Infectious Disease/ Immunology Flashcards
(97 cards)
1
Q
Pasteurella multocida is the most common bacteria from what?
A
Majority of animal bites are from cats and dogs.
2
Q
Animal bites + human bites
Mx (2)
A
- Clean wound - nil need for suturing unless cometic concerns
- Coamox/ doxy+metro if pen allergic
3
Q
Typical chest infection mx
Pen allergy
If suspected staph what do you give?
Atypical chest mx
HAP mx (2)
<5 days
> 5 days
A
Chest
Amoxicillin
Pen allergy = doxy or clarithro
Add fluclox if suspected Staph –> e.g influenza
Atypical chest
Clarithro
HAP
<5 days coamox/ cefuroxime
>5 days taz/ cephalasporin
4
Q
Quinolone example
A
Ciprofloxacin
5
Q
Pyleo abx
Prostatitis abx
A
Cephalosporin/ quinolone
Quinolone/ trimethroprim
6
Q
Impetigo (3)
A
- Topical hydrogen peroxide
- fusidic acid
- fluclox/ erythro if widespread
7
Q
Abx choice Throat infection Sinusitis Otitis media Otitis externa Periapical or periodontal abscess Gingivitis
A
Phenoxymethylpenicillin Phenoxymethylpenicillin Amoxicillin Fluclox Amoxicillin Metronidazole
8
Q
Abx choice Gonnorrhea Chlamydia PID Syphillis BV
A
Abx choice
IM ceftriaxone
Doxy/ azithro
Ofloxacin + metro OR IM ceftriaxone + doxy + metro
Benzathine benzylpenicillin or doxy or erythro
Metro
9
Q
C diff First presentation Second presentation Campylo Salmonella Shigellosis
A
C diff Metro Vanc Clarithro Cipro Cipro
10
Q
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome
A
Campylo
11
Q
Two types of illness are seen
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours
A
Bacillus cereus
12
Q
Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
A
Amoebiasis
13
Q
Severe vomiting
Short incubation period
A
Staph Aureus
14
Q
Bloody diarrhoea
Vomiting and abdominal pain
A
Shigella
15
Q
Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers
A
Cholera
16
Q
Prolonged, non-bloody diarrhoea
A
Giardiasis
17
Q
Common amongst travellers
Watery stools
Abdominal cramps and nausea
A
E coli
18
Q
Legionella Where is it from? Features (5) Dx (1) Mx (2)
A
Air conditioning 1. Flu like illness 2. Hyponatraemia 3. Abnormal LFTs 4. Dry cough 5. Pleural effusion 30% of pts Dx urinary antigen Mx Erythro/ clarithro
19
Q
Infectious mononucleosis AKA Triad of sx Features (3) Dx
A
EBV Human herpes 4 (HHV 4) 1. Sore throat 2. Lymphadenopathy 3. Pyrexia
Features
- Splenomegaly - risk of splenic rupture, nil contact sports for 8 weeks
- Hepatitis - transient rise in ALT
- Haemolytic anaemia secondary to cold agglutins (IgM)
Dx
1. FBC and Monospot (heterophil antibody test) in 2nd week of illness
20
Q
Cause of central line infections
Coagulase positive or negative?
Staph Aureua - coag positive or negative?
A
Staph Epidermis
- Coagulase-negative
- Cause of central line infections and infective endocarditis
Staph Aureus
- Coagulase-positive
- Causes skin infections (e.g. cellulitis), abscesses, osteomyelitis, toxic shock syndrome
21
Q
Fine maculopapular rash on face spreading down body
Suboccipital lymphadenopathy
A
Rubella
22
Q
HSV-1
HSV-2
Primary infection presentation
Rx
A
Oral ulcers Genital ulcers Gingivostomatitis Rx acyclovir If an outbreak >K28 then for CS
23
Q
Syphillis Caused by which organism Primary features (2) Secondary features (3) Tertiary features (4)
A
Treponema pallidum
Primary
- painless ulcer - chancre
- local non-tender lymphadenopathy
Secondary
- fevers, lymphadenopathy
- rash on trunk, palms and soles
- buccal ‘snail track’ ulcers (30%)
- condylomata lata (painless, warty lesions on the genitalia )
Tertiary
- gummas (granulomatous lesions of the skin and bones)
- ascending aortic aneurysms
- general paralysis of the insane
- tabes dorsalis
- Argyll-Robertson pupil
24
Q
Bronchiolitis
A
Respiratory syncytial virus
25
Croup
Parainfluenza virus
26
Common cold
Rhinovirus
27
Flu
Influenza virus
28
The most common cause of community-acquired pneumonia
Streptococcus pneumoniae
29
Community-acquired pneumonia
Most common cause of bronchiectasis exacerbations
Acute epiglottitis
Haemophilus influenzae
30
Pneumonia, particularly following influenza
Staphylococcus aureus
31
Atypical pneumonia
Flu-like symptoms classically precede a dry cough. Complications include haemolytic anaemia and erythema multiforme
Mycoplasma pneumoniae
32
Atypical pneumonia
Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen
Legionella pneumophilia
33
Common cause of pneumonia in HIV patients. Typically patients have few chest signs and develop exertional dyspnoea
Pneumocystis jiroveci
34
A wide range of presentations from asymptomatic to disseminated disease are possible. Cough, night sweats and weight loss may be seen
Mycobacterium tuberculosis
35
Mx Meningitis caused by Listeria
Intravenous amoxicillin + gentamicin
36
Meningococcal meningitis
Intravenous benzylpenicillin or cefotaxime
37
Mx meningitis pen allergic
| What medication should be given if meningitis other than abx?
