Infectious Diseases Flashcards
(260 cards)
1
Q
TB Meningitis Tx
A
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol for 2 months
R + I for 10 more months
+/- dexamethasone
+/- fludrocortisone
2
Q
side effects of ethambutol
A
optic neuritis
AVOID if renal impairment (CrCl 10-50ml/min)
3
Q
side effects of pyrazinamide
A
hepatitis
arthralgia
contraindicated in gout, porphyria
4
Q
side effects of rifampicin
A
orange secretions
enzyme (CYP450) induction
hepatitis
if renal impairment-> reduce rifampicin dose by 50%
5
Q
side effects of isoniazid
A
hepatitis
peripheral sensory neuropathy
(can give Vit B6 - pyridoxine alongside)
6
Q
tx for latent TB
A
Rifampicin + Isoniazid for 3 months
or
Isoniazid alone for 6 months
7
Q
hypopigmented, insensate plaques
trophic ulcers
thickened nerves
keratitis
A
mycobacterium leprae
8
Q
pauci vs multibacillary leprosy
- what is the difference?
A
Pauci: 2-5 spots
Multi: >5 spots
9
Q
tx of lepromatous leprosy
(mycobacterium leprae)
A
tx for 2 years
rifampicin monthly
clofazamine + dapsone daily
10
Q
tuberculoid vs lepromatous leprosy
- who develops lepromatous leprosy?
A
failure of Th1 cell activation
11
Q
tx of tuberculoid leprosy?
A
6 month tx
rifampicin monthly
clofazamine daily
12
Q
mycobacterium avium intracellulare (MAI)
- who is affected?
A
usually HIV patients / any immunosuppressed
CD4 <100
13
Q
symptoms of MAI (mycobacterium avium intracellulare) complicating HIV infection
A
widely disseminated disease: lungs/ GIT
fever, night sweats, weight loss
diarrhoea
hepatomegaly
14
Q
in immunocompromised host,
begins as a painless dermal papule or subcutaneous edematous nodule, which, over a period of weeks to months, breaks down to form an extensive necrotic ulcer with undermined edges
A
Buruli Ulcer
mycobacterium ulcerans
15
Q
buruli ulcer
which organism?
A
mycobacterium ulcerans
16
Q
fish tank granuloma
what organism?
A
mycobacterium marinum
17
Q
oral neuraminidase inhibitor
against Influenza A and B
A
Oseltamivir
18
Q
inhaled neuraminidase inhibitor
against Influenza A and B
A
Zanamivir
19
Q
how does HIV seroconversion present?
A
transient illness 2-6 wks after exposure
fever, malaise, myalgia, pharyngitis, macpap rash
sore throat, lymphadenopathy
20
Q
Dx of HIV?
A
HIV PCR
p24 antigen tests: usually +ve wk1 - wk3/4
screening ELISA- for serum anti-HIV Abs
confirmatory Western Blot: HIV Abs (95% by 4-6 wks)
21
Q
Monitoring of HIV
using?
A
CD4 count
Viral Load (HIV RNA)
FBC, U+Es, LFTs, lipids, glucose
22
Q
Ix of suspected HIV?
A
HIV diagnostic tests
Drug resistance studies
Mantoux test
Serology: CMV, toxo, HBV, HCV, syphilis
23
Q
CD4<50 - prophylaxis against MAI?
A
azithromycin
24
Q
HIV CD4 <100: prophylaxis against toxoplasmosis?
A
co-trimoxazole
25
HIV + CD4 \<200: prophylaxis against PCP
co-trimoxazole
26
Diagnosing TB in HIV pts
problems?
higher false -ve skin tests
higher false -ve sputum cultures
27
presentation of PCP?
dry cough
exertional dyspnoea
fever
desaturation on exercise
28
CXR signs of PCP?
bilateral perihilar interstitial shadowing
may be normal
29
CMV in HIV patients causes?
CMV retinitis
+ pneumonitis, colitis, hepatitis
30
Tx for CMV retinitis in HIV pt
Ganciclovir
31
signs of CMV retinitis
decreased visual acuity
eye pain
photophobia
pizza sign on fundoscopy
32
CT/MRI head findings of toxoplasmosis
ring shaped contrast enhancing lesions
33
tx of toxoplasmosis in HIV pts
pyrimethamine
+
sulfadiazine
+
folate
34
presentation of toxoplasmosis in HIV Pts
posterior uveitis
encephalitis
focal neurology
35
tx for oral candidiasis?
nystatin suspension
36
tx of oesophageal candidiasis
PO itraconazole
37
presentation of oesophageal candidiasis?
dysphagia
retrosternal pain
38
Ix for suspected cryptococcal meningitis?
India Ink CSF stain
Raised CSF pressure
CrAg in blood and CSF
39
What virus causes progressive multifocal leukoencephalopathy?
