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Year 3 Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

How should you take blood cultures from a patient with suspected endocarditis?

A

Three cultures from at least three different sites

To be taken before antibiotics commenced

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2
Q

What is sepsis?

A

life-threatening organ dysfunction caused by a

dysregulated host response to infection

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3
Q

What is the sepsis 6?

A 
Give O2 
Give IV fluids
Give IV Abx
Take blood cultures 
Measure lactate 
Measure urine output
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4
Q

What are the common organisms that cause soft skin infections?

A

Staphylococcus aureus
Streptococci
MRSA

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5
Q

What organisms can cause MSK infections?

A

Staphylococcus aureus
Streptococci
MRSA
TB

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6
Q

What organisms commonly causes respiratory infections?

A

Streptococci pneumoniae
Haemophilus influenzae
Atypical: legionella, mycoplasma
Rhinovirus/adenovirus/enterovirus/influenza

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7
Q

What organisms commonly cause GI infections?

A 
Rotavirus, adenovirus
Campylobacter
Shigella
E.Coli
Salmonella typhi/paratyphi
Enterobacteriacae (visceral infection/peritonitis)
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8
Q

What organisms typically cause GU infections?

A 
Enterobacteriacae (e.g. e.coli, klebisella sp, proteous sp.)
Pseudomonas arogenosa
ESBL/resistant organisims 
Neisseria gonorrhoeae
Chlamydia trachomatis
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9
Q

What organisms commonly cause CNS infections?

A 
Streptococci pneumoniae
Neisseria meningitidis
Listeria
TB
Herpes simplex virus
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10
Q

What organisms typically cause endocarditis?

A

Streptococci viridans group
Enterococci faecalis/faecium
Staphlococcus aureus
MRSA

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11
Q

What organisms typcially cause line infections?

A

Staphylococcus aureus
Streptococci
MRSA

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12
Q

What is the first line antibiotic to treat suspected sepsis?

A

Meropenem stat dose

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13
Q

What organisms typically cause hospital aquired infections?

A

Enterobacteriacae (E.coli, Klebsiella spp.)
Pseudomonas spp.
C. difficile
Staph. aureus (pneumonia)

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14
Q

What is the 10 point approach to a patient with an infection?

A
  1. What is the evidence for infection
  2. Severity
  3. Patient factors to consider
  4. Body system/organ affected
  5. What is the likely organism involved?
  6. And therefore what is the best antimicrobial therapy?
  7. Which route of administration is best?
  8. Is any other treatment needed?
  9. Is there any risk of transmission to others?
  10. What planning is required for follow-up and discharge?
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15
Q

What travel-related illness signs/symptoms do patients most commonly present with?

A 
Diarrhoea
Vommiting
Jaundice
Lymphadenopathy
Hepatosplenomegaly
Cough
SOB
Rash
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16
Q

What should be asked when taking a history from a patient where travel-related infection is suspected?

A 
Geographic region of travel within the last 12-18 months
ANY previous travel to the tropics
Dates of travel and duration of stay
Time and onset of signs and symptoms
Rural vs urban stays - accomidation
Recreational activities and exposures
Food and water
Sexual exposures
PMH and predisposition to infection
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17
Q

What kind of infection is likely to present 0-10 days after travel

A 
Dengue
Rickettesa (insects)
Viral
Bacteria
Amoeba
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18
Q

What type of infection is likely to present 10-21 days after returning from travel?

A

Malaria
Typhoid
Primary HIV infection

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19
Q

What type of travel-related infection is likely to present after 21 days?

A

Malaria
Chronic bacterial infections (brucella, coxiella, endocarditis, bone and joint infections)
TB
Parasitic infections

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20
Q

What infections can cause splenomegaly?

A 
Mononucleosis 
Malaria
Visceral leishmaniasis
Thyphoid fever
Brucellosis
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21
Q

What infections may present with a maculopapular rash?

A 
Dengue fever
Leptospirosis
Rickettsia
EBV
CMV
Rubella
Parovirus 19
Primary HIV infection
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22
Q

What travel-related infections can cause meningo-encephalitis?

