AKT – Infectious diseases

Clara Atkinson, aged 22, presents with a 4-day history of dysuria, urinary frequency, and lower abdominal discomfort. She is sexually active with a new male partner in the last month and is not using barrier contraception.

She denies fever or flank pain. Her only medication is the oral contraceptive pill. On examination, she is afebrile, with mild suprapubic tenderness and no costovertebral angle tenderness.

Urinalysis shows leukocytes and nitrites. First-pass urine NAAT is pending.

What is the MOST appropriate next step in management?

Michael Radovic, aged 64, presents with a 5-day history of fevers, rigors and productive cough with rusty sputum. He has a past history of hypertension and type 2 diabetes. He is a lifelong smoker. His respiratory rate is 26/min, oxygen saturation 92% on room air, and temperature 38.9°C.

On auscultation, he has bronchial breath sounds and crepitations in the right lower zone. Chest X-ray confirms right lower lobe consolidation.

What is the MOST appropriate management?

Sara Henderson, aged 36, is 20 weeks pregnant and presents for routine antenatal screening. She is asymptomatic. Routine serology reveals she is non-immune to rubella and her CMV IgG is positive, IgM negative.

She works in a childcare centre. She is concerned about cytomegalovirus and its risk to her baby.

What is the MOST appropriate advice regarding her CMV status?

Daniel Costa, aged 27, presents with a 2-week history of malaise, sore throat, and enlarged cervical lymph nodes. On examination, he has splenomegaly and exudative tonsillitis. He denies cough. His temperature is 38.2°C and heart rate is 88/min.

His monospot test is positive.

What is the MOST appropriate management?

Akash Bhatt, aged 45, presents with fevers, myalgia and a petechial rash after returning from a 2-week holiday in northern Queensland, where he camped near floodwaters. He also reports headaches and mild photophobia. He is afebrile today and his vital signs are stable. Blood tests reveal mildly elevated liver enzymes and thrombocytopenia.

What is the MOST likely diagnosis?

Rebecca Lloyd, aged 33, presents with a 6-day history of fever, dry cough, and increasing shortness of breath. She returned from overseas 10 days ago. She has not improved on oral amoxicillin started by another doctor. On examination, she has bilateral crepitations, a respiratory rate of 24/min, and oxygen saturation of 91% on room air. Chest X-ray shows bilateral patchy infiltrates.

What is the MOST likely causative organism?

Wendy Tran, aged 29, presents with fever, rash, and arthralgia after returning from a trip to Fiji 4 days ago. She reports mosquito exposure. On examination, she has conjunctival injection and a blanching maculopapular rash. Her platelets are 98 × 10⁹/L, and liver enzymes are mildly elevated.

What is the MOST likely diagnosis?

Julian Morris, aged 52, presents with fever, night sweats and weight loss over the past month. He has a history of previous pulmonary tuberculosis in his 20s. He was born in South Africa. On examination, there is palpable lymphadenopathy in the neck and axilla. His chest X-ray is normal. FBC reveals normocytic anaemia and raised ESR. HIV test is negative.

What is the MOST appropriate next investigation?

Nina Sutherland, aged 27, is 10 weeks pregnant and presents with nausea and a mild fever. She recently adopted a stray kitten and is concerned about toxoplasmosis. She is otherwise well and examination is unremarkable.

Which test would be MOST appropriate to assess for acute toxoplasmosis infection?

Jackie Morrow, aged 40, presents with new onset of jaundice, dark urine, and fatigue. She recently returned from visiting family in India 3 weeks ago. She denies alcohol or medication use. On examination, she has scleral icterus and mild hepatomegaly. LFTs show markedly elevated AST and ALT, and bilirubin of 120 µmol/L.

What is the MOST likely diagnosis?

Edward Bain, aged 68, presents with confusion, fever and urinary incontinence. He resides in a nursing home. On examination, he is febrile at 38.3°C, disoriented, and has suprapubic tenderness. His BP is 105/65 mmHg and HR 96/min. Urinalysis shows leukocytes, nitrites and blood.

What is the MOST appropriate management?

Louisa Yuen, aged 19, presents with a painless genital ulcer that developed 3 weeks ago. She is otherwise well and sexually active with multiple male partners. On examination, she has a solitary, indurated, clean-based ulcer on her vulva and non-tender inguinal lymphadenopathy.

What is the MOST likely diagnosis?

Amir El-Sayed, aged 55, presents with chronic cough and unintentional weight loss. He migrated from Egypt 5 years ago and has type 2 diabetes. On examination, he is afebrile with reduced breath sounds over the right upper lobe. Chest X-ray shows cavitary lesions in the right apex.

What is the MOST appropriate next investigation?

Sharon Wallace, aged 38, presents with fever and a painful red swelling on her left lower leg. She recalls shaving her legs a few days ago. On examination, the area is hot, tender, erythematous and has poorly demarcated borders. There is no abscess or fluctuation.

What is the MOST appropriate treatment?

