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um So today we're gonna be covering infectious diseases. So, uh, jacket and we're just looking on to the next slide here. Yeah, well, there you go. So, yeah, this is gonna be infectious diseases. As you can see, this is the, um, is gonna be the fifth session. We're doing so well. So but end up crying and hematology to come up, but yes. So today, Jack Wellington has very kindly agreed to help us out with this session, so he comes very well recommended by a lot of people. So hopefully we'll have a very good teaching session today, so yeah, Jack, Whenever you're ready, take your way. Okay. So thank you, everyone. Thank you very much. The same team. Teo, allow me to speak today, so just be brief backgrounds. I'm Jack and 40 medical students on Die Integrated A masters in medical microbiology. Hence why I'm being recommended to do this lecture on day. Yes, I think we'll just get into it. So the thing with erections these before I started a bit of a disclaimer is that everyone thinks that you must approach medicine through assistance based approach to try and get the right diagnosis and pathology. The problem with infectious diseases is it may encompass every single system from respiratory cardio CNS to come. It will. It can manifest anybody who manifest in a bar in two different ways, including how the immunosuppressive immunocompromised you up. So when you're talking about systems based approach is for infectious diseases is actually quite difficult to just home in on one, um, organism, which will cause the syndrome. So for this for this lecture, I don't want to think systems. I want you to think I want to think about the organism, which is causing a syndrome rather than the system and in associating bugs, because that will help you understand the pathology of a lot better than just home in in your systems and trying to find out which matches the singer now infectious diseases and medical micro biology is quite logical. A lot of people hate this subject, but it's actually very, very logical. And symptoms symptoms often relate to the pathogen question. So, for example, if you have a staphylococcus aureus and it's producing a toxin, think a toxic syndrome classic would be retained. Tampon will cause the staphylococcal tosses toxic shock syndrome. Think think, um, think about the pathogen in question related to last syndrome and how the symptoms will relate now, if actually sees is covers a lot of things, so bacteria viruses produce so in parasites and funky on, there's even even more subtypes of each. So what I'm going. What I want you to think off is the typical presentations. Use our comes razor. So if it's things like a canary and it looks like urinary, it's most likely going to be a canary. But infectious diseases that can be a killer on it can change your perspective on what's differential diagnoses are. So what I'd say is in most instances of France razor, but then I would convert them to some people. Hiccups dictum. So if it sounds like a canary cause things like a canary, it could be a zebra, especially in the subject of trouble disease. Don't let the most common things for you. It could be something else. Now. Antibiotics make up most of management if active, so please don't get into the habit of, um, again treating everything with antibiotics because it might not be so. If it's a virus, it's not gonna touch it. on and in exams, and I emphasize this. Remember your stains so gram stain zeal, Niles and Stain, which is an acid fast bacilli test on day and India rink. These will give you the answer straight away, and we'll give you the suggested syndrome. So if you know your stains and you know what you know, if it's a cock higher. But this elicits a cluster, it's a chain on what kind of they are. You'll get the answer so it's worth noting different stains. But all that. Just remember, think logically. If it sounds like a toxin mediated bug, it's probably going to be a toxic syndrome, so bit of a disclaimer. Infectious diseases covers everything on it will make up most of your practice in the future, so it's hard to try and pinpoint what to cover in a spit and of stroll space of time. I mean, I did a masters. It was a full degree, and I still think her for everything. So I'm gonna go through the things which can come up with exams on the high yield stuff, which you might not necessarily see in real life. But it will definitely come up on paper. So the things I'll be covering chest infections, your typical atypical pneumonias and how they present how you diagnose, um hum, manage. I'm gonna go through a CNS. That's my particular forte. So I'm gonna go from meningitis skin cathflo in cattle itis on of this sort of bugs in the CNS on I also go through STDs, HIV complications because that's really like high yield stuff on GIC. Infections on bit more. Okay, so visible. I'm going to ask you a question is like a pull it, please. Okay, so have you read the question and then let me know what you think The correct course is for this question. The people that can't read the question because of the whole it says 45 year old male. But then he surgery with new onset, either cough and laugh calories. He's a known smoker of 30 figure out today on have a past medical history of chronic bronchitis. His teacher is Parliament s I 02 is 91%. You send him for a hospital admission. So which of these is most likely the cause of symptoms and then the options are stressed. Him awfulest right Santa Claus, Cialis of Mycobacterium. Okay, so is the whole finished? Yeah, right. So most people went for I the I'll be. So if I move onto the next slides again, so any acute exacerbation tea on It's a very common problem, and it's just common reasons for inpatient mission in the developed well. So if you think COPD and acute exacerbation, the most common bacterial organized organism is haemophilus influenzae. So if you see COPD in the question and it's Nick, use oxidation and have given you a whole list of bugs, Haemophilus is gonna be probably the right choice, and it's the most common there's doing clear strap on more extended catarrhalis Moraxella casseroles is not as prominent. Strep would be the second most common and some offices to talk. So in a time of viruses, especially come in 19, you should always think of other viral causes. So rhinoviruses, a very common in acute suspicion. COPD are speed less so, and then influences another really important differential. Covert 19 is another important novel causes well, so most places swap now for covert 19 anyway, but it is a course because of acute exacerbation of COPD. Now, um Basically a chest X ray is done on a middle lobe. Pneumonia is diagnosed. The patients is allergic to flu crops. Acilin. So what would call what would comprise the management plan for patients with an acute exacerbation CBC, and associate it pneumonia last the whole Thank you. I'm I'm ready. Usually the way. It's a 50% completion of the bowl, so yeah, we just go there. So Yeah. Thank you. Okay. So most people went for the with that is up the correct. That's I'm I'm going to see you show, you know, so an acute exacerbation Beijing off COPD management's. So the nice guidelines of 2010 detail the following. So what you gonna do is increase the bronchodilator frequency and query warrants in a nebulizer. What you're gonna want to do next, which is quite important, is administer of five day course of oral steroids. Usually this is price and 30 minutes from 70. Antibiotics are only considered if it's pure and sputum on or clinical symptoms and pneumonia. So I suspect it's got signs of pneumonia you would treat with antibiotics. Now the choices would be an amoxicillin. This patient is fruit clocks, incident allergic so there is a penicillin. Therefore, come on. I'm not sitting. You would avoid. Erythromycin is probably the second is to comment. An end of the doxycycline is the doxycycline is quiet, is used quite commonly, actually in South Wales on Accordance micro guys. But usually it would be Claritin. My zing. There are other things to note about Christmas in which I get onto later but clears my son's in macular eyes on sometimes these can affect See why people 50, which is a liver enzyme system which metabolizes a lot of our drugs. So, Chris, my son, is something you would want to query if the patient was say on warfarin or blood thinner. So bad on like a big asterisk my son could be is because he is a modern penicillin. Allergic. Now, this is what the right middle lobe pneumonia looks like. That you can see which is highlighted there. And then this is the difference between a different spirit. It's so, um, you Gois is quite why it's isn't nothing, really. You cope your lenses getting yellows, more mucus. You know, I'm sure it will look pretty much yellow. It, um very plus, like And if you see this, then you should definitely get some antibiotics. Time after me on day will probably be quite ill. So next question, a 56 year old female presents with local any department complaining to grasses really worsening chest pain, lethargy and fever. She also shows you her most recent streets and sample, which appears rest and John like that is a biggie. High yield, uh, points in this question. She's a personal history of liver cirrhosis and consumes 30 units valuable. Every