FFCP infectious disease Flashcards
(152 cards)
1
Q
Which protozoa causes most malaria cases?
A
plasmidium falciparum (disproportionate amount of deaths too)
2
Q
Gold standard for malaria diagnosis?
A
Light microscopy
3
Q
What do p.malariae cells look like on light microscopy?
A
they have a broad band form of plasmodium
4
Q
What does p.falciparum look like on light microscopy?
A
double chromatin dots, multiple parasitzation of cells
5
Q
What antigen associated with p.falciparum is often tested for on rapid diagnostic tests?
A
HRP-2 (histidine-rich protein 2)
6
Q
What parasite count indicates severe malaria in the UK?
A
> 2%
7
Q
What are some side effects of chloroquine?
A
GI upset, pruritus
8
Q
complications of quinine?
A
cardiotoxicity, hypoglycaemia
9
Q
Side effects of antifolates? (sulfonamides, pyrimethamine, proguanil, dapsone)
A
GI upset, headache, also bone marrow suppression. Haemolysis in G6PD deficiency
10
Q
What class of drugs are the most effect for treating malaria?
A
Artemsinin derivatives eg artesunate, artnemether, dihydroartemisinin
11
Q
Malaria treatment for severe p.falciparum?
A
IV artesunate (preferred) or IV quinine (cardiac and blood glucose monitoring)
12
Q
Malaria treatment for non falciparum?
A
chloroquine followed by primaquinine
13
Q
What does synergistic antimicrobials mean?
A
If there combined activity is greater than the sum of the individual activities eg B-lactam and aminoglycoside
14
Q
What class of antimicrobials target DNA gyrase?
A
quinolones
15
Q
What antimicrobials target cell wall synthesis?
A
Beta lactams (eg penicillins, cephalosporins, carbapenems etc) and glycopeptides (vancomycin and teicoplanin)
16
Q
Antimicrobials that target protein synthesis through inhibiting 50s?
A
macrolides, clindamycin, chloramphenicol
17
Q
Antimicrobials that target protein synthesis through inhibiting 30s?
A
aminoglycosides (gentamicin, streptomicin etc) and tetracyclines eg doxycycline
18
Q
If patients have penicilin allergy, what other class of antimicrobials are approx 10% allergic to?
A
cephalosporings
19
Q
Adverse effects of aminoglycosides? eg gentomycin, streptomycin
A
ototoxicity, nephrotoxicity, NMJ blockade
20
Q
are macrolides (azithroymycin, clindomycin) bacteriostatic or bacteriocidal?
A
bacteriostatic
21
Q
Adverse effects of fluroquinolone? drugs with flox in
A
tendon rupture, seizures - prolonged QT, dizziness, confusion, photosensitvity
22
Q
What are the broad spectrum antimicrobials?
A
carbapenems, amoxicillin/clavulanate, cephalosporins, chloramphenicol, tetracylcine
23
Q
How does fluconozole and other azoles work?
A
they inhibit ergosterol synthesis enzyme thats important for creating fungal cell membrane
24
Q
How do echinocandins work? (caspofungin)
A
they inhibit glucan synthase, an enzyme that is important in making fungal cell wall
25
What score is used to asses severity of pharyngitis?
FEVERPAIN score
26
What does a FEVERPAIN score of 1 or less indicate?
that antibiotics arent indicated
27
Pathophysiology of scarlet fever?
exotoxin mediated disease caused by some strains of group A strep
28
management of scarlet fever?
10 day course of penicillin V, notification of health protection team
29
management of sinusitis?
analgesia, decongestants, trial of nasal corticosteroids for 14 days
30
Over what CURB65 score should you be treating as an inpatient ?
greater than 3
31
antibiotics for different CURB score?
CURB 0-1 amoxicillin, CURB2-3 amoxicillin and clarythromycin, CURB4-5, co-amoxiclav and clarythromycin
32
What does positive TST (Mantoux test) and pos interferon-gamma release assay test with neg culture and neg sputum smear normally mean?
latent TB infection
33
Investigations for pulmonary TB?
CXR/ CT chest, 3x sputum for TB microscopy and culture, TB PCR§
34
treatment for TB?
