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FLASH FINALS > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Acute pyelonephritis m/c causative organism

A

E.coli

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2
Q

Amoebiasis
route of transmission
treatment antibiotic

A

Faecal-oral

Metronidazole

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3
Q

Animal bites - Pasteurella multocida
Tx antibiotic?
if penicillin allergic:

A

Co-amoxiclav

Doxycycline + metronidazole

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4
Q

Human bites - strep,staph,eikenella,fusobacterium,prevotella

Tx antibiotic?
if penicillin allergic:

A

Co-amoxiclav

Doxycycline + metronidazole

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5
Q

Examples of antibiotics which are PROTEIN SYNTHESIS INHIBITORS

A 
Aminoglycosides 
Tetracyclines
Chloramphenicol 
Clindamycin
Macrolides
MALT 
Macrolides 
Aminoglycosides 
Lincosamides 
Tetracyclines
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6
Q

Aspergilloma - mass like fungus ball.
occurs secondary to?
features:
Ix:

A

Tuberculosis, lung cancer or cystic fibrosis

Cough, haemoptysis

Chest x-ray containing a rounded opacity. A crescent sign may be present
High titres Aspergillus precipitins

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7
Q 
Bacillus Cereus - 
Gram +ve/-ve?
assoc w/ what food:
time of onset: 
typically resolves in: 
Mx:
A 
Gm +ve ROD 
Under-cooked or reheated rice
0.5-6 hours 
24 hours 
rarely required for food poisoning however - VANCOMYCIN = AB of choice.
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8
Q

Management of bacterial vaginosis:

Adverse effects on pregnancy?

A

Oral metronidazole 5-7 days

Increased risk of preterm labour, low birthweight and chorioamnionitis, late miscarriage

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9
Q

Bed bugs:
Infesting organism:
Treatment to control itch?

A

Cimex hemipteru

topical hydrocortisone

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10
Q

Clostridium botulinium - releases botulinum toxin which blocks the release of acetylcholine
Describe:
Treatment:

A

Gram positive anaerobic bacillus

Botulism antitoxin and supportive care

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11
Q 
Camplyobacter - the commonest bacterial cause of infectious intestinal disease in UK 
Describe:
Spread:
Incubation period: 
Treatment: 
complications:
A

Gm -ve bacillus

Faecal-oral route

1-6 days

Self-limiting but if AB is required - CLARITHROMYCIN is given (if severe symptoms)

Guillain-Barre, reactive arthritis, septicaemia endocarditis

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12
Q

Cat scratch disease organism:

A

Bartonella Henselae

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13
Q

Cellulitis ABs:
mild/moderate
severe

A

FLUCLOXACILLIN = first line for mild/moderate
CLARITHROMYCIN (erythromycin in pregnancy) or doxyxycline if allergic to penicillin

Co-amoxiclav,
cefuroxime,
clindamycin,
ceftriaxone if severe

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14
Q

Chancroid organism:

painful genital ulcers assoc with unilateral painful lymph node enlargement

A

Haemophilus ducreyi

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15
Q

Who should get Varicella Zoster Ig (VZIG) prophylaxis

A

1) Significant exposure to chicken pox or herpes zoster
2) condition that increases risk of severe varicella
3) No antibodies to Varicella virus

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16
Q

Chlamydia Investigation of choice:

Samples tested with this method?

A

Nuclear acid amplification test (NAATs)

Urine (first void sample), vulvovaginal swab or cervical swab

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17
Q

When should chlamydia testing be carried out post-possible exposure

A

2 weeks after

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18
Q

Management of Chlamydia:

if pregnant?

A

1) Doxycycline (7 days)
2) Azithromycin (1 day)

Azithromycin, erythromycin or amoxicillin may be used

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19
Q

Partner notification chlamydia:
Men with symptoms:
Women and asymptomatic men:

A

Men with symptoms: all contacts since and in four weeks prior to onset of symptoms
Women and asymptomatic men = last 6 months or the most recent sexual partner

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20
Q

Cholera
Gram?
hyper/hypoglycaemia?
Mx?