two days, Chest X ray is completed and you observe a cavitation consolidation in the right upper lobe. So I've given you the main concern, which would point towards diagnosis. The what organism is most likely to be a challenge. E I give. Okay, thank you very much. So it's between C and D. Okay, so I can tell you the difference. So klebsiella is quite a nasty organism on, but it has got about 30 different percent mortality on it usually presents in people who have a past history of alcoholism on diabetics. So this on it's classically causes a sputum sample, which is Red John current, like so, think so in in deception. For example, that would say Red currant jelly stool. When you say pneumonia and is a red jam like red current jelly, whatever it's most like, you're gonna be klebsiella. Klebsiella is a candidate in or an organism, so it will cause these capitated relations in the right in, in in the lungs. So TB is the reason why it's not TB is to be more presents, no insidiously. So the weight loss they'll be signs of consumption. They would also be a night sweats and beautiful be there'll be a mop. It assists, but it wouldn't be Red Jam like Onda, TB is classically hello Fibro's in, and it causes going complexes. I'll get on start later. Yes, this is TV. Sorry, this is close together. I do apologize. So klebsiella pneumonia on the morphology is a gram negative bacillus It is in capsulated. It's mucoid, so it sticks and it's gross. When you basically grow it on a plate, it literally looks mucusy and new, clean, slimy on it produces this endotoxin, which therefore is more likely to cause bleeding and get this bread currently on. John likes using the transmission. It's mostly hospital acquired. You don't really get this in the community. Compared to, say, streptococcus pneumonia in my office on the clinical features unique too close together. It's common in our politics. Diabetes on also bronchiectasis but not, um, it's common. Able says it made follow aspirations, So someone's got an aspiration. Pneumonia. I Jude's You say you're a muscular information or your Mesler failure. This could happen on its red currant jelly sputum production Early up alot on it's capitated. It produces these abscesses in the lungs. Mortality is approximately 30 to 50% on Did also may cause you guys, But if you're thinking klebsiella, I think used the question or pinpoints and alcoholic in someone with diabetes they got they got red. Current gel is beautiful Hello, on below counties nations On the there is a also a bug which I should say which is an STD called klebsiella Donna Vonnie because his donovanosis so don't get mixed up between the two. They they're two different organisms and this is what it looks like to see these cavities. But the air is our that is these abscess formation these cavities nations and it's usually a load. Okay, my question. A 75 year old male presents the local any department from plain another cough, lethargy and fever most of time it's always these pro general symptoms of Prophelatically. Viva! The symptoms followed from a previous flu like illness and now planes that his hands get very tail and cold. Wash this off on examination. He looks unwell. Impair with conjunctival color. You observed target like lesions on his legs with associate bruises on his torso district. Give all give it away. Well, organism is he explains These lesions have been there for a while, but fault nothing of it. You order a chats, X ray and observed bilateral solid a shin. So what investigation with them? The etiology of this patient's clinical presentation. Okay, so the most popular answer is C which is serology, and that would be correct. So this organism is known is mycoplasma pneumonia and it causes a whole range of things, especially immune mediated complications. So this, for example, the target like lesions. This is something cold erythema margin and marginated on these from this is classically seen with mycoplasma pneumonia. Now Michael possibly can have any really be confirmed by serology, so, you know, react to General get onto later and fbc Okay. And May will probably not confirm the etiology on interactions. Tests is or hemolysis on decaf. You do get hemolysis in mycoplasma pneumoniae I but we'll get you out of the bet on sputum. Culture is refusing culture. It is more is more aimed at TB and other organisms rather than serology. So if I move once in next slide, this is Michael Pasadena know morphology. Why? Why do I say it complicates it? Because mycoplasma is a very unique bacteria which doesn't stain on granting very well. So if you did a gram stain, it would show it would show a mixture of ground positive and wrong. Negative. Because mycoplasma, how this weird morphology, when it comes from cell wall on it, lacks it. The wall. So what it actually does is parasitic in nature. On the only way to really stay Nissen you won't sustain it is using an acid phosphatase. The light test, which is the same one you do for a TB now as part of facility, is parasitic nature that has a lot like to solve all. Hence, my grand scheme is futile on immediate same unit responses. I got it all started a bit, so transmission is usually droplets on. It's got very unique features. If you are thinking exams on, do you want to know epidemiology? It wasn't a really good want to learn. So every four years there's typically an epidemic, and they have increased resistance because of this lacking of this cell wall. It's a long duration of disease. It's a longer pneumonia on set on treatments on recovery On first of all, is a flu like program, which then goes in for cough chats that chest X ray. It's everywhere. Bilateral consolidation now the complications, which a really important on might be tested on exams it causes. Sorry, and it wasn't imagination was multiform. I do apologize. I always get confused between the tip. It causes an eye GM mediated, called a gluten in alter immune human lot him a little anemia. Now what does this mean? So cold basically means humanistic. Is that possibly four degrees Celsius on wise importance? The clinical features is Reinertsen on it. So I go back and show you if you making out complains that his hands get very calls and pale when he's walking. Adult. This could be a Reynaud's Norman on also an actress. Sinuses, which basically means it's decreased circulation. Now with IgM mediated called Blues and also, I Mean Humana. Cigna that is a mouthful you do a direct to instead of three positive in a cold gluten. A shin fast. It would be positive. And for example, this is this is a type two hypersensitivity reaction. Now what is the difference? Stream erythema, multiform and erythema. No dose. Um, they're actually very, very similar, but multiform. And that does them. They're both type four hypersensitivity rack reactions because the girl I think it's called Gila Coombs on constipation and a multi form is a superficial microvasculature inflammation. Now this can be minor. So erythema multiform a minor, which is non because, er make me cause all or major. Now Major is really is immediate hospital mission. They need fluid resuscitation on. For example, this is if it says there is a, um um multiple major. There's a disease called Wolff O. R s, which, with the classically causes a security my multi four major. Now the dose in which you might see in chromes diseases that extra colonic sort of future is the subcutaneous fat information. So they're both very, very similar. But one notice, Ms Fats, and in multiform is microvasculature. Now, the other things which mycoplasma pneumonia could do is it can cause something called green bars syndrome. So not just compile a back to judge me, but mycoplasma no pneumonia, I can cause, um, barring And it's actually probably one of the most common causes of GPS. And it does cause, um, in injury catalysis. Also, you get this thing called blistering joins us, which is basically it's impacting information on it. That's not communist, but it might be seen an exams. You get this liver dysfunction on, but it's not that common compared to another. Initially, she must have gone in a minute. That's it May cause the pancreatitis habits. Fighters, uh, picture there is some nephritis. Associate it with humanistic you remix syndrome. They're rare. That may be seen as pericarditis, and my ankles are just the things to take away from. This does. Is the investigation so serology if you if you see mycoplasma pneumonia and a question of suspected it serology on, it's everything multiform on. I gm mediated called occlusion and humanistic anemia. Now this is what it looks like. So this is your irritable multiform is sort of these target like lesions. It doesn't necessarily look like a target, but it's these rounds. Is these round lesions which may which predominantly on the legs and maybe on the trunk is found. So management. I'm sorry. And this is this is called a gluten and C's. So, basically, is the merging with the red blood cells. They all come together. This is my what you might see honestly and a black feel. Sorry. So management's You either use Dr Cycling or a macrolide Most of times, for example, is probably be clarithromycin. And but you may use doxycycline is, um okay, so a 25 year old male, this just arrived back to consolidate in Spain, Feeling absolutely miserable. He has a lot of the