Infectious Diseases Flashcards
(317 cards)
1
Q
Pneumonia + Alcoholic + Cavitation =
Pneumonia + Prior Flu =
Pneumonia + Chicken Pox Rash =
Pneumoniae Pneumonia + Hemolytic Anemia =
Pneumonia + Hyponatraemia + Travel History =
Pneumonia + Fleeting opacities =
Pneumonia + Fits/LOC =
Pneumonia + HSV oral lesion =
Pneumonia + parrot =
Pneumonia + farm animals =
Pneumonia + HIV =
Pneumonia + Cystic fibrosis =
Pneumonia + COPD or exac =
A
Pneumonia + Alcoholic + Cavitation = Klebsiella
Pneumonia + Prior Flu = Staph Pneumonia
Pneumonia + Chicken Pox Rash = Varicella
Pneumoniae Pneumonia + Hemolytic Anemia = Mycoplasma
Pneumonia + Hyponatraemia + Travel History = Legionella
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
2
Q
Commonest cause of CAP =
A
Strep Pneumonia
3
Q
What infections can cause caveatting lesions in the lungs? (4)
A
Staph aureus
Klebsiella
TB
Aspergillosa
4
Q
What should you do if you have a needlestick from suspected/confirmed Hep B patient?
A
If responder to vaccine -> need a booster
If non-responder -> need Hep B immunoglobulins + vaccine
If only had one jab so far -> need Hep B immunoglobulins + vaccine
5
Q
What should you do if you have a needlestick from suspected/confirmed Hep C patient?
A
monthly PCR - if seroconversion then protease inhibitors +/- ribavirin PO
6
Q
What should you do if you have a needlestick from suspected/confirmed Hep A patient?
A
Human Normal Immunoglobulin (HNIG) or hepatitis A vaccine may be used
7
Q
What should you do if you have a needlestick from suspected/confirmed HIV patient?
A
a combination of PO antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) asap (i.e. within 1-2 hrs, but may be started up to 72 hrs) for 4 weeks
serological testing at 12 wks following completion of PEP
reduces risk of transmission by 80%
8
Q
What should you do with pregnant women/IC if exposed to varicella zoster?
A
If pregnant – check Abs
- If <20wks + not immune, give VZIg
- If >20wks + not immune, give VZIg or aciclovir from day 7-14
- If develops chickenpox, give PO aciclovir if >20wks and 24hrs since onset of rash
- Consider the above if <20wks pregnant
9
Q
How to treat human and animal bites?
A
Co-amox
if penicillin-allergic then doxycycline + metronidazole
10
Q
What is the most common organism that may infected a patient following an animal bite?
A
Pasteurella multocida
11
Q
What is the most common organism that may infected a patient following a human bite?
A
Human bites commonly cause multimicrobial infection
12
Q
Which bacteria cause fish tank granulomas?
A
Mycobacterium marinum
13
Q
Which HIV patients should receive prophylaxis for PCP?
A
all patients with a CD4 count < 200/mm³
14
Q
What is a common complication of PCP?
A
Pneumonthorax
15
Q
Name the gram positive rods?
A
ABCD-L
Actinomyces
Bacillus anthraces
Clostridioides spp
Diphtheria
Listeria
16
Q
What are the five types of malaria?
A
Plasmodium vivax – most © non-falciparum
Plasmodium ovale – more © Africa
Plasmodium malariae – associated with nephrotic syndrome
Plasmodium falciparum ©-est! – often causes severe malaria
Plasmodium knowlesi
17
Q
Protective conditions/genetics for malaria?
A
- SCA
- G6PD deficiency
- HLA-B53
18
Q
Malaria host?
A
Female Anopheles mosquito
19
Q
Features of severe malaria?
A
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications: cerebral malaria, renal failure, ARDS, DIC
STARCHS
20
Q
What type of fever might you see with the non-falciparum malarias?
A
Plasmodium vivax/ovale: cyclical fever every 48 hours
Plasmodium malariae: cyclical fever every 72 hours
Knowlesi: every 24 hours
21
Q
Which malaria prophylaxis to give pregnant women?
A
Chloroquine
22
Q
Which malaria prophylaxis to give children?
A
DEET
Doxy if >12yo
23
Q
Treatment of severe malaria?
A
IV artesunate (alternative = quinine) - If parasite count \>10%, consider exchange transfusion
24
Q
Treatment of uncomplicated falciparum malaria?
A
artemisinin combination therapies (ACT) e.g. artemether-lumefantrine
25
Treatment of non-falciparum malaria?
chloroquine (P. vivax + ovale) + primaquine (to eradicate liver hypnozoites)
26
Investigations in malaria?
Thick blood smear – locates parasites in RBCs
Thin blood smear – directly identifies the plasmodium species
Bloods may show:
- Thrombocytopaenia
- Elevated LDH
- Normochromic, normocytic anaemia
- Normal WCC
27
Mechanism by which malaria affects the body?
Mosquito gets infected by gametocytes
Plasmodium resides in salivary glands -\> injected into humans when bitten
Exoerythrocytic Phase - asymptomatic
Over 1-2 weeks undergoes asexual reproduction in the liver
May then go dormant for months/years (P. vivax/ovale)
Erythrocytic Phase
Released into blood -\> invade RBCs
P. vivax only invades reticulocytes
P. malariae only invade old RBCs
Undergo more reproduction
RBC bursts and releases contents
This happens in waves in tune with reproductive cycles -\> causes a ‘swinging fever’
Haemolytic anaemia happens as a results and is responsible for fatigue, headaches, jaundice, splenomegaly
28
What might you see in the CSF in Listeria?
CSF may reveal a pleocytosis, with 'tumbling motility' on wet mounts
29
How to treat listeria infection incl in the case of meningitis?