A

Gram-negative
Hypoglycaemia
oral rehydration therapy
antibiotics: doxycycline, ciprofloxacin

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21
Q

Gram positive RODS (bacilli) - ABCD L

A 
Actinomyces 
Bacilus anthracis (anthrax) 
Clostridium 
Diptheria 
Listeria Monocytogenes
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22
Q

Gram negative rods = the rest

A 
E.coli
Haemophilus Influezae
Pseudomonas aeruginosa
Salmonella sp 
Shigella 
Campylobacter
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23
Q

Gram negative cocci?

A

Neisseria meningitidis, gonorrhoeae, morxella catarrhalis

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24
Q

Cryptosporidiosis - the commonest protozoal cause of diarrhoea in the UK
Diagnosis:
Management:

A

STOOL: Modified Ziehl Neelsen stain (acid-fast) may reveal red cysts

Supportive for most
Nitazoxanide for immunocompromised pts

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25
Q 
Severe Dengue (dengue haemorrhagic fever) 
blood tests results:
A

Thrombocytopenia, leukocytopenia, raised amino transferases

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26
Q

Diptheria:

Investigation:

Treatment:

A

Investigation: Culture of throat swab

Treatment: IM penicillin, diptheria antitoxin

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27
Q

Which is the only DNA virus that is NOT double stranded

A

Parvovirus

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28
Q

Commonest cause of Viral meningitis in adult population:

A

Enteroviruses

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29
Q

Malignancies assoc. with EBV infection:

4

A

Burkitts lymphoma
Hodgkins lymphoma
nasopharyngeal carcinoma
HIV associated Nervous system lymphomas

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30
Q

Gastroenteritis causes: Which infection px. w/
Commonest cause of travellers diarrhoea
Watery stools
Abdominal cramps a nausea

A

E.Colii

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31
Q

Gastroenteritis causes: Which infection px. w/

Prolonged non bloody diarrhoea

A

Giardiasis

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32
Q

Gastroenteritis causes: Which infection px. w/
Profuse watery diarrhoea
severe dehydration resulting in wt. loss
not common amongst travellers

A

Cholera

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33
Q

Gastroenteritis causes: Which infection px. w/
Bloody diarrhoea
vomiting and abdominal pain

A

Shigella

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34
Q

Gastroenteritis causes: Which infection px. w/
severe vomiting
short incubation period

A

Staphylococcus aureas

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35
Q

Gastroenteritis causes: Which infection px. w/
Flu-like prodrome followed by crampy abdominal pain, fever and diarrhoea which many be bloody.
complications include Guillane Barre

A

Campylobacter

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36
Q

Gastroenteritis causes: Which infection px. w/
Two types of illness:
Vomiting within 6 hours (due to rice)
diarrhoeal illness occurring after 6 hours

A

Bacillus Cereus

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37
Q

Gastroenteritis causes: Which infection px. w/

GRADUAL onset bloody diarrhoea, abdominal pain and tenderness that may last for several weeks?

A

Amoebiasis

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38
Q 
Incubation periods: Gastroenteritis organisms 
1-6 hours 
12-48 hours 
48-72 hours 
>7days
A

1-6 hours: Staph aureas, bacillus cereus
12-48 hours: salmonella, E.coli
48-72 hours: shigella, campylobacter
>7days: giardiasis, amoebiasis

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39
Q

Genital herpes:
Investigation of choice?
Management of choice?

A

Now NAAT - considered superior to viral culture

General measures: saline bathing, analgesia, topical anaesthetic - lidocaine
Some patient with frequent exacerbations may benefit from long term aciclovir.

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40
Q

Pregnant women with primary herpes attack - what is advised re delivery if greater than 28 weeks gestation?

A

Elective C-section at term

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41
Q

HPV types:
Genital warts:
Cervical cancer:

A

Genital warts: 6 & 11

Cervical cancer: 16,18,33

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42
Q

Genital warts management:

A

1) Topical podophyllum or cryotherapy

2) imiquimod cream is second line

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43
Q

Giardiasis investigations:

Treatment: (AB)

A

Stool microscopy - for trophozoite and cysts
Stool antigen detection assay (greater sensitivity and faster turn around time).

Metronidazole

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44
Q

Gonorrhoea AB of choice:

if IM refused?