A

Cerebral maleria
Japanese enchephalitis
West nile virus encephalitis
(+common causes) N.meningitis/STrep penumonia/ HSV

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23
Q

What is the most common species of malaria that causes serious illness?

A

Plasmodium falciparum

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24
Q

What is the most common species of malaria?

A

Plasmodium vivax

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25
Q

How does malaria present?

A 
Abrupt onset rigors
High fevers
Malaise
Severe headache
Myalgia
Vague abdo pain
N&V
Diarrhea (25%)
Jaundice
Hepatoslenomegaly 
Anaemia, thromovytopenia, leukopenia, abnormal LFTs(chronic illness)
Untreated p. falciparum: hypoglycemia, renal failure, pulmonary odema, neurologic deterioration
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26
Q

Where is typhoid fever prevalent?

A

South east Asia

Southern and Centeral America

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27
Q

How does Thypoid Fever present?

A 
Sustained fever
Anorexia
Malaise
Vague abdominal discomfort 
Constipation or diarrhea
Dry cough
Hepatospleonmegaly
Rose spots
Pule-temperature dissociation
Leucopenia, lymphopenia, raised CRP
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28
Q

How is typhoid fever diagnosed?

A

Isolation of organism in cultures of blood, stool, urine, bone marrow, duodenal aspirates

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29
Q

How is suspected Typhoid fever treated empirically?

A

IV Ceftriaxone

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30
Q

What is used to treat Typhoid once sensitivites known?

A

Ciprofloxacin or Azithromycin

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31
Q

What is the definition of Pyrexia of Unknown Origin?

A

Temperature > 38 degrees on multiple ocassion
Illness > 3 weeks duration
No diagnosis despite > 1 week inpatient stay

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32
Q

Causes of PUOs?

A

Infective - TB, abscesses, infective endocarditis, brucellosis
Autoimmune/connective tissue adult onset Still’s disease, temporal arteritis, Wegner’s granulomatosis
Neoplastic - leukaemias, lymphomas, renal cell carcinoma
Other - drugs, thromboembolism, hyperthroidsim, adrenal insufficiency

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33
Q

Key parts of examination when reviewing a pt with PUO

A

Lymph nodes
Stigmatat of endocarditis
Evidence of weight loss
Joint abnormalities

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34
Q

What is the lifetime reactivation risk of TB?

A

10-15% usually due to immunosupression, HIV, increasing age

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35
Q

What screening is used to identify latent TB?

A

quantiFERON or T-spot - measurement of interferon gamma

CXR

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36
Q

Who should be screened for latent TB?

A

Immigrants from high prevalence countries
Healthcare workers
HIV positive patients
Patient starting on immunosupression

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37
Q

What drugs are used to treat latent TB?

A

3 MONTHS RIFAMPICIN + ISONIAZID
or
6 MONTHS RIFAMPICIN

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38
Q

Active TB symptoms

A

Non-resolving cough
Unexplained persistent fever (low or high grade)
Drenching night sweats
Weight loss

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39
Q

What clinical signs may be present in a patient with TB?

A 
Clubbing
Cachexia
Lymphadenopathy
Hepato/splenomegaly 
Erythema Nodosum 
Crepitations
Bronchial breathing
Pericardial rub
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40
Q

What imaging may be used for TB?

A

CXR - pulmonary TB
CT - Lymphadenopathy, nodes with central necrosis, lesions in viscera
MRI - can show leptomeningeal enhancement in TB meningitis

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41
Q

What may be seen on the CXR of a patient with pulmonary TB?

A

Mediastinal lymphadenopathy
Cavitating pneumonia
Pleural effusion

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42
Q

What is the gold standard for diagnosing TB?

A

Bacterial culture
Ideally taken before treatment commenced
But do not need to wait to start therapy as may take up to 6 weeks

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43
Q

What is smear positive TB?

