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Phase 3B > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

Name six gram positive bacteria.

A 
Staphylococcus (including aureus, epidermis, viridans)
Strep pneumoniae
Strep pyogenes
Strep viridans
Diphtheria
C.difficile
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2
Q

Name eight gram negative bacteria.

A 
Bordetella pertussis
Escherichia coli, shigella, salmonella
Haemophilus influenzae
Vibrio cholerae
Legionella pneumoniae
Heliobacter pylori
Chlamydia
Neisseria
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3
Q

What are the six subtypes of E.coli infection?

A 
Enterotoxigenic (traveller's diarrhoea)
Enteropathogenic
Enterohaemorrhagic
Enterioinvasive
Enteroaggregative
Uropathogenic
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4
Q

What type of bacteria is Neisseria?

A

Gram negative non-flagellated diplococci

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5
Q

What is primary complex TB?

A

Granuloma + inflammation in the lymphatics and lymph nodes

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6
Q

What are three risk factors for tuberculosis?

A

HIV
Malnutrition
CKD

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7
Q

What type of bacteria causes tuberculosis?

A

Acid-fast aerobic mycobacteria

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8
Q

What are the pulmonary symptoms of tuberculosis?

A

Productive cough + haemoptysis
Weight loss, fever, sweats
Hoarse voice
Pleuritic pain

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9
Q

What does CXR show in a patient with tuberculosis?

A

Consolidation
Cavitation
Pleural effusion
Thickening/widening of mediastinum

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10
Q

Which nodes are infected in TB following pulmonary infection?

A

Extrathoracic
Cervical
Supraclavicular

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11
Q

Which patients with TB develop GI symptoms?

A

Immunocompromised

Ethnic minorities

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12
Q

What can develop after typical TB infection?

A 
Bone/spine involvement
Tuberculus meningism
Tuberculus peritonitis
Pericardial TB
Miliary TB
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13
Q

What stain is used to rapidly identify TB mycobacteria in a sample?

A

Auramine-phenol

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14
Q

How is TB diagnosed?

A

Sample culture

PCR: rapid and sensitive. Confirms species e.g. TB v non-tuberculus mycobacteria

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15
Q

What is the treatment of TB?

A

2 months isoniazid, ethambutol, rifampicin, pyrazinamide

4 months isoniazid and rifampicin

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16
Q

What is the treatment of latent TB?

A

6 months isoniazid or 3 months isoniazid and rifampicin

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17
Q

What are the side effects of rifampicin and isoniazid?

A

Rifampicin - oral contraceptive not effective. Stains body secretions pink
Isoniazid - polyneuropathy

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18
Q

What are the side effects of ethambutol and pyrazinamide?

A

Ethambutol - optic retrobulbar neuritis

Pyrazinamide - hepatic toxicity

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19
Q

How is latent TB diagnosed?

A

Tuberculin skin test shows a raised indurated lesion (delayed hypersensitivity reaction)

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20
Q

What is multidrug resistant TB?

A

TB that is at least resistant to isoniazid and rifampicin

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21
Q

How is contact screening performed for a TB patient?

A

Mantoux test

Quantiferon/Elispot - interferon gamma release assay (IGRA)

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22
Q

What colour is sputum in pneumococcal pneumonia?

A

Rusty

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23
Q

What are three signs of pneumonia on examination?

A

Lung consolidation on percussion and auscultation
Crackles +/- wheeze
Bronchial breathing

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24
Q

What score is used to grade severity of pneumonia?

