Infections Flashcards
Infections (101 cards)
1
Q
What is glandular fever also known as?
A
Infective mononucleosis
2
Q
What is the most common cause of infective mononucleosis?
A
EBV
3
Q
What proportion of people have had infective mononucleosis?
A
90% of world population
4
Q
What is the classic triad of infective mononucleosis?
A
Lymphadenopathy
Pharyngitis
Fever
5
Q
How is infective mononucleosis transmitted?
A
Kissing disease- saliva
Sexual transmission
Blood products, organ transplant
6
Q
How may infective mononucleosis present?
A
Fever 1-2 weeks
Lymphadenopathy
Pharyngitis
Photophobia, cough, fatigue, headache, splenomegaly
7
Q
What are the investigations for infective mononucleosis?
A
FBC: -lymphocytosis -atypical lymphocytosis Heterophile antibodies -monospot test -positive heterophile antibodies EBV specific receptors (high sensitivity) Real time PCR
8
Q
What are the three EBV specific receptors measured?
A
Viral caspid antigen IgM
Viral caspid antigen IgG
Epstein-Barr nuclear antigen IgG (EBNA IgG)
9
Q
What EBV specific receptors will be seen in a healthy Ptwithout EBV?
A
- ve VCA IgM
- ve VCA IgG
- ve EBNA IgG
10
Q
What EBV specific receptors will be seen a Pt with early infective mononucleosis?
A
+ve VCA IgM
- ve VCA IgG
- ve EBNA IgG
11
Q
What EBV specific receptors will be seen a Pt with acute infective mononucleosis?
A
+ve VCA IgM
+ve VCA IgG
-ve EBNA IgG
12
Q
What EBV specific receptors will be seen a Pt with a history of infective mononucleosis?
A
-ve VCA IgM
+ve VCA IgG
+ve EBNA IgG
13
Q
What is the management for a Pt with infective mononucleosis?
A
Supportive care (paracetamol, hydration etc) Corticosteroids if URT obstruction, haemolytic anaemia, or thrombocytopaenia
14
Q
Why should you not give aspirin to children?
A
Risk of developing Reye’s syndrome
Causes swelling in the liver and brain
15
Q
What are the two conditions caused by varicella zoster infections?
A
Chicken pox (aka varicella) Shingles (aka herpes zoster)
16
Q
What are the characteristics of varicella?
A
Fever
Malaise
Generalised pruritic vesicular rash
17
Q
What are the characteristics of herpes zoster?
A
Reactivation of VZV
Dermatomal distribution of rash
18
Q
What are the risk factors for a VZV infection?
A
> 50 yrs or child
HIV +ve
Chronic corticosteroid use
aka any form of immunosuppression
19
Q
What are the investigations for a VZV infection?
A
Clincial diagnosis
Can consider PCR, viral culture, ELISA
20
Q
What is the management for varicella?
A
Supportive care
Paracetamol
Diphenhydramine (antihistamine)
Avoid aspirin and NSAIDs
21
Q
What is the management for herpes zoster?
A
Antiviral therapy:
1st line- famciclovir/valaciclovir
2nd line- acyclovir
22
Q
What are the complications of VZV?
A
Ocular complications
Meningoencephalitis
Peripheral nerve palsy
Spinal cord myelitis
23
Q
What can a HSV1 infection cause?
A
Herpes labialis
Genital herpes
HSV encephalitis
24
Q
What can a HSV2 infection cause?
A
Genital herpes
25
How may a HSV1 infection present?
```
Gingivostomatitis/cold sores
Herpetic whitlow (vesicles in fingers)
Eczema herpeticum
Systemic signs (fever, sore throat, lymphadenopathy)
Herpes simplex encephalitis
```
26
How may a HSV2 infection present in a male?
```
Vesicles on shaft or glands
Proctitis with discharge
Rectal pain
Tenesmus
Constipation
Impotence
```
27
How may a HSV2 infection present in a female?
Genital pain
Discharge
Dysuria
Ulcerative lesions
28
What are the investigations for HSV infections?
Viral culture
HSV PCR
Glycoprotein G-based type specific serology (gG1 and gG2)
29
What type of virus is HIV caused by and what cells does it infect?