Listeria is sensitive to amoxicillin/ampicillin (cephalosporins usually inadequate)
Listeria meningitis should be treated with IV amoxicillin/ampicillin and gentamicin
30
What type of virus is hep C?
RNA flavivirus
31
What test to confirm exposure and then ongoing infection in Hep C?
HCV Abs confirms exposure
HCV-RNA PCR confirms ongoing infection/chronic
32
If HCV-PCR positive, what further investigation should you do?
Transient elastography to assess for liver damage
33
How to treat Hep C?
Avoid alcohol
Combination therapy: protease inhibitors +/- ribavirin PO
- Virus is cleared in 95% of patients
- Ribavirin = teratogenic, women should not become preg within 6m
Liver transplantation may be considered
Aim for undetectable viral load
34
Complications of Hep C?
- Arthralgia/arthritis
- Sjogren’s syndrome
- Cirrhosis/HCC
- Cryoglobulinaemia (type 2)
- Porphyria cutanea tarda
35
Features of campylobacter GI infection?
A flu-like prodrome usually followed by crampy abdo pains, fever + diarrhoea (may be bloody)
May mimic appendicitis
36
Management and complication of campylobacter?
Complications include GBS
Mx: clarithromycin
37
What to offer a chlamydia contact?
Offer Chlamydia testing and antibiotic treatment immediately without waiting for the results
38
What is the causative organism for Q fever?
Coxiella burnetii
39
How do you treat Q fever?
doxycycline
40
What type of people get Q fever?
Farmers
Typically caught from cattle/sheep or inhaled from infected dust
41
What type of virus is measles?
RNA paramyxovirus
42
What is the measles incubation period?
10-14 days
43
When is measles infective?
from prodrome -\> 4/7 of rash
44
What are the features of measles?
Prodrome: fever, irritable, **_conjunctivitis_**
Koplik spots on buccal mucosa – before rash
Rash – starts behind ears, maculopapular -\> blotchy
Diarrhoea in 10% of patients
45
Complications of measles?
Otitis media ©
Pneumonia – most © cause of death
Encephalitis – typically 1-2wks after illness onset
Subacute sclerosing panencephalitis – may occur 5-10yrs later
- Fatal within 1-3yrs
Febrile convulsions
Keratoconjunctivitis
Myocarditis/appendicitis
46
Most common causative organism of travellers diarrhoea?
E. coli
47
Cause of prolonged, non-bloody diarrhoea?
Giardiasis
48
Cause of profuse, watery diarrhoea + severe dehydration resulting in WL?
Cholera
49
Cause of bloody diarrhoea, vomiting and abdo pain?
Shigella
50
Symptoms of bacillus cereus infection?
Two types of illness are seen
• Vomiting within 6 hours (often d/t rice)
• Diarrhoeal illness occurring after 6hrs
51
Incubation periods for common gastro bugs?
* 1-6 hrs: Staphylococcus aureus, Bacillus cereus
* 12-48 hrs: Salmonella, E. coli
* 48-72 hrs: Shigella, Campylobacter
* \>7 days: Giardiasis, Amoebiasis
52
How is giardiasis spread?
Faeco-oral route
53
Symptoms of giardiasis?
Often asymptomatic
Lethargy, bloating, abdo pain
Flatulence
Non-bloody greasy chronic diarrhoea -\> due to malabsorption
54
Investigation in giardiasis?
duodenal fluid aspirates or 'string tests' (fluid absorbed onto swallowed string) are sometimes needed
Stool tests are often negative
55
Treatment of giardiasis?
Metronidazole
56
Which vaccines are CI in HIV positive patients?
Cholera intranasal
Poliomyelitis-oral
Tuberculosis (BCG)
TCP
57
Which vaccines are not given if CD4 \<200?
MMR
Varicella
Yellow fever
58
What type of virus is Orf?
Parapox virus
59
What are the features of Orf?
Affects hands/arms
Small raised red-blue papules -\> 2-3cm flat-topped + haemorrhagic
60
Features of hand, foot and mouth disease?
Sore throat/fever
Oral ulcers
Followed by vesicles on the palms and soles of the feet
61
How to treat cerebral toxoplasmosis in IC pts?
pyrimethamine + sulphadiazine for 6wks
Nothing in patients without immunocompromise
62
What are the two different types of trypanosomiasis?
```
African trypanosomiasis (sleeping sickness)
American trypanosomiasis (Chagas' disease)
```
63
What are the two different types of african trypanosomiasis?
```
Trypanosoma gambiense (West Africa)
Trypanosoma rhodesiense (East Africa)
- the Gambia is in West Africa
```
64
How is trypanosomiasis spread?
Tsetse fly
65
Features of African trypanosomiasis?
Trypanosoma chancre – at site of infection
Intermittent fever
Posterior cervical lymphadenopathy
Later: CNS involvement – headache, mood changes, meningoencephalitis
66
Management of African trypanosomiasis?
early disease: IV pentamidine or suramin
later disease or CNS involvement: IV melarsoprol
67
Features of Chagas disease?
95% are asymptomatic
chagoma (an erythematous nodule at site of infection) and periorbital oedema are sometimes seen
68
Chronic infection with Chagas Disease complications?
Myocarditis -\> dilated cardiomyopathy and arrythmias
GI features -\> megaoesophagus/megacolon causing dysphagia + constipation
69
Management of Chagas Disease?
Acute phase - benznidazole or nifurtimox
Chronic phase – treating the complications
70
Investigations of PCP?
```
CXR – bilateral pulmonary infiltrates
Bronchoalveolar lavage (BAL) often needed to demonstrate PCP – use silver stain
```
71
Management of PCP?
Co-trimoxazole
IV pentamidine for severe cases
Steroids if hypoxic
72
Common complication of PCP?
