Infectious Disease and STI Flashcards
(118 cards)
1
Q
How does Toxoplasmosis present ?
A
Similar to IM
Cervical Lymphadenopathy
Single or Multiple Ring Enhancing Lesions on CT in HIV patients
2
Q
Management for Toxoplasmosis
A
No Treatment if Immunocompetent
Pyrimethamine plus sulphadiazine for 6 weeks if HIV/Immunocompromised
3
Q
Congenital Toxoplasmosis Features
A
Neuro
Hydrocephalus
Chorioretinitis
Cerebral Calcifications
Opthalmo
Cataracts and Retinopathy
4
Q
Leprosy Treatment ?
A
If >/=6 Multibacillary
1. Extensive Skin
2. Involvement
Symmetrical Nerve Involvement
If </=5 Paucibacillary
(Tuberculoid Leprosy)
1. Limited Skin Involvement
2. Asymmetrical Nerve –> Hypersthesia
3. Hair Loss
5
Q
Treatment of Leprosy ?
A
If Multibacillary then give Rifampicin, Dapsone, Clofazimine for at least 2 years
If Paucibacillary then Rifampicin, Dapsone for 6 months
6
Q
Animal Bites Causative Pathogen and Treatment
A
Pasteurella Multocida
Treatment - Co-Amoxiclax (doxycycline + metronidazole ) and Don’t Suture them unless Cosmetic Reasons
7
Q
Human Bites Causative Agent and Treatment
A
Streptococci spp.
Staphylococcus aureus
Eikenella
Fusobacterium
Prevotella
Co-Amoxiclav
8
Q
Non Specific Urethritis Treatment and Causative Agents
A
Only inflammatory cells seen in Discharge no GN Cocci (Gonorrhea) or Chlamydia
Check Gonorrhoeic and Chlamydia NAAT within 2 week window usually and Retest if NEG BUT COVER in the mean time WITH …..
Doxycycline or Azithromycin
9
Q
Malaria Life Cycle Explain
A
Sporozytes injected into Blood Circulation
Sporozytes infect hepatocytes –> reproduce asexually —> merozoites —> schizont merozoites
If P.Vivax or P.Ovale —> Reside in Hepatocytes –> Hypnozoites
Schizont Merozoites burst —> enter blood circulation —> infect RBC to become Trophozoites (Early - Signet Ring Cell)
Trophozoite Burst Releasing Merozoites and the cycle continues
After several Asexual cycles —> Merozoites –> Gametocytes —> Taken up by mosquito –> Gametocytes fuse into Oocyte –> Oocyte Burst and go to Mosquito salivary glands –> Cycle Repeats
P.Malariea - Every 72 hours
P.Falciparum P.O/P.V –> 48 hrs
10
Q
Malaria Treatment
A
If Uncomplicated Falciparum —> ACT (Free Radical Mediated)
Chloroquine Resistant —> Quinine OR Atovaquone + Proguanil
If Non Falciparum –> ACT or Chloroquine
Complicated Malaria –> IV Artesunate (Hemolysis) or IV Quinine (Hypoglycemia)
Hypnozoites –> Primaquine
If Parasetemia > 10% then Exchange Transfusion
11
Q
Most Common Cause of Non Falciparum Malaria ?
A
Vivax
12
Q
Aspergilloma Feature on CXR ?
A
Crescent Sign
13
Q
If Thick and Thin Film Negative first time What to do Now ?
A
Start Chemoprophylaxis –> Repeat daily for 2 days –> Unlikely but finish prophylaxis
PCR only 1 week after infection
14
Q
When to Start Treatment in Viral Meningitis vs Viral Encephalitis ?
A
Viral Meningitis –> No need to start
Viral Encephalitis (Drop in GCS / Motor or Speech / Altered Behavior) –> IV Acyclovir
15
Q
Leptospirosis Treatment
- High Risk Occupation
- Features
- Investigations
A
- Sewage Workers, Farmers (Rat Urine), Vets or People who work in slaughter Houses / Abattoirs OR WATER SPORT ENTHUSIAST
2.
