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MSRA > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Mycoplasma pneumoniae features?

A
  1. Prolonged and gradual onset
  2. Flu like symptoms precede a dry cough
  3. Bilateral consolidation on XR
  4. Often affects younger pts, epidemics every 4 years
  5. Atypical –> lacks peptidoglycan cell wall –> may not respond to penicillins or cephalosporins
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2
Q

Mycoplasma complications?

A
  1. Cold Agglutins (IgM) –> haemolytic anaemia, thrombocytopenia
  2. Erythema multiforme, erythema nodosum
  3. Heart = peri/myocarditis
  4. GI = hepatitis, pancreatitis
  5. Renal = acute glomerulonephritis
  6. Neuro = Meningoencephalitis, GBS
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3
Q

Mycoplasma Dx?

A
  1. Serology
  2. Positive cold agglutination test
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4
Q

Mycoplasma Rx?

A

Doxycycline or macrolide

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5
Q

Is HIV a notifiable disease?

A

No

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6
Q

Sepsis definition?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

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7
Q

Septic shock definition?

A

A more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’

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8
Q

qSOFA score?

A

Adult patients outside of ICU with suspected infection are identified as being at heightened risk of mortality if score >=2 of:
1. RR > 22/min
2. SBP < 100
3. Altered mentation

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9
Q

Sepsis 6?

A
  1. IVF
  2. IV Abx
  3. O2
  4. UO
  5. Lactate
  6. Cultures
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10
Q

Giardiasis risk factors?

A
  1. Foreign travel
  2. Swimming/drinking water from river or lake
  3. Male-male sexual contact
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11
Q

Giardiasis features?

A
  1. Non-bloody diarrhoea = steatorrhoea
  2. Bloating, abdominal pain
  3. Lethargy, weight loss
  4. Flatulence
  5. Malabsorption and lactose intolerance can occur
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12
Q

Giardiasis Ix?

A
  1. Stool microscopy for trophozoite and cysts: sensitivity of around 65%
  2. Stool antigen detection assay: greater sensitivity and faster turn-around time than conventional stool microscopy methods
  3. PCR assays being developed
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13
Q

Giardiasis Rx?

A

Metronidazole

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14
Q

Parvovirus B19 infection causes?

A
  1. Erythema infectiosum
  2. Fifth disease
  3. Slapped cheek syndrome
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15
Q

Parvovirus exposure in early pregnancy?

A

If before 20 weeks, she should seek prompt advice from whoever is giving her antenatal care as maternal IgM and IgG will need to be checked.

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16
Q

Parvovirus B19 presentation?

A
  1. Slapped cheek in children
  2. Pancytopenia in immunosuppressed
  3. Aplastic crises in SCD
  4. Hydrops fetalis
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17
Q

Necrotising fasciitis causative organism

A
  1. Type 1 = Most common, mixed anaerobes and aerobes (often occurs post-surgery in diabetics)
  2. Type 2 = S. pyogenes
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18
Q

Necrotising fasciitis RFs?

A
  1. Skin factors = trauma, burns, soft tissue infections
  2. DM esp. SGLT2
  3. IVDU
  4. Immunosuppression
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19
Q

Necrotising fasciitis most common site?

A

Perineum (Fournier’s gangrene)

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20
Q

Necrotising fasciitis features?

A
  1. Acute onset
  2. Worsening cellulitis with pain out of keeping with physical features
  3. Extremely tender over infected tissue with hypoaesthesia to light touch
  4. Skin necrosis and crepitus/gas gangrene are late signs
  5. Fever and tachycardia may be absent or occur late in the presentation
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21
Q

Necrotising fasciitis Rx?

A
  1. Urgent surgical debridement
  2. IV Abx
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22
Q

Necrotising fasciitis prognosis?

A

Average mortality 20%

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23
Q

Cellulitis organisms?

A

S. aureus or S. pyogenes

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24
Q

Cellulitis diagnosis?

A

Clinical, no further Ix required in primary care

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25
Q

Cellulitis admission criteria classification system?

A

Eron classification (I-IV)
1. Ok and no comorbidities
2. Well/unwell and 1 comorbidity
3. Very unwell or limb threatening
4. Sepsis or Necrotising fasciitis

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26
Q

What cellulitis pts should be admitted for IV Abx?

A
  1. Eron Class III/IV
  2. Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin)
  3. Is very young (under 1 year of age) or frail
  4. Immunocompromised
  5. Significant lymphoedema
  6. Facial cellulitis (unless very mild) or periorbital cellulitis
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27
Q

Cellulitis Rx?

A
  1. Flucloxacillin 1st line
  2. Clarithromycin/doxycycline/erythromycin (pregnancy) if pen allergic
  3. Severe –> Co-amoxiclav/cefuroxime/clindamycin/ceftriaxone
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28
Q

Traveller’s diarrhoea definition?

A

At least 3 loose to watery stools in 24 hours with or without one of more of abdominal cramps, fever, nausea, vomiting or blood in the stool. The most common cause is Escherichia coli.

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29
Q

Acute food poisoning definition?

A

Sudden onset of nausea, vomiting and diarrhoea after the ingestion of a toxin. Typically caused by Staphylococcus aureus, Bacillus cereus or Clostridium perfringens

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30
Q

E.coli diarrhoea history?

A

Traveller, watery stool, abdominal cramps and nausea

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31
Q

Giardia diarrhoea history?

A

Prolonged, non-bloody diarrhoea

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32
Q

Cholera diarrhoea history?

A
  1. Profuse, watery diarrhoea
  2. Severe dehydration resulting in weight loss
  3. Not common amongst travellers
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33
Q

Shigella diarrhoea history?

A

Bloody diarrhoea, vomiting, abdominal pain

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34
Q

S. aureus diarrhoea history?

A

Severe vomiting, short incubation period

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35
Q

Campylobacter diarrhoea history?

A
  1. Flu-like prodrome –> crampy abdominal pain, fever, diarrhoea
  2. May mimic appendicitis
  3. Complications incl. GBS
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36
Q

Bacillus cereus diarrhoea history?

A
  1. Vomiting within 6 hours stereotypically due to rice
  2. Diarrhoeal illness occurring after 6 hours
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37
Q

Amoebiasis diarrhoea history?

A

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

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38
Q

Diarrhoea 1-6 hour incubation period?

A

S. aures, B. cereus

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39
Q

Diarrhoea 12-48 hours incubation period?

A

Salmonella, E. coli

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40
Q

Diarrhoea 48-72 hours incubation period?

A

Shigella, campylobacter

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41
Q

Diarrhoea >7 day incubation period?

A

Giardia, Amoeba

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42
Q

Genital wart aka?

A

Condylomata accuminata

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43
Q

HPV types causing genital warts?