new dry after flu like symptoms. His vitals are 80% saturations are over two. Heart rate is 55 BPM. Tympanic met sanctuaries instead of nine. BP is a bit low. You admit this patient and all the bloods, which revealed a lymphopenia lft derangements on low sodium. That is big giveaway in his question. The patients becoming more confusing. Well, see Walter Chest Saturday, which reveals patchy consolidations. I'll actually with a payroll. A fusion. So what investigation would you do? Thank you. Good. Okay, so I think everyone is pretty little motion. A. Yes. So this bug is actually one of my favorites to learn and's is legionella. So legionella Noon. If either this is quite a interesting bug, because the morphology is ground and getting coccobacillus. So when I say coccobacillus, it can either look bacillus or you come up like a calmness, and it's an absolute nightmare to grow. Legionella will take ages to grow, and he uses a specific a guard called B C Y E, which is a cold based a guard. It will take ages ago. It's a nightmare, and usually the a garbled get contaminated. So when you suspect Legionella, what you want to do is definitely just do a You know the answer gyn on check for the sodium a check from Compatic function cause they will give you the clinical diagnosis before anything grows on. Be a guard. Now the pathophysiology is an interstellar back by bacteria, and it's beater lactamase producing. So your simple penicillins this. It will not high. She's another it's at all will not touch is. Therefore you have to change management transmission. Classically, it's water tanks. Air conditioning on gets. The question usually is from someone who's travels recently to say a conference or where there's bean on the ship. Where is being saying water tank and a C now Legionella is means causes. Legionella is sorry mutineers disease or or Pontiac fever? Now legionnairesdisease is where it is the pneumonia, and it's it's quite enjoyable in shock, and it's and it's systemic, a Pontiac fever you cope with. It just causes, you know, been coughing. You can get over it. But if it goes into full blown legionnairesdisease, then you will definitely possible mission on probably fluid resuscitation and electrolytes and on electrolytes monitoring. Now Legionella is names purely because there was a conference call the Legionnaires conference or something like that on. They all got contaminated with this bug, hence wise condition, and it's very unique features. It causes a relative brother cardio, so they're in my mind's. There's two organisms which cause of relative bradycardia. One is legionella, which basically means that that's how much it will be quite high, so you expected tachycardia. But actually, there's a brother coffee, which is you wouldn't suspect if you're 10, which is, say, 40 degrees, you expect to be Tuckey, but it's not in the service and syndromes. There's another bug, which I'll get to you later, but it'll course is relative. You get this lymphopenia on classically an exam question. Reduce sodium. So if you see on pneumonia suspected pneumonia, question and then you see, start using knees and show you a low sodium think lesion lesion. Sometimes you get this pleural effusion, which is a possibility the percent on you get. Also LFT derangements, which would is more of a patty cake picture rather than an obstructive legionella, is the investigation is an anti itch in unity answered, because this is excreted by the kidneys on a legionella, a legionnairesdisease. It's sort of it's quite a bilateral solid a shin. But sometimes on this X rays, you can see it's quite focused on the one side, but you'll also get these pleural effusions as well. Mission may see on chest. Actually, the management is a macrolide classically Christmas. Now there are other causes of pneumonia on the most probably the most common you'll see in the community is pneumococcal. Pneumonia is caused by streptococcus pneumonia. On if you see a grand saying it's gram positive, call chi in chains, streptococcus and then obviously the immune, the one which causes pneumonia. Classically, it's new. Only I so clinical features most common cause the Creon to quiet pneumonia. So compared to an acute exacerbation COPD, which is more time off less. And if you suspect a community acquired pneumonia, strep is the most common. It's sudden is rapid onset onset. Sorry is increased. This quite high fever on the chest pain is pleuritic, so it's worse on inspiration ons. You'd also may get this herpes the baby s, which is basically you. And also on it could be a real and that sometimes strep pneumo me, I can cause a reactivation of babies. You just be well, too. So that's also a good indicator of a question and stuff for a cotton pneumonia. You can Really This question will be obvious if you know the, um, you know the compassion with influenza, so it's usually occurs after in an influenza a usually on post in France way. So if you have a pneumonia after influencer, say, two weeks after your friends and you got this full blown pneumonia. You thinkin Staphylococcus aureus on This is grand positive, cocky in clusters. Now you're several jobs or it is different from the other stuff about by because it's quite a list positive. So it breaks down on it's a mess around with you. Calculate the coagulation whilst Staphylococcus Epidemic did this or or other and stuff like. Okay, I, um, classically, quite a list. That's question. So a 21 year old female presents for annual review as her local hospital. The past medical history is consistent with CF, and she is currently as the pediatric respiratory specialist for the management of her sister progresses. Recently, she has has increasingly more frequent admission to the hospital concerning exacerbations off the bronchiectasis. Obviously, cause she was, you know, she's been business in another patient on the CF wars who she has feelings for for what organisms would you suspect are causing this? There are a couple of key things in this question. This will give you the answer. Okay, so a bit of a mixed picture, but choice d seems speed the most common on Yes. So it is D now when he thinks too sick progresses you on a couple of bugs, which are hormone economize. The Pseudomonas is a big one, which is called Nice to see you back, and then the other one. You'd think him off this influenzae because his bronchial says, but is actually Bickell's your patient. Now the big giveaway in this question is it's more frequent admission to the hospital on, and she's been visited another patient in the world with CF. And the reason why you keep you try to keep to patients with CF away from each other is because they comic on ice with these organisms on. You don't want to get both their students originals that bagels your patient. These are really awful resistant bugs, which are nightmares and trees has wide. We try and isolates now pneumonia, bronchitis is so even so in the constant. Forget about Cialis. But in the context of just grown cactuses without Cialis, Um, office in frenzy is actually the most common. So even though Pseudomonas is up there, if someone's go promptly active cysts think from office in frenzy first, and then you get your other books that just collapsed yellow pneumonia. Pseudomonas originals. The stress comes normal, but in Sierra is a bit of a difference. So the main thing you gotta chancel cf patients on is the cross infection on the race across infection. So the two big bugs, which are very resistant, our vehicles. The record patient complex, which basically means there are a bunch of other species underneath the tomb vehicle to your patient on Pseudomonas originals that now they are calmly colonized on CF patients on's Big thing for exams. If someone has a chronic big, ulterior, capacious infection, is actually culture indications and long transplantation. So say the question is CF the one of the transplant, but they're colonized a bagel. Zero. Uh, what what would you do? It's a contraindications, a lot of transplants, so it's actually quite a few eating. If you're colonized with their chronically on, as they said, they're very resistance Now. This is a pseudomonas chest, actually on. It's awful, basically on. It's just it gets everywhere. It's slimy. It's mucoid on this Purell in on Did it sticks and it's It's one of the most awful bugs to be called nice with on if you've ever um so if you have ever ground pseudomonas, it's a very weird growth. So if you, um, culture it, then it's actually not a very slimy. Such a green color on more Connie on is because it produces this thing called High site in, which basically changes the color. It's expels, actually quite floral on a guard. So just little key things for you, that but yeah, it's a nightmare bug. And it's this big to your patient on biggest, your patient is probably in the microwave. Oldest one, wrist resistant bugs on this planet on it takes a lot of different weird antibiotics, probably never heard off to treat it. So we s o a cystic fibrosis for pseudomonas. We usually use tobramycin, which is a meat aminoglycoside. So it's it's you can't really have. You know, they're simple penicillin, just simple. Michaelides. These sort of bouts you needs to treat different things now. Pneumonia assessment. This will definitely kind of stick sounds. So in a community, you basically take the you out of here and 65 on it's now heard. 