A

TB can be seen on a sample using single microscopy

High bacterial load and high infectivity

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44
Q

In smear negative pulmonary TB what investigation is done next?

A

Bronchoscopy +/- endobronchial guided biopsy of pulmonary lymph nodes

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45
Q

How is meningeal TB diagnosed?

A

Lumbar puncture for TB culture and PCR

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46
Q

How is lymph node TB diagnosed?

A

Core biopsy of lymph node

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47
Q

How is pericardial TB diagnosed?

A

If practical (often not) pericardiocentesis

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48
Q

How is GI TB diagnosed?

A

Colonoscopy and bowel biopsy/US guided omentum biopsy

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49
Q

What is seen on TB histology?

A

Caseating/necrotising granulomatous inflammation

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50
Q

When should steroids be given alongside ATT?

A

When TB is affecting sites that cannot tolerate swelling e.g. meningial/spinal/pericardial
Steroids given at the start of treatment

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51
Q

Why do many patients feel worse at the start of TB treatment?

A

Increase in inflammation as bacteria die causing worsening symptoms

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52
Q

What complications may result from pericardial TB? What signs might be seen?

A

Pericardial Effusion
Tamponade
Pericardial rub
Kussmaul’s sign

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53
Q

When should ATT be started in patients with MIliary TB?

A

As soon as it is determined whether or not there is a CNS involvement, using CT/MRI head, should not be delayed whilst awaiting biopsies

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54
Q

Where can Miliary TB be found?

A 
Widespread
Lung 
CNS
Bone marrow
Pericardium
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55
Q

What precautions should be taken in terms of infection control for patients with MDR TB

A

Negative pressure room

Staff to wear masks and PPE

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56
Q

What is the Standard ATT (used for all sites but CNS)

A 
2 months:
Rifampicin 
Isoniazid 
Ethambutol 
Pyrazinamide 
(Pyridoxine)
4 months 
Rifampicin
Isoniazid 
(Pyridoxine)
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57
Q

Side effects of Rifampicin?

A

Turns urine/tears orange

Hepatitis

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58
Q

Side effects of Isoniazid?

A

Peripheral nueropathy
Colour blindness
Hepatitis

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59
Q

Ethambutol side effects?

A

Optic neuropathy

Reduced visual acuity

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60
Q

Which drug used in ATT is most likely to cause hepatitis?

A

Pyrazinamide

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61
Q

What monitoring is required before commencing ATT?

A

Baseline LFTs

Ethambutol - visual acuity

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62
Q

What must be monitored throughout ATT?

A

LFTs

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63
Q

For how long must a patient with TB be isolated?

A

Until they have been treated for 2 weeks

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64
Q

How can NAATS be performed when screening for chlamydia trachomatis or neisseria gonorrhoeae?

A

first pass urine (men)
vulvo-vaginal swab
pharyngeal swab
rectal swab

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65
Q

Where should a vaginal discharge swab be taken from when testing for trichomonas vaginals and candida?

A

Posterior fornix

Charcoal swab

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66
Q

Where should a vaginal discharge swab be taken from when testing for Gonococcal culture?

A

Cervical os

Charcol swab

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67
Q

What kind of swab should be used for Gonococcal cultures?

A

Charcol

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68
Q

What viruses should be tested for in patients with genital and oral ulcers?

A

HSV 1

HSV 2

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69
Q

What infections may cause anal discharge?

A

Gonorrhea

HSV

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70
Q

What baseline investigations should be carried out on patients newly diagnosed with HIV?

A

Confirmatory HIV test
CD4 count
HIV viral load
HIV resistance profile
HLA B*5701 status
Serology for syphillis, hepatitis B, hep C, heP A
Toxoplasma IgG measles IgG varicella IgG rubella IgG
FBC U&Es LFTs bone profile lipid profile
Schistosoma serology (if spent >1 month in sub-Saharan Africa)
Women should have annual cervical cytology

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71
Q

What serology should be conducted for Hep B?

A

sAg
cAb
sAb

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72
Q

Below which CD4 count should HIV patients be perscribed prophylactic antibiotics against PCP?

