Pathology EMQ template.

Name: Alex Rothnie

Candidate number: 9254

Theme: PUO and Endocarditis

OPTION LIST

A	Borreliosis	I	Staphlococcus aureus
B	Cat scratch disease	J	Streptococcus viridans
C	Haemophilus parainfluenzae	K	TB
D	Klebsiella	L
E	Leptospirosis	M
F	Plasmodium malariae	N
G	Plasmodium vivax	O
H	Rheumatic fever	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. An 11 year old girl presents with a 10 day history of fever, pallor and weight loss. Examination reveals a new heart murmur. Blood cultures were positive for gram negative rods.

2. A cattle farmer developed a severe headache with a fever, malaise, anorexia and myalgia one week after his land was severely flooded.

3. A 27 year old female presents to you with a rash and painful swollen left elbow with grossly reduced range of movement. She also has a bradycardia.

4. Symptoms of this infection include weakness, vomiting and tertian fever.

5. This organism is found in 30 - 40% of cases of endocarditis in adults.

ANSWERS

1. C

2. E

3. A

4. F

5. J

HACEK organisms are an important cause of endocarditis in infants and children, in that they are the most common cause of pediatric Gram-negative endocarditis.

Leptospires are excreted in animal urine, and enter the host through a skin abrasion or intact mucous membranes surviving in fresh water for many days. Leptospirosis outbreaks have been associated with flooding and in England remains largely an occupational disease of farmers and vets.