Phase 1
Subconjunctival Suffusion / Haemorrage
Phase 2
Aseptic Meningism
Severe
Hepatorenal (Weils)
- IgM at the end of 7 days post infection
Blood CSF Cultures Positive in 10 days
Urine 14 days - Mild / Moderate - Doxy or Azithromycin
Severe - IV Ben Pen
16
Q
Which Pathogen works via Endotoxin ?
A
Neisseria Meningitis
17
Q
Exotoxins Types and MOA
A
Read Note and Memorize
18
Q
TB investigations
A
So Mantoux first line.
If positive- suggests TB or BCG vaccine.
If negative - no exp to TB or no vaccine history.
If positive then Interferon Gamma to distinguish between TB and BCG
If positive then pt has been exposed to TB.
If negative then pt has had the BCG vaccine.
If mantoux negative but at risk of a false neg result then Interferon Gamma, again if negative no exposure to TB
19
Q
When will Mantoux Test be Risk of False Negative ? Hence when should we doing IGRA
A
False negative tests may be caused by:
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
20
Q
TB Smear (ZN and Fluorescent) Vs Culture (Gold Standard)
A
By Ziehl-Neelsen stain
Fix the smear –> stain with carbol-fuchsin (pink dye) –> decolourise with acid-alcohol –> counterstain with methylene blue
Acid fast bacilli appear pink (Resistant to decolouration by acid, can retain dye)
Fluorescent staining
Auramine-phenol stain –> 15 mins –> wash with acid-alcohol –> counterstain with thiazine red
Observe under fluorescent microscope –> see fluorescent bright greenish yellow in a dark background
21
Q
For Culture what’s the Solid Culture Called?
A
Solid: Lowenstein-Jensen
We do PCR looking for MTB and Rifampicin Resistance (rpoB Gene)
22
Q
Campylobacter Antibiotic of Choice
A
Clarithromycin
23
Q
Trypanosomiasis
- Types and Pathogens
- Features
- Treatment
American in Next Slide
A
African -
East African (T.Rhoedensi)
More Acute
1. Trypanosoma chancre - 2. Intermittent fever
3. enlargement of posterior cervical lymph nodes
later: CNS involvement
West African (T.Gambeinse)
Treatment for AFRCIAN
Early : IV pentamidine or suramin
Late or central nervous system involvement: IV melarsoprol
24
Q
American Trypanosomiasis (Chaga’s)
A
Trypsonama Cruzi
Acutely (90% asymptomatic) but Chagoma (Erythematous Nodule) + Periorbital Swelling Seen (Romana Sign)
Later
Myocarditis –> Dilated Cardiomyopathy
Megaesophagus and Megacolon
Treatment
Acute benznidazole or nifurtimox
Chronic - Treat Complications
25
Leishmaniasis Types and Facts
1. Cutaneous (L.Mexicana or L.Tropica)
Crusted Lesion at Site of Bite
If acquired in Central or South America --> Treat
If Africa or India --> Conservatively
2. Mucocutanoeus (L. Brazilians)
Spread to Nose and Pharynx
3. Kala Azar Black Sickness (Leishmania donovani)
HEPATOSPLENOMEGALY
Black Skin
Gold Standard Ix ( Bone Marrow Aspirate - amastigotes)
Tx - sodium stibogluconate
Amphotericin B if Resistant to
26
Pneumonia Causative Agents and Associations
Pneumonia + Alcoholic + Cavitation = Klebsiella
Pneumonia + Prior Flu = Staph Pneumonia
Pneumonia + Chicken Pox Rash = Varicella
Pneumoniae Pneumonia + Hemolytic Anemia = Mycoplasma
Pneumonia + Hyponatremia + Travel History = Legionella (Relative Bradycardia + Low Lymphocytes / LFT deranged --> Erythromycin/Clarithromycin)
Pneumonia + Fleeting opacities = Cryptogenic Pneumonia
Pneumonia + Fits/LOC = Aspiration Pneumonia
Pneumonia + HSV oral lesion = Strep Pneumonia
Pneumonia + parrot = Chlamydia psitatssi
Pneumonia + farm animals = Q fever (coxillea brunetii)
Pneumonia + HIV = think pcp but if straight forward case strep pneumonia is still most common
Pneumonia + Cystic fibrosis = consider pseudomonas/Burkholderia
Pneumonia + COPD or exac = c1::Haemophilus Influenza
Commonest cause of CAP = Strep Pneumonia
27
Tetanus when to Vaccinate and give Tetanus Immunoglobulins ?