Pneumothorax
73
What bug causes Lyme disease?
Caused by Borrelia burgdorferi
74
Presentation of Lyme disease?
Early – erythema chronicum migrans (target) rash (seen in 80%), headache, fever, arthralgia
CVS – heart block, myocarditis
Neuro – facial nerve palsy, meningitis
75
Investigations for Lyme disease?
Clinical Dx
ELISA for Abs (IgG + IgM)
- If negative, can repeated 4-6wks after the first
If +ve (or -ve but high suspicion), then immunoblot test (western blot) should be done
76
Management of Lyme disease?
Doxycycline if early disease
If CI, give Amoxicillin (e.g. pregnancy)
Ceftriaxone if disseminated disease
77
What is the Jarisch-Herxheimer reaction?
sometimes seen after initiating therapy in Lyme disease/syphilis
- Reaction produced from the death of microorganisms on starting abx (endotoxin-like)
- Fever, rash, tachycardia
- No treatment needed
78
In addition to 12-13yo girls (and now boys), who else should be given the HPV vaccine?
HPV vaccination should also be offered to men who have sex with men under the age of 45 to protect against anal, throat and penile cancers
79
Which HPV strains are you protected against with the vaccine?
6, 11, 16 and 18
80
Which bacteria are gram negative cocci?
Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
81
Which bacteria are gram positive cocci?
staphylococci + streptococci (including enterococci)
82
What percentage of hep C will turn chronic?
55-85%
83
Other than usual pneumonia symptoms, what symptoms might you get in legionella pneumonia?
relative bradycardia
confusion
hyponatraemia
deranged LFTs
pleural effusion: seen in around 30% of patients
84
How to investigate legionella?
Urinary antigen
85
Management of legionella?
erythromycin/clarithromycin
86
What class of bacteria is H. influenzae in?
gram negative coccobacilus
87
Staph, coagulase negative vs positive example?
Coag -ve: S. epidermidis
Coag +ve: S. aureus
88
What to do if \<20 weeks pregnant and exposed to varicella with no previous infection?
Give immunoglobulins
89
What is Lemierre's syndrome?
an infectious thrombophlebitis of the internal jugular vein
90
What causes Lemierre's syndrome?
occurs secondary to a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess. A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.
91
Presentation of Lemierre's syndrome?
history of bacterial sore throat followed by neck pain, stiffness and tenderness (may be mistaken for meningitis) and systemic involvement (fevers, rigors, etc)
92
Complication of Lemierre's syndrome?
Septic pulmonary emboli
93
What type of bug causes schistosomiasis?
Parasitic flatworm
94
What are the acute symptoms of schistosomiasis?
• Swimmers itch
• Acute schistosomiasis syndrome (Katayama fever)
o Fever
o Urticaria
o Arthralgia
o Cough
o Diarrhoea
o Eosinophilia
95
What does schistosoma haematobium do and what complications can it lead to?
Deposit eggs clusters in the bladder -\> inflammation + calcification
- causes frequency/haematuria
o Can cause obstructive uropathy/kidney damage
o Risk of bladder SCC
96
What does Schistosoma mansoni + Schistosoma japonicum do?
Mature in liver - travel through portal system to distal colon
o Can cause progressive hepatomegaly + splenomegaly due to portal vein congestion
o Can also cause liver cirrhosis, variceal disease + cor pulmonale
97
How do you manage schistosomiasis?
Praziquantel
98
What to do if IC individual e.g. on Mtx, is exposed to varicella?
Check Abs
Give VZIg if -ve
Don't delay giving VZIg past 7/7 whilst waiting for Abs
99
What type of virus is Rabies?
RNA rhabdovirus
100
What are the symptom of Rabies?
Headache, fever, agitation
Hydrophobia
Hypersalivation
101
What is seen on microscopy in Rabies?
Negri bodies: cytoplasmic inclusion bodies found in infected neurons
102
How to treat Rabies?
Wash wound
Two further doses of vaccine required
If not previous immunised, human rabies immunoglobulin should be given alongside full course of vaccination
103
How do strongyloides travel through the body?
Worm enters through the skin -\> travels to the lungs -\> trachea -\> pharynx -\> is swallowed to the small intestine and lays eggs in the mucus
104
What are the features of strongyloidiasis and what is the name of the skin condition?
Diarrhoea
Abdo pain/bloating
Papulovesicular lesions where larvae have penetrated e.g. soles/buttocks
Larvae currens – the path of the worm below the skin, disappears
105
How to treat strongyloidiasis?
Ivermectin
Albendazole
106
Which organism are usually responsible for PID?
Chlamydia trachomatis
Neisseria gonnorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
107
Features of PID?
Abdo pain
Fever
Deep dyspareunia
Dysuria + menstrual irregularities
Vaginal or cervical discharge
Cervical excitation
108
Investigations in PID?
Preg test to exclude an ectopic
High vaginal swab
Screen for Chlamydia/Gonorrhoea
109
Management of PID?
Low threshold for treatment
PO oflaxacin + PO metronidazole
Or IM ceftriaxone + PO doxycycline + PO metronidazole
Consider removal of IUD
110
Complications in PID?
Perihepatitis (Fitz-Hugh Curtis Syndrome)
- Occurs in 10% of cases
- RUQ pain
Infertility
Chronic pelvic pain
Ectopic pregnancy
111
Incubation period for chickenpox?
10-21 days
112
Infective period for chickenpox?
4/7 before rash -\> 5/7 after rash
113
Management of chickenpox?
Calamine lotion
School exclusion – until lesions have crusted
IC patients/newborns should receive VZIg if Ab negative
Consider IV aciclovir
114
Complications of chickenpox?
Secondary bacterial infection
- NSAIDs may increase risk
- Risk: group A strep soft tissue infection -\> nec fasc
Pneumonia – most © complication, ausculatation often unremarkable
Encephalitis
A little similar to measles
115
What bacteria causes chlamydia?