65 cents a day, 65 curbs. Five c is the confusion so if you used the MGs confusions underneath is equal to or an eight out of respiratory it should be about. There will be about 30 a VP. They will stick to the question you should, and it will be quite tricky because they might say like 65 diastolic instead of 55. So you have to you have to know your values. So BP underneath 90 as a sonic BP under new sixties diastolic and then 65 eventful, equal to 65 years old. A nice also recommend using point of care. CRP test in, but it's not routinely done so. If you have a seat up here brother 100 you automatically warrants anti mild. Since now, with the CRV 65 assessment, a zero is low risk. 1 to 2 is moderate. Risk return for his high risk. And if the baby basically above job warrants our mission now in hospital curbs 65 him, he is just a bigger area. So on. And here's one is juice risk to 10 stories. More risk about three is very high risk of a higher mortality now, investigations obviously going to do chest X ray to see what's happening sputum, blood cultures, a pneumococcal legionella anti androgen. That sense of the pneumococcal you handing Anderson tested, which is a lot quicker than growing back on board culture in it and then start monitoring. So antibiotics, if it's reduced, risk, amoxicillin or, um, apple eyes or tetracycline if it's sort of moderate to high risk amoxicillin, plus remarkable I. So if you know that same lesion and you know that's vitiligo Amis stable, he's like to be producing. You want to use a responsive, which contracts that so, for example, to almost life would be instead of amoxicillin. Say Okay. Next question. 30 hard year old Male presents was low, cheaply with worsening exertion. All disappear. Persistent dry cough that should be Indians. Already, he has also been experienced night sweats, weight loss in fluctuation beavers. He has it and established history of HIV, which is not well controlled, with highly on directory, viral on therapy, highly active cancer exercise. Maybe his last book, Trump, was below 200. You stand you in the hospital. The subsequent chest X rays, which reveals a one centimeter pneumothorax. Otherwise normal. You treat accordingly. So what? It's just like because your symptoms thank you very much. Yes. Okay. All right, guys. So if you go Hey, try being an existing dyspnea on a persistent dry cough on there in the AIDS criteria, which is underneath 200 cells, minimized. Cute. Then you're thinking Pneumocystis. Generally checking your own your PCP. So the etiology is a fungus is a yeast like fungus It's unicellular that you carry it in. The clinical significance is, is the most common option is stick infection in hatred, these shades. So if they're see people canceling 300 you should be given a coach moxisylyte from for prophylaxis. Now the presentation it's usually in existence is me a dry cough. Cheap being is more related with a wet cough, which with human success, you get you don't actually get that much as big monster. So, uh, you people don't really have mean they may be asymptomatic, and if it's very, it's sort of a natural cereal. PCP is her past that, um, ugly and Corey. Lesions on the chest actually may be normal. So if you're in an SG and it's got this presentation, but the actually is normal still think PCP and it cause it, or if it's not normal. Bilateral interstitial infiltrates, and you may see your throat pneumothorax. Now it's beautiful. Culture is actually a few trial. It doesn't really do anything, and culture doesn't regrow anything. So you want to do a bronchoalveolar lavage, which would be better. That's not That's more invasive, but it is diagnostically better on knowing it stains. If you see it's still the state your question and insists PCP management coach amoxicillin. Or, if it's very severe, you can use a drug called Penthamine. But for the exams coach mostly. And this is what a silver thing looks like with cystic sort of the the cystic appearance. And this is what a PCP see actually look like. So it's Sometimes you look quite normal. That's question. Four year old boy presents the Children's the CIA. You of his parents is the same day we felt the street exploring where he received I am Bensel Pen. Patients are warm and well diffused and is irritable on examination of boys. Pail of it's 78 is normal. Aging rash does not operate when examining you pillory reflexes. Your listeners are positive, chronic side and immediately start in here Last month for this condition was organism is most likely. Cause is of the symptoms. Yes, so this is something you should definitely know on. But again, if the patient's not warm while the fuses irritable, it's manage a couple steps senior and sell droop and otherwise. So. Meningitis is early Features, headache, leg pains, fever, cold hands and feet, abnormal skin, Cholestech a lot muscles. Or they may have this rush. The late features you got this manages and which is a trial of nuclear rigidity. Photophobia, sometimes on a failure. So here, in on headache turning sign. So this is basically it's very much similar to us, a straight leg raise, but then you, then whole on the foot. And it shouldn't cause meningeal irritation. Which then, if they shoot up in pain, is current X sign, which is meant meningeal irritation. So we're point usual. The diagnosis of meningitis is or manages. It causes presents. He signs of ray. So I wouldn't I wasn't really in it, but just say it in exams to Christians. Yes, they may be in a coma that seizures been happen and focal sienna signs such as a bit impulsive. 60 pulse. If that's raised icy be on this thing called office office for shingles, which is basically the high arch in of the back. But you may seen in Mesa the intestines. Particular rash. This is the thing with mothers and fathers. Are parents are lectures on Is the normal 100 rash give you a glass test? It should. So a rush to disappear, but with the glasses. But it's not. It's petechial. So therefore, you think medical septicemia. Now this is obviously it's nose. And then this is Colonel. Sign on Ben. Uh, the A of the top they're trying to elicits Brzezinski is check sign, but it's not really showing very well. The diagnosis is nice. Include the following you do your Bloods FBC using his electives CRP inflammation markers Your coagulation screen on a blood on blood glucose on for meningococcus septicemia. A lover puncture is actually contraindicated. So you what you want to do is do a whole blood PCR for Neisseria. Manage many minutes. Call us because obviously your lung punctures contraindicated. You're gonna basically throw everything on them. You want to do everything, maybe to be between blood cultures. Throat swamps, one for bacteria, one for for allergy chest X ray. Maybe considering finding TV taskers TV is a common well, not common, but it's an uncle because of meningitis is And you want to get seeing your help You want once a performance a lover puncher Unless it's contraindicated Onda Yeah, you get I see you on and yeah, you fucking Yeah, I see you escape hair. So there's four year old boys been started. The same one is on Perricone spots experts waiting blood cultures, whole blood PCR and relevant bloods. Your senior are shooting for love in this meantime, so give me the one which is not enough on absolutely contraindications of performing a lumbar puncture in this patient is this is difficult. Good, yes, cinemas popular. So Auspitz sign. So also, a sign is just a It's a red herring indiscretion. It's basically bleeding spots on be aware, and psoriasis scales are taking off basically. But yes, the other four are absolute contraindication. So a lumbar puncture are quickly go through the procedure. You probably will be doing a snack one, but you may be taught how to do it. So you should know your anatomy from serious anterior symptoms. It goes from the skin superficial Fashir, both ligaments, ligaments and flavum. This is this is where it's the talk and then the actual space. Germont arachnoid, Martha silver active space, That's where the CSF it's contraindications, says Rays ICP or any funny, a shin all space occupying lesion. Evidence about that bleeding diabetes says this could be coagulopathy. Even Christians Concordes. This site infections and then deformities. Such a kyphosis a scoliosis is now minutes. Concept senior is a a massive contraindications. Therefore, do blood cultures PCR meningococcus really important on did visit effects that probably most comment is host spinal headache and nausea. Now, in example, maybe asked, you treat this so it's actually quite well, so prolonged bed rest maybe. Well, if there's a leak warrant repair analgesia. Old caffeine actually works on the spinal headache. So just remember that exams, rare things, parasthesia average or hemorrhage. And then this thing called a decent Iraq fighters very red. Back again is textbook exam soldiers. Okay, here's your cardinal funeral percents. Any progressively wisdom has a fever and neck stiffness. She's recently recovered from the shots sexually, and it's been experienced bit ago alongside diplopia and blueness. On examination, your list it's and Abdus since nerve defect in science of meninges, um, of PMH a positive history is consistent with HIV AIDS, which