Which inflammatory marker would you expect to be elevated on a FBC if there is a: 1. Bacterial cause of infection 2. Viral cause of infection

Bacterial: Raised neutrophils Viral: Raised lymphocytes

Infection Flashcards by Charlotte Colling

If someone has a positive HBsAg (Hep B surface antigen), what does this indicate regarding Hep B infection?

They currently have an active infection

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What are the aims of HIV treatment?

What does HIV treatment involve?
~ when is it started?

Aims of treatment:
• normal CD4 count
• undetectable viral load

HIV treatment: cART
Treatment involves a combination of 3 of the below:
• Protease inhibitors
• Integrase inhibitors
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• NNRTIs
~ treatment is started as soon as infection is confirmed regardless of their CD4/ viral load count!

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If an infection isnt resolving, despite adequate treatment, what condition should you investigate for?

HIV

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Explain the routes of transmission of each type of viral hepatitis:

A - faecal-oral route

B - bodily fluids / vertical transmission (mother-baby)

C - bodily fluids

*D -** bodily fluids
*** can only survive in patients who also have a Hep B infection ****

E - faecal-oral route

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Name 4 antibiotics that are associated with C.difficile infection after their use:
C’s….

• Co-amoxiclav

Cephalosporins (eg, ceftriaxone)
Clindamycin
Ciprofloxacin

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What antibiotic is 1st line to treat the first episode (presentation) of a clostridium difficile infection?

If C. diff returns post treatment, what antibiotic is recommended to treat the recurring infection?

10 days of oral Vancomycin

Oral fidaxomicin

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What group of bacteria are the commonest (70%) cause of cellulitis?

What is the 1st line antibiotic to treat cellulitis because of the above bacteria?

IF the cellulitis is _hospital acquired_ (eg, from a cannula), what is the most likely causative organism then???

*Streptococcus**
(Staphlococci = 30%)*

1st line antibiotic: Flucloxacillin

Hospital acquired: Staph aureus (commonly MRSA!!)

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What cells does HIV destroy?

What are the 3 ways that HIV can be tested for in someone?

What 2 things are used to monitor a HIV infection? (below what num. would be abnormal/ end stage disease?)

CD4 T helper cells

1) Antibody blood test - may appear negative until 3 months post exposure
2) PCR: p24 antigen - detects the HIV antigen in the blood
2) PCR: HIV RNA - detects the quantitiy of HIV in the blood (used to measure viral load)

Monitoring:
1) CD4 count
~ below 500 cells/mm³ = abnormal (deficient)
~ below 200 cells/mm³ = end stage disease (AIDs)
2) Viral load

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What investigation is essential in order to diagnose meningitis in children?
~ What would be an absolute contraindictation to this?

Lumbar puncture
~ signs of raised ICP

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In terms of blood results, viral hepatitis and autoimmune hepatitis will cause a raised AST & ALT +/- bilirubin. What other blood results allow you to distinguish between a viral or autoimmune cause of hepatitis?

Autoimmune hepatitis will always ha a raised IgG but a viral cause won’t.

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Name the commonest 1. bacterial and 2 viral causative organisms of tonsillitis:

What would be the treatment of tonsillitis if it is caused by:

*1. bacteria
2. virus**

Bacterial: strep throat = penicillin

Viral: epstein barr virus (aka, glandular fever) = supportive (analgesia & fluids)

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What scoring system is used to assess the severity of a pneumonia?

CURB-65

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What are the 6 components of sepsis 6?
~ state the order you would do these in

(take 3, give 3)

1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output

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What bacteria is the commonest cause of a community acquired pneumonia?

What is the 1st line antibiotic used to treat a mild/moderate CAP? (if the patient has no allergies)

Strep pneumoniae

Oral amoxicillin

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Which inflammatory marker would you expect to be elevated on a FBC if there is a:

Bacterial cause of infection
Viral cause of infection

Bacterial:* Raised neutrophils
Viral:* Raised lymphocytes

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What are the 6 components of sepsis 6?
~ state the order you would do these in

(take 3, give 3)

1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output

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If a pregnant woman is HIV positive, is she able to have a normal vaginal delivery?

