EMQs in Clinical Medicine.pdf - Peshawar Medical College

242 Miscellaneous
pseudomembranes, but in a proportion of patients the site of disease is
more proximal and would therefore not be detected.
Diagnosis is confirmed by detection of the toxin in the stool.
H
D
L
A young man presents with progressive ascending weakness and
areflexia in all four limbs a few weeks after a gastrointestinal
infection.
This is presentation of Guillain–Barré syndrome. There is a recognized
association between a preceding gastrointestinal infection and the development
of this condition. Around 70–85 per cent of patients make a
complete/almost complete recovery. The most important complication of
Guillain–Barré syndrome is the involvement of respiratory muscles.
Arterial blood gases and bedside spirometry (forced vital capacity) should
be monitored daily to detect significant compromise early.
High-dose intravenous immunoglobulin can reduce the severity and
duration of illness in some patients.
A 33-year-old IVDU presents with fever, rigors and nightsweats. On
examination he has a pansystolic murmur best heard at the lower
sternal edge.
This is the presentation of infective endocarditis. The signs suggest that
there is tricuspid valve involvement. Right-sided endocarditis occurs
more commonly in intravenous drug users where Staphylococcus aureus
is the most common infecting organism. In others, a large variety of
organisms may cause bacterial endocarditis including -haemolytic
streptococci and more rarely the HACEK group (Haemophilus,
Actinobacillus, Cardiobacterium, Eikenella, Kingella).
A 65-year-old woman presents with frequency and dysuria.
E. coli is the most common cause of urinary tract infection. Klebsiella sp.
and Proteus mirabilis are other common pathogens.
97 Infections
Answers: J I G A F
J
An 18-year-old young man with sickle-cell disease presents with
osteomyelitis.
Staphylococcus aureus infection is by far the most common infecting
organism in acute osteomyelitis. It is important to remember that
Salmonella sp. infection is a well-recognized cause of osteomyelitis in
a patient with sickle-cell disease.
A 23-year-old Somali man presents with fever, nightsweats, weight
loss and haemoptysis.