A 17-year-old boy suffered a generalized seizure at school and is brought to accident and emergency by ambulance. His teachers report he was well during the day but has suffered from repetitive ear infections and despite taking antibiotics during the week still suffered from headaches and ear discharge. On examination, he appears well but complains of headache, his temperature is 39°C and he is neurologically intact. A CT scan confirms a cerebral abscess and rapid culture tests confirm streptococcal infection. The most appropriate management is:

A. Cefuroxime alone B. Cefuroxime and metronidazole C. Flucloxacillin alone D. Flucloxacillin and cefuroxime E. Surgical decompression

2. Hypothalamic-adrenal axis

A 55-year-old woman presented with truncal obesity, easy bruising, a dorsal fat pad and depression. She denies any headaches, weight loss or any other abnormalities. An ultrasound scan showed bilateral adrenal atrophy. The most likely cause is:

A. Exogenous steroid use B. Pituitary dependent Cushing’s disease C. Ectopic adrenocorticotroph hormone (ACTH) production D. Adrenal malignancy E. 21-Hydroxylase deficiency

3. Management of cold sores

Which of the following treatment options would be the most appropriate for the management of a cold sore?