A

Single dose of IM CEFTRIAXONE
Cephalosporins now - used to be ciprofloxacin

If IM ceftriaxone is refused, oral cefixime (400mg) PLUS oral azithromycin (2g) should be used,

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45
Q

Most common cause of septic arthritis in young adults:

A

Gonorrhoea

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46
Q

Hepatitis A:
Is there an increased risk of hepatocellular cancer?
Vaccine available?
Who should be vaccinated?

A

No
Yes

people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
people with chronic liver disease
patients with haemophilia
men who have sex with men
injecting drug users
individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates

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47
Q

Hepatitis B:
Features:
complications?
Management:

A

Fever, jaundice and elevated liver transaminases

Chronic hepatitis
Fulminant liver failure
Hepatocellular carcinoma
glomerulonephritis

Only tx. is Peg Interferon ALPHA.

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48
Q 
Hepatitis C: 
Features (30%)
At risk:
Vaccine? 
investigation to rule out acute infection:

Can it lead to chronic infection?

A

Transient rise in serum aminotransferases/jaundice
Fatigue
Arthralgia

IVDU, pts. who received a blood transfusion before 1991

NO

HCV RNA

Yes, for majority of patients it will (C for chronic)

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49
Q

Chronic Hep C complications:

Rheumatological problems:
eye problems:
Liver problems:
Cancer:

A

Arthralgia, arthritis
Sjogrens syndrome
cirrhosis
Hepatocellular carcinoma

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50
Q

Hep C treatment:

A

Combination of protease inhibitors: Daclatasvir + sofosbuvir with or without RIBAVIRIN

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51
Q

Side effects:
Ribavirin:
IFNa:

A

Ribavirin - Hemolytic anaemia, cough, women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

IFNa - flu like symptoms, depression, fatigue, leukopenia, thrombocytopenia

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52
Q 
Herpes simplex virus: 
Management: 
Gingivostomatitis 
Cold sores: 
Genital herpes:
A

Gingivostomatitis: Oral aciclovir, chlorhexidine mouthwash
Cold sores: topical aciclovir
Genital herpes: oral aciclovir

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53
Q

Antiretroviral therapy:

combination of at least 3 drugs - which are these?

A

2 NRTI

Protease inhibitor or NNRTI.

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54
Q

NRTI examples:
General side effects:
Zidovudine side effects:

A

Zidovudine, abacavir, ‘VUDINEs”, tenofivir

Peripheral neuropathy.

Anaemia, myopathy, black nails

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55
Q

Protease inhibitors examples: ‘VIRs’

General side effects:

A

Indinavir, nelfinavir, ritonavir, saquinavir

diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition

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56
Q

Integrase inhibitors:

A

‘GRAVIRS’

relategravir, elvitegravir, dolutegravir

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57
Q

HIV complications:

Toxoplasmosis management

A

sulfadiazine and pyrimethamine

58
Q

HIV complications:
Primary CNS lymphoma:
Associated with which other virus:
treatment:

A

EBV

Steroids, chemotherapy (methotrexate)

59
Q

Pneumocystis Jiroveci pneumonia - the most common opportunistic infection in AIDS:

common complication of PCP

Management (Ix and Tx):

A

Pneumothorax

CXR, exercise induced desaturation
Sputum.

tx. Co-trimoxazole
IV pentamidine in severe cases.

60
Q

When does HIV seroconversion typically occur?

how does it present?

A

3-12 weeks after infection.

glandular fever-type illness

61
Q

HIV diagnosis:
HIV antibodies - when do they present, how are they found?:
p24 antigen - when is it positive?

What is standard for diagnosis

A

HIV antibodies: a 4-6 weeks
ELISA (screening) and confirmatory western blot assay.

p24 usually positive from 1 week to 3-4 weeks

Combines HIV abs and p24 test is standard.

62
Q

When should HIV testing in asymptomatic pts. occur?

when should repeat test be offered?