is poorly controlled. Every little punchers performs. What will be passive gnomic for this clinical presentation? And this is really important one which comes up comedy and exams. Okay, so but if it makes sure But it was common that the most popular and sit dean is actually the right answer. So there's a couple things to pay cash for. This question is recent recovered from a chest infection uh, the the abuses of defects, a deficit and the size of veges um, and then the heat I v eight's hospital history. And the reason why this is important is you get sorry you get this thing called cryptococcal meningitis, which, under India ink is in cutting, uses a fungus on. It is quite common in immunocompromised individuals on when you're doing a lumbar puncture. If you if the question says in your ink and C's on as East on injuring, it is cryptococcal manage cryptococcus near Foreman's instill proven otherwise let me punctured depreciation. So this is what this a big table. But things to take from this are learned a difference between righty really viral fist. A viral will look very quite normal, actually, and cultures will be negative, but they'll be markedly increased lymphocytes. This is the most important and sometimes increased closing bacterial. It's two when it's yellow past like it's more polymorphous. So it's your next immune system rather than your adaptive consistent, and you get this higher opening pressure on glucose will be decreased because bacteria are gluttonous, they want to eat drinkers. And if you've got a decrease glucose in me in the CSF, then you're thinking it's not gonna be viral because virus doesn't need it, because now the difference between CBN fungal So this big brim Web thing. You'll never see it in your life. I've never seen it, and even I do the Masters in that you'll never see it. You'll never see this because it's just text book and it's quite rare. They'd have to be very, very unwell and systemically burdens with this organism. She make a difference, so it's no harm. But you will see a viscous yellowish, which is a sample, Um, but the difference between, um, TB on fungal is they staying differently and also glucose, so fungal will have a normal slightly decrease. Because whilst TB is markedly markedly decreased, TV will completely take Get rid of all your glucose. You see a sac and the also with fungus to notes open precious is quite high. So hungry, All TB, Look at the glucose. Looked at the staining. Now a bacterial. Any joints is liniments because this will change your management. So series of three months there was comin in units is group B strep? So ask mother if there's if they call a nice Group B strep coli Listeria monocytogenes is rare, but it can happen. And then from 3 to 3 to six year, three months or six years. Actually, it's my cereal manages just streptococcinum only I and maybe come off less So these are all commensalism the throat. So therefore you get into your bloodstream and then cause meningitis above 60 again is exactly same. If it's, um, you know, compromise think listeria monocytes are Ginny's. He call. I can also happen about this is about the age of 60. Is Mom as human falls in fences just received a diagnosis of bacterial meningitis caused by streptococcus. I collect a which is Group B strep. You want to initiate a parent? That's politics, Which and follow it through to administer. Okay, bit of a difference. Yeah. Okay, Right. So the actual answer is be Now, The reason I changed slightly is because it was usually be kept. Attacks him on amoxicillin. But because you can absent in isn't alternative so long system in, then you can use it. So sorry. I think so. This is you'll be enough. Recommendation. So initial empirical therapy, Asians and three months is IV catheter, axiom or amoxicillin. Sorry, I because and most in or initial empirical for three months of 50 years, it's just catheter, aximum or cancer. Um, onset of birth 50. You're gonna wants to again go back to add in the amoxicillin. Meningococcus, meningitis. So you can is a couple things you can do even administer IV bend hand or have a taxi or cataracts. You'll call call again. Cache Saxon meningitis caused by her Marsellus against the same. And then this is the difference to a listeria. If you see a listeria, it's gentamicin and amoxicillin on the senate. So I can understand why people want a monster. Then gentamicin but this person was colonized with streptococcus. I collect a, which is normal Syria, so therefore you go back to see him here in therapy. Now, Prophylaxes is usually given seven days before onset on. It's ciprofloxacin. Family thing is the old school drug, but it causes a lot of side effects on more. It's a side effect from candles later, so give us the important thing is dexamethasone, but you will not give this. If there's many medical substance of the size of sepsis, increased immunity or off operative energizes. So if you have the pneumococcal, you can give that medicine. It actually decreases the amount of complications. So say essential hearing is proven to help and how without prevents it. Sorry, So if penicillin will cover, it's more allergic. You can use chloramphenicol because it crosses the blood brain barrier. But chloramphenicol should be used sparingly if we've called sandwich with with units because they don't because it can cause cervical great big syndrome. And I won't get into that bit much for that. Got by another complication. Okay, so 35 year old male was recently being worked in steps or in Africa present staining with a whisker headache. Aviva. He elicit size of manages, um, and has no indications of raised. I'd be so therefore, you could get a loan along the puncture, which will follow. It is a correct diagnoses, and I will take the house. Okay. Yes. Okay, so this one's quite obvious. One side giving you the culture, and it's positive ones that insane. So I said before was positive on dust. Possible? Still, it is on my compartment, Phoebe or my pastor species that this is the infamous. Maybe now this is probably Mama's is my favorite bacteria. Sounds weird, but it is, and it's so interesting, it's It's quite devastating as well, so as it's fast, but still, I I. So he'll Nile Nielsen staining on. It's either latents or active. So most, actually was. People are walking around with TB, just latent, and it's until you have an immunocompromised or on events where your health isn't a great site should become active. Now the signs and symptoms TB affects everything absolutely everything. So whole memory is most famous. So he mocked. Is this something called a Rasmussen aneurysm, which is pathognomic for TB is upon the artery aneurysm on it causes a pillow. Sclerosis is one of the low fibrosis, and it's one of those courses extrapulmonary TB, meningitis, pox disease, which is TV in the spine. It caused a cervical scrofula, which is the survival if it's a nice sense. A military TV that means is everywhere on it can also be in your bother. Surprisingly so. General is fatigue, night sweats, fever, weight loss. They're actually quite a list of the sentence of lymphoma. If you think that and you see an infection, you're thinking okay, maybe TV diagnosis. So, for instance, used the monster, too. Broken skin test is not accurate, but it's xrays lab. Your gap. Michigan's. See if you have latent TB or you can use I'd, er is active. It's a culture you wanted to dispute. Um, culture or blood culture. Urine culture. Wherever the TV is for the management, which you should know, this comes up exams humans off right. So we found it in my eyes, and I've had periods in height, even beautiful. And then you follow that reform instead of Avastin, and I see my XYZ only now the BCG is in question splint days. That's you can get half the BCG it's and you can spend. The problem is you can still catch TV. You know, you've been vaccinated for B C, and it's given the high risk individuals. This is a chest X ray of team being on on days. You could see it doesn't look very good, is it? So this is again I was gonna ask you a question, but it's fine to switch, but at a time, actual pulmonary. So this is this is, um, addictive pots on on the left. But you see a spine and spinal mentions this sort of warrants and TB in the question. Same pox disease. This is a raspy since aneurysm, and in the last is scrofula, which is the survival of the night. It's now TV manager, and this is really important. You should know the side effects off my heart because it is common in some questions. So refund person. It's red orange bodily secretion. So your tears your year and you sweat longer. What Red orange? I need to be quiet hepatic toxic as well. Tense. Why? The prophylaxis is simple. Fossen is better, or razors idolizes peripheral neuropathy so you can treat this revetment B six, which is pyridoxine. But, yeah, it's just annoying side effects. There is a nice guy. You have beautiful retrobulbar neuritis. In other words, not generators. Eye problems. So everyone should be tested or visual acuity before that on TV treatments. Streptomycin we don't don't you don't need to worry about. It's not used second one. And that's the TV manageable side. So that's 27 year old female with a known possible history of HIV AIDS presents, aiming with increasing confusion. Headache. So most recent CD four count is 150 