A

6 and 11

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44
Q

HPV types predisposing to cervical cancer?

A

16, 18, 33

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45
Q

Genital wart features?

A
  1. Small 2-5mm fleshy protuberances which are slightly pigmented
  2. May bleed or itch
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46
Q

Genital wart management?

A
  1. Topical podophyllum/cryotherapy 1st line
    a. Multiple, non-keratinised warts –> topical podophyllum
    b. Solitary, keratinised warts –> cryotherapy
  2. Imiquimod 2nd line
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47
Q

Most common organism from animal bite?

A

Pasteurella multocida

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48
Q

Animal bite Rx?

A
  1. Cleanse wound. Don’t suture puncture wound unless cosmesis is at risk
  2. Co-amoxiclav
  3. If pen allergic then doxycycline + metronidazole
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49
Q

Human bite Rx?

A

Co-amoxiclav

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50
Q

Exacerbation of chronic bronchitis Rx?

A

Amoxicillin or tetracycline or clarithromycin

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51
Q

Uncomplicated CAP Rx?

A

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

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52
Q

Possible atypical pneumonia Rx?

A

Clarithromycin

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53
Q

HAP Rx?

A
  1. Within 5d = Co-amoxiclav or cefuroxime
  2. > 5d = Tazocin or Quinolone (ciprofloxacin) or Broad-Spectrum Cephalosporin (Ceftazidime)
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54
Q

UTI Rx?

A
  1. Trimethoprim or nitrofurantoin
  2. Alternative = Amoxicillin or cephalosporin
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55
Q

Acute pyelonephritis Rx?

A

Broad-spectrum cephalosporin or quinolone

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56
Q

Acute prostatitis Rx?

A

Quinolone or trimethoprim

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57
Q

Impetigo Rx?

A
  1. Topical hydrogen peroxide
  2. Oral flucloxacillin or erythromycin if widespread
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58
Q

Cellulitis Rx?

A

Flucloxacillin

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59
Q

Cellulitis near eyes or nose Rx?

A

Co-amoxiclav

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60
Q

Erysipelas Rx?

A

Flucloxacillin

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61
Q

Mastitis during breast feeding Rx?

A

Flucloxacillin

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62
Q

Throat infection Rx?

A
  1. Phenoxymethylpenicillin
  2. Erythromycin alone if penicillin-allergic
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63
Q

Sinusitis Rx?

A

Phenoxymethylpenicillin

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64
Q

Otitis media Rx?

A

Amoxicillin (erythromycin if penicillin-allergic)

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65
Q

Otitis externa Rx?

A

Flucloxacillin (erythromycin if penicillin-allergic)

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66
Q

Periapical or periodontal abscess Rx?

A

Amoxicillin

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67
Q

Gingivitis: acute necrotising ulcerative Rx?

A

Metronidazole

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68
Q

Gonorrhoea Rx?

A

IM Ceftriaxone

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69
Q

Chlamydia Rx?

A

Doxycyline or Azithromycin

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70
Q

PID Rx?

A
  1. Oral ofloxacin + Oral metronidazole OR
  2. IM Ceftriaxone + Oral Doxycycline + Oral metronidazole
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71
Q

Syphilis Rx?

A

Benzathine benzylpenicillin or doxycycline or erythromycin

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72
Q

Bacterial Vaginosis Rx?

A

Oral/topical metronidazole or topical clindamycin

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73
Q

C. diff Rx?

A
  1. 1st episode = oral vancomycin
  2. 2nd episode = Oral fidoxamicin
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74
Q

Campylobacter enteritis Rx?

A

Clarithromycin

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75
Q

Salmonella (non-typhoid) Rx?

A

Ciprofloxacin

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76
Q

Shigella Rx?

A

Ciprofloxacin

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77
Q

Gonorrhoea features?

A
  1. Male = urethral discharge, dysuria
  2. Female = cervicitis e.g. leading to vaginal discharge
  3. Rectal and pharyngeal infection usually asymptomatic
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78
Q

Gonorrhoea local complications?

A
  1. Urethral strictures and epididymitis
  2. Salpingitis –> may lead to infertility
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79
Q

Gonorrhoea systemic complications?

A
  1. DGI = Disseminated gonococcal infection
  2. Gonococcal arthritis
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80
Q

Tenosynovitis, migratory polyarthritis and dermatitis (lesions can be maculopapular or vesicular)?

A

Disseminated gonococcal infection

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81
Q

Aspergilloma definition?

A

A mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis).

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82
Q

Aspergilloma features?

A

Cough and haemoptysis

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83
Q

Aspergilloma Ix?

A
  1. CXR containing a rounded opacity, crescent sign may be present
  2. High titres of Aspergillus precipitins
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84
Q

Spinal epidural abscess definition?

A

A collection of pus that is superficial to the dura mater (of the meninges) that covers the spinal cord

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85
Q

Spinal epidural abscess most common organism?

A

S. Aureus

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86
Q

Spinal epidural abscess pathophysiology?

A
  1. Contiguous spread = discitis
  2. Haematogenous spread = IVDU
  3. Direct infection = spinal surgery
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87
Q

Spinal epidural abscess presentation?

A
  1. Fever
  2. Back pain
  3. Focal neurological deficit
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88
Q

Spinal epidural abscess Ix?

A
  1. Bloods = incl. HIV, Hep B, Hep C
  2. Blood cultures
  3. MRI whole spine (since skip lesions may be present)
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89
Q

Lyme disease cause?

A

Borrelia burgdorferi

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90
Q

Lyme disease feature classification?

A
  1. Early (within 30 days) = erythema migrans, systemic features
  2. Late (after 30 days) = cardio, neuro
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91
Q

Lyme disease early features?

A
  1. Erythema migrans = bulls eye rash, 1-4 weeks after bite, painless, >5cm in diameter and slowly increases in size, present in 80% pts
  2. Systemic features = headache, lethargy, fever, arthralgia
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92
Q

Lyme disease later features?

A
  1. Cardio = heart block, peri/myocarditis
  2. Neuro = facial nerve palsy, radicular pain, meningitis
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93
Q

Lyme disease Ix?

A
  1. Clinically if erythema migrans is present –> Abx can be started
  2. 1st line = ELISA to borrelia burgdorferi = if negative and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA 4-6 weeks after the first ELISA test. If still suspected in people who have had symptoms for 12 weeks or more then an immunoblot test should be done, if positive or equivocal then an immunoblot test for Lyme disease should be done
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94
Q

Rx of asymptomatic tick bites?

A

Remove tick with fine tipped tweezers, wash area, routine Abx not recommended

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95
Q

Suspected/confirmed Lyme disease Rx?