JC virus
40
Tx of cryptococcal meningitis
Amphotericin B + Flucytosine for 2 wks
then
Fluclonazole for 6 months/ until CD4 count \>200
41
Ix of suspected PML?
JC viral PCR
42
HIV patient
with
Weakness, paralysis, visual loss, cognitive decline.
you suspect a demyelinating inflammation of brain white matter
Progressive multifocal leukoencephalopathy
caused by JC virus
43
Mx of PML in HIV pt
HAART
44
benign recurrent aseptic meningitis?
mollaret's meningitis
mostly HSV-2
45
Ix of herpes encephalitis
CSF findings: high lymphocytes
CSF PCR
MRI head
46
herpes infection
painful red finger
herpetic whitlow
mx: topical aciclovir
47
genital herpes
-\> urinary retention + sacral sensory loss
Elsberg Syndrome
HSV-2 Sacral radiculiltis
48
Complications of chicken pox
pneumonitis
encephalitis
hepatitis
haemorrhage
increased risk in immunocompromised/ pregnancy
49
complications of shingles
post-herpetic neuralgia
(severe dermatomal pain)
Ramsay Hunt Syndrome
(Facial palsy, vesicles in ear, decreased taste/ hearing)
50
starry sky appearance
t(8;14)
c-myc
jaw or abdo mass
Burkitt's lymphoma
51
what cells does EBV infect?
B lymphocytes
52
HIV pt
painless shaggy white plaque along lateral tongue border
oral hairy leukoplakia
EBV
53
tx of oral hairy leukoplakia
Aciclovir
54
lymphoma following solid organ transplant?
B cell proliferation
post-transplant lymphoproliferative disorder
55
Tx of post transplant lymphoproliferative disorder
Rituximab
56
mx of neisseria gonorrhoea?
ceftriaxone 500 mg IM + azithromycin 1 g oral
57
features of disseminated gonococcal infection?
tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)
Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)
58
pathophysiology of tetanus?
clostridium tetani produces exotoxin
- \> prevents the release of inhibitory transmitters GABA and glycine
- \> generalise muscle overactivity
59
presentation of tetanus?
prodrome: fever, malaise, headache
trismus
risus sardonicus (spasm of facial muscles that appears grinning)
opisthotonus (hyperextension of neck/ spine)
spasms may -\> resp arrest
autonomic dysfunction: arrhythmias, fluctuating BP
60
Mx of tetanus?
Mx in ITU: may need intubation
Human tetanus Ig
Metronidazole, benpen
61
Prevention of tetanus?
active immunisation w tetanus toxoid
clean minor wounds
- uncertain hx / \<3 doses: give vaccin
3 or more doses: only vaccinate if \> 10 yrs since last dose
Heavily contaminated wounds
- uncertain hx/ \< 3 doses: vaccine + Tetanus Ig
3 or more doses: vaccinate if 5 or more years since last dose
62
Actinomycosis features?
Subcut infections: esp. on jaw
Forms sinuses which discharge pus containing sulphur granules.
63
tx of actinomycosis?
Ampicillin for 30d, then Pen V for 100d
64
Swelling of eyelid (Romana's sign)
fever, swollen lymph nodes, headaches, or local swelling at the site of the bite
enlargment of heart ventricles -\> heart failure
enlargement of oesophagus/ colon
Chagas Disease
transmitted by kissing bugs (Reduviids)
65
diagnosis of african trypanosomiasis (sleeping sickness)?
thick and thin films -\> flagellated protozoa
serology
66
Tender subcut nodule @ site of infection
_Haemolymphatic Stage (1st stage):_
- rash, fever, rigors, headaches
- itchiness
- joint pains
- LNs and HSM
- Posterior cervical nodes (Winterbottom’s sign)
_Miningoencephalitic Stage (2nd stage)_
- Wks – Mos after original infection
- Convulsions, agitation confusion
- Apathy, depression, hypersomnolence, coma
Sleeping sickness
African trypanosomiasis
transmitted by Tsetse fly
T. gambiense: more common, gradual onset
T. rhodesiense: rapid, more severe
67
skin ulcer @ bite -\> depigmented scar
bitten by sandflies
Cutaneous Leishmaniasis
| (L. major, L. tropica)
68
Bitten by sandflies
Widespread nodules which fail to ulcerate?
Diffuse cutaneous Leishmaniasis
69
bitten by sand flies
skin and mucosal ulcers with damage primarily of the nose and mouth
Mucocutaneous leishmaniasis (L braziliensis)
70
bitten by sandflies
Dry, warty hyperpigmented skin lesions (dark face and hands)
- Prolonged fever
- Massive splenomegaly, LNs, abdo pain
visceral leishmaniasis (Kala Azar)
L donovani
**leishman-donovan bodies**
71
lymphatic filariasis
- Wuchereria bancrofti
- elephantiasis
72
what carrier is responsible for transmitting dengue fever?