as she's not complying fast CT scan reveals ring enhancing lesions What is the correct diagnosis again? Another popular. These are questions. Good. Yeah, Ms. Problem on CNN sponsored plans ministers. So that's a positive plasmosis Gandhi. A test positive. Gandhi. It's parasitic on the usual little clinical presentation. If you're, um, you know, if you're you know, So uh, you mean system's fine, then it's usually a mild through, like all this, but if you're not immune confidence than it's well, it could be quite devastating. So risk factors into the pregnancy because it's congenital defects is one of the torch on species criteria on the suppression So it's commonly acquired community or I am inspection so congenital systemic illness, then CNS and localization because it's damaged the I tried to Catholics an interesting referral. Calcification, if you're immuno Suppressed, is one of the major causes of death in HIV AIDS patients, and it resulted in a Catholic picture toxoplasma necroes absences. So these ring enhancing lesions that's pathognomic for CNS or false positive is is heart has reduced the number of cases drastically plastic me transmissions by a copy sees an undercurrent foods and diagnosis serology, amniotic fluids. Ass is if it's cancel an MRI. CT management. If you're pregnant, you're not gonna want to give anything distrust. Four days. So you have spare my sin. But for, say, this patient's on the question here. Vitamin subsidizing on because it's a preacher Feel like you could give a lot of acid. So this is what it is. This is a ring enhancing lesion on. The reason why I put the next picture is because this is known as a valley. Inspect on investigation. Scan on if you want. How the difference. Sorry between CNS Toxoplasma menses and say, um CNs um, Stoma. The spent respect will tell you which ones, which was positive and negative, so that could be. It could be in the question, which distinguishes between the two now with CNS and FOMA is more homogeneous. They don't have this ring in House and Nation, that's all. There is a homogeneous spread, and it's you ccs left over in here. So a 28 year old female besides a any with increasing confusion and headache, past history is a remarkable popular recent chest infection three weeks ago for which she has also had a flare of a particular or a little rush. MRI shows Temple little Bit Hudson's What is the correct diagnosis? Okay, so it's good. Just one of the heat. This is one of the hippie simplex virus is gone. Which one? It's long it again. So it's definitely and catalysis difficult by herpes simplex buts. So it's a patent on the H. So, for example, this is 20 female, so there for a just being half lifes. One is the Ms Contin. Now again, you can say the mucosal or source is Hey, just be one. But it's actually been proven that hatred's we wanted to actually overlap so one to be gentle, one computer or all source. So it's hard to say, um, it actually between the tip, which it does change. But those combination operative catalyze is is HSC. Hey, just being careful, Isis and it's caused by her. He just be once you have any innings agency to and this is a quiet by botulism every therefore, if someone has an outbreak of herpes and they're pregnant, you want to avoid vaginal delivery. And she was cesarean section. All the Children adults ages be one size of symptoms is an aseptic meningitis on Do it May presents with Patrick skin or mucosal lesions. Diagnosis. If you see temporal lobe in Hansen's in A in a MRI, Down and Step is going to be hated. Seeing catalyze is the management IV acyclovir for 21 days, you know, pumping with IV acyclovir now. Occasionally, there are other, uh, the virus is Michigan, causing capsulitis visa be CMP on her B six, but these are usually associate with muse oppression. His IV. It's rare for aging. Please it that there's something called the virus, which you can get a severe facial capitalizes and it's fired. My cock monkey. That's usually the way. This is what it looks like. This is the temple of Inhance mention of the MRI, and that's question an 18 year old male presents the any with joint pain is just started. University has been recently drinking heavily. The also complains of the Syrian. You're just charged. When she stays offensive of us, like one is diagnosis, we'll see each other. Okay, so it's home between a and so this is probably one of the most common and along with the media, which committees most common, that gonorrhea is another one. So in this question on it's offensive and past, like so Comedia is actually be asymptomatic, and it doesn't really. It may not disseminate me gonorrhea, you getting at this how plus like discharged. And that's why the question would be, um, gonorrhea. On what particles? So the morphology is a grand negative, typically the same as Neisseria manages. That's the same harmony on the clinical presentation depends on on gender, but if it's a female, is classically so deciders males. Prostate size is on. Depending on the way out sex, you could get a prostatitis or throat infection also complications. Your resource stricture reactive arthritis s. It was also his righteous and right tried back. We can use that anymore for for different reasons. So it's called reactive arthritis down and you can get complications such as evident Might isn't salvage itis and diagnostics. It's a swap, and then CNS to wherever the infection is, you're going to swap back with this and the management. So current gonorrhea is on the rise of different assistants. Person's where you are in UK Currently, it's I'm Katherine So, or a mixture of or Aleve fixing. And, um, is it from my side? An incisional disseminates a golden couple infection is a try, as if my great tree arthritis is Tina. Sign of Eyes is on this particular matter of fact, Uh, the genotype is is next question an 18 year old female presents for local gun connected to Syria. Jews also complains of increasing wisdom lower at all. She denies any more that vaginal discharge that feels well. She also notes that she is worried that she has picked something up as she has had multiple sexual partners on speculum. Examination. Survival exhortation is noted in pregnancy is is negative, which the phone is ms like the HRT. There is a bit of a clear since, um, Michael Excitation. There's a couple of things, of course, that possibly option is yes, it's definitely correct. That's a vital explanation. Gives the way in. It's on because there's classically true things which cross the Vicodin execution. So perfect. If lunch is sort of just what's happening here, which is most commonly caused by committed creditors on ectopic, So pregnancy test is negative. They're freaking from. That's chlamydia is is actually quite a bit. So most people think there's, you know it's because of genital infection. There's different serum, gas troubles, different things. So it is the most common STD in the UK and committed to conferences and see if I d. P. K. The morphology is an interesting little you bacteria is Paris, is it? So you can see from this image where the air is pointed that would be consistent with comedia. Now, clinical presentation is often asymptomatic, which is why it's different, wise, aggressive on sufficiently to help pick inflammatory disorder, you get a discharge to Syria and then service. I just prostatitis. Diagnosis is by a bat. You play acid amplification tests on females. Is this fire a urine culture for females. This is a form of a vitamin small on. It should be taken two weeks post exposure that because it could be negative failure management doxycycline to seven days. Or this is from so this year is your Pap peri peri habits right? In cities. Her Patrick occasions, which basic be is consistent with a condition called Fitzhugh Curtis Syndrome, which is classically sing in a Chlamydia poster. A pelvic inflammatory cause disease called Comedian, a 45 year old female presents just spotting vaginal discharge, which is very self conscious fact. The urge is so awful, that is, she is worried that this judge here, whilst cash in a local best to work. She's on a long term relationship with her husband and denies being unfaithful. What is the etiology? Okay, so we have a split between eight and see so the crackdown. So here it would be, see, because it's consistent with bacterial vaginosis. Trachomatis vaginalis. I'll get on to bit needs, and it's so bacterial Vaginosis. Etiology is Gardnerella vaginal. This this is those common bug force it, but there is also other associate it bugs such a pep to strap bacteroides mobile. Long as now, the mythology is ground variables so hard to really help you. The clinical presentation is vaginal discharge is fishing is offensive thing, and you can honestly you can. It's quite offensive spending on people to be quite self conscious about it, and it's usually described is and then white modernise discharge. You could be instance matting, and it's usually not distressing. It's just more, you know, effects lifestyle, etcetera. So management is P O metronidazole to seven days. Or if you don't want that, you can use a topical clindamycin. Now, this is I'm not because I'm cautious about time, but this is known as a clear cell. Now, clear cell is pathognomic for be the Gardnerella usually, and you use something called the answers