Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt > Hepatitis, Pneumonia > Flashcards

Hepatitis, Pneumonia Flashcards

(64 cards)

Start Studying
1
Q

Common infections which may lead to varicies

A

Hepatitis
Shisto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hep A incubation? Phases of illness? Kids?

A

Incubation period: 2-6 weeks

Prodromal Phase: ~7d
*Fever, malaise
*Anorexia, nausea, vomiting
*Abdominal pain

Icteric Phase:
*Jaundice, scleral icterus (40-70%)
*Dark urine, pale stools
*Hepatomegaly

Children: no or few symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HepB who receives rx? drug choice?

A

Treat if Cirrhosis (fibroscan or APRI score >2)
OR >30 years with abnormal ALT and viral load >20k

Tenofovir + entecavir
Just entecavir in age 1-10

[kids 10 or less don’t get TENofovir - same as HIV]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Oral options for HepB rx ? usual regime for HIV and HepB in rich countries

A

Tenofovir, Lamivudine and entecavir

Tenofovir + lamivudine + dolutegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is in the vaccines for hepB

A

HBsAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Worlds biggest iatrogenic epidemic of BBV was ?

A

Mass treatement with tartar emetic to treat schisto in egypt and yemen
-Used same needles
resulted in around 30% carrier of hep C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HepC rx

A

Direct acting antivirals
[+ daily oral ribavirin if genotype 1]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which Hep virus can you get repeatedly ? Geographicly common where?

A

Hep E
India and central asia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HepE vaccine quality?

A

Very effective
-Only licenced in china

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Key risks for hepatocellular Ca

A

HepB/C
Alcohol cirrrhosis
Alfatoxin (Aspergillus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pneumonia with ‘rusty’ sputum most commonly which bug? staining ?

A

S pneumo
Gram positive diplococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rx pneumonia caused by gram -ve eg klebsiella

A

Aminoglycoside eg Gent
[taz in rich contries]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which pneumococcal vaccine best

A

PCV 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cause of tropical pulmonary eosinophilia? Geography? Sx?

A

Asthma-like disease caused by
-Wuchereria bancrofti or Brugia malayi
- Progresses to granulomatous and eventually fibrosis

India and west Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tropical pulmonary eosinophilia ix? Found on Lung function tests?

A

Eosinophilia
CXR - diffuse alveolar mottling with 1-2mm nodules
Filarial antigen testing

LFTs - Restrictive [not obstructive]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tropical pulmonary eosinophilia rx?

A

Diethylcarbamazine
-Add albendazole if not responding

[or doxy + ivermectin]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tropical pulmonary eosinophilia control

A

Control of ades mosquito (eg breeding sites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of pneumonia in kids
Neonate vs <3m vs <5 y vs >5y

A

Neonates: Group B Srep, Gram -ve bacteria , CMV, Listeria, HSV

3w- 3m : Chlamydia trachomatis , RSV, PIV, S.
pneumoniae , B. pertussis, S. aureus

3m - 5y : viral (RSV, PIV, influenza, adeno, rhino),
[S. pneumoniae , H. influenzae , Mycoplasma,
TB .]

5y - 15y : Mycoplasma, Chlamydia pneumoniae ,
S. pneumoniae , TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Main causes of severe pneumonia in kids

A

s pneumo
h influenza
RSV / viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Key signs of severe CAP in kids

A
  • Lower chest wall indrawing
  • Nasal flaring
  • Grunting (in young infants)
  • Inability to feed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Abx in pneumonia kids mild vs severe? HIV?

A

Mild / some chest indrawing = amox

Severe / HIV - IV ampicillin + gent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Case. Septic 13 yo with fever and boils on buttocks and difficulty breathing
Multiple alveolar infiltrates with arthritis

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Penicillin resistance in s pneumo by location of bug?

A

Very high in meningitis ~60% -> use Ceftriaxone
Low in pneumonia - ie can still use amox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Loculated complex pleural effusion - addition in rx to abx + drain