A

CD4 < 200

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73
Q

Below what CD4 is considered AIDs?

A

CD4 < 200

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74
Q

What vaccinations should be given to patients with HIV?

A

Hep B
Pneumococcus
Annual Influenza

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75
Q

After what time period following ingestion does Bacillus cereus infection present?

A

Within 6 hours

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76
Q

What food most commonly causes Bacillus cereus?

A

Rice

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77
Q

What symptoms does Bacillus Cereus infection cause?

A

Vomiting

Diarrhoea

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78
Q

How does Heamophillus Influenzae present on gram stain?

A

Gram negative cocci

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79
Q

What drugs can be used to treat VRE?

A

Linezolid

Teicoplanin

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80
Q

What is the gold standard in diagnosis of malaria?

A

Thick and thin blood films
Thin: identification of species
Thick: estimation of parasite density

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81
Q

What is the most common cause of food poisoning in the UK?

A

Campylobacter jejuni

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82
Q

What kind of diarrhoea does campulobacter jejuni cause?

A

Dysenteric (blood+mucus) due to bacterial invasion of the intestinal mucosa

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83
Q

What is the investigation of choice for chlamydia?

A

NAATs

Nuclear acid amplification test

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84
Q

How does HSV typically present

A

Painful ulcers

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85
Q

How does syphillis normaly present?

A

Painless ulcers

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86
Q

What kind of bacterium is chlamydia trachomatis?

A

Obligate intracellular

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87
Q

What kind of bacterium is N.gonorrhoea - intracellular or extracellular?

A

Extracellular

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88
Q

How is chlamydia managed?

A

7 days doxycycline

Azithromycin if not tolerated or in pregnancy

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89
Q

What can predispose patients with parovirus B19 to aplastic aneamia?

A

Patients with a background of haemolytic aneamia

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90
Q

What virus can cause a characteristic slapped cheek rash, particularly in children?

A

Parovirus 19/fifth disease

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91
Q

Parovirus 19 can cross the placenta, before what gestation should a pregnant woman seek advice if exposed?

A

20 weeks

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92
Q

What is Lemieere’s syndrome?

A

Thrombophlebitis of the internal jugular vein following an anaerobic oropharangeal infection (e.g. tonsillitis)

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93
Q

How long after transmission does hep A present? How is it often transmitted?

A

2-4 weeks

Undercooked meat/unclean water consumed in developing countries

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94
Q

Why should bacteria in the urine of a pregnant woman be treated, regardless of symptoms?

A

Risk factor for low birth weight, pyelonephritis, premature delivery

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95
Q

At what point in a pregnancy is trimethoprim tetragenic?

A

First trimester

96
Q

When shout nitrofurantonin be avoided during pregnancy?

A

At term - may produce neonatal haemolysis

97
Q

What are the main caustive organisms for cellulitis?

A

Staphylococcus aureus

Streptococcus pyogens

98
Q

Antibiotic of choice for cellulitis?

A

Flucloxacillin

Clarithromycin if pen allergic

99
Q

What is the treatment of choice for Neisseria gonorrhoeae infection

A

intramuscular antibiotic injection of ceftriaxone

100
Q

Which antibiotic class can cause defective desquamation of the filiform papillae of the younger, leading to a black, hairy tongue

A

Tetracyclines (doxycycline, tetracycline)

101
Q

What is the drug of choice to treat Schistosoma mansoni?

A

praziquantel

102
Q

What is the treatment for PID?

A

Doxycycline + metronidazole + ceftriaxone

103
Q

What is the antibiotic of choice for extensive otitis externa?

A

Flucloxacillin

104
Q

What should be used to treat an outbreak of genital herpes?

A

Oral aciclovir

105
Q

How many doses of tetnus vaccination is suitable for long term protection?

A

5

106
Q

What vaccinations are routinely offered to women who are pregnant?

A

Influenza

Pertussis

107
Q

How does BV (gardnerella vaginalis) infection present?