Chloramphenicol
| Dexamethasone
38
Mx of contacts of meningitis
Everyone who has been in close contact/ respiratory secretion exposure should be offered prophylaxis in the 7/7 prior to onset of symptoms + offer meningococcal vaccination
Ciprofloxacin
39
Kaposi's sarcoma is caused by?
| What is it?
HHV-8
| Purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
40
small papule which develops into a larger annular lesion with central clearing, 'bulls-eye' AKA erythema migrans = which condition?
Lyme disease
41
Pharyngitis, grey-white membrane on pharynx
bulky cervical lymphadenopathy
'bull neck' appearance
Diptheria
42
Diphtheria is caused by which organism?
Gram +ve/ -ve
Mx
Gram positive bacterium Corynebacterium diphtheriae
intramuscular penicillin
diphtheria antitoxin
43
```
Lyme disease
Early features (1)
Late features (2)
```
1. Bulls eye lesion AKA erythema migrans
1. CN palsy
2. Myocarditis/ polyarthritis/ meningitis
44
EBV associated conditions:
1. Burkitt's lymphoma
2. Hodgkin's lymphoma
3. nasopharyngeal carcinoma
4. HIV-associated central nervous system lymphomas
5. Hairy leukoplakia
45
Helicobacter pylori
| Associated with which cancer?
B cell lymphoma of MALT tissue
46
A 35-year-old man who has recently emigrated to the country presents with back pain associated with night sweats. He has also lost 5kg in weight over the past month is a stereotypical history of:
Pott's disease
Tuberculosis spondylitis - TB in the spine
47
```
BV findings (5)
Bacteria
pH
Discharge smell
Discharge colour
Microscopy
Mx (3)
```
```
Gardnerella vaginalis
Raised pH ( > 4.5 )
Fishy discharge
Thin white discharge
Clue cells
```
Mx PO metro/ topical metronidazole or topical clindamycin
48
Gram +ve
| Gram -ve staining
Purple
| Pink
49
```
Anaphylaxis doses of adrenaline, hydrocort, chloram
<6 months
6 months - 6 years
6-12 years
Adult and child > 12 years
```
```
150 mcg (0.15ml 1 in 1,000) 25 mg 250 mcg/kg
150 mcg 0.15ml 1 in 1,000) 50 mg 2.5 mg
300 mcg (0.3ml 1 in 1,000) 100 mg 5 mg
500 mcg (0.5ml 1 in 1,000) 200 mg 10 mg
```
50
```
Which hepatitis is spread by the faecal-oral route?
Which are RNA and DNA?
Significant mortality in which?
Which has vaccines?
Which has risk of HCC
Which requires another to propogate?
```
```
Hep A+ E
All RNA except Hep B = DNA
Significant mortality in Hep E
A+B have vaccines
B+C = risk of HCC
Hep D requires Hep B to propogate
```
51
a 5-year-old develops fever, pharyngitis and conjunctivitis = ?
adenovirus
52
Gonorrhea caused by?
Gram +ve or negative?
Mx
Gram-negative diplococcus Neisseria gonorrhoeae
IM ceftriaxone
If sensitive to cipro to give single dose
53
Most common cause of septic arthritis in young adults
Gonoccocal
54
Aminoglycosides adverse effects (2)
Nephrotoxicity, Ototoxicity
55
Which abx commonly causes c diff?
Clindamycin
56
Chloramphenicol adverse effect?
Aplastic anaemia
57
```
Name the condition
1. Parotitis
2. Orchitis
3. Hearing loss (ear ache also)
Notifiable disease
```
Mumps
58
Live attenuated vaccines (7)
1. BCG
2. measles, mumps, rubella (MMR)
3. influenza (intranasal)
4. oral rotavirus
5. oral polio
6. yellow fever
7. oral typhoid
59
```
CSF analysis Bacterial
Appearance
Glucose
Protein
White cells
```
```
Analysis
Cloudy
Low
High
5000
```
60
```
CSF analysis Viral
Appearance
Glucose
Protein
White cells
```
```
Analysis
Cloudy/ clear
High (60-80% of plasma glucose)
Normal/ raised
1000
```
61
```
CSF analysis TB
Appearance
Glucose
Protein
White cells
```
Slight cloudy/ fibrin web
Low
High
300
62
```
CSF analysis Fungal
Appearance
Glucose
Protein
White cells
```
Cloudy
Low
High
200
63
Non-gonococcal urethritis
Most common organisms (2)
Rx
Chlamydia
Mycoplasma genitalium
Rx doxy / azithro
64
First line mx for UTI in pregnant women
Secondline mx
Which abx is teratogenic?
