MRCEM 2 Category: Infectious Diseases

mrcem2-0908

A 45 year old patient is brought to the emergency department (ED) by a family member. The patient began experiencing coughing symptoms ten days ago, but within the past 48 hours, they have developed a high fever, difficulty breathing during mild exertion, and the family reports that the patient appears confused. It is noted that the patient is currently taking azathioprine for the treatment of rheumatoid arthritis.

Upon assessing the patient’s vital signs, you decide to initiate the sepsis 6 pathway. What is the recommended timeframe for implementing the ‘sepsis six’?

mrcem2-0909

A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
Based on the NICE traffic light system, which of the subsequent symptoms or signs are indicative of an intermediate-risk of a severe illness?

mrcem2-0910

A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
Based on the NICE traffic light system, which of the subsequent symptoms or signs indicate a high risk of a severe illness?

mrcem2-0911

A 2-year-old toddler is brought to the Emergency Department by his father with a high temperature. NICE suggests using the traffic light system to evaluate the likelihood of a severe illness in children under 3 with a fever.
Based on the NICE traffic light system, which of the subsequent symptoms or signs indicate a low risk of a serious illness?

mrcem2-0912

A 28 year old IV drug user comes to the emergency department with complaints of feeling sick. Considering the history of IV drug abuse, there is concern for infective endocarditis. Which structure is most likely to be impacted in this individual?

mrcem2-0913

A traveler contracts a viral haemorrhagic fever while on a backpacking adventure during their gap year.
Which of the following is NOT a viral haemorrhagic fever?

mrcem2-0914

A 35-year-old individual presents to the emergency department complaining of progressive weakness and numbness over the past few days. The patient reports initially experiencing numbness in both feet, which has gradually extended up to the knees. Additionally, there is weakness in both legs and numbness in the fingertips that appeared earlier today. The patient has no regular medication and is generally in good health. However, about three weeks ago, during a trip to India, the patient suffered from a week-long illness characterized by watery, occasionally bloody, diarrhea and abdominal cramps, which have completely resolved. What is the most likely causative organism?

mrcem2-0915

A 25-year-old bartender presents to the emergency department complaining of feeling unwell for the past week. He has been experiencing muscle aches, headaches, and fatigue. This morning, he woke up with a severely sore throat and noticed the presence of pus in the back of his throat. Upon examination, the patient has a temperature of 38.4ºC and both tonsils are covered in white exudate. Additionally, he has tender enlarged cervical lymph nodes and tenderness in the left and right upper quadrants of his abdomen, with a palpable liver edge.

What is the most likely cause of this patient’s symptoms?

mrcem2-0916

A 75 year old man is brought into the emergency room by ambulance. He started with a cough about a week ago but now appears somewhat confused and drowsy. His vital signs are as follows:

Temperature: 37.9ºC
Blood pressure: 98/65 mmHg
Respiration rate: 22 rpm
Pulse rate: 105 bpm
Blood glucose: 6.9 mmol/l
SpO2: 91% on air rising to 96% on 2L oxygen

Which of the above parameters, if any, would be a cause for concern indicating sepsis?

mrcem2-0917

A 36 year old man has arrived at the Emergency Department seeking treatment for a deep cut on his leg. He is by himself, and before examining the wound, he warns you to ‘be careful’ and reveals that he recently tested positive for HIV. He suspects that he contracted the virus after engaging in an extramarital affair. The nurse then approaches and asks if it is permissible for his wife to enter the room. He informs you that his wife is unaware of his diagnosis and he wishes to keep it that way. You observe that his wife appears to be in the early stages of pregnancy.
In addition to providing appropriate medical care for the wound, what steps should you take?