A

4 weeks

12 weeks

63
Q

HPV vaccine
routine offering is to:
special offering:

A

BOYS and GIRLS aged 12/13 years

MSM under the age of 45 to protect against anal, throat and penile cancers

64
Q

EBV - what antibiotic is contraindicated =

A

Amoxicillin

65
Q

Diagnosis of infectious mononucleosis (EBV)

A

Heterophil antibody test (monospot) along with FBC - both in the second week of illness

66
Q

Legionella -
causes tachycardia/bradycardia?
Diagnosis?
Treatment

A

Bradycardia
Urinary antigen
Antibiotics - Erythromycin/Clarithromycin

67
Q

Protozoal infection that can present with increased appetite with paradoxical wt. loss

A

Leishmaniasis

68
Q 
Features of which protozoan infection?
Fever, night sweats, rigors
Massive splenomegaly
grey skin,
pancytopenia secondary to hypersplenism

Gold standard for diagnosis is bone marrow or splenic aspirate:

A

Leishmaniasis

69
Q

Organism in Lymes disease:

A

Borrelia Burgdoferi

70
Q

Can antibiotics be started in Lymes disease based on erythema migrans alone?

A

YES

71
Q

Condition caused by mycobacterium leprae

types of skin lesion

Treatment:

A

Leprosy

patches of hypopigmented skin

Rifampicin
Dapsone
Clofazimine

72
Q

Leptospirosis
common in what type of workers?

spread by what animals infected urine?

Ix:

Mx:

A

sewage workers, farmers, vets, people working in an abattoir

Infected RAT urine.

Serology
PCR
Culture

High-dose benzylpenicillin or doxycycline

73
Q

Lyme disease:

Early feature (skin)

Later features:

A

ERYTHEMA MIGRANS

CVS: heart block, myocarditis
Neuro: cranial nerve palsies, meningitis polyarthritis

74
Q

Lymphogranuloma Venereum is caused by which STI ?

Typically comprises of 3 stages:

Treated with:

A

Chlamydia trachomatis servers
L1, L2, L3

1) painless pustule -> ulcer
2) painful inguinal lymphadenopathy
3) proctocolitis

Doxycycline

75
Q

Commonest form of malaria - falciparum or non falciparum?

Px: 
Schizonts on blood film
Parasitaemia
Hypoglycaemia
Acidosis 
Temp > 39 degrees 
Severe anaemia

Treatment?

A

Falciparum - also MOST SEVERE

Artemisinin-based combination therapy -
e.g - Artemether, lumefantrine,artesunate,amodiaquine

76
Q

Causes of false Mantoux test:

A 
Immunosupression (military TB, AIDS, steroid therapy) 
Sarcoidosis
lymphoma 
Extremes of age 
Fever 
Hypoalbuminaemia
77
Q 
Meningitis causes: 
0-3 months:
3 months - 6 years:
6 years - 60 years:
>60 years:
Immunosuppressed:
A

0-3 months: Group B strep, e.coli, listeria

3 months - 6 years: Neisseria meningitidis
streptococcus pneumoniae, haemophilus influenzae

6 years - 60 years:
Streptococcus pneumoniae, Neisseria Meningitidis

> 60 years: Strep pneumoniae
neisseria meningitidis, Listeria monocytogenes

Immunosuppressed: Listeria monocytogenes

78
Q

Meningitis investigations: (7)

A

FBC, CRP, Coag screen, blood screen, whole-blood PCR,
Blood glucose, BLOOD GAS

(Lumbar puncture if no signs of increased ICP)

79
Q 
Meningitis management: 
Initial empirical therapy:
<3 months: 
>3 months to 50 years: 
>50 years:
A

IV cefotaxime plus amoxicillin
IV cefotaxime or ceftriaxone
IV cefotaxime plus amoxicillin

80
Q

Meningococcal meningitis tx:

A

IV benzylpenicillin or cefotaxime

81
Q

Pneumococcal meningitis tx:

A

IV cefotaxime or ceftriaxone

82
Q

Meningitis from Haemophilus influenzae tx:

A

IV cefotaxime or ceftriaxone

83
Q

Meningitis from listeria tx:

A

IV amoxicillin plus gentamicin

84
Q

IV dexamethasone should be given to reduce the risk of neurological sequelae but withhold if the patient has (4):

A

Septic shock
Meningococcal septicaemia
Immunocompromised
Meningitis following surgery

85
Q

Does prophylaxis need to offered to household and close contacts of patients with meningococcal meningitis?
If so, what should be used for this?