Chlamydia trachomatis
116
What are the symptoms of chlamydia if any?
Urethritis and vaginal discharge
117
Ix for chlamydia?
NAAT testing
Women - high vaginal swab
Men - urine
118
Management of chlamydia? What if pregnant?
Doxycycline - 1st line
Azithromycin
Preg - azithro/erythro/amoxicillin
119
Complications of chlamydia?
Reactive arthritis
PID
120
What bacteria causes thrush?
Candida albicans
121
What are the RFs for thrush?
Pregnancy
Diabetes
Antibiotics
122
What are the symptoms of thrush?
Cottage cheese discharge
Vulval irritation + itching
May also have sup dyspyrunia + dysuria + inflamed/red vagina or vulva
123
Ix for thrush?
High vaginal swab
124
Management of thrush?
Clotrimazole/PO fluconazole
125
What is the main organism to cause BV?
Gardnerella vaginalis
126
What are the symptoms of BV?
Grey-white discharge
Fishy odour
NOT itchy/red
127
What is Amsel's criteria for BV?
pH \>4.5
Positive whiff test
Presence of 'clue cells' on microscopy
Thin white discharge
(need 3/4)
128
What is the management of BV?
Metronidazole PO
Clindamycin cream
129
Complications of BV?
PID
Preterm labour
130
What are the symptoms of trichomoniasis? Usual presentation in men?
Offensive grey-green discharge (frothy)
Cervicitis = punctuate 'strawberry' appearance
Vulval irritation and sup dyspareunia
Men - urethritis
131
How to diagnose trichomoniasis?
microscopy of a wet mount shows motile trophozoites
132
pH in trichomoniasis?
\>4.5
133
Treatment of trichomoniasis?
Metronidazole 5-7/7
Can do one off 2g
134
Normal vaginal pH, bacteria and cells?
Squamous cell
Colonised with lactobacillus
pH \<4.5
135
Organism causing gonorrhoea?
Neisseria gonorrhoea
136
Symptoms of gonorrhoea?
Asymptomatic
May have vaginal discharge, urethritis, cervicitis
137
Diagnosis of gonorrhoea?
```
Endocervical swabs (women)
Urethral swab (men)
```
138
Management of gonorrhoea?
Ciprofloxacin (although increasing antibiotic resistance)
1st line: IM ceftriaxone (can add azithro if needed)
139
Complications of gonorrhoea?
Bacteraemia
Septic arthritis
PID (second most (c) cause after chlamydia)
Infertility
140
What else do you need to consider when you diagnose gonorrhoea?
Partner notification and contact tracing
141
Organism causing genital warts?
Condylomata acuminata
142
Cause of genital warts?
HPV 6 + 11
143
Treatment of genital warts?
Topical podophyllin/cryotherapy
Imiquimod cream
144
Recurrence risk in genital warts?
25%
145
Herpes symptoms?
Primary infection = the worst
Multiple small PAINFUL vesicles around introitus
Local lymphadenopathy
Dysuria
Systemic symptoms
146
What percentage of patients get a reactivation of their herpes?
75%
The virus lies dormant in the dorsal root ganglion
147
Investigation for herpes?
Viral swabs
148
Treatment of herpes?
Aciclovir
Analgesia, rest, bathe in warm water
149
Causes of painless/painful ulcers?
Painless:
Syphilis
Lymphogranuloma venereum
Painful:
Herpes
Chancroids
Behcets
150
Incubation period in syphilis?
9-90 days
151
Syphilis - primary features?
Chancre – painLESS ulcer at site of sexual contact
- In women, may be on the cervix
Local non-tender lymphadenopathy
152
Syphilis - secondary features?
(6-10wks later)
Systemic – fever, lymphadenopathy
Rash on trunk, palm and soles
Buccal ‘snail track’ ulcers - white
Condylomata lata (painless warty lesions on genitals)
153
Syphilis - tertiary features?
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
tabes dorsalis – sensory demyelination causing locomotor ataxia
Argyll-Robertson pupil
154
Features of congenital syphilis?
blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins (anterior bowing of the shin)
saddle nose
deafness
Saber shins, saddle nose, SN deafness
Short teeth, scars at edge of mouth
155
Investigations in syphilis?
Cardiolipin tests
- VDRL + RPR
- Become negative after treatment
Treponemal specific antibody tests
- TPHA
- Remains positive after treatment
156
Causes of false positive cardolipin tests?
pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV
157
Causes of false positive cardolipin tests?
pregnancy
SLE, anti-phospholipid syndrome
TB
leprosy
malaria
HIV
'SomeTimes Mistakes Happen' (SLE, TB, malaria, HIV)
158
Which organism causes chancroid?
Haemophilus ducreyi
159
Symptoms of chancroid?
causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border
160
What is the groove sign?
raised LNs either side of the inguinal ligament (which isn't inflamed)
161
What is the groove sign?
Sign seen in lymphogranuloma venereum - raised LNs either side of the inguinal ligament (which isn't inflamed)
162
What are the three stages of lymphogranuloma venereum?
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
163
How to treat lymphogranuloma venereum?
Doxy
164
How to treat lymphogranuloma venereum?
Doxy
165
Where can you catch brucellosis?
© Middle East + farmers/vets/abattoir (slaughterhouse) workers
4 main species causing human infection come from sheep, cattle and pigs
Can be caught from unpasteurised products
166
Features of brucellosis?
Fever
Hepatosplenomegaly
Sacroiliitis/spinal tenderness
Complications – osteomyelitis, infective endocarditis, meningoencephalitis, orchitis
Leukopaenia
167
Investigations in Brucellosis?