If Vaccination Incomplete or Unknown
Give BOOSTER and Check Ig
If all 5 doses given < 10 years ago
DO NOTHING regardless of wound severity
If all 5 doses given >10 years ago
1. If Tenatus Prone Wound - Booster
2. If High Risk Wound - Booter + Immunoglobulins
28
What is High Risk Wound in Tetanus Context ?
Devitalized Tissue Visible
Burns or Wounds requiring Surgery
Obviously Dirty Contaminated
29
Tetanus Schedule in UK (5 doses)
2 months
3 months
4 months
3-5 years
13-18 years
30
Strongyloides stercoralis (Nematode)
What to look for in questions ? and Treatment ?
Itchy Rash on Palms and Soles + Diahorrea
Ivermectin and Albendazole
31
Post Exposure Prophylaxis for HIV ?
Raltegravir + Truvada (emtricitabine + tenofovir) start within hours daily for 28 days and HIV test 3 months later
not needed for human bites !!!!!
32
Hep C Post Exposure Prophylaxis ?
Monthly PCR if seroconversion then Interferon +/- Rivabarin
33
Hep B Post Exposure Prophylaxis
💉 If we know the other person has Hepatitis B:
1. If the person who got exposed had their vaccine and it worked → just give them a booster shot (like a little extra protection).
2. If the vaccine didn’t work for them → give them a special medicine (HBIG) and a booster shot.
❓If we don’t know if the other person has Hepatitis B:
1. If the person had the vaccine and it worked → maybe give a booster just to be safe.
2. If the vaccine didn’t work → give the special medicine (HBIG) and a booster shot.
3. If they’re still getting their vaccines → give the shots faster to protect them quickly.
34
Streptococcus pyogenes, AKA: Group A Streptococcus (GAS) Can cause ?
Streptococcus pyogenes, AKA: Group A Streptococcus (GAS) Can cause :
- pharyngitis
- impetigo
- cellulitis
- necrotising fasciitis
- erysipelas
- scarlet fever
35
Alpha and Beta Hemolytic Strep and their Pathogen
Alpha -
Strep Viridans
Strep Pnumoniae
VAN
Beta -
Strep Pyogenes
Strep Agalactia - Neonatal Meningitis
Strep Enterococcus
Py B Ag
36
Bacterial Vaginosis Treatment
Oral Metro if Symptomatic if adherence issues then STAT 2g Metro Oral
If Asymptomatic - NOTHING unless TOP
If Pregnant + Symptomatic ---> Oral Metro 5-7 days but NEVER STAT DOSE
37
Diptheria
1. Features
2. MOA
3. Treatment
Pseudomembrane on Tonsils
Bull Neck (Lymphadeno)
Heart Block
2.
Release Exotoxin by Beta Prophage -->
Inhibit Protein Synthesis by catalyzing ADP-ribosylation of Elongation Factor EF2
3. Penicillin IM
38
What vaccinations to give in Post Splenectomy Patients
if elective, should be done 2 weeks prior to operation
Hib
Meningitis A & C
annual influenza vaccination
pneumococcal vaccine every 5 years
39
Pathogen causing Low Glucose CSF and is also a virus ?
Mumps
40
HSV1 vs HSV2 Management
HSV1: Cold sores: Topical aciclovir
HSV2: Genital herpes: Oral aciclovir.
41
Chlamydia Treatment
Doxycycline --> Azithromycin
If Pregnant ---> STAT Azithromycin is the drug of Choice
OR AMOXICILLIN (if QT Prolongation or other CI to Macrolides)
42
Chlamydia Close Contact Approach ?
1. Asymptomatic Men and Women --> 6 months look back or most recent sexual partner
2. Symptomatic Men --> 4 months look back
Treat ALL close contacts before results even come back
Treat then Test Approach
43
When to use Doxycycline
DOXYCYCLINE in
- Lyme Disease
-LGV
- Chlamydia
- Brucellosis (along with Streptomycin)
- TULAREMIA
44
If Back Pain (Sacroillitis) + Hepatosplenomegaly + Farmer ---> Think What ?
What Ix ?
