A 32-year-old man who has recently returned from Nigeria complains of a painful ulcer on his genitals. Upon examination, you observe a lesion that is 1cm x 1cm in size and has a ragged border. Additionally, you notice tender lymphadenopathy in the groin area. What is the probable causative organism?
You are working in a GP surgery and you meet a 25-year-old newly qualified healthcare assistant who has come in to see you as she would like to know more about the BCG vaccination and whether she needs to have it. You advise her that she will need the BCG as she is at risk of occupational exposure. She would also like to know more about who needs to have the BCG vaccination.
Who needs a BCG vaccination assuming they have not had one before?
A 32-year-old female sex worker presents to the emergency department complaining of a high fever and severe headache. During the physical examination, you observe neck stiffness and mild photophobia, prompting you to perform a lumbar puncture. The results of the lumbar puncture reveal the presence of a yeast and a capsule in the CSF stained with India ink.
What is the most probable diagnosis?
A 65-year-old woman presents to the emergency department with a 6 cm erythematous skin lesion on her upper arm after experiencing a high fever of 39ºC, headache, and vomiting for the past 48 hours. A skin biopsy revealed a beta-haemolytic group A streptococcal infection in the upper dermis. What is the most appropriate term to describe this condition?
A 55-year-old rancher presents to the ER with his spouse. He is experiencing a high fever and excessive sweating. During the examination, multiple black blisters are observed, which are producing a malodorous discharge. What is the typical microorganism linked to this ailment?
A 26-year-old man presents to the GUM clinic with penile discharge and dysuria for the past 5 days. Urethral swabs are taken and microscopy reveals the presence of diplococci. Sensitivities are not yet available, and he is diagnosed with gonorrhoea. What is the recommended initial treatment?
A 67-year-old man presents to the emergency department with a productive cough of green sputum. He has a history of COPD and is an active smoker. Upon examination, he is wheezy bilaterally and saturating at 94% on room air. A chest X-ray shows no signs of consolidation. The following blood tests were obtained:
CRP 26 mg/L (< 5)
Na+ 133 mmol/L (135 – 145)
K+ 3.6 mmol/L (3.5 – 5.0)
Bicarbonate 34 mmol/L (22 – 29)
Urea 6 mmol/L (2.0 – 7.0)
Creatinine 100 µmol/L (55 – 120)
What is the most likely causative organism for this clinical presentation?
A 67-year-old woman presents with a 2-week history of frequent loose stools, left iliac fossa discomfort and fever without rectal bleeding.
Three months ago she was treated for confirmed Clostridium difficile infection with oral vancomycin, with a resolution of symptoms.
On examination, her heart rate is 90 bpm, respiratory rate of 18 breaths/min, temperature 37.6ºC and blood pressure of 130/86 mmHg. Her abdomen is generally mildly tender, without guarding.
A repeat stool culture confirms Clostridium difficile infection.
What is the most appropriate treatment for this patient?
A 45-year-old woman visits her primary care physician after being bitten by a tick. She explains that the tick was removed by her husband using tweezers and is worried about the potential for Lyme disease. She reports no symptoms such as rash, headache, fever, lethargy, or joint pain. Her vital signs are normal and a full physical examination reveals no abnormalities. What is the best course of action for management?
You are taking the history of an Emergency Department patient who was assaulted. The victim is a 20-year-old female who has a deep laceration on her thigh caused by a rusty machete. The wound has exposed tendon, muscle, and subcutaneous fat. According to her medical records, she received all her childhood immunizations on schedule, including 5 doses of tetanus vaccine, with the last one administered when she was 16 years old.
What is the appropriate management for tetanus risk in this patient?