infectious diseases

A 28-year-old female presents with a chronic cough and fatigue. She has no significant past medical history but reports recent travel to Southeast Asia. A chest PET-CT was performed. What is the MOST appropriate next step in the management of this patient?

A 48-year-old woman presents to her GP with a 3-month history of increasing fatigue, exertional dyspnoea, and a persistent cough productive of small amounts of mucus. She mentions a history of recurrent 'sinus infections' over the past year, often treated with antibiotics. She has recently felt lightheaded on standing. On examination, her blood pressure is 95/60 mmHg, pulse 88 bpm, respiratory rate 20 breaths/min, and oxygen saturation 96% on room air. Chest auscultation reveals diffuse expiratory wheezes. Blood tests performed last week show haemoglobin 85 g/L (reference range 120-150), MCV 72 fL (reference range 80-100), and normal white cell count and platelet count. Spirometry performed concurrently shows an FEV1/FVC ratio of 0.65 (predicted >0.70) with partial reversibility after bronchodilator. Considering the clinical presentation and investigations, what is the most appropriate next step in management?

A 28-year-old woman, 18 weeks pregnant, presents to her GP two days after her 5-year-old son developed varicella. She is unsure of her immunity status and is asymptomatic. Which of the following is the most appropriate initial management step?

A patient with community-acquired pneumonia has a CURB-65 score of 3. What is the most appropriate management setting?

A 10-year-old boy presents to the pediatric clinic with a history of fever, a rash characterized by erythema marginatum, and migratory arthralgia. His mother reports that he had a sore throat about three weeks ago, which resolved without treatment. On examination, he has a temperature of 38.5°C, a heart rate of 110 bpm, and a faint erythematous rash on his trunk. His joints are tender but not swollen. Given the suspicion of acute rheumatic fever, which of the following is the most appropriate next step in management?

A 32-year-old woman presents to the emergency department with a 2-day history of fever, chills, and right flank pain. She has a history of recurrent urinary tract infections. On examination, she is febrile with a temperature of 38.5°C, her heart rate is 110 bpm, and her blood pressure is 110/70 mmHg. There is tenderness on palpation of the right costovertebral angle. Urinalysis shows pyuria and bacteriuria. What is the most appropriate initial management for this patient?

A 10-year-old presents with a sore throat, fever, and fatigue for 2 days. Examination reveals tonsillar exudates and tender anterior cervical lymph nodes. What is the most appropriate next step in management?

A 40-year-old man presents with fever, pleuritic chest pain, and cough. A chest X-ray shows a pleural effusion. What is the next step in management?

A patient with community-acquired pneumonia has a CURB-65 score of 3. What is the most appropriate management setting?

A 32-year-old woman presents to the emergency department with a 2-day history of fever, malaise, and a painful, swollen left knee. She denies any recent trauma or travel history. She has no significant past medical history and is not on any medications. On examination, her temperature is 38.7°C, heart rate is 110 bpm, and blood pressure is 120/80 mmHg. The left knee is erythematous, warm, and tender with a moderate effusion, and she has limited range of motion due to pain. Laboratory tests reveal leukocytosis with a left shift. Blood cultures are pending. What is the most appropriate next step in the management of this patient?

A 70-year-old woman with a history of diabetes presents with fever, cough, and weight loss. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A 48-year-old sheep farmer presents to his GP with a two-week history of persistent fever, severe retro-orbital headache, and profound fatigue. He denies cough, shortness of breath, or rash. On examination, his temperature is 38.5°C, pulse 85 bpm, BP 120/80 mmHg. The remainder of the examination, including chest auscultation, is unremarkable. He has not travelled outside the region recently.

A 23-year-old backpacker doing farm work presents with a low-grade fever for 4 days. Q fever is suspected. What is the most appropriate diagnostic method for acute Q fever in Australia?

A 25-year-old gentleman presents with 3 days of rhinorrhea, fever, cough, and abdominal pain. On examination, his temperature is 39.6°C, he has reduced breath sounds, and an enlarged spleen. Which of the following causative pathogens, if identified, would require mandatory notification in Australia?

A 55-year-old farmer presents with a week of fever, severe headache, and myalgia. He reports recent exposure to lambing ewes on his property. Physical examination is unremarkable except for mild hepatomegaly and normal vital signs. Considering the patient's occupation, exposure history, and clinical presentation, what is the most likely diagnosis?

A 55-year-old man with a history of renal transplant on immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical examination is unremarkable except for mild tenderness on deep palpation of the right upper quadrant. Blood tests show a mild leucocytosis and elevated CRP. Imaging is performed. Based on the clinical presentation and imaging findings, what is the most appropriate next diagnostic step?