What Treatment ?
Brucellosis
Rose Bengal Test (RBT) ---> followed by confirmation using standard tube agglutination (STA) or (ELISA)
Doxy + Streptomycin
45
HIV Anti-retrovirals - P450 interactions
What induces and what inhibits ?
HIV: anti-retrovirals - P450 interaction
nevirapine (a NNRTI): induces P450
protease inhibitors: inhibits P450
46
Neurological Presentation in HIV
Differentiate
Toxo vs Lymphoma vs Primary Progressive Leukoencephalopathy
Toxo
Ring Enhancing
Multifocal
Thallium SPECT Negative
Lymphoma
Solitary Enhancing
Single
Thallium SPECT Positive
JC Virus
Multifocal or Single BUT
NON ENHANCING
47
Live Attenuated Vaccines
Live attenuated -
You Musn't Prescribe BCG Incase They RIP Stat
Yellow fever
MMR
Polio(oral)
BCG
Influenza(intranasal), Typhoid
Rotavirus(oral)
Shingles'
48
Genital Warts Treatment
If multiple, non-keratinised warts --> topical podophyllum ---> Imiquimod
If solitary, keratinised warts: cryotherapy
49
False Positive of Non-Treponemal Tests ?
Causes of false positive non-treponemal (cardiolipin) tests:
pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV
50
TT- Treponemal Tests (TPPA/TPHA)
NTT - Non Treponemal Tests (RPR/VRDL)
TT+ and NTT - = Treated
TT+ and NTT + = Active Primary
TT - and TPP + = False Positive
51
Bacteriostatic Antibiotics Mnemonic
CORe - ChlORamphenicol
Medical - Macro
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim
52
HIV Tests
Screening --> antigen/antibody combo test (p24 antigen + HIV antibodies)
AKA 4th Gen ELISA
Acute HIV (seroconversion) --> same as above
Confirmatory --> HIV-1/2 differentiation assay is preferred over Western blot.
53
Revision of Common Pathologies and their Antibiotics
1. Chlamydia (LGV): doxycycline
2. Syphilis: benzathine penicillin
3. Gonorrhoea: ceftriaxone IM single dose. Or cefixime 400 mg + azithromycin 2 g, single dose.
** Non-gonococcal urethritis: doxycycline or azithromycin.
4. M.avium: rifabutin, ethambutol, and clarithromycin.
5. M.leprae: rifampicin, dapsone, and clofazimine.
6. M.TB: INH, RIF, PYZ, ethambutol
7. Anthrax: ciprofloxacin.
8. Lyme disease: first early disease, doxycycline, amoxicillin is alternative. For disseminated, ceftriaxone is the drug of choice.
10. Leptospirosis: high dose benzyl penicillin or doxycycline.
11. Bacterial vaginosis: oral metronidazole. Topical metronidazole or topical clindamycin are alternative.
12. Strongyloides stercoralis: ivermectin and albendazole.
13. Cysticercosis: niclosamide.
14. Hydatid cyst: albendazole
15. Dog/human bite: co-amoxiclav, if allergic >> doxycycline + metronidazole.
16. Cholera: doxycycline, ciprofloxacin.
17. Toxoplasmosis: supportive treatment.If treatment is required then a combination of pyrimethamine and sulfadiazine is usually given for several weeks.
Spiramycin may reduce the risk of toxoplasmosis transmission from mother to fetus in pregnancy.
18. E.histolytica: oral
metronidazole
19. Chagas disease: benznidazole or nifurtimox
20. Sleeping sickness: IV pentamidine or suramin in early disease. IV melarsoprol in CNS involvement.
21. Brucellosis (Malta fever): doxycycline and streptomycin.
22. Cryptosporidium: supportive in immunocompetent. Nitazoxanide or rifaximine can be used in immunodeficient patient.
54
Endemic Typus (Rickettsia Typhus)
vs
RMSF
Rash Starts Centrally and Spread to Peripheries
Rash Starts Peripherally and Spread to Centre
55
Incubation Period for Diahorreal Illnesses ?
Incubation period
1-6 hrs:
Staphylococcus aureus, Bacillus cereus*
12-48 hrs:
Salmonella,
Escherichia coli
48-72 hrs:
Shigella,
Campylobacter
> 7 days:
Giardiasis,
Amoebiasis
56
Pathogens Causing Dysentery
SEECSY !!!!