A
  1. Doxycycline if early disease (amoxicillin in pregnancy)
  2. Ceftriaxone if disseminated disease
  3. Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease
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96
Q

URTI symptoms + amoxicillin –> rash?

A

Likely glandular fever

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97
Q

Glandular fever causes?

A

EBV, CMV, HHV6

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98
Q

Glandular fever presentation?

A
  1. Sore throat
  2. Pyrexia
  3. Lymphadenopathy
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99
Q

Glandular fever features?

A
  1. Malaise, anorexia, headache
  2. Palatal petehiae
  3. Splenomegaly (50%)
  4. Hepatitis, transient rise in ALT
  5. Lymphocytosis = presence of 50% lymphocytes and at least 10% atypical lymphocytes
  6. Haemolytic anaemia secondary to cold agglutins (IgM)
  7. A maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
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100
Q

Glandular fever Dx?

A

Heterophil antibody test (Monospot test) - NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

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101
Q

Glandular fever Rx?

A
  1. Supportive, avoid alcohol
  2. Avoid contact spots for 4 weeks to reduce risk of splenic rupture
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102
Q

Leptospirosis aetiology?

A

The spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae), classically being spread by contact with infected rat urine.

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103
Q

Leptospirosis epidemiology?

A
  1. Sewage workers, farmers, vets, abattoir
  2. Returning traveller
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104
Q

Weil’s disease?

A

Hepatorenal failure associated with Leptospirosis

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105
Q

Leptospirosis features?

A
  1. Early = fever, flu-like symptoms, subconjunctival haemorrhage
  2. Late = AKI, Hepatitis, aseptic meningitis
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106
Q

Leptospirosis Ix?

A
  1. Serology = Abs to leptospira develop after about 7 days
  2. PCR
  3. Culture = may take several weeks so limits usefulness in Dx, blood and CSF samples are generally positive for the first 10 days, urine cultures become positive during the second week of illness
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107
Q

Leptospirosis Rx?

A

High dose benzylpenicillin or doxycycline

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108
Q

Differentiating erysipelas from other skin infections?

A

Lack of involvement of subcutaneous tissue

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109
Q

Main cause of erysipelas?

A

Streptococcus pyogenes, a beta-haemolytic group A streptococci and the rash is caused by an endotoxin rather than the bacteria itself

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110
Q

Most common STI in UK?

A

Chlamydia, around 1 in 10 young women have it

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111
Q

Chlamydia features?

A

Asymptomatic in 70% women and 50% men
1. Women = cervicitis (discharge, bleeding), dysuria
2. Men = urethral discharge, dysuria

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112
Q

Chlamydia Ix?

A

NAAT = vulvovaginal swab in women, urine test in men (should be carried out 2 weeks after a possible exposure)

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113
Q

Chlamydia screening?

A

Open to all 15-24 years

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114
Q

Chlamydia Rx?

A
  1. Doxycycline 7d 1st line
  2. If doxy C/I then Azithromycin 1g OD one day then 500mg OD two days
  3. If pregnancy = azithromycin/erythromycin/amoxicillin
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115
Q

Chlamydia contact tracing?

A
  1. Men with urethral symptoms = all contact since, and in the four weeks prior to, the onset of symptoms
  2. Women and asymptomatic men = all partners from the last six months or the most recent sexual partner should be contacted
  3. Contacts should have treat then test
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116
Q

When is test of cure for chlamydia in pregnant women?

A

6 weeks post infection

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117
Q

Is Test of Cure required in uncomplicated chlamydia infection in men and non- pregnant women?

A

No

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118
Q

Clue cells?

A

Bacterial vaginosis

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119
Q

BV definition?

A

Describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

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120
Q

BV features?

A
  1. Vaginal discharge = fishy, offensive
  2. Asymptomatic in 50%
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121
Q

Amsel’s criteria for BV?

A

3 out of 4 should be present
1. Thin, white homogeneous discharge
2. Clue cells on microscopy: stippled vaginal epithelial cells
3. Vaginal pH > 4.5
4. Positive whiff test (addition of KOH results in fish odour)

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122
Q

BV Rx?

A
  1. Oral metronidazole 5-7 days
  2. 70-80% initial cure rate
  3. Relapse rate > 50% within 3m
  4. Topical metronidazole/topical clindamycin are alternatives
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123
Q

Strawberry cervix?

A

Trichomonas vaginalis

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124
Q

BV in pregnancy mushkies?

A
  1. Results in an increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage
  2. Treat with oral metronidazole as normal
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125
Q

Hep B needlestick transmission risk?

A

20-30%

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126
Q

Hep C needlestick transmission risk?

A

0.5-2%

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127
Q

HIV needlestick transmission risk?

A

0.3%

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128
Q

Hepatitis A PEP?

A

Human Normal Immunoglobulin (HNIG) or hepatitis A vaccine may be used depending on the clinical situation

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129
Q

Hepatitis B PEP HBsAg positive source?

A
  1. If the person exposed is a known responder to the HBV vaccine then a booster dose should be given
  2. If they are a non-responder (anti-HBs < 10mIU/ml 1-2 months post-immunisation) they need to have hepatitis B immune globulin (HBIG) and a booster vaccine
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130
Q

Hepatitis B PEP unknown source?

A
  1. For known responders the HBV vaccine the Green Book advises considering a booster dose of HBV vaccine
  2. For known non-responders HBIG + vaccine should be given whilst those in the process of being vaccinated should have an accelerated course of HBV vaccine
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131
Q

Hepatitis C PEP?

A
  1. Monthly PCR - if seroconversion then interferon +/- ribavarin
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132
Q

HIV PEP?

A
  1. The risk of HIV transmission depends heavily on the incident (e.g. needle stick, type of sexual intercourse, human bite etc) and the current viral load of the patient
  2. A combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
  3. Serological testing at 12 weeks following completion of post-exposure prophylaxis
  4. Reduces risk of transmission by 80%
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133
Q

Varicella zoster PEP?

A

VZIG for IgG negative pregnant women/immunosuppressed

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134
Q

Listeria monocytogenes mushkies?

A

A Gram-positive bacillus which has the unusual ability to multiply at low temperatures. It is typically spread via contaminated food, typically unpasteurised dairy products. Infection is particularly dangerous to the unborn child where it can lead to miscarriage

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135
Q

Listeria features?

A
  1. Diarrhoea, flu-like illness
  2. Pneumonia, meningoencephalitis
  3. Ataxia and seizures
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136
Q

Listeria Ix?

A
  1. Blood cultures
  2. CSF may reveal a pleocytosis with ‘tumbling motility’ on wet mounts
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137
Q

Listeria Rx?

A
  1. Amoxicillin/ampicillin
  2. Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin
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138
Q

Listeria in pregnant women mushkies?

