A 60-year-old man with a past medical history of osteoarthritis presents with a swollen, red and hot left knee joint. He is unable to move it due to the pain. On examination he is pyrexial with a temperature of 38.7 C and a blood sample shows a white cell count of 22.8 *109/l.
Following joint aspiration, what is the most appropriate antibiotic therapy?
Correct Answer C: Septic arthritis: IV flucloxacillin.
Septic arthritis:
Overview:
Management:
A 27-year-old pregnant woman is found to have Chlamydia.
What is the most appropriate treatment?
Correct Answer C: Erythromycin or amoxicillin is currently recommended for pregnant or breast feeding women. The efficacy of amoxicillin, often assumed to be ineffective against Chlamydia, was supported in a recent Cochrane review. A test of cure should be carried out following treatment.
Chlamydia: Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia. The incubation period is around 7-21 days, although it should be remembered a large percentage of cases are asymptomatic.
Features:
Potential complications:
Investigation:
Screening:
A 43-year-old sheep farmer presents with a lesion on his right hand. It initially started as a small, raised, red papule but has now become larger. On examination a 2cm, flat-topped haemorrhagic lesion is seen.
What is the most likely diagnosis?
Correct Answer A:
Orf: Orf is generally a condition found in sheep and goats although it can be transmitted to humans. It is caused by the parapox virus.
In animals:
In humans:
A 35-year-old woman is referred to hospital. As part of a liver screen the following results are obtained:
Anti-HBs = Hepatitis B Surface Antibody; Anti-HBc = Hepatitis B Core Antibody; HBs antigen = Hepatitis B Surface Antigen
What is the patient's hepatitis B status?
Correct Answer D: The negative IgM anti-HBc points to a chronic rather than acute infection.
Hepatitis B serology:
Interpreting hepatitis B serology is a dying art form which still occurs at regular intervals in medical exams. It is important to remember a few key facts:
Example results:
A 23-year-old man is admitted to the Emergency Department with an evolving purpuric rash, pyrexia and confusion. His GP had given him intramuscular benzylpenicillin in the surgery and dialled 999.
Which one of the following investigations is most likely to reveal the diagnosis?
Correct Answer B: The blood cultures are likely to be negative as antibiotics have already been given. PCR has a sensitivity of over 90%.
Meningococcal septicaemia: investigations:
Meningococcal septicaemia is a frightening condition for patients, parents and doctors. It is associated with a high morbidity and mortality unless treated early - meningococcal disease is the leading infectious cause of death in early childhood. A high index of suspicion is therefore needed. Much of the following is based on the 2010 NICE guidelines.
Presentation of meningococcal disease:
Investigations:
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