A

CURB-65

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25
What is the treatment of mild, moderate, and severe pneumonia?
Mild - PO amoxicillin (macrolide/tetracycline if allergic) Mod - PO amoxicillin + macrolide Severe - IV co-amoxiclav/cefuroxime + macrolide
26
Give three examples of macrolide antibiotics.
Erythromycin Clarithromycin Azithromycin
27
What are the signs of empyema?
Pleuritic pain | Signs of pleural collection - dull to percussion and decreased air entry
28
Thoracocentesis of empyema shows what?
pH<7.2 Glucose <3.3mmol/L Pus LDH>1000iu
29
How is hepatitis B transmitted?
Vertical transmission - during parturition or soon after | Horizontal transmission - close contact, sharps, sexual
30
What is the presentation of acute hepatitis B infection?
Subclinical usually Fever, jaundice, rash, arthralgia Extra-hepatic manifestations - PAN or glomerulonephritis
31
What is the function of the following antigens and antibodies? 1) HBsAg and HBsAb 2) HBeAg and HBeAb
1) Surface antigen = infection Surface antibody = immunity 2) Envelope antigen = assess phase of infection Envelope antibody = evidence of immune response as appears in the later phase of acute or chronic disease.
32
What is the function of HBV DNA?
Quantified by PCR, helps determine viral activity
33
What is the function of HBcAb (core antibody)?
Identifies exposure - previous, current, chronic etc
34
How is Hepatitis B usually managed?
Usually none, or supportive
35
What percentage of Hepatitis B patients do not clear the virus?
1-10% - they develop chronic infection and fulminant hepatitis
36
What patient groups are more at risk of developing chronic hepatitis B infection?
Neonates | Child below 5 years
37
How is chronic hepatitis B diagnosed?
Moderate rise in aminotransferases and ALP Ground glass appearance of liver HBsAg and HBcAb found
38
What is required for Hepatitis D to replicate?
Hepatitis B
39
How is chronic Hepatitis B managed?
48 weeks PEGylated alpha-2alpha interferon | Entacavir or tenofovir disoproxil - more likely this as less side effects
40
In chronic hepatitis B infection, what is a marker of fulminant hepatitis?
Increasing INR
41
How is hepatitis C transmitted?
Blood/blood products - parenteral
42
What is the presentation of acute hepatitis C?
Flu-like illness | Jaundice and RUQ pain
43
What percentage of patients with acute hepatitis C develop chronic disease and end stage liver disease?
66% | 33% in first 25 years
44
What suggests a patient is less likely to clear the virus and will progress to end stage liver disease?
They are asymptomatic in the acute stage. Co-existing hepatic pathology HIV African American
45
What are the extra-hepatic manifestations of hepatitis C?
Essential mixed cryoglobulinaemia Membranoproliferative glomerulonephritis Porphyria cutanea tarda Autoimmune thyroid disease
46
How is hepatitis C diagnosed?
Enzyme immunoassay Immunoblot assay for HCV antibody PCR for HCV RNA
47
How is liver fibrosis assessed in chronic hepatitis C?
Assessment of transient liver elastography: Fibroscan
48
What are the details of hepatocellular carcinoma screening in patients with advanced fibrosis or cirrhosis?
6 monthly alpha-FP | Liver USS
49
The aim of Hepatitis C treatment is to cure. Define cure:
Undetectable HCV RNA in blood 12 weeks post treatment (suggests a sustained virological response)
50
What is the treatment of Hepatitis C?
2+ Direct-Acting Antivirals (DAAs) for 8-16 weeks | May have the addition of ribavarin
51
Give an example of DAAs for Hepatitis C?
Harvoni: ledipasvir (NS5A inhibitor) and sofosbuvir (NS5B inhibitor)
52
In pregnant patients with HIV, what value of viral load makes vaginal delivery a possibility?
Undetectable viral load
53
What are three risk factors for HIV?
Multiple sexual partners Sharing needles MSM
54
What may be the first presentation of HIV?
Generalised lymphadenopathy Acute generalised rash on palms and soles Oral candida/herpes simplex Recently developed seborrheic dermatitis/psoriasis Odd looking mouth lesions
55
How is HIV tested for?
Venous blood sample - HIV antibodies are detected in serum 4 weeks post exposure
56
What are the three phases of HIV?
1) Acute primary infection 2i) Asymptomatic phase 2ii) Early symptomatic HIV 3) AIDS
57
Define AIDS.
CD4+ count <200 or presence of an AIDs defining illness
58
What viral load suggests uncontrolled HIV?
>500,000 copies
59
What are the main risks once CD4+ count falls below 50?
Mycobacterium avium intracellulare (MAI) | CMV
60
Where does the HIV virus replicate?
Genital tract CNS Bone marrow GI tract
61
Name two bacterial AIDS-defining conditions in adults.
Mycobacterium tuberculosis | MAI
62
Name two viral AIDS-defining conditions in adults.
CMV other than liver, spleen, or nodes | HSV chronic ulcer >1m or bronchitis, pneumonitis, or oesophagitis
63
Name three other AIDS-defining conditions.
Candidiasis of bronchi, lungs, or oesophagus Histoplasmosis Toxoplasmosis of brain PCP - fungal
64
Name three AIDS-defining malignancies.
Cervical carcinoma Burkitt's lymphoma Kaposi's sarcoma
65
What are three side effects of HAART?
Lipodystrophy Lactic acidosis Insulin resistance
66
Define persistent generalised lymphadenopathy.
Enlarged lymph nodes involving at least 2 non-contingous sites other than inguinal nodes.
67
Name six conditions that may present during the early symptomatic HIV (Phase 2ii).
