Welcome to the microregistrar.com. It is here to help the trainees preparing for FRCPath Microbiology. Please look around and use the FORUM to discuss about the examination or any other microbiology or infection related issue.
New guideline: Surgical site infection
NICE guideline on SSI
New guideline – BASHH Standard
BASHH Standard for management of Sexually transmitted diseases (STI) including diagnostic tests.
https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/
Question 3
What is the name of this test?
Where would you use this test?
How effective was the influenza vaccine this year?
Flu season is not over yet but we have already started wondering about the efficacy of the most effective weapon against influenza this season (2018-19).
Before we look into the efficacy, a few words about flu and flu vaccine. Skip next 3 blocks if you want to go the efficacy directly.
How much time should you give yourself to prepare?
It is difficult to say how long you need as it very much depends upon you –
your method and speed of study,
whether you are working while preparing for the examination (Non-UK trainees; UK trainees – tough, you will be always working while preparing),
whether you are trained in the UK or familiar with the UK system etc.
For UK trainees – I would suggest you discuss with your educational supervisor. He is the best person to advise you if you are ready. I would consider giving myself at least six months.
Format of part 2 FRCPath Microbiology examination
The Format of the Part 2 FRCPath was changed in 2017. Please make sure to check the RCPath website before you start preparing for the examination.
The examination format now (from RCPath website, accessed 29/4/2019)
Question 2
Forty-five years old man of Bangladesh origin presented to the A&E with a 2-month history of cough, fever, haemoptysis and weight loss. Chest X-ray (CXR) revealed upper right lobe haziness and a cavity. WCC – 13 x10^9/L (Normal 4 – 11 x10^9/L ), normal renal function, mildly raised Alanine aminotransferase (ALT) and bilirubin, CRP of 50 mg/L (Normal<5 mg/L) . Sputum was acid-fast bacilli (AFB) negative and had been sent for AFB culture. CT abdomen thorax pelvis– confirmed the cavitation and showed some hypodense area in his spleen.
He has been to Bangladesh recently to visit his flood affected family members. The patient has a background history of diabetes and on
Sputum culture grew this bacteria(see picture for the colony).
It is an aerobic, gram-negative bacillus, sensitive to co-amoxiclav but resistant to amoxicillin, gentamicin, erythromycin, aztreonam.
Q –
Would you consider the bacteria significant?
What is your provisional diagnosis?
What treatment would you consider?
What infection control or precautionary measure would you take considering the epidemiology and the sputum culture result?
Question 1
Jane Doe (28 years, F), 18 weeks pregnant, reported to the midwife that she had contact with her nephew (Age: 1 year), who has been seen by his GP for a maculopapular rash. GP is suspecting measles. The midwife is asking for your advice regarding further management.
What additional information would you ask?
Parasitology treatment – aide-memoire
Acanthamoeba
Keratitis:
Polyhexanide (PHMB) 0.02%
Chlorhexidine 0.02% (+/- Brolene 0.1%)
Propamidine (0.1%) or
hexamidine (0.1%)
Imidazole, neomycin,
NSAID, prednisolone.
(Ref: Acanthamoeba Keratitis Treatment, AAO; Focus, Autumn 2013, RCOphth)
Granulomatous amoebic encephalitis:
The optimum treatment is unknown. A combination of drugs has been used – cotrimoxazole, metronidazole, pentamidine, miltefosine, and fluconazole.
Other drugs with activity – Azithromycin, rifampicin, voriconazole, flucytosine, caspofungin etc.
Cutaneous lesion:
Optimum treatment is unknown. Drugs used-
Topical chlorhexidine, ketoconazole cream,
Pentamidine, Itraconazole, voriconazole, liposomal amphotericin B, flucytosine, miltefosine etc