A
  1. 20 times more likely to develop listeriosis compared with the rest of the population due to changes in the immune system
  2. Fetal/neonatal infection can occur both transplacentally and vertically during child birth
  3. Complications include miscarriage, premature labour, stillbirth and chorioamnionitis
  4. Diagnosis can only be made from blood cultures
  5. Rx = amoxicillin
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139
Q

Enteric fever (typhoid/paratyphoid) organism?

A

Salmonella typhi and Salmonella paratyphi (types A, B & C) respectively. They are often termed enteric fevers, producing systemic symptoms such as headache, fever, arthralgia.

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140
Q

Salmonella gram stain?

A

Gram negative rod

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141
Q

Enteric fever transmission?

A

Faeco-oral route

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142
Q

Enteric fever features?

A
  1. Relative bradycardia
  2. Constipation more common in typhoid
  3. Rose spots in 40%, more common in paratyphoid
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143
Q

Enteric fever complications?

A
  1. Osteomyelitis (esp. in sickle cell)
  2. GI bleed/perforation
  3. Meningitis
  4. Cholecystitis
  5. Chronic carriage (1%, more likely if adult females)
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144
Q

Pre-hospital setting Meningitis Rx?

A

IM Benzylpenicillin

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145
Q

Meningitis < 3m Rx?

A

IV Cefotaxime + amoxicililn/ampicillin

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146
Q

Meningitis 3m - 50 y/o Rx?

A
  1. IV Cefotaxime/Ceftriaxone
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147
Q

Meningitis > 50 y/o Rx?

A

IV Cefotaxime/Ceftriaxone + Amoxicillin/Ampicillin

148
Q

Meningococcal meningitis Rx?

A

IV Benzylpenicillin or Cefotaxime/Ceftriaxone

149
Q

Pneumococcal meningitis Rx?

A

IV Cefotaxime/Ceftriaxone

150
Q

H. influenzae meningitis Rx?

A

IV Cefotaxime/Ceftriaxone

151
Q

Listeria Meningitis Rx?

A

IV Amoxicillin/Ampicillin + Gentamicin

152
Q

Steroids for meningitis?

A

IV Dexamethasone unless:
1. Septic shock
2. Meningococcal septicaemia
3. Immunocompromised
4. Meningitis following surgery

153
Q

Meningitis Rx if pt has history of immediate hypersensitivity reaction to penicillin or to cephalosporins?

A

Chloramphenicol

154
Q

Meningitis Rx of contacts?

A
  1. Prophylaxis to household and close contacts within 7d before onset
  2. Oral ciprofloxacin/rifampicin
  3. Vaccination should be offered to close contacts when serotype results are available
  4. Pneumococcal meningitis = no prophylaxis is generally needed
155
Q

Syphilis Abx?

A
  1. IM Benzathine penicillin
  2. Alternatives = doxycycline
156
Q

Jarisch-Herxheimer reaction?

A
  1. Fever, rash, tachycardia after the first dose of antibiotic
  2. In contrast to anaphylaxis, there is no wheeze or hypotension
  3. Thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
  4. No Rx other than antipyretics if required
157
Q

Trichomonas vaginalis features?

A
  1. Frothy yellow/green offensive vaginal discharge
  2. Vulvovaginitis
  3. Strawberry cervix
  4. pH > 7.5
  5. Usually asymptomatic in men, can cause urethritis
158
Q

Trichomonas Ix?

A

Microscopy of a wet mount shows motile trophozoites

159
Q

Trichomonas Rx?

A

Oral metronidazole for 5-7 days (although BNF also supports one-off dose of 2g metronidazole)

160
Q

Two conditions that cause offensive vaginal discharge with vaginal pH > 4.5?

A

BV and Trichomonas –> treat both with metronidazole

161
Q

Bronchiolitis?

A

RSV

162
Q

Croup?

A

Parainfluenza virus

163
Q

Common cold?

A

Rhinovirus

164
Q

Flu?

A

Influenza virus

165
Q

Most common cause of CAP?

A

S. pneumoniae

166
Q

Most common cause of bronchiectasis exacerbations?

A

Haemophilus influenzae

167
Q

Pneumonia following influenza?

A

Staphylococcus aureus

168
Q

Flu like symptoms preceding a dry cough?

A

Mycoplasma pneumoniae

169
Q

Legionella features?

A
  1. Air conditioning, dry cough
  2. Lymphopenia
  3. Deranged LFTs
  4. Hyponatraemia
170
Q

Few chest signs, exertional dyspnoea, HIV?

A

Pneumocystis Jirovecii

171
Q

Lower UTI in non-pregnancy women Rx?

A
  1. Trimethoprim or nitrofurantoin for 3 days
  2. Send urine culture if: > 65 y/o, or visible/non-visible haematuria
172
Q

Lower UTI in pregnancy women Rx?

A
  1. Symptomatic = culture, nitrofurantoin 1st line, amoxicillin/cefalexin 2nd line
  2. Asymptomatic = culture at first antinatal visit, 7 days course of nitro/amox/cefalexin, needs further culture for TOC
173
Q

What UTI Abx is teratogenic in first trimeter?

A

Trimethoprim

174
Q

Men lower UTI Rx?

A

Trimethoprim or Nitrofurantoin 7 days unless prostatitis suspected

175
Q

Catheterised pt Lower UTI Rx?

A
  1. Do not treat if asymptomatic
  2. Symptomatic = 7d course, consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days
176
Q

Types of Influenza?

A

A, B and C.
A and B account for majority of clinical cases.

177
Q

Influenze vaccine type?

A
  1. Child = live
  2. Regular = inactivated
178
Q

NHS influenza vaccination for children?

A
  1. Given intranasally
  2. 1st dose at 2-3 years, then annualy after that
  3. Live vaccine
179
Q

NHS influenza vaccination mushkies?

A
  1. If immunosuppressed should receive inactivated, injectable vaccine
  2. Only children aged 2-9 years who have not received an influenza vaccine before need 2 doses
  3. More effective than the injectable vaccine
180
Q

Children influenza vaccine contraindications?

A
  1. Immunocompromised
  2. < 2 y/o
  3. Current febrile illness/blocked nose
  4. Current wheeze or history of severe asthma
  5. Egg allergy
  6. Pregnancy/breastfeeding
  7. If child is taking aspirin
181
Q

Child influenza vaccine s/e?

A
  1. Blocked nose/rhinorrhoea
  2. Headache
  3. Anorexia
182
Q

Adult influenza vaccine mushkies?