Rose Bengal plate test – used for screening
Brucella serology – best for diagnosis
Blood/BM cultures may be useful but are often negative
168
Management of brucellosis?
Doxycycline + streptomycin
169
What condition can cause a false negative tuberculin test?
military TB, sarcoidosis, HIV, lymphoma, very young age \<6m
170
When can you give sequential live vaccines?
Either on the same day or 4 weeks apart
171
Other than staph + step, what may be isolated following a human bite?
Eikonella corrodens
Also Fusobacterium and Prevotella
172
Antibiotic for invasive diarrhoea/immunocompromised/bloody diarrhoea?
Ciprofloxacin
173
What causes nec fasc?
Type 1 © – caused by mixed anaerobes + aerobes (often post-surgery in DM)
Type 2 – caused by Streptococcus pyogenes (gram +ve cocci in chains)
174
What commonly causes cellulitis?
strep pyogenes / staph aureus
175
What is Eron classification?
Class 1: No signs of systemic toxicity + no uncontrolled co-morbidities
Class 2: Either systemic unwell/well but with a co-morbidity (e.g. PAD, morbid obesity) which may complicate or delay resolution of infection
Class 3: Significant systemic upset e.g. acute confusion, tachycardia, tachypnoea, hypotension or unstable co-morbidities that may interfere with the response to Tx, or a limb-threatening infection d/t vascular compromise
Class 4: Sepsis syndrome or a severe life-threatening infection e.g. necrotising fasciitis
176
Features of rheumatic fever?
Fever
Erythema marginatum
Sydenham’s chorea: often late feature
Polyarthritis
Carditis/vulvitis
177
Investigations for rheumatic fever?
Raised inflam markers
ECG: prolonged PR (T1 HB)
178
Management of rheumatic fever?
Penicillin V
NSAIDs
Treat complications
179
What causes EBV?
HHV-4 in 90% of cases
180
What is the classic triad in EBV?
Sore throat
Lymphadenopathy - ant/post
Pyrexia
Also splenomegaly (50%), malaise, headache
181
How long do symptoms usually last in EBV?
2-4 weeks
182
How to diagnose EBV?
Monospot + FBC in 2nd week of illness
FBC - \>20% reactive lymphocytes
183
What conditions are associated with EBV?
Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma
184
How do you treat EBV?
Rest, fluids, avoid alcohol
Simple analgesia
Avoid playing sport for 8 weeks to reduce risk of splenic rupture
185
Different types of leprosy?
Low degree of cell mediated immunity -\> lepromatous leprosy
- Extensive skin involvement
- Symmetrical nerve involv
High degree of cell mediated immunity -\> tuberculoid leprosy
- Limited skin disease
- Asymmetrical nerve involvement -\> hypesthesia
- Hair loss
186
Treatment of leprosy?
TRIPLE therapy: rifampicin, dapsone and clofazimine
DRC
187
What causes leprosy?
Mycobacterium leprae
188
How to treat toxoplasmosis in non IC patients?
often asymptomatic and self-limiting (similar to EBV)
189
What is the disseminated gonococcal infection triad?
tenosynovitis, migratory polyarthritis, dermatitis
190
What is the difference between T1 + T2 HIV?
Type 1: causes the majority of infections
Type 2: mostly seen in West Africa (lower transmission and progression)
191
What type of virus is HIV?
RNA retrovirus
192
When should you start ARVs if Dx with HIV antenatally?
At the end of the **1st** trimester
193
In what circumstance can you consider a vaginal delivery?
Viral load is measured every 2 weeks from 30 wks, if undetectable can consider a vaginal delivery, if not C-section (zidovudine infusion should be started 4hrs before beginning op)
194
What treatment should the newborn be started on and for how long?
Post-natally infant started on triple AZT for 4 weeks + exclusive bottle formula feeds
If mothers viral load \<50, may only be started on zidovudine
195
Investigations in HIV?
HIV Ab test
- Consists of a screening test (ELISA) and confirmatory test (Western Blot Assay)
- Abs can be identified from 4 weeks after infection, 99% by 3 months
- After initial negative result, offer repeat at 12 weeks
P24 antigen test
- +ve from 1-4 weeks after infection
- If testing during suspected seroconversion – use this
- Sometimes used as an additional screening tool in blood banks
196
What is used to monitor HIV?
CD4 count and viral load – used to establish how advanced the disease is/monitor treatment
197
Which category of medications should you use two of in the treatment of HIV? And an example?
nucleoside reverse transcriptase inhibitors (NRTIs)
Tenofovir
198
SE of NRTIs and tenofovir specifically?
SE: peripheral neuropathy
Tenofovir specific: renal impairment, osteoporosis
199
What is an example of a Non-nucleoside reverse transcriptase inhibitors (NNRTIs)? and what are their SEs?
Nevirapine
SE: P450 enzyme inducers
200
What is an example of a protease inhibitor? And SEs?
Indinavir (end with navir)
SE: diabetes, hyperlipidaemia
(PIs inhibitor the glucose transporter Glut 4 leading to hyperglycaemia)
201
What is an example of an integrate inhibitor?
Raltegravir
block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell
202
Who can be given HIV post-exposure prophylaxis?
can be given to patients who are HIV seronegative and have had a high risk exposure (4 week course with follow-up HIV testing) – can be taken up to 72 hours after the event
203
What causes a Kaposi's sarcoma?
HHV-8
204
How does a Kaposi's sarcoma present?
Purple papules on the skin/mucosa, may ulcerate
May be massive haemoptysis + pleural effusion
205
How to treat Kaposi's sarcoma?
Radiotherapy + resection
206
Symptoms of cryptosporidiosis?
Watery diarrhoea
207
Diagnosis and treatment of cryotsporidiosis?