If a pregnant woman is HIV positive, is she able to breastfeed?

What prophylaxis treatment is given to all babies born to HIV+ women?

Vaginal delivery: ONLY if her viral load is undetectable (< 50 copies/ ml) - otherwise C-section recommended

Breastfeeding: NO. Even if viral load is undetectable, HIV can be transmitted to baby through the breast milk!

Prophylaxis:
• Viral load is undetectable (< 50 copies/ ml) = 1x antiviral for 4 weeks
• Viral load is detectable (> 50 copies/ ml) = 3x antiviral for 4 weeks

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Regarding Hepatitis B infection, what do the following biochemical markers mean/ indicate:

HBsAg (Hep B surface antigen)
HBeAg (Hep B E antigen)
HBcAb (Hep B core antibodies)
~ IgM
~ IgG
HBsAb (Hep B surface antibodies)
HBV DNA (Hep B virus DNA)

1. HBsAg - indicates an active infection

2. HBeAg - marker of viral infection (so the acute phase of the disease when the virus is actively replicating)
~ the higher the HBeAg, the more infectious the person is ~

3. HBcAb - indicates a past or current infection
~ IgM version of HBcAb = active infection
~ IgG version of HBcAb = past infection (HBsAg will be negative)

4. HBsAb - indicates vaccination / past/ current infection

5. HBV DNA - viral load

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To be classed as having neutropenic sepsis, the patient needs to have sepsis and a neutrophil count of what?

Name some medications that can cause neutropenia: (6)

Less than 1x10⁹/L

Chemotherapy drugs
Clozapine (schizophrenia)
Carbimazole (hyperthyroidism)
Methotrexate (RA)
Sulfasalazine (RA)
Hydroxychloroquine (RA)

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Name the antibiotic of choice for treating neutropenic sepsis:

Tazocin

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What bacteria is the commonest cause of a community acquired pneumonia in:
1. healthy patients

patients with cystic fibrosis (2)

Strep pneumoniae
CF: staph aureus/ pseudomonas aeruginosa

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What bacteria is the commonest cause of a UTI?

~ is this a gram positive or gram negative bacteria?

E.coli

~ gram negative

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Which 2 antibiotics are commonly used in the treatment of a lower UTI?

~ State which one is used 1st and 2nd line

Which of the above is commonly used in pregnancy?
~ when is it safe to use in pregnancy? (eg, which trimesters)

What medication is used in the remaining trimester of pregnancy when the above medication is no longer suitable?

1st line: trimethoprim

2nd line: nitrofurantoin
~ 1st & 2nd trimesters of pregnancy

Amoxicillin
~ used in 3rd trimester of pregnancy

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Which antibiotic is used 1st line for the treatment of a lower UTI?

State the duration of antibiotic treatment of lower UTI in the following:
1. healthy women

women that are immunosuppressed/ impaired kidney function
men, pregnancy, catheter related UTI’s

1st line: trimethoprim

1. healthy women: 3 days

2. women that are immunosuppressed/ impaired kidney function: 5-10 days

3. men, pregnancy, catheter related UTI’s: 7 days

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Why is **nitrofurantoin** **avoided in the 3rd trimester** of pregnancy? Why is **trimethoprim** **avoided in the 1st & 2nd trimesters** of pregnancy?

**Nitrofurantoin:** it can cause haemolytic anaemia in the newborn **Trimethoprim:** it works by inhibiting folate production & fetus's need folate (*folate deficiency can cause neural tube defects*)

If **cellulitis** has a **golden-yellow crust**, which bacteria does this indicate as the cause of infection?

**Staph aureus**

What is the commonest bacteria that causes **cellulitis?** Name the 2nd commonest bacterial cause of cellulitis:

1: **Staph aureus** 2: Strep pyogenes (*group A strep*)

Name the commonest bacterial cause of **cellulitis**: Which **classification system** is used to assess the **severity of cellulitis**? ~ patient's in which class would require an **admission** to hospital? Name the **1st line** antibiotic used to treat **cellulitis**:

Staph aureus ``` **Eron classification** (class 1 - 4) ~ class 3 & 4 would require admission ``` **Flucloxacillin**

Name the commonest **bacterial cause** of tonsillitis: ~ what is the 2nd commonest cause? What is the **management** of a bacterial tonsillitis?

