I have been to a number of meetings and had numerous discussions with colleagues, who lament the loss of the practical component of the Fellowship of the Royal College of Pathologists (FRCPath) exam. With a tear in their eye they talk about the “good old days”, that the exam was “character building” and how “trainees today have it so easy”… but is this really true? Was the practical exam such an essential element of the examination, were we made better for completing it; were those days really all rosy and wonderful as they say? And if so why has it been changed?
 
Back in the dim distant past when I took my FRCPath exam it was very different to what it is now. In 2003 the FRCPath consisted of two parts, and was sat after 1-3 years in a Registrar post. You needed to “lose some sense of reality” my wife says in order to submerge yourself enough to pass!

The patient was admitted 3 days after arriving in the UK from Nigeria. He had felt unwell with a fever and generalise aches and pains the day before he travelled. On the morning of admission he had noticed a rash on his left leg as well as tender enlarged lymph nodes in his groin.
 
The admitting Consultant Physician spoke to infection control before the patient arrived and it was decided to admit the patient directly to a negative pressure side-room in the infectious diseases unit without bringing the patient into the main hospital in case this might be a viral haemorrhagic fever. The patient met a diagnosis of low possibility of viral haemorrhagic fever; temperature ≥ 37.5 oC PLUS been in endemic area within 21 days of onset of illness.

The Practice Nurse was getting a bit bored, sitting in the travel clinic listening to all of these people wanting advice for their various holiday destinations. There was only so much advice she could give for beach holidays to Ibiza and Magaluf. So when she opened the next patient record and saw it was a couple about to go on a wildlife spotting trip to Madagascar, she said out loud… “ooh that’s a bit more like it!” and called them in…

​One of the most common bacterial infections we see in the hospital setting is cellulitis; an infection of the skin and subcutaneous tissues. Most of these are caused by Gram-positive bacteria such as Staphylococcus aureus and the Beta-haemolytic streptococci. First line antibiotic treatment is usually Flucloxacillin, or Teicoplanin or Vancomycin (if the patient is allergic to beta-lactams such as Flucloxacillin). I have recently got to thinking about new antibiotics that might be useful in the treatment of cellulitis and in particular a new cephalosporin called Ceftaroline, which is supposedly active against all S. aureus including MRSA and the Beta-haemolytic streptococci.
 
So what have I found out about Ceftaroline? How does it work? Why is it active against MRSA? Read on to discover the answers to these questions and many more about this new antibiotic…

Any story involving the unnecessary death of a child and the removal of a doctor from the medical register is going to hit the headlines, but why do the medical profession as a whole feel so affected? Two weeks ago, Dr Bawa-Garba’s name was reintroduced to the medical register and she was allowed to continue to practice medicine. I watched the BBC Panorama program “Doctors on Trial” and I was even more shocked at what has happened. I have also been asked for my opinion of the situation by a number of Medical Student and Junior Doctor colleagues and since one of the main areas of criticism of Dr Bawa-Garba was her apparent failure to recognise sepsis I felt I needed to blog about the issues raised.

While sat in the cystic fibrosis multidisciplinary team (MDT) meeting a tricky clinical question was asked…
 
“We have a patient with an infective exacerbation of their cystic fibrosis with Burkholderia multivorans but she is allergic to Ceftazidime and Meropenem and gets bad gastrointestinal symptoms with tetracyclines. What do you think?” asked the Respiratory Consultant.
 
I really like these types of MDTs when I have to scratch my head and try to work out a solution but this one was a bit of a puzzler. I know Ceftazidime and Meropenem are often used to treat infections with Burkholderia spp. and that Minocycline is also an option, but what to do when these can’t be used? I had to admit I didn’t know for sure and that I would have to go and look at the literature and get back to them. So off I went to consultant the “Interweb”.

***WARNING – SPOILERS***

​Previously …on Poldark’s “Brain Fever”…
Last week I looked at the curious case of Lieutenant Hugh Armitage who acquired a “Brain Fever” in a French prison before escaping with the help of Ross Poldark. Lt. Armitage then went on to seduce Poldark’s wife (that’s gratitude for you!) before eventually succumbing to “Brain Fever”, despite the excellent efforts of Dr Enys.

I’m not a big fan of television, which won’t come as a surprise to those of you who know me from working with me (I like books, the older the better). In the past I have even gone 3 years without a TV at home, it was very liberating! However more recently I have reluctantly bought a digital TV (when I returned my old analogue TV from storage, it turned on OK but had stopped “working”, I was puzzled for a good few days until my Registrar told me about the digital “switch over” which had happened over 6 months earlier, …huh, no one told me!). Anyhow I still try to keep my viewing limited but I do watch the occasional program. One such program is Poldark.

Previously I wrote a couple of blogs about Poldark’s Putrid Throat and Poldark’s Putrid Throat Revisited.  This time I am going to tackle a new diagnosis from the latest series of the hit BBC drama. If you haven’t watched series 4 yet and don’t want to know what happens then best not to read any further… there will be spoilers… you have been warned! ***WARNING – SPOILERS***
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Okay, so the big scandal at the end of series 3 was the illicit romance between Demelza Poldark and Lieutenant Hugh Armitage. Lt. Armitage was a companion of Dr Dwight Enys during his incarceration in a French prison after their ship was captured by the French. Dr Enys and Lt. Armitage were eventually rescued in a daring plan by Ross Poldark but it quickly became apparent that Lt. Armitage was not a well man.

Okay so it’s a bit weird “celebrating” a nasty viral infection, but the emphasis of World Hepatitis Day is to draw people’s attention to hepatitis and as you’ll see in the case of Hepatitis C, there’s actually a lot to celebrate, so please read on…

The patient was a young woman with the most severe headache she had ever had. She was normally fit and well. Her headache was so bad that she kept a towel over her eyes because the light made it worse. She was noted to have a fever and so a provisional diagnosis of meningitis was made.

Whilst taking her history the doctor discovered that she had returned from the USA at the weekend where she had been visiting family. In particular she had been staying in New York. The doctor consulted “Dr Google” and found mention of a cause of meningitis called West Nile Virus. They called the duty Microbiologist to ask for additional tests on the CSF sent earlier to the lab.

“Stone the Crows” thought the Microbiologist after he got over the slight irritation from the lack of initial travel history documented on the request card. He had to admit though that he was pleased that the doctor had taken the trouble to look into this patient’s story in more detail and then do something with the new knowledge they had acquired.