A

YES

Ciprofloxacin or rifampicin

86
Q

Which antibiotic works by forming reactive cytotoxic metabolites inside bacteria:

A

Metronidazole

87
Q

Antibiotics used in MRSA infection? (3)

A

Vancomycin, teicoplanin, linezolid

88
Q

Mumps: causative virus?

Infective 7 days before and 9 days after parotid swelling begins

Complications:

A

RNA paramyxovirus

Orchitis, hearing loss, meningoencephalitis, pancreatitis

89
Q

Mycoplasma pneumoniae tx. antibiotic:

A

Doxycycline or a macrolide

90
Q

Necrotising fasciitis:
Type 1 causative organism?
Type 2 causative organism?

A

T1: mixed anaerobes and aerobes - most common
T2: Strep pyogenes

91
Q

What is the most common prexisting medical condition in necrotising fasciitis:

A

Diabetes mellitus - especially if tx. with SGLT-2 inhibitor

92
Q

Most common cause of NON-gonococcal urethritis:
second cause:
Antibiotic treatment for this condition:

A

Chlamydia trachomatis
Mycoplasma genitalium
Oral azithromycin or doxycycline

93
Q

Key distinguishing factor between:
Norovirus and rotavirus (age):
Norovirus and salmonella:
Norovirus and E.coli:

A
  • Rotavirus typically presents in those <5 years
  • Salmonella more likely to cause bloody diarrhoea and pts. often have high fever.
  • E.coli does cause vomiting and diarrhoea like noravirus but has a longer incubation period (between 3-4 days) but can be up to 10 days. E.coli also causes bloody diarrhoea.
94
Q

Pneumonia typically seen in alcoholics:

Most common CA pneumonia:

A

Klebsiella pneumoniae

Streptococcus pneumoniae

95
Q

Needle stick injury: Order of transmission risk:

Hep B, Hep C, HIV

A

Hep B - (20-30%)
Hep C - (0.5%-2%)
HIV (0.3%)

96
Q

A radionucleotide labelled red cell scan is the most sensitive test for which condition:

A

Hyposplenism.

Howell-Jolly bodies

97
Q

Vaccines which should be received in those having splenectomy (3)

Intervals?

A

Pneumococcal
Haemophilus Influenza type b
Meningococcal type C

Men C HIs at 2 weeks then booster at 2 years
PPV - 5 yearly interval

98
Q

Prophylaxis in splenectomy:

A

Penicillin V 500 mg BD or Amoxicillin 250 mg BD

99
Q

Pseudomonas Aeruginosa

Produces:

A

Gm -ve ROD

Produces an endotoxin

100
Q

Pyrexia of unknown origin:
Prolonged fever over how many weeks?

Causes -
Neoplasias:
Infections:

A

> 3 weeks which resists diagnosis after a week in hospital

Neoplasias: lymphoma
hypernephroma, preleukaemia, atrial myxoma
Infections: abscess, TB

101
Q

Antibiotic of choice for Q fever:

A

Doxycycline

102
Q

Most common cause of bronchiectasis exacerbations:

A

Haemophilus influenzae

103
Q

Staph aureus pneumonia typically follows which common seasonal virus:

A

Influenza

104
Q

Adverse effects of rifampicin (4):

A

Potent CYP450 liver enzyme inducer
Hepatitis
Orange secretions
Flu-like symptoms

105
Q

Lymphadenopathy locations in Rubella:

A

Suboccipital and post-auricular

106
Q

Gold standard investigation for Schistosomiasis:

Treatment for schistosomiasis

A

Urine/stool microscopy looking for eggs

one single dose of Praziquantel

107
Q

Components of qSOFA:

A

RR > 22/min
altered mentation
Systolic blood pressure < 100 mmHg

Score >2 = sepsis

108
Q

Most common bug in spinal epidural abscess?

Investigations:

A

Staphylococcus Aureas

Bloods (inflammatory markers, HIV, Hep B, C and coal screen G&S)
Blood cultures
Infection screen: CXR and urine culture

MRI WHOLE SPINE (as skip lesions may be present)

109
Q

Post-splenectomy - at risk infections:

Think of the vaccination plus one more

A

Pnemococcus, haemophilus, meningococcus, (vaccines) capnoctyophaga canimorsus:

110
Q

Post-splenectomy vaccinations:

Antibiotic prophylaxis:

A

Hib, Men A and C

Annual flu vaccine

Pneumococcal vaccine every 5 years.