Aedes mosquito
| (RNA virus)
73
features of dengue fever?
Flushes: face, neck, chest
Central macpap rash
Headache, arthralgia
Hepatosplenomegaly
Jaundice
Haemorrhage: petechial, GI, gums or nose, GU
NB. can exclude if fever starts \>2wks after leaving endemic area.
74
mx of uncomplicated falciparum ovale, vivax, malariae?
chloroquine then primaquine
75
mx of uncomplicated falciparum malaria?
artemeter-lumefantrine (Riamet)
Quinine + doxy
76
mx of severe falciparum malaria?
need ITU mx
IV Quinine (Antimalarials)
77
Prophylaxis against malaria in pt w no resistance?
proguanil + chloroquine
78
prophylaxis against Malaria in pts with resistance?
mefloquine or Malarone (atovaquone + proguanil)
79
Which antimalarial causes haemolysis if G6PD deficiency?
primaquine
80
Diagnosis of malaria?
serial thick and thin blood films
parasitaemia level
81
Ix in malaria after diagnosis?
FBC: anaemia, thrombocytopenia
Clotting: DIC
Glucose
ABG: lactic acidosis
U+E: renal failure
Urinalysis: haemoglobinuria
82
features of falciparum malaria?
90% present within 1 month.
v acute illness
flu like prodrome: headache, myalgia, malaise
Rigors
fever every 3-4 days
83
signs in malaria?
anaemia
jaundice
hepatosplenomegaly
no rash, no LNs
84
which type of malaria species causes fever every 72 h?
(Quartan fever)
Plasmodium malariae
85
which type of malaria species causes tertian rhythm fever (every 48h)?
Plasmodium falciparum
Plasmodium vivax
& ovale
86
which species of malaria have a chronic liver stage?
vivax and ovale
87
pathophysiology of Malaria?
Plasmodium sporozoites injected by females Anopheles mosquito.
Sporozoites migrate to liver, infect hepatocytes and multiply asymptomatically (incubation period) → merozoites
Merozoites released from liver and infect RBCs
Multiply in RBCs
Haemolysis
RBC sequestration → splenomegaly
Cytokine release
88
Features of Primary Syphilis?
indurated, painless ulcer = Chancre
Regional LNs
Heals in 1-3wks
89
features of secondary syphilis?
6wks -6mo wks after chancre
Systemic bacteraemia → fever, malaise
Skin rash: Symmetrical, non-itchy, mac pap / pustular
Rash on Palms, soles, face, trunk
Buccal snail-track ulcers
Warty lesions: condylomata lata
90
features of tertiary syphilis?
2-20yrs latency
1. **Gummatous syphilis**
Gummas: Granulomas in skin, mucosa, bones, joints
2. **Neurosyphilis**
Tabes Dorsalis
Argyll Robertson pupil
dementia
3. **cardiovascular syphilis**
Aortic aneurysm
Aortic regurg
91
features of Syphilitic aortitis?
Aortic aneurysm
Aortic regurg
92
features of Neurosyphilis?
Paralytic dementia
Meningovascular: CN palsies, stroke
**Tabes dorsalis**
* Degeneration of sensory neurones, esp. legs
* Ataxia and +ve Romberg’s
* Areflexia
* Plantars ↑↑
* Charcot’s joints
**Argyll-Robertson pupil**
accommodates, doesn’t react
93
Diagnosis of Syphilis?
_Cardiolipin antibody_
E.g. **VDRL, RPR**
Not treponeme specific
False +ve: pregnancy, pneumonia, SLE, malaria, TB
+ve in 1O and 2O syphilis (wanes in late disease)
Reflects disease activity: -ve after Rx
_Treponeme-specific Ab_
+ve in 1O and 2O syphilis
Remains +ve despite Rx
**THPA and FTA**
_Treponemes_
Seen by dark ground **microscopy of chancre fluid**
Seen in lesions of 2O syphilis
May not be seen in late syphilis
94
What marker is used to monitor disease activity in syphilis?
RPR
95
What test would remain +ve even after tx of syphilis?
THPA and FTA:
treponene-specific Ab
96
Mx of syphilis?
IM Benzathine Penicillin 2-3 doses
or Doxycycline for 28 days
97
What reaction is common after receiving tx for syphilis?
Jarisch-Herxheimer Reaction
Fever, ↑HR, vasodilatation hrs after first Rx
? sudden release of endotoxin
Rx: steroids
98
features of Jarisch-Herxheimer reaction?
Fever, ↑HR, vasodilatation hrs after first Rx
? sudden release of endotoxin
Rx: steroids
99
Mx of travellers diarrhoea?
