Infection- OSCE Jan 2021

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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

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

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

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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

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Choose the correct statement:
Select one: -1p

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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) ( Neuroborreliosis, Bacterial meningitis, Tick-borne encephalitis, Normal )

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) ( Tick-borne encephalitis, Bacterial meningitis, Neuroborreliosis, Normal )

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) ( Normal, Bacterial meningitis, Tick-borne encephalitis, Neuroborreliosis )

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 ( Bacterial meningitis, Tick-borne encephalitis, Neuroborreliosis, Normal )

2021 (Jan 2021) OSCE Stations Test sobre Infection- OSCE Jan 2021, creado por Lit Med el 10/12/2021.

Infection- OSCE Jan 2021

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

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

Choose the correct statement: Select one: -1p

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

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

Choose the correct statement:
Select one: -1p