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FRACP Written Exam 2023 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Live vaccines

A

BCG
Japanese encephalitis
MMR
Rotavirus
Oral typhoid
Varicella
Yellow fever
Zoster

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2
Q

Treatment of choice for aspergillus?

A

Voriconazole

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3
Q

Treatment of choice for nocardia?

A

Sulfa-based medications
Bactrim - TMP-SMX

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4
Q

Treatment of choice for strongyloides?

A

Ivermectin

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5
Q

Side effects of linezolid?

A

BM depression (reversible, with prolonged use)
Neuropathy (irreversible)
Optic neuropathy (rare)
Serotonin syndrome (avoid concurrent tramadol/SSRIs)

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6
Q

Mechanism of resistance to vancomycin?

A

D-Ala D-Ala > D-Ala D-Lac

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7
Q

VanA vs. VanB vs. VanC gene clusters?

A

VanA - transferable, resistant to vancomycin & teicoplanin, high vancomycin MIC

VanB - transferable, moderate resistance to vancomycin but teicoplanin sensitive

VanC - non-transferable, resistant to vanc (low-level) but teicoplanin sensitive

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7
Q

VanA vs. VanB vs. VanC gene clusters?

A

VanA - transferable, resistant to vancomycin & teicoplanin, high vancomycin MIC

VanB - transferable, moderate resistance to vancomycin but teicoplanin sensitive

VanC - non-transferable, resistant to vanc (low-level) but teicoplanin sensitive

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8
Q

Indications for CT prior to LP

A

Immunocompromised state
History of CNS disease
New onset seizure
Papilloedema
Focal neurological deficit
Abnormal GCS

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9
Q

Common causes of bacterial meningitis in adults

A

SHIN

Strep. pneumoniae
Haemophilus influenzae
Neisseria

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10
Q

Causes of aseptic meningitis?

A
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11
Q

4 high-risk criteria requiring TOE if bacteraemic:

A

Community acquired bacteraemia
IV drug use
High risk cardiac condition
Indeterminate/positive TTE

In patients without above 4, normal TTE ruled out IE with sensitivity of 97% and NPV of 99%

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12
Q

Indications for surgery in infective endocarditis

A

(1) Heart failure
- Severe valve dysfunction
- Poor cardiac function
- Pulmonary oedema

(2) Uncontrolled infection
- Root abscess
- Persisting fevers/positive BC despite >10 days therapy
- Fungal/MDRO

(3) Prevention of embolism
- Vege >15mm
- Large vege + embolic episodes

If valve culture negative at surgery, antibiotics can be stopped 2/52 post op

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13
Q

Class of drug: raltegravir, dolutegravir?

A

Integrase inhibitors (HIV)

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14
Q

Class of drug: ritonavir, lopiravir, indinavir?

A

Protease inhibitors (HIV)

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15
Q

Class of drug: tenofovir, adefovir?

A

Nucleotide reverse transcriptase inhibitors (HIV)

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16
Q

Class of drug: abacavir, emtricitabine, lamivudine?

A

Nucleoside reverse transcriptase inhibitors (HIV)

17
Q

What HIV medication is associated with hypersensitivity reactions ?

A

Abacavir
Test for HLAB5701 prior to commencing therapy

18
Q

Examples of gram positive rods?

A

Non-spore forming:
Listeria monocytogenes
Corynebacterium
Gardnerella vaginalis

Spore forming:
Bacillus cereus
Clostridium

19
Q

Treatment of uncomplicated malaria?

A

Symptomatic but without features of severe malaria.

Oral therapy can be used.

1st line: artemether + lumefantrine (can be used after 1st trimester)

If in 1st trimester: atovaquone + proguanil.

If P vivax/P ovale: need primaquine for hypnozoites.

20
Q

Features of severe malaria?

A
  • Blood parasite count >100 000/mL (>2% cells parasitised)
  • Impaired consciousness
  • Jaundice
  • Oliguria/AKI
  • Respiratory distress
  • Severe anaemia
  • Hypoglycaemia
  • Vomiting
  • Metabolic acidosis
21
Q

Treatment of severe malaria?

A

Immediate IV treatment.

Usually caused by P falciparum.

1st line: IV artesunate

IV ceftriaxone 2g as concurrent bactereraemia common.

Paracetamol - reduces risk of haemolytic AKI

22
Q

Which species of malaria have dormant stages?

