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ID Flashcards

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1
Q

Primary TB

A

 Organism multiples at pleural surface = Ghon focus
 Macrophages take TB to LNs, which with lesion is known as Ghon complex
 Fibrosis of Ghon complex –> calcified nodule (Ranke complex)
 Usually asymptomatic
 Rarely in immunocompromised pts progresses to primary progressive TB

Primary progressive:
 resembles acute infxn with mid and lower zone consolidation, effusions and bihi lymphad
 Lymphohaematogenous spread → milliary TB (diffuse seeding of TB in lung) and extra-pulmonary

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2
Q

Latent and secondary TB

A

Latent TB:
 Infected but no clinical or x-ray signs of active TB, pt is non-infectious
 weakened host resistance leads to reactivation

Secondary TB:
 reactivation from weakened immune system or reinfxn
 typically develops in upper lobes and have cavitation with caseating granulomas

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3
Q

Extrapulmonary TB features

A

 CNS –> meningism with papilloedema and CN palsy (Rx = RIPE 2 months–>RI 10 mo +/- dexamethasone)
 GU –> sterile pyuria and symptoms of UTI
 LN –>Firm, painless lesions (scrofula) that eventually ulcerate with a granular base with no sign of infxn
 skin –> lupus vulgaris (apple-jelly nodules)
 adrenals –> addison’s

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4
Q

Ix for TB

A

 Latent TB: tuberculin skin test; if +ve then interferon gamma release assay (IGRA)
 NB tuberculin skin test can give false -ve with HIV, sarcoid and lymphoma

 Active TB: CXR showing upper lobe caviting lesions –> take 3 sputum samples (or BAL) and use Lowenstein-Jensen culture + Ziehl Neelsen stain

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5
Q

RIPE SE

A

R: orange urine (+hepatitis)
I: peripheral neuropathy (+hepatitis)
P: hepatitis (C/I: gout, porphyria)
E: optic neuritis

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6
Q

Other mycobacterium

A

 Leprosy / Hansen’s disease
 Mycobacterium avium-intracellulare - complicates HIV infxn with wide dissemination in lungs and hepatomegaly
 M. ulcerans - Buruli ulcer from initial nodule in Australia
 M. marinum - Fish tank granuloma

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7
Q

Leprosy

A

Tuberculoid
 Less severe
 TH1-mediated control of bacteria → paucibacillary  Anaesthetic hypopigmented macules
 Rx = 6 months Rif monthly and clofazamine daily

Lepromatous
 Weak TH1/2 → multibacillary
 Skin nodules
 Nerve damage (esp. ulnar and peroneal)
 Rx = 2 years Rif monthly clofazamine + dapsone daily
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8
Q

Reyes syndrome

A

rash, vomiting, ↑LFTs in children recovering from influenza and linked to them being given aspirin

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9
Q

Rx for influenza

A

Bed rest and paracetamol

If severe:
 Mx in ITU
 Cipro and co-amoxiclav: prevent Staph and Strep

High risk patients:
 Oseltamivir if >1yr with symptoms of <48hr. Can also be use as prophylactic
 Zanamivir if >5yrs with symptoms <48h

Trivalent vaccine for:
 >65yrs
 DM, COPD, heart, renal, liver failure
 Immunosuppression: splenectomy, steroids
 Medical staff
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10
Q

HIV effects

A

 Osteoporosis
 Dementia
 Neuropathy
 Nephropathy

AIDS-related complex (ARC) = AIDS prodrome  with FLAWS + minor opportunistic infxns e.g:
 Oral candida
 Oral hairy leukoplakia (EBV) 
 Recurrent HSV
 Seborrhoeic dermatitis
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11
Q

HIV Ix:

A

 ELISA: detect serum (or salivary) anti-HIV Abs
 Western Blot: for confirmation
 If recent exposure, may be window period; usually 1-3wks but can be 3-6mo
 PCR: can detect HIV virions in the window period
 Rapid Antibody Tests: false positives are a problem and results should be confirmed by Western Blot