Retrovirus
| Human lymphocytes/macrophages
30
What are the routes of HIV transmission?
```
Sexual contact
Before birth
During delivery
Breast feeding
IVDU
```
31
What are the 3 stages of HIV infection?
Primary
Asymptomatic
AIDS-related complex
32
What is the primary HIV stage?
2-6 weeks transient illness
| Fever, malaise, myalgia, pharyngitis, generaised lymphadenopathy
33
What is the asymptomatic HIV stage?
Persistent generalised lymphadenopathy
FLAWs, diarrhoea after a while
CD4 <400x10^6
34
What is the AIDS-related complex HIV stage?
Opportunistic infections
| CD4 200x10^6
35
What is the cause of oral candidiasis?
Fungal candida infection
| Due to immunosuppression
36
What is the cause of hairy leukoplakia?
Triggered by EBV
| White patches appear on tongue/inside cheek
37
What is the cause of Kaposi's sarcoma?
Human herpes virus 8
| Pink/violaceous path on skin/mouth
38
What are the investigations for HIV?
```
ELISA
Serum HIV rapid test
Sample buccal saliva
HIV PCR
CD4 count
```
39
What are some common pathogens that cause tonsillitis?
```
Rhinovirus
Coronavirus
Adenovirus
Beta-haemolytic/streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
```
40
What are the features of tonsillitis?
```
Pain on swallowing
Fever
Tonsillar exudate
Sudden onset sore throat
Tonsillar erythema
Tonsillar enlargement
Anterior cervical lymphadenopathy
```
41
What are the investigations for tonsillitis?
Throat culture
| Rapid streptococcal antigen test
42
What are the common locations of candidiasis?
Mouth
| Genitals
43
What is systemic candidiasis?
Acute disseminated candidiasis to blood, pleura and peritoneal fluid
Associated with fever, hypotension and leukocytosis
44
What are the risk factors for candidiasis?
```
HIV
Malnutrition
Diabetes
Malignancy
Chemotherapy/radiotherapy
Other forms of immunosuppression
```
45
What are the investigations for candidiasis?
Superficial smear for microscopy
Urinalysis
Random/fasting glucose
46
What are the pathogens that cause the common cold?
```
Rhinoviruses (50%)
Coronavirus (10-15%)
Influenza (5-15%)
Parainfluenza (5%)
Respiratory syncytial virus (5%)
```
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
47
What is the investigation for the common cold?
Clinical diagnosis
48
What is the management for the common cold?
Hydration
Antipyretic/analgesic
Decongestant
Antitussive
49
What is an abscess?
A collection of pus within a tissue/organ/confined space
50
What are the features of an abscess?
```
Erythema
Hot
Oedema
Pain
Loss of function
Fever
Systemically unwell
```
51
What is the investigation for an abscess?
Clinical diagnosis
52
What is the management for an abscess?
Incision and drainage
Only give antibiotics if severe eg:
Sepsis, cellulitis, multiple sites of infection
53
What is Bartholin's abscess?
A build up of pus in one of Bartholin's glands, found on each side of the vaginal opening
54
What is Quinsy's abscess?
A build up of pus between one of the tonsils and the wall of the throat
55
What is a pilonidal abscess?
A build up of pus in the skin of the cleft of the buttock
56
What are the common causes of meningitis?
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenza type B
57
What is a common cause of encephalitis?
Herpes virus
58
What are the features of meningitis?
Stiff neck
Photophobia
Non-blanching rash
59
What are the features of encephalitis?
```
Altered state of consciousness
Seizures
Personality change
Cranial nerve palsies
Speech problems
Motor and sensory deficit
```
60
What are the investigations of meningitis?
LP if there are no clinical features of raised ICP
61
What is the management for meningitis?
Empirical antimicrobial therapy
- ceftriaxone
- vancomycin
62
What is Brudzinski's sign?
Neck flexion causes hip and knee to flex
63
What is Kernig's sign?
Cannot straighten leg when hip is at 90 degrees
64
What does the following CSF sample show?
