A 33-year-old woman who was diagnosed as having HIV-1 two years ago is reviewed in clinic. She is fit and well currently and has no symptoms of note. The only medication she takes is the occasional paracetamol for tension headaches. Her latest blood tests are as follows:
What is the most appropriate action?
Correct Answer D: Start anti-retrovirals in HIV when CD4 < 350 * 106/l
HIV: anti-retrovirals: Highly active anti-retroviral therapy (HAART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging.
Nucleoside analogue reverse transcriptase inhibitors (NRTI):
Non-nucleoside reverse transcriptase inhibitors (NNRTI):
Protease inhibitors (PI):
A 19-year-old student is brought to the Emergency Department by friends due to a severe headache and drowsiness. On examination he has a widespread purpuric rash. Meningococcal infection is strongly suspected but he is known to be penicillin allergic (previous anaphylaxis).
What is the antibiotic of choice?
Correct Answer A:
Meningitis: management: Investigations suggested by NICE:
Lumbar puncture if no signs of raised intracranial pressure.
Management: All patients should be transferred to hospital urgently. If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected then intramuscular benzylpenicillin may be given, as long as this doesn't delay transit to hospital.
BNF recommendations on antibiotics:
If the patient has a history of immediate hypersensitivity reaction to penicillin or to cephalosporins the BNF recommends using chloramphenicol.
Management of contacts:
A 43-year-old man from South Africa is reviewed in clinic. He has recently started treatment for tuberculosis but is complaining of a deterioration in his vision.
Which one of the following drugs is most likely to cause decreased visual acuity?
Correct Answer D: Optic neuritis is common in patients taking ethambutol.
Isoniazid may also cause optic neuritis but it is not as common a cause as ethambutol.
Tuberculosis: drug side-effects: Common side effects:
Rifampicin:
Isoniazid:
Pyrazinamide:
Ethambutol:
Which one of the following statements is true regarding Listeria monocytogenes?
Correct Answer E:
Listeria: Listeria monocytogenes is a Gram positive bacillus which has the unusual ability to multiply at low temperatures.
It is typically spread via contaminated food, typically un-pasteurised dairy products. Infection is particularly dangerous to the unborn child where it can lead to miscarriage.
Features - can present in a variety of ways:
Suspected Listeria infection should be investigated by taking blood cultures. CSF may reveal a pleocytosis, with 'tumbling motility' on wet mounts.
Management:
Following a diagnosis of tetanus, what is the most appropriate antibiotic therapy to give with human tetanus immunoglobulin?
Correct Answer D:
Tetanus: Tetanus is caused by the tetanospasmin exotoxin released from Clostridium tetani. Tetanus spores are present in soil and may be introduced into the body from a wound, which is often unnoticed. Tetanospasmin prevents release of GABA.
Features:
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