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ID Flashcards

1
Q

2 conditions to delay ART in HIV

A

Tuberculous meningitis
Cryptococcus meningitis

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2
Q

Window period for HIV - how long, why, how to overcome

A

First 2-4 weeks, No Ab formation, can’t test for on ELISA

New tests pick up p24, or can test for VL (high within 5 days)

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3
Q

A/E to tenofovir

A

Nephrotoxicity
Myelosuppresion

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4
Q

WHich tenofovir has higher A/E profile

A

TDF higher ris

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5
Q

A/E of Abacavir

A

Hypersensitivity to HLA-B57*01

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6
Q

HIV treatment with depression/CNS toxicity in first few weeks

A

Efavirenz

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7
Q

HIV medication highest risk of SJS

A

Nevirapine

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8
Q

Integrase inhibitors - how to identify, A/E

A

Gravir

Weight gain

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9
Q

CCR5 antagonist

A

Maraviroc. Not useful as HIV can switch to binding CCR4

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10
Q

lamuvidine A/E

A

Lamuvidine - pancreatitis

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11
Q

When to use PRed in PJP pneumonia

A

PaO2 70 –> use Pred in addition to bactrim

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12
Q

CMV manifestations in HIV

A

Retinitis - Opthal

Colitis - inclusion bodies

CNS disease

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13
Q

Causes of enhancing CNS lesions in HIV

A

Toxoplasmosis
- +ve serology, enhancing lesions, CD4 <200
- Rx - bactrim

Primary CNS lymphoma
- CD4 < 50

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14
Q

Viral association Karposi’s

A

HHV8

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15
Q

Binding and fusion of HIV - important proteins

A

Binding - GP120 and GP41

FUsion - CCR5/CXCR4 coreceptors

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16
Q

HIV in pregnancy

A

Mothers - ART

At delivery
- C section
- VL > 1000 –> Anti-HIV IgG

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17
Q

PEP timeline

A

Must be < 72 hours

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18
Q

PEP for known source

A

Sexual
- VL +ve = ART for 28 days, VL- = leave

Occupational
- VL +ve - ART for 28 days
- VL -ve - x2 drugs for 28 days

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19
Q

PEP unknown source

A

x2 drugs 28 days

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20
Q

Elevated opening pressure

A

Cryptococcus meningitis

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20
Q

Management of PJP

A

Bactrim

Pred if PaO2 < 70

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21
Q

Treatment of syphilis

A

Benziathine penicillin (long acting)

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22
Q

Rx of gonorrhoea

A

Ceftriaxone and azithromycin

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23
Q

Rx of chlamydia

A

Doxycyline

Can use azithromycin as alternative

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24
Q

Immunocompromsied, fevers, blistering rash, neutrophilic infiltrate on biopsy

A

Sweet’s syndrome

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25
Q

Gram positive diplococci

A

S pneumoniae

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26
Q

Gram negative diplococci

A

N meningitidies

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27
Q

Gram positive rods

A

BLANC
Bacillus
Listeria
Actinomyces
Nocardia
CLostridia/Corynebacteria

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28
Q

Gram negative coccoid rods

A

H influenzae
Bordatella pertussis

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29
Q

Ecythema gangrenosum cause

A

Pseudomonas

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30
Q

Treatment of cryptococcus

A

L-amb + 5FC (2 weeks)

8 week tail fluconazole

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31
Q

Treatment of invasive aspergillus

A

Voriconazole

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32
Q

Filamentous gram +ve rods (2)

A

Nocardia
Actinomyces

Nocardia is acid fast positive and grows well in aerobic conditions

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33
Q

Presentations of Nocardia

A

Pulmonary
CNS - parenchymal abscess
Cutaneous

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34
Q

Rx of nocardia

A

Bactrim

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35
Q

Neutropenic patient, abdo pain, bowel wall thickening and mucosal enhancement?

A

Typhilitis

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36
Q

RIsk factors for PTLD

A

EBV serostatus
Degree of immunosuppression

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37
Q

1st line treatment for PTLD

A

Lower immunsuppression

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38
Q

Pathophys of PTLD and 2nd line treatments

A

Aberrant clonal EBV positive B cell proliferation due to excessive T cell suppression

Rx - CD20 depletion (rituximab)

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39
Q

Daptomycin ineffective in?