Dx: modified Ziehl-Neelsen stain of stool may reveal red cysts
Treatment is supportive
Can use nitazoxanide for IC patients
208
Investigations for toxoplasmosis?
Ab test, Sabin-Feldman dye test, MRI (multiple ring shaped contrast enhanced lesions – account for 50% of cerebal lesions in HIV)
209
How to treat cryptococcus meningitis?
Amphotericin B + flucytosine
210
Cause and effect of progressive multifocal leukoencephalopathy?
Secondary to the JC/BK virus
Widespread demyelination
211
Associated condition, CT result and treatment of primary CNS lymphoma?
Accounts for around 30% of cerebral lesions
Associated with EBV
CT: single/multiple homogenous enhancing lesions
Mx: steroids + chemo
212
Symptoms and treatment of Mycobacterium avian intracellulare?
Fever, SOB/cough, abdo pain/diarrhoea
Tx: rifampicin + ethambutol + clarithromycin
MAI REC
213
Symptom and effect + Tx of cytomegalovirus?
Blurred vision
Clinical diagnosis
‘Pizza’ retina – haemorrhages + necrosis
Tx: IV ganciclovir
214
Mechanism of action of aciclovir?
DNA polymerase inhibitor
Polymerase is responsible for DNA replication
215
Where can you catch leptospirosis from?
Contact with infected rat urine
Common in sewage workers, farmers, vets + people who work in abattoirs
However far more common in the tropics + returning travellers
216
What occurs in the early phase of leptospirosis?
Early phase – due to bacteraemia (1 week)
Mild fever
Flu-like symptoms
Subconjunctival haemorrhage
217
What occurs in the second phase of leptospirosis?
Second phase – can lead to more severe disease (Weil’s disease)
Acute kidney injury (seen in 50% of patients)
Hepatitis: jaundice, hepatomegaly
Aseptic meningitis
218
What are the investigations in leptospirosis?
Serology: Abs to Leptospira develop after about 7 days
PCR
Culture
- Growth may take several weeks so limits usefulness
Use blood/CSF for first week
Then urine cultures from second week onwards
219
What are the live vaccines?
You Musn't Prescribe BCG Incase They RIP, Shit.
BCG, MMR, influenza, rotavirus PO, polio PO, yellow fever, typhoid PO, shingles
220
What causes amoebiasis?
Entamoeba histolytica (an amoeboid protozoan)
221
How is amoebiasis spread?
Faecal-oral route
222
What is amoebic dysentery?
Profuse, bloody diarrhoea
223
How to investigate amoebic dysentery?
Hot stool (examined within 15 minutes, may show trophozoites)
224
How to treat amoebic dysentery?
Metronidazole
225
What is an amoebic liver abscess?
Usually single mass in the right lobe - contents described as 'anchovy sauce'
226
How to investigate for amoebic liver abscess?
Positive serology \>90%
227
How to treat amoebic liver abscess?
Metronidazole, followed by luminal amoebicide to eradicate the cystic stage
228
Which antibiotics inhibit cell wall synthesis?
Beta-lactams (penicillins, cephalosporins, carbopenems)
Glycopeptides (vancomycin/teicoplanin)
229
Which antibiotics inhibits nucleus acid synthesis? ie: inhibit folate synthesis, inhibit DNA gyrase, bind to RNA polymerase, damage DNA?
Inhibit folate synthesis -\> trimethoprim + sulphonamides (sulfamethoxazole)
Inhibit DNA gyrase -\> fluoroquinolones (cipro/levo/ofloxacin)
Bind to RNA polymerase -\> rifampicin
DNA strand breaks -\> metronidazole
230
Which antibiotics inhibit protein synthesis?
Chloramphenicol
Macrolides - clarithro/erythromycin
Tetracyclines - tetracycline/doxycycline
Aminoglycosides - gentamycin, streptomycin
231
Which antibiotics are bacteriostatic?
CORe - ChlORamphenicol
Medical - Macrolides
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim
232
What is Hydadtid disease, who gets it and how to Tx?
- Caused by dog tapeworm Echinococcus granulosus
- Dog ingests hydatid cysts from sheep liver
- © farmers
- May cause liver cysts
- Management: albendazole
233
What is Immune reconstitution inflammatory syndrome?
IRIS is an exaggerated immune response to a pre-existing opportunistic infection in HIV patients who commence antiretroviral therapy
234
What skin/vascular changes might you get with Hep B?
Urticaria
Polyarteritis nodosa
235
On checking Hep B level after vaccination, how would you interpret the results?
\>100 - protected
10-100 - give another shot of the vaccine
\<10 - repeat all 3 doses. if still not covered then would been Ig if exposed
236
What type of virus is Dengue fever?
Flavivirus
237
What is the incubation period for Dengue fever?
7 days
238
What transmits Dengue fever?
Aedes aegypti mosquito
239
What are the three classifications for Dengue fever?
- Dengue without warning signs
- Dengue with warning signs
- Severe dengue
240
What are the symptoms of dengue without warning signs?
o Fever, headache (often retro-orbital)
o Myalgia, arthralgia
o Pleuritic pain
**o FACIAL FLUSHING**
o Maculopapular **RASH**
o Haemorrhagic manifestations – positive tourniquet test, petechiae, purpura etc
241
Warning signs in Dengue?
Abdo pain
Hepatomegaly
Persistent vomiting
Clinical fluid accumulation (ascites, pleural effusion)
242
Symptoms of severe Dengue?
A form of DIC resulting in:
- Thrombocytopaenia
- Spontaneous bleeding
Around 20-30% go on to develop dengue shock syndrome (DSS)
243
Blood results in Dengue and other diagnostic tests?
Leukopaenia + thrombocytopaenia
Raised aminotransferases
Serology
NAAT testing for viral RNA
NS1 antigen test
244
How to treat Dengue fever?