``` Oral hair leukoplakia Varicella zoster virus >2 episodes Cervical dysplasia Bacillary angiomatosis Pelvic inflammatory disease ITP ```
68
Which virus is oral hair leukoplakia associated with?
EBV
69
What type of retinitis can be seen in HIV?
CMV | Toxoplasma
70
What is the most common combination of HAART drugs for treatment of HIV, and give an example?
NRTI backbone (2NRTIs) plus one of: - Integrase inhibitor - NNRTI - Protease inhibitor E.g. tenofovir+emtricitabine PLUS raltegravir
71
What is a NRTI and give an example.
Nucleoside reverse transcriptase inhibitor Abacavir
72
What is post-exposure prophylaxis?
4 week HAART treatment given to patients who are HIV seronegative but have had a high risk exposure
73
Which antibiotic is given as prophylaxis against PCP pneumonia?
Co-trimoxazole
74
What is the name given to the malaria parasite when inside the mosquito, inside the liver, and inside RBC?
Mosquito: sporozoites Liver: merozoites RBC: gametocytes
75
How does a virus evade host defence mechanisms?
Antigenic variability Prevention of host cell apoptosis Down regulation of interferon production
76
What is the function of complement proteins in the humoral immune response?
Opsonisation and lysis
77
How does a bacterium evade host defence mechanisms?
Secrete proteases that lyse IgA Polysaccharide capsule prevents phagocytosis Antigenic variation Secretion of elastase inhibits C3a and C5a
78
What are the symptoms of Dengue fever?
Fever Headache Severe MSK pain Rash
79
What is the aetiology of Dengue fever?
RNA flavivirus using aedes mosquito as a vector
80
Name two transmissible haemorrhagic viruses.
Ebola | Lassa fever
81
What are the two types of trypanosomiasis?
South American - Chagas disease | African - Tsetze fly
82
How is malaria transmitted?
The bite of the female anopheles mosquito that is infected with plasmodia spp
83
Following a bite, what is the pathogenesis of malaria?
Merozoites are released into the bloodstream and infect red blood cells every 72 hours
84
What are the symptoms of malaria?
Fever, sweats, headache, fatigue, myalgia Nausea, vomiting, diarrhoea Anaemia, jaundice, hepatosplenomegaly Dark urine
85
How is malaria diagnosed?
Mildly raised ALT/AST Low platelets and anaemia, low glucose Hyperbilirubinaemia Thick and thin blood films identify species Blood cultures MSU, CXR, stool culture for ovum, parasites, cysts
86
What are the signs and symptoms of cerebral malaria?
Increased ICP and shock Hypoglycaemia and coma Convulsions ARDS
87
Why are malaria patients hypoglycaemic?
The parasite utilises glucose.
88
What is the treatment of non-falciparum malaria?
Chloroquine OR Artemisinin based combination therapy (ACT) - includes artesunate and amodiaquine
89
What is the treatment of uncomplicated falciparum malaria?
Artemisinin based combination therapy (ACT) - artesunate and amodiaquine
90
What is the treatment of complicated falciparum malaria?
IV artesunate
91
What is the treatment of toxoplasma?
Sulfadiazine and pyrimethamine
92
What is the treatment of amoebiasis?
Metronidazole
93
What is the treatment of trypanosomiasis?
Pentamidine
94
What is the treatment of giardiasis?
Metronidazole
95
What is the treatment of schistosomiasis?
Praziquantel
96
What is the treatment of pinworms/threadworms?
Mebendazole or pyrantel
97
Give five causes of drug induced fever?
``` Malignant hyperthermia from general anaesthetic Lamotrigine/progesterone Neuroleptic malignant syndrome Serotonin syndrome Cocaine ```
98
What is the cause of malignant hyperthermia?
AD inherited myopathy due to ryanodine receptor gene on chromosome 19
99
What are five symptoms and signs of malignant hyperthermia?
``` Tachycardia Hypoxia and hypercapnia Fever Muscular rigidity Hypotension ```
100
How is malignant hyperthermia managed?
``` Give 100% oxygen Deepen anaesthesia with opioids IV dantrolene Correct blood gases and arrhythmias Cool patient ```
101
Which antibiotic is recommended to treat invasive (bloody) diarrhoea?
Ciprofloxacin
102
How do you monitor the response to treatment of a malaria patient?
Parasite count
103
What must you check for before initiating anti-malarials?
Glucose 6-phosphate dehydrogenase deficiency
104
Name the most common anti-malarial drug.
Malarone - atovaquone and proguanil
105
What is seen in legionella pneumonia?
Hyponatraemia | Increased transaminases
106
What does mucous in the stool suggest?
Malabsorption/giardia
107
How is PCP pneumonia diagnosed?
Sputum sample for detection of the fungus using silver staining of the cyst wall. If no sputum can be aspirated then broncholavage for deep lung tissue High resolution CT
108
What is the most common cause of infective endocarditis?
S.aureus/strep.viridans
109
How do you differentiate between staph and strep with the catalase test?
Staph: catalase positive Strep: catalase negative
110
How do you differentiate staph aureus from other types of staph?
Staph aureus: coagulase positive | Staph epidermis: coagulase negative
111
What is the treatment of c.difficile?
Metronidazole or vancomycin
112
What are three risk factors for development of c.difficile?
Clindamycin/penicillin PPIs Increasing age
113
How does Parvovirus B19 infection present in children and adults?
Children - slapped cheek rash | Adults - lacy macular widespread rash, rheumatoid-like arthritis

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