1. Nitro (unless near term)
2. Amoxi or cefalexin
Trimethoprim in 1st trimester
65
Symptomatic UTI in catheterised pt:
Abx length of time
Asymptomatic bacteria in catheterised pt mx
```
7 days (usually trimeth)
Nil abx
```
66
Mx Active TB
First 2 months
1. Rimfampacin
2. Isoniazid
3. Pyranzinomide
4. Ethambutol
Next four months
1. Rifampicin
2. Isoniazid
RIPE RI
67
Trypanosomiasis
Type of disease
Types (2)
How is it spread?
Mx of both types
Protozoal
African Trypanosomiasis (sleeping sickness)
American Trypanosomiasis (Chaga's disease)
Tsetse fly
African Mx early disease: IV pentamidine or suramin
America Mx: azole
68
Trimeth adverse effect
Myelosuppression
69
TV
Discharge colour
O/E
pH
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
70
multiple ring-enhancing lesions =
mx
Seen in which condition?
Toxoplasmosis
pyrimethamine plus sulphadiazine for at least 6 weeks
HIC
71
Fungal nail infections Mx
Terbinafine
72
Rose-red rash makes the cheeks appear bright red
Rash can spread but does not affect palms/ soles
x4 names for the disease
Mx
```
Fifth disease
Parvovirus B19
Erythema infectiosum
Slapped cheek
Mx self limiting
```
73
Haemophilus ducreyi
painful genital ulcers
unilateral, painful inguinal lymph node enlargement
ulcers sharply defined, ragged, undermined border.
Chancroid
74
Trimethoprim and co-trimoxazole should be avoided in patients taking which medication?
MTX
75
Type of allergy test for contact dermatitis
Skin patch
76
Type of allergy test
Most commonly used
Useful for food allergies and also pollen
Skin prick
77
Type of allergy test
Useful for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom
Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines
Radioallergosorbent test (RAST
78
Small (2 - 5 mm) fleshy protuberances which are slightly pigmented, can bleed or itch = what is it? what is it caused by?
Mx (2)
Genital warts usually caused by HPV 6&11
1. topical podophyllum or cryotherapy
2. imiquimod
79
Tetanus
When to treat
Patient has had full course of vaccines, with the last dose < 10 years ago = nil treatment needed
> 10 years ago
if tetanus prone wound: reinforcing dos
high-risk wounds reinforcing dose of vaccine + tetanus immunoglobulin
If vaccination history is incomplete or unknown
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
80
1. grey, pseudomembrane on the posterior pharyngeal wall
2. bulky cervical lymphadenopathy
= which condition
Mx
diptheria
| Mx penicillin IM, diptheria anti-toxin
81
Campylobacter jejuni
Gram +ve/-ve
Complications
Rx
```
Gram-negative bacillus
Guillain-Barre
Reiter's syndrome
septicaemia, endocarditis, arthritis
Rx clarithro
```
82
How should a patient be screened for MRSA?
nasal swab and skin lesions or wounds
83
Suppression of MRSA from a carrier once identified
nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
84
MSRA Mx (2)
vancomycin
| teicoplanin
85
What is the most important advice you should give a pt regarding the side effect of metronidazole?
Inhibitor/ inducer?
Do not take + drink alcohol
| Inhibitor
86
Rabies can cause?
| Mx
Acute encephalitis
1. Wash wound
2. If pt already immunised then to give x2 further doses
3. If not already immunised then HRIG should be given with vaccination. Dose to be given around the site of wound.
87
How often can adrenaline be repeated in anaphylaxis?
Every 5 minutes
88
Chlamydia Rx
| Contact tracing
doxycycline (7 day course) first-line
if pregnant then azithromycin
for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
for women and asymptomatic men all partners from the last six months
89
First line treatment of non disseminated Lyme disease
| Disseminated
14 day course of oral doxycycline
| Ceftriaxone
90
Giardiasis mx
metro
91
```
Bloody diarrhoea (3)
Short incubation periods (2)
Persistent diarrhoea (2)
```
Shigella, campylo, amoebiasis
Bacillus + Staph
Giardiasis + amoebiasis
92
CF + chest infection = which bacteria
| Which type of bacteria (-ve/+ve)
Pseudomonas aeruginosa
Gram-negative rod
non-lactose fermenting
oxidase positive
93
prevents acetylcholine (ACh) release leading to flaccid paralysis
C. botulinum
94
Commonest protozoal cause of diarrhoea?
| Common in which group of pts?
Cryptosporidiosis
| Immunocompromised e.g HIV + young children
95
Gram-negative rod
non-lactose fermenting
oxidase positive
=
Pseudomonas aeruginosa
96
stool: modified Ziehl-Neelsen stain (acid-fast stain) characteristic red cysts found in which organism?
Cryptosporidium
97
positive whiff test = ?
BV