```
Appearance- clear
WCC- low
Protein- normal
Glucose- normal
Gram stain- NA
```
Normal CSF
65
What does the following CSF sample show?
```
Appearance- turbid
WCC- high neutrophil
Protein- high
Glucose- low
Gram stain- positive
```
Gram positive bacterial meningitis
| eg. Streptococcus pneumoniae
66
What does the following CSF sample show?
```
Appearance- turbid
WCC- high neutrophil
Protein- high
Glucose- low
Gram stain- negative
```
Gram negative bacterial meningitis
| eg. Neisseria meningitidis
67
What does the following CSF sample show?
```
Appearance- clear/cloudy
WCC- high lymphocyte
Protein- raised
Glucose- normal
Gram stain- NA
```
Viral meningitis
68
What does the following CSF sample show?
```
Appearance- clear/cloudy
WCC- high lymphocytes
Protein- raised
Glucose- low
Gram stain- NA
```
TB/Fungal meningitis
69
What further investigation could be done to differentiate between a TB and fungal meningitis?
Ziehl-Neeslon stain- TB
| India ink stain- fungal
70
What are the risk factors for infective endocarditis?
```
Rheumatic heart disease Hx
Age-related valvular degeneration
Prosthetic valve (S. epidermidis)
IVDU (Staph. aureus)
Dental procedures (S. viridans)
```
71
What are the investigations and management for infective endocarditis?
3 blood cultures at least 1hr apart within 24hrs
Urgent echo
Broad spec antibiotics
72
Which infections can cause gastroenteritis with diarrhoea?
```
Campylobacter/C difficile
Staph aureus
Vibrio cholera
E. coli
Bacillus cereus
```
73
Which infections can cause gastroenteritis with dysentery?
```
CHESS
Campylobacter/C difficile
Haemorrhagic E. coli
Entamoeba histolytica
Shigella
Salmonella
```
74
What are the investigations for gasteroenteritis?
FBC
| Stool MC+S
75
How is Hep A and E transmitted?
Faecal-oral route
76
What is the management for Hep A and E?
Supportive care
77
What are the clinical features of Hep B?
```
Flu-like prodrome
Rash
Lymphadenopathy
RUQ pain
Jaundice
```
78
What are the risk factors for Hep B?
Unprotected sex
MSM
IVDU
Blood transfusion
79
What is the management for Hep B?
Acute- supportive
| Chronic- peginterferon alpha, Tenofovir
80
Can you get Hep D without Hep B?
No
81
What is the main worry for Hep B/C?
Risk of HCC
82
What are the common pathogens of UTIs?
Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis
Enterococci
83
What are the investigations for a UTI?
Dipstick urinalysis- positive nitrates +/- leukocytes
Urine microscopy- leukocytes
Urine MC&S
Abdo USS- exclude urinary tract obstruction or renal stones
84
What is the management for a UTI?
Trimethoprim
85
What are the five types of malaria?
```
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
```
86
What are the characteristics of Plasmodium flaciparum?
```
Most threatening
Common in tropical regions:
Sub-Saharan Africa
South east Asia
Oceania
Amazon basis of South America
```
87
What are the features of malaria?
```
Headache
Weakness
Myalgia
Arthralgia
Anorexia
Diarrhoea
Fever - Characteristic paroxysms of chills and rigors followed by fever and sweats may be described
```
88
What are the investigations for malaria?
Giemsa-stained thick and thin stains
Thick- detects parasites
Thin- identifies species
FBC, Clotting profile, U+E, LFTs, blood glucose, Urinalysis, ABG
89
A 30 yo lady on the HIV ward has white plaques all over her tongue that extend into her throat. She says it’s very painful to swallow.
What is the most likely causative organism?
```
A. Candida albicans
B. Epstein-Barr virus
C. Herpes Simplex Virus
D. Streptococcal throat infection
E. Human Herpes Virus 8
```
A. Candida albicans
90
A 50 year old homeless man presents to A&E with purple purpural lesions on his back and on his gums.
What is the most likely causative organism?