Leo Nguyen, aged 31, presents with low-grade fevers, malaise, and a painless ulcerated lesion on his forearm after returning from a hiking trip in Bolivia. The lesion started as a papule and gradually ulcerated. He denies systemic symptoms.

What is the MOST likely diagnosis?

Kylie Morrison, aged 34, presents with fever, severe headache and neck stiffness. She is photophobic and has vomited twice today. On examination, her temperature is 39.2°C, BP 110/70 mmHg, and she has a positive Kernig’s sign. No rash is noted. She has no significant medical history.

What is the MOST appropriate next step in management?

Thomas Ling, aged 45, presents with a 2-week history of dry cough, night sweats and mild weight loss. He works as a vet and mentions exposure to birthing sheep. Chest X-ray reveals diffuse interstitial infiltrates. His FBC shows lymphocytosis and elevated ESR.

What is the MOST likely diagnosis?

Susan Gregor, aged 72, presents with fever, cough, and dyspnoea on exertion 7 days after a confirmed COVID-19 infection. She initially had mild symptoms but now feels worse. On auscultation, fine inspiratory crackles are present. Oxygen saturation is 89% on room air. Chest X-ray shows bilateral ground-glass opacities.

What is the MOST likely diagnosis?

Alison Booth, aged 27, presents with acute fever, vomiting and abdominal pain. She returned from Bali 2 weeks ago. Examination reveals right upper quadrant tenderness and mild hepatomegaly. LFTs show elevated ALT and AST. Ultrasound reveals a 5 cm hypoechoic liver lesion.

What is the MOST likely diagnosis?

Natalie Dawson, aged 31, presents with fever, sore throat, and a diffuse sandpaper-like rash. She has tender cervical lymphadenopathy and a red, swollen tongue. She reports her daughter recently had ‘strep throat’.

What is the MOST likely diagnosis?

Samuel Jovic, aged 39, presents with low-grade fevers, a chronic non-productive cough, and exertional dyspnoea. He is HIV-positive with a CD4 count of 150 cells/mm³. He is not on prophylactic medications. Chest X-ray reveals bilateral perihilar interstitial infiltrates.

What is the MOST likely diagnosis?

Isabella Fraser, aged 23, presents with painful genital ulcers, dysuria and fever. She has a past history of genital herpes. On examination, there are multiple vesicular and ulcerated lesions on the vulva with bilateral tender inguinal lymphadenopathy.

What is the MOST appropriate management?

Travis Nolan, aged 59, presents with persistent fevers, fatigue and new systolic murmur. He has a history of mitral valve prolapse. He recently had dental work. Blood cultures are positive for Streptococcus sanguinis. Echocardiography reveals mitral vegetations.

What is the MOST appropriate treatment?

Bianca Leung, aged 41, presents with recent onset of nausea, fatigue and right upper quadrant discomfort. She works as a nurse and received a needlestick injury 8 weeks ago. Serology today reveals positive hepatitis B surface antigen and positive IgM anti-HBc.

What is the MOST likely diagnosis?

Liam Doyle, aged 47, presents with high fever, headache, myalgia and a petechial rash. He recently returned from a camping trip in the Flinders Ranges. He removed a tick from his leg 5 days ago. On examination, he has conjunctival injection and mild hepatomegaly.

What is the MOST likely diagnosis?

Emily Zhou, aged 3, is brought in by her parents with a 2-day history of fever, irritability and refusal to bear weight. There is no history of trauma. On examination, she is febrile at 38.6°C and has reduced movement of her left leg with tenderness over the proximal femur. X-ray is normal.

What is the MOST appropriate next investigation?

Ashok Menon, aged 60, presents with 3 weeks of chronic diarrhoea, fatigue and weight loss. He was treated for lymphoma with chemotherapy 6 months ago. On examination, he has mild dehydration and oral thrush. Stool microscopy shows acid-fast oocysts.

What is the MOST likely diagnosis?

George Papadopoulos, aged 72, presents with new-onset right facial weakness and vesicular rash on the right pinna and ear canal. He also reports tinnitus and unsteadiness. Examination confirms right lower motor neuron facial palsy and vesicles in the ear.

What is the MOST likely diagnosis?

Monica Tait, aged 51, presents with painless haematuria and frequency. She recently returned from a 6-week visit to rural Egypt, where she swam in freshwater. Urine microscopy shows eosinophils and terminal haematuria. Ultrasound shows bladder wall thickening.

What is the MOST likely diagnosis?

Declan Hughes, aged 48, presents with fever, cough and haemoptysis. He has recently migrated from Vietnam and was previously treated for tuberculosis. On examination, he is febrile, and CXR shows cavitary lesions in the upper lobes. Sputum culture reveals Aspergillus species.

What is the MOST likely diagnosis?

Alana McBride, aged 29, presents with fever, malaise and a maculopapular rash that started on her face and spread to her trunk. She also reports arthralgia. She is 8 weeks pregnant and has not received MMR vaccination. Her children recently had a similar illness.

What is the MOST likely diagnosis?