A

P vivax
P ovale

Dormant = hyponozoite = liver

23
Q

Definition of drug-resistant TB?

A

Resistance to one or more TB drugs

24
Q

Definition of multidrug-resistant TB (MDR-TB)?

A

Resistance to at least isoniazid AND rifampin

And possibly other TB drugs.

25
Q

Definition of extensively drug-resistant TB (XDR-TB)?

A

Resistance to isoniazide, rifampin, a fluoroquinolone and at least one second line injectable agent or linezolid.

26
Q

Most important predictors of drug-resistant TB?

A
  • Previous episode of TB treatment
  • Persistent or progressive clinical and/or radiographic findings whilst on first-line TB therapy
  • Residence/travel to a region with high prevalence of drug-resistant TB
  • Exposure to an individual with known/suspected infectious drug-resistant TB
27
Q

Treatment for drug susceptible pulmonary TB?

A

Traditional regimen of ≥6 months
- 2 months intensive phase
- ≥4 months continuation phase

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

After completion of intensive phase, repeat clinical assessment + repeat sputum AFB
- Routine CXR not required if improving clinically

28
Q

Indications for shortened regimen for TB?

A

Non-pregnant patients with drug susceptible TB in absence of extra pulmonary involvement.

Exclusion criteria:
History of cardiac disease
Advanced liver/renal disease
Pregnant/lactating women

Rifapentin, moxifloxacin, isoniazid, pyrazinamide
- 8 weeks intensive phase
- 9 weeks continuation phase

29
Q

Role of pyridoxine (vit B6) in TB?

A

Given to patients with isoniazid and at risk of neuropathy (pregnancy, HIV, diabetes, EtOH, renal failure)

Isoniazid prevents conversion of pyridoxine to active form. Needed as cofactor for GABA.

30
Q

ESCHAPPM organisms?

A
  • Enterobacter spp
  • Serratia spp.
  • Citrobacter freundii
  • Hafnia spp.
  • Aeromonas spp.
  • Proteus spp. (except P mirabilis)
  • Providencia spp.
  • Morganella morganii

AmpC beta lactamase genes
Inducible

31
Q

Clinically important CPE/CREs?

A
  • Klebsiella pneumoniae carbapenemase - KPC
  • New Delhi metallo-beta-lactamase proteinase - NDM
  • Oxacillin-type beta lactamase 48 - OXA 48
  • Verona integron encoded metallo-beta-lactamase - VIM
  • Imipenem hydrolysing metallo beta lactamase - IMP
32
Q

CSF in bacterial meningitis?

A

High opening pressure
Elevated WCC (primarily PMNs)
Low glucose
High protein

Neisseria, S pneumoniae, Listeria

33
Q

CSF in viral meningitis?

A

Normal/high opening pressure
Elevated WCC (primarily lymphocytes)
Normal glucose (may be low in HSV)
Elevated protein

HSV, VZV

34
Q

CSF in GBS?

A

Clear
Normal/high opening pressure
Normal WBC
Normal glucose
High protein ++

Albuinocytologic dissociation

35
Q

NS5B nucleotide inhibitors?

A

Sofosbuvir

36
Q

NS5A nucleotide inhibitors?

A

Velpatasvir
Elbasvir
Ledipasvir

37
Q

Drug of choice for Hep B treatment during pregnancy?

A

Tenofovir

38
Q

Indications for Hep B treatment in chronic HBV infection?

A

Immune clearance
- HBsAg positive
- HBeAg positive
- Anti-HBeAg negative
- ALT >19 women, >30 men
- Viral load >20,000

Immune escape
- HBsAg positive
- HBeAg negative
- Anti-HBeAg positive
- Elevated ALT
- Viral load >20,000

Detectable viral load + cirrhosis

39
Q

When to start HCC surveillance in hep B?

A

Cirrhosis
ATSI >50
Asian male >40
Asian female >50
African >20
1st degree relative with HCC

40
Q

Indications for Hep B treatment with chemotherapy/immunosuppression?

A

If HBsAg positive, should have antiviral therapy if undergoing chemotherapy/immunosuppression.

If B-cell depleting (e.g. rituximab), need to continue for 18-24 months post therapy. Also with B-cell depleting therapy, indication includes HBsAg negative/anti-HBc positive.

FRACP Written Exam 2023 (20 decks)

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