A
  1. Trivalent: 2 subtypes of A, 1 subtype of B
  2. An inactivated vaccine, so cannot cause influenza. A minority of patients however develop fever and malaise which may last 1-2 days
  3. Should be stored between +2 and +8ºC and shielded from light
  4. C/I = hypersensitivity to egg protein
  5. 75% effective in adults, less in elderly
  6. 10-14 days before Ab at protective levels
183
Q

Adult influenza vaccination indication?

A

> 65 y/o and at-risk groups:
1. Chronic resp/heart/liver/kidney/neurological disease
2. DM
3. Immunosuppression
4. Asplenia or splenic dysfunction
5. Pregnant women
6. BMI > 40
7. Health and social care staff, those living in long-stay residential care homes, carers of the elderly/disabled person

184
Q

Metronidazole and alcohol?

A

Disulfiram-like reaction with alcohol

185
Q

Commonest bacterial cause of infectious intestinal disease in UK?

A

Campylobacter (gram negative bacillus)

186
Q

Campylobacter features?

A
  1. Prodrome = headache and malaise
  2. Diarrhoea = often bloody
  3. Abdominal pain = may mimic appendicitis
187
Q

Campylobacter Rx?

A
  1. Usually self limiting
  2. If severe, clarithromycin
  3. Ciprofloxacin is alternative
188
Q

Campylobacter complications?

A
  1. GBS
  2. Reactive arthritis
  3. Septicaemia, endocarditis
189
Q

HIV seroconversion features?

A

Symptomatic in 60-80% and typically presents as a landular fever type illness. Increased symptomatic severity is associated with poorer long term prognosis. It typically occurs 3-12 weeks after infection
1. Sore throat, lymphadenopathy
2. Malaise, myalgia, arthralgia
3. Diarrhoea
4. Maculopapular rash
5. Mouth ulcers
6. Rarely meningoencephalitis

190
Q

HIV Dx?

A
  1. HIV antibodies
  2. p24 antigen
  3. If combined test of above is positive, should be repeated to confirm diagnosis, some centres may also test viral load
191
Q

Testing for HIV in asymptomatic patient timing?

A
  1. 4 weeks after possible exposure
  2. Offer repeat test at 12 weeks
192
Q

HIV antibodies mushkies?

A
  1. May not be present in early infection, but most people develop antibodies to HIV at 4-6 weeks but 99% do by 3 months
  2. Usually consists of both a screening ELISA and a confirmatory Western Blot Assay
193
Q

p24 antigen mushkies?

A
  1. A viral core protein that appears early in the blood as the viral RNA levels rise
  2. Usually positive from about 1 week to 3-4 weeks after infection with HIV
194
Q

Winter vomiting bug?

A

Norovirus

195
Q

Norovirus symptoms?

A
  1. Within 15-50 hours of infection
  2. Most have both vomiting and diarrhoea
196
Q

Is norovirus notifiable?

A

No

197
Q

Norovirus Dx?

A

Clinical history and stool culture viral PCR

198
Q

Norovirus-like picture further differentials?

A
  1. Salmonella
  2. E. coli
  3. Rotavirus
199
Q

Salmonella > Norovirus differentiation?

A

Bloody diarrhoea, high fever, animal products

200
Q

Rotavirus > Norovirus differentiation?

A

Children < 5 y/o

201
Q

E. coli > Norovirus differentiation?

A

Longer incubation (up to 10 days), severe abdominal cramping, bloody diarrhoea

202
Q

Herpes simplex virus infection features?

A
  1. Primary infection = severe gingivostomatitis
  2. Cold sores
  3. Painful genital ulceration
203
Q

HSV gingivostomatitis Rx?

A

Oral aciclovir, chlorhexidine mouthwash

204
Q

HSV cold sore Rx?

A

Topical aciclovir

205
Q

Genital herpes Rx?

A

Oral aciclovir

206
Q

HSV Pregnancy Rx?

A
  1. Elective C-section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
  2. Women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
207
Q

3Ms of HSV?

A
  1. Multinucleation
  2. Margination of Chromatin
  3. Molding of the nuclei
208
Q

Hepatitis C pathophysiology?

A

RNA flavivirus, incubation period 6-9 weels

209
Q

Hepatitis C transmission mushkies?

A
  1. Needlestick = 2%
  2. Mother to child = 6% (higher ith HIV)
  3. Breastfeeding is not C/I
  4. Sex = <5%
  5. No vaccine
210
Q

After exposure to Hepatitis C virus?

A

30% will develop:
1. Transient rise in serum aminotransferase
2. Fatigue
3. Arthralgia

211
Q

Hepatitis C Ix?

A

HCV RNA for acute infection

212
Q

Hepatitis C prognosis?

A

Around 15-45% of patients will clear the virus after an acute infection (depending on their age and underlying health) and hence the majority (55-85%) will develop chronic hepatitis C

213
Q

Chronic hepatitis C definition?

A

Persistence of HCV RNA in the blood for 6 months

214
Q

Hepatitis C complications?

A
  1. Rheumatological = arthralgia, arthritis
  2. Eye = Sjogrens
  3. Cirrhosis (5-20%), HCC
  4. Cryoglobulinaemia (Type II, mixed monoclonal and polyclonal)
  5. Porphyria Cutanea Tarda
  6. Membranoproliferative Glomerulonephritis
215
Q

Chronic Hepatitis C Rx?

A
  1. Depends on virus genotype
  2. Clearance rates of 95%, aim is sustained virological response (SVR) = undetectable serum HCV RNA six months after the end of therapy
  3. Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) +/- Ribavarin
216
Q

Ribavarin s/e?

A
  1. Haemolytic anaemia, cough
  2. Women should not become pregnant within 6m as is teratogenic
217
Q

IFN-a s/e?

A
  1. Flu-like symptoms
  2. Depression, fatigue
  3. Leukopenia, thrombocytopenia
218
Q

Live attenuated vaccines?

A

BOOOM YI
1. BCG
2. Oral rotavirus, typhoid, polio
3. MMR
4. Yellow Virus
5. Influenze (intranasal)

219
Q

Inactivated vaccines?

A

HIR
1. Hepatitis A
2. Influenza (IM)
3. Rabies

220
Q

Toxoid (inactivated toxin) vaccines?

A

DTP

221
Q

Conjugate vaccines?

A
  1. Pneumococcus, meningococcus, haemophilus
  2. HPV, HBV
222
Q

Lyme disease Rx?

A

14-21 day course

223
Q

Chancroid organism?

A

Haemophilus Ducreyi

224
Q

Chancroid features?

A
  1. Painful genital ulcers
  2. Unilateral, painful inguinal lymph node enlargement
  3. Ulcers typically have a sharply defined, ragged, undermined border
225
Q

Painful genital ulcers?

A

Chancroid

226
Q

Pneumonia in alcoholic?

A

Klebsiella

227
Q

What UTI Abx avoided near term?