Shigella
E. Coli (ETEC/EHEC)
Entameoba
Campylobacter
Salmonella
Yersinia Enterocolitca
57
Tetracycline Side Effect
discoloration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue
58
Aspergillosis Treatment
Aspergillosis tx voriconazole
Aspergiloma tx surgical resection
59
Which Disease shows Biphasic Pattern of Illness with Brief Remission in between ?
Yellow fever typically presents with flu like illness → brief remission→ followed by jaundice and haematemesis
Councilman Bodies in Hepatocytes
60
Japanese Encephalitis Pathognomic
Parkinsonism
61
Pregnancy and HIV
If Viral Load >50 at 36 weeks then
C section and start Zidovudine transfusion 4 hours before C/S
FORMULA FEED
If Viral Load <50 give baby oral Zidovudine otherwise TRIPLE ART for 4-6 weeks
62
Who is Eligible for an HPV vaccination ?
eligible GBMSM under the age of 25 also receive 1-dose
eligible GBMSM aged 25 to 45 years receive a 2-dose schedule
eligible individuals who are immunosuppressed or HIV+ receive a 3-dose schedule
All GIRLS AND BOYS at 12 / 13 receive HPV vaccine One off
63
Lymphogranuloma venereum
Causative Agent
Features
Chlamydia trachomatis serovars L1, L2 and L3
Normal Chlamydia serovars D through K
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboe
stage 3: proctocolitis
64
Varicella Zoster Exposure in Pregnany
What to Do !!!
Pregnancy + exposure to VZV:
1. Hx of chicken pox?
a. yes -> do nothing
b. unsure -> test for varicella antibodies
2. Antibody result:
a. Positive ->do nothing
b. Negative:
- <20 weeks = Aciclovir or IVIG
- >20 weeks = Aciclovir or IVIG at 7-14 days post exposure
If actually develops VZV whilst
a. <20 weeks - Acyclovir with caution after ID discussion
b. >/= 20 weeks - Acyclovir if presents within 24 hours of rash onset
65
Fetal Varicella Syndrome Features
Everything Small
small eye- Microopthalmia
Small brain - Microcephaly and learning difficulty
Small limbs- limb hypolasia
66
Treatment for Giardiasis (Steatorrhea) and Amoebiasis (Long Incubation Period)
Metronidazole
67
How does Fournier's Gangrene Present Like ?
Rapidly progressing Cellulitis with Pain out of Proportion
68
What are the indications for antibiotics in Diahorrea ?
Antibiotics are recommended if severe symptoms
1. high fever
2. bloody diarrhea
3. >8 stools per day
4. Lasted > 1 week
69
Black Eschar that is Painless and Pruritic vs Black Eschar with Surrounding Erythema and Tender Lymphadenopathy
Anthrax (Bacillus anthracis)
Produces Tripartite Protein Toxic to Macrophages
Treated with Ciprofloxacin
vs
Scrub Typhus (Orientia)
70
Gram Positive Cocci
vs
Gram Negative Cocci
GPC - Streptococcus , Enterococcus
GNC - Neisseria Meningitis , Neisseria Gonorrea AND Moraxella catarrhalis
71
Gram Positive Rods
ABCD L
Actinomyces
Bacillus Anthrax
Clostridium
Diphtheria
Listeria Monocytogenes
72
Gram Negative Rods
Anything that isnt GPR !!!
But
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
73
What Orf ?
Sheep and Goat Farmers
(Parapoxvirus)
Raised Papule that enlarges and has a flat and hemorrhagic top
74
Tamiflu MOA ?