Penicillin V

111
Q

Post splenectomy changes:
Which blood product will rise first:
What features will appear on blood film (2)?:

A

Platelets

Howell-Jolly Body and Pappenheimer bodies

112
Q

Staphylococcal toxic shock syndrome

Diagnostic criteria: 
Fever Temperature?
Hypotension - below what?
Rash?
Involvement of how many organ systems?

Classic cause:

A

38.9 degrees
<90 mmHg
Diffuse erythematous rash: especially in the palms and soles
Three

Infected tampons

113
Q

Staphylococcus:
Gm?
Facultative aerobes/anaerobes?
Produce?

A

Gram-positive cocci
Facultative Anaerobes
Produce catalase

114
Q

Sulphonamides:
MoA:

Examples:
Cotrimoxazole is a combination of which 2 drugs:

Adverse effects (3):

A

Inhibiting Dihydropteroate synthetase

Sulfamethoxazole

Sulfamethoxazole plus Trimethoprim

Headaches
Rash (SJS)
HYPERKALAEMIA

115
Q

Streptococcus Pyogenes possible antibiotics to treat:

A

PENICILLIN sensitive still

macrolide may be used as an alternative.

116
Q 
Syphilis: 
Bug:
Primary phase:
Secondary phase: 
Teritary phase:
A

Treponema Pallidum

1) Chancre (painless ulcer), non-tender lymphadenopathy.

2) Systemic features: fevers, lymphadenopathy
Rash on trunk, palms soles, snail track ulcers

3) Neurosyphilis:
Argyll robertson Pupil, ascending aortic aneurysms, tabes dorsalis (neurosyphilis) , granulomas of skin and bone

117
Q

Investigations for Syphilis:
Serological tests divided into:
Non-treponemal tests:
Treponemal tests:

NON-TREPONEMA TESTS (VDRL etc.) ARE CARDIOLIPIN TESTS thus, may get false positives in pregnancy, lupus, APL, TB, HIV etc.

A

Non-treponemal tests:
VDRL, RPR (rapid plasma reagin)
Treponemal tests: Generally more specific and expensive
T.Pallidium enzyme immunoassay (TP-EIA)

118
Q

Syphilis test results:

Positive non-treponemal test + positive treponemal test =

Positive non-treponemal test + negative treponemal test =

Negative non-treponemal test + positive treponemal test =

A

Positive non-treponemal test + positive treponemal test
consistent with ACTIVE SYPHILIS INFECTION

Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result

Negative non-treponemal test + positive treponemal test:
consistent with SUCCESSFULLY TREATED syphilis

119
Q

Treatment for syphilis:
alternative antibiotic

Name of reaction seen following treatment

A

IM Ben Pen is first line

Doxycycline

Jarisch-Herxheimer reaction

120
Q

If antibiotic is to be used in tetanus:

A

Metronidazole now preferred to benzyl penicillin as first choice

121
Q

Tetanus vaccine: given at which intervals
(3X months, 2X years)
- 5 doses total

A 
2 months
3 months 
4 months 
3-5 years 
13-18 years
122
Q

Tetracyclines -
MoA:
Indications (4)
Adverse effects-

Can they be given in pregnancy or breast feeding?

A

Protein synthesis inhibitors: bind to 30s subunit.

Acne vulgaris, lyme disease, chlamydia,mycoplasma pneumoniae

Discolouration of teeth (should not be used in children <12)
Photosensitivity
Angioedema
Black hairy tongue

NO

123
Q

Toxoplasmosis: obligate intracellular protozoan.
Ix of choice (immunocompetent)
tx. of choice (immunocompetent)

HIV/immunosuppressed ix.
mx.

A

Ix of choice (immunocompetent): Serology
tx. of choice (immunocompetent): No treatment

CT scan
Pyrimethamine plus sulphadiazine for at least 6 weeks

124
Q

Trichomonas vaginalis:
STI or not?
tx.

A

STI

Oral metronidazole 5-7 days - BNF supports one off dose of 2g metronidazole.

125
Q

Distinguishing features of BV vs trichomonas?