E coli
Cipro
100
Commonest bacterial diarrhoea
Bloody diarrhoea, fever
assoc w Guillain-Barre + Reactive arthritis
Campylobacter jejuni
- unpasteurized milk, animal faeces
2-5d incubation
101
Mx of Campylobacter jejuni GI infection?
Dx by stool MCS
erythromycin
or
Ciprofloxacin
102
Commonest cause of diarrhoea/ vomiting in adults
50% of all gastroenteritis worldwide
Fever, diarrhoea, projectile vomiting
Norovirus
12-48h incubation time
103
Commonest cause of diarrhoea in children
Secretory diarrhoea and vomiting
Rotavirus
104
Profuse diarrhoea, abdo pain, vomiting
assoc w Raw/undercooked seafood
Japan
Vibrio parahaemolyticus
tx: Doxycycline
100-200mg/d PO
105
Rice-water stools
Shock, acidosis, renal failure
Vibrio cholera
Faecal-oral spread
Dirty water
hrs-5d incubation
diagnosis by stool MCS
106
Mx of vibrio cholera?
dx by stool MCS
**Rehydrate**
- Cooked rice powder solution
- Hartmann’s w K+ supplements
Cipro
Zn supplement
107
Watery diarrhoea + cramps
assoc w gas gangrene
Clostridium perfringens
- assoc w reheated meat
108
Mx of clostridium perfringens?
Diagnosis by stool MCS
Benpen + metro
109
Afebrile
Descending symmetric flaccid paralysis
No sensory signs
Autonomic: dry mouth, fixed dilated pupils
recently eaten canned/ vacuum packed food
Kids = honey
students = beans
Clostridium botulinum
dx: Toxin in blood samples
110
Mx of clostridium botulinum?
Antitoxin
Benpen + metro
111
Bloody diarrhoea, abdo pain, fever - foul smelling
Pseudomembranous colitis
Toxic megacolon
GI perforation
C difficile
assoc w antibiotic use
cephalopsporins, ciprofloxacin, clindamycin
Faecal oral spread
Environment: spores
112
Mx of C difficile?
Stop causative Abx
1st: Metronidazole 400mg TDS PO for 10d
2nd: Vanc 125mg QDS PO
Colectomy may be needed
113
Watery diarrhoea, cramps, flu-like
Pneumonia
Meningoencephalitis
Miscarriage
assoc w refrigerated food, soft cheeses, pates
Listeria monocytogenes
114
Mx of listeria monocytogenes?
diagnosis by blood culture
Ampicillin
115
Diarrhoea, vomiting, fever, abdo pain
Poultry, eggs, meat
Salmonella enteritidis
116
features of gonorrhoea?
**Men**: - Purulent urethral discharge, dysuria, prostatitis
**Women**: - Usually asympto, dysuria, discharge
117
diagnosis of Gonorrhoea?
Urine NAATs
**Culture is gold standard**
- Intracellular Gm- diplococci
- Transport in Stuart’s Medium
118
Mx of gonorrhoea?
Cefixime PO
Ceftriaxone IM
+
azithromycin
119
complications of gonorrhoea?
Prostatitis
Epididymitis
Salpingitis / PID
Reactive Arthritis
Ophthalmia neonatorum
120
Features of chlamydia?
v common iin \<25 yr group
Asympto in 50% men and 80% women
Men: - Urethritis
Women: - Cervicitis, urethritis, salpingitis
121
diagnosis of chlamydia?
**1st line NAATs** (Nucleic Acid Amplification Test)
- Urine
**Culture**
- Endocervical swab
- Discharge
122
mx of chlamydia?
Azithromycin 1g PO once
or
Doxycycline PO 100mg BD for 7 days
123
complications of chlamydia?
Prostatitis
Epididymitis
Salpingitis / PID
increased incidence of ectopic pregnancies
Reactive Arthritis
Opthalmia neonatorum
perihepatitis (Fitz-Hugh-Curtis syndrome)
124
features of Lymphogranuloma venereum
primary stage?
caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis
primarily an infection of lymphatics and lymph nodes.
common in MSM
tropical STI
- painless genital ulcer, heals fast
- balanitis, proctitis, cervicitis
125
features of lymphogranuloma venereum?
Inguinal syndrome
caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis
primarily an infection of lymphatics and lymph nodes.
common in MSM
tropical STI
- Painful inguinal buboes
- Fever, malaise → genital elephantiasis
126
features of lymphogranuloma venereum?
anorectal syndrome
caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis
primarily an infection of lymphatics and lymph nodes.
common in MSM
tropical STI
- Proctocolitis → Rectal strictures → Abscesses and fistulae
127
diagnosis of lymphogranuloma venereum?
Chlamydia serovars L1, L2, L3
NAATs
128
Mx of lymphogranuloma venereum?
Azithromycin / doxycycline
129
Complications of lymphogranuloma venereum?