price. Here now is all things a positive test. So if you have the distractible testing my doctor over there, it reproduces this bishi odor. Vaginal discharge is above 4.5 p. H. Lien that man, because it's really use off other things. A smile on you get the skin whiter, marshals discharge and then you get to your cells on my posture, which is bucks to a 24 year old male presents with very painful lesions on his foreskin. Inscription. He's a very painful, physically nature. You suspect he just be to infection on. Want to initiate religions vision? Following is most likely great. Okay, so, yes, it's answer. C is the correct answer. So STD genital herpes. I know, I know. It's a bit offensive. This picture's this is what it will. This maybe looks like so hey, just we want to just be too. There is an overlap, so it can be either. But classically is a just to clinical presentation. Painful sore. So in an STD, if there's a painful sore think herpes is probably most common. It's a painless or I'll get on start later, and these sorts of particular. So there blister like and you can actually pop them. And this is how the baby's is actually spread is via skin to skin contact in the popping of these physicals between releases the virus in in my seven months, so you get to Syria, you get up your rights, us because it's itchy. You get tender England on lipids. Nice is in a systemic syndrome. You can feel quite unwell with genital herpes on the diagnostics is the same. It's coming up to any 18 and serology if it's applicable. Management is p o excited yet, and relaxes may occur it. So you may need long term pos item here. Now you can use the conservative measures because these are painful. So you want analgesia. See like Bath in and maybe a topical local anesthetic. Help smile if pregnant above the age of 28 weeks. Elective C section. And that's really important, for example, because you don't want it passes on the unit and 35 year old male presented a generalized rash across his trunk. Parts and soles is began six months. Post development of a painless lesion on his glands Penis. He also describes an ongoing fever. Widespread lymphadenopathy, which the following is most likely diagnosis. Great, Good. So this question's really tested in the differences between syphilis, the different syphilis stages. So this is syphilis is also known as trapping in a palate. Um, and it's a spirochete. So another spirochete, which people mean I was like disease? It's a, um it's Barilla, which is a spirochete, a swell on. You can't really stay knees. There's a really difficult staying you need to use and your knees, ears, doc field lights and and it is difficult to stay in, basically the clinical presentation. Primary Syphilis is a counter, and it's painless. So this is how you distinguish between herpes long, tender, local and lifted healthy. Now the secretary Syphilis, this is this is what the pressure was. Higher 6 to 10 weeks postpartum singer and it's you get this generalized rash defensive Parcells and Trump. You get snail truck bucal and lesions, and some people can dial a martial arts mart, a lot of which is basically a wart like lesions. Now, many years you don't get this treated. And this is what used to happen in the olden days is a progress to church is a class Now. This is life debilitating, and you can get tough tablets. Dorsalis and our goal Robinson people Government is lesions. General Promises of the Insane is also known as part of dementia on an ascending aortic aneurysm. Really awful stuff. You do not treat this on the magic. Simplest is actually a very easy budgeted streets you just used classically, I am bends of been penicillin or doxycycline on simplest doesn't really get resisted soon. This being the same treatment for years. But you can't be warned of the generics excimer reaction and because unconscious time, we're not really gonna go into it. But that's something Issues should be washed out when using penicillin G on medicine. This in general. Now, I've seen this come up in questions. This is advanced. So there are different types of tests and you can use to stage the disease. What I would do, I'm not gonna explain it. That winds you just learned this table cause it could be become very helpful if your chairman of different stages no STDs, other tranquilizers to go back to be the question. The difference between trichomonas fashion honest and Gardnerella is it's what is a flash related protozoan on it's green offenses discharge. You get a strawberry pinpoint servants on speculum and it is associated with more of an alkaline DH. But it's this is sexually transmitted on is actually on the rise in UK. So the diagnosis is cervical wet wrap, which you wouldn't you wouldn't need to know. But it's something which we do. His medical microbiologists and management is pure metronidazole Any protozoa in or Paris been a process. So in salt causes metronidazole to go to antibiotics now lymphogranuloma Vinny area. This is really because it's a committee. A serovar L1 to L3 on this is seen in hatred become infection. And classically, the question will be manual sex with men. So the clinical presentations is It's painless pressure ulcer, which then goes into official eyes and you bow and approximately litis and it's read. This is quite an awful condition and you need to treat that doxycycline. This is what it looks like. So on the on the left is allergy V and then on the right. This is strawberry six. Okay, bit of a difference. 1 40 old males returned from vacation of Vietnam with ongoing cramp. Feels awful pain with associated watery, non bloody diarrhea. This has been effecting his work. Life is years, opening his bowels 57 times daily for the last three months. So it'll follow. Do you think is the right answer? I have the whole thank you. Great. Yes. So this is classic Fiji, Ozzy Lambda and reason why this is what it looks like actually on. It's a pleasure to present it began. Transmission is mainly fingers or rich on the presentation is a chronic. No bloody diarrhea disease has gone on long intervention. There's therefore it's usually because of the holiday, and you come back if sold off. This non bloody crampy absorbed diarrhea on increased flashes and bloating. Sometimes it be's it's rising, but for high yield stuff, it causes malabsorption on a lactose. Intolerance is, well, diagnostics. You stool some home so and this will classically show actually nothing. So what you want to do is some people in June, you know, aspirin. So swallow a piece of string, get down to the drug scene and then take it at and then test it. And that's that is actually was what is used. So management is metronidazole as many three year old female. This return from vacation in Egypt with crampy hands are all pain and nausea associated watery, non bloody diarrhea. She's had more than three loose stools in the last 24 hours. What do you think it is? Thank you. Okay. Make sure. Yeah. So, yes, Ekulama is the most popular. And, yes, this is what we call like a traveler's diarrhea equalize. Most common cause of traveler's diarrhea. This is what it looks like on ground saints. Ground is tell us on the transmission is use your fecal or rich on clinical presentation. Normal bloody water, diarrhea, crampy, abdominal pain, nausea, vomiting. Males would be seen now the difference between geology and E. Coli. Everything controllable. Diarrhea job is a lot longer. They will be going on for a lot longer information. So the certifying traveler's diarrhea It's more than three watery stools in train for hours, with without associates, symptoms and the mattress is conservative or replacement therapy. That's like diarrhea like there's nothing you can do. And don't be confused with the bloody vision off the toxin. Mediated coli um, which will cause a humanistic your remix syndrome that is again conservative but may warrant admission. 35 year old male change from traveling around Southeast Asia with adult pain, nausea and constipation. He also complains of a new onset rash. Different his torso. Basic observation show a fever 39 along so the heart rate of 55 BPM. So it's it's not relative product cause you get what's the most likely diagnosis. Guess the most popular answer here is similar. Type E. Yes, this is typhoid fever. All parents are or paratyphoid feel. The difference between the two. Salmon is 5 ft, and in Paris, I tree, therefore causes bridge type of fever. What's the names? They're both grand. Negative, but still like on the transmission is Fecal road a vehicle or Aleve or water? It's suit gets water little presentation, So the main thing with the with the gut is when it comes to infections. Salmonella causes usually a constipation picture rather than diarrhea. But if it does cause diarrhea is usually bloody, so you get absorbed peanut distention and you get a relative bradycardia. High temperature in no heart rate's on. Did you get this sort of rose sports appearance? So you get these tiny little spots all over the trunk, and they considered red spots that. But this is more common in Parent's life. Complications, perforation and hemorrhage is a big thing in life because you got this constant pain tree picture and, for example, this is sickle cell. Salmonella causes osteomyelitis in sickle cell patients. It's not. It could be some type of about using these, some another enter it. It is it just same letter in general courses An osteomyelitis picture in sickle cell. You can also be a chronic current carrier of salmonella. On you can get the biliary and manageable information, which is red. So problem with salmonella is it's increasing resistance. So therefore, classically was rock, you know, lens. But now we use Is it from my sin cap? It's foreign in endemic regions. The food poisoning really important because the identify vacation. Of course, if organism is the pencil, the incubation period. So, for example, classic scenarios. Bacillus serious is short incubation related to rice, rice consumption or overcooked, undercooked rice. It's rice is to the questioning or food poisoning. Think the Sinus Sablikova Sorious. So this is seen in like dairy products. Cream. Classically cream causes do poisoning with stuff on top stories, then a bit longer to go to 48 hours. 