2 months rifampicin, isoniazid, pyrazinamide, ethambutol
35
side effects of rifampicin?
oragne discolouration of body fluids
36
side effects of isoniazid?
peripheral neuropathy
37
Fever classifications?
low grade 37.3- 38
moderate grade 38.1-39
high grade 39.1 to 41
hyperthermia >41
38
What causes PCP pneumonia?
pneumocystis jirovecii
39
What candidas can be resistant to fluconazole?
candida krusei and candida glabrata
40
What is erysipelas?
superficial form of cellulitis often seen in face and lower limbs
41
What bacteria often causes necrotising fascilitis?
often polymicrobial- type 1 or caused by group A strep or clostridium perfringens -type 2
42
Treatment for impetigo?
Fusidic acid or oral flucloxacillin
43
Treatment for cellulitis/ erysipelas?
mild - oral flucloxacillin (or clindamycin if allergic). Severe cases IV antibiotics
44
What would you see in lumbar puncture for bacterial meningitis?
bacterial - high WBCs, low glucose, high protein[
45
What would you see in a lumbar puncture for viral meningitis?
lymphocytic pleocytosis (abnormally high), nomral glucose
46
Empiric antibiotics to treat bacterial meningitis?
IV ceftriaxone 2g BD, if listeria meningitis suspected ie elderly immunocompromised pregnant, then IV amoxicillin should be added in
47
If you suspect HSV encephalitis what should be given?
IV aciclovir
48
What does pyuria refer to?
presence of 10^4 white blood cells/ml in freshly voided urine specimen
49
What do nitrites in UTI dip suggest?
gram negative organisms eg E.coli
50
Treatment for uncomplicated UTI?
Nitrofuratoin but avoid if eGFR is less than 30 or trimethoprim
3 days in women, 7 days in men
51
Score system for sepsis?
SOFA score (A score of more than 2 identifies patients at risk of worse outcomes)
52
Why should you not use CRP to exclude sepsis?
bc CRP lags 24 hours behind so a normal CRP doesnt exclude infection
53
fluid resus for sepsis?
balanced solution eg hartman's - aim for 30ml/kg as boluses in the first 3 hours
54
Diagnostic criteria for infective endocarditits?
Modified Duke's criteria
55
What Duke scores would imply definite IE?
2 major criteria, or 1 major and 3 minor, or 5 minor
56
Length of time for IV antibiotic treatment for IE?
4 weeks for native valve, 6 weeks for prosthetic
57
What does a serum beta-D-glucan test do?
Detects fungal cell component in blood, serving as biomarker for invasive fungal infections like pneumocystis jirovecii pneumonia, candidiasis, aspergillosis
58
PJP prophylaxis?
co-cotrimoxazole - should be considered for severely immunocompromised patients
59
Treatment for Toxoplasmic encephalitis? (occurs in AIDS patients)
sulfadiazine plus pyrimethamine
60
What does serum galactomannan test for?
a fungal antigen released by aspergillus species
61
Normal opening pressure for CSF in lumbar puncture?
7-18cm
62
What mosquito causes dengue fever?
Aedes mosquito
63
What is Charcot's triad?
triad of RUQ plain, fever and jaundice typical of acute cholangitis
64
First-line for non life threatening C.diff infection?
oral vancomycin
65
Treatment for life threatening C.diff?
IV metronidazole and oral vancomycin
66
What meds should you stop in C.diff infection?
antibiotics, PPIs, laxatives and meds that cause dehydration eg ACE and diuretics
67
What is a blanching rash?
A rash that goes away under a glass
68
Koplik spots?
spots in inside of cheeks that indicate measles
69
Measles PEP?
For immunocompromised patients, intravenous immunoglobulin is recommended. For pregnant women and infants, HNIG is recommended
70
infectious period for parvovirus B19?
Infectious period 7 days before until onset of rash
71
management after exposure to varicella zoster virus?
pregnant contacts, if IgG>100 MIU/ml reassure, if not then aciclovir. Immunocompromised if IgG >150 reassure
72
What must resp rate be higher than in CURB-65 scoring for a point?
Greater than 30 breaths/min
73
What must blood pressure be lower than for a point on CURB-65?
systolic less than 90, diastolic less than 60
74
Most common infective agent in breast abscess?
Staphylococcus aureus
75
First line management of breast abscess?
needle aspiration, then guided antibiotic treatment. Also breast feeding should continue
76
first line management of mastitis?
continue breastfeeding, analgesia, warm compress.
If systemically unwell or if symptoms dont imporve then oral flucloxacillin for 10-14 days and breast feeding needs to stop during antibiotic treatment
77
Firstline for mild to moderate oral candidiasis?
nystatin suspension, miconazole gel
78
first line for severe or refractory cases of oral candidiasis?
oral fluconozole
79
Main agent causing cellulitis?
streptococcus pyogenes
80
What features would suggest that leg rash isnt cellulitis?