A

BV: thin, White discharge
microscopy: clue cells

Trichomonas: frothy yellow-green sputum, vulvovaginitis, strawberry cervix

126
Q

Trimethoprim adverse effects (2) :

folate antagonist

A

Myelosupression

Transient rise in creatinine (reversible)

127
Q

Latent TB treatment: 2 options

Meningeal tuberculosis us treated for a prolonged period- how long?

A

2 options:
3 months of ISONIAZID with pyridoxine and rifampicin or
6 months of ISONIAZID with pyridoxine

treated for a prolonged period - at least 12 months with the addition of steroids.

128
Q

TB drugs A/Es

A

Rifampicin - potent liver enzyme INDUCER hepatitis, orange secretions, flu-like symptoms

Isoniazid - PERIPHERAL NEUROPATHY (prevent with Pyridoxine B6), hepatitis, liver enzyme INHIBITOR

Pyrazinamide - Hyperuricaemia causing GOUT
ARTHRALGIA, myalgia, hepatitis

Ethambutol - optic neuritis: visual acuity before and during treatment

129
Q

Main test used to screen for latent tuberculosis:

When is an Interferon gamma test used?:

A

Mantoux test
If Mantoux test is positive of equivocal
where a tuberculin (Mantoux) test may be falsely negative.

130
Q 
Diagnosis of active TB, findings - 
CXR: 
Sputum smear: 
Sputum culture: 
NAAT:
What is gold standard test?
A

CXR: Upper lobe cavitation = classical finding
bilateral hilar lymphadenopathy
Sputum smear: stained for acid fast bacilli (Ziehl-Neelsen stain)
Sputum culture: GOLD STANDARD - most sensitive, can also assess drug sensitivities
NAAT: allows rapid diagnosis (24-48 hours)

131
Q

Causes of NSU (non-specific urethritis)
Ix.
Mx:

A

Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium

Urethral swab: gm stained look for leukocytes and Gm-ve diplococci
Chlamydia now increasingly diagnosed using urinary NAATs

Mx: Oral DOXYCYCLINE or single dose Azithromycin

132
Q

UTIs Tx. (NICE)
Non-pregnant women: (when should you also send culture?)
Pregnant women:
Pregnant women asymptomatic bacteriuria:

A

Trimethoprim or nitrofurantoin for 3 days:
send culture only if > 65 years, haematuria

Urine culture should be sent in all cases:
First line AB: Nitrofurantoin (avoided near term)
second line: Amoxicillin or cefalexin

Urine culture at first antenatal visit plus immediate nitrofurantoin for 7 days.

133
Q

UTIs Men tx:

Should you treat asymptomatic UTI in catheterised pts.?-

A

Trimethoprim or nitrofurantoin for 7 DAYS.

NO, if pt. symptomatic then treat with 7 day ABs

134
Q

Acute pyelonephritis tx:

A

Cephalosporin or quinolone for 10-14 days

135
Q

Live attenuated vaccines - examples:

A

Live attenuated:

BCG, MMR, influenza (intranasal), oral rotavirus, oral polio, yellow fever, typhoid.

136
Q

Inactivated preparations:

A

Rabies, Hep A, IM Influenza

137
Q

Vancomycin:
Mechanism of action:
Adverse effects:

A

Inhibits cell wall formation by binding to D-ala-D. Preventing polymerisation of petidoglycans
Nephrotoxicity
Ototoxicity
Thrombophlebitis
Red man syndrome - assoc. with rapid infusions.

138
Q

Viral meningitis:

Ix.

A

Pts. should have LP to confirm diagnosis.

139
Q

Yellow fever:
What type of fever:
px:
Cells seen in the hepatocytes:

A

Haemorrhagic fever
Incubation period = 2-14 days
Classic description + sudden onset of fever, rigors, N&V, bradycardia may develop, brief remission followed by jaundice, haematemesis, oliguria.

Councilman bodies (inclusion bodies) may be seen in the hepatocytes.

140
Q

Legionella typically causes what, with regards to WCC

A

Lymphopaenia

141
Q

Which commonly prescribed drug may cause a false negative Mantoux test

A

Steroid therapy

142
Q

Which class of pain-killers should be stopped in C.difficile

A

Opioids - medications which are ANTI-motility and ANTi- peristaltic should be stopped

FLASH FINALS (34 decks)

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