70. Let you go like then a bit longer than out. Should jealous of estrogel a causes a dysentery, bloody diarrhea. She got spots in there. Very alarmed. She wished agenda compiler back to judge me. Cut the Colyte, so compile it back to judge me. Causes can cause a green Bari syndrome on it's classically chicken. Sorry, it's possibly pork chicken and you cook barbecue stuff in a question. On an above one week giardia ambulance. Enter Neema sent immunohistological causes and amoebic liver disease. And if you see that in a question, they see the aspirins off one of these liver liver abscess is is and Children's sores and shit and show V sort of fish source. That would be an entamoeba. Okay, so 47 year old male, who is a known IVG year, has present it's a surgical assessment. Units was suspected cellulitis. However, on examination, you notice resting Can't image of a white pill Centrum endoscopy on the memory test on augmentation it was most likely diagnosis is what is the most likely etiology. I've been meaning discretion because all of these Concordes it Yeah, very good. So you might have fought. This is ineffective and a card I The most common cause is start or es. Now there's a difference. Other bugs can cause this, but if it's if they haven't bought the rights, you know, description or hospital history. So if someone has hearts a prosthetic file surgery under two months ago, I think start Epogen minutes, which it Another quietly is negative. Sample Coke. I stopped. Warriors is quietly is positive. Be others on a Cordless negative on. So if you think it's active processing files start epigenetics caucus. Bovis is eyes One you can catch swelling is a group D Strap on it is associated with colorectal transected If you got and infectivity part of it is they've grown streptococcus and is a colorectal cancer sort of picture in question. Think strep constipated. Now there is a strep, so you can get this in dental plaque and poor oral hygiene. This can cause an effective medical titers also, and then with endocarditis the hey, stick the culture negative bugs So on, if you were really interested um, awfulest actually, business card you material. I can link it. Just call in the Hastings species, and this is what it looks like so that that pale white spot that's called a rough spot also snows Jane Relations. A painless also is a painful, and then you get these splints of hemorrhage is if you've got all this on a new murmur, it's infected endocarditis until proven otherwise. Now you can use that that you can use the criteria called Modified You criteria. Now also do this for carotid Ultram set. This is a different job. So the major criteria that you can see above it needs to be two of the major criteria. One major cross here in three minor criteria or five other criteria. And I'm not gonna go through that at the moment and in the management. So again, this is something you just have to learn. But if you have a native So in this case, a native valve with staphylococcus confirmed through cloxacillin If it's Paddison allergic, fungal mycin find my sin and response. Um, okay, So 76 year old females being, um, introducer ever stayed positive cellulitis use a minister antibiotics your bloops shortly after the patient's being turning progressively red. Um, the most likely diagnosis which the following was given basically good. So this is a vancomycin mediated red man syndrome. It says name. To be honest on, you can get vancomycin for MRSA positive satellites to swell. So the reason why this happens is vancomycin. When it's given IV, it's can. It causes systemic histamine release, which then causes a systemic vasodilation hands turning red. So if this does happen you want to stop the vancomycin on. She wants to treat with maybe an antihistamine to control this phase of violation in the history meats. So I chose in a couple of importance on the first drug reactions, which you should know for the for the exam. So the ones to take out this amoxicillin opposite in you can get a glance your fever related rush so EBV. Epstein Barr virus causes fever. You get a rash if you have a baby and then anaphylaxis many of the Palestinians or antibiotics in general. To be honest. Augmentin, Zocor, monster class. It's called Qala Stasis on it. Also, really, any of these antibiotics causes got disturbance. Call Meloxicam is a nightmare for the gut, so just be careful when it minister in it called Meloxicam, is also given for dog bites and animal rights. That's another really important thing to note. You're sitting again called Stasis, but this is usually several weeks pushes and flax is, but you've got this increased risk of super infection with Candida erythromycin crystallized. And as I said before, you could get the see where I p 450 inhibition you do not want to give this with statins. It causes. It can cause rhabdomyolysis it causes. Got this disturbance and you can prolong the QT interval. Several folks in the ones notes see why people find your inhibition decreases the session seizure threshold. So if someone say is on keppra on, they're more likely to get the seizure. It was got epilepsy. Then we'll like you to get the get a seizure on separate on because his tendonitis, um on also, it can predispose to some mild suppression as well. Metronidazole you get something called the disulfiram effect they have you drank. If you've drank or metronidazole, you'll feel awful. Absolutely awful. It's if it's has instant hangover, doxycycline, voter sensitivity, growth. It stands gross. You don't really want to give this and Children, and it causes a black hairy tongue and close halitosis, part trimethoprim. So this is so late inhibition. So I think you matter queasy suppression, and also you can get rashes. So I've gone through a lot on by hope that is being very useful. I've picked up the most high heel things, which I expect it going to come up, so I really hope you found it useful on but, um, yes. Thank you for having me. If you have any questions, email me or, um, message in a Facebook, I hope is very useful. Thank you very much. Yeah. Thank you so much, Doctor. I was really good. As you can see from the comments. Yeah, I Sorry. You see, that could make the comment. I know I transit all like in the the T CT. Good. You're a pro accident teaching. Yeah. Thanks. Jackals Really good. Thank you very much for probably. So everybody. Make sure you felt the feedback for me before you leave. And if you've got any questions for Jack, if you don't have any questions the moment you can always mess up your facebook, I'm pretty much free arms. This one? Yeah. The somebody else close the slides, the other slides would be up on medal so you'll be able to go through them in your own time. Um, but yeah, but it doesn't seem like you have any more questions. Thank you, Sam. I jak thank you very much. And what? What do you know? Well, yeah. You could just leave whenever it's obscene. Thank you so much. You don't want to see Jack. That was really, really good. So I'm sure everyone found it really useful. Yeah, I don't know. I also was a bit long. I do apologize, but yeah, there's a lot of No, it's fine because we were like, Oh, the slides after That's pretty good. And just for anybody remaining, there's a summary slides at the end that we've know So you can look at those your exams. Someone's asking. Why does TB cause low sodium TBA? Oh, you mean Legionella liver isn't TV that they might need? S O T. V doesn't as no, I don't think it does a lesion. Ality is the reason. Yeah, no, nor is so. It is a weird process, but legionella it does, uses it in. It's a tablet, of course, America, but at the same time it can cause, um, it can cause this function in the in the way a. D. H works a swell. So I think I think there's a difference. I think there's an interaction with that, and I there is a part. There is a There is a a mechanism it does despite, but I can't remember the moment. So I do apologize. I guess for exams. Hyponatremia. Definitely Legionella. That's proven otherwise. It's okay. You should be calling me Cruise a day. Yeah, I think so. Yeah, I think so. That so they won't thank you for coming on. But when is our next one should be? Just enough, Frank. Sunday Sunday, seven PM One day, seven PM is it? And technology? Yeah. Yeah, I send the cardiology. We're going to see you. Well, that bro. Thanks again, Jack. Thank you very much. Everyone takes everyone.