A

Nitrofurantoin as may cause neonatal haemolysis

228
Q

Treatment for active TB?

A
  1. RIPE 2m
  2. RI 4m
229
Q

Latent TB Rx?

A
  1. 3m RI OR
  2. 6m I
230
Q

Meningeal YB Rx?

A

12m with addition of steroids

231
Q

Directly observed TB therapy?

A

3 times a week dosing regimen for:
1. Homeless with active TB
2. Pts more likely to have poor concordance
3. All prisoners with active or latent TB

232
Q

TB treatment complications?

A
  1. Immune reconstitution disease = 3-6 weeks after starting Rx, often presents with enlarging lymph nodes
  2. Drug s/e
233
Q

Rifampicin s/e?

A
  1. Potent enzyme inducer
  2. Hepatitis, orange secretions
  3. Flu-like symptoms
234
Q

Isoniazid s/e?

A
  1. Peripheral neuropathy
  2. Hepatitis, agranulocytosis
  3. Liver enzyme inhibitor
235
Q

Pyrazinamide s/e?

A
  1. Hyperuricaemia causing gout
  2. Arthralgia, myalgia
  3. Hepatitis
236
Q

Ethambutol s/e?

A

Optic neuritis: check visual acuity before and during treatment

237
Q

Prodrome, abdominal pain, bloody diarrhoea?

A

Campylobacter

238
Q

Common trigger for cold sores?

A

Sunlight

239
Q

Toxoplasmosis mushkies?

A

Toxoplasma gondii is an obligate intracellular protozoan that infects the body via the gastrointestinal tract, lung or broken skin. It’s oocysts release trophozoites which migrate widely around the body including to the eye, brain and muscle. The usual animal reservoir is the cat, although other animals such as rats carry the disease.

240
Q

Toxoplasmosis treatment in immunocompetent pts?

A

Not needed

241
Q

Toxoplasmosis Ix?

A

Serology

242
Q

Toxoplasmosis in HIV presentation?

A

Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV = single or multiple ring-enhancing lesions, mass effect may be seen

243
Q

Cerebral toxoplasmosis Rx?

A

Pyrimethamine plus sulphadiazine for at least 6 weeks

244
Q

Congenital toxoplasmosis features?

A
  1. Neurological = cerebral calcification, hydrocephalus, chorioretinitis
  2. Ophthalmic = retinopathy, cataracts
245
Q

Rusty sputum?

A

S. aureus

246
Q

COPD chest infection organism?

A

H. influenzae

247
Q

Behcet’s triad?

A
  1. Oral ulcers
  2. genital ulcers
  3. Uveitis
248
Q

HSV1 typically?

A

Cold sores

249
Q

HSV2 typically?

A

Genital herpes

250
Q

Lymphogranuloma venereum mushkies?

A

Caused by Chlamydia trachomatis, infection has 3 stages:
1. Small painful pustule which later causes an ulcer
2. Painful inguinal lymphadenopathy
3. Proctocolitis

251
Q

LGV Rx?

A

Doxycycline

252
Q

Granuloma inguinale bacteria?

A

Klebsiella granulomatis

253
Q

Uncomplicated CAP and staphylococci suspected e.g. influenze Rx?

A

Amoxicillin AND flucloxacillin

254
Q

Hepatitis B mushkies?

A

A double-stranded DNA hepadnavirus and is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child. The incubation period is 6-20 weeks.

255
Q

Hepatitis B features?

A
  1. Fever
  2. Jaundice
  3. Elevated transaminases
256
Q

Hepatitis B complications?

A
  1. Chronic hepatitis (5-10%) = ground glass hepatocytes –> fulminant liver failure
  2. HCC
  3. Glomerulonephritis
  4. PAN
  5. Cryoglobulinaemia
257
Q

Testing for anti-HBs in which groups?

A

Should be checked 1-4 months after primary immunisation
1. Healthcare workers
2. CKD

258
Q

Anti-HBs < 10?

A

Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus

259
Q

Anti-HBs 10-100?

A

Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required

260
Q

Anti-HBs > 100?

A

Indicates adequate response, no further testing required. Should still receive booster at 5 years

261
Q

Hepatitis B Rx?

A
  1. Pegylated IFN-a
  2. Others = tenofovir, entecavir, telbivudine
262
Q

PEP HIV duration?

A

4 weeks

263
Q

What improves neurological outcomes in the treatmetn of bacterial meningitis?

A

Dexamethasone

264
Q

LGV genital ulcer painful or painless?

A

Painless

265
Q

How many doses of tetanus confers lifelong protection?

A

5

266
Q

Tetanus immunisation timings?

A
  1. 2m, 3m, 4m
  2. 3-5 years
  3. 13-18 years
267
Q

Tetanus prone wound?

A
  1. Puncture injury in contaminated environment
  2. Wounds with foreign bodies
  3. Compound fractures
  4. Wounds/burns with systemic sepsis
  5. Certain animal bites and scratches
268
Q

High-risk tetanus prone wounds?

A
  1. Heavy contamination with material likely to contain tetanus spores e.g. soil, manure
  2. Wounds or burns that show extensive devitalised tissue
  3. WOunds or burns that require surgical intervention
269
Q

Wound and Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago?

A

No vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

270
Q

Wound and Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago?

A
  1. Tetanus prone wound = reinforcing dose of vaccine
  2. High risk wound = Reinforcing dose of vaccine + tetanus immunoglobulin
271
Q

Wound and tetanus vaccination history is incomplete or unknown?

A
  1. Reinforcing dose of vaccine, regardless of the wound severity
  2. For tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
272
Q

Kaposi’s sarcoma mushkies?

A
  1. HHV8
  2. Purple papules/plaques on the skin or mucosa (e.g. GI and respiratory tract) –> may later ulcerate
  3. Respiratory involvement may cause haemoptysis and pleural effusion
  4. Rx = Radiotherapy + resection
273
Q

Most common cause of COPD exacerbations?

A

Haemophilus influenzae

274
Q

Salmonella Rx?

A

Ciprofloxacin

275
Q

Clostridia gram stain?

A

Gram +ve, obligate anaerobic bacilli

276
Q

Clostridia types x 4?

A
  1. Botulinum
  2. Difficile
  3. Tetani
  4. Perfringens
277
Q

Clostridium botulinum mushkies?

A
  1. Typically seen in canned foods and honey
  2. Prevents ACh release leading to flaccid paralysis
278
Q

Clostridium perfringens mushkies?

A
  1. Produces α-toxin, a lecithinase, which causes gas gangrene (myonecrosis) and haemolysis
  2. Features include tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation
279
Q

Clostridium tetani features?

