Choosing the Right Antibiotic for Epilepsy Patients

When it comes to choosing an antibiotic for patients with epilepsy, it’s important to consider the history of epilepsy. Rifampicin is the best option in this case, although it may reduce the effectiveness of other medications like phenytoin. Ofloxacin is an alternative, but it’s not recommended for patients with epilepsy. Ciprofloxacin is generally preferred for chemoprophylaxis, but it’s contraindicated for patients with epilepsy or conditions that increase the risk of seizures. However, in patients being treated with phenytoin, the benefits may outweigh the risks. It’s crucial to carefully consider the patient’s medical history and medication regimen before selecting an appropriate antibiotic.

Mycoplasma Infection: Diagnosis and Treatment

The symptoms of a young man with a chronic course, less severe chest signs than x-ray appearance, and erythema multiforme suggest mycoplasma infection. However, culture of mycoplasma is difficult, so diagnosis is mainly done through serology and PCR. The incubation period is around three weeks, and the infection is more common in the first two decades of life, especially in summer and autumn. Macrolides like erythromycin or clarithromycin are the primary treatment, with doxycycline as an alternative. With appropriate antibiotics, full recovery without long-term sequelae is expected. For more information on mycoplasma pneumonia, refer to the BMJ Best Practice and Clinical Features and Management articles.

The patient is likely suffering from acute renal colic due to a calcium-containing renal stone. IM diclofenac is the initial step in management, along with increased fluid intake and arranging for a urology opinion. Antispasmodics should not be offered. Assess response to initial treatment and admit if no response within 1 hour. Offer urgent imaging to confirm diagnosis and assess likelihood of spontaneous stone passage. Offer NSAIDs for pain relief, and consider opioids if necessary. Do not offer antispasmodics. Provide written information on renal and ureteric stones.

Prophylactic Antibiotics in Dog Bites

The use of prophylactic antibiotics in dog bites is a controversial topic. However, evidence supports their use in deep wounds, bites to the hands, and signs of infection. It is also important to consider immune compromise as an indication, along with involvement of deep structures such as joints or tendons, or in the presence of prosthetic joints.

For complicated animal bites, including those from cats or humans, co-amoxiclav is recommended as the first-line treatment. It is important to note that the treatment of animal bites, especially those on the hand, may require more than just antibiotics. Seeking the advice of a plastic surgeon for debridement or tendon repair may also be necessary. Proper treatment and care can help prevent further complications and promote healing.

Diagnosis Considerations for a Patient with Anorexia Nervosa

This patient is presenting with anorexia nervosa and self-induced vomiting, which can explain the low levels of sodium, potassium, and alkalosis. It is important to note that hypoalbuminemia may not be present until later stages of the disease.

When considering other potential diagnoses, Addison’s disease can cause hyponatremia and hyperkalemic acidosis, but the patient’s clinical presentation doesn’t align with this diagnosis. Additionally, there is no postural drop in blood pressure, which is not supportive of Addison’s disease.

Cushing’s disease can cause hypokalemic alkalosis, but again, the patient’s presentation doesn’t fit with this diagnosis.

Conn’s syndrome, which is associated with adrenal adenoma, can cause hypertension and hypokalemia. However, this diagnosis is not likely in this case.

In summary, the patient’s symptoms and laboratory results are consistent with a diagnosis of anorexia nervosa with self-induced vomiting.

Lyme Disease: A Tick-Borne Infection

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted through tick bites. The disease was first described in Lyme, Connecticut, USA, and is also prevalent in areas such as the New Forest in Hampshire, UK. Not all patients remember being bitten, so a lack of tick bite history doesn’t rule out the disease.

Symptoms of Lyme disease include lethargy, arthralgia, and cognitive impairment, as well as lymphadenopathy, myocarditis, meningitis, cranial nerve palsies, and neuropathy. The typical rash, erythema chronicum migrans, presents as a papule that develops into a large spreading annular lesion with central fading. This rash can last up to three months, and multiple lesions can develop.