Genital elephantiasis
Rectal strictures
130
features of HPV 6/11
often asymptomatic
genital warts
131
Mx of genital warts
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: Cryotherapy
132
Features of HSV?
Flu-like prodrome
Inguinal LNs
Painful grouped vesicles → ulcers
Dysuria may -\> urinary retention
133
diagnosis of HSV
PCR
Serology
134
mx of HSV
Analgesia
Aciclovir
cold sores: topical aciclovir
135
Complications of HSV?
Meningitis
Elsberg Syndrome: sacral radiculomyelitis → retention + saddle paraesthesia
136
sacral radiculomyelitis → retention + saddle paraesthesia
HSV?
Elsberg syndrome
137
features of Chancroid?
Papule → Painful soft genital ulcer
- base covered in yellow/grey
Progressing to inguinal buboes
Haemophilus ducreyi
mainly Africa
138
Diagnosis of Chancroid?
Haemophilus ducreyi
- Culture
- PCR
139
Mx of Chancroid?
Azithromycin
140
Features of Donovanosis?
aka Granuloma inguinale
- Klebsiella granulomatis
**Painless, beefy-red** ulcer
Subcutaneous inguinal granulomas = Pseudobuboes
Possible elephantiasis
141
Diagnosis of Donovanosis?
**Donovan bodies**
- Giemsa stain
142
Mx of Donavonosis?
Erythromycin
143
secretory vs inflammatory diarrhoea?
**_Secretory Diarrhoea_**
Bacteria only found in lumen: don’t activate innate immunity
No / low fever
No faecal leukocytes
Caused by bacterial toxins: Cholera, E. coli (except EIEC), S. aureus
Toxin → ↑cAMP→ open CFTR channel → Cl loss followed by HCO3, Na and H2O loss → secretory diarrhoea
**_Inflammatory Diarrhoea_**
Bacteria invade lamina propria: activate innate immunity
Fever
PMN in stool
Campylobacter, shigella, non-typhoidal salmonella, EIEC
144
malaise, headache, cough, constipation
high fever w relative bradycardia
Rose spots: patchy red macules
Epistaxis, splenomegaly
Diarrhoea after 1st wk
Salmonella typhi/paratyphi
(typhoid fever)
incubates 3-21d
145
main features of typhoid fever?
constipation
high fever w relative bradycardia
Rose spots: patchy red macules
splenomegaly
146
diagnosis of typhoid fever?
Leukopenia
Blood culture: salmonella typhi/ paratyphi
Urine or stool culture
147
mx of typhoid fever?
Cefotaxime or cipro
148
abdo pain, fever, diarrhoea
Mesenteric adenitis
Reactive arthritis, pharyngitis, pericarditis
Erythema Nodosum
Yersinia enterocolitica
dx: by serology
mx: cipro
149
Bloating, explosive diarrhoea, offensive gas
Malabsorption → steatorrhoea and wt. loss
symptoms for 1-4wk
assoc w MSM, Hikers, Travellers
Giardia lamblia
150
diagnosis of giardia?
Direct fluorescent Ab assay
Stool microscopy: Pear-shaped trophozoites w 2 nuclei
Duodenal fluid analysis on swallowed string
151
mx of giardia?
Tinidazole
152
Who should be screened for MRSA?
all patients awaiting elective admissions
(exceptions include day patients having terminations of pregnancy and ophthalmic surgery. Patients admitted to mental health trusts are also excluded)
all emergency admissions screened
153
How should a patient be screened for MRSA?
nasal swab and skin lesions or wounds
the swab should be wiped around the inside rim of a patient's nose for 5 seconds
the microbiology form must be labelled 'MRSA screen'
154
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
155
what antibiotics are commonly used in the treatment of MRSA infections?
**vancomycin**
teicoplanin
linezolid
156
recommended abx for Hospital-acquired pneumonia?
Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam
OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
157
recommended abx for Exacerbations of chronic bronchitis?
Amoxicillin or tetracycline or clarithromycin
158
recommend abx for UTI?
Trimethoprim or nitrofurantoin.
Alternative: amoxicillin or cephalosporin
159
Recommended abx for acute prostatis?
Quinolone (e.g. cipro) or trimethoprim
160
recommended abx for Acute pyelonephritis?
Broad-spectrum cephalosporin or quinolone (e.g. cipro)
161
recommended abx for Animal or human bite?
Co-amoxiclav
(doxycycline + metronidazole if penicillin-allergic)
162
recommended abx for Mastitis during breast-feeding?
Flucloxacillin
163
recommended abx for Erysipelas?
Flucloxacillin (erythromycin if penicillin-allergic)
164
recommended abx for Cellulitis?
Flucloxacillin
(clarithromycin or clindomycin if penicillin-allergic)
165
recommended abx for Impetigo?