Entirely symptomatic treatment – no antivirals available
245
When do you not need to give a tetanus vaccine to patient with a wound caused by metal?
If a patient has had 5 doses of tetanus vaccine, with the last dose \< 10 years ago, they don't require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
246
Treatment/tests involving Interferon-alpha/Interferon-beta/Interferon-gamma?
Interferon-alpha -\> Hep B treatment
Interferon-beta -\> Multiple sclerosis treatment
Interferon-gamma -\> TB test
247
What is the MOA of linezolid and what are the SEs?
a type of oxazolidinone antibiotic which has been introduced in recent years. It inhibits bacterial protein synthesis by stopping the formation of the 50s initiation complex and is bacteriostatic in nature
Highly active against resistance staph aureus bugs
SE: thrombocytopaenia
monoamine oxidase inhibitor: avoid tyramine foods
248
Type of organism causing Japanese Encephalitis, carried by what host, and who is at risk?
Most common cause of viral encephalitis in parts of Asia + Western Pacific
Flavivirus transmitted by Culex mosquitos
Breeds in rice paddy fields, or interaction with birds or pigs
249
Features of Japanese Encephalitis?
Majority asymptomatic
Headache
Fever
Seizures, confusion
Parkinsonian features indicate basal ganglia involvement
Can also present with acute flaccid paralysis
250
Diagnosis and management of Japanese Encephalitis?
Dx: Serology/PCR
Mx: Supportive
251
What should you not prescribe with trimethoprim?
Methotrexate
252
How to treat non-specific urethritis?
Azithromycin or doxycycline
253
What is C. perfringens + symptoms?
Clostridium spp that produces alpha-toxin which causes gas gangrene and haemolysis
- features: tender, oedematous skin with haemorrhagic blebs/bullae
- often crepitus can be heard on movement
254
What is C. botulinum, where found and symptoms? Treatment?
- seen in canned foods/honey, also from IVDU
- toxin produced prevents Ach release
- leading to flaccid paralysis, diploplia, ataxia
- Tx: antitoxin if given early, supportive care
255
What causes C. difficile and complication?
Occurs following broad-spectrum antibiotics which disrupt normal gut flora and allow C. diff to over-colonise
256
Which abx can cause C. difficile?
Cephalosporins
Co-amoxiclav
Ciprofloxacin
Clindamycin
Carbapenem
257
Symptoms of C. difficile?
Typically 3-9 days post-abx
Produces an exotoxin which causes intestinal damage -\> pseudomembranous colitis
Diarrhoea – green foul-smelling
Abdo pain
Raised WCC
**Toxic megacolon** may develop
258
What are the rare complications from an infection with Clostridium sordellii?
is a very rare cause of post-partum and post-termination sepsis
259
What is a granuloma inguinale?
Caused by Klebsiella granulomatis
causes a painless, red lump on or near the genitals, which slowly enlarges, then breaks down to form a sore
Tx: Azithromycin
260
What percentage of adults don't respond to 3x Hep B vaccine?
10-15%
261
Who should have their blood checked for Hep B antibodies after 3x doses?
testing for anti-HBs is only recommended for those at risk of occupational exposure (i.e. Healthcare workers) and patients with chronic kidney disease
262
Who typically catches CMV?
* IC patients
* HIV
* Patients on immunosuppressants following organ transplantation (e.g. kidney)
263
What would you see on microscopy in CMV?
‘Owl’s eye’ appearance – intranuclear inclusion bodies
264
What are the different presentations of CMV?
Congenital – growth retardation, ‘blueberry muffin’ skin lesions, microcephaly
CMV mononucleosis – infectious mononucleosis-like illness
CMV retinitis – common in HIV pts with low CD4, presents with blurred vision, fundoscopy shows retinal haemorrhages and necrosis, often called ‘pizza’ retina, Tx = IV ganciclovir
CMV encephalopathy – seen in pts with HIV who have low CD4 counts
265
What organism causes anthrax and how is it spread?
Caused by Bacillus anthracis
Spread: infected carcasses
266
What are the features and management of anthrax?
Features
Painless black eschar
May be marked oedema
Can cause GI bleeding
Mx: Ciprofloxacin
267
What organism causes typhoid?
Salmonella
268
Presentation of typhoid?
Initially systemic – headache, fever, arthralgia
Bradycardia
Abdo pain/distention
Constipation
Rose spots: present on trunk
269
Complciations of typhoid?
Osteomyelitis
GI bleed/perforation
Meningitis etc
270
If pen allergy, what should you give in cellulitis?
Clarithromycin/erythromycin/doxycycline
271
If untreated, how many people can be infected from 1 TB patient each year on average?
If left untreated, 1 person with active pulmonary TB may infect as many as 10 to 15 people every year
272
Sites of extra pulmonary TB?
* CNS (tuberculous meningitis – most serious)
* Vertebral bodies (Pott’s disease)
* Cervical LNs
* Kidneys
* GI tract
273
TB treatments?
Start Tx before culture results if clinically suspected
6m: Isoniazid
6m: Rifampicin
2m: Ethambutol
2m: Pyrazinamide
274
SEs of isoniazid + prevention?
peripheral neuropathy (prevent with pyridoxine)
275
SE rifampicin?
urine/sweat discolouration
276
SE ethambutol?
optic neuritis, need baseline eye check before
277
SE pyrazinamide?
arthralgia/liver toxicity
278
How to Tx CNS TB?
1 year (extend isoniazid and rifampicin for 12 months)
279
How long to Tx MDR TB?
For 24 months
Use NAT test to see which drugs are resistant
280
Complications of TB?
Pleural effusion
Empyema
Pneumothorax
Laryngitis
Cor pulmonale secondary to extensive fibrosis
281
Meningitis 0-3 months?