**Group A strep** (*strep pyogenes*) ~ 2nd commonest: strep pneumoniae **Penicillin V**

What is the **management** of a **viral** cause of **tonsillitis**? What is the **management** of a **bacterial** cause of **tonsillitis**? (*what if there is a penicillin allergy?*)

**Viral:** simple analgesia for pain & fever control (paracetamol & ibuprofen) + *worsening advice* **Bacterial: _Penicillin_ _V_** for **10** days *Penicillin allergy:* **_clarithromycin_** for **10** days

The commonest cause of **tonsillitis** is **viral** \> bacterial. Which 2 **criteria** are used to estimate the probability that tonsillitis is due to a **bacterial** infection? ~ list the **features within each criteria** ~ state the **score** needed in each criteria to consider **prescribing antibiotics**

_CENTOR:_ score of 3+ **Fever** over 38 degrees Tonsillar **exudates** **NO** cough **Tender** anterior cervical **lymph nodes** _Fever PAIN:_ score of 4+ **F**ever **P**urulent exudate **A**ttended within 3 days of the onset of symptoms **I**nflamed tonsils **_N_**_o_ cough/coryzal symptoms

What is **otitis media**? What is the **management** of otitis media? ~ how long does it usually take to resolve? If the infection **fails to resolve** with the above management, what would the **next step** in management be?

Infection of the **middle ear** **Supportive** management (*ibuprofen/ paracetamol*) ~ usually resolves within **3-7 days** Prescribe **amoxicillin** if supportive management fails

**Sinusitis** can be *bacterial* or *viral* but commonly **self-resolves without treatment**. How long does sinusitis usually last for before it self resolves? What is the **management of sinusitis** according to the NICE guidelines: 1. symptoms **less than 10 days** 2. no improvement of symptoms **after 10 days** 3. no improvement of symptoms **after 10 days &** ***likely*** **a bacterial** cause

2-3 weeks _Management:_ 1. symptoms **less than 10 days** ~ supportive treatment (*no antibiotics*) 2. no improvement of symptoms **after 10 days** ~ 2 weeks of **high dose steroid nasal** **spray** 3. no improvement of symptoms **after 10 days &** ***likely*** **a bacterial** cause ~ **penicillin V for 5 days** ~ *clarithromycin if allergic*

Which joint is the commonest joint to be affected by **septic arthritis?** Name the commonest organism to cause septic arthritis: ~ what would be the likely organism in **sexually active** people? Which **investigation** is required in suspected septic arthritis to make a definitive diagnosis?

**KNEE** **Staph aureus** ~ neisseria **gonorrhoea** **Joint aspirate** → gram staining, crystal microscopy, culture & antibiotic sensitivities

Name the 2 commonest causes of viral gastroenteritis in the UK: What are the typical symptoms of gastroenteritis? (3)

* Rotavirus * Norovirus Symptoms: ~ Nausea ~ Vomiting ~ Diarrhoea

**E.coli** is a cause of gastroenteritis. By which **route** is E.coli **spread**? The **Shiga toxin** is produced by which strain of E.coli? What **symptoms** does this strain of E.coli produce? (3) What **complication** is associated with the Shiga toxin?

Faecal-oral transmission **E.coli 0157** ~ abdominal cramps ~ **bloody diarrhoea** ~ vomiting **Haemolytic uraemic syndrome**

**Campylobacter jejuni** is a common cause of travellers diarrhoea. By which ways can the bacteria be **spread**? (3) What are the **symptoms** of a campylobacter infection? (4)

Transmission: * raw/ undercooked chicken * dirty water * unpasteurised milk Symptoms: * abdominal cramps * diarrhoea +/- **blood** * vomiting * **fever**

**Shigella** is a cause of gastroenteritis. By which route is the bacteria **spread**? What are the **symptoms** of a shigella infection? (3) What **toxin** can shigella produce? ~ what **complication** is associated with this toxin?