A 
Offensive vaginal discharge
Fishy smell - positive whiff test when potassium hydroxide added
Clue cells
Grey in colour
Vaginal pH > 4.5
108
Q

How does a vaginal canddida albicans infection typically present?

A

White ‘curdy’ vaginal discharge

pH < 4.5

109
Q

How to trichomonas vaginalis infections typicall present?

A

Vulvovaginitis acoompinied by offensive, yellow-green frothy discharge

110
Q

What drug is used to treat both BV and trichomonas

A

Metronidazole

111
Q

WHat is the latest time HIV PEP can be given?

A

72 hours after exposure

112
Q

What antibiotic should be given to treat an atypical pneumonia?

A

Clarithromycin

113
Q

What antibiotic should be used to treat a lower urinary tract infection?

A

Trimethoprim
Nitrofurantonin
Amoxicillin
Cephalosporin

114
Q

What antibiotic should be added in the treatment of penumonia secondary to influenza?

A

Flucloxacillin

115
Q

What is the first-line antibiotic threapy for campylobacter infection?

A

Clarithromycin

116
Q

What organism causes Q fever and what is its natural resevoir?

A

Coxiella burnetti

Cattle and sheep

117
Q

What organism causes Q fever and what is its natural resevoir?

A

Coxiella burnetti

Cattle and sheep

118
Q

Common local complication of gonorrhoea in men?

A

Urethral stricture

119
Q

How does Neisseria Meningitidis appear on gram stain?

A

Gram negative diplococci

120
Q

How does E coli appear on gram stain?

A

Gram negative rods

121
Q

How does Staph aureus appear on gram stain?

A

Gram positive cocci - grape like

122
Q

How does staph epidermis appear on gram stain?

A

Gram positive cocci - grape like

123
Q

How does staph pyogenes appear on gram stain?

A

Gram positive cocci chains

GROUP A are B HAEMOLYTIC

123
Q

How does staph pyogenes appear on gram stain?

A

Gram positive cocci chains

GROUP A are B HAEMOLYTIC

124
Q

How does C. difficile appear on gram stain?

A

Gram positive rod

125
Q

How does step pneumoniae appear on gram stain?

A

Gram positive cossus (usually diplococci)

126
Q

How does viridans streptococci appear on gram stain?

A

Gram positive cocci in chains

127
Q

How does haemophilus influenzae appear on gram stain?

A

Gram negative coccobacilli

128
Q

How does salmonella typhi appear on gram stain?

A

Gram negative bacilli with flagella

129
Q

How does legionella pneumophillia look on gram stain?

A

Gram negative bacilli

130
Q

What kind of virus is EBV?

A

dsDNA envoloped virus

131
Q

How does EBV appear on a FBC?

A

Elevated lymphocytes, on microscopy atypical lympocytes will be seen

132
Q

What kind of virus is Varicella Zoster?

A

Enveloped DNA virus

133
Q

Where does latent infection of varicella zoster lie?

A

Dorsal root ganglia

134
Q

What kind of rash does varicella zoster cause?

A

Vesicular rash

135
Q

How can varicella zoster be treated?

A

Acyclovir

136
Q

What kind of virus is HIV?

A

ssRNA, enbeloped retrovirus

137
Q

Name opportunistic infections that can be found in patients with HIV?

A

Oral candidiasis - candida albicans
Kaposis sarcoma - HHV8
Pneumonocystis pneumonia - pneumonocystis

138
Q

How is P.Falciarum treated

A

Quinine
Doxyclcyline
Can use chloroquinine but do G6PDH testing first

139
Q

How is candida albicans treated?

A

Nystatin
CLotrimazole
IV fluconazole

140
Q

How is aspirgillous infection treated?

A

Amphotericin B

141
Q

What antibiotic is used to treat Neisseria Meningitdes infection?

A

Ceftriaxone (good activity in CSF) in sepsis

142
Q

Best antibiotic for e-coli UTI?

A

Trimethoprim

143
Q

What antibiotic is used to treat staph epidermis infection?

