Infection- OSCE Jan 2021

Question 1

A 19-year-old student is presented to the emergency department in January due to a fever up to 38’C, severe headache and vomiting. She has been sick for 1 day and she is deteriorating fastly She used paracetamol and ibuprofen but did not get any better and then noticed some rash.

She is a university student and attends lectures. Some of the group mates had runny nose and coughed. She has no chronic diseases or allergens.

Physical examination: Temperature is 39’C, sweaty skin. Conscious apathetic, nasopharynx is erythematous. The tongue is dry with white plaque. HR 128 bpm rhythmic BP 90/60 mmhg. Respiratory rate is 24 breaths per minute, SpO2 96% on room air. Normal breath sounds on auscultation, no crackles or rales. The abdomen is soft, indolent, normal bowel sounds. Jordan sign negative bilaterally (-). Nuchal rigidity. Positive Kernig’s sign bilaterally. Rash on lower legs and lumbar area that does not blanch on pressure.

1. What is your preliminary diagnosis? 
Select one or more: -2p

Accepted Answer

Meningococcal sepsis

Accepted Answer

Meningitis

Answer

Herpetic encephalitis

Answer

Allergic reaction

Answer

Yersinosis

Answer

Encephalitis

Question 2

2. Which of the following laboratory tests would you perform? 
Select one or more: -1p

Accepted Answer

K, creatinine

Accepted Answer

CBC

Accepted Answer

Head CT scan

Accepted Answer

CRP

Accepted Answer

Serum lactates

Accepted Answer

Blood culture

Accepted Answer

CSF analysis and culture

Answer

Urine culture

Answer

LDH

Answer

EEG

Question 3

3. What would be your preliminary treatment? 
Select one or more: -3p

Accepted Answer

Fluid therapy

Accepted Answer

Antipyretic

Accepted Answer

Ceftriaxone 2 g IV

Accepted Answer

The patient should be isolated for 24 hours

Answer

The patient should be isolated for the duration of treatment in the hospital

Answer

Cefazolin 2 g IV

Answer

Penincillin 6 million units IV

Question 4

After one hour you receive the results of the tests:
WBC 15x10’9/l (Neu 9-%), CRP 370 mg/l, K 4 mmol/l, creatinine 90 umol/l.

CSF analysis: cloudy, WBC 1500 x 10’6/l. predominant neutrophils, protein 2 g/l, glucose 3 mmol/l (serum glucose 6.7mmol/l), lactates 8mmol/l, Gram(-) diplococci on microscopy.

4. What further treatment would you prescribe? 
Select one or more: -2p

Accepted Answer

Dexamethasone IV

Accepted Answer

Ceftriaxone 2 g IV

Answer

Penicillin 6 million units IV

Answer

Cefazolin 2 g IV

Answer

Acyclocllovir IV

Question 5

Choose the correct statement: 
Select one: -1p

Accepted Answer

Treatment of sepsis must be started in one hour from the patient’s arrival the other health-care facility.

Answer

HR 128 bpm, BP 90/60 mmHg, respiratory rate 24 times per min meet 3 of the qSOFA criteria

Answer

Treatment of sepsis is started only when a positive blood culture result is received

Answer

In Lithuania the government funds vaccination for all individuals older than 65 years against pneumococcal and meningococcal infection

Question 6

Please match CSF analysis results with correct infections:

a. WBC 500x10’6 /l (Neu 45%, Lymph 55%), protein 3.4 g/l, lactates 3 mmol/l, glucose 1.08 mmol/l (serum glucose 6.8 mmol/l) [blank_start]Neuroborreliosis[blank_end]

b. WBC 15x10’6 /l (Neu 10, Lymph 5), protein 0.26 g/l, lactates 1.2 mmol/l, glucose 2.25 mmol/l (serum glucose 6 mmol/l) [blank_start]Tick-borne encephalitis[blank_end]

c. WBC 3x10’6 /l (Neu 0, Lymph 3), protein 0.26 g/l lactates 1.1 mmol/l, glucose 2.85 mmol/l (serum glucose 6 mmol/l) [blank_start]Normal[blank_end]

d. WBC 5000X10’6 /l (Neu 89% Lymph 21%), protein 4 g/l, glucose 2.5 mmol/l (serum glucose 6.7mmol/l), lactates 8 mmol/l [blank_start]Bacterial meningitis[blank_end]

Accepted Answer

Neuroborreliosis

Accepted Answer

Tick-borne encephalitis

Accepted Answer

Normal

Accepted Answer

Bacterial meningitis

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Infection- OSCE Jan 2021

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