Topical fusidic acid
oral flucloxacillin or erythromycin if widespread
166
recommended abx for Throat infections?
Phenoxymethylpenicillin
(erythromycin alone if penicillin-allergic)
167
recommended abx for Sinusitis?
Amoxicillin or doxycycline or erythromycin
168
recommended abx for Otitis media?
Amoxicillin (erythromycin if penicillin-allergic)
169
recommended abx for Otitis externa\*?
Flucloxacillin (erythromycin if penicillin-allergic)
170
recommended abx for Periapical or periodontal abscess?\>
Amoxicillin
171
recommended abx for Gingivitis: acute necrotising ulcerative?
Metronidazole
172
recommended abx for Pelvic inflammatory disease?
Oral ofloxacin + oral metronidazole
or IM ceftriaxone + oral doxycycline + oral metronidazole
173
recommended abx for Chlamydia?
Doxycycline or azithromycin
174
recommended abx for Gonorrhoea?
IM ceftriaxone + oral azithromycin
175
recommended abx for Syphilis?
Benzathine benzylpenicillin or doxycycline or erythromycin
176
recommended abx for Bacterial vaginosis?
Oral or topical metronidazole or topical clindamycin
177
recommended abx for Shigellosis/ Salmonella (non-typhoid)?
Ciprofloxacin
178
painful vs painless Genital ulcers?
painful: herpes, chancroid
painless: syphilis, lymphogranuloma venereum (may have painful inguinal lymphadenopathy)
179
dysentery, wind, tenesmus
weight loss if chronic
liver abscess
- RUQ pain, swinging fever, sweats
- mass in R lobe
flask shaped ulcer on histo
Entamoeba histolytica
assoc w MSM, travelling
1-4 wks incubation
180
features of Entamoeba histolytica?
dysentery, wind, tenesmus
weight loss if chronic
liver abscess
- RUQ pain, swinging fever, sweats
- mass in R lobe
flask shaped ulcer on histo
assoc w MSM, travellers
181
Diagnosis of entamoeba histolytica?
Stool micro:
- motile trophozoite w 4 nuclei
Stool Ag
182
Mx of Entamoeba histolytica?
Metronidazole
- Tindazole if severe or abscess
183
Migrating urticarial rash on trunk and legs
Pneumonitis, enteritis
Malabsorption → chronic diarrhoea
**Strongyloides stercoralis**
Endemic in sub-tropics
Hyperinfestation in AIDS
mx: Ivermectin
184
what is enteric fever?
Abdo pain, fever, mononuclear cells in stool
e.g Typhoidal salmonella, Yersinia enterocolitica, Brucella
185
features of Rabies?
animal bites
Prodrome: headache, malaise, itch, odd behaviour
Furious Rabies: Hydrophobia, Muscle spasms
hypersalivation
Dumb Rabies: flaccid limb paralysis
186
Diagnosis of Rabies?
"bullet shaped" RNA virus
Negri bodies
187
Mx of rabies?
immunised:
diploid vaccine
Unimmunised:
vaccine + rabies Ig
188
features of Toxoplasmosis?
cats are definitive hosts
mostly asympto
reactivated in immunodeficiency
- \> encephalitis: confusion, seizures, focal
- \> SOL/ raised ICP
- \> Posterior uveitis
189
Diagnosis of Toxoplasmosis?
CT/ MRI head: ring-shaped contrast enhancing CNS lesions
Serology
190
Mx of toxoplasmosis?
Pyrimethamine + sulfadiazine
Septrin (co-trimoxazole) Prophylaxis in HIV
191
features of cat scratch disease?
bartonella henselae
hx of cat scratch
tender regional LNs
192
Mx of cat scratch disease?
Azithromycin
Diagnosis: +ve cat scratch skin Ag test
193
Features of Anthrax?
Cutaneous
- ulcer w Black centre
- rim of oedema
Inhalational:
- massive Lymphadenopathy
- mediastinal haemorrhage
- resp failure
GI
- severe bloody diarrhoea
194
Mx of anthrax?
Cipro + clindamycin
195
features of Lyme Disease?
Borrelia burgdorferi
Ixodes tick bite
walkers, hikers
**Early localised: erythema migrans** (target lesions)
**Early disseminated:** mirgatory **arthritis**, malaise, LN, hepatitis
**Late persistent:**
Arthritis, focal Neuro (Bells Palsy), heart block, myocarditis
Lymphocytoma: blue/ red ear lobe
196
Mx of Lyme Disease?
Rash: Doxycycline
Complications: IV benpen
197
Undulant Fever (PUO): peak PM, normal AM
sweats, malaise, anorexia
arthritis, spinal tenderness
LN, HSM
Rash, jaundice
assoc w unpasteurised milk/ cheeses
Brucellosis
Diagnosed by pancytopenia,
Positive Rose Bengal Test: anti-O-polysaccharide Ag
198
Mx of Brucellosis?