A

Flucloxacillin

144
Q

What antibiotic is used to treat strep pyogenes infection?

A

Penicillin V

Clarithromycin if resistant

145
Q

What antibiotic is used to treat c.diff infection?

A

Vancomycin

146
Q

What antibiotic is used to treat strep pneumoniae infection?

A

MILD Amoxicillin/doxycyline
MODERATE (amoxicillin) + doxycycline
SEVERE: CO amoxiclav/meropenem and Doxycycline

147
Q

What antibiotic is used to treat haemophilus influenzae infection?

A

Amoxicillin

148
Q

What antibiotic is used to treat salmonella thyphi infection?

A

3rd gen cephalosporin (cefixime)

149
Q

What is used to treat legionella pneumophila

A

CLarithromycin or fluroquinolones

150
Q

In hepatitis B which antibody will be positive in vaccinated patients?

A

Anti HbsAb

151
Q

How is Hep C treated?

A

Ribovarin and interferon (8-12 weeks)

152
Q

How is HIV treated?

A

2 Nucleoside inhibitors + 1 non-nucleoside reverse transcriptase inhibitor / 1 protease inhibitor / 1 intergrase inhibitor

153
Q

What is the most common caustive ogranism of bacterial tonsilitis?

A

Streptococcus pyogenes

154
Q

What is used to treat bacterial tonsillitis?

A

Penicillin V

155
Q

Most common causes of pharangitis?

A

EBV
Adenovirus
Steptococcus pyogenes

156
Q

How may schitosomiosis infection present?

A 
Hepatospleonmegaly 
Eosinophillia
Katayama fever
Helminth eggs in stools and urine
Liver/bladder fibrosis
157
Q

What is the diagnostic test for mumps?

A

Salivary IgM testing

158
Q

Mode of transmission for measles?

A

Resp droplets

159
Q

What are the white spots inside a patients cheek that are called found in children with measels?

A

Koplik

160
Q

What test can quickly identify streptococcus pneumonia?

A

Urinary antigen testing

161
Q

Risk factors for brucellosis?

A

Abatoir work
Unpasturised milk consumption
Transmission through resp droplets between farmers

162
Q

Incubation of brucellosis

A

5-30 days

163
Q

What CSF findings are found in bacterial meningitis?

A

Macroscopically purulent
Neutrophillic leukocytosis
Low glucose
High protein

164
Q

What often causes a tertian pattern (every two days) fever?

A

Plasmodium vivax or ovale species

165
Q

What is used to treat schistosomiasis?

A

Corticosteroids

Praziquantel

166
Q

Whats the first line treatment for c diff?

A

Oral vancomycin

167
Q

How does leprosy present?

A

Hypopigmented, hypoesthetic skin lesions
Leonine facial appearence
Neuorpathy with thickening of the peripheral nerves

168
Q

Best investigation to diagnose BV?

A

Gram stain

169
Q

Most common bacterial causes of gastroenteritis?

A

Staphylococcus aureus: usually found in cooked meats and cream products
Bacillus cerus: mainly found in reheated rice
CLostridium perfringes
E.coli
Salmonella
Shigella

170
Q

What clinical exmaination test is ussed to differentiate gastroenteritis from Dengue?

A

Torniquet test

171
Q

What is a positive torniquet test?

A

BP cuff inflated to midway between systolic and diastolic for five mins
If 10 or petechiae per square inch, positive

172
Q

Treatment for athletes foot?

A

Topical terbinafine?

173
Q

What ATT is most likely to cause hepatotoxicity?

A

Isoniazid

174
Q

What is given in bacterial meningitis to reduce morbiditiy and mortality?

A

IV Dexamethasone

175
Q

What should be used with caution in patients with a history of penicilin anaphylaxis?

A

1st gen cephalosporins such as ceftazadime

176
Q

What is the Argyll Robertson pupil and what is it associated with?

A

The pupil is constricted and does not react to light but does react to the accomidation reflex
Tertiary syphillis or neurosyphillis

177
Q

What is the first line in suspected bacterial meningitis in the primary care setting?