**Faecal-oral route** ~ *usually faeces contaminating food/water/swimming pools* Symptoms: * abdominal cramps * **blood diarrhoea** * **fever** **Shiga toxin** ~ haemolytic uraemic syndrome

**Salmonella** is a cause of gastroenteritis. By which ways can the bacteria be spread? (2) What are the **symptoms** of a salmonella infection? (3)

* Eating raw eggs/ poultry (chicken) * Food contaminated with infected faeces Symptoms: * **watery diarrhoea** +/- mucus/blood * abdominal pain * vomiting

**Bacillus cereus** is a gram positive rod that can cause gastroenteritis. How is this bacteria **spread**? ~ In an **SBA**, what **food** would indicate this infection? What are the **symptoms** associated with this infection? (3) How long does it usually take for symptoms to resolve?

Spread through **inadequately cooked food**. ~ *EXAMS: **fried rice** left out at room temperature* Symptoms: * abdominal cramps (after **5h** of ingestion) * vomiting (after **5h** of ingestion) * **watery diarrhoea** (after **8h** of ingestion) Symptoms resolve within **24hours**

**Giardiasis lamblia** is a **parasite** that causes gastroenteritis. What is the route of transmission of this parasite? Infection doesn't always cause symptoms, however if it does, what is the **symptom** that it causes? What is the **treatment** of this infection?

**Faecal-oral transmission** ~ commonly from animals, eg pets/ farmyards Symptom: **chronic diarrhoea** **Metronidazole**

Name the 2 commonest bacterial causes of **meningitis** in **adults & children:** Name the commonest cause of bacterial meningitis in **neonates:**

Adults & children: **~ neisseria meningitidis** ~ strep pneumoniae Neonates: ~ **group B strep**

List the typical symptoms of a **meningitis** infection: (7) If the meningococcus bacteria **enter the bloodstream**, what condition does this cause? ~ what other symptom would you see in this condition?

* neck stiffness * fever * vomiting * headache * photophobia * altered consciousness * seizures **Meningococcal septicaemia** ~ *non-blanching rash*

If you're working in **GP** and you see a **child** with suspected **meningitis + a** ***non-blanching rash***, how should you manage them? (2) Which investigations should be performed if someone presents to **hospital** with suspected **meningitis**? (3)

1. IM/ IV **benzylpenicillin stat** 2. **immediate** transfer to **hospital** * Blood cultures * lumbar puncture (for CSF) * meningococcal PCR (this looks for meningococcal DNA)

**Bacterial meningitis** is treated with an antibiotic regime ASAP. What **other medication** should be given to **children \>3 months**? ~ **why** is this medication given?

**Steroids** (*dexamethasone)* ~ **reduces** the severity of **hearing loss & neurological damage**

Name the 3 commonest causes of **viral meningitis**: If meningitis is suspected, what investigation should be performed?

* **Herpes simplex virus** * Enterovirus (*usually causes flu-like symptoms*) * Varicella zoster virus Lumbar puncture

You have the lumbar puncture results from a patient with suspected meningitis. From these results determine whether the likely cause is **bacterial** or **viral**: ~ explain why you think this Appearance of CSF: **cloudy** Protein: **3.2g/L** (normal = 0.2-0.4g/L) Glucose: **0.2** (normal = 0.6-0.8) WCC: **2400, neutrophils present**

**Bacterial** meningitis ~ CSF is cloudy ~ high protein, low glucose (bacteria use the glucose and produce protein) ~ **neutrophils** are produced in response to a **bacterial** infection

You have the lumbar puncture results from a patient with suspected meningitis. From these results determine whether the likely cause is **bacterial** or **viral**: ~ explain why you think this Appearance of CSF: **clear** Protein: **0.45g/L** (normal = 0.2-0.4g/L) Glucose: **0.6** (normal = 0.6-0.8) WCC: **1800, lympocytes present**

**Viral** meningitis ~ CSF is clear ~ **lymphocytes** are produced in response to a **viral** infection

The immune system releases neutrophils in response to what type of infection? (*bacterial/ viral*) The immune system releases lymphocytes in response to what type of infection? (*bacterial/ viral*)

Neutrophils = **bacterial** Lymphocytes = **viral**

What is the **commonest** long-term **complication** associated with **meningitis** infection?