Ian Robertson, aged 67, presents with fever, chills and right upper quadrant pain. He had a laparoscopic cholecystectomy 2 years ago. On examination, he is febrile and jaundiced. LFTs show elevated ALP and GGT. Ultrasound shows dilated intrahepatic ducts and a CBD of 9 mm.

What is the MOST appropriate next step?

Yasmin Ali, aged 4, presents with a 3-day history of fever and a widespread vesicular rash, mostly on her trunk and face. She attends daycare and is otherwise well. On examination, she is alert and playful with multiple crusting vesicles in different stages.

What is the MOST likely diagnosis?

Trevor Jennings, aged 52, is undergoing chemotherapy for lymphoma and presents with a 2-day history of fever, chills and malaise. He is neutropenic on bloods. On examination, he is hypotensive and febrile. No localising signs of infection are present.

What is the MOST appropriate initial management?

Mei Lin, aged 37, presents with pruritus and skin irritation between her fingers. She reports worsening itch at night. Examination reveals linear burrows and excoriated papules between fingers and on wrists. No systemic symptoms.

What is the MOST appropriate treatment?

Hamid Qureshi, aged 58, presents with weight loss, persistent fever, and anaemia. He migrated from Pakistan 1 year ago. On examination, he has splenomegaly and appears chronically unwell. Blood smear reveals intracellular amastigotes.

What is the MOST likely diagnosis?

Brooke Martin, aged 17, presents with fever, sore throat, and fatigue. On examination, she has tonsillar exudates, cervical lymphadenopathy, and hepatosplenomegaly. A full blood count shows atypical lymphocytes. Monospot test is negative.

What is the MOST appropriate next investigation?

James Walker, aged 46, presents with fever, severe muscle aches and conjunctival suffusion. He recently participated in a triathlon involving swimming in a rural dam. Bloods show elevated creatinine and mildly deranged LFTs.

What is the MOST likely diagnosis?

Olivia Barnes, aged 6, presents with itchy scalp and white flecks in her hair. Her school has had a recent outbreak of similar symptoms. On examination, there are nits and live lice visible on her scalp.

What is the MOST appropriate treatment?

Daniela Costa, aged 32, presents with watery diarrhoea and abdominal cramps 3 days after returning from a holiday in Thailand. She reports eating street food and has no blood in stool. She is afebrile and mildly dehydrated.

What is the MOST appropriate management?

Amelia Nguyen, aged 35, presents with fever and a new onset of vaginal discharge. She is sexually active with multiple partners and inconsistently uses condoms. On examination, she has mucopurulent cervical discharge and cervical motion tenderness. NAAT for chlamydia and gonorrhoea is pending.

What is the MOST appropriate next step?

Leo Campisi, aged 44, presents with fever, malaise and a diffuse erythematous rash following initiation of allopurinol. He has mucosal involvement and eosinophilia. Examination reveals a dusky macular rash with some blistering.

What is the MOST likely diagnosis?

Alfreda Thomas, aged 70, presents with fever and non-productive cough. She recently returned from a cruise ship holiday. Chest X-ray reveals patchy infiltrates in the lower lobes. Urinary antigen is positive for Legionella.

What is the MOST appropriate antibiotic treatment?

Grace Mulligan, aged 24, presents with a painless ulcer on her vulva and a history of unprotected sex. Her serology returns positive for both Treponema pallidum EIA and RPR with a titre of 1:64. She is otherwise well.

What is the MOST appropriate next step in management?

Christopher Lane, aged 57, presents with a 2-week history of cough and haemoptysis. He had tuberculosis as a child. Sputum AFB is negative but galactomannan assay and culture confirm Aspergillus fumigatus. Chest CT shows a fungal ball in a residual cavity.

What is the MOST likely diagnosis?

Jasmine Pham, aged 19, presents with fatigue, sore throat and cervical lymphadenopathy. She is prescribed amoxicillin and develops a widespread maculopapular rash. Monospot test is now positive.

What is the MOST likely diagnosis?

Karen Boyd, aged 36, presents with fever, weight loss and a productive cough. She has returned from Papua New Guinea. On exam, she has right apical crackles. CXR shows right upper lobe cavitation. Sputum is positive for acid-fast bacilli.

What is the MOST appropriate management?

Anna-Rose Kelly, aged 66, presents with burning dysuria and frequency. She is afebrile and has no flank pain. Urine dipstick is positive for leukocytes and nitrites. She has no antibiotic allergies.

What is the MOST appropriate antibiotic?

Mason Goh, aged 49, presents with fever, cough and weight loss. He is a returned traveller from Indonesia. Chest X-ray shows right upper lobe consolidation and cavity. Sputum culture is negative for AFB, but fungal culture shows a rapidly growing mould.

What is the MOST likely organism?

Zoe Winchester, aged 27, presents with fever, vesicular lesions on the palms and soles, and painful oral ulcers. Several children at her childcare centre are unwell. She is otherwise well and afebrile today.

What is the MOST likely diagnosis?