A

Intrapleural fibrinolytic
VATS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Low income countries - how many are immune to HepA by age 10?
90%
26
HepA Dx? Which liver enzyme is highest?
ALT>AST (opposite to alcoholics) IgM anti-HAV By the time Sx start - should have detectable IgM
27
HepA Rx? Prevention?
No Rx - supportive only Vaccine - 2 doses = 95% protection [PEP - HAV vaccine / Ig within 2 weeks Cooking appropriately, iodine, chlorine etc]
28
HepE has 4 sero groups. Which in developing regions? which has animal reservoirs?
HEV 1&2 - Developing regions, Human reservoirs -> contaminated drinking water with faeces HEV 3&4 - Developed countries, animal reservoirs (mostly pig) -> consumption of undercooked meat Pigs have 4 legs, humans have 2 (animal farm)
29
Key complications of HEV? Who is at high risk?
Neuro: Guillain-Barre syndrome, neuralgic amyotrophy, encephalitis, myelitis Renal: All the renal things [IgA nephropathy, membranoproliferative glomerulonephritis with or without cryoglobulinaemia, membranous glomerulonephritis] Pregnant women high risk mortality ~20%
30
HEV dx? When would you call HEV chronic?
anti-HEV IgM and/or HEV RNA Chronic HEV infection: detection of HEV RNA in serum > 6 months
31
HEV rx?
Ribavarin *contraindicated in pregnancy
32
HEV immunocompetent vs suppressed. Which genotype? ALT? Dx? outcomes?
Supressed - Only HEV 3 -Lower ALT ~300 vs >1000 -Need PCR (lack of immune response) -More likely chronic infection -Interferon a + ribavirin for Rx
33
HepC which genotype is most common? Which in SE Asia? Which in Africa / middle east?
Genotype 1: 44% of all HCV infections. *More common in high-and middle-income countries (60%) Genotype 3: 25% of all HCV infections. *More common in LMIC (75% south Asia) Genotype 4: 25% of all HCV infections. *More common in north Africa and Middle East [Order of wealth]
34
How many untreated would go on to develop chronic HCV infection? How many develop complications?
80% 20% develop complications by 20 years - Cirrhosis / HCC
35
HCV Dx? Rx example drugs?
HCV RNA - early infection HCV antibodies appear after 12 weeks All should get - Direct acting antivirals Eg Sofosbuvir + velpatasvir or other -tasvir drugs
36
Monitoring in HCV
US / AFP every 6m for HCC Check HCV RNA 12 weeks following Rx to see sustained virological response
37
Combination of which respiratory pathogens is particularly bad for old people?
Influenza (which gets rid of the bronchial lining) followed by strep pneumonia
38
Name 2 flu treatments
M2 ion channel blockers - (amantadine, rimantidine) Neuraminidase inhibitors - oseltamivir (Tamiflu ™ - zanamivir (Relenza ™) inhaled or IV - peramivir (Rapivab ™) IV - Laninimuvir (long-acting inhaled Japan only)
39
Intrahepatic cholestasis leads to what hyperbilirubinaemia
Conjugated
40
Erythrocyte destruction leads to which type of jaundice
Unconjugated
41
72yo from Anta (close to Cusco) Presents with 3 days of acute onset severe epigastric pain, mild fever. No PMHx. Good diet. No ETOH. Physical exam: Jaundice, tender epigastric abdominal pain WBC 12,200 (70% PMNs, 2% eos) Tbili 3.8, Dbili 2.8 Alk Phosh elevated x5; Amylase x10, ALT x2 upper limit of normal CT /ERCP: pancreatitis and filling defect DDx of biliary obstruction with eosinophilia? Which if no eosinophilia in HIV?
Nematodes (Ascaris) Trematodes (Clonorchis, Opstorchis, fasciola) Echinococcus (only because of the size) Protozoans (cryptosporidium parvum associated with cholangiopathy in immunosuppressed HIV patient
42
Which liver fluke in? - China, Japan, Korea, Taiwan, Vietnam - China, Laos, Thailand, Vietnam, Cambodia, Myanmar - Europe - World wide (especially Peru and bolivia)
Clonorchis sinensis: China, Japan, Korea, Taiwan, Vietnam opistorchis Viverrini: China, Laos, Thailand, Vitnam, Cambodia, Myanmar Opistorchis Felineus: Southeast asia, cenetral and eastern Europe Fasciola hepatica:
43
61 year old male from Iquitos, 7 days of fever, generalized muscle pain, jaundice; works as logger no insect repellent, eats at local market, goes swimming in the pool Physical exam with febrile, tachycardia; muscle pain, hepatomegaly; Jaundice Lab workup: Hgb 9.8, WBC 13, 94,000 Plt, Tbili 18 (9.6 direct); ALT 72, Alk phosph 150; CPK 4x ULN, Creatinine 8.2 Dx? Confirm with? Rx? Ddx?
Myositis + Hepatic involvement + renal involvement = leptospirosis -PCR for early or urine for late disease (after the first week) -Serology (usually after first week Ab will be detectable Rx - Doxy / azithro for mild -Ceftriaxone for severe [ddx: Malaria (severe malaria) v. hepatitis (severe viral) v. Severe leptospirosis v. yellow fever (consider hemorrhagic) v. dengue (doesn’t quite fit) v. visceral leish]
44
Liver biopsy shows: Councilman bodies: hepatocytes with eosinophilic degeneration
Yellow fever [Acute viral hepatitis / other viral syndromes]
45
hemolytic anaemia with unconjugated bilirubinemia ddx? DDx of intravascular hemolysis:
severe dengue v. typhoid v. malaria v. bartonella v. visceral leish -Malaria -Bartonellosis -C. Perfrinens -Babesia
46