Once HIV confirmed:
 CD4 count (<350 is indication for Rx)
 viral load
 Perform Mantoux test and serology for toxo, CMV, HBV, HCV, syphilis

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12
Q

HAART indications and regimes

A 
Indications
 CD4 ≤350
 AIDS-defining illness
 Pregnancy
 HIVAN (associated nephropathy)
 Co-infected with HBV when Rx is indicated for HBV

Regimens
1 NNRTI + 2 NRTIs
 NNRTI = Efavirenz
 NRTI = emtricitabine + tenofovir (Truvada)
 Atripla = efavirenz + emtricitabine + tenofovir
PI + 2 NRTIs
 PI = lopinavir (+ low dose ritonavir = Kaletra)

NB PEP = truvada + Kaletra, continue at least 28 days

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13
Q

Major AIDS illnesses

A

4Cs 2Ps 2Ts KLM:
 Candidiasis: oesophageal or pulmonary
 Cryptococcal meningitis - halo on india ink CSF stain
 Cryptosporidiosis - chronic diarrhoea
 CMV retinitis - pizza sign on fundoscopy
 Kapsosi sarcoma - HHV8
 Lymphoma: Burkitt’s, 1O brain
 MAC - disseminated lung infxn
 PCP - bilat perihilar interstitial shadowing with dry cough and exertional dyspnoea
 PML
 Toxo - ring-shaped contrast enhancing lesion with encephalitis
 TB - may have false -ve in tests; also absence of characteristic granuloma (as no immune response). Increasing CD4 paradoxically worsens TB symptoms

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14
Q

Progressive multifocal leukoencephalopathy

A

Demyelinating inflammation of brain white matter
caused by JC virus.

Presentation
 Weakness
 Paralysis
 Visual loss
 Cognitive decline

Ix: JC viral PCR

Rx: HAART + mefloquine may halt progression

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15
Q

Toxoplasmosis Rx + prophylaxis:

A

ring-shaped contrast enhancing lesions

Rx: pyrimethamine + sulfadiazine + folate

Prophylaxis: Co-trimoxazole if CD4 <100 = lifelong 2ndary prophylaxis

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16
Q

Kaposi’s sarcoma Rx

A

 HAART

 Radiotherapy or chemotherapy

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17
Q

PCP Rx + prophylaxis:

A

Rx
 High-dose co-trimoxazole IV
 Or, pentamidine IVI
 Prednisolone if severe hypoxaemia

Prophylaxis
 Co-trimoxazole if CD4 <200 or after 1st attack

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18
Q

Cryptococcal meningitis Rx:

A

Amphotericin B + flucytosine for 2wks then fluconazole for for 6mo / until CD4 >200

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19
Q

CMV retinitis Rx

A

IV ganciclovir or eye implant of intravitreous ganciclovir

Owl’s eye inclusions seen

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20
Q

Herpes Encephalitis

A 
90% HSV-1, 10% HSV-2
Features:
Flu-like prodrome
Headache
focal neuro e.g. fits, odd behaviour
↓GCS
Haemorrhagic necrosis of temporal lobes
Rx: IV aciclovir
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21
Q

Mollaret’s Meningitis

A

HSV-2 mostly
Benign recurrent aseptic meningitis
Rx = IV aciclovir

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22
Q

Herpes Gladiatorum

A

Rugby players, wrestlers
Features:
Painful vesicular rash, lymphadenopathy, fever
Rx = PO aciclovir

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23
Q

Herpetic Whitlow

A

Healthcare workers, children
Features:
Painful red finger
Rx = topical aciclovir

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24
Q

Elseberg syndrome

A

genital herpes leading to sacral radiculomyelitis = urinary retention + sacral sensory loss

