the tsetse fly. Trypanosoma rhodesiense tends to follow a more acute course. Clinical features include:
American trypanosomiasis, or Chagas' disease, is caused by the protozoan Trypanosoma cruzi. The vast majority of patients (95%) are asymptomatic in the acute phase although a chagoma (an erythematous nodule at site of infection) and periorbital oedema are sometimes seen. Chronic Chagas' disease mainly affects the heart and gastrointestinal tract:
A 39-year-old man with HIV is admitted due to shortness of breath. Chest x-ray shows bilateral pulmonary infiltrates and Pneumocystis carinii pneumonia is suspected.
What type of staining should be applied to the bronchoalveolar lavage to demonstrate the organism?
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.
Extrapulmonary manifestations are rare (1-2% of cases), may cause:
Investigation:
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