Neuraminidase Inhibitor
75
Malaria Fever Patterns
Falciparum - Irregular
Malariae - Every 72 hours
Vivax / Ovale - Every 48 hours
Knowlesi - Every 24 hours (short erythrocyte replication cycle)
76
Genital Herpes and Treatment
Primary Genital Herpes --> at time of delivery or 6 weeks before EDD ---> C Section
If Secondary Herpes ---> Suppressive treatment with Acyclovir from 36 weeks
Analgesia - Topical Lidocaine and Saline Bathing
77
Stains and their relevant pathologies
Rubeanic = copper (Wilson's)
Perl's Prussian blue = iron (Haemochromatosis)
Rose Bengal = Corneal Scrapping for Fungal Keratosis or Acanthamoeba AND Brucellosis
Congo red = Amyloidosis
Pearls Reaction in
78
Botulism Treatment (Flaccid Paralysis and Cranial Nerve Features)
Antitoxin STAT
79
Vaccines that can be used if CD4 >200
vs
Contraindicated in HIV Totally
Yellow Fever
Varicella
MMR
Oral Polio
BCG
Intranasal Influenza
Cholera
80
Rabies Investigations and Treatment
Negri Bodies - Cytoplasmic Inclusions in Neurons
1. If Vaccinated then --> 2 additional doses only
2. If not vaccinated then IV Rabies IG + Full Course of Vaccination
81
UTI Guidelines
Non-pregnant women
1. Trimethoprim or nitrofurantoin for 3 days
2. Send culture if >65 OR hematuria
Pregnant women
1. Symptomatic:
Send culture
2. 7-day antibiotics:
1st line nitrofurantoin (avoid near term)
2nd line amoxicillin/cefalexin
Avoid trimethoprim (teratogenic)
Asymptomatic:
1. Routine culture at 1st antenatal
2. Immediate 7-day antibiotics (same options)
3. Test of cure needed (risk of Progression to Pyelonephritis)
Recurrent post-coital UTIs: post-coital trimethoprim/nitrofurantoin
Catheterized patients
Do not treat asymptomatic bacteriuria
1. If symptomatic: treat for 7 days
2. Remove/change catheter if >7 days
82
When to Treat Asymptomatic Bacteriuria ?
1. Pregnant
2. Immunocompro
3. Child < 5 years.
83
What test in Infectious Mononucleosis ?
Heterophil antibody test (Monospot test) = Paul Bunnell Test
Splenomegaly
ALT elevated
Lymphocytosis - Atypical in 10%
Hemolytic Anemia due to IgM Cold Agglutin
84
Warthin-Starry staining
Ipsilateral lymphadenopathy
History of Cat Scratch
Fever
Which what disease by what organism ??
Bartonella by Gram negative rod Bartonella henselae
85
Listeria Monocytogene Facts
Listeria =L=
****Lymphocytes **** in CSF and Raised Protein and Low Glucose
Like Low Temperature, Like Low immunity individuals(neonates,elderly, immunosupressed pregnant ladies)
Lack of Muscle Control - Ataxix
'tumbling motility' on wet mounts
86
Which drig promotes MRSA ?
Ciprofloxacin promotes acquisition of MRSA
87
Salmonella Facts and Complications
Very very Unwell patients Think Salmonella.
Constipation>Diahorrea
Rose Spots in Abdomen
Complications
Osteomyelitis (especially in Sickle Cell Patients)
Gi Perf
88
Mechanism of Action of Antifungals
CHECK NOTE FROM PRINOUTS !!!
Print Note from Passmed
1. TErbinafine> Inhibits Squalene Epoxide
2. Azoles> Alpha demethylase inhibitor which produces Ergosterol
3. Nystatin/Amphotericin B > Binds to Ergosterol and Makes a Transmembrane Channel causing Mono Ionic Leakage K Ca Na etc..
4. CaspofunGin> glucan inhibitor
5. Flu> converted to 5-FU by Cysteine Deaminase which inhibitor Thimydine Synthase disrupting Fungal Protein Syhthesis.
6. Griosfulvin - Interacts with microtubules to disrupt mitotic spindle
89
Prophylaxis for Meningococcal Meningitis for Close Contacts
Ciprofloxacin or Rifampicin
Regardless of Vaccination Status
90
BCG Vaccine
Does it protect against Pulmonary / Primary TB ?
NO !!!
Protects against TB Meningitis and Disseminated TB in CHILDREN !!!!!
Administration
any person being considered for the BCG vaccine must first be given a tuberculin skin test.
The only exceptions are children < 6 years old who have had no contact with tuberculosis.
BCG can be given at the same time as other live vaccines, but if not administered simultaneously there should be a 4 week interval
Contraindications
previous BCG vaccination
a past history of tuberculosis
HIV
pregnancy
positive tuberculin test (Heaf or Mantoux)
91
When can we say Syphyllis is Adequately Responding to Treatment ?