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25
Herpetic keratitis
Unilat/bilat conjunctivitis + pre-auricular LNs May cause a corneal ulcer = dendritic ulcer
26
Ramsay hunt syndrome
ear herpes zoster, facial palsy, ↓ taste, ↓ hearing
27
Varicella zoster Dx
Tzanck cells seen from scrapings
28
EBV Ix
+ve heterophile Ab - either paul bunnell or monospot test | Atypical lymphocytes seen
29
Burkitt's lymphoma Ix
Starry-sky appearance CD10, BCL6 | t(8;14)
30
Post-transplant lymphoproliferative disorder
EBV associated lymphoma post solid organ transplant | Rx: rituximab
31
Oral hairy leukoplakia
Painless shaggy white plaque along lateral tongue border in HIV +ve pts Rx = aciclovir
32
Hep B Ix
 HBsAg +ve = current infection (+ve >6mo = chronic disease)  HBeAg +ve = high infectivity  Anti-HBc IgM = recent infection  Anti-HBc IgG = past infection  Anti-HBs = cleared infection or vaccinated  HBV PCR: monitoring response to Rx NB chronic infxn in 5%; can get cryoglobulinaemina
33
Hep B Rx
Chronic disease: PEGinterferon α2b
34
Hep C Rx
Indications  Chronic haepatitis  ↑ ALT  Fibrosis ``` Rx = PEGinterferon α2b + ribavirin. ↓ efficacy if:  Genotype 1, 4, 5 or 6  ↑ VL  Older  Black  Male ```
35
Hep D Ix
anti-HDV Ab
36
Campyelobacter jejuni
Unpasterised milk or animal feces Features: Bloody diarrohoea, fever Guillain-Barre (ascending paralysis) Reactive arthritis Rx: cipro
37
Listeria
Soft cheese / pates ``` Features: Watery diarrhoea, cramps, flu-like Pneumonia Meningoencephalitis Miscarriage ``` Rx: ampicillin
38
C. botulinum
Canned food: Kids = honey students = beans ``` Features: Afebrile Descending symmetric flaccid paralysis No sensory signs Autonomic: dry mouth, fixed dilated pupils ``` Rx = antitoxin, benpen + metro
39
C. perfringes
Reheated meat Features: watery diarrhoea + cramps Rx = benpen + metro
40
Norovirus
commonest causes in adults | Fever, diarrhoea, projectile vomiting
41
Rotavirus
commonest cause in children | secretory diarrhoea and vomiting
42
Typhoid Rx
Cefotaxime or cipro
43
Yersinia entero
Abdo pain, diarrhoea, fever Mesenteric adenitis Reactive arthritis, pharyngitis, pericarditis Erythema Nodosum Rx = cipro
44
Entamaeoba histolytica
MSM or travellers ``` Features Dysentery, wind, tenesmus Wt. loss if chronic Liver abscess - RUQ pain, swinging fever, sweats - Mass in R lobe Flask shaped ulcer on histology - Micro = motile trophozoite with 4 nuclei ``` Rx = metro or tinidazole if abscess or severe
45
Giardia Rx
Tinidazole
46
Jarisch-Herxheimer Reaction
hours after 1st pen dose for syphillis get fever, tachy and vasodilation Rx = steroids
47
LGV
Chlamydia L1,2,3 Primary stage: - painless genital ulcer, heals fast - balanitis, proctitis, cervicitis Inguinal Syndrome: - Painful inguinal buboes - Fever, malaise → genital elephantiasis Anogenitorectal syndrome: - Proctocolitis → Rectal strictures → Abscesses and fistulae Rx = azithromycin/doxy
48
Gonorrhoea Rx
IM ceftriaxone + azithromycin for chlam
49
Granuloma inguinale
Painless beefy-red ulcer from klebsiella Shows donovan bodies on giemsa stain Rx = erythromycin
50
Chancroid
H. ducreyi Painful ulcer progressing to inguinal buboes Rx: azithromycin
51
Argyll-Robertson pupil
accomodates but doesn't react to light
52
Tabes dorsalis
 Degeneration of sensory neurones, esp. legs  Ataxia and +ve Romberg’s  Areflexia  Plantars ↑↑  Charcot’s joints (occurs in DM as well)
53
Syphillis Ix