```
A. HHV-2
B. HHV-4
C. HHV-5
D. HHV-7
E. HHV-8
```
E. HHV-8
91
A 26 year old architect presents to GP with a history of sharp tingling around his lips followed by a painful ulcer on the side of his mouth. O/E he has cervical lymphadenopathy and a blister on his finger.
What is the pathogen?
```
A. Varicella Zoster Virus
B. Epstein-Barr Virus
C. Herpes Simplex Virus 1
D. Herpes Simplex Virus 2
E. Cytomegalovirus
```
C. Herpes Simplex Virus 1
92
A 20 year old medical student presents with sore throat, headache, myalgia and coryzal symptoms. O/E she has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly.
What is the most likely diagnosis?
```
A. Varicella Zoster Virus
B. Epstein-Barr Virus
C. Herpes Simplex Virus 1
D. Herpes Simplex Virus 2
E. Cytomegalovirus
```
B. Epstein-Barr Virus
93
A 20 year old medical student presents with sore throat, headache, myalgia and coryzal symptoms. O/E he has cervical lymphadenopathy, enlarged exudative tonsils and splenomegaly.
What is the most appropriate management?
```
A. Rest at home, paracetamol
B. Amoxicillin
C. Acyclovir
D. Ceftriaxone
E. Vancomycin
```
A. Rest at home, paracetamol
94
A 15 year old female patient presents to A&E with difficulty speaking. 4 days ago she experienced a sore throat, which progressively got worse. It’s now difficult for her to speak or swallow. She has not had a cough or cold recently.
O/E there is bilateral tonsillar exudate and the oropharynx is not erythematous. There are 3 tender swellings on the anterior border of the sternocleidomastoid muscle.
Her observations are: T 39.1, HR 90, BP 113/68, SpO2 97%
What is the most likely diagnosis?
```
A. Infectious mononucleosis
B. Viral tonsillitis
C. Common cold
D. Bacterial tonsillitis
E. Chickenpox
```
D. Bacterial tonsillitis
95
A 22 year old university student is seen in the GP with a fever, headache, neck stiffness and photophobia. Which is the most likely causative organism in this patient?
A. Bacterial meningitis due to Haemophilus influenzae
B. Bacterial meningitis due to Neisseria meningitides
C. Bacterial meningitis due to Streptococcus pneumoniae
D. Fungal meningitis
B. Bacterial meningitis due to Neisseria meningitides
96
A 22 year old university student is seen in the A&E with a fever, headache, neck stiffness and photophobia. A lumbar puncture was performed. The appearance of the fluid is clear, there are raised proteins and normal glucose. Lymphocyte count is raised. What is the most likely cause of this?
```
A. Bacterial meningitis
B. Drug induced meningitis
C. Fungal meningitis
D. TB meningitis
E. Viral meningitis
```
E. Viral meningitis
97
40 year old woman returns from holiday in Vietnam. She started getting diarrhoea after eating some local food on her last day in Vietnam. She presents with fever, nausea and is sore all over. The white of her eyes are yellow.
What is the most likely causative organism?
```
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
```
A. Hepatitis A
98
A 29 yo male comes to the GP with fever, fatigue, joint pain and urticaria-like skin rash. He had unprotected anal sex a month ago. He comes back a week later for a blood test, which shows raised ALT and AST. He now complains of feeling sick, RUQ pain and looks a bit yellow.
What is the most likely causative organism?
```
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
```
B. Hepatitis B
99
A 70 yo M has been in hospital for the past two weeks for severe pneumonia. He develops bloody diarrhoea, colitis and reduced urine output. He has raised CRP, WCC and low albumin.
What is the most likely causative organism?
```
A. Campylobacter
B. C. Difficile
C. Bacillus cereus
D. E. Coli
E. Vibrio cholera
```
B. C. Difficile
100
A 20 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood.
What is the most likely cause?
```
A. Entamoeba histolytica
B. Staph aureus
C. Bacillus cereus
D. E. Coli
E. Vibrio cholera
```
E. Vibrio cholera
101
A 40 yo woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain.
What is the most likely cause?
```
A. Campylobacter
B. Shigella
C. Bacillus cereus
D. E. coli
E. Salmonella
```
A. Campylobacter
