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Treatment for urethral swabs showing chlamydia?
The treatment of chlamydial urethritis is with doxycycline 100mg bd for seven days or 1g of azithromycin stat
A 16-year-old boy who presents with epididymitis. Urethral swabs show Gram negative diplococci. What is likely? and what is tx?
This is a classic presentation of genital gonorrhoea and the treatment is low dose ceftriaxone (250 mg of ceftriaxone rather than 500 mg IM stat)
A 27-year-old lady with an offensive vaginal discharge. Culture reveals Gardnerella. What is it? what is tx?
bacterial vaginosis and tx is a single 2g dose of metronidazole or one week's course of metronidazole 400mg 12 hourly for five days.
A 23-year-old lady with poorly controlled type 1 diabetes who develops vulvovaginal candidiasis. What is tx?
The treatment of vaginal candidiasis is with a single 150 mg dose of fluconazole or seven days of nystatin pessaries.
A 30-year-old man with a painless ulcer on the shaft of the penis. Dark background microscopy showsTreponema pallidum. What is it? what is tx?
- The treatment of primary and secondary syphillis is with 600 000 U IM of procaine penicillin for a total of 10 days.
What do you call nail hypertrophy that typically resembels a rams horn?
What can amphetamines such as dexamphetamine and methyl phenidate be used in? and what are the side effects?
- In the treatment of certain behavioural problems such as attention deficit hyperactivity disorder (ADHD).
- They are associated with many side effects;
What are oestradiol and gonadotrophin levels like in primary (premature) ovarian failure?
The low oestradiol with elevated LH and FSH indicates primary ovarian failure
Erythema Nodusum is associated with what conditions?
- Ulcerative colitis
- Crohns disease
- Acute Sarcoidosis
- Bacterial infections due to mycobacterium (primary TB, leprosy)
- Streptococcal infection
- Rheumatic fever
- Drugs such as sulphonamides, penicillin, oral contraceptive pill (OCP), codeine, salicylates, barbiturates, especially Co-trimoxazole (combination of trimethoprim and the sulphonamide, sulphamethoxazole)
Pyoderma gangrenosum is seen in what conditions?
- Crohns disease
- Ulcerative colitis
- Autoimmune hepatitis
- Wegeners granulomatosis
Pyoderma ganagrenosum are recurring nodulo-pustular ulcers, with tender red/blue overhanging necrotic edge, healing with cribriform scars. They are commonly seen in leg, abdomen and face.
What diseae is Necrobiosis lipoidica associated with?
Diabetes. It is a shiny area on shin with yellowish skin and telangiectasia.
Descibe tetralogy of fallot?
- Ventricular septal defect
- Narrowing of the pulmonary outflow tract (pulmonary infundibular stenosis)
- Overiding aorta
- Right ventricular hypertrophy
Cyanosis usually presents at 3-6 months of age.The ECG should show right ventricular hypertrophy in this condition.Squatting is a characteristic clinical sign. Ejection murmur of pulmonary stenosis
Is mycobacterium tubercolosis a motie bacillus? forms spores? stains with what? aerobic/anaerobic? shape?
MTB is one of many aerobic, rod shaped, immotile mycobacterium (avium, leprae, bovis) that are acid fast. Mycobacterium species, along with members of a related genus Nocardia, are classified as acid-fast bacteria due to their impermeability by certain dyes and stains. They are typically stained by the Ziehl-Neelsen stain. Infection produces both humoral and cell mediated (mostly) immunity. MTB produces spores
A prolonged bout of vomiting is associated with?
- Tetany - caused by metabolic alkalosis
- Hypochlorhydria -if acid is vomited then les retains in the stomach
- Hypokalaemia - gastric loss and from kidney because of lack of competition of H+ ions
- High serum aldosterone to preserve salt and water
Even in bulimia if there is an anaemia it is usually normochromic normocytic (and iron deficient).
Drug tx for chlamydia ?
arithromycin 1g stat
Classical symptoms of normal pressure hydrocephalus?
wet, wobbly and weird
- urinary incontinence
- gait disturbance (apraxia: "glued-to-the-floor" sign)
CT scan shows enlarged ventricles disproportionate to the degree of cortical atrophy. CSF pressure is characteristically normal.
There is an association between postmenopausal bleeding and?
Benign teratoma of the ovary (germ cell tumours have a bimodal distribution), tamoxifen therapy and the admission of anticoagulants
Complication of Escherichia coli in children?
Haemolytic Uraemic Syndrome (form of renal failure)
Whats in CSF of pt with Neiserria menigitidis?
increased polymorphs, turbid appearance (cloudy) and a high protein count would be expected
causative agent of rheumatic fever?
Rheumatic fever results from immune-mediated post Group A streptococcal infection, Streptococcus pyogenesbeing a common pathogen. Mitral regurg is associated with rheumatic fever
CMV infection is associated with what in newborn?
Congenital CMV infection is associated with petechiae, choroidoretinitis, hepatosplenomegaly, intracerebral calcification which may lead to CNS damage with long term sequaelae.
Describe the murmur in the following case?
A 25-year-old woman is noticed to have a murmur during pregnancy, which is still present six months after she has delivered.There is no past medical history. There is a mild parasternal lift. The chest x ray shows a normal heart size, but there is pulmonary plethora.
This case history would suggest a ventricular septal defect (VSD) (the pulmonary plethora and parasternal heave suggest this, more so than atrial septal defect [ASD]) and a systolic murmur over the fourth intercostal space (ICS) may be audible.
Describe the murmur in the following case? A 61-year-old woman has been taking warfarin since she had a stroke at the age of 52 years, from which she has made a good recovery. She is in New York Heart class 2. She has a parasternal lift, and a loud first heart sound. The chest x ray shows left atrial enlargement.
This woman has mitral stenosis, and a mid-diastolic murmur would be expected.
Describe the murmur in the following case? A 47-year-old man has been unwell for five months, with lethargy, weight loss and night sweats. For one week he has been breathless when lying flat. The apical impulse is displaced and forceful, his blood pressure is 150/60 mmHg, and he has a collapsing pulse. The chest x ray shows an enlarged heart with upper lobe venous diversion.
aortic regurgitation, hence an early diastolic murmur would be expected.
Describe the murmur in following case? A 74-year-old man has a three month history of breathlessness and central chest pain on exertion. He has had one episode of syncope while carrying shopping
Aortic stenosis. Ejection systolic murmur over aortic area, conducted to neck
Describe the murmur in following case? A 67-year-old woman, who had a mitral valve replacement eight years ago, complains of a recurrence of breathlessness on exertion over the past year. She has abdominal discomfort and the jugular venous pressure is elevated. Her chest x ray shows a prominent main pulmonary artery and clear lung fields.
tricuspid regurgitation, hence a pan-systolic murmur over the left sternal edge is expected.
Causes of pruiritis?
- underlying malignancy - (Hodgkin's)
- Infections such as scabies
- metabolic disorders (thyrotoxicosis and hypothyroid)
- liver disease (cirrhosis, PBC)
- Dermatitis herpetiformis
- Polycythaemia rubra vera (after a hot bath)