A

Lungs - inactivated by surfactant

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40
Q

What to do with ABx in pneumococcal resistance?

A

Treatment failure rare, usually have SIE for MIC so increase dose

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41
Q

Proteus what?
Citrobacter what?

In ESCAPPM

A

Proteus Vulgaris

Citrobacter freundii

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42
Q

Gene transfer through direct cell to cell contact, usually through sex pillus

A

Conjugation

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43
Q

Transfer of genetic material between bacteria by means of viral vector

A

Transduction
Vector called bacteriophage

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44
Q

Amb Class B CRO
- Example
- WHere?

A

NDM-1

New Dehli

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45
Q

Amber Class C
- Example

A

AmpC enzymes

ESCAPPM organisms

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46
Q

Oxa-48 B lactams - ?where

A

North Africa and Mediterranean

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47
Q

CRE most common in USA

A

KPC

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48
Q

Management of CRO

A

Colitistin + tigecycline + 3rd agent

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49
Q

Recurrent viral self resolving viral meningitis - cause?

A

Mollaret’s

HSV-2

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50
Q

Which conditions would be indications for TOE in suspected ?IE

A

Bacteraemia
IVDU
High risk cardiac condition
Indeterminate TTE

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51
Q

Indications for IE Prophylaxis

A

High risk heart condition - rheumatic, prosthetic valve

High risk surgery - dental, tonsillectomy, surgery at site of known infection

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52
Q

TB interferon test - how does it work?

A

Patient’s plasma re-exposed to TB antigen - T cells will produce IFNy which can be detected

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53
Q

Uncomplicated P falciparum treatment

A

Simple - artemether + lumefantrine

Severe - significant organ involvement, parasite count > 100,000 or >10% - IV artesunuate

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54
Q

Treatment of P vivax/ovale

A

Add primaquine to standard treatment, beware G6PD deficienc

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55
Q

Malaria PPx

A

Doxycycline 1 day before and 4 weeks after

Malarone - Atuovacone + proguanil

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56
Q

C’s of measles

A

Prodrome - fevrs, cough, coryzal, conjunctivitis

K(c)oplik’s spots

Craniocaudal rash

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57
Q

Live vaccines

A

MMR BOY Japenese RITZ
BCG
Oral Polio
Yellow fever
Japanese encephalitis
Rotavirus
Typhoid
Zoster/Varicella

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58
Q

Chigger mites

A

Scrub typhus

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59
Q

Borelia burgfolderi

A

Lyme disease

60
Q

Bullseye type rash which expands and grows bigger

A

Erythema migrans –> Lyme disease

61
Q

Eating coral fish, paresthesias, temperature related dysethesias

A

Ciguatera

62
Q

Vesicles at tip/side of nose

A

Hutchinson’s sign

Concern for coreal involvement (Herpes zoster opthalmicus)

63
Q

Acyclovir in VZV - benefits

A

Shortens duration of illness

If given < 48 hours, reduces severity of complications

64
Q

Precautions for VZV

A

Chicken pox - negative pressure, till lesions have crusted

Shingles - uncomplicated, local dermatome –> standard precautions

65
Q

Post-exposure PPx for VZV:
- Indication
- What to give

A

Indicated for those susceptible - no prior exposure, vaccination and undetectable Ig levels

If can have vaccine, give vaccine within 5 days

If cannot have vaccine, give VZV Ig within 10 days

66
Q

Anaerobic cover options

A

Add metro
Augmentin

Penicillin hypersensitivity - clindamycin, moxifloxacin

67
Q

Branching filamentous fungi with septate hyphae

A

Aspergillus

68
Q

Tests for syphilis and diagnosis

A

Treponemal - qualitative

Non-treponemal (RPR) - measure titres.