Doxy + Rifampicin + Gent
199
High fever, headache, myalgia / myositis
Cough, chest pain ± haemoptysis
± hepatitis w jaundice
± meningitis
assoc w infected rat urine, swimming, canoeing
Leptospirosis
mx: doxycycline
200
presentation of Hepatitis A?
prodromal phase:
fever, malaise, arthralgia, nausea, anorexia
distaste for cigarettes
Icteric phase:
jaundice, HSM, lymphadenopathy, cholestasis
201
Ix of hepatitis A?
↑↑ALT, ↑AST (AST:ALT \<2)
IgM+ ~25d after exposure = recent infection
IgG+ for life
202
Mx of Hepatitis A?
Supportive
Avoid alcohol
IFN-a for fulminant hepatitis
prevention: passive Ig -\> \<3 mo protection
can give active vaccine
203
Ix of Hep B?
HBsAg +ve = current infection
+ve \>6mo = chronic disease
HBeAg +ve = high infectivity
Anti-HBc IgM = recent infection
Anti-HBc IgG = past infection
Anti-HBs Ab = cleared infection or vaccinated
HBV PCR: monitoring response to Rx
204
complications of Hep B?
Fulminant hepatic failure
Chronic hepatitis (5-10%) -\> cirrhosis in 5%
HCC
glomerulonephritis
polyarteritis nodosa
cryoglobulinaemia
205
Ix of Hep C?
Anti-HCV Abs
HCV-PCR
Liver biopsy if PCR +ve to assess liver damage and need for tx
HCV genotype
206
Mx of Hepatitis C?
_Indications_
* Chronic haepatitis
* ↑ ALT
* Fibrosis
treatment depends on viral genotype - test prior to tx
combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) +/- ribavarin
↓ efficacy if:
- Genotype 1, 4, 5 or 6
- ↑ VL
- Older
- Black
- Male
207
what diseases are assoc w EBV?
Infectious mononucleosis
Burkitt's lymphoma
Post Transplant Lymphoproliferative Disorder
Oral hairy leukoplakia
Primary brain lymphoma
Nasopharyngeal Ca
208
Jaw or abdo mass
Endemic: Africa, malaria
Sporadic: non-African, impaired immunity
Immunodeficiency: HIV or post-Tx
Burkitt's lymphoma
209
Diagnosis of Burkitt's lymphoma?
Starry-sky appearance
CD10, BCL6
t(8;14)
210
complications of infectious mono?
splenic rupture
CN lesion (e.g. 7)
ataxia GBS
pancytopenia with megaloblastic marrow
meningoencephalitis
chronic fatigue
211
Diagnosis of Infectious mono?
Lymphocytosis
Atypical Lymphocytes
+ve heterophile abs: Monospot, Paul Bunnell
NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.
Blood: serology, PCR
212
features of infectious mono?
Saliva or droplet spread
Fever, malaise, sore throat, cervical LNs +++
Splenomegaly, hepatitis (→ hepatomegaly and jaundice)
213
features of CMV reactivation?
immunocomprised
HIV: retinitis \> colitis \> CNS disease
Transplant: penumonitis \> colitis \> hepatitis \> retinitis
214
Diagnosis of CMV?
Blood; PCR, serology
Owl's Eye intranuclear inclusions
Atypical Lymphocytes
215
Mx of PCP?
co-trimoxazole
IV pentamidine in severe cases
steroids if hypoxic (if pO2\<9.3 kPa then steroids reduce risk of resp failure by 50% and death by 1/3)
216
choice of antibiotic for UTI in breastfeeding mother?
Trimethoprim
217
most common infective cause of diarrhoea in HIV patients?
Cryptosporidium
Presentation is very variable, ranging from mild to severe diarrhoea
A modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium.
Treatment is difficult, with the mainstay of management being supportive therapy\*
218
what organism may cause diarrhoea in HIV pts w CD4 count \<50?
Mycobacterium avium intracellulare
ypical features include fever, sweats, abdominal pain and diarrhoea.
may be hepatomegaly and deranged LFTs.
Diagnosis is made by blood cultures and bone marrow examination
Management is with rifabutin, ethambutol and clarithromycin
219
what organism is most common in bronchiolitis?
Respiratory syncytial virus
220
what organism is most responsible in croup?
parainfluenza virus
221
what organism is most responsible for pneumonia following influenza?
staph aureus
222
Atypical pneumonia
Classically spread by air-conditioning systems, causes dry cough.
Lymphopenia, deranged liver function tests and hyponNa may be seen
Legionella pneumophilia
223
post-exposure prophylaxis for Hep A?
Human Normal Immunoglobulin (HNIG) or hep A vaccine
224
Post-exposure prophylaxis for Hep B?