This patient has developed the typical rash and acute illness with a facial nerve palsy and evidence of myocarditis on the background of a trip to an area where infection is endemic. Serological diagnosis is needed to confirm infection, and treatment is with antibiotics active against the causative bacterium. Early treatment is essential, and treatment with antibiotics doesn’t preclude later testing. A common regime is several weeks’ treatment with doxycycline, provided treatment is started early.

Urgent Referral for Painless Visible Haematuria

Male or female patients who present with painless visible haematuria should be referred urgently for specialist assessment. However, if a patient presents with dysuria and visible haematuria, it is important to establish whether there is a urinary tract infection. If an infection is present, it can be treated appropriately, and referral for further investigation of the haematuria may not be necessary.

On the other hand, if an infection is not confirmed, urgent referral is warranted to investigate the haematuria with speed. Therefore, the next most appropriate step is to establish if a urinary tract infection is present. It is crucial to identify the underlying cause of haematuria to ensure prompt and effective treatment. Early referral and assessment can help prevent potential complications and improve patient outcomes.

Assessment and Severity of Acute Asthma

The British Thoracic Society provides clear guidance on the assessment and management of acute asthma. It is important to familiarize oneself with this document, as questions about the assessment and severity of acute asthma are common in exams.

Indicators of acute severe asthma include a peak expiratory flow rate of 33-50% of the patient’s best or predicted rate, a respiratory rate of 25 or greater, a heart rate of 110/min or greater, or the inability to complete sentences in one breath. The goal of oxygen therapy is to maintain SpO2 levels between 94-98%.

It is important to note that there is no fixed numerical peak flow rate for all patients to determine the severity of their asthma. It depends on their personal best reading or predicted peak flow reading. If their actual peak flow is 33-50% of this figure, it is a marker of an acute severe attack.

For example, a peak flow rate of 400 L/min in a patient with a personal best of 500 L/min equates to 80% of their best and would not be considered a marker of an acute severe attack. However, a pulse of 115 would be considered a marker of acute severe asthma because the threshold is 110/min or greater.

If any of these features of an acute severe asthma attack persist after initial treatment, the patient should be admitted.

Assessment and Severity of Acute Asthma

Questions about the assessment and severity of acute asthma are common in exams. To address this, the British Thoracic Society has provided clear guidance on the assessment and management of acute asthma. It is important to familiarize oneself with this document.

Indicators of acute severe asthma include a peak expiratory flow rate of 33-50% of best or predicted, a respiratory rate of 25 or greater, a heart rate of 110/min or greater, or the inability to complete sentences in one breath. The goal of oxygen therapy is to maintain SpO2 at 94-98%.

It is important to note that increasing symptoms is a vague description that only indicates a moderate asthma exacerbation and is not a marker of an acute severe attack. The only indicator of an acute severe asthma attack in this case is the patient’s inability to complete sentences in one breath.

If any of these features of an acute severe asthma attack persist after initial treatment, the patient should be admitted.

Peritonitis in a Patient with Tenckhoff Catheter

This patient has a Tenckhoff catheter in-situ for peritoneal dialysis, which puts them at risk of peritonitis, most commonly caused by Staphylococci. Symptoms such as pyrexia, low BP, tachycardia, and diffuse abdominal pain make peritonitis the most likely answer. Cloudy dialysis fluid is also a common sign of peritonitis.

Aluminium toxicity is now rare due to the removal of aluminium from dialysate, which has reduced the incidence of dialysis dementia. Dialysis disequilibrium syndrome is a phenomenon that occurs with haemodialysis, not peritoneal dialysis, and is characterised by symptoms such as disorientation, headache, blurred vision, nausea, and seizures.

Hernias and exit site infections can develop at the site of the Tenckhoff catheter, but they would not typically cause systemic unwellness such as pyrexia and diffuse abdominal pain. Bowel obstruction can occur secondary to a hernia, but peritonitis is a much more likely answer in this case. Exit site infections are characterised by localised erythema and sometimes pus exudation.