ID seminar Community acquired infections

Community acquired infections

- worksheet
Learning Objectives
Assessment of patients presenting with febrile illnesses: importance of good history taking;
examination; choosing the right tests at the right time. Use of antibiotics: not always
required; choosing empiric antibiotics; review and modify depending on microbiology
results. Look for underlying causes for infections

For the discussion to be successful the student should read through the VLE
notes on this topic before the seminar
Case 1 - You are an FY1 in MAU

A 19 year old woman is brought in by her worried mother with a 4 day history of fever
associated with headache, a painful neck and vomiting

She is previously fit, is on the oral contraceptive pill and has no known allergies

She works as a shop assistant and lives with her parents

No one else has had similar symptoms, no recent travel and no pets

T 39.8, PR 120, BP 100/55, RR 20, O2 sat 97%

Unwell, flushed, mildly photophobic, Kernig's sign negative

Unable to flex neck, general neck tenderness and with multiple 1-2cm glands

HS normal, chest clear, vague epigastric tenderness, GCS 15, no neurological signs
Questions to be discussed in the seminar:
What is your differential diagnosis?

What else should you examine?

What investigations would you do?

What is your final diagnosis now?

(based on the test results)

ID seminar Community acquired infections

Case 2 - you are an FY1 in MAU

A 55 year old woman is referred by her GP with a 5 day history of rigors and sweats,
headache, abdominal discomfort
Yesterday she developed vomiting and diarrhoea
Questions to be discussed in the seminar:
What other questions would you ask?
(You will be provided with some additional history in the tutorial and examination findings)

What is your differential diagnosis?

What initial investigations do you request? (you will be provided with results of initial tests)

What is the likely diagnosis now? (based on the test results)

What is your initial management?

Case 3 You are an FY1 on MAU

A&E refer a 60 year old man with fever for 3 weeks with a dry cough, muscle aches,
fatigue, anorexia and dark urine

1 month ago he and his wife went on a short break to Barcelona. She has been well
apart from a cold

He is an ex-smoker, drinks a couple of bottles of wine a week and has just retired from
the oil industry
Questions to be discussed in the seminar:
What other questions would you ask?
(You will be provided with some additional history in the tutorial and examination findings)

What initial investigations do you request? (you will be provided with results of initial tests)

What is the likely diagnosis?

What further investigations do you want? (you will be provided with results of further tests)