infection

Question 1

patient group most at risk of c.diff?

Answer 1

women and elderly

Question 2

which antibiotics cause c.diff the most

Answer 2

clindamycin most

penicillins and quinolones can

Question 3

treatment of c.diff

Answer 3

1st: oral metronidazole
2nd: oral vancomycin/ oral fidoxamicin

10-14 days

Question 4

what is contraindicated in c.diff?

Answer 4

no, loperamide is contraindicated as we want to get rid of the bacteria

Question 5

how to treat endocarditis

Answer 5

amoxicillin, flucloxacillin (staphylococcus), benzylpenicillin (strep), vancomycin if MRSA
can add low dose gentamicin

Question 6

treatment of mild CAP?

Answer 6

7 days:
amoxicillin
pen allergy: clarithromycin or doxycycline

Question 7

treatment of moderate CAP?

Answer 7

amoxicillin+ clarithromycin or doxycycline

7 days

Question 8

treatment of HAP?

Answer 8

7 days
early: <5 days
co-amox or cefurox

severe/ >5 days : piperacillin or broad spectrum quinolone

Question 9

what would you add into the treatment of HAP if you suspected pseudomonas aeruginosa?

Answer 9

aminoglycoside

Question 10

meningitis treatment?

Answer 10

empirical benzylpenicillin or cefotaxime
pen allergy: chloramphenicol

meningococcal: 7 days
pneumococcal: 14 days
h. influenzae: 10 days

Question 11

osteomyelitis treatment

Answer 11

clindamycin: concentrates in the bones
flucloxicillin
if MRSA: +Vancomycin

Question 12

conjunctivitis drops/ ointment dose?

Answer 12

chloramphenicol: 1 drop every 2 hours for the first day then 1 drop every 4 hours till day 5

Oint: TDS-QDS for 5 days

refer if no improvement in >48 hours

Question 13

impetigo treatment?

Answer 13

Fusidic acid for 7 days

Flucloxicillin oral for 7 days if wide spread

Question 14

cellulitis treatment?

Answer 14

Flucloxicillin 250-500mg QDS

Clindamycin

Question 15

animal bites treatment:

Answer 15

co-amoxiclav 1-2 TDS for 7 days

doxycycline+ metro

Question 16

MRSA treatment

Answer 16

Glycopeptide (vancomycin or teicoplanin which is better on the kidneys)

can give a tetracycline or linezolid as well

Question 17

oral infection treatment and dose? and alternative

Answer 17

metronidazole 200mg TDS for 3 days

amoxicillin or doxy if allergic
can combine pen/ macrolide with metronidazole if needed

Question 18

what should you do if theres no response to treatment of dental infection within 48 hours

Answer 18

switch to an alternative

Question 19

sore throat treatment?

treatment if severe?

Answer 19

phenoxymethylpenicillin
benzylpenicillin

clarithromycin if pen allergic

Question 20

what are sore throats caused by commonly

Answer 20

strep

Question 21

otitis externa treatment and why

Answer 21

fluclox or clarithromycin as usually caused by staph

Question 22

if youre going to treat otitis media what would you give treatment
when wouldn’t you treat it?

Answer 22

amoxicillin or Clari if allergic

only treat if it doesnt improve after 3 days or there are systemic symptoms

Question 23

when should you not give amoxicillin?

Answer 23

in glandular fever: mapupapular rash

Question 24

TB treatment:

Answer 24

initial phase for 2 months: 
Rifampicin
Isonazid 
Pyrazinamide 
Ethambutol 

continuous phase for 4 months:
RI

Question 25

Cautions of TB treatment

Answer 25

all hepatotoxic

Question 26

what should you report with ethambutol

Answer 26

visual changes

Question 27

two things to monitor with linezolid

Answer 27

report any visual changes: ocular neuropathy monitor bloods every week especially with treatment over 10-14 days anaemia and thrombocyopenia

Question 28

antibiotics effecting vision

Answer 28

linezolid: optic neuropathy quinolones ethambutol Rifampicin can colour contacts red