Four Fold Decrease in RPR or VRDL titres
92
Zanamavir MOA and Side Effect
Tamiflu's inhaled Version
Neuroaminase Inhibitor
Asthma
93
Lemierres Disease
Thrombolhebitis of the Interval Jugular Vein
SEPTIC Pulmonary Embolism as Side Effect
94
Malaria Falciparum Severe Criteria
1. schizonts on a blood film
2. parasitaemia > 2%
3. hypoglycaemia
4. acidosis
5. temperature > 39 °C
6. severe anaemia
95
Acute Toxoplasmosis Mimics What Pathology ____________
EBV
Especially will have Negative EBV Screens
Do not treat in immunocompetent but if immunocompromised or Pregnant TREAT !!!!
96
Gram Positive Cocci vs Gram Negative Cocci
Gram-positive cocci = staphylococci + streptococci (including enterococci)
Gram-negative cocci = Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
97
Lassa Virus Vectors
Excreta of infected African rats (Mastomys rodent)
98
Chikungunya Features that differentiate it from Dengue
DEBILITATING JOINT PAIN
99
Leishmaniasis Vector vs Trypanosomiasis Vector ?
Sandflies
Tsetse Fly
100
Cryptosporidium Diahorrea Diagnostic Test
Treatment ?
1) Cryptosporidium causes Diarrhoea in HIV diagnosed by Modified Ziehl Neelsen (Acid fast)
If Immunocompromised - nitazoxanide
If Immunocompetent - DO NOTHING (MOSTLY THIS)
2) Cryptococcus is the most commmon fungal infections of CNS in HIV and where INDIA INK test is positive
101
Which Antibiotics inhibit 30s and which inhibit 50s ?
Buy AT 30, 'CCEL' at 50
(Aminoglycosides, Tetracyclines bind to 30S,
Clinda, Chloramphenicol and Erythromycin bind to 50S
102
Do we give prophylaxis to all Meningitis Close Contacts ?
NO !!!!
Only Meningococcal
Not Pneumococcal
103
If Rhabditiform Larvae found in Stool then what pathogen are we suspecting ?
Strongyloidiasis
Strongyloides stercoralis exist as rhabditiform larvae in soil (non-infective first stage larvae) and as filariform larvae in humans (infective third stage larvae)
104
Amoebiasis
1 Feature
1.5 Investigations
2 Treatment
Bloody Diahorrea
TENDER Hepatomegaly
Long Incubation Period
Hot Stool !!! 15 mins or kept warm
Oral Metronidazole
A 'luminal agent' (to eliminate intraluminal cysts) is recommended usually as well e.g. diloxanide furoate
105
ETEC- TRAVELLERS WATERY DIARHHEA
EHEC,Shigella -TRAVELLERS BLOODY DIARRHOEA
106
Organism Responsible for Erysipelas
Staphylococcus Pyogenes
107
Cat Scratch Disease
Bartonella Henselae
108
Organism Responsible for Filiaris ?
Wucheria Bancrofti
109
Which Plasmodium is the most Common (Non Falciparum Type) ? + Locations
Vivax (MCC) - Central America and Indian Subcontinent
Ovale - Africa
Knowlesi - South East Asia
110
Which Malaria causes Nephrotic Syndrome ?
Plasmodium Malariae
111
Which Hepatitis in Pregnancy ?
Hep E
112
Q fever how does it present ?
Culture Negative Endocarditis
113
Granuloma Inguinale (Genital Ulcers) causative organism ?
Klebsiella Granulamatis
114
When ''dark and ashen' skin ' think WHAT ?
Visceral Leishmaniasis
Leishmania Donovani
Massive Splenomegaly
Fever
Dark Skin
Pancytopenia
115
Which Antibiotics given for Botulinism and Tetanus ?
BBBenPen for BBBBBotulism
Metro for Tetro
116
Most Common Cause of Death in Measles ?
Pneumonia
Subacute Sclerosing Panencephalitis in 5 to 10 years
117
JC Virus MRI brain shows ?
Multifocal Non Enhancing Lesions AND White Matter Lesions in T2
118