* Group B Streptococcus (most common cause in neonates)
* E. coli
* Listeria monocytogenes
282
Meningitis 3 months - 6 yrs?
* Neisseria meningitidis (meningococcus)
* Streptococcus pneumoniae (pneumococcus)
* Haemophilus influenzae
283
Meningitis 6 yrs - 60 yrs?
* Neisseria meningitidis
* Streptococcus pneumoniae
284
Meningitis \>60 yrs?
* Streptococcus pneumoniae
* Neisseria meningitidis
* Listeria monocytogenes
285
CSF in bacteria/virus/TB?
See chart
286
How to treat meningitis empirically in different age groups?
Age \<3 months – IV cefotaxime + amoxicillin
Age 3m-50yrs – IV cefotaxime
Age \>50yrs – IV cefotaxime + amoxicillin
287
How to treat listeria meningitis?
IV amoxicillin + gentamicin
288
IV dexamethasone to reduce risk of neurological complications in meningitis, except in?
- Septic shock
- Meningococcal septicaemia
- Immunocompromised
- Meningitis following surgery
289
Prophylaxis/contact tracing
PO ciprofloxacin (single dose) or rifampicin
Contact risk highest in first 7/7, persists for 4/52
Meningococcal vaccine to close contacts (incl booster doses) once serology known
If pneumococcal meningitis – no prophylaxis generally needed
290
Complications of meningitis?
Neurological sequalae
- Sensorineural hearing loss (most common)
- Seizures
- Focal neurological deficit
- Infective (sepsis/intracerebral abscess)
- Pressure (brain herniation/hydrocephalus)
Patients with meningococcal meningitis -\> at risk of Waterhouse-Freiderichsen syndrome
291
Presentation of cutaneous leishmaniasis?
Crusted lesions at site of bite
May be underlying ulcer
If acquired in S/central America – needs to be Tx d/t risk of mucocutaneous type
If acquired in Africa/India – can be managed more conservatively
292
Presentation of mucocutaneous leishmaniasis?
Skin lesions that may spread to involve the mucosae of the nose/pharynx
293
Presentation of visceral leishmaniasis?
(kala-azar, meaning black sickness d/t skin colour)
Occurs in Mediterranean, Asia, S America, Africa
Sx: fever, sweats, rigors
Massive splenomegaly, hepatomegaly
Poor appetite and WL
Grey skin
Pancytopaenia 2\* to hypersplenism
294
Type of virus causing rubella?
Togavirus
295
Rubella incubation period?
14-21 days
296
Rubella infectious period?
7/7 before symptoms -\> 4/7 of rash
297
Congenital rubella syndrome symptoms?
- Sensorineural deafness
- Congenital cataracts
- Congenital heart disease
- Growth retardation
- ‘salt and pepper’ chorioretinitis
- Cerebral palsy
Foetus most at risk in first 8-10 weeks of pregnancy (up to 90%)
298
Management of rubella?
Discuss with local Health Protection Unit
No longer routinely checked at booking visit
Off MMR in post-natal period (do not give during/before pregnancy)
299
Infectious period for slapped cheek syndrome?
Infectious for 3-5 days BEFORE rash develops
300
Features of slapped cheek syndrome?
May only be mild fever
May develop red cheeks
- Peaks after a week then fades
- May reappear in following months following hot bath/fever/sunlight
301
Features of staph toxic shock syndrome?
Reaction to staphylococcal exotoxins (TSST-1 superantigen toxin)
Fever, hypotension, diffuse erythematous rash with desquamation, involvement of 3+ organs
302
Zika vector?
Aedes mosquito
303
Features of Zika?
- Majority asymptomatic
- Otherwise mild (2-7d)
o Fever, rash, arthralgia/myalgia, conjunctivitis, headache, retro-orbital pain
304
Complications of Zika?
Serious complications in adults are uncommon
Has been associated with Guillain-Barre syndrome
Can cause microcephaly/congenital abnormalities in foetus
305
Type of virus and vector for Chikungunya?
Alphavirus
Caused by infected mosquitoes
Africa, Asia, Indian continent
306
Symptoms and treatment for Chikungunya?
Sever joint pain
Abrupt onset high fever
General flu-like illness
Similar to Dengue but more emphasis on joint pain +/- swelling
No specific treatment
307
What causes Melioidosis (Whitmore’s disease)?
gram -ve Burkholeria pseudomallei
308
Incubation for Melioidosis (Whitmore’s disease)?
1-21 days (mean 9 days)
309
Transmission of Melioidosis (Whitmore’s disease)?
Contact with soil and fresh water
310
Features of Melioidosis (Whitmore’s disease)?
Can be acute, chronic, or reactivation of latent infection
Acute pulmonary infection ©
Localised skin infection
Visceral abscesses: prostate, spleen, kidney, liver
Disseminated infection: fever + septic shock, occurs in 55% of cases
311
Ix in Melioidosis (Whitmore’s disease)?
Culture – sputum/abscess pus
CXR – pneumonia
312
Tx of Melioidosis (Whitmore’s disease)?
IV ceftazidime, imipenem or meropenem 10-14 days
Followed by eradication therapy: oral TMP/SMX (plus doxy) for 3-6 months
May need abscess drainage
313
Mx of scarlet fever?
Penicillin V for 10 days
Notifiable disease
Can return to school 24hrs after commencing abx
314
Organism causing diphtheria?
Corynebacterium diphtheriae
Releases an exotoxin -\> inhibits protein synthesis
315
Features of diphtheria?
Pharyngitis + Bradycardia = Diphtheria
Sore throat with a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells
Bulky cervical lymphadenopathy
Heart block
Neuritis e.g. CNs
316
Investigation in diphtheria?
Throat swab culture
317
Management in diphtheria?
IM penicillin
Diphtheria antitoxin