Need both for diagnosis

69
Q

HIV antimicrobial PPx

A

Bactrim for CD4 < 200 (for PJP)

No evidence for azithro for MAC < 50 anymore

70
Q

Nocardia vs Actinomycoses

A

Snap

Sulfur Nocardia AFB aerobic filamentous gram positive rod

Actinomycoses penicillin anaerobic flimanetous gram positive rod

71
Q

Factors affecting HIV progression

A

HIV-1 vs HIV-2 - HIV 1 more aggressive

Co-receptor - CXRC4 use more aggressive

CD38 on CD8 cells - more aggressive

72
Q

Types of HIV testing

A

Screening
- Ab only - ELISA - false positives from window period
- Ab-Ag - AB and p24 antigen, can detect positive 10-14 days

Confirmatory
- 4th generation assay - HIV1 vs HIV2
- Western blot - IgG to HIV1. Takes long time
- HIV Viral RNA/load

73
Q

HIV Rx A/E IHD

A

Abacavir

74
Q

HIV Rx increased risk of rhabdo

A

Reltagravir

75
Q

HIV Rx A/E elevated bilirubin

A

atazanavir

76
Q

HIV Rx A/E renal colic

A

indanavir

77
Q

Suffix of protease inhibitors in hiv

Joint A/E

A

-navir

Insulin resistance, hyperolipidaemia, lipodystrophy

78
Q

Treatment of Hep B and HIV

A

TAF and emtricitabine

79
Q

PrEP regimen

A

TAF and emtricitabine

80
Q

CD4 < 50

A

MAC
CMV

81
Q

CD4 < 200

A

PJP - give PPx

82
Q

CD4 < 150

A

Cryptoccus
HSV

83
Q

CD4 < 250

A

Oral candidiasis

84
Q

Management of toxoplasmosis encephalitis

A

Pyrimethamine - antiparsitic DHFR antagonis
- give with folinic acid

AND

Sulfadiazine

85
Q

Cell most implicated in sarcoid

A

TH1
- TNF, IFNy help with macrophage recruitment
- TNF inhibitors can be used for treatment

86
Q

Activated or memory T cells cell surface marker

A

CD45Ro

87
Q

Cells that produce IL-1?

A

Dendritic cells + macrophages

88
Q

Inflammasome
- What is it
- Associated syndromes
- Treatment of syndromes

A

Cytoplasmic protein complex, which when assembly is triggered stimultes cytokine release (particularly IL-1)

Gout - NALP3
FMF - Pyrin inflammasome

Colchicine - inhibits microtubule formation (required for inflammasome formation)

Anakinra

89
Q

T independant antigen for B cells

A

Lipopolysaccharides
- Can stimulate B directly

90
Q

IFNy - deficiency causes infection with?

A

Mycobacterium

91
Q

MSSA bacteraemia length of treatment
- Uncomplicated (no IE)
- IE

A

No IE - 2 weeks

IE - 4-6 weeks

92
Q

UTI cause that is negative for nitrites?

A

Enterococcus faecalis

93
Q

Candida - eye signs

A

Chorioretinitis

Endopthalmitis - inflammation within eye

94
Q

PREP - monitoring?

A

STI testing 3 monthly

ACR and urine every 6 months (TAF)

95
Q

Most sensitive and specific test for TB

A

TB MCS - sputum, fluid or tissue
80% sens, spec 98%

96
Q

Most likely bug to cause nitrites on urine

A

E Coli

97
Q

Asplenia - can you give yellow fever vaccine?

A

Yes

98
Q

Azithromycin resistance due to?

A

Long half life

99
Q

Neisseria meningitis
Previous severe hypersensitivity to penicillins?
Use?

A

Ciprofloxacin

100
Q

Feature of Dengue that portends poor prognosis?

A

Increasing haemtaocrit

101
Q

EBV antibody testing - excluded acute infection

A

EBNA Ig (nuclear antigen)

Only present after 6 weeks

102
Q

Organism causing multiple, irregular, softer painful genital lesions

A

Hamophilus decrei

Chancroid

103
Q

TSS-1 toxin

A

Toxic shocks syndrome

104
Q

Young female
Fever
Hypotension
Erythematous rash tongue and hands and soles

A

TSS

105
Q

Bug causing TSS

A

S aureus - strain that produces exotoxin

106
Q

Rx of TSS

A

Vanc + fluclox to cover staph

Clinda for antitoxin cover

107
Q

Forestry worker, tick bite

A

Ricksettia

108
Q

Tick bite, fever, maculopapular rash, Australia

A

Ricksettia

109
Q

Rx of ricksettia

A

Doxycycline

110
Q

Panton Valentine Leucocidin (PVL)
-bug
-Most common infection

A

Staph aureus

Pyogenic skin infections

111
Q

Rheumatic fever PPx

A

Benziathine pencillin every 21-28 days

Minimum for 5 years after diagnosis, or until age 21, whichever is longer

112
Q

Hep C protease inhibitors

A

Have previr

113
Q

Hep C NS5A inhibitors
- Role of NS5A
- Inhibitors have which suffix?