A

Produces an exotoxin (tetanospasmin) that prevents the release of glycine from Renshaw cells in the spinal cord causing a spastic paralysis

280
Q

EBV associated malignancies?

A
  1. Burkitt’s
  2. Hodgkin’s
  3. Nasopharyngeal
  4. HIV-associated CNS lymphomas
281
Q

BCG vaccine type?

A

Live attenuated Mycobacterium bovis. It also offers limited protection against leprosy

282
Q

Who receives BCG vaccine?

A
  1. All infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of TB is 40/100,000 or greater
  2. All infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. The same applies to older children but if they are 6 years old or older they require a tuberculin skin test first
  3. Previously unvaccinated tuberculin-negative contacts of cases of respiratory TB
  4. Previously unvaccinated, tuberculin-negative new entrants under 16 years of age who were born in or who have lived for a prolonged period (at least three months) in a country with an annual TB incidence of 40/100,000 or greater
  5. Healthcare workers, prison staff, care home staff, those who work with the homeless
283
Q

What must be done before BCG vaccination?

A

Tuberculin skin test (only exception is children < 6 y/o who have had no contact with TB)

284
Q

BCG administration mushkies?

A
  1. Given intradermally, normally to the lateral aspect of the left upper arm
  2. BCG can be given at the same time as other live vaccines, but if not administered simultaneously there should be a 4 week interval
285
Q

BCG contraindications?

A
  1. Previous BCG
  2. Previous TB
  3. HIV
  4. Pregnancy
  5. Positive Tuberculin test (Heaf or Mantoux)
286
Q

Is BCG vaccine given to > 35 y/o?

A

No

287
Q

Diphtheria cause?

A

Gram positive bacterium Corynebacterium diphtheriae

288
Q

Diphtheria features?

A
  1. Recent visitor to Eastern Europe/Russia/Asia
  2. Sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall
  3. Bulky cervical lymphadenopathy (bull’s neck appearance)
  4. Neuritis e.g. cranial nerves
  5. Heart block
289
Q

Diphtheria Ix?

A

Culture of throat swab = uses tellurite agar or Loeffler’s media

290
Q

Diphtheria Rx?

A
  1. IM penicillin
  2. Diphtheria antitoxin
291
Q

Malaria prophylaxis?

A
  1. Atovaquone + Proguanil (Malorone)
  2. Chloroquine
  3. Doxycycline
  4. Mefloquine (Lariam)
  5. Proguanil (Paludrine)
  6. Proguanil + Chloroquine
292
Q

Malorone mushkies?

A
  1. GI upset
  2. 1-2 days before travel
  3. 1 week after travel
293
Q

Chloroquine mushkies?

A
  1. Headache, C/I in epilepsy, taken weekly
  2. 1 week before travel
  3. 4 weeks after travel
294
Q

Doxycycline mushkies?

A
  1. Photosensitivity, oesophagitis
  2. 1-2 days before travel
  3. 4 weeks after travel
295
Q

Mefloquine (Lariam) mushkies?

A
  1. Dizziness, neuropsychiatric disturbance, C/I in epilepsy, taken weekly
  2. 2-3 weeks before travel
  3. 4 weeks after travel
296
Q

Proguanil (Paludrine) mushkies?

A
  1. 1 week before travel
  2. 4 weeks after travel
297
Q

What Malaria drugs are C/I in epilepsy?

A

Chloroquine and Mefloquine (they are also both taken weekly)

298
Q

Pregnancy malaria prophylaxis?

A
  1. Chloroquine can be taken
  2. Proguanil = folate supplementation needed
  3. Malorone = try to avoid, if taken then take folate
  4. Mefloquine = caution advised
  5. Doxycycline contraindicated
299
Q

Children malaria prophylaxis?

A
  1. DEET 20-50% has been shown to repel up to 100% of mosquitoes if used correctly. It can be used in children over 2 months of age
  2. > 12 y/o = Doxycycline
300
Q

Legionella mushkies?

A
  1. Air conditioning or foreign holidays
  2. Flu-like symptoms incl. fever (>95%)
  3. Dry cough, relative bradycardia, confusion
  4. Lymphopenia, hypontraemia, deranged LFTs
  5. Pleural effusion: seen in 30% pts
301
Q

Legionella Dx?

A

Urinary antigen

302
Q

Legionella Rx?

A

Erythromycin/Clarithromycin

303
Q

Rabies definition?

A

A viral disease that causes an acute encephalitis. The rabies virus is classed as a RNA rhabdovirus (specifically a lyssavirus) and has a bullet-shaped capsid. The vast majority of cases are caused by dog bites but it may also be transmitted by bat, raccoon and skunk bites. Following a bite the virus travels up the nerve axons towards the central nervous system in a retrograde fashion.

304
Q

Rabies features?

A
  1. Prodrome = headache, fever, agitation
  2. Hydrophobia = water-provoking muscle spasms
  3. Hypersalivation
  4. Negri bodies = cytoplasmic inclusion bodies found in infected neurons
305
Q

Negri bodies?

A

Rabies

306
Q

Risk of rabies following an animal bite in the UK?

A

No risk

307
Q

Animal bite Rx in foreign countries?

A
  1. Wash wound
  2. If immunised = 2 further doses of vaccine should be given
  3. Not immunised = HRIG + full course of vaccination, if possible give dose locally around the wound
308
Q

BV in pregnancy?

A

Still use oral metronidazole

309
Q

PCP mushkies?

A
  1. Pneumocystis jiroveci is an unicellular eukaryote, generally classified as a fungus but some authorities consider it a protozoa
  2. Most common opportunistic infection in AIDS
  3. All pts with CD4 < 200 should receive PCP prophylaxis
310
Q

PCP features?

A
  1. Dyspnoea, dry cough, fever, very few chest signs
  2. Pneumothorax is a common complication
  3. Extrapulmonary manifestations (1-2%) are rare = hepatosplenomegaly, lymphadenopathy, choroid lesions
311
Q

PCP Ix?

A
  1. CXR
  2. Exercise-induced saturation
  3. Sputum often fails to show PCP, BAL often needed
312
Q

PCP on BAL?

A

Silver stain shows chaarcetristic cysts

313
Q

PCP Rx?

A
  1. Co-trimoxazole
  2. IV Pentamidine in severe cases
  3. Aerosolized pentamidine is an alternative
  4. Steroids if hypoxic
314
Q

Syphilis definition?

A

STI caused by the spirochaete Treponema pallidum. Infection is characterised by primary, secondary and tertiary stages. The incubation period is between 9-90 days

315
Q

Primary syphilis features?

A
  1. Chancre = painless ulcer at the sit of sexual contact
  2. Local non-tender lymphadenopathy
  3. Often not seen in women (lesion may be on the cervix)
316
Q

Secondary syphilis features?