HBsAg positive source: hepatitis B immune globulin (HBIG) and accelerated course of the vaccine
unknown source: HBIG and accelerated course of the HBV vaccine
225
Post-exposure prophylaxis for Hep C?
monthly PCR - if seroconversion then interferon +/- ribavirin
226
Post-exposure prophylaxis of HIV?
combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) asap (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
## Footnote
serological testing at 12 weeks following completion of PEP
227
diagnosis of legionella pneumophilia?
urinary antigen
tx: w erythromycin
228
mx of infectious mono?
supportive
rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
avoid playing contact sports for 8 weeks after having glandular fever to reduce the risk of splenic rupture
229
main test to check for latent TB?
Mantoux test
IGRA:
when Mantoux test is positive or equivocal
people where a tuberculin test may be falsely negative:
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. \< 6 months)
230
HIV+ve
associated with the Epstein-Barr virus
CT: single or multiple homogenous enhancing lesions
Primary CNS lymphoma
treatment generally involves steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours
231
Toxoplasmosis vs primary CNS lymphoma?
**_Toxoplasmosis_**
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative
**_Lymphoma_**
Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive
232
most common fungal infection of CNS?
Cryptococcus
headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit
233
Ix of cryptococcus?
CSF: high opening pressure, India ink test positive
CT: meningeal enhancement, cerebral oedema
234
widespread demyelination
due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)
symptoms, subacute onset : behavioural changes, speech, motor, visual impairment
MRI is better - high-signal demyelinating white matter lesions are seen
Progressive multifocal leukoencephalopathy (PML)
235
Pneumonia in an alcoholic?
Klebsiella pneumoniae
236
mx of anti-HbS \<10 mIU/ml after undergoing primary immunisation against hep B?
Non-responder.
Test for current or past infection.
Give further vaccine course (i.e. 3 doses again) with testing following.
If still fails to respond then HBIG would be required for protection if exposed to the virus
237
mx of anti-HbS 10-100 mIU/ml after undergoing primary immunisation against hep B?
Suboptimal response
- one additional vaccine dose should be given.
If immunocompetent no further testing is required
238
mx of anti-HbS \>100 mIU/ml after undergoing primary immunisation against hep B?
Indicates adequate response, no further testing required.
Should still receive booster at 5 years
239
recommended abx prophylaxis for close contacts of pt w meningococcal meningitis?
oral **ciprofloxacin** (preferred) or rifampicin or may be used
240
abx for mengingitis caused by listeria?
IV amoxicillin + gentamicin
241
Mx of rabies immunised person who just got an animal bite?
the wound should be washed
if an individual is already immunised then 2 further doses of vaccine should be given
if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination. If possible, the dose should be administered locally around the wound
242
Kaposi's sarcoma
caused by HHV-8
presents as purple papules or plaques on the skin or mucosa
may later ulcerate
respiratory involvement may cause massive haemoptysis and pleural effusion
243
Mx of kaposis sarcoma?
radiotherapy + resection
244
what virus causes progressive multifocal leukoencephalopathy?
JC virus
245
what type of medications should be stopped during a c diff infection?
medications which are anti motility or anti-peristaltic (e.g. opioids)
246
For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?
at least 2 weeks before surgery
247
mx of bacterial vaginosis?
metronidazole
Treatment should be offered to all pregnant woman who are symptomatic. Symptomatic BV in pregnancy is associated with late miscarriage and preterm delivery.
248
what organism is mainly implicated in bacterial vaginosis?
Gardnerella vaginalis
This leads to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.
249
What are Ansels criteria for diagnosis of BV?
3 of the following 4 points should be present:
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH \> 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)
250
Malignancies associated with EBV infection
Burkitt's lymphoma\*
Hodgkin's lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
251
which pneumonia commonly causes reactivation of the herpes simplex virus resulting in 'cold sores'?
Streptococcus pneumoniae
252
diagnosis of mycoplasma pneumoniae?
diagnosis is generally by Mycoplasma serology
positive cold agglutination test
253
PEP for Hep C?
monthly PCR - if seroconversion then interferon +/- ribavirin
254
PEP for HIV?
a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
serological testing at 12 weeks following completion of post-exposure prophylaxis
255
most common causes of meningitis in 0-3 mo old?
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
256
Causes of meningitis is immunosuppressed?
Listeria monocytogenes
257
classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
Councilman bodies (inclusion bodies) may be seen in the hepatocytes
Yellow fever
Type of viral haemorrhagic fever (also dengue fever, Lassa fever, Ebola).
258
live attenuated vaccines?
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
259
Toxoid (inactivated toxin) vaccines?
tetanus
diphtheria
pertussis
260
Inactivated preparations
vaccines?
rabies
hepatitis A
influenza (intramuscular)