A

New protein and RNA processing and virion assembly

Suffix - asvir

114
Q

Hep C NS5B inhibitors
- Role of NS5B

A

RNA dependant RNA polymerase –> replicate RNA for new viruses

Have B in them –> sofosbuvir

115
Q

Two main pangenotypic Hep C regimens

A

SVE GPM
Sofosbuvir and vepravir = epclusa

Maviret = glcepravir and pibrentasvir

116
Q

Sandfly
Chronic pink papule that evolves into plaque

A

Leishmeniasis

117
Q

Alpha haemolytic strep

A

Strep pneumoniae

Viridans strep

118
Q

Beta haemolytic strep

A

GAS - pyogenes

GBS - strep agalactiae

119
Q

Gamma haemolytic strep

A

Enterococcus

120
Q

IE association with CRC?

A

Strep gallolyticus

121
Q

Strep Viridans
- Site
- Organisms

A

Ontongeic

Mutans, sanguinis, salivarus

122
Q

Strep pyogenes
- antigen produced?
- toxin produced?

A

Streptolysin O - can induce molecular mimicry (rheumatic fever, post-strep GN). Can test ASOT titres

Exotoxin - TSS, pyogenic skin infection

123
Q

Atypical cells on blood film in acute EBV

A

CD8

124
Q

Two forms entamoeba

A

Cysts (ingested), infectious form

Trophozites - invade colon and blood stream

125
Q

Treatment entamoeba

A

Intraluminal - paromycin

Invasive disease - metronidazole/tinidazole

126
Q

Airborne precautions
- Requirements
- Indications

A

Negative pressure + respiratory

Indications
- TB
- Varicella
- Measles
- COVID

127
Q

When should tetanus vaccine be given to someone previously vaccinated

A

Wound, >10 years since vaccine

128
Q

When is tetanus IgG given

A

Major wound, no previous vaccine

129
Q

Viral diarrhoea adults

A

Norovirus

130
Q

Viral diarrhoea children

A

Rotavirus

131
Q

Solid organ transplant
- Which organism for universal PPx?

A

Bactrim for PJP/PCP

132
Q

Why add primaquine for ovax/vivale?

A

Eradicate dormant hyponizites

133
Q

1st trimester pregnancy and malaria?

A

Use malarone

134
Q

P falciparum with steady parasite count after 72 hours

A

Consiedr changing to:
- malarone
- quinine

Beware patients from mekong region

135
Q

Cat bite
Gram negative coccobaccillus

A

Pasteurella

136
Q

Most common method transmission Hep C

A

IVDU

137
Q

MDR TB

A

RI and flouroquinolone + 1 other

138
Q

Treatment for MDR TB

A

bPALM

Bedaquiline, pretomanid, linezolid, moxifloxacin

139
Q

CI to sofosbuvir?

A

Renal impairment

140
Q

Most important RF for acyclovir resistance

A

Immunosuppression

141
Q

Most common valve for infective endocarditis

A

Mitral valve prolapse

142
Q

Mutation in which receptor confers resistance to HIV infection

A

CCR5

x2 HSCT’s where HIV was cured

143
Q

Most common organism type to cause HAP

A

Aerobic gram negative bacilli - e.g Klebsiella

144
Q

Strep pneumonia resistant to penicillin in meningitis - treat?

A

Vancomycin

145
Q

MALDI-TOF
- Benefits
- Why MC&S is better

A

Rapid

Accurate identification of genus and species from wide range of bacteria

Will NOT grow rare bacteria, MC&S is more sensitive

146
Q

Post rabies exposure with monkey bite 3 weeks ago. Normal rabies PEP vaccines are up to day 14.
Treatment?

A

Offer rabies vaccine

147
Q

Treatment of stenotrophomonas

A

Bactrim

BPT (18 decks)

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