A

6-10 weeks after primary infection
1. Systemic = fevers, lymphadenopathy
2. Rash on trunk, palms and soles
3. Buccal ‘snail track’ ulcers (30%)
4. Condylomata lata (painless, warty lesions on the genitalia)

317
Q

Tertiary syphilis features?

A
  1. Gummas = granulomatous lesions of the skin and bones
  2. Ascending aortic aneurysms
  3. General paralysis of the insane
  4. Tabes dorsalis
  5. Argyll-Robertson pupil
318
Q

Congenital syphilis features?

A
  1. Blunted upper incisor teeth (Hutchinson’s teeth), mulberry molars
  2. Rhegades (linear scars at the angle of the mouth)
  3. Keratitis
  4. Saber shins
  5. Saddle nose
  6. Deafness
319
Q

HIV and meningitis organism?

A

Cryptococcus neoformans

320
Q

Cryptococcus neoformans stain?

A

India ink

321
Q

Antiretroviral therapy broad strokes?

A

Antiretroviral therapy (ART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). This combination both decreases viral replication but also reduces the risk of viral resistance emerging

322
Q

When should ART be started?

A

As soon as they have been diagnosed with HIV

323
Q

NRTI examples?

A

Nucleoside analogue reverse transcriptase inhibitors (NRTI)
1. Zidovudine
2. Abacavir
3. Emtricitabine
4. Didanosine
5. Lamivudine
6. Stavudine
7. Zalcitabine
8. Tenofovir

324
Q

ART entry inhibitors?

A

Prevent HIV-1 from entering and infecting immune cells
1. Maraviroc = binds CCR5, preventing interaction with gp41
2. Enfuvirtide = binds to gp41, aka fusion inhibitor

325
Q

NRTI s/e?

A

Peripheral neuropathy

326
Q

Tenofovir s/e?

A

Renal impairment and osteoporosis

327
Q

Didanosine s/e?

A

Pancreatitis

328
Q

Zidovudine s/e?

A

Anaemia, myopathy, black nails

329
Q

NNRTI examples?

A

Nevirapine and efavirenz

330
Q

NNRTI s/e?

A

P450 enzyme inducer, rashes

331
Q

Protease inhibitor examples?

A
  1. Ritonavir
  2. Indinavir
  3. Nelfinavir
  4. Saquinavir
332
Q

Protease inhibitor s/e?

A
  1. DM, hyperlipidaemia, buffalo hump, central obesity
  2. P450 enzyme inhibition
333
Q

Indinavir s/e?

A

Renal stones, asymptomatic hyperbilirubinaemia

334
Q

Ritonavir s/e?

A

Potent P450 inhibitor

335
Q

Integrase inhibitor example?

A
  1. Raltegravir, Dolutegravir, Elvitegravir
  2. Blocks the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell
336
Q

Trimethoprim s/e?

A
  1. Myelosupprssion
  2. Transient rise in creatinine
337
Q

Methorexate which Abx should be avoided?

A

Trimethoprim and co-trimoxazole

338
Q

Pneumonia in CF?

A

Psuedomonas Aeruginosa

339
Q

Psuedomonas Aeruginosa gram stain?

A

Aerobic gram negative rod

340
Q

Hot tub folliculitis?

A

Pseudomonas aeruginosa

341
Q

DM with malignant otitis externa organism?

A

Pseudomonas aeruginosa

342
Q

Psuedomonas Aeruginosa pathophysiology?

A

Produces both an endotoxin (causes fever and shock) and exotoxin A (inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2)

343
Q

Lyme disease in pregnancy Rx?

A

Amoxicillin

344
Q

Painful genital ulcer with a ragged border associated with tender inguinal lymphadenopathy?

A

Chancroid

345
Q

Painless genital ulcer causes?

A
  1. Chlamydia trachomatis = lymphogranuloma venereum
  2. Treponema pallidum = syphilis
  3. Klebsiella granulomatis = granuloma inguinale
346
Q

Genital warts cause?

A

HPV 6 and 11

347
Q

Cervical cancer HPV?

A

16 and 18

348
Q

HPV associations?

A
  1. > 99% Cervical cancers
  2. 85% anal cancers
  3. 50% vulval and vaginal cancers
  4. 20-30% mouth and throat cancers
349
Q

HPV vaccine protect against?

A

HPV 6, 11, 16, 18

350
Q

HPV vaccination mushkies?

A
  1. All 12 and 13 year olds, normally given in school
  2. Daughter may receive vaccine against parental wishes
  3. Given as 2 doses - girls have the second dose between 6-24 months after the first, depending on local policy
351
Q

HPV for MSM?

A

MSM < 45 y/o to protect against anal, throat and penile cancers

352
Q

All sexually active men with dysuria test?

A

STI

353
Q

Campylobacter Rx?

A

Clarithromycin, but usually self limiting

354
Q

Dental abscess Rx?

A

Amoxicillin

355
Q

Acute prostatitis Rx?

A

Ciprofloxacin or trimethoprim

356
Q

Who should be screened for MRSA?

A

All elective admissions and emergency admissions

357
Q

How should a pt be screened for MRSA?

A
  1. Nasal swab and skin lesions or wounds
  2. Swab should be wiped around the inside rim of a patient’s nose for 5 seconds
  3. The microbiology form must be labelled ‘MRSA screen’
358
Q

MRSA suppression from a carrier?

A
  1. Nose = mupirocin 2% in white soft paraffin 5d TDS
  2. Skin = Chlorhexidine gluconate 5d OD, particularly to axilla, groin and perineum
359
Q

MRSA infection Rx?

A

Vancomycin, Teicoplanin, Linezolid

360
Q

Wound with unclear tetanus vaccination history?

A

Booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old

361
Q

VZV PEP criteria?

A
  1. Significant exposure to chickenpox or herpes zoster
  2. Clinical condition that increases the risk of severe varicella; this includes immunosuppressed patients, neonates and pregnant women
  3. No antibodies to the varicella virus
362
Q

Diarrhoea in HIV most likely cause?

A

Cryptosporidium

363
Q

Diarrhoea in HIV causes?

A
  1. HIV Enteritis
  2. Cryptosporidium + other protozoa (mmost common)
  3. CMV
  4. MAI
  5. Giardia
364
Q

Mycobacterium Avium intracellulare features?

A
  1. Seen with the CD4 count is below 50
  2. Fever, sweats, abdominal pain, diarrhoea, hepatomegaly, deranged LFTs
  3. Dx = blood cultures and bone marrow examination
  4. Rx = Rifabutin, ethambutol, clarithromycin
365
Q

Most common complication of gonorrhoea?

A

Infertility secondary to PID

MSRA (25 decks)

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