Cardiolipin Ab on VDRL or RPR (not specific) Treponeme specific Ab via THPA and FTA (remains +ve after Rx) Treponemes can be seen by dark ground microscopy
54
Leptospirosis (Weil's disease)
Infected rat urine Presentation: High fever, headache, myalgia / myositis, cough, chest pain ± haemoptysis ± hepatitis with jaundice ± meningitis Rx = doxycycline
55
Brucellosis
Unpasteurised milk/cheese Undulant fever (PUO) which peaks PM and normal AM Ix: pancytopenia with positive rose bengal test and anti-O-polysaccharide Ag Rx: doxy + Rifam + gent
56
Cat scratch disease
Tender regional LN Rx = azithromycin
57
Rabies
Bullet-shaped RNA virus and negri bodies Rx Immunised = diploid vaccine Unimmunised = vaccine + rabies Ig
58
Toxoplasmosis Rx
Pyrimethamine + sulfadiazine Septrin prohylaxis in HIV
59
Anthrax features
Spread by infected carcasses or hides Features Ulcer with BLACK centre and rim of oedema
60
Anthrax Ix and Rx
Gram +ve spore forming rod Rx = cipro + clindamycina
61
Antimalarial SE
 Chloroquine: retinopathy  Fansidar: SJS, ↑LFTs, blood dyscrasias  Primaquine: haemolysis if G6PD deficient  Malarone: abdo pain, nausea, headache  Mefloquine: dysphoria, neuropsychiatric signs
62
Uncomplicated Ovale, Vivax and Malariae Mx
Chloroquine and primaquine
63
Uncomplicated falciparum Mx
Artemether-lumefantrine (riamet) OR Quinine + Doxy
64
Severe Falciparum Mx
 Need ITU Mx |  IV antimalarials
65
Falciparum Complications
```  Cerebral malaria: confusion, coma, fits  Lactic acidosis → Kussmaul respiration  Hypoglycaemia  Acute renal failure: 2O to ATN  ARDS ```
66
Malaria Ix
```  Serial thick and thin blood films  Parasitaemia level  FBC: anaemia, thrombocytopenia  Clotting: DIC  Glucose  ABG: lactic acidosis  U+E: renal failure  Urinalysis: haemoglobionuria ```
67
African Trypanosomiasis | Sleeping sickness
Tsetse fly T. gambiense: West Africa T. rhodesiense: East Africa - More severe than gambiense Posterior cervical nodes (Winterbottom’s sign) Sleeping sickness occurs months after original infxn
68
American Trypanosomiasis | Chagas Disease
``` Reduviids fly: T. cruzi - Erythematous nodule, fever, LN, HSM - Swelling of eyelid (Romana’s Sign) - Cardiac disease ```
69
Leishmaniasis
Sandflies:  Cutaneous (Major, tropica)  Mucocutaneous (Braziliensis)  Visceral / Kala Azar (Donovani)
70
Kala Azar
L Donovani Features: - Dry, warty hyperpigmented skin lesions (dark face and hands) - Prolonged fever - Massive splenomegaly, LNs, abdo pain Visualisation of Leishman-Donovan bodies on Ix and pancytopenia
71
Mucocutaneous leish
Ulcer in mucous mems of mouth and nose
72
Cutaneous leish
skin ulcer @ bite → depigmented scar Widespread nodules (fail to ulcerate)
73
Filariasis
Wuchereria bancrofti Elephantiasis Ix: Eosinophilia Microfilariae in the blood
74
Dengue Fever Ix
Tourniquet test Serology can exclude if fever starts >2wks after leaving endemic area
75
Schistosomiasis
Itchy papular rash at site of penetration - Swimmer’s Itch
76
Schistosomiasis Mansoni
- abdo pain D&V - later hepatic fibrosis and portal HTN - HSM
77
Schistosomiasis Haematobium
- frequency, dysuria, haematuria - may → hydronephrosis and renal failure - ↑ risk of bladder SCC
78
Tetanus Rx
 Mx on ITU: may need intubation  Human tetanus Ig  Metronidazole, benpen
79
Actinomycosis Rx
ampicillin for 30d, then pen V for 100d From subcut infxn (esp on jaw)

Finals PACES (12 decks)

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