A

Benzylpenicillin

178
Q

What is a chancre?

A

A painless ulcer, appears in syphillis, typically with central slough and rolled edge

179
Q

What is a clinincal sign pathonogenic for Lymes disease?

A

Erthema migrans

Rash with red centre and red circle surrounding

180
Q

Which patients may suffer from pneumocystis jirovecci infection (fungal)?

A

Immunocompromised patients, usually with HIV

181
Q

How is pneumocystis jirovecii treated?

A

Co-trimoxazole

182
Q

What type of pneumonia does klebsiella pneumoniae cause?

A

Cavitating pneumonia

183
Q

How does klebsiella pneumoniae appear on gram stain?

A

Gram negative rods

184
Q

Where is pseudomonas usually aquired?

A

Hospital - contaminated ventilator

185
Q

How is Legionella pneumophilia treated?

A

Macrolides: erythromycin, roxithromycin, azithromycin and clarithromycin

186
Q

What blood test abnormalities may be present in legionella?

A

hyponatraemia and lymphopenia

187
Q

What is erythema migrans pathognomic of?

A

Lyme disease

188
Q

What causes lyme disease?

A

Borrellla burgdoferi (tick borne)

189
Q

How does stahpylococcal scalded skin syndrome present?

A 
Red tender blistering skin
Positive Nikolsky (the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender)
A prodome of sore throat or conjunctivitis may occur
190
Q

What CSF results are typical of bacterial meningitis?

A

A cell count of 90-1000+ mm3
Predominantly consisting of polymorphs
CSF glucose < 1/2 plasma glucose
CSF protein of over 1.5g/L

191
Q

What is bordetella pertussis?

A

Whooping cough

Symptoms, worse at night: cold, a runny nose, red and watery eyes, a sore throat, and a slightly raised temperature

192
Q

What triad does pneumocystis jirovecii?

A

Shortness of breath
Cough
Fever
Presents in Immunocompremised states such as HIV

193
Q

What is the gold standard investigation for TB?

A

Culture in Lowenstein-Jensen media

194
Q

What is schistosomiasis?

A

Infection from a trematode (fluke) of the genus Schistosoma
Indemic in many countries in sub-sahran africa
Leading cause of portal-HTN in those endemic areas (ascities, caput medusae)
Can cause genitourinary symptoms: frquency, haematuria, urinary tract obstruction)
GI symtpoms: GI bleed, diarrhoea, abdominal pain

195
Q

How does Mycoplasma penumonia infection present

A

Preceding flu like lillness, dry cough, erthema mutiforme (target shaped lesions), eveidence of anaemia (SOB and low Hb)
Common cause of atypical pneumonia

196
Q

What is erythema multiforme?

A

Target shaped lesions

197
Q

First line treatment for ESBL-producing organisms?

A

Cabapenums e.g. meropenem

198
Q

Treatment of MRSA?

A

Glycopeptides such as
Teicoplanin
Vancomycin

199
Q

Treatment for pseudomonas?

A

IV Ciprofloxacin

200
Q

1st line treatment for haemophilius influenzae?

A

Amoxicillin

Doxycycline if pen allergic

201
Q

1st line treatment for pseudomonas aeruginosa?

A

Ciprofloxacin

202
Q

What rare side effect of Ciprofloxacin should patients be conselled about?

A

Achillies tendinitis

203
Q

Common causative organisims of reactive arthritis?

A

Chlamydia trachomatis
Chlamydia pneumoniae
Campylobacter spp.
Neisseria gonorrhoeae

204
Q

Which oral antibiotic is most suitable for a dog bite?

A

Co-amoxiclav

205
Q

Treatment of choice for severe cellulitis?

A

IV benzylpenicillin and IV flucloxacillin

206
Q

What blood tests may be derranged in in legionella pneumophila?

A

LFT
FBC
U&E - hyponatremia

207
Q

Other than on FBC, how might legionella pneumophilla cause derranged blood tests?