Hearing loss

**TB** usually presents with chronic, slowly progressive symptoms. List some: (6) What is the management of **acute TB**? (*RIPE*) ~ state the common side effects

* Cough +/- haemoptysis * Fever/ night sweats * Weight loss * Fatigue * Erythema nodosum (nodules on shins) * Lymphaddenopathy **Management of acute TB:** **_R:_ Rifampicin (6 months)** S/E: red/ orange tears/ urine (secretions) **_I:_ Isoniazid (6 months)** S/E: peripheral neuropathy **_P:_ Pyrazinamide (2 months)** S/E: gout (causes high uric acid levels!) **_E:_ Ethambutol (2 months)** S/E: colour blindness

**TB** usually presents with chronic, slowly progressive symptoms. List some: (6) What is the management of **acute TB**? (*RIPE*) ~ state how long each medication should be taken for

* **Cough** +/- haemoptysis * Fever/ **night sweats** * **Weight loss** * Fatigue * Erythema nodosum (nodules on shins) * Lymphadenopathy **Management of acute TB:** **_R:_ Rifampicin** (6 months) **_I:_ Isoniazid** (6 months) **_P:_ Pyrazinamide** (2 months) **_E:_ Ethambutol** (2 months)

What is the management of **acute TB**? (*RIPE*) ~ state the common side effects

**_R:_ Rifampicin (6 months)** S/E: red/ orange tears/ urine (secretions) **_I:_ Isoniazid (6 months)** S/E: peripheral neuropathy **_P:_ Pyrazinamide (2 months)** S/E: gout (causes high uric acid levels!) **_E:_ Ethambutol (2 months)** S/E: colour blindness

What condition does the statement below indicate? *Sputum culture from a patient with a persistent cough grows acid-fast bacilli that stain red with Zeihl-Neelsen staining*

**TB**

If TB is suspected, which staining would be required from the list below? 1. Gram staining 2. Zeihl-neelsen staining 3. Flagella staining 4. Anaerobic staining What colour would the bacteria stain on the above staining?

**Zeihl-neelsen staining** ~ RED

What type of vaccine is the **TB vaccine**? What must someone have done prior to being allowed the TB vaccine?

**Live, attenuated** vaccine Mantoux test (*to see if they have had a previous infection*)

What **condition** does this **xray** show? (*be specific*) What is this condition?

**Disseminated miliary TB** TB infection that the **immune system is unable to control** (and thus it spreads everywhereeeeee)

What **condition** does this xray show? (*be specific*) **What** **features** can you see on this xray/ would you expect to see on an xray of someone with this condition? (3)

**Primary TB** * patchy consolidation * hilar lymphadenopahy * pleural effusions

What is the management of **acute TB**? (*RIPE*) ~ state the common side effects

There are **4 different types/stages of TB infection,** name them and describe what each type is:

**Active** **TB** - current, active infection **Latent** **TB** - immune system manages to encapsulate the infection and thus stop progression of the disease **Secondary TB** - reactivation of *latent* TB (reactivation of a previous TB infection!) **Disseminated miliary** **TB** - occurs when the immune system is unable to control the infection and thus it spreads everywhere

Name the **3 sample types** that can be acquired for **TB cultures**:

* Sputum * Blood cultures * Lymph node aspiration/ biopsy

A **healthy patient** is found to have **latent TB** on routine testing, what **treatment** would they require?

**No treatment needed.** *Only patients at risk of reactivation (secondary TB) (eg immunocompromised) are treated*

A patient undergoing HIV anti-viral therapy is found to have **latent TB** on routine testing, what treatment would they require?