Question 29

which anti fungal should be avoided in HF

Answer 29

Itraconazole can cause HF | increased risk if with CCB

Question 30

hepatotoxic antibiotics/ antifungals

Answer 30

``` itraconazole, ketoconazole fluconazole terbinafine voriconazole: supply with alert card ``` ``` co-amox flucloxacillin erythromycin co-trimoxazole RI ```

Question 31

drugs causing cholestatic jaundice

Answer 31

flucloxicillin co-amoxiclav nitrofurantoin

Question 32

MHRA Ketoconazole

Answer 32

fatal hepatotoxity: do not use for anything except cushings send back Rx if you see it

Question 33

Voriconazole side effects

Answer 33

hepatotoxic and phototoxic alert card for liver SPF and avoid the sun

Question 34

amphotericin side effects

Answer 34

nephrotoxicity

Question 35

how to administer amphotericin

Answer 35

IV but monitor for 30 minutes as can cause anaphylaxis | not brand interchangeable

Question 36

oral thrush treatment

Answer 36

POM nystatin OTC metronidazole gel if severe can give oral fluconazole

Question 37

vulvovaginal thrush treatment

Answer 37

oral fluconazole | topical imidazole

Question 38

what is tinea capatis

Answer 38

scalp ringworm

Question 39

what is tinea cruris

Answer 39

jock itch

Question 40

what is tinea pedis

Answer 40

athletes foot

Question 41

what is terbinafine

Answer 41

treatment for athletes food ONLY | tinea pedis

Question 42

treatment of tineas?

Answer 42

topical imidazoles: miconazole, clotrimazole | daktacort 10+ BD for 7 days

Question 43

daktacort age restriction OTC

Answer 43

10+

Question 44

DAKTACORT dose regimen for tinea treatment

Answer 44

BD for 7 days

Question 45

OTC treatment of herpes simplex? +dose

Answer 45

aciclovir 5 times a day for 4 days with 4 hour intervals Penciclovir: 12+ 8 times daily for 4 days with 2 hour intervals

Question 46

what can be used as influenza prophylaxis? who would use this?

Answer 46

oseltamivir >65 diabetes immunocompromised

Question 47

ABCD acronym in malaria?

Answer 47

aware of risk bite prevention chemoprophylaxis Diagnose promptly

Question 48

strength of DEET? age restriction what must you wear with it

Answer 48

20-50% >2 months old suncream 35-40 SPF put on before DEET. DEET reduces the SPF of suncream

Question 49

macaroni contains?

Answer 49

atorvaquone and proguanil

Question 50

different regimens for malaria chemoprophylaxis?

Answer 50

1. Malarone 2. Chloroquine only 3. Chloroquine and proguanil 4. Mefloquine 5. Doxycycline

Question 51

before giving chloroquine what should be checked

Answer 51

the area for chloroquine resistance

Question 52

doxycycline for malaria treatment regimen

Answer 52

1-2 days before and 4 weeks after

Question 53

doxycycline CA labels

Answer 53

not to be given with CA, FE, ZN antacids 2 h before or after photosensitivity with a whole glass of water

Question 54

if someone wants a quick get away holiday which malaria regimen should they take

Answer 54

doxycycline or macaroni as only 1-2 days before

Question 55

MHRA for mefloquine + a counselling point

Answer 55

C/I if history of psychiatric disorders or convulsions care when driving as can cause dizziness stop and seek immediate medical attention if neuropsychiatric effects occur- replace with alternative anti-malarial

Question 56

when can the side effects of mefloquine occur

Answer 56

months after stopping as long half life

Question 57

Flucloxicillin safety?

Answer 57

hepatitis and liver toxicity | can occur 2weeks-2 months after stopping

Question 58

length of treatment for chemoprophylaxis on malaria before and after travel

Answer 58

Usually 1 week before EXCEPT: Mefloquine is 2-3 weeks to see if they tolerate malarone and doxycycline are 1-2 days after: usually 4 weeks EXCEPT: Malarone which is 1 week after

Question 59

malaria long term prophylaxis?

Answer 59

>5 years: chloroquine and proguanil 2 years: doxy 1 year: mefloquine and malarone but if tolerated mefloquine can be used for up to 3 years

Question 60

which malaria prophylaxis can be used for up to 5 years

Answer 60

chloroquine and proquanil

Question 61

which malaria prophylaxis can be used for up to 2 years

Answer 61

doxycycline

Question 62

which malaria prophylaxis can be used for up to 1 years

Answer 62

malarone and mefloquine but mefloquine can be used for up to 3 years

Question 63

which anti malarials should be avoided in epilepsy

Answer 63

mefloquine and chloroquine can give malarone

Question 64

which anti malarials should be given in renal impairment | which should be avoided

Answer 64

give doxycycline or mefloquine avoid: proguanil, malarone and chloroquine (if eGFR <30)

Question 65

which anti malarials can be given in pregnancy which cannot be given

Answer 65

chloroquine and proguanil give proguanil with folic acid 5mg mefloquine in the second/ third trimester if no alternative dont give doxycycline or mefloquine

Question 66

which patient group require different malaria chemoprophylaxis?

Answer 66

warfarin patients- start 1-2 weeks before to stabilise INR before

Question 67

malaria treatment?

Answer 67

1. falciparum: quinine, malarone, raiment | 2. non-falciparum: chloroquine

Question 68

what can be given as malaria stand by treatment. when would this be provided?

Answer 68

quinine if cant reach medical care within 24 hours

Question 69

treatment of chlamydia and dose alternative?

Answer 69

doxycycline 100mg BD 7 days azithromycin if pregnant, allergies or breast feeding

Question 70

when would you give azithromycin instead of doxycycline for treatment of chlamydia

Answer 70

pregnant, allergies or breast feeding