A

LFTs deranged

U&Es - hyponatraemia

208
Q

What are fluroquinolones?

A

Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin etc.) are commonly used antibiotics for conditions such as infectious diarrhoea, pyelonephritis, otitis externa, pseudomonal infections and many other medical problems. Notable side effects include gastric distress, QT interval prolongation, tendonitis and tendon rupture. They are contraindicated in pregnant women.

209
Q

In patients with suspected infection without evidence of erythema migrans, NICE guidelines recommend what?

A

ELISA - enzyme linked immunosorbant assay

210
Q

What organism stains with india ink?

A

Cryptococcus neoformans

211
Q

Rash associated with rheumatic fever?

A

erythema marginatum

212
Q

Features associated with cholera diagnosis?

A

DIahorrea

Hypoglycemia

213
Q

Causes of genital ulcers?

A

painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum

214
Q

Prophylaxis against animal bites?

A

co amoxiclav

215
Q

W

A

A risk higher than 3% (as is the case with this patient) indicates that the patient should undergo PCI within 72 hours of hospital admission

216
Q

Preceding influenza predisposes to which organism?

A

staph aureus pneumonia

217
Q

menigococcal meningitis prophylaxis

A

Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis

218
Q

A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with what?

A

A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with oral fidaxomicin

219
Q

Gas gangrene?

A

There are multiple causes of gas gangrene but often clostrida species, particularly clostridium perfringens are implicated. Key features often begin with pain and then become systemic (fever, dehydration). This progresses on to skin changes, which are often seen as blisters which can burst produced a foul smelling discharge. Often crepitus can be heard on movement.

220
Q

pH glucose and LDL in empyema?

A

Empyema: Turbid effusion with pH<7.2, Low glucose, High LDH

221
Q

Causes of false negative mantoux test?

A 
TB
AIDS
Long-term steroid use
Lymphoma
Sarcoidosis
Extremes of age
Fever
Hypoalbuminaemia
Anaemia
222
Q

What travel related infection gets better and the worse again over a short duration?

A

Yellow fever has an incubation period of 2 to 14 days

223
Q

Special considerations in MENINGOCOCCAL SEPTICAEMIA? (VS classic bacterial meningitis)

A

DO NOT GIVE DEXAMETHASONE
DO NOT DO LUMBAR PUNCTURE
DO give cefotaxime

224
Q

Gastroenteritis within 12 hours?

A

Staph aureus

Bacillus cereus

225
Q

Bloody diahorrea

A

Salmonella
Shigella
Campylobacter (flu-like)

226
Q

Non bloody diahorrea most likely

A

E Coli

227
Q

Giardiasis vs amoebiasis?

A

G: bleeding, bloating, abdominal pain, flatulence, non-bloody diarroea
A:: non-bloody, liver absess

228
Q

What can vitamin A def cause?

A

Immune deficiency

Loss of nighttime vision

229
Q

Most common gram pos cause of CAP

A

Strep pneumonia

230
Q

Most common gram neg cause of CAP

A

H Influenzae

231
Q

Mechanism of action of amoxicillin?

A

Inhibits bacterial cell wall synthesis

232
Q

Clarithromycin mechanism of action?

A

Inhibits protein synthesis

233
Q

Mechanism of action of doxycycline?

A

Inhibits protein synthesis

234
Q

Pneumocystis jiroveci penumonia is treated withwhat?

A

Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

235
Q

Post-HIV exposure screening?

A

p24 antigen and antibody testing in 4 weeks time and in 3 months time

236
Q

What organism that often causes infection in patients with HIV may manifest as newfound breatjlessness?

A

The classic sign of PCP is a lowering of oxygen saturations on exercise. This would manifest as newfound breathlessness in patients recently infected

Pneumocystis Pneumonia (PCP) is an infection with the fungus Pneumocystis Jiroveci. It is a common presentation associated with individuals with HIV who are noncompliant with their cART regimens or antibiotic prophylaxis.

Year 3 Medicine (8 decks)

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