If its bilateral, or if its occurred over months as cellulitis is acute
81
What antiviral drug can be given to covid patients requiring oxygen?
Remdesivir
82
Steroids for covid 19?
dexamethasone can be given for severe cases with respiratory distress
83
Gold standard for diagnosing genital herpes?
NAAT PCR, culture taken from ulcer's base
84
What antibiotics are most likely to cause C. difficile?
cephalosporins, clindamycin, co-amoxiclav
85
What are the clinical features of C.diff diarrhoea?
diarrhoea, abdominal pain, raised white blood cell count, if severe might get toxic megacolon
86
staging of c.diff infection?
moderate = WCC raised but less than 15 and 3-5 stools a day, severe = WCC above 15, creatinine over 50% above baseline, temp greater than 38.5 or evidence of severe colitis, life-threatening = hypotension, ileus, toxic megacolon
87
First-line for a first episode of C.Diff?
oral vancomycin for 10 days
88
first-line for recurrent infection of c.diff?
within 12 weeks of symptom resolution - oral fidaxomicin, after 12 weeks oral vancomycinn or fidaxomicin
89
treatment for complicated c.diff?
oral vancomycin and IV metronidazole
90
What are the two definitions of diarrhoea?
>200g of stool per 24 hour or more than 3 stools a day that are loose
91
If diarrhoea occurs rapidly after food (less than 6 hours) what are most common organisms at faut?
toxin producing organisms eg B.cereus, S.aureus
92
What bacteria is most likely to cause fever and bloody diarrhoea?
salmonella, shigella, campylobacter, E.Coli
93
treatment for life-threatening c.diff?
oral vancomycin, iv metronidazole, faecal microbiota transplant, consider colectomy
94
what's the most common causative agent of viral gastroenteritis in adults?
norovirus
95
what's the most common causative agent of viral gastroenteritis in children?
rotavirus
96
What bacteria typically contaminates undercooked meat, unpasteurised milk and untreated water?
campylobacter
97
What bacteria can cause food poisoning from reheated rice?
bacillus cereus
98
What is the most common infective endocarditis causing agent in health-care associated IE?
Staphylococcus
99
Signs of pneumonia and peripheral smear showing red blood cell agglutination, what agent?
Mycoplasma pneumoniae, typically occurs in cold agglutinin disease which is often triggered by certain infections
100
For a patient with HIV presenting with diarrhoea, what is the most likely organism?
cryptosporidium parvum
101
Serum levels of what can be checked for anaphylaxis?
serum tryptase
102
If someone presents with pneumonia symptoms but with the presence of hyponatraemia, lymphopenia and mild ALT derangements, what does it suggest?
that it is caused by an atypical organism, in particular legionella pneumophilia
103
Prophylaxis for contacts of patients with meningococcal meningitis?
oral ciprofloxacin or rifampicin
104
When should prescribing antiviral treatment for influenza be considered?
If all of the following apply:
1) patient is in at risk group,
2) there is circulating influenza nationally
3) the patient is able to start treatment wothin 48 hours from symptom onset
105
differentiating bronchitis from pneumonia?
sputum, wheeze, breathlessness tend to be absent in bronchitis and there tends to be no chest signs on examination
106
What CRP might indicate antibiotics should be prescribed for acute bronchitis?
a CRP of 20-100 offer delayed prescription or over 100 offer prescription immediately
107
common cause of pneumonia in alcoholics?
klebsiella pneumoniae
108
What does the term walking pneumonia mean?
symptoms may be subacute or less severe - in case of atypical pneumonia
109
What score constitutes confusion on CURB65 score?
abbreviated mental test score less than or equal to 8/10
110
What should be used to treat CAP if penicillin allergic?
macrolide (eg azithromycin) or tetracycline (eg doxycycline)
110
What urea score constitutes a point on CURB65 score?