What is the recommended initial antibiotic regimen for severe community-acquired pneumonia in an Australian adult requiring ICU admission?

A 32-year-old male, recent immigrant from a high-TB prevalence country, presents with a persistent cough and night sweats for the past two months. He denies fever or weight loss. Physical examination is unremarkable except for mild, diffuse rhonchi on auscultation. Sputum cultures are pending. A PET-CT scan of the chest was performed, the axial view is shown. Given the clinical context and imaging findings, what is the MOST appropriate next step in management?

A 10-year-old presents with a sore throat, fever, and tonsillar exudates. Rapid strep test is negative. What is the MOST appropriate next step?

A 55-year-old patient with a history of solid organ transplant on immunosuppressive therapy presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical examination is unremarkable except for mild tenderness in the right upper quadrant. Blood tests reveal a CRP of 85 mg/L (normal <5), WCC 11.5 x 10^9/L (normal 4-11), and mildly elevated alkaline phosphatase. Imaging is performed as shown. What is the most appropriate next step in management?

A 55-year-old renal transplant recipient on long-term immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical exam is unremarkable except for mild tenderness. Labs show mild leucocytosis and elevated CRP. Imaging is shown. Based on these findings, what is the most appropriate immediate management step?

A 24-year-old woman presents to the emergency department with a 3-day history of fever, sore throat, and fatigue. She also reports a rash that developed after taking amoxicillin prescribed by her GP for a presumed bacterial throat infection. On examination, she has cervical lymphadenopathy, a diffuse maculopapular rash, and mild splenomegaly. Her vital signs are stable. A monospot test is positive. Which of the following is the most likely explanation for the rash?

A 35-year-old lady who underwent laparoscopic appendicectomy presents 3 days later with diarrhea, fever (39.5°C), and erythematous port sites. She had a 5-day course of cefotaxime. What is the most likely diagnosis?

A 58-year-old non-smoker presents with a 4-month history of intermittent fever, night sweats, and a persistent cough productive of small amounts of sputum. He recently emigrated from a region with a high prevalence of tuberculosis. Physical examination is unremarkable. Chest X-ray reveals a solitary nodule in the right upper lobe. A PET-CT scan is performed as part of the investigation. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?

Which zoonotic infection is a leading cause of culture-negative endocarditis?

A 10-year-old presents with a sore throat, fever, and tonsillar exudates. Rapid strep test is negative. What is the most appropriate next step?

A 28-year-old immunocompetent patient presents with a chronic cough and low-grade fever. Initial investigations, including sputum microscopy, are negative. A PET-CT scan was performed (image shown). What is the MOST appropriate next step?

A 35-year-old man presents to the clinic with a 3-month history of persistent cough, night sweats, and weight loss. He has a history of travel to Southeast Asia six months ago. On examination, he appears thin and has crackles in the upper zones of his lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?

A 28-year-old male presents with a persistent cough and fatigue. A PET-CT scan was performed. What is the MOST likely diagnosis?

A 35-year-old man, recently arrived from a country with a high burden of tuberculosis, presents to the emergency department with a 2-week history of worsening headache, low-grade fever, and general malaise. Over the past 48 hours, he has become increasingly drowsy and confused. He denies cough, weight loss, or night sweats. His past medical history is unremarkable, and he is not on any regular medications. On examination, he is febrile (38.5°C), drowsy but rousable, with a Glasgow Coma Scale (GCS) of 13/15 (E3 V4 M6). His neck is stiff, and Kernig's sign is positive. Fundoscopy is normal. Chest auscultation is clear. Neurological examination reveals no focal deficits. Initial blood tests show a mild lymphocytosis, normal electrolytes, and normal renal and liver function. A non-contrast CT scan of the brain shows subtle basal meningeal enhancement. A lumbar puncture is performed. CSF Results: * Appearance: Slightly turbid * Opening pressure: 25 cm H2O (elevated) * White cell count: 150 cells/µL (normal <5), 80% lymphocytes * Red cell count: 5 cells/µL * Protein: 1.5 g/L (normal 0.15-0.45) * Glucose: 1.8 mmol/L (normal 2.5-4.5), simultaneous blood glucose 5.5 mmol/L Given the clinical presentation and investigation findings, what is the most appropriate immediate next step in management?

A farmer successfully treated for acute Q fever presents 6 months later with unexplained weight loss and night sweats. Physical exam reveals a new murmur. What is the most likely diagnosis?

A 3-year-old boy is brought to the emergency department with a high fever, irritability, and a rash. The rash started on his face and has now spread to his trunk and limbs. On examination, he has conjunctivitis and Koplik spots are noted on the buccal mucosa. What is the most likely diagnosis?

A 56-year-old gentleman, a gardener and cat owner, presents with 24 hours of pain, swelling, and redness on his right index finger. His temperature is 38.1°C and pulse is 72. Suspected gout. What is the most appropriate next step?

A 10-year-old girl with a 3-day history of shortness of breath, fever, and headache has been diagnosed with pneumonia. What signs might be seen in severe pneumonia?

A 25-year-old man and a 23-year-old woman, newlyweds, are planning a 3-week trip to South America. The woman is not on oral contraceptives and wants to conceive. They are concerned about Zika. What advice can you provide?

A 45-year-old farmer presents with a 10-day history of fever, severe retro-orbital headache, and myalgia. He denies cough or dyspnoea. Physical examination is unremarkable. What is the most appropriate initial investigation?

A 55-year-old renal transplant recipient on long-term immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical exam is unremarkable except for mild tenderness. Labs show mild leucocytosis and elevated CRP. Imaging is shown. What is the most appropriate next step to determine the specific aetiology of the findings?

A 59-year-old lady with a past history of Type 2 Diabetes Mellitus and hypertension, and no smoking history, presents with a 3-month history of cough, blood-tinged sputum, night sweats, and a 5 kg weight loss. What are the most appropriate initial investigations for the likely diagnosis?

A 6-year-old child presents with intensely itchy, small, fluid-filled blisters on their hands and feet, especially between the fingers and toes. The lesions are linear and excoriated. Multiple family members have similar symptoms. What is the most likely diagnosis?

A patient presents with severe community-acquired pneumonia. Which initial investigation is most crucial for guiding immediate management?

A 32-year-old male, originally from a high-TB prevalence country, presents to the emergency department with a persistent cough for the past 3 weeks, night sweats, and a 5 kg weight loss. He denies any fever or shortness of breath. Physical examination reveals normal breath sounds bilaterally, with no wheezes or crackles. His vital signs are stable: temperature 37.2°C, heart rate 88 bpm, blood pressure 120/80 mmHg, and oxygen saturation 98% on room air. A chest X-ray was initially interpreted as showing a possible lung mass, prompting further investigation with a PET-CT scan, the axial view of which is shown. Sputum samples have been sent for microscopy and culture, but results are pending. Given the clinical presentation and the imaging findings, what is the MOST appropriate next step in management?

A child has a sore throat and fever. Centor criteria are 3/4. What's the next step?

A 5-year-old boy presents with wheezing, shortness of breath, and a history of recurrent respiratory infections. His symptoms worsen with exercise and during the night. What is the most likely diagnosis?

A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He also reports a persistent cough that has recently become productive of blood-streaked sputum. He has no significant past medical history and is not on any medications. He recently returned from a trip to Southeast Asia. On examination, he is febrile and has bilateral crackles in the upper lung fields. A chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?

A 3-year-old child is brought to the general practice clinic by his parents due to recurrent episodes of wheezing and cough, particularly following viral upper respiratory tract infections. The child has had multiple similar episodes over the past year, each resolving with bronchodilator therapy. There is no history of eczema or allergic rhinitis, and the family history is unremarkable for atopic conditions. On examination, the child appears well between episodes, with normal growth parameters and no signs of respiratory distress. Auscultation of the chest reveals clear lung fields without wheezes or crackles. Which of the following is the most likely underlying condition?

A 35-year-old woman who recently underwent laparoscopic appendicectomy and completed a 5-day course of cefotaxime presents with a 3-day history of diarrhea and a temperature of 39.5°C. Her vital signs are otherwise normal, and a digital rectal exam is normal. Examination reveals erythematous port sites. Which of the following is the most likely diagnosis?

A 45-year-old recent immigrant from a high-prevalence country has a positive tuberculin skin test (18mm) and negative chest X-ray. He has chronic hepatitis B. Which is the most appropriate initial management for latent tuberculosis infection in this patient?

A 1-year-old child is brought to the emergency department with a 3-day history of cough, wheezing, and difficulty breathing. The child has a fever of 38.5°C and a runny nose. On examination, the child appears in mild respiratory distress with nasal flaring and intercostal retractions. Auscultation reveals diffuse wheezing and crackles throughout the lung fields. The child has no significant past medical history and is up to date with vaccinations. A chest X-ray shows hyperinflation but no focal consolidation. Which of the following is the most likely diagnosis?

A 5-year-old boy is brought to the clinic by his parents due to a 3-day history of fever, irritability, and refusal to eat. On examination, he has a temperature of 39°C, erythematous oropharynx, and tender cervical lymphadenopathy. There are also vesicular lesions on his hands and feet. What is the most likely diagnosis?

Adult with suspected aspiration pneumonia. Initial antibiotic?