*This patient is immunocompromised so is at high risk of reactivation of TB (secondary TB), and thus would require treatment.* Treatment is either: * **Isoniazid** for **6** months OR * **Isoniazid** + **rifampicin** for **3** months

**Isoniazid** is a medication used in the management of **acute TB infection**. Name the **common side effect** associated with this medication: What **additional** **medication** is commonly prescribed alongside isoniazid to help **prevent this side effect?**

Isoniazid ~ **peripheral neuropathy** **Pyridoxine** (vitamin B6) helps reduce peripheral neuropathy

**How long after initiating treatment** should patients with active **TB** be **isolated** for?

2 weeks

**Rifampicin** is a medication used in the management of **acute TB infection**. Name the **commonest side effect** associated with rifampicin: Rifampicin can also **reduce the effectiveness of other medications**. Which medication in-particular should you let patients know about? (*eg, females*)

Rifampicin ~ **red/ orange secretions (urine/tears)** **COCP** effect is reduced by rifampicin

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed **unusual sensations** in their fingertips and feet. Which medication is most likely to be implicated?

**Isoniazide**

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed a **numb sensation** in their legs and feet. Which medication is most likely to be implicated?

**Isoniazide**

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed that their **urine is bright orange**. Which medication is most likely to be implicated?

**Rifampicin**

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed **difficulty recognising colours**. Which medication is most likely to be implicated?

**Ethambutol**

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed that the base of their **big toe has become hot, swollen and painful**. What acute condition has this patient presented with? Which medication is most likely to be implicated?

**Pyrazinamide**

A patient recently started on **treatment for TB**. Since starting treatment, they've noticed **pain in their fingers**. O/E you note **gouty tophi** appearing in the DIP joints. Which medication is most likely to be impliacted?

**Pyrazinamide**

**Pneumocystitis jirovecii pneumonia** (PCP) is an **opportunistic** infection associated with which **condition**? What **medication** is given as prophylaxis to patients with the above condition to protect against this infection?

**AIDS** (*end stage HIV)* **Co-trimoxazole**

What is the range of a normal **CD4 count**?

500-1200 cells/mm³

**End stage HIV/AIDS** is defined as a CD4 count below what?

**200** cells/mm³

What **prophylaxis** is given to ALL **babies** born to **HIV+ve** mothers?

**Prophylaxis:** • Viral load is **undetectable** (\< 50 copies/ ml) = **1x** antiviral for 4 weeks (ART) • Viral load is **detectable** (\> 50 copies/ ml) = **3x** antiviral for 4 weeks (cART)

The **plasmodium** family of **protozoan parasites** cause what **infection**?

MALARIA

Malaria is spread through bites from what type of creature? (*be specific*)

**_Female_ anopheles mosquitoes**

From the options below, which type of plasmodium causes the **most severe type of malaria**? 1. Plasmodium ovale 2. Plasmodium malariae 3. Plasmodium falciparum 4. Plasmodium vivax

**Plasmodium falciparum**

From the options below, which type of plasmodium is the **commonest** cause of malaria in the **UK**? 1. Plasmodium ovale 2. Plasmodium malariae 3. Plasmodium falciparum 4. Plasmodium vivax

**Plasmodium falciparum**

What are the **3 signs** that you'll commonly see if someone has **malaria**?

* Pallor (due to anaemia) * Jaundice (high bilirubin due to the haemolytic anaemia) * Hepatosplenomegaly

If someone is presenting with features of **malaria**, what investigation should you do to confirm the diagnosis?

**Blood film** (*malaria blood film*)

A **malaria blood film** is required for a diagnosis of malaria. **How many** samples are needed to exclude a diagnosis of malaria? ~ what **timeframe** should these be taken at? Why is this?

**3 samples** are required over **3 consecutive days** Malaria has a 48h cycle of maturation in RBC until they rupture and malaria is released back into the blood - 3 samples over 3 days means that at least 1 sample will detect malaria!

Which of the below antimalarials is associated with **sunburn & rash associated with sun exposure:** 1. malarone 2. mefloquine 3. doxycycline

Doxycycline

What is the classical finding of secondary (reactivated) TB on a chest xray?