Urea greater than 7
111
What is potassium clavulanate?
a beta lactamase inhibitor, used alongside amoxicillin in co-amoxiclav to stop resistance
112
Gold standard for diagnosing malaria?
blood film - thick is more sensitive and then thin can be used to determine species
113
Treatment for severe or complicated p.falciparum/
IV artesunate (preferred) or IV quinine
114
Treatment for uncomplicated p.falciparum?
oral therapy with either malarone, riamet (artemisinin-combo therapies), or quinine and doxy/clindamycin
115
what are the features of severe malaria?
schizonts on blood film, parasitaemia >2%, hypoglycaemia, acidosis, temp >39, severe anaemia
116
What will you see in lumbar puncture for bacterial meningitis?
cloudy appearance, low glucose, high protein
117
What will you see in the CSF of viral meningitis?
clear or cloudy, higher glucose will be around 60-80% of plasma glucose, normal or raised proteins
118
viral or bacterial meningitis worse?
bacterial
119
When should lumbar puncture be delayed in suspected meningitis?
if rapidly evolving rash, severe resp/cardiac compromise, signif bleeding risk, or signs of raised intracranial pressure
120
What initial empirical antibiotic therapy for bacterial meningitis in patients aged 3 months to 50 years?
cefotaxime/ ceftriaxone
121
If a patient of allergic to penicilin or to cephalosporins and has meningitis what should it be treated with?
chloramphenicol
122
What type of bacteria is mycobacterium tuberculosis?
an aerobic, acid-fast bacilli
123
What type of response is caseating granuloma formation in tuberculosis?
Th1 response
124
What does multi-drug resistant tuberculosis refer to?
strains resistant to at least isoniazid and rifampicin
124
What does extensively drug resistant TB refer to?
MDR-TB plus resistance to any fluroquinolone and at least one additional second line injectable drug
125
First line investigations for TB?
mantoux, interferon gamma release assays and chest xray (then do further investigations depending on results)
126
advantages and disadvantages of sputum culture for TB?
gold standard, allows detection and determination of drug susceptibility but results can take up to 7 weeks
127
differentiating between sarcoidosis and TB?
Sarcoidosis often presents with extrapulmonary manifestations such as erythema nodosum and uveitis
128
How should TB treatment be monitored?
sputum samples at monthly intervals until two consecutive cultures are negative
129
What is Scarlet fever?
A reaction to erythrogenic toxins produced by Group A haemolytic streptococcus (usually streptococcus pyogenes)
130
Management of scarlet fever?
oral penicillin V for ten days (people with penicillin allergy should be given azithromycin)
131
When should you consider a bacterial cause of sinusitis?
if theres been symptoms for more than ten days, discloured nasal discharge, severe localised pain, fever greater than 38
132
management of UTI in non pregnant women?
trimethoprim or nitrofurantoin for three dyas
133
management of uti in pregnant woman?
nitrofurantoin for seven days (or amoxicillin or cefalexin, trimethoprim is teratogenic)
134
When is infective period of chicken pox?
from 4 days before rash until 5 days after the rash
135
Management of chickenpox exposure in immunocompromised patients and newborns?
should receive varicella zoster immunoglobulin and if chickenpox develops then IV aciclovir should be considered
136
management of shingles?
most commonly supportive, analgesic. In immunocompromised or if moderate to severe pain antibioitcs and consider if patient is over 50. If using anti-viral then consider course of oral corticosteroids
137
When is shingles vaccine offered?
to all patients aged 70-79 (live vaccine so contraindication is immunosuppression)
138
If someone has a positive IGRA but is asymptomatic and normal CXR how should you treat?
treat as latent TB - offer rifampicin and isoniazid (with pryidoxine) for three months
139
How does campylobater infection normally present?
flu like prodrome followed by abdo pain, vomiting and bloody diarrhoea around 48-72 hours post ingestion
140
Classic clinical features of PJP?
desaturaion on exercise and normal chest exam
141
Transmission of hep A?
faecal-oral route
142
typhoid symptoms?
fever, abdominal pain, constipation, "rose" spots and relative bradycardia
143
Treatment for MRSA infections?
vancomycin
144
prophylaxis for contacts of patients with meningococcal meningitis?
ciprofloxacin or rifampicin
145
At what CD4 count should prophylaxis against pneumocytstis jirovevi pneumonia be started?
a cd4 count less than 100/mmcubed
146
Agent most likely to cause cavitating pneumonia?
staphylococcus aureus
147
classic features of dengue?
retro-orbital headache, fever, facial flushing, rash and thrombocytioenia
148
What causative agent is typically characterised by a short incubation period and severe vomiting?
staphylococcus aureus (short incubation period of 30 mins to 8 hours )
149
What drugs are used to treat legionella?
macrolides eg clarithromycin
150
What can cause non-bloody diarrhoea that often floats and can precipitate lactose intolerance?
giardiasis
