IM Germ

A 44-year-old plumber has a 4-day history of fever and generalized myalgia. Two days ago he developed a dry cough coupled with mild dyspnoea and has been feeling very lethargic. On examination his temperature is 38.5°C, respiratory rate 20, oxygen saturations ranging between 93 and 96 per cent on room air and auscultation of the chest reveals bibasal crackles. Bloods show a raised white cell count of 18.2 and neutrophil count of 11.0, CRP of 90 and a raised ALT of 261 and ALP 96. Chest x-ray reveals bibasal consolidation. The patient is treated with antibiotics for bi basal pneumonia. From the list below, select the most likely organism responsible for the pneumonia:

A 12-year-old boy who has been suffering from atopic dermatitis for the last ten years presents to you with a 3-day history of severe itching and pus discharge from his left elbow. On examination, you observe lichenification of his left elbow with superimposed excoriations which are weeping a viscous yellow fluid. You take a swab of this discharge. Which one of the following organism growths would you likely expect to be isolated from the swab?

A 45-year-old woman presents to you with a 3-day history of an ovoid patch of tender erythema, on the posterolateral aspect of her left calf, which has been increasing in size. She recalls injuring her left leg a week ago while gardening. On examination, the patient is afebrile and on inspection of the left calf, the patch of erythema measures roughly 3 x 3 cm with poorly demarcated edges. On palpation the zone of erythema is warm and very tender. Full blood count reveals a white cell count of 20.1 with a neutrophil count of 15.0. Which of the following organisms is the most likely cause of this condition?

A 54-year-old investment banker presents to accident and emergency with a 5-day history of productive cough of green sputum, fevers and feeling generally unwell. On examination, there is bronchial breathing in the left lower zone. Chest x-ray demonstrates left lower zone consolidation. What is the most likely causative organism?

A three-year-old boy presents, with his mother, to his GP with a 2-day history of fevers, vomiting and diarrhoea. His mother mentions that several other children at the nursery have been off sick this week with the same problem. What is the most likely cause?

A nine-year-old boy presents to his GP with a 2-day history of sudden onset itchy rash over his face, scalp, neck and trunk, On examination, his temperature is 38° C and there is a widespread vesicular rash. What is the most likely infective organism?

A 23-year-old man presents to accident and emergency with a 1-day history of severe headache, discomfort when looking at the lights and neck stiffness. There is a non-blanching rash observed on his trunk. He has recently recovered from chicken pox. On examination he is pyrexial at 39°C. The most likely causative organism is:

A 90-year-old man presents to accident and emergency with a 2-week history of fevers, lethargy and night sweats. He has recently had crowns fitted at the dentists. He has a past medical history of hypertension, gout and type 2 diabetes mellitus. On examination his temperature is 39°C, his pulse is 120 bpm and splinter haemorrhages are seen in the nails. On auscultation of the heart a pansystolic murmur is audible. A diagnosis of endocarditis is suspected and blood cultures are taken. What organism is most likely to be grown?

A 20-year-old man presents to accident and emergency with extreme pain in the right knee. On examination, his temperature is 38.5° C and the knee is hot and swollen. He is unable to move his knee due to pain. The joint is aspirated and blood cultures are taken. The patient is admitted and started on intravenous antibiotics. Gram staining of the joint aspirate shows gram-negative diplococci. What is the most likely responsible organism?

A 74-year-old man presents to accident and emergency with extreme pain in the left knee. On examination, his temperature is 39° C and the knee is swollen and hot. He is unable to move the joint due to pain. The joint is aspirated and the patient is admitted and started on intravenous antibiotics. What is the most likely causative organism?

A 42-year-old man presents to accident and emergency with a 3-week history of shortness of breath, dry cough, fevers and malaise. He has presented as his exercise tolerance has deteriorated. He mentions that he has been mv positive for ten years. On examination, there are fme crackles throughout both lung fields. Chest x-ray demonstrates bilateral perihilar interstitial shadowing. What is the most likely causative organism?

A 42-year-old man presents to accident and emergency with a 3-week history of retrosternal discomfort after swallowing. He mentions that he has been unable to keep any food down at all. He has been HIV positive for ten years. He is admitted and endoscopy shows areas of ulceration throughout the oesophagus. What is the most likely causative organism?

A 42-year-old man presents to his GP with 'blotches' over his legs. He has been mv positive for ten years. On examination, there are multiple purple and brown papules over his legs and his gums. A diagnosis of Kaposi's sarcoma is suspected. What is the most likely causative organism?

You see a 57-year-old man who has been diagnosed with hepatocellular carcinoma (HCC). You are asked about risk factors in HCC by your consultant. Which of the following is not a known predisposing factor for developing hepatocellular carcinoma?

A four-year-old girl presents to her GP, with her mother, with a 2-day history of fevers and diarrhoea. Her mother has contacted her nursery, who have informed her that several of the other children have been off sick with the same problem. What is the most likely causative
organism?

A 21-year-old man presents to accident and emergency with a hot, swollen, painful right knee and feeling generally unwell. On examination, his temperature is 38.5°C and he is unable to weight bear. He cannot move his right knee joint due to the pain. A diagnosis of septic arthritis is suspected and the joint is aspirated. What organism is most likely to be seen on the Gram stain of the joint aspirate?

A 29-year-old man presents to the emergency department with a 1-week history of nonproductive cough, muscle aches, fever, vomiting and diarrhoea. His observations include temperature 38.4° C, pulse rate 105 bpm, blood pressure 110/76 mmHg and respiratory rate 22/min. On examination, his chest is clear to both auscultation and percussion. A chest X-ray shows bilateral lung basal infiltrates. The blood results show Na+ 128 mmol/L, K+ 4.0 mmol/L, urea 5.9 mmol/L, creatinine 130 mmol/L, albumin 26 g/L, ALT 106 IU/L, ALP 230 IU/L. What is the most likely causative organism?

A 40-year-old man presents to the emergency department after 8 hours of a severe frontal headache, photophobia and two episodes of vomiting. On examination his Glasgow Coma Score (GCS) is 13 (eyes open to voice, verbal response with confused sentences, and moving freely), he
has a temperature of 38.5°C, a BP of 95/65 mmHg and pulse rate of 105 bpm. He is photophobic
and has neck stiffness. There is no rash and no focal neurological deficit as far as you can
ascertain. His wife is present and is able to elaborate on the history. He has hit the bottle quite
hard since losing his job 7 months ago and has been drinking 8 1- 0 cans of lager per night. He
has recently been coughing a lot and feeling unwell. He still lives at home and has not appeared
to lose weight recently. What are you most concerned that this might be?

A 78-year-old woman presents with palpitations that began an hour ago. She feels clammy to the touch. Whilst she is clutching your hand and telling you her past medical history, you check her observations on the bedside monitor. You notice that her heart rate is 230 bpm and regular. The QRS complexes are narrow and no P-waves are noted. What is the most likely arrhythmia?

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