73yoM with 16 days of abdominal pain -Diffuse, then right upper quadrant pain< associated with high fever, chills, jaundice 12 days prior to admission, then vomiting and worsening abdominal pain -From Pucallpa (Central amazon) Physical exam: afebrile, jaundice, liver 3cm below R costal margin, no splenomegaly Hgb 10.6, WBC 14200 84% PMNs, no eos, plt normal ALT 56, Alkphosph 395, bilirubin 7.6 (direct 4.8), protein 5.8 Most likely? dx? rx?
obstructive cholestasis picture : Amoebic abscess -Usually diagnosed by serology (only really from stool, not from the fluid from the liver abscess) Metronidazole + paramomycin
47
Kwy things in your DDX when Hemolysis: Biliary obstruction: Intrahepatic cholestasis: With raised bili Hepatocellular injury with transminase >bili?
Hemolsysis: Think of viruses (intraerythrocytic pathogens) Biliary obstruction: Think of trematodes Intrahepatic cholestasis: think of bacterial-lepto (LFTs are not as elevated as Bili), Brucella, Typhoid fever (severe clinical presentation) TB (miliary dissemination), Pyogenic/Amebic liver abscess Hepatocellular injury: Think of yellow fever (transaminase>bili)
48
Bartonella baciliformis vector?
Lutzomyia
49
HBV - when do antibodies become detectable? How many people develop Sx? Progression to chronic?
After 4-6 weeks Approx 1/3 develop Sx *90% of infants <1 year *30% of children aged 1-5 y *5-10% of adults
50
How do define chronic HepB? how many get complications?
detection of HBsAg on 2 occasions measured 6 months apart 25% - HCC or cirrhosis
51
Interpretation of HBsAg, Anti-HBs, Anti-HBc, HBV DNA Active infection? resolved infection? Immunity?
52
Extra-hepatic HBV
Polyarteritis nodosa Membranous glomerulonephritis Membranoproliferative glomerulonephritis Aplastic anaemia Vasculitis
53
Why might Anti-HBc be the only one positive in HepB panel
There is a window period of a couple weeks
54
Assess cirrhosis without a fibro scan - eg resource-poor
AST to platelet ratio index >2 = cirrhosis [((AST/AST ULN) / Platelet count) x 100]
55
HDV - what does it cause? Rx?
HDV superinfection with HBV -More likely fulfilment hepatitis in acute infection -Chronic HDV leads to severe and progressive chronic hepatitis with a high rate of cirrhosis -Suppresses HBV It can be cured by either -Curing HBV - Pegylated interferon - acts on HDV (NRTIs don't)
56
61 7 day history of fever, diffuse myalgia, dyspnea, jaundice and several episodes of hemoptysis Swims in a non authorized pool Marked jaundice, bilateral rales in both lung fields WBC: 13,100 with left shift platelets: 93,000 total bilirubin: 18 mg/dl (10 direct) ALT 42 IU/L (<40) creatinine: 7 mg/dl; BUN 339 (<20) Dx?
Leptospirosis Ceftriaxone
57
51M with 8 month history of fever, cough, weight loss, painful oral lesions Poor farmer in the high jungle of Peru Heavy smoker and drinker Painful oral lesions with easy bleeding dots, cervical adenopathies, bilateral pulmonary rales
Paracoccidioidomycosis
58
26 2 month history of fever, dry cough, progressive dyspnea, and weight loss of 10Kg Born in the high jungle of Colombia HIV not on ART; CD4 23 cells/mm Wasted; cervical adenopathies, diffuse rales in both lungs, organomegaly WBC: 2,100 with marked lymphopenia; platelets: 93,000, Hb 8 g/dl LDH 1200 U/L (<150)
Histoplasmosis Amphotericin B followed by itraconazole
59
42M, 2 year history of fever, dry cough, several episodes of hemoptysis Started TB treatment 2 months ago Born in the highlands of Cajamarca, Peru School teacher; no travel history Normal physical examination WBC: 6,100 with 10% eosinophils Multiple negative studies including ZN stain, Xpert MTB/RIF, KOH, Gram stain and cultures
Paragonimiasis praziquantel
60
32M 2 day history of fever, cough, progressive dyspnea, pleuritic chest pain and several episodes of hemoptysis Lives in the rural highlands of Peru BP 70/35. HR 122, resp 28, 89%StHb WBC: 26,100 with 10% bands A Gram negative rod identified in the sputum
Yersinia pestis Gent + cipro / doxy [Streptomycin + fluorquinolone]
61
45M 4 day history of fever, cough, pleuritic chest pain, myalgia Contact with farm animals in French Guiana BP 120/85, HR 92, resp 24, 94%StHb WBC: 8,100 with no bands, 100,000 platelets ALT 250 U/l (<40) Negative blood cultures
Coxiella burnetii Doxycycline
62
Q fever acute vs chronic
Acute (pneumonia, hepatitis) -usually mild pneumonia - involvement may be lobar, segmental, or patchy -opacities may be oval, wedge shaped, perihilar, or round -round opacities may be more frequent than in other types of pneumonia chronic (endocarditis, osteomyelitis, FUO)
63
Asymptomatic Raised eosinophils
Dirofilaria immitis (dogs; coin nodule) -dog heartworm Clinical diagnosis; surgical excision
64
55F 2 day history of fever, shaking chills, severe headache, dyspnea Mother and sister died of lymphoma PMx intermittent diarrhea for last 2 years Febrile, no rash, + ve meningeal signs WBC: 19,100, no eosinophils CSF: 1000 WBC, 90% PMNs, low glucose E. coli isolated from blood and CSF
Strongyloides stercolis Hyperinfection syndrome; disseminated disease Ivermectin

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions