MCQS 211-213 :Chlamydia trachomatis is a cause of

Chlamydia trachomatis is a cause of
a) Lymphogranuloma Venereum
b) Testicular Torsion
c) Hydrocele
d) Epididymitis
e) seminoma
f) mature teratoma
g) varicocele
h) lymphoma
i) orchitis
j) Spermatocele
An eight year old is brought to Casualty with fever and a petechial rash. On examination he is found to be lethargic and shocked. Meningitis is suspected. The child has a severe allergy to beta-lactam antibiotics. The most appropriate treatment would be
a) stibogluconate sodium
b) sulfonamides
c) chloramphenicol sodium succinate
d) ampicillin
e) erythromycin
f) rifampicin
g) metronidazole
h) nystatin pessaries
i) chloroquine
j) tetracycline
INR: Normal APTT: Elevated Thrombin time: Elevated Platelet count: Normal Bleeding time: Normal A likely aetiology is
a) Waldenström's macroglobulinaemia
b) Heparin
c) Sézary cell leukaemia
d) Pelger-Hüet anomaly
e) von Willebrand's disease
f) Haemophilia
g) HIV infection
h) Disseminated intravascular coagulation
i) Acanthocytosis
j) Vitamin K deficiency
Correct Answer: A
LGV is caused by Chlamydia trachomatis. It gains entrance through skin breaks and abrasions, or it crosses the epithelial cells of mucous membranes. The organism travels via the lymphatics to multiply within mononuclear phagocytes in regional lymph nodes.
Correct Answer: C
This clinical presentation is suggestive of Neisseria meningitidis. The presence of a petechial, purpuric, or ecchymotic rash in a patient with meningeal findings almost always indicates meningococcal infection and requires prompt treatment because of the rapidity with which this infection can progress Aqueous penicillin G is the drug of choice and should be given in doses of 250,000-300,000 U/kg/24 hr, administered intravenously in six divided doses. Cefotaxime (200 mg/kg/24 hr) and ceftriaxone (100 mg/kg/24 hr) are acceptable alternatives. Chloramphenicol sodium succinate (75-100 mg/kg/24 hr IV in four divided doses) provides effective treatment for patients who are allergic to beta-lactam antibiotics. Therapy is continued for 5-7 days.
Correct Answer: B
Heparin initiates anticoagulation rapidly but has a short duration of action, unlike warfarin. It is referred to as being standard or unfractionated to distinguish it from low molecular weight heparin [LMWH] where the half-life is 2-4 times longer than that of standard heparin. Heparin inactivates thrombin and this is manifested by an elevated thrombin time [common pathway] and activated partial thromboplastin time [APTT - intrinsic pathway]. Thrombin time represents the time taken for thrombin [in plasma] to convert fibrinogen to fibrin [normal ratio: 10-15s]. Thrombin time is increased in heparin treatment, DIC or afibrinogenaemia. Laboratory monitoring, preferably on a daily basis, is essential in heparin therapy, and this is achieved by determining APTT levels. Heparin is the only anticoagulant used perioperatively. INR [international normalized ratio] target levels represent a balance between too little anticoagulation and risk of thromboembolism, and too much anticoagulation and risk of bleeding. It is measured as a ratio compared with standard prothrombin time or PT [extrinsic pathway]. Warfarin levels are monitored by measuring the INR and by adjusting the dose to keep the INR within the target range. This range varies as the risk of thromboembolism varies with the clinical situation in different diseases and conditions. APTT is the time taken for kaolin to activate the intrinsic system. Normal range is between 35-45s and is prolonged in heparin treatment and haemophilia. However, in haemophilia the thrombin time is normal


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