UPPER LOBE consolidation (*with cavitation = gas filled spaces*)

What is the treatment of **trichomonas vaginalis**?

Oral **metronidazole** for 5-7 days

What is the gold-standard investigation for assessing drug sensitivities in TB?

Sputum culture

A 20y/o woman comes in for review as 4 weeks ago she had acute cystitis and was treated with no complications. Urine culture showed no resistant or atypical organisms. She has a history of **recurrent lower UTIs** and is frustrated as she had **6 in the last year**, which has strained her new relationship. She tried cranberry juice and probiotics without benefit. An ultrasound you arranged of her abdomen revealed **no abnormality**. Her post-void volume was 25 ml. You review her behavioural and self-hygiene measures and find the only **identifiable trigger is sexual intercourse**. What is the next best action?

Prescribe prophylactic antibiotics to be taken *alongside* sexual intercourse (single-dose use)

An untreated **rabies** infection is usually always fatal. What is the management following an animal bite in an at-risk country in: 1. patient's *with* previous rabies immunisation 2. patient's *without* previous rabies immunisation

1. *With* previous rabies immunisation ~ wash the wound ~ give **2 further doses** of rabies **vaccine** 2. *Without* previous rabies immunisation ~ wash the wound ~ give **human rabies immunoglobulin + full course of vaccination**

A 24y/o recent **immigrant** from Albania presents to ED with **fever**, **headache** and **malaise**. Over the past 24 hours he has also developed **bilateral pain and swelling at the angle of the jaw**, which is made worse by **talking** or **chewing**. O/E: his pulse is 90/min, temperature 38.4ºC and bilateral palpable, **tender parotid glands.** What is the most likely diagnosis? What is the management of this condition?

**Mumps** Rest & analgesia (paracetamol for fever) ~ *notifiable disease!!!*

Name the 2 first line treatments of **genital warts**: ~ state when each treatment would be used

* **Topical podophyllum** (*topical antiviral*) ~ for multiple, non-keratinised warts * **Cryotherapy** ~ for single, keratinised warts

Toxic shock syndrome is caused by which group of bacteria? What rash is associated with this condition?

Staphylococcus Widespread erythematous rash with **desquamation** (the rash (affected skin) starts to peel off)

Which class of antibiotics can cause a **black, hairy tongue**? Name an example of an antibiotic in this class:

**Tetracycyclines** Eg, doxycycline

People who have been exposed to a patient with confirmed **bacterial meningitis** should be given prophylactic antibiotics. Which antibiotic is used 1st line?

**Ciprofloxacin**

If you see ‘acid-fast bacilli’ in a question, what condition should you be thinking of?

A 28y/o woman presents to the GP 2 weeks after returning from a holiday **kayaking in a lake**. She reports feeling **exhausted** as she has been having ongoing **fatty diarrhoea** with **abdominal pain**, **bloating and flatulence**, all of which started while abroad, which appear **worse when she takes any dairy**. What is the most likely cause of her presentation? What is the biggest risk factor for contracting this condition? What is the treatment of this condition?

**Giardiasis** infection (*Giardia lamblia)* Swimming/drinking water from a **lake/river** Treatment: **metronidazole**

A classical finding of secondary TB on a chest xray is **upper lobe consolidation** **with cavitation** *(gas filled spaces*). What organism is known to colonise these gas filled spaces? What is the classical sign seen on a chest xray that would indicate colonisation by this organism?

**Aspergillus fumigatus →** forms an **aspergilloma** (a ball of fungus) **Crescent sign** is seen on a chest xray

Which STI is caused by *Treponema pallidum?*

Syphilis

Name the 2 features of a **primary syphilis infection**: How is syphilis transmitted? What is the 1st line treatment of **primary** syphilis?

* Local, non-tender lymphadenopathy * **Chancre** (a painless ulcer at the site of sexual contact) Through sexual intercourse A single dose of **IM benzathine